FNB Hand and Micro Surgery: Admissions, Medical Colleges, fees, eligibility criteria details

FNB Hand and Micro Surgery or Fellow of National Board in Hand and Micro Surgery also known as FNB in Hand and Micro Surgery is a doctoral fellowship program for doctors in India that is done by them after completion of their postgraduate medical degree course. The duration of the FNB course is for 2 years.

Training in FNB Hand and Microsurgery emphasizes traumatic and acquired conditions of the hand, wrist, forearm, elbow, arm, and shoulder including peripheral nerve disorders, microsurgical training in collaboration with Plastic Surgery, brachial plexus arthroscopy of the hand, wrist, joint replacement of the hand, wrist, and congenital hand surgery.

The course is a full-time course pursued at various accredited institutes/hospitals across the country the top institutes offering fellowship include Sir Ganga Ram Hospital, New Delhi, and more.

Candidates can get admission to 2 years FNB course after successfully qualifying for the FET (Fellowship Entrance Test) examination which is conducted by NBEMS. FET is conducted annually as per the prescribed schedule. The merit-based counseling for admissions to the FNB Programme after the conduct of FET is administered by NBEMS.

The fee for pursuing FNB Hand & Micro Surgery varies from accredited institutes/hospital to hospital and is around Rs.1,25,000 per year.

After completion of their respective course, doctors can either join the job market. Candidates can take reputed jobs at positions as research fellows, Senior residents, Consultants, etc. with an approximate salary range of Rs. 12 lakhs to Rs.20 lakhs per year which varies according to experience.

The Nomenclature of the FNB qualification awarded by the National Board of Examinations in Medical Sciences is “Fellow of National Board”. The FNB qualifications are recognized qualifications in terms of the Gazette notification dated 10th August 2016.

What is FNB in Hand & Micro Surgery?

FNB in Hand & Micro Surgery is a two-year doctoral fellowship program that candidates can pursue after completing a postgraduate degree.

The fellowship combines clinical, teaching, and research opportunities for Plastic, Orthopaedic and General surgeons interested in furthering their knowledge of the upper extremity. Training emphasizes traumatic, congenital, and acquired conditions of the hand, wrist, forearm, and elbow.

The purpose is to help the Fellow develop an understanding of surgical and medical management of musculoskeletal problems of the entire upper extremity. The program provides a mix of basic hand surgery and complex hand surgery conditions.

The National Board of Examinations (NBE) has released a curriculum for FNB Hand & Micro Surgery.

The curriculum governs the education and training of FNB Hand & Micro Surgery.

Course Highlights

Here are some of the course highlights of FNB Hand & Micro Surgery

Eligibility Criteria

Note:

Admission Process

The admission process contains a few steps to be followed for the candidates for admission to FNB. Candidates can view the complete admission process for FNB Hand & Micro Surgery mentioned below:

• FET is a qualifying-cum-ranking examination for admission to Fellow of National Board (FNB)/Fellow of National Board - Post Doctoral (FNB-PD) courses.
• The selection of a student will be through an MCQ-based examination namely Fellowship Entrance Test.
• A student can apply for the fellowship courses for which his/her broad or super specialty qualification/ equivalent qualification is eligible, at the time of online submission of the application form.
• The total duration of the question paper will be 105 minutes (Part A - 45 minutes and Part B - 60 minutes).
• QUALIFYING CRITERIA: Students who obtain a minimum of 50th Percentile in their respective question paper/specialty shall be declared as “Qualified”.
• NBEMS shall declare a specialty-wise merit list i.e., there will be a separate merit list for each fellowship course. There shall not be any equating/scaling and normalization. The merit shall be generated strictly based on marks obtained by the student and the application of the prescribed tie-breaking criteria.
• The admission to Fellowship courses in the accredited hospitals shall be undertaken solely based on merit-based counseling conducted by NBEMS.
• Documents required to be produced at the time of counseling: MBBS Degree Certificate and MD/MS/DNB/DM/MCh/DrNB Degree Certificate/Provisional Pass Certificate of eligible Post Graduate Medical Qualification issued.

Fees Structure

The fee structure for FNB Hand & Micro 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 FNB Hand & Micro Surgery is Rs.1,25,000 per year.

Colleges offering FNB Hand & Micro Surgery

Syllabus

FNB in Hand & Micro Surgery is a two years specialization course that provides training in the stream of Hand & Micro Surgery.

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

SYLLABUS

THEORY

Basic Sciences

• Anatomy of the hand and upper limb

• Embryology of the Hand and Upper Limb

• Physiology of muscle, nerve and bone metabolism

• Principles of infection, microbiology

• Healing of wound, tendon, bone, nerve

• Anatomy and physiology of blood supply to limb including skin

• Imaging (MRI, Ultrasound, Plain radiographs, CT)

• Pathology of rheumatic, degenerative and neoplastic disorders

• Biomechanics of the hand and wrist

• Embryology of the Upper Extremity

• Basic Pathology of the Hand, Wrist, and Forearm: Bone and Joint

• Basic Pathology of the Hand, Wrist, and Forearm: Tendon and Ligament

• Basic Pathology of the Hand, Wrist, and Forearm: Nerve

• Basic Vascular Pathophysiology of the Hand, Wrist, and Forearm Principles of Hand Surgery

• Examination of nerves, tendons, vascular system, joints

• Injured hand - wound care, management of skeletal, vascular, tendon and nerve injuries

• Treatment of fractures and malunions of the hand

• Ligament ruptures and joint instabilities of the hand

• Arthroscopy of the hand and wrist

• Amputations in the hand and upper limb

• Burns of the hand

• Reconstructive surgery of the mutilated hand

• Management of upper limb nerve injuries, including brachial plexus injuries

• Management of tetraplegia, stroke, brain injury, and cerebral palsy

• Tendon transfers

• Congenital abnormalities of the hand and upper limb

• Arthrosis of the hand and wrist

• The arthritic hand in rheumatoid arthritis and other inflammatory arthritides, e.g. LES and scleroderma

• Dupuytren’s contracture

• Overuse syndromes

• Nerve compression syndromes

• Infections of the hand

• Vascular disorders (inc ischemia, HAVS)

• Tumours of the hand

• Psychiatric manifestations, secondary gain etc.

• Principles of Hand Therapy

• Complex regional pain syndrome

• Skin grafts

• Local, distant and free flaps

• Extravasation injuries

• Enhancing wounds including specialized dressings and vacuum therapy

• Spasticity

Applied sciences

• Anesthesia in Hand and Upper Extremity Surgery

• Radiographic Imaging of the Hand, Wrist, and Forearm

• Principles of Hand Therapy

• Entraarticular Fractures of the Phalanges

• Extraarticular Fractures of the Metacarpals

• Intraarticular Injuries of the Distal and Proximal Interphalangeal Joints

• Intraarticular Injuries of the Metacarpophalangeal and Carpometacarpal Joints

• Fractures and Joint Injuries of the Thumb

• Malunion and Other Posttraumatic Complications in the Hand

• Fractures and Joint Injuries of the Child's Hand

• Extraarticular Distal Radius Fractures

• Intraarticular Distal Radius Fractures

• Acute Injuries of the Distal Ulna

• Malunion of the Distal Radius and Ulna

• Distal Radioulnar Joint Instability

• Triangular Fibrocartilage Complex Injuries and Ulnar Impaction Syndrome

• Fractures of the Carpus: Scaphoid Fractures

• Nonunions of the Carpus

• Wrist Instability

• Ligament Injuries and Instability of the Carpus

• Dissociations of the Radius and Ulna: Surgical Anatomy and Biomechanics

• Principles of wrist Arthroscopy

• Arthroscopic Repair and Stabilizati

• Arthroscopic Debridement, Resections, and Capsular Shrinkage

• Ganglionectomy

• Flexor Tendon Injuries

• Flexor Tendon Grafting

• Early Active Motion after Flexor Tendon Repair

• Early Repair of Extensor Tendon Injuries

• Extensor Tendon Reconstruction after Chronic Injuries

• Rehabilitation after Extensor Tendon Injury and Repair

• Tendon Disorders: de Quervain's Disease, Trigger Finger, and Generalized Tenosynovitis

• Tennis Elbow Entrapment Neuropathies in the Upper Extreimity

• Principles and technique of of Tendon Transfers following nerve injuries

• Brachial Plexus Injury: Acute Diagnosis and Treatment

• Brachial Plexus: Neurotization and Pedicle Muscle Transfer

• Brachial Plexus: Free Composite Tissue Transfers

• Reconstruction of the Spastic Hand

• Burns of the Hand and Upper Extremity

• Frostbite

• Dupuytren's Contracture

• Fingertip and Nailbed Injuries

• Skin Grafts and Tissue Expanders

• Skin and Soft Tissue: Pedicled Flaps

• Free Tissue Transfers for Coverage

• Rheumatoid Arthritis in the Hand and Digits

• Rheumatoid Arthritis of the Wrist

• Crystalline Arthritis and Other Arthritides

• Osteoarthritis of the Hand and Digits: Distal and Proximal Interphalangeal Joints

• Osteoarthritis of the Hand and Digits: Metacarpophalangeal and Carpometacarpal Joints

• Osteoarthritis of the Hand and Digits: Thumb

• Principles of Limited Wrist Arthrodesis

• Scaphotrapeziotrapezoid and Scaphocapitate Fusions

• Four-Corner Fusion

• Radiocarpal and Total Wrist Arthrodesis

• Proximal Row Carpectomy

• Wrist Arthroplasty

• Denervation of the Wrist

• Congenital Disorders: Classification and Diagnosis

• Congenital Disorders: Syndactyly

• Congenital Disorders: Polydactyly

• Congenital Disorders: Hypoplastic Thumb

• Congenital Disorders: Radial and Ulnar Club Hand

• Congenital Disorders: Cleft Hand

• Camptodactyly and Clinodactyly

• Delta Phalanx and Madelung's Deformity

• Macrodactyly, Constriction Band Syndrome, Synostosis

• Replantation

• Vascular Injuries: Acute Occlusive Conditions

• Compartment Syndromes and Ischemic Contracture

• Vascular Disorders: Arteriovenous Malformations

• Raynaud's Syndrome

• Thumb Reconstruction

• Finger Reconstruction and Ray Resection

• Wrist and Mid-Hand Reconstruction

• Tumors: General Principles

• Soft Tissue Tumors of the Hand: Malignant

• Primary Bone Tumors

• Metastatic Lesions

• Hand Infections

• Open-Wound, Injection, and Chemical Injuries

• Practical Guide for Complex Regional Pain Syndrome in the Acute Stage and Late Stage

• Pediatric Brachial Plexus Palsy

• Hand, Wrist, and Forearm Fractures in Children

• Rehabilitation

• Recent advances in hand and microsurgery

PRACTICAL

List of procedures follows a description with the operations to be performed independently by the trainee or, for operations of a higher degree of difficulty, as a participant. Microvascular experience is essential.

Surgical procedures can be listed according to the anatomical structures involved:

Skin and subcutaneous tissue

• Free skin graft

• Pedicled localflaps

• Regional and-or island flaps

• Free flap with microvascular anastomosis

• Treatment of retracting scars of the hand and wrist

• Application of vacuumtherapy

• Dupuytren’ s including PNF, collagenase, limited and radical surgery

• Extravasation

• Infection

Tendons

• Flexor tendon repair

• Flexor tendon graft

• Flexor pulley reconstruction

• Flexor tendon tenolysis

• Trigger finger release

• Extensor tendon repair

• Extensor tendon graft

• Extensor tendon tenolysis

• Tendon sheath synovialectomy

• Tendon reconstruction in rheumatoid arthritis

• Tendon transfers (injury, paralysis, spastic conditions)

• Free muscular flap with microvascular anastomosis

• Flexor sheath infection

Bone and Joints

• Closed reduction and fixation of fractures and dislocations

• Open reduction and fixation of fractures and dislocations

• Corrective osteotomies

• Treatment of non-union

• Bone resections

• Bone grafts and substitutes

• Free bone transfers with microvascular anastomosis

• Finger joint ligament or palmar plate repair-reconstruction

• Wrist ligament repair-reconstruction

• Arthrolysis Digital-wrist arthroplasty (incl. allo-arthroplasty)

• Wrist partial and total fusion, PRC

• Hand Arthrodesis

• Denervation

• Synovectomy

• Arthroscopy

• DRUJ reconstruction

• Fractures in children

Nerves

• Microsurgical repair of nervelesions

• Nerve grafting and neurotisation andconduits

• Neurolysis

• Neuroma

Vascular

• Tumours and malformations

• Ischaemia (inc Kienbock’ s, Raynauld’ s)

• Replantation

• Revascularisation

Other

• Congenital disorders

• Children’ s disorders

• 5. Oncology- biopsy (transcutaneous, open); excision,reconstruction

• Brachial plexus repair-reconstruction

• Neuromas

• Nerve tumours

• Treatment of nerve compressionsyndromes

Blood vessels

• Microsurgical arterial anastomosis

• Microsurgical venous anastomosis

• Vein graft

• Adventitiectomy

List of procedures should also include operations for the treatment of complex trauma of the hand, special diseases, malformations:

