Medical education systems vary across ASEAN countries and affect the development of MLE systems. Medical students usually were required to complete 5–7 years of coursework. In Singapore, medical students must pass an annual examination in their medical schools before they can proceed to the next level. Immediately following successful completion of the fifth-year examination, they receive provisional registration which is valid only for the internship period; successful completion of the internship allows progression to full registration. This 5-step MLE system is similar to Thailand's system before centralization.