There has lately been a lot of brouhaha and a tug of war between the Medical Council of India (MCI) and the National Board of Examinations (NBE) on the issue of equivalence of the degrees issued by each one of them. The MS, MD, DM, and MCh courses are conducted by MCI in University Teaching Hospitals, while the National Board runs the parallel system of education, awards the DNB degree, and is held in non-teaching hospitals, including private sector hospitals. The general impression seems to have been given by MCI that the training in teaching hospitals is far superior to the ones provided under the NBE umbrella. Though we do not have any hard core evidence one way or the other in Indian literature, recently, an article in JAMA Surgery by Sellers et al. [
1] has examined a similar debate in the American system where teaching and training in University hospitals was compared to the one offered by non-teaching community hospitals. The authors looked at a huge volume of data covering over 3600 surgeons, 1.2 million plus patients, and covering over 214 training programs in the states of New York, Florida and Pennsylvania in the USA and examined and analyzed the clinical outcomes data for nearly 3,12,000 patients undergoing treatment under 2300 surgeons. Contrary to the general belief, they found that the surgeons training in non-teaching hospitals out-performed those from the teaching hospitals in terms of morbidity, mortality, complications, and survival rates. They also found that these surgeons were more satisfied with the operative experience that they were exposed to in the non-teaching hospitals than their counterparts in the teaching hospitals. Further, it was found that most of the trainees passing out from the non-teaching hospitals settled in to private practice, and the probable reason offered by Dr. Balinger and Kao in an accompanying editorial [
2] was “It may give them more opportunities to focus on bread and butter general surgeries instead of the more esoteric cases referred to academic medical centres.” Probably smaller number of trainees in these community hospitals also gives them better exposure to clinical work with less time spent on core research and in the animal or experimental labs. …
