National Doctor’s Day | What’s NEXT? Future of Docs in India Remains Uncertain

Modifications to the medical education system is making students anxious about the new National Exit Test exam.

National Doctor's Day 2023: NEXT Exam, FMG, Future of Indian Medical Students

(Photo:  Arnica Kala/FIT)

Last week, the National Medical Commission (NMC), the apex body for the regulation of medical education in the country, ended months of speculation and uncertainty when they announced that the country's first National Exit Test (NEXT) exam for postgraduate medical entrances will be held from May 2024 onwards.

In a recent pan-India webinar meeting with the students and medical faculty of all the medical colleges of the country, the NMC tried to clear the confusion associated with the exams to the present MBBS final year students, who have, for months now, felt like they were left in limbo without any clear answers.

However, it did little to ease the minds of the students as many questions still remain unanswered and their future as doctors in India continues to hang by a thread.

What is NEXT?

To recap, NEXT is an all-encompassing common entrance exam proposed to replace the final MBBS examination, the National Eligibility-cum-Entrance Test-PG (NEET-PG), and the Foreign Medical Graduate Examination (FMGE).

According to the NMC's proposal, without clearing this exam, a medical student cannot register as a doctor to practice medicine in India. 

As per the present plans, NMC is going to initiate the newly designed exam pattern from 2024, with the mock test for the same being held as early as this year.

The commission has decided to bestow the responsibility of conducting the NEXT exam to AIIMS Delhi.

As per the official notification released by AIIMS Delhi,

"The National Exit Test is a two-part Examination: Step I and Step II. NEXT-Step I will be a Computer Based Test (CBT)."

What Are Step 1 and Step 2 All About?

The NEXT Step 1 exam will be conducted twice a year, and is proposed to serve both – as a final year MBBS exam as well as an entrance test for postgraduate admission.

The merit list for admission in broad specialty medical seats will also be framed as per the performance in this exam.

It will be composed of subjects including,

• Medicine (+ allied subjects)

• Surgery (+ allied subjects)

• Obstetrics (+ allied subjects)

• Paediatrics

• Ears, Nose, Throat (ENT)

• Ophthalmology

This step will be an objective test as opposed to the previously subjective final-year professional exams.

Dr Jagdish Chaturvedi, faculty of ENT at PhysicsWallah MEDED is of the view, "Clubbing a final year degree exam with an entrance test, the terms seem unreasonable & scary. Unfortunately innocent students will suffer."

What Happens In NEXT Step 2?

The NEXT Step 2, also to be conducted twice a year, is aimed at checking the clinical acumen of the MBBS graduates. It's still unclear who will be conducting this exam.

Step 2 of the exam would comprise:

• Actual cases

• Objective Structured Clinical Examination (OSCE)

• Simulations

Depending on the ability of satisfactory or unsatisfactory performance, there shall be only two levels of grades: competent (pass) and non- competent (fail).

The Internship Completion Certificate & the MBBS degree will both be awarded if the candidate passes the NEXT Step 2.

The subjects covered in NEXT Step 2 are:

• Medicine (+ allied subjects)

• Surgery (+ allied subjects)

• Obstetrics & Gynaecology

• Paediatrics

• ENT

• Ophthalmology

• Orthopedics & PMR

As of now, it is likely that NEET PG 2024 will be the last NEET Postgraduate exam for admission in broad specialty medical courses. From here on, it will get replaced by NEXT Step 1 which will serve as an entrance test for postgraduate admissions.

What About Foreign Medical Graduates?

The FMGE, which serves as a licentiate examination for practicing modern medicine in India by foreign graduates, will also get replaced by NEXT Step 1.

FMGE graduates need to pass the Step 1 exam to register themselves in India.

Will the FMGE be held in December this year? The answer is in store with the NMC only and they will notify it later.

As for the mock tests being conducted in the coming month by AIIMS, FMGE graduates will not be eligible to appear for them.

High Costs & Confusion Still Prevail

In most of the universities across India, final prof MBBS is scheduled to be held in November and the upcoming months. With confusion still prevailing on the layout of exams and the sudden changes in schedules, most students are finding themselves in a chaotic state of mind.

The NMC though tried to clear the air, a majority of the students are still in a dilemma regarding Step 1, Step 2, University practical exams, and the entire procedure associated with the MBBS degree course.

On top of that, many are outraged by the exorbitant fees being charged for the mock tests that are currently being conducted.

Dr Dhruv Chauhan, zonal co-ordinator of the Indian Medical Association, MSN, wrote on Twitter, "2000 rupees for a mock test on NEXT exam is being charged which was nowhere mentioned in NMC webinar. This uncertainty of new exam is stressing & cherry on top is such an expensive price for a mock test is astonishing."

Dr Shankul Dwivdedi, from IMA-JDN adds, "The NEXT exam though will try to discourage rote learning but at the same time it will heavily increase students' dependence on different coaching platforms from first year MBBS itself. High fees being charged for mock will fill the pockets of exam conducting body & give students an undue burden."

Only time will tell the far reaching consequences of the proposed changes in the medical education system in the country, though the frenzy and uncertainties associated have left the affected students deeply frazzled.

How Can The Process Be Eased?

The criticism isn't against introducing a new, potentially more efficient system of examination, rather that things could have been handled better.

If changes are brought up in a step-by-step manner taking all the stakeholders in confidence, especially the student fraternity who will be taking charge of the medical ecosystem in the coming years, a lot of anxiety and uncertainty could have been avoided.

On one hand, the NEXT Exam and its proposed objectives are aimed at checking the clinical acumen and skills of the medical graduates but on the other hand there is a push from many sides to introduce bridge courses and integrative medicine therapy which is a non-scientific idea.

Nevertheless, the proposed changes and associated chaos with postgraduate medical entrance is pushing the students to think of greener pastures and shifting broad with options such as USMLE/PLAB/AMC .

If the fears get true, we might face the problem of quality brain drain that will anyhow impact our public as well as private health ecosystem. Questions are many but only time will tell the appropriate answers.

(Dr Faiz Abbas Abidi is a resident doctor at Lucknow's Dr Ram Manohar Lohia Institute of Medical Sciences. He is working on biomedical research, public health issues, and digital health interventions. Dr Abidi is specifically working on a Department of Biotechnology-supported project on developing cost-effective solutions to improve maternal & child health care in tier 2,3, and 4 cities and villages. He tweets at @doc_faiz.)