Association between physician licensing and certification examination performance and quality of patient care: a...

Licensure and certification examinations have traditionally served to ensure physicians possess the knowledge and skills required for independent practice. However, with the growing emphasis on workplace-based assessment, the role and relevance of these point-in-time examinations are increasingly debated. This systematic review aimed to explore the association between physician performance on national licensing and certification examinations and subsequent measures of quality of care in practice.

The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Six databases were searched through November 2025. Original research studies were included if they examined the relationship between performance on medical licensing or certification examinations and physician performance in independent practice, including patient outcomes and fitness to practice. Data were extracted and analyzed using content analysis to identify patterns and trends across studies.

A total of 44 studies involving 1,021,187 physicians were included. The findings demonstrated that examination performance was consistently associated with quality of patient care and fitness-to-practice concerns. Better examination performance was linked to improved adherence to mammography screening recommendations, appropriate prescribing practices, improved care of patients with diabetes, lower patient morbidity and mortality, fewer complaints to regulatory bodies, and lower malpractice payments. The association was observed across examination formats and medical specialties.

The results suggest that national licensing and certification examinations are valuable predictors of future clinical performance. They provide a uniform benchmark to ensure physicians meet rigorously defined criteria. The findings support continued use of these examinations as part of a comprehensive assessment program to promote high-quality patient care and physician competence. This is critical in an era of increased physician mobility, where many physicians have trained in jurisdictions with widely varying curricula and assessment practices. National examinations help ensure that all licensed physicians meet a consistent standard for clinical competence.