DM Infectious Diseases
DM Infectious Diseases
DM Infectious Diseases
Goal
The Infectious Diseases training programme provides rigorous training and supervised
experience by faculty with broad clinical and research expertise so that the post graduate student
acquires necessary skills and competencies as a specialist in infectious diseases.
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the DM programme. PG training should include regularly encountered inpatient and
outpatient infections and special situations including HIV/AIDS, transplant-associated
infections, Hematology-Oncology infections, immune-compromised hosts, illnesses of
travelers, hospital acquired infections, ICU patients with sepsis, sexually transmitted
infections and the epidemiology of these infections. The students should be able to perform
the following:
• meticulous history taking,
• thorough clinical examination,
• order diagnostic tests,
• interpret results, especially those provided by the Microbiology Laboratory including
molecular methods,
• make diagnostic and therapeutic decisions,
• perform procedures,
• counsel and manage patients,
• use antimicrobial agents appropriately and rationally and work with other departments to
provide patient-focused care.
b. Teaching Skills
The post graduate student should be exposed to teaching methods and develop competence in
teaching medical, paramedical and nursing students at the undergraduate and post graduate
levels.
c. Research Skills
The students should gain basic skills and knowledge to function as independent investigators
and should be exposed to state-of-the-art basic, translational, and clinical research. They
should acquire scientific knowledge and critical evaluation of the relevant literature, problem
solving, design and interpretation of experiments, communication of progress and research
results in formal and informal settings, and understand national and international systems
available for funding of research. Scientific professionalism will be stressed in each
encounter. Basic knowledge of statistics, along with clinical epidemiologic principles like
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appropriate study designs, critical appraisal of data management and analysis are also
required.
d. Group Approach
The students would be required to interact with various departments to provide patient
centered holistic care, be able to lead a team of health care workers and provide expertise to
public health authorities during an outbreak of infectious diseases or natural calamities.
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a. Cognitive Domain (knowledge domain)
The post graduate student would learn a broad range of problems in infectious diseases care of
the individual patient and the larger community through patient care in a variety of settings,
conferences, lectures, and appropriate use of the medical literature. The students will have
appropriately supervised primary responsibility for applying their knowledge to the solution of
problems in differential diagnosis and complex disease management. They will learn to manage
challenges unique to the treatment of Infectious Diseases including antimicrobial resistance,
from the individual patient to the environment; loss of useful antimicrobial agents and
recognition of new diseases. The students will become experts in using current medical literature
to support evidence based decision-making. They will learn to appraise the medical literature
critically and perfect their clinical skills. They will maintain a record of the cases for grand
rounds and possible publication of case reports.
At the end of the DM course in Infectious Diseases, the students should acquire the following
competencies:
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7. Ability to develop an appropriate therapeutic approach depending on the patient’s
clinical condition and perform therapeutic procedures when appropriate to the patient's
condition.
8. Knowledge of mechanism of action, indications, contra-indications, dosing schedule,
efficacy, cost, side effects, and pharmacokinetics and pharmacodynamics of
antimicrobials and biological products including monoclonal antibodies.
9. Ability to choose the right antimicrobial, rational combinations of antibiotics where
required keeping in mind the clinical syndrome, tissue penetration and therapeutic drug
monitoring where required.
10. Knowledge of drugs of choice for most microorganisms and chemoprophylaxis when
required.
11. Knowledge of indications and contraindications for active and passive immunization of
infectious diseases including comprehensive knowledge of the National Immunization
Programme including travel related immunization.
12. Knowledge of global and local epidemiology, geographical habitats, reservoirs and
modes of transmission of infections of public health importance and preventive
measures.
13. Knowledge of reportable infectious diseases and proper documentation and procedures
required for reporting them.
14. Knowledge of the basic principles of nosocomial infectious diseases in various
institutional settings, especially catheter-associated urinary tract infections, nosocomial
pneumonia, and sepsis associated with intravascular devices and therapy.
15. Knowledge for the purposes of referral and patient education, indications, success rates,
and complications of common surgical procedures for infectious disease problems.
B. Affective Domain
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1. Should be able to function as a part of a team, develop an attitude of cooperation with
colleagues, and interact with the patient and the clinician or other colleagues to provide
the best possible diagnosis or opinion.
2. Always adopt ethical principles and maintain proper etiquette in dealings with patients,
relatives and other health personnel and to respect the rights of the patient including the
right to information and second opinion.
3. Develop communication skills to word reports and professional opinion as well as to
interact with patients, relatives, peers and paramedical staff, and for effective teaching.
C. Psychomotor domain
At the end of the course, the student should acquire following clinical skills and be
able to:
1. observe and manage patients with wide variety of infectious diseases on both an inpatient
(Inpatient Consultation Service, Immunocompromised Consultation Service) and an
ambulatory basis (Infectious Disease Clinics including HIV/AIDS, Hepatitis Clinic,
Fever Clinic, Sexually Transmitted Disease Clinic etc.). This would help to gain
longitudinal experiences in a continuum of care to observe the course of illness and the
effects of therapy.
2. learn proper methods of specimen collection, transport, handling and preparation by
completing the faculty-supervised microbiology checklist
3. Procedures to be observed
a. Gram Stain of exudates and body fluid from various sources - 20 numbers
b. Sputum Acid fast stain -15 numbers
c. Malaria parasite -10 numbers
d. Bone Marrow aspirate and Biopsy -5 numbers
e. Body fluid aspiration including joints -10 numbers
4. follow up of patients in Infectious Diseases wards during the acute and recovery phases
of their illnesses.
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5. provide consultative services to outpatient clinics and inpatient services in other
specialties and subspecialties including the management of antibiotic administration in
such diverse settings as the hospital, the office, or in conjunction with home-care
services.
6. able to carry out a research project under the guidance of faculty from the Infectious
Disease department including project planning, research design, collection and
interpretation of data and publication.
SYLLABUS
Course contents:
The syllabus will include a study of infectious diseases of bacterial, viral, fungal and parasitic
origin occurring in the adults and in the pediatric age group. The student must also have a
practical knowledge of infections encountered in oncology, surgery, Obstetrics & Gynaecology,
post-transplant patients, and in other specialties.
During the training programme, the post graduate student will have formal instruction, clinical
experience or other opportunities to gain expertise in the etiology, pathogenesis, epidemiology,
clinical presentation, differential diagnosis, management and prevention of the disorders
pertaining to various pathogens and organ systems.
A detailed log book of at least 100 patients with different infectious diseases (minimum twenty
of different systems) should be maintained. Grand round cases should also be recorded in log
book.
The syllabus is based on (a) Syndromic or Systemic and (b) Organism based approach.
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2. Upper respiratory tract infections
o Sinusitis
o Common cold
o Pharyngitis, retropharyngeal and parapharyngeal infections
o Laryngitis and croup
o Ear infections including otitis and mastoiditis
o Epiglottitis
o Manifestations of different systemic infections in oral cavity, neck and head
o Local infections of neck, oral cavity and head
3. Pleuro- pulmonary and bronchial infections
o Infections associated with COPD and cystic fibrosis
o Bronchiolitis
o Acute bronchitis
o Pneumonia (acute and chronic) including CAP and atypical pneumonia
o Lung abscess
o Pleural effusion and empyema
4. Urinary tract infections
5. Sepsis syndromes
6. Intra - abdominal infections
o Peritonitis and intraperitoneal abscesses
o Infections of liver and biliary system including liver abscess
o Pancreatic infections
o Splenic abscess
o Acute and chronic appendicitis
o Diverticulitis, typhlitis
o Principles and syndromes of enteric infections including acute and chronic
diarrhea
o Enteric fever and other causes of abdominal symptoms with fever
o Malabsorption syndromes
o Food poisoning
o Lower abdominal pain syndromes including Pelvic inflammatory disease and
prostatitis
o H. pylori infection
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7. Cardiovascular infections
o Infections of endocardium, prosthetic valve, non- valvular cardiovascular devices
o Myocarditis, pericarditis
o Mediastinitis
8. CNS infections
o Approach to a patient with CNS infections
o Meningitis: acute and chronic
o CSF shunt infection
o Encephalitis
o Infections causing Brain SOLs and abscesses
o Infections of dural spaces and brain sinuses
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o Infection in asplenic hosts
o Infection in IDU (Infectious Diseases Unit)
o Surgical and trauma related infection: Bite, Burn, post operative fever
1. Viral Diseases
• Arbo-viral illnesses including Dengue, Yellow fever, KFD, Chikungunya,
Hantavirus, WNV, JE, Tick borne encephalitis, Syndromes associated with
Arboviral infections; Herpes viridae and its infections (HSV, CMV, EBV,
HSV6&7, KSAV, VZV), Poxviridae
• Hepatitis causing viruses including Hepatitis E
• Corona virus and SARS
• Mumps and measles viruses
• Rhabdoviruses
• Ebola and Marburg virus and other viral haemorrhagic fevers
• Adenovirus
• Papillomavirus
• JC, BK other polyoma viruses
• Influenza and parainfluenza
• Zoonotic paramyxoviruses like Nipah, Hendra
• RSV
• Polio, Coxsackie, Echo, Enteroviruses
• HTLV 1 & 2
• HIV: history, epidemiology, virology, immunology, disease spectrum including
pulmonary, gastroenterological and neurological manifestations of HIVOI,
malignancy, treatment guidelines including antiretrovirals, drug toxicity, Drug
resistance, prevention, future planning
2. Prion Diseases Creutzfeldt Jacob, Kuru, Bovine spongiform encephalitis
3. Bacterial Diseases
• Gram positive organisms; Gram negative organisms
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• Anaerobic infections
• Mycobacteria: Tuberculosis: primary, secondary, pulmonary, extrapulmonary (as
per anatomical structures), MDR and XDR TB
• Leprosy, Non-Tuberculous Mycobacteria
• Brucellosis, Chlamydial diseases, Mycoplasma
• Rickettsial diseases
• Syphilis, Leptospirosis other spirochetes, Nocardia, Actinomycosis
4. Mycoses
• Superficial mycoses, Subcutaneous mycoses
• Deep mycoses including endemic systemic mycoses
5. Protozoal diseases
• Entamoeba, Free living amoeba, Malaria, Babesia, Leishmaniasis,
Toxoplasmosis, Trypanosomiasis, Giardiasis, Trichomoniasis, Cryptosporidium
and other HIV associated protozoas
6. Helminthic infections:
Geohelminths, Tissue and blood nematodes, Cestodes, Trematodes
7. Ectoparasitic diseases:
Lice (pediculosis), scabies, myasis, Mites including Chiggers, Ticks
8. Diseases associated with toxic algae:
Prototheca
GENERAL
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The student will undergo clinical rotations during the three-year programme (as given in the
section dealing with Teaching and LearningMethods).The main features of these rotations will
involve history taking and examination of the patients, recommend relevant investigations,
reviewing investigation reports and following up with microbiology, formulating a differential
diagnosis and a therapeutic plan, discussing the case with the primary consultant and the core
faculty for the programme. Identification of critical questions related to the case, reading the
topic from a standard ID textbook, literature search to retrieve comprehensive review including
epidemiology, microbiology, pathology, clinical manifestations, investigative approach,
treatment modalities, prognosis and preventive strategies, retrieve practice guidelines (Indian and
international), systematic reviews (Cochrane review) if any, review of controversies and
identification of research needs of the specific state will also be required.
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g) Emergency situation: Emergency duty by rotation among the post graduates with
faculty cover.
h) Ward rounds: DM students should take history, conduct examination, clinically evaluate
and manage inpatients admitted to wards. Ward rounds should be conducted by faculty
for appropriate patient care and teaching. This should also cover calls from other
specialties and emergency.
i) Combined Round/Grand Round: These exercises are to be done once a week or twice a
month involving presentation of unusual or difficult cases.
k) Clinical teaching: In outpatient, ward rounds, emergency and ICU, the post graduate
students shall be required to participate in the teaching and training programme of
undergraduate students, interns, junior residents and nurses.
l) The Department should encourage e-learning activities.
j) A post graduate student of a post graduate degree course in broad specialities/super
specialities would be required to present one poster presentation, to read one paper
at a national/state conference and to present one research paper which should be
published/accepted for publication/sent for publication during the period of his post
graduate studies so as to make him eligible to appear at the postgraduate degree
examination.
k) Teaching strategies
Clinical work includes the following:
• Rotation through various work stations for direct observation and hands-on learning
• Rounds in the laboratory trouble-shooting problems and addressing clinical
correlation.
