Imm Pathology 2016

intermediAte module
in
PAthology
REQUIREMENTS FOR TRAINING & EXAMINATION
PY
CO
2016 E
IC
FF
College of
O Addendum
Basic Life Support (BLS) is a mandatory course for
all postgraduate trainees
PhysiCiAns And
surgeons
(FCPS and MCPS). All Fellowship residents are
PAkistAn
required to attend BLS course before they can
appear in Intermediate Module (IMM) examination.
A
Composed by:
Syed Faisal Babar
Department of Medical Education
Published: March, 2016
College of PhysiCiAns And surgeons PAkistAn.

7th Central Street, Defence Housing Authority, Karachi-75500.
Phone No. 99207100-10 UAN: 111-606-606 Fax No. 99266432
Contact Details:
College of Physicians and Surgeons, Pakistan.
7th Central Street, Phase II, D.H.A. Karachi - 75500.
Phone: 99207100-10, UAN 111-606-606
Facsimile: 99266450
Website: www.cpsp.edu.pk
CONTENTS
1 INTRODUCTION
4 TRAINING AND EXAMINATION
11 SYLLABUS OF PATHOLOGY
33 ASSESSMENT
36 USEFUL ADDRESSES AND TELEPHONE NUMBERS
C
This is an evolving docuMenT.
The college of Physicians and surgeons Pakistan

would appreciate any criticism, suggestions,
advice from the readers and users of this document.
Comments may be sent in writing or by
e-mail to the CPSP at:
directorate of national Residency Program (dnRP)

College of Physicians and Surgeons Pakistan (CPSP)
7th Central Street, Defence Housing Authority, Karachi-75500.
nrp@cpsp.edu.pk
INTRODUCTION
The College was established in 1962 through an ordinance of the
Federal Government. The objectives/functions of the College include
promoting specialist practice of Medicine, Obstetrics & Gynaecology,
Surgery and other specialties by securing improvement of teaching
and training, arranging postgraduate medical, surgical and other
specialists training, providing opportunities for research, holding and
conducting examinations for awarding College diplomas and
admission to the Fellowship of the College.
Since its inception, the College has taken great strides in improving
postgraduate medical and dental education in Pakistan. Competency-
based structured Residency Programs have now been developed,
along with criteria for accreditation of training institutions, and for the
appointment of supervisors and examiners. The format of
examinations has evolved over the years to achieve greater objectivity
and reliability in methods of assessment. The recognition of the
standards of College qualifications nationally and internationally,
particularly of its Fellowship, has enormously increased the number of
trainees and consequently the number of training institutions and the
supervisors. The rapid increase in knowledge base of medical
sciences and consequent emergence of new subspecialties have
gradually increased the number of CPSP fellowship disciplines to
seventy three.
CPSP Intermediate Module in Pathology 2016
After completing two years of core training during IMM, the trainees
are allowed to proceed to the advanced phase of FCPS training in the
specific specialty of choice for 2-3 years. However, it is mandatory to
qualify IMM examinations before taking the FCPS-II exit examinations.
The prospectii of IMM in each discipline have been extensively revised
and structured so as to delineate well defined competencies to be
achieved along with their level of participation. These prospectuses
have been complemented by color coded Structured Visual
Curriculum Display (SVCD) charts to be placed at a prominent place
in each training Unit. They help remind at a glance, the trainees and
the supervisors, about the competencies and their levels to be
achieved at a given time period along with the minimum number of
cases.
1
They also describe the rotations to be performed along with their
duration and objectives, mandatory workshops to be attended, and the
requirements and deadlines for submitting research synopsis and
dissertation (or two research articles in lieu of the dissertation as per
CPSP rules). The work performed by the trainee is to be recorded in the
e-logbook on daily basis. The purpose of the e-log is to ensure that the
entries are made on a regular basis and to avoid belated and fabricated
entries. It will hence promote accuracy, authenticity and vigilance on
the part of trainees and the supervisors.
The average number of candidates taking CPSP examinations each

year is over 32,000. The College conducts examinations for FCPS I (11
groups of disciplines), IMM, FCPS II (73 disciplines), MCPS 22
disciplines, including MCPS in Health Professions Education and Health
Care System Management. A large number of Fellows and senior
medical teachers from within the country and overseas are involved at
various levels of examinations of the College. Since IMM examination is
used merely as a midway assessment, it now includes TOACS (Task
Oriented Assessment of Clinical Skills) only, which is more objective
and standardized method to assess clinical skills. It is important to note
that in the overall scenario of health delivery over 85% of the total
functioning and registered health care specialists of the country have
been provided by the CPSP. To coordinate training and examination, and
provide assistance to the candidates stationed in cities other than
Karachi, the College has established 14 Regional Centers (including five
Provincial Headquarter Centers) in the country.
The five Provincial Headquarter Centers, in addition to organizing the

capacity building workshops/short courses also have facilities of libraries,
I.T, and evaluation of synopses and dissertations along with providing
guidance to the candidates in conducting their research work. The training
towards Fellowship can be undertaken in more than 198 accredited
medical institutions throughout the country and 48 accredited institutions
abroad. The total number of trainees in these institutions is over 18300

who are completing residency programs with around 3172 supervisors.
These continuous efforts of the College have even more importantly
developed a credible system of postgraduate medical education for the
country. The College strives to make its courses and training programs
‘evidence’ and need ‘based’ so as to meet international standards as well
as to cater to the specialist healthcare needs not only for this country but
also for the entire region.
Prof. Zafar ullah chaudhry

