The announcement of the National Exit Test (NExT) has created an uproar among the medical fraternity. As intricate details of the exam seem to elude students, experts are concerned about how beneficial the exam would actually prove for the medical infrastructure of the country. The primary uncertainty looms over the exam date and has one and all worried.
Timeline troubles
According to a gazette notification released by the government on June 30, NExT would be conducted twice a year in November and May. However, it has not been mentioned if it would be held in November 2023 or 2024. Since NExT will serve both as a qualifying and entrance test, it was proposed to be conducted by the All India Institute of Medical Sciences (AIIMS) Delhi when students' final year semesters were due. However, the final semester is coming up in December, while the same for other states is due in March-May 2024.
The question on everyone's mind, thus, is if the exam takes place in November, would students have to appear for it before they complete their final year? And if it takes place in May, students would still be at a disadvantage since there will be no time to prepare.
"The announcement was made mid-session of our final year and has left us no time to prepare. When NEET PG is announced about six months earlier, shouldn't a new exam be informed about at least that much early, if not earlier?" questions Sachin Sharma, a 2019-batch MBBS student from Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak.
Sudden implementation
The students at PGIMS held a peaceful demonstration against NExT on July 4, Tuesday. Similarly, the All India Democratic Students' Organisation (AIDSO) announced a week-long demonstration, which included protests against the exam, from July 1 to July 7. Several medical colleges from different parts of the country like Fakir Mohan Medical College & Hospital in Balasore, Odisha and Dr Radhakrishnan Government Medical College in Hamirpur, Himachal Pradesh also organised protests.
Demands that the exam be implemented for the next batch have been made. Dr Meet Ghonia, former National Vice-President of the Indian Medical Association's Medical Students' Network (IMA MSN), however, points out that the guidelines of the exam for the 2020 batch also have to be made clear. Amidst so much confusion students from the 2019 batch, who are in their final year currently, ask the National Medical Commission (NMC) to clarify the date of the exam at the earliest so that they can start preparing.
Even the 2018 batch, which is currently undergoing internship, is uncertain about whether they will be appearing for NExT or NEET PG in 2024. If the former, they wouldn't have much time to prepare and would be forced into writing a new exam.
Exam syllabus and pattern
The preparation itself is a herculean task, as students have to be thorough with all 19 subjects in MBBS. The situation gets more tense, with no clarity on which chapters are important. "In the webinar conducted by the NMC on June 27, it was mentioned that 60-70 per cent are must-know chapters, while 20-30 per cent are should-know chapters. But which are the exact chapters was not informed. Even our professors do not know," says Nirupama N, a student from Kottayam Medical College, Kerala.
Students mention that as they knew the weightage in NEET PG, it would immensely help to know the weightage for this new exam. Additionally, the exam pattern is problematic. NExT is proposed to have clinical-based multiple choice questions (MCQ) questions. Medicos are concerned that the infrastructure and faculty of certain medical colleges might not be able to cater to such preparation. And in the absence of any update from the NMC, the colleges are continuing to teach with an emphasis on theory.
Chances of partiality?
Students are used to theory-based questions and studying only the final-year subjects for their final exams, they state. They also fear that clinical-based questions might lead to partiality. "Health is state-specific. For example, Malaria is prominent in Gujarat, and our clinical training would focus on it. In Delhi, it would be focussed on something different. If AIIMS Delhi sets the question paper, the questions might be asked based on what the students studied there, but I may have little knowledge of it," explains Alisha Lakhani, a student at Shantabaa Medical College, Gujarat, and National Zonal Coordinator, IMA MSN.
She adds that AIIMS faculty might help the students get acquainted with the exam pattern, whereas, other college students would bear the brunt. "A separate body should be conducting the exam," she opines.
A qualifying exam — how?
The fact that NExT is introduced as a qualifying exam is also problematic, amidst a lack of clarity in the NMC guidelines. "There is no sense in combining a qualifying and entrance exam," says Sachin.
"If it is a qualifying exam, guidelines should be made clear on how our internal assessment and attendance criteria would be used," Alisha adds. Students further question the arrangement of their respective colleges providing the MBBS degree if AIIMS conducts the exam.
Health activist Dr Vivek Pandey further brings to the notice that there is no provision for students who have failed in one or two subjects in their previous semesters. "These students would officially belong to the 2018 batch but would be completing the course with the 2019 batch. NMC has not made it clear if these students would be eligible for NExT," he explains.
Alisha adds that when colleges provided degrees, there was the provision of a supplementary exam for such students, about which, there is no information now.
There is also much uncertainty over negative marking in the exam. "The AIIMS notification on NExT mentions negative marks, whereas the gazette notification does not," points out health activist Dr Dhruv Chauhan. Meanwhile, students state that if it is a qualifying exam, NExT should not have a negative marking scheme.
Percentage problem
A fifty per cent qualifying mark has been set for NExT, which experts and students opine is too high, and the number of people qualifying will come down. "This year, the NEET PG qualifying mark was 289 out of 800, still only 30-40 per cent qualified," Dr Chauhan says.
"The number of repeaters will increase every year," adds Dr Ghonia.
"Just passing the exam won't be enough. Since it is going to replace NEET PG, we also have to obtain a good percentage so as to obtain a seat in a good college," Nirupama states further. Preparation for NExT Step 2 during their internship period will also prove hectic for the students.
Rise of coaching culture?
Experts and students fear that the difficulty of the exam and inadequacy of the current medical education system would encourage students to opt for NExT coaching, which coaching centres would only gladly offer. "Studying all the subjects from the first to final years, that too for an MCQ pattern with clinical-based questions will only terrify students and in order to do well in the exam, they will be compelled to opt for coaching. The situation will be similar to students who opt for NEET and JEE (Joint Entrance Exam) coaching," says Scahin.
The scenario will enable students from affluent financial backgrounds to have easy access to good coaching, and subsequently, do well in the exam, while students from economically weaker sections will suffer, opines Dr Ghonia.
Undermining its own purpose
Speaking about the provisions of the gazette notification, Dr Ghonia mentions that a student wishing to appear for PG counselling has to clear all six papers of NExT in one go. To qualify NExT, however, a student can appear multiple times to clear a failed paper. "This again makes it seem like one is appearing for two separate exams, which NExT was supposed to do away with," he says.
What about dreams?
NExT as an entrance test has more drawbacks in its share. Dr Shahroz Khan, all India students' coordinator of Indian students in China, mentions that like himself, many medicos after an MBBS degree do not directly wish to enroll for PG. "We want to practice as regular consultants, gather three to four years of experience and then go for higher studies. So, if students do not want to take a PG entrance test, will they not qualify as doctors as well?" he questions, adding that students were being forced into PG courses, shattering their future plans.
Hassles ahead
Besides, the exam was proposed to be five to six days long. "A majority of the students don't live close to the exam centres and they would have to travel and find themselves accommodation for the duration of the exam. Booking hotel rooms for about a week means additional financial burden," states Dr Khan.
FMGs' woes
The primary concern of FMGs is also surrounding the exam date. The Foreign Medical Graduate Exam (FMGE) is supposed to be held in December, while NExT seeks to replace it. The question, therefore, is whether FMGE will be held in 2023 or whether FMGs have to prepare for NExT.
"The NMC webinar also went on for two to three hours, but not once were FMGs discussed. They were simply asked to follow IMGs (Indian medical graduates). But what should we follow? There is no clarity and nothing was mentioned in the gazette notification either. The future of about 50,000 FMGs is on the line," Dr Khan states. Many FMGs started FMGE coaching in June, and have invested money, for whom the uncertainty creates more tension.
In any case, since the exam seeks to replace FMGE at some point, FMGs would need to look at the exam pattern, a chance of which is being given to IMGs through a mock test being conducted by the NMC on July 28. FMGs were not included in the registration notification. "Neither were interns, post-interns and juniors. If it is a paid exam, everyone should be allowed to participate," Dr Ghonia says.
According to the gazette notification, a student has to clear NExT within 10 years from the time of admission to MBBS. "This is extremely problematic for FMGs, as it takes them seven to eight years to complete their degree and internship. This means they have only two attempts to clear NExT," he tells. The ten-year rule is also troublesome for bonded and in-service doctors, as they will need to continue their service for a certain number of years after MBBS, Dr Ghonia notifies.
Legally faulty?
On top of these lacunae, experts state that several provisions of the government's gazette notification need to be looked into. "Words and phrases used in these Regulations which are not defined here, but defined in the National Medical Commission Act, 2019 shall have the same meaning assigned to them there," the interpretation section reads. Dr Ghonia opines that a gazette notification should have all the words defined clearly, with no scope for doubt.
He adds that Chapter 2, point v of the notification mentions that NExT will comprise all subjects of III MBBS parts 1 and 2. However, Section 15 of the NMC Act mentioned only III MBBS part 2. Moreover, there is no formula for normalisation spoken of in the gazette. Clarity is also lacking on how the NExT score, which is valid for five years, would be used.
Dr Ghonia further states that according to the NMC guidelines, AIIMS students do not come under the purview of the commission. "The concept of NExT exam violates this guideline then," he says. Further, according to Section 49 of the NMC Act 2019, the provisions of the Act would be applicable to students who took admission after its establishment. Implementing NExT for the 2019 batch then is a gross violation, experts say, as the 2019 batch was admitted a few days before the Act came into being.
Few suggestions
"A proper consultation should have been done with all stakeholders and all the issues taken into account, before implementing the exam," concludes Dr Rishiraj Sinha, National Executive Member, Federation of All India Medical Doctors' Association (FAIMA). "Now, it is as if the authority is finding out about what problems could arise only after students are pointing them out," he adds.
Sachin feels that the infrastructure and faculty strength should be improved in medical colleges in order to make better doctors. "Introducing a new exam will be of little help if the health infrastructure remains the same. New medical colleges are being built, but these colleges lack basic infrastructure and faculty. How can we prepare for a tough exam like NExT if this continues?" he asks.
"Students are not against the exam. But they are against the pattern, confusing guidelines and sudden announcement," states Dr Chauhan.