Annexures : Titles to be included in theory for MD General Medicine Part-II Titles for orientation programme for all PG students

in the beginning of their PG course on various aspects for a period of one month. III. Formative assessment of PG medical students IV. Model forms [a] Assessment card, [b] Dissertation: review of activities [for three years PG] [c] Academic programme for clinical PGs and [d] Technical procedure for MD General Medicine PG. Annexure :I. Titles to be included in theory for MD General Medicine Part - II examination. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Titles Climate change on Health and illness Environmental Medicine Occupational & Industrial Medicine Refuge and Prisoner Medicine Sexual Medicine Disaster Medicine Travel Medicine Adolescent Medicine Bioterrorism medical aspects Palliative and terminal care Critical care and emergency medicine including toxicology Emerging infections, epidemics, endemics & pandemics Quality assurance in health care Legal and ethical aspects in medical care I. II.

Annexure:

II.ORIENTATION PROGRAMME FOR ALL POST GRADUATE MEDICAL STUDENTS

ORGANISER: MEDICAL EDUCATION DEPARTMENT OF RESPECTIVE MEDICAL COLLEGES UNDER THE GUIDANCE OF THE UNIVERSITY PERIOD : 25 DAYS (15TH JUNE TO 16TH JULY OF EVERY YEAR)

-----------------------------------------------------------------------------------------------------------Current medical education focuses more on knowledge and skill but attends less on needs and expectations of the patients, community and administration. Also, importance of health science research and educational technologies do not receive due attention. Hence, there is a need to develop a programme for all medical colleges affiliated to the TamilNadu Dr. M. G. R Medical University, Chennai.

1. Medical education unit of each medical college of all systems of medicine has to organize the programme under the supervision of Dean / Principal of the respective Medical Colleges (Modern Medicine / Dental / Other systems of medicine) under the guidance of the university 2. All PGs irrespective of the specialty and the systems of medicine have to undergo all the programme. 3. Each programme will commence with a pre test and complete with post test and the answers will be graded and entered into the PG students log book. 4. Each PG has to obtain at least 70 marks in each programme. 5. If any PG fails to attend any of the programme it will be entered as zero. 6. The Dean / Principal of the respective Medical College have to prepare the Teaching / Training module for their PG students and send a copy of the same to the university along with participants pre test and post test grade in the form of soft copy & hard copy as their grade becomes part of the formative assessment. 7. For further clarification, the academic officer of the university may be contacted.

Humanities in medical education No. 01. 02. 03. 04. 05. 06. 07. 08. 09. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Titles Professional Matters Ethical aspects Patient related activities Social aspects Community works Administrative issues Critical analysis of medical documents Team work Duty register of PG students Legal aspects Pharmacovigilance programme Soft skill development Technical skills Medical Devices Blood Bank Monitoring & supervisory capacity Training on medical education Health Sciences Research Non-academic / Extra curricular activities Duration in hrs 18 6 18 4 2 12 2 6 2 6 6 12 6 4 12 2 12 12 2

AREA OF TRAINING FOR ALL BRANCHES OF POST GRADUATE MEDICAL STUDENTS 1. PROFESSIONAL MATTERS Professionalism Doctor patient - society relationship Doctor - Doctor relationship Complementary and alternative medical practice Sharing of responsibilities Being a good doctor Appointment and waiting time Biomedical waste disposal Hand wash Universal Infection Control Practices (UICP) Cleanliness of IP and OP section 3

Sanitation and water supply Reporting of notifiable diseases Participation in Hospital infection control policy Confidentiality Leadership skill Health policy Sterilization

