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Curriculum

Curriculum

PHYSIOLOGY Objectives

Goal

The broad goal of the teaching of undergraduate students in Physiology aims at providing the student comprehensive knowledge of the normal functions of the organ systems of the body to facilitate an understanding of the physiological basis of health and disease.

Objectives

a. Knowledge:

At the end of the course the student will be able to:

  1. Explain the normal functioning of all the organ systems and their interactions for well coordinated total body function;
  2. Assess the relative contribution of each organ system to the maintenance of the milieu interior;
  3. Elucidate the physiological aspects of normal growth and development;
  4. Describe the physiological response and adaptations to environmental stresses;
  5. List the physiological principles underlying pathogenesis and treatment of disease

b. Skills

At the end of the course the student will be able to:

  1. conduct experiments designed for study of physiological phenomena;
  2. interpret experimental/investigative data;
  3. Conduct and interpret clinical examination in normal healthy subject;
  4. distinguish between normal abnormal data derived as a result of tests, which he/she has performed and observed in the laboratory.

c. Attitude and communication skills:

At the end of the course the student will be able to:

  1. show due respect to persons who volunteer to be examined for the purpose of learning clinical examination.
  2. communicate effectively with peers, teachers and volunteer in clinical examination
  3. demonstrate the ability of teamwork

d. Integration:

At the end of the integrated teaching the student should acquire an integrated knowledge of organ structure and function and the regulatory mechanisms.

List of systems included in Physiology:

  • General Physiology
  • Hematology
  • Nerve-Muscle Physiology
  • Gastro-Intestinal Physiology
  • Cardiovascular physiology
  • Respiratory physiology
  • Renal Physiology
  • Endocrine Physiology
  • Reproductive Physiology
  • Neurophysiology (Central Nervous System and Special Senses)
  • Integrated Physiology

Physiology Syllabus

Theory:

General Physiology (PY 1.1-1.9)                                             (8 hrs)

Structure and functions of a mammalian cell; Homeostasis, Intercellular communication; Apoptosis; Transport mechanisms across cell membranes; Fluid compartments of the body; pH & Buffer systems in the body; Evaluation of functions of the cells and products in clinical care and research.

Hematology:  (PY 2.1 – 2.13)                                                 (16 hrs)

Components of blood: formation, regulation and functions; plasma proteins – origin, types, variations and functions; Hemoglobin- synthesis, variants, functions and its breakdown & Jaundice; Blood indices; Anemia and its classification; Hemostasis: mechanism, regulation & disorders Anticoagulants; Blood groups, blood banking and transfusion; Immunity: types, mechanism & regulation; ESR; Lymph-composition, circulation and functions  

Nerve & Muscle Physiology: (PY 3.1 – 3.18)                       (10hrs)

Neuron and neuroglia: structures, types, functions; Resting membrane potential; Action potential in nerve, skeletal & smooth muscle; Nerve fibres: classification, functions & properties; nerve injuries, degeneration and regeneration in peripheral nerve; Neuromuscular junction: structure, transmission of impulses, neuro-muscular blocking agents, Myasthenia gravis; Muscle fibres: structure, types & functions; Muscle contraction; molecular basis (skeletal, smooth), Isotonic Vs. Isometric, Energy sources and metabolism, gradation of muscle activity; muscle dystrophy, Myopathies; Strength-duration curve  

Gastrointestinal Physiology: (PY 4.1 – 4.10)                           (10hrs)

Functional anatomy and broad functions of digestive system, enteric nervous system; GI Secretions- composition, mechanism of secretion, functions, and regulation of saliva, gastric, pancreatic, intestinal juices and bile secretion; GI movements- types, regulation, functions, reflexes; role of dietary fibres; Digestion and absorption of nutrients; GI hormones- source, regulation, functions; Gut-brain axis; structure and functions of liver and gall bladder; gastric function tests, pancreatic exocrine function tests & liver function tests, Pathophysiology – Achalasia cardia, peptic ulcer, gastro oesophageal reflux disease, vomiting, diarrhoea, constipation, Adynamic ileus, Hirschsprung’s disease.71 

Cardiovascular Physiology: (PY 5.1 – 5.16)                                 (25hrs)

Functional anatomy of heart; Pacemaker tissue and conducting system-generation, conduction of cardiac impulse; Properties of cardiac muscle; Cardiac cycle; ECG- recording, normal ECG, uses, cardiac axis, Abnormal ECG in common arrhythmias, changes with hypertrophy & MI; Haemodynamics; Heart rate- factors affecting, regulation; Cardiac output- factors, regulation, measurement; Blood pressure- components, determinants, factors, regulation and applied aspect, Regional circulation- autoregulation, microcirculation, lymphatic circulation, coronary, cerebral, capillary, skin, fetal, pulmonary and splanchnic circulation; Pathophysiology- shock, syncope, heart failure & coronary artery disease 

Respiratory Physiology: (PY 6.1-6.10)                                    (12hrs)

Functional anatomy of respiratory tract, dead space; Mechanics of respiration; Pressure volume changes during ventilation; Lung volume and capacities; Alveolar surface tension; Compliance; Airway resistance; alveolar ventilation, V/P ratio; Diffusion capacity of lungs; Transport of respiratory gases- Oxygen and Carbon dioxide; Neural and chemical regulation of respiration; Physiology of high altitude and deep sea diving; Principles of artificial respiration, oxygen therapy; Patho-physiology of dyspnoea, hypoxia, cyanosis, asphyxia, drowning, periodic breathing; Lung function tests & its clinical significance 

Renal Physiology: (PY 7.1 – 7.9)                                              (10hrs)

Structure and functions of kidney & juxta glomerular apparatus, role of renin-angiotensin system ; Renal blood flow; Mechanism of urine formation, concentration and diluting mechanism; Concept and significance of ‘clearance’ tests; Renal regulation of fluid and electrolytes & acid base balance; Structure and innervation of urinary bladder, physiology of micturition, cystometry, and its abnormalities; Artificial kidney(dialysis) and renal transplantation; Renal Function Tests 

Endocrine Physiology: (PY 8.1 – 8.6)                                         (16 hrs)

Mechanism of action of steroid, protein and amine hormones; Synthesis, secretion, transport, physiological actions, regulation and effect of altered (hypo and hyper) secretion of pituitary gland, thyroid gland, parathyroid gland, adrenal gland, pancreas and hypothalamus; Physiology of bone and calcium metabolism; Physiology of growth; Physiology of Thymus & Pineal Gland; Hormone function tests ; Obesity & metabolic syndrome; Stress response 

Reproductive Physiology: (PY 9.1 – 9.12)                                      (10hrs)

Sex determination; sex differentiation and their abnormalities; Puberty: onset, progression, stages; early and delayed puberty; Male reproductive system: functions of 72 testis, spermatogenesis and its regulation, Cryptorchidism ; Female reproductive system: functions of ovary and its control, menstrual cycle: Hormonal, uterine and ovarian changes; Tests for ovulation; Physiological effects of sex hormones; Contraceptive methods for male and female; Effects of removal of gonads on physiological functions; Physiology of pregnancy, fetoplacental unit, pregnancy tests, parturition & lactation; Semen analysis; Causes and principles of management of infertility; Hormonal changes and their effects during perimenopause and menopause; Psychological and psychiatric disturbances associated with reproductive physiology. 

