Summary
The conversation provides a detailed historical narrative of the evolution of residency curricula in India, focusing on the transition from the *1+2 system* (one-year house job followed by a two-year MD) to the *three-year direct PG system*. The participants recount their personal experiences during residency, including the challenges of intense workloads, competitive exams, and significant strikes that shaped postgraduate medical education. Strikes by Resident Doctors' Associations (RDAs) in the 1980s and 1990s were pivotal in standardizing the three-year postgraduate (PG) curriculum across India. The discussion also highlights formative assessments during the older system, the introduction of thesis requirements in the modern curriculum, and the camaraderie, hardships, and institutional politics that defined the residency experience.
Key Words
- *Residency Curriculum*
- *1+2 System*
- *Three-Year PG Program*
- *Resident Doctor Strikes*
- *Formative Assessments*
- *Summative Assessments*
- *Medical Council of India (MCI)*
- *NICU/PICU Duties*
- *RDA (Resident Doctors’ Association)*
- *PGI (Postgraduate Institute)*
- *AIIMS*
- *Singularity of Events*
- *Camaraderie*
- *Workload and Pressure*
UDLCO Keyword glossary:
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[31/08, 22:50] hu1: Yes… it was really tough back then, with no DM seats and only 10–15 selected for MD each year. Unlike now, where almost every department has 40 MDs and 4 DMs, per year our journey was very different.
I was mostly posted in NICU and PICU, and I hardly remember much of OPD postings. Even when I did get OPD, I would often be shifted back to ICU as replacement. Nights in PICU were intense—I would wake up to the sound of alarms in the middle of the night even after completion of night duties . After long duties, we would eat at nearby dhabas or relish the frozen food kept aside at the South Mess by Kalyan (the ever-smiling guy).at 12 MN 😊
Because we were in a separate building, a little away from other departments, we all shared great bond with batchmates, juniors, and seniors /staff . My ICU duties were made tolerable thanks to the great company of @& @ @ and many other contemporaries. My teachers were truly caring and supportive—many of whom I’m still in touch with even today.
During those years, we built our own little world inside that building. I maintained the “coffee club” for almost two years, and we celebrated birthdays, small get-togethers, and countless moments of joy amidst the workload. Though it was three years of hard work, plus one more as SR, they are memories I deeply cherish.
I truly miss my residency days… unforgettable times that I could easily write a memoir about. 🥰
[01/09, 06:27] hu2: How are the work demands today in ...?
Are there more residents per bed or is it still as demanding?
Who does the sampling and basic case sheet maintanence?
[01/09, 07:26]hu3: Demanding ..🤔hmm
Recall 1 house surgeon ..me.on alt days ,..2 jrs 1 year ahead of me sharing alt with me.
With the damocles sword of 1 plus 2..I.e.no guarantee of a pg seat, needed another all india exam to clear..
36 hours official duty for 8 hours sleep
We had to organise a strike to get a 3 year direct pg for the rest of you ..
Deserve a plaque in our honour..mine and preceding batches..
[01/09, 08:39]hu4: Yes, those days 1+2 were very tough...the tension of no guaranteed PG seat after a full year of Donkeys Job.. Fortune has to smile twice at you before one walks out of PGI - Pressure Generating Instrument. I know a few people had to quit the Institute due to the Pressure of Work and Study!
[01/09, 08:46]hu5: 1+2 Means ??
No guaranteed seat ?? Elaborate sir
When selected through entrance why not guaranteed seat ?
[01/09, 08:53] hu6 : I don't think entrance exam existed in their time..
[01/09, 08:54]hu5: Ok
Then selection basis ?
[01/09, 08:54] hu6 : @ Enlighten the curious minds sir.. I dunno..😅
[01/09, 08:55]hu4: Practical Exams interview
[01/09, 09:01]hu4: Before 1983, ... entrance exams were of a 2-point entry. The first entry exam is only a Theory paper with Negative marks, each MCQs have 5 options to mark YES or NO, similar to MCRP exams. The toppers select Medicine, Paediatrics, Surgery & OBGYN. This is for a one-year term to work as a House Physician in the selected departments. At the end of the Year, again sit for a PG entrance exam comprising a Theory Paper and a Practical, including a Viva Voce, for a 2 Year MD/MS exam with no Thesis.
[01/09, 09:11] hu4 : _The Clinical Skill test in Medicine comprises 4 sections, each with 10 marks. All are Objective in each System: Neurology, Cardiology, Respiratory & GE. One may be asked only to inspect, palpate, percuss, or auscultate. Only 3 Questions - Diagnosis, 3 relevant Labs to confirm the diagnosis, and the treatment. Viva is a rapid-fire test. Ten questions are asked to all the examinees, and the one who answers the most, of course, gets selected. The theory portion in the chosen subject has 50 marks._
[01/09, 09:45]hu3: Good summary..
This lead to a piquant situation..
Where after 1 year of " Hamali" where one couldn't study..you faced another all india exam with diploma holders from all over india..often top students with experience.
The viva in this exam provided you made the theory grade ( i know some who did not ) now became a test indeed..because your practical experience in phlebotomy, general sucking up, and running around doing unskilled work, was pitted against real practical experience..
In general medicine, peds etc, say 4 Seats..there were 4 internals, and 8 externals..and at least one dch brain from bengal and one MLAs connect..
So 2 persons would be left hanging around hoping for an act of God.. or reasearch post
The home state bridges would have been burnt so no going back..
[01/09, 09:45]hu3: Nobody had the guts to protest.
[01/09, 09:46]hu3: The association office bearers were basically trying to ensure they got Best outgoing awards
[01/09, 09:47]hu3: So how did it change..?
[01/09, 09:49]hu3: If anybody is interested indicate this old man will share.🙂
[01/09, 10:32]hu7: This is amazing and I wonder if all this has been formally documented somewhere and if not it should asap!
I guess they were trying to forge an apprentice model that may only be assessed formatively and the upcoming summative assessment evolution was just short of bursting forth into the firmament that created this unholy atmosphere that you have so well outlined here
[01/09, 10:33]hu7: Do we have the contacts of those who had to return after a year? What happened to their careers eventually?
[01/09, 12:17]hu4: That's true. 4 long cases in Medicine - in each System of Neuro, Cardio, Respiratory and GE.
Each case may have multi system involvement and to face 8 examiners.. luckily, most of the candidates pass out due to objective assessment.
Cases are first given to the external examiners to take History including Physical examination and note down their findings.
When they examine the candidate they are supposed to match with their own findings, if the candidate scores equal, then only one passes.
During my exam, my Cardiac case was Mitral Stenosis. The Cardiologist who examined me wanted to fail me as he missed PSS - Progressive Systemic Sclerosis in the same patient.
The system did not allow him to fail me as he himself missed a major disease in the patient. My HOD won the argument and I was promoted.
He further advised me not to allow any one in my practice to fail me.
[01/09, 13:01]hu8: It means that you had to do one exam to be selected for house job/ man as it was called then . After one year house job you took another exam for getting a PG seat for the 2 year MD course- no guarantee.
For example I did 6 months house job in Bangalore and the next 6 months at ... after taking the entrance. In the first 6 months you didn't get any of the coveted postings( cardiology, neurology,chest etc) which would help you in the entrance for the MD. My first posting was the private wards.
As a back up during the MD selection,I had appeared for pathology also
The MD entrance was a written and practical exam
[01/09, 13:06]hu4: Yes, I know several people who couldn't make it at the First entry or the Second, many had their fortunes overseas. Incidentally, while working in Gulf, few Members and Fellows from Royal College recognised me and admitted that they did not make it PGI and soon left India did PLAB and after their training from UK they came back in the same Hospital where I was working with 3 times the Salary of mine. Sadly, Postgraduates from India are recruited as Specialist and Members, Fellows from Royal College as Consultants 😔
[01/09, 13:22] hu7: This is an amazing history around ... that i learned for the first time today
[01/09, 13:32] hu4: Those who attempted to get into PGI and could not make it also has carved a niche in our Profession. As matter of fact getting a Call letter - Interview is in itself is a honour as there is a pre Test Screening. Only 500 people during my time are called to take the entrance. Only 50 get selected . I do not know now, may be the same system except it is One point entry with 3 Yr PG with added Thesis.
[01/09, 13:37]hu4: Answering the Query of hu3, the system of 1+2 changed to One point entry to PG after RDA went on strike during 1982 which was never heard of in ... and after a Roar and Cry administration recommended 3 Yr PG course to MCI and was soon implemented in 1983.
[01/09, 14:14] hu4: Adopted Standardization Across India
- The Medical Council of India (now replaced by the National Medical Commission) standardized postgraduate medical education to ensure uniformity.
- Most MD/MS programs across India are 3 years long, so PGI aligned with national norms
[01/09, 14:16] hu4: Could any one tell me still PGI & AIIMS conduct their own entrance for PG or is it INI - CET ?
[01/09, 14:17]hu3: Aha..as one who was a jt secretary of the RDA who organised the strike..lots of trivia to share
[01/09, 14:19]hu4: Which batch was yours hu3 ??
[01/09, 14:22]hu3: It started innocuous.. a patient complaint against an SR who couldn't attend as he was doing a procedure.
... Administration set up an inquiry and found the concerned doc guilty..😳
He finds this when he reads his name in the Sunday paper
Everybody is furious..no amount of Bete..tussi naraz na hona..pacifies
The RDA head has Akali connections so the association is emboldened
The strike in right earnest complete with parallel opds ..near the car park
Mess is closed..🫩
The minister comes and is presented with a 16 point charter of demands..
Reinstatement of doc..etc.. but 4th point..3 year direct ms/MD..
The minister asks the ias ..he asks director..long explanation..to which he asks again what is system in AIIMS..3 years..so why this 1 plus 2 ..
Voila a 10 year demand is accepted..the same obstructers are now agreeing vehemently..
All kinds of changes in the aftermath.
People are scared that simple logic will be applied elsewhere
[01/09, 15:32]hu2: We had a ARD strike during our times when they retrospectively applied electricity charges on all residents to the extent of Rs 33,000 ( worth many lakhs of contemporary money’s worth). Our residency ended on January 1st instead of Dec 31st, after our successful strike.
[01/09, 15:51]hu3: Which year?
[01/09, 16:38] hu3 : recall an army col who did his Neurosurgery Mch..saying on his last working..I have worked in this hospital now can work in Andamans..😳
[01/09, 17:07]hu2: 1997 sir, we were exam going in 6 months time when this happened. Again same apathy and threats to residents to withdraw strike. Some idiots had siphoned power from resident hostels and the residents were easy bakras to pass the buck.
[01/09, 18:26]hu3: Some trivia of strike
Me and a friend..mess closes..go to sector 17 every evening..for dinner..salary 550 a month..that also stopped..dad retired..
So found this restaurant..2 parotas, chicken do pyaza.. with 2 pieces of chicken in gravy..
Shared
After one week..the restauranter got suspicious..
We had to fight as there was only one piece of chicken..from then on
We argued Chicken do pyaaza.. so two ..he came back..with do pyaaz milega..
Luckily strike lifted soon after.
Thematic Analysis
1. Evolution of Residency Curriculum
- *1+2 System*: The older system involved a one-year house job followed by a competitive exam for a two-year MD/MS program. This system placed extreme pressure on residents, as PG seats were not guaranteed after the house job.
- *Three-Year PG System*: Standardized across India in the 1980s after a major RDA strike, this system eliminated the need for a second entrance exam and introduced a thesis requirement. The change aligned PGI and other institutions with AIIMS and international norms.
2. Strikes and Advocacy
- *Catalyst for Change*: The RDA strike in 1982 was pivotal in transitioning from the 1+2 system to the three-year PG program. Residents protested over workload, unfair assessments, and systemic inequities, forcing administrators to adopt reforms.
