72

P.G. Curriculum
M.D. Medicine
Index

1. Goals

2. Objectives

3. Syllabus

4. Teaching programme

5. Posting

6. Thesis

7. Assessment

8. Job responsibilities

9. Suggested books and journals

10. Model Test Papers

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Curriculum
M.D. Medicine
The infrastructure and faculty of the department of medicine will be as per MCI
guidelines

1. Goals
The goal of MD course in Medicine is to produce a competent physician who:

Recognizes the health needs of adults and carries out professional obligations in
keeping with principles of National Health Policy and professional ethics;

Has acquired the competencies pertaining to medicine that are required to be
practiced in the community and at all levels of health care system;

Has acquired skills in effectively communicating with the patients, family and the
community;

Is aware of the contemporary advances and developments in medical sciences.

Acquires a spirit of scientific enquiry and is oriented to principles of research
methodology; and

Has acquired skills in educating medical and paramedical professionals.

2. Objectives
At the end of the MD course in Medicine, the student should be able to:

Recognize the key importance of medical problems in the context of the health
priority of the country;

Practice the specialty of medicine in keeping with the principles of professional
ethics;

Identify social, economic, environmental, biological and emotional determinants
of adult medicine and know the therapeutic, rehabilitative, preventive and
promotion measures to provide holistic care to all patients;

Take detailed history, perform full physical examination and make a clinical
diagnosis;

Perform and interpret relevant investigations (Imaging and Laboratory);

Perform and interpret important diagnostic procedures;

Diagnose medical illnesses in adults based on the analysis of history, physical
examination and investigative work up;

Plan and deliver comprehensive treatment for illness in adults using principles of
rational drug therapy;

Plan and advise measures for the prevention of medical diseases;

Plan rehabilitation of adults suffering from chronic illness, and those with special
needs;

Manage medical emergencies efficiently;

Demonstrate skills in documentation of case details, and of morbidity and
mortality data relevant to the assigned situation;

Demonstrate empathy and humane approach towards patients and their families
and respect their sensibilities;

Demonstrate communication skills of a high order in explaining management and
prognosis, providing counseling and giving health education messages to
patients, families and communities.

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Develop skills as a self-directed learner, recognize continuing educational needs;

use appropriate learning resources, and critically analyze relevant published
literature in order to practice evidence-based medicine;

Demonstrate competence in basic concepts of research methodology and
epidemiology;

Facilitate learning of medical/nursing students, practicing physicians, para-
medical health workers and other providers as a teacher-trainer;

Play the assigned role in the implementation of national health programs,
effectively and responsibly;

Organize and supervise the desired managerial and leadership skills;

Function as a productive member of a team engaged in health care, research
and education.

3. Syllabus
3.1. Theory
The theory syllabus should include the cardinal manifestations, definition,
epidemiology, etiopathogenesis, clinical presentation, complications, differential
diagnosis, investigations, treatment and prevention of all adult diseases. It should
also cover the advances that have occurred in the science of medicine into its
armamentarium of diagnosis, prevention and treatment.

Nutrition
Nutritional requirements and dietary assessment, Malnutrition, Obesity, Enteral
and Parenteral therapy, Eating disorders, Vitamins and trace mineral deficiency
and excess.

Genetics
Principles of human genetics, Chromosomal disorders, Single gene disorders,
Multifactorial/ Polygenic disorders, Genetic diagnosis, Gene therapy.

Cardiovascular
 Dyspnoea and pulmonary edema, Heart murmur, Hypertension, Chest
discomfort, Palpitations, Edema, Syncope.
 Atherosclerosis, Angina, Myocardial infarction, Revascularisation, Heart
failure, Congenital heart diseases (cyanotic and acyanotic), Rheumatic fever
and rheumatic heart disease, Infective endocarditis, Brady and
Tachyarrhythmias, Diseases of myocardium (cardio-myopathy, myocarditis),
Diseases of pericardium, Systemic hypertension, Diseases of the Aorta, Cor
Pulmonale, Pulmonary embolism, Pulmonary hypertension, Peripheral
vascular disease, Cardiac involvement in systemic disease, Echocardiography,
Tread mill test, Nuclear cardiology, Cardiac catherization and angiography.

Respiratory
 Cough and Haemoptysis, Breathlessness, Hypoxia and Cyanosis.
 Infections of upper respiratory tract, tonsils and adenoids, Obstructive sleep
apnea, Pneumonia, Suppurative lung disease, COPD and Emphysema,
Bronchial asthma, Bronchiectasis, Pleural effusion, Pneumothorax, Mediastinal
mass, Carcinoma lung, Chest imaging (X-Ray and CT scan), Bronchoscopy
and Spirometery.

Gastrointestinal and liver diseases
 Acute and chronic diarrhea, Abdominal pain and distension, Ascites, Vomiting,
Constipation, Gastrointestinal bleeding, Jaundice, Dysphagia,
Hepatosplenomegaly.

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 Diseases of mouth, Oral cavity and tongue, Disorders of deglutition and

esophagus, Peptic ulcer disease, H-pylori infection, Intestinal obstruction,
Malabsorption syndrome, Acute and chronic diarrhea, Irritable bowel
syndrome, Crohn’s disease, Ulcerative colitis, Mesenteric ischaemia,
Appendicitis, Peritonitis.
 Liver disorders: Acute viral hepatitis, Fulminant hepatic failure, Chronic liver
disease, Cirrhosis and its complications, Portal hypertension, Ascites, Hepatic
encephalopathy, Wilson’s disease, Budd-Chiari syndrome, Metabolic diseases
of the liver.
 Acute and Chronic pancreatitis, Diseases of the gall bladder.

