NExT exam divides medical fraternity: Immediate rollout or phased implementation?

New Delhi: The National Medical Commission's proposed common exit -licentiate examination, i.e., the National Exit Test (NExT), is yet to see the light of day. Amid this, a fresh debate has emerged within the medical community over the exam's necessity and timing of implementation.

While a section of doctors have sought the implementation of NExT examination for MBBS students, some have expressed concerns regarding the immediate rollout.

NExT was introduced through the National Medical Commission Act, 2019, as a common exit-licentiate examination, which will replace three existing exams- the final MBBS exams, the National Eligibility-Entrance Test for post-graduate seats (NEET-PG), and the Foreign Medical Graduate Examination (FMGE), the screening test for the medical graduates from abroad.

Editorial Stresses the Necessity of NExT to Reform the Existing Medical Education System:

In an editorial published last month in the Journal of Family Medicine and Primary Care, titled "Immediate NExT rollout is vital for MBBS students and the medical education ecosystem of India", medicos, resident doctors and faculty associated with the departments of medicine, gynaecology, psychiatry, paediatric surgery from institutes such as AIIMS New Delhi, AIIMS Nagpur, AIIMS Patna, and RML have sought implementation of the National Exit Test- arguing that the exam may enhance validity and reliability of assessments, support student learning, increase institutional transparency, and contribute to the development of a competent medical workforce.

The authors of the editorial have highlighted the shortcomings in the existing university final examinations and postgraduate entrance tests. "University-based MBBS final examinations differ widely in quality, validity, and fairness across institutions. Theory exams remain largely subjective, content may not uniformly map to national competencies, and evaluations vary across states and universities. This creates inconsistency in determining whether a graduate is adequately prepared to practice medicine," they argued.

Regarding the PG entrance test, the doctors and MBBS medicos pointed out that such tests rely on a relatively small pool of 200 MCQs to sample an entire MBBS curriculum. Therefore, the authors opined that such limited sampling reduces reliability and increases the role of chance. They also argued that emphasis on recall-based questions encourages coaching-driven preparation rather than clinically meaningful learning.

Further, they pointed out how the students currently have to prepare for multiple examinations of different format- final University examinations, PG entrance exam, etc.

The doctors opined that "A national exit examination is not merely a change in format; it represents a significant reform toward a more clinically oriented assessment, with an increased number of questions that are uniform for all students, thereby enhancing both learning outcomes and standards of doctors in our country."

According to the authors, NExT examination will have enhanced validity through better curriculum alignment as NExT Step 1 includes a larger MCQ pool built primarily around clinical vignettes and applied reasoning.

The reliability of the exam will also be better through larger question sampling. Apart from this, Step 2 of the NExT examination will objectively assess clinical skills and ultimately NExT will set a fair and uniform standard for all graduates.

"A national exit examination is not merely a change in format; it represents a significant reform toward a more clinically oriented assessment, with an increased number of questions that are uniform for all students, thereby enhancing both learning outcomes and standards of doctors in our country," the doctors said in the editorial.

"NExT applies equally to students from government medical colleges, private and newly established institutions, and foreign medical graduates (FMGs). By assessing all candidates through the same national standard, it strengthens public confidence in medical training and ensures that every licensed doctor demonstrates a uniform threshold of competence, regardless of where they received their education," they added.

Further, the editorial opined that a unified test instead of many examinations will ultimately reduce the burden on students of preparing for multiple examinations with different formats. The authors also opined that NExT will promote consistent learning rather than shotcut methods of MCQs solving and it will also reduce stress on students through transparent, and structured evaluation.

"A uniform national benchmark will allow colleges, especially newer and private institutions, to demonstrate their training quality through measurable student outcomes. This might shift public perception from reputation-based subjective judgments to objective performance-based comparisons. Institutions that invest in quality teaching can rapidly gain credibility," the authors of the editorial opined.

"The strengthening of medical education requires robust and valid assessment systems. Experiences from engineering, management, and dental education over the past two decades illustrate how rapid expansion without strong evaluation mechanisms can compromise quality.[9] Many institutions in these sectors lacked rigorous student assessment processes and gradually became degree-granting centers rather than environments that foster meaningful learning. The closure of several such colleges highlights the long-term risks associated with expansion in the absence of credible quality assurance," they further added.