President
College of Physicians
and Surgeons Pakistan
2
INTERMEDIATE MODULE
To ensure better training, the CPSP introduced an Intermediate
Module Examination in several disciplines in 2001. This mid-training
assessment strengthens the monitoring and in-training assessment
systems by providing trainees with an estimate of mid-training
competence. It also serves as a diagnostic tool for trainees and
supervisors, provides a curricular link between basic and advanced
training, and an opportunity for sampling a wider domain of
knowledge and skills.
Vide Notifications No. 6-1 / Exam-04 / CPS / 1438 S and R, dated July
21, 2004, the Intermediate Module (IMM) examination is mandatory
eligibility requirement for all FCPS II examinations as of September
2007.
College of Physicians and Surgeons Paksitan offer fellowship

programs in six specialties of Pathology. The faculties of these
specialties and the Combined faculty of Pathology have made great
efforts to develop a common IMM training program spread over two
years as is being practiced in clinical specialties, and a common IMM
examination upon completion two years of training.
The Intermediate Module training in Pathology includes one year of

training in the chosen specialty and one year duration is earmarked
for rotations in all six specialties. This arrangement will allow the
residents of any specialty of Pathology to acquire essential
competencies of all specialties.
After two years’ of training in the core competencies of Pathology, the

trainees are allowed to continue their training in the chosen specialty
but they must pass the Intermediate Module examination prior to
sitting the final FCPS II examination.
TRAINING AND
EXAMINATION
GENERAL REGULATIONS
Candidates are admitted in the residency program and to the
examination in the name (surname and other names) as given in the
MBBS degree. CPSP will not entertain any application for change of
name on the basis of marriage/ divorce / deed.
REGISTRATION AND SUPERVISION

All training must be supervised and trainees are required to register with
the Research and Training Monitoring Cell (RTMC) within 30 days of
starting their training for the intermediate module. In case of delay in
registration, the start of training will be considered from the date of
receipt of application by the RTMC. Registration forms are available
with RTMC and at the Regional Centers. They can also be downloaded
from the CPSP Website. Training is compulsorily monitored by an
approved supervisor who is a CPSP fellow or a specialist with relevant
postgraduate qualifications and experience and registered with the
RTMC. The trainees are not allowed to work simultaneously in any other
department/institutions for financial benefit and/or for other academic
qualifications. The candidate shall register in any of the following
specialties of Pathology at the time of induction in residency program:

- Chemical Pathology - Haematology/Clinical Haematology
- Histopathology - Immunology
- Microbiology - Virology
APPROVED TRAINING CENTRES

Training must be undertaken in units, departments and institutions
approved by the College. A current list of approved institutions is
available from the College and its regional offices as well as on the
College website: www.cpsp.edu.pk
4
DURATION
The duration of training for Intermediate Module (IMM) is two
years, and residents become eligible to appear in Intermediate
Module examination upon completion of IMM training.
First six Months: Should be spent in the chosen specialty.
next one Year: Carry out rotations as specified below.
last six Months:To be spent in the chosen specialty prior to
appearing in IMM examination.
Candidates are be eligible to pursue advance phase of training
(FCPS II) in the chosen specialty after completing IMM training.
ROTATIONS
*In the institutes where blood bank is part of Haematology

Department, 6 weeks will be spent in blood bank section with
dedicated training in transfusion techniques
**In institutes where Virology and Immunology are part of another

major department, this training will be carried out in that particular
department(s).
This time period also includes the formative (Internal) assessment to
be carried out by every department at the end of training period.
5
COMPONENTS OF TRAINING
Mandatory Workshops
It is mandatory for all trainees to attend the following four mandatory
CPSP workshops in the first year of training:
1. Introduction to Computer and Internet
2. Research Methodology and Dissertation Writing
3. Communication Skills
4. Basic Life Support (BLS)
Any other workshop as may be introduced by the CPSP.
noTe: No candidate will be allowed to appear in IMM examination

without attending the abovementioned workshops including BLS.
E-logbook
The CPSP council has made e-logbook mandatory for all residency
program trainees inducted from July 2011 onwards. Upon registration
with RTMC each trainee is allotted a registration number and a
password to log on to the e-logbook on the CPSP website. The trainee
is required to enter all work performed and the academic activities
undertaken in the e-logbook on daily basis. The concerned supervisor is
required to verify the entries made by the trainee. This system ensures
timely entries by the trainee and prompt verification by the supervisor. It
also helps in monitoring the progress of trainees and vigilance of
supervisors.
Work place based assessment tools like Mini CEX and DOPS are being
developed. Once they are developed, the trainees will be required to

undergo these formative assessment tools and make their entries in the
e-logbook to document attainment of of competence.
Research (Dissertation / Two Papers)

One of the requirements for fellowship training is writing of a dissertation
or two research papers on a topic related to the field of specialization.
Synopsis of the dissertation or abstracts of research papers must be
submitted for approval to the Research & Evaluation Unit (REU) of CPSP
by the end of first year of the Intermediate Module.
6
Training Progression
Training should incorporate the principle of gradually increasing
responsibility, and provide each trainee with a sufficient scope, volume
and variety of experience in a range of settings that include inpatients,
outpatients, emergency and intensive care.
Instructional Methodology
Teaching occurs using several methods that range from formal
lectures to planned clinical experiences. The learining domains
include knowledge, skills, attitudes and practices relevant to the
discipline. College of Physicians and Surgeons Pakistan has
developed its own competency model as under:
In order to achieve the competencies of CPSP model, all

curriculum components including instructional methods should be
appropriately aligned.
The theoretical part of the curriculum presents the current body of

knowledge necessary for practice. This can be imparted using
lectures, small group sessions, grand teaching rounds, clinico-
pathological meetings, morbidity/mortality review meetings,
literature reviews and presentations, journal clubs, self-directed
learning, conferences and seminars.
Clinical learning is organized to provide appropriate expertise and

competence necessary to evaluate and manage common clinical
problems. Demonstration in outpatient and inpatient clinics and
procedural/ practical skills training in laboratory and clinical
settings are also included in instructional methods.
7
ASSESSMENT
ELIGIBILITY REQUIREMENTS
For appearing in Intermediate Module examination a candidate should
have:
l Passed FCPS-I in Pathology or granted exemption by CPSP.
l Registered with Research and Training Monitoring Cell (RTMC)
l Completed two years of RTMC registered training under an
approved supervisor in an institution recognized by the CPSP.
A certificate of completion of training must be submitted.
l Completed entries in e-logbook along with validation by the
supervisor.
l Submitted certificates of attendance of mandatory workshops.
l Approval of synopsis of dissertation or abstract of research
articles.
EXAMINATION SCHEDULE
l The Intermediate Module theory examination will be held
twice a year.
l Theory examinations are held in various cities of the country
usually at Abbottabad, Bahawalpur, Faisalabad, Hyderabad,
Islamabad, Karachi, Nawabshah, Larkana, Lahore, Multan,
Peshawar, Rawalpindi and Quetta centers. The college shall
decide where to hold TOACS examination depending on the
number of candidates in a city and shall inform the candidates

