Exit exam for MBBS medical students? It’s necessary, say experts

An exit exam for medical students at the MBBS level has been proposed – a move that health experts say is essential. A draft prepared by the health ministry of the Indian Medical Council (Amendment) Bill 2016 recommends an exit exam at the MBBS level, combined counselling at the undergraduate and postgraduate levels and reservations of up to 50% of the seats of the postgraduate courses for medical officers.

Section 10E, to be added to the Indian Medical Council Act 1956, proposes a uniform national exit test (NEXT) be conducted for all medical institutions at the undergraduate level. NEXT will replace the uniform entrance exam at the postgraduate level. Suggestions on the feasibility of the draft were invited till January 6.

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An exit test is “an essential tool for meeting the basic objectives of quality and safe physicians for the society,” given the vast diversity of medical institutions in the country offering medical education of variable standards, says Dr Bipin Batra, executive director, National Board of Examinations.

The test is likely to be at the level of an MBBS final exam to assess the basic knowledge and skills of a medical graduate.

According to Dr Arun Kumar Agarwal, former president, Delhi Medical Council, the concept of an exit exam was mooted about six years ago to improve the quality of fresh MBBS graduates in India.

He is also of the opinion that this exam should replace the National Eligibility cum Entrance Test (NEET) as well as the Foreign Medical Graduates Exam (FMGE) as the candidates should not appear for such an examination more than once during the MBBS phase.

Asked if the exit exam can replace any of the existing exams or entrance tests, Dr Batra says, “It will be an ideal scenario if one exam in the early phase of internship is used as the exit test and the performance is used as a grading tool for ranking the medical graduates for entry to PG residency programmes.” The same exam can be applicable for foreign and Indian medical graduates. The United States Medical Licensing Examination administered by Educational Commission for Foreign Medical Graduates is a similar test used for licensing as well entry to residency programmes for domestic as well as foreign medical graduates.”

There will be no impact on foreign medical graduates if the exit exam is introduced. There will be no change for their licensing requirements. “Currently, they write the FMGE screening test, which in all likelihood will be subsumed as the exit test, bringing parity between the Indian and foreign medical graduates,” adds Dr Batra.

Implementing NEXT will also put pre-PG coaching institutes at an advantage, say doctors. Will that be a good thing? Not likely, says Dr Manish C Prabhakar, president, Indian Medical Association Young Doctors’ Wing. Instead of churning out better doctors, India will produce more of medical graduates only with less clinical skill because of the burden of too many exams.

Only, 2,700 to 3,000 vacancies exist in primary and community health centres in rural areas, while more than 60,000 MBBS graduates clear the exam every year, says Dr Prabhakar. “Therefore, majority of the students will spend their time in coaching classes or in the library or studying at home; in a country where the doctor-patient ratio is already so low. NEXT is an indirect way to pressurise the doctors to go for the rural postings,” he adds.

The proposed bill also seeks to introduce common counselling for undergraduate (UG) and postgraduate (PG) medical students. Counselling for 15% all-India quota seats at the UG level and 50% all-India quota seats at the PG level will be conducted by the Directorate General of Health Services and for remaining seats including private colleges and private/deemed universities at both levels will be conducted.

Common counselling is already implemented for National Institutes of Technology and the Indian Institutes of Technology.

Experts say such a concept for medical students will be a good idea. Medical graduates across the country have applauded the Central government’s proposal to conduct common counselling and the Delhi Medical Association has also supported it, apart from the Supreme Court upholding it. Common counselling at UG, PG and super specialty levels is needed to allay candidates’ anxiety about participating in multiple seat allocation processes conducted at institution or deemed university levels. “It will also ensure fair play and equity of access of seats to all aspiring candidates on a common platform,” adds Dr Batra.

The wastage of seats due to multiple admission processes running concurrently and variable criterion used for admissions will be minimised and boost chances of candidates getting admission only on merit.

As Dr Agarwal says, “Common counselling is the only solution, otherwise there will be lot of confusion among students. It will also help those seeking admission at the PG level.”

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