The National Medical Commission (NMC) has published a draft of proposed regulations for the National Exit Test (NExT), which is set to replace exams conducted by medical universities for final MBBS part II students as a qualifying exam and also NEET-PG for post-graduate admissions. Despite its potential to significantly disrupt medical education and consequently the healthcare system in the country, there has been minimal discussion on the proposed regulations by the public.
NExT will be conducted in two parts or steps. Step 1 will be a theoretical examination with multiple choice questions covering the final MBBS part I and part II subjects. It will replace the final MBBS part II theory examinations. NExT step 2 will be a practical examination conducted by the university after the completion of an internship. It will assess the competency of medical graduates in terms of clinical examination, communication, and other relevant skills. NExT step 2 doesn’t have a score, it will just assess whether a medical student is competent or not in practical skills. Clearing NExT step 2 is essential to get the licence for practising modern medicine for both foreign and Indian medical graduates.
Concerns regarding the changes
There are several practical and ideological problems with NExT. To begin with, it is yet another assault on federalism by the Union government. The healthcare needs and challenges of India are diverse, and each state through its medical university should have the freedom to administer the qualifying exam to suit the objectives of its healthcare system. This will not be possible with NExT, which intends to be a uniform qualifying exam for the entire country.
NExT, which is intended to replace NEET-PG, will not assess the students on first and second year subjects or on the final year part I subject ‘social and preventive medicine’. It will only assess the clinical subjects and the applied aspects of the non-clinical subjects. This is a strange development and one that significantly differs from NEET-PG. Knowledge of basic science and public health is crucial for any medical or surgical speciality, let alone the fact that there is a significant number of postgraduate seats in non-clinical subjects for which NExT scores will be used for admission.
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It will be an added burden on final-year students in MBBS part 2 to revise part 1 ophthalmology, and otorhinolaryngology when the actual subjects in part 2 are by itself voluminous and time-consuming to study. This exam will mount undue pressure on final-year students and will inevitably force a majority of them to take multiple NExT exams to improve their scores for post-graduate admissions. With multiple choice questions as the sole type of questions in step 1, as is the current scenario with NEET-PG, students would be forced to seek the help of the multi-million dollar coaching industry even more than before because of the added need to qualify for step 1 to do an internship. One also needs to remember that the complete omission of other types of questions such as essays in qualifying examination limits evaluating and and prevents different aspects of learning.
Yet another problem – and arguably the easiest to do away – is the proposed rule of using the average of the last three attempts of NExT step 1 to calculate the score for post-graduate admissions. This will unnecessarily force the students to put in sustained efforts for more than one year if they can’t secure their choice of postgraduate seat on the first attempt.
In the current scenario of NEET-PG, many students take a break from work and family obligations for at least a few months to crack NEET-PG. With NExT, if the average score over three attempts were to be calculated, it will put underprivileged students at a disadvantage as they may not be able to afford to take breaks from their work for more than a year and can undermine a student’s yearlong effort to boost the score, since the poor score obtained in the first attempt can pull down the average score to a greater extent. Particularly, the already poor representation of women in postgraduate seats will worsen since it would prove difficult to manage multiple years of sustained effort to prepare for NExT because they may have to juggle pregnancy and childcare duties.
This sustained effort, over multiple years, will mean even more wastage of critical human resources that the healthcare system needs.
A NEET centre in Chennai, Tamil Nadu. Photo: PTI
Issues with respect to NExT step 2
NExT step 2 exam is certainly essential for foreign medical graduates since that is the only way to assess their competencies in clinical case examination and other practical skills. However, this exam seems redundant for an Indian medical graduate who is already being assessed for these skills during the final MBBS part II university practical exams.
In our opinion, NExT is neither going to be beneficial for the students nor for the healthcare system in any way. Rather, it can lead to inordinate strain on the students to prepare for too many subjects in a short span of time during the final year for step 1, appear for a redundant practical examination in step 2 and put in sustained efforts over multiple years to secure postgraduate admission.
Padmanaban V. and Muthurman N. are associate professors of biochemistry, CMC Vellore.