FNB Onco-Anaesthesiology: Admissions, medical colleges, fees, eligibility criteria details

FNB Onco-Anaesthesiology or Fellow of National Board (FNB) in Onco-Anaesthesiology also known as FNB in Onco-Anaesthesiology is a doctoral fellowship program for doctors in India that they do after completion of their postgraduate medical degree course. The duration of the FNB course is for 2 years.

The program enables the candidate to work in a multi-disciplinary oncology team and learn the perioperative care of oncology patients, management of critically ill oncology patients in ICU, learn communication skills, interventional radiology procedures in oncology setup, anesthesia for specialized oncology procedures like brachytherapy, learn skills of relevant procedures, teaching, and research.

The course is a full-time course pursued at various accredited institutes/hospitals across the country, the top hospitals include Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Cancer Institute (WIA), Chennai, and more.

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

The fee for pursuing FNB Onco-Anaesthesiology varies from accredited institute/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. 11 lakhs to Rs. 30 lakhs per year.

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 Onco-Anesthesiology?

FNB in Onco-Anaesthesiology is a two-year doctoral fellowship program that candidates can pursue after completing a postgraduate degree.

The program enables the candidate to work in a multi-disciplinary oncology team and learn the perioperative care of oncology patients, management of critically ill oncology patients in ICU, learn communication skills, interventional radiology procedures in oncology setup, anesthesia for specialized oncology procedures like brachytherapy, learn skills of relevant procedures, teaching, and research.

It deals with the study of different super specialties and sub-specialty in the field of cancer prevention and cancer treatment such as Surgical Oncology, Medical Oncology, Radiation Oncology Intervention Radiology w.r.t oncology, Pain and Palliative care, and other allied sciences related to cancer patients.

At the end of the course, the candidate would be able to function as a specialist onco-anaesthesiologist, well-trained in the practice of onco- Anaesthesia, Critical Care, and Pain Management, with knowledge of Resuscitation of all acute or acute chronic conditions and command over the core concepts of Palliative medicine.

The National Board of Examinations (NBE) has released a curriculum for FNB Onco-Anaesthesiology.

The curriculum governs the education and training of FNB Onco-Anaesthesiology.

Course Highlights

Here are some of the course highlights of FNB Onco-Anesthesiology

Name of Course	FNB Onco-Anesthesiology
Level	Fellowship
Duration of Course	Two years
Course Mode	Full Time
Minimum Academic Requirement	Candidates must have a postgraduate medical Degree in DNB/MD Anaesthesia 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.
Admission Process / Entrance Process / Entrance Modalities	Entrance Exam (FET) Merit-based counselling administered by NBEMS
Course Fees	Rs.1,25,000 per year
Average Salary	Rs. 11 lakhs to Rs.30 lakhs per year

The eligibility criteria for FNB in Onco-Anesthesiology are defined as the set of rules or minimum prerequisites that aspirants must meet to be eligible for admission, which include:

Name of Fellowship course	Course Type	Prior Eligibility Requirement
Onco-Anesthesiology	FNB	DNB/MD Anaesthesia

Note:

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 Onco-Anesthesiology 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 Onco-Anesthesiology 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 Onco-Anesthesiology is around Rs.1,25,000 per year.

Colleges offering FNB Onco-Anesthesiology

Various accredited institutes/hospitals across India offer courses for pursuing FNB Onco-Anesthesiology.

As per the National Board of Examinations website, the following accredited institutes/hospitals are offering FNB Onco-Anesthesiology courses for the academic year 2022-23.

FNB in Onco-Anesthesiology is a two years specialization course that provides training in the stream of Onco-Anesthesiology.

The course content for FNB Onco-Anesthesiology is given in the NBE Curriculum released by the National Board of Examinations, which can be assessed through the link mentioned below:

SYLLABUS

1. Basic Sciences:

i. Clinical anatomy and physiology of various tissues, organs, and organ systems.

ii. Clinical Anatomy and its clinical implications:

a. Systems: Respiratory, CVS, CNS (Brain, spinal cord, and cranial/spinal/peripheral nerves and plexuses), GI Tract, Hepatobiliary, Urology, Gynecological.

b. Sensory and motor dermatome distribution and innervations

iii. Physiology and its clinical implications:

a. Understanding various organ and system functional physiology and its clinical implication in the perioperative period, critical care, advanced diseases, and pain (acute and chronic)

b. Physiology related to Theories of anesthesia; Respiratory, cardiovascular, hepatobiliary, renal, and endocrine system, blood, muscle, and N-M junction, Nerve impulse transmission, Cardiac conduction, regulation of temperature and metabolism, stress response, cerebral blood flow, and ICP;

Central, autonomic, and peripheral nervous systems; Metabolic response to stress and trauma.

iv. Physics in perioperative care in cancer patients: Physics for anaesthesiologists including basics of oxygen therapy, equipment-related physics, anesthesia workstations, and airway equipment.

a. Gas laws

b. Anaesthesia machine; machine check and assembly of necessary machine

c. Airway equipment including

d. Tracheostomy/Equipment for airway management-mask, SGAs, fibreoptic endoscopes/laryngoscopes, video laryngoscopes; other devices

like Combitube etc.

e. Breathing systems continuous flow systems, draw over the system.

f. Physics related to equipment used in anesthesia monitors, ventilators, vaporizers, fiberoptics; Laser; Pacemaker and defibrillator; Monitoring equipment used for assessment of cardiac functions, temperature, respiratory functions, blood gases, intracranial pressure, depth of anesthesia and neuromuscular block; Sterilization of equipment.

g. Fluidics; Electricity and diathermy

2. Pharmacology:

i. Pharmacology related to General Principles, concepts of pharmacokinetics and pharmacodynamics; Drug interactions in anesthesiology, anaphylactoid reactions; Drugs used for premedication, induction of anesthesia, general anesthetics, intra-venous and inhalational, neuromuscular block and reversal of muscle relaxants. Pharmacology of drugs used in cardiovascular, respiratory, endocrine, renal diseases, and

CNS disorders.

ii. General Pharmacological principles, the concept of pharmacodynamics and pharmacokinetics.

iii. Inhalational, intravenous anesthetics, drugs used in premedication, postoperative pain, neuromuscular blocking drugs, and in the ICU, autonomic drugs, vasopressors,s and vasodilators.

iv. Drugs used for different diseases.

v. Drug Interactions in Anesthesiology.

vi. Drugs used for spinal, epidural, and local anesthesia.

vii. Interaction of drugs used in the perioperative period on cancer biology, cancer recurrence, and metastasis

3. Chemotherapy:

i. To know details of anticancer chemotherapy drugs (Curative/palliative) Pharmacology (pharmacokinetics, pharmacodynamics).

ii. Various chemotherapy regimens and side effects profiles of chemotherapy agents.

iii. Implications of chemotherapeutic drugs and their impact on anesthesia.related accessories.

iv. Effects and toxicities of chemotherapeutic drugs.

4. Biochemistry:

i. Acid-base homeostasis with focus on cancer patients: Impact of cancer and its treatment

ii. Shock- pathophysiology, clinical diagnosis, and management

iii. Fluids physiology, fluid assessment, blood and blood products, and management in the perioperative period and critical care setup.

iv. Monitoring in Anaesthesia with concepts of minimal and advanced monitoring.

v. Principles of oximetry, capnography, and neuromuscular monitoring.

vi. Principles of different monitoring equipment used in the perioperative period and critical care setup.

vii. Safety in Anaesthesia equipment

viii. Medical gases; storage and central pipeline system and cylinders.

ix. Pulmonary function tests: principles, assessment and interpretations and its applications in optimization and perioperative management.

x. Theoretical background on systemic disorders: Cardiovascular, respiratory, hepatobiliary, Renal, Neurologic, Degenerative, Endocrine and Metabolic syndromes, DIC, and ARDS.

xi. Oxygen therapy.

xii. Basics of various imaging modalities including X-rays, Ultrasound, MRI, CT Scan, PET scan, and other relevant imaging for cancer patients.

xiii. Understanding the concept of cancer cellular and tissue biology

xiv. Basic and Advanced life support measures.

xv. Temperature regulation and management in the perioperative period and effect on oncology patients.

xvi. Airway assessment including history, examination, and imaging including the latest advancements in airway management and assessment including Ultrasound and reconstructed images, and virtual endoscopies.

xvii. Principles of mechanical ventilation including physics of ventilator, understanding of loops and graphics, various ventilatory modes, initiations of ventilation, and weaning.

xviii. Artificial ventilation, ventilators, currently used modes, choice of ventilators, care of the patient on a ventilator.

xix. Sterilization and disinfectants for various machines, equipment, and tools for perioperative and critical care of cancer patients.

xx. Acute and Chronic Pain: Pathophysiology and Management

xxi. Monitor and assess the depth of anesthesia.

5. Clinical Sciences:

i. Details related to appropriate pre-anesthetic checks of patients including history, physical examination, examining the reports of relevant laboratory tests, and imaging and their interpretation.

ii. Patient assessment, anesthesia-related various scoring systems for assessment, risk stratification, and prognostications.

iii. General principles of premedication

iv. Understand the problems and anesthetics implications of the various comorbid conditions and situations including:

a. Endocrine disorders: Including Thyroid, pheochromocytoma, paraneoplastic syndrome

b. Chronic respiratory disease; respiratory crises situations

c. Hypertension and coronary artery disease

d. Congenital heart disease

e. Geriatric anesthetic problems

v. Anaesthesia in difficult situations/outside OR/remote locations/NORA:

Radiology including EBUS, MRI, CT Scans (especially about dye allergy and embolization, Ultrasound-guided biopsies; endoscopic and airway-sharing procedures including pulmonary interventions, GI interventions; day care surgery, laser surgery, radiotherapy, neuroradiologic procedures.

vi. Oncologic procedures for focused specialties: laparoscopic, robotic, neurosurgical, neonatal, pediatric, gynecological, orthopedic, thoracic

(thoracic surgeries including lung, mediastinum, and esophageal surgeries, chest wall resection, and reconstructions), reconstructive plastic, head and neck, the base of the skull, and ENT procedures. It includes all relevant situations for perioperative care and critical care management for cancer patients.

vii. Recognize anesthetic problems in high-risk patients and select further investigations and referrals for expert opinion for dealing with specific problems. Further optimization is preparation for surgical interventions.

viii. Perioperative care of peritoneal surface malignancies and Specialized procedures like HIPEC, and PIPAC.

ix. Perioperative care for emergency surgery, recognize perioperative complications,s and institute therapy in oncology patients.

x. Nutrition in critically ill patients by parenteral and enteral nutrition and preoperative nutritional optimization.

xi. Understanding of basics, assessment, optimization, and perioperative management of associated comorbidities for oncologic surgeries: CADs,

Thyroid disorders, Neurological disorders like stroke, hypertension, renal, hepatobiliary, diabetes mellitus, chronic obstructive airway disease,

including bronchial asthma, myasthenia gravis, obesity, paraplegia, neuromuscular disorders, burns resuscitation and critical care, intensive

care management of all assorted patients.

xii. Perioperative management of cancer patients with Malignant hyperthermia, myasthenia gravis, GB syndrome and other neuromuscular

diseases, obesity, COPD, Diabetes Mellitus, bronchial asthma, and hypertensive crises.

xiii. Regional anesthesia techniques- Learning of thoracic epidural catheter placement for intraoperative and postoperative analgesia for thoracic and GI surgeries, lumbar epidural, segmental block and paravertebral block, Spinal/Intrathecal anesthesia, Combined spinal and epidural block,

Caudal block, Peripheral Nerve block, Brachial plexus block by inter scalene, supraclavicular and axillary approach, Intravenous regional anesthesia, and newer fascial plane blocks. Including anatomy for various neural innervations, the decision for selection of an appropriate block, and administration using anatomical landmarks, nerve stimulator, ultrasound, and fluoroscopy-guided interventions.

xiv. Understanding basics of various regional blocks including indications, contraindications, method/steps, complications, and management, drugs, and adjuncts to be administered for the blocks and their advantage, disadvantage, and limitations.

xv. Perioperative and periprocedural procedures in neonates and children with cancers: surgeries; biopsies; radiation therapies etc.

xvi. Anaesthetic implication of coagulation disorders: impact of cancer and treatment on coagulopathies.

xvii. Identify conditions like difficult airways by following difficult airway algorithms.

xviii. Understanding the spectrum of critical illnesses requiring admission to ICU.

xix. Understanding, initiation, and interpretation of various invasive and noninvasive monitoring modalities in perioperative and critical care setup for a cancer patient.

xx. Understanding of pain assessment: Acute and chronic including physiology, pathology, assessment, and management.

xxi. Acute Pain management: pharmacological and non-pharmacological (interventions and adjunct therapies). Organization of acute pain service

xxii. Chronic Pain management: pharmacological and non-pharmacological (interventions and adjunct therapies). Physiological changes secondary to Pain

xxiii. Principle of patient-controlled analgesia and assessment of its efficacy

xxiv. Pain control in concurrent medical diseases – COAD, IHD, bleeding tendency, geriatric.

xxv. Practice principles of management of cancer pain, the principle of management of non-cancer neuropathic pain - phantom limb pain, post-herpetic neuralgia, complex regional pain syndrome, trigeminal neuralgia. Principle of management of non-cancer nociceptive pain - myofascial pain, lower back pain, intractable angina, burns, chronic pancreatitis, PVD. Recognize complications associated with each block and appropriate treatment of each.

xxvi. Palliation in advanced cancers

xxvii. Interventions for palliation in advanced/metastatic cancers like Pleural tap, ascitic tap, pleurodesis, etc.

xxviii. Neurolytic Blocks: Nerve and plexus blocks.

xxix. Principles for insertion and management of implantable drug delivery pumps, nerve stimulator implants; Stimulation techniques such as

transcutaneous electrical nerve stimulation (TENS), dorsal column stimulation, and deep brain stimulation.

xxx. Chronic pain syndromes: Understanding, pathology, assessment, and management including pharmacological/non-pharmacological/adjunct modalities.

xxxi. Knowledge about palliative care including care of the terminally ill, hospice management, do not resuscitate orders, etc.

6. Anaesthetic Considerations Specific for Oncology:

i. Theoretical knowledge about pathophysiology, diagnosis, and treatment of cancer.

ii. To know about various cancer treatment modalities

iii. Anaesthetic Considerations in Onco-surgery

a. Elective postoperative care in major oncological surgeries

b. Postoperative care of emergency onco- surgery patients

c. Preoperative optimization of critically ill onco patients

d. Patients with multiple comorbidities

e. Major airway surgeries

f. Major tumor and organ resections

g. Major reconstructive procedures

h. Higher ASA status patients

i. Delayed postoperative sepsis

j. Analgesia and Sedation

k. Hemodynamic instability

l. Airway edema, ventilatory management

m. Coagulation abnormalities

n. Thermoregulation

o. Postoperative Delirium and Agitation (POCD)

iv. Fluid Management in Onco-surgery

a. Goal-directed fluid therapy – near zero balance

b. Invasive hemodynamic monitoring – CVP, IBP, Flotrac, CO, SVV, SVR, etc.

c. Optimal use of vasopressors and inotropes – the low threshold for usage

d. Optimal use of blood components.

v. Coagulation Abnormalities and its effects on peri-operative management.

a. Thrombo-embolism and DVT Prophylaxis

vi. Difficult Airway management:

vii. Temperature Monitoring and Management

viii. ERAS

ix. ICU admission of cancer patients: Open & Closed ICU setups for cancer patients

a. Identification of cancer patients benefiting ICU care

b. Factors leading to delayed ICU admission (e.g., healthcare access, acuteness, and severity of the disease, initial admission to a ward vs. the emergency department

c. Patients with persistent multiple organ failure

x. Ventilatory Management:

a. Lung protective ventilation strategies – low tidal volume, optimal PEEP, low driving pressures

b. Prevention of VILI and VAP – closed suction, subglottic suction ET tubes

c. Early weaning

d. Customized ventilation strategies for lung volume reduction surgeries

xi. Special Concerns in CRS + HIPEC:

a. AKI (due to hemodynamic compromise, cisplatin)

b. Pleural effusion (reactive to peritonectomy of diaphragmatic surfaces)

c. Thrombocytopenia (cytotoxic chemotherapy drugs), dilutional coagulopathy

d. Electrolyte imbalance

e. Postoperative ileus (correct electrolyte imbalance, use Alvimopan)

f. Sepsis

g. Pulmonary embolism

xii. Special Concerns in Flap Surgeries:

7. Monitoring:

i. Electrocardiogram with ST-segment analysis

ii. Noninvasive blood pressure

iii. Capnograph: values and changes in values and waveform.

iv. Pulse oximetry: values and changes in values

v. Neuromuscular blockade monitor

vi. Respiratory gas monitors – MAC

vii. Invasive arterial pressure: waveform and changes in the waveform

viii. Central venous pressure: values and waveform

ix. Minimally invasive cardiac output monitoring

x. Pulmonary artery pressure: Values and waveforms, pulmonary capillary wedge tracing.