Nephrological disorders
 Hematuria, Dysuria, Azotemia, Fluid and Electrolyte disturbances.
 Acute and Chronic Glomerulonephritis, Nephrotic syndrome, Acute renal
failure and Chronic renal failure, Peritoneal dialysis and Haemodialysis, Renal
transplantation, TTP, Hemolytic uremic syndrome, Urinary tract infection and
Pyelonephritis, Renal involvement in systemic diseases, Renal tubular
disorders, Renal and bladder stones, Hydronephrosis, Cystic disease in
kidney, Renal vascular hypertension.

Neurological disorders
 Syncope, Vertigo, Weakness, Movement disorders, Disorders of sensory
system, Sleep disorders, Headache, Back and Neck pain, Aphasia, Memory
loss, Confusion and delirium
 Seizure and non seizure paroxysmal events, Epilepsy and epileptic
syndromes, Cerebrovascular disorders, Alzheimer’s disease, Parkinson’s
disease, Diseases of the spinal cord, Meningitis, Chronic and recurrent
meningitis, Prion diseases, Brain abscess, Acute encephalitis,
Neurocysticercosis, HIV encephalopathy, SSPE, Muscle diseases and
Muscular dystrophies, Multiple sclerosis, Motor neuron disease, Myasthenia
gravis, Acute flaccid paralysis, Guillain-Barre syndrome, Ataxia, Movement
disorders, CNS tumors, Psychiatric disorders, Cranial nerve disorders,
Peripheral neuropathy.

Hematology and oncology
 Anemia and Polycythaemia, Bleeding and Thrombosis, Lymphadenopathy,
Splenomegaly, Disorders of granulocytes and monocytes.
 Iron deficiency anemia, Megaloblastic anaemia, Hemolytic anemia, Aplastic
anemia, Myelodysplastic syndrome, Pancytopenia, Disorders of hemostasis,
Thrombocytopenia, Platelets disorders, Blood component therapy, Transfusion
related infections, Bone marrow transplant, Stem cell transplant, Acute and
Chronic Leukemias, Hodgkin disease, Myeloproliferative disorders, Non-
Hodgkin’s lymphoma, Hypercoagulable states.
 Head and neck cancer, Breast cancer, GIT cancer, Tumours of the liver and
biliary tract, Pancreatic cancer, Endocrine tumours of the GI tract and
Pancreas, Bladder and Renal cell cancer, Carcinoma prostate, Testicular
cancer, Gynaecological malignancies, Sarcomas of soft tissue and bone,
Metastatic cancer of unknown primary site, Paraneoplastic syndromes.

Endocrinology
Hypopituitarism/hyperpituitarism, Diabetes insipidus, Hypo- and hyper-thyroidism,
Hypo- and hyper-parathyroidism, Adrenal insufficiency, Cushing’s syndrome,
Pheochromocytoma., Diabetes mellitus, Hypoglycemia, Gonadal dysfunction,
Disorders of the testes and ovaries, The menopauses transition and post
menopausal therapy, Disorders affecting multiple endocrine systems.

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Infections
Bacterial, Viral, Fungal and algal, Parasitic, Rickettssial, Mycoplasma,
Pneumocystis carinii and protozoal infections, Tuberculosis, Spirochaetal
diseases, HIV infection, Nosocomial infections, Infective endocarditis, Infection in
transplant receipients, Complicated urinary tract infection, Food poisoning,
Infections of the Skin, Muscles and Soft tissue, Ostomyelitis, Control of epidemics,
Hospital infection control.

Emergency and critical care
Emergency care of shock, Cardio-respiratory arrest, Respiratory failure,
Congestive cardiac failure, Acute renal failure, Status epilepticus, Fluid and
electrolyte disturbances and its therapy, Acid-base disturbances, Drug overdose
and Poisonings, Accidents, Scorpion and snake bites, GI bleed (upper and lower),
Hepatic encephalopathy.

Immunology and Rheumatology
Introduction to the immune system, Primary immune deficiency diseases,
Rheumatoid arthritis, SLE, Sjogren’s syndrome, Vasculitis, Scleroderma,
Polymyositis, Gout, Ankylosing spondylitis, Reactive arthritis, Undifferentiated
spondyloarthropathy, Sarcoidosis.

ENT
Acute and chronic otitis media, Conductive/sensorineural hearing loss,
Acute/Chronic tonsillitis/adenoids, Allergic rhinitis, Sinusitis.

Skin diseases
Exanthematous illnesses, Vascular lesions, Pigment disorders, Vesicobullous
disorders, Infections: pyogenic, fungal and parasitic; Steven-Johnson syndrome,
Eczema, Seborrhoeic dermatitis, Drug rash, Urticaria, Alopecia, Icthyosis.

Eye problems
Refraction and accommodation, Partial/total loss of vision, Cataract, Night
blindness, Chorio-retinitis, Optic atrophy, Papilledema.

3.2. Practical

History, examination and writing of records:
 History taking should include the back ground information, presenting
complaints and history of present illness, history of previous illness, family
history, social and occupational history and treatment history.
 Detailed physical examination should include general examination and
systemic examination (Chest, Cardio-vascular system, Abdomen, Central
nervous system, locomotor system and joints).
 Skills in writing up notes, maintaining problem oriented records, progress
notes, and presentation of cases during ward rounds, planning investigations
and making a treatment plan should be taught.

Bedside procedures & Investigations:
 Therapeutic skills: Venepuncture and establishment of vascular access,
Administration of fluids, blood, blood components and parenteral nutrition,
Nasogastric feeding, Urethral catheterization, Administration of oxygen,
Cardiopulmonary resuscitation, Endotracheal intubation, Intrathecal
administration of drugs, Common dressings, Abscess drainage.
 Investigative skills: Venous blood sampling, Arterial blood sampling, Lumbar
puncture, Bone marrow aspiration, Pleural, Peritoneal & Pericardial tap, Biopsy
of liver and kidney.
 Bedside investigations: Hemoglobin, TLC, DLC, ESR, Peripheral smear
staining and examination, Urine: routine and microscopic examination, Stool
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microscopy including hanging drop preparation, Examination of CSF, Pleural

fluid and Peritoneal fluid, Gram staining, ZN staining, etc.

3.3. Clinical Teaching

Residents should have the practical knowledge and clinical skills to evaluate and
manage the various medical disorders. Clinical work should be closely guided and
supervised by Consultants and Senior Residents. If a particular clinical teaching
material is not available in the institution, then the resident should be posted in
another institution for acquiring the practical knowledge and skills.

Infectious Diseases
 Clinical
The junior resident should have knowledge and skills to assess, common
infectious diseases problems:
 OPD: The junior residents should work up common OPD medical problems
like acute febrile illness, acute diarrhea, urinary tract infection, lower
respiratory tract infection, etc.
 WARD: During the ward posting the resident should acquire the knowledge
to assess the following problems:-
o Investigative workup of a patient with pyrexia of unknown origin.
o Diagnosis/investigations and management of common tropical infectious
diseases like Malaria, HIV, TB, Typhoid, Dengue fever, Gram +ve and
Gram –ve infections, Fungal infections, Viral infections, Protozoal &
Helminithic infections.
o Management of a patient with sepsis, septicaemia and septic shock.
o Management of patients with multi systemic involvement.
o Awareness about local notification procedures and adult vaccination.
o Principles of infection control.

Toxicology and Clinical Pharmacology

 Clinical
Residents should have knowledge and skills to assess and manage acute
medical emergencies of drug overdose, illicit drug use and poisonings
(accidental/suicidal). The resident should have the following skills:
 Assessment and emergency care of the unconscious patient with poisoning.
 Effects of common drugs/poisons ingested.
 Toxicology screen.
 Methods to prevent absorption and enhance elimination.
 Specific treatment of various drug overdoses and poisonings.

Emergency Medicine
 Clinical
At the end of the casualty posting the Junior Resident should be able to
diagnose and manage the following medical problems in the casualty:

Acute myocardial infarction, tachyarrhythmias & bradyarrhythmias,

hypertensive emergencies, pneumothorax, massive pleural effusion,
pulmonary thromboembolism, perforation peritonitis, intestinal obstruction,
diabetic ketoacidosis, myxedema coma, thyroid crisis, acute renal failure,
metabolic acidosis, cerebrovascular accident, epilepsy, meningitis, cerebral

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malaria, coma, dehydration, diarrhea, septicemia, common poisonings,

drowning, electrical injury etc. He should develop skills of triage and efficient
emergency care.

 Procedures
At the end of the casualty posting, the Junior Resident should possess
theoretical knowledge of and should be able to perform the following
procedures.
 External cardiac massage.
 Use of defibrillator/external cardiac pacemaker.
 Emergency IV cannula insertion and venesection.
 Emergency ryle’s tube insertion.
 Gastric lavage in case of poisonings.
 Insertion of foley’s catheter (both in males and females).
 CVP line insertion (subclavian/jugular).
 Endotracheal intubation.
 Arterial puncture for blood gas analysis.
 Thoracic and abdominal paracentesis.

Critical Care Medicine

During the training in internal medicine, residents should be posted in the intensive
care unit. The unit should have modern monitoring facilities as well as facilities for
providing artificial ventilatory support. The residents should be physically present in
the ICU during their hours of posting, including night duties. The working in the ICU
is fully supervised by seniors. During their posting in the ICU, the residents should
acquire the following skills :
 Care of the seriously ill patients with haemodynamic monitoring.
 Providing assisted ventilation using correct mode and strategies using modern
ventilators under senior advice.
 Insert central venous lines and arterial lines under supervision.
 Care of the unconscious patients.
 Care of patients with multiorgan failure.
 To look after the nutritional requirements of the patients.

Cardiology
 Clinical
 OPD: Work up and management of common OPD cases (Rheumatic Heart
disease, Ischemic heart disease, Heart failure, Hypertension etc.). He/She
should be able to give advice regarding primary/secondary prevention of
cardiac disease.
 WARD: Duties should include diagnostic case work up and day to day
management of common cases (angina, myocardial infarction, rheumatic
heart disease, ischemic heart disease, hypertension, congestive heart
failure, congenital heart disease etc.).
 Intensive coronary care unit (ICCU): A resident should acquire the
expertise/knowledge to diagnose and manage acute myocardial infarction
and its complications, common arrhythmias, cardiogenic shock, pericardial
tamponade etc. The resident should also learn to perform the procedures
and investigations (listed below) necessary to manage such patients.

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Residents should be familiar with the

indications/contraindications/complications of thrombolytic therapy and
antithrombotic therapy. They should be fully conversant with the
pharmacology and usage of anti-arrhythmic drugs, vasopressors and
ionotropes and indications of pace maker implantation.

 Procedures
The Junior Residents should be trained to carry out the following common
procedures:
 Performing and interpreting a 12-lead electrocardiogram.
 Pericardiocentesis (under cardiac monitoring).
 Cardioversion (elective/emergent).
 Defibrillation.
 Haemodynamic monitoring.

 Investigations
The junior resident should be exposed to the theoretical and practical
knowledge about the following investigations and their interpretation and
applications in the various clinical situations:
 Tread Mill Test (TMT).
 Echocardiography/Doppler.
 Holter monitoring.
 Dobutamine stress test.
 Thallium scan
 Angiography & Angioplasty.
 Pacing (Permanent and temporary).

Respiratory Medicine
 Clinical
 OPD: Work up and management of common OPD cases like Bronchial
asthma, COPD, Acute bronchitis, Tuberculosis etc under consultant
supervision.
 WARD: Diagnostic case work up and day to day management of common
chest cases (asthma, COPD, pneumonia, tuberculosis including drug
resistant tuberculosis, pleural effusion, lung cancer, interstitial lung disease
etc.). Residents should be fully trained in assessment/management of
emergencies like acute severe asthma, pneumothorax, haemoptysis and
respiratory failure. They are expected to be fully conversant with the
diagnosis/investigations/treatment of tuberculosis and the Revised National
Tuberculosis Control Programme including DOTS (directly observed therapy
short course) treatment.

 Procedures
The Junior Resident should be trained to carry out the following common
procedures:
 Pleural fluid tapping.
 Oxygenation therapy.

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 Observation of pleural biopsy.

 Nebulisation.
 Investigations
The Junior Resident should be guided and helped in acquiring theoretical and
practical knowledge about the following investigations and their interpretation
and applications to the various clinical situations.
 Basic chest radiology.
 CT scans chest (spiral/HRCT) - indications/patterns.
 Indications/applications of fibreoptic bronchoscopy.
 Interpretation of spirometry.

Neurology
 Clinical
 OPD: A Junior Resident should work up patients, discuss them with the
consultant and suggest relevant investigations and management of common
neurological problems.
 WARD: The Junior Resident should be able to carry out diagnostic case
work up and day to day management of the following cases: Meningitis,
encephalitis, comatose patients, seizures (including monitoring of drug
levels and management of status epilepticus), cerebrovascular accidents,
systemic disease with CNS involvement, peripheral neuropathy, metabolic
and degenerative diseases of nervous system, polymyositis and other
muscle disorders, spinal cord diseases.
 Stroke ICU: Residents should know the concepts of Stroke ICU where
patients of acute stroke, thrombolytic therapy in stroke and comatose
patients are being managed.
 Procedures and Investigations
The junior resident should be able to know the indications/interpretation of the
following:
 CSF examination.
 Muscle and Nerve biopsy.
 Interpretation of plain X-ray-skull, CT scan, and MRI scans.
 Indications/interpretation of EEG record.
 Indications/applications of nerve conduction studies.
 Indications/interpretation of EMG record.
 Indications/applications of evoked potentials.
 Edrophonium test.
 Indications of continuous EEG monitoring.

Gastroenterology
 Clinical
 OPD: A Junior Resident should work up common cases and discuss with
the consultant.
 WARD: A Junior Resident should gain competency in diagnostic case work
up and day to day management of the following cases:
Acute viral hepatitis and its complications, chronic hepatitis, cirrhosis of
liver and its complications, management of hepatic encephalopathy, upper
and lower gastrointestinal bleed (assessment/monitoring/indications for
transfusion), acute abdomen (peritonitis, intestinal obstruction, pancreatitis
etc), liver abscess, inflammatory bowel disease, malabsorption, intestinal

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tuberculosis and its complications, malignant lesions of liver, gall bladder,

stomach, pancreas and intestines etc.
 Procedures
The Junior Resident should have acquired practical knowledge of/and should
be able to carry out the following:
 Per rectal examination and proctoscopy.
 Nasogastric intubation.
 Ascitic tap.
 Liver biopsy.
 FNAC of abdominal masses (under ultrasound guidance).
 Needle aspiration from liver abscess (under ultrasound guidance).
 Investigations
The Junior Resident should have acquired the theoretical/practical knowledge
about following investigations:
 Interpretation of plain X-ray of the abdomen, barium swallow, barium meal,
barium enema, abdominal ultrasound and CT scan of the abdomen.
 Pattern of liver biopsy in common diseases (e.g. chronic hepatitis, cirrhosis
of the liver etc.).
 Indication for upper GI Endoscopy, Sigmoidoscopy, Colonoscopy,
Endoscopic Sclerotherapy and Banding, Enteroscopy.
 ERCP and MRCP- indications and interpretations.
 Capsule Endoscopy- indications and interpretations.

Endocrinology
 Clinical
 OPD: A Junior Resident in the OPD should work up common endocrine
disorders listed below.
 WARD: A Junior Resident should be able to manage of the following
common endocrine disorders: Type 1 & 2 Diabetes Mellitus and their
complications (insulin therapy/oral drug therapy/dietary advice and
management of emergencies like ketoacidosis, hypoglycemia,
hyperosmolar coma), Hypo and Hyperthyroidism, Cushing’s syndrome,
Addison’s disease, Pituitary disorders (growth retardation,
panhypopituitarism), Hirsutism and Virilisation, Pubertal disorders, Disorders
of fertility and sexual potency, etc.

