This draft is in response to an esteemed assignment that said,
"...are requested to submit standardized list of topics and sub topics to be covered in classes for an academic year with topics and sub topics arranged in a chronological order as per CBME -NMC curriculum, by Monday 4 pm."
The message arrived at a time that provided a generous 3-4 days to submit.
We have previously discussed the issues and limitations of CBME before at length here while critiquing a paper on "stages of concern with CBME as an innovation" : https://groups.google.com/g/ meu_india/c/WEUzo-QCJYU/m/ fJdOLS4vBQAJ?utm_medium=email& utm_source=footer
So without going into our differences with how CBME is being implemented and how we would wish it was (outlined in our inputs in the above link), we shall straight away jump to how it can be simplified into a quick implementable objective within the current confines of the Indian healthcare curriculum that is limited to best clinical guidelines based practices utilizing best research done in the Western world.
On the flip side it may help to strengthen and simplify healthcare domain ontologies even in the West but that is wishful thinking at best.
So to modify the very well done CBME with lots of standard examples by NMC that covers "General Medicine" rather meticulously and exhaustively here : https://www.nmc.org.in/ information-desk/for-colleges/ ug-curriculum/ (check out the freely downloadable PDF marked as UG curriculum vol II also downloadable from here : https://www.nmc.org.in/wp- content/uploads/2020/01/UG- Curriculum-Vol-II.pdf), we may begin by first trying to identify the standardized list of topics and sub topics to be covered in classes for an academic year with topics and sub topics arranged in a chronological order as per CBME -NMC curriculum, especially from the very well done NMC PDF and then reducing that very well done work into a simplified list of topics and subtopics that retains a few CBME key words or drivers promoted by the original esteemed authors of the NMC document.
So here goes :
Topic: Heart Failure
(with delineation of a number of competency domains categorized into knowledge, skills, attitude and communication throughout the subtopics)
Topics and subtopics can be made in bold
Subtopics:
KNOWLEDGE domain--Subtopics that addresses the knowledge domain of the learner and demonstrates that the learner KNOWS HOW :
Describe and discuss the
Epidemiology,
Pathogenesis,
Clinical
evolution and
Course
of
Common causes of heart disease including:
rheumatic/
valvular,
ischemic,
hypertrophic
inflammatory
Genetic
SKILLS Domain--Subtopics that addresses skills acquisition in the learner and demonstrates that the learner can SHOW HOW :
Elicit
document and
present an
appropriate history that
will establish
the diagnosis,
cause and
severity of heart failure
including:
presenting complaints,
precipitating and
exacerbating factors,
risk
factors,
exercise tolerance,
changes in sleep patterns,
features suggestive of infective endocarditis
KNOWLEDGE 2
Describe and discuss the
clinical presentation and
features,
diagnosis,
recognition and
management of acute rheumatic fever
SKILLS 2
Perform and demonstrate a
systematic examination based on
the history
that will help establish the diagnosis and
estimate its severity
including:
measurement of pulse,
blood pressure and
respiratory rate,
jugular venous forms and
pulses,
peripheral pulses,
conjunctiva and fundus,
lung,
cardiac examination including
palpation and auscultation with
identification of heart sounds and
murmurs,
abdominal distension and splenic palpation
Generate a differential diagnosis based
on
the learner's competence to
capture the
clinical presentation
and
prioritise it
based on
the most likely diagnosis
SKILLS 3
Order and
interpret
diagnostic testing (based on
the clinical diagnosis)
that includes
performing and interpreting
a 12 lead ECG,
Chest radiograph,
blood cultures
COMMUNICATION of patient requirements that comes from a competent understanding of disease outcomes where the learner can SHOW HOW to communicate that understanding to the patient.
Determine
the severity of
valvular heart disease
based on
the
clinical and
laboratory and
imaging features
and
determine
the level
of intervention required
including surgery
SKILLS and COMMUNICATION :
Administer
an intramuscular injection
with
an appropriate
explanation to the patient
ATTITUDE that stems from a competent understanding and ability to communicate that understanding of disease keeping the human suffering from that disease at the topmost priority and we need to ensure that this attitude SHOWS in the learner :
Counsel and
communicate to
patients with
empathy
about
lifestyle
changes in
heart failure
The next topic in the NMC list is Acute Myocardial infarction followed by Pneumonia but I guess now we may get the drift on how to simplify them and also begin to add other medicine topics not currently listed in the NMC document.
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