DNB Diploma In Family Medicine in India: Check out NBE released Curriculum
The National Board of Examinations (NBE) has released the Curriculum for Diploma in Family Medicine.
I. Introduction to Family Medicine
B. Cardiovascular and Respiratory
o Cough
o Chest Pain
o Dyspnoea
o Palpitations
o Hemoptysis
C. Central Nervous System/ Eye/ ENT
o Dizziness
o Deafness and hearing loss
o Painful/Discharging Ear
o Red/ painful eye
o Reduced Vision
o Faints and fits
o Headache
o Hoarseness
o Sore Throat
o Sleep disorders
o Unconscious Patient
o Paralysis/weakness
D. Musculoskeletal System
o Arthritis
o Back pain
o Facial pain
o Neck pain
o Shoulder pain
o Hip and buttock pain
o Painful leg
o Painful knee
o Pain in foot and ankle
o Pain in arm and hand
o Painful elbow
o Limp
E. Mental Health
o The disturbed patient
o Depression
o Anxiety
o Substance abuse
o Agitated patient
o Medically unexplained physical symptoms
o Grief
F. Miscellaneous
o Neck Lumps
o Weight gain/ loss
o Mouth ulcers, leg ulcers
o Edema
o Urinary Problems
o Obesity
G. Social Issues
o Domestic violence
o Sexual assault
o Child abuse
o Elder abuse
H. Infectious Diseases
o Fever with localizing symptoms
o Acute undifferentiated fever
I. Skin Problems
o Pruritus
o Skin Ulcers
o Hair and Nail Disorders
o Skin-Rash,Vésicules, Pigmentation, Plaques, Nodules, Bullae
J. Sexual Health/ Genital Symptoms
o Erectile dysfunction
o Inguino-scrotal lumps
o Scrotal pain
o Disorders of the penis
o Disorders of the prostate
o Sexually Transmitted Diseases
o Infertility
o Contraception
K. Common Chronic Diseases
o Allergy
o Asthma
o COPD
o Epilepsy
o Hypertension
o Diabetes
o Dyslipidemia
o Ischemic Heart Disease
4. Emergency Medicine
The Family Medicine physician should possess the skills to recognize and treat the following common emergencies and to arrange to transport to tertiary care, those patients requiring more sophisticated treatment.
• Acutely Dyspnoeic Patient
o Chest Pain
o Cardiac Arrest
o Loss of Consciousness
o Seizures
o Paralysis
o Epistaxis
o Acute Gastrointestinal Emergencies
o Trauma including road traffic accidents, sexual assault, victims of violence, mass casualty, drowning, and near-drowning
o Hemoptysis
o Acute burns
o Acute musculoskeletal disorders including fractures, sprains, dislocations and compartment syndromes
o Common poisonings, animal bites and stings
o Environmental disasters (floods, earthquakes, Etc.)
o Acute urinary system disorders including retention and anuria
o Psychiatric emergencies
o Choking
o Shock
IV. List of Skills and Procedures
The resident's list of skills should be able to perform independently after completion of the course is given below:
1. Medicine
o Elicit history and perform detailed clinical examinations of the adult patient, who presents to general medicine outpatient or emergency
o Cardiopulmonary resuscitation
o Chest drainage with under-water seal
o Ascitic tap
o Bladder catheterization
o Lumbar puncture
o Peripheral vascular access
o Nebulization therapy
o Gastric lavage
o Oxygen therapy
o Pleural fluid aspiration
o Interpretation and application of results of ECG / Chest X-ray / USG/ CT scan
2. Pediatrics
o Resuscitation of newborns
o Vascular access: emergency and elective
o Lumbar puncture
o Intraosseous line placement
3. Anesthesia
o Local and regional anesthesia
o Spinal anesthesia
o Intravenous anesthesia
4. Surgical procedures
o Assessment and closure of simple wounds
o Assessment and management of simple burns
o I & D of a superficial abscess
o Excision of simple, superficial skin and subcutaneous lesions
o Trauma assessment - triaging and primary/ secondary surveys
o Management of ulcers
5. Obgyn procedures / contraceptive procedures
o Pap Smear
o Conduct Normal Labor
o Conduct Assisted Vaginal Delivery
o Cervical Biopsy
o Dilatation and Curettage
o Manual Vacuum Aspiration
o Non-Scalpel Vasectomy
o Iucd Insertion
o Tubal Ligation
6. Ophthalmology
o Examination of the eye using a torch
o Fundus examination using an ophthalmoscope
o Epilation
o Removal of a superficial foreign body under the supervision
7. Orthopedic procedures
o POP application
o X-ray interpretation
o Manipulation and closed reduction of fractures and dislocations
o Application of splints
o Intra-articular injections
o Health education for back problems and chronic arthritis
o Basic physiotherapy advice
V. Rotations for the Diploma in Family Medicine
The residents will be rotated in the different departments of the district hospital/ or accredited training center for twenty months and the Community Health Centre for four months. They must spend one day each week during the rotations in the different departments in the Community Health Centre (CHC) under the supervision of a consultant.
