Friday, May 3, 2013

The advantages and disadvantages of DNB residency program

The advantages and disadvantages of DNB residency program

Diplomate in National Board (DNB) is a post graduate degree awarded by the National Board of Examinations under the Union Ministry of Health, India. DNB residency positions are available in 54 specialties. As per Central Government notifications DNB degree is equivalent to MD/MS. While MD/MS candidates are trained at Medical Colleges, DNB candidates are trained at large private hospitals. Choosing to enroll for the DNB degree program has its advantages and disadvantages as we will see below.

1) Easy of entry. This is the most common reason for someone to choose DNB degree program. To enroll in MD/MS you need to clear tough nationwide entrance exam for Govt. Medical Colleges or pay expensive capitation fee at Private Medical Colleges. Most of the DNB candidates are students who couldn't secure their preffered specialty in MD/MS. For enrolling in DNB program, you need to clear NBE common entrance test which is relatively easy compared to MD/MS exams followed by interview at the institution of your choice. 
2) Inexpensive. All you need to pay is the yearly fee stipulated by the NBE. Compared to the fees charged by private medical colleges it is a very small amount.
3) Management as per guidelines. Except in large govt medical colleges, many medical colleges in India may not have sufficient resources and equipment to manage patients as per latest guidelines. Hence for residents in some medical colleges there is a disconnect between what they learn theoretically and what they do practically. But in many large private hospitals, the management of the case is on par with international standards.  
4) Some of the latest procedures, surgical techniques, medical advances, expensive investigations are more commonly done at private hospitals. You get trained in them. For example latest radiological methodologies like PET scanning are more likely to be available in private hospitals than in govt medical colleges.

In an major welcome move, the Union Health Ministry of India has issued a notification that DNB holders can also be allowed to teach in medical colleges. With this the former discriminatory regime that differentiated those who hold MD/MS and DNB graduates is gone. Ho wever the DNB holders need to complete one year of senior residency in recognised medical colleges prior to appointment in faculty positions.

DNB is awarded by the National Board of Examinations (NBE) under the Ministry of Health while MD/MS is awarded by Medical Council of India (MCI), an autonomous body. As per the government regulations both are considered equal. But because of some vested interests, the MCI refused to consider DNB degree as valid for teaching in medical colleges. This resulted in discriminatory pay structure in some private medical colleges with those holding MD/MS being paid higher than DNB graduates for the same amount of work. It is sheer irony that some of the best medical professionals who cleared tough DNB exit exams (with pass rate around 30-40%) were never allowed to teach in medical colleges while those who graduated from dubious private medical colleges were considered eligible to teach in medical colleges.

The reason for this relaxation is the increase in the number of private medical colleges and the need for qualified faculty. Government is aware of the shortage of medical faculty in both the government sector and the private sector and had earlier relaxed the age of retirement. Professors who retire from the government medical colleges can take up work in the private medical colleges. The move to include DNB graduates will possibly address to some extent the shortage of qualified medical faculty in teaching institutions


1) Low pass rate. The final exam is considered tough and the pass rate is generally at 15 to 20%. 
2) There might be less hands on training in specialities like surgery in some institutions
3) There is less recognition among the general public about DNB degree and this may affect your clinical practise
4) DNB graduates need to complete one year of senior residency in medical colleges prior to appointment as faculty in teaching institutions.
5) Less teaching. The teaching schedule in DNB program may not be as regular as in medical colleges. 

Certain large private institutions provide better training for DNB candidates than Govt Medical Colleges. It is important to choose the institution carefully prior to enrollement. It is generally advisable to join in a large hospitals that has DNB program in multiple specialities. Large hospitals with many DNB residents generally have an uniform approach, have person incharge of educational activities and regular teaching program. Do visit the institution prior to the interview and talk to the residents there. Enquire about  the previous pass rate, what the past residents are doing, regularity of classes and if residents are allowed to perform procedures.

Overall, DNB is an excellent option if you carefully select the institution/department and if you are willing to work extra hard.


No comments: