New Learning Outcomes of MMMC SEM 6&7 (B29 Onwards)

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)
LEARNING OUTCOMES
(Batch 29 Onwards)
CONTENTS
page
1.
DEPARTMENT OF ORTHOPAEDICS......4
1.1 Overall Learning Outcomes....5
1.2 Lecture Topics (Semester 6 & 7) ...7
1.3 Clinical Teaching (Semester 6 & 7). 43
1.4 Tutorial (Semester 6 & 7)..45
1.5 Problem Based Learning........56
1.6 Small Group Teaching...64
1.7 Self Directed Learning...69
1.8 Clinical Teaching (Semester 10).... 71
2.
DEPARTMENT OF COMMUNITY MEDICINE..73

2.1 Overall Learning Outcomes ...74
2.4 Clinical Posting (Semester 6 & 7): Evidence Based Public Health.103
2.6 Clinical Posting (Semester 6 & 7):Journal Critique Module.......104

2.7 Clinical Posting (Semester 6 & 7): Biostatistics..105
2.8 Problem Based Learning (Semester 6 & 7)...105
2.4 Clinical Posting (Semester 8 & 9)......106
2.9 Family Medicine (Senior Clerkship Semester 9 & 10)...107
3.
DEPARTMENT OF PAEDIATRICS....108
3.1 Overall Learning Outcomes .109
3.2 Lecture Topics (Semester 6 & 7)......110
3.3 Problem based Learning ..119
3.3 Clinical Teaching (Semester 8 & 9).... 122
3.4 Senior Clerkship (Semester 10)... 123
4.
DEPARTMENT OF ENT.......124
4.2 Lecture Topics (Semester 6 & 7)......126
4.4 Problem Based Learning.......143
5.
DEPARTMENT OF SURGERY....145
5.2 Learning Outcomes for Semester 6 & 7.......147
5.3 Learning Outcomes for Lecture Topics Semester 6 & 7..........148
5.4 Learning Outcomes for PBL Semester 6& 7159
5.5 Learning Outcomes for Skills Lab & SDL Semester 6 & 7.160
5.6 4 Learning Outcomes for Clinical Teaching Semester 6 & 7..162
5.7 Learning Outcomes (Semester 8 & 9)..164
5.8 Clinical Learning Outcomes (Semester 10).....165
6.
DEPARTMENT OF OBSTETRICS & GYNAECOLOGY...167

6.2 Lecture Topics (Semester 6, 7)........170
6.3 Clinical Teaching (semester 6 & 7)......198
6.4 Semester 8 & 9 Clinical Teaching and senior clerkship (Semester 10)204
6.5 Learning Outcomes for senior clerkship (Semester 10)...213

7.
DEPARTMENT OF PSYCHIATRY......217
7.1 Lecture Topics (Semester 6, 7).........218
7.2 Clinical Teaching (Semester 6,7).....224
7.3 Clinical Teaching (Semester 8, 9)........225
7.4 Clinical Teaching (Semester 10).......226
8.
DEPARTMENT OF MEDICINE........229
8.1 Overall Learning Outcomes..230
8.2 Lecture Topics (Semester 6, 7).....234
8.3 Clinical Teaching (Semester 6 & 7).........266
8.4 Clinical Teaching (Semester 8 & 9).276
8.5 Problem Based Learning..287
8.6 e-Learning ...298
8.7 Senior Clerkship. .....299
9.
DEPARTMENT OF OPTHALMOLOGY......305
9.1 Overall Learning Outcomes..308
9.2 Lecture Topics (Semester 6 & 7) .........306
9.4 Problem Based Learning ......319
9.5 Operation Theatre learning Outcomes.321
10.
ACCIDENT & EMERGENCY........322

10.1 Learning Outcomes....323
10.2 Developing skills...........324
10.3 Summary............326
11.
PATIENT SAFETY..........327
11.1 Learning Outcomes....328
Learning Outcomes
Overall objectives in terms of expected knowledge, skills and behavior of

Students (Orthopaedics)
Knowledge
At the end of the course, the student shall:
o Have
sound
knowledge
of the principles in recognition and
immediate
management of Orthopaedic emergencies (fractures and dislocations).

o Identify common congenital skeletal anomalies, infections of bones and joints;
common
metabolic bone diseases and neoplasms affecting bones.
o Be conversant with appropriate investigations and ability to interpret them and

institute initial care to these patients.
Skills
At the end of the course, the student shall be able to:
o Apply clinical skills (history taking, clinical examination) to diagnose common
Orthopaedic conditions
o Provide for immediate care (first aid) in acute conditions and be able to manage
simple conditions like sprains, strains and uncomplicated fractures.
o Shall know the principles in application of plaster and tractions and be able to
splint fractures appropriately, manage common bone infections, and know the
indications for amputations and corrective measures for bone deformities.
o Advise appropriate aspects of rehabilitation wherever necessary.
o View the patient as a whole and advise appropriate treatment/referrals.
Attitudes
At the end of the course, the student shall:
o Have the right attitude and commitment to deliver the best possible care for
his/her patients.
o View the patient with a holistic approach.
o Maintain confidentiality in the conduct of clinical examination and documentation

of diagnosis of patients.
o Uphold the principles of ethical conduct in all his/her dealings with the patients.
o Develop a caring attitude towards the patients and their families and function as a
compassionate physician.
Integration
At the end of the course, the student shall be able to integrate:
o With the community and society as a whole and be able to communicate freely
and effectively with the patients, families, health care professionals and public
regarding the nature, course, consequences and prevention of disease process.
-------------------------------------------------------------- ----------------------------------------------
Melaka-Manipal Medical College, Melaka

Department of Orthopaedics
PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: TRAUMA: Fractures and general principles in fracture management
DAY / DATE : As per schedule

VENUE
DURATION: (3 Hours)
: Lecture hall
LECTURER : MMMC faculty
1. AIM / GOAL
Understanding the basics of a fracture, types / classification, mechanism of injury,
clinical features, principles in its union and management and complications of
fractures.
2. LEARNING OBJECTIVES
Should be able to identify or suspect a fracture and its type with the clinical history
and be able to initiate its management with the understanding of the basic principles.
3. CONTENTS
Definition of fracture, mechanism of injury, classification and types, healing of a
fracture, principles in its management, complications of fracture
4. TEACHING METHODS: Didactic lecture
5. REFERENCES
a)
b)
c)
d)
Apleys System of Orthopaedics and Fractures

Book of Orthopaedics and Traumatology: M Natarajan & Mayilvahanan Natarajan
Essential Orthopaedics : J. Maheshwari
Clinical Oriented Anatomy: Keith Moore and Arthur Dalley

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: TRAUMA: Stress fracture, pathological fracture, compartmental syndrome

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the definition, mechanism of injury and cause of stress and
pathological fractures. Understanding the definition, causes, clinical features and after
effects of compartmental syndrome as a complication of fractures
Be able to identify or suspect a pathological fracture or stress fracture in a patient
Have an understanding of compartmental syndrome and identify it early.
3. CONTENTS
Definition of stress and pathological fractures, causes for these fractures,
investigations and management. Definition, causes, cardinal clinical features, effects
on tissues, investigations and management of compartmental syndrome. After effects
of compartmental syndrome : Ischemic contractures, types and principles in
management.
5. REFERENCES
a) Apleys System of Orthopaedics and Fractures
b) Book of Orthopaedics and Traumatology: M Natarajan & Mayilvahanan Natarajan

c) Essential Orthopaedics : J. Maheshwari
d) Clinical Oriented Anatomy: Keith Moore and Arthur Dalley
PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: TRAUMA : Open fractures

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the basics of open fractures, its definition, classification and principles
in management.
Be able to identify or suspect an open fracture in a patient and initiate care and
treatment with the understanding of the principles in its management
3. CONTENTS
Definition, classification, initial care of the wound, investigations of importance,
procedure in debridement of wounds and methods in stabilization of bone, after care
of the wound and complications of open fractures.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: TRAUMA : Upper limb fractures and dislocations:

Fracture of Clavicle and anterior shoulder dislocation (acute and chronic)

VENUE
DURATION: (2 Hours)
: Lecture hall
1. AIM / GOAL
Understanding the basics of clavicular fractures, displacements at the site,
investigations and principles in its management.
Gain knowledge on the definition, types, mechanism of injury, clinical features,
investigation and principles in the management of acute and chronic anterior
dislocation of shoulder
Be able to identify or suspect clavicular fracture and acute and chronic anterior
dislocation of the shoulder in a patient and initiate care and treatment with the
understanding of the principles in its management
3. CONTENTS
Relevant anatomy, mechanism of injury, clinical features, investigations,
complications and principles in management of clavicular fractures
Definition of dislocation, relevant anatomy, types, mechanism of injury, cardinal
clinical features, investigations, methods of reduction, and after care. Complications
of acute dislocation and causes and principles in management of chronic dislocation
5. REFERENCES
10


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC

Fracture shaft and supracondylar fractures of humerus

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
(a) Understanding the displacements at the site, causes for displacement,
investigations and principles in its management and complications of the fracture
(b) Definition, types, mechanism of injury, clinical features, investigation and
principles in the management acute and complications of supracondylar fracture
Be able to identify fractures of the shaft and supracondylar fractures of the humerus
in a patient and initiate care and treatment with the understanding of the principles in
its management
3. CONTENTS
complications and principles in management of fractures of the shaft of the humerus
Definition of supracondylar fractures, relevant anatomy, types, mechanism of injury,
cardinal clinical features, investigations, methods of fixation, complications and
principles in management.
11
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC

Fracture of both bones of the forearm, Fractures around the wrist & hand

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the concepts in fracture in a two bone situation, special types of
fracturedislocations, investigations and principles in its management.
Gain knowledge on the definition, types, mechanism of injury, clinical features,
investigation and principles in the management of fractures around the wrist and hand
Be able to identify or suspect fracture both bones of the forearm or other fractures and
fracture dislocations therein and those around the wrist and be able to investigate
them and initiate or plan management.
3. CONTENTS
complications and principles in management of both bones of the forearm, Monteggia
and Galeazzi fracture-dislocation.
Definition , relevant anatomy, types, mechanism of injury, cardinal clinical features,
investigations and treatment and complication of Colles, Smiths and Bartons
fracture, scaphoid fracture and Bennet fracture dislocation.
12

5.
a)
b)
c)
d)
REFERENCES

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: TRAUMA : Vertebral fractures and dislocations, spinal cord injuries

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the basics of vertebral fractures and dislocation and associated spinal
cord injuries and the principles in its management.
Be able to identify or suspect vertebral fractures and dislocations in a patient and
initiate care and treatment with the understanding of the principles in its management
3. CONTENTS
Relevant anatomy, mechanism of injury, classifications, clinical features,
investigations, complications and principles in management of vertebral injuries and
spinal cord damage and complications thereof.
13
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: TRAUMA: Pelvic fractures:Fracture of pelvic ring, sacrum& acetabulum

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the basics of pelvic, sacral and acetabular fractures, investigations and
principles in its management.
3.
Be able to identify or suspect pelvic fractures and sacral and acetabular injuries in a
patient and initiate care and treatment with the understanding of the principles in its
management
3. CONTENTS
14
Relevant anatomy, mechanism of injury, classification,clinical features,

investigations, complications and principles in management of pelvic fractures. Brief
account of sacral and acetabular in juries.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: TRAUMA : Lower limb fractures and dislocations:

Fracture of neck of the femur and inter trochantric fractures

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the basics of fractures of the neck of the femur and inter trochantric
fractures, displacements at the site, investigations and principles in its management
and complications of this fracture.
Be able to identify or suspect fractures of the neck of the femur and inter trochantric
fractures in a patient and initiate care and treatment with the understanding of the
principles in its management and complications
15
3. CONTENTS
Relevant anatomy, mechanism of injury, clinical features, classification,
investigations, complications and principles in management of fractures of the neck
of the femur and inter trochantric fractures and their complications.
5. REFERENCES
a)
b)
c)
d)
Aleys System of Orthopaedics and Fractures


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC

Dislocations of the hip and fracture of shaft of the femur

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the basics of hip dislocations, types, and principles in its identification
and management as also that of fractures of the shaft of the femur, the displacements
at the site, investigations and principles in its management.
16
Be able to identify or suspect dislocation of the hip and fractures of the shaft of the
femur in a patient and initiate care and treatment with the understanding of the
3. CONTENTS
Relevant anatomy, classification, mechanism of injury, clinical features,
investigations, complications and principles in management of dislocations of the hip
Fractures of the shaft of the femur: relevant anatomy, types, mechanism of injury,
clinical features, investigations and principles in management.
5. REFERENCES
a)
b)
c)
d)

Book of Orthopaedics and Traumatology: M Natarajan & Mayilvahana n Natarajan

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC

Ligament injuries: knee : Collaterals, Meniscii, ACL and PCL

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the basics of common ligament injuries around the knee and the
meniscus, the methods in clinical and other investigations and principles in its
management.
17
Be able to identify or suspect injuries to the ligaments in and around the knee in a
patient and initiate care and treatment with the understanding of the principles in its
management
3. CONTENTS
Relevant anatomy, mechanism of injury, clinical features and tests, investigations,
complications and principles in management of injuries to the ligaments in and
around the knee and the meniscus.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC

Fracture of Patella and Fractures of the tibia and fibula

VENUE
DURATION: (1 Hour)
: Lecture hall

_______________________________________________________________________
1. AIM / GOAL
18
Understanding the basics of fractures of the patella, its clinical features, investigations
and principles in its management.
Gain knowledge on basics of fracture of the tibia and fibula at different levels, types,
mechanism of injury, clinical features, investigation and principles in the
management
Be able to identify or suspect patella, tibia and fibula fractures in a patient and initiate
care and treatment with the understanding of the principles in its management
3. CONTENTS
Relevant anatomy, classification, mechanism of injury, clinical features,
investigations, complications and principles in management of fractures of the patella,
tibia and fibula and complications thereof.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC

Ankle injuries and some fractures of the foot

VENUE
DURATION: (2 Hours)
: Lecture hall
19
1. AIM / GOAL
Understanding the basics of injuries to the ankle, types of injuries, investigations and
principles in its management.Gain knowledge on some fractures and fracturedislocations of the foot ( Talar fractures, Lisfrancs and Choparts fracture
dislocations, Jones fracture, March fracture), mechanism of injury, clinical features,
investigation and principles in the management.
Be able to identify or suspect ligament and bony in juries around the ankle as also
fractures and fracture-dislocations in the foot in a patient and initiate care and
3. CONTENTS
Relevant anatomy, classification,mechanism of injury, clinical features,
investigations, complications and principles in management of injuries around the
ankle and foot.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: TRAUMA : Nerve injuries
DURATION: (1 Hour)
20
VENUE
: Lecture hall
1. AIM / GOAL
Understanding the basics of injuries to nerves, investigations modalities and
Gain knowledge on tendon injuries in general and principles in its management
Be able to identify or suspect injuries to nerves in a patient and initiate care and
3. CONTENTS
Relevant anatomy of the structure of a nerve, types of nerves, classification, clinical
features in general, investigations, complications and principles in management of
nerve injuries.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Congenital Anomalies:
21
Congenital Talipes Equinus Varus

VENUE
DURATION: (1 hour)
: Lecture hall
1. AIM / GOAL
Understanding the etiology, deformities, types, pathology, clinical features,
investigations and principles in management of congenital talipes equino varus.
Be able to identify or suspect CTEV in a child and initiate care and treatment with the
3. CONTENTS
Definition, etiology, deformities, types, pathology, clinical features, investigations
and principles in management of congenital talipes equino varus in different age
groups.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
22
TOPIC
: COLD ORTHOPAEDICS: Congenital Anomalies:

Developmental dysplasia of the Hip (DDH)

VENUE
DURATION: (1 hour)
: Lecture hall
1. AIM / GOAL
Understanding the incidence, etiology, pathology, clinical features and tests,
investigations and principles in management of developmental dysplasia of the hip.
Be able to identify or suspect DDH in a child and initiate care and treatment with the
3. CONTENTS
Definition, etiology, pathology, clinical features and tests in identification,
investigations and principles in management of developmental dysplasia of the hip in
different age groups.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
23
TOPIC
: COLD ORTHOPAEDICS: Metabolic diseases : Rickets and Osteomalacia

VENUE
DURATION: (1/2 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the etiology, types, pathology, clinical features, investigations and
principles in management of rickets and osteomalacia.
Be able to identify or suspect this condition in a child and initiate care and treatment
with the understanding of the principles in its management
3. CONTENTS
and principles in management of rickets and osteomalacia
5. REFERENCES
a)
b)
c)
d)

24

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Orthopaedic Radiology
DAY / DATE :As per schedule

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Introduction to various radiological investigative modalities available and used in
Orthopaedic practice.
Be able to think of the appropriate investigative radiological tool that may help
diagnose or confirm diagnosis in a given patient.
3. CONTENTS
Aspects of Orthopaedic radiology, the method in reading an X-ray to help diagnose
Orthopaedic conditions. Understanding types of bony lesions commonly seen.
Introduction to additional methods like CT scan, MRI, myelogram, sinogram,
arthrogram and Isotope bone scan.
5. REFERENCES
a)
b)
c)
d)

25

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Gait

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding normal gait in a person and some abnormal gaits seen in Orthopaedic
parctice.
Be able to identify or suspect a given pathology in a patient by understanding the gait
presented by the patient and help initiate care and treatment with the understanding of
the likely disease process.
3. CONTENTS
Definition, normal gait, phases in a gait cycle, analyzing gait in a patient and certain
abnormal gaits.
5. REFERENCES
a)
b)
c)
d)

26

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Neurological conditions:

Cerebral Palsy and Poliomyelitis

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the definition, causes, classification, deformities, clinical features and
principles in management of cerebral palsy and poliomyelitis.
Be able to identify these conditions in a child and initiate care and treatment with the
3. CONTENTS
Definition, etiology, deformities and their causes, types, pathology, clinical features,
and principles in management of cerebral palsy and poliomyelitis.
5. REFERENCES
a)
b)
c)
d)

27

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Deformities:

Axial (kyphosis, scoliosis, torticolis) and appendicular (cubitus and genu
varus and valgus and Genu recurvatum) skeleton

VENUE
DURATION: (1 Hour)
: Class room
1. AIM / GOAL
Understanding the definition, etiology, pathology, clinical features, investigations and
principles in management of deformities of the axial and appendicular skeleton.
Be able to identify deformities and suspect possible causes in a patient and initiate
3. CONTENTS
Definition, etiology, types, pathology, clinical features, investigations and principles
in management of deformities of the axial and appendicular skeleton.
4. TEACHING METHODS: Small group teaching
5. REFERENCES
a)
b)
c)
d)

28

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Infection: Diabetic foot

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the etiology, clinical features, deformities, diabetic ulcers,
investigations and principles in management of diabetic foot.
Be able to identify Orthopaedic complications of diabetes in a patient and initiate care
and treatment with the understanding of the principles in its management
3. CONTENTS
Definition, etiology, pathology, clinical features, deformities, investigations and
principles in management and care of the diabetic foot.
5. REFERENCES
a)
b)
c)
d)

Book of Orthopaedics and Traumatology: M Natarajan & Mayilva hanan Natarajan
29

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Infection: Osteomyelitis and septic arthritis

VENUE
DURATION: (1.5 Hours)
: Lecture hall
1. AIM / GOAL
Understanding the etiology, types, pathology, pathogenesis, clinical features,
investigations, principles in management and complications of Osteomyelitis and
septic arthritis .
Be able to identify or suspect Osteomyelitis or septic arthritis in a patient and initiate
3. CONTENTS
Definition, etiology, types, pathology, pathogenesis, clinical features, differential
diagnosis, investigations, principles in management and complications of
Osteomyelitis and septic arthritis.
5. REFERENCES
a)
b)
c)
d)

30

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Soft tissue lesions I:

Tennis elbow, Carpal tunnel syndrome and trigger finger

VENUE
DURATION: (2 Hours)
: Lecture hall
1. AIM / GOAL
Understanding the etiology, pathology, clinical features and tests, investigations and
principles in management of certain common soft tissue lesions (Tennis elbow, carpal
tunnel syndrome and trigger finger).
Be able to identify or suspect these conditions in a patient and initiate care and
3. CONTENTS
Definition, etiology, types, pathology, clinical features and tests, investigations and
principles in management of Tennis elbow, carpal tunnel syndrome and trigger finger.
5. REFERENCES
a)
b)
c)
d)

31

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Soft tissue lesions II:

Periarthritis shoulder, supraspinatus tendonitis, deQuervains disease,
Plantar fascitis, Dupuytrens contracture

VENUE
DURATION: (2 Hours)
: Lecture hall
1. AIM / GOAL
Understanding the etiology, deformities, types, pathology, clinical features,
investigations and differential diagnosis and principles in management certain soft
tissue lesions seen in Orthopaedics practice.
3. CONTENTS
differential diagnosis and principles in management of Periarthritis shoulder,
supraspinatus tendonitis, deQuervains disease, Plantar fascitis and Dupuytrens
contracture
5. REFERENCES
32


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Infections: Tuberculosis spine & paraplegia

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the etiology, common sites, types, pathology, clinical features,
investigations differential diagnosis and principles in management of tuberculosis of
the spine and Potts paraplegia.
Be able to identify or suspect this condition in a patient and initiate care and treatment
3. CONTENTS
Etiology, common sites, types, pathology, clinical features, investigations, differential
diagnosis and principles in management of tuberculosis of the spine and Potts
paraplegia.
5. REFERENCES
33


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Infections: Tuberculous arthritis

VENUE
: Lecture hall
1. AIM / GOAL
Understanding the incidence, risk factors, types, stages, pathology, clinical features,
investigations differential diagnosis and principles in management of tuberculous
arthritis / tuberculosis of the hip joint.
3. CONTENTS
Incidence, etiology, types, stages, pathology, clinical features, investigations,
differential diagnosis and principles in management of tuberculous arthritis /
tuberculosis of the hip joint.
34
5.
REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Backache: IVDP and spondylolisthesis

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the incidence, risk factors, causes, stages, pathology, clinical features,
investigations differential diagnosis and principles in management of IVDP and
spondylolisthesis.
3. CONTENTS
Incidence, risk factors, etiology, types, causes, stages, pathology, clinical features,
investigations, differential diagnosis and principles in management of tuberculous
arthritis / tuberculosis of the hip joint.
35

5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Bone tumors I:

Benign : Ostoid osteoma, Osteochondroma, Enchondroma,simple bone
cyst, Aneurysmal bone cyst and Giant cell tomor

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the classification, common investigations, staging, and method of
treatment of bone tumors in general and specifically regarding Ostoid osteoma,
Osteochondroma, Enchondroma,simple bone cyst, Aneurysmal bone cyst and Giant
cell tomor
36
3. CONTENTS
Classification, types, investigations, staging, and method of treatment of bone tumors
in general and specific information regarding Ostoid osteoma, Osteochondroma,
Enchondroma,simple bone cyst, Aneurysmal bone cyst and Giant cell tomor
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Bone tumors II:

Malignant : Osteosarcoma, Chondrosarcoma, Ewings sarcoma and
Multiple myeloma

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the classification, types, clinical features, investigations, staging, and
method of treatment of Osteosarcoma, Chondrosarcoma, Ewings sarcoma and
Multiple myeloma.
37
3. CONTENTS
Classification, common investigations, staging, and method of treatment of bone
tumors in general and specific information regarding Osteosarcoma,
Chondrosarcoma, Ewings sarcoma and Multiple myeloma.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Degenerative: Osteoarthrosis

VENUE
DURATION: (1 Hour)
: Lecture hall
1. AIM / GOAL
Understanding the etiology, types, pathology, clinical features, investigations,
differential diagnosis and principles in management of Osteoarthosis.
3. CONTENTS
38
Definition, etiology, types, pathology, clinical features, investigations, differential

diagnosis and principles in management of Osteoarthosis.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Metabolic: Gout

VENUE
: Lecture hall
1. AIM / GOAL
Understanding the etiology, types, pathology, clinical features, investigations,
differential diagnosis and principles in management of Gout.
39
3. CONTENTS
Definition, etiology, types, pathology, clinical features, investigations and principles
in management of Gout.
5. REFERENCES
a)
b)
c)
d)


PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Avascular necrosis

VENUE
: Lecture hall
1. AIM / GOAL
Understanding the definition, etiology, susceptible sites, pathogenesis, pathology,
clinical features, investigations and principles in management of Avascular necrosis
of the bone.
40
3. CONTENTS
Definition, etiology, susceptible sites, pathogenesis, pathology, clinical features,
investigations, radiology (staging) and principles in management of Avascular
necrosis of the bone.
5. REFERENCES
a)
b)
c)
d)

Book of Orthopaedics and Traumatology: M Natarajan & Mayilvaha nan Natarajan

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: COLD ORTHOPAEDICS: Avascular necrosis: Perthes disease

VENUE
: Lecture hall
1. AIM / GOAL
Understanding the definition, etiology, pathogenesis, pathology, clinical features,
investigations and principles in management of Perthes disease.
41
3. CONTENTS
Definition, etiology, pathogenesis, pathology, clinical features, investigations,
radiology (staging/grading) and principles in management of Perthes disease.
5. REFERENCES
a)
b)
c)
d)

42

Programme: M.B., B.S.

Semester: 6 & 7
Topic: Clinical Teaching
Aim/Goal:
To consolidate the ability to take basic History.
Ability to carry out a detailed physical examination, which includes eliciting important
physical signs.
To arrive at a reasonable Diagnosis/Differential Diagnosis.
Learning Objectives:
Thorough history taking.
Detailed clinical examination.
Reasoning out a Diagnosis.
Contents:
Patients with Orthopaedic injuries and disorders.
Learning areas:
Melaka & Muar Hospitals:
Orthopaedic Wards.
Orthopaedic Out-patient Department.
Operation Theatre.
A & E Department.
Physiotherapy & Occupational Therapy.
Teaching methods:
Bedside Clinical teaching.
Case presentation by students.
Demonstration of clinical signs & relevant discussion applied to Basic Sciences and
management by the Faculty.
References:
Clinical Orthopaedic Examination: Ronald McRae.
Clinical Examination is Surgery: SS Das.
Physical Examination in Orthopaedics: Lee Joon Kiong.
Clinical oriented Anatomy: Keith L Moore and Arthur F Dalley.
Essential Orthopaedics: J Maheshwari.
Orthopaedics & Traumatology: M Natarajan & Mayilvahanan Natarajan.
Tractions and Orthopaedic appliances: John D.M.Stewart & Jeffrey P.Hallett.
Assessment:
Clinical Anatomy and Basic Sciences Tests.
Clinical End-Posting test.
Project work
43
Basic Orthopaedics test (MCQs, Diagrams & short essays).

PBL marks.
Log book maintenance.
Mid-Semester & Sessional Examinations.
----------------------------------------------------------------
44

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Amputations

VENUE
DURATION: (1 Hour)
: Skill laboratory
1. AIM / GOAL
Basics of Amputation: types / classification, indications, levels of amputation in
upper / lower limb, steps in amputation and complications of amputations.
Should be able to identify the indications for an amputation. Identify the
complications when present and be able to initiate its management with the
understanding of the basic principles.
3. CONTENTS
Definition of amputation, classification and types, levels of amputation, steps of
amputation, definition of stump, ideal stump, management of stump and
complications of amputations.
4. TEACHING METHODS: Tutorial
5. REFERENCES
a)
b)
c)
d)

45

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Tourniquette

VENUE
DURATION: (1 Hour)
: Skill laboratory

________________________________________________________________________
1. AIM / GOAL
Understanding the basics of tourniqettes used in Trauma and orthopaedic surgery.
Should be able to know the different types of tourniqettes used in Orthopaedics
Surgery,method of appllying,indications and contraindications for its use.
3. CONTENTS
Tourniqette
4. TEACHING METHODS: Tutorial and demonstration
5. REFERENCES
a)
b)
c)
d)

Text Book of Orthopaedics and Traumatology: M Natarajan & Mayilvahanan Natarajan
46

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Prosthesis

VENUE
DURATION: (1 Hour)
: Skill laboratory
1. AIM / GOAL
Understanding the basics of a prosthetics, different types, parts of prosthesis and its
function in amputees.
Should be able to define,identify the different types of prosthesis and understand the
basic principles.
3. CONTENTS
Definition of prosthesis, its parts and different types of prosthesis.
5. REFERENCES
a)
b)
c)
d)

47

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Orthotics

VENUE
DURATION: (1 Hour)
: Skill laboratory
1. AIM / GOAL
Basics of Orthoses: types / classification, International terminologies used.
Should be able to define, identify different types of orthoses and know its indication
in different orthopaedic conditions.
3. CONTENTS
Definition of orthoses, International terminologies used, and types and indications for
orthoses
5. REFERENCES
a)
b)
c)
d)

48

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Implants and instruments

VENUE
DURATION: (1 Hour)
: Skill laboratory

________________________________________________________________________
1. AIM / GOAL
Understanding the basics of common implants and instruments used in Trauma and
orthopaedic surgery.
Should be able to identify basic implants and instruments and know its use in various
Orthopaedic surgeries.
3. CONTENTS
Implants and Instruments
5. REFERENCES
e) Clinical Oriented Anatomy: Keith Moore and Arthur Dalley
49

PROG
: M.B.B.S
SEMESTER : 8 & 9
TOPIC
: Tutorial: Orthopaedic Radiology

VENUE
DURATION: (1 Hour)
: Skill laboratory
1. AIM / GOAL
Reading an x-ray and understanding the basics of radiological features in various
Trauma and Orthopaedic conditions.
Should be able to identify the fractures of different long bones and also the
radiological features in different Orthopaedic conditions .
5. CONTENTS
Common Trauma and Orthopaedic x-rays
4. TEACHING METHODS: Demonstration
5. REFERENCES
a)
b)
c)
d)

50

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Splints and Tractions

VENUE
DURATION: (1 Hour)
: Skill laboratory

________________________________________________________________________
1. AIM / GOAL
Understanding the basics of common splints and tractions used in Trauma and
Orthopaedics.
Should be able to identify and also apply the common splints and tractions when
necessary in management of common Orthopaedics and Trauma conditions.
3. CONTENTS
Definition of splints and traction, types, its indications and complications.
5. REFERENCES
a)
b)
c)
d)

51

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Plaster of Paris

VENUE
DURATION: (1 Hour)
: Skill laboratory

________________________________________________________________________
1. AIM / GOAL
Understanding the basics of Plaster of Paris: Its indication, types, uses and
complications.
Should be able to apply and identify the complications of Plaster of Paris.
3. CONTENTS
Chemical composition of POP, types, its indications and complications.
5. REFERENCES
a)
b)
c)
d)

52

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Synovial fluid analysis

VENUE
DURATION: (1 Hour)
: Skill laboratory

________________________________________________________________________
1. AIM / GOAL
Understanding the basics of Synovial fluid: Its contents, normal values and
complications.
Should be able to identify the common pathological conditions by reading the
synovial fluid analysis report.
3. CONTENTS
Synovial fluid, its normal contents and normal values of synovial fluid analysis
5. REFERENCES
a)
b)
c)
d)

53

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Bone grafting

VENUE
DURATION: (1 Hour)
: Skill laboratory

________________________________________________________________________
1. AIM / GOAL
Understanding the basics of Bone grafting procedure: Definition,types,indications &
complications of bone grafting.
Should be able to learn the types of bone grafting & its indications in clinical field.
3. CONTENTS
Bone grafting : Definition,various types of bone grafting with their indications.
5. REFERENCES
54

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Tutorial: Internal and External fixation of fractures

VENUE
DURATION: (1 Hour)
: Skill laboratory

________________________________________________________________________
1. AIM / GOAL
Understanding the basics of principles of internal and external fixation: Its indication,
types, and complications.
Understanding types and indications of / for internal and external fixation used in
management of fractures
3. CONTENTS
Internal fixation: Plates, Screws, Intramedullary nails, K- wires, Stainless steel wires
definitive indication / relative indication and contraindication
External fixation: Types, Indications and Complications
5. REFERENCES
a)
b)
c)
d)

55

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: PBL: Development of bones and joints, Joints and its types

VENUE
DURATION: (1 Hour)
: Small group teaching room

________________________________________________________________________
1. AIM / GOAL
Discuss the development of and types of joints and highlight on important aspect in
each joint.
Correlate developmental and anatomical aspects to clinical conditions and understand
the basics of a given pathology.
3. CONTENTS
Definition of a joint, classification of joints and development of joints including spine
4. TEACHING METHODS: PBL
5. REFERENCES
a)
b)
c)
d)

Clinical Oriented Anatomy : Keith Moore and Arthur Dalley
56

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: PBL: Physiology and histology of bone

VENUE
DURATION: (1 Hour)

________________________________________________________________________
1. AIM / GOAL
Discuss the anatomy, histology and physiology of bone highlight on important aspect
of clinical importance.
Correlate anatomical and physiological aspects to clinical conditions and understand
the basics of a given pathology.
3. CONTENTS
Histology of a bone, physiology of a bone (regulation of bone minerals)
5. REFERENCES
a)
b)
c)
d)

57

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: PBL: Anatomy of the nerves of the upper and lower limb

VENUE
DURATION: (1 Hour)

________________________________________________________________________
1. AIM / GOAL
Understanding the anatomy of nerves of the upper and lower limb to better
understand the basics in nerve injury and identification of levels of nerve injury.
Applications of knowledge in anatomy of nerves of the upper and lower limb to better
understand the basics in nerve injury and identification of levels of nerve injury.
3. CONTENTS
Anatomy of nerves of the upper and lower limb. Nerve injury its types.
5. REFERENCES
a)
b)
c)
d)

58

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: PBL: Nerve injuries and its management(Clinical Scenarios)

VENUE
DURATION: (1 Hour)

________________________________________________________________________
1. AIM / GOAL
Understanding the basics of nerve injuries and its management.
Detecting levels and types of nerve injuries and planning management
3. CONTENTS
Nerve injuries, types of nerve injuries, investigation in the management of and
principles in the treatment of nerve injuries
5. REFERENCES
a)
b)
c)
d)

59

PROG
: M.B.B.S
SEMESTER : 8 & 9
TOPIC
: PBL: Metabolic bone diseases ( Rickets, Osteomalacia, Osteoporosis)Clinical Scenarios.
VENUE
DURATION: (1 Hour)

________________________________________________________________________
1. AIM / GOAL
Understanding the etiology, physiology, pathology and management of metabolic
bone diseases.(Clinical Scenarios)
Understanding the basic pathology and factors responsible for these changes in
metabolic bone diseases.
3. CONTENTS
Etiology, physiology, pathology, clinical features, investigations and management of
metabolic bone diseases.
5. REFERENCES
a)
b)
c)
d)

60

PROG
: M.B.B.S
SEMESTER : 8 & 9
TOPIC
: PBL: Infections & Inflammatory conditions Clinical Scenarios.

VENUE
DURATION: (1 Hour)

________________________________________________________________________
1. AIM / GOAL
Understanding Bone & joint infections and some common inflammatory joint
conditions(Clinical Scenarios).
Understanding the basic pathology and factors responsible for these changes in
infective & inflammatory conditions.
3.CONTENTS
Etiology, physiology, pathology, clinical features, investigations and management of
infective & inflammatory conditions.
5. REFERENCES
a)Apleys System of Orthopaedics and Fractures
b)Book of Orthopaedics and Traumatology: M Natarajan & Mayilvahanan Natarajan
c)Essential Orthopaedics : J. Maheshwari
d)Clinical Oriented Anatomy : Keith Moore and Arthur Dalley
61

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: PBL: Bone tumors (Osteochondroma, Osteosarcoma, Ewings sarcoma,

GCT, Multiple myeloma) Clinical Scenarios.

VENUE
DURATION: (1 Hour)

________________________________________________________________________
1. AIM / GOAL
Understanding the classification and basics principles in management of bone tumors.
Understanding the pathology of common benign and malignant types of bone tumors
and the principles in their management.
3. CONTENTS
Classification of bone tumors, and individual details of particular tumors on its cell of
origin, clinical, radiological and histological features and management.
5. REFERENCES
a)
b)
c)
d)

62

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: PBL: Fractures: Healing,classification,methods of treatment &
complications
VENUE
DURATION: (1 Hour)
: Small group teaching room.

1. AIM / GOAL
Understanding the classification & healing of fractures,methods of treatment and
various common complications.
Understanding the stages of fracture healing,classification of fractures,principles &
methods of treatment and its complications.
3.CONTENTS
Various stages of fracture healing and factors influencing it,clinical and radiological
classification of fractures,conservative & Surgical methods of treating fractures with
their indications, and common systemic & local complications of fractures.
5. REFERENCES
d) Clinical Oriented Anatomy : Keith Moore and Arthur Dalley
63

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Small group teaching : Individual Muscle testing:Upper limb

VENUE
DURATION: (1 Hour)
: Skill laboratory
1. AIM / GOAL
With the basic knowledge of various major muscles of upper limb,to learn the method
of testing these muscles
Should be able to test individual muscles and grade its power and apply in clinical
practice.
3. CONTENTS
Testing of muscles of Upper limb.
4. TEACHING METHODS: Small group teaching & Demonstration.
5. REFERENCES
a)
b)
c)
d)
Snells textbook of Anatomy,7th edition.

64

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Small group teaching : Individual Muscle testing:Lower limb

VENUE
DURATION: (1 Hour)
: Skill laboratory
1. AIM / GOAL
With the basic knowledge of various major muscles of lower limb,to learn the method
of testing these muscles
Should be able to test individual muscles and grade its power and apply in clinical
practice.
3.CONTENTS
Testing of muscles of Lower limb.
5. REFERENCES
a)Snells textbook of Anatomy,7th edition.
65

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
limbs.
: Small group teaching : Special tests for individual nerves-Upper

VENUE
DURATION: (1 Hour)
: Skill laboratory
1. AIM / GOAL
With the basic knowledge of major nerves of upper limbs,to learn special tests for
each nerve.
Should be able to test individual nerves of upper limbs(Median,ulnar,radial & axillary
nerve) & apply it in clinical practice.
3.CONTENTS
Special tests for individual nerves of Upper limbs.
5. REFERENCES
b)Book of Orthopaedics and Traumatology: M Natarajan & Mayilvaha nan Natarajan
d)Clinical Oriented Anatomy: Keith Moore and Arthur Dalley
66

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
limbs.
: Small group teaching : Special tests for individual nerves-Lower

VENUE
DURATION: (1 Hour)
: Skill laboratory
1. AIM / GOAL
With the basic knowledge of major nerves of Lower limbs,to learn special tests for
each nerve.
Should be able to test individual nerves of Lower limbs(Median,ulnar,radial &
axillary nerve) & apply it in clinical practice.
3. CONTENTS
Special tests for individual nerves of Lower limbs.
5. REFERENCES
67

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Small group teaching : Special tests & signs for individual joints

VENUE
DURATION: (1 Hour)
: Skill laboratory
1. AIM / GOAL
To learn some special tests and signs for various joints of upper and lower limbs.
Should be able learn the special tests and signs for major joints of the
limbs(Hip,knee,shoulder & elbow joint) and apply them in clinical practice.
3.CONTENTS
Special tests and signs for individual joints-Upper & Lower limbs.
5. REFERENCES
68

PROG
: M.B.B.S
SEMESTER : 6 & 7
TOPIC
: Self-Directed Learning

VENUE
DURATION: (2 Hours)
: Small rooms
LECTURER : MMMC faculty (Supervision only)
1.AIM / GOAL
a) To cover some of the minor topics which are not included in the major
curriculum.
b) Allowing the students to get insight into some topics in depth.
c) To develop the skills of interpreting Clinical Anatomy/Clinical
scenarios.
d) To develop the skill of E-learing & internet use for Research
purposes.
Student should be able to analyse,correlate and reason out the facts related to Basic
Anatomy,Data interpretation,Plan of management of a given problem.
3.CONTENTS
a) Anatomy diagrams with some clinical Scenarios to correlate.
b) Clinical scenarios to check the skill of reasoning out.
c) Research programme related to the given problem.
4. TEACHING METHODS: Self-Directed Learning(unde r minimal
supervision)
5. EVALUATION
a) Group discussion in a small room
b) Assessment in terms of achieving the aims.
c) Continuous assessment
69
6. REFERENCES
e)Apleys System of Orthopaedics & Fractures.
70

Programme: M.B., B.S.

Semester: 10
Topic: Clinical teaching
Aim/Goal:
Reinforcement on History taking and clinical examination.
List out relevant investigations and treatment options.
To address ethical & Medico-legal issues as applicable.
Learning Objectives:
Correlation of History & Clinical findings.
Application of theoretical knowledge in arriving at a
Diagnosis/Differential Diagnosis.
Ability to plan a treatment protocol.
Contents:
Patients with Orthopaedic injuries and disorders.
Learning areas:
Melaka Hospital:
Orthopaedic Wards.
Orthopaedic Out-patient Department.
Operation Theatre.
A & E department.
Teaching methods:
Bedside Clinical teaching.
Case presentation by students.
Demonstration of clinical signs & relevant discussion applied to Basic
Sciences by the Faculty.
References:
Clinical Orthopaedic Examination: Ronald McRae.

Clinical Examination is Surgery: SS Das.
Physical Examination in Orthopaedics: Lee Joon Kiong.
Essential Orthopaedics: J Maheshwari.
Orthopaedics & Traumatology: M Natarajan & Mayilvahanan
Natarajan.
Apleys System of Orthopaedics & Fractures: Graham Apley & Louis
Solomon.
Assessment:
Clinical Anatomy and Basic Sciences Tests.
71
Clinical End-Posting test.

Project work.
Basic Orthopaedics test (MCQs, Diagrams & short essays).
Mid-Semester & Sessional Examinations.
University Examinations (Theory & Clinical).
72
Learning Outcomes
73
Overall Goal:
The broad goal of the teaching of undergraduate students in Community Medicine is to
prepare them to function as first level physicians in the community, health care centers,
hospitals and other health institutions in accordance with the institutional goals.
Objectives:
A) Knowledge:
1) describe the health care delivery system including rehabilitation of the disabled in
the country;
2) describe the National Health Programmes with particular emphasis on maternal
and child health programmes, family welfare planning, and population control;
3) list epidemiological methods and describe their application to communicable and
non-communicable diseases in the community or hospital situation;
4) apply biostatistical methods and techniques;
5) outline the demographic pattern of the country and appreciate the roles of the
individual, family, community and socio-cultural milieu in health and disease;
6) describe the health information systems;
7) enunciate the principles and components of primary health care and the national
health policies to achieve the goal of Health For All;
8) identify the environmental and occupational hazards and their control;
9) describe the importance of water and sanitation in human health;
10) to understand the principles of health economics, health
administration, health education in relation to community.
B) Skill:
1) use epidemiology as a tool to make rational decisions relevant to community and
individual patient intervention;
74
2) collect, analyse, interpret and present simple community and hospital-based data;
3) diagnose and manage common health problems and emergencies at the
individual, family and community levels keeping in mind the existing health care
resources and in the context of the prevailing of the prevailing socio-cultural
beliefs;
4) diagnose and manage maternal and child health problems and advise a couple and
the community on the family welfare planning methods in the context of the
national priorities;
5) diagnose and manage common nutritional problems at the individual and the
community level;
6) plan, implement and evaluate a health educational programme with skill to use
simple audio-visual aids;
7) interact with other members of the health care team and participate in the
organization of health care services and implementation of national health care
programmes.
C) Integration:
Develop capabilities of synthesis between cause of illness in the environment or
community and individual health and respond with leadership qualities to institute
remedial measures for this.
75
Department of Community Medicine

Melaka Manipal Medical College
Programme: MBBS
Semester 6 & 7
Lecture 1: Concepts and determinants of health and disease
No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to differentiate the various types of

concepts of health and disease.
Able to categorize the dimensions of health.
Able to describe the determinants of health.
2.
Contents:
i.
ii.
iii.
iv.
v.
Concepts of health.
Concepts of disease.
Spectrum of health and disease.
Natural history of disease.
Determinants of health.
3.
Readings:
i.
Parks Textbook Of Preventive And Social

Medicine K. Park
Lecture 2: General principles of prevention primary, secondary and tertiary

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to describe the various modes of

intervention.
Able to recognize the various health
activities with its level of prevention.
Able to differentiate control, prevention,
elimination and eradication of diseases.
2.
Contents:
i.
ii.
iii.
Levels of prevention.
Modes of intervention.
Types of rehabilitation.
3.
Readings:
i.

Medicine K. Park
76
Lecture 3: Health indicators

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
iv.
3.
Readings:
i.
Able to enumerate the main indicators of

health.
Able to describe the main uses of health
indicators.
Able to recognize the use of health
indicators in public health activities.
Definition
Uses of health indicators.
Types of health indicators, principally
mortality and morbidity indicators.
Indicators of quality of life.
Medicine K. Park
Lecture 4: Maternal health

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
iv.
3.
Readings:
i.
ii.
iii.
Able to describe the objectives of maternal

health.
Able to explain the activities under maternal
health services.
Able to discuss the safe motherhood
initiative programme.
Objectives of maternal health.
Components and activities of maternal
health.
Safe motherhood initiative.
High risk approach.
Medicine K. Park
Maternal and Child Health Around The
World H.M. Wallace and G.J. Ebrahim
(Macmillan)
Textbook of Community Medicine in SouthEast-Asia W.O Phoon & P.C.Y. Chen
(Wiley Medical Publication)
77
Lecture 5: Child health

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to describe the objectives of child

health.
Able to explain the activities under child
health services.
Able to discuss the basic preventive care for
child health.
2.
Contents:
i.
ii.
iii.
iv.
Objectives of child health.

Components and activities of child health.
Infant and toddler feeding / nutrition.
Strategies in care of children in community.
3.
Readings:
i.

Medicine K. Park
(Macmillan)
ii.
iii.
Lecture 6: School health and care of the elderly

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
Able to describe the objectives of school

health programme.
Able to explain the activities under school
health services.
Able to enumerate activities under the
elderly health care programme.
Objectives of school health programme.
Components and activities of school health
services.
Health care programme for the elderly.
Medicine K. Park
78
Lecture 7: Perinatal health

No.
Item
1.
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
iii.
Able to describe the objectives of perinatal

health.
Able to explain the activities under perinatal
health services.
Able to assess perinatal health via the use of
indices.
Objectives of perinatal health.
Components and activities of perinatal
health.
Perinatal mortality rate.
Medicine K. Park
(Macmillan)
Lecture 8: Maternal and infant mortality

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
iii.
Able to differentiate the various

terminologies depicting maternal death.
Able to relate the use of maternal mortality
rate in the assessment of public health
services.
Able to assess infant health via the use of
indices.
Definition of maternal death, late maternal
death, direct and indirect obstetric deaths.
Maternal mortality rate.
Infant mortality rate.
Medicine K. Park
(Macmillan)
Textbook of Community Medicine in South-
79
East-Asia W.O Phoon & P.C.Y. Chen

Lecture 9: Demography
No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to state the components of

demography.
Able to identify sources of demography.
Able to assess population via population
pyramid.
2.
Contents:
i.
ii.
iii.
Definition and components of demography

Sources of demography.
The various types and uses of population
pyramid.
3.
Readings:
i.

Medicine K. Park
ii.
Lecture 10: Population dynamics

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to describe the various transitions of a

community in relation to size.
Able to relate the dependency ratio with the
demographic and health characteristics of a
community.
Able to state the various types of fertility
indicators.
2.
Contents:
i.
ii.
iii.
Demographic cycle.
Dependency ratio and its uses.
Fertility indicators.
3.
Readings:
i.

Medicine K. Park
ii.
80
Lecture 11: Introduction to environmental health

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
Able to state the relationship of environment

and health.
Able to identify the various dimensions of
environment physical, biological and
psychosocial.
Able to describe the ill-effects of improper
environmental control.
Definition and dimensions of environment.
Relationship between environment and
health.
Air, noise, water and land pollution.
Medicine K. Park
Lecture 12: Air pollution

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to explain the sources of air pollution.

Able to enumerate the various pollutants and
its ill effects.
Able to describe proper environmental
control.
2.
Contents:
i.
ii.
iii.
Definition of air pollution.

Air pollutants.
Prevention and control of air pollution.
3.
Readings:
i.

Medicine K. Park
81
Lecture 13: Water purification and solid waste disposal.

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to enumerate the types of water

treatment.
Able to explain the various processes
involved in water treatment.
Able to describe the types of solid waste
disposal.
2.
Contents:
i.
ii.
iii.
Sources of water.
Water treatment types and processes.
Solid waste disposal open dumping,
sanitary landfill, incineration, etc.
3.
Readings:
i.

Medicine K. Park
ii.
Lecture 14: Ionising and non ionising radiation

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to explain the sources of ionising and non

ionising radiation.
Able to describe the ill effects of ionizing and non
ionizing radiation.
Able to discuss the strategies in controlling
ionizing and non ionizing radiation.
2.
Contents:
i.
ii.
iii.
Types of ionising and non ionizing radiation.

Sources of ionizing and non ionizing radiation.
Protection against ionizing and non ionizing
radiation.
3.
Readings:
i.
http://en.wikipedia.org/wiki/Nonionizing_radiation
http://en.wikipedia.org/wiki/Ionizing_radiation
ii.
82
Lecture 15: Health information system

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
Able to explain the uses of health

information system.
Able to state the various sources of health
information system.
Able to describe the limitations of health
information system.
Definition and uses of health information
system.
Sources of health information systemcensus, registration of vital events,
notification, hospital records, etc.
Weakness of health information system.
Medicine K. Park
Lecture 16: Health communication

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
Able to state the various models of health

communication.
Able to describe the various variables of
health communication..
Able to describe the importance of health
communication.
Health communication models.
Variables of health communication
empathy, control, trust, self-disclosure,
confirmation.
Importance of health communication.
Medicine K. Park
83
Lecture 17: Quality assurance

No. Item
1.
Outcomes:
Outline
i.
ii.
iii.
Able to define quality assurance.

Able to state the concepts of quality assurance.
Able to illustrate the steps in implementation of quality assurance.
2.
Contents:
i.
ii.
iii.
Definition and concepts of quality assurance.

ABNA Achievable Benefit Not Achieved
Steps in quality assurance implementation.
3.
Readings:
i.
ii.
http://www.clario.org/clario_building_a_procedure_for_tqm_in_lasik.php
http://www.publichealth.pitt.edu/supercourse/SupercoursePPT/1701118001/17501.ppt
84
Department of Community Medicine

Programme: MBBS
Semester 6 & 7
Lecture 18: Epidemiology: definition, purpose and scope
No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to describe the components of

epidemiology.
Able to state the basic methods of
epidemiology.
Able to approach events using
epidemiology.
2.
Contents:
i.
ii.
iii.
Scope of epidemiology.
Aims of epidemiology
Epidemiological approach.
3.
Readings:
i.

Medicine K. Park
Primer of Epidemiology - Gary D.
Friedman (McGraw Hill)
ii.
Lecture 19: Measurements in epidemiology

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
iv.
3.
Readings:
i.
ii.
Able to apply the basic concepts of

measurements in epidemiology.
Able to state the domains or areas of
measurements in epidemiology.
Able to make use of rates, ratio and
proportion.
Definition
Measurements in epidemiology.
Tools of measurements rates, ratio and
proportion.
Population at risk vs mid-year population.
Medicine K. Park
85
iii.

Lecture 20: Epidemiology: Reservoirs and transmission of infection

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to identify the various concepts of

diseases.
Able to state the concepts of reservoir and
source of infection.
Able to enumerate the biological properties
of an agent.
2.
Contents:
i.
ii.
iii.
Definition of communicable disease.

Reservoir, source of infection and host.
Incubation and communicable period.
3.
Readings:
i.

Medicine K. Park
ii.
Lecture 21: Epidemiology: Patterns of diseases

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
Contents:
i.
ii.
iii.
Types of carriers.
Epidemic, endemic and pandemic.
Herd immunity.
3.
Readings:
i.

Medicine K. Park
ii.
iii.
Able to state the various types of carriers.

Able to identify the various types of
epidemic
86
Lecture 22: Medical certification of death

No.
1.
Item
Outcomes:
Outline
i.
ii.
Able to state the principles of writing a

medical certificate of death.
Have basic knowledge in applying and
writing correctly a medical certificate of
death based on case scenarios.
2.
Contents:
i.
ii.
iii.
Definition of death.
Guidelines of medical certificate of death.
International Classification of Disease ICD
10
3.
Readings:
i.
International Classification of Disease ICD

10.
http:www.cdc.gov
ii.
Lecture 23: Exercise in medical certificate of death.

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
Contents:
i.
ii.
3.
Readings:
i.
Able to write a medical certificate of death

when faced with a scenario of death due to
communicable or non communicable disease
Able to explain the dos and donts in
completing the death certificate.
Exercise sessions in completing medical
certificate of death relating to diseases.
Exercise sessions in completing medical
certificate of death relating to injuries.
http://www.cdc.gov
87
Lecture 24: Mortality indicators

No.
1.
Item
Outcomes:
Outline
i.
ii.
Able to apply the various measurements of

mortality.
Able to calculate a standardized death rate.
2.
Contents:
i.
ii.
iii.
Measurements of mortality
Crude death rate and age specific death rate.
Calculation of standardized death rate.
3.
Readings:
i.

Medicine K. Park
ii.
Lecture 25: Mortality and morbidity indicators

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
Have basic knowledge of mortality rates

used in communicable diseases.
Able to calculate the various mortality rates.
Have basic understanding of morbidity rates.
Measurements of mortality in communicable
diseases proportional mortality rate, case
fatality rate, disease specific death rate.
Application and calculation of the above
rates.
Definition of morbidity indicators.
Medicine K. Park
Textbook of Community Medicine in SouthEast-Asia W.O. Phoon & P.C.Y. Chen
88
Lecture 26: Morbidity indicators

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Have basic knowledge of morbidity

indicators used in public health.
Able to enumerate the various types of
denominator used in various morbidity
indicators.
Able to calculate the various morbidity
indicators.
2.
Contents:
i.
ii.
iii.
Incidence and prevalence rate

Mid year population vs population at risk.
Calculation of incidence / prevalence rates.
3.
Readings:
i.

Medicine K. Park
ii.
Lecture 27: Principles of prevention and control of communicable diseases

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
Apply the basic principles of prevention

and control of communicable diseases.
Able to explain the levels of prevention and
control according to the chain of infection
reservoir level, source of infection level and
host level.
Chain of infection
Modes of intervention at the various levels
according to chain of infection - reservoir
level, source of infection level and host
level.
Surveillance of communicable diseases.
Medicine K. Park
89
Lecture 28: Dynamics of disease transmission

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
Able to describe the impact of

communicable diseases on man.
Able to identify the various modes of
transmission between sources of infection
and host.
Mortality and morbidity of major
communicable diseases.
Direct mode of transmission of
Indirect mode of transmission of
Medicine K. Park
Lecture 29: Food borne diseases I

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
iv.
Able to illustrate basic concepts relating to

food-borne diseases.
Able to illustrate the epidemiological
concepts relating to Cholera.
concepts relating to Typhoid.
concepts relating to Shigellosis.
2.
Contents:
i.
ii.
iii.
iv.
Introduction to food-borne diseases.

The epidemiology of cholera.
The epidemiology of Typhoid.
The epidemiology of Shigellosis.
3.
Readings:
i.

Medicine K. Park
Control of Communicable Diseases Manual
- Abram S. Benenson (United Book Press)
ii.
iii.
90
Lecture 30: Food borne diseases II

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
iii.
Able to illustrate
concepts relating
Able to illustrate
concepts relating
the epidemiological
to Viral Hepatitis A.
the epidemiological
to Poliomyelitis.
The epidemiology of Viral Hepatitis A

The epidemiology of Poliomyelitis.
The differences between food poisoning and
other food-borne pathogen (ex. Cholera).
Medicine K. Park
Lecture 31: Air-borne diseases I

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
iv.

air-borne diseases.
concepts relating to Chickenpox.
concepts relating to Measles.
concepts relating to Mumps.
2.
Contents:
i.
ii.
iii.
The epidemiology of Chickenpox.

The epidemiology of Measles.
The epidemiology of Mumps.
3.
Readings:
i.

Medicine K. Park
ii.
iii.
91
Lecture 32: Air-borne diseases II

No.
1.
Item
Outcomes:
Outline
i.
ii.
Able to illustrate
concepts relating
Able to illustrate
concepts relating
the epidemiological
to Diphtheria.
the epidemiological
to Tuberculosis.
2.
Contents:
i.
ii.
iii.
The epidemiology of Diphtheria.

The epidemiology of Tuberculosis.
DOTS therapy in Tuberculosis.
3.
Readings:
i.

Medicine K. Park
ii.
iii.
Lecture 33: Vector-borne diseases I

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
Contents:
i.
ii.
3.
Readings:
i.
ii.
iii.

vector-borne diseases.
concepts relating to Dengue and Dengue
haemorrhagic fever.
Biological transmission in vector-borne
diseases.
The epidemiology of Dengue.
Medicine K. Park
92
Lecture 34: Vector-borne diseases II
No.
1.
Item
Outcomes:
Outline
i.
ii.

concepts relating to Malaria.
concepts relating to Filariasis.
2.
Contents:
i.
ii.
The epidemiology of Malaria.

The epidemiology of Filariasis.
3.
Readings:
i.

Medicine K. Park
ii.
iii.
Lecture 35: Sexually transmitted diseases I

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.

sexually transmitted diseases.
concepts relating to Syphilis.
concepts relating to Gonorrhoea.
2.
Contents:
i.
ii.
The epidemiology of Syphilis.

The epidemiology of Gonorrhoea.
3.
Readings:
i.

Medicine K. Park
ii.
iii.
93
Lecture 36: Sexually transmitted diseases II

No.
1.
Item
Outcomes:
Outline
i.
ii.
Able to illustrate
concepts relating
Able to illustrate
concepts relating
the epidemiological
to Hepatitis B.
the epidemiological
to HIV / AIDS.
2.
Contents:
i.
ii.
The epidemiology of Hepatitis B.

The epidemiology of HIV / AIDS.
3.
Readings:
i.

Medicine K. Park
ii.
iii.
Lecture 37: Zoonosis

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to illustrate the basic concepts and

terminologies used in zoonosis.
concepts relating to Rabies.
Able to state the epidemiological concepts
relating to Plague.
2.
Contents:
i.
ii.
iii.
Classification of zoonosis.
The epidemiology of Rabies.
The epidemiology of Plague.
3.
Readings:
i.

Medicine K. Park
ii.
iii.
94
Lecture 38: Emerging and re-emerging diseases

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
3.
Readings:
i.
Able to illustrate the basic concepts in

emerging and re-emerging diseases.
Able to discuss the problem scope of these
diseases.
Be able to apply the basic principles in
prevention and control in these diseases.
Emerging communicable pathogens /

diseases.
ii.
Re-emerging communicable pathogens /
diseases.
iii.
Causes of emerging / re-emerging diseases.
iv.
Principles of prevention and control.
ii.
iii.

Medicine K. Park
Lecture 39: Screening of diseases

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to explain the basic concepts of

screening of diseases.
Able to enumerate the uses of screening.
Able to apply and calculate measurements
used in screening such as validity.
2.
Contents:
i.
ii.
iii.
iv.
Definition of screening.
Concept of screening time and lead time.
Characteristics of a proper screening test.
Sensitivity vs specificity.
3.
Readings:
i.

Medicine K. Park
Textbook of Community Medicine in
South-East-Asia W.O. Phoon & P.C.Y.
Chen (Wiley Medical Publication)
ii.
95
Lecture 40: Surveillance of diseases

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to illustrate the basic principles of

surveillance of diseases.
Able to state the rationale and objectives of
surveillance.
Able to explain the flow of surveillance data
from periphery to headquarters.
2.
Contents:
i.
ii.
iii.
Objectives of surveillance.
Core functions of surveillance.
Surveillance: data flow.
3.
Readings:
i.

Medicine K. Park
http://www.cdc.gov
http://www.who.int
http://www.dph.gov.my
ii.
iii.
iv.
v.
Lecture 41: Investigation of an epidemic I

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to state the various terminology for

occurrences of diseases.
Able to list the types of epidemic.
Able to apply the principles of investigating
and controlling an epidemic.
2.
Contents:
i.
ii.
iii.
iv.
Sporadic, endemic and epidemic.

Common-source single exposure epidemic.
Propagated epidemic.
Objectives of investigation of an epidemic.
3.
Readings:
i.

Medicine K. Park
ii.
96
Lecture 42: Investigation of an epidemic II

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Apply the proper cycle of investigating an

epidemic.
Able to come out with an epidemiological
diagnosis of an epidemic.
Able to confirm an epidemic based on
simple calculation.
2.
Contents:
i.
ii.
iii.
iv.
The cycle of investigation of epidemic.

Verifying diagnosis.
Confirming an epidemic.
Defining population at risk.
3.
Readings:
i.

Medicine K. Park
ii.
Lecture 43: Exercise on investigation of epidemic.

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
Able to come out with an epidemic curve.

Able to calculate the various attack rates for
the factors associated with an epidemic.
Able to formulate hypothesis of the causal
agent in an epidemic.
2.
Contents:
i.
ii.
iii.
Epidemic curve formulation.

Rapid search for cases and data analysis.
Attack rates of suspected factors.
3.
Readings:
i.

Medicine K. Park
ii.
97
Lecture 44: Acts / Laws on Communicable diseases

No. Item
1.
Outcomes:
Outline
i.
ii.
Able to state the various acts / laws on communicable diseases.

Able to apply the various scenarios in which these acts / laws may
be enforced.
2.
Contents:
i.
ii.
iii.
Destruction of Disease-Bearing Insect Acts 2000 (Amended).

Communicable Disease Prevention and Control Act 1988.
Other acts.
3.
Readings:
i.
ii.
iii.
iv.
http://www.dph.gov.my/vektor/akta/ddbia_2000.htm
http://www.jknsel.moh.gov.my/penerangan.php?id=27&page=5
http://www.pkdsetiu.com/viewpage.php?page_id=22
http://www.dph.gov.my/cdc/downloads/law/Regulation%
20Import%20Eksport.pdf
Lecture 45: International Health Regulations

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
Contents:
i.
ii.
3.
Readings:
i.
Able to state the role of International Health

Regulations in prevention and control.
Able to apply the various scenarios in which
these regulations may be enforced.
Purpose and objectives of international
Health Regulations.
Limitations of International Health
Regulations.
http://www.who.int
98
Lecture 46: Introduction to communicable diseases

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
Able to state the epidemiological concepts

relating to non communicable diseases.
Able to compare the differences between
communicable and non communicable
diseases.
Concept of disease causation in non
Epidemiological transition.
Strategies in controlling non communicable
diseases.
Medicine K. Park
Lecture 47: Cardiovascular diseases

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
Able to state basic concepts relating to

cardiovascular diseases.
Able to apply the epidemiological concepts
relating to coronary heart disease, essential
hypertension.
Illustrate the epidemiological concepts
relating to cerebrovascular diseases, chronic
rheumatic heart disease.
Introduction to cardiovascular diseases.
The epidemiology of coronary heart disease,
essential hypertension.
The epidemiology of cerebrovascular
diseases, chronic rheumatic heart disease.
Medicine K. Park
99
Lecture 48: Diabetes mellitus

No.
1.
Item
Outcomes:
Outline
i.
ii.
Able to state basic concepts relating to

diabetes mellitus.
relating to NIDDM.
2.
Contents:
i.
ii.
iii.
Classification of diabetes.
The epidemiology of NIDDM.
Prevention and control of NIDDM.
3.
Readings:
i.

Medicine K. Park
ii.
Lecture 49: Cancers I

No.
1.
Item
Outcomes:
Outline
i.
ii.
iii.
2.
Contents:
i.
ii.
iii.
3.
Readings:
i.
ii.
Able to state basic concepts relating to the

various cancers in general.
Able to illustrate the risk factors involved in
the various cancers in general.
relating to breast cancer.
Introduction to cancers.
The epidemiology of cancers globally,
Malaysia.
The epidemiology of breast cancer.
Medicine K. Park
100
Lecture 50: Cancers II

No.
1.
Item
Outcomes:
Outline
i.
ii.
Able to illustrate
concepts relating
Able to illustrate
concepts relating
cancer.
the epidemiological
to cervical cancer.
the epidemiological
to stomach and lung
2.
Contents:
i.
ii.
The epidemiology of cervical cancer.

The epidemiology of stomach, lung cancer.
3.
Readings:
i.

Medicine K. Park
ii.
Lecture 51: Home and Road Traffic Accidents

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
3.
Contents:
Readings:
i.

home accidents.
Able to illustrate the basic concepts relating
to road traffic accidents.
ii.
iii.
Introduction to accidents at home / road

traffic.
The epidemiology of home accidents.
The epidemiology of road traffic accidents.
i.
http://www.who.int
101
Lecture 52: Industrial Accidents

No.
1.
Item
Outcomes:
Outline
i.
ii.
2.
3.
Contents:
Readings:
i.
ii.

industrial accidents.
Able to identify factors involved in industrial
accidents.
iii.
Introduction to industrial accidents.

Agent, host, environmental factors in
industrial accidents.
The epidemiology of industrial accidents.
i.
http://www.osha.gov
102
SEMESTER 6 & 7: Clinical Posting
1.
EVIDENCE BASED PUBLIC HEALTH PRACTICAL SESSION

1.1
LEARNING OUTCOMES:
At the end of the practical course, the student shall be able to:
1.1.1 Describe the various types of study designs available.
1.1.2 Identify the various measures of association used in these various study
designs.
1.1.3 Come up with a report detailing the study and incorporating the IMRAD
(introduction, methodology, results and discussion) system.
1.1.4 Interpret basic statistical tools used in journals /articles.
1.1.5 Read a paper / article and come up with flaws / limitations pertaining to
the study.
CONTENTS
1. Introduction to epidemiological studies
2. Writing a report
3. Descriptive study
4. Cross sectional study
5. Case control study
6. Cohort study
7. Experimental study
8. Measures of association
9. Literature review
10. Sample size calculation
11. Designing questionnaire
1.2
EVALUATION AND REPORTS
A. Students are to go through training sessions on data collection (simulation)

which would be followed by data processing and data analysis by the use of
Precursor software.
The report should contain the following components:
I)
II)
III)
IV)
INTRODUCTION
METHODOLOGY
RESULTS
DISCUSSION & CONCLUSION
Summary and recommendations will be made based on the findings.
103
2. JOURNAL CRITIQUE MODULE
Learning Outcomes
At the end of the module the student shall be able to:
1. Have basic knowledge in the components of a published research paper
2. Describe in detail the good points and negative points of a published paper
3. Write a scientific paper based on guidelines listed for each component of the
manuscript
Essential Contents
a)
Basic contents
b)
Basic contents
c)
Basic contents
d)
Basic contents
/ components
/ components
/ components
/ components
- Introduction
- Methodology
- Results
- Discussion
Student Presentations
Journal Critique I
Journal Critique II
Journal Critique III
104

3. BIOSTATISTICS MODULE
Learning Outcomes
At the end of the module the student shall be able to:

1)
2)
3)
4)
5)
6)
Employ basic techniques for data collection, recording, coding & summary.
Present & interpret data in the form of indices, tables, charts & diagrams.
Process, compile & evaluate data with the use of basic statistical methodology
Discuss & communicate quantitative problems & their solutions in a quantitative
manner
Read, understand, interpret & criticise objectively research reports & papers
To utilise the computer & application software as statistical tools
Essential Contents
a)
b)
c)
d)
e)
f)
g)
h)
i)
Introduction to Biostatistics
Sampling techniques
Quantitative and qualitative data
Data presentation
Measures of central tendency
Measures of dispersion
Distribution Pattern
Hypothesis testing
Correlation and regression
4. PROBLEM BASED LEARNING SESSION

1.1
OBJECTIVES:
At the end of the problem based learning sessions, the student shall be able to:
1.1.1
1.1.2
1.1.4
1.1.5
Have an inquisitive and detailed look at issues, concepts and principles

contained within the problems.
Develop an appreciation for the interrelated nature of the basic sciences
that must be considered with each health problem.
Develop skills of problem synthesis and hypothesis generation for health
problems.
Cultivate the skills of self directed learning.
Students will receive health topics at the beginning of each week. Students will
then go through the PBL process (as depicted below) before making a
professional presentation the following week.
105
SEMESTER 8 & 9: Clinical Posting

LEARNING OUTCOMES:
1. Describe the health care delivery system performed at the health centre level with
reference to the Maternal Child Health programme.
2. Identify and explain the various activities at the health centre level which pertains
to antenatal care, postnatal care, childcare, family planning and support activities.
3. Appraise antenatal, child health and family planning cases and make
recommendations on appropriate preventive care in the community level.
4. Interact with other health care team and participate in the running of these
activities at the health centre level.
The whole posting in Community Medicine is divided as follows:
FOCUS OF LEARNING IN THE CLINICS

The posting effectiveness will depend on the self-learning initiatives of the students. To
realise this, students must show interest in learning and take the lead inquisitive role. The
learning should be focus on Family Health in the area of Maternal and Child Health care.
It will also include expanded scope activities being implemented at the health clinics. The
core learning areas will be:
1.
2.
3.
4.
5.
6.
Antenatal care at the health clinic level all aspects.

Postnatal care at the health clinic level all aspects.
Childcare all aspects.
Family planning.
Organisation and health care delivery structure at the health clinic.
Support activities such as home visiting, health education, health promotion,
health counselling and advice, and data record & management.
Learning will be facilitated by staffs at the health clinics.
106
FAMILY MEDICINE: SENIOR CLERKSHIP

(Semester 9 & 10)
LEARNING OUTCOMES:
1. Describe the concepts and principles of primary care.
2. Demonstrate clinical competency in performing history taking, physical examination in
a primary care setting.
3. Arrive at a reasonable diagnosis / differential diagnosis in a primary care setting.
4. Demonstrate communication skills and appraise problems in communication, if any.
5. Evaluate and treat common conditions in a primary care setting.
6. Demonstrate and practise common procedures performed at a primary care setting.
7. Interact with other health care team and participate in the running of these activities at
the health centre level.
1.0 FOCUS OF LEARNING IN THE CLINICS

The focus of learning will include
1. Understanding the concept and principles of primary care
2. To develop skills in history taking and physical examination, Diagnostic Process
3. Developing Communication skills and understanding the Problems in
communication
4. Management in Primary Care
5. Preventive and Promotive care
6. Notification requirements and procedures
7. Development of other skills needed by a doctor (how to set up a drip, how to do
and I & D, dressing, etc)
8. Presentation skills
107
Learning Outcomes
108
OVERALL OUTCOMES FOR PAEDIATRIC CLINICAL CURRICULUM

The overall goal of the Paediatric curriculum is to turn our students into caring and
child friendly doctors. They are expected to have a good communication skill to
communicate with children and their parents, competence to make a diagnosis and
manage common paediatric problems seen in this country. Students are expected to
develop attitudes and professional behavior appropriate for the profession. They are
expected to acquire basic life support skills to deal with emergencies in the community
and in the hospital.
109
LEARNING OUTCOMES FOR LECTURE TOPICS (SEMESTER 6 & 7)

1. Lecture topic: Introduction to Pediatrics: Relevance of History Taking
and Examination; Innovation in presentation

After this lecture session student should:
1. Recognize that a childs age is always a key feature in history and examination.
2. Recognize that history is the most fruitful source of diagnostic information
and parents are astute observers.
3. Demonstrate skills to take a comprehensive history and recollect format for
general & systems examination.
4. Be able to progress from a comprehensive history and examination to a goal
orientated one when necessary.
5. Be able to collate findings from history and examination, and summarize positive
and relevant negative points in history and examination.
6. Be able to formulate a working diagnosis or differential diagnosis on the basis of
logical deduction.
Suggested further reading:

1. Illustrated textbook of Paediatrics Lissauer & Clayden
2. Hutchisons Clinical Methods
2. Lecture topic: Normal Growth and Development; Anthropometry and
Developmental Assessment
After this lecture session student should
1. Be able to describe normal growth.
2. Be able to describe normal development
3. Recognize the influence of heredity and environment on growth & dev.
4. Know how to measure weight, length, head circumference and plot on charts.
5. Be aware of tools used (eg DDST) to screen development.
6. Be able to detect growth problems and detect delays in development

1 Illustrated textbook of Paediatrics Lissauer & Clayden, 3rd edtion.
3. Lecture topic: GENETICS

110
1. Be aware of the Human Genome Project and its culmination in Human Genome
Sequence in 2001, and the availability of databases.
2. Be able to explain the basics of genetic disorders chromosomal abnormalities,
Mendelian inheritance, polygenic inheritance
3. Recognise terms used in dysmorphology.
4. Should be able to describe common genetic disorders, be aware of burden of
genetic disease and know principles of genetic counselling.
5. Should know clinical application of the newer advances.
1. Illustrated textbook of Paediatrics Lissauer & Clayden, 3rd edition.
4. Lecture topic: Learning Difficulty; Emotional / Behavior Disorders
1 Recognise terms used in learning difficulty and developmental delay.
2 Know causes of learning difficulty and developmental delay.
3 Be able to evaluate learning difficulty and developmental delay and propose
appropriate investigations.
4 Be able to recall triad of difficulties and co-morbidities in autism.
5 Be able to differentiate the normally active from the hyperactive child.
6 Recognise common problems of nocturnal enuresis, constipation/ soiling,
________________________________________________________________________
5. Lecture topic: Failure to thrive (FTT)
1. Be able to define FTT and recognize / detect it on growth charts.
2. Be able to list causes of FTT.
3. Demonstrate the skill to evaluate FTT utilizing the growth charts in combination
with a focused history and examination.
4. Be able to list investigations to be considered in FTT and select appropriate
investigation according to likely diagnosis.
5. Be able to plan management of a child with non-organic FTT.
1
Illustrated textbook of Paediatrics Lissauer & Clayden, 3rd edition.
6. Lecture topic: INFANT FEEDING

After this lecture session student should
1. Have the knowledge of breast milk production, its contents.
111
2.
3.
4.
5.
6.
Have the knowledge of weaning foods and principles of weaning

Have the knowledge of nutritional requirements in infants and children
Know the nutritive value of breast milk and various formula milks.
Be able to list the advantages of breast feeding
Be able to give proper advice on weaning.

1 Nelson textbook of pediatrics Kliegman, Behrman, Jenson, Stanton- 18th edition.
7. Lecture topic: CHILD AND ENVIRONMENT
After this lecture session:
1. Student should be able to describe the effect of different types of environment on
childs health, growth and development.
2. He/she should be able to relate the disease/health problems of the children to
environmental hazards.
1. Illustrated Textbook of Paediatrics Lissauer & Clayden
8. Lecture topic: NON ACCIDENTAL INJURIES

1. Be able to differentiate accidental injuries from child abuse.
2. Be able to recall/describe different types of non accidental injuries
3. Be able to relate the impact of NAI on children physical and psychological
4. Be able to analyze the risk factors for child abuse
5. Be able to document history and examination of a child with NAI.
6. Recognise role of case conference and team approach in child abuse management.
1. Illustrated Textbook of Paediatrics Lissauer & Clayden- 3rd edition
2. Nelson Textbook of Pediatrics Kliegman, Behrman, Jenson, Stanton 18th edition
112
9. Lecture topic: APPROACH TO CONGENITAL HEART DISEASES

1. Be able to recall fetal circulation and changes that take place after birth.
2. Be able to recall classification of congenital heart diseases with examples.
3. Be able to differentiate innocent murmurs from congenital heart diseases.
4. Be able to explain the cause of cyanosis in CHD
5. Be able to recall symptoms and signs of heart failure.
6. Have the skill to take relevant history, perform relevant physical examination and
give a reasonably good clinical diagnosis and order for relevant investigations.
1. Pediatric cardiology for Practitioners Myung Park, 5th edition
2. Nelson Essentials of Pediatrics Behrman, Kliegman
10. Lecture topic: Paediatric Therapeutics: Anticonvulsants in immediate
and long term control of seizures

1. Be able to recall AEDs available for immediate control of seizures versus
AEDs available for long term control of seizures.
2. Be able to list the stepwise and timely therapeutic management of status
epilepticus.
3. Be able to calculate dose of 1st line drug in emergency management of status
epilepticus.
4. Be able to select 1st line AED for partial versus generalized epilepsies.
5. Be able to explain possible side effects and adverse effects of AED to parent
(basis of start low go slow policy in outpatient treatment).
11. Lecture topic: Paediatric Therapeutics: Steroids in children short term
and long term indications and use

1 Be able to list acute conditions in which steroids are useful.
2 Be able to list chronic conditions in which steroids are useful in the long term.
3 Be able to list the side effects of long-term steroid use.
4 Know how to mitigate these side effects by using the appropriate route, dose and
choice of steroid.
5 Know concept of tapering dose in long-term use.
6. Be able to advice parents on immunization and need for steroids at time of stress
in children using steroids long term.
113
Nelson Textbook of Paediatrics- Kliegman, Behrman, Jenson, Stanton 18th edition.

12. Lecture topic: CHILDHOOD MALIGNANCIES
1. Be able to recall different common pediatric malignancies in this country.
2. Be able to reproduce the common etiologies of childhood malignancies
3. Be able to recall the clinical presentations, investigations and management of
common childhood malignancies.
4. Be able to describe the clinical presentation, investigations and management
issues in acute lymphoblastic leukemia
5. Be able to demonstrate the ability to relate different signs and symptoms in ALL
with the pathophysiological changes.
1. Nelson Textbook of Pediatrics Kliegman, Behrman, Jenson, Stanton- 18th edition
2. Illustrated Textbook Paediatrics- Lissauer & Clayden, 3rd edition
13. Lecture topic: ACUTE GASTROENTERITIS
1. Be able to define diarrhea and list the etiological agents causing diarrhea.
2. Be able to describe the pathophysiology of dehydration and electrolyte
disturbances.
3. Be able to list complications of acute gastroenteritis.
4. Be able to recall the contents, preparation and use of ORS
5. Be able to demonstrate the skill to interpret various signs to assess dehydration
and electrolyte imbalance.
6. Be able to plan management of a child with diarrhea and dehydration
7. Be able to demonstrate the skill to calculate the fluid requirement for child with
dehydration requiring IV fluid therapy.
1. WHO website on diarrhea
2. Nelson textbook of Pediatrics 18th edition.
14. Lecture topic: Critically Ill Child
1. Be able to recall the principles of basic life support in a child and infant and
intervention to be done.
2. Have a brief idea about the paediatric advanced life support about assessment of a
critically ill child.
3. Be conversant with the common paediatric issues in critical care like respiratory
and cardiac failure, shock, coma, anaphylaxis and trauma.
114
4. Have a general idea about the skills and equipments used in managing a critically
ill child like intubation, oxygen therapy, ventilators and monitoring.
5. Have an idea about other issues in critical care like transportation and nutrition of
a sick child, brain death and other ethical issues and importance of counseling of
parents
.
1. NMS Pediatrics Paul H. Dwarkin, 4th edition
15. Lecture topic: UTI/VUR
1. Be able to recall the aetiopathogenesis of urinary tract infection and vesicoureteric reflux in children.
2. Be able to recall the symptoms and signs of a child presenting with urinary tract
infection.
3. Be able to list the investigations done to diagnose the above conditions.
4. Be able to outline the management of a case of urinary tract infection and vesicoureteric reflux
5. Be able to list the complications of the above conditions.
1. Paediatric nephrology. Srivastava, Bagga.
16. Lecture topic: FLUID RESUSCITATION IN SPECIAL SITUATIONS
1. Be able to recall about the fluid homeostasis with special reference to paediatric
population.
2. Be able to list various fluids available for therapeutic use including their
indications.
3. Be able to calculate normal maintenance fluid requirement in a child according to
body weight.
4. Be able to calculate the fluid deficit in a child with acute gastroenteritis with
various grades of dehydration.
5. Be able to explain the fluid management in a child with dengue shock syndrome
and burns.
1. Clinical Practice Guidelines. Management of dengue fever in children. MOH
Malaysia.
115
17. Lecture topic: NEONATAL JAUNDICE

1. Be able to differentiate physiological jaundice from other causes
2. Be able to describe the bilirubin metabolism, and basis of physiological jaundice.
3. Be able to recall few causes of pathological jaundice.
4. Understand the pathophysiology of kernicterus.
5. Understand the relevance of different investigations in pathological jaundice.
6. Exhibit skill to recognize jaundice early and order appropriate investigations and
start therapeutic measures.
1. Illustrated Textbook of Paediatrics Lissauer & Clayden, 3rd edition
2. Manual of Neonatal Care John P. Cloherty, Ann Stark, 5th edition
18. Lecture topic: POISONINGS
1. Be able to recall common causes of poisoning.
2. Be able to name common substances of poisoning.
3. Be able to describe/recognize clinical features of common poisoning.
4. Be able to describe the broad outline of management and prevention of
poisoning in children.
1. Illustrated Textbook of Paediatrics Lissauer & Clayden
19. Topic: FITS, FUNNY TURNS, HEADACHES, BELLY ACHES
After this session student should:
1. Have knowledge about the common pediatric problems.
2. Be able to differentiate organic from functional disorders.
3. Be able to propose necessary investigations if needed
4. Demonstrate the necessary skill to counsel the parents.
Suggested reading:
1. Illustrated Textbook of Paediatrics Lissauer & Clayden, 3rd edition.
116
20. Topic: COMMON ENDOCRINE PROBLEMS IN PAEDIATRICS

1. Be able to list the common paediatric endocrinological problems (DM,
Hypothyroidism and CAH) and know the importance of newborn
screening for congenital hypothyroidism.
2. Be able to make an early diagnosis based on the clinical presentation.
3. Be able to recognize the endocrinological emergencies.
4. Know the specific management plan for each disease.
5. Recognise that these illnesses are chronic and the parents need counseling regarding
long-term treatment and the good prognosis on proper management
Suggested reading:
1. Illustrated Textbook of Paediatrics Lissauer & Clayden, 3rd edition
________________________________________________________________________
21. Topic: SHORT STATURE, CHILDHOOD OBESITY

After this session student should be able to:
1.
2.
3.
4.
5.
6.
7.
define and detect short stature.

list the causes of short stature.
evaluate the short child and be able to identify the normal short child.
calculate body mass index for obese children and plot on centile charts.
analyze risk factors for obesity.
recognise the long term problems associated with obesity.
formulate a plan of management for obesity.
Suggested reading:
Illustrated Textbook of Paediatrics Lissauer & Clayden, 3rd edition.
117
22. Topic: IMMUNISATION

1. Be aware that immunisation is a most effective and economic public health
measure to improve health.
2. Know the composition and schedule of Malaysian immunisation programme.
3. Be aware of complications, contraindications and controversies surrounding
immunisation.
1. Paediatric protocols for Malaysian hospitals
2. Malaysian immunisation manual.
3. Illustrated textbook of paediatrics Lissauer & Clayden, 3rd edition.
_______________________________________________________________________
23. Topic: Low birth weight babies.
1. Know that external appearance and neurological findings in infants provide an
estimate of gestational age.
2. Know the etiology of RDS, use of surfactant /artificial ventilation and also the
role of antenatal corticosteroids.
3. Be aware of other problems of very low birth weight babies.
1. Illustrated Textbook of Paediatrics Lissauer & Clayden, 3rd edition.
118
PROBLEM BASED LEARNING

LEARNING OUTCOMES
Topic: Breathlessness
At the end of the session student should be able to:
1. List causes of breathlessness.
2. Discuss the symptoms and signs in the various causes of breathlessness.
3. Interpret and analyze various clinical scenarios involving breathlessness.
Topic: Cyanosis
At the end of the session student should be able to:
1. Define cyanosis and be aware of central / peripheral cyanosis.
2. Enumerate causes (CVS, RESPIRATORY AND CNS) of cyanosis and be aware
that respiratory/CNS causes are emergencies.
3. Interpret and analyze various clinical scenarios involving cyanosis.
Topic: Vomiting
At the
1.
2.
3.
end of this session student should:

Be able to list various causes of vomiting in childhood in different age groups.
Be able to differentiate functional from organic causes of vomiting.
Have the capability to analyze the metabolic derangements and initiate
appropriate corrective measures.
4. Interpret and analyze various clinical scenarios involving vomiting.
Topic: Jaundice
At the
1.
2.
3.
end this session student should:

Be able to list important causes of jaundice in neonates and older children.
Be able to describe bilirubin metabolism.
Interpret and analyze various clinical scenarios involving jaundice.
Topic: Pyrexia of Unknown Origin

At the
1.
2.
3.
end of this session student should:

Be able to define pyrexia of unknown origin
Be able to list few causes of prolonged fever in children
Interpret and analyze various clinical scenarios with prolonged fever.
119
Topic: Hematuria
At the end of this session student should:
1. Be able to define microscopic hematuria
2. Be able to recall few common causes of hematuria in children depending on age.
3. Have the requisite skill to analyze and interpret various scenarios with hematuria..
Topic: Seizures
At the end of this session student should be able to:
1. Define seizure, convulsion and epilepsy.
2. List different types of seizures / 1-2 epileptic syndromes
3. List common causes of seizures.
4. Differentiate seizures from events mimicking seizures.
5. Interpret and analyze various clinical scenarios involving seizures.
Topic: Drowsiness
1. Be able to use modified Glasgow coma scale for children.
2. Know the different causes of altered sensorium in a child.
3. Have capability to analyze and interpret scenarios involving drowsiness.
Topic: Fluid and Electrolyte therapy
1. Be able to describe the water, sodium, potassium and bicarbonate homeostasis .
2. Be able to recall the contents of various types of commonly used IV Fluids.
3. Have the capability to choose an appropriate fluid for management of shock,
replacement therapy for dehydration and maintenance therapy.
_____________________________________________________________________
Topic: Pallor
After this session student should be able to:
1. List important causes of anemia in infants and children.
2. Clinically differentiate between them.
3. Interpret and analyse various clinical scenarios involving pallor.
_____________________________________________________________________
120
Topic: Investigations
1. Know that normal values vary with age eg. Hb, SAP.
2. Be aware of investigations in common diseases.
3. Be aware of various categories of investigations
4. Be able to confirm/rule out differential diagnosis based on investigations
5. Be able to do baseline investigations in ill/chronic patients.
6. Be able to do investigations for screening and for prognosis/monitoring of
complications.
_____________________________________________________________________
Topic: Antibiotics
1. Know that choice of antibiotic depends on the age /patient/likely causative
organism.
2. Know that viral infection should not be treated with antibiotic.
3. Know that samples be taken for culture and sensitivity before blindly prescribing
antibiotics, which may lead to difficulty in diagnosis.
4. Know prevalent organism and its sensitivity is of great help in antibiotic selection.
5. Be aware that dose, route and duration of treatment can vary.
6. Know the adverse effects of the antibiotic used.
7. Select antibiotics according to various scenarios.
________________________________________________________________________
121
DEPARTMENT OF PAEDIATRICS
LEARNING OUTCOMES: CLINICAL TEACHING
6th and 7th Semester

Posting duration: 6 weeks
At the
1.
2.
3.
4.
5.
end of this posting:

Student should learn to communicate with children and carers of children.
Student should have the capability to take complete history.
Student should recognize various patterns of growth and development in children.
Student should be able to perform a thorough physical examination.
Student should be able to recognize common paediatric problems / illnesses
including those of growth and development.
6. Student should be able to explain the pathophysiology of common paediatric
problems.
7. Student should be able to arrive at a reasonable diagnosis.
8th and 9th Semester

Posting duration: 4 weeks
During
1.
2.
3.
4.
this posting student:

Should consolidate the learning done in the previous posting.
Should lay more emphasis on improving the communication skill.
Should emphasize on diagnosis and differential diagnosis.
Should have the capability to request relevant basic investigation to arrive at a
diagnosis.
5. Should also lay emphasis on management of common paediatric problems.
6. Documentation, problem-solving and presentation skills to be fine tuned.
7. Participation in BLS course is expected.
122
LEARNING OUTCOME FOR SENIOR CLERKSHIP

(Semester 10)
Duration of posting: 4 weeks
At the end of training as senior clerkship a student should
1. Strengthen his skills acquired in previous semesters of good history taking and
conducting clinical examination (clinical skills)
2. Be able to formulate a provisional diagnosis with justifications.
3. Be able to list reasonable investigations for common pediatric illnesses and plan
management.
4. Have good communication skills and appropriate professional behavior.
5. Know the routine documentation procedures followed in the hospital from
admission to discharge
6. Have developed adequate competency in common clinical procedures done in the
ward.
123
Learning Outcomes
124
Department of ENT Head&Neck Surgery

Goal:
The comprehensive goal of the teaching of undergraduate students in ENT Head & Neck
Surgery is to prepare them to diagnose and manage common ENT disorders and
emergencies and to identify cases which needs immediate and long term specialist care
and refer them accordingly.
Knowledge:
At the
1.
2.
3.
4.
5.
6.
7.
end of course, the student shall be able to:

Correlate the basic sciences with common ENT disorders.
Identify the ENT emergencies.
Suggest common investigative procedures.
Interpret the investigations
Use appropriate medications
Manage socially challenged groups like elderly, and deaf mutism.
Recognize cases which needs immediate and long term specialist care and refer
them accordingly.
Skills
At the end of the course, the student should be able to
1. Elicit a good history, examine and diagnose common ear, nose and throat
problems.
2. Manage all ear, nose and throat problems at the primary level
3. Interpret the Pure tone audiograms
4. Care of tracheostomy patient
5. Recognize cases which needs immediate and long term specialist care and refer
them accordingly.
Integration:
Develop the right attitude and commitment to deliver the best possible medical care
for his/her patients and maintain confidentiality. Uphold the principles of ethical
conduct in all his dealings with patients.
125
Department of ENT
Programme: MBBS
Semester 6 & 7 (Lecture Topics)
ENT Theory Learning Outcomes (Semester 6 & 7)
Lecture 1: Anatomy of Ear &Physiology of Hearing
No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. To understand and describe anatomy of the ear.
II. Able to draw labeled diagram of ear
III. To discuss the Physiology of hearing and
equilibrium
I. Diseases of ear, nose and throat- P L Dhingra
II. Fundamentals of Ear, Nose and Throat
Diseases- S K De
III. Scott- Browns otolaryngology Alan G Karr
IV. Otolaryngology- Head & Neck surgeryCummings
V. Colour Atlas of ENT diagnosis- TR Bull
Lecture 2: Audiology& assessment of hearing

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. To recognize the type and degree of hearing
loss
II. To analyze and identify the site of hearing loss
III. To interpret the pure tone audiogram
I.
II.
III.
IV.
V.
Diseases of ear, nose and throat- P L

Dhingra
Fundamentals of Ear, Nose and Throat
Diseases- S K De
Scott- Browns otolaryngology Alan G
Karr
Otolaryngology- Head & Neck surgeryCummings
Colour Atlas of ENT diagnosis- TR Bull
126
Lecture 3: Diseases of Pinna and external auditory canal

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I.
Able to list the diseases of Pinna and

external auditory canal
II.
To recognize and differentiate the diseases
of Pinna and external auditory canal
III.
To manage the diseases of Pinna and
external auditory canal
I. Diseases of ear, nose and throat- P L Dhingra

II. Fundamentals of Ear, Nose and Throat DiseasesS K De
III. Scott- Browns otolaryngology Alan G Karr
Lecture 4: Disorders of middle ear, ASOM &. SOM

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I.
To define acute suppurative otitis
media and serous otitis media
II.
To diagnose acute suppurative otitis
and
serous otitis media
III.
To manage acute suppurative otitis
and
serous otitis media
I.
II.
III.
IV.
V.

Dhingra
Diseases- S K De
Karr
127
Lecture 5: CSOM-TTD
No.
1.
Item
Outcomes:
2.
Readings:
Outline
I.
II.
To define chronic suppurative otitis media

To diagnose and distinguish between
tubotympanic and attico-antral type of CSOM
III.
To manage chronic suppurative otitis media
(tubotympanic type)
I.
II.
III.
IV.
V.

Dhingra
Diseases- S K De
Karr
Lecture 6: Cholesteatoma-AAD& Complications of CSOM
No.
1.
Item
Outcomes:
2.
Readings:
Outline
I.
To define and diagnose the chronic

suppurative otitis media attico-antral disease
II.
To Enumerate, diagnose& refer the
complications of CSOM unsafe type
III.
To manage the CSOM (AAD type)
I.
II.
III.
IV.
V.

Dhingra
Diseases- S K De
Karr
128
Lecture 7: Menieres disease

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. To define the Menieres disease
II. To diagnose and Enumerate the differential
diagnosis of Menieres disease
III. To manage Menieres disease
I. Diseases of ear, nose and throat- P L
Dhingra
Diseases- S K De
III. Scott- Browns otolaryngology Alan G
Karr
Lecture 8: Otosclerosis
No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. To define Otosclerosis
II. To diagnose and Enumerate the differential
diagnosis otosclerosis
III. To manage otosclerosis
Dhingra
Diseases- S K De
Karr
129
Lecture 9: Acoustic trauma, NIHL & Ototoxicity

No.
Item
Outline
1.
Outcomes:
I. To define and differentiate between acoustic
trauma, noise induced hearing loss and
Ototoxicity
II. To diagnose acoustic trauma, noise induced
hearing loss and Ototoxicity
III. To know maximum permissible sound
exposure level in noise induced hearing loss
IV. To manage acoustic trauma, noise induced
hearing loss and Ototoxicity
2.
Readings:
I.
II.
III.
IV.
V.

Dhingra
Diseases- S K De
Karr
Lecture 10: Facial nerve disorders

No.
Item
Outline
1.
Outcomes:
I. Able to diagrammatically describe the
anatomy and course of facial nerve
II. To enumerate the etiology of facial nerve
disorders.
III. To diagnose and identify the site of lesion.
IV. To differentiate between UMN and LMN
type of facial palsy
V. To manage Bells palsy& herpes zoster.
Oticus
2.
Readings:
I.
II.
III.
IV.
V.

Dhingra
Diseases- S K De
Karr
130
Lecture 11: Deaf child

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. Define deaf mutism
II. To list the causes of deaf mutism
III. To able to evaluate and diagnose a deaf
child.
IV. To manage deaf mutism
I.
II.
III.
IV.
V.

Dhingra
Diseases- S K De
Karr
Lecture 12: Tumors of ear

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. Able to classify tumours of ear.
II. Able to diagnose Acoustic neuroma and
glomus tumour.
III. Describe the management plan for Acoustic
neuroma and glomus tumour.
I.
II.
III.
IV.
V.

Dhingra
Diseases- S K De
Karr
131
Lecture 13: Anatomy& physiology of nose &Para nasal sinuses

No.
1.
Item
Outcomes:
Outline
I.
II.
III.
IV.
2.
Readings:
To understand and describe anatomy of

Anatomy& physiology of nose &Para nasal
sinuses
Able to draw labeled diagram of lateral wall
of nose
Able to draw labeled diagram of septum of
nose
To discuss the Physiology of nose & para
nasal sinuses

Dhingra
Diseases- S K De
Karr
Lecture 14: External nasal Disease

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. Able to list the diseases of external nose
II. To recognize and differentiate the diseases
of external nose
III. To manage the diseases external nose

Dhingra
Diseases- S K De
Karr
132
Lecture 15: Facial Trauma, CSF rhino rhea & Fracture nasal bone
No.
1.
Item
Outcomes:
Outline
I.
II.
III.
2.
Readings:
Able to classify maxillofacial trauma.

Able to diagnose fracture nasal bone and
CSF rhinorrhoea
Describe the management plan for maxillofacial trauma

Dhingra
Diseases- S K De
Karr
Lecture 16: Acute & Chronic Sinusitis
No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. Define acute and chronic sinusitis
II. Describe and differentiate clinical features
of acute and chronic sinusitis
III. To manage acute and chronic sinusitis
Dhingra
Diseases- S K De
Karr
133
Lecture 17: Allergic Rhinitis & VMR

No.
1.
Item
Outcomes:
Outline
I.
II.
III.
2.
Readings:
Define allergic Rhinitis & VMR

Diagnose and differentiate allergic Rhinitis
& VMR
Able to manage allergic Rhinitis & VMR

Dhingra
Diseases- S K De
Karr
Lecture 18: Nasal septum &its diseases

No.
1.
Item
Outcomes:
Outline
I.
II.
III.
IV.
2.
Readings:
Enumerate the various septal diseases.

Able to diagnose deviated nasal septum,
septal haematoma and septal abscess
Recall the complications deviated nasal
septum, septal haematoma and septal abscess
Able to manage the deviated nasal septum,
septal haematoma and septal abscess

Dhingra
Diseases- S K De
Karr
134
Lecture 19: Nasal polyposis

No.
1.
Item
Outcomes:
Outline
I.
II.
III.
2.
Readings:
Define nasal polyps

Able to distinguish between antro-choanal
and ethmoidal polyp
Able to explain the management of nasal
polyposis.

Dhingra
Diseases- S K De
Karr
Lecture 20: Benign & malignant tumors of nose

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. Able to classify Benign & malignant
tumors of nose.
II. Able to diagnose juvenile
nasopharyngeal carcinoma and
carcinoma maxilla
III. Describe the management plan for
juvenile nasopharyngeal carcinoma and
carcinoma maxilla
Dhingra
Diseases- S K De
Karr
135
Lecture 21: Nasopharyngeal carcinoma

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. Enumerate the etiopathogenesis of
nasopharyngeal carcinoma.
II. Enumerate the clinical features of NPC
III. Able to diagnose nasopharyngeal carcinoma
IV. Describe the management of
nasopharyngeal carcinoma
Dhingra
Diseases- S K De
Karr
Lecture 22: Anatomy, Physiology of pharynx, larynx

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. To understand and describe anatomy of
pharynx and larynx.
II. Able to draw ILS findings of laryngeal inlet
III. To discuss the Physiology of pharynx and
larynx
Dhingra
Diseases- S K De
Karr
136
Lecture 23: Adeno-Tonsilitis & tonsillectomy

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I.
II.
III.
IV.
V.
Define acute and chronic tonsillitis

Enumerate the clinical features of tonsillitis
To describe adenoid facies
Able to diagnose tonsillitis and adenoditis
To plan the management for tonsillitis and
adenoditis

Dhingra
Diseases- S K De
Karr
Lecture 24: Quinsy, Retropharyngeal & Parapharyngeal abscess

No.
1.
Item
Outcomes:
Outline
I.
II.
III.
2.
Readings:
Define quinsy, retropharyngeal &

parapharyngeal abscess
Enumerate the clinical features of quinsy,
retropharyngeal & parapharyngeal abscess
Describe the management of quinsy,
retropharyngeal & parapharyngeal abscess

Dhingra
Diseases- S K De
Karr
137
Lecture 25: Acute and Chronic Laryngitis
No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. Define acute and chronic laryngitis
II. Describe and differentiate clinical features
of acute and chronic laryngitis
III. To manage acute and chronic laryngitis
Dhingra
Diseases- S K De
Karr
Lecture 26: Benign laryngeal disorders

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. Enumerate various benign laryngeal
disorders
II. Describe the clinical features of various
benign laryngeal disorders
III. Outline management of benign laryngeal
disorders

Dhingra
Diseases- S K De
Karr
138
Lecture 27: Laryngeal & Pharyngeal Malignancies

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. Enumerate the etiopathogenesis of
Laryngeal & Pharyngeal Malignancies
II. To enumerate the clinical features of
pharyngeal and laryngeal malignancies.
III. Able to diagnose laryngeal and pharyngeal
malignancies
IV. Describe the management of laryngo
pharyngeal carcinoma

Dhingra
Diseases- S K De
Karr
Lecture 28: Foreign body in ENT

No.
1.
Item
Outcomes:
2.
Readings:
Outline
I. List the various foreign bodies in ear, nose
and throat
II. Able to diagnose common foreign bodies in
ear, nose and throat
III. Able to manage common foreign bodies in
ear, nose and throat
Dhingra
Diseases- S K De
Karr
139
Lecture 29: Laryngotracheal trauma

No.
1.
Item
Outcomes:
Outline
I.
II.
III.
2.
Readings:
Discuss the etiopathogenesis of

laryngotracheal trauma.
Outline the clinical features of
Describe the management plan for

Dhingra
Diseases- S K De
Karr
140
ENT Clinical (Semester 8 & 9)

General Objectives:
The ENT Head& Neck program has been designed such that a student when he /she
completes the posting successfully, should be able to:
Demonstrate ability to take and record a complete otolaryngological history.

Perform a complete otolaryngological examination
Correlate history with examination findings.
Perform the relevant clinical tests (e.g. Tuning fork, Probe test) satisfactorily
Differentiate between life-threatening, serious and minor conditions and to
instigate treatment of common otolaryngological conditions.
Diagnose and manage common diseases of Ear, Nose and Throat.
Recognize the necessity in certain conditions to refer to specialists in this field
Conversant with the methods of special investigation of otolaryngological
complaints.
Conversant with the various modalities of treatment used in otolaryngology
Understand the implication of ENT problem in the society.
Appreciate Otolaryngology as a specialty and its scope in the future.
.
Specific Objectives:
Knowledge:
At the end of the posting he/she should be able to obtain a satisfactory history, perform
satisfactory clinical examination and plan management for a patient with following
problems.
1. Ear discharge
2. Hearing loss
3. Tinitus
4. Vertigo
5. Nasal discharge
6. Anosmia
7. Epistaxis
8. Sore throat
9. Hoarseness of voice
10. Dysphagia
11. Stridor
12. Foreign body in ENT
13. Headache and facial pain
14. Neck swellings
141
Skills
At end of the course, the student shall be able to perform:
1. Otoscopy
2. Tuning fork tests
3. Voice test
4. Ear syringing
5. Interpretation of Pure tone audiogram
6. Cold spatula test
7. Anterior rhinoscopy
8. Removal of Nasal foreign body
9. Anterior nasal packing
10. Throat examination
11. Neck examination
12. Tracheostomy care
At the end of the posting he/she should be able to obtain a satisfactory history, perform
satisfactory clinical examination and plan management for the following clinical cases.
Chronic suppurative otitis media

Acute suppurative otitis media
Perichondritis
Otitis externa
Otomycosis
Diffuse otitis externa
Kerotosis obturans
Malignant otitis externa
FB ear
Aural polyp
Serous otits media
Deviated nasal septum
Fracture nasal bone
Allergic rhinitis
Vasomotor rhinitis
Chronic sinusitis
Acute sinusitis
Antrochonal polyps
Ethmoidal polyps
Atropic rhinitis
Nasopharyngeal carcinoma
Chronic tonsillitis
Acute tonsillitis
Peritonsillar abscess
Neck swellings
142
Problem based Learning: Learning outcomes (Semester 8 & 9)
Topic 1: Ear discharge
Learning Outcomes:
1.
2.
3.
4.
5.
To
To
To
To
To
understand the anatomical divisions of the ear

be aware of the possible origins of aural discharge
do a clinical evaluation of ear discharge patients
discuss the management of patients with ear discharge
be aware of potential life threatening complications.
Topic 2: Hearing loss:

Learning Outcomes:
1.
2.
3.
4.
5.
6.
To understand the physiology of hearing and perception of sound

To be conversant with the types of hearing loss
To know the possible causes of hearing loss
To be familiar with methods of diagnosis and assessment of hearing loss
To do a clinical evaluation of patient with hearing loss
To discuss the management of hearing loss
Topic 3: Evaluation of Nasal mass
Learning Outcomes:
1.
2.
3.
4.
To
To
To
To
discuss the causes of nasal mass in children and adult

do a clinical evaluation of a patient with nasal mass
familiarize with investigations of nasal mass
discuss various treatment options for nasal mass
Topic 4: Epistaxis
Learning Outcomes:
1. To understand the vascular anatomy of nasal septum and lateral wall of the nose
2. To be conversant with causes of epistaxsis
3. To do a clinical evaluation of a patient with epistaxis
4. To discuss the management of epistaxis
143

Topic 5: Stridor and hoarseness
Learning Outcomes:
1. To evaluate the causes of stridor
2. To evaluate the causes of hoarseness
3. To plan the investigations for patient with stridor and hoarseness
4. To review the treatment of common voice disorders
Topic 6: Tracheostomy
1.
2.
3.
4.
5.
To
To
To
To
To
recall the indications of tracheostomy

understand the difference between intubation and tracheostomy
describe the types and techniques of tracheostomy
plan postoperative care of tracheostomy patients.
be aware of the complications of tracheostomy.
Topic 7: HIV manifestations In ENT
Learning Outcomes:
1. To discuss the Human Immunodeficiency Virus infection
2. To recognize ENT manifestations in HIV/AIDS
3. To plan management for HIV patients in ENT.
Topic 8: Evaluation of a case of dysphagia
Learning Outcomes:
1.
2.
3.
4.
5.
To
To
To
To
To
revise the functional anatomy of the pharynx and oesophagus

understand the physiology of swallowing
evaluate the causes of dyspahgia
do a clinical evaluation of a patient with dyspahgia
plan management for a patient with dysphagia
Topic 9: Neck swelling
Learning Outcomes:
1.
2.
3.
4.
To
To
To
To
understand the anatomical divisions and contents of the neck

discuss the etiopathology of neck swellings
evaluate neck swellings
plan management for a patient with neck swellings
144
Learning Outcomes
145
OVERALL GOAL:
The broad goal of the teaching of undergraduate students in Surgery is to produce
graduates capable of delivering efficient first contact surgical care.
Objectives of the overall course:

KNOWLEDGE
At the end of the course, the student should be able to:
describe aetiology, pathophysiology, clinical features, principles of diagnosis and

management of common surgical problems including emergencies, in adults and
children,
explain fluid and electrolyte therapy and acid-base disorders in surgical patients,
identify indications, complications and technique of blood transfusion,
express prevention of nosocomial infections in surgical patients and use of
personal protective equipment,
schedule the approach to surgical emergencies in the accidents and emergency
department, including diagnosis, investigations and initial management,
recognise prevention of preventable surgical diseases, including infections and
malignancies,
employ counseling and palliative care,
reproduce the types and routes of anaesthesia, their indications, mode of
administration, and side effects.
BEDSIDE CLINICAL SKILLS
At the end of the course, in a given surgical patient, the student should be able to:
take an adequate history and correctly and competently perform a

bedside clinical examination,
formulate an appropriate diagnosis,
list various laboratory tests for further management, and interpret the
results,
interpret common plain and contrast X-ray findings; and
recognise basic CT scan findings like liver and lung secondaries,
intracranial haematomas, abdominal neoplasms etc.
SKILLS CENTRE
At the
Given
end of the course, in a simulated trauma patient the student should be able to:
identify life threatening injuries; and
demonstrate the management of trauma using the ATLS protocol.
the appropriate task by the trainer, the student should be able to:
146
perform correctly common surgical interventions expected of a house

officer e.g. nasogastric tube insertion, urinary catheterization, non-surgical airway
management, per rectal examination, wound suturing etc.; and
describe the principles of Focused Abdominal Sonography in Trauma

(FAST) and demonstrate the technique of FAST on a standardized patient.
The learner should be able to:
perform an adequate surgical scrub and wear sterile gown and gloves
correctly.
At the end of the course, in a given surgical mannequin, the student should be able to:
perform resuscitation and monitoring of a trauma patient.

AFFECTIVE
At the end of the course, the student should be able to:
demonstrate the professional behaviour expected of a medical student with

patients and colleagues,
communicate effectively to obtain and provide information,
illustrate counselling,
take informed consent,
practice ethical medicine, following the established principles of ethical practice
and guidelines of Ministry of Health, Malaysia and
perform effectively as a member of a surgical team.
LEARNING OUTCOMES FOR SEMESTER 6 & 7 (Junior Clerkship)

KNOWLEDGE
At the end of the semester, the student should be able to:
describe the applied anatomy, physiology, biochemistry and pathology of various
systems in the human body that are affected by surgical disorders,
explain aetiology, pathophysiology and clinical features of common surgical
problems in adults and children,
state fluid and electrolyte therapy in surgical patients,
express indications, complications and technique of blood transfusion,
recognise prevention of nosocomial infections in surgical patients and use of
personal protective equipment.
SKILLS
At the end of the semester, in a given surgical patient, the student should be able to:
take an adequate history and competently perform a bedside clinical examination;
perform an adequate surgical scrub and wear sterile gown and gloves correctly.
At the end of the course, in a given surgical mannequin, the student should be able to:
perform correctly common surgical interventions i.e. nasogastric tube insertion,
urinary catheterisation, per rectal examination.
147
AFFECTIVE
communicate effectively to obtain information and
and guidelines of Ministry of Health, Malaysia.
Learning Outcomes of Lecture Topics in Semester 6 & 7 (Junior Clerkship)

Fluid & Electrolytes in surgery. Acid-Base balance
Prerequisites:
Before the session, the student must be able to:
state the distribution of fluid and electrolytes in the body compartments,
recall the physiology of fluid and electrolytes regulation and the role of the
kidneys,
list the normal range of Na+, K+, HCO3-, and Cl- in serum.
recognise electrolyte composition of other body fluids such as gastric juice, bile,
pancreatic juice and ileostomy contents.
recognise the composition of IV fluids in common usage: normal saline, Ringers
lactate, 5% Dextrose water and Dextrose saline.
state the definitions of pH, acid and base.
list normal values of pH and arterial blood gases.
reproduce the body buffers, the role of the kidneys and the lungs in regulating the
blood pH
At the end of the session the student should be able to:
calculate an average daily water balance of a healthy adult,
calculate perioperative fluid therapy,
interpret the values of serum electrolytes,
describe the causes, clinical features and management of
o dehydration and over hydration,
o hypo- and hyper-natraemia,
o hypo- and hyperkalemia,
o hypo- and hyperchloraemia,
describe the concept of a third space and list the conditions that can cause fluid
sequestration of this type,
interpret the values of arterial blood gases analysis.
describe the causes, clinical features and management of acid-base disorders:
metabolic acidosis and alkalosis; respiratory acidosis and alkalosis.
Surgical Nutrition. Surgical Haemostasis
Prerequisites: Before the session, the student must be able to:
state physiology of metabolic response to starvation, and
148
express the physiology of haemostasis.

At the end of the lecture the students should be able to:
discuss the assessment of nutritional status in surgical patients,
list various types of nutritional support and progress,
explain possible complications related to various types of nutrition support,
express different types of bleeding in surgery, and
describe the various measures to arrest bleeding.
Surgical Oncology: Basic principles. Skin tumours
recall the pathology of cancer, and
express the anatomy and functions of skin.
state the principles of cancer aetiology and the major known causative factors,
express the multidisciplinary management of cancer,
describe the principles of palliative care in patient with advanced cancer, and
describe the classification, the aetiology and clinical features and general
management of benign and malignant skin tumours.
Principles of Trauma Surgery Triage, Primary Survey with Simultaneous
Resuscitation, Secondary Survey
state the mechanisms of trauma, and
recognise the importance of time in trauma management.
define the principles of triage plan in trauma,
apply primary and secondary survey in trauma management,
identify immediate life threatening conditions in trauma patient,
discuss resuscitation techniques and steps in acute trauma case, and
list and analyse investigative procedures performed in trauma.
Plastic Surgery: Burns. Wound Cover
explain the anatomy of skin,
identify basic principles of fluid & electrolytes balance, and
recall basic principles of hypovolemic shock.
describe the assessment of area and depth of burns,
apply methods for calculating the rate and quantity of fluids to be given,
describe the care of burns wounds and the patient,
state the pathophysiology of electrical and chemical burns and
apply the principles of skin grafts and flaps appropriately.
149
Breast: Benign Breast Diseases Fibroadenoma. Fibroadenosis. Breast abscess.

Nipple discharge
state Gross anatomy and histological structure of breast, and
recall hormonal influence on breast.
state the pathophysiology and aetiology of fibroadenoma, fibroadenosis, breast
abscess and nipple discharge;
describe the clinical presentation, investigation and management of
Fibroadenoma, Fibroadenosis, Breast abscess and Nipple discharge.
Breast: Carcinoma Breast
state gross anatomy and histological structure of breast, and
recall hormonal influence on breast.
state the aetiology of carcinoma breast;
describe the clinical presentation, diagnosis and management of carcinoma
breast; and
apply the in-depth modern management of breast cancer.
Thyroid: Goitre. Hyperthyroidism. Solitary Thyroid Nodule
recall anatomy of thyroid gland and physiology of thyroid hormone synthesis.
describe the surgical anatomy of the thyroid.
state the pathogenesis of multinodular goitre and hyperthyroidism.
state the investigation of thyroid function. and
describe the types, clinical presentation, diagnosis and principles of management
of hyperthyroidism and thyroid failure.
state the causes of solitary thyroid nodule. and
identify the investigations of solitary thyroid swellings.
Thyroid: Carcinoma of thyroid. Thyroid surgery and Complications
recall anatomy of thyroid gland and physiology of thyroid hormone synthesis.
express the aetiology of carcinoma of thyroid,
describe the clinical presentation, diagnosis and management of carcinoma of
thyroid; and
discuss the indications, technique, the risks and complications of thyroid surgery.
Dysphagia & Oesophageal cancer. Gastro-oesophageal Reflux Disease (GERD)
150
repeat anatomy of oesophagus especially normal anatomical narrowing of

oesophagus,
state motility of esophagus, and
recall physiology of upper & lower esophageal sphincters.
express the anatomy and physiology of the oesophagus;
list the causes of dysphagia; and
describe the aetiology, pathology, clinical features, investigations and treatment of
carcinoma oesophagus.
describe the aetiology, clinical features, investigations and management of gastrooesophageal reflux disease.
Stomach and duodenum: Peptic Ulcer Disease & Complications of peptic ulcer.
Carcinoma Stomach
state anatomy of stomach and structures at stomach bed,
recall physiology of stomach and duodenum, and
causes of a mass in epigastrium
express the anatomy and pathophysiology of the stomach; and
describe the aetiology, pathology, clinical features, investigations, complications
and treatment of peptic ulcer disease.
describe the aetiology, pathology, clinical features, investigations, and treatment
of carcinoma stomach.
Abdominal Injury: Liver Trauma. Ruptured Spleen
reproduce surgical anatomy of liver especially blood supply,
recall segmental anatomy of liver, and functions of liver,
state physiological basis of liver function tests,
repeat anatomy of spleen,
state clinical signs of splenomegaly,
state hematological changes after splenectomy, and
recognise pathophysiology of hypovolemic shock.
describe the clinical features, investigations, complications and management of
liver injury,
express the anatomy and physiology of the spleen, and
describe the causes, clinical features, investigations, complications and treatment
of splenic rupture.
Liver: Abscesses of Liver. Tumours of Liver
reproduce surgical anatomy of liver especially blood supply,
recall segmental anatomy of liver, and functions of liver, and
151
state physiological basis of liver function tests,

discuss the aetiology, clinical features, investigations and treatment of pyogenic
and amoebic liver abscesses;
explain the aetiology and pathophysiology of tumours of the liver; and
describe the clinical features, investigations, complications and treatment of
tumours of the liver.
Pancreas: Acute and Chronic Pancreatitis, their complications
recall anatomy of pancreas,
state physiology of pancreatic secretions, and
memorise pharmacology of analgesic drugs.
state the surgical anatomy of the pancreas;
express the aetiology and pathophysiology of acute and chronic pancreatitis; and
describe the clinical features, investigations, complications and management of
acute and chronic pancreatitis.
Pancreas: Carcinoma Pancreas
define anatomy of pancreas,
recall exocrine & endocrine secretions of pancreas, and
memorise bilirubin metabolism.
express the anatomy and physiology of the pancreas;
identify the investigations of the pancreatic diseases; and
describe the clinical features, diagnosis, and treatment of pancreatic cancer.
Gall Bladder : Cholelithiasis & Cholecystitis
recall anatomy of gallbladder & biliary tract, and
state physiology of bile secretion & composition of bile.
state the pathophysiology and aetiology of formation of gall stones in the
gallbladder and bile duct,
describe the clinical presentation and management of gall stones in the
gallbladder and bile duct,
identify the techniques used for imaging the biliary tree,
describe the potential complications of stones in the bile duct and gall bladder,
and
state the advantages of laparoscopic cholecystectomy.
Appendix: Acute Appendicitis and Complications
152
recall anatomy of appendix and physiology of pain.

express the surgical anatomy of the vermiform appendix,
explain the pathogenesis of acute appendicitis,
describe the clinical signs and differential diagnoses of appendicitis,
explain the basic surgical techniques of both open and laparoscopic
appendicetomy,
describe the management of problems following appendicetomy,
describe the pathogenesis, clinical features and management of appendicular
mass,
describe the pathogenesis, clinical features and management of appendix abscess,
and
describe the pathogenesis, clinical features and management of perforation of
appendix.
Intestines Diverticulosis. Volvulus. Prolapsed rectum.
state the anatomy of colon, rectum anal canal, and
recall the physiology of pelvic floor musculature.
explain the pathophysiological process leading to colonic diverticulosis,
describe the clinical features, complications, investigations, diagnosis and
treatment of colonic diverticulosis,
describe the clinical features, complications, investigations, diagnosis and
treatment of volvulus, and
describe the pathophysiological process leading to prolapsed rectum, their clinical
features and principles of treatment.
Intestinal obstruction Types, causes, pathophysiology, clinical features,
investigations and management
recognise the anatomy of gastrointestinal tract, and
state the physiology of gastrointestinal tract motility.
recognize the pathophysiology of dynamic and adynamic intestinal obstruction,
state the cardinal features on history and physical examination,
list the causes of large and small bowel obstruction,
discuss the principles of management of patients with acute intestinal obstruction,
and
describe the indications for surgical intervention in intestinal obstruction.
Intestines Polyp. Colorectal and Anal Canal Malignancies
recognise the anatomy of rectum and anal canal, and
recall the lymphatic drainage and blood supply of rectum and anal canal.
153

state the classification of different types of colonic polyps,
explain the adenoma-carcinoma sequence,
describe the clinical features, investigations and treatment of colonic polyps,
state the classification of different types of colorectal and anal canal malignancies,
review the pathology of colorectal and anal canal malignancies, and
describe the clinical features, complications, investigations and treatment of
colorectal and anal canal malignancies.
Anal canal Haemorrhoids. Pilonidal sinus. Anorectal abscesses. Fissure -in-ano.
Fistula-in-ano.
recognise the anatomy of pelvic floor, ischiorectal fossa, gluteal region, rectum
including blood supply of rectum, and
recall the physiology of pelvic floor muscles and tissue planes.
At the end of the session the students should be able to:
review the anatomy of the anus and anal canal and their relationship to surgical
disease,
describe the pathology, clinical presentation, differential diagnosis, investigation,
and treatment of diseases that affect the anus and anal canal,
recognise that the anal disease is common and its treatment tends to be
conservative, although surgery may be required, and
recognise that too aggressive or inappropriate surgery may render the patient
permanently disabled.
Hernia Abdominal wall & groin hernias. Wound dehiscence (burst abdomen)
recall the anatomy of anterior abdominal wall,
state the anatomy of inguinal canal and femoral canal.
review the composition of a common hernia,
state the classification of different types of abdominal wall & groin hernias,
recognise the pathophysiology of strangulated hernias,
recognise that femoral hernias are especially susceptible to strangulation,
describe the clinical features, complications, investigations and diagnosis of
abdominal wall & groin hernias, and
describe the principles of the management of abdominal wall & groin hernias.
discuss the predisposing factors, clinical presentation, prevention and
management of wound dehiscence.
Neurosurgery Head injury
state the cerebral anatomy,
recall the the physiology of cerebral blood flow, and
reproduce the pathophysiology of raised intracranial pressure.
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At the end of the session the student must be able to:

apply advanced trauma and life support (ATLS) guidelines,
discuss the neurological assessment of (conscious level) by Glasgow coma scale,
recognize the features of increased intracranial pressure and its management,
order and interpret the skull x-ray and CT scan,
discuss the surgical treatment for extradural haematoma, and
state the surgical treatment for subdural haematoma.
Thoracic surgery Thoracic injury. Lung tumour
reproduce the gross anatomy of thoracic cage and lungs, and
memorise the physiology of homeostasis and respiration.
recognise that the management of injury is based on physiology rather than
anatomy,
state the surgical anatomy of the chest,
express the pathophysiology of chest injury,
recognise the limitations of clinical assessment in the injured patient with chest
injury,
state the special investigations needed in a case of chest injury,
state the operative approaches to the thoracic cavity,
describe the special features of an emergency room thoracotomy for haemorrhage
control,
describe the indications for and techniques of the emergency thoracotomy, and
describe the classification, clinical features, complications, investigations,
diagnosis and management of the lung tumours.
Paediatric Surgery Hirschprungs disease. Anorectal malformation. Congenital
hypertrophic pyloric stenosis (CHPS). Intussusceptions.
Prerequisites: Before the session the student must be able to:
recall the anatomy and embryological development of gastrointestinal tract.
At the end of the lecture the student should be able to:
discuss initial measures in Hirschprungs disease and ano-rectal malformation,
list the clinical presentations in Hirschprungs disease and ano rectal
malformation,
state investigations to get diagnosis,
describe management plan in Hirschprungs disease and ano-rectal malformation,
and
list the associated congenital malformations in Hirschprungs and ano-rectal
malformation.
describe the pathology, clinical presentation, investigations and treatment of
Infantile Hypertrophic Pyloric Stenosis and Intussusception.
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Paediatric Surgery Undescended testis. Hypospadias. Tracheo-oesophageal fistula.

Cleft lip & palate.
state the embryological development of urinary tract,
recall the anatomy of urinary tract and physiology of urinary secretion and
drainage,
reproduce the embryological development of oesophagus and trachea,
state the embryological development of face and palates.
describe the embryology and anatomy of testis; pathology, consequences, clinical
features, and the reasons for intervention for incompletely descended testis,
state the classification and treatment of hypospadias,
describe the pathophysiology, presentation, diagnosis and treatment of tracheooesophageal fistula, and
express the aetiology, classification, and principles of reconstruction of cleft lip
and palate
Urology Urolithiasis
memorise the anatomy of urological system and the sites of physiological
narrowing of ureter, and
recall the physiology of urine formation.
classify different types of urinary stones,
review the pathophysiology of their formation;
describe the aetiology, complications, clinical presentation and surgical
management of obstruction to the upper urinary tract, and
describe the aetiology, presentation and the modern management of urinary tract
calculi.
Urology Trauma. Infection.
define the anatomy of upper and lower urinary tract and its blood supply,
recall the physiology of urinary secretion and excretion, and
reproduce the pathophysiology of haemorrhagic shock.
describe presentation and principles of management of trauma to kidney, ureter,
urinary bladder and urethra; and
state the aetiology, pathology, presentation, investigation and treatment of upper
urinary tract infections (acute and chronic pyelonephritis, renal carbuncle,
perinephric abscess, renal tuberculosis etc.)
Urology Urinary Tract Obstruction
define the anatomy of upper and lower urinary tract and its blood supply, and
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recall the physiology of urinary secretion and excretion.

express the types of urinary obstruction, causes (such as urinary calculi, BPH, Ca
prostate etc.), pathophysiology, and presentation of urinary obstruction, and
state the emergency room measure for acute urinary obstruction, and principles of
management for urinary obstruction (e.g. BPH etc.)
Urology Tumours (Kidney, Bladder, and Prostate)
reproduce the anatomy of the urogenital tract, and
state the lymphatic drainage of the urological organs.
describe the types of renal neoplasm, symptoms and signs, and surgical
management of renal neoplasm,
explain the different types of carcinoma of urinary bladder; aetiology, staging,
clinical features, investigations and treatment for the carcinoma of the bladder,
and
indicate the pathology, clinical features, investigation and treatment of Ca
Prostate.
Urology - Scrotum: Hydrocele. Varicocele. Spermatocoele. Epididymal cyst.
recall the anatomy of scrotum, and
state the physiology of secretion and absorption at the tunica.
classify the different types of hydrocele,
describe the clinical features, complications, investigations, diagnosis of
hydrocele, varicocele, spermatocoele and epididymal cysts, and
describe the principles of management of hydrocele, varicocele, spermatocoele
and epididymal cysts.
Urology Torsion of testis. Epididymo-orchitis. Fourniers gangrene. Phimosis.
Paraphimosis.
state the anatomy of scrotum and testes, including blood supply and lymphatic
drainage of the testes, and
memorise the anatomy of inguinal canal.
recognise testicular torsion as a urological emergency,
describe the aetiology, complications and clinical presentation of the common
diseases of the penis, testis and the principles of their surgical management; and
identify the common surgical infections of the scrotum and testis and their
management.
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Urology Carcinoma penis. Testicular tumours.

state the anatomy of penis and testes including blood supply and lymphatic
drainage of these organs.
express the aetiology, pathology, clinical features, and treatment of carcinoma
penis, and
describe the classification, clinical features, complications, investigations, and
management of testicular tumours.
Operative Surgery Peri- & Post-operative care. Informed consent
take the detailed history of the patient with symptoms related to the various
systems,
perform the detailed general physical examination and the detailed examination of
the various systems, and
memorise the metabolic response to injury.

At the end of the session the student must be able to:
describe the general preparation for surgery and anaesthesia,
discuss the special pre-operative preparation such as bowel preparation for colorectal surgery, preparation for jaundiced patient, preparation for thyrotoxic
patient, etc.,
describe the perioperative management of the patient with diabetes,
cardiovascular problems - hypertension, ischaemic heart diseases and heart
failure, patients with COPD, and anti-coagulant therapy, and
explain stages in the consent process.
Operative Surgery Sterilization and disinfection. skin preparation. Sutures
recall the aetiology and

mode of infection in surgical practice.
recognize the importance

of sterilization and disinfection in prevention and control of surgical site infection,
define asepsis, antisepsis,

decontamination, cleaning, disinfection and sterilization,
describe the methods of

disinfection and sterilization,
apply appropriate methods

of sterilization and disinfection,
explain the advantages and

disadvantages of different methods of sterilization and disinfection, and
describe the skin preparation of patient for operation.
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Operative surgery Minor surgical procedures (excision of subcutaneous lumps.

I&D of abscess. Lymph node biopsy)
recall the anatomy of the skin and neck lymph nodes,
pathology of common skin lesions recognised for minor surgery.
At the end of the lecture the student should able to:
discuss types of anaesthesia used in minor surgery,
list the terms used in minor surgery,
recall preoperative assessment in minor surgery,
list possible complications occurred in minor surgery, and
discuss criteria required for day care surgery.
Learning Outcomes of PBL Topics in Semester 6 & 7 (Junior Clerkship)
Ulcer, sinuses and fistula
At the end of the course the student should be able to:
define ulcer, sinuses and fistula,
discuss the aetiology, classification, and clinical features of malignant skin ulcers,
and
apply principles of general management of malignant skin ulcers,
classify causes of ulcers, sinuses and fistula, and
describe the aetiology, clinical signs and management of sinuses and fistula in
general.
Neck swellings (enlarged neck lymph nodes)
recognize the anatomy of the triangles of neck;
state the causes of midline and lateral neck swellings;
discuss the aetiology, classification, clinical features, investigations, and
apply principles of general management of enlarged neck lymph nodes.
Peripheral vascular disease
differentiate between pain originating from bones, muscles, joints and pain due to
peripheral vascular diseases,
demonstrate how to clinically locate the pulses of the various arteries palpable in
the lower limb,
identify the sight of obstruction in a suspected case of peripheral vascular disease,
order the relevant investigations needed to diagnose disorders of the limbs that
present as pain in the lower limb,
recognize limb threatening emergency diseases,
outline the principles of treatment of common diseases of arteries, veins and
lymphatics, and
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list the complications of peripheral arterial and venous diseases and outline the
principles of their management.
Learning Outcome of skills lab sessions in Semester 6 & 7 (Junior Clerkship)

Nasogastric tube insertion
recognise the indications for the procedure,
identify required equipments for the procedure,
demonstrate competently the technique of insertion of nasogastric tube on a
mannequin,
discuss the complications of the procedure.
Urethral catheterization
state indications and contraindications for urethral catheterization in male,
identify required equipments for the procedure,
demonstrate competently the technique of urethral catheterization in male on a
mannequin, and
apply aftercare of the procedure.
Digital rectal examination
state the indications for digital rectal examination,
identify required equipments for the procedure, and
demonstrate competently the technique of digital rectal examination on an
mannequin.
Surgical scrubbing, gowning and gloving
recall preparation before scrubbing,
identify the types of scrub disinfectant solutions used in operating theatre for
hand-washing, and their mechanisms of action,
perform hand-washing systematically under supervision,
recognise the precautions during the process of gloving/Degloving, and
demonstrate the donning a gown and gloves correctly under supervision.
Learning Outcome of SDL Topics in Semester 6 & 7 (Junior Clerkship)

TOPIC 1: Shock. Wounds and wound healing
At the end of the SDL the student should be able to:
define and classify shock,
report the pathophysiology and clinical features of shock,
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apply the principles and priorities of resuscitation of patient with shock,

employ appropriate monitoring and end points of resuscitation,
review the various types of wounds,
state the factors influencing the wound healing,
describe normal and abnormal wound healing,
express the management of acute wound.
TOPIC 2: Surgical Infection. Antibiotics in surgery

recognize risk factors for increased risk of wound infection,
explain the classification of sources of infection,
discuss the types of localized infection (abscess, cellulitis and lymphangitis),
report the definitions of infected states such as SIRS, MODS, MSOF, bacteraemia
and sepsis,
discuss the specific wound infections such as gas gangrene, tetanus, synergistic
spreading gangrene,
explain principles of treatment of surgical infection,
arrange classification of surgical wounds,
discuss the indications for and choice of prophylactic antibiotics,
review the spectrum of commonly used antibiotics in surgery and the principles of
therapy,
recognize the misuse of antibiotic therapy with the risk of resistance such as
methicillin resistant Staphylococcus aureus (MRSA) and emergence of
complications such as Clostridium difficile enteritis.
TOPIC 3: Haemorrhage
explain pathophysiology, types, degree/ classification, and management principles
of haemorrhage in surgical practice.
TOPIC 4: Blood transfusion and blood product
list the indications and complications of blood transfusion, presentation and
management of complications, and
express the use of blood and blood product.
TOPIC 5: Lymphatic system. Venous disorders
explain the applied anatomy and physiology of the lymphatic system,
describe the aetiology, pathogenesis, clinical features, diagnosis and management
of lymphoma, and
describe the aetiology, applied anatomy, pathogenesis, clinical features, diagnosis
and management of lymphoedema.
TOPIC 6: Peripheral arterial disease
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express the cause and effects of arterial stenosis and occlusion,

identify features, investigations and treatment options of chronic arterial stenosis
or occlusion in the leg, and
discuss the causes, clinical features and treatment of acute limb ischaemia.
Learning Outcome of Clinical Teaching (Semester 6 & 7) (Junior Clerkship)

TOPIC 1: History taking in surgical patient
demonstrate completeness of history taking in a surgical patient,
elicit all relevant information,
analyse information obtained from the patient,
demonstrate ability of good presentation skills and
express factual knowledge.
TOPICS 2: General examination
demonstrate how to elicit physical signs on general appearance of patient, hands,
vital signs and head-to-toe examination, and
appraise the overview of the general state of health.
TOPICS 3: Examination of swelling and ulcer
demonstrate competently examination technique for swelling / ulcer,
elicit physical signs,
interpret clinical findings and
synthesize information to arrive at diagnostic possibility.
TOPICS 4: Examination of abdomen / thyroid / breast.
apply knowledge of anatomy of abdomen/ breast / thyroid,
demonstrate examination technique for abdomen/ breast / thyroid,
elicit physical signs on abdomen, breast and thyroid,
interpret the clinical findings, and
synthesize information to arrive at diagnostic possibility.
MMMC. Department of Surgery. Recommended Books.
Theory Text Books:
1. Bailey and Loves Short Practice of Surgery (26th Ed)
2. Principles and Practice of Surgery
(A.P.M Forest, D.C Carter, L.B. Macleod) (5th Ed)
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Reference Text Books:
1. Emergency Surgery by Hamilton Bailey (18th Ed)
2. Pyes Surgical Handicraft
3. Clinical Surgery (Michael M. Henry & Jeremy M. Thompson) (2nd Ed)
4. Textbook of Surgery (David C Sabiston) (19th Ed)
5. Principles of Surgery (S.J. Schwartz) (9th Ed)
Clinical Books:
1. Clinical Methods in Surgery (S.Das) (10th Ed)
2. An Introduction to symptoms and Signs of Surgical Disease
(Norman L. Browse) (4th Ed)
Basic Sciences reference Book:
1. Synopsis of Surgical Anatomy (McGregor)
2. Clinically oriented anatomy (Keith .L. Moore, Arthur F Dalley)
Journal: 1.Surgery International
Web Link: 1. http://surgical-tutor.org.uk
2. www.emedicine.com
3. http://www.ncbi.nlm.nih.gov/pubmed
4. E-learning portal: mbbs.manipal.edu.my
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SEMESTER 8/9 LEARNING OUTCOMES

KNOWLEDGE
describe aetiology, pathophysiology, clinical features, principles of diagnosis and
investigations of common surgical problems including emergencies, in adults and
children;
explain fluid and electrolyte therapy and acid base disorders in surgical patients;
describe indications, complications and technique of blood transfusion;
indicate prevention of nosocomial infections in surgical patients and use of
personal protective equipment; and
describe approach to surgical emergencies in the Accidents ad Emergency
Department, including diagnosis, investigations and initial management.
SKILLS
At the end of the semester, in a given surgical patient, the student should be able to:
take an adequate history and correctly perform a bedside clinical
examination;
formulate an appropriate diagnosis;
list various laboratory tests for further management, and interpret the
results;
interpret common plain and contrast X-ray findings;
recognize basic CT scan findings like liver and lung secondaries,
intracranial haematomas, abdominal neoplasms etc.
At the end of the semester, in a given surgical mannequin, the student should be able to:
perform correctly common surgical interventions expected of a house
officer e.g. nasogastric tube insertion, urinary catheterization, nonsurgical airway management, per rectal examination, wound suturing
etc.
AFFECTIVE
communicate effectively to obtain and provide information and
and guidelines of Ministry of Health, Malaysia.
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Semester 10
CLINICAL LEARNING OUTCOMES FOR FINAL YEAR (Semester 10)
1. Overall Outcome:
At the end of the semester the student should be able to demonstrate adequate
competency (as determined by the surgical department faculty and a panel of examiners)
in all the cognitive, psychomotor and affective domains as listed earlier for the overall
surgical course.
2. Objectives
At the end of Surgery posting student must be able to: analyse the nature of problems related to medical care, develop knowledge and
understanding of disease processes,
apply skills acquired to obtain history, conduct clinical examination and formulate
a provisional diagnosis,
apply the skills acquired to communicate effectively both orally and in writing
with patients and relatives, with doctors and other members of the health care
team, within the hospital and community settings,
plan and conduct, if applicable, the necessary investigations,
safeguard patients and his own well-being by adopting all the necessary safety
precaution in handling equipments and biological materials,
conduct all interactions with patients and community in a professional manner, in
particular respect for dignity of patient, concern for relatives and awareness of
legal and ethical issues and
work as a member of the team respecting the roles of each and the contributions
they provide to ensure that comprehensive health care is given.
3. Content
To acquire the skills in:handling of clinical emergencies,

communicating with patient and relatives in specific areas particularly pain relief
and the dying or terminally ill patient,
- patient education in health promotion and prevention of illnesses,
- awareness of issues related to medical ethics and medico-legal aspects,
- maintenance of good written records,
competent in making a diagnosis with measurable accuracy surgical cases including
emergencies and identifying the acutely ill,
participate in resuscitation and management of critically ill patients,
observe and assist conduct of diagnostic and therapeutic procedures,
observe and assist, if directed, in surgical operations particularly common surgical
procedures,
-
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in the Operation Theatre, observe surgical operations conducted on patients clerked

and follow up patients through recovery area until patients are sent back to the
ward,
interpret laboratory results accurately and
monitor and follow up progress of patients until discharge and keep accurate notes.
Learning Outcome of PBL Topics in Semester 10

1. Upper & Lower GI haemorrhage
2. Acute Abdomen
3. Trauma
Upper & lower GI haemorrhage
AIMS
To know the basic physiological response to bleeding
To know anatomy of upper GIT
To know the causes & clinical features of upper GI haemorrhage
To learn the emergency management of upper GI haemorrhage
Learning Outcomes
apply principles of emergency management in the upper GI bleeding.
Describe the underlying causes and definitive management of upper GI bleeding.
Acute Abdomen
AIMS
To
To
To
To
know the definition & scope of acute abdomen.

know the surgical & non-surgical causes of acute abdomen
know the anatomical basis of acute abdomen
revise the pain pathways
LEARNING OUTCOMES
apply the principles of emergency management of acute abdomen and
Indicate non-surgical causes of acute abdomen.
Trauma
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Learning Outcomes
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OVERALL CLINICAL LEARNING OUTCOMES

Goal
The student should be able to elicit relevant history (obstetric & gynecological) and
analyze it, demonstrate the ability to do a methodical and technically correct method
of (obstetric & gynecological) examination and interpret clinical findings, and
formulate a diagnosis.
At the end of Semester 9 posting, students should acquire the following:
Knowledge
1.
2.
3.
4.
5.
Antenatal care, postnatal care & normal labor

Identification of and investigations in High Risk Pregnancy
Recognition of deviations from normal labor & complications during labor
Recognition and description of common conditions in Gynecology
Comprehends definition, pathogenesis, clinical features, evaluation and treatment
of common conditions in obstetrics and gynecology.
6. Review of theatre asepsis with ability to explain common obstetrical and
gynecological surgical procedures performed (correlates anatomy and
pathogenesis with surgical procedure)
7. Cancer screening protocols with staging of common gynecological malignancies
Skills
1. Able to take history and examine obstetric & gynecology cases (communicative,
cognitive & psychomotor skills)
2. Able to analyze history and interpret clinical findings (cognitive & interpretative
skills)
3. Able to summarize & arrive at a provisional diagnosis (intellectual, analytical
skills)
4. Able to monitor progress of labor and recognize deviations from normality
(intellectual, psychomotor skills & analytical skills)
5. Able to evaluate if a patient regarding mode of delivery depending on risk factors
(intellectual, analytical skills)
6. Identify acute emergencies in O&G, and take initial steps in acute emergency
management (intellectual, analytical & communicative skills)
7. Identify (by history and clinical examination) and investigate common benign and
malignant conditions (intellectual, psychomotor & interpretative skills)
8. Observe cancer-screening procedures (Pap smear, Pipelle, TVS)
9. Counsel patients with common O & G problems (with consent-taking communicative skills)
10. Document precise and relevant details of cases (intellectual, analytical skills)
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Attitude
1. Empathy and compassion for patients and good bedside manners
2. Communicate effectively with patients and relatives
3. Team spirit, professionalism and good communication with colleagues
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Learning Outcomes for Lecture Topics (Semester 6-7)

Lecture 1: Physiological and anatomical changes in pregnancy - cvs, rs, blood, renal,
hormonal
Learning Objective : The student should
1. be able to list CVS changes during pregnancy , in relation to pulse rate, blood pressure
and cardiac output etc..
2. evaluate how these changes affect the course and management of heart disease during
pregnancy.
RS: 1. be able to list the physiological changes that occur in the respiratory system
during pregnancy.
2. judge the impact that these might have on preexisting respiratory illness.
Lecture 2: Blood
1. be able to list the haematological changes during pregnancy.
2. recall the basis for physiological anemia.
3. recall the normal coagulation pathways and the changes that occur in pregnancy.
Lecture 3: Renal
1. be able to list the anatomical and physiological changes in the renal system during
pregnancy.
2. recall normal values for renal function tests during pregnancy.
3. recall the incidence and significance of renal glycosuria during pregnancy.
4. analyse how these anatomical & functional changes will alter the bladder habits
5. revise why urinary infections are more common during pregnancy.
Lecture 4: Metabolism
1. recall the calorie requirements and recommendations during pregnancy.
2. recall the normal weight gain during pregnancy.
3. explain the physiology of carbohydrate metabolism during pregnancy.
4. list the reasons for carbohydrate intolerence during pregnancy.
5. describe physiology of protein & fat metabolism during pregnancy.
Lecture 5: Hormones
1. interpretation of urinary/serum hCG levels in normal /abnormal pregnancies.
2. list & assess the significance of hormones produced from the placenta.
3. describe the physiology of lactation.
4. recall the changes that take place in the pituitary.
5. describe the physiological and biochemical changes in thyroid function during
pregnancy.
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Lecture 6: Anatomical
Recall the anatomical changes in the external genitalia as well as uterus and cervix along
with the changes in their blood supply and should be able to enumerate the signs seen
with the changes in the organs.
Learning Outcome : The student should be able to
1. assess pregnancy in a woman
2. differentiate normal pregnancy from pathological conditions
Lecture 7: Antenatal care and high-risk pregnancy
1.
be able to define aims and objectives of antenatal care
2.
recall the routine antenatal schedule
3.
be able to describe procedures and investigations at each scheduled visit
4.
formulate antenatal advice during these visits
5.
identify high risk pregnancy
6.
assess the significance of the same in developing countries
7.
be able to describe the screening procedures for the same
1. offer routine antenatal care for a low-risk pregnancy, regarding nutritional
requirements, healthy lifestyle, iron proohylaxis, immunization and schedule for antenatal
visits.
2. identify high risk pregnancy based on history and physical examination.
Lecture 8: Facts about fetus and pelvis / mechanism of normal labor
1. recall the areas of the fetal skull, anatomy of sutures, fontanelles, diameters of skull,
2. recall moulding and caput formation
3. describe pelvis, all the diameters and conjugates, boundaries of cavity, outlet and
midpelvis, understand pelvic axis and pelvic joints.
4. define mechanism of labour
5. be able to list all events in order and understand the mechanism behind each event.
1. demonstrate the diameters on the fetal skull and their various positions in the maternal
pelvis
2. demonstrate the measurement of conjugates in the maternal pelvis
3. demonstrate the events in mechanism of labour
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Lecture 9: Clinical features and management of normal labor - 1st and 2nd stage
1. describe the clinical course of 1st and 2nd stages of labour , dilatation and taking up of
the cervix, rupture of membranes and descent of the fetus.
2. construct partogram
1.identify the stage of labour based on clinical findings
2.construct a partogram
Lecture 10: 3rd stage -clinical features and management

1.be able to define third stage of labour
2.recall signs of placental separation
3.recall methods of placental separation
4.dramatize how to examine the placenta and the baby
5.recall active management of third stage of labour
6.revise complications and methods to prevent them
1.demonstrate placental delivery and placental examination
2. identify postpartum haemorrhage
Lecture 11: Postnatal care / lactation

1.recoznise the aims and objectives of postnatal care,its advantages
2. dramatize to examine mother and baby
3.apply the general advices and family planning guidance along with management of
minor ailments
4.describe physiology of lactation
1.arrange post-natal care to a low-risk mother
2.formulate contraceptive advice to post-natal mother
Lecture 12: Gdm / dm complicating pregnancy

1. define GDM, screening for GDM, how to do GTT and the criteria to diagnose GDM
based on GTT
2. recall complications of GDM-maternal and fetal
3.recall objective of preconceptional counselling
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4.plan dietary therapy for GDM

1.plan screen for GDM, diagnose GDM in a pregnant woman based on GTT values
2.Formulate diabetic diet in GDM patient
3.recognize the complications in a GDM patient
Lecture 13: Abortion / recurrent abortion

1. be able to define miscarriage and different types of miscarriage
2.recall the etiological factors
3. distinguish different types of miscarriage based on history, examination and USG.
4.define septic miscarriage, know clinical features, grading and complications and
outlines of management
5.recall the etiological factors behind 1st and 2nd trimester recurrent miscarriages and
investigations to diagnose them
1.distinguish between all different types of miscarriage based on history and examination
2.interpret the USG findings and diagnose miscarriage
3.diagnose septic miscarriage based on history and examination findings
Lecture 14: Pap smear / carcinoma cervix

1.recall the objective behind pap smear , the procedure and the classification of cytology
smears
2.describe dysplasia and CIN
3.plan the treatment of dysplasia and CIN
4.recall the pathology of carcinoma cervix and its mode of spread
5.recall signs and symptoms of carcinoma cervix
6.recall the FIGO staging for carcinoma cervix and treatment for various stages of
carcinoma cervix
1.perform pap smear test
2.diagnose a case of carcinoma cervix based on history and examination
2.plan treatment based on stage of CIN and carcinoma cervix
Lecture 15: Physiology of menstruation

1.describe concepts relating to hypothalamo-pituitary-ovarian axis.
2.describe steroidogenesis
3.recall the normal sequence of events in puberty.
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4.recall the physiology of normal menstual cycle .

5.describe the ovarian & endometrial events that take place during follicular phase,
ovulation & during secretory phase.
1.construct the hormonal profile on graph
2.assess the phase of menstrual cycle based on histology pictures
Lecture 16: Physiology of ovulation and anovulation

Learning Objective : The student should be able to
1.describe the physiology of ovulation
2.define different disorders of menstruation
3.differentiate between anovulatory and ovulatory dysfunctional uterine bleeding and
understand the histological findings for each
4.appraise the modalities of management and understand the principles behind
management of the same
1.judge different disorders of menstruation based on history
2.evaluate different menstrual disorders based on history, examination and histological
findings
3.evaluate anemia, thyroid and haematological disorders based on general physical
examination.
4.perform an abdominal examination to detect any mass per abdomen.
5..list differential diagnosis, based on the history and examination.
Lecture 17: Fibroid uterus

Learning Objective : The student should be able to
1. recall etiology and anatomical classification of fibroid uterus
2. assess signs and symptoms and differential diagnoses
3.recall secondary changes in fibroid uterus
4. plan treatment modalities
1. evaluate fibroid uterus based on history and examination findings
2.plan treatment for different clinical scenarios based on history and clinical examination
Lecture 18: Contraception: temporary and permanent methods

Learning Objective : The student should be able
1. to define contraception, classify types and list methods of temporary type
2.criticize the individual method, mechanism of action, indications, contraindications,
advantages and disadvantages of different methods of contraception
3.recall procedure and the timing to use each method
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4.recall recent advances in temporary methods (patches,new pills etc)

5.to define what is sterilization
6.recall types of permanent methods and approaches. -Laparotomy,laparoscopy,mini- lap
7. recall steps of Pomeroys method of tubectomy .
8.recall intra and post operative complications of tubectomy
Learning Outcome : The student should be able to counsel a woman to help her in
arriving at a decision regarding the choice of method
Lecture 19: Antenatal care & High-risk pregnancy

Expected goal
The student must be able to perform routine antenatal care and screen for high-risk
pregnancy
Theoretical knowledge
1. The student is able to describe the goals of antenatal care, schedule of antenatal
care and components of antenatal care
2. The student is able to evaluate the fetal &maternal health
3. The student is able to list the common high-risk factors
Practical skills
1. The student must be able to clinically evaluate a lady with pregnancy and
interpret the routine investigations during pregnancy
2. The student must be able to screen pregnant women with high risk factors and
refer accordingly
3. The student must be able to educate mother regarding physiology of pregnancy,
childbirth, care of the newborn & puerperium
Lecture 20: Problems in early pregnancy (Ectopic pregnancy, Miscarriage)
Expected goal
The student must be able to clinically diagnose and manage problems in early pregnancy
like miscarriage (different types) and ectopic pregnancy.
1. The student must understand the physiology of early pregnancy, implantation and
embryogenesis.
2. The student must know the etiology, clinical features and incidence of different
types of miscarriage
3. The student must be able to describe recurrent miscarriage and list the relevant
investigations
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4. The student must know the etiology, clinical features and incidence of ectopic
pregnancy
5. The student must be able to list the investigations in ectopic pregnancy
6. The student must be able to describe treatment of different types of miscarriage
(e.g. evacuation of retained products of conception) and ectopic pregnancy
(expectant, medical and surgical)
Practical skills
1. The student must be able to clinically evaluate a lady with early pregnancy
bleeding and interpret the investigations (UPT, USG)
2. The student must be able to suggest medical and surgical options for a lady with
early pregnancy bleeding (different types of miscarriage and ectopic pregnancy)
based on patients presentation and eligibility criteria
3. The student must be able to recognize women presenting in shock (due to early
pregnancy complications like ruptured ectopic pregnancy)
Lecture 21: Gestational trophoblastic disease
Expected goal
The student must be able to clinically diagnose, manage and follow-up a lady with molar
pregnancy.
1. The student must understand the pathogenesis of gestational trophoblastic disease
2. The student must know the clinical features and complications of gestational
trophoblastic disease
3. The student must be able to list relevant investigations for gestational
4. The student must know the modalities of treatment and follow-up
5. The student must know the role of chemotherapy (single and multi-agent) in highrisk patients
Practical skills
1. The student must be able to recognize and clinically diagnose gestational
2. The student must be able to counsel a lady with gestational trophoblastic disease
regarding options for treatment based on age, parity and complications
3. The student must be able to follow-up a lady with gestational trophoblastic
disease and recognize persistant trophoblastic disease based on clinical features
and serum beta HCG.
176
Lecture 22: Pregnancy induced Hypertension/Eclampsia

Expected goal
The student must be able to clinically diagnose and manage a lady with pregnancyinduced hypertension and eclampsia
1. The student should describe the pathophysiological changes in pregnancy-induced

hypertension and eclampsia
2. The student should explain the maternal and fetal effects of pregnancy-induced
3. The student should recall the definition and clinical features of pregnancy-induced
4. The student should list the investigations done to know the severity of pregnancyinduced hypertension
5. The student should be able to use the anti-hypertensive agents, magnesium sulfate
and should know about the dosage and common side effects of the same
6. The student should review the indications for termination of pregnancy in
pregnancy-induced hypertension
Practical skills
1. The student should be able to detect pregnancy-induced hypertension during the
antenatal period by clinical evaluation and by doing relevant investigations.
2. The student should be able to treat pregnancy- induced hypertension
3. The student must be able to counsel women with pregnancy-induced hypertension
regarding potential complications to the mother & fetus (e.g. symptoms of
impending eclampsia, abruptio) & timing of delivery
4. The student must be able to detect and manage pregnancy-induced hypertension
during labour
Lecture 23: DM/GDM complicating pregnancy
Expected goal
The student must be able to clinically diagnose and manage a lady with diabetes mellitus
complicating pregnancy gestational diabetes mellitus & pre-gestational diabetes
mellitus
177
1. The student should describe the physiological changes in carbohydrate
metabolism
2. The student should explain the maternal and fetal effects of patients with
gestational diabetes mellitus or pre-gestational diabetes mellitus
3. The student should recall the definition and clinical features (risk factors for
GDM) of gestational diabetes mellitus & pre-gestational diabetes mellitus
4. The student should list the investigations done to screen (GCT), diagnose
(MGTT) and follow-up (BSP) patients with gestational diabetes mellitus & pregestational diabetes mellitus
5. The student should be able to use the different types of insulin and diet therapy to
treat patients with gestational diabetes mellitus & pre-gestational diabetes mellitus
6. The student should review the indications for termination of pregnancy in
gestational diabetes mellitus & pre-gestational diabetes mellitus
Practical skills
1. The student should be able to detect gestational diabetes mellitus & pregestational diabetes mellitus during the antenatal period by clinical evaluation and
by doing relevant investigations.
2. The student should be able to treat gestational diabetes mellitus & pre-gestational
diabetes mellitus
3. The student must be able to counsel women with gestational diabetes mellitus &
pre-gestational diabetes mellitus regarding potential complications to the mother
& fetus & timing of delivery
4. The student must be able to detect and manage gestational diabetes mellitus &
pre-gestational diabetes mellitus during labour
Lecture 24: Anemia in pregnancy

Expected goal
The student should be able to detect and treat common types of anemia antenatally
1. The student should describe the physiological changes of the blood in pregnancy
2. The student should explain the maternal and fetal effects of anemia in pregnancy
3. The student should recall the definition and common causes of anemia in
pregnancy
4. The student should list the investigations done to know the severity of anemia and
detect the cause of anemia in pregnancy
178
5. The student should be able to use the different preparations of oral and parenteral
iron therapy, indications for using different preparations of iron, dosage and
common side effects of iron therapy.
6. The student should review the indications for blood transfusion in pregnancy
Practical skills
1. The student should be able to detect anemia during the antenatal period by clinical
evaluation and by doing relevant investigations.
2. The student should be able to treat the common type of anemia in pregnancy like
nutritional anemia (mainly iron deficiency)
3. The student must be able to counsel and treat patients with Thalassemia (minor)
4. The student must be able to detect and manage anemia during labour
Lecture 25: Antepartum hemorrhage
Expected goal
The student should be able to recognize and manage a patient with antepartum
hemorrhage
1. The student should describe the common causes of antepartum hemorrhage
(placenta previa & abruptio placenta)
2. The student should recall the definition and common causes of antepartum
hemorrhage
3. The student should explain the maternal and fetal effects of placenta previa &
abruptio placenta
4. The student should list the investigations done to know the detect the cause of
antepartum hemorrhage, type of placenta previa and grade of abruptio placenta
5. The student should review the indications for conservative management &
termination of pregnancy of placenta previa
6. The student should list the indications for LSCS (emergency & elective) for
different causes of antepartum hemorrhage
Practical skills
1. The student should be able to detect different causes of antepartum hemorrhage in
the antenatal period by clinical evaluation and by doing relevant investigations.
2. The student should be able to counsel women with placenta previa & abruptio and
to treat them (basic management only, especially in an emergency)
3. The student must be able to detect and manage antepartum hemorrhage during
labour
179
Lecture 26: Intrauterine growth restriction

Expected goal
The student must be able to clinically suspect IUGR and do the necessary investigations
to rule out common causes of symmetrical & asymmetrical IUGR
1. The student must be able to define IUGR
2. The student must be able to list common causes of symmetrical & asymmetrical
IUGR
3. The student must be able to recall investigations done to rule out common causes
of symmetrical & asymmetrical IUGR
4. The student must be able to review the methods of antepartum fetal monitoring &
assess the timing & mode of delivery based on antepartum fetal monitoring
Practical skills
1. The student should be able to detect different causes of symmetrical &
asymmetrical IUGR in the antenatal period by clinical evaluation and by doing
relevant investigations (e.g. USG).
2. The student should be able interpret common modalities of antepartum fetal
monitoring
3. The student must be able to counsel women with IUGR and manage them during
the antepartum & intrapartum period
Lecture 27: Multiple pregnancy

Expected goal
The student should be able to recognize and manage a patient with multifetal pregnancy
1. The student must be able to list common causes & complications (maternal &
fetal) of multifetal pregnancy
2. The student must be able to recall investigations done to rule out common
complications of multifetal pregnancy
3. The student must be able to describe the methods of antepartum fetal monitoring
& assess the timing & mode of delivery based on antepartum fetal monitoring,
presentation etc.
180
4. The student must be able to discuss the mangement of a lady with multifetal
pregnancy in labour
Practical skills
1. The student should be able to detect multifetal pregnancy by clinical evaluation
and by doing relevant investigations (e.g. USG).
2. The student should be able to recognize common complications of multifetal
pregnancy during pregnancy & in labour (both mother & fetus)
3. The student should be able to interpret common modalities of antepartum fetal
monitoring used for fetal evaluation
4. The student must be able to counsel women with multifetal pregnancy and
manage women during the antepartum & intrapartum period
Lecture 28: PROM/Preterm labor

Expected goal
The student should be able to recognize and manage preterm labour and in-utero transfer
of the mother.
The student should be able to recognize and manage prelabour rupture of membranes in
term & preterm pregnancies.
1. The student must be able to describe contribution of spontaneous preterm delivery
to overall perinatal mortality & morbidity (stratified by gestation)
2. The student must be able to name the etiologies responsible for preterm delivery
3. The student must be able to describe the risks associated with prelabour rupture of
membranes term & preterm
4. The student must be able to recall risk factors & list investigations done to screen
for preterm delivery
5. The student must be able to describe the methods of tocolysis, principles of
antenatal steroid administration & role of antibiotics
6. The student must be able to discuss the mangement of a lady with preterm labour
7. The student must be able to review the management options for PPROM &
PROM at term (antibiotics for specific organisms responsible for
chorioamnionitis)
Practical skills
1. The student should be able to detect preterm labour (PTL) & prelabour rupture of
membranes by clinical evaluation and by doing relevant investigations (e.g. USG,
Nitrazine test, Litmus test etc as relevant for PTL & PROM).
181
2. The student should be able to recognize common complications of preterm labour

& prelabour rupture of membranes (chorioamnionitis)
3. The student should be able to formulate plan of management for women with risk
factors for PTL, women with threatened PTL & established PTL
4. The student must be able to counsel women regarding safety of tocolytic therapy
Lecture 29: Bad obstetric history

Expected goal
The student must be able to counsel women with pregnancy loss (miscarriage & perinatal
death) and initiate basic management for those with ongoing pregnancy but with history
of previous pregnancy loss
1. The student must be able to describe causes of recurrent pregnancy loss
(miscarriage, late fetal death, stillbirth)
2. The student must be able to name the investigations done to determine cause of
recurrent pregnancy loss
3. The student must be able to describe the management options for pregnant women
with history of recurrent pregnancy loss
Practical skills
1. The student should be able to formulate plan of management for women with
history of recurrent pregnancy loss
2. The student must be able to counsel women with recurrent pregnancy loss
Pregnancy with Rh isoimmunization
Expected goal
The student should be able to identify and manage an antenatal woman with Rh negative
blood group.
1. The student should know about the different blood groups and the impact of Rh
negative blood group on outcome of pregnancy
2. The student should know the genetic makeup of Rh blood group and its
inheritance.
3. The student should know the manifestations of Rh isoimmunization on the fetus.
4. The student should know the sensitizing events of Rh isoimmunization on the
fetus and different ways to prevent it.
182
5. The student should know how to investigate a pregnant lady with Rh negative
blood group and to treat Rh isoimmunization.
Practical skills
1. The student should be able to detect Rh isoimmunization by clinical evaluation
and by doing relevant investigations.
2. The student should be able to counsel a pregnant lady with Rh negative blood
group and to prevent Rh isoimmunization.
Lecture 30: Fetal well being tests/fetal distress

