The Union Health Ministry recently issued the draft Indian Medical Council (Amendment) Bill 2016 which seeks to make a National Exit Test (NEXT) mandatory for MBBS passouts 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.
As regards the National Exit Test, I have already penned a couple of write-ups expounding on the pros and cons of it, and how it needs to be shaped so as to be of maximum benefit in our setting. Now that the idea of it is finally out of the sphere of speculation, and is about to manifest — I believe I should discuss on some very pertinent aspects of this proposed ambitious step towards reforming our medical education.
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. There shall be conducted a common counselling for admission of candidates to all medical educational institutions at the undergraduate level and postgraduate level.
3. Upto 50% of the seats in Post Graduate Courses in Government Medical Colleges may be reserved by the appropriate 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, the Medical Officers may further be required to serve for a period of 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 be able to live up to its purpose of assuring adequately competent physicians, the exit test has to be much more rigorous than what we have conceived thus far.
To imagine the demands an exit test should place to be a worthy one would take us to visualize what the making of a doctor actually involves. Medicine is an art that is mastered over years of instruction and even further 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 (United States Medical Licensing Examination) and PLAB (Professional and Linguistic Assessments Board) counterparts.
Moreover, we need to be really serious here, as much as it provides a great opportunity to, about making our exams more understanding — and concept — oriented, rather than the descriptive skew we see 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 — and the way the current exit test is being envisaged as just another objective type exam, I am dubious about it carrying any more value than a plain rhetoric.
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, and 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 burden of the already burdened medical students. Instead, individual medical 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 optimize their standard of instruction. Even though it might sound 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.
The proposal on a 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 look up 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 — and 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 admittedly detrimental from an academic standpoint. Why doctors are loath to work as medical officers, which are 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 as medical officers, who are not only inadequately competent as doctors but receive no formal training in administration, 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 its plan to introduce the National Exit Test, and it ought to be so. Any addition of whatever obstacle 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 standardizing our medical education but also in making medicine more fulfilling and meaningful as a journey.
Dr Soham D Bhaduri is a medical doctor and philosophy of mind enthusiast, and takes keen interest in topics pertaining to mental health and medical education. He blogs at The Free-Thinking Medic.
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