Neurophysiology: (PY 10.1 – 10.20)                            (37 hrs)

Organization of nervous system; Sensory system: types, functions and properties of synapse, receptors, reflex; Somatic sensations & sensory tracts; Physiology of pain; Motor system: organization, motor tracts, mechanism of maintenance of tone, control of voluntary movements ; Posture and equilibrium & vestibular apparatus; Reticular activating system, Autonomic nervous system ; Spinal cord: functional organization and lesions ; Formation, circulation and function of CSF; Blood brain barrier; Neurotransmitters. Organization, connections and functions of cerebral cortex, basal ganglia, thalamus, hypothalamus, cerebellum and limbic system and their abnormalities; Higher mental functions ; Physiology of sleep, memory, learning and speech and their disorders; EEG. Special senses- Smell and taste sensation and their abnormalities; Functional anatomy of ear and auditory pathways & physiology of hearing, Deafness, hearing tests; Functional anatomy of eye, Image formation, Visual pathway and its lesions, Physiology of vision including acuity of vision, colour vision, field of vision, refractive errors, physiology of pupil; light reflex, accommodation reflex, dark and light adaptation; Auditory & visual evoked potentials 

Integrated Physiology: (PY 11.1 – 11.14)                        (6 hrs)

Temperature regulation: mechanism, adaptation to altered temperature (heat and cold environment), mechanism of fever, cold injuries and heat stroke; Exercise- cardio-respiratory and metabolic adjustments during exercise (isotonic and isometric), exercise in heat and cold, physical training effects; Physiological consequences of sedentary lifestyle; Brain death; Physiology of Infancy*; Physiology of aging-free radicals and antioxidants*; Physiology of meditation*.

(* ‘Non-core’ competencies as per “Competency based Undergraduate Curriculum for the Indian Medical Graduate 2018: Medical Council of India”). 

PRACTICAL

 The following list of practical is minimum and essential. Additional exercises can be included as and when feasible and required. All the practicals have been categorized as Procedures to be performed’ and ‘Demonstrations’. The procedures are to be performed by the students during practical classes to acquire skills. These would be included in the practical during University examination. Those categorized as ‘Demonstrations’ are to be shown to students during practical 73 classes. Questions based on these would be given in the form of data, charts, graphs, problems and case histories for interpretation by students during university examination.

I. Procedures to be performed by the students:

a. Haematology:

  1. RBC count
  2. WBC Count
  3. Differential Leucocyte Count
  4. Estimation of haemoglobin
  5. Blood grouping
  6. Bleeding time
  7. Clotting time
  8. Calculate RBC indices – MCV, MCH, MCHC.

b. Procedures to be performed on human subjects:

  1. Mosso’s ergography.
  2. Recording of Blood Pressure, pulse rate at rest and effect of posture.
  3. Effect of mild and moderate exercise on blood pressure, pulse rate and respiratory rateusing Harvard step test.
  4. Record and interpret Lead II ECG. Given a normal ECG, determine cardiac axis.
  5. Spirometry – Lung volumes and capacities, MVV, Timed vital capacity.
  6. Peak Expiratory Flow Rate
  7. Demonstrate Basic Life Support in a simulated environment
  8. Visual field by Perimetry

c. Clinical Examination:

  1. Components of history taking and general physical examination
  2. Examination of radial pulse
  3. Examination of Cardiovascular system
  4. Examination of Respiratory system
  5. Examination of abdomen
  6. Examination of Higher mental functions
  7. Examination of Sensory system
  8. Examination of Motor system including reflexes.
  9. Examination of Cranial Nerves

II. Demonstrations:

1.Haematology:

  1. Erythrocyte sedimentation rate
  2. Haematocrit
  3. Reticulocyte count
  4. Platelet count
  5. Osmotic fragility

2.Human:

  1. Record Arterial pulse tracing using finger plethysmography*
  2. Stethography
  3. Tests of cardiovascular autonomic functions*

(* ‘Non-core’ competencies as per “Competency based Undergraduate Curriculum for the

Indian Medical Graduate 2018: Medical Council of India”)

III. Interpretation

charts: clinical case histories, graphs, charts, problems (Suggested topics for preparation of these are given under ANNEXURE I. However, many more could be developed which is under discretion of each institution) Chart also includes – Interpret growth chart*, Interpret anthropometric assessment of infants*: (*these two charts are ‘Non-core’ competencies as per “Competency based Undergraduate Curriculum for the Indian Medical Graduate 2018: Medical Council of India”)

