MBBS Internship in India

The students who are undergoing MBBS from any recognised medical college have to undergo medical internship in India. This internship is known as Compulsory Rotatory Residential Internship (CRRI). The medical internship guidelines set by the National Medical Commission (NMC) are to be followed by every MBBS student to complete their internship successfully.

The NEET MBBS internship is a crucial criterion for the completion of MBBS. Without 12 months of CRRI, the student would not be awarded the MBBS degree even if they have fulfilled other criteria. The main goal of CRRI in India is to successfully equip the medical graduates to fulfil their role as doctors’ first contact in the community. 

Compulsory Rotatory Residential Internship (CRRI)

The Compulsory Rotatory Residential Internship (CRRI) programme is a 12-month program in hospitals attached to the medical college of the students. The NEET MBBS internship is essential for the completion of the MBBS course. For BDS students, the CRRI is provided by the Dental Council of India.

The medical students undergoing CRRI are provided with a monthly stipend during the entire duration of the internship. The amount varies from one college to another. The medical council has announced that a fixed stipend, as approved by the institution/university/state, would be provided to the medical graduates during CRRI. A provisional certificate is provided at the end of the MBBS course through which the medical students can apply for a medical internship in India. After the successful completion of CRRI, the medical students are awarded a medico-legal permanent registration certificate. The medical graduates are issued the license to practise in terms of the permanent registration certificate along with the final MBBS degree.

The CRRI is an important phase as the students are provided with various responsibilities to groom them for the medical environment. After completing the NEET MBBS internship in a recognised hospital, the medical candidates can pursue higher education like MD, DM, MS, MCh, DNB, Diplomas or fellowships approved by the National Board of Examination (NBE) or Medical Council of India (MCI). They can even start practising at any hospital.

In CRRI, the medical graduates would be given ample opportunity to learn all the required skills and become confident primary care physicians. Emphasis would be given to hands-on training by applying the scientific and theoretical knowledge given to the graduates during their MBBS course. They would be under the supervision of experienced physicians in each department. The internship should focus on utilising the available clinical facilities in district hospitals, Taluka hospitals, primary health centres, teaching hospitals and health care centres. On completion of their training, a certificate of successful completion countersigned by the Dean/principal of the college is provided to the medical graduates by the relevant administration.

Importance of CRRI

This NMC MBBS internship is indispensable as it equips the medical students with the skills and competencies required to perform in a medical environment. The internship has to be completed within two years of completion of the MBBS degree.

During the internship phase, the medical students are posted in different departments to have a detailed understanding of those departments and gather clinical experience before joining duty. Once the medical students complete their CRRI, they are issued a permanent registration certificate to practise in India. CRRI is a vital eligibility criterion for post-graduation and further studies.

Without successful completion of a medical internship in India, it is not possible to practise or pursue higher studies. The board has mandated this internship to ensure the overall development of medical graduates before they enter the medical environment. The medical graduates should understand the ecosystem and be comfortable with it before being given the actual charge for the same. Without a proper internship, the medical graduates would be putting their job and the lives of the patients at risk.

The entire MBBS internship duration stresses training the medical graduate to work under supervision in a medical ecosystem. This phase teaches many practical skills to the medical graduates and provides them invaluable experience to help them in their professional careers. All the learning methodologies, along with multiple practise sessions, are imparted to the medical graduates during the MBBS course to provide a better understanding of the subjects.

Objectives of Compulsory Rotatory Residential Internship (CRRI)

The NEET MBBS internship has been designed in such a manner that it meets the objective of turning a medical graduate into a complete doctor. Following are certain objectives due to which the CRRI has been incorporated with the MBBS degree –

1. The medical graduate should function as a clinician who understands the entire ecosystem of the healthcare structure and acts accordingly. 
2. The medical graduate should be able to lead and be an active member of the team as well as the healthcare system.
3. The medical graduate should be a peoples’ person and should be able to communicate effectively with the patients, their families, colleagues and the community.
4. The medical graduate should be comfortable in diagnostic and therapeutic skills in different disciplines of medicine. 
5. The medical graduate should be committed to the journey of improvement of skills and knowledge. 
6. The medical graduate should be committed to excellence and be ethical, responsive and accountable towards the patients, their families, colleagues and the community.

CRRI Guidelines and Eligibility

The medical students need to fulfil the following eligibility criteria before applying for CRRI. 

1. The medical students should have completed the MBBS degree from a college/institution recognised by the National Board of Examination.
2. The medical students have to score the qualifying marks in the Nation Exit Test (NExT) as per the guidelines set by the NBE.
3. The foreign medical students would be regulated under the Foreign Medical Graduate Regulations 2021.

The medical students pursuing CRRI have to follow the below-mentioned guidelines set by NBE to complete their internship.

1. The intern cannot issue any medical certificate.
2. The intern cannot perform any medico-legal procedures, like an autopsy, in the absence of spervision.
3. The intern cannot perform any surgery or interventional procedures in absence of supervision.
4. The intern cannot hold any teaching position in any medical college.
5. The intern cannot be involved in any medical practice outside of CRRI.
6. The intern should strictly follow the guidelines laid down by the college/institution.
7. The intern is allowed a maximum of 15 days leave with prior permission. 

