Saudi Licensing Exam for General Practitioners: Resources to Help You Succeed

So, I've been getting a lot of questions from doctors who wished to know how to prepare for the Saudi Licensing Exam. Instead of responding to each individual email, I thought it would be time-saving to respond to most of the questions that I typically get.


What is the Saudi Licensing Exam (SLE)?

The SLE is a one-step examination for healthcare professionals in Saudi Arabia. Physicians who wish to practice in the kingdom have to take the exam in order to be registered with the Saudi Commission for Health Specialties. While some physicians have been reported to practice without sitting for the SLE, the exam is mandatory for those who wish to join a residency programme in Saudi Arabia or for those who earned their medical degrees out of the kingdom to ensure that they have achieved the appropriate standards and criteria to practice in the kingdom.


The exam for general practice consists of 100 multiple choice questions (MCQs) from the following areas:

- Internal medicine (25 questions)
- Family medicine (15 questions)
- Ophthalmology (3 questions)
- Gynaecology/obstetrics (10 questions)
- Paediatrics (15 questions)
- General surgery (15 questions)
- Orthopaedics (3 questions)
- Ear, nose, and throat (3 questions)
- Basic sciences (3 questions)
- Psychiatry (5 questions)
- Dermatology (3 questions)

It is considered an easy exam to pass, but candidates need to put in more work to get high scores. The passing grade for the SLE is 50%, but you should aim for a much higher grade (>75%) if you wish to increase your chances of joining a postgraduate programme.


Resources

Anecdotal reports from interns and general practitioners suggest that the questions are recycled. This said, it might help to revise previous exam questions. A few books currently on the market are great for the exam:

SLE Made Easy: Saudi License Examination by Dr. Yasser Albrahim


Where to purchase: Jarir Bookstore

This 769-page long book contains over 1,300 MCQ, including answers and explanations, to help students understand concepts instead of them just practising to memorise answers to questions.

Comprehensive Review for Saudi License Examination (SLE) by Dr Yahia M Al-Khaldi.

Price: 26.66 USD (100 SAR)

Where to purchase: Jarir Bookstore (either online or at a physical store in your area)

Format: Paperback


This 306-page long book contains more than 1,200 MCQs, with answers provided by the author.





Other helpful books

Oxford Handbook of Clinical Medicine by Murray Longmore, Ian Wilkinson, Andrew Baldwin, and Elizabeth Wallin

Price: 39.49 USD (148.13 SAR) for the Kindle version and 46.81 USD (175.59 SAR) for the flexibound version

Where to purchase: Amazon and Jarir Bookstore

Format: Kindle and flexibound

First Aid for the USMLE Step 3 by Tao Le, Vikas Bhushan, James Yeh, and Kachiu Lee

Price: 33.08 USD (124.07 SAR) for the Kindle version and 42.32 USD (158.73 SAR) for the paperback version

Where to purchase: Amazon and Jarir Bookstore

Format: Kindle and paperback









How to Register for the SLE

To register for the exam, you need to visit the offices of the Saudi Commission for Health Specialties (SCFHS). They have offices in several cities of the kingdom. You can visit their website for information on how to register and the location of testing centres, both within and outside Saudi Arabia.

The SCFHS warns all candidates on their website not to submit fraudulent degrees when registering for the exam, as they check all certificates submitted to the council. Frauds risk a jail term and a permanent ban from Saudi if caught.


Have you taken the SLE? If yes, please share your experience below. And for first-time takers of the exam, I wish you all the best!

Saudi Arabia: Chest X-ray

In 2002, if you asked any third year medical student what were the best conditions to perform a chest X-ray he would tell you that one of them was to perform it with the patient bare-chested. In my country, technologists always asked patients to take off their clothes before proceeding with the examination because they had been trained that clothing might interfere with X-ray images.


I remember I was 19 when I had my first chest X-ray as a grown up. When I was a kid, it didn't matter because I had nothing to hide at that time. On that day when I arrived at the clinic, I wasn't very comfortable that the technologist was male, and when he asked me to take off my top, I wasn't very happy about it. I had two things in my mind. First, I had to get that exam done because I was scared to hell that I had picked up a serious chest infection (tuberculosis). Second, I convinced myself that I didn't have to worry because he didn't know me and more so he would never see me again. 


I had my second X-ray (as an adult) in Saudi Arabia. I had just arrived and the sexual segregation thing had not yet registered in my mind. When I got into the examination room, I thought I had to take off my scarf and abaya. I was so anxious to get over with the examination that I immediately started to do just that. The poor technologist panicked and he got me in the same state too. There I was, standing perplexed and wondering what I had done to scare the poor man this way. All he could say was "Astaghful Allah! Astagful Allah! No madam, no remove, no remove." You bet how relieved I was when I understood the cause of his panic. Of course, I was also relieved that I didn't have to do that exam bare-chested.


At the few hospitals that I have been to, I noticed that most often women were asked to keep their clothes on when performing a chest X-ray. It didn't matter whether they had too many clothes on or not. I have seen only one case where the patient was asked to take off her clothes and wear a hospital gown before the exam. However, her relative stayed behind the curtains to help her get into a hospital gown. I have never stopped asking myself whether chest X-rays done in cases where the patients were overdressed were of really good quality. Would something be done about this if it really was the case? 

Saudi Arabia: What is the Fate of Non-Arab Doctors?

Many doctors who migrate to Saudi Arabia have little or no knowledge of what is waiting for them. This is especially true for doctors who come via family visa. Doctors who come via work visa are usually informed of the salary, the benefits and sometimes of the nature of the job. Those who pass through recruitment agencies know that they have to pay them (these agencies) a specific percentage of their salaries over a given period.

If you are a non-Arab doctor who is coming under the sponsorship of a relative, you should be aware of the obstacles waiting for you. This is especially hard for doctors who have not yet done their postgraduate studies, i.e., MBBS or MBChB holders. For specialists and consultants, the way could be smoother, as they are highly needed in most hospitals and clinics. If you are a specialist or consultant, you could be fortunate to find a hospital or clinic that is either willing to get you a visa, or pay for the transfer process (which is not easy as I heard, and it could take up to 6 months for this to be done).

So, MBBS/ MBChB holders, what lies ahead? If you have less than 2 years experience as a practitioner, you will be required to do an internship of at least 1 year at any government hospital. At the end of your internship you will get an internship certificate from each department that accepts to take you as a training resident. Bear in mind that some departments would reject your application for internship for one reason or the other. Most often, the reason is that they have reached the maximum of interns required for their department, and they would ask you to reapply later. It is necessary that you pass through the internal medicine, paediatrics, surgery, gynaecology and obstetrics, and Emergency Departments. If possible, you could also do an internship at a Family Medicine Department. After this, you can apply to sit for the Saudi License Examination (SLE). You can get the application form as well as the list of requirements from the office of the Saudi Commission for Health Specialties located at Al Ruwais District.

Learn more about the SLE and the books that can help you prepare for the exam by clicking here.

If your wish is to work as a general practitioner, passing the SLE, even with the highest score, is no guarantee that you will get a job in any hospital or clinic. Your application might be rejected because most of the clinics and hospitals usually want Egyptian, Indian, or Pakistani doctors. This is not because they are racist. No. They select physicians based on the nature of patients they get at their institutions. For example, many Indian patients want to be seen only by an Indian doctor or more specifically by an Indian doctor from Kerala. Hospitals and clinics might also turn you down because you do not speak Arabic, as more than 80% of the patients who show up at their facilities do not hear or speak English. Hiring a translator or finding a nurse to translate is not something that most of them are willing to do. And why would they do this, anyway?

If you are planning to continue postgraduate studies, good luck! The path is rough, but it is not impossible to make it. You should be very determined to continue till the end. To start with, certain specialties are reserved for Saudis only. If you wish to join the Saudi Board, you can choose internal medicine, paediatrics, surgery or gynaecology and obstetrics. If one of these is your first choice, then, masha'Allah, you are in for a good start. 