IV. Computer assisted learning:

(i) Amphibian nerve – muscle experiments and interpretation of graphs

List of graphs on nerve-muscle experiments:

  • Simple muscle twitch
  • Effect of various strengths of stimuli on Simple muscle twitch
  • Effect of changes in temperature on Simple muscle twitch
  • Effect of two successive stimuli on muscle contraction
  • Effect of multiple successive stimuli (treppe, clonus, tetanus)
  • Study of fatigue in skeletal muscle
  • Velocity of nerve conduction
  • Effect of load on muscle
  • Measurement of isometric contractions using nerve muscle preparation

(ii) Amphibian cardiac experiments and interpretation of graphs

List of graphs on cardiac experiments:

  • Normal cardiogram
  • Effect of temperature on frog heart
  • Effect of Stannius ligatures
  • Properties of cardiac muscle – all or none law, staircase effect, refractory period in a beating heart (extrasystole and compensatory pause), refractory period in a quiescent  heart
  • Effect of vagus on frog’s heart
  • Action of drugs on vagus (nicotine and atropine)
  • Perfusion of isolated heart and effect of ions (NaCl, KCl, CaCl2)
  • Perfusion of isolated heart and effect of drugs (adrenaline, acetyl choline, atropine followed by Ach)

SKILL CERTIFICATION:

The list of certifiable skills is given below. The general instructions, blank template, samples of certification checklist suggested for skill certification are provided as ANNEXURE – IIa, IIb, IIc, IId.

List and number of sessions for skill certification as prescribed by MCI:

  TOPICS Number required to certify as per MCI
PY5.12 Record blood pressure & pulse at rest and in different grades of exercise and postures in a volunteer or simulated environment 1each x 3

PY6.9

 

Demonstrate the correct clinical examination of the respiratory system in a normal volunteer or simulated environment 1

PY 10.11

 

Demonstrate the correct clinical examination of the nervous system: Higher functions, sensory system, motor system, reflexes, cranial nerves in a normal volunteer or simulated environment

1 each (total 5)

 

PY 10.20

 

Demonstrate (i) Testing of visual acuity, colour and field of vision and (ii) hearing (iii) Testing for smell and (iv) taste sensation in volunteer / simulated environment

1 each (total 4)

 

SUGGESTED AREAS FOR INTEGRATION:

As per the “Competency based Undergraduate Curriculum for the Indian Medical Graduate 2018: Medical Council of India”

EARLY CLINICAL EXPOSURE:

Clinical visits: 12 hours (Suggested format for assessing participation in ECE sessions is provided as ANNEXURE III which could be a part of the practical record book) Suggested hospital visits: (can include more than the below suggestions) Anemia, Jaundice, Visit to blood bank, Computerized lung function tests, acid peptic disease, endoscopy procedure, dialysis unit, hemiplegia, etc.

Basic science correlations: 18 hours

Discussion based on case vignettes, graphs, clinical videos, patient in classroom setting, etc linked to various systems in physiology.

SELF-DIRECTED LEARNING:

Twenty-five hours of dedicated time for self-directed learning is provided for physiology.

AETCOM  MODULES TO BE COVERED UNDER PHYSIOLOGY: 

AETCOM module number (as per MCI document) *  TOPIC
1.2 What does it mean to be a patient?
1.3 The doctor-patient relationship

* https://www.mciindia.org/CMS/wp-content/uploads/2019/01/AETCOM_book.pdf

Suggested format for reflective writing for the above AETCOM modules is given in

ANNEXURE IV. This could be a part of the practical record book.

LOG BOOK:

Suggested Template of logbook is attached as annexure. The minimum elements that needs to be

included are mentioned in the template provided for log book. 

TEACHING HOURS AND METHODS:

Curricular component  Time allotted in hours 
Lectures  160
Small group teaching / tutorials / integrated learning /practical  310
Self-directed learning 25
Early clinical exposure (basic science correlation and clinical skills)  30 (18 +12) 
TOTAL 525 
AETCOM module 1.2 and 1.3 () 15 (8+7) 

Note: It is recommended that didactic teaching be restricted to less than one third of the total time allotted for that discipline.

