DM IN PULMONARY MEDICINE

Curriculum for DM Pulmonary Medicine

Introduction

GENERAL GOALS OF THE RESIDENCY TEACHING CUM TRAINING PROGRAM IN DM Pulmonary Medicine

The main goal of the training program is to produce pulmonary physicians with the necessary knowledge, skill and attitude to diagnose and manage in an effective manner, a wide range of clinical problems in Pulmonary Medicine as seen in the community or in secondary/tertiary care setting. Special emphasis is placed on the relatively common and treatable disorders. Possession of clinical skills required for making a diagnosis is given utmost importance.

As a result of training in Pulmonary Medicine, the physician should become competent in life saving interventions, the use of the various diagnostic tests, and interprets their results intelligently & promptly. In addition, trained pulmonary physician should possess knowledge and skills of all the relevant medical fields and  appropriately  deliver  the  required  health  care  in  these  sectors.  It  is considered desirable for the post graduate residents from this specialty to be familiar with the fundamentals of research methodology also.

In order to be considered a competent Pulmonologist, a resident in Pulmonary Medicine must possess humanistic qualities, attitudes and behaviour necessary for the development of appropriate patient-doctor relationship.

SPECIFIC AIMS AND OBJECTIVES OF THE RESIDENT TRAINING PROGRAM IN PULMONARY MEDICINE

As a result of the training under this program, at the end of 3 years of postgraduate training, a resident must acquire the following knowledge, skills and competencies:

1. A thorough knowledge of pathological abnormalities, clinical manifestations, and principles of management of a large variety of medical conditions affecting respiratory system.

2. Skill and competence to choose and interpret correctly the results of the various routine investigations necessary for proper management of the patient. While ordering these investigations, a resident must be able to understand the sensitivity, specificity and the predictive value of the proposed investigation, as well as its cost-effectiveness in the management of the patient.

3. Skill and competence in interventions like endotracheal intubation, needle lung biopsy, bronchoscopy, needle thorococentesis, Intercostal drain placement, pericardiocentesis, thoracoscopy, and various endobronchial procedures.

4. Skills and competence to perform commonly used diagnostic procedures, namely, pleural aspiration, pleural biopsy, lung biopsy, allergy testing, fine needle aspiration, polysomnography, ultrasonography and cardiopulmonary exercise testing.

5.  Skill  and  competence  to  choose  and  interpret  correctly  the  results  of specialized investigations including radiologic, ultra-sonographic, biochemical, hemodynamic, electro-cardio graphic, electrophysiological, pulmonary functional, haematological, immunological, nuclear isotope scanning, arterial blood gas analysis results. polysomnographic and bronchoscopic results.

6. Skill and competence to provide consultation to other medical and surgical specialties and  sub-specialties, whenever needed.

7. Skill and competence to function effectively in varied clinical settings, namely emergency/critical care, ambulatory care, out-patient clinic, in-patient wards.

8. Skill and competence to take sound decisions regarding hospitalization, or timely referral to other consultants of various medical sub specialties recognizing his limitations in knowledge and skills in these areas.

9.  Proficiency  in  selecting  correct  drug  combinations  for  different  clinical problems with thorough knowledge of their pharmacological effects, side-effects, interactions with the other drugs, alteration of their metabolism in different clinical situations, including that in the elderly.

10.Skill   and   competence   to   advise   on   the   preventive,   restorative   and rehabilitative aspects including those in the elderly, so as to be able to counsel the patient correctly after recovery from an acute or chronic illness.

14. Skill and competence to understand research methodology in  Pulmonary Medicine and  to  undertake a  critical appraisal of  the  literature published in various medical journals and be able to apply the same in the setting in which the resident is working.

15. Skill and competence to work cohesively in Resuscitation team along with paramedical personnel and maintain discipline and healthy interaction with the colleagues.

16. Skill and competence to communicate clearly and consciously, and teach other junior residents, medical students, nurses and other paramedical staff, the theory as well as the practical clinical skills required for the practice of Pulmonary Medicine.

Recommendations for D. M Pulmonary Medicine

(3 Year Post Doctoral Course)

There are 52 weeks in a year. Approximately 2 weeks are gazetted / restricted holidays. Therefore, for academic requirements 50 weeks per year are available. Hence, for a three year course 150 weeks are available. Out of these, 10 weeks in three years are not available for hospital work & academics due to
conferences / CMEs / exchange programmes / thesis and case study writing.

Since this speciality demands a 24 hour service to the people, post graduates are required to work 8 hours a day and they are given a day off in a week.

Hours available per day

Six days in a week           8 hours                                   8 hours Total number of hours per week        8X6                     48 hours. Total credit hours available for academics
(No of weeks X No of hours available /week = 150 X 48 = 7200 hrs)

The break up is proposed to be as follows :

A   Bedside teaching / Practicals.

No of weeks( 140) X No of working day / week (6) X No of hours available /day (6)
5040 hrs

B   Thesis / case study writing / conferences / CMEs programmes

(No of weeks ( 10) X No of hours available /week (48) )
480 hrs.

C   Theory

No of weeks( 140) X No of working day / week (6) X No of hours available /day (2)
1680 hrs
Grand total                                                                                             7200 hrs

A.   Practical

1) Skill stations                      140 X 6 hours = 840 hrs.

Duration 6 hrs / week

No of weeks   140.

Skill Stations: Includes all the bedside medical skills pertaining to Pulmonary
Medicine

2) Bed side Medical clerky         140 X 30 = 4200 Hrs

Duration    5 Hrs / day.

30 hrs / week.

Bed side Medical clerky includes case history taking, formulating a working diagnosis, ordering appropriate investigations, and accompanying the patient to the specialized investigation areas, interpretation of all the results and finally starting the treatment protocol for them.

It also lays emphasis on in field resuscitation and transportation of critically ill patients and continuing the care in the ER, ICU and various other places also.

B.  Thesis writing :

NOTE: The 480 hours available should be fruitfully utilized by the student for attending conferences / CME programmes and for dessertation and case study.  Apart  from  this  they  can  utilize  these  hours  for  creating  basic awareness of Pulmonary Medicine among the other specialties and common masses.

C.  Theory

Total Hours Available                             1680 hours.

Besides interactive lectures theory includes Induction, documentation, Orientation, Journal Club, Internal Examination and Final Examination.

Curriculum

Total duration of training program                       3 Years

YEAR I

Introduction and preliminary posting in the

Pulmonary Medicine                                                   3 months

Respiratory Intensive Care Unit                                   3 month

General Medicine / Medical Intensive Care Unit          3months

Cardiology                                                                  2 months

Anaesthesiology                                                          1 month

YEAR II

Pulmonary Medicine                                        3 months

Intensive Respiratory Care Unit                      3 month

Paediatrics / PICU                                         3 months

Emergency Dept                                            2 months

Community Medicine                                     1 month

YEAR III

Pulmonary Medicine                                        6 months

Pulmonary Critical care                                    6month

Final Examination in D M Pulmonary Medicine
At the end of three years of training programme, a post graduate of DM
Pulmonary Medicine should at least possess following skills

CLINICAL SKILLS

1         History taking & Physical examination: Analysis of data for clinical diagnosis
2         Knowledge about common clinical problems, Symptom complex, Diagnostic reasoning
3         Various investigations, interpretation
4         Interventional procedures
5         Critical care, Life saving procedures, Palliation and end of life decisions

COMMUNICATION SKILLS

I          Professional Relationships

A         Patients and relatives B         Colleagues/team work C         Other staff

II         Consultation Skills

II         Record keeping

III       Bereavement Care

A         Breaking bad news

B         Referral for counselling

MANAGERIAL SKILLS

I          Policies/procedures (NHS, Hospital, Departmental) II         Staff management (planning, recruitment, appraisal) III       Equipment (choosing to ordering, medical physics)

IV       Resource management/clinical budgeting

V         Contracting/ setting standards, quality monitoring

VI       Information technology/Health informatics VII      Clinical governance/audit, risk management VIII     Compliments/complaints
IX       Medico-legal statements

X         Committee Work

XI       Liasing with other agencies (e.g. police, coroner) XII      Public Relations/media
XIII     Major Incident planning/exercises

TEACHING SKILLS

I          Lecture preparation

II         Small Group techniques III       Presentation techniques IV       Teaching critique
V         Departmental teaching programme

VI       Professional Development (self-directed learning) VII      Teaching certificate expected

RESEARCH SKILLS

I          Literature survey

II         Scientific study design

III       Data evaluation/Statistics

IV       Preparing publications

PROFESSIONAL ATTRIBUTES

I          Leadership II         Reliability III       Teamwork
IV       Self-motivation (prioritisation, project completion)
SCHEME OF EXAMINATON

Distribution of marks

(Duration – 3 hours each paper)

Paper 1          Applied basic sciences in relation to General Medicine & Pulmonary
Medicine

Paper 2          Non infectious Respiratory Diseases including those affecting
Respiratory centre, Chest wall and Mediastinum

Paper 3          Respiratory Infections including tuberculosis

Paper 4          Respiratory Critical Care and recent advances in Pulmonary
Medicine

Paper I                                                                                                            -- 100marks

a)  2 long essays b)   8 Short notes Model Questions
1) What is acquired immunodeficiency? Discuss the different pulmonary problems in an
immunosuppressed patient.                                                                           20
2) Discuss the central control of Respiration. What you know about hypoventilation syndromes?                                                                                                  20
3) Write short notes on                                                                                 60

a) Thoracic outlet syndrome
b) Role of diaphragm in Respiration c) Dynamic compliance
d) Delayed type hypersensitivity e) Line probe assay
f)  Role of ultrasound in Pulmonary Medicine g) Pressure support ventilation
h) Sepsis syndrome

Paper II                                                                                                          -- 100marks

c)  2 long essays d)   8 Short notes Model Questions
1)   Discuss in detail the relationship between sleep disordered breathing and Hypertension and review relevant studies.                                                                                                   20
2)   Discuss the etiopathogenesis of Lung Cancer.                                                 20
3)   Write short notes on                                                                                       60

 a)   Chylothorax
b)   Asthma mimics
c)    Tiotropium
d)   Congenital cystic adenomatoid malformations e)   Honey comb lung
f)    LVRS
g)    Tracheal stenosis
h)   Primary pulmonary hypertension

Paper III                                                                                                         -- 100marks

e)  2 long essays f)    8 Short notes Model Questions
1) What is pneumonia severity index? Discuss the management of community acquired
pneumonia                                                                                                      20
2) Discuss the relative merits and demerits of revised national tuberculosis control programme.                                                                                                     20
3) Write short notes on                                                                                    60

 a) Mycobacterium growth index tube
b) Acinetobacter
c) XDR TB
d) Exudative effusion
e) Hospital infection control policy
F)  Viral Pandemics g) Haemopysis
h) Hydatid Cyst

Paper IV                                                                                                      -- 100marks

g)  2 long essays h)   8 Short notes Model Questions
1) How will you manage a case of ARDS with multiorgan failure                        20
2) What is health care associated pneumonia ?
How will you manage VAP?                                                                              20
3) Write short notes on                                                                                      60
a) Pulmonary AV fistula b) DLCo
c) Indacaterol
d) Bronchial artery enbolization e) LVEF
f) Toxic gas inhation
g) Diagnosis of Pulmonary thromboebolism h) Lupus pneumonia

Minimum for a pass

Theory aggregate (50% in each paper)                                                      200/400

Clinical/Viva /Dissertations (100+50+50)    (50%)                                    100/200

Grand total                                                                                                300/600

Dissertation                                  Accepted/Not Accepted

(Precondition to appear for the final University Examination)
Clinical         One main case (25x3)                                                -- 75 marks
Two short case(25x2)                                                                    -- 50 marks

Viva-voce/Skill assessment :( 5X10=50marks)

1.  ECG

2.  Radiology (x-rays/ CT)
3.  Sonography(FAST/USG)
4.  Instruments
5.  Ventilatory settings
6.  BLS
7.  Airway and breathing skills( intubation, diagnosed ventilation, needle thorococentesis, intercostals drainage)
8.  Skills related to circulation( central venous cannulation central venous pressure management)
9.  Arrhythmia recognition and management (defibrillation, and
Cardioversion)
10. ABG,Polysomnography PFT Conferences and awards