Candidates of Diplomate of National Board (DNB) degree which is equivalent to a MS (Master of Surgery) or MD (Doctor of Medicine Degree), are only left with their practical exams before getting their degree in their chosen speciality. The NBE has mandated that the DNB students will be required to travel to designated exam centres to appear for the practical exam. These exam centres are in other states or cities from where they completed their training.
While admission to both courses is under the NEET-PG entrance exam, MD and MS degrees are given by Medical Council of India (MCI), and DNB is given by National Board of Examination (NBE). NBE conducts the theory and practical exams for DNB courses in centres different from the students’ home institute as standard practice. However, asking the candidates to travel to different centres during a pandemic, and while many of them have been working in COVID wards, is dangerous, say the candidates.
Around 5,000 DNB candidates are eligible for the exam this year, and they say that apart from the dangers of traveling, it is also unnecessary when all they need is access to the internet and computers to take the practical exam.
Some doctors say the practical examination should either be waived off as a one-time exemption due to the pandemic, and the degrees should be awarded on the basis of their thesis and theory exams. But most of them demand that they be allowed to take the practical exam at their institute of training, or one of their choice in the vicinity, depending on where they are.
Dr Shekhar*, member of the Association of DNB Doctors (ADD) in India and a COVID-19 survivor, tells TNM that he completed his training around six months ago in Kolkata. Now, he is in Delhi.
“I don’t know where my centre will be now,” he tells TNM. “I may have chosen to be allotted a centre in a zone based on where I was many months ago. But like me, many DNB candidates have had to relocate – either on COVID-19 duty or have gone back to their native places. Some candidates are unemployed because without the DNB degree, they can’t render their services. If a COVID-19 patient has to be put on a ventilator, a specialist with a relevant DNB degree can help. But without the degree, many are unable to do anything.”
He adds that some states like Maharashtra and Delhi have passed notifications mandating all final year MD, MS and DNB graduate doctors to be engaged in COVID hospitals for at least six months. “If a doctor has been infected by coronavirus, and then travels, isn’t that a huge risk to the fellow travellers?” questions Dr Shekhar. Further, some states and cities have mandatory quarantine for those coming from outside the state as well, which is also stressing out the DNB candidates.
Dr Rakesh*, another member of the Association and part of its governing body, argues that the NBE has allowed its examiners to oversee the candidates virtually, so what is the need for candidates to travel as long as they have access to computers and webcam.
He explains that NBE conducts the theory and practical exams for DNB at external centres to avoid candidates influencing examiners at their training institutes. Usually, a practical exam would require three external examiners to also travel to the exam centre, apart from a local examiner. “But since many of the examiners are old and hence, more vulnerable to coronavirus, they will only be examining the candidate virtually from NBE’s Delhi office,” says Dr Rakesh.
“If you are just going to have the examiners online for checking and the patient cases will also be simulated, why can’t it happen in any city?” argues Dr Rakesh. He also alleges that many candidates haven’t even gotten centres in the zones they chose. For example, even if a candidate chose south zone, he/she has gotten a centre in Maharashtra or Delhi.
Further, Dr Rakesh says, that many smaller cities don’t have an examination centre, but they have DNB institutes. The final practical exams should be allowed there, he states.
Meanwhile NBE Executive Director Professor Pawanindra Lal told TOI that while holding the exams was imperative as DNB specialties are feeder qualifications for NEET super speciality entrance tests, he said that they were trying to ensure minimum travel for students. He added that it wasn’t easy to organise centres locally because centres are decided based on the number of candidates per speciality.
Another change is that usually, the DNB practical requires students to work with four cases of patients in-person. However, due to the pandemic, this format has also been changed to a digital one, where only a simulation of a patient’s photos or videos will be shown to candidates and candidates.
The new format of exams also makes it mandatory for them to pass a separate Observed Structured Clinical Examination (OSCE) to qualify for the practical exam in the revised format.
Further, NBE has said exams will be conducted simultaneously for two days instead of the previous system of multiple dates. ADD argues that this will effectively occupy DNB candidates for four days, taking into account two days of travel, thus taking them away from duties at COVID hospitals.
“NBE is supposed to make things easier in view of COVID-19, but it appears NBE is reluctant to pass DNB candidates even in the middle of a pandemic. The MCI recommends passing of practicals as a whole and never in the history of India have components of practical exams been made mandatory to pass separately. Secondly, NBE used to conduct OSCE components in pediatrics and ENT courses but it was not mandatory to pass different components of practical separately. So why does NBE suddenly want candidates to pass OSCE separately, that too in the middle of a pandemic,” ADD wrote in a letter to Health Minister Dr Harshvarshan on June 17, highlighting their grievances.
DNB candidates have made many attempts to vocalise their issues. Many have written on the Ministry of Health and Family Welfare grievance portal.
The Federation of Resident Doctors’ Association India also wrote to NBE to consider centralised assessment at institute or regional level for DNB practical exam as early as possible. This, in light of the exam having been postponed by three months already, after the final theory exam happened in December 2019. The letter also pointed out that many MD, MS and DNB students have been posted for six months in COVID hospitals, and in some places, the tenure will be extended further.
ADD also moved the Supreme Court last month over the issue. SC had given a notice to NBE to figure out whether DNB exams could be held at certain centres conveniently without the danger of spreading COVID-19.
Dr Rakesh says that the next date for the hearing was set for July 14. However, the NBE has announced the exams from July 13 itself. Practicals for only 18 out of the 57 specialities will be held till August 27, causing further delay for other candidates.