Why is NEET not such a Neat Medical Examination Policy?

The introduction of NEET was supposed to be a giant leap forward in medical education. However, the controversies regarding the standard entrance examination still refuse to die — a HE report.

When Mohini Jain, a young student from Meerut approached the Supreme Court in 1991 for relief against the high fees being charged by a private medical college in Karnataka, little did she know the impact it would have on the education sector. For the first time in 1992, the court declared that the right to education is concomitant to fundamental rights enshrined under Part III of the Constitution that every citizen has a right to education under the Constitution (Mohini Jain v. State of Karnataka (1992) SCR (3) 658).

The ruling got the attention of the policymakers about the state of medical education in the country. The introduction of NEET was supposed to bring a similar paradigm shift in the medical education sector.

The NEET Story

The objective of NEET was to standardise entrance examinations around the country for all professional courses. It was supposed to prevent private medical schools and "deemed" universities from holding their own set of entrance tests and rigging the rankings to get people who do not have the aptitude to become doctors into the system. Multiple exams meant multiple entrance exam fees and travelling all across the country writing entrance exams.

Despite the best intentions, however, it failed in addressing several more significant issues addressing medical education, say experts."While the intentions may be good, the government has done a poor job with getting buy-in from doctors and medical students. Instead of trying to partner with doctors, they have antagonised them by forcefully pushing their reforms through Parliament, without engaging with the medical profession. It has created a lot of angst and resentment because doctors feel short-changed. They believe the government is disconnected from reality and has refused to address their concerns by not respecting their perspective. They are unhappy," says Dr Aniruddha Malpani, an angel investor. "Much more important than just a policy, is how well it's implemented! The problem with our examinations is that they are all MCQs, and this is not a good way of testing whether a student will become a good doctor not,” he adds.

For NEET examination, several points of contention have also been raised — the important ones being its viability and the impact on students from different educational backgrounds. Since the syllabus for a NEET is most likely to be based on the NCERT syllabus, candidates who study in State syllabi may be put at a disadvantage.

What it fails to address?

There are 479 medical colleges out of which 227 are government-owned, and 252 are private colleges. These colleges offer 67,352, MBBS seats and 31,415, postgraduate seats. "The NEET system brings in both advantages and challenges. The single admission exam system can help avoid the myriads of admission tests which students have to take for individual colleges/universities/state level exams, and can also help to some extent in a nationally standardized approach to entrance exams for medical courses. It has led to discontent since the NEET exam is based on the CBSE curriculum, and it puts students graduating from state boards at a disadvantage. There have been quality and content issues with translations of NEET exam papers to local languages which can have major ramifications for exam results and rankings as the exam is very competitive. Furthermore, there has been confusion on test dates because of court cases, and decisions implemented hurriedly," says Anant Bhan, a public health researcher.

Bhan notes that it's essential to learn from the shortcomings and challenges of conducting NEET and relook comprehensively at its design and approach. A way of being fair to state board students needs to be devised. "Implementation of any exam should be preceded by enough lead time, clarity on how it will be conducted, timelines and dates announced well in advance, taking all relevant stakeholders in confidence. Also, the exam should not remain static in a way that it leads to a further spread of NEET specific coaching class culture. It will lead to significant changes from the way the regulation of medical education is made (disbanding the MCI, and the four boards under the NMC) to the move towards having a unified national exit exam post-MBBS which needs to be cleared to practice medicine (with an MBBS degree) and also to gain entry to postgraduate courses. It also changes the way fee regulation is being approached with the NMC only regulating fees for 50 percent seats in private institutions. It could mean that medical education becomes costlier and less equitable,” Bhan adds.

National Medical Council Act and Medical Education

Further, there will be significant changes in the medical education sector due to the new National Medical Council Act. Section 15 (1) of the bill proposes a common final-year MBBS exam, the National Exit Test (NEXT) before an individual starts practising medicine and for seeking admission to postgraduate medical courses and for enrolment in the state register or the national register. There will also be a screening test for foreign medical graduates.

Problem+Policy+Politics

India follows a federal structure, with power divided between the centre and the state. This power-sharing is, however, not equal nor constant. Unlike the US where the states chose to give up certain powers to the federal government; in India, the central government shared certain powers with the state but kept the lion's share with itself.

How the Centre has pushed for NEET is also symptomatic of a more significant issue of centre-state relations. Education is a subject on the concurrent list, which means both the Centre and states can make decisions regarding it. However, the fact that NEET overrides every other method of admissions, including exams by the state government, is seen as a challenge to federal powers of the states.

In 2015, more than 100 petitions were filed in various High Courts in the country by various institutions asking that the NEET not be made applicable to them.

Why we need clear policies about the creation of human health resources?

Dr Jagdish Chaturvedi, a Consultant ENT surgeon, Fortis Hospital Bannerghatta Road, Bangalore, points out that there are a lot of positive aspects of government policies regarding medical education. "It is the vagueness regarding the policies which is creating confusion among doctors and students," he concludes.

While the government is almost by definition the formulator and implementer of public policy, in an effective democracy, the thought and debate informing policy formulation should necessarily extend beyond the confines of government bureaucracy. This can happen when either the bureaucracy either reaches out to external experts for their inputs or when experts like Dr Chaturvedi give an analysis in media by using facts and figures, influencing public opinion. That is how policymaking becomes more informed and gets progressively based on evidence.

Every single policy decision produces winners and losers and therefore has supporters and detractors. It is for the decision-maker to balance the interests of the various competing groups over scarce resources— in this case, medical seats, and between the principle of individual rights and collective welfare.

Mahatma Gandhi's famous talisman about recalling the face of the weakest person is one such objective. Another goal is provided in the Preamble of the Constitution, which resolved to secure to all its citizens: Justice, social, economic and political; liberty of thought, expression, belief, faith and worship, equality of status and of opportunity, and to promote among them all fraternity assuring the dignity of the individual and unity and integrity of the Nation'.