CURRICULUM

FOR
2 YEARS DIPLOMA PROGRAMME
IN

ANAESTHESIOLOGY
(DA)

2007

UNIVERSITY OF HEALTH SCIENCES

LAHORE, PAKISTAN
SR. CONTENTS PAGE NO

1 Foreword 1
2 Aims and Objectives of the Course 3
3 Specific Learning Outcomes 4

3 Nomenclature and Duration 5

4 Eligibility Criteria for Admission 8

Recognition/Equivalence of the Degree and
5 9
Institution
6 Content Outline 10

9 Methods of Instruction/Course Conduction 17

10 Log Book 19

11 Literature Review 21

12 Examinations 22

13 Recommended Books 27
 FOREWORD
University of Health Sciences (UHS) Lahore was inaugurated by the
President of Pakistan on the 3rd of October 2002 with the vision to
explicitly address academic and research needs in the field of health
sciences and allied disciplines and to uplift their existing level to bring
them on a par with the international standards.

The mission of the University is to develop an intellectual nexus to

provide excellence and innovation in medical education and research in
order to;

• Impart knowledge and skills to health care providers to enhance

their competence in providing community oriented and multi-
disciplinary patient -centered care
• Train and produce researchers and specialists in basic and
clinical medical sciences
• Establish and maintain continuing professional development
programmes for the faculty
• Provide trained professionals and scientists/researchers to the
field of Electro Medical/Bio-Medical disciplines
• Assure quality in health education and research at all levels

A university is the zenith of knowledge that imparts quality education

and awards degrees for extensive educational attainments in various
disciplines with attendant advancement for the development of
intellectual community. Protection of tradi tional knowledge, making
exploration about it and obtaining deep understanding of modern
technology and research techniques are some of the responsibilities of
any university.

UHS is running a number of courses in the field of health sciences in

Punjab. The list extends from undergraduate level courses up to the
doctorate level both in basic, clinical and allied health sciences.

Since its inception, certain vital tasks were taken into serious
consideration by UHS, for instance, curricula development and their
up-gradation were among the most important ones besides
introduction of contemporary educational programmes.

UHS has revised and finalized curricula for undergraduate Medical/

Dental Education, B.Sc Nursing, and Allied Health Sciences.

In keeping with its commitment for further improvement in the

standard of medical education, UHS has taken an initiative to modify
1
and improve one year postgraduate diploma courses to 2 years
structured training programmes.

I do not believe in selling an old product in a new packing with a fresh

label on it, just to do the job. Original products with actual outcomes
for the society must be guaranteed. Being the Vice Chancellor of a
public sector health university, I believe, it is my duty to remain
vigilant and committed to the cause of improvement of the
conventional medical and allied health sciences’ curricula on regular
basis. This will help produce technically sound professionals with
advanced knowledge and skills.

Presently, UHS has designed and facilitated curriculum development

committees for eleven clinical disciplines namely: DTCD, DPM, DMRT,
DOMS, DLO, Dip. Card, DCH, DCP, DGO, DMRD and DA.

This document precisely briefs the details of updated curriculum for

Diploma in Anaesthesiology (DA) as prepared by the Experts’
Committee.

I am pleased to acknowledge the efforts made by Prof. I. A. Naveed,

the Department of Medical Education and the members of the
committee for DA consisting of: Prof. Taif-ul-Islam Gillani (SIMS), Prof.
Asghar Ali Randhawa(PMC), Prof. Khalid Bashir(PGMI), and Prof.
Salman Waris (NMC). The contributions made by them will go a long
way in the education and training of doctors in this field.

I hope, the revised course will be able to meet the needs of latest
trends in Anaesthesiology and will certainly produce competent mid-
level specialists in the field, which is the main objective of this
programme.

Prof. M. H. Mubbashar
Hilal-e-Imtiaz, Sitara-e-Imtiaz
MB, FRCP, FCPS Psych, FRC Psych, DPM
Vice Chancellor/ Chief Executive
University of Health Sciences, Lahore

2
 AIMS AND OBJECTIVES OF THE COURSE
AIM

The aim of 2 years diploma programme in Anaesthesiology is to equip

medical graduates with relevant professional knowledge, skills and
ethical values to enable them to apply their acquired expertise at
primary and secondary health care organizations as non-academic
consultants.

OBJECTIVES

DA training should enable a student to:

1. Demonstrate comprehensive knowledge of General Medicine,

General Surgery, Physiology, Pharmacology, physical properties of
gases and working of vast array of anaesthetic equipment
2. Apply national and international guidelines to assess a patient
3. Satisfactorily addresses fears, concerns and expectations of
the patients
4. Evaluate patients in the setting of outpatients department, hospital
wards, labour room, emergency and operation theatre
5. Order a set of relevant investigations considering availability,
diagnostic yield, cost-effectiveness, side effects, and implications
for management
6. Take proper informed consent for physical examination and ensure
confidentiality and appropriate environment for intimate physical
examination
7. Counsel patients and relatives in patient’s preferred language in
elective and emergency situations in keeping principles of good
communication skills, empathy and empowerment of patients
8. Exhibit emotional maturity and stability, integrity, ethical values and
professional approach, sense of responsibility in day-to-day
professional activities
9. Act as an independent specialist at community level/Tehsil and
District Headquarter Hospital
10. Show initiative and become life long self-directed learners tapping
on resources including clinical material, faculty, internet and on-line
learning programmes and library

3
 SPECIFIC LEARNING OUTCOMES

Following competencies will be expected from a student completing 2

years course in Anaesthesiology:

1. Discuss principles of basic sciences as applied to Anaesthesiology

like haemorrahage, blood transfusion, shock, sterilization of
instruments, infection, antibiotics, inflammation, repair & healing
2. Able to procure informed consent in accordance with the guideline
set by PMDC
3. Well-versed with triad of Anaesthesia i.e, hypnosis, analgesia and
muscle relaxation
4. Aware of his/her role as the one who not only ensures provision of
ideal operating conditions for surgery, but also intensive care,
resuscitation, alleviation of acute and chronic pain and anaesthesia
for diagnostic procedures
5. Is able to assess and balance the risks of anaesthesia
6. Is able to ensure that the patient is as fit as possible
7. Is able to decide on the type of anaesthesia and analgesia
8. Communicate effectively with patients about the intended surgical
procedure, can rationally explain benefits vs. risk factors involved in
both anaesthesia and the anticipated surgery
9. Is able to allay anxiety and pain

4
 NOMENCLATURE AND DURATION

NOMENCLATURE OF THE PROPOSED COURSE:

The name of diploma course should be retained as DA. This name has
been recognized and established for the last many decades worldwide.
The duration of courses should be two years structured training in a
recognized department under an approved supervisor.

Course Title: DA (Diploma in Anaesthesiology)

Training Centres: Departments of Anaesthesia (accredited by UHS)

in affiliated institutes of the University
of Health Sciences Lahore

Course Duration and Scheme of the Course:

Total Duration 2 years structured training (6 months in Part I

and one & a half year in Part II) in a recognized depart ment under the
guidance of an approved supervisor

Part I- SIX MONTHS

Theoretical Component

1. Applied Anatomy
2. Applied Physiology
3. Pharmacology
4. General Pathology/ Applied Hematology
5. Physics & Anaesthetic Equipment
6. Monitoring Equipment
7. Biostatistics and research
8. Behavioural sciences
9. Resuscitations & crisis management.
10. Introduction of basic principles in anaesthesia
11. Practical conduct of Anaesthesia

a. Preoperative assessment
b. Clinical examination & recognition of medical diseases
c. Premedication
d. Induction of anaesthesia
e. Airway maintenance
f. Monitoring during anaesthesia
g. Recovery from anaesthesia

5
 h. Post op problems and care

Part II- YEAR & a HALF

Theoretical Component

1. General surgical conditions and anaesthesia

2. Medical diseases and anaesthesia
3. Obstetrical and gynaecological anaesthesia
4. Neuro-anaesthesia
5. Paediatric anaesthesia
6. Urology anaesthesia
7. Day care anaesthesia
8. Eye & ENT anaesthesia
9. Trauma & orthopaedic anaesthesia
10. Post anaesthesia care and recovery
11. Crisis management
12. Cardiac arrest and resuscitation
13. Regional anaesthesia: Spinal and epidural, Intrathecal,
Extremity blocks

