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

Topics & competencies in Pathology for MBBS as per the CBME

Topic	Competencies	Practicals	Procedures for certification	Integrations
1. Introduction to Pathology	3	NIL	Nil	NIL
2. Cell Injury and Adaptation	8	1	Nil	NIL
3. Amyloidosis	2	1	Nil	NIL
4. Inflammation	4	1	Nil	V-2 / H-0
5. Healing and repair	1	NIL	Nil	V-1 / H-0
6. Hemodynamic disorders	7	1	Nil	V-2 / H-0
7. Neoplastic disorders	5	NIL	Nil	V-0 / H-1
8. Diagnostic cytology	3	1	Nil	V-2 / H-0
9. Immunopathology and AIDS	7	NIL	Nil	V-5 / H-4
10. Infections and Infestations	4	NIL	Nil	V-4 / H-4
11. Genetic and paediatric diseases	3	NIL	Nil	V-3 / H-0
12. Environmental and nutritional diseases	3	NIL	Nil	V-2 / H-1
13. Introduction to haematology	5	1	Nil	V-5 / H-0
14. Microcytic anemia	3	1	Nil	V-3 / H-0
15. Macrocytic anemia	4	1	Nil	V-3 / H-0
16. Hemolytic anemia	7	1	01	V-5 / H-0
17. Aplastic anemia	2	NIL	Nil	V-2 / H-0
18. Leukocyte disorders	2	NIL	Nil	NIL
19. Lymph node and spleen	7	3	Nil	V-5 / H-0
20. Plasma cell disorders	1	1	Nil	NIL
21. Hemorrhagic disorders	5	NIL	Nil	V-4 / H-0
22. Blood banking and transfusion	6	NIL	Nil	V-3 / H-1
23. Clinical Pathology	3	2	Nil	NIL
24. Gastrointestinal tract	7	NIL	Nil	V-7 / H-0
25. Hepatobiliary system	6	1	01	V-6 / H-0
26. Respiratory system	7	NIL	Nil	V-7 / H-4
27. Cardiovascular system	10	1	Nil	V-10 / H-3
28. Urinary Tract	16	NIL	Nil	V-14 / H-0
29. Male Genital Tract	5	NIL	Nil	V-5 / H-0
30. Female Genital Tract	9	NIL	Nil	V-9 / H-0
31. Breast	4	1	Nil	V-4 / H-0
32. Endocrine system	9	NIL	Nil	V-9 / H-0
33. Bone and soft tissue	5	NIL	Nil	V-5 / H-1
34. Skin	4	1	Nil	V-4 / H-0
35. Central Nervous System	3	1	01	V-3 / H-2
36. Eye	1	NIL	Nil	V-1 / H-0
Total: 36	186	20	03	V-135 / H-21

Sample of the detailed description of the competencies:

No	Competency	DLC	Teaching	Assessment	V/H
PA6.1	Define and describe edema, its types, pathogenesis and clinical correlations	K-KH-Y	Lecture, Small group discussion	Written/ Viva voce	V: General Medicine
PA6.2	Define and describe hyperemia, congestion, hemorrhage	K-KH-Y	Lecture, Small group discussion	Written/ Viva voce
PA6.3	Define and describe shock, its pathogenesis and its stages	K-KH-Y	Lecture, Small group discussion	Written/ Viva voce	V: General Surgery

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 Pathology for MBBS

Objectives: Knowledge – At the end of training in Pathology will be able to:

1. Understand the concepts of cell injury and changes produced thereby in different tissues and organs and the body’s capacity for healing.
2. Understand the normal homeostatic mechanisms, the derangements of these mechanism and the effects on human systems.
3. Understand the etiopathogenesis, the pathological effects and the clinico-pathological correlation of common infectious and non-infectious diseases.
4. Understand the concept of neoplasia with reference to the etiology, gross and microscopic features, diagnosis and prognosis in different tissues and organs of the body.
5. Correlate normal and altered morphology (gross and microscopic) of different organ systems in different diseases to the extent needed for understanding of disease processes and their clinical significance.
6. Have a knowledge of common immunological disorders and their resultant effects on the human body.
7. Have an understanding of the common haematological disorders and the investigations necessary to diagnose them and determine their prognosis.
8. Perform and interpret in a proper manner the basic clinico-pathological procedures.
9. Know the principles of collection, handling and dispatch of clinical samples from patients in a proper manner

Teaching and learning methodology in Pathology 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).
  - The lecture is followed by Case studies in small groups discussion →
    demonstration of the gross and microscopic features of the disease in that case by the pathologist → clinico-pathologic correlation.
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 deal with a demonstration of gross, and/or microscopic features of the disease entities.& DOAP session (Demonstrate, Observe, Assess, Perform)
5. Self-directed learning +/- multimedia aids (Audiovisual presentations).
6. Seminars, symposia & quizzes.

Distribution of approximate teaching hours in Pathology 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 250 hrs (teaching hours & distribution might differ slightly per university).
Theory:

	Topic	Hrs
A) General Pathology
1	Definitions and causes of diseases	1
2	Modes of cell injury	1
3	Necrosis & gangrene	1
4	Intracellular accumulations and alterations	1
5	Cellular Adaptations/ Growth disturbances	1
6	Acute inflammation	1
7	Chemical mediators of Inflammation	1
8	Chronic inflammation (including granulomatous)	1
9	Regeneration and repair (general)	1
10	Repair in specialized tissues	1
11	Oedema	1
12	Shock	1
13	Thrombosis	1
14	Embolism and Infarction	1
15	Hyperaemia and Haemorrhage	1
16	Disturbances of pigment metabolism	1
17	Disturbances of Mineral metabolism	1
18	Genetic disorders	2
19	Hypersensitivity reactions	1
20	Autoimmune diseases	1
21	Amyloidosis	1
22	AIDS	2
23	Typhoid fever	1
24	Syphilis	1
25	Tuberculosis	1
26	Leprosy	2
27	Fungal diseases	2
28	Malaria	1
29	Neoplasia – Nomenclature and classification	3
30	Neoplasia – Carcinogenesis	2
31	Neoplasia – Biology and Lab diagnosis	2
32	Neoplasia – Spread, grading and staging	2
B) Haematology
1	Introduction to haematology and hemopoiesis	1
2	Anaemias (general)	1
3	Iron deficiency anaemia	1
4	Megaloblastic anaemia	1
5	Haemolytic anaemia	2
6	Haemoglobinopathies	2
7	Haemorrhagic disorders	2
8	Leukocytic disorders	1
9	Acute Leukaemias	1
10	Chronic Leukaemias	1
11	Paraproteinemia	1
12	Aplastic Anaemias	1
13	Blood groups	1
14	Blood Transfusion	1
C) Systemic pathology
1	Atherosclerosis	1
2	Hypertension	1
3	Other diseases of blood vessels	1
4	Ischaemic heart disease	1
5	Congenital heart disease	1
6	Rheumatic heart disease	1
7	Endocardial and pericardial diseases	1
8	Cardiomyopathies	1
9	Pneumonias	1
10	Lung Abscess and Bronchiectasis	1
11	Chronic Bronchitis and Emphysema	1
12	Occupational lung diseases	1
13	Tumours of lung and pleura	1
14	Lesions of oral cavity and salivary glands	1
15	Gastritis and Peptic Ulcer	1
16	Ulcers of Intestines	1
17	Idiopathic Inflammatory Bowel disease	1
18	Tumours of upper GIT	2
19	Tumours of lower GIT	2
20	Viral Hepatitis	2
21	Alcoholic liver disease	1
22	Cirrhosis	1
23	Tumours of liver	1
24	Pancreas and gall bladder	1
25	Diabetes mellitus	2
26	Acute nephritis and rapidly progressive GN	1
27	Nephrotic syndrome	1
28	Renal failure	1
29	Pyelonephritis and interstitial Nephritis	1
30	Tumours of kidney and Pelvis	1
31	Tumours of testis and Prostate	2
32	Tumours of Cervix and Uterus	1
33	Tumours of Ovary and trophoblastic tissue	1
34	Non-neoplastic and Neoplastic lesions of breast	2
35	Non-neoplastic lesions of lymph nodes and Spleen	1
36	Hodgkin’s Lymphoma	1
37	Non-Hodgkin’s Lymphoma	1
38	Tumours of skin – Non-pigmented	1
39	Tumours of skin – Pigmented	1
40	Soft tissue tumours	1
41	Non-neoplastic lesions of bone and joints	1
42	Tumours of bone, cartilage and joints	1
43	Inflammatory and neoplastic conditions of CNS	1
44	Lesions of Thyroid
45	Myopathies	1
D) Clinical pathology
1	Differential diagnosis of Jaundice	1
2	Renal function tests	1
3	Diabetes mellitus	1
E) Autopsy		1

Practicals:

Topics		Hrs
General pathology		12
1	Microscopy and tissue processing
2	Identify the common types of cells by light microscopy
3	Intracellular accumulation
4	Acute inflammation
5	Chronic inflammation and Repair
6	Thrombosis, embolism, infarction and gangrene
7	Oedema and congestion
8	Disturbances of pigment metabolism
10	Leprosy
11	Amyloidosis
12	Disturbances of growth (Atrophy, hypertrophy, hyperplasia, metaplasia, Dysplasia, hypoplasia)
Haematology
1	Collection of specimen, anticoagulants &common haematological tests (Hb)
2	Common Haematological Counts (TLC, DLC) & Interpretation of ESR
3	Haemopoiesis	7
4	Investigations in Anaemia
5	Investigations in Leukaemia
6	Investigations in haemorrhagic disorders
7	Blood Banking
Systemic pathology		18
1	Diseases of blood vessels (Atherosclerosis, syphilitic aortitis)
2	Diseases of Heart (IHD & RHD)
3	Pneumonias
4	Tumours of lung
5	Diseases of kidney
6	Gross and Microscopic features of peptic ulcer and duodenal ulcer
7	Gross & Microscopic features of other intestinal ulcers
8	Tumours of GIT
9	Diseases of Liver
10	Lymphomas
11	Diseases of male and female genital system
12	Tumours of breast
13	Tumours of skin (Pigmented)
14	Tumours of skin (non-pigmented)
15	Soft tissue tumours
16	Tumours of bone
17	Diseases of thyroid
Clinical pathology		5
1	Urine RE – Carryout a bedside routine urine examination and interpret the results.
2	Pregnancy test and Semen Analysis – (Practical demonstration).
3	Common cytological preparations (lecture demonstration).
4	CSF examination.
5	Serous effusion examination.
Autopsy		2

Examination pattern & marks distribution in Pathology 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: 3
  - Clinical subjects should also be assessed 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 3 tests in Para-clinical subjects 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: