What are the options to implement an undergraduate medical exit examination in India?

Medical education and assessment processes in India are expected to undergo a paradigm shift with the introduction of the National Medical Commission Act, 2019. The Government of India intends to introduce a national exit test (NEXT) which is supposed to act as a single examination for graduation from medical school, granting licence to practice modern medicine, and allocating postgraduate residencies. As the nature, scope and stakes of these are different, various options regarding the content and conduct of the examination require careful consideration. We explore the options for implementation of this examination on a national scale. These options include theoretical (multiple assessment methods) with clinical examinations, multiple-choice question (MCQ)-based examination with separate clinical examination, only an MCQ-based examination, and multistep examination including screening followed by mixed assessment methods and clinical evaluation. We discuss the possible strengths and challenges of different options of implementing NEXT, and the caveats of the options.