NExT exam or Final prof? Study sheds light on students preferences

New Delhi: While there is still no clarity regarding when the National Exit Test (NExT), the proposed licentiate and entrance test, might be held, a recent study revealed that only 31% of the students across the country are aware of the entire pattern of the NExT exam.

The study also revealed that the majority of medical students prefer NExT to serve as an exam for post-graduate entrance competition but not the third professional part 2 (final year) theory exam. Medical students participating in the study preferred NExT Step 1 to be conducted every 6 months as a 1-day exam of 3-hour duration. "Most students want no attempt limits. Majority further prefer at least three mock tests to be conducted annually. Students prefer 100% MCQ-based examination for theoretical university professional exams for better alignment with the entrance exam pattern. They also opine that NExT Step 2 should be conducted by NMC after completion of the Internship," the study results stated.

The study conducted by ten doctors across the country was published in the Medical Science Educator journal. It revealed that among the total number of 729 students, who participated in the study, 504 i.e. 69.1% students believed that NExT Step 1 shall serve as a PG entrance exam, and 380 i.e. 52.1% students believed that NExT Step 1 shall be a medical licensing exam, while only 314 i.e. 43.1% students believed that NExT Step 1 shall be conducted as the Third professional Part 2 (Final Year) theory exam.

Almost all the students who participated in the study opined that conducting a mock test similar to NExT Step 1 would be beneficial. 80.7% of the students expressed their opinion that if the theoretical University Professional exams are turned into 100% MCQ-based examinations, it would help their preparation for competitive exams like NEXT Step 1.

The research concluded that the medical students prefer NExT Step 1 to be conducted every 6 months in the form of a 1-day exam of 3 hour duration. It also noted that regular feedback from all stakeholders, including students, was necessary for proper implementation of the new exam, and real-time modification of the exam pattern must be undertaken in the long run once the exam is rolled out.

Research for the study, 'Perception of Indian Medical Students Towards University Exams and Proposed Licensure and Post-Graduate Specialty (Residency) Entrance Examination (National Exit Test), was conducted over four months on the medical students admitted to Indian Medical Colleges between 2018 and 2022. Those students, who dropped out of the colleges, were excluded from the study.

The researchers include MBBS students, interns, and PG medical students from various medical colleges in Delhi, Chennai and Andhra Pradesh's Amalapuram. A medical student at WMU School of Medicine, Kalamazoo, Michigan, USA was also one of the researchers.

Acknowledging that there is a gap in the existing literature for understanding student's perspectives on the proposed change in the examination patterns (from NEET PG & University Exams to NExT), the study aims to analyse the perspective of Indian medical students towards this change.

Test Results: 

Altogether 729 students (including 431 males) participated in the Study and they belonged to medical colleges across six regions- North, North East, Central, South, East, and West. While most of the participants (37.6%) were from the first professional year, the least i.e. 6% were from the internship year. The students recorded their responses to a pre-tested and pre-validated questionnaire comprising 25 questions to assess the knowledge and perception of medical students about the university exams and NExT.

"...despite being the major stakeholders, students have to date been largely left out of the decision-making processes and guidelines regarding the NExT examination, leading to increased distress and resentment," recorded the study.

After analysing the answers to the question if they were aware of the entire pattern of NExT exam, the researchers found that only 226 i.e. 31% students were aware of it. 

40.9% of the students suggested having more than three mock tests and majority of the students i.e. 70.2% of the students preferred conducting the NExT Step 1 exam every 6 months to improve on their previous scores. The researchers found that most students opted for a 1-day exam of 3 hours of duration. Most of the students i.e. 36.2% students wanted the exam to only comprise clinical subjects while a sizeable number i.e. 32.4% wanted to include para-clinical and non-clinical subjects as well.

As per the student, around 60.2% of the students participating in the study favoured having no attempt limited and only six students preferred a single attempt limit. Most of the students i.e. 67% found final year theory exams to be redundant given NExT Step 1 being introduced. 

Students were equally divided on NExT Step 2 being a practical exam as 50.1% of the students believed that it is necessary as a post-internship exam in addition to the university practical exam conducted in fnal year (before internship). They also wanted NExT Step 2 to be considered a practical exam for the final year as this opinion was expressed by 68.7% of the students. Meanwhile, 75.9% of the students believed that it should be conducted after completing the internship. Most students i.e. 57.8% wanted the NMC to conduct the NExT Step 2.

The distribution of preferences regarding the purpose of the NExT was more or less uniform across students from different years of study — 63 to 74% wanted it to serve as a postgraduate entrance exam; 51 to 55% wanted it to be a medical licensing exam; and 52 to 68% wanted it to entirely replace the third professional part 2/final year exams.

Meanwhile, the distribution of preferences regarding subject inclusion, on the other hand, varied across different years of study- most first professional students i.e. 34.7% and interns 43.2% preferred a mix of clinical, para clinical, and non-clinical subjects whereas second, third part 1, and final year professional students (47, 41.6%; 76, 42.9%; and 48, 39.7%, respectively) preferred the exams comprise clinical subjects only

After analyzing the data, the researchers concluded that majority of the students are unaware of the examination pattern and its purpose as an entrance or a licentiate exam.  

"We have found that the current dominant pattern of examination, with long answer type questions, does not align with the preference of medical students, who prefer clinical and multiplechoice questions. The diference in patterns has historically been one of the causes for increased stress amongst medical students as they prepare to sit for their fnal year and postgraduation exams, and our study further emphasizes the need for alignment of the two patterns," the researchers noted in the study.

"Students, however, conclusively agreed on wanting the NExT Step 1 to be designed as a 1-day exam lasting 3 h, being conducted every 6 months. In total, 60% students preferred no attempt limit(s) for NExT Step 1. It can be inferred that the students prefer a 1-day exam rather than a 3-day tedious exam to decrease burden. Also, a 6-monthly exam might remove the undue pressure of losing an entire year. If we consider these aspects and preferences expressed by students (which are a defnite possibility for implementation), the impact can be an overall well-being of the students," they further mentioned.

"They also want regular mock tests simulating the exam to be held which can be utilized by the students as practice-cum-self assessment exams to allow better preparedness before appearing for the high-stakes NExT exam. These mock exams can follow the pattern of the self-assessment exams conducted by the National Board of Medical Education (NBME) in the USA for medical students appearing for USMLE, which can be purchased by the students," further mentioned the study.

The researchers concluded that regular feedback from all stakeholders should be sought before the exam is implemented. They also recommended conducting briefing sessions for not just students, but also the faculty, so that teaching in medical institutions can be aligned with the exam.

'It is imperative to provide adequate time between the announcement of the exam and its frst implementation so that students have time to familiarise themselves with the pattern and prepare without anxiety. Finally, once the NExT exam is implemented, continuous feedback gathering and monitoring must persist without interruption. The true measure of the exam’s long-term efectiveness and appropriateness can only be assessed in real-world contexts," they concluded.

NExT Controversy:

Recently, in response to a Right to Information (RTI) application, the National Medical Commission (NMC) informed that the implementation and preparedness for the NExT exam is being examined by a committee constituted by the Directorate General of Health Services (DGHS).

Also Read:Is NExT exam happening? NMC says Implementation, Preparedness being examined