Copyright © 2017 by Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka. All rights reserved. This course document is the intellectual property of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. No part of this document may be copied, reproduced or transmitted in any form by any means (electronic, photocopying, recording or otherwise) without the prior written permission of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka.

Curriculum of MBBS Course 2016

FACULTY OF MEDICINE AND ALLIED SCIENCES RAJARATA UNIVERSITY OF SRI LANKA MIHINTALE

Approved by the Faculty Board, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka on 29th March 2017

Table of Contents

CHAPTER ONE ...... 5

Introduction ...... 5

CHAPTER TWO ...... 6

Vision, Mission and Outcomes of the Medical Course ...... 6

2.1 Vision ...... 6

2.2 Mission ...... 6

2.3.1 Outcomes of the Medical Course ...... 6

2.3.2 Rules of the Medical Course ...... 7

CHAPTER THREE ...... 8

Course structure ...... 8

3.1 Foundation course for medical studies ...... 8

3.2 Compulsory English examination ...... 8

3.3 The Academic programme ...... 8

3.3.1 Year 1 and 2 ...... 8

3.3.1.1 Personal and Professional Development Stream………………9

3.3.2 Year 3 ...... 10

3.3.3 Year 4 ...... 12

3.3.4 Year 5 ...... 14

3.4 Outline of the Clinical programme ...... 14

3.5 Notional Hours of the MBBS Degree Programme ...... 17

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CHAPTER FOUR ...... 18

Alignment of faculty outcomes with the SLQF outcomes ...... 18

CHAPTER FIVE ...... 19

Alignment of faculty outcomes with the subject bench mark statement ...... 19

CHAPTER SIX ...... 20

Detailed course structure ...... 20

6.1 Foundation course- course structure ...... 20

6.1.1 Lecture topics of foundation course ...... 20

6.1.2 English objectives ...... 21

6.2 Structure of Pre-clinical academic programme ...... 24

6.3 Personal and Professional Development Stream ...... 68

6.4 Research in Medicine ...... 76

6.5 Structure of the Para clinical academic programme ...... 78

6.5.1 Parasitology ...... 78

6.5.2 Microbiology ...... 97

6.5.3 Pharmacology ...... 107

6.5.4 Forensic Medicine ...... 123

6.5.5 Pathology ...... 129

6.5.6 Community Medicine ...... 166

6.6 Structure of the Clinical academic programme ...... 189

6.6.1 Medicine ...... 189

6.6.2 Paediatrics ...... 197

6.6.3 Gynaecology and obstetrics ...... 205

6.6.4 Surgery ...... 211

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6.6.5 Psychiatry ...... 219

6.6.6. Marking system of the final examination ...... 224

6.7 Skills Expected from a Medically Qualified Graduate ...... 225

6.8 Public Health Elective Programme for medical undergraduates 232

List of figures

Alignment of faculty outcomes with the SLQF outcomes ...... 18 Alignment of faculty outcomes with the subject bench mark statement ...... 19

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CHAPTER ONE Introduction

Rajarata University of Sri Lanka was established on 7th November 1995 under section 21 of the Universities Act No. 16 of 1978 by amalgamating the resources of the affiliated University Colleges in the Central, North Western and North Central Provinces. It was inaugurally opened on 31st January 1996. The first Batch of medical students was recruited to the Faculty of Medicine, Rajarata University of Sri Lanka, on 11th September 2006. The number of students admitted each year to the Faculty is 180. The Faculty of Medicine developed its curriculum through the curriculum committee and it was revised in 2012 and 2015 moving towards an outcome based curriculum and involving new assessment methods. The duration of the entire course is five years followed by one year of internship. Each academic year consists of two semesters of fifteen weeks each.

Admission criteria - The University Grants Commission of Sri Lanka selects students for all medical schools in Sri Lanka on the basis of their performance in the G.C.E (A/L) examination held by the Department of Examination, Sri Lanka.

Degrees awarded- Bachelor of Medicine and Bachelor of Surgery [MBBS] (Rajarata University of Sri Lanka)

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CHAPTER TWO Vision, Mission and Outcomes of the Medical Course

2.1 Vision To be the premier institution in Sri Lanka in training health professionals

2.2 Mission Faculty of Medicine and Allied Sciences is committed to train health professionals with values of highest ethical conduct and mutual respect in an environment of excellence. This would involve a holistic education in preventive and curative medicine and research and embody a desire for continuing education while recognizing responsibility for betterment of the health of people at all levels in Sri Lanka.

2.3.1 Outcomes of the Medical Course At the end of the MBBS course the graduate should possess knowledge and competencies regarding

1. scientific knowledge for medical practice 2. skills essential for medical practice 3. ethics, attitudes and professionalism 4. leadership, interpersonal relationships and teamwork 5. research, evidence-based medicine and problem solving 6. health promotion and social, cultural and environmental perspectives on health 7. continuing professional development

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2.3.2 Rules of the Medical Course 1. The number of attempts at the 2nd MBBS examination is limited to four and passing the 2nd MBBS examination is compulsory to precede the course 2. The maximum period of study in the faculty is 10 years 3. All clinical appointments should be completed before commencement of professorial appointments

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CHAPTER THREE Course structure 3.1 Foundation course for medical studies This consists of a 10 weeks course which includes several modules relevant to the study of medicine including general English, medical English, information technology, and medical ethics. An end-of-course English examination will be conducted at the end of the course and 25% marks from here will be awarded for the compulsory English examination.

3.2 Compulsory English examination There will be a compulsory English examination which should be passed before sitting the final MBBS examination.

3.3 The Academic programme The medical programme is a fulltime course conducted over a period of five years.

3.3.1 Year 1 and 2 The modules and semester assessments during each of the semesters are as follows. Assessment (components of Year and Semester Modules and topics examinations) Year 1: Semester 1 Introduction to the study Continuous Assessment 1 of Man, Blood, Anatomy(MCQ,SEQ,OSPE) Cardiovascular system, Continuous Assessment 1 Respiratory system, Gross Physiology(MCQ,SEQ) anatomy, Nutrition Continuous Assessment 1 (upper limb, Thorax) Biochemistry (MCQ,SEQ) Year 1: Semester 2 Gastrointestinal system, Continuous Assessment 2 Urinary system, Anatomy (MCQ,SEQ,OSPE) Reproductive system, Continuous Assessment 2 Endocrine system, Physiology (MCQ,SEQ) Nutrition, Continuous Assessment 2 Gross anatomy Biochemistry (MCQ,SEQ) (Abdomen, pelvis)

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Assessment (components of Year and Semester Modules and topics examinations) Year 2: Semester 3 Central Nervous System and Special senses, Revision, gross anatomy, Nutrition (Head and neck, Lower limb) Year 2: Semester 4 Foundation to clinical practice MSPOG appointments

At the end of year 2 semester 3, 2nd MBBS examination will be held having three subjects Anatomy, Physiology and Biochemistry. The components of the 2nd MBBS examination are as follows.

2nd MBBS examination

Subjects Components of 2nd MBBS examination Anatomy MCQ,SEQ,OSPE, Continuous Assessment Physiology MCQ,SEQ,OSPE, Continuous Assessment Biochemistry MCQ,SEQ,OSPE, Continuous Assessment

Successful completion of 2nd MBBS examination is a prerequisite for entering into the 3rd year. A student is allowed a maximum of 4 attempts to pass the above subjects. If unsuccessful after 4 attempts, the studentship will be terminated.

Award of Distinctions At the end of 2nd MBBS, students will be awarded distinctions and medals for Anatomy, Physiology, Biochemistry based on marks obtained. Distinctions will be awarded to the students who obtain a mark of 70% or above at the first attempt.

3.3.1.1 Personal and Professional Development (PPD) Stream PPD stream has been included to MBBS curriculum in 2016 to develop a graduate with values of highest ethical conduct and mutual respect. Further this stream was

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Medical curriculum 2016 introduced to achieve the requirements of Sri Lanka Quality Framework (SLQF) level 06 learning outcomes; communication, teamwork and leadership, creativity and problem solving, networking and social skills, adaptability and flexibility, attitude values and professionalism and vision for life (SLQF learning outcomes 3, 4, 5, 8, 9, 10 and11). PPD stream is conducted from year 1 to 4. Personal and professional skills module and Human Psychology and Behaviour module are coordinated and assessed by the Department of Psychiatry. Professional skills and Primary Care module and Medical Ethics Module are coordinated and assessed by the Department of Community Department of Medicine and Medicine respectively (Refer section: PPD).

Foundation to clinical practice Students are expected to follow an introductory clinical program at the Teaching Hospital Anuradhapura, following 2nd MBBS examination. Repeat examination will be held after 6 weeks from the release of the results of 2nd MBBS examination.

Research in Medicine At the commencement of the 5th semester students will be grouped and a research should be conducted by each group under the supervision of a Senior Lecturer in the faculty. Four (4) semesters are allocated for the Research in Medicine. The presentations on the research are conducted during the 8th semester (Refer section: Research in Medicine).

MSPOG appointments Fourth semester consisted of four clinical appointments (16 weeks). Medicine and Surgery clinical appointments are conducted at Matale and Polonnaruwa base hospitals, for 8 weeks period. Paediatrics and Gynaecology and Obstetrics clinical appointments are conducted at Teaching Hospital Anuradhapura, for 8 weeks period.

3.3.2 Year 3 All students who pass 2nd MBBS will be allowed to proceed to the year 3 and clinical training. Students are expected to follow clinical programme on all the days other than designated holidays and the clinical programme does not follow the semester system.

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Structure of Year 3 Academic programme Assessments (components of Semester Subjects examinations) Year 3 Parasitology, Continuous Assessment 3 Semester 5 Microbiology, Parasitology (SEQ) Continuous Assessment 3 Pharmacology, Pathology, Microbiology (MCQ, practical Community Medicine examination) Continuous Assessment 3 Pharmacology (MCQ) Continuous Assessment 3 Pathology (SEQ) Community Medicine Module Exams Module Exam I - Child health (SEQ, MCQ) Module exam II – Demography (MCQ, SEQ) Year 3 Parasitology, Continuous Assessment 4 Semester 6 Microbiology, Parasitology (MCQ) Pharmacology, Pathology, Continuous Assessment 4 Community Medicine Microbiology(MCQ,OSPE) Community Medicine Module Exams Module Exam III - Maternal health (SEQ, MCQ) Module exam IV – Statistics (SEQ, MCQ)

During the year 3 semester 5 and semester 6 clinical training will be provided in the morning hours and coursework will be in the afternoon. 100% attendance is compulsory for all clinical appointments. At the end of year 3, Part 1 examination will be held in the subjects Microbiology and Parasitology. The components of part 1 examination are as follows.

Year 3: 3rd MBBS Part-I examination Subject Components of examinations Microbiology MCQ,SEQ,OSPE, Continuous Assessment Parasitology SEQ,OSPE, Continuous Assessment

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A student who did not obtain pass mark for Microbiology and Parasitology must sit for the repeat examination. 3rd MBBS Part-I examination is not a bar examination and all students could proceed to year 4.

Award of Distinctions At the end of 3rd MBBS Part-I examination, students will be awarded distinctions and medals for Microbiology and Parasitology based on marks obtained. Distinctions will be awarded to the students who obtain a mark of 70% or above at the first attempt.

3.3.3 Year 4 During year 4, semester 7 and semester 8 short appointments and long clinical rotations at Teaching Hospital Anuradhapura will be continued in the morning hours and course work related to pharmacology, pathology, community medicine and forensic medicine will be done in the afternoon.100 % attendance is compulsory for all clinical appointments.

Structure of the Year 4 Academic Programme Semester Subjects Assessments (Components of examinations) Year 4 Pharmacology, Continuous Assessment 4 Semester 7 Pathology, Community Pharmacology (MCQ) Medicine, Forensic Continuous Assessment 4 Medicine Pathology (SEQ) Continuous Assessment 5 Community Medicine Module Exams Module Exam V – Basic epidemiology (SEQ, MCQ) Module exam VI – Nutrition (SEQ, MCQ) Continuous Assessment 4 Forensic Medicine

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Year 4 Pharmacology, Continuous Assessment 5 Semester 8 Pathology, Community Community Medicine Module Medicine, Forensic Exams Medicine Module Exam VII – Applied epidemiology (SEQ, MCQ) Module exam VIII – Occupational and environmental health (SEQ, MCQ)

At the end of year 4, 3rd MBBS Part-II examination is held including subjects of Pharmacology, Community Medicine, Pathology and Forensic Medicine. The components of 3rd MBBS Part-II examination are as follows.

Year 4: 3rd MBBS Part-II Examination Subjects Components of examinations Pharmacology MCQ,SEQ,OSPE, Continuous Assessment Community medicine Paper 1 (Non communicable diseases) - SEQ Paper 2- SEQ,OSPHE Viva and project report for family study Pathology Essay, OPSE, Continuous Assessment Forensic Medicine SEQ, Essay, OSPE

A student who did not obtain pass mark for Pharmacology, Pathology, Community Medicine and Forensic medicine must sit the repeat examination. 3rd MBBS Part-II examination is not a bar examination and all students could proceed to year 5.

Award of Distinctions At the end of 3rd MBBS Part-II examination students will be awarded distinctions and medals for Community Medicine, Pathology, Pharmacology and Forensic medicine based on Marks obtained. Distinctions will be awarded to the students who obtain a mark of 70% or above at the first attempt.

