Institute: Deenanath Mangeshkar Hospital and Research Center, Pune
Mentors: Dr. Sanjay Desai
Duration: 6 months
No. of seats: At my time there were 2 seats (I did fellowship from dec-2018 to May-2019 ). Currently there are 2 +1 seats available (2 seats through exam and 1 paid seat is for foreign candidates. If a foreign candidate is not available, Indian student can apply).
Eligibility: MD/DNB/DMRD for Indian students and an equivalent qualification for foreign candidates.
Entrance exam: Yes; it is a multilevel exam. Entrance examination held in September and March of every year. Exam includes 40 MCQs, 40 spotters and interview. Interview is taken by three faculties (Two internals and one external). Selected candidates are informed through mail and asked them to submit their acceptance and required documets by a specific date.
Questions asked in interview, would be both academic (MSK related) and non-academic.
Fellowship application: Fellowship starts from 1st December and 1st June every year; interviews usually happen 2 to 3 months prior. The hospital website would provide the details (usually around September and March). Send your CV on their email for application: firstname.lastname@example.org
Duty hours and emergencies/on call duties and type of work: (Please note, I am sharing the information of my tenure. The world has been changed a lot in the Covid era; so few things may have possibly changed there as well).
Routine work hours: 12-15 hours – Only MSK work.
Work starts around 7.30 AM in morning. Either alternate day or alternate week, one candidate starts reporting around 7.30 AM and another candidate starts reporting around 9 AM. The day ends at 8.30 to 9.30 PM.
Night duties: 4-5 monthly.
On Night duties – all types of USG / CT / MRI cases / Bedside USG / Bed side non MSK procedures have to be done. Night duties starts from 9 PM to 9 AM. Average scans / per night duty – 10-15 USGs, 2-3 Bed sides, 5-10 CTs and 4-5 MRI.
No day off after night duty during my tenure.
Fees and salary: No fees to be paid during admission. Stipend salary of Rs 50,000 per month.
Leaves: 6 casual leaves + GH (Gazetted Holidays) available during given tenure. You can take complementary leaves, if your working hours exceed the norm.
Workflow: The MSK Radiology department caters to multimodality and multisystem imaging. It drains a wide spectrum of cases, including sports injuries and post-operative scans. The routine work is mainly divided into MSK USG, MSK MRI and MSK tele-reporting.
Candidates work under Dr. Sanjay Desai sir, who is the mentor of fellowship. He allows the candidates to learn MSK USG in a separate sports surgery department under Dr. Joban Babhulkar Ma’am. Joban Ma’am comes to hospital on alternate days from 9 AM to 2 PM (Mostly Monday, Wednesday and Friday).
MSK USG : Most of the MSK USG and MSK intervention work done by Dr. Joban Ma’am in sports surgery department. On an average, 15-20 MSK USG scans and 5-6 USG guided percutaneous interventions per day would be done. The posted candidate initially does the USG and then Ma’am cross checks the findings. Interventions are mainly done by Ma’am.
MSK MRI : Reporting of in-house MSK MRI and CT reporting starts from 9.30 AM and it goes till 8.30-9.30 PM with two half hour breaks in between.
There is a double check system for the MSK work, which essentially means a primary report is followed by a second proof read. The musculoskeletal imaging is almost always cross checked by Sanjay sir. All types of cases would be covered like knee, shoulder, wrist, ankle, elbow, hip, post-op imaging, orthopaedic spine, brachial plexus, neural imaging, TM joint etc.
MSK telereporting : MSK telereporting starts from 7.30 in morning and it goes till 8.30 -9.30 PM. Most of the cases come from out of India.
Expectation from a fellow: A fellow’s role is to finish up all the in-house and telereporting MSK scans within the given time limit along with MSK USG, CT guided interventions and nigh calls. The fellow is also supposed to take a lecture every month for DNB students. Case presentation in CROP meeting (combined meeting of orthopaedics, oncologist, pathologist and radiologist) is expected by the candidate which held every month.
Amount of work and daily schedule: On an average, a fellow would do primary reporting of around 150-200 MSK cases (CT and MRI), 70-75 MSK USG cases and 8-10 guided interventions in a week.
Intervention and hands on exposure: The intervention procedures commonly performed include CT guided bone and soft tissue biopsies, ultrasound guided joint, bursal and tendon sheath injections and miscellaneous procedures like calcific tendinosis barbotage, high flow injection for adhesive capsulitis etc. Dr. Joban and Dr. Sanjay do guide the fellows through these. Sanjay sir’s procedures are usually done by fellows on a rotation basis.
Academic activities and research/publications: A teaching session of Sanjay sir happens weekly but lot of learning happens on case-to-case basis. Case based discussions with orthopaedic surgeons often take place at the institute giving invaluable insight into the management algorithms and importance of our imaging findings. As far as research activities and publications are concerned, usually one project is allotted to the fellow, which is expected to be accomplished in the tenure; it is however not compulsory for the completion of the fellowship.
Exit Exam: Clearing the exit exam is mandatory for the candidate to get the fellowship. The examination is taken by external MSK radiologists. The exam is based only on practical approach and live demos with few long cases and spotters.
Pros: Candidate learn a lot about all MSK pathologies. At the end of the tenure, one is confident enough to report and answer the most complicated queries of referring orthopaedic or spine surgeons. One receives regular feedback and follow ups, learns USG guided MSK interventions, and gets a good exposure in post-operative and nerve cases.
Cons: Personally, for me the hectic night duties without any subsequent day-off are biggest drawback, which are actually managed by non-MSK persons. Another con is that there was no exposure of fluoroscopy guided interventions and relatively limited exposure of paediatric, onco-orthopaedics and rheumatology related MSK work at that time.
Personal experience at the fellowship: DMH is one of the top institutes for musculoskeletal radiology training in our country. Dr Sanjay Desai sir and Dr. Joban Babhulkar ma’am offer an in depth insight and understanding of the most complex as well as the commonest of common cases. I learnt a lot of things from there. After the fellowship, I feel more confident in my diagnosis and orthopaedics give more respect to my opinion.
Does it add value over MD /DNB degree: Of-course, No doubt about it.
Dr. Vikas Jhanwar
Fellow in Musculoskeletal Radiology, Dec-2018- May-2019 (DMH, Pune).
Ex-Assistant Professor, SMS Medical College- Jaipur