INI-SS Apr'26 Nephrology AML 1, CML 6, Dr Prem says, "Most questions begin with a patient..."

Añadido: 2026-06-03

[00:00:00]So, welcome to yet another topper interview session, the second of 2026 INIC INISS May exam that we're doing.

[00:00:07]And this time around, very proud to interact with Dr. Tilak, who is basically a Malayali Tamil guy, but has done all his schooling and MBBS from Ahmedabad, Gujarat, and thereafter his MD medicine from the prestigious AIMS, New Delhi. So, this is a pretty special moment as well because when he got the rank, I was not aware, but when I just got his number, I I kind of found out that we are in touch for a long time.

[00:00:32]So, about 4-5 years of his messages that he has sent to me way back in 2021-22 are there on my phone. So, there he has mentioned about the fact that he started off with Harrison's, but then he was not able to continue reading Harrison, then he watched the videos, then he watched almost all the videos of edition five, then he did the Q banks. It's a long story. His messages are all very, very long. So, I think I have read them at some point and I forgot. So, I'm very happy that such a guy who's been with Marrow and has been with our pattern of learning for a long time now, almost five years now, has entered into nephrology. That's a very special, happy thing for me. And more than that, I think his conviction, I mean, that's that's very clear from his messages itself. It's very clear. So, anyway, happy interacting with you and congratulations at the outset, Tilak.

[00:01:15]So, very, very happy to interact with you.

[00:01:18]>> Thank you, sir.

[00:01:20]>> So, my first question to you is not a cliche kind of question, but still I want to know because we are in an era where people are always looking out for work-life balance. It is now pivotal to work-life balance is the key word now.

[00:01:33]And nephrology is one subject that has zero work-life balance. So, that's one of the reasons why people are not so fond of nephrology these days because we get to they get to understand during their PGs, especially in good colleges like AIMS, that nephrology is like tilting more towards work, work, work and less towards life, life, life. So, in spite of knowing that, I think you'll be aware of that. I'm not the first person telling you. In spite of knowing that, when did you know that I have to pursue nephrology only in nephrology itself and why?

[00:01:59]>> Sir, it's interesting because when I first joined my MD program in Ames, Delhi, I was I actually decided I was going to do a DM in endocrinology because if you remember in during your marrow PG exams you often say that endocrinology is an out of the box specialty where you have to There is less tension and it offers a much better balance than something like nephrology.

[00:02:21]>> Yeah.

[00:02:22]>> But during initially when I was working there as a resident like all residencies in India, I was really overworked.

[00:02:28]So initially you want something that gives you a much better work-life balance, but as I worked I realized that I wanted something that kept me working and kept me busy all the day.

[00:02:37]>> Okay. Okay.

[00:02:39]>> So counter intuitively that was the work-life the excessive work that is in nephrology actually made it attractive for me.

[00:02:46]So I thought that when I was too free I was not able to get through my day.

[00:02:53]So and another thing one thing that I really like about nephrology that you compared nephrology to scoring a set piece goal.

[00:03:02]Why you have said endocrinology is often like scoring a goal from open play.

[00:03:06]So I really like nephrology is it's simple but it's also intricate at the same time.

[00:03:13]And nephrology was also the first super specialty I was posted in during my rotational postings in medicine.

[00:03:19]So yeah, so that was another factor that prompted me to really like nephrology.

[00:03:23]So yes, that was >> Yeah. Yeah. I always I always say that because it's scoring in nephrology is like scoring from a set piece, but scoring from a set piece is not easy.

[00:03:33]You can see so many people who play football really well, but when it comes to free kicks there are only few people who do well with free kicks. So it's not like an on-field game. You will actually get everything correct if you put the puzzle in place, but then to put the puzzle in place I mean it takes a lot of effort, takes a lot of hard work and all those things. And I'm very glad that you understood the fact that working keeps you happy. Now this is something which many people are not able to decipher because when they work they feel okay, they're happy for the time being. When they go back home they feel he they're overworked and that's kind of putting them under stress. But if you really do understand yourself, like in your case, that work keeps me happy, then I think there is no better subject than nephrology. Nephrology is work and work with a difference and work also to make a difference in somebody else's life as well. So, I think that's a very very good choice. And again, on the same same note, what is it in nephrology that has actually interested you the most?

[00:04:22]Because because nephrology is a subject that is not one domain. It has so many different domains. It's almost like doing a DM in four, five subjects.

[00:04:28]Because dialysis has nothing to do with transplant, has nothing to do with general nephrology, has got nothing to do with glomerular diseases, has nothing to do with interventions. So, there are wide arena specialties inside nephrology. So, what has interested you the most?

[00:04:41]>> I think my exposure to dialysis and transplant has been a little limited because at Vanderbilt we don't get exposure. But based on what I have seen, I think glomerular diseases fascinate me more than because a lot of systemic diseases actually involve the glomerulus more than dialysis and transplant seems to be more of core nephrology. And like I've talked with a lot of my colleagues who are confused about what specialty to take.

[00:05:03]So, a lot of them feel they love medicine and they want to take something that is intricately associated with medicine. Yeah. So, that is why they're not considering something like say dermatology or internal medicine.

[00:05:14]>> Correct.

[00:05:14]>> So, that is why nephrology is also quite closely linked to medicine through glomerular diseases. Yeah.

[00:05:20]>> So, that is why like >> medicine only through AKI and glomerular diseases. Rest of nephrology is completely different. So, if you look at nephrology and its connection to medicine, we are all very wrongly told during MD times that nephrology is very close to medicine. Only very small part of nephrology is very close to medicine.

[00:05:35]That is AKI part, renovascular hypertension, tubular interstitial diseases, and of course the glomerular part. They've all got some medicine inside it. But the rest of nephrology is a completely different domain. It's basically got nothing to do with medicine. And what you said this perfectly spot on because nephrology as a specialty now gives you diverse domains to explore. Because once you are into See, suppose I get taken DM in endocrine and then try to teach medicine, I don't think it would be possible. Because I can teach only endocrine and maybe a few other things.

[00:06:04]I can never teach cardiology or neurology after studying endocrine. But you can study nephrology and actually teach anything and everything because nephrology having this big domain of transplant, a big domain CKD. These people will have hundreds of complications which are related to cardiology, neurology, and all the specialties. So, if you want to remain in touch with the other specialties, especially endo, gastro, rheumat, and all that so closely connected, I think the best specialty is always nephrology because you'll be in touch with the other specialties. That's the nature That's the nature of the subject per se.

[00:06:35]So, that is the advantage. Now, yesterday when I interviewed the rheumatology first rank holder, Divakar, he was of the opinion that clear INI SS exam, whatever we subject, you need to actually read the textbook. So, he feels that okay, videos are there, they are aiding, everything is there, notes are there, but INI SS exams are centric on that core textbook like Kelly's in rheumat. So, have you got that same belief? Have you focused on reading textbook or you feel I basically don't feel it is necessary. If you have the right materials, you won't actually have to read textbooks and waste time. What is your opinion on that?

[00:07:09]>> I can't speak for other specialties.

[00:07:10]Like there are a couple of my batchmates who have preferred for gastroenterology and they have actually not read Slezinger in any way.

[00:07:17]>> Correct.

[00:07:17]>> For nephrology, I think Fihaly is essential because there were a quite a few questions from INI SS that were like straight lines from Fihaly.

[00:07:24]>> Yeah, yeah.

[00:07:25]>> Interestingly, they have taken them from chapters that were not considered to be quite important. Like we are taught that glomerular diseases, CKD, ADPKD are important chapters.

[00:07:33]>> Yeah.

[00:07:34]>> But they've taken questions from chapters such as the effect of drugs on drug toxicity on the kidney, effect of aging on kidney, and they've taken straight lines from the fact even in government they have taken lines from the text.

[00:07:47]>> Yeah.

[00:07:48]>> So it's just reading the tables that it suffices. So I think Fuhrman continues to be one of if not the backbone.

[00:07:53]>> Reading Fuhrman cannot be compared to reading Kelly or reading Slezinger because Kelly and Slezinger are like Bible books. Fuhrman is a manageable book. It's a it's a user-friendly kind of a book. It's not a book which will kind of frighten you with the content. I you can read Fuhrman as many number of times you want. And I basically feel videos are also centered on Fuhrman. So they are basically centered on Fuhrman only. They've all been actually kind of molded in a way that is actually taken from Fuhrman. So when you decided that you want to prepare for nephrology, how was your modus operandi? How did you start? What what all you studied and what was your plan?

[00:08:26]>> Uh I had actually started liking nephrology back in my first year. So I already read Fuhrman quite I already read glomerular disease and chronic kidney disease. But what I was really not familiar with was dialysis and transplant. So that was where we started out using the marrow notes and the question bank. I used to read the notes on dialysis and transplant first because the immunologic aspect as you mentioned repetitively in your review is something that we are not very familiar with because it is score that is not core nephrology. So we have to read that multiple times to get familiar with it. So I just had I read dialysis and transplant in detail in my final final year. And I had to read congenital cystic diseases just ADPKD once.

[00:09:06]>> Yeah.

[00:09:07]>> But apart from that glomerular diseases I We have uh regular discussions about how we manage glomerular diseases in our day-to-day work practice. Yeah. I was quite well versed with KDIGO guidelines. So I just had to brush up on the notes for glomerular diseases.

[00:09:22]>> Okay. So as a person who was already done your MD from a central institute, were you clear with the fact that DM also you wanted to do from INI itself or you were open to doing from state centers as well?

[00:09:35]>> I think I pretty much made up my mind that I had to do it from either aims or PGI.

[00:09:40]>> Okay, so very clear.

[00:09:42]>> Yes.

[00:09:43]>> Uh so the fact is that once you decided that you are having to go for INI because only students who are empty from state centers who want to actually make it to INI in for DM. So for them what will be your tips for somebody who's doing empty from an average center but very keen and very motivated to do DM from a central institute. Uh what should their plan be as per your thing from nephrology point of view and also >> Sir, I don't think that plays a role because most of the senior residents in my nephrology department are actually from state colleges.

[00:10:12]So I think that is something that is out of reach of people who are doing from state colleges. I think uh it is I don't think the preparation differs much whether you're doing from a state college or in fact I would say the state colleges see much more flux of patients. So clinical exposure that they have is probably greater than that of a central institute PGI.

[00:10:33]Because the one of the drawbacks of being in a central institute is that the presence of multiple super specialty departments narrows down your exposure that you get to multiple super specialties. So in state medical colleges where there are not a lot of super specialties you might actually be more well versed with respect clinical management of a patient. What is that I think theory aspect can be prepared wherever you irrespective of >> Because you were saying that you you have had rounds where there were there was like continuous discussion on glomerular diseases. I am doubtful about the fact that there would be like very few colleges who do that way where during ward rounds you have discussion on glomerular diseases. So that itself means that your ward rounds are of a higher quality. So that is what I am I was actually asking.

[00:11:14]>> I think uh So one thing central institutes do promote is academic sound discussion both morning as well as evening rounds.

[00:11:21]Yeah. So most of the discussion that takes place is evidence-based or guideline-based.

[00:11:26]And we have regular classes as well. So that is one thing that state colleges might not have access to and they might have to read a little extra to bridge that gap.

[00:11:34]>> When you are into your MD course, do you feel like the owners has to be more on learning and accumulating knowledge or in the beginning itself having a set plan that I have to actually pursue cardiology, neurology, something and I have to actually prepare in that direction.

[00:11:50]>> I think there are two types of people that I've seen in my JR ship. There are people who enter JR ship with the goal that they are using JR ship only as a bridge to SR ship.

[00:11:58]>> Correct.

