1. Introduction:
1.1. Overview of the Speciality
The speciality of Pulmonology developed as a sub-specialization of
physicians who are predominantly concerns with the care of patients
with respiratory disorders. It is a branch of internal medicine
concerned with prevention intervention, investigation and therapy and
research into diseases involving the respiratory system. Care of
patients with respiratory disorders embraces a wide range of clinical
activities and respiratory physicians need a broad view of the
respiratory needs of individual patients and the communities in which
they live including an understanding of any prevailing healthcare
inequalities. This requires knowledge of not only the diagnostic and
therapeutic modalities available, but also an appreciation of the
importance of the epidemiology and potential for prevention of
respiratory diseases.
Although pulmonology is generally stereotyped and highly practical
skill based medical speciality, with invasive and interventional skills as
high-profile components of the workload, competence in other areas of
practice such as respiratory clinical pharmacology and respiratory
imaging are equally important. Indeed the expert clinical management
of patients with respiratory failure, pulmonary. hypertension, use of
Non-Invasive Ventilation (NIV) as rewarding as the quasi surgical skills
demanded of the pulmonary interventionist. Respiratory physicians
generally work as hospital based specialists and need to integrate their
work with not only community based primary care colleagues but also
other hospital based physicians. e.g. critical care specialist, ENT
surgeons, as well as working closely with Thoracic surgeons and
anesthesiologists and the imaging specialties, e.g. radiology and
nuclear medicine. Sub-specialization within Pulmonology has become
common place with individuals focusing the development of their
expertise in areas such as pulmonary intervention, Sleep medicine
specialist, respiratory failure and pulmonary hypertension.
1.2. Pulmonology Residency Program
Residents will undertake a three year intensive Phase B training after
completion of Phase A training in order to achieve the levels of
knowledge, skills and expertise required for clinical practice in the field
of respiratory medicine. It is a competency-based program
emphasizing on meaningful integration and contex- tualization. The
two years phase A training program is designed to introduce and
develop the broad range of core knowledge, skills, attitudes and
behaviours required to become a competent physician. The
knowledge and skills acquired during Phase A training are further
focused and refined during Phase B training, which is a 3 year
speciality-specific training in Pulmonology.
The teaching, learning and assessment of the curriculum is facilitated
by the provision of comprehensive, educationally oriented supervision
and support, which is provided to all trainees across both the phases
of the program.
2. Goals and objectives:
2.1. Overall Goals
1. To prepare respiratory physicians who would be able to meet
and respond to the changing healthcare needs and
expectation of the society.
2. To develop respiratory physicians who posses knowledge,
skills and attitudes that will ensure that they are competent to
practice respiratory medicine, safely and effectively.
3. To ensure that they have appropriate foundation for lifelong
learning and further training in their speciality.
4. To help them develop to be critical thinkers and problem
solvers when managing health problems in the community
they serve.
2.2. General Objectives:
The educational and training process aims to produce respiratory
physicians who:-
• Can address all aspects of the healthcare needs of patients
and their families
• Maintain the highest standards appropriate in their
professional field
• Are aware of current thinking about ethical and legal issues
• Are able to act as safe independent practitioners whilst
recognizing the limitation of their own expertise and are able
to recognize their obligation to seek assistance of colleagues
where appropriate
• Are aware of the procedures, and able to take appropriate
action, when things go wrong, both in their own practice and
in that of others
• Will be honest and objective when assessing the performance
of those they have supervised and trained
• Can take advantage of information technology• to enhance all
aspects of patient care
• Can develop management plans for the "Whole patient" and
maintain a knowledge in other areas of medicine which
impinge on the speciality of Pulmonology.
• Understand that more effective communication between them
and their patients can lead to more effective treatment and
care
• Apply appropriate knowledge and skill in the diagnosis and
management of patients
• Establish a differential diagnosis for patients presenting with
medical problems by the appropriate use of the clinical
history, examination and investigations
• Are competent to perform the core investigations and
procedures required in their specialties.
• Develop clinical practice which is based on an analysis of
relevant clinical trials and to have an understanding of their
research methodologies
• Are able to apply the knowledge of biological and behavioral
sciences in clinical practice
• Are able to identify and take responsibility for their own
educational needs and the attainment of these needs
• Have developed the skills of an effective teacher
3. Admission Requirements for Phase B Training:
A. Residents who has successfully completed Phase A training
and passed Phase A Final Examination are eligible for
enrolment in the Phase B program.
B. Candidates with FCPS/MD in Internal Medicine can be
enrolled directly into Phase- B of the residency program
4. Phase B Curriculum structure:
The training is designed to develop both the generic and
speciality-specific attributes necessary to practice independently as a
consultant respiratory physicians. The aim is to train individuals to
provide the highest standard of service to patients with respiratory
disorders. This includes the development of positive attitudes towards
lifelong learning and the ability to adopt to future technological
advances and the changing expectations of society.
4.1. Phase B: Pulmonology Speciality Training:
In-depth speciality-specific educational and training program in this
phase will make the resident competent and prepare them for the
speciality qualification. It will provide educational program covering
the speciality of Respiratory Medicine and its subspecialties,
Biostatistics, Research Methodology and Medical Education along
with rotation specific clinical training.
4.2. Expected outcome sat the completion of the Phase B Program:
Resident of this training program will be equipped to function
effectively within the current and emerging professional, medical and
social contexts. At the completion of the training program in
Pulmonology, as defined by this curriculum, it is expected that a new
Respiratory specialist will have developed the clinical skills and have
acquired the theoretical knowledge for competent practice in the field
of Pulmonology. It is expected that a new Respiratory specialist will be
able to
• Utilize effective communication with patients and their families
and with professional colleagues
• Be devoted to life long learning
• Be equipped to manage both acute and chronic respiratory
diseases
• Identify the path of physiology and manifestations of
respiratory diseases and modern therapeutics, which can be
applied to patient diagnosis and management
• Apply appropriate skills to perform necessary diagnostic and
therapeutic decisions
• Demonstrate a capacity to rationally analyze clinical data and
published work
• Demonstrate an understanding of and commitment to the role
of research in advancing medical care of respiratory disease
• Develop a commitment to compassionate, ethical professional
behavior
• Identity respiratory medicine related health issues of
importance to the community and contribute constructively to
debate about those issues
• Apply primary and secondary prevention strategies in
respiratory disease
5. Teaching and Learning Methods:
The bulk of learning occurs as a result of clinical experiences
(experiential learning, on-the-job learning) and self-directed study.
The degree of self-directed learning will increase as trainees became
moral experienced. teaching and learning occurs using several
methods that range from formal didactic lectures to planned clinical
experiences Aspects covered will include knowledge, skills and
practices relevant to the discipline ifl order to achieve specific learning
outcomes and competencies. The theoretical part of the curriculum
presents the current body of knowledge necessary for practice. This
can be imparted using lectures, grand teaching rounds,
clinico-pathological meetings, morbidity/mortality review meetings,
literature reviews and presentations, journal clubs, self-directed
learning, conferences and seminars.
6. Record of Training:
The evidence requires confirming progress through training includes:
• Details of the training rotations, the training plan agreed with
weekly timetables and duty rosters; and numbers of practical
procedures and outcomes
• Confirmations of attendance at events in the educational
program, at departmental and inter-departmental meetings
and other educational events.
• Confirmation (certificates) of attendance at subject based/
skills- training/ instructional courses
• A properly completed logbook with entries capable of
testifying to the training objectives which have been attained
and the standard of performance achieved.
• CME activity
• Supervisor's report on Observed performance (in the
workplace): of duties, practical procedures of presentations
made and teaching activity; of advising and working with
others, of standards of case notes, correspondence and
communication with others.
6.1. Logbook:
Residents are requested to maintain a Logbook in which entries of
academic/ professional work done during the period of training should
be made on daily basis and signed by the supervisor completed and
duly certified logbook will form a part of the application for appearing
in Phase B Final examinations.
7. Research:
Development of research competencies forms an important part of the
Residency program curriculum as they are an essential set of skills for
effective clinical practice undertaking research helps to develop
critical thinking and the ability to review medical literature. Every
Resident shall carry out work on an assigned research project under
the guidance of a recognized supervisor; the project shall be written
and submitted in the form of a Thesis/Research Report.
8. Assessment:
The assessment for certification of the MD degree of the University is
comprehensive, integrated and phase-centered attempting to identify
attributes expected of specialists for independent practice and lifelong
learning and covers cognitive, psychomotor and affective domains. It
keeps strict reference to the components, the contents, the
competencies and the criteria laid down in the curriculum.
Assessment includes both Formative Assessment and Summative
(Phase final) Examinations.
8.1.1. End of Block Assessment (EBA):
End of Block Assessment (EBA) is a periodic formative assessment
and is undertaken after completion of each training block, assessing
knowledge, skills and attitude of the residents. Components of EBA
are written examination, structured clinical Assessment (SCA),
medical record review, and logbook assessment. Unsatisfactory block
training must be satisfactorily completed to be eligible for phase final
examination
8.1. Formative Assessment:
Formative assessment will be conducted throughout the training
phases. It will be carried out for tracking the progress of residents,
providing feedback, and preparing them for final assessment (Phase
completion exams).
There will be Continuous (day-to-day) and Periodic type of formative
assessment.
• Continuous (day-to-day) formative assessment in classroom
and workplace settings provides guide to a resident's learning
and a faculty's teaching / learning strategies to ensure
formative lesson / training outcomes.
• Periodic formative assessment is quasi-formal and is directed
to assessing the outcome of a block placement or academic
module completion. It is held at the end of Block Placement
and Academic Module Completion. The contents of such
examinations include Block Units of the Training Curriculum
and Academic Module Units of the Academic Curriculum.
8.1.2. Formative assessment for Academic modules for
Biostatics and Research Methodology and Medical
Education to be done in the first nine months of Phase
B training. Residents getting unsatisfactory grade must
achieve satisfactory grade by appearing the
re-evaluation examination to be eligible for the Phase B
Final Examination.
8.2. Summative Examination:
Assessment will be done in two broad compartments.
a) Compartment A: Consist of 3 (three) components.
1. Written Examination (Consists of 2 papers).
2. Clinical Examination (One long and four short cases).
3. SCA and Oral (10 stations SCA. Oral one board
consisting of 2 examiners).
Every Resident must pass all the 3 components of compartment-A
separately. Candidates will be declared failed if he/she fails in one or
more component (s) of the examination. He/she then have to appear
all the 3 components in the next Phase B Final Examination.
b) Compartment B: Thesis and Thesis defense.
8.2.1. Written Examination:
Two Papers: Contents of written papers listed in Annexure II
Question type and marks:
• Two Papers (Paper I and Paper II); 100 marks each;
Time 3 hrs for each paper. Pass marks-60% of total of
2 papers.
• Each paper will consist of Two Groups:
• Group A:
- 10 short questions (5 marks each)
- These will assess the knowledge of different level
and its application
• Group B:
- 5 scenario based problem solving questions
(10 marks for each).
- The questions should focus to assess the capability
of handling clinical problem independently and
comprehensively as a specialist.
- Suggested format:-
- A scenario followed by question(s).
- Questions may include diagnosis, differential
diagnosis, investigation plan, treatment, follow up
and patient education.
8.2.2. Clinical Examination: Long case and Short case:
• There will be one long case and four short cases.
i) Long case: Marks-100
- Directly observed
- Two examiners for each examinee.
- History taking and examination by the examinee - 30min.
- Discussion on the case 20 min.(presentation 6min,
crossing 6x2min and decision 2min).
- Examiners will not ask any question nor stop the
examinee in any way during history taking and
physical examinations.
- Discussion should be done preferably as per
structured format and proper weightage on different
segments of clinical skills.
II. Short cases : Marks-100
- Four in number
- Time 20-30 min. (Time will be equally divided for
each short case)
- Crossing should be done with proper weightage on
different segment of clinical skills.
II. Pass marks: 60% of total of Long and Short Cases
8.2.3. Structured Clinical Assessment (SCA): Marks-100
• 10 stations: 5 min each
8.2.4. Oral Examination: Marks-100
- One board consisting of 2 examiners.
- 20 minutes (9+9+2).
8.2.5. Pass marks in SCA and Oral: 60% of total (SCA and Oral.)
8.3. Thesis Evaluation:
• Marks: Thesis writing-200; Defense-100: Marks for
acceptane-60% of total.
- To be evaluated by 3 (three) evaluators:- 2 subject
specialists and one academician preferably involve in
research and teaching research methodology.
- Among the subject specialists one should be external.
- Evaluators should be in the rank of Professor/Associate/
Professor.
- Supervisor will attend the defense as an observer and
may interact only when requested by the evaluators.
- Thesis must be submitted to the controller of Exam not
later than 27 months of enrolment in Phase-B. I Thesis
must be sent to the evaluators 2 (Two) weeks prior to
assessment date.
- Evaluation will cover Thesis writing and its defense.
- For thesis writing evaluator will mark on its structure,
content, flow, scientific value, cohesion, etc.
- For defense - Candidate is expected to defend, justify and
relate the work and its findings.
- Assessment must be completed in next 3 months.
- Outcome of the assessment shall be in 4 categories -
"Accepted", "Accepted with minor correction", "Accepted
with major correction" and "Not Accepted".
8.3.1. Description of terms:
• Accepted: Assessors will sign the document and resident will
bound it and submit to the Controller of Examinations by 10
days of the examination.
• Accepted with minor correction: Minor correction shall
include small inclusion/exclusion of section; identified missing
references, correction of references and typographical and
language problem. This should be corrected and submitted
within 2 weeks.
• Accepted with major correction: Task is completed as) per
protocol with acceptable method but some re-analysis of
result and corresponding discussion are to be modified.)
To be corrected, confirmed by Supervisor and submit within 3
(Three) weeks.
• Not Accepted: When work is not done as per protocol or
method was faulty or require further inclusion or confirmation
of study.
- To complete the suggested deficiencies and reappear in
defense examination during its next Phase Final
Examination.
- Candidate has to submit his/her thesis and sit for
examination and pay usual examination fees for the
examination.
8.3.2. Residents must submit and appear Thesis defense at notified
date and time. However non- acceptance of the Thesis does
not bar the resident in appearing the written, clinical and oral
exam.
8.4. Qualifying for MD Degree:
On passing both the compartments, the candidate will be conferred
the degree of MD in the respective discipline. If any candidate fails in
one compartment he/she will appear in that compartment only in the
subsequent Phase-B exam.
9. Supervision and Training Monitoring:
Training should incorporate the principle of gradually increasing
responsibility, and provide each trainee with a sufficient scope, volume
and variety of experience in a range of settings that include inpatients.
outpatients, emergency and intensive care. All elements of work in
training rotation must be supervised with the level of supervision
varying depending on the experience of the trainee and the clinical
exposure. Outpatient and referral supervision must routinely include the
opportunity to personally discuss ail cases. As training progresses the
trainee should have the opportunity for increasing autonomy, consistent
with safe and effective care for the patient. Trainees will at all times
have a named Supervisor, responsible for overseeing their education.
Supervisors are responsible for supervision of learning throughout
the program to ensure patient and I or laboratory safety, service
delivery as well as the progress of the resident with learning and
performance. They set the lesson plans based on the curriculum.
undertake appraisal, progress against the curriculum, give feedback
on both formative and summative assessments as well as sign the
logbook and portfolio. The residents are made aware of their
limitations and are encouraged to seek advice and receive help at all
times. The Course Coordinator of each department coordinates all
training and academic activities of the program in collaboration with
the Course Director. The Course Director of each faculty directs
guides and manages curricular activities under his/ her jurisdiction
and is the person to be reported to for all events and performances of
the residents and the supervisors.
10. Curriculum Implementation, Review and Updating:
Both Supervisors and Residents are expected to have a good
knowledge of the curriculum and should use it as a guide for their
training program.
Since Pulmonology has historically been rapidly changing speciality
the need for review and up-dating of curriculum is evident. The
Curriculum is specifically designed to guide an educational process
and will continue to be the subject of active re-drafting, to reflect
changes in both pulmonology and educational theory and practice.
Residents and Supervisors are encouraged to discuss the curriculum
and to feedback on content and issue regarding implementation at
Residency Course Director. Review will be time tabled to occur
annually for any minor changes to the curriculum. The Curriculum will
be reviewed with input from the various subspecialties of
Pulmonology.
11. Phase B Syllabus:
The educational process in Respiratory Medicine aims to provide
basic knowledge, intellectual, clinical and transferable skills to
produce competent specialists in Pulmonology. These specialists will
be capable of providing specialized care of the highest order to
patients with respiratory disorders in the community as well as clinical
tertiary centres. They will recognize the health needs of the
community and carry out professional obligations ethically and
keeping their standards by engaging in continuing medical education.
The program also aims to introduce the candidate to the basics of
scientific medical research.
Module A.1: Structure and function of the respiratory system
A.1.1 Anatomy
A.1.2 Development and ageing of respiratory system
A.1.3 Physiology
A.1.4 Pathophysiology A.1.5 Microbiology A.1.6 Genetics
A.1.7 Pharmacology
A.1.8 Pathology
A.1.9 Immunology and defence mechanisms
A.1.10 Molecular biology
A.1.11 Biochemistry
Module B.1: Airway diseases
B.1.1 Asthma
B.1.2 Acute bronchitis
B.1.3 Chronic bronchitis
B.1.4 COPD (chronic bronchitis and/or emphysema)
B.1.5 Bronchiolitis
B.1.6 Bronchiectasis
B.1.7 Airway stenosis and malacia B.1.8 Trachea-oesophageal fistula
B.1.9 Upper airway disease
B.1.10 Vocal cord dysfunction
B.1.11 Foreign body aspiration
B .1.12 Gastro-oesophageal reflux
Module B.2: Thoracic tumours
8.2.1 Lung cancer
8.2.2 Metastatic pulmonary tumours
8.2.3 Mesothelioma
8.2.4 Metastatic and other pleural tumours
8.2.5 Benign intra-thoracic tumours
8.2.6 Mediastinal tumours B.2.7 Chest wall tumours B.2.8 Sarcoma
B.2.9 Lymphoma
Module B.3: Non-TB respiratory infections
B.3.1 Upper respiratory tract infections
B.3.2 Lower respiratory tract infections
B.3.3 Community-acquired pneumonia (CAP)
B.3.4 Nosocomial pneumonia
B.3.5 Pneumonia in the immunocompromised host
B.3.6 Other pneumonia
B.3.7 Parapneumonic effusion and empyema
B.3.8 Lung abscess B.3.9 Fungal infection B.3.10 Parasitic infection
B.3.11 Epidemic viral infection
Module B.4: Tuberculosis
B.4.1 Pulmonary TB
8.4.2 Extrapulmonary TB
B.4.3 TB in the immunocompromised host
8.4.4 Latent tuberculous infection
B.4.5 Non-tuberculous mycobacterial diseases
B.4.6 Tuberculosis and HIV
Module B.5: Pulmonary vascular diseases
B.5.1 Pulmonary embolism
B.5.2 Primary pulmonary hypertension
8.5.3 Secondary pulmonary hypertension
B.5.4 Vasculitis and diffuse pulmonary haemorrhage
B.5.5 Abnormal a-v communication
Module B.6: Occupational and environmental diseases
B.6.1 Occupational asthma
B.6.2 Reactive airway dysfunction syndrome (RADS)
B.6.3 Pneumoconiosis and asbestos-related disease
B.6.4 Hypersensitivity pneumonitis
B.6.5 Dust and toxic gas inhalation disease
B.6.6 Indoor pollution related disease
B.6.7 Outdoor pollution related disease
B.6.8 Smoking-related disease
B.6.9 High-altitude disease
B.6.10 Diving-related disease
Module B.7: Diffuse Parenchymal (interstitial) lung diseases (DPLD)
B.7.1 Sarcoidosis
B.7.2 Idiopathic interstitial pneumonias including idiopathic
pulmonary fibrosis (IPF). non-specific interstitial pneumonia
(NSI P), cryptogenic organising pneumonia (COP), acute
interstitial pneumonia (AIP), respiratory bronchiolitis- associated
interstitial lung disease (RB-ILD), desquamative interstitial
pneumonia (DIP), lymphoid interstitial pneumonia (LIP)
B.7.3 Cryptogenic organising pneumonia (COP) of unknown
aetiology/ bronchiolitis obliterans organising pneumonia (BOOP)
Module B.8: Iatrogenic diseases
B.8.1 Drug-induced disease
B.8.2 Complications of invasive procedures
B.8.3 Radiation-induced disease
Module B.9: Acute injury
B.9.1 Inhalation lung injury
B.9.2 Traumatic thoracic injury
Module B.10: Respiratory failure
B.10.1 Acute respiratory distress syndrome
B.10.2 Obstructive lung disease
B.10.3 Neuromuscular disease
B.10.4 Chest wall disease
B.10.5 Other restrictive diseases
Module B.11: Pleural diseases
B.11.1 Pleural effusion
B.11.2 Chylothorax
B.11.3 Haemothorax
B.11.4 Fibrothorax
B.11.5 Pneumothorax
Module B.12: Diseases of the chest wall and respiratory muscles
including the diaphragm
B.12.1 Chest wall deformities
B.12.2 Neuromuscular disorders
B.12.3 Phrenic nerve palsy
B.12.4 Diaphragmatic hernia
Module B.13: Mediastinal diseases excluding tumours
B.13.1 Mediastinitis
8.13.2 Mediastinal fibrosis
B.13.3 Pneumo-mediastinum
Module B.14: Pleuro-pulmonary manifestations of systemic/
extrapulmonary disorders
B.14.1 Collagen vascular disease
B.14.2 Cardiac disease
B.14.3 Abdominal disease
B.14.4 Haematological disease
B.14.5 Obesity
B.14.6. Hyperventilation syndrome
Module B.15: Genetic and developmental disorders
B.15.1 Cystic fibrosis
B.15.2 Primary ciliary dyskinesia
B.15.3 Alpha-1 antitrypsin deficiency
