Academics

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Eligibility Criteria for admission and intake capacity :

• MD. Internal Medicine with M.M.C. Registration
• 2 students per year

Selection Criteria for candidates:

Fellows should be selected in a fair and non-discriminatory manner in accordance with the Equal Opportunities. The selection process will be according to MUHS guidelines.

The candidate is expected to appear for the multichoice(MCQ) written examination of 100 marks. Selected candidates will be called for the interview. Ultimately , selection of a candidate for a fellowship will be done by an interview with panel of faculties constituted by the MUHS.

Examination paper for selection of candidates for Fellowship :

Three sets of MCQ paper will be set by the committee of the faculties approved by MUHS & only one paper will be selected by random process on the day of examination.

Evaluation of the examination conducted will be done by a committee of faculties

Merit list & Successful candidates name will appear on the WEB site of MUHS

Complete Curriculum of the course :

• IHD (3 Lectures)
• CHF (1 Lecture)
• Arrhythmias (2 Lectures)
• Long. Heart Diseases in Adult (1 Lecturer)
• Cardiac Emergencies (3 Lectures)
• Systematic Hypertension (2 Lectures)
• Valvular Heart Disease (2 Lectures)
• Cardiomyopathies (2 Lectures)
• Miscelleneous (1 Lecture)
• Pharmacotherapy of acute coronary syndrome
• 2D Echo Cardiography (1 Lecture)

Text Books & Reference Books :

• Braunwald’s – Heart Disease
• J. Willis Hurst – The Heart
• Eric J. Topotl – Textbook of Cardiovascular Medicine

Faculty required with their qualifications and experience :

• Faculty should have DM/DNB Cardiology degree
• At least 1 yr. of teaching experience as faculty.

Faculty :

• Dr. Ashish Deshpande

Scheme of Evaluation :

• Evaluation will be by Credit Based System.
• Allotment of Credits Total Credit Points 300
• Minimum required for passing 240 (80%)

Didactic Credits: 25 credit points

• Didactic on various topics as per syllabus spread over One Hour lecture. Total 10-20 Lectures depending upon specified course material and depth of theory.

Presentation,Publications & Project Work: 25 credit point

• Under faculty guidance, presentations for Local , Regional & national conferences.

Video Learning, Grand Rounds, Faculty Discussions:10 credit Points

• Review of Recorded Cases/ Procedures/Surgeries with Faculty Input.
• Specific/specialized Surgery Grand Round/Clinical Case Conference.
• Disease/Journal Club, Round Table Discussions.

Sessions in Imaging Clinics:15 credit points

• Learning of Ultrasound, CT scan, MRI & Various Procedures required for the particular course/module (e.g. Doppler etc. )
• INTENSIVE CARDIAC CARE MANAGEMENT CREDITS: TOTAL 175
• A Candidate is expected to maintain certified Log book indicating number of cases assisted or individually managed and procedures performed under the guidance of faculty for each Module.
• Fellowship Examination 50 Credit Points (Terminal Exam by MCQs)
• The examination for a particular course may be conducted according to the requirement of a course.

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Program Objectives :

The GI Endoscopy fellowship is designed to

• Provide comprehensive training and acquisition of skills in diagnostic and therapeutic endoscopy procedures
• Help in integration of endoscopy in diagnosis and management of gastrointestinal and hepatobiliary disorders
• Training in research
• Inculcate appreciation of humanistic (cost conscious, caring) and ethical (accountability, integrity) aspects of medicine.
• Develop ability to work as part of a multidisciplinary team

Complete curriculum of the course :

• Understanding basic physics and principles of endoscopy
• Understand the features of various types of endoscopes and accessories
  • i) Reprocessing and maintenance of endoscopes and accessories
  • ii) Understanding the principles, techniques and complications or conscious sedation /analgesia as well as patient monitoring during and after endoscopy
• Obtain familiarity with informed consent and medical ethics, and explaining risk of endoscopy to patients
• Antibiotic prophylaxis
• Cognitive understanding of diagnostic /therapeutic procedures interpreting the findings and understanding the clinical indications / contraindications as well as complications.
• Integrate endoscopic Knowledge with patient care
• Motility studies – Esophageal & anorectal 24 hr pH study

Teaching Scheme :

Acquire technical skills in performing the following diagnostic / therapeutic procedures, interpreting findings, recognizing and treating complications :

• • Management of gastrointestinal bleed : lesion identification and appropriate therapy – adrenaline injection, APC, variceal sclerotherapy , variceal Band ligation and cyanoacrylate injection of fundal varices
  • Luminal dilatation (strictures, achalasia cardia ,webs ): Savary Guillard, pneumatic, CRE
  • Stent placement – esopyageal, small bowel, colonic
  • Percutaneous endoscopic gastrostomy tube placement and exchange
  • Nasogastric and nasojejunal tube placement
  • Foreign body removal
  • polypectomy
  • Pancreatic pseudocyst drainage
  • Side viewing endoscopy
  • ERCP- biliary and pancreatic duct connulation , biliary and pancreatic sphincterotomy ,biliary and pancreatic and pancreatic stent placement , stone removal, biliary stricture dilatation, nasobiliary drainage tube placement.
  • Pediatric endoscopy
    • Rotation through GI Department at Tata Hospital for 3 months attaining skills in endosonography and specific issues regarding endoscopy in oncology patients
    • Minimum number of procedures for minimum competence :
      • Therapy of gastrointestinal bleed – Varical 50 & NonVarical 50
      • Esophageal dilatation 50
      • Esophageal stenting 20
      • PEG 15
      • Naso –jejunal tube placement 25
      • Peroperative enteroscopy 15
      • ERCP :
        • Biliary sphincterotomy 30
        • Biliary / pancreatic stenting/ NBD 30
        • Stone extraction (bile duct ) 25
        • Paeudocyst drainage 10
      • Paediatric procedures once a month
      • Motility studies (esophageal / anorectal ) 25
      • 24 hr pH monitoring 20
    • Night call on rotation for observing / assisting ./performing emergency endoscopies
    • See consultations for endoscopy procedures and follow up patients after the procedures
    • Supervising and teaching basic endoscopy skills to D. M trainees
    • Regular discussion with radiologists ,pathologists
    • Regular presentation of journal articles and seminars in the departmental Weekly academic meetings .
    • Integrate endoscopic knowledge with patient care
    • Research presentation at national conferences
    • Clinical research in endoscopy and evidence based practice. Regular Meeting will be held between fellows and faculty members to design and Conduct research . the fellows are required to complete a minimum of one research project in endoscopy during the one year training under the supervising of faculty members . The project proposal should be submitted within a month of joining the fellowship to the project proposal should joining the fellowship to institute review board for obtaining ethical clearance and funding if required

Suggested Books for Reading :

• • • Practical gastrointestinal endoscopy :The Fundamentals -6thedition , P .B. Cotton, C. Williams
    • Endoscopy related topics from Sleisenger and Fordtran’ s Gastrointestinal and liver disease. 7th edition,Robert H, Hawes : Endosonography (Elsevies , Saunder )
    • Sugano K Double balloon endosclpy – Therapy and practice (Springer )
    • M . Classon. Gastroenterological endoscopy (Thieme )
    • Tytgat GWK. Practice of therapeutic endoscopy W.W.Saunders )
    • Sivak Gastroenterologic endoscopy (W.B. Saunders )
    • J. H. Siegal . Endoscopic Retrograde Cholangio pancreatography
    • Barkin . Advanced therapeutic endoscopy (Raven press )
    • Van Dam , Sivak . GI Endosonography (w. B. Saunders )
    • Wilcox . Atlas 0f Clinical G.I. Enodscopy (Saunders )
    • Keeffe E.B. Atlas of G.I. Endoscopy (Current Med. Ins)
    • Klaus . Atlas of G.I. Endoscopy and pathology (Blackwell)
    • Kenchel .Atlas of video capsule endoscopy (Springer )
    • Messmann H. Atlas of colonoscopy (Thrieme )
    • Advanced therapy in gastrointestinal and liver disease
    • Sohendre . Colour atlas of prerative techniques – Therapeutic endoscopy

Suggested Journals :

• • Endoscopy
  • G. I Endoscopy
  • Endoscopy

Evaluation process :

• The performamce of the fellow will be monitored carefully during the course of training
• Formal evaluation by the faculty members on a regular basis. This include the performance of procedure. of findings and planning/ performance of appropriate therapy. These will be recorded in the log book maintained by the candidate .
• At the end of the course there will be :
  • Written exam
  • Practical test: Skill assessment in performing endoscopies
  • Orals :radiology/ instruments, clinical reasoning and selection of endoscopic procedures in different case scenarios . The candidate should secure a minimum of 50%marks each in written 5% practical tests and 50% in orals to pass the examination
  • Evaluation of research project

To successfully complete the fellowship :

• The candidate should pass the exit exam with at least 50%marks
• The research project should be complete an approved by Faculty
• The log book containing documented competence in endoscopic procedures should be approved by the external faculty

Faculty :

• Dr. P.P. Wasadikar
• Dr. U.V. Takalkar
• Dr. S.S. Bhalsing

 

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CRITERIA FOR INSTITUTIONAL RECOGNITION BY MUHS

List of various training centres, hospitals & institutes should be prepared & will have MOU with MUHS for allowing the faculties to train the candidates & work in their respective institutes for the purpose of award of fellowship. The list of such institute should be prepared & maintained in accordance with & as per approved faculties by MUHS.

Criteria for Soft skill Development Centres/Training Centres/Laboratories

The Centre must have minimum 3 years of experience in conducting such courses. In one academic year, they should have conducted at least 12 courses and minimum number of trainees should be 50 (Fifty).
In addition they should have,

• Operating room fully equipped with laparoscopic/basic set up for Wet lab or Cadaveric surgery with at least 2 working stations.
• Dedicated Operating room for dry labs which is well equipped with simulators for individual participants for developing hands eye coordination or any additional required practice.
• Various simulators for Hands eye coordination skill development, any other skill development for respective courses e.g.Virtual Simulator (LAP MENTOR)
• Conference room facility, Polycom facility for Audio visual
• Library (BOOKS, JOURNALS & VIDEO)
• Live relay OT facility

Criteria for Clinical, Operative Sessions Institutes/ Hospitals :

• Minimum of 50 bedded Hospital/ Institute for Single speciality and 200 bedded hospital for Multispecialty
• Modern ICU for Postoperative Care
• Dedicated Operating room fully equipped with Basic infrastructure and Instruments required for the particular course set up e.g. laparoscopic set up
• For example in laparoscopic surgery, a Laparoscopic set fully equipped with various telescopes, camera, light source,Monitor, CO2 insufflators, suction irrigation, Bipolar, Monopolar, Harmonic & Ligasure or Enseal like devices
• Independent Pathology facilities
• Imaging devices like Ultrasound ,CT Scan, MRI
• Conference room facility, Polycom facility for Audio visual
• Library (BOOKS, JOURNALS & VIDEO). The library services available to fellows should include electronic retrieval of information from medical databases
• Live relay OT facility preferred
• Independent Department with stipulated criteria of Faculties/Teachers
• A sufficient number of patients must be available to ensure that fellows receive appropriate experience in the management of complex problems without adversely affecting particular surgery core program. Specifically, a fellowship will not be approved in an institution that has a program deficiency in the pertinent areas of surgery.
• Institutes with High Volume of surgery work for the specific course/module offered is preferred. Should have a workload of more than 50 cases in 2 months in respective courses/modules.
• Lines of responsibility for general surgery residents and other residents and fellows must be defined clearly. Fellows may serve as teaching assistants for residents when appropriate.
• Conferences, including medical-surgical reviews, analyses of complications and deaths, seminars, and clinical and basic science instruction, must be regularly scheduled

Criteria for the faculty with MUHS for Fellowship in Breast Surgery :

Minimum 15 years’ experience of Surgery in the specified course/module.

Minimum 10 years’ experience of Professor/Teacher/Instructor/Faculty at various specific course Surgery training Institutes

A University Diploma/Fellowship/Doctorate in specific surgery is preferred

1. Program Director

A single program director must be responsible for the fellowship program.

Qualifications of the program director :

The program director must be a surgeon who is qualified to supervise and to educate fellows and must meet requirements stipulated by MUHS. The director must be recognized nationally or regionally by his or her peers as a leader in the area of the program’s focus.

Program director must:

• Be certified by the Medical Council of India.
• Be licensed to practice medicine in the state in which the sponsoring institution is located.
• Maintain a cooperative working relationship with all other recognized surgical training programs
• Be a member in good standing of at least one of the constituent societies
• Minimum 15 years’ experience of Specific/specialized Surgery
• A University Diploma/Fellowship/Doctorate in Specific/specialized surgery.
• Demonstrated experience and/or expertise in teaching residents, fellows, or post graduate surgeons on a regional, national or international level.

Responsibilities of the program director :

It is the responsibility of the program director to support the fellowship program by devoting his or her efforts to its management and administration. The director is also expected to be an active and recognized participant in the institution’s clinical and educational programs.

Preparation of a written statement: to include an outline of the goals of the fellowship program with respect to knowledge, skills, and other attributes, a narrative description of the fellowship, including details of fellows’ involvement in clinical, research, teaching, and administrative activities, and a description of the relationship between the fellowship and the general surgery residency program. This statement must be made available to fellows, general surgery residents, the director of the general surgery residency program, and members of the teaching staff.

• • Selection of fellows for the program in accordance with institutional policies and procedures.
  • Selection and supervision of the teaching staff and other program personnel at each institution participating in the program.
  • Supervision of fellows through explicit written descriptions of supervisory lines of responsibility for the care of patients. Such guidelines must be communicated to all members of the fellowship program staff.
  • Organization and supervision of the research activities of fellows.
  • Organization and supervision of fellows’ participation in conferences and other educational activities, and oversight of implementation of the fellowship curriculum.
  • Implementation of fair procedures, as established by the sponsoring institution, regarding academic discipline complaints and grievances.
  • Oversight of accurate tabulation and recording of operative logs by surgical fellows in the Fellowship case log system.
  • Notification in writing to Accreditation Committees of MUHS if there is change in the faculty complement for the fellowship.

2. Teaching staff / Faculties

• Other than the program director, additional teaching staff with documented qualifications and a commitment to instruct and supervise fellows must be available.
• Minimum 10 years’ experience of Professor/Teacher /Instructor/Faculty at various Specific/specialized Surgery training Institutes
• A University Diploma/Fellowship/Doctorate in Specific/specialized surgery is preferred
• Staff members should have a recognized record of achievement in clinical practice, teaching, research, or a combination of these. Faculty members should be primarily committed to the program’s area of focus and have a clinical practice that supports areas of special skills. Members of the teaching staff must be able to devote sufficient time to supervisory and teaching responsibilities.
• When the fellowship program is located in more than one institution, a member of the teaching staff of each participating institution must be designated to assume responsibility for the day-to-day activities of the program at that institution, with overall coordination by the program director.
• The teaching staff must submit to regularly and formally review of performance in accordance with the goals and objectives of the fellowship.

Faculty :

• Dr. P.P. Wasadikar
• Dr. U.V. Takalkar
• Dr. U.B. Kulkarni
• Dr. S.S. Bhalsing

Scheme of Evaluation :

General Guidelines for allotment of Credits

Total Credits : 300 Minimum Number of Credits for successful completion of programme:-240 credits (80%)

Transfer of Credit to and from other Universities : Not at present but will be informed once broad consensus among other universities is established.

Breakup of credits

(In any course, if soft skill module is NOT required then its total credits may be merged with Operative modules) It should be based on following Modules :

• SOFT SKILL DEVELOPMENT MODULE – (25 credits points) (May not be required in all Modules/Courses) : These include Working at MUHS recognised Basic Skill Institutes, Virtual Reality Stations, Cadaveric Surgeries, Knotting and suturing Techniques, Basic knowledge of instrumentation and Energy Sources. A candidate may have to take additional Basic course pertaining to any special operative techniques
• Didactic Credits – ( 25 credit points) : Didactic on various topics as per syllabus spread over One Hour lecture. Total 10-20 Lectures depending upon specified course material and depth of theory.Topics of Didactic lectures will depend upon the particular course/Module offered.
• Presentation, Publications & Project Work ( 25 credit point) : Under faculty guidance, presentations for Local , Regional & national conferences.
• Video Learning, Grand Rounds, Faculty Discussions ( 10 credit Points) : Review of Recorded Surgical Procedures with Faculty Input. Specific/specialized Surgery Grand Round/Clinical Case Conference. Disease/Journal Club, Round Table Discussions.
• Sessions in Imaging Clinics ( 15 credit points) : Learning of Ultrasound, CT scan, MRI & Various Procedures required for the particular course/module (e.g. Doppler study for diabetic foot surgery)
• Operative Session Credits (TOTAL 150 ) : A Candidate is expected to maintain certified Log book indicating number of cases assisted or individually operated under the guidance of faculty for each Module.
• Fellowship Examination 50 Credit Points (Terminal Exam by MCQs) : The examination for a particular course may be conducted according to the requirement of a course.

Rotation

A Fellow during his tenure of One year will be rotated through various institutes /faculties for total exposure to various aspects and skill in Specific/specialized Surgery. Rotations to other faculties within the course are important part of the skills curriculum. Rotations are agreed upon by the faculty and optional rotations are available upon request of the fellow and approval by the faculty program director. Upcoming interesting cases by faculty should be broadcast to all fellows through the monthly didactic meetings so freely available fellows can travel to the sites to participate or see these unusual cases.
Evaluations of the fellows by the faculty and of the faculty by the fellows will be performed at all teaching sites every quarter during the year and upon the completion of each rotation.

This requires rotation in :

• Soft Skill Development and working at skill station and Virtual reality module for proper hand to eye co-ordination ,basic skills, basic laboratory work and proper perspective
• Didactic Lectures /Grand Rounds/ Clinical meetings
• Operative sessions in various modules/subjects/expertise in particular surgical procedure in the specified/specialized course
• Other

Curriculum :

Course Director/Programme Director is required to fill up the requirements according to guidelines presented below and submit it to University

• Management of early breast cancer and sentinel node biopsy
• Recurrent and metastatic breast cancer
• Evolution of breast cancer management
• Principles of chemotherapy
• Principles of hormonal therapy
• Principles of radiation therapy
• Imaging modalities
• Screening- concepts and practice
• Microarrays
• Molecular biology
• Palliation, rehabilitation
• Oncologic emergencies
• Recent advances
• Pathology
• Benign breast diseases

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