[00:11:59]>> I think will have a super specialty in mind when they enter JR ship and those people focus on that particular specialty. I was not like that. I had an open mental about my fifth semester. So, but I think the volume of information that we have is too large that it actually many of my juniors keep asking me how does one read medicine?

[00:12:20]>> Yeah.

[00:12:20]>> So, funny part is I actually don't have an actual accurate answer to tell them. But there's so much information that how does one fit that into a schedule like in most >> My point is we don't have to read. The more you read that means the more lacunas are there in your preparatory strategies or the place you work because the more you see I think the less you read. You read only guidelines. You are very much welcome to read KDIGO guidelines, but you want to read membranous nephropathy to understand means there is a problem.

[00:12:48]Perspective on membranous nephropathy should be purely yours. Management is purely yours. You can always read KDIGO.

[00:12:54]There is nothing no harm in that. But if you have to understand by reading then I I don't think that's the right way. So, if you start reading there is no end to it. Absolutely there is no end to it.

[00:13:03]So, that is how the whole thing is.

[00:13:05]And just tell us about the plan or sorry, program at AIIMS Delhi that we are talking of. You have two rounds per day and you have daily academic sessions. So, who presents and who chairs and how is the pattern of learning basically for a second year and final year MBBS?

[00:13:21]>> So, we have academic sessions that last for about four months. Four months in a cycle like we have semesters, so in each semester the first month is usually not academic. We don't have academic sessions in the first month. So, academic sessions academic classes begin in around the second month and we have six classes a week.

[00:13:40]>> Okay. So, seminars, we have journal clubs, we have dedicated infectious disease journal club because the department of medicine ID work together.

[00:13:49]>> Okay.

[00:13:51]>> Academics, there is a junior resident, like there's a person who's practicing in practicing only. There are two junior residents. One is one of them is supposed to actually prepare the seminar and one of them is supposed to supervise the seminar.

[00:14:04]And we have a consultant in charge who's supposed to oversee. And once the presentation is done, we invite questions from the audience. And in case of the journal, there is an active discussion about the strengths and limitations of the trial and whether the trial is applicable to our daily life practice.

[00:14:19]>> Oh, very good. So, that's like really strong academics, very strong academics.

[00:14:23]And on top of that, you have rounds morning as well as evening.

[00:14:26]>> We have consultant rounds in the morning and we have senior resident rounds in the evening.

[00:14:29]>> Okay. So, you you work as unit, so how many units are there?

[00:14:34]>> We have three units.

[00:14:36]>> Three units. And how many SRs?

[00:14:38]>> Around five three to four SRs in each unit.

[00:14:42]>> Each unit. Okay, so they are they have not done essentially from AIIMS. They studied in different other places and come to AIIMS to do SRship.

[00:14:48]>> There is a mix of people who have done both their and we have infectious disease SRs who are pursuing their DM degree. So, they all >> Okay.

[00:14:57]Okay. So, the the camaraderie is actually very good on the whole.

[00:15:00]>> Yes.

[00:15:01]I would come here actually did my UG from a state college.

[00:15:05]>> Yeah.

[00:15:05]>> I would say that the relationship between the residents and among the residents is one of the best I've seen.

[00:15:10]>> Best today. That's fine. That's fantastic. And what about your nephrology department? How was the postings in nephrology there and what was inspiring as far the department is concerned?

[00:15:20]>> So, we only have around 15-day postings in nephrology in our medicine postings.

[00:15:25]>> During your entire course, only 15 days?

[00:15:28]>> Yes, sir.

[00:15:28]>> Oh, that's too less. Okay.

[00:15:30]>> Yes, less.

[00:15:31]Uh So, nephrology nephrology admits limited number of patients. They have a selected number of patients who they admit. Usually, the bulk of the patient load is post transplant.

[00:15:43]So, AIIMS is one of the largest renal transplant center in the country. So, most of the care is centered around post transplant patients. While patients with rapidly progressive renal failure or nephrotic syndrome are usually admitted in medicine and evaluated by nephrology using consults.

[00:15:57]>> Okay.

