RESIDENCY TRAINING CURRICULUM FOR INTERNAL MEDICINE 2010 [Draft Copy

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DEPARTMENT OF MEDICINE Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh

Contents
Items 1. Introduction 1.1 About Internal Medicine 1.2 The Modern-Day Physician 1.3The Science and ART of Medicine 1.4The competency-based curriculum 2. Mission statement 3. General objectives 4. Educational Objectives 5. Teaching and Learning Methods 6. Entry requirements 7. Rotations in phase A 8. Contents of learning Syllabus: Applied basic sciences 8.1.1. Anatomy course content 8.1.2. Physiology course content 8.1.3. Biochemistry and clinical chemistry course content 8.1.4. Pathology course content 8.1.5. Microbiology 8.1.6. Virology 8.1.7. Genetics & Immunology 8.1.8. Clinical Pharmacology 8.1.9. Statistics and (in phase B) Syllabus: Clinical and procedural competencies 8.2.1. General clinical competencies: 8.2.1.1. History taking 8.2.1.2. Clinical examinations 8.2.1.3. Decision making and clinical reasoning 8.2.1.4. Therapeutics and safe prescribing 8.2.2. Symptom based competencies 8.2.3. Management of acute medical problems 8.2.4. System based competencies 8.2.4.1. Palliative care and End of Life care 8.2.4.2. Cardiology 8.2.4.3. Endocrinology and metabolic disorders including diabetes mellitus 8.2.4.4. Gastroenterology and hepatology Page No.

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8.2.4.5 Hematology 8.2.4.6. Psychiatry/ Mental health disorder 8.2.4.7. Rheumatology / Disorders of Musculoskeletal system 8.2.4.8 Neurology/ Disorders of neurological system 8.2.4.9. Nephrology/ Disorders of the renal and genitourinary systems 8.2.4.10. Pulmonary Medicine/Disorders of the Respiratory and sleep system 8.2.4.11. Dermatology/Skin disorders 8.2.4.12. Infectious diseases 8.2.4.13. Otolaryngology and ophthalmology 8.2.4.14. Oncology 8.2.4.15. Genetic diseases 8.2.5. Medicine throughout the lifespan/growth and development 8.2.5.1. Manage common medical problems in pregnancy 8.2.5.2. Manage problems in the older patients/Elderly/ Geriatrics 8.2.5.3. Manage common problems associated with the menopause/Women’s Health 8.2.5.4. Public Health Issues and Health Promotion 8.2.5.5. Evidence-Based Medicine (EBM) 8.2.6. Investigational competencies 8.2.7. Procedural competencies 8.3. Educational syllabus 8.3.1. Maintaining good medical practice 8.3.2. Professional behavior 8.3.3. Ethics and legal issues 8.3.4. Patients’ education and prevention 8.3.5. Team working and leadership 8.3.6. Teaching and educational supervision 8.3.7. Patients’ safety 8.3.8. Infection control 8.3.9. Clinical governance 8.3.10. Information technology, computer assisted learning and information management 8.3.11. Research 9. Assessment strategy 10. Trainee supervision and feedback 11. Curriculum implementation strategies

Introduction 1. About Internal Medicine (Ref. a discipline popularized in Germany in the late 1800s to describe physicians who combined the science of the laboratory with the care of patients.12. Curriculum review 13. Annexure 1. ACP) What does "internal medicine" mean? Page101 The term "Internal Medicine" comes from the German term Innere Medizin. Many early 20th century American doctors studied medicine in Germany and brought this medical .1.

internists take pride in caring for their patients for life -. They also bring to patients an understanding of wellness (disease prevention and the promotion of health). Internists are sometimes referred to as the "doctor's doctor. obstetrics and pediatrics. They are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses may strike at the same time. it unfortunately doesn't exactly fit an American meaning. nervous system and reproductive organs. or how simple or complex. and in nursing homes. Role of an internist: Caring for the whole patient Internists are equipped to deal with whatever problem a patient brings -. Cardiologists." "family practitioners. and treat diseases that affect adults. Like many words adopted from other languages. ears. When other medical specialists. such as surgeons or obstetricians.field to the United States. Doctors of internal medicine focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. Although internists may act as primary care physicians. the name "internal medicine" was adopted. diagnose.no matter how common or rare." or "general practitioners." who are doctors in their first year of residency training. What's an "internist"? Simply put. Doctors for Adults. Internal medicine subspecialties Internists can choose to focus their practice on general internal medicine." because they are often called upon to act as consultants to other physicians to help solve puzzling diagnostic problems. including "internists. for example. are doctors of internal medicine who subspecialize in diseases of the heart. or may take additional training to "subspecialize" in one of 13 areas of internal medicine.in the office or clinic. Subspecialty training (often called a "fellowship" in USA) usually requires an additional one to three years beyond the standard three year general internal medicine residency. The training an internist receives to subspecialize in a particular medical area is both broad and deep. mental health. they are not "family physicians. internists are Doctors of Internal Medicine. Page101 . skin. women's health. are involved." But don't mistake them with "interns." "general internists" and "doctors of internal medicine. during hospitalization and intensive care. Thus. substance abuse." whose training is not solely concentrated on adults and may include surgery.® But they are referred to by several terms. as well as effective treatment of common problems of the eyes. At least three of their seven or more years of medical school and postgraduate training are dedicated to learning how to prevent. Role of an internist: Caring for patient’s life In today's complex medical environment. they coordinate their patient's care and manage difficult medical problems associated with that care.

scientific knowledge. [the physician] needs technical skill. Despite more than 50 years of scientific advances since the first edition of this text. This explosion of scientific knowledge is not at all static as it continues to intensify with time. and reassurance. [The patient] is human. responsibility. and prevent disease. As today's physician struggles to integrate the copious amounts of scientific knowledge into everyday practice. allow access to the innermost parts of the cell and provide a window to the most remote recesses of the body. degenerative disease. –Harrison's Principles of Internal Medicine. treat. and other disorders. Increasingly. The advent of molecular biology with its enormous implications for the biological sciences (the sequencing of the human genome). and hopeful. . Tact. cell biology. Spectacular advances in biochemistry. and human understanding. damaged organs. Revelations about the nature of genes and single cells have opened the portal for formulating a new molecular basis for the physiology of systems. or obligation can fall to the lot of a human being than to become a physician. sophisticated new imaging techniques. The widespread use of electronic medical records and the Internet have altered the way we practice medicine and exchange information.2 The Modern-Day Physician No greater opportunity. disordered functions. and disturbed emotions. In the care of the suffering. We are beginning to decipher the complex mechanisms by which genes are regulated. coupled with newly developed imaging techniques. and understanding are expected of the physician. sympathy. we understand how subtle changes in many different genes can affect the function of cells and organisms. The knowledge gleaned from the science of medicine has already improved and undoubtedly will . diagnose. . seeking relief.1. and advances in bioinformatics and information technology have contributed to an explosion of scientific information that has fundamentally changed the way we define. for the patient is no mere collection of symptoms. . 1950 The practice of medicine has changed in significant ways since the first edition of this book appeared in 1950. We have developed a new appreciation of the role of stem cells in normal tissue function and in the development of cancer. help. fearful. signs.3 The Science and ART of Medicine Page101 Science-based technology and deductive reasoning form the foundation for the solution to many clinical problems. it is critical to underscore that cultivating the intimate relationship that exists between physician and patient still lies at the heart of successful patient care. 1. it is important to remember that the ultimate goal of medicine is to treat the patient. and genomics.

the learning outcomes are clearly specified and decisions about the content of training and how it is organized. an effective physician must be able to identify the crucial elements in a complex history and physical examination. a trainee in Internal Medicine will acquire skills. Yet skill in the most sophisticated application of laboratory technology and in the use of the latest therapeutic modality alone does not make a good physician. which is as necessary to the practice of medicine as is a sound scientific base. to a large extent. It is. iii) To ensure that they have appropriate foundation for lifelong learning and further training in their specialty The mission of the residency program in Internal Medicine is Page101 . and to extract the key results from the crowded computer printouts of data to determine whether to "treat" or to "watch. 2." Deciding whether a clinical clue is worth pursuing or should be dismissed as a "red herring" and weighing whether a proposed treatment entails a greater risk than the disease itself are essential judgments that the skilled clinician must make many times each day. expected that through this curriculum. the standard in postgraduate medical education. skills and attitudes that will ensure that they are competent to practice Medicine safely and effectively. experience. When a patient poses challenging clinical problems. In outcome based education. the educational strategies. outcome oriented curriculum has become. intuition. The new Internal Medicine curriculum reflects the changes in practice in hospitals where “true” general medical wards and clinics are diminishing in number but also recognizes that an increasing number of patients have complex medical problems involving multiple problems. This combination of medical knowledge. Mission statement i) To prepare the Internists who would be able to meet and respond to the changing healthcare needs and expectation of the society ii) To develop Internists who posses knowledge. A competency-based. 1.4 The competency-based curriculum A key trend in postgraduate medical education is a move to a model in which the emphasis has changed to focus on the product and the expected learning outcomes. therefore. knowledge and attitudes in broad aspects of Medicine encompassing both acute and chronic illnesses. and the educational environment are made in the context of the stated learning outcomes. the assessment procedures. to order the appropriate laboratory tests. and judgment defines the art of medicine.further improve our understanding of complex disease processes and provide new approaches to disease treatment and prevention.

General objectives The objectives of the Residency program in Internal Medicine are to produce medical specialists who: 1. Will be honest and objective when assessing the performance of those they have supervised and trained 8. when things go wrong. Manage time and resources to the benefit of themselves. 4. Educational Objectives Page101 . Are able to apply the knowledge of biological and behavioural sciences in clinical practice 17.iv) To help them develop to be critical thinkers and problem solvers when managing health problems in the community they serve 3. Are aware of the procedures. Can address all aspects of the healthcare needs of patients and their families 2. Establish a differential diagnosis for patients presenting with cardiovascular problems by the appropriate use of the clinical history examination and investigations 14. Are able to act as safe independent practitioners whilst recognising the limitation of their own expertise and are able to recognise their obligation to seek assistance of colleagues where appropriate. Understand that more effective communication between cardiologists and their patients can lead to more effective treatment and care 12. Can take advantage of Information Technology to enhance all aspects of patient care 10. Are aware of current thinking about ethical and legal issues 5. both in their own practice and in that of others 7. Develop clinical practice which is based on an analysis of relevant clinical trials and to have an understanding of other research methodologies 16. Are competent to perform the core investigations and procedures required in cardiovascular medicine 15. 18. Have acquired and developed leadership and team working skills. and able to take appropriate action. their patients and colleagues 9. Maintain the highest standards appropriate in their professional field and show themselves able to respond constructively to assessments and appraisals of professional competence and performance 4. to deliver patient centred care 3. Can develop management plans for the “whole patient” and maintain a knowledge in other areas of medicine which impinge on the specialty of cardiovascular medicine 11. Apply appropriate knowledge and skill in the diagnosis and management of patients with cardiovascular disorders 13. 6. especially with other healthcare professionals. Have developed the skills of an effective teacher. Are able to identify and take responsibility for their own educational needs and the attainment of these needs.

Trainees should regularly update their personal portfolio to keep a personal record. seeing a patient or their relatives there is an opportunity for learning. Page101 Experiential Learning Opportunities: 1. There are other opportunities for learning that are not listed here. Ward rounds should be led by a consultant and include feed-back on clinical and decision making skills. This includes encouragement for self-directed learning as well as recognizing the learning potential in all aspects of day to day work. Ward-based learning including ward rounds. which will be enhanced by following the patient through the course of their illness. Every patient seen. Every time a trainee observes another doctor. Patients seen should provide the basis for critical reading around clinical problems. Teaching and Learning Methods Adults learn by • • • • Reflecting and building upon their own experiences Identifying what they need to learn Being involved in planning their education and training Evaluating the effectiveness of their learning experiences. and be able to present to others. 4. on the ward or in out-patients. For Internal Medicine trainees to maximize their learning opportunities it is important that they work in a ‘good learning environment’. Lectures and formal educational sessions make up only a small part of the postgraduate training in Medicine. provides a learning opportunity. 3. the resident will have acquired the following seven roles of an ideal physician as described in The Can Meds framework: Annexure 2 5.At the completion of training. 2. There should be active involvement in group discussion as this is an important way for doctors to share their understanding and experiences. The bulk of learning occurs as a result of clinical experience (experiential learning. the evidence of the learning methods used. Trainees will learn in different ways according to their level of experience. There should be a positive attitude to training with learning from peers being encouraged. on-the-job learning) and self-directed study. Supervised consultations in outpatient clinics. Trainees should have the opportunity to assess both new and follow-up patients and discuss each case with . The list of learning opportunities below offers guidance only. A supportive open atmosphere should be cultivated and questions welcomed. The degree of self-direct learning will increase as trainees become more experienced. consultant or fellow trainee.

As trainees gain experience they will progress from observing to performing and from simple to more complex cases. Feedback following assessments provides excellent teaching opportunities. 3. 6. Critical incident analysis. Trainees should maintain a logbook of experience. Review of out-patients. letters and summaries. 3. investigations and treatment consistent with their level of experience and competence and with maintaining patient safety. including the care and counseling of the patient/carers before and after the procedure. This should include critical incident analysis. One-to-One Teaching: 1. Small Group Learning Opportunities: 1. particularly of difficult cases. journal clubs and research presentations etc. 4. ward referrals or in-patients with supervisor. Also with advances in technology the use of simulators will play an increasing part in the training of practical procedures. including presentations at clinical and academic meetings. These provide excellent opportunities for observation of clinical reasoning. particularly covering problem areas identified by trainees. Discussion between trainee and trainer of knowledge of local protocols. Participation in audit meetings. Review/case presentations with educational supervisor including selected notes. 2. 5. Training in Practical Procedures: Undertaking supervised practical procedures in different sub-specialty of Medicine with a consultant or more senior trainee. Page101 Formal postgraduate teaching: Examples include: i) Lectures both clinical and preclinical . Where appropriate the curriculum indicates the likely minimum number of procedures thought necessary to encompass a sufficiently broad spectrum of clinical experience to define performance or “does” in Miller’s triangle. 2. There are many situations where clinical problems are discussed with clinicians in other disciplines. Trainees need to learn to make increasingly independent decisions on diagnosis. Case presentations and small group discussion. Small group sessions of data interpretation. Small group bedside teaching. These decisions should be reviewed with their supervisors. particularly covering problem areas identified by trainees. 5.the supervisor so as to allow feedback on diagnostic skills and gain the ability to plan investigations. such as multidisciplinary medical boards or meetings. is the key method of gaining competence in these aspects of the curriculum.

including web-based material ii) Maintenance of personal portfolio (self-assessment. Trainees should be involved in guideline generation and review. reflective learning.Journal clubs. Teaching undergraduate medical students and students in allied health professions and postgraduate doctors provides excellent learning opportunities for the teacher. Community based/ community oriented learning: In future Problem based learning (PBL): In future Audit and Guidelines: In future Participation in audit: trainees should be directly involved and expect. It is therefore highly likely that many Page101 . 3. Research (In phase B) Development of research competencies forms an important part of the curriculum as they are an essential set of skills for effective clinical practice. personal development plan) iii) Reading journals iv) Writing reviews and other teaching materials v) Achieving personal learning goals beyond the essential. Suggested activities include: i) Reading. case presentations. after understanding the rationale and methodology.ii) Morning sessions. grand round s iii) Joint specialty meeting iv) Attendance in training program organized by deanery/ other academic body v) Attending lectures on educational syllabus Independent self directed learning Trainees will use this time in a variety of ways depending upon their stage of learning. Clinical research also allows development of particular expertise in one area of medicine allowing more in depth knowledge and skills and helping to focus long term career aims and interests. Undertaking research helps to develop critical thinking and the ability to review medical literature. Presenting cases at grand rounds or similar clinical meetings provides the opportunity to review the literature relating to the clinical case. This provides the opportunity for in depth study of one clinical problem as well as learning important critical thinking and communication skills. 2. core curriculum Teaching Others: 1. to undertake a minimum of one indepth audit every in two-years of training. Journal club presentations allow development of critical thinking and in depth study of particular areas.

Contents of learning Competencies are defined as the ability to use knowledge.23rd & 24th month) of the part A: will be allotted for Assessment The remaining 21 months will be divided into 7 BLOCKS each comprising of 3 months as follows: Total duration: 24 months BLOCK 1 2 3 4 5 6 7 SPECIALITY Internal Medicine Cardiology Rheumatology. Each stage/phase of learning in the curriculum has defined the competences to be attained by the trainee within the domains of knowledge. Rotations in phase A • • Last 3 months (22nd. clinical rotations and generic skills. and proficient way for optimal patient and societal outcome This section lists the contents of the syllabus including applied basic medical sciences. skills and attitude/behaviors. Nephrology Dermatology. Page101 . ethical. skills and appropriate attitudes and personal qualities to solve clinical problems in professional. i) ii) iii) Entry requirements Graduation from an accredited institute with MBBS or equivalent One year after successful completion of internship Registration with BMDC 7. Endocrine & Respiratory Medicine Gastroenterology or Hepatology Neurology Haematology.trainees in Internal Medicine with the appropriate aptitude and desire will wish to take the opportunity to spend extra time in research during the training period. 6. Psychiatry & ICU DURATION (months) 3 3 3 ( 1 month each) 3 3 3 (1& ½ month each) 3 ( 1 month each) 8.

glomerulus. pancreas. Anatomy course content i) Cardiology: conductive system of heart and accessory pathways. gastro-esophageal sphincter Gross structure of liver. recurrent laryngeal nerve nerves.1. ventricles of the brain and CSF system Structure of bone. factors governing cardiac output. Pain: pathophysiology ii) Regulation of body temperature iii) Cardiology: production of heart sounds and murmurs in relation to cardiac cycle. Syllabus: Applied basic sciences 8.8. jugular veins Gastrointestinal tract: gross structure of GI tract. coronary circulation. concept of anatomical dead space. bronchopulmonary segments. RAA system v) GI tract: Control of gastric. basal ganglia.1. GI hormones vi) Liver: blood supply in liver.2. course of cranial nerves & phrenic.1. extra pyramidal system optic pathway. cardiac valves. corticospinal tracts. radial medial and ulnar.1. contents of commonly available replacement fluids. cardiac performances control of blood pressure iv) Hormones: Functions of hormones of hypothalamus. Acid base balance. muscle and synovium with special emphasis on synovial joint. brachial plexus. nephron. functions of liver ii) Page101 . branches of dermatomes of clinical significance. anterior and posterior pituitary. sensory tracts. pulmonary circulation. portal vein Neuroanatomy: cerebral blood supply. digestion of fat protein carbohydrate & absorption of end products of digestion of fat. pancreatic and intestinal secretions. Physiology course content i) Fluid & electrolytes: Physiology of body fluids. feedback control of hormones. porto systemic circulations. fluid and electrolytes requirements in well and unwell patients. hormone receptors. blood supply of liver. gross structure of brain including limbic system. joints. internal capsule. adrenal glands. Renal system: structure of kidney. protein & carbohydrate. male and female genital tract Respiratory system: gross structure of lung including airways. thyroid hormones. thoracic duct Anatomy of thyroid and parathyroid glands ii) iii) iv) v) vi) vii) viii) 8. small and large intestinal motility. branches of aortic arch.

disorders of globin synthesis. and their diagnosis i) General discussion of HBV.6.1. xi) Physiological changes associated with normal pregnancy and lactation Physiological changes associated with peri and post-menopausal period 8. mechanisms of hemolysis. embolism. mechanism of homeostasis. gluconeogenesis.xii) vii) Blood: structure of hemoglobin. HCV. principles of measurement of GFR. lipid transport & lipoproteins. creatinine clearance x) Respiratory system: Gas exchange. urine formation and its composition. calcium: glycolytic pathway. hospital practices to reduce risk. infarction. ketone body formation.3.1. potassium. site of action of diuretics. protein. lipolysis. glycogenolysis. structure of spleen lymph nodes and other lymphoid tissues viii) CNS: Neurotransmitters and neurotransmission ix) Renal: Function of kidneys.1. control of hemopoesis. pentose phosphate pathway. Microbiology course content i) ii) iii) iv) v) vi) Infection control: Universal precautions. TCA cycle. Fallacies in interpretations of biochemical reports ii) 8. prostanoid (eicosanide) metabolism. thrombosis. Biochemistry and clinical chemistry course content i) Metabolism: fat. basic respiratory physiology to interpret the lung function tests. transport microbiological specimens specially blood and urine Gram positive and gram negative bacterial Antimicrobial drug resistance Common pathogenic fungi. cell injury. cholesterol metabolism. healing & repair Cardiovascular: atherosclerosis Cellular pathology: cell growth and aging. preserve. action of ADH.1. Virology course content .4. hand washing General principles of microbial pathogenesis How to collect. glycogenesis. Pathology course content i) ii) iii) iv) v) vi) Acute and chronic Inflammation.5. shock How to preserve and transport histopathological specimens 8. Renal transport of sodium. Purine metabolism. HIV Page101 8. carbohydrate. death & apoptosis Molecular and cellular oncogenesis Haemodynamic disorders: edema. Vitamin D. metabolism of haem. isolation procedures. lactate production. coagulation cascades & fibrinolytic pathway.

8.1.7. Genetics & Immunology course content
i) ii) iii) iv) v) vi) vii) viii) ix) x) xi) Genetics of thalassemia Autoimmunity Hypersensitivity reactions Cells involved in the immune response HLA system Structure of human gene, DNA, RNA Protein synthesis Human Genome project Defn of Polymorphism, mutation, trisomy, deletions, Philadelphia chromosomes Principles of Mendelian, sex-linked, mitochondrial, polygenic inheritance Genetic basis of disease: genetic mechanism of disease, basic knowledge of the common genetic disorders as well as understanding of commonly used genetic tests including PCR Principles of gene therapy Principles of blood grouping, blood transfusion, rhesus incompatibility Transplant immunology including graft rejection and GVH reaction principles of Coomb’s test, CFT

xii) xiii) xiv) xv)

8.1.8. Clinical Pharmacology ( linked to …………) 8.1.9. Statistics and……. ( in phase B)
i) ii) iii) i) ii) iii) iv) v) vi) vii) viii) Incidence, prevalence, accuracy, precision, predictive value, correlation Sensitivity, specificity Measures of central tendency Frequency distribution Measures of dispersion Probability distribution Sampling Hypothethesis testing and statistical significance Test of significance Protocol writing Writing of scientific paper

8.2. Syllabus: Clinical and procedural competencies
8.2.1. General clinical competencies: i) History taking, ii) clinical examinations, iii) decision making and clinical reasoning, and iv) Therapeutics and safe prescribing 8.2.2. Symptom based competencies

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8.2.3. Management of acute medical problems 8.2.4. System based competencies 8.2.5. Medicine throughout the lifespan/growth and development 8.2.6. Investigational competencies 8.2.7. Procedural competencies

8.3. Educational syllabus
8.3.1. Maintaining good medical practice 8.3.2. Professional behavior 8.3.3. Ethics and legal issues 8.3.4. Patients’ education and prevention 8.3.5. Team working and leadership 8.3.6. Teaching and educational supervision 8.3.7. Patients’ safety 8.3.8. Infection control 8.3.9. Clinical governance 8.3.10. Information technology, computer assisted learning and information management 8.3.11. Research

8.2.1. General clinical competencies
8.2.1. 1. History taking The written history of an illness should include all the facts of medical significance in the life of the patient. Recent events should be given the most attention. The patient should, at some early point, have the opportunity to tell his or her own story of the illness without frequent interruption and, when appropriate, receive expressions of interest, encouragement, and empathy from the physician. Any event related by the patient, however trivial or seemingly irrelevant, may provide the key to solving the medical problem. In general, only patients who feel comfortable will offer complete

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information, and thus putting the patient at ease to the greatest extent possible contributes substantially to obtaining an adequate history. An informative history is more than an orderly listing of symptoms; by listening to patients and noting the way in which they describe their symptoms, physicians can gain valuable insight into the problem. Inflections of voice, facial expression, gestures, and attitude, i.e., "body language," may reveal important clues to the meaning of the symptoms to the patient. Because patients vary in their medical sophistication and ability to recall facts, the reported medical history should be corroborated whenever possible. The social history can also provide important insights into the types of diseases that should be considered. The family history not only identifies rare Mendelian disorders within a family but often reveals risk factors for common disorders such as coronary heart disease, hypertension, or asthma. A thorough family history may require input from multiple relatives to ensure completeness and accuracy. However, once recorded, it can be readily updated. The process of history-taking provides an opportunity to observe the patient's behavior and to watch for features to be pursued more thoroughly during the physical examination. The very act of eliciting the history provides the physician with the opportunity to establish or enhance the unique bond that forms the basis for the ideal patientphysician relationship. This process helps the physician develop an appreciation of the patient's perception of the illness, the patient's expectations of the physician and the health care system, and the financial and social implications of the illness to the patient. Although current health care settings may impose time constraints on patient visits, it is important not to rush the history-taking since the patient may get the impression that what he or she is relating is not of importance to the physician and therefore may hold back relevant information. The confidentiality of the patientphysician relationship cannot be overemphasized.

Learning objective: Elicit the history and obtain other relevant data. Goal: To progressively develop the ability to obtain a relevant focused history from increasingly complex patients and challenging circumstances. To rerecord accurately and synthesize history with clinical; examination and formulation of management plan according to likely clinical evolution.

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personal health records. family physician. carers. 2.g. physical findings. general practitioners.1. emergency and ambulatory care Recognize other potential sources of data (e.Knowledge Recognize the importance of different elements of history Recognize that patients do not present history in structured fashion Know likely causes and risk factors for conditions relevant to mode of presentation Recognize that history should inform examination.2. medical records.. The significance of these objective indications of disease is enhanced when they Page101 8. family members.g.. and other data Persist in seeking information to assist in clinical decision making Revisit the history when clinical situation is not clear Behaviors Show respect and behave in accordance with Good Medical Practice The purpose of the physical examination is to identify the physical signs of disease. efficient and accurate history Records and presents accurate clinical history relevant to the clinical presentation Elicit most important positive and negative indicators of diagnosis Starts to ignore irrelevant information Ability to obtain history in difficult circumstances e. pharmacy records etc) Skills Identify and overcome possible barriers to effective communication Establish a rapport and professional relationship with patients. Clinical examination . their carers and relatives Obtain a focused. investigations and management Recognize the different approaches of history taking as needed in various clinical settings such as acute inpatient. angry or distressed patients/ relatives Evaluate critically the history in light of the degree of functional impairment.

it may be tempting to put less emphasis on the physical examination. Because physical findings can change with time. The results of the examination. depression score. GCS. Although attention is often directed by the history to the diseased organ or part of the body. the physical signs may be the only evidence of disease. a faint diastolic murmur. like the details of the history. Skill in physical diagnosis is acquired with experience. Indeed. This should not deter the physician from performing a thorough physical examination since clinical findings are often present that have "escaped" the barrage of pre-examination diagnostic tests. At times. Unless the physical examination is systematic and performed in a consistent manner from patient to patient. The physical examination should be performed methodically and thoroughly. Because a large number of highly sensitive diagnostic tests are available. 6minute walk tests etc Perform a through. the examination of a new patient must extend from head to toe in an objective search for abnormalities. particularly imaging techniques. many patients are seen for the first time after a series of diagnostic tests have already been performed and the results known. however. but of a mind alert to these findings. the physical examination should be repeated as frequently as the clinical situation warrants. Learning objective: Conduct an appropriate physical examination Goals: To progressively develop the ability to perform focused and accurate clinical examination in increasingly complex patients and challenging circumstances To relate physical findings to history in order to establish diagnosis and formulate a management plan Knowledge Understand the need for valid clinical examination Understand the basis for clinical signs and the relevance of positive and negative physical signs Recognize the limitations of physical examination and the need for adjunctive functional/ screening test. not hours later when they are subject to the distortions of memory. but it is not merely technique that determines success in eliciting signs of disease. The detection of a few scattered petechiae. or a small mass in the abdomen is not a question of keener eyes and ears or more sensitive fingers. important segments may be inadvertently omitted.confirm a functional or structural change already suggested by the patient's history. accurate complete physical examination of new patients Page101 Skills . should be recorded at the time they are elicited.mini mental state examination. with consideration for the patient's comfort and modesty.

and develop action plan Recognize how to use expert advice. clinical guidelines and algorithms Know how relative and absolute risks are derived and the meaning of the terms predictive value. 3. sensitivity and specificity in relation to diagnostic tests Skills Page101 Knowledge reading normal values of different laboratory tests . Conceptualize clinical problem.2. embarrassed or who are vulnerable 8.1. Decision making and clinical reasoning Learning objective: Synthesize findings from history and physical examination to develop a differential diagnosis and management plan Goal: To progressively develop the ability to formulate a diagnostic and therapeutic plan for a patient according to the clinical information available To progressively develop the ability to prioritise the diagnostic and therapeutic plan To be able to communicate the diagnostic and therapeutic plan appropriately Knowledge Define the steps of diagnostic reasoning: Interpret history and clinical signs. refine.Perform a focused clinical examination in selected settings Tailors physical examination according to the patient’s history Interpret physical signs accurately Perform relevant adjunctive examination Clearly documents examination findings Behaviors Considers patients dignity and the need for a chaperone for somer or all of the examination Demonstrate sensitivity to patients who are in pain. and verify hypothesis. generate hypothesis.test.

and clear instructions on parameters for action Elicit the co-morbities and other patients’ factors influencing the management plan Apply quantitative data of risks and benefits of therapeutic intervention to an individual patient Communicate with the patient.1. Therapeutics and safe prescribing . particularly in patients with multiple medical problems Priorities the urgency of individual investigations and treatment Record history. differential diagnosis on the basis of clinical evidences Institute appropriate investigation and therapeutic plan Justify the diagnosis based on clinical information Modifies working diagnosis based on new information or response to therapy Provide instructions regarding frequency of observations. 4.2. and plan for investigations and management accurately and concisely Develop provisional diagnosis (working diagnosis0. examination findings. synthesizes. and benefit/risks balance of therapeutic intervention Be willing to facilitate patient choice Show willingness to search for evidence to support clinical decision making Demonstrate ability to identify one’s own biases and inconsistencies in clinical reasoning Learning objective: Prescribe appropriate and safe pharmacotherapy Page101 8.Interpret and integrate the history and physical findings Formulate a complete and reasonable problem list with differential diagnoses and a management plan Priorities the problem list. their family and carers to develop a management plan Behavior Recognize the difficulties in predicting occurrence of future events Show willingness to discuss intelligibly with the notion and difficulties of prediction of future events.

distribution. age. pregnancy Appropriate dose adjustment in disease.allergy. contraindications and dosage of commonly used drugs Patient factors impacting on prescribing. adverse drug reactions Common interactions between complementary therapies prescription and non-prescription and Report adverse drug reactions to appropriate authority Therapeutic drug monitoring Quality use of medicines Page101 Recall drugs requiring therapeutic monitoring and interpret results . Knowledge Basic Science Mechanism of drugs at the receptor and intracellular level Principals of absorption. and lactation on pharmacokinetics Importance of genetic alterations in drug metabolism Pharmacological basis of drug interactions Impact of organ dysfunction on pharmacokinetics and dose modification Principles of prescribing Recall indications.Goal: To progressively develop ability to prescribe. metabolism and excretion of drugs Effects of aging. pregnancy. ageing. pregnancy Categories of drug safety in pregnancy and impact on prescribing Principles of dose titration Legislation regarding prescribing and controlled and restricted drugs Adverse drug reactions and interactions Common and life-threatening drug interactions and common presentations of druginduced disease. review and monitor appropriate medication relevant to clinical practice including therapeutic and preventive indications.

adverse drug reaction and drug interactions and treats appropriately Monitors for development of common adverse drug reactions.Factors affecting adherence Factors increasing risk of medication error Technique for enhancing medication safety Factors predisposing to polypharmacy and reasons for overprescribing Delivery techniques for specific medicines Skills Basic Science Applies basic science principles in prescribing Prescribes appropriately with reference to specific patient factors including organ dysfunction. or potential for.. including selection of appropriate laboratory investigations (e. monitoring of renal & hepatic function) Therapeutic drug monitoring Monitors drug levels and effects when appropriate and responds accordingly to results Practice regular medication review with appropriate adjustment of regimen and avoidance of polypharmacy Page101 Quality use of medicines . Body surface area Principles of prescribing Takes a complete drug history including history of use of complementary therapies and over-the-counter medications Consults pharmacist/MIMS/ similar database to obtain prescribing information Take help of guidelines for prescribing Writes a clear and unambiguous for prescription Provides accurate medication list with all the necessary information on discharge Adverse drug reactions and interactions Identify presence of. body weight. allergies and adverse effects Calculate loading dosed and maintenance doses Calculate GFR.g.

copharmacokinetics. explaining drug therapy and monitoring and following up verbal with written information where appropriate Assess patient uses of delivery devices Uses a range of strategies to enhance patient adherence Behaviors Recognize the benefit of minimizing number of medications Recognize the importance of patient compliance Recognize the importance of resources when prescribing Ensure the sharing of prescribing information with the patient and caregivers Remain up-to-date with therapeutic alerts and respond appropriately Knowledge Analgesics Patho physiology of pain Measurement of pain Non-pharmacological management of pain approaches Skill Take a relevant pain history Identify source of pain Use common pain-scoring tools to Utilize non-drug approaches to pain management Classes of commonly available analgesics Prescribe appropriate analgesia with with respect to mode of action. severity. potency and efficacy morbidities and co.medications in various pain syndromes Monitors efficacy of treatment and Common adverse effects and drug adjusts regimen appropriately interactions for drug class Prescribe adjuvant therapy where Principles of acute and chronic pain appropriate management Refers to pain team when appropriate Principles of adjuvant therapy in pain management Page101 Anticoagulant therapy Initiate anticoagulation with appropriate agent at appropriate dose taking patient Actions and indications of factor into consideration anticoagulants.Ceases medications where proven ineffective or no longer indicated Engage patient in decision making. reference to cause. both prophylactic and .

prevention of adverse effects Escalate dose on sick days are not Manages dose reduction/tapering Minimizes and manages adverse effects if steroid use unavoidable Antimicrobial therapy Initiate empiric antimicrobial therapy Mode of action.2. dose taking patient factors into pharmacokinetics of common classes of consideration antimicrobials Antimicrobial resistance and strategies for prevention Psychotropic medication Mode of action. initially. pharmacokinetics. anticoagulation adverse effects. benzodiazepines.2. monitoring of Manages over anticoagulation Uses steroid judiciously Adjusts therapy to achieve target ranges and monitors therapy appropriately Corticosteroid therapy Actions and indications of Recognize when steroids corticosteroids. interactions. relative potencies. where possible antidepressants Checks interactions to avoid the seronergic syndrome Uses these medications judiciously. adverse effects. Symptom & Sign Based competencies/Management of patients with undifferentiated presentations Page101 . appropriate monitoring. antimicrobial spectrum. interactions. pharmacokinetics of Uses non-pharmacological approaches antipsychotics. with appropriate agent at appropriate adverse effects. carefully monitoring for side effects 8.therapeutic Drug interactions.

