Guidelines

For

Competency Based Training Programme

In

DNB- CARDIOLOGY

NATIONAL BOARD OF EXAMINATIONS

Medical Enclave, Ansari Nagar, New Delhi-110029, INDIA
Email: mail@natboard.edu.in Phone: 011 45593000

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 CONTENTS

I. OBJECTIVES OF THE PROGRAMME

a) Programme goal
b) Programme objective

II. ELIGIBILITY CRITERIA FOR ADMISSION

III. TEACHING AND TRAINING ACTIVITIES

IV. SYLLABUS

V. COMPETENCIES

VI. THESIS & THESIS PROTOCOL

VII. LOG BOOK

VIII. NBE LEAVE GUIDELINES

IX. EXAMINATION –

a) FORMATIVE ASSESSMENT
b) FINAL THEORY & PRACTICAL

X. RECOMMENDED TEXT BOOKS AND JOURNALS

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PROGRAMME GOAL

The goal of course is to produce a competent cardiologist who:

• Recognizes the health needs of patients and carries out professional

obligations in keeping the principles of National Health policy and
professional ethics
• Has acquired the competencies pertaining to neurology that are required
to be practiced in the community and at all levels of health care system
Has acquired skills in effectively communicating with the patients, family
and the community
• Is aware of the contemporary advances and developments in medical
sciences Acquires a spirit of scientific enquiry and is oriented to principles
of research methodology
• Has acquired skills in educating medical and paramedical professionals

PROGRAMME OBJECTIVES

At the end of the Postgraduate training in the discipline concerned the student
shall be able to
• Recognize the importance of Cardiology in the context of the health needs
of the community and national priorities in the health sector.
• Practice Cardiology ethically and in step with the principles of primary
health care.
• Demonstrate sufficient understanding of the basic sciences relevant to
Cardiology.
• Identify social, economic, environmental, biological and emotional
determinants of health in a given case, and take them into account while
planning therapeutic, rehabilitative, preventive, and promotive
measures/strategies.

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• Diagnose and manage majority of conditions in the specialty of Cardiology
on the basis of clinical assessment, and appropriately selected and
conducted investigations.
• Plan and advice measures for the prevention and rehabilitation of patients
suffering from disease and disability related to the specialty of Cardiology.
• Demonstrate skills in documentation of individual case details as well as
morbidity and mortality data relevant to the assigned situation.
• Demonstrate empathy and humane approach towards patients and their
families and exhibit interpersonal behaviour in accordance with the
societal norms and expectation.
• Play the assigned role in the implementation of National Health
Programme, effectively and responsibly.
• Organize and supervise the Cardiological Health Care services
demonstrating adequate managerial skills in the clinic/hospital in the field
situation.
• Develop skills as a self-directed learner, recognize continuing educational
needs: select and use appropriate learning resources.
• Demonstrate competence in basic concepts of research methodology and
epidemiology and be able to critically analyze relevant published research
literature.
• Develop skills in using educational methods and techniques as applicable
to the teaching of medical/nursing students, general physicians and
paramedical health workers.
• Function as an effective leader of a health team engaged in health care,
research or training.
• Take detailed history, perform full physical examination and make a
clinical diagnosis.
• Perform and interpret relevant investigations (Imaging and Laboratory).
• Perform and interpret important diagnostic procedures.
• Diagnose cardiovascular illnesses based on the analysis of history,
physical examination and investigative work up;

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• Plan and deliver comprehensive treatment for illness using principles of
rational drug therapy.
• Plan and advice measures for the prevention of cardiovascular disease
• Plan rehabilitation of adults suffering from chronic illness, and those with
special needs
• Manage cardiological emergencies efficiently;
• Demonstrate skills in documentation of case details, and of morbidity and
mortality data relevant to the assigned situation;
• Demonstrate empathy and humane approach towards patients and their
families and respect their sensibilities;
• Demonstrate communication skills of a high order in explaining
management and prognosis, providing counseling and giving health
education messages to patients, families and communities.
• Develop skills as a self- directed learner, recognize continuing educational
needs; use appropriate learning resources, and critically analyze
published literature in order to practice evidence-based medicine
• Demonstrate competence in basic concepts of research methodology and
epidemiology;
• Facilitate learning on MD residents, medical/nursing students, practicing
physicians, paramedical health workers and other providers as a teacher-
trainer
• Play and assigned role in the implementation of national health programs,
effectively and responsibly;
• Organize and supervise the desired managerial and leadership skills;
• Function as a productive member of a team engaged in health care,
research and education.

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NATIONAL OBJECTIVES

• Should be able to work in any hospital in India with minimum of facilities

and should be able to diagnose and treat cardiac disease swiftly and
efficiently both on an elective and emergency basis.
• Should be able to start a Cardiac Unit with effective functioning with
minimum inputs. 1.2.3: Should be able to work effectively in National
Programme for the Prevention or Eradication of Heart Diseases.

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ELIGIBILITY CRITERIA FOR ADMISSIONS TO THE PROGRAMME

(A) DNB Cardiology Course:

1. Any medical graduate with MD/DNB in General Medicine or Paediatrics

qualification , who has qualified the Entrance Examination conducted by
NBE and fulfill the eligibility criteria for admission to Super Specialty
courses at various NBE accredited Medical Colleges/ institutions/Hospitals
in India is eligible to participate in the Centralized counseling for allocation
of DNB Cardiology seats purely on merit cum choice basis.

2. Admission to 3 years post MBBS DNB Cardiology course is only through

Entrance Examination conducted by NBE and Centralized Merit Based
Counseling conducted by National Board of Examination as per
prescribed guidelines.

Duration of Course: 3 Years

Every candidate admitted to the training programme shall pursue a regular

course of study (on whole time basis) in the concerned recognized institution
under the guidance of recognized post graduate teacher for assigned period of
the course.

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TEACHING AND TRAINING ACTIVITIES

The fundamental components of the teaching programme 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 have one oral presentation at least once during their training
period in a recognized conference.

8. One Session on Graphics i.e ECGs, X-Rays, CT, CMR, PET, Nuclear
Cardiology, Hemodynamic Tracings, Basic EP Tracings, Pacemaker
Surveillance and Trouble Shooting.

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 being divided into theoretical, clinical and
practical in all aspects of the delivery of the rehabilitative care, including methodology of
research and teaching.

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 in view
of an inadequate exposure to the subject in the undergraduate curriculum.

Symposia: Trainees would be required to present a minimum of 20 topics based on the

curriculum in a period of three years to the combined class of teachers and students. A

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free discussion would be encouraged in these symposia. The topics of the symposia
would be given to the trainees with the dates for presentation.
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.

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

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 by 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.

Research: The student would carry out the research project and write a thesis/
dissertation in accordance with NBE 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 so as to learn various aspects of research.

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SYLLABUS

Fundamentals of Cardiovascular Disease

• Global Burden of Cardiovascular Disease,
• Heart Disease in Varied Populations,
• Economics and Cardiovascular Disease,
• Clinical Decision-Making in Cardiology,
• Measurement and Improvement of Quality of Cardiovascular Care,
• The Principles of Drug Therapy.

Molecular Biology

The Cardiovascular History and Physical Examination

The Electrocardiogram

Choice of imaging technique

Cardiac Ultra sound

Cardiovascular Magnetic Resonance

Cardiovascular Computed Tomography

Nuclear Cardiology

Evaluation of the Patient

• The History and Physical Examination:
• An Evidence-Based Approach,
• Electrocardiography
• Exercise Stress Testing, Echocardiography,
• Genetics of Myocardial Disease, Genetics of Myocardial Disease,
• The Chest Radiograph in Cardiovascular Disease,
• Nuclear Cardiology,
• Cardiovascular Magnetic Resonance,
• Computed Tomography of the Heart,

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 • Cardiac Catheterization,
• Coronary Angiography and
• Intravascular Ultrasound Imaging.

Preventive Cardiology

• The Vascular Biology of Atherosclerosis,

• Risk Factors for Atherothrombotic Disease,
• Systemic Hypertension: Mechanisms and Diagnosis,
• Systemic Hypertension:
• Therapy
• Lipoprotein Disorders and Cardiovascular Disease,
• The Metabolic Syndrome, Diabetes Mellitus, and Atherosclerotic Vascular
Disease,
• Nutrition and Cardiovascular Disease,
• Primary and Secondary Prevention of Coronary Heart Disease,
• Comprehensive Rehabilitation of Patients with Cardiovascular Disease,
• Complementary and Alternative Approaches to Management.

BASIC SCIENCES RELATED TO CARDIOLOGY

CARDIAC ANATOMY

The cardiac anatomy with special emphasis

• Development of heart and blood vessels,
• Foetal circulation and its changes in post natal life;
• Coronary circulation
• Venous drainage of heart ; the heart and pericardium and its relation to
neighbouring structures; anatomy of cardiac chambers and valves;

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 • Arteries and veins; histology of heart and blood vessels.
• Functional anatomy of the heart,
• Orientation of the heart within the Thorax,
• Methods used to study cardiac anatomy, correlative anatomy,
• New developments and future challenges,
• Quantum computing, Ultrastructure of the heart,
• Cardiac Embryology and Histology.

CARDIAC PHYSIOLOGY

Cardiac Physiology will cover all the physiological changes in the heart during its
normal function with special reference to cardiac cycle; myocardial contractility;
pressure changes in the cardiac chambers; cardiac output; factors controlling
blood flow; regulation of cardiac function; cardiac reflexes; coronary blood flow;
exercise physiology; physiology of blood pressure regulation; normal influence on
cardiovascular system; preload; after-load; assessment ofventricular function;
regulation of cardiac contraction; action potentials; the cellular basis of cardiac
contraction, Integration of the cardiovascular system the response to dynamic
exercise, etc.

CARDIAC MOLECULAR BIOLOGY

• Principles of molecular biology including Gene Structure,

• Expression and regulation;

• Recombinant DNA Technology; PCR Techniques,

• Molecular basis for cellular growth,

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 • Molecular and cellular bilology of the normal, hypertrohied and failing
heart including cardiac growth and hypertrophy

• Molecular and Cellular biology of the blood vessels including endothelial

cell vascular smooth muscle interactions, atherosclerosis etc,

• The Human Genome and its future implications for cardiology including
bioethical implications and genetic counselling,

• Cardiovascular Tissue modification by genetic approaches including Gene

Transfer etc, Molecular Development of the heart including anomalies.

CARDIAC BIOCHEMISTRY

All aspects of normal and abnormal patterns of cardiac biochemistry including

cardiac enzymes; lipid profile, cardiac metabolism, electrolytes and their effect on
cardiac function etc.

CARDIAC PHARMACOLOGY

All the drugs used in the treatment of cardiac disorders inclusive of antianginal
agents like
• Beta-blocking agents,
• Nitrates and calcium channel blockers,
• Antifailure agents like diuretics,
• Angiotensin-Converting Enzyme (ACE) Inhibitors,
• Angiotensin-II Receptor Blocking Drugs (ARBs) and aldosterone
antagonism, Digitalis,
• Acute Inotropes and inotropic Dilators
• Antihypertensive Drugs,
• Antiarrhythmic Drugs,

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 • Antithrombotic agents like Platelet Inhibitors, Anticoagulants and
Fibrinolytics, Lipid-Lowering and Atherosclerotic Drugs , choice of drugs,
which drug for which disease?, Adverse Cardiovascular Drug Interactions
and Complications.

CARDIAC PATHOLOGY

• All pathological changes in various cardiac diseases with special

reference to clinical correlation included.
• Special emphasis on pathological changes in the pulmonary vascular
system in various cardiac disorders;
• Pathogenesis and pathology of rheumatic fever and rheumatic heart
disease;
• cardiomyopathies
• Dilated hypertrophic and obliterative / restrictive; congenital heart
diasease-
• Cyanotic and acyanotic; atherosclerosis;
• Coronary artery disease;
• Cardiac involvement in other systemic diseases and storage disorders etc.

CARDIAC MICROBIOLOGY

The various microbiological aspects of cardiac diseases including rheumatic

fever, infective endocarditis, myocarditis are included. Cardiac Molecular Biology
has been included under a separate head.

CLINICAL CARDIOLOGY INCLUDING PEDIATRIC CARDIOLOGY

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A. GENERAL EVALUATION OF THE PATIENT

• The History,
• Physical Examination and Cardiac Auscultation including elements of
accurate history taking, symptoms associated with cardiovascular disease,
• The physical examination of adults, children, infants and neonates,
• syndromes associated with congenital heart disease,
• measurement of arterial blood pressure, venous pulse,
• examination of the retina,
• inspection and palpation of the precordium,
• Cardiac auscultation.

B. HEART FAILURE

• Pathophysiology and diagnosis of Heart Failure,

• Diagnosis and management of heart failure,
• Cardiac transplantation and mechanical ventricular support.

C. RHYTHM AND CONDUCTION DISTURBANCES

• Mechanisms of cardiac arrhythmias and conduction disturbances,

• Recognition,
• clinical assesment and management of arrhthmias and conduction
disturbances, antiarrhythmic drugs, etc

D. SYNCOPE, SUDDEN DEATH AND CARDIO-PULMONARY

RESUSCITATION

• Diagnosis and management of syncope,

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 • sudden cardiac death,
• Cardiopulmonary Resuscitiation and the subsequent management of the
patient etc.

E. CORONARY HEART DISEASE

• Atherogenesis and its determinants,

• Pathology of coronary atherosclerosis,
• Coronary blood flow and myocardial ischemia,
• Dyslipidemia, other risk factors, and the prevention of coronary heart
disease
• Non atherosclerotic coronary heart disease,
• Diagnosis and management of patients with chronic ischemic heart
disease,
• Diagnosis and management of patients with unstable angina,
• Diagnosis and management of patients with acute myocardial infarction,
• The electrocardiogram in Acute myocardial infarction,
• Thrombogenesis, antithrombotic and thrombolytic therapy,
• rehabilitation of the patient with coronary heart disease etc.
• Congenital heart disease and other paediatric cardiac disorders.

F. SYSTEMIC ARTERIAL HYPERTENSION

• Hypertension, epidemiology,
• pathophysiology,
• diagnosis and treatment.

G. PULMONARY HYPERTENSION AND PULMONARY DISEASE

• Pulmonary hypertension,

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 • Pulmonary embolism,
• Chronic Cor pulmonale etc.

H. VALVULAR HEART DISEASE

• Acute rheumatic fever

• Aortic valve disease,
• Mitral valve disease, Mitral valve prolapse syndrome,
• tricuspid valve,
• pulmonic valve and multivalvular disaese,
• Clinical performance of prosthetic heart valves,
• Antitihrombotic therapy for valvular heart disease etc.
•
I. CONGENITAL HEART DISEASE
• Cardiovascular disease due to genetic abnormalities
• the pathology,
• pathophysiology,
• recognition and treatment of congenital heart diseases,
• Congenital heart disease in adults etc

.J. CARDIOMYOPATHY AND SPECIFIC HEART MUSCLE DISEASES

• Classification of cardiomyopathies,
• Dilated cardiomyopathy,
• hypertrophic cardiomyopathy,
• Restrictive, obliterative and infiltrative cardiomyopathies,
• Myocarditis and specific cardiomyopathies
• endocrine disease and alcohol,
• AIDS and the cardiovascular system,
• Effect of noncardiac drugs,
• electricity, poisons and radiation and the heart etc.

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K. PERICARDIAL DISEASES AND ENDOCARDITIS
• Diseases of the pericardium,
• Infective endocarditis

L. THE HEART, ANESTHESIA, AND SURGERY

• Perioperative evaluation and management of patients with known or
suspected cardiovascular disease who undergo noncardiac surgery
• , Anesthesia and the patient with cardiovascular disease, etc

M. MISCELLANEOUS DISEASES AND CONDITIONS

• The connective tissue diseases and the cardiovascular system,

• Neoplastic heart disease,
• Diabetes and cardiovascular disease,
• traumatic heart disease,
• effects of mood and anxiety disorders on the cardiovascular system,
• Heart disease and pregnancy,
• The heart and obesity,
• the heart and kidney disease,
• exercise and the cardiovascular system,
• Acute hemodynamics conditioning training the athelete’s heart and
sudden death,
• Cardiovascular aging in health and therapeutic considerations in older
patients with cardiovascular diseases, women and coronary artery disease
• Cardiac trauma.
• Tumors of hear
• Geriatric heart disease.

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 • General Anaesthesia and non cardiac surgery in patients with heart
disease
• Sports and Heart Disease
• Cardiac rehabilitation

Psychological factors in heart disease

Occupational and Regulatory Aspects of Heart Disease

Non-cardiac Surgery in Cardiac Patients

N. TROPICAL CARDIOLOGY Conditions which are specifically found in the

tropics like
• rheumatic heart disease,
• Endomyocardial Fibrosis
• , Eosinophilic Heart Disease,
• Aortoarteritis etc.
•
O. DISEASES OF THE GREAT VESSELS AND PERIPHERAL VESSELS
• Diagnosis and treatment of diseases of the aorta,
• Cerebrovascular disease and neurologic manifestations of heart disease,
• diagnosis and management of diseases of the peripheral arteries and
veins,
• surgical treatment of peripheral vascular diseases, etc.

P. Cardiovascular Disease and Disorders of Other Organs

• Endocrine Disorders and Cardiovascular Disease,
• Hemostasis,
• Thrombosis,

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 • Fibrinolysis, and Cardiovascular Disease,
• Rheumatic Fever, Rheumatic Diseases and the Cardiovascular System,
• The Patient with Cardiovascular Disease and Cancer,
• Psychiatric Behavioral Aspects of Cardiovascular Disease,
• Neurological Disorders and Cardiovascular Disease,
• Interface Between Renal Disease and Cardiovascular Illness,
Cardiovascular
• Manifestations of Autonomic Disorders.

DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY INCLUDING CARDIAC

INSTRUMENTATION

A DIAGNOSTIC CARDIOLOGY
• The resting Electrocardiogram,
• The Chest roentgenogram and cardiac fluoroscopy,
• The Echocardiogram,
• ECG Exercise Testing
• , Cardiac Catheterization,
• Coronary Arteriography,
• Coronary Blood Flow and Pressure Measurements,
• Cardiac Ventriculography
• , Pulmonary Angiography, Angiography of the Aorta and Peripheral
Vessels,
• Nuclear Cardiology, Computed tomography of the Heart,
• Magnetic resonance Imaging of the heart,
• Magnetic Resonance imaging of the Vascular System,
• Positron Emission Tomography for the noninvasive study and
quantification of blood flow and metabolism in human cardiac disease,

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 • long-term continuous electrocardiographic recordings
• , Signal Averaging techniques and measurement of Late Potentials,
• Techniques of Electrophysiologic evaluation of Brady and
tachyarrhythmias,
• Coronary Intravascular
• Ultrasound Imaging endomyocardial biopsy etc.

B INTERVENTIONAL CARDIOLOGY
• Percutaneous Coronary Interventions,
• Coronary Angioplasty,
• Atherectomy, Atheroablation and Thrombectomy,
• Coronary Stenting, Balloon Valvuloplasty,
• Peripheral Intervention, Pediatric interventions,
• Intraaortic Balloon
• Counterpulsation and other Circulatory Assist Devices
• ,Interventional Electrophysiology
• ,Cardiac pacemakers,
• Implantable devices for heart failure and for the treatment of cardiac
arrhythmias etc.

C CARDIAC INSTRUMENTATION
• Principles of cardiac instrumentation,
• pressure recording, ECG Machines
• Cardiac Monitors,
• Defibrillators
• Cath-Lab Equipment,
• EP Lab Equipment,
• Gamma Camera,
• CT Scan, MRI Equipment, PET Scans,

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 • Echocardiography including Stress Echo, Colour Doppler and TEE,
Pacemakers temporary and Permanent, ICDs,
• Triple Chamber Devices
• radiofrequency ablation equipment,
• programmed stimulators
• IABP, Holter and Signal Averaging and ABP machines,
• Treadmill equipments,
• Hemodynamic recorders
• oximeters,
• Computers and image processing in Cardiology etc.

RECENT ADVANCES IN CARDIOLOGY, CARDIAC EPIDEMIOLOGY,

PREVENTIVE CARDIOLOGY INCLUDING RELATED CARDIAC SURGERY

A Atherosclerosis and Prevention

Epidemiology of Cardiovascular Diseases, Risk factors for atherosclerotic
diseases & assessment of cardiac risk

Special Problems in the prevention of cardiovascular disease

(a) Diabetes mellitus type 2;
(b) Menopausal women;
(c) Non-traditional risk factors for coronary disease

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Special problems in hyperlipidemia therapy
(a) Child with hypercholesterolemia;
(b) Transplant patient;
(c) Hypercholesterolemia in the elderly;
(d) Elevated lipoprotein.

B Cardiac Vascular Disease

Special problems in Vascular Disease;

(a) Compromise of an internal thoracic artery to coronary artery graft by
subclavian artery disease; localized lymph edema

C Ischemic Heart Disease

Special Diagnostic issues in Ischemic Heart Disease:

(a) The patient with chest pain, a positive stress test and normal coronary
arteries;
(b) The patient with coronary artery disease and acute and chronic heart failure

D Stable Coronary Syndromes

Special problems in myocardial ischemia;

(a) Management of variant angina breakthrough;
(b) Management of the non-revascularization patient with severe angina;
(c) Treatment of silent ischemia;
(d) Treatment of microvascular angina;
(e) Viagra, sexual activity and the cardiac patient.

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E Acute Coronary Syndromes

Special problems in Acute Myocardial Infarction;

(a) Right ventricular infarction
(b) Acute myocardial infarction and normal coronary arteries;
(c) Non perfused acute myocardial infarction after thrombolytic therapy.

F Non Pharmacological treatment of Ischemic Heart Disease:

Special problems in non pharmacologic therapy:
(a) unprotected left main coronary angioplasty;
(b) chronic total occlusion;
(c) saphenous vein graft interventions;
(d) percutaneous intervention of cardiac allograft vasculopathy;
(e) In-stent restenosis.

G Hypertension

Management issues in difficult hypertension like

(a) Hypertension and ethnicity;
(b) hypertension in pregnancy preeclampsia;
(c) perioperative hypertension;
(d) ambulatory blood pressure monitoring;
(e) diabetes and hypertension;
(f) resistant hypertension;
(g) hypertension in the context of acute myocardial infarction or coronary
interventions;
(h) concomitant therapy in hypertension.

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H Cardiac Arrhythmias

Special problems in cardiac pacing like

(a) pacemaker syndrome;
(b) temporary cardiac pacing;
(c) diagnostic and surgical procedures in pacemaker patients;
(d) pacemaker lead extraction;
(e) biventricular pacing for congestive heart failure.

Special problems in supraventricular arrhythmias like

(a) Syncope in PSVT;
(b) paroxysmal and perioperative atrial fibrillation;
(c) cycle length alternantion in supraventricular tachycardia;
(d) atrial flutter;
(e) atrial fibrillation and anticoagulants.

Special problems in ventricular arrhthmias like;

(a) problems of implanted defibrillators;
(b) syncope in a patient;
(c) palpitations and VT in a young woman.

I Heart Failure and Cardiomyopathy:

Special problems in chronic heart failure like;

(a) mechanisms of exercise intolerance and exercise testing;
(b) cardiac cachexia;
(c) anemia, renal dysfunction and depression inn heart failure;
(d) disease management programs.

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Special problems in myocarditis and cardiomyopathy like

(a) peripartum cardiomyopathy

(b) HIV myocarditis and cardiomyopathy;
(c) Adriamycin induced cardiomyopathy;
(d) Tachcardiomyopathy;
(e) Diabetic Cardiomyopathy

J Valvular Heart Disease

Special problems in valvular heart diseases like;

(a) new onset atrial fibrillation in asymptomatic mitral stenosis;
(b) mitral stenosis and pregnancy;
(c) low gradient, low ouput aortic stenosis;
(d) mild to moderate aortic stenosis in patients undergoing by pass surgery;

Special problems in surgical treatment of valvular diseases:

(a) perivalvular leaks;
(b) pregnancy and anticoagulation;
(c) postoperative management of valvular dysfunction in valvular surgical
treatment.

K Congenital Heart Disease:

Special problems in Adult Congenital heart diseases:

(a) pregnancy in a woman with eisenmenger syndrome;
(b) thromboembolism after fontan procedure;
(c) late systemic RV failure in patients with TGA.

L Special problems for the Cardiology Consultant.

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Community Cardiology : The training of PG students will involve learning
experience “Derived from” or “Targeted to” the needs of the community. It shall
therefore be necessary to expose the students to community based activities.
Throughout the course of training the emphasis shall be on acquiring knowledge,
skill and attitudes through first hand experiences as far as possible. The
emphasis will be on self learning rather than on didactic lectures

Schedule of posting

Ward & ICCU’s Duties : 12 months

• Duties should include diagnostic case workup and day to day
management of common cases (angina, myocardial infarction, rheumatic
heart disease, hypertension, congestive heart failure, congenital heart
disease,).
• The resident should acquire the expertise / knowledge to diagnose and
manage the cardiac emergencies (acute myocardial infarction and its
complications, LVF, common arrhythmias, cardiogenic shock, pericardial
tamponade etc)

Cardiac Emergency posting : 6 months

• The resident should learn prompt diagnosis and management of
cardiac emergencies.
• He/she should fortify the skills of hemodynamic monitoring in
emergency situations and should learn procedures like arterial line
insertion, temporary venous pacing, central line insertion,
pericardiocentesis, intra aortic balloon pump insertion, swan ganz
catheter insertion etc.

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Cath Lab posting : 8 months
• The resident should acquaint himself with the pre, peri and post
procedural management of patients to be taken up for intervention in
a cath lab.
• He/she should assist and perform procedures like coronary
angiography, percutaneous coronary angioplasty, balloon
valvoloplasty, cardiac catheterization of congenital heart disease
patients, temporary pacemaker, permanent pacemaker,
• Electrophysiological diagnosis and management of arrhythmias,
• AICD, Bi-ventricular pacemaker, IABP insertion etc.

Non-invasive lab posting : 8 months

• The resident should learn the principles and fundamentals of
echocardiography.
• He should be able to perform echo-cardiograms of adults,
adolescents and infants under direct supervision. He should observe
transesophageal echo’s and should also master the skills of
performing and interpreting stress tests and holter monitoring.

Cardiac surgery posting : 2 months

• Mandatory Posting with certificate of satisfactory attendance from
the CTVS Dept Head.
• The resident should learned pre operative preparation and
management of post operative recovery patients.
• He/She should have seen CABG, valve replacement, congenital
heart disease surgery and aortic surgery.

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Practical:
• History, examination and writing of records:
• History taking should include the background information, presenting
complaints and the history of present illness, history of previous illness,
family history, social and occupational history and treatment history.
• Detailed physical examination should include general physical and CVS
examination
• Skills in writing up notes, maintaining problem-oriented medical records
(POMR), progress notes, and presentation of cases during ward rounds,
planning investigation and making a treatment plan should be taught.
• The resident should fortify the skills of hemodynamic monitoring in
emergency situations and should learn procedures like arterial line
insertion, temporary venous pacing, central line insertion,
pericardiocentesis, intra aortic balloon pump insertion, swan ganz catheter
insertion etc.
• The resident should assist and perform procedures like coronary
angiography, percutaneous coronary angioplasty, balloon valvoloplasty,
cardiac catheterization of congenital heart disease patients, temporary
pacemaker, permanent pacemaker, Electrophysiological diagnosis and
management of arrhythmias, AICD, Bi-ventricular pacemaker, IABP
insertion etc.
• Ability to perform echo-cardiograms of adults, adolescents and infants
under direct supervision. He should observe transesophageal echo’s and
should also should also master the skills of performing and interpreting
stress tests and holter monitoring.
• Simulation based training should be given particularly in Transesophageal
Echocardiography, Some Complex Structural Interventions and Coronary
Interventions, CRTs, and TAVRs.

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Biostatistics, Research Methodology and Clinical Epidemiology
Ethics
Medico legal aspects relevant to the discipline
Health Policy issues as may be applicable to the discipline

Job Responsibilities

Outdoor Patient (OPD)

Responsibilities
• The working of the residents in the OPD should be fully supervised.
• They should evaluate each patient and write the observations on the
OPD card with date and signature. • Investigations should be ordered
as and when necessary using prescribed forms
• Residents should discuss all the cases with the consultant and
formulate a management plan.
• Patient requiring admission according to resident’s assessment
should be shown to the consultant on duty.
• Patient requiring immediate medical attention should be sent to the
casualty services with details of the clinical problem clearly written on
the card.
• Patient should be clearly explained as to the nature of the illness, the
treatment advice and the investigations to be done.
• Resident should specify the date and time when the patient has to
return for follow up. In-Patient Responsibilities Each resident should
be responsible and accountable for all the patients admitted under
his care.

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In-Patient Responsibilities
The following are the general guidelines for the functioning of the residents in the
ward:
• Detailed work up of the case and case sheet maintenance:
• He/She should record a proper history and document the various
symptoms.
• Perform a proper patient examination using standard methodology.
• He should develop skills to ensure patient comfort/consent for
examination.
• Based on the above evaluation he/she should be able to formulate a
differential diagnosis and prepare a management plan.
• Should develop skills for recording of medical notes, investigations
and be able to properly document the consultant round notes.
• To organize his/her investigations and ensure collection of reports.
• Bedside procedures for therapeutic or diagnostic purpose. •
Presentation of a precise and comprehensive overview of the patient
in clinical rounds to facilitate discussion with senior residents and
consultants
• To evaluate the patient twice daily (and more frequently if necessary)
and maintain a progress report in the case file.
• To establish rapport with the patient for communication regarding the
nature of illness and further plan management.)
• To write instructions about patient’s treatment clearly in the
instruction book along with time, date and the bed number with
legible signature of the resident.
• All treatment alterations should be done by the residents with the
advice of the concerned consultants and senior residents of the unit.

31
Admission day
Following guidelines should be observed by the resident during admission day.
• Resident should work up the patient in detail and be ready with the
preliminary necessary investigations reports for the evening
discussion with the consultant on duty
• After the evening round the resident should make changes in the
treatment and plan out the investigations for the next day in advance.
Doctor on Duty
• Duty days for each Resident should be allotted according to the duty
roster.
• The resident on duty for the day should know about all sick patients
in the wards and relevant problems of all other patients, so that he
could face an emergency situation effectively
• In the morning, detailed over (written and verbal) should be given to
the next resident on duty. This practice should be rigidly observed.
• If a patient is critically ill, discussion about management should be
done with the consultant at any time.
• The doctor on duty should be available in the ward through out the
duty hours. Care of Sick Patients • Care of sick patients in the ward
should have precedence over all other routine work for the doctor on
duty.
• Patients in critical condition should be meticulously monitored and
records maintained
• If patient merits ICU care then it must be discussed with the senior
residents and consultants for transfer to ICU.

Discharge of the Patient

• Patient should be informed about his/her discharge one day in advance
and discharge cards should be prepared 1 day prior to the planned
discharge.

32
 • The discharge card should include the salient points in history and
examination, complete diagnosis, important management decisions,
hospital course and procedures done during hospital stay and the final
advice to the patient.
• Consultants and DNB Residents should check the particulars of the
discharge card and counter sign it.
• Patient should be briefed regarding the date, time and location of OPD for
the follow up visit

In Case of Death
• In case it is anticipated that a particular patient is in a serious
condition, relatives should be informed about the critical condition of
the patient beforehand.
• Residents should be expected to develop appropriate skills for
breaking bad news and bereavements.
• Follow up death summary should be written in the file and face sheet
notes must be filled up and the sister in charge should be requested
to send the body to the mortuary with respect and dignity from where
the patient’s relatives can be handed over the body.
• In case of a medico legal case, death certificate has to be prepared
in triplicate and the body handed over to the mortuary and the local
police authorities should be informed.
• Autopsy should be attempted for all patients who have died in the
hospital especially if the patient died of an undiagnosed illness.
Bedside Procedures The following guidelines should be observed
strictly
• Be aware of the indications and contraindications for the procedure
and record it in the case sheet. Rule out contraindications like low
platelet count, prolonged prothrombin time, etc.
• Plan the procedure during routine working hours, unless it is an
emergency.

33
 • Explain the procedure with its complications to the patient and his/her
relative and obtain written informed consent on a proper form.
Perform the procedure under strict aseptic precautions using
standard techniques. Emergency tray should be ready during the
procedure.
• Make a brief note on the case sheet with the date, time, nature of the
procedure and immediate complications, if any.
• Monitor the patient and watch for complications(s). Medico-Legal
Responsibilities of the Residents • All the residents are given
education regarding medico-legal responsibilities at the time of
admission in a short workshop.
• They must be aware of the formalities and steps involved in making
the correct death certificates, mortuary slips, medico-legal entries,
requisition for autopsy etc
• They should be fully aware of the ethical angle of their responsibilities
and should learn how to take legally valid consent for different
hospital procedures & therapies.
• They should ensure confidentiality at every stage.

Bedside Procedures
The following guidelines should be observed strictly:
• Be aware of the indications and contraindications for the procedure
and record it in the case sheet. Rule out contraindications like low
platelet count, prolonged prothrombin time, etc.
• Plan the procedure during routine working hours, unless it is an
emergency. Explain the procedure with its complications to the
patient and his/her relative and obtain written informed consent on a
proper form. Perform the procedure under strict aseptic precautions
using standard techniques. Emergency tray should be ready during
the procedure.

34
 • Make a brief note on the case sheet with the date, time, nature of the
procedure and immediate complications, if any.
• Monitor the patient and watch for complications(s).

Medico-Legal Responsibilities
• All the residents are given education regarding medico-legal
responsibilities at the time of admission in a short workshop.
• They must be aware of the formalities and steps involved in making
the correct death certificates, mortuary slips, medico-legal entries,
requisition for autopsy etc.
• They should be fully aware of the ethical angle of their responsibilities
and should learn how to take legally valid consent for different
hospital procedures & therapies.
• They should ensure confidentiality at every stage.
• The Candidate should be trained in some Medico-Legal Aspects
regarding patient management like how to obtain informed consent,
how to approach litigations and what problems can occr on the
unexpected death of patients.
• They should also be trained in laws especially with regards to
Medico-Legal Cases and Transplantation laws.

The student would be given adequate training during the course so that he/she
will be able to perform and interpret various non-invasive and invasive
techniques as outlined below:

35
Non - invasive

1. Electrocardiography
2. Stress ECG
3. Ambulatory ECG
4. Echocardiography – M-mode, Two dimensional, Doppler, Colour flow imaging,
Transoesophageal echocardiography and stress echocardiography.
5. Ambulatory BP monitoring.

Invasive

1. To perform temporary pacemaker insertion and pericardiocentesis.

2. To perform left and right heart catheterization, to calculate and interpret
various hemodynamic parameters.
3. To assist in various interventions including Valvuloplasty, coronary and
congenital interventions.
4. To interpret electrophysiological data and assist in electrophysiology
procedures, permanent pacemaker implantation and AICD implantation

Minimum No. of Procedures for competency

1.Trans thoracic Echocardiography .….………………….. 400

2.Transoesophageal Echocardiography.…………………. 25
3.Stress ECG… ……………………………………………... 100
4.Temporary Pacemaker ….……………………………….. 20
5. Ambulatory ECG’s analysed ………………………..… 50
6. Permanent pacemaker Implantation’s assisted …..…… 5
7.Cardiovascular Catheterization….. …………………….... 100
8.Percutaneous Cardiovascular Intervention’s assisted …...10

36
Affective Domain

• To adopt ethical practices in dealing with patients, colleagues,

subordinates superiors and health care workers.
• To promote cordial interpersonal relation
• To perform as a team
• To learn to be a leader when the need arises.
• To learn to order investigations and prescribe drugs rationally.
• To be aware of ethical issues in human and animal research.
• Take rationale decision in the face of ethical dilemmas in cardiac
diseases.
• Demonstrate sympathy & Humane approach towards patients & their
families & exhibit interpersonal behaviour in accordance with social norms
& expectations.

Attitude & Values

Demonstrate empathy and humane approach towards patients and their families
and exhibit interpersonal behaviour in accordance with the societal norms and
expectation.

37
Competencies

• Possess complete Clinical Diagnostic Skills for the recognition of common

heart diseases.
• Possess a complete knowledge of all the commonly used Non-Invasive
Cardiac Diagnostic Tests like Electrocardiography, Cardiac
Roentgenology, Exercise Stress Testing, Dynamic Cardiography,
Echocardiography etc.
• Acquire skills in the performance and interpretation of commonly used
Invasive Cardiac procedures like Diagnostic Cardiac Catheterization and
Angiography and Cardiac Interventions
• Able to apply sound clinical judgement and rational cost effective
investigations for the diagnosis and management of Cardiac Cases in the
OPD, Wards, Emergency Room and Intensive Care unit.
• Possess some understanding of the recent advances in the subject of
Cardiology and all its allied specialities and working knowledge of the
sophisticated and routine equipments, consumables used in Cardiology.
• Possess knowledge of research work in the field of Cardiology in both the
Clinical and experimental field with the ability to usefully analyse data.
• Be able to teach undergraduate students MBBS as well as Post Graduate
Students MD Med or Pediatrics Clinical as well as investigative
Cardiology.
• Be able to perform Clinical and Investigative studies and to present in
Seminars etc.
• Have the ability to organise specific teaching and training programmes for
para medical staff, associated professionals and patient education
programmes. Should be able to develop good communication skills and
give consultations to all other departments of the

38
Resuscitation skills

• At the time of joining the residency programme, the resuscitation skills

should be demonstrated to the residents and practical training provided at
various work stations.
• • Residents should be fully competent in providing basic and advanced
cardiac life support.
• • They should be fully aware of all advanced cardiac support algorithms
and be aware of the use of common resuscitative drugs and equipment
like defibrillators and external cardiac pacemakers. • The resident should
be able to lead a cardiac arrest management team..
• The Candidate has to attend the ACLS course conducted by the AHA and
should get certified in ACLS.

39
THESIS PROTOCOL & THESIS
The candidates are required to submit a thesis at the end of three years of
training as per the rules and regulations of NBE.

Guidelines for Submission of Thesis Protocol & Thesis by candidates

Research shall form an integral part of the education programme of all

candidates registered for DNB degrees of NBE. The Basic aim of requiring the
candidates to write a thesi protocol & thesis/dissertation is to familiarize him/her
with research methodology. The members of the faculty guiding the
thesis/dissertation work for the candidate shall ensure that the subject matter
selected for the thesis/dissertation is feasible, economical and original.

Guidelines for Thesis Protocol

The protocol for a research proposal (including thesis) is a study plan, designed
to describe the background, research question, aim and objectives, and detailed
methodology of the study. In other words, the protocol is the ‘operating manual’
to refer to while conducting a particular study.

The candidate should refer to the NBE Guidelines for preparation and
submission of Thesis Protocol before the writing phase commences. The
minimum writing requirements are that the language should be clear, concise,
precise and consistent without excessive adjectives or adverbs and long
sentences. There should not be any redundancy in the presentation.

The development or preparation of the Thesis Protocol by the candidate will help
her/him in understanding the ongoing activities in the proposed area of research.
Further it helps in creating practical exposure to research and hence it bridges
the connectivity between clinical practice and biomedical research. Such
research exposure will be helpful in improving problem solving capacity, getting
updated with ongoing research and implementing these findings in clinical
practice.

Research Ethics: Ethical conduct during the conduct and publication of research
is an essential requirement for all candidates and guides, with the primary
responsibility of ensuring such conduct being on the thesis guide. Issues like
Plagiarism, not maintaining the confidentiality of data, or any other distortion of
the research process will be viewed seriously. The readers may refer to standard
documents for the purpose.

The NBE reserves the right to check the submitted protocol for plagiarism, and
will reject those having substantial duplication with published literature.

40
PROTOCOL REQUIREMENTS

1. All of the following will have to be entered in the online template. The
thesis protocol should be restricted to the following word limits.

• Title : 120 characters (with spacing) page

• Synopsis [structured] : 250-300
• Introduction : 300-500
• Review of literature : 800-1000
• Aim and Objectives : Up to 200
• Material and Methods : 1200-1600
• 10-25 References [ICMJE style]

2. It is mandatory to have ethics committee approval before initiation of the

research work. The researcher should submit an appropriate application to
the ethics committee in the prescribed format of the ethics committee
concerned.

Guidelines for Thesis

1. The proposed study must be approved by the institutional ethics

committee and the protocol of thesis should have been approved by NBE.

2. The thesis should be restricted to the size of 80 pages (maximum). This

includes the text, figures, references, annexures, and certificates etc. It
should be printed on both sides of the paper; and every page has to be
numbered. Do not leave any page blank. To achieve this, following points
may be kept in view:

a. The thesis should be typed in 1.5 space using Times New

Roman/Arial/ Garamond size 12 font, 1” margins should be left on
all four sides. Major sections viz., Introduction, Review of Literature,
Aim & Objectives, Material and Methods, Results, Discussion,
References, and Appendices should start from a new page. Study
proforma (Case record form), informed consent form, and patient
information sheet may be printed in single space.
b. Only contemporary and relevant literature may be reviewed.
Restrict the introduction to 2 pages, Review of literature to 10-12
pages, and Discussion to 8-10 pages.
c. The techniques may not be described in detail unless any
modification/innovations of the standard techniques are used and
reference(s) may be given.
d. Illustrative material may be restricted. It should be printed on paper
only. There is no need to paste photographs separately.

41
 3. Since most of the difficulties faced by the residents relate to the work in
clinical subject or clinically-oriented laboratory subjects, the following
steps are suggested:
a. The number of cases should be such that adequate material,
judged from the hospital attendance/records, will be available and
the candidate will be able to collect case material within the period
of data collection, i.e., around 6-12 months so that he/she is in a
position to complete the work within the stipulated time.
b. The aim and objectives of the study should be well defined.
c. As far as possible, only clinical/laboratory data of investigations of
patients or such other material easily accessible in the existing
facilities should be used for the study.
d. Technical assistance, wherever necessary, may be provided by the
department concerned. The resident of one specialty taking up
some problem related to some other specialty should have some
basic knowledge about the subject and he/she should be able to
perform the investigations independently, wherever some
specialized laboratory investigations are required a co-guide may
be co-opted from the concerned investigative department, the
quantum of laboratory work to be carried out by the candidate
should be decided by the guide & co-guide by mutual consultation.

4. The clinical residents are not ordinarily expected to undertake

experimental work or clinical work involving new techniques, not hitherto
perfected OR the use of chemicals or radioisotopes not readily available.
They should; however, be free to enlarge the scope of their studies or
undertake experimental work on their own initiative but all such studies
should be feasible within the existing facilities.

5. The DNB residents should be able to freely use the surgical

pathology/autopsy data if it is restricted to diagnosis only, if however,
detailed historic data are required the resident will have to study the cases
himself with the help of the guide/co-guide. The same will apply in case of
clinical data.

6. Statistical methods used for analysis should be described specifically for

each objective, and name of the statistical program used mentioned.

General Layout of a DNB Thesis:

• Title- A good title should be brief, clear, and focus on the central theme of
the topic; it should avoid abbreviations. The Title should effectively
summarize the proposed research and should contain the PICO elements.

42
• Introduction- It should be focused on the research question and should
be directly relevant to the objectives of your study.

• Review of Literature - The Review should include a description of the

most relevant and recent studies published on the subject.

• Aim and Objectives - The ‘Aim’ refers to what would be broadly achieved
by this study or how this study would address a bigger question / issue.
The ‘Objectives’ of the research stem from the research question
formulated and should at least include participants, intervention,
evaluation, design.

• Material and Methods- This section should include the following 10

elements: Study setting (area), Study duration; Study design (descriptive,
case-control, cohort, diagnostic accuracy, experimental (randomized/non-
randomized)); Study sample (inclusion/exclusion criteria, method of
selection), Intervention, if any, Data collection, Outcome measures
(primary and secondary), Sample size, Data management and Statistical
analysis, and Ethical issues (Ethical clearance, Informed consent, trial
registration).

• Results- Results should be organized in readily identifiable sections

having correct analysis of data and presented in appropriate charts,
tables, graphs and diagram etc.

• Discussion–It should start by summarizing the results for primary and

secondary objectives in text form (without giving data). This should be
followed by a comparison of your results on the outcome variables (both
primary and secondary) with those of earlier research studies.

• Summary and Conclusion- This should be a précis of the findings of the

thesis, arranged in four paragraphs: (a) background and objectives; (b)
methods; (c) results; and (d) conclusions. The conclusions should strictly
pertain to the findings of the thesis and not outside its domain.

• References- Relevant References should be cited in the text of the

protocol (in superscripts).

• Appendices -The tools used for data collection such as questionnaire,

interview schedules, observation checklists, informed consent form (ICF),
and participant information sheet (PIS) should be attached as appendices.
Do not attach the master chart.

43
Thesis Protocol Submission to NBE

1. DNB candidates are required to submit their thesis protocol within 90 days
of their joining DNB training.

2. Enclosures to be submitted along with protocol submission form:

a) Form for Thesis Protocol Submission properly filled.
b) Thesis Protocol duly signed.
c) Approval letter of institutional Ethical committee. (Mandatory, non
receivable of any one is liable for rejection)

Thesis Submission to NBE

1. As per NBE norms, writing a thesis is essential for all DNB candidates
towards partial fulfillment of eligibility for award of DNB degree.
2. DNB candidates are required to submit the thesis before the cut-off date
which shall be 30th June of the same year for candidates appearing for
their scheduled December final theory examination. Similarly, candidates
who are appearing in their scheduled June DNB final examination shall be
required to submit their thesis by 31st December of preceding year.
3. Candidates who fail to submit their thesis by the prescribed cutoff date
shall NOT be allowed to appear in DNB final examination.
4. Fee to be submitted for assessment (In INR): 3500/-
5. Fee can be deposited ONLY through pay-in-slip/challan at any of the
Indian bank branch across India. The challan can be downloaded from
NBE website www.natboard.edu.in
6. Thesis should be bound and the front cover page should be printed in the
standard format. A bound thesis should be accompanied with:
a. A Synopsis of thesis.
b. Form for submission of thesis, duly completed
c. NBE copy of challan (in original) towards payment of fee as may be
applicable.
d. Soft copy of thesis in a CD duly labeled.
e. Copy of letter of registration with NBE.

7. A declaration of thesis work being bonafide in nature and done by the

candidate himself/herself at the institute of DNB training need to be
submitted bound with thesis. It must be signed by the candidate
himself/herself, the thesis guide and head of the institution, failing which
thesis shall not be considered.

The detailed guidelines and forms for submission of Thesis

Protocol & Thesis are available at
www.natboard.edu.in.thesis.php.

44
LOG BOOK

A candidate shall maintain a log book of operations (assisted / performed) during

the training period, certified by the concerned post graduate 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 log book should show evidence that the before mentioned subjects were
covered (with dates and the name of teacher(s) The candidate will maintain the
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 practical examination, will be required to
produce performance record (log book) containing details of the work done by
him/her during the entire period of training as per 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 production of log book, the result will not be declared.

45
Leave Rules
1. DNB Trainees are entitled to leave during the course of DNB training as per the
Leave Rules prescribed by NBE.
2. A DNB candidate can avail a maximum of 20 days of leave in a year excluding
regular duty off/ Gazetted holidays as per hospital/institute calendar/policy.
3. MATERNITYLEAVE:
a. Afemale candidate is permitted a maternity leave of 90 days once during
the entire duration of DNB course.
b. The expected date of delivery (EDD) should fall within the duration of
maternity leave.
c. Extension of maternity leave is permissible only for genuine medical
reasons and after prior approval of NBE. The supporting medical
documents have to be certified by the Head of the Institute/hospital where
the candidate is undergoing DNB training. NBE reserves its rights to take
a final decision in such matters.
d. The training of the candidate shall be extended accordingly in case of any
extension of maternity leave being granted to the candidate.
e. Candidate shall be paid stipend during the period of maternity leave. No
stipend shall be paid for the period of extension of leave.
4. Male DNB candidates are entitled for paternity leave of maximum of one week
during the entire period of DNB training.
5. No kind of study leave is permissible to DNB candidates. However, candidates
may be allowed an academic leave as under across the entire duration of training
program to attend the conferences/CMEs/Academic programs/Examination
purposes.
DNB COURSE NO. OF ACADEMIC LEAVE
DNB 3 years Course (Broad & Super Specialty) 14 Days
DNB 2 years Course (Post Diploma) 10 Days
DNB Direct 6 years Course 28 days

46
6. Under normal circumstances leave of one year should not be carried
forward to the next year. However, in exceptional cases such as
prolonged illness the leave across the DNB training program may be
clubbed together with prior approval of NBE.
7. Any other leave which is beyond the above stated leave is not permissible
and shall lead to extension/cancellation of DNB course.
8. Any extension of DNB training for more than 2 months beyond the
scheduled completion date of training is permissible only under extra-
ordinary circumstances with prior approval of NBE. Such extension is
neither automatic nor shall be granted as a matter of routine. NBE shall
consider such requests on merit provided the seat is not carried over and
compromise with training of existing trainees in the Department.
9. Unauthorized absence from DNB training for more than 7 days may lead
to cancellation of registration and discontinuation of the DNB training and
rejoining shall not be permitted.
10. Medical Leave
a. Leave on medical grounds is permissible only for genuine medical
reasons and NBE should be informed by the concerned
institute/hospital about the same immediately after the candidate
proceeds on leave on medical grounds.
b. The supporting medical documents have to be certified by the Head
of the Institute/hospital where the candidate is undergoing DNB
training and have to be sent to NBE.
c. The medical treatment should be taken from the institute/ hospital
where the candidate is undergoing DNB training. Any deviation
from this shall be supported with valid grounds and documentation.
d. In case of medical treatment being sought from some other
institute/hospital, the medical documents have to be certified by the
Head of the institute/hospital where the candidate is undergoing
DNB training.

47
 e. NBE reserves its rights to verify the authenticity of the documents
furnished by the candidate and the institute/hospital regarding
Medical illness of the candidate and to take a final decision in such
matters.
11.
a. Total leave period which can be availed by DNB candidates is
120+28 = 148 days for 6 years course, 60+14=74 days for 3 years
course and 40+10 = 50 days for 2 years course. This includes all
kinds of eligible leave including academic leave. Maternity /
Paternity leave can be availed separately by eligible candidates.
Any kind of leave including medical leave exceeding the
aforementioned limit shall lead to extension of DNB training. It is
clarified that prior approval of NBE is necessary for availing any
such leave.
b. The eligibility for DNB Final Examination shall be determined strictly
in accordance with the criteria prescribed in the respective
information bulletin.

48
EXAMINATION

FORMATIVE ASSESSMENT

Formative assessment includes various formal and informal assessment

procedures by which evaluation of student’s learning, comprehension, and
academic progress is done by the teachers/ faculty to improve student
attainment. Formative assessment test (FAT) is called as “Formative “as it
informs the in process teaching and learning modifications. FAT is an integral
part of the effective teaching .The goal of the FAT is to collect information which
can be used to improve the student learning process.

Formative assessment is essentially positive in intent, directed towards

promoting learning; it is therefore part of teaching. Validity and usefulness are
paramount in formative assessment and should take precedence over concerns
for reliability. The assessment scheme consists of Three Parts which has to be
essentially completed by the candidates.

The scheme includes:-

Part I:- Conduction of theory examination

Part-II :- Feedback session on the theory performance
Part-III :- Work place based clinical assessment

Scheme of Formative assessment

Candidate has to appear for
CONDUCT OF THEORY
PART – I Theory Exam and it will be
EXAMINATION
held for One day.
FEEDBACK SESSION ON Candidate has to appear for
PART – II THE THEORY his/her Theory Exam
PERFORMANCE Assessment Workshop.
After Theory Examination,
WORK PLACE BASED
PART – III Candidate has to appear for
CLINICAL ASSESSMENT
Clinical Assessment.

The performance of the resident during the training period should be monitored
throughout the course and duly recorded in the log books as evidence of the
ability and daily work of the student

1. Personal attributes:
• Behavior and Emotional Stability: Dependable, disciplined, dedicated,
stable in emergency situations, shows positive approach.
• Motivation and Initiative: Takes on responsibility, innovative,
enterprising, does not shirk duties or leave any work pending.

49
 • Honesty and Integrity: Truthful, admits mistakes, does not cook up
information, has ethical conduct, exhibits good moral values, loyal to the
institution.
• Interpersonal Skills and Leadership Quality: Has compassionate
attitude towards patients and attendants, gets on well with colleagues and
paramedical staff, is respectful to seniors, has good communication skills.

2. Clinical Work:

• Availability: Punctual, available continuously on duty, responds promptly

on calls and takes proper permission for leave.
• Diligence: Dedicated, hardworking, does not shirk duties, leaves no work
pending, does not sit idle, competent in clinical case work up and
management.
• Academic ability: Intelligent, shows sound knowledge and skills,
participates adequately in academic activities, and performs well in oral
presentation and departmental tests.
• Clinical Performance: Proficient in clinical presentations and case
discussion during rounds and OPD work up. Preparing Documents of the
case history/examination and progress notes in the file (daily notes, round
discussion, investigations and management) Skill of performing bed side
procedures and handling emergencies.

3. Academic Activity: Performance during presentation at Journal club/

Seminar/ Case discussion/Stat meeting and other academic sessions.
Proficiency in skills as mentioned in job responsibilities.

FINAL EXAMINATION

The summative assessment of competence will be done in the form of DNB Final
Examination leading to the award of the degree of Diplomate of National Board in
cardiology The DNB final is a two-stage examination comprising the theory and
practical part. An eligible candidate who has qualified the theory exam is
permitted to appear in the practical examination.

Theory Examination

1. The theory examination comprises of Three papers, maximum marks 100

each.
2. There are 10 short notes of 10 marks each, in each of the papers. The
number of short notes and their respective marks weightage may vary in
some subjects/some papers.

50
 3. Maximum time permitted is 3 hours.
4. Candidate must score at least 50% in the aggregate of Three papers to
qualify the theory examination.
5. Candidates who have qualified the theory examination are permitted to
take up the practical examination.
6. The paper wise distribution of the Theory Examination shall be as follows:

Paper I:

• Basic sciences applied to the specialty (including Applied Anatomy,

Physiology, Pathology and Embryology)
• Research Methodology

Paper II:

Clinical Cardiology(Clinical non-invasive and invasive diagnostic

techniques, Therapeutics)

Paper III:

• Recent advances (Imaging , Devices , Innovations, Therapeutics etc) ,

Cardiac Epidemiology, Prevent Cardiology and related Cardiac Surgery

a) Practical Examination:

1. Maximum Marks: 300.

2. The Clinical and Viva-Voce Examinations could be conducted in the

following way
A. Four Clinical Cases or Case Scenarios: Each 50 Marks=200
B. Ward Rounds : Minimum 4 Cases of 10 Marks each=40
C. Non-Invasive Cardiology Station : ECG, CXR, TMT, Holter, ECHO,
TEE, Stress Echo, CT, CMR, Nuclear Scans, PET, etc.=20 Marks
D. Invasive Cardiology Station: Display of Angiograms, Interventions,
Structural, Coronary, Pacing EP etc = 20 Marks.
E. Viva-Voce: 20 Marks
Total = 300 Marks.

51
 3. Comprises of Clinical Examination and Viva.
4. Candidate must obtain a minimum of 50% marks in the Clinical
Examination (including Viva) to qualify for the Practical Examination.
5. There are a maximum of three attempts that can be availed by a
candidate for Practical Examination.
6. First attempt is the practical examination following immediately after the
declaration of theory results.
7. Second and Third attempt in practical examination shall be permitted out
of the next three sessions of practical examinations placed alongwith the
next three successive theory examination sessions; after payment of full
examination fees as may be prescribed by NBE.
8. Absentation from Practical Examination is counted as an attempt.
9. Appearance in first practical examination is compulsory;
10. Requests for Change in center of examination are not entertained, as the
same is not permissible.
11. Candidates are required not to canvass with NBE for above.

Declaration of DNB Final Results

1. DNB final is a qualifying examination.

2. Results of DNB final examinations (theory & practical) are declared as
PASS/FAIL.
3. DNB degree is awarded to a DNB trainee in the convocation of NBE.

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RECOMMENDED TEXT BOOKS AND JOURNALS

TEXT BOOKS

• Braunwald E. Zipes D. Libby P.: Heart Disease : A Text Book of

Cardiovascular Medicine:
• Fuster V.: Hurst’s The Heart
• Topol E. Comprehensive Cardiovascular Medicine
• Crawford MH. DiMarco JP. Paulus WJ: Cardiology 2nd Edition
• Baim DS. GrossmanW: Grossman’s Cardiac Catheterization, Angiography
and Intervention: 6th Edition 2000 or Later.
• Feigenbaum H. Echocardiography: 6th Edition 2000 or Later.
• Otto: Text book of Echocardiography: 2nd Edition.
• Perloff J: The Clinical Recognition of Congenital Heart Diseases: 4th
Edition.
• Nadas AS. Pediatric Cardiology; 4th Indian Edition;
• Garson A. The Science and Practice of Pediatric Cardiology: 2nd Edition
• Moss and Adams: Heart Disease in Infants, Children and Adolescents: 6th
Edition
• Anderson RH: Pediatric Cardiology: 2nd Edition.
• Constant J. Bedside Cardiology: 5th Edition
• Marriot HJL: Practical Electrocardiography: 7th Edition.
• Opie LH. Drugs for the Heart 5th Edition
• Topol E. Text Book of Interventional Cardiology 4th Edition.

JOURNALS

• Indian Heart Journal

• Journal of the Association of Physicians of India.
• Journal of the Indian Medical Association.

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 • Bulletin of the ICMR
• Bulletin of the WHO
• American Heart Journal
• Journal of the American College of Cardiology.
• American Journal of Cardiology.
• New England Journal of Medicine.
• British Medical Journal
• The Lancet
• The Heart (Formerly called the British Heart Journal). 16
• International Journal of Cardiology.
• American Journal of Medicine.
• Journal of the American Medical Association.
• European Heart Journal.
• Circulation
• Circulation Research
• Cardiology Clinics of North America.
• Medical Clinics of North America.
• Journal of Clinical Ultrasound
• Catheterization, Cardiovascular Diagnosis.
• PACE
• Indian Journal of Echocardiography
• Current Problems in Cardiology.
• Radiology Clinics of North America.

The Student should also be familiarized with Internet browsing for Journals,
Special Articles, Review Articles and other recent recommendations of
International Societies like the American Heart Association, NASPE, European
Cardiac Society etc.

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