How a Medieval Islamic Caliphate Designed the Medical Licensing System We Use Today

As a doctor, I am grateful for much of the medical knowledge that developed during the Islamic Golden Age. However, Muslim rulers of that period also left us with another important legacy – the establishment of the medical licensing system.

Although medical students loathe any mention of exams, we cannot deny that licensing exams are an important barrier to ensure baseline knowledge, and to prevent quacks and snake-oil salesmen from harming the public. 

Historical Precursors: The Qin Dynasty’s Civil Service Exams

The concept of medical licensing exams has a long history, with one of its earliest predecessors found in the Qin Dynasty of ancient China, dating back to the 200s BCE.

During this period, medical examinations were integrated into the civil service examination system. Aspiring physicians had to demonstrate their knowledge and skills to secure positions within the government, a practice that foreshadowed the modern licensing exam’s purpose: to ensure competence and quality in medical practice. 

The Abbasid Dynasty’s Pioneering Influence

While the Qin Dynasty laid an early foundation, it was the Abbasid Dynasty that exerted the most direct influence on the development of our modern medical licensing system.

The turning point came in 931 CE when a tragic incident unfolded in the heart of Mesopotamia. A patient in Baghdad had met a tragic end due to a physician’s error. In response, Caliph Al-Muqtadir took decisive action, summoning his chief physician, Sinan-ibn Thabit bin Qurrah, to address the pressing need for medical regulation.

Under the mandate of Caliph Al-Muqtadir, Sinan-ibn Thabit bin Qurrah embarked on a mission to ensure the competence of those practicing medicine. In the first year of the decree, more than 860 medical practitioners underwent rigorous examinations in Baghdad. 160 of them failed to meet the required standards, highlighting the pressing need for such oversight.

From that moment forward, the landscape of medical practice was forever altered.

Licensing examinations became a mandatory step for anyone seeking to practice medicine, and they were administered in various locations across the region. A critical component of this system was the establishment of Licensing Boards, each overseen by a government official known as the Muhtasib, or inspector general. This regulatory body ensured that only qualified individuals were granted the privilege to practice medicine.

The Path to Medical Practice

The licensing process was a comprehensive one, and remains remarkably similar to our current system.

Chief physicians conducted thorough oral and practical examinations, evaluating candidates’ knowledge, clinical skills, and ethical understanding. Successful candidates earned the honor of taking the Hippocratic Oath, a solemn pledge of ethics and professionalism that remains central to the medical profession to this day. Upon taking the oath, a license to practice medicine was bestowed upon the aspiring physician.

The Influence of Arab Rule in Sicily

The influence of Arab rule extended beyond the Middle East – one of the profound impacts of Arab rule can be found in Sicily.

The island, under Muslim rule for a significant period, witnessed the establishment of schools dedicated to teaching the art of medicine and the construction of hospitals to provide medical care. At the center of the Mediterranean, Sicily was a melting pot of diverse cultures and beliefs, where ideas from various civilizations could germinate and spread to other areas of Europe.

The Normans continued the Islamic medical traditions of Sicily when they conquered the island in the mid-12th century CE. In 1140, Roger II, the Norman king of Sicily, mandated that physicians must pass an examination before they could practice medicine. This decree was a watershed moment in European medical history, as it laid the groundwork for the regulation of medical practice on the continent.

Further Developments under Frederick II

Building upon Roger II’s pioneering efforts, the Hohenstauffen king of Sicily, Frederick II, made substantial contributions to the regulation of medicine. In his Constitutions of Melfi, issued in the 13th century, he decreed that for a physician to practice medicine or provide healing, they must first pass a public examination convened by the master of the School of Salerno.

This marked a significant leap in the formalization of medical licensing and examination protocols in Europe. These systems of medical pedagogy gradually spread to major universities throughout continental Europe such as those in France and Spain, ultimately setting the stage for the development of the modern medical licensing system. 

Conclusion

In January 2022, the United States Medical Licensing Exam transitioned to a pass/fail grading system, prompting heated discussion from the medical community. This change may be the latest chapter in the ongoing saga of medical licensing exams, but it is a story that spans millennia and continents.

From the civil service exams of the Qin Dynasty to the pioneering work of the Abbasid Dynasty in Mesopotamia and the influence of Arab rule in Sicily, the quest for ensuring the competence of medical practitioners has left an indelible mark on the history of medicine.

As we reflect on the controversies and reforms in modern medical licensing, it is essential to recognize the enduring influence of historical precedents and their role in shaping the medical landscape we know today.