Analysis of anatomy questions in China's National Medical Licensing Examination (2010–2023): Content distribution characteristics and cognitive level evolution trends

This study examines the evolving distribution and emphasis of anatomy questions within China's National Medical Licensing Examination (NMLE) for Clinical Practitioners from 2010 to 2023, offering evidence-based insights to refine instructional approaches and enhance learning efficiency. A total of 374 anatomy-related questions were retrospectively analyzed and systematically classified across several dimensions: anatomical system, regional focus, thematic emphasis, and cognitive level based on Bloom's Taxonomy. The findings indicate a strong concentration on neuroanatomy and the musculoskeletal system, with the head and neck region and abdominal area representing the most emphasized anatomical regions. Thematically, items most frequently addressed structural characteristics, functional mechanisms, and clinical integration. A noticeable shift in cognitive emphasis has occurred over time, with a decline in questions assessing lower-order reasoning and a marked increase in those demanding application and analytical skills. These trends reflect a deliberate alignment of the national examination with contemporary educational priorities, highlighting the growing emphasis on integrative clinical anatomy and higher-order cognitive competencies. The outcomes support ongoing curricular modernization and the adoption of competency-based educational strategies in anatomy training. As a representative case of competency-based transformation in medical licensing assessment in a large developing country, this study also provides valuable insights for anatomy education and examination design worldwide.