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3.3.4 Year 5 Year 5, equivalent to 9th and 10th semesters, is spent entirely in clinical training in professorial units at the TH Anuradhapura. 100 % attendance is compulsory for all clinical appointments. However afternoon lectures will be conducted by the departments of Surgery, Medicine, Gynaecology and Obstetrics, Paediatrics, Psychiatry and Anaesthesiology. At the end of the year 5, Final MBBS Examination will be held. Components of Final MBBS Examination are as follows.

Components of Final MBBS Examination Subject Components of assessment Medicine Common MCQ, SEQ, Long case, Short cases, Continuous Assessment Paediatrics Common MCQ, SEQ, Long case, Short cases, Continuous Assessment, Gynaecology and obstetrics Common MCQ, SEQ, Long case, Short cases, Continuous Assessment Surgery Common MCQ, SEQ, Long case, Short cases, Continuous Assessment Psychiatry Common MCQ, SEQ, Long case, Short cases/ OSCE, Continuous Assessment

The MCQ paper is common to all Faculties of Medicine and is held on the same day at the same time in all the Faculties. The common MCQ examination is held twice a year. The pass mark with respect to each subject is described by the UGC standing committee document (section IV). Distinctions will be awarded to the students who obtain a mark of 70% or above at the first attempt. The students will have to complete the final MBBS within ten academic years from the date of entering the university.

MBBS Degree class awarding criteria <50.00  failure ≥50.00  pass 59.50 ≤ 64.50  second class lower 64.51 ≤ 69.50  second class upper ≥ 69.51  first class & distinction

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3.4 Outline of the Clinical Programme Appointments Hospital Duration 1. Introductory clinical appointment (Semester 4) Medicine T.H. Anuradhapura 1 week 4 weeks Surgery 1 week Gynaecology and Obstetrics 1 week Paediatrics 1 week 2. MSPOG appointments (Semester 4) Medicine D.G.H. Matale / 4 weeks 16 weeks Surgery D.G.H Pollonnaruwa 4 weeks Gynaecology and Obstetrics T.H. Anuradhapura 4 weeks Paediatrics 4 weeks 3. Year 3 and Year 4 (Semester 5 to 8) Medicine 1 T.H. Anuradhapura 6 weeks 72 weeks Medicine 2 6 weeks Surgery 1 6 weeks Surgery 2 6 weeks Short Appointments I Neurosurgery 2 weeks Oncology 2 weeks Community Medicine 4weeks Dermatology 2 weeks Forensic Medicine 2 weeks Clinical Pathology 2 weeks Orthopaedics 2 weeks Anaesthiology 2 weeks Radiology 2 weeks Cardiology 2 weeks Rheumatology 2 weeks Short Appointments II Psychiatry 4 weeks Paediatrics 4 weeks Gynaecology and Obstetrics 4 weeks Neurology 2 weeks

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Respiratory Medicine 2 weeks Ear, Nose, Throat Surgery 2 weeks Eye 2 weeks Sexually transmitted diseases 2 weeks Urology/Nephrology 2 weeks 4. Year 5: Professorial appointments (Semester 9 and 10) Medicine 8 weeks 40 weeks Surgery 8 weeks Paediatrics 8 weeks Gynaecology and Obstetrics 8 weeks Psychiatry 8 weeks Total Duration 132 weeks

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3.5 Notional Hours of the MBBS Degree Programme*

Number of Department/ Programme Notional Hours

Pre-clinical course - integrated (Anatomy, Biochemistry, Physiology) 2551

Community Medicine 745

Forensic Medicine 380

Microbiology 348

Parasitology 208

Pathology 623

Pharmacology 436

Research in Medicine (Coordinated by Dept. of Community Medicine) 400

Medicine 1719

Surgery 1507

Pediatrics 859

Gynaecology & Obstetrics 868

Psychiatry 595

Personal & Professional Development Stream 280

Total 11526 * Notional Hours were calculated excluding the foundation course.

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CHAPTER FOUR Alignment of faculty outcomes with the Sri Lanka Qualification Framework (SLQF) outcomes SLQF Outcomes 1 2 3 4 5 6 7 8 9 10 11 12 Faculty Outcomes Scientific knowledge for × medical practice Skills essential for medical × × × practice Ethics, attitudes and × × professionalism Leadership, interpersonal × × × × × relationship and teamwork Research, evidence based × × medicine and problem solving Health promotion and social, × × × × cultural and environmental perspectives on health Continuing Professional × × Development

Learning outcomes of SLQF document 1. Subject / Theoretical Knowledge 2. Practical Knowledge and Application 3. Communication 4. Teamwork and Leadership 5. Creativity and Problem Solving 6. Managerial and Entrepreneurship 7. Information Usage and Management 8. Networking and Social Skills 9. Adaptability and Flexibility 10. Attitudes, Values and Professionalism 11. Vision for Life 12. Lifelong Learning

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CHAPTER FIVE Alignment of faculty outcomes with the subject bench mark statement (SBS) SBS Outcomes 1 2 3 4 5 6 7

Faculty Outcomes Scientific knowledge for medical practice × × × × ×

Skills essential for medical practice × × × × ×

Ethics, attitudes and professionalism × × ×

Leadership, interpersonal relationship and × × × teamwork Research, evidence based medicine and × × × problem solving Health promotion and social, cultural and × × × × environmental perspectives on health Continuing professional development × × × ×

Learning outcomes of subject bench mark statement (SBS) 1. Professional values, attitudes, behaviour and ethics 2. Scientific foundation of medicine 3. Communication skills 4. Clinical skills 5. Population health and health systems 6. Management of information 7. Critical thinking and research

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CHAPTER SIX Detailed course structure 6.1 Foundation course- course structure Week 1 Inauguration, Introducing mentors, Hostel Allocation, Placement test, Viva, Lectures Week 2 Lectures, Library orientation, Information technology, Study skills, English lectures Week 3 Lectures, Information technology, English lectures, Study skills Week 4 Archaeology site visit, Hospital visit, Archaeology site visit presentation Week 5 English lectures, Sinhala/Tamil lectures, Department visit, Talent show, Lectures Week 6 English lectures, Sinhala/Tamil lectures, Department visit, Lectures Week 7 English lectures, Sinhala/Tamil lectures, Department visit, Lectures Week 8 English lectures, Lectures ,Preparation for presentation, Final English Exam, Presentation day

6.1.1 Lecture topics of foundation course

1. History of RUSL and FAMS 2. Ancient Medical Institutions of Sri Lanka 3. Etiquette of a medical student 4. An over view of medical course 5. Enjoying university life 6. Medicine as a noble profession 7. Development of attitudes to be a good doctor (Doctor in society) 8. Responsibility and role of a doctor 9. Avoidance from alcohol, smoking and other distractions 10. Anger Management

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11. Hardship during training and their relevance to capacity building as a doctor 12. Health promotion and public health 13. Reproductive health 14. Sports facilities in the university 15. What the corpse say 16. Introduction to research in medicine 17. Health care team 18. How to get the maximum use of brain 19. Studying medicine 20. Complimentary Medicine 21. Stress management 22. Evidence based Medicine 23. Future prospective 24. Development of personal and leadership skills 25. Introduction to Anatomy 26. Introduction to Biochemistry 27. Introduction to Physiology

6.1.2 English objectives This course is designed with a view to enabling to understand English speech at ordinary speed and respond to it effectively. This course is also expected to enable students to read, understand and analyse texts with ease and write correctly, coherently and comprehensibly. This course will consist of a general component designed to increase social competence in the Language and develop skills in analytical reading and creative writing and a medical component as an aid for their medical course. The course consists of 2 components.  General English  Medical English

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Course in General English (16 lectures = 32 lecture hours)

General Objective Language - Nouns Structure - Adjectives - Verbs (verbs “be” and action verbs: simple tenses with interrogative and negative forms) - Adverbs - Prepositions - Pronouns ( In their various cases as well as possessive adjectives) - The structure of simple sentences - Present continuous and perfect tenses - Use of apostrophe - Use of articles (Definite, Indefinite) - Modal Auxiliaries Listening and Speaking Listening - Dictation - Listening Scanning - Listening Comprehension - Following Instructions (Filling in grids, labeling diagrams etc.)

Speaking - Language Functions (greetings, asking for information, giving information, requesting, refusing, expressing ones feelings, predicting etc.) - Describing a person, place, subject or an object - Giving directions

- Describing a tour, and accident, a past incident etc.

- Reading aloud- News items, Reports, Proposals etc.

- Telephone Conversations

- Dialogues- based on given situations

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Reading and Writing

Reading - Scanning of advertisements, brochures, catalogues, information sheets, news items. - Skimming to extract the most important information from a given discourse - Scanning a text for main points - Skimming a text for the gist - Distinguishing between main points and supporting details

Writing - Mechanics of writing with special reference to punctuation and paragraph. - Filling in different types of forms requiring information and questionnaires. - Drafting application and Bio data forms. - Designing advertisements, handbills, notices, posters etc. - Planning and organizing information concisely descriptions. - Transferring information from graphs and tables

Course in Medical English (15 lectures = 30 lecture hours)

- Medical English course is designed to make the undergraduates familiar with the medical terms used in the subjects related to the Medicine, to familiarize with the relevant text books, to improve understanding and answering questions and to improve their English presentation skills.

- Five lectures (10 lecture hours) will be allocated for each pre-clinical department (Anatomy, Biochemistry, Physiology) for the following activities. Each department will submit the relevant study materials (sections of the text books, video clips, web links, articles and presentation topics etc.) to the Medical Education Department one week before the commencement of the Foundation Course each year.

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6.2 Structure of Pre-clinical academic programme Course : 1st Semester of the Medical Course Module No. : M1101 Module Title : Introduction to the study of Man Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. describe the origin of life (primordial soup) 2. describe the structure and function of the cell, cell organelles and cell components 3. adopt good laboratory practice including basic microscopic techniques 4. relate the roles of the biomolecules to the maintenance of normal structure functions of the human body 5. apply the knowledge on enzymes to their effects in metabolic and hormonal regulation of the body 6. explain how the human body is organized for function 7. apply basic sciences to explain the signs, symptoms and complications of diseases involving functional organization

Module Content Mammalian cell Prokaryotes and eukaryotes Biomolecules How does the gene express itself? Cell cycle Energy for life Metabolic regulation Body waste Genetic makeup Body development – result of the fertilized ovum Organization of cells into tissues Organization of the body for function

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- Homeostatic functions - Body fluids; Regulation of extra cellular fluid volume and tonicity - pH and buffers; Introduction to regulation of pH - Transport across capillary walls - Body composition and Body mass index - Autonomic regulation of body function - Membrane potentials and excitable tissues - Body defences and immune mechanisms - Human variation

Teaching/Learning Lectures 78 hours, practicals 30 hours; Problem based activities tutorials (small group discussion) 36 hours, clinical case discussion 4 hours; Video 6 hours; Fixed learning modules, Student presentations 2 hours and discussions 2 hours Details of teaching learning activities are attached (Annex I)

Time Allocation 154 hours

Assessment Formative assessment. 1 hour integrated MCQ paper and 1 ½ hour SEQ paper, Continuous assessment 1, 2nd MBBS Recommended Find the appendix Reading/ References Coordinating Biochemistry department

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Course : 1st semester of the Medical Course Module No. : M1102 Module Title : Blood Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. discuss aspects of blood cell formation, structure and function 2. deduce and interpret the data of hypothetical clinical cases related to biochemical aspects of blood 3. discuss the process of haemostasis 4. discuss the basis of blood groups and transfusion 5. discuss the basis of common serological and haematological tests in interpretation in disease 6. discuss the pathophysiology of anaemia 7. apply your knowledge of haematology to solve clinical problems in haematology 8. analyze a haematological report in order to arrive at a tentative diagnosis

Module Content Blood as a circulating body fluid Biochemical aspects of blood Haemostasis Blood groups and transfusion Haemoglobin Plasma Proteins Basis of common serological and haematological tests and interpretation in disease Pathophysiology of anaemia

Teaching/Learning Lectures 15 hours; practicals 10 hours; Clinical case discussion activities 2 hours; problem based tutorials (small group discussions) 8 hours

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Details of teaching learning activities are attached (Annex I) Time Allocation 35 hours Assessment Formative assessment. 6 questions in 1 hour integrated MCQ paper and 2 essay question in 1 ½ hour SEQ paper; Continuous Assessment 1, 2ndMBBS Recommended Find the appendix Reading/ References Coordinating Physiology department

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Course : 1st semester of the Medical Course Module No. : M1103 Module Title : Cardiovascular system Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. describe the epidemiology of cardiovascular diseases in relation to the community 2. describe the anatomy of the heart and vascular system 3. discuss development of the heart and vascular system 4. describe the normal functioning of the heart, arteries, arterioles, capillaries, venules and veins 5. interpretation of anthropometric and biochemical data of clinical cases in evaluating cardiovascular risk 6. apply knowledge of cardiovascular physiology to explain the signs & symptoms in hypothetical clinical scenarios and clinical situations with disturbances of normal function Module Content Epidemiology of Cardiovascular diseases Spatial organizations and relationships of the heart and vascular system Anatomy of Heart and Great Vessels Development of the heart and vascular system Functions of the heart, arteries, arterioles, capillaries, venules and veins - Properties of cardiac muscle - Electrical activity of the heart; - Principles and interpretation of ECG - Heart as a pump; Cardiac cycle - Cardiovascular regulatory mechanisms - Blood vessels; Dynamics of blood flow; - Microcirculation - Arterial and Venous pressures, Blood pressure measurement

