How INI-SS Question Papers Are Designed by AIIMS Professors

I want to tell you about the INI-SS exam. A 32-year-old MD Medicine candidate took the INI-SS Stage I exam. The candidate got a question with an ECG and a clinical scenario. The patient was on haemodialysis. Had unexplained low blood pressure. The answer was not easy. The candidate had to know about hyperkalaemia-induced pseudo-STEMI. This is something that AIIMS professors see often in their ICUs. It is not something that you read about every day in textbooks. This is how INI-SS questions are made. They are based on life, not just theory.

QUICK ANSWER

The INI-SS question papers are made by a group of experts. This group is chosen by the AIIMS New Delhi Examination Section. The INI-SS exam has two parts. Stage I has 80 choice questions. The candidate has 90 minutes to answer them. The questions are from the part of the qualifying degree and the super-specialty that the candidate applied for. Each question is worth one mark.

If the candidate answers a question incorrectly, they lose one-third of a mark. The candidate needs to get at least 50% to pass. Stage II is different. It is an assessment. The candidate has a video conference with the department. This is for AIIMS and PGIMER applicants.

NEET PG RELEVANCE

Understanding how the INI-SS question paper is designed is very important for every specialty aspirant. The candidate needs to know about the question blueprint structure, the difference between Stage I and Stage II, and the negative marking strategy.

The INI-SS exam is changing. Now it has image-based and integrated clinical questions. These questions are not easy. The candidate needs to think and use their knowledge to answer them.

 In This Post:

• What Is the INI-SS Examination?
• Who Designs the INI-SS Question Paper?
• The Question Paper Blueprint. Structure & Composition
• How Questions Are Selected. The Design Philosophy
• Stage I vs Stage II. Key Differences
• Difficulty Calibration & Question Types
• INI-SS vs SS. Comparison Table
• High-Yield Strategy Points, for INI-SS 2026
• FAQs

What is the INI-SS Examination?

The Institute of National Importance Super-Specialty Entrance Test, which is also known as the INI-SS, is the way to get into DM, MCh, and MD Hospital Administration programs at the medical schools in India. The AIIMS New Delhi is in charge of this exam, which is given two times a year in January and July.

This exam is for people who want to get into AIIMS New Delhi and the other AIIMS schools, as well as JIPMER Puducherry, PGIMER Chandigarh, NIMHANS Bengaluru, and SCTIMST Thiruvananthapuram.

I have seen doctors who have finished their MD or MS degrees, and they do not understand how the INI-SS exam works. The INI-SS exam is not a harder version of the INI-CET exam. The questions on the INI-SS exam are for people who already have a degree in medicine and want to become super-specialists.

This means that the exam assumes you already know a lot about your field, and it tests how well you can use that knowledge to make decisions when treating patients. The INI-SS exam is given on a computer. It is only in English.

Who makes the questions for the INI-SS exam?

This is a question that many people who want to take the exam ask, but not many people can answer. I have been watching how AIIMS makes its exams for 25 years, so I can tell you what I know.

The people in charge of making the exam are at the AIIMS, New Delhi. They do not share the questions with anyone because they are secret. This is because of a law that was made in 1956, which says that the questions have to be kept secret.

There is a group of professors at AIIMS who decide how the exam should be conducted. They are the ones who say what the questions should be about and how they should be graded.

The people who actually make the questions are professors and doctors who work at AIIMS and the other schools that are part of the INI-SS exam. They are the ones who teach the students and take care of patients, so they know what the students need to know to become doctors.

The important thing to know is that the INI-SS exam is not made by a company that just makes tests. It is made by the doctors who teach and take care of patients. The questions on the exam are based on cases that the doctors have seen, so it is not just a matter of memorizing things from a book.

The Question Paper Blueprint. Structure And Composition

The INI-SS Stage I paper has a plan that is explained in every official prospectus.

The plan is like this:

Questions: 

• 80 multiple-choice questions
• The test lasts for 90 minutes.
• Total marks: 80. You get 1 mark for every answer.
• If you answer a question incorrectly, you lose 1/3rd of a mark.
• If you do not answer a question, you do not get any marks. You do not lose any marks either.
• The test is in English only. It is online.
• You take the test on a computer.

Also Read: How Many INI-SS Previous Year Questions Are Enough?

The questions are divided into two groups:

 Pool 1. General or Basic Component: These questions are based on what you learned in your medical course, like MD or MS.This part of the test checks if you still remember the things you learned in your postgraduate studies.

 Pool 2. Sub-specialty or Systems Component: These questions are about the course you are applying for. For example, if you are applying for DM Cardiology, you will get questions about the heart, like how it works, how to fix problems with it, and how to treat people with heart problems. These questions are harder than what you would get in an MD Medicine course.

Some students think that the questions are divided evenly between these two groups. The official prospectus does not say exactly how the questions are divided. This means the people who make the test can make it easier or harder depending on what they want.

If we look at the tests from before, we can see that 40 to 50 percent of the questions are from the basic group and 50 to 60 percent are from the specific course group. This can change depending on the course you are taking.

How Questions Are Selected. The Design Philosophy

I have been training students for over twenty years. I have found that there are three principles that guide the selection of INI-SS questions.

1. Clinical Scenario Primacy

INI-SS questions are different from PG questions. INI-SS questions are more about scenarios. A typical question will give you a patient's details. Age, history, examination findings, and lab values. Ask you to find the most likely diagnosis or the next step in management. This is how doctors think when they are on ward rounds. They do not just remember facts; they use the information to make decisions.

2. Integration Across Disciplines

The people who design INI-SS questions are professors from AIIMS. They make sure that the questions cover specialties. For example, a question about neurology might involve a drug interaction that a pharmacologist would know about. A question about nephrology might require you to understand an echocardiographic finding. This is how it works in life when doctors from different specialties work together in big hospitals. When I talk to my colleagues from departments, they all say the same thing: INI-SS rewards doctors who think like consultants, not like residents who are just studying for exams.

3. Image-Based and Data-Interpretation Questions

In recent years, INI-SS has included more image-based questions. These questions might show you an ECG, a histopathology slide, a radiological image, or a clinical photograph. This is similar to how AIIMS departments test their residents. The professors who design the questions use these images in their work. So you can expect to see real-life images, not diagrams from textbooks, in the exam questions.

Also Read: INI-SS 2026 Exam Pattern + Smart Attempt Strategy

Stage I vs Stage II: Key Differences

INI-SS has a two-stage design. It is essential to understand the difference between the two stages.

Stage I is a written computer-based test with eighty multiple-choice questions that you have to complete in ninety minutes. You need to score at least fifty percent to qualify. The Common Merit List, which is prepared based on Stage I scores, is used for admission to all participating INIs except AIIMS and PGIMER Chandigarh.

Stage II is an assessment that is worth twenty marks. It is for candidates who have applied for seats at AIIMS or PGIMER Chandigarh. To be eligible for Stage II, you need to score fifty percent or more in Stage I. The qualified candidates are then. Those who are ranked up to three times the number of advertised seats are called for this assessment.

Stage II is conducted online through video conferencing. Each department designs its assessment, which might include case discussions, clinical problem-solving, image interpretation, or practical demonstrations related to the super-specialty.

The AIIMS Merit List is prepared by combining the marks from Stage I and Stage II. To qualify for an AIIMS seat, you need to score at least fifty percent in the combined total. If two candidates have the same combined marks, the older candidate is ranked higher.

This two-stage system is similar to how clinical recruitment works. First, there is a written test. Then there is a hands-on departmental evaluation. The professors who design the Stage II questions are usually the heads of departments or senior faculty who will supervise the DM/MCh candidates.

Difficulty Calibration & Question Types: How do they decide the difficulty level of the questions?

The question-setting committee aims to create a paper where about fifty to sixty percent of the questionsre moderately difficult, twenty to twenty-five percent are straightforward, and fifteen to twenty percent are challenging. This ensures that the fifty percent qualifying cutoff filters out candidates, and the tough questions differentiate between strong contenders.

Some common question types in INI-SS sessions include:

• Single Best Answer questions, which are the most common type. You are given a scenario and four options, and you have to choose the most appropriate one.
• Image-based questions, which have increased in sessions to about ten to fifteen percent of the paper. These might show you an ECG, a CT or MRI image, a histopathology slide, or a clinical photograph.
• The assertion-reasoning format, which is less common in INI-SS, is used to test your understanding of underlying mechanisms.
• Drug-specific questions, which might ask about dosing, mechanisms, adverse effects, and contraindications for super-specialty-specific drugs.
• One classic trap in INI-SS exams is including a "distractor" option that would be correct in the parent specialty but incorrect in the -specialty context. For example, a management question might offer a step that's appropriate, in general internal medicine, but not in the specific super-specialty setting.

INI-SS vs NEET SS — Comparison Table

High-Yield Strategy Points for INI-SS 2026

• The INI-SS exam has 80 multiple-choice questions that you need to answer in 90 minutes. This means you have 67 seconds for each question. You have to manage your time well.
• The cutoff mark for qualifying is 50 percent, which is 40 out of 80 in the first stage. For every three answers, you will lose one correct answer mark because of the negative marking system.
• The questions are taken from two areas: the part of your medical degree and the specific super-specialty you are applying for. You should prepare both areas with effort.
• In recent years, there have been more questions with images like ECGs, radiology, and histopathology. You should practice with images from clinics, not just pictures from textbooks.
• The second stage of the exam is an assessment that is done through video conferencing. This stage is for people who are applying to AIIMS and PGIMER Chandigarh.
• The final merit list for AIIMS is made by combining the marks from the second stage. Doing well in the stage is not enough if you do not do well in the second stage.
• The people who make the exam often test your knowledge of specialty drugs, including how they work, their side effects, and how they interact with other drugs. These can be different from the drugs used in medicine.
• One tricky thing about the INI-SS exam is that some questions have answers depending on whether you are thinking like a general doctor or a super-specialist. You should always think like a super-specialist.
• To prepare for the INI-SS exam, you can use the BASIC method: understand the exam pattern, practice with images, study your super-specialty in depth, practice with scenarios, and review cases.
• You can also use the PrepLadder app to practice with topic-wise questions that are tailored to your super-specialty.

Frequently Asked Questions

Q1. Who makes the INI-SS question paper?

The question paper is made by a group of experts who work under the AIIMS New Delhi Examination Section. Senior teachers from AIIMS and other participating institutes contribute questions. This process is controlled by the AIIMS Act, 1956. All papers are kept confidential.

Q2. What is the pattern of the INI-SS Stage I question paper?

The first stage has 80 multiple-choice questions that you need to answer in 90 minutes. The questions are taken from the part of your medical degree and the super-specialty you are applying for. You get one mark for each answer and lose one-third of a mark for each wrong answer.

Q3. Is INI-SS harder than SS?

INI-SS is generally thought to be more focused on practice and less predictable than NEET-SS. The people who make the exam are doctors who also teach. The questions are more like real-life clinical situations. NEET SS has a standard pattern with 150 questions divided into sections.

Q4. How many stages are there in the INI-SS exam?

The INI-SS exam has two stages. The first stage is a written exam that all candidates must take. The second stage is an assessment that is only for candidates who are applying to AIIMS or PGIMER Chandigarh. The final merit list is made by combining the marks from both stages.

Q5. Can I see INI-SS question papers?

AIIMS does not allow previous question papers to be made public. However, you can find memory-based recalls of exams through various study materials. Practicing with these recalls is the closest you can get to the exam.

Q6. How is the INI-SS question paper design tested in exams?

While the design process itself is not directly tested, understanding the pattern can help you plan your study time better. Knowing that 40-50 percent of questions come from the basic part of your medical degree and 50-60 percent come from your super-specialty can guide your study.

Clinical Pearl

The INI-SS paper is not written by people who just read books. It is written by doctors who have experience in clinics. You should study the way they think: first, think about the patient's case. Then think about the answer.

In my 25 years of teaching medicine, one thing I have noticed is that exams that test your ability to think clinically will always favor the candidate who studied from patients, not just from books.