The Chinese, Japanese, and English literature were searched by the same researcher, who ensured that the relevant sources were up to date and comprehensive. The literature review process involved identifying research articles, policy papers, official announcements, and examination outlines related to dental practice qualification systems in China and Japan.

Databases: Major academic and professional databases such as PubMed, Google Scholar, CNKI (China National Knowledge Infrastructure), and Japanese government websites were used for data retrieval.

The latest NED (National Examination for Dentists) question standards, issued by Japan’s Ministry of Health, Labor, and Welfare in 2024, were used for comparison with the newly revised Chinese Oral Practitioner Examination Outline in 2024.

The study used the 2024 NED pass rate data provided by the Ministry of Health, Labor, and Welfare of Japan. Similarly, the 2024 Chinese Oral Practitioner Examination results analysis data were accessed from the National Medical Examination Center. These results allowed for a direct comparative analysis of the pass rates, which serve as an indicator of how well the examination systems align with the professional competencies required for dental practice.

In general, literature research and comparative research methods were used to carefully review the materials, analyze the Chinese and Japanese oral practitioner examinations and their reforms in recent years, and explore the reforms and trends in the future training of oral physicians from the aspects of examination content, examination cognition, and examination focus.

The Japanese dental practitioner qualification examination is strictly governed by the “Dentist Law”, which outlines the legal framework for becoming a licensed dentist in Japan. ¹⁰ The following key articles from the law define the eligibility criteria and registration conditions for the National Examination for Dentists (NED): Article 2: To be officially recognized as a dentist in Japan, an individual must pass the National Examination for Dentists (NED) and obtain a dentist qualification certificate issued by the Minister of Health, Labor and Welfare. Article 11: To be eligible to sit for the NED, applicants must meet at least one of the following conditions: 1. Domestic Academic Route: Complete a regular dental course at a Japanese university accredited under the School Education Law (Law No. 26 of 1948) and successfully graduate. 2. Preparatory Route with Clinical Training: Successfully pass the NED preparatory examination, followed by more than one year of clinical training that focuses on oral hygiene diagnosis and treatment. 3. Foreign Graduates or Overseas Qualifications: Graduate from a foreign dental school or hold a foreign dentist qualification, and receive official recognition from the Minister of Health, Labor and Welfare that their academic qualifications and clinical competencies are equivalent to or exceed the standards of the first two domestic routes. These provisions clearly emphasize the importance of formal education, clinical experience, and official government recognition for maintaining the high standards expected in Japan’s dental profession. The inclusion of a pathway for foreign-trained dentists indicates Japan’s openness to international qualifications, but also highlights the stringent review process to ensure equivalency in education and clinical competency. Moreover, in line with the recommendations from the Dental Practitioners Council, the Dental Practitioners Act was partially amended on May 28, 2021. The key changes include:

Eligibility for the National Examination: Passing the common examination is now a requirement to be eligible for the national dental examination. Clarification on Clinical Training: It is legally confirmed that students who pass the common examination can engage in clinical practice under the supervision of a licensed dentist.

The specific articles of the law were updated:

Article 11, Section 1: Specifies that students must pass a common exam as defined by the Ministry of Health, Labour, and Welfare before beginning clinical practice.

Article 17, Section 2: Allows students to perform dental procedures under the supervision of a dentist during their clinical training.

The Chinese oral practitioner examination is primarily governed by the “Practicing Physician Law of the People's Republic of China”, which lays out the legal framework for obtaining the necessary qualification to practice as a dentist in China. ¹¹ Below are the key provisions and conditions based on this law:

Article 8 of the law specifies the structure of the physician qualification examination and outlines the two main components of the exam: Practical Skills Test: This test assesses the hands-on abilities of candidates in performing essential dental procedures. ¹¹ Comprehensive Medical Written Test: Only those who pass the practical skills test are eligible to sit for the comprehensive written test, which covers a broad range of theoretical medical knowledge and dental science. Eligibility Criteria for Applicants: The following are the basic requirements for individuals seeking to apply for the oral practitioner qualification: Undergraduate and Above: Candidates must hold a bachelor’s degree or higher in a related medical field from an accredited institution. In addition, they must have completed at least one year of practical work in a medical or health institution under the supervision of a practicing physician. Secondary Vocational and Practicing Assistant Path: Alternatively, candidates who have a degree in a related medical field from a secondary vocational school, have obtained a practicing assistant physician's license, and have worked for five years in a medical or health institution are also eligible to apply for the oral practitioner examination.