 Procedures and Investigations

The Junior Resident should have the knowledge about the following
procedures:
 Daily glucose monitoring with glucometer.
 Stimulation tests (ACTH stimulation test etc.).
 Suppression tests (dexamethasone suppression tests, GH suppression
test).
 Prolonged fasting test, water deprivation test, etc.
 Continuous blood glucose monitoring.

Oncology/Haematology
 Clinical

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 OPD: A Junior Resident should undergo the following clinical/other teaching

exercise and acquire knowledge of following:
o Basic workup of a cancer patient.
o Metastatic work up.
o Principles of staging a tumor.
o OPD work up of a patient of anemia.
 WARD: A Junior Resident should be trained for carrying out diagnostic
workup and management of common oncological diseases and anaemias.
o Indications for chemotherapy/radiation therapy/surgery in the various
oncological diseases & awareness of the toxicity of
chemotherapy/radiation therapy and its management.
o Palliation of a patient with cancer.
o Management of oncological complications like hypercalcaemia, tumor
lysis syndrome, SVC obstruction, cord compression etc.
o Management of a patient with neutropenia including principles of infection
control/isolation/barrier nursing.
o Workup of a patient presenting with anemia, its investigations and
treatment.
o Investigations and management of coagulation abnormalities and
thrombocytopenia.
o Indications, contraindications and complications of blood transfusion and
component therapy like packed cell transfusion, platelet transfusion and
fresh frozen plasma transfusion.
 Procedures:
The Junior Resident should be able to know the indications of the following
diagnostic and therapeutic modalities:
 Intra thecal drug administration.
 Chemo port needle insertion.
 PICC line insertion.
 Stem cell transplantation.
 Bone marrow transplantation.

Nephrology
 Clinical
 OPD: A junior resident is expected to work up common nephrology cases
and discuss with the consultant.
 WARD: A Junior Resident should be trained for carrying out diagnostic case
work up and day to day management of the following cases:
RPGN (rapidly progressive glomerulonephritis), acute renal failure(ARF),
chronic renal failure (CRF), renal carcinoma, obstructive uropathy, congenital
renal disorders, renal calculus disease, systemic diseases with renal
involvement, urinary tract infection, hypertension, renal transplant
management (pre-operative workup and follow up), renal tubular disorders.
He should have complete knowledge of drug pharmacology in renal failure,
dietary modification, fluid and electrolyte balance and acid base balance.

 Investigations
The Junior Resident should have practical and theoretical knowledge of
following investigations:
 Urine examination.

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 Serum and urine osmolality.

 Glomerular and renal function test studies.
 Renal dynamic screening and imaging (esp., renal ultrasound).
 Immunological tests related to renal diseases.
 Cyclosporin immunoassay (interpretation).
 Pattern of renal biopsy of common renal disease.

 Dialysis training
The Junior Resident should be exposed to dialysis unit functioning. They
should acquire the knowledge of :
 Initiation/indications/monitoring of peritoneal dialysis.
 Indications/contraindications of hemodialysis.
 Initiation of hemodialysis.
 Familiarity with various routes of dialysis access: veno-venous, fistulas,
shunt.
 Monitoring during hemodialysis and knowledge of the likely complications.
 Indications for hemofilteration.

Rheumatology
 Clinical
 OPD: Residents should have knowledge and skills to be able to assess
common rheumatological problems like Rheumatoid arthritis, SLE, Sjogren’s
syndrome, Gout, Sceleroderma, Spondyloarthropathies, Osteoarthritis,
Vasculitis, etc.
 WARD: Residents should have knowledge and skills to be able to assess
and manage the patients admitted with the diseases listed above.

Nutrition
During training in wards and ICU, resident should have the knowledge and skills
in nutritional issues that are listed below:
 Assessment of nutritional status.
 Malnutrition.
 Impact of disease on nutritional status.
 Calculation of caloric requirement in various disease states.
 Principles and routes of nutrition support (enteral/parenteral).
 Methods of providing nutrition support.

4. Teaching Programme
4.1 General Principals
Acquisition of practical competencies being the keystone of postgraduate medical
education, postgraduate training is skills oriented.

Learning in postgraduate program is essentially self-directed and primarily

emanating from clinical and academic work. The formal sessions are merely meant
to supplement this core effort.

4.2 Teaching Sessions

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The teaching methodology consists of bedside discussions, ward rounds, case

presentations, clinical grand rounds, statistical meetings, journal club, lectures and
seminars. Along with these activities, trainees should take part in inter-departmental
meetings i.e clinico-pathological and clinico-radiological meetings that are organized
regularly.

Trainees are expected to be fully conversant with the use of computers and be able
to use databases like the Medline, Pubmed etc.

They should be familiar with concept of evidence based medicine and the use of
guidelines available for managing various diseases.

4.3Teaching Schedule
Following is the suggested weekly teaching programme in the Department of
Medicine:

1. Case Presentation & Discussion Once a week

2. Seminar Once in two weeks

3. Journal Club Once in two weeks

4. Grand Round presentation (by rotation medical Once a week

units
5. and subspecialties)
6. Emergency case discussions Once a week

7. Statistical & Mortality Meet Once a month

8. Clinico–Pathological meet Once a month

9. Clinico–Radiological meet Once a month

10. Faculty lecture teaching Once a month

11. ECG teaching Once a week

• Each unit should have regular teaching rounds for residents posted in that unit.
The rounds should include bedside case discussions, file rounds (documentation
of case history and examination, progress notes, round discussions,
investigations and management plan), interesting and difficult case unit
discussions.
• Central hospital teaching sessions should be conducted regularly and junior
residents should present interesting cases, seminars and take part in clinico-
pathological case discussions.

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5. Posting
The resident should be posted in the medical wards, sub-specialty wards,
emergency (casualty) and intensive care unit during the three year course. They
should undergo rotation in all the medical units and should be exposed to the
subspecialty units such as Cardiology, Neurology, Chest & TB, Gastroenterology,
Nephrology, Endocrinology and Oncology. The following should be the training
programme in the department:

Medical Units (By rotation in each unit)

Casualty (Emergency)

Intensive care unit

Subspecialty units

6. Thesis
6.1. Every candidate shall carry out work on an assigned research project under the
guidance of a recognized Postgraduate Teacher; the project shall be written
and submitted in the form of a thesis.
6.2. Every candidate shall submit thesis plan to the University within the time frame
specified by the university.
6.3. Thesis shall be submitted to the University before the commencement of theory
examination as per the regulation of the university.
6.4. Requirements:-
i) Identify a relevant research question
ii) Conduct a critical review of literature
iii) Formulate a hypothesis
iv) Determine the most suitable study design
v) State the objectives of the study
vi) Prepare a study protocol
vii) Undertake the study according to the protocol
viii) Analyze and interpret research data, discuss, summarize and draw
conclusions
ix) Write a research paper.

7. Assessment
All the PG residents should be assessed daily as well as periodically.

7.1. General Principles:

The assessment should be valid, objective, and reliable.

It should cover cognitive, psychomotor and affective domains.

Formative and summative (final) assessment is to be conducted in theory as well
as practicals/clinicals. In addition, thesis should be assessed separately.

7.2. Formative Assessment

The formative assessment is continuous as well as end of term.

The former is based on the feedback from the consultants concerned.

Formative assessment will provide feedback to the candidate about his/her
performance and help to improve in the areas they lack.

Record of internal assessment should be presented to the board of examiners for
consideration at the time of final examination.

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7.3. Internal Assessment

The performance of the Postgraduate student during the training period
should be monitored throughout the course and duly recorded in the log books as
evidence of the ability and daily work of the student. Marks should be allotted out of
100 as followed.
Sr. No. Items Marks
1. Personal Attributes 20
2. Clinical Work 20
3. Academic activities 20
4. End of term theory examination 20
5. End of term practical examination 20

1. Personal attributes:

Behavior and Emotional Stability: Dependable, disciplined, dedicated, stable
in emergency situations, shows positive approach.

Motivation and Initiative: Takes on responsibility, innovative, enterprising, does
not shirk duties or leave any work pending.

Honesty and Integrity: Truthful, admits mistakes, does not cook up information,
has ethical conduct, exhibits good moral values, loyal to the institution.

Interpersonal Skills and Leadership Quality: Has compassionate attitude
towards patients and attendants, gets on well with colleagues and paramedical
staff, is respectful to seniors, has good communication skills.

2. Clinical Work:

Availability: Punctual, available continuously on duty, responds promptly on
calls and takes proper permission for leave.

Diligence: Dedicated, hardworking, does not shirk duties, leaves no work
pending, does not sit idle, competent in clinical case work up and management.

Academic ability: Intelligent, shows sound knowledge and skills, participates
adequately in academic activities, and performs well in oral presentation and
departmental tests.

Clinical Performance: Proficient in clinical presentations and case discussion
during rounds and OPD work up. Preparing Documents of the case
history/examination and progress notes in the file (daily notes, round discussion,
investigations and management) Skill of performing bed side procedures and
handling emergencies.

3. Academic Activity: Performance during presentation at Journal club/ Seminar/

Case discussion/Stat meeting and other academic sessions. Proficiency in skills
as mentioned in job responsibilities.

4. End of term theory examination conducted at end of 1st, 2nd year and after 2
years 9 months

5. End of term practical/oral examinations after 2 years 9 months.

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Marks for personal attributes and clinical work should be given annually by
all the consultants under whom the resident was posted during the year. Average of
the three years should be put as the final marks out of 20.

Marks for academic activity should be given by the all consultants who have
attended the session presented by the resident.

The Internal assessment should be presented to the Board of examiners for

due consideration at the time of Final Examinations.

7.4. Summative Assessment

Ratio of marks in theory and practical will be equal.

The pass percentage will be 50%.

Candidate will have to pass theory and practical examinations separately.

A. Theory examination (Total=400)

Marks
Paper 1 Basic sciences as related to Medicine 100
Paper 2 Principles of Medicine 100
Paper 3 Practice of Medicine 100
Paper 4 Recent Advances in Medicine 100
Total : 400

B. Practical & Viva-Voce Examination

4 (Four) Long Cases 300

Viva-voce 100
Total : 400

8. Job Responsibilities
The trainees in internal medicine should be designated as residents.
According to year of residency he/she should be designated as
First/Second/Third year resident.

Outdoor Patient (OPD) Responsibilities

 The working of the residents in the OPD should be fully supervised.
 They should evaluate each patient and write the observations on the OPD card
with date and signature.
 Investigations should be ordered as and when necessary using prescribed
forms.
 Residents should discuss all the cases with the consultant and formulate a
management plan.

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 Patient requiring admission according to resident’s assessment should be

shown to the consultant on duty.
 Patient requiring immediate medical attention should be sent to the casualty
services with details of the clinical problem clearly written on the card.
 Patient should be clearly explained as to the nature of the illness, the
treatment advice and the investigations to be done.
 Resident should specify the date and time when the patient has to return for
follow up.

In-Patient Responsibilities
Each resident should be responsible and accountable for all the patients
admitted under his care. The following are the general guidelines for the functioning
of the residents in the ward:
 Detailed work up of the case and case sheet maintenance:
He/She should record a proper history and document the various symptoms.
Perform a proper patient examination using standard methodology. He
should develop skills to ensure patient comfort/consent for examination.
Based on the above evaluation he/she should be able to formulate a
differential diagnosis and prepare a management plan. Should develop skills
for recording of medical notes, investigations and be able to properly
document the consultant round notes.
 To organize his/her investigations and ensure collection of reports.
 Bedside procedures for therapeutic or diagnostic purpose.
 Presentation of a precise and comprehensive overview of the patient in
clinical rounds to facilitate discussion with senior residents and consultants.
 To evaluate the patient twice daily (and more frequently if necessary) and
maintain a progress report in the case file.
 To establish rapport with the patient for communication regarding the nature
of illness and further plan management.
 To write instructions about patient’s treatment clearly in the instruction book
along with time, date and the bed number with legible signature of the
resident.
 All treatment alterations should be done by the residents with the advice of
the concerned consultants and senior residents of the unit.

Admission day
Following guidelines should be observed by the resident during admission day.
 Resident should work up the patient in detail and be ready with the preliminary
necessary investigations reports for the evening discussion with the consultant
on duty.
 After the evening round the resident should make changes in the treatment
and plan out the investigations for the next day in advance.

Doctor on Duty
 Duty days for each Junior Resident should be allotted according to the duty
roster.
 The resident on duty for the day should know about all sick patients in the
wards and relevant problems of all other patients, so that he could face an
emergency situation effectively.
 In the morning, detailed over (written and verbal) should be given to the next
resident on duty. This practice should be rigidly observed.
 If a patient is critically ill, discussion about management should be done with
the senior resident or consultant at any time.

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 The doctor on duty should be available in the ward through out the duty hours.

Care of Sick Patients
 Care of sick patients in the ward should have precedence over all other routine
work for the doctor on duty.
 Patients in critical condition should be meticulously monitored and records
maintained.
 If patient merits ICU care then it must be discussed with the senior residents
and consultants for transfer to ICU.

Resuscitation skills
At the time of joining the residency programme, the resuscitation skills should be
demonstrated to the residents and practical training provided at various work
stations.
 Residents should be fully competent in providing basic and advanced cardiac
life support.
 They should be fully aware of all advanced cardiac support algorithms and be
aware of the use of common resuscitative drugs and equipment like
defibrillators and external cardiac pacemakers.
 The resident should be able to lead a cardiac arrest management team.

Discharge of the Patient

 Patient should be informed about his/her discharge one day in advance and
discharge cards should be prepared 1 day prior to the planned discharge.
 The discharge card should include the salient points in history and
examination, complete diagnosis, important management decisions, hospital
course and procedures done during hospital stay and the final advice to the
patient.
 Consultants and Senior Residents should check the particulars of the
discharge card and counter sign it.
 Patient should be briefed regarding the date, time and location of OPD for the
follow up visit.

In Case of Death
 In case it is anticipated that a particular patient is in a serious condition,
relatives should be informed about the critical condition of the patient
beforehand.
 Residents should be expected to develop appropriate skills for breaking bad
news and bereavements.
 Follow up death summary should be written in the file and face sheet notes
must be filled up and the sister in charge should be requested to send the
body to the mortuary with respect and dignity from where the patient’s relatives
can be handed over the body.
 In case of a medico legal case, death certificate has to be prepared in triplicate
and the body handed over to the mortuary and the local police authorities
should be informed.
 Autopsy should be attempted for all patients who have died in the hospital
especially if the patient died of an undiagnosed illness.

Bedside Procedures
The following guidelines should be observed strictly:

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 Be aware of the indications and contraindications for the procedure and record
it in the case sheet. Rule out contraindications like low platelet count,
prolonged prothrombin time, etc.
 Plan the procedure during routine working hours, unless it is an emergency.
Explain the procedure with its complications to the patient and his/her relative
and obtain written informed consent on a proper form. Perform the procedure
under strict aseptic precautions using standard techniques. Emergency tray
should be ready during the procedure.
 Make a brief note on the case sheet with the date, time, nature of the
procedure and immediate complications, if any.
 Monitor the patient and watch for complications(s).

Medico-Legal Responsibilities of the Residents

 All the residents are given education regarding medico-legal responsibilities at
the time of admission in a short workshop.
 They must be aware of the formalities and steps involved in making the correct
death certificates, mortuary slips, medico-legal entries, requisition for autopsy
etc.
 They should be fully aware of the ethical angle of their responsibilities and
should learn how to take legally valid consent for different hospital procedures
& therapies.
 They should ensure confidentiality at every stage.

