DNB Practical Exam Pattern - Orientation To Clinical Cases and OSCE

Knowing your exam in detail is one of the first steps towards preparation for any exam. This is especially important in the DNB exam where the pattern is different from the rest of the medical exams conducted in India.

In fact, pediatrics is one of the first subspecialty in DNB to include OSCE's in clinical exams. This is a detailed discussion on what is the structure of the DNB Pediatrics exam.

DNB Practical exams can be broadly divided as

  1. OSCE and
  2. Clinical cases

One needs to pass individually in both OSCE and Clinical cases to successfully clear the practical exam

What is the Pattern of OSCE exam?

Typical OSCE station in DNB exam
Fig.1 - A typical OSCE station. Source[1]

There are total of 30 stations, in the exam.

  1. Out of these 30, 20 stations are un-observed stations – each carrying 5 marks each.
  2. The remaining 5 are observed stations – 7 to 10 marks each.
  3. And there will be 5 rest stations.
Arrangment of OSCE stations
Fig.2 - OSCE circuit: students rotate around a number of stations one by one. Source[1]

What are the different types of OSCE stations?

The OSCE stations are distributed in such a way to test your different clinical skills, like examination, ability to counsel, your picture based memory, emergency handling skills etc.

Overall this is the structure of the OSCE station. Even though there may be some variations each time, more or less it includes.

1.History taking

These type of OSCE stations involve taking a focused history, around particular clinical symptoms or diagnosis. For example history of a child with respiratory distress.

2. Systemic examination

These stations involve examining particular systems like respiratory or cardiac including all 4 aspects of the examination, i.e. Inspection, palpation, percussion, and Auscultation, or for example, the examination of cranial nerves, elicitation of deep tendon reflex or motor system. One of the subtypes Focused clinical examination is discussed in detail here.

3. Counseling and communication skill based OSCE

This involves interaction with a dummy patient or carers on varying types like counseling about a particular disease or breaking bad news etc.

4. Clinical procedure

These stations test your procedure skill for a particular clinical procedure like Lumbar puncture, IV cannulation or Chest tube insertion etc. Biomedical waste management skills are also tested in such stations as it is one of the several important steps we need to perform in front of the examiner.

5. Picture based diagnosis

The OSCE station will display an image, that may be a radiology picture or a picture of dysmorphic features, and we have to answer the given questions. There may be more than one question on such spots.

The Pictures can be, X rays ( Chest, Abdomen), MRI, CT, ECG, Fundoscopy, Hematology slides etc

6. Developmental assessment

This involves a correct identification of the developmental age of a given dummy child with the available tools given in the station.

7. Clinical case scenario

Short case details are given followed by a couple of questions. They may sound like MCQ but mostly are clinical and not theoretical.

8. Investigations

This involved interpretation of various lab results given in the questions, these questions are more focused on lab values than the clinical scenario. The labs given are ABG,s, peripheral smear, hematology, urinalysis, and stool analysis etc.

9. Neonatal

One or more spot will belong to Neonatology focused section, involves gestational assessment, resuscitation (NALS), the examination of normal newborn etc

10. Charts and tables

There will be a display of charts and tables, like growth charts or clinical finding and you will be either asked to match pairs or fill the blanks

11. PALS

This will include either demonstration of your skills or questions on pediatric advanced life support.

12. Equipment or instruments

Includes identification and explaining various instruments like Bone marrow biopsy needle, CPAP, etc

13. Nutrition

Includes calculation of calories and nutrition gap based on the information given or question on how many calories a particular item in the question etc.

14. Medications/Drugs/ Vaccines

Involves viva like the question about a particular drug or the procedure to give it. This also covers various vaccines

15. Biostatistics

Question of medical statistics or identification and interpretation of particular statistical methods like forest charts.

16. Genetics

The Genetic OSC spots may display a picture or chart. You may be asked to identify a particular dysmorphic feature shown in the image and answer the questions given or you may be provided with a pedigree chart and asked to interpret them etc.

If you think there is anything missing in the above list please ad using the comment box.

More details on observed OSCEs here and what is focused clinical examination? here

How to attempt and write OSCE answers?

  1. DO NOT FORGET – to write your Roll number and sign the answer sheet.
  2. Mention the station number before writing your answer.
  3. Time management – This depends on no. of questions for a particular spot and time availability, but try to move on to the next question (in case multiple questions for the same spot which is generally the case)

Quick tip on how to attempt Observed OSCE station?

Think about how will you present the answer in Observed stations before actually speaking as you always get a time before you start.

At Rest stations – Do not think about your previous question and OSCE spot.

The pattern of history taking and Case Presentation in the DNB exam

Structure of DNB Practical exam

Overall there are 2 clinical cases. There were no long or short cases, both cases carried the same weightage during my time.

Marks - Both cases carry 75 marks each.
Timing – for history taking and clinical examination approx 20 to 30 mins are given. The session for your viva depends on you. The more you make the examiner interested to know from you, the longer the durations are.

There might be few changed in recent years, if this is the case, let others know using the comment section.

Important things to remember while taking pediatric history

These are peculiar things in Pediatric History taking, focus on these...

  1. Socio-economic status
  2. Immunization history
  3. Development history and assessment
  4. The family tree in family history
  5. Consolidation and Summarization after finishing history and Physical examination ( signposting)
  6. Short and complete diagnosis, differentials, etc.

What are the Frequently asked cases in DNB Practical exam?

It is a good habit to have a list of frequently asked case presentations and related questions. This helps in revising such cases and question more frequently.

Even though it is not necessary but more likely these are the cases kept for the practical exam.

  1. CNS cases - There is a strong possibility that one of your exam cases will be from neurology and to be more specific it is mostly going to be cerebral palsy, developmental delay, stroke, etc.
  2. Case with anemia and hepatosplenomegaly.
  3. Cases with infantile jaundice.
  4. Cardiac cases with the right to left shunts. Cases with pneumonia, Pleural effusion, etc.
  5. Cases with abdominal mass like a tumor.
  6. Cases with unexplained fever and rash.

Preparation of CNS cases is a must as one of the cases is going to be from CNS. That's 50% of your marks.

Some Tips on how to prepare for a Practical exam?

Stick to “your books". ( The books you must read for DNB Practical exam)
Read, write, and discuss. Repeat the cycle.
No ‘new books’ during the last month of preparation
Prepare your “exam kit” well in advance. (How to prepare. the clinical exam kit?)

Some tips for Viva during the actual exam

  1. Think before u talk - Be sure what you are talking to the examiner.
  2. Do not “beat around the bush”, accept if u do not know the answer.
  3. DO NOT ARGUE with the examiner. Learn about your body language and practical exams here.
  4. DO NOT try to fool the examiner - 30-40 years of experienced teaching vs. 3 years of clinical training. There is no match.
  5. Examiners always start with basics. There is nothing like a ‘bouncer’ in the questions, it is just a feeling.

More Do's and Dont's for the practical exam here.

There may be some changes in the pattern in recent years and It will be great if you could share with us all using the comment section.

More Exam related articles

  1. Exam corner - Everything related to the DNB exam.
  2. DNB Exam preparation - When the exam is near.
  3. DNB exam during the covid-19 pandemic.

Image source [1]- Dr Sandeep Kavade. PG CME, August 2012. D.Y. Patil Medical college. Pune

About Author

Shivhar Sonvane | DNB Pediatrics, Fellowship in Pediatric Nephrology

Shivhar is currently working in Mumbai as Pediatrician and Pediatric Nephrologist