National Exit Test (NEXT)

One of the key changes in the national medical commission bill is the proposed National Licentiate Examination (NLE), now approved to be amended to a National Exit Test (NEXT). This is aimed at ensuring a minimum quality standard for the nearly 61,000 MBBS (bachelor of medicine, bachelor of surgery) graduates India produces annually.

NEXT intends to ensure uniformity in quality of the MBBS graduates. However it may not achieve the objective of addressing the challenges of medical education because it risks reducing it to just another exam that does not deliver on what it aims to do.

The various challenges before NEXT are

• Standardisation to suit the diversity of the country.
• Reports suggest that NEXT is to become another MCQ (multiple choice questions)-based test, an often used model for standardized tests across country. This would not test any higher order of learning or clinical skills but the status quo final year MBBS exam will not lead to desired change.

International practices which can aid India in addressing the crisis

• India can take cue from the United States Medical Licensure Examination which has become more clinically applied over the years. The USMLE in all its three steps has added components of patient safety and quality improvement.
• The proposed United Kingdom Medical Licensing Assessment (UKMLA) aims to ensure that the graduate has the skills and competence to practice.

India can learn from the experience of these nations and develop a well thought process which is evolutionary not static.

A hurriedly implemented NEXT will make things worse and further alienate medical students who have been protesting for the past many months about sections of the proposed NMC. Steps must be taken to ensure that

• The NEXT should integrate and build on the internal mechanisms and framework of the MBBS course.
• Since NEXT will also act as an entrance to post-graduate programmes, it is important to make sure that it should not be easily gamed and provide fodder for the post-graduate medical exams coaching centre business.

NEXT has good intentions and purpose. Its not the intentions but it’s the implementation which makes the process redundant in India. It must be ensured that NEXT does not reduce to just another exam. [Reference]