Table 2. NLEs and Component Parts^a .

Country and Examination	Components	Candidacy
Australia AMC	Part 1: AMC CAT. Tests knowledge of the principles and practice of medicine in general practice, internal medicine, pediatrics, surgery, obstetrics and gynecology. Candidates must pass this examination to go to take the AMC Clinical Examination. Part 2: AMC Clinical Examination: assesses clinical skills in medicine, surgery, obstetrics, gynecology, pediatrics, and psychiatry. Also assesses ability to communicate with patients, their families and other health workers.	Type 3 These are examinations on the Standard Pathway ie, the pathway for those IMGs who do not qualify for the other pathways into the Australian workforce.
Bahrain BMLE	Part 1: Written MCQ with a stem followed by 4 or five responses (1 correct answer). Followed by written MCQ test based on Patient Management Problems. Assesses clinical reasoning skill and ability. Part 2: OSCE followed by questions.	Type 1 Taken by all doctors who wish to practice in Bahrain.
Canada MCCQE	Part 1: Computer test consisting of MCQs followed by short menu, short answer questions on Clinical Decision-Making. Part 2: OSCE style simulation stations assessing competence, specifically knowledge skills and attitudes.	Type 2 IMGs and IMSs (along with home students) must pass the MCCEE.
Chile EUNACOM	Part 1: Written MCQs in different areas. Part 2: Practical examination of general practice. Clinical evaluation in a real or simulated environment in the areas of medicine, surgery, obstetrics- gynecology and pediatrics.	Type 2 Taken by all doctors who wish to practice in Chile. http://www.eunacom.cl/.
Croatia Croatian Medical Licensing Examination	No detail available.	Type 1 Taken by Croatian Graduates and non-EU/EEA nationals. EU/EEA nationals are exempt.
Finland: Professional Competence Examination	Part 1: Written exam on key areas of medicine. Part 2: Written exam on healthcare management. Part 3: Oral examination in a clinical setting (with patient present).	Type 3
France: Epreuves Classantes Nationales NCE (ranking examination)	Written theory test for national ranking.	Type 1/2 EU/EEA nationals can apply to take the ENC but non-EU/EEA IMGs must take a separate exam with limited places available.
Germany: Staatsexamen	Part 1: M1 Physikum or preclinical medicine after 2 years. Part 2: M2 written and oral practical includes the content of the entire clinical phase. MCQs.	Type 1 Only German doctors take these examinations. Non-EU/EEA nationals may be required to take a ‘knowledge test’ to prove their qualifications are equivalent to German standards.
Hong Kong: The Licensing Examination	Part 1: Examination in Professional Knowledge MCQs to test knowledge in basic science, medical ethics, community medicine, medicine, surgery, orthopedic surgery, psychiatry, pediatrics, obstetrics, and gynecology. Part 2: Proficiency Test in Medical English (scheduled for March 2015). Part 3: The Clinical Examination: to test how candidates apply professional knowledge to clinical problems. (scheduled for May/June 2015).	Type 2 All IMGs must pass Parts 1 and 2 to take Part 3.
Ireland: PRES	Part 1: All applicants undergo level 1 assessment and verification of their documentation. Those not exempt after this process go on to take the next parts. Part 2: Level 2: Computer-based examination using MCQs. Pass is required to move to level 3. Part 3: Assessment of Clinical Skills. OSCE style examination. Interpretation Skills test is one paper based examination.	Type 3 Non-EU/EEA graduates may be required to take a medical council examination unless exempt.
Israel	Written examination in Hebrew uses MCQs.	Type 1/2 For physicians who have graduated in Israel and from abroad. Requirement waived for physicians who have passed the USMLE. http://www.ima.org.il/ENG/Default.aspx.
Japan: NMLE	No detail available.	Type 2 Taken by all those who wish to work in Japan. Test is in Japanese. http://www.med.or.jp/english/.
Korea: KMLE	Part 1: Written examination. Part 2: OSCE-style clinical skills test.	Type 2 Overseas qualifications must be recognized by the Minister of Health & Welfare prior to IMGs taking the test.
New Zealand: NZREX (Clinical)	OSCs covering: history taking, clinical examination, investigating, management, clinical reasoning. Also, communication and professionalism is assessed.	Type 3 Eligibility requirements must be satisfied on each occasion. IMGs only.
Poland: State Physician and Dental Final Exam	The SP/DE is a written test, in Polish and consists of 200 MCQs only one correct answer out of the choices. Mix of medical knowledge, questions about specific medical processes, analysis of medical records, and establishing medical diagnosis.	Type 1 Content of the examination does not exceed the scope of the internship program. Oral skills are not tested. Medical schools test communication and procedural competencies.49 Taken by IMG and not EEA candidates.
Portugal: ‘Exame Nacional de Seriacao’ (Ranking examination for residency posts)	Written test MCQs on internal medicine.	Type 1/3 Medcial graduates sit a Portuguese licensing exam. IMGs must take a communication skills test.
Spain: MIR (National Residency Examination) ‘examen MIR’	Written test - MCQs	Type 1 Used for ranking medical students for specialty training.
Sweden: TULE-test	Part 1: Written test of medical knowledge. Part 2: Practical tests over 2 days.	Type 3
United Kingdom PLAB	Part 1: 200 single best answer questions Part 2: 18 scenarios OSCE	Type 3 For non-UK, EEA or Switzerland doctors medical school graduates who have no EC rights or an approved sponsor, or an approved postgraduate qualification eligibility to enter the GP or specialist register.
United States USMLE	Step 1: 322 MCQs to test and measure basic science knowledge. Consists of 7 blocks of 46 items. 1 hour for each block of test items. Maximum of 7 hours testing. Step 2: Clinical Knowledge test using MCQs and OSCE Clinical Skills test using standardized patients. Step 3: MCQs CCS followed by case simulations.	Type 2 IMGs must be certified by the ECFMGO to take USMLE Step 3 although individual jurisdictions may require extra training for IMGs of at least 1 year.
Qatar: Qualifying Examination	No detail available	Type 1/2 Graduates must pass the exam as must IMGs, but there is a waiver for certain recognised NLEs.
Switzerland: FLE	Part 1: Locally administered written exam using MCQs Part 2: OSCE style Clinical Skills examination.	Type 1 Swiss graduates must take the FLE. Non EU/EEA graduate qualifications are assessed at Cantonal level. IMGs take the test if they wish to practice independently.
UAE	No detail available	Type 2 Separate registration required to work in Dubai.

Abbreviations: AMC, Australian Medical Council; UAE, United Arab Emirates; IMSs, International medical students; MCCEE, Medical Council of Canada Evaluating Examination; EEA, European Economic Area; PRES, pre-registration examination system; USMLE, United States Medical Licensing Examination; NMLE, National Medical Licensing Examination; OSCE, objective structured clinical examination; CAT, computer adaptive test; ENC, Epreuves Classantes Nationales; MCQs, multiple choice questions; KMLE, Korean Medical Licensing Examination; PLAB, Professional and Linguistic Assessments Board; OSCs, Objective Structured Clinicals; FLE, Federal Licensing Examination; CCS, computer-based case simulation; ECFMGO, Educational Commission for Foreign Graduates; BMLE, Bahrain Medical Licensure Exam; MCCQE, Medical Council of Canada Qualifying Examination; IMG, international medical graduate.

^a Adapted from Archer et al.⁴³