Professional Documents
Culture Documents
ZPPD Curriculum 2014 II
ZPPD Curriculum 2014 II
FOR
MEDICAL COURSE
2014
[Volume 2]
CLINICAL COURSE
Faculty of Medicine
UNIVERSITY OF JAFFNA
Page- i
Page- ii
Summary
Table of Contents
INTRODUCTION .................................................................................................................................. 5
SUMMARY OF CLINICAL APPOINTMENTS ................................................................................... 7
FOURTH YEAR COMMON OSCE ...................................................................................................... 9
INTRODUCTION TO CLINICAL COURSE ..................................................................................... 10
1.
Page- iii
Page- iv
Summary
INTRODUCTION
The clinical course starts during the Phase II but introduction to clinical
situations are provided in Phase I in the form of applied anatomy and applied
physiology with the objective of showing the relevance of basic sciences for clinical
practice. They go to the teaching Hospital for clinical studies in the morning and
attend thepara-clinical studies in the afternoons during Phases II and III. Students
spend the entire day in the hospital during the professorial studies in the Phase IV.
The course starts with one week of introductory program. Then the students
are posted for first appointment in Medicine of 8 weeks and Surgery of 4 weeks.
This is followed by 4 week appointments in Paediatrics and Obstetrics &
Gynaecology followed by one week appointments in Blood Bank,Venereology,
Neurology and Oromaxillary surgery and two week appointments in Chest medicine,
Radiology, Clinical Pathology, and Dermatology.
Students are then posted to second appointment in Surgery of six weeks
followed by four week appointment in Orthopaedics, eight week appointment in
Community Medicine and 6 week appointment in Psychiatry. Students are posted to
second Paediatrics and second Obstetrics & Gynaecology and Forensic Medicine of
four weeks and two week appointments in Otolaryngology [ENT], Ophthalmology,
Oncology, Primary Health Care institutions under Medical Officer of Health and
Cardiology.Anaesthesia& Intensive Care is given 3 weeks.
Finally they go for the second appoint in Medicine for 8 weeks and third
appointment in Surgery of six weeks. At the end of all the pre-professorial
clerkships, the students are taken on educational tour of two weeks to visit important
national institutions related to health and at the same time they will visit other
Faculties of Medicine to improve social harmony.
At the end of all these rotations the students are sent for elective
appointments of four weeks. Before the commencement of final year appointments,
a Common OSCE will be conducted to ensure that the students have acquired the
prescribed clinical knowledge, skills and attitudes during the pre-professorial
appointments.
Finally they go for eight weeks of professorial appointments in Medicine,
Surgery, Paediatrics and Obstetrics & Gynaecology and four week appointments in
Psychiatry and Family / Community Medicine.
The students should have the following to be admitted to the professorial
appointments:
Completed the Second Examination for Medical Degrees.
Completed all pre-professorial appointments.
Passed fourth year Common OSCE.
Passed the examination in Sociology.
Passed the examination in second part of PPDS.
All the major appointments and most of the short appointments are held in the
Teaching Hospital. They will have to go to the Chest Clinic at Pannai, Psychiatric
unit at BH Tellipallai and many other institutions as need arise.
More appointments will be included as new units are developed in the
Teaching hospital. However, patients related all subspecialties are exposed to
Page- 5
Introduction
students as those patients are managed in Medical or Surgical Units if no special unit
is available.
Page- 6
Introduction
Subject
General
Community
and Family
Medicine
Forensic
Medicine
Pathology
Psychiatry
Medicine
Obstetrics
and
Gynaecology
Appointment
Weeks
1
1
2
2
6
8
2
2
2
14
Forensic Medicine
Clinical Pathology
First Psychiatry
Professorial Psychiatry
Total
First Medicine
Dermatology
Sexually Transmitted diseases
Chest Medicine
Cardiology
Rheumatology
Neurology
Second Medicine
Professorial Medicine
Total
First Obstetrics & Gynaecology
2
8
10
8
2
1
2
2
1
8
8
32
4
4
8
16
Page- 7
Introduction
First Paediatrics
Neonatology
Second Paediatrics
Professorial Paediatrics
Total
First Surgery
Second Surgery
Orthopaedics
Oromaxillary surgery
Third Surgery
Otolaryngology
Ophthalmology
Anaesthesiology & Intensive care
Neurosurgery
Cardiothoracic surgery
Vascular surgery
Paediatric surgery
Urology
Accident and trauma
Professorial Surgery
Total
4
1
4
8
17
4
6
4
1
6
2
2
3
Elective 1
Depends on selection
Total
All
Paediatrics
Surgery
139
Page- 8
Introduction
8
36
Page- 10
Introduction
SURGERY
Page- 11
Introduction
1. GENERAL APPOINTMENTS
This section describes the appointments that
cannot be classified as an independent subject
because clinical material related to all fields of
medicine is involved in these appointments.
They include,
1.1. Blood Bank
1.2. Radiology
1.3. Oncology
Page- 12
Common Appointments
Consultant/supervisor
Duration
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
no
Places to visit
10
11
12
13
14
Assessment method
15
16
References
Page- 13
Common Appointments
1.2. Radiology
1
Consultant/supervisor
Consultant Radiologist
Duration
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
no
Places to visit
Radiology unit
10
11
12
13
14
Assessment method
15
Attendance.
16
References
Page- 14
Common Appointments
1.3. Oncology
1
Consultant/supervisor
Consultant Oncologist
Duration
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
Places to visit
10
11
12
13
14
Assessment method
15
16
References
Page- 15
Common Appointments
Page- 16
Community Medicine
Consultant/supervisor
Duration
Number of Students
Usual time
8-12 noon
Additional time
Saturdays till1 PM
Prerequisite
no
Places to visit
As in the objectives
10
As in the objectives
11
As in the objectives
12
As in the objectives
13
14
Assessment method
15
16
References
Page- 17
Community Medicine
Programme
Introduction
Programme timing and duration
1. Timing: Third and Fourth year
2. Duration: Eight weeks
3. Tutors: Staff from Department of Community and Family Medicine (DCFM),
Medical Officer of Health (MOH) Nallur and other community tutors.
The teaching and assessment are shared among the staff of the Department of
Community and Family Medicine (DCFM), Medical Officer of Health (MOH)
Nallur and other community tutors. Community tutors are drawn from a wide variety
of backgrounds, some will be working or have worked with a social care or health
care (conventional or alternative) organisation, or with a voluntary organization
providing support or advice for people in need. Ideally, they will represent the sort of
partnership and collaboration that can exist between the statutory and voluntary
Page- 18
Community Medicine
sectors. Most of the teaching and course activities take place at the MOH Nallur, but
sometimes community tutors meet students at their own place of work or arrange and
accompany students on visits to local organisations. Both DCFM staffs and MOH
Nallur staffs should both be involved in the assessment of the students.
Students are expected to be with the tutors from8.00 am to12.00 pm.
Learning methods
The objectives for each day are clearly set out in this student guide, with suggestions
for activities for achieving them. Students will enjoy a variety of teaching methods.
These could include:
reflection
clinical skills
case studies
Students should obtain the assistance of the tutors to choose an aspect of each
days activities.
Students should maintain learning logs related to the activities of each day.
Student can get the support from the tutorsto achieve and assess their learning
objectives. If the student feels that he/shehas not met the learning objectives for
the day,can get the guidance.
Student can get the support to select a topic for the health education.
Page- 19
Community Medicine
Organization
Group leaders will be selected from the groups and will be rotated during the
appointment.
Each student will receive a student guide for the Community Medicine Attachment
All students should maintain a portfolio and should submit it to the Department of
Community Medicine at the end of the appointment for assessment.
Assessment:
The clerkship assessment will take place at the end of the appointment of four weeks.
The assessment will comprise of the following
a. Attitude and application (AA) (20%)
b. Health education. (30%)
c. A paper with Structured Essay Questions (SEQ) (50%)
d. Portfolio Assessment (50%)
A total mark assigned is 15% at 3rd MBBS Part II Examination.
List of Activities:
1. Appointment with MOH (19 days)
1.1.
1.2.
Poly clinic
1.3.
1.4.
Postnatal care
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Community Medicine
1.5.
1.6.
1.7.
1.8.
Supervision of a staff
1.9.
MOH conference
1.10.
1.11.
1.12.
1.13.
1.14.
1.15.
Occupational health
1.16.
1.17.
Outbreak investigation
1.18.
2.2.
2.3.
Infection control
2.4.
Administration set up
2.5.
2.6.
2.7.
Surveillance system
2.8.
2.9.
TB control activity
3.2.
3.3.
3.4.
3.5.
AROD
3.6.
CANE
3.7.
3.8.
3.9.
3.10.
Skill Lab
Clerkship Programme
Poly clinic:
Antenatal clinic (ANC), Child Welfare Clinic (CWC) and Family Planning clinic are
conducted during a poly clinic day of a clinic Centre of Nallur MOH. Students are
expected to work in ANC and CWC during their poly clinic visit.
The students will work in small groups during their assigned visit to the poly clinic.
During the ANC time a mother will be allocated to a student. Each student should
follow up the mother from the time of registration at the clinic and take part in all
clinic procedures in respect to this mother during her stay at the clinic. During this
activity the student should observe the activities of the PHM, PHNS and the MOH in
the clinic. The students should critically evaluate the activities in the clinic and
prepare a report to be included in the portfolio.
Outcomes:
The students should be able to
describe the activities carried out to improve the health of the pregnant
mothers
describe the health and the social risk assessment and the referral procedures
Then during the CWC time a mother with a child will be allocated to a student. Each
student should follow up the child from the time of registration at the clinic and take
part in all clinic procedures in respect to this child during his/her stay at the clinic.
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Community Medicine
During this activity the student should observe the activities of the PHM, PHNS and
the MOH in the clinic. The students should critically evaluate the activities in the
clinic and prepare a report to be included in the portfolio.
Outcomes:
The students should be able to
Describe the activities carried out in the CWC in the order in which they are
performed
methods
Observe a home visit by PHM to a couple adopted a family planning
method
Postnatal Care
Students will be posted with PHM. Initially tutor will discuss the objectives and the
activities carried at postnatal clinic and postnatal home visit. Then students will be
divided into two groups and will be carried the home visit. The students should
discuss the postnatal care and involve in reflective writing. All the learning activities
will be included in the portfolio
Outcomes:
At the completion of the visit the student should be able to
non-lactating
discharge counseling
Community Medicine
List the non communicable diseases targeted at well women clinics and
Carry out the clinical and investigations which are done at WWC
describe the health promotion activities that can be done to overcome the
Page- 25
Community Medicine
describe the health services available for school children in Sri Lanka
Discuss the roles of the teachers and health personnel at a SMI session
groups
SMI
places
Identify the common illness found among school children indifferent age
List the health education topics, materials used and describe the methods used
Supervision of Staff
Students will be posted with MOH. Initially tutor will discuss the objectives and
importance of the supervision. Then tutor will explain the way to carry out
supervision and using the findings of supervision to improve the performance of the
programme. Then students will observe the supervision activity which is carried out
by the MOH. Then MOH will discuss the issues related to the particular supervision.
Finally students should involve in reflective writing. All the learning activities will
be included in the portfolio.
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Community Medicine
Outcomes:
At the completion of the activity, the student should be able to
MOH conference
Students will be posted with MOH. Initially tutor will discuss the objectives and
importance of the MOH conference. Students will observe the activities carried
during the conference. Student will maintain the learning log to list and reflect the
activities. Finally students should involve in reflective writing. All the learning
activities will be included in the portfolio.
Outcomes:
At the completion of the visit the student should be able to
identify the common illness found among people indifferent age groups
Page- 28
Community Medicine
to consumers
Market&Refuse Disposal
Outcome:
At the completion of the visit the student should be able to
3.4.
2.
3.
Gender Based Violence (GBV) and Child abuse divisional multi disciplinary
team (MDT) meeting
Students will be posted with MOH. Initially tutor will discuss the issues related to
GBV and child abuse and various stakeholders who are working in GBV and child
abuse at MOH and divisional secretary level. Then they will attend the MDT meeting
at divisional secretary office and observe the case discussion. Each student should
follow up acaseand write a report. All the learning activities will be included in the
portfolio
Objectives
At the completion of the activity, the student should be able to
Community Medicine
Identify the common risk factors for the prevention of GBV and child
abuse
Describe the referral pathway to handle the cases related to GBV and
child abuse.
List records and other instruments needed for the prevention of GBV
and child abuse
Describe the role of various community organizations for the
prevention of the GBV and child abuse
Occupational health
Students will be posted with PHI. Initially tutor will discuss the objectives,
importance and components of the occupational health of Sri Lanka. Then students
will be divided into groups. Groups will visit to small scale work place and observe
the activities of the PHI in different components of the occupational health. Student
will maintain the learning log to list and reflect the activities. Finally students should
involve in reflective writing. All the learning activities will be included in the
portfolio.
Outcomes:
The students should be able to:
Describe the interaction between the management and the workers its effects
The students will prepare their presentations according to the specific questions and
objectives for 30 minutes. Students will be randomly selected and asked to present
Outbreak investigation
Students will be posted with PHI. Initially tutor will discuss the objectives,
importance and components of the outbreak investigation. Then students will be
divided into groups. Groups will visit to relevant places where infectious cases
reported in the particular month and observe/ discuss the activity/activities carried
out by the PHI. Student will maintain the learning log to list and reflect the activities.
Finally students should involve in reflective writing. All the learning activities will
be included in the portfolio.
Outcome
At the completion of the activity, the student should be able to
Describe the referral pathway to handle the cases related to GBV and
child abuse.
List records and other instruments needed for the prevention of GBV
and child abuse
Describe the role of various community organizations for the
prevention of the GBV and child abuse
health activities. Then students will be divided into groups. Groups will meet the
mothers club members and discuss with them about their activities and community
empowerment activities to improve the health status of the community. Student will
maintain the learning log to list and reflect the activities. Finally students should
involve in reflective writing. All the learning activities will be included in the
portfolio.
Outcomes
At the end of the community empowerment activity students should be able to:
understand the socio cultural issues and their influence on disease prevention
2.
3.
4.
5.
2.2.
Students will be posted with medical statistics unit Teaching Hospital Jaffna and
MOH Nallur. Initially tutor will discuss the health information system of Sri Lanka.
Then students will be divided into groups. One group will go to the statistics unit TH
Jaffna and second group will go to MOH office Nallur. Groups will critically
evaluate the effectiveness of the existing HIS and compare the HIS in different
settings in the world. Students will be requested to do the presentation about their
activities. Student will also maintain the learning log to list and reflect the activities.
Finally students should involve in reflective writing. All the learning activities will
be included in the portfolio.
Outcome:
At the completion of the visit the student should be able to
2.3.
1.
2.
3.
4.
5.
Students will be posted with infection control nursing officer at Teaching Hospital
Jaffna. Initially tutor will discuss the infection control activities carried out in an
institution and the hospital waste management. Then students will be divided into
groups and visit the wards, theatre, sterilizing unit and hospital waste management
unit. Student will discuss the present status and the short comings compare to the
national guide line produced by the Quality and Safety unit of Ministry of Health.
Student will also maintain the learning log to list and reflect the activities. Finally
students should involve in reflective writing. All the learning activities will be
included in the portfolio.
Outcome:
At the completion of the visit the student should be able to
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Community Medicine
List the activities that are done by the infection control nurses
Understand and discuss the short comings of the infection control activity
2.4.
Administration set up
Students will be posted with Director of Teaching Hospital Jaffna. Initially director
will discuss the administrative setup of an institution. Then students will be divided
into groups. Groups will go and discuss the administrative and financial role with the
accountant and administrative officer at the hospital. Students also will be introduced
the Sri Lanka establishment code and financial regulations. Students will be
requested to do the presentation on the information which they gather during the
visit. Student will also maintain the learning log to list and reflect the activities.
Finally students should involve in reflective writing. All the learning activities will
be included in the portfolio.
Outcome:
At the completion of the visit the student should be able to
care
consumable etc.
office of the
Accountant
Page- 35
Community Medicine
2.5.
Students will be posted with Chief pharmacist and in charge nursing officer of
Teaching Hospital Jaffna. Initially chief pharmacist will discuss the need assessment,
ordering and getting drugs and equipment from the Medical Supplies Division,
storage and distribution of drugs within the institution. Then students will visit to the
drug stores and observe the facility, and then students will go to a ward where ward
in charge nursing officer will explain how the drugs are odered and maintained at
ward level. Students will learn about the drug regulation in the country. Students will
be requested to do the presentation on the information which they gather during the
visit. Student will also maintain the learning log to list and reflect the activities.
Finally students should involve in reflective writing. All the learning activities will
be included in the portfolio.
Outcome:
At the completion of the visit the student should be able to
List the duties and responsibilities of the Chief Pharmacist and ward
incharge sister
2.6.
Students will be posted with RDHS. Initially tutor will discuss the objectives and
importance of the public health review meeting. Students will observe the activities
carried out during the meeting. Student will maintain the learning log to list and
reflect the activities. Finally students should involve in reflective writing. All the
learning activities will be included in the portfolio.
Page- 36
Community Medicine
Outcome:
At the completion of the visit the student should be able to
level
2.7.
Surveillance System
Students will be posted with Regional Epidemiologist. Initially tutor will discuss the
objectives and importance of the different surveillance methods and strategies to
control major diseases in the country. Students will also learn and discuss the
notification system in Sri Lnaka. Students in small groups will be attached to the
paediatric or medical wards in which they should identify a child/adult who had been
admitted to the ward with a notifiable disease for more than a week
fromNallurMOH area. They are expected to follow up the notification procedures in
the hospital and in the patients PHI area and prepare a report for presentation.
Student will maintain the learning log to list and reflect the activities. Finally
students should involve in reflective writing. All the learning activities will be
included in the portfolio.
Objectives
The students should be able to:
Describe the different surveillance methods used to control the different types
describe the procedure of the surveillance system in the hospital and in the
field
Describe the parasite and vectors with special reference to the common one
List control methods that are carried out in the Jaffna district at MOH level
level
Describe the control methods carried out in the Jaffna District at MOH
students should involve in reflective writing. All the learning activities will be
included in the portfolio.
Outcomes
At the completion of the visit the student should be able to
1. Describe the organization of the NPTCCD (National Programme for
Tuberculosis and chest diseases
2. Describe the functions of the NPTCCD.
3. Describe the prevalence of TB in Jaffna & Sri Lanka
4. Describe the control measures carried out and their effectiveness and failures
5. Describe the drug schedule for different types of TB and the side effects
6. Describe the role of PHI in prevention of TB
7. Describe the WHO stop TB Strategy.
8. Evaluate the DOTS programme in the community
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Community Medicine
Describe the facilities and tools to assess the health, social and
emotional needs of the institutionalized elders.
Challenges encountered by the elders, workers and managers to
provide good services.
On admission
On follow up care
limp
Page- 41
Community Medicine
2.
3.
4.
5.
6.
7.
8.
3.5. AROD
Students will be posted with Director of the AROD Jaffna. Initially tutor will discuss
the organizational structure, facilities and activities of the organization. Then
students will be divided into groups and work with the trainees and trainers. Students
will carry out the interviews with trainees and trainers. They also will observe the
facilities available at the school and critically discuss the health and social related
issues. Students will be requested to prepare a report and also will maintain the
learning log to list and reflect the activities. Finally students should involve in
reflective writing. All the learning activities will be included in the portfolio.
Outcomes:
At the completion of the visit the student should be able to
Page- 42
Community Medicine
3.6. CANE
Students will be posted with Director of the CANE. Initially tutor will discuss the
organizational structure, facilities and activities of the hospice. Then students will be
divided into groups and work with the patients and service providers. Students will
carry out the interviews with patients and service providers. Students also will
observe the facilities available at the CANE and critically discuss the health and
social related issues. Students will be requested to prepare a report and also will
maintain the learning log to list and reflect the activities. Finally students should
involve in reflective writing. All the learning activities will be included in the
portfolio.
Outcomes:
At the completion of the visit the student should be able to
carry out the interviews with elders and service providers. Students also will observe
the facilities available at the institutions and critically discuss the health and social
related issues. Students will be requested to prepare a report and also will maintain
the learning log to list and reflect the activities. Finally students should involve in
reflective writing. All the learning activities will be included in the portfolio.
Outcomes:
At the completion of the visit the student should be able to
Discuss the neediness of the organization to provide good health care for
elders
the community
Describe the activities carried out by the organization, in the institution and
Community Medicine
3.9.Skill Lab
Students will be posted to the skill lab. Initially tutor will teach the clinical skills
with the help of models. Then students will be divided into groups and practice with
the models. Students will be requested to prepare a report and also will maintain the
learning log to list and reflect the activities. Finally students should involve in
reflective writing. All the learning activities will be included in the portfolio.
Outcomes:
At the completion of the activity the student should be able to
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Community Medicine
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
8.10
8.11
8.12
Page- 46
Community Medicine
Consultant/supervisor
Duration
2 weeks[2x6x4=48 hours]
Number of Students
Usual time
8 A M -12 noon
Additional time
no
Prerequisite
Yes
Places to visit
10
11
Record keeping.
Adopt the appropriate consultation model
Management in primary health care setup
12
13
14
Assessment method
15
16
References
Page- 47
Community Medicine
1.
2.
3.
4.
5.
6.
7.
8.
Observation phase
Discussion about the future place of family medicine in the srilankan health
system
Discussion about the WHO recommended primary health care center
Observing in the medical records and its maintaince, prescription format,
referral letter format, medical certificate format the appointment system
Observe the impotent of family in the management of health related problem
in the primary care
Observe about the patient management in primary care set up
Visit to the pharmacy familiar with the available drugs,
Involving in the home visit
Observe in rotation basis about the consultation process ,discuss about it
Second week
Active participation phase
1. Actively participate in the maintains of health records, appointment system
2. Actively participate in health education, counseling
3. Participate in the prescription of drugs and maintain the compliance
Teaching methodology
1. lectures
2. small group discussion
3. Observation
4. Active participation
5. Encouragement ; create new ideas regarding the new development of
primary care
6. Production ; valuable material which use full for the medical education and
patient care
Evaluation methods
1. In course assessment
2. Case study
3. Family study
Page- 48
Forensic Medicine
Consultant/supervisor
Duration
2 weeks
Number of Students
the batch
Usual time
Full time
Additional time
Prerequisite
Yes
Places to visit
10
11
Attitudes students to acquire Good attitudes and applying medical ethics in all
aspects of the appointment
13
14
Assessment method
15
16
References
Page- 50
Forensic Medicine
3. FORENSIC MEDICINE
Details of appointment in Forensic Medicine
are given in this section.
Page- 51
Forensic Medicine
Duration
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
yes
Places to visit
Objectives / purpose
of the appointment
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
Forensic Medicine
Criteria to sign
Student record book
16
References
B)
C)
(1)
(2)
(3)
(4)
D)
(1)
(2)
E)
F)
G)
H)
I)
Skeletal productions
(1)Examine skeletal productions towards identifying
(a) Age
(b) Sex
(c) Stature
(d) Cause of death
(e) Time since death
(f) Other medico-legal issues.
Sending specimens to the Government Analyst
Describe how you would collect, preserve, document and transport material
for analysis by government analyst of the following
(a) Poisons
(b) Seminal fluid
(c) Blood
(d) GSR in firearm injuries (Gun Shot Residue)
(e) Swabs for saliva
(f) Hairs
(g) Other contact trace material.
Sending specimens to the Microbiologist
Describe how you would collect, preserve, document and transport material
for analysis by microbiologist.
Sending specimens to the Histopathologist
Describe how you would collect, preserve and transport tissues for
histological Analysis.
Court visit
Visit a court of law and witness doctor giving evidence or court proceedings.
Maintaining medico legal documents, confidentiality & chain of custody
Describe how you would maintain documents, files and registers in relation
to medico-legal work in the office. State the people who may have access to
documents maintained by you.
Page- 54
Forensic Medicine
4. PATHOLOGY
Details of appointment in Clinical Pathology
are given in this section.
Page- 55
Pathology
Consultant/supervisor
Clinical Pathologist
Duration
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
no
Places to visit
10
11
Haematological investigations
12
13
14
Assessment method
15
16
References
Page- 56
Pathology
5. MEDICINE
This section describes the appointments that
are predominantly related to Medicine. They are,
5.1. First Medicine
5.2. Dermatology
5.3. Sexually Transmitted diseases
5.4. Chest Medicine
5.5. Cardiology
5.6. Neurology
5.7. Rheumatology
5.8. Second Medicine
5.9. Professorial Medicine
Page- 57
Obstetrics & Gynaecology
Consultant/supervisor
All Physicians
Duration
Number of Students
Up to 15 students / Physician
Usual time
8 A M -12 noon
Additional time
Prerequisite
yes
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 58
Obstetrics & Gynaecology
skills
of
Introducing self to the patient and getting consent to examine the patient.
Training in talking to patients and relatives.
Understanding the components of the history and their importance.
Punctuality: students must be in the ward before 7.30 A.M. and should
not leave without permission before 12 noon.
5. Attendance: 80% attendance is required before they could be signed up.
6. Attitude: Students must have a sense of responsibility and belonging to the
medical profession. They must be kind towards patients and be aware of
their problems. They also must be courteous towards patients and the staff
attached to the ward and the hospital. They must show keenness in
improving the quality of medical care. The students must understand and
respect the right of the patients and staff who are working in the ward.
1.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
History taking:
The students must be able to,
Elicit information to establish the identity of the patient. (Name, age, sex,
address etc.)
Elicit the chief complaints and the duration of each complaint.
Establish the relevant symptoms pertaining to the various systems.
Explore the past medical history related to presenting complaint and others.
Explore the personal habits and affective state.
Elicit the family history and its impact on illness.
Explore the environment and its effect on illness.
Interpret any information obtained with regard to the pathophysiology of the
patients illness.
Present at least two case histories to the supervising officer.
Maintain a log book of case histories which should be signed by the
supervising officer.
Physical Examination;
General Examination.
The students should be able to,
Identify the general state of health and comfort.
Identify the state of nutrition.
Identify the signs of any vitamin deficiency.
Inspect the face and identify any abnormalities.
Inspect the tongue and conjunctiva and identify the presence of anaemia
and cyanosis.
Inspect the sclera and identify the presence of jaundice.
Inspect for and identify the presence of enlarged lymph nodes.
Inspect the finger nails and identify any abnormalities.
Inspect for and identify the presence of ankle and sacral oedema.
Inspect the skin and identify any lesions.
Identify any other abnormalities.
Joint inflammation and deformities
Page- 59
Obstetrics & Gynaecology
2.
Cardiovascular System.
The students should be able to,
i.
Examine the radial pulse and identify the rate, rhythm, volume, and
character of the pulse.
ii.
Examine other peripheral pulses and identify the diminution or delay of
any pulse.
iii.
Measure supine and standing blood pressures.
iv.
Inspect the neck for arterial pulsations and identify any abnormalities.
v.
Inspect the neck for jugular venous pulse and identify any elevation of the
venous pressure.
vi.
Inspect the precordium and identify any deformities, position of the apex
beat and any other pulsations.
vii.
Palpate for and identify the position of the apex beat and describe the
character.
viii. Palpate for and identify the presence of a left parasternal heave.
ix.
Palpate for and identify the presence of thrills, palpable heart sounds and
any other abnormal pulsations.
x.
Demonstrate the correct technique of percussion and delineate the cardiac
borders.
xi.
Auscultate all areas of the precordium and identify any abnormality in the
heart sounds, murmurs and pericardial friction rub. Palpate for neck
thrills and conductance of murmur to neck.
xii.
Interpret any physical sign elicited with reference to the pathophysiology
within the cardiovascular system.
3.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
4.
i.
ii.
iii.
iv.
v.
vi.
Respiratory System.
The students should be able to,
Inspect the chest anteriorly, laterally and posteriorly.
Describe the configuration of the chest.
Determine the rate of respiration.
Describe the nature of the chest movements.
Palpate the chest anteriorly, laterally and posteriorly.
Identify the expansion of the chest in the three zones.
Identify any abnormalities in the vocal fremitus in the three zones.
Palpate for and identify the position of the trachea.
Percuss to delineate the lungs from the heart and the liver
Identify any alteration in the percussion note over the lungs.
Auscultate all areas of the lungs and identify any abnormalities in the
intensity and character of breath sounds, intensity of the vocal resonance
and the presence of any adventitious sounds.
Interpret any physical sign elicited with reference to the pathophysiology
of the respiratory system.
Abdomen.
The students should be able to,
Inspect the abdomen including hernial orifices and genitalia.
Describe the findings of inspection.
Palpate abdomen systematically.
Identify the presence of tenderness, guarding or rigidity.
Palpate for and identify an enlarged liver and describe its size, surface,
consistency, edge and presence of tenderness.
Palpate for and identify the presence of enlarged kidneys.
Page- 60
vii.
viii.
ix.
x.
xi.
5.
Nervous System.
The students should be able to examine the following, describe,
identify any abnormalities and interpret any physical sign elicited with reference to
the pathophysiology of the nervous system.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
Management of patient:
Students should know what happens to the patient on admission, while in the
ward and on discharge.
Students must follow the types of treatment.
At the outpatient clinics:
The students must be present in the clinic before the physician arrives,
allocate all new patients to be seen that day and examine them. Also follow any
other instructions of the consultant under whom they are working.
Casualty admissions:
Students must clerk these patients as usual. But they must understand that
these patients may need urgent treatment.
Reading:
Students must read from standard text books about their patients disease,
symptoms and signs, aetiology, pathophysiology, treatment, and prognosis.
Page- 61
Obstetrics & Gynaecology
5.2. Dermatology
1
Consultant/supervisor
Consultant / MO Dermatology
Duration
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
no
Places to visit
10
11
12
Attitudes students to acquire Care for patients with skin lesions and understand the
cosmetic handicap of the patients.
13
14
Assessment method
15
Attendance.
16
References
Page- 62
Obstetrics & Gynaecology
Consultant/supervisor
MO STD
Duration
1 week[1x6x4=24 hours]
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
Places to visit
STD clinic
10
11
12
13
14
Assessment method
15
16
References
Page- 63
Obstetrics & Gynaecology
Consultant/supervisor
Duration
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
no
Places to visit
Chest Clinic.
10
11
12
13
14
Assessment method
15
16
References
Page- 64
Obstetrics & Gynaecology
5.5. Cardiology
1
Consultant/supervisor
Consultant Cardiologist
Duration
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
yes
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 65
Obstetrics & Gynaecology
5.6. Rheumatology
At present, done along with appointments in Medicine
1
Consultant/supervisor
Duration
Number of Students
Usual time
Additional time
Prerequisite
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 66
Obstetrics & Gynaecology
5.7. Neurology
1
Consultant/supervisor
Duration
Number of Students
Usual time
8 A M -12 noon
Additional time
Prerequisite
No
Places to visit
Objectives / purpose of the Learn to take relevant history and elicit physical
signs
appointment
Form differential diagnosis and plan
appropriate investigations
Learn basic management strategies for common
neurological disorders
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 67
Obstetrics & Gynaecology
Consultant/supervisor
All Physicians
Duration
Number of Students
Up to 15 students / Physician
Usual time
8 A M -12 noon
Additional time
Prerequisite
yes
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 68
Obstetrics & Gynaecology
Target:
At the end of the appointment the student should be able to,
Formulate a problem list to include medical, social, environmental factors.
Identify problems of a patient as a member of the family unit.
Identify effects of illness on family dynamics.
