CURRICULUM/STATUTES & REGULATIONS

FOR
5 YEARS DEGREE PROGRAMME
IN
CARDIOLOGY
(MD CARDIOLOGY)
 UNIVERSITY OF HEALTH SCIENCES,
LAHORE

STATUTES

Nomenclature Of The Proposed Course

The name of degree programme shall be MD Cardiology. This name is well
recognized and established for the last many decades worldwide.

Course Title:
MD Cardiology

Training Centers
Departments of Cardiology (accredited by UHS) in affiliated institutes of University of
Health Sciences Lahore.
 Duration of Course
The duration of MD Cardiology course shall be five (5) years with structured
training in a recognized department under the guidance of an approved
supervisor. The course is structured as follows

After admission in MD Cardiology Programme of University resident will spend

first 6 Months in the relevant Department of Cardiology as Induction period
during which resident will get orientation about the chosen discipline and will
also undertake the mandatory workshops (Appendix E). The research project
will be designed and the synopsis be prepared during this period.

On completion of Induction period the resident will start formal training in the
Basic Principles of Internal Medicine for 18 Months. During this period the
resident must get the research synopsis approved by AS&RB. At the end of 2 nd
years, the candidate will take up Intermediate Examination.

During the 3rd, 4th, & 5th years, of the Program, there will be two components of
the training
1) Clinical training in cardiology
2) Research and thesis writing
.

The candidate shall undergo clinical training to achieve educational objectives of

MD Cardialogy (knowledge & Skills) alongwith rotation in the relevant fields ,
Which will be carried out during the 4 th and 5th year of the programme. The
clinical training shall be competency based. There shall be generic and specialty
specific competencies and shall be assessed by continuous Internal Assessment.
(Appendix F&G).

The Research Component and thesis writing shall be completed over the five
years duration of the course. The Candidate will be spend total time equivalent
to one calendar year for research during the training. Research can be done as
one block or it can be done in the form of regular periodic rotation over five
years as long as total research time is equivalent to one calendar year.

Admission Criteria

Applications for admission to MD Training Programs of Cardiaology will be

invited through advertisement in print and electronic media mentioning closing
date of applications and date of Entry Examination.

Eligibility: The applicant on the last date of submission of applications for

admission must possess the:

i) Basic Medical Qualification of MBBS or equivalent medical qualification

recognized by Pakistan Medical & Dental Council.

ii) Certificate of one year's House Job experience in institutions recognized by

Pakistan Medical & Dental Council Is essential at the time of interview. The
applicant is required to submit Hope Certificate from the concerned Medical
Superintendent that the House Job shall be completed before the Interview.

iii) Valid certificate of permanent or provisional registration with Pakistan

Medical & Dental Council.
 Admission will be made through Central Induction policy of the Government of
the Punjab in all PG Institutions.

Registration and Enrollment

 As per policy of Pakistan Medical & Dental Council the number of PG Trainees/
Students per supervisor shall be maximum 05 per annum for all PG
programmes including minor programmes (if any).
 Beds to trainee ratio at the approved teaching site shall be at least 5 beds per
trainee.
 The University will approve supervisors for MD courses.
 Candidates selected for the courses after their enrollment at the relevant
institutions shall be registered with UHS as per prescribed Registration
Regulations.

Accreditation Related Issues Of The Institution

A). Faculty
Properly qualified teaching staff in accordance with the requirements of
Pakistan Medical and Dental Council (PMDC)

B). Adequate Space

Including class-rooms (with audiovisual aids), demonstration rooms, computer
lab and clinical pathology lab etc.

C). Library
 Departmental library should have latest editions of recommended books,
reference books and latest journals (National and International).

 Accreditation of Cardiology training program can be suspended on temporary

or permanent basis by the University, if the program does not comply with
requirements for residents training as laid out in this curriculum.
 Program should be presented to the University along with a plan for
implementation of curriculum for training of residents.

 Programs should have documentation of residents training activities and

evaluation on monthly basis.
 To ensure a uniform and standardized quality of training and availability of the
training facilities, the University reserves the right to make surprise visits of the
training program for monitoring purposes and may take appropriate action if
deemed necessary.
 AIMS AND OBJECTIVES OF THE COURSE

AIM

The aim of five years MD programme in Cardiology is to train residents to

acquire the competency of a specialist in the field of Cardiology so that they
can become good teachers, researchers and clinicians in their specialty after
completion of their training.

GENERAL OBJECTIVES
MD Cardiology training should enable a resident to:
1. Overall assessment of patient care that is effective, safe, timely,
efficient, equitable and patient-centered.
2. Medical knowledge about established and evolving biomedical, clinical
and cognate sciences (e.g., epidemiological and social-behavioral) and
the application of this knowledge to patient care.
3. Interpersonal and communication skills that result in effective
information exchange and teaming with patient, their families and
other health professionals.
4. Professionalism, as manifested through a commitment to carrying out
professional responsibilities, adherence to ethical principles and
sensitivity to a diverse patient population, providing cost-effective,
ethical and humanistic care.
5. System-based practice, as manifested by actions that demonstrate an
awareness of and responsiveness to the larger context and system of
health care and the ability to effectively call on system resources to
provide care that is of optimal value.
6. Practice-based learning and improvement that involves investigation
and evaluation of their own patient care, appraisal and assimilation of
scientific evidence and improvement in patient care.
 SPECIFIC LEARNING OUTCOMES
Following competencies are expected from a resident completing MD Cardiology
training;
 Clinical Cardiology: Includes training in cardiac physiology, physical diagnosis,
coronary artery disease, valvular heart disease, vascular disease and
hypertension.

 Cardiac Catheterization: The resident will acquire the cognitive and motor
skills to perform left and right heart catheterization. All procedures shall be
performed under the direct supervision of an attending cardiologist. The resident
is also expected to learn the indications for coronary intervention and post -
intervention management. Trainees with an interest in interventional cardiology
may be offered advanced training in this field.

 Noninvasive Diagnostic Cardiology.

Includes training in perfusion imaging and radionuclear ventriculograms, as well as
exposure to cardiac MRI. Training is comprised of the following rotations:

 Echocardiography: The goal of the echocardiography rotation is to train all

residents in the essentials of clinical echocardiography. For all cardiology
residents, training will include instruction in the basic aspects of ultrasound,
instrumentation, the ability to perform routine transthoracic and transesophageal
studies, including Doppler examinations, and to relate the findings to the patient's
medical management. The trainees are responsible for the acquisition and
interpretation of echocardiograms during this rotation, and are supervised by both
technical staff and attending specialists in echocardiography.

 Nuclear Cardiology and Stress Testing: The goals of this rotation are to
instruct the resident in the indications, the performance, and the interpretation of
diagnostic nuclear cardiology and stress testing. The trainee is directly responsible
to the attending of the exercise/nuclear lab for all components of this rotation.
 For exercise testing, the cardiology resident will become proficient with
performing and interpreting maximal and submaximal exercise tests. He will also
become familiar with exercise physiology, know the essentials of preparation for
exercise testing (skin prep, electrode placement, etc.), and know the clinical
importance of the findings. The trainee will be instructed in all types of
pharmacologic testing (dipyridamole, adenosine, dobutamine), and learn when it
is appropriate to use each method. The resident will be given primary
responsibility to perform stress tests. Trainees will be instructed in the
interpretation of stress test following myocardial infarction for the purpose of
identifying high risk patients and prescribing appropriate exercise regimens for
cardiovascular rehabilitation.

 ECG and Holter: The goal of training in ECG and Holter is to become familiar
with most clinically encountered arrhythmias, understand the clinical importance
of these findings, and have a basic understanding of the physiologic mechanisms
involved in ECG waveforms. For Holter monitoring, the resident should
understand the differences in record.

 Electrophysiology and pacemaker follow-up. Includes training in diagnostic

EPS, ablation, cardiac pacing, and arrhythmia management. The cardiology
residents are expected to acquire knowledge and experience in the diagnosis and
management of arrhythmias, the indications and limitations of electrophysiologic
studies, the appropriate use of antiarrhythmic agents and defibrillator devices.
They will obtain adequate exposure to noninvasive and invasive techniques used
to assess patients with arrhythmias. A minimum of 2 months is dedicated to this
area.

 Heart Failure and Transplantation: Includes training in the evaluation and

treatment of CHF and pre-transplant evaluation. The cardiology resident is
expected to acquire an understanding of the pathophysiology, clinical evaluation,
and management of patients with heart failure that includes detailed assessment
of hemodynamics and cardiac function. Training will include both inpatient and
outpatient settings, under the direct supervision of the attending on the heart
failure/transplant service.

 Interventional Cardiology; Echocardiography: Includes training in 2D, M-

mode, color flow Doppler echo, TEE and stress echocardiography.
  Cardiovascular Research: Includes opportunities for basic cardiac research.

 Preventative Cardiology: Includes training in the management of lipid

disorders, prescription for exercise and stress management strategies.

Technical and Other Skills

Cardiology residents are expected to acquire skill in the performance and

interpretation of:

 History and physical examination. This is supervised by faculty members while

on the clinical services. The residents should take every opportunity to correlate
their physical findings with results of cardiac diagnostic procedures.

 Cardiopulmonary resuscitation and advanced cardiac life support.

Residents are expected to be supervised for complex resuscitative procedures and
treat complex acute life threatening arrhythmias during the CCU rotation.

 Elective cardioversion. Both inpatient and outpatient cardioversion of atrial

fibrillation shall be performed by the residents and is supervised by the faculty
members.

 Bedside right heart catheterization. In the CCU, the cardiology resident will
perform bedside right heart catheterization under the supervision of faculty
members for the first several months until competence is demonstrated.

 Insertion and management of temporary pacemakers. Performed routinely

in the electrophysiology and catheterization laboratories as well as emergently in
the CCU.

 Right and left heart catheterization including coronary arteriography.

 Exercise stress testing. Residents should perform a initially supervised

interpretation and then independently.

 Echocardiography. Residents should perform and interpret the Echo studies.

 Cardiology residents are expected to acquire experience with the
performance and interpretation of:
 Pericardiocentesis
 Programming and follow-up surveillance of permanent pacemakers.
 Intracardiac electrophysiologic studies.
 Intra-aortic balloon counterpulsation.
 Percutaneous transluminal coronary angioplasty and other interventional
procedures.
 Cardiovascular rehabilitation.

The cardiology residents are expected to acquire skill in the interpretation

of:
 Chest x-rays.
 Electrocardiograms
 Ambulatory ECG recording.
 Radionuclide studies of myocardial function and perfusion
 Intensive rotation with didactic and practical interpretation.
 Ongoing research projects
 Cardiovascular literature.

Research Experience:
All residents in the categorical program are required to complete an academic
outcomes-based research project during their training. This project can consist of
original bench top laboratory research, clinical research or a combination of both.
The research work shall be compiled in the form of a thesis which is to be
submitted for evaluation by each resident before end of the training. The
designated Faculty will organize and mentor the residents through the process, as
well as journal clubs to teach critical appraisal of the literature.
 REGULATIONS

Scheme of the Course

A summary of five years course in MD Cardiology is presented as under:

Course
Components Examination
Structure
At the
 Principles of Internal Medicine Intermediate Examination at the
End of
 Relevant Basic Science (Physiology, end of 2nd Year of M.D. Cardiology
2nd
Pharmacology, Pathology) Programme
year MD
Cardiolo
Written MCQs = 300 Marks
gy
Clinical, TOACS/OSCE & ORAL = 200 Marks
Progra
mme Total = 500 Marks

Clinical component Final Examination at the end of 5th

year of M.D. Cardiology Programme.
 Professional Education in Cardiology
Written = 500 Marks
Training in Cardiology with compulsory/ Clinical, TOACS/OSCE & ORAL = 500 Marks
At the
optional rotations. Contribution of CIS = 100 Marks
end of
Thesis Evaluation = 400 Marks
5th year
of MD
Total = 1500 Marks
Cardiolo
gy
Research component
Progra
mme
Research work / Thesis writing must
be completed and thesis be submitted Thesis evaluation and defence at the end
atleast 6 months before the end of of 5th year of M.D. Cardiology Programme.
final year of the programme.
 Intermediate Examinations M.D. Cardiology

All candidates admitted in M.D. Cardiology course shall appear in Intermediate

examination at the end of 2nd calendar year.

Eligibility Criteria:
The candidates appearing in Intermediate Examination of the M.D. Cardiology
Programme are required:
a) To have submitted certificate of completion of mandatory workshops.
b) To have submitted certificate of completion of first two years of
training from the supervisor/ supervisors of rotations.
c) To have submitted CIS assessment proforma from his/her own
supervisor on 03 monthly basis and also from his/her supervisors
during rotation, achieving a cumulative score of 75%.
d) To have submitted certificate of approval of synopsis or undertaking /
affidavit that if synopsis not approved with 30 days of submission of
application for the Intermediate Examination, the candidate will not be
allowed to take the examinations and shall be removed from the
training programme.
e) To have submitted evidence of payment of examination fee.

Intermediate Examination Schedule and Fee

a) Intermediate Examination at completion of two years training, will be
held twice a year.
 b) There will be a minimum period of 30 days between submission of
application for the examination and the conduction of examination.
c) Examination fee will be determined periodically by the University.
d) The examination fee once deposited cannot be refunded / carried over
to the next examination under any circumstances.
e) The Controller of Examinations will issue Roll Number Slips on receipt
of prescribed application form, documents satisfying eligibility criteria
and evidence of payment of examination fee.

Written Part of Intermediate Examination

The candidate of MD Cardiology programme will appear in the subject of

principles of Internal Medicine and relevant basic sciences.

Written Examination = 300 Marks

Clinical, TOACS/OSCE & ORAL = 200 Marks

Written Examination:
The marks of written exam will be divided as follows:

MCQs = 200 Marks

SEQs = 100 Marks

Total = 300 Marks

Principles of Internal Medicine = 70 MCQs 7 SEQs
Specialty specific = 10 MCQs 1 SEQs
Basic Sciences (Physiology, = 20 MCQs 2 SEQs
Pharmacology, Pathology)
Total = 100 MCQs 10 SEQs

Clinical, TOACS/OSCE & ORAL

Four Short Cases = 100 Marks
One Long Case = 50 Marks
Toacs/OSCE & Oral = 50 Marks
Total = 200 Marks

Declaration of Results

The Candidate will have to score 50% marks in written, Clinical,

TOACS/OSCE & ORAL component and a cumulative score of 60% to be
declared successful in the Intermediate Examination.
A maximum total of four consecutive attempts (availed or unavailed) will be
allowed in the Intermediate Examination during which the candidate will be
allowed to continue his training program. If the candidate fails to pass his
Intermediate Examination within the above mentioned limit of four attempts,
the candidate shall be removed from the training program, and the seat
would fall vacant, stipend/ scholarship if any would be stopped.
 Final Examination in MD Cardiology

At the end of 5th year of M.D. Cardiology Programme

Eligibility Criteria:

To appear in the Final Examination the candidate shall be required:

i) To have submitted the result of passing Intermediate Examination.

ii) To have submitted the certificate of completion of training, issued

by the Supervisor will be mandatory.

iii) To have achieved a cumulative score of 75% in Continuous Internal

assessments of all training years .

iv) To have got the thesis accepted and will then be eligible to appear in Final
Examination.

v) To have submitted no dues certificate from all relevant departments

including library, hostel, cashier etc .

vi) To have submitted evidence of submission of examination fee .

Final Examination Schedule and Fee

a) Final examination will be held twice a year.

 b) The candidates have to satisfy eligibility criteria before permission is granted
to take the examination.

c) Examination fee will be determined and varied at periodic intervals by the

University.

d) The examination fee once deposited cannot be refunded / carried over to the
next examination under any circumstances.

e) The Controller of Examinations will issue an Admittance Card with a

photograph of the candidate on receipt of prescribed application form,
documents satisfying eligibility criteria and evidence of payment of
examination fee. This card will also show the Roll Number, date / time and
venue of examination.

Components of Final Examination

Written Part of Final Examination Total marks 500

Clinical, TOACS/OSCE & ORAL Total marks 500
Contribution of CIS to the Final Examination Total marks 100
Thesis Evaluation Total marks 400

Written Part of Final Examination

a) There will be two written papers which will cover the whole syllabus of the
specialty of training with total marks of 500 .

b) The written examination will consist of 200 single best answer type Multiple
Choice Questions (MCQs) and 10 Short Essay Questions (SEQs). Each correct
answer in the Multiple Choice Question paper will carry 02 marks, but an
incorrect response will result in deduction of 0.5 mark. Each Short Essay
Question will carry 10 marks.
 c) The Total Marks of the Written Examination will be 500 and to be divided as
follows:

 Multiple Choice Question paper Total Marks = 400

 Short Essay Question paper Total Marks = 100

d) The candidates scoring a score of 50% marks in multiple choice question

paper and short essay question paper will pass the written part of the final
examination and will become eligible to appear in the clinical and
Toacs/OSCE & Oral.

e) The written part result will be valid for three consecutive attempts for
appearing in the Clinical and Oral Part of the Final Examination. After that the
candidate have to re-sit the written part of the Final Examination.

Clinical, TOACS/OSCE & ORAL:

a) The Clinical and Oral Examination will consist of 04 short cases, 01 long case
and Toacs/OSCE & Oral with 01 station for a pair of Internal and External
Examiner Each short case will be of 07 minutes duration, 05 minutes will be
for examining the patient and 02 minutes for discussion. The Oral
Examination will consist of laboratory data assessment, interpretation of
Radiology images, ECG and others.

b) The Total Marks of Clinical, TOACS/OSCE & ORAL will be 500 and to be
divided as follows:

Short Cases Total Marks = 200

Long Case Total Marks = 100
TOACS/OSCE & ORAL Total Marks = 200
 c) A panel of four examiners will be appointed by the Vice Chancellor and of
these two will be from UHS whilst the other two will be the external
examiners. Internal examiner will act as a coordinator. In case of difficulty
in finding an Internal examiner in a given subject, the Vice Chancellor
would, in consultation with the concerned Deans, appoint any relevant
person with appropriate qualification and experience, outside the
University as an examiner.

d) The internal examiners will not examine the candidates for whom they
have acted as Supervisor and will be substituted by other internal
examiner.

e) The candidates scoring 50% marks in each component of the Clinical & Oral
Examination will pass this part of the Final Examination.

f) The candidates will have two attempts to pass the final examination with
normal fee. A special administration fee of Rs.10,000 in addition to normal
fee or the amount determined by the University from time to time shall be
charged for further attempts.

Declaration of Result

For the declaration of result

I. The candidate must get his/her Thesis accepted.

II. The candidate must have passed the final written examination with
50 % marks and the clinical & oral examination securing 50% marks.
The cumulative passing score from the written and clinical and
Toacs/OSCE & Oral shall be 60%.
 III. The MD degree shall be awarded after acceptance of thesis and
success in the final examination.
IV. On completion of stipulated training period, irrespective of the result
(pass or fail) the training slot of the candidate shall be declared
vacant.

Submission / Evaluation of Synopsis

1. The candidates shall prepare their synopsis as per guidelines provided by

the Advanced Studies & Research Board, available on university website.
2. The research topic in clinical subject should have 30% component related
to basic sciences and 70% component related to applied clinical sciences.
The research topic must consist of a reasonable sample size and sufficient
numbers of variables to give training to the candidate to conduct
research, to collect & analyze the data.
3. Synopsis of research project shall be submitted by the end of the 2nd year
of MD program. The synopsis after review by an Institutional Review
Committee shall be submitted to the University for Consideration by the
Advanced Studies & Research Board, through the Principal / Dean /Head
of the institution.
Submission of Thesis

1. Thesis shall be submitted by the candidate duly recommended by the

Supervisor.
2. The minimum duration between approval of synopsis and submiss ion of
thesis shall be one year.
3. The research thesis must be compiled and bound in accordance with the
Thesis Format Guidelines approved by the University and available on
website.
4. The research thesis will be submitted along with the fee prescribed by the
University.

Thesis Examination

a) The candidate will submit his/her thesis at least 06 months prior to

completion of training.

b) The Thesis along with a certificate of approval from the supervisory

will be submitted to the Registrar’s office, who would record the date /
time etc. and get received from the Controller of Examinations within
05 working days of receiving.

c) The Controller of Examinations will submit a panel of eight examiners

within 07 days for selection of four examiners by the Vice Chancellor.
The Vice Chancellor shall return the final panel within 05 working days
to the Controller of Examinations for processing and assessment. In
case of any delay the Controller of Examinations would bring the case
personally to the Vice Chancellor.

d) The Supervisor shall not act as an examiner of the candidate and will
not take part in evaluation of thesis.

e) The Controller of Examinations will make sure that the Thesis is

submitted to examiners in appropriate fashion and a reminder is sent
after every ten days.

f) The thesis will be evaluated by the examiners within a period of 06

weeks.
g) In case the examiners fail to complete the task within 06 weeks with
02 fortnightly reminders by the Controller of Examinations, the
Controller of Examinations will bring it to the notice of Vice Chancellor
in person.

h) In case of difficulty in find an internal examiner for thesis evaluation,

the Vice Chancellor would, in consultation with the concerned Deans,
appoint any relevant person as examiner in supersession of the
relevant Clause of the University Regulations.

i) There will be two internal and two external examiners. In case of

difficulty in finding examiners, the Vice Chancellor would, in
onsultation with the concerned Deans, appoint minimum of three, one
internal and two external examiners.

j) The total marks of thesis evaluation will be 400 and 60% marks will be
required to pass the evaluation.

k) The thesis will be considered accepted, if the cumulative score of all

the examiners is 60%.

l) The clinical training will end at completion of stipulated training period

but the candidate will become eligible to appear in the Final
Examination at completion of clinical training and after acceptance of
thesis. In case clinical training ends earlier, the slot will fall vacant
after stipulated training period.

Award of MD Cardiology Degree

After successful completion of the structured courses of MD Cardiology and

qualifying Intermediate & final examinations, (written, clinical, Toacs/OSCE

& Oral and thesis) the degree with title MD Cardiology shall be awarded.
 CONTENT OUTLINE

MD Cardiology

1. Physiology

 Cellular membrane function

 Membrane structure and function
 Membrane transport of non-electrolytes (diffusion and osmosis)
 Membrane transport of electrolytes (membrane potentials)
 Physiologic anatomy of the heart, the atria, ventricles, pericardium and
myocardium
 Properties of cardiac muscle
 Cardiac muscle: electrical and mechanical properties.
 Metabolism
 Origin of the HR beat, the electrical activity of the heart (normal and
findings is cardiac and systemic diseases)
 Origin and propagation of cardiac impulse
 Mechanism of production of heart sounds, their location, characters and
relationship with the cardiac cycle.
 The cardiac cycle
 Pressure change during cardiac cycle
 The stroke volume and stroke out-put, cardiac out-put
 Regulation of cardiac function.
 The normal electrocardiogram and characters of its various components.
 Significance of its parts, voltage and calibration, principles and methods
of recording, electrocardiographic leads and general information obtained
from ECG.
 Physiology and abnormalities of apex beat.
 Cardiac output, amount, distribution, measurement, control, cardiac
index and cardiac reserve.
 The special excitatory and conductive system of the heart and their
control
 Abnormalities of the cardiac rhythms
 Echocardiography, exercise tolerance test and the basis of ETT.
 Patho-physiology of cardiac failure, valvular heart disease and
hypertension. Interpretation of data of diagnostic tests .
 Functional classification of blood vessels
 Peripheral circulation: pressure and resistance
 The arterial blood pressure
 The arterial pressure pulse
 The physiology of the veins
 The jugular venous pulse
 The physiology of the capillaries
 Lymph and lymphatics
 Arterial and arteriolar circulation capillary circulation, lymphatic
circulation and venous circulation
 Laws of haemodynamics governing flow, pressure and resistance in blood
vessels
 Vasomotor system and control of blood vessels
 Characters of arterial pulse and venous pulse
 Significance of central venous pressure.
 Hypertension
 Mechanism of haemorrhage and shock
 Coronary, cutaneous, splanchnic and peripheral circulation.
 Cardiovascular regulatory mechanisms local regulation
 Endothelium; systemic regulation by hormones and systemic regulation
by nervous system.
 Circulation through special organs: organs: coronary circulation, cerebral
circulation and pulmonary circulation.
 C.V homeostasis in health and diseases: exercise, gravity, shock,
hypertension and heart failure
 Pathophysiology and classification of edema
 The cutaneous circulation, coronary circulation, cerebral circul ation and
pulmonary circulation
 Hemorrhage or bleeding, circulatory shock
 Respiration, gas exchange & diffusion
 Perfusion and ventilation/perfusion matching
 Cardiopulmonary integration
 The blood. Major cellular and fluid components
 The blood: plasma: clotting, fibrinolysis
 Water, electrolytes (sodium, potassium, calcium) and their distribution
 Mechanism of edema
 Isotonic, hypertonic, and hypotonic, alterations in sodium and water
balance
 Acid - base imbalances: pathophysiology of acidosis and alkalosis
 Heat exchange, filters and reservoirs
 Membrane biochemistry and signal transduction
 Gene expression and the synthesis of proteins
 Bioenergetics; fuel oxidation and the generation of ATP
 Enzymes and biologic catalysis
 Tissue metabolism
VITAMINS
 Classification, components, sources, absorption and functions
(physiological and biochemical role).
 Daily requirements, effects of deficiency and hypervitaminosis.
 Salient morphologic features of diseases related to deficiency or excess of
vitamins.
MINERALS
 Sources of calcium, phosphorous, iron, iodine, fluorine, magnesium and
manganese.
 Trace elements and their clinical importance.
 Absorption and factors required for it.
 Functions and fate.
METABOLISM
 Metabolic rate and basal metabolic rate
 Factors influencing metabolic rate, principles of measurement.
Carbohydrates
 Classification and dietary sources.
 Digestion, absorption and utilization of dietary carbohydrates. Glucose
tolerance test.
  Glycogenesis, glycolysis, gluconeogenesis, glycogenolysis, processes with
the steps involved and effects of hormones.
 Citric acid cycle, steps involved, its significance and the common final
metabolic pathway.
 Hexose monophosphate shunt: mechanism and significance.
Lipids
 Classification of simple, derived and compound lipids.
 Dietary sources.
 Digestion, absorption, utilization and control.
 Fatty acid oxidation with steps involved.
 Ketogenesis and its significance.
 Lipotropic factors and their actions. Lipoproteins, types and importance.
Proteins And Amino Acids
 Classification and dietary sources of proteins.
 Digestion, absorption, utilization and control.
 Fate of amino acids.
 Urea formation with steps involved.
 Functions and effects of deficiency.
Nucleoproteins:
 Structure and metabolism.
 Pigment Metabolism
 Basic concept of endogenous and exogenous pigments.
 Causes of pigmentation and depigmentation.
 Disorders of pigment metabolism, inherited disorders, acquired disorders
from deficiency or excess of vitamins, minerals, fats, carbohydrates,
proteins etc.
Balanced Diet
 Requisites of an adequate diet.
 Role of carbohydrates, fats, proteins, minerals, vitamins and water in
diet.
 Principles of nutrition as applied to medical problems
Biotechnology and concepts of molecular biology with special emphasis on
use of recombinant DNA techniques in medicine and the molecular biology of
cancer

2. Pathology
Pathological alterations at cellular and structural level along with brief
introduction of Basic Microbiology and Haematological pathology as related to
cardiology:

Cell Injury and adaptation

 Reversible and Irreversible Injury
 Fatty change, Pathologic calcification
 Necrosis and Gangrene
 Cellular adaptation
 Atrophy, Hypertrophy,
 Hyperplasia, Metaplasia, Aplasia
Inflammation
 Acute inflammation
 Cellular components and chemical mediators of acute inflammation
 Exudates and transudate
 Sequelae of acute inflammation
 Chronic inflammation
 Etiological factors and pathogenesis
 Distinction between acute and chronic (duration) inflammation
 Histologic hallmarks
 Types and causes of chronic inflammation, non-granulomatous &
granulomatous,
Haemodynamic disorders
 Etiology, pathogenesis, classification and morphological and clinical
manifestations of Edema, Haemorrhage, Thrombosis, Embolism,
Infarction & Hyperaemia
 Shock; classification etiology, and pathogenesis, manifestations.
 Compensatory mechanisms involved in shock
 Pathogenesis and possible consequences of thrombosis
 Difference between arterial and venous emboli
Neoplasia
 Dysplasia and Neoplasia
 Benign and malignant neoplasms
 Etiological factors for neoplasia
 Different modes of metastasis
 Tumor staging system and tumor grade
Immunity and Hypersensitivity
 Immunity
  Immune response
 Diagnostic procedures in a clinical Immunology laboratory
 Protective immunity to microbial diseases
 Tumour immunology
 Immunological tolerance, autoimmunity and autoimmune diseases.
 Transplantation immunology
 Hypersensitivity
 Immunodeficiency disorders
 Immunoprophylaxis & Immunotherapy

Haematopathology
 Normal blood picture & variation in disease
 Haematologic disorder

Related Microbiology
 Role of microbes in various cardiovascular diseases
 Infection source
 Main organisms that cause cardiovascular and pulmonary diseases
 Nosocomial infections
 Bacterial growth and death
 Pathogenic bacteria
 Vegetative organisms
 Spores
 Important viruses
 Important parasites
 Sterilization and disinfection
 Infection prevention
 Immunization
 Personnel protection from communicable diseases
 Use of investigation and procedures in laboratory

Special Pathology
 Vascular phenomenon in pathology e.g. Ischemia, infarction, thrombosis
 Shock etc.
 Rheumatic heart diseases
 Ischemic heart diseases
 Hypertensive heart diseases
 Cardiac failure
  Cardiac tumour
 Cardiomyopathies
 Pericardial diseases
 Endocardial diseases
 Miscellaneous
3. Pharmacology

Introduction to pharmacology
 Receptors
 Mechanisms of drug action
 Drug-receptor interactions
 Pharmacokinetic process
 Absorption
 Distribution
 Metabolism
 Elimination
 Drug effect
 Beneficial responses
 Harmful responses
 Allergic responses
 Drug dependence, addiction
 Abuse and tolerance
 Dosage forms and routes of administration
 Oral routes
 Parenteral routes
 Topical routes
 The drug prescription
 Factors that influence drug effects
 Special considerations in elderly
 Special considerations in pediatric

MD Cardiology
Basic Principles of Internal Medicine
After the induction period of 6 months, the resident will undertake
Internal Medicine training for next 18 months. Resident should get
exposure in the following organ and system competencies (listed below)
while considering and practicing each system in terms of: -

 Medical ethics
 Professional values, student teachers relationship
 Orientation of in-patient, out-patients and cardiology labs
 Approach to the patient
 History taking
 General physical examination
 Systemic examination
 Routine investigations
 Special investigations
 Diagnostic and therapeutic procedures

Course Contents:

1. Cardiovascular Medicine
Common and / or important Cardiac Problems:
 Arrhythmias
 Ischaemic Heart Disease: acute coronary syndromes, stable angina,
atherosclerosis
 Heart Failure
 Hypertension – including investigation and management of accelerated
hypertension
 Valvular Heart Disease
 Endocarditis
 Aortic dissection
 Syncope
 Dyslipidaemia
Clinical Science:
 Physiological principles of cardiac cycle and cardiac conduction
 Pharmacology of major drug classes: beta blockers, alpha blockers,
ACE inhibitors, Angiotensin receptor blockers (ARBs), anti-platelet
agents, thrombolysis, inotropes, calcium channel antagonists,
potassium channel activators, diuretics, anti-arrhythmics,
 anticoagulants, lipid modifying drugs, nitrates, centrally acting anti-
hypertensives

2. Dermatology;
Common and / or Important Problems:
 Cellulitis
 Cutaneous drug reactions
 Psoriasis and eczema
 Skin failure: e.g. erthryoderma, toxic epidermal necrolysis
 Urticaria and angio-oedema
 Cutaneous vasculitis
 Herpes zoster and Herpes Simplex infections
 Skin tumours
 Skin infestations
 Dermatomyositis
 Scleroderma
 Lymphoedema
Clinical Science:
 Pharmacology of major drug classes: topical steroids,
immunosuppressants

3. Diabetes & Endocrine Medicine

Common and / or Important Diabetes Problems:
 Diabetic ketoacidosis
 Non-acidotic hyperosmolar coma / severe hyperglycaemia
 Hypoglycaemia
 Care of the acutely ill diabetic
 Peri-operative diabetes care
Common or Important Endocrine Problems:
 Hyper/Hypocalcaemia
 Adrenocortical insufficiency
 Hyper/Hyponatraemia
 Thyroid dysfunction
 Dyslipidaemia
 Endocrine emergencies: myxoedemic coma, thyrotoxic crisis,
Addisonian crisis, hypopituitary coma, phaeochromocytoma crisis
Clinical Science:
 Outline the function, receptors, action, secondary messengers and
feedback of hormones
 Pharmacology of major drug classes: insulin, oral anti-diabetics,
thyroxine, anti-thyroid drugs, corticosteroids, sex hormones, drugs
affecting bone metabolism

4. Gastroenterology and Hepatology

Common or Important Problems:
 Peptic Ulceration and Gastritis
 Gastroenteritis
 GI malignancy (oesophagus, gastric, hepatic, pancreatic, colonic)
 Inflammatory bowel disease
 Iron Deficiency anaemia
 Acute GI bleeding
 Acute abdominal pathologies: pancreatitis, cholecystitis, appendicitis,
leaking abdominal aortic aneurysm
 Functional disease: irritable bowel syndrome, non-ulcer dyspepsia
 Coeliac disease
 Alcoholic liver disease
 Alcohol withdrawal syndrome
 Acute liver dysfunction: jaundice, ascites, encephalopathy
 Liver cirrhosis
 Gastro-oesophageal reflux disease
 Nutrition: indications, contraindications and ethical dilemmas of
nasogastric feeding and EG tubes, IV nutrition, re-feeding syndrome
 Gall stones
 Viral hepatitis
 Auto-immune liver disease
 Pancreatic cancer
Clinical Science:
 Laboratory markers of liver, pancreas and gut dysfunction
 Pharmacology of major drug classes: acid suppressants, anti-
spasmodics, laxatives, anti-diarrhoea drugs, aminosalicylates,
corticosteroids, immunosuppressants, infliximab, pancreatic enzyme
supplements

5. Renal Medicine
Common and / or Important Problems:
 Acute renal failure
 Chronic renal failure
 Glomerulonephritis
 Nephrotic syndrome
 Urinary tract infections
 Urinary Calculus
 Renal replacement therapy
 Disturbances of potassium, acid/base, and fluid balance (and
appropriate acute interventions)
Clinical Science:
 Measurement of renal function
 Metabolic perturbations of acute, chronic, and end-stage renal failure
and associated treatments

6. Respiratory Medicine
Common and / or Important Respiratory Problems:
 COPD
 Asthma
 Pneumonia
 Pleural disease: Pneumothorax, pleural effusion, mesothelioma
 Lung Cancer
 Respiratory failure and methods of respiratory support
 Pulmonary embolism and DVT
 Tuberculosis
 Interstitial lung disease
 Bronchiectasis
 Respiratory failure and cor-pulmonale
 Pulmonary hypertension
Clinical Science:
 Principles of lung function measurement
 Pharmacology of major drug classes: bronchodilators, inhaled
corticosteroids, leukotriene receptor antagonists, immunosuppressants

7. Allergy
Common or Important Allergy Problems
 Anaphylaxis
 Recognition of common allergies; introducing occupation associated
allergies
 Food, drug, latex, insect venom allergies
 Urticaria and angioedema
Clinical Science
 Mechanisms of allergic sensitization: primary and secondary
prophylaxis
 Natural history of allergic diseases
 Mechanisms of action of anti-allergic drugs and immunotherapy
 Principles and limitations of allergen avoidance

8. Haematology
Common and / or Important Problems:
 Bone marrow failure: causes and complications
 Bleeding disorders: DIC, haemophilia
 Thrombocytopaenia
 anticoagulation treatment: indications, monitoring, management of
over-treatment
 Transfusion reactions
 Anaemia: iron deficient, megaloblastic, haemolysis, sickle cell,
 Thrombophilia: classification; indications and implications of screening
 Haemolytic disease
 Myelodysplastic syndromes
 Leukaemia
 Lymphoma
 Myeloma
 Myeloproliferative disease
 Inherited disorders of haemoglobin (sickle cell disease, thalassaemias)
 Amyloid
Clinical Science:
 Structure and function of blood, reticuloendothelial system,
erythropoietic tissues

9. Immunology
Common or Important Problems:
 Anaphylaxis (see also ‘Allergy’)
Clinical Science:
 Innate and adaptive immune responses
 Principles of Hypersensitivity and transplantation

10. Infectious Diseases

Common and / or Important Problems:
 Fever of Unknown origin
 Complications of sepsis: shock, DIC, ARDS
 Common community acquired infection: LRTI, UTI, skin and soft tissue
infections, viral exanthema, gastroenteritis
 CNS infection: meningitis, encephalitis, brain abscess
 HIV and AIDS including ethical considerations of testing
 Infections in immuno-compromised host
 Tuberculosis
 Anti-microbial drug monitoring
 Endocarditis
 Common genito-urinary conditions: non-gonococcal urethritis,
gonorrhoea, syphilis
Clinical Science:
 Principles of vaccination
 Pharmacology of major drug classes: penicillins, cephalosporins,
tetracyclines, aminoglycosides, macrolides, sulphonamides,
quinolones, metronidazole, anti-tuberculous drugs, anti-fungals, anti-
malarials, anti-helminthics, anti-virals

11. Medicine in the Elderly

Common or Important Problems:
 Deterioration in mobility
 Acute confusion
 Stroke and transient ischemic attack
 Falls
 Age related pharmacology
 Hypothermia
 Continence problems
 Dementia
 Movement disorders including Parkinson’s disease
 Depression in the elderly
 Osteoporosis
 Malnutrition
 Osteoarthritis
Clinical Science:
 Effects of ageing on the major organ systems
 Normal laboratory values in older people

12. Musculoskeletal System

Common or Important Problems:
 Septic arthritis
 Rheumatoid arthritis
 Osteoarthritis
 Seronegative arthritides
 Crystal arthropathy
 Osteoporosis – risk factors, and primary and secondary prevention of
complications of osteoporosis
 Polymyalgia and temporal arteritis
 Acute connective tissue disease: systemic lupus erythematosus,
scleroderma, poly- and dermatomyositis, Sjogren’s syndrome,
vasculitides
Clinical Science:
 Pharmacology of major drug classes: NSAIDS, corticosteroids,
immunosuppressants, colchicines, allopurinol, bisphosphonates

13. Neurology
Common or Important Problems:
 Acute new headache
 Stroke and transient ischaemic attack
 Subarachnoid haemorrhage
 Coma
 Central Nervous System infection: encephalitis, meningitis, brain abscess
 Raised intra-cranial pressure
 Sudden loss of consciousness including seizure disorders (see also above
syncope etc.)
 Acute paralysis: Guillian-Barré, myasthenia gravis, spinal cord lesion
 Multiple sclerosis
 Motor neuron disease
Clinical Science:
 Pathophysiology of pain, speech and language
 Pharmacology of major drug classes: anxiolytics, hypnotics inc.
benzodiazepines, antiepileptics, anti-Parkinson’s drugs (anti-muscarinics,
dopaminergics)

14. Psychiatry
Common and /or Important Problems:
 Suicide and parasuicide
 Acute psychosis
 Substance dependence
 Depression
Clinical Science:
 Principles of substance addiction, and tolerance
 Pharmacology of major drug classes: anti-psychotics, lithium, tricyclic
antidepressants, mono-amine oxidase inhibitors, SSRIs, venlafaxine,
donepezil, drugs used in treatment of addiction (bupropion, disulpharam,
acamprosate, methadone)

15. Cancer and Palliative Care

Common or Important Oncology Problems:
 Hypercalcaemia
 SVC obstruction
 Spinal cord compression
 Neutropenic sepsis
 Common cancers (presentation, diagnosis, staging, treatment principles):
lung, bowel, breast, prostate, stomach, oesophagus, bladder)
Common or Important Palliative Care Problems:
 Pain: appropriate use, analgesic ladder, side effects, role of radiotherapy
 Constipation
 Breathlessness
 Nausea and vomiting
 Anxiety and depressed mood
Clinical Science:
 Principles of oncogenesis and metastatic spread
 Apoptosis
 Principles of staging
 Principles of screening
 Pharmacology of major drug classes in palliative care: anti -emetics, opioids,
NSAIDS, agents for neuropathic pain, bisphosphonates, laxatives, anxiolytics
16. Clinical Genetics
Common and / or Important problems:
 Down’s syndrome
 Turner’s syndrome
 Huntington’s disease
 Haemochromatosis
 Marfan’s syndrome
 Klinefelter’s syndrome
 Familial cancer syndromes
 Familial cardiovascular disorders
Clinical Science:
 Structure and function of human cells, chromosomes, DNA, RNA and cellular
proteins
 Principles of inheritance: Mendelian, sex-linked, mitochondrial
 Principles of pharmacogenetics
 Principles of mutation, polymorphism, trinucleotide repeat disorders
 Principles of genetic testing including metabolite assays, clinical examination
and analysis of nucleic acid (e.g. PCR)

17. Clinical Pharmacology

Common and / or Important problems:
 Corticosteroid treatment: short and long-term complications, bone
protection, safe withdrawal of corticosteroids, patient counselling regarding
avoid adrenal crises
 Specific treatment of poisoning with:
 Aspirin,
 Paracetamol
 Tricyclic anti-depressants
 Beta-blockers
 Carbon monoxide
 Opiates
 Digoxin
 Benzodiazepines
Clinical Science:
 Drug actions at receptor and intracellular level
 Principles of absorption, distribution, metabolism and excretion of drugs
 Effects of genetics on drug metabolism
  Pharmacological principles of drug interaction
 Outline the effects on drug metabolism of: pregnancy, age, renal and liver
impairment

Investigation Competencies
.
Outline the Indications for, and Interpret the Following Investigations:
 Basic blood biochemistry: urea and electrolytes, liver function tests, bone
biochemistry, glucose, magnesium
 Cardiac biomarkers and cardiac-specific troponin
 Creatine kinase
 Thyroid function tests
 Inflammatory markers: CRP / ESR
 Arterial Blood Gas analysis
 Cortisol and short Synacthen test
 HbA1C
 Lipid profile
 Amylase
 Drug levels: paracetamol, salicylate, digoxin, antibiotics, anti -convulsants
 Full blood count
 Coagulation screen
 Haemolysis screen
 D dimer
 Blood film report
 Haematinics
 Blood / Sputum / urine culture
 Fluid analysis: pleural, cerebro-spinal fluid, ascitic
 Urinalysis and urine microscopy
 Auto-antibodies
 H. Pylori testing
 Chest radiograph
 Abdominal radiograph
 Joint radiographs (knee, hip, hands, shoulder, elbow, dorsal spine, ankle)
 ECG
 Peak flow tests
 Full lung function tests

More Advanced Competencies;

 Urine catecholamines
 Sex hormones (FSH, LH, testosterone, oestrogen and progesterone) &
Prolactin
 Specialist endocrine suppression or stimulation tests (dexamethasone
suppression test; insulin tolerance test; water deprivation test, glucose
tolerance test and growth hormone)
 Coeliac serology screening
 Viral hepatitis serology
 Myeloma screen
 Stool testing
 HIV testing
 Ultrasound
 Detailed imaging: Barium studies, CT, CT pulmonary angiography, high
resolution CT, MRI
 Imaging in endocrinology (thyroid, pituitary, adrenal)
 Renal imaging: ultrasound, KUB, IVU, CT
 Echocardiogram
 24 hour ECG monitoring
 Ambulatory blood pressure monitoring
 Exercise tolerance test
 Cardiac perfusion scintigraphy
 Tilt testing
 Neurophysiological studies: EMG, nerve conduction studies, visual and
auditory evoked potentials
 Bone scan
 Bone densitometry
 Scintigraphy in endocrinology
 V/Q scanning
Procedural Competencies

 The trainee is expected to be competent in performing the following

procedures by the end of core training. The trainee must be able to outline
 the indications for these interventions. For invasive procedures, the trainee
must recognize the indications for the procedure, the importance of valid
consent, aseptic technique, safe use of local anaesthetics and minimization
of patient discomfort.
 Venepuncture
 Cannula insertion, including large bore
 Arterial blood gas sampling
 Lumbar Puncture
 Pleural tap and aspiration
 Intercostal drain insertion: Seldinger technique
 Ascitic tap
 Abdominal paracentesis
 Central venous cannulation
 Initial airway protection: chin lift, Guedel airway, nasal airway, laryngeal
mask
 Basic and, subsequently, advanced cardiorespiratory resusci tation
 Bronchoscopy
 Upper and lower GI endoscopy
 ERCP
 Liver biopsy
 Renal biopsy
 Bone marrow and lymph node biopsy
 Cytology: pleural fluid, ascitic fluid, cerebro-spinal fluid, sputum
 DC cardioversion
 Urethral catheterization
 Nasogastric tube placement and checking
 Electrocardiogram
 Knee aspiration
 Temporary cardiac pacing by internal wire or external pacemaker
 Skin Biopsy (this is not mandated for all trainees but opportunities to
become competent in this technique should be available especially for
trainees who subsequently wish to undertake specialist dermatology
training)
Specialty Training in Cardiology
SPECIFIC PROGRAM CONTENT
1. Adult/ Clinical Cardiology

 History taking and examination

 Cardiac failure
 Arrhythmias and conduction defects
 Rheumatic Heart disease
 Endocarditis
 Myocarditis and cardiomyopathies
 Pericardial diseases
 Hypertension
 Cardiac tumor
 Cardiac manifestation of systemic disease.
 Traumatic cardiac injuries
 Atherosclerosis & Arteriosclerosis
 Pulmonary hypertension and Cor-pulmonale

2. Paediatric Cardiology

 History taking and clinical examination

 Heart Failure
 Cyanotic Congenital Heart Disease {Tetralogy Of Fallot (TOF)}
 Acyanotic Congenital Heart Diseases {Ventricular Septal Defect
(VSD), Patent Ductus Arteriosis (PDA), Atrioseptal Defects (ASD)}
 Coarctation of the aorta
 Transposition of great vessels
 Status post fontan patients
 Ebstein anomaly
 Pulmonary stenosis
 Eisenmmenger syndrome
 Rheumatic Fever
 Hypertension
 Viral Myocarditis
 Common Rhythm Disorders {Paroxysmal Atrial Tachycardia (PAT)}
 Presentation of neonatal patients with congenital heart disease.
 EKG findings for disease entities with congenital heart disease and their
various arrhythmic presentations.
 Chest x-ray findings of congenital heart disease patients.
 Echocardiographic appearance of normal heart and be able to recognize
abnormal appearances of most common congenital heart disease defects
 Principles of management in children
 Surgical procedures for correction or palliation of congenital heart disease
 Post-operative management of patients with congenital heart disease
 Congenital heart disease that presents in the adult patient population
 Clinical findings of congenital heart disease as well as the long-term follow
up care required with medical and surgical therapies for this patient
population
 Appropriate management techniques for treating patients with congenital
heart disease over lifetime follow

3. Emergency Cardiology/ Cardiac Intensive Care Unit

 Acute coronary syndromes

 Recognition
 Management
 Complications
 Post intervention follow-up
 Aortic dissection
 Congestive heart failure and pulmonary edema
 Acute valvular complications
 Acute pulmonary embolism
 Pericardial diseases
 Primary arrhythmia
 Bedside procedural complications
 Cardiac arrhythmias
 Hypotension
 Hypertensive crisis
 Shock
 Cardiac Tamponade
 Acute arterial occlusions
Recognize and evaluate all manifestations of arteriosclerotic heart disease
including:
 Acute coronary syndromes
 Hypertensive heart disease
  Cardiac arrhythmias
 Valvular heart disease
 Cardiomyopathy
 Pulmonary heart disease
 Peripheral vascular disease
 Cerebral vascular disease
 Heart disease in pregnancy
 Adult congenital heart disease
 Coronary artery disease and its manifestations and complications
 Non-cardiac chest pain
 Acute and chronic congestive heart failure
 Acute myocardial infarction and other acute ischemic syndromes
 Unstable angina
 CPR
 Implantation of temporary pacemaker
 Minor surgical procedures like CVP, Arterial line, swan genz monitoring.
 Complications of therapy

INVASIVE CARDIOLOGY
4. Clinical Electrophysiology Service

 Introduction to electrophysiology
 Principals of basic electrophysiology including determinants of the
normal action potential and normal cardiac rhythm and conduction.
 Genesis of cardiac arrhythmias, including congenital and acquired
arrhythmias syndromes and action of antiarrhythmic drugs.
 Implantation of cardiac arrhythmia control devices
 Surface EKG interpretation (evaluation of normal and abnormal
intervals, recognition of myocardial infarction/ischemia, metabol ic and
drug effects, conduction disturbances, accessory AV conduction
locations, Exercise testing for arrhythmia assessment).
 Non-invasive testing modalities, such as ambulatory EKG recordings,
telemetry, event recordings, Tilt-table testing, signal-averaged EKG's,
exercise and pharmacological stress testing, heart rate variability, and T
wave alternans.
 Bradyarrhythmias (sinus node dysfunction, AV conduction disorders)
and tachyarrhythmias (atrial arrhythmias, reentrant arrhythmias, wide
complex rhythms).
 Novel arrhythmogenic situations: long QT syndrome, Brugada
syndrome, arrhythmogenic right ventricular dysplasia, idiopathic
ventricular fibrillation.
 Invasive electrophysiologic evaluation, including principles of
stimulation, sinus node function, AV nodal arrhythmias, his-purkinjie
system, ventricular arrhythmias, as well as ablation therapy for
tachyarrhythmias.
 Basic pharmacokinetics and pharmacodynamics of drugs used in
electrophysiology.
 Technique of electrical cardioversion and the sedation procedures that
accompany this technique
 Indications and basic methods of placing pacemakers and automatic
defibrillators.
 Evaluation of patients for syncope and assessment of risks for sudden
cardiac death in certain high risk populations

5. Cardiac Catheterization
 Right heart catheterizations and pulmonary artery catheterizations with
balloon-tipped, flow-guided catheters and will be trained to interpret the
acquired hemodynamic data.
 Insertion of temporary right ventricular pacemakers as well as atrial
pacemakers.
 Pulmonary angiography and left heart catheterization including
ventriculography and coronary and graft angiography.
 Foreign body removal from the right-sided cardiac structure and
pulmonary arterial tree.
 Pericardiocentesis for diagnostic or therapeutic purposes.

 Active participation in the performance of all PCI’s and peri -procedural

management.
 Active participation in peripheral diagnostic and interventional
procedures including assessment of renovascular hypertension and
PVOD.
 Learn the indications and safe performance of femoral closure devices
and recognize and manage their potential complications.
The trainees will become familiar with catheterization laboratory
equipment including:
 Physiologic recorders
 Transducers
 Blood gas and activated clotting time (ACT) analyzers
 Image intensifiers and other x-ray equipment
 Digital imaging
 Report generation (in-line)
The trainees shall be instructed in the principles and management
thereof:
 Shunt detection
 Cardiac output determination
 Wave-form pressure recording and analysis.
 Endomyocardial biopsy
 Insertion of intra-aortic balloon counterpulsation equipment
During the rotation in the catheterization laboratory the trainee
gains experience in;
 The hemodynamics and anatomy of coronary artery disease
 Valvular heart disease including aortic stenosis
 Aortic insufficiency
 Mitral stenosis and mitral insufficiency
 Mitral valve prolapse
 Ventricular septal defects
 Atrial defects
 Ischemic and dilated cardiomyopathy
 Diseases of the aorta
 Pulmonary embolism and pulmonary hypertension
 Renovascular hypertension and peripheral vascular occlusive disease.

Pre-cath work-up of the patients prior to catheterization. This

includes;
 Documentation in the chart of non-invasive tests that have been
performed
 Obtaining reports of previous cardiac catheterizations, cardiac surgery
and other pertinent angiograms.
 After the pre-cath work-up is completed the trainee discusses the case
with the attending cardiologist who will be supervising the procedure.
  The trainees ensure that the appropriate pre-cath blood work-up has
been obtained and is normal. Usual blood work includes CBC, platelet
count, PT, PTT, electrolytes, BUN and creatinine and glucose. Clotting
studies are particularly important in patients on oral anticoagula nts.
 The trainees review the patient’s medications and history of allergies.
Patients with a history of iodine dye allergy, even an equivocal history,
should receive dye allergy prophylaxis prior to catheterization.
 Patients undergoing a PTCA must get aspirin and clopidrogel prior to
the procedure unless clear-cut allergies are documented.
 Patients on long-action Insulin should have a reduction in their dose
the morning of catheterization.
 Potassium should be in the normal range.
 Patients on Glucophage will have their drug held for 48-72 hours post
procedure.
 The cardiovascular resident helps explain the indications and risks for
the catheterization and the procedure to the patient and their family,
and obtain an informed consent.
 The trainees are expected to participate in the follow-up of the patient
after the procedure. This may include performance of closure devices
and removal of any sheaths that were left in after the procedure, often
with continuation of IV GP II BIIIA inhibitor drips.
 Laboratory, nursing and technical staff may assist in sheath removal.
 Catheterization reports will be completed on the day of the procedure.

6. Non Invasive Cardiology

Echocardiography:
 Cognitive Skills
 Indications for echocardiography and it's component parts.
 Case specific knowledge of differential diagnostic problems and specific
echocardiography techniques required conducting a thorough
investigation.
 Alternatives to echocardiography.
 Physical principles of echocardiography image formation
 Doppler evaluation of blood flow velocity measurement.
 Cardiac abnormality due to acquired and congenital heart disease.
  Fluid dynamics of normal and abnormal blood flow patters due to
acquired and congenital heart disease.

Ultrasound Procedures:
 Ultrasound transducer and the Doppler flow signals.
 Transesophageal echocardiography
 Intraoperative transesophageal echocardiography
 Stress echocardiography
 Dobutamine stress echocardiography
 Contrast echocardiography
 The resident must show the ability to correlate the findings by cardiac
auscultation and electrocardiography with echocardiography-Doppler
results.
 The ability to communicate the results of the echocardiography
examination to the patient, physician, and the medical record.
 Operation of the echocardiography equipment and all the controls
affecting the quality of image acquisition.
 Quantitative analysis of the echocardiography examination and
generation of an understandable report.

ECG And Ambulatory Electrocardiography

 Patterns of electrocardiography
 Clinical implications, sensitivity, specificity and normal versus
abnormal variants
 Electrocardiographic interpretation of
 Normal ECG
 General concepts of arrhythmia recognition in:
 Sino atria
 Atria
 AV node
 Ventricles
 AV block
 Abnormalities of ST and T segments
 Chamber abnormalities
 IVCD's
 MI's
 Pacemaker rhythms
All cardiology residents must provide the knowledge and experience
necessary to be fully capable of performing and interpreting M-Mode, 2-
Dimensional and Doppler examination independently under the supervi sion
of the laboratory director and various special ultrasound procedures
For exercise and pharmacologic stress echocardiography, the trainee must
have participated in at least 100 supervised studies beyond level 2 training;
this represents a minimal amount of specialized training.

7. Nuclear Cardiology

 Basic physics and instrumentation in Nuclear Cardiology

 Standard treadmill stress tests.
 The mechanism of action, efficacy, indications, and contraindications of
pharmacological stress testing.
 The clinical outcome assessment.
 Indications for specific Nuclear Cardiology tests, the safe use of
radionuclides, basic instrumentation, and image processing.
 Most commonly used radionuclides, including their physical properties
and bio-availability
 Imaging studies with regards to coronary anatomy and various potential
acquisition abnormalities
 Radiopharmaceutical agents in Nuclear Cardiology: properties and
kinetics.
 Myocardial perfusion imaging: Planar and SPECT
 Protocol and techniques, acquisition, processing, and quantification of
cardiac images.
 Artifacts: Types of artifacts, detection, and attenuation correction.
 Exercise treadmill and pharmacological stress testing (with myocardial
perfusion imaging).
 Radionuclide imaging in risk assessment of CAD.
 Suspected of known CAD.
 Risk assessment in acute coronary syndromes.
 Risk assessment before non-cardiac surgery
 Radionuclide evaluation post CABG and PCI
 Radionuclide imaging in the emergency department and chest pain unit
 Assessment of myocardial viability by radionuclide imaging
  PET and other applications of radionuclide imaging

8. Cardiovascular Imaging

Diagnostic techniques, including:

 Magnetic resonance imaging
 Multi-detector and electron-beam computed tomography
 Positron emission tomography
Pre-operative evaluation for non-cardiac surgery
 Coronary stenting
 Echo-valvular disease
 Echo-wall motion/stress echocardiography
 Aortic disease
 Cardiopulmonary stress testing
 Nuclear cardiology
 Regurgitant valvular lesions
 Stenotic valvular lesions
 Coronary artery bypass grafting vs. Percutaneous coronary
intervention

9. Heart Failure and Transplantation

Inpatient Experience

 Differential diagnosis of dilated cardiomyopathy and the means by which

a diagnosis is established; working knowledge of indications for
endomyocardial biopsy
 Various therapeutics in the acute setting including the use of oral
medications such as diuretics, ACE-inhibitors, digoxin, nitrates, and other
vasodilators. In addition, residents should understand the use of, and
indications for intravenous inotropic therapy including dobutamine
dopamine and milrinone.
 Indications for mechanical support in heart failure patients such as intra-
aortic balloon counterpulsation and ventricular assist device therapy.
 Appropriate work up and management of patients with heart failure and
coronary artery disease who may benefit from surgical revascularization.
  Working knowledge of the inpatient care of patients before and after
cardiac transplantation.
 Working knowledge of the risks and benefits of cardiac transplantation,
including the appropriate pre-transplant evaluation.
 Absolute and relative contraindications to cardiac transplantation.

 Care of patients immediately post-transplant, including the use of

complex hemodynamic monitoring, inotropic and mechanical device
support when needed.
 Use and actions of immunosuppressive drugs in the cardiac transplant
recipient including cyclosporin, FK506 (Tacrolimus), azothioprine,
celcept, and prednisone.
 Working knowledge of the treatment of both acute and chronic allograft
rejection.
 Diagnosis and management of other post-transplant complications
including bacterial, viral, and fungal infections, malignancy, and late
graft vasculopathy.

Outpatient Experience

 During this continuity experience, the resident should participate in the

care of patients who are both established in the clinic as well as those newly
referred. These clinics are aimed at caring for patients with chronic heart
failure, those being considered for cardiac transplantation, and those
following cardiac transplantation.

Objectives for the outpatient experience include:

 Outpatient evaluation of patients with heart failure including the physical

exam, differential diagnosis of their particular condition (systolic vs.
diastolic dysfunction), and appropriate pharmacologic therapy.
 Appropriate counseling and emotional support of these often chronically ill
patients including maximizing the patient’s own participation in their care
(i.e. dietary and medical compliance, self monitoring etc.).
 Predictive variables which portend a bad prognosis for the purpose of
timing of cardiac transplantation.
  Outpatient evaluation and counseling of those patients referred for cardiac
transplantation. The resident should understand factors that make a
patient
suitable or unsuitable for cardiac transplantation. Residents will attend
biweekly meetings of a multidisciplinary transplant team, during which new
patients are presented and discussed. In addition, the status of all
inpatients (either pre or post-transplantation) are discussed.
 Outpatient care of patients in the pre-transplant phase while on the cardiac
transplant list
 Patient in the outpatient setting following cardiac transplantation. This
includes managing and adjusting the immunosuppressive regimen
depending on the results of periodic endomyocardial biopsies. The heart
failure/transplant service holds weekly meetings to review hemodynamic,
biopsy, and other clinical data pertaining to individual patients.
 Working knowledge of the outpatient care of transplant patients suffering
from various complications of immunosuppressive therapy that include
cyclosporine-induced hypertension and renal dysfunction, prednisone-
induced diabetes, etc.
 Appropriate diagnosis and management of infectious complications in non-
acutely ill patients in the outpatient setting.

10. Cardiology Therapeutics

 Pharmacokinetics and pharmacodynamics of common drugs related to

cardiology
 The drug prescription
 Factors that influence drug effects
 Special considerations in elderly
 Special considerations in pediatric
Cardiac glycosides (Class I-IV)
 Inotropic agents
 Antiarrhythmic drugs
 Antianginal agents
 Drugs effecting skeletal muscle
 Anaesthetics
 Analgesics
 Diuretic therapy in cardiovascular diseases
  Narcotic and sedative therapy
 Anti-hypertensive therapies
 Anticoagulant, fibrinolytic and thrombolytic therapy and the cardiac
perfusion
 Steroid therapy and the cardiac perfusion
 Bronchodilator therapy
 Diabetic therapies and the cardiac perfusion
 Cardiac preserving/energy supplying agents
 New cardiopulmonary and renal agents
 Medications regimens related to transplantation of organs
 Various antimicrobial agents/antibiotics commonly used in
cardiovascular diseases
 Solutions
 Composition and therapy
 Volume and tonicity
 Specific electrolytes
 Blood substitutes
 Myocardial Drug Therapy

11. Vascular Medicine

 Ordering and interpretation of non-invasive testing
 Peripheral artery disease
 Acute arterial occlusions
 Carotid artery disease
 Cerebrovascular disease
 Aortic aneurysm
 Aortic dissection
 Renal artery stenosis
 Vasculitis
 Basal spasm
 Venous thrombosis
 Venous insufficiency
 Lymphedema
 Indications, strengths, and weakness of the various non-invasive test
 Technical aspects in the performance of modality
Vascular studies including:
 Duplex ultrasonography of the veins and arteries of the upper and lower
extremities
  Duplex ultrasonography of the aorta and it's branches
 Duplex ultrasonography of the carotid arteries
 Physiologic test of the peripheral arteries and veins
 Management and treatment options of various vascular diseases.
 Primary and secondary risks stratification
 Indications and limitations of percutaneous interventions in the treatment of
peripheral vascular disease
 Surgical treatment of peripheral vascular disease

12. Preventive Cardiology

 Lipid management; Dyslipidemias
 Assessment of cardiovascular risk
 Smoking
 Blood pressure control
 Obesity
 Diabetes mellitus
 Medical therapy for chronic coronary artery disease
 Risks and benefits of cardiac rehabilitation
 Arrhythmia management
 Appropriate management of anticoagulation with the necessary indications
Risk factors and educate patients in reducing risk factors:

13. Clinical Case Conferences and Specialty Lectures

 Non-invasive Conference covering all aspects of echocardiographic, nuclear,
magnetic resonance and CT imaging as well as an Integrated Imaging
Conference and an Intra-Operative TEE Conference
 Cardiac CT/MR Conference
 Electrocardiographic/EP Conference
 Cardiology Grand Rounds
 Residents Journal Club
 Cardiology Research Conference
 Cardiac Catheterization Conference
 Interventional Cardiology Conference
 Vascular Medicine Conference

14. Clinical Rotations:

 During the third, fourth and final year, the cardiology resident s shall rotate
in the following clinical services. This is accomplished through the supervised
performance of consultations, daily hospital rounds and active participation
in procedures under the supervision of attending faculty. Clinical decision-
making and a cost-effective scholarly approach to cardiology problems are
emphasized through teaching rounds, clinical rounds and clinical
conferences. The 3rd year cardiology resident is expected to present cases at
the clinical conferences.

Third Year MD Cardiology

 Three months Coronary care unit
 Three months consultation service
 Three months non-invasive service
 Three months cardiac catheterization laboratory.

During this time, the resident is expected to develop basic cognitive and
procedural skills including:

 Left and right heart catheterization

 Temporary transvenous pacemaker insertion
 Intra-aortic balloon pump placement
 Exercise and chemical stress testing with or without imaging
studies
 Transthoracic and transesophageal echocardiogram
performance.

Fourth Year MD Cardiology

The resident will complete the required time for the year, which include:

 Three months of echocardiography

 Two months of nuclear cardiology
 One month of other non-invasive cardiac testing including
exercise stress testing, EKG interpretation and Holter monitoring
 Two months in the cardiac catheterization laboratory
 Two months in electrophysiology

The inpatient experience during the 3rd & 4th years will comprise eight months
of non-laboratory clinical practice activities i.e. consultations, cardiac care unit
and post-operative care of cardiac surgery patients. Two months will be
devoted to the electrophysiology rotation and pacemaker follow-up as well as
ICD follow-up. In addition to further developing clinical and echocardiographic
skills, the resident will develop more complex procedural skills as outlined
below (cardiac catheterization, interventional procedures, transesophageal
echocardiograms and electrophysiology studies) and will develop an
appreciation for the indications, contraindications and technical limitations of
these procedures. He/she will serve as a primary teaching resource for medical
students, residents and first year cardiology residents.

Final Year MD Cardiology

The final year resident in cardiovascular diseases can follow one of two tracks:
invasive or non-invasive.
During the invasive track the goals are perfect ion of procedural as well as
clinical and cognitive skills.

Objective:

 The resident will participate actively in the performance of diagnostic cardiac

catheterization as well as interventional procedures and will be involved in the
training of junior residents assigned to the catheterization laboratory. All of
this will be under the close supervision of the attending faculty.
 In the intensive care and cardiac care setting, the senior cardiology resident
will supervise and assist in the performance of emergency procedures such as
right heart catheterization, temporary pacemaker insertion, pericardiocentesis,
and elective and emergency cardioversions.
 In the non-invasive track, the senior cardiovascular resident will spend more
time in the echocardiography laboratory where he will be responsible for
supervising exercise and chemical stress tests as well as improving his skills in
echocardiography with particular emphasis on transesophageal
echocardiography and intravascular ultrasound.
 In the electrophysiology laboratory, the senior resident will be participating in
diagnostic electrophysiology procedures, ablation procedures, insertion of
permanent pacemakers and insertion of implantable cardioverter defibrillators.
 The trainees will maintain records of participation in the form of a logbook
documenting their participation in procedures such as cardiac catheterization,
interventional procedures, echocardiograms, transesophageal
echocardiograms, cardioversions, pacemaker implantations, and
electrophysiologic procedures such as ablations.

RESEARCH/ THESIS WRITING

Total of one year will be allocated for work on a research project with thesis
writing. Project must be completed and thesis be submitted before the end of
training. Research can be done as one block in 5th year of training or it can be
stretched over five years of training in the form of regular periodic rotations
during the course as long as total research time is equivalent to one calendar
year.

Research Experience

The active research component program must ensure meaningful,

supervised research experience with appropriate protected time for each
resident while maintaining the essential clinical experience. Recent
productivity by the program faculty and by the residents will be required,
including publications in peer-reviewed journals. Residents must learn the
design and interpretation of research studies, responsible use of informed
consent, and research methodology and interpretation of data. The program
must provide instruction in the critical assessment of new therapies and of
the medical literature. Residents should be advised and supervised by
qualified staff members in the conduct of research.

Clinical Research
Each resident will participate in at least one clinical research study to
become familiar with:
1. Research design
2. Research involving human subjects including informed consent and
operations of the Institutional Review Board and ethics of human
experimentation
3. Data collection and data analysis
4. Research ethics and honesty
5. Peer review process

This usually is done during the consultation and outpatient clinic rotations.
Case Studies or Literature Reviews
Each resident will write, and submit for publication in a peer-reviewed
journal, a case study or literature review on a topic of his/her choice.

Laboratory Research

Bench Research
Participation in laboratory research is at the option of the resident and may
be arranged through any faculty member of the Division. When appropriate,
the research may be done at other institutions.

Research involving animals

Each resident participating in research involving animals is required to:
1. Become familiar with the pertinent Rules and Regulations of the
University of Health Sciences Lahore i.e. those relating to "Health and
Medical Surveillance Program for Laboratory Animal Care Personnel" and
"Care and Use of Vertebrate Animals as Subjects in Research and
Teaching"
2. Read the "Guide for the Care and Use of Laboratory Animals"
3. View the videotape of the symposium on Humane Animal Care

Research involving Radioactivity

Each resident participating in research involving radioactive materials is
required to
1. Attend a Radiation Review session
2. Work with an Authorized User and receive appropriate instruction from
him/her.
 METHODS OF INSTRUCTION/COURSE CONDUCTION
As a policy, active participation of students at all levels will be encouraged.
Following teaching modalities will be employed:

1. Lectures
2. Seminar Presentation and Journal Club Presentations
3. Group Discussions
4. Grand Rounds
5. Clinico-pathological Conferences
6. SEQ as assignments on the content areas
7. Skill teaching in ICU, emergency and ward settings
8. Attend genetic clinics and rounds for at least one month.
9. Attend sessions of genetic counseling
10. Self-study, assignments and use of internet
11. Bedside teaching rounds in ward
12. OPD & Follow up clinics
13. Long and short case presentations

In addition to the conventional teaching methodologies interactive strategies

like conferences will also be introduced to improve both communication and
clinical skills in the upcoming consultants. Conferences must be conducted
regularly as scheduled and attended by all available faculty and res idents.
Residents must actively request autopsies and participate in formal review of
gross and microscopic pathological material from patients who have been
under their care. It is essential that residents participate in planning and in
conducting conferences.

1. Clinical Case Conference

Each resident will be responsible for at least one clinical case conference
each month. The cases discussed may be those seen on either the
consultation or clinic service or during rotations in specialty areas. The
resident, with the advice of the Attending Physician on the Consultation
Service, will prepare and present the case(s) and review the rel evant
literature.
2. Monthly Resident Meetings

Each affiliated medical college approved to conduct training for MD

Cardiology will provide a room for resident meetings/discussions such as:

a. Journal Club Meeting

b. Core Curriculum Meetings
c. Skill Development

a. Journal Club Meeting

A resident will be assigned to present, in depth, a research article or topic of

his/her choice of actual or potential broad interest and/or application. Two
hours per month should be allocated to discussion of any current articles or
topics introduced by any participant. Faculty or outside researchers will be
invited to present outlines or results of current research activities. The
article should be critically evaluated and its applicable results should be
highlighted, which can be incorporated in clinical practice. Record of all such
articles should be maintained in the relevant department.

b. Core Curriculum Meetings

All the core topics of Cardiology should be thoroughly discussed during these
sessions. The duration of each session should be at least two hours once a
month. It should be chaired by the chief resident (elected by the residents of
the relevant discipline). Each resident should be given an opportunity to
brainstorm all topics included in the course and to generate new ideas
regarding the improvement of the course structure

c. Skill Development

Two hours twice a month should be assigned for learning and practicing
clinical skills.

List of skills to be learnt during these sessions is as follows:

1. Residents must develop a comprehensive understanding of the

indications, contraindications, limitations, complications, techniques, and
 interpretation of results of those technical procedures integral to the
discipline (mentioned in the Log Book).
2. Residents must acquire knowledge of and skill in educating patients
about the technique, rationale and ramifications of procedures and in
obtaining procedure-specific informed consent. Faculty supervision of
residents in their performance is required, and each resident's
experience in such procedures must be documented by the program
director.
3. Residents must have instruction in the evaluation of medical literature,
clinical epidemiology, clinical study design, relative and absolute risks
of disease, medical statistics and medical decision-making.
4. Training must include cultural, social, family, behavioral and economic
issues, such as confidentiality of information, indications for life
support systems, and allocation of limited resources.
5. Residents must be taught the social and economic impact of their
decisions on patients, the primary care physician and society. This can
be achieved by attending the bioethics lectures and becoming familiar
with Project Professionalism Manual such as that of the American
Board of Internal Medicine.
6. Residents should have instruction and experience with patient
counseling skills and community education.
7. This training should emphasize effective communication techniques for
diverse populations, as well as organizational resources useful for
patient and community education.
8. Residents may attend the series of lectures on Nuclear Medicine
procedures (radionuclide scanning and localization tests and therapy)
presented to the Radiology residents.
10. Residents are required to assist in the advanced cardiological procedures
on a limited basis for exposure to the technique. All trainees should be
well versed in the indications for, management of and complications of
patients with regard to interventional procedures at the end of the
programme. Cardiology residents are expected to acquire skill in the
performance and interpretation of:
 History and physical examination.
 Cardiac diagnostic procedures.
 Cardiopulmonary resuscitation and advanced cardiac life support
 Complex resuscitative procedures and treatment of complex acute life
threatening arrhythmias during the CCU rotation.
  Elective cardioversion. Both inpatient and outpatient cardioversion of
atrial fibrillation
 Right and left heart catheterization including coronary arteriography
 Intra-aortic balloon counterpulsation
 Insertion and management of temporary pacemakers
 Programming and follow-up surveillance of permanent pacemakers
 Exercise stress testing
 Echocardiography
 Pericardiocentesis
 Intracardiac electrophysiologic studies.
 Percutaneous transluminal coronary angioplasty and other interventional
procedures
 Cardiovascular rehabilitation; prescription of exercise in cardiac
patients.

The cardiology residents are expected to acquire skill in the

interpretation of:

 Chest x-rays. On an individual basis with the attending radiologist as

well as part of the didactic program.
 Electrocardiograms. As part of the bimonthly conference schedule
ECG's are reviewed. All clinical services require ECG review. The trainee
reads
 ECG’s with the attending cardiologist.
 Ambulatory ECG recording
 Radionuclide studies of myocardial function and perfusion. Intensive
rotation with didactic and practical interpretation.
 Ongoing research projects. The resident will have regular meetings with
the program director to review research in progress.
 Cardiovascular literature.
 Residents should have experience in the performance of clinical
laboratory and radionuclide studies and basic laboratory techniques,
including quality control, quality assurance and proficiency standards.

3. Annual Grand Meeting

Once a year all residents enrolled for MD Cardiology should be invited to the
annual meeting at UHS Lahore.
One full day will be allocated to this event. All the chief residents from
affiliated institutes will present their annual reports. Issues and concerns
related to their relevant courses will be discussed. Feedback should be
collected and suggestions should be sought in order to involve residents in
decision-making.
The research work done by residents and their literary work may be
displayed.
In the evening an informal gathering and dinner can be arranged. This will
help in creating a sense of belonging and ownership among students and the
faculty.
 LOG BOOK
The residents must maintain a log book and get it signed regularly by the
supervisor. A complete and duly certified log book should be part of the
requirement to sit for MD examination. Log book should include adequate
number of diagnostic and therapeutic procedures observed and performed,
the indications for the procedure, any complications and the interpretation of
the results, routine and emergency management of patients, case
presentations in CPCs, journal club meetings and literature review.

Proposed Format of Log Book is as follows:

Candidate’s Name: ---------------------------------------------

Supervisor ------------------------------------------------------
Roll No. ----------------------------------------------------------

The procedures shall be entered in the log book as per format

Residents should become proficient in performing the related procedures (pg. 43). After
observing the technique, they will be observed while performing the procedure and, when
deemed competent by the supervising physician, will perform it independently. They will be
responsible for obtaining informed consent, performing the procedure, reviewing the results
with the pathologist and the attending physician and informing the patient and, where
appropriate, the referring physician of the results.

Procedures Performed

Name of Patient, Age, Procedure Supervisor’s

Sr.# Date Diagnosis
Sex & Admission No. Performed Signature
1
2
3
4
Cardiac Emergencies Handled

Sr. Name of Patient, Age, Procedure/ Supervisor’s

Date Diagnosis
# Sex & Admission No. Management Signature
1
2
3
4

Case Presented

Name of Patient, Age, Supervisor’s

Sr.# Date Case Presented
Sex & Admission No. Signature
1
2
3
4

Seminar/Journal Club Presentation

Supervisor’s
Sr.# Date Topic
Signature
1
2
3
4
Evaluation Record
(Excellent, Good, Adequate, Inadequate, Poor)

At the end of the rotation, each faculty member will provide an evaluation of
the clinical performance of the resident.

Method of Evaluation
(Oral, Practical, Theory) Rating Supervisor’s
Sr.# Date
Signature
1
2

EVALUATION & ASSESSMENT STRATEGIES

Assessment

It will consist of action and professional growth oriented resident-centered

integrated assessment with an additional component of informal internal
assessment, formative assessment and measurement-based summative
assessment.

Resident-Centered Integrated Assessment

It views students as decision-makers in need of information about their own
performance. Integrated Assessment is meant to give students responsibility
for deciding what to evaluate, as well as how to evaluate it, encourages
students to ‘own’ the evaluation and to use it as a basis for self-
improvement. Therefore, it tends to be growth-oriented, resident-controlled,
collaborative, dynamic, contextualized, informal, flexible and action-
oriented.

In the proposed curriculum, it will be based on:

 Self-Assessment by the resident

 Peer Assessment
 Informal Internal Assessment by the Faculty

Self-Assessment by the Resident

Each resident will be provided with a pre-designed self-assessment form to

evaluate his/her level of comfort and competency in dealing with di fferent
relevant clinical situations. It will be the responsibility of the resident to
correctly identify his/her areas of weakness and to take appropriate
measures to address those weaknesses.

Peer Assessment

The residents will also be expected to evaluate their peers after the monthly
small group meeting. These should be followed by a constructive feedback
according to the prescribed guidelines and should be non-judgmental in
nature. This will enable students to become good mentors in future.

Informal Internal Assessment by the Faculty

There will be no formal allocation of marks for the component of internal

assessment so that students are willing to confront their weaknesses rather
than hiding them from their instructors.

It will include:
 a. Punctuality
b. Ward work
c. Monthly assessment (written tests to indicate particular areas of
weaknesses)
d. Participation in interactive sessions

Formative Assessment

Will help to improve the existing instructional methods and the curriculum in
use

Feedback to the faculty by the students:

After every three months students will be providing a written feedback

regarding their course components and teaching methods. This will help to
identify strengths and weaknesses of the relevant course, faculty members
and to ascertain areas for further improvement.

Summative Assessment

It will be carried out at the end of the programme to empirically evaluate

cognitive, psychomotor and affective domains in order to award degrees for
successful completion of courses.
 MD CARDIOLOGY EXAMINATIONS
Intermediate Examination MD Cardiology
Total Marks: 500

All candidates admitted in MD Cardiology course shall appear in Intermediate

examination at the end of 2nd calendar year

Written Examination = 300 Marks

Clinical, TOACS/OSCE & ORAL = 200 Marks

Written:
MCQs = 200 Marks
SEQs = 100 Marks

Total = 300 Marks

Principles of Internal Medicine = 70 MCQs 7 SEQs

Specialty specific = 10 MCQs 1 SEQs
Basic Sciences = 20 MCQs 2 SEQs

Physiology = 8 MCQs 1 SEQ

Pharmacology = 4 MCQs ------
Pathology = 8 MCQs 1 SEQ

Clinical, TOACS/OSCE & ORAL

Four Short Cases = 100 Marks
One Long Case = 50 Marks
TOACS/OSCE & ORAL = 50 Marks
Total = 200 Marks
 Final MD Cardiology
Total Marks: 1500

All candidates admitted in MD course shall appear in Final examination at the

end of structured training (end of 5th calendar year) and after clearing
Intermediate examination.

There shall be two written papers of 250 marks each, Clinical, TOACS/OSCE
& ORAL of 500 marks, Internal assessment of 100 marks and thesis
examination of 400 marks.

Topics included in paper 1 200 Marks 50Marks

1. Adult/Clinical Cardiology (40 MCQs) (1 SEQs)

2. Pediatric Cardiology (25 MCQs) (1 SEQs)
3. Nuclear Cardiology / Cardiovascular Imaging (15 MCQs) (1 SEQs)
4. Emergency Cardiology (10 MCQs) (1 SEQs)
5. Heart Failure and Transplantation (10 MCQs) (1 SEQs)

100 MCQs 5 SEQs

Topics included in paper 2 200 Marks 50Marks

1. Invasive Cardiology (30 MCQs) (1 SEQs)

2. Non Invasive Cardiology (30 MCQs) (1 SEQs)
3. Cardiology Therapeutics (15 MCQs) (1 SEQs)
4. Preventive Cardiology (15 MCQs) (1 SEQs)
5. Vascular Medicine (10 MCQs) (1 SEQs)

100 MCQs 5 SEQs

Theory

Paper I 250 Marks 3 Hours

 5 SEQs 50 Marks
100 MCQs 200 Marks

Total 250 Marks

Paper II 250 Marks 3 Hours

5 SEQs 50 Marks
100 MCQs 200 Marks

Total 250 Marks

Only those candidates, who pass in theory papers, will be eligible to appear in
the Clinical, TOACS/OSCE & ORAL.

Clinical, TOACS/OSCE & ORAL 500 Marks

Four short cases 200 Marks

One long case: 100 Marks
Clinical, TOACS/OSCE & ORAL 200 Marks

Continuous Internal Assessment 100 Marks

Thesis Examination 400 Marks

All candidates admitted in MD courses shall appear in thesis examination at

the end of 5th calendar year of the MD programme. The examination shall
include thesis evaluation with defense.