Accreditation by RSSDI is discontinued since 2003.
School of Diabetology,
University Department of Endocrinology and Metabolism,
Nizam's Institute of Medical Sciences, Hyderabad
adopts the following RSSDI guidelines for
Accreditation in Diabetology 2004

CONTINUING MEDICAL EDUCATION IN DIABETOLOGY IN INDIA

1.0 OBJECTIVES
2.0 NATIONAL ACCREDITATION COUNCIL
2.1  ACCREDITATION COMMITTEE
3.0 CERTIFICATES OF ATTENDANCE IN DIABETOLOGY
3.1  ACCREDITATION IN DIABETOLOGY
4.0  ELIGIBILITY FOR ADMISSION TO CONTINUING MEDICL EDUCATION
5.0  LEVELS OF CONTINUING MEDICAL EDUCATION
6.0 RSSDI COURSE IN DIABETOLOGY
6.1 CURRICULUM
6.2  CURRICULUM-TOPICS
6.3 FRAME WORK FOR RSSDI COURSE
6.4  DRAFT DAILY SCHEDULE
6.5  THE FORMAT for RSSDI COURSE IN DIABETOLOGY
      SECTION I : A FEW GENERAL HINTS, DIRECTIONS AND IDEAS
      SECTION II : THE MAIN SYLLABUS
      SECTION III : PRACTICAL WORK-SHOP - PRACTICAL DIABETES
      SECTION IV : ACCESSORIES IN WORK-SHOP
6.6  RSSDI GUIDE LINES for RSSDI COURSES
7.0 APPLICATION PROCEDURES for RSSDI ACCREDITATION
7.1 RSSDI GUIDE LINES for RSSDI ACCREDITED PROGRAMS
8.0 EVALUATION
8.1 SELF-EVALUATION
8.2 QUESTION BANK
8.3  QUESTION PAPER
8.4  ELIGIBILITY FOR ACCREDITATION
8.5 RE-EVALUATION
8.6 FEES
  ACCREDITATION COMMITTEE MEMBERS
  RSSDI ACCREDITED CONTINUING MEDICAL EDUCATION PROGRAM 1996-1999


Draft as adapted from
 

1. Minutes of the Executive Meeting of the RSSDI held on February 18, 1995 at Aurangabad
2. Minutes of the XXIII Annual General Meeting and the Executive meeting of the RSSDI held on September 16, 1995 at Goa
3. Minutes of the Executive Meeting of the RSSDI held on February 24, 1996 at Hyderabad
4. Minutes of the XXIV Annual General Meeting and the Executive meeting of the RSSDI held on November 2, 1996 at Mysore
5. Minutes of the Executive Meeting of the RSSDI held on February 23, 1997 at Agra

1.0 OBJECTIVES
 

1. To provide up-to-date information on basic, clinical and management aspects of diabetes
2. To facilitate coordinated health care system for providing comprehensive diabetes care
3. To impart competence in dealing with diabetes up to secondary level and preview for referring to tertiary care eg. photo coagulation, renal transplant or coronary by-pass surgery
4. To familiarize nutritional counseling, exercise programs, and patient education 
5. To develop leadership in forming support groups for diabetes health care


 

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2.0  NATIONAL ACCREDITATION COUNCIL for RSSDI COURSES IN DIABETOLOGY and, CLINICAL WORK-SHOPS and CME in DIABETES

To maintain high standards of the continuing medical education in diabetes and to stimulate more clinicians to get better training in diabetes care, Research Society for the Study of Diabetes in India (RSSDI) has constituted the Accreditation Committee for Diabetology with Late Prof. M.M.S. Ahuja, Dr. Nadeem Rais, Prof. Sam G.P. Moses and Prof. B.B. Tripathy from North, West, South and Eastern regions of the country in 1995. The committee was empowered to constitute National Accreditation Council with Dr. P.V. Rao as the Secretary. 

Since 1998 Accreditation Committee of RSSDI is functioning with Prof. Sam G.P. Moses, Prof. Ashok K. Das and Prof. P.V. Rao as members. 


 

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2.1 Pending constitution of the National Accreditation Council, the ACCREDITATION COMMITTEE provisionally
1. assigns `RSSDI Credit Hours' to the topic-oriented Clinical Work-shops or CME programs in diabetes held in any part of the country on application from the Organizers
2. arranges RSSDI Courses in Diabetology at the teaching hospitals of eminence in the country, and 
3. periodically reviews and may revise the credit hours assigned to any program, other functions, rules and regulations of the Committee.

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Following are subject to periodic revision of the Accreditation Committee


 

3.0 CERTIFICATES OF ATTENDANCE IN DIABETOLOGY
 

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3.1 ACCREDITATION IN DIABETOLOGY

Accreditation is an attendance and self evaluation system of the continuing medical education activity for primary care physicians. It is not equivalent to a Certificate, Diploma or Degree awarded by the Universities, and it does not confer any academic qualification or distinction on a clinician.

Accreditation is announced at the Annual Scientific Meetings to a qualified clinician after -
 

1. attendance for 80 RSSDI credit hours, * 
2. participation in one RSSDI Course,
3. evaluation after 100 Credit Hours,
4. life Membership in RSSDI and
5. payment of Accreditation fee 

* excluding credit hours through RSSDI Course in Diabetology
 

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4.0 ELIGIBILITY for ADMISSION to Continuing Medical Education

Continuing Medical Education is open to qualified clinicians -
 

1. with MD in Medicine,
2.  in diabetes practice for 10 years or
3. in faculty or specialist posts at Government Hospitals


 

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5.0 LEVELS of Continuing Medical Education
 

1. RSSDI Course in Diabetology - at national level in Post Graduate Medical Institutions of the country.
2. Advanced Courses, Clinical Work-shops, theme-oriented Symposia, Conferences, Training or C.M.E. programs in diabetes - 

       a. at national level in a major town by the senior CME faculty

       b. at state or regional level as organized by IMA Specialities, API, National Academy or
          Medical College Faculty.

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6.0 RSSDI COURSE IN DIABETOLOGY

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6.1  CURRICULUM [ as suggested by Prof. M.M.S. Ahuja ]

Broad out-lines are that candidates are expected to go through text material or journals on the subject before attending the course. The courses or programs are by and large to provide a basic structure, to enable the candidates to understand pathophysiology, investigative methods and therapeutic applications in the field of diabetes - with emphasis on applied or practical aspects of diabetes. Courses may also incorporate curriculum as suggested by the International Agencies, or followed by American or European Diabetes Associations. 

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6.2  CURRICULUM-TOPICS 

          Basic Sciences
          Genetic Markers in Diabetes
          Immune System and Diabetes
          Environment, Nutrition and Diabetes
          Insulin secretion and regulation
          Intermediary Metabolism
         Gut hormones, amyelin, glucagon, pancreatic polypeptide
          Pathogenesis of macro and microvascular complications

         Clinical (problem solving)
         Tropical Pancreatic Diabetes
         Management problems - OHA, secondary failure
         Insulin (types/combinations, insulin resistance)
         Hypertension 
 

         Peripheral vascular disease (foot problem)
         Nephropathy
         Retinopathy
         Autonomic Neuropathy, GE, GU, Sex
         Hyperlipidemia
         Hypoglycemia
         Monitoring standards of care

         Allied Specialities
         Dermatology
         Psychosocial aspects
         Obstetrics, pregnancy, gestational Diabetes
         Infections, Surgery
         Education
         Emergencies

         Future research
 

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6.3 FRAME WORK for RSSDI Course
 

1. Basic Sciences (20% time)Immunogenetics, Insulin resistance, Intermediary metabolism, Pathogenesis of microvascular and macrovascular complications, and lipid disorders.
2. Clinical problem solving exercises (60% time) Problems in diagnosis, Screening for complications, Management issues, Drug interactions, Emergencies and Patient education. This may include clinical demonstrations, C.P.C. or other similar activity.
3.  Related speciality interaction (20% time) Ophthalmic, Nephrology, Reproductive, Obstetric, Dermatological and Psychological areas.


 

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6.4 DRAFT DAILY SCHEDULE

DAY 09.00-1.00  11.30-01.30 02.00 - 03.30 04.00 - 05.00
FRIDAY BL    PDL PDL    PDL  SSL    CLINICAL CASE  EMERGENCY
SATURDAY BL    PDL  PDL    PDL  SSL    THERAPEUTIC 
           CONFERENCE 
EMERGING INFORMATION
SUNDAY  BL    PDL PDL    PDL SSL    NUTRITION  ASSESSMENT EXERCISE 

L: Lecture, B: Basic, PD: Practical diabetes, SS: Subspecialty
 

SUB SPECIALTIES

           Diabetic Foot (by Vascular Surgeon)
           Eating disorders (by Psychiatrist)
           Infections (by Microbiologist)

CLINICAL CASE DISCUSSION

           Diabetes case with interesting problem
           Therapeutic Conference

SHORT CASES

          Obesity, a major problem
          Drug interactions
          Interpretation of lipid abnormalities
          Practical nutrition-exercise

EMERGENCIES

          Diabetic Coma

EMERGING INFORMATION

         APP, IGF-1

ASSESSMENT ON COURSE CONTENT AND ON PERFORMANCE
 

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6.5 THE FORMAT for RSSDI COURSE IN DIABETOLOGY by Professor Sam G.P. MOSES

SECTION I : A FEW GENERAL HINTS, DIRECTIONS AND IDEAS
 
 

1. The postgraduate level training is for three days, including half a day out door visit to teaching hospital or other institution for introduction to laboratory and clinical skills. The course may also be extended to four days.
2. Various topics in clinical diabetes as in section II are included. Each topic presentation is only 20 minutes and it is followed by 10 minutes of full discussion, which must be compulsory.
3. The main lectures or talks need not be exhaustive, and too many slides should be avoided. Mostly open talking (vocal) must be preferred.
4. The working of a diabetic clinic (8am to 1pm) including the diabetes laboratory is shown as an audio-visual program during tea time or lunch time. A proposal to prepare an audio-visual cassette in Indian context and not as the European clinic model is with Novo-Nordisk.
5. Full and free discussion between faculty and the participants is made possible at personal levels, and the `Meet the Experts Session' are also arranged.
6. A summary of the lectures must be distributed at each lecture with some extra hints on the topic (not included in the presentation ) and a few dictums are most helpful. 
7. Some `Dos' and `Don'ts' with regard to diabetic complications - (like foot syndrome or nephropathy) must be written and distributed to participants.
8. The various aspects of hypoglycemia - insulin and oral drugs induced hypoglycemia and its management hints etc. must be printed and distributed rather than by covering in lectures.
9. A general set of Indian diet charts - South and North Indian routine diets, and diets in different diabetic complications must be distributed as leaf lets since they can not be covered in mini lectures.
10. The faculty is chosen from really interested diabetologists with intrinsic interest, but this selection should not be as a matter of `giving a chance to one with flair or reputation' etc. as all diabetologists are not suitable for teaching. This is the most important aspect or else the concept will be a failure. Two or three diabetologists plus two or three specialist physicians must be closely involved in the organization of the program.
11. As regards to the venue of the program - the government teaching hospitals are most unsuitable owing to various reasons. As this is a `paying' and accreditation program, it may not be allowed in Governmental institutions, but faculty can be from the Governmental Institutions. [ However, many other senior teachers insist that these programs should be held at the National Institutes of repute, and not at private hospitals ] 
12. Ideal venue is a private institute, as in the case of the Steno Memorial in Copenhagen `affiliated' to Novo-Nordisk on a part-time basis for hosting Novo-Nordisk training programs. 
13. The selection of the personnel participation must also be carefully looked into. It must be made clear that `full' participation and attendance is essential and not as a mere `lunch or tea time attendance' and not a mere question of receiving `certificates'. This must be made clear with written instructions in the beginning itself and an undertaking must be taken. Or else it will be of the usual company meetings wherein the participants are more casual `appearing and disappearing' as they like, in spite of the lectures by reputed speakers and then come later for receiving the certificate. This is more common with local participants.
14. The feed back of each of the participants must be taken with recommendations for the future. 
15. In general the number of participants does not exceed 60 individual participants.
16. In the end a `fare well party' is arranged wherein all faculty and participants are present and elaborate discussions must take place and the distribution of the participation `certificates'.
17. The various topics can be changed, coupled together or they can be suitably modified, as it is not necessarily a rigid pattern.
18. Regarding the program committee, there can be - a. patrons (Institutions or senior teachers) and sponsors (RSSDI and one or more pharmaceutical companies) - b. an advisory committee consisting of senior faculty members - c. Program Coordinator or Program Directors are the most important personnel who should be enthusiastic, able and well accepted. These two mid-senior level persons organize the whole program. They can even be from outside the town or state, which only ensures their presence all the time during the course - d. the various faculty members - e. the participation of the senior active persons. A preliminary meeting of all organizing and faculty members in the previous evening in a `get together' is very important to clarify issues and to have a homogenous and fruitful program.
19. Small pamphlets must be prepared - on diet and dietary hints - exercise hints - oral drugs - and a pamphlet on insulins - and initiation of insulin therapy and on insulin in NIDDM - and a pamphlet on hypoglycemia.