2. ETHICAL ASPECTS Ethics and ethical aspects in medical practice and research Ethical aspects in prescription writing Handling medical sales personnel / marketing Ethical aspects of being a teacher / facilitator Maintaining good clinical practice Taking photography or using patients materials for teaching and academic purposes Inclusion of patients / subjects for clinical trial / research Respecting patients and care givers 3. PATIENT RELATED ACTIVITIES Assessment of patient on a holistic manner Competency in BLS and ALS Handling patients without care givers Handling discharging destitute cases Handling foreign nationals Patient participation in decision making Patient empowerment Understanding the behaviour of patients Providing information on Disease / Diagnostics / Drugs / Diet / Alternatives / Follow up Referral and cross referral Second consultation Patient satisfaction Quality of life Quality of health care Prescribing medicines / investigations - use / misuse / overuse Prescription audit Antibiotic policy for institution Use of internet in patient care and decision making Medical Errors Incident reporting Root cause analysis Prevention of medical errors Sharing observations Introduction of innovative methods for patient safety Understanding patient safety programme

Anticipating complications and untoward incidents (related to patients, professionals, societal, technical, etc.,) Care of IV line / Ryles Tube / Catheters / ET Tube, etc., Care of back Care of unconscious / comatosed cases Issues related to prisoner / mentally disabled I.V. cannulation Extravasation Preparing patients for ECG EEG Ultra sonogram Echo cardiogram Biopsy, FNAC, Endoscopy and invasive / therapeutic procedures Other radiology & imaging tests

4. SOCIAL ASPECTS Management of clinical problems in resource poor settings Understanding socio-cultural issues of patients Handling violence in clinical practice Implementing national health policies Social accountability Meeting the Press and Media Health economics Pharmaco-economics Preventive aspects and promotion aspects of health 5. COMMUNITY WORKS Participation in community outreach activities Participation in community health programme Understanding of disease dynamics in natural surrounding Health checkup activities Participation in National Health programmes eg. RNTCP / HIV-AIDS / Malaria control and other communicable diseases Non-communicable diseases (NCDs) Integrated diseases surveillance programme (IDSP) 6. ADMINISTRATIVE ISSUES Medical records of inpatients and outpatients Preparation of Discharge summary / report Medical audit of medical records Issue of medical certificates and intricacies (Medical leave, Fitness to return after medical leave, Driving license, Death certificate, computation of pension, for travel, judiciary etc.,) Filling up the forms and declaration of death Issue of certificate to differently abled persons Welfare programmes to the sick, disabled and family of the deceased Setting up of consultation clinic 5

Health management aspects Medical insurance / reimbursement system Medicaid / Medicare system Quality assurance in health care Preparing medical reports on demand from patients / judiciary, etc., Contributory aspects to strengthen health care system.

7. CRITICAL ANALYSIS OF DOCUMENTS (Elicit deficiencies / lacunae and identify remedial measures) Medical records IP & OP Medical certificates Discharge summary / reports Medical reports 8. TEAM WORK Planning and management of cases Interaction with colleagues Interpretation to arrive at diagnosis towards evaluation and management Elicitation of strength and weakness Role and influence of sister specialties 9. DUTY REGISTER OF POSTGRADUATE STUDENTS Number of cases / specimens attended Nature of the problems Number of cases attended in different wards / emergency rooms Lessons learnt Difficulties encountered Missed aspects Knowledge and skills gained 10. LEGAL ISSUES Informed consent Medical Negligence and the law Legal aspects in medical practice Depositing witness / expert opinion Indian Medical Council regulations with latest amendments Professional conduct Advertisement Hippocrates oath and other related matters Human rights and health Right to Information Act 2005 Consumer protection act and judgments related to health Regulations related to entry in Accident Register (AR) Responsibilities towards Medico Legal Cases Sending information to police Discussion on regulations of hospital / dispensary, etc., act of the respective state Documentation of dying declaration Interaction of hospital establishment act 6

11. PHARMACOVIGILANCE PROGRAMME Adverse drug reaction Recognition, investigations, confirmation, classification, documentation, reporting, patient / family education, sharing with colleagues and others Participation in drug information centre 12. SOFT SKILL DEVELOPMENT Attitude Communication skills Listening skills Behaviour of Doctors Verbal & Physical expressions Breaking bad news Leadership skills in health care team Simulating models Ability to work under pressure 13. TECHNICAL SKILLS Ultra Sonogram of abdomen During radiology postings for PGs (who are in General Medicine, Pediatrics, Surgery & Obstetrics and Gynecology) they are taught to develop skill to recognize the pathology independently and interact with sonologist. Echo cardiogram - To learn and acquire skills on trans thoracic echocardiogram (Skill to recognize the functional and pathological status and to make clinical decision towards treatment) during their postings (PGs of Medicine, Pediatrics) to cardiology Preparing Drug Requirement a) Prepare and monitor the supply of medicine towards their ward and to emergency room. b) Prepare the indent and monitor the supply of the drugs and registered material to their ward / OP Organization skills Organization Clinical society meeting Departmental meeting Special meeting Inter / Intra institutional meeting Other academic programmes Community activities Expected from PG Prepare Agenda Discuss with participants Confirm their participation Inform others Arrange for required materials Take down notes Edit minutes of meeting Prepare proceedings Circulate to others if required

14. MEDICAL DEVICES Basic lessons on electrical and electronic aspects Medical equipments use and risks Purchase and handling 7

Maintenance Log book of medical devices Recognizing deficiencies and errors

15. BLOOD BANK Training Donor selection Cross matching Reporting adverse reactions following transfusion 16. MONITORING & SUPERVISORY CAPACITY Guide to prepare and check drug tray, emergency trolley / resuscitation trolley Verify records, register, statistics, etc., Verify availability of material for Advance Life Support (ALS) Monitoring on facilities available in ambulance Monitoring and training of health care staff attached to ambulance 17. TRAINING ON MEDICAL EDUCATION Exposure to teaching aids & utilization Curriculum development Microteaching Objective structured clinical examination (OSCE) Objective structured practical examination (OSPE) Problem based learning Activity based learning Evidence based learning Preparing various forms of questions for theory / written examination Training on various forms of assessment a) Formative b) Summative c) Video based assessment for skills d) Simulating models Being an examiner role replay Quality assurance in teaching Cost consciousness & Cost containment 18. HEALTH SCIENCES RESEARCH Formulation of research questions, aims, need and significance of the study Research methodology Choosing research designs Writing a research proposal / project Sampling method / size / techniques Data collection Bio statistics Preparing master chart and entry into computer Data analysis and interpretation Writing research reports / articles to medical hospitals Reading journals and articles 8

Constructive criticisms of journals, articles and reports Review of literature Identification of lacunae Selection of articles Writing a review article Correcting articles / reports as a peer reviewer Preparing abstract for conference Preparing power point for presentation Preparing poster presentation Learning on various databases Eg: Pub Med, Embase, Ind Med Etc., online journals, free websites Use of computer and internet Telemedicine

19. NON ACADEMIC / EXTRA CURRICULAR ACTIVITIES Orientation of PG students on entertainment, fine arts, sports, tourism, National days, NCC, NSS, Social work etc.,

III. FORMATIVE ASSESSMENT OF POSTGRADUATE MEDICAL STUDENTS: MD., GENERAL MEDICINE. 1. The Professor and HOD of primary Speciality shall a. Discuss with Chiefs of other Departments b. Provide their expectations & pattern of training required and c. Assessment models so that other departments get oriented to PGs coming from different specialties.

2. PG may be informed about the departmental objectives, goals and vision. PG of primary speciality when posted to different specialties, he / she shall be informed about the realistic goals & skills expected from him / her during the period of posting by the respective department specialist.

3. The Professor and Head or in-charge Medical Officer of the respective speciality department to which a PG is posted for training shall take utmost care to teach and train the PG students during the given time on essential matters and common illnesses or / and issues as well as related emergencies. They shall see that the PG-

a) Has acquired sufficient knowledge and skills to attend to the needs of the patients. b) Shall identify unusual/uncommon aspects of given cases and explain the features with literature support. c) Shall discharge his / her duties with human concern in an empathetic manner. d) Shall maintain patient safety aspects and necessary records without any lapses. e) Shall recognize his/her limitations and refer the cases to concerned specialist without delay. f) Shall participate in academic forum and share his/her observation in a scientific manner. g) Shall understand his/her deficiencies/ lacunae and requirements, and improve his knowledge & skills. h) Shall obtain 80% attendance to the speciality / department to which posted. i) Shall be assessed by the Chief in charge of the department / speciality for the knowledge gained and skills acquired by written, clinical and viva voce examination. j) Shall get a minimum of 70% in his/her theory and viva and other skills. 10

4. Accordingly the Assistant Professor and the Professor / Unit Chief / Chief in charge of the department have to assess the PG on the last day of posting to their department for different skills.

5. The Chief in charge of the respective speciality shall conduct theory (written), clinical and viva voce examination along with the help of one more colleague of their Speciality or allied Speciality and award marks.

6. The Professor and HOD of the primary Speciality has to coordinate with Chief of other specialties / departments and solve issues if any controversies/conflicts arises.

7. The Professor and HOD of the primary Speciality shall enter the attendance and marks acquired by the PG in the PGs electronic log book maintained by the University within a week after receiving the report from other department or Speciality and sign in the log book (hard copy) of the PG.

8. The Chief of the Primary Speciality shall assess the essential / desirable knowledge acquired by the PGs during their posting on monthly basis by conducting written, clinical and viva voce examination, and assess various skills, and award marks which shall be entered under different Title or sub-title as per the university on line records with necessary entries in the individual log book [hard copy].

9. The PG shall be informed on the deficiencies / lacunae on completion of the respective sub speciality posting / assessment in his / her primary speciality, and given an opportunity to rectify his / her deficiencies / lacunae.

10.The theory mark acquired by him / her in the formation assessment along with viva voce and it shall be a minimum of 70% in any one assessment made in the tests conducted by primary speciality as well as assessment made by other specialties / departments where PG has been posted.

11. The marks acquired by PG in different postings shall be entered in the final mark list of the candidates. 11

12. Every Assistant Professor, Chief of Specialties / Associate Professor / Professor & HOD shall train the PGs on all aspects required to them through various methods such as activity based learning, problem based training and evidence based learning methods or simulating models etc., as the case may be .

13. Each PG shall be allowed to teach and train undergraduate students on theory, clinical aspects, laboratory investigation reports, preparing patients for various procedures including medical / surgical / rehabilitative treatment and discharge plan which shall be monitored by the Assistant Professor and rectified if any deficiency has been observed .

12

MODEL FORMS Annexure - IV. [A] ASSESSMENT CARD OF THE POSTGRADUATE STUDENT [1] Name of the Department assessing the candidate and the name of the College and address where PG has undergone the training: [2] Address for communication Email ID: Telephone Number (STD): Postal address:

[3] Name of the primary Speciality of the : PG and Email ID [4] Name of the College to which PG belongs to [5] Name of the PG with expended initials:[6] University Number D M [7] Period of posting : From -------------------To [8] Department No. No. 1. 2. Yr.

--------------------and Date of assessment: Skills acquired

Marks [Maximum 100]

Theoretical knowledge to discuss the case during clinical rounds Writing case record [IP / OP / discharge summary or medical report] Ability to make working diagnosis Decision making skills Ordering investigation and abilities to interpret the data Ability to provide management plan and substantiate with reasons Ability to prescribe diet and drugs, and convince patients for adherence Maintenance of records Humanistic approach 13

3. 4. 5. 6. 7.

8. 9.

10. 11. 12. 13. 14.

Team work Teaching abilities Academic contributions Attending to the calls and making appropriate action Any other remarks TOTAL

Speciality seal Name and signature of the Name & signature of the Unit Chief / Chief i/c Assistant Professor -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-. Overall marks of the post-graduate student Number Category 1. 2. 3. 4. Theory Clinical/practical Viva voce Marls for the skills

Marks obtained

Maximum

Signature of the HOD of the Primary speciality with date

Signature of the candidate with date

Name and signature of Chief/Chief i/c with date and seal

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Date of entry into university online record------------------------Annexure IV [B] DISSERTATION: review of activities [for 3 years PG] No ACTIVITIES TIME FRAME for 3 years PG [from admission] 3rd month Signature of the Guide / Supervisor

I.

