The National Medical Commission has finally released the draft gazette pertaining to National Exit Test (NExT) and specified that it would serve as both a licentiate exam solely for the purpose of practice of modern medicine for both Indian medicos and foreign medical graduates and also as a gateway entrance examination for seeking admission to various post-graduate medical education courses. Further, the draft also covers all NExT related details, including the objectives, applicability, division into STEP 1 and STEP 2, and methods to conduct the exams, along with the calculation and validity of NExT scores. 

Objective: 

The primary objective behind the regulation is to bring uniformity in the accumulative evaluation countrywide concerning the minimum common standards of education and training of a medical graduate.

Purpose of NExT:

The primary purpose of NExT is to

• Certify the eligibility of all the medical graduates registering to practice the modern system of medicine in India and, therefore, serve as a licentiate examination.
• It would also serve as a gateway examination to decide the ranking and eligibility for admission of candidates willing to pursue further PG medical education in the country in broad medical specialties.

Eligibility Criteria for NExT:

• All UG medical students pursuing MBBS in all medical colleges approved by the NMC through the medical assessment and rating board, along with the undergraduate medical education board.
• Every Foreign Medical Graduate approved by the NMC for obtaining a license to practice medicine as a registered practitioner in India and for the purpose of enrollment in the State Register or the National Register.
• Anyone with a medical degree for pursuing an academic course, observership, or other purposes specified and approved by the NMC through due notification or regulations from time to time.   

The fate of the Current Exam Structure and the Previous Batches

• The draft clearly states that whenever NExT is enforced, all the corresponding equivalent examinations would no longer be applicable, and NExT should take its place. 
• For previous batches, the existing examinations would remain applicable as may be decided by the State Government, Commission Central Government, Universities, and applicable laws; the existing examinations would continue to be appropriate for such time with the comprehension that NExT should eventually replace the existing equivalent examinations. 
• Use of Scores, normalisation of different examinations, and the NExT, when applicable simultaneously for the purpose that may be appropriate, should be determined and notified by the Commission. 
• Through appropriate regulations or notification, the Commission should highlight from time to time the appropriate manner of utilising the results of NExT for taking admission to PG courses in broad medical specialties. 

Conduct of NExT in Two Steps:

The draft has confirmed that the NExT examination would comprise of two separate of examination referred as ‘Steps’,

Features of NExT Step 1

• NExT Step 1 should be a theoretical examination.
• The questions can be either one or more than one type of the MCQ Type.
• The exam should be delivered by a Computer Based /Online mode.
• NExT should be a Centralised Common All India Examination to be conducted by an authority/Body/ authority for the purpose by the commission.
• The Examination should comprise Six papers, including 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 I

• All students who have completed the III MBBS /Final MBBS course from a medical college recognised by the Commission should be able to appear in the examination.
• Regular NExT Step 1 Examination should be held once a year before the University Practical Examination for the III MBBS (Part2)/Final MBBS preceding Compulsory Rotating Internship
• The NExT Step 1 Supplementary Examination should be annually 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.
• Candidates failing to pass the NExT Step 1 Regular and the Supplementary Examination of a specific year should be able to appear for the NExT Step 1 Regular Examination only the following year.
• The number of attempts to appear in NExT Step 1 has no limitation provided the candidate has passed both NExT Step 1 and NExT Step 2 Examination within ten years of joining the MBBS Course.
• To improve scores, there is no limitation to the number of attempts to appear in the NExT Step 1 Regular Examination, provided these examinations to improve scores are taken at least after one year of completion of NExT Step 2.
• The NExT Step 1 can be replaced by the conventional university/institutional Theory Examinations of III MBBS /Final MBBS Part II. However, III MBBS/Final MBBS Part 1 and III MBBS/ Final MBBS Part II Practical/clinical examinations should be held conventionally unless notified otherwise by the commission.

Features of NExT Step 2

• NExT Step 2 should be a Practical /Clinical and Viva Voce Examination likely to cover seven clinical subjects/disciplines;

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)

• The examination pattern should be Objective Structured, Simulated Cases/Patients aimed at evaluating Practical /Clinical skills, Clinical Case Based, clinical decision-making, and communication skills as expected of an Indian Medical Graduate.
• The examination should be conducted live by the respective state Health Universities / Institutions adhering to the standards and guidelines provided by the Commission. Where state Health Universities do not exist, the Commission should have the authority to decide on the University/ Institution authorised to conduct NExT Step 2 for respective colleges.
• The NExT Step 2 Examination should be conducted on a regular basis once a year
• The Supplementary NExT Step 2 Examination should be held annually and is limited to only those candidates who have failed in one or more (up to 3 Subjects) of the seven subjects and are required to reappear for the particular subjects.
• Candidates failing to pass both the NExT Step 2 Regular and the Supplementary Examination of a specific year should be able to appear for the NExT Step 2 Regular Examination only in the following year.
• The number of attempts to appear in NExT Step 2 has no limitation provided the candidate has passed both NExT Step 1 and NExT Step 2 Examination within ten years of joining the MBBS Course.