SCHEME OF EXAMINATION: 

INTERNAL ASSESSMENT:

Scheme for calculation of Internal Assessment marks:

Theory (maximum marks)  Marks  Practicals  Marks 
Theory written paper  30*  Practical exam (25 marks) and viva- voce(5 marks)  30
Formative assessment  Formative assessment 
(Part completion tests/ (system-wise reviews)    Early clinical exposure + Skill certification  7
Record 3
Total  40 Practical record  40

Please note:

• *Prior to submission to the University, the marks for each of the three internal examination theory assessments must be calculated out of 30 marks, regardless of the maximum marks.

• **Prior to submission to the University, the marks for each of the three internal examination  practical assessments must be calculated out of 30 marks, regardless of the maximum marks.

• Only the final marks out of 40 needs to be submitted to the University, separately for theory and practical for each internal assessment. 

Guidelines: For general guidelines on Internal Assessment refer section II

UNIVERSITY EXAMINATION

SCHEME FOR MARKS DISTRIBUTION FOR UNIVERSITY EXAM:

type of questions Number of questions marks Total Marks
Long essay 2 10 20
Short essay 8 5 40
Short answers 10 3 30
Mulktple choice questions 10 1 10
Total marks 100

Blue print for theory question papers:

Paper 1 (Max 100 marks)

Systems Marks allotted
 General Physiology 5
Hematology 20
Cardiovascular Physiology 25
Respiratory Physiology 20
Gastrointestinal Physiology 15
Renal Physiology 15

Paper II (Max 100 marks)

Systems Marks allotted
NMP 12
Central nervous system 35
endocrine 20
Reproductive system 15
Special senses 10
Intergrated 08

Note:

  • All the questions should be structured compulsorily. One short essay (5 marks) to be preferably a case vignette in each paper.
  • The systems assigned to the different papers are generally evaluated under those sections. However, a strict division of the subject may not be possible and some overlapping of systems is inevitable. Students should be prepared to answer overlapping systems.
  • Example of the structured questions and case vignettes are given in the example question papers in ANNEXURE Va, Vb. This is only a sample paper. The systems under each section of the paper (long essay, short essay and short answer) and the system from which the case vignette may be prepared can vary. However, marks allotted to the various systems as given in the above tables must be adhered to (with a variation of distribution of 1-2 marks between systems).
  • A minimum of 35% marks shall be allocated to assess the higher order thinking skills of the student.

PRACTICAL: 80 Marks

There shall be four practical sessions, each carrying 20 marks. The distribution of content and marks for the practical would be as follows:

Practical session Allotted topics Marks allotted
Practical – I Clinical examination – I (CNS – sensory / motor/ reflexes / cranial nerve) 15
Chart: Clinical case histories 5
Total 20
Practical – II Clinical examination-II (CVS / RS) 15
Clinical examination (general physical examination / abdomen examination) 05
Total 20
Practical – III

Human experiments

• Mosso’s ergography

• Effect of posture / exercise on BP and Pulse rate

• Effect on BP and pulse rate during exercise using the Harvard step test

• Record and interpret Lead II ECG

• Spirometry and PEFR

• Perimetry

• Demonstrate BLS

15
Amphibian charts 5

Total

20

 

 

 

Practical – IV

 

Hematology

• RBC count

• WBC count

• Making a peripheral smear + DLC on the provided stained slide

• BT + blood group

• CT + blood group

• Hb + blood group

15
Chart: calculations / problem solving (note: there should not be duplication of charts between practical – I and IV for a given student) 05
  Total 20
  GRAND TOTAL 80

Viva-Voce Examination: 20 Marks

The viva-voce examination shall carry 20 marks and all examiners will conduct the examination. Viva should focus on application and interpretation. Charts and graphs should be prepared on all systems which could be divided amongst 4 examiners (system-wise) and could be used in viva. (viva marks to be added to practical and not theory).