The Union Health Ministry recently promulgated that a National Exit Test (NEXT) shall be made mandatory for MBBS graduates to become practising, licensed physicians. Those of my medical colleagues who might have followed my columns here and elsewhere would know how dear anything relating to medical education is to me. Now that the idea of the National Exit Test is finally out of the sphere of speculation, and is about to manifest, I want to discuss some very pertinent aspects of this ambitious step towards reforming our medical education.
To live up to its purpose of assuring competent physicians, the exit test has to be much more rigorous than what we have conceived thus far.
Now, the Indian Medical Council (Amendment) Bill, which brings in the idea of a nationwide exit exam, centres around the following three proposals:
1. NEXT would substitute the uniform entrance examination at the postgraduate level.
2. Common counselling shall be conducted for admission of candidates to all medical educational institutions at the undergraduate and postgraduate levels.
3. Up to 50% of the seats in postgraduate courses in government colleges may be reserved by the state governments/UTs for medical officers in the government services, who have served for at least three years in remote and difficult areas. After acquiring the PG degree, medical officers may further be required to serve for a period up to three years in remote and/or difficult areas by the state governments/UTs concerned.
I am going to concern myself mainly with the first one of these proposals.
To think that anything short of a single, nationwide assessment system can level a playing field as uneven as ours would be an utter waste of time. It is in fact astonishing that we've come a long way without such a system, while a rot has gradually and insidiously affected us from inside. I have reiterated time and again that exams, much like the rate limiting step of a chemical reaction, determine the course of learning and teaching. But to envision just another exam to be able to meet this purpose would be far too simplistic. To live up to its purpose of assuring competent physicians, the exit test has to be much more rigorous than what we have conceived thus far.
Medicine is an art that is mastered over years of instruction and decades of experience, and involves a humongous syllabus to say the least. A worthy exit test, therefore, has to be thorough and detailed enough to cover all of it in entirety. It should have sections devoted separately to preclinical and clinical subjects, and should include a practical skills assessment exam, just like our USMLE and PLAB counterparts. Moreover, we need to be really serious about making it more oriented towards assessing understanding of concepts, steering clear of the descriptive skew we see in our exams today. In this way, the exit exam could cultivate better learning practices and streamline our learning culture. Any plans for ensuring competency and transparency without attention to these aspects would be abortive. Unfortunately, the current exit test is being envisaged as just another objective type exam, so its value is dubious.
Unfortunately, the current exit test is being envisaged as just another objective type exam, so its value is dubious.
An analysis of such nationwide licensing-cum-entrance exams in other countries would throw light on another important aspect. An exit test of this sort would reduce university-level exams (not to be confused with college-level exams) to redundancy. The prudent step here would be to put an end to such examinations as we have at the university level. In the presence of a uniform, all-pervading assessment method as the exit test, university exams would only add to the load of the already burdened medical students. Instead, individual colleges and institutions should be accorded the autonomy to conduct their own periodic exams. We know that at times, autonomy is the only way to assure accountability, and this step would also directly meet the purpose of the exit test to force individual institutions to optimise their standard of instruction. Even though it might sound like a radical idea, saddling students with another highly decisive exam after multiple university exams would daunt anyone sane of mind, and only discourage prospective medicos from registering themselves in this journey.
I'm squeamish about the provision of 50% reservation for medical officers. It suggests that the government is trying to apply tawdry hacks to the problem of shortage of rural doctors.
The proposal for uniform counselling for UG and PG aspirants from around the nation is a welcome one. However, I cannot help but be squeamish about the provision of 50% reservation for medical officers. It only suggests that the government is desperately trying to apply tawdry hacks to the problem of shortage of rural doctors in India. We need to understand that such feeble inducements can only be short-term, rather inept fixes—a stable solution can never be founded on such formulations. The ministry in a way endorses a divide between UG and PG studies, which is detrimental from an academic standpoint. Why doctors are loath to work as medical officers—meant to be dignified administrative positions—should call for some serious brainstorming rather than planning for quick fixes. Leaving rural healthcare in the hands of freshly baked physicians— who are not only inadequately competent as doctors but receive no formal training in administration—as medical officers is a pretty serious topic deserving a separate article. I shall bar myself from going off on it here.
There has been a lot of ruckus and hullabaloo ever since the Health Ministry has unveiled the National Exit Test, and it ought to be so. Any addition obstacles into this already enervating journey would further tarnish its appeal, but certain practical reforms as a wisely structured exit test could go a long way not only in standardising our medical education but also in making medicine more fulfilling and meaningful as a journey.