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Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore


Regulations and Curricula

for

Post Graduate Degree and Diploma Courses

in

Medical Sciences  

2000 
 
 
 
 
 
 

 

Volume III: Clinical Subjects

 

Diploma in Ophthalmology  (D.O.)

 

 

  
 
 
 
 
 
 

 

Rajiv Gandhi University of Health Sciences, Karnataka

4th 'T' Block, Jayanagar, Bangalore - 560 041 
 
 
 

 

Regulations for Post Graduate Degree and Diploma Courses in Medical Sciences

(Annexure to University Notification No. UA/ORD-6/99-2000 dated 01.01.2000) 
 

Contents 
 


  Notification      
  Notification     
Chapter I           : Regulations
Chapter II          : Goals and Objectives
Chapter III         : Course Description
Diploma in Ophthalmology  (D.O.)
Chapter IV           :

Monitoring Learning Progress

Chapter V           : Medical Ethics
 

 

  
 
 

Rajiv Gandhi University of Health Sciences, Karnataka

4th T Block, Jayanagar, Bangalore - 560 041 

No. UA/ORD-06/1999-2000                        01.01.2000 

NOTIFICATION 

    Sub: Revised Ordinances pertaining to Post Graduate Degree, Diploma and Super Speciality Courses in Medicine

            Ref:  Minutes of the 16th syndicate meeting held on 16.11.1999. 

      In exercise of the powers conferred under Sec. 35(2) of the RGUHS Act, the Syndicate at its meeting held on 16.11.1999 has been pleased to approve the Revised Ordinances pertaining to Post Graduate Degree, Diploma and Super Speciality Courses in Medicine as given in schedule here to annexed. 

      The Revised Ordinances as above shall come into force immediately and is applicable for University examination of March 2000 and onwards. 

                                                              By order,

                                                                  Sd/

                          REGISTRAR

To  

  1. The Principals of all Medical Colleges affiliated to RGUHS
  2. The Members of the Syndicate/Senate/Academic Council.
 
 

 

Rajiv Gandhi University of Health Sciences, Karnataka

4th T Block, Jayanagar, Bangalore - 560 041 

No. UA/ORD-06/1999-2000                        26.12.2000

NOTIFICATION 

    Sub:  Revised Ordinance pertaining to PG Degree, Diploma and                                       Super Specialty Courses in Medicine

Read: The Revised Ordinance along with Syllabus and   Scheme of Examination of Pre-clinical and Para-clinical subjects pertaining to Postgraduate Degree, Diploma and Super Sociality courses in Medicine as approved by the Syndicate at its meeting held on 16.11.1999 and notified in the University notification No. UA/ORD-6/1999-2000 dt. 01.01.2000. Now the Syndicate at its meeting held on 22.11.2000 has approved Syllabus of Postgraduate Clinical Subjects and the same is notified. 

      In exercise of the powers conferred under Sec. 35(2) of the RGUHS Act, the Syndicate has been pleased to approve the Curriculum (Syllabus) of following PG Clinical Subjects in respect of above ordinance as given in the schedule here to annexed. 


Subject Degree Diploma
Anesthesiology
  1. M.D.
  1. D.A.
Aviation Medicine
  1. M.D.
      ---
Dermatology, Venereology and Leprosy
  1. M.D.
  1. DDVL
General Medicine
  1. M.D.
      ----
General Surgery
  1. M.S.
      ----
Obstetrics & Gynecology
  1. M.S.
  1. DGO
Oto-Rhino-Laryngology
  1. M.S.
  1. DLO
Ophthalmology
  1. M.S.
  1. DO
Orthopedics
  1. M.S.
  1. D. Ortho
Pediatrics
  1. M.D.
  1. DCH
Psychiatry
  1. M.D.
  1. DPM
Radio-Diagnosis
  1. M.D.
  1. DMRD
Radiotherapy
  1. M.D.
  1. DMRT
Tuberculosis & Respiratory Medicine
  1. M.D.
  1. DTCD
 

      The Syllabus as above shall be applicable from the Academic Year 2000-01. 

                                                              By order,

                                                                  Sd/

                          REGISTRAR 

To  

  1. The Principals of all Medical Colleges affiliated to RGUHS
  2. The Members of the Syndicate/Senate/Academic Council.
 

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. 

Regulations for Post Graduate Degree and Diploma Courses in Medical Sciences 

Chapter I 

  1. Branches of Study
 

    1.1     Postgraduate Degree Courses 

          The following courses of studies may be pursued.

      1. M.D. (Doctor of Medicine)
        1. Anaesthesiology 
        2. Aviation Medicine
        3. Anatomy
        4. Biochemistry
        5. Community Medicine
        6. Dermatology, Venereology and Leprosy
        7. Forensic Medicine
        8. General Medicine
        9. Microbiology
        10. Pathology
        11. Paediatrics
        12. Pharmacology
        13. Physiology
        14. Psychiatry
        15. Radio-diagnosis
        16. Radio-threapy
        17. Tuberculosis & Respiratory Medicine
     

        and such other subjects as might have been introduced by the Universities in Karnataka prior to commencement of Health University i.e., 1.6.1996, or recognised by Medical Council of India. 

      1. M.S. (Master of Surgery)
        1. General Surgery 
        2. Obstetrics and Gynecology
        3. Ophthalmology
        4. Orthopedics
        5. Oto-Rhino-Laryngology
     

        and such other subjects as might have been introduced by the Universities in Karnataka prior to commencement of Health University i.e., 1.6.1996, or recognised by Medical Council of India. 

          1. D.M. (Doctor of Medicine)
            1. Cardiology and such subjects recognised by Medical Council of India. 
          1. M.Ch (Master of Chirurgie) 
         

            In the subjects recognised by Medical Council of India. 

              1.2 Postgraduate Diploma Courses  

                      Post graduate diploma course may be pursued in the following subjects: 

                        Child Health (D.C.H.), Obstetrics and Gynaecology (D.G.O.), Otorhinolaryngology (D.L.O.), Ophthalmology (D.O.), Orthopaedics (D.Ortho), Anaesthesiology (D.A.), Clinical Pathology (D.C.P.), Microbiology (D. Micro), Public Health (D.P.H), Forensic Medicine (D.F.M.), Dermatology, Venerology and Leprosy (D.D.V.L.), Psychiatry (D.P.M.), Radio-Diagnosis (DMRD), Radio-therapy (DMRT), Tuberculosis and Chest Diseases (D.T.C.D.) and such other subjects as might have been introduced by the Universities in Karnataka prior to commencement of Health University i.e., 1-6-1996, and recognised by Medical Council of India. 

                  2. Eligibility for Admission  

                    2.1 MD / MS Degree and Diploma Courses: A candidate affiliated to this university and who has passed final year M.B.B.S.  examination after pursuing a study in a medical college recognised by the Medical Council of India, from a recognised Medical College affiliated to any other University recognised as equivalent thereto, and has completed one year compulsory rotating internship in a teaching Institution or other Institution recognised by the Medical Council of India, and has obtained permanent registration of any State Medical Council shall be eligible for admission. 

                    2.2 D.M and M.Ch Courses: 

                          D.M.: Candidate seeking admission for D.M courses in any subject must posses recognised degree of MD (or its equivalent recognised degree) in the subject specified in the regulations of the Medical Council of India from time to time. 

                           M.Ch : Candidate seeking admission for M.Ch course in any subject must posses recognised degree of MS (or its equivalent recognised degree) in the subject specified in the regulations of the Medical Council of India from time to time. 

                    3. Obtaining Eligibility Certificate by the University before making Admission 

                        No candidate shall be admitted for any postgraduate degree/diploma course unless the candidate has obtained and produced the eligibility certificate issued by the University. The candidate has to make an application to the University with the following documents along with the prescribed fee :

                      1. MBBS pass / degree certificate issued by the University.
                      2. Marks cards of all the university examinations passed MBBS course.
                      3. Attempt Certificate issued by the Principal.
                      4. Certificate regarding the recognition of the medical college by the Medical Council of India.
                      5. Completion of internship certificate.
                      6. In case internship was done in a non-teaching hospital, a certificate from the Medical Council of India that the hospital has been recognised for internship.
                      1. Registration by any State Medical Council and  
                      2. Proof of SC/ ST or Category I, as the case may be.
                     

                          Candidates should obtain the Eligibility Certificate before the last date for admission as notified by the University.

                          A candidate who has been admitted to postgraduate course should register his / her name in the University within a month of admission after paying the registration fee. 

                    4. Intake of Students  

                          The intake of students to each course shall be in accordance with the ordinance in this behalf. 

                    5. Duration of Study  

                        1. M.D /M.S Degree Courses

                                  The course of study shall be for a period of 3 years consisting of 6 terms. 

                        1. D.M /M.Ch

                                  The courses of study shall be for a period of 3 years consisting of 6 terms. 

                        1. Diploma courses:

                                  The course of study shall be for a period of 2 years consisting of 4 terms. 

                            5.2   Requirement to complete the course       --      deleted * 

                      6.  Method of training   

                            The training of postgraduate for degree/diploma shall be residency pattern with graded responsibilities in the management and treatment of patients entrusted to his/her care. The participation of the students in all facets of educational process is essential.  Every candidate should take part in seminars, group discussions, grand rounds, case demonstration, clinics, journal review meetings, CPC and clinical meetings. Every candidate should be required to participate in the teaching and training programme of undergraduate students.  Training should include involvement in laboratory and experimental work, and research studies.  Basic medical sciences students should be posted to allied and relevant clinical departments or institutions.  Similarly, clinical subjects' students should be posted to basic medical sciences and allied speciality departments or institutions. 

                      7. Attendance, Progress and Conduct 

                        7.1 A candidate pursuing degree/diploma course should work in the concerned department of the institution for the full period as a full time student. No candidate is permitted to run a clinic/laboratory/nursing home while studying postgraduate course. 

                          1. Each year shall be taken as a unit for the purpose of calculating attendance.
                          1. Every  student shall  attend  symposia, seminars, conferences, journal review meetings, 

                          grand rounds, CPC, case presentation, clinics and lectures during each year as prescribed by the department and not absent himself / herself from work without valid reasons. 

                          *  deleted vide university notification No. UA/ORD-6/1999-2000 dated 9.4.2001 

                            7.4 Every candidate is required to attend a minimum of 80% of the training during each academic year of the post graduate course.  Provided further, leave of any kind shall not be counted as part of academic term without prejudice to minimum 80% attendance of training period every year.   

                              7.5 Any student who fails to complete the course in the manner stated above shall not be permitted to appear for the University Examinations. 
                               

                              8.  Monitoring Progress of Studies: 

                              8.  Monitoring Progress of Studies: 

                                8.1 Work diary / Log Book - Every candidate shall maintain a work diary and record of his/her participation in the training programmes conducted by the department such as journal reviews, seminars, etc. (please see Chapter IV for model checklists and logbook specimen copy).  Special mention may be made of the presentations  by the candidate as well as details of clinical or laboratory procedures, if any conducted by the candidate.  The work diary shall be scrutinised and certified by the Head of the Department and Head of the Institution, and presented in the university practical/clinical examination. 

                                  8.2  Periodic tests: 

                                  Incase of degree courses of three years duration (MD/MS, DM, MCh.), the concerned departments may conduct three tests, two of them be annual tests, one at the end of first year and the other in the second year. The third test may be held three months before the final examination. The tests may include written papers, practicals / clinicals and viva voce.  Records and marks obtained in such tests will be maintained by the Head of the Department and sent to the University, when called for. 

                                  In case of diploma courses of two years duration, the concerned departments may conduct two  tests, one of them be at the end of first year and the other in the second year three months before the final examination. The tests may include written papers, practicals / clinicals and viva voce.   

                                  8.3 Records: Records and marks obtained in tests will be maintained by the Head of the Department and will be made available to the University or MCI. 

                                  9.  Dissertation 

                                  9.1 Every candidate pursuing MD/MS degree course is required to carry out work on a selected research project under the guidance of a recognised post graduate teacher.  The results of such a work shall be submitted in the form of a dissertation. 

                                    9.2 The dissertation is aimed to train a post graduate student in research methods and techniques.  It includes identification of a problem, formulation of a hypothesis, search and review of literature, getting acquainted with recent advances, designing of a research study, collection of data, critical analysis, comparison of results and drawing conclusions. 

                                      9.3 Every candidate shall submit to the Registrar (Academic) of the University in the prescribed proforma, a synopsis containing particulars of proposed dissertation work within six months from the date of commencement of the course on or before the dates notified by the University.  The synopsis shall be sent through the proper channel. 

                                        9.4 Such synopsis will be reviewed and the dissertation topic will be registered by the University.  No change in the dissertation topic or guide shall be made without prior approval of the University. 

                                          9.5 The dissertation should be written under the following headings: 

                                              i.    Introduction

                                              ii.   Aims or Objectives of study

                                              iii.  Review of Literature

                                              iv   Material and Methods

                                                  v.   Results

                                              vi.  Discussion

                                              vii.  Conclusion

                                              viii. Summary

                                              ix    References

                                              x.    Tables

                                              xi.   Annexures 

                                            9.6 The written text of dissertation shall be not less than 50 pages and shall not exceed 150 pages excluding references, tables, questionnaires and other annexures. It should be neatly typed in double line spacing on one side of paper (A4 size, 8.27"  x 11.69") and bound properly.  Spiral binding should be avoided.  The dissertation shall be certified by the guide, head of the department and head of the  Institution. 

                                            9.7 Four copies of dissertation thus prepared shall be submitted to the Registrar (Evaluation), six months before final examination on or before the dates notified by the University. 

                                              9.8 The dissertation shall be valued by examiners appointed by the University.  Approval of dissertation work is an essential precondition for a candidate to appear in the University examination. 

                                                9.9 Guide: The academic qualification and teaching experience required for recognition by this University as a guide for dissertation work is as per Medical Council of India Minimum Qualifications for Teachers in Medical Institutions Regulations, 1998.  Teachers in a medical college/institution having a total of eight years teaching experience out of which at least five years teaching experience as Lecturer or Assistant Professor gained after obtaining post graduate degree shall be recognised as post graduate teachers.

                                                 

                                                      A Co-guide may be included provided the work requires substantial contribution from a sister department or from another medical institution recognised for teaching/training by Rajiv Gandhi University of Health Sciences/Medical Council of India. The co-guide shall be a recognised post graduate teacher of Rajiv Gandhi University of Health Sciences.

                                                 

                                                9.10 Change of guide: In the event of a registered guide leaving the college for any reason or in the event of death of guide, guide may be changed with prior permission from the university.

                                               

                                                 

                                              10.  Schedule of Examination 

                                                  The examination for M.D / M.S courses shall be held at the end of three academic years ( six academic terms).  The examination for D.M and M.Ch courses shall be held at the end of three years.  The examination for the diploma courses shall be held at the end of two academic years (four academic terms).  The university shall conduct two examinations in a year at an interval of four to six months between the two examination.  Not more than two examinations shall be conducted in an academic year. 
                                             

                                            11.  Scheme of Examination 

                                            11.1 M.D. / M.S. Degree  

                                        M.D. / M.S.  Degree examinations in any subject shall consist of dissertation, written paper (Theory), Practical/Clinical and Viva voce. 

                                          11.1.1 Dissertation: Every candidate shall carryout work and submit a dissertation as indicated in Sl.NO.9. Acceptance of dissertation shall be a precondition for the candidate to appear for the final examination. 

                                            11.1.2 Written Examination (Theory): A written examination shall consist of four question papers, each of three hours duration.  Each paper shall carry 100 marks.  Out of the four papers, the 1st paper in clinical subjects will be on applied aspects of basic medical sciences. Recent advances may be asked in any or all the papers. 

                                              11.1.3 Practical / Clinical Examination:

                                                    In case of practical examination, it should be aimed at assessing competence and skills of techniques and procedures as well as testing students ability to make relevant and valid observations, interpretations and inference of laboratory or  experimental work relating to his/her  subject. 

                                                      In case of clinical examination, it should aim at examining clinical skills and competence of candidates for undertaking independent work as a specialist.  Each candidate should examine at least one long case and two short cases.    

                                                      The total marks for practical / clinical examination shall be 200. 

                                                  11.1.4 Viva Voce: Viva Voce Examination shall aim at assessing depth of knowledge, logical reasoning, confidence and oral communication skills.  The total marks shall be 100 and the distribution of marks shall be as under:

                                                            (i) For examination of all components of syllabus     80 Marks

                                                   (ii) For Pedagogy       20 Marks  

                                                  11.1.5 Examiners: There shall be at least four examiners in each subject.  Out of them two shall be external examiners and two shall be internal examiners.  The qualification and teaching experience for appointment as an examiner shall be as laid down by the Medical Council of India. 

                                                    11.1.6 Criteria for declaring as pass in University Examination: A candidate shall secure not less than 50% marks in each head of passing which shall include (1) Theory, (2) Practical including clinical and viva voce examination. 

                                                          A candidate securing less than 50% of marks as described above shall be declared to have failed in the examination. Failed candidate may appear in any subsequent examination upon payment of fresh fee to the Registrar (Evaluation).    

                                                    11.1.7 Declaration of distinction: A successful candidate passing the University examination in  first attempt will be declared to have passed the examination with distinction, if the grand total aggregate marks is 75 percent and above.  Distinction will not be awarded for candidates passing the examination in more than one attempt. 
                                                     

                                                          11.2 D.M / M.Ch: 

                                                            The examination shall consist of theory, clinical/practical and viva voce examination. 

                                                      11.2.1 (Theory) (Written Examination): The theory examination shall consist of four question papers, each of three hours duration.  Each paper shall carry 100 marks.  Out of the four papers, the first paper will be on basic medical sciences. Recent advances may be asked in any or all the papers. 

                                                      11.2.2 Practical / Clinical Examination:

                                                            In case of practical examination it should be aimed at assessing competence, skills of techniques and procedures as well as testing students ability to make relevant and valid observations, interpretence and experimental work relevant to his / her subject. 

                                                            In case of clinical examination it should aim at examining clinical skills and competence of candidates for undertaking independent work as a specialist.  Each candidate should examine at least one long case and two short cases.   

                                                            The maximum marks for Practical / Clinical shall be 200. 

                                                      11.2.3 Viva Voce: Viva Voce examination shall aim at assessing thoroughly depth of knowledge, logical reasoning, confidence and oral communication skills.  The maximum marks shall be 100. 

                                                        11.2.4 Examiners: There shall be at least four examiners in each subject.  Out of them, two shall be external examiners and two shall be internal examiners.  The qualification and teaching experience for appointment as an examiner shall be as laid down by the Medical Council of India.  

                                                        11.2.5 Criteria for declaring as pass in University Examination: A candidate shall secure not less than 50% marks in each head of passing which shall include (1) Theory, (2) Practical including clinical and viva voce examination. 

                                                              A candidate securing less than 50% of marks as described above shall be declared to have failed in the examination. Failed candidate may appear in any subsequent examination upon payment of fresh fee to the Registrar (Evaluation).    

                                                        11.3 Diploma Examination: 

                                                                Diploma examination in any subject shall consist of theory (written papers), Practical / Clinical and Viva - Voce. 

                                                            11.3.1 Theory: There shall be three written question papers each carrying 100 marks.  Each paper will be of three hours duration.  In clinical subjects one paper out of this shall be on basic medical sciences.  In basic medical subjects and para clinical subjects, questions on applied clinical aspects should also be asked. 

                                                            11.3.2 Practical / Clinical Examination:

                                                                  In case of practical examination it should be aimed at assessing competence, skills related to laboratory procedures as well as testing students ability to make relevant and valid observations, interpretation of laboratory or experimental work relevant to his/her subject. 

                                                                  In case of clinical examination, it should aim at examining clinical skills and competence of candidates for undertaking independent work as a specialist.  Each candidate should examine atleast one long case and two short cases.   

                                                                  The maximum marks for practical / Clinical shall be 150. 

                                                            11.3.3 Viva Voce Examination: Viva Voce examination should aim at assessing depth of knowledge, logical reasoning, confidence and oral communication skills.  The total marks shall be 50. 

                                                            11.3.4 Criteria for Pass: Criteria for declaring as pass in University Examination: A candidate shall secure not less than 50% marks in each head of passing which shall include (1) Theory, (2) Practical including clinical and viva voce examination. 

                                                                  A candidate securing less than 50% of marks as described above shall be declared to have failed in the examination. Failed candidate may appear in any subsequent examination upon payment of fresh fee to the Registrar (Evaluation).    

                                                            11. 3.5 Declaration of distinction: A successful candidate passing the University examination in  first attempt will be declared to have passed the examination with distinction, if the grand total aggregate marks is 75 percent and above.  Distinction will not be awarded for candidates passing the examination in more than one attempt. 

                                                            11.3.6 Examiners: There shall be at least four examiners in each subject.  Out of them, two shall be external examiners and two shall be internal examiners.  The qualification and teaching experience for appointment as an examiner shall be as laid down by the Medical Council of India.  

                                                            12. Number of Candidates per day The maximum number of candidates for practical/clinical and viva-voce examination shall be as under:

                                                                   MD / MS Course: Maximum of 6 per day

                                                                 Diploma Course: Maximum of 8 per day

                                                                DM / M.Ch  Course: Maximum of 3 per day 

                                                             

                                                                   CHAPTER  II 

                                                              GOALS AND GENERAL OBJECTIVES OF POSTGRADUATE

                                                              MEDICAL EDUCATION PROGRAM 

                                                              GOAL 

                                                                The goal of postgraduate medical education shall be to produce competent specialist

                                                                  and /or Medical teacher: 

                                                              1. who shall recognise the health needs of the community, and carry out professional obligations ethically and in keeping with the objectives of the national health policy;
                                                              1. who shall have mastered most of the competencies, pertaining to the specialty, that are required to be practiced at the secondary and the tertiary levels of the health care delivery system: 
                                                              1. who shall be aware of the contemporary advances and developments in the discipline concerned; 
                                                              1. who shall have acquired a spirit of scientific inquiry and is oriented to the principles of research methodology and epidemiology; and 
                                                              1. who shall have acquired the basic skills in teaching of the medical and paramedical professionals. 
                                                             

                                                              GENERAL OBJECTIVES 

                                                              At the end of the postgraduate training in the discipline concerned the student shall be able to: 

                                                              1. Recognise the importance of the concerned speciality in the context of the health need of the community and the national priorities in the health sector.
                                                              1. Practice the speciality concerned ethically and in step with the principles of primary health care. 
                                                              1. Demonstrate sufficient understanding of the basic sciences relevant to the concerned speciality. 
                                                              1. Identify social, economic, environmental, biological and emotional determinants of health in a given case, and take them into account while planning therapeutic, rehabilitative, preventive and promotive measures/strategies. 
                                                              1. Diagnose and manage majority of the conditions in the speciality concerned on the basis of clinical assessment, and appropriately selected and conducted investigations. 
                                                              1. Plan and advise measures for the prevention and rehabilitation of patients suffering from disease and disability related to the specialty. 
                                                              1. Demonstrate skills in documentation of individual case details as well as morbidity and mortality data relevant to the assigned situation. 
                                                              1. Demonstrate empty and humane approach towards patients and their families and exhibit interpersonal behaviour in accordance with the societal norms and expectations. 
                                                              2. Play the assigned role in the implementation of national health programmes, effectively and responsibly.
                                                              1. Organise and supervise the chosen/assigned health care services demonstrating adequate managerial skills in the clinic/hospital or the field situation. 
                                                              1. Develop skills as a self-directed learner, recognise continuing educational needs; select and use appropriate learning resources. 
                                                              1. Demonstrate competence in basic concepts of research methodology and epidemiology, and be able to critically analyse relevant published research literature. 
                                                              1. Develop skills in using educational methods and techniques as applicable to the teaching of medical/nursing students, general physicians and paramedical health workers. 
                                                              1. Function as an effective leader of a health team engaged in health care, research or training. 
                                                             

                                                              STATEMENT OF THE COMPETENCIES 

                                                                  Keeping in view the general objectives of postgraduate training, each disciplines shall

                                                                aim at development of specific competencies, which shall be defined and spelt out in clear terms.  Each department shall produce a statement and bring it to the notice of the trainees in the beginning of the programme so that he or she can direct the efforts towards the attainment of these competencies. 

                                                                COMPONENTS OF THE PG CURRICULUM 

                                                                            The major components of the PG curriculum shall be: 

                                                                  • Theoretical knowledge
                                                                  • Practical/clinical Skills 
                                                                  • Training in Thesis. 
                                                                  • Attitudes, including communication. 
                                                                  • Training in research methodology. 
                                                                 
                                                                 

                                                                      Source: Medical Council of India, Regulations on postgraduate medical education, 1997. 
                                                                 
                                                                 
                                                                 

                                                                 

                                                                Chapter III 

                                                                Course Description 

                                                                Diploma in Ophthalmology  (D.O.) 
                                                                 

                                                                 

                                                                  Goal:  The candidate shall be able to practice ophthalmology competently and safely in the community that he/she serves.  

                                                                  Objectives of the course: At the completion of the course, the candidate shall be able to:

                                                                    1. offer to the community, the current quality of ‘standard of care’ in ophthalmic diagnosis as well as therapeutics, medical or surgical, in most of the common and easily managed situations at the District or Secondary level of health service.
                                                                    2. periodically self assess his or her performance and keep abreast with ongoing advances in the field and apply the same in his /her practice.
                                                                    3. be aware of his or her own limitations to the application of the specialty in situations which warrant referral to more qualified centers or individuals.
                                                                    4. apply research and epidemiological methods during his / her practice. The candidate  shall be able to present or publish work done by him/her.
                                                                    5. contribute as an individual/or in a group or institution  towards the fulfillment of national objectives with regard to prevention of blindness.
                                                                    6. effectively communicate with patients or relatives so as to educate them sufficiently and give them the full benefit of informed consent to treatment and ensure compliance.
                                                                    7. effectively communicate with colleagues.
                                                                   
                                                                   

                                                                  Essential theoretical  knowledge

                                                                    These are only broad guidelines and are illustrative, there may be overlap between sections.  

                                                                    1. The Basic Sciences :
                                                                      1. Orbital and Ocular anatomy  
                                                                          1. Gross anatomy
                                                                          1. Histology
                                                                      1. Ocular Physiology
                                                                      1. Pathology 
                                                                      1. General pathology
                                                                      2. Ocular pathology : Gross pathology, Histopathology.
                                                                      1. Biochemistry: General biochemistry, Biochemistry applicable to ocular function.
                                                                      1. Microbiology

                                                                        a. General Microbiology

                                                                        b. Specific microbiology applicable to the eye

                                                                        c. Immunology with particular reference to ocular immunology

                                                                      vi. Geometric and ophthalmic optics

                                                                      1. Basic physical optics
                                                                      2. Ophthalmic optics
                                                                      3. Applied optics including optical devices
                                                                   

                                                                    b.   Clinical Ophthalmology 

                                                                        1. Disorders of Refraction
                                                                        2. Disorders of the Lids
                                                                        3. Disorders of the Lacrimal System
                                                                        4. Disorders of the Conjunctiva
                                                                        5. Disorders of the Sclera
                                                                        6. Disorders of the Cornea
                                                                        7. Disorders of the Uveal Tract
                                                                        8. Disorders of the Lens
                                                                        9. Disorders of the Retina
                                                                        10. Disorders of the Optic Nerve & Visual Pathway
                                                                        11. Disorders of the Orbit
                                                                        12. Glaucoma
                                                                        13. Neuro ophthalmology
                                                                        14. Paediatric ophthalmology
                                                                        15. Systemic ophthalmology ( Ocular involvement in systemic disease)
                                                                        16. Immune ocular disorders
                                                                        17. Strabismus & Amblyopia

                                                                     

                                                                    Essential diagnostic skills - instrumentation

                                                                      • Tonometry  
                                                                        1. Applanation
                                                                        2. Indentation ( commonly Schiotz )
                                                                      • Assessment of epiphora
                                                                        1. Jone’s dye test
                                                                        2. Syringing – performance & interpretation
                                                                      • Dry eye evaluation
                                                                        1. Schirmer test
                                                                        2. Rose Bengal staining
                                                                        3. Tear film breakup time
                                                                        4. Tear meniscus evaluation
                                                                      • Corneal ulceration
                                                                        1. Taking a corneal scraping
                                                                        2. Inoculation into media
                                                                        3. Evaluation of Gram’s stain
                                                                        4. Evaluation of KOH preparation
                                                                      • Direct ophthalmoscopy
                                                                        1. Distant direct
                                                                        2. Media assessment
                                                                        1. Use of filters provided 
                                                                      • Indirect ophthalmoscopy
                                                                        1. Scleral depression
                                                                        2. Fundus drawing capability
                                                                        3. Use of filters provided
                                                                      • Slit Lamp Examination
                                                                        1. Diffuse examination
                                                                        2. Focal examination
                                                                        3. Retroillumination – direct & indirect
                                                                        4. Sclerotic scatter
                                                                        5. Specular reflection
                                                                        6. Staining modalities and interpretation
                                                                      • Slit Lamp Accessories:
                                                                        1. Applanation Tonometry
                                                                          1. Goldman’s applanation
                                                                        2. Gonioscopy
                                                                          1. Single mirror gonioscope
                                                                          2. Grading of the angle
                                                                          3. Testing for occludability
                                                                          4. Indentation gonioscopy
                                                                        3. 3- mirror examination of the fundus
                                                                        4. 78-D / 90-D / 60-D examination
                                                                      • Colour vision evaluation
                                                                        1. Ishihara pseudoisochromatic plates
                                                                      • Use of Amsler’s charting
                                                                        1. Instructing in the use of and interpreting the chart.
                                                                      • Keratometry
                                                                        1. Performance & interpretation of keratometry
                                                                        2. Diagnosis of situations such as keratoconus
                                                                        3. Keratoscopy
                                                                      • Fundus photography & fundus fluorescein angiography (FFA, FAG)
                                                                        1. Performance of and interpretation of FFA
                                                                        2. Performance of indirect fluorescein angioscopy
                                                                      • Refraction
                                                                        1. Retinoscopy
                                                                        2. Streak Retinoscopy
                                                                        3. Use of trial set
                                                                        4. Use of Jackson’s cross-cylinder
                                                                        5. Subjective and objective refraction
                                                                      • Diagnosis & assessment of Squint
                                                                        1. Ocular position and motility examination
                                                                        2. Versions, ductions, and vergences
                                                                        3. Convergence facility estimation
                                                                        4. Cover / Uncover / Alternate cover test
                                                                        1. Use of prism bars or free prisms in assessment of squint 
                                                                        2. Use of Bagolini’s striated glasses / red filters / Maddox rod
                                                                        3. Use of Worth’s four dot test
                                                                        4. Use of minor amblyoscope
                                                                        5. Use & interpretation of the Hess chart / Lees’ screen
                                                                        6. Performance & interpretation of diplopia charting
                                                                        7. Diagnosis of amblyopia
                                                                      • Exophthalmometry
                                                                        1. Measurement of proptosis or exophthalmos
                                                                      • Use and evaluation of ophthalmic ultrasound 
                                                                        1. A- scan ultrasound with biometry
                                                                      • Interpretation  of  perimetry
                                                                        1. Static computerized perimetry
                                                                          1. Interpretation of commonly managed problems
                                                                      • Radiology
                                                                        1. Interpretation of plain skull films
                                                                          1. PA-20 ( Caldwell’s view )
                                                                          2. PNS ( Water’s view )
                                                                          3. Lateral
                                                                          4. Submentovertical
                                                                          5. Optic canal views
                                                                          6. Localisation of intra ocular and intra orbital FBs
                                                                        2. Interpretations of contrast studies
                                                                        3. Interpretation of CT – Scans
                                                                          1. Orbital CT interpretation
                                                                     
                                                                     

                                                                    Essential surgical skills 


                                                                    Procedure

                                                                    Nature of Activity and Number

                                                                    O A PA PI
                                                                    1. Operating theatre
                                                                           
                                                                      1. Anaesthesia :
                                                                           
                                                                        1. Retrobulbar anaesthesia
                                                                    - - - 15
                                                                        1. Peribulbar anaesthesia
                                                                    - - - 15
                                                                        1. Facial blocks
                                                                    - - -
                                                                          • O’Brein
                                                                    - - - 15
                                                                          • Atkinson
                                                                    - - - 15
                                                                          • van Lint & modifications
                                                                    - - - 2
                                                                        1. Frontal blocks
                                                                    - - - 1
                                                                        1. Infra orbital blocks
                                                                    - - - 1
                                                                        1. Blocks for sac surgery
                                                                    - - - 3
                                                                             
                                                                      1. Magnification :
                                                                           
                                                                        1. Operating microscope : Familiarity with use is essential
                                                                    - - -
                                                                             
                                                                      1. Lid surgery:
                                                                           
                                                                        1. Tarsorrhaphy
                                                                    - - - 5
                                                                        1. Ectropion and entropion procedures
                                                                    - - - 1
                                                                        1. Lid repair following trauma
                                                                    - - 1 -
                                                                        1. Epilation,
                                                                    - - - 5
                                                                      1. Destructive procedures:
                                                                           
                                                                        1. Evisceration with or without implant
                                                                    - - - 1
                                                                        1. Enucleation with or without implant 
                                                                    - - - 3
                                                                             
                                                                      1. Sac surgery
                                                                           
                                                                        1. Dacryocystectomy
                                                                    - - - 2
                                                                        1. Dacryocystorhinostomy
                                                                    - - - 1
                                                                        1. Probing for congenital obstruction of nasolacrimal duct
                                                                    - - 1 -
                                                                             
                                                                      1. Extraocular muscle surgery
                                                                           
                                                                        1. Recession and resection procedures on the horizontal recti
                                                                    - - 1 -
                                                                               
                                                                      1. Cataract surgery
                                                                           
                                                                        1. Standard ECCE with or without IOL implantation.
                                                                    - - - 1
                                                                        1. Small incision ECCE with or without IOL implantation
                                                                    - - -
                                                                        1. Secondary AC or PC IOL implantation
                                                                    - - -
                                                                        1. Vectis extraction
                                                                    - - 1 -
                                                                             
                                                                      1. Orbit surgery
                                                                           
                                                                        1. Incision and drainage via anterior orbitotomy for abscess
                                                                    - 1 - -
                                                                      1. Vitrectomy
                                                                           
                                                                        1. Intra vitreal and intra cameral ( anterior chamber ) injection techniques and dosages , particularly for endophthalmitis management.
                                                                    - - 1 -
                                                                        1. Needs to know the basics of open sky vitrectomy ( anterior segment ) as management of cataract surgery complication
                                                                    - - - 1
                                                                             
                                                                      1. Keratoplasty
                                                                           
                                                                        1.  Assisting penetrating keratoplasty ( therapeutic, optical )
                                                                    - - 1 -
                                                                      1. Glaucoma surgery
                                                                           
                                                                        1. Trabeculectomy
                                                                    - - - 1
                                                                        1. Pharmacological modifications of trabeculectomy
                                                                           
                                                                        1. Cyclocryotherapy
                                                                    - - - 1
                                                                      1. Surface ocular procedures
                                                                           
                                                                        1. Pterygium excision with modifications
                                                                    - - - 2
                                                                        1. Conjunctival grafting
                                                                    - - 1 -
                                                                             
                                                                      1. Pterygium excision
                                                                    - - - 2
                                                                      1. Tarsorrhaphy
                                                                    - - - 5
                                                                      1. Retrobulbar, parabulbar anaesthesia
                                                                    - - - 15
                                                                             
                                                                    1. Outpatient :
                                                                           
                                                                             
                                                                      1. Manual diagnostic procedures such as syringing, corneal scraping, conjunctival swab collection, conjunctival scraping etc.
                                                                    - - - 5
                                                                      1. Conjunctival and corneal foreign body removal on the slit lamp
                                                                    - - - 5
                                                                      1. Chalazion  incision and curettage
                                                                    - - - 5
                                                                      1. Biopsy of small lid and  tumours
                                                                    - - 1 -
                                                                      1. Suture removal  skin, conjunctival, corneal, and corneoscleral
                                                                    - - - 3
                                                                      1. Subconjunctival injection
                                                                    - - - 8
                                                                      1. Posterior Sub- Tenon’s injections
                                                                    - - - 2
                                                                      1. Artificial eye fitting
                                                                    - - - 2

                                                                     

                                                                    Essential Research Skills

                                                                          1. Basic statistical knowledge  
                                                                        1. Ability to undertake clinical & basic research
                                                                        2. Descriptive and Inferential statistics
                                                                        3. Ability to publish results of one’s work
                                                                      1. Ability to constructively criticize publications in the field and without
                                                                      1. This could be achieved during the course by attending  regularly  Journal Clubs etc. where selected articles could be taken and evaluated for content quality and presentation.
                                                                     

                                                                    Other skills required: 

                                                                          1. Contact lenses
                                                                        1. Assessment 
                                                                           
                                                                        2. RGP fitting
                                                                        3. Soft lens fitting
                                                                        4. Troubleshooting
                                                                    1. Subjective correction of refraction
                                                                      1. Techniques of subjective correction
                                                                      2. Knowledge of basic optical devices available and relative advantages and disadvantages of each.
                                                                    2. Low vision aids
                                                                      1. The basics of fitting with knowledge of availability & cost
                                                                    3. Community ophthalmology
                                                                      1. Ability to organize institutional screening
                                                                      2. Ability to organize peripheral eye screening camps
                                                                      3. Knowledge and ability to execute guidelines of National Program for Prevention of Blindness
                                                                    4. Presentation
                                                                      1. Ability to present one’s work  effectively at  various scientific for a particularly free papers in scientific conferences within allotted framework of time
                                                                    5. Organisation
                                                                      1. Ability to organize meetings, seminars and symposia
                                                                      2. Ability to get along with colleagues and work as a team with the other members of the department.
                                                                      3. Ability to interact with and work as a team with other disciplines that may exist in the same hospital.
                                                                    1. Communication skills  
                                                                      1. With patients
                                                                      2. With colleagues
                                                                    2. Record keeping
                                                                      1. The ability to maintain records as scientifically as possible
                                                                      2. Knowledge of computer software is helpful
                                                                    3. Teaching
                                                                      1. The ability to pass on skills acquired to one’s juniors, theoretical, procedural and surgical

                                                                     

                                                                     

                                                                    Academic Activities

                                                                     

                                                                    Year – wise structured training schedule

                                                                     

                                                                     First year : 

                                                                    1. Theoretical knowledge
                                                                      1. Basic sciences should be addressed during this period
                                                                      2. It is useful to have an internal examination of the basic sciences at the end of the first year, which will decide appearance at the final examination.
                                                                      3. Clinical ophthalmology.
                                                                    2. Clinical examination and diagnostics
                                                                      1. The basics of history taking, order and correct methods of examination and recording have to be learnt during this time.
                                                                      2. Clinical and surgical decision making is encouraged under supervision.
                                                                    3. Diagnostics
                                                                      1. All procedures in bold should as far as possible be done and the student should be fairly conversant with most of the techniques marked in bold.
                                                                    4. Surgery
                                                                      1. Extra ocular surgery including
                                                                        1. Destructive procedures must have been done independently with or without assistance
                                                                        2. Local Anaesthesia ( retrobulbar and peribulbar blocks )
                                                                        3. Subconjunctival injections
                                                                        4. Assisting for squint surgery
                                                                        5. Assisting for lid surgery. Tarsorrhaphy should be performed independently as also the simpler oculoplastic procedures.
                                                                        6. Chalazion and Pterygium surgery.
                                                                        7. Lid and corneal foreign body removal, suture removal on the slit lamp etc.
                                                                        8. At the end of the first year, the student should have participated as

                                                                             assistant in most of the intra ocular procedures as an assistant.

                                                                        1. Cataract surgery :
                                                                          1. Cataract surgery should be approached in stages, emphasis to be given on microscopic surgery.
                                                                          2. At the end of the first year, the student should  be able to do standard extracapsular cataract extraction at least under guidance.

                                                                  Second year :

                                                                      Theoretical Knowledge :

                                                                      Here stress will be laid on clinical ophthalmology

                                                                      Clinical examination and diagnostics 

                                                                        The student is encouraged to take diagnostic investigational and therapeutic decisions on his / own. He / she should be able to manage most of the common problems that arise without guidance. However, the degree of freedom allowed in decision making is left to the confidence of the teacher in the student’s abilities. It is to be encouraged.  May require guidance for more complex cases.

                                                                        Diagnostics

                                                                        The student should be conversant and at ease with all the diagnostic procedures  outlined in the section on ‘Essential diagnostic skills- instrumentation’. 

                                                                        Surgical skills

                                                                          At the end of the second year, the student should  capable of operating, without assistance, but under supervision, all varieties of cataract except congenital cataract. He / she should also know the management of cataract induced complications and cataract surgical complications ( management of  vitreous loss ).

                                                                          He/she should have performed the basic antiglaucoma procedures such as trabeculectomy either with assistance or under supervision

                                                                          Extra ocular surgery such as squint surgery could be performed  with assistance.

                                                                          In addition, lacrimal  sac surgery such as dacryocystectomy and dacryocystorhinostomy  should be possible with assistance or under supervision.  
                                                                           

                                                                          Conferences and workshops 

                                                                          The candidate should have attended one or two regional workshops and one national conference if possible. Presentation of a free paper at these venues is to be encouraged.  

                                                                          Clinical Case discussions 

                                                                          Bedside discussion on the rounds,  outpatient teaching  in addition to these,  clinical case discussions should form part of a department’s schedule.  

                                                                          Case discussions on the patient’s records written by the student is to be encouraged as it  helps exercise the student’s diagnostic and decision making skills. It also helps the consultant in critical evaluation of the student’s progress academically.  

                                                                          Case presentation at other  hospitals and multidisciplinary forums may be encouraged. 

                                                                          Seminars 

                                                                          Seminars should be conducted at least once weekly. The duration should be 1 – 1.5 hours. The topics selected should be repeated once in 2 years so as to cover as wide a range of topics as possible.  

                                                                        Seminars could be individual presentations or a continuum ( large topic ) with many candidates participating.  

                                                                      Each candidate shall present at least three seminar a year and a total of six seminars in two years 

                                                                      Journal Clubs 

                                                                  This also should be a once a week  or once in two week exercise. The topics selected should be current. It could be done topic wise or journal wise. Ideally, indexed journals are recommended. 

                                                              Each candidate shall present journals allotted at least three times in a year and a total of six such presentations be made in two years 

                                                              CPC 

                                                              CPCs  are extremely useful clinicopathological exercises and two or more should be done per year ideally.  

                                                              Lectures 

                                                              Lectures to candidates should be in the form of instructional courses at the beginning of the academic term. These would include topics such as dark room techniques, fundus fluorescein angiography,  evaluation of perimetry, squint evaluation and management, slit lamp examination with accessories such as gonioscopy etc.  

                                                              Lectures could also be arranged round the year on subspecialty topics.  

                                                            During the course, the candidates should have one lecture / one seminar on National programs (eg. National program for control of blindness, Trachoma program etc.), International assistance schemes for execution of national program (DAN-PCB, Lion’s International, Christoffel-Blunden Mission etc ). These would be addressed to in detail, including current status etc..  In addition, it would be useful to include a few details of other non-ophthalmic programs being undertaken in the country. 

                                                      Research Activities 

                                                    Every candidate may be allotted a departmental project either clinical or basic research, ongoing or afresh. A candidate should learn to be conversant with journal browsing, medline search etc. to help in project and clinical and research work.  

                                                    Rotation and Posting in other Departments: 

                                                    In institutions where subspecialities are not  being usually performed, ( eg. VR surgery, orbit surgery etc.), students could be deputed for a month or so in institutions in which these specialities are highly developed.

                                                    For an Diploma student, optional rotation postings to allied departments would include

                                                      Plastic Surgery

                                                      Neurology / Neurosurgery

                                                      Intensive Care

                                                      ENT

                                                    The total duration of posting should not exceed 2 months.

                                                     

                                                     

                                                    Orientation program

                                                     

                                                    All postgraduates from all specialties should have an introductory program in the institution where they are informed about candidate responsibilities, working systems, library usage, lab protocols etc.

                                                    Specific orientation regarding the departmental working could be made as an introductory talk in the department concerned.  

                                                    Monitoring of teaching and learning activities 

                                                    It is essential to monitor  the learning progress of each candidate through continuous appraisal and regular assessment. It not only also helps teachers to evaluate students, but also students to evaluate themselves. The monitoring be done by the staff of the department based on participation of students in various teaching / learning activities. It may be structured and assessment be  done using checklists that assess  various aspects. Checklists are given in Chapter IV.  

                                                    The learning out comes to be assessed should included: (i) Personal Attitudes, (ii) Acquisition of Knowledge, (iii) Clinical and operative skills, (iv) Teaching skills and (v) Dissertation. 

                                                    i) Personal Attitudes. The essential items are:

                                                    • Caring attitudes
                                                    • Initiative
                                                    • Organisational ability 
                                                    • Potential to cope with stressful situations and undertake responsibility
                                                    • Trust worthiness and reliability
                                                    • To understand and communicate intelligibly with patients and others
                                                    • To behave in a manner which establishes professional relationships with patients and colleagues
                                                    • Ability to work in team
                                                    • A critical enquiring approach to the acquisition of knowledge
                                                     

                                                    The methods used mainly consist of observation. It is appreciated that these items require a degree of subjective assessment by the guide, supervisors and peers. 

                                                    ii) Acquisition of Knowledge  :  The methods used comprise of `Log Book’ which records participation in various teaching / learning activities by the students. The number of activities attended and the number in which presentations are made are to be recorded. The log book should periodically be validated by the supervisors. Some of the activities are listed. The list is not complete. Institutions may include additional activities, if so, desired. 

                                                    Journal Review Meeting ( Journal Club):  The ability to do literature search, in depth study, presentation skills, and use of audio- visual aids are to be assessed. The assessment is made by faculty members and peers attending the meeting using a checklist ( see Model Checklist – I, Chapter IV) 

                                                    Seminars / Symposia:  The topics should be assigned to the student well in advance to facilitate in depth study. The ability to do literature search, in depth study, presentation skills and use of audio- visual aids are to be assessed using a checklist (see Model Checklist-II, Chapter IV) 

                                                    Clinico-pathological conferences : This should be a multidisciplinary case study of an interesting case to train the candidate to solve diagnostic and therapeutic problems by using an analytical approach. The presenter(s) are to be assessed using a check list similar to that used for seminar. 

                                                    1. Clinical  skills
                                                     

                                                    Day to Day work :  Skills in outpatient and ward work should be assessed periodically. The assessment should include the candidates’ sincerity and punctuality, analytical ability and communication skills (see Model Checklist III, Chapter IV). 

                                                    Clinical meetings :   Candidates should periodically present cases to his peers and faculty members. This should be assessed using a check list (see Model checklist IV, Chapter IV). 

                                                    Clinical and Procedural skills :  The candidate should be given graded responsibility to enable learning by apprenticeship. The performance is assessed by the guide by direct observation. Particulars are recorded by the student in the log book. (Table No.3, Chapter IV) 
                                                     
                                                     

                                                    1. Work diary / Log Book - Every candidate shall maintain a work diary and record his/her participation in the training programmes conducted by the department such as journal reviews, seminars, etc.  Special mention may be made of the presentations  by the candidate as well as details of clinical or laboratory procedures, if any conducted by the candidate.  The work diary shall be scrutinised and certified by the Head of the Department and Head of the Institution,  and presented in the university practical/clinical examination.

                                                      iv) Periodic tests: The  departments may conduct two  tests, one of them be at the end of first year and the other in the second year three months before the final examination. The tests may include written papers, practicals / clinicals and viva voce. 

                                                    1. Records: Records, log books and marks obtained in tests will be maintained by the Head of the Department and will be made available to the University or MCI.
                                                     

                                                    Log book 

                                                    The log book is a record of the important activities of the candidates during his training, Internal assessment should be based on the evaluation of the log book. Collectively, log books are a tool for the evaluation of the training programme of the institution by external agencies. The record includes academic activities as well as the presentations and procedures carried out by the candidate.

                                                    Format for the log book for the different activities is given in Tables 1,2 and 3 of  Chapter IV, Copies may be made and used by the institutions. 

                                                    Procedure for defaulters:  Every department should have a committee to review such situations. The defaulting candidate is counselled by the guide and head of the department. In extreme cases of default the departmental committee may recommend that defaulting candidate be withheld from appearing the examination, if she/he fails to fulfill the requirements in spite of being given adequate chances to set himself or herself right. 

                                                 

                                                Scheme of examination

                                                 

                                                a.   Theory ( Written) 

                                                  There shall be four question papers, each of three hours duration, carrying 100 marks.  Each paper shall consist of two long essay questions each carrying 20 marks and six short essay type of questions each carrying 10 marks. Questions on recent advances may be asked in any or all the papers. Details of distribution of topics for each paper will be as follows: 

                                                  Paper I : 

                                                  1. Basic Sciences :

                                                    Anatomy of the eye & orbit

                                                    Ocular physiology

                                                    Ophthalmic pathology

                                                    Microbiology & Immunology  

                                                                      Biochemistry relevant to ophthalmology

                                                    Ocular Pharmaocology

                                                    Geometric and ophthalmic optics

                                                  1. Disorders of Refraction
                                                  2. Concomitant Strabismus and Amblyopia
                                                  3. Paediatric ophthalmology
                                                  4. Disorders of the Lens
                                                 

                                                      Paper II : 

                                                  1. Disorders of the Sclera
                                                  2. Disorders of the Uvea
                                                  3. Immune ocular disorders
                                                  4. Disorders of the Cornea
                                                  5. Disorders of the Conjunctiva
                                                  6. Injuries of eye and orbit

                                                   

                                                            Paper III : 

                                                  1. Disorders of the Orbit
                                                  2. Disorders of the Lids
                                                  3. Disorders of the Lacrimal system
                                                  4. Neuroophthalmology
                                                  5. Glaucoma
                                                  6. Systemic ophthalmology
                                                  7. Disorders of the Retina
                                                  8. Community ophthalmology
                                                  9. Surgical Ophthalmology
                                                 

                                                Note: The distribution of chapters / topics shown against the papers are suggestive only. 
                                                 

                                                b.  Clinical Examination: Total marks = 150 

                                                1. One long case
                                                  1. Marks: 50
                                                  2. Type of case:
                                                    1. Neuro ophthalmology
                                                    2. Proptosis
                                                    3. Sclerokeratouveitis
                                                    4. Uveitis with complications
                                                    5. Lens induced complications
                                                    6. Glaucoma
                                                    7. Other
                                                1. Two short cases:  Marks: 25 + 25 = 50 
                                                1. One fundus case:  Marks: 25 

                                                    Type of cases:

                                                    1. Rhegmatogenous retinal detachment
                                                    2. Diabetic retinopathy, background & proliferative
                                                    3. Vasculitis
                                                    4. Tractional RD
                                                    5. Hypertensive retinopathy and combinations of the same with DR
                                                    6. Mass lesions
                                                    7. High myopia with degeneration
                                                    8. Coloboma choroids, simple or with detachment
                                                    9. Posterior uveitis, retinitis etc.
                                                    10. Pigmentary Retinopathy
                                                1. One refraction case: 
                                                  1. Duration: 10 minutes 
                                                  2. Marks: 25
                                                  3. The candidate should perform retinoscopy, on each eye.
                                                 
                                                 

                                                c.  Viva - voce: Marks: 50 

                                                  Viva- voce shall include questions on the following :

                                                  1. Surgical instruments displayed
                                                  2. Pathology slides:
                                                  3. Pathology gross specimens:
                                                  4. Microbiology slides:
                                                  5. Radiology
                                                  6. Perimetry
                                                  7. Neuro-ophthalmology & Systemic disorders
                                                  8. Community ophthalmology
                                                  9. Uvea and Glaucoma
                                                  10. Conjunctiva,Cornea, Lens
                                                  11. Orbit & oculoplastics
                                                  12. Retina
                                                  13. Miscellaneous
                                                 
                                                 

                                                iv.    Maximum marks for  Theory  Practical Viva Grand Total

                                                      DO               300               150              50      500 
                                                 

                                                Recommended Books and Journals: 

                                              Recommended books: 

                                                Duane’s System of Ophthalmology

                                                Jakobiec Series

                                                Peyman’s Series

                                                Duke-Elder’s System of Ophthalmology

                                                American Academy Series

                                                Podos & Yanoff Series

                                                Jack Kanski: Clinical Ophthalmology

                                                Cornea :

                                                1. Smolin & Thoft
                                                2. Grayson
                                                3. Kaufman & Leibowitz

                                                Glaucoma

                                              1. Bruce Shields Text Book of Glaucoma
                                              2. Krupin & Shields Series on Glaucoma
                                              3. Becker & Schaeffer’s Text Book of Glaucoma
                                              4. Anderson’s Computerised Perimetry
                                              5. Harrington’s Text Book of Perimetry
                                              6. Leiberman and Drake : Computerised perimetry

                                                Retinal disease:

                                              1. Stephen Ryan’s Retina
                                              2. Ron Michel: Retinal Detachment
                                              3. Steve Charles: Basic Vitrectomy

                                                Ultra Sound:

                                                 a.  Sandra Byrne & Ronald Green: Ophthalmic Ultrasound

                                                Uvea:

                                              1. Nussenblatt & Palestine
                                              2. Smith & Nozik

                                                Neuroophthalmology:

                                                 a. Walsh & Hoyt

                                                Orbital diseases:

                                                 a. Rootman’s diseases of the orbit

                                                 b. Jakobiec & Snow – Diseases of the orbit

                                                Tumours:

                                              1. Jerry Shields – Diagnosis and management of orbital tumours
                                              2. Jerry Shields – Diagnosis and management of ocular tumours

                                                Strabismus:

                                              1. Gunter von Noorden
                                              2. Mein &Trimble

                                                Ophthalmic Pathology:

                                              1. Yanoff & Fine
                                              2. Zimmerman

                                                Pharmacology:

                                                 a. Havener 

                                                Anatomy:

                                                  Wolff

                                                  Snell’s

                                                Physiology:

                                                  Adler’s Physiology of the Eye

                                                Biochemistry:

                                                  Standard text books

                                                Immunology:

                                                  Ocular immunology

                                                Paediatric ophthalmology

                                                  Kenneth Wright

                                                Refraction:

                                                  Duke Elder’s practice of refraction

                                                  Elkington &Frank

                                               

                                              ADDITIONAL READING

                                              1. Indian Council of Medical Research, "Ethical Guidelines for Biomedical Research on Human Subjects", I.C.M.R, New Delhi, 2000. 
                                              1. Code of Medical Ethics framed under section 33 of the Indian Medical Council Act, 1956.   Medical Council of India, Kotla Road, New Delhi. 
                                              1. Francis  C M, Medical Ethics, J P Publications, Bangalore, 1993. 
                                              1. Indian National Science Academy, Guidelines for care and use of animals in Scientific Research, New Delhi, 1994.   
                                              1. Internal National Committee of Medical Journal Editors, Uniform requirements for manuscripts submitted to biomedical journals, N Engl J Med 1991; 424-8 
                                              1. Kirkwood B R, Essentials of Medical Statistics , 1st Ed., Oxford: Blackwell Scientific Publications 1988. 
                                              1. Mahajan B K, Methods in Bio statistics for medical students, 5th Ed. New Delhi, Jaypee Brothers Medical Publishers, 1989. 
                                              1. Compendium of recommendations of various committees on Health and Development (1943-1975). DGHS, 1985 Central Bureau of Health Intelligence, Directorate General of Health Services, min. of Health and Family Welfare, Govt. of India, Nirman Bhawan, New Delhi. P - 335.  
                                              1. National Health Policy,  Min. of Health & Family Welfare, Nirman Bhawan, New Delhi, 1983  
                                              1. Srinivasa D K etal, Medical Education Principles and Practice, 1995. National Teacher Training Centre, JIPMER, Pondicherry 
                                               

                                              Chapter IV 

                                              Monitoring Learning Progress 

                                              It is essential to monitor  the learning progress of each candidate through continuous appraisal and regular assessment. It not only also helps teachers to evaluate students, but also students to evaluate themselves. The monitoring be done by the staff of the department based on participation of students in various teaching / learning activities. It may be structured and assessment be  done using checklists that assess  various aspects. Model Checklists are given in this Chapter which may be copied and used.   

                                              The learning out comes to be assessed should included: (i) Personal Attitudes, (ii) Acquisition of Knowledge, (iii) Clinical and operative skills, and (iv) Teaching skills. 

                                              1. Personal Attitudes. The essential items are:
                                              • Caring attitudes
                                              • Initiative
                                              • Organisational ability
                                              • Potential to cope with stressful situations and undertake responsibility
                                              • Trust worthiness and reliability
                                              • To understand and communicate intelligibly with patients and others
                                              • To behave in a manner which establishes professional relationships with patients and colleagues
                                              • Ability to work in team
                                              • A critical enquiring approach to the acquisition of knowledge
                                               

                                              The methods used mainly consist of observation. It is appreciated that these items require a degree of subjective assessment by the guide, supervisors and peers. 

                                              ii) Acquisition of Knowledge  :  The methods used comprise of `Log Book’ which records participation in various teaching / learning activities by the students. The number of activities attended and the number in which presentations are made are to be recorded. The log book should periodically be validated by the supervisors. Some of the activities are listed. The list is not complete. Institutions may include additional activities, if so, desired. 

                                              Journal Review Meeting ( Journal Club):  The ability to do literature search, in depth study, presentation skills, and use of audio- visual aids are to be assessed. The assessment is made by faculty members and peers attending the meeting using a checklist ( see Model Checklist – I, Chapter IV) 

                                              Seminars / Symposia:  The topics should be assigned to the student well in advance to facilitate in depth study. The ability to do literature search, in depth study, presentation skills and use of audio- visual aids are to be assessed using a checklist (see Model Checklist-II, Chapter IV) 

                                              Clinico-pathological conferences : This should be a multidisciplinary case study of an interesting case to train the candidate to solve diagnostic and therapeutic problems by using an analytical approach. The presenter(s) are to be assessed using a check list similar to that used for seminar. 

                                              Medical Audit: Periodic morbidity and mortality meeting  be held. Attendance and participation in these must be insisted upon. This may not be included in assessment.

                                              1. Clinical  skills

                                              Day to Day work :  Skills in outpatient and ward work should be assessed periodically. The assessment should include the candidates’ sincerity and punctuality, analytical ability and communication skills (see Model Checklist III, Chapter IV). 

                                              Clinical meetings :   Candidates should periodically present cases to his peers and faculty members. This should be assessed using a check list (see Model checklist IV, Chapter IV). 

                                              Clinical and Procedural skills :  The candidate should be given graded responsibility to enable learning by apprenticeship. The performance is assessed by the guide by direct observation. Particulars are recorded by the student in the log book. (Table No.3, Chapter IV) 

                                              iv)  Teaching skills : Candidates should be encouraged to teach undergraduate medical students and paramedical students, if any. This performance should be based on assessment by the faculty members of the department and from feedback from the undergraduate students (See Model checklist V, Chapter IV) 

                                              vi)  Periodic tests: In case of degree courses of three years duration, the concerned departments may conduct three tests, two of them be annual tests, one at the end of first year and the other in the second year. The third test may be held three months before the final examination. The tests may include written papers, practicals / clinicals and viva voce.   

                                              In case of diploma courses of two years duration, the concerned departments may conduct two  tests, one of them be at the end of first year and the other in the second year three months before the final examination. The tests may include written papers, practicals / clinicals and viva voce.   

                                              vii) Work diary / Log Book- Every candidate shall maintain a work diary and record his/her participation in the training programmes conducted by the department such as journal reviews, seminars, etc. Special mention may be made of the presentations by the candidate as well as details of clinical or laboratory procedures, if any conducted by the candidate.  

                                              viii) Records: Records, log books and marks obtained in tests will be maintained by the Head of the Department and will be made available to the University or MCI. 

                                              Log book 

                                              The log book is a record of the important activities of the candidates during his training, Internal assessment should be based on the evaluation of the log book. Collectively, log books are a tool for the evaluation of the training programme of the institution by external agencies. The record includes academic activities as well as the presentations and procedures carried out by the candidate. 

                                              Format for the log book for the different activities is given in Tables 1,2 and 3 of Chapter IV. Copies may be made and used by the institutions. 

                                              Procedure for defaulters:  Every department should have a committee to review such situations. The defaulting candidate is counseled by the guide and head of the department. In extreme cases of default the departmental committee may recommend that defaulting candidate be withheld from appearing the examination, if she/he fails to fulfill the requirements in spite of being given adequate chances to set himself or herself right.

                                               

                                              CHAPTER IV (Contd.) 

                                               

                                              Format of Model Check Lists  

                                              Check List -I.    MODEL CHECK-LIST FOR EVALUATION  OF  JOURNAL REVIEW PRESENTATIONS 

                                              Name of the Student:    Name of the Faculty/Observer:                                  Date: 


                                              Sl. No. Items for observation during presentation Poor 

                                              0

                                              Below Average

                                              1

                                              Average 

                                              2

                                              Good 

                                              3

                                              Very Good

                                              4

                                              Article chosen was          
                                              Extent of understanding of scope & objectives of the paper by the  candidate          
                                              Whether cross references have been consulted          
                                              Whether other relevant publications consulted          
                                              Ability to respond to questions on the paper / subject          
                                              Audio-Visual aids used          
                                              Ability to defend the paper          
                                              Clarity of presentation          
                                              Any other observation          
                                                 
                                              Total Score
                                               
                                               
                                               
                                               

                                                Check List - II. MODEL CHECK-LIST FOR EVALUATION  OF SEMINAR

                                                                        PRESENTATIONS 
                                                 

                                                Name of the Student:    Name of the Faculty/Observer:                               Date: 


                                                Sl. No. Items for observation during presentation Poor 

                                                0

                                                Below Average

                                                1

                                                Average 

                                                2

                                                Good 

                                                3

                                                Very Good

                                                4

                                                 
                                                Whether other relevant publications consulted
                                                         
                                                 
                                                Whether cross references have been consulted
                                                         
                                                 
                                                Completeness of Preparation
                                                         
                                                 
                                                Clarity  of Presentation
                                                         
                                                 
                                                Understanding of subject
                                                         
                                                 
                                                Ability to answer questions
                                                         
                                                 
                                                Time scheduling
                                                         
                                                 
                                                Appropriate use of Audio-Visual aids
                                                         
                                                 
                                                Overall Performance
                                                         
                                                Any other observation 
                                                         
                                                 
                                                 
                                                 
                                                Total Score
                                                 
                                                 
                                                 
                                                 
                                                 
                                                 
                                                 

                                                Check List - III 

                                                MODEL  CHECK LIST FOR EVALUATION  OF  CLINICAL  WORK IN WARD  /  OPD 

                                                (To be completed once a month by respective Unit Heads including  posting in other departments) 

                                                Name of the Student:    Name of the Unit Head:    Date: 


                                                Sl. No. Points to be considered: Poor 

                                                0

                                                Below Average

                                                1

                                                Average 

                                                2

                                                Good 

                                                3

                                                Very Good 

                                                4

                                                 
                                                Regularity of attendance
                                                         
                                                 
                                                Punctuality
                                                         
                                                 
                                                Interaction with colleagues and supportive staff
                                                         
                                                 
                                                Maintenance of case records
                                                         
                                                 
                                                Presentation of cases during rounds
                                                         
                                                 
                                                Investigations work up
                                                         
                                                 
                                                Bedside manners
                                                         
                                                 
                                                Rapport with patients
                                                         
                                                 
                                                Counseling patient's relatives  for blood donation or Postmortem and Case follow up.
                                                         
                                                 
                                                Over all quality of Ward work
                                                         
                                                  Total Score  
                                                 
                                                 
                                                 
                                                 
                                                 
                                                 

                                                Check List - IV

                                                EVALUATION FORM FOR CLINICAL PRESENTATION 

                                                Name of the Student:      Name of the Faculty:    Date:


                                                Sl. No. Points to be considered 
                                                Poor 

                                                0

                                                Below Average

                                                1

                                                Average 

                                                2

                                                Above

                                                Average

                                                3

                                                Very Good

                                                4

                                                Completeness of history          
                                                 
                                                Whether all relevant points elicited
                                                         
                                                 
                                                Clarity of Presentation
                                                         
                                                 
                                                Logical order
                                                         
                                                 
                                                Mentioned all positive and negative points of importance
                                                         
                                                Accuracy of general physical examination          
                                                 
                                                Whether all physical signs elicited correctly
                                                         
                                                 
                                                Whether any major signs missed or misinterpreted
                                                         
                                                Diagnosis:

                                                Whether it follows follows  logically from history and   findings

                                                         
                                                10 Investigations required
                                                • Complete list
                                                         
                                                • Relevant order
                                                         
                                                • Interpretation of investigations
                                                         
                                                Ability to react to questioning

                                                Whether it follows logically from history and findings

                                                         
                                                Ability to defend diagnosis          
                                                Ability to justify differential diagnosis          
                                                Others          
                                                  Grand Total  
                                                 
                                                 

                                                 

                                                Check List - V 

                                                MODEL CHECK LIST FOR EVALUATION OF TEACHING SKILL PRACTICE 


                                                Sl. No.   Strong Point Weak Point
                                                Communication of the purpose of the talk    
                                                Evokes audience interest in the subject    
                                                The introduction    
                                                The sequence of ideas    
                                                The use of practical examples and/or illustrations    
                                                Speaking style (enjoyable, monotonous, etc., specify)    
                                                Attempts audience participation    
                                                Summary of the main points at the end    
                                                Asks questions    
                                                Answers questions asked by the audience    
                                                Rapport of speaker with his audience    
                                                Effectiveness of the talk    
                                                Uses AV aids appropriately    
                                                 
                                                 

                                                Check list VI 

                                                MODEL CHECK LIST FOR DISSERTATION PRESENTATION 

                                                Name:                            Faculty/observer:                                                  Date: 


                                                Sl. No.  
                                                Points to be considered

                                                divine

                                                Poor 

                                                0

                                                Below Average

                                                1

                                                Average 

                                                2

                                                Good  

                                                3

                                                Very Good

                                                4

                                                 
                                                Interest shown in selecting a topic
                                                         
                                                 
                                                Appropriate review of literature
                                                         
                                                Discussion with guide & other faculty          
                                                 
                                                Quality of protocol
                                                         
                                                Preparation of proforma          
                                                 
                                                 
                                                 
                                                 
                                                 

                                                Checklist-VII  

                                                CONTINUOUS   EVALUATION   OF   DISSERTATION   WORK  BY GUIDE / CO-GUIDE 
                                                 

                                                Name of the Student:    Name of the Faculty/Observer:                                              Date: 


                                                Sl. No. Items for observation during presentation Poor 

                                                0

                                                Below Average

                                                1

                                                Average 

                                                2

                                                Good

                                                3

                                                Very Good

                                                4

                                                Periodic consultation with guide/co-guide          
                                                Regular collection of case material          
                                                Depth of analysis / discussion          
                                                Departmental presentation of findings          
                                                Quality of final output          
                                                Others          
                                                  Total Score  
                                                 
                                                 

                                                  

                                                LOG BOOK 

                                                Table 1 :  Academic activities attended 

                                                Name:        Admission  Year: 

                                                College:   
                                                 


                                                Date Type of Activity

                                                Specify Seminar, Journal Club, Presentation,        UG teaching

                                                Particulars
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                 
                                                 

                                                LOG BOOK 

                                                Table 2 :  Academic presentations made by the student 

                                                Name:        Admission  Year: 

                                                College:   
                                                 


                                                Date Topic Type of Presentation

                                                Specify Seminar, Journal Club, Presentation,   UG teaching etc.

                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                     
                                                 
                                                 

                                                LOG BOOK 

                                                Table 3 :  Diagnostic and Operative procedures performed 

                                                Name:        Admission  Year: 

                                                College:   
                                                 


                                                Date Name ID No. Procedure Category

                                                O, A, PA, PI*

                                                         
                                                         
                                                         
                                                         
                                                 
                                                 
                                                 

                                                *  Key:   O     -   Washed up and observed

                                                                  A     - Assisted a more senior Surgeon

                                                                  PA   - Performed procedure under the direct supervision of a senior surgeon

                                                                  PI     -  performed independently  
                                                 
                                                 

                                                 

                                                Model Overall Assessment Sheet 

                                                Name of the College:          Academic Year: 


                                                Sl. No Faculty Member &

                                                Others

                                                Name of Student and Mean Score 
                                                A B C D E F G H I J
                                                1                      
                                                2                      
                                                3                      
                                                4                      
                                                5                      
                                                Total Score                    
                                                 

                                                Note: Use separate sheet for each year.

                                                 

                                                 

                                                Chapter  V 

                                                Medical Ethics

                                                Sensitisation and Practice 

                                                Introduction

                                                      There is now a shift from the traditional individual patient, doctor relationship, and medical care.  With the advances in science and technology and the needs of patient, their families and the community, there is an increased concern with the health of society.  There is a shift to greater accountability to the society.  Doctors and health professionals are confronted with many ethical problems.  It is, therefore necessary to be prepared to deal with these problems. To accomplish the Goal (i), General Objective  (ii) stated in Chapter II (pages 2.1 to 2.3), and develop human values it is urged that ethical sensitisation be achieved by lectures or discussion on ethical issues, clinical case discussion of cases with an important ethical component and by including ethical aspects in discussion in all case presentation, bedside rounds and academic postgraduate programmes. 

                                                Course Contents

                                                1. Introduction to Medical Ethics

                                                  What is Ethics

                                                  What are values and norms

                                                  Relationship between being ethical and human fulfillment

                                                  How to form a value system in one’s personal and professional life

                                                  Heteronomous Ethics and Autonomous Ethics

                                                  Freedom and personal Responsibility

                                                1. Definition of Medical Ethics

                                                  Difference between medical ethics and bio-ethics

                                                  Major Principles of Medical Ethics 0

                                                        Beneficence    = fraternity

                                                        Justice     = equality

                                                        Self determination (autonomy)  = liberty 

                                                  1. Perspective of Medical Ethics

                                                    The Hippocratic oath

                                                    The Declaration of Helsinki

                                                    The WHO Declaration of Geneva

                                                    International code of Medical Ethics (1993)

                                                    Medical Council of India Code of Ethics 

                                                    1. Ethics of the Individual

                                                      The patient as a person

                                                      The Right to be respected

                                                      Truth and Confidentiality

                                                      The autonomy of decision

                                                      The concept of disease, health and healing

                                                      The Right to health

                                                      Ethics of Behaviour modification

                                                      The Physician – Patient relationship

                                                      Organ donation 

                                                      1. The Ethics of Human life

                                                        What is human life

                                                        Criteria for distinguishing the human and the non-human

                                                        Reasons for respecting human life

                                                        The beginning of human life

                                                        Conception, contraception

                                                        Abortion

                                                        Prenatal sex-determination

                                                        In vitro fertilization (IVF), Artificial Insemination by Husband (AIH)

                                                        Artificial Insemination by Donor (AID),

                                                        Surrogate motherhood, Semen Intrafallopian Transfer (SIFT),

                                                        Gamete Intrafallopian Transfer (GIFT), Zygote Intrafallopian Transfer (ZIFT),

                                                        Genetic Engineering 

                                                        1. The Family and Society in Medical Ethics 

                                                          The Ethics of human sexuality

                                                          Family Planning perspectives

                                                          Prolongation of life

                                                          Advanced life directives – The Living Will

                                                          Euthanasia

                                                          Cancer and Terminal Care 

                                                          1. Profession Ethics

                                                            Code of conduct

                                                            Contract and confidentiality

                                                            Charging of fees, Fee-splitting

                                                            Prescription of drugs

                                                            Over-investigating the patient

                                                            Low – Cost drugs, vitamins and tonics

                                                            Allocation of resources in health cares

                                                            Malpractice and Negligence 

                                                          1. Research Ethics

                                                            Animal and experimental research / humanness

                                                            Human experimentation

                                                            Human volunteer research – Informed Consent

                                                            Drug trials 

                                                            1. Ethical workshop of cases

                                                              Gathering all scientific factors

                                                              Gathering all human factors

                                                              Gathering all value factors

                                                              Identifying areas of value – conflict, Setting of priorities,

                                                              Working out criteria towards decisions 

                                                              Recommended Reading

                                                              Francis C.M., Medical Ethics, 1 Ed, 1993, Jaypee Brothers, New Delhi, p 189, Rs. 60/- 
                                                               


                                                               

                                                               

                                                               

                                                               

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