National Exam, Yay or Nay ?

Becoming a doctor is a struggle. We have to face many years to get this title. Even though, the educational period is different depends on each university. But the differences are not that far. Let’s make a count : 

To get a bachelor, we have to study for about 3,5 until 4 years. After that, we have to take clerkship for about 1,5 until 2 years. Note, it’s the fastest time, if you can pass all part without remedial. If you have to study over again, it will take more time. Next, we have to take the final exam, the one, and only exit exam. After that, we can get Hippocratic oath. Finally, we are legal to become a doctor. But, we haven’t practice yet. It’s illegal. We have to take an internship for 1 year, the place depends on the national. They will give us some places, then we have to select one of many places by using a computer.

In this writing, I want to give my opinion about national exam.

National exam as an exit exam began in 2014. There are two national exams. First is a theory, it’s a multiple choice, we have to choose one from five possibly answer. We call this a CBT (Computer Based Test) because you have to do this exam by computer. Second, it’s a skill, we call it OSCE (Objective Stricture Clinical Examination). We have twelve stations with different diagnoses, then we did doctor-patient (with simulation patient) activity and the senior doctor will observe and rate us. Many students say that the most horrible test is CBT because we’re rated by a computer while OSCE by senior doctor, mostly from their own university. 

There are pro and contra about national exam. There are four batches of national exam in one year. If a student doesn’t pass the exam yet, then he has to take the exam again 4 months later. Many sources have different sight about how much national exam can be taken. Some say twelve, but others say different. If until twelve times he still doesn’t pass the exam, he has to get private study from national then takes another exam. If he still doesn’t pass it, he can’t be a doctor and can’t get Hippocratic oath. His journey stops in bachelor. 

There was a medical student passed away a few moments ago because of depression. He didn’t want to eat anything. This news becomes viral because the reason for his depression was he didn’t pass the national exam for tenth times. 

It’s ironic. The struggle for, say six years, and still can’t be a doctor yet. How can be six years of study determined by 200 minutes for CBT and about four hours for OSCE ? Many people asking that question. Let’s we make some analyze.

There are so many faculties of medicine and not all of them have the same accreditation. Some have A accreditation, but there are many C accreditation (my university’s accreditation is B). National exam was made to be standardized for medical education in Indonesia. If students pass national exam, then they considered having same competence whatever their university accreditation.    

National exam becomes hard when it’s the one and only exit exam for becoming a doctor. If they can’t pass the exam, then they can’t be a doctor. They become bachelor of medicine, it’s not a doctor yet. Imagine their dream (and maybe their parent’s dream) to be a doctor, they have studied for many years, and the dream just falls off because of national exam. That’s why there was a student passed away because of depression. I believe there are a lot of students out there, without publicity, feel depression because of this national exam.

I had an informal talk with one of the senior doctor in my university. He said that national exam is ironic. Why should it be the one and only exam ? If a student doesn’t pass the exam, their journey stop in bachelor. Why not their journey stop in doctor ? at least, they have that title, but maybe they can’t practice in clinic.

I totally agree with that. There are many ways for a doctor. They not only just sitting in the chair, examining patient, making diagnose, then giving the medicine, but also they can be a lecture (by continuing study as a master), became a researcher, or maybe become a politician, businessman, and so on. 

I don’t agree with national exam as one and only an exit exam. There are many situations that can’t be predicted that make someone failed. Maybe they were sick while doing an exam, maybe they nervous so bad then they can’t do their best. We can’t judge their not competent just because they do not pass the national exam. Maybe we can make a deal with this by make a percentage. Example, 100% of all graduate mark can be divided 50% percentage by national exam and 50% by institution. And for the final result is make an average of this mark.

My conclusion is, 

National exam as a standardized quality in medical education ? yay. 

National exam as one and only exit exam ? nay.