The Tamil Nadu Dr. M.G.R. Medical University Courses

M.D. (General Medicine)

Annexures :

I. Titles to be included in theory for MD General Medicine Part-II

II. Titles for orientation programme for all PG students in the beginning of their PG course on various aspects for a period of one month.

III. Formative assessment of PG medical students

IV. Model forms –

[a] Assessment card,

[b] Dissertation: review of activities [for three years PG]

[c] Academic programme for clinical PGs and

[d] Technical procedure for MD General Medicine PG.

Detail of Annexures:

Annexure : I

 Titles to be included in theory for MD General Medicine Part - II examination.

No. Titles

• Climate change on Health and illness
• Environmental Medicine
• Occupational & Industrial Medicine
• Refuge and Prisoner Medicine
• Sexual Medicine
• Disaster Medicine
• Travel Medicine
• Adolescent Medicine
• Bioterrorism – medical aspects
• Palliative and terminal care
• Critical care and emergency medicine including toxicology
• Emerging infections, epidemics, endemics & pandemics
• Quality assurance in health care
• Legal and ethical aspects in medical care

Annexure: II.

Orientation Programme For All Post Graduate Medical Students

Organiser: Medical Education Department Of Respective Medical Colleges Under The Guidance Of The University

Period : 25 Days (15^th  June to 16^th  July Of Every Year)

1. Medical education unit of each medical college of all systems of medicine has to organize the programme under the supervision of Dean / Principal of the respective Medical Colleges (Modern Medicine / Dental / Other systems of medicine) under the guidance of the university

2. All PGs irrespective of the specialty and the systems of medicine have to undergo all the programme.

3. Each programme will commence with a pre test and complete with post test and the answers will be graded and entered into the PG students log book.

4. Each PG has to obtain at least 70 marks in each programme.

5. If any PG fails to attend any of the programme it will be entered as zero.

6. The Dean / Principal of the respective Medical College have to prepare the Teaching/Training module for their PG students and send a copy of the same to the university along with participants pre test and post test grade in the form of soft copy & hardcopy as their grade becomes part of the formative assessment.

7. For further clarification, the academic officer of the university may be contacted.

Humanities in medical education

No. Titles Duration in hrs

• Professional Matters 18
• Ethical aspects 6
• Patient related activities 18
• Social aspects 4
• Community works 2
• Administrative issues 12
• Critical analysis of medical documents 2
• Team work 6
• Duty register of PG students 2
• Legal aspects 6
• Pharmacovigilance programme 6
• Soft skill development 12
• Technical skills 6
• Medical Devices 4
• Blood Bank 12
• Monitoring & supervisory capacity 2
• Training on medical education 12
• Health Sciences Research 12
• Non-academic / Extra curricular activities 2

Area of Training For All Branches Of Post Graduate Medical Students

• 1. Professional Matters
  • Professionalism
  • Doctor – patient - society relationship
  • Doctor - Doctor relationship
  • Complementary and alternative medical practice
  • Sharing of responsibilities
  • Being a good doctor
  • Appointment and waiting time
  • Biomedical waste disposal
  • Hand wash
  • Universal Infection Control Practices (UICP)
  • Cleanliness of IP and OP section
  • Sanitation and water supply
  • Reporting of notifiable diseases
  • Participation in Hospital infection control policy
  • Confidentiality
  • Leadership skill
  • Health policy
  • Sterilization
• 2. Ethical Aspects
  • Ethics and ethical aspects in medical practice and research
  • Ethical aspects in prescription writing
  • Handling medical sales personnel / marketing
  • Ethical aspects of being a teacher / facilitator
  • Maintaining good clinical practice
  • Taking photography or using patients materials for teaching and academic purposes
  • Inclusion of patients / subjects for clinical trial / research
  • Respecting patients and care givers
• 3. Patient Related Activities
  • Assessment of patient on a holistic manner
  • Competency in BLS and ALS
  • Handling patients without care givers
  • Handling discharging destitute cases
  • Handling foreign nationals
  • Patient participation in decision making
  • Patient empowerment
  • Understanding the behaviour of patients
  • Providing information on Disease/Diagnostics/Drugs/Diet/Alternatives/Follow up
  • Referral and cross referral
  • Second consultation
  • Patient satisfaction
  • Quality of life
  • Quality of health care
  • Prescribing medicines / investigations - use / misuse / overuse
  • Prescription audit
  • Antibiotic policy for institution
  • Use of internet in patient care and decision making
  • Medical Errors
  • Incident reporting
  • Root cause analysis
  • Prevention of medical errors
  • Sharing observations
  • Introduction of innovative methods for patient safety
  • Understanding patient safety programme
  • Anticipating complications and untoward incidents (related to patients, professionals, societal, technical, etc.,)
  • Care of IV line/Ryle’s Tube/Catheters/ET Tube, etc.,
  • Care of back
  • Care of unconscious/comatosed cases
  • Issues related to prisoner/mentally disabled
  • I.V. cannulation
  • Extravasation
  • Preparing patients for
  • ECG
  • EEG
  • Ultra sonogram
  • Echo cardiogram
  • iopsy, FNAC, Endoscopy and invasive / therapeutic procedures
  • Other radiology & imaging tests
•  4. Social Aspects
  • Management of clinical problems in resource poor settings
  • Understanding socio-cultural issues of patients
  • Handling violence in clinical practice
  • Implementing national health policies
  • Social accountability
  • Meeting the Press and Media
  • Health economics
  • Pharmaco-economics
  • Preventive aspects and promotion aspects of health
• 5. Community Works
  • Participation in community outreach activities
  • Participation in community health programme
  • Understanding of disease dynamics in natural surrounding
  • Health checkup activities
  • Participation in National Health programmes
    • eg. RNTCP / HIV-AIDS / Malaria control and other communicable diseases
    • Non-communicable diseases (NCDs)
    • Integrated diseases surveillance programme (IDSP)
• 6. Administrative Issues
  • Medical records of inpatients and outpatients
  • Preparation of Discharge summary / report
  • Medical audit of medical records
  • Issue of medical certificates and intricacies (Medical leave, Fitness to return after medical leave, Driving license, Death certificate, computation of pension, for travel, judiciary etc.,)
  • Filling up the forms and declaration of death
  • Issue of certificate to differently abled persons
  • Welfare programmes to the sick, disabled and family of the deceased
  • Setting up of consultation clinic
  • Health management aspects
  • Medical insurance / reimbursement system
  • Medicaid / Medicare system
  • Quality assurance in health care
  • Preparing medical reports on demand from patients / judiciary, etc.,
  • Contributory aspects to strengthen health care system.
•  7. Critical Analysis of Documents (Elicit deficiencies / lacunae and identify remedial measures)
  • Medical records – IP & OP
  • Medical certificates
  • Discharge summary / reports
  • Medical reports
• 8. Team Work
  • Planning and management of cases
  • Interaction with colleagues
  • Interpretation to arrive at diagnosis towards evaluation and management
  • Elicitation of strength and weakness
  • Role and influence of sister specialties
•  9. Duty Register of Postgraduate Students
  • Number of cases / specimens attended
  • Nature of the problems
  • Number of cases attended in different wards / emergency rooms
  • Lessons learnt
