Reconsider implementation of National Exit Test: IMA to NMC
New Delhi: Opposing the National Medical Commission's (NMC) plans for conducting the National Exit Test (NExT) for medical graduates, the Indian Medical Association (IMA) has opined that since the standards of medical education across all academic institutions vary, testing the entire country with one test would not be "feasible".
In a letter addressed to the Chairman of NMC, Dr B.N.Gangadhar, the association has highlighted that the medical colleges across the country are facing inadequate technical infrastructure, and faculty training and support. Therefore, IMA has stated that NMC should not proceed with NExT until these prerequisites are duly satisfied.
"Implementation of NEXT without proper evaluation of its potential benefits, limitations and impact on medical education is gross injustice to medical students, because even after completing the course they would be deprived of their right to practice medicine. Adequate technical infrastructure, faculty training and support are required in all medical institutions across the country. It may be noted that 349 colleges were given notice for Faculty deficiencies in 2023-24 and 40 medical colleges were derecognized in last 2 months. Limited access to resources may hinder the equal distribution and adoption of NEXT across all medical colleges," IMA mentioned in the letter dated 06.02.2024.
"In light of these stipulations, we assert that NExT should not proceed until these prerequisites are duly satisfied," the letter further mentioned.
Medical Dialogues had earlier reported that after postponing the National Exit Test (NExT) for an indefinite period, recently the Apex Medical Commission asked the stakeholders to submit their feedback on the NMC National Exit Test Regulations, 2023, by 07.02.2024.
Stakeholders were asked to submit their opinion on whether the NExT exam should replace the conventional MBBS final year exam, held separately in addition to the MBBS final year exam, or be conducted in any other manner.
Accordingly, on 06.02.2024, IMA wrote to the NMC Chairman and expressed that the Indian Medical Association has very serious reservations about the concept of NExT. "IMA is convinced that Medical Education in India will be jeopardised by introducing NExT," mentioned the letter.
The association opined that the NExT defeats the vision of the Prime Minister and the Government of affordable and accessible medical education as it hampers the survival of medical institutions in under-privileged communities and situations.
"We can't afford to train Doctors and deny degree to practice. It may be noted that only around twenty percent of candidates had secured more than fifty percent marks in the NEET PG exams in previous years. IMA feels that India's time-tested method is the best and blindly emulating Western countries will not be in the best interest of our country," highlighted the Commission.
Further referring to the varying standard of medical education across the country, IMA opined, "Currently uniform standards of medical education across all academic institutions does not exist and testing entire country with one test would not be feasible."
Apart from this, the association has highly criticized the use of the same exam to test the basic minimum required for licensing and the highest standards required for the post-graduate entrance assessment. Terming it "illogical", the letter added, "NEXT cannot be conducted both as a licentiate exam and a PG entrance exam, as the focus of the licensing exam should be on assessing the minimum standard while that of the PG exam should be to select the most meritorious students."
Referring to the suggested format of MCQ-based test, IMA opined that it will only decrease the attention and interest of students in the classes and clinics and help in mushrooming of coaching centres which are already threatening the medical education systemn in the country by patronising only the rich and affordable classes.
IMA opined that this will also seriously hamper the academic and clinical skills of the students and thereby deprive the citizens of good health. The association mentioned that covering entire syllabus in 6 months is an extremely difficult task for any student. "MBBS Students without License would be reduced to 12th pass after so much of time, money and studies," IMA highlighted in the letter, adding that the Universities should not be deprived of their right to award medical degree.
The association has demanded extensive discussions with IMA and other stakeholders, as and when NExT gets planned. As per the association, the following matters need consideration at that stage:
1. The establishment of passing criteria that strike a balance between accessibility and the preservation of academic rigor.
2. The initiation of comprehensive stakeholder consultations, followed by a trial period to address potential concerns.
3. The adoption of an assessment methodology that ensures equitable evaluation, accommodating the diverse demographics of our student body.
