The NEET Stalemate – a balanced proposal based on Math for the way forward.

-Karthik Palaniappan

I write this article at a time when several of us are mourning the untimely passing of S. Anitha. Anitha, just 17 years old, was born in an environment typically not associated with privilege or advantage. She cherished dreams of becoming a doctor and became the victim of an admission system in transition. She scored 1176 out of 1200 in the Tamil Nadu State Board exams, and if the admissions were to be conducted as per her Tamil Nadu State Board marks, she would have received admission to one of the state’s topmost medical colleges. However, she was only able to score only 86 out of 700 on the newly instituted NEET exam, and this score would have rendered her ineligible for admission to medical colleges from across the country.

Anitha was a girl from modest means, with limited access to the kind of resources people from the cities do. If I can hypothesise, I can only imagine that becoming a doctor would have been the culmination of a 17 year dream for her – one that offered her the opportunity to serve the society that she grew up in, climb up the ladder of respect in her community – a ladder in which she and her family were placed at the lowest rungs, and work her way towards an economic prosperity that people in the middle class take for granted, but which is denied to several of our countrymen. It is impossible for people who’ve grown up with a fair amount of privilege to imagine the kind of trauma that this must have caused her. The fact that Anitha was pushed to take this decision only means that we as a country have failed to offer her a fair opportunity to pursue her dreams, and for that, we should feel sorry.

But the introduction of NEET alone was not responsible for her death. Our entire education and admissions system needs an overhaul.

While examining what an ideal admissions system should look like, we first need to acknowledge two outcomes that such a system should possess to cater to the broader interest of the public: fairness and competence. Competence is easy to understand. We need good doctors to take care of us: when we get sick, and when we get old. There cannot be much misunderstanding about what this entails. Fairness implies that students are not denied the opportunity to an education based on the social, communal or economic circumstances. In an Indian context, this can be interpreted to include dimensions of caste, community, language, social, rural/urban background and economic factors. This, again, is relatively straightforward. Our current system of admissions leaves a lot of room for misuse on both dimensions. For example, private colleges are run as businesses that “sell” medical seats for unreasonably large sums of money. Requiring a student’s parents to be millionaires for him/her to get into medical school is fundamentally unfair to students from economically weaker sections of society.

NEET based admissions aim to eliminate such sources of unfairness. This is something that we cannot and should not take exception to. This is for our own collective good.

Unfortunately, in the process of creating a fairer system, it has introduced other sources of unfairness. This implementation, then, is the main issue. Case-in-point – the current struggle in Tamil Nadu where students of the state board are simply underprepared to compete on favorable terms with CBSE students.

Another source of unfairness associated with the NEET exam, especially in today’s conditions, is that signing up for coaching classes provides a huge advantage for such students – especially in the situation where it has been established that simply following the Tamil Nadu State Board syllabus, in its current form, is not adequate. Given that schools are restricted to teaching material covered in the State Board’s syllabus, students will have to look outside for help with preparing for material not covered in school. Access to after school coaching is typically available only in the urban areas. Moreover, such coaching tends to be expensive. If one needs access to such coaching to do well on a test, and such coaching is neither affordable nor accessible, that introduces another source of unfairness into this system.

Our constitution can be considered to provide equal opportunity to all our fellow-citizens only if it offers access to such a basic right – access to education – without introducing such sources of unfairness in its pursuit. We need to provide people from the lowest rungs of society he opportunity to reach the highest offices in the country. If we make it difficult for them to get middle-class jobs, then we are failing as a nation.

So what then is the solution? Do we compromise on competence in pursuit of fairness? Or do we compromise on fairness, as we have done now, in pursuit of competence? I believe that there is a way to achieve both. And that is to ease the transition from the old to the new, thereby allowing all the stakeholders in the system to adjust and make course corrections – these stakeholders include organisations like the Medical Council of India (MCI), the CBSE, the respective State Boards, and most important of all – all of our students and their families.

