Towards a valid National Eligibility Cum Entrance Test (NEET - UG): Possible implications of the NEET-UG 2025 paper and a framework for Reform in selection for undergraduate medical courses in India

ABSTRACT

The National Eligibility cum Entrance Test (NEET-UG) examination serves as the principal gateway to undergraduate medical education in India, influencing the academic trajectory of over 20 lakh students annually. In recent years, concerns have emerged regarding the increasing difficulty and disproportionate emphasis on the physics and chemistry, particularly in the 2025 examination. This article critically examines the implications of such a pattern, arguing that it may compromise the validity of the test by favoring analytical skills more suited to engineering disciplines rather than the competencies essential for compassionate, patient-centered medical practice. It explores how the current structure contributes to student stress, over-reliance on coaching, and the rise of “dummy schooling,” while weakening the role of formal school education. The article also addresses counterarguments in support of the existing model and proposes a practical, reform-oriented framework aligned with the National Council of Educational Research and Training (NCERT) curriculum/school education, prioritizing biology and related disciplines more relevant to medicine. The proposed structure includes an effective tie-breaking mechanism and offers a feasible, minimally disruptive alternative to the current system. Through this perspective, the authors aim to initiate constructive discussion and advocate for evidence-based reform that upholds the educational integrity and societal purpose of the NEET-UG examination.

Introduction

The National Eligibility cum Entrance Test (NEET-UG) 2025, conducted by the National Testing Agency (NTA) on May 4, 2025, for admissions to Bachelor of Medicine and Bachelor of Surgery (MBBS), AYUSH, and allied health sciences courses.[1] It has led to considerable discussion regarding the level of difficulty and time required to solve it (especially the Physics section). Subject experts indicate that a substantial portion of the Physics questions posed significant challenges to solve within the allocated 1-min-per-question timeframe, even for top-tier medical aspirants.[2] This editorial critically examines the implications of such a question paper, attributes of a valid pre-medical entrance examination, and proposes a reformed examination framework to enhance validity, reliability, and alignment with the holistic development of future healthcare professionals.

Beyond Ranking: The Broader Implications of NEET-UG

A common argument in defense of a difficult NEET-UG paper is that it affects all aspirants equally, thereby preserving the integrity of the merit list. However, this perspective is narrowly focused and fails to account for the broader purpose and far-reaching impact of the NEET-UG examination. As a high-stakes national examination undertaken by over 20 lakh students annually,[1] NEET-UG does much more than ranking candidates—it actively shapes learning behaviors, influences the broader educational ecosystem, and significantly affects the psychological and developmental trajectory of Indian adolescents.

Each question in the examination is not just a test item—it is a signal to students, parents, teachers, and institutions about what matters in the journey toward becoming a medical professional. The unintended consequences of a disproportionately difficult paper reinforce the dependence on the private coaching institutes, driving the continued expansion of “dummy schooling culture”—a system, in which students are formally enrolled in schools but spend the majority of their time in coaching centers.[3] This arrangement undermines the core objectives of school education, which emphasize not only academic knowledge but also the development of critical thinking, ethical reasoning, communication skills, and social-emotional learning—attributes essential for future medical professionals. Besides, students experience elevated levels of stress, anxiety, and burnout, often leading to a narrowed academic focus and diminished personal growth.[4]

Validity and Reliability: Cornerstones of a Robust Examination Framework

A sound entrance examination must rest on two foundational principles: validity and reliability. Validity refers to the extent, to which an exam accurately assesses a candidate’s readiness for the course of study,[5] in this case, medical science. For NEET-UG, this means identifying students, who possess the foundational knowledge and aptitude to excel in medical education and eventually serve as competent primary care physicians. This can only be achieved if the questions reflect competencies that align with the medical curriculum. The NEET-UG syllabus should therefore priorities disciplines that are fundamental to medical science, such as human physiology, biochemistry, genetics, nutrition, and psychology, largely covered under the subject of biology.[6] These domains underpin the early MBBS curriculum and clinical training. In contrast, advanced topics in physics (e.g. Semiconductor devices, nuclear physics, electricity, mechanics) and chemistry (e.g. complex organic reaction mechanisms or detailed study of inorganic chemistry) bear limited relevance to actual medical education and training. Their overrepresentation in NEET-UG success dilutes the exam’s focus and misaligns it from the goal of identifying appropriate future medical professionals.

Reliability, however, ensures that the examination produces consistent and dependable results, minimizing the impact of chance factors.[5] A reliable NEET-UG should enable repeated, reproducible rankings that reflect a candidate’s true aptitude rather than test-taking strategy or coaching exposure. This reliability is best maintained through strict adherence to the syllabus and difficulty level for Classes 11 and 12, ensuring a level playing field for students across different boards and backgrounds. The 2024 NEET-UG paper is a good example in this regard. Such alignment not only ensures fairness in education, but also makes the exam more effective in identifying candidates truly suited for medical education.

NEET-UG Examination Pattern: Current Practice and Ideal Pedagogical Alignment

The “Examination Pattern” serves as the foundational blueprint for any assessment, meticulously detailing components such as the total number of questions, stipulated duration, comprehensive syllabus coverage, and the anticipated distribution of difficulty levels across topics. This structured framework is crucial for both test question setters and candidates, providing essential clarity on how the examination will be organized and assessed. This section critically examines the current NEET-UG examination pattern, comparing it with an ideal pedagogical alignment that would better serve the overarching goals of medical education and holistic student development.

Medical education inherently differs from engineering training in its fundamental objectives and the competencies it seeks to cultivate. While engineering prioritizes innovation, swift problem-solving, and analytical sharpness for developing novel solutions, medical practice demands a profound understanding of a vast syllabus, rigorous adherence to clinical protocols, and an expansive knowledge base for accurate diagnosis and treatment. Success in medicine hinges significantly on compassionate, patient-centered skills, including the ability to understand human psychology, navigate complex social norms, and exhibit empathy—attributes critical for building trust and delivering effective care.[7] This contrasts sharply with the engineering ethos, which often values a keen, agile mindset capable of swiftly addressing technical challenges, where creativity frequently takes precedence over emotional intelligence. Consequently, an ideally aligned NEET-UG should priorities core competencies in biology, physiology, biochemistry, genetics, nutrition, and even foundational psychology, rather than disproportionately emphasizing advanced physics or chemistry, to select candidates possessing the emotional and intellectual attributes essential for compassionate, protocol-driven medical practice.

However, the observed trend, particularly in the NEET-UG Physics section leading up to 2025, with its disproportionately high level of complexity, may fundamentally misalign with these intended objectives. Rather than effectively assessing knowledge aligned with the school-based curriculum or competencies directly relevant to medical practice, this elevated difficulty appears to favor advanced analytical problem-solving skills, which are arguably more characteristic of engineering disciplines. This emphasis compromises the validity of the examination by potentially selecting candidates based on the attributes that, while valuable in other fields, are not the most pertinent indicators of success or suitability for the unique demands of a medical career.

Aligning the difficulty level and content of the NEET-UG examination, particularly in Physics and Chemistry, with the school-level education offers substantial academic benefits. Such an approach would reaffirm the paramount importance of school education, thereby reducing the escalating over-reliance on specialized coaching centers.[8] This alignment fosters a more holistic development of students, encouraging a deeper, conceptual understanding of scientific principles rather than mere rote memorization or the pursuit of overly complex problems. Furthermore, it would significantly alleviate the mental health burden on students, promoting a more balanced and sustainable educational journey.

Proponents of the current NEET-UG pattern often argue that subjects like Physics and Chemistry, integral to senior secondary science education, serve as proxies for logical reasoning and intellectual agility—qualities potentially correlated with success in medicine. Additionally, their inclusion is posited to accommodate students, who remain undecided between medical and engineering streams in Class 11, thus preserving academic flexibility. It is also relevant to note that the erstwhile AIIMS MBBS entrance examination (that continued until 2019), included 60 questions each from Physics, Chemistry, and Biology, alongside 20 general awareness questions, explicitly aiming to assess analytical and problem-solving skills. However, NEET-UG is very different from the former AIIMS MBBS entrance exam in its scope. It caters to a much larger and more diverse group of candidates, with admissions spanning over 600 medical, AYUSH, and nursing colleges, and merit ranks for admission going beyond 6–7 lakh.[9] A paper that is too difficult, like the NEET-UG 2025 exam, may allow candidates with scores as low as 20% to get admission in the MBBS course in private medical colleges, which compromises the fairness of the selection process. In contrast, the rationalized NEET-UG 2024 exam required candidates to score at least 23% to qualify for an MBBS seat, providing a more reliable way to assess students’ readiness.[10]

