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):
  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 Surgery for MBBS

Objectives (Knowledge): Student shall be able to

1. Describe aetiology, pathophysiology, principles of diagnosis and management of common surgical problems including emergencies, in adults and children:
2. Define indications and methods for fluid and electrolyte replacement therapy including blood transfusion:
3. Define asepsis, disinfection and sterilization and recommend judicious use of antibiotics:
4. Describe clinical features and risk factors of common malignancies in the country and their management including prevention.
5. Enumerate different types of anaesthetic agents, their indications, mode of administration, contraindications and side effects.

Objectives (Skills):

1. Diagnose common surgical conditions both acute and chronic, in adult and children;
2. Plan various laboratory tests for surgical conditions and interpret the results;
  Identify and manage patients of haemorrhagic, septicaemic and other types of shock;
3. Be able to maintain patent air-way and resuscitate a critically injured patient, patient with cardio-respiratory failure & a drowning case.
4. Monitor patients of head, chest, spinal and abdominal injuries, both in adults and children;
5. Provide primary care for a patient of burns;
6. Acquire principles of operative surgery, including pre-operative, operative and post operative care and monitoring;
7. Treat open wounds including preventive measures against tetanus and gas gangrene;
8. 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:
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 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:
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: