IMNCI has been accepted as part of undergraduate curriculum in India and the same has been reflected in this document. I have the following suggestions to share.
1. IMNCI is being reflected as part of Pediatrics teaching curriculum only, while recommendations are for teaching the skills in both pediatrics and Community medicine and repetition of same during internship. The same needs to be reflected in the document.
2. Evaluation done by GOI recommends that some marks be kept reserved for IMNCI in the final exam for facilitating learning and needs to be reflected in the document.
3. IMNCI is integration of most common morbidities and mortalities in the outpatient care and needs to be reflected that way. That means as per evaluation report IMNCI teaching is to be initiated first and then individual conditions such as Diarrhoea, ARI etc to complement the missing issues and not to teach by two different ways as is being reflected.
4. IMNCI has almost all the skill based components of IYCF. Gujarat has suggested an integrated approach where some of the additional knowledge is provided as additional lectures without duplicating the same.
Dr Harish Kumar
NPO(CHD)WHO, India
Friday, August 10, 2007
Medical Training
Duration of MBBS- 5 yrs- Assessments at completion of each module- not EXAM TIME at the end of professionals .................................................................................Pre-clinical: 1 year Anatomy Biochemistry Physiology
Para-clinical: 1 year Microbiology Pharmacology Pathology
Clinical: 4-5 years1 year - Foundation1 year - Carry On Foundation 1 Year - Advanced Foundation1 year - Directly Supervised Hands on 1 Year- Optional/Gap year
Post-Graduation:3 years- Residency in choosen speciality
Superspeciality training1 Year (or more depending on sub-specilaity) ..................................................................................Foundation- 4 modules Starter- theoritical-Skill lab/Dummy based etcNo hospital postings/attchements yetMedicine, Surgery ,Gynae/Obst, PaedsFocussing on simple Principles rather on details-------------------------------------------------------------------------------- Hospital/Community attachments starts now--------------------------------------------------------------------------------Carry On Foundation -7 modules
Medicine...more detailsSurgery...more detailsGynae/Obst...more detailsPaeds...more details
Medical Law, \nEthics and forensic Medicine\u003cbr\>Community medicine and organisation of health \nservices\u003cbr\>Medical information \ntechnology\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>.................\u003cbr\>Advanced \nFoundation / Allied to foundation- Modules and Sub-modules\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Medicine- Psychiatry,Endocrinology, \nDermatology,Rheumatology, Transfusions \u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Surgery- Burns, Orthopaedics, Eye, ENT, \nDental/Maxillofacial, Neurosurgery, Cardiac surgery\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Cancer Medicine- Hematology,Chemotherapy, \nRadiotherapy, cancer surgery \u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Diagnostic Medicine- Pathology, Biochemistry,Radiology, \nNuclear Medicine, \nPost-Mortmes\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003cbr\>Hands \non/ Practical/ Directly Supervised - 7 Modules\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Acute medicine \n(Anaesthesia)-Resuscitation\u003cWBR\>,Transfer,Intensive care\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Hospital/Community based Management training\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>General Medicine- Emergency / Basic /Common \u003cbr\>Surgery - \nEmergency / Basic /Common \u003cbr\>Trauma - Emergency / Basic /Common \u003cbr\>Obstetrics- \nEmergency / Basic /Common \u003cbr\>Paediatrics- Emergency / Basic /Common \n\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003cbr\>1 \nYear- Optional/Gap- Two or more modules in \u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Top up training other Hospital, particular \nspeciality\u003cbr\>Inter-state/ Overseas/ Exchange programmes/ \nSponsorships\u003cbr\>Defence services\u003cbr\>Community/ NGO\u003cbr\>Alternative \nMedicine\u003cbr\>Academics/Research\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003cbr\>3 \nyears- \u003cbr\>Residency in choosen speciality( traditional)",1]
);
//-->
Medical Law, Ethics and forensic MedicineCommunity medicine and organisation of health servicesMedical information technology.............................................................................Advanced Foundation / Allied to foundation- Modules and Sub-modules
Medicine- Psychiatry,Endocrinology, Dermatology,Rheumatology, Transfusions
Surgery- Burns, Orthopaedics, Eye, ENT, Dental/Maxillofacial, Neurosurgery, Cardiac surgery
Cancer Medicine- Hematology,Chemotherapy, Radiotherapy, cancer surgery
Diagnostic Medicine- Pathology, Biochemistry,Radiology, Nuclear Medicine, Post-Mortmes..................................................................................Hands on/ Practical/ Directly Supervised - 7 Modules
Acute medicine (Anaesthesia)-Resuscitation,Transfer,Intensive care
Hospital/Community based Management training
General Medicine- Emergency / Basic /Common Surgery - Emergency / Basic /Common Trauma - Emergency / Basic /Common Obstetrics- Emergency / Basic /Common Paediatrics- Emergency / Basic /Common
..................................................................................1 Year- Optional/Gap- Two or more modules in
Top up training other Hospital, particular specialityInter-state/ Overseas/ Exchange programmes/ SponsorshipsDefence servicesCommunity/ NGOAlternative MedicineAcademics/Research..................................................................................3 years- Residency in choosen speciality( traditional)
Introduction of \nFamily/General/Referal Medicine, \u003cbr\>Introduction of Acute Medicine\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Entry exams \u003cbr\>In Training Assessments\u003cbr\>Abolish exit \nexams\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Uniform titles...MD /MS /DNB\u003cbr\>Abolish \nDiplomas\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Academics and reserach should be segregated from this \ntraining\u003cbr\>Allow to integrate depending on interest and aptitude.\u003cbr\>Not forced \non everybody- save resources for those with aptitude\u003cbr\>Delink from \nMD,MS,DM,MCh\u003cbr\>Uniform BSc, MSc, MPhil and \nPhD\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003cbr\>1 \nYear (or more depending on sub-specilaity) Superspeciality training \u003cbr\>Uniform \ntitles DM and MCh \u003cbr\>Abolish PDCC and ambiguous \nfellowshis\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Emphasis should be on -\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>1.Clear objective- to make High Quality CLINICIANS- NOT \nALL ROUNDERS e.g. Keep research and academics for those willing to pursue \nit\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>2.Inefficient/unrealistic/failed methods should be \nabandonded or given only due importance in training e.g.Preventive and social \nmedicine\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>3.Early introduction of Management in to the curriculum to \nhelp them apply their skills/ knowledge and to dovelop right \nattitude\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>4.Stop producing walking encyclopedia( limit MCQ exams to \nbasic sciences) but encourage dovelopment of application skills\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>5.COMPETENCY BASED IN HOUSE assessments- Onus to organise \nand pass THEM should be on the candidates not the teachers who should only \nfacilitate.\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>6.Regular assessments,feedback and MUTUALLY agreed \ncorrection plans",1]
);
//-->
Introduction of Family/General/Referal Medicine, Introduction of Acute Medicine
Entry exams In Training AssessmentsAbolish exit exams
Uniform titles...MD /MS /DNBAbolish Diplomas
Academics and reserach should be segregated from this trainingAllow to integrate depending on interest and aptitude.Not forced on everybody- save resources for those with aptitudeDelink from MD,MS,DM,MChUniform BSc, MSc, MPhil and PhD
..................................................................................
1 Year (or more depending on sub-specilaity) Superspeciality training Uniform titles DM and MCh Abolish PDCC and ambiguous fellowshis
..................................................................................
Emphasis should be on -
1.Clear objective- to make High Quality CLINICIANS- NOT ALL ROUNDERS e.g. Keep research and academics for those willing to pursue it
2.Inefficient/unrealistic/failed methods should be abandonded or given only due importance in training e.g.Preventive and social medicine
3.Early introduction of Management in to the curriculum to help them apply their skills/ knowledge and to dovelop right attitude
4.Stop producing walking encyclopedia( limit MCQ exams to basic sciences) but encourage dovelopment of application skills
5.COMPETENCY BASED IN HOUSE assessments- Onus to organise and pass THEM should be on the candidates not the teachers who should only facilitate.
6.Regular assessments,feedback and MUTUALLY agreed correction plans
7.Ensure basic training in 'Common and Acute problems' before allowing any independent- or credible supervised- patient interaction
8.Alternative career(?within healthcare) advice to mal-adjusted at the earliest opportunity
9.Reform of medical education Funding - not purely by tax-payers money(govt subsidies/grants)- Govt Medical colleges should also generate some income- Rather than subsiding and later ending up failing to force bonds on unwilling beneficiaries or be content with substandard pay-back service , govt can provide legally sound education loans.-This will also discourage rich parents to hijack merit by money,provide level opportunity for poor aspirants and may check brain-drain too.-Private medical college should be banned from charging upfront fees but asked to set up education loans for every applicant successful purely on merit.
All in all, this would be more of reorganisation of the existing training structure.Further fine tuning can be undertaken in later phases.
Para-clinical: 1 year Microbiology Pharmacology Pathology
Clinical: 4-5 years1 year - Foundation1 year - Carry On Foundation 1 Year - Advanced Foundation1 year - Directly Supervised Hands on 1 Year- Optional/Gap year
Post-Graduation:3 years- Residency in choosen speciality
Superspeciality training1 Year (or more depending on sub-specilaity) ..................................................................................Foundation- 4 modules Starter- theoritical-Skill lab/Dummy based etcNo hospital postings/attchements yetMedicine, Surgery ,Gynae/Obst, PaedsFocussing on simple Principles rather on details-------------------------------------------------------------------------------- Hospital/Community attachments starts now--------------------------------------------------------------------------------Carry On Foundation -7 modules
Medicine...more detailsSurgery...more detailsGynae/Obst...more detailsPaeds...more details
Medical Law, \nEthics and forensic Medicine\u003cbr\>Community medicine and organisation of health \nservices\u003cbr\>Medical information \ntechnology\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>.................\u003cbr\>Advanced \nFoundation / Allied to foundation- Modules and Sub-modules\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Medicine- Psychiatry,Endocrinology, \nDermatology,Rheumatology, Transfusions \u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Surgery- Burns, Orthopaedics, Eye, ENT, \nDental/Maxillofacial, Neurosurgery, Cardiac surgery\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Cancer Medicine- Hematology,Chemotherapy, \nRadiotherapy, cancer surgery \u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Diagnostic Medicine- Pathology, Biochemistry,Radiology, \nNuclear Medicine, \nPost-Mortmes\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003cbr\>Hands \non/ Practical/ Directly Supervised - 7 Modules\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Acute medicine \n(Anaesthesia)-Resuscitation\u003cWBR\>,Transfer,Intensive care\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Hospital/Community based Management training\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>General Medicine- Emergency / Basic /Common \u003cbr\>Surgery - \nEmergency / Basic /Common \u003cbr\>Trauma - Emergency / Basic /Common \u003cbr\>Obstetrics- \nEmergency / Basic /Common \u003cbr\>Paediatrics- Emergency / Basic /Common \n\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003cbr\>1 \nYear- Optional/Gap- Two or more modules in \u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Top up training other Hospital, particular \nspeciality\u003cbr\>Inter-state/ Overseas/ Exchange programmes/ \nSponsorships\u003cbr\>Defence services\u003cbr\>Community/ NGO\u003cbr\>Alternative \nMedicine\u003cbr\>Academics/Research\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003cbr\>3 \nyears- \u003cbr\>Residency in choosen speciality( traditional)",1]
);
//-->
Medical Law, Ethics and forensic MedicineCommunity medicine and organisation of health servicesMedical information technology.............................................................................Advanced Foundation / Allied to foundation- Modules and Sub-modules
Medicine- Psychiatry,Endocrinology, Dermatology,Rheumatology, Transfusions
Surgery- Burns, Orthopaedics, Eye, ENT, Dental/Maxillofacial, Neurosurgery, Cardiac surgery
Cancer Medicine- Hematology,Chemotherapy, Radiotherapy, cancer surgery
Diagnostic Medicine- Pathology, Biochemistry,Radiology, Nuclear Medicine, Post-Mortmes..................................................................................Hands on/ Practical/ Directly Supervised - 7 Modules
Acute medicine (Anaesthesia)-Resuscitation,Transfer,Intensive care
Hospital/Community based Management training
General Medicine- Emergency / Basic /Common Surgery - Emergency / Basic /Common Trauma - Emergency / Basic /Common Obstetrics- Emergency / Basic /Common Paediatrics- Emergency / Basic /Common
..................................................................................1 Year- Optional/Gap- Two or more modules in
Top up training other Hospital, particular specialityInter-state/ Overseas/ Exchange programmes/ SponsorshipsDefence servicesCommunity/ NGOAlternative MedicineAcademics/Research..................................................................................3 years- Residency in choosen speciality( traditional)
Introduction of \nFamily/General/Referal Medicine, \u003cbr\>Introduction of Acute Medicine\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Entry exams \u003cbr\>In Training Assessments\u003cbr\>Abolish exit \nexams\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Uniform titles...MD /MS /DNB\u003cbr\>Abolish \nDiplomas\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Academics and reserach should be segregated from this \ntraining\u003cbr\>Allow to integrate depending on interest and aptitude.\u003cbr\>Not forced \non everybody- save resources for those with aptitude\u003cbr\>Delink from \nMD,MS,DM,MCh\u003cbr\>Uniform BSc, MSc, MPhil and \nPhD\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003cbr\>1 \nYear (or more depending on sub-specilaity) Superspeciality training \u003cbr\>Uniform \ntitles DM and MCh \u003cbr\>Abolish PDCC and ambiguous \nfellowshis\u003cbr\>..............................\u003cWBR\>..............................\u003cWBR\>......................\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>Emphasis should be on -\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>1.Clear objective- to make High Quality CLINICIANS- NOT \nALL ROUNDERS e.g. Keep research and academics for those willing to pursue \nit\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>2.Inefficient/unrealistic/failed methods should be \nabandonded or given only due importance in training e.g.Preventive and social \nmedicine\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>3.Early introduction of Management in to the curriculum to \nhelp them apply their skills/ knowledge and to dovelop right \nattitude\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>4.Stop producing walking encyclopedia( limit MCQ exams to \nbasic sciences) but encourage dovelopment of application skills\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>5.COMPETENCY BASED IN HOUSE assessments- Onus to organise \nand pass THEM should be on the candidates not the teachers who should only \nfacilitate.\u003c/font\>\u003c/div\>\n\u003cdiv\> \u003c/div\>\n\u003cdiv\>\u003cfont face\u003d\"Arial\"\>6.Regular assessments,feedback and MUTUALLY agreed \ncorrection plans",1]
);
//-->
Introduction of Family/General/Referal Medicine, Introduction of Acute Medicine
Entry exams In Training AssessmentsAbolish exit exams
Uniform titles...MD /MS /DNBAbolish Diplomas
Academics and reserach should be segregated from this trainingAllow to integrate depending on interest and aptitude.Not forced on everybody- save resources for those with aptitudeDelink from MD,MS,DM,MChUniform BSc, MSc, MPhil and PhD
..................................................................................
1 Year (or more depending on sub-specilaity) Superspeciality training Uniform titles DM and MCh Abolish PDCC and ambiguous fellowshis
..................................................................................
Emphasis should be on -
1.Clear objective- to make High Quality CLINICIANS- NOT ALL ROUNDERS e.g. Keep research and academics for those willing to pursue it
2.Inefficient/unrealistic/failed methods should be abandonded or given only due importance in training e.g.Preventive and social medicine
3.Early introduction of Management in to the curriculum to help them apply their skills/ knowledge and to dovelop right attitude
4.Stop producing walking encyclopedia( limit MCQ exams to basic sciences) but encourage dovelopment of application skills
5.COMPETENCY BASED IN HOUSE assessments- Onus to organise and pass THEM should be on the candidates not the teachers who should only facilitate.
6.Regular assessments,feedback and MUTUALLY agreed correction plans
7.Ensure basic training in 'Common and Acute problems' before allowing any independent- or credible supervised- patient interaction
8.Alternative career(?within healthcare) advice to mal-adjusted at the earliest opportunity
9.Reform of medical education Funding - not purely by tax-payers money(govt subsidies/grants)- Govt Medical colleges should also generate some income- Rather than subsiding and later ending up failing to force bonds on unwilling beneficiaries or be content with substandard pay-back service , govt can provide legally sound education loans.-This will also discourage rich parents to hijack merit by money,provide level opportunity for poor aspirants and may check brain-drain too.-Private medical college should be banned from charging upfront fees but asked to set up education loans for every applicant successful purely on merit.
All in all, this would be more of reorganisation of the existing training structure.Further fine tuning can be undertaken in later phases.
e-learning
while i see the concept of e-learning, i did not see a formal recommended course for the use of computers.similarly, formal course including lectures, group discussions, mock cases etc in the field of medical ethics and evidence based learning are requireda introduction to the concept of Professional development is neededMCI must formally recognise the adequacy of a digital libraryMCI must also recognise the worth of specialists/teachers with foreign qualifications - this should not be dictated by political considerations
Dr K Lakshman FRCS
Dr K Lakshman FRCS
Thursday, August 9, 2007
UROLOGY
THIS IS TO INFORM YOU THAT SURGERY IN PRACTICE COMPRISSES NEARLY 60% OF UROLOGY WHICH IS NEGLECTED. DEFINITELY A SUBSPECIALITY OF UROLOGY NSHOULD BE CREATED TO BE SUPERVISED BY UROLOGIST
DR PAWAN KESARWANI
DR PAWAN KESARWANI
curiculum
It is a laudable effect. However, success of this venture depends on one very crucial factor and that is the medical teacher. Without teacher training, this curriculum will also degenerate into what happened to earlier models. Equally important is to take away high stake examinations (prof. examinations, entrance examinations) and replace them with continuous assessment. We have to believe teachers- everything cannot depend on one 2 hours paper, ignoring the efforts and conduct during 5 years of medical studies. Internal assessment should also reflect emphasis on skills and should be a criterion referenced test. Further progression in the course should depend on acquiring the prescribed skills.--
Dr Tejinder Singh
Director
CMCL-FAIMER Regional Institute
its a good move, let me congragulate the initiative, especially theModular approach and core competencies development.It's fine to regard community medicine as a core clinical entity,provided its social engineering aspects are not neglected altogether.Couldn't understand what is meant by Medicine skill? And I am surprisedin not finding Paediatrics amongst the clinical subjects.
Dr Biju Soman
Dr Tejinder Singh
Director
CMCL-FAIMER Regional Institute
its a good move, let me congragulate the initiative, especially theModular approach and core competencies development.It's fine to regard community medicine as a core clinical entity,provided its social engineering aspects are not neglected altogether.Couldn't understand what is meant by Medicine skill? And I am surprisedin not finding Paediatrics amongst the clinical subjects.
Dr Biju Soman
Subject of Physical Medicine and Rehabilitation
This is in regard to bringing the Subject of Physical Medicine and Rehabilitation in to the curriculum of the MBBS Students for the following reasons.
1. Predominantly the subjects deals with Rehabiltation of the chronically ill patients like stroke, traumatic brain injury, orthopedically injured patients, geriatric patients etc.. and as a primary care physician the Medical graduate needs to know about the availabilities of the Rehab services and role it can play in bringing these patients to realise their abilities and incorporate them into the society and reduce the social burden.
2.This also deal with Disabled persons and Medical graduate needs to know about impairment, disabilty, handicap and how to help the disabled person to realize his independence
3. Brief knowledge about physiotherapy and occupational therapy is essential as a medical graduate need to know about the services rendered by these paramedical group personnel
Hope Physical Medicine and Rehabilitaion will be included in subsequent syllabus.
Dr.P.Thirunavukkarasu
Associate Prof in Physical Medicine
Govt. Vellore Medical College
1. Predominantly the subjects deals with Rehabiltation of the chronically ill patients like stroke, traumatic brain injury, orthopedically injured patients, geriatric patients etc.. and as a primary care physician the Medical graduate needs to know about the availabilities of the Rehab services and role it can play in bringing these patients to realise their abilities and incorporate them into the society and reduce the social burden.
2.This also deal with Disabled persons and Medical graduate needs to know about impairment, disabilty, handicap and how to help the disabled person to realize his independence
3. Brief knowledge about physiotherapy and occupational therapy is essential as a medical graduate need to know about the services rendered by these paramedical group personnel
Hope Physical Medicine and Rehabilitaion will be included in subsequent syllabus.
Dr.P.Thirunavukkarasu
Associate Prof in Physical Medicine
Govt. Vellore Medical College
Regarding Evaluation Methods
Its nice to have a curriculum plan as per the global essentials of medical education.the technology is rapidly changing.we have to train and teach our students according to this.I felt very happy so much emphasis was given in to anaesthesia and resuscitation in curriculum. in fact we have to train basic doctor these skills.the other topics also quite useful.we can include management of trauma victim and management of unconscious patient.ICU posting during intern ship is a must for all. more emphasis should be given to problem based learning. Communication skills, medical ethics,managerial skills, computer knowldge, should be included in curriculum.
Regarding Evaluation Methods.
its time to modify evaluation methods by including tools with more validity and reliability.OSCE.OSPE,has to be included.the curriculum and evaluation methods should be uniform through out country.
Prof.T.VenugopalaRao
Senete member, Dr.NTRuniversity of Health Sciences
Regarding Evaluation Methods.
its time to modify evaluation methods by including tools with more validity and reliability.OSCE.OSPE,has to be included.the curriculum and evaluation methods should be uniform through out country.
Prof.T.VenugopalaRao
Senete member, Dr.NTRuniversity of Health Sciences
Infant and Neonatal Mortality
This is a welcome step to revise MBBS curriculum and to make it more relevant to our national needs. The country, at this time is facing a very high infant and neonatal mortality to which malnutrition among the children contributes significantly. We are also striving hard to fulfill our global commitments like achieving MDG goals for child survival and containment of HIV. However, i was surprised to note that child health including newborn health is completely missing from the curriculum given on the website. Also child nutrition (early and exclusive breastfeeding and timely complementary feeding) is not included here. We are facing a lack of understanding and skills among the medical graduates for these issued for quite long times, once more we will miss the opportunity to address our needs in the revised curiculum.
SUGGESTIONS AND COMMENTS ON THE PROPOSED SYLLABUS FOR BIOCHEMISTRY
LEARNING OBJECTIVES
Item 6: The common genetic disorders that need to be covered should be specified.
Item 9: The biochemical techniques that need to be covered should be specified.
COURSE CONTENTS
1. Acid-base disorders
The study of acid-base disorders, their causes and laboratory diagnosis should be included in the “must know” category.
2. Enzymes
Topics under this should include the following in the “must know” category
Properties of enzymes
Coenzymes and cofactors
Diagnostic and therapeutic importance of enzymes, icluding use of isoenzymes.
3. Carbohydrates
Topics under this should include the following in the “must know” category
Overview of metabolism of fructose and galactose to be included in the “must know” category.
Hyper- and hypoglycemia
Uronic acid pathway and basic concepts of glycogen storage disease
Regulation by hormones in starvation, the well-fed state and diabetes mellitus.
Topics under this should include the following in the “desirable to know” category
Importance of mucopolysaccharides
4. Lipids
Topics under this should include the following in the “must know” category
Metabolism of ketone bodies
Metabolism of triacylglycerols
Metabolism of adipose tissue
Essential fatty acids
Topics under this should include the following in the “desirable to know” category
Overview of phospholipid metabolism
Drugs used to treat dyslipidemias
Sphingolipidosis
5. Proteins
Topics under this should include the following in the “must know” category
Essential amino acids
General pathways for amino acid catabolism
Overview of disorders associated with metabolism of phenylalanine, tryptophan, glycine, serine, sulfur containing amino acids and histidine
Specialized products obtained from amino acid, metabolism and their
importance, eg. creatine, melatonin, melanin, epinephrine, thyroxine, nitric oxide
Biogenic amines
Importnace of glutathione
Overview of aminoacidurias
6. Intermediary metabolism
Methods of study of intermediary metabolism are not required.
7. Nucleic acids
Topics under this should include the following in the “must know” category
Salvage pathways for purines and pyrimidines
Synthetic nucleotides
Nucleotide analogues
Biologically important nucleotides
8. Energy metabolism
Topics under this should include the following in the “must know” category
Basal metabolic rate
Specific dynamic action
Components and requirements of a balanced diet
Overview of nutrition in physiological states and in diseases such diabetes mellitus, ischemic heart disease, renal diseases
Parenteral feeding
9. Human genetics and molecular biology
Topics under this should include the following in the “must know” category
Genetic code
Mutations
10. Mechanisms of actions of hormones
This topic should be included
11. Apply concepts of rational diagnostic methods and tests in laboratory medicine
Diseases to be covered under this heading should be specified to be covered in the “must know category” (eg, diabetes mellitus, dyslipidemias, myocardial infarction, renal diseases, thyroid disease, etc).
Item 6: The common genetic disorders that need to be covered should be specified.
Item 9: The biochemical techniques that need to be covered should be specified.
COURSE CONTENTS
1. Acid-base disorders
The study of acid-base disorders, their causes and laboratory diagnosis should be included in the “must know” category.
2. Enzymes
Topics under this should include the following in the “must know” category
Properties of enzymes
Coenzymes and cofactors
Diagnostic and therapeutic importance of enzymes, icluding use of isoenzymes.
3. Carbohydrates
Topics under this should include the following in the “must know” category
Overview of metabolism of fructose and galactose to be included in the “must know” category.
Hyper- and hypoglycemia
Uronic acid pathway and basic concepts of glycogen storage disease
Regulation by hormones in starvation, the well-fed state and diabetes mellitus.
Topics under this should include the following in the “desirable to know” category
Importance of mucopolysaccharides
4. Lipids
Topics under this should include the following in the “must know” category
Metabolism of ketone bodies
Metabolism of triacylglycerols
Metabolism of adipose tissue
Essential fatty acids
Topics under this should include the following in the “desirable to know” category
Overview of phospholipid metabolism
Drugs used to treat dyslipidemias
Sphingolipidosis
5. Proteins
Topics under this should include the following in the “must know” category
Essential amino acids
General pathways for amino acid catabolism
Overview of disorders associated with metabolism of phenylalanine, tryptophan, glycine, serine, sulfur containing amino acids and histidine
Specialized products obtained from amino acid, metabolism and their
importance, eg. creatine, melatonin, melanin, epinephrine, thyroxine, nitric oxide
Biogenic amines
Importnace of glutathione
Overview of aminoacidurias
6. Intermediary metabolism
Methods of study of intermediary metabolism are not required.
7. Nucleic acids
Topics under this should include the following in the “must know” category
Salvage pathways for purines and pyrimidines
Synthetic nucleotides
Nucleotide analogues
Biologically important nucleotides
8. Energy metabolism
Topics under this should include the following in the “must know” category
Basal metabolic rate
Specific dynamic action
Components and requirements of a balanced diet
Overview of nutrition in physiological states and in diseases such diabetes mellitus, ischemic heart disease, renal diseases
Parenteral feeding
9. Human genetics and molecular biology
Topics under this should include the following in the “must know” category
Genetic code
Mutations
10. Mechanisms of actions of hormones
This topic should be included
11. Apply concepts of rational diagnostic methods and tests in laboratory medicine
Diseases to be covered under this heading should be specified to be covered in the “must know category” (eg, diabetes mellitus, dyslipidemias, myocardial infarction, renal diseases, thyroid disease, etc).
prevention and control of injuries
With regard to undergraduate medical education, there is need for building both knowledge and skill base towards prevention and control of injuries. Recent studies and data indicate that nearly 15 - 20 % of deaths, 20 - 30 % of hospitalizations and ine third of total disabilities are due to injuries in India. At present, there is very little emphasis on prevention - control - rehabilitation aspects of injuries , while greater thrust is placed on high tech investigations and management of injuries.
