National Exit Test: How Will One Size Fit All?

Medical education in India is expected to undergo a significant reform after the introduction of the National Medical Commission Act. Single, nationwide National Exit Test (NEXT) is an essential provision under this act, which will be implemented during the next three years. It aims to bring about uniformity in the minimum standard of final MBBS examination, quality control in the licentiate examination and elimination of multiple entrance examinations for admission in postgraduate courses. Since the NEXT has multiple and varied objectives, we suggest a three-step scheme for the conduct of NEXT. Step I (Part A and B) will be equivalent to present-day first and second professional MBBS examinations and step II will act as the final professional MBBS and licentiate examination. Step III will form the basis for admission to the different PG courses. The written exam of Step I and II will consist of structured long, short and multiple choice type questions, whereas practical or clinical examination will consist of structured instruments with lesser inter-rater variability (viz., OSCE, OSPE, OSLER, etc.). This opinion piece is a result of in-depth discussions among major stakeholders such as MBBS students, resident doctors, and faculty of AIIMS, New Delhi. The suggested three-step plan is probably the most feasible way to ensure that the three modalities (final year MBBS, licentiate examination, and PG entrance competitive) are assessed in a valid, reliable, and acceptable manner. Due consideration is given to the fact that an assessment process has a significant impact on learning and teaching. The government may consider these suggestions while formulating the regulations of the NMC Act.