4. Any change in Medical Exam system, has to be from Fresh Batch after proper notification and making them understand clearly about the pattern
Feedback from IMA:
IMA opined that the core component which needs to be primarily examined is whether the entire proposition of NEXT is in conformity with the operational mandate as is brought out in Section 15(1) of the National Medical Commission Act, 2019, which mentions:
"15(1) A common final year undergraduate medical examination, to be known as the National Exit Test shall be held for granting licence to practice medicine as medical practitioners and for enrolment in the State Register or the National Register, as the case may be."
Further referring to section 15(2) and section 15(5) the association highlighted that a plain reading of the aforesaid provisions inevitably makes one conclude that a single final Undergraduate Medical Examination would be serving the purpose of licensing as well as admission to postgraduate courses in broad specializations in various medical colleges that come under the ambit of the provisions of NMC Act, 2019 or any other law in force at the given point of time.
IMA mentioned that in the context of section 15(1) of the NMC Act a grave error of legal wrong stands committed in as much as the final MBBS examination of the MBBS programme in case conducted by any authority other than the examining/affiliating University, cannot be computed by the said examining University for the purposes of conferment of the MBBS Degree, as the same would be in contravention of the binding inclusions in the Indian Medical Universities Act, 1960 read with the University Grants Commission Act, 1956.
"The said anomaly is palpable in as much as that all the First Professional, Second Professional, Part-1 and Part-2 of Third Professional Examination would be conducted by the examining / affiliating University on the strength of which the learner would be entitled for the conferment of MBBS degree. However, the material question is the proposed scheme stipulates two examinations styling it as fourth professional examinations in two parts designated as ‘NEXT-I’ and ‘NEXTII’ respectively of which NEXT-I would be a common examination on the basis of MCQs to be conducted by the designated authority / the National Medical Commission in accordance with Section 15(2) of the Act and clearance thereof would entitle the examinee to go ahead for his / her one year rotating internship," mentioned IMA.
After the internship, the examinee would have to appear in NEXT-II examination where the assessment of the psychomotor skill would be conducted by the examining/affiliating University which would be the licentiate examination and the clearance would be the basis for his/her entitlement to be included in the State or the Indian Medical Register. NEXT-I would be availed for admission to PG Courses in broad specialities.
Highlighting that the NEXT exam is split into two parts- NEXT-I and NEXT-II respectively, IMA questioned, "How is it and under what mandate it has been named as Fourth Professional Examination, which otherwise is also outside the ambit of the conferment of degree from the point of view of its consideration. What is the validity of NEXT-II being conducted by the same examining / affiliating University which has already cleared and certified him on the very count one year ago."
"Imagine a situation where in the very University the learner passes Third Professional Examination successfully and is entitlement for the conferment of the degree but the very University does not find him to be fit for passing one year later thereto in NEXTII? All these situations and many more are nothing but a consequential creation of non-application of mind and sole attempt at hiding the wrong that has already crept in framing of Section 15(1) of the NMC Act, 2019," mentioned the association.
Referring to the Section 15(2) of NMC Act, 2019, IMA pointed out that the said mandate requires that NEXT will be conducted by the Commission. However, the association questioned "...how is it NEXT-II is required to be conducted by the examining / affiliating University. Where is the mandate for the said dispensation?"
"Contemplate a situation where the learner clears NEXT-I, completes his internship but fails in NEXT-II and therefore is not eligible to seek the registration with the State Medical Council, then what has he achieved with clearing the NEXT-I. Such a chronology so badly ill conceived without authority and jurisdiction is nothing but playing havoc with the fate, future and the lives of the young learners," it opined.
In respect of the scheme of the examination, IMA mentioned that in terms of the Notified regulation that has binding effect and that mandates that 'Theory and Practical Clinical and Viva Voce' are separate heads of passing. Any examinee can clear the Third Professional Part-II examination exclusively and after clearing the Part-II Third-Year exam, the student would be eligible for NEXT-I exam, conducted by NMC, in the month of March. Those who fails the Third Professional Exam would get an attempt in terms of a supplementary exam held in February.
At this outset, IMA questioned, "...the examinee who has passed Third Professional Examination both in Theory and Practical alone in terms of the prescribed scheme of examination and binding regulation thereto is entitled to commence his / her rotating internship by seeking provisional registration with the concerned State Medical Council. However, in the present instance the learner is made to begin with his internship after NEXT- Part-I without his examination in Practical Clinical and Viva-Voce which would be held after his / her completion of internship in the form of NEXT-II which would be exclusively conducted for skill assessment by the concerned affiliating / examining University. The premise of letting a learner do his internship without certification of his clearance in practical clinical and viva voce is untenable because such a person would not be entitled to procure his / her provisions registration with the State Medical Council and on the very ground would not be entitled to do his internship for the want of provisional registration."
Another dichotomy that IMA highlighted is that an examinee in terms of the present stipulations in the governing regulations would be declared as clearing the Third Professional Part-II examination by the examining University exclusively on he / she clearing the theory and practical examinations separately of the concerned subjects.
"It is a binding rule that an examinee who has availed an examination with the University and has been declared as ‘Pass’ thereto is barred from taking the same examination not only by the concerned examining University but by any other statutory University in the country. The said binding rule disentitles the learner to take NEXT- Part-II examination by the examining University that has declared him already Pass in the very examination of Part-II of Third Professional Examination," IMA mentioned.
Referring to the proposed scheme for a supplementary exam for those who fail in the Third Professional Part-II exam, the association pointed out that the availability of such supplementary exam in respect of NEXT Part-I and NEXT Part II have not been indicated in the scheme in any manner.
"As such the entire scheme is not only a bundle of contradictions, impossibilities, untenability and inconsistent with the binding provisions of the NMC Act, itself but it also makes the mockery of the entire medical educational system and the binding governing stipulated procedures in the Universities in the country in terms of the stipulations included in University Grants Commission Act, 1956 as well as Indian Medical Universities Act, 1916," mentioned IMA.
"It is difficult to comprehend because the present proposed scheme conveys a picture as if the provisions of the NMC Act 2019 have an overriding effect over the University Grants Commission Act, 1956 and Indian Medical Universities Act, 1916, which is evidently erroneous. As such the very edifice on which the proposed scheme of NEXT is formulated is full of contradictions, fallacies and seems to have been made without any understanding of educational system as in vogue and is more of an imagination in wilderness. In nutshell it is an open invitation unconditionally extended to impending disaster to rule the roost," it further opined.
Also Read: How will NExT be conducted? Feedback from stakeholders invited by NMC
The NExT Dillemma:
The issue of the NExT exam has been making waves in the medical fraternity ever since its first announcement. Although last year NMC released the NExT regulations and announced conducting the exam for the 2019 MBBS batch, it was ultimately put on hold for an indefinite time.
Medical Dialogues had earlier reported that NMC NExT Regulations, 2023, were published in the official Gazette on June 28, 2023. "These Regulations shall come into force at once from the date of their publication in the official Gazette," mentioned the apex medical commission.
In fact, a mock test for NExT exam was scheduled to be held on July 28 and it was decided that the All India Institute of Medical Sciences (AIIMS), New Delhi would conduct the mock test.
However, opposing the decision to conduct the NExT exam for the 2019 batch, the students and doctors termed it to be a violation of the NMC Act, 2019. Referring to the 2019 Act, the doctors pointed out that the 2019 MBBS batch started on August 1, 2019, i.e. the batch started before the publication of the NMC Act 2019. Therefore, the doctors argued that conducting NExT for the 2019 batch would be a violation of the NMC Act 2019.
Even though NMC had announced that the NExT exam would be implemented from the 2019 MBBS batch, the Union Health Minister Mansukh Mandaviya announced at an event at AIIMS Raipur that there will be no NExT Exam for the 2019 MBBS Batch and the exam will not replace the final MBBS examinations.
Consequently, based on the directions and advice of the Union Health Ministry, NMC deferred the NExT examination until further notice from the Ministry.
Later, the NExT mock test scheduled to be held on July 28, 2023, was also cancelled and since then there has been no intimation from the side of the NMC regarding the issue of conducting NExT, the common exit cum licentiate examination.
Thereafter, the Union Health Ministry has constituted a seven-member committee to look into the preparedness of States and medical colleges for the implementation of the exam for the final year MBBS students of the 2020 batch.
