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Special Articles

A Study on Pre-Employment Medical
Examination for Non-Gazetted Railway Services

A study, based on retrospective record analysis of all the consecutive 471 candidates was conducted. These recruits
appeared for Pre-employment Medical Examination (PMES) for non-gazetted Railway Services between January and
December 2001, in Divisional Railway Hospital, Kharagpur. Majority of the candidates (89.17%) were male. Maximum
number of candidates appeared for B-1 & B-2 (41.82%) and A-1 (33.12%) medical categories. 42.67% cases could
be finalised within a day. 81.10% candidates could be declared fit for original higher categories without any glasses.
3.18% were made fit for alternative lower categories. 6.15% were declared ‘unfit’ for appointments. 8.91% were fit for
original higher categories with glasses. Reasons for declaring ‘unfit’ for higher categories or for appointments were
(i) Deficiency in visual acuity (5.52%), (ii) Deficiency in perception of colours (2.54%), (iii) Deficiency in binocular
vision (1.06%) and (iv) Cataract (0.21%). 8.91% cases were referred to ‘special clinics’ for opinion regarding ‘fitness’.
Medical Officers engaged in PMES should be well familiar with the different nature of jobs associated with various
categories of employment in an Industry for efficient management of PME cases.
Key words: Pre- employment Medical Examinations, Non Gazetted Rly. Services, Medical Categories.

INTRODUCTION: (ii) Premature decategorisation and alternative
One of the most important duties of a railway medical employment without any significant loss of
officer is to conduct Pre-employment medical emoluments and
examinations of candidates in various medical (iii) Wastage of human and financial resources due to
categories to ensure selection of ‘physically and untimely loss of experienced and trained staff2.
mentally fit’ persons. We have a huge population of
unemployed youth in our country. To give all of them
a fair chance of employment, medical examiners
during Pre-employment check ups should always rely (i) To highlight some key issues.
on ‘abilities’ rather than ‘disabilities’ of candidates1 . At (ii) To produce base-line data for academic as well
the same time organisations like Railways will never as administrative interest.
compromise with safety aspects at any cost . Indian
Railway Medical Manual (IRMM) had published (iii) To suggest some recommendations based on the
detailed guidelines regarding the physical and visual experiences gained during the present study.
standards of candidates appearing in various medical
categories. Judicious pre-employment medical MATERIALS AND METHODOLOGY
examination will reduce the possibilities of
Place of Study: S.E.Railway Main Hospital,
(i) Accidents due to human errors, Kharagpur.

* Senior Divisional Medical Officer, Health and Family Welfare, Kharagpur Type of Study: Retrospective study based on record
Division, South Eastern Railway. analysis.

Study Methodology: Pre-employment medical either in the reporting hospital or in the referral
examination records of all the consecutive 471 hospital were taken into consideration. Routine eye
candidates who had appeared between January and examination by eye surgeon or physical examination
December 2001 were recorded systematically. Age, by lady medical officer for female Candidates in the
sex, medical category, physical findings, details of divisional hospital was not considered as a ‘referral’.
any ‘referral’ and final results of the examinations The following standards of visual acuity at
were recorded as documented. For referred cases, examination on appointments of non gazetted
cases referred to ‘special clinics’ on nominated days, employees were followed2.

TABLE – I : Standards of visual acuity on appointment.

Medical category & examples of categories of Distant vision Near vision
A1 (Engine Drivers, Assistant Drivers, Shunters etc.) 6/6, 6/6 with out glasses with Sn 0.6, 0.6 with out glasses
fogging test (must not accept +2D)
A2 (Guards, Switch men, Station Masters etc.) 6/9, 6/9 without glasses
(no fogging test) -Do-
A3 (Loco foreman, Senior Section Engineer- P.Way, 6/9, 6/9 with or without glasses, Sn 0.6, 0.6 with or without glasses
Gate man etc.) power of lenses not to exceed 2D
B1 (Gang men, Key men, Ambulance Drivers etc.) 6/9, 6/12 with or without glasses. Sn 0.6, 0.6 with or without glasses
power of lenses not to exceed 4D when reading or close work is
B2 (Travelling Ticket inspectors, Crane Driver, Mason etc. -Do- -Do-
C1 (Station clerks, Stenographers, Sweepers etc.) 6/12, 6/18 with or without glasses -Do-
C2 (Pharmacists, Nurses, chowkidars etc. 6/12, Nil with or with out glasses Sn 0.6 combined with or without
glassed when reading or close
work is required.


