An evaluation of the undergraduate medicine licensure examinations development and implementation practices: lessons from Ethiopia with global implications

Abstract Background The development of undergraduate medicine licensure examinations is critical for ensuring physicians’ competencies. Existing literature primarily focuses on exams Psychometric properties while leaving a gap in understanding the developmental processes, stakeholder engagement, and contextual influences, particularly in resource-limited settings. This study evaluated the mechanisms and stakeholders’ perspectives on shaping the Ethiopian undergraduate medicine licensure examination development and implementation practices. Methods A qualitative study design combining a phenomenological orientation with a realistic evaluation approach was employed. Purposive sampling was used to select eight experienced experts from four major stakeholder institutions. Data were collected through key informant interviews and cross-validated against exam development guidelines and expert profile datasets. Thematic analysis was conducted to present challenges, enablers, and institutional factors. Results The study evidenced that the Ethiopian Undergraduate Medicine Licensure Examination follows a standard approach, consisting of task analysis, blueprint preparation, item construction and appraisal, and exam administration. However, critical gaps were identified in expertise psychometric competencies, and challenges associated with paper-based testing and exam security concerns. Conclusion While participants perceive the undergraduate medicine licensure examination design aligned with national goals, its implementation is compromised by technical and logistic gaps. Transitioning to Computer-Based Testing, professionalizing item writing, and balancing stakeholder representation with experienced experts are essential facets to maintain the exam’s validity.