Recommendations of the Expert Groups Meetings Held on 4Th, 5Th, 6Th & 7Th January 2010 at New Delhi

Draft report of the recommendation of the expert groups on strengthening of NBE

Recommendations of the Expert Groups Meetings Held on 4th, 5th, 6th & 7th January 2010 at New Delhi

1 Draft report of the recommendation of the expert groups on strengthening of NBE

Contents

I. Brief background of national board of examinations (NBE ) 3

1.1. Introduction 1.2. Objectives of NBE 1.3. Activities of NBE

II. Genesis of the expert group meetings 10

III. Composition of the expert groups & terms of reference 12

IV. Recommendations

4.1. Recommendations for reforms in the accreditation process for recognition of hospitals/ institutions for DNB courses 20 4.2. Recommendations for improving DNB teaching and training in accredited hospitals 21 4.3. Recommendations for improving DNB thesis research work in accredited hospitals 22 4.4. Recommendations for improving availability of Learning Material and Library 23 4.5. Recommendations for improving DNB Curriculum 24 4.6. Recommendations for starting new DNB courses/ PG Certificate Courses 24 4.7. Recommendations for reforms in the periodic appraisal system or concurrent assessment 24 4.8. Recommendations for reforms in entry level exam (CET) 24 4.9. Recommendations for reforms in exit theory exam 25 4.10. Recommendations for reforms practical exam 25 4.11. Recommendations for reforms in the certification process 26 4.12. Recommendations for reforms in FMGE 26 4.13. Recommendations for improving NBE Communication (Protocol) 27 4.14. Recommendations for setting up of Regional Centers 29 4.15. Recommendations for setting up of Learning Resource Centre for NBE 32 4.16. Recommendations for resource generation & enhancing revenues for NBE 33 4.17. Grant of statuary status for NBE by an Act of Parliament 34 4.18. Formulation of operationalisation plans for NBE development & restructuring 35

V. List of documents submitted to the expert groups 36

VI. Annexure

6.1 Report of Expert committee set up by Ministry of Health and Family Welfare under the chairmanship of Dr. A K Mukherjee DGHS for grant of statutory status to NBE. 6.2 Report of expert committee meeting under the chairmanship of Dr. Ranjit Roy Chaudhary to constitute and independent body to organize and regulate Post Graduate Medical Education-Feb 2007.

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I. BRIEF BACKGROUND OF NATIONAL BOARD OF EXAMINATIONS (NBE )

1.1. Introduction

The National Board of Examinations was established in 1975 on the basis of the Report of a Working Group set up by the then Prime Minister Smt. Indira Gandhi:

“To examine the need for uniformity in the standard of examination for the award of postgraduate degrees and diplomas ……. And to suggest ways and means of achieving it either through one or more national examining bodies, in replacement of or in addition to the existing system, “To recommend the nature, composition, scope, functions and power of such national examining body/bodies ………………”

The working group Recommended that:

“There is an urgent need for an organization that could conduct postgraduate examinations at national level of high academic standards to ensure:

• A high quality of medical services given to the people by doctors certified by such examinations • Raising of standards of medical education in general • Availability of prestigious qualifications within the country comparable to similar qualifications given in foreign countries and thus minimize the tendency of medical graduates to go abroad to acquire these degrees • National integration

The National Board functioned as a wing of the National Academy of Medical Sciences from 1975 to 1982. The Government of India, after a review, took a policy decision to make it an independent autonomous body with effect from March 1, 1982 under the Ministry of Health and Family Welfare as a registered society.

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1.2. Objectives of NBE

As per the Memorandum of Association of NBE (1982), the objectives are as follows: (i) The conduct of post-graduate examinations in the discipline of Modern Medicine and other allied sciences at the national level; (ii) To maintain a high standard of examinations to ensure that candidates have received adequate training both theoretical and practical, and are competent in every way to practice as specialists in their respective fields; (iii) To determine the general principles for the examinations, and the specialties in which the examinations will be conducted. (iv) To constitute Specialist Board for each discipline in which the examinations are to be conducted; (v) To formulate basic training requirements for eligibility to appear for the respective examination;

(vi) To constitute an Accreditation Committee and establish standards & to prove the accredited centers of studies which provide adequate facilities for training; (vii) To maintain liaison with professional associations, societies, colleges concerned with Post-graduate education and training and with Universities and Commissions concerned with raising of standards of Medical Education; (viii) To cooperate and deal with national and international bodies, agencies, foreign countries and universities for the furtherance of the objectives of the Board; (ix) To secure and manage funds and endowments for the promotion and implementation of the above objectives; (x) To develop patterns of teaching in Post-graduate Medical Education in all its branches, other allied sciences including physical and biological sciences, so as to achieve high standard of Medical Education in all Medical colleges and other allied institutions in India; (xi) To conduct experiments in new methods of Medical Education in order to arrive at satisfactory standards of education; (xii) To prescribe courses and curricula for post-graduate studies; (xiii) To determine the nature of qualification to be awarded, hold examinations and grant such degrees, diplomas and other academic distinctions and titles in post-graduate medical education and other allied sciences as may be laid down in the regulations; (xiv) To undertake, aid, promote, guide and coordinate research of a high caliber in medical and other allied sciences including physical and biological sciences; (xv) To provide and promote effective linkages on a continuing basis between various scientific and research agencies / laboratories and other organisations working in the country in the field of medicine and other allied sciences;

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(xvi) To organize post-graduate courses, workshops, seminars symposia and training programme of specialized nature; (xvii) To institute professorships, other faculty positions, fellowships, research cadre positions & scholarships etc. for releasing the objectives of the Board; (xviii) To receive grants-in-aid in cash or other forms from the Govt. of India, State Governments, Charitable institutions / Trusts, individuals and industry within the country; (xix) To receive, with the prior approval of the central Government monetary assistance from foreign sources including international organizations for the activities of the Board; (xx) To acquire by gift, purchase, exchange, lease, hire or otherwise howsoever any property movable and or immovable and to construct, improve, after, demolish or repair buildings and structures as may be necessary or convenient for carrying on the activities of the Board; (xxi) To sell, mortgage, lease, exchange and otherwise transfer or disposal of all or any property moveable or immovable of the Board for the furtherance of its objectives; (xxii) For investing the funds of or money entrusted to the institution, to open such securities or in such manner as may from time to time be determined by the Board and to sell or transpose of such investment for the objects of the Board. (xxiii) To undertake and provide for the publications of journals, research papers, leaflets and textbooks and to augment and maintain library information services for the furtherance of the objects of the Board; (xxiv) To collect, organize, disseminate and publish knowledge about medical and allied sciences; (xxv) To institute offers and grants, prizes, awards, scholarships, research grants and stipends in furtherance of the objects of the Board; (xxvi) To create administrative, technical ministerial and other posts in the Board and to make appointments thereto in accordance with the rules and regulations laid down by the Board; (xxvii) To appoint & hire services or discharge terminate the services of personnel & to pay them in return for the services rendered to the Board salaries, wages, gratuities, provident fund and other allowances or remuneration in accordance with the rules and regulations of the Board; (xxviii) To take over and manage the functions, duties, responsibilities, assets, liabilities of any organization and particularly of the institution operating under the name of the National Academy of Medical Sciences, New Delhi.

