What’s NExT for medicos?

On February 8, 2024, the National Medical Commission (NMC) released a notification seeking feedback regarding the National Exit Test (NExT) within 10 days by February 17. The notification also states that a committee is being constituted by the Minister of Health and Family Welfare to examine the implementation of the NExT exam. This article examines these concerning developments and their implications.

What is the National Exit Test? NExT refers to the final year medical undergraduate examination for two specifically identified reasons:

(i) to grant a licence to practice medicine (subject to other conditions being fulfilled by the candidate passing NExT); and

(ii) to form the basis for admission to broad-speciality medical education in medical institutions.

NExT also replaces the current examination of foreign medical graduates who intend to practice medicine in India. The primary aim of NExT is to bring uniformity and efficiency to the assessment process for Indian postgraduate medical professionals.

In order to prevent any plausible conflict of interest scenarios, the National Medical Commission Act, 2019, mandates NMC to have the test conducted through any other designated authority by specifying modalities and details. Therefore, the NMC conducted due stakeholder consultations and then brought into force the NMC National Exit Test Regulations on June 28, 2023.

Why now, seven-and-a-half months later, are they seeking stakeholder feedback on the same topic once again? Does this indicate an attempt to revamp the existing regulations? Moreover, it is alarming to see that the Minister of Health and Family Welfare is establishing a committee on NExT when the conduct of NExT through any other agency or authority is the statutory privilege of the NMC and not the government, as specified under the National Medical Commission Act, 2019. Under Section 15 of the Act, inter alia, the conduct of a National Exit Test (NExT) is the statutory mandate of the NMC.

Despite the statutory mandate that NExT shall become reality within three years from the date of starting NMC, it has yet to materialise.

One of the major causes of this delay is the confusion among the stakeholders regarding the legal position of NExT. The authors of this article came across multiple stakeholders advancing an argument that the ‘regulatory’ and ‘competitive’ aspects of the NexT examination cannot be effectively combined. Perhaps they are stating that the final year exams of MBBS, which are currently conducted by the concerned state health universities or other universities in the absence of the health university, are done according to the respective university regulations, and the NMC Act may not impede that autonomy of theirs.

The existing regulations indicate that NExT will be conducted in two stages, viz., NExT Step 1 and NExT Step 2. The first is testing through multiple-choice type via computer-based online mode (implying that the testing is done without human intervention and subjectivity), and the second is ascertaining the student’s understanding and application of skills, which shall include a viva voce examination. The regulations specify clearly that NExT Step 2 shall be conducted by the respective state health universities or universities themselves.

Any concerns about the regulatory and competitive nature of the exam should be addressed with a focus on practicality and student welfare. If found to be reasonable and convenient to the students (who are the most critical stakeholders in the argument) by suitably making necessary amendments to the existing regulations, universities may allow the NExT examination to be conducted.

(Nandimath is Professor of Law, National Law School of India University and Alexander Thomas is founder and patron, Association of National Board Accredited Institutions.)