Earlier this week, the Directorate General of Medical Education (DGME) published the results of the 2024-25 medical admission test. Out of the 131,729 students who participated in the exam, 60,095 passed, while only 5,372 of them were chosen for 37 state-run medical colleges. Many have been disappointed by the results, not because they were not qualified, but rather because the system is fundamentally unfair.

One of the most problematic elements of this year's university admission test procedure is the ongoing usage of quotas, particularly the 5 percent reserved for the descendants of freedom fighters. Many students who received scores much over the cutoff, like 73.5, were unable to get admission into government medical colleges. However, candidates under the freedom fighter (FF) quota were selected with scores as low as 41–45, which is barely above the passing cutoff mark of 40. This discrimination is troubling, especially in light of the recent anti-discrimination student protests across the country. The movement, which ultimately led to the downfall of the Awami League government, called for a merit-based system to dismantle added privilege and ensure equal opportunities for students from all backgrounds.

Even after all this, when the quota system in admission tests remains, it begs the question of why we still need to favour a select group while sidelining other deserving candidates. If anything, it just acts to demotivate other students, raising concerns about whether we would ever be able to adopt a merit-based system. Students appearing for the MBBS admission test often spend months, sometimes even two years, preparing for the exam. The vast syllabus, intense competition, and uncertainty of public exams make this phase nothing less than an emotional rollercoaster for a candidate. The fact that we have 25 students fighting for one seat in a government medical college says a lot about the pressure these candidates feel during their preparation phase. The stakes are much higher for students from underprivileged backgrounds because their only practical option for pursuing the goal of becoming a doctor is through these state-run medical colleges.

For students from the English medium background, the obstacles are even bigger. To begin with, the question sets based on the HSC syllabus are not standardised and are very different from the global curriculum followed by English medium schools. Students who have spent their years learning under the British curriculum are forced to memorise an entirely new syllabus, one that does not really overlap with the content they are familiar with. The test itself is designed to judge the memorisation capabilities of students, instead of assessing their understanding of subject matter. 

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With three A-level sessions in a year, most candidates with English medium backgrounds grapple with this new syllabus in very little time. Despite their academic excellence, many find it challenging to keep up with their peers from the national curriculum. Furthermore, many English-language translations of the questions tend to have errors in grammar, misinterpretations, or the questions themselves are formulated incorrectly. Even while they might not seem like much, these mistakes frequently lose students four to five marks or more, which can make or break them in an exam this competitive. 

Not only do they have to deal with a completely different syllabus, but they are also disadvantaged by the equivalence procedure for GPAs, which converts grades into the national curriculum system. The medical admission committee employs a methodology that ignores international grade boundaries and Uniform Mark Scale (UMS) marks, in contrast to institutions such as Dhaka University and BUET, which align their equivalency requirements with British Council norms. For instance, my younger sister achieved a GPA of 4.4 on a scale of 5.00 in equivalence despite having seven A*s in her O-Levels, which is an impressive feat by any global standard. Like her, many high-achieving English-medium students are penalised by this system, which makes it impossible for them to get into government medical colleges. 

This system has far-reaching effects. Every year, hundreds of deserving candidates are turned away from these colleges—not because they lack skill, but rather because the system does not provide equitable opportunity. Because of this, many students are forced to either completely abandon their dreams or enrol in extremely expensive private medical colleges. So, if there are systematic biases in the selection of future doctors, how can we develop a healthcare system that serves a diverse population?

The first step towards resolving these problems is to rethink the medical admission process. Even if quotas are still required to maintain social justice, they must be used carefully and with precise criteria to avoid arbitrarily excluding individuals based solely on their merits. Perhaps both fairness and excellence might be guaranteed by a well-rounded strategy that eliminates unnecessary quotas and establishes a minimum performance criterion. There is also an urgent need to overhaul the English-medium students' equivalency procedure. It would be simple yet effective to align medical entrance requirements with international grade boundaries. We cannot think about reforming the healthcare system if we do not begin by reforming the admission process, and without selecting qualified students, it is impossible to produce qualified doctors. The least we can do is honour the sacrifices of all those who fought for equity and justice and against quotas. Perhaps then we can build a healthcare system—and a nation—worthy of the dreams and aspirations of its people. 

Maisha Islam Monamee is student at the Institute of Business Administration (IBA) at the University of Dhaka and a contributor at The Daily Star. She can be reached at @monameereads on Instagram.

Views expressed in this article are the author's own.

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