In conclusion, while the current NEET-UG examination pattern attempts to standardize medical admissions, its occasional deviation into disproportionately difficult questions, particularly in Physics, risks undermining its scholastic validity and its primary goal of identifying suitable medical professionals. A more ideal alignment with the school-based curriculum would not only reinforce foundational learning and reduce external pressures but also ensure that the examination truly assesses the blend of knowledge, critical thinking, and compassionate attributes essential for a successful career in medicine, especially for primary care physicians.

Potential Reasons for the Increased Difficulty of the NEET-UG 2025 Paper

In recent years, NEET-UG question papers have largely adhered to the National Council of Educational Research and Training (NCERT) syllabus, resulting in a trend of progressively increasing cut-off scores for government medical college MBBS seats. A growing number of students have been scoring extremely high marks, with several candidates achieving perfect or nearly perfect scores.[11] This trend has led to an unusually large cluster of students securing marks above the 90^th percentile, making the merit list heavily crowded at the same score.

This phenomenon has triggered widespread debate across academic circles and social media platforms. A key concern is the diminishing ability of the current NEET-UG structure to effectively differentiate among top-performing students. The existing tie-breaking criteria—such as age or subject-wise marks[12]—have come under criticism for being arbitrary or insufficient in resolving the clustering of high scorers.

In response, the NTA may have deliberately increased the difficulty level of the NEET-UG 2025 paper, particularly in Physics, as a strategy to restore the discriminative power of the exam. By introducing tougher questions, the aim could be to reduce score saturation at the top, ensure a more meaningful merit-based ranking, and reduce the number of ties among high-scoring candidates. However, while this approach may help in distributing the top scores, there are concerns that it could potentially affect the validity of the examination, particularly if the difficulty level extends beyond the prescribed NCERT syllabus or emphasizes skills with less direct relevance to medical education. Besides, a more valid system of tie-breaking can be implemented without compromising the overall validity of the examination.

A Proposed Framework for Reform

To balance validity, reliability, and educational alignment, we had initially proposed a two-step, computer-based NEET-UG examination.[6] However, in view of the potential logistical challenges, we alternatively recommend a single-sitting, pen-and-paper format with a duration of 3 hours and 30 min [Table 1 and Boxes 1&2]. The exam would consist of 200 questions divided into three parts: Part A would include 100 biology questions focusing on human physiology, biochemistry, genetics, histology, and cytology; Part B would comprise 80 questions, with 20 each from physics, chemistry, psychology, and nutrition/physical education; and Part C would include 20 general aptitude questions. For evaluation, candidates would be assessed on 150 questions—comprising all 100 questions from Part A and any 50 of their choice from Part B—while the remaining 50 questions (30 from Part B and 20 from Part C) would be used as tie-breakers. The difficulty level of the questions should align with the Central Board of Secondary Education (CBSE)/NCERT Class 11 and 12 syllabus, consistent with the 2024 NEET-UG paper, to ensure accessibility and reduce undue pressure on the students.

Table 1.

Summary of recommendations and justification

Recommendation	Justification/Basis
Align NEET-UG question difficulty strictly with NCERT/CBSE/State boards Class 11–12 syllabus	Ensures accessibility for all students, promotes school-based learning, and reduces over-reliance on coaching; reinforces the validity and fairness of the exam.
Reduce the weightage of Physics and Chemistry in the exam	Advanced topics in these subjects like physics and chemistry have limited relevance to medical education and clinical practice; overemphasis selects for engineering-like skills not essential for future doctors. Reduction in the volume of topics redundant for medical education.
Include Psychology and Nutrition/Physical Education as subjects in NEET-UG	These subjects are more aligned with medical education and promote a more holistic assessment of candidates, enhancing relevance to real-world knowledge and medical education.
Add General Aptitude section (20 questions)	Assesses reasoning and problem-solving skills in a balanced manner, without inflating overall scores; contributes to effective tie-breaking and evaluating well-rounded candidates.
Proposed format: 3.5-hour, single-sitting pen-and-paper exam	Practical and minimally disruptive to the existing examination system, while accommodating the restructured format and subject distribution.
200-question paper split into three parts (A: Biology, B: Physics/Chemistry/Psychology/Nutrition, C: Aptitude)	Ensures balanced subject representation and prioritizes medically relevant knowledge; acknowledges the importance of both scientific and psychosocial dimensions in medicine.
Evaluate based on 150 questions (100 from Biology + any 50 from Part B)	Promotes flexibility and student choice, while ensuring core emphasis on biology; reduces pressure on students to master all sections.
Use remaining 50 questions (30 from Part B and 20 from Part C) for tie-breaking	Introduces a fair and educationally sound mechanism to address score clustering among top scorers, unlike arbitrary methods like age or alphabetical order.
Strict adherence to Class 11–12 school syllabus (especially for Physics/ Chemistry)	Ensures fairness across school boards, promotes curriculum-based preparation, and addresses educational equity concerns.
Reduce the syllabus for Physics and Chemistry by 50%, keeping only medically relevant topics	Aligns assessment with clinical relevance and foundational knowledge needed for MBBS, avoiding selection based on advanced technical concepts irrelevant to medical training.
Limit difficulty level to that seen in NEET-UG 2024 (a model example)	2024 paper achieved a better balance between accessibility and rigor, ensuring fair evaluation of students without excessive coaching dependency or mental stress.

The proposed NEET-UG examination framework addresses multiple critical goals essential for a fair and valid assessment. By placing greater emphasis on biology and medically relevant subjects, such as psychology, nutrition, and sociology, while moderating the weightage of physics and chemistry, it ensures balanced and relevant subject representation aligned with the demands of medical education. The alignment of question difficulty with the NCERT/CBSE syllabus helps maintain consistency with school education standards, thereby reducing the undue pressure on students to seek external coaching. Besides, there is adequate time to solve the 150 main questions and 50 tiebreaker questions. This alignment also supports equitable participation from students across various boards and socio-economic backgrounds. Furthermore, the proposed structure incorporates a well-thought-out tie-breaker mechanism based on optional questions in Parts B and C, which evaluates analytical and problem-solving skills without inflating overall scores, helping to resolve the issue of high-score clustering. The single-sitting, pen-and-paper format ensures minimal disruption to the current system and is logistically feasible, making it a practical and scalable solution that upholds both educational integrity and student well-being. Through this opinion piece, we invite educators, policymakers, examination authorities, and other key stakeholders to engage in this critical dialogue actively and collaboratively work toward evidence-based reforms in the NEET-UG examination pattern, in the best interest of students, medical education, and the nation’s healthcare system.

Box 1: Attributes of an ideal NEET UG examination

1. Balanced and Relevant Subject Weightage

2. Alignment of difficulty level with the NCERT/CBSE/School education board syllabus

3. Reduce stress and dependency on coaching.

4. Effective Tie-Breaker System

5. Minimally disruptive to the existing System

6. Feasible in terms of resources

Box 2: Proposed framework for NEET-UG examination

• Format: Single-sitting, pen-and-paper test

• Duration: 3 hours and 30 min

• Total Questions: 200, divided into three parts:

  • Part A (Biology – 100 questions): Emphasis on human physiology, genetics, biochemistry, histology, cytology

  • Part B (80 questions): 20 each from Physics, Chemistry, Psychology, and Nutrition/Physical Education

  • Part C (20 questions): General knowledge and aptitude.

• Evaluation Criteria:

  • Score based on 150 questions (100 from Part A and any 50 from Part B)

  • Remaining 50 questions (30 from Part B and 20 from Part C) used for tie-breaking

• Syllabus Alignment: All questions strictly based on the NCERT/CBSE Class 11 and 12 syllabus

Note: The syllabus for Physics and Chemistry should be reduced by 50%, retaining only those topics that are relevant to medical science. In addition, selected topics from the CBSE curriculum in Psychology and Nutrition/Physical Education should be included.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.