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1.3. Activities of NBE

The major activities of the NBE are:

1.3.1. Accreditation of hospitals/Institutions for conducting DNB courses The hospitals/ institutions who wish to start any DNB course apply to NBE in the given application form, along with inspection fee. The inspection is done by the subject mater expert considering the minimal criteria and standard inspection format. The report is reviewed in the Accreditation Committee and recommendations of the committee are ratified by the Governing Body. Thereafter the hospital is accredited for running DNB course for three years after which renewal inspection is done. As on December 2009, there are 616 hospitals/institutions running DNB courses in Broad specialties and Super specialties; 56 hospitals are conducting Post Doctoral Fellowships and 198 hospitals have DNB(Family Medicine, New Rules). The total number of primary seats in broad specialties DNB courses are 2616, in super specialties courses are 652, in post doctoral fellowship courses are 154, in DNB ( Family Medicine, New rules) are 676. Besides there are nearly 2000 post diploma seats.

1.3.2. Entry & Exit Examinations for DNB courses The NBE conducts DNB examinations in 46 post -graduate medical streams.

The entry examinations(CETs) conducted by NBE include:

• CET Broad Specialties( Twice a year with nearly 14,000 applicants) • CET Super Specialties( Once a year, with sub specialty specific CET in 18 sub specialties and with nearly 1,200 applicants) • CET Fellowship ( Once a year with subspecialty specific CET in 15 sub specialties and with nearly 600 applicants)

The exit examinations(Final) conducted by NBE include:

• Fellowship examinations( Once a year in15 sub specialties and with nearly 100 applicants) • DNB Super specialty exit examination with 18 sub specialties and nearly 600 applicants. • Central evaluation of DNB Theory answer sheets ( Twice a year in various specialties) • Central counseling in Post doctoral fellowship seat allotments (usually two sessions) • Declaration of result for theory & practical examinations

In addition from 2002 onwards on the directions of MOHFW, NBE is also conducting Screening test for foreign medical graduates, FMGE examination (March and September every year with nearly 5,000 applicants)

1.3.3. Recognition of DNB qualifications

NBE degrees are included in the schedule-1 of the Medical Council Act 1956, because NBE is autonomous by the Registered Society Act and not by an Act of parliament. Thus the Post- graduate Medical Education Regulations 2000 of Medical Council of India Act are applicable to the degrees awarded by the Board. The PG regulations states that the candidates should pass in

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theory as well practical separately with 50% marks. NBE conducts a uniform theory examination of four ( Broad specialties)/ three ( super specialties) papers each comprising of 10 short structured question( requiring them to be through in 40 /30 topics). The DNB candidate has to first clear theory examination with 50% marks and only those who qualify theory examination are allowed to take practical examination. At present, only 35 of the 46 courses are recognized as per provisions of Indian Medical Council Act. None of the innovative courses namely DNB Family Medicine, DNB Rural Surgery, Post-doctoral Fellowship courses are recognized.

1.3.4. CME programmes & DNB faculty development programmes

NBE has standard modules for CMEs for DNB candidates & consultants ( 76 CMEs were conducted in 2008 and 40 CMEs in 2009), thorough the following centres:

• Delhi (Maulana Azad Medical College, St. Stephen Hospital, Safdarjung Hospital and Vardaman Mahavir Medical College, RR Hospital, Lady Harding Medical College, All India Institute of Medical Sciences, Sir Ganga Ram Hospital and Research Centre) • Bangalore (St. John Medical College and Command Hospital AF) • Hyderabad (Nizams Institute of Medical Sciences, Osmaina Medical College, Care Hospital) • Chennai ( Madras Medical College, Kilpock Medical College, Southern railway Head Quarter Hospital) • Pune (Command Hospital, Deenanath Mangeshkar Hospital & Research Centre and BJ Medical College)

CME Module on thesis work covers

• Issues related to protocol writing and research in DNB accredited hospitals/institutions (Including ethical issues, funds, committees etc). • Identification of topic for thesis work and writing a good thesis protocol. • Planning of DNB thesis work • Writing of DNB thesis CME Module on Practical examination covers

• Long case discussions • Short case discussions • Ward Rounds • Iinstruments for clinical/surgical procedures • Investigation modalities • OSCE/ Preparing for theory examination CME Module on Theory examination covers

• Planning and organisation of short structured questions • Grading of short structured questions and listing of key skills for attempting theory questions • Attempting short structured questions

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CME Module on bedside teaching, thesis writing and evaluation for the consultants covers

• Planning and organisation of long and short cases presentations, ward round and spots • Issues related to protocol writing and research in DNB accredited • Identification of topic for thesis work and writing a good thesis protocol and guidance and supervision of DNB thesis work • Development of short structured questions and MCQs and Listing of skills of an effective examiner and planning for theory and practical examinations.

1.3.5. CME through Satellite based infrastructure of IGNOU since July 2006

Interactive satellite based teleconferencing for DNB candidates and consultants is being done on every thursday from 2.30 to 7.30 PM. This is being extended to twice a week with facilities for repeat telecast in 2010. This transmission is also available as web cast from 2009

1.3.6. Radio counseling for DNB candidates in Delhi Zone

Interactive FM radio based(105.6 MHZ) counseling for DNB candidates and consultants is done on every Thursday from 5.00 to 6.00 PM. IGNOU is likely to make it to all major cities in 2010

1.3.7. NBE journal of Postgraduate Medical Education, Training and Research

The journal gives DNB candidates access to editorials, commentaries, review articles, original articles, interesting case reviews, recent advances, book reviews etc.The journal was started in 2006 on quarterly basis covering various themes articles such as Thyroid, Breast, Cancers etc. It’s publication has increased to six issues per year during 2008, once in two months. It is sent to all accredited hospitals, institutions, and libraries. The journal is available free of cost on line at NBE website.