xi. Cardiac output

xii. Mixed venous oxygen saturation

xiii. Evoked potential

xiv. Transesophageal echocardiography: basic understanding

xv. BIS/Entropy /EEG monitoring

8. Intensive Care:

i. Respiratory management

ii. Principles of ventilatory management

iii. Non-invasive ventilation

iv. Pulmonary edema –

v. Adult respiratory distress syndrome

vi. Severe asthma and COPD

vii. Respiratory infections community and hospital-acquired

9. Principles of Cardiac and Hemodynamic Management:

i. Hemodynamic instability and shock

ii. Cardiac arrest

iii. Acute myocardial infarction

iv. Unstable angina

v. Severe heart failure

vi. Common arrhythmias and conduction disturbances – Cardiomyopathies

vii. Cardiac tamponade

viii. Pulmonary embolism

10. Oncology:

i. Oncology emergencies like SVC syndrome, tumor lysis syndrome, etc.

ii. Anaesthetic considerations of radiotherapy

iii. Acute pain syndromes during oncology treatment

iv. Management of chemotherapy-induced neuropathy

v. Prehabilitation

vi. Anaesthetic considerations of chemotherapy

11. Renal:

i. Oliguria/ anuria

ii. Acute renal failure

iii. Renal replacement therapy (RRT)

iv. Continuous RRT

12. Metabolic and Nutritional:

i. Fluid balance

ii. Electrolyte balance and its disorders

iii. Acid-base disorders

iv. Endocrine disorders (including diabetes mellitus, acute adrenal insufficiency, pituitary disorders, hyper, and hypothyroidism)

v. Nutrition in critical illness

vi. Enteral and Parenteral nutrition

vii. Monitoring of nutrition

13. Hematological:

i. Disseminated intravascular coagulation and other coagulation disorders

ii. Thrombocytopenia

iii. Hypercoagulable states and anticoagulation

iv. Haemolytic syndromes

v. Acute blood loss and anemia

vi. Neutropenia

vii. Blood component therapy

viii. Immunological disorders

14. Infections:

i. Severe infection due to aerobic and anaerobic bacteria

ii. Acute severe viral infection

iii. Fungal and parasites infections with sepsis and organ failure

iv. Nosocomial infection

v. Infection in the immunocompromised host

vi. Tropical disease

vii. Antimicrobial therapy

15. Gastrointestinal and hepatic disorders:

i. Prevention and treatment of acute upper G.I. bleeding

ii. Management of acute lower GI bleeding

iii. Perforated viscus and Peritonitis

iv. Acute hepatic failure and Ascites

16. Clinical skills to be acquired:

i. Pre-anesthetic evaluation for elective and emergency oncosurgery

ii. Anaesthetic and Perioperative management of various oncological conditions

iii. Intensive Care for oncological patients (both surgical and medical)

iv. Palliation and communication in oncology – Integration of Palliative Care including communication skills and end-of-life care (EOLC).

Career Options

After completing FNB Onco-Anesthesiology, 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, Consultants.

While in the Private sector, the options are Fellow (Onco-Anesthesiology), Junior research fellow, Senior Research fellow (Onco-anesthesiology), and Consultants.

Frequently Asked Questions (FAQs) –FNB Onco-Anesthesiology Course/ FNB in Onco-Anesthesiology Course

• Question: What is the full form of FNB?

Answer: The full form of FNB is Fellow of National Board.

• Question: What is FNB Onco-Anesthesiology?

Answer: FNB in Onco-Anesthesiology or Fellow of National Board in Onco-Anesthesiology is a doctor fellowship course for doctors in India that they do after completion of their postgraduate medical degree course.

• Question: What is the duration of FNB in Onco-Anesthesiology?

Answer: FNB in Onco-Anesthesiology is a doctoral fellowship program of two years.

• Question: What is the eligibility of FNB in Onco-Anesthesiology?

Answer: The candidate must have a postgraduate medical Degree in DNB/MD Anaesthesia 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 Onco-Anesthesiology?

Answer: FNB Onco-Anesthesiology offers candidates various employment opportunities and career prospects.

• Question: What is the average salary for an FNB Onco-Anesthesiology candidate?

Answer: The FNB Onco-Anesthesiology candidate’s average salary is between Rs. 11 lakhs to Rs. 30 lakhs per year depending on the experience.

• Question: Can you teach after completing FNB Onco-Anesthesiology Course?

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