Surgery syllabus for MBBS in India (Competency based Education/CBME 2019)
Topics & competencies in Surgery as per the CBME
| Topic | Competencies | Practicals | Procedures for certification | Integrations |
| 1. Metabolic response to injury | 3 | NIL | Nil | V-2 / H-0 |
| 2. Shock | 3 | 1 | Nil | V-2 / H-0 |
| 3. Blood and blood components  | 3 | 2 | Nil | V-1 / H-0 |
| 4. Burns | 4 | NIL | Nil | V-1 / H-0 |
| 5. Wound healing and wound care  | 4 | NIL | Nil | V-1 / H-0 |
| 6. Surgical infections | 2 | NIL | Nil | V-1 / H-0 |
| 7. Surgical Audit and Research | 2 | NIL | Nil | V-2 / H-0 |
| 8. Ethics | 3 | 1 | Nil | V-3 / H-0 |
| 9. Investigation of surgical patient | 3 | 1 | Nil | V-1 / H-0 |
| 10. Pre, intra and post- operative management. | 4 | 3 | Nil | V-1 / H-0 |
| 11. Anaesthesia and pain management | 6 | 1 | Nil | V-0 / H-4 |
| 12. Nutrition and fluid therapy  | 3 | NIL | Nil | V-3 / H-0 |
| 13. Transplantation  | 4 | 1 | Nil | V-4 / H-0 |
| 14. Basic Surgical Skills  | 4 | 1 | Nil | V-1 / H-0 |
| 15. Biohazard disposal  | 1 | NIL | Nil | V-1 / H-0 |
| 16. Minimally invasive General Surgery | 1 | NIL | Nil | NIL |
| 17. Trauma | 10 | 2 | Nil | V-0 / H-2 |
| 18. Skin and subcutaneous tissue | 3 | 1 | Nil | NIL |
| 19. Developmental anomalies of face, mouth and jaws | 2 | NIL | Nil | V-2 / H-0 |
| 20. Oropharyngeal cancer | 2 | NIL | Nil | V-1 / H-0 |
| 21. Disorders of salivary glands | 2 | NIL | Nil | NIL |
| 22. Endocrine General Surgery: Thyroid and parathyroid | 6 | NIL | Nil | V-3 / H-1 |
| 23. Adrenal glands | 3 | NIL | Nil | V-1 / H-1 |
| 24. Pancreas | 3 | NIL | Nil | V-1 / H-0 |
| 25. Breast | 5 | 2 | Nil | V-2 / H-0 |
| 26. Cardio-thoracic General Surgery- Chest – Heart and Lungs | 4 | NIL | Nil | NIL |
| 27. Vascular diseases   | 8 | 2 | Nil | NIL |
| 28. Abdomen | 18 | 3 | Nil | V-7 / H-0 |
| 29. Urinary System | 11 | 1 | Nil | V-2 / H-0 |
| 30. Penis, Testis and scrotum | 6 | NIL | Nil | V-4 / H-0 |
| Total: 30 | 133 | 22 | NIL | V-47 / H-8 |
Sample of the detailed description of the competencies:
| No | Competency | DLC | Teaching | Assessment | V/H |
| SU24.1 | Describe the clinical features, principles of investigation, prognosis and management of pancreatitis. | K-KH-Y
|
Lecture, Small group discussion | Written/ Viva voce | V: Human Anatomy |
| SU24.2 | Describe the clinical features, principles of investigation, prognosis and management of pancreatic endocrine tumours | K-KH-Y | Lecture, Small group discussion, Demonstration | Written/ Viva voce | |
| SU24.3 | Describe the principles of investigation and management of Pancreatic disorders including pancreatitis and endocrine tumors. | K-KH-Y | Lecture, Small group discussion, Demonstration | Written/ Viva voce/ Skill assessment |
- Abbreviations & details:
- No & Competencies: No – serial number of the competency with subject/topic coding, & Competencies – description of competencies
- Domain/level-Core (DLC):
- Domain (Identifies the domain): K- Knowledge, S – Skill, A – Attitude/professionalism, C- Communication.
- Level (Identifies the level of competency): K – Knows, KH – Knows How, SH – Shows how, P- performs independently.
- Â Core: Y – must achieve/compulsory, N – non-core/desirable/optional
- Skills required to certify:Â P – many procedures must be done independently for certification/ graduation.
- Integration: V – Vertical Integration, H – horizontal integration.
General Objectives of Surgery for MBBS
- Objectives (Knowledge): Student shall be able to
-
- Describe aetiology, pathophysiology, principles of diagnosis and management of common surgical problems including emergencies, in adults and children:
- Define indications and methods for fluid and electrolyte replacement therapy including blood transfusion:
- Define asepsis, disinfection and sterilization and recommend judicious use of antibiotics:
- Describe clinical features and risk factors of common malignancies in the country and their management including prevention.
- Enumerate different types of anaesthetic agents, their indications, mode of administration, contraindications and side effects.
- Objectives (Skills):
-
- Diagnose common surgical conditions both acute and chronic, in adult and children;
- Plan various laboratory tests for surgical conditions and interpret the results;
Identify and manage patients of haemorrhagic, septicaemic and other types of shock; - Be able to maintain patent air-way and resuscitate a critically injured patient, patient with cardio-respiratory failure & a drowning case.
- Monitor patients of head, chest, spinal and abdominal injuries, both in adults and children;
- Provide primary care for a patient of burns;
- Acquire principles of operative surgery, including pre-operative, operative and post operative care and monitoring;
- Treat open wounds including preventive measures against tetanus and gas gangrene;
- Diagnose neonatal and paediatric surgical emergencies and provide sound primary care before referring the patient to secondary / tertiary centers;
Identify congenital anomalies and refer them for appropriate management.
Teaching and learning methodology in Surgery as per the CBME
- Details of the competencies, lectures, practicals & skills to be acquired are mentioned in the table given above.
- Teaching Learning Method:
- Learner centric didactic lectures with Vertical/horizontal integrations (CBME).
- Tutorial & Seminars
- Problem-based Learning (PBL) & Small group discussions (especially focus on practical & clinical implications of the knowledge through cases)
- Conventional Practical classes & DOAP session (Demonstrate, Observe, Assess, Perform),
- Self-directed learning +/- multimedia aids (Audiovisual presentations).
- Seminars, symposia & quizzes.
Distribution of approximate teaching hour in Surgery 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 | Wounds-closed and open, wound-healing and management.
Hemorrhage and shock Fluid and Electrolyte balance & Acid-Base Balance. Blood transfusion Pyogenic infections – Local, diffuse and septic Common clinical lesions – swelling , ulcer etc., |
16 |
| 2 | Thermal injuries, burns, electrical injuries;
Ulceration and Gangrene : Simple non- specific ulceration, acute and chronic ulcers, skin grafting, gangrene, threatened, dry and moist, vascular, infective, traumatic and toxic gangrene Chemotherapy & principles of radiation. |
15 |
| 3 | Diseases of the skin; Boils , Carbuncles, Impetigo, Tubreculosis, Infections, Growth, Cysts and Sebaceous Glands,Nails;
Infections of the Fingers and hand :Anatomy, Prophylaxis The distal Segment of the fingers, Tenosynovitis, Abscess in the palm, Lymphangitis The surgery of the Blood vessels: Arteries: Injury, Diseases, Atheroma, Arteriosclerosis, Aneurysm, Thrombosis and Embolism; Veins: Injury, Phlebitis Varicose Veins, growths of the blood vessels; The diseases of lymphatic system: The diseases and growths of lymphatics, elephantiasis, infections of the lymph glands, lymphoedema, Lympho sarcoma, Lymph nodes – Diseases and surgery, slides of TB. And Hodgkins. Diseases of the Mouth Palate, Lips, Cheek, Tongue, Teeth, Gums jaws – Salivary glands, Maxillofacial injuries, Tumours of jaw and mouth |
16 |
| 4 | Anatomy of oesophagus, stomach, small and large bowel and anal canal ( including vermiform appendix Peritoneum, congenital anomalies) Diseases affecting them with emphasis on cancer colon and volvulus of sigmoid – Specimens of Cancer colon and Ileocaecal TB. & Colostomy
Anorectal suppuration Haemorrhoids internal and external Ulcers and Tumours of Anal Canal Rectum – Specimens of cancer Rectum |
32 |
| 5 | Thyroid – surgical anatomy, Physiology Classification of goitres, thryrotoxicosis, tumours and surgery – specimens and slides of Thyrotoxicosis, Carcinoma and Colloid goitre.
Parathyroid & Adrenal glands. Breast _ Surgical Anatomy, Physiology, Diseases and Surgery; specimens and slides of Fibroadenoma and Carcinoma Hernias Penis – Ulcers and tumors of penis Anatomy of abdominal wall – ventral hernia- Abdominal incision and Mc. Burney’s point Anatomy of inguinal canal and inguinal hernia- Bassinis’ operation. Other types of Hernia Abdominal injuries-open and closed. |
32 |
| 6 | Anatomy and diseases of liver
Abscess Tumours Specimens of Hydatid cyst and liver abscess. Cholecystitis and cholelithiasis- Specimens of Cholecystitis and gall stones. Surgical Jaundice Pancreatitis, Pancreatic Calculi and tumours Spleen Testis Thorax and chest injuries. Urinary symptoms, investigations of urinary tract Kidney – Ureter, Bladder, Prostate, Seminal Vesicles, Urethra and Genito Urinary Surgery. Cranium, spinal cord, Peripheral nerves and Head injuries. |
32 |
Examination pattern & marks distribution in Surgery for MBBS
- Exam pattern:Â
- The formative or internal assessment will not be added to the university examination marks.
- Should score 50Â % & 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
- The formative or internal assessment will not be added to the university examination marks.
- Formative Assessment:
- Theoretical assessment:Â 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
- Suggested combination of various types of question:
- Structured essays (Long Answer Questions – LAQ)
- Short Answers Questions (SAQ)
- Objective type questions (Various type of MCQs: < 20% weightage)
- Distribution of the competencies: The examiner must sample the contents appropriately from competencies.
- Suggested combination of various types of question:
- Practicals for 100 marks:Â
- Application-oriented exercises (Should not be simple tests of knowledge).
- Â 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:
- Theory Papers: 2 papers for 200 marks
List of recommended books in Surgery for MBBS
- Short Practice of surgery- Bailey & Love
- ASI Textbook of surgery Ed.A.K. HAI
- An introduction to the symptoms and signs of surgical Disease-Norman Browse
- Hamilton Bailey’s Physical Signs in
- Principles and Practice of Surgery Eds-Garden, Bradbury
- Pye’s Surgical
Also watch:
- Lecturer in Surgery for MBBS:
- Practical class in Surgery for MBBS:
Also read:
- Surgery syllabus in China
- Surgery syllabus in Russia & other CIS
- New Indian MBBS syllabus (CBME 2019)