1.3.8. NBE News letter

This is being published every quarterly since 2006.It provides a useful forum for sharing teaching and training experiences for NBE institutions, DNB candidates, as well as gives information on various activities of the Board

1.3.9. Development of learning materials for DNB candidates and consultants

Nearly 350 topics are available on DVDs for the benefit of DNB candidates and consultants

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1.3.10. Students support services, counseling and grievance redressal on internet

NBE web portal www.natboard.edu.in has the followings:

• Query on current status of registration, accreditation, thesis, results etc • Availability of curriculum • Dates for examination • Dates for CMEs • Lists of DVDs/CDs on clinical cases, procedures, therapeutics • Key elements for case presentations • Latest circulars and guidelines • Copy of Bulletins of information • Registration formats for Counseling, Academic placements with experts

1.3.11. Communication on telephones

NBE has out sourced its telecommunication to call centre, with dedicated staff of 6 and one supervisor.It has 30 dedicated telephone lines . Calls received in 2009 (January to December) at Ansari Nagar office-86,767 (12 months) and Dwarka office- 52,303( 6 months)

1.3.12. SMS on mobile phone of DNB candidates sent by NBE

1.25 lakh per year by NBE own soft ware by IT section of NBE as follws: • First message- application received by NBE • Second message-Roll number dispatched • Third message- In case roll number not received down load from website • Fourth message- Result declared • Fifth message -Certificate dispatched

1.3.13. Visitors coming to NBE office New Delhi

Number of visitors received per day at Ansari Nagar office are 30 to 50 and the number of visitors received per day at Dwarka office vary from 10 to 40. Besides NBE receives E mail queries on [email protected], varying from 1500 to 2100 per month.

1.3.14. DNB coordinator & co-cordinators in each accredited hospital

• All circulars, notices, Information bulletins etc. received are sent to all concerned departments • Planning and organization of academic programmes for DNB courses • Appraisal – conduct and records and feedback • All administrative issues related to registration, accreditation, thesis • Ensuring participation in teleconferencing sessions, CMEs etc. • Ensuring books, journals, DVDs in library as per NBE norms

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II. GENESIS OF THE EXPERT GROUP MEETINGS

The first meeting of the IX Governing Body of the Board was held on 27th November 2009 at 2.30 PM at New Delhi. Prof. K Srinath Reddy, President, NBE expressed that with the support and cooperation of the distinguished members of the GB, activities of the Board will achieve new heights. He also mentioned that the focus of the Board should be on quality, optimal use of resources, transparency and accountability of the participating hospitals /institutions. To achieve this, he felt that major re-organization, strengthening and re-structuring of various processes and resources would be required. He mentioned that there was an urgent need to have regional and state level offices of the Board, to take the functioning of the Board closer to the stakeholders. President, NBE also highlighted the need for additional resources and support required from Ministry of Health and Family Welfare, Govt. of India. President, NBE emphasized the need for a statutory status by an act of parliament to fulfill the mandate given to NBE in toto.

Dr. P S Maini, Vice President, NBE said that DNB examination system was much more superior to MD/MS/Mch stream. He further said that the Board should also focus on other specialties like Rural Surgery, Geriatric Medicine etc. The Accredited Institutions must ensure regular teaching and training for DNB candidates and for this a culture of teaching is cultivated amongst institutions. Dr. Maini expressed the need for various DNB courses in meeting the health human resource deficit in the country and highlighted the role of National Board of Examinations in setting global standards.

Dr. S S K Marthanadam, Vice President, NBE appreciated the high and uniform standards of NBE maintained over the years and suggested that these standards should not be diluted. He added that it was much more difficult to get DNB degree and the Board should also provide counseling services to DNB candidates. There should be a regular mechanism to hold meetings with DNB candidates and faculty.

Dr. R N Salhan, Vice President, NBE suggested that the Board should extend it’s services by opening regional and state level centres to improve the reach of NBE and Government’s support in this regard should be sought . He also suggested that learning resource centers would help in improving the training of the candidates. He said that the teaching environment of private institutions should improve. He further added that the examination system of the Board was of high standard and it should not be compromised.

Dr. S Jalal, Vice President, NBE observed that the number of accredited hospitals and DNB candidates had increased over the years where as there was an urgent need to strengthen the infrastructure at the office of the NBE. He also felt that opening of regional and state centers would improve academic activities and communication of the Board. He agreed that providing Statutory Status for NBE will go a long way in fulfilling objectives of the Board. Funding from the Government should also be increased to start regional and state centers. He suggested that there should be local networking of various accredited hospitals for academic placement of DNB candidates.

Mr. Naved Masood, Additional Secretary & FA, MoHFW, Member, NBE said that in order to get regular Government support, NBE should get statutory status by Act in Parliament. Mr. Masood highlighted the fact that all autonomous organizations should be self reliant for meeting their day to day /regular expenses. He further stated that NBE should expand its revenue base and meet its

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expenditure on its own resources. The Central Government considers the request of institutions for funding as part of the five-year plan as per approval of planning commission.

Dr. Bhabhatosh Biswas, remarked that in many NBE Accredited Institutions training of the DNB candidates needed strict monitoring and supervision. Candidates should be exposed to structured training programmes. The Board should also take feed back from the candidates who complete training from these institutions.

Lt. Gen. N K Parmar, DGAFMS, said that NBE can utilize facilities and expertise available with more than 150 services hospitals spread all over the country. He was satisfied with the DNB courses running in various army hospitals. He suggested that NBE should also start DNB course in Aviation Medicine, High Altitude Medicine, Marine Medicine in view of need and urgency of Medical Services in these areas.

Dr. R K Srivastava, DGHS, said that NBE was started nearly 30 years ago as an alternate system of postgraduate medical education. The country needs a large number of specialists in various medical specialties, but the conventional stream of postgraduate medical education through medical colleges was not able to fulfill this need, therefore NBE had an important role to play for production of specialized postgraduate medical manpower as per requirement of the Government. He suggested that the Board should focus on various input, process and product indicators to further improve DNB training programmes. He further added that NBE should have very strict parameters while accrediting hospitals for training and these institutes should be periodically visited to ensure that the infrastructure and facilities for training were available to DNB trainees. In additions to the inspection done by inspectors every three years, he also suggested that accreditation format be made specialty specific and concept of team inspection be also introduced.

Dr. Maheshwari suggested that there should be further improvement in NBE communications with Accredited Institutions and DNB candidates. For this regular feedback be obtained from the students as well as from the consultants from the institutions.

In view of the above suggestions given by the members of the Governing Body, and also to ensure a planned development of various activities and units of NBE in the next five years, the president NBE appointed four Expert Groups to examine the current role of NBE vis a vis the mandate given to it in it’s Memorandum of Association, identify the constraints and to recommend mechanisms for strengthening the infrastructures, processes and procedures in order to meet the new challenges in thea re of post graduate medical education in the country.

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III. COMPOSITION OF THE EXPERT GROUPS & TERMS OF REFERENCE

Group-I, Accreditation, Examinations, recognition of DNB qualifications, External communications, grievance redressal

The meeting held on 6.1.2010,under the chairmanship of Dr. S.Jalal, Vice President NBE. The Chairperson welcomed the members and informed them that the purpose of the meeting was review the current mechanisms of NBE for accreditation, examinations, recognition of DNB qualifications, external communications, grievance redressal and to recommend measures to develop newer processes, mechanisms for further development in these identified areas in the next few years in a panned manner. The NBE office circulated all the relevant documents and information related to these issues to facilitate discussions. The recommendations given by the experts have been listed in this document. The expert comprised of- Dr. S. Jalal, Vice President NBE , Dr. Anil Kohli; Dr. Chintamani; Brig. Chander Mohan; Dr. Avinash Supe; Dr. R.K. Srivastava; Dr. Arvind Saili; Dr.B.K. Jain; Dr. Nikhil Tandon; Dr.Pradeep Garg; Dr. Y.K. Sarin; Maj. Gen M.N. G. Nair

Group-II, Training & monitoring, new courses and revision of curriculum

The meeting held on 5.1.2010, under the chairmanship of Dr. P.S. Maini, Vice president NBE. The Chairperson welcomed the members and informed them that the purpose of the meeting was to review the current mechanisms of NBE for DNB teaching & training being carried out by the accredited hospitals, including thesis work. He also mentioned that the Board had felt the need for the revision of DNB curriculum in various specialties incorporating the newer areas of advancements as well as to list newer specialties where DNB courses could be started in future. The NBE office circulated all the relevant documents and information related to these issues to facilitate discussions. The recommendations given by the experts have been listed in this document. The expert comprised of- Dr. P.S. Maini, Vice president NBE, Chairperson;Lt. Gen. N K Parmar, AVSM, VrC, VSM, PHS;Dr. D. Prabhakaran; Dr. V.K. Sharma; Dr. Piyush Gupta; Dr. S.B. Arora; Dr. Amit Banerjee; Brig. R. Bhalwar; Col.S.S. Bhatia; Surg. Cdr. S.S. Khanuja; Group-III, Development of learning materials, building academic partnerships and development of faculty pool

The meeting held on 4.1.2010, under the chairmanship of Dr. R.N. Salhan, Vice president NBE. The Chairperson welcomed the members and informed them that the purpose of the meeting was to review the current mechanisms of NBE for development of learning materials, building academic partnerships and development of faculty pool for various academic activities of the NBE.

The NBE office circulated all the relevant documents and information related to these issues to facilitate discussions. The recommendations given by the experts have been listed in this document. The expert comprised of- Dr. R.N. Salhan, Vice President NBE, Chairperson; Dr. A. K. Agarwal; Dr. K.K. Talwar; Dr. Maheshwari Sharma; Dr. R. Krishan Kumar; Dr. K. Ganpathi; Dr. Sanjay Zodpey; Dr. Deoki Nandan;

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Group-IV, Formulation of operationalisation plans for NBE development & restructuring, development of global linkages, regional centers and augmentation of resources

The meeting held on 7.1.2010, under the chairmanship of Dr. Devi Shetty. The Chairperson welcomed the members and informed them that the purpose of the meeting was to recommend formulation of operationalisation plans for NBE development & restructuring, development of global linkages, regional centers and augmentation of resources.

The NBE office circulated all the relevant documents and information related to these issues to facilitate discussions. The recommendations given by the experts have been listed in this document. The expert comprised of- Dr. Devi Shetty, Chair person; Dr. R.K. Srivastava; Prof. Bhabatosh Biswas; Dr. R.K. Batra; Dr. Uma Chawala;Dr. Shashi Raheja; Dr. Rakesh Dua; Dr. Baljit Singh; Dr. B.L. Sherwal; Dr. Amit Banerjee;

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IV. RECOMMENDATIONS

4.1. Recommendations for reforms in the accreditation process for recognition of hospitals/ institutions for DNB courses

1. NBE should reduce number of hospitals for DNB courses by following more strict parameters. 2. NBE should redefine minimal criteria and modify its inspection formats specialties wise. 3. NBE should also increase the number of total beds, beds in the specialty, OPD case load, Indoor case load, define pattern of cases, define types of equipments, infrastructure facilities etc. as identified by the subject matter expert in the revised curriculum as above 4. NBE should ensure that all facilities and infrastructure is in the same campus 5. NBE should ensure no single specialty hospitals are accredited for DNB courses other than Ophthalmology. 6. NBE should ensure from the accredited hospitals that they make a written legal undertaking for consultants/ Faculty commitment with regard to teaching and training, thesis work and carrying of joint academic prgrammes as per NBE norms, as well as providing hospital facilities for NBE CMEs, examinations, sensitization workshops, question bank development activities etc. The hospitals must also ensure unbiased mechanisms for feedback and regular interactions with DNB candidates. 7. NBE should ensure from the accredited hospitals that they have thesis protocol and ethical committees and regular teaching and training is monitored by a teaching training committee. The details of the same would be communicated to NBE and updated on NBE website online. 8. NBE should ensure periodic team inspections and define and impose financial penalties and even consider derecognizing, if no satisfactory action is taken by the accredited hospitals to improve teaching and training 9. NBE should also conduct sensitization meetings with of management of hospitals for improving academic activities. 10. NBE should work on an objective mechanism for grading of Hospitals on quality of training. 11. NBE should work on maintaining online record of consultants academic performances. 12. NBE should ensure that the accredited hospitals work on development of academic linkages of hospital with government hospitals / Medical colleges. 13. NBE should work on once a year admission & calendar base for accreditation, to ensure standardization in teaching and training as well as of the certification mechanisms as mentioned above.

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4.2. Recommendations for improving DNB teaching and training in accredited hospitals

1. Improve hands on training facility in surgical specialties. 2. Ensure proper teaching and training as per NBE curriculum for Basic Sciences. 3. Ensure that the consultants are available for teaching and training for atleast 8 hours per week as per NBE norms and the hospitals must give them adequate incentives. 4. Consultant’s turnover rate high in some specialties for that develop mechanism for immediate replacement within 1 month. 5. Consultants may be given teaching designations by NBE, such as NBE Professors and Associate Professors etc. if they fulfill the minimal criteria developed by NBE for them. 6. The hospitals must link with local hospitals in Government and private sector to ensure adequate exposure to clinical and surgical cases as per NBE curriculum. 7. Consultants working on part time basis or those having their own clinics should not be considered for NBE courses. 8. Teaching is not priority in the opinion of management of Hospitals. They should therefore also be sensitized to encourage teaching and research activities and undertaking in this regard be procured from them at the time of accreditation. 9. Increase Consultants- Students interactions by having more frequent case presentations, academic ward rounds, guest lectures, seminars etc. 10. Ensure proper placement of students in various sub-specialties to cover NBE curriculum. Efforts should be made to ensure that no single specialty hospital is accredited for DNB courses. 11. The hospitals must maintain documents and records for training schedules, sessions taken by various consultants and DNB candidates and NBE should develop online mechanism for keeping records of these. 12. Teaching and training activities should be standardized so that all hospitals cover the NBE curriculum in same way by specifying contents at the end of first, second and third years. 13. Formal lectures/ sessions must be conducted by accredited hospitals to cover basic sciences, basic aspects of statistics, research methods, recent advances as per the NBE curriculum. Larger hospitals must have statistical experts fulltime or part time basis for DNB candidates. . 14. The hospitals must have networking within departments, between departments and within local accredited hospitals for teaching and training of DNB candidates. 15. Hospital campuses should be in one premises. Outsourcing of facilities by hospitals may result in inadequate training of DNB candidates in these areas. 16. Consultants shown for DNB courses must be oriented to teaching and training methods, research methods periodically and records by maintained for these. 17. The hospitals must encourage teaching culture and environment. 18. Consultants involved in DNB courses must have log books for taking teaching sessions, attending CME on TOT etc. and this should be taken into consideration while designating them as NBE Professors/ Associate professors. Feedback from students on consultants should also be taken as one of the parameters by NBE. 19. The hospitals should pay incentives to consultants involved in teaching and training out of the fee paid by students. 20. Best teacher awards should be introduced by NBE based on objective parameters for teaching and training.