  • Difficulties encountered
  • Missed aspects
  • Knowledge and skills gained
• 10. Legal Issues
  • Informed consent
  • Medical Negligence and the law
  • Legal aspects in medical practice
  • Depositing witness / expert opinion
  • Indian Medical Council regulations with latest amendments
  • Professional conduct
  • Advertisement
  • Hippocrates oath and other related matters
  • Human rights and health
  • Right to Information Act – 2005
  • Consumer protection act and judgments related to health
  • Regulations related to entry in Accident Register (AR)
  • Responsibilities towards Medico Legal Cases
  • Sending information to police
  • Discussion on regulations of hospital / dispensary, etc., act of the respective state
  • Documentation of dying declaration
  • Interaction of hospital establishment act
• 11. Pharmacovigilance Programme
  • Adverse drug reaction – Recognition, investigations, confirmation, classification, documentation, reporting, patient / family education, sharing with colleagues and others
  • Participation in drug information centre
• 12. Soft Skill Development
  • Attitude
  • Communication skills
  • Listening skills
  • Behaviour of Doctors – Verbal & Physical expressions
  • Breaking bad news
  • Leadership skills in health care team
  • Simulating models
  • Ability to work under pressure
•  13. Technical Skills
  • Ultra Sonogram of abdomen – During radiology postings for PGs (who are in General Medicine, Pediatrics, Surgery & Obstetrics and Gynecology) they aretaught to develop skill to recognize the pathology independently and interact with sonologist.
  • Echo cardiogram - To learn and acquire skills on trans thoracic echocardiogram (Skill to recognize the functional and pathological status and to make clinicaldecision towards treatment) during their postings (PGs of Medicine, Pediatrics) tocardiology
  • Preparing Drug Requirement
    • a) Prepare and monitor the supply of medicine towards their ward and toemergency room.
    • b) Prepare the indent and monitor the supply of the drugs and registeredmaterial to their ward / OP
  • Organization skills (Organization Expected from PG
  • Clinical society meeting
  • Departmental meeting
  • Special meeting
  • Inter / Intra institutional meeting
  • Other academic programmes
  • Community activities
  • Prepare Agenda
  • Discuss with participants
  • Confirm their participation
  • Inform others
  • Arrange for required materials
  • Take down notes
  • Edit minutes of meeting
  • Prepare proceedings
  • Circulate to others if required
• 14. Medical Devices
  • Basic lessons on electrical and electronic aspects
  • Medical equipments use and risks
  • Purchase and handling
  • Maintenance
  • Log book of medical devices
  • Recognizing deficiencies and errors
• 15. Blood Bank
  • Training
  • Donor selection
  • Cross matching
  • Reporting adverse reactions following transfusion
•  16. Monitoring & Supervisory Capacity
  • Guide to prepare and check drug tray, emergency trolley / resuscitation trolley
  • Verify records, register, statistics, etc.,
  • Verify availability of material for Advance Life Support (ALS)
  • Monitoring on facilities available in ambulance
  • Monitoring and training of health care staff attached to ambulance
• 17. Training On Medical Education
  • Exposure to teaching aids & utilization
  • Curriculum development
  • Microteaching
  • Objective structured clinical examination (OSCE)
  • Objective structured practical examination (OSPE)
  • Problem based learning
  • Activity based learning
  • Evidence based learning
  • Preparing various forms of questions for theory / written examination
  • Training on various forms of assessment
    • a) Formative
    • b) Summative
    • c) Video based assessment for skills
    • d) Simulating models
  • Being an examiner – role replay
  • Quality assurance in teaching
  • Cost consciousness & Cost containment
•  18. Health Sciences Research
  • Formulation of research questions, aims, need and significance of the study
  • Research methodology
  • Choosing research designs
  • Writing a research proposal / project
  • Sampling method / size / techniques
  • Data collection
  • Bio statistics
  • Preparing master chart and entry into computer
  • Data analysis and interpretation
  • Writing research reports / articles to medical hospitals
  • Reading journals and articles
  • Constructive criticisms of journals, articles and reports
  • Review of literature
  • Identification of lacunae
  • Selection of articles
  • Writing a review article
  • Correcting articles / reports – as a peer reviewer
  • Preparing abstract for conference
  • Preparing power point for presentation
  • Preparing poster presentation
  • Learning on various databases
    • Eg: Pub Med, Embase, Ind Med Etc., online journals, free websites
  • Use of computer and internet
  • Telemedicine
    
