A NEET entry into medical sciences ?

One test: Those against single-exam system cite unfair urban advantage over rural candidates

The National Eligibility cum Entrance Test (NEET) has been in the news recently. The NEET is a centralised medical entrance test conducted by the Central Board of Secondary Education (CBSE) for admissions to MBBS/BDS courses in medical/dental colleges run with the approval of the Medical Council of India/Dental Council of India.

To secure a medical seat, an aspirant had to write multiple entrance examinations: state-specific medical entrance examination, national institute-specific entrance examination and also All India Pre-Medical Entrance Examination - before NEET. Moreover, violation of merit in admissions, particularly in some private medical colleges and deemed universities, was a matter of concern.

The NEET was thought of as a solution to reduce student’s burden of examinations, curtail profiteering in medical education and standardise medical entrance examinations.
From the governance perspective, NEET is a logical step towards achieving transparency and standardisation in medical entrance examinations. There were reports of irregularities and corruption, especially in some private medical colleges, in the allocation of seats and fee payments which were based on the whims and fancies of the management of private institutions/universities.

Hence, having a single medical entrance test across all states for both public and private medical colleges makes a lot of sense. This goes well with the principle of providing equal opportunity to all medical aspirants to study in the best institutes in the country, provided they secure high rankings. This also eliminates the undue stress of taking multiple examinations at different places in the country and spending thousands of rupees on travel.

Given that the merit list prepared through NEET provides flexibility for separate all-India and state merit lists, for the all-India quota (15% of the seats) and state-specific quota (85% of the seats) in the state-run medical colleges, respectively, it allows medical aspirants to take admission in a college of their choice across the country and allows state governments to fill seats in their medical colleges as per the pre-existing criteria on reservations, preventing any prejudice to any reservation promised to the medical aspirants.

This ensures transparent allocation of seats not only across states but also across public and private institutions, while at the same time protecting the interest of the states. Another key advantage of having a unified state merit list is transparency in seat allocation which acts as a deterrence against corrupt practices of a few private institutions. Further, the regulatory requirement laid out in NEET potentially acts against market failure on account of management quota, exorbitant fee structures and lack of information.

There are contrarian views also on NEET- against having a centralised national medical entrance test. Some of the stakeholders are of the opinion that NEET has put them at a disadvantage on account of the syllabus which is different from CBSE and language of instruction other than English. For example, it is recognised that syllabus in senior/higher secondary education and language of instruction across states is variable and this may put medical aspirants from some states at advantage or disadvantage, relative to others depending upon concordance or discordance of their state board’s syllabus to CBSE curriculum.

To address some of these issues, this year’s NEET was conducted in eight regional languages besides English and Hindi. However, for a section of aspirants, this changed pattern of examination and sudden implementation without appropriate and timely information was itself a barrier. For example, the teaching and learning outcomes for successfully qualifying NEET and senior secondary examinations are entirely different – multiple choice questions (MCQ)-based assessment for NEET and written examination for senior secondary examination.

Such an arrangement puts a section of medical aspirants at a serious disadvantage and provides opportunities for private coaching institutes to flourish and profiteer by offering NEET-targeted coaching classes, which may be prohibitively expensive for poor students. This will impact the current and future batches of medical aspirants taking the examination unless corrective actions are instituted. It was expected of national regulators to be thoughtful of the consequence and inconvenience that would happen to the stakeholders, especially students and their parents, which it seems they were not.

Holistic approach

Now that NEET has been mandated as a single entrance for all medical colleges, except for AIIMS and JIPMER, this would ensure a standardised medical entrance and hopefully in future standardised teaching and learning environment in medical and dental schools, leading to better learning outcomes. Going forward, it is also important that with the learnings from two cycles of NEET examination, the regulators should take stock of the situation and should engage with all stakeholders, especially the medical aspirants and their parents, to address their concerns appropriately and in a timely manner through the establishment of a responsive system.

Further, the next frontier for CBSE would be to work closely with State Boards to harmonise their curriculum with CBSE’s, especially for the subjects that are assessed in NEET examination, to provide a level playing field to all aspirants.

Reforms in medical education were long overdue. From the perspective of health workforce planning also, the Lancet Commission on Education of Health Professionals for 21st Century strongly recommended for instructional reforms that encompass the entire range, from admission to graduation – NEET in that sense is the first step towards developing a transformative learning based system in India.

The National Health Policy, 2017, has also recognised the need, not only for undergraduate entrance at the all-India level but also a common national-level Licentiate/exit examination for all medical and nursing graduates and a regular renewal at periodic intervals with Continuing Medical Education (CME) credits based system.

(The writer is director, Indian Institute of Public Health, Delhi)