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The National Eligibility-cum Entrance Test (NEET) discriminates against socially disadvantaged groups and encourages a “coaching” culture, according to the findings of the High Level Committee formed to investigate the impact of NEET on medical admissions in Tamil Nadu.
Furthermore, the research stated that the NEET examination, which is mostly for repeaters, “reduces confidence of the students and affects their psych.” In fact, the Committee has noticed that a lack of faith and confidence has had a negative impact on the number of Tamil Nadu students enrolling in the HSc Science stream.

“HSc TNSBSE students seem to have lost faith in and confidence on the process and criteria being adopted in medication admission. The consequence presumably seems to reflect in the enrolments in HSc Science Stream by the Tamil Nadu students in the post-NEET period,” the Committee mentioned in the report.”The aftermath effect of the NEET has already embarked with signs of changing profile of the Doctors between the pre-NEET and post-NEET period, creating a generation of doctors and teaching faculties from mainly the privileged communities- the affluent, the creamy, the urban genre who are well away from the grass root realities of the diverse social structure – the implication of which will be palpable in the society in years to come if not intervened at the earliest. While the reasons and interventions may be multi-dimensional including academic reforms and bottom up socio economic uplift, if the pre and post NEET scenario is considered, the aftermath effect has aggravated the divide and worsened the medical and healthcare sector in all its tributaries; like medical education, medical profession, and public healthcare system and service,” further read the report.

In India, NEET was implemented as a centralised test for enrolling medical students at both the undergraduate and postgraduate levels. However, Tamil Nadu has been opposing the exam since its inception, citing the fact that after it was implemented, more than a dozen kids from low-income families committed suicide. These kids from outlying locations were unable to obtain the materials required to pass the admission exams.

A report by daily earlier stated that  the State had formed a high-level panel to study the impact of the National Eligibility-cum-Entrance Test, NEET on aspirants in Tamil Nadu, especially those belonging to the rural areas, and socially disadvantaged sections.

It was decided that the eight-member committee led by a retired judge of Madras High Court, A K Rajan would study the impact of the screening test required for medical admissions on the students and submit its recommendations within a month.

After detailed investigations, the findings of the Committee proved that NEET is biased, not based on common core standards, does not measure the chronologically developed academic abilities by the students, could not predict the success of students in their higher studies (MBBS), promotes coaching as opposed to learning, and is vulnerable to charges of cultural, regional, linguistic and socio-economic biases.

“NEET seems to have clearly undermined the diverse societal representation in MBBS and higher medical studies, favouring mainly the affordable and affluent segment of the society while equally thwarting the dream of pursuing medical education by the underprivileged social groups. The analysis in multiples of dimensions related to Socio Economic and Other Demographic Status (SEODS) of those who have competed for medical education has proved this fact,” concluded the Committee.

Opining that NEET is against the socially disadvantageous groups, the report further mentioned, “In particular, the NEET has deserted the representation of the social and other demographic groups having low SEODS in medical education. Those social groups who were highly affected were the students of Tamil medium, rural background, government schools, parental income less than 2.5 Lakhs, and socially depressed and disadvantaged groups like MBC, SC, SCA, and ST.

Apart from this, the Committee also opined that NEET was mainly for repeaters and those who had received coaching. Claiming that the exam is not for the first time applicants and it promotes coaching culture, the report further added, “The Committee therefore strongly condemn the growing culture of „coaching‟ as it is gradually replacing „learning‟ which is very much essential for the would-be-Doctors (medical aspirants) to acquire all round skills including reasoning, decision making, judgemental, analytical and psychosocial skills.

The Committee also addressed the issues like malpractices, dual domicile exploitations, and impersonation and noted that NEET reduces the confidence of the students.

Further, the report also clarified that the findings have indicated that NEET has only enabled and empowered comparatively the low performing (in NEET scores and HSc scores) students to get admission to MBBS. “Therefore, the question of NEET ensuring quality and merit of the students is to be ruled out,” the report mentioned.

Besides, referring to the inclusion of 50% of PG and 100% of Super Specialty seats under the All India Quota, the report added, “As the Super Specialty seats were filled fully under the purview of the AIQ, the OBCs (Other Backward Class) were deprived of getting their due share that they once enjoyed under the State‟s reservation system. This is against the social justice philosophy that the State has nurtured in all spheres of development.”

In order to arrive at the conclusion regarding NEET, the Tamil Nadu Health Committee tried to consider whether the test evaluates the merits of the candidates in an unbiased manner and also several other factors related to the centralized medical entrance examinations. The findings of the committee are the following,

NEET is Biased and not based on common standards and criteria

It is that the NEET is a standardised „criterion based test‟, but it does not conform to the principles of the criterion based test. A criterion based test is designed to assess students‟ performance against a fixed set of predetermined standards or criteria, which at the level of secondary education is used to assess if students have acquired a specific body of knowledge or a specific skill set. Whereas, despite its nature of being a criterion based standardised test, the NEET does not have any such standards and criteria that are „common‟ and „relevant‟ to all states in the country.