Summarize the findings and make tentative diagnosis and understand the
principles on which a diagnosis is made.
Understand the criteria applied on confirming or rejecting such a single
diagnosis.
Understand the need for narrowing the diagnosis and arriving at a firm single
diagnosis.
Understand the difficulties on making a firm single diagnosis and the method
of eliminating these difficulties.
.
Consolidation of the knowledge acquired in history taking, examination and skills
during the first appointment
.
History taking:
Maintain a logbook of case histories that should be signed by the supervising
officer.
Writing and presenting case histories with differential diagnosis (as many as
possible)
Emphasize on problem based histories rather than system based histories.
Encourage presentation of patients to consultants / senior house officers /
registrars during the ward rounds.
System examination.
Examination of each of the following systems under supervision of a
consultant / SHO / Registrar.
General examination.
Cardiovascular system.
Respiratory system.
Abdomen.
Central nervous system.
Loco motor system.
Examination of fundus
Interpretation of common problems in ECG and X Ray
2. Formation of clinical summaries and problem lists and emphasize solving the
problem.
Page- 69
Obstetrics & Gynaecology
3. Differential Diagnosis:
Students should know the differential diagnosis of patients coming with:
Dyspnoea.
Tiredness.
Chest pain.
Palpitation.
Giddiness, Syncope.
Body swelling, bilateral ankle oedema.
Cough dry, productive.
Haemoptysis.
Wheezing.
Fever with cough, fits, chest pain, Abdominal pain and dysuria.
Pyrexia of Unknown Origin.
Dysphagia.
Heamatemesis.
Melaena.
Diarrhoea, dysentery.
Loss of appetite, loss of weight.
Yellow discoloration of eyes.
Abdominal distension
Abdominal pain.
Polyuria.
Haematuria.
Bleeding tendency.
Arthralgia
Seizures.
Headache.
Weakness of limbs.
Unconsciousness.
Numbness of limbs.
Snake bite.
4.
5.
6.
Page- 70
Obstetrics & Gynaecology
7.
Familiarization with:
Drug trolley.
Emergency trolley.
Drug charts.
Administration of medicines.
Nebulization.
8.
9.
10.
11.
1.
13.
Page- 71
Obstetrics & Gynaecology
14.
Students should know the following for each of the medical problems listed
below.
Aetiology.
Pathophysiology.
Clinical features: history, examination and investigation (basic and special).
Diagnosis.
Differential diagnosis.
Brief treatment general and specific.
Follow up.
Prognosis.
o
o
o
o
o
o
o
o
o
Types of treatment:
The students should know the following types of treatment.
General.
Specific.
Symptomatic.
Prophylactic.
Follow up.
Prevention of spread.
Prevention of recurrence.
Treatment of the family.
Rehabilitation.
Common Medical Problems.
Hypertension.
Cardiac failure.
Rhythm disturbances.
Coronary artery diseases
Rheumatic fever and rheumatic heart disease.
Infective endocarditis.
Pericarditis and pericardial effusion.
Bronchial asthma.
Bronchiectasis.
Acute respiratory tract infections pneumonia.
Chronic respiratory tract infections unresolved pneumonia, lung
abscess, tuberculosis.
Pleurisy and pleural effusion.
Pneumothorax.
Carcinoma of the lung
COPD
Haemoptisis
Feverso PUO.
o Bacterial Typhoid.
o Viral infectious mononucleosis, measles, mumps, chickenpox.
o Protozoal malaria, amoebiasis.
o Spirochaetal leptospirosis.
o Typhus.
Peptic ulcer.
Haematemesis and melaena.
Page- 72
Dysenteries.
Acute / chronic diarrhoeas
Jaundice.
Hepatitis, alcoholis
Acute renal failure.
Chronic renal failure.
Glomerulonephritis.
Nephrotic syndrome.
Urinary tract infections.
Diabetes mellitus.
Hypo and hyperthyroidism.
Addisions disease
Cushing syndrome
Acromegally.
Obesity.
General wasting.
Anaemiao Megaloblastic.
o Iron deficiency.
o Haemolytic.
o Aplastic.
o Secondary.
Leukaemias acute, chronic myeloid leukaemia, chronic lymphatic
leukaemia.
Lymphomas.
Myeloma.
Patients with high ESR.
Rheumatoid arthritis.
Systemic lupus erythematosus.
Epilepsy.
Headache.
Meningitis, cerebral abscess, encephalitis.
Paraplegia.
Peripheral neuropathies.
Poisoning organophosphates, organochlorines, yellow oleander,
paracetamol, corrosives, kerosene
Snake and insect bites.
Stroke- CVA
Alcohol withdrawal
Unconsciousness.
Recommended books.
Clinical Medicine a text book for medical students and doctors. Edited by
Parveen Kumar and Michael Cleark.
Davidsons principles and practice of medicine.
Clinical methods by Hutchison.
Clinical methods by John Macleod and John Munro.
Chamberlains clinical methods.
Neurology Dr. J. B. Peries.
Page- 73
Obstetrics & Gynaecology
Consultant/supervisor
Duration
Number of Students
Usual time
Full time
Additional time
Prerequisite
yes
Places to visit
10
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 74
Obstetrics & Gynaecology
Page- 75
Obstetrics & Gynaecology
Upper GI endoscopy
Ultrasound examination
CT scan
Echocardiographic examination
Preparation for an IVP examination
Pleural tap & Biopsy
Abdominal paracentesis
Barium studies
Liver biopsy
Lung function test
Bronchoscopy & Endotracheal intubation
Bone marrow examination
Renal biopsy
Passing a nasogastric tube and performing gastric lavage
lumbar puncture
Page- 76
Obstetrics & Gynaecology
Diabetes
Ischaemic heart disease
Shock
Anaemia
Cerebrovascular disease
Chronic renal failure
Heart Failure
COPD
Page- 77
Obstetrics & Gynaecology
Page- 78
Obstetrics & Gynaecology
Consultant/supervisor
All VOGs
Duration
Number of Students
Usual time
8 A M -12 noon
Additional time
Prerequisite
yes
Places to visit
10
11
Attendance
12
13
14
15
Assessment method
16
References
Logbook
1.
Ash
Monga,
Stephen
Dobbs.
Gynaecology by Ten Teachers.
Nineteenth Edition. Hodder Arnold
London 2011.
2. Philip N.Baker, Louise C Kenny.
Obstetrics
by
Ten
Teachers.
Nineteenth Edition. Hodder Arnold
London 2011.
3. S.Arulkumaran,
V.Sivanesaratnam,
A.Chatterjee, P.Kumar. Essentials of
Obstetrics. Second edition. New Delhi
2011.
S.Arulkumaran, V.Sivanesaratnam,
A.Chatterjee, P.Kumar. Essentials of
Page- 79
Obstetrics & Gynaecology
Topics to learn
Obstetrics
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
Gynaecology
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
Other less common malignant tumours of the uterus and fallopian tubes
Tumours of the ovary
Endometriosis
Amenorrhoea
Abnormal uterine bleeding
Dysmenorrhoea
Hormone therapy in Gynaecology
Infertility
Abortion
Extra uterine pregnancy
Contraception and sterilization
Psychosomatic problems and sexual difficulties
Urinary mal function in gynaecological cases
Backache
Gynaecological problems in developing countries
Gynaecological operations
Radiotherapy in gynaecology
Page- 82
Obstetrics & Gynaecology
Consultant/supervisor
All VOGs
Duration
Number of Students
Usual time
8 A M -12 noon
Additional time
Prerequisite
yes
Places to visit
10
11
12
As in introductory course
Keep the medical institution clean,
respectable and reassuring.
13
14
Assessment method
Logbook.
15
Attendance.
16
References
4.
5.
6.
Ash
Monga,
Stephen
Dobbs.
Gynaecology
by
Ten
Teachers.
Nineteenth Edition. Hodder Arnold
London 2011.
Philip N.Baker, Louise C Kenny.
Obstetrics by Ten Teachers. Nineteenth
Edition. Hodder Arnold London 2011.