• Reading of textbook sources regarding background information
• Slide lectures addressing specific microscopy topics.
• HIV ELISA detection, CD4 testing, viral load in PCR lab (during lab posting)
Hospital Epidemiology:
• Discussion sessions to review readings and basic concepts in hospital epidemiology
• Regular schedule of meetings: Infectious Diseases (ID) Seminar, Infection Control
(IC) Staff and Committee meetings, Drug Utilization
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• Special project assignments, evaluating new or ongoing problems/nosocomial
infections.
• Outbreak investigation training
• One report on hospital infection epidemiology during the course.
Infectious Disease Epidemiology
• Environmental factors in Infectious Diseases
• Emerging and re-emerging diseases like dengue, Ebola. Epidemic alert: Notification
and reportable diseases, Recognition of Bioterrorism
• Control strategies (levels of prevention and modes of intervention, source reduction,
vaccination, integrated vector control and diagnosis and treatment) especially with
regard to malaria, kala azar, scrub typhus)
• International instruments (International Health Regulations and international disease
surveillance) and WHO regulations and guidelines
• Research in Infectious Diseases
• Knowledge of the Geo-sentinel network and Geographical Information mapping of
various diseases
The post graduate student is required to work full time in the department, participate in
the patient care and academic and research activities as described below.
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The post graduate students will be primarily responsible for the care of patients which
include clinical, investigative and therapeutic aspects. In addition, they shall pursue
research and academic activities.
a. Clinical Rotations
i. First Year posting: in the parent department with resident duty (in turns)
on all days (depending on the number of candidates)
ii. Second year posting will include the following:
One month posting each in:
a. General Medicine
b. Pediatrics
c. Obstetrics & Gynaecology
d. Clinical Microbiology (including Lab. work)
e. Community Medicine (including Preventive Clinic)
f. Casualty (Emergency Medicine)
g. Immuno-suppression Unit (Transplant / Oncology)
h. Medicine ICU
i. Surgery ICU
j. PICU
k. NICU
l. RNTCP Unit*
m. ART Clinic*
n. STD Clinic*
* - only morning hours- rest of the day to be spent in the parent department
iii. Third Year posting: in the parent department with on call duty on all days
(in turn if feasible, depending on the number of candidates).
b. Clinical Microbiology Laboratory exposure
i. Rotation through various work stations for direct observation and hands-
on learning
ii. Rounds in the laboratory trouble-shooting problems and addressing
clinical correlation.
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iii. Reading of textbook (and other sources) regarding background
information
iv. Directed reading of the primary literature for specific information
v. Slide lectures addressing specific microscopy topics.
vi. HIV ELISA testing, CD4 testing, viral load in PCR lab
c. Hospital Epidemiology:
i. Discussion sessions to review readings and basic concepts in hospital
epidemiology
ii. Regular schedule of meetings: Infectious Diseases (ID) Seminar, Infection
Control (IC) Staff and Committee meetings, Drug Utilization
iii. Special project assignments, evaluating new or ongoing
problems/nosocomial infections.
iv. Outbreak investigation training
v. One report on hospital infection epidemiology during the course.
d. Infectious diseases epidemiology
i. Environmental factors in Infectious Diseases
ii. Emerging and re-emerging diseases like dengue, ebola. Epidemic alert:
Notification and reportable diseases, Recognition of Bioterrorism
iii. Control strategies (levels of prevention and modes of intervention, source
reduction, vaccination, integrated vector control and diagnosis and
treatment) especially with regard to malaria, kala azar, scrub typhus)
iv. International instruments (International Health Regulations and
international disease surveillance) and WHO regulations and guidelines
v. Research in Infectious Diseases
vi. Knowledge of the Geo-sentinel network and Geographical Information
mapping of various diseases
e. Prevention of Hospital acquired Infections (Infection Control)
i. Epidemiology and Surveillance
ii. Cluster investigation
iii. Transmission and control of nosocomial infection
iv. Disinfection and sterilization
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v. Isolation system
vi. Regulatory compliance
ASSESSMENT
FORMATIVE ASSESSMENT
Formative assessment should be continual and should assess medical knowledge, patient
care, procedural & academic skills, interpersonal skills, professionalism, self directed
learning and ability to practice in the system.
