ENT syllabus for MBBS in India (Competency based Education/CBME 2019)

Topics & competencies in ENT as per the CBME

Topic	Competencies	Practicals	Procedures for certification	Integrations
1. Anatomy and Physiology of ear, nose, throat, head & neck	2	NIL	Nil	V-2 / H-0
2. Clinical Skills	15	12	Nil	NIL
3. Diagnostic and Therapeutic procedures in ENT	6	NIL	Nil	NIL
4. Management of diseases of ear, nose & throat	53	25	Nil	V-1 / H-0
Total: 4	76	37	NIL	V-3 / H-0

Sample of the detailed description of the competencies:

No	Competency	DLC	Teaching	Assessment	V/H
EN3.1	Observe and describe the indications for and steps involved in the performance of Otomicroscopic examination in a simulated environment	S-KH-N	Lecture, Small group discussion, Demonstration	Written/ Viva voce
EN3.2	Observe and describe the indications for and steps involved in the performance of diagnostic nasal Endoscopy	S-KH-N	Lecture, Small group discussion, Demonstration	Written/ Viva voce
EN3.3	Observe and describe the indications for and steps involved in the performance of Rigid/Flexible Laryngoscopy	K-KH-N	Lecture, Small group discussion, Demonstration	Written/ Viva voce

Abbreviations & details:

No & Competencies: No – serial number of the competency with subject/topic coding, & Competencies – description of competencies
Domain/level-Core (DLC):
1. Domain (Identifies the domain): K- Knowledge, S – Skill, A – Attitude/professionalism, C- Communication.
2. Level (Identifies the level of competency): K – Knows, KH – Knows How, SH – Shows how, P- performs independently.
3. Core: Y – must achieve/compulsory, N – non-core/desirable/optional
Skills required to certify: P – many procedures must be done independently for certification/ graduation.
Integration: V – Vertical Integration, H – horizontal integration.

General Objectives of ENT for MBBS

Objectives: Student shall be able to

1. Examine and diagnose common ear, nose, and throat problems
2. Suggest common investigative procedures and their interpretation to diagnose and manage the patient.
3. Treat the common ear, nose, throat and neck problem at primary care centre, while treating the patient. He should know the rational use of commonly used design with their adverse effects.
4. Train to perform various minor surgical procedures like ear syringing nasal packing and biopsy procedure.
5. Assist common surgical procedures such as tonsillectomy, mastoidectomy, septoplasty, tracheostomy and endoscopic removal of foreign bodies.
6. Have awareness of Preventive otology and head & neck cancer for public guidance.

Teaching and learning methodology in ENT for MBBS

Details of the competencies, lectures, practicals & skills to be acquired are mentioned in the table given above.
Teaching Learning Method:
1. Learner-centric didactic lectures with Vertical/horizontal integrations (CBME).
2. Tutorial & Seminars
3. Problem-based Learning (PBL) & Small group discussions (especially focus on practical & clinical implications of the knowledge through cases)
4. Conventional Practical classes & DOAP session (Demonstrate, Observe, Assess, Perform),
5. Self-directed learning +/- multimedia aids (Audiovisual presentations).
6. Seminars, symposia & quizzes.

Distribution of approximate teaching hours in ENT for MBBS

NBE provided the particulars of competencies, teaching methodology, Vertica/.horizontal integrations, AETCOM & Exam methodology however the distribution of hours per class/tutorial & practicals are left for the individual universities to be handled therefore subjected to inter-university variability.

Total number of teaching hours: approximately 150 hrs (teaching hours & distribution might differ slightly per university).
Theory:

Topics	Hours
1. Nose, paranasal sinuses and nasopharynx	14
2. Pharynx	6
3. Ear	16
4. Larynx, trachea and bronchi	6
5. Oesophagus	3

Operative Procedures to be familiar with:

1. Tonsillectomy
2. Adenoidectomy
3. Septoplasy
4. Caldwell-Luc operation
5. Myringoplasty
6. Modified radical mastoidectomy
7. Radical mastoidectomy
8. Biopsy for diagnosis of carcinoma of tongue, etc
9. Direct larygnoscopy
10. Neck node biopsy
instruments to be familiar with:
1. Thudicum nasal
2. Killiani self retaining nasal speculum
3. Tielley lichwitz antrum puncture trocar and cannula
4. Higginson’s rubber syringe
5. Ballenger’s swivet knife
6. Walsham’s forceps
7. Luis forceps
8. Tilleys forceps
9. St clair thomson post nasal mirror
10. Simpson’s antral syringe
11. Jobson hornes probe and ring curette
12. Siegle pneumatic speculum
13. Tuning fork
14. Barany noise box
15. Head mirror
16. Toynbee ear speculum
17. Boyle Davis mouth gag
18. Lack’s tongue depressor
19. Draffins bipod metallic stand
20. Eve’s tonsillar snare
21. St Clare Thomson Adenoid curette with / without cage
22. Trousseau’s trocheal dilator
23. Jackson’s metallic tracheostomy tube
24. Direct laryngoscope
25. Chevalier Jackson’s oesophagoscope
26. Negus bronchoscope

Examination pattern & marks distribution in ENT for MBBS

Exam pattern:
1. The formative or internal assessment will not be added to the university examination marks.
  - Should score 50 % & in theory and practical combined to be eligible to sit for university exams.
2. University exam: Each subject will have two papers.
  - 200 marks will be reserved for the theory of two papers.
  - Another 100 will be reserved for either practical, oral, or clinical exam.
  - Should secure 50 % in theory and practical to pass in university examinations

Formative Assessment:
1. Theoretical assessment: clickers, one-minute papers, and muddiest point
2. Practical/clinical assessment: one-minute preceptor (OMP) and/or viva voce.
3. Scheduling: during teaching-learning activities & planned by the teachers on a day to day basis and modified depending on the tasks at hand.
Internal assessment
1. Theory: Written tests, should have essay questions, short notes, and creative writing.
2. Practical / Clinical: practical/clinical tests, Objective Structured Clinica/Objective Structured Practical Examination (OSPE) and/or viva voce.
3. Scheduling:
  - Minimum Number of tests during the year: 2
  - Clinical subjects should also be tested at end of each posting (EOP)-Theory and Practical
  - There should be at least one short question from AETCOM in each subject
  - One of the tests in Ophthalmology, Otorhinolaryngology/Forensic Medicine & Toxicology/ Community Medicine should be prelim or pre-university examination
Summative assessment (For Universities)
- Theory Papers: 2 papers for 200 marks
  1. Suggested combination of various types of question:
    1. Structured essays (Long Answer Questions – LAQ)
    2. Short Answers Questions (SAQ)
    3. Objective type questions (Various type of MCQs: < 20% weightage)
  2. Distribution of the competencies: The examiner must sample the contents appropriately from competencies.
- Practicals for 100 marks:
  1. Application-oriented exercises (Should not be simple tests of knowledge).
  2. Objective Structured Practical Examination (OSPE), One- Minute Preceptor (OMP), Directly Observed Procedural Skills (DOPS) etc. can be suitably modified for this purpose and/or viva voce.
- Scheduling: