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

Topics & competencies in Pediatrics as per the CBME

Topic	Competencies	Practicals	Procedures for certification	Integrations
1. Normal Growth and Development	7	NIL	01	V-0 / H-3
2. Common problems related to Growth	6	NIL	NIL	V-1 / H-0
3. Common problems related to Development -1 (Developmental delay , Cerebral palsy)	8	1	NIL	V-2 / H-1
4. Common problems related to Development-2 (Scholastic backwardness, Learning Disabilities , Autism , ADHD)	6	NIL	NIL	V-1 / H-0
5. Common problems related to behavior	11	NIL	NIL	V-0 / H-4
6. Adolescent Health & common problems related to Adolescent Health	13	1	NIL	V-0 / H-7
7. To promote and support optimal Breast feeding for Infants	11	4	01	V-2 / H-5
8. Complementary Feeding	5	1	NIL	V-5 / H-0
9. Normal nutrition, assessment and monitoring	7	NIL	NIL	V-7 / H-0
10. Provide nutritional support , assessment and monitoring for common nutritional problems	6	1	NIL	V-5 / H-0
11. Obesity in children	6	1	01	V-2 / H-0
12. Micronutrients in Health and disease-1 (Vitamins ADEK, B Complex and C)	21	NIL	NIL	V-20 / H-0
13. Micronutrients in Health and disease -2: Iron, Iodine, Calcium, Magnesium	14	NIL	NIL	V-14 / H-0
14. Toxic elements and free radicals and oxygen toxicity	5	NIL	NIL	V-4 / H-1
15. Fluid and electrolyte balance	7	NIL	NIL	NIL
16. Integrated Management of Neonatal and Childhood Illnesses (IMNCI) Guideline	3	2	NIL	NIL
17. The National Health programs, NHM	2	2	NIL	V-2 / H-0
18. The National Health Programs: RCH	8	2	NIL	V-7 / H-7
19. National Programs, RCH – Universal Immunizations program	16	5	01	V-7 / H-1
20. Care of the Normal New born, and High risk New born	20	4	NIL	V-0 / H-1
21. Genito-Urinary system	17	1	NIL	V-11 / H-2
22. Approach to and recognition of a child with possible Rheumatologic problem	3	NIL	NIL	NIL
23. Cardiovascular system- Heart Diseases	18	NIL	NIL	V-9 / H-0
24. Diarrhoeal diseases and Dehydration	17	3	03	V-6 / H-0
25. Malabsorption	1	NIL	NIL	V-1 / H-0
26. Acute and chronic liver disorders	13	1	NIL	V-6 / H-0
27. Pediatric Emergencies – Common Pediatric Emergencies	35	14	10	NIL
28. Respiratory system	20	3	NIL	V-15 / H-0
29. Anemia and other Hemato-oncologic disorders in children	20	1	NIL	V-10 / H-0
30. Systemic Pediatrics-Central Nervous system	23	NIL	NIL	V-5 / H-0
31. Allergic Rhinitis , Atopic Dermatitis, Bronchial Asthma , Urticaria Angioedema	12	1	NIL	V-4 / H-0
32. Chromosomal Abnormalities	13	NIL	NIL	V-8 / H-2
33. Endocrinology	11	1	02	V-1 / H-0
34. Vaccine preventable Diseases – Tuberculosis	20	1	03	V-18 / H-12
35. The role of the physician in the community	1	NIL	NIL	NIL
Total: 35	406	50	22	V-173 / H-46

Sample of the detailed description of the competencies:

No	Competency	DLC	Teaching	Assessment	V/H
PE1.1	Define the terminologies Growth and development and discuss the factors affecting normal growth and development	K-KH-Y	Lecture, Small group discussion	Written/ Viva voce
PE1.2	Discuss and describe the patterns of growth in infants, children and adolescents	K-KH-Y	Lecture, Small group discussion	Written/ Viva voce	V: Psychiatry
PE1.3	Discuss and describe the methods of assessment of growth including use of WHO and Indian national standards. Enumerate the parameters used for assessment of physical growth in infants, children and adolescents	K-KH-Y	Lecture, Small group discussion	Written/ Viva voce	V: Psychiatry

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 Pediatrics for MBBS

Objectives (Knowledge): Student shall be able to

1. Describe the normal growth and development during fetal life, neonatal period, childhood and adolescence and outline deviations thereof;
2. Describe the common pediatrics disorder and emergencies in terms of epidemiology, etiopathogenesis, clinical manifestations, diagnosis, rational therapy and rehabilitation;
3. State age related requirements of calories, nutrients, fluids, drugs etc. in health and disease;
4. Describe preventive strategies for common infectious disorders, malnutrition, genetic and metabolic disorders, poisonings, accidents and child abuse;
5. Outline national programmes relating to child health including immunization programmes;

Objectives (Skills):

1. Take a detailed pediatrics history, conduct an appropriate physical examination of children including neonates, make clinical diagnosis, conduct common bedside investigative procedures, interpret common laboratory investigations and plan and institute therapy;
2. Take anthropometric measurements, resuscitate newborn infants with bag and mask at birth, prepare oral rehydration solution, perform tuberculin test, administer vaccines available under current national programmes, start an intravenous line and provide naso-gastric feeding, observe venesection and intra-osseous infusion if possible.
3. Conduct diagnostic procedures such as lumbar puncture, bone marrow aspiration, pleural tap and ascitic tap; observe liver and kidney biopsy.
4. Distinguish between normal newborn babies and those requiring special care and institute early care to all new born babies including care of pre-term and low birth weight babies, provide correct guidance and counselling in breast-feeding.
5. Provide ambulatory care to all sick children, identify indications for specialized/inpatient care and ensure timely referral of those who require hospitalization.

Teaching and learning methodology in Pediatrics 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 Pediatrics 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:

	Topic	Hours
1	Introduction to Pediatrics	1
2	Normal growth	1
3	Normal development	1
4	Immunization	1
5	Introduction to newborn and normal newborn baby	1
6	Temperature regulation in newborn	1
7	Breast feeding and lactation management	1
8	Infant and child feeding (Include complimentary feeding)	1
9	Birth Asphyxia	1
10	Normal fluid and electrolyte balance in children	1
11	Low birth weight babies	1
12	Neonatal respiratory distress	1
13	Jaundice in newborn	1
14	Neonatal infections	1
15	Neonatal convulsions	1
16	PEM and its management	1
17	Vitamins deficiencies – Vitamin A deficiency, Scurvy, Rickets	2
18	Nutritional anemia in infancy and childhood	3
19	Acute diarrhea	1
20	Hypothyroidism in children	1
21	Congestive heart failure – diagnosis and management	1
22	Congenital heart disease	2
23	Rheumatic heart disease	2
24	Hypertension in children, including hypertensive emergencies	1
25	Acute respiratory infections	2
26	Bronchial asthma including status asthmaticus	2
27	Nephrotic syndrome	1
28	Acute glomerulonephritis and hematuria	1
29	Chronic liver disease	1
30	Hemolytic anemia including thalassemia	3
31	Aplastic anemia	1
32	Leukemias	2
33	Bleeding and coagulation disorders (Hemophilia, ITP)	2
34	Seizure disorders including status epilepticus	1
35	Cerebral Palsy	1
36	Common exanthematous illnesses – Measles, Chickenpox, Dengue, Chickengunya	3
37	Childhood tuberculosis	1
38	Shock and anaphylaxis	1
39	Adolescent growth and normal puberty	1
40	Other childhood malignancies (neuroblastoma, wilms tumour, – lymphomas)	1
41	Mental retardation	1
42	Behaviour disorders	1
43	Meningitis	1
44	Diptheria, Pertussis and Tetanus	3
45	Enteric fever	1
46	Common childhood Poisonings	1
47	Down’s syndrome	1
48	Medical ethics	1
49	Pediatric prescription & rational drug therapy	1
50	Protein energy malnutrition (PEM)	1
51	Rickets	1
52	Acute diarrhea; fluid therapy	1
53	Persistent diarrhea	1
54	Hepatosplenomegaly	1
55	Hemolytic anemia; other anemias	1
56	Bleeding in children	1
57	Leukemia	1
58	Generalized lymphadenopathy	1
59	Congenital heart disease (cyanotic, acyanotic)	1
60	Rheumatic heart disease	1
61	Nephrotic syndrome; edema	1
62	Acute glomerulonephritis	1
63	Pleural effusion/consolidaton	1
64	Bronchial asthma; respiratory distress	1
65	Upper respiratory infections	1
66	Bronchopneumonia	1
67	Rash	1
68	Meningitis	1
69	Hemiparesis	1
70	Monoparesis including acute flaccid paralysis	1
71	Mental retardation (preventable and cerebral palsy)	1
72	Epilepsy and febrile convulsions	1
73	Hydrocephalus	1
74	Normal newborn	1
75	Low birth weight babies	1
76	Preterm babies	1
77	Neonatal jaundice	1
78	Neonatal septicemia	1
79	Newborn resuscitation	1
80	Respiratory distress in newborn	1
81	Convulsions including status epilepticus	1
82	Coma	1
83	Pyrexia of unknown origin	1
84	Jaundice	1
85	Portal hypertension	1
86	Respiratory failure	1
87	Shock and anaphylaxis	1
88	Rheumatic heart disease	1
89	Hypertension	1
90	Diabetes mellitus	1
91	Hypothyroidism	1
92	Anemia	1
93	Bleeding	1
94	Renal failure	1
95	Tuberculosis	1
96	Malaria	1
97	HIV infection	1
98	Poliomyelitis and AFP surveillance	1
99	Perinatal asphyxia (with obstetrics)	1
100	Intrauterine growth retardation (with obstetrics)	1

Examination pattern & marks distribution in Pediatrics for MBBS

Exam pattern:

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.
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:

Theoretical assessment: clickers, one-minute papers, and muddiest point
Practical/clinical assessment: one-minute preceptor (OMP) and/or viva voce.
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

Theory: Written tests, should have essay questions, short notes, and creative writing.
Practical / Clinical: practical/clinical tests, Objective Structured Clinica/Objective Structured Practical Examination (OSPE) and/or viva voce.
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:

List of recommended books in Pediatrics for MBBS

“Essentials of Pediatrics” by OP Ghai, Vinod K Paul and Piyush Gupta
“Care of the Newborn” by Meharban Singh
“Nelson Textbook of Pediatrics” by Richard E. Behrman, Robert M. Kliegman, Waldo Nelson and Victor C. Vaughan
“Rudolph’s Pediatrics” by Abraham M. Rudolph, Julien IE Hoffman, Colin D. Rudolph and Paul Sagan
“Pediatrics Clinical Methods” by Meharban Singh