Doctors, students and faculty from the All India Institute of Medical Sciences (AIIMS) have renewed calls for the immediate implementation of the National Exit Test (NExT), arguing that it could overhaul India’s fragmented medical assessment system and align it with real-world clinical competence.

Members of the Resident Doctors Association and Student Association at AIIMS Delhi, alongside faculty from AIIMS Delhi, Nagpur, Patna and Dr Ram Manohar Lohia Hospital, said the proposed exam addresses deep-rooted inconsistencies in current university and postgraduate entrance tests, offering a more streamlined and competency-based evaluation framework.

In an editorial published last month in the Journal of Family Medicine and Primary Care, the authors described India’s existing undergraduate medical assessments as “inconsistent and fragmented,” often poorly aligned with competency-based training. They argued that NExT would introduce a uniform, transparent and clinically relevant system of evaluation.

Proposed under the National Medical Commission Act and detailed in a 2023 Gazette notification, NExT was envisioned as a single qualifying exam to replace three key tests: final MBBS examinations, NEET-PG, and the Foreign Medical Graduate Examination (FMGE).

However, repeated postponements have stalled its rollout, creating uncertainty and delaying long-pending reforms.

The editorial underscores that current university-based MBBS exams vary widely in quality and fairness. Theory papers are often subjective, content does not consistently reflect national competency standards, and evaluation criteria differ across institutions—raising concerns about whether graduates are uniformly prepared for medical practice.

It also flagged limitations in existing postgraduate entrance tests, which rely on a relatively small pool of around 200 multiple-choice questions to assess the vast MBBS curriculum. This, the authors said, reduces reliability, increases the role of chance, and encourages coaching-driven preparation over clinical learning.

At present, students must navigate two contrasting systems: theory-heavy, long-answer university exams and entirely MCQ-based postgraduate tests. “This mismatch forces students to adopt different strategies and adds to stress,” the editorial noted, making a case for a unified approach.

NExT proposes to bridge this gap through a two-step format. Step 1 would feature a larger pool of clinically oriented MCQs based on case vignettes and applied reasoning, while Step 2 would assess practical skills, communication and clinical competence through structured clinical examinations—though detailed guidelines are still awaited.

Importantly, the exam would apply uniformly to all candidates, including those from government and private colleges, as well as foreign medical graduates. A single national standard, the authors argued, would enhance transparency, ensure fairness, and strengthen public confidence in the medical profession.

They added that a unified score could also streamline postgraduate admissions, government recruitment, and access to fellowships or scholarships, reducing reliance on multiple exams and arbitrary selection processes.

The editorial also warned against unchecked expansion in medical education without robust evaluation mechanisms, citing lessons from engineering, management and dental sectors where inadequate assessment standards led to declining quality and eventual closure of institutions.

“In medicine, poor training can lead to serious harm,” the authors stressed, arguing that NExT would establish a minimum national benchmark for all graduates before independent practice, safeguarding public health.

To ensure a smooth transition, they recommended extensive preparatory support, including mock tests, sample questions, workbooks and detailed syllabus guidance.