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A couple of days back my mind happened to halt at a topic that's been brewing briskly for quite some time now. I decided to give it some thought and it seemed worth a post.
Somewhere around 2010 the union ministry of health and the MCI had unifiedly churned out a proposal regarding a common, universal 'national exit exam' for Indian MBBS graduates before they were let free to run their hands and minds in medical practice. The proposal allegedly met some opposition until recently, when it garnered limelight and some enthusiastically backing voices. The national exit exam aims to ensure adequate competency among graduates, and also a level of uniformity in competency owing to the varying standard of medical instruction across institutions, before handing them a permanent registration to practice medicine freely. The academic council of the MCI propounds five pertinent changes in it's report:
- Every graduate has to clear an 'exit test' before being able to practice independently across India.
- Duration of MBBS to be reduced from 4.5 to 3.5 years.
- Right in the beginning of their academic journey, the student is to be offered a choice to choose an area of specialization and learn only related subjects.
- The academic council of the MCI will be entrusted with the power to form any academic course in medicine.
- The MCI will have it's own mechanism for accreditation of medical coleges.
We'll zoom into the first proposal for the rest of this discussion.
To be fairly simple, the idea of an examination is based on the promise that you test something when you want it to meet a certain standard. And when you want something to meet a certain standard, you need to be sure enough of a delivery system that delivers such a standard. Obviously, before thinking of an exit exam that tests the adequacy of competency, we need to be confident enough that our system of medical instruction is not flawed at creating adequately competent MBBS doctors. I reiterate once more, and it has been reverberating across forums for long, that graduate MBBS training today does not allow adequate practical approach and competency for practice, and requires additional time of training under supervision. The MBBS curriculum is in a great need of modernization. To summarize things, the theory aspect of study has received more preponderance than it rightly should. Browse through medical colleges and you find an undue amount of time devoted to develop strategies to clear the theory exams.
Our examinations are predictable and archetypal – they often call for more of tactics and less of understanding. The standards of our practical instruction vary greatly across institutions and often, there is little stringency, little quality control and little enforcement of order in practical training. Practical training and evaluation is often left at the whims of the student, the staff and the examiners. Furthermore, the year of compulsive rotating internship, which is the time of developing a world vision in medicine, is variably consumed by trivial routine work, mindless activities and often a tumultuous environment of little order that assures little learning. With all that as the backdrop, the idea that simply another exam will confirm us of uniformly and exceptionally competent MBBS graduates seems strongly credible to be worthwhile. Why does not the MCI address these blemishes that create a competency inadequacy before chalking out a test that evaluates competency? Is not that paradoxical?
We can stretch a similar talk over the other objective of this exit test. The academic council of the MCI claims that the exit test would serve to uniformize the quality of competency among engineers, but it tells little about the ways to dissolve this standard discrepancy in the first place, and to insure that every institution, irrespective of any administrative or social division, deliveries a defined, exalted standard of medical instruction. How can such a standardising test be fruitful enough before levelling the field between merit based govt. colleges and the private colleges that auction seats for crores?
In a sense, we can say that a national exit test taking place in such an askew setting will do everything to highlight the problems we face but nothing to solve them. And then, there are concerns over the nature of the exam. Is it going to be another stereotypical MCQ test? Or a familiar descriptive test like the university theory exams? Can preparing for and passing such a test be equated with the competency gained through months of dedicated, methodical medical training. Without doubt, it will take little time for such a test to become 'just another exam' of dubious value. It will menacingly shroud the deep gorge of incompetence resulting from a sloppy training. And if we somehow put up a near ideal exit test that actually backs it's claims, a good chunk of our MBBS graduates might flunk owed to the loopholes in our system of instruction, and that's certain to raise mayhem across the medical community.
The only way to bring meaning to the picture of the national exit test is to first address the basic issues in our medical training. Once we bring it out of disrepair, such a single, nationwide exam would prove an essential tool to ensure a defined standard of competency among doctors with varying individual skill levels- something we unfortunately need. A single test scrutinizing both Indian and foreign graduates will be enchanting and satisfying to foreign trained indian doctors too. Similar tests are in effect in the US, Canada, Australia etc and are performing prolifically to their satisfaction.
Conclusively, it's upon us as to what we make out of the national exit test- a substance emblematising dynamism or an empty, tawdry rhetoric.
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Source by Soham Bhaduri