Apprehensions of a Diploma in Anaesthesiology student.

Abstract

Sir, The National Eligibility cum Entrance Test (Postgraduate) [NEET (PG)] was arduous and after securing a Diploma in Anaesthesiology (DA) seat in a postgraduate medical institution, we soon started developing apprehensions about our future. After joining the course, we started worrying about whether a diploma degree would be sufficient to gain the knowledge and clinical skills required to practise Anaesthesiology and whether we should re-attempt NEET (PG) to secure the degree of Doctor of Medicine (MD) in Anaesthesiology. We soon realised that we needed to adjust to the dynamic atmosphere of the operation theatre in a shorter period of time compared to an MD student. There is not much change in the syllabus of diploma and MD course in most of the universities in India, but the major difference lies in the duration of the course, which is shorter by nearly one third in diploma. This makes a diploma student lag behind in both clinical exposure as well as academics. Nevertheless, for the 2019–2020 batch, the coronavirus disease pandemic added insult to injury and further reduced the learning opportunities. Teaching and learning were badly hit in medical colleges all over the country.[1] The second major difference is that diploma students do not have to do thesis work. Hence, they have a feeling that they have not studied any topic in depth and are unsure of their ability to conduct any research activity in the future. Ideally, three years are required to study and understand anaesthesia and critical care.[2] Once we clear our exams and go out to practise, we fear that there might be a stigma attached to the ‘diploma’ anaesthesiologist. Is the degree more important than the knowledge and skills? Lack of academic positions for diploma candidates in teaching institutions is another concern. In medical colleges, as per the National Medical Commission rule, diploma anaesthesiologists cannot be upgraded beyond senior resident and are also not eligible to hold any permanent faculty or administrative post.[3] Anaesthesiology is a vast speciality, with subspecialities ranging from pain management to obstetric anaesthesia, cardiac anaesthesia, neuroanaesthesia and so on.[4] Diploma holders are not eligible to do superspeciality courses in anaesthesiology. Where will they stand in this rapidly growing speciality? Furthermore, nowadays, the general public is educated and patients are free to choose their anaesthesia provider. So, they may opt for MD candidates, restricting our job opportunities. Same is the case with hospital administrators recruiting higher-qualification candidates. So, will we have to go to rural areas to practise anaesthesia? Nonethelesss, diploma courses were added in the past to meet the shortage of specialists in rural India more than fifty years ago. Most of the problems can be resolved if the diploma candidates opt to pursue a secondary Diplomate of National Board (DNB) course following the diploma course, which will take additional years. Now, there are a plethora of opportunities in intensive care units and the private sector for postgraduates. But these require a course in critical care like Doctorate of Medicine (DM) in critical care, DrNB in critical care medicine and Indian Diploma in Critical Care Medicine, for which diploma holders are not eligible. No one takes a diploma course by choice. One gets enroled because a degree seat is not available with the marks. Moreover, competing for the next entrance is competing with at least double the number of aspirants (a new batch is ready to take the entrance exam every year). All this makes diploma degree holders professionally insecure. We would, therefore, like to conclude by saying that whatever said and done, students should choose the course (MD or DA seat) wisely and after carefully considering the opportunities and scope that the degree will usher in. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.