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21. Residency designation for DNB candidates as Junior / Senior residents would ensure uniform working conditions for DNB candidates.

4.3. Recommendations for improving DNB thesis research work in accredited hospitals

1. All Consultants involved in DNB courses must be oriented to research methods, ethical issues, writing research papers etc. 2. The DNB thesis protocols must be screened by thesis and ethical committees. And the thesis progress should also be monitored by the thesis committee regularly. NBE should develop some mechanism to ensure this on regional basis. 3. The hospitals must keep some separate funds for DNB thesis research. 4. Research is not a priority many times with the hospitals. NBE having nearly 6500 DNB candidates every year doing thesis, must develop mechanisms to ensure joint research projects with common guidelines so that national level research data is available. These mega projects would make DNB thesis research work must more relevant for the medical fraternity. 5. No statistical experts are available at many NBE accredited hospitals for guiding students. NBE must ensure that these inputs are available to the DNB candidates by issuing necessary guidelines and modifying accreditation criteria. 6. Quality of thesis is not good. There may be duplication / copying of data / fake data by the candidates. This results in high Thesis rejection. Compulsory training of DNB candidates and their guides and co guides in research methods, statistical methods, paper wring etc must be planned by NBE. 7. Students not given separate time for thesis works / data collection / not are given resources for investigation etc. NBE must ensure that adequate time and resources are provided by the hospitals to the DNB candidates and the hospitals must give undertaking in this regard in the accreditation agreement with NBE 8. No emphasis is given on writing research articles, or making presentation in conferences etc. by consultants. NBE must ensure that the DNB candidates as well as the consultants (shown as NBE consultants) make minimal contribution during the three years of DNB course. 9. Students must contribute research articles for journals or NBE Journals before they take final examination at least from their thesis work. This must be given weight-age in their log books or towards concurrent assessments. 10. NBE should coordinate with INCLEN, NICD, PHFI, NML, ICMR for developing research registry, identifying areas for research in various specialties, compile summary or thesis as such in digital format for wider dissemination within and outside the country as crucial research resource material. 11. NBE should include it its thesis guidelines an Undertaking from the DNB candidates and consultants for allowing NBE to use the thesis work for above mentioned academic activities 12. NBE must encourage good research by instituting Best paper award and Best thesis award based on objective parameters.

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4.4. Recommendations for improving availability of Learning Material and Library

1. The hospitals must ensure that adequate number of Text Books / Reference Books ( latest Editions) in various specialties are available in their libraries. NBE should make much more stringent norms for libraries 2. The hospitals must ensure availability of online journals in libraries besides the hard copies. 3. Learning materials on DVDs ( all sets) must be available to DNB candidates and in libraries. NBE must explore the possibility of giving online access to DNB candidates to all the learning materials, for this suitable fees be charged from the candidates and hospitals. 4. The hospitals must ensure adequate participation in tele-conferencing and radio counseling sessions conducted by NBE for consultants and students. All these be recorded on loog books and penalty be introduced if students and consultants’ participation is not at the desired level. These should be taken as a part of the academic activities for the DNB candidates. 5. NBE should coordinate with NML & DELNET for extension of library facilities to hospitals and candidates. NBE should also explore the possibility of taking up the responsibility of providing online journals and virtual library facilities on the basis of some charges from hospitals and the candidates. 6. NBE must develop it’s own Learning Resource Centre with online connectivity, facilities for learning courses and materials ,online virtual classroom sessions etc. 7. NBE must charge from students for learning materials and from institution for strengthening these facilities.

4.5. Recommendations for improving DNB Curriculum

1. NBE curriculum developed in 2002 needs to be revised & modified at the earliest. 2. NBE must develop and modify curriculum in all specialties for which it conducts courses, by referring to best teaching and training practices available in the country and abroad. 3. Immediately NBE should appoint three experts in each specialty to work out a base document on curriculum , with details such as-goal, objectives, posting schedule, desired skills at the end of I, II, III year, specify clinical procedure, surgical procedure at the end of I, II, III year, details of the equipment and facilities, faculty requirements and their competencies, details of topics in I, II, III, IV papers, case based questions, short structured questions and very short questions for examination. 4. These experts should also accordingly modify and develop specialty based minimal stringent criteria for accreditation of hospitals and also the inspection formats. 5. NBE should given more importance to the log books maintained by students and quality of thesis. 6. NBE must develop Internal assessment systems and credit systems as has been a practice in most of the modern universities and prominent institutions in the country.

17 Draft report of the recommendation of the expert groups on strengthening of NBE

4.6. Recommendations for starting new DNB courses/ PG Certificate Courses

The experts recommended that the following courses be introduced by NBE in a phased manner beginning 2010 :

1. Clinical Skills in management of chronic diseases (Non communicable diseases, Diabetes, Cancer, CAD) for government doctors 2. Essential surgical skills , Obst. & Pediatric Care and Anesthesia for government doctors 3. DNB (Gyne oncology) 4. DNB courses in Epidemiology, Occupational Health, Entomology, Disaster Management, Emergency Medicine 5. DNB (Marine Medicine) 6. DNB (High Altitude Medicine) 7. DNB (Emergency Medicine) 8. DNB courses for Pan African, Gulf, SARC, and SEA countries. 9. Post Doctoral Fellowship in Pediatric Gastroenterology 10. The subject matter experts would wok out the details for these courses

4.7. Recommendations for reforms in the periodic appraisal system or concurrent assessment

1. NBE should make it on regional basis through the regional centers. 2. NBE should appoint its own examiners as appraisers. 3. NBE should ensure that all the hospitals follow the curriculum in the same way there are clear cut directions in the curriculum about the skills and topics to be covered in I,II and III year. NBE appointed experts in each of the region should conduct appraisals using the same question papers and practical examination plan. This would ensure standardization of the concurrent assessment system and also then due certification can be made by NBE based on the performance of the candidates in these assessments. 4. NBE can the issue certification to candidates on I, II, III year performance. 5. NBE team to inspect infrastructure & facilities at hospitals more frequently. 6. NBE should introduce penalty & administrative actions if facilities for teaching and training are not satisfactory.

4.8. Recommendations for reforms in entry level exam (CET)

1. All the NBE’s CETs( Broad specialties, Supper specialties, Post doctoral fellowship )courses must be made MCQs based, with negative marks. 2. There must be merit based central counseling mechanism for admission to these courses carried out by NBE. The validity of these CETs should be for one session only. 3. NBE should consider the possibility of giving marks and also a copy of the OMR sheet to the candidates and the key be placed on website as is the practice with IITs and IIMs

18 Draft report of the recommendation of the expert groups on strengthening of NBE

4.9. Recommendations for reforms in exit theory exam

1. NBE should develop Question paper bank rather than question bank( which is being done at present). 2. 50% questions on case scenarios in each theory paper. 3. NBE should give more details of topics to be covered in I, II, III, IV question papers by making suitable modifications in the curriculum. 4. NBE should ensure more detailed structuring & specification marks for each component of question as is being done by CBSE by having case based, short structured and very short questions (add 2,3, 4 marks question ). 5. NBE should explore the possibility of introducing on demand theory exam for students by starting regional and sate level centres of the Board in a phased manner. 6. NBE should further reduce time for assessment of theory papers by having more than one examiner for one paper as has been the practice in CBSE. 7. NBE should also specify / limit the answers of candidates to two sheets per question. 8. NBE should giving marks to failed candidates. 9. NBE should also explore the possibility of giving answer sheets to failed candidates. 10. NBE should also explore the possibility of introducing percentile system based on group performance. 11. NBE should also explore the possibility of introducing grading system. 12. NBE should also explore the possibility of introducing credit system by giving weightage to yearly concurrent assessments done by NBE as yearly appraisals . 13. NBE should also look into the possibility of giving the choice o the candidates to clear paper-I,II,III,IV as per their choice, e.g if a candidate clears Paper-I in first attempt and fails in other papers, he/she will have to clear only the papers where he/she has failed in the next attempt. 14. NBE should have more workshops for sensitization of candidates, consultants in accredited hospitals and also for examiners on the examination system.

4.10. Recommendations for reforms practical exam

1. NBE in a phased manner must develop regional and state level centers for its activities and thus ensure that the practical exam is held in the in same state. 2. NBE should hold more CMEs for sensitization of examiners, coordinators in selection of cases and practical examination process. The reforms could be in the forms of identifying for each case key questions in history, exam, differential diagnosis, management after examining each case by examiner, not repeating cases for candidates, feedback on each examiner by students, observer examiner, define must know skills & assess the candidates on these areas etc. ( NBE should look into the other examination systems such as those of other Boards and Royal Colleges, etc to list and identify the best practices in these systems and explore the possibility of introduction of these in the NBE systems.) 3. In long terms once the regional and state centers are identified and developed, NBE should be able to offer on demand practical examinations as well. 4. NBE should introduce OSCE ,50% of total clinical component in all specialties. 5. NBE should also work on computer based OSCE, Spots, exams. 6. Feedback to failed candidates by examiners. Marks to failed candidates.

19 Draft report of the recommendation of the expert groups on strengthening of NBE

7. The practical examination must have some marks for communication, counseling skills, medico legal aspect etc.

4.11. Recommendations for reforms in the certification process

1. NBE should give weight -age to concurrent assessment appraisals after standardization of the appraisal process for all specialties at end of I, II, III year and by having once a year admission. NBE should also introduce grading system, percentile system, and other reforms as mentioned above. 2. DNB candidates who qualify the theory and practical examinations conducted by NBE through its regional centers, at the end of I -year would be given PG certificate in that specialty 3. DNB candidates who qualify the theory and practical examinations conducted by NBE through its regional centers, at the end of II -year would be given PG Diploma in that specialty 4. DNB candidates who qualify the theory and practical examinations conducted by NBE through its regional centers, at the end of III -year would be given Degree in that specialty 5. DNB candidates who fail to qualify the theory and practical examinations conducted by NBE through its regional centers, at the end of III -year would be given Board eligible certificate, subject to the conditions that the III year examination would be qualified within a period of three years

4.12. Recommendations for reforms in FMGE

1. The group felt that NBE in its bye laws has the mandate to conduct post graduate medical courses and examinations. The conduct of FMGE required the expertise at the under graduate level, which is available with the medical colleges running MBBS courses. Therefore the government medical college(s) would be the most appropriate agency to conduct this examination. The experts noted that NBE was given this task by MOHFW as a stop gap arrangement in 2002, till the government institution running MBBS courses take over the same.

2. The group recommended that the MOHFW be requested to identify a suitable institution running MBBS courses for the conduct of FMGE, till then NBE may continue to conduct this examination.

3. Any modification in the current scheme of FMGE requires changes in the Screening test Regulations for Foreign Medical Graduates duly approved by the parliament in 2002, under the MCI schedule.

4. This is important that NBE should focus on its mandate to conduct examinations in post graduate medical courses.

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4.13. Recommendations for improving NBE Communication (Protocol)

1. NBE office will ensure the following on website www.natboard.edu.in

• Latest details of status of Accreditation, Registration, Thesis, Application form, Roll no., Examination Result etc. on website and the same would be updated at least once a week. • All circulars issued to NBE Accredited Hospitals will be put on the website including Examination schedule and Accreditation Calendar. • All information bulletins, Accreditation Application formats, Registration formats, Thesis formats etc will be put on website. • All the students enrolled for examinations will be sent SMS at time of receipt of Application issue of roll no., declaration of results and issue of certificate. • All DNB Hospitals will be requested to appoint DNB Coordinators and co-co-ordinators with experience of teaching and those who are able to spend minimum time for DNB programmes , etc. (i.e. as per given parameters) they will be issued SMS alerts as well as email

2. Tele Query Handling at NBE The calls received at NBE Ansari Nagar and Dwarka Office will be handled as follows : • Phone Numbers of Ansari Nagar : 46054605 – 30 Lines • Phone Numbers at Dwarka office : 45593000 – 30 Lines

• Each caller will be required to give details of his / her name, mobile number and query. • The general query related to bulletin, date of receipt of applications, date of examination etc., and the general information available on website will be handled by the call center staff. • The frequently asked questions and their replies related to information Bulletin, registration, Thesis, Results, Accreditation, etc., as given by the concerned sections will be replied by the call center staff. • The calls requiring information which is not available on NBE website and with Call Center Staff, would be noted by the staff and the will be caller issued a query no. with request to call after 24 hours. Meanwhile this information will be collected from the concerned unit. In Case this is available before the 24 hrs, the same will be given to the caller by calling back, by the call center staff. • In case the caller is GB Member, VIP, the call will be directed to the designated officer (s), who will take the call and reply back as per the norms. • In exceptional cases the calls will be directly attended by the unit head. • The supervisor of the call center staff will check the 10% calls to review satisfaction level of caller.

3. Handling of Written Queries • All the queries, letters received by dak will be entered in receipt register at Ansari Nagar Office. • All these will be sent the next day to NBE Dwarka Office in Office Vehicle in the morning. All applications form will be entered separately.

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• All court cases, legal cases and confidential exam dak will be immediately informed on phone to the designated officer at Dwarka office and put up in a separate bag and envelops. • The dak will be scrutinized at Dwarka Office by the designated staff and put into bundles as per various units / sections. • These will be entered on computer by the designated staff indicating the receipt no., name, nature of dak and the unit / office etc where it is to be sent. • The dak will be distributed to the head of the unit who will take necessary action to review and reply back in time bound manner, within a fortnight of receipt. • VIP Communications from Ministry and GB Members etc., will be handled by the designated officer in the time bound manner within a fortnight • The RTI cases addressed to PIO will be entered on the specified register by the designated officer and a copy will be retained, before sending the same to the PIO. • The RTI cases addressed to appellate authority will be entered to separate register and a copy will be retained by the designated officer, before sending the same to Appellate authority .

4. Handling of Personal Visitors

NBE Ansari Nagar Office • All the visitors will be required to enter their name, phone no. and nature of query etc. on the enquiry format kept in the office. • The slips will be examined by the designated officer and information. if available, will be provided immediately. • In case the information is not available the designated officer will contact the nodal unit head for information. This information will be provided on phone to the visitors or in person.

NBE Dwarka Office • The NBE Dwaka office will handle the confidential work and visitors will be not be encouraged to visit this office. • The visitors will be permitted only on Friday for 3-5pm after taken appointment. • The visitor will fill up the enquiry form and handed over to the guard, who will take her / him to reception.

5. Accredited Hospitals will ensure the following measure to improve communications • Appointment DNB coordinators and co-cordinators as per NBE guidelines. • It will be mandatory for then to interact with students for 2-3 hours per week to give them information and share circular related to DNB courses. • The hospitals will down load all Circulars, Applications forms, Registration form, Thesis form, information bulletin and curriculum etc. and send a copy to all the dept. of DNB courses. • The Departments running DNB courses will display the circular guidelines on the departmental notice boards

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• The Hospitals will prepare monthly teaching and training schedule for case presentations, Seminars, Guest lectures, interesting case reviews, research methods, rotation in various dept. etc. and give to each DNB candidate and also display it on the departments’ notice boards. • The hospital will maintain records of the teaching and training activities accredited by the consultants and the DNB candidates department wise, and would update the same on NBE website atleast once in a month as per the details given for the same by NBE. • The Hospital will separately conduct thesis review committee and ethic committee meetings every quarterly .

6. Each candidate undergoing DNB course will ensure : • He / She has a copy of latest information bulletin, curriculum, circulars and guidelines for registration, thesis, Accreditation, Appraisal etc. • He / She will refer to NBE website www.natboard.com at least once in a fortnight to download circulars and other information from time to time. • He / She will meet atleast once in a fortnight with local DNB coordinator, co-cordinator to clarify doubts etc. • He / She will write to NBE with through local DNB coordinator only after seeking their remarks. • No candidates will directly contact NBE office except in cases where the grievances of the candidate have not been addressed by the local coordinators or where the NBE has asked the candidates to clarify or send additional documents.

4.14. Recommendations for setting up of Regional Centers

Venue for the proposed regional centers : Delhi, Kolkatta, Chennai, Hyderabad, Bangalore, Pune

Criteria for Regional Centers • NBE institutions / Govt Hospitals running DNB Programme with enough teaching materials • Provides space for office on rent / gratis • Provides Honorary DNB Faculty • Memorandum of Collaboration (MOC) for atleast 3 years or 5 years joint work • Any other

1. Activities or Functions

1.1. Academic activities • CME Students and Consultants on training technologies, Research methods, Thesis writing, examination, specific skills • Students academic placements • Students counseling • Joint Academic training with local networked Hospitals ⎯ Case discussion ⎯ Seminars ⎯ Guest lectures

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⎯ Recent advances ⎯ Basic sciences

Sensitization Workshops for • Examiners • Inspectors • Appraisers

Academic Programmes with Local Professional Bodies & Associations • Thesis protocol reviews • Thesis monitoring through ethical and thesis committees • Appraisals (once a year ) - theory exam, practical exam • Monitoring - infrastructure facilities for training and teaching • Development of question papers banks and workshops for validation

1.2. Administrative activities

• Arrangements for theory exam centers • Arrangements for practical exam centers • Handling queries for regional hospitals • Handling queries of students • Communication of circulars and guidelines to the regional hospitals • Interaction with DNB coordinators in monthly meetings • Periodic visits to institutions for administrative and academic matters • Holding sensitization workshops with administrative and academic coordinators of kkaccredited hospitals • Holding periodic meetings with DNB candidates on academic / administrative issues • Providing logistics and support for all academic activities • Reporting to National or Central office of NBE • Extension of communication facilities from central office as per the protocol • Coordinating distribution of information bulletins and other documents

2. Staff and Infrastructures

Administrative Staff • Regional Director ( In the scale of Deputy Director of NBE) • Assistant Director • Section Officer • MSAs(4) • Group-D (1)

Infrastructure • Office Furniture and Set up Space on rent • 5 Computers systems with software and connectivity • Internet and phone lines

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• Photocopier , fax, printers etc

Academic staff • Honorary DNB Faculty from local city both from government and private hospitals • Databank of local faculty and facilities for teaching and training

Criteria for faculty (Post graduate with 8 Years of experience, Teaching Experience, Research Experience, TOT , research articles, experience as NBE Examiners etc)

4.15. Recommendations for setting up of Learning Resource Centre for NBE

1. Facilities at Learning Resource Center • Learning materials in audio-video, text, audio form for PG Medical and DNB courses available to candidates and consultants online • Virtual library access for standard text books and reference books and journals • Virtual class room facilities for candidates and consultants • Thesis registry in digital format • Thesis digitalization ( summary in the given format) • Simulation skill lab for imparting selected clinical and surgical skills • Teleconferencing facilities for live interactive CMEs, with candidates and consultants • Networking on line for sharing of information and materials

2. Automation at back end • Updating websites • Online information of exam, registration and thesis • On line log book for students • On line log book for consultants • On line database for experts • On line data base for question and question paper banks • On line receipts & payments • Virtual library • E mail • SMS to students / institutions • On line examination • On demand examination • Others 4.16. Recommendations for resource generation & enhancing revenues for NBE

Charging fees from DNB Candidates

• Registration fee for candidates • CME Fee • Online Learning Material • Thesis assessment fee • Examination fees

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• Virtual counseling classroom session • Academic placement fees • Counseling Fees • Answer sheets for failed candidates • Skill Lab fees • Annual appraisal and certification fee by NBE

