Diary of an endocrine resident: Recollections from Post Graduate Institute of Medical Education and Research, Chandigarh.

Endocrinology is a relatively newer field in medicine but it has gained tremendous progress in the recent past and is currently one of the most cherished and sought after superspecialty subject. The journey is long and an average of 12 years is spent to complete a superspecialty training starting from Bachelor of Medicine, Bachelor of Surgery career. To get a seat in endocrinology in institutes like PGIMER, Chandigarh is difficult, the training is grueling and the final exit is tough but the vast clinical experience, research oriented teaching and the team work of the closely knit family of faculty members and resident colleagues had made these 3 years of our life as the most enjoyable years to be remembered forever.

INTRODUCTION

With the ever expanding field of medicine, focusing on a particular superspecialty subject and giving the best quality of care to the patient is the need of the hour! Endocrinology is a relatively newer field of Medicine but it has gained tremendous progress in the recent past and is one of the most cherished and sought after superspecialty subject. Currently nine new colleges are offering Doctorate of Medicine (DM) in endocrinology apart from the established departments at various premier institutes of India.[1] However, the journey to superspecialty is not easy and one has to spend a minimum of 11.5 years for completing the course starting from Bachelor of Medicine, Bachelor of Surgery (MBBS) career.[2]

Bachelor of Medicine, Bachelor of Surgery curriculum and endocrinology

Though we (authors) had completed our MBBS training from three different medical colleges of India, we had one thing that was common and that was a strong inclination towards internal medicine. We were fortunate enough to get seats in internal medicine after completion of MBBS. However, during our MBBS carrier, we were hardly ever exposed to a subject called endocrinology except for few theory and clinical classes of diabetes.

Postgraduation course in internal medicine and preparation for Doctorate of Medicine Endocrinology

The postgraduation course in medicine was interesting but after the end of 2nd year I could realize the importance of doing superspecialty. Fortunately, the area of interest of my guide was diabetes and I got a thesis on that subject. Our postgraduate course in internal medicine was more oriented toward neurology, cardiology, and pulmonary medicine and hardly ever we discuss topics in endocrinology either in theory or in practical. The Department of Endocrinology in our state medical college used to run only two OPDs in a week and there was no posting of MD students in the department. However since I had a thesis in diabetes I had to visit endocrinology OPD with due permission from my unit head and guide. By the end of the 3rd year of MD career I had already made up my mind to go for superspecialisation in Endocrinology and I had already bought the William's Textbook of Endocrinology. After passing the MD examination my only aim was to get DM endocrinology in a good institute.

Doctorate of Medicine entrance examination and getting through endocrinology at PGIMER, Chandigarh

In 2006, there were six institutes offering DM and three institutes offering DNB in endocrinology. Hardly 70–80 candidates would compete for DM seats for these colleges. The exam pattern was slightly different for each institute. As in AIIMS, SGPGI, and BHU the theory examination consisted of multiple choice questions (MCQ) from topics related to endocrinology only. Whereas, in PGIMER, Chandigarh one had to appear two MCQ sets: One from medicine and one paper from Endocrinology. Institutes such as AIIMS, SGPGI and PGIMER, had a practical examination after being shortlisted in theory paper. The question banks vary widely and there were hardly any MCQ guides for DM preparation. But for Endocrinology DM seat one had to be very thorough in endocrinology part of Harrison's textbook of Internal Medicine and few chapters of William's Textbook of Endocrinology. The DM entrance examinations used to happen twice a year, but the seats are quite limited.

A lot of our colleagues and we (the coauthors) met for the first time while waiting for the interview at Lucknow after being shortlisted in the theory examination. Little did we know that all of us waiting there would end up as good friends and endocrinogists passed out of different institutes.

The examination and interview in PGI Chandigarh was held in December, where we could barely move our fingers due to the unaccustomed winter! We were quizzed about many clinical cases and scene was tense. However finally, the results put up on Kairon block made us all jump with happiness. Our happiness turned into curiosity as we approached the department for ourfirst few days. We were posted with our seniors in different wards.

