Topics & competencies in Obstetrics and Gynecology as per the CBME

Topic	Competencies	Practicals	Procedures for certification	Integrations
1. Demographic and Vital Statistics	3	NIL	NIL	V-3 / H-1
2. Anatomy of the female reproductive tract (Basic anatomy and embryology)	1	NIL	NIL	V-1 / H-0
3. Physiology of conception	1	NIL	NIL	V-1 / H-0
4. Development of the fetus and the placenta	1	NIL	NIL	V-1 / H-0
5. Preconception counselling	2	NIL	NIL	NIL
6. Diagnosis of pregnancy	1	NIL	NIL	NIL
7. Maternal Changes in pregnancy	1	NIL	NIL	NIL
8. Antenatal Care	8	4	NIL	V-1 / H-0
9. Complications in early pregnancy	5	1	NIL	V-1 / H-1
10. Antepartum haemorrhage	2	NIL	NIL	V-1 / H-0
11. Multiple pregnancies	1	NIL	NIL	NIL
12. Medical Disorders in pregnancy	8	NIL	NIL	V-0 / H-7
13. Labour	5	3	01	NIL
14. Abnormal Lie and Presentation; Maternal Pelvis	4	3	NIL	V-1 / H-0
15. Operative obstetrics	2	1	NIL	NIL
16. Complications of the third stage	3	NIL	NIL	NIL
17. Lactation	3	1	NIL	NIL
18. Care of the new born	4	1	NIL	V-0 / H-4
19. Normal and abnormal puerperium	4	3	NIL	V-1 / H-0
20. Medical termination of pregnancy	3	1	NIL	V-3 / H-0
21. Contraception	2	NIL	NIL	V-1 / H-0
22. Vaginal discharge	2	NIL	NIL	NIL
23. Normal and abnormal puberty	3	NIL	NIL	NIL
24. Abnormal uterine bleeding	1	NIL	NIL	NIL
25. Amenorrhea	1	NIL	NIL	NIL
26. Genital injuries and fistulae	2	NIL	NIL	V-0 / H-1
27. Genital infections	4	NIL	NIL	NIL
28. Infertility	4	NIL	NIL	NIL
29. Uterine fibroids	1	NIL	NIL	NIL
30. PCOS and hirsutism	2	NIL	NIL	NIL
31. Uterine prolapse	1	NIL	NIL	NIL
32. Menopause	2	NIL	NIL	NIL
33. Benign, Pre-malignant (CIN) and Malignant Lesions of the Cervix	4	1	NIL	V-1 / H-1
34. Benign and malignant diseases of the uterus and the ovaries	4	NIL	NIL	NIL
35. Obstetrics & Gynecological skills – I	17	7	NIL	NIL
36. Obstetrics & Gynecological skills – II	3	NIL	NIL	NIL
37. Obstetrics & Gynecological skills – III	7	NIL	NIL	NIL
38. Should observe	4	NIL	NIL	NIL
Total: 38	126	26	01	V-16 / H-15

Sample of the detailed description of the competencies:

No	Competency	DLC	Teaching	Assessment	V/H
OG12.1	Define, classify and describe the etiology and pathophysiology, early detection, investigations; principles of management of hypertensive disorders of pregnancy and eclampsia, complications of eclampsia.	K-KH-Y	Lecture, Small group discussion, Bedside clinics	Written/ Viva voce/ Skill assessment	H: General Medicine
OG12.2	Define, classify and describe the etiology, pathophysiology, diagnosis, investigations, adverse effects on the mother and foetus and the management during pregnancy and labor, and complications of anemia in pregnancy	K-KH-Y	Lecture, Small group discussion, Bedside clinics	Written/ Viva voce/ Skill assessment	H: General Medicine
OG12.3	Define, classify and describe the etiology, pathophysiology, diagnosis, investigations, criteria, adverse effects on the mother and foetus and the management during pregnancy and labor, and complications of diabetes in pregnancy	K-KH-Y	Lecture, Small group discussion, Bedside clinics	Written/ Viva voce/ Skill assessment	H: General Medicine

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 Obstetrics and Gynecology for MBBS

Objectives (Knowledge): Student should be able to
1. Make Diagnosis and organize management of antenatal, intranatal and postnatal period of normal and abnormal pregnancy
2. Provide adequate care of common gynae problems and emergencies
3. Manage common gynae problems and emergencies
4. Provide Counseling and delivery of fertility regulation methods.
5. Acquire knowledge of methods of termination of pregnancy.
6. Apply knowledge of vital statistics in obstetrics and RCH program
7. Develop communication skills.
Objectives (Skills): Student should be able to
1. Students should be trained about proper history taking, clinical examination.
2. Advising relevant necessary investigations and their interpretation and management.
3. Posting in OPD, wards, operation theaters, labor room, and family planning clinics.
4. Students should observe common OPD procedures like E.A., D & C, MTP, Pap Smear, CuT insertion.
5. Observe normal deliveries, forceps and ventouse assisted deliveries, cesrean section
6. Smear, CuT insertion. Observe normal deliveries, forceps and ventouse assisted deliveries, cesarean section.
7. Ligations, minilap procedures like abdominal, vaginal hysterectomy, foltergill repair.

Teaching and learning methodology in Obstetrics and Gynecology 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 Obstetrics and Gynecology 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	Basic Sciences in Obstetrics	8
2	Clinical Case Taking and Skills in Obstetrics	12
3	Antenatal Care and Counseling	12
4	Normal Labor and Delivery	16
5	Normal Puerperium	5
6	Early Pregnancy Complications	8
7	Late Pregnancy Complications	13
8	Maternal Medicine	20
9	Special Pregnancy Situations	10
10	Infections in Pregnancy	10
11	Fetal Medicine	9
12	Abnormal Labor	6
13	3rd stage Complications and Abnormal Puerperium	6
14	Operative Obstetrics	8
15	Rural Obstetrics	4
16	MTP and Contraception
17	Miscellaneous	5

Practical skills in Obstetrics:

1. History taking and examination of a pregnancy woman
2. Watching progress of labour and conduct of a normal labour
3. Management of third stage of labour, prevention and treatment of post partum haemorrhage
4. Witness caesarean section, breech delivery, forceps and vacuum delivery
5. Essential care of a newborn
6. Non stress testing of fetus; biophysical scoring of fetus

Practical skills in Obstetrics:

1. How to take history and examination of female pelvic organs
2. Making of pap smear, wet smear preparation on vaginal discharge
3. Minor gynaecologic procedures : cervical biopsy, endometrial biopsy, dilatation & curettage; fractional curettage
4. Medical termination of pregnancy (MTP) : in first & second trimesters
5. Insertion and removal of intrauterine contraceptive device

Operative Skills:

1. Conduct of normal delivery
2. Making and repair of episiotomy
3. Insertion and removal of intrauterine device
4. Making of pap semar
5. Performing minilap tubectomy (under supervision)

Examination pattern & marks distribution in Obstetrics and Gynecology 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: