SYLLABUS FOR SUPER SPECIALITY COURSE

(DM- PULMONARY MEDICINE AND CRITICAL CARE)

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

at most 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 (DM) 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 thoracocentesis, 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, electrocardiographic, 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.

2) 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)

5040hrs

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)

1680Hrs

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 patientsand continuing the care in the ER, ICU and various other places also.

B. 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

EXAMINATION:

Part A

Paper I Basic Sciences

Part B

Paper II

Paper III

Paper IV

Practicals

Ward Rounds

Viva Voce

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 counseling

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.

MODEL QUESTION PAPERS

PAPER 1

D.M. (Pulmonary Medicine) Degree Examinations

(Model Question Paper)

Paper I – Applied basic sciences in relation to General Medicine & Pulmonary Medicine

Time: 3 hrs Max marks: 100

• Answer all questions

• Draw diagrams wherever necessary

Essays: (20)

1. What is acquired immuno deficiency. Discuss the different pulmonary problems

in an immuno suppressed patient. Classify the drugs used in HIV infection.

(5+8+7=20)

Short essays: (8x10=80)

2. Obesity- hypoventilation syndrome.

3. Thoracic outlet syndrome

4. Role of diaphragm in respiration

5. Dynamic compliance

6. Line probe assay

7. Role of ultrasound in pulmonary medicine

8. Pressure support ventilation

9. Sepsis syndrome

PAPER 2

D.M. (Pulmonary Medicine) Degree Examinations

(Model Question Paper)

Paper II - Non infectious Respiratory Diseases including those affecting

Respiratory centre, Chest wall and Mediastinum

Time: 3 hrs Max marks: 100

• Answer all questions

• Draw diagrams wherever necessary

Essays: (20)

1. Discuss the etiopathogenesis of lung cancer. What are the systemic diseases

related to smoking. How will you plan an anti smoking strategy? (7+7+6= 20)

Short essays: (8x10=80)

2. Chylothorax

3. Metabolic syndromes and OSA

4. Asthma mimics

5. Tiotropium

6. Congenital cystic adenomatoid malformations

7. LVRS

8. Tracheal stenosis

9. Primary pulmonary hypertension

PAPER 3

D.M. (Pulmonary Medicine) Degree Examinations

(Model Question Paper)

Paper III - Respiratory Infections including tuberculosis

Time: 3 hrs Max marks:100

• Answer all questions

• Draw diagrams wherever necessary

Essays: (20)

1. What is pneumonia severity index. Discuss the management of community

acquired pneumonia. (10+10=20)

Short essays: (8x10=80)

2. Relative merits and demerits of revised national tuberculosis control programme.

3. Mycobacterium growth index tube

4. Acinetobacter

5. XDR TB

6. Exudative effusion

7. Hospital infection control policy

8. Viral pandemics

9. Haemoptysis

PAPER 4

D.M. (Pulmonary Medicine) Degree Examinations

(Model Question Paper)

Paper IV - Respiratory Critical Care and recent advances in

Pulmonary Medicine

Time: 3 hrs Max marks:100

• Answer all questions

• Draw diagrams wherever necessary

Essays: (20)

1. How will you manage a case of ARDS with multi organ failure. What is lung

protective ventilation. How will you prevent baro trauma. (10+6+4=20)

Short essays: (8x10=80)

2. Health care associated pneumonia.

3. Pulmonary AV fistula

4. DLCo

5. Indacaterol

6. Bronchial artery embolization

7. Toxic gas inhation

8. Diagnosis of pulmonary thrombo ebolism

9. Lupus pneumonia