Expected goal
The student must be able to interpret the common investigations done to diagnose fetal
compromise during the antepartum as well as intrapartum period.
1. The student must know the various antepartum markers of fetal well-being.
2. The student must know the importance of fetal movements and different ways to
chart the same.
3. The student must know the different components of CTG and the criteria to say if
its reactive, non reactive or equivocal.
4. The student must know about the use of ultrasound for biophysical profile,
modified BPP, and Doppler for detecting fetal compromise
5. The student must know the causes that lead to fetal compromise
Practical skills
1. The student must know how to do cardiotocogram and interpret it.
2. The student must be able to counsel the pregnant lady regarding fetal movements
3. The student must be able to do artificial rupture of membranes and decide if the
fetus is in distress based on the colour of liquor
Post term pregnancy/induction of labor
Expected goal
The student must be able to manage a patient with prolonged pregnancy and know when
and how to induce labour.
183
1. The student must know how to determine the EDD accurately clinically as well as
by investigations like ultrasound
2. The student must have a knowledge of the maternal and fetal complications due to
prolonged pregnancy
3. The student must know about the various methods of induction of labour
Practical skills
1. The student must be able to determine the accurate period of gestation
2. The student must know how to monitor a patient with prolonged pregnancy and
decide when to terminate the pregnancy
3. The student must know how to counsel a patient regarding the maternal and fetal
risks after the EDD.
Lecture 31: Normal labor and partogram
Expected goal
1. The student must be able to diagnose and manage a lady in labour.
2. The student must be able to chart a partogram and recognize the deviations of
normal labour.
1. The student
2. The student
labour
3. The student
labour
4. The student
descriptors
5. The student
must revise the anatomy of the uterus and birth canal.

must understand the endocrinology and pharmacology governing
must understand the biochemistry controlling corpus and cervix in
must know the stages of labour and the definitions of labour
must have the knowledge of different components in a partogram
Practical skills
1. The student must be able to interpret routine data collected in labour
2. The student must be able to chart a partogram and define normal and abnormal
progress of labour
3. The student must able to conduct normal labour
184
Lecture 32: CPD/obstructed labor/prolonged labor

Expected goal
The student must be able to recognize prolonged labour, obstructed labour and rule out
cephalopelvic disproportion.
1. The student should revise about the different types of pelvis and the various
diameters at the inlet, cavity and the outlet.
2. The student should understand the importance of the complex interplay between
the passenger (fetus) in the passage (pelvis).
3. The student must know the causes and concept of abnormal labour and its
management based on clinical signs and potential pathologies.
4. The student must appreciate the limitations of augmentation with oxytocin and the
appropriate timing of alternative management strategies depending on the cause
of dysfunctional labour.
Practical skills
1. The student must be able to interpret a partogram, and formulate a management
plan based on the different patterns of partogram.
2. The student must be able to define findings on vaginal and abdominal
examination accurately and be effectively be able to document it
3. The student must be able to counsel a patient regarding the causes of
dysfunctional labour and options for further management.
Lecture 33: Oxytocics in Obstetrics
Expected goal
The students must be able to use the common oxytocics in labour for induction,
augmentation and for third stage complications (post partum hemorrhage)
1. The student must revise about the pharmacology of commonly used oxytocics in
obstetrics.
2. The student must know about the process of parturition and understand the
relative merits of using different oxytocics for different indications.
3. The student must know about the indications, methods of administration
complications and contraindications for usage of specific oxytocics in Obstetrics.
Practical skills
185
1. The student must be able to use common oxytocics like oxytocin, methylergometrine and prostaglandins in labour room.
2. The student must be able to counsel patients regarding the indications, merits and
complications of using oxytocics in obstetrics.
3. The student must know how to titrate oxytocin infusion for dysfunctional labour
and for atonic postpartum hemorrhage.
Lecture 34: Occipito posterior position

Expected goal
The student must be able to identify and manage occipito-posterior position in labour.
1. The student must know the definition of occipito-posterior position.
2. The student must know the incidence, causes responsible for OP position and to
diagnose occipito-posterior position.
3. The student must understand the concept of malposition in labour and the possible
mechanisms of labour in occipito-posterior position.
4. The student must know the management of labour in occipito-posterior position.
Practical skills
1. The student must be able to diagnose occipito-posterior by clinical examination.
2. The student must be able to identify the complications of occipito-posterior
position in labour and initiate preliminary management of the same.
Lecture 35: Breech/transverse lie/cord prolapse

Expected goal
1. The student must be able to identify breech presentation, abnormal lie during
pregnancy and during labour.
2. The student must be able to identify and manage cord prolapse in labour.
1. The student must know the incidence and causes responsible for malpresentations.
2. The student must understand the maternal and fetal consequences of
malpresentation in labour and the possible mechanisms of labour in breech
presentation and abnormal lie.
3. The student must know the impact of cord prolapse in labour.
4. The student must know how to diagnose and manage malpresentations.
186
5. The student must know regarding the options for delivery in different
malpresentations
Practical skills
1. The student must be able to diagnose malpresentations by abdominal and vaginal
examination
2. The student must be able to identify complications of malpresentations when in
labour.
3. The student must be able to counsel patients regarding different options for mode
of delivery during pregnancy and when in labour.
4. The student must be able to diagnose cord prolapse by clinical examination and
initiate primary management for a patient with cord prolapse in labour
Lecture 36: Postpartum hemorrhage

Expected goal
The student must be able to recognize different types of postpartum hemorrhage and be
able to initiate primary management and co-ordinate multi-disciplinary-based plan of
management of the same.
1. The student must know the definition, etiology, and predisposing factors of
postpartum hemorrhage.
2. The student must know the types of postpartum hemorrhage and its clinical
presentation.
3. The student must know how to prevent postpartum hemorrhage.
4. The student must know the stepwise management of postpartum hemorrhage.
Practical skills
1. The student must be able to clinically ascertain the type of postpartum
hemorrhage.
2. The student must be able to initiate primary treatment of all types of postpartum
hemorrhage.
3. The student must be able to use the common oxytocics to effectively treat a
patient with atonic postpartum hemorrhage.
4. The student must be able to counsel a patient with postpartum hemorrhage
regarding the condition (high risk patient).
Lecture 37: 3rd Stage complications (other than PPH)
187
Expected goal
The student must be able to recognize different types of third stage complications, be able
to initiate primary management and co-ordinate multi-disciplinary-based plan of
management of the same.
1. The student must be able to describe causes of third stage complications & their
clinical features
2. The student must be able to name the complications of retained placenta,
morbidly adherent placenta, inversion of uterus etc
3. The student must be able to describe the management options women with
retained placenta, morbidly adherent placenta, inversion of uterus
Practical skills
1. The student should be able to formulate plan of management for women with
retained placenta, morbidly adherent placenta, inversion of uterus
2. The student must be able to counsel women with retained placenta, morbidly
adherent placenta, inversion of uterus (in emergency situations)
Lecture 38: Fibroid uterus

Expected goal
The student should be able to clinically detect and suggest common modalities of
treatment for fibroids
1. The student should know the common etiological associations for fibroids
2. The student should know the common subtypes of fibroids, common
complications and different types of degenerations of fibroids
3. The student should be able to list the clinical features of fibroids and possible
complications during pregnancy
4. The student should know the investigations (sonography) done to know the types
of fibroids
5. The student should know the different modalities of treatment of fibroids
available, medical (GnRh analogues etc) & surgical (myomectomy/
hysterectomy).
Practical skills
188
1. The student should be able to detect fibroid by clinical evaluation and by doing
relevant investigations
2. The student should be able to counsel patients regarding different options
available for treatment of fibroid medical & surgical
3. The student should be able to suggest treatment based on patients age, symptoms
and desire for fertility
Lecture 39: Endometriosis/Adenomyosis
Expected goal
treatment for endometriosis and adenomyosis
1. The student must understand the pathogenesis and clinical presentation of
endometriosis
2. The student must be able to list the common investigations & principal medical
therapies used in endometriosis
3. The student must be able to reason the underlying principles of medical and
surgical management
Practical skills
1. The student should be able to detect endometriosis by clinical evaluation and by
interpreting relevant investigations
available for treatment of endometriosis medical & surgical
and desire for fertility
Lecture 40: Dysfunctional uterine bleeding

Expected goal
treatment for dysfunctional uterine bleeding in different age groups
dysfunctional uterine bleeding
189
2. The student must be able to list the common investigations & principal medical
therapies used in dysfunctional uterine bleeding
surgical management in dysfunctional uterine bleeding
Practical skills
1. The student should be able to detect dysfunctional uterine bleeding by clinical
evaluation and by interpreting relevant investigations
available for treatment of dysfunctional uterine bleeding medical & surgical
3. The student should be able to suggest treatment based on patients age and
symptoms
Lecture 41: PCOS and Hirsutism
Expected goal
treatment for polycystic ovarian disease
polycystic ovarian disease
2. The student must be able to list the common investigations (biochemical,
sonological) & principal medical therapies (e.g. clomiphene citrate) used in
polycystic ovarian disease
surgical management (ovarian drilling) in polycystic ovarian disease
Practical skills
1. The student should be able to detect polycystic ovarian disease by clinical
evaluation and by interpreting relevant investigations
available for treatment of polycystic ovarian disease medical & surgical
and desire for child-bearing
Lecture 42: Infertility/HSG
Expected goal
190
treatment for common causes of infertility
1. The student must explain the physiology of normal conception and causes of male
& female subfertility
2. The student must be able to list the common investigations done to determine the
causes of male & female subfertility
3. The student must be able to discuss the management options for common causes
of male & female subfertility
Practical skills
1. The student should be able to evaluate a couple with subfertility by history,
clinical examination and by interpreting relevant investigations
available for treatment of male & female subfertility along with their success rates
3. The student should be able to suggest treatment based on the etiology responsible
for subfertility
Lecture 43: Genital prolapse
Expected goal
treatment for genital prolapse
1. The student must explain
supports of uterus) in the
2. The student must be able
3. The student must be able
in different age groups
the functional pelvic anatomy (with emphasis on

female
to discuss the etiology of genital prolapse
to discuss the management options for genital prolapse
Practical skills
1. The student should be able to evaluate a lady with genital prolapse by history and
clinical examination
(conservative and surgical) available for treatment of genital prolapse in different
age groups
Lecture 44: Primary and secondary amenorrhoea
191
Expected goal
The student should be able to clinically recognize and formulate a plan to determine the
cause of primary & secondary amenorrhoea
1. The student must define primary & secondary amenorrhoea and name the clinical
features
2. The student must be able to discuss the etiology of primary & secondary
amenorrhoea (with emphasis on genetic, endocrine and anatomical basis)
3. The student must be able to discuss the management options for primary &
secondary amenorrhoea
Practical skills
1. The student should be able to evaluate a lady with primary & secondary
amenorrhoea by history and clinical examination & by relevant investigations
available for treatment of primary & secondary amenorrhoea
Lecture 45: Urinary problems UTI, Stress, retention etc
Expected goal
The student should be able to clinically recognize common causes for urinary problems
in women & formulate a plan to determine the cause of the same
1. The student must explain the relevance of specific urinary symptoms in
gynecology
2. The student must be able to discuss the etiology & clinical presentation of
common causes for urinary tract infection, urinary incontinence and urinary
retention
3. The student must be able to discuss the management options and underlying
priniciples of threatment (surgical & non-surgical) of common causes for urinary
tract infection, urinary incontinence and urinary retention
Practical skills
1. The student should be able to evaluate a lady with urinary tract infection, urinary
incontinence and urinary retention by history and clinical examination & by
relevant urogynecological investigations
192

available for treatment of common causes for urinary tract infection, urinary
incontinence and urinary retention in gynecology
Lecture 46: Postmenopausal bleeding
Expected goal
The student should be able to clinically evaluate common causes of postmenopausal
bleeding and suggest investigations to diagnose the various causes of postmenopausal
bleeding
1. The student must be able to list the causes of postmenopausal bleeding
2. The student must be able to identify the investigations done to rule out different
causes of postmenopausal bleeding
3. The student must be able to review the treatment of different causes of
postmenopausal bleeding
Practical skills
1. The student should be able to detect different causes of postmenopausal bleeding
by clinical evaluation and by interpreting relevant investigations
2. The student should be able to appraise patients regarding different causes of
postmenopausal bleeding and counsel patients regarding treatment of the same
Lecture 47: CIN & Carcinoma cervix

Expected goal
The student should be able to clinically suspect and suggest common screening
modalities and treatment for cervical cancer
1. The student must be able to list the risk factors, comprehend epidemiology,
describe pathogenesis and clinical presentation of cervical cancer
2. The student must have the knowledge of staging of cervical cancer
3. The student must be able to list the common investigations & principal modes of
delivery of radiotherapy (teletherapy/brachytherapy) used in cervical cancer
4. The student must be able to reason the underlying principles of surgical
management and chemo-radiation of early, advanced and recurrent disease
193
Practical skills
1. The student should be able to detect cervical cancer by clinical evaluation and by
interpreting relevant investigations
2. The student should be able to perform Pap smear and interpret the Bethesda
classification of the same.
3. The student should be able to counsel patients regarding available treatment of
cervical cancer
4. The student should be able to break bad news, suggest prognosis, follow-up and
appropriate treatment (radical hysterectomy/ chemo-radiotherapy) based on
patients age and staging of cervical cancer
Lecture 48: Carcinoma endometrium
Expected goal
The student should be able to clinically suspect and suggest common screening
modalities and treatment for endometrial cancer
describe pathogenesis and clinical presentation of endometrial cancer
2. The student must have the knowledge of staging of endometrial cancer
3. The student must be able to list the common investigations & modes of delivery
of radiotherapy (vault irradiation, whole abdominal radiation etc) used in
endometrial cancer
management and chemo-radiation of early, advanced and recurrent disease
Practical skills
1. The student should be able to detect endometrial cancer by clinical evaluation and
by interpreting relevant investigations
endometrial cancer
appropriate treatment (surgery/ chemo-radiotherapy) based on patients age and
staging of endometrial cancer
194
Lecture 49: Ovarian tumors

Expected goal
The student should be able to clinically diagnose and suggest common modalities of
treatment for ovarian tumors.
The student must be able to clinically diagnose other causes of ovarian enlargements
(physiological cysts, chocolate cysts, tubo-ovarian abscess) and suggest different
management options for the underlying condition.
describe pathogenesis and clinical presentation of ovarian tumors (benign and
malignant)
2. The student must have the knowledge of etiology and staging of ovarian tumors
3. The student must be able to list the common investigations (especially tumor
markers and risk malignancy index) & principal chemotherapeutic agents
(cisplatin/carboplatin & paclitaxel) used in ovarian tumors
management and chemotherapy of early, advanced and recurrent disease
Practical skills
1. The student should be able to detect ovarian tumors by clinical evaluation and by
interpreting relevant investigations (ultrasound and tumor markers)
2. The student must be able to competently diagnose an ovarian tumor presenting as
emergency
ovarian tumors
appropriate treatment (primary surgery/ chemotherapy and neoadjuvant
chemotherapy / interval debulking surgery) based on patients age and staging of
ovarian tumors
Lecture 50: Contraception: Temporary & Permanent

Expected goal
The student must know the indications for temporary & permanent methods of
contraception and be able to counsel women regarding the merits & demerits of each
method
195
1. The student must be able to define contraception & list the common temporary &
permanent methods of contraception
2. The student must be able to describe the risks, benefits &adverse effects of
common temporary & permanent methods of contraception
3. The student must be able to review & appraise all available methods based on
age, parity, desire for child-bearing etc
Practical skills
1. The student must be able to compare the need to use different methods of
temporary & permanent methods of contraception and counsel women regarding
the pros and cons of each method (cafeteria method)
2. The student must be able to plan a recognize adverse effects of various methods
of temporary & permanent methods of contraception & initiate basic management
Lecture 51: Menopause & HRT

Expected goal
The student must know the presentation during menopause and be able to counsel women
regarding the pros and cons of HRT
4. The student must be able to define menopause & list the common clinical features
of menopause
5. The student must be able to describe the short term & long term effects of
menopause
6. The student must be able to review & appraise all available methods to treat
menopausal symptoms
Practical skills
3. The student must be able to recognize menopausal symptoms and counsel women
regarding the pros and cons of HRT
4. The student must be able to plan a follow-up of women on HRT
Lecture 52: Common procedures in O&G

Expected goal
The student must discuss the indications of common procedures done in O&G and be
able to counsel patients regarding the procedure (e.g. before informed consent).
196
1. The student must list the indications & complications of common obstetric
procedures like LSCS, instrumental delivery, external cephalic version,
episiotomy, ARM etc
2. The student must list the indications & complications of common gynecological
procedures like hysterectomy, D&C, ERPOC, Papsmear, Pipelle sampling etc
3. The student must be able to outline the technique of common procedures done in
O&G
4. The student must be describe the preoperative and postoperative workup of
different procedures
Practical skills
1. The student must be able to counsel and explain to patients regarding common
procedures done in O&G
2. The student must be able to discuss the preoperative and postoperative workup of
different procedures
Lecture 53: Ultrasound in O&G
Expected goal
The student must discuss the indications of ultrasound in O&G and be able to interpret
the basic sonological reports.
1. The student must list the indications of ultrasound in each trimester in Obstetrics.
2. The student must list the indications of ultrasound in gynecology
3. The student must be able to recall the abnormalities detected on ultrasound in
O&G
Practical skills
3. The student must be able to interpret the sonological reports of common
conditions in O&G
4. The student must be able to counsel patients based on the sonological reports of
common conditions in O&G
5. The student must be able to formulate a plan of further management based on the
sonological report.
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Department of Obstetrics and Gynaecology

Learning Outcomes for Clinical Teaching (Semester 6 & 7)
Students should be oriented to:

1. general objectives of clinical posting in the dept. of O&G.
2.hospital posting, ward rotation &bed allotment.
3.rules and regulations concerning hospital, regarding professionalism and bedside
manners.
HISTORY TAKING & EXAMINATION IN OBSTETRICS:
Learning Objective :The student should be able to
1.record history in a logical & thorough manner which will include the following;
patient profile, chief complaint, H/O presenting illness/pregnancy, menstrual history, past
obstetric history, sexual history, family & social history.
2.calculate date of confinement.
3.record focussed history based on trimester.
4.list conditions/drugs that are teratogenic.
5.demonstrate knowledge on conditions that require preconceptional counseling.
6.distinguish high risk pregnancies based on historical factors.
7.demostrate appropriate communication skills and learn to respect patients privacy and
feelings with regard to her social & cultural background.
8.record the information obtained according to the predesigned format, list down the
problems, aeemble them & formulate diagnostic impressions.
Learning Outcome:
Perform general physical examination & obstetric examination including measurement of
SFH & obstetric grips.
HISTORY TAKING & EXAMINATION IN GYNECOLOGY:
Learning Objective :The student should be able to
1.assess the importance of complete history along with focussed history pertinent to the
given case.
2.recognize the relevance of menstrual history, irrespective of chief complaints.
3.list symptoms &signs of common gynecological conditions and apply this knowledge
in obtaining focused history specific to cases.
4.identify pregnancy &contraception in any clinical scenario in the reproductive age
group women.
5.demonstrate knowledge on various screening procedures done in gynecology
(particulary pap smear) and know the current recommendations.
6.demonstrate appropriate communication skill and sensitivity while eliciting sexual
history.
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7.record the information obtained, correlate the information to list & prioritize
differential diagnosis.
Learning Outcome:
1.Perform general physical, abdominal examination, observe speculum & bimanual
examination so as to be able to narrate the procedures for these examinations.
2.Perform pap smear screening.
NORMAL ANTENATAL CASE
Learning Objective:
1.Recall the methods to confirm pregnancy.
2.Judge the importance of prepregnancy counselling in relevant cases.
3.Recall the objectives of antenatal care.
4.Demonstrate a thorough knowledge on the routine investigations performed, including
the role of USG in antenatal care.
5.List the recommended schedule for antenatal visits.
6.Demonstrate knowledge regarding routine iron prophylaxis, immunization and drugs
contraindicated.
7.Plan routine antenatal advice, regarding nutritional requirements and healthy lifestyle.
Learning Outcome:
1.demonstrate competency and confidence in performing general physical examination
(including breast &thyroid) and obstetric examination which will include measurement of
SFH and obstetric grips.
NORMAL POSTNATAL CASE
Learning Objective:
1.Relate the physiology of puerperium and know normal postnatal events.
2.Discuss physiology of lactation & involution.
3.List common postpartum complications
4.Compare the advantages of breast feeding & disadvantages of formula feeding.
5.Recall the recommended immunization schedule for the newborn.
Learning Outcome :
1.Demonstrate appropriate communication skill in advising the postnatal mother on the
importance of early ambulation, adequate fluid intake, perineal care & postnatal exercise.
2.Perform postnatal examination on the mother & appreciate the normal and abnormal
findings during puerperium.
3.Formulate contraception counselling and advice
ANY HIGH RISK ANTENATAL CASE

Learning Objective ;
1.Identify high risk pregnancies.
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2.Describe the incidence, etiopathogenesis, maternal (ante,intra & postpartum) & fetal
complications of common medical disorders like anemia, preeclampsia, GDM & heart
disease.
3.demonstrate knowledge on antenatal & intrapartum implications for other high risk
pregnancies like previous LSCS, IUGR, recurrent pregnancy loss, multiple pregnancies
& abnormal lie & presentation.
4.Demonstrate thorough knowledge on screening & diagnostic investigative procedures
which are used to either diagnose or to assess the severity of any of these high risk
pregnancies.
5. Evaluate how these disorders affect the outcome.
6.Evaluate concepts relating to antepartum fetal surveillance and application of the same
in these high risk pregnancies.
Learning Outcome :
1.Evaluate any of these conditions based on history & physical examination.
2.demonstrate appropriate communication skill on warning signs of adverse pregnancy
events.
POSTNATAL CASE WITH A COMPLICATION
Learning Objective :
1.List common postnatal complications.
2.Recall the definition & different etiologies for primary & secondary postpartum
haemorrhage.
3.Name different etiologies of postpartum collapse.
4.Recall the definition & common causes for puerperal pyrexia.
5.Relate the local practice & recommendation regarding thromboprophylaxis for
postnatal & post caesarian section patients.
6.Recall the incidence & etiology of various mood disorders during puerperium.
7.Identify common problems relating to breast feeding & offer appropriate advice and
support if required.
8.Demonstrate knowledge on concepts relating to immediate resuscitation & evaluation
of women with postpartum collapse & haemorrhage.
Learning Outcome :
Assess any of the above conditions based on history and examination findings.
VAGINAL DISCHARGE
1.Discuss etiology of trichomoniasis, candidiasis and bacterial vaginosis.
2.Compare & contrast the clinical manifestations of these three types of lower genital
infections.
3.List the investigations to be performed and state "amsel's criteria" for the diagnosis of
bacterial vaginosis.
4.Discuss differential diagnosis including leucorrhea, drainage of amniotic fluid & genital
malignancies.
5.Discuss management including pharmacotherapy, follow up and management of the
partner.
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6.Recall the preferred treatment regime during pregnancy.

Learning Outcome :
Perform per speculum examination and make a diagnosis based on visual inspection.
ABNORMAL UTERINE BLEEDING
1.Define abnormal uterine bleeding.
2.List & define different types of menstrual disorders.
3.Discuss characteristics of normal menstruation.
4.List common etiologies for AUB and be aware of pregnancy & contraception in the
differential diagnosis.
5.Differrentiate between functional & organic causes.
6.List common manifestations of AUB that are specific to pre, peri &postmenopausal
status.
7.Discuss various diagnostic procedures used in the evaluation of AUB.
Learning Outcome :
1.Assess for anemia, stigmata of thyroid & haematological disorders on general physical
examination.
2.perform an abdominal examination to detect any mass per abdomen.
3.List differential diagnosis, based on the history obtained.
MASS PER ABDOMEN
1.List common gynecological conditions that present as mass per abdomen.
2.Differrentiate between acute and chronic causes.
3.Report pertinent history including menstrual history, H/O of infertility, H/O weight loss
GI and bladder symptoms.
4.Evaluate the role of various imaging techniques in the evaluation of this condition.
5.Discuss findings on examination & on imaging that would point towards malignancy.
Learning Outcome :
1.Demonstrate ability to differrentiate between malignant & benign conditions based on
history, general physical and abdominal findings.
2.Demonstrate ability to differrentiate between uterine and ovarian masses based on
history & physical examination.
MASS PER VAGINA

Learning Objective
1.Demostrate knowledge on pelvic floor anatomy and uterine supports.
2.List the differential diagnoses for mass per vagina.
3.Discuss the common symptoms associated with uterine prolapse.
4.Discuss the natural history of cystocele, rectocele & uterine prolapse in a
postmenopausal women.
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5.Discuss obstetric factors that predispose to uterine prolapse.

Learning Outcome Demonstrate knowledge on prevention of uterine prolapse.
A CASE IN LABOUR
1.Identify labour based on history, abdominal & pervaginal examination.
2.Discuss the stages of labour.
3.Compare and contrast the labour patterns between a primi and a multigrvida.
4.Discuss mechanism of labour.
5.Discuss indications and methods for induction of labour.
6.Demonstrate knowledge on and interpret electronic fetal monitoring in labour.
7.List common methods of obstetric analgesia.
8.List indications & complications of instrumental delivery.
9.Discuss active management of third stage of labour and list third stage complications.
Learning Outcome :
1.Evaluate stages of labour based on history and physical findings.
2.Analyse electronic fetal monitoring tracing.
3.Construct partogram
ABORTIONS
1.List differential diagnosis for bleeding in first trimester.
2.Define & distinguish various types of spontaneous abortions.
3.Recall etiology & complications of septic abortion.
4.Identify various ways of clinical presentation of ectopic pregnancy.
5. Identify signs & symptoms of missed abortion.
6.Recall follow up protocol for molar pregnancy.
7.Recall etiology & evaluation of recurrent abortion.
8.List indications & methods of MTP
Learning Outcome :
1.Evaluate findings of a bimanual examination in a women with early pregnancy
bleeding
2.Appraise ultrasound findings of differrential diagnoses in early pregnancy bleeding.
3.Counsel woman with H/O recurrent abortion.
PAIN ABDOMEN
1.Define acute & chronic pelvic pain.
2.Describe causes for each.
3.Identify emergencies.
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4.Record targeted history to arrive at a diagnosis.

5.Record menstrual/sexual & relevant medical/surgical history to distinguish between
causes arising from nonreproductive organs.
6.Design evaluation protocol for each & understand the role of USG in these situations.
Learning Outcome :
1.Perform general physical examination to ascertain patient's haemodynamic status or to
exclude shock.
THIRD STAGE OF LABOUR/EPISIOTOMY

1.Define third stage of labour
2. List signs of placental separation
3.Recall methods of placental separation
4.Recall how to examine the placenta and the baby
5.Describe active Management of Third Stage
6.Recognize complications and methods to prevent them
7. Explain the procedure to suture episiotomy
Learning Outcome :
1.Perform placental delivery and placental examination
2.Assist in suturing episiotomy
Recommended Reading
Basic Reading:
1)
Ten teachers: Obstetrics by S. Cambell and C Lees. 2000. 17th Ed. Arnold P
2)
Ten teachers : Gynecology by S.Campbell and A Monga.2000.17th Ed. Arnold P
3)
Obstetrics Illustrated: Hanretty P Kevin, 2003. 16th Ed. Churchill Livingston
4)
Gynecology Illustrated: David Mc Kay Heart, 5th Ed. 2000. Churchill Livingston
5)
Shaws textbook of gynecology: VG Padubidri & SN Daftary.1999. 12th Ed. CL
6)
Oxorn Foote Human Labor and Birth: Harry Oxorn. 2000. 5th Ed. McGraw Hill
7)
Essential Obstetrics: S. Arulkumaran et al. 2004. Jaypee Publishers
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OBSTETRICS AND GYNECOLOGY
LEARNING OUTCOME FOR SEMESTER 8 & 9

CLINICAL TOPICS
HYPERTENSION IN PREGNANCY
Intended Learning Outcome
At the end of the session the student should be able to
Take an appropriate history and conduct an examination to assess women with
preeclampsia
Perform and interpret appropriate investigations
Formulate, implement management plan in preclampsia of varied presentation
Manage with antihypertensive drug therapy in antenatal and postnatal period
Counsel women and her partner according to maternal and fetal risks, safety of
antihypertensive therapy, recurrence risks and future management
ECLAMPSIA
Demonstrate to knowledge of diagnose imminent eclampsia and eclampsia
Plan the treatment in a multidisciplinary approach
Formulate and implement emergency measures and timing and mode of delivery
Formulate and implement fluid, anticonvulsive, antihypertensive therapy and obstetrical
Management
Counsel the patient s relatives with fetal risk, maternal risk, recurrent risks and
contraception
DIABETES
Take an appropriate history and conduct an examination to assess women with diabetes
Perform and interpret appropriate investigations to differentiate differential diagnosis
Formulate, implement management plan including timing and mode of delivery
Manage antidiabetic therapy in antenatal and postnatal period
Liase with dietician and neonatologist
Counsel women according to maternal and fetal risks, importance of glycemic control,
contraception and long-term risk and management
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ANEMIA COMPLICATING PREGNANCY

The student should be able to
Take an appropriate history and conduct an examination to assess women with anemia
complicating pregnancy
Manage anemia treatment in antenatal and postnatal period
Liaise with hematologist and neonatologist
Counsel women and her partner according to maternal and fetal risks, prenatal diagnosis,
contraception long-term outcome
HEART DISEASE COMPLICATING PREGNANCY

Take an appropriate history and conduct an examination to assess women with heart
disease complicating pregnancy
Formulate, implement management plan in multidisciplinary approach
Liaise with cardiologist
Counsel women and her partner according to maternal and fetal risks, contraception longterm outcome
ANTEPARTUM HEMORRHAGE: ACCIDENTAL HAEMORRHAGE
Take an appropriate history and conduct an examination to assess APH
Perform and interpret appropriate investigations to assess cause and consequences of
APH
Liaise with anesthesiologist, neonatologist
Counsel women with maternal, fetal risks and recurrence risks
MULTIPLE PREGNANCY
Take an appropriate history and conduct an examination to assess multiple pregnancy
Interpret USG to assess chorionicity,amnioncity and fetal anomaly in multiple pregnancy
Liaise with neonatologist
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Counsel women with maternal, fetal risks, prenatal diagnosis, fetal risks, fetal
reduction and recurrence risks
INTRAUTERINE GROWTH RESTRICTION (IUGR)
Intended Learning outcome
Take an appropriate history and conduct an examinatio n to assess fetal size
Perform and interpret USG in fetus with suspected growth disorder
Liaise with anesthesiologist and neonatologist
Counsel women with maternal, fetal risks, long-term health implications and recurrence
risks
BOH/RECURRENT ABORTION
At end of the session the student should be able to
Take an appropriate history and conduct an examination
Interpret USG in mother with suspected BOH/Recuurent abortion
Liaise with anesthesiologist, neonatologist
Counsel women with maternal, fetal risks and recurrence risks
BREECH/ TRANSVERSE LIE / OCCIPITO POSTERIOR PRESENTATION

Take an appropriate history and conduct an examination to assess fetal lie/presentation
Interpret USG in fetus with suspected breech presentation/unstable lie
Formulate, implement management plan, including timing and mode of delivery and to
perform ECV
Counsel woman about risks and benefits of ECV, management options and mode of
delivery
VAGINAL DISCHARGE
Take an appropriate history and conduct an examination to assess a woman with vaginal
discharge
Formulate implement management plan.
Liase with microbiologists
Counsel a woman with antibiotic therapy
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ABNORMAL UTERINE BLEEDING

Take an appropriate history and conduct an examination to assess a woman with
abnormal bleeding per vagina
Liase with microbiologists,pathologists
Counsel a woman with risks, drug therapy and surgical treatment
FIBROID UTERUS
Take an appropriate history and conduct an examination to assess a woman with fibroid
uterus
Liase with pathologists
Counsel a woman with pregnancy risks, drug therapy and surgical treatment
ENDOMETRIOSIS/ADENOMYOSIS
Take an appropriate history and conduct an examination to assess a woman with
endometriosis/adenomyosis
Liase with pathologists
Counsel a woman with risks, drug therapy and surgical treatment
PROLAPSE UTERUS
Take an appropriate history and conduct an examination to assess a woman with prolapse
uterus
Liase with urologists
Counsel a woman with risks, pessary therapy and surgical treatment
CARCINOMA OF CERVIX
Take appropriate history, conduct examination and investigate properly
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Perform and interpret PAPS report

Perform cervical biopsy and clinical staging
Formulate implement management plan
Liase with clinical oncologist
Counsel for treatment options and palliative care
CARCINOMA OF ENDOMETRIUM
Perform and interpret Pipelle sampling
OVARIAN TUMOR
Recognise histopathological pattern of disease
Appropriately stage ovarian cancer
LABOR THEATRE
Demonstrate the knowledge of discriminating emergency & non-emergency, need for
hospitalization of patient.
Demonstrate the knowledge of differentiating the patient in labor, monitoring the patient
in labor, induction of labor
Demonstrate the observation skill in noninvasive and invasive procedures.
Understand the application of analgesia, hydration on patient in labor
Demonstrate the understanding and application of knowledge in CTG and partogram
Demonstrate the application of knowledge in early recognisation of complications during
labor,
and take emergency measures.
Demonstrate the knowledge of therapeutic usage of commonly used drugs in Labor
Theatre
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OPD
Demonstrate the observation skill of relevant history taking and examination of patients.
Demonstrate the application of knowledge as observation skill in noninvasive and
invasive
procedures
WARD WORK

Demonstrate the art of history taking, physical examinatio n,clinical reporting, integration
and management skill in patient management
Demonstrate the procedural skill by observation/assistance in ward procedure
Demonstrate the communication skill with patient,families, colleagues and paramedical
staff
Demonostrate the professionalism by courteous and cooperative attitude with colleagues,
empathy and compassion to patients.
Demonstrate active participation in learning
PBL
General Learning Outcome:
At end of session the student should able to
Identify the learning areas and recognize differential diagnoses
Apply the knowledge of basic science to learning areas
Reproduce varied clinical features of recognized differential diagnoses
Identify the specific investigation to confirm diagnosis and interpret them.
Formulate treatment plan
Summarize and apply gained knowledge to real patient scenario
TUTORIALS / SKILL TOPICS
General Learning Outcome
At the end of session student should able to
Demonstrate the understanding of basic concepts and able to apply to patient care
Demonstrate the application of prior knowledge of practical skill,analytical and
communication skill in a given scenario
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MATERNAL PELVIS & FETAL SKULL, CLINICAL PELVIMETRY, MECHANISM

OF LABOUR IN OCCIPITOANTERIOR, OCCIPITOPOSTERIOR, ASSISTED
BREECH DELIVERY
Demonstrate the applied anatomy knowledge of female pelvis and assess the pelvis in a
patient at term in systematic manner
Show and explain the different parts of fetal skull and be able to clinically ascertain the
different presenting parts and position of fetus while doing a vaginal examination
Demonstrate mechanism of labor in a Occipitoanterior, Occipitoposterior & Assisted
Breech delivery by step by step
REVIEW OF STATIC STATION EXHIBITS INCLUDING CONTRACEPTION,
INSTRUMENTS IN O&G, CTG, PARTOGRAM
The student should be able to identify the various exhibits and should able to demonstrate
clinical knowledge in them.
BLADDER CATHETERISATION, GYNECOLOGICAL EXAMINATION (LOCAL

EXAMINATION, PS/PV EXAMINATION), PAP SMEAR, PIPELLE SAMPLING,
PROCEDURES O & G
Formulate and demonstrate the procedural skill of bladder catheterization

Counsel patient about catheterization procedure and its limitations
Formulate, implement and document the procedural skill of performing pelvic
examination
Counsel the woman about clinical finding
Formulate, implement and document the procedural skill of performing the PAPS smear
step by step. Counsel about the results and limitations
Formulate, implement and document the procedural skill of performing the Pipelle
sampling step by step. Counsel about the results and limitations
Demonstrate the procedural knowledge of principles of different common procedures
observed during OT & LT, and the complications (Episiotomy, Perineal tear, Vulval &
vaginal hematoma, LSCS, D&C, Hysterectomy, Salpingectomy)
210
EMERGENCY DRILL
General Learning Outcome
At the end of session the student be able to
Formulate implement document management plan for an obstetric emergency
Rapidly assess the severity of maternal/fetal distress and institute resuscitative measures
To liase with anesthesiologist, neonatologist, gynecologist
Counsel for maternal, fetal and recurrent risks
PPC
At the end of session the student should be able to
Rapidly assess maternal collapse and institute resuscitative measures
To work effectively as part as of a multidisciplinary team
Formulate, implement management plan in maternal collapse.
Formulate appropriate surgical intervention
To liase with anesthesitists, hematologists and neonatologist
To debrief family members with management options, maternal risks, recurrent risk
ECLAMPSIA
Quickly assess eclamptic mother and institute resuscitative measures
Formulate, implement management plan including appropriate choice of delivery and
method of delivery
To manage antihypertensive, anticonvulsant therapy in proper manner
To liase with anesthesitists, hematologists and neonatologist
To debrief family members with management options, maternal risks, recurrent risk
CORD PROLAPSE
Rapidly assess fetal status and institute appropriate manoveuvres to prevent cord
compression
Formulate, implement management plan
Formulate appropriate surgical intervention
To liase with anesthesitists, and neonatologist
To debrief family members with management options, fetal risks, recurrence risk
SHOULDER DYSTOCIA
Formulate, implement management plan for shoulder dystocia
Perform manoveuvres to achieve delivery in shoulder dystocia
To liase with anesthesitists, and neonatologist
To debrief family members with management options, fetal risks, recurrent risk
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INSTRUMENTAL DELIVERY
Formulate, implement management plan for instrumental delivery
Perform maneuvers to achieve delivery by instrumental delivery
To liase with anesthesitists and neonatologist
To debrief family members with management options, fetal risks and recurrent risk
ACTIVE 3RD STAGE MANAGEMENT
Formulate, implement management plan for 3 rd stage of delivery
Perform technique to achieve delivery of placenta
To liase with staff
ARM
Formulate, implement management plan for ARM
To liase with anesthesiologist, neonatologist
SDL
General Intended Learning outcome:
Demonstrate the application of SDL concept for a given clinical problem, Medicolegal
issues and Ethics
Able to select and critically appraise the scientific article for a choosen clinical scenario
Able to analyse clinical guideline and apply to choosen clinical scenerio
COMMON PROGRAMME
Demonstrate the knowledge of clinical, integrative, management, communicative,
professional skills and educational attitude.
METHOD OF ASSESSMENT
Formative: Case sheet write ups, Case Presentation Evaluation
Summative: Clinical assessment, MEQs, MCQs.
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LEARNING OUTCOME FOR SENIOR CLERKSHIP