Table –II : Distribution of candidates, medical category Table – III : Distribution of candidates, age and
wise (n= 471) sex wise (n=471)

A1 156 33.12 No. % No %
A2 and below 94 19.95 18-24 96 20.38 8 1.69
A3 and below NIL — 25-30 198 42.03 5 1.06
B1 and B2 197 41.82 31-36 91 19.32 20 4.24
C1 and C2 24 5.09 37 & above 35 7.43 18 3.82
Total 471 100.00 Total 420 89.17 51 10.82

Table – IV : Time taken for disposal of PME cases (n=471)

DAYS A1 A2 & Below B1 & B2 C1 & C2 TOTAL
NO %
01 65 47 78 11 201 42.67
02 55 19 46 4 124 26.32
03-07 23 15 32 3 73 15.49
08-21 5 3 18 3 29 6.15
22 days & above 6 9 23 3 41 8.70
‘Closed’ due to non attendance 2 — — — 2 0.42
Temporary unfit — 1 — — 1 0.21
Total 156 94 197 24 471 100.00

Table – V: Referred cases in special clinics of reporting/referral hospital (n=471)

Sr No. Clinic Reasons for referral Number Percentage
1 Surgical OPD ‘Hydrocele’ 10 2.12
Undescended testis 1 0.21
2 Medical/Cardiology OPD High B.P. 5 1.06
ECG ‘abnormalities’ 11 2.33
Cardiac murmurs 4 0.84
3 Chest clinic ‘Abnormal’ X-ray Shadows 2 0.42
4 Eye Clinic Refractive errors 5 1.06
Cataract 1 0.21
5 Skin OPD ‘white Patches’ 2 0.42
6 Ortho OPD Bony Deformity 1 0.21
Grand Total 42 8.91

Table – VI : Reasons for declaring ‘unfit for appointment’/ candidates could be made fit in higher categories
unfit for higher medical categories (n=471) without any glasses. In A1 & A2 categories, glasses
Reasons Number Percentage are not permitted during initial medical examinations.
8.91% cases had to be referred to ‘special clinics’ for
Deficiency in Visual acuity 26 5.52
opinion regarding ‘fitness’ for appointments or
Deficiency in perception of colours 12 2.54
otherwise. Three referred cases of ‘Hydrocele’ had to
Deficiency in binocular vision 5 1.06 undergo surgical operation before being declared as
Cataract 1 0.21 ‘fit’. Such candidates can be declared ‘fit’ after a two
Total 44 9.34 week period of rest following hydrocele operation1 . All
referred cases for ‘high B.P.’ were ultimately
Table – VII: Summary of results of PMES diagnosed as ‘white coat’ hypertension or ‘Labile’
(n= 471) hypertension. All such cases were declared ‘fit’ due to
Results Number Percentage lack of any evidence of target organ damage. ECG
Fit in initial higher category without
findings such as sinus tachycardia, supraventricular
any glasses 382 81.10 ectopics, Lt Axis deviations, LVH and T inversions
Fit in initial higher category with noted by reporting hospital were declared as ‘WNL’
glasses 42 8.91 by the referral hospital. Similarly all cardiac murmurs
Fit in alternative Lower categories 15 3.18 were declared as ‘innocent’. 2.54% candidates
(males) were having deficiency in colour perceptions
Unfit for appointments 29 6.15
and 1.06% candidates were having deficiency in
Temporary unfit 1 0.21
binocular vision. The ‘red green colour blindness’ is
‘Closed’ due to non attendance 2 0.42 the most common deficiency of colour perception
Total 471 100.00 and found in about 3 to 4% male and 0.4% of female
population3. Candidates in A1 to B1 categories are
required to be tested for any deficiency in colour
perceptions and candidates up to B2 categories are
Maximum number of candidates appeared for B1 and tested for presence of binocular visions. Safety in
B2 (41.82%) categories followed by A1 (33.12%) movement of trains under diverse conditions depends
categories. Majority (89.17%) were male. Many largely on Running and Operating staff having correct
females appeared for appointments on perceptions of colours and intact binocular visions.
compassionate grounds. 42.67% cases could be
finalised in a day and 26.32% cases were finalised
within two days. Reasons for delays in finalisation of RECOMMENDATIONS
cases are attributed to (i) ‘Doubtful’ physical findings (1) All Medical officers engaged in PMES should be
requiring 2nd opinion, (ii) Non attendance by made well conversant with the various types of
candidates, (iii) Incorrect entries in medical requisition jobs and actual working conditions prevailing in
memos and (iv) Leave, holidays etc. 81.10% the concerned industries with the help of slides,

videos and simulation models. This will help them
to dispose the PME cases promptly, judiciously
(1) Guidelines on pre-employment medical examination, Editor
and effectively. Dr A.G. HARSHE, published by Indian Association of Occupational
Health, 1, 26.
(2) All industrial medical officers should be
periodically trained for updating of their (2) Indian Railway Medical Manual (Vol-1), 3rd edition, Ministry of Rlys.,
Rly. Board, New Delhi 90, 61.
knowledge and skills.
(3) Text book of ophthalmology -2nd editions, Neema & Singh, Jay payee
(3) All equipments required for PMES should be Brothers, 63.
periodically checked and properly maintained.