Periodic Evaluation:
Candidates will be evaluated continuously for their performance in all areas such as clinical and
investigative work, case presentations, seminars, journal clubs, procedures etc. Additional
periodic assessment will include theory and practical assessment mimicking the final
examination should be conducted every 6 months. Such an evaluation will help assessing the
progress of the trainees and the quality of the training programme. Evaluation will be communicated
to trainees and their feedback would be taken into consideration for modifications in training programme.
Internal Assessment should be frequent, cover all domains of learning and used to provide
feedback to improve learning; it should also cover professionalism and communication skills.
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The student to be assessed periodically as per categories listed in Postgraduate Student
Appraisal form (Annexure I).
SUMMATIVE ASSESSMENT
The summative examination would be carried out as per the Rules given in
POSTGRADUATE MEDICAL EDUCATION REGULATIONS, 2000.
A. Theory examination.
B. Practical, Clinical examination and Viva-voce.
Theory examination shall comprise of four papers. Passing percentage shall be cumulatively
50% with minimum of 40% marks in each theory paper.
Practical /Clinical examination consisting of at least one long case, three short cases and viva-
voce. Passing percentage shall be 50%.
Passing shall be separate for each head and failing shall be common, meaning thereby that
clearance at theory and failure at practical / clinical shall amount to failure at Summative
examination and vice versa.
2. Practical: The practical examination should consist of the following and should be spread over
two days, if the number of candidates appearing is more than five.
3. Viva-voce Examination: covering affective and psychomotor domain.
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RECOMMENDED READING
Books (Latest editions)
1. Mandell, G.L., Bennett, J.E., Dolin, R. Mandell. Douglas, and Bennett’s Principles and
Practice of Infectious Diseases, Philadelphia, Churchill Livingstone.
2. Andrew Cliff and Matthew Smallman-Raynor Turgeon. Oxford Textbook of Infectious
Disease Control. M.L. Oxford University Press.
3. John G. Barlett. Pocket Book of Infectious Disease Therapy. Lippincort Williams &
Wilkins.
4. David Schlossberg. Clinical Infectious Disease. Cambridge University Press.
5. R Guerrant, Walker D.H, Weller P.F. Tropical Infectious Diseases. Elsiever Churchill
Livingston.
6. Forbes, B., Sahm, D., Weissfeld, A. Bailey and Scott’s Diagnostic Microbiology. Mosby,
St. Louis.
7. Koneman, E.W., Allen, S.D. Janda, W.M., Schreckenberger, P.C., Winn, W.C. Color Atlas
and Textbook of Diagnostic Microbiology, J.B. Lippincott, Philadelphia.
8. Murray P.R, Baron E.J, Pfaller M.A, Tenover F.C, Yolken R.H. Manual of Clinical
Microbiology, American Society for Microbiology.
9. Garcia L.S, Bruckner D.A. Diagnostic Medical Parasitology. American Society for
Microbiology.
10. Immunology & Serology in Laboratory Medicine. St. Louis, Mosby.
Journals
03-05 International and 02 national journals (all indexed)
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Annexure I
Postgraduate Students Appraisal Form
Clinical Disciplines
Name of the Department/Unit :
Name of the PG Student :
Period of Training : FROM…………………TO……………
Sr. PARTICULARS Not Satisfactory More Than Remarks
No. Satisfactory Satisfactory
1 2 3 4 5 6 7 8 9
1. Journal based / recent
advances learning
2. Patient based
/Laboratory or Skill
based learning
3. Self directed learning
and teaching
4. Departmental and
interdepartmental
learning activity
5. External and Outreach
Activities / CMEs
6. Thesis / Research work
7. Log Book Maintenance
Publications Yes/ No
Remarks*____________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________
*REMARKS: Any significant positive or negative attributes of a postgraduate student to be
mentioned. For score less than 4 in any category, remediation must be suggested. Individual
feedback to postgraduate student is strongly recommended.
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