It is a rote framework aiming to assess students on simply a set of „contents‟ relevant to three subjects, viz., Biology, Chemistry and Physics. Not having drawn from a predetermined broad based set of standards and criteria, the content based test is directionless, and its ability to correlate with performance in higher education (MBBS) is doubtful. As entrance tests are often meant to judge or evaluate a student‟s academic potential, capacity and/or readiness to perform in his/her higher studies, such tests should have a clear set of standards and criteria (that bridge the academic potentials achieved in the secondary studies and the performance potentials required by the higher studies), so that the potentials of the students to study higher programmes can reasonably be evaluated.

Contrary to this, the NEET tests the students only on the prescribed contents (syllabus). Instead of setting core academic standards and making the assessment more open to test all possible knowledge within the purview of those standards, the NEET prescribes an exclusive syllabus like an academic programme.

For instance, a similar competitive examination, called SAT (Scholastic Assessment Test), conducted by a private agency – College Board – states that its assessment framework has been built upon the national level „Common Core Standards‟, developed by the Association of Governors of all the constituent states. With this the College Board claims that its assessment is regionally or provincially bias-less and that it conforms to the nationally developed common standards agreed upon by all the states of USA.

The NEET lacks any such common features; neither common standards and criteria nor a common syllabus that is common and relevant to all Indian states. Despite its claim that it has developed the syllabus after a review of various states syllabi, academics have been challenging that it is not so.

It is evident from the results that it is CBSE biased, as the results have consistently proved that the students from the CBSE stream have secured MBBS seats as high as 26.83% in 2020-21 from 0%in 2015-16 in government medical colleges and 12.01% in 2020-21 from a negligible 0.07% in 2015-16 in Self-financed colleges in this high stake exam (see Table 7.16).

Critics supporting the duo of the NEET and CBSE argue that the CBSE students are academically potential more than the State Boards students. It is baseless as there is no evidence in support of this claim, as those who make such claims are making so based on, again, such rote surveys which are not testing all round all relevant knowledge, skills and attitudes.

On the other hand, the NEET seems to duplicate the Board exams (both state Boards and CBSE), as it assesses the students using the same standardised criteria-referenced test as used by the Board exams. Unlike the tests, used in some progressive countries, like UCAT (University Clinical Aptitude Test) and MCAT (Medical College Admission Test), which assess both the students „achievement‟ and/or „aptitude‟ and whose scope is completely different from the Board/School exams, the NEET uses only a standardised criteria-referenced test only on the contents, partially or fully used by the different Boards.

Insofar as the NEET uses the same standardised criteria-referenced test on a similar set of contents, as done by the different Boards, it is not warranted again as it simply duplicates the Board exams, making them redundant, amounting double hardship to the fateful students, and it is by no means a superior test than the state Boards as it largely deviates from the globally accepted principles of the standardized criteria-referenced test.

NEET does not measure the chronologically developed academic abilities

The notion of a continuum of knowledge acquisition ranging from no proficiency at all to highest performance is the underling concept of scholastic achievement. The degree to which the achievement of the students resembles desired performance at a specified level of education should be the purpose of the measures of achievement.

The NEET does not have any inherent, either implicit or explicit, means of such measures to predict the achievement correctly, except its content based crude assessment. In the continuum of knowledge acquisition, “developed abilities” – i.e., the level of development attained by an individual over a period of time in abilities – should be the focus of the testing, be it achievement or aptitude (Anastasi, 1982).

This requires that the assessment should be able to have features that are composite and continuum, which more accurately reflects the overlapping of aptitude and achievement tests. If an individual’s relative position along the continuum of attainment is the primary concern, as it might arise in testing certain abilities, then an appropriate achievement measure, like normbased, should be administered.

However, this can best be achieved in the school based exams or Board exams, as they provide a continuum of a multitude of testing opportunities (like, continuous achievement evaluations, verbal type intelligence, practicals, etc.), and that too in a composite manner (like achievement, aptitude, norm based, criteria based etc.), to test chronologically developed academic abilities.

One could easily notice that this sophistication is very much lacking in the NEET, and that it is content based multiple-choice test. Over reliance on such a test, would lead teachers to emphasize exercises that would promote rote learning, foster test-taking skills, and discourage complex thinking and higher order skilling.

Uncertain Predictability of the NEET on the success of the students in their higher studies

The primary rational for using the standardised NEET test in medical college admissions is to predict success in college. Similar tests around the world like MCAT, UCAT and SAT all have been going through the test of time for their „predictive validity‟ to ensure their reliability in predicting the future performance of the students in the college. Despite being observed for their inability to accurately predict success in college as a lone predictor, coupled with other predictors like (school) GPA, they proved to be a reasonable predictor.

For instance, Validity studies consistently find that high school grades and SAT scores together are good predictors of achievement in college (Camara and Echternacht, 2009). The combination of GPAs and MCAT total scores performs well as a predictor of unimpeded progress toward graduation. They both together are strong predictors of academic performance in medical school through graduation (Dana et al, 2013).Five years of its existence is longer than enough to evaluate the validity and reliability of the NEET, but lack of this information has become a cause of concern for its genuinity. The NEET organisers [formerly CBSE and now NTA (National Testing Agency)] have failed to undertake any serious studies on the predictive effectiveness, validity and reliability of the report. Minus the aura of entrance and eligibility, as an entry check point, and compared with the Secondary Board examination grades (standardised achievement test score), the NEET will be the least predictor of the performance in higher studies.

Despite variability in educational input and educational service, school courses provide the experience, both in learning and on examination that most closely relates to courses in higher studies. The Board examination pertaining to particular subjects would be expected to correlate better with performance in higher studies than does with the NEET.

An examination, on subject matters like physics, chemistry and biology, not placed in the continuum of the realm of learning, would not connect the subject-learning with the learning assessment. The NEET, being a discrete, one-off test, without any connections whatsoever with learning experience cannot predict precisely the subject potential and readiness of the students for higher studies. Neither a composite of „achievement‟ and „aptitude‟ test does the job better in the Indian condition, as ever widening socio economic gap between various social groups and other variance in psychosocial conditions facing students during their schooling all would not create a level playing field for the disadvantaged students to contest such test fairly. Therefore, the score obtained in the Board examinations is comparatively a reasonable yardstick to measure and predict the student‟s academic ability and readiness to pursue medical education.

NEET promotes coaching as opposed to learning

Truly, any universal entrance examination (aptitude test or assessment test) that aims to test the students potential or their readiness and or ability to pursue higher studies, then it should be distinct from the standardized tests of learning achievements (e.g. Secondary Board Exams). The abilities measured by the test are developed over a student‟s entire academic life, as such, the test shall not incur a prior special coaching or training.

If, on the other hand, coaching for the test can raise students‟ scores, then it does not conform to the concept of entrance examination. Standardised one-off qualifying test privileges those affluent with financial strength and social status to go for a prior training and coaching, so that the fundamental objectives of such tests should be to make them less susceptible to socio economic advantages.

In India, several coaching factories have mushroomed since the advent of the NEET in 2016. The alarming rise of such coaching factories, both offline and online, above 400, generating around Rs. 5750 crore annually indicates that coaching has become the means to be successful in the NEET (Chapter 7).

This has also been vindicated in the recent figures that consistently, in recent years, the percentage of the repeaters, taking the test repeatedly, has increased, and that the repeaters are often able to finish the test successfully to get admission in a medical college.For instance, the percent of repeaters who have secured admissions in MBBS programme rose to 71.42% in 2020-21 from a meagre 12.47% in 2016-17.It is the fact that these repeaters stay un-enrolled for higher studies after their 12^th standard only to be coached by the corporate and school-based coaching factories for the subsequent few years until they clear the NEET with enough score to get admission in their desired college or according to their financial strength. This clearly indicates that medical education has treaded rapidly, just in a couple of years of its inception, into the hands of those affluent segments of the society who can afford to pay such a sizable fees for coaching; be it school based or corporate based. On an average, a repeater has to invest Rs.10 Lakhs exclusively for coaching. The NEET has become a cause for the universal practice of an unintended but a detrimental consequence of „coaching‟.Both educational institutions and parents are now inclined more towards coaching the kids to prepare them for successfully appearing in the NEET rather than grooming them all round as educated human beings with all relevant knowledge, skills and attitudes.

Even many state governments and agencies in India [Uttar Pradesh (2), Maharashtra (3), Indian Army (4)] have started offering coaching classes to the underprivileged students, without which, they assume that these students may not succeed in the competitive exams like NEET, JEE and UG CLAT. Beyond this the union territory of Ladakh had announced Rs. One Lakh financial assistance to meritorious students to join the private coaching centres for the preparation ofNEET, JEE, UG CLAT, and NDA for Two years (1). Such market trends even forced the progressive states like Tamil Nadu to impart coaching to the needy students in order to remain in the competitive race.

This trend confirms that coaching has replaced learning and paved the way for the entry of poorly skilled candidates (who are financially and socially strong) belonging to the affluent segment of the society into medical education.

Thus, the future medical profession is likely to be more commercialised than now and dominated by medical professionals of poor quality. This is what the progressive worlds, which had pioneered in such competitive exams over a century, had feared for when they started considering these scores for admission into higher studies. Therefore, those offering these exams have continually been tweaking the exams to ensure that previous experience or training or coaching on the part of the individual is assumed to be lacking for all individuals comprising the population considered. Exams like SAT had made several attempts to ensure that coaching does little or nothing to raise the students score (Slack and Porter, 1980).

The NEET, however, by its very nature, inadvertently attracts prior preparation in the form of coaching and destroys the „learning‟ – and made learning already redundant – which is very much a fundamental element of „education‟ and converts students like machines.

Medical aspirants studying 12^th Standard do not undergo learning in their studies but outsource private coaching for their success in the NEET is an irrefutable fact. Wherever learning is overlooked by a rote training, an all-round grooming of secondary students on different aspects including logical reasoning, decision making, social disposition, emotional intelligence and other abilities – that are very much essential for medical studies – will not be possible.

NEET is vulnerable to charges of cultural, regional, linguistic, and socio-economic biases

The relation between achievements in standardised entrance exams and socioeconomic and other demographic disadvantages is one of the most widely replicated findings in educational research. Especially, a country, where the society is graded hierarchically with social inequality and unequally segregated in terms of economic conditions, level of income, level of education, occupation, living standards, cultures, linguistic status and geographical location, a standardised common entrance exam like NEET is more likely to exacerbate its reflection of all such inequities than to attenuate them.

If there is any significant difference in score distributions according to these segregated groups, that difference would probably be an increase in the score gap between the specially cultivated upper classes and socially suppressed lower classes, high income and low income of parents, high living standards and low living standards, literate and illiterate parents, urban and rural students, private run and government run students.

While this gap in educational performance in general has been historically observed by different reports including the series of Five Year Plans, reports of education departments, and the recently unveiled National Education Policy, it is pertinent to note the observations, in specific to the common entrance exam, made by; 1) the Hon‟ble Madras High Court Bench comprised of Hon‟ble Justice P. Misra and Justice J.A.K.S. Kumar, in Minor S. Aswin KmarVs State of Tamil Nadu [(2007) 2 CTC 677]; and 2) Report of the Commission on Reservation to State Government Schools‟ Students in MBBS Course, chaired by Honourable Justice P. Kalayarasan.

The Hon’ble Madras High Court observed that the common entrance test is advantageous to the aristocrat schools imparting education to students of graduate parents; coaching centres imparting coaching to students for fees; students of elite people devote full time in studying with comfort; parents who attend the care of their children for their studies; students of highly qualified parents; and disadvantageous to students of illiterate parents; students who cannot afford to go to the coaching centres due to financial crunch; students of socially and economically backward area who cannot afford to devote full time in studying as they have to attend to other work also; parents who cannot afford to care of their children for their studies as they have to afford to the work otherwise to eke out their livelihood; students of unqualified parents; and students studying under the greenwood tree with mosquito bites.

The latter also observes more or less the same factors that influence the scores in the NEET exam including significant gap in children‟s cognitive development; parents‟ it or any other forms of common entrance examinations, cannot be applied in India because the diverse nature of the Indian polity and society and its inherent socio economic and other demographic inequalities would result in inequal test results between the advantaged and disadvantaged. As long as the diversity exists, which is the strength of the nation and cannot be undone as it is evolutionary and natural, and until the historically embedded inequalities are ameliorated and a level playing field is established, a unified common entrance test is a curse to both the nation and society. occupation/education; parental income; living standards; economic conditions

And psychology of the child. The Anandakrishnan Committee (2006), commissioned to examine the implications of the abolition of Tamil Nadu Professional Courses Common Entrance Test (CET), also recommended abolition of the test on account of severe disadvantages encountered by different vulnerable sections of the student population such as rural households, Tamil medium students and underprivileged categories.

The analytical section of this report, in the later pages, also vindicates that the ever-present socio-economic disadvantages and other educational, geographical and linguistic backwardness facing the students of the Tamil Nadu state do not favour the practice of a common entrance exam as it causes injustice to the disadvantaged majority people of the state.

Even if the aforesaid five conditions, viz., –

• Tests the academic abilities of the concerned student population using „bias-less common standards and criteria‟;

• Tests the academic abilities developed by the concerned students over their entire academic life;

• Precisely ‘predicts’ the success of the students in their higher studies (after being admitted based on the NEET);

• Ensures that previous experience or training or coaching on the part of the individual is assumed to be lacking for all individuals comprising the population considered

• is less vulnerable to charges of cultural, regional, linguistic, and socio-economic biases – are met by the NEET, either it or any other forms of common entrance examinations, cannot be applied in India because the diverse nature of the Indian polity and society and its inherent socio economic and other demographic inequalities would result in inequal test results between the advantaged and disadvantaged. As long as the diversity exists, which is the strength of the nation and cannot be undone as it is evolutionary and natural, and until the historically embedded inequalities are ameliorated and a level playing field is established, a unified common entrance test is a curse to both the nation and society.