INQUIRY-DRIVEN STRATEGIES FOR INNOVATION IN MEDICAL EDUCATION IN INDIA CURRICULAR REFORMS
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INQUIRY-DRIVEN STRATEGIES
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INNOVATION IN MEDICAL EDUCATION
IN INDIA
CURRICULAR REFORMS - extracted text
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INQUIRY-DRIVEN STRATEGIES
FOR
INNOVATION IN MEDICAL EDUCATION
IN INDIA
CURRICULAR REFORMS
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I he CONSORTIUM of Medical Institutions
for reform of Medical Education in India
WHO-SEARO Project 1ND-HMD 017/G
SE/1NDHRH 001/RB92
EorroRiAi C ommittep
Prof. S. K. Kacker, Director
All India Institute of Medical Sciences
Ansari Nagar
New Delhi - 110 029
Prof. Booshanam V. Moses
Christian Medical College
Vellore - 632 002
Tamilnadu
Dr. Anand Kumar
Institute of Medical Sciences
BHU, Varanasi - 221 005
Prof. D. K. Srinivasa
JIPMER
Pondicherry - 605 006
Dr. R. K. Taluja
G. R. Medical College
Gwalior, M.P.
Dr. G. Venkata Ratnam
Siddhartha Medical College
Vijayawada - 520 008, A. P.
Dr. Surekha Devi
SCB Medical College
Cuttack - 753 007, Orissa
Dr. Prem Pais
St. John's Medical College
Bangalore - 560 034
Editors
Prof. Kusum Verma
Prof. Usha Nayar
Mr. B. V. Adkoli
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Resourcs F acuity
Special Invitees:
Dr. Ashok Rattan
Assoc. Prof. Microbiology
Dr. V. M. Gupta
Prof, of P & SM
Dr. Mohan Garg
DME - UIC
Chicago, US
Prof. Meharban Singh
Prof, of Pediatrics
Dr. S. C. Mohapatra
Reader in P & SM
Dr. Ramesh Kumar
Prof. Microbiology
C. M. C., Vellore
Dr. A. N. Malaviya
Prof, of Medicine
Dr. Booshanam V. Moses
Principal & Prof, of Surg.
Dr. L. K. Sharma
Prof of Surgery
Dr. Abraham Joseph
Prof, of Comm. Med.-
Dr. Aung Than Batu
Director (HRH)
WHO-SEARO
New Delhi
Dr. S. N. Mehta
Prof, of Surgery
Dr. Molly Thomas
Vice Principal
Prof, of Pharmacology
Dr. D. B. Bisht
WHO-SEARO
New Delhi
Dr. P. K. Dave
Prof, of Orthopedics
Dr. S. D. Sharma (ADG)
DGHS, Nirman Bhavan
New Delhi
Dr. Palitha Abeykoon
Medical Officer, (Med. Edu.)
WHO-SEARO
New Delhi
Dr. S. Bal
Asst. Prof. Surgery
Dr. Ashok Chacko
Addl. Vice Principal
Prof, of Gastro.
Dr. Vinod Paul
Assoc. Prof. Paediatrics
Dr. Mary V. Jesudason
Addl. Vice Principal
Prof, of Microbiology
Dr. Rita Sood
Assoc. Prof. Medicine
Dr. Alka Ganesh
Prof, of Medicine
Dr. K. Buckshee
Prof, of Obst. & Gynae
Dr. Sulochana Abraham
Prof, of Comm. Medicine
Dr. D. Takkar
Prof, of Obst. & Gynae
Dr. Chellam Kirubakaram
Prof, of Paediatrics
Dr. K. P. Puthuraya
Prof, of Physiology
Bangalore Medical College
Bangalore
Dr. Arvind Jayaswal
Assoc. Prof. Orthopedics
Dr. M. K. Lalitha
Prof, of Microbiology
Dr. Chandrama Anand
Principal
L. H. M. C.
New Delhi
B. V. Adkoli
Educationist, CMET
Dr. Grace Chandi
Prof, of Anatomy
Institute of Medical Sciences
B. H. U., Varanasi
J. I. P. M. E. R., Pondicherry
A. I. I. M. S., New Delhi
Dr. N. N. Khanna
Director, IMS-BHU
Dr. D. S. Dubey
Director
Dr. S. K. Kacker
Director
Dr. V. P. Singh
Prof, of Medicine
Dr. D. K. Srinivasa
Prof, of P & SM.
Dr. L. M. Nath
Prof. Comm. Med.
Dr. S. S. Gambhir
Prof, of Pharmacology
Dr. A. J. Veliath
Medical Superintendent
Dr. Usha Nayar
Prof, of Physiology
Dr. P. K. Dey
Dept, of Physiology
Dr. Asha Oumachigui
Prof, of Obst. & Gynae.
Dr. Kusum Verma
Prof, of Pathology
Dr. Y. N. Gupta
Prof, of Pathology
Dr. N. Ananthakrishnan
Prof, of Surgery
Dr. Veena Bijlani
Prof, of Anatomy
Dr. A. M. Tripathi
Prof, of Paediatrics
Dr. K. R. Sethuraman
Prof, of Medicine
Dr. G. Gopinath
Prof, of Anatomy
Dr. K. K. Tripathi
Reader in Medicine
Dr. K. M. Rajendran
Prof, of Anaesthesia
Dr. Bir Singh
Assoc. Prof. Comm. Med.
Dr. Anand Kumar
Reader in Surgery
Dr. D. K. Patro
Assoc. Prof, of Ortho.
Dr. Swarana Bhardwaj
Executive Director
National Board of Examinations
New Delhi
Dr. A. Krishna Rao
Prof, of Medical Edu.
The Kasturba Medical College
Manipal
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Dr. D. P. Thombre
Prof, of Physiology
Dr. Mrs. S. Sapre
Prof, of Obst. & Gynae.
Dr. (Mrs.) G. Venkata Ratnam
Prof, of Pathology
Dr. PH Ananthanarayanan
Prof, of Biochemistry
Dr. (Mrs.) R. K Taluja
Prof, of Paediatrics
Dr. C. H. Shashindran
Prof, of Pharmacology
Dr. S. R. Agarwal
Deptt. of ENT
Vice Principal
Dr. N. S. Das
Prof, of Biochemistry
Dr. S. Robinson Smile
Assoc. Prof, of Surgery
Dr. K. L. Saraf
Prof, of Surgery
Dr. S. Laksmanan
Prof, of Anatomy
Dr. S. Kapoor
Deptt. of Medicine
Dr. Sudha Rao
Prof, of Anatomy
Dr. P. S. Tonpay
Deptt. of Physiology
Dr. B. D. Bhatia
Prof, of Pediatrics
S. C. B. Medical College, Cuttack
Dr. Vasudev Ananad Rao
Prof, of Ophthalmology
Dr. S. C. Patnaik
Prof, of Cardiothoracic Surgery
Principal, SCBMC
Dr. M. G. Sridhar
Asstt. Prof., Biochemistry
Dr. P. T. Rao
Prof, of Orthopedics
Dr. R. Narasimhan
Prof. Pathology
Dr. K. K. Mishra
Prof, of Medicine
Dr. Jayanthi
Assoc. Prof, of Pathology
Dr. S. N. Tripathi
Deptt. of Obst. Gynae.
Dr. S. M. Sharif
Prof, of Forensic Medicine
Dr. H. B. Mohapatra
Prof, of Social & Prev. Med.
Dr. K. D. Tripathi
Prof, of Pharmacology
Dr. K. C. Biswal
Prof, of Physiology
G. R. Medical College, Gwalior
Dr. B. Sarangi
Prof, of Medicine
Dr. A. K. Govila
Dean, GRMC
Dr. (Mrs.) H. L. Swain
Prof, of Obst. & Gynae.
Dr. M. K. Gupta
Ag. Dean
Dr. Bhagyadhar Swain
Prof, of E.N.T.
Dr. K. C. Sharma
Dean and Prof, of Surgery
Dr. Surekha Devi
Asstt. Prof. Physiology
Dr. Ravi Raman
Prof, of Medicine
Dr. R. N. Mallick
Prof, of Pathology
Dr. J. S. Chabra
Professor
Dr. N. C. Padhi
Deptt. of Surgery
Dr. N. N. Laha
Professor
Dr. R. Panigrahi
Deptt. of Obst. Gyane
Dr. P. C. Mahajan
Prof, of Prev. & Social Med.
Dr. K. C. Behera
Deptt. of Pathology
S. P. Saxena
Deptt.. of Physiology
Siddhartha Medical College
Vijayawada, A. P.
Dr. N. Trikha
Deptt. of Pathology
Dr. TMV Prasada Rao
Principal, SMC
Dr. Sree Rama Rao
Prof, of Microbiology
Dr. TSS Manidhar
Asstt. Prof, of P & SM
Dr. Anjaneyalu
Prof, of Medicine
Dr. A. Aswini Kumar
Prof, of Medicine
Dr. S. Narasimha Reddy
Prof, of Comm. Medicine
Dr. C. Shobha Rani
Asst. Prof, of Physiology
Dr. K. Jayalakshmi
Prof, of Obst. & Gynae.
St. John’s Medical College
Bangalore
Dr. A. F. A. Mascarenhas
Principal
Dr. Mary Ollapalloy
Vice Principal
Dr. Chitra Stephen
Coordinator, MFC
Dr. Prem Pais
Prof, of Medicine
Dr. Nandakumar Jairam
Prof, of Surgery
Dr. R. Narayanan
Prof, of Obst. Gynae.
Dr. Sayee Rajangam
Prof, of Anatomy
Dr. Ragini Macaden
Prof, of Microbiology
Dr. Dara S. Amar
Prof, of Community Health
Students’ Representatives
(From CMC, Vellore)
Ms. Priya Abraham
Ms. Indu Koshy
Sowmya Satyendra
Mr. Sanjay Murala
Mr Sanjeev Maskara
ACKN OWLEDGMENTS
The editors wish to acknowledge the support received from, the
Government of India, Ministry of Health & Family Welfare in
recommending this project for WHO support. But for the financial
support received from WHO-SEARO, this publication would, not
have seen the light of the day. Though many officials in the W’HOSEARO have been supportive in our ventures, Dr. Palitha Abeylkoon
deserves special mention for his guidance and keen interest
throughout this project. Dr. Mohan Garg from DME-UIC, USA has
been instrumental in germinating the idea and guiding the
deliberations of the consortium right from its inception. We owe
him a tremendous debt of gratitude.
It is not possible to mention the individual contributions made by
a large number of faculty members belonging to eight consortium
institutions and their Deans/Principals. We thank them profusely
for their contribution.
- - thanks
’ ; are due to Mrs. Chander Kanta for the
Our special
secretarial assistance and Print Tech., New Delhi for designing and
printing in a short time.
Editors
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Foreword
The need for reorienting medical education in line with the health needs of the society
is a matter of global concern, though the nature of changes envisaged by different
countries, and the strategies contemplated for bringing about those changes, might vary
considerably. Towards this end, restructuring undergraduate curriculum is an intervention
which is invaluable and inevitable. The deliberations of a consortium of eight medical
schools in India, who addressed the question of curricular reforms, by adopting an inquirydriven strategy, is a testimony to the growing belief that a change ‘is’ possible, and there
are several ways to bring about this change.
The concern for introducing changes in medical education has emerged from extramural
factors as well as pressures from within the profession itself. The change in the
demographic profile of countries, especially the increase in the aging population, degrading
environment, population explosion resulting in diseases of poverty, emergence of new
diseases including AIDS, resurgence of old diseases, childhood afflictions, growing immigra
tion from developing to developed countries owing to globalization and free market
economies, technological revolution resulting in urbanization and the resultant stress and
diseases of affluence have all contributed to a new health situation to which medical
education must respond urgently.
Within the medical profession the continuing explosion of scientific knowledge is the
greatest challenge to the already over crowded curriculum with multiplicity of subjects and
narrow specialities competing for curricular time. In some cases bureaucratic controls have
restricted the autonomy of medical schools to innovate and change. The continuing growth
in high technology has tended to erode the human touch resulting in a new ethical dilemma
which should be addressed in the educational system.
Nevertheless, the medical education system all over the world has responded to some
of these challenges. As early as in 1910, Abraham Flexner’s report resulted in the
separation of basic sciences from clinical teaching, and laid the foundation for the
emergence of new departments. The next wave of changes began after the Second World
War which prompted some medical schools to search for alternate tracks and educational
strategies marked by student- centered learning and problem-based learning approaches.
WHO has always been in the forefront while taking initiatives to support health
manpower development across the globe. Through its pioneering work of establishing a
network of Regional and National Teacher Training Centres (RTTCs and NTTCs), and
promoting fellowship and exchange programmes, WHO has facilitated the application of
educational science and has focused on the need to view medical education in the broader
perspective of health care delivery.
The 1978 Alma Ata declaration of HFA/2000 through PHC is a major initiative to place
medical education in the broader context of health delivery system. It became apparent
that educational reforms must take into account the structure and requirements of the
national health care delivery system, health problems prevalent in the region as well as
the constraints of the medical profession besides student characteristics.
The Agenda for Action, launched by WHO in 1991, underlines three components, viz.
setting standards, developing tools for assessment, and identifying appropriate strategies
for change and follow-up through worldwide monitoring. The South East Asia Regional
Office of WHO has, to its credit, the distinction of having arranged regional consultations
on reorientation of Medical Education and bringing out a series of related publications.
There are other major players in medical education, viz. the World Federation of
Medical Education (WFME) which proclaimed the Edinburgh Declaration in 1988 and
organized the World Summit on Medical Education in 1993, and the Network of Communityoriented Health Institutions, besides leading centres in medical education in the USA, UK
and Australia.
India, having one of the largest network of health care infrastructure and a pool of
health personnel in the world, has been debating the issue of relevance and quality of
medical education from time to time since the constitution of the Bhore Committee in 1946.
Several organizations such as the Indian Association for the Advancement of Medical
Education and the Medical Council of India, besides the Ministry of Health and Family
Welfare, have grappled with the issue of making medical education more need, based and
task-oriented.
However, the work of the consortium of medical institutions to reform medical education
can be singled out as a significant landmark, as it is based on a systematic inquiry-driven
approach. It is pertinent to note how the strategies proposed by WHO for global action are
being implemented by the institutes forming part of the consortium. The principle of
attaining a common goal by collective effort utilizing a common protocol is a fascinating
example of how to achieve optimum utilization of resources. Deliberations based on
inter-institutional dialogue and liaison with other bodies such as the Medical Council of
India would enable the building of a national consensus. The inquiry-driven strategy
implies collection of a comprehensive database on the health situation and health needs,
which will provide a population perspective to the curriculum planning exercise. The
integrated teaching modules suggested in this work are based on important public
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health problems of India or common conditions such as tuberculosis, AIDS, mother and
child health care, cardio-pulmonary resuscitation, first aid, etc.
The modular approach is also found to be a very effective educational intervention for
reducing the curriculum burden and promoting self-paced learning. The courses proposed
in the curriculum, viz. behavioural science and medical ethics, are an attempt to fill the
gap of psychosocial and humanistic aspects of care which are found lacking in the present
curriculum. The concept of essential skills and core curriculum lays a solid foundation for
a competency-based model which could be extended as an experimental track.
The consortium has plans to delineate an assessment strategy that will encourage
problem-solving orientation, which is another strategy which has high feasibility as
against grafting PEL approach in a traditional medical school.
The consortium has already constituted several task forces to work out a detailed
;eaching/learning methodology, produce of learning materials on thrust areas, develop
assessment strategies, promote on-going health system research (HSR) and disseminate
information to all medical schools in the country.
Thus, with a strong base of R&D activities built into the system, and with concerted
nter-institutional efforts, the deliberations of the consortium of medical schools will be
ceenly watched, not only in the Indian sub-continent but also in other countries of the
South East Asia Region and elsewhere.
January, 1995
i4ew Delhi
Dr. Uton Muchtar Rafei
Regional Director
World Health Organization
South East Asia Region
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Consortium of Institutions
Phase-II
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2. IMS-BHU, Varanasi
3. CMC, Vellore
4. JIPMER, Pondicherry
Phaae II:
6. GR Medical ColleQe. Gwalior
6. SCB Medical College. Cultack
7. Siddhartha Medical College, Vijayawada
8. St.John'a Medical College, Bangalore
Phase III:
9. Goa Medical College
10. Assam Medical College. Dlbrugarr.
11. Lady Hardinge Medical College. New Delhi
12. Seth QS Medical College, Bombay
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1. AllMS, New Delhi
13. Andhra Medical College. Viaak
14. Aligarh Medical College. U.P.
15. Medical College. Trlchur
16. MX C G.Medical College. Ganjam, Orlaaa
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across the consortium institutions. As such, it is extremely difficult to capture
the authenticity and accuracy of the information and views often divergent
emanating from diverse groups. Nevertheless, what is presented in this
monograph is a consensus and collective view of selected brains. We fully
believe that any exercise in delineating the curriculum is an evolving process
which needs scrutiny, review and update from time to time.
A point of clarification on the sanctity of this work may be necessary The onus
of laying down the undergraduate curriculum rests on the Medical Council of
India, which has initiated several activities in the recent past including a
curriculum document. MCI has officially recognised “the consortium” for
collaboration in curricular development and Teachers Training. What consortium
has attempted is to delineate the undergraduate curriculum into two tiers viz,
what an undergraduate ‘must know’ and what is ‘desirable to know’. This we
hope, is a useful strategy to cope with the every increasing curriculum load.
The list of ‘essential skills’ provide a basis for organizing teaching learning
activities which are task oriented and competence based. The thirteen integrated
teaching modules provide a basic framework for promoting both horizontal and
vertical integration, a recommendation which is strongly voiced by the MCI
and others. Besides a national health perspective has been added to it by
choosing needbased topics.
We are aware of our limitations. We cannot call a curriculum document as
‘complete’ unless we have a teaching learning methodology and an assessment
strategy built into it. The consortium has already constituted several taskforces
to look into some of these issues. However, with a sense of humility, we would
like to set the ball in motion, so that we have some thing to discuss and debate.
The following quote should sum up what we wish to express.
“Look, this is what some of us have collectively arrived at. You may not totally
agree with us. But we would like to work together for, we have a common
concern.”
S.K. Kacker
Director
AIIMS
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Introduction
Eight years ago, to be more precise in November, 1986, a group of motivated
medical educationists representing four medical colleges in India in collaboration
with the Department of Medical Education, University of Illinois, Chicago
(DME-UIC) met at New Delhi. All of them had a dommon concern of
restructuring the medical education in tune with the health care needs of the
country. Learning from the lessons learnt in the past, they resolved to address
the issue by adopting an Inquiry-Driven Strategy - a strategy based on actual
database resulting from an extensive inquiry. It was also decided to adopt a
common protocol for initiating a co-ordinated and collective action. This
marked the beginning of a consortium of medical institutions for reform of
medical education. During the first phase (1989-90) the four institutions
generated extensive data base, identified curricular deficiencies and proposed
certain innovations. The findings of these deliberations were presented at a
National Conference held at AIIMS in April, 1990 to a wider audience
consisting of consortium institutions,. Deans of selected medical colleges,
besides representatives from Ministry of Health, Medical Council of India,
and WHO-SEARO. The proceedings resulted in a monograph entitled
“Inquiry-Driven Strategies for Innovation in Medical Education in India”,
popularly called ‘green book’.
The April, 1990 conference unanimously recommended the adoption of Inquiry
Driven Strategy and enlargement of the consortium to spread the message to
a larger number of medical colleges on a regional basis. Thanks to the approval
given by the Government of India and financial assistance from the
WHO-SEARO, the consortium could embark upon a second phase with more
intensified activities.
During the second phase the consortium institutions deliberated on five main
issues, viz, developing a list of essential skills to be performed by an
MBBS doctor; a'core curriculum which identified what a student ‘must know’
and what is ‘desirable to know’; a set of integrated teaching modules on need
based topics; a course on behavioural sciences; and medical ethics. What is
presented in this monograph is essentially an extract from the deliberations
made by eight consortium institutes on these issues, over a period of three
years.
It is important to realize that the deliberations were made at different point
in time, by several groups both disciplinary and inter-disciplinary, spread
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Undergraduate Medical
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INSTITUTIONAL GOALS AND OBJECTIVES
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INSTITUTIONAL GOALS :
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The teaching and training during MBBS course will
equip the undergraduate to provide health care
appropriate to his/her position in the health team to
an individual and community in health and sickness.
Objectives :
At the end of the teaching/training the undergraduate
will be able to :
Diagnose and manage common health problems of
the individual and the community appropriate to his/
her position as a member of the health team at
primary, secondary and tertiary levels.
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Be competent to practise curative, preventive,
promotive and rehabilitative medicine and
understand the concepts of primary health care.
Understand the importance and implementation of
the National Health Programmes in the context of
the national priorities.
Understand the socio-psychological, cultural,
economic and environmental factors affecting health
and develop humane attitude required for
professional responsibilities.
Develop the ability for continued self learning with
a scientific attitude of mind and acquire further
expertise in any chosen area of medicine.
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List of S kills for MB3S
Graduate
At the end of an undergraduate training programme
in a medical college, it is expected that the doctor
will be able to:
I. CLINICAL
*1. Obtain a proper relevant history, perform a humane
and thorough clinical examination including internal
examinations (per-rectal, per-vaginal) and examinations of
all organs/systems in adults and children including neonates.
