The DNB Resident

 

For Non-Medicos & Doctors outside India: After completing their basic medical degree of MBBS, doctors in India do further specialization in either Medical or Surgical specialties, the Master of Surgery or Medicine courses. They are then known as junior resident doctors (JR). These courses are of three-year duration with a final exam at the end. In addition to the clinical work, these junior resident doctors also do research work and write a thesis. They are allotted a professor to serve as a guide in their thesis work.

The residents have to identify a specific topic or disease and read up on what research has been done and published in the medical journals previously on that topic, known as the review of the literature. Based on this review of literature they make a detailed plan and submit the plan to the medical college's academic section and ethical committee for clearance and approval. This submission of the plan has to be done within six months of joining the course. 

Then the junior resident has to do the thesis research work in the next two years period and submit the finished thesis after approval of his thesis guide, at least six months before the final exam. If the junior resident does not submit his thesis in time, he/she is not allowed to sit in his/her exam and has to give the exam after a delay of six months. But some colleges did not strictly follow these guidelines in the past as due to the less number of junior resident doctors in the department, the JRs were busy with patient-related work and do not get time for research activities.

After completing their basic medical degree of MBBS, doctors in India do further specialization (Post-Graduate or PG course) in either Medical or Surgical specialties, the Master of Surgery (MS) or Medicine (MD) courses. They are then known as junior resident doctors (JR). These courses are done in Medical colleges, mainly government colleges.

Due to the shortage of PG seats in medical colleges and the availability of excellent private hospitals with a good number and variety of clinical patients and infrastructure with consultant doctors experts in their field, the Indian government set up a parallel system of DNB (Diplomate of National Board) qualified PG medical doctors who will fill the gap to provide expert care to the population and now is practically equivalent to the normal MD/MS degree.

The DNB courses are run and the degrees are awarded by the National Board of Examinations (NBE), New Delhi, an autonomous academic body under the Ministry of Health and Family Welfare, Government of India. Since this course is permitted only in those private hospitals with good clinical work and consultant doctors, it is a matter of prestige for the hospital and the department where the DNB course is permitted by the government.

In addition to the clinical work, both the junior resident doctors and DNB residents also do research work and write a thesis. They have to submit the completed thesis checked and signed by the professor or consultant guide at least 6 months before their final exam.

Although, both of these courses are of three-year duration there are some fundamental and practical differences between the two courses. The DNB courses are being done in a private hospital where the patient is paying full charges, so they demand that they be treated by the senior doctor whose fees they are paying. Therefore the practical hands-on training of these DNB students suffers, especially in surgical branches as they are not allowed to operate on these paying patients for fear of complications and litigations. The MD/MS JRship is usually in a government medical college hospital with patients coming by the hospital name, so there is a free hand to the junior residents (JRs) to practice and gain skills, especially in surgical branches.

Being a medical college there is a system of regular teaching and academic activities in MD/MS courses, but such a system is lacking or poorly developed in many of the private practice-oriented DNB course hospitals. So the academic activities and thesis writing of the DNB residents suffer.

Due to this many DNB residents feel they are just bonded laborers for three years without any theoretical or practical teaching and training. This leads to dissatisfaction among the DNB residents and many leave the course midway. Some even take the extreme step of committing suicide.

There is also a difference between the final exam method. The MD/MS final exam, both theory and practical, is held in their respective colleges with external examiners from other states. In many medical colleges, the theory answer sheets are checked in the same department with the external examiners from other states. So the head of the department and other internal examiners play a large role in determining whether the junior resident should be passed or not.

In the DNB system, the theory paper is held at a separate center, and all the answer sheets are checked by external examiners, after hiding the candidates' identities. The practical exams are held outside the state at a few designated centers and not in the hospital where the DNB candidate did his residency. So the consultants of the hospital have no direct role in passing or failing the DNB resident in their final exam.

One of my senior colleagues was permitted to start a DNB course in his psychiatry hospital. A few years later I learned that he had applied and stopped the DNB course at his hospital. Curious,  I asked him the reason for stopping the prestigious course, when I met him at a Medical conference.

He disclosed, ‘I had started the course with the expectation that the DNB residents will work dedicatedly and provide better care to the patients in our hospital than the medical officers we employ, as they will be motivated to learn by working and interacting with the patients. Also with their thesis work, there will be increased research activity in our hospital.’

‘When the DNB residents joined, they demanded that they be paid salary according to the central government pay scale. They also demanded that they be provided with accommodation or given a house rent allowance. With the high central government salary to resident doctors and the high rent in our city, I had to spend more money on a single DNB resident in which I can hire two local medical officers.’

He further revealed, ‘They also said, they will work a maximum of eight hours in a day and will take weekly off. If they will do night duty, then they will take the next day off. This is unlike your medical college residents who sometimes work continuously for 36 hours or more.’

‘And increased academic activities?’ he blurted, ‘My foot! These DNB residents were least interested in academic activities.’ ‘When I asked them, they replied that they just want the three-year experience certificate so that they can give the exam. They will learn on their own when they will start to practice after getting their DNB degree.’

‘You medical college people have an advantage over us DNB hospitals. Since you, as internal examiners control 50 % of their final exam marks and unofficially can influence the remaining 50% by the external examiners, your residents are worried about creating a good impression on you and working beyond their capacity. In DNB, the final exam is held in a different center and we cannot change even a single mark in the result, so our DNB residents are not worried about impressing us.’

‘But about the thesis?’ I queried, ‘Even your DNB residents have to do a thesis. You can make them run around in their thesis and not approve the thesis if their work is not satisfactory.

My friend replied, ‘My DNB resident submitted his thesis plan, but after that, I did not see him doing any thesis work. I was surprised when I learned that he has been allowed to sit in the final exam without getting any completed thesis checked and approved by me.’

He further continued, ‘When I had gone to Delhi for some work, I visited the DNB office and asked them how my DNB resident was allowed to sit in the final exam without submitting the thesis signed by me?’ ‘The clerk there said, to leave an application with all the details, and they will look into the matter and let me know.'

‘When next time I went to the DNB office, I enquired about my previous application, the clerk replied, as they were busy they had not looked into the matter until now, please write a reminder application and we look into the matter and let you.’

‘It is now months but still has not heard anything on that matter. The DNB office appears to be least interested in finding the truth. I guess that the DNB resident had submitted a thesis copied from somewhere with my forged signature so that he could sit in the exam’

‘With such a bad experience, I decided to stop the DNB course at my hospital and rely on the local medical officer for working in our hospital’

Unlike many other DNB residents, the DNB resident of my friend’s hospital was well aware of his rights and asserted them and had mastered the art of:

Create tension for other

Not get tense due to others

टेंशन लेना का नहीं

टेंशन देने का

It’s not our circumstance and situation but It’s all our frame of mind and attitude that determines our mental peace.

— ND

(Based on allegedly true incident.)

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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal, and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to NMC and other Board norms.