I know a few doctors and have heard of many others who, out of frustration, ended up teaching or doing non-clinical medical jobs. These are good positions with rewarding salaries in the range of 6000-7500 SAR (1600-2000 USD), but it can be pretty frustrating for doctors who have always dreamt of staying in clinical practice. Very good opportunities can be found at Bupa Arabia, AXA, the Islamic Development Bank, and many other private companies.

For doctors who are determined to continue their postgraduate studies and who do not wish to go through these difficult stages, my best advice is for you to stay in your home countries.

NB: This does not apply to doctors trained in the West.

The Best Physicians in Jeddah

There are many health institutions within the Kingdom that offer varied services to patients. The quality of service which is offered differs from one health institution to the other; from horrible to excellent.

Despite the fact that medicine has become so commercial these days with many doctors being more interested in the quota they generate each time a patient presents himself at their clinic, some doctors however have not lost the sense of respect for human life. This percentage is unfortunately very small.

Physician rating is a subjective issue which can be influenced by many different factors. According to a study, ideal behaviours that identified the ideal physician are: confident, humane, empathetic, forthright, personal, respectful and thorough. However, each patient's or individual's perception of a good physician would differ and to some extent might be inappropriate.

I will present some hospitals which are reputed to have the best physicians in terms of specialties. I am not in any way influenced by a third party for whatsoever benefit. I do not discriminate against any particular group of people or hospital. The results presented here are based on patient satisfaction, and again this is a subjective matter.

Internal Medicine

-Saudi German Hospital (SGH) Jeddah

Many patients have particularly appreciated the neurology and nephrology consultants. They are satisfied with the level of care and always have the feeling that their physicians are attentive to their health problems.

-King Abdul Aziz University Hospital (KAUH)

Many patients seem to be satisfied with the treatment they get here but however complain that it is difficult to get an appointment. 

-My Care Medical Centre

It is a small medical centre but the patients (Indians and Pakistanis especially) appreciate the senior internist in terms of patient care. In addition, the services are affordable for low-income earners.

Family Medicine:

-KAUH

The consultants and residents are very appreciated by their patients. The team is made up of well-trained Saudi physicians.

Gynaecology and Obstetrics:

-Jeddah National Hospital

Many claim they have gotten very good care, especially post-partum. In addition to the support of their physicians, patients appreciate the staff and particularly love the treats they get after discharge.

-KAUH

Patients report that the unit is very clean and the staff is competent. The only inconvenience is to get an appointment.

Surgery:

-National Guard Hospital

-Dr. Erfan and Bagedo Hopital

-King Faisal Specialist Hospital

Neuro-Surgery:

-Al Mostaqbal Hospital

-King Faisal Specialist Hospital

Opthalmology and Refractive Surgery:

-Al Maghrabi Hospitals

Many appreciate their opthalmologists and eye surgeons even though they complain that the services offered are costly.

Paediatrics:

-Soleiman Fakeeh Hospital

-Dr. Erfan and Bagedo General Hospital

-International Medical Centre

Rehabilitation:

-Abdul Latif Jameel Hospital

Patients appreciate the consultants and even seek them years after termination of their contracts. The hospital seems to have an ever-changing taste for the best rehab specialists and consultants.

There are other hospitals and clinics in the south of Jeddah that are reputed to have very good gynecologists/gbstetricians (Indians and Egyptians). Even though many patients and caretakers complain that these southern hospitals are usually crowded and not very clean, they do however comfirm that they have confidence in their healthcare providers, especially their treating physicians.

As I mentioned earlier, the information presented here is based on the satisfaction of some patients and their personal experiences at different health institutions within Jeddah. This list does not necessarily express my opinion nor reflect the current preferences of the inhabitants of Jeddah. There are certainly other hospitals within Jeddah that I believe would offer the same or almost the same standard of care.

Alcohol in Saudi Arabia

"O God, that men should put an enemy in their mouths to steal away their brains! that we should, with joy, pleasure, revel, and applause, transfrom ourselves into beasts!" (William Shakespeare, Othello).


The consumption and sale of alcohol is punishable by law in Saudi Arabia. The punishment is a jail term and flogging. Yet each year we hear of an individual or a group of individuals who have been caught again either involved in the consumption or distribution of alcohol.


