DNB Obstetrics and Gynaecology in India: Check out NBE released Curriculum

The National Board of Examinations (NBE) has released the Curriculum for DNB Obstetrics and Gynaecology. 

I. OBJECTIVES OF THE PROGRAMME

1. Programme Goal

A postgraduate student is required to acquire knowledge of Anatomy, Physiology, Pharmacology,  and Pathophysiology related to the reproductive system and is competent to manage all normal and pathological states and function as a productive member of a team engaged in health care, research, and education

2. Programme Objectives

i. OBSTETRICS

a. Basic sciences as applicable to Obstetrics

b. Provide quality maternal care in the diagnosis and management of Antenatal, Intra-natal & Post-natal periods of normal and abnormal pregnancy including emergencies, and management of neonatal problems

c. Development of Adequate Surgical skills

d. Recent advances

ii. GYNECOLOGY

a. Basic sciences as applicable to Gynecology

b. Should be able to diagnose and manage all types of gynecological problems

c. Development of Adequate Surgical skills

d. Recent advances

iii. FAMILY WELFARE

a. Provide counseling and delivery of fertility regulation methods

b. Organize and implement National Health Programs

c. Vital Statistics

iv. OTHERS

a. Medico-legal aspects in Obstetrics & Gynecology

b. Biomedical Waste Management

c. Biostatistics and research methodology

d. Facilitate learning and teaching of medical/nursing students / paramedical health workers

e. Use of newer information technologies (computer & internet)

f. Develop communication skills and a compassionate attitude towards the patients and their formulas

II. TEACHING AND TRAINING ACTIVITIES

The fundamental components of the teaching program should include:

1. Case presentations & discussion- once a week

2. Seminar - Once a week

3. Journal club- Once a week

4. Grand round presentation (by rotation departments and subspecialties)- once a week

5. Faculty lecture teaching- once a month

6. Clinical Audit-Once a Month

7. A poster and one oral presentation at least once during their training period in a recognized conference.

The rounds should include bedside sessions, file rounds & documentation of case history and examination, progress notes, round discussions, investigations, and management plan) interesting and difficult case unit discussions.

The training program would focus on knowledge, skills, and attitudes (behavior), all essential components of education. It is divided into theoretical, clinical, and practical into all aspects of the delivery of rehabilitative care, including the methodology of research and teaching.

1. Theoretical: The theoretical knowledge would be imparted to the candidates through discussions, journal clubs, symposia, and seminars. The students are exposed to recent advances through discussions in journal clubs. These are considered necessary given inadequate exposure to the subject in the undergraduate curriculum.

2. Symposia: Trainees would be required to present a minimum of 20 topics based on the curriculum in three years to the combined class of teachers and students. A free discussion would be encouraged in these symposia. The topics of the symposia would be given to the trainees with the dates for presentation.

3. Clinical: The trainee would be attached to a faculty member to be able to pick up methods of history taking, examination, prescription writing, and management in rehabilitation practice.

4. Bedside: The trainee would work up cases, and learn the management of cases by discussing with the faculty of the department.

5. Journal Clubs: This would be a weekly academic exercise. A list of suggested Journals is given towards the end of this document. The candidate would summarize and discuss the scientific article critically. A faculty member will suggest the article and moderate the discussion, with participation from other faculty members and resident doctors. The contributions made by the article in furtherance of the scientific knowledge and limitations, if any, will be highlighted.

6. Research: The student would carry out the research project and write a thesis/ dissertation by NBEMS guidelines. He/ she would also be given exposure to partake in the research projects going on in the departments to learn their planning, methodology, and execution to learn various aspects of research.

III. SYLLABUS

1. Basic Sciences

• Normal & abnormal development, structure, and function of the female urogenital system and female breast

• Applied Anatomy of the female genitourinary system

• Physiology of spermatogenesis, Gametogenesis, fertilization, implantation & early development of the embryo

• Endocrinology and Physiology during puberty, adolescence, menstruation, ovulation, fertilization, climacteric & menopause

• Development, structure & function of the placenta, umbilical cord & amniotic fluid (normal and abnormal)

• Anatomical, biochemical, endocrine & physiological changes in the female genital tract during pregnancy

• Anatomy of the fetus, fetal growth & development, fetal physiology & fetal circulation

• Physiological changes during pregnancy, labor, and Puerperium

• Pharmacology of drugs used during pregnancy, labor, and post-partum period about their absorption, distribution, excretion, (hepatic) metabolism, transfer across the placenta, the effect of the drugs (used) on labor, on the fetus, their excretion through breast milk and gynecology

• Role of hormones in Obstetrics & Gynaecology

• Markers in Obstetrics & Gynaecology

• Normal and abnormal microbiology of genital tract. Bacterial, viral & parasitic infections are responsible for maternal, fetal, and gynaecological disorders.

• Humoral and cellular immunology in Obstetrics & Gynaecology

• Lactation

• Basic Genetics as applicable in the specialty

2. Clinical Obstetrics

• Identification and management of complications of pregnancy œ abortions, ectopic pregnancy, gestational trophoblastic disease, hyperemesis gravidarum, multiple pregnancies, antepartum hemorrhage, pregnancy-induced hypertension, preeclampsia, eclampsia, other associated hypertensive disorders, anemia, Rh incompatibility, diabetes, heart disease, renal & hepatic diseases, preterm pregnancy and post-term pregnancy, intrauterine fetal growth retardation.hydramnios, oligoamnios, premature rupture of membranes, and recurrent pregnancy loss.

• Neurological, hematological, dermatological diseases, immunological disorders, and other medical & surgical disorders/ problems associated with pregnancy

• Diagnosis of the contracted pelvis, Cephalo-pelvic disproportion,   and their management.

• Evaluation of fetal & maternal health in complicated pregnancy by making use of diagnostic modalities including modern ones (USG, Doppler, Electronic monitors) and plan for a safe delivery for mother and fetus. Identifying fetus at risk & its management.

• Infections in pregnancy (Bacterial, viral, fungal, protozoal) -Malaria, Toxoplasmosis, Rubella, Cytomegalovirus Herpes, HIV, Hepatic viral

• infections (B, C,  etc.), Sexually transmitted infections (STDs), Mother to fetus transmission of infections,

• Identification & management of fetal malpositions and malpresentation of COVID-19 infection in pregnancy, ZIKA Virus infection in pregnancy

• Management of pregnancies complicated by medical, surgical (with other specialties as required) & gynecological diseases.Anemia, hematological disorders, Respiratory, Heart, Renal, Liver, skin diseases, Gastro Intestinal, Hypertensive, Autoimmune, Endocrine disorders, Associated

• Surgical Problems. Acute Abdomen (surgical emergencies œ appendicitis & gastrointestinal emergencies). Other associated surgical problems. Gynecological disorders associated with pregnancy- congenital genital tract developmental anomalies, GYN pathologies- fibroid uterus, Carcinoma Cervix, genital prolapse, etc. Hematological problems in obstetrics including coagulation disorders. Use of blood and blood components/ products

• Obstetric Analgesia and anesthesia

• HIV infections in pregnancy, its effects and management, and the PPTCT Program

• Imaging techniques in Obstetrics

• Prenatal screening, diagnosis, and therapy of developmental anomalies

• Pre-pregnancy counseling

• Climate change and its impact on Pregnancy and Fetal Health

• Effect of Air pollution on Pregnancy and Fetal Health

• Heatwaves and their impact on Pregnancy and Fetal Health

3. Antenatal Care

• Prenatal care of normal pregnancy including examination, nutrition, immunization & follow-up counseling.

4. Intrapartum Care

• Normal labor œ mechanism & management.

• Pantographic monitoring of the progress of labor, recognition of abnormal labor, and its appropriate management.

• Induction and augmentation of labor

• Maternal & fetal monitoring in normal & abnormal labor and its appropriate management

• Electronic fetal monitoring

• Identification and management of intrapartum complications, Cord presentation, cord prolapse, abruptio placentae, and complications of 3rd stage of labor- retained placenta, inversion of the uterus, rupture of the uterus, postpartum hemorrhage. Management of primary & secondary postpartum hemorrhage, Post-partum collapse, amniotic fluid embolism

• Identification & management of genital tract trauma- perineal tear, episiotomy complications

• Management of critically ill women

• COVID-19 infection in labor

5. Postpartum

• Identification and management of genital tract trauma - perineal tear, cervical / vaginal tear, episiotomy complications, rupture uterus.

• Management of critically ill women.

• Postpartum shock, sepsis, and psychosis.

•Postpartum contraception.

• Breastfeeding practice; counseling and importance of breastfeeding.

• Problems in breast-feeding and their management, baby-friendly practices

• Problems of newborn - at birth (resuscitation), management of early neonatal problems, and Immunization at birth

• Normal and abnormal puerperium - sepsis, thrombophlebitis, mastitis, Breast abscess, psychosis, and deep vein thrombosis

• Hematological problems in obstetrics including coagulation disorders. Use of blood and blood components/products.

6. Operative Obstetrics

The resident must have performed a reasonable number of routine procedures and assisted/ observed uncommon procedures.

• Surgical management of Abortions

• Conduct normal delivery

• Episiotomy, Management of Genital tract injuries

• Vaginal instrumental delivery- Vaccum and Forceps

• Caesarean section

• Obstetric. Hysterectomy

• Surgical procedures for Management of PPH

• Manipulations (External cephalic and internal podalic version, manual removal of placenta, etc.)

• Destructive operations

• Cervical Cerclage

7. Clinical Gynaecology

• Epidemiology and etiopathogenesis of gynecological disorders in women of all age groups

• Diagnostic modalities and management of common benign and malignant gynecological diseases (diseases of the genital tract)

• Rational approach in diagnosis and management of endocrine, abnormalities such as menstrual abnormalities, amenorrhea (primary/ secondary), abnormal uterine bleeding, Polycystic ovarian disease,

• hyperprolactinemia (galactorrhea), hyperandrogenism, thyroid-pituitary-adrenal disorders

• Fibroid uterus

• Endometriosis & adenomyosis

• Genital prolapse (uterine & vaginal)

• Cervical erosion, cervicitis, cervical polyps, cervical neoplasia.

• Benign, Premalignant and Malignant lesions of Vulva, vagina, cervix, uterus tubes, and ovaries

• Gestretional Trophoblastic diseases

• Diagnosis and surgical management of clinical conditions related to congenital malformations of the genital tract including Reconstructive surgery in gynecology

• Intersex, ambiguous sex, and chromosomal abnormalities.

• Reproductive endocrinology- Evaluation of Primary/ Secondary Amenorrhea, management of hyperprolactinemia, Hirsutism, Chronic- ovulation, Polycystic Ovarian Disease, thyroid, and other endocrine dysfunctions.

• Urological problems in gynecology œ diagnosis and management of - Urinary tract infection, Urogenital fistulae, Incontinence, and Other Urological problems

• Menopause: management (Hormone replacement therapy) and prevention of its complications

• Endoscopy (Laparoscopy Hysteroscopy)

• Diagnostic & simple therapeutic procedures (PG students must be trained to do these procedures)

• Principles of radiotherapy and chemotherapy in gynecological malignancies, Choice, schedule of administration & complications of such therapies

• Preventive Oncology

• Recognize the importance of good health for adolescent and postmenopausal women.

• Identification and management of health problems of postmenopausal women.

• Understanding and planning an intervention program for the social, educational, and health needs of adolescent girls and menopausal women

• Infertility workup evaluation and management of an infertile couple

• Basic knowledge of Assisted Reproductive Techniques (ART)

• Reproductive Tract Infection including HIV infection in women of reproductive age group its Diagnosis, management, and Prevention

• Imaging techniques in Gynecology

• Recent Advances, Uterine transplantation, COVID-19 in Gynecology, Stem cell therapy in Gynecology

8. Operative Gynaecology

• Pre and post-operative care for Gynecological cases

• Knowledge of all minor and major Surgical Procedures as mentioned in further sections

• Recent advances in Operative gynecology

9. Family Welfare & Demography

• Definition of demography and its importance in Obstetrics and Gynaecology

• Various methods of male and female contraception

• Knowledge of contraceptive techniques (including recent developments)

• Provide adequate services to service seekers of contraception including follow-up.

• Medical termination of pregnancy: MTP act, its implementation, providing safe and adequate services.

• Population dynamics

• Statistics regarding maternal mortality, perinatal mortality/ morbidity, birth rate, and fertility rate.

• Organizational and operational aspects of National health policies & programs about population and family welfare including Reproductive & Child Health

• Medical termination of pregnancy and safe abortions-selection of cases, technique & management of complications

• Maternal Child Health MCH programs, Social Obstetrics & Vital statistics

• PCPNDT Act

10. Diagnostic Procedures

Obstetrics

• Ultrasound and Doppler

• Fetal surveillance methods - Electronic fetal monitoring and its interpretation

• CVS Amniocentesis

Gynecology

• Cervical PAP Smear - VIA / VILI (visual inspection with acetic acid / visual inspection with Lugol's iodine)

• Colposcopy

• Endomatrial Sampling

• Cervical Biopsy

• Endoscopy - Laparo & Hysteroscopy.

• Sonography in infertility: Follicular study and Endometrial study

• Amniocentesis

a. Interpretation of x-rays - Twins, common fetal malformations/ mal- Presentations, abnormal pelvis (pelvimetry), Hysterosalpingography

b. Sonographic pictures at various stages of pregnancy - normal and abnormal pregnancies, Fetal biophysical profile & doppler study, common gynecological pathologies.

11. Medicolegal aspects

• Knowledge and correct application of various acts and laws while practicing obstetrics and gynecology, particularly the MTP act and sterilization.

• Knowledge of the importance of proper recording of facts about history, examination findings, investigation reports, and treatment administered in all patients.

• Knowledge of steps recommended for examination and management of cases of sexual assault

• Knowledge of steps to be taken in the event of the death of a patient or a stillbirth

12. Biomedical Waste Management, Environment, and Health

• Concept of safe disposal of human body fluids and other materials

• Universal precautions to be taken in examining and carrying surgical procedures for the prevention of HIV and other diseases.

• Effect of the environment of pregnancy outcome.

PRACTICAL

The student should know the basic management of patients in the operation theatre including anesthetic procedures, preoperative and post-operative care and related instruments and equipment used in the Operation Theatre, and the safety issues regarding the use of equipment

1. Obstetrics

• Surgical procedures for the management of PPH

• Venepuncture

• Amniotomy

• Conduct of normal Vaginal delivery

• Perineal infiltration & Pudendal block

• Episiotomy

• Ventouse delivery

• Forceps delivery

• Management of Genital tract injuries

• Exploration of Cervix

• Lower Segment Caesarean Section

• Manual Removal of Placenta

• Breech vaginal delivery

• External Cephalic Version

• Delivery of twins

• Management of shock

• Management of Postpartum hemorrhage

• Cervical Cerclage

• Amnio infusion

• Instillation of extra amniotic & intra amniotic drugs

• Non-stress Test

• Suction Evacuation, MVA

• Dilatation & Evacuation

• Repair of complete perineal tear

• Repair of cervical tear

• Caesarean Hysterectomy Internal iliac ligation

• Uterine & Ovarian Artery ligation

• Destructive operations

• Reposition of inversion uterus

• Amniocentesis

• Balloon Tamponade

• Maternal Pelvis and fetal skull practical demonstration

• Knowledge of Instruments and Equipment

2. Gynaecology

• PAP smear

• Wet smear examination

• Post Coital Test

• Endometrial Biopsy Endometrial Aspiration

• Dilatation and Curettage/Fractional Curettege / Polypectomy

• Cervical Biopsy

• Cryo / Electrocautery of Cervix

• Hystero Salpingography

• Diagnostic Laparoscopy & Hysteroscopy

• Opening & closing of abdomen

• Operations for utero vaginal prolapse

• Operations for Ovarian tumors

• Operations for Ectopic pregnancy

• Vaginal hysterectomy

• Abdominal Hysterectomy

• Myomectomy

• Colposcopy

• Loop Electro-Surgical Excision Procedure

• Tuboplasties

• Paracentesis

• Culdocentesis

• Endoscopic surgery (Operative Laparoscopy & Hysteroscopy)

• Repair of genital fistulae

• Operations for Urinary incontinence

• Radical operations for gynecological malignancies

• Vaginoplasty

• Intrauterine insemination

• Basic ultrasound / TVS

• Vulval Biopsy

• Incision & drainage

3. Family Planning

• Counseling

• Intra Uterine Contraception Device Insertion / removal

• Female sterilization - Post Partum & Interval, Open & Laparoscopic

• MTP- First and second trimester Both surgical and Medical methods

• Male Sterilization

4. Teaching Program

5. General Principles

• Acquisition of practical competencies being the keystone of postgraduate medical education, postgraduate training should be skills oriented.

• Learning in a postgraduate program is essentially self-directed and primarily emanates from clinical and academic work. The formal sessions are meant to supplement this core effort.

6. Teaching Sessions

• Clinical case discussions:

a. Bed side

b. Teaching rounds

• Seminars / Journal Club

• Statistical meetings: Weekly / Monthly

•Mortality meetings

• Interdepartmental Meetings: Pediatrics, Radiology

• Others - Guest Lectures / Vertical Seminars / Central Stat Meets

7. Teaching Schedule

The Suggested departmental schedule is as follows

8. Postings

• Emphasis should be on self-directed learning, group discussions, case presentations & practical hands-on learning.

• Students should be trained in proper history taking, clinical examination, advising relevant investigations their Interpretations,  and instituting medical surgical management by posting the candidates in OPD, specialty clinics, wards, operation theatres, labor room, family planning clinics & other departments like neonatology, radiology, and anesthesia

• The candidates must be trained to manage all emergency situations seen frequently

a. GynecologyWard

b. Labour-room

c. Emergency

d. Family Planning

e. Gynaecology Operation Theatre

9. Practical and Clinical Training

Emphasis should be self-directed learning, group discussions, case presentations, and practical hands-on learning. Student should be trained in proper history taking, clinical examination, advising/ ordering relevant investigations, their interpretation, and instituting medical/surgical management, by posting the candidates in OPD, specialty clinics, wards, operation theaters, labor rooms, family planning clinics, and other departments like neonatology, radiology, radiotherapy.

The candidates must be trained to manage all emergency situations seen frequently.

The student should attend to the duties (routine and emergency), Outpatient department, inpatients in the wards, Operation theater, and labor rooms, write clinical notes regularly and maintain records.

The posting of DNB candidates in allied subjects should be done in the fourth semester for total 4 months as follows:

• Neonatology - 1 week

• Anesthesia - 1 week

• Surgery - 2 weeks (optional)

• Oncology - 2 weeks

• Skin and VD - 1 week

• Radiology - 1 week

Details of training in the subject

• Attend to routine and emergency duties

• OPD

• Indoor/wards

• Operation Theater

• Labor room

• Family welfare department

OPERATIONS MUST BE DONE / OBSERVED

1. Obstetrics

• Conduct normal deliveries

• Episiotomy and its repair

• Application of forceps and ventouse (10)

• Assisted breech delivery

• Cesarean section delivery (10 must be done)

• Manual removal of placenta

• Amnioinfusion, Amniocentesis (therapeutic)

• Management of genital tract obstetrical injuries

• Postpartum sterilization / mini lap tubal ligation (20 must be done)

• Medical termination of pregnancy - various methods (20 must be done)

• Venesection

• Culdocentesis

2. Gynaecology

• Endometrial / cervical biopsy

• Dilatation and curettage

• Evacuation

• Culdocentesis, colpotomy

• Opening and closing of the abdomen (10 must be done)

• Operations for uterovaginal prolapse

• Ovarian cyst operation

• Operation for ectopic pregnancy (2)

• Vaginal and abdominal hysterectomy (5 must be done)

• Basic Laparoscopic skills

• Laparoscopic sterilization

3. Operations must be OBSERVED AND/OR ASSISTED

• External Cephalic Version

• Internal podalic version

• Caesarean Hysterectomy

• Internal iliac artery ligation

• Destructive obstetric operations

• Vaginal reconstructive surgery

• Tubal microsurgery

• Radical operations for gynecologic malignancies

• Repair of genital fistulae

• Operations for urinary incontinence

• Myomectomy

• Diagnostic & Operative Laparoscopic surgery

• LEEP, Cryotherapy, Electrocautery

• IUI

Biostatistics, Research Methodology, and Clinical Epidemiology

Ethics Medico legal aspects relevant to the discipline

Health Policy issues as may be applicable to the discipline

IV. COMPETENCIES

Details of The Skills to Be Acquired During The Training Period

V. LOG BOOK

A candidate shall maintain a log book of operations (assisted/performed) during the training period, certified by the concerned postgraduate teacher / Head of the department / senior consultant.

This log book shall be made available to the board of examiners for their perusal at the time of the final examination.

The logbook should show evidence that the before-mentioned subjects were covered (with dates and the name of the teacher(s) The candidate will maintain a record of all academic activities undertaken by him/her in log book.

1. Personal profile of the candidate

2. Educational qualification/Professional data

3. Record of case histories

4. Procedures learnt

5. Record of case Demonstration/Presentations

6. Every candidate, at the time of the practical examination, will be required to produce a performance record (log book) containing details of the work done by him/her during the entire period of training as per the requirements of the log book. It should be duly certified by the supervisor as work done by the candidate and countersigned by the administrative Head of the Institution.

7. In the absence of the production of log book, the result will not be declared.

VI. RECOMMENDED TEXTBOOKS AND JOURNALS

1. Danforth's Obstetrics & Gynaecology

2. Dewhurst Textbook of Obstetrics & Gynecology for postgraduates

3. Shaw's textbook of Operative Gynaecology

4. Shaw'sǰ Stanton & Souter Gynaecology

5. Kistner's Gynaecology

6. Coppelson Gynaecological Oncology

7. Manju Pandey Biostatistics

OBSTETRICS

1. William's Obstetrics

2. Turnbull's Obstetrics

3. Fernado Arias- Practical guide to High Risk pregnancy & delivery

4. De Sweit- Medical Disorders in Pregnancy

5. D.K. James- High-risk pregnancy management options

6. J B Sharma Text book of Obstetrics

7. DC Dutta Test book of Obstetrics

8. Sheila Balakrishnan Textbook of Obstetrics

GYNAECOLOGY

1. Telinde's operative Gynecology

2. Novak's œ Textbook of Gynaecology

3. Speroff Leon's œ Clinical Gynaecology Endocrinology & Infertility

4. Jeffcoate's Principles of Gynaecology

5. Studd- Progress in Obstetrics & Gynaecology

6. Bonner- Recent advances in Obstetrics & Gynaecology

7. J B Sharma Text book of Gynecology

8. Lakshmi Seshadri Essentials of Gynecology

9. Sheila Balakrishnan Text book of Gynaecology

LIST OF JOURNALS

1. Journal of Obstetrics & Gynaecology of India

2. Obstetrics & Gynaecology Survey

3. Obstetrics & Gynaecology Clinics of North America

4. Clinical Obstetrics & Gynaecology

5. British journal of Obstetrics & Gynaecology

6. Contraception

7. International Journal Obstetrics & Gynaecology

8. American Journal of Obstetrics & Gynaecology

9. Obstetrics & Gynaecology