(SEMESTER 10)
At the end of the posting, the student will be able to:
I) Execute all the clinical skills listed below such as:
Enumerate the symptoms of preeclampsia-eclampsia syndrome
Summarize the physical findings of preeclampsia-eclampsia syndrome
List the causes of third trimester bleeding
Differentiate the signs and symptoms of third trimester bleeding
Define the risk factors for preterm labor
Summarize the history, physical findings and diagnostic methods to confirm rupture of
the membranes
Identify risk factors and diagnose postpartum blues, postpartum depression and
postpartum psychosis
Identify the normal period of gestation & intepret naegles rule.
Incorporate screening questions for urinary incontinence when eliciting a patient history.
List the chief complaints a patient with endometriosis may present.
Identify the symptoms of endometriosis in a female patient presenting with abdominal
pain.
List the physical exam findings a patient with endometriosis may have.
Discuss diagnostic approach to a woman with the chief complaint of breast mass, nipple
discharge or breast pain.
Perform an assessment of the symptoms and physical findings associated with
hypoestrogenism.
Define infertility.
Describe the causes of male and female infertility.
Identify the risk factors for cervical neoplasia and cancer.
Describe the symptoms and physical findings in patients with uterine leiomyomas.
List the risk factors for endometrial carcinoma.
Describe the symptoms and physical findings of a patient with endometrial cancer.
Outline the appropriate management of the patient with postmenopausal bleeding
Outline the approach to a patient with an adnexal mass
Compare the characteristics of functional cysts, benign ovarian neoplasm and ovarian
malignancies
Describe the symptoms and physical findings of a patient with ovarian malignancy
List the risk factors for ovarian cancer
Assess risk for unintended pregnancy, sexually transmitted infections, cervical pathology,
breast malignancy, gynecologic malignancies and domestic violence
Assess compliance with recommended screening measures specific to women (e.g.
cervical malignancy, gynecologic exam, breast exam, diagnostic breast imaging) in riskappropriate circumstances
Demonstrate interpersonal and communication skills that build trust by addressing
contextual factors (e.g. culture, ethnicity, language/literacy, socioeconomic class,
spirituality/religion, age, sexual orientation, disability)
213
Communicate the results of the ob-gyn and general medical interview by well-organized
written and oral reports .
Interact with the patient to gain her confidence and cooperation, and assure her comfort
and modesty .
Perform accurate examinations in a sensitive manner, including: breast examina tion,
abdominal examination, complete pelvic examination, and recto-vaginal examination
Use accurate medical terminology to describe the: normal female anatomy across the life
cycle, appearance of common pathology of the female urogenital tract and appearance of
common breast changes and disorders.
Perform an adequate Pap smear.
Obtain specimens to detect sexually transmitted infections.
Handle specimens properly to improve diagnostic accuracy.
Provide an explanation to the patient regarding the purpose of these tests.
II) Conduct appropriate investigation and management:

Discuss the use of immunoglobulin prophylaxis during pregnancy for the prevention of
isoimmunization
Describe the initial management plan for shock secondary to acute blood loss
Counsel the patient regarding the signs and symptoms of preterm labor
Describe treatment options for postpartum blues, postpartum depression and
postpartum psychosis
Identify appropriate treatment options for depression in pregnancy
Describe the key components of pre-operative evaluation and planning, including
complete medical histories, the informed consent process and working with consultants
Describe the common peri-operative prophylactic measures, including steps taken to
reduce infection and deep venous thrombosis
Describe the components of routine post-operative care
List common post-operative complications
Describe and list the indications and complications of spontaneous vaginal delivery
Describe the physiologic basis of contraception (OCPs, emergency contraception,
patches, rings, IUD, sterilization, etc.)
Describe the effectiveness of each form of contraception.
Counsel the patient regarding the benefits and risks for each form of contraception.
Describe the methods of female surgical sterilization.
List the risks and benefits of procedures, including: potential surgical complications,
failure rates.
Explain surgical and non-surgical methods of pregnancy termination.
Identify potential complications of induced abortion.
Provide non-directive counseling to patients surrounding pregnancy options.
Diagnose and manage a patient with vaginitis.
Describe the methods of evaluation for the following STIs: gonorrhea, Chlamydia, herpes
simplex virus, syphilis, human papillomavirus infection, human immunodeficiency virus
(HIV) infection, hepatitis B virus infection.
214
Describe the management of the following STIs: gonorrhea, Chlamydia, herpes simplex
virus, syphilis, human papillomavirus infection, human immunodeficiency virus (HIV)
infection, hepatitis B virus infection
Describe the signs and symptoms ,pathogenesis and management and long term effects
of salpingitis.
Describe the diagnosis and management of UTIs.
Describe the key components of pre-operative evaluation and planning, including
complete medical histories, the informed consent process and working with consultants.
Describe the common peri-operative prophylactic measures,
Including steps taken to reduce infection and deep venous thrombosis.
Describe the components of routine post-operative care.
List common post-operative complications.
Describe the evaluation methods of abnormal uterine bleeding.
Describe the evaluation and management of dysmenorrhea.
Perform an adequate Pap smear.
Describe the initial management of a patient with an abnormal Pap smear.
Counsel a woman with risk for ovarian cancer
Complete a comprehensive womens medical interview, including: menstrual history;
obstetric history; gynecologic history; contraceptive history; sexual history; including
sexual orientation and sexual function; family history and social history
Evaluation
1.Portfolio evaluation.
2.Clinical Evaluation: Prior to completion of the 2 weeks senior clerkship, students are
expected to acquire the following skills:
Ability to:
Perform a complete history and physical examination of the female (both pregnant and
nonpregnant) and generate a problem list and a differential diagnosis.
Synthesize the data obtained from the history and physical to arrive at a diagnosis and
management plan for patients presenting in the typical manner with the following
obstetrical/gynecologic conditions: menstrual irregularity, menopause, osteoporosis,
vaginitis, common sexually transmitted diseases, pelvic or abdominal pain, pelvic mass,
common GYN malignancies (cervix, endometrial, ovarian, breast), normal pregnancy,
abnormal pregnancy including ectopic pregnancy and abortion, bleeding in pregnancy,
preeclampsia, and diabetes in pregnancy.
Communicate about a new patient in both an oral presentation and a written note that
presents subjective and objective data in a succinct and organized manner and is followed
by a realistic assessment and plan.
Perform an uncomplicated vaginal delivery.
Perform the pap smear and interpret the resulting report.
Describe the components of basic prenatal care.
Describe the physiologic changes associated with pregnancy.
Prescribe various forms of contraception.
Practice evidence based medicine, utilizing biomedical information from electronic
databases and other resources.
Observe
215
Operative gynecology, including abdominal and vaginal hysterectomy, D&C,

hysteroscopy, laparoscopy, LEEP.
Commonly used diagnostic and therapeutic modalities, including ultrasound, colposcopy,
cystoscopy, and endometrial biopsy.
Common postoperative and intra operative complications.
Common antepartum and intrapartum complications.
Common postpartum problems.
Operative obstetrics, including forceps delivery, cesarean section, cervical cerclage, and
post partum tubal ligation. Introduction to the subspecialty areas of obstetrics and
gynecology including perinatology, reproductive endocrinology and infertility,
gynecologic oncology and urogynecology and pelvic reconstructive surgery.
REFERENCES
1) Ten teachers: Obstetrics by S. Cambell and C Lees. 2000. 17th Ed. Arnold P
2) Ten teachers: Gynecology by S.Campbell and A Monga.2000.17th Ed. Arnold P
3) Obstetrics Illustrated: Hanretty P Kevin, 2003. 16th Ed. Churchill Livingston
4) Gynecology Illustrated: David Mc Kay Heart, 5th Ed. 2000. Churchill Livingston,
5) Shaws textbook of Gynecology: VG Padubidri & SN Daftary.1999. 12th Ed. CL
6) Essential Obstetrics: S. Arulkumaran et al. 2004. Jaypee Publishers
7) Text Book of Gynecology: D.C.Dutta 2001. 3 rd edition New Central Book Agency
(P) Ltd
8) Text Book of Obstetrics: D.C.Dutta. 6 rd edition New Central Book Agency (P) Ltd
Reference Books
1) Williams Obstetrics: Cunningham et al. 2001. 21st Ed. McGraw Hill
2) Novaks Gynecology: J Berek.2002. 13th Ed. Lippincott Williams and Wilkins
216
Learning Outcomes
217
LECTURES IN PSYCHIATRY
(TOPICS, LEARNING OBJECTIVES AND OUTCOME)
Learning objectives for Semester Semester 6/7 from Batch 29)
1. Introduction to Psychiatry
Learning objective: The student will learn the definition of psychiatry, functions of
the mind, history of psychiatry, current practice of psychiatry and future of
psychiatry.
Learning outcome: The student will understand the definition of psychiatry, functions
of the mind, history of psychiatry, current practice of psychiatry and future of
psychiatry.
2. Classification of Mental Disorders
Learning objective: The student will learn the classification of mental disorders
according to the Diagnostic and Statistical Manual of the American Psychiatric
Association as well as the International
Classification of Diseases of the World Health Organisation.
Learning outcome: The student will understand the classification of mental disorders
according to the Diagnostic and Statistical Manual of the American Psychiatric
Association as well as the International
Classification of Diseases of the World Health Organisation.
3. Aetiology of Mental Disorders
Learning objective: The student will learn the various causes for mental disorders
(biological, psychological and social) as well as chronological factors (predisposing,
precipitating and perpetuating and protective) causing mental disorders in individuals.
Learning outcome: The student will understand the various causes for mental
disorders (biological, psychological and social) as well as chronological factors
(predisposing, precipitating and perpetuating and protective) causing mental disorders
in individuals.
4. Learning and Memory
Learning objective: The student will learn the various theories of learning and its
application in psychiatry (understanding and treatment of some mental disorders) as
well as types of memory, brain memory centers and memory disorders
218
Learning outcome: The student will understand the various theories of learning and
its application in psychiatry (understanding and treatment of some mental disorders)
as well as types of memory, brain memory centers and memory disorders.
5.
Intelligence and Mental Retatardation

Learning objective: The student will learn the meaning of intelligence, assessment of
intelligence as well as the meaning, causes, types and management of mental
retardation.
Learning outcome: The student will understand the meaning of intelligence,
assessment of intelligence as well as the meaning, causes, types and management of
mental retardation.
6.
Motivation and Defense Mechanism

Learning objective: The student will learn the various types of inborn motives
(survival, social and curiosity) and its application in Psychiatry as well as the
meaning of ego defense mechanism, characteristics and commonly used defense
mechanism.
Learning outcome: The student will understand the various types of inborn motives
(survival, social and curiosity) and its application in Psychiatry as well as the
meaning of ego defense mechanism, characteristics and commonly used defense
mechanism.
7.
Personality and Personality Disorders

Learning objective: The student will learn the definition of personality, development
of personality and the various types of personality disorders.
Learning outcome: The student will understand definition of personality,
development of personality and the various types of personality disorders.
8. Stress and Emotion

Learning objective: The student will learn the definition of stress, sources of stress,
physiological changes to acute and chronic stress and how stress affects physical and
mental health. The student also learns the meaning of emotion, theories of emotions
and factors involved in fear and rage reactions
Learning outcome: The student will understand the definition of stress, sources of
stress, physiological changes to acute and chronic stress and how stress affects
physical and mental health. The student also understands the meaning of emotion,
theories of emotions and factors involved in fear and rage reactions.
219
Neurocognitive Disorders:
Learning objective: The student will learn the meaning of organic mental disorders,
types of organic mental disorders (focal and generalized) and the causes, symptoms
and management of delirium, amnestic disorder and dementia.
Learning outcome: The student will understand the meaning of organic mental
disorders, types of organic mental disorders (focal and generalized) and the causes,
symptoms and management of delirium, amnestic disorder and dementia.
10. Substance use/abuse Disorders

Learning objective: The student will learn the causes for drug use, characteristic
features of drug dependence, classification of dependence producing drugs and learn
in detail (pharmacological effect, complications, withdrawal symptoms and
management) the commonly abused drugs in Malaysia such as heroin, cannabis, ATS,
solvent abuse and alcohol
Learning outcome: The student will understand the causes for drug use, characteristic
features of drug dependence, classification of dependence producing drugs and learn
in detail (pharmacological effect, complications, withdrawal symptoms and
management) the commonly abused drugs in Malaysia such as heroin, cannabis, ATS,
solvent abuse and alcohol
11.Schizophrenia and Related disorders
Learning objective: The student will learn the aetiology, signs and symptoms,
diagnostic criteria, types, prognosis and management of schizophrenic disorder as
well as other psychotic disorders.
Learning outcome: The student will understand the aetiology, signs and symptoms,
diagnostic criteria, types, prognosis and management of schizophrenic disorder as
well as other psychotic disorders.
12. Mood (affective) Disorders
diagnostic criteria, types, prognosis and management of depression and bipolar
disorders
diagnostic criteria, types, prognosis and management of depression and bipolar
disorders
220
13. Anxiety and Stress Related Disorder

diagnostic criteria, types, prognosis and management of the various types of anxiety
disorder such as generalized anxiety disorder, panic disorder, phobic disorders and
obsessive compulsive disorders as well as stress related disorders such as acute stress
reaction and post traumatic stress disorder.
diagnostic criteria, types, prognosis and management of the various types of anxiety
disorder such as generalized anxiety disorder, panic disorder, phobic disorders and
obsessive compulsive disorders as well as stress related disorders such as acute stress
reaction and post traumatic stress disorder.
14. Somatoform and Dissociative Disorders
diagnostic criteria, types, prognosis and management of the various types of
somatoform disorders (conversion, somatisation, body dysmorphic, pain) and
dissociative disorders (amnesia, fugue, multiple personality)
somatoform disorders (conversion, somatisation, body dysmorphic, pain) and
dissociative disorders (amnesia, fugue, multiple personality)
15. Childhood Psychiatric Disorders
childhood psychiatric disorders such autism, ADHD, elimination disorders, conduct
disorders and other emotional disorders in childhood.
childhood psychiatric disorders such autism, ADHD, elimination disorders, conduct
disorders and other emotional disorders in childhood.
16. Sleep and Eating Disorders
Learning objective: The student will learn the basic physiology of sleep,
classification, aetiology, signs and symptoms and management of sleep disorders
(insomnias, hypersomnias and parsomnias) as well as eating disorders (anorexia
nervosa, bulimia nervosa and pica)
Learning outcome: The student will understand the basic physiology of sleep,
classification, aetiology, signs and symptoms and management of sleep disorders
(insomnias, hypersomnias and parsomnias) as well as eating disorders (anorexia
nervosa, bulimia nervosa and pica)
221
17. Disorders of Sexuality and Gender Identity

Learning objective: The student will learn the normal sexual cycle in male and
female, psychosexual disorders in male and female (aetiology manageme nt) and
abnormal sexual desires (paraphilias) as well as gender identity disorder
(transsexualism)
Learning outcome: The student will understand the normal sexual cycle in male and
female, psychosexual disorders in male and female (aetiology management) and
abnormal sexual desires (paraphilias) as well as gender identity disorder
(transsexualism)
18. Disorders Associated With Menstruation and Pregnancy & Old Age Psychiatry
Learning objective: The student will learn about the various psychiatric disorders
related to menstruation (PMS) and childbirth (blues, depression, psychosis) as well as
psychological problems in old age (factors contributing, depression, dementia and
delusional disorders)
Learning outcome: The student will understand the various psychiatric disorders
related to menstruation (PMS) and childbirth (blues, depression, psychosis) as well as
psychological problems in old age (factors contributing, depression, dementia and
delusional disorders)
19. Counseling and HIV counseling
Learning objective: The student will learn the definition of counseling, principles of
counseling and steps in counseling. The student will also learn how to do counseling
in HIV cases (pre-test, post-test, supportive and counseling in AIDS)
Learning outcome: The student will understand the definition of counseling,
principles of counseling and steps in counseling. The student will also learn how to
do counseling in HIV cases (pre-test, post-test, supportive and counseling in AIDS)
20. Treatments in Psychiatry-Psychological,Pharmacological and Electroconvulsive
therapy
Learning Objective:
The student is taught the various aspects of Psychological and pharmacological treatment
modalities that are usually used, in the treatment. The student learns about the basic
psychological prinicples and rationale for the various psychological treatments like
behaviour therapy, relaxation techniques, and Cognitive Behaviour therapy and briefly
introduced to the various forms of Psychotherapy. The Pharmacological treatment covers
broadly the various
antipsychotics,antidepressants,anxiolytics,mood stabilisers and
their mechanism of action and specific roles of each of these drugs, and their indications.
222
The student learns about Electroconvulsive therapy and the bio psychosocial aspects of
managing mental illness.
Learning Outcome:
The student understands various aspects of Psychological and pharmacological treatment
modalities that are usually used, in the treatment. The student learns the basic
psychological prinicples and rationale for the various psychological treatments, and the
pharmacological aspects of various drugs such as antipsychotics,
antidepressants,anxiolytics,mood stabilisers and their mechanism of action and specific
roles of each of these drugs, and their indications. The student gets to witness
electroconvulsive therapy being undertaken, during the clinical posting in psychiatry. The
different indications and contraindications for ECT also discussed. The student is to
understand the bio psychosocial method of managing a person with mental illness.
(Some lectures are one hour and some are two hours)
223
PSYCHIATRY
LEARNING OBJECTIVES FOR SEMESTER 6 & 7: CLINICAL TEACHING
CLINICAL
The medical student will be able to demonstrate the ability to:
a. Perform an independent competent patient interview which will explore all
aspects of patients history (identification data, chief complaints, history of
presenting illness, current psychosocial stressors, functional impairment due to
the illness, current medical and drug history, family history, personal history,
premorbid personality and past medical and psychiatric history.
b. Perform a complete mental status examination (general appearance and
behaviour, speech, mood, thought content, perceptual disturbances and cognitive
functions which includes performing mini mental status examination (MMSE)
c. Perform a complete physical examination (general and systemic)
MEDICAL KNOWLEDGE
The student will be able to:
a. Know the meaning and clinical importance of terms used in psychiatric
evaluation (psychopathology)
b. Know the diagnostic criteria for various psychiatric disorders and be able to elicit
these criteria clinically from the patient and obtain relevant data form family
members.
COMMUNICATION SKILLS
a.
b.
c.
d.
Express findings
Express findings
Be empathic and
Work effectively
in a coherent, orderly oral presentation in the clinics

in a coherent ,orderly written presentation in log book
develop rapport with patients and their families
as a team player with other students
PROFESSIONALISM
a. Demonstrate an understanding of the ethical values and codes of a member of the
medical profession when dealing with patients and families.
b. Exemplify personal and intellectual integrity
c. Recognize and adapt to cultural differences
d. Demonstrate respect for patients and colleagues in interactions
e. Demonstrate a sensitivity and awareness of the patients culture, age, gender,
socioeconomic status, sexual orientation, religion and spirituality, and disabilities.
224
f.
Demonstrate respect towards physician and non-physician colleagues (eg nurses)
PSYCHIATRY
LEARNING OBJECTIVES FOR SEMESTER 8 & 9
CLINICAL
The medical student will be able to demonstrate the ability to:
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
Perform an independent competent patient interview which will explore all

aspects of patients history (identification data, chief complaints, history of
presenting illness, current psychosocial stressors, functional impairment due
to the illness, current medical and drug history, family history, personal
history, premorbid personality and past medical and psychiatric history.
Perform a complete mental status examination (general appearance and
behaviour, speech, mood, thought content, perceptual disturbances and
cognitive functions which includes performing mini mental status
examination (MMSE)
Perform a complete physical examination (general and systemic)
Utilize the information obtained during a patient interview to develop an
accurate differential diagnosis and provisional diagnosis
Develop a pertinent management plan (investigations and treatment) for the
patient.
Recognizes the pharmacological and non-pharmacological (psychotherapy)
treatment of psychiatric patients
Recognize and manage the side-effects of psychotropic drugs.
Demonstrate the ability to perform supportive psychotherapy, and will know
how to utilize crisis intervention techniques in the treatment of acute patients
Understand the use of support and psycho-education techniques when
working with families of patients.
Understand the use of ECT in acute psychiatric patients
Understand the effective use of community nursing for optimum patient
benefit by making home visits with the community nurse.
Understand the admission process of psychiatric patients- voluntary
admission as well as certification process practiced in Malaysia. This will
include a working knowledge of the paperwork involved.
1.13
Understands the evaluation and treatment of special children in a
rehabilitation centre (The Salvation Army)
225
From Batch 29 in Semester 8 & 9 the shift: The above components of Semester 6
(Batch 28) will come in the first 2 weeks of Semester 8 & 9.
First 2 weeks - Semester 6 component (in Semester 8 & 9)
Learning Objectives and Outcomes
The following objectives and learning outcomes are to be taught and achieved by the
end of this three weeks posting:
a. The student will be taught and the student must be able to develop the basic
skills and knowledge in communication techniques, interview techniques (history
taking) in psychiatry.
b. The student will be illustrated / demonstrated signs, symptoms; verbal, nonverbal communication (Mental Status Examination) and the student must be
knowledge to these Mental Status Examination findings.
c. The student will be taught to understand problems related to the signs and
symptoms and the student must be able to understand problems of the patient
and able to relate them to signs and symptoms (Psychiatric Psycho-Pathology
PPP).
d. The student will be taught on aspects of active listening and hearing and
emphasis on open-ended and closed ended questions and note taking. This, the
student must learn to listen (Active Hearing) of what the patient / informant says,
understand their problems, strength, weakness, use appropriately open-ended
and close-ended questions.
The second two weeks of semester 8&9
The Portfolio currently followed in Semester 9&10 will be adhered to.
Semester !0 (proposed shift)
Beginning with Batch 29 it is proposed to have a few changes as a shift in the
Curriculum and also in the Portfolio. The changes include introduction of Portfolio Based
Challenge, DOPS, MINI-CEX, and Reflections.
MEDICAL KNOWLEDGE
1.1
Know the meaning and clinical importance of terms used in psychiatric

evaluation (psychopathology)
226
1.2
1.3
1.4
1.5
Know the diagnostic criteria for various psychiatric disorders and be able to
elicit these criteria clinically from the patient and obtain relevant data form
family members.
Display proficiency in using the various drugs used in psychiatry such as
antipsychotics, antidepressants, mood stabilizers and anti-anxiety with regards
to drug selection in particular clinical scenarios, dosage, mechanism of action,
side-effects, appropriate monitoring, duration of treatment and safety in
children and pregnancy.
Know the various types of psychotherapy used to treat psychiatric disorders.
Have a good knowledge about culture bound syndrome pertaining to
Malaysia, Law and Psychiatry, Psychiatric emergencies and Medical ethics
INTERPERSONAL AND COMMUNICATION SKILLS

a. Establish rapport with patient and family
b. Understand and develop a therapeutic alliance with the patient
c. Listen to non-judgmental and with openness
d. Facilitate the patient talking openly and freely
e. Empathize with the patients feeling states
f. Convey empathic understanding
g. Be empathic and develop rapport with patients
h. Express findings in a coherent, orderly oral presentation in the clinics
i. Express findings in a coherent ,orderly written presentation in log book
j. Work effectively as a team player with other students
k. Adapt his/her style of interaction specific to age and cognitive capacity of the
patient and family
l. Break bad news to patient and family and handle the situation tactfully.
PROFESSIONALISM
1.1
1.2
1.3
1.4
1.5
1.6
Demonstrate an understanding of the ethical values and codes of a member of

the medical profession when dealing with patients and families.
Exemplify personal and intellectual integrity
Recognize and adapt to cultural differences
Demonstrate respect for patients and colleagues in interactions
Demonstrate a sensitivity and awareness of the patients culture, age, gender,
socioeconomic status, sexual orientation, religion and spirituality, and
disabilities.
Demonstrate respect towards physician and non-physician colleagues (eg
nurses)
227
SELF DIRECTED LEARNING

a. Establish an educational alliance with the supervisor
b. Locate, critique, and assimilate evidence from scientific studies as it relates to
patients health problems
c. Analyze practice based experience and perform practice based improvement
activities (reflective learning)
d. Motivation and eagerness to learn
e. Use information technology to access on-line medical information and support
his/her own education
PROBLEM BASED LEARNING

Demonstrate critical thinking skills in the approach to particular clinical
scenarios given with regard to questions asked to arrive at diagnosis and rule out
differential diagnosis and management. (bio psychosocial approach in evaluation and
management)
SIMULATION IN PSYCHIATRY
The student will be able to understand the diagnostic criteria (signs and symptoms) for
the must see cases of common psychiatric disorders and the clinical manifestations of
these findings in actual patients. This involves a theoretical understanding of the
disorders, the meaning of the terminologies used, the presentation of these findings in the
(simulated) patient and the theoretical knowledge in making accurate diagnosis
.
PSYCHIATRIC PSYCHOPATHOLOGY
The student will be able to understand the basic sign and symptoms
(terminology/glossary) I psychiatry. The student have a theoretical understanding of the
terminology and recall the definition. This understanding should help them to relate to the
cognitive, affective and behavioral, signs and symptoms in a patient.
TUTORIALS
The will be able to understand and acquire a basic knowledge and skill in the approach in
the various subjects listed. These will enhance the student in the clinical field after the
graduation. The topics discussed are :- Law and Psychiatry, Emergency Psychiatry,
Breaking Bad News, Primary Care in Psychiatry,Psychiatic aspects of Medical
conditions,Disoders related to Menstruation, Pregnancy and Postpartum Period and
Cultural Psychiatry.
228
Learning Outcomes
229
Objectives and outcome of training in department of medicine of the

undergraduate course:
The comprehensive goal of training in internal medicine is

To instill in the medical student the knowledge and awareness of the broad
spectrum of diseases, their prevalence as geographically relevant and illness.
Make them aware of advances in medical technology.
Develop in them the ability to use this knowledge effectively in their professional
life in a humane and humble way and to develop the confidence and pride, which
goes with their responsibility, qualities which will be theirs for the remainder of
life.
At the end of training through internal medicine a student is required to acquire

following competency
Knowledge
Be able to recognize and diagnose common clinical disorders with special

reference to the rising trend of non-communicable diseases in the country.
Be conversant with the modes of management of common ailments with a sound
knowledge of drug therapeutics.
Be able to propose diagnostic and investigative procedures and acquire the
ability to interpret them.
To acquire sound knowledge of the immediate management of acute
emergencies.
230

To acquire the knowledge needed to recognize and manage socially challenged
groups such as the elderly, and the disabled.
Have the ability to regularly update their
knowledge, retrieve current
developments in medicine and practice evidence-based medicine.

Skills
The student shall be able to:
Conduct a patient-centered interviewing that is reassuring, tactful, accurate,
organized and problem-focused.
Conduct physical examinations across the following systems: neurological,
cardio-vascular, respiratory, gastrointestinal, haemopoietic, endocrinology &
metabolism, renal & hematology.
Interpret and integrate history and physical examination findings to frame
appropriate diagnoses/differential diagnoses in commonly presenting complaints.
Communicate clearly, considerately and sensitively with patients, relatives,
doctors, nurses, and other health professionals and the general public.
Recognize serious illnesses and to perform common emergency and life-saving
procedures such as caring for the unconscious patient and cardiopulmonary
resuscitation and decide when to refer a patient to secondary and/or tertiary level
of health care after having instituted primary care.
Attain technical proficiency in skills of venepuncture, branula insertion, arterial
puncture, urinary catheterization, endotracheal tube insertion and assist and
participate in conducting the common bedside procedures such as ascitic tap,
peritoneal
dialysis,
pleural
aspiration,
lumbar
puncture,
bone
marrow
aspiration/biopsy and liver biopsy.
231
Attitudes:
The student shall:
Have the understanding and respect for all patients with different religious,
cultural and social values.
Have the understanding of ethical standards acceptable to the profession.
Have the right attitude and commitment to deliver the best possible medical care
for his/her patients, deriving maximal benefit from the available resources.
Develop a caring attitude towards patients and their families, and function as a
Integration
The student shall be able to integrate

With basic sciences as applied to clinical medicine in order to understand the
pathophysiology and implications of disease processes and sound basis of their
treatment.
With community medicine: to have the knowledge and be aware of important
current national health programs and policies.
With the society at large and be able to communicate effectively with patients,
their families, health care professionals and public regarding the nature, course,
consequences and prevention of various illnesses.
The training would also enable the student to view the patient and his/her illness
as a whole in his/her physical, social, cultural, geographical and economic milieu.
232
Over all learning outcome: at the end of effective training student will
Recognize and diagnose common clinical disorders with special reference to the
rising trend of non-communicable diseases in the country.
Will be conversant with the modes of management of common ailments with a
sound knowledge of drug therapeutics.
Will be able to propose diagnostic and investigative procedures and acquire the
ability to interpret them.
Will have a sound knowledge of the immediate management of acute
emergencies.
Will have the knowledge needed to recognize and manage socially challenged
groups such as the elderly, and the disabled.
Will have the ability to regularly update their knowledge, retrieve current
developments in medicine and practice evidence-based medicine.
Please note: Specific objectives and learning outcomes in terms of knowledge,

skills and behavior to be acquired in each semester are described under the
respective semester modules.
233
Lecture classes (Semester 6 & 7)

Cardiovascular System
Topic 1.
Topic: Rheumatic Fever and its

management
Mode of delivery: Lecture
Learning Objectives
Expected Learning Outcomes
To understand the basic concepts of rheumatic
Students will be able to
fever and its management
1. explain the aetiopathogenesis

2. describe the clinical features
3. list the criteria for diagnosis
4. outline the treatment and prophylaxis
strategies
5. list the long term complications of
rheumatic fever
234
Topic 2.
Topic: Valvular Heart Diseases

Learning Objectives
To understand the basic concepts of valvular
heart disease and their complications and
1. list the common causes,
management.
2. explain the aetiopathogenesis,

3. describe the clinical features,
4. outline the treatment,
5. long term complications
of important valvular heart diseases including
a. mitral stenosis,
b. mitral regurgitation,
c. aortic stenosis,
d. aortic regurgitation and
e. tricuspid regurgitation.
235
Topic 3.
Topic: Infective Endocarditis and its

management
Learning Objectives
To understand the basic concepts of infective
endocarditis and its management
1. list the causes and risk factors

4. list the criteria for diagnosis
5. outline the treatment
6. prophylaxis strategies for infective
endocarditis.
236
Cardiovascular System Topic 4.

Topic: Coronary Artery Diseases Risk
factors, primary and secondary prevention.
Angina, MI and their management
Learning Objectives
To understand the basic concepts of coronary
artery disease and its management
1. recognize the nature and burden of the

disease in Malaysia and in the world.
2. list the causes and risk factors
4. differentiate the types (stable angina,
unstable angina and myocardial
infarction)
6. describe the investigations for
diagnosis, especially
electroardiography and cardiac
enzymes
7. outline the treatment
8. primary and secondary prophylaxis
strategies for coronary artery disease.
237

Topic: Hypertension and its management
Learning Objectives

To understand the basic concepts of systemic
hypertension and its management

2. list the risk factors for essential
hypertension
3. list the causes for secondary
hypertension
5. list the investigations required for
monitoring of hypertension and its
treatment
6. outline the principles of treatment
7. list the important classes of
antihypertensive drugs with examples
and important class adverse effects
8. Describe hypertensive emergencies
and urgencies
9. enumerate the long term complications
of hypertension
238
Topic 6.
Topic: Cardiac Failure and its management

Learning Objectives
To understand the basic concepts of cardiac
failure and its management
1. list the causes of cardiac failure

3. differentiate between left and right
sided heart failures
4. list the investigations required for
diagnosis
6. list the important classes of drugs used
in cardiac failure with examples and
important adverse effects
7. enumerate the complications of cardiac
failure
239

Topic: Cardiac Arrhythmias and their
management
Learning Objectives
To understand the basic concepts of cardiac
arrhythmias and their management
1. list the common types of arrhythmias

with classification
2. describe their clinical features
3. identify common arrhythmias
including ectopic beats, atrial
fibrillation, supraventricular and
ventricular tachycardia, ventricular
fibrillation and heart blocks
4. differentiate between atrial and
ventricular ectopics
5. differentiate between supraventricular
and ventricular tachycardias
6. identify the various rhythms seen in
cardiac arrest
8. list the important classes of drugs used
in managing arrhythmias with
examples
9. enumerate the complications of cardiac
arrhythmias
240
Topic: Pulmonary Hypertension, Venous

Thrombosis, Embolism and their
management
Learning Objectives
To understand the basic concepts of
pulmonary hypertension, venous thrombosis,

embolism and their management
1. list the common causes for pulmonary

hypertension
3. list the investigations required with
their expected abnormalities
4. enumerate the complications
5. outline the principles of treatment of
pulmonary hypertension
6. list the common causes for venous
thrombosis and embolism with their
aetiopathogenesis
7. describe the clinical features and
complications and
8. principles of treatment and prophylaxis
of venous thrombosis and embolism
241
Endocrinology
Topic 9.
Topic: Diabetes mellitus, complications and

management
Learning Objectives
To understand the basic concepts of diabetes
mellitus, its complications and their

management
1. list the diagnostic criteria for diabetes

mellitus
3. differentiate between type 1 and type 2
diabetes mellitus
diabetes mellitus
8. outline the monitoring of diabetes
control with glycemic targets
9. outline the management of
complications
242
Endocrinology
Topic 10.
Topic: Thyroid disorders and their

management Hyperthyroidism and
Hypothyroidism
Learning Objectives
To understand the basic concepts of thyroid
disorders their management
1. list the important causes of hypo and

hyperthyroidism
2. differentiate between primary and
secondary thyroid disorders
hypo and hyperthyroidism
243
Endocrinology
Topic 11.
Topic: Pituitary disorders and their

management Anterior and posterior
pituitary diseases
Learning Objectives
To understand the basic concepts of pituitary
1. demonstrate an understanding of the

feedback mechanisms within the
endocrine system
2. list the important causes of
hypopituitarism and other pituitary
disorders
3. describe the clinical features of
hypopituitarism, acromegaly and
hyperprolactinemia
4. describe the effects of micro and
macroadenomas in the pituitary
hypopituitarism, acromegaly and
hyperprolactinemia
244
Endocrinology
Topic 12.
Topic: Adrenal disorders and their

management Cushings and Addisons
diseases
Learning Objectives
To understand the basic concepts of adrenal
1. list the important causes of adrenal

disorders including Cushings
syndrome and Addisons disease
2. describe the clinical features of
Cushings syndrome, Addisons
disease and Conns syndrome
3. describe the diagnostic tests for adrenal
disorders
Cushings syndrome and Addisons
disease.
245
DEPARTMENT OF INTERNAL MEDICINE

Semester 7 & 8
Theory classes -1
Expected learning outcome:
Topic: Introduction to ECG
Mode of delivery: Didactic lecture with

audio visual aids
Learning Objectives
Expected learning outcomes
To describe the basic electrophysiology of

heart and learn the methodic interpretation
and analysis of 12 lead ECG
To develop an approach to analyse 12 lead
ECGs in clinical postings
Students will demonstrate a basic

knowledge of interpretation of normal 12
lead ECG and apply the acquired skills to
analyze the ECG of common cardiac
conditions in the hospital; and outpatient
settings
Theory classes 2
Topic: Endocrinology- Cushings syndrome,
Addisons & Phaeochromocytoma
Mode of delivery: Didactic Lecture with

audiovisual aids
Learning Objectives
Students will describe the roles of adrenal

medulla and cortex and know the salient
clinical features, investigation and
management of adrenal over and under
activity
Students will recognize the etiopathogenesis,
Students will demonstrate a basic

knowledge of applied anatomy and
physiology [especially the endocrine
axis] of adrenal glands. They will explain
the pathophysiology, principles of
evaluation and therapeutics of Cushings
syndrome and synopsis of Addisons and
Phaeochromocytoma
clinical presentations, evaluation&,

complications with principles of treatment of
Cushings syndrome and with synopsis of
Addisons and Phaeochromocytoma
246
Theory classes 3
Topic: HIV infection: Epidemiology, Natural

history, Clinical features, Investigations and
treatment

audiovisual aids
Learning Objectives
Students will describe the pathogenesis of

AIDS, [natural history & mode of spread]
and basic elements of HIV reproduction.
Will know the clinical features and criteria
for AIDS and opportunistic infections.
Management of HIV/AIDS - will discuss the
basis of laboratory tests, grasps the
importance of combination antiretroviral
therapy along with issues of counseling
Students will demonstrate the basic

knowledge of HIV virus replication,
mode of spread and important risk
factors.
Student demonstrates the knowledge of
clinical manifestations of HIV-AIDS,
including criteria and common
opportunistic infections.
Students will be able to analyze clinical
features, interpret the lab data in HIV
pharmacology of HAART
Student will be cognizant of the major
issues in counseling patients for HIV
antibody testing
247
Theory classes - 4
Topic: Dengue fever & Meliodosis
Learning Objectives
To describe the etiopathogenesis,
complications, diagnosis, management of
Dengue fever.
To discuss the clinical manifestations,

complications and management of
Meliodosis

audiovisual aids
knowledge of dengue virus, mode of
infection and transmission
Student will be able to demonstrate the
knowledge of clinical manifestations of
Dengue fever including the classification
by W.H.O based on clinical severity
Students will be able to analyze clinical
features, interpret the cardinal lab data in
dengue
knowledge of fluid management and
management of complications
Student will be cognizant of the major
issues in counseling patients for HIV
antibody testing
Students will demonstrate the knowledge

of etiological agent, clinical features and
microbiological background of
meliodosis.
Students will demonstrate the appropriate
knowledge of therapeutics of various
types of meliodosis
Students will be cognizant of the issue of
correlation of meliodosis & diabetes
mellitus
248
Theory classes 5
Topic: Diagnosis and therapeutics of

Malaria, Tuberculosis Enteric fever and
Leptospirosis

audiovisual aids
Learning Objectives
To describe the etiology, clinical

manifestations, systemic complications,
diagnostic tests and management of Malaria,
Tuberculosis, enteric fever& Leptospirosis

of etiopathogenesis, mode of spread and
important risk factors for malaria,
tuberculosis, enteric fever and
leptospirosis
Student will demonstrate the knowledge
of clinical manifestations of malaria,
leptospirosis
Students will analyze clinical features,
interpret the lab data in malaria,
leptospirosis
Students will demonstrate the therapeutic
knowledge of the above mentioned
diseases with side effect profile of
various treatments
249
Theory classes 6
Topic: Introduction to rheumatology
clinical aspects

audiovisual aids
Learning Objectives
formulate a differential diagnosis based on

history and examination findings and
laboratory data
To discuss the key investigations
demonstrate a working knowledge of main
Students demonstrate the clinical

approach, both history taking and
physical examination various
rheumatological conditions
of key laboratory evaluations and
interpret the same
drugs used in rheumatological conditions and

their potential harm
Students will analyze clinical features,

interpret the lab data for the specific
rheumatological disorders
knowledge of the above mentioned
diseases with side effect profile of
various treatments
Theory classes 8
Topic: Gout
Clinical features of scleroderma

audiovisual aids
Learning Objectives
To describe the etiopathogenesis, clinical

of etiopathogenesis, clinical
manifestations & systemic complications
of polyarticular gout
manifestations, complications of gout,

investigations & management of acute and
chronic gouty arthritis
To describe the metabolism of uric acid and
how the abnormalities lead to gout
To have a working knowledge of principles
of management of gout
Students will analyze the clinical

features, interpret the lab data in gout
knowledge of acute and chronic gouty
arthritis
Students demonstrate the clinical
knowledge of scleroderma and the
250
To know the clinical features of systemic

sclerosis and CREST in brief
systemic involvement in brief
Theory classes 9
Topic: Poisonings
Clinical features & management of Organo
phosphorus compound, Paraquat and
paracetmol poisoning

audiovisual aids
Learning Objectives
To discuss the principles of management
poisoning in brief and antidotes usage with
rationale for Organophosphorus Compound,
Paraquat & Paracetamol with succinct
knowledge of protean manifestations of each
poisoning

of clinical features, systemic
manifestations and complications of the
common poisonings
knowledge of antidotes usage with
rationale and supportive management for
Organophosphorus Compound, Paraquat
& Paracetamol poisonings
Theory classes 10
Topic: Envenomation & Environmental
disorders
Learning Objectives
To describe the clinical manifestations of
snake envenomation and systemic
complications.
To acquire the basic concepts of
environmental medicine, with brief
knowledge of heat stroke and malignant
hyperthermia

audiovisual aids
of clinical features, systemic
manifestations and complications of
envenomation [snake bite]
Students will demonstrate the
therapeutic knowledge of antidotes usage
with rationale and supportive
management for envenomation.
of clinical severity of various
environmental disorders and the
appropriate treatment
251
Theory classes 11
Topic: Management of Iron Deficiency Anaemia

& Megaloblastic anaemia

audiovisual aids
Learning Objectives
anaemia in general and outline the clinical
approach for classification of anaemias

of clinical features of various causes of
anaemia and their etiological
classification
To acquire the basic concepts of evaluation

of anaemia along with the skills to interpret
the laboratory data in haematology

of haematological laboratory tests with
rationale
To acquire the knowledge on therapeutics of

iron deficiency anaemia and megaloblastic
anaemia
Student will demonstrate the therapeutic

knowledge of the anaemias, Iron
deficiency and megaloblastic anaemias in
detail
Theory classes 12
Topic: Classification & management of
Leukaemias Part I

audiovisual aids
Learning Objectives
and classification of leukaemias

of clinical features of leukaemias
To acquire the knowledge of clinical and

laboratory approaches in the diagnosis of
different types of leukaemias and skills to
interpret the laboratory data of leukaemias

rationale in establishing the diagnoses of
leukaemias
To acquire the knowledge of principles of the

therapeutics of leukaemias with recognition
and treatment of complications & side effects
of chemotherapy

knowledge of leukaemias briefly with the
recognition of complications and side
effects of chemotherapy
252
Theory classes 13
lymphomas Part II

audiovisual aids
Learning Objectives
To describe the clinical manifestations of and
classification of lymphomas

of clinical features of lymphomas

different types of lymphomas and skills to
interpret the laboratory data of lymphomas

lymphomas

therapeutics of lymphomas with recognition
of chemotherapy

knowledge of lymphomas briefly with
the recognition of complications and side
Theory classes 14
leukaemias and myeloproliferative disorders
Part II

audiovisual aids
Learning Objectives
To describe the pathogenesis, clinical features,

investigations management of leukaemias &
Clinical features of Myeloproliferative disorders

of pathogenesis, clinical features,

different types of leukaemias and

investigations management of leukaemias &

Clinical features of Myeloproliferative
disorders [esp. CML]
253
myeloproliferative disorders [esp. CML] and

skills to interpret the laboratory data of these
disorders
Chronic myeloid leukaemia

therapeutics of CML with recognition and
treatment of complications & side effects of
chemotherapy

knowledge of CML briefly with the
Theory classes 15

lymphomas

audiovisual aids
Learning Objectives
To understand the clinical manifestations of
and classification of lymphomas

of clinical features of lymphomas

different types of lymphomas and skills to
interpret the laboratory data of lymphomas

lymphomas

therapeutics of lymphomas with recognition
of chemotherapy

knowledge of lymphomas briefly with
the recognition of complications and side
254
Theory classes 16
Topic: Paraproteinemias (multiple myeloma
clinical features & management) &
Thrombocytopenia [ITP- Management]

audiovisual aids
Learning Objectives
To describe the pathogenesis, clinical

features, investigations management of
multiple myeloma & Clinical features of
Idiopathic thrombocytopenic purpura [ITP]

of pathogenesis, clinical features,
investigations management of multiple
myeloma & Idiopathic
thrombocytopenic purpura

different types of multiple myeloma & ITP
and skills to interpret the laboratory data of
these disorders

multiple myeloma and ITP

therapeutics of multiple myeloma with
recognition and treatment of complications &
side effects of chemotherapy and therapeutic
modalities of ITP

knowledge of CML briefly with the
effects of chemotherapy and the
principles of modalities of treatment of
ITP
255
Theory classes 17
Topic: Blood and blood products; Blood
transfusion and bone marrow transplantation
and tem cell transplantation

audiovisual aids
Learning Objectives
To discuss the principles of transfusion

medicine in brief and the availability of
various blood products and their therapeutic
indications viz. FFP, Cryoprecipitate and
specific coagulation factors.

the principles of transfusion medicine in
brief and the availability of various blood
products and their therapeutic indications

acute and chronic complications of blood
transfusion

of complications and recognition of
blood transfusion reactions and
appropriate therapy of the same
Theory classes 18
Topic:
a. Genetics - Genes, Genetic disorders and
Genetic counseling
b. Obesity - Definition, etiology,

audiovisual aids
management and complications of Obesity
Learning Objectives
a. To describe the types of genetic

inheritance and the clinical application of
Genetics & principles of Genetic counseling
for common genetic disorders

Mendelian inheritance, genetic
application & principles of Genetic
counseling for common genetic disorders
256
b. To discuss the etiopathogenesis, clinical

features, classification, complications and
therapeutics of obesity.

of etiopathogenesis, clinical features,
classification, complications and
therapeutics of obesity.
Theory classes 19
Topic: Etiology, clinical features & management Mode of delivery: Didactic Lecture with
of Acute Hepatitis
audiovisual aids
Learning Objectives
To describe the causes of acute liver disease,
clinical manifestations, complications,
initiate appropriate investigations and outline
a management plan for the important causes
of acute liver disease

of etiopathogenesis of acute hepatitis
with the salient clinical features &
complications.
Students will acquire an ability to analyze
the laboratory data and construct a broad
framework of appropriate therapy for
various causes of acute liver disease
To recognize acute liver cell failure and

know the principles of management plan for
the important causes of acute liver disease
257
Theory classes 20
Topic: Clinical features, complications

&management of Cirrhosis of liver
Dyslipidaemia

audiovisual aids
Learning Objectives
To describe the pathology and metabolic

derangements in cirrhosis

of etiopathogenesis, clinical features and
complications of cirrhosis of liver,
inclusive of hepatic encephalopathy
Students will be able to outline the
clinical features, complications &
principles of treatment of cirrhosis of
liver with portal hypertension
To outline the clinical features,

complications & principles of treatment of
cirrhosis of liver with portal hypertension
To apply the knowledge of classification and

treatment of dyslipidaemia
Students will classify and outline the

therapeutics for dyslipidaemia
Theory classes 21
Topic: Malabsorption syndromes and their

evaluation

audiovisual aids
Learning Objectives
To describe the clinical manifestations,

diagnostic features and treatment of tropical
sprue in detail with an ability to discuss
evaluation of chronic diahrroea
Students will demonstrate an ability to

clinically evaluate [clinical features &
investigations] malabsorption syndrome
and will outline the therapeutics of
tropical sprue in detail
258
Theory classes 22
Topic: GERD, Non-ulcer dyspepsia &
management of Peptic Ulcer disease

audiovisual aids
Learning Objectives
To describe the clinical manifestations,
diagnosis and treatment of GERD, NonUlcer dyspepsia, peptic ulcer disease and
outline the H.Pylori eradication therapy

Students will be able to describe
the clinical manifestations, diagnosis and
treatment of GERD, Non-Ulcer
dyspepsia, peptic ulcer disease and
outline the H.Pylori eradication therapy
Theory classes 23
Topic: Inflammatory bowel disease,

Diverticulosis & Irritable bowel syndrome

audiovisual aids
Learning Objectives
To define the inflammatory bowel diseases

viz, ulcerative colitis and Crohns disease,
explain the clinical features and
complications, differentiate between the two
and to outline the therapeutic modalities for
them
To enlist the extra intestinal manifestations
and complications of IBD
Students will demonstrate the ability to

describe, analyze and draw an outline for
treatment of IBD
To describe the clinical features of IBS &

Complications of Diverticulosis

of clinical features of IBS &
complications of Diverticulosis
Students will be able to compare and

contrast the two main IBDs and will be
able to list the extra intestinal
manifestations and complications of
IBDs
259
Theory classes 24
Topic: Cerebrovascular disease-Definitions,

classification, Etiopathogenesis, Clinical
features, investigations and treatment

audiovisual aids
Learning Objectives
Learn to define, classify stroke.

To describe the etiopathogenesis based on
classification [vascular and neuroanatomy]
and list the risk factors for cerebrovascular
diseases [stroke]
To outline the principles of management of
cerebrocasular diseases with recognition and
treatment of risk factors
Student will be able to define, illustrate

the etiopathogenesis based on
classification and recall the risk factors
Student will design the treatment plan
after analyzing the clinical presentations
of different types of strokes, including
principles of rehabilitation and social
support
Theory classes 25
Topic: Clinical features and management of

migraine & Tension headache

audiovisual aids
Learning Objectives
To acquire the knowledge of

etiopathogenesis & management of migraine
and tension headache
Will identify the salient clinical

manifestations of headaches and compare
and contrast the common causes of
headache
Will outline the treatment of migraine
and tension headache
To acquire the therapeutic knowledge of

headache
260
Theory classes 26
Topic: Therapeutics of Epilepsy and Status

Epilepticus

audiovisual aids
Learning Objectives
To demonstrate the knowledge of

classification of antiepileptic drugs and their
pharmacological actions and side effect
profile.
Will apply the therapeutic knowledge of

antiepileptic drugs with the side effect
profile and drug to drug interaction for
epileptic disorders in adult population
To define status epilepticus and recognize the

precipitating factors fro the same
Will be able to recognize status

epilepticus and formulate the treatment
plan for this emergency
Theory classes 27
Topic: Infections of nervous systemmeningitis, encephalitis

audiovisual aids
Learning Objectives
To discuss the etiology of meningitis,

encephalitis with management [CSF
analysis& antimicrobial therapy]
Student will be able to explain the

etiopathogenesis and salient clinical
features of different types of meningitis
& encephalitis.
To be able discuss the means of transmission

of Japanese B encephalitis & Nipah Virus
encephalitis
Student will analyze CSF and distinguish

bacterial, viral and tubercular meningitis.
Student will outline the specific
pharmacotherapy for different types of
meningitis and encephalitis
261
Theory classes 28
Topic: Coma and brain death

audiovisual aids
Learning Objectives
To be able to discuss the etiopathogenesis &
management of coma
To be able to identify causes of coma

Student will discuss the causes of coma
And identify the same
Student will outline the general principles
of management of coma, with an
demonstrates the knowledge of
identification of treatable causes
To be able to define brain death

Will define breath death
To be able to recall and apply the Glasgow
coma scale on a patient in coma
Will practice application of Glasgow

coma scale in patients with coma
Theory classes 29
Topic: Movement disorders &

Demyelinating diseases

audiovisual aids
Learning Objectives
To describe the clinical presentation of

movement disorders in broad terms and
Parkinsons disease in detail
Student will describe the clinical features

of movement disorders and the salient
features of Parkinsons disease
To outline the therapeutics for Parkinsons

disease with an emphasis on rehabilitation
Student will outline the therapeutics of

Parkinsons disease with the side effect
profile and demonstrates the knowledge
of rehabilitation
262
Theory classes 30
Topic: Peripheral neuropathy, GBS &

Myasthenia Gravis

audiovisual aids
Learning Objectives
To recall the knowledge of dermatomes and
myotomes.
To discuss the, etiology, clinical
manifestations, classifications &
management of peripheral neuropathy.

Student will recall the knowledge of
dermatomes and myotomes
Will be able to discuss the, etiology,
clinical manifestations, classifications &
management of peripheral neuropathy.
To recognize and assess the Gullian-Barre

syndrome clinically and acquire the
therapeutic knowledge of the same
Will recognize and outlines the treatment

of GBS
To recognize the clinical manifestations,

interpret the investigations and therapeutics
of Myasthenia Gravis
Will demonstrate the ability to identify

Myasthenia Gravis and analyze the
laboratory data
Will outline the treatment for Myasthenia
Theory classes 31
Topic: Glomerulonephritis, Criteria,

complications and management of acute
nephritic & nephrotic syndrome

audiovisual aids
Learning Objectives
To be able to define glomerulonephritis and
list the criteria for nephrotic and nephritic
syndromes with complications
To be able to discuss the etiology,
pathogenesis and histopathology of
glomerulonephritis in adult patients
To be able to apply the laboratory data and
interpret the same

Will define glomerulonephritis,
enumerate causes and discuss the clinical
features and apply the criteria
Will compare and contrast acute nephritic
and nephrotic syndromes
Will outline the management with ability
to analyse the laboratory data and
recognize complications
263
Theory classes 32
Topic: Etiology & management of Acute

renal failure [ARF], including ATN

audiovisual aids
Learning Objectives
To be able to define ARF and discuss the

mechanism of renal failure and to enumerate
and classify causes of ARF
To be able to apply the laboratory data and
interpret the same for ARF
To outline the management of ARF based on
the etiology
Will define, classify ARF and compare

and contrast the causes
Will explain and interpret the
investigative procedures to establish the
diagnosis of ARF and its underlying
causes
Will outline the management of ARF and
its complications including acute tubular
necrosis
Theory classes 33
Topic: Chronic renal failure, Renal

replacement therapy, especially dialysis

audiovisual aids
Learning Objectives
To be able describe the etiology and clinical
features of CRF

Student will describe the etiology and
clinical features of CRF
To be able to discuss and interpret the

investigations to establish the cause &
severity of CRF
Student will discuss, interpret and

analyze the various investigations to
establish the cause & severity of CRF
To describe the steps in management of CRF

especially Renal replacement therapy,
dialysis [in detail] and renal transplantation
[in brief]]
Student will describe the steps in

management of CRF especially Renal
replacement therapy, dialysis [in detail]
and renal transplantation
264
Theory classes 34
Topic: Electrolyte and fluid imbalance

audiovisual aids
Learning Objectives
To discuss the etiology, clinical
manifestations of fluid & electrolyte
imbalance [especially hyperkalaemia,
hypokalaemia, hypercalcemia and
hyponatraemia] and their complications

Student will discuss etiology, clinical
manifestations of fluid & electrolyte
imbalance [especially hyperkalaemia,
hypokalaemia, hypercalcaemia and
hyponatraemia]
To be able to interpret laboratory data

[inclusive of ABG], analyze and outline the
treatment plan
Will apply the laboratory knowledge and

interpret the various data
Will outline the principles of
management of fluid and electrolyte
abnormalities and their complications
265

Clinical component (Semester 6 & 7)
Topic: History taking
Timings: morning & afternoon sessions
Lecturer: Department of medicine at

MMMC, MGH & Muar Hospital
Learning Objectives
Mode of delivery: Bedside clinics

To know the general format of recording case

notes the student
To develop the art of editing the history
database focusing the specific details of the
major system affected as indicated by the
working diagnosis

of system review in various organ based
systems with sound knowledge of
cardinal manifestations, with the ability
to summarize the history
To emphasize the History taking in a patient

and elicit the salient symptomatology in
Respiratory, Cardiovascular, Neurological,
Abdominal, haematological, endocrine,
Renal and Locomotor systems
To know the difference between
Will demonstrate the history taking skills

with knowledge of relevant positive and
relevant negative symptoms
interrogation and conversation.

To incorporate a conversation style, the art
of talking besides figuring out the relevant
problem in patients own words.
To develop the ability to integrate basic
sciences knowledge in correlating history
with general examination to the extent
possible depending on the semester of the
MBBS course.
History taking is the essence of medical
practice. It combines considerable
interpersonal skill and diversity with the need
for logical thought, based on a wealth of
medical and general knowledge about
society, and is the beginning of treating and
caring for patients in the widest sense
At the end of history taking student will

be able to formulate a very precise and
concise summary without missing out the
relevant positive and negative symptoms
Will demonstrate his /her ability to
integrate basic sciences knowledge in
correlating history with examination
[general physical and systemic] to the
extent possible depending on the
semester of the MBBS course.
266
Topic: History taking system wise

Lecturer: Department of medicine

MMMC, MGH & Muar
Learning Objectives

Suggested scheme for basic history

taking
Name, age, occupation, country of birth,
other clarification of identity
Main presenting problem
History of main presenting problem
Past medical history Before we talk
about why you have come I need to ask you
to tell me about any medical problems you
have had in the past.
Specific past medical history e.g.
diabetes, hypertension, dyslipidaemia, gout
jaundice, TB, heart disease, high blood
pressure, rheumatic fever, epilepsy
Family history
Occupational history
Smoking, alcohol, drug & food allergies
Dietetic history
Drug and other treatment history
Socioeconomic history with welfare SOCSO
etc as relevant
Direct questions about bodily systems not
covered by the presenting complaint [system
review]

of stepwise elicitation of history by
various interview techniques acquired
along their learning
relevant negative symptoms in the chief
complaints with an ability to emphasize
the most significant or salient complaints
Will demonstrate the ability to do system
review of other bodily systems with
clinical correlation of the main organ
system involved
Will demonstrate the ability to elicit basic
history schematically in all the patients
he/she comes across during learning
[clinical sessions]
267
Initially in the posting this may go according to the checklist in the standard format,
however by the end of posting the student should be able to summarize the data into a
short, relevant account without overlooking important points. History should run like a
story not as a checklist of questions in a questionnaire. The student should be trained to
know the difference between interrogation and conversation. Conversation style
incorporates the art of talking besides figuring out the relevant problem in patients own
words.


MMMC, MGH & Muar
Respiratory system
Learning Objectives

To acquire the skills to elicit a complete

history for the respiratory system disorders
,with ability to gather the relevant positive
history by doing a system review with the
help of the cardinal manifestations list
viz;breathlessness,wheezing cough with or
without sputum,fever,chest pain, hoarseness
of voice ,haemoptysis ,weight & appetite
loss, tobacco smoking
Will demonstrate the skills at eliciting

history for the respiratory system
disorders ,with ability to gather the
relevant positive history by doing a
system review with the help of the
cardinal manifestations list
viz;breathlessness,wheezing cough with
or without sputum,fever,chest pain,
hoarseness of voice ,haemoptysis ,weight
& appetite loss.
Learn to clarify the details of all the positive

symptoms in pulmonary disorders
Will develop an ability to clarify specific

symptoms and details in pulmonary
disorders
The student should demonstrate his ability to
The student will demonstrate his ability

to integrate basic sciences knowledge in
procuring an elaborate, relevant history
on a case-to-case basis in respiratory
system

procuring an elaborate, relevant history on a
case-to-case basis in respiratory system
268


MMMC, MGH & Muar
Cardiovascular system
Learning Objectives


history for the cardiovascular system
disorders ,with an ability to gather the
relevant positive history by doing a system
review with the help of the cardinal
manifestations list viz;exertional
breathlessness,orthopnoea,paroxysmal
nocturnal dyspnoea ,cough with pink frothy
sputum ,fever, angina pectoris ,ankle
swelling & abdominal distension

disorders ,with an ability to gather the
cardinal manifestations list viz;exertional
breathlessness,orthopnoea,paroxysmal
nocturnal dyspnoea ,cough with pink
frothy sputum ,fever, angina pectoris
,ankle swelling & abdominal distension

symptoms in cardiovascular disorders

symptoms and details in cardiovascular
disorders
The student should demonstrate his
ability to integrate basic sciences
knowledge in procuring an elaborate,
case-to-case basis in cardiovascular disorders
relevant history on a case-to-case basis in
[Few examples: chronic rheumatic heart
cardiovascular disorders [Few examples:
disease ,IHD,CCF ,long standing
chronic rheumatic heart disease
hypertension]
,IHD,CCF ,long standing hypertension ]
269


MMMC, MGH & Muar
Central nervous system

Learning Objectives


history for the central nervous system
disorders, with an ability to gather the
manifestations list viz; headache, vomiting,
seizures, motor weakness, sensory &
sphincter disturbances, specific symptoms
for each cranial nerve dysfunction.
In the commonality of disease pattern in the
geography to elicit detailed history for risk
factors and complications of stroke, epilepsy,
GBS & peripheral neuropathy

cardinal manifestations list viz; headache,
vomiting, seizures, motor weakness,
sensory & sphincter disturbances,
specific symptoms for each cranial nerve
dysfunction.

symptoms in neurological disorders

symptoms and details in neurological
disorders
case-to-case basis in neurological disorders
[Few examples: Stroke, GBS, Paraplegia,
cranial nerve paralyses, Parkinsonism,
cranial nerve paralyses Parkinsonism,
Cerebellar Disorders]
270


MMMC, MGH & Muar
Abdomen [Gastrointestinal system,

hepatobiliary and nephrology]
Learning Objectives
history for the abdominal disorders, [which
includes three systems mainly GIT,
hepatobiliary & Renal organ based disorders
with an ability to gather the relevant positive
help of the cardinal manifestations pain
abdomen, dyspepsia, nausea, vomiting,
diarrhoea, jaundice, symptoms of anaemia,
symptoms of renal failure and uraemia
factors and complications of chronic hepatitis
& cirrhosis of liver with complications,
nephritic syndrome, nephritic syndrome
acute & chronic renal failure with
complications

symptoms in abdominal disorders

symptoms and details in various
abdominal disorders
case-to-case basis in Gastrointestinal system,
hepatobiliary system and nephrology [Few
[Few examples: Cirrhosis of liver with
examples: Cirrhosis of liver with portal
portal hypertension, nephrotic syndrome
hypertension, nephrotic syndrome & chronic
acute & chronic renal failure]

cardinal manifestations list pain
jaundice, symptoms of renal failure and
uraemia
In the commonality of disease pattern in
the geography to elicit detailed history
for risk factors and complications of
chronic hepatitis & cirrhosis of liver with
complications, nephritic syndrome,
nephritic syndrome acute & chronic renal
failure with complications
renal failure]
271


MMMC, MGH & Muar
Endocrinology & Metabolic disorders

Learning Objectives
history for the common endocrine disorders
with diabetes mellitus in great detail


symptoms in common endocrine disorders
Diabetes mellitus, Thyroid disorders
Cushings syndrome, Pituitary disorders and
obesity

endocrine disorders

history for the endocrine disorders, with
an ability to gather the relevant positive
help of the cardinal manifestations of
diabetes mellitus, Thyroid disorders
Cushings syndrome, pituitary disorders
and obesity

case-to-case basis in endocrinology

[Viz; diabetes mellitus with complications,

Thyroid disorders {hyper thyroidism & hypo
thyroidism}], Cushings syndrome Pituitary
disorders and obesity]
endocrinology
[Viz; diabetes mellitus with
complications, Thyroid disorders {hyper
thyroidism & hypo thyroidism}],
Cushings syndrome, Pituitary disorders
and obesity]
272


MMMC, MGH & Muar
Haematology
Learning Objectives
history for the common haematological
disorders


symptoms in common haematological
disorders and their long term complications

case-to-case basis in haematology

anaemia based on etiology
haematological disorders
[Viz; Iron deficiency anaemia, chronic

haemolytic anaemias]

273


MMMC, MGH & Muar
Infectious diseases
Learning Objectives
history for the common and life threatening
prevalent infections and their acute and
chronic complications in the geography

various infectious diseases
Learn to clarify the details of all the salient

clinical presentations pathognomonic for
each infectious disease and their
complications
Will develop an ability to clarify the

details of all the salient clinical
presentations pathognomonic for each
infectious disease and their complications
case-to-case basis in Infectious diseases
[Viz; HIV-AIDS, Tuberculosis, Viral

Hepatitis Dengue fever, Malaria encephalitis,
Meliodosis, Leptospirosis, Typhoid and
others]

Hepatitis Dengue fever, Malaria
encephalitis, Meliodosis, Leptospirosis,
Typhoid and others]
274


MMMC, MGH & Muar
Locomotor system
Learning Objectives
history for the common Rheumatologic &
connective tissue disorders

the common rheumatological disorders
and connective tissue disorders

symptoms in the common rheumatological

rheumatological and connective tissue
disorders

case-to-case basis in Rheumatology &
connective tissue diseases
[Viz; Rheumatoid arthritis, Gout, SLE,

Ankylosing Spondylitis and others]

in Rheumatology & connective tissue
diseases
275

Semester 8 & 9
Clinical component (Semester 8 & 9)
Topic: Clinical evaluation & management
[history, examination, diagnosis,
investigations and treatment] -system wise
Learning Objectives
Lecturer: Faculty of Department of

medicine at MMMC, MGH & Muar GH
wards PKK & Jasin OPD. CCU
Mode of delivery: Bedside clinics &
Outpatient setting
To know the general format of recording case

notes the student
To develop the art of editing the history
database focusing the specific details of the
major system affected as indicated by the
working diagnosis

of system review in various organ based
systems with sound knowledge of
cardinal manifestations, with the ability
to summarize the history
To emphasize the History taking in a patient and

elicit the salient symptomatology in Respiratory,
Cardiovascular, Neurological, Abdominal,
haematological, endocrine, Renal and Locomotor
systems

relevant negative symptoms
To know the difference between

interrogation and conversation.
To incorporate a conversation style, the art
of talking besides figuring out the relevant
problem in patients own words.
To develop the ability to integrate basic
sciences knowledge in correlating history
with general examination to the extent
possible depending on the semester of the
MBBS course.
History taking is the essence of medical
practice. It combines considerable
interpersonal skill and diversity with the need
for logical thought, based on a wealth of
medical and general knowledge about
society, and is the beginning of treating and
caring for patients in the widest sense
At the end of history taking student will

be able to formulate a very precise and
concise summary without missing out the
relevant positive and negative symptoms
Will demonstrate his /her ability to

correlating history with examination
[general physical and systemic] to the
extent possible depending on the
semester of the MBBS course.
276
Topic: Clinical evaluation & management [history,

examination, diagnosis, complications, differential
diagnoses where relevant, investigations and
treatment] -system wise
Learning Objectives
Suggested scheme for basic history
taking
Name, age, occupation, country of birth, other
clarification of identity
Main presenting problem
History of main presenting problem
Past medical history Before we talk about why
you have come I need to ask you to tell me about
any medical problems you have had in the past.
Specific past medical history e.g. diabetes,
hypertension, dyslipidaemia, gout
jaundice, TB, heart disease, high blood pressure,
rheumatic fever, epilepsy
Family history
Occupational history
Smoking, alcohol, drug & food allergies
Dietetic history
Drug and other treatment history
Socioeconomic history with welfare SOCSO etc as
relevant
Direct questions about bodily systems not covered
by the presenting complaint [system review]

medicine MMMC, MGH & Muar GH
wards, PKK& Jasin OPD. CCU
Outpatient setting
Students will demonstrate the
knowledge of stepwise elicitation of
history by various interview
techniques acquired along their
learning
Will demonstrate the history taking
skills with knowledge of relevant
positive and relevant negative
symptoms in the chief complaints with
an ability to emphasize the most
significant or salient complaints
Will demonstrate the ability to do
system review of other bodily systems
with clinical correlation of the main
organ system involved
Will demonstrate the ability to elicit
basic history schematically in all the
patients he/she comes across during
learning [clinical sessions]
Initially in the final year posting of six weeks history taking may go according to the
checklist in the standard format, however by the end of posting the student should be able
to summarize the data into a short, relevant account without overlooking important points
and the students compulsorily on a rotational basis present in summary rounds as they are
adept in the above mentioned areas and it should run like a story not as a checklist of
questions in a questionnaire. The student already being trained in fourth year to know the
difference between interrogation and conversation will enhance his communication skills
with clinical fluency. Conversation style incorporates the art of talking besides figuring
out the relevant problem in patients own words.
277

complications, investigations and treatment]
Respiratory system
Learning Objectives

wards, PKK& Jasin OPD. CCU
Outpatient setting

history for the respiratory system disorders,
with ability to gather the relevant positive
help of the cardinal manifestations list viz;
breathlessness, wheezing, cough with or
without sputum, fever, chest pain, hoarseness
of voice, haemoptysis, weight & appetite loss,
tobacco smoking

history for the respiratory system
disorders, with ability to gather the
cardinal manifestations list viz;
breathlessness, wheezing & cough with
or without sputum, fever, chest pain,
hoarseness of voice, haemoptysis, weight
& appetite loss.

symptoms in pulmonary disorders

symptoms and details in pulmonary
disorders

case-to-case basis in respiratory system

on a case-to-case basis in respiratory
system
The student will demonstrate his/her ability to

come to final clinical diagnosis and or
differential diagnoses
278

investigations and treatment]
Faculty of Department of medicine

MMMC, MGH & Muar GH wards, PKK
& Jasin OPD. CCU.
Cardiovascular system
Learning Objectives

Outpatient setting

manifestations list viz; exertional
breathlessness, orthopnoea, paroxysmal
nocturnal dyspnoea, cough with pink frothy
sputum, fever, angina pectoris, ankle swelling
& abdominal distension

cardinal manifestations list viz; exertional
breathlessness, orthopnoea, paroxysmal
nocturnal dyspnoea, cough with pink
frothy sputum, fever, angina pectoris,
ankle swelling & abdominal distension

symptoms in cardiovascular disorders

symptoms and details in cardiovascular
disorders

case-to-case basis in cardiovascular disorders
[Few examples: chronic rheumatic heart
disease, IHD, CCF, long standing
hypertension]
Student should demonstrate his/her ability to
analyse, interpret the laboratory and
radiological data, plan the treatment based on
final accurate diagnosis
Should demonstrate a basic pharmacological
approach to the diseases with relevant
therapeutic agents and /modalities

on a case-to-case basis in cardiovascular
disorders [Few examples: chronic
rheumatic heart disease, IHD, CCF, long
standing hypertension]
Student will demonstrate his/her ability
to analyze, interpret the laboratory and
radiological data, plan the treatment
based on final accurate diagnosis
Should demonstrate a basic
pharmacological approach to the diseases
with relevant therapeutic agents and
/modalities
279

complications investigations and treatment]
Central nervous system
Learning Objectives
Faculty of Department of medicine

MMMC, MGH & Muar GH wards &
Jasin OPD. CCU
Outpatient setting

manifestations list viz; headache, vomiting,
seizures, motor weakness, sensory &
sphincter disturbances, specific symptoms for
each cranial nerve dysfunction.
factors and complications of stroke, epilepsy,
GBS & peripheral neuropathy
symptoms in neurological disorders

cardinal manifestations list viz; headache,
vomiting, seizures, motor weakness,
sensory & sphincter disturbances,
specific symptoms for each cranial nerve
dysfunction.

case-to-case basis in neurological disorders

on a case-to-case basis in
Encephalitis, meningitis & Cerebellar
Disorders]


symptoms and details in neurological
disorders

/modalities
280

Abdomen [Gastrointestinal system,
hepatobiliary and nephrology]
Learning Objectives
history for the abdominal disorders, [which
includes three systems mainly GIT,
hepatobiliary & Renal organ based disorders
with an ability to gather the relevant positive
help of the cardinal manifestations pain
diarrhoea, jaundice, symptoms of anaemia,
symptoms of renal failure and uraemia
factors and complications of chronic hepatitis
& cirrhosis of liver with complications,
nephritic syndrome, nephritic syndrome acute
& chronic renal failure with complications

wards & Jasin OPD
Outpatient setting
cardinal manifestations list pain
jaundice, symptoms of renal failure and
uraemia
In the commonality of disease pattern in
the geography to elicit detailed history
for risk factors and complications of
chronic hepatitis & cirrhosis of liver with
complications, nephritic syndrome,
nephritic syndrome acute & chronic renal
failure with complications

symptoms in abdominal disorders

abdominal disorders

case-to-case basis in Gastrointestinal system,
hepatobiliary system and nephrology [Few
examples: Cirrhosis of liver with portal
hypertension, nephrotic syndrome & chronic
renal failure]

on a case-to-case basis in
[Few examples: Cirrhosis of liver with
portal hypertension, nephrotic syndrome
acute & chronic renal failure]


/modalities
281

Endocrinology & Metabolic disorders
Learning Objectives
history for the common endocrine disorders
with diabetes mellitus in great detail

wards & Jasin OPD .CCU
Outpatient setting
diabetes mellitus, Thyroid disorders
Cushings syndrome, pituitary disorders
and obesity

symptoms in common endocrine disorders
Diabetes mellitus, Thyroid disorders
Cushings syndrome, Pituitary disorders and
obesity

endocrine disorders

case-to-case basis in endocrinology

endocrinology
[Viz; diabetes mellitus with complications,

Thyroid disorders {hyper thyroidism & hypo
thyroidism}], Cushings syndrome Pituitary
disorders and obesity]
[Viz; diabetes mellitus with

complications, Thyroid disorders {hyper
thyroidism & hypo thyroidism}],
Cushings syndrome, Pituitary disorders
and obesity]
/modalities

analyze, interpret the laboratory and
282

Haematology
Learning Objectives
history for the common haematological
disorders
symptoms in common haematological
disorders and their long term complications

case-to-case basis in haematology

wards & Jasin OPD CCU
Outpatient setting
anaemia based on etiology
haematological disorders




/modalities
283

Infectious diseases
Learning Objectives
history for the common and life threatening
prevalent infections and their acute and
chronic complications in the geography
Learn to clarify the details of all the salient
clinical presentations pathognomonic for
each infectious disease and their
complications

wards & Jasin OPD. CCU
Outpatient setting
various infectious diseases
Will develop an ability to clarify the
details of all the salient clinical
presentations pathognomonic for each
infectious disease and their complications

case-to-case basis in Infectious diseases


Hepatitis Dengue fever, Malaria encephalitis,
Meliodosis, Leptospirosis, Typhoid and
others]

Hepatitis Dengue fever, Malaria
encephalitis, Meliodosis, Leptospirosis,
Typhoid and others]

analyze, interpret the laboratory and

/modalities
284

[history, examination, diagnosis, investigations
and treatment]
Locomotor system
Learning Objectives
To acquire the skills to elicit a complete history
for the common Rheumatologic & connective
tissue disorders

wards & Jasin OPD. CCU.
Outpatient setting
the common rheumatological disorders

symptoms in the common rheumatological and
connective tissue disorders

rheumatological and connective tissue
disorders

integrate basic sciences knowledge in procuring
an elaborate, relevant history on a case-to-case
basis in Rheumatology & connective tissue
diseases

in Rheumatology & connective tissue
diseases




/modalities
285
5.0 Recommended books for reading / reference

1. Davidsons principles of Medicine - 20th Edition
2. Kumar and Clarks practice of clinical medicine 6th Edition
3. Hutchisons clinical methods 22nd Edition
4. McLeods clinical methods 11th Edition
5.Nicholas J Tally, Simon O Connors: Clinical examination-6th edition [with a DVD]
6. Neurology And Neurosurgery Illustrated Kenneth Lindsay 4th Edition
7.Making neurological Diagnosis at the Bedside Chew Nee Kong
8.Making sense of the ECG A hands on guide Andrew R.Houghton & David Gray
Reference Books
1 Harrisons Principles of Internal Medicine 17th Edition
2.Textbook of Medicine, Souhami and Moxam
3 Clinical Problems in General Medicine and Surgery, Churchill Livingstone, 2nd Ed
4 Washington Manual of Medical Therapeutics 32nd Edition
5.Dale Dubins rapid interpretation of EKGs 6th Edition
6.Medical short cases for medical students Bob Ryder
L.N.Naik
For Professor Choo Beng Huat
HOD, Medicine
Malacca Manipal Medical College
CCU: Coronary Care Unit
PKK-Peringitt Clinic
OPD-Out Patient Department
286
Semester 6 & 7 PBL Sessions:

Topic: Clinical Problems in Cardiovascular
system, Respiratory System, Endocrinology,
Neurology, Nephrology and Hematology
Date: Once a week

2.00pm-3.30pm
During Clinical postings
Mode of delivery: small group teaching with

audio visual aids
Learning Objectives
To understand the basics of clinical problem
solving in cardiorespiratory disorders,

Endocrine disorders, Neurology, Nephrology
and Haematological disorders
*Emphasis in sixth semester is on history,
system review and clinical examination
1. Identify the need for differential

diagnosis
2. Use the available information for
reaching the most likely diagnosis
3. Use the available resources like text
books, online databases for solving
clinical problems
4. Discuss with their peers regarding
clinical problems
5. Solve important clinical scenarios
commonly seen in the system specified
287
Semester 6 & 7
Problem Based Learning
Topic: 1.ECG analysis and interpretation
Date: Once a week
Learning Objectives
Mode of delivery: small group teaching

with audio visual aids
2.00pm-3.30pm
To learn analysis of 12 lead ECG with

interpretation of conditions like chamber
enlargements, IHD, arrythmias, electrolyte
abnormalities [Hyperkalemia, hypokalaemia,
hypercalcaemia & Hypocalcaemia], Cor
Pulmonale, pericardial effusion and
pulmonary embolism

Student will analyse a given 12 lead ECG
in the clinical postings and interpret and
diagnose the following conditions:
Chamber enlargements, IHD [ with
ACS]*, arrhythmias, electrolyte
abnormalities [Hyperkalemia,
hypokalaemia, hypercalcaemia
&Hypocalcaemia], Cor Pulmonale,
pericardial effusion and pulmonary
embolism
* Acute coronary syndrome
Topic: 2.Approach to anaemia and jaundice

Date: Once a week
2.00pm-3.30pm
Mode of delivery: small group learning

with audio visual aids and relevant
websites
Learning Objectives
To be able to recognize the clinical

presentations of anemia and jaundice,
illustrate the basic science knowledge and
analyse various etiologies of anemia and
jaundice in a clinical context with problem
based questions or a case based question
Student will recognize and analyse the

clinical problems and interpret the
clinical and laboratory data and gives
differential diagnoses for anaemia an
jaundice
To be able to recall the system review

essential to recognize the underlying
pathology
Demonstrates an ability to perform

system review essential to recognize the
underlying pathology
288
Topic: 3.Approach to edema and ascites

Date: Once a week
2.00pm-3.30pm
Learning Objectives
To be able recognize the clinical
presentations of edema and ascites, illustrate
the basic science knowledge i.e.
pathophysiology of edema and ascites

websites

pathology
Student will recognize various

manifestations of edema and ascites and
demonstrates an approach to differentiate
the clinical conditions
To be able to describe and analyse various

etiologies of edema and ascites in a clinical
context with problem based questions or a
case based question
Student will describe the etiology of

edema and ascites in a clinical context
with problem based questions or a case
based question
To develop an ability to interpret laboratory

data in ascitic fluid analysis
Will interpret and analyze the laboratory

data in conjunction with the clinical
manifestations
Topic: 4.Approach to chest pain and

dyspnoea

websites
Date: Once a week

2.00pm-3.30pm
Learning Objectives

presentations of chest pain and dyspnoea,
illustrate the basic science knowledge i.e.
pathophysiology of chest pain and dyspnoea
To be able to enumerate various causes of
chest pain and dyspnoea
Student will recognize the clinical

presentations of chest pain and dyspnoea
pathophysiology of chest pain and
dyspnoea
Will recall causes of chest pain and
dyspnoea in an algorithm fashion

pathology

289
Semester 8 & 9: Topics

Once a week
2.00pm-5.00pm
Clinical postings

websites and interactive
Learning Objectives
To be able recognize the clinical problem,

using the data provided and to be able to use
clinical reasoning and develop a logistic
approach for each case based scenario
provided.

problem and records the definitive
diagnosis based on the case scenario
handed out
With an ability to integrate basic science
knowledge and clinical reasoning and
logic discusses the differential diagnoses,
final diagnosis, investigations, treatment
modalities and complications of the
pathology if any
To be able to discuss differential diagnosis,

final diagnosis and formulate appropriate
investigations and treatment modalities.
To be able to recognize complications of the
pathology if any based on the case.
To be able to plan treatment modalities with
an ability to solve the clinical problem
Will plan, formulate the accurate

treatment with an ability to solve the
clinical problem
Semester 8 & 9: Topics [8 weeks]

Once a week
Clinical postings
2.00pm-5.00pm

websites and interactive
Semester 10: Topics
Semester 10: Topics
1. Ischaemic Heart Disease

2. Arrhythmias and Cardiac Arrest
3. Dyspnoea in Respiratory Disorders,
Interpretations of respiratory investigations
5. Fluids, Electrolytes, Oedema and

Renal failure
6. Approach to CNS infections, CSF
analysis & Lumbar puncture procedure
290
4.Clinical problems in Abdomen (GIT,

Hepatology, Hepatosplenomegaly)
7. Approach to anaemia, Polyarthritis &

Bone marrow procedure
8.Revison
Learning Objectives
To be able recognize the clinical problem,

using the data provided and to be able to use
clinical reasoning and develop a logistic
approach for each case based scenario
provided.

handed out
With an ability to integrate basic science
knowledge and clinical reasoning and
logic discusses the differential diagnoses,
final diagnosis, investigations, treatment
modalities and complications of the
pathology if any
To be able to discuss differential diagnosis,

final diagnosis and formulate appropriate
investigations and treatment modalities.
To be able to recognize complications of the
pathology if any based on the case.
To be able to plan treatment modalities with
Will plan, formulate the accurate

treatment with an ability to solve the
clinical problem
291

PBL Session 1
Topic: Clinical Problems in Cardiovascular

and Respiratory Systems
Date: First week of clinical posting

Time: 2.30 PM - 4.30 PM
Mode of delivery: Small Group Session
Learning Objectives
solving in cardiorespiratory disorders
6. identify the need for differential

diagnosis
7. use the available information for
8. use the available resources like text
clinical problems
9. discuss with their peers regarding
clinical problems
10. solve important clinical scenarios
commonly seen in cardiovascular and
respiratory disorders
292
PBL Session 2
Topic: Clinical Problems in Neurology,
Nephrology and Hematology
Date: Second week of clinical posting
Mode of delivery: Small Group Session
Time: 2.30 PM - 4.30 PM
Learning Objectives
solving in neurology, nephrology and

hematological disorders
1. identify the need for differential

diagnosis
2. use the available information for
3. use the available resources like text
clinical problems
4. discuss with their peers regarding
clinical problems
5. solve important clinical scenarios
commonly seen in neurology,
nephrology and hematological
disorders
293
PBL Session 3
Topic: ECG analysis and interpretation

Date: Twice a week
Clinical postings
2.00pm-3.30pm
Mode of delivery: small group teaching

with audio visual aids
Learning Objectives
To learn analysis of 12 lead ECG with

interpretation of conditions like chamber
enlargements, IHD, arrythmias, electrolyte
abnormalities [Hyperkalemia, hypokalaemia,
hypercalcaemia &Hypocalcaemia], Cor
Pulmonale, pericardial effusion and
pulmonary embolism
Student will analyse a given 12 lead ECG

in the clinical postings and interpret and
diagnose the following conditions:
Chamber enlargements, IHD [ with
ACS]*, arrhythmias, electrolyte
abnormalities [Hyperkalemia,
hypokalaemia, hypercalcaemia
&Hypocalcaemia], Cor Pulmonale,
pericardial effusion and pulmonary
embolism
* Acute coronary syndrome
294
PBL Session 4
Topic: Approach to anaemia and jaundice

Twice a week
2.00pm-3.30pm
Clinical postings

websites
Learning Objectives
To be able to recognize the clinical

presentations of anemia and jaundice,
illustrate the basic science knowledge and
analyse various etiologies of anemia and
jaundice in a clinical context with problem
based questions or a case based question
Student will recognize and analyse the

clinical problems and interpret the
clinical and laboratory data and gives
differential diagnoses for anaemia an
jaundice

pathology

PBL Session 5
Topic: Approach to edema and ascites

Twice a week
2.00pm-3.30pm
Clinical postings

websites
Learning Objectives
pathophysiology of edema and ascites

pathology
Student will recognize various

manifestations of edema and ascites and
demonstrates an approach to differentiate
the clinical conditions
295
To be able to describe and analyse various

etiologies of edema and ascites in a clinical
context with problem based questions or a
case based question
Student will describe the etiology of

edema and ascites in a clinical context
with problem based questions or a case
based question
To develop an ability to interpret laboratory

data in ascitic fluid analysis
Will interpret and analyze the laboratory

data in conjunction with the clinical
manifestations
PBL Session 6
Topic: Approach to chest pain and dyspnoea

Twice a week
2.00pm-3.30pm
Clinical postings
Mode of delivery: : small group learning

websites
Learning Objectives

pathophysiology of chest pain and dyspnoea
To be able to enumerate various causes of
chest pain and dyspnoea

presentations of edema and ascites,
pathophysiology of chest pain and
dyspnoea
Will recall causes of chest pain and
dyspnoea in an algorithm fashion

pathology

296
PBL Session 7
Topic: Prescription writing
Twice a week
2.00pm-3.30pm
Clinical postings

websites
Learning Objectives
To be able recognize the clinical problem and Student will recognize the clinical
records the definitive diagnosis based on the
case scenario handed out
handed out
To be able to plan, formulate the treatment
Will plan, formulate the treatment with
with an ability to write out legible
an ability to write out legible prescription
prescription for common medical conditions
for common medical conditions seen in
seen in the hospital
the hospital
This is a practice session

PBL Session 8
Topic: Analysis of arterial blood gas
Lecturer: L.N.Naik
Twice a week
2.00pm-3.30pm
Clinical postings

websites
Learning Objectives
To be able to analyse the given ABG report

in conjunction with a case scenario step wise

To be able recognize the clinical problem and handed out
records the definitive diagnosis based on the
case scenario handed out
Will plan, formulate the treatment with
To be able to plan, formulate the treatment
with an ability to solve the clinical problem
with abnormal ABG report
with abnormal ABG report
This is a practice session
297
e-Learning
Topic: eLearning use of available
resources including authentic internet
resources and online medical databases
Date: Third week of clinical posting
Mode of delivery: Small Group, e-Learning
Time: 2.30 PM - 4.30 PM
Session
Learning Objectives
To understand the basics of information
retrieval and strategies for using internet
1. identify the need for information
resources and online medical databases
2. use the available authentic internet

resources including online databases
like PubMed and Cochrane
collaboration
3. Use the uMedic cardiac auscultation
system for learning cardiac
examination and interpretation.
298
SENIOR CLERKSHIP PROGRAMME FOR SEMESTER 10:
Senior clinical clerkship in the department of medicine:

Duration: Four weeks
Goal: At the end of the effective two weeks training in the structured programme of
senior clerkship in the 10th semester student should be able to analyze history, examine
the patient systematically, and interpret the clinical signs with accuracy, enabling him or
her to postulate differential diagnoses, to come to a final clinical diagnosis and be able to
plan the appropriate management
Learning objectives:
During the two weeks session at department of medicine in the hospital, student should:
a. Apply the knowledge of pathophysiology and evaluation methodology
[History taking skills, clinical examination and appropriate clinical diagnosis] by
integrating the basic science knowledge and the clinical know-how] throughout the
duration of clerkship, where he/she will be allocated hospital beds
c. Develop ability to clerk patients independently as part of shadow housemanship in the

more practical format utilizing the skills and knowledge acquired throughout the course,
which enables them to write progress notes
b. Develop the ability to make decisions, which are apt to different real life case scenarios
in the wards
Example using SOAP

S [subjective]: observations, chief complaints of the patients
O [Objective]: description of physical findings & recordings of laboratory data,
Radiology or ECG data
A [Assessment]: Analysis of data and tentative diagnosis
299
P [Plan]: Diagnostic studies for confirmation and planning of therapeutic regimen
d. To acquire the skills

1. To gather, interpret and weigh the relevant data and organize hierarchically and
document the clinical problems encountered in real patients during their two weeks of
clerkship at the hospital wards
2. To communicate effectively and conduct an interview responsibly with the patient and
the relatives, always acknowledging the their cultural background, adhering strictly to the
patient confidentiality in the milieu of general wards at the hospitals
3. To respect the patients wishes at all contexts or clinical encounters especially with the
terminally ill
4. To lucidly record the relevant patient data
5. To work in a team with interactions and communication with peers and the ward
doctors [Medical officers and housemen posted in medicine department]
6. To present ward patients and discuss independently during ward rounds
7.To interpret the laboratory data [biochemical, histopathology, haematological, serology
& other microbiological investigations] interpretation [inclusive of Radiological data,
Arterial blood gases and ECG as relevant to the acute and chronic ailments in the ward]
of the patients allocated with clinical reasoning
8.To plan the therapeutics applying the knowledge acquired in pharmacology of the
common disease he/she comes across in the wards
9. To identify the common emergencies and participate in the care of critically ill patients
and in resuscitations of patients in emergencies arising in the ward
10. To follow-up the patients and note down the progress of illness or recovery and
document the same
11.Procedural skills: in the ward setting student is under direct supervision of the seniors
and follow a general dictum for all procedural skills with a clear instruction list indicating
the procedures allowed to be performed by the student
300
Procedure
Observe
Assist
Perform
12.To educate the patients and the family and community in large for holistic approach
for individual health and prevention of diseases in the society by participating the patient
counseling held at bedside during ward work
e. Learning/Teaching activities: Most of the clerkship period is self-learning, highly
interactive with self- motivation and enthusiasm towards achieving an all round training
in different areas of Internal Medicine
f. Assessments: All the learning activities in the hospital which are documented in the
senior clerkship diary with various components of procedural skills under supervision,
patient data, follow up, discussions and compulsory long case clerking and laboratory
data [biochemical, histopathology, haematological, serology & other microbiological
investigations] interpretation inclusive of Radiological data, Arterial blood gases and
ECG as relevant to the acute and chronic ailments in the ward
Along with the daily evaluation student will be given a grade and score based on the
performance
Portfolios will be evaluated and students are encouraged to do reflective writing and
narrative article on their encounter with one patient, which enables him/her to
communicate well with the patient
Over all learning outcome of senior clerkship in medicine:
At the end of successful completion of two weeks clerkship in the department of
medicine student will apply the knowledge of pathophysiology and evaluation
methodology [History taking skills, clinical examination and appropriate clinical
301
diagnosis] by integrating the basic science knowledge and the clinical know-how]
throughout the duration of clerkship, where he/she will be allocated hospital beds
Will be able to clerk patients independently as part of shadow housemanship in the more
practical format utilizing the skills and knowledge acquired throughout the course, which
enables them to write progress notes
Will be able to make clinical decisions, which are apt to different real life case scenarios
in the wards
Will make a beginning for acquisition of the skills and ability to perform under
supervision by:
1. Gathering, interpreting and weighing the relevant data and organizing hierarchically
and document the clinical problems encountered in real patients during their two weeks
of clerkship at the hospital wards
2. Effective communication and conduct of an interview responsibly with the patient and
the relatives, always acknowledging the their cultural background, adhering strictly to the
patient confidentiality in the milieu of general wards at the hospitals
3. Respecting the patients wishes at all contexts or clinical encounters especially with the
terminally ill
4. Lucid recording of the relevant patient data
5. Working in a team with interactions and communication with peers and the ward
doctors [Medical officers and housemen posted in medicine department]
6. Acquiring presentation skills of ward patients and discussions independently during
ward rounds
7.Interpreting the laboratory data [biochemical, histopathology, haematological, serology
& other microbiological investigations] interpretation [inclusive of Radiological data,
Arterial blood gases and ECG as relevant to the acute and chronic ailments in the ward]
of the patients allocated with clinical reasoning
8.Plannning the therapeutics applying the knowledge acquired in pharmacology of the

common disease he/she comes across in the wards
302
9. Identifying the common emergencies and participate in the care of critically ill patients
and in resuscitations of patients in emergencies arising in the ward
10. Following-up of the patients and noting down the progress of illness or recovery and
document the same
303
Reference books:
Main source of reference
1 Davidsons principles and practice of medicine

2 Kumar and Clarks practice of clinical medicine
3 Hutchisons clinical methods
4 Macleods clinical methods
5. Nicholas J Talley and Simon O Connor
a systematic guide to physical diagnosis
Additional references
1 Roxburg's synopsis of skin disease

2.Andrews text book of Dermatology
3. Harrisons Principles of Internal Medicine
4. Washingtons Manual of therapeutics
5.British National Formulary [BNF]
6. Antibiotic Essentials Burke A Cunha
7.Sarawak manual of emergencies
304
Learning Outcomes
305
Overall Learning Outcomes:

The broad goal of teaching ophthalmology to undergraduates is to provide knowledge
and skills that shall enable him/her to practice as a clinical and as a primary eye care
physician. It will also help them to function effectively as a community health leader to
assist in the implementation of the National Programme for the prevention of blindness
and rehabilitation of the visually impaired.
Lecture Topics - Learning Outcomes (Semester 6 & 7):

Lecture 1:general and applied anatomy of the eye and orbit, orbital inflammations, cavernous
sinus thrombosis
No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To learn the anatomy of the eye, gross, microscopic
theatre
and the blood supply
/college
B) To learn the anatomy of the orbit, various bones and
the structures in the ortbit, relations of the orbit, blood
supply
C) To be able to study the applied aspect in relation to the
various diseases and lesions caused by them
D) To be able to draw the diagram of different structures
and recognize them
.
E) To be able to know about the various clinical methods
and investigative procedures available to study the
diseases of the orbit
Lecture 2:Thyroid ophthalmopathy,

No
Venue
ITEM
1)
Lecture OUTCOME
theatre
/college
Proptosis differential diagnosis

OUTLINE
A) To learn and memorise various features of thyroid eye
disease
B) To recognize the various signs and complications that
can produce visual loss
C) To study the various modalities of investigation and
treatment available
D) To study the various causes of proptosis and
differential diagnosis in adults and children
306
Lecture 3: optics: Ametropia, myopia, hypermetropia, astigmatism, presbyopia

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the basic anatomy and physiology how the
theatre
images are formed on the retina and how the visual stimuli
/college
are transmitted to give us the visual sense
B) To understand the changes occurring in various
refractive conditions
C) To study how to treat the various errors
D) To educate the public and children how to take care of
the vision
E) To educate the public about the importance of frequent
check up by a qualified ophthalmologist
Lecture 4: cornea; Applied anatomy, corneal ulcers-bacterial and fungal

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the basic anatomy and physiology of the
theatre
cornea
/college
B) To understand the changes occurring in various
corneal ulcers and differentiate them from one another
C) To study the various investigations available and
treatment of corneal ulcers
D) To recognize this condition as an ocular emergency
and to initiate prompt and proper treatment
E) To educate the public about the importance of avoiding
injuries and to seek medical help in cases of eye infections
307
Lecture 5: Cornea: viral. Acanthamoeba keratitis, exposure keratitis, neurotropic keratitis

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) TO study the various conditions as outlined above
theatre
B) To be able to diagnose and differentiate and investigate
/college
the various lesions
C) To be able to educate the public about the proper use of
contact lenses
D) To be able to educate the public about the importance
of hygiene and to prevent the blind ness due to trauma and
other causes of cornel ulcer
Lecture 6: Cornea: degenerations, dystrophies, keratoplasty and eye banking

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) TO study the various conditions as outlined above
theatre
B) To be able to enumerate the different indications of
/college
keratoplasty, their complications
C) To be able to obtain a working knowledge about the
functioning of eye bank
D) To be able to educate the public about the causes of
blind ness and the preventive aspects
E). To be able to educate the public about the importance
of eye banking and eye donation
F) To recognize the importance of voluntarily donating
the eyes
Lecture 7: Uvea: introduction, classification, anterior and posterior uveitis

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the relevant anatomy and physiology of uvea
theatre
B) TO understand the various aspects of uveitis including
/college
the causes, differential diagnosis, investigations and
treatment
C). To understand various complications and damage that
can be caused by uveal inflammation
308
Lecture 8: uveitis in systemic diseases

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To studythe various aspects of uveitis
theatre
B) TO study the different types fo uveitis that are caused
/college
by different systemic disease
C). To study how the various findings help in diagnosis
and confirmation of systemic diseases to help the internist
Lecture 9: Lens: applied anatomy and physiology, classification clinical features and types
No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the normal anatomy and physiology and how
theatre
the alterations cause cataract
/college
B) To be able to recognize cataract as the most leading
cause of preventable blindness
C) To be able to diagnose, the different types of cataract
depending on the various symptoms and signs
Lecture 10: Lens: investigations, counselling and treatment of cataract surgery, complications
No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the various aspects of investigations of
theatre
cataract
/college
B) TO study how to counsel the patient regarding the care
to be taken before and after the cataract surgery
C) To be able to give the visual prognosis
D). To familiarize about the various techniques of cataract
operation
E) To be able to recognize the various complications of
cataract surgery and their treatment
309
Lecture 11: Lens: developmental cataract its management

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the various aspects of developmental cataract
theatre
and how to prevent them
/college
B) TO study the various presentations and investigations
of developmental cataract
C) TO study the different problems peculiar to children
in the treatment and follow up
D). To be able to educate the pregnant women about the
importance of good diet, hygiene and protection against
infections during pregnancy
Lecture 12: glaucoma; aqueous humor dynamics, classification, methods of examination

&congenital glaucoma
No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the various aspects applied anatomy and
theatre
physiology of aqueous humor dynamics
/college
B) To stdy different methods of presentation and
differential diagnosis of congenital glaucoma
C) To study the various investigations and treatment
options available for congenital glaucoma
Lecture 13: glaucoma; primary open angle glaucoma

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the various aspects of primary open angle
theatre
glaucoma including pathophysiology
/college
differential diagnosis
options available to treat the condition
D) To diagnose and treat at the early stages before
considerable damage occurs
E) TO educate the general public about the disease and the
importance of early diagnosis and treatment
310
Lecture 14: glaucoma; primary angle closure glaucoma

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the various aspects of primary angle closure
theatre
glaucoma including pathophysiology
/college
differential diagnosis
options available to treat the condition
D) To diagnose and treat at the early stages before
considerable damage occurs
E) TO educate the general public about the disease and the
importance of early diagnosis and treatment
Lecture 15: Secondary glaucomas&Glaucoma operations

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the aetiology and pathogenesis of secondary
theatre
glaucomas
/college
B) To learn the clinical features and reason the different
investigations
C) To study the various modalities of treatment available
D) To study the basic principles of various glaucoma
operations, indications and important complications
Lecture 16: RetinaApplied anatomy, physiology and clinical evaluation

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To learn the anatomy of the retina, gross, microscopic
theatre
and the blood supply
/college
B) To be able to study the applied aspect in relation to the
various diseases and lesions caused by them
C) To be able to study the physiology of the retina, about the
visual pigments, and about the visual cycle.
D) To be able to know about the various clinical methods
and investigative procedures available to study the diseases
of the retina
311
Lecture17: Retinavascular disorders-diabetic retinopathy and hypertensive retinopathy

No
Venue
ITEM
OUTLINE
1
Lecture
OUTCOME A) To study the etiology, pathothology, physiology,
theatre/medical
clinical features of the conditions
college
B) To recognize the various lesions and stages of the
retinopathy
C) To study the various investigative techniques and
treatment modalities available
D) To identify the importance of recognizing the various
lesions in managing the clinical condition
E) To know how to follow the patient and when to refer
the patient for specialized treatment
Lecture 18: Vascular disorders-CRAO, CRVO Retinopathy of prematurity

No
Venue
ITEM
OUTLINE
1
Lecture
OUTCOME A) To study the etiology, patho physiology, clinical
theatre/medical
features of the conditions
college
B) To recognize the various lesions and stages of the
retinopathy
C) To draw the diagram of different lesions
D) To identify the importance of recognizing the various
lesions
E) To know how to follow the patient and when to refer
the patient for specialized treatment
Lecture 19: Retina-Retinitis pigmentosa,

No
Venue
ITEM
1
Lecture
OUTCOME
theatre/medical
college
Retinal detachment, Retinoblastoma

OUTLINE
A) To study the aetiology, clinical presentation of retinitis
pigmentosa and its mode of genetic transmission
B) To study the pathogenisis,presentation and fundus
characters of retinal detachment
C) To study the basic techniques of examination and out
line the principles of treatment of retinal detachment
D) To Study the genetics,clinical features ,differential
diagnosis of retinoblastoma
E) To study in brief the treatment of Retinoblastoma and
genetic counselling
312
Lecture 20: Optic nerve: papilloedema and inflammations of the optic neve
No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the various aspects of the optic nerve diseases
theatre
B) To recognize the importance of papilloedema and its
/college
different causes
C) TO be able to use this knowledge in the clinical
examination at a later stage
D) To study the various types of inflammations affecting
the optic nerve and their importance of recognition
E) To study the various investigative techniques and
treatment aavailable for the various conditions
Lecture 21: Optic nerve: AION.optic atrophy and toxic amblyopia

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the various aspects of the optic nerve diseases
theatre
as outlined above
/college
B) To recognize the various presentations, investigations
and treatment available for these conditions
C) TO be able to use this knowledge in the clinical
examination at a later stage
Lecture 22: -Applied anatomy, symptomatic disturbances of vision, abnormalities of pupil, Light
reflex pathway and visual field pathway
No
Venue
ITEM
OUTLINE
1
Lecture
OUTCOME A) To study the applied anatomy of optic nerve, light
theatre/medical
reflex pathway and visual pathway.
college
B) To study the various signs and symptoms associated
with optic nerve diseases
C) To study the various abnormalities of pupil,light reflax
and visual pathways
D) To study the various investigations available to
diagnose and differentiate the conditions responsible for
these abnormalities
313
Lecture 23:Muscle balance-Anatomy of extra ocular moments, types of squint

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To study the anatomy and physiology of ocular
theatre
movements
/college
B) To recognize the various types of ocular motility
disorders
C) To study the various modalities of investigative
procedures and treatment available
D) To detect paralytic and non paralytic squint
E) To be able to educate the general public about the
myths of squint and the importence of early recognition
and treatment
Lecture 24: Trauma, Chemical injuries and blunt trauma

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To understand the various mechanisms and causes of
theatre
trauma
/college
B) To recognize the damage that can be produced to
various structures of the eye
procedures and treatment available
D) To be able to recognize the features and give the basic
first aid in ocular emergencies to prevent further damage
E) To be able to educate the general public about the
damage to the eye because of injuries and the preventive
aspect
314
Lecture 25: Perforating injuries and

No
Venue
ITEM
1)
Lecture OUTCOME
theatre
/college
retained intra ocular foreign bodies

OUTLINE
A) To understand the various mechanism and causes of
perforating injuries
B) To recognize the damage that can be produced to
various structures of the eye
C) To recognize the specific problems associated with
perforating injuries and retained intra ocular bodies
D) To study the various modalities of investigations and
treatment available
E) TO be able to recognize the features and give the basic
F) To be able to educate the general public about the
damage to the eye because of injuries and the preventive
aspect
Lecture 26: Sympathetic ophthalmitis

No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To recognize the various types of injuries that can cause
theatre
sympathetic ophthalmitis
/college
B) To understand the mechanism of the condition
eprocedures and treatment available
D) To be able to recognize the features and give the basic
E) Must be able to answer the questions given at the end of
the lecture
F) To be able to educate the general public about the damage
to the eye because of injuries and the preventive aspect
315
Lecture 27: Community ophthalmology, causes and prevention of blindness. National

programme for control of blindness
No
Venue
ITEM
OUTLINE
1)
Lecture OUTCOME
A) To learn about the common causes of blind ness and
theatre
the various preventive aspects
/college
B) To gain the knowledge about National programmes for
controle of blindness
C) To educate the community about the various eye
diseases and the preventive aspects and the importance of
seeking early medical attention
D) To get oneself familiar with conducting various surveys
for cataract, glaucoma. Diabetic retinopathy etc
Lecture 28: overview

No
Venue
ITEM
1)
Lecture OUTCOME
theatre
/college
OUTLINE
A) Discuss about the lectures in general
B) Orientation about the sessional examination
2)
RECOMMENDED BOOKS
REFERENCE
TEXT BOOKS
1) Parsons diseases of the eye
2) Ophthalmology- A. K. Khurana
3) Essentials of ophthalmology By Samar. K. Basak
ADDITIONAL REFERENCES
1) Manual of ocular diagnosis and therapy by Deborah
Pavan Langston
2) Clinical ophthalmology- by Jack.J.Kanski
3) Anatomy and physiology of the eye-by A. K. Khurana
316
Clinical Learning Outcomes (Semester 8 & 9):

OBJECTIVES
.
KNOWLEDGE
At the end of the clinical session, the student shall have knowledge of:
Common problems affecting the eye.
Principles of management of major ophthalmic emergencies.
Common systemic diseases affecting the eye.
Effects of local and systemic disease on patients vision and the necessary action required
minimizing the sequelae of such diseases.
Adverse drug reactions with special reference to ophthalmic manifestations;
Magnitude of blindness in Malaysia and its main cause.;
Eye care education for prevention of eye problems.
Integration of the national programme for control of blindness with the other national
health programmes.
Eye bank organization.
SKILLS
Elicit a history pertinent to general health and ocular status.
Assist in diagnosis procedures such as visual acuity testing, examination of the eye,
tonometry, staining for corneal ulcer, confrontation perimetry, direct ophthalmoscopy and
Cover test.
Diagnose and treat common problems affecting the eye.
Interpret ophthalmic signs in relation to common systemic disorders.
Provide first aid in major ophthalmic emergencies.
317
Assist to organize primary eye care service through primary health centers;
Attitudes
Have understanding and respect for all patients with different religious, and cultural and
social values.
Develop a caring attitude towards patients and their families and function as
compassionate doctor.
Have understanding of medical ethics
318
PBL learning outcomes (Semester 8 & 9)

OBJECTIVES
To make learning more meaningful and authentic
Discover the knowledge on their own
Construct the knowledge on their own
Application of existing knowledge.
KNOWLEDGE
Be familiar with established knowledge
Have sound knowledge of the established principles in recognition and management
of common conditions affecting the eye.
Have sound knowledge of the principles of immediate recognition and treatment of
common ophthalmic emergencies
Thorough knowledge of systemic diseases affecting the eye and their recognition
Knowledge and ability to recommend and justify the relevant investigations
pertaining to the problem identified in a logical sequence
Ability to discover and construct knowledge on their own
Have a sound knowledge of medical ethics
SKILLS and APPLICATION
Ability to apply the knowledge in familiar and new situations for academic and
clinical purposes
Application of the knowledge acquired to properly diagnose and differentiate from
similar conditions and to initiate appropriate therapy so as to avoid further
complications
Able to provide the immediate care and appropriate referral in case of ocular
emergencies
319
LEARNING AND THINKING

Capacity for independent learning without having to depend on teachers
Capacity for critical thinking; creativity; capacity to make informed decisions on the
basis of available knowledge and information
Capacity for independent inquiry; intellectual curiosity, openness of mind, and
intellectual skepticism;
ATTITUDE
Have the right attitude and commitment to deliver the best possible care for his/her
Maintain confidentiality in the conduct of clinical examination and documentation of
diagnosis of patients.
Uphold the principles of ethics
Develop a caring attitude towards the patients and their families and function as a
COMMUNICATION AND INTEGRATION
Shall be able to communicate freely and effectively with individuals, groups and the
society as a whole in educating them and helping them in prevention of blindness
shall be able to integrate with the various national programmes of prevention of
blindness
320
EXPECTED OPERATION THEATRE LEARNING OUTCOMES AT THE END

OF POSTING
Students should have learnt the maintenance of asepsis in operation theatre.
Students should know the techniques used for anesthesia in Eye OT and the drugs
used for anesthesia and complications related to anesthesia.
Students should be acquainted with the common instruments used in Ophthalmic
Surgery.
Students should know the steps of common eye operations like cataract,
trabeculectomy
Students should have a thorough idea about the medicines and fluids used in Eye OT.
Students should have learnt the operative complications that may follow an eye
Operation.
321
Learning Outcomes
322
A&E Learning Outcomes (Semester 10)
1. Learning objectives:
Over all objectives of Clerkship:
a. Understand concept of Emergency Department
b. Understand initial evaluation of the undifferentiated Emergency Medicine patient, and
stabilization of acutely ill patients, functioning as part of Emergency Department team.
c. Acquire knowledge of skills to approach traumatic injuries with priority to life
threatening problems, but also to common, less acute injuries, by observation and
participation in resuscitation activities
d. Understand structure and functions of A&E [Triaging and the level of emergency].
e. Understand the management of patients with toxic exposures in general, along with
specific, common overdoses, infectious, notifiable diseases.
f. Sharpen procedure skills, by constant practice
Learning outcomes: at the end of clinical rotation at A&E student will
a. demonstrate the understanding of basic concepts of Emergency Department
b. demonstrate the knowledge of initial evaluation of the undifferentiated Emergency
Medicine patient, and stabilization of acutely ill patients, functioning as part of
Emergency Department team.
c. demonstrate the knowledge of skills to approach traumatic injuries with priority to life
threatening problems, but also to common, less acute injuries, by observation and
participation in resuscitation activities
d. demonstrate the understanding of structure and functions of A&E [Triaging and the
level of emergency].
e. demonstrates the knowledge of management of patients with toxic exposures in
general, along with specific, common overdoses, infectious, notifiable diseases.
f. demonstrates a continual ability to sharpen the procedure skills, by constant practice
under supervision of the allowed clinical procedures
323
Developing Skills:
During the three weeks session at department of Emergency medicine in the hospital,
student will develop skills in the following competencies:
1. Information Management
a. Student demonstrates skill in case presentation.
b. Student demonstrates organized, complete written documents.
c Student demonstrates knowledge of accessing data and information systems.
d. Student treats each record as confidential and handles well, realizing the medico
legality of the documents
2. Diagnostic
a. Student will demonstrate a rapid, focused but thorough history and physical
examination.
b. Student will demonstrate appropriate usage and interpretation of laboratory and
ancillary tests by applying the knowledge of pathophysiology and evaluation
methodology
[History taking skills, clinical examination and appropriate clinical diagnosis] by
integrating the basic science knowledge and the clinical know-how]
3. Procedural
In the A&E setting student is under direct supervision of the seniors and follow a general
dictum for all procedural skills with a clear instruction list indicating the procedures
allowed to be performed by the student
Procedure
Observe
Assist
Perform
324
All students MUST follow Universal Precautions at all times in the A&E department
4. Professional Behaviour
Student will demonstrate ability to function as part of health care team, showing respect
for patients, staff, and physicians.
Student will demonstrate understanding of patient right to treatment, refusal of treatment,
and when care needs to be performed against a patients will.
Professional working attire is a must to follow the dress code at all times inclusive of
duty days on public holidays
5. Problem solving
a.Student will demonstrate list of differential diagnoses given a specific chief complaint
and patient characteristics.
b.Student will demonstrate ability to use history, physical exam and ancillary studies to
test initial diagnoses.
c.Student will demonstrate the ability to rerank the differential diagnoses based on
gathered information.
5.Human Relationships and Communications :
Student will demonstrate ability of
a. inquiry about family and support systems, understanding of cultural diversity in health
care delivery
b. understanding social, psychological, and economic factors in health care delivery
c. effectively engaging patient and family in verbal communication.
325
Summary:
Patient Care:
Develop proper interviewing techniques
Perform directed physical examinations
Develop comprehensive differential diagnoses
Initiate resuscitation and stabilization
Selected procedural and wound care techniques
Proper patient disposition and follow-up
Medical Knowledge
Identification of the acutely ill patient
Practice evidence-based medicine
Development an evaluation plan
Test interpretation
Development of a therapeutic plan
Treatment of common acute problems
Interpersonal and Communication Skills
Establishing rapport
Effective presentation
Professional interaction with consultants
Professionalism
Respect
Ethical behavior
Sensitivity to cultural issues
Compliance to regulations
Systems-based Practice
Understanding of emergency procedures
Assessment of undifferentiated patient
326
Learning Outcomes
327

Topics
1.Patient
safety
Objectives
Outcomes
Understand the
Knowledge
discipline of patient
safety and
its role in
minimizing the
incidence and
impact
of adverse events,
and maximizes
recovery
from them.
Skills
2.What is
human
factors and
why is it
important to
patient
safety?
(Human
factor in
Patient
safety)
3.Understan
ding systems
and the
impact of
complexity
on patient
care
(Understandi
ng hospital
functioning
about
patient care)
Understand human
factors and its
relationship to
patient safety.
Knowledge
Skill
Understand how
systems thinking
can
improve health
care and minimize
patient adverse
events.
Year 1
the harm caused by
health-care errors and
system failures
the lessons about
error and system failure
from other industries
the history of patient
safety and the origins of
the blame culture
the difference
between system
failures, violations and
errors
a model of patient
safety
apply patient safety
thinking in all clinical
activities;
demonstrate ability to
recognize the role of
patient safety in safe
health-care delivery.
explain the meaning
of the term
human factors;
explain the
relationship between
human factors and
patient safety.
apply human factors
thinking to your
work environment.
Year2
Year3
**
**
**
**
Knowledge
Skill
explain what is meant

by the terms
system and complex
system as they
relate to health care;
explain why a systems
approach to patient
safety is superior to the
traditional approach
Describe the term
Highly Reliability
Organisation and the
**
328
Year4

elements of
a safe health-care
delivery system
**
4.Being an
effective
team player
understand the
Knowledge
importance of
teamwork in
health-care;
know how to be
an effective team
player;
recognize you will
be a member of a
Skill
number of healthcare teams as a
medical students.
explain the meaning

of the term
human factors;
explain the
relationship between
human
factors and patient
safety
apply human factors
thinking to your work
environment.
5.Understan
ding and
learning
from errors
Understand the
nature of error and
how
health care can
learn from error to
improve patient
safety
Knowledge
6.Understan
ding and
managing
clinical risk
Know how to apply

risk management
principles by
identifying,
assessing and
reporting
hazards and
potential risks in
the workplace
Knowledge
Explain the terms error,

violation, near miss,
hindsight bias
Know the ways to learn
from errors;
participate in an
analysis of an adverse
event;
practise strategies to
reduce errors
the activities for
gathering information
about risk;
fitness-to-practice
requirements;
personal
accountability for
managing clinical
risk.
**
**
Skill
Skill
**
**
Know how to report

known risks or hazards
in the workplace
Keep accurate and
complete medical
records
know when and how
to ask for help from a
**
329
7.Introductio
n to quality
improvemen
t methods
describe the
Knowledge
principles of quality
improvement and
to introduce
students to the
basic methods and
tools for
improving the
quality of health
care.
Skill
8.Engaging
with patients
and carers
The objective of
this topic is to
understand
the ways in which
patients and carers
can be
involved as
partners in health
care, both in
preventing harm
and learning and
healing from an
adverse event
Knowledge
Skill
supervisor, senior
clinician and other
health-care
professionals
patient safety;
participate in
meetings that discuss
risk
management and
patient safety;
respond appropriately
to patients and families
after an adverse event;
respond appropriately
to complaints.
the science of
improvement;
the quality
improvement model;
change concepts;
two examples of
continuous
improvement
methods;
methods for providing
information on
clinical care.
know how to perform
a range of
improvement activities
and tools
Students need to know:
basic communication
techniques;
informed consent
procedures;
the basics of open
disclosure.
Students need to:
actively encourage
patients and carers to
share
information;
show empathy,
honesty and respect for
patients and carers;
communicate
effectively;
**
**
**
**
330
9.Minimizing
infection
through
improved
infection
control
Demonstrate
the devastating
effects of
inadequate
infection
control and to
show students
know they can
minimize the risks
of contamination
Knowledge
obtain informed
consent;
show respect for each
patients differences,
religious and cultural
beliefs, and individual
needs;
describe and
understand the basic
steps in an
open disclosure
process;
apply patient
engagement thinking in
all clinical
activities;
demonstrate ability to
recognize the place of
patient and carer
engagement in good
clinical
management
know the extent of
the problem;
know the main causes
and types of
infections.
**
Skill
apply universal
precautions;
be immunized against
Hepatitis B;
use personal
protection methods;
know what to do if
exposed;
encourage others to
use universal
Precautions
**
331

10.Patient
safety and
invasive
procedures
11.Improving
medication
safety
understand
Knowledge
the main causes of
adverse events in
surgical and
invasive procedural
care and how the
use of
guidelines and
verification
processes can
Skill
facilitate
the correct patient
receiving the
correct procedure
at the appropriate
time and place.
objectives:
to provide an
overview of
medication
safety;
to encourage
students to
continue to learn
and practise ways
to improve the
safety of
medication use
Knowledge
the main types of

adverse events
associated with surgical
and invasive
procedures care;
the verification
processes for improving
surgical and invasive
procedures care.
follow a verification
process to eliminate
wrong patient, wrong
side and wrong
procedure;
practise operating
room techniques that
reduce risks and errors
(time-out, briefings,
debriefings, stating
concerns);
participate in an
educational process for
reviewing surgical and
invasive procedures
mortality and morbidity.
understand the scale
of medication
error;
understand that using
medications has
associated risks;
understand common
sources of error;
understand where in
the process errors
can occur;
understand a doctors
responsibilities when
prescribing and
administering
medication;
recognize common
hazardous situations;
learn ways to make
medication use safer;
understand the
benefits of a
multidisciplinary
**
**
**
332
Skill
approach to medication
safety
clinician performs in the
following tasks:
use generic names;
tailor prescribing for
each patient;
learn and practise
thorough medication
history taking;
know the high-risk
medications;
be very familiar with
the medications you
prescribe;
use memory aids;
communicate clearly;
develop checking
habits;
encourage patients to
be actively involved in
the medication process;
report and learn from
errors;
learn and practise
drug calculations.
**
Implementation of patient safety as a stand alone subject in an integrated curriculum

Year 3
1,2:Patient safety; Introduction to human factor in patient safety
3,5:Understanding systems and the impact of complexity on
patient care; understanding and learning from errors
4,7,9,10:Effective team player; methods of quality improvement;
minimising infection through improved infection control; reducing
risks associated with invasive procedures
Year 4
6,8,11:How to manage clinical risk; enganging with patients and
carers; improving medication safety
333

New Learning Outcomes of MMMC SEM 6&7 (B29 Onwards)

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New Learning Outcomes of MMMC SEM 6&7 (B29 Onwards)

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Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

DEPARTMENT OF COMMUNITY MEDICINE..73

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

2.6 Clinical Posting (Semester 6 & 7):Journal Critique Module.......104

DEPARTMENT OF OBSTETRICS & GYNAECOLOGY...167

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

6.5 Learning Outcomes for senior clerkship (Semester 10)...213

ACCIDENT & EMERGENCY........322

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

Overall objectives in terms of expected knowledge, skills and behavior of

of the principles in recognition and

management of Orthopaedic emergencies (fractures and dislocations).

metabolic bone diseases and neoplasms affecting bones.

o Be conversant with appropriate investigations and ability to interpret them and

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

o Maintain confidentiality in the conduct of clinical examination and documentation

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

Melaka-Manipal Medical College, Melaka

: TRAUMA: Fractures and general principles in fracture management

DAY / DATE : As per schedule

LECTURER : MMMC faculty

Apleys System of Orthopaedics and Fractures

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

Melaka-Manipal Medical College, Melaka

: TRAUMA: Stress fracture, pathological fracture, compartmental syndrome

DAY / DATE : As per schedule

LECTURER : MMMC faculty

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

b) Book of Orthopaedics and Traumatology: M Natarajan & Mayilvahanan Natarajan

: TRAUMA : Open fractures

DAY / DATE : As per schedule

LECTURER : MMMC faculty

Apleys System of Orthopaedics and Fractures

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

Melaka-Manipal Medical College, Melaka

: TRAUMA : Upper limb fractures and dislocations:

DAY / DATE : As per schedule

LECTURER : MMMC faculty

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

c) Essential Orthopaedics : J. Maheshwari

Melaka-Manipal Medical College, Melaka

: TRAUMA : Upper limb fractures and dislocations:

DAY / DATE : As per schedule

LECTURER : MMMC faculty

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

Apleys System of Orthopaedics and Fractures

Melaka-Manipal Medical College, Melaka

: TRAUMA : Upper limb fractures and dislocations:

DAY / DATE : As per schedule

LECTURER : MMMC faculty

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

4. TEACHING METHODS: Didactic lecture

Melaka-Manipal Medical College, Melaka

: TRAUMA : Vertebral fractures and dislocations, spinal cord injuries

DAY / DATE : As per schedule

LECTURER : MMMC faculty

Melaka Manipal Medical College: Learning Outcomes (Batch 29 Onwards)

Apleys System of Orthopaedics and Fractures

Melaka-Manipal Medical College, Melaka

: TRAUMA: Pelvic fractures:Fracture of pelvic ring, sacrum& acetabulum

DAY / DATE : As per schedule

LECTURER : MMMC faculty