In addition various dictums can also be distributed. Finally if financially possible, proceedings can be printed - but this printing is highly controversial - it comes out later and does not serve the purpose - people may imagine that it is enough - and it will reach unnecessary and unwanted people. -But the main advantage is that it may be a small reference manual.

20. The syllabus of the tentative program can be modified according to the feed back and other circumstances. 


 

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SECTION II : THE MAIN SYLLABUS

[ Mini lecture topics and discussions are as follows - each lecture is for a maximum 20 minutes followed by 10 minute discussion - two or 3 topics can also be combined ]

1. The basic and applied intermediary metabolic aspects in diabetes mellitus and its complications - with relevance to clinical diabetes
2. The epidemiology of diabetes mellitus - a brief global profile highlights - with large focus on epidemiology of diabetes in India
3. The diagnostic criteria and classification of diabetes mellitus - and varied clinical patterns
4. Basic laboratory tests in diabetes mellitus - blood glucose, urine ketones and albumin, HbA1, fructosamine, lipids, creatinine and their significance
5. `Day to day management' of diabetes mellitus - diet, exercise, drugs, non drug therapy, insulin and diabetic education - an overview
6. Practical aspects and hints on diet therapy - diabetic diet exhibits, certain selective aspects like glycemic index, fiber therapy etc.
7. Exercise and its aspects in diabetes mellitus and allied disorders - obesity, hypertension, insulin resistance etc.
8. Various aspects of oral antidiabetic drugs - including a touch on indigenous drugs
9. The current insulins, newer insulins and insulin delivery systems - the initiation of insulin therapy and insulin therapy in diabetes 
10. Monitoring of blood glucose control - criteria, control and achievements in control - practical aspects
11. An overview of complications of diabetes mellitus - and their recognition and presentation.
12. Metabolic complications in diabetes mellitus - brief outlines and management.
13. Diabetes related `hypoglycemia' in all its aspects
14. Infections and diabetes mellitus - the precautions including the foot syndrome
15. The diabetic neuropathies and management
16. Diabetes and the eye - a brief over view and aspects in management
17. Diabetes and the kidney - nephropathy and non-nephropathy aspects
18. Surgery - anesthesia and diabetes mellitus
19. Pregnancy and diabetes - problems, highlights and management
20. The organization and development of a diabetic clinic in clinical practice

`Meet the experts' and `open forum' are held daily for one hour with pre-prepared questions and answers on the spot (any question on diabetes, A to Z) in the evenings.
 

