Some salient features of CISP

of Competency based

UG Medical Education

Curriculum
What is the need
for change ?
 Some critical views on traditional learning methods
1. Huge teaching load and less learning at the end of the day.

2. Nobody is concerned about customer satisfaction (the

students).

3. Only dictum - “Go and study to be a parrot”

4. Rarely incorporates students in the teaching and learning

process.

5. If somebody fails to understand the subject or fails to qualify in

traditional examinations, does it mean that he/she is not
capable? Traditional educational system is a kind of despotism
i.e. it is a one way traffic.

6. Summary - “It dims the diamond and polishes the pebbles”

 Need of Integrated Curriculum

“Information in isolation is inert and

unhelpful. It is easier to retrieve and use

information when it is combined in

meaningful schemata”.
Regehr & Norman 1996
“ If musicians learned to play their instruments as
physicians learn to interview patients, the procedure would
consist of presenting in lectures or may be in a
demonstration or both -- the theory and mechanisms of the
music-producing ability of the instrument and telling him to
produce a melody. The instructor of the course, would not
be present to observe or listen to the student’s efforts, but
would be satisfied with the student’s subsequent verbal
report of what came out of the instrument.”

- George Engel (Physician and Psychiatrist)

after visiting 70 medical schools in USA
• Keeping this in mind, the new regulations have become more
– Learner centric, patient centric, gender sensitive, outcome
oriented and environment appropriate.
• With these goals in mind, some of the changes made in new
curriculum are:
1. Introduction of ‘Foundation course’ and ‘Early clinical exposure’
2. Revised training format
3. Introduction of ‘Electives’
4. Alignment and integration of curriculum across phases.
5. Introduction of competency based assessment.
6. Exposure of students to longitudinal care of patients.
7. Certified acquisition of certain essential skills - using skill labs and
exposure to simulated and guided environment.
8. Introduction of AETCOM module (ethical values, responsiveness,
communication skills).
New academic calendar
At the end of 1st Professional examination, do the classes start immediately or we wait
for the results? If we wait for results, it further reduces the extent of 2nd phase.
 Total Duration Distribution
Foundation course – 1 month
First MBBS 13 months Teaching – 11 months
Examinations – 1 month

Teaching – 11 months
Second MBBS 12 months
Examination – 1month

Teaching – 12 months
Third MBBS Part 1 13 months
Examination -1 month

Electives - 2 months
Third MBBS Part II 15 months Teaching - 12 months
Examinations – 1 month

Internship 11 months ?
 First Phase
Subject Small group teaching/tutorials
Lectures SDL Total
/ integrated learning/ practical
Anatomy 220 415 40 675
Physiology 160 310 25 495
Biochemistry 80 150 20 250
Early clinical exposure
90 0 90

Community Medicine 20 27 5 52
AETCOM 26 8 34
Sports 60
FET/ Term Exam
80

Total 1736
Second Phase
Foundation Course
 Rationale of introducing Foundation Course
• Presently, selection of students in medical colleges doesn't
include assessment of their non-cognitive abilities.
• Students entering medical colleges are very young. They are
from varying background and are likely to face maladjustment
to hostel life, food and possibly to the medium of instruction of
medical subjects.
• Before entry to medical courses, it is also likely that they have
acquired knowledge through rote learning. For them, a different
learning environment in medical college may be difficult to
cope with.
• Objective of Foundation course is:
– To acclimatize students to campus environment

– To develop familiarity with teaching program

– Help them adapt to academic challenges they are likely to encounter.

 Contents of Foundation Course
Subject content Teaching hours SDL Total Hours

Orientation 30 0 30

Skill module 35 0 35

Field visit to community

center 8 0 8

AETCOM 10

Sports and extra-

curricular activity 22 0 22

Language and computer

skill 50 0 50

155
Early Clinical Exposure
 Goals of early clinical exposure
• To provide context and relevance of teaching of basic sciences
to medical students.

• To impart some gain in medical knowledge, few basic clinical

skills and wide range of attitudes.

• To enhance motivation.

• To prepare them towards the purpose for which they entered

the profession.

• To enable students to correlate knowledge of basic sciences

with human diseases.

• To encourage students to acquire professional behavior.

• To provide context for application of their basic science

learning to clinical practice.
 Roadmap of early clinical exposure
• The course will run during initial six months of first
phase and the total time allotted is 90 hours.

• Time allotted to each subject (Anatomy, physiology

and biochemistry) is 30 hours with following break
up -

– Correlation of basic science with clinical :- 3 hrs

session per month for 6 months (Total 18 hours).

– Development of clinical skills :- 3 hrs session per

month for 4 months (Total 12 hours).
 Correlation of basic science to clinical

This is can be done with the help of

– Charts

– Graphics

– Videos

– Reports

– Field visits

– Case demonstration in class rooms or

hospital labs
 Development of clinical skill session
Each 3 hour session will consist of:-

– Introduction and instruction : 30 min

– Hospital/ Community visit: 1 hr 30 min

– Summary and conclusion : 30 min

– Reflection: 30 min
Revised training format
of students
• Teaching learning method shall predominantly be
– Small group teaching
– Interactive teaching methods
– Hand on training
– Case based learning.
– Symposia and seminars
– Small group discussions
– Problem oriented and problem based discussions
• Didactic teaching will constitute < 30% of curriculum.
• Clinical training will include
– Early exposure
– Measurable and certified skill acquisition
– Community and secondary care based learning
– Experience in patient care, diagnostic and skill labs.
• Special focus on
– National health schemes
– Study of communicable and non-communicable diseases
– Disaster management
 2/3rd of teaching schedule should be interactive sessions as indicated
earlier (practicals, clinicals, PBL and group discussions etc).

 Concept of global competencies (end of course achievements) and sub-

competencies has been incorporated.

 Some basic science competencies are to be achieved in later phases and

time for pre and para-clinical competencies has been allotted in phase III

Core Non core

Taught Yes yes

% of curriculum Not < 80% Not > 20%

Summative assessment Y N

Formative assessment Y Y
• During second phase, at least 3 hours of clinical
instructions each week must be allotted to training in
clinical and procedural skill lab.

• 25% of allotted time of third professional (?) shall be

utilized for integrated learning with pre and para-clinical
subjects and shall be assessed during the clinical
subject examination. (Assessment method and assessed
by ?).

• This allotted time will be utilized as integrated teaching

by (?) para-clinical subjects with clinical subjects as
clinical pathology, clinical pharmacology and clinical
microbiology
Introduction of Elective courses
• It is a brief course available to the student during his/her UG
study period where he/she can chose from available options
depending upon their interest and career preferences.

• Two months are allotted for elective rotations after completion of

the exam at the end of 3rd MBBS part I and before
commencement of 3rd MBBS part II.

• The learner will rotate through two electives blocks of 4 weeks

each

• Block 1: - Pre or para-clinical or basic science laboratory or

under a researcher in an ongoing research project.

• Block 2:- to be done in a clinical department including

specialties, super specialties ICU, blood bank and casualty.

• Electives can be done within the institute or at a rural and urban

community clinic under supervision.
• 75% attendance will be mandatory

• This time period cannot be utilized for any other purpose,

however clinical posting will continue during this period.

• The department and student mentor will be identified and

trained for various requirements of the elective. A log
book will be maintained by the student.

• It can be done in other institutions within/outside the

country.

• Students will be assessed during and at the end of

electives and marks will contribute towards internal
assessment.

• Student feedback is to be documented in a structured

format.
 Some examples of Electives
• General Electives:
– Bioinformatics, Tissue engineering
– Computer applications
– Immunology
– Genetics, nutrition
– Lab sciences - research methodology
– Ethics and emergencies
• Clinical Electives:
– CVTS, Cardiology
– Pediatric surgery, GE and GE surgery
– Rheumatology
– Neonatology
– Nephrology
• Community electives:
– District, community hospitals, national programmes
• Lab electives:
– Pathology, Biochemistry, Virology, FTM etc
Alignment and integration of
curriculum across phases.
 Benefits of Integration
• Improved motivation and satisfaction of students.

• Reinforced and deep learning

• Prepares for life‐long learning

• Heightened awareness of relevance of learning

• Facilitates curriculum review

• Promotes co‐operation between staff members from different

disciplines

• Enhances clinician’s reflections on the scientific basis of practice

• Enhances basic scientist’s reflections on clinical applications and

research
 What’s needed to achieve integration?
• Effective management of change.

• Requires in‐depth review of the curriculum.

• Commitment of faculty, departments and individuals.

• Agreement on topics that need integration.

• Agreement on how much vertical and horizontal integration is

to be achieved.

• Develop teams and structures to support planning

and implementation.

• Requirement of infra-structural and other facilities.

• MCI mandate is for horizontal and vertical integration along
with alignment in each phase.

• Hence it is desirable that as far as possible, teaching/

learning occurs in each phase through concurrent study of
organ systems or disease blocks.

• Even in the proposed integrated curriculum, primacy of

phase based objectives remains intact. Integrative element is
used to facilitate recall and explain clinical application of
concepts.

• Clinical cases may be used to integrate and link learning

across disciplines.
• About 20% of total curricular teaching should involve ‘sharing’ and
‘correlation’ of topics.
 Share – Two disciplines agree to plan and jointly implement a
topic.
 Correlate – Emphasis remains on subject based topic, however an
integrated teaching session is introduced within this framework..
Preferably this should be a case based discussion in an
appropriate format ensuring that elements in the same phase and
from other phases are addressed.
• Integration does not necessarily require multiple teachers in each
class. Experts from each phase and subject may be involved in the
lesson planning and not in its delivery unless deemed necessary.

• Assessment will continue to be subject based. However candidate

should also be tested for internalization of the integrated concept
and its application.
Practical demonstration of Harden’s Integration ladder
 STEPS IN DEVELOPMENT OF INTEGRATED TOPIC
Curriculum E.g. Anemia block, CAD
committee Each topic team is in block, Trauma block
forms topic charge of a topic
teams Competencies reviewed,
Allocation done
Topic team reviews competencies for In early phases, clinical
the block and assigns competencies to correlates done to provide
phases relevance. Basic science
reinforced in later stages

For each phase topic team develops Construction of objectives and

learning objectives, assessment methods learning sessions.
and sessions Learning sessions allotted to
depts.
Linkages created
Topic team liaises with phase I/C to create
space in calendar Phase team helps block team to
make calendar
Block team provides support
Topic team provides implementation support Identifies support needs
Identifies student need
Collects feed back
Competency based assessment
• Since competency in one task does not imply competence in
other activities, hence each competency has to be assessed.

• In competency based curriculum, emphasis has been placed

on formative assessment as opposed to earlier summative
assessment.

• Assessment tools and methodology of CBA has been covered

in basic workshops carried out earlier

• A blueprint would be needed to decide what competencies

should be assessed during internal assessment and which
should go to summative/university examinations (?)
 Internal assessment
– Should be day to day based.
– Can include assignments, seminars, clinical case
presentation, project participation, practical skills,
research project, written test etc.
– At least 3 IA exams in pre/paraclinical subjects.
– Not less than 2 IA/year in each clinical subject
– End of posting clinical assessment for each clinical
posting every year.
– For subjects extending over phases – e.g. In Medicine,
students are assessed in 2nd professional, 3rd
professional part 1 and 3rd professional part 2 (?).
– Students must have 35% marks separately in practical
and theory to appear for professional exam.
– Should have at least 50% marks (combined theory and
practical) in order to be declared successful in university
examinations. IA marks will reflect as separate head of
passing at summative exam.
– IA marks will not be added to marks obtained in
professional exams.
– Remedial exam allowed before/after professionals to
reach cut off value of 50%.
– If student fails to reach cut off mark- University result to
be annulled.
 University examinations
• Different types of questions to be included – LAQ, SAQ and
MCQs.
• MCQs not more than 20% marks of total theory
examinations.
• In subjects that have 2 papers, student must secure at least
40% marks in each paper with minimum 50% marks in
aggregate.
• Clinical cases in exams should be of conditions likely to be
seen by the candidate as physician of first contact in
community.
• One main exam in one academic year.
• Supplementary exam to be held within 90 days of
declaration of results.
Exposure of students to
longitudinal
care of patients
• Patients at the time of admission to the hospital will be
assigned to individual students.
• Students will follow the patient throughout their hospital
stay.
• Students to be conversant with complete work up and
management of the allotted patient till their discharge from
the hospital.
• A complete log book about this patient will be maintained
by the student.
• As and when patient comes for follow up, it will be the
responsibility of the student to be aware of further
developments.
• By this exercise the student would be able to observe and
study the course of a disease.
Certified acquisition of
certain essential skills
• Various skills that a student needs to develop during his UG training has
been listed in detail in MCI document.
• The student is expected to develop
– Technical skills including psychomotor and communication skills.
– Non-technical skills including team skills and intellectual skills.
• Organizational set up includes
– Communication skill lab
– Clinical skill lab
• Clinical skill labs may consist of simulated
– Space for seminars
– Clinical settings
– Emergency room setting
– Outpatient setting
– Intensive care setting
– Consulting rooms
– Procedural rooms
– Operating rooms
– Different types of simulators
• Student also has to learn to perform about 60 procedural skills that are to be
certified by the concerned departments.
 Introduction of AETCOM module
• A structured longitudinal programme on
– Attitude
– Communication and
– Ethics is proposed by MCI.
• In this the student will be trained on learning the
importance of bioethics, law, clinical reasoning in
care of patients, system based care, patient empathy
and other human values, effective communication
with patient, families, colleagues and other health
care professionals, alternative systems of medicine
etc.
 Dean Curricular Governance Structure

Curriculum committee MEU/MED HODs

Meets 6 times/year
Creates timetable with help of
phase committee and &
2 more responsibilities.
Faculty education and support
Helps develop teaching and
assessment methods
Quality control
Liaises with MCI nodal centers
and
1 more responsibility
Curriculum implementation
Liaises with other HODs for
smooth implementation
and
4 more responsibilities

Topic teams
Responsible for integrated
topics across phases.
Reviews competencies and
develops learning objectives
and
4 more responsibilities
Phase wise curriculum sub-committee
Implementation in each phase
Reviews competencies
Alignment and integration
and
3 more responsibilities
Thank You