Structured training programme enables PMC students to bag 19 out of 23 Distinctions in Medicine

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UHS Examinations

Structured training programme enables
PMC students to bag 19 out of 23
Distinctions in Medicine

Exam cell has been established in the Medical Unit-I
and MCQ Bank has twelve thousand questions

FAISALABAD: It is not uncommon to hear allegations that medical teachers in public sector medical colleges do not come in time and leave soon in the afternoon. They do not concentrate on teaching as well as patient are but it may be true in some cases but one cannot generalize this as there are quite a few exceptions. A recent visit to Allied Hospital the affiliated teaching hospital for Punjab Medical College Faisalabad proved it so. During this unscheduled visit,  It was heartening to note that  soon after one batch of medical students had finished their class at about 12.30 in the afternoon, the other batch of students were taken in by another faculty member after half an hour. Enquiries revealed that it is because of Prof. Ahmad Bilal, Head of the Dept. of Medicine who with the help of all the faculty members and all the medical units has organized a structured training programme for medical students.

The department has also established an Examination Cell and the MCQ Bank has twelve thousand questions. Entry to the examination cell is strictly monitored and whosoever enters there has to make entry of his  entry and exit time. All these measures have paid of which was evident from the fact that in the University of Health Sciences examinations which has over fifty affiliated  medical colleges in the province, Punjab Medical College Students bagged nineteen out of twenty three distinctions in Medicine. Prof. Ahmed Bilal told Pulse International that they have also started internal assessment and about ten internal examinations are conducted and its credit is added in the annual examination.

We also found out how the students cheat in the examination hence in the MCQ we just change one or two words which changes the whole diagnosis  and the correct answer with the result that now it is no more possible for the students to cheat, Prof. Ahmad Bilal remarked. We have also appointed Directors for the class and they have started monitoring the teaching and training programme. None of these Directors of the class are from my unit.  Initially there was some reluctance and resentment by some faculty members who opined that it was not fair to be monitored by junior faculty members but eventually every one realized that it was in the best interest of the department, students and the training programme, hence now it is functioning smoothly.  Replying to a question Prof. Ahmed Bilal said that we do get feedback from the students and at least I do discuss it with the staff in my unit.

Visit to the ward showed that in order to accommodate the rush of patients, more than one patient had been accommodated on each bed. There are three medical units at Allied Hospital though keeping in view the workload, we need at least six medical units so that one unit has an emergency daily. This Medical Unit-I had forty five beds in addition to twelve beds in High Dependency Unit (HDU). Answering another question Prof. Ahmed Bilal said that they receive about three hundred medical emergencies daily and over 20% of them do need hospitalization.  Hence what we do is that as soon as the hospitalized patient is stable, we try to discharge them to accommodate new patients because there is no other option to take care of the ever increasing rush of patients. Punjab Medical College admits three hundred fifty students in the First Year Class and the average number of students in each batch which comes here in the ward for teaching and training is twenty. Hence, the whole class is rotated through different medical units in batches.

A comprehensive detailed teaching schedule with day, topic to be discussed and the name of the teacher in all the four medial units has been prepared. Training the medical students in clinical skills is given adequate importance so that they master the art of history taking and physical examination which plays a vital role in making correct diagnosis.  The topics which are covered during the Third Year curriculum in the Wards in respiratory system include presenting complaints, history of presenting complaints, history taking by the students and interactive session, bleeding per Rectum and Malena, positioning of the patient and general appearance. In CVS they are taught about pain and fever, in GIT vomiting, diarrhoea and bleeding, in CNS weakness, paralysis, assessment of conscious level, eliciting and recognition of signs of meningeal irritation. Other subjects which are covered include Examination of cranial nerves, differential diagnosis of respiratory symptoms, systemic examination related to GIT,  General Physical Examination related to CVS, GIT, Inspection and palpation, palpation of pericardium, inspection of abdomen, Motor system upper limb, cerebellum which is performed by the trainer and then rehearsal is carried out in groups, systemic examination  related to CVS, Auscultation of  pericardium,  superficial and deeply palpation, visceral palpation,  Motor System (Lower limb), cerebellum and gait,  Auscultation, examination of musculoskeletal system, visceral palpation plus causes of hepatosplenomegaly,  sensory  system, demonstration of dermatomes, investigations related to  respiratory system, discussion on investigations related to CVS,  Percussion, auscultation of abdomen and genitourinary system, cerebral examination,  Positioning, GPE, Inspection, Palpation, Percussion and Auscultation of  GIT, CVS and respiratory systems. A group of four medical students are required to take history in the evening and present it in the morning class. Interpretation of normal X-Ray Chest, normal ECG and normal CT scan of brain are also discussed in detail. The teachers are informed about the timing and day of their class and the programme is monitored by the Program Director.  If any of the teachers is unable to take the class as per programme, they are supposed to inform the programme coordinator much in advance so that alternate arrangements can be made.

The topics which are covered in the Final Year  curriculum in the Wards are Basics of ECG, Basics of  X-Rays,  How to do an ECG,  Viewing of Chest X-ray, CVP line, following the list of long and short cases,  Rate calculation Sinus Tachycardia and Sinus Bradycardia, Orientation of X-Rays and their clinical implications, double lumen catheter,  practice of rate calculation for regular and irregular rhythms, Inspiratory and Expiratory Chest Films and Cardiothoracic Ratio, LP needle,  Introduction to Cardiac Axis Left,  right and normal cardiac Axis,  Quality of X-rays, Foley’s Catheter, Pleural Effusion, introduction to Regular  and Irregular Rhythms, how to pass NG tube, Atrial Fibrillation and Atrial Flutter, Pneumothorax, Laryngoscope, SVT, Tension Pneumothorax, ETT, Hydropneumothorax, liver biopsy needle, Introduction to Ischemic changes on ECG, Consolidation and venture mask, T Wave inversions, ST segment depression, subcutaneous emphysema, oropharyngeal airway,  St segment Elevation, Pericarditis ECG, Hilar Lymphadenopathy Unilateral and Bilateral, Indications of Adrenaline,  Introduction to Hypertrophy of cardiac chambers,  Indications of Atropine, Left Atrial Hypertrophy, Mediastinal widening, indications of  steroids, Left Ventricular Hypertrophy,  Bronchiectasis,  Right Ventricular Hypertrophy, Cavitations,  Introduction to heart blocks, Aspergillum,  LBBB and RBBB, Elevated Diaphragm,  LAH and LPH, Lung collapse, Cancer of Lung, Solitary nodules, Military tuberculosis, Pulmonary tuberculosis, Upper and lower Zone Fibrosis, Introduction to Regular and Irregular rhythms, mitral stenosis,  Tetralogy of Fallot, Pulmonary oedema, Cardiomegaly,  Wolff Parkinson White Syndrome, Coarctation of Aorta,  Introduction to Ischemic changes  on ECG, Metallic Valves, T wave inversions, St segment depression. Achalasia,  ST segment Elevation Pericarditis ECG, CA esophagus, Rheumatoid of Hands, Ankylosing spondylitis, osteoporosis, Collapsed vertebrae,  Introduction to Heart Blocks, Avascular necrosis of head of Femur, Sacrilitis, Osteoarthritis and Lytic lesions.

Short and Long Cases

Long cases taught in the Fourth Year and Final Year include spastic paraplegia, Flacid Paraplegia, Hmiplegia,  PICA, Hypoglycemic Brain Injury, Pyogenic Meningitis, Viral Encephalitis, Tuberculous Meningitis, COPD, Asthma, Interstitial Lung Disease, Rheumatoid Arthritis, SLE, Systemic Sclerosis, Mixed Connective Tissue Disease, Polymyositis, Dermatomyositis, Gout, Osteoarthritis,  Congestive Cardiac Failure, Corpulmonale, Constrictive Pericarditis, Myocardial Infarction, Hypertension, Rheumatic Fever and Rheumatic Heart Disease, Infective Endocarditis, Atrial Fibrillation, Peripheral Vascular Disease, DVT and Pulmonary Embolism, Hepato Cellular Carcinoma, DCLD, Abdominal tuberculosis, Inflammatory Bowel Disease, Malabsorption, Acute Hepatitis, Enteric Fever, Pulmonary tuberculosis, Leptospirosis, Leukemia, Lymphoma, Myelopoliferative Disorders, Hemophilia, Aplastic Anemia, Hemolytic Anemia, Megaloblastic Anemia, Iron Deficiency Anaemia, Acute Kidney Injury, Chronic Renal Failure, Glumeronephritis, Cushing’s Syndrome and  Diabetes Mellitus.

The short cases include Hemiplegia, Flacid Paraplegia, Spastic Paraplegia, PICA, Bell’s palsy, Pleural Effusion, Lung Collapse, Consolidation, COPD and Asthma, Mixed Valve Disease, Mixed Aortic Disease, VSD, PDA, Left Ventricular Failure, CCF, CorPulmonale, Hepatomegaly, Splenomegaly, Hepatosplenomegaly, Ascites, Palpable Kidneys, Right Iliac Fossa Mass, Rheumatoid Hands, Osteoarthritis, SLE, Scleroderma besides Mixed Connective Tissue Disease.

Practical Procedures

The practical procedures which are  taught in the Final Year include  How to check Patient Vitals, How to pass nsogastric tube, How to pass a Foley Catheter, How to give intramuscular injection, How to Give intravascular injection, How to pass an I/V Cannula, How to observe passing and care of CVP line/double lumen line, How to give Insulin injection, Preparation and Regulation of inotropic support, Observe how to do a lumbar puncture, Observe  how to do a diagnostic pleural tap, Observe how to do Cardiopulmonary Resuscitation in emergency, Observe how to  pass Endotracheal tube in unconscious patient, How to take a blood sample, How to pass an Airway, Care of unconscious patient for the first six hours, How to do suction, Nebulization, How to use Glucometer and checking of RBS and how to do ECG.

According to the teaching schedule the batch representative is responsible for keeping the long and short cases logbook. Class facilitator selects the long case for discussion for the next day. His assistant is responsible for facilitating students about case selection. One long case and two short cases are discussed each day and common long cases and sort cases are given priority for class discussion. In case the desired case is not available, then previous case can be repeated. Those long and short cases which are not discussed in the first rotation get priority in the second rotation. Each medical student is required to maintain a skill card proforma that they have to submit at the end of the ward rotation. After going through such a comprehensive training covering almost all the diseases, the students are bound to perform well in the final examination as well.