Five myths and the case against a European or national licensing examination.

The introduction of a European licensing examination or national examinations, where these do not already exist, offers significant advantages. These are more than offset, however, by the disadvantages and the collateral damage incurred. Five myths about centralizing examinations are explored. Myth 1: The claim that a central examination will ensure that candidates are assessed in important areas of medical practice is unfounded. What tends to be assessed are learning outcomes that can be easily assessed. These are often not the important outcomes related to the overall competence of a doctor. Myth 2: It is claimed that a central examination will lead to improvements in assessment practice. The evidence is that this is not the case and that, in fact, a central examination stifles change and inhibits innovation. Myth 3: A central examination, it is suggested, will meet a need for greater uniformity. There is also an important need to recognize diversity. Myth 4: Central examinations are seen as an indicator that will track the performance of the system. The limitations of the data, however, are usually not recognized and there maybe unfortunate and unintended consequences if the results are used in this way. Myth 5: Finally, a major argument proposed for a European or national examination is that it will lead to safer medical practice and that this will protect the patient from substandard practitioners. There is, in fact, no evidence to support this argument. There is a need for further work and new initiatives on standards and quality improvement in assessment approaches. This can be achieved in a number of ways including monitoring the assessment process and sharing tools and assessment approaches between schools.