Reflections on the English Questions in the 120th Japan Medical Licensing Examination (JMLE)

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On the weekend of February 7-8, 2026, the 120th Japan Medical Licensing Examination (JMLE) was held.

As you know, the JMLE includes English-related questions every year under the official guideline that they assess “general medical English necessary for clinical practice.” This raises an important question for those of us engaged in medical English education: What exactly are these questions assessing, and how should we interpret the results educationally?

Overall Assessment of the English Questions in the 120th JMLE

At the 27th JASMEE Academic Meeting in 2024, Prof. James Hobbs of Keio University delivered an oral presentation entitled “English questions in the Japanese National Medical Licensing Examination: An English teacher’s perspective.” In that presentation, he highlighted longstanding concerns about the JMLE English questions, including grammatical errors, unnatural phrasing, and items that could be answered without meaningful medical knowledge. He also drew attention to questions in which the correct answer was effectively stated in the question stem itself, rendering clinical reasoning unnecessary.

Against this background, the English questions in the 120th examination deserve careful consideration.

After reviewing all five English-related questions from the 120th JMLE, no obvious grammatical errors or clearly unnatural expressions were identified. (The five questions from this year’s examination are presented in full later in this article.) In that respect, it is reasonable to say that the linguistic quality appears to have improved from the 120th examination onward.

At the same time, the overall difficulty level of these questions was relatively low. Most items could be answered without advanced medical English skills, provided that examinees possessed a basic understanding of clinical concepts and standard terminology.

Although it was not classified as an English-related question, the following question was also included in the 120th examination.

120E-10

https://bbs.icrip.jp/forums/topic/120e-10

下記は、歴史上のある医師に関する記載である。
「1849年にカナダで生まれ、医師としての科学的視点と患者に寄り添う姿勢の重要性を説き、今日の臨床医学、医学教育の発展に多大な貢献をした内科医である。
感染性心内膜炎において指趾末端にみられる有痛性皮下出血について記載したことでも知られる。
また、
“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.”
などの名言を残した。」

この説明に該当する人物はどれか。

  1. Albert Schweitzer
  2. Edward Jenner
  3. Louis Pasteur
  4. Robert Koch
  5. William Osler

Answer: e

 

English translation of Question 120E-10:

The following description refers to a historical physician.
“He was born in Canada in 1849 and was an internist who emphasized the importance of a scientific approach to medicine as well as empathy toward patients, making significant contributions to the development of modern clinical medicine and medical education.
He is also known for describing painful subcutaneous hemorrhages at the fingertips, which are observed in cases of infective endocarditis.
In addition, he is remembered for leaving behind famous quotations, including:
‘To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.’”
Which of the following individuals does this description refer to?

This question reminds us that medical English education is not limited to vocabulary memorization or test strategies. Understanding historically important physicians, classic quotations, and professional values is also part of becoming a physician who can function in English-speaking clinical and academic environments. Personally, I believe that questions involving medical history and professional values also deserve attention within medical English education, even if they are not formally categorized as “English questions.”

What Medical English Education Should Take Responsibility For

The relatively modest difficulty of the English questions highlights an important reality: the responsibility for preparing students lies not primarily with the national examination, but with each medical school’s own curriculum.

The English questions on the JMLE are not designed to be advanced proficiency tests. They assess competencies that graduating medical students should already possess. Ensuring that students meet this standard is the responsibility of individual institutions.

When we discuss outcomes in medical English education, multiple indicators are available: TOEFL or IELTS scores; performance on medical English specific assessments, such as EPEMP or OET; and assessment of clinical communication skills through objective structured clinical examinations (OSCEs). However, performance on the English-related questions of the JMLE should also be regarded as one meaningful outcome measure.

In practice, each university already collects JMLE results through students’ self-reported answer checks. These data are typically managed by the medical education office. Medical English educators should actively review student performance on the English-related questions and incorporate these findings into curriculum design and revision.

Performance on JMLE English questions should not be considered peripheral. It is one concrete reflection of how effectively we are preparing students for real-world medical English use.

