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

Topics & competencies in Physiology for MBBS as per the CBME

The syllabus of Physiology in India has been modified as per the competency based education (CBME) implemented by the NMC in 2019.

Topic	Competencies	Practicals	Procedures for certification	Integrations
1. General Physiology	9	NIL	Nil	V-1 / H-2
2. Haematology	13	1	Nil	V-6 / H-3
3. Nerve and Muscle Physiology	18	3	Nil	V-6 / H-3
4. Gastro-intestinal Physiology	10	1	Nil	V-1 / H-6
5. Cardiovascular Physiology (CVS)	16	5	03	V-5 / H-2
6. Respiratory Physiology	10	3	01	V-1 / H-0
7. Renal Physiology	9	NIL	Nil	V-1 / H-1
8. Endocrine Physiology	6	NIL	Nil	V-0 / H-1
9. Reproductive Physiology	12	NIL	Nil	V-5 / H-1
10. Neurophysiology	20	1	09	V-12 / H-8
11. Integrated Physiology	14	2	Nil	V-4 / H-0
Total: 11	137	16	13	V-43 / H-27

Sample of the detailed description of the competencies:

No	Competency	DLC	Teaching	Assessment	V/H
PY3.1	Describe the structure and functions of a neuron and neuroglia; Discuss Nerve Growth Factor & other growth factors/cytokines	K-KH-Y	Lecture, Small group discussion	Written/Viva-voce	H: Human Anatomy
PY3.2	Describe the types, functions & properties of nerve fibers	K-KH-Y	Lecture, Small group discussion	Written/Viva-voce
PY3.3	Describe the degeneration and regeneration in peripheral nerves	K-KH-Y	Lecture, Small group discussion	Written/Viva-voce	V: General Medicine
PY3.4	Describe the structure of neuro-muscular junction and transmission of impulses	K-KH-Y	Lecture, Small group discussion	Written/Viva-voce	V: Anaesthesia
PY3.5	Discuss the action of neuro-muscular blocking agents	K-KH-Y	Lecture, Small group discussion	Written/Viva-voce	V: Anaesthesia, Pharmacology
PY3.6	Describe the pathophysiology of Myasthenia gravis	K-KH-Y	Lecture, Small group discussion	Written/Viva-voce	V: Pathology
PY3.7	Describe the different types of muscle fibres and their structure	K-KH-Y	Lecture, Small group discussion	Written/Viva-voce	H: Human Anatomy

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 Physiology for MBBS

Objectives: Knowledge – At the end of the course the student will be able to:

1. explain the normal functioning of all the organ systems of the body and their interactions.
2. narrate the contribution of each organ system to the maintenance of homeostasis.
3. elucidate the physiological aspects of normal growth and development.
4. describe the physiological response and adaptations to environmental stresses
5. list the physiological principles underlying pathogenesis and treatment of disease.

Objectives: Skills – At the end of the course the student will be able to:

1. Perform experiments designed either primarily for the study of physiological phenomena or for assessment of function.
2. Analyze and interpret experimental/investigative data critically.
3. Distinguish between normal and abnormal data derived as a result of tests which he/she has performed and observed in the laboratory.

Teaching and learning methodology in Physiology 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 Physiology 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 450 hrs (teaching hours & distribution might differ slightly per university).

Chapter	Duration
1. General Physiology	6
2. Cell Physiology Muscle & Nerves	12
3. Blood, Body fluids & RES	18
4. Cardiovascular System	30
5. Respiratory & Environmental Physiology	18
6. Digestive System	18
7. Excretion & Skin	18
8. Endocrines & Reproductive System	30
9. Central Nervous System	30
10. Autonomic Nervous System	3
11. Special Senses	18
12. BioPhysics	4
Total	210

Practicals

A. Human Practicals
1. Introduction – Use of Microscope and Laboratory Protocol	110 hrs
2. R.B.C.Count
3. Total Leucocyte Count
4. Bleeding Time & Clotting Time
5. Blood Groups
6. E.S.R.
7. Estimation of Hemoglobin
8. Hematological Indices
9. Platelet Count
10. Reticulocyte Count
11. Recording of Pulse & Blood Pressure
12. Effect of Posture & Exercise on Blood Pressure
13. Lung Function Tests – Spirometry & PEF
14. Clinical Examination of Cardiovascular System
15. Clinical Examination of Respiratory System
16. Clinical Examination of Sensory Nervous System
17. Clinical Examination of Motor Nervous System
18. Clinical Examination of Cranial Nerve Functions
19. Reflexes
20. Tests for Hearing-Rinne’s & Weber’s Tests
21. Acuity of vision & Tests for colour vision
B. Amphibian practicals
1. Recording of simple Muscle Twitch	80 hrs
2. Effect of Two successive stimuli of Muscle contraction
3. Effect of Fatigue on Muscle-Nerve preparation
4. Effect of Increasing strength of stimuli on Muscle contraction
5. Genesis of Tetanus
6. Effect of Temperature variation of Muscle contraction
7. Effect of Afterload and Freeload on Muscle twitch
8. Determination of velocity of Nerve conduction
9. Recording of normal Cardiogram
10. Effect of Temperature variation on Heartbeat
11. Refraction period on beating Heart
12. Properties of Cardiac Muscle-Stannius Legature, Summation, All-or-None Law, Treppe
13. Effect of Vagosympathetic Stimulation on Frog’s Heart
14. Effect of lons & Drugs on perfused frog’s heart
C. General Demonstrations
1. E.C.G.	50 hrs
2. Pregnancy test
3. E.M.G.
4. Perimetry
5. Ophthalmoscope
6. E.E.G
7. Mosso’s ergography
8. Bicycle ergography
9. Treadmill
10. Pulmonary function tests
Total	240

Examination pattern & marks distribution in Physiology 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
  - ECE assessment should be included subject wise
  - There should be at least one short question from AETCOM in each subject
  - One of the 3 tests in preclinical 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:

List of recommended books in Physiology for MBBS

Theory
1. Principles of Medical Physiology, Sabyasachi Sircar
2. Textbook of Physiology, A K Jain
3. Textbook of Medical Physiology, Indu Khurana
4. Essentials Of Medical Physiology, K Sembulingam
5. Textbook of Medical Physiology, D Venkatesh, H H Sudhakar
6. Textbook of medical physiology, G K Pal
7. Ganong’s Review of Medical Physiology
8. Guyton and Hall. Text of Medical Physiology
Practicals
1. Textbook of practical physiology, GK Pal and Pravati Pal
2. A textbook of Practical Physiology, CL Ghai
3. Manual Of Practical Physiology, Ak Jain