What happened to the NExT exam? Only 31% medical students know exam pattern, says study

NEW DELHI: A study published in the Medical Science Educator journal has revealed that Indian medical students favour having the National Exit Test (NExT) Step 1 conducted every six months, as a single-day three-hour exam.

Only 31% of medical students across the country are aware of the NExT exam pattern. The research has emphasised the need for consistent feedback from stakeholders, including students, to ensure the effective implementation of this new exam.

Research for the study, ‘Perception of Indian Medical Students Towards University Exams and Proposed Licensure cum Post‑Graduate Specialty (Residency) Entrance Examination (National Exit Test)’ was conducted over four months, from November, 2022 to February, 2023.

NMC had drafted a set of NExT guidelines in December 2022 but put their finalisation on hold in July, 2023. It still remains unclear which batch will be the first to sit for the NExT exam.

The researchers include MBBS students, interns, PG medical students from various medical colleges in Delhi, Chennai and Andhra Pradesh’s Amalapuram. It also included Lokesh Edara, a medical student at WMU School of Medicine, Kalamazoo, Michigan, USA.

The study was conducted to assess Indian medical students’ awareness and perception of the change in the entrance examination pattern for postgraduate medical courses.

NExT exam: NEET PG and FMGE

The National Exit Test (NExT) is a unified test for medical graduates and is set to replace the NEET PG for admission to PG medical seats. It will serve as the qualifying exam for foreign medical graduates (FMG) who wish to practice in India by replacing Foreign Medical Graduates Examination (FMGE).

NExT will also act as a licencing exam for Indian medical graduates to practice medicine in India. Only those who pass this test will be allowed to register as medical practitioners. According to the draft guidelines, the exam will be conducted in two steps.

The NExT Step 1 shall be a theory examination and the questions shall be one or more than one type of multiple-choice type with the examinations being conducted through a computer based online mode.

The NEXT Step 2 shall be a practical or clinical and viva voce examination covering seven disciplines – medicine and allied disciplines, surgery and allied disciplines, obstetrics and gynaecology, paediatrics, otorhinolaryngology, ophthalmology and orthopaedics and physical medicine and rehabilitation (PMR).

NExT exam: Medical students awareness

Medical students admitted in Indian medical colleges across six regions – North, North East, Central, South, East, and West – between 2018 and 2022 were part of the study. The researchers received responses from 729 students using a pre-tested and pre-validated questionnaire comprising 25 questions to assess the knowledge and perception of medical students about university exams and NExT. Among 729 participants, 431 or 59.2% were male.

The researchers found that students have been largely left out of the decision-making processes and guidelines regarding the NExT examination “leading to increased distress and resentment”.

“The ambiguity surrounding the exact details and commencement of the NExT exam significantly affect the career trajectories of medical students as they struggle to plan out their future timelines. Students are the most affected stakeholders from the NExT exam.”

The researchers found that only 226 – 31% – participants seemed to know the “entire pattern” of the NExt, even which part will serve what purpose with any clarity.

“In total, 504 (69.1%) students believed that NExT Step 1 shall serve as a PG entrance exam and 380 (52.1%) students believed that NExT Step 1 shall be a medical licensing exam, while only 314 (43.1%) students believed that NExT Step 1 shall be conducted as the Third professional Part 2 (Final Year) theory exam,” the study says.

NExT mock tests, MCQ-based exam

A total of 93.6% students agreed that a mock test similar to NExT Step 1 would be beneficial. And 80.7% believed that a 100% MCQ-based examination for the university professional exams will help their preparation for competitive exams like NExT Step 1.

As many as 70.2% preferred conducting NExT Step 1 every six months to improve on their previous scores and most students want no limits on the number of attempts. Almost 57.8% students wanted the NMC to conduct the NExT Step 2 after their internship.

“We also recommend conducting briefing sessions for not just students, but also the faculty, so that teaching in medical institutions can be aligned with the exam,” the researchers said.

"NMC should consider students’ perspective towards NExT exam. The perspective of medical students is very much visible in this study. Before implementing NExT, NMC officials should read our paper and consider our recommendations. It is the first scientific paper on NExT exam published in an international journal," said Abhinav Jha, one of the researchers, and MBBS intern at Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi.

NExT exam: Timeline of flip-flops

Even after seven years since the concept of NExT exam was introduced through the NMC Bill 2017, the modalities of the exam are yet to see the light of day.

