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Subject curriculum
P.G Degree curriculum
FIRST YEAR TEACHING PROGRAMME OF BASIC
SCIENCES
AUTONOMIC NERVE SYSTEM :
RESPIRATORY SYSTEM
Anatomy : Mouth – Nose – Pharynx – Larynx – Trachea – Main bronchi – Tracheo bronchial tree – Lung segments - Physiology : Respiratory system – Respiratory physiology and functions during anaesthesia.
Neural control of respiration – Chemical control of respiration -Non respiratory functions of lungs.
CARDIOVASCULAR SYSTEM
Anatomy : Anatomy of heart, pericardium, coronary vessels
Physiology : Cardiac Physiology - Regulation of coronary blood flow - Physiology of blood pressure and its regulations -Measurement of cardiac output and central venous pressure
CENTRAL NERVOUS SYSTEMS
Anatomy of vertebral canal and its contents, Vertebra and sacrum, Spinal Meanings and Spinal nerves, Spinal cord with its blood supply - Physiology of CSF circulation
MUSCLE AND NERVOUS SYSTEM
Anatomy of Neuro muscular junction, Physiology of nerve conduction, Physiology of Neuro muscular transmission. Factors affecting Neuro muscular transmission.
Anatomy – Brachial plexus, Cervical plexus and Coeliac plexus, lumbosacral plexus, l
LIVER – Anatomy of liver - Physiology of liver and liver function tests - Drug metabolism and liver.
RENAL SYSTEM : Physiology of renal function, Regulation of renal blood flow and Renal function tests
GERIATIC PHYSIOLOGY :
PHYSICS : Density of gases – vaporization – heat lost – during anaesthesia – latent heat of crystallization – partial pressure – vapour pressure- compressed gases and gas laws- pressure reducing valves – principles of Anaesthetic apparatus
BIOCHEMISTRY: Porphyrin metabolism – lipid metabolism, regulation of pH of blood and body fluids – Water and electrolyte balance.
PATHOLOGY INCLUDING MICROBIOLOGY: Histopathology, Microbiology investigations and their broad outlines.
PHARMACO KINETIC PRINCIPALS:
CONSUMER PROTECTION ACT: Other legal aspects in relation to specialty.
NEONATAL PHYSIOLOGY:
PHARMACOLOGY OF DRUGS USED IN DAY TO DAY PRACTICE:
INTEGRATED TEACHING PROGRAMME OF SECOND
YEAR & THIRD YEAR
|
OBSTETRIC ANAESTHESIA PAEDIATRIC ANAETHESIA GERIATRIC ANAETHESIA ENDOCRINE SYSTEM
- Etiopathology, diagnosis & treatment VOMITING & REGURGITATION HYPERTENSION SHOCK PHYSIOLOGY OF COAGULATION |
Anaesthesiology
Anaesthesiology Pediatrician
Anaesthesiology Physician
Anaesthesiology Physician
Anaesthesiology Physician
Anaesthesiology Physician
Anaesthesiology Haematologist |
CURRICULUM OF STUDIES FOR POSTGRADUATE STUDENTS
1. Name of Department : Department of Anaesthesiology
2. Head of Department : Dr. D.C.Tripathi
3. Other faculty members : Annexure – VIII
A-I Institutional Goal :
The goal of postgraduate medical education shall be produce a competent specialist and / or a medical teacher :
- Who shall carry out professional obligations ethically.
- Who shall have mastered most of the competencies, retraining to the specialty, that are required to be practiced at the secondary and the tertiary levels of the health care delivery system :
- Who shall be aware of the contemporary advances and developments in the discipline concerned ;
- Who shall have acquired a spirit of scientific inquiry and is oriented to the principles of research methodology and epidemiology; and also possesses the attitude for continued self learning and to seek further expertise.
- Who shall have acquired the basic skills in teaching of the medical and paramedical professionals.
- Have personal characteristics and attitudes such as personal integrity, sense of responsibility and dependability and ability to show concern for his/her collegues, patients and other person with whom he/she his working.
A-II Departmental Goal :
The goals of three year degree course in Anaesthesiology would be to train a MBBS doctor who after the satisfactory completion of which shall:
- Practice independently the art and science of Anaesthesiology and resuscitation effectively and ethically, backed by scientific knowledge and skill base.
- Undertake responsibilities in critical care unit, trauma unit, and respiratory therapy unit of unconscious patients requiring ventilatory support.
- Undertake acute and chronic pain management.
- Continue to evince keen interest in continuous professional or in private anaesthetic practice.
- Be a decided, motivated teacher who is always keen to train or to share his knowledge and skill with a colleague or junior or any learner.
B. Objectives :
The following objectives are laid out to achieve the goals of the course. These objectives have to be achieved by the candidates by the time of completion of the course. The objectives may be considered under the following headings.
- Knowledge ( Cognitive domain )
- Skills ( Psychomotor domain )
- Attitudes communication skills, human values and ethical practice.
At the end of the training the candidates must be able to :
B-I. Essential Knowledge :
- Demonstrate understanding of basic sciences relevant to Anaesthesia.
- Describe the Anaesthetic Management of common and uncommon surgical ailments belonging to various branches of surgery, at all ages requiring operative interventions with a basic knowledge of the aetiology, pathophysiology and the surgical treatment of the conditions.
- Describe the underlying theoretical background of mechanism pain perception and pain management.
- Describe the theory of the underlying aetiology, mechanism and management of the conditions requiring resuscitation.
- Demonstrate understanding of the theoretical base of polytrauma and the science of resuscitation.
- Recognise the conditions that may be outside the area of his competence and refer them to an appropriate specialist prior to anaesthetizing them.
- Advise regarding the anaesthetic management of any surgical case and to carry out this management effectively.
- Update himself / herself by self-study and by attending courses, conferences and seminars relevant to anaesthesia.
- Teach and guide his team colleagues and students.
- Demonstrate understanding of medicolegal aspects of anaesthesia.
- Demonstrate basic knowledge of the administrative aspects operating rooms complex.
- Undertake audit, use information technology tools and carryout research, both basic and clinical with the aim of publishing the work and presenting the same at various scientific fora.
Course Contents :
It includes topic not only of anaesthesilogy but also those aspects of all the other branches of medicine relevant to Anaesthesia viz., Medicine and its allied subjects, Surgery and its allied branches, Paediatrics, applied Anatomy, Physiology, Pathology, Pharmacolgy, Microbiology etc. It is intended as a guide to the candidates and it is not comprehensive. As and when there is newver development, it becomes eligible for inclusion. Hence, the candidates should be familiar themselves with the current content of the scientific journals and reviews of major topics, in Anaesthesia.
- History of Anaesthesiology.
- Basic Sciences related to Anaesthesia including Anatomy, Physiology, Pharmacology, Biochemistry, Patho physiology, Immunology and Genetics.
- Medicine applied to Anaesthesiolgy.
- Physics related to anaesthesiology, Electronics, Computers and Lasers, in Anaesthesiolgy, Internet/Medicine and its uses and applications.
- Anaesthesiolgy.
- Pre anaesthetic evaluation and prepararion.
- Principles and Practice of Anaesthesiology including pre, per and post operative care of patients belonging to General Surgery and other subspecialities like Cardithoracic Surgery, Neurosurgery, Orthopaedics, Plastic Surgery and Surgical Endocrinology, Urology, Dental Surgery, Laproscopy Surgery etc.
- Blood transfusion-Fluid and electrolyte balance, - Acid Base Balance, Natrition.
- Fires and Explosion in operation theatre.
- Operation theatre sterilization procedures.
- Essential monitoring.
- Pain Clinic organization and management. Pain pathway, and management of pain.
- Respiratory therapy and management of both acute and chronic respiratory insufficiencies and ventilator commitments in I.C.U.
- Critical Care Anaesthesiolgy and Trauma Care Unit management.
9. Different methods of anaesthetic Techniques.
- Regional anaesthesia including spinal, epidural and caudal etc.
- Local Anaesthesia including nerve blocks.
- Difficult airway
- Anaesthesia in abnormal environments like high attitude anaesthesia etc.
- Complication in Anaesthesiolgy and their management both per and post operatively.
- Anaesthesia for day care surgery.
- Anaesthesia for diagnostic procedures like endoscpy, C.T. Scan, M.R.I. etc.
10. Informed consent/ medicolegal issues : understanding the implications of acts of omission and commission in practice. Issues regarding consumer protection. Implications in medicolegal cases.
11. Communication skill with colleagues, teachers, patients and patients relatives.
12. Principles of Anaesthesia audit understanding the audit process and outcome; methods adopted for the same.
13. Essentials of Research metholdology :
i. Basics of Biostatistics and its application.
ii. Ability to undertake clinical and basic research.
iii. Ability to publish results of one’s work.
- Principles of Evidence Based Medicine and its application in anaesthetic practice.
- Medical Ethics/social responsibilities of the anaesthesiologists.
- Record keeping : Ability to keep records as scientifically as possible; knowledge of computers is beneficial.
B-2 Essential Skills : Technical skills to be acquired :
The list within the tables indicates the procedures that the students should by the end of the course, be able to perform independently (PI) by himself / herself, should have should have observed ( O ) or during the course.
Skills may be considered under the following headings :
- Basic Graduate skills.
- Anaesthesia Procedures.
- Critical Care Procedures.
- Emergency Room Procedures.
- Pain Alleviation Procedures.
Basic Graduate Skills :
The student should have acquired the certain skill using his under graduation and internship. Their skills have to be reinforced at the beginning of the training period. This include ;
Procedure
Insertion of I.V. lines PI
Insertion of Nasogastric Tubes PI
Monitoring and recording of vital signs PI
C Teaching and learning activities :
A candidate pursuing the course should work in the institution as full time student. Every student shall attend teaching and learning activities during each year as prescribed by the department and will not remain absent from work without valid reasons.
A list of teaching and learning activities to acquire essential knowledge and skills is given below.
1. Lectures : Diadectic lectures are to be kept to a minimum. They may, however, be
employed for teaching certain topics. Lectures may be didactic or
integrated.
a) Didactic Recommended for selected common topics for postgraduate
students of all specialities. Few topics are suggested as examples :
- Bio-statistics.
- Research Methods
- Medical code of Conduct and Medical Ethics.
- Communication skills etc.
- Initial introductory lecture about the subject.
These topics may preferably taken up in the first few weeks of the 1st year.
- Integrated Lectures : These are recommended to be taken by
multidisciplinary teams for selected topics, e.g. Jaundice, Diabetes
Mellitus, Thyroid, Fluid therapy, Acid-base balance, shock etc.
2. Journal Club: Once a week. All the PG students are
expected to attend and actively participate in discussion and enter in the
logbook the relevant details. Further, every candidate must make a
presentation from the allotted journal(s) of selected articles at least 10
presentations in three years.
- Subject Seminar: Recommended to be held once a month. All the PG students are expected to attend and actively participate in discussion and enter in the logbook relevant details. Further, every candidate must present on selected topics at least four times a year and a total of 12 seminar presentations in three years.
- Student Symposium: Recommended as an optional multi disciplinary programme.
- Postgraduate students should do ward rounds every day.
- For pre anaesthetic evaluation of the patients posted for operation.
- To do the post anaesthetic follow up of operated patients for alleviation of post-operative pain and for diagnosis and management of any post-operative complication.
6. Clinical Pathological conference: Recommended once a month for all postgraduate students.
Presentation be done by rotation and by the students who had conducted / assisted anaesthetic
management.
- Inter Departmental Meetings : Strongly recommended particularly with departments of
surgery & medicine at least once a month. These meetings should be attended by postgraduate students and relevant entries must be made in the Logbook.
- Teaching skills : Postgraduate students must teach Undergraduate students (e.g. Medical,
Nursing) by taking demonstration, bed side clinics, tutorials, lectures etc. Record of their participation should be kept in Logbook. Training of postgraduate students in Educational Technology is recommended.
9. Continuing Medical Education Programmes (CME) : At least 2 state / national
level CME programmes should be attended by each student in 3 year.
10. Conferences : Attending conferences is optional. However participation &
presentation of scientific paper should be encouraged.
Dissertation :
Every candidate pursuing MD degree course in Anaesthesiology is required to carry out work on a selected research project under the guidance of recognized postgraduate teacher. The results of such a work shall be submitted in the form of a dissertation.
The dissertation is aimed to train a postgraduate student in research methods and techniques. It includes identification of problem, formulation of a hypothesis, search and review of literature, getting acquainted with recent advances, designing of a research study, collection of data, critical analysis, comparison of results and drawing conclusions.
Every candidate shall submit to University in the prescribed proforma, a synopsis containing particulars of proposed dissertation work within six months from the date of commencement of the course on or before the dates notified by the University. The synopsis shall be sent through the proper channel.
Such synopsis will be reviewed and the dissertation topic will be registered by the University. No changes in the dissertation topic or guide shall be made without prior approval of the University.
The dissertation should be written under the following headings :
i. Introducation.
ii. Aims or objectives of study
iii. Review of Literature
iv. Material & LIterature
v. Results
vi. Discussion
vii. Conclusion
viii. Summary
ix. References
x. Tables
xi. Annexure
The written text of dissertation shall be not less than 50 pages and shall not exceed 150 pages excluding references, tables, questionnaires and other Checklists. It should be neatly typed in double line spacing on one side of paper (A4 size, 8.27” x 11.69”) and bound properly. Spiral binding should be avoided. The dissertation shall be certified by the guide, head of the department and head of the Institution.
Four copies of dissertation thus prepared shall be submitted to the University, six months before final examination on or before the dates notified by the University.
The dissertation shall be valued by examiners appointed by the University. Approval of dissertation work is an essential precondition for a candidate to appear in the University examination.
4. Year Wise Schedule :
First Year :
1. In the first year student should acquire the knowledge of basic sciences
related to Anaesthesiology like Anatomy, Physiology, Pharmacology etc.
2. Anaesthesia skills include :
- Pre anaesthesia evaluation / under supervision.
- Monitoring of patients through out perioperative period.
- Assisting setting up of Anaesthesia Machine, Monitor & Ventilator.
- Assisting the conduct of Anaesthesia for major surgeries; knowledge
about the complications of Anaesthesia
- Assisting for short anaesthesia initially and later on doing independently
under supervision.
- Conduct of Anaesthesia OPD.
- CPR training and mastering of BLS & ACLS.
3. Theoretical knowledge of different methods of anaesthesia & resuscitation.
4. Learning of communication skills.
5. Basic knowledge about Research Methodology, Medicolegal Aspects, etc.
Second Year :
1. Theoretical knowledge of allied subjects, subspecialities of Anaesthesia. Assisting senior anaesthesiologists in specialized branches like pediatric surgery, cardiothoracic surgery, critical care trauma etc.
2. Anaesthetic Skills : At the end of 2nd year the student should be capable of;
a) Anaesthetising patients without assistance but under supervision.
b) Indentifying the complication of anaesthesia and manage them
independently.
- Setting up of Anaesthesia Machine, monitor and ventilator
independently.
3. Conference & Workshops : Attending state level and national level
conference/CME and presentation of a scientific paper.
4. Dessertation : Carrying out of the dissertation study work, periodic
reviews, interaction with guide. Organisation of the data, writing up of the manuscript of dissertation at end of 2nd year.
5. The student should be actively involved in presentation of seminars,
journal clubs, case presentation/discussions.
Third Year :
1. The student should be well versed with basics, allied subjects and recent
advances in the respective fields.
2. Anaesthesia skills : At the end of the 3rd year the candidate should be able
to make independent decisions as regards to anaesthesia, pain management and post operative care of all kinds of patients.
3. Teaching Activities : final year student should take lead in conducting
seminars, journal clubs, case discussions, panel discussions with I & II year students. The third students should also involve in teaching undergraduate students specially bedside clinics.
4. Dissertation : The completed dissertation dissertation must be submitted
to the university, 6 months before the examination before the notified date.
Monitoring Progress of Studies :
It is essential to monitor the learning progress of each candidate through continuous appraisal and regular assessment.
The learning out comes to be assessed should include : (i) Personal attitudes, (ii) Acquisition of Knowledge, (iii) Clinical and operative skills, (iv) Teaching skills and (v) Dissertation.
i) Personal Attitudes. The essential items are :
-
-
- Caring attitudes
- Initiative
- Organisational ability
- Potential to cope with stressful situations and undertake responsibility
- Trust worthiness and reliablility
- To understand and communicate intelligibly with patients and others
- To behave in a manner which establishes professional relationships with patients and colleagues.
- Ability to work in team
- A critical enquiring approach to the acquisition of knowledge.
-
The methods used mainly consist of observation. It is appreciated that these items require a degree of subjective assessment by the guide, supervisors and peers.
ii) Acquisition of knowledge :
The methods used comprise of ‘Log Book’ which records participation in various teaching / learning activities by the students. The number of O.T. activities attended and the number in which presentations are made to be recorded. The log book should periodically be validated by the supervisors. Journal Review Meeting ( Journal Club ) : The ability to do literature search, in depth study, presentation skills, and use of audio-visual aids are to be assessed. Seminars / Symposia : The topics should be assigned to the student well in advance to facilitate in depth study, the ability to do literature search, in depth study, presentation skills and use of audio-visual aids are to be assessed.
Clinico-pathological conferences : This should be a multidisciplinary case study of an
interesting case to train the candidate to solve diagnosis and therapeutic problems by
using an analytical approach.
iii) Clinical Skills :
Day to Day work : Skills in outpatients and ward work should be assessed
periodically. The assessment should include the candidate’s sincerity and
punctuality, analytical ability and communication skills.
Clinical Meetings : Candidates should periodically present cases to his peers and
faculty members.
Clinical and Procedural skill : The candidate should be given graded
responsibility to enable learning by apprenticeship. The performance is assessed
by the guide by direct observation. Particulars are recorded by the student in the
log book.
iv) Teaching skills : Candidates should be encouraged to teach undergraduate
medical students and paramedical students, if any. This performance should be
based on assessment by the faculty members of the department and from feedback
from the undergraduate students.
v) Work diary / Log Book : Every candidate shall maintain a work diary and
record his/her participation in the training programmes conducted by the department such as journal reviews, seminars, etc. Special mention may be made of the presentations by the candidate as well as details of clinical procedures, if any conducted by the candidate.
vi) Periodic Tests : The departments may conduct three tests, two of them be annual tests, one at the end of first year and the other in second year. The third test may be held three months before the final examination. The tests may include written papers, practicals / clinicals and viva voce.
vii) Records : Records, log book and marks obtained in tests will be maintained by the Head of the Department.
Log Book
The log book is a record of the important activities of the candidates during his training, Internal assessment should be based on the evaluation of the log book. Collectively, log books are a tool for the evaluation of the training programme of the institution by external agencies. The record includes academic activities as well as the presentations and procedures carried out by the candidate.
B – 5 Training in Basic and allied specialities :
1. a. Anatomy : - Larynx, Trachea, Tracheobvronchial tree, Lung, Segments
- Heart, Pericardium, Coronary vessels
- Vertebral canal, Vertebra, Sacrum, Spinal Maniges, Spinal
nerves
- Neuromuscular function
- Brachial plexus, cervical plexus, coeliac plexus etc.
b. Physiology: - Respiratory system
- Cardio vascular system
- CSF circulation
- Neuromuscular transmission, Nerve conduction
- Renal system
- Coagulation
- Shock
- Neonate
- Pregnant patients etc.
c. Pharmacology of drugs used in anaesthesia and for the treatment of other
medical disorders.
d. Haematology : Blood transfusion, Haemoglobinopathies etc.
e. Immunology : Effect of anaesthetic agents, Intravenous fluids, Nutrition &
blood transfusion on immune system.
Immune response to trauma, stress and sepsis etc.
2. Students should be posted in ICU / ICCU / SICU and pain clinic during 2nd year of
training.
3. Training in other subspecialities include :
Cardiothoracic surgery
Paediatric surgery
Plastic surgery
Urology
Neurology
Cancer surgery
Oramaxillary surgery
Laparoscopic and Endoscopic surgery
Anaesthesia for investigation procedures like CT Scan, Myelogeaphy etc.
NOTE: We send our P.G. students to U.N. Mehta institute of cardiology and research centre for their exposure in cardiothoracic surgery for a duration of 15 days.