NExT Scores:

1. Nature of Scoring

• The marks obtained in NExT Step 1 should be calculated as a whole number that should serve as the Raw Scores with proper decimals, and subsequently, corresponding Percentages [marks out of a maximum of 100] with correct decimals may be calculated if at all required.
• The results of the NExT 2 Examination should be declared as only Pass/Fail based on the acquisition of appropriate competence that is being evaluated.

2. Minimum Scores for Passing

• The minimum passing mark should be 50% [50 out of 100] OR half of the maximum possible Raw for NExT Step 1
• In each of the six papers of NExT Step 1, a minimum of 50% [50 out of 100] OR half of the maximum possible Raw Scores should be scored to pass the examination.
• The passing criteria of NExT Step 2 should be based on a satisfactory demonstration of having acquired the competencies that are evaluated that should be declared as a Pass /Fail result.

3. NExT Step 1 Score calculation and determination of merit for admission to PG courses in broad medical specialties

• The Total Marks for the purpose of determining merit, especially for admission to broad specialty Postgraduate Courses should be calculated from the sum of raw scores obtained in each paper /subject.
• In case of failure in one or more subjects, the Total Marks /Percentage of NExT Step I should be calculated from the sum of the total raw scores in each subject /paper obtained in both the Regular and Supplementary Examinations in which the candidate has secured pass marks.
• For candidates who have appeared in the NExT Step Examination to improve their scores, the percentage of the total marks should be calculated from the average/mean of the last three consecutive scores.
• To determine merit, especially for admission to broad-specialty PG Courses, the validity of NExT Step scores is decided to be for three years.

NExT Step 1: Distribution of Items and knowledge level of Questions

To ensure cutting-edge medical learning, a majority of items should be formulated to test higher-level comprehension, analytical skills, and clinical problem-solving related to competencies. The format is made to discourage rote learning and thus, the MCQ items in all subjects are distributed as follows:

Problems-solving and analytical skills types	65% clinical vignettes 15/ hour of exam
Comprehension type	25%
Recall Type	10%

However, variations in the distribution are likely to be expected.

The Knowledge level related to the addition of competencies should be approximately:

Must Know	60%
Nice to Know	30%
May Know	10%

Papers and Distribution of Subjects:

• The NExT Step 1 examination should have six subject papers with respective weightage in items and time allotment.
• The applied aspects of the other subjects of MBBS, including Forensic Medicine and Toxicology and Community Medicine, should be mainstreamed into the relevant clinical subjects.
• In each paper, 10% of items should be related to applied aspects of Anatomy, Physiology, Biochemistry, Microbiology, Pathology, Pharmacology, and Forensic Medicine relevant to the subjects evaluated.
• In each paper, 10% of items should include applied aspects of Public health / Community Medicine relevant to the subjects evaluated.

The table provides the subjects in each paper with respective weightage in items and the time allocated

Paper	Subject	No. of Items	Duration
1	Medicine and allied subjects	120 items	3.0 hours
2	Surgery and Allied subjects	120 items	3.0 hours
3	Obstetrics and Gynaecology	120 items	3.0 hours
4	Paediatrics	60 items	1.5 hours
5	Otorhinolaryngology	60 items	1.5 hours
6	Ophthalmology	60 items	1.5 hours

Proposed Time Scheduled of Papers:

Day	Subject	Duration	Break	Subject	Duration
1	Medicine and allied subjects	3.0 hours	2.0 hours	Paediatrics	1.5 hours
2	Rest Day No Examination
3	Surgery and Allied Subjects	3.0 hours	2.0 hours	Otorhinolaryngology	1.5 hours
4	Rest Day No Examination
5	Obstetrics and Gynaecology	3.0 hours	2.0 hours	Ophthalmology	1.5 hours

The above schedule is only indicative subject to feasibility and logistics

Information regarding NExT Step 2:

Evaluation Methods:

The examination should comprise of

• Actual cases
• Objective Structured Clinical Examination (OSCE)
• Simulations if possible

Based on the ability of satisfactory performance or unsatisfactory performance, there should be only two levels of grading system, either “Competent or “Pass” or “Not Competent” or “Fail”.

Distribution of Subjects:

The following subjects should be included for evaluation during NExT Step 2:

• Medicine and allied subjects
• Surgery and allied subjects
• Obstetrics and Gynaecology
• Paediatrics
• Otorhinolaryngology
• Ophthalmology
• Orthopaedics and Physical Medicine & Rehabilitation (PMR)

Time Schedule:

The time schedule and other modalities, including the amount required to get admission to the PG Courses of that year of NExT Step 2, is supposed to be decided by the NMC and the respective authorised Universities/Institutions after completion of the internship.

Time Schedule of NExT Examination and associated events^[1]:

The proposed timetable is provided in the table below, which is subject to change as may be necessary from time to time and should be notified accordingly.

S.no	Event	Date of Exam/Commencement	Date of Result/ Completion
1	NExT Step I Regular	2nd Week December	2nd Week January
2	NExT Step Supplementary
3	III MBBS /FINAL MBBSPART 2 Practical / ClinicalUniversity Examination	1st Week January	4th Week January
4	Internship	1st February	28 February Following year
5	NExT Step 2 Regular	2nd week March	1st Week April
6	NExT Step 2 Supplementary
7	Post-Graduate Admission	May-June	30th June
8	Post-Graduate Course	1st July