- *Camaraderie and Struggles*: Strikes brought residents together in solidarity despite financial hardships, threats, and apathy from authorities. Stories of shared meals, makeshift arrangements, and resilience highlight the human aspect of the struggle.
3. Assessments and Workload
- *Formative Assessments*: The older system relied heavily on formative, practical assessments with viva voce, clinical skill tests, and subjective evaluations by examiners. These methods often lacked transparency and fairness.
- *Summative Assessments*: The evolution toward written exams and objective assessments marked a shift toward more standardized and equitable evaluation systems.
- *Workload*: Residency involved long hours, with residents juggling clinical duties, exams, and personal challenges. The NICU/PICU postings were particularly intense, with night alarms and extended shifts.
4. Institutional Politics and Inequities
- *Selection Bias*: The older system often favored candidates with political or regional connections, leaving many deserving candidates without opportunities. This created a culture of frustration and resignation among residents.
- *Systemic Inequities*: The conversation highlights how some residents had to leave India for better opportunities abroad, where their qualifications were recognized more generously.
5. Personal Narratives and Camaraderie
- *Memories of Residency*: Despite the hardships, residents fondly recall the camaraderie they shared with peers, mentors, and staff. They created informal support systems, such as "coffee clubs" and birthday celebrations, to cope with the intense workload.
- *Cultural and Social Context*: The stories of shared meals, financial struggles, and relationships within the residency environment underscore the human dimension of medical training.
6. Standardization and Modernization
- *Role of MCI (Now NMC)*: The Medical Council of India played a key role in standardizing postgraduate medical education, ensuring uniformity across institutions.
- *Current Landscape*: The conversation touches on modern entrance exams like INI-CET, which have replaced earlier systems, and asks whether the same challenges persist today.
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Comparative Reflection
The discussion highlights a significant transformation in medical education, moving from an *apprenticeship-based formative system* to a *standardized summative assessment model*. While the older system emphasized practical, hands-on skills, it was fraught with inequities and subjective evaluations. The modern system, with its structured curriculum and objective assessments, aims for fairness and uniformity but may lack the personalized mentorship of the past. The personal anecdotes humanize the narrative, emphasizing the resilience and camaraderie of residents during a time of systemic change.
Feedback from other human users hu1,2,3,n:
[02/09, 10:48]hu1: Brilliant piece in fact a lot more can be added to it
[02/09, 13:19]hu2: Please do and even if you share the text here I can add
[02/09, 21:29]hu2: Here's some additional feedback by another reader:
[02/09, 19:07]dhu1: At AIIMS, New Delhi ours was the first batch of MBBS graduates to face this sudden transition from 2 + 1 to 3 year MD/MS with a thesis requirement. For me the challenge was even greater as I was using my spare time to read Indian History and Political Science for the IAS entrance exam while the rest of my batchmates were preparing for the ECFMG (precursor to the VQE).
Towards middle of October 1977 (during my internship) I had to decide whether to continue preparing for the remaining two papers for the IAS which I had to take on October 31, 1977 or get back to medical books for the entrance examination of MD/MS in the third week of December for AIIMS, New Delhi. At that time, we were treated as equivalent to outsiders appearing for the entrance exam for an all Indian competition.
Anyway, I decided to write the remaining two written exam papers for the IAS.
On November 1, 1977 switched back to medical books. Topped the entrance exam for MD pediatrics which had three open seats. Joined MD (Paediatrics) on 1.1.78 but left it on 12.7. 78 to join the IAS.
My formal practice as a doctor was limited to pro bono practice in Arunachal Pradesh where I was Deputy Commissioner of a district.
I left IAS in Nov 93 to join the World Intellectual Property Organisation, Geneva, Switzerland, from where I retired on 31.08.2017.
The only time I practiced medicine full time (again on a pro bono basis) was during the height of Covid-19 when I was working remotely for patients in dire need for almost 16 to 18 hours per day for a few weeks.
At present, my medical practice is limited to pro bono practice with friends and family. Mostly for second opinions.
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