MS and DNB Orthopaedics Exams in India: Format, Rules and Preparation

India has two routes to a broad-specialty orthopaedic qualification. The Master of Surgery (MS) Orthopaedics is a university degree regulated by the National Medical Commission (NMC). The Diplomate of National Board (DNB) Orthopaedics is awarded by the National Board of Examinations in Medical Sciences (NBEMS) after training at an accredited hospital. Both end in an exit examination with four theory papers followed by a clinical or practical examination and viva. This guide sets out the rules for each from the official sources (NBEMS (opens in a new tab) and the NMC (opens in a new tab)) and then covers how to prepare. For the training route itself, see how to become an orthopaedic surgeon in India.

MS vs DNB at a glance

Entry and training

The NBEMS manual says the DNB course is joined after NEET-PG (three-year post-MBBS course) or DNB-PDCET (two-year post-diploma course). Under PGMER-23, MS admission stays with NEET-PG until the first batch admitted through the National Exit Test (NExT) becomes eligible. MS is three years including the examination, or two years for those who already hold a recognised two-year diploma in the same subject.

PGMER-23 adds requirements that MS candidates must meet before they are allowed to sit the exam:

• an online research methodology course, an ethics course (including Good Clinical Practice) and BCLS and ACLS training, all expected in the first year;
• at least one poster, podium presentation or first-author paper in the specialty (the 2022 NMC MS Orthopaedics guidelines ask for more: two national conference presentations and one paper published or accepted in an indexed journal);
• a three-month residential District Residency Programme in the third, fourth or fifth semester;
• a logbook of work done, and at least 80% attendance.

DNB trainees keep an e-logbook of cases, journal clubs and seminars, which must be reviewed regularly by their guide.

The DNB Final: theory

NBEMS normally runs DNB final sessions twice a year. Recent theory sessions were held on 18–21 December 2025 and 18–21 June 2026, one paper a day. An NBEMS notice of 10 April 2026 lists a tentative 19–22 November 2026 session, with no fresh batch scheduled to take it. Theory exams now use a hybrid format: you read the questions on a computer screen and write your answers in a barcoded 50-page answer booklet, with five pages set aside for each question.

Format. Four papers of 100 marks, three hours each, usually 10 short notes of 10 marks. NBEMS notes that the number of questions and marks per question may vary in some papers. That gives you 18 minutes per 10-mark question. Spend 25 minutes on the first and you will run out of time on the tenth.

Passing. You need 200/400 in aggregate. There is no minimum per paper in the DNB rules. Candidates scoring 192–199 are considered for grace marks of up to 8. Failed candidates can buy digital copies of their answer scripts for Rs 100 plus GST per paper within seven days of the result.

Eligibility. You must finish your training by the cut-off date in the bulletin, submit a training completion certificate with your leave declared, and have sat the minimum number of Formative Assessment Tests (FAT). The June 2025 bulletin requires two FAT appearances for post-MBBS trainees and one for post-diploma trainees. NBEMS runs the FAT in the second year of a three-year course (first year of the post-diploma course), and your hospital runs internal assessments in the other years. FAT marks do not count towards the final exam.

Fees. The June 2025 bulletin listed Rs 5,250 for DNB trainees (theory and practical) and Rs 6,250 for MS graduates, including a Rs 1,000 registration fee. A practical-only attempt was Rs 5,250.

The DNB Final: practical

Only candidates who pass the theory may sit the practical. It is marked out of 300 and comprises "OSCE and/or Clinical Examination, and Viva", with a pass mark of 150 and no grace marks. NBEMS lists the orthopaedics practical as an OSCE. For the June 2026 session it ran in batches on 29–30 September 2026, with a further batch tentatively on 31 October 2026. NBEMS can allot you a centre anywhere in India and does not allow changes of centre or date.

Attempts. You get three. The practical in the same session as your theory pass is the compulsory first attempt, even if you are absent. Your second and third attempts can be any two of the next three consecutive DNB final sessions, at the full fee. If you fail all three, you must sit the theory again. Absence after you have applied still counts as an attempt.

The DNB thesis

The thesis deadlines are strict. The NBEMS manual sets them from your date of joining, and research for the three-year course should be complete by 24 months:

Your institution's ethics committee approves the protocol, and NBEMS does not approve protocols itself. Miss the protocol deadline and you are ineligible for the first DNB theory exam you would otherwise have sat. Miss the thesis deadline and you cannot apply for the next theory exam. Even after you pass both theory and practical, your result is withheld until NBEMS accepts your thesis. Consult a statistician while you are still collecting data, not after.

The MS Orthopaedics examination

Your university runs the MS exam under PGMER-23 (opens in a new tab) and the NMC's MS Orthopaedics guidelines. Universities may hold no more than two exams a year, between four and eight months apart. There must be at least four examiners, at least two of them external, and at least one from a university outside the state.

Theory. Four papers, held before the clinical exam so they can be marked in advance. Under the NMC guidelines they are:

• Paper I: basic sciences as applied to orthopaedics
• Paper II: traumatology and rehabilitation
• Paper III: orthopaedic diseases
• Paper IV: recent advances in orthopaedic surgery, and general surgery as applied to orthopaedics

PGMER-23 allows descriptive questions, MCQs or a mix. Every script is marked twice and the two marks are averaged. If they differ by 15% or more of the paper's total, a third examiner marks it and the best two marks are averaged. Universities must use digital marking, and no revaluation is allowed once results are declared.

Clinical, practical and viva. PGMER-23 specifies one long case and two short cases, a viva, and an OSCE as part of the clinical exam. The NMC guidelines spread the practical over two days. The viva covers clinical, procedural and communication skills, your logbook, and orthopaedic radiology, pathology, histopathology and gross anatomy, instruments, and orthotics and prosthetics.

Thesis. The NMC MS Orthopaedics guidelines require the thesis to be submitted at least six months before the examination and accepted by three examiners (one internal, two external) before you may sit. PGMER-23 also gives the thesis 20 marks within the practical, assessed in a viva by the external examiner from outside the state.

Passing. You need 50% in theory in aggregate with at least 40% in every paper, and 50% in clinical, practical and viva combined (200/400). There are no grace marks. If you fail either head, you resit both theory and practical.

Writing the theory papers

• Structure every answer. Use underlined headings: definition, aetiology and pathogenesis, classification, clinical features, investigations, management, complications and recent advances. Never write one long paragraph.
• Draw. A labelled line diagram of the leg compartments, the brachial plexus or a classification is faster than prose and easier to mark.
• Give algorithms. If the question says "management of", give a flowchart.
• Basic science and recent advances are papers I and IV for MS, and basic science runs through every DNB paper. Learn surgical approaches with their internervous planes, fracture healing, implant materials (titanium, stainless steel, trabecular metal) and statistics (Statistics for Orthopaedic Surgeons). For recent advances, cite named papers from the last few years in JBJS, Bone & Joint Journal or Indian Journal of Orthopaedics.
• Trauma questions reward AO principles, the major classifications (Gustilo-Anderson, Schatzker, Letournel) and the case for damage control orthopaedics versus early total care.

The clinical examination

Long case. Take a full history and examine thoroughly, including the systemic examination. Candidates who skip it in a patient with a bone tumour or tuberculosis lose marks. Prepare presentations for conditions common in Indian practice: tuberculosis of the spine, nonunion of the femoral shaft, chronic osteomyelitis, clubfoot and neglected DDH. Open with one sentence: age, sex, main complaint and its duration. Then give the positive and relevant negative findings, a provisional diagnosis with differentials, and a plan that runs from conservative care to surgery and rehabilitation.

Short cases. These test a rapid, focused examination: peripheral nerve palsies (ulnar or radial claw hand, winged scapula), cubitus varus, solitary exostosis, Achilles tendon rupture, mallet finger. Talk the examiner through the signs as you elicit them. Say "a positive Lachman test and joint-line tenderness suggest an ACL tear with a meniscal injury, which I would confirm with MRI", not "I will order an MRI".

OSCE stations. Expect gross specimens (describe the lesion and its zone of transition), radiographs and MRI (for example a missed posterior shoulder dislocation, a subtle Lisfranc injury, or rickets versus scurvy), and practical tasks such as demonstrating the Silfverskiöld test or marking the incision for a surgical approach.

The viva: instruments, implants and orthoses

The instrument and implant viva is one of the most predictable parts of the exam. Name the implant exactly ("a 135-degree dynamic hip screw side plate"), then explain how it works. A dynamic compression plate has sloped oval holes, so a screw placed eccentrically compresses the fracture. A locking plate has threaded holes that give angular stability. Know the thread and core diameters of cortical and cancellous screws. For orthoses, name the device (Milwaukee brace, SOMI brace, PTB cast, SACH foot) and explain how it works, such as three-point fixation. For operative surgery, describe the exposure step by step and the structures at risk.

When you do not know something, say so and describe the principle you would apply. A made-up answer costs you more than an honest "I don't know". For answer structure, see passing the orthopaedic viva.

A 12-month plan

Books. The NMC MS Orthopaedics guidelines recommend Campbell's Operative Orthopaedics, Rockwood and Green's Fractures in Adults, Rockwood and Wilkins' Fractures in Children, Tachdjian's Pediatric Orthopaedics, Apley's Concise System of Orthopaedics and Fractures, Kulkarni's Textbook of Orthopedics and Trauma and Hoppenfeld's Surgical Exposures in Orthopaedics, among others. Use Campbell's as a reference rather than reading it cover to cover. Miller's Review of Orthopaedics is efficient for basic science revision, and McRae's Clinical Orthopaedic Examination is the standard for clinical technique. An undergraduate textbook alone will not give you the depth these papers need.

If you plan to train or work abroad later, the global orthopaedic board exam atlas compares the FRCS, FRACS, ABOS and EBOT exams.