B.15.4 Malformations
Module B.16: Respiratory diseases and pregnancy
B.16.1 Asthma
B.16.2 Cystic fibrosis
B.16.3 Tuberculosis
B.16.4 Sarcoidosis
B.16.5 Restrictive lung diseases
B.16.6 Pregnancy-induced respiratory diseases
Module B.17: Allergic diseases (lgE•mediated)
B.17.1 Upper airway disease
B.17.2 Asthma
B.17.3 Bronchopulmonary aspergillosis
B.17.4 Anaphylaxis
Module B.18: Eosinophilic lung diseases
B.18.1 Non-asthmatic eosinophilic bronchitis
B.18.2 Acute and chronic eosinophilic pneumonia
B.18.3 Hyper-eosinophilic syndrome
B.22.3 Tuberculosis
8.22.4 Surfactant deficiency diseases
Module B.19: Sleep-related disorders
B.19.1 Obstructive sleep apnoea syndrome
B.19.2 Central sleep apnoea syndrome
B.19.3 Obesity hypoventilation syndrome
Module B.20: Immunodeficiency disorders
B.20.1 Congenital immunodeficiency syndrome
B.20.2 Acquired immunodeficiency syndrome
B.20.3 HIV-related disease
B.20.4 Drug-induced disease
B.20.5 Graft versus host disease
B.20.6 Post-transplantation immunodeficiency
Module B.21: Orphan lung diseases
B.21.1 Langerhans' cell histiocytosis
B.21.2 Lymphangioleiomyomatosis (LAM)
B.21.3 Pulmonary alveolar proteinosis
8.21.4 Amyloidosis
Module B.22: Paediatric pulmonology
B.22.1 Asthma
B.22.2 Respiratory tract infections (ARI)
B.22.3 Tuberculosis
B.22.4 Surfactant deficiency diseases
Module C.1: Symptoms and signs
C.1 .1 Dyspnoea
C.1 .2 Wheeze
C.1.3 Stridor
C.1.4 Hoarseness
C.1.5 Cough
C.1.6 Sputum production
C.1.7 Chest pain
C.1.8 Haemoptysis
C.1.9 General symptoms of disease including fever, weight loss,
oedema, nocturia, and daytime somnolence
C.1.10 Abnormal findings on inspection including cyanosis,
abnormal breathing patterns, finger clubbing, chest wall
deformities, superior vena cava syndrome and Homer's
syndrome
C.1.11 Abnormal findings on palpation and percussion
C.1.12 Abnormal findings on auscultation
Module D.1: Pulmonary function testing
D.1.1 Static and dynamic lung volumes- interpretation and performance
D.1.2 Body plethysmography- interpretation
D.1.3 Gas transfer- interpretation
D.1.4 Blood gas assessment and oximetry/capnography- interpretation
and performance
D.1.5 Bronchial provocation testing- interpretation and performance
0.1.6 Exercise testing including 6 MWT and spiro-ergometry
(cardio-pulmonary exercise testing)- interpretation and
performance
D.1. 7 Assessment of respiratory mechanics- interpretation
D.1.8 Compliance measurements- interpretation
D.1.9 Respiratory muscle assessment- interpretation
D.1.10 Ventilation-perfusion measurement- interpretation
D.1.11 Shunt measurement- interpretation
D.1.12 Sleep studies/POLYSOMNOGRAPHY- interpretation and
performance
D.1.13 Measurement of regulation of ventilation- interpretation
Module D.2: Other procedures
D.2.1 Blood tests and serology relevant to respiratory medicine
D.2.2 Analysis of exhaled breath components including NO, CO
and breath condensate
D.2.3 Sputum induction
D.2.4 Sputum analysis
D.2.5 Tuberculin skin testing
0.2.6 Allergy skin testing
D.2.7 Pleural ultrasound imaging
D.2.8 Thoracentesis
0.2.9 Closed pleural needle biopsy
D.2.10 Pleuroscopy (medical thoracoscopy)
D.2.11 Flexible bronchoscopy
0.2.12 Transbroncnial lung biopsy D.2.13 Transbronchiat needle
aspiration D.2.14 Endobronchial ultrasound
D.2.15 Broncho-alveolar lavage
D.2.16 Bronchography
0.2.17 Rigid bronchoscopy
0.2.18 lnterventional bronchoscopic techniques including fluorescence
bronchoscopy, brachytherapy, endobronchial radiotherapy,
afterloading laser and electrocoagulation cryotherapy,
photodynamic therapy, airway stents/thermoplasty
0.2.19 Percutaneous needle biopsy
D.2.20 Fine needle lymph node aspiration for cytology
D.2.21 Right heart catheterisation
D.2.22 Chest X-ray
D.2.23 Fluoroscopy
Module D.3: Procedures performed collaboratively
D.3.1 Thoracic imaging (X-ray, CT, MRI)
D.3.2 Nuclear medicine techniques (pulmonary and bone scan PET)
0.3.3 Electrocardiogram D.3.4 Echocardigram
D.3.5 Ultrasound
D.3.6 Transoesophageal ultrasound
D.3.7 Oesophageal pH monitoring
D.3.8 Cytology/histology
D.3.9 Microbiology testing
Module E.1: Treatment modalities and prevention measures
E.1.1 Systemic/inhaled drug therapy
E.1.2 Chemotherapy
E.1.3 Other systemic anti-tumour therapy
E.1.4 lmmunotherapy including de-/hyposensitisation
E.1 .5 Oxygen therapy
E.1.6 Ventilatory support (invasive/non-invasive/CPAP)
E.1.7 Cardiopulmonary resuscitation
E.1.8 Assessment for anaesthesialsurgery
E.1.9 Endobronchial therapies
E.1.10 lntercostal tube drainage
E.1.11 Pleurodesis
E.1.12 Home care
E.1.13 Palliative care
E.1.14 Pulmonary rehabilitation
E.1.15 Nutritional interventions
E.1.16 Surfactant therapy
E.1.17 Gene therapy
E.1. 18 Principles of stem cell therapy
E.1.19 Smoking cessation
E.1.20 Vaccination and infection control
E.1.21 Other preventative measures
Module F: Core generic abilities
F.1 Communication in~luding patient education and public awareness
F.2 Literature appraisal
F.3 Research
F.4 Teaching
F.5 Audit/quality assurance of clinical practice
F.6 Multidisciplinary teamwork
F.7 Administration and management
F.8 Ethics
Module G: Competence in fields shared with other specialties
G.1 Intensive care
G.2 High-dependency unit (HOU)
G.3 Critical Care Medicine (CCM)
Module H: Knowledge of associated fields relevant to adult
respiratory medicine
H.1 Thoracic surgery (including lung transplantation)
H.2 Radiotherapy
H.3 Chest physiotherapy
H.4 Other relevant medical specialties
Module I: Further areas relevant to respiratory medicine
1.1 Epidemiology
1 .2 Statistics
1.3 Evidence-based medicine
1.4 Quality of life measures
1.5 Psychological factors in the development of respiratory disease
1.6 Psychological consequences of chronic respiratory disease
1. 7 Public health issues
1.8 Organization of healthcare in Bangladesh (Healthcare delivery
system)
1.9 Economics of healthcare across the world
1.10 Compensation and legal issues in home & abroad
FCPS (Pulmonary & Thoracic Surgery)
This course is under supervision of Bangladesh College of Physicians
& Surgeons. But theses part student placed here for 2 years. Thesis
work also done here.
Library
The institute is equipped with a library for the teachers and students of
NIDCH. The library run by a librarian and an assistant. Library of the
institute is located in the 4th floor of the National Asthma Center (NAC)
building. It has a sitting capacity of about 100 students. The library is
fully air-conditioned. About 1500 books and a small number of
Journals are available in this library.
The library is open from 8 a.m. to 9 p.m. The library provides
photocopy facilities round the service hour. Broad band internet facility
is an special addition to this library.
COURSE CURRICULUM FOR THE MS (THORACIC SURGERY)
PART-A
• Anatomy
• Physiology, Biochemistry, Pharmacology
• Pathology, immunology, biostatistic
• General surgery
All mentioned in syllabus
PART-B
1. Thoracic Surgery (Syll: 1-30)
2. Operative Surgery (Chest)
3. Surgical Pathology (Chest Diseases)
4. Thoracic Anesthesiology (Principle)
5. Cardiac Surgery (Principle of open heart surgery- heart-lung mac)
6. Vascular Surgery (Aneurysm principle of repair)
SYLLABUS FOR THE MASTER OF SURGERY (THORACIC)
BANGABANDHU SHEIKH MUJIB MEDICAL UNIVERSITY (BSMMU)
PART – A
A. Anatomy:
1. Gross Anatomy & Regional Anatomy
a) General
b) Lungs, Bronchovascular Segment, Trachea,
Mediastinum, Pleura, Diaphragm, Thoracic cavity & chest
wall, oesophagous
c) Heart
d) Blood vessels & lymphatics
e) Gl tract (stomach, duodenum, small and large gut, liver,
spleen, pancreas, omentun, mesentry, portal system)
2. Developmental Anatomy of Respiratory Systen
3. Histology – of allied subject
4. Applied Anatomy – of allied subject
B. Physiology, Biochemistry & Pharmacology
a. Physiology :
1. General Principle of Physiology
2. Cardiovascular Physiology
a) Cardiac cycle
b) Heart muscle & its contractions
c) Conducting system and Electro-Physiology
d) Haemodynamics
3. Respiratory Physiology with Positive Pressure Ventilation
(Artificial ventilation)
a) Respiratory functions & tests
b) Positive Pressure Ventilation (Artificial ventilation)
