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Introduction

The recent decision to reduce the NEET-PG 2025 cut-off to the zero percentile (and negative scores for certain categories) has sparked a fierce debate. While intended to fill nearly 18,000 vacant seats, critics argue this move prioritizes administrative seat-filling over clinical competence, potentially compromising the “merit-patient safety” nexus in specialist healthcare.

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Limitations of Centralised Exams in Assessing Clinical Competence

• Rote-Learning Orientation: MCQ-based formats often reward memory and test-taking strategies rather than the complex clinical reasoning required at the bedside.
  Eg: High-scoring candidates in theory often struggle with “differential diagnosis” in real-world, unpredictable patient scenarios.
• Cognitive Domain Gap: NEET-PG primarily tests the “Knows” and “Knows How”(including parameters like MCQs, True-False) lower levels of Miller’s Pyramid, failing to evaluate the “Does” level (actual clinical performance).
• Neglect of Soft Skills: Standardised tests cannot measure empathy, bedside manner, or communication, which are vital for surgical consent and palliative care. 
• Snapshot Observation: A single three-hour exam provides a “snapshot” of a student’s knowledge but ignores five years of longitudinal clinical exposure and internship performance.
• Lack of Psychomotor Assessment: Crucial psychomotor skills (like intubation or suturing) are invisible to computer-based tests, yet essential for PG residency.
• Technological Divide: Centralized online exams can disadvantage students from rural colleges with limited exposure to high-tech testing environments.
  Eg: The digital divide remains a significant barrier for rural medical aspirants as highlighted in NEP 2020 assessments.

Measures to Reform PG Medical Assessment

• National Exit Test (NExT) Implementation: The NEXT examination can be transformative if implemented sincerely, with a USMLE-like model emphasising longitudinal assessment, practical exams, OSCEs, and clinical reasoning.
• Weightage to Clinical Rotations: Introducing a percentage of marks from Logbooks and Internships into the final PG ranking to value hands-on experience.
• Objective Structured Clinical Examination (OSCE): Incorporating standardized practical stations into the selection process to evaluate technical skills and patient interaction. 
• Mandatory Qualifying Percentile: Re-establishing a non-negotiable floor percentile (e.g., 25% or 35%) to ensure that “zero-competence” candidates do not handle critical specialties.
• Longitudinal Faculty Feedback: Utilizing “Entrustable Professional Activities” (EPAs) where mentors sign off on a student’s ability to perform tasks independently before PG entry.

Conclusion

The dilution of cut-offs suggests that “seat utilization” has overtaken “academic rigor” as a policy priority. To safeguard public health, India must move toward a Competency-Based Assessment model that values the “healer” over the “test-taker.” Strengthening the NMC’s regulatory oversight and ensuring that specialist degrees are earned through clinical excellence not just rank-based eligibility is essential for maintaining global trust in the Indian medical fraternity.

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