The foundations of the Indian Medical Education System is based on the principles of testing students via the use of MCQs. Whilst the system is probably the best possible way of evaluating a student objectively, and without letting subjective bias creeping in on the results (which is often the case in the in-course MBBS examinations, where the theoretical examinations are mostly essay based answers in most parts of India), there are a lot of caveats in the system. In this post, I would like to highlight some of the obvious fallacies of testing the post graduation entrance examinees using MCQs.
First and foremost, I abhor the negative marking system in the Indian PG entrance exams. Why should I be penalized for something I do not know by taking away the credit I score for knowing something else? The counter argument is that it prevents students from taking random guesses at questions in order to “game the system”. There is an easy way out: Why not increase the number of options? It is simple probability, actually. If there are four options (as is the norm nowadays with most of the Indian PG entrance exams), the chances of getting one right (purely by guessing without having eliminated a single option) is 25%. It would come down to 10% if there are 10 answers to choose from. Agreed, that would make reading the questions a pain, but it would eliminate the system of taking my credits away for a wrong answer. I am not even starting on the issue of providing credits for giving the correct answers, as the USMLE is rumored to do. I will, someday, write a detailed post on the hows and whys of the system of USMLE scoring that floats around in the gossip-based student groups online.
Secondly, the type of questions asked is a big issue. At least with me. The general consensus is that most questions in any PG entrance examination is based on information-utilized recall memory. Put simply, it encourages rote learning and memorizing of random facts in the hope of cracking an examination to gain access to the next level of medical studentship. The examination system fails to test the student on his or her clinical skills – something which is going to stand the ones who want to make it to the clinical disciplines in the future in good stead. And, one does not need to add that this kind of system is like Manna from Heaven for the different coaching institutes which have sprung up like mushrooms all over the place. The PG entrance examinations are walking the same way as have the IIT-JEE. And that is, in my honest opinion, a step backwards.
Thirdly, the multiple examination system. In the USA the USMLE happens to be just one examination which determines whether a medical student can move into residency and beyond. I do not expect the lackluster and corruption-ridden Indian system to adopt that kind of an educational program in the foreseeable future, but taking one, single entrance exam could be a step towards that end. But thankfully, the reconstituted MCI seems to have seen reason and we can finally have a unified, common entrance test. I realize that it would make the performance on THAT particular day like a be-all-and-end-all thing for the doctors but then again, with a number of examinations, each with varying degrees of difficulty, it is more or less a sham system which fails to quantify the qualities of doctors from different parts of the country on a comparative basis.
Fourthly, the MCQ based examination hardly takes into account the medical students’ career throughout medical school.This, again is due to the fact that since every state has a university controlling the undergraduate medical examinations, there is wide variation in the scoring profiles of students of one state from another. Heck, the differences in the scoring patterns of different medical schools in the same state is wildly divergent. A system, not unlike the USMLE Step 1 could be an excellent move to consolidate the status of the undergraduate medical system by testing the students on their qualities half way through their medical school curriculum and thereby manage to create a single comparison reference frame for all the students at the half way stage as well. The common exit test for the Indian Medical Graduate license could well be the first step in that direction.
Fifthly, what is with the caste-based reservations in the PG entrance examinations? I mean I understand reservation for people who have served in rural areas and government services. In my opinion serving in the backward areas is a huge pain and the folks who guts it out should stand to gain something. In this aspect reservation is legitimate. And it helps to draw more doctors out into the far flung areas. I am all for it. In fact, I also happen to be one of the very few medical students who openly supported the idea of a compulsory year of rural service following internship. (That again is a matter for a longer blog post sometime later in the future) But why the caste based congenital advantage? I mean, isn’t getting an MBBS empowerment enough? This is a topic close to my heart and when I had just entered medical school, the Youth for Equality movement had gained a lot of momentum. Being a newbie, I did not quite realize what the big brouhaha was, but having since understood the mechanics of the system, I lament the untimely demise and ultimate failure of the first revolution of, for and by the Indian (enlightened) youth in the modern/contemporary history of the nation.
And finally, the issue of seats. The United States of America has an inverted pyramid if the seats of undergraduate and post graduate student are concerned. That means that there are more post graduation seats than undergrad ones. Now this is another thing which might become fodder for a longer independent blog post sometime later in the future. But the system in India is the reverse. We have more Undergrad seats and lesser post grad ones. Until the time we reach a tubular system, where at least every passing medical student gets a chance to get into a post graduate program (woohoo! one more topic ripe for usage in a later post. Remind to me write about all these some day, eh, someone?) there will always be a crisis of seats at the PG level. And with the private medical schools mushrooming all over the place (even in commie states like Kerala and West Bengal), this problem is becoming even more acute. We need a tubular strata. At the least.