Decoding the University of Tokyo Medical Faculty's National Exam Challenges

Japan's University of Tokyo (UTokyo), long regarded as the nation's premier institution for higher education, presents a curious case in its Faculty of Medicine. Despite consistently topping global and national university rankings, its performance in the National Medical Licensing Examination (NMLE, or Ishi Kokka Shiken in Japanese) has often fallen short of expectations. Recent data from the 119th NMLE in 2025 shows an overall pass rate of 93.3% for UTokyo graduates, placing it 43rd out of 82 medical schools. This figure exceeds the national average of 92.3%, yet lags behind leaders like International University of Health and Welfare at 100%. For new graduates, UTokyo achieved 97.2%, ranking around 19th, but repeat examinees pulled the total down to 64.3%.

This discrepancy sparks debate among educators, students, and policymakers in Japan's higher education landscape. Why does the most selective medical program—entered via the grueling Science III track (Rika III) of the Common Test for University Admissions—struggle with exam outcomes? Exploring this reveals insights into curriculum priorities, student motivations, and evolving medical training paradigms.

Background on Japan's Rigorous National Medical Licensing Examination

The NMLE is a pivotal hurdle for all medical graduates in Japan, administered annually in February by the Ministry of Health, Labour and Welfare. This three-day test comprises 500 multiple-choice questions divided into compulsory (basic sciences), general (clinical knowledge), and practical sections. Passing requires meeting thresholds: typically 80% on compulsory problems (around 160/200 points) and an overall score adjusted yearly, hovering near 73-75% in recent years.

Established post-World War II to standardize physician competency, the exam emphasizes rote memorization, clinical scenarios, and ethical judgment—skills honed through six years of medical school (four preclinical, two clinical). National pass rates have stabilized at 90-95% since the 2010s, reflecting improved preparation but also criticism for not fully testing advanced reasoning. In 2025's 119th iteration, 10,282 candidates sat, with 9,486 passing—a 92.3% rate.

• Compulsory Problems: 200 questions, pass/fail basis.
• General Problems: 200 questions on broad medicine.
• Clinical Training Problems: 100 case-based queries.

UTokyo's med faculty, with ~110 new admits yearly via hyper-competitive entry (acceptance ~3-5 per 100 applicants), feeds into this system uniquely.

UTokyo's Track Record: Data from Recent Years

Examining UTokyo's performance reveals consistency rather than crisis. Here's a breakdown:

Data sourced from official tallies. Trends show steady new grad rates above average, but repeaters—often those pursuing research—drag totals. No 120th (2026) data yet, as results emerge in March.

Ranking Against Competitors: UTokyo in Context

In 2025's total pass rate ranking, UTokyo slotted 43rd:

• Top: Kokusai Iryo Fukushi (100%), Jichi Ika (99.3%).
• Private standouts: Juntendo (97.9%), Fujita Health (97.3%).
• Bottom: Kurume (82.9%), Kawasaki Med (86.4%).

National unis like Kyoto (89.3%, 75th) and Kyushu (89.1%) also trail expectations. UTokyo outperforms many but trails exam-focused privates.View full M3 table.

Unpacking the Reasons Behind UTokyo's Performance

Several interconnected factors explain this:

1. Research-Centric Curriculum: UTokyo prioritizes basic science and innovation over clinical cramming. Students engage in labs, publications—skills for Nobel-caliber work (e.g., Biggin Prize winners)—but less exam drill.
2. Diverse Motivations: ~40% of grads opt for non-clinical paths like pharma R&D, academia. Some skip/fail exam deliberately, viewing it as secondary.
3. Elite Entrants, Exam Mismatch: Rika III aces excel in reasoning, not memorization-heavy NMLE.
4. No Dedicated Prep: Unlike privates' mock exams, UTokyo relies on self-study.
5. Repeater Impact: High-achievers delaying for PhDs lower stats.

Discussions on X highlight these, linking to Aera articles.

Voices from Students and Experts

Current students note: "East big med emphasizes holistic docs/researchers, not test-takers." Alumni like those in research roles thrive post-grad. Experts urge balancing curricula amid doctor shortages.

Stakeholders: MEXT pushes reforms; unions worry rankings affect prestige/recruitment.

Implications for Japan's Healthcare and Higher Ed

Low-ish rates question if rankings (QS Medicine: UTokyo top 20 global) reflect clinical readiness. Japan faces aging population, rural shortages—does research focus help? Positively, UTokyo grads lead innovations, bolstering Japan's med ecosystem.

Career Trajectories: Beyond the Stethoscope

Many UTokyo MD-PhDs enter academia, biotech. Explore faculty positions or professor jobs. Clinical paths remain strong, with high salaries (~¥15M start).

Reforms, Improvements, and Future Prospects

UTokyo introduced clinical boosts; pass rates rose post-2020. With AI diagnostics rising, exam may evolve. Outlook: Stabilizing 95%+ as hybrids grow.

Photo by Stephanie Hau on Unsplash

Guidance for Future Med Aspirants

Aim holistic: Balance exam prep with research. Check career advice, prof reviews. Japan med jobs booming—find yours.