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Year : 2018  |  Volume : 13  |  Issue : 2  |  Page : 80-81

Rheumatology training in India: Pragmatism needed

Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication24-May-2018

Correspondence Address:
Dr. Durga Prasanna Misra
Department of Clinical Immunology, C-Block, 2nd Floor, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareily Road, Lucknow - 226 014, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injr.injr_16_18

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How to cite this article:
Misra DP, Agarwal V. Rheumatology training in India: Pragmatism needed. Indian J Rheumatol 2018;13:80-1

How to cite this URL:
Misra DP, Agarwal V. Rheumatology training in India: Pragmatism needed. Indian J Rheumatol [serial online] 2018 [cited 2022 Aug 12];13:80-1. Available from:

Over the 70 years of independent India, medical education has evolved from undergraduate courses, which have origins similar to those in the United Kingdom (UK),[1] to postgraduate specialty training and further subspecialty training under the umbrella of broader medical and surgical specialties, formalized via Doctorate of Medicine (DM) and Diplomate of the National Board (DNB) degrees. Clinical Immunology and Rheumatology is one of the latter specialties to develop DM and DNB courses, with formalized training programs culminating in a degree becoming available only in the late 1980s.[2] In the past 10 years, formal training opportunities in this subspecialty have expanded significantly;[2] however, much remains to be done yet to achieve the numbers of professionals required to cater to patients with rheumatic diseases all over the country.[3] In this context, the recent study by Das et al.[4] comparing training in Rheumatology in India and the UK is relevant. This study highlights the important differences in subspecialty training in India and the UK, wherein trainees in the UK are exposed to formal courses in communication, management skills, and leadership, have greater exposure to musculoskeletal ultrasound, and combined clinics with other specialties such as Nephrology and Pulmonology. Whereas Indian subspecialty training posts are generally restricted to that particular subject, a significant proportion of the UK subspecialty training entails general internal medicine intake as well. Indian trainees have full-time training and research as a compulsory part of a 3-year training program with the requirement to submit a dissertation or publish papers before being eligible for the exit examination, something not uniformly mandatory for the UK trainees. The patterns of exit examinations for such training courses also differ, with explanatory answers with long and short cases and viva voce for Indian trainees and multiple choice questions and continuous workplace assessment for the UK trainees.

As alluded to previously, few formal training opportunities in Clinical Immunology and Rheumatology present themselves in the Indian scenario,[2] with the requirement to pass increasingly competitive entrance examinations to qualify for the same.[4] Therefore, there exists a definite scope for prospective trainees to train abroad and return back to provide much-needed Rheumatology services in India. It has been previously noted that there is a scarcity of medical teachers in India.[5] The existing regulations unfortunately do not permit such individuals trained abroad to be recruited and recognized as medical teachers.[6] There is a potential to tap into the pool of such individuals trained abroad, a proportion of whom are likely to be highly motivated to pursue teaching careers in the subspecialty, and this should be noted by policymakers in medical education. Since good Rheumatology and Clinical Immunology practice requires exhaustive knowledge and application of common principles of general medicine, the UK model of having additional general medicine intake included in subspecialty training merits consideration in the Indian context.[4] Another point not highlighted in the paper was that existing Rheumatology and Clinical Immunology services in India are mostly run by the doctors alone, often without or with minimal support of other trained health-care professionals such as physiotherapists or specialist nurses. There is a scope to improve Indian Rheumatology and Clinical Immunology training and services in India on these lines also.

The need to develop an adequate number of rheumatologists to cater to the needs of the ever-increasing Indian population merits innovative solutions. In continuation with the aforementioned point that Rheumatology and Clinical Immunology is, in essence, “intellectual” general medicine, the reservoir of faculty in general medicine in medical colleges all over the country should be tapped into. Such interested faculty should be invited to existing training centers in Rheumatology and Clinical Immunology for short-term (3 months–1 year) training, which should enable them to open their independent subspecialty clinics to provide day-to-day services for rheumatic diseases. There should exist a provision for such clinicians to refer more complex patients to existing tertiary care centers, with an existing two-way communication wherein such patients are managed and then sent back to the referring clinicans, enabling them to gain knowledge and experience in managing such difficult cases over a period of time. Another potential solution could be to separate out compulsory research in existing subspecialty training programs, with establishment of a separate training stream in Clinical Immunology and Rheumatology with a purely clinical training of a shorter duration. Either of these training solutions could be certified at a national level by means of a common exit examination assessing competency of basic clinical knowledge in the subject to offer validity to such trained individuals.

To conclude, Clinical Immunology and Rheumatology training in India requires evolution and innovative strategies to meet the existing and ever-increasing needs of the populations. All stakeholders should unite to drive forth this subspecialty in India further with adequate consideration of the long-term consequences of present-day decisions in this regard.

  References Top

Anshu, Supe A. Evolution of medical education in India: The impact of colonialism. J Postgrad Med 2016;62:255-9.  Back to cited text no. 1
Misra DP, Agarwal V, Negi VS. Rheumatology in India: A Bird's eye view on organization, epidemiology, training programs and publications. J Korean Med Sci 2016;31:1013-9.  Back to cited text no. 2
Al Maini M, Adelowo F, Al Saleh J, Al Weshahi Y, Burmester GR, Cutolo M, et al. The global challenges and opportunities in the practice of rheumatology: White paper by the world forum on rheumatic and musculoskeletal diseases. Clin Rheumatol 2015;34:819-29.  Back to cited text no. 3
Das P, Moorthy A, Dharmanand B. Rheumatology training in India compared to the United Kingdom. Indian J Rheumatol 2018;13:113-6.  Back to cited text no. 4
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Mudur G. Faculty shortages may thwart India's plans for more AIIMS-like institutions in every state. BMJ 2014;349:g4822.  Back to cited text no. 5
Ravindran V. Shortage of teaching faculty in rheumatology – Pragmatism necessary. Indian J Rheumatol 2014;9:159-60.  Back to cited text no. 6
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