Timeline for Medical Internship in India

The MBBS internship duration is 12 months after completion of  MBBS from a college recognised by the National Board of Examination. While this duration can’t be decreased under any circumstances and is compulsory, it can be increased under certain circumstances. The completion of CRRI can be extended due to the following reasons –

1. Insufficient attendance.
2. Failing to qualify for the assessment.
3. Failing to gain the required competence.
4. A natural disaster or any unforeseen circumstances as notified by the Government of India. 

The MBBS internship Duration can be temporarily suspended/ curtailed/withdrawn/ cancelled at any time by the institution under certain circumstances. Let us look at those circumstances –

1. The medical graduate does not complete the CRRI within the stipulated time.
2. The medical graduate does not fulfil the eligibility criteria. 
3. The medical graduate is found responsible for acts of indiscipline, professional misdemeanour or misconduct.
4. The medical graduate has violated the laws of the land.

The medical students undergoing CRRI have to fulfil the time distribution at all the departments mentioned by NMC. The medical graduate would maintain a logbook which would be checked and verified by the medical officer. Let us look at the time distribution of the NMC MBBS internship. 

Department	Time Duration	Remarks
Community Medicine	2 months	Posting should be in community/rural health centre
General Medicine	1.5 months	Posting in Out/In-patient wards & Admission Day Emergency and exposure to HDU and ICU
Psychiatry	1 month	Posting in out-patient wards.
Pediatrics	1 month	Posting in Out/In-patient wards & Admission Day Emergency and exposure to HDU/ICU/NICU/PICU
General Surgery	1.5 months	Posting in Out/In-patient wards & Admission Day Emergency and exposure to HDU/ICU/NICU/PICU
Anaesthesiology & Critical Care	2 weeks	Posting in the operation theatre, ICU, pain clinics and palliative care.
Obstetrics & Gynaecology, including family & welfare planning	1.5 months	Posting in Out/In-patient wards & Admission Day Emergency, labour rooms, OT and exposure to HDU/ICU/NICU/PICU
Emergency/Trauma/Casualty	2 weeks	Posting in resuscitation areas, triage, In-patient wards, OT  as well as medico-legal procedures.
Forensic Medicine & Toxicology1	1 week	Posting in autopsy centres
Dermatology, Venereology & Leprology	1 week	Posting in out-patient ward
Orthopaedics that includes physical medicine and rehabilitation  (PM&R)	2 weeks	Posting in In/Out patient wards, admission day emergency, plaster room and OT.  For PM&R posting may run concurrently in mornings/afternoons equal to 4 half days
Otorhinolaryngology	2 weeks	Postings in the out-patient ward. Postings in the forenoon with postings in Laboratory Sciences and Hospital support services in the afternoon
Ophthalmology	2 weeks	Postings in the out-patient ward. Postings in forenoon with postings in Laboratory Sciences and hospital support services in the afternoon.
Laboratory Sciences and Hospital support services	2 weeks	Lab medicine and chemical biochemistry, Histopathology & Cytopathology and Haematology and transfusion of medicine and blood bank.  Postings in forenoon with postings in Laboratory Sciences and Hospital support services in the afternoon.
Laboratory Sciences and Hospital support services	2 weks	Microbiology, hospital infection control, biomedical waste management, central sterile supply units. medical record-keeping and hospital information services. Postings in forenoon with postings in Laboratory Sciences and hospital support services in the afternoon.

The detailed medical internship guidelines can be found on the official website of the National Medicine Commission. The students can download the detailed guidelines for CRRI 2021 by clicking on this link. There are certain compulsory and elective departments which the medical graduates have to choose as per the requirements. They should discuss it with their supervisor and choose the electives accordingly. They should divide their time properly so they can complete the internship in time. The medical graduates should regularly get their logbooks verified by their supervisors.

External MBBS internship in India

The medical graduates can pursue their NEET MBBS internship at a different hospital instead of the college where they have pursued their MBBS. The medical graduates need to ensure if that hospital is recognised under the MCI. If the hospital is eligible, the medical graduates can inform their college and go ahead with their CRRI. But if the hospital is not recognised under MCI, the internship would not be recognised and they would have to undergo the internship again under an MCI-recognised hospital. Medical graduates can check the list of housemanship hospitals from the official website of the National Medical Commission. 

The medical graduates usually opt to complete their CRRI from the college they have pursued their MBBS. But they are also provided with the option to complete the CRRI from other MCI recognised hospitals in India. The MBBS internship duration remains the same for the external internship.

Conclusion

The MBBS Internship in India in India is compulsory after the completion of the MBBS degree. The Compulsory Rotatory Residential Internship is for 12 months during which the medical graduates have to spend time in each department and learn the necessary skills. The internship is verified and certified by a medical officer. Medical graduates have to fulfil the eligibility criteria to be eligible for the NMC MBBS internship. Medical graduates can complete their internship from external hospitals that are recognised by the Medical Council of India.

The similarity with the content is only due to the technical terms used.