2.1 Examination guide

Both NED and China’s oral practitioner qualification examination have undergone significant revisions over the years to adapt to evolving healthcare needs and international trends. The NED examination system is regularly revised every four to five years. The most recent revision was announced in 2023 by Japan's Ministry of Health, Labor, and Welfare, incorporating several key changes to keep up with evolving global healthcare trends. The outline points out a new focus was added to address the role of Chinese medicine in treating elderly patients and individuals with systemic diseases, as well as international health issues accompanying the globalization of medical care. In addition, knowledge will increase not only in the oral field, but also in areas related to systemic diseases and traditional Chinese medicine. In addition to the current provision system that mainly focuses on oral outpatient treatment, the oral health care services previously provided will also be expanded to medical care for inpatients and people recuperating at home, with more emphasis on the community comprehensive care system and multidisciplinary collaboration.

In 1999, China established and implemented the physician qualification examination system, promulgated the physician qualification examination outline for the first time, and revised it four times in 2002, 2009, 2013 and 2019. In order to comprehensively consider the new requirements for the basic qualities of doctors in the new era, and to re-examine the positioning of dentists with job competency as the orientation, the new outline was revised in 2023. The new outline has been increased from the original five parts to six parts. Among them, the medical humanities comprehensive has added the “Medical Waste Management Regulations” and deleted the “Maternal and Child Health Law and Its Implementation Measures”; the content and concepts of the medical ethics part have been revised; in addition, the new outline emphasizes the comprehensive clinical application of stomatology and the prevention of oral diseases. Adhere to prevention first and the integration of medical and prevention, and pay attention to the theory and skills of clinical prevention services and population health management. Emphasize “infection and control in oral health care” and highlight occupational protection and environmental disinfection.

2.2 Exam format and question types

NED does not involve practical skills test. The NED is a written examination held over two days, with a total of 360 questions divided into four units. The total possible score is 560 points, and each unit consists of 90 questions, with a duration of 135 minutes per unit. It includes compulsory questions (80 questions, a total of 80 points), general questions (180 questions, a total of 180 points), and clinical field questions (100 questions, 3 points each, a total of 300 points). The passing standard for compulsory questions requires more than 80% correct answers. The passing standard for general questions and clinical questions is determined by the average score and standard deviation. NED question types include: Type A, Type X2, Type X3, Type X4, Type XX, Type LA, calculation problems and sequence problems. Each question type likely has its specific purpose, testing different aspects of dental knowledge, from theoretical understanding to practical application in clinical scenarios. ^{12, 13}

The Chinese Stomatological Practitioner Examination is divided into a practical skills test, which is held in June every year.this test involves multiple stations where candidates demonstrate their hands-on clinical skills in a simulated environment. Passing this practical skills test is a prerequisite to taking the written exam. The written test takes 2 days and is divided into 4 units; each unit is two hours. The written test is all in the form of multiple-choice questions. The total number of questions is about 600. A total score of 360 or above is considered a pass.

2.3 Cognitive level of the exam

Generally speaking, in evaluating the cognitive demands of dental qualification examinations, educational theory typically divides cognitive levels into three classes, reflecting the depth of processing required to answer questions. The first type of question is a memory question to recalling facts and definitions. The second type of question is an understanding question to grasping meaning, interpreting data, or identifying relationships. The third type of question is an application question to applying knowledge in clinical or problem-solving contexts.

The NED is intentionally structured to reflect a progressive cognitive model, with distinct question categories aligning with different cognitive levels. We believe that the compulsory questions in NED belong to the first type of questions, which can be answered by simply memorizing the questions of previous years and basic knowledge. General questions refer to questions that do not specify conditions such as gender and age, and test knowledge about a given topic such as a disease or pathology, which belong to the second type of questions. Clinical questions, on the other hand, require specific conditions such as the patient's gender, age, and actual cases to test the problem-solving and thinking abilities cultivated through clinical training. They belong to the third type of questions. The proportion of NED is 14% for the first type, 32% for the second type, and 54% for the third type. In the analysis report of the Chinese Oral Practitioner Examination, taking 2021 as an example, the memory type accounts for about 12%. The understanding type accounts for about 39%, while the application type questions account for about 49%.

Based on the test score data provided by the Ministry of Health, Labor and Welfare of Japan and National Medical Examination Center of China the pass rates of new graduates in the past four years were compared and analyzed, see Table 1.