UNIFORM CURRCULUM FOR MCh AND DNB NEUROSURGERY

Introduction:
The neurosurgical training in India at present has many drawbacks. The important of
these are lack of uniformity in the facilities in various teaching departments, lack of uniform
curriculum, lack of uniformity in the standard of examinations and lack of adequate practical
experience, especially, of those trained in non teaching private institutions. Hence there is an
urgent need to streamline the standard of training and evaluation throughout the country. The
following recommendations are put forward in this regard (Common for M.Ch. and D.N.B.
qualifications). These recommendations are the summary of the consensus arrived at the Meeting
of the NSI Committee for devising the uniform guidelines for neurosurgical training held at the
AIIMS, New Delhi on 15-3-2014.
DURATION OF TRAINING:
3 years for post M.S./D.N.B. (General Surgery) candidates
6 years for M.B.B.S. candidates (1year General Surgery + 5 years Neurosurgery)
More centres to be encouraged to start 6 year training program.
MINIMUM INFRASTRUCTURE FOR STARTING NEUROSURGERY TRAINING
Number of Trainees: Maximum should be 6 per year irrespective of the size of the
Department.
Staff pattern:
For one candidate intake per year, the department must have at least:
One Professor/Senior Consultant (Associate Professor + 3 years) One Associate Professor/
Reader/Consultant(Asst. Professor+2 years), One Assistant Professors/Junior Consultant (with
PG qualification)
Bed strength:
Minimum 20 beds exclusively for Neurosurgery.
Exclusive Neurosurgery ICU beds with ventilators and monitors (Minimum 5)
Diagnostic facilities:
CT scan, MRI are essential. Angiography facilities are desirable.
Allied departments:
Neurology unit, Pathology (exclusive Neuropathology desirable) department.
Operation Theatre:
Exclusive Neurosurgery OT.
Operating Microscope (High end with Observer eye piece and recording facilities),
C arm,
Neurosurgical drill,
Neuroendoscopy (Desirable)
Stereotaxic equipment (Desirable)

CUSA (Desirable)
Microsurgical training lab with a surgical microscope and surgical drills.

Department Library:
With recent Neurosurgery textbooks, Basic Science and Neurology textbooks.
Internet facilities, Minimum of two International Journals to be subscribed. Access to online
Journals and reading material through sites like HINARI, UPTODATE, etc.
Sub speciality:
Minimum one sub speciality to be established (viz. spinal surgery, skull base surgery,
neurovascular surgery, paediatric neurosurgery, etc.)
Academic activity:
Minimum weekly clinical discussion, journal club, monthly symposia, seminars.
(Records to be maintained)
Accreditation to be renewed every five years, after formal inspection.

These are the bare minimum mandatory infrastructure required for starting Neurosurgery training
program and accreditation to all such institutions running the programs in the absence of the
above infrastructure should be revoked.

TRAINING CURRICULUM:
1st year of 6 year training: Posting in General Surgery to learn basic principles of
surgery, basic surgical skills, exposure to patients and operative procedures in general
surgery.
3 years training/ 6years training:
Posting in Neurosurgery
1st year/2nd-3rd year: Patient care, history taking and neurological examination, casesheet writing, preparing discharge summaries, supervised emergency calls, exposure to
basic neurosciences, Academic activity, Neurology posting for one month.
2nd 3rd year/ 4th to 6th year: Overall in-charge of ward work, OPD, Emergency calls,
Academic activity, Posting in other Neurosurgical centre(s) for 2 months in the beginning
of final year.
Academic activity: Clinical case discussion, pre-operative discussion, journal club,
neuro-radiology discussion, grand rounds, medical audit, symposia, seminars. (Active
participation to be recorded in logbook and certified)

Minimum operative surgical exposure required for the trainees:

Mandatory:
- 400 cases exposure at least for the whole training program (Minimum 300 cases
performed in the OT in a year).
-

At least 2 OTs a week including trauma

About 1/3 cranial and 1/3 spinal cases

At least 10% supervised/performed independently (at least 10 craniotomies)

Spectrum of surgeries should include Neuro-trauma, Neuro-oncology, Stroke and

cerebrovascular surgery, Pediatric Neurosurgery, Spinal surgery.

If any of the above specialities is not available, the trainee may be posted to other
centres where such speciality is available.

Desirable:
Exposure to sub-specialites including
- Cerebrovascular surgery including endovascular procedures
- Functional Neurosurgery and Epilepsy surgery
- Neuro-endoscopy
- Peripheral nerve surgery
Practical Surgical training curriculum:
1st year of 6 year training: Posting in General Surgery to learn basic principles of
surgery, basic surgical skills, exposure to patients and operative procedures in general
surgery.
3 years training/ 6years training:
- 1st year/2nd -3rd year: Lumbar puncture, external ventricular drainage, tracheostomy,
endotracheal intubation, emergency scalp suturing, Simple neuro-trauma including
chronic subdural hematoma, extradural hematoma, learning elective case exposures,
VP shunt (under supervision).
-

2nd year/ 4th-5th years: Neurotrauma: contusion and intracerebral hematoma,

Elective cases: craniotomy and spinal exposures.

3rd year/ 6th year: Elective exposures, supervised surgery, Sub-speciality exposure
depending on interest.

Independent surgery (supervised):

Neuro-trauma : Chronic SDH, EDH, depressed fractures, ICH, contusions, (
Experience with conventional craniotomy required).

