A common entrance test (CET), also called National Eligibility-cum-Entrance (NEET) test was proposed by the Medical Council of India (MCI) in 2012 for the admission to MBBS, BDS and postgraduate courses (MD/MS) in all colleges across the country. Many State governments opposed the proposal and moved to court with the plea that NEET infringes upon their right to keep education as a State subject. NEET was declared unconstitutional by the Supreme Court in 2013. The private medical colleges were completely opposed to the idea as they seemed to be the biggest losers if NEET is implemented. Recently, the Supreme Court of India ordered the implementation of NEET overturning its previous directive. The MCI claims that NEET will improve the process of admissions, bring transparency and remove observed malpractices. It is thought that many States do not have a robust mechanism of admissions and situation is worse when it comes to the private medical colleges. There are often allegations of corruption and favouritism.
The aspiring candidates, medical students and doctors mostly welcomed the NEET. On the positive side, candidates can just appear in one exam and this will save their time and money. They do not have to apply at various places and pay every time. The allocations can be done with ease choosing their favourite colleges depending on merit. The psychological stress of appearing in multiple examinations will be lessened. On the other hand, the sudden introduction of the NEET meant that some candidates may be at a disadvantage due to their background or the way they were preparing for the exam etcetera. Candidates from Jammu and Kashmir will lose the advantage of filling all the seats in the J&K Medical colleges, as non-State subjects are not allowed admission. The fifty percent reservation for women in government colleges will also be lost in J&K.
Coming to a bigger question, is NEET the only solution to the declining standards of medical education in the country? What else has MCI done so far to advance the medical education? It is a welcome first step towards the long awaited reforms. It will make the life of the aspirant’s easy; avoid unnecessary bureaucracy and red tape. The NEET is a multiple choice examination (MCQs), which is the gold standard for entrance examinations in India. In view of the prevalent crony capitalism and corruption, an MCQ type of exam is the best option to cut down fraud and favouritism. As there is no interview, it limits any outside interference.
Across the globe, the methods of admission, teaching and assessment have advanced keeping up with the developments in medicine and technology but India is still stuck in the early fifties of the twentieth century. The MCI has proved to be a big disappointment due to its inability or rather inaction to reform the medical education over last six decades. It is a shame that the MCI has not even been able to put together a proper syllabus and curriculum. Every medical college trains and teaches, depending on the beliefs and whims of the faculty and there is no uniformity or standard across the country.
Becoming a doctor is not an easy task and apart from the academic qualifications and merit, one needs to have right aptitude and personality. This cannot be examined by a simple multiple choice examination. The overall personality, career goals and resilience to stand the gruelling exams and responsibility which comes with the job need to be kept in mind. In the United Kingdom, admissions to medical colleges are done by a multistage process. Aspirants with good grades in A-levels (10+2) are eligible to apply to the medical schools of their own choice. There is an initial longlisting process. There is no MCQ type exam and they do not have to waste time revising and cramming the 10+2 syllabus again. UK applicants must take one of three additional tests- the UK Clinical Aptitude Test (UKCAT), the Biomedical Admissions Test (BMAT) or the Graduate Medical School Admissions Test (GAMSAT). The candidates have to demonstrate suitability for becoming doctors by working with charities, hospitals or simply shadowing doctors, so that they can test themselves in real life situations and make an informed decision to enter the medical profession. Such work experience is scored in the shortlisting process.
Candidates who are shortlisted are invited for interviews by the medical schools. Interviews are a complex process of assessment (Multiple Mini Interviews-MMI) comprising of multiple stations in which various attributes of the candidate like attitude, ethics, compassion, resilience, and conscientiousness etcetera are assessed. They are given clinical scenarios and asked to comment and give their opinion. Interestingly there is hardly any stress on the theoretical knowledge as it is presumed that candidates have already done well in the 10+2 examinations and there is no need to assess the rote memory again. Compare this to the MCQ type of examination. Apart from testing the rote memory, there is hardly any emphasis on testing other attributes. While as the candidates in the UK make an informed choice to join medicine, many of our candidates sit the entrance because of social pressure. Such candidates often become frustrated in the future leading to dangerous consequences like suicide, as there is usually no going back due to pressure from family and stigma.
It is too ambitious to suggest switching from the MCQ type exam to this multi-stage assessment, but more needs to be done if we want to produce high quality and safe doctors. Having a common exam like NEET is a good start, but much more needs to be done if the deteriorating situation has to improve. MCI needs to reform the curriculum and subjects taught in medical schools on a war footing. The focus needs to shift from reading thick books and theory to practical skills, empathy, ethics and accountability just to name a few. There needs to be a common minimum standard of doctors passing out of the medical colleges. If the MCI is not able to deliver, then it may be better to start with disbanding the monster as recommended by the parliamentary committee. The Committee on petitions (Lok Sabha) has already invited views/suggestions on the petition “Medical reforms in the country” which is a good start and may hopefully lead to some positive changes. Interestingly, due to pressure from various state governments, the central cabinet passed an ordinance postponing the implementation of NEET by one year. Only time will tell if it will be implemented or not and who’s interests will be dearer to the politicians running the country.
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