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

Topics & competencies in Orthopedics as per the CBME

Topic	Competencies	Practicals	Procedures for certification	Integrations
1. Skeletal Trauma, Poly trauma	6	1	NIL	V-0 / H-4
2. Fractures	16	NIL	NIL	V-16 / H-0
3. Musculoskeletal Infection	3	2	NIL	V-1 / H-2
4. Skeletal Tuberculosis	1	NIL	NIL	V-1 / H-1
5. Rheumatoid Arthritis and associated inlammatory disorders	1	NIL	NIL	V-0 / H-1
6. Degenerative disorders	1	NIL	NIL	NIL
7. Metabolic bone disorders	1	NIL	NIL	NIL
8. Poliomyelitis	1	NIL	NIL	NIL
9. Cerebral Palsy	1	NIL	NIL	NIL
10. Bone Tumors	1	NIL	NIL	V-1 / H-1
11. Peripheral nerve injuries	1	NIL	NIL	V-1 / H-1
12. Congenital lesions	1	NIL	NIL	V-1 / H-0
13. Procedural Skills	2	NIL	NIL	V-0 / H-1
14. Counselling Skills	3	NIL	NIL	V-0 / H-3
Total: 14	39	3	NIL	V-21 / H-14

Sample of the detailed description of the competencies:

No	Competency	DLC	Teaching	Assessment	V/H
OR2.1	Describe and discuss the mechanism of Injury, clinical features, investigations and plan management of fracture of clavicle	K/S-KH/SH-Y	Lecture, Small group discussion, Bed side clinic	Written/ Viva voce/ OSCE	V: Human Anatomy
OR2.2	Describe and discuss the mechanism of Injury, clinical features, investigations and plan management of fractures of proximal humerus	K-K/KH/SH-Y	Lecture, Small group discussion, Bed side clinic	Written/ Viva voce/ OSCE	V: Human Anatomy
OR2.3	Select, prescribe and communicate appropriate medications for relief of joint pain	K-KH/SH-Y	Lecture, Small group discussion, Bed side clinic	Written/ Viva voce/ OSCE	V: Human Anatomy

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 Orthopedics for MBBS

Objectives (Knowledge):

1. Musculoskeletal system embryology, applied anatomy, physiology, pathology, clinical features, diagnostic procedures, and the principles of therapeutics including preventive methods, (medical/surgical) pertaining to musculoskeletal system.
2. Diagnose conditions from history taking, clinical evaluation, investigations, and DDx
3. Pediatric orthopedics: common congenital and developmental disorders such as CTEV (club-Foot), developmental dysplasia of hip, Perthe’s disease, and infections
4. Orthopedic oncology: common tumors encountered in orthopedic practice.
5. Management of Trauma: basic life-saving skills, control of hemorrhage, splintage of musculoskeletal injuries, and care of the injured spine.
6. Sports Medicine: common orthopaedic pathologies encountered in sportspersons and their diagnostic and preventive aspects.
7. Physical Medicine and Rehabilitation: common orthotic and prosthetic devices and their applications.
8. Orthopedic Neurology: all kinds of nerve injuries as regards their recognition & principles of management, cerebral palsy and acquired neurologic conditions such as post-polio residual paralysis.
9. Disorders of Spine: various kinds of spinal disorders such as scoliosis, kypho-scoliosis, spinal trauma, prolapsed intervertebral disc and infections (tuberculosis and pyogenic).
10. Radiology: interpret radiographs typical of common orthopaedic pathologies.
11. Patient doctor relation: UG should learn the skills to communicate with the patient and his/her relatives pertaining to the disease condition, its severity and options available for the treatment/ therapy
12. Preventive Aspect: Undergraduate should acquire knowledge about prevention of some conditions especially in children such as poliomyelitis, congenital deformities, cerebral palsy and common orthopaedic malignancies.

Teaching and learning methodology in Orthopedics 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 Orthopedics 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 & Practicals:

Topics	Hours
1. General orthopaedics	2
2. Congenital deformities	2
3. Developmental disorders of bones	2
4. Infections of bones and joints	3
5. Bone and joint tuberculosis:	4
6. Generalised diseases of bones:	1
7. Diseases of joints	1
8. Avascular necrosis of bone and epiphyseal osteochondritis
9. Tumors of bone	4
10. Neurological and muscular disorders	1
11. Regional conditions of the spine and lower limb	2
12. Physical medicine and rehabilitation	5
13. General injuries to bones and joints	5
14. Injuries of the shoulder and arm	2
15. Injuries of elbow, forearm and wrist	3
16. Injuries of the hand	1
17. Injuries of the hip and thigh	4
18. Injuries of the knee, leg	2
19. Injuries of the ankle and foot	1
20. Injuries of the spine	1
21. Fractures of the pelvis	1
22. Poly trauma	1
23. Compound fractures	1
24. Soft tissue injuries including sports injuries	1
25. Nerve injuries	1

Basic orthopedic skills
1. Application of splints and tractions
2. Application of Slabs and casts
3. Manipulative reduction of common fractures and
4. Infiltration of tender periarticular
5. The aseptic technique of joint fluid

Examination pattern & marks distribution in Orthopedics 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: