Negative Marking: Proposing An Alternative System

in #MedEd by

I had written this quite some time ago and I decided to publish this now for obvious reasons. I have an exam this Sunday!

The AIPGMEE is a very dicey exam. My personal brush with it has not been very pleasant, so I have obvious conflicts of interest in proposing changes in it and hoping that it works out for me, but, I have observed that all medical students detest this exam. It is like a toss of a coin half way down the innings of a riveting test match to determine the outcome of the game. For a lot of people this step has become a waste of time as they have labored on for years before making it through to the pantheons of post graduate medical education. Some have given up the fight against this unmovable obstacle and decided to make the best use of their time and MBBS degree rather than obsessing over a post graduation. And there have been others, who have made an unhappy compromise to settle for whatever the exam gods gave them rather than going ahead to follow their dream specialties, in which they probably would have excelled. Many, in their spite for the apparently random exam, have decided to take the more regulated exams like USMLE or GRE and skipped shores. And finally, there have been the gunners who have shot it down like a deer caught in the headlights. I know many people from each of these categories, and though they range the entire demographic spectrum, I have found one thing uniting them all: their common hatred for the AIPGME exam system…

I am not sure which of those categories I am in right now, thanks to the state of flux and mutability my life is in, but I definitely have an axe to grind about the entrance exam. There are several issues about the exam that I find unfair and illogical, but for now, the focus is on the marking pattern.

What is the deal with negative marks? I mean it is touted to be a way to sort out students into ranks, but it seems unjust to me. In my eyes, this is an inordinately negative way of going about things. Why not make it up in a positive manner? Challenging the well entrenched theory of positive-negative marking is like opening up the Pandora’s Box of medical education. But, let me endeavor to open one of the many such boxes lying all over the place… let me try to see if there is any way in which a system that encourages positivism can emerge from the present system that seeks to pull us down for our errors.

We all know that in every exam, there are a sizeable number of repeated questions. I think that can be exploited to make a positive system to sort the students out. Now, let us consider a few things:

First let us define the number of times they have been asked in the previous years. For that we define the concept of student-years. So:

Student years = No. of years question was asked X No. of students it was asked to.

So if a question A was asked 3 times in the last (defined period of time), to an average of 30,000 students per year, then the SY for this question A is:

SY(A) = 3 X 30,000 = 90,000

So it is, in essence, something like cigarette pack year calculations. Please keep in mind this is just a crude framework to build up a system of examination that looks at positive reinforcement rather than negative one. I am sure more statistically advantaged people will be able to think up a better way to do this.

Finally, let us consider a credit quotient for each repeated question.

Credit Quotient = 1 – (No. of correct attempts/SY(A))

So, if question A was answered correctly 10,000 times the first year, 20,000 times the second time and 24,000 times the third time around, CQ for this is:

CQ(A)= 1 – (54,000/90,000) = 1 – 0.6 = 0.4

So the harder the question, the higher is the CQ for it. And the easier the question, the lower the CQ for it. Simple. If you answer a difficult question, you get more credit, if you answer a simpler one, lesser so. And if you do not answer it or answer it incorrectly, well then you get no score, instead of a negative one. Now this seems to me to be a viable option of going about business developing an examination system which feeds into positive reinforcement rather than negative one.

However, each coin has two sides and the other side of the coin comes in the form of a host of new responsibilities for the examination control board. At first brush, the problems I identify with this system are:

1. It is a very game-able system. If someone can mug up the last few years’ papers, they are sure to get through. But, this is nothing new, as it is the same situation right now. The toppers from every exam are of the opinion that nothing is more important than the last decade’s worth of papers. Ask Dr. Mudit Khanna… he will vouch for the truth of it!

2. Like the USMLE, the Indian exam controllers will need to ban discussing of questions in public forums. This will lead to the sub culture of peer to peer coaching, which is, again, already rampant! Now I must say the USMLE takes any breach of this issue very seriously and marks the transcript of any student discussing USMLE questions on any public forum with “Irregular Behavior”. And that mark stays on like a branding forever, and obviously, does a lot of damage to the candidate’s future. Whether or not it will be possible for the Indian system to have such a rigid monitoring system is doubtful. However, if the USMLE can watch all over the world for such transgressions, surely, we can look after one nation?

3. There will be massive logistic issues to be taken care of, especially in terms of storing and calculating information. Once again, instituting such a system would mean that the exam board is taking on itself the major headache of managing all the questions and the data that comes thereof.

4. I am not aware of the present system of framing questions, but from popular urban legends, it seems that the system is to approach the big shots in different fields for questions relating to their specialty for a particular exam. And they, in turn, dutifully hand it over to their senior residents to do the scutwork before finally signing off on the dotted lines.

If this system is adopted, question makers will have to adhere to stricter guidelines, which means random questions cannot be asked. Like:

“Which of the following is a feature of Lhermitte Duclos disease?”

[Digression: LDD is an EXTREMELY rare disease. The word is EXTREMELY rare, not just any other kind of rare, ok? I am sure if one went to look for the guy who set this, they will find that they were dealing with LDD or something like it (which is more likely… Cowden’s Syndrome, perhaps?) at the time of making the question. There is of course, the skeptic school of thought that believes they have not dealt with anything of that sort in their whole lifetimes (which has a greater statistical probability of happening) and just were plain high while setting the question. Or worse, were looking through the Rare Diseases Database of the NIH to inflict pain on the examined in a gleeful paroxysm of sadism by asking about the rarest of rare diseases… but let me digress no more and get back to the point].

While this is obviously good news for the average medical student, for the average question setter, it means a lot of pain in the… erm… you know where…

5. This system, like the one now in place (but what with all the talk of NEET CET and all, I am not even sure if there is a system in place right now!), does not take into account the half-decade long toil through medical school. Now since doing that would mean having some kind of a national standard to judge against, this is like opening another of Pandora’s box all over again!

However, in conclusion, I strongly argue against a system where negative marking is the accepted protocol. It is the philosophy of taking credit away that bothers me no end. Is this in any way different from handing out a corporal punishment of sorts? I hope someday the big bosses sitting up there in the ivory towers of medical education will look down upon us with their telescopes and realize that Pavlov had it right a long time ago… its time to ring in the changes…

Skeptic Oslerphile, Scientist at the Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!


  1. At:
    the Conclusions include: “The disadvantage of negative scoring is that it takes examinees longer, the directions are more complicated, and it might discourage answering based on good partial knowledge. Also, if the more able students are more likely to comply with instructions, negative marking may actually penalise the better students who might be less likely to give educated guesses.”

  2. I have a policy of attempting ALL the questions in every MCQ based exam, almost always with a good result. If one can rule out two choices in a given question, then the probability of marking a correct answer is high and should outweigh the negative marking.

Leave a Reply

Latest from #MedEd

Go to Top