According to NMC Chairman as mentioned in his address to final year students in a recent webinar, the following mentioned ‘Logics’ are the rationale behind NeXT. Let’s examine them one by one.
Logic 1) Students only read relevant selective topics for university examinations, so introducing NeXT will make them read all topics with substantial importance.
Ok, do all diseases occur with the same frequency in a given population or some diseases are more common and need extra attention? What do we call them? Must Know questions! Which is exactly how NeXT proposes to break up it’s questions among Must Knows and Good to Knows. So does that not bring selective topics? No competitive examination has been able to eliminate selective questions, be it NEET UG, NEET-PG, JEE or WBJEE. All have set patterns which are ultimately tweaked every year. This same Must Know and Good to Know format is how our teachers and professors mentally assess students while they’re answering in theirs scripts and viva.
Most importantly would we even want to eliminate selective topics for a rationally structure medical education system?
Logic 2) University practical examinations have a chance factor and discrimination when it comes to facing a biased examiner. Computers aren’t biased hence the chance factor is eliminated.
Understood, who among us who has appeared for any competitive MCQ exam would accept the chance factor does not apply in any form in that case? We all know how last few days before your examination can derail your whole preparation. How you mental situation on the day of examination or your health on the day of examination can derail your situation.
It feels conspiratorial but who is to bet that NMC control over whole examination process would not allow discriminatory measures by Central Government to be taken against out of line students? Discrimination being systematized does not equate to uprooting discrimination. It is to check and balance such actions by individual teachers that regulatory state and central bodies are created rather than facilitate them. We have seen how Central Government authorities have discriminatated against selective students although does not suggest state government’s hands to be clean.
Logic 3) Medical Curriculum and Licentiate Examination all over India is not uniform, we need uniformity in medical education throughout the country.
But do we? Are the prevalence of diseases, needs for healthcare, and resources for medical education uniform throughout the country, are they even uniform for two places in the same state? Does not UP (Gorakhpur) need special attention towards Japanese Encephalitis? Do not urban slums of Kolkata need to specially address Malaria and Dengue? Doesn’t every institute have its special advantages and disadvantages which it might strategically use to administer education and train doctors with specific focus? The question here is of real federalism and autonomy for strategic and rational use of resources rather than blind uniformity.
Until now MBBS degree was finally awarded by the state university which in theory is an elected body. Besides the central institutes, all government colleges are majorly funded by the state governments and hold a higher stake in the subject. Now licensing of a medical graduate is being transferred from
state universities to central government whose implication is rendering university imparted education virtually redundant. How would you expect to smoothly run the MBBS course with university playing a significant role in dictating students’ education when their licenses are in the hands of NMC.
Logic 4) NeXT pattern of examinations of Step 1 and Step 2 provides more time for students to focus on clinics during internship because they’ll have secured seats and would not have to worry about PG entrance.
So two points, clinics and PG MCQ race.
How many students do secure a PG seat in the first attempt? If your agenda is allotting seats before internship is it technically possible by transposing the examination to final year? Amount of seats is virtually constant for more students.
According to the above mentioned logic clinical learning has no role until internship. So why the ECE, Electives and other shenanigans? What in actuality will happen is students will avoid preparation for all college level and university level examinations.
Moreover students who had a chance to study for clinics during their final year and overall UG life will be forced to practice MCQs majorly even during UG phase. Those who do not secure a seat but pass will still be preparing hence virtually destroying all clinical learning.
Logic 5) Why give two examinations? University Exams and then NEET PG. That is one too many. Just give one exam and your burden is reduced.
Ok, this one is actually hilarious in a gory way. Are you even sure you want to reduce examinations, we have already seen first year semesters have been replaced by trimesters. Instead of two internal assessments and an university examination and an extra semester were added. Isn’t it stand contradictory to the idea of reducing examinations?
Next point, Does NEET PG and university examinations have the same agenda? Will forcefully combining these examinations with completely different end goals and assessment techniques reduce the burden of students or even satisfy the need to assess the quality of doctors produced?
Logic 6) We are trying to make the exam pattern in accordance with USMLE so it will be easier for you to prepare for USMLE/PLAB.
But Why? Why does the Indian Medical Education System need to prepare students for entrance examinations of foreign countries? The proclaimed directive of any health regulatory body of India has been and still is to produce doctors, better say ‘Indian Medical Graduates’ who can provide leadership to the healthcare system of this country. Meanwhile the licensing examination of the same course pushes students to prepare accordingly to complete in foreign examinations so that they can flee the country in hopes of better career outcomes. Does this not stand diametrically opposite to placement of bonds after medical degrees?
Then Why NeXT? We have already seen that the above mentioned publicly announced logics do not go with the said agenda, then why?
Logic 1) Increase the profitability and market scope for coaching industry.
If someone is going to reap the most immediate profit of NeXT it is the NEET PG coaching industry which had already been increasing their profits by fear mongering since first year of college. Until now a substantial section of students used to commit to coaching from 3rd year. Now introducing the MCQ examination as the mode for licensing will give new meaning to the coaching industry. Does it not make sense now that heads of coaching institutes have had a clear tendency and opinion towards NeXT since the inception of its talks? Have they not boasted multiple times boasted about their ‘connections’ with the NMC and how they are well informed which batch NeXT will be implemented from.
The coaching industry has been pushing for such a change as it lines up directly with their interests.
Logic 2) Produce semi skilled doctors who can easily be appointed at low wages and turn huge profits for the healthcare industry.
As the pattern of assessment becomes more MCQ based and forgets the importance of clinical postings, interacting with the patient and actual hands-on learning, we will be left with a large pool of ill trained doctors. Studying for picking the right option out of four ones won’t ever make up for the clinical exposure needed to make one ready to deal with the rush and chaos in the wards. The proposed pedagogical model is not suited for the type of learning befitting an Indian Medical Graduate where patient exposure is as much as needed as the theoretical know-how, if not more. These fallacies in the medical education system will be producing a surplus of semi-skilled doctors who will be forced to work with low wages in either ill equipped private nursing homes concentrated in urban and sub urban areas or as low wage workers in corporate hospitals. As the government gradually realizes its plan to let the private sector capture the health industry, only a small elite class of doctors will trickle out of the system who all will be meant to deliver high skilled labor to patients in big corporate hospitals who are ready to “buy healthcare” at market rates. For the part who can’t afford to pay for healthcare, there is the surplus pool of the substandard ill trained doctors who will soon face the brunt of the problem in the form of growing frustration and anger against doctors. The hospitals employing these doctors on low pay structures are surely not expected to equip them with the proper infrastructure and adequate resources and the wrath of the common man, already bogged down by rising out of pocket expenditure in the insurance schemes and inability to afford quality healthcare, will soon befall on the doctors who were themselves the victims of the system as pointed out above.
Logic 3) Centralize, Increase Surveillance, Control
Another issue receding into the background in the midst of all this confusion is the change of hands when it comes to recognizing and handing out the degree of a medical graduate. Under the previous system, the university had the necessary competence to issue licenses to medical graduates but under the new system, that power has entirely shifted to the centre.
In the latest document released by NMC, the proposition towards installation of surveillance cameras in all lecture theatres has been proposed along with facial recognition technologies. With such a level of centralisation, surveillance along with authority to decide on licensing of a student pointing towards a dystopic college life seems easily imaginable.
Logic 4) Education System more favourable for the huge pool of private colleges.
The imbalance between private and government medical colleges is very interesting when seen in respect to the NeXT examination. Private colleges have extensive infrastructure to the extent that accurate heart murmur simulation models may be available at the college, while the patient load and availability of quality teaching staff is close to non-existent compared to government colleges which the exact opposite is true with respect to government colleges. Quality faculty, crumbling infrastructure and high patient load. Introduction of NeXT clearly offsets this imbalance now with reduced relevance of clinics in MBBS theoretical study with online lectures. This qualitative change will boost the acceptability of private medical colleges and hence a boom in enrollment.
