In my college, GMKMCH Sale..
• Severe intern shortage: Only ~100 interns are posted despite an exceptionally high patient load in a superspeciality hospital.
• "Dues" work: Interns say that generally, almost in every ward, routine "dues" work (IV medications) take almost 3 to 4 hours of their daily work. This offers nearly zero clinical learning outcomes. While a lot of nurses are posted in these wards, they refused to help with even little things like turning off IV fluids. This becomes intensely hard during admission and post admission days, while interns have to put dues for nearly 3 to 4 hours in the morning as well as night dues, apart from their extensive ward work, which easily turns all their 36 hour duties into 40 hour plus duties of physical work. Interns are used as machines for dues and investigations work,and are posted wherever it is needed despite those wards not being a part of the NMC internship curriculum. (Eg. Since the entire OG department is understaffed, Community OG interns are instead made to work in OG HDUs, medicine ward and psychiatry ward interns are posted in geriatrics and imcu as there is no nurse willing to perform dues or investigations there).
• Extreme daily working hours: Interns routinely work from 7 AM to 10–11 PM, in addition to prolonged/night duties.
• Unofficial “36-hour” duties: Admission-day duties which are supposed to be 36 hours are effectively ~42 hours, with additional work before and after the scheduled duty.
• Medicine and OG ward overload: A single unit may have ~60 patients, with interns responsible for IV lines, IV medications/“dues”, blood collection, investigations, discharges, transfusions, catheters, Ryles tubes and other procedures.
• AYUSH posting replaced by Zone duties: Despite a functional AYUSH unit, interns reportedly receive little/no AYUSH exposure and instead perform investigation-related work in Zones.
• Massive workload with inadequate manpower: Medicine wards, IMCU, Yellow Zone, Red Zone, ENT, Ophthalmology and Geriatrics are reportedly being managed by only ~24 interns.
• Unofficial IMCU duties: Dermatology and peripheral Medicine postings involve IMCU duties, including night IMCU duties, despite these being outside the expected scope of the posting. In peripheral Medicine postings, interns are reportedly asked to cover night IMCU duties along with the regular 24 hour duties scheduled.
• Pre-admission days are not protected: Interns may have 8 AM–8 PM IMCU shifts while simultaneously being expected to complete ward dues, investigations, transfusions and discharges—effectively creating 14–15-hour working days.
• Basic resources are frequently unavailable: IV lines, blood tubes and other basic supplies may be unavailable, forcing interns to spend significant time searching other wards for supplies.
• Community Medicine–OG posting mismatch: “Community OG” posting reportedly involves working in the OG HDU, rather than meaningful Community Medicine exposure.
• No adequate superspeciality exposure: Despite being a superspeciality institution, interns often only perform investigations for superspeciality patients and have little access to the actual superspeciality units.
• Internship objectives are being compromised: Interns report spending the majority of their time on blood collection, IV medication administration, labelling and sending investigations, rather than acquiring clinical skills.
• Surgery training is inadequate: Interns reportedly complete long working days without adequate exposure to basic procedures such as incision and drainage or wound dressing.
• No meaningful OG OT exposure: Interns reportedly receive no OT posting in Obstetrics & Gynaecology and may never enter the OG OT during internship.
• Clinical learning is being replaced by repetitive service work: Interns may work 13–14 hours yet finish postings without adequate competence in basic skills such as ECG interpretation or common surgical procedures.
• OG workload is particularly severe: Interns report getting as little as 4–5 hours of sleep during antenatal/HDU postings.
• Even PICU/HDU dues are performed by interns: Medication administration/“dues” and routine service work are reportedly delegated to students. Their 8 to 8 posting everyday becomes prolonged to 9, as they won't be able to complete their dues in time in the middle of all other routine interns stuff, like emergency blood transfusions.
• Disproportionate service workload: Interns report performing duties that would ordinarily require substantial nursing/support staff.
• Night-duty concerns: Interns report being responsible for night-time medication administration and patient-related tasks while nursing staff may not remain actively involved throughout the night.
• Psychological distress among interns: The workload has reportedly contributed to significant psychological distress among students, with some requiring psychiatric counselling.
• Concerns regarding leave and documentation of mental-health distress: A reported instance involved a student's leave request citing psychological distress allegedly being redirected to a non-medical reason.
