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Replacing a Bad System with a Different Bad System
The National Eligibility cum Entrance Test (NEET) has become one of the most contentious issues in Tamil Nadu today. Although the number of people writing the exam is a mere fraction of those finishing school each year, it is an issue that always inflames sentiments and consumes news cycles. But the controversy around NEET is emblematic of deeper, older issues medical education faces.16 lakh students registered for NEET nationwide(of which 1.4 lakhs were from Tamil Nadu) . They are all competing for a mere 80,448 MBBS seats nationwide .
This means that about 20 people are competing for a single MBBS seat in the country. The starkness of these numbers is reflected in our perilous doctor patient ratio: there is one doctor for every 1343 Indians, with wide disparities across regions .For the same number of people, the global average is twice the number of doctors, and we are yet to meet the WHO-recommended ratio of 1:1000 . Testing systems are extremely competitive and based on outdated rote learning. While there is a need to address the immediate challenges posed by NEET, these problems require further introspection.
Prior to the nationwide requirement for NEET, medical admissions in Tamil Nadu were based entirely on the results of Class XII board examinations, backed by a comprehensive, broad-based reservation policy. This has ensured that Tamil Nadu’s health system is amongst the strongest in the country. After all, about 12% of India’s allopathic doctors are from Tamil Nadu. With as many as 4 doctors per 1,000 people, the state is far ahead of the national average . However, before NEET too, medical admissions were much less inclusive than they are made to appear today. In the din around NEET, this is conveniently forgotten.
While I am not advocating a NEET-based system for the state, it is important to recognize the flaws of the past system, so that we do not promise simple, silver bullet solutions when there are none. Before NEET too, government school students were least represented. RTI data revealed that only 0.7% of MBBS students in government medical colleges and 1.1% from private medical colleges came from government schools between 2006 and 2016. This means that government school students secured only 213 of 29,925 seats in government medical colleges and 65 of 6,132 seats in private medical colleges in these ten years . These numbers are abysmal, and cast serious doubt on the rosiness of the pre-NEET picture.
The board exam-based system was notorious for the high emphasis placed on rote learning and memorization. Many who succeeded in this period relied heavily on high-pressure coaching centres, such as those in Namakkal . These centres succeeded in gaming the old testing system through tried and tested strategies of “exam cracking”. This included ignoring any content unlikely to be tested in the board exam, particularly the Class XI syllabus, which NEET now requires .
This approach disincentivised upgradation of syllabi and pedagogies and experts have long argued that the state board syllabus is outdated. In 2017, NEET forced the first review and update of the Tamil Nadu state board curriculumin 12 years .An expert committee was set up to do this, a change that experts said would require at least two years to be implemented . It is hardly surprising that old coaching centres were caught unprepared for a new exam that is based on a new, up-to-date curriculum.
Clearly, the prevailing NEET system has obvious issues. Under NEET, according to the Government, 0.15% of seats have gone to “students hailing from poor economic backgrounds who study in government schools .”NEET is strongly modelled on the CBSE, which places those studying in state boards, a majority of the school students in India, at a disadvantage.It is also a stark reminder of a crisis in centre-state relations today.
A nationwide imposition of NEET as the only admission test has not only taken away states’ autonomy in picking an admission system but has now left this issue at an impasse that hurts students. Rising pass percentages are being celebrated, but this means little in the effort to actually get a seat; cut-offs, and not just passing, determine seats. If reservation for government school students was not instituted, this would have resulted in very few government school students entering medical colleges this year as well.
NEET’s reservation structure is also deeply flawed. There is no reservation for OBC students in the national quota.The BJP-led central government has decided against 50% reservation for OBC students in the ’20-’21 academic year and the Supreme Court has now rejected a plea for the same . Some estimates suggest that this has cost OBC students 11,000 seats since 2017 . This year too, OBC students will suffer the consequences of a broken reservation system . Instead, the centre has instituted a 10% quota for Economically Weaker Sections.The process of enumeration of this category is fallible: the household income criteria of Rs. 8 lakh is very high, opening the door for a majority of the population to be eligible for the quota .
The poorest of the poor families will compete with those who can easily afford to pay for the low costs of government medical colleges. And yet, EWS cut-offs are often equal to other reservation categories. It is unclear how EWSs cut-offs are being calculated. The EWS has a moving target: students who register as EWS under its vague definition one year, need not be EWS again the next year. Without an OBC quota, a level playing field across social groups is lost. Like with government school education quotas, EWS reservation should be built into existing quotas, so that no disadvantaged social group is left out of the quota net.
Following extensive campaigning across the political spectrum, students from government schools who have been in Class VI to Class XII who have cleared NEET will now be able to access a 7.5% quota in medical colleges. This means that the level of representation of government school students in medical colleges under NEET will now go beyond pre-NEET figures. The state’s performance in NEET is also improving with each passing year, with syllabi, teachers, schools and coaching centres adapting to the new system. But the real test now will be to ensure that in the effort to deal with the persisting issues, we do not replace a bad system with a different bad system.
Rather, we must take this as a rare opportunity to identify and address deeper issues. Across the world, standardised tests are being rejected as absolute indicators of merit. A return to the days of the Namakkal-style coaching centres and the confusions of curriculums and reservation policies changing every year will contribute greatly to the pressures students face. The number of government medical college seats, which are truly affordable to all, is still not enough and a learning crisis looms over public school education. These are problems that have grave implications for the future of medicine and education in Tamil Nadu, but will not be fixed through a mere exam change. We will have to go further.