DrNB Thoracic Surgery: Admissions, Medical Colleges, Eligibility Criteria, fee details here

DrNB Thoracic Surgery or Doctorate of National Board in Thoracic Surgery also known as DrNB in Thoracic Surgery is a super speciality level course for doctors in India that is done by them after completion of their postgraduate medical degree course. The duration of this super speciality course is 3 years, and it focuses on the study of diseases related to the thorax, including the esophagus, lungs, mediastinum, trachea, and diaphragm.

The course is a full-time course pursued at various accredited institutes/hospitals across the country. Some of the top accredited institutes/hospitals offering this course include Sir Gangaram Hospital, New Delhi, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, and more. 

Admission to this course is done through the NEET-SS Entrance exam conducted by the National Board of Examinations, followed by counseling based on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee for pursuing DrNB (Thoracic Surgery) varies from accredited institutes/hospital to hospital and may range from Rs. 80,000 to Rs.2,50,000 per year.

After completion of their respective course, doctors can either join the job market or can pursue certificate courses and Fellowship programs recognized by NMC and NBE. Candidates can take reputed jobs at positions as Senior residents, Consultants, etc. with an approximate salary range of Rs.10 lakhs to Rs.30 lakhs per annum.

DNB is equivalent to MD/MS/DM/MCh degrees awarded respectively in medical and surgical super specialities. The list of recognized qualifications awarded by the Board in various broad and super specialities as approved by the Government of India are included in the first schedule of the Indian medical council Act, 1956.

The Diplomate of National Board in broad-speciality qualifications and super speciality qualifications when granted in a medical institution with the attached hospital or in a hospital with the strength of five hundred or more beds, by the National Board of examinations, shall be equivalent in all respects to the corresponding postgraduate qualification and the super-speciality qualification granted under the Act, but in all other cases, senior residency in a medical college for an additional period of one year shall be required for such qualification to be equivalent for teaching also.

What is DrNB in Thoracic Surgery?

Doctorate of National Board in Thoracic Surgery, also known as DrNB (Thoracic Surgery) or DrNB in (Thoracic Surgery) is a three-year super specialty program that candidates can pursue after completing a postgraduate degree.

Thoracic Surgery is the branch of medical science dealing with the study of diseases related to the thorax, including the esophagus, lungs, mediastinum, trachea, and diaphragm.

The National Board of Examinations (NBE) has released a curriculum for DrNB in Thoracic Surgery.

The curriculum governs the education and training of DrNB in Thoracic Surgery.

The postgraduate students must gain ample knowledge and experience in the diagnosis, and treatment of patients with acute, serious, and life-threatening medical and surgical diseases.

PG education intends to create specialists who can contribute to high-quality health care and advances in science through research and training.

The required training done by a postgraduate specialist in the field of Thoracic Surgery would help the specialist to recognize the health needs of the community. The student should be competent to handle medical problems effectively and should be aware of the recent advances in their speciality.

The candidate is also expected to know the principles of research methodology and modes of the consulting library. The candidate should regularly attend conferences, workshops, and CMEs to upgrade her/ his knowledge.

Course Highlights

Here are some of the course highlights of DrNB in Thoracic Surgery

Eligibility Criteria

The eligibility criteria for DrNB in Thoracic Surgery have been defined as the set of rules or minimum prerequisites that aspirants must meet to be eligible for admission, which includes:

Note:

• The prior entry qualifications shall be strictly by Post Graduate Medical Education Regulations, 2000, and its amendments notified by the NMC and any clarification issued from NMC in this regard.
• The candidate must have obtained permanent registration with any State Medical Council to be eligible for admission.
• The medical college's recognition cut-off dates for the Postgraduate Degree courses shall be as prescribed by the medical council of India (now NMC).

Admission Process

The admission process contains a few steps to be followed in order by the candidates for admission to DrNB in Thoracic Surgery. Candidates can view the complete admission process for DrNB in ThoracicSurgery mentioned below:

• The NEET-SS or National Eligibility Entrance Test for Super speciality courses is a national-level master's level examination conducted by the NBE for admission to DM/MCh/DrNB Courses.
• Qualifying Criteria-Candidates placed at the 50th percentile or above shall be declared as qualified in the NEET-SS in their respective speciality.
• The following Medical institutions are not covered under centralized admissions for DM/MCh courses through NEET-SS:

1. AIIMS, New Delhi, and other AIIMS

2. PGIMER, Chandigarh

3. JIPMER, Puducherry

4. NIMHANS, Bengaluru

• Candidates from all eligible feeder specialty subjects shall be required to appear in the question paper of the respective groups if they are willing to opt for a super speciality course in any of the super specialty courses covered in that group.
• A candidate can opt for appearing in the question papers of as many groups for which his/her Postgraduate specialty qualification is an eligible feeder qualification.
• By appearing in the question paper of a group and on qualifying for the examination, a candidate shall be eligible to exercise his/her choices in the counselling only for those super specialty subjects covered in the said group for which his/ her broad specialty is an eligible feeder qualification.

Fees Structure

The fee structure for DrNB in Thoracic Surgery varies from accredited institute/hospital to hospital. The fee is generally less for Government Institutes and more for private institutes. The average fee structure for DrNB in Thoracic Surgery is around Rs. 80,000 to Rs.2,50,000 per year.

Colleges offering DrNB in Thoracic Surgery

There are various accredited institutes/hospitals across India that offer courses for pursuing DrNB in Thoracic Surgery.

As per the National Board of Examinations website, the following accredited institutes/hospitals are offering DrNB (Thoracic Surgery)courses for the academic year 2022-23.

Syllabus

A DrNB in Thoracic Surgery is a three years specialization course that provides training in the stream of Thoracic Surgery.

The course content for DrNB in Thoracic Surgery is given in the NBE Curriculum released by the National Board of Examinations, which can be assessed through the link mentioned below:

The curriculum includes both clinical teaching (in the operating room, on the wards, and in the outpatient clinic), and classroom teaching (lectures, small group discussions, and simulation).

1. Basic Knowledge

2. History of Thoracic Surgery

i. Preoperative Evaluation

• Introduction

• Estimation of Cardiac Risk

• Predicted Postoperative Forced Expiratory Volume in the First Second

• Diffusing Capacity of the Lung for Carbon Monoxide

• Exercise Testing

ii. Perioperative Management

• Introduction

• Preparation for Surgery

• Airway Management

• Pain Management

• Postoperative Monitoring

• Chest Tube Management

• Fast track Recovery

iii. Intensive Care after Thoracic Surgery

• Monitoring of Patient Vital Variables

• Pain Monitoring and Control

• Sedation and Muscle Paralysis

• Fluid Resuscitation and Balance

• Vascular and Heart Failure

• Management of Respiratory Failure

• Sepsis

• Renal Failure

iv. Postoperative Complications

• Early Postoperative Complications

v. Delayed Complications in Thoracic Surgery

vi. Clinical Knowledge

• Open versus minimally invasive approaches to the thorax and abdomen

• Early and late complications of thoracic incisions, and abdominal incisions

a) Clinical Skills

• History and Examination

o System-specific and general history and examination, including drug

history, identification of comorbidity, and functional status

• Data Interpretation

• Patient Management

o Risk assessment and stratification

o Management of post-thoracic surgical complications

o Postoperative management of pain control

o Treatment of cardiac arrhythmias

o Physiotherapy and rehabilitation

o Understanding thoracic-specific ventilatory techniques (e.g., lung isolation)

b) Technical Skills

• Endoscopy

• Bronchoscopy

• Tracheostomy

• Correct positioning of the patient for thoracic surgery

• Select, perform and close thoracic incisions, including lateral, anterior, muscle

sparing, median sternotomy, and VATS incisions

c) NEOPLASM OF LUNG

• Knowledge

• Benign and malignant tumors of the trachea, bronchus, lung

Strategies for Non-small Cell Lung

d) Cancer Treatment

• Introduction

• Early Stage Nonsmall Cell Lung Cancer

• Locally Advanced Nonsmall Cell Lung Cancer

• Advanced Nonsmall Cell Lung Cancer

• Small Cell Lung Cancer

e) Classification

• Epidemiology

• Aetiology and Pathogenesis

• Clinical Presentation

• Diagnosis and Staging

• Treatment

• Prognosis

• Prevention

f) Lung Carcinoid Tumours

• Definition

• Incidence

• Classification

• Clinical Symptoms

• Diagnosis

• Mediastinal Lymph Node Involvement

• Treatment

g) Bronchial Gland Tumours

• Introduction

• Incidence

• Clinical Presentation

• Adenoid Cystic Carcinoma

• Mucoepidermoid Carcinoma

• Pleomorphic Adenoma

• Mucous Gland Adenoma

• Epithelial‑ Myoepithelial Carcinoma

h) Rare Tumours of the Lung

• Introduction

• PleuropulmonaryBlastoma

• Primary Pulmonary Carcinosarcoma

• Primary Intrapulmonary Thymoma

• Primary Malignant Melanoma of the Lung

• Primary Malignant Germ Cell Tumours

• Primary Sarcoma of the Lung

• Primary Malignant Lymphoreticular Disorders

• Epidemiology, genetic signatures, presentation, and diagnosis

• Staging including all staging tools (CT, CT/PET, EBUS, EUS, Mediastinoscopy)

• Multimodality management of thoracic malignancy

• Non-resectional techniques (SBRT, RFA, etc)

• Survival and recurrence patterns

• Postop complications (BP fistula, space problems, empyema, prolonged air leak, etc.)

• Surgical palliative techniques (stents, RFA, etc.)

• Secondary and metastatic neoplasms of the lung

• Patient Management/Clinical Skills

• Clinical assessment to establish clinical stage (radiologic interpretation)

• Assessment of function and risk

• Diagnosis and management of non-thoracic metastatic lesions

• Postop management including complications such as empyema, bronchopleural fistulae, space issues, prolonged air leak, pneumonia, chylothorax, hemorrhage, etc.

• Technical Skills

• Surgery for benign and malignant conditions of the lungs (open and VATS)

• Wedge resection

• Lobectomy

• Segmentectomy

• Bilobectomy

• Sleeve lobectomy

• Resection with the chest wall, including reconstruction techniques

• Pneumonectomy

• Carinal pneumonectomy

• Extrapleural pneumonectomy

• Pancoast tumors

• Extended resections (SVC, spine, etc.)

• Repeat resections for benign and malignant conditions of the lung, including the completion

• pneumonectomy

• Clagett procedure and Eloesser flap

• Soft tissue flaps for stump coverage

i) Lung Cancer Screening Ugo Pastorino

• Background

• Early Trials of Lung Cancer Screening

• Observational Studies With Low Dose Spiral Computed Tomography

• Randomised Trials With Low Dose Spiral Computed Tomography

• Critical Issues in Low Dose Computed Tomography Screening Trial

j) Pulmonary Metastases

• Introduction

• Biology of Metastases

• Question of the Effectiveness of Metastasectomy

• Clinical Presentation of Pulmonary Metastases

• Is Imaging Sufficiently Sensitive or Must the Lung Always Be Palpated?

• Factors Associated With a Good Outcome

• The Role of Lymph Node Dissection

• Evolving Criteria for Pulmonary Metastasectomy

• Evidence on Particular Primary Cancer Types

k) Principles of the Surgical Treatment of Lung Cancer

• Introduction

• Aims of the Surgical Treatment of Lung Cancer

• Selection of Patients for Lung Cancer Surgery

• Technique of Lung Cancer Surgery

• Audit and Outcomes

l) Principles of Radiation, Chemotherapy, and Biological Therapy for Lung Cancer

• Current Status of Chemotherapy and Radiotherapy in Resected Early Non‑ small Cell Lung Cancer

• Neoadjuvant Chemotherapy in Early Stage Nonsmall Cell Lung Cancer

• Current Status of Radiotherapy in Nonsmall Cell Lung Cancer

• Genetic Determinants of Prognosis in Resected Early Non-small Cell Lung Cancer

• Gene Expression Signatures and Recurrence-free Survival in Early Non-small Cell Lung Cancer

• Prognostic and Predictive Roles of BRCA1

• Non-small Cell Lung Cancer with EGFR Mutations

m) Nonresectional Alternatives in Lung Cancer Treatment

• Introduction

• Radiofrequency Ablation

• Stereotactic Radiosurgery

• Cryotherapy

n) BENIGN LUNG CONDITIONS

i. Bronchiectasis

• Knowledge

o Medical therapy

o Role of surgery

o Criteria for surgical resection

o Diagnostic studies

• Patient Management/Clinical Skills

o Familiarity with medical therapy

o Clinical evaluation and assessment for possible surgery

• Technical Skills

o Resection

ii. Bacterial Infections

• Knowledge

o Community-acquired pneumonia

o Nosocomial pneumonias

o Aspiration pneumonia

• Lung Abscess

o Pneumonia in the immunocompromised host

o Antibiotic therapy

• Patient Management/Clinical Skills

o Clinical assessment

o Techniques for culture

o Interpretation of imaging

o Advanced ventilator management (prone position)

o Familiarity with medical therapy

o Management of lung abscess

iii. Tuberculosis and Atypical Mycobacteria

• Knowledge

o Epidemiology and screening

o Clinical presentation

o Medical treatment

o Indications for surgery, including complications and outcome

• Patient Management/Clinical Skills

o Familiarity with medical therapy

o Management of complications of Tb

o Timing and preparation of patients who are candidates for surgery

• Technical Skills

o Resection techniques (open and VATS)

o Bronchial stump coverage

iv. Mycotic Infections

• Knowledge

o Epidemiology of various fungal diseases

o Diagnosis – cultures/serology

o Imaging

o Manifestations of:

Histoplasmosis

Aspergillus

Coccidioidomycosis

Blastomycosis

Pulmonary cryptococcus

Mucormycosis

• Patient Management/Clinical Skills

o Familiarity with medical therapy

o Role of Surgery

v. Parasitic Diseases

• Knowledge

o Hydatid disease

o Epidemiology

o Complications

o Laboratory testing

o Imaging

o Diagnostic techniques

o Familiarity with medical therapy

o Surgical treatment

vi. Interstitial Lung Disease

• Knowledge

o Categorization

o Presentation, laboratory, and physiological testing, and imaging

o Diagnostic options

o Role of lung biopsy

• Patient Management/Clinical Skills

o Assessment of surgical risk, probability of effecting treatment change

• Technical Skills

o Open and VATS lung biopsy

vii. Emphysema and Bullae

• Knowledge

o Etiology, pathology, and physiology of COPD

o Smoking cessation measures and outcomes

o Imaging and physiological (V-Q scan, pulmonary function, DLCO, etc.) techniques

o Surgical techniques and results used in the treatment of nonbullous emphysema and bullae

o Lung volume reduction surgery: patient selection, criteria, and surgical techniques

o Indications for bullectomy

• Patient Management/Clinical Skills

o Interpretation of imaging and pulmonary function

o Patient selection with an assessment of function and risk

o Postop management of patients undergoing surgery for emphysema or complications of the disease

• Familiarity with pulmonary rehabilitation

• Technical Skills

o Procedures to deal with secondary pneumothorax and bullae by open and VATS techniques

o Lung volume reduction surgery, unilaterally and bilaterally, using open and

VATS techniques

viii. DISORDERS OF THE PLEURA

• Knowledge

o Anatomy and physiology of the pleura

o Inflammatory, infective and malignant diseases of parietal and visceral pleura

o Pneumothorax (spontaneous, secondary, catamenial)

o Complex pleural effusion/empyema

o Mesothelioma

o Hemothorax

o Chylothorax

o Fibrous tumor of the pleura

• Patient Management/Clinical Skills

o Chest drains insertion, management, removal, and treatment of complications

o Interpretation of imaging of the pleura

o Multimodality management of mesothelioma

o Medical and surgical management of pleural disease, including radiological, open, and VATS techniques

o Techniques to deal with the failure of primary treatment

• Technical Skills

o Open and VATS procedures for uncomplicated pleural problems, (pneumothorax, effusions, hemothorax, etc.) including drainage, biopsy, lytic therapy, and pleurectomy

o Open and VATS procedures for empyema, including techniques for decortication

o Advanced techniques of pleural space obliteration

o Surgical options for malignant mesothelioma

o Resection of other pleural tumors

ix. DISORDERS OF THE CHEST WALL

• Knowledge

o Anatomy of the chest wall

o Chest wall tumors

o Congenital lesions (e.g. pectus deformities)

o Thoracic outlet syndrome

o Inflammatory/infectious conditions affecting the chest wall

o Clinical, laboratory, and imaging techniques used in the evaluation of chest wall pathology

o Techniques used in the diagnosis of chest wall disease

o Techniques used to resect the sternum and chest wall, physiological and cosmetic sequelae

o Techniques of chest wall reconstruction (prosthetic and muscle flaps)

• Patient Management/Clinical Skills

o Interpretation of laboratory, physiological, and imaging techniques

o Patient selection for operation

o Diagnose and manage patients with thoracic outlet syndrome

• Technical Skills

o Chest wall biopsy and choice of appropriate technique (incisional biopsy, excisional biopsy, FNA, core biopsy)

o Chest wall resection for benign and malignant diseases, in combination with resection of underlying lung

o Selection and insertion of prosthetic materials for reconstruction Surgery for complications of chest wall resection, and repeat surgery

o to resect recurrent chest wall conditions

o Complex chest wall reconstruction (muscle flaps)

o Supraclavicular and transaxillary first rib approach to thoracic outlet syndrome

o Chest wall deformity repair

x. DISORDERS OF THE DIAPHRAGM

• Knowledge

o Anatomy and physiology of the diaphragm

o Pathology of the diaphragm

o Clinical, physiological and imaging techniques in the assessment of diaphragmatic abnormalities

o Physiologic consequences of diaphragmatic herniation or paresis

o Surgical techniques used to biopsy and resect diaphragmatic tumors

o Situations in which replacement of the diaphragm is required and

reconstructive materials

• Patient Management/Clinical Skills

o Interpretation of physiological and imaging techniques

o Patient selection

o Management of patients after diaphragmatic operation

• Technical Skills

o Resection, repair, and reconstruction of diaphragm

o Diaphragmatic plication

o Familiarity with diaphragmatic pacing

xi. DISORDERS OF THE MEDIASTINUM

• Knowledge

o Anatomy of the mediastinum

o Congenital, benign, infectious, and malignant (primary and secondary)

conditions of the mediastinum

o Systemic conditions associated with the mediastinum

o Clinical, laboratory, and imaging techniques used in the diagnosis and

assessment of patients with mediastinal disease

o Myasthenia gravis: medical, surgical, and periop management

o Staging of thymoma

o Oncologic treatment of malignant diseases of the mediastinum, including

multidisciplinary care (Thymoma, germ cell cancers)

o Surgical techniques for the treatment of myasthenia gravis, mediastinal cysts

and tumors, complications, and results.

• Patient Management/Clinical Skills

• Clinical history and exam

o Interpretation of laboratory, physiological, and imaging techniques

o Patient selection with the assessment of function and risk

o Postop management and recognition of complications

o Selection of appropriate routes for biopsy and excision of mediastinal tumor and cysts

• Technical Skills

o Biopsy of mediastinal masses

o Thymectomy for myasthenia gravis

o Resection of mediastinal tumors, including extended resection of adjacent structures

o Mediastinal Lymph Node Dissection

o HisaoAsamura

a) Evolution of Lung Cancer Surgery and Mediastinal Lymph Node Dissection

b) Definition of Mediastinal Lymph Node Dissection and the Relevant Procedures

c) The Lymph Node Map for Lung Cancer

d) Relative Advantages and Disadvantages of Mediastinal Lymph Node Dissection

xii. ENDOSCOPY

• Knowledge

o Endoscopic anatomy of larynx, trachea, bronchi, esophagus, stomach

o Thoracic lymph node stations (including foregut)

o Role of rigid and flexible bronchoscopy in the investigation of the airway and pulmonary disease

o Role of rigid and flexible esophagoscopy in the investigation of esophageal disease

o Role of mediastinoscopy, Chamberlain procedure or extended mediastinoscopy, endobronchial ultrasonography (EBUS), and endoscopic esophageal ultrasonography (EUS) in the staging of malignant and benign conditions of the thorax

o Anesthetic management and ventilating management during rigid and flexible endoscopy

o Types of bronchial and esophageal stents

o Application of lasers, PDT, cryotherapy, radiofrequency ablation, and endomucosal resection (EMR) in Barrett's or malignant esophageal disease

o Nonsurgical ablative airway techniques

• Patient Management/Clinical Skills

o Choice of endoscopic techniques to stage thoracic malignancies

o Choice of endoscopic techniques to palliate thoracic malignancies

o Indications for postop bronchoscopy

• Technical Skills

o Rigid and flexible bronchoscopy

o Rigid and flexible esophagoscopy

o Mediastinoscopy

o Chamberlain procedure

o Familiarity with EBUS and EUS

o Endobronchial and esophageal stenting

o Bronchoscopic and esophageal biopsy, including management of complications

o VATS approaches for biopsy and resection

o Endoscopic management of tumors –"core-out," stents, laser, PDT

o Techniques of esophageal dilation

xiii. DISORDERS OF THE AIRWAY

• Knowledge

o Anatomy of the larynx, trachea, and bronchus

o Inflammatory, infectious, benign, and neoplastic diseases of the airways

o Symptoms, signs of airway disease

o Techniques for surgical resection of the trachea

o Bronchoplastic procedures and the limitations of these techniques

o Medical and oncologic airway disease treatments

o Presentation, investigation, and management of anastomotic complications following airway surgery

o Presentation, evaluation, and treatment of fistulas in the aerodigestive tract due to benign, malignant, and iatrogenic causes

• Patient Management/Clinical Skills

o Interpretation of laboratory and imaging techniques

o Diagnosis and assessment of airway obstruction

o Patient selection with an assessment of function and risk

o Postop care of patients after airway surgery

• Technical Skills

o Sleeve resection of the trachea for simple benign conditions

o Sleeve resection of the main bronchi, including lobectomy

o Techniques for the relief of major airway obstruction

o n, including stenting, "core-out," PDT, dilation, cryotherapy, etc.

o Airway resection for tumors and complex benign conditions, and techniques

for airway reconstruction, anastomosis, and laryngeal release

o Repeat resections for recurrence and complications of prior resection

o Management of fistulas in the aerodigestive tract by surgical and endoscopic techniques

xiv. MANAGEMENT OF BENIGN ESOPHAGEAL DISORDERS

• Knowledge

o Esophageal and gastric anatomy

o Anatomy of the small and large intestine as related to reconstruction

o Pathophysiology

o Motility disorders (esophageal sphincter dysfunction, achalasia, esophageal spasm

o Diverticula (Zenker's, epiphrenic)

o GE reflux and types of Hiatal hernias – sliding and paraesophageal

o Trauma (blunt, penetrating, iatrogenic perforations, radiation-induced, caustic ingestion, drug-induced)

o Infection (Candida, herpetic)

o Strictures (reflux-induced, caustic, anastomotic)

o Tracheoesophageal fistula

o Barrett's esophagus

o Diagnostic procedures and their interpretation

o Imaging: radiography (Barium swallow/UGI series), CT scan, nuclear medicine (gastric emptying, GE reflux)

o Esophageal function tests (manometry, pH studies)

o Drugs used in the treatment of GE reflux and dysmotility disorders

o Treatment options for achalasia (pneumatic dilation, botox, surgery)

• Patient Management

o General and specific history and exam, including previous surgery, identification of comorbidity, and risk assessment

o Non-operative and operative options for treatment

o Management of the postop patient

o Management of postop complications

• Technical Skills

o Open and laparoscopic fundoplication (Belsey, Nissen, Dor, Toupet)

o Open and laparoscopic esophagomyotomy

o Reoperations (after failed anti-reflux/hiatal hernia surgery or surgery for motility disorders)

o Surgical treatment (Stent, Repair, Diversion) of esophageal perforation

o Open or minimally invasive resection/esophagomyotomy for diverticula

(Zenker's, epiphrenic)

xv. MANAGEMENT OF ESOPHAGEAL NEOPLASIA

• Knowledge

o Anatomy of the esophagus and its anatomical relationships from cricopharyngeus to cardia, including details of blood supply and lymphatic drainage

o Anatomy of the stomach, including its anatomical relationships, blood supply, and lymphatic drainage

o Anatomy of the colon including its blood supply

o Etiology and epidemiology of esophageal cancer

o Metaplasia-dysplasia sequence

o Role of induction therapy

o Diagnosis, staging, and treatment options for esophageal cancer

o Risk assessment of patients undergoing esophageal resection

o Staging of esophageal cancer

o Esophageal resection options

o Palliative procedures (stents, laser, PDT, radiation therapy)

o Treatment options for high-grade dysplasia or very early esophageal cancer Screening and prevention

• Patient Management/Clinical Skills

o Interpretation of staging tests

o Risk assessment

o Management of post-esophagectomy patient

o Identification and management of post-resection complications (acute and chronic)

o Long-term follow-up and management of recurrence

• Technical Skills

o Mobilization of the esophagus, stomach, and colon

o Esophageal resection (including different approaches)

o Esophageal reconstruction including interposition techniques

o Jejunostomy

o Management of intraoperative complications

xvi. LUNG TRANSPLANTATION

• Knowledge

o Patient and donor selection criteria

o Basic pharmacology of immunosuppression

o Reperfusion injury

o Results of lung transplantation

• Patient Management/Clinical Skills

o History and exam including identification of comorbidity and risk assessment

o Management of post-op lung transplant patient

o Management of acute and chronic complications of lung transplantation

o Management of rejection

• Technical Skills

o Familiarity with donor retrieval, single and bilateral lung transplant, and management of anastomotic complications

2. CONGENITAL HEART, LUNG, AND THORACIC DISEASE

• Knowledge of Congenital Heart Disease

• Physiology

o Hemodynamics; physiology and measurement including shunt calculations, PVR, SVR determinations

o Physiology of Left-to-Right shunts and Right-to-Left shunts

o Physiology of pulmonary vasculature and changes with development

o Basic conduction disorders

o Acid-base balance (including Ph stat and alpha stat CPB mgmt)

o Physiology of pediatric cardiopulmonary bypass including hypothermia, low-flow, and circulatory arrest.

• Anatomy

o Basic embryology of the heart, lungs, and great vessels

o Coronary anatomy and variants

o Location and course of the conduction system in congenital heart disease

o Anatomy as it pertains to vascular conduits including aortopulmonary shunts

o Basic anatomy of the atrial septum and ventricular septum

o Basic concepts of cardiac position, situs, atrioventricular and ventriculoarterial connections

• Pathophysiology

o Basic concepts of volume and pressure overload

• Pharmacology

o Specific drugs used in the treatment of congenital heart disease (beta blockers, ACE inhibitors, Digoxin, Diuretics, PGE1, nitric oxide, systemic vasodilators)

o Specific dosing and application

o General indications and use of inotropes, anti-arrhythmic drugs, hemostatic drugs, antiplatelet, anticoagulant and thrombolytic drugs, analgesics, antibiotics, anesthetic agents, and vasodilators (systemic and pulmonary) in the pediatric population

• Clinical Knowledge

o Proficiency with the anatomy, pathophysiology, natural history, management, and results of the following conditions or procedures:

o Mechanisms of cyanosis

o Manifestations of congestive heart failure in infants and children

o Patent ductus arteriosus

o Atrial septal defect

o Ventricular septal defect

o Coarctation

o PA banding and shunts

o Transposition of the great arteries/arterial switch procedure

o Tetralogy of Fallot

o Vascular rings

o Familiarity with anatomy, pathophysiology, natural history, management, and results of the following congenital conditions or procedures.

o Functional single ventricle leading to single ventricle pathway and principles of treatment (Fontan procedure)

o Congenital aortic stenosis/insufficiency (Konno, Ross procedure)

o Rastelli procedure

o Hypoplastic left heart and Norwood procedure

o Truncus arteriosus

o Double outlet right ventricle

o VSD, Pulmonary atresia, and MAPCAs

o Pulmonary atresia and intact septum

o Partial and complete atrioventricular septal defects

o Mitral valve disease

o Tricuspid valve disease including Ebstein's anomaly

o Interrupted aortic arch

o Total anomalous pulmonary venous drainage

o Extra Corporeal Membrane Oxygenation

o Transplantation – Heart and Lung

o Vascular sling (Anomalous origin of LPA from RPA)

• Patient Management/Clinical Skills History and Examination

o Cardiovascular system and general history and examination of child or adult with congenital heart disease

• Data Interpretation o Routine hematology and biochemical investigations

o Chest radiograph and ECG

o Cardiac catheterization data including interpretation of hemodynamic data, shunt and resistance calculation

o Basic congenital heart disease imaging (Echo, MRI, CT) interpretation

• Patient Management

o Diagnosis, assessment, and treatment of common congenital heart disease

o Collaborative and complementary role of interventional cardiology

o Risk assessment and stratification

o Basic pediatric intensive care to include ventilator management

o Perioperative management of adults and children following congenital heart surgery

o Mechanical assist (IABP, VAD, ECMO)

o Indications for heart or lung transplantation referral

o Management of complications of surgery

o Cardiopulmonary resuscitation

o Diagnosis and treatment of common congenital cardiac arrhythmias

o Wound infection and sternal dehiscence

• Technical Skills

o Sternotomy - open and close

o Thoracotomy - open and close

o Preparation for and management of cardiopulmonary bypass including partial bypass

o Basic ECMO techniques, cannulation, and management.

o Basic Surgical management of uncomplicated cases:

o Patent ductus arteriosus

o Atrial septal defect

o Coarctation

o PA banding and shunts

o Ventricular septal defect

• Knowledge of Congenital Thoracic Disease

o Familiarity with anatomy, pathophysiology, natural history, management, and results of the following congenital conditions or procedures:

o Congenital lung disease (cystic adenomatoid malformation, congenital lobar

o emphysema, sequestration

o Foregut duplication cysts

o Diaphragmatic hernia and eventration

o Esophageal atresia/fistula

o Diagnosis, assessment, and treatment of common congenital pulmonary and oesophagal disease.

Below is the resulting rotation schedule:

• Other areas in which knowledge is to be acquired:

o Biostatistics, Research Methodology, and Clinical Epidemiology o Ethics

o Medico-legal aspects relevant to the discipline

o Health Policy issues as may apply to the discipline

Career Options

After completing a DrNB in Thoracic Surgery, candidates will get employment opportunities in Government as well as in the Private sector.

In the Government sector, candidates have various options to choose from which include Registrar, Senior Resident, Demonstrator, Tutor, etc.

While in the Private sector the options include Resident Doctor, Consultant, Visiting Consultant (Thoracic Surgery), Junior Consultant, Senior Consultant (Thoracic Surgery), critical care Specialist, etc.

Courses After DrNB in Thoracic Surgery Course

DrNB in Thoracic Surgery is a specialization course that can be pursued after finishing a Postgraduate medical course. After pursuing a specialization in DrNB in ThoracicSurgery, a candidate could also pursue certificate courses and Fellowship programs recognized by NMC and NBE, where DrNB in Thoracic Surgery is a feeder qualification.

Frequently Asked Questions (FAQs) – DrNB in Thoracic Surgery Course

Question: What is the full form of DrNB?

Answer: The full form of DrNB is Doctorate National Board.

Question: What is a DrNB in Thoracic Surgery?

Answer: DrNB Thoracic Surgery or Doctorate National Board in Thoracic Surgery is a super specialty level course for doctors in India which is done by them after completion of their postgraduate medical degree course.

Question: What is the duration of a DrNB in thoracic surgery?

Answer: DrNB in Thoracic Surgery is a super speciality program of three years.

Question: What is the eligibility of a DrNB in Thoracic Surgery?

Answer: Candidates must have a postgraduate medical Degree in MS/DNB General Surgery from any college/university recognized by the Medical Council of India (now NMC)/NBE., this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

Question: What is the scope of a DrNB in thoracic surgery?

Answer: DrNB in Thoracic Surgery offers candidates various employment opportunities and career prospects.

Question: What is the average salary for a DrNB in Thoracic Surgery candidate?

Answer: The DrNB in Thoracic Surgery candidate's average salary is between Rs.10 lakhs to Rs. 45 lakhs per annum depending on the experience.

Question: Can you teach after completing DrNB Course?

Answer: Yes, the candidate can teach in a medical college/hospital after completing the DrNB course.

Question: What is the difference between DrNB and DNB?

Answer: As of today, DrNB is a super-specialist qualification imparted by the NBE (SS level). Whereas DNB is a specialist qualification (PG level). Earlier, DrNB used to be called DNB SS but now it is called DrNB.