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Nothing ‘national’ about this entrance test

The medical entrance scene in India has changed with the introduction of the undergraduate National Eligibility cum Entrance Test (NEET). Meant to be a single window test, the NEET has, in one go, replaced most of the state medical entrance tests. By qualifying in the NEET, students would be able to compete for a percentage of seats in most medical colleges, throughout the Indian union, by their ‘national’ rank. Their ‘state rank’ would help them compete for medical college seats within the states where they fulfill domicile requirements.

From the outset, the NEET has been mired in controversy, with the initial steadfast refusal of the apparatchiks of the Medical Council of India (MCI) to allow question papers in non-Hindi subcontinental languages. In the non-Hindi states, a majority of students study primarily in their mother tongue. The status of English as the pre-eminent language of contemporary medical science is clear. That didn’t explain why the MCI was fine with Hindi but not with other languages. Finally, the MCI had to buckle under severe pressure exerted by several non-Hindi states like Gujarat, Tamil Nadu, West Bengal, etc. The disgraceful compromise was that students can opt for question papers in Telugu, Assamese, Gujarati, Marathi, Tamil and Bengali (languages corresponding to the states that showed some spine) but those who do opt for the test in the ‘regional’ language will not be eligible for the all-India quota. The unconstitutional term ‘Regional language’ has been used in the information booklet issued by the Central Board of Secondary Education (CBSE), another Delhi based outfit that is in charge of conducting the test. However, a student taking the test in Hindi would be eligible for the all-India quota. There have been very few instances where the federal system has been abused to such a grave degree in matters of education.

The results of the NEET were announced on 5 June. The states stood ranked in terms of the percentage of students who qualified. Assuming an equal medical seat density throughout the Union (this is not true), a worse overall result from a state would mean that more seats in medical colleges of that state would be bagged by out-of-state individuals while there will not be any corresponding parity. For states, which have a greater than average medical seat density and a low performance in the NEET, this is a double whammy. This has been the case with Maharashtra in the results that were announced.

In this India-wide marketplace, it is only ‘merit’ that should matter, isn’t it? This ‘merit’ talk falls flat on its face as we know, that for decades together, private medical colleges have been admitting students who need not demonstrate any more merit than a 50% score at the Class XII examination. They have gone on to become doctors. It shows that the undergraduate medicine course-work is not something that requires top ranks. The ranks have become important as a sieving tool due to the severe dearth of medical seats in a territory as populous as the Indian Union. The problem is compounded by the fact that a MBBS degree is a sure-shot ticket to the top 5% income bracket in the nation. Hence the over-subscription for medical college seats and all the merit talk that comes with it. There is no systematic empirical evidence from the subcontinent that one’s rank in a medical entrance has anything to do with one’s success as a medical practitioner or researcher.

Let’s take a step back and ask: what are medical colleges for? Let’s remind ourselves what it is not for. It is not for providing good exam takers of 12th standard science with a prize in the form of a lucrative career or worsening the already skewed urban rural divide in doctor density. At a very basic level, it is to produce trained health workers who would provide healthcare to the multitude and/or advance the understanding of human biology and diseases by research. The way in which the NEET is set up, is a grave challenge to these objectives.

Framed from Delhi, after ‘consultation’ (the most abused term in a flawed federal system), the NEET syllabus favours those who have undergone their schooling and training in a central board (CBSE/ISC) framework. States boards with syllabi that differ from the CBSE are at an unfair disadvantage – they have to change or perish, for absolutely no reason. The viability or ‘worth’ of a board of education’s science syllabus then is not in how well it teaches science to the students but incredibly, by how well it has adapted (or not) the basic framework of a Delhi-based boards’ syllabus. If the state-boards are being forced to emulate the CBSE (in the name of removing aligning syllabi), is it something worth emulating? By rigorous research work (published in Current Science, 2009) that analysed the comparative performance of students from different boards, Anil Kumar and Dibakar Chatterjee, scientists at the Indian Institute of Science, showed that when it comes to science proficiency, CBSE is not numero uno. West Bengal board students did better than CBSE students in all four science subjects – Physics, Chemistry, Biology and Mathematics. Andhra Pradesh does better than CBSE in Mathematics and Physics. By the same metric, Maharashtra is hardly the worst performing state as it was in the NEET. Tellingly, neither West Bengal nor Andhra Pradesh was the top performing state in the NEET. CBSE ‘pattern’ of syllabus has become the standard, even though research shows it isn’t the best.

At a time when the urban-rural divide in doctor density is dismal, the NEET favours a certain breed of to-be-doctors. Within a state, those segments of society who study in non-state boards are disproportionately over-represented in the NEET ranks. It means, more seats in medical colleges in states will be occupied by those who are more likely to be urban, non-native speakers of the state’s principal language, from a higher economic class who can afford to send their wards to well-established entrance exam factories in Kota and elsewhere, with feebler roots to the state and so on. The implications are not very encouraging. Usually those from non-metro backgrounds in a state are more likely to serve in rural outposts of the state as a career-physician. All these speculative points can be debated, but for that we need data. The NEET was conceived without any such data being made publicly available.

Ostensibly, the NEET minimises the number of entrance exams. A very low proportion of students studying science at the 12th standard took multiple medical entrance exams in the first place? And those of the central board profile are over-represented even there. So this grand scheme forces everyone to change to help an already privileged minority. This puts science education at the higher-secondary level in jeopardy all over as it reduces its goals to professional course entrance examinations. What the whole NEET exercise may be doing is to widen the pipeline that supplies medical manpower for snazzy hospitals that are being opened in metropoles that attract capital.
The humble status of central boards to such commanding heights of dictation (not necessarily excellence) has happened with a concomitant fall in the status (again, not necessarily quality) of state boards. This phenomenon cannot be divorced from the centre-state context of the Indian Union where federalism means what bit of power the states have is wrested from them under various ruses. Education was a state subject after partition.  It was forced into the concurrent list during the Emergency. Education, like other concurrent list subjects, has seen the ceding of power from state to centre, ‘consultations’ notwithstanding. The long-term implications of such India-wide tests are a future two-tier education system – the CBSE/ISC route for ‘people like us’ and state boards for the rest. A majority of students will continue to study in state-boards. Amidst the ‘federal front’ buzz, the return of education to the state list should be considered seriously for greater common good. For starters, states that take rural healthcare seriously, should consider quitting the NEET. IPA
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