The outcomes of the DNB examinations

For the DNB examinations (8) we find that there are four theory papers, each of which consists of 10 short notes of 10 marks each, to be completed in three hours. If the examinees pass this, they will be allowed three attempts to clear the practical examinations.

Now if we compare the methodology of the NBE with that of those enumerated in the previous section, the irrationality and outdatedness of the method becomes evident. Unless a student passes in these 40 essay-type questions, that cannot measure performance or competence in any way, there is no question of the practical examinations or logbook or dissertation being of any value.

The essay type questions (and MCQs) can only judge the cognitive aspects of knowledge (“knows”) and competence (“knows how”) of [C1]the student. For the assessment of higher aspects, the [C2]competence (“shows how” ) and (performance (“does”), these essay type questions are simply inadequate. The knowledge pyramid shows the transition of data to information (organised data with content and perspective), from there to knowledge (useful information that can be used as a guideline), and finally to wisdom (understanding and making the knowledge useful or applicable). Bloom’s taxonomy (9) has conceptualised the cognitive domain through the successive steps of knowledge, comprehension, application, analysis, synthesis and finally evaluation. It was later modified (10) through the sequential steps of remembering, understanding, applying, analyzing, evaluating, and ultimately creating. In the affective domain, Bloom’s taxonomy has been represented through receiving, responding, valuing, organising and conceptualizing, and eventually characterising by value or value concept. In the psychomotor domain, Bloom’s taxonomy evolves through the order of imitation, manipulation, precision, articulation and naturalisation. The DNB examinations do not take care of these which should have been accorded due weightage to further the founding vision of the organisation.

Further, the pass rates through this obsolete method of theoretical knowledge testing are hardly 15-25%, and often as low as 4-6% in disciplines like orthopaedics and anesthesiology (11). And the handful of those who pass are not recognised by the MCI unless they possess an MD (Doctor of Medicine ) or MS (Master of Surgery) that are the MCI-recognized post graduate degrees, defeating the very purpose of DNB. Many of those who clear DNB do already possess MD , but the possession of degree or its lack should not interfere with the results/certification of DNB being accepted by the MCI. Of course, anyone who has cleared DNB exams, especially in the last couple of years, is no less than a genius. But does it mean that the vast majority, especially those who have been fortunate enough to have completed their rigorous training in highly reputed hospitals, are good for nothing? The National Board approves certain hospitals for imparting training and allows them to collect fees up to Rs 50,000 per annum. However, since the pass rates of the trainees from most such hospitals are dismal, the examinations formally declare that the centres approved by the Board are not fit to train the trainees sufficiently to pass the examinations even with repeated attempts. So, what is the value of the approval and the thorough and painstaking training that many such hospitals offer?

Are the pass rates of DNB examinations reflective of quality or farce? During the DNB practical exams the examiners do not even bother to look at the logbook or dissertation.What are these for, then? Not even looking at the logbook means that the meticulous training at the approved centers count for/amount to nothing. In many other countries like the UK (12), Hong Kong (13) and Oman (14), the logbook is given due importance. To make effective use of technology, the UK and Ireland have already operationalised the Pan-Surgical Electronic Logbook (15).

To make matters worse, the NBE does not formally publish the pass rates or even the rating criteria. At present it does not even send candidates their marksheets. However, a recent notification announces that starting in December 2009, marks will be provided, but only to unsuccessful candidates (16). In other words, those who pass are not entitled to know how they have fared in the examinations.

The time may have come to rename it the National Board of Eliminations.