14. Practical conduct of Anaesthesia

a. Preoperative assessment
b. Optimization of common medical diseases
c. Premedication
d. Induction of anaesthesia
e. Airway maintenance
f. Monitoring during anaesthesia
g. Recovery from anaesthesia
h. Post op problems and care

6
 PROPOSED ROTATIONS

(The supervisors can schedule these rotations according to their own circumstances)

YEAR I & II

General Surgery 6 months

Orthopaedics and trauma 4 months
Gynae. & Obs. 4 months
Urology 2 months
ENT 2 months
Eye 1 month
ICU & Post anaesthesia care unit 2 month
Neurosurgery 1 month
Paediatrics 1 month
Cardiothoracic 1 month
___________
24 months

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 ELIGIBILITY CRITERIA FOR ADMISSION

DOCUMENTS REQUIRED FOR THE ADMISSION

1. Completed DA application form

2. Copy of MBBS degree with mark sheets of professional
examinations and certificate of number of attempts in professional
examinations
3. Copy of PMDC registration certificate
4. Three latest passport size photographs
5. Reference letters from two consultants, with whom the applicant
has worked
6. Certificates of completion of required experience

GENERAL REQUIREMENTS

Candidates eligible for admission should have MBBS or equivalent

qualification, registered with PMDC and can fulfill one of the following
criteria:

a. One year experience in Anaesthesiology as medical officer/house

surgeon
b. Six months in Medicine/Surgery and six months in allied specialty
as medical officer/house officer/ house surgeon

SPECIAL REQUIREMENTS

1. Obtaining pass percentage in the entry test as determined by the

UHS
2. Qualifying the interview successfully
3. Having up to the mark credentials, determined by the UHS (no. of
attempts in each professional, any gold medals or distinctions,
relevant work experience, research experience from a recognized
institution, any research article published in a National or an
International Journal)

REGISTRATION AND ENROLLMENT

• Total number of students enrolled for the course must not exceed 8
per unit
• UHS Lahore will approve supervisors for diploma courses
• Candidates selected for the courses will be registered with relevant
supervisors and enrolled with UHS

8
 RECOGNITION/EQUIVALENCE OF THE DEGREE AND
INSTITUTION
After two years training course, candidate should be given status of a
mid-level specialist equivalent to any other similar qualification.

Accreditation related issues of the institution:

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

2. Adequate Space
Including class-rooms (with audiovisual aids), computer lab

3. Library
Departmental library should have latest editions of recommended
books for DA, reference books and latest journals (two national
and one international)

9
 CONTENT OUTLINE
PART I DA

APPLIED ANATOMY: Relevant to Anaesthesiology.

Nervous System (central and peripheral)

Brain and spinal cord, cranial nerves (in particular 5, 7, 10)
Cerebral Circulation
CSF formation and flow
Vertebral column, spinal and epidural spaces
Dermatomes of body
Nerve supply upper and lower limbs, thorax, abdomen and perineum
Pain Pathways
Autonomic Nervous System
Detailed anatomy of sympathetic and parasympathetic nervous
system
Head and Neck
Mouth, pharynx, Great vessels neck and thorax, Thoracic inlet,
intercostals spaces, Thyroid gland
Respiratory System
Nose, Larynx, trachea and bronchial tree, lungs, pleura,
Mediastinum, muscles of respiration, diaphragm
Cardiovascular System
Heart, coronary circulation, conduction system, Blood supply of upper
and lower limbs and other relevant organ systems of the body.

APPLIED PHYSIOLOGY:

Nervous System

1. Neuromuscular physiology
2. Nervous system: structure and formation of brain and spinal
cord, physiology of sensation, neuromuscular transmission,
synaptic transmission, cerebrospinal fluid.
3. Autonomic nervous system
4. Pain pathways
5. Stress response

Respiratory System
1. Control of Respiration
2. Mechanics of Respiration
3. Gas Exchange
4. 02 & C02 Transport
10
 5. Acid-Base Balance

Cardio-Vascular System
1. Origin and Conduction of Cardiac Impulse
2. Cardiac Cycle
3. Coronary Circulation
4. Regulation of Blood Pressure
5. Regulation of Cardiac Output
6. Control of Blood Flow through Organs

Haematology
1. Physiology pertinent to anaemias
2. Physiology of Haemostasis & coagulation
3. Blood and Blood Component Therapy
4. Blood & Blood groups

Gastrointestinal System
1.Nausea & vomiting
2.Hepatic physiology

Renal System
1. Body Compartments, Body fluids, electrolytes balance
2. Renal Blood Flow Regulation
3. Glomerular Filteration,Tubular Functions, formation of urine,
4. Renal Control of Acid/Base Balance
5. Renal failure

Maternal and Neonatal Physiology

1. Physiology of Pregnancy
2. Placental Physiology
3. Foetal Physiology of Circulation
4. Neonatal Physiology and APGAR Scoring

Endocrine system
Pituitary, adrenals, thyroid & parathyroid, Insulin secretion
Physiology of Temperature Regulation

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PHARMACOLOGY

A) Principles of General Pharmacology

B) Special pharmacology

General Anaesthetics
1. Intravenous induction agents
2. Inhalation agents: Nitrous oxide, halothane, Isoflurane,
desflurane, Sevoflurane
3. Local anaesthetics
Sedatives
1. Benzodiazepines
2. Butyrophenones
3. ALPHA Adrenergic Agonists
4. Clonidine, Dexmetatomidine
5. Phenothiazines
Analgesics
Analgesics: Simple analgesics, NSAIDs, Opiates
Muscle Relaxants
Depolarizing & non-depolarizing, reversal agents
Anti-Cholinergics
a) Atropine
b) Glycopyrolate
Medical Gases
c) Oxygen
d) Nitrousoxide
e) Operation theatre environment and recovery area humidity
f) Entonox
g) Co2
h) Medical Air
Inotropes and vasopressors
Beta blockers
Antihypertensive agents, vasodilators
Antiarrhythmic drugs
Diuretics
Insulin and Oral Hypoglycaemics
Antiemetics
Anti-Histaminics
Antacids
Corticosteroids
Diuretics
Crystalloids and colloids

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GENERAL PATHOLOGY/ APPLIED HEMATOLOGY

1. General Pathology

Cell Injury and adaptation

Cell Injury
• Reversible and Irreversible Injury
• Fatty change, Pigmentation, Pathologic calcification
• Necrosis and Gangrene
Cellular adaptation
• Atrophy, Hypertrophy,
• Hyperplasia, Metaplasia, Aplasia
Inflammation
• Acute inflammation --- Vascular changes, Chemotaxis,
Opsonization and Phagocytosis
• Enlist the cellular components and chemical mediators of
acute inflammation
• Differentiate between exudates and transudate
• Chronic inflammation
• Etiological factors, Granuloma
Cell repair and wound healing
• Regeneration and Repair
• Healing--- steps of wound healing by first and second
intention
• Factors affecting healing
• Enlist the complications of wound healing
Haemodynamic disorders
• Define and classify the terms Edema, Haemorrhage,
Thrombosis, Embolism, Infarction & Hyperaemia
• Define and classify Shock with causes of each.
• Describe the compensatory mechanisms involved in shock
• Describe the pathogenesis and possible consequences of
thrombosis
• Describe the difference between arterial and venous
emboli
Neoplasia
• Dysplasia and Neoplasia
• Differences between benign and malignant neoplasms
• Enlist the common etiological factors for neoplasia
• Define and discuss the different modes of metastasis
• TNM staging system and tumor grade
Immunity and Hypersensitivity
Urinary system: Effect of injury and disease