English-Related Questions in the 120th JMLE

In the 120th Japan Medical Licensing Examination, the following five English-related questions were included.

120A-8

https://bbs.icrip.jp/forums/topic/120a-8

Chronic kidney disease (CKD), which affects around 20 million people in Japan, is a major cause of end-stage kidney disease. CKD severity is classified based on ① and ②.

Choose the correct combination for ① and ② from below.
eGFR: estimated glomerular filtration rate

  1. ① body weight ② eGFR
  2. ① body weight ② proteinuria (albuminuria)
  3. ① creatinine ② daily salt intake
  4. ① creatinine ② eGFR
  5. ① eGFR ② proteinuria (albuminuria)

Answer: e

120A-49

https://bbs.icrip.jp/forums/topic/120a-49

A 28-year-old man visited the emergency department with severe low back pain and right leg pain, which started two days ago. The patient has no recent history of trauma. Straight leg raising test was positive on the right side. Neurological examination revealed marked motor weakness of his right ankle plantar flexion.

What is the most likely diagnosis?

  1. Ankylosing spondylitis
  2. Lumbar disc herniation
  3. Spinal canal stenosis
  4. Spondylosis deformans
  5. Vertebral fracture

Answer: b

120D-11

https://bbs.icrip.jp/forums/topic/120d-11

Which of the following is heard during chest auscultation in a child with croup syndrome?

  1. Diffuse wheezing
  2. Inspiratory stridor
  3. Pleural friction rub
  4. Crackles at the lung bases
  5. Weak breath sounds in the right lung

Answer: b

120E-37

https://bbs.icrip.jp/forums/topic/120e-37

A 64-year-old man visited the family physician for an abnormal finding in the annual health check-up. He quit smoking three years ago. He does not have any history of stroke, coronary heart disease, or peripheral artery disease. He is currently not on any medication.

His body measurements are as follows: height 170 cm, weight 65 kg, waist circumference 81 cm, blood pressure 128/74 mmHg.

His fasting blood test results are as follows: LDL cholesterol 183 mg/dL, HDL cholesterol 58 mg/dL, triglycerides 130 mg/dL, glucose 102 mg/dL, HbA1c 5.5% (reference range 4.9–6.0), creatinine 0.76 mg/dL.

Which of the following best describes the man’s condition?

  1. Obesity
  2. Dyslipidemia
  3. Hypertension
  4. Diabetes mellitus
  5. Metabolic syndrome

Answer: b

120F-11

https://bbs.icrip.jp/forums/topic/120f-11

Which deficiency is suspected in patients with macrocytic anemia?

  1. Erythropoietin
  2. Folic acid
  3. Potassium
  4. Sodium
  5. Vitamin D

Answer: b

JMLE Questions on Quizlet

All English-related questions from past JMLEs, including those from the 120th examination, are available here:

https://quizlet.com/jp/681832460

Since English-related questions were first introduced into the JMLE, I have personally reviewed all 400 questions each year, carefully examining every item. The English-related questions from each year have been compiled and uploaded to this Quizlet set as flashcards.

I hope that educators will feel free to use these materials in their medical English classes as a practical teaching resource.

Looking Ahead

The 120th JMLE suggests a welcome step forward in terms of linguistic accuracy. Nevertheless, the broader challenge remains: English questions should assess how future physicians understand and use English in authentic clinical contexts.

Addressing this challenge is not solely the responsibility of examination committees. It belongs to all of us involved in medical English education. For that reason, medical English educators should actively review their own students’ performance on the JMLE, regard the results as one meaningful outcome measure of their programs, and use this information to refine and improve their medical English curricula.

AI Disclosure
This article was drafted with the assistance of generative AI and subsequently reviewed and revised by the author. The final content and opinions expressed here are entirely the author’s responsibility.

Reflections on the English Questions in the 120th Japan Medical Licensing Examination (JMLE) © 2026 by Takayuki Oshimi is licensed under CC BY-ND 4.0