So how do we ease the transition from the old to the new? Well – use Math, of course. Math models have been used to make predictions about unknown situations in a variety of contexts – including the well-known Duckworth Lewis model used for determining target scores in rain-affected cricket matches. Similarly, Math allows us several strategies for smoothly transitioning from the old admissions system to the new system. For purposes of illustration, we will transition using a sigmoid formula. Again, for purposes of illustration, we will develop this formula only for the combination of the Tamil Nadu board and the NEET score – this is something, again, that can be tailored for every individual board in our country.

Step 1:

Step 1 is to convert the student’s comprehensive Tamil Nadu BPC score (Biology-Physics-Chemistry), as per the earlier formula to NEET’s base score of 720. For, example, Anitha had scored 196.75 out of 200. (Her NEET score was 86) If we were to convert it to a scale of 720, we would have to divide her score by 200 and multiply by 720.

TNBPC_720 = TNBPC_200*720/200.

Using this formula, Anitha’s converted TNBPC_720 score would be 708.3

Step 2:

The second step will require us to transition the score from the old system (TNBPC_720) to the new system (NEET_720) over a period of 5 years. We could, in theory, do this over any number of years. I’ve chosen the number 5 just for illustration. We can adjust the formula so that the combined score is equal to TNBPC_720 this year (2017), and gradually transitions to the NEET_720 score in 2021. Such a formula would look like this:

Combined_720 = TNBPC_720 – (TNBPC_720-NEET_720)/(1+exp(3*(2019-y)))

where y is the year of interest, and exp() refers to the exponential function. The transition is done using a variant of the sigmoid function which finds applications in fields as diverse as Chemistry, Economics, Machine Learning and Population Modeling.

As per this formula, Anitha’s score in 2017 (this year) would have been:

Anitha’s Combined_720 score (2017) = 708.22. (This is the same as her TNBPC_720 score for this year.)

Using the same formula, her score in 2021 would have been:

Anitha’s Combined_720 score (2021) = 115.51. (This is close to her NEET_720 score from this year – and will become equal to her actual NEET_720 score in 2022.)

In fact, her Combined_720 score would change from year to year as per the yellow line shown in the graph below:

As per the vacancy list in http://www.tnhealth.org/online_notification/notification/N1708945.pdf, we can see that Tamil Nadu provides for 1091 free seats under the OC category. Combining this with the Phase 1 counseling data available at https://admission.aglasem.com/tamil-nadu-mbbs-bds/, we can see that the student who scored a rank of 1209 in the General Rank category scored 368. This person would have just missed getting a free seat under the OC category if everyone before him/her took up an OC seat. We can thus infer that the highest possible NEET cut-off to get a free medical seat in Tamil Nadu is approximately 370. This is assuming that admissions are carried out strictly according to NEET ranks. If admissions were to be carried out using our Combined_720 scores, the cut-off would also change from year to year as per the same formula discussed above. (For this, we assume that the State board cut-off for the general category remains constant at a TNBPC_200 of 195 which is equivalent to a TNBPC_720 of 702)

We now plot Anitha’s Combined_720 across the years and see how that compares with the NEET_720 cut-off for that particular year (also transitioned as per the sigmoid formula).

As per this graph, it is evident that a girl like Anitha would have qualified for admission in the years 2017 and 2018 while missing qualification from 2019 onwards. While this might seem like we have just delayed the inevitable, we should not view it as such. Rather, in this time, we should provide students with necessary study material and access to coaching so that they can improve their performance. With such extra coaching, it is conceivable that a talented girl like Anitha could have improved her NEET score by 100 points each year so that she increases her score to 486 in the year 2021. The following picture then shows the growth of her actual NEET score, and along with it plots how her Combined_720 score changes year on year (assuming her board exam marks remain constant)

You will now observe that both Anitha’s actual NEET_720 score increases every year, resulting in a Combined_720 score that always stays ahead of the admissions cut-off. It should also be noted, again, that in 5 years, the Comined_720 score would have completely transitioned to the NEET_720 score (as evidenced by the fact that the blue and the yellow lines merge) so that only the NEET can be used from the year 2022 as planned. Till that time, the admissions cut-off can be bolstered by the students’ state board performance.

When such a change is introduced gradually, it gives the entire population time to absorb the impact, and prepare for the new challenges ahead. Tragedy struck in Anitha’s case because it was imposed on her all of a sudden. But kids who will be appearing for medical entrance in 2022 will currently be in their 7th standard. This is more than enough time for them to adapt to a new syllabus and examination style.

Further observations/comments:

1) This is just one possible transition formula. The idea here is to illustrate that such transitions can be accomplished. If more time and effort is invested, a variety of transition schemes (which are more statistically rigorous) can be identified.

2) We have a lot of data from the current NEET exam, and it will be possible to do a thorough statistical analysis to see where the biases in the test exist. It is possible to combine the student’s demographic data with his/her performance on the test to identify population wide biases. We can answer questions like “Is the test biased towards urban students”, or “Is the test biased towards CBSE students”, or “Is the test biased towards students from higher income backgrounds” with a great deal of certainty. If such biases are identified, then we need to redesign the test so that the effects of such biases are minimised. That is just the fair thing to do.

3) It is possible to do such analysis on a question-by-question level, and identify which questions display biases. If it turns out that 90% of the questions display no major bias, but 10% do, then it is possible to use results from the same exam by just omitting the questions that display bias. This is something that we can implement with minimal disruption to the entire system that has been established. All we need is to do good statistical analysis.

4) The Tamil Nadu government, because it teaches the syllabus that it prescribes in its government schools, is responsible for making sure that its students can get into institutions of higher education under its control. That thought is noble, in and by itself. But it should do so using the right means. In my position as a person who has worked with several hundreds of students from the state and other boards from across the country and outside, I can speak with some authority on this subject. The Tamil Nadu state board is woefully inadequate in its design and implementation.

There is no doubt that the Tamil Nadu government needs to upgrade its syllabus. In 2009, 15-year-old school students from two Indian states – Tamil Nadu and Himachal Pradesh were asked to represent India in the Programme for International Student Assessment (PISA) – a test that measures the learning effectiveness of students from around the world. Tamil Nadu was ranked 71st out of 73 regions from across the world. And Himachal was ranked 72nd. Students from the Tamil Nadu board (even the urban centers) routinely do badly in international standardized tests like the GRE, the GMAT, and the SAT. These are tests that don’t require the student to be familiar with anything beyond 8th standard Math. Most of the questions, in fact, use concepts taught early on in life – concepts as basic as LCM and GCD. The questions on such tests are difficult, not because of the content covered, but because of the way they are framed. They require the student to process this knowledge and apply it in ways previously unthought of. Doing this is possible only if the student understands the philosophy behind the mathematical operation, and combines that with an aptitude for recognizing what is being tested even if the question isn’t framed in an obvious manner. An element of creativity is also required to apply previously acquired knowledge in ways previously not discussed.

Our syllabus and teaching methodologies don’t allow for students to adequately develop these abilities – rather they focus on rote memorization. This is compounded by easy grading that gives students an inflated impression of their abilities. This needs to change.

5) The CBSE has a conflict of interest with respect to the organization of the NEET. The CBSE is not the only board from across India. The NEET test, however, is targeted at students from all Indian (and foreign) boards. It would be best if a neutral organization is tasked with preparing the NEET exam – one that does not have reason to favor one board over another. While I am, by no means, questioning the integrity of the CBSE here, I will have to acknowledge that it takes a great amount of effort for the test-makers to venture beyond a board that they are extremely familiar with while setting the question papers.

This is something that is practiced in the US – the GRE is conducted by ETS. The GMAT is conducted by GMAC. The SAT is conducted by Collegeboard – all of these are independent organizations that claim no allegiance to one particular board. And because of their independence, they have the additional responsibility to make sure that the questions they use in their exams are free of cultural and other forms of bias, and appropriate for students from a wide variety of boards/universities.

6) Finally, the Medical Council of India (MCI) also needs to rethink its 2022 plan. India is a country of 1.3 billion people, on course to become the world’s most populous country in a few years. We do not have enough doctors to serve our growing population. Under such circumstances, the MCI should be looking to upgrade the teaching infrastructure at new and existing medical colleges and increasing its intake substantially. While this is necessary, this will also partially solve the problems faced by students like Anitha. By creating more medical seats, we will be able to educate more students who cherish the same dreams Anitha had – with or without the NEET.

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