With the advancement of the competency-based medical education reform, both China and Japan have carried out a series of reforms to test the competencies of clinicians in respective Medical Practitioners Examinations (MPE). How to reconstruct a high-fidelity representation of clinical environments by designing examination questions to assess comprehensive ability and clinical thinking in a simulated setting, has become an urgent problem to be solved in the medical examinations in both countries. By comparing the questions of Medical Practitioners Examinations between China and Japan, it is concluded that both countries are committed to improving the quality of clinical case type examination questions. The Japanese clinical case type examination questions, starting with increasing the proportion of fusion type examination questions, making clinical case type examination questions with higher cognitive levels, practically examining examinees' information processing, disease induction and reasoning, and ability to make decisions at the moment, which are valuable to inform China's MPE.