What is this liquor that man will break the law just to have a drop on his tongue? What does it have that man would risk going to jail just because he wants a taste of it? In as much as I have had a couple of glasses in the past (in my home country), I do not see why anyone would want to risk facing a jail sentence and flogging because he/she wants a taste of this liquor.


No one would imagine my surprise when I met a few people who suffered from cirrhosis and hepatocellular cancer at a hospital, and who revealed on history taking that they were chronic alcohol drinkers. They lived right here in the Kingdom and had been carrying on this practice for years! This happened only a year and half after I came into the Kingdom. I was shocked. To me it was inconceivable that people did really consume alcohol in this country. Yes, I was naive.


Now I am not surprised when acquaintances talk about their drinking habits. Many expats drink alcohol when they meet for certain social events in compounds and diplomatic quarters. A lady teacher I know even talked of drinking once until she lost her senses because she had not tasted alcohol for a long time. She had been in the Kingdom for only 3 months and she was already complaining of going dry!

Some people even brew their own wine. They claim they use grape juice, yeast and sugar, but the result depends on how well you can do it. Don't ask me the recipe, for I do not know and I'd rather discourage you from trying this here. It is also said that some people brew beer, but I have never personally met anyone who did.

In certain neighbourhoods such as Qarantina, there are people who distill and distribute alcohol in large quantities. Some expats (one of my in-laws inclusive) even affirm that they have been proposed to buy a bottle of well-distilled alcohol. At what price? 200 SAR a bottle of 1.5 L! Pretty cheap to me.

Only a few days ago, the police in Riyadh caught 2 individuals, who were involved in the production and distribution of alcohol. An alcohol factory in the middle of Riyadh city!...read more. They were both sentenced to 2 years in jail and 300 lashes. 

It seems that most of the alcohol available in the Kingdom does not come from local brewers but is smuggled into the country (from a local source). Unfortunately, there is no data available to confirm this as alcohol is an illegal product.


Man. Oh man! Ye who cannot do without alcohol. What profit does it bring thou?

Glass vs Plastic Bottles

In the past, most parents mainly bought glass baby bottles. This was common practice even in third world countries where these bottles were pretty expensive. After the production of plastic bottles, many manufacturers enjoyed a flourishing business as many parents tended to purchase plastic baby bottles instead, probably for their convenience.


In the late 1990s, scientists however discovered that these plastic bottles leach a substance called Bisphenol A, which was potentially hazardous to health. The FDA nevertheless said that this substance was released only when these bottles were exposed to higher temperatures.


In western countries, most manufacturers of baby plastic bottles saw a drastic decline in their sales. Many parents were worried about these bottles, which were said to release a substance that could cause behavioural disorders and prostate cancer later in life. This is not the case in Saudi Arabia, particularly in Jeddah. On the contrary, I have noticed that plastic bottles are frequently used. At hospitals, at vaccination centres, and in malls you would find babies conveniently carrying their bottles and helping themselves. On a few occasions, I asked some mothers why they used plastic bottles. Most of them gave me similar responses: it is easy for the baby to hold and feed itself. Plus, it gives them (the mothers) time to do something else instead of carrying the baby and feeding it.


Which one to use? Glass or plastic bottles?

Safety:
-Glass bottles do not leach chemicals even when hot.

Convenience:
-Plastic bottles are cheaper than glass ones.
-Glass bottles can be cumbersome for outings compared to plastic ones, which are light and can even be carried by the baby while feeding.
-Glass bottles can easily break especially when dropped accidentally. Not the case with plastic bottles.
-Glass bottles hold temperatures better than plastic ones.


You might want to use plastic bottles because of their convenience. Look for bottles that are labelled "BPA FREE" or those that have a number 7 marked at the bottom of the bottle. Also, do not pour boiling water into the bottle when preparing your baby's feed. Let the water cool down before pouring it into the bottle. As an indicator, BPA free bottles tend to be softer and less see-through. No pharmacist or his assistant would get angry if you gently squeeze a bottle to run a check.


Whatever be the case, glass bottles appear to be safer but inconvenient. I use glass bottles for formula and plastic bottles for juices. The choice is up to you: glass or plastic?