9. Suggested Books and Journals

9.1. Core Books

Hutchinson’s Clinical Methods

Harrison’s Principles of Medicine

Oxford Text Book of Medicine

Cecil Text Book of Medicine

API Text Book of Medicine

9.2. Reference Books

Braunwald’s Heart Disease

Hurst’s The Heart

Sheila Sherlock’s Diseases of the Liver and Biliary system

Adams and Victor’s Principles of Neurology

Crofton and Douglas Respiratory Diseases

Brenner and Rector’s The Kidney

William’s Text Book of Endocrinology

Mandell’s Principles and Practice of Infectious Diseases

Kelley’s Text Book of Rheumatology

Devita’s Principles and Practice of Oncology

Text Book of Critical Care Medicine

Shamroth’s An Introduction to Electrocardiography

9.3. Core Journals

New England Journal of Medicine

The Lancet

Annals of Internal Medicine

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Journal of Association of Physicians of India

Medical Clinics of North America

9.4. Reference Journals

Circulation

Heart

Indian Heart Journal

JIMA (Journal of Indian Medical Association)

Journal of Indian Academy of Clinical Medicine

Quarterly Journal of Medicine

National Medical Journal of India

Critical Care Medicine

Diabetes Care

Cancer

Gastroenterology

Neurology India

Chest

American Journal of Kidney Diseases

10. Model Test Papers

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MODEL QUESTION PAPER

MD (Medicine)
Paper-I
Basic Sciences as related to Medicine
Max. Marks:100 Time: 3 hrs

• Attempt ALL questions

• Answer each question & its parts in SEQUENTIAL ORDER
• ALL questions carry equal marks
• Illustrate your answer with SUITABLE DIAGRAMS

I Describe the life cycle of malaria. What is the treatment of cerebral malaria?

II What is antinuclear antibody (ANA)? Discuss the laboratory diagnosis of SLE.

III Discuss haemoglobin synthesis. Write the classification of

haemoglobinopathies.

IV Write in brief about the pathogenesis of atherosclerosis.

V Give an account of the anatomy of the mediastium.

VI Write about the production and metabolism of bilirubin. Enumerate the

hereditary defects in bilirubin conjugation.

VII Enumerate the neurocutaeous syndromes. Describe the clinical features of

Neurofibromatosis.

VIII Discuss the pathogenesis of bone disease in chronic renal failure. What is its
treatment?

IX Discuss the pathogenesis of type 1 diabetes mellitus.

X Write about the food sources, deficiency and treatment of thiamine.

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MODEL QUESTION PAPER

MD (Medicine)
Paper-II
Principles of Medicine

Max. Marks:100 Time: 3 hrs

• Attempt ALL questions

• Answer each question & its parts in SEQUENTIAL ORDER
• ALL questions carry equal marks
• Illustrate your answer with SUITABLE DIAGRAMS

I Discuss the biology and evaluation of obesity.

II Enumerate the plasma cell disorders? Describe the management of multiple

myeloma.

III Define sepsis & septic shock. Discuss the treatment strategies of Septic
Shock.

IV Describe the clinical features & management of heart failure.

V What is pulmonary thromboembolism? Enumerate its various risk factors and

diagnostic modalities.

VI What are the causes of acute pancreatitis? Describe the systemic

complications of acute pancreatitis.

VII Enumerate the various modalities of renal replacement therapies. Describe

chronic Ambulatory Peritoneal dialysis.

VIII What is systemic sclerosis? Differentiate between its diffuse & limited variants.

IX Discuss the diagnosis & management of osteoporosis.

X Outline the management of acute ischemic cerebrovascular attack.

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MODEL QUESTION PAPER

MD (Medicine)
Paper-III
Practice of Medicine
Max. Marks:100 Time: 3 hrs

• Attempt ALL questions

• Answer each question & its parts in SEQUENTIAL ORDER
• ALL questions carry equal marks
• Illustrate your answer with SUITABLE DIAGRAMS

I What is neutropenic PUO? Outline the causes and treatment of neutropenic

PUO.

II Describe the malignancies associated with AIDS.

III Discuss the classification and investigative workup of acute myeloid

leukaemia.

IV Enumerate the causes and pathophysiology of pulsus paradoxus.

V Discuss the metastatic complications of carcinoma lung.

VI Classify chronic hepatitis and enumerate the causes.

VII Enumerate the causes of acute polyradiculopathy.

VIII Discuss the classification and treatment of lupus nephritis

IX Give an account of thiazolidinediones

X Describe empty sella syndrome?

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MODEL QUESTION PAPER

MD (Medicine)
Paper-IV
Recent advances in Medicine
Max. Marks:100 Time: 3 hrs

• Attempt ALL questions

• Answer each question & its parts in SEQUENTIAL ORDER
• ALL questions carry equal marks
• Illustrate your answer with SUITABLE DIAGRAMS

I Describe the role of biologics in rheumatoid arthritis.

II Discuss briefly about activated protein C. What is its current status in

management of severe sepsis.

III Discuss HCV treatment challenges in patients co-infected with HIV.

IV Describe the role of recombinant factor VII a as a novel haemostatic agent.

V Discuss Incretin biology and its present status in management of Type 2

diabetes.

VI Enumerate the mechanisms of anemia in CRF and what are current

recommendations for its management.

VII Discuss the present status of platelet ADP- receptor antagonists for
Cardiovascular Disease.

VIII Describe current diagnostic and therapeutic strategies for pulmonary artery
hypertension.

IX Discuss recent guidelines for prevention, diagnosis and treatment for ventilator
associated pneumonia.

X Enumerate the newer antiepileptic drugs. Discuss the role of surgery in

epilepsy.

Curriculum MD (Medicine)