Hospitals, specially private institutes, see two major advantages in having DNB trainees:
1. Assured workers for three years at lower costs, without the conditions of employer-employee contracts or special privileges.
2. Academic interests keep most of the senior doctors updated and on their toes. So overall, confidence, quality of care is felt to improve.
Back in 2007…
Initially, those doing FM were primarily rooted in one department. Usually it used to be Internal Medicine.
This seems to be true even now, in 2013, in many hospitals. Some colleages in FM training have had more than 6-9 months of posting only in the Casualty, or Neurology, Gastro, Surgery, etc.
FM trainees were “fillers” for departments such as casualty, ward calls, etc. as and when the need arose. Actually, this was a very much felt need (versatility). This versatility of family medicine trainees could not be met by other specialty trainees. This was a very important point to note.
Though there used to be a NBE-recommended schedule of training, it was hardly put into practice. When we entered into training in 2007, our group grew to six. We made a sincere request to the hospital management to let our training proceed as per rules. That was permitted. Life improved.
We had a good library, access to relevant journals, a PHC, a nursing home attachment, some excellent and supportive teachers, excellent research opportunities, etc.
There was initially a distinct feeling of being treated as “below par” compared to other trainees.
Some trainee colleagues from conventional specialties made it explicitly clear on more than one occasion that we were “temporary parasites” in “their” department (my suspicion is that they felt insecure that we put in more hours of work and study than them). Some peers jestingly coined terms such as “free radicals”, “jokers in the pack of cards”, “guests of the department” and “step-specialists” (as in step-children).
On the other hand, many senior doctors were keen on helping us with relevant tips and training whenever possible.
Back then, there were no exams/ bed-side classes/ etc specifically for FM. We had to merge with other specialty trainees. Some topics which were discussed during classes had little relevance to FM. While we gained useful clinical skills and knowledge, it was mostly “technical”, not holistic at most times.
There was little opportunity to liaise with FM trainees from other institutes. There were no FM CMEs, and no FM teachers.
There was no AFPI then. So no mentors for most part.
Appraisals were inconsistent. They used to be conducted by various specialists, based on guidelines from the board, mixed with the particular individual appraiser’s personal ideas and assumptions about FM- which again generally appeared to be generally disappointing.
I was part of three appraisals, first by a Internist, second by a FM professor and third by a Gynecologist. There were many notable differences in the manner in which all were conducted. The internist was disdainful throughout and did not provide constructive feedback. The other two very methodical and guiding.
After the FM professor’s appraisal feedback, there was a remarkably positive difference in the way the management supported us and the way we trained. (This interaction probably saved a few careers too). This Professor was none other than Prof Sunil Abraham, who was the first real FM person we saw in flesh and blood after spending three years in FM training! Later on, I fondly remember 3-4 of us trainees huddled around my mobile phone, kept in speaker mode, listening to Sunil sir guiding us on how to train better, prepare better, keep spirits high and positive, and be a better doctor.
We felt there were very good opportunities to learn in every posting; nature of work was almost the same as other trainees in the respective departments.
Few days preceding the final exams were reserved for preparations. We used them properly and studied as per a plan. They were of immense benefit. Our teachers taught us wherever they could- even over tea and snacks in the canteen, and during drama dress rehearsals for the annual day.
All the candidates who made sincere and reasonable efforts passed DNB or equivalent exams. When the results came, it was very clear that those who failed were the ones who were negative in attitude, half-hearted or not interested.
Presently, training of the lone FM candidate remaining here is much better and steady compared to 5 years ago. Most importantly, a nucleus for forming a Dept of FM is in place.
But due to less candidates joining (2011), and mainly due to absurd excuses form the board to deny FM seats in spite of good results and trainee feedbacks (2012, 2013- apparently as per their new policy of trying to finish off DNB FM), the present candidate does not have a peer to train with.
The institute provided stipend and leave facilities as per National Board guidelines. Extra duties were compensated as per prevailing institutional rules. Decent hostel accommodation was provided.
In short, holistically, I would rate the training we got as 4/10 in 2007, steadily improving to 8/10 by 2011. There was a marked change in the systematicity of training, attitude of the institute and colleagues, etc. The results were there to show.
NBE’s role in training and support: Pratical considerations:
The board has outlined a decent syllabus for FM.
The board does not provide training material to FM trainees as much as provided to other specialties- but this is overcome to a good extent since a lot of training overlaps- e.g Thursday broadcast topics, theory and practical training CMEs etc.
When FM training is perceived by some teachers as just “mixing with normal trainees”, the “essence” of FM i.e holistic care is never a component in such CMEs or training programmes. Many teachers simply feel that aspects such as empathy, social atmosphere, shared management etc are trivial, not applicable or irrelevant.
The National Board is an extremely unfriendly place to deal with, from trainees’ point of view. They don’t answer telephone calls (I used to keep the phone on loud speaker and wait for them to pick up- which was sometimes after 20-30 minutes. This went on 3-4 times a day, for about 20 days! My mobile bill posted a record that month.)
They didn’t reply relevantly to queries. They discover lack of (practically insignificant) documents with them (because they misplace it) and withhold results at critical junctures- putting months or even years of trainees at stake. They are hardly bothered about doctor’s’ careers.
It happened with me in 2010, it happened with another Doctor from Mumbai this year.
All this news adversely affects other trainees’ morale.
Curiously, such hassles only seem to happen to FM trainees; others with amusingly bigger issues are left unharassed. For example, I have a friend in pediatrics who passed in 2010, with me. His just-completed, un-submitted thesis is lying on my table right now, in Apr 2013! He or colleagues from other specialties never had to suffer the agony which FM candidates suffered due to incompetence on part of the NBE staff!
During the convocation in Feb-2012, the 32 FM doctors were seated in the farthest, dimmest corner of the upper-most balcony of Siri Fort auditorium, even beyond other “less glamorous” specialties such as PSM and Ophthal.
Radiology, Medicine, Surgery were in the best, nearest seats right in front of the stage. Behind them were the pediatricians.
In our remotely accessible seating area, where the loudspeakers were barely audible, we could make out intermittently that radiologists and surgeons were selectively praised by various wise speakers.
Simply from the well-thought seating it could be made out which specialties were the NB’s pets.
FM found a lone mention towards the fag end of the day, when the handful who remained in the massive auditorium probably saw 2-3 FM specialists disinterestedly rise for the oath.
There is no gold medal for FM yet!
So much for moral support from the board, during training and even after passing! 🙂
P.S. In spite of all the cribbing, I am sincerely grateful to those few in the NBE for having provided a few of us the opportunity to have become FMs.
Jai Ho!! 🙂