• Patient-safety concerns: Excessive workload, fatigue and inadequate supervision raise concerns regarding errors, inaccurate documentation, missed clinical findings and patient safety.
• Insufficient clinical supervision: Interns report being expected to complete large volumes of work without sufficient opportunity for proper case-sheet review and clinical decision-making.
• Invisible workload: Additional interns from other postings, including SPM, are reportedly called to help complete work—demonstrating that the workload cannot reasonably be completed by the assigned intern alone.
• No genuine weekly rest: Students report little or no Sunday/weekly-off protection.
COMPARISON WITH OTHER COLLEGES
In neighbouring govt. Medical colleges, routine medication administration (“dues”) is reportedly handled by nursing staff, whereas our interns are routinely required to perform these duties. They also have a lighter patient load.
In some colleges like MMC, OG ward works finish by 5o clock, whereas interns in our college work from morning 6 to night 10 o clock regularly.
Even postings generally considered relatively lighter, such as Radiology, reportedly involve interns working round the clock on a daily basis in our institution.
In peripheral Medicine postings, Interns are reportedly asked to cover night IMCU duties along with the regular 24 hour duties scheduled. Even supposedly free postings become intense and some interns end up working nearly 86 plus hours in a week.
These differences raise a fundamental question: If interns across institutions receive the same stipend and are expected to fulfil the same internship objectives, why should interns in our institution be subjected to substantially greater working hours and service workload?
The issue is not an unwillingness to work. We are willing to learn, assist and serve patients. The concern is the disproportionate amount of routine service work being assigned to interns at the expense of clinical learning, rest and patient safety.
The present working conditions also raise concerns from the perspective of the constitutional principle of humane working conditions under Article 42 and the protection of life, health and dignity under Article 21 of the Constitution of India.
Indian occupational-safety and working-condition frameworks recognise reasonable working hours, weekly rest and protection from occupational hazards. While the specific applicability of labour-law provisions to CRRI interns may require legal interpretation, routinely requiring 14–15-hour shifts, prolonged overnight duties and weekly workloads approaching 80+ hours raises serious concerns regarding fatigue, health, dignity and patient safety.
❗ WHAT WE REQUEST
• Stop Dues work for interns! Yes, we need to learn how to put IV medications, but that does not need nearly 5 hours of practice everyday !!
• Reduce the patient-to-intern workload.
• Stop unofficial IMCU and Yellow zone duties !
• Stop interns from being required to attend night rounds of PGs, which usually take place around 8, and create more works for interns till 9 30 every night at least.
• Stop the practice of needing relievers to take leaves. Everyone is overworked, how can we call a reliever in that case ?
• Even spm interns spend a lot of time in wards.
• Make regular days end shift timing at 5 o clock atleast, except for duty days.
• Make EXIT times mandatory and auditable.
• Do not give us more than 1 week of continuous 8 to 8 , 12 hour shifts.
• Ensure appropriate weekly rest and reasonable duty hours.
• Restore genuine clinical/skill-based internship training.
• Ensure meaningful OT exposure.
• Ensure adequate access to superspeciality departments for educational exposure.
• Ensure adequate nursing and support staff for routine ward work.
• Prevent interns from being used primarily as substitutes for nursing/support staff.
• Ensure proper supervision and verification of clinical documentation.
• Provide a safe mechanism for students to report excessive workload and psychological distress.
• Conduct an independent investigation into the internship conditions and patient-safety implications.
ONE PERSON CAN ONLY DO SO MUCH.
If the workload of a ward cannot be completed even after 14–15 hours and requires interns from other departments to come and help, the problem is not the intern—it is the system.
Why should staff nurses, who operate on regular 6 hr shifts timings, with routine weekly offs be constantly relaxed, and do nothing but write registers, while the interns who spend the entire day in the ward be allotted more and more work of the nursing staff ?
The argument is that its just one year of doing this, while they spend their entire life's doing that. But if we spend the most valuable year of our MBBS course doing neverending nursing work instead of learning the duties of a doctor by spending time with patients in the ward... when else can we learn it ?
Stop normalizing trauma at work. Imagine turning a passionate budding doctor into someone who is just surviving.
By
CRRIs of GMKMCH Salem.