The National Medical Commission has recently released draft regulations for the proposed National Exit Test for MBBS students in India. This article will describe the salient points of the draft regulations.
Key Messages:
The National Exit Test for MBBS students will be conducted in ‘Steps’.
Step 1
Timing:
Each year after completion of Third MBBS Part II and before commencement of University Third MBBS Part II Practical Examinations.
This will replace the current University Third MBBS Part II Theory Examinations. University Third MBBS Part II Practical Examinations will continue to be conducted as is the practice at present.
Eligibility:
All those students who have completed the III MBBS /Final MBBS course from a medical
college recognized by the Commission shall be eligible to appear in the examination.
Subjects:
The Examination shall consist of six papers covering subjects of III MBBS /Final MBBS, both Part 1 and Part 2:
a. Medicine and allied disciplines
b. Surgery and allied disciplines
c. Obstetrics and Gynaecology
d. Paediatrics
e. Otorhinolaryngology
f. Ophthalmology
g. Applied aspects of all subjects covered under I MBBS and II MBBS
h. Applied aspects of all subjects covered under III MBBS /Final MBBS Part l
Type of exam:
This shall be a Centralized Common All India Examination to be conducted by an
authority/Body/ authority for the purpose by the commission, delivered by a Computer Based /Online mode. The Questions shall be one or more than one type of Multiple Choice Type questions.
Distribution of Items, Level of Knowledge, Subjects:
To ensure assessment of higher domains of medical learning, a majority of items shall test higher level comprehension, analytical skills clinical problem-solving that are aligned to competencies.
NExT Step 1 format in intended to discourage rote learning by the medical students.
Case vignettes/ clinical case scenarios shall be the overwhelming Pattern of examination.
MCQ items in all subjects shall be distributed approximately as follows;
- Problems-solving and analytical skills types 65% clinical vignettes 15/ hr of exam
- Comprehension type 25%
- Recall type 10%
The level of Knowledge related to the acquisition of competencies shall be approximately
- Must Know :60%
- Nice to Know :30%
- May Know :10%
Applied aspects of all other subjects of MBBS including Forensic Medicine and Toxicology (FMT) and Community Medicine will be mainstreamed into the relevant clinical subjects.
In each paper 10% items will pertain to applied aspects of Anatomy, Physiology, Biochemistry, Microbiology, Pathology, Pharmacology, Forensic Medicine relevant to the subjects evaluated.
In each paper 10% items will pertain to applied aspects of Public health / Community Medicine relevant to the subjects evaluated.
Scores:
The marks in NExT Step 1 shall be calculated as whole number which shall serve as the Raw Scores with appropriate decimals and subsequently corresponding Percentages [marks out of a maximum of 100] with appropriate decimals may be calculated if required.
Pass criteria:
The minimum marks for passing shall be 50% [50out of 100] OR half of the maximum possible Raw Score for NExT Step 1.
For the NExT Step 1, in each of the six papers a minimum of 50% [ 50 out of 100] OR half of the maximum possible Raw Scores should be scored to pass the examination.
Utility of Scores:
- Eligibility for Provisional Registration and commencement of Internship (must have passed both NExT Step 1 [all six papers] and the University III MBBS/ Final MBBS (Part 2) Practical / Clinical Examination.
- Eligibility for admission to Postgraduate Medical Courses in broad specialty (Only the actual raw marks or marks / percentages (scores out of a maximum of 100) with decimal fractions obtained in NExT Step 1 (all six papers) in Regular and Supplementary Examinations, as may be applicable, shall be utilized for the purpose of ranking / determining order merit of otherwise eligible candidate for the purpose of the appropriate subject and seat.).
Supplementary Examination:
A NExT Step 1 Supplementary Examination shall be held once a year and is restricted to only those candidates who have failed in one or more of the six papers and are required to repeat those particular papers /subjects.
Those who do not pass both the NExT Step 1 Regular and the Supplementary Examination of a particular year shall be able to appear for the NExT Step 1 Regular Examination only in the following year.
Number of Attempts permitted:
There is no restriction to the number of attempts to appear in NExT Step 1 provided the
candidate has passed both NExT Step 1 and NExT Step 2 Examination within 10 years of joining the MBBS Course.
