Application of the "Plan-Do-Check-Action" plan in improving the pass rate of the "National Medical Licensing Examination"

Abstract

Background: The National Medical Licensing Examination (NMLE) is the only objective, standardized metric to evaluate whether a medical student possessing the professional knowledge and skills necessary to work as a physician. However, the overall pass rate of NMLE in our hospital in 2021 was much lower than that of Peking Union Medical College Hospital, which was required to be further improved.

Methods: To find the reasons for the unsatisfactory performance in 2021, the quality improvement team (QIT) organized regular face-to-face meetings for in-depth discussion and questionnaire, and analyzed the data by "Plato analysis" and "Brainstorming method". After finding out the reasons, the "Plan-Do-Check-Action" (PDCA) cycle was continued to identify and solve problems, which included the formulation and implementation of specific training plans by creating the "Gantt charts", the check of effects, and continuous improvements from 2021 to 2022. Detailed information about the performance of students in 2021 and 2022, and the attendance, assessment, evaluation and suggestions from our hospital were provided by the relevant departments, and the pass rate-associated data was collected online.

Results: After the PDCA plan, the pass rate of NMLE in our hospital increased by 10.89% from 80.15% in 2021 to 91.04% in 2022 (P = 0.0109), with the pass rate of skill examination from 95.59% in 2021 to 99.25% in 2022 (P = 0.0581) and theoretical examination from 84.5% in 2021 to 93.13% in 2022 (P = 0.027). Additionally, the mean scores of all examinees increased with the theoretical examination score increasing from 377.0 ± 98.76 in 2021 to 407.6 ± 71.94 in 2022 (P = 0.004).

Conclusions: Our results showed a success application of the PDCA plan in our hospital which improved the pass rate of the NMLE in 2022, and the PDCA plan may provide a practical framework for future medical education and further improve the pass rate of NMLE in the next year.

Keywords: Education; National Medical Licensing Examination; PDCA plan; Pass rate.

Fig. 1

The PDCA Plan

Fig. 2

The “Plato analysis” of the poor performance in 2021. The Plato analysis showed that the off-campus residents, the clinical masters (excluding “5 + 3” students), and the doctors occupied a major proportion

Fig. 3

The “fishbone diagram” of the poor performance in 2021. The brainstorming method was utilized to analyze the factors that contributing to the poor performance in 2021 from the perspective of personnel categories

Fig. 4

The PDCA schedule developed by the “Gantt chart”

Fig. 5

The performance of NMLE in 2021 and 2022