Reconsider theNext to Save Education and Health

Keeping changing the exam pattern of medical education in mind Indian Medical Association (IMA) demands that it has to be either totally done away with or modified to ensure justice to medical fraternity and good health to all citizens…….…
By Dr Vinay Aggarwal

Medical students all over the country are anxious, making studying almost impossible. Next, the proposed new exam is creating much confusion and agony. Medical education in the country is under the direct control of NMC (National Medical Commission). Each seat in UG and PG course needs their sanction. The curriculum is decided and implemented by NMC, courses conducted by approved colleges and exams held by the universities.

A student gains admission through the entrance, conducted by the government. He undergoes one of the toughest training, appears in umpteen theories, practical, viva and clinical exams and qualifies all exams conducted by respective the universities. Hitherto passing the final MBBS exam conducted by the university would allow the student to graduate and completion of internship would get him his right to practice medicine. This system has prevailed for decades and has produced some of the best doctors in the world.

Now NMC feels, for unknown reasons without any gap analysis whatsoever, that the system has to change. Medicos, they say, should appear in a final exam, NEXT if they’re to be allowed to practice. The idea is to test the standards and also to provide a common test for license and post graduate entrance. This will be a mcq type centralized theory exam conducted by AIIMS followed by a practical exam by the University. Students have to pass both to be eligible to become an intern and then have to pass one more viva at the end of internship to be eligible to get license to practice medicine.

Few legitimate questions arise here
1. Whose standards are we trying to test? Whether it’s of the authorities who sanction these courses, NMC who set the curriculum, universities which conduct the exams or colleges who conduct the courses? How can testing students ensure standards of any of these institutions? Shouldn’t we be having mechanism to test these systems and not the students who have undergone a five year course according to set standards?

2. Changing the exam pattern to MCQ (multiple Choice Questions) has serious repercussions. Review of the results of MCQ based PG entrance exam of previous years show that only around 25 percent have scored 50 percent marks. The NEXT exam being common for license and PG entrance can be expected to be of similar standards. What should the 75% leftovers do? After five years of rigorous course they’ll continue to be just plus two qualified.

3. Currently the best out of those who appear get PG seats, the cut off qualifying marks being around 30 percent. With only 25 percent expected to qualify the next exam how the PG seats will be filled. How will we get interns and junior doctors? Won’t this lead to collapse of not just medical education but health care too?

4. MBBS testing pattern has never been MCQ based. Now there are only 10% multiple choice questions, rest 90 percent are subjective, which is only legitimate given the nature of medical studies. Having MCQ mode of exam for PG entrance is well understood. But using the same format for medical licensing that too with negative marks can never be justified. MBBS students are trained all along in the subjective method and neither students nor teachers are aware or trained in MCQ method and suddenly changing the exam pattern will only help in mushrooming of entrance coaching centers and divert the students main purpose from learning and acquiring clinical skills to mugging entrance questions.

5. While entrance is a competitive exam to test the best, licensing exam should be a qualifying exam to test the minimum essential skills and how can both be tested with the same exam? If at all anyone insists on MCQ tests as licensing exam, shouldn’t it be different from the competitive PG entrance test?

6. As such we all know that medical students are equipped to practise Medicine not through the tests they undergo but through the course, curriculum and training. Exam topper may not be the best Doctor. What we’ve to ensure are the best standards of Medical education and right connect with society.

7. On one hand the government wants to liberalize medical education and are opening up more medical colleges to overcome deficiency of medical manpower. On the other hand trained graduates are being prevented from practicing Medicine. Isn’t this paradoxical? Won’t this result in wasting of the huge investment in Medical education?

Next is neither feasible nor desirable. It’ll only distract Medicos from focusing on their studies, deny them of their legitimate right to practice the medicine and deprive the society of the services of qualified doctors.

That’s why we are demanding that it has to be either totally done away with or modified to ensure justice to medical fraternity and good health to all citizens.

(The author is Past National President IMA and Chairman Action Committee IMA)