How to prepare for DNB Theory and Practical Exam?


DNB Examination has always been in news for their difficulty level, in fact, it remains the number one issue when one has to choose between MD or DNB.


Even though the difficulty level of the DNB exam is high, the panic is not entirely true. Those who have appeared will agree on the standards and the way, DNB exam is conducted by NBE.

The Mantra for passing DNB Exam

The most important thing to crack lies in understanding the pattern of exams and the systemic approach to preparing. It is not as simple as read and pass. This game requires three more things.

  1. Having a strategy for the game
  2. Its Implementation
  3. Respecting the timeline

Reading and overall knowledge are basic building blocks but Exam-oriented preparation ensures that you pass without any hassles or setbacks.


Why do we fail?

The most important factor is the difference between the pattern of traditional medical exams and the exams conducted by NBE. 

Unfortunately, The whole medical system at least up until now is mostly memory-based and not skill-based. We try to apply the same thing to DNB exams, so knowing your exam pattern is the first step toward the success

The other reason is the inability to follow the three things I mentioned above. The fact that we are not formally oriented toward the exam from the beginning equally contributed to all this. The training institutes need to act on this.


What DNB exam is difficult or rather appear difficult?

DNB exam introduces new skill sets like OSCE station and more holistic theory questions such as approach toward a particular disease in children. And this seems way difficult cause previously it was always short notes on this and that.

One more thing, the examiners are not allowed to give marks as to what they think the answer could be. Rather they are provided with the key answers and division on marks and they have to follow it. This is more objective than a subjective way of skill testing.

This removes the bias of local trends of practices and treatment in a particular disease or entity. This is in fact a better way to learn. But the sudden change of the entire psychology of exam from memory-based testing to skill-based testing costs us a lot.

Why OSCE is important?

The newer systems of medical training rely on the collective knowledge and skills you gain during your residency and the wide range of ist application. 

For example - A counseling of a patient with a particular ailment or breaking bad news. They are important. Arent they? This is covered in the DNB exam through things like OSCEs. It gives you a real-life feel of how you are going to behave as a doctor overall and not just clinicians.

Why MCQs are important?

Latter MCQs were introduced in the DNB theory exam. Which again is a big question mark. So many different patterns of question?. The new pattern needs new books, a new way of reading. So much to fuss about. But MCQs are important. They...

  1. Allow assessment of a wide range of learning goals.
  2. They are Objective and they limit scoring biases
  3. You have to quickly respond to many items or options, permitting wide testing and coverage.

Never the less the sudden change in the whole psychology of exam pattern is bound to result in bad outcomes. At some point, this will be applicable for other parallel systems like MD. So you have two options to keep grunting or understanding the exams.

What makes DNB courses conducted by NBE different from others is the way it tests your knowledge and skills.

Unfortunately, all this realization comes when you are past the turmoil of multiple attempts and frustration toward the solid foundation of DNB training. If not for all, but few examiners do understand the problems, Dr. Janani Shankar is one of those.

While in KKCTH for my PICU training I got a chance to interact with Dr. Janani Shankar who is one of the Examiners for DNB Pediatrics. I tried to understand what the DNB trainees exactly need to do while preparing for their exams. Both theory as well as practicals. Following is a brief summary of the tips she kindly agreed to share.


How to approach your exam?


Setting Goals, implementing and winning the Game

Try not to make exams, a do-or-die experience. The following things might be helpful to save from the panic that is created.

  1. Start Early - There is no point in delaying exam-oriented reading. While you are reading a topic, keep thinking about what sorts of questions on theory can be asked or What possible OSCE question this topic can have.
  2. Be systematic - That's the word, being systematic in everything, reading, writing, answering, and applying. Almost everything in a list format. No one is interested in your grammar.
  3. Plan ahead - Start your planning from which year, which tasks are you going to finish.
  4. Set realistic goals -for that start early. Everything has a timeline, You cannot just suddenly start reading 24 hours and finish the topic, understand it, and be able to answer. Get realistic
  5. Work towards your goals - Don't just set them like new year's resolutions ion. Work on goals, Show yourself data, how successful you were in your last goals. If not modify your implementation techniques
  6. Keep motivating yourself and others.

Remember the real purpose of your training.

Pediatrics is not limited to a theory and clinical exam. The real test is your daily routine. What you do for 3 years. The real purpose is either to save the lives of kids or make it better. So don’t lose focus on that.

If you are sincere and hardworking at taking care of kids under your care, you will know what to do in the exams.


Exams are just a phase in life. It too shall pass

Look at the exams as stepping stones. They actually help you become a better doctor by making an effort. Do what you need to do to reach your goals.

So many people pass DNB exams every year, it may be difficult but not an impossible task. Start with a positive attitude.


How to Prepare for DNB theory exam?

1. Make a schedule

While making the schedule be realistic, small goals work better be it any exam in life. Starting early is again the pre-requisite. Try to covers every chapter in Nelson.

You may jumble up systems or sit with a single system till that is over, that is a personal choice. But do not omit any system.

2. Making Notes that belong to you

Prepare notes in your own style and revise them whenever possible. Repeat on and on. The time will come when you no longer require it.

You must know the salient points in each topic. It is not necessarily that you remember every point. With practice, you will yourself understand what must be important and what is not for the exam.

3. Work out previous question papers.

To get an idea of the pattern of questions you will have to go through the previous year's question papers. Practicing with q papers will give you an idea about your progress of exam-oriented preparation.

Do not exclude community medicine, vaccination, recent advances from your reading. They may sound boring but are high yield topics.

Try to, formulate or imagine your own questions in each topic. Think about how you would answer.

4. Master Data flow Diagrams

Prepare algorithms and flowcharts for questions like – approach to a disease or a condition, line of investigation, or treatment. They earn more scores for your answer with lesser time, thus giving you more time for the rest of the theory.

5. Make a list of questions you want to revise the day before.

You can not read everything just before the exams, like days or weeks so you need a plan. Note the question you want to read before the exam. these questions can be

  1. High yield or repeatedly asked questions in the last few years.
  2. The questions which need more revision and that were read less by you.
  3. Table and charts. Short snippets of noted which can rapidly be revised ( more coverage in less time)

On the night before the exam, I would advise you to stop reading by dinner time, have a good dinner, relax and give your body time to ease out the tension. Try to get a good night's sleep.

Do not worry about the questions, it is something that you cannot control. Do not think about all the “what if” questions that fill our heads with fear.

It is just another day of your life. Face it with courage, determination, and a willingness to win.


How to write the theory paper

1. Order

Answer in the given order.

2. Highlight

While writing the answer, highlight the salient points either by using a different color pen or by underlining them. Use different colors/capitals/ underlining, to show the different parts of the same question. Marks are being allotted in parts. Ensure examiner knows what is where.

3. Space out

Write neatly and use spaces. let it not go on for pages. Make the answers neat, precise, and legible.

4. Handle one questions at a time

There is a high probability that you may not know the answer to some question completely. Do not panic. Face questions one at a time.

Focus on the answer you are writing rather than thinking about the next one. Do not think and worry about a question you do not know.

If you do not know the answer, leave out a few pages. Attempt the next. Come back to that question at the end, when you will be able to think and write.

This will help you maintain the order.

5. Use your clinical sense

For clinical questions, Try to imagine what you would do, when a patient comes to you. How you would approach a child with the given condition in the ER / OP is the answer to such questions.

6. Get Over it

Do not think about the paper you have written and submitted. It is done. You cannot change it. Focus on the next paper. That is the best thing to do.


How to Prepare for DNB Practical examination

You deserve a small break.

Relax for a few days/weeks after theory exams and then start preparing for practicals.

Prepare skeleton

Prepare a list of systems and diseases that are commonly kept for the practical exam.

Imitate the exam

Present cases to your teachers and colleagues often. Write a fake case sheet for each disease. This way you know what all needs to be covered in history, clinical examination, and viva and what you are missing.

Present the entire history to your colleagues and teachers, don’t worry about making errors, it is better to make them now than in the exam. Learn from your mistakes and others’ too.

Fix the timeline of the presentation

Try to finish taking history and clinical exam within 45 minutes. Practice this repeatedly.

Don't make errors in the basics

Do not make errors in the basics. Keep the order of presentation as it is historically. Avoid mistakes in eliciting the signs when asked. If you realize you did a mistake, explain, and correct.

Be thorough in anthropometry, nutrition, and immunization. These are the things that separate kids from adults, pediatrics from general medicine. There is no excuse if you falter in these areas.

Preparing for OSCE

Prepare for OSCE parallelly. There are certain topics that you must cover during OSCE preparation. More on OSCE tips here


On the day of your practical exam!

  1. Dress neatly.
  2. Wear a coat with long sleeves preferably.
  3. Take some toys to befriend the kid who is helping you in the exam (by being your patient)
  4. Do not panic if the examiner asks you a question that you are not able to answer. Try to think about the answer or else respectfully say you do not know. But don’t make it a habit.
  5. Be loud and clear while you talk.
  6. Be confident.

Summary

The examiner is making you do what you are supposed to do daily in the hospital—take a history, do a clinical examination, formulate the differential diagnosis, and plan the line of management. Nothing different.


You need to Converse.  Do not just keep quiet. By not attempting the answer, you are making it hard for the examiner to help you. Do not worry about the reputation of the teachers/examiners. At the end of the day, you have to perform and excel. Be yourself.


Other articles by Dr. Janani Shankar

  1. Tips for DNB theory Exam - DOs and Donts
  2. Covid - 19 Pandemic and Virtual Exam of DNB
  3. Exam Corner - Everything exam-related
auhtor

About Authors

Dr Janani Shankar | DNB PhD MNAMS

Dr Janani Shankar is a senior consultant in Pediatrics and Pediatric Infectitious diseases at Kanchi Kamakoti Child Trust Hospital, Chennai, India. She is involved in teaching activities conducted by NBE across the country for many years and also an examiner for the DNB Pediatrics exam conducted by NBE

auhtor

Ajay Agade | DNB FNB Fellowship in Pediatric pulmonology

Ajay is a Paediatric Intensivist, currently working in Pediatric Respirology & LTV at Great Ormond Street Hospital, London

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