'2. Do psychiatric evaluation and recognise common
psychiatric illnesses.
3. Use the Stethoscope, B.P.Apparatus, Auroscope,
Thermometer, Nasal Speculum, Tongue depressor, Weighing
scales, vaginal Speculum. Percussion hammer, measuring
tape, proctoscope, tuning fork and head mirror.
*4. Arrive at a logical working diagnosis after clinical
examination.
:1:5. Order appropriate investigations keeping in mind their
relevance (need based) and cost effectiveness.
6. Plan and institute a line of treatment which is need
based, cost effective and appropriate for common ailments
taking into consideration:
a. Patient,
b. Disease,
c. Socio-economic status,
d. Institutional/governmental guidelines.
7. Recognise situations which call for urgent or early
treatment at secondary and tertiary centres and make a
prompt referral of such patients after giving first aid or
emergency treatment.
8. Monitor growth and development of children and
differentiate normal from abnormal.
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t9. Assess severity of dehydration.
10. Assess and manage fluid/electrolyte and acid-base
imbalance.
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11. Detect and institute corrective measures for nutritional
deficiencies.
*12. Determine gestational age.
*13. Demonstrate surface marking of common superficial
arteries, veins, nerves and viscera.
*1
II. INTERPRETIVE
*1. Interpret abnormal biochemical laboratory values of
common diseases.
*2. Interpret skiagrams of common diseases.
3. Identify irrational prescriptions and explain their
irrationality.
:|:4. Interpret serological tests such as VDRL, ASLO, Widal,
HIV, Rheumatoid factor, Hepatitis and TORCH infections.
5.
Interpret antimicrobial sensitivity reports.
6.
Interpret peripheral smear of common diseases.
III. ETHICAL AND AFFECTIVE
1. Demonstrate empathy and humane approach towards
patients, relatives and attendants.
2. Demonstrate interpersonal and communication skills
befitting a physician in order to discuss the illness and its
outcome with patient and family.
3. Develop a proper attitude towards patients, colleagues
and other staff.
4. Maintain an ethical behaviour in all aspects of medical
practice.
5. Develop a holistic attitude towards medicine taking in
social and cultural factors in each case.
6. Keep patients' welfare foremost to provide quality care
as well as avoid consumer initiated legal problems.
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7. Obtain informed consent for any examination/procedure.
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8. Appreciate patients’ right to privacy.
9. Motivate colleagues, community and patients to
participate actively in national health programmes.
10. Motivate people regarding desirability of blood and organ
donation and autopsies.
11. Develop a positive attitude to pursue self directed learning
to continuously keep abreast of advances and also motivate
colleagues to do the same.
IV. COMMUNICATION
*1. Write a complete case record with all necessary details.
2. Write a proper discharge summary with all relevant
information.
3. Write a proper referral note to secondary or tertiary
centres or to other physicians with all necessary details.
4. Assess the need for and issue proper medical certificates
to patients for various purposes.
5. Establish rapport and talk to patients, relatives and
community regarding all aspects of medical care and disease.
V. MANAGERIAL
1. Provide leadership to a medical team and promote team
spirit in time of :
a. Disasters
b. Mass casualties
c.
Organizing health programmes.
2. Organise antenatal, postnatal, well-baby and other clinics.
3. Organise and give training in first aid.
4. Plan and manage health camps such as family welfare
camp.
*5. Adopt universal precautions for self protection against
HIV and hepatitis and counsel pateints.
6. Organise and carry out investigation of an epidemic and
institute corrective/preventive measures.
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7. Manage stores, indenting and stock keeping relevant
to managing a primary health centre or a general practice
set up.
8. Maintain cold chain for vaccines.
9. Collect, present and report vital health statistics with
special reference to national health programmes.
VI. MEDICO-LEGAL
1. Examine and prepare proper certificates in the following
medico-legal situations:
a. Injured patient.
b. Sexual offences.
c. Determination of age.
d. Intoxicated patient.
2. Prepare proper certificates of birth and death.
3. Record dying declaration.
4. .Give evidence in a court of law as an expert witness.
5. Collect and do proper labelling, preservation and despatch
of medico-legal specimens.
6. Perform, record findings and issue a report for a medico
legal autopsy.
VII. LABORATORY
1. Be able to collect and transport materials for various
pathological tests including histopathology, cytopathology,
microbiology and biochemistry.
’2. Do complete urine examination including microscopy.
*3. Do and interpret HB, TLC, DLC, ESR, PCV, BT, CT and
blood smear for parasites and red cell morphology.
4. Do blood grouping and cross matching.
*5. Do stool exam for ova, cysts, and occult blood; and
hanging drop for vibrio cholerae.
6. Perform skin scrapings and do a KOH preparation for
fungus infections.
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7. Do and examine a wet film of vaginal smear for
Trichomonas and fungus.
*8. Perform and interpret Gram's stain, Albert's stain, ZiehlNielsen or modified Ziehl Nielsen's stain.
9. Do cell counts and gram stain of CSF and other body
fluids.
10. Perform skin sensitivity tests for drugs and serum.
11. Perform and read Mantoux test.
12. Prepare slit skin and nasal smear for lepra bacilli.
13. Record and interpret an ECG and be able to identify
common abnormalities like myocardial infarction and
arrhythmias.
VIII. MANIPULATIVE
1. Start i.v. line and infusion in adults, children and
neonates.
2. Do venous cutdown.
*3. Give intradermal / SC/ IM/IV injection.
4. Insert and manage a C.V.P. line.
5. Conduct CPR (Cardiopulmonary resuscitation) and first
aid in newborns, children and adults including endotracheal
intubation.
6. Pass a nasogastric tube.
7. Pass a stomach tube and do stomach wash.
:|:8. Administer enemas.
9. Perform vasectomy.
10. Perform circumcision.
11. Perform reduction of paraphimosis.
12. Do Proctoscopy.
.13. Do injection and banding of piles.
14. Incise and drain superficial abscesses.
15. Manage superficial wounds and do suturing of superficial
wounds and wound toilet.
19
16. Remove small cutaneous/subcutaneous swellings.
17. Maintain airway (tracheostomy / endotracheal intubation/
cricothyroidostomy).
18. Control external haemorrhage.
19. Apply skin traction.
*20. Apply figure of 8 bandage for fracture clavicle.
*21. Apply POP slabs/casts and splints.
22. Transport safely victims of accidents including those with
spinal injury.
23. Reduce colle's fracture.
24. Reduce shoulder dislocation.
25. Reduce tempro-mandibular joint dislocation.
26. Record visual acuity.
27. Examine anterior segment of eye.
28. Remove extraocular foreign body.
29. Incise and drain lid abscess.
30. Perform epilation of cilia.
31. Do lumbar puncture.
32. Do Pleural/peritoneal tap.
33. Aspirate liver abscess.
34. Take a pap smear.
35. Take punch biopsy of cervix.
*36. Conduct normal vaginal delivery.
37. Do artificial rupture of membranes.
38. Perform and suture episiotomies.
39. Apply outlet forceps.
40. Do post partum tubectomy.
41. Perform MTP in the first trimester and be able to do
evacuation in incomplete abortion.
42. Insert and remove IUCD.
20
■
I
I
43. Catheterise bladder in both males and females.
44. Perform syringing of ear.
45. Do nasal packing for epistaxis.
46. Perform nerve blocks like infiltration, digital, pudiendal,
paracervical, and field block.
47. Prepare ORS.
48. Estimate residual chlorine and chlorine demand for
producing safe drinking water.
49. Relieve tension pneumothorax by inserting a needle.
50. Administer O2 by mask, catheter, O2 tent and be able to
handle O2 cylinder.
51. Advise dietetic management in different diseases and
teach mothers feeding of new borns, infants and children.
52. Implement sterilization and antiseptic measures.
53. Perform extraction of loose teeth.
*54. Insert flatus tube.
IX. EMERGENCY MANAGEMENTS
1. Be able to diagnose and provide emergency management
of antepartum and postpartum haemorrhage.
2. Provide first aid to patients with peripheral vascular
failure and shock.
3. Manage acute anaphylactic shock.
4. Manage diarrhoeas/dysenteries; Assess dehydration;
Prepare and administer oral rehydration therapy (ORT).
5. Manage emergencies of drowning.
6. Manage
common poisonings.
7. Manage acute pulmonary oedema and left ventricular
failure.
8. Manage acute severe bronchial asthma.
9. Do emergency management of epilepsy and status
epilepticus.
21
10. Do emergency management of comatose patients
regarding airway, positioning, prevention of aspiration and
injuries.
11. Assess degree of burns and administer emergency
management.
12. Manage hyperpyrexia.
NOTE:
Skills marked * to be learned during undergraduate
course; Rest to be learnt during internship.
22
_.
-;-»a jili-4-i. «siawiiMi MwWUnXr s«u—'••w»w* -..•
■'^O-
Behavioural Sciences Course
Departmental Objectives :
At the end of the course, the student should be able
to:
Understand nature and development of different
aspects of normal human behaviour like learning,
memory, motivation, personality, and intelligence.
Recognize differences between normal and abnormal
behaviour.
Understand how psychological and social factors
influence man's behaviour throughout his life cycle
and how they affect his health and response to
illness.
Conduct the clinico-social evaluation of the patient
in respect to attributes like socio-economic status;
attitude to health and disease and health services.
Establish harmonious doctor-patient relationship.
Communicate effectively with the individual, family
and the community.
Possess and utilise the knowledge and skills of
behavioural science/techniques for adoption of
health practices.
23
Course Contents
I. INTRODUCTION TO TYPES OF BEHAVIOURAL
SCIENCES
1. Sociology, psychology, and anthropology relevant to health
and disease.
2. Aspects of health economics and management sciences.
II. FAMILY STUDIES
1. Family support system : Role of family in health and
disease.
2. Types of families : Structure and functioning; Social problems.
III. ILLNESS AND HEALTH
1. Mores about illness and health.
2. Beliefs, custom, norm.
IV. SOCIO-ECONOMIC STATUS
1. Relationship of socio economic status with health and
disease.
2. Measurement of socio economic status.
V. COMMUNICATION SKILLS
1. Interview techniques; Methods of communication with
patients and their relatives; Role of communication in
interpersonal relationship.
2.
Communication
medias.
VI. METHODS OF SOCIAL WORK
1. Social case work.
2. Social group work; and Community organisation.
VII. SOCIAL SECURITY
1.
Social assistance and social insurance, social security schemes.
VIII. INTRODUCTION TO PSYCHOLOGY
1. Basis of human behaviour.
2. Application of psychology to medicine.
24
-
3. Role of nature vs. nurture in shaping human behaviour.
IX. HUMAN DEVELOPMENT : INFANCY TO
ADOLESCENCE
1. Stages of development; and Individual differences.
2. Behavioural expectancies and problems.
X. HUMAN DEVELOPMENT : ADULTHOOD TO
OLD AGE
1. Development tasks of adulthood and old age; Adjustment
problems in old age.
XI. PERSONALITY DEVELOPMENT
1. Types of personality.
2. Premorbid personality and relationship with illness
behaviour.
XII. DEATH AND DYING
1. Reactions of terminally ill patient and family.
2. Breaking news of fatal illness/death to the family.
XIII. LEARNING AND CONDITIONING
1. Nature of learning.
2. Performance, role of motivation in learning and
methods to make learning effective.
3. Learning of adaptive and maladaptive behaviours.
4. Various learning methods like association, cognitive, verbal, motor
and social.
XIV. COGNITIVE PROCESSES
1. Sensory processes: attention, sensation, perception and
thinking.
2. Sensory processes and psychopathology.
3. Problem solving, decision making, and communication in
thinking process.
4. Salient features of abnormal thinking.
5.
Methods of improving memory.
25
6.
Forgetting and its determinants.
7.
Thinking
process like concept
formation and role of language.
XV. EMOTION
1. Relationship of emotions to illness.
2.
Development of emotive behaviour
and its physiological basis.
XVI. INTELLIGENCE
1. Nature of intelligence.
2. Role of genetic and environmental influences in
intelligence.
3.
Assessment of intelligence in clinical setting.
4. Growth of intelligence from birth to old age.
XVII. BEHAVIOURAL MEDICINE
1. Behavioural aspects applied to illness.
9
Methods of behavioural treatment for psychosomatic diseases.
XVIII. COPING AND STRESS
1.
Different stressors and their effects.
2. Methods of adaptive and maladaptive coping and stress
management.
XIX. DOCTOR-PATIENT RELATIONSHIP
1. The doctor-patient relationship.
XX. ILLNESS BEHAVIOUR
1. Tolerance, threshold of pain and sensitivity.
2. Sick role.
3. Role of socio-cultural background in illness behaviour.
XXI. PAIN
1. Psychology and perception of pain.
2.
Management of pain by psychological methods.
XXII. PSYCHOLOGICAL METHODS OF
TREATMENT
1.
Counselling.
26
XXIII. ATTITUDES
1. Nature and development of attitudes.
2. Theories and methods to change attitudes.
3. Measurement of attitudes.
Methods of Teaching
Lecture, practical work and small group discussions.
Assessment
To be included in psychiatry and community medicine with
appropriate weightage.
27
.-4.
.............. .
Medical E rnies
Course Contents
I. INTRODUCTION TO MEDICAL ETHICS
1. What is ethics?
2. What are values and norms?
3. Relationship between being ethical and human fulfilment.
4. How to form a value system in one's personal and
professional life?
5. Heternomous ethics and autonomous ethics.
6. Freedom and Personal responsibility.
II. DEFINITION OF MEDICAL ETHICS
1. Difference between medical ethics and bioethics.
2. Major Principles of Medical EthicsBeneficence
’
fraternity,
equality;
Justice
Self determinationfautonomy) - liberty.
HI. APPROACHES TO MEDICAL ETHICS
a)
Utilitarian
Fletcher-
b)
Deontological
Kant
- duty;
c)
National Law
-
Aquinas
- . reason;
d)
Justice
-
Rawls
-
equality;
e)
Modified Deonotology
-
Ross
-
intuition.
consequences;
IV. PERSPECTIVES OF MEDICAL ETHICS
1. The Hippocrates oath.
2. Medical Council of India Code of ethics.
3.
The Declaration of Helsinki.
4.
Nazi doctors and human experimentation.
5.
The WHO declaration of Geneva.
6.
The Religious Perspective of Ethics.
28
fur-*''
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V. ETHICS OF THE INDIVIDUAL
1. The patient as a person; The right to be respected; Truth
and Confidentiality; and The autonomy of decision.
2. The concept of disease, health and healing.
3. The right to health.
4. Ethics of behaviour modification.
5. The physician - patient relationship; Teacher - student
relationship; and Peer relationship.
6. Organ donation.
VI. ETHICS OF HUMAN LIFE
1. What is human life:Criteria for distinguishing the human
and the non human.
2. Reasons for respecting human life.
3. The beginning of human life. Conception, contraception
and Abortion; Prenatal sex-determination.
4. In-Vitro fertilisation (IVF), Artificial insemination
by husband (AIH), and Artificial insemination by donor
(AID).
5. Genetic Engineering.
6. Surrogate motherhood. Gamete in-vitro fertilisation
technique (GIFT), Zygote in vitro fertilisation technique
(ZIFT), TOT.
7. Rights of children, psychiatric patients and mentally and
physically handicapped persons.
VII. THE FAMILY AND SOCIETY IN
MEDICAL ETHICS
1. The ethics of human sexuality.
2. Family Planning perspectives.
3. Prolongation of life; Euthanasia - society's perspective.
4. Cancer and terminal care.
VIII. DEATH AND DYING
1. Use of life-support systems.
2. Death awareness; The moment of death.
29
.
*‘»'-
Prolongation of life : ordinary and extraordinary life support.
3. Advanced life directives - The living will; Euthanasia :
passive and active.
4. Suicide : The ethical outlook.
5. The right to die with dignity.
IX. PROFESSIONAL ETHICS
1. Contract and confidentiality.
2. Charging of fees; Fee splitting.
3. Prescription of drugs; Over investigating the patient;
Unnecessary referrals and patient sharing. Low cost drugs,
vitamins and tonics.
4. Allocation of resources in health care.
X. RESEARCH ETHICS
1.
Animal and experimental research/humaneness.
2. Human experimentation. Human volunteer research : informed
consent.
3.
Drug trials.
4.
Authorship.
XL ETHICAL WORKUP OF CASES
1. Gathering all scientific factors; all human factors; all
value factors.
2. Identify areas of value - conflict. Setting of priorities.
3. Working out criteria towards decisions.
TEACHING LEARNING METHODOLOGY
Although many of these topics might be covered in
Forensic medicine , but purpose of this course is to make
impact on students.
It should have least number of lectures. Teaching to be
preferably by case examples / case discussion and role
model.
To be administered in final year MBBS course by a group
of faculty drawm from a number of departments with one
of them acting as coordinator.
Assessment of course to be built into assessment of
clinical subjects either as short case or viva-voce or OSCE
station. It may be part of internal assessment or of final
professional examination.
30
•■ . -WMfWWW'SWWwtfK'W' ■•■• •
Departmental Objectives :
At the end of the course, the student should be able
to:
Comprehend the normal disposition, inter
relationships, functional and applied anatomy of the
various structures in the body.
Identify the microscopic structure of various organs
and tissues and correlate the structure with the
functions as a prerequisite for understanding the
altered state in various disease processes.
Comprehend the basic structure and connections of
the central nervous system to analyse the integrative
and regulative functions of the organs and systems.
He/She should be able to locate the site of gross
lesions according to the deficits encountered.
Demonstrate knowledge of the basic principles of
embryology including genetic inheritance and
sequential development of the organs and systems,
recognise the critical stages of development and the
effects of common teratogens, genetic mutations and
environmental hazards. He/She should be able to
explain the developmental basis of the major
variations and abnormalities.
31
00',c
? 4 NG M-’
w>
•
* .......... ■ ~ '
Course Contents
I. GENERAL EMBRYOLOGY
1. Definition of embryology; gestation period: subdivisions;
definition of gonads: testis, ovary; definition of gamete:
sperm, ovum; gametogenesis, migration of primordial germ
cells into gonadal ridge; spermatogenesis; structure of sperm,
oogenesis; structure of ovum; growth of ovarian follicles,
ovarian and uterine cycles.
2. Sperm in the male genital tract; sperm in the female genital tract:
activation and capacitation of sperm in the female genital tract.
First week of Development
3. Definition and process of fertilisation, formation of Zygote;
cleavage division; formation of morula and blastocyst;
implantation; formation of decidua - its subdivisions. Types
of implantation and abnormal sites of implantation.
Second week of Development
4. Differentiation of embryoblast and trophoblast; changes
in the embryoblast - bilaminar germ disc; changes in the
trophoblast; formation of cytotrophoblast, syncytiotrophoblast,
amniotic membrane, yolk sac, extra embryonic mesoderm
and extra embryonic coelom and connecting stalk; formation
of chorion, amniotic cavity, primary yolk sac cavity;
appearance of prochordal plate.
Third week of Development
5. Appearance of primitive streak and primitive node;
formation of intracmbryonic mesoderm resulting in trilaminar
germ disc; formation of notochord, buccopharyngeal and
cloacal membranes, pericardial bar, paraxial, intermediate
and lateral plate mesoderm, secondary yolk sac,
intraembryonic coelom and allantoic diverticulum; derivatives
of ectoderm, endoderm and mesoderm.
Fourth To Eighth week of Development
h. Pormation of somites, neural tube, cephalocaudal folding,
lateral foldings, body form, stomodeum. proctodeum, gut and
vitelline duct; subdivisions of gut into foregut. midgut and
bin dgut.
H2
Third to Tenth Month of Development
bodyIatUratlOn °f tissues and or&ans and rapid growth of
8.
Estimation of age, horizons of development.
Placenta
9. Formatioin of placenta and chorionic villi; decidua basaliseatures and functions of placenta; placental circulation'
abnormalities; placental barrier; types of placenta.
Umbilical Cord
10. Formation of umbilical cord; features of umbilical cord.
Amniotic Cavity
11. Amniotic cavity and membrane; amniotic fluid - functionsexpansions of amniotic cavity and fusion with chorion'
chorion eave with decide capsularis; decidua capsularis with
panetalls; obliteration of chorionic and uterine cavitiesfunction of fused foetal membranes to dilate cervical canal.
12. Abnormalities; obliteration of chorionic and uterine cavities
abnormalities of chorion.
13. Formation of twins and types of twins.
14. Arrangement of foetal membranes. Conjoined twins.
Teratology
15. Genetical and environemntal factors as causative factors
lor congenital malformations.
16. Mode of actions of teratogenes and critical periods.
II. SYSTEMIC EMBRYOLOGY
1. Development of the individual organs of digestive system
genital system, urinary system, respiratory system
cardiovascular system, nervous system, special sensory
organs, endocrine glands and mammary gland.
2.
Developmental abnormalities; pathogenesis of the anomalies.
3.
Histogenesis of various organs.
4 Development of skeletal system, muscular system and derivatives
of coelomic cavities.
5. Development of face and the pharyngeal arches and the associated
congenital anomalies.
a
33
III. OSTEOLOGY
1. Names of the bones of the body and their position;
classification of the bones with examples; general features
of the bone and normal development; microscopic anatomy
of bone; general pattern of blood supply; ossification of the
bones of the limbs for age determination.
Process of repair of bone.
2.
IV. MUSCULAR SYSTEM
1. Classification and identification of the muscles of the
body: main attachments, nerve supply and action; microscopic
anatomy of muscles and the nerve terminations.
2. Details of attachments of the muscles; ultrastructural features of
muscle; mechanism of the movement caused by the muscle/muscles and
various forces exerted by them.
V. ARTHROLOGY
1. Classification ofjoints, general features of different types
of joints; detailed study of major joints of the limbs and
movements.
2. Microscopic anatomy of articular cartilage; maintenance of articular
cartilages; blood supply and nerve terminals in the articular cartilage.
VI. CARDIOVASCULAR SYSTEM
1. Position and parts of the heart; names of the blood
vessels and their distribution in the body ; mormal
development of heart and major blood vessels of the body.
2. Developmental anomalies; valvular defects and their effects;
pathogenesis of the anomalies.
VII. RESPIRATORY SYSTEM AND THE ORGANS
1. Position, parts, relations, blood supply, microscopic
anatomy, blood air barrier, normal development.
2.
Ultrastructure of pulmonary epithelium.
VIII. DIGESTIVE SYSTEM AND THE ORGANS
1. Position, parts, relations, blood supply, nerve supply,
normal development, microscopic anatomy; sphincters of the
gastrointestinal system.
2.
Sphincteric action and mechanism.
34
I
■
-
IX. GENITO-URINARY SYSTEM AND THE ORGANS
1. Parts, position, relations, blood supply, nerve supply
normal development, and microscopic anatomy.
2. Anatomical basis of Family Planning measures.
3.
Electron microscopy of renal glomerulus.
X. ENDOCRINE SYSTEM AND INDIVIDUAL
ENDOCRINE GLANDS
1. Organs, location, relations, blood supply, nerve supply,
microscopic anatomy and normal development
2.
Clinical manifestations of common endocrine disorders.
XL NERVOUS SYSTEM AND ITS COMPONENTS
1. Parts of nervous system, meninges, nerve terminals,
neuroglia, myelination, ventricles, motor and sensory
pathways, cranial nerves, functional areas, normal
development, microscopic anatomy of neurons, motor and
sensory cortex and their blood supply.
2.
Reticular formation, limbic system, correlation of microscopic
anatomy with function, developmental anomalies, anatomical basis of
common neurological disorders.
XII. SPECIAL SENSORY ORGANS
1. Gross and Micro Anatomy of eyeball, ear, nose, skin and
tongue.
XIII. LYMPHATIC SYSTEM
1. Gross anatomy of the major groups of the lymphnodes
of the body and their drainage areas. Gross anatomy of
the major lymphatics specially thoracic duct and its
tributaries.
I
I
XW. HUMAN GENETICS
1. Nucleus, DNA, chromosomes, classification, karyotype,
chromosomal aberrations (Klinefelter and Turner syndrome)
and their Prenatal diagnosis.
I
I
I
2. Pedigree chart. Pathogenesis of chromosomal aberrations and
their effects, recombinant DNA, genetic inheritance, genetic counselling
inborn errors of metabolism.
r :
35
■
---
1**9-&*M
Prosected Parts: Perineum including ischio-rectal fossa.
Lower limb: Dissection: Gluteal region, front and back of
popliteal fossa and leg.
Prosected Parts: Sole of the foot and joints.
Head & Neck: Dissection: Superficial and deep dissection
of face and neck, orbit and eye ball. Submandibular region.
Prosected parts: Temporal and infratemporal fossa, cranial
cavity, naso and oropharyngeal regions. Ear, larynx and
pharynx.
NERVOUS SYSTEM:
Sections of brain and prosected specimens to demonstrate
visual system, auditory and vesibular pathways and major
functional areas.
DEMONSTRATIONS:
-
Bones
Brain and spinal cord
Cross-sectional anatomy
Radiological Anatomj'
CT and MRI scan.
MICROSCOPIC ANATOMY:
Stained slides of all the tissues and organs.
Electronmicrographs to demonstrate filtration barrier of
kidney, alveolar septum, tight junctions of capillaries and
such relevant areas.
DEVELOPMENTAL ANATOMY:
-
Models to demonstrate various stages of early foetus and
different organs development.
Slides of ovary and tests to show follicles and stages of
maturation of spermatozoa; and early chick and pig
embryo.
GENETICS:
Demonstration of normal karyotype and common abnormal
conditions including banding; Pedigree chart.
t
37
■
iSt»
- —... .
Skills
1. Demonstrate surface markings of important organs.
2. Localise important pulsations and the structures against
which pressure can be applied in case of bleeding from a
particular artery.
3. Elicit superficial and deep reflexes.
4. Demonstrate muscle testing and movements at joints.
5. Locate sites for: Lumbar puncture, sternal puncture,
pericardial tapping, liver biopsy.
6. Locate veins for venae puncture.
7. Locate the site for emergency tracheostomy.
8. Locate the subcutaneous positions of large nerves.
AREAS FOR INTEGRATED TEACHING
S.No.
Area/subject
Department/s
to be involved
1.
Anatomical basis of birth
control measures
Obstetrics and
Gynaecology; and
Surgery
2.
Postnatal growth and
development
Pediatrics and
Community
Medicine.
3.
Antenatal growth and
development
Obstetrics and
Gyanecology.
4.
Genetic disorders
Various clinical
departments.
5.
Neuro-An atomy
Physiology and
Medicine
6.
Kinesiology - movements at
various joints.
Orthopedics
7.
Embryological basis of
important and common
congenital anomalies.
Pediatries, Obst. and
Gynaecology.
38
I
Physiology
Departmental Objectives :
At the end of the course, the student will be able to:
Describe the normal functions of all the organ
systems, regulatory mechanisms and interactions of
the various organs for well-coordinated total body
function.
Assess the relative contribution of each organ system
and the principles in the maintenance of the milieu
interieur (homeostasis).
Elucidate the physiological aspects of normal growth
and development.
Analyse the physiological responses and adaptation
to environmental stresses.
Comprehend the physiological principles underlying
pathogenesis and treatment of disease.
Correlate knowledge of physiology of human
reproductive system in relation to National Family
Welfare Programme.
■
<
39
i
<
■4
I
Course Contents
I. GENERAL PHYSIOLOGY
1. Homeostasis, concepts of physiological norms, range and
variations, active and passive transports, Relationship
between stimulus and response.
2. Structure of cell membrane, resting membrane potentials,
cellular receptors, intercellular communications.
3. Physico-chemical properties of cell membrane. Cell inclusions,
their functions.
II. BODY FLUIDS, BLOOD
1. Blood Composition, principles of estimation, functions of
plasma proteins, cellular elements of blood, their formation
and regulation, haemoglobin and functions, jaundice,
anaemias and their classification, haemostatic mechanisms,
anticoagulants, blood groups, Rh incompatibility, blood
transfusion; ESR; Basic mechanisms of immunity with
respect to lymphocytes and functions of WBCs. Lymph.
2. Changes in body fluids in disease; Hypoproteinaemia; oedema.
Replacement of body fluid loss. Effects of lymphatic obstruction.
Functions of thymus, Structure of immunoglobulins, Autoimmunity,
AIDS.
III. NERVE AND MUSCLE
1. Classification; electrical, mechanical properties.
Mechanism of muscle contraction and its molecular basis.
Neuromuscular transmission, thermal changes, oxygen debt,
mechanical efficiency. Smooth muscle, electrical and
mechanical properties, nerve supply, neuro-transmitters.
2. Effects of denervation on muscle, neuromuscular disorders,
investigations for nerve and muscle disorders, details of chemical
changes in muscle contraction.
IV. GASTROINTESTINAL TRACT
1. Functional morphology, functions, regulation of secretion
of salivary glands, stomach, small intestine and large
intestine; regulation of gastrointestinal movements; functions
of gall bladder, liver; site of production and action of G.I.
hormones; physiological basis of investigating disorders of
secretion and motility.
40
«•
2. Effects of disorders of secretion and motility. Physiological basis
of peptic ulcer and achalasia; motility disorders; liver function tests;
diarrhoea and its treatment.
V. KIDNEY
I
1. Functions of different parts of nephron in urine formation.
Role of kidney in water and electrolyte balance. Acidification
of urine, diuresis, kidney function tests. Juxtaglomerular
apparatus; Renin-Angiotensin system. Renal blood flow.
Structure and innervation of bladder; micturition,
cystometrogram.
2. Mechanism of action of diuretics, renal failure, principles of
artificial kidney, disorders of micturition.
VI. SKIN AND BODY TEMPERATURE
(ENVIRONMENT)
1. Functional morphology, heat gain and loss mechanisms,
role of skin in temperature regulation. Body temperature,
Normal values and variations. Hyperthermia, fever, heat
stroke, cold injury.
VII. ENDOCRINE GLANDS
(To be integrated with Biochemistry)
1. General principles'of regulation of endocrine glands.
Hormones, functions, regulation of secretion. Experimental
and clinical disorders of anterior and posterior pituitary,
thyroid, parathyroid, adrenal cortex, adrenal medulla and
endocrine pancreas. Stress and hormones. Physiology of
growth.
2. Synthesis and transport of hormones, receptors and blockers.
Functions of local hormones; pineal; cellular mechanism of hormonal
action, investigation.
VIII. REPRODUCTION
Male Reproduction
1. Regulation and functions of testis, constituents of semen,
ejaculation, testicular hormones, puberty.
2. Abnormalities of testicular function, sex determination and
differentiation.
.•
41
■i-wse-..
Female Reproduction
1. Menstrual cycle; changes in ovary, uterus, cervical mucus,
vagina and hormonal regulation. Ovulation and its detection,
fertilisation, implantation, physiological changes during
pregnancy, parturition, placenta, physiology of lactation,
menopause.
2. Foetoplacental unit, composition of milk, colostrum, nutritional
needs of mother and child during pregnancy and lactation, investigations
for infertility.
Family Planning and Welfare
1. Physiological basis of contraception in males and females,
principles of use of oral contraceptives, safe period rhythm
and other methods of contraception.
IX. CARDIOVASCULAR SYSTEM
1. F unctional anatomy of heart, properties of cardiac muscle;
electrical and mechanical changes in cardiac cycle, normal
ECG. Cardiac output; measurement in man, physiological
variations. Regulatory mechanisms of heart rate and blood
pressure. Regional circulations: normal values, measurement
and regulation of coronary, cerebral, skin and foetal. Changes
in CVS during muscular exercise, postural changes,
gravitational forces, hypovolemia, hypoxia and
cardiopulmonary resuscitation.
2. Principles of electrocardiography and cardiac catheterisation.
Arrhythmias, pathophysiology of cardiac failure, hypertension, valvular
disorders.
X. RESPIRATORY SYSTEM
1. Functional anatomy of respiratory system. Mechanics of
normal respiration. Lung compliance, alveolar ventilation,
ventilation perfusion ratio, oxygen and carbon dioxide
transport, Diffusing capacity, Pulmonary function tests,
Regulation of respiration, respiratory acidosis and alkalosis,
pulmonary blood flow. Hypoxia, cyanosis, asphyxia.
Respiratory adjustments during muscular exercise, hyperbaric
conditions, principles of oxygen therapy, artificial respiration.
2. Hyaline membrane disease. Pathophysiology of obstructive and
restrictive disorders. Pulmonary oedema, decompression sickness,
hyperbaric oxygen therapy, dyspnoea.
42
I
XI. CENTRAL NERVOUS SYSTEM
t
9
1. Organization of the central nervous system. Functions
and neuronal organization at spinal cord level. Synaptic
transmission. Motor and sensory systems and their lesions.
Reticular system in brain stem, sleep, wakefulness, EEG
waves and physiological changes in EEG. Clinical lesions
and experimental sections at spinal cord, brain stem and
sub-cortical levels. Physiology of basal ganglia, cerebellum,
thalamus, hypothalamus, limbic system, prefrontal lobe
and cerebral cortex. Speech and its disorders. Autonomic
nervous system. Formation and functions of CSF. Blood
brain barrier. Central Neurotransmitters.
2. Evoked potentials. Imaging techniques. Neuroglia. Physiological
basis of CNS disorders like Alzheimer's disease, Parkinsonism,
Syringomyelia, Tabes dorsalis.
XII. SPECIAL SENSES
Eye
1. Image formation on retina. Errors of refraction, functions
of aqueous humour, intra-ocular tension. Mechanisms of
accommodation, dark adaptation, pupillary reflexes, functions
of retina. Role of visual cortex in perception, optic pathway
and lesions. Field of vision. Colour vision.
2. Structure of photoreceptors, generator potentials of rods and cones,
electroreti nogram.
Auditory Apparatus
1. Functions of tympanic membrane, middle ear, cochlea,
auditory receptors and pathway. Deafness and its causes.
2.
Audiometry, theories of hearing.
Vestibular Apparatus
1. Division, functions, connections
Vestibuloocular function, nystagmus.
2.
and
lesions.
Tests of vestibular functions, mechanism of habituation.
Taste and Smell
1. Receptor, pathways and cortical and limbic areas
associated with taste and smell.
2.
Disorders of taste and smell perception.
43
Practicals
The following list of experiments and demonstrations is
not exhaustive. Additional experiments can be included as
and when feasible and required.
I. HAEMATOLOGY
1. Preparation and staining of blood films; identification of
blood cells in a stained film; total and differential leucocyte
count; estimation of haemoglobin; fragility of red blood cell;
erythrocyte sedimentation rate, haematocrit value; blood
grouping; bleeding and clotting time.
2. Laboratory classification of anaemias and determination of absolute
indices like MCH, MCHC, MCV, colour index.
3. Methods of blood collection; Arneth count; enumeration of reticulocyte
and platelets (demonstration); viscocity of blood (demonstration); blood
volume estimation (demonstration); bone marrow smear (demonstration).
II. NEURO MUSCULAR PHYSIOLOGY
Human
1. Mosso's ergography; effects of prolonged voluntary activity,
rest, motivation, fatigue on human muscle contractions and
calculation of work done; bicycle ergometry and treadmill,
mechanical efficiency of human body.
2. Demonstration of electromyography; velocity of nerve impulse and
strength duration curve in humans (demonstration); compound action
potential (demonstration).
Experimental
1. Study of laboratory appliances in experimental physiology. Frog's
gastrocnemius - sciatic muscle nerve preparation; simple muscle curve;
effects of increasing strength of stimuli; effects of temperature; genesis
of fatigue; effects of two successive stimuli; genesis of tetanus; effect
of afterload and free load on muscle contraction and calculation of work
done; velocity of nerve impulse in sciatic nerve of the frog; isometric
contraction and determination of resting length.
Smooth Muscle
1. Recording of contraction of frog's rectum; recording of movements
of small intestine (rabbit) and effects of ions, drugs, temperature.
44
™...
-
1
J
J
III. METABOLISM, BODY TEMPERATURE AND
KIDNEY
1
i
1. Recording of body temperature and effects of exercise on
body temperature.
2. Basal metabolic rate in humans; water excretion test.
IV. ENDOCRINES AND REPRODUCTIVE SYSTEM
I
1. Demonstration of vaginal smears of rats; identification of the
phases of the estrus cycle; pregnancy diagnostic tests; effects of
adrenaline, posterior pituitary extract on uterine muscle; examination
of semen - sperm count, sperm motility (demonstration); Demonstration
of slides showing the proliferative and secretory changes in the
endometrium.
V. CARDIOVASCULAR SYSTEM
1. Clinical examination of cardiovascular system,
sphygmomanometry: effect of exercise and posture on blood
pressure, radial pulse, cold-pressor test. Electrocardiography.
2. Experimental cardiogram: effect of warmth and cold on sinus
venosus and ventricle; extra systole and compensatory pause; properties
of cardiac muscle effect of acetylcholine, adrenaline, nicotine and
atropine on frog heart; perfusuion of blood vessels of frog; perfusion
of mammalian heart and effect of drugs on it; perfusion of frog's heart
and effect of ions on it.
3. Demonstration : Echocardiography; cardiac output in dogs; record
of blood pressure, venous pressure, respiration in animals (dog) and
effects of various factors on it; phonocardiogram; effect of passive tilt
on B.P.; effect of exercise on hemo-cardio-respiratory system; Cardiac
function tests; Cutaneous circulation in man.
VI. RESPIRATORY SYSTEM
1. Pulmonary function tests including spirometry; clinical
examinations of respiratory system; stethography;
cardiopulmonary resuscitation; respiratory response to
exercise.
2. Demonstrations: Compliance and surfactant; Donder’s model to
demonstrate the mechanism of respiration; Dog/cat: intrapleural and
intraoesophageal pressures and the effect of various influences on
them; Mullers manoeuver; Collection and analysis of respiratory gases;
uses of Douglas bag.
VII. NERVOUS SYSTEM
1. Examination of motor functions, sensory functions and
cranial nerves; examination of reflexes of normal subject.
45
1
1
.
.
■
•
.
.
. .
.
.
.
*
2. EEG, EMG and nerve conduction studies : sensory and motor,
compound action potential: decerebrate rigidity; in cat: reaction time;
spinal frog and reciprocal innervation; decerebrrate frog; examination
of autonomic functions.
VIIL SPECIAL SENSIES
1. Perimetry, acuity of vision-distant land near; colour
vision; tests on smell and taste; tuning fork tests.
2. Principles of ophthalmoscopy and retinoscopy;;.audiometry; PurkinjeSamson images.
Skills
1. Perform experiments designed for study of physiological
phenomena.
2. Interpret experimental/investigative data.
3. Distinguish between normal and abnormal data derived
as a result of tests which he/she has performed and observed
in the laboratory.
LIST OF TOPICS FOR INTEGRATED TEACHING
1. Endocrine glands : Biochemistry and Medicine
2. Family Planning and Welfare : Anatomy and Obstetrics
and Gynaecology.
3. Echocardiography : Cardiology.
4. Basic Life support : Anaesthesiology and Anatomy.
5. Patho Physiology of hypertension - Medicine.
6. Clinical Neurology medicine.
7. Intraocular tension and retinoscopy : Ophthalmology.
8. Audiometry and vestibular tests : Oto-rhino-laryngology.
46
1
I
Biochemistry
Departmental Objectives :
At the end of the course, the student should be able
to:
Describe the molecular and functional organization
of a cell.
Delineate structure, function and interrelationships
of biomolecules and consequences of deviation from
normal.
Summarize the basic and clinical aspects of
enzymology and regulation of enzymatic activity.
Describe digestion and assimilation of nutrients and
consequences of malnutrition.
*
Integrate the various aspects of metabolism, and
their regualatory pathways.
Describe mechanisms involved in maintenance of
body fluid and pH homeostatsis,
Explain the biochemical basis of inherited disorders
with their associated sequelae.
Outline the molecular mechanisms of gene expression
and regulation, principles of genetic engineering and
their application in medicine.
Summarize the molecular concepts of body defence
and their application in medicine.
47
■ ............................ •«< .Vt.
"■
.
■
•
■/:
;
.............................................
--■
■
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•
...
..
.
.-
..........................
..
.-
.......
,
—
----- ------------------------------ ----
-..
: '?.:c ;3M3, L .v
....
Identify the principles of conventional amd specialized
laboratory investigations and insttrumentation;
analysis and interpretation of a giwen data; the
ability to suggest experiments to support theoretical
concepts and clinical diagnosis.
48
■ ■ ...... ....................
"T.
- ««*»■ •.>
.A
----- :~-
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...••«*>-.
^..^Wii..-Wnfai.i^BWSmaiy.-"SA- ...•'. • ■ -•■■
Course Contents
I. EUKARYOTIC CELL STRUCTURE
1. Cellular compartments; environment, organization and
composition of cells; functional role of cellular organelles and
membranes.
II. CARBOHYDRATE CHEMISTRY
1. Definition, classification and nomenclature of mono, di
and polysaccharides. Structure of carbohydrates including
heteropolysaccharides and glycoproteins.
2. Sialic acids and blood group substances.
HI. LIPID CHEMISTRY
1. Definition, classification, nomenclature, biological
importance and properties of lipids. Structure and functions
of biological membrane, liposomes.
TV. PROTEIN CHEMISTRY
1. Definition, classification and structure of proteins and
aminoacids; their classification and properties.
V. STRUCTURE-FUNCTION RELATIONSHIP OF
PROTEINS
1. Oxygen transport proteins: Structure and structural
basis of physiological functions. Modification of Hemoglobin
structure and diseases.
2. Lipoproteins: Structural characteristics, classification and
biological importance.
3. Enzymes: key concepts, mechanism of action, regulation
of enzyme activity and their importance in health and
disease.
4. Vitamins: Definition, classification, occurence, sources,
daily requirements, functions, deficiency manifestation of fat
soluble and water soluble vitamins. Antivitamins and
hypervitaminosis.
5. Collagen structure and function. Isolation of enzymes, lipid
peroxidation and overview of antioxidants.
49
-ITT-'-'”—
VI. NUCLEIC ACIDS
1. Definition, structural description and functions;
transcription of genetic information, translation of genetic
code, regulation of genetic expression and protein synthesis.
2. Genetic engineering and its importance, DNA damage and repair,
gene therapy.
VII. DIGESTION AND ABSORPTION
1. Mechanism of digestion and absorption of carbohydrates,
lipids, proteins and aminoacids and factors influencing
digestion and absorption. Role of dietary fibre.
2.
Alterations in the mechanism of digestion and absorption.
VIII. INTRODUCTION TO INTERMEDIARY
METABOLISM
1. Biological oxidation and generation of energy.
2. Carbohydrates: Metabolism of glucose and glycogen.
Interconversion of hexoses, metabolism of fructose and
galactose, blood glucose homeostasis, overview of common
disorders of carbohydrate metabolism and their clinical
significance.
3. Lipids: Metabolism of fats, biosynthesis of fatty acids,
triglycerides and phospholipids; oxidation of fatty acids,
cholesterol homeostasis, lipoprotein metabolism.
4. Proteins and aminoacids: General catabolism of amino
acids; ammonia metabolism. Formation and biological
significance of glycine, tryptophan, tyrosine, phenylalanine,
histidine, sulphur containing aminoacids. Common inborn
errors of aminoacid metabolism.
5. Biosynthesis and degradation of purine and pyrimidine
nucleotides and gout.
6. Minerals: metabolism.
7. Energy and nutrition: Calorie requirements, specific
dynamic action, BMR; balanced and adequate diet.
8. Outline of detoxication mechanisms in the human body.
9. Acid base balance, blood buffers, regulation of blood PH.
50
-J
I
1
10. Breakdown of hemoglobin, biochemical basis ofjaundice,
classification and their importance; bile pigments and their
importance; overview of biochemical basis of porphyrins.
11. Methods of investigations of intermediary metabolism;
phospholipids, lipoproteins, prostaglandins, leucotriene and
thromboxanes. Rare disorders related to lipid metabolism and inherited
disorders related to aminoacid metabolism. Purine salvage pathways,
secondary hyperuricemia, metabolism of chromium, cobalt, selenium
and toxicity manifestation. Basic concepts of total parenteral nutrition.
IX. ORGAN FUNCTION TESTS
1. Thyroid, Liver, Stomach, Kidney.
X. ENDOCRINOLOGY
1. Mechanism of action and biochemical functions of insulin,
steroids, thyroxine.
2.
Biochemical tests of fetal maturity.
XI. IMMUNOLOGY
1. Structure and biochemical function of immune system,
characteristics of humoral and cell-mediated immune
response, complement system, immunoregulation and
application of the immunological techniques.
2.
Immunodiagnostic methods.
51
> so
O
OOCUMeNTATtON
UNH
*a
. - J
Practicals
1. Spectroscopic examination of hemoglobin and derivatives.
2. Qualitative analysis of gastric juice and bile; principles
of Vandenberg test. Interpretation of gastric analysis with
correlation to diseases.
3. Milk : qualitative analysis.
4. Qualitative analysis of normal and abnormal constituents
of urine and interpretation of results of such analysis.
5. Principles of colorimetry.
6. Principles of estimation of glucose, urea, creatinine,
proteins, bilirubins, calcium, cholesterol and uric acid in
blood and interpretation of results.
7. Principles of estimation of urea, creatinine in urine and
the interpretation of results.
8. Principles of chromatographic and electrophoretic
techniques and interpretation of a chromatogram and
electrophoretic pattern of serum proteins.
9. Analysis of clinically important enzymes : Alkaline
phophatase, SGOT, SGPT and amylase.
Skills
1. Use conventional techniques and instruments to perform
biochemical analysis relevant to clinical screening and
diagnosis.
2. Analyze and interpret investigative data.
52
I
Section - III
We present in this section, a breif note
on the modular approach to the
curriculum design initiated by the
consortium institutes. An outline of
thirteen integrated teaching modules
on thrust areas is given. What is
presented is only a plan and further
details need to be worked out in
implementing these modules.
I
Tuberculosis
(AIIMS, New Delhi)
Objectives :
At the end of the unit, the MBBS student should be
able to :
1. State the importance of tuberculosis as major
major
health problem of the country and state the magnitude
thereof. (LC ; B)
2. Outline the importance of the host, the environment
and the agent factors in the epidemiology of
tuberculosis. (LC ; A)
3. State common characteristics of Mycobacteria
which differentiate it from all other groups of bacteria.
(LC ; A)
4. Enumerate all Mycobacteria capable of causing
disease in man and place them into respective
recognized groups of classification. (LC ; B)
5. Indicate major differences between these
Mycobacteria. (LC ; B)
6. Perform Zeihl Nielsen staining (ZNS) on a sputum
sample and identify the AFB on bright ground
microscopy. (Psy. ; A)
7. Demonstrate familiarity with relevant laboratory
procedures other than ZNS for the isolation,
identification and antibiotic susceptibility of M.
tuberculosis. (LC ; A)
8. Describe the mode of infection, pathogenesis,
virulence, role of induced hypersensitivity immunity
and genesis of granulomatous reaction in tuberculosis
(LC ; A)
177
9. List common symptoms, elicit important signs an
make clinical diagnosis of pulmonary anc
extrapulmonary (disseminated, TBM abdomma
genitourinary, bone and joints, lymphadenopathy)
infections in children and adults. (LC , A)
10. Enumerate differences in the clinical presentation
of and recognize the development and morphology
(gross and microscopic) of primary progressive
primary, miliary, disseminated fibrocalcific
tuberculosis in lungs and various other organs m
immunocompetent and immunocompromized host.
(HC ; A)
11 Plan investigations (including micro, path
biochemical, radiologic and Mantoux) in a suspected
patient. (HC ; A)
12 Choose the appropriate samples to be collected
at eanous stages of illness and from ddfe. ent srtos.
for making a laboratory diagnosis. (LC . A
13. Carry out a Mantoux test and correctly interpret
the result of the test, on a child, (Psy. ; A)
14. Interpret the following specific investigations m
the context of tuberculosis infection: (HC , A
* AFB staining
*
Mantoux test
CSF : Cells, biochemistry, culture, serology
*
Pleural fluid : Gross, microscopic, biochemical,
*
cytology, ZN stain.
15. Describe the radiological features of P^iona^
and extrapulmonary infection and mterpre c res
ray for presence of primary, progressive primary,
miliary and fibrocalcific lesions. (LC ; A)
16. Describe antitubercular therapy in the following
178
forms of tuberculosis in children and adults givingdose formulation and duration of therapy: (LC : A)
pulmonary
tuberculin positive school child
TBM
adenopathy
miliary
disseminated
bone and joint
genitourinary
17. Advice adjunct and supportive management to a
case. (HC ; A)
18. Recognize cases of tuberculosis which, on the
basis of complications/complexity. require opinion
of a specialist, or referral to a higher level of care
(HC : A)
19. Plan investigations of the patient if there i< no
satisfactory improvement after six months of
treatment. (HC ; A)
20. Advice the patient about appropriate steps if the
a oiatoiy lepott indicates isolation of Mycobacteria
other than tubercle (MOTT) bacilli, (HC ; B)
21..Analyse the impact of the disease on the individual,
the family and social and occupational life and advice
measures to ameliorate. (HC : A)
22. Advice regarding BCG vaccination to a child,
administer the vaccine and interpret the take
response of the vaccine. (Psy. ; A)
23] Institute management of a pregnant lady, lactating
lady as well as a neonate born to such a mother. (HC
; B)
179
24. Describe the salient features of the National
Tuberculosis Control Programme. (LC ; A)
25. Describe the role of medical officer of a P.H.C.
in the implementation of the NTP (LC ; A)
LC = Lower Cognitive Objective
11C = Higher Cognitive Objective
I ’sy = Psychomotor Objective
= What Student Must Know
A
= What is Good to Know
B
180
-
TEACHING LEARNING ACTIVITIES
Objective
Time
Title
Method
Departments
Day 1
09.00 to 09.30
Question naire
09.30 to 10.00
Objectives of
workshops
1
10.00 to 10.30
Magnitude of
the problem
LeeLu re
Medicine
3 to •”
1 LOO to 12.00
(lenos
Mycobacteria
Lecture*
M icrnbiologv
S
12.00 to 13.00
Pathogenesis
of tuberculosis
Leet u re
Pathology
10
I 1.00 to IS.00
(I ross &
microscopic
pathology
Pract ical
Pathology
9.1')
09 00 to 10.30
Clinical
presentation
Seminar
Med. Surg. Paed.
Obst & Cynae
1">
10.30 to 1 | 30
Radiological
I eat u res
Small
group
Radiojogv
13.
12.00 to 1300
PJ’t; X:
Small group Paediatric.-.
manloux testing
('ommunit \
Medicim*
(i
1 I 00 to IS.00
Zeihl Xielsen
staining
Pract. ica I
M icrohiology
2.2 1.23
0.900 to 10.00
Public health
Lectu ia*
Community
Medicine
7.1 1.12
14
1(1.(H) to I 1.30
Laboratory
diagnosis
Seminar
Med. Path.
Micro. Radiolog\
Ki to 21.
23
12.00 to 13.30
Medical
management
Seminar
Medicine.
Paediatrics.
Pha rmacologv
IB. to 21,
23
14.30 to IS.30
Su rgical
management
Seminar
Surg. Obst
& Cynae. Ortho.
Comm Med
09.30 to 13.00
Visit to
TH hospital
Small
group
TB hospital
staff. Medicine.
Surgery.
Paed iatrics.
Community
Medicine
Day 2
Day 3
Day 4
1.2.9
181
I
7
Title
Method
Depart merits
1*1.00 to 15.00
Mantoux test
reading
Snail
group
Paediat rics.
Community
Med icine
15.00 to 18.00
Case studies
Small
group
Med. Paed.
Surg. Ortho.
Path
09.30 to 11.30
('linico-psycho- Small
group
social case
review
Community
Medicine
1 1.30 to 13.30
Cast1 studies
15.0(1
Valedictory &
post-workshop
questionnaire
Time
Objective
13.22
Day 5
1.2.24.25
Small
group
Med. Paed. Surg.
(>rt h<>. I ’al h
SUGGESTED ASSESSMENT STRATEGIES
Objective
Objective
Suggested
Suggested test
Pracl icul
1
MCQ
13
2
SAQ
14
Viva-voce
MCQ
15
Viva-voce and
3
M('Q
4
MCQ & SA(J
16
MCQ&SAQ
5
MCQ
17
SAQ
6
I’ract ical
IS
SAQ
i
M('Q
19
SAQ
S
MCQ & SAQ
20
MCQ
Bedside case
21
Cl’SCK
presentat ion
10
I’ract ical
('ase study.
practical viva-voce
and specimen
23
SAQ
11
MCQ
24
ESSAY
12
MCQ
25
ESSAY
identif’icat ion
MCQ = Multiple Choice (Questions
SA(^ = Short Answer (Questions
CPSCR - Clinico-Psychosocial Case Review
182
O’'
'
;
“o
Section 2 and 3 of this monograph give compilation
of the core curriculum, the essential skills, courses
on behavioural science and ethics and series of
integrated teaching modules for undergraduate
medical education.
Though consortium has been able to achieve a
considerable degree of success in restructuring
medical
t
n education curriculum, it
-J is duly
acknowledged that the tasks ahead are far more
challenging and vital for producing a definite impact.
