In orthopaedics, postgraduate training in India is offered through two routes: the MS (Master of Surgery) and the DNB (Diplomate of the National Board).

The DNB Orthopaedics is a three-year course accredited by the National Board of Examinations (NBEMS), offering preparation in the diagnosis and treatment of musculoskeletal disorders, joint replacement, pediatric orthopaedics, cancer, sports injuries, and other related specialities.

This article provides an overview of DNB Orthopaedics in India, including its structure, eligibility criteria, admission procedure, and employment opportunities. Keep reading for a detailed insight.

Overview of DNB Orthopaedics

DNB (Orthopaedics) is a 3-year intensive specialist program by NBEMS, preparing a doctor to become a comprehensive orthopaedic care provider, including trauma, paediatrics, and sports injuries. It is considered equivalent to MD/MS, focusing on clinical, surgical, research, and teaching competencies.

DNB (Orthopaedics) is a specialist training program that provides competency-based training in accredited hospitals, aiming to produce skilled orthopaedic surgeons with clinical, surgical, teaching, and research expertise in the field.

The trainees cope with a wide range of conditions, including fractures and deformities, infections, joint pain caused by arthritis, tumours, and sports injuries, under the guidance of experts. The qualification of DNB (Orthopaedics) can be recognised as the same as the orthopaedic MD/MS on completion.

Key Points:

• Program Length: 3 years (full-time) of clinical orthopaedic training.
• Awarding Body: National Board of Examinations (NBEMS), which is an independent government agency under the Ministry of Health.
• Degree: DNB in Orthopaedics, considered on par with MD/MS Orthopaedics.
• Focus Areas: Bone and joint pathology, trauma care, pediatric orthopaedics, sports injuries, biomechanics, imaging, perioperative care, and research and teaching capacities.

What is the Eligibility and Admission Process?

Applicants must also satisfy (1) completion of an MBBS programme in an institution recognised by the NMC (previously MCI), (2) have one-year mandatory rotatory internship, and (3) permanent medical registration.

Once a student has passed the NEET PG, they are subjected to centralised counselling (all-India and state quotas) regarding DNB seats. Allocation of seats is made on a rank-and-preference basis. DNB seats are included in the NEET PG allotment, and no special entry test is required for the program.

There is also a different post-diploma pathway; doctors with a recognised Diploma in Orthopaedics (D.Ortho) can take the DNB Post-Diploma Orthopaedics (a 2-year course) through the NBE Post-Diploma CET (PDCET). Some of the major eligibility criteria are:

• Basic Eligibility: MBBS degree plus 1-year internship plus a valid NEET PG score.
• Counselling: Seats are allocated through centralised counselling conducted by NEET PG (DNB Quota).
• Post-Diploma Route: MBBS + Diploma in Orthopaedics, and then DNB (Post Diploma) through NBEMS PDCET.
• Quota: Covers all-India (All India DNB quota) and state quotas (according to national medical counselling policies).

What is the Curriculum and Training Structure?

The DNB Orthopaedics curriculum (according to the NBEMS standards) is widely-based and comprehensive, combining basic science and clinical orthopaedics. It is structured according to essential subjects and skills, allowing trainees to gain in-depth knowledge and practical skills.

Key components include:

• Basic Sciences: Bone and joint anatomy, physiology, histology, pathology, and biochemistry involved in orthopaedics. They include biomechanics (e., gait analysis, prosthesis mechanics) and imaging modalities (X-ray, CT, MRI, USG).
• Fracture and Trauma Care: Management of fractures, management of internal and external fixation, management of polytrauma (ATLS protocols), compartment syndrome, fat embolism, open fractures, and amputations.
• Infections and Inflammatory Conditions: Infectious arthritis diagnosis and treatment of osteomyelitis (acute/chronic), septic arthritis, tuberculosis of bone/spine, and diagnosis/treatment of other infections.
• Arthritis & Joint Disorders: Degenerative (osteoarthritis), inflammatory (rheumatoid, ankylosing spondylitis, gout), neuromuscular (Charcot joints), and post-traumatic arthritis.
• Joint Replacement & Reconstruction: Signs and methods of arthroplasty (hip, knee, shoulder), osteotomies, arthrodesis, and prosthesis complications.
• Pediatric Orthopaedics: Congenital disorders (DDH, clubfoot), developmental dysplasia, pediatric fracture, cerebral palsy, neuromuscular deformity (CP, poliomyelitis).
• Musculoskeletal Oncology: Assessment and resection of bone/soft tissue tumours, biopsy methods, limb-salvage, chemotherapy, and radiotherapy.
• Sports Medicine & Miscellaneous: Ligament ruptures, meniscal ruptures, arthroscopic principles, tendinopathy, and sport (e.g. ACL ruptures, rotator cuff ruptures).
• Other Topics: Spine pathologies, peripheral nerve pathologies, hand surgery, deformities, rehabilitation, biomechanics, ethics, research methodology, and community orthopaedics.

