Endurance is Not Education: Rethinking Residency in India’s Medical System By Dr. Ankit Sharma

A recent headline reported that resident doctors in India are working up to 36 hours continuously, with hundreds leaving their seats and several deaths linked to stress. For many outside the system, this may seem alarming.

For those within, it feels routine.

This normalization of extreme working conditions in medical training raises an uncomfortable but necessary question:

Are we training competent doctors—or conditioning them to survive exhaustion?

The Myth of “Necessary Hardship”

Medicine has long embraced the idea that suffering builds competence. Long hours, sleepless nights, and relentless workloads are often framed as rites of passage.

But let us separate myth from reality.

Fatigue does not sharpen clinical judgment—it impairs it. Sleep deprivation does not enhance learning—it diminishes retention, attention, and decision-making. When a resident is expected to function after 30+ hours without rest, the system is not testing resilience; it is compromising safety—both for the doctor and the patient.

Endurance, in this context, is not education.

Residents: Students or Workforce?

At the core of the issue lies a structural contradiction.

Resident doctors are:

Students, expected to learn, study, and pass rigorous examinations

Employees, responsible for the functioning of hospitals

Primary caregivers, often forming the backbone of public healthcare delivery

Yet, they are fully protected by none of these roles.

They are paid stipends, not salaries. They are evaluated academically, but utilized operationally. They are expected to learn, but are often too overworked to do so effectively.

This hybrid identity has created a system where residents become indispensable yet undervalued.

The Hidden Curriculum of Toxicity

Beyond workload, there exists an unspoken culture—a “hidden curriculum.”

A belief persists across generations:

“We endured it, so must you.”

This manifests in subtle and overt ways:

Public humiliation under the guise of teaching

Hierarchical dominance replacing mentorship

Emotional suppression mistaken for professionalism

Such an environment does not produce confident clinicians. It produces burnout, fear, and disengagement.

The Cost We Rarely Measure

When residents suffer, the consequences extend beyond individual well-being.

Patient Care Suffers

Fatigued doctors are more prone to errors. Decision-making slows. Communication breaks down. In a system already stretched thin, this becomes a silent risk to patient safety.

Talent is Lost

Increasingly, residents are leaving seats, switching specialties, or avoiding high-burnout branches altogether. Each dropout represents not just personal distress, but a systemic failure to retain trained professionals.

Mental Health Crisis Deepens

The most tragic outcomes—self-harm and suicide—are not isolated incidents. They are the extreme end of a continuum of chronic stress, unaddressed anxiety, and institutional neglect.

Why Change Has Been Slow

Despite repeated discussions, committees, and guidelines, meaningful reform remains limited.

The reasons are clear:

Dependence on residents to sustain overburdened hospitals

Lack of enforceable duty-hour regulations

Economic convenience, as residents provide relatively low-cost labor

Cultural inertia, resistant to questioning long-standing norms

Policies exist. Implementation does not.

What Needs to Change

Reform does not require reinvention—it requires intention.

1. Define Reasonable Working Hours

A strict cap on continuous duty hours, with mandatory rest periods, is essential—not optional.

2. Recognize Residents as Dual Stakeholders

They must be treated as both learners and employees, with rights and protections appropriate to both roles.

3. Shift from Hierarchy to Mentorship

Teaching must evolve from authority-based to guidance-based. Respect should not be a privilege—it should be a standard.

4. Prioritize Mental Health

Confidential support systems, counseling access, and a culture that normalizes seeking help are critical.

5. Reduce Service Burden

Hiring adequate support staff and redistributing workload can allow residents to focus on what they are meant to do—learn medicine, not just deliver it.

The Role of Medical Educators

As educators, we stand at a crucial intersection.

We can choose to perpetuate the system as we inherited it—or reshape it for the future.

True teaching is not measured by how much a student can endure, but by how well they understand, apply, and grow. The goal of residency should not be survival—it should be transformation into a competent, confident, and compassionate clinician.

A Final Reflection

Medicine is built on the principle of care.

It is time we extend that principle inward.

If the system continues to demand that doctors sacrifice their well-being to sustain it, then the system itself requires treatment.

Because in the end, a healthcare system that exhausts its healers cannot truly heal.