PLANNING & APPROVAL Collection of literature Critical review of literature Selecting title for dissertation with alternatives Interaction with collaborating Department[s] if required with finalization of the title. Preparation of research protocol & Proforma Approval from institutional ethical committee [IEC]

4th month

5th month 6th month

II.

Data / sample collection Collection of cases / data and entry into Master chart Brief consolidation, analysis and interpretation

Every month for 12 consecutive months

III.

IV. V. VI.

Writing literature review and other Every month for 12 consecutive aspects months 19th & 20th Preparation of brief paper / article month for an index Journal / conference st Master chart preparation, line listing, 21 month consolidation 22nd & 23rd Analysis, interpretation month 24th & 25th Discussion / correction / revision month 26th month Rewriting, finalization Submission to University 27th month

15

Annexure IV. [C] ACADEMIC PROGRAMME FOR CLINICAL POSTGRADUATES Frequency Programme Activities Remarks / signature of Chief / Asst. Prof

Daily

Department/unit meeting with Chief & Assistant Professor(s), SRs, other PGs/JR and CRRI and with or without HOD Clinical rounds Clinical demonstration

Weekly

Physician / Department meeting / conference Grand rounds with all members of unit Statistics Theory class for MBBS students Group activities Assessment of MBBS students Participation in student seminar Preparation of modules on selected topics. Dissertation review Clinco pathology conference [CPC] General clinics

Discussion on PG duty report Case presentation Demonstration of findings Explanation for symptoms/signs Plan for investigations Interpretation of laboratory reports / radiology & imaging reports Ability to prescribe drugs, fluids and diet Prescription audit Medical record / discharge Recognition, prevention and care of bedsores, catheter, IV access, Ryles Tube, ET Tube and ICD Tube. All the above components but with evidences from literature for discussion and interaction.

Submission of weekly statistics of each unit. Participation & assessment of MBBS students. Review of activities Review of assignments Learn to grade MBBS students performance

Fort Nightly

Monthly

Review and analysis of morbidity and mortality of Unit / Department Preparation of report and compare with previous month and with the respective period of previous year Publication / presentation of papers 16

 Speciality clinics Department CME Journal club meet Internal audit Debates & discussion on topics such as- Natural history of Illness/disease - Clinical aspects - Diagnostic areas - Therapeutic aspects - Prevention aspects Attendance

Review of modules Review of written tests Review of ongoing research works. Review of lecture schedule for MBBS students.

Submission of attendance from each department

17

Annexure IV [d] TECHNICAL PROCEDURES FOR M.D., GENERAL MEDICINE PG. No. Technical Procedures Carried out Assisted Observed Remarks on skills & ability to interact & interpret

I.

II.

III.

IV.

V.

VI

HEMATOLOGY Peripheral smear [preparation, staining & interpretation] Bone marrow aspiration [transport, processing and interpretation] RESPIRATORY SYSTEM Pulmonary function test Use of Nebulizer for patients Pleural aspiration Insertion of intercostal tube [ICT] Pleural biopsy Fibrotic bronchoscopy CARDIO VASCULAR Pericardiocentesis Temporary pacing GIT Naso-gastric tube insertion Stomach wash for poisoning Paracentesis abdominis Peritoneal biopsy Liver biopsy Endoscopy Rectal examination Splenic puncture Cholangiogram Porto-splenovenogram RENAL SYSTEM Renal biopsy Insertion of catheter forA] Peritoneal dialysis B] Hemodialysis Care of catheter Catheterization of bladder Preparing AV fistula Care of AV fistula CNS Lumbar puncture, EEG, EMG, Muscle Biopsy, Nerve 18

VII

Biopsy Endocrine investigations

VIII. OTHERS Arterial puncture for ABG Central venous catheter [insertion & care] IX. SPECIMEN COLLECTION FOR A] Microbiology Urine Stool Blood Body fluids Swabs Throat, nasal, etc., B] Pathology Body fluids Smear Specimen C] Biochemistry [special investigation] mention Collection Transportation X. PREPARATION OF PATIENTSA]. Radiology & Imaging X-rays Contrast studies CT scan MRI B]. Radio-isotope studies C]. Radiotherapy D]. Invasive / Non invasive procedures

19