[ Daily News and Analysis, 11 Jun 2013 ; The Telegraph (Kolkata), 26 Jun 2013 ; Millenium Post, 19 Jun 2013 ; Echo of India, 22 Jun 2013 ; Hitavada, 20 Jun 2013 ]
The medical entrance scene in India has changed with the introduction of the undergraduate National Eligibility cum Entrance Test (NEET). This was meant to be a single window test. In one go, the NEET has replaced most of medical entrance tests that were prevalent. 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, while their ‘state rank’ would be useful to compete for medical college seats in states where they fulfill domicile requirements. From the very start, the NEET scheme scheme 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 the science in the world today is clear – but that didn’t explain why the MCI was fine with Hindi (not really known to have some long-standing language of science heritage) 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. ‘Regional language’ is not a term that exists anywhere in the constitution of the Indian Union – it is a figment of imagination and is a telling clue to the mindscape of Delhi-based administrators. This term 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, if a student took the test in Hindi, they 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 abject surrender of the states is even more sordid as they finally buckled under the pressure.
The results of the NEET were announced on June 5. The states stood in a pecking order of sorts, in terms of the percentage of students who qualified. Assuming an equal medical seat density throughout the Union ( this is not true), a worse over-all 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 then 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.
One may ask, 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.
It is useful to ask what are medical entrance exams for. It may not be out of place to take one step back and ask, what are medical colleges for? To answer that, it is important to 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. It is also not for nourishing holy cows like ‘national integration’, filling the medical college seats with the most ‘meritorious’ (with all the dubious assumptions associated with that term) or worsen the already skewed urban rural divide in the density of doctors. 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. The results of the first NEET bear out that bitter truth.
Framed from Delhi, after ‘consultation’ (it has to be one of the most abused terms in a flawed federal system), the NEET syllabus favours those who have undergone their schooling and training in the CBSE/ISC framework, the syllabus being a vital component of that framework. States boards with syllabi that differ considerably 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. Are students studying science at the 12th standard in the CBSE syllabus uniquely equipped with an understanding of the sciences that is unparalleled by the state-boards? Or in other words 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 reviewed 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 4 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 were top performing states in the NEET. Independent non-CBSE excellence has thus become an albatross around their neck. the 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 a matter of serious concern, the NEET favours a certain breed of to-be-doctors. Within a state, it favours students who study in central syllabi. This means, those segments of society who study in non-state boards will be disproportionately over-represented in the NEET. What are the implications? 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. Central boards have a lesser penetration in the non-Hindi regions. A recent 2-page advertisement from a Kota-based entrance-exam factory mentioned nearly a score of its clients in the top 50 NEET ranks. Of these 20 odd students, almost all were clearly North-Indian names. The south, on the other hand, has a higher seat density. The implications are not very encouraging as it can be assumed that those who are from 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.
The NEET was sold on the point that it minimizes the number of entrance exams. What proportion of students studying science at the 12th standard took multiple medical entrance exams? This data is crucial. This is a very low number. And those of the central board profile likely to be over-represented even in that low number. 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. There is a feverish rush of activity in an industry quite ironic for India – medical tourism.
The humble status of central boards to such commanding heights of dictation ( and not necessarily excellence) has happened with a concomitant fall in the status ( and 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 that the states have can be wrested from them under various ruses. Education was classified as a state subject after partition. It needed the Emergency under the Indira Congress to push education to the concurrent list by a constitutional amendment. Education, like most other concurrent list subjects has seen the slow 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. As it is now, more students will continue to study in state-boards. In this year of ‘federal front’ talk, the return of education to the state list should be considered seriously for greater common good. For starters, the states which take rural healthcare seriously should consider quitting the NEET.
Disclaimer: Garga Chatterjee was educated in a state board and was once a ‘topper’ of a state medical entrance examination.
*** DNA version ***
The undergraduate National Eligibility cum Entrance Test (NEET) was conceived as a single test by which students would be able to compete for seats in medical and dental colleges all over the Indian Union and also in states where they can prove domicile. Since inception, this scheme has been controversial — Central Board of Secondary Education (CBSE) initially refusing to allow question papers in non-Hindi subcontinental languages. Under the
compromise formula, those who do choose Telugu, Assamese, Gujarati, Marathi, Tamil or Bengali would be ineligible for the all-India quota. Hindi comes with total eligibility. Few of Delhi’s interventions have been so blatant.
NEET results were announced on June 5. States varied widely in their performance. Let’s clarify what medical entrance exams are not for. It is not for providing the kid who can answer many questions in a stipulated number of hours after months of training at costly coaching institutes with a lucrative career prospect and possibly a good bargaining chip for dowry or to provide manpower for medical tourism or worsen the already skewed urban rural divide in the density of doctors. It is to produce human resource that would provide health care to the multitude and advance the understanding of human diseases by research. NEET is a grave challenge to these goals.
The syllabus of NEET, framed by the CBSE, favours those who have studied in the CBSE syllabus. State boards with non-CBSE syllabi are at a distinct disadvantage. Are 12th standard students studying science by the CBSE syllabus uniquely good? Research by Kumar and Chatterjee shows that when it comes to high-level science proficiency, state boards like West Bengal and Andhra Pradesh are excellent. West Bengal board outperformed the CBSE in all science subjects — Physics, Chemistry, Biology and Mathematics. Andhra Pradesh outperforms CBSE in Mathematics and Physics. Maharashtra is not the worst performing state as it was in NEET. Neither Bengal nor Andhra Pradesh makes it to the top three states in NEET.
The syllabus issue is important as within a state it also favours those segments of society who study in CBSE — they are 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 Kota- based entrance exam factories, with feebler roots to the state and so on. What are the long-term effects of such individuals occupying more seats?
The USP of the NEET was that it minimizes the number of entrance exams. What proportion of students studying science at the 12th standard took multiple medical entrance exams? This is a very low number. Higher-secondary level science education’s goal must look beyond medical/engineering entrance examinations.
In medical research, the Union is abysmally backwards. This is only to be expected from a system that increasingly produces doctors evermore distant from people’s realities with medical colleges having become assembly line for private hospitals that will be opened in the greater-greater-NCR.
Such NEET ways of killing off the state boards points to a future two-tier education system — the CBSE/ISC route for the elite, uppity and the aspirational and the state boards for the rest. Children of the elite- predominantly do not study in state boards — they too ‘national’ for the ‘lowly’ states. But at the end of the day, education is a state subject. Caesar should claim what is rightfully his and push back the encroaching beast. If equitable healthcare is a goal of medical education, the states should considering quitting the NEET.