National Exit Test is now mandatory for MBBS graduates

A uniform final MBBS exit examination called NEXT step 1 will be held in the country as well as for students graduating from outside India who wish to practise medicine here. Representation pic

Aiming to bring transparency, accountability and uniformity, the National Medical Commission, the apex body that regulates medical education and medical professionals in the country, has come up with a mandate on conducting compulsory NEXT (National Exit Test) exams for all MBBS graduates and Foreign Medical Graduates (FMG) while NEET (National Eligibility cum Entrance Examination) will continue for medical entrance. NEXT is to ensure that students clearing MBBS have mandatory practical internships and even theoretical knowledge before enrolling for licence to practice with the respective State Medical Councils.

However, Dr Vedprakash Mishra, Pro-Chancellor, Datta Meghe Institute of Medical Sciences (Deemed to be University), Nagpur, who was also Former Chairman, Postgraduate Medical Education Committee, Medical Council of India, New Delhi and Former Chairman of Academic Committee of Medical Council of India, New Delhi, counters the need for NEXT. mid-day in its report titled ‘Remove caps on age, attempts for MBBS students: NMC' (October 27), had highlighted the concern of the regulatory body on Indian students going abroad for medical education, a proposal to remove the age bar for entry to MBBS and lowering of fees at government medical colleges in the country.

"Interestingly, this will also ensure that only serious and qualified doctors get a chance to practice, which unfortunately is not the case at present. We are anticipating that the new norm may be implemented from the academic year 2023 once the Union Health Ministry and Government of India approve the same. A detailed study has been done on the same and our submissions have been made to the ministry, for doing the needful," said Dr Aruna Vanikar, President Under Graduate Medical Education Board, NMC, a 1980 MBBS batch Alumni of Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha.

Interestingly, Dr Aruna, along with three of her colleagues, Dr Vijayendra Kumar, Member (Full Time), Dr M Mintz, and Dr D Chakraborty, have worked together on their research paper, titled ‘Medicine and Society' in the National Medical Journal of India, published by All India Institute of Medical Studies (AIIMS).

Dr Aruna, said, "NEXT will be a mandatory test for both Indian and Foreign Medical Graduates (FMG), who want to practice medicine in India, which will have compulsory examination to test their practical skills (to be conducted by respective university) and theory (to be conducted by agency hired by NMC). This will bring in the much-needed transparency, accountability and uniformity, within the medical profession, which unfortunately is not the case today. Moreover, we have also seen that each state medical university has their own norms, while conducting medical examinations and the patterns would vary - for instance the exam pattern may be the same, but the manner in which it is conducted may vary. NEXT will bring in uniformity, across the country as far as medical education is concerned."

When asked to elaborate, Dr Aruna, said, "Implementation of the National Exit Test (NEXT) as per the NMC Act 2019, the NMC is to introduce a robust NEXT examination soon. The salient features of this test will be: a uniform final MBBS exit examination called NEXT step 1 for all students across the country as well as for students graduating from outside India who wish to practise medicine in India. The NEXT step 1 is mooted to be a multiple-choice theory examination in which all students will appear simultaneously.

"Indian students who pass in theory will appear for a university practical examination, and if declared successful, will start their clinical clerkship/internship in the colleges from which they graduated. Foreign students who are successful in the NEXT step 1 examination will have to take up an internship in designated hospitals/institutions. After being declared successful in internship, which will be certified by the mentors, all candidates will appear for the NEXT step 2 examination. These will be based upon the practical knowledge gained during internship," explained Dr Aruna.

She added, "The examinations will be conducted at the state health university levels or centres of excellence or standard medical education centres where previous facilities do not exist. The timelines and details for these examinations will be publicised widely. Successful candidates will then be enrolled in the state/ national medical register. Each doctor will have his/her unique identity. This examination system will usher in high quality and transparency in the system. Thus, FMGs, after being certified as medical practitioners in the countries where they pursued their medical graduation, will have to spend an additional 15-18 months to be qualified as registered medical practitioners in India."

