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Article History

Received: 3 October 2025

Accepted: 2 January 2026

First Online: 9 January 2026

Declarations

:

: This study used secondary data to analyze examination items, without involving human participants or personally identifiable information. Therefore, we did not require individual informed consent. We obtained ethical approval for this study from the Ethiopian Medical Association Institutional Research Ethics Review Committee (Protocol No.: EMA.0061.01) and the Ludwig-Maximilians-Universität Institutional Review Board (Project No.: 24–0856). We conducted all procedures in accordance with the ethical principles outlined in the Declaration of Helsinki. Before we accessed the examination data, the principal investigator provided the Ministry of Health, Health and Health-Related Institutions and Professionals Regulatory Lead Executive Office with detailed information regarding the study objectives, along with the ethical approval letters and supporting documents, and received permission. We adhered to all procedures in line with the ethical and confidentiality requirements set by the examination center, ensuring secure handling and anonymization of all assessment data.

: Not applicable.

: The authors declare no competing interests.