S.Arulkumaran,
V.Sivanesaratnam,
A.Chatterjee, P.Kumar. Essentials of
Obstetrics. Second edition. New Delhi
Page- 83
Obstetrics & Gynaecology
2011.
S.Arulkumaran, V.Sivanesaratnam,
A.Chatterjee, P.Kumar. Essentials of
Gynaecology. Second edition. New Delhi
2011.
Topics to learn
Obstetrics
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Page- 84
Obstetrics & Gynaecology
21. Abnormalities of the pelvic organs complicating pregnancy, labour and the
puerperium.
22. The foetus at risk in late pregnancy, intrauterine foetal death.
23. Dystocia
24. Foetal malposition and mal presentation and foetal abnormalities which cause
dystocia.
25. Pelvic abnormalities and cephalo pelvic disproportion
26. Abnormal uterine action
27. Obstructed labour
28. Traumatic lesions
29. Postpartum haemorrhage and abnormalities of the third stage
30. Premature labour and premature rupture of the membrane
31. Presentation and prolapse of umbilical cord
32. Foetal distress during labour
33. The relief of pain in labour
34. obstetric Operations
35. Oxytocic drugs
36. Puerperal Pyrexia
37. Disorders of the breast in the puerperium
38. Coagulations disorders
39. Psychiatric disorders in pregnancy and the puerperium
40. Haemolytic disorder
41. Infant feeding
42. Disease s of the new born
43. Vital statistics
44. Care of the newborn infant
Gynaecology
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
Venereal disease
Cysts and new growths of the vulva
Cysts and new growths of the vagina
Fibromyoma of the uterus
Uterine polyp
Carcinoma of the uterus
Other less common malignant tumours of the uterus and fallopian tubes
Tumours of the ovary
Endometriosis
Amenorrhoea
Abnormal uterine bleeding
Dysmenorrhoea
Hormone therapy in Gynaecology
Infertility
Abortion
Extra uterine pregnancy
Contraception and sterilization
Psychosomatic problems and sexual difficulties
Urinary mal function in gynaecological cases
Backache
Gynaecological problems in developing countries
Gynaecological operations
Radiotherapy in gynaecology
Page- 86
Obstetrics & Gynaecology
Page- 87
Obstetrics & Gynaecology
Consultant/supervisor
Duration
Number of Students
Usual time
Full time
Additional time
Prerequisite
yes
Places to visit
As annexed
10
As in the objective
11
As in the objective
12
As in the objective
13
As in the objective
14
Assessment method
Final examination
15
16
References
7.
Page- 88
Obstetrics & Gynaecology
1.
2.
Additional references:
D.Keith Edmonds. Dewhursts Textbook of
Obstetrics & Gynaecology. Seventh
Edition. Blackwell Publishing 2007.
MRCOG and Beyond Series. Second
Edition. RCOG Press, London.
Topics to learn
Obstetrics
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Gynaecology
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
Salpingo oophorotis
Tuberculosis of the genital tract
Venereal disease
Cysts and new growths of the vulva
Cysts and new growths of the vagina
Fibromyoma of the uterus
Uterine polyp
Carcinoma of the uterus
Other less common malignant tumours of the uterus and fallopian tubes
Tumours of the ovary
Endometriosis
Amenorrhoea
Abnormal uterine bleeding
Dysmenorrhoea
Hormone therapy in Gynaecology
Infertility
Abortion
Extra uterine pregnancy
Contraception and sterilization
Psychosomatic problems and sexual difficulties
Urinary mal function in gynaecological cases
Backache
Gynaecological problems in developing countries
Gynaecological operations
Radiotherapy in gynaecology
Page- 91
Obstetrics & Gynaecology
7. PAEDIATRICS
Appointments done in Paediatrics
described in this section. They are,
7.1. First Paediatrics
7.2. Neonatology
7.3. Second Paediatrics
7.4. Professorial Paediatrics
Page- 92
are
Consultant/supervisor
All Paediatricians
Duration
Number of Students
Usual time
8 A M -12 noon
Additional time
Prerequisite
Places to visit
10
11
12
13
14
Assessment method
In course assessment
(OSCE)/SBA/MCQ examination
15
16
References
Page- 93
o
o
o
o
o
Page- 94
5.2. Examine the head and neck of the child with reference to inspection, palpation
and Auscultation if necessary
5.3 Cardiovascular system:
This should include examination of the radial and all the peripheral pulses,
including recording of the BP
Inspection of the precordium
Palpation of the precordium
Percussion of the precordium
Ausculatation over the precordium and related areas
5.4 Respiratory system
Rate of respiration and unusual positions during respiration
Inspection
Palpation
Percussion
Auscultation
This should include measurement of the chest and peak flow rate if relevant
5.5 Abdomen
Inspection
Palpation- superficial and deep
Percussion
Auscultation
Always include genitalia in this examination
If necessary the child may have to be examined in standing position as well
5.6 Central nervous system
The mental state
Gait and abnormal movements
Speech
The cerebella functions
Cranial nerve function
The cerebral functions: the motor system- upper motor and lower motor
neurone functions
The sensory system- superficial and deep sensation
5.7 Do the unpleasant part of the examination at the last. These include the
examination of the nose, ears, mouth and throat
5.8 The learning of examination technique should include that of a new-born baby as
well.
6. Familiarisation with anthropometric measurements
Equipment used for measuring
Correct technique of measuring
Page- 95
Page- 96
7.2. Neonatology
1
Consultant/supervisor
All Paediatricians
Duration
Number of Students
1/8 batch
Usual time
8 A M -12 noon
Additional time
Prerequisite
Places to visit
10
11
Newborn examination
12
13
14
Assessment method
15
16
References
Page- 97
Newborn Examination:
During the week in neonatology you should:
Attend newborn examination rounds
Be able to carry out a normal newborn examination
Be able to identify certain abnormalities like cardiac murmur, clicking
hips and cleft lip/palate
Recognise the importance of the referral system in place of detecting
any anomalies
Page- 98
Consultant/supervisor
All Paediatricians
Duration
Number of Students
Usual time
8 A M -12 noon
Additional time
Prerequisite
Places to visit
10
11
12
As in first appointment
Keep the medical institution clean,
respectable and reassuring.
13
14
Assessment method
OSCE II
15
16
References
Page- 99
Page- 100
Consultant/supervisor
Duration
Number of Students
Usual time
Full time
Additional time
Prerequisite
yes
Places to visit
As in objectives
10
As in objectives
11
12
As in objective
13
14
Assessment method
15
16
References
Page- 101
a. Overall Objectives
At the completion of the required clerkship in Paediatrics a student will be expected
to demonstrate an understanding of the ways children change from birth through
adolescence and how these changes are reflected in physiology, pathology and
growth and development (physical, psychosocial and behavioural). The overall
objective will be met through participation in clerkship activities and with a program
of self-directed learning which will result in the ability to perform each of the
following at the completion of the Paediatric clerkship:
Professional Conduct and Attitudes
It is important that you are aware of the ethical issues of discussing details and
prognosis with relatives and that such discussion should be undertaken with care and
sensitivity.
Page- 103
Page- 104
Neonatology:
Carry out a routine examination of a newborn baby and identify variations from
normal
know the principles of gestational assessment
recognise neonatal jaundice, describe the underlying biochemical disturbances and
appropriate management
be able to explain the terms small for gestational age, low birth weight and very low
birth weight
feed and change a baby
state the common cause of failure to establish feeding and delay in passing
meconium
recognise respiratory distress, evaluate severity and explain the management
Describe neonatal hypoglycaemia and be able to evaluate
Be able to identify the problems of prematurity
Develop a reasonable differential diagnosis and evaluation scheme for newborns
with the following clinical problems
o Lethargy and poor feeding
o Cyanosis
o Vomiting bilious and non bilious
o Jitteriness or seizures
o Sepsis
o Collapse in a neonate
Page- 105
Be able to identify certain congenital abnormalities and know the referral pathway
for them eg: clickyhip,cleft palate/lip, Talipes, various types of naevi and
hypospadiasis
Know the basic chromosomal defects and the various clinical manifestations Eg:
trisomy 18 and 2, Turner/Noonans etc..
Respiratory system:
Cardiovascular system:
Objectives:
Be able to identify the problems based on history and examination
To able appreciate the investigations in relation to the differential diagnosis
Initiate management in common cardiovascular problems
Be able to know the aetiology, pathophysiology, presenting complaints and the
natural history of the clinical problem
Recollect the embryology of the cardiovascular system
Common clinical problems to be learnt
o Acyanotic heart disease
o Cyanotic heart disease
o Acquired heart disease rheumatic heart disease, Kawasaki disease
o Hypertension in children
o Endocarditis
o Heart failure
Gastrointestinal system:
Objectives:
Be able to take a history and do examination of the abdomen
To identify the differential diagnosis based on the individual patient
Identify the problems in the patient and be able to identify the relevant investigation
and initiate management
Be able to know the aetiology, pathophysiology, presenting complaints and the
natural history of the clinical problem
Clinical problems to be learnt
Page- 106
o
o
o
o
o
o
o
o
o
Renal
Objectives:
Endocrine
Objectives
Objectives
Page- 108
Objectives
Miscellaneous
Objectives
Accidents and poisoning
Be able to identify the common forms of home accidents and initiate management
Be able to identify the risks of various types of poisoning paracetamol, kerosene
oil ingestion and organophophates
Student must be confident in managing a child with acute poisoning including the
advice in preventing the accidental forms of poisoning.
Child abuse
Be aware of child health exploitation issues including child prostitution, child labour
and children in combat
Be aware of the effects of armed conflict on child health
Be aware of the UN convention on rights of the child and understand the works of
WHO and UNICEF
Paediatric emergencies:
Prescribing in children:
Page- 110
8. PSYCHIATRY
Appointments done in Psychiatry
described in this section. They are,
8.1. First Psychiatry
8.2. Professorial Psychiatry
Page- 111
are
Consultant/supervisor
Duration
Number of Students
1/4 batch
Usual time
8 A M -12 noon
Additional time
Optional
Prerequisite
yes
Places to visit
10
11
12
13
Assessment method
15
Satisfactory attendance
Present one short history
Fulfilling the tasks given in the appointment
16
References
Page- 113
Consultant/supervisor
Duration
6 weeks
Number of Students
1/4 batch
Usual time
8 A M -5 PM
Additional time
Optional
Prerequisite
yes
Places to visit
10
11
Page- 114
common
psychiatric
12
13
14
Assessment method
16
References
15
Satisfactory attendance
Presenting a short case (to show the students
skills in diagnosing and management plan
Submitting a long case (to show that the
patients problem has been understood in a
wider context)
Participating in group presentation
Fulfilling the tasks given during the
appointment.
Page- 115
8. SURGERY
Appointments predominantly related to surgery
are described in this section. They are,
8.1. First Surgery
8.2. Orthopaedics
8.3. Oromaxillary surgery
8.4. Second Surgery
8.5. Otolaryngology
8.6. Ophthalmology
8.7. Anaesthesiology& Intensive care
8.8. Neurosurgery
8.9. Cardiothoracic surgery
8.10. Paediatric surgery
8.11. Urology
8.12. Accident and trauma
8.13. Third Surgery
8.13. Professorial Surgery
Page- 116
Surgery
Consultant/supervisor
All Surgeons
Duration
Number of Students
Up to 15 students / Surgeon
Usual time
8 A M -12 noon
Additional time
Prerequisite
Places to visit
10
11
12
13
14
Assessment method
15
16
References
Page- 117
Surgery
General:
1.1.
Punctuality:Students must be in the ward at or before 7.30 A. M. and should
not leave without permission before 12 noon.
1.2.
Attendance:A 90% attendance is required before they could be signed up.
1.3.
Attitude:Students must have a sense of responsibility and belonging to the
medical profession. They must be kind towards patients and be aware of
their problems. They also must be courteous towards patients and the staff
attached to the ward and the hospital. They must show keenness in
improving their knowledge and skills, and also in improving the quality of
medical care. The students must understand and respect the right of the
patients not to be examined by them.
1.4.
Dress: As in the Faculty with doctors over coat. [males should be in shoes]
2.
History taking:
2.1.
Students must take detailed history from patients allocated to them and
write them down in a note book.
2.2.
Students must talk to their patients daily and record any change in their
symptoms or arrival of any new symptoms analysis of symptoms.
3.
Examination:
3.1.
Students must do a complete physical examination and record them.
3.2.
Students must examine the relevant part of the body frequently (at least
once a day or more frequently if required) and note the change.
3.3.
Students must make an attempt to summarize their findings and identify
tentative anatomical site and basic pathology of the illness.
Note: Students should know the summary of symptoms and signs of all patients of
interest in the ward even if they are allocated to somebody else.
4.
Management of patients:
The students must follow the type of treatment (operative, drugs, symptomatic etc.)
given to their patients.
4.1.At the outpatient clinics:
The students must be present in the clinic before the surgeon arrives, allocate
all new patients to be seen that day and examine them. Also follow any other
instructions of the surgeon under whom they are working.
4.2.At the operating theatre:
Students must follow the operating theatre regulations.
Students must understand and strictly follow the aseptic principles.
Must watch the operations and understand the nature and type of operation
and the pathology of the disease. The student whose patient is being
operated must take it a point to watch the operation. (Students are not
expected to assist at the operations during the first appointment.
Page- 118
Surgery
4.3.Casualty admissions:
Students must clerk these patients as usual. But they must understand that
these patients may need urgent treatment.
5.
Reading:
Students must read from standard text books about their patients disease,
symptoms and signs, aetiology, pathology, treatment, and prognosis.
6.
Log book:
The students should complete and submit the logbook provided to them at the
end of the appointment. This will record skills, histories taken, examinations
performed and given notes prepared.
They should attach histories and complete examination records of two
patients clerked by them with the logbook.
7.
Target:
At the end of the appointment,
7.1.
The student should be able to,
a. Take a reasonable history and perform relevant examination.
b. Perform general and specific clinical examination.
c. Make a clinical diagnosis and exclude other possibilities
d. Understand the methods of treatment available.
7.2.
The student should be proficient on the examination of the following:
a. General examination.
b. Superficial Lumps.
c. Ulcers.
d. Abdomen.
7.3.
The student should have a basic knowledge of aetiology, pathology, clinical
features and management of the common diseases which occur in the above
organs.
7.4.
The student should be able to perform certain practical procedures such as:
a. Suturing of wounds.
b. Dressing of ulcers.
c. Intra muscular and sub-cutaneous injection.
d. Veni puncture etc.
7.5.
Should be able to communicate effectively with the patients.
8.
1)
2)
3)
4)
References:
Demonstration of Physical signs Norman L. Browse.
Clinical signs Hamilton Baily
Baily and Love Short Text Book of Surgery.
Scott An Aid to Clinical Surgery.
Page- 119
Surgery
Consultant/supervisor
Duration
1 week[1x6x4=24 hours]
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
no
Places to visit
Dental clinic
Objectives / purpose of
the appointment
10
Knowledge students
should acquire
11
Examination of mouth,
Refer appropriate patients for treatment by Dental
Surgeon / relevant section
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 120
Surgery
Consultant/supervisor
Orthopaedic Surgeon
Duration
Number of Students
Usual time
Additional time
Prerequisite
yes
Places to visit
10
11
12
13
14
Assessment method
15
16
References
Page- 121
Surgery
Consultant/supervisor
All Surgeons
Duration
Number of Students
Up to 15 students / Surgeon
Usual time
8 A M -12 noon
Additional time
Prerequisite
Places to visit
10
11
12
13
14
Assessment method
15
16
References
Page- 122
Surgery
2.
General:
As for the first appointment
3.
a.
b.
c.
d.
History taking:
Students must take detailed history from patients allocated to them and
write them down in a note book.
Students must talk to their patients daily and record any change in their
symptoms or arrival of any new symptoms.
Examination:
Students must do a complete physical examination and record them.