Amputations

• Hand level

• Carpal or forearm-upper limb level

Replantation in limbamputations

• Digital or metacarpal level

• Carpal or forearm-upper limb level

• Lower limb

Treatment of thermal burn, chemical injury, electrical trauma

Mangled hand treatment

Fasciotomy

• Acute

• Chronic

Infections of the Hand

• Treatment of wound infection incl. tendonsheath

• Treatment of paronychial or pulpinfection

• Treatment of osteomyelitis or septic arthritis

• Necrotising fasciitis

Tumours

• Resection of skin and soft tissue tumour

• Resection of bonetumour

• Resection of tumour-likelesion

Contracture

• Dupuytren’ s

• Volkmann’ s

• Stiffness

• Burns

Treatment of congenital malformations of the hand

RESEARCH

The Hand Surgeon should undertake some research during his/her training, At the very least, a thorough understanding of the basics of research is essential

• Formulating a hypothesis

• Designing an appropriate methodology to test that hypothesis

• Using appropriate statistics to report the research

• Deducing appropriate conclusions form the data

• Understanding the limitations of a study

• Epidemiological principles

Biostatistics, Research Methodology and Clinical Epidemiology Ethics Medico legal aspects relevant to the discipline

Health Policy issues as may be applicable to the discipline

In addition, the Hand Fellow will attend one national Hand Surgery meeting and is encouraged to become a member of the National body of Hand Surgery.

Skills

Intellectual Skills

Education: A Hand Surgeon must be able to critically assess a research article or podium presentation, to understand the strengths and weaknesses of the material and to apply it to his own practice.

Continuing Medical Education: Education is a life-long process; the Hand Surgeon should take personal responsibility to use all resources to improve and update his knowledge and practice.

Personal Skills

Team working: Hand Surgeons work with theatre teams, therapists, nurses, junior doctors and many others who are involved in the care of patients. The Hand Surgeon will often be the leader of the team and should develop the necessary qualities of leadership.

Delegation: Many problems in Hand Surgery can be shared with others. The Hand Surgeon should develop skills of delegation so that patient care can be safely delegated to the appropriate practitioner to help provide an efficient, safe and cost- effective service.

Time Management and Stress Management: Surgery is stressful. It requires long hours with many competing demands on time and skill. Some decisions are uncertain; some procedures are very complex with potentially serious complications and uncertain outcome. The Hand Surgeon must learn to manage time and cope with stress.

Referral: The Hand Surgeon must appreciate the responsibility of asking for advice or referring to another practitioner when a case is beyond his expertise or comfort.

Other Skills

Consent: Informed consent is important in developingt he confidence of a patient by engaging them in the choice of treatmen and avoiding medico-legal issues with unexpected outcomes.

Documentation: Clear contemporaneous documentation is important for many reasons: to allow proper handover, for example post-operative instructions; to record the basis of clinical decisions; for medico-legal protection; to collect data for research and audit.

Service Management: A Hand Surgeon must be able to prioritise and also develop the skills to manage their service with the skills, resources and personnel available.

Career Options

After completing FNB Hand & Micro Surgery, candidates will get employment opportunities in Government and the Private sector.

In the Government sector, candidates have various options to choose from which include Junior research fellow, Teaching at academic medical centers, and Consultants.

While in the Private sector the options Fellow (Hand and microsurgery), Junior research fellow, Senior Research fellow (Hand and microsurgery), and Consultants.

Frequently Asked Questions (FAQs) –FNB Hand & Micro Surgery Course/ FNB in Hand & Micro Surgery Course

• Question: What is the full form of FNB?

Answer: The full form of FNB is a Fellow of National board.

• Question: What is FNB Hand & Micro Surgery?

Answer: FNB in Hand & Micro Surgery or Fellow of National Board in Hand & Micro Surgery is a doctoral fellowship program for doctors in India that is done by them after completion of their postgraduate medical degree course.

• Question: What is the duration of FNB in Hand & Micro Surgery?

Answer: FNB in Hand & Micro Surgery is a doctoral fellowship program of two years.

• Question: What is the eligibility of FNB in Hand & Micro Surgery?

Answer: The candidate must have a postgraduate medical Degree in DrNB/MCh Plastic Surgery or DNB/MS Orthopaedics or DNB/MS General Surgery obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE.The 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 FNB Hand & Micro Surgery?

Answer: FNB Hand & Micro Surgery offers candidates various employment opportunities and career prospects.

• Question: What is the average salary for FNB Hand & Micro Surgery candidate?

Answer: The FNB Hand & Micro Surgery candidate’s average salary is between Rs.12 lakhs to Rs. 20 lakh per annum depending on the experience.

• Question: Can you teach after completing FNB Hand & Micro Surgery Course?

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