Clinical work

PGI Endocrinology Department had different postings: Male ward, female ward and on call duties. Each posting was a different experience clinically. We used to have 2 days of Endocrinology OPD and 1-day of medicine OPD. On OPD days, 1st year residents have to evaluate each and every new patient, prepare their case records meticulously and present before the consultants. Follow-up patients are seen by the 2nd year or 3rd year residents, and interesting cases were presented and discussed at the end of the OPDs.

In our wards, we have endocrinology patients and few (10%) medicine patients. This had helped us not only to learn endocrinology but also sharpened our medicine acumen. Ward rounds and discussions are scheduled every day with a grand round on each Friday, where all the interesting endocrine cases were being presented before the faculty with thorough clinical discussions.

We had a posting in our laboratory for 1-month. During our time, there was a transition from radio immune assay techniques to immunochemiluminiscence (ICMA). Though we had a good exposure in specimen sampling, processing and use of ICMA during our thesis, we still lack the expertise in genetics and clamp techniques which have been recently started in the department.

Academics and thesis

The academic training was comprehensive and intense. Twice weekly seminars, twice weekly journal clubs, grand rounds, post-OPD discussions meant that our minds never ceased to learn. We had grand rounds with departments such as pathology, radiology, and nuclear medicine. Learning and research were in the air. Each day spent in the hospital was packed with case discussions and academics. Patient care was of paramount importance and any negligence by resident was taken seriously, and they were properly guided. The divisions among faculty as specialists in different aspects of endocrinology helped us a lot.

The insistence for publications, talks, and presentation was enormous. We found that aspect difficult, but each one of us came out of PGI with an average of 15 publications and enormous confidence for delivering scientific orations, which we feel is very important for our personal stature as consultants. We thank our faculty in retrospect for this aspect!

Thesis work was given a great importance in the department and each one had to pass through a tough time, starting from protocol submission to doing the actual fieldwork with sample processing and preservation to final drafting of the thesis manuscript.

The department was organizing various national conferences, and we were fortunate to be associated with organizing Indian thyroid society conference and Indian Society of Bone and Mineral Research conference in our institute. Few of us got the opportunity to present our papers in international conferences. Myself and two of my colleagues had also won the “ESI-Torrent Young Scholars Award – 2007,” a unique platform for young endocrinologist of India supported by Endocrine Society of India.[3]

Close knit family

We had five faculty members, four of them in the clinical side and one faculty in the Endocrinology Laboratory Prof. Anil Bhansali, we were told was a tough professor. So we thought! In the 2nd month of residency, I (co-author) decided to speak only the truth. I wanted to leave because I got 2 days complimentary vacation with the television I had bought. The ice broke when Professor Bhansali replied, surprise on my face and his. “Which TV is this? Why didn't I get it? Lucky fellow! Enjoy!”

Truth and sincerity played a very integral role thereafter. The team of 5 faculty, 8 senior residents, and all the other staff were one extremely close family. We were together during times of celebration and remorse. We used to have frequent gatherings along with faculties and their family at least once in every 3 months apart from Holi and Diwali celebrations at Prof Bhansali's house. Each and everyone's birthday was being celebrated. That has actually made our bond so strong even years after leaving the institution!

Final examination

To enter into the curriculum was tough, our exit examination was grueling to say the least, but our clinical experience in PGI helped us overcome all hurdles. The final examination had four theory papers and 2 days of practical examination. Examination in PGI was being conducted at the end of 2½ years. So after passing the final examination, the next 6 month was spent mostly on research and publications apart from clinical duties.

CONCLUSION

It was a sad moment for us to leave the department at the end of 3 years. However, the clinical experience, research oriented teaching and the highly talented and yet friendly faculty members had made the 3 years as the most glorious years of our life to be cherished forever. Proud to be PGI Endocrinology alumni!

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest