DNB 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.

What is the Pattern of OSCE 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.

What are the different types of OSCE stations?

The OSCE stations are designed to test different clinical skills set, like clinical examination, ability to communicate and counsel, picture based memory, emergency and critical skills etc.

You can click on links below to see how OSCE's are structured in the actual exam

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.

Want to know how clinical cases are presented? here you go

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 sub types Focused clinical examination is discussed in detail here.

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

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.

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

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

Short case details are given followed by a couple of questions. The answers are mostly one liners, like what is the possible diagnosis, what other clinical feature do you expect or what is the treatment in short etc. These OSCE often have a typical sign or symptom given amid a long story which directs toward the diagnosis. Our Job is to identify those clues.

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

Hematology slide picture with an arrow on particular cell (like acanthocyte) is a commonly asked question.

Many a times a table with lab parameters along with clinical diagnosis are given and we have to answer that the lab parameter will have increasing or decreasing trend for that particular diagnosis, say for eg phosphate in nutrition rickets. This post has one such practise question.

Not uncommonly, we might be asked to match the pair between a clinical diagnosis and a clinical condition.

One or more spot will belong to Neonatology focused section, usual questions involves

1. Assessment of Gestational age
2. Neonatal Resuscitation scenario
3. Examination of normal newborn 
4. Eliciting the neonatal reflexes
5. Bilirubin chart interpretation etc

Charts and tables will be kept on the station, and we will be asked to fill in the empty cells or match the pair. These are usually growth charts or blood group compatibility charts etc.

These station carry higher marks and will include either demonstration of your skills or questions on pediatric advanced life support.

These station includes identification and or explaining parts, uses of various instruments like Bone marrow biopsy needle, CPAP, intraosseus needle, Ambu bags,t piece resuscitatoretc. Sometimes questions like how will you use it appropriately can be asked as well.

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.

Here are practise OSCE stations based on Pediatric nutrition and nutrition based OSCE

These station involves viva like the question about a particular drug. Sometimes we may be asked to demonstrate the procedure to give it, say for eg. subcutaneous injections. This also covers various vaccines used in pediatric age group and might involve question like storage methods

Honestly these are tough one, partly also because we do not focus on research methodology during residency, the focus is entirely upon clinical aspect and theory. These are high yielding questions that usually involve identification and interpretation of particular statistical methods say for example forest charts and sometimes definition of statistical terminologies like define.

all about statistics here

The Genetic OSCE spots usually involve a picture of chromosomal anomaly or pedigree chart and asked to interpret them. Inversely you may be asked to draw a pedigree chart from the scenario. You may also be asked to identify a particular dysmorphic feature shown in the image and answer the questions given.

If you think there are OSCE station types missing in the above list, submit correction using comment box below.

How to attempt and write OSCE answers?

Quick tip on how to attempt Observed OSCE station?

Spend some seconds to think about presenting the answer to examiner before actually speaking

History taking and clinical case Presentation in the DNB exam

1. Overall there are 2 clinical cases. There were no long or short cases in my exam and both cases carried same marks.
2. Marks - Both cases carry 75 marks each.
3. Timing – for history taking and clinical examination approx 20 to 30 mins are allotted.
4. The session for your viva depends on you. The more you make the examiner interested to know from you, the longer the duration are

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

Focus on these peculiar things in Pediatric History taking.

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.

It is a good practise to know the list of frequently asked cases and related questions. Revising such cases and viva-question frequently help in making a good square. It also greatly reduces the anxiet while presenting cases

Following are the clinical cases often repeated in the DNB practical exams.

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

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?

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 everyone in this space using the comment section below.

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

Author

Shivhar Sonvane | DNB Pediatrics, Fellowship in Pediatric Nephrology

Shivhar is currently working in Mumbai as Pediatrician and Pediatric Nephrologist

Author

Ajay Agade | DNB(Pediatrics), FNB(Pediatric Intensive Care), Fellowship in Pediatric pulmonology and LTV

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