| Year 1 | |
| Foundation course | 15 days |
| General Medicine | Three months |
| Pediatrics | Two months |
| Obstetrics and Gynecology including one month of labor room and one month of Gynecology OPD | Two months |
| General surgery OPD and minor OT including anesthesia | One month |
| Orthopedics OPD | 15 days |
| ENT | 15 days |
| Ophthalmology | 15 days |
| Community health center | 15 days |
| Dermatology | One month |
| Physical medicine and rehabilitation | 15 days |
| Total | 12 months |
The resident will be posted in the CHC once in two weeks.
| Year 2 | |
| Psychiatry | 15 days |
|
Accident and Emergency | Two months and fifteen days |
| Pediatrics | Two months |
| OBG including one month of labor room and one month of Family Planning | Two months |
| General Medicine | Two months |
| Community health center | Three months |
| Total | 24 months |
| Note: during the first year, the residents should visit the community health center once in two weeks for follow up of patients, learn continuity of care for a defined population, and be trained in the Family Medicine setting. During the final three months in the community health center, they have to spend one day of the week in the General Medicine department of the district hospital for seeing patients in the OPD and for academic activities under the guidance of the faculty. The educational supervisor for the resident will be from the General Medicine department of the district hospital if no faculty with Family Medicine qualification is available. | |
VI. Postgraduate Teaching Program
In addition to the clinical postings, students will be required to attend individual teaching sessions as follows and should obtain 80% attendance.
1. Seminar/clinical demonstrations weekly.
2. Knowledge needed for this rotation
i. Infectious diseases
o Rational Antibiotic Therapy
o Pneumonia
o Tuberculosis
o Human Immunodeficiency Virus Infection
o Malaria
o Typhoid
o Urinary Tract Infections
o Leptospirosis
o Rickettsia
o Sexually Transmitted Disease
o Leprosy
o Kala-Azar
o Pyrexia of unknown origin
o Septicemia
ii. Cardiology
o Hypertension
o Congestive Heart Failure
o Rheumatic Heart Disease
o Coronary Artery Disease
o Cardiomyopathy
iii. Respiratory system
o Asthma / COPD
o Bronchiectasis / Lung Abscess
o Occupational Lung Disease
o Bronchogenic Carcinoma
o Severe Acute Respiratory Illness
iv. Gastroenterology
o Acute Diarrhoea
o Chronic Diarrhea
o Malabsorption
o Acute and Chronic Hepatitis
o Cirrhosis Liver
o Alcoholic Liver Disease
o Acute and Chronic Pancreatitis
v. Nephrology
o Acute renal failure
o Chronic Renal Failure
o Obstructive uropathy
o Recurrent UTI
vi. Metabolic diseases
o Diabetes Mellitus
o Hypo and Hyperthyroidism
o Addison’s Disease
o Cushing’s disease
o Electrolyte disturbances
o Hypocalcemia and Vitamin D deficiency
vii. Hematology
o Anemia
o Pancytopenia
o Bleeding Disorders
o Leukemia
o Lymphoma
viii. Neurology
o Stroke
o TIA
o Headache
o Seizure Disorders
o Cranial Nerves
o Meningitis
o Encephalitis
o SOL
o Peripheral Neuropathy
o Parkinsonism
ix. Toxicology
o Initial management of poisoning including legal aspects
o Breastfeeding, feeding difficulty, feeding in particular situations (LBW, Cleft palate, HIV or TB in mother)
o Common problems in Neonate; establishing feeding, tachypnea in newborn, anemia
o Prematurity and Low-birth weight
o Neonatal seizures
o Neonatal Jaundice
o Neonatal sepsis
iii. Common conditions in children:
o Frequent infections, including Sepsis/septicemia, Meningitis, Tuberculosis, HIV, malaria, UTI.
