PMC Woes: National Licensing Exam (NLE) Worrying Medical Students

PMC Woes: National Licensing Exam (NLE) Worrying Medical Students
If you are a medical student in the country, right now especially a final year MBBS one, you would be very well aware of the NLE exam which is most likely to be conducted this year. It has received an unwelcome response from both medical students and doctors resulting in protests in person as well as on social media.

The PMC act

The national licensing exam is a part of the new rules and regulations under the PMC Act 2020.The background of which is October 2019, when the PMDC was dissolved and replaced by the Pakistan Medical Commission (PMC) following President Arif Alvi’s signing of the Pakistan Medical Commission Ordinance 2019. The move was done in order to improve and standardize medical education, training, and bring recognition of qualifications in medicine.

According to the PMC Act and under section 21 of the PMC Ordinance 2019, The NLE will be conducted twice a year as per schedule approved by the Council conducting the NLE. Passing the NLE shall be mandatory for obtaining a full licence for both students holding an undergraduate medical/dental qualification from the country or any foreign institution duly recognized by the council. However any student holding a foreign undergraduate degree and a postgraduate qualification from Pakistan will be exempted from NLE.

Ex post facto law

Although the primary reason for the introduction of NLE is the standardization of medical education in Pakistan, it has received a lot of objections from the medical community. The first one being the fact that the exam is being introduced from March 2020. And thus cannot be held legally as pointed out by a number of people because the PMC act is an ex post facto law simply meaning that it cannot apply to batches admitted to medical colleges before the PMC act was introduced. And therefore students till batch 2024 should be exempted from the exam.

The introduction of medical assessments is not a new thing. Infact an excellent example of this is the United Kingdom Medical licensing exam or UKMLA- a two step licensing exam which is going to be applicable on all international medical graduates and United Kingdom's own graduates (who were previously exempted from PLAB) from early 2024. However, the first suggestion for the exam was made in 2005 and the official announcement was made by the General Medical council in 2017, almost 6 years before the actual exam is going to be conducted. On the other hand, PMC is holding the exam within less than one year of introduction of PMC act.


The Special Assistant to the Prime Minister on National Health Services (NHS) Dr Zafar Mirza has called the NLE the best filter to ensure only competent doctors are allowed to practice in the country and making a point that such exams are taking place in other countries like the USMLE in the United States and PLAB in the United Kingdom. The argument in response to this made by the students is that there is no reason to hold a National exam when all medical students appear in standardized annual professional every year (5 in total). As well as other professional qualifications including IMM, FCPS- M-S/MD part one and two; hence, there is no need to burden the students. On the other hand, in United States there are no annual Professional exams. According to the examination’s official website, “the USMLE is not administered immediately after graduation but students actually take the USMLE Step I when they are halfway through medical school, then the Step II closer to the end of medical school and Step III before the end of their internship [house job] year.

Similarly, it is also worth mentioning that similar to the USMLE, the UK’s licensing examination will be introduced and undertaken as part of the medical school degree programme and will not be an isolated examination with an unknown format and undeclared outcomes imposed suddenly after graduation, like the NLE. Hence, there remains no reason for comparing NLE with the other licensing examinations.

Lack of standardization

Perhaps the most important question raised is the centralization and standardization of the exam. Pakistan has been unable to successfully hold even the National medical and dental college admission test (NMDCAT) which was also a part of the PMC act. This single uniform test for all public and private colleges became notorious last year because of a number of ambiguities including difference of syllabus among provinces, problems with mcqs as well as the pandemic situation resulting in court cases some of which are still going on. If we cannot hold a single entrance test how would we ensure a competitive and credible test for young medical professionals?

Leeway for Private Sector

Many senior doctors and faculty members have labelled the NLE as an eye wash by PMC since it is unable to hold up standards in medical colleges resulting in many shady and substandard medical colleges operating in the country. Another worrying thing is that through the introduction of new ordinance, influential private college owners are under no obligation to keep a minimum mandatory strength of qualified faculty as most of the burden for regulation and quality of education would fall on the Medical Commission which will eventually fail because the NLE has been imposed abruptly and without any visible professional preparation, with unknown outcomes, format and mechanisms of examination.

The given arguments all point towards the fact that NLE is going to be not only a problem for the students but a bigger one for the regulatory body, because Pakistan like all other countries is required to keep up with the standards of regulatory bodies like World Health Organisation and World Health Association. And if it fails to do so, then it faces a threat of having its name removed from the World Directory of Medical Schools by the year 2023. As a consequence, all of Pakistan’s medical graduates will have no recognition of their degrees in the rest of the world which is quite alarming.