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

Topics & competencies in Pharmacology for MBBS as per the CBME

Topic	Competencies	Practicals	Procedures for certification	Integrations
1. Pharmacology	64	7	Nil	V-33 / H-8
2. Clinical Pharmacy	04	4	Nil	V-1 / H-0
3. Clinical Pharmacology	08	NIL	04	V-3 / H-0
4. Experimental Pharmacology	2	1	Nil	NIL
5. Pharmacology	7	NIL	Nil	V-4 / H-1
Total: 5	85	12	04	V-41 / H-9

Sample of the detailed description of the competencies:

No	Competency	DLC	Teaching	Assessment	V/H
PH1.12	Calculate the dosage of drugs using appropriate formulae for an individual patient, including children, elderly and patient with renal dysfunction.	K/S-SH-Y	Lecture, practical	Written/ Viva voce	V: Pediatrics, General Medicine
PH1.15	Describe mechanism/s of action, types, doses, side effects, indications and contraindications of skeletal muscle relaxants	K-KH-Y	Lecture	Written/ Viva voce	V: Anesthesiology, Physiology

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 Pharmacology for MBBS

Objectives: Knowledge – At the end of the Pharmacology course, the student is expected to:

1. Understand pharmacokinetic and pharmacodynamic principles involved in the use of drugs
2. Understand and identify the various factors that can affect the action of drugs
3. Know the various routes of drug administration with advantages and disadvantages of the various routes
4. Undertake dosage calculations as appropriate for the patient and be able to select the proper drug and dose for the at risk population i.e. patients with kidney or liver disease, elderly, pregnant and lactating females, and children
5. Understand the importance of rational prescribing of drugs and the concept of essential drugs
6. To be able to identify and monitor adverse drug reactions (ADRs) and appreciate the importance of ADR reporting
7. Know the drugs used in systemic illnesses, infections and chemotherapy with main mechanism(s) of action, pharmacokinetics, uses, side-effects and indications
8. Understand the principles and practice of pharmacy
9. Understand the methods in experimental pharmacology, principles of bioassay and be able to correlate drug effects with the action of drugs at the receptors.
10. Have knowledge of common drugs and doses used for different ailments
11. Have an understanding of basic mechanism by which a drug acts
12. Should be able to select rationally from the available drugs

Teaching and learning methodology in Pharmacology 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 pharmacology teaching shall be done with the goal of making the student understand the concept of rational use of drugs.
  - The clinical aspects as well as the rationality of the use of a given drug shall be discussed with the students.
2. Tutorial & Seminars: important topics will be planned in which the use of a given drug shall be discussed by a clinical expert in the field.
3. Problem-based Learning (PBL) & Small group discussions (especially focus on practical & clinical implications of the knowledge through cases).
4. Conventional Practical classes (exercises/demonstrations & students will learn prescription writing and discuss exercise on drug interactions and shall also be shown various spots) & DOAP session (Demonstrate, Observe, Assess, Perform)
5. Self-directed learning +/- multimedia aids (Audiovisual presentations).
6. ymposia & quizzes.

Distribution of approximate teaching hours in Pharmacology for MBBS

Total number of teaching hours: approximately 250 hrs (teaching hours & distribution might differ slightly per university).
Theory:

	Topic	Hours
A. General Pharmacology
1.	Pharmacology -a foundation to clinical practice	1
2.	Routes of drug administration	1
3.	Pharmacokinetics	6
4.	Pharmacodynamics	6
5.	Adverse drug Reactions	2
6.	New drug discovery & clinical trials	1
B. Autonomic nervous system Pharmacology
1	Introduction:	1
2	Cholinergic system and drugs	2
3	Anticholinergic drugs,drugs acting on autonomic ganglia	1
4	Adrenergic system and drugs	1
5	Anti-adrenergic drugs	4
6	Drugs for glaucoma	1
C. Drugs for cough & Bronchial Asthma
1	Introduction: Cough	1
2	Bronchial Asthma	2
D. Autacoids
1	Histamine and antihistaminics	1
2	5-Hydroxytryptamine (5-HT), its antagonists & Drug therapy of Migraine	1
3	Prostaglandins, Leukotrienes(Eicosanoids) and PlateletActivating Factor	1
4	Nonsteroidal AntiinflammatoryDrugs and Antipyretic-Analgesics	2
5	Antirheumatoid and antigout drugs	1
E. Peripheral Nervous System (PNS) Pharmacology
1	Local anesthetics	2
2	Skeletal muscle relaxants	1
F. CNS Pharmacology
1.	Introduction to CNS Pharmacology	1
2.	General Anaesthetic	2
3.	Alcohol	1
4.	Sedative-hypnotics and anxiolytic drugs	2
5	Antiepileptic Drugs	2
6	Antiparkinsonian Drugs	1
7	Antipsychotic and Antimanic Drugs	2
8	Antidepressant and Antianxiety Drugs	2
9	Opioid analgesics & antagonists	2
G. CVS Pharmacology
1.	Cardiac Electrophysiological Considerations	1
2.	Drugs affecting Renin- Angiotensin System and Plasma Kinins	2
3.	Cardiac Glycosides And Drugs for Heart Failure	2
4.	Anti Arrthymic Drugs	2
5.	Anti – Anginal And Anti Ischaemic Drugs	2
6	Anti Hypertensive Drugs	2
H. Endocrine pharmacology
1	Hypothalamic and pituitary hormones	1
2	Thyroid Hormones and Thyroid Inhibitors	2
3	Insulin, Oral Hypoglycaemic Drugs and Glucagon	3
4	Corticosteroids	2
5	Gonadal hormones & inhibitors	4
6	Drugs Affecting Calcium Balance	1
I. Gastrointestinal drugs Pharmacology
1	Drugs for Peptic Ulcer and Gastroesophageal Reflux Disease (GERD)	1
2	Antiemetic, Prokinetic and Digestant Drugs	1
3	Drugs for Constipation and Diarrhoea	1
J. Blood Pharmacology
1	Haematinics and Erythropoietin	2
2	Drugs affecting Coagulation, Bleeding & Thrombosis	3
3	Hypolipidaemic drugs	1
K. Chemotherapy of microbial diseases
1	Principles of antimicrobial therapy	2
2	Folate antagonists and Quinolones	1
3	Inhibitors of cell wall synthesis	2
4	Protein synthesis inhibitors	2
5	Drugs for tuberculosis	3
6	Antileprotic Drugs	1
7	Antifungal drugs	1
8	Antiviral drugs	2
9	Antimalarial Drugs	2
10	Antiamoebic and Other Antiprotozoal Drugs	2
11	Antiparasitic drugs	1
12	Anticancer drugs	1
L. Miscellaneous topics
1	Immunopharmacology	1
2	Chelating agents	1
3	Antiseptics & Disinfectants	1
4	Drugs acting on skin & mucous membranes	1
5	Vitamins	1
6	Vaccines & sera	1
7	Rational pharmacotherapy	1

Practicals:

1. Experimental pharmacology exercise on isolated organ

1. - Assay of various drugs using guinea pig ileum
  - Identification of unknown drugs by evaluating its action antagonism and drug interaction on guinea pig ileum
  - Determination of concentration of unknown drug solution by different methods
2. Experimental exercise on pharmacy
  - General principles of pharmacy
  - Prescription writing exercises
  - Preparation and dispensing of powders, emulsions ointments, mixtures, liniments, suppositories and syrups
3. Spotting exercise – Identify the commonly used items in Pharmacology
4. Exercises on drug interactions

Examination pattern & marks distribution in Pharmacology 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: including spots with various chemicals, drugs, instruments used in pharmacology & prescriptions.
  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 Pharmacology for MBBS

Goodman & Gilman’s – The Pharmacological Basis of Therapeutics
Basic & Clinical Pharmacology by Bertram G, Katzung
Clinical Pharmacology by DR Lawrence, PN Bennett & MJ Brown
Essentials of Medical Pharmacology by K.D. Tripathi
Pharmacology and Pharmacotherapeutics by RS Satoskar, SD Bhandarkar, SS Ainapure
Fundamentals of Experimental Pharmacology by MN Ghosh