Elective cases: VP shunt (always supervised), Gliomas (at least 2 anatomical

regions), Surface meningiomas, Chiari malformation, Midline suboccipital exposure
and surgery, Lumbar disc and cervical disc surgery.
Internal assessment:
Theory and clinical:
- Once in 6 months
Operative skills:
- Once in 6 months
- Cases performed under supervision and graded by a faculty (different faculty each
time) and assessment should include Pre-operative assessment, Surgical planning,
Exposure, Surgical techniques and tissue handling and Hemostasis.

Log Book:
- Should be maintained with at least the following entries:
- Name/Hospital ID No/ age/ sex
- Diagnosis
- Name of Surgery
- Special remarks
- Role of the resident
- Comments by the surgeon with signature.
- Participation in academic activity with details also should be recorded and certified.
- The log book should be hand written and signed by the Unit Head/ HOD every
month.
Thesis/Dissertation:
- The thesis should be of a good quality that is worthy of publication in an indexed
journal.
- The thesis should be submitted 6 months before the final examination and evaluated
by external examiners.
- The thesis/dissertation has to be approved before the trainee is permitted to appear for
the final examination.
Attendance of Neurosurgical conferences/workshops:
For 6 year candidates: Minimum 5.
For 3 year candidates: Minimum 3.
Paper presentation at conferences:
For 6 year candidates: Minimum 3. ( 1 in a national conference of NSI
preferably)

For 3 year candidates: Minimum 2. ( 1 in a national conference of NSI

preferably)

Publication of papers (in peer reviewed journals):

For 6 year candidates: Minimum 2.( at least one in Neurology India)
For 3 year candidates: Minimum 1. ( ideally in Neurology India)
(In case an Institution is unable to fulfil the bare requirements, e.g. absence of a particular subspeciality, the trainees should be allowed to go and train for a stipulated period at any other
Institute, where that particular surgery is practised.)
Trainees who fail to achieve the above mentioned targets, despite facilities being available,
should not be allowed to take the examination.
EXAMINATION:
Examination Pattern:
6 YEAR COURSE:
Part I: at the end of I year.
Theory papers:
1. Basic Sciences in relation to General Surgery
2. General Surgery.
Clinical and oral examination in General Surgery:
Long and 2 short cases in General Surgery
Viva in General Surgery
Part II: at the end of III year.
Theory papers in Basic Neurosciences and Clinical Neurology:
1. Neuroanatomy and physiology
2. Neurochemistry and pathology;
3. Clinical Neurology
Clinical and Oral examination in Clinical Neurology:
Long and 2 short cases in Neurology
Viva (including Neuroanatomy and Neuropathology specimens, EEG, Evoked
potentials, etc.)
Part III: at the end of VI year.
Theory papers in Neurosurgery:
1. Neuroradiology and Clinical Neurosurgery
2. Operative Neurosurgery and Recent advances.
Clinical examination, ward rounds and oral examination:

Clinical examination:
Long case and 2 short cases
Ward Rounds: Minimum 2 cases in Head Injury and Neurosurgery ICU
Viva:
Neuro-radiology
Instruments,
Operative procedures,
Recent advances,
History of Neurosurgery.
3 YEAR COURSE:
Part I: at the end of I year.
Theory papers in Basic Neurosciences and Clinical Neurology:
1. Neuroanatomy and physiology
2. Neurochemistry and pathology;
3. Clinical Neurology
Clinical and Oral examination in Clinical Neurology:
Long and 2 short cases in Neurology
Viva (including Neuroanatomy and Neuropathology specimens, EEG, Evoked
potentials, etc.)
Part II: at the end of III year.
Theory papers in Neurosurgery:
1. Neuroradiology and Clinical Neurosurgery
2. Operative Neurosurgery and Recent advances.
Clinical examination, ward rounds and oral examination:
Clinical examination:
Long case and 2 short cases
Ward Rounds: Minimum 2 cases in Head Injury and Neurosurgery ICU
Viva:
Neuro-radiology
Instruments,
Operative procedures,
Recent advances,
History of Neurosurgery.
Theory papers to be evaluated by the external examiners well before clinical and oral
examination and only those candidates who have passed the theory shall be allowed to appear for
the clinical and viva examination.

EXAMINERS:
For Part I of 6 year course:
At least one Internal and One External General Surgeons with an Internal Neurosurgeon
convenor
For Part II of 6 year course and Part I of 3 year course:
One Internal and One External Neurosurgeons
One Internal and One External Neurologists
For Part III of 6 year course and Part II of 3 year course:
Two Internal and Two External Neurosurgeons
Examiners shall be only from M.Ch. teaching institutions for M.Ch. and M.Ch./D.N.B.
training institutions for D.N.B.
Examiners shall be Professors with minimum 9 years teaching experience and not
Associate Professors/Readers.
MANDATORY POST QUALIFICATION EXPERIENCE:
Minimum one year post-qualification work/training (as Tutor/Lecturer) after 6 or 3
year postgraduate training in the same or another Neurosurgery department shall be
made mandatory before the M.Ch./D.N.B. qualification is registered by the Medical
Council. This one year period will help the candidate to advance and fine-tune his
surgical skills.

CONCLUSION:
The above recommendations are the minimum standards for Neurosurgery training and
are purported to have uniform standard of training and evaluation throughout India in both M.Ch.
and D.N.B. training centres.