The delineation of appropriate teaching learning
methodology is an important factor for the smooth
implementation of the curriculum document. It is,
therefore, necessary to work out the details of the
same.
It has been recognised that the most important
component in curriculum is the assessment
strategy which overrides other components. It is,
therefore, inevitable to work out a comprehensive
assessment strategy for measuring the learning
outcome.
It will be pertinent to monitor and evaluate the
effectiveness of the .innovations which are being
implemented by various consortium institutes.
Appropriate indicators need to be developed for
evaluating the process as well as the impact. It is
also necessary to promote health systems research
(HSR) on a continued basis.
Most of the medical colleges in India are ill-equipped
to produce learning resource materials on their
own. It is, therefore, necessary to think of a central
241
■
■
'
'
■
■
.
••
.
■
co-ordinated mechanism to produce these materials
with collective effort, try-out, finalise and
disseminate to all other institutes.
Effective dissemination of the information pertaining
to the data base, teaching learning methodology ,
assessment and other innovations, is considered not
only desirable but also essential. For this purpose it
is proposed to start a journal, ‘Trends in Medical
Education’.
It is envisaged to expand the consortium while
continuing the inquiry process in eight colleges.
This is proposed to be achieved by a mechanism in
which each institute works with one or two medical
colleges in the region, initiates inquiry process and
shares experience with the same. This can be
achieved through joint forums-workshops or,
exchange visits depending upon the local situation.
The institutions involved are listed in the figure.
For the successful implementation of these
programmes, the essential instruments have to be
developed. In order to utilise the available human
resources and their expertise, the tasks ahead are
being assigned to each of the consortium institutions.
These are:
1. Teaching Learning
Methodology
IMS-BHU, Varanasi
2. Assessment Strategy
JIPMER, Pondicherry
3. Health Systems Research
CMC, Vellore
4. Learning Resource Materials ARMS
5. Dissemination of information St.John's Med. College,
Bangalore
6. Expansion of the consortium
242
All Institutions by
twinning
The specific details in respect of each of the task
forces are given below:
1. TEACHING LEARNING METHODOLOGY
Specific Objectives :
•
To produce a resource book (hand book) for indicating:
a) general guidelines for teaching-learning (b) specific
suggestions for certain topics of national thrust.
•
To sensitize a group of medical teachers in applying
innovative teaching methods and play leadership role at
a regional/local level
•
To try-out integrated teaching modules on specific
needbased topics and to consolidate their findings.
•
To set up a regional resource centre for teaching learning
methodology.
Methods and Approaches :
The task force will consist of 6-8 medical educators drawn
from pre, para and clinical disciplines. It will hold
preliminary meeting to plan for two workshops (national) of
3 days duration each targetted at preparing teaching
learning methodology for topics of Thrust. About 30
participants belonging to preclinical (10), paraclinical (10),
and clinical (10) drawn from local (10) and outside (20)
medical colleges will be invited for this workshop. The
workshop deliberations will be synthesized into a resource
book.
At the end of the first year the task force will hold two
onsite workshops in two medical‘colleges of U.P. These
workshops would enable the taskforce to sensitize a new
group of teachers who will be able to try out these methods
in their colleges and send feed back to the taskforce. The
taskforce will consolidate the resource book and present it
to the consortium.
A learning resource centre will be established for housing
the learning materials and for dissemination which will be
equipped with computer, photocopier, fax machine etc.
243
Proposals for Evaluation and Follow up :
The workshops will have in-built evaluation in the form of
session evaluation and course evaluation questionnaires.
The efficacy of the resource book will also be evaluated by
circulating a questionnaire to selected medical colleges and
obtaining their feedback.
2. ASSESSMENT STRATEGY
Specific Objectives :
•
To critically review the existing methcx'.s used for
evaluation in undergraduate medical education for their
strengths and weaknesses.
•
To develop/refine tools/instruments capable of measuring
learning outcomes of three domains (cognitiv \ afiective
including communication and psychomoter i.ilis;.
•
To suggest alternate or additional mwki- •_ if uny,
which are applicable to formative and si;mm ■
types.
Methods and Approaches :
The Taskforce will consist of 6-8 medical .
d ..
JIPMER, Pondicherry. It will deliberate mp:: a
of the following issues:
•; d at
n each
i) The task force will appraise the cur? .
administering a questionnaire to med bn!
and students.
: 'A OV
ii) The task force will hold planning me ■' inc
days duration, to prepare for the works?: :ps
instruments.
faculty
k of three
hi) There will be one or two work/ncn; ik i uree days
duration. Each workshop will have 10 ouc ■ ;ui crtkkants
and 10 local participants from dive; s iis
; ii-s with
proven experience in medical educat e
t ch k ?gy. Each
workshop will deliberate on specific is-'.. 1 ■ • .-•er ciiod •..wlier
and prepare tools/instruments.
Proposals for Evaluation and Fcihi v :
i) Pre-and post test and programme ev i v. k s w vo/: hops
ii) The instruments developed wot i '
244
"
■ ...........................................
.
■
I.?/:--1 at
JIPMER. Opinion of teachers and students would be
obtained.
iii) Later, they will be tried-out in other consortium
institutions.
iv) A report will be prepared and submitted.
3. HEALTH SYSTEMS RESEARCH
Specific Objectives :
•
To create an iawareness and sensitize faculty and
students regarding HSR.
®
enable consortium institutes to carry out FISR using
a common protocol.
•
To identify and overcome impediments in popularising
HSR.
•
To use HSR as a basic determinant for curriculum
planning and community oriented education.
Methods and Approaches :
An initial workshop will be conducted with three members
from each institution to discuss methods of health system
research and to identify the topic for research to be carried
out. A common protocol will be prepared. The role of the
faculty and students and the method of assess meof the
students will be discussed.
Each member institution will identify a rural or urban
community. The protocol will be field tested. A review
meeting will be held 4 to 6 months later to analyse the
results of the pilot study and to improve the protocol. Losing
the modified protocol, data will be collected from the
community for one year. Institutions where the pilot study
is unsatisfactory will not be included in the second phase.
Quarterly reports will be sent to the coordinating institutions
to be disseminated to the member institutions, State and
Central Governments in the form of a news letter. Feed
back will be sent to each institution at the end of one year.
The project will be for three years.
The studies will provide information related to health
conditions and will also document involvement of students
and the faculty. Teaching methods, duration of the
245
•. -
programme, period of the MBBS course when students are
involved and the students assessment in the community
will be documented. The finding will be used to prepare a
teaching module on community based education which will
be disseminated through the journal of the consortium.
Proposals for Evaluation and Follow up :
The effectiveness of the workshop will be determined by
administering questionnaire to the participants in the form
of daily evaluation, session evaluation and programme
evaluation. The quality of the HSR carried out by each
institution will also help to assess the effectiveness of the
workshop.
4. LEARNING RESOURCE MATERIALS
Specific Objectives:
•
To organize planning, production and dissemination of
learning resource materials on need based topics.
•
To strengthen/utilize the existing infra-structure for
producing learning materials.
Methods and Approaches to be Used :
The taskforce on learning resource materials will consist of
three core faculty and five satellite faculty coopted according
to the content of the LRM.to be produced.
The Strategy Involves :
(i) Identification of areas/topics for the production of LRMs.
(ii) Planning meeting of the taskforce for organizing two
workshops (four meetings).
(iii) One workshop for producing prototype LRMs (four)
consisting of 10 local and 20 outside participants drawn
from diverse disciplines.
(iv) Try-out of the materials in select colleges and obtain
feedback (to be done subsequently)
. (v) Finalization of the materials; reproduction and
distribution through meetings ( to be done subsequently)
The K.L. Wig CMET at AIIMS has the infrastructure for
the production of learning materials in print and other
media such as tape slides, video etc. The actual cost of
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production is proposed to be reimbursed from the project
funds. The services of production personnel and technical
staff will be hired.
Proposals for Evaluation and Follow up :
The effectiveness of the meetings and workshops will be
judged by means of session evaluation and program
evaluation questionnaire. Indicators will be developed for
evaluating the effectiveness of the learning resource
materials.
5. DISSEMINATION OF INFORMATION
Specific Objectives :
•
To establish proper information and dissemination
system for consortium activities.
•
To share consortium experiences with larger audiences
both nationally and internationally.
•
To put on record the updated national developments in
the field foi' posterity.
•
To make available international information in an
abridged and meaningful form.
Methods and Approaches :
i) St. John s Medical College will identify a group of eight
faculty members belonging to diverse disciplines to constitute
the task force for dissemination.
ii) The task force will plan and initiate publication of a
journal entitled “Trends in Medical Education" twice a
year.
iii) The editorial board will be continuously in touch with
the consortium institutes to receive information or reports
on their activities which will be synthesized and published
in the journal.
iv) A computerized system of publication will be developed
to enable each of the consortium institutes to quickly access
information.
The editorial board will hold three meetings for bringing
out one issue - viz, for planning, selecting suitable articles
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or refer back for modification, and considering the modified
article.
In addition the edilcrinl board members will work
individually to perform editorial function.
Proposals for Eva-nation and Follow up :
The draft of the jouim : will be thoroughly screened by the
editorial board by co eloping suitable indicators for the
purpose. It is also pi >r c l to circulate questionnaire to the
readers to judge th u lefulues.: of the. journal and their
suggestions will be
' •poratec' for improving the quality
of the journal.
6. EXPANS1
07 T.UE CONSORTIUM
Specific Objectives
•
To initiate inquiry di .7e:' ..... eg .' in two institutes;
e
To enable the a-. . iatu '.'.hi utu to collect database,
identify curric H • u_r y : id adopt suitable
innovation.
•
To promote lead, mbi
b m?dical education by
nmkidis
dp'.i
facilitating a nnikidis :ip'.i : ry approach to curriculum
development.
t , L ? Us. d :
Methods and Approachi
(i) A group of eight U '-.d • r
will site visit the new ins ti
consortium.
. r ch o 'the eight institutes
(s) for initiating them into
(ii) To hold an on-site work.-h j al the associate institute to
sensitize them in inquiq, chi . n strategy.
(iii)The newly associated me .nbcrs v mild conduct inquiry,
collect data on mortality/m wb‘ iity etc. alongwith information
on existing curriculum.
(iv) Some of the inn.-w.nh- c- kkntih?.! by the consortium
will also be tried out i. ; ch.- .-ew inmitute.
(v) There will be cons! -.it in'.eracticn between existing and
new member to share information co their experiences.
2 i-3
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•
Proposals for Evaluation and Follow up :
* ■
The consortium institutions will develop suitable indicators
) , . Ige the diffusion of inquiry driven approach into the
iy associated institutes. The workshop will have inbuilt
tluation through session and program e'/aluation
s-ionnaires.
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