And for those students who do not clear NEXT, they will get a chance to reappear. However, the entire duration of their MBBS course and clearing NEXT needs to be done within 10 years of their taking admission to MBBS, Dr Aruna explained. "Reviewing the poor performance of many FMG graduates over the years, the chance of dramatic improvement in the passing score with the introduction of NEXT is miniscule. The question about whether they can practise as registered medical doctors in India will always haunt these students and their families. The additional mental and economic stress incurred by them and their families is only likely to increase. When the ailment or disease is of a serious magnitude, the treatment also has to be radical," said Dr Aruna.

"Similarly, certain tough steps need to be taken to save public health and the future of the nation. These include capping of fees in all colleges/institutions with the support of Central and state governments, institutions, philanthropists and stakeholders, so as to make medical graduation more humane and worthy to be pursued. India needs high-quality doctors committed to the profession and not ‘substandard doctors' to deliver basic services to patients," she said.

When asked if the NEXT score would also be considered for postgraduate medical courses, Dr Aruna said, "An MBBS pass out is expected to watch surgeries, do suturing and dressing of wounds, and should be able to collect blood, counsel patients and relatives and even be able to write down clinical history of patients, which we used to practise during our learning phase at MGIMS, Sevagram. Unfortunately, we have observed that new generation medical students clear MBBS and immediately start preparing for the post graduation entrance examination NEET-PG and skip the crucial practical field work, was ignored completely by the previous authorities governing the medical education system in India, prior to inspection of NMC. Therefore, NMC has now decided to use the NEXT score for those intending to go for post graduation courses viz (MD, MS or DNB etc)."

"Aspirants for medical graduation and their families should weigh the pros and cons before taking up admission in medical colleges in Commonwealth of Independent states countries or neighbouring countries. In addition, to curb the exodus of aspirants of medical education outside India, consolidated efforts by the UGMEB- NMC and the health system at various government levels are needed to rejuvenate the health of the nation," she concluded.

'Impracticable and inconsistent with the statutory governing provision'

"In terms of the governing provisions of the National Medical Commission Act, 2019, National Exit Test (NEXT) is required to be put into place within three years from the date of NMC Act, 2019, coming into force. In terms of the proposition which has been brought out, the important aspect which needs to be taken note of is that NEXT is a common final MBBS Theory Examination which will be conducted on the basis of Multiple-Choice Questions (MCQs). The examinations will be conducted by an authority other than the examining university, wherefrom the learner has cleared his First, Second and MBBS Part-I Examinations in terms of the scheme prescribed in the Graduate Medical Education Regulation Notified by the NMC," said Dr Vedprakash Mishra, Pro-Chancellor, Datta Meghe Institute of Medical Sciences (Deemed to be University), Nagpur, who was also Former Chairman, Postgraduate Medical Education Committee, Medical Council of India, New Delhi and Former Chairman of Academic Committee of Medical Council of India, New Delhi, who counters the need for NEXT.

Dr Mishra added, "The material question is that practical examinations for final MBBS are required to be conducted by the examining university. This is dichotomous in as much as the university is required to confer the degree to the learner in terms of the governing provisions in the University Grants Commission Act, 1956. The degree can be conferred on an assessment which is exclusively conducted by the examining University. Here the dichotomy is that all examinations except the Final MBBS Theory Examination will not be conducted by the examining University, in absence of the required modification in the University Grants Commission Act, vide which the State Universities conferring the MBBS Degree, the Health Sciences Universities is conducting the MBBS Examinations, the Deemed Universities created under section 3 of the UGC Act and the All India Government Run institutions entitled to confer the degree would be required to be amended to the required extent."

"Further, in absence of the same the proposed scheme is impracticable, it is unheard of that the university is required to confer a degree on the strength of an examination the assessment of which has been done by another authority. Such a scheme is dichotomous in character in an unheard way. Further for the Foreign Medical Graduates (FMG) the same test and same modality would be applicable. It is difficult to decipher how the Foreign Universities where the required conduct of examination and conferment of the degree is under the jurisdiction of the universities concerned, the said provision would become applicable," said Dr Mishra

"As such, although NEXT is a welcome proposition except the modalities for the operationalization of the same need to be critically deciphered for their applicability, rest NEXT would turn out to be not only impracticable, inconsistent with the statutory governing provision but also dreads than the disease itself," Dr Mishra concluded.