DNB Practical Exams: A Deep Dive into Mark Distribution and pattern
This post provides a comprehensive overview of the pattern of DNB practical exams in Pediatrics. We will discuss the breakdown of marks, time limits, diverse scenarios, and strategic breaks in the OSCE, clinical cases, viva and ward rounds, providing valuable insights.
From time to time National Board has made changes in the exam pattern to make them structurally robust, and note that knowing the pattern of your exam is step one toward successful outcomes.
The goal here, is to empower students, offering guidance to navigate this crucial part of their academic path with confidence and success.
To begin with we will discuss the morning session which consists of the OSCE exam followed by the post-OSCE session which includes clinical cases and Viva.
A. OSCE (Objective Structured Clinical Examination) - Morning session
OSCE plays a pivotal role in shaping the result of the DNB final exam.
The morning session is a dynamic journey comprising 20 OSCE and is a crucial phase that demands strategic preparation.
| Session | Total OSCE Stations | Time | Total marks |
| Morning | 20 | 4 Mins each Total 1 hour | 5 marks each Total 100 |
Let's delve into the intricacies that make this session a unique challenge.
Time is of the Essence
OSCE is a fast-paced sprint, each candidate faces a series of 20 OSCES, with a tight timeframe of 4 minutes allotted to navigate through the complexities of each scenario. The clock ticks as questions are meticulously screened, ensuring a comprehensive evaluation of your knowledge within the designated time. Focus, knowledge, and presence of mind, all are tested.
Multidimensional Challenges
Prepare for a diverse range of scenarios as each OSCE station is a set of few inter-related questions and some stations even extend beyond a single slide.
This nuanced approach tests candidates' ability to adapt and respond effectively to multifaceted clinical situations. The richness of the examination lies in its ability to mirror the dynamic nature of pediatric practice.
Strategic Breaks
The rhythm of the OSCE stations is planned, allowing a 2-minute break between each OSCE. This time is utilized to collect answer sheets from candidates. Additionally, this strategic pause serves another purpose – a moment for candidates to collect their thoughts. Such intervals not only foster concentration but also ensure a seamless administrative process.
Recognizing the intensity of the session, a well-thought-out break of 4 minutes is provided after every 7 OSCE station. This brief break acts as a mental reset, allowing candidates to approach the subsequent set of scenarios with renewed focus.
Answer sheet - Data Flow
Post each OSCE, the candidates' answer sheets become digital data, and are directly uploaded into the repository of the National Board of Examinations (NBE). This real-time uploading not only streamlines the evaluation process but also provides an instant overview of candidates' performances.
B. Case Scenarios - History taking and Physical examination
| No of Cases | Time | Marks |
| 2 | 15-20 mins each Total time 30 to 40 mins | 50 marks each Total 100 Marks |
In post OSCE session, candidates encounter two distinct clinical case scenarios designed for history taking and examination.
Usually one of the cases typically revolves around neurology, while the other is non-neuro cases, though this can vary based on the exam center's available cases. Each case is allotted a thoughtful 30 minutes for a comprehensive exploration.
Visit the link below to know list of clinical cases that are repeatedly asked in practical exams along with tips on how to prepare clinical cases and viva.
Following the history taking and physical examination, candidates transition to presenting their findings in a format. This is followed by a viva discussion with the examiner. This dialogue, ranging from 15 to 20 minutes, delves into the intricacies of the cases, showcasing the candidate's ability to analyze, synthesize, and communicate clinical information effectively.
With each case carrying a weightage of 50 marks, the total evaluation encompasses both the structured presentation and discussion. This segment not only assesses clinical acumen but also emphasizes the importance of clear communication and analytical power, making it a cornerstone in the evaluation of DNB pediatric candidates.
Here are the tools that may help in preparation of practical exam
C. Viva
Viva is the 3rd component of the practical exam. Viva is a series of oral questions asked by examiners. Students are expected to demonstrate not just rote memorization but a profound understanding of the subject.
| Total Viva session | Time | Marks |
| 4 | Each 15 mins Total 60 mins | Each 15 marks Total 60 marks |
The Viva encompasses a diverse range of inquiries, spanning from the mechanism of action of pharmaceuticals to the proper utilization of diagnostic tools. This format not only assesses the breadth of a student's knowledge but also evaluates their ability to think critically and respond coherently under pressure.
The Viva sessions can be short clinical scenarios, drugs, vaccines, instruments, procedures, NRP, etc. Let us categorize them into
- Emergency pediatrics,
- Ambulatory or office-based pediatrics,
- Guidelines such as NRP and PALS
- Social Pediatrics, and
- Vaccinology
Examples of Viva sessions
Emergency pediatrics
- Acute Exacerbation of wheeze
- Convulsing child
- Child with stridor
- Child in shock
- Child with DKA
- Poisoning
- Snake Bite
- Scorpion Envenomation
- CPR
- BVM
- Intra Osseous needle insertion
- LMA insertion
- Nebulisation
- Emergency drugs
Success in the Viva requires a holistic grasp of medical concepts, quick thinking, and effective communication skills, reflecting the multifaceted demands of the medical profession.
Ambulatory Pediatrics
- Incessant crying
- Child with Acute Gastro Enteritis
- A child with short febrile illness
- Habit Constipation
- Picky Eater
- Poor weight gain
- Anthropometry
- Using Nebuliser
- Spacer devices
Current Guidelines
- NRP scenarios
- PALS related viva
- Asthma guidelines etc.
- Disaster management-related guidance etc
Social Pediatrics
- National Programmes
- Social issues such as adoption etc.
Vaccines
- Current ACVIP guidelines
- National immunization program
- Individual vaccines
D. Ward Rounds
Ward round compramises of real life scenarios in medical ward. The examiner will brief you with a short history, chief complaint etc and asked question that demonstrate your knowledge, application and ability to communicate. The 4 ward round will belong to 4 different sub-specialites. You can conisder these as a short cases which were previosuly the part of DNB exam.
| Ward rounds | Marks |
| 4 | 10 marks each Total 40 Marks |
Let's Take an example.
You are called into a room/ward where the examiner is already present. The examiner briefs you about a child who is present with parents in the ward.
This is 2 a year old, and he started crying for not being given a screen to watch, this was followed by a sudden onset cyanosis followed by stiffening of the body for about 40 sec.
Following questions can be asked
Can you examine and state your findings?
You will have to perform a focused clinical examination here, like stating pallor in general examination (Nore that anemia can increase frequency of BHS or can cause prolong spells), detailed neurological (to rule out CNS related issues) and cardiovascular (to rule oout cardiovascular causes of cyanosis, syncope etc) examination.
What are your thoughts about the diagnosis?
You will have to state the diagnosis of a breath-holding spell (BHS) along with points to support your diagnosis.
What is the role of Iron in BHS
Read this article for a very details discussion on Breath Holding spells.
How will you counsel the parents?
Read the above article on BHS. For a more detailed discussion on counseling, you can visit this post.
How many marks do I need to pass the DNB Practical exam?
Candidate must obtain a minimum of 150/300 marks to
qualify for the Practical Examination.
Is there a provision for Grace Marks in the Practical exam?
here is no provision for grace marks from NBE.
How many attempts are permissible?
- A maximum of three attempts can be availed for clearing Practical Examination. Read do's and don'ts for the DNB exam.
- After the theory results are announced in the same session, the practical examination is scheduled as the first attempt. It is a mandatory attempt.
- If a candidate doesn't pass the first practical examination attempt, they are allowed two more attempts. These two attempts can be taken in any two practical examinations conducted during the next three consecutive sessions of DNB Final Examinations.
- If you don't appear for the exam after submitting an application, It will be counted as an attempts
As DNB Pediatrics aspirants gear up for the practical exams, these insights may serve as a compass, guiding them through the intricacies of this examination. I believe that understanding the nuances of the process is the first step towards mastering it. Here's to unlocking success in the DNB Pediatrics OSCE exam – a journey of skill, knowledge, and mental fitness!
Author
Dr Janani Shankar | DNB (Pediatrics) PhD MNAMS
Dr Janani Shankar is a Medical director and senior consultant in Pediatrics and Pediatric Infectitious diseases at Kanchi Kamakoti Child Trust Hospital, Chennai, India. She is a passionate mentor and teacher for many of us. She is also an examiner for the DNB Pediatrics exam conducted by NBE
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