CBME General Medicine topics and subtopics standardized list simplified domainwise

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.