Doctors Take on NExt: Good on idea, Tough on implementation

National Medical Commission (NMC) proposed a draft for National Exit Test and said that the objective is to bring uniformity in the summative evaluation across the country with reference to the minimum common standards of education and training of a medical graduate.

The union government is working to introduce the National Exit Test (NExT) as a medical licensing exam that is designed to assess the competency of medical graduates. NExT exam will be the substitute for the MBBS final year exam and FMGE exam which means the students who received their medical degrees from NMC-approved medical institutions and overseas students also will have to qualify for the National Exit Test.

 On December 28, 2022, National Medical Commission invited comments from stakeholders on the proposed draft regulations related to the test.

 Shiksha spoke to several stakeholders to know how they see the proposed draft and what to expect out of the upcoming National Exit Test.

 Dr Datta of AIIMS Delhi and also a former FAIMA member sharing his thoughts on NExT exam says: “I think NExT is a welcome move, the concept is good, what they want to do, the idea behind NExT was that they wanted us to focus more on the clinical side during the internship, right now what was happening is that during the internship, people were studying for the entrance exam, and hence they were not focussing on internship and were not learning a lot of clinical skills because of the tough competitive exam preparation." 

NMC’s NexT draft has flaws; Amendments needed

"However, the way NExT has been drafted is unacceptable due to many reasons and there are multiple problems with NExT. It should not be introduced retrospectively, right now the format is given, it should be introduced prospectively."

 "For people who are planning to join MBBS after the NExT exam is introduced and the curriculum is changed, it should be given only to them and not to the rest of the people who have given their professional year exams and now they are in their final year. They should not be expected to suddenly give NExT the next year because then they are not prepared for that. Once the entire curriculum is changed throughout the country then NExT is useful. The students must be well prepared for that.”

Medicos should get enough time to prepare for NExT

 "The second thing is if NExT is implemented from December 2023, which is this year, as per the draft, so whichever year it is implemented there will be less time available for interns as the NEET PG was held in March and they have only nine months time for the NEXT in December 2023. So, they will have to make a gradual schedule wherein there is one month decrease in the NEET timeline and then at the end of three years they can start NExT from December as they have proposed. By the time the new graduates who had joined the MBBS are aware of NExT they will be fully versed with the curriculum." 

Best NExt scores must be considered for calculating percentile

The third point is if a student reappears in NExT to improve his/her score, then the average score of his/her three previous scores will be considered. We are against this thing as it is an entrance exam and it can very well happen that on the exam day, the candidate falls sick or is unwell and he/she is not able to give the exam properly to the best of his/her potential. So, suppose in one exam the candidate gets a 90 percentile when the candidate was not well but in another NExT exam the same candidate gets 99.9 percentile, so if they will do an average it will come around 95 percentile. The candidate will still not get a good seat in any government medical college, even if they might be ranked one in the one second exam. That is very unfair. We want the best scores of the students to be considered average.

NExT basic idea borrowed from West

Dr Aviral Mathur, President of the doctors association FORDA says on the upcoming exam:

“They have proposed in the draft that they will replace NEET PG with an exam which is more holistic in its nature. Currently, postgraduate students are getting selected on the basis of a three-hour-long exam that has only 300 questions. These 3 hours and 300 questions are going to decide your life. In our profession one requires extensive practical knowledge. The approach and the basic idea behind NExT, NMC has borrowed which is already practised in the west.

USMLE (United States Medical Licensing Examination) has a similar outlay, PLAB is UK exam which has a similar outlay and Australian Medical Council conducts its exam in a similar manner."

 "Each candidate can appear only once and he has to choose his slot. So, the windows are quite broad compared to India. The Indian government has yet not published how they are going to conduct the NExT exam. Mostly, they will have to do it in collaboration with medical institutes and universities with which the college is affiliated.”

 "They are doing this in a way that is already being done in the west, they are conducting in phases, i.e. in two stages. They are saying that as MBBS is a vast course, there are subjects which are non-clinical, and pre-clinical and some are only clinical in nature. So, they are saying that let us segregate the examination, let us conduct the exam first for non-clinical or pre-clinical subjects and then conduct the separate exam for clinical subjects. Also, because they are trying to replace the final year MBBS exam, so they are going to inculcate practical and clinical exams in this exam. So, the overall structure on paper sounds balanced but there are some flaws about which we have written to the NMC that these can be considered.”

Implementation will be uphill task

 We welcome the idea and the overall intent behind this but we welcome the part where they asked the candidates to suggest the changes the most, said FORDA's president.

 This is the first time that for a medical exam, they have asked the students to suggest their own changes and how they feel that something should be altered. This is the first time this has happened and that window is closed now. They issued a circular in January that these are NExT regulations, these are rough guidelines and we plan to conduct an exam based on these but if you have some suggestions you can mail them to us. We were very happy that they took this kind of initiative. So, rather than the students complaining at a later stage, they can constructively intervene at this stage. However, we feel that the implementation is going to be an uphill task, he said.

 On the question that whether the medical fraternity is expecting the government to implement the suggested changes and if yes by when we will have some clarity, he said, “Yes, we think that they will take those suggestions into account because they have asked for it and students have submitted. So, we are hopeful that it will be taken into the account, whether they will imbibe it or not in the final draft is something which naturally is their decision.”

 Every university and student needs time to prepare for this new exam because they have to appear for the pre-clinical and non-clinical subjects. So, they will have to prepare for these subjects also. Currently, every MBBS student is reading only the subjects which are in that year. They are not reading the subjects of the previous year. So, at least a nine-month period for preparation is needed, added FORDA's President.

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