By Harika Palabatla and Prabhat Prakash
Hyderabad: For many decades, medical education has been one of the massive pillars of the Indian education system with thousands of students graduating every year. To enhance access to quality and affordable medical education the National Medical Commission (NMC) of India released the NMC Bill 2019, which focused on the key reformations of medical education systems in India. One of the crucial points discussed under the bill was the ‘National Exit Test (NExT)’. According to the bill, the NExT exam will be a common final-year undergraduate medical examination that will be held for granting the licence to practice medicine as a medical practitioner as well as for the admission of postgraduate broad-speciality medical education in medical institutions.
NMC on December 28, 2022, issued the guidelines for the examinations that will commence in the second week of December 2023 and will conclude in the second week of January 2024. The NExT will comprise two separate examinations called ‘Steps’. NExT Step 1 shall be a theoretical examination whereas NExT Step 2 shall be a practical /clinical and viva voce examination covering seven clinical subjects/disciplines. The marks in NExT Step 1 shall be calculated as whole number which shall serve as the raw scores with appropriate decimals and subsequently, corresponding percentages [marks out of a maximum of 100] with appropriate decimals may be calculated if required. NExT 2 examination results shall be declared as only pass / fail based on the acquisition of appropriate competence that is being evaluated.
Prior to the dates issued for the NExT examination while speaking to ETHealthworld Dr Rohan Krishnan, President, Federation of All India Medical Association (FAIMA) said, “As per our information, the NExT examination is scheduled to happen for the academic admission year of 2024. The Neet PG 2023 examination which has been occurring since the establishment of NMC is going to happen in March for the admission of the academic year of 23 and the admission of the academic year of 24, this NExT PG examination is scheduled.”
What experts say
Before the draft guidelines were issued on December 28, 2022, the NExT PG was to be initiated by December 2022. On September 23, 2022, the Union Ministry of Health released a notification stating that the implementation of the NExT examination was extended from three years to four years from the enforcement of the NMC Act 2019. However, the notification didn’t disclose any details about the exam dates, eligibility, syllabus, patterns, exam procedures, and marking schemes, due to which severe concerns were raised by the students regarding this exam. Since there was no clarity by the council, the establishment of this new exam created mixed opinions in the medical field, some appreciated the move taken by the government to enhance the quality of medical education and to produce skilled doctors for the country, while some sought more clarification about the exam details.
Appreciative of the move by the government Dr Aviral Mathur, President, Federation of Resident Doctors Association (FORDA) said “NExT PG exam will do away with rote learning practices and inculcate more of clinical and practical scenarios as well as critical thinking which is needed for a professional who is just entering into his post-graduation in the medical field. The Neet PG exam is currently very theory-based. Moreover, every coaching institute has its things planned. Basically, what they teach the MBBS students is not valued much by the exam pattern, which I think will be combated by this NExT exam.”
As the NExT exam lays the foundation to increase the quality of education by improving clinical and practical scenarios for medical students, there are also challenges to implementing it.
Preceding the draft guidelines issued, there were certain challenges associated with the NExT examination, Dr Krishnan voiced, “There is a lot of chaos and confusion among the students about the pattern of the examination, about whether it would be a subjective kind of or objective, about the subjects covered, the patterns and everything. The validity of the practical examination and the number of marks that will be concluded is going to be a serious issue. Also, we have to maintain an impartial and very transparent education system. So, it is going to be very challenging, but it’s a new step and if done properly, it may help.”
The NExT PG exam will act as a common final-year undergraduate medical examination for all medical students including foreign return medical graduates, the number of students appearing for the exam with the number of medical seats available becomes a challenge. Dr Krishnan suggested that in many countries, all medical examinations happen twice a year. And this should be the norm. We have raised this issue that the examination should happen twice a year because earlier we were having different kinds of examinations happening for the same entrance. So I’ve also been telling this for a long time that students should be given two chances to enter into postgraduate courses.”
The draft guidelines issued mention there shall be regular NExT Step 1 examinations held once a year prior to the University Practical Examination for the III MBBS (Part2)/Final MBBS preceding compulsory rotating internship. A NExT Step 1 supplementary examination shall be held once a year and is restricted to only those candidates who have failed in one or more of the six papers and are required to repeat those particular papers /subjects.
What students say
Lack of clarity and misinformation about the NExT PG exam kept the students confused and concerned. Shivani M, MBBS fourth-year student, Mahavir Institute of Medical Sciences, Telangana stated, “There is no sufficient time to prepare for the exam and we don’t even know what exactly the pattern is, also as NExT exam is of two parts if people don’t qualify even in part-1 they will not get chance to do internship due to which there will be a lag in getting a degree.”
Echoing Shivani M’s sentiments, R Bharath Naik, MBBS fourth-year student, Mahabubnagar Govt Medical College, Telangana highlighted, “Previously, the students used to appear for Neet PG exam once after the end of their internship, which gives them a lot of time to prepare and get exposed to patients in the hospital making it easier to understand and improvise the subject more thoroughly, but this is not going to happen in this NExT exam. He also mentioned, “Instead of the NExT exam with two steps, if the government improvises the Neet PG exam with a better pattern it would be great for the medical students.”
Keerthana, MBBS fourth-year student, Chalmeda Anand Rao Institute of Medical Sciences, Telangana said, “We need a lot of clarity regarding many things about the exam. Also, as the sources said that we would be having a mock test to get hands-on with it and inculcate the process of this new exam, we request more details regarding this as well. Currently, we are in a confused state with a lot of questions and little time.”
As there was a delay in issuing the guidelines, the lack of time and lack of knowledge about the pattern of the exam was becoming a huge barrier to medical students, Dr Mathur advised, “The curriculum is the same across every college in the country. They are more or less the same textbooks that we all read. So if students keep reading them as per their MBBS curriculum demands, if they keep on preparing that way, then I am sure they would excel in the NExT exam too.”
The delay in issuing guidelines created a state of chaos and confusion for students and academicians alike. There were several questions unanswered in relation to the examinations, which have been clarified post the issuing of draft guidelines on December 28, 2022. The feasibility and acceptance will depend on the implementation and the challenges that students and institutions face in the coming months. Hopefully in the coming months, the NMC will address the several challenges that are voiced by institutions and students without delay and provide guidelines timely in implementing NExT PG.