Students must examine the relevant part of the body frequently (at least
once a day or more frequently if required) and note the change.
Students must do simple laboratory tests wherever necessary- for eg. Urine
for albumen, sugar, ESR, etc.
Students must make an attempt to summarize their findings and make
tentative diagnosis. They must be able to correlate their history and
physical examination with the diagnosis made.
Note: Students should know the summary of symptoms and signs of all patients of
interest in the ward even if they are allocated to somebody else.
4.
Management of patients:
The students must follow the type of treatment (operative, drugs, symptomatic etc.)
given to their patients.
a.
At the outpatient clinics:
The students must be present in the clinic before the surgeon arrives, allocate
all new patients to be seen that day and examine them. Also follow any other
instructions of the surgeon under whom they are working.
b.
At the operating theatre:
Students must not be a nuisance or a danger to the patients and those who
work in the theatre.
Students must understand and strictly follow the aseptic principles.
Must watch the operations and understand the nature and type of operation.
The student whose patient is being operated must take it a point to watch the
operation. (Students are not expected to assist at the operations during the
first appointment. But this depends on the surgeon concerned.)
c.
Casualty admissions:
Students must clerk these patients as usual. But they must understand that
these patients may need urgent treatment.
5. Reading:
Students must read from standard text books about their patients disease,
symptoms and signs, aetiology, pathology, treatment, and prognosis.
Page- 123
Surgery
6. Assessment:
Log book
The students should complete and submit the logbook provided to them at the
end of the appointment. This will record skills, histories taken, examinations
performed and given notes prepared.
They should attach histories and complete examination records of two
patients clerked by them with the logbook.
7. Target:
At the end of the appointmentthe student should be able to,
7.1. Take a reasonable history and perform relevant examination.
Understand the prognosis and be able to explain the condition to the patient.
7.2. The student should be proficient on the examination of the following:
General examination.
Superficial Lumps.
Ulcers.
Inguino-scrotal lumps.
Abdomen.
Thyroid lump
Breast lump
7.3. The student should have a basic knowledge of aetiology, pathology, clinical
features and management of the common diseases which occur in the above
organs.
7.4. The student should be able to perform certain practical procedures such as:
e.
Suturing of wounds.
f.
Dressing of ulcers.
g.
Intra muscular and sub-coetaneous injection.
h.
Veni puncture etc.
7.5. Should be able to communicate effectively with the patients.
8. References:
Demonstration of Physical signs Norman L. Browse.
Clinical signs Hamilton Baily
Baily and Love Short Text Book of Surgery.
Scott An Aid to Clinical Surgery.
Page- 124
Surgery
9.5. Otolaryngology
1
Consultant/supervisor
ENT Surgeon
Duration
Number of Students
1/8
Usual time
Additional time
Prerequisite
yes
10
11
Identification of emergencies.
12
Attitudes students to
acquire
13
14
Assessment method
15
Attendance
16
References
Page- 125
Surgery
9.6. Ophthalmology
1
Consultant/supervisor
Eye Surgeon
Duration
Number of Students
1/8
Usual time
8-12
Additional time
Prerequisite
no
Places to visit
Objectives / purpose of the Learn to treat simple eye conditions and be able
to refer appropriate patients for specialized
appointment
treatment
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
Importance of eye
Importance of immediate / early action for
preserving the eye
Promotion of eye donation
13
14
Assessment method
15
16
References
Page- 126
Surgery
Consultant/supervisor
Consultant Anaesthetist
Duration
Number of Students
Usual time
8 AM -12 noon
Additional time
Prerequisite
no
Places to visit
10
Anaesthesia:
Pre-anaesthetic assessment, optimization &
medication
Protection of the unconscious patient
Intra &post operative complications
Monitoring of conscious levels, CVS, RS, Fluid
balance
Assessment of blood loss and blood transfusion
CPR, Shock, ventilation and oxygen therapy.
Obstetric anaesthesia& analgesia
Resuscitation of newborn
Fluid, electrolyte & acid base balance
Methods of pain relief
Pharmacology of commonly used drugs in
anaesthesia
Intensive care:
Life support systems- RS, CVS
Hepatic & renal failure
Shock, tetanus poisoning
11
13
14
Assessment method
15
16
References
Page- 128
Surgery
9.8. Neurosurgery
At present, done along with appointments in Surgery
1
Consultant/supervisor
Duration
Number of Students
Usual time
Additional time
Prerequisite
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 129
Surgery
9.9.Cardiothoracic Surgery
At present, done along with appointments in Surgery
1
Consultant/supervisor
Duration
Number of Students
Usual time
Additional time
Prerequisite
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 130
Surgery
Consultant/supervisor
Duration
Number of Students
Usual time
Additional time
Prerequisite
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 131
Surgery
Consultant/supervisor
Duration
Number of Students
Usual time
Additional time
Prerequisite
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 132
Surgery
9.12. Urology
At present, done along with appointments in Surgery
1
Consultant/supervisor
Duration
Number of Students
Usual time
Additional time
Prerequisite
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 133
Surgery
Consultant/supervisor
Duration
Number of Students
Usual time
Additional time
Prerequisite
Places to visit
10
Knowledge students
should acquire
11
12
Attitudes students to
acquire
13
14
Assessment method
15
16
References
Page- 134
Surgery
Consultant/supervisor
All Surgeons
Duration
Number of Students
Usual time
8 A M -12 noon
Additional time
Prerequisite
yes
Places to visit
10
11
As in objectives
12
As in objectives
Keep the medical institution clean,
respectable and reassuring.
13
14
Assessment method
15
16
References
Page- 135
Surgery
Assessment
1. At the end of the appointment, an in course assessment will be held including
structured essay questions and a small OSCE.
2. Log book:
The students should complete and submit the log book provided to them at the end
of the appointment. This will record skills, histories taken, examinations performed
special investigations and procedures observed and note on preparation for them
and given notes prepared.
They should attach operative notes of 2 operations they have assisted.
Page- 136
Surgery
Page- 138
Surgery
Consultant/supervisor
Duration
Number of Students
Usual time
Full time
Additional time
Prerequisite
yes
Places to visit
As in the objective
10
As in the objective
11
As in the objective
12
As in the objective
13
14
Assessment method
15
16
References
Final examination
Page- 139
Surgery
Page- 140
Surgery
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Head injury
Surgical, Radiological, Anaesthesia,
Abdominal trauma
Anatomy and Physiology
Acute thoracic conditions
Fracture management Surgery, orthopaedic, Anatomy, Radiology and physiology
Surgical infection Surgery, Microbiology, Anaesthesis, and physiology
Ischemic limb Surgery, Radiology. Anatomy, Physiology
Chronic ulcer of Lower limb Surgery, Physiology, Radiology, Anatomy,
Microbiology
Dysphagia
Epigastric pain
RHC pain
Obstructive jaundice
RIF mass / pain
Bleeding PR / Chronic blood and mucous diarrhoea
Intestinal obstruction
Peritonitis
Thyroid malignancy
Breast malignancy
LUTS
Haematuria
Painful scrotum
Pain
Palliative care in Malignant disease
Objectives
At the end of the appointment the students should
Be able to diagnose and plan treatment for common problems
Be able to diagnose and plan the management for emergencies.
Prepare the patients for surgery
Manage the post operative patients
Scrub, Assist in surgery and write operative notes
Prepare patients for special investigations
Perform the minor procedures necessary in the ward
Write diagnostic cards and clinic books
Have a deep knowledge of surgical diseases and their management expanded their
clinical knowledge in clinical history taking, examination and managements [pre
operative, peri operative, post operative and clinical follow up].
Have developed their communication skill and attitude towards the patients
Page- 141
Surgery
Page- 142
Surgery
Page- 143
Surgery
10. ELECTIVES
Details of the elective appointment are given
in this section.
Page- 144
Elective
10.1. Elective
1
Consultant/supervisor
Duration
Number of Students
individual
Usual time
Additional time
Prerequisite
Places to visit
10
11
12
13
14
Assessment method
15
16
References
Page- 145
Elective