The National Exit Test (NExT) is a proposed comprehensive examination for all MBBS, BAMS, BUMS, BSMS, and BHMS students in India.
NExT will be conducted in two steps — Step 1 (MCQs) and Step 2 (practical). (Supplied)
Recently, the Indian Medical Association (IMA), the foremost doctors’ body in the country, penned a letter to the National Medical Commission (NMC) opposing the National Exit Test (NExT) for medical graduates.
The IMA argues that the varying standards of medical education across institutions make a nationwide one-test-fits-all approach unfeasible. The association suggests that the implementation of NExT without proper evaluation could jeopardise the affordability and accessibility of medical education. The IMA urges reconsideration of certain provisions.
The IMA expresses concerns that introducing the NExT without thoroughly assessing its potential benefits, limitations, and impact on medical education would be a gross injustice to students. The association underscores the necessity of adequate technical infrastructure, faculty training, and support in all medical institutions nationwide.
Notably, the IMA points out deficiencies in faculty noticed in 349 colleges in 2023-24, with 40 medical colleges being derecognised in the last two months, highlighting potential obstacles in the equal distribution and adoption of NExT.
The National Exit Test (NExT) is a proposed comprehensive examination for all MBBS, BAMS, BUMS, BSMS, and BHMS students in India. Crafted to serve as a single-window exit test for medical graduates, NExT is a mandatory requirement for obtaining a medical license in India. Administered in two steps, the examination comprises both theoretical and practical components.
Introduced through the National Medical Commission Bill 2019, National Commission for Indian System of Medicine Bill 2019, and National Commission for Homoeopathy, NExT aims to streamline and standardise medical entrance examinations, acting as a screening test for foreign medical graduates seeking to practice in India.
The NMC is responsible for the implementation of NExT, while the All India Institutes of Medical Sciences (AIIMS) is expected to conduct it.
The NExT exam will be conducted in two steps — Step 1 and Step 2.
Step 1 of NExT will be a computer-based examination based on high-quality multiple choice questions (MCQs). It will have six subject papers, each having different weightage and time allocation.
Step 2 of NExT will be a practical/clinical examination which will be conducted after the completion of the internship.
The NMC has released preliminary guidelines for NExT, applicable to postgraduate medical programmes and licensure for medical practice in India. According to the most recent information, the examination is scheduled for August 2025, targeting final-year MBBS students from the 2020 batch. The subsequent Step 2 exam is set to take place in February 2026.
The IMA staunchly opposes the introduction of NExT, asserting that it contradicts the Prime Minister’s vision of affordable and accessible medical education, thereby posing a threat to the viability of medical institutions in underprivileged communities.
“We can’t afford to train doctors and deny degrees to practise. It may be noted that only around 20 percent of candidates had secured more than 50 percent marks in the NEET PG exams in previous years. The IMA feels that India’s time-tested method is the best, and blindly emulating Western countries will not be in the best interest of our country,” the IMA said in its letter to the NMC.
The association underscores the absence of uniform standards in medical education across academic institutions, deeming it unfeasible to subject the entire country to a single test.
“Using the same exam to test the basic minimum required for licensing and highest standards required for postgraduate entrance assessment is completely illogical. NExT cannot be conducted both as a licentiate exam and a PG entrance exam, as the focus of the licensing exam should be on assessing the minimum standard, while that of the PG exam should be to select the most meritorious students,” said the IMA.
The IMA underscores the pivotal role of universities in conferring medical degrees and raises concerns over the potential encroachment on their autonomy by the proposed National Exit Test. Drawing attention to legal intricacies, the IMA points to Section 15(1) of the National Medical Commission Act, 2019.
Section 15(1) stipulates:
“A common final-year undergraduate medical examination, to be known as the National Exit Test, shall be held for granting licence to practise medicine as medical practitioners and for enrolment in the State Register or the National Register, as the case may be.”
Section 15(2) stipulates:
“The Commission shall conduct the National Exit Test through such designated authority and in such manner as may be specified by regulations.”
Section 15(5) stipulates:
“The National Exit Test shall be the basis for admission to the postgraduate broad-speciality medical education in medical institutions which are governed under the provisions of this Act or under any other law for the time being in force and shall be done in such manner as may be specified by regulations.”
A straightforward interpretation of these provisions implies that a singular final Undergraduate Medical Examination serves the dual purpose of licensing and admission to postgraduate courses in various medical colleges governed by the NMC Act, 2019, or relevant laws.
However, Dr RV Asokan, President of the IMA, points out, “In the context of Section 15(1) of the NMC Act, a grave error of legal wrong stands committed in as much as the final MBBS examination of the MBBS programme in case conducted by any authority other than the examining/affiliating university, cannot be computed by the said examining university for the purposes of conferment of the MBBS degree, as the same would be in contravention of the binding inclusions in Indian Medical Universities Act, 1960, read with University Grants Commission Act, 1956.”
The IMA raises critical concerns about the proposed NExT system, highlighting several issues within the existing structure of MBBS courses and potential repercussions for medical education in India.
The IMA points out the current MBBS examination structure, including First Professional (first year), Second Professional (second year), Part-1 (third year), and Part-2 (fourth year) of the Third Professional Examination, conducted by the examining/affiliating university. Successful completion of these examinations entitles the learner to the conferment of an MBBS degree.
In contrast, the proposed NExT system introduces a common examination (NExT-I) based on Multiple Choice Questions (MCQs), conducted by the National Medical Commission. Clearing NExT-I allows students to proceed to a one-year rotating internship. After the internship, students must take NExT-II, assessing psychomotor skills, conducted by the university. Success in NExT-II is crucial for inclusion in the State or Indian Medical Register.
The IMA identifies several issues with this proposed system. Firstly, it questions the designation of NExT as the “Fourth Professional Examination” and its alignment with the degree conferment process. The critique raises concerns about splitting NExT into two parts and allowing the university to conduct NExT-II, which appears contrary to the mandate outlined in Section 15(2) of the NMC Act, 2019.
Potential consequences of this disjointed system are explored, such as a situation where a student passes NExT-I but fails NExT-II, jeopardising their chances of State Medical Council registration. The lack of clarity regarding the validity of NExT-II, conducted by the same university that previously certified the student, adds complexity to the proposed system.
Dr Asokan further questions the naming of NExT as the Fourth Professional Examination and its consideration for degree conferment. He emphasises the potential chaos arising from a situation where a student successfully passes the Third Professional Examination but is deemed unfit for NExT-II a year later.
“All these situations and many more are nothing but a consequential creation of non-application of mind and of the sole attempt at hiding the wrong that has already crept in framing of Section 15(1) of the NMC Act, 2019,” said Dr RV Asokan.
Another major concern raised by Dr Asokan is the mismatch between the proposed NExT scheme and established regulations. The proposed system deviates from the mandatory separation of theory and practical components in passing examinations, particularly in the Third Professional Part-II examination.
The critique also points out issues related to binding rules disallowing students from retaking an examination they have passed, creating a contradiction within the proposed scheme. Additionally, the absence of provisions for supplementary examinations for NExT-I and NExT-II failures adds further complexity and inconsistency.
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