Charging fees from Institutions • Accreditation fee • CME for consultants • Counseling for seat allocation • Annual fees for Board Certification • Professorship and fellowships-Registration fee • Communication Fees / SMS / Email / Fax • Annual contribution for teleconferencing etc. • Online journal, materials, library facilities

Grant from MOHFW

1. Submission of proposals to MOHFW for one time grant for Regional Center, Learning Resource centre at NBE 2. Submission of proposals to MOHFW for one time grant for starting DNB courses for Government doctors under National Rural Health Mission or other National Health Programmes • Clinical Skills in management of chronic diseases (Non communicable diseases, Diabetes, Cancer, CAD) for government doctors • Essential surgical skills , Obst. & Pediatric Care and Anesthesia for government doctors • DNB courses in Epidemiology, Occupational Health, Entomology, Disaster Management • DNB ( Family Medicine) under NRHM 3. Submission of proposals to MOHFW for one time grant for construction of Academic block for NBE

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4.17. Grant of statuary status for NBE by an Act of Parliament

In view of the mandate given to NBE in its Memorandum of Association,(MOA) the objectives of the NBE requires it to ensure uniform high standard of post graduate medical examination in the country at the national level, to develop general principles and with newer methods of examinations,(i,ii,iii,iv,v); formulate courses and curriculum as per national requirement, experiment with newer methods of education, and to achieve high standard of post graduate medical education in the country (vi,xx,xxi,xii,xiii,xvi,xvii); to undertake, aid, promote, guide, coordinate, document research of high caliber in medical sciences ( xiv,xxiii,xxiv,xv); to cooperate, coordinate, maintain liaison with professional associations, bodies, societies, colleges, universities, commissions, national and international bodies, concerned with raising the standards of medical education (vii,viii,xix,xv,xviii,xiv,xx,xxi,xxii) etc. can only be fulfilled if the Board is able to function as a fully autonomous body with a statuary status.

Since the NBE autonomous by the Registered Society Act, and is not a statuary body by an Act of the Parliament, its degrees, courses, examination mechanisms etc. has been placed in the schedule-1 of the Medical Council Act 1956, and the Post-graduate Medical Education Regulations 2000 are applicable to the degrees awarded by the Board. The mandates given to NBE for innovation in post gradate medical education and in examination pattern can only be achieved if it is de-linked from PG regulations of MCI and a statuary status is granted to NBE by an Act in parliament.

This issue has been discussed in the various expert group committee appointed by the MOHFW, Govt. of India, from time to time as follows:

The expert committee appointed by the MOHFW, GOI, under the chairmanship of Dr. A.K. Mukherjee, DGHS, in 1994, to discuss the proposal for grant of statuary status to NBE, observed that: ..”granting of statuary status to the Board will help to improve the manpower requirements at post graduate and post doctoral level especially the medical professionals serving in the rural and district level hospitals. …..Once the statuary status is granted to NBE India will be in a the inevitable position to have impact on the neighboring countries who would like their doctors to take up our examinations.……This examination which has acquired very high peer rating can look forward for reciprocal relationship with countries like UK. Australia and USA.…..The statuary status for NBE does not conflict with the MCI, as precedent of autonomous statuary status for AIIMS, New Delhi, PGI, Chandigarh has already been existence for many years.……The role of NBE in conduct of post graduate and post doctoral examinations of high and uniform standard is well settled…..in future the private sector is going to play a major role in the delivery of health care services.

The report of the Committee on Post graduate Medical Education, constituted by the MOHFW, GOI, under the chairmanship of Prof. Ranjit Roy Chaudhury, in 2007, also recommended to establish the Post graduate medial Education Board of India, by an Act of Parliament.

It was recommended that all efforts be made by NBE to acquire statuary status by an act of parliament.

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4.18. Formulation of operationalisation plans for NBE development & restructuring

In view of the recommendations made by the expert groups for further expansion and development of NBE, it was recommended that strengthening of infrastructure and staff poison at NBE must be done on a priority basis.

The members noted that the sanctioned strengthened of the regular staff had been 78 in 1976 when the Board was established, which has remained more or less the same till date. The members were informed that the NBE office had submitted a restructuring and strengthening plan in the Tenth Five Year Plan. The Governing Body in 2006 had appointed a Committee under the chairmanship of the then DGAFMS, Surg. Vice Admiral V.K. Singh, to suggest restructuring plan for NBE , the same was approved by the Governing Body in its meeting held on 6.9.2006 and 16th December 2006 and implemented wef 1.1.2007. However in view of the suggestions given by the expert group members as above, and due to some anomalies found in the 2006 restructuring plan, it is recommended that the current RR of the NBE be reviewed by the RR committee. And appropriate action be taken to increase the strengthen of the officers and the staff, in the NBE head quarter and the proposed regional centers. .

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V. List of documents submitted for perusal of working group committee members

1. Memorandum of Association of National Board of Examinations. 2. Annual report for the year 2007-2008. 3. Standard Operating Procedures for Registration, Thesis, Practical Examination, Final Examination, Periodic Appraisal Mechanism. 4. Standard operating procedure for Accreditation inspection format, minimum criteria for Accreditation and list of Hospitals for DNB programmes. 5. Accreditation calendar and examination calendar. 6. Current Curriculum for various courses being conducted by NBE. 7. Draft Curriculum received for DNB Gynecology-Oncology concept paper on DNB in Epidemiology, Occupational Health, Disaster Management and Entomology for inservice doctors in the Government sectors. 8. Draft Curriculum proposed by experts for DNB in Marine Medicine and High Altitude Medicine. 9. Proposal for Introducing Certificate course in Chronic Disease (Non Communicable) and Emergency Obstetrics care, Pediatrics care and Anesthetic care for inservice doctors under various National Health Programmes. 10. Copy of MCI Post Graduate Medical Education Regulation – 2000. 11. Communication Mechanism at NBE. 12. Grievances Redressal system of NBE. 13. List of Learning materials available in the form of DVD. 14. CME Modules for training of Consultants and DNB candidates. 15. Circulars of Ministry of Health and Family Welfare and Gazette notification related to DNB qualification. 16. Report of Expert committee set up by Ministry of Health and Family Welfare under the chairmanship of Dr. A K Mukherjee DGHS for grant of statutory status to NBE. 17. Communication from Dr. Manmohan Singh, Dr. C P Thakur, Minister of Health and Family Welfare dated 20th June 2000 requesting to consider proposal of giving statutory to NBE. 18. Copy of expert committee meeting under the chairmanship of Dr. Ranjit Roy Chaudhary to constitute and independent body to organize and regulate Post Graduate Medical Education-Feb 2007. 19. Copy of Information Bulletin CET – Broad Specialty, CET Super Specialty, Post Doctoral Fellowship. 20. Copy of Information Bulletin Final Examination. 21. Copy of Information Bulletin Screening Test for Foreign Medical Graduate along with although circulars and screening test regulations. 22. Feed back forms received from DNB candidates and consultants during CMEs conducted during 2008-2009