Mastering the Japanese NMLE: Study Tips for Local and Foreign Medical Students

For any aspiring physician hoping to practice in Japan, the Japanese National Medical Licensing Examination (NMLE)—also known as 医師国家試験 (Ishi Kokka Shiken)—is the final and most important hurdle. It's not just a test of knowledge but a test of endurance, discipline, and preparedness. If you're feeling overwhelmed by the complex structure of the exam or unsure about where to begin your preparation, this guide is designed for you.

Whether you're a Japanese medical student in your sixth year or a foreign medical graduate hoping to get licensed in Japan, this comprehensive guide will walk you through everything you need to know to ace the Japanese NMLE on your first attempt.

Table of Contents

1. What is the Japanese National Medical Licensing Exam (NMLE)?
2. Who Can Take the Exam?
3. Exam Structure and Format
4. Core Medical Topics Covered
5. Understanding the Grading System
6. Language Barrier: Japanese Proficiency Required
7. Top Resources to Use
8. Effective Study Plan: Month-by-Month
9. Practice Questions and Mock Exams
10. Exam Day Tips
11. Post-Exam: What Happens Next?
12. Common Mistakes to Avoid
13. Final Thoughts
14. Bonus: Real-Life Advice from Japanese Doctors

1. What is the Japanese National Medical Licensing Exam?

The Ishi Kokka Shiken is the standardized, government-regulated medical licensing examination required for all doctors who want to practice medicine in Japan. It is administered by the Ministry of Health, Labour and Welfare (MHLW) and held annually in February. Passing this exam grants the candidate a medical license recognized across Japan.

2. Who Can Take the Exam?

There are two main categories of eligible candidates:

• Japanese Medical Students: Typically taken at the end of the sixth year of medical school.
• Foreign Medical Graduates (FMGs): They must first pass a screening process to validate their qualifications and demonstrate Japanese language proficiency, especially medical terminology.

FMGs should note that the equivalency process may take months and includes an interview, documentation checks, and often additional requirements.

3. Exam Structure and Format

The NMLE is a computer-based test and spans two consecutive days, comprising about 400–500 questions in total. The questions fall into several types:

• General Clinical Knowledge
• Medical Ethics and Public Health
• Specialist Questions (Pediatrics, Surgery, Internal Medicine, etc.)
• Emergency and Critical Care
• Medical Safety and Legal Compliance

Question Types:

• Multiple-choice (single best answer)
• Image-based clinical scenarios
• Applied practice situations
• True or false judgments

The test is known for being exhaustive and detail-heavy. You’ll be expected to apply knowledge—not just recall facts.

4. Core Medical Topics Covered

The Japanese NMLE covers a broad spectrum of medical science:

• Internal Medicine: Cardiology, endocrinology, nephrology, etc.
• Surgery: General, orthopedic, thoracic
• Pediatrics
• Obstetrics and Gynecology
• Psychiatry
• Preventive Medicine and Public Health
• Clinical Diagnostics and Interpretation
• Emergency and Disaster Medicine

Expect to encounter cross-specialty cases, requiring integrated thinking.

5. Understanding the Grading System

To pass the NMLE, candidates must:

• Score above the minimum passing threshold, usually around 70%.
• Avoid incorrect answers on certain “do-not-fail” key questions, which are safety-related and non-negotiable.
• Score above a cumulative minimum on both days of the exam.

Failing the safety-critical questions means automatic failure—even if your overall score is high.

6. Language Barrier: Japanese Proficiency Required

There is no English version of the Japanese NMLE.

• All materials, questions, and patient scenarios are presented in Japanese.
• You’ll need to understand both everyday language and advanced medical vocabulary.

This is a serious obstacle for many foreign applicants. It’s advisable to have at least N1 level proficiency (JLPT), though N2 may be acceptable if your medical Japanese is strong.

Pro Tip:

Study Japanese clinical case reports and attend Japanese medical lectures to improve your vocabulary and comprehension speed.

7. Top Resources to Use

Japanese Students’ Favorites:

• QB (Question Bank) Series: Subject-wise practice books.
• MEC Review Courses
• TECOM Videos and Handouts
• INFORMA and KOKUSHI Navigator
• Medu4 (Online lectures in Japanese)

For Foreign Graduates:

• Japanese for Healthcare Professionals by Asuka Kaneko
• Lang-8 and HiNative for language corrections
• Medical textbooks in Japanese translation
• Anki decks with both vocabulary and clinical pearls

8. Effective Study Plan: Month-by-Month

12–9 Months Before the Exam:

• Master the language: Learn 5000+ Japanese medical terms.
• Begin reviewing major textbooks in both English and Japanese.

8–5 Months Before:

• Start QB practice questions by system (e.g., cardiology, gastro).
• Watch Medu4/TECOM review lectures.
• Translate case studies from Japanese journals.

4–2 Months Before:

• Focus on mock exams, identify weak areas.
• Take weekly full-length simulations.
• Master key ethical and safety concepts.

1 Month Before:

• Review high-yield mistakes.
• Sleep well and build a healthy routine.

9. Practice Questions and Mock Exams

Importance:

• They simulate real exam difficulty and time pressure.
• Help you get used to reading clinical case descriptions in Japanese.

Where to Find Them:

• MEC and TECom official mocks
• QB simulated papers
• Past question compilations used by Japanese students

10. Exam Day Tips

• Sleep early for at least 3 nights prior.
• Bring extra pens, ID, and exam admission slip.
• Manage time tightly: Don’t dwell on one question for too long.
• Read all answer options carefully—some are nuanced in wording.
• Don’t underestimate medical ethics and law questions—they’re weighted heavily.

11. Post-Exam: What Happens Next?

• Results are announced in March via the MHLW official website.
• Successful candidates receive their medical license registration shortly after.
• Foreign graduates can then apply for hospital jobs or postgraduate training (Shūshin kōshū).

12. Common Mistakes to Avoid

• Neglecting Japanese practice—even fluent speakers struggle with medical jargon.
• Studying only from English materials—the phrasing in Japanese exams is different.
• Ignoring minor specialties like dermatology, ENT, or rehab medicine.
• Overemphasis on recall instead of clinical reasoning.
• Poor time management during the test.

13. Final Thoughts

The Japanese NMLE is among the most rigorous and language-dependent licensing exams in the world. But with a structured plan, disciplined practice, and immersion in Japanese clinical language, it’s absolutely possible to pass.

Thousands of students, both local and international, do it every year. What sets successful candidates apart is their early preparation, commitment to mastering medical Japanese, and a sharp focus on practice-based learning.

14. Bonus: Real-Life Advice from Japanese Doctors

“Don’t just memorize. Think like a clinician. That’s what the kokushi (NMLE) really tests.” — Dr. Kenji Saito, Tokyo Medical University

“Clinical vignettes are your best friends. Solve 10 a day and reflect deeply on your mistakes.” — Dr. Ayaka T., Osaka