Training is practical, and residents operate in the wards, clinics, and operating theatres. They also acquire supervised experience in the processes of casting, fracture fixing, joint replacement, and deformity repair.

At the final, applicants should demonstrate competence in patient care, surgery, teaching, and research, complete a thesis, and maintain case logbooks, in accordance with the NBEMS guidelines.

DNB Orthopaedics vs Other Courses

Medical students often compare the DNB Orthopaedics pathway with the MD/MS and Diploma pathways. While DNB and MD/MS have a similar entrance exam in NEET PG, the courses have diploma and post-diploma entry pathways, with different qualifying exams. Each of the qualifications is widely recognised nationally and has unique training time and frameworks.

Medical students tend to make comparisons between the DNB and other orthopaedic qualifications. The table below shows some significant differences between orthopaedic postgraduate courses:

Course	Duration	Eligibility	Entrance Exam	Awarding Body
DNB (Orthopaedics)	3 years (post-MBBS)	MBBS + 1-year internship	NEET PG (NBE)	NBEMS (NBE)
MD/MS (Orthopaedics)	3 years (post-MBBS)	MBBS + 1-year internship	NEET PG (NBE)	NMC (MD/MS certificate)
Diploma in Orthopaedics (D.Ortho)	2 years (post-MBBS)	MBBS + 1-year internship	NEET PG / State Diploma CET	NMC (Diploma certificate)
DNB (Post-Diploma) Ortho	2 years (post-D.Ortho)	MBBS + Diploma in Orthopaedics (D.Ortho)	PDCET (Post Diploma CET by NBE)	NBEMS (NBE)

Examination Pattern (Theory and Practical)

The DNB Orthopaedics final examination is a comprehensive test conducted in two parts, comprising theory and practical components. To take the sensible, which consists of OSCE stations, case presentations, and viva voce examinations, applicants must first clear four theory papers. The pass rate is generally very low because the format is challenging.

The DNB Orthopaedics end assessment consists of two phases (theory and practice) and is reputed to be challenging. Based on NBEMS regulations, the exam content consists of a theory exam comprising four papers (each 3 hours long, 100 marks) and ten short-answer questions on each paper.

To be eligible, the candidates should have a minimum of 200 out of 400 in aggregate. Only those who succeed in the theory exam are allowed to proceed to the practical. The practical exam will have a mark value of 300, and it will include an OSCE (Objective Structured Clinical Examination) question.

Additionally, there will be a discussion of clinical cases and a viva voce examination. As a rule, the test takes place in two days; one day is devoted to the OSCE stations and the viva on the instruments, and another day is dedicated to the long cases and more vivas. Specifically:

• OSCE Stations: A succession of 15-25 brief stations (e.g. 1-3 minutes each) in which the candidates complete specific tasks (e.g. identify instruments, interpret X-rays, demonstrate manoeuvres). Practical skills and time-based clinical reasoning are tested in these stations.
• Clinical Cases: Conventional long and short case presentations on real or simulated patients, including history, examination, investigations, and management.
• Vivas: Oral exams with a discussion of instruments, implants, new developments, and essential issues in orthopaedics.

To pass, candidates must achieve at least 150 out of 300 in the practical. With this rigorous assessment, the overall pass rate of DNB Orthopaedics is traditionally low (around 30-40%). Notably, when a candidate fails the practical but passes the theory, they are allowed to take three attempts, as per NBE regulations.

