Lowering benchmarks and higher risks in medical education

As per details presented in the Rajya Sabha, India has a Doctor-Population Ratio estimated at 1:811 (i.e. 1 doctor per 811 people) based on the availability of Allopathic and AYUSH practitioners, while the World Health Organization (WHO) often uses a benchmark of 1:1,000 (i.e. 1 doctor per 1,000 people) and over 44% of countries report having less than one physician per 1,000 population. It gives a cue that the country has attained a number of doctors better than the WHO benchmark, but the continued establishment of new medical colleges and capacity enhancement will further improve the availability of doctors. In the ongoing expansion of medical education, the quality of doctors coming out of the medical colleges ought to be assessed, especially at a time when there is a buzz about the negative mark holders of NEET seeking admission in specialised PG programmes. Nevertheless, the lowering cut-off does help in filling the PG seats in medical education temporarily, but prima facie, a reasonable threshold cut-off mark as eligibility to pursue post-graduate medical education appears logical to prevent the healthcare from crumbling under mediocrity.

Is the entrance test a check of merit?

Indeed, the entrance test(s) aim to ensure uniformity and transparency in merit list preparation and cannot be used to assess the merit of qualifying degrees. These are intended to rank the appearing candidates in order of merit based on the test, which may be a pen-and-paper or computer-based test from the prescribed syllabus. The syllabus coverage depends upon the attributes to be assessed and could be completely from the subject knowledge based on eligibility qualification or a combination of subject knowledge, reasoning, analytical ability and responsiveness under time constraint; thus, the outcome of the test as an assessment tool is different in each of these situations and cannot be a sole check of merit. Instead, a blend of the candidate’s educational performance up to the test stage and test performance together can yield something worthwhile regarding merit. Also, amongst the usual two modes of test, the single-session test conducted in pen-and-paper mode is completely objective and a true reflection of the performance, while the multi-session computer-based tests do involve relative performance moderation.

However, when the examinees perform abysmally in an entrance test which aims to objectively assess the desired competency and merit commensurate to eligibility qualification through a single numerical outcome in test(s) call for a holistic analysis from the perspective of why it has happened and demands course corrections.

NEET-PG cut-off marks fiasco

The ongoing debate about the cut-off marks in NEET PG ought to be seen from the perspective of whether it really points to declining merit or it is merely the relative performance of the admission aspirants. Thus, had it been mere relative performance in the test, then the standard of test questions is the determinant of the performance by the appearing doctors, and the marks could be low. Nonetheless, in the present case, as the test questions are from the prescribed syllabus and MBBS degree holders appear therein, and no uproar was reported in the past regarding the difficulty level and high standard of test questions at the time of the conduction of the NEET PG 2025, the arguments about the deficient capability of doctors appearing in it cannot be ruled out.

There are numerous viewpoints, i.e. one relates it to a culmination of the drooping capabilities of the PG aspirants and question the standard of the UG medical education, while the others do not link the NEET PG test marks with their professional capability and refer it to the negative marking scheme and the lowering of cut-off marks due to equity considerations and to fill all the seats of PG in medical education across the country. The moot point is that this precarious situation of negative marks is evinced despite the long duration of special efforts being put in by UG degree holders to get good scores in NEET PG for getting admission in the speciality of their choice.

Irrespective of the arguments and counterarguments, the unexpected performance by the MBBS degree holders calls for a credible, independent academic audit of the quality of UG education across the medical colleges to evaluate the rigour level of the teaching-learning-examination system that entitles such poor performers with medical degrees. Because it not only questions the educational standard of medical professionals but also indicates the likely lack of their core professional capabilities, and may erode public faith in the healthcare services.

Way forward

The negative perception created by the too-low marks in NEET PG necessitates immediate corrections. The difficulty level of test questions must be thoroughly assessed in light of the requirements of the PG programmes, and reasonable cut-off marks must be fixed immediately after the test to determine the merit list of the successful ones. In order to improve quality and ensure the seriousness of the students in UG medical education, there is a need to fix a minimum UG degree mark as an eligibility condition for admission to PG programmes. Alternatively, a thought may be given to having a combined weighted criterion of UG degree marks and entrance test marks to decide the merit list. There should be consideration to filling the PG seats, but the same cannot be at the cost of sacrificing the competency level of doctors getting admitted.

It’s high time to draw policy-level changes by striking a trade-off between ‘whether to leave postgraduate seats vacant for want of suitable candidates’ or to ‘fill these seats by compromising merit’. Indisputably, the dilution in admission standards is likely to risk the abilities of the specialised PG degree holders and weaken the healthcare delivery in the long run. The regulators and academics of medical education must take an honest call for overcoming structural challenges and strategise overall amelioration to achieve excellence and offer a safe and dependable healthcare system with access and equity.

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