High competition, scarcity of medical seats, and hefty fees of private medical colleges in India may drive hundreds of medical aspirants to look for opportunities in other countries. The urge to have a bright and flourishing medical career among Indian medical aspirants has led to the popularity of MBBS abroad. This is a fact that many Indian students join medical universities abroad for their MBBS studies, but that doesn’t deviate them from the path of practicing medicine in India. The foreign medical graduates who want to practice in India have to qualify for a medical licensing examination, Foreign Medical Graduate Examination (FMGE), that is going to be taken over by the National Exit Test (NExT) as per the proposition of the National Medical Commission (NMC). 

Presently, there are two entrance examinations in India for the foreign medical graduates – FMGE and NEET-PG. The former exam is a licensing examination to obtain the registration certificate from the National Medical Commission (NMC) and latter is an entrance exam for Indian medical graduates to enroll for postgraduate medical courses in Indian medical institutes. The aim of the National Exit Test is to unify all the examinations meant for the medical graduates from foreign universities or Indian medical colleges.

I. What is the National Exit Test (NExT)?

The National Exit Test (NExT) is a proposed exam for medical students in India, including Indian medical graduates from foreign medical universities, to obtain a license to practice medicine in India and get admission in PG courses. According to the National Medical Commission Bill 2019, NExT will fulfill the purpose of a screening test for foreign medical graduates and entrance exam for PG medical courses. The aim of NMC behind introducing NExT is to bring uniformity in the Indian system of medicine and set a minimum common standards of education and training of medical graduates. 

In 2021, the National Medical Commission published draft regulations concerning foreign medical graduates amending the requirements of FMGE. The NExT examination will get rolled out in 2023 to replace FMGE and NEET-PG examinations. Under the NExT provisions, the foreign graduates are required to pass the exam within two years of graduation.  

II. Objectives/Purposes of National Exit Test (NExT)

The purposes of the implementation of NExT for medical graduates in India include:

• To certify the eligibility of the foreign medical graduates to practice medicine in India and fulfill the purpose of a licentiate examination.
• To evaluate the eligibility and ranking of medical graduates desiring to pursue postgraduate medical course in India in broad medical specialities and hence serve the need of entrance examination to PG medical courses. 

It is implied that from the time NExT becomes applicable, the other existing equivalent exams shall cease to exist. However, there may be previous batches to which FMGE/NEET-PG would be applicable, the sole discretion in this regard would be in the hands of the Commission, Central Government, State Government, Universities, and applicable laws. The scoring scheme of various examinations and NExT shall be determined as and when required by NMC. 

III. Eligibility Criteria To Appear For National Exit Test (NExT)

NExT will be applicable to the following categories of candidates:

• All undergraduate medical students of medical colleges approved by NMC through the Medical Assessment and Rating Board and the Undergraduate Medical Education Board.
• All foreign medical graduates (FMG) approved by NMC to obtain a medical license to practice medicine in India and enroll in the State Register or the National Register.
• All medical graduates willing to pursue a medical course, observership program, or any other purposes as approved by NMC. 

IV. Features of National Exit Test (NExT)

The National Exit Test (NExT) is broadly classified into two sets of examinations referred to as “STEPS”.

(1) NExT STEP-1

The NExT Step 1  is going to be an extensive online-based examination comprising multiple choice questions (MCQs) to ensure fairness and consistency throughout the country in a safe manner. The questions of the examination include higher segments of medical knowledge to check the competencies expected from a medical graduate seeking admission in PG courses or practicing medicine in India. 

1. Provisions/Regulations of the NExT Step-1 Examination

• Medical students who have completed III MBBS /Final MBBS course from a NMC-recognized medical college can appear for the exam. 
• The NExT Step-1 exam will be held once a year before the university practical examination for III MBBS (Part2)/Final MBBS prior to Compulsory Rotating Internship.
• The Supplementary Examination of NeXT Step-1 is conducted once a year and will be applicable to only the students who have failed in one or more subjects. 
• Students who fail in the Regular and Supplementary NExT Step -1 examinations can appear for the exam next year.
• A candidate has to pass both NExT Step 1 and NExT Step 2 Examination within ten years of joining the MBBS course. 
• Candidates can sit for the NExT Step 1 Regular Examination to improve scores for any number of times but only after a minimum of one year of passing NExT Step 2.
• The NExT Step 1 examination will replace the theoretical examination of III MBBS /Final MBBS Part II.  III MBBS /Final MBBS Part 1 and III MBBS/ Final MBBS Part II Practical/ clinical examinations shall continue unless otherwise notified by the Commission.

1. Distribution of items and question types

The NExT Step-1 Examination aims to evaluate the higher areas of medical learning. The major areas of the exam will check higher level comprehension, clinical problem-solving skills, and analytical skills of the candidates. The format of the exam intends to discourage candidates from mugging the medical concepts. Most clinical case studies or case vignettes shall be comprising the patter of the examination. 

The type and distribution of the MCQs in all the subjects will be as follows:

• Problems-solving and analytical skills – 65% (Clinical case scenarios 15/ hr of exam)
• Comprehension type – 25%
• Recall type – 10% 

Note: There can be slight variations in the distributions. 

The level of medical knowledge regarding the acquisition of competencies shall be approximately:

• Must know – 60%
• Nice to know – 30%
• May know – 10%

(C) Papers & distribution of subjects

• There are a total of 6 subject papers in NExT Step 1 with varied score weightage in items and time allocation.
• The applied areas of the medical subjects like Community Medicine and Forensic Medicine and Toxicology (FMT)) will be included in the relevant clinical subjects.
• 10% of items in every paper will include applied aspects of Physiology, Anatomy, Microbiology, Biochemistry, Pharmacology, Pathology, Forensic Medicine having relevance to the evaluated subjects.
• 10% of items in every paper will include applied aspects of Community Medicine/Public Health having relevance to the evaluated subjects.
• The item weightage and time allocation of every subject with the provision of 20% items distribution mentioned above.

(D) Proposed time scheduled for papers

The NExT Step 1 will be conducted on alternate days with two subjects covered on a single day with a 2-hour break in between. 

(2) NExT Step-2

It is an all-inclusive clinical/practical examination held after the successful completion of internship to evaluate the competencies in practical diagnosis, patient and clinical decision-making, and practical and communication skills required to practice contemporary systems of medicine in India.

1. Methods of evaluation:

Every examination would consist of:

• Actual cases

1. Objective Structured Clinical Examination (OSCE)
2. Simulations, if possible

There shall be two levels of grading – “Competent/Pass” and “Not competent/Fail” on the basis of the performance of the candidates. 

(B) Subjects distribution:

Below are the subjects evaluated during NExT Step 2:

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

(V) NExT Scores

• Nature of scoring:

1. The marks obtained in NExT Step 1 shall be a whole number serving as raw marks with appropriate decimals and ultimately corresponding percentages with appropriate decimals. 
2. The result of NExT Step 2 examination shall be declared as “Pass” or “Fail”.

•  Minimum scores for passing:

1. The minimum score for passing NExT Step 1 shall be 50% (50 out of 100) or 50% of the maximum potential raw scores. 
2. Each of the six papers of the NExT Step 1 shall have a minimum score of 50% (50 marks out of 100) or 50% of the maximum potential raw scores. 
3. The passing criteria to qualify for the NExT Step 2 shall be a good demonstration of medical competencies.

• Calculation of NExT Step 1 marks for admission to PG courses in broad specialties:

1. The total scores to determine merit for admission to PG courses in broad specialties will be calculated from the total of raw scores in each subject and shall remain valid for three years.
2. In case the candidate fails in one or more subjects, the total score/percentage will be calculated from the sum of raw scores in every subject/paper that he/she has passed in both Regular and Supplementary Examination.
3. The total marks and percentage of candidates who appeared for NExT Step 1 for improvement in scores will be calculated from the average of the last 3 consecutive scores. 

• Utility of NExT Score:

1. Eligibility for provisional registration for internship in an appropriate institution to practice medicine according to the  Internship Regulations of the National Medical Commission by an Indian Medical Graduate:

2. Eligibility for provisional registration in an appropriate body to practice medicine as an intern and eligibility to purpose Internship as governed by the Internship Regulations of the National Medical Commission by an Indian Medical Graduate:

3. Eligibility requirements for grant of medical license to practice in India and registration in the National Medical Register/ State Medical Register /State Medical Registers for such practice.

4. Eligibility for admission to PG medical courses in broad specialty subjects in a college/institution approved by the NMC.

5. Other utilization of NExT scores

The Indian Government or any other organization authorized by it may utilize the NExT Step 1 scores for the purpose of scholarship, employment, fellowship, and more after taking the permission for the particular use by the National Medical Commission or any other competent authority. 

(VI) Time Schedule of NExT Examination and associated events

The time schedule of the complete process of the NExT exam, internship, and admission to broad specialty PG courses will be announced by the NMC and other bodies authorized by it.

The below table provides the estimated/proposed time schedule for the NExT examination. It is subject to changes from time to time.

Conclusion

The National Exit Test will undoubtedly bring the FMGE and NEET-PG exam under a common umbrella. The FMGs can appear for the NExT examination either to get a license to practice medicine in India or to join postgraduate medical courses in various medical institutions in India. The date of the applicability of the National Exit Test is still unknown, it is certain that it will simplify various entry routes to the healthcare industry of India.