There is no restriction to number of attempts to appear in the NExT Step 1 Regular Examination to improve scores provided these examinations for improvement of scores are taken at least after one year of completion of NExT Step 2.
Step 2
Timing:
Once a year (NExT Step 2 Regular Examination, and NExT Step 2 Supplementary Examination)
Eligibility:
Completion of appropriate duration of internship from a recognized medical college.
Subjects:
Seven subjects will be included
a. Medicine and allied disciplines
b. Surgery and allied disciplines
c. Obstetrics and Gynaecology
d. Paediatrics
e. Otorhinolaryngology
f. Ophthalmology
g. Orthopaedics and PMR (Physical Medicine and Rehabilitation)
Type of exam:
NExT Step 2 shall be a Practical /Clinical and Viva Voce Examination (covering seven clinical subjects/disciplines mentioned above), shall be held in person /live and shall be conducted by the respective state Health Universities / Institutions following the standards and guidelines provided by the Commission.
The examination shall be Objective Structured, Clinical Case Based, Simulated Cases/Patients aimed at evaluating Practical /Clinical skills, clinical decision-making and communication skills expected of an Indian Medical Graduate.
Scores:
NExT 2 Examinations results shall be declared as only Pass / Fail based on the acquisition of appropriate competence that is being evaluated.
Pass criteria:
The criteria for passing NExT Step 2 shall be satisfactory demonstration of having acquired the competencies that are being evaluated and shall be declared as a Pass /Fail result.
Comment: As there is no mention of the (minimum) number of stations, or the number of stations one must pass to achieve an overall pass grade, it simply means that candidates must pass every station.
Supplementary Examination:
A NExT Step 2 Supplementary Examination shall be held once a year and is restricted to only those candidates who have failed in one or more (up to 3 Subjects) of the seven subjects and are required to repeat particular subjects.
Those who do not pass both the NExT Step 2 Regular and the Supplementary Examination of a particular year shall be able to appear for the NExT Step 2 Regular Examination only in the following year.
Utility of Scores:
- Eligibility for grant of License (and Permanent Registration) to practice modern medicine (Permanent Registration with a State Medical Council will be permitted only upon successfully passing NExT Step 2 after completion of internship).
- Eligibility for admission to Postgraduate Medical Courses in broad specialty (Admission to Postgraduate Medical Courses will be permitted only after a candidate has passed NExT Step 1 and Step 2; and has gone through the common/centralized counselling process).
Number of Attempts permitted:
There is no restriction to the number of attempts to appear in NExT Step 2 provided the candidate has passed both NExT Step 1 and NExT Step 2 Examination within 10 years of joining the MBBS Course.
Tentative Schedule for Step 1 and Step 2:
Summary:
National Exit Test (NExT) will be conducted in two ‘Steps’- Step 1 after completion of Third MBBS Part II, and before University Third MBBS Part II Practical Examinations.
NExT Step 1 will determine eligibility to obtain Provisional Registration and commence internship (provided a candidate passes the University Third MBBS Part II Practical Examinations), as well as merit list for admission to Medical Postgraduate Courses (broad specialty). This will be a computer-based/online theory examination comprising of six papers covering subjects from Third MBBS Part I and Part II, as well as applied aspects of other subjects (10% weightage in each paper) and public health/community medicine (10% weightage in each paper).
NExT Step 2 will be conducted after completion of approved duration of internship and will be a live/in-person examination that will assess competencies in all seven subjects included for the exam. It will comprise of Objective Structured Clinical Examination (OSCE), actual cases, simulations. Candidates will receive a pass/fail decision at each station and the overall Step 2 examination. Passing Step 2 will be necessary for permanent registration with a State Medical Council, grant of Licence to practice modern medicine, as well as admission to a broad specialty Medical Postgraduate course.
A candidate may take any number of attempts to pass NExT Step 1 and Step 2 provided both are passed within 10 years of admission to MBBS. Supplementary Step 1 and Step 2 examinations will be offered to those who fail Step 1 and/or Step 2 examinations.
Useful Link:
Link to the NMC Draft Regulations on NExT:
communitymedicine4all 