Key Exam Facts:

• Theory: 4 papers × 100 marks; 10 short answers per paper. Minimum 200/400 to clear.
• Practical: 300 marks total, includes OSCE stations and vivas. This needs 150/300 to pass.
• Attempts: A maximum of 3 attempts in a practical examination following the passing of the theory.
• Format: The standardisation of practical evaluation was introduced with the introduction of the OSCE (Objective Structured Clinical Examination) format.

DNB OSCE (Practical Exam Format)

The DNB Orthopaedics OSCE is a station-based test that is structured and used to objectively evaluate clinical and practical skills. Applicants are assigned a series of tasks to perform under time pressure, so they must prepare for real-life situations that require similar time constraints. Time management is the key to passing the test.

The NBE has recently introduced OSCE (Objective Structured Clinical Examination) in the DNB practical exams to have an objective assessment of skills. During the DNB Orthopaedics OSCE, candidates are assessed through numerous brief stations (usually 20-25), each involving a specific task.

The duration of each station is typically 1-3 minutes, and each station has a score sheet. Through this format, a wide range of knowledge and skills is represented. Preparation includes tips on how to prepare for the OSCE, which include:

• Practice Common Tasks: Memorise names and uses of instruments, implant and radiographic appearances.
• Study Clinical Scenarios: Be prepared to know the main steps in outlining history/exam in general conditions (e.g., “How to examine a patient with knee pain?).
• Time Management: In mock OSCEs, practice in speaking brief answers using strict time constraints.
• Resource Lists: Refer to published station lists from OSCE or training modules (conceptual ortho apps, review courses) to find high-yield practice cases.

The OSCE can be addressed systematically with preparation. It is essential to note that the NBEMS guidelines explicitly assume that the most basic competencies should be demonstrated in the following stations.

Preparing for DNB Orthopaedics

To succeed in DNB Orthopaedics, one must engage in systematic study, gain exposure in a clinic, and undergo constant revision. Techniques such as mapping syllabi, conducting group discussions, presenting case studies, participating in OSCE exercises, and reviewing previous papers help build confidence and prepare for exams. The most important aspects include active learning and effective time management.

To pass the DNB (Orthopaedics) exams, one needs to study diligently and practice regularly. Medical students can use the key strategies:

• Understand the Syllabus: Familiarise yourself with the course materials by going over the NBEMS topics in the curriculum. Divide it into subjects (e.g., trauma, paediatrics, tumours) and get the fundamentals (anatomy, physiology) straight.
• Join Study Groups: Create a DNB club with classmates and present cases daily, ask one another questions, and debate the subject. NBE highly recommends group learning to aid in exam preparation.
• Case Presentations: Consider the clinical presentation (history, examination, investigations, management) of traditional clinical cases regularly. Primary conditions (e.g., “Approach to limp child”) should use a flashcard or child notes and practice orally.
• Old Question Papers: Practise past years ‘ DNB Orthopaedics theory and viva questions (found online) to get acquainted with the type of questions.
• Visual Learning: Videos, flowcharts, and complex topics (such as orthopaedic procedures and anatomy) should be supplemented with the use of diagrams. Clear and neat handwriting will assist in theoretical writing.
• OSCE Drills: Mimic the events of an OSCE by timing station activities (identification of instruments, X-rays). Refer to such sources as Conceptual Orthopaedics checklists or textbooks.
• Attend Teaching Sessions: Participate in seminars/CME/learning material (e.g. OrthoTV webcasts). But also focus on self-study.

Knowledge is strengthened by regular revision of topics and active learning. Have a well-structured program that combines both clinical and study activities.

The National Board recommends a minimum of 1 hour of self-studying per day, and an active role in departmental teaching rounds.

Key Skills and Competencies

The NBEMS competency standards of DNB Orthopaedics focus on clinical assessment, surgical skillfulness, emergency management, and diagnostic reasoning. The trainees will be expected to develop the skills of effective communication, teaching, and research to emerge as well-rounded, autonomous orthopaedic specialists.

