Diplomate in National Board Palliative Medicine

I am pleased to announce the commencement of the Diplomate in National Board (DNB) Palliative Medicine program starting 2021. It was approved by the National Board of Examination (NBE) in December 2020.

The DNB Palliative Medicine training program's goal is to create an opportunity for specialist palliative medicine training in India. It aims to provide competency-based training in symptom management, supportive care, awareness of a range of medical and nonmedical options available for the disease management of palliative care patients, and psychosocial support to patients and families. It will also enable the physicians to work in a multi-disciplinary/inter-disciplinary team, in diverse clinical settings, and will enhance their communication and decision-making skills. It will equip them to have procedural skills relevant to palliative medicine and facilitate ethics-based good practice, leadership, teaching, and research.

Any medical graduate with an MBBS qualification, and who has qualified the entrance examination conducted by the NBE and fulfills the eligibility criteria for admission to DNB broad specialty courses at various NBE accredited medical Colleges/institutions/hospitals in India is eligible to participate in the centralized counseling for allocation of DNB Palliative Medicine seats purely on merit cum choice basis.

The duration of the course is 3 years. The candidate admitted to the training program shall pursue a regular course of study on the whole-time basis as an academic resident in the concerned recognized institution under the guidance of a recognized postgraduate teacher for an assigned period of the course.

With this regard, a ten-member executive committee was constituted under the leadership of Dr. Sushma Bhatnagar. The committee was responsible for creating the curriculum for the DNB Palliative Medicine, accreditation criteria for accrediting institutions eligible to conduct this program, and developing teachers' eligibility criteria, i.e., medical teachers eligible to teach and guide postgraduate students pursuing DNB Palliative Medicine.

The DNB Palliative Medicine curriculum outlines the broad concepts of the DNB program, subject-specific learning objectives, theoretical knowledge (cognitive domain), attitudes and behaviors (affective domain), and clinical skills (psychomotor domain) required to become a specialist palliative medicine physician. After the DNB Palliative Medicine Program, it is expected that the postgraduate trainee will have acquired the knowledge base, attitude, and clinical skills required for competent palliative medicine practice.

The trainees should be skilled to provide clinical services at a consultant level, unsupervised and comprehensive medical care. Attaining competency in all aspects of this curriculum is expected to take 3 years of supervised training. It is expected that all teaching, learning, and assessment associated with the palliative medicine specialist training curriculum will be undertaken within the 3 years of training.

In June 2020, an initial appeal was made to the NBE for starting the DNB Palliative Medicine program. In the concept note sent to NBE, an urgent need to commence DNB Palliative Medicine in India was emphasized stating the following reasons.

1. The rapid surge in chronic and life-limiting illness in India due to a paradigm shift in the disease demographics over the last three to four decades

2. Significant increase in cancer incidence and 70%–75% of patients present in advanced stages of cancer need upfront palliative care

3. Higher incidence of end-stage organ impairment such as chronic kidney disease, advanced heart failure, chronic lung disease, and dementia needing palliative care

4. Palliative care access in India is estimated to be <1%. A significant number of people dying in India do not have access to necessary symptom control measures and end of life care. The majority of the Indian population experience health-related severe suffering and low quality of death

5. More than two-thirds of the population in India spend out of pocket. In the absence of palliative care, people receive inappropriate medical interventions at their end of life, draining patients' and families' resources

6. Although palliative care has its presence in India for the last four decades, it has failed to make its mark due to a lack of structured specialist training program

7. The MD Palliative Medicine program initiated in India in 2012 is still in a nascent state, and it has added only a few specialists, which is insufficient to cater to the demand.

The NBE recognized this need. They fast-tracked the regulatory process involved in new course approval and decided to approve DNB Palliative Medicine as a broad specialty was done in a record 6-month period.

I feel that starting the DNB Palliative Medicine program will go a long way in augmenting and bridging the need for specialist palliative medicine workforce in India.