In order to ensure a smooth rollout and minimize apprehension, the doctors opined that comprehensive preparatory support should be provided, including multiple mock tests, sample questions, workbooks, and detailed syllabus material. They also opined that during the initial years, the students may be permitted to attempt only a fixed proportion of questions in NExT Step, for example, 540 out of 600 to ease the transition while preserving the examination’s validity.

Concerns over Immediate Implementation of NExT:

Meanwhile, the Federation of All India Medical Association (FAIMA) has expressed serious concern regarding the possibility of an immediate implementation of the National Exit Test (NExT) across the country.

Speaking to Medical Dialogues, the Chief Patron of the Association, Dr. Rohan Krishnan, clarified that FAIMA is not opposed to reform and it recognises the need for standardization, transparency, and quality assurance in India’s medical education system. However, he opined that the timing, structure, and preparedness for NExT raise significant and legitimate concerns.

Pointing out that reform must address root causes and not create new burdens, Dr. Krishnan added, "The challenges in medical education today are well known—uneven clinical exposure, faculty shortages, and infrastructure gaps across institutions. Introducing a centralized exit examination without first addressing these systemic deficiencies risks placing an unfair burden on students, without meaningfully improving competency."

"India already has a competitive and merit-based system in the form of NEET PG. The introduction of NExT, in its current form, effectively replaces one high-stakes examination with another—without reducing stress, uncertainty, or redundancy. Instead, it risks further intensifying the exam-centric culture in undergraduate medical training," he added.

Dr Krishnan highlighted the risk to clinical training and patient-centred learning and mentioned, "Medical education cannot be reduced to a single high-stakes theoretical assessment. There is a real and present danger that NExT will shift student focus away from bedside learning and patient interaction toward coaching-driven preparation. This undermines the very essence of clinical training and could have long-term implications for patient care quality."

Apart from this, he also pointed out that repeated changes, lack of detailed guidelines, and uncertainty regarding the examination pattern, scoring, and implementation timeline have created anxiety among medical students nationwide. Therefore, he expressed that any reform of this magnitude must be preceded by clear communication, pilot testing, and stakeholder consultation.

He has urged the policymakers to adopt a phased implementation strategy, including pilot testing across selected institutions, parallel runs without immediate high-stakes consequences, structured feedback from students, faculty, and medical bodies, alignment of undergraduate teaching methodologies before rollout.

"Reform in medical education must be thoughtful, inclusive, and evidence-based. An abrupt implementation of NExT, without systemic readiness, risks doing more harm than good," he added.

Similar opinions have been expressed by Dr. Meet Ghonia, the National General Secretary of the Federation of Resident Doctors Association (FORDA). When asked his opinions on the immediate implementation of NExT exam, he told Medical Dialogues, "NExT is a necessary reform for the future of Indian medical education, but its immediate implementation without adequate preparation risks undermining both its objectives and student confidence. A phased, transparent, and well-tested rollout would be far more effective than abrupt enforcement."

Dr. Indranil Deshmukh, the National Secretary of the Indian Medical Association Junior Doctors Network (IMA-JDN), appreciated the efforts taken by the Government of India and the National Medical Commission in reforming medical education in the country, adding how such steps have been progressive and aimed at improving the overall quality and credibility of our healthcare system.

However, he also highlighted the concerns raised by the doctors regarding NExT exam. He mentioned, "While the idea of having a uniform benchmark is well-intentioned, the ground reality across medical colleges in India is quite varied. Nearly half of the medical colleges have come up in the last 10- 15 years, and the level of infrastructure, teaching, and clinical exposure is not uniform everywhere."

"There is also a fundamental issue in combining a licensing exam with a postgraduate entrance exam. Both serve very different purposes, and merging them into a single exam may not be the most appropriate approach. If a common licensing exam is introduced, its pattern and intent should ideally remain distinct from that of a PG entrance test. There is a concern that, in the absence of uniform standards, a high-stakes national licensing exam may create uncertainty among students who are on the verge of becoming doctors. This could lead to frustration and may even discourage future aspirants from pursuing medical education, especially in newer institutions," he added.

Highlighting the need to consult wider stakeholders, he mentioned, "We humbly request the authorities to undertake wider stakeholder consultations involving the Indian Medical Association and the IMA Junior Doctors Network."