title: The ASEAN economic community and medical qualification.
abstract: BACKGROUND
  In the regional movement toward ASEAN Economic Community (AEC), medical professions including physicians can be qualified to practice medicine in another country. Ensuring comparable, excellent medical qualification systems is crucial but the availability and analysis of relevant information has been lacking.
  
  
  OBJECTIVE
  This study had the following aims: 1) to comparatively analyze information on Medical Licensing Examinations (MLE) across ASEAN countries and 2) to assess stakeholders' view on potential consequences of AEC on the medical profession from a Thai perspective.
  
  
  METHODS
  To search for relevant information on MLE, we started with each country's national body as the primary data source. In case of lack of available data, secondary data sources including official websites of medical universities, colleagues in international and national medical student organizations, and some other appropriate Internet sources were used. Feasibility and concerns about validity and reliability of these sources were discussed among investigators. Experts in the region invited through HealthSpace.Asia conducted the final data validation. For the second objective, in-depth interviews were conducted with 13 Thai stakeholders, purposely selected based on a maximum variation sampling technique to represent the points of view of the medical licensing authority, the medical profession, ethicists and economists.
  
  
  RESULTS
  MLE systems exist in all ASEAN countries except Brunei, but vary greatly. Although the majority has a national MLE system, Singapore, Indonesia, and Vietnam accept results of MLE conducted at universities. Thailand adopted the USA's 3-step approach that aims to check pre-clinical knowledge, clinical knowledge, and clinical skills. Most countries, however, require only one step. A multiple choice question (MCQ) is the most commonly used method of assessment; a modified essay question (MEQ) is the next most common. Although both tests assess candidate's knowledge, the Objective Structured Clinical Examination (OSCE) is used to verify clinical skills of the examinee. The validity of the medical license and that it reflects a consistent and high standard of medical knowledge is a sensitive issue because of potentially unfair movement of physicians and an embedded sense of domination, at least from a Thai perspective.
  
  
  CONCLUSIONS
  MLE systems differ across ASEAN countries in some important aspects that might be of concern from a fairness viewpoint and therefore should be addressed in the movement toward AEC.
authors.affiliation: Medical Students for Health Systems and Services (MS-HSS), Thailand Research Center for Health Services System (TRC-HS), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Jathurong
authors.initials: J
authors.lastname: Kittrakulrat
authors.affiliation: Medical Students for Health Systems and Services (MS-HSS), Thailand Research Center for Health Services System (TRC-HS), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Witthawin
authors.initials: W
authors.lastname: Jongjatuporn
authors.affiliation: Medical Students for Health Systems and Services (MS-HSS), Thailand Research Center for Health Services System (TRC-HS), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Ravipol
authors.initials: R
authors.lastname: Jurjai
authors.affiliation: Medical Students for Health Systems and Services (MS-HSS), Thailand Research Center for Health Services System (TRC-HS), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Nicha
authors.initials: N
authors.lastname: Jarupanich
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Bumrungrad International Hospital, Bangkok, Thailand; doctorkrit@gmail.com.
authors.forename: Krit
authors.initials: K
authors.lastname: Pongpirul
mesh_terms: D001210:Asia, Southeastern; D002983:Clinical Competence / Q000592:standards; D004501:Education, Medical / Q000458:organization & administration* / Q000592:standards; D004641:Emigration and Immigration; D006075:Governing Board / Q000458:organization & administration*; D006801:Humans; D007802:Language; D008007:Licensure, Medical / Q000592:standards*; D010820:Physicians / Q000592:standards*; D013785:Thailand
keywords: AEC; medical education; medical licensing examination; medical practice; medical qualification