NBEMS competency guidelines (2017 curriculum) outline attributes expected of DNB (Ortho) specialists. Major skills include:

• Clinical Evaluation: Skills in taking the history and investigating the musculoskeletal system (all joints, spine, limbs). It is imperative to distinguish typical patterns (e.g. neuropathic vs inflammatory arthritis).
• Surgical Skills: Skills to carry out or assist in necessary surgeries: fracture fixation, joint replacements, arthroscopies, spine surgeries (basic), deformity corrections, and emergency surgeries. The use of safe surgery and post-operative procedures is put to the test.
• Emergency Care: Orthopaedic emergencies, resuscitation of trauma (principles of ATLS), compartment syndrome, septic joints, etc.
• Interpretation: Fluent in reading X-rays, CTs, and MRIs on orthopaedic cases. Placing and reading blood tests (e.g. ESR/CRP for infection) and ultrasound when required.
• Decision-Making: Formulation of alternative diagnosis and evidence-based treatment (nonoperative vs operative).
• Communication: Getting patients and family members to understand the diagnoses and plans using simplistic language. Counselling on disability prevention and rehabilitation.

The training should produce surgeons capable of working independently on essential orthopaedic cases and making significant contributions to the speciality. According to NBEMS, candidates are expected to be highly skilled specialists who possess a wide range of skills.

Career Prospects after DNB Orthopaedics

Once a doctor has completed DNB (Orthopaedics), they can pursue a career in clinical practice, super-specialisation, teaching, or research. The qualification is the same as MD/MS and provides various opportunities to serve in a hospital, as a fellow, or as an independent practitioner in India and overseas.

Once DNB (Orthopaedics) is completed, a doctor can take several career options:

• Clinical Practice: As consultants or specialists, work in government or private hospitals. DNB is entirely qualified to work in the teaching field; the direct equivalence to MD/MS is granted (but each institution may have its own criterion). DNB surgeons may enter as senior residents or consultants.
• Super-Specialisation: Take further training (DM/MCh or DNB Super Speciality) in disciplines such as Spine Surgery, Pediatric Orthopaedics, Hand Surgery, and so on. Eligibility is through NEET-SS or related exams.
• Fellowships and Skills Upgradation: Those who graduate choose short-term fellowships or senior residencies at trauma or arthroplasty centres, or abroad (e.g., UK, Australia).
• Academia and Teaching: A DNB may become a teacher of medical colleges with experience (or other MD vs. DNB equivalence and, in some cases, an extra year of senior residency). 

NBEMS states that broad speciality DNB is identical in every aspect to MD/MS; however, there may be some regulations that mandate additional higher residency requirements for academic appointments.

• Research and Industry: There is an opportunity to explore research projects, develop a device/implant, or write about medicine, aligned with their interests.

In India, orthopaedic surgeons face a high demand due to the prevalence of trauma cases and an ageing population. DNB Ortho specialists can practice independently or in groups.

The compensation at the entry level is relatively small, but it increases significantly with experience among consultants. Nevertheless, emphasis needs to be on skills development among trainees.

FAQs about DNB Orthopaedics in India

1. What career options are available after DNB Orthopaedics?

Graduates can practice as consultants, senior residents, or registrars in a hospital, pursue fellowships, or participate in the research and development of medical devices.

2. Can DNB Orthopaedics graduates pursue super-specialisation?

Yes, they can take super-speciality examinations, such as MCh or DNB (S) in areas like Spine Surgery, Pediatric Orthopaedics, and Hand Surgery; typically through NEET-SS.

3. Are DNB Orthopaedics graduates eligible for teaching positions?

DNB is considered equivalent to MD/MS for teaching purposes. Academic appointments can, however, be mandated by other institutions to have more senior residency experience or other documentation.

4. Can DNB Orthopaedics be pursued abroad or recognised internationally?

Although DNB is recognised in India, its international recognition varies by country. Certain countries accept DNB as a fellowship or as a licensing examination; however, additional requirements or examinations may be necessary.

5. What kind of surgeries do DNB Orthopaedics trainees learn?

Under supervision, trainees are involved in and engaged with the practice of clinical surgery, including fracture repair, joint replacement, arthroscopies, deformity repair, and emergency procedures.

Conclusion

DNB Orthopaedics requires hard work, discipline, and a learning spirit. This demanding program will provide comprehensive knowledge and practical skills in the training program. Success depends on meeting the eligibility requirements (MBBS with internship, NEET PG qualification) and adequately preparing for the theory and OSCE exams.

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