Performance of China's new medical licensing examination for rural general practice

To evaluate the performance of China's new medical licensing examination (MLE) for rural general practice, which determines the number of qualified doctors who can provide primary care for China's rural residents, and to identify associated factors.

Data came from all 547 examinees of the 2017 MLE for rural general practice in Hainan province, China. Overall pass rates of the MLE and pass rates of the MLE Step 1 practical skills examination and Step 2 written exam were examined. Chi-square tests and multivariable logistic regression were used to identify examinee characteristics associated with passing Step 1 and Step 2, respectively.

Of the 547 examinees, 68% passed Step 1, while only 23% of Step 1 passers passed Step 2, yielding an 15% (82 of 547) overall pass rate of the whole examination. Junior college medical graduates were 2.236 (95% CI, 1.127-4.435) times more likely to pass Step 1 than secondary school medical graduates. Other characteristics, including age, gender, forms of study and years of graduation, were also significantly associated with passing Step 1. In contrast, examinees' vocational school major and Step 1 score were the only two significant predictors of passing Step 2.

Our study reveals a low pass rate of China's new MLE for rural general practice in Hainan province, indicating a relatively weak competency of graduates from China's alternative medical education. An effective long-term solution might be to improve examinees' clinical competency through mandating residency training for graduates of China's alternative medical education.