It is important that an integrated - intersectoral approah to this problem is included in the undergraduate medical curriculum. This can later get expenaded to prevention / health promotion/ life skills approaches during 3rd and 4th years with practical skill development in road safety - home safety - work safety - injury prevention - safety promotion in final year and during internship period.
WHO and MOH have made significant efforts already by designing course curriculum for medical and nursing students and pilot work is in progress in selected medical colleges.
In addition, there is a section on emrging diseases . It is not clear as to what will be included in this area. One of the important issues to be included is Behavioural and substance abuse disorders
Gururaj
Health Delivery Institutions
It is important that an integrated - intersectoral approah to this problem is included in the undergraduate medical curriculum. This can later get expenaded to prevention / health promotion/ life skills approaches during 3rd and 4th years with practical skill development in road safety - home safety - work safety - injury prevention - safety promotion in final year and during internship period.
WHO and MOH have made significant efforts already by designing course curriculum for medical and nursing students and pilot work is in progress in selected medical colleges.
In addition, there is a section on emrging diseases . It is not clear as to what will be included in this area. One of the important issues to be included is Behavioural and substance abuse disorders
Gururaj
Health Delivery Institutions
Forensic Medicine
Forensic Medicine" in the undergraduate medical curriculum - the following are some of the main issues that need to be addressed:
I. Medicine split into many separate branches long ago. Doctors who work in one branch do not consider themselves competent in other branches. The same is true of Forensic Medicine and it is not possible for a forensic practitioner to be competent in all its subdisciplines. Yet we persist in the regressive approach of advocating a single subject called "Forensic Medicine". Till now the standard way to get around this problem has been to invite staff from other disciplines to handle the teaching of the forensic aspects of their specialties. This "integration" sounds good in theory but in practice it runs into the following problems:
a) Difficult to co-ordinate - staff are not always available when needed and one is not always able to repeatedly change the undergraduate teaching program to suit all conveniences.
b) The staff tend to teach the MEDICAL aspects of their specialty because that is what they are familiar with. The FORENSIC aspect gets ignored.
c) Because of the present curriculum, which considers Forensic Medicine as a para-clinical subject, the forensic aspects of the various medical disciplines quite often have to be taught to students who are yet to have been introduced to these disciplines. For example they may have to learn forensic psychiatry before ever having had a psychiatry posting and forensic aspects of OG in the absence of an OG posting. This is a highly unsatisfactory state of affairs.d) At the end of the course the evaluation of the students is done only by staff of Forensic departments who may not (for the reason mentioned in the first paragraph) be fully familiar with the way specialists teach their own particular fields. Thus a forensic pathologist may not be fully competent to adequately assess a student's response to a question on forensic psychiatry or toxicology simply because it his not his or her area of routine practice and therefore he or she is likely to be unfamiliar with the latest developments which the specialist will be aware of.
THERE IS AN EASY AND OBVIOUS SOLUTION TO THE ABOVE PROBLEMS - instead of teaching Forensic Medicine as ONE subject, and trying to get input from other departments, it is much better to simply allocate the different aspects of Forensic Medicine to the various concerned departments to be taught at the same time as the regular medical posting in that subject. For example Forensic Pathology (autopsies, death and postmortem changes) can be taught as part of Pathology, Forensic psychiatry can be taught as part of psychiatry, toxicology as part of medicine etc, etc. This means doing away with Forensic Medicine as a separate subject. The advantages of this approach are as follows
1. The students learn the topics alongside the medical posting in that subject and so get a better understanding.
2. There is no need for time consuming and difficult co-ordination between different departments - each department teaches the forensic aspects of their subject whenever the students are posted with them.
3. The staff of each medical specialty are encouraged to take up the forensic aspects of their specialty. This is essential if we wish to keep up with developed countries who have long ago realized that this is the most progressive approach. Only in this way can Forensic Medicine grow. A single person is no longer competent to handle all aspects of Forensic Medicine.4. As far as exams and assessment of the students is concerned, it can be done by the respective departments. Thus the pathology exam can have a separate section on forensic pathology (theory and practical), the OG exam can have a section on forensic aspects like sexual offences, the medicine exam could include general medical jurisprudence, toxicology and drunkenness assessment, surgery and orthopaedics could take up mechanical injuries, the anatomy exam could include forensic osteology and radiology, etc, etc.
II. The observing of 10 medico-legal autopsies is another problem area. Many private colleges do not perform such cases and so have great difficulty in complying with this regulation. Getting students to go to the local government hospital for this purpose is also troublesome because permission for the same is often not granted by the responsible person OR there is lack of co-operation and co-ordination between the two concerned institutions. In theory, the observing of an actual autopsy sounds good but in practice when many students crowd around an autopsy table only the few in front of the group get to properly see the injuries - that too for no more than a few minutes. One also cannot guarantee when a case for autopsy might arrive - it may come when students are not available or not come when the students are ready to see it. A well taken photograph or video of positive autopsy findings is just as good for the student to evaluate and has the added advantage that it can be studied for as long or as often as is required and at the student's convenience. So can this method of recording autopsies also be allowed in the new curriculum?
Dr. Noel Walter,
MD FRCPathHead of Forensic Medicine
Christian Medical College, Vellore
I. Medicine split into many separate branches long ago. Doctors who work in one branch do not consider themselves competent in other branches. The same is true of Forensic Medicine and it is not possible for a forensic practitioner to be competent in all its subdisciplines. Yet we persist in the regressive approach of advocating a single subject called "Forensic Medicine". Till now the standard way to get around this problem has been to invite staff from other disciplines to handle the teaching of the forensic aspects of their specialties. This "integration" sounds good in theory but in practice it runs into the following problems:
a) Difficult to co-ordinate - staff are not always available when needed and one is not always able to repeatedly change the undergraduate teaching program to suit all conveniences.
b) The staff tend to teach the MEDICAL aspects of their specialty because that is what they are familiar with. The FORENSIC aspect gets ignored.
c) Because of the present curriculum, which considers Forensic Medicine as a para-clinical subject, the forensic aspects of the various medical disciplines quite often have to be taught to students who are yet to have been introduced to these disciplines. For example they may have to learn forensic psychiatry before ever having had a psychiatry posting and forensic aspects of OG in the absence of an OG posting. This is a highly unsatisfactory state of affairs.d) At the end of the course the evaluation of the students is done only by staff of Forensic departments who may not (for the reason mentioned in the first paragraph) be fully familiar with the way specialists teach their own particular fields. Thus a forensic pathologist may not be fully competent to adequately assess a student's response to a question on forensic psychiatry or toxicology simply because it his not his or her area of routine practice and therefore he or she is likely to be unfamiliar with the latest developments which the specialist will be aware of.
THERE IS AN EASY AND OBVIOUS SOLUTION TO THE ABOVE PROBLEMS - instead of teaching Forensic Medicine as ONE subject, and trying to get input from other departments, it is much better to simply allocate the different aspects of Forensic Medicine to the various concerned departments to be taught at the same time as the regular medical posting in that subject. For example Forensic Pathology (autopsies, death and postmortem changes) can be taught as part of Pathology, Forensic psychiatry can be taught as part of psychiatry, toxicology as part of medicine etc, etc. This means doing away with Forensic Medicine as a separate subject. The advantages of this approach are as follows
1. The students learn the topics alongside the medical posting in that subject and so get a better understanding.
2. There is no need for time consuming and difficult co-ordination between different departments - each department teaches the forensic aspects of their subject whenever the students are posted with them.
3. The staff of each medical specialty are encouraged to take up the forensic aspects of their specialty. This is essential if we wish to keep up with developed countries who have long ago realized that this is the most progressive approach. Only in this way can Forensic Medicine grow. A single person is no longer competent to handle all aspects of Forensic Medicine.4. As far as exams and assessment of the students is concerned, it can be done by the respective departments. Thus the pathology exam can have a separate section on forensic pathology (theory and practical), the OG exam can have a section on forensic aspects like sexual offences, the medicine exam could include general medical jurisprudence, toxicology and drunkenness assessment, surgery and orthopaedics could take up mechanical injuries, the anatomy exam could include forensic osteology and radiology, etc, etc.
II. The observing of 10 medico-legal autopsies is another problem area. Many private colleges do not perform such cases and so have great difficulty in complying with this regulation. Getting students to go to the local government hospital for this purpose is also troublesome because permission for the same is often not granted by the responsible person OR there is lack of co-operation and co-ordination between the two concerned institutions. In theory, the observing of an actual autopsy sounds good but in practice when many students crowd around an autopsy table only the few in front of the group get to properly see the injuries - that too for no more than a few minutes. One also cannot guarantee when a case for autopsy might arrive - it may come when students are not available or not come when the students are ready to see it. A well taken photograph or video of positive autopsy findings is just as good for the student to evaluate and has the added advantage that it can be studied for as long or as often as is required and at the student's convenience. So can this method of recording autopsies also be allowed in the new curriculum?
Dr. Noel Walter,
MD FRCPathHead of Forensic Medicine
Christian Medical College, Vellore
Regarding Internship
In 12 weeks of community medicine postings, 2 weeks of postings should be in RNTCP cell of the respective medical colleges, wherein they will be learning counselling of Patients,categorization of patients,smear preparation,home visits to NSP patients,default retrieval,chemoprophylaxis and cross referrals.
Dr.B.N.Sharath
Health Delivery Institutions
Dr.B.N.Sharath
Health Delivery Institutions
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