PUO Establishes a differential diagnosis and a Night sweats provisional diagnosis. weakness Initiates basic investigations. undifferentiated clinical presentations including: Skills Behavior Recognize the importance of multidisciplinary approach including early surgical assessment when appropriate Involve other specialties when required Display sympathy to physical and mental response to specific symptom Recognize the anxiety of the patient or relative till a reasonable diagnosis is reached Recognize the anxiety and distress caused to patients or families and care givers by underlying condition and admission to hospital Page101 Recall the common causes. investigate appropriately.Learning objective: competencies required to practice in general internal medicine by listing the common ways in which a patient can present Goal: The patient usually presents with some symptoms and exhibits some signs. Aggressiveness/disturbed Identifies acutely unwell behavior patients and initiates appropriate Visual disturbances resuscitation and/or therapy. Dyspnoea dyspnoea etc. Syncope/collapse/loss of Interprets investigations consciousness to plan a further diagnostic process. based on clinical history Chronic and physical fatigue/Lethargy/Generalized examination. initiate management plan. Acute & chronic confusional Initiates management state on the basis of clinical findings. nausea. . and initial management for the common. It is the duty of a primary care physician to assess the patient on first presentation. Knowledge Differential diagnosis. to formulate valid differential diagnosis. appropriate investigations. Substance dependence Initiates symptomatic management of Panic attack problems such as pain. Engages in discussion Hemoptysis with supervisors and patient Hemetemesis regarding when to stop investigations. pathophysiology of each of the symptom Recognize that patient present with symptoms or signs but it is the duty of a physician to find out the underlying cause Fever.

Melena Epistaxis Wight loss Weight gain Nausea Anorexia/Loss of appetite Vomiting Anemia Cyanosis Jaundice Edema Hematuria Abdominal pain Chest pain Back pain Neck pain Bodyache Acute. mental illness or personality disorder to the clinical presentation. Page101 . chronic and recurrent cough Acute and chronic diarrhea Constipation Falls in the elderly Fits /Seizures Paresthesia and numbness Headache Polydipsia Polyuria For any presentation the Trainee recognizes the possible contribution of psychological factors.

Pruiritus Rectal bleeding Oral ulcers Skin blisters Speech disturbances Dysphagia Limb pain Palpitation Rash Purpura/ bruises Physical symptoms in absence of organic disease Hepatosplenomegaly Lymphadenopathy Abdominal mass Ascities Dysuria/Burning micturation Incontinence of urine Micturation difficulties Genital discharge Genital ulcers Head injury Hoarseness and stridor Involuntary movements Joint swelling Loin pain Chance/incidental findings Medical Recognize a surgical Recognize the Page101 .

However. These presentations appropriate frequently occur in the consultation with the context of long-term medical surgical team illness and as a complication Institute measures for of medical illness. and abdominal pain etc and management of which are traditionally patients with common managed by surgical teams. provides following surgical initial resuscitation. fluid arrhythmia. the thrombosis prophylaxis hospital-at-night team when appropriate structure leads to physicians Encourage preventative thromboat all levels of training taking measures: responsibility for surgical in. The role of the physiotherapy. thrombo-embolism. symptoms appear in this curriculum is to recognise glycemic control. adequate physician in these situations analgesia is not to take responsibility for the full management of these patients. and baseline investigations procedures: and refers appropriately patient with Goals: Surgical Assess history and examination Presentations – define form differential symptoms such as to diagnosis Investigation haematuria. and make a referral to the appropriate surgical team for a specialist opinion in a timely manner. peri-operative problemsdelirium. that often a physician is balance. Knowledge The trainee will be able to assess. a physician is expected to stabilize the patient as necessary. initial assessment of these Initiate treatment when in patients. effective analgesia. gastric protection Call for senior help when appropriate Respect opinion of referring surgical team Page101 . patients.prophylaxis. called upon to perform the unresolved pain. Also. The reason that these sepsis. investigate and treat medical problems arising postoperatively and during acute illness and recognize importance of preventative measures plan importance of thromboembolic complications and prophylaxis during acute illness and in postoperative period Recognize the importance of measures to prevent complications: DVT prophylaxis. rectal bleeding. nutrition.problems/complications condition. perform initial investigations and management if urgently required. physiotherapy.

drowsiness. post operative period Recall the investigations indicated in different scenarios: shortness of breath. hypochondriasis. malingering.Recall the common medical complications occurring in post-operative patients and how they present Recall the reasons for medical problems frequently presenting atypically post-operatively Pre-operative assessment of cardiovascular and respiratory risk Causes of delirium in the per. respiratory failure. chest pain. and formulate an anxiety appropriate management Formulate a plan management plan for acute period of care Knowledge Define and differentiate from each other: somatisation disorders. GI bleeding Physical symptoms in Safely determine after absence of organic appropriate work up that a patient is likely to disease have a non-organic for their Goal: The trainee will be cause presentation able to assess and appropriately investigate a underlying patient to conclude that Identify psychiatric disease: organic disease is unlikely.g. collapse. or sensitively. depression. psychogenic (or somatoform) pain disorders and factitious disorders Recognise the phenomenon of excessive symptoms in the context of established disease e. counsel psychosis. breathlessness in well controlled asthma Recognise the pattern of repetition that nonorganic presentations can have Respect the distress the mode of presentation may be causing Adopt a nonjudgemental sensitive attitude when engaging in counselling a patient over the likelihood of non-organic disease Involve psychiatric services when appropriate Address security issues where necessary Recognise the importance of the Primary Care team in assessment and management Page101 Recognise the cultural differences in somatoform disorders Communicate with . fever. dissociative disorders.

Determines rapidly the clinical context and sequence of events leading to the emergency.primary Care and other health workers where possible 8. including areas of Page101 . and any limits on escalation of care. The general internist must have a basic understanding of the treatments unique to the Critical Care setting such as invasive hemodynamic monitoring. A general internist must be able to recognize the unstable patient who is at risk for acute organ failure. Most importantly.2. Discusses the current situation within the broader context of the trajectory of patient illness and quality of life. Establishes a provisional diagnosis and orders appropriate initial investigations. immediate therapeutic goals.3. mechanical ventilation. Behavior Conveys to families/carers the progress to date. focused clinical examination. Knowledge Basic cardiovascular physiology and hemodynamics Pathophysiology of shock Pathophysiology of sepsis Basic principles of mechanical ventilation Principle of blood component therapy Physiology & pharmacology of vasopressors and ionotropes Pharmacology of antibiotics used in ICU setting Skills Recognizes emergency situations and the critically ill adult. The general internist should be familiar with the multidisciplinary approach to Critical Care and the appropriate use of consultants including a Critical Care specialist. it is important to understand the basic principle of Critical Care Medicine. the general internist must also recognize the importance of end of care issues in the Critical Care setting. Conducts a rapid. The general internist must also have a basic understanding of the nature and treatment of medical conditions commonly encountered in the critical Care Unit. expected outcome. and vesopressors. likely cause for situation. Management of Acute Medical Problems Learning objectives: Recognize and manage the critically ill patients Goal: As general internist. Upon recognition of this patient. the general internist must be able to appropriately provide initial supportive management and facilitate the transfer of these patients to the appropriate level of care.

the Trainee describes the clinical presentation. including summoning help. Advanced Life Support For the following emergencies or potential emergencies. Demonstrate caring and respectful behaviors when interacting with patients and their families Page101 . and reflects on indicators and actions to be taken in the management plan. to relevant health care staff. Anticipates patients in whom there may well be a rapid deterioration. For each of these poisonings the Trainee identifies symptoms and signs of common poisonings and toxic uncertainty. and verbally. respiratory failure. Develops appropriate care plans for patients in whom resuscitation or emergency escalation of care is not indicated. initial management. team leadership and urgent referral to other services. Indicates when medical staff will review the situation and/or meet with family again. Causes of acute airway obstruction. Basic Life Support. initial investigations. teamwork. Monitors patient’s condition appropriately and recognizes and acts on complications. Principles and practice of defibrillation. Principles of oxygen delivery and assisted ventilation. Location and contents of hospital resuscitation trolleys and their contents. shock and coma.Basic respiratory Physiology Pathophysiology of hypoxemia and hypercapnoea Principles of End of Life Care Signs and symptoms of impending Cardio-respiratory arrest. Discusses the situation with a more senior staff member at earliest appropriate opportunity and recognizes if transportation or retrieval to another facility is required. Principles of fluid resuscitation. underlying patho physiology. Principles of teamwork and leadership in an acute emergency. Initiates appropriate emergency management. Principles of inotropic support. Local indications and contraindications for ICU. Conveys these plans in the notes. and likely complications: • cardiac arrest • stridor/airway obstruction determines severity of organ dysfunction(s). Hospital emergency codes. differential diagnosis. Performs CPR and BLS according to ILCOR guidelines. Clinical features of serious illness. Performs ALS according to ILCOR guidelines.

neurogenic.• acute difficulty swallowing • hypoxia. assesses and monitors for other serious consequences of poisoning. Seeks specialist and ICU advice in a timely manner. respiratory failure • hypotension. initiates emergency management including specific Antidotes. Assesses suicidality Page101 . •Diarrhea & dehydration Massive hemetemesis and melena Massive hemoptysis Oliguria/Anuria Severe hypertension Severe headache Acute abdominal pain Coma Severe sepsis syndromes. cardiogenic. shock – hypovolemic. septic. adrenal and pituitary crisis • meningitis • hyperthermia and hypothermia • Electrocution • extensive skin blistering. anaphylactic • arrhythmia • seizures • acute paraplegia/weakness/rigidity • painful red eye • Acute loss of vision • acute agitation • suicidal behavior • severe acid base disorders • Electrolyte disturbances • hypoglycemia • diabetic ketoacidosis •Non Ketotic Hyperosmolar Coma • thyroid.

Severe pneumonia Acute coronary syndrome COPD exacerbation Acute severe asthma Fever in ICU Ventilator pneumonia Status epilepticus Cardiac temponade Severe pancreatitis Near drowning Nutrition in ICU Pulmonary embolism Venous thromboembolism prophylaxis Pneumothorax Cardiovascular accident Coagulopathy DIC Fulminant hepatic failure The Trainee describes the related pharmacology. clinical presentation and initial acute management of the following common and serious poisonings/ overdoses: • paracetamol • antidepressants • antipsychotic drugs • alcohol • amphetamines • opioid drugs associated Page101 .

care setting and follow up) Complications Prevention (where relevant to condition) 8. lifestyle. and should continue to improve with time in line with the principles of a spiral curriculum: Definition Pathophysiology Epidemiology Features of History Examination findings Differential Diagnosis Investigations indicated Detailed initial management and principles of ongoing management (Counseling. and to manage both pain and other issues in terminally ill patients. medical.1. Palliative care and End of Life care Educational purpose: General Internal Medicine encompasses a variety of disorders over a wide spectrum of ages in both sexes. provide end-of-care. The goal of this sorts of training is to strengthen a resident’s knowledge and ability to take care of patients with terminal illness. for example a GP referring ‘a breathless patient with heart failure’.4.• benzodiazepines • anticholinesterases • snake bite. Therefore. System Specific Competencies Learning objective: Manage patients with disorders of organ systems Goals: Learning to manage each mode of presentation does not avoid the need for a trainee to have a solid grounding of knowledge in specific medical conditions. A framework for the knowledge required for specific conditions arranged alphabetically is set out below.2.4. Page101 . 8. A critical component to the trainee of an Internal Medicine resident is the ability to care for patients with acute and chronic pain and those with terminal illnesses. The list also gives a guide to the topics that will form the basis for formal and work-place assessments. surgical. In the age of better patient education and patient involvement in their chronic disease management. listing the specific disease conditions aims to advise the trainee on the conditions that require detailed comprehension. It is also the case that patients very often already have a ‘diagnostic label’. frequently today’s clinician needs to refer to disease-specific knowledge earlier in the consultation.2.

Breathlessness. bisphosphonates. Constipation.2. Nausea & Vomiting. family and Recognize when palliative colleagues appropriately care opinion is needed and sensitively ensuring interests are Recognize the dying phase patients paramount. as well as be able to deliver “ bed news” to patients and family members. Assessment and evaluation of brain death 8. agents for neuropathic pain. pressure sores.4. history Recognize the common problems in terminally ill patient: Pain. anti-emetics. Cardiology Page101 .on decisions not to factorial causes resuscitate with patient. Anxiety & depression Pharmacology of major drug classes in palliative care: Opoids.2. laxatives. carers. NSAIDs. anxiolytics pain Recognize the psychological and social issues surrounding Recognize that the patients at the end of life terminally ill patients often present with Contribute to discussions problems with multi. syndromes encountered at nurse the end of life.Knowledge Skill accurate Behavior Define palliative care and Take an terminally ill patient. of terminal illness Develop proficiency in Effectively work with other counseling patients on health care professionals common symptoms and including social worker. Manage symptoms in dying patients appropriately Practice safe use of syringes drivers Recognize importance of hospital and community Palliative Care teams Recognise that referral to specialist palliative care is appropriate for patients with other life threatening illnesses as well as those with cancer.

blood pressure. potassium channel activators. Perform an adequate physical examination. lipid modifying drugs. nitrates. B. centrally acting anti-hypertensive. ionotropes. Evaluate and manage a wide range of cardiac disorders. and jugular venous pressure iii) Detailed heart examination iv) Mastering clinical signs of the various valve lesions D. Take a chronological problem-oriented history. Basic science i) Anatomy of cardiovascular system ii) Physiologic principles of cardiac cycle and cardiac conduction iii) Blood pressure homeostasis iv) Pathogenesis of Shock v) Pathogenesis of atherosclerosis vi) Laboratory markers of cardiac diseases vii)Pharmacology of major drug classes: Beta adrenoceptor blockers. Anti-platelet agents. alpha adrenoceptor blockers. diuretics. anti-coagulants. including but not limited to: i) Subjective description of complaints ii) Past history of rheumatic heart disease and cardiac procedure iii) Identify risk-factors for coronary artery disease C. thrombolysis. ACE inhibitors. Knowledge A. anti-arrhythmics. calcium channel blockers. including: i) Coronary artery disease b) Manage stable and unstable angina and myocardial infarction Page101 a) Discuss risk-factors modification in primary and secondary prevention .Educational purpose: The trainee should be able to provide primary and secondary preventive care and initially manage the full range of cardiovascular disorders. including: i) Extra-cardiac signs ii) Abnormalities in the pulse. ARBs.

prophylaxis and surgical interventions v) Pericardial disease a) Know the etiology of pericarditis/ pericardial effusion b) Know the clinical presentation of pericardial effusion and cardiac tamponade c) Diagnosis and treatment of pericardial effusion and tamponade d) Pathogenesis. and endocarditis in intravenous rug abusers. left and biventricular heart failure. symptoms and etiology of right. investigations. ii) Heart failure therapy. percutaneous a) Describe the signs. diagnosis and approach to medical therapy and surgical therapies. Meanings of CCF b) Discuss the selection of medical therapy iii) Valvular and congenital heart diseases a) Know the etiology.c) Discuss the selection of medical revascularization and surgical therapy. b) Describe the clinical presentations and diagnosis c) Know the microbiology. d) Discuss the antimicrobial treatment. iv) Endocarditis a) Know the classifications of native and prosthetic valve endocarditis. presentations and management of constrictive pericarditis vi) Arrhythmias with heart block a) Describe the pathophysiology of recurrent ventricular and supraventricular arrhythmias b) Develop competence in using anti-arrhythmic drugs vii) Cardiomyopathies viii) Hypertension ix) x) xi) Dyslipidemia Dissection of aorta Page101 Primary and secondary pulmonary hypertension .

arrange appropriate investigations. ETT iii) Hemodynamic studies Behavior Page101 Conduct interviews with patients. and can independently initiate appropriate medical management for uncomplicated disease. the trainee recognizes this.. myocardial perfusion scans. diabetes. ABI. renal. stress tests. thyroid. Applies basic science knowledge to appreciate the significance of and appropriately act on reports of echocardiograms. angiograms. echocardiograms Cardiac catheterization Coronary angiography and angioplasty Cardiac nuclear mediocine studies Electrophysiology Pacemakers 24-hour ECG monitoring Pericardiocentesis Learn to interpret: i) Chest X-ray ii) ECG. or procedural intervention is required.xii) DVT and PE xiii) Cardiovascular manifestations of systemic diseases ( e. Applies knowledge to establish a provisional diagnosis. Applies basic science knowledge to interpret complex ECGs and chest radiograph. duplex ultrasound scans. and patient-centered manner . and their families in a compassionate. SLE) Skill Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs. arterial Doppler. ETT.g. provides initial emergency management and refers appropriately and timely Learn the indications for: i) ii) iii) iv) v) vi) vii) viii) Electrocardiogram. If there are complications. culturallyeffective. Recognize the need for and appropriate time for referral to cardiologist/ cardiac surgeon.

severe hyper-and hypocalcemia. and feedback control of hormones Carbohydrate. adipose tissues iii) iv) Secretion. thyroxin.2. and secondary diabetes ii) Understand laboratory diagnosis iii) Understand specific therapeutic modalities. protein and lipid metabolism v) Pharmacology of major drug classes used: Insulin. be able to interpret basic endocrinologic diagnostic tests. and hormone action ii) Structure and function of hypothalamus. drugs affecting bone metabolism B. gonads. transport. second messengers. and addisonian crisis. adrenals. OHA. including oral agents and conventional and intensive insulin therapy. hypoglycemia complications: diabetic ketoacidosis. pituitary. Diabetes mellitus i) Understand the different etiologies. hormone receptors.Know how to obtain inform patients and obtain voluntary consent for the treatment plan and specific diagnostic and therapeutic interventions Counsel patients on risk factors for cardiovascular disease including smoking cessations 8. and be able to diagnose and manage a variety of common endocrine disorders. Basic science i) Structure and functions of hormones. making referrals when appropriate. Knowledge A. Endocrinology and metabolic disorders including diabetes mellitus Educational purpose: The goal of the resident is to gain a general knowledge of the major conditions specific to the endocrine system. Page101 iv) Diagnose and manage acute hyperosmolar coma. parathyroid. pathophysiologic process. thyroid. including diabetic keto acidosis and hyperosmolar nonketotic coma. Antithyroid drugs.4.3. corticosteroids. sex hormones. and clinical presentations of type 1 & 2. The trainees plays a key role in managing endocrine emergencies. .

incidentilomas ii) Understand the hypothalamic-pituitary-end organ function and interpret the test measuring HPA axis iii) Evaluate and treat patients with pituitary or hypothalamic hormone deficiencies E. Thyroid disorders i) Interpret thyroid function tests in thyroid and non-thyroid illness ii) Describe the use of anti-thyroid medications and thyroid hormone replacement therapy iii) Diagnosis and different treatment options for thyrotoxicosis iv) Discuss the use of radioactive iodine in the treatment of hyperthyroidism and thyroid cancer v) Evaluation and management of hypothyroidism vi) Evaluation of patients with thyroid nodules vii)Evaluation and management of sub acute and Hashimoto’s thyroiditis D. neuropathy. Cushing’s disease. hypoparathyroidism. acromegaly. Endocrine hypertension i) Evaluate for secondary causes of hypertension. Adrenal disorders Page101 iii) Discuss the medical and surgical therapies . including pheochromocytoma and syndrome of mineralocorticoid excess ii) Discuss the role of imaging studies in the diagnosis G. infections C. dermopathy. Hypothalamic and pituitary diseases i) Recognize and evaluate patients with pituitary tumors: prolactinomas. iii) Interpretations of skeletal radiography and BMD F. osteoporosis.v) Diagnose and manage chronic complications: retinopathy. osteomalacia. Disorders of calcium and skeletal metabolism i) List the etiologies. nephropathy. evaluation and management of hyper and hypocalcaemia ii) Evaluation and management of metabolic disorders including hyperparathyroidism. arteriosclerotic vascular disease.

differential diagnosis. and management of Cushing’s syndrome iii) Diagnose adrenal insufficiency. gastrinoma. Reproductive endocrinology i) List the differential diagnosis of hormonal causes of infertility ii) List the causes of primary and secondary hypogonadism and discuss the indications and use of hormone replacement therapy iii) List the differential diagnosis. nutritional factors. insulinoma. evaluation and treatment of amenorrhea J. pheochromocytoma. and initiate therapy iv) Evaluate and mange congenital adrenal hyperplasia and virilizing disorders. Endocrine and metabolic manifestations of systemic diseases . and lipid lowering agents iii) Describe the use of screening procedures I. exercise. Disorders of growth and sexual development i) Understand the impact of systemic diseases. Endocrine emergencies Page101 L. Hyperlipidemia i) Categorize lipid disorders based on lipoprotein measurements. Hormone producing neoplasm i) Understand the pathophysiology associated with hormone-producing tumors. and endocrine abnormalities ii) Interpret dynamic endocrine testing in the evaluation of disorders of growth and sexual development M. including. and small cell cancer ii) Identify imaging studies for suspected hormone producing neoplasm iii) Diagnose and manage syndromes of ectopic hormone production K. multiple endocrine neoplasia. and recognize their genetic & secondary forms ii) Discuss the role of diet. but not limited to carcinoid syndrome.i) Interpret hormonal testing in the evaluation of adrenal diseases ii) Recognize the clinical presentations. lists its causes. and adrenal masses H.

the trainee recognizes these. establish a provisional diagnosis. orders appropriate investigations. thyrotoxic crisis. evaluate a broad array of gastrointestinal symptoms. and manage many gastrointestinal and hepatic disorders. If there are complications. 8. and refers appropriately Learn to interpret: Dexamethasone suppression test Short and long Synacthin test Thyroid function tests.4. The trainee must be familiar with the indications. contraindications. and independently initiate appropriate management for uncomplicated diseases. hyperlipidemia. Gastroenterology and hepatology Educational purpose: The general internist should have a wide range of competency in gastroenterology and hepatology and should be able to provide primary and in some cases secondary preventive care. and interpretations of GI procedures. Addisonian crisis. WHR. Knowledge Page101 . triceps skin fold) Recognize the presenting illness. home blood glucose monitoring log Thyroid and parathyroid nuclear scans Behavior Recognize the vital importance of patient education and a multidisciplinary approach for the successful long-term care of diabetes Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families Willingness to give basic dietary counseling for diabetes. and obesity Education for patients on the disease course of diabetes and rationale of treatment to decrease blood glucose.2. phaecromocytoma crisis.4.myxedema coma. diabetic coma Skill Conduct a focused clinical examination and applies basic science knowledge to interpret clinical signs Applies basic science knowledge to interpret basic endocrine tests Conducts anthropometric assessment ( BMI.

stricture and cancer C. pylori and follow-up strategies iii) Know the prevention and treatment of NSAID induced ulcers iv) Know the diagnosis and management of acid hypersecteion (gastrinoma) E. GERD. Dysphagia i) Differentiate oropharyngeal from esophageal Dysphagia ii) Know the general approach to esophageal dysphagia: rings. Diarrhea .A. Peptic ulcer disease i) Know the role of Helicobacter pylori. Basic science i) Structure and functions of gastrointestinal system ii) Structure of liver iii) Hormone/enzymatic control of alimentary tract including control of acid and pancreatic secretion iv) Laboratory markers of hepatic and pancreatic functions and malabsorption v) Bilirubin metabolism vi) Macro and micronutrient absorption vii) Pharmacology of major drug classes used B. NSAIDs and acid hyper secretion ii) Know the initial treatment of H. Gastro esophageal reflux i) Know the symptoms and complications: for example Barrett’s esophagus ii) Know the treatment options D. Upper GI bleeding i) Know common causes ii) Know resuscitation techniques and when endoscopy treatment is needed iii) Know the primary and secondary prevention i) Know causes and initial management of acute diarrhea Page101 F.

investigations and treatment options K. clinical manifestations iii) Know the appropriate medical therapy and surgicsal options H. Inflammatory bowl diseases (IBD) i) Know the clinical presentations. Pancreatitis i) Know the common causes and clinical presentations of acute and chronic pancreatitis ii) Know the definition and use of Ranson and Apache criteria iii) Learn about diagnostic tests: Role/time course of amylase/lipase. CT/MRI of pancreas. Diverticular disease i) Know the clinical presentation. diabetes. complications. adjuvant chemotherapy and radiation therapy in cancer stomach and colon cancer J. pathology. laxative abuse G. ERCP. Irritable bowel syndrome (IBS) i) Know differentiations from IBD and treatment options I. flexible sigmoidoscopy. complications of Crohn’s disease and ulcerative colitis ii) Know how to differentiate Crohn’s from ulcerative colitis using radiology. Gastrointestinal malignancy i) Know the use and limitations of colon cancer screening strategies: fecal blood testing. endoscopy. bacterial overgrowth. pancreatic function tests iv) Determine the treatment options of acute and chronic pancreatitis v) Know the diagnosis and management of complications of acute and chronic pancreatitis L. secretary diarrhea iii) Know the risk factors for secondary diarrhea: endocrine tumor. Gallstone disease i) Know the clinical presentations of biliary colic. including extra intestinal manifestations. barium x-rays ii) Know the role of surgery. colonoscopy.ii) Know the approach to chronic diarrhea: osmotic vs. acute cholecystitis and choledocholithiais Page101 .

liver screen. common bile duct stones and cholecystitis M. CT.ii) Known the indications for abdominal ultrasound. Applies basic science knowledge to appreciate the significance of. abdominal X-ray. Malabsorption P.. diagnosis and management of Cirrhosis of liver including PBC x) Know about the liver transplantation N. perforation of hollow viscous. acute cholecystitis. MRCP. Applies basic science knowledge to interpret clinical signs. ERCP. intestinal obstruction. and laboratory tests (including LFTs.g. coeliac serology. NASH) Skill Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs. ERCP iii) Know the management strategies for cholangitis. O. abdominal CT scan. Acute abdominal conditions i) Know the diagnosis and initial work up and emergency management of acute appendicitis. MRCP. MRA. viral serology. and appropriately act on reports of. abdominal ultrasound. persistent intermittent iii) Know the chronicity of virus B and C iv) Know the hepatotrophic viruses v) Know the diagnosis and management of acute hepatitis vi) Diagnosis and management of chronic B hepatitis vii) Management chronic asymptomatic B virus infection viii) Diagnosis and management hepatitis C infection ix) Know the clinical presentation. helicobacter testing. Page101 . Liver diseases i) Know approach to abnormal liver function tests ii) Know approach to jaundiced patients: acute. malabsorption tests. Gastrointestinal manifestations of systemic disease (e. upper and lowerendoscopy. Nasogastric feeding Q. faecal microscopy and culture and toxin testing).

potential complications of Page101 . differential diagnosis. Describe the clinical presentations. If there are complications or procedural intervention is required. and patient-centered manner Communicate effectively with patients and other health care professionals Discuss issues of palliation for GI malignancies. and blood components ii) Hemoglobin structure and function iii) Process of coagulation iv) Haemopoesis v) Iron. the trainee recognizes this. laboratory. the diagnosis and management of neutropenia / immunosuppression. Vit B12. the assessment of the need for bone marrow aspirate and biopsy and lymph node biopsy. the management of therapeutic and prophylactic anticoagulation. Basic science i) Structure and function of blood forming tissues. investigations. initial management. and chemotherapy Know how to inform and obtain voluntary consent for the treatment plan and specific diagnostic and therapeutic interventions 8. the assessment of the indications and procedure for transfusion of blood and its separate components. folate metabolism vi) Principles of transfusion and bone marrow transplantations vii)Pharmacology of major hematinics and erythropoietin viii) Genetics of thalassemia ix) Evidences of hemolysis B. and parenteral alimentation. orders appropriate investigations. including blood transfusions. Knowledge A. and can independently initiate appropriate medical (non-procedural) management for uncomplicated disease.5 Hematology Educational purpose: The general internist should be competent in the detection of abnormal physical. provides initial emergency management and refers appropriately. the initial diagnostic evaluation and management of the haemostatic and clotting system.2. Behavior Conduct interviews with patients and their families in a compassionate. and radiologic findings relating to the lymphohematopoetic system.4.The Trainee recognizes the presentation of illness. culturally effective. establishes a provisional diagnosis. reticulorendothelial system. enteral.

full blood count and film. coagulation profile. If there are complications. and independently initiates appropriate management for uncomplicated disease. the trainee recognizes these. plans and arranges appropriate investigations. Behavior Be able to provide genetic counseling to patients and family members when appropriate Assists patients in decision making regarding treatment options. DIC iii) Coagulation disorders including hypercoagulable state iv) Thrombocytopenia including ITP v) Anemias: Iron deficient. hemolytic vi) Hemolytic disorders vii) Mylodysplastic syndrome (MDS) viii) Acute and chronic Lekemias ix) Lymphomas and lymphadenopathy x) Plasma cell dyscrasia/Multiple myeloma xi) Myeloproliferative disease xii) Amyloidosis xiii) Thrombophilia xiv) Neutropenia xv) Pancytopenia C. Hematological manifestations of systemic diseases (anemia of chronic disease. and refers appropriately. Applies basic science knowledge to appreciate the significance of. bone marrow aspirate and trephine.the disease and its management for the following common and important conditions: i) Aplastic anemia/Bone marrow failure ii) Bleeding disorders: Hemophilia. establishes a provisional diagnosis. and appropriately acts on reports of. thrombophilia screens. megaloblastic. Applies basic science knowledge to interpret clinical signs. hemolysis. Understand the basis of bone marrow transplantation. and recognizing complications of treatment Page101 . both autologous and allogenic hemopoetic stem cell transplantation and recognize complications like GVHD D. discharge planning. cytopenia) Skill Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs. cytogenesis The trainee recognizes the presentation of illness.

and learn methods for delivering care in these situations.2. Patients may present to an internist with complaints that are a manifestation of mental illness. tricyclic antidepressants. ii) Principles of neurotransmitters iii) Principles of addiction and tolerance iv) Pharmacology of major drug classes used: anti-psychotics. donepezil.Discuss the impact of hematological and oncologic disorders on patient’s quality of life Demonstrate integrity. kindness and empathy Recognize potential problems that may have an impact on the treatment and outcome. investigations. Knowledge A.4. MAO inhibitors. differential diagnosis. Describe the clinical presentations. potential complications of the disease and its management for the following common and important conditions: i) Mood disorders ii) Bipolar disorder iii) Acute psychosis iv) Schizophrenia v) Personality disorders vi) Anxiety and panic disorders vii) Phobias viii) Stress disorders ix) Obsessive compulsive disorders x) Grief reaction xi) Eating disorders Page101 . Then resident must be able to recognize those mental illnesses that can be treated by the general internist and when a patient should be referred for psychiatric cae. SSRIs.6. The resident must also understand the impact of a patient’s mental illness on the provision of care for medical problems. disulpharama) B. Venlafexine. initial management. including compliance and social factors 8. Basic science: i) Structure and function of limbic system and hippocampus. and exhibit compassion. drugs used for addiction (bupropion. respect. Psychiatry/ Mental health disorder Educational purpose: Internists will care for patients with diagnosed and undiagnosed psychiatric disease. lithium.

Rheumatology / Disorders of Musculoskeletal system Educational purpose: The trainee must be competent in the initial diagnosis and management of wide range of disorders affecting musculoskeletal system to prevent disability and death.xii) Substance abuse: the pattern of use. Psychiatric manifestations of systemic disease Skill Conduct a focused clinical examination and applies basic science knowledge to interpret clinical signs Applies basic science knowledge to interpret mental status examination. benzodiazepines. opioids. plans and arranges appropriate initial investigations to rule out organic causes. relevant pharmacology. immunosuppressive.4. nicotine and its management Evaluate suicide risk Behavior Recognizes role of community mental health care teams 8. He/She must also be proficient in monitoring the effects of anti-inflammatory. and secondary preventive strategies xiii) Unsuccessful suicide attempt xiv) Parasuicide xv) Dementia xvi) Unexplained physical symptoms which suggests somatization xvii) Alcohol syndrome: alcohol dependence and alcohol withdrawal C. initiates appropriate emergency management and involves other members of the team whenever appropriate and refers appropriately.7. the trainee recognizes these and refers appropriately For any presentation the trainee recognizes the possible contribution of mental illness or personality disorder to the clinical presentation Recognizes withdrawal state of alcohol. detailed management of acute intoxication. establishes a provisional diagnosis. and cytotoxic drugs Knowledge Page101 . and tests of cognitive functions The trainee recognizes the clinical presentation.2. discusses broad therapeutic options. If there are complications.

cryoglubulinemia Crystal induced arthropathy: gout and pseudo gout Osteoarthritis Osteoporosis Dermatomyositis/polymyositis Anti-phospholipid syndrome (APLS) Sjogren’s syndrome Systemic sclerosis/PSS Fibromyalgia Septic arthritis B. corticosteroids. psoriatic arthritis. laboratory tests of bone and mineral metabolism (Ca/PO4/PTH/VitD/ALP). clinical presentations. Reiter’s syndrome. Basic science     Structure and function of bone.A. bone densitometry). differential diagnosis. imaging (plain radiographs. Musculoskeletal manifestations of systemic diseases • • • • • • • • • • • Skill Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs. giant cell or temporal arteritis. colchicines. Takayasu’s arteritis. CRP. initial management. potential complications of the disease and its management. preventive strategies for the following common and important conditions: Rheumatoid arthritis Systemic lupus erythamatosus • Spondyloarthropathies: ankylosing spondylytis. bisphosphonates  Describe the epidemiology. RF. inflammatory bowel disease associated arthritis • Systemic vasculitidies: polyarterirtis nodusa. Approach to a patient with acute monoarthritis D. Wegener’s granulomatosis. muscle and synovium Bone and mineral metabolism Purine metabolism Pharmacology of major drug classes used: NSAIDs. immunosuppressants. investigations to monitor inflammation and disease activity and to diagnose immunologically-mediated disease (ESR. Page101 . investigations. Approach to a patient with polyarthritis C. Applies basic science knowledge to interpret clinical signs. ANA. allopurinol.

Recognizes the indications of the following: Muscle biopsy Minor salivary gland biopsy EMG/NCV Arthroscopy Peripheral nerve (sural) biopsy Muskuloskeletal X rays. CANCA. C4. and appropriately act on. C3. visceral. Scl-70. La. synovial fluid analysis. CT scans Angiography: cerebral. Monitors for complications. the Trainee recognizes these. ANA. limb Interpret the following: Parameters of systemic inflammation: ESR. Synovial fluid findings: Examination under polarized light microscopy and identification of MSU and CPPD crystals Imaging studies: X-rays of joints and other parts. The Trainee recognises the presentation of illness. reports of specialised imaging of bones and joints. If there are complications. p-ANCA. establishes a provisional diagnosis. BMD Page101 .ENA). Applies basic science knowledge to appreciate the significance of. Jo-1. plans and arranges appropriate investigations. anti-dsDNA. CRP Auto antibodies: rheumatoid factor. MRI. and independently initiates appropriate management for uncomplicated disease. MRI. ENAs. and refers appropriately.

Page101 . anti-parkinson drugs Vision and hearing. Resident will use clinical knowledge on lesion localization and differential diagnosis generation. Resident will develop proficiency in the neurologic exam with emphasis on normal and abnormal neurologic and motor responses. Pharmacology of major drug classes used: anxiolytics. 8. orthopedicians Listen carefully and respond appropriately to patients’ concern Understand the impact of chronic pain. medical knowledge.4. and experience in coherent care plan. fatigue. coma. and cognitive disturbances on family and workplace Know when to involve other specialists to prevent or treat complications of rheumatologic disease. mental status exam. anti-epileptics.8 Neurology/ Disorders of neurological system Educational purpose: Neurologic complaints are expected to increase due to an increase burden of degenerative neurological disease in our aging population. Sleep-wake regulation. Residents should understand the management of emergent neurologic problems.2. hypnotics. Basic science Neuroanatomy including cerebral blood supply. Knowledge A. and sensory exam.Behavior Recognizes the importance of multidisciplinary approach to rheumatologic diseases including physiotherapists. and when to obtain urgent consultation. Neurotransmitters and neurotransmission (including ANS). Residents should be able to perform a focused history on common neurologic presenting syndromes. Emphasis will be on cultivating sound judgment in diagnosis and management of neurologic disorders linking data. Electrical activity of the brain and nerve conduction. Concept of brain death. Metabolism of the brain.

and establish etiological diagnosis Take an adequate problem oriented history Perform an efficient and complete neurological examination Recognizes when a neurological consultation is apprppriatre Page101 Participate in the care of seriously ill neurological patients . investigations. metastatic Retinopathies Visual disturbance Neurological manifestations of systemic disease( peripheral neuropathy. preventive strategies: Stroke and TIA Epilepsy/seizures Headache including migraine Subarachnoid hemorrhage Raised intra-cranial pressure Peripheral neuropathy Bell’s palsy. clinical presentation. including those in the ICU. principles of ongoing management.B. detailed initial management. differential diagnosis. Parkinson’s disease Guillan Barre syndrome Multiple sclerosis Motor neurone disease Myesthenia gravis Cerebellar disorders Coma Acute confusional state: Wernicke’s encephalopathy Dementia Tremors Vertigo CNS tumors: Pituitary. define pathophysiology. pathophysiology. potential complications of the disease and its management. and those with traumatic injury of head and spine . seizure) • • • • • • • • • • • • • • • • • • • • • • CNS infections: Meningitis. encephalitis. paraneoplastic. brain abscess Skill Learn the approaches to patient with neurologic disease: locate the lesion. Describe the epidemiology.

EMG. MRI. PET Scan. EEG. or special intervention is indicated (e. and medical assistants to provide an effective and comprehensive patient care Apply evidence-based. plans and arranges appropriate investigations. and major abnormalities on CT head.g. and refers appropriately Learn to interprete: CSF . Evoked potentials. Muscle biopsy Understand the steps of brain death diagnosis and its ethical issues Behavior Carefully approach to the relatives of critically ill patients Discuss ethical issues that may face patients and their families. establishes a provisional diagnosis. EEGs. Brain CT. NCSs and EMGs. Applies basic science knowledge to appreciate the significance of. and management of disease Page101 . Cerebral angiography. cost-conscious strategies to prevention. the Trainee recognises the presentation of illness. Applies basic science principles to interpret clinical findings.Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs. including Brain death and resuscitation issues Discuss appropriate management and discharge plan with patients and /or their families who are distressed Recognize potential problems that may have an impact on the treatment and outcome. thrombolysis for stroke). NC studies. nurses. diagnosis. and appropriately act on reports of. If there are complications. and independently initiates appropriate management for uncomplicated disease. reports of perimetry. audiometry. Applies basic science knowledge to interpret clinical signs. the Trainee recognises these. including compliance and social factors Interact with social workers. Brain CT and MRI List the indications for Lumbar puncture. autonomic function testing.

renal disease in pregnancy. The resident should also understand how systemic diseases affect the kidneys. asymptomatic urine abnormalities. Basic science i) Structure and function of the renal system and male and female genital tract ii) Regulation of fluid and electrolyte status iii) Acid base regulation iv) Urine composition v) Hormonal regulation ( ADH. and post-transplant care. potential complications of the disease and its management. rennin-angiotensin system) vi) Measurement of renal function/ calculation of creatinine clearance and GFR vii)Principles of renal replacement therapy. Knowledge A.9. nephrolithiasis. Commonly encountered conditions in Nephrology that the resident should be competent and comfortable in assessment and management of include disorders of fluid. and recognize the potential toxicities of various therapeutic and diagnostic agents. Nephrology/ Disorders of the renal and genitourinary systems Educational purpose: Nephrology involves the diagnosis and management of diseases of kidneys. The resident must be competent in managing patients with chronic kidney disease who are not yet on dialysis and know indications for initiating dialysis. and acid base balance. electrolyte. tubular defects. and bladder. pathophysiology. clinical presentation. tubulointerstitial disorders. and its vasculature.2. The resident should also recognize when consultation of a nephrologist is appropriate in the management of any of the aforementioned conditions.transplant and dialysis viii) Pharmacology of major drug classes used ix) Renal diet: what it consists and when to initiate it? B. differential diagnosis. and neoplasm of the kidneys. including pre-transplant. Describe the epidemiology.4. collecting system. investigations. renal vascular diseases. detailed initial management.8. and its contiguous collecting system. Other problems include disorders involving the glomerulus. renal transplantation. preventive strategies: Acute renal failure Chronic renal failure Glomerulonephritis Nephrotic syndrome Urinary tract infections Page101 i) ii) iii) iv) v) . The resident must understand current strategies to delay or prevent kidney disease. chronic kidney disease. acute renal failure. principles of ongoing management. and infections.

vi) vii) viii) ix) x) xi) Polycystic kidney disease Acute tubular necrosis Interstitial kidney disease Renal cell carcinoma Genitourinary malignancies uterine/cervical/ovarian) Obstructive uropathy (prostate. ABGs). plans and arranges appropriate initial investigations. Renal manifestations of systemic disease Skill Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs. MSU. Applies basic science knowledge to appreciate the significance of. renal biopsies. Adjustment of medications in patients with renal disease D. and refers appropriately. discusses broad therapeutic options. risks. establishes a provisional diagnosis. List the indications. functional renal scans. initiates symptomatic therapy. renal angiograms. C. Dietary modification in renal failure Management of anemia in chronic renal failure Management of Fluid and electrolyte disorders Management of Acid-Base disorders Cauterization Page101 Knowing when to refer or prescribe suppressive antibiotics for chronic indwelling bladder catheter . laboratory tests (renal function. Applies basic science knowledge to interpret clinical signs. urograms). and avoids cannulation of target vessels. electrolytes. bladder. Anticipates future need for dialysis or transplant refers for vascular access where appropriate. The Trainee recognizes the presentation. testicular. on reports of imaging (renal tract ultrasound. and contraindications of renal biopsy E. and appropriately act.

principles of ongoing management. Describe i) ii) Pneumonia Acute respiratory failure Page101 the epidemiology. WBCs. Basic science i) Airway of lungs/airways ii) Gas exchange iii) Ventilation iv) Ventilation perfusion matching v) Acid base balance vi) Applied respiratory physiology – to interpret basic pulmonary function tests vii) Pharmacology of major drug classes used: bronchodilators.4. and to know how to optimize consultation with specialists in the care of one’s patients. clinical presentation. immunologic. inhaled corticosteroids . immunosuppressents viii) Occupational and environmental toxins ( cigarettes. potential complications of the disease and its management. investigations. bacteria and various types of casts Behavior Discuss with the patient likely outcome. asbestos) ix) Inflammation of airways B. He or she is expected to apply this understanding in the obtaining the history and examining and counseling the patient.2. preventive strategies for the following conditions: . pathophysiology. The general internist is also expected to understand the indications and contraindications of diagnostic tests or interventions. inflammatory. Knowledge A. progress of the condition and requirement of long term follow up Discuss the risks and benefits of renal replacement and its impact on quality life Understand the ethical issues of organ donation and promote community awareness of brain death and organ donation 8. to assess validity of tests before interpreting them. Pulmonary Medicine/Disorders of the Respiratory and sleep system Educational purpose: The general internist is expected to understand the environmental. differential diagnosis.10. leukotriene receptor antagonists. detailed initial management.Demonstrate ability read a urine dipstick and recognize RBCs. and genetic mechanisms that usually maintain gas exchange but can sometimes lead to disordered function.

including histoplasmosis and aspergillosis Sleep apnea C. pulse oximetry. pulmonary function tests iii) The Trainee recognizes the presentation of illness. skin test for allergy. plans and arranges appropriate investigations. the Trainee recognizes these.iii) iv) v) vi) vii) viii) ix) x) xi) xii) xiii) xiv) xv) xvi) xvii) Chronic respiratory failure Bronchial asthma COPD and corpulmonale Pleural effusion Pneumothorax Tuberculosis Bronchiectasis Diffuse parenchymal lung disease/ILD Lung cancer Bronchieactasis Pulmonary hypertension Pulmonary embolism Cystic fibrosis Mycotic lung disease. ABG. i) a) b) c) d) e) f) ii) Page101 . bronchoscopy (including BAL. peek flow rate. and independently initiates appropriate management for uncomplicated disease. including Subjective description of the complaints Previous chest X-rays TB exposure including past history of anti-TB therapy History of thoracic procedures Occupational history. pleural biopsy. CT scan of chest. V/Q scan Understands the indications. Understands the principles of safe oxygen therapy Understands the principles of short and long term oxygen therapy Understands the different delivery systems for respiratory medications Understands the methods of smoking cessation of proven efficacy Counsel patients in smoking cessation appropriately Recognizes side effects of anti-TB drugs Able to interpret Chest R-rays. Respiratory manifestations of systemic diseases Skill Take a complete problem-oriented history. contraindications and limitations of the following studies: Endotracheal intubation. BiPAP. establishes a provisional diagnosis. pleural fluid study reports. blood gases. If there are complications. brush. imaging. 6-min walk test. Monitors for complications. pulmonary function tests. and refers appropriately. including exposures Family history of specific pulmonary disease Conduct a focused clinical examination and applies basic science knowledge to interpret clinical signs.

endo-vs transbronchial biopsy) . inflammatory. to provide patient-focused care: i) Radiologists ii) Allergists iii) Otolaryngologists iv) Cardiologists( distinguish pulmonary vs. investigations. mediastinoscopy. clinical presentation.11. Describe the epidemiology. immune responses of the skin iii) Pharmacology of major drug classes used: topical corticosteroids. preventive strategies for the following conditions: I) II) Infestations with scabies and lice Dermatitis Page101 .. principles of ongoing management.4. CT scan. Knowledge A. video-assisted thoracoscopy. and common skin malignancies. cancer Utilize information technology to enhance patient care and patient education Proper counseling of TB patients 8. immunosuppressents B. detailed initial management. and recognizing skin signs of systemic disease. He or she should be proficient at examining the skin. describing the findings. Basic science i) Structure and function of skin. percutaneous lung biopsy. pleural biopsy. pulmonary artery cathetarization. open lung biopsy Behavior Resident must communicate effectively and demonstrate caring and respectful behaviors when interacting with the patients and their families: i) Motivational interviewing for smoking cessation: 5A’s. lung scan.2. set a quit date ii) Asthma management plan iii) Explain gang preparing for oxygen therapy iv) Giving bed news regarding terminal illness (e. cardiac cause of symptoms) v) Psychiatry. lung cancer) Resident must work effectively with other health care professional including those from other disciplines. differential diagnosis.depression in COPD. pathophysiology. ventilation perfusion scan (VQ scan). Dermatology/Skin disorders Educational purpose: The resident should be able to diagnose and manage a variety of common skin conditions and make referrals when appropriate. normal findings.g. hair and nails ii) Pigmentory. end-stage COPD. potential complications of the disease and its management.

the Trainee recognizes these. and appropriately act on reports of. Behavior Counsel patients on preventive strategies for skin tumors (e. Skin manifestations of systemic disease Skill Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs. and the diagnostic features for early detection of malignant melanoma Recognizes when a patient’s presentation heralds a systemic disease Page101 . the Trainee recognizes the presentation of illness.g tinea Psoriasis Vasculitis Eczema Acne Toxic epidermal necrolysis Erythema multiforme Skin cancer: squamous and basal cell carcinoma Pitriasis Rosacea Erythema nodosum Skin ulcers Urticaria and angioedema Cellilitis and abscess. Applies basic science knowledge to interpret clinical signs including description of skin lesions using standard nomenclature. For these conditions. avoiding excess UV exposure). Monitors for complications. establishes a provisional diagnosis.. plans and arranges appropriate investigations.III) IV) V) VI) VII) VIII) IX) X) XI) XII) XIII) XIV) XV) XVI) XVII) XVIII) XIX) XX) XXI) XXII) Fungal infections e. and refers appropriately. impetigo Viral infections: Herpes simplex and herpes zoster infections Bullous disorders Cutaneous drug reactions Skin rashes Dermatomyositis Scleroderma Melanoma C. If there are complications. skin and lesion biopsy. Applies basic science knowledge to appreciate the significance of. and independently initiates appropriate management for uncomplicated disease.g.

principles of ongoing management. and host factors that predispose to infection. Important elements include the environmental. fungal. Infectious disease medicine requires an understanding of the microbiology. pathophysiology. differential diagnosis. occupational.Patient education on proper skin care for sensitive skin. encephalitis. and management of disorders caused by viral. infections. Recently the emergences of new infections have made management of communicable diseases a global issue. Residents must understand principles and systems of infection control for individual patients and larger populations. clinical presentation.12. skin and soft tissue infections CNS infection: meningitis. investigations. detailed initial management. Complications of sepsis: shock. UTI. and therapeutic care for most infections. diagnostic. brain abscess Fever in the returning traveler HIV and AIDS including ethical consideration of test in Infections in immunocompromised host Tuberculosis i) ii) iii) iv) v) vi) vii) Page101 .4. preventive strategies for the following conditions: PUO Septicemia. and parasitic infections. Residents should also be able to evaluate symptoms that may be caused by a wide range of infectious disorders. ARDSB Common community acquired infection: LRTI. Knowledge A. as well as basic principles of the epidemiology and transmission of infection. 8.2. vaccines. and chronic pruiritic skin disorders. Infectious diseases Educational purpose: Infections lead to significant amount of morbidity and mortality. It is important that residents be able to provide appropriate preventive. including appropriate use of antimicrobial agents. DIC. Basic science i) Biology of common and important pathogens ii) Host response to infection iii) Principles underlying laboratory testing for infectious disease iv) Principles of infection control v) Immunasitation vi) Pharmacology of major classes of drug used including pharmacology of antibiotics B. Describe the epidemiology. prevention. potential complications of the disease and its management. and other immunologic agents.

Herpes simplex.viii) Common genitor-urinary conditions: non-gonococcal urethritis. syphilis ix) Fungal infections e. ii) Applies basic science knowledge to interpret clinical signs.. ultrasound scan v) The Trainee recognizes the presentation of illness. laboratory tests (FBC. CT abdo/pelvis). basic imaging (CXR. iv) Applies basic science knowledge to appreciate the significance of and appropriately act on reports of complex investigations – nuclear medicine scanning. jirovecii infection x) Lyme disease xi) Viral infections: CMV. CT head. gonorrhea. microbiology. the Trainee recognizes these. iii) Applies basic science knowledge to assess potential routes of infection/transmission. varicella zoster xii) Endocarditis xiii) Osteomyelitis. septic arthritis xiv) Viral Hepatitis xv) Diarrheal illness xvi) Conjunctivitis xvii) Malaria. plans and arranges appropriate investigations. must know how to seek appropriate evaluation and to make appropriate notification xi) Resident must learn to assess the clinical usefulness of new antibiotics xii) Learn to communicate with microbiology laboratory regarding culture and sensitivity results xiii) Know the local antimicrobial resistance pattern Page101 . Resident must learn to protect them to minimize the risk of occupational exposure. establishes a provisional diagnosis. virology. kala-azar xviii) Rabies xix) Hydatid diseases xx) Global outbreak: SARS. If an exposure does occur. serology). EBV. vii) Monitors for complications. avian influenza Skill i) Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs.g. vi) If there are complications. pneomocystis. secondary sites of infection. viii) Resident must know to interpret a laboratory’s antibiogram and use the information for empiric antibiotic choice for clinical care ix) Resident must understand the indications for and types of isolation procedures x) Resident must be able to obtain informed consent for HIV testing. inflammatory markers. and independently initiates appropriate management for uncomplicated disease. asperogillus. pandemic flue. and refers appropriately.

nose. principles of ongoing management. Basic science i) Anatomy of ear. investigations. differential diagnosis. Describe the epidemiology. pathophysiology.6 nerve palsies Proptosis Page101 i) ii) iii) iv) v) vi) vii) viii) ix) x) xi) xii) xiii) xiv) xv) xvi) xvii) xviii) xix) . preventive strategies for the following conditions: Earache Ear discharge Ringing in the ear Sore throat Sinusitis Epistaxis Hoarseness of voice Otitis media Otits externa Cerumen impaction Hearing loss Laryngitis Pharyngitis Acute visual loss Diplopia Nystagmus Opthalmoplegia 3. nose and throat B. The resident will also need to be able to recognize ear. The resident must be familiar with those complaints and problems that can be diagnosed and treated by the internists. detailed initial management. informing patients of positive diagnosis of STDs 8. Otolaryngology and ophthalmology Educational purpose: The general internist will see complaints related to the ear.xiv) Know the local immunization and vaccination practice Behavior • • Resident should be able to assess vaccine utilization in their patients Resident must utilize the skill when delivering HIV results.13. potential complications of the disease and its management.2. Knowledge A.4. and which conditions need referral to an otolaryngologists. clinical presentation. nose and throat during the care of patients. and throat manifestations of diseases managed by the internist.4.

compassion.xx) Cavernous sinus thrombosis xxi) Red eyes xxii) Retinopathies including retinal hemorrhage: diabetes. and altruism to those who are blind 8. For the following malignancies. cell injury. broad therapeutic options and preventive strategies including screening: • lung • breast • gastrointestinal • prostate • skin • brain Page101 . Basic science i) cell growth and aging. apoptosis ii) molecular and cellular oncogenesis iii) Principles of metastatic spread iv) Principles of staging v) Broad pharmacological principles of chemotherapy. the risk factors. undertake the palliative care of patients with solid and hematologic tumors. and syndromes suggestive of underlying malignancy. radiotherapy. nose and throat and refer appropriately Should be able to do fundoscopic examination and to interpret them and to act on as necessary Behavior Become familiar with the appropriate referral services for hearing impaired Must demonstrate respect. clinical presentation. and immunotherapy vi) Principles of screening tests B. investigate clinical symptoms. identify neoplasms with a potential for cure. Oncology Educational purpose: Resident should be able to identify individuals at risk for malignancy and counsel them regarding risk reduction and screening.14.2.4. and manage appropriately Knowledge A. natural history. hypertensive Skill Should be able to do examination of Ear.

The management of important acute complications of cancer: • uncontrolled pain • malignant hypercalcemia • spinal cord compression • SVC obstruction • pericardial tamponade. If there are complications and/or procedural intervention is required. Initiates management of complications including pain. Applies basic science knowledge to interpret clinical signs. common chemotherapy side effects. Skill Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs. host disease. bone scan. The management of important complications of cancer therapy: • bone marrow suppression • neutropenic sepsis • tumour lysis syndrome • mucositis • Graft vs. mucositis. abdomen. C. and independently initiates appropriate management of presenting symptoms. tumors markers. If a diagnosis of cancer is considered.• carcinoma of unknown primary • lymphoma • multiple myeloma • leukaemia • potentially curable cancers. reports of more specialized imaging. fluid balance disturbances. CXR. CT head. neutropenic sepsis. cytology. predictive genetic testing For conditions listed.g. and appropriately act on. D. the Trainee recognizes the presentation of illness. Recognise the dying phase of terminal ilness Page101 . plans and arranges appropriate investigations. laboratory tests (e. the Trainee recognizes this. tumour lysis syndrome. the Trainee develops an appropriate management plan in consultation with their supervisor. provides initial emergency management and refers appropriately. body fluid analysis). chest. Applies basic science knowledge to appreciate the significance of. establishes a provisional diagnosis.

colleagues appropriately and sensitively ensuring patients interest are paramount. Basic principles of individualised medicine and pharmacogenetics. Human Genome Project.4. mitochondrial . natural history.Behavior Recognizes the associated social and psychological problems Break bed news to patient and family with cancer in sensitive and appropriate manner Contribute to discussions on decisions not to resuscitate with patient. DNA.and cellular proteins. family. sex-linked. Principles inheritance: Mendelian. complications and comorbidities principles of ongoing management and appropriate referral: • • • • • • • • • • • • Trisomy 21 Turner’s syndrome cystic fibrosis haemochromatosis Marfan’s syndrome Klinefelter’s syndrome Huntington’s disease Down’s syndrome Hemophilia Von Willebrand’s disease Polycystic kidney disease Thalasemia Page101 . carers.15. polygenic Principles of mutation. B. gene sequencing. FISH. phenotype(s). Awareness of genetic databases.2. Genetic diseases Educational purpose: Manage patients with common genetic disorders Knowledge A. RNA. Principles of enetic testing techniques: PCR. polymorphism. the inheritance. clinical presentation. genes. 8. Describe the common genetic diseases. Basic Science • • • • • • • • Structure and function of human cells. trinucleotide repeat disorder Major cancer genetics.

5.g. the Trainee develops an appropriate management plan in consultation with their supervisor Behavior Recognize the anxiety caused to an individual and their family when investigating genetic susceptibility to disease Recognize the implications of a genetic diagnosis to family 8. diabetes List the common medical problems occurring in pregnancy: jaundice in pregnancy. and appropriately act on reports of. Knowledge Demonstrate awareness of the possibility of pregnancy in women of reproductive years Outline the normal physiological changes occurring during pregnancy Demonstrate awareness of the impact of long term conditions in relation to maternal and fetal health e.2. Conducts a focused clinical examination and applies basic science knowledge to interpret clinical signs. Applies basic science knowledge to appreciate the significance of. Constructs and interprets a family pedigree. investigation and management of the common and serious medical complications of pregnancy.2.1.• Skill Familial cancers. renal disease in pregnancy Identify the unique challenges of diagnosing medical problems in pregnancy Recall safe prescribing practices in pregnancy and post partum Page101 . Medicine throughout the lifespan/growth and development 8. Applies basic science knowledge to collate an accurate family history. Manage common medical problems in pregnancy Educational purpose: The trainee will be competent in the assessment.5. Recognize the importance the importance of skilled counseling in the investigation of genetic susceptibility to disease Recognize basic pattern of inheritance Estimate risk for relatives of patients with Mandelian disease If a genetic disease is present. genetic tests. or considered.

diabetes mellitus. For the following common and important problems in older people the • polypharmacy and adverse drug reactions Page101 Trainee describes the epidemiology. epilepsy. eclampsia Skill Recognize the critically ill pregnant patient.Demonstrate awareness of pregnancy related illness. Produce a valid list of differential diagnoses. internal medicine residents can expect to be involved in the care large number of elderly patients. e. Within the training program the trainee should acquire the defined knowledge. behaviors and attitudes needs to provide comprehensive care for the geriatric patient in a variety of settings as competent internists. Basic Science • • • • Physiology of ageing – pharmacology. changes associated with ageing in major organ systems. Normal laboratory values in older people B. Behavior Recognize interrelationships between maternal and fetal health. investigations. suspected pulmonary embolism. detailed initial management. clinical presentation. tissue growth and repair. Cellular ageing. heart failure. Manage problems in the older patients/Elderly/ Geriatrics Educational purpose: With the aging of the baby Boomers. preventive strategies: . Formulate a management for acute period of care: pre-eclampsia. Knowledge A. Take a valid history from a pregnant patient. infection. differential diagnosis.g. Examine a pregnant patient competently.5. skill. Communicate with obstetric team throughout the diagnostic and management process. asthma.2. 8. Non-specific presentation of illness in the elderly.2. eclampsia. principles of ongoing management. Discuss case with senior promptly. Initiate resuscitation measures and liaise promptly with senior colleagues and obstetrician. Recognize the anxiety of the family members regarding the outcome of pregnancy.

Recognize that “the elderly” are a diverse group with reguard to personalities. BPH constipation functional decline/detoriaration in mobility psychiatric presentations including depression. basic imaging. and refers appropriately.• • • • • • • • • • • • • • • • • • • • • • • Skill falls Fractures delirium Acute confusion cognitive decline/dementia/memory loss Movement disorder including parkinsonism Stroke and TIAs Syncope incontinence. anxiety. If there are complications. plans and arranges appropriate investigations. values. and independently initiates appropriate management for uncomplicated disease. and tests of cognitive function. laboratory tests. Monitors for complications. establishes a provisional diagnosis. tests of mental status examination. Osteoporosis Osteoarthritis Leg and pressure ulcer Insomnia Vertigo/dizziness Hearing loss Constipation Vision loss Malnutrion Sexuality and aging Glaucoma Applies basic science knowledge to interpret clinical signs. functional levels and medical illnesses. their families. the Trainee recognizes these. mania. and health professionals. Page101 . The Trainee recognizes the presentation of illness. Behavior Demonstrate interpersonal and communication skils that result in effective exchange of information and collaboration with patients.

5. Promotes screening to detect early disease – breast. including breast and pelvic examination and screening investigations. Risk factors for disease in post-menopausal female: • osteoporosis • cardiovascular disease • neoplasia • incontinence • depression. cervical.8. compassion. Evidence for interventions to detect and prevent cardiovascular disease Skill Detects symptoms of normal and abnormal menopause.and post-menopausal women regarding healthy lifestyle. Manages disease associated with menopause. Counsels peri. Manage common problems associated with the menopause/Women’s Health Educational purpose: Manage common problems associated with the menopause Knowledge Physiological changes associated with peri-menopause and post-menopausal period. bone density for those with risk factors. integrity. Appropriately examines and conducts investigations for post-menopausal female. Behavior Female patient will be treated with respect.3. Appropriately examines and conducts investigation for early onset menopause. Detects symptoms of depression and recognizes psychosocial factors impacting on presentation. Page101 .2. and altruism post-menopause-osteoporosis. cardiovascular risk screening. Clinical presentation of menopause.

biological. Recall the effect of addictive behaviours.8. Demonstrate knowledge of the determinants of health worldwide and strategies to influence policy relating to health issues including the impact of the developed world strategies on the third world. Public Health Issues and Health Promotion Educational purpose: To Recognize that the public health issues can impact on an individual’s patient’s wellbeing. Know the key local concerns about health of communities such as smoking and obesity Understand the role of other agencies and factors including the impact of globalisation in protecting and promoting health. affordable interventions to reduce these.2. Understand the purpose of screening programmes and know in outline the common programmes available within the UK. Smoking Outline the effects of smoking on health Promote smoking cessation Recognise the need for support during cessation attempts Recognise and utilise specific Smoking Cessation health professionals Alcohol Recall safe drinking levels Recognise the health and psychosocial effects of alcohol Recommend support networks for problem drinkers Outline appropriate detoxification programme and methods to retain abstinence Page101 . Understand the relationship between the health of an individual and that of a community. remove inequalities in healthcare provision and improve the general health of a community. social. Also to recognize that the opportunities to be taken for health promotion with the patient population that presents to hospital. Understand the influence of lifestyle on health and the factors that influence an individual to change their lifestyle. Outline the major causes of global morbidity and mortality and effective. on health and poverty. Understand the factors which influence health – psychological. especially substance misuse and gambling. cultural and economic especially poverty.5. Knowledge To progressively develop the ability to work with individuals and communities to reduce levels of ill health.4. Understand the factors which influence the incidence of and prevalence of common conditions.

Obesity Recognize medical impact of obesity Outline good dietary practices Promote regular exercise Recommend specialist dietician input as appropriate Define principles of therapeutic interventions in morbid obesity Recognize the public health problem of poor nutrition Perform basic nutritional assessment Identify patients with malnutrition and instigate appropriate management Recognize importance of dietician input and follow-up Define principles of enteral and parenteral feeding Nutrition Recognize the public health problem of poor nutrition Perform basic nutritional assessment Identify patients with malnutrition and instigate appropriate management Recognize importance of dietician input and follow-up Define principles of enteral and parenteral feeding Outline the ethical issues associated with nutrition Promote safe sexual practices Recognize the health and psychosocial effects of substance abuse Recommend support networks Be able to define the levels of social deprivation in the community Recognize the impact of social deprivation on health Recognize the impact of occupation on health Outline the role of Occupational Health consultants Define the health benefits of regular exercise Outline the ethical issues associated with nutrition Sexual behavior Promote safe sexual practice Substance abuse Recognise the health and psychosocial effects of substance abuse Recommend support networks Social Deprivation Be able to define the levels of social deprivation in the community Recognise the impact of social deprivation on health Occupation Recognise the impact of occupation on health Outline the role of Occupational Health consultants Page101 .

Identify the interaction between mental. physical and social wellbeing in relation to health Counsel patients appropriately on the benefits and risks of screening Work collaboratively with other agencies to improve the health of communities Behavior Engage in effective team-working around the improvement of health Encourage where appropriate screening to facilitate early intervention 8. efficacy of therapy. and utility of diagnostic tests as they apply to questions about one’s patients.5. and pathophysiologic rationale as sufficient ground for clinical decision-making and stresses the examination of evidence from clinical research. It de-emphasizes intuition. systematic.Exercise Define the health benefits of regular exercise Promote regular exercise Mental health Recognise the interaction of mental and physical health Recommend appropriate treatment and support facilities Skill Identify opportunities to prevent ill health and disease in patients. EBM represents a new paradigm in the ongoing evolution of the practice of Medicine. reproducible. when possible. Knowledge i) Understanding the application of statistics in scientiofic medical practice ii) Understand the advantages and disadvantages of different study methodologies (randomized control trials. This paradigm emphasizes the use of.2. case control study) iii) Understand the principles of critical appraisal iv) Understand levels of evidence and quality of evidence v) Understand the role and limitations of evidence in the development of clinical guidelines vi) Understand the advantages and disadvantages of guidelines Page101 . and unbiased observations recorded in the medical literature to increase one’s confidence in the true prognosis. unsystematic clinical experience. Evidence-Based Medicine (EBM) Educational purpose: The BSMMU residency program believes that it is vitally important that residents be able to incorporate the principles of Evidence-Based Medicine (EBM) into their daily practices.5. Identify opportunities to promote changes in lifestyle and other actions which will positively improve health.

It is also essential to appreciate the limitations of diagnostic tests. clinical decision-making. However. complexity. abnormalities of hepatic function may provide the clue to such nonspecific symptoms as generalized . Rather. which often prove useful. Page101 Single laboratory tests are rarely ordered. the instruments used in the tests.2. Cochrane reviews and the internet • Appraise retrieved evidence to address a clinical question • Apply conclusions from critical appraisal into clinical care • Identify the limitations of research • Apply an open-minded. and apparent precision. and critical thinking in the clinical setting. they often gain an aura of authority regardless of the fallibility of the tests themselves. physicians generally request "batteries" of multiple tests. • Contribute to the construction. examining.vii)Understand the processes that result in nationally applicable guidelines (e. analytical approach to acquiring new knowledge • Access and critically evaluate current medical information and scientific evidence • Apply an evidence-based approach to clinical problem-solving. For example. and studying the patient. Behavior a) Keep up to date with national and international reviews and guidelines of practice (NICE & SIGN) b) Aim for best clinical practice at all times.6. and the individuals performing or interpreting them. NICE & SIGN) Skill • Ability to search the medical literature including use of Medline..g. By virtue of their impersonal quality. accumulated laboratory data do not relieve the physician from the responsibility of carefully observing. Physicians must weigh the expense involved in the laboratory procedures relative to the value of the information they are likely to provide. responding to evidence based medicine c) Recognize the occasional need to practice outside clinical guidelines d) Encourage discussion amongst colleagues on evidence-based practice 8. Investigation competences Diagnostic Studies We have become increasingly reliant on a wide array of laboratory tests to solve clinical problems. review and updating of local and national guidelines of good practice using the principles of EBM.

such as hyperparathyroidism or underlying malignancy. A group of laboratory determinations can be carried out conveniently on a single specimen at relatively low cost. a variety of isotopic scans. suggesting the diagnosis of chronic liver disease. it is important to consider its potential significance in the context of the patient's condition and other test results. the physician must learn to evaluate occasional abnormalities among the screening tests that may not necessarily connote significant disease. Ultrasonography. Nonetheless. patients must endure each of these tests.weakness and increased fatigability. The thoughtful use of screening tests. MRI. these tests are ordinarily repeated to ensure that the abnormality does not represent a laboratory error. such as low-density lipoprotein cholesterol. it is tempting to order a battery of imaging studies. CT. often provide a major clue to the presence of a pathologic process. may be quite useful. urinalysis. Cognizant of their capabilities and the rapidity with which they can lead to a diagnosis. On the other hand. On the one hand. These tests provide remarkably detailed anatomic information that can be a pivotal factor in medical decision-making. Sometimes a single abnormality. If there is no suspicion of an underlying illness. points to a particular disease. If an abnormality is confirmed. biochemical measurements. it would not be unusual for one or two of them to be slightly abnormal. always considering whether the results will alter management and benefit the patient. Learning objective: Plan and arrange investigations appropriately Goal: To progressively develop to formulate first line and second line investigations for an individual patient Page101 . and the added cost of unnecessary testing is substantial. The development of technically improved imaging studies with greater sensitivity and specificity is one of the most rapidly advancing areas of medicine. and sedimentation rate. All physicians have had experiences in which imaging studies turned up findings leading to an unexpected diagnosis. Among the more than 40 tests that are routinely performed as screening. more invasive approaches and opening new diagnostic vistas. and positron emission tomography have benefited patients by supplanting older. Screening tests are most informative when directed toward common diseases or disorders and when their results indicate the need for other useful tests or interventions that may be costly to perform. An in-depth workup following a report of an isolated laboratory abnormality in a person who is otherwise well is almost invariably wasteful and unproductive. together with simple laboratory examinations such as blood count. A skilled physician must learn to use these powerful diagnostic tools judiciously. such as an elevated serum calcium level.

Procedural competences Page101 . likelihood ratio of investigations Skills Rationally and effectively plans and arranges investigations based on findings from history and physical examination Adapts approaches to investigations taking into account patient factors and comorbidities Weighs the costs and benefits of investigations in each clinical situation Choose the most cost-effective investigation path Applies diagnostic reasoning to minimize the number of investigation minimize harm from false positives Recognize situations where it is appropriate to not investigate at all Choose and order first-line investigation appropriate for a patients Select second-line or specific investigation and formulate the criteria for their selection Avoid unnecessary repetition of investigations Checks results of investigations in a timely manner and acts on results appropriately Modify working diagnosis and treatment plan in response to investigation results Behavior The trainee should stop temptations in doing unnecessary investigations.2. s used and 8. positive & negative predictive value.7. its costseffectiveness. specificity.Knowledge Clinical indications and contraindications of investigation Relative cost of investigations Risk of performing investigations Impact of false negative and false positives on patients care Sensitivity. risk and benefits. Every patient should be informed regarding the utility of doing the investigations.

recognize the indications. aseptic technique.Learning objectives: Prepare patient for procedure. providing care following the procedures Goals: The trainee is expected to be competent in performing the procedures. analgesia and sedation where required and cardio Uses manual defibrillator Defibrillator function Necessity of synchronized shock Perform as team member and as team leader Page101 . staff and consent and environment for documentation of consent procedure Indications. side effects of anesthetic agents and sedation Appropriate instruments and environment including infection control measures and staffing requirements required for procedure. and minimization of patient discomfort (for complete list see in the appendix) Knowledge Skills Attitude/Behavior Preparing patient for Explain procedure to procedure patient and obtains informed consent Indications. Principles of informed carers. contraindications. Procedures Emergency elective DC version Uses smart (automatic) defibrillator Administers appropriate local anesthetic. contraindications. performing the procedures relevant to adult internal Medicine. and Documents discussion potential complications and informed consent related to procedure Prepare the patient. the importance of valid consent.

Starting voltage Number of shocks Pressure Measures CVP accurately measurement and line monitored care of central venous CV regularly line Desired position of CVP And maintained in good condition for as long as line necessary Physiology of CVP monitoring and strategies Complications are dealt to ensure measurements with appropriately are accurate How to secure line and maintain patency Potential complications Pleural and ascetic fluid aspiration Anatomical landmarks Safe approach Intercostal insertion management Punctures pleural /ascetic space Safe and successful aspiration of fluid drain Perform safe blunt and dissection to pleural space and inserts intercostals tube Anatomical landmarks Connects UWS and How an underwater seal secures in place functions Maintenance of drain in good working condition until removal Safe removal of the drain Knee joint aspiration Anatomical landmarks Lumbar puncture Safely punctures the joint Minimization of patient’s at appropriate site discomfort Removal of sample Safe and successful Minimization of patient’s Page101 .

dislocation open the airway complication management Anatomy Components functioning and Providing care Documents procedures following procedures and provides clear instructions related to Potential complications of observations and procedures’ management required Provide analgesia appropriate Responds appropriately to changes in observations Page101 . Respond immediately to immediate obstruction.Anatomical landmarks Appropriate procedure timing of puncture at appropriate discomfort site Measures CSF pressure Fits masks Prescribe pressure Ventilation maintained effectively for as long as required Non-invasive ventilation Principles of CPAP and BiPAP Principles of monitoring and adjustment Tracheotomy care and Recognize infection.

No component should have less than two questions B. Medical Record Review (POMR focused assessment): • Assessment is to be reported as follows: Satisfactory : 81-100% satisfactorily completed Unsatisfactory : <81% satisfactorily completed D.9. Portfolio Assessment: • Assessment is to be reported as follows: Page101 . 1) Case based focused history taking 2) Case based specific system clinical examination 3) Demonstration of clinical skill/procedure 4) Data interpretation covering disease covered during the block 5) Communication skill and patient education 6) Case scenario based management of common emergencies related to the block 7) Scenario based situation to assess the managerial cum leadership quality training C. (b) Applied Basic Medical Sciences. Assessment strategy a)Formative assessment at the end of each block End of Block Assessment Guidelines I. Content and Process A. Logbook Assessment: • Assessment is to be reported as follows: Complete :81-100% of the activities /Task were completed satisfactorily Recoverable : 6 1-80% completed satisfactorily Irrecoverable :<60% Completed satisfactorily E. Objectives of the EOB Assessment: • Formative assessment at the end of each block • End of Block assessment will be organized by the Course Coordinators • Assessment is to be completed within the last 7 days of each block • Report must be completed within 7 days after Block Completion and be preserved by the Parent Course Manager • Debriefing / Feedback on Block activities / performance should be provided to the Resident following assessment before they leave the training Department / Service II. Time: 100 mm Type of questions : Short Essay Question (SEQ) Content : (a) Lectures /Tutorials/Journal Presentations. Written Examination: Marks : 50. Clinical Examination (OSCE / OSPE): • Ten stations to be distributed among the following categories. etc during the block period in the respective discipline. and (c) Professional Qualities / Medical Humanities Number of questions : 10 SEQs from the above mentioned components.

Complete and satisfactory Deficient : <81% of the desired contents is complete. Global Rating of Resident’s Competence! Performance (EOBR Rating): • Average rating (Rating scale I to 10) Page101 .Uptodate : 8 1-100%. needs to revise the contents F.

Supervisor Page101 .End of Block Assessment Report (EBAR) Resident’s name:…………. d)………… c) Scholarship d) Professionalism Overall Comment*: Feedback Summary: …………………………………. the weakness can be overcome by guided personal efforts -‘Needs to repeat’: both conception and basic skills are unsatisfactory ..………. Complete and satisfactory Deficient: <80% of the desired contents is complete. Training Department/Service: ……. Competence Assessment: [ EOBR forms] b)………… a) Clinical competency.…………………….. Portfolio Assessment Uptodate: 8 -100%.‘Needs more effort’: has clear conception but lacks competency in basic skills. needs to revise the contents. Discipline: …………………...... ……. Logbook Assessment Complete :80-100% of the activities /Task were completed satisfactorily Recoverable: 60 -79% completed satisfactorily Irrecoverable :< 60% Completed satisfactorily..... Coarse Co-ordinator * Assessment to be categorized as: ……………………………….. Block Period:…………. has clear conceptions and competent in basic skills .‘Outstanding’: Overall excellent performance . Category of Assessment Assessment Scale (Score/Grade) Score/Grade Achieved Written examination Total marks 50 Clinical examination Total marks 100 Medical Record Review Satisfactory: 80-100% satisfactorily (POMR assessment) completed Unsatisfactory : <80% satisfactorily completed..……………………………………….‘Expected’: Expected progress in all the areas of education and training. Resident’s Work-based Average rating (Rating scale 1 to 10) a)……….... c)………… b) Communication skills..RID NO..

reflective case study/essay. case based learning exercise. one presentation in clinical meetings/grand rounds/ journal clubs. any one assignments (reflective essays. monitoring and feedback Monitoring methods: i) ii) POMR Log book: (Daily Training Record) It provides trainees with a personal record of all procedural and other training experiences. Trainee supervision.Viva-voce: 10. which are requirements for satisfactory completion of the relevant training program. Page101 . iii) Portfolio: contents of the portfolio in each block: At least one best case note based on POMR. problem-solving exercise. one best discharge summary. critical incident report. 1) Case based focused history taking 2) Case based specific system clinical examination 3) Demonstration of clinical skill/procedure 4) Data interpretation covering disease covered during the block 5) Communication skill and patient education 6) Case scenario based management of common emergencies related to the block 7) Scenario based situation to assess the managerial cum leadership quality training b) Long case .b) Summative assessment at the end of phase A • • • Conducted by the University examination department Successful completion of eight blocks will be prerequisite for appearing in the examination Examination format Written tests: SEQ Clinical examination: a) OSCE: Ten stations to be distributed among the following categories. one best referral note. SDL plan.

iv)

EOBR form evaluating Can Meds 7 roles of a physician.

11. Curriculum implementation strategies
A Medical Education Unit (MEU) should be established to provide logistic and technical support for proper implementation of the curriculum and better educational environment. This unit in turn will support the following areas: Developing study skill rooms Audiovisual accessories Effective and appropriate media selection and development Preparing lesson plan for each session Developing academic calendar Preparing effective methods for respective individual teaching learning session Faculty development Staff training For better assessment Selecting and developing valid and reliable assessment tools with model answers when needed Development of question bank

12. Curriculum review:
- Ongoing monitoring should be done for proper implementation of curriculum through checklist, questionnaire and from both formal and informal feedback from the trainer, trainees and other stakeholders - Course evaluation should be done for further improvement of the curriculum continuously

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Annexure 1
Procedural competencies
The trainee should be competent and confidant to perform the following procedures relevant to general medicine by the end of phases A training period. •Venepuncture •Cannula insertion, including large bore •Arterial blood gas sampling •Lumbar puncture •Pleural fluid aspiration •Ascitic fluid aspiration •Intercostal drain insertion •Central venous cannulation •Pressure measurement and care of central venous lines •Initial airway protection including insertion of an oral airway •Basic and subsequently advanced cardio respiratory resuscitation •DC cardio version •Urethral catheterization-male and female •Nasogastric tube insertion and checking •ECG recording •Supervision of Exercise ECG testing •Knee joint aspiration •Blood culture from peripheral and central sites •Application of oxygen administration devices •Inhaler devices •Nebulisation •Water seal drainage •Minor suturing and debridement of wounds •Dipstick urinalysis •Blood glucose determination using capillary blood •Bag and mask ventilation of unintubated patients •Spirometry and peak expiratory flow rate determination •Throat/pus/wound swab •Cervical smear and swabs •Nasal support ventilation (CPAP, BiPaP) •Tracheostomy care •Bone marrow aspiration •Splenic aspiration •Collection, storage and transportation of pathological specimens with accompanying notes.

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Annexure 2 : CanMEDS Role : The seven Roles of Doctor

P
Role 1: Medical Expert: Definition: As medical experts, physicians integrate all of the CanMEDS Roles, applying medical knowledge, clinical skill, and professional attitudes in their provision of patient-centered care. Medical expert is the central physician role in the CanMEDS framework. Description: Physicians possess a defined body of knowledge, clinical skills, procedural skills and professional attitudes, which are directed to effective patientcentered care. They apply these competencies to collect and interpret information, make appropriate clinical decisions, and carry out diagnostic and therapeutic interventions. They do so within the boundaries of their discipline, personal expertise, the healthcare setting and the patient’s preferences and context. Their care is characterized by up-to-date, ethical, and resource-efficient clinical practice as well as with effective communication in partnership with patients, other health care

Medical exper
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Good clinical care

Poor communication can lead to undesired outcomes. 2. Role 2: Communicator: Definition: As communicators. colleagues and other professionals. 4. striving for mutual understanding. Page101 . and important other individuals. and effective communication is critical for optimal patient outcomes. Develop rapport. Accurately elicit and synthesize relevant information and perspectives of patients and families. 4.providers and the community. The role of medical expert is central to the function of physicians and draws on the competencies included in the roles of communication. formulating a diagnosis. collaborator. health advocate. other professional. integrating all of the CanMEDS roles to provide optimal. 5. during.. Key Competencies: Physicians are able to. delivering information. recognizing the limits of their expertise. Description: Physicians enable patient-centered therapeutic communication through shared decision-making and effective dynamic interactions with patients.. trust and ethical therapeutic relationships with patients and families. 3. Develop a common understanding on issues. Convey effective oral and written information about a medical encounter. problems and plans with patients and families. Establish and maintain clinical knowledge. and after the medical encounter. caregivers. 3. and facilitating a shared plan of care. families. physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before. The application of these communication competencies and the nature of the doctor-patient relationship vary for different specialties and forms of medical practice. 5. Key Competencies: Physicians are able to :1. skills and attitudes appropriate to their practice.. both diagnostic and therapeutic. Seek appropriate consultation from other health professional. The competencies of the role are essential for establishing rapport and trust. Accurately convey relevant information and explanations to patients and families. Perform a complete and appropriate assessment of a patient. Function effectively as consultants. scholar and professional. ethical and patient-centered medical care. colleagues and other professionals. 6. 1. Demonstrate proficient and appropriate use of procedural skills. manager. colleagues and other professionals to develop a shared plan of care. 2. Use preventive and therapeutic interventions effectively.

The CanMEDs manager role describes the active engagement of all physicians as integral participants in decision-making in the operation of the healthcare system. Serve in administration and leadership roles. Manage their practice and career effectively. and resolve interprofessional conflict. 3. and contributing to the effectiveness of the healthcare system. physicians effectively work within a healthcare team to achieve optimal patient care. Description: Physicians interact with their work environment as individuals. and an interprofessional team of expert health professionals for the provision of optimal care. Role 4: Manager: Definition: As managers. Such as a ward team. resources and organizational tasks. and make systematic choices when allocating scarce healthcare resources. physicians are integral participants in the healthcare organizations. Page101 . Description: Physicians work in partnership with others who are appropriately involve in the care of individuals or specific groups of patients. Physicians function as managers in their everyday practice activities involving co-workers. Key competencies: Physicians are able to: 1. effectively execute tasks collaboratively with colleagues. negotiate. as appropriate. 2. Allocate finite healthcare resources appropriately. but all specialties have explicitly identified management responsibilities as a core requirement for the practice of medicine in their discipline. making decisions about allocating resources. families. The balance in the emphasis among these three levels varies depending on the nature of the specialty. Effectively work with other health professionals to prevent. and as participants in the health system locally regionally or nationally. Participate in activities that contribute to the effectiveness of their healthcare organizations and systems. Key Competencies: Physicians are able to:1. This is increasingly important in a modern multiprofessional environment. in multiple locations. but also extended teams with a variety of perspectives and skills. as members of teams of group. physicians require the ability to prioritize. 4. It is therefore essential for physicians to be able to collaborate effectively with patients. where the goal of patientcentered care is widely shared. Participate effectively and appropriately in an interprofessional healthcare team.Role 3: Collaborator: Definition: As collaborators. such as care processes. education and scholarship. 2. and policies as well as balancing their personal lives Thus. organizing sustainable practices.

Key Competencies: Physicians are able to :1. health advocacy involves efforts to change specific practices or policies on behalf of those served. application and translation of medical knowledge. Communities and societies need physicians special expertise to identify and collaboratively address broad health issues and the determinants of health. families. health advocacy is an essential and fundamental component of health promotion. dissemination. residents. Critically evaluate information and its sources. Health advocacy is appropriately expressed both by individual and collective actions of physicians in influencing public health and policy. Respond to individual patient heath needs and issues as part of patient care. as well as the creation. physicians responsibility use their expertise and influence to advance the health and well-being of individual patients. 3. Framed in this multi-level way. they contribute to the creation. As learners. and populations. Facilitate the learning of patients. Identify the determinants of health of the populations that they serve. Through their scholarly activities. and others. as appropriate. physicians demonstrate a lifelong commitment to reflective learning . 4. dissemination. colleagues. for populations of patients and for communities. and others. and apply this appropriately to practice decisions. Maintain and enhance professional activities through ongoing learning. they facilitate the education of their students. At this level. communities and populations. dissemination. Doctors identify advocacy activities are important for the individual patient. they recognize the need to be continually learning and model this for others. Key competencies: Physicians are able to : 1. 2. other health professionals. Page101 . 2.Role 5: Health Advocate: Definition: As health advocates. Description: Physicians engage in a lifelong pursuit of mastering their domain of expertise. Promote the health of individual patients. Description: Physicians recognize their duty and ability to improve the overall health of their patients and the society they serve. 3. application and translation of new medical knowledge practices. 4. Role 6 : Scholar: Definition: As scholars. patients. Contribute to the creation. communities. application and translation of medical knowledge. As teachers. Respond to the health needs of the communities that they serve. the public. Individual patients need physicians to assist them in navigating the healthcare system and accessing the appropriate health resources in a timely manner.

and abdominal pain which are traditionally managed by surgical teams.define the knowledge. and high personal standards of behaviour. ii) Demonstrate a commitment to their patients. personal well-being. Key Competencies: Physicians are able to:i) Demonstrate a commitment to their patients. as well as the art of medicine. These are competences with which the specialist trainee should be well acquainted throughout the training period. physicians are committed to the health and well-being of individuals and society through ethical practice. The first three common competences cover the simple principles of history taking. As such.Role 7: Professional: Definition: As professionals. skills and attitudes required for each level of learning for different problems with which a patient may present. integrity. and to the promotion of the public good within their domain. iii) Demonstrate a commitment to physician health and sustainable practice. “top 20” and other presentations. Symptom Competences . Their work requires the mastery of a complex body of knowledge and skills.The common competences are those that should be acquired by all physicians during their training period starting within the undergraduate career and developed throughout the postgraduate career. profession. These symptoms are further broken down in to emergency. clinical examination and therapeutics and prescribing. altruism. the embracing of appropriate attitudes and behaviors. Description: Physicians have a unique societal role as professionals who are dedicated to the health and caring of others. and society through participation in profession-led regulation. profession. in return. and are based on medical admissions unit audit data including the “next 40” less common presentations Surgical Presentations – define symptoms such as haematuria. These presentations frequently occur in the context of long-term medical illness and as a Page101 . rectal bleeding. Common competencies. The top 20 presentations are listed together to emphasize the frequency with which these problems are encountered in clinical practice. grants physicians the privilege of profession-bed regulation with the understanding that they are accountable to those served. Society. and society through ethical practice. the professional role is guided by codes of ethics and a commitment to clinical competence. The reason that these symptoms appear in this curriculum is to recognize that often a physician is called upon to perform the initial assessment of these patients. These commitments from the basis of a social contract between a physician and society. profession-led regulation.

Investigation Competences . perform initial investigations and management if urgently required. and make a referral to the appropriate surgical team for a specialist opinion in a timely manner System Specific Competences .define competences to be attained by the end of training.lists investigations that a trainee must be able to describe. Procedural Competences . a physician is expected to stabilize the patient as necessary.complication of medical illness. Also. The role of the physician in these situations is not to take responsibility for the full management of these patients. and also lists the conditions and basic science of which the trainee must acquire knowledge.lists procedures that a trainee should be competent in by the end of training. the hospital-at-night team structure leads to physicians at all levels of training taking responsibility for surgical in-patients. However. Page101 . order. and interpret by the end of training.

Involuntary limb movement 24. Hemi facial pain Page101 . Foot and ankle pain 16. Shoulder pain 13. Proptosis 36. Upper abdominal pain 3. Palpitation 2. Knee pain 14. low back pain 4. Loss of memory 30. Recurrent loss of consciousness 28. Facial palsy 37.Daytime somnolence 31.Slurred speech 29. Upper limb pain 15. Headache 7. Ptosis 34. Acute polyarthritis 10. Insomnia 32.Annexure 3: List of lecture to be delivered in the department of Medicine (List will be upgraded) Evaluation of patients with 1. Neck pain 6. Tremor 23. Generalized weakness 22. Generalized aches 12. Unpleasant sensation in lower limbs 33. Prolonged pyrexia 19. Acute fever 18. Unconscious patient 27. Diplopia 35. Chronic polyarthritis 9. Paraesthesias 25. Hip pain 17.Dizziness 21. Lateral wall chest pain 8. Acute confusional state in the elderly 26. Headache and fever 20. Pain in single joint (Monoarthritis) 11. Diffuse abdominal pain 5.

Page101 38.Involuntary movement of face 39. Lower abdominal pain 68. Incontinence of urine . Haemoptysis 53.Imbalance of gait 41.Upper GI bleeding 65. Early satiety 60.Acute abdominal pain 67. Oral ulcers 46.Chest pain on exertion 50.Proteinuria 81. Jaundice 74. Weight loss 71. Anorexia 58. Shock 56.Acute breathlessness 47. Haematuria 78. Chronic diarrhea 63. Urethral discharge in male patient 77. Pyuria 79. Lower GI bleeding 66. Periodic paralysis 42. Gaseousness in abdomen 62. Hypertension assessing secondary causes and target organ damage 52. Bilateral pedal edema 54.Hemiplegia 45. Proximal muscular weakness 43.Chronic cough 49. Polyuria 80.Acute central chest pain 51. Chronic constipation 64. Nausea 59. Recurrent convulsions 40. Steatorrhea 72. Unilateral limb edema 55.Heartburn 69.Vomiting 61.Dryness of mouth 70. Paraplegia 44. Dysphagia 57. Shortness of breath on exertion 48. Dysuria 76. Asymptomatic abnormal LFTs 75. Ascites 73.

Iron deficiency anemia 100. Gum bleeding 101. Depressed mood 125. Cushing’s syndrome and disease 118. Short stature 115. Hepatosplenomegaly 104. Infertlity 86. Solitary thyroid nodule 111. Asymptomatic abnormal thyroid function test results 112.Tight and thick skin 97. Gynecomastia 117.Oliguria and anuria 83. Hepatomegaly 103. Leg ulcers 94.Facial rash 89. Pancytopenia 109. Lymphadenopathy 105. Loss of libido 116.Raynaud’s phenomenon 95.Erectile dysfunction 84. DVT 110. Medically unexplained somatic symptoms 124. Evaluation of HPA axis 122. Weight gain 119. Hypothyroidism 114.Purpuric spot 91. Alopecia 92. Evaluation of ST-T changes in ECG 106. Unexplained raised ESR .Hisutism and virilisation 85. Spontaneous hypoglycemia 120. Urticaria 88. Dark skin 98. Errors in interpretation of ECG 107. Claudication 96.Pruritis 87. Splenomegaly 102. Evaluation and monitoring of a diabetic patient 123. Papules and nodules 93.Blisters and bullae 90. Thyrotoxicosis 113.Anemia 99. Night sweats 121. Polycythemia 108.Page101 82.

139. 146. 134. 151. 147. 141. 160. 127. 153. 167. 136. 150.Page101 126. 166. 135. 162. Fever with drowsiness Genital ulcers Asymptomatic abnormal urinary findings Malabsorption Acute agitation Spontaneous hypoglycemia Common pulmonary infections in immunocompromised patients Carcinoma of unknown primary origin Adult patient with dyspnoea in emergency department Bleeding disorders Hypogonadism Acute tubular necrosis PUO Metabolic syndrome Thyroid swelling Acute paralysis Hoarseness voice Renal tubular acidosis Empty sella syndrome Jaundice in pregnant woman Dyslipidemia DPLD SLE and pregnancy Adrenocortical insufficiency Osteoporosis Pulmonary hypertension Rheumatoid arthritis and pregnancy Patient presenting with erythema nodosum Galactorrhroea Hypertensive urgencies and emergencies Anxiety disorder Fall in elderly Painless cervical lymhadenopathy Recurrent fracture Right iliac fossa lump Unexplained raise of ESR Bruising and spontaneous bleeding Hypothermia Hyperthermia/heat stroke Severe anemia Acute new onset headache Deliberate self harm . 158. 157. 142. 168. 144. 137. 165. 164. 131. 149. 161. 129. 138. 143. 155. 133. 154. 156. 152. 148. 159. 130. 132. 140. 128. 145. 163.

Methanol poisoning 9.Management of 1. Steven – Johnson syndrome & TEN 2. Management of HTN in special situation 36. Prevention and management osteoporosis 27. Leprosy 23. Newly diagnosed type II diabetes 7. Pneumonia 24.Atrial fibrillation 29. Management of congenital heart diseases 38. Hyperosmolar coma 5. Heat injuries 11.Hypertrophic cardiomyopathy 39. Nutropenia and fever 3. Management of hyperglycemia in Diabetes with end stage renal failure 42. Withdrawal of steroid 4. Management of obesity 12. Diabetic coma 6. Acute coronary syndrome 34. Unstable angina 33. Chronic respiratory failure 16. Supraventricular tachycardia 30. Management of Rheumatic valvular diseases 37. Snake bite 10. Palliative treatment of cancer patients 19. MDR TB 22. DHF 26. Management of heart failure 40. Uncomplicated Tuberculosis: pulmonary and extra pulmonary 20. OPC poisoning 8. UTIs 28. Stable angina 32. OPC poisoning 17. Acute respiratory failure 15. Management of hypertension 35. Acute circulatory failure 14.VES 31.Management of septic arthritis 41. Snake bite 18. Malaria 25. MOF & SIRS 13. Managing patients at the end of life Page101 .Complicated tuberculosis 21.

TBM Page101 . Deep fungal infection 16.Mx of COPD 61.Management of glycemic control in acute illnesses 49. Miliary tuberculosis 19. Urethral discharge in male 5. Hyponatremia 11. Hypercalcemias 15. Mx of nephritic syndrome 58. Mx of IBS 55. Step care management of bronchial asthma 52. Acidosis 9. Hypocalcaemia 14. Management of important complications of cancer therapy 46.43. Hyperkalamia 13. Management of glycemic control in acute illness 44. Evaluation and General management of the poisoned patient 3.Mx of patient with HBV infection in carrier state 50. Principles of Management of CRF 60.Mx of diabetes in ESRD 47. Pericardial effusion 17. Mx of Obstructive sleep apnea syndrome 63. Hypokalaemia 12.Peripheral vascular disease 45. Mx of crystal arthropathy 56. Evaluation and treatment of acute diarrhea 8. Mx of polymyelgia rheumatic and giant cell arterirtis 57. Mx of IBD 54. Mx of patient at the end of life 48. Alkalosis 10. Asymptomatic hyperuricemia 7. Heel pain 2. Chronic tubulointerstitial diseases 6. Acute diarrhea 4. Mx of GN 59. Mx of pulmonary hypertension 62. Mx of acute pulmonary embolism 64.Emergency management of bronchial asthma 51. Mx of Acute renal failure Evaluation and management of 1. Mx of psoriasis 53. Anti-phospholipids syndrome 18.

Miscellaneous 1. Respiratory manifestations of systemic disease 17. Neurological manifestations of systemic disease 16. Common pulmonary infections in immunocompromized patients 20. Common an life threatening drug interactions and common presentation of drug induced disease 10. Interstitial kidney disease 22. Principles of antimicrobial therapy Diagnosis and management of HIV infection Complications of steroid and their prevention Lung function tests Risk factors for thromboembolism and indications for thromboprophylaxis Methods of delivery of oxygen and ventilation Components of blood products and indications. Page101 . 3. 2. Mechanical ventilation 11. Infective endocarditis 23.Potentially curable cancers 21. 6. Bone marrow failure-potential causes and complications 23. 5.20. Gastrointestinal manifestations of systemic disease 13. 4. Principles of acute and chronic pain management 9. contraindications and adverse effects of the use of the blood products 8. Cardiovascular manifestations of systemic disease 18. Hematological manifestations of systemic disease 14. Patient with vasculitis 21. Dermatological manifestations of systemic disease 19. 7. Avascular necrosis 22. Renal manifestations of systemic disease 12. Musculoskeletal manifestations of systemic disease 15.

dyslipidemia or patient with bronchial asthma.A • • • List of symptoms that a trainee should learn to evaluate List of self-limiting conditions curable or treatable on one-step basis List of very common chronic condition for which intern should acquire to offer best evidence-based longitudinal care For Phase – B • • • List of uncommon emergency List of less common chronic condition that needs best evidence-based longitudinal care Non-interventional longitudinal care of patients with multiple problems e.. hypertension. patient with IHD.g. DM. RA & CAD Page101 .Annexure: 4 For Phase .

Note Page101 .

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