Mradul Varshney

My Notebook !!

Recently NBE or the National board of examination started a new post graduate diploma course , the Post MBBS diploma in eight subjects, namely Radio-diagnosis, Obstetrics and gynecology, Pediatrics, ENT, Ophthalmology, Respiratory Medicine, Family medicine and Anesthesia. NBE is also credited to run post graduate degree courses named DNB aka Diplomat of National Board in few private and government hospitals. These DNB hospitals are accredited by NBE itself and are our of the purview of MCI or recently known as NMC (National Medical Commission). 

Why start a diploma course?
In the last few years , we saw that MCI started converting all diploma courses run at various medical colleges to degree. The rationale being add one more year of training and you get a specialist doctor who can treat as well as teach. As per the norms , a diploma holder is not eligible for faculty position in medical educational institutes. 

But again NBE thought that start diploma again because we need more specialist doctors to cater to ever expanding Indian population. But why diploma?? Why not degree? It is may be because, NBE has set the minimum guideline to start a diploma course at any hospital at a significantly lower level than a regular post graduate degree course so as to accommodate almost all small hospitals in the list of eligible institutes where these diploma courses can be run. 
If you don't know, NMC has a certain guideline for institutes where a post graduate program can run. These guidelines are made to ensure enough patient load and variety of cases available at the hospital along with facility for treatment and specialists to treat such cases, so that a post graduate trainee can acquire sufficient skills to manage cases once he completes the training. Unfortunately the hospitals which are selected for these diploma courses, lack all the infrastructure and facility for a post graduate training.
So is it good to have these diploma courses?

It is good on one hand that we will get more specialist doctors to cater to the rural population. But my main concern is training at these centers. The centers which are selected for the diploma courses are mainly the district hospitals of the tier 2 cities. These district hospitals have been running to cater mainly to OPD patients and less critical indoor patients. These hospitals refer more critical patients to nearby medical college hospitals or other tertiary care hospitals. So to say, these hospitals work as referal centers for CHCs and PHCs and cater to mostly less critical patients only. Similarly these hospitals lack equipment and infrastructure too. Many investigations and superspeciality departments are not available in these hospitals. Medical science needs working together and many sick patients need higher investigations or reference to some super specialty department. There is also lack of proper teaching faculty in these hospitals, as these hospitals are mainly run by medical officers. 

So few questions still remain to be answered. 
Is it sensible to make specialist doctors with incomplete training?
Will these doctors, able to handle cases in periphery better than a MBBS doctor and the refer rate will decrease ?

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