NEET: The Question of Merit in NEET & its impact on Medical Education the Health Care System: The context of the Neo-liberal Political Economy
The notion of the so-called Merit in NEET is constructed to adjust with what is required by commercialized medical colleges and health system geared to sub-serve the needs of the elite classes and castes. In this sense, NEET is not designed to select those inspired by the needs of the masses whom the state-funded Public Health System serves, with disciplines like rural health and epidemiology taking a back seat.
In this context, the Justice Dr. AK Rajan Committee’s Report makes the following significant observations unfolding the scope and implications of Merit in medical education and the social role of the physician in society (all emphasis by the author):
Plato said “A society is stably organised when each individual is doing that for which (s)he has aptitude by nature in such a way to as to be useful for others; and that it is the business of education to discover these aptitudes and progressively to train them for social use.”
“Coming to Medical Education, cultivation of the highest levels of the desirable aptitude, attitude, skills, knowledge and commitment by the physicians during their studies and beyond, life long, and enabling them to apply these for social use is what medical education is to deliver. Social responsibility, integrity and accountability are core values expected of physicians. Much emphasis on social accountability has therefore been attached to the medical profession since time immemorial.”
The Hippocratic Oath taken even today by physicians emphasizes social accountability and professional ethics to be inherited by the physicians, and the World Federation for Medical Education (WFME, 2015), requires that “social accountability should include willingness and ability to respond to the needs of society, of patients and the health and health related sectors and to contribute to the national and international development of medicine by fostering competencies in health care, medical education and medical research”. Social accountability connects medical education to the diverse needs of society based on factors such as geography, ethnicity, gender and sexual orientation, religion, socioeconomic status, social structure (caste), illness, different health contexts of population, those who are most vulnerable.
Achieving this diversity means – 1) curricula needs to: focus more attention to humanism, reflection of current evidence, patient communication, shared and ethical decision-making, clinical reasoning, team working, use of technology, and leadership; replacement of the biomedical model of health and disease with a broader bio- psychosocial model of health, disease, and the patient-physician relationship; be transformed from hospital to community based education; integrate health system science with traditional basic and clinical medical sciences; and address medical ethics and human rights as core requirements . . .; and 2) the physician will have to be an all- rounder; as a communicator, team worker, scholar, manager, health advocate, counsellor, professional, and a medical expert..
According to the WFME (2015), the health needs of the community and society would include consideration of intake according to gender, ethnicity and other social requirements (socio-cultural and linguistic characteristics of the population), including the potential need of a special recruitment, admission and induction policy for underprivileged students and minorities. This means the selection process and admission criteria used to select students should correctly predict the cognitive, social and behavioural skills of the potential students and ensure that the diversity is achieved.
None of the above humane and humanizing attributes required for making a socially accountable physician with sensitive appreciation of India’s diversity and disparities have survived the assault of unabated corporatization of both medical education and medical care in the era of post-Neoliberal political economy. In the process, the notion of Merit in NEET, too, has suffered from reductionalism. Thus the NEET and the corporate-driven Coaching business tend to determine the character of both medical education and care.
This inherent critique of NEET (and by implication of CUT as well) was powerfully articulated by Late Justice V. R. Krishna Iyer who made the following observation while giving his judgment in the matter of Jagdish Saran vs. Union of India (AIR 1980 SC 820):
“If potential for rural service or aptitude for rendering medical attention among backward people is a criterion of merit – and it, undoubtedly, is in a land of sickness and misery, neglect and penury, wails and tears – then, surely, belonging to a university catering to a deprived region is a plus point of merit. Excellence is composite and the heart and its sensitivity are as precious in the case of educational values as the head and its creativity and social medicine for the common people is more relevant than peak performance in freak cases”. Merit cannot be measured in terms of marks alone, but human sympathies are equally important. The heart is as much a factor as the head in assessing the social, value of a member of the medical profession. This is also an aspect which may, to the limited extent possible, be borne in mind while determining merit for selection of candidates for admission to medical colleges…….”. (emphasis supplied)
Similar concerns are expressed by Thanthai Periyar and also in another Supreme Court Judgment, as would be evident in the following citations:
“I will emphasize it is not only that even a person with least knowledge will agree but it is also a conclusion drawn from the experience that mark can neither identify smartness and laziness nor it could identify virtue, vice, intellect and fool. … If more and more conditions are to be imposed for merit and efficiency, how merit and efficiency could be righteous and genuine” – Thanthai Periyar (Viduthalai Editorial dated 16.3.1968)
“… Merit cannot be measured solely in terms of marks. Merit must be construed in terms of the social value of a member in the medical profession (Pradeep Jain (supra)); ……. Thus, we need to reconceptualize the meaning of ‘merit’. For instance, if a high-scoring candidate does not use their talents to perform good actions, it would be difficult to call them “meritorious” merely because they scored high marks. The propriety of actions and dedication to public service should also be seen as markers of merit, which cannot be assessed in a competitive examination. Equally, fortitude and resilience required to uplift oneself from conditions of deprivation is reflective of individual calibre.” – Supreme Court in the Judgement dated 20th January, 2020
The challenge boils down to liberate NEE-CUET and similar centralized entrance tests that must be on the way as long as the pro-corporate and anti-Constitution framework of NEP-2020 continues to dictate terms to the state/UT governments, denying their federal rights and thus depriving the oppressed impoverished masses access to physicians educated through humane and humanizing medical education and care.
On the other hand, the real solution lies in liberating medical education (and all other disciplines, professional or otherwise) from the idea of centrally controlled and dictated tests altogether and restore the right to decide the socio-pedagogical character of the selection process back to the state/UT governments as conceived by the Founding Fathers of the Constitution. In order to ensure equality and Social Justice in Medical Care, there is no option but to liberate medical Care and Public Health from corporatization itself!