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SECTION III : PRACTICAL WORK-SHOP - PRACTICAL DIABETES
 

1. Diet exhibition and diet workshops - and well designed charts  2hours
2. Diabetes - laboratory techniques - visiting diabetes laboratories in a teaching hospital or private Hospital 
3. Instrumental diabetology - various instruments - Doppler - Neurology and Eye Institute Hospitals  2hours
4. Eye and diabetes - fundus examination and techniques (photocoagulation) demonstration  2hours
5. Visiting a standard diabetes clinic - out-patients and in-patients - keeping case records etc. and techniques  
6. Insulin, insulin syringes and Insulin pens - display and explanation - self injection demonstration  1hour
7. A visit to Intensive Coronary Care and the Intensive Medical Care 

Some of the above mentioned programs (if visits are not possible) - can be demonstrated as an audio-visual program.
 

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SECTION IV : ACCESSORIES IN WORK-SHOP
 

1. Various pamphlets and leaflets for distribution 
2. Distribution of dictums and study leaflets
3.  Diet charts - hypoglycemia charts 
4. Books and book references recommended
5. A correspondence course material with questions, and at a later date `Correspondence Library' may be made available. eg. `Novo-Nordisk Correspondence Library'
6.  Proceedings of the RSSDI course programs - this may or may not be or need not be published, as there are good reasons for not publishing also - since this is a accreditation course.


 

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6.6 RSSDI GUIDE LINES for RSSDI COURSES IN DIABETOLOGY
 

1. Only the 3-day RSSDI Courses in Diabetology conducted as per the format of Prof. Sam G.P. Moses and the suggestions of Prof. M.M.S. Ahuja are awarded 20 RSSDI Credit Hours
2. RSSDI Courses in diabetology are organized with strict discipline ensuring full attendance of all participants throughout the Course. 
3. RSSDI Credit hours obtained by a candidate attending more than one RSSDI Course in Diabetology are not considered towards Accreditation.
4. Admission to the RSSDI Courses in Diabetology may be denied to those who have already attended one RSSDI Course. Organizers of the RSSDI Course are to take this decision. This is to avoid repetition of the syllabus during the training program, and to limit the number of participants to more manageable number. 
5. Apart from 20 RSSDI Credit Hours obtained by attending one course, the prospective candidates are required to attend other accredited CME programs to gain further 80 RSSDI Credit Hours before applying for Accreditation.


 

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7.0 APPLICATION PROCEDURES for the RSSDI ACCREDITATION

Organizers intending to hold Clinical Work-Shops, CME programs, or Courses in diabetes should write to Secretary, Accreditation Committee with -
 

1. information on total duration of program
2. lecture topics included and
3.  names of the speakers
4. at least 3 months before the proposed program

The RSSDI Executive Patrons advise that the organizers of the accredited programs should be encouraged to give emphasis on a mono-theme in diabetes for the proposed one- or two-day Work-Shops, CME programs, or Courses in diabetes. The organizers are requested to consult the Secretary, Accreditation Committee while framing such one- or two-day course format. The proposed program details may be informed to the Secretary, in Hyderabad. After formally receiving a letter of approval for RSSDI accreditation from the Secretary or one of the Accreditation Committee members - the organizers are requested to include the following 3-line statement -

tentatively approved by the Accreditation Committee for * RSSDI Credit Hours towards Accreditation in Diabetology 

* (no.) as applicable 

- in the 1. ANNOUNCEMENTS
           2. BROCHURES
           3. PROGRAM LEAF-LETS 
           4. PARTICIPATION CERTIFICATES 
of the proposed - program in Diabetes, to be organized.


 

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7.1 RSSDI GUIDE LINES for ACCREDITED PROGRAMS IN DIABETES
 

1. The organizers are encouraged to conduct topic-oriented courses, work-shops and CME programs in diabetes all over the country. Such topic-oriented programs are based on the mono-theme topics as listed by Prof. M.M.S. Ahuja and Prof. Sam G.P. Moses.
2. Advanced or National Courses, Clinical Work-shops, Symposia, Conferences, Training or CME in diabetes and RSSDI Annual Scientific Meetings are not equated to the RSSDI Course in diabetology for RSSDI Credit hours. 

a. Participants of these programs are given less than 20 Credit Hours.

b. RSSDI also invites proposals for Research Symposia or Workshops on important topics in diabetes. The proposals should demonstrate participants' high standards of research and a commitment to the inclusion of an intentational and national distribution of participating scientists. Preference will be given to meetings particularly focused on a specific topic.

SYMPOSIA should be theoretical and conceptual in orientation, emphasizing verbal presentation of recent research work and perspectives. Only a small proportion of work presented should involve demonstrations of experiments or hands-on research.

WORKSHOPS should be technical and practical in orientation. A major proportion of the program would involve hands-on experiments or demonstrations. The emphasis should be on the teaching of techniques and the concepts and controls necessary for their use.

c. Each program in diabetes is assigned a maximum of 5 hours per day. Programs for half-day or less duration carry only 2 RSSDI Credit Hours. 

d. Though this is a tentative suggestion for awarding accreditation and deciding on the number of Credit Hours to be assigned to a particular program, the nature, contents and the speakers in an individual program are taken into consideration for assigning RSSDI Credit Hours.

3. Organizers are free to accept or refuse admission or registration to any participant, depending on their resources and the number of delegates as limited by them.


 

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8.0 EVALUATION

Candidates seeking evaluation for Accreditation are required to join RSSDI as life members (if not done already) and send
 

1. a copy of MB BS degree certificate, 
2. 20 diabetes case histories (including two IDDM and two diabetic pregnancy) investigated and managed by them, on A4 size sheets in spiral binding.
3. evidence (copies of the participation certificates) for having completed 100 RSSDI credit hours of approved continuing medical education (one course + 80 hours of CME programs), and 
4. evaluation fee of Rs. 1000 by draft favoring RSSDI 

- to reach RSSDI secretariat before November 30

The relevant information on their eligibility for self- evaluation and acceptance of the clinical record (case histories) with the date of self evaluation will be informed to individuals seeking Accreditation in December.

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8.1  SELF-EVALUATION

Self evaluation of the candidates is conducted at one of the Postgraduate Medical Institutes once a year - if there are a minimum of 20 candidates seeking self-evaluation. Self- evaluation may also be conducted more than once a year, if there are 20 more candidates seeking self-evaluation. The venue and date of the self-evaluation is at the discretion of the Secretary, Accreditation Committee depending on the region to which the majority of the candidates belong to, convenience of transport and administrative formalities. 

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8.2 QUESTION BANK

About 1000 objective type questions (one right choice among four options) are prepared by the RSSDI Executive and senior teachers on invitation. Analysis of case-studies, Data or Research papers and not MCQs alone in the format of the American Board Examinations, are followed for preparing the question bank.

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8.3 QUESTION PAPER

The self-evaluation paper is set by a senior teacher with a maximum of 60 objective questions, analysis of case-studies, data and research papers, are selected from the question bank. The candidates are required to identify correct answers in 2-hour period. Evaluation is done based on the answer-key as provided by the experts contributing to the question bank.

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8.4 ELIGIBILITY for ACCREDITATION

Candidates with - 60 % correct score are eligible for Accreditation

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8.5 RE-EVALUATION

Candidates failing to qualify for Accreditation by getting -

- less than 60 % correct score are required to obtain 25 RSSDI Credit Hours before re-evaluation - less than 30 % correct score are required to obtain 50 RSSDI Credit Hours before re-evaluation   and application for re-evaluation.

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8.6 FEES

Self-evaluation fee is Rs. 1000, to be paid along with application for evaluation with proof of completion of 100 RSSDI Credit Hours of training.

Re-evaluation fee is Rs. 1000, to be paid along with application for evaluation with proof of completion of 25 or 50 RSSDI Credit Hours of training, as applicable.

Accreditation is given to the successful candidates after payment of the prescribed Accreditation Fee. 

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