Compulsory rotating medical internship: duration, postings and leave

What the internship is, legally

The Regulations came into force on publication in the Gazette, dated 18 November 2021. Three provisions set the frame:

• Internship is an integral part of undergraduate medical education (Regulation 3). The Graduate Medical Education Regulations, 2023 repeat this: a student is not deemed to have completed graduation until the rotating internship is done (GMER-23, Regulation 23).
• No permanent registration without it. No medical graduate is eligible for permanent registration to practise in India unless they complete the internship in India as the Regulations provide (Regulation 4). How permanent registration itself works is on the permanent registration page.
• Quality is a condition. An internship counts only if the essential practical areas in Schedules III and IV are completed, under the active supervision of a qualified mentor who certifies it (Regulation 6).

Duration and the two-year window

• At least twelve months, after passing the final MBBS examination (or NExT, once in force), “to the satisfaction of the college authorities and the University” (Schedule I, 1).
• Finished within two years of passing the final MBBS, the Foreign Medical Graduate Examination or NExT Step 1 (Schedule I, 2(a)).
• Extensions. The college or university can recommend extending the minimum period by a reasonable time — for insufficient attendance, or for disasters or other unforeseen circumstances notified by the Government of India or a competent authority (Schedule I, 2(b)).
• Curtailment or cancellation. The institution or university may curtail, suspend, withdraw or cancel the internship if the intern does not wish to continue, is found not to meet eligibility, or for proven indiscipline, professional misconduct or acts that violate the law (Schedule I, 2(c)).

Where it is done

• Indian graduates do the whole internship in the institution where they completed the MBBS (Schedule II, 1(c)). The Regulations make no provision for transfer.
• The college, its affiliated hospitals and community health centres must be recognised by the Commission for running the programme (Schedule II, 2(d)).
• Armed Forces Medical Services. One year of approved service in the AFMS after passing the final MBBS is treated as equivalent to this training, preferably at a base or general hospital, with community medicine training meeting NMC norms. The Regulations add that NExT Step 2 will be mandatory for these candidates too (Schedule II, 1(c)(i)).
• Colleges are directed to use district hospitals, taluka hospitals, community health centres and primary health centres as well as the teaching hospital. Where an intern is posted to a district or sub-divisional hospital, a committee of the college or university, the state government and the district administration regulates that training (Schedule IV, 4(v)).

Graduates of medical schools outside India follow separate rules — see internship for foreign medical graduates.

The postings

Schedule III sets the rotation. All postings are exclusive to that department except Physical Medicine and Rehabilitation, which may run alongside Orthopaedics.

Electives. The Schedule’s note allocates at least one week to a major broad specialty and the remaining three weeks to any broad specialty, or two weeks to a broad specialty and one week to an Indian system of medicine. The broad-specialty options listed are Respiratory Medicine with a DOTS-TB centre, Radio-diagnosis, Laboratory Medicine and Geriatric Medicine. The Indian-systems options are Ayurveda, Yoga, Unani, Siddha, Homeopathy and Sowa Rigpa. If a college has no AYUSH facility, it may sign a memorandum of understanding with a government institution in the same town, city or district.

Exposure during clinical postings is also mandatory to laboratory medicine and clinical biochemistry; histopathology and cytopathology; haematology and transfusion medicine; microbiology; hospital infection control, biomedical waste management and central sterile supply; medical record keeping; and hospital information services.

The Schedule also lists the procedural skills to be recorded in the log book, each marked as performed independently, done under supervision after demonstration, or observed.

Leave

Schedule I, 2(d) allows:

• Normal leave: at most fifteen days across the whole internship, with prior permission. The full fifteen days cannot be taken during a single one- or two-week posting.
• Medical leave: counted within the fifteen days. Anything beyond must be recommended by a duly constituted Medical Board.
• Maternity leave: according to the prevailing Central or State Government rules.
• Paternity leave: two weeks, together or as two separate weeks, within the internship year.

Leave beyond this extends the internship by the same number of days, and the extension is served only in the department or specialty where the time was lost (Schedule I, 2(d)E).

Supervision, assessment and completion

• Mentor. A mentor must hold a postgraduate qualification in the subject and be certified as a mentor for interns by the Professor and Head of the Department (Regulation 7; Schedule IV, 1).
• Supervision. Interns work under the direct supervision of a designated faculty member, who is responsible for ethical and legal issues arising from the intern’s work (Schedule IV, 4(i)).
• Assessment. Interns keep a log book certified by the medical officer they work under. Training is also assessed through objective situation tests of knowledge, skills and attitude during and at the end of training, predominantly of clinical and practical skills (Schedule IV, 2).
• Certification. The Head of the Unit and Head of the Department certify each posting; the Dean or Principal issues the cumulative certificate at the end (Schedule IV, 2(c)–(d)).

NExT and the internship

The Regulations are written for a system in which the National Exit Test replaces the final MBBS examination — NExT Step 1 before internship, and a licentiate test or NExT Step 2 before permanent registration “whenever duly notified” (Schedule IV, 2(e)). On 13 July 2023 the Commission published a public notice that NExT “is deferred on the advice of the Ministry … till further directions”. Until that changes, the final MBBS examination remains the qualifying examination for internship.