c) Blood gases
d) Blood vessels & lymphatics
4. Physiology of Nervous System – specially cardio-resp.
innervation
b. Pharmacology :
1. General Pharmacology
a) Machanism of drug action
b) Drug interaction
c) Adverse reaction to drug
d) Principle of drug therapy
2. Pain killers
3. Chemotherapy & Antibiotics (Pharmacology of Respiratory
system in the surgical pain)
4. Diuretics
5. Drug working on Autonomic Nervous System
6. Anticoagulants
7. Bronchodilators & Mucolytic agtents
8. Steroid in Surgery
9. Vasodilators
10. Vitamin and Mineral
Biochemistry :
a) Cell & its function
b) Fluid & Electrolytes
c) Acid Base balance
d) Metrobolic response to trama
e) Nutrition in surgical patient
f) Parenteral Nutrition
g) Enzymes of clinical importance
c. Pathology & Microbiology :
a. Pathology :
1. General Pathology
a) Cellular degeneration & necrosis & oedema
b) Inflammation
c) Infarction
d) Thrombosis and Embolism
e) Athero Sclerosis
f) Haemorrhage & Shock
g) Aneurysm
h) Calcification
i) Neoplasm (tumour)
j) Infection
b. Microbiology :
1. Micro organism of surgical importance
2. Hospital infections
3. Investigation & Diagnosis of Microbial Disease
4. Prevention and Treatment of Microbial Diseases
5. Medical Genetics
D. Immunology :
E. Biostatistic
F. General Surgery
Basic Principles of General Surgery
a. Laparotomy, incision
b. Disease & Surgery of Liver
c. Surgery in Portal Hypertension
d. Diabetes & Surgery
e. Disease and Surgery of Stomach, Duodenum (small & large
gut)
f. Disease and Surgery of Spleen
g. Disease and Surgery of Breast
h. Incision & exploration of the neck
PART – B ( 3 Years)
1st Term : 6 months
o Statistics : Genetics, epidemiology class
o Ward Duty
o Research methodology
o Submit thesis protocol/original papers (at the end of 6
months)
Next 2 (two) years
o Residential clinical duty – Evaluation
o Lecture attend
o Clinical meetings
o Case Presentation, Clinical seminar
Next 2 (two) months
o Exposure to cardiac vascular surgery ( NICVD)
Next 4 (four) months
o Submit Thesis, Residential work
o Total Evaluation
Examination
o Theory : Written (100 marks)
- Paper I
- Paper II
o Practical : Long Viva (200 marks)
- Instrument
- X-ray
- Specimen
- Operative surgery
o Clinical (100 marks) : - Long case
- Short case
o Thesis - (200 marks)
Defence
SYLLABUS FOR MS (Thoracic Surgery)
PART – B
1. Thoracic Surgery – Surgical Pathology & Operative Surgery 75 hrs
Thoracic Surgery :
1. Endoscopy Bronchoscopy, Oesophagoscopy & Mediostinoscopy
2. Preoperative assessment of patient
3. Chest Radiology
4. Anesthesia for thoracic surgery
5. Shock & circulatory collapse
6. Post operative management
7. Thoracic incisions and surgical approches
8. Tracheostomy and assisted ventilations
9. Congenital lesions, neoplasms & injuries of trachea
10. Thoracic surgery in infants
11. Chest injury
12. Mediastinum & Mediastinum tumours
13. Lung infarctions
14. Non malignant tumours of lung
15. Cancer lung
16. Surgical treatment of pulmonary Tuberculosis
17. Congenital lessions of the lung & emphysema
18. Pulmonary enbolism
19. Surgical problems of the oesophagus in infants and children
20. Disorder of the oesophagus in adult
21. Oesophygal hiatus hernia
22. The diaphragm
23. Role of Radio therapy in the malignant diseases of chest
24. Role of Physiotherapy in Chest diseases and chest surgery
25. Foreign body in air passages and oesophagus
26. Role of Nuclear Medicine in Thoracic and Surgery
27. Diseases and surgery of the pleura, Chest wall
28. Computer for surgeons & surgical audit
29. Lung transplantation
30. Pulmonary hypertension
Affiliation
1. University of Dhaka
2. Bangladesh College of Physicians and Surgeons
3. Bangabandhu Sheikh Mujib Medical University (BSMMU)