o Respiratory infections, asthma, stridor and bronchiolitis
o Nutritional disorders, including malnutrition, obesity, and common vitamin deficiencies
o Rheumatic Fever
o Heart failure in children including Congenital heart diseases
o Infections of the skin, drug reactions, allergic skins disease,
o Anemia in children, Thrombocytopenia, bleeding disorders, thalassemia
o Renal disorders including Nephritic syndrome, nephrotic syndrome,
o Developmental delays and Cerebral palsy
o Behavioral problems, including nocturnal enuresis, ADHD
iv. Growth & development of children:
o Physiological influences on normal growth in childhood
o Physiological changes from birth to adulthood, puberty, and adolescence
o Normal feeding and eating behavior from birth to adulthood
o Growth & main developmental milestones of children 0-5 years
v. Childhood immunization in India: Both UIP and IAP schedule:
Procedures: At the end of the rotation, the student will perform the following procedures
Independently:
o History taking and examination
o Prescribing in children
o Neonatal resuscitation
o Developmental assessment
o Anthropometry of a child, interpretation of growth chart
o Blood culture, Lumbar puncture
o Intravenous access
o Suprapubic aspiration for the urine sample
o Intraosseous line insertion
4. Labor room: At the end of the posting, the student will be able to:
i. Do the following skills independently:
o Elicit history and perform a thorough physical examination of women who present to the labor room.
o Conduct normal delivery
o Repair episiotomy and perineal tears
o Monitor women in labor and on augmentation with oxytocin
o Insert cervical ripening agents
o Read cardiotocograph and interpret
o Explain with empathy the progress and ongoing management to the expectant mother and relatives
ii. Do the following skills with the assistance?
o Operative delivery (Vacuum extraction / low forceps)
o Management of postpartum haemorrhage
The student should also have acquired knowledge about the following clinical problems through management, observation, discussion, and self-directed learning:
o Management of pre-eclampsia and eclampsia
o Indication of induction/augmentation of labor
o Management of shoulder dystocia
o Management of term and pre-term rupture of membranes
o Management of women presenting with meconium-stained liquor
o Management of malpresentation
o Indication for operative delivery
o Immediate post-natal monitoring and management
5. Surgery objectives (OPD and minor OT only)
At the end of the surgical rotation, the trainee should be able to:
o Develop the knowledge needed to take an accurate and relevant surgical history and perform a physical examination.
o Demonstrate knowledge in the pre- and post-operative management of common surgical conditions and associated complications.
o Develop the clinical skills required to competently diagnose, investigate, refer and manage common surgical conditions in a community health center
i. Common surgical conditions
Experience and expertise should be gained in the recognition and appropriate evaluation and initial management of the following common conditions:
o Abscess, hematoma, and cellulitis
o Abdominal mass
o Altered bowel habits
o Breast infection
o Breast lumps
o Burns
o Intermittent claudication
o Foreign bodies
o GIT bleeding
o In-growing toenails
o Leg ulcers
o Lumps in the groin
o Lumps in the neck
o Perianal conditions
o Peripheral vascular disease
o Pilonidal abscess/sinus
o Prostate disease
o Rectal bleeding
o Renal pain
o Scrotal swellings/pain
o Urinary tract obstruction
o Voiding difficulties
o Wounds - simple and complex infections
ii. Common surgical skills and procedures
o Local wound infiltration with anesthetic
o Suturing lacerations
o Incision and drainage of abscesses
o Drainage of hand infections
o Drainage of perianal abscess
o Removal of foreign bodies, e.g., splinters
o Correct application of dressings and bandages
o Burns dressings
o Proctoscopy
o Avulsion of toenail
o Removal of pure benign tumors/cysts such as sebaceous cyst, lipoma
o Lymph node biopsy in neck
o Fine needle aspiration cytology
o Urethral catheterization
iii. Anesthesia skills to be learned during a surgery rotation
o Assessment of a patient for anesthesia
o Physiology and pharmacology of local, field, digital and ketamine anesthesia
o Local anesthesia
o Field block
o Digital block
o Wrist block
o Ketamine anesthesia
6. Dermatology
At the end of the posting, the student will be able to perform these skills independently:
o Describe a skin lesion
o Skin scrape for mycology/scabies
o Give an intralesional injection of corticosteroid
o Perform a skin biopsy
The student should also have acquired knowledge about the following conditions/clinical problems through self-reading, observation, or discussion.
i. Diagnosis and management
o Acute dermatological conditions:
o Impetigo and Cellulitis
o Herpes zoster
o Acute contact dermatitis
o Oral ulcers
o Drug rash
o Common viral rashes including Varicella, Measles
o Angio edema/ Anaphylaxis
ii. Chronic dermatological conditions:
a. Eczema
b. Skin lesions due to systemic illnesses
c. Infections:
o Fungal and yeast infections: Candida, pityriasis Versicolor, tinea.
o Viral infections: molluscum contagiosum, viral warts, pityriasis rosea
o Infestation: scabies, lice, insect bites
d. Psoriasis
e. Other Conditions:
o Chronic leg ulcers
o Generalized pruritus
o Acne
o Alopecia
o Vitiligo
o Photosensitivity
o Genital dermatoses: Chancre, chancroid, Etc.
f. Skin Tumors:
o Premalignant lesions in the skin: like solar keratosis, Bowen’s disease
o Malignant lesions like basal cell cancer, squamous cell cancer, malignant melanoma
7. Accident and Emergency
At the end of the posting, the student will be able to do these skills independently:
o Triage in A & E: decision to admit, refer, follow up, or discharge.
o Basic Life Support
o Oral and Nasopharyngeal Airway maintenance
o Mask Ventilation
o Intubation
o Defibrillation
o Gaining peripheral intravenous access
o Insertion of an intraosseous needle
o Bladder catheterization
o Limb splinting
o Suturing & other wound closure techniques
o Wound management - dressings
o Local anesthetic techniques
o Acute subcutaneous abscess - drainage/incision
o Nasal packing
o Heimlich Manoeuvre
o Communication Skills
a. Communication Skills in A&E
b. Multi-Disciplinary Team Working
c. Talking to Bereaved and Distressed Relatives
d. Dealing with Difficult Patients and Relatives
e. Accident Prevention and Health Promotion
The student should also have acquired knowledge about the following conditions/clinical problems through self-reading, observation, or discussion.
i. Poisoning and overdose
ii. Cardiovascular
o Acute Cardiac Failure: causes and management
o Hypertensive Emergencies
o Diagnosis, initial management, and appropriate referral of a patient with acute coronary syndrome
iii. Neurology
o Management of acute headache
o Management of Status Epilepticus
o Assessment and Management of the Unconscious Patient
o Management of TIA and Stroke, Meningitis
8. ENT: At the end of the posting, the student will be able to:
Perform these skills with assistance:
o Clinical Examination of the Ear, Nose, and Throat (especially children) and identification of pathology
o Hearing tests – Rinne’s and Weber’s
o Use of the nasal speculum, ENT mirror, and otoscope
o Differentiate safe and unsafe ear in CSOM
o Removal of wax for the ear
o Removal of foreign bodies for the ear and the nose
o Early management of epistaxis and anterior nasal packing
o Interpretation of audiometry
o Hallpike test
o Epley.s manouvere for BPPV
o Ear lobe repair
The student should also have acquired knowledge about the following conditions/clinical problems through self-reading, observation, or discussion.
Diagnosis and management of:
o Acute upper respiratory infection
o Acute and chronic (safe and unsafe) otitis media
o Mastoiditis
o Vertigo – evaluation, management, and appropriate referral
o Otitis externa
o Fungal infections of the ear
o Hearing loss – assessment
o Tinnitus – assessment
o Nasal polyps
o Atrophic rhinitis
o Deviated nasal septum
o Epistaxis
o Sinusitis – Acute and chronic
o Tonsillitis – acute and chronic
o Adenoiditis – acute and chronic
o Quinsy
o Hoarseness of voice
o Dysphagia
o Lumps in head & neck – differential diagnosis and evaluation
o Bell's palsy – diagnosis, evaluation, and management
9. Ophthalmology:
At the end of the posting, the student will be able to perform:
o Clinical examination of the eye
o Fundoscopy
o Confrontation fields
o Flashlight test to assess anterior chamber depth
o Pupil examination
o Foreign body removal from lid, conjunctiva, and cornea under supervision
o Irrigation of eye
o Triaging patient in casualty with the acute problem of the eye
o Checking vision with the use of Snellen's chart and use of pinhole
The student should also have acquired knowledge about the following conditions/clinical problems through self-reading, observation, or discussion.
o Redeye (Conjunctivitis, Corneal ulcers, and Uveitis)
o Corneal Abrasions,
o Xerophthalmia
o Lid disorders, Chalazion
o Phlycten
o Pterygium
o Episcleritis
o Scleritis
o Bitot’s spots
o Cataract
o Acute glaucoma
o Refractory error, Colorblindness
o Foreign body in the eye
o Panophthalmitis
o Retinal Detachment
o Sudden visual loss and progressive visual loss
o Drugs used in ophthalmology
o National Program for the control of blindness
10. Paediatric emergency rotation:
The objective of the rotation: Equip the resident to manage children who present with emergencies at CHC. The resident should be able to:
o Differentiate between the “toxic/ sick looking child” and other children
o Recognize children who need immediate resuscitation or stabilization and perform what is required
o Assess the child with an appropriate history and physical examination and ask for appropriate investigations
o Prepare a list of probable causes for the child's complaints.
o Prepare a plan of management for the child based on the analysis of the history, physical examination findings, and investigations.
The resident will learn the management of common pediatric emergencies including:
i. General
o Airway obstruction
o Respiratory distress
o Shock
o Septicemia
o Trauma
o Acute febrile illness
o Anaphylaxis
o Cardiac arrest
ii. Neurological
o Seizures
o Headache
o Altered sensorium / unconscious child
iii. Environmental
o Poisoning
o Heatstroke/ hyperthermia
iv. Respiratory
o Dyspnea
o Foreign body
o Stridor
iv. Metabolic
o Electrolyte imbalance
o Hyper and hypokalemia
o DKA
o Hyper and hypothyroidism
vi. Gastrointestinal
o Acute diarrheal disease
o Dehydration
o Abdomen pain
o Vomiting
o Constipation
o Foreign body ingestion
vii. Psychiatry
o Suicidal ideation
o Anxiety and panic disorders
o Depression
o Psychosis
o Substance abuse
viii. Genito-Urinary Disorders
o Scrotal pain or swelling
o Urinary retention
o Dysuria
o Haematuria
o Flank pain
o Paraphimosis
x. Skin Conditions
o UrtIcaria
o Rash
o Cellulitis / abscess
o Stevens-Johnson syndrome
xi. Musculoskeletal
o Lacerations
o Painful joints
o Limp
o Fracture
xii. ENT
o Epistaxis
o Sore throat
o Foreign body in the ear
The resident will be able to perform the following procedures:
o Bag-valve mask ventilation
o Endotracheal intubation
o Peripheral vein access
o Intraosseous insertion
o Lumbar puncture
o Incision and drainage of abscess
o Reduction of fracture, casting and splinting
o Digital nerve block
o Suturing of laceration
o Debridement of wounds
The resident will learn the indications for and be able to apply the results of:
o Arterial and venous blood gases
o Oxygen saturation
o ECG
o Common blood investigations
o Common Xrays, Ultrasound scan
xiii. Communication Skills
o Demonstrate an understanding of anxieties and stress among children and the family and communicate to them in an empathetic manner
o Communicate effectively with others in the team in the emergency room demonstrating an ability to respond to stressful situations appropriately
11. Psychiatry
At the end of the psychiatry rotation, the resident should be able to
o Perform a mental health assessment of a patient
o Diagnose and manage patients with mild to moderate depression
o Diagnose and manage a patient with anxiety
o Diagnose and refer appropriate patients with psychosis
o Provide initial care for a patient presenting with acute psychosis
o Assess a patient for suicide risk
o Screen for and diagnose postpartum depression and psychosis
o Diagnose and manage somatization disorders
o Use the CAGE questionnaire.
o Demonstrate an understanding of motivational interviewing.
o Manage and refer if needed patients with the problem of substance abuse
o Manage alcohol detoxification
12. Physical Medicine and Rehabilitation
At the end of the posting, the student will be able to do these skills independently:
a. Prepare a walking cast for trophic ulcers in the foot.
b. Intermittent Clean Catheterization.
c. Exercises for patients with musculoskeletal problems
The student should also have acquired knowledge about the following conditions/clinical problems through self-reading, observation, or discussion:
o Management and rehabilitation of a patient with Hemiplegia
o Management and rehabilitation of a patient with Paraplegia
o Rehabilitation after a fracture
o Rehabilitation after head injury.
o Management of stiffness of the joints after disuse.
o Management of the following conditions
o Cervical spondylosis
o Frozen shoulder
o OA knee
o Mechanical back pain
o Hip pain
o Plantar fasciitis
o Ankle sprain
o De quivervan’s tenosynovitis
o Tennis and Golfer’s elbow
o Costochondritis
13. Community Health Center
At the end of the rotation, the student must be able to:
o Elicit appropriate history, perform a detailed physical examination, implement a clear management plan, and follow up for patients with joint problems presenting in a community health center.
o Assess patients needing admission and manage those admitted with common problems both in routine outpatients and in emergencies.
o Assess the interaction of the social and economic aspects of the patient's life with the disease processes and make appropriate action plans for the management of those aspects.
They will be responsible for the care of patients who are attending outpatients and inpatients. Residents will also be on call as per the schedule.
The following groups of patients and the disease categories can act as a guide to training in RUHSA. The student should be able to deal with the health issues affecting specific groups of people as listed below:
i. Children: Nutrition and development, common childhood infections, behavior disorders, emergencies, child abuse issues
ii. Adolescents: Problems of puberty, adolescent behavioral problems, school health
iii. Women: Breast pain, breast lumps, abnormal uterine bleeding, pelvic pain, premenstrual syndrome, menopause, osteoporosis, contraception, vaginal discharge, infertility, screening, and early detection genital tract malignancy.
iv. Obstetrics: Antenatal care: Diagnosis and management of pregnancy, including common complaints during pregnancy, excessive vomiting, medications, antenatal care, and fetal monitoring, diagnosis and referral of high-risk pregnancy cases
v. Elderly and Disabled: Comprehensive assessment of older persons addresses unique problems such as falls, incontinence, delirium, dementia, common diseases in the elderly, prescribing in elderly, recognizing and addressing social problems.
VIII. Recommended Textbooks and Journals
1. Journal of Family Medicine and Primary Care
2. Australian Family Physician
3. Tropical Doctor
4. American Family Physician
5. General Practice Textbook Edited by John Murtagh
6. Oxford Handbook of General Practice
7. A Textbook of Family Medicine by Ian Mcwhinney
8. Textbook of Family Practice by Rakel
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