13
 Respiration: disturbance resulting from injury or
Disease ( Asthma, emphysema, Bronchitis)

2. Applied Hematology

• Blood Transfusion
• Cross matching techniques
• Infections and blood transfusions.
• Blood and Blood Component Therapy
• Complications of blood transfusion
Salient pathophysiological and clinical Features Of:
• Different types of anemias
• Immune hemolytic anemias.
• Clotting and bleeding abnormalities
• Acute / Chronic leukemias

PHYSICS AND EQUIPMENT

1. Basic Definitions
For example Vapour Pressure, Critical Pressure, Critical
Temperature, Boiling Point, Thermal Conductivity
2. Basic laws of physics applicable to Anaesthesia
3. Operation theatre environment and recovery area
For instance, humidity, temperature, light, electrical safety,
pollution, infection, post-anaesthesia care unit (PACU)
4. Medical gas supply system VIE (Visual Information Engineering),
manifolds, cylinders, regulation
5. Anaesthesia machines, machine check, safety feature, flow meters,
vaporizers, pressure relief valves
6. Delivery system / Breathing systems
Mapelsons circuits, circle absorber
7. Ventilation
Basic principles of minutes’ volume dividers,
(Pressure generator, flow generation)
8. Scavenging System
9. Anaesthesia Sundries
Largyngoscopes, guedel airways, face masks, laryngeal
mask airways, endotracheal tubes, bougies, stilettos,
connectors
10. Monitoring
a. Standards / Principles of monitoring
b. Record Keeping
c. Critical Incident Monitoring
d. Principles of Oximetry
e. Principles of Capnography
f. Electrocardiography
14
 g. Temperature Monitoring
h. Neuromuscular Monitoring
1. Blood Pressure Monitoring, Non-Invasive and Invasive
j. Blood Loss
k. Airways Pressures / Spirometry
l. Cerebral Function Analysis Monitor

BEHAVIOURAL SCIENCES

a. Bio-Psycho-Social (BPS) Model of Health Care

b.jUse of Non-medicinal Interventions in Clinical
Practice
• Communication Skills
• Counselling
• Informational Skills
c. Crisis Intervention/Disaster Management
d. Conflict Resolution
e. Breaking Bad News
f. Medical ethics, Professionalism and Doctor-Patient
Relationship
• Hippocratic Oath
• Four Pillars of Medical Ethics (Autonomy,
Beneficence, Non-malficence and Justice)
• Informed Consent and Confidentiality
• Ethical Dilemmas in a Doctor’s Life
g. Delivery of Culturally Relevant care and Cultural
Sensitivity

h. Psychological aspects of health and Disease

• Psychological Aspect of Health
• Psychological Aspect of Disease
• Stress and its management
• Psychological aspect of Pain
• Psychological Aspect of Aging

BIOSTATISTICS AND RESEARCH

a. Introduction to Bio-Statistics
b. Introduction to Bio- Medical Research
c. Why research is important?
d. What research to do?
• Selecting a Field for Research
• Drivers for Health Research
• Participation in National and International
Research

15
 • Participation in Pharmaceutical Company
Research
• Where do Research Ideas come from
• Criteria for a good research topic
e. Ethics in Health Research
f. Writing a Scientific Paper
g. Making a Scientific Presentation
h. Searching the Literature

PART II DA

CLINICAL ANAESTHESIA

In the 2nd year of DA, knowledge base of general and regional

anaesthesia in the following disciplines will be required:

1. General Surgery
2. Obstetrics and Gynaecological Surgery
3. Paediatric Surgery
4. Neuro Surgery
5. Opthalmic Surgery
6. Ear, Nose and Throat Surgery
7. Urological Surgery
8. Day Care Surgery
9. Basic Principles of Thoracic Anaesthesia
10. Inter-current medical diseases and Anaesthesia
11. Emergency / Trauma / Orthopaedic Surgery
12. Resuscitation
13. Acute post-operative pain
14. Post-anaesthesia care and recovery
15. Intra-thecal Anaesthesia
16. Pre-operative Assessment

16
 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 operating theatres
8. Self study, assignments and use of internet
9. Bedside teaching rounds in ward
10. Long and short case presentations

In addition to the conventional teaching methodologies following

interactive strategies will also be introduced to improve both
communication and clinical skills in the upcoming mid-level
consultants:

1.1. Monthly Student Meetings

Each affiliated medical college approved to conduct training for DA will

provide a room for students’ meetings/discussions such as

a. Journal Club Meeting

b. Core Curriculum Meetings
c. Skill Development

a. Journal Club Meeting

Two hours per month should be allocated to the presentation and

discussion of a recent Journal article related to Anaesthesiology. 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 of
each medical college. Students of different medical colleges may be
given an opportunity to share all such interesting articles with each
other.

b. Core Curriculum Meetings

All the core topics of DA should be thoroughly discussed during these

sessions. The duration of each session should be at least two hours
17
once a month. It should be chaired by the chief student (elected by
the students of the relevant diploma). Each student 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. Communication skills
2. Interpretation of radiographs, interpretation of ECG, interpretation
of ABGs, interpretation of lab investigations
3. Practical skills i.e. use of relevant clinical instruments
4. Presentation skills: Power point, lectures, small group discussions,
article presentation etc.
5. Research and scientific writing
6. For acquisition of procedural skills like I/V cannulation, airway
management, sub-arachnoid block, caudal block, I/V regional
anaesthesia (Bier’s Block) opportunities during ward rotations
should be availed

1.2 Annual Grand Meeting

Once a year all students for DA should be invited to the annual
meeting at UHS Lahore.

One full day will be allocated to this event. All the chief students will
present their annual reports. Issues and concerns related to their
relevant diploma courses will be discussed. Feedback should be
collected and also suggestions should be sought in order to involve
students in decision making. The research work and their literary work
can be displayed.
In the evening an informal gathering and dinner may be arranged.
This will help in creating a sense of belonging and ownership among
students and the faculty.

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 LOG BOOK
The trainees 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 the DA examination. Log book should
include adequate number of anaesthetic procedures, 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: _________________________________

Roll No. _____________

PROCEDURES:

• I/V cannulation
• Airway management (intubation technique)
• Infiltration
• Nerve blocks
• Femoral nerve block
• Spinal aneasethesia
• Epidural anaesthesia
• Sub-arachnoid block
• I/V regional anaesthesia (Bier’s Block)
• Intra-thecal anaesthesia
• Thoracic anaesthesia
• Caudal block
• Resuscitation

Sr.# Name of Patient, Diagnosis Procedure Supervisor’s

Date Age, Sex & Performed Signature
Admission No.
1
2

Emergencies Handled

Sr. Name of Patient, Procedure Supervis

# Date Age, Sex & Diagnosis /Manage or’s
Admission No. ment Signatur
e
1
2

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Case Presented

Sr.# Date Name of Patient, Case Presented Supervisor’s

Age, Sex & Signature
Admission No.
1
2

Seminar/Journal Club Presentation

Sr.# Date Topic Supervisor’s

signature
1
2

Evaluation Record
(Excellent, Good, Adequate, Inadequa te, Poor)

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

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 LITERATURE REVIEW
Students will be assigned a clinical problem most commonly
encountered in the relevant specialty and will be specifically trained to
review literature in the relevant field and write a ‘Review of an
Article’ comprising of:

• Topic
• Introduction
• Discussion of the reviewed literature
• Conclusion
• References

21
 EXAMINATIONS
Assessment

It will consist of action and professional growth oriented student-

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

Student-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, student-controlled, collaborative, dynamic, contextualized,
informal, flexible and action-oriented.

In the proposed curriculum, it will be based on:

• Self Assessment by the student

• Peer Assessment
• Informal Internal Assessment by the Faculty

Self Assessment by the Student

Each student will be provided with a pre-designed self-assessment

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

Peer Assessment

The students 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.
22
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 diplomas for successful completion of courses.

Eligibility to Appear in Final Examination

- Only those candidates will be eligible to take final examination,

who have passed Part 1 examination (after 6 months of
education) and have completed two years of
structured/supervised training programme.
- Only those candidates who have completed their log books and
hold certificates of 75% attendance should be allowed to sit for
the exam
- Application for the final examination will be submitted with
supervisor’s recommendation
- Only those candidates who qualify in theory will be called for
clinical examination

DA Examination

Part I DA

The examination will be held after completion of 6 months of education.

23
Topics included in paper 1

• Anatomy (17 MCQ)

• Physiology (25 MCQ)
• Principles of Pharmacology and Therapeutics (25 MCQ)
• General Pathology/ Applied Hematology (10 MCQ)
• Physics and Equipment (13 MCQ)
• Behavioural Sciences (05 MCQ)
• Introduction to Biostatistics and Research (05 MCQ)

Components of the Part 1 examination

MCQ Paper 100 One Best Type

Total Marks 100 Marks

Part II DA

Topics included in paper 1

Clinical Anaesthesia
1. Day Care Surgery
2. Inter-Current Medical Diseases and
Anaesthesia
3. Emergency/ Trauma/ Orthopaedic
Surgery
4. Resuscitation
5. Acute Post-Operative Pain
6. Post- Anaesthesia Care and Recovery
7. Intra-Thecal Anaesthesia
8. Pre-Op Assessment

Topics included in paper 2

Clinical Anaesthesia
1. General Surgery
2. Obstetrics and Gynaecological Surgery
3. Paediatric Surgery
4. Basic Principles of Thoracic Anaesthesia
5. Neuro Surgery
6. Ophthalmic Surgery
7. ENT Surgery
8. Urological Surgery

24
Part II Examination

Theory

Paper I 100 Marks 3 Hours

10 SEQs (No Choice) 50 Marks
50 MCQs 50 Marks

Paper II 100 Marks 3 Hours

10 SEQs (No Choice) 50 Marks
50 MCQs 50 Marks

The candidates who pass in theory papers, will be eligible to appear in

the clinical & viva voce.

OSCE 90 Marks

10 stations each carrying 9 marks of 10 minutes duration; each

evaluating performance based assessment with five of them
interactive

Clinical 90 Marks

Four short cases each carrying 15 marks and one long case of 30
marks.

Components of the Part II examination

Theory paper 1 100 marks

Theory paper 2 100 marks

Clinical/Oral 180 marks

Log Book 20 marks

Total Marks 400

A panel of four examiners from Anaesthesia Department (Two internal

and two external) will be appointed for practical examination.

Each component of practical examination will be assessed by two

examiners awarding marks simultaneously and independently. The
final score awarded will be an average score, as agreed by both
examiners.
25
Pass Percentage and other Regulations Regarding Examination

• Criterion referenced assessment principles will be used

• 20 marks for the log book will be included in the OSCE
component
• 60 % marks will be a pass score in each component
• Candidates failing in any one component will have to re-
sit the entire examination
• A maximum of 5 attempts to sit for the examination will
be allowed, to be availed within 3 calendar years of the
first attempt
• Re-admission in DA course is not permissible under any
circumstances
• Results will be announced according to rules and
regulations set by the Examination Branch of the
University of Health Sciences Lahore

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 RECOMMENDED BOOKS

1. Aithenhead A. R., Smith G., Rowbotham D. J. Textbook of

Anaesthesia. 5th ed. Churchill Livingstone
2. Morgan G. E., Mikail M. S., Murray M. J. Clinical
Anaesthesiology. 4th ed. Lange
3. Yao and Artusio’s. Anaesthesiology:Problem oriented Patient
Management 5th ed. Lippincott Williams and Wilking
4. David P. D. and Kenny G. N. C. Basic Physics and Measurement
in Anaesthesia. 5th ed. Butterworth Heinmann
5. Rana M. H., Ali S. Mustafa M. A Handnook of Behavioural
Sciences for Medical and Dental Students. Lahore: University of
Health Science; 2007.
6. Fathalla M. F. and Fathalla M. M. F. A Practical Guide for Health
Researcher. Cairo: World Health Organization; 2004.

RECOMMENDED JOURNALS

1. British Journal of Anaesthesiology

2. Anaesthesia (British Journal)
3. Anaesthesia and Analgesia (American Journal)
4. Anaesthesia and Critical Care (British Journal)

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