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

Topics & competencies in Anesthesia for MBBS as per the CBME

Topic	Competencies	Practicals	Procedures for certification	Integrations
1. Anaesthesiology as a specialty	4	NIL	Nil	V-1 / H-0
2. Cardiopulmonary resuscitation	2	2	Nil	V-2 / H-0
3. Preoperative evaluation and medication	6	5	Nil	V-1 / H-5
4. General Anaesthesia	7	5	Nil	V-3 / H-0
5. Regional anaesthesia	6	4	Nil	V-3 / H-1
6. Post-anaesthesia recovery	3	3	Nil	V-0 / H-1
7. Intensive Care Management	5	5	Nil	V-2 / H-4
8. Pain and its management	5	5	Nil	V-5 / H-2
9. Fluids	4	4	Nil	V-1 / H-2
10. Patient safety	4	4	Nil	V-2 / H-2
Total: 10	46	37	NIL	V-20 / H-17

Sample of the detailed description of the competencies:

No	Competency	DLC	Teaching	Assessment	V/H
AS5.2	Describe the correlative anatomy of the brachial plexus, subarachnoid and epidural spaces	K-KH-Y	Lecture, Small group discussion	Written/ Viva voce	V: Human Anatomy
AS5.3	Observe and describe the principles and steps/ techniques involved in peripheral nerve blocks	S-KH-Y	Lecture, Small group discussion, DOAP session	Written/ Viva voce	V: Human Anatomy
AS5.4	Observe and describe the pharmacology and correct use of commonly used drugs and adjuvant agents in regional anesthesia	S-KH-Y	Lecture, Small group discussion, DOAP session	Written/ Viva voce	V: Pharmacology

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 Anesthesia for MBBS

The purpose of anesthesia:
1. To give students knowledge of basic concepts used in anesthesia
2. To teach them skills of airway management and vascular access that may be useful to them in other areas of medical practice.

Objectives (Knowledge) students should be able to:
1. Introduce principles of acute medicine as it is practiced in managing the anesthetized patient in the operating room and in managing the patient in the recovery unit.
2. Discuss and demonstrate principles of applied physiology and applied Simulation on Human patient Simulator (HPS) Is ideal to teach many aspects of applied physiology and
  pharmacology.
3. Review principles of and teach skills in resuscitation (cardiopulmonary, cerebral, fluid and others).
4. Teach care of the unconscious patient, including airway and ventilation
5. Teach management of blood ,fluid, electrolyte balance , and metabolic disturbances in the surgical patient, with specific emphasis on those derangements which are encountered in the anesthetized patient.
6. Review management of acute and chronic pain
7. Introduce concepts of drug interactions, especially as they apply to patients receiving anesthesia
8. Demonstrate the evaluation of patients relative to surgical and anesthetic risk.
9. Introduce the various techniques of anesthesiology
10. Introduce the various techniques of anesthesiology
11. Pharmacology of muscle relaxant, application and monitoring
12. Pharmacology: Basic / Applied of local anaesthetics : Various types of blocks advantages / Problems with each. Descriptive for same main blocks. Local inflitration , Brachial Plexus, Caudal
Objectives (Skill) students should be able to:
1. Maintenance of Clear airway
2. Bag-Mask Ventilation
3. Starting A Venous Access
4. CPR — Basic and advanced
5. Giving a simple infiltration block, Some nerve block
6. Performing A lumbar puncture

Teaching and learning methodology in Anesthesia 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 Anesthesia 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:

	Topic	Hours
1	Introduction to Anesthesia	2 Hours
2	History of Anaesthesia	1 Hour
3	Pre-anaesthesia assessment and preparation	2 Hour
4	Premedication	1 Hour
5	Anaesthesia machine and related equipments	2 Hour
6	Oxygen therapy and devices	2 Hour
7	Spinal and epidural anaesthesia	1 Hour
8	Local anaesthesia drugs and techniques	1 Hour
9	General anaesthesia	1 Hour
10	Endotracheal intubation	2 Hours
11	Introduction to ventilators	1 Hour
12	Care of unconscious patient.	1 Hour
13	CPR and emergency drugs for resuscitation	2 Hour
14	Orientation to pain clinic, analgesics chronic pain and cancer pain management	1 Hour

Practicals:

Skills	Hours
1.I/V Cannulation	5
2. Oropharyngeal/Nasopharyngeal Airway insertion	10
3. Bag Mask Ventilation first on Mannekin	5
4. Mask Ventilation in unconscious patient	5
5. Attaching pulse oximeter,BP cuff and ECG
6. electrodes and setting up a monitor	5
7. Lumbar puncture	2
8. Infiltration block	2
9. Demonstration of epidural/nerve block	2 each
10. LMA insertion demo	5
11. Intubation demo	5
12. CPR on mannekin	5

Examination pattern & marks distribution in Anesthesia 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:

List of recommended books in Anesthesia for MBBS

“The book of Anaesthesia” edited by Alan R. Aitkenhead, David J. Rowbotham, Graham Smith published by Churchill
“Fundamentals of Anaesthesia” edited by Colin Pinnock, Ted Lin, Tim Smith Published by Greenwich Medical Media
Fundamental Principles and practice of Anaesthesia, Ed. Petter Hurtton, Cooper Butterworth, Published by Martin Dunitz,
Principles and Practice of Anaesthesiology Edited David E. Longnecker Published by Mosby St.