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Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor emeritus Adrian Freeman, University of Exeter,
- Second opponent: Associate Professor Kulamakan Kulasegaram, University of Toronto,
- Third member and chair of the evaluation committee: Professor Hilde Wøien, University of Oslo
Chair of the Defence
Professor emeritus Kristin Heggen, University of Oslo
Principal Supervisor
Associate professor Stefan Schauber, University of Oslo
Summary
Ethiopia’s national licensure examination for new graduate medical doctors is an important safeguard for patient safety and public trust. This thesis shows that the exam needs clearer, better-designed questions, more focus on supporting expert judgement when setting the pass mark, and more consistent routines to truly ensure that only ready-to-practice graduates receive a licence.
The study found that, although the exam is fairly reliable, many individual multiple-choice questions are weak. Over the years, with more than 2,000 candidates, many questions failed to clearly separate well-prepared candidates from those who were not ready for independent practice, and often included wrong answer options that almost no one chose. This reduces the exam’s power to identify graduates who may not yet be safe to work as doctors.
The thesis also examined how experts who help set the pass mark evaluate the difficulty of each question. Their average predictions were close to how students performed, but in detail, there were large differences across and within individual experts. Overall, their ratings explained only about one-third of the actual variation in how difficult questions were for candidates.
Finally, interviews with those involved in the exam process showed that official guidelines are generally followed, but not consistently from year to year. Concerns included outdated descriptions of what new doctors should be able to do, uneven experience among experts, limited representation of some medical schools, and ongoing worries about possible cheating rumours.
The thesis concludes that improving question quality, training and supporting experts more systematically, and tightening exam procedures would make Ethiopia’s licensure exam a more trustworthy tool. These lessons may also be useful for other countries that rely on similar national exams to license new doctors.
Additional information
Contact the research support staff.