[00:15:58]>> As for academics, I did attend a few academic sessions when I was posted in nephrology. Again, they have discussions on They have seminars and they have journal club discussions on a regular basis.

[00:16:08]>> So, that's good. So, that's really nice.

[00:16:10]So, you you really know like how what are the strengths and weaknesses of each of the departments. No department is going to be perfect. And more than that, nephrology is one specialty which I think in a very short while will be having special subspecialties under nephrology. So, people now even at the end of the DM course actually go and do some fellowships. It's mandatory now these days to get a fellowship in either interventional nephrology or critical care nephrology or glomerular diseases or dialysis or something because it is not possible to study the whole thing in 3 years. You just get an overview of the whole thing in 3 years. It's not like you become 100% strong in 3 years. You can become 100% strong in glomerulus and vascular and tubular interstitium.

[00:16:46]That's possible. But to become 100% strong in dialysis and 100% strong in transplant and interventions at the end of 3 years is not a practical proposition. So, probably you will have to do fellowships to kind of strengthen your understanding on the subject as you push forward. And that's why I believe people who come into nephrology should have their like you say first cause of MS is rheumatic and then rheumatic and rheumatic and rheumatic always. In nephrology also, your priority has to be nephrology and nephrology and nephrology and nephrology. The moment you shift gears and change priorities to so many other things in life, nephrology will leave and go.

[00:17:18]So, that is the problem. That is the biggest challenge in the subject. So, overall your feeling at the end of this INI CET exam like the practical part of it, the interviews. So, everybody will be like keen on knowing how was your interview or how did your interview go?

[00:17:32]So, just tell us about what what are questions you are asked and how was your interview, please.

[00:17:37]>> Sir, the questions in nephrology usually I felt clinical clinical case-based. They are not particularly interested in the pathophysiology or the actual values that underlie the development of a disease. They will usually provide you a clinical vignette. For example, I was asked a case of renal vein thrombosis in a patient who has nephrotic syndrome.

[00:17:57]And what are the risk factors for development of a thrombotic event in a patient with nephrotic syndrome?

[00:18:01]Uh apart from that, they do ask a little bit about how much research you have done during your residency. Uh both departments, both CMC as well as PGI, places a high emphasis on candidates who have significant history uh significant exposure to research and have conducted research apart from their thesis.

[00:18:17]And every candidate I feel should be well-versed and thorough with their thesis whether it has something to do with nephrology or not.

[00:18:23]So, they are not interested in the nephrology part of the thesis. They are also interested in how well we analyze our thesis and why if it what were the results and what were the pros and cons of our thesis.

[00:18:35]The interviews are often focused around what our thesis was about.

[00:18:38]>> Yeah, okay.

[00:18:40]Fine. So, I think that also actually you went well.

[00:18:44]So, wonderful. So, it was a very uh what is a easy easy interview for me. It was not like an interview. It was more like chatting with you. And I think you you have got all the boxes covered and I think you are very clear about why you want to choose the subject, where you want to do the subject, and what you want to do with the subject also. So, I think that is all very good and I think this is a big example for people who are pursuing medicine, MBBS as a course, and want to make it big. Because I was just reading through your messages that you sent me 5 years ago. I think you were very clear even at that point that you wanted to really study, that you wanted to up your knowledge, and you wanted to get a cracking rank for NEET PG as well.

[00:19:15]I think your rank was three for NEET PG, right? NEET PG or INI-CET?

[00:19:19]>> Rank two in NEET PG.

[00:19:21]Two in NEET PG, and INI-CET was four.

[00:19:24]>> Four, yeah. So, that that actually speaks. So, you don't have to further keep on proving yourself. So, that's wonderful. So, I think the biggest take home is to have clarity, and that's what is common to all the toppers, and that is clarity. Very very clear about why you want to do this, how you want to do this, and what you want to do with this.

[00:19:41]So, once I think that clarity is there, the rest of the things will just come into motion. So, wonderful discussing with you.

[00:19:49]Hearty congratulations and all the best for a great career in the following.

[00:19:53]>> Thank you, sir.