accordingly.
l English is the medium of all examinations for theory, practical
and viva.
l The College will notify of any change in the centers, the dates
and format of the examination.
l A competent authority appointed by the college has the
power to debar any candidate from any examination if it is
satisfied that such a candidate is not a fit person to take the
college examination because of using unfair means in the
examination, misconduct or other disciplinary reasons.
8
EXAMINATION FEE
l Applications along with the prescribed examination fee and
required documents must be submitted by the last date
notified for this purpose before each examination.
l The details of examination fee and fee for change of centre,
subject, etc shall be notified before each examination.
l Fee deposited for a particular examination shall not be
carried over to the next examination in case of withdrawal,
absence or exclusion.
REFUND OF FEES
If after submitting an application for examination, a candidate
decides not to appear, a written request for a refund must be
submitted before the last date for withdrawal with the receipt of
applications. In such cases a refund is admissible to the extent of
75% of fees only. No request for refund will be accepted after the
closing date for receipt of applications for refund.
If an application is rejected by the CPSP, 75% of the examination

fee will be refunded, the remaining 25% being retained as a
processing charge.No refund will be made for fees paid for any
other reason, e.g late fee, change of centre/subject fee, etc.
FORMAT OF EXAMINATION
Intermediate Module examination consists of the following two
components:
l Theory examination:
It consists of:
Paper i 10 Short Answer Questions (SAQs) 3 hours
Related to the specialty in which trainee has
been registered for FCPS II.
Paper ii 100 Single Best Answer type of MCQs 3 hours
This paper will be common for all specialties and
will comprise of following distribution:
i. Haematology, Histopathology,
Chemical Pathology, Microbiology: 20 MCQs each (80)
ii. Virology and Immunology: 05 MCQs each (10)
9
iii. Blood Banking: 10 MCQs (10)
l Clinical/practical examination:
To test basic clinical/practical skills the examination consists of:
TOACS (Task Oriented Assessment of Clinical Skills).
Only those candidates who qualify in the theory will be eligible to

take the TOACS examination in their selected specialty.
Clinical/practical examination may be held at the nearest regional

centers depending upon the number of candidates.
TOACS
TOACS will comprise of 10 to 12 stations with a change time of one
minute for the candidate to move from one station to the other. The
stations may have an examiner, a patient or both. Structured
clinical/practical tasks will be set at each station. There will be two
types of stations: static and interactive. On static stations the
candidate will be presented with patient data, a clinical/practical
problem or a research study and will be asked to give written
responses to questions asked.
In the interactive stations the candidate will have to perform a

procedure, for example, taking history, performing clinical
examination, counseling, assembling an instrument etc. One
examiner will be present at each interactive station and will either
rate the performance of the candidate or ask questions testing
reasoning and problem-solving skills.
Following considerations should be kept in mind while setting

Toacs exam:
l Depending on the availability of examiners at least half stations
should be interactive type.
l At least two stations should be dedicated to assessment of
communication skills of the candidates
l As the number of examiners in Immunology and Virology are quite
limited, these disciplines may organize their TOACS with more
static stations or they may borrow examiners from other
10
appropriate specialty e.g. Microbiology (for Virology).
ROLE AND RESPONSIBILITIES OF

SUPERVISOR
Training held under the aegis of CPSP is compulsorily supervised. A
supervisor is a CPSP fellow or a specialist with relevant postgraduate
qualifications recognized by CPSP.
Supervision of a trainee is a multifaceted job. Arbitrarily the task is

divided into the following components for the sake of convenience.
This division is by no means exhaustive or rigid. It is merely meant to
give semblance to this abstract and versatile role.
EXPERT TRAINER
l This is the most fundamental role of a supervisor. He/She has to
not only ensure and monitor adequate training but also provide
continuous helpful feedback (formative) regarding the progress
of the training.
l This would entail observing the trainee's performance and
rapport with all the people within his work environment.
l He / she should teach the trainee and help him / her overcome
the hurdles during the learning process.
l It is the job of the supervisor to make the trainee develop

the ability to interpret findings in his/her patients and act
suitably in response.
l The supervisor must be adept at providing guidance in writing
dissertation / research articles (which are essential
components of training).
l Every supervisor should participate actively in Supervisors'
workshops, conducted regularly by CPSP, and do his/her best
to implement the newly acquired information/ skills in the
training. It is his/her basic duty to keep abreast of the
innovations in his/her field of expertise and ensure that this
11
information percolates to trainees of all years under him/her.
RELIABLE LIAISON
l The supervisor must maintain regular contact with the College
regarding training and the conduct of various mandatory
workshops and courses.
l It is expected that the supervisor will establish direct contact
with relevant quarters of CPSP if any problem arises during
the training process, including the suitability of trainee.
l They must be able to coordinate with the administration of their
institutions/ organizations in order to ensure that their trainees
do not have administrative problems hampering their training.
PROFICIENT ADMINISTRATOR
He/ she must ensure that each trainee makes regular entries in e
logbook.
l Provide feedback regarding each trainee quarterly through e-log
system.
l The supervisors might be required to submit confidential reports
on trainee's progress to the College.
l The supervisor should notify the College of any change in the
proposed approved training program.
l In case the supervisor plans to be away for more than two
months, he / she must arrange satisfactory alternate supervision
during the period.
12
ROLE AND RESPONSIBILITIES OF
TRAINEE
Given the provision of adequate resources by the institution. The
trainees should:
l Accept responsibility for their own learning and ensure that it is
in accord with the relevant requirements;
l Investigate sources of information about the program and
potential Supervisor, and play an informed role in the selection
and appointment of the Supervisor;
l Seek reasonable infrastructure support from their institution and
Supervisor, and use this support effectively;
l Ensure that they undertake training diligently;
work with their supervisors in writing the synopsis/ research
proposal and submit the synopsis/ research proposal within six
months of registration with the RTMC;
l Accept responsibility for the dissertation, and plan and execute
the research within the time limits defined;
l Be responsible for arranging regular meetings with the
supervisor to discuss any hindrances to progress and document
progress etc. If the supervisor is not able/willing to meet with the
student on a regular basis, the student must notify the College;
l Provide the supervisor with word-processed updated synopsis
and dissertation drafts that have been checked for spelling,
grammar and typographical errors, prior to submission;

l Prior to submission of dissertation, the student should ensure
that the supervisor has all the raw data relevant to the thesis;
l Submit completed Dissertation to REU or evidence of
publication/ acceptance for publication of two research papers
in CPSP approved journal (s) or JCPSP six months before the
completion of (last year of) training. The trainee should be the
first or second author of both papers and the synopsis of both
papers must have a prior approval of REU;
l Follow the College complaint procedures if serious problems arise;
l Complete all requirements for sitting an examination;
provide feedback regarding the training post to the College on
13
the prescribed confidential form;
CURRICULUM IMM PATHOLOGY
The curriculum for first two years in Pathology involves balanced and
objective integration of basic medical sciences and essential core
clinical knowledge in all six disciplines of Pathology. The trainee
should be able to diagnose and monitor un-complicated conditions
prevalent in the region, and recognize, stabilize and refer complicated
cases to appropriate place / person. The trainee should complete the
minimum number of required competencies by second year of
training, before Intermediate Module examination. The coverage that
each discipline receives is not indicative of the relative importance
placed on each discipline in the training program, or in the
examination. These are guidelines, not comprehensive definitive lists.
Only minimum levels of expected competence have been identified
but sufficient scope, volume and variety of experience are desirable.
AIM
The overall aim of training for IMM is to facilitate the development of
a Pathologist who is equipped with minimum competence for:
l Pursue advance phase of Fellowship (FCPS-II) in any of the
branches of choice.
l Handle basic workload pertaining toall the specialties of
Pathology (including specialties other than that of his/her
choice)after successfully completing the fellowship.
GOALS
Upon completion of specified training the resident must have
acquired the competencies comprising knowledge, skills and
attitudes, which constitute the foundation of the standard practice for
a specialist in order to:

l Provide an appropriate, cost effective and standard care to
patients at all levels.
l Promote health and prevent disease in patients, families and
communities.
l Practice Continuing Professional Development.
To attain competence the trainee must achieve:

l Knowledge and expertise in diagnostic, clinical and procedural
managementof relevant diseases.
l Basics of relevant bench work and other skills.
l Effective clinical judgment and decision making in dealing with
health problems using evidence based medicine and evidence
14
based laboratory medicine.
CORE COMPETENCIES
Competencies are broad abilities requiring a varying combination of
knowledge, skills and abilities. Core competencies expected of a
trainee by the end of two years of training and before appearing in
Intermediate Module Examination in Pathology are:
history Taking
l Understand the Symptomatology and recognize Alarm symptoms
l Take history in problem situations as when patient's language is
different from trainee’s language or when confronted with
confused and deaf patients.
l Formulate differential diagnosis after analysis and synthesis of
identified problems
l Perform bench work appropriate to his/her specialty
l Make appropriate diagnosis on the basis of clinical features/ tissue
examination/blood film/laboratory date
l Effectively communicate with the patient, hospital staff and others
l Show empathy with the patient
collection of Biological specimens

l Take consent of the patient for performing venipuncture or other
procedures for biological specimen collection.
l Ensure patient safety i.e. collection of correct sample from
correct patient.
l Maintain records with dates and sign each entry
l Ensure that notes are accessible to all members of the team and
patients /relatives (if required)
l Use latest technology for the benefit of patient e.g. fax, email etc.
Time Management
l Prioritize tasks (clinical and others) that are to be accomplished
l Plan line of action while keeping realistic expectations of tasks to
be completed by self and others.
decision Making
l Analyze and synthesize clinical problems
l Recognize the role of, and consult other members of the health
care team
l Approach tasks with flexibility
15
Basic life support
l Examine and assess a collapsed patient
l Maintain adequate airway and perform effective cardiopulmonary
resuscitation
l Control self-emotions and enable others to keep calm
communication skills
l Use open ended questions for gaining information
l Communicate effectively with patients, taking care of their level
of understanding
l Provide information to patients in simple and precise language,
avoiding technical terms
l Encourage questions from the patients and their relatives
l Seek help of interpreters where necessary
l Give due respect to patient’s privacy and share information
when appropriate
l While counseling give choices and help the patient in decision
making
l Show empathy and concern during breaking bad news
l Avoid conveying unrealistic optimism
l Discuss ethics, medical procedure & legal implications related
to organ donation with the patient and relatives when required
life long learning

l Pursue activities/ programs for professional development
l Understand the role of appraisal and assessment
l Recognize and make full use of learning opportunities
l Make effort to learn from seniors, colleagues and others
l Demonstrate proficiency in the use of information technology
Practice evidence Based Medicine

l Show competence in use of various information sources e.g.
Medline, library and internet
l Use evidence to support patient care effectively
l Critically evaluate medical evidence using principles of EBM
clinical audit, guidelines

l Recognize the relevance of audit to benefit patient care
l Participate in clinical audits
l Comprehend the problems and benefits of existing guidelines
l Use local guidelines where applied
l Take care of individual patient needs when using guidelines
16
ethical and legal issues
l Recognize the importance of Informed consent and practice it in
a manner that the patient is able to understand it fully
l Respect the right to confidentiality
l Maintain patients confidentiality regarding lab data and other
information
l Use and share all information with the patient and relatives as
and where appropriate
l Partake legal responsibilities of writing death certificate & mental
health certificate
Professional Behavior
l Show responsibility in maintaining continuity of care
l Ensure satisfactory completion of delegated tasks by the end of
the shift/day with appropriate handover
l Display nondiscriminatory attitude towards all the patients
l Refrain from giving unnecessary personal comments
l Exercise care in managing inappropriate behavior e.g.
aggression, violence, sexual harassment in patients
l Recognize own limitations and accept constructive criticism
l Act as a responsible member of health care team
Patient education
l Educate patients about: disease, investigations & therapy
l Counsel patients; explaining individual treatment plans and the
actions to be taken if the condition deteriorates or improves
l Encourage patients to access further information / patient
support groups
disease Prevention
l Identify role of environmental and lifestyle risk factors, such as
diet, exercise, social deprivation, occupation and substance
abuse in disease causation
l Comprehend the Epidemiology and screening procedures for
risk factors
l Provide support and advice on quitting the use of tobacco/
alcohol
l Assess individual patient's risk factors
l Encourage participation in appropriate disease prevention or
screening programs
Teaching and Training
17
l Communicate and share information with all members of health
care team
l Adopt learner-centered approach while teaching/training
l Demonstrate willingness, enthusiasm and patience to teach
l Seek feedback from peers as well as from juniors
l Make best use of all teaching opportunities
l Develop effective presentation skills
l Use multiple audio-visual aids effectively for presentation
safe Management while on call

l Recognize medical indications for urgent investigations and
therapy
l Identify skills and competencies of other members of the 'on call'
team
l Prioritize the tasks to be carried out
l Call for help and refer the case whenever required
l Effectively interact with other health care professionals
l Keep patients and relatives informed
l Hand over all the information to the proceeding team staff, safely
discharge Planning
l Recognize the impact of unnecessary hospitalization
l Educate the patient and relatives regarding impact of physical
problems on daily activities
l Liaise and communicate with patient, family and primary care
services
l Write reports for appropriate bodies
Resuscitation and Basic life support

l Recognize critically ill patients

l Practice basic life support algorithms
ONE YEAR TRAINING IN THE SELECTED
18
SPECIALTY
CHEMICAL PATHOLOGY
learning outcomes (Knowledge)
l Pathophysiology of Routine Chemical Pathology including
following topics:
- Diabetes Mellitus and Hypoglycaemia
- Electrolytes and Acid Base Disorders
- Liver Function Tests
- Renal Function Tests
- Cardiac biomarkers
- Lipid Disorders
- Iron Disorders
- Disorders of Bones
- Others
l Pathophysiology of Endocrinology and Miscellaneous including

following topics:
- Thyroid Disorders
- Adrenal Disorders
- Pituitary Disorders
- Tumour Markers
- Paediatric Metabolic Disorders
l Lab Management including following topics:

- Quality Control
- Quality Assurance
- EBLM
- Pre-analytical variables
- Sample Collection
- Lab Safety
- Inventory management
- Communication skills with lab staff, patients, administration
and vendors
learning outcomes (skills)

l Analytical Techniques and Instrumentation including
19
following topics:
- Optical Techniques
- Electrochemistry
- Electrophoresis
- Lab Automation
l Methods of detection of Common Analytes:

- Glucose
- Urea
- Bilirubin
- ALT
- Alkaline Phosphatase
- Albumin
- Calcium
- Cholesterol
- Urea
- Creatinine
- Others
l Quick Interpretation of Data Interpretation skills (QADIS)
MICROBIOLOGY
l General bacteriology
- Structure of bacterial cell
- Normal flora
- Pathogens
- Host defenses
- Laboratory diagnosis
l Anti-Microbials
- Mechanism of action
- Mechanism of resistance
- Bacterial vaccines
l Sterilization and disinfection

l Staining / Culture techniques for:
20
l Gram positive cocci and rods
- Staphylococci
- Streptococci
- Bacillus
- Clostridia
- Corynebacteria
- Listeria
l Gram negative organism

- Neisseria
l Gram Negative Rods

- Related to Enteric tract
w Enterobacteriaceae
w Non- Enterobacteriaceae
- Related to respiratory Tract
w Zoonatic gram negative organism
l Others
- Mycobacteria
- Actinomycetes
- Spirochetes
- Chlamydia
- Rickettsia
l Parasitology
- Protozoa
w Entamoeba
w Giardia
w Cryptosporidium
w Trichomonas
w Plasmodium
w Leishmania
w Toxoplasma
w Pneumocystis
w Trypanosoma
- Cestodes
w Taenia
w Echinococcus
21
w Diphyllobothrium
w H.nana
- Trematodes
w Schistosomahaematobium
w Paragonimuswestermani
w Clonorchissinensis
- Nematodes
w Ascaris lumbricoides
w Enterobius
w Trichuris Ancylostoma and Necator
w Strongyloides
w Trichinella
w Tissue nematodes
w Nematodes whose larvae cause disease
l Others
- Mycobacteria
- Actinomycetes
- Spirochetes
- Chlamydia
- Rickettsia
l Lab Management including following topics:

- Quality Assurance
- Sample Collection
- Lab Safety

and vendors
HAEMATOLOGY
Routine haematology:
22
l Define haematopoiesis
l Discuss aetiology, pathophysiology, clinical features and
laboratory investigations of:
- Iron Deficiency anaemia
- Megaloblastic anaemia

l Prepare and stain blood films
l Identify abnormalities of red cell, white cell and platelet morphology
l Perform reticulocyte staining and reticulocyte count
l Perform WBC count and DLC
l Perform RBC count
l Perform and interpret Platelet count
l Perform Haematocrit
l Interpret all CBC parameters
l Ensure quality control in routine haematology
haemoglobin studies:
l Disucss aetiology, pathophysiology, clinical features and
- Genetic defects of haemoglobin
- Haemolytic anaemias

l Perform haemoglobin electrophoresis and interpret the common
findings
l Interpret the results of screening tests for Glucose 6 Phosphate
Dehydrogenase deficiency
l Perform and interpret sickling test

l Perform and interpret hemoglobin A2 estimation
l Perform and interpret hemoglobin F estimation
l Identify abnormal haemoglobins
coagulation studies:
l Discuss the aetiology, pathophysiology, clinical features and
- Coagulation disorders
23
- Thrombophilia
- Platelet disorders

l Perform and interpret
- Bleeding time
- Prothrombin time
- Activated Partial Thromboplastin Time
- Thrombin Time
- Fibrinogen level
- D dimers and Fibrinogen Degradation Products
- Mixing studies
- Factor assays
- Platelet function studies
- Urea lysis test
- Thrombophilia screening
Bone Marrow Pathology:

l Discuss the aetiology, pathophysiology, clinical features and
- Aplastic Anaemia
- Acute leukemias
- Myeloproliferative disorders
- Myelodysplasia
- Hodgkin Lymphoma
- Non Hodgkin Lymphoma
- Chronic lymphocytic leukemia
- Plasma cell disorders

l Perform bone marrow aspiration and trephine biopsy with
preliminary reporting.
l Perform and draw inference on cytochemical stains
Transfusion Medicine:
l Methodology and specificity/sensitivity of infectious disease
markers
l Types of blood donors and strategies to recruit voluntary blood
donors
24
l Immunoglobulin structure and genetic basis for antibody diversity
l Red cell alloantibodies and autoantibodies
l Factors influencing antigen antibody reactions
l Natural and acquired antibodies
l Mechanisms of red cell sensitization
l Mechanisms of red cell destruction – complement activation,
intravascular and extravascular destruction
l Biochemistry, genetic inheritance, immunogenicity and clinical
significance of Carbohydrate (Lewis, P, I/i) and
Protein (Kell, Kidd, Duffy, MNS and others) red cell antigens
l Disease associations with the null phenotypes of ABO,
Rh and Kell
l Serologic testing by different formats – Tube, gel,
solid phase and microplates
l Indications, reagents and methods of Weak D testing, antibody
screening and identification, cross matching, enhancement
techniques, adsorption/elution techniques,
Donath Landsteiner test and antibody titration tests
l Platelet refractoriness
l Quality assurance of blood components
l Quality assurance of blood grouping sera and Coomb’s sera
l Clinical, viral and serological course of HBV, HCV, HIV infections
l Malaria and syphilis carrier state in blood donors
l Call back of blood donors and lookback investigations

l Management of complications of blood transfusion
l Identification of red cell antibodies by serologic
specificity, isotype and thermal amplitude
l Preparetion of blood components from whole blood

l Use of blood product anticoagulants and preservatives
l Proper storege of blood components as per their storage
temperatures and shelf lives
l Pooling of platelet concentrates and plasma thawing
l Use of pediatric blood bags, sterile connecting devices,
irradiation of red cell and platelet concentrates, leucodepleted
blood products and leucocyte concentrate
l Disposal of blood components
l Quarantine of blood donor samples
l Investigation of transfusion related infections
l Investigation of transfusion reactions
l Perform bacterial cultures
25
l Quality control of blood products
l Quality control of blood grouping and Coomb’s antisera
Benchwork skills:
Use and maintain following laboratory instruments:
l Centrifuge
l Waterbath
l Analytical Balance
l Adjustable pippete
l Automated haematology analyzers
l Microscope
l Spectrophotometer
l Cytocentrifuge
l Automated coagulation analyzer
l Platelet aggregometer
l Gel electrophoresis
HISTOPATHOLOGY
l Basic Techniques
- Biopsy Specimen collection including cytology specimens.
- Tissue fixation (Rationale, Types and Techniques)
- Gross cutting (Observation-To handle common surgical
pathology specimens including importance of slicing large
specimens. Salient features to be described as per
recommended guidelines).
- Tissue processing (Steps and Rationale)
- Special precautions for tissue to be sent for (electron

microscopy, special biopsies, immunofluorescence etc.)
- Decalcification (Methods)
- Basic Molecular Biology Techniques and FISH testing for

Her-2-neu /common solid tumor testing.
- Specimen, slides and block storage protocols.
l Staining
- Hematoxylin and Eosin (H&E) staining
- Special stains-requirements and principles.
- Immuno-histochemical staining-principles(Technique) and
common applications
26
l Surgical Pathology
International reporting protocols, checklists, synoptic reporting of
common resections (Breast, Gastric, Colon, H&N, Prostate,
Urinary Bladder, Uterus & Ovaries)
- Head & Neck:
w Oro-pharyngeal carcinoma
i. Precursor lesions
ii. Grading & Staging
- GIT:
w Esophagus:
i. Esophagitis (Reflux/ Herpes / candida)
ii. Barrett’s esophagus with dysplasia
iii. Carcinoma esophagus
w Stomach:
i. Gastritis (Types) H.Pylori infection / gastritis.
ii. Adenocarcinoma: Grading & Staging
w Small Intestine / Large Bowel:
i. Coeliac disease
ii. Polyps
iii. IBD
iv. Adenocarcinoma with Staging and Grading.
w Appendix:
i. Acute appendicitis
ii. Neuroendocrine tumors
w Gall Bladder:
i. Cholecystitis
ii. Carcinoma Gall Bladder
- Female genital system:
w Endometrium
w Normal phases of menstrual cycle

w Precise dating of endometrial biopsy
w Polyp/Hyperplasia
l Frozen Section:
To have an in sight of Principles, steps, indications and
interpretation of frozen section technique, (requirement from
surgeon, liaison with surgeon, conveying of report etc).
l Cytology including FNA

- Ensure adequacy of cervical smear
- Perform cervical smear in special circumstances / where
required
- Take appropriate history and clinical examination of the patients
27
- Perform FNAC followed by smear preparation and
assessment of adequacy
- Cytology sample collection, preservation in proper fixative
l Quality Control in Histopathology
l Communication Skills
- Develop rapport with laboratory staff
- Communicate effectively with other clinicians and contribute
to multi-disciplinary team work
- Communicate with patients with empathy and respect
IMMUNOLOGY
l Lab safety and good lab practices
l Innate immunity
l Specific immunity
l Antigens, antibodies and immune response
l HLA system
l Complement system
l Autoimmune disorders
l Immunodeficiency disorders
l Allergy/hypersensitivity

l Indications and sample requirements for immunology lab tests
l Agglutination procedures including ELISA
l Observe/understand the principles of Immunofluorescence
l HLA typing (serology & DNA based)
l Skin prick test for allergy

l Flow cytometry
l Immunoelectrophoresis/immunofixation
l Microbead array procedures (Luminex)
VIROLOGY
l Classify viruses
28
l Principles of viral diagnosis
l Laboratory safety and housekeeping
l Types of samples required in different viral infections for lab
diagnosis
l Basic knowledge of common viral infections
l Basic knowledge of the etiology, pathophysiology, clinical
features and laboratory investigations of Viral hepatitis
l Transfusion transmitted infections
l Dengue and CCHF

l Perform immunochromatographic tests
l Identify abnormal results
l Perform ELISA for HBsAg, AntiHIV and AntiHCV
l Interpret ELISA results
l Carry out Quality Control of ELISA
note: Where procedures have been identified; it is expected that at

least one procedure will be performed.
ROTATIONAL TRAINING
CHEMICAL PATHOLOGY
l Pathophysiology of Routine Chemical Pathology including:
- Diabetes Mellitus and Hypoglycaemia
- Electrolytes and Acid Base Disorders
- Liver Function Tests
- Renal Function Tests
- Cardiac biomarkers
- Lipid Disorders
29
- Iron Disorders
- Disorders of Bones
l Pathophysiology of Endocrine disorders:

- Thyroid Disorders
- Adrenal Disorders
- Pituitary Disorders
- Tumour Markers
- Paediatric Metabolic Disorders
l Laboratory Management
- Quality Control
- Quality Assurance
- Evidence based laboratory medicine (EBLM)
- Sample Collection
- Lab Safety
and vendors
- Implementation of policies and SOPs on the above mentioned
subjects

l Use and maintenance of:
- Centrifuge
- Waterbath
- Analytical Balance
- Adjustable pipette
- Automated chemistry analyzers
- Spectrophotometer
l Analytical Techniques and Instrumentation including:
- Optical Techniques
- Electrochemistry
- Electrophoresis
- Lab Automation
l Estimation Methods of Common Analytes:

- Glucose
- Urea
- Bilirubin
- ALT
- Alkaline Phosphatase
30
- Albumin
- Calcium
- Cholesterol
- Urea
- Creatinine
- Others
- Calculations of various lab tests
MICROBIOLOGY (10 WEEKS)

l General Bacteriology
- Structure of bacterial Cell
- Normal flora
- Pathogens
- Host defenses
- Laboratory methods for diagnosis
l Anti-Microbials
- Mechanism of action
- Mechanism of Resistance
- Bacterial Vaccines
l Sterilization and disinfection
l Gram positive cocci & rods

- Staphylococci
- Streptococci
- Bacillus
- Clostridia
- Corynebacteria
- Listeria
l Gram Negative organism

- Neisseria
l Gram Negative Rods

- Related to Enteric tract
- Enterobacteriaceae
- Non- Enterobacteriaceae
- Related to respiratory Tract
- Zoonatic gram negative organism
l Others
31
- Mycobacteria
- Actinomycetes
- Spirochetes
- Chlamydia
- Rickettsia
l Mycology
- Opportunistic fungi
- Deep mycosis
l Infectious diseases
- Gastrointestinal tract infection
- Upper respiratory tract infections
- Lower respiratory tract infections
- Skin and soft tissue infection
- Urinary tract infection
l Parasitology
- Protozoa
w Entamoeba
w Giardia
w Cryptosporidium
w Trichomonas
w Plasmodium
w Leishmania
w Toxoplasma
w Pneumocystis
w Trypanosoma
- Cestodes
w Taenia
w Echinococcus
w Diphyllobothrium
w H.nana
- Trematodes
w Schistosomahaematobium
w Paragonimuswestermani
w Clonorchissinensis
- Nematodes
w Ascarislumbricoides
32
w Enterobius
w TrichurisAncylostoma and Necator
w Strongyloides
w Trichinella
w Tissue nematodes
w Nematodes whose larvae cause disease
HISTOPATHOLOGY (10 WEEKS)

l Specimen collection including autopsy specimen collection,
DNA specimen collection
- Tissue fixation
- Gross cutting (Observation;To handle common surgical
pathology specimens including importance of slicing
large specimens. Salient features to be described as per
recommended guidelines.)
- Tissue processing
- Special precaution for tissue to be sent for (electron
microscopy, special biopsies, immuno-fluorescence etc.)
- Decalcification
- Basic Molecular Biology Techniques & FISH testing for
Her-2-neu/solid tumors
l Staining
- Routine H & E staining
- Special stains
- Immunohistochemical staining, requirements and
principles
l Surgical Pathology
- Histopathological diagnoses of common Bacterial,
Protozoal, Fungal, Viral & Parasitic Infections.
- Common Benign, Pre-malignant and malignant lesions
of all organs particularly of top 10 cancers in Males &
Females.
l Cancer epidemiology and Role of Population based,

Pathology based & Hospital based Cancer Registries.
33
l Frozen Section To have an insight of Principles, Steps,
indications and interpretation of frozen section technique,
(requirement from surgeon, liaison with surgeon, conveying of
report etc.)
l Cytology including FNA

- Adequacy of cervical smear
- Perform cervical smear in special circumstances / where
required
- Perform FNAC followed by smear preparation and
assessment of adequacy.
- Cytology samples collection, preservation in proper fixative
l Quality Control in Histopathology
HAEMATOLOGY(10 WEEKS)
l Basic Haematology
- Haemopoiesis
- Anaemias
- Leukemias/Lymphomas
- Coagulation disorders
- Thrombophilia
- Platelet disorders
- Blood transfusion
- Stem cell transplantation

l Procedure and Interpretation of Haematological Analytes
- CBC using automated hematology analyzer
- Preparation and staining of blood films
- Reticylocyte staining and reticulocyte count
- Manual blood counts
- Quality control in routine haematology
- Bone marrow aspiration and trephine biopsy
- Screening tests for G6PD deficiency
- Sickling test
34
- Coagulation studies
- Hb Studies
- Platelets
- Reticulocytes
- MCV
- MCH
- TRBC
- RDW
- PT
- PTTK
- Hb A
- HbA2
- HbF
- D-Dimers
- Fibrinogen
l Quality Control in Hematology

- Calculation of mean, SD and CV
- Application of tests of significance
- Plotting of LJ charts of Quality Control
- Application of Westgard Rules
BLOOD TRANSFUSION (6 WEEKS)

- Components preparation
- Forward and reverse grouping and cross match
- Coombs test
IMMUNOLOGY (3 WEEKS)
- Innate immunity and Specific immunity
- Antigens, antibodies and immune response
35
- HLA system, Complement system
- Autoimmune disorders
- Immunodeficiency disorders and Allergy/hypersensitivity
VIROLOGY (3 WEEKS)
- Classification of Viruses
- Knowledge of principles of viral diagnosis
- Laboratory safety and housekeeping, knowledge of type of
samples required in different viral infections for lab diagnosis
- Basic knowledge of the etiology, pathophysiology, clinical
features and laboratory investigations of common viral
infections i.e. Viral hepatitis, Common Transfusion transmitted
infections, Dengue and CCHF
36
USEFUL ADDRESSES
AND TELEPHONE
NUMBERS
1. Regional Offices of the CPSP
MUZAFFARABAD LAHORE
CMH Muzaffarabad Next to INMOL, Hospital
Azad Kashmir New Muslim Town, Block-D
TEL: 058810 - 43307 Lahore.
FAX: 058810 - 43902 UAN: 042-111-666-666
Email: ssgr-brehman@cpsp.edu.pk TEL: 042- 9231320-8
FAX: 042- 9231327
ABBOTTABAD Email: rc_lahore@cpsp.edu.pk
Ayub Hospital Complex
Abbottabad
MULTAN
TEL: 0992-383330
Nishtar Medical College,
Email: rc_abbottabad@cpsp.edu.pk
Distt. Jail Road, Opp Circuit House,
Multan.
PESHAWAR
Hayatabad Medical Complex UAN: 061-111-666-666
Phase IV, Hayatabad, TEL: 061-9200946, 9200952
Peshawar Email: rc_multan@cpsp.edu.pk
UAN: 091-111-666-666
TEL: 091-9217011, 091-9217320-1 BAHAWALPUR
FAX: 091-9217062 Quaid-e-Azam Medical College
Email: rc_peshawar@cpsp.edu.pk Bahawalpur
TEL: 062- 9250461
ISLAMABAD Email: rc_bahawalpur@cpsp.edu.pk
P.I.M.S, Ravi Road, Sector G- 8/ 3
Islamabad. NAWABSHAH
UAN: 051-111-666-666
Peoples Medical College for Girls
TEL: 051-9262590-1,
Nawabshah
FAX: 051-9262592
TEL: 0244-9370271, 9370479
Email: rc_islamabad@cpsp.edu.pk
FAX: 0244-9370478
FAISALABAD Email: rc_nawabshah@cpsp.edu.pk
Punjab Medical College
Faisalabad LARKANA
UAN: 041-111-666-666 Chandka Medical College
TEL: 041-9210131, 9210366-8 Larkana
FAX: 041-9210224 TEL: 074 – 9410726
il:rc_faisalabad@cpsp.edu.pk Email: rc_larkana@cpsp.edu.pk
37
HYDERABAD QUETTA
Liaquat University Hospital, Jamshoro CPSP Bolan Medical College
Hyderabad Sandeman Civil Hospital
TEL: 022-3877393 TEL: 081- 9202424
Email: rc_hyderabad@cpsp.edu.pk Email: rc_quetta@cpsp.edu.pk
KARACHI
2. Departments of CPSP Karachi OVERSEAS CPSP CENTRES

UAN – 021-111-606-606 3. Saudi Arabia
RIYADH
l Examination (FCPS Part I) Saudi Commission for Health
9207100 -10 Ext: 311
Specialities,
l Examination (FCPS Part II) Diplomatic Quarter, P.O. Box 94656
9207100 -10 Ext: 215 Riyadh -11614, KSA.
TEL: 966-1-4822415 Ext: 156/141
l Department of Medical 966-2-6401000 Ext: 25843
Education
Email: medexam5@scfhs.org
9207100 -10 Ext: 305
l Registration, Training & 4. Nepal

Monitoring Cell KATHMANDU
9207100 -10 Ext: 320 T.U. Institute of Medicine
For further Information visit the Maharajganj, Kathmandu, Nepal
College website at : TEL: 977-1- 416224
www.cpsp.edu.pk Email: cpsp@healthnet.org.np
38

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intermediAte module

REQUIREMENTS FOR TRAINING & EXAMINATION

Published: March, 2016

College of PhysiCiAns And surgeons PAkistAn.

4 TRAINING AND EXAMINATION

36 USEFUL ADDRESSES AND TELEPHONE NUMBERS

The college of Physicians and surgeons Pakistan

directorate of national Residency Program (dnRP)

The average number of candidates taking CPSP examinations each

The five Provincial Headquarter Centers, in addition to organizing the

abroad. The total number of trainees in these institutions is over 18300

Prof. Zafar ullah chaudhry

College of Physicians and Surgeons Paksitan offer fellowship

The Intermediate Module training in Pathology includes one year of

After two years’ of training in the core competencies of Pathology, the

REGISTRATION AND SUPERVISION

specialties of Pathology at the time of induction in residency program:

APPROVED TRAINING CENTRES

*In the institutes where blood bank is part of Haematology

**In institutes where Virology and Immunology are part of another

noTe: No candidate will be allowed to appear in IMM examination

developed. Once they are developed, the trainees will be required to

Research (Dissertation / Two Papers)

In order to achieve the competencies of CPSP model, all

The theoretical part of the curriculum presents the current body of

Clinical learning is organized to provide appropriate expertise and

number of candidates in a city and shall inform the candidates

If an application is rejected by the CPSP, 75% of the examination

Only those candidates who qualify in the theory will be eligible to

Clinical/practical examination may be held at the nearest regional

In the interactive stations the candidate will have to perform a

reasoning and problem-solving skills.

Following considerations should be kept in mind while setting

ROLE AND RESPONSIBILITIES OF

Supervision of a trainee is a multifaceted job. Arbitrarily the task is

l It is the job of the supervisor to make the trainee develop

grammar and typographical errors, prior to submission;

a specialist in order to:

To attain competence the trainee must achieve:

collection of Biological specimens

life long learning

Practice evidence Based Medicine

clinical audit, guidelines

safe Management while on call

Resuscitation and Basic life support

l Recognize critically ill patients

ONE YEAR TRAINING IN THE SELECTED

l Pathophysiology of Endocrinology and Miscellaneous including

l Lab Management including following topics:

learning outcomes (skills)

l Methods of detection of Common Analytes:

l Quick Interpretation of Data Interpretation skills (QADIS)

l Sterilization and disinfection

learning outcomes (skills)

l Gram negative organism

l Gram Negative Rods

l Lab Management including following topics:

- Communication skills with lab staff, patients, administration

learning outcomes (skills)

learning outcomes (skills)

l Perform and interpret sickling test

learning outcomes (skills)

Bone Marrow Pathology:

learning outcomes (skills)