• 19. Non – Academic / Extra Curricular Activities
  • Orientation of PG students on entertainment, fine arts, sports, tourism, National days, NCC, NSS, Social work etc.,

Annexure :III

 Formative Assessment Of Postgraduate Medical Students:

MD. General Medicine.

• 1. The Professor and HOD of primary Speciality shall
  • a. Discuss with Chiefs of other Departments
  • b. Provide their expectations & pattern of training required and
  • c. Assessment models

so that other departments get oriented to PGs coming from different specialties.

• 2. PG may be informed about the departmental objectives, goals and vision. PG of primary speciality when posted to different specialties, he / she shall be informed about the realistic goals & skills expected from him / her during the period of posting by the respective department specialist.
• 3. The Professor and Head or in-charge Medical Officer of the respective speciality department to which a PG is posted for training – shall take utmost care to teach and train the PG students during the given time on essential matters and common illnesses or/and issues as well as related emergencies. They shall see that the PG
  • a) Has acquired sufficient knowledge and skills to attend to the needs of the patients.
  • b) Shall identify unusual/uncommon aspects of given cases and explain the features with literature support.
  • c) Shall discharge his/her duties with human concern in an empathetic manner.
  • d) Shall maintain patient safety aspects and necessary records without any lapses.
  • e) Shall recognize his/her limitations and refer the cases to concerned specialist without delay.
  • f) Shall participate in academic forum and share his/her observation in a scientific manner.
  • g) Shall understand his/her deficiencies/ lacunae and requirements, and improve his knowledge & skills.
  • h) Shall obtain 80% attendance to the speciality / department to which posted.
  • i) Shall be assessed by the Chief in charge of the department / speciality for the knowledge gained and skills acquired by written, clinical and viva voce examination.
  • j) Shall get a minimum of 70% in his/her theory and viva and other skills.
• 4. Accordingly the Assistant Professor and the Professor / Unit Chief / Chief in charge of the department have to assess the PG on the last day of posting to their department for different skills.
• 5. The Chief in charge of the respective speciality shall conduct theory (written), clinical and viva voce examination along with the help of one more colleague of their Speciality or allied Speciality and award marks.
• 6. The Professor and HOD of the primary Speciality has to coordinate with Chief of other specialties / departments and solve issues if any controversies/conflicts arises.
• 7. The Professor and HOD of the primary Speciality shall enter the attendance and marks acquired by the PG in the PGs electronic log book maintained by the University within a week after receiving the report from other department or Speciality and sign in the log book (hard copy) of the PG.
• 8. The Chief of the Primary Speciality shall assess the essential / desirable knowledge acquired by the PGs during their posting on monthly basis by conducting written, clinical and viva voce examination, and assess various skills, and award marks which shall be entered under different Title or sub-title as per the university on line records with necessary entries in the individual log book [hard copy].
• 9. The PG shall be informed on the deficiencies / lacunae on completion of the respective sub speciality posting / assessment in his / her primary speciality, and given an opportunity to rectify his / her deficiencies / lacunae.
• 10.The theory mark acquired by him / her in the formation assessment along with viva voce and it shall be a minimum of 70% in any one assessment made in the tests conducted by primary speciality as well as assessment made by other specialties / departments where PG has been posted.
• 11. The marks acquired by PG in different postings shall be entered in the final mark list of the candidates.
• 12. Every Assistant Professor, Chief of Specialties / Associate Professor / Professor & HOD shall train the PGs on all aspects required to them through various methods such as activity based learning, problem based training and evidence based learning methods or simulating models etc., as the case may be .
• 13. Each PG shall be allowed to teach and train undergraduate students on theory, clinical aspects, laboratory investigation reports, preparing patients for various procedures including medical / surgical / rehabilitative treatment and discharge plan which shall be monitored by the Assistant Professor and rectified if any deficiency hasbeen observed .
  

Model Forms

Annexure - IV.

• [A] Assessment Card of The Postgraduate Student
  • Name of the Department assessing the candidate and the name of the College and address where PG has undergone the training:
  • Address for communication –
    • Email ID:
    • Telephone Number (STD):
    • Postal address:
  • Name of the primary Speciality of the :
    • PG and Email ID
  • Name of the College to which PG belongs to
  • Name of the PG with expended initials:-
  • University Number  D M Yr.
    • Period of posting : From --------------------
    • To ---------------------
  •  Department No. and Date of assessment: No. Skills acquired Marks [Maximum 100]
    • Theoretical knowledge to discuss the case during clinical rounds
    • Writing case record [IP / OP / discharge summary or medical report]
    • Ability to make working diagnosis
    • Decision making skills
    • Ordering investigation and abilities to interpret the data
    • Ability to provide management plan and substantiate with reasons
    • Ability to prescribe diet and drugs, and convince patients for adherence
    • Maintenance of records
    • Humanistic approach
    • Team work
    • Teaching abilities
    • Academic contributions
    • Attending to the calls and making appropriate action
    • 14. Any other remarks
    • Speciality seal
    • Name and signature of the Name & signature of the Unit Chief / Chief i/c Assistant Professor
  • Overall marks of the post-graduate student
    • Number Category Marks
    • obtained
  • Maximum
    • Theory
    • Clinical/practical
    • Viva voce
    • Marls for the skills
  • Signature of the HOD Signature Name and signature of
  • of the Primary speciality of the candidate Chief/Chief i/c with date
  • with date with date and seal
  • Date of entry into university online record-------------------------

Annexure –IV

[B] Dissertation: review of activities [for 3 years PG]

No Activities Time Frame for 3 years PG [from admission]

Signature of the Guide/ Supervisor

I. Planning & Approval

• Collection of literature
• Critical review of literature
• Selecting title for dissertation with alternatives
• Interaction with collaborating Department[s] if required with finalization of the title.
• Preparation of research protocol & Proforma
• Approval from institutional ethical committee [IEC]
  • 3rd month
  • 4th month
  • 5th month
  • 6th month

II. Data / sample collection

• • Collection of cases / data and entry into Master chart
• • Brief consolidation, analysis and interpretation Every month for 12 consecutive months
• • Writing “literature review” and other aspects Every month for 12 consecutive months
• • Preparation of brief paper/article for an index Journal/conference 19th & 20^th month

III. • Master chart preparation, line listing, consolidation

21st month

• • Analysis, interpretation 22nd & 23^rd month

IV. • Discussion / correction / revision 24th & 25^th month

V. • Rewriting, finalization 26th month

VI. • Submission to University 27th month

Annexure IV

[C] Academic Programme For Clinical Postgraduates 

Frequency Programme Activities Remarks/signature of Chief / Asst.Prof Daily

• Department/unit meeting with Chief & Assistant Professor(s), SRs, other PGs/JR and CRRI and with or without HOD
• Clinical rounds
• Clinical demonstration
• Discussion on PG duty report
• Case presentation
• Demonstration of findings
• Explanation for symptoms/signs
• Plan for investigations
• Interpretation of laboratory reports / radiology & imaging reports
• Ability to prescribe drugs, fluids and diet
• Prescription audit
• Medical record / discharge
• Recognition, prevention and care of bedsores, catheter, IV access, Ryle’s Tube, ET Tube and ICD ube.Weekly
• Physician / Department meeting / conference
• Grand rounds with all members of unit
• Statistics
• Theory class for MBBS students
• All the above components but with evidences from literature for discussion and interaction.
• Submission of weekly statistics of each unit.
• Participation & assessment of MBBS students. Fort Nightly
• Group activities
• Assessment of MBBS students
• Participation in student seminar
• Review of activities
• Review of assignments
• Learn to grade MBBS students performance Monthly
• Preparation of modules on selected topics.
• Dissertation review
• Clinco pathologyconference [CPC]
• General clinics

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

• Publication / presentation of papers
• Speciality clinics
• Department CME
• Journal club meet
• Internal audit
• Debates & discussion on topics such as-
  • Natural history of Illness/disease
  • Clinical aspects
  • Diagnostic areas
  • Therapeutic aspects
  • Prevention aspects
• Attendance
• Review of modules
• Review of written tests
• Review of ongoing research works.
• Review of lecture schedule for MBBS students.
• Submission of attendance from each department

Annexure IV

[d] Technical Procedures For M.D., General Medicine PG 

No. Technical Procedures Carried out Assisted Observed Remarks on skills & ability to interact & interpret

• I. Hematology
  • Peripheral smear – [preparation, staining & interpretation]
  • Bone marrow aspiration [transport, processing and interpretation]
• II. Respiratory System
  • Pulmonary function test
  • Use of Nebulizer for patients
  • Pleural aspiration
  • Insertion of intercostals tube [ICT]
  • Pleural biopsy
  • Fibrotic bronchoscopy
• III. Cardio Vascular
  • Pericardiocentesis
  • Temporary pacing
• IV. GIT
  • Naso-gastric tube insertion
  • Stomach wash for poisoning
  • Paracentesis abdominis
  • Peritoneal biopsy
  • Liver biopsy
  • Endoscopy
  • Rectal examination
  • Splenic puncture
  • Cholangiogram
  • o-splenovenogram
• V. Renal System
  • Renal biopsy
  • Insertion of catheter for-
    • A] Peritoneal dialysis
    • B] Hemodialysis
  • Care of catheter
  • Catheterization of bladder
  • Preparing AV fistula
  • Care of AV fistula
• VI • CNS Lumbar puncture, EEG, EMG, Muscle Biopsy, Nerve Biopsy
• VII Endocrine investigations
• VIII. OTHERS
  • Arterial puncture for ABG
  • Central venous catheter [insertion & care]
• IX. Specimen Collection For
  • A] Microbiology
  •  
    • Urine
    • Stool
    • Blood
    • Body fluids
    • Swabs – Throat, nasal, etc.,
  • B] Pathology
    • Body fluids
    • Smear
    • Specimen
  • C] Biochemistry [special investigation] – mention
    • Collection
    • Transportation
• X. Preparation of Patientsa.
  • Radiology & Imaging
    • X-rays—
    • Contrast studies
    • CT scan
    • MRI
      •  Radio-isotope studies
      •  Radiotherapy
      •   Invasive / Non invasive procedures