Kittrakulrat Jathurong, Jongjatuporn Witthawin, Jurjai Ravipol, Jarupanich Nicha, Pongpirul Krit
Medical Students for Health Systems and Services (MS-HSS), Thailand Research Center for Health Services System (TRC-HS), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Bumrungrad International Hospital, Bangkok, Thailand;
Glob Health Action. 2014 Sep 10;7:24535. doi: 10.3402/gha.v7.24535. eCollection 2014.
In the regional movement toward ASEAN Economic Community (AEC), medical professions including physicians can be qualified to practice medicine in another country. Ensuring comparable, excellent medical qualification systems is crucial but the availability and analysis of relevant information has been lacking.
This study had the following aims: 1) to comparatively analyze information on Medical Licensing Examinations (MLE) across ASEAN countries and 2) to assess stakeholders' view on potential consequences of AEC on the medical profession from a Thai perspective.
To search for relevant information on MLE, we started with each country's national body as the primary data source. In case of lack of available data, secondary data sources including official websites of medical universities, colleagues in international and national medical student organizations, and some other appropriate Internet sources were used. Feasibility and concerns about validity and reliability of these sources were discussed among investigators. Experts in the region invited through HealthSpace.Asia conducted the final data validation. For the second objective, in-depth interviews were conducted with 13 Thai stakeholders, purposely selected based on a maximum variation sampling technique to represent the points of view of the medical licensing authority, the medical profession, ethicists and economists.
MLE systems exist in all ASEAN countries except Brunei, but vary greatly. Although the majority has a national MLE system, Singapore, Indonesia, and Vietnam accept results of MLE conducted at universities. Thailand adopted the USA's 3-step approach that aims to check pre-clinical knowledge, clinical knowledge, and clinical skills. Most countries, however, require only one step. A multiple choice question (MCQ) is the most commonly used method of assessment; a modified essay question (MEQ) is the next most common. Although both tests assess candidate's knowledge, the Objective Structured Clinical Examination (OSCE) is used to verify clinical skills of the examinee. The validity of the medical license and that it reflects a consistent and high standard of medical knowledge is a sensitive issue because of potentially unfair movement of physicians and an embedded sense of domination, at least from a Thai perspective.
MLE systems differ across ASEAN countries in some important aspects that might be of concern from a fairness viewpoint and therefore should be addressed in the movement toward AEC.
在朝着东盟经济共同体（AEC）迈进的区域进程中，包括医生在内的医疗行业人员可以获得在其他国家行医的资格。确保可比且优秀的医学资格体系至关重要，但相关信息的可得性和分析一直欠缺。
本研究有以下目标：1）对东盟各国的医学执照考试（MLE）信息进行比较分析；2）从泰国视角评估利益相关者对AEC对医疗行业潜在影响的看法。
为搜索关于MLE的相关信息，我们以每个国家的国家机构作为主要数据源开始。若缺乏可用数据，则使用包括医科大学官方网站、国际和国内医科学生组织的同事以及其他一些合适的互联网来源等二级数据源。研究人员讨论了这些来源的可行性以及对有效性和可靠性的担忧。通过HealthSpace.Asia邀请的该地区专家进行了最终数据验证。对于第二个目标，对13名泰国利益相关者进行了深入访谈，这些人是基于最大差异抽样技术特意挑选出来的，以代表医学执照颁发机构、医疗行业、伦理学家和经济学家的观点。
除文莱外，所有东盟国家都存在MLE体系，但差异很大。虽然大多数国家有国家MLE体系，但新加坡、印度尼西亚和越南接受大学进行的MLE结果。泰国采用了美国的三步法，旨在考查临床前知识、临床知识和临床技能。然而，大多数国家只要求一步。多项选择题（MCQ）是最常用的评估方法；改良短文问题（MEQ）是其次最常用的。虽然这两种测试都评估考生的知识，但客观结构化临床考试（OSCE）用于验证考生的临床技能。医学执照的有效性以及它反映一致且高标准的医学知识这一点是一个敏感问题，因为至少从泰国视角来看，医生可能存在不公平流动以及潜在的主导感。
东盟各国的MLE体系在一些重要方面存在差异，从公平角度来看可能令人担忧，因此在迈向AEC的进程中应予以解决。