NMC officials did not respond to Careers360’s calls and texts. Based on existing notifications as well as coverage, here’s a timeline of events related to the National Exit Test.

July 2017: The central government drafted a National Medical Commission (NMC) Bill which introduced the concept of NExT – a common exit test for MBBS students.

July 2019: The union cabinet cleared the National Medical Commission Bill, 2019 which had proposed a common final-year MBBS exam called National Exit Test (NEXT). NMC came into force on September 25, 2020; NExT was to “become operational” within three years.

July 2021:

• The NMC said that the test would be conducted in the first half of 2023 and that there would be a mock test before it. In the absence of clarity on NExT, MBBS students remained confused.
• The health ministry said efforts were on to launch the exam in the first half of 2023 and a mock-run in 2022.

August 2021: In its draft "The Postgraduate Medical Education Regulations, 2021” (PGMER 2021), NMC said that NExT will eventually replace NEET PG which will continue till the new system is implemented. The final PGMER-2021 guidelines were never published and NMC published a revised draft PGMER-2023 guidelines in September 2023.

September 2022: The central government, invoking provisions of the NMC Act, extended the time limit for conducting the National Exit Test (NExT) till September 2024.

December 2022: NMC published draft guidelines for NExT. According to that, NExT Step 1, a theory exam, will be held in December. NExT Step 2, a practical, clinical and viva voce exam, will be held in March and be valid for three years.

The proposed guidelines had said that the students have to clear the NEXT exam (Steps 1 and 2) within 10 years from the date of their MBBS admission.

A section of medical students, teachers and leaders of organisations have raised concerns about NExT pattern, objectives and implementation.

January 2023: Through a draft amendment in NMC Act 2019, the Ministry of Health and Family Welfare proposed a new board, called ‘Board of Examinations in Medical Sciences’ under NMC, to replace the existing National Board of Examinations in Medical Sciences (NBEMS). According to the draft amendment, the proposed board will conduct NExT. However, the law has not been amended.

May 2023: NMC’s “Registration of Medical Practitioners and Licence to Practice Medicine Regulations, 2023” stated that both Indian and foreign medical students have to clear NExT to get themselves registered in the National Medical Register (NMR).

June 2023:

• In a webinar with medical college faculty and final-year MBBS students, NMC shared detailed information about the schedule, pattern and modes of NExT exams. In the webinar, NMC officials said the MBBS batch of 2019 will be the first batch to sit for NExT exam.
• A day after the webinar, AIIMS Delhi began registration for NExT mock test. The test was scheduled on July 28.
• “NMC, National Exit Test Regulations, 2023” containing pattern, schedule and other details of NExT exam was notified in ‘The Gazette Of India’ on June 27, 2023.

July 2023:

• Former union health minister Mansukh Mandaviya said the NExT exam will not be implemented for the 2019 MBBS batch. He later told parliament that the draft regulations had been framed after considering 6,500 suggestions but the NExT exam was deferred after protests.
• A week later, NMC deferred the NExT exam until further notice, on the advice of the health ministry.
• Three days later, AIIMS Delhi cancelled NExT mock test.

August 2023: In its Competency Based Medical Education (CBME) Regulation 2023, NMC said that MBBS students joining medical colleges in 2023 will write the National Exit Test (NExT) Step 1 in February 2028; the NExT step 2 will be held in February 2029.

October 2023: Union health ministry formed a seven-member committee to examine preparedness of states and medical colleges for the National Exit Test (NExT) for final year MBBS students of the 2020 batch. The committee under the directorate general of health services was supposed to submit the report in two weeks.

January 2024: In line with recommendations of the committee NMC sought comments from all stakeholders on NExT and asked them to go through the National Exit Test Regulations, 2023. The stakeholders were given till February 7, 2024.

May 2024: Former NMC spokesperson Dr Yogender Malik said the agenda regarding NExT guidelines will be listed in the next NMC meeting.

October 2024: In response to another RTI by Pandey, the union health ministry informed that the NExT exam remains under consideration.

Meanwhile, the National Commission for Indian System of Medicine (NCISM) in July 2024 issued a notification regarding the conduct of NExT. As per the notification, future NExT exams for Ayush students will be conducted twice a year – in February and August. In September, union minister Prataprao Jadhav announced that NExT for Ayush will be for students admitted in 2021-22.

The test is mandatory for licensing after a one-year internship.