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- Circulation through special regions - Cardiovascular system adjustments in muscular exercise, gravitational effects - Examination of the cardiovascular system Disturbances of Normal Function - Shock - Heart failure - Biochemical basis of atherosclerosis - Cardiac markers - Lipid profile; - Cardiovascular risk factors Anthropometry in cardiovascular assessment

Teaching/Learning Lectures 42 hours; practicals 22 hours; Clinical case activities discussion 12 hours; small group discussion 22 hours; Dissection 8 hours Details of teaching learning activities are attached (Annex I)

Time Allocation 106 hours Assessment Formative assessment. 1 hour integrated MCQ paper and 1 ½ hour SEQ paper ,Continuous Assessment 1,2nd MBBS Recommended Find the appendix Reading/ References Coordinating Physiology department

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Course : 1st semester of the Medical Course Module No. : M1104 Module Title : Respiratory system Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. describe the applied and functional anatomy of thoracic region and the Broncho-pulmonary system 2. describe the development of the respiratory system 3. describe the lung volumes and its subdivisions 4. explain the mechanics of breathing 5. discuss the exchange of gases in alveoli and tissues 6. discuss the transport of gases in blood 7. explain the control of respiration 8. describe the non-respiratory functions of the lung 9. describe the pulmonary circulation 10. perform cardiopulmonary resuscitation 11. perform an examination of the respiratory system 12. discuss high altitude physiology 13. interpret a ventilator function report 14. apply knowledge of respiratory physiology to solve clinical problems in respiratory illnesses

Module Content Applied anatomy of thoracic region Development of the respiratory system Functional anatomy of the broncho-pulmonary system Lung volumes and its subdivisions Mechanics of breathing

Exchange of gases in alveoli and tissues Transport of gases in blood - Oxygen transport - Carbon dioxide transport - Role of respiration in maintenance of acid-base balance

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- Transport of gases and buffering Control of respiration Respiratory insufficiency Non-respiratory functions of the lung The pulmonary circulation Cardiopulmonary resuscitation Clinical examination of the respiratory system High altitude physiology

Teaching/Learning Lectures 17 hours; practicals 6 hours; Clinical case discussion activities 10 hours; small group discussion 4 hours; Dissection 5 hours (See module on Thorax)

Time Allocation 42 hours

Assessment Formative assessment. 1 hour integrated MCQ paper and 1 ½ hour SEQ paper, Continuous Assessment 1 ,2nd MBBS exam Details of teaching learning activities are attached (Annex I) Recommended Find the appendix Reading/ References Coordinating Physiology department

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Course : 1st semester of the Medical Course Module No. : M1105 Module Title : Regional Anatomy 1A – Upper Limb Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. describe the musculoskeletal and neurovascular organization of the upper limb with reference to the functions of the upper limb 2. identify and describe the macroscopic, radiological and surface anatomy of the musculoskeletal and neurovascular structures of the upper limb 3. describe the anatomical basis of common injuries of the upper limb relating to clinical features, diagnosis and management of these injuries 4. apply the anatomical knowledge to recognize and solve clinical problems related to upper limb 5. describe the macroscopic and applied anatomy of the female breast 6. utilize a variety of resources (faculty, peers, textbooks, specimens, internet, etc.) to locate information on anatomy of the upper limb and related clinical problems Module Content Osteology of the upper limb Anatomy of the pectoral region and the axilla Macroscopic and applied anatomy of the female breast Anatomy of the shoulder joint Anatomy of the forearm, cubital fossa and the elbow, forearm and the wrist Macroscopic and applied anatomy of the carpel tunnel Anatomy of the hand Arterial system of the upper limb and collateral circulation Venous and lymphatic drainage of the upper limb Arrangement of the brachial plexus and the nerves of the upper

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limb Radiological and surface anatomy of the upper limb Applied anatomy of the skeletal and neurovascular injuries of the upper limb

Teaching/Learning Lectures: 18 hours, Dissections: 34 hours, Demonstration of activities prosected specimens: 2 hours (x 3 groups) , Practical: 4 hours (2 sessions x2 hours x3 groups; each group divided into 3 small groups of ~ 15 students) [Topics: 1.Osteology, 2. Surface anatomy and radiology] Problem-based tutorial – 10 hours (x6 groups) Clinical case discussion 2 hours (x3 groups) [Topic: Breast carcinoma] Details of teaching learning activities are attached (Annex I)

Time Allocation Course duration: 8 weeks (Semester 1: Week 1 – Week 8) Each weeks program will have, - Lectures: 2-3 hours - Problem-based tutorial: 2 hours - Clinical case discussion/ Demonstration of prosected specimens: 6 hours (2 hours x3 groups) - Dissections/ small group activities (practical): 5 hours

Assessment Formative assessments Formative evaluation with immediate feedback on individual and group performance during dissections using mini-vivas Mid-semester formative assessment: - At the end of 8 weeks - OSPE (integrated with the ‘Introduction of study of man’ Module): 15 stations x2 min per station Summative assessments Continuous assessment 1: - At the end of semester 1

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- Integrated with Introduction of study of Man module, Modules on cardiovascular and respiratory systems and regional anatomy of the thorax - 20 MCQs; T/F type (1 hour), – 35/100 marks, 3 SEQs (1 ½ hours) – 35/100 marks, OSPE 30 stations (x2min per station) – 30/100 marks - Contribution of regional anatomy of upper limb to each - MCQ: 7-8 questions - SEQ: 1 question - OSPE: 8-10 stations 2nd MBBS examination: Includes ~7 MCQs (T/F type), 1 SEQ and ~4 OSPE stations from the regional anatomy upper limb

Recommended Reading/ Find the appendix References Coordinating Anatomy department

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Course : 1st semester of the Medical Course Module No. : M1106 Module Title : Regional Anatomy 1B – Thorax Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. identify and describe the general topography/ surface anatomy of the thorax 2. describe the anatomy of the bony thoracic case, muscles of the thoracic wall , the diaphragm and neurovascular structures of the thoracic wall in relation to their function 3. describe the arrangement, divisions and contents of the thoracic cavity/ mediastinum 4. identify and describe the radiological anatomy of the thorax 5. describe the anatomical basis of the common thoracic injuries and procedures 6. apply the anatomical knowledge to recognize and solve clinical problems related to thorax 7. utilize a variety of resources (faculty, peers, textbooks, specimens, internet, etc.) to locate information on anatomy of the thorax and related clinical problems Module Content General topography of the thorax Osteology of the thoracic spine and rib cage Anatomy of the thoracic wall and intercostal muscles Arrangement of intercostal neurovascular structures Anatomy of diaphragm Arrangement, divisions and contents of the mediastinum Surface anatomy of the intrathoracic organs/ structures Radiological anatomy of the thorax Applied anatomy of the thoracic injuries and procedures

# Macroscopic, microscopic, developmental and applied

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anatomy of the heart and great vessels, lungs and the tracheobronchial tree is done with the respective system-based modules. Teaching/Learning Lectures: 8 hours, Dissections: 10 hours, Small group activities activities (practical): 6 hours (3 sessions x2 hours x3 groups; each group divided into 3 small groups of ~ 15 students) [Topics: 1. Osteology, 2. Surface anatomy 3. Radiology] Problem-based tutorial – 4 hours (x6 groups) Clinical case discussion 2 hours (x3 groups) [Topic: Chest trauma] Details of teaching learning activities are attached (Annex I) Time Allocation Course duration: 7 weeks (Semester 1: Week 9 - Week 15) Each weeks program will have, Lectures: 2-3 hours Tutorial: 2 hours Clinical case discussion/ Practical: 6 hours (2 hours x3 groups) Dissections: 5 hours (T-L activities in Anatomy during this period include those of the modules on cardiovascular and respiratory systems)

Assessment Formative assessments: Formative evaluation with immediate feedback on individual and group performance during dissections using mini-vivas Summative assessments: Continuous assessment 1: - At the end of semester 1 - Integrated with Introduction of study of man module, Modules on cardiovascular and respiratory systems and regional anatomy of the upper limb - 20 MCQs; T/F type (1 hour), – 35/100 marks, 3 SEQs (1 ½ hours) – 35/100 marks, OSPE 30 stations (x2min per station) – 30/100 marks

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- Contribution of regional anatomy of the thorax to each - MCQ: 3-4 questions - SEQ: 1 question - OSPE: 3-4 stations 2nd MBBS examination: Includes ~3 MCQs (T/F type), 1 SEQ and ~2 OSPE stations from the regional anatomy thorax

Recommended Reading/ Find the appendix References Coordinating Anatomy department

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Course :2nd semester of the Medical Course Module No. : M1207 Module Title : Gastrointestinal system Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. describe the anatomy and histology of the oesophagus stomach small intestine large Intestine, liver, pancreas and extrahepatic biliary apparatus 2. describe the development of the gastrointestinal System 3. describe the physiology of gastrointestinal motility 4. describe the secretory functions of the alimentary tract 5. describe the normal process of digestion and absorption 6. apply the knowledge on digestion and absorptionto identify the gastro-intestinal disorders 7. Analyze and interpret serum biochemical data related to dysfunctions of the liver and biliary tract compared to the normal function 8. design a management plan to manage gastroenteritis in a home setting

Module Content Arrangement of the Gastrointestinal System, Oral cavity, Tongue and Salivary Glands Applied anatomy and histology of oesophagus, stomach and intestines Applied anatomy and histology of liver pancreas and biliary system

Development of the Gastrointestinal System Gastrointestinal motility - Electrical and contractile properties of gastrointestinal smooth muscle - Neuroendocrine control of gastrointestinal function - Mastication

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- Swallowing - Motor functions of the stomach - Movements of the small intestine and the colon - Defaecation Secretory functions of the alimentary tract - Gastrointestinal secretions - Secretion of saliva - Gastric secretion - Pancreatic exocrine secretion - Secretion of bile - Secretions of small intestine Digestion - Digestion of carbohydrate - Digestion of fat - Digestion of protein - Absorption Gastrointestinal disorders - Diarrhoeaand vomiting - Malabsorption Liver and Biliary Tract - Liver functions - Jaundice - Liver dysfunction - Gallstones

Teaching/Learning Lectures 47 hours; practicals 8 hours; Clinical case discussion activities 12 hours; Problem based tutorials(small group discussion) 16 hours; Dissection 12 hours;

Time Allocation 87 hours

Assessment Formative assessment. 1 hour integrated MCQ paper and 1 ½ hour SEQ paper, Continuous Assessment 2, 2nd MBBS

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Recommended Find the appendix Reading/ References Coordinating Physiology department

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Course : 2nd semester of the Medical Course Module No. : M1208 Module Title : Urinary system Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. describe the anatomy of the urinary system: kidney, ureter, bladder and urethra 2. describe the histology of the urinary system 3. describe the development of the urinary system 4. compare the constituents of normal urine with abnormal urine in various pathological conditions and perform urinalysis 5. interpret the results of renal function tests and the laboratory investigations of given hypothetical clinical conditions 6. discuss the process of urine formation under the following headings: - Glomerular filtration - Tubular functions - Renal handling of water - Control of extra cellular fluid osmolality and Na+ - Control of extra cellular fluid and blood volume - Control of K+ - Acid base balance 7. describe the process of micturition and describe the associated clinical abnormalities 8. explain diuresis and diuretics 9. apply physiological knowledge to explain signs and symptoms of urinary diseases

Module Content Organization of the urinary system: kidney, ureter, bladder and urethra Histology of the Urinary System

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The Development of the Urinary System Urinary constituents and their composition in health and disease Renal functions tests renal stones; Urine analysis Laboratory Investigations Urine formation - Glomerular filtration - Tubular functions - Renal handling of water - Control of extra cellular fluid osmolality and Na+ - Control of extra cellular fluid and blood volume - Control of K+ - Acid base balance Micturition Diuresis and diuretics Pathophysiology of renal disease

Teaching/Learning Lectures 25 hours; practicals 8 hours; Clinical case discussion activities 9hours; Problem based tutorial (small group discussion) 10hours; .Dissection 5 hours; Details of teaching learning activities are attached (Annex I)

Time Allocation 57 hours Assessment Formative assessment. 1 hour integrated MCQ paper and 1 ½ hour SEQ paper, Continuous Assessment 2, 2nd MBBS Recommended Find the appendix Reading/ References Coordinating Physiology department

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Course : 2nd semester of the Medical Course Module No. : M1209 Module Title : Endocrine system Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. discuss the anatomy of the endocrine organs 2. discuss physiology, synthesis of hormones, pathophysiology, biochemistry and clinical disorders with respect to the following endocrine glands: - Hypothalamus - Pituitary gland - Thyroid gland - Parathyroid gland - Adrenal cortex and medulla - Endocrine pancreas 3. discuss blood glucose homeostasis Endocrinology of gut, kidney and vascular endothelium 4. discuss calcium and phosphorus metabolism 5. apply physiological principles to explain the occurrence of signs and symptoms in diseases of the endocrine system Module Content Anatomy of the endocrine organs Introduction to endocrine system Hypothalamus Pituitary Thyroid Parathyroid Adrenal cortex and medulla Endocrine pancreas Diabetes mellitus (DM) Blood glucose homeostasis Endocrinology of gut, kidney and vascular endothelium

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Calcium and phosphorus metabolism Endocrine function tests (round-up) Teaching/Learning Lectures 31 hours; practicals 6 hours; Clinical case discussion activities 8hours; small group discussion 14hours Details of teaching learning activities are attached (Annex I)

Time Allocation 59 hours Assessment Formative assessment. 1 hour integrated MCQ paper and 1 ½ hour SEQ paper, Continuous Assessment 2, 2nd MBBS Recommended Find the appendix Reading/ References Coordinating Physiology department

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Course : 2nd semester of the Medical Course Module No. : M1210 Module Title : Reproductive system Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. discuss the synthesis and functions of sex hormones 2. describe the anatomy of male reproductive system 3. discuss the histology of male reproductive system 4. describe the composition and functions of seminal fluid, functions of male sex hormones and regulation of male sexual functions 5. describe the anatomy of female reproductive system 6. describe the histology of female reproductive system 7. discuss the synthesis, metabolism and functions of the female sex hormones 8. describe the female reproductive cycle 9. describe the development of the reproductive systems and sexual differentiation 10. discuss the features of puberty and menopause 11. describe the sexual act 12. describe the physiology of pregnancy and lactation 13. discuss physiology and biochemistry of fetus 14. discuss the screening process for malignancy 15. discuss the biochemistry of inborn errors 16. apply knowledge on Biochemistry to design primary diagnostic tools and management plans forinborn errors 17. discuss physiology of contraception

Module Content Male reproductive system Synthesis, metabolism and functions of sex hormones Anatomy and histology of male reproductive system Seminal fluid, male sex hormones and regulation of male sexual functions

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Female reproductive system Anatomy and histology of female reproductive system Physiology of female sex hormones and female reproductive cycles The development of the reproductive systems and sexual differentiation Physiology of puberty and menopause and the sexual act

Pregnancy and lactation Fetal Physiology Screening for and monitoring malignancy Inborn errors Contraception physiology Teaching/Learning Lectures 30 hours; practicals 12 hours; video 6 hours; Problem activities based tutorials (small group discussion) 12hours; Dissections 6 hours; Details of teaching learning activities are attached (Annex I)

Time Allocation 66 hours Assessment Formative assessment. 1 hour integrated MCQ paper and 1 ½ hour SEQ paper, Continuous Assessment 2, 2nd MBBS Recommended Find the appendix Reading/ References Coordinating Physiology department

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Course : 2nd semester of the Medical Course Module No. : M1211 Module Title : Human Nutrition Module Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. describe the process and factors affecting digestion and absorption of nutrients stating the end products 2. calculate the protein and energy requirements at various stages of life giving reasons for the variations 3. evaluate whether the energy and protein intake is sufficient in given hypothetical clinical cases 4. explain various forms of protein energy malnutrition and state their adverse effects on health 5. state the active forms, functions, sources, factors affecting bioavailability, metabolism, deficiency and toxicity of water soluble and fat soluble vitamins 6. apply the knowledge on vitamins to explain the effects of vitamin deficiencies and overdoses and the ways of overcoming 7. apply the knowledge on micro and macro minerals, their distribution in the body, sources, functions, absorption, metabolism and transport, bioavailability, requirement to interpret datarelated to mineral disorders 8. relate the effects of dietary fibre on human health 9. deduce growth and health status of children and adults applying standard anthropometric indices 10. plan the dietary interventions for common diseases 11. calculate nutritional value of a diet using food composition tables 12. state the changes in dietary patterns with advancing age 13. describe the nutritional value of commonly consumed foods of plant origin and animal origin in Sri Lanka and

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factors that affect food quality 14. relate the effects of different food processing methods to the nutritional quality 15. analyze and interpret the data and plan basic management procedures of hypothetical clinical situations related to nutritional deficiency disorders using the knowledge in basic sciences

Module Content Digestion and absorption - digestion of nutrients and their end products - factors influencing the bioavailability of nutrients - mechanism of nutrient absorption - metabolism of absorbed nutrients - food allergies - food additives Energy and protein - flow of energy in the biosphere - physiological fuel value of a food - Atwater factors for starch, fat, protein and ethanol - respiratory quotient (RQ) - energy value of oxygen for a food item - basal metabolism and basal metabolic rate (BMR) - thermogenic action of foods - energy requirements - Body mass index (BMI) and its uses - body frame - ideal body weight - influence of T3 and T4 on energy metabolism - brown adipose tissue - excess intake of energy - anthropometry - energy sources in Sri Lankan diet - role of dietary protein

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- dynamic state of body protein and labile body protein - nitrogen balance - essential amino acids and non-essential amino acids - essential amino acid deficiency - amino acid imbalance - amino acid supplements - biological methods for the assessment of nutritive value of proteins - digestibility coefficient and net protein utilization (NPU) - amino acid score - limiting amino acid - dietary factors that affect the nutritive value of protein - reference protein - obligatory losses of Nitrogen - safe level of protein intake - recommended allowance of protein - protein homeostasis - protein-energy malnutrition - growth charts Vitamins, minerals and dietary fiber - fat soluble vitamins and water soluble vitamins - essential Fatty Acids - micro minerals and macro minerals - fibre Anthropometry - anthropometric measurements - adult anthropometry Introduction to dietetics - factors that affect food quality - balanced diet - food composition tables - therapeutic diets

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o liver damage o kidney dysfunction o chronic constipation o hypercholesterolaemia o hypertension o obesity o diabetes mellitus o lactase deficiency o phenylketonuria o galactosaemia o gout - breast feeding - weaning - food supplementation - formula milk - dietary practices in infancy, childhood, adolescence, middle age and elderly Food and food processing - foods of plant and animal origin - food processing and cooking Teaching/Learnin Lectures, Practical ,Small group discussions, Fixed learning g activities sessions ,Student seminars Details of teaching learning activities are attached (Annex I) Time Allocation Course duration: 24 weeks (Semester 2 and 3) Lectures 28 hours; Practical 4 hours; Small group discussions 16hours; Fixed Learning Sessions 13 hours

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Assessment Continuous assessment 2: MCQs; T/F type SEQ Formative assessment: - At the end of the 8th week of the 2nd semester - Integrated with the modules on GI system MCQs; T/F type 2nd MBBS examination: At the end of the preclinical course MCQs; (T/F type) SEQ OSPE Recommended Reading/ References

Coordinating Biochemistry department

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Course : 2nd semester of the Medical Course Module No. : M1212 Module Title : Regional Anatomy 2 – Abdomen, Pelvis and Perineum Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. identify and describe the general topography/ surface anatomy of the abdomen, pelvis and male and female perineum 2. describe the anatomy of the lumbosacral spine and the pelvic girdle in relation to the reproductive functions in females and weight bearing and transmission 3. identify and describe the fascial and muscular arrangement of the anterorolateral and posterior abdominal walls and the pelvis 4. describe the developmental, macroscopic and applied anatomy of the inguinal canal 5. describe the arrangement, divisions and contents of the peritoneal and pelvic compartments 6. describe the arrangement of the neurovascular structures of the abdomen and pelvis 7. identify and describe the radiological anatomy of the abdomen and pelvis 8. apply the anatomical knowledge to recognize and solve clinical problems related to abdominal and pelvic regions 9. utilize a variety of resources (faculty, peers, textbooks, specimens, internet, etc.) to locate information on anatomy of the abdomen and pelvis and related clinical problems

Module Content General topography of the abdomen

Osteology of the lumbosacral spine and pelvis Anatomy of the anterolateral abdominal wall and abdominal incisions

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Anatomy of inguinal canal and inguinal herniae Arrangement of the peritoneum and peritoneal compartments Anatomy of the posterior abdominal wall Anatomy of the pelvic wall and pelvic floor Anatomy of the male and female perineum Arrangement and distribution of the abdominal and pelvic vasculature Lumbosacral plexus and the nerves of the abdomino-pelvic region Radiological and surface anatomy of the abdomen and pelvis

# Macroscopic, microscopic, developmental and applied anatomy of the gastrointestinal and genitourinary organs is done with the respective system-based modules.

Teaching/Learning Lectures 16 hours; Dissections 12 hours; Demonstration of activities prosected specimens 2 hours (x3 groups); Practical: 6 hours (3 sessions x2 hours x3 groups; each group divided into 3 small groups of ~ 15 students )[Topics: 1. Osteology, 2. Radiology, 3. surface anatomy] Problem-based tutorial – 6 hours (6 groups) Clinical case discussion 2 hours (x3 groups) [Topic: abdominal herniae] Details of teaching learning activities are attached (Annex I) Time Allocation Course duration: 12 weeks (Semester 2: Week1 - Week 12) Each weeks program will have, Lectures: 2 hours Tutorial: 2 hours Practical/ Demonstration of prosected specimens/ Clinical case discussion: 6 hours (x2 hours x3 groups) Dissections/ small group activities (practical): 5 hours (T-L activities in Anatomy during this period include those

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of the modules on gastrointestinal, urinary and reproductive systems)

Assessment Formative assessments: Formative evaluation with immediate feedback on individual and group performance during dissections using mini-vivas Mid-semester formative assessment: - At the end of the 8th week of the 2nd semester - Integrated with the modules on Gastrointestinal and urinary systems - MCQ; T/F type: 20 questions - OSPE: 15 stations x2 min per station Summative assessments: Continuous assessment 2: - At the end of semester 2 - Integrated with modules on gastrointestinal, urinary, reproductive and endocrine systems - 20 MCQs; T/F type (1 hour), – 35/100 marks, 3 SEQs (1 ½ hours) – 35/100 marks, OSPE 30 stations (x2min per station) – 30/100 marks - Contribution of regional anatomy course to each - MCQ: 7-8 questions - SEQ: 1 question - OSPE: 7-10 stations 2nd MBBS examination: Includes ~15 MCQs (T/F type), 1 SEQ and ~8 OSPE stations from the regional anatomy of the abdomen and pelvis

Recommended Find the appendix Reading/ References Coordinating Anatomy department

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Course : 3rd semester of the Medical Course Module No. : M2313 Module Title : Nervous system Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. describe the structure and organization of the nervous system 2. describe the functional and applied anatomy of spinal cord, brainstem, cerebrum, cerebellum and diencephalon” and “ describe the blood supply, venous drainage and coverings of the central nervous system 3. discuss the biochemistry of neurotransmitters 4. discuss cerebrospinal fluid physiology 5. describe the development of the nervous system 6. analyze the signs and symptoms observed in clinical situations involving the nervous system Sensory functions 7. describe the sensory receptors and pathways 8. discuss the physiology of pain and inhibitory pathways

Special senses 9. discuss anatomy and physiology of vision 10. discuss anatomy and physiology of hearing and equillibrium

11. discuss anatomy and physiology of olfaction and taste Motor functions 12. discuss physiology of spinal cord, brainstem and basal ganglia, cerebellum 13. discuss how posture is maintained 14. describe the anatomy of the cranial nerves 15. perform clinical examination of the cranial nerve 16. perform clinical examination of the nervous system 17. discuss the physiology of the hypothalamus and temperature

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regulation Higher functions 18. discuss physiology of speech 19. discuss physiology of sleep, arousal and electrical activity of brain 20. discuss the limbic system, intellectual and behavioural functions of the brain 21. discuss the pathophysiology of Central Nervous System lesions

Module Content Structure and organization of the nervous system - The spinal cord and the ascending and descending tracts

- The brainstem - The cerebrum and functional localization of the cerebral cortex - Neurotransmitters - Coverings of the brain and spinal cord, intracranial venous sinuses - Blood supply to the brain and spinal cord - Cerebrospinal fluid - Development of the nervous system Sensory system - Sensory receptors and pathways - Pain physiology and inhibition of pain Special senses - Vision - Hearing and equillibrium - Olfaction and taste Motor functions - Spinal cord - Brainstem and basal ganglia

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- Cerebellum - Posture Central Nervous System examination - Anatomy of cranial nerves - Examination of the cranial nerves and Central Nervous System Thalamus, hypothalamus and internal capsule - Anatomy of thalamus, hypothalamus and internal capsule - Physiology of hypothalamus and temperature regulation

Higher functions - Speech - Sleep, arousal and electrical activity of brain - Intellectual and behavioural functions of the brain Central Nervous System lesions Teaching/Learning Lectures 53 hours; practicals18 hours; video 2; (Problem based activities tutorials) Small group discussion 30 hours; Demonstrations 14 hours; Dissections 8 hours; Details of teaching learning activities are attached (Annex I)

Time Allocation 125 hours Assessment Formative assessment. 1 hour integrated MCQ paper and 1 ½ hour SEQ paper, 2nd MBBS Recommended Find the appendix Reading/ References Coordinating Physiology department

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Course : 3rd semester of the Medical Course Module No. : M2314 Module Title : Regional Anatomy 3A – Head, neck and Spine Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. identify and describe the osteological, radiological and applied anatomy of the skull and the vertebral column 2. describe the fascial and muscular arrangement of the scalp, face and the neck 3. describe the macroscopic and applied anatomy of the thyroid gland, salivary glands, oral cavity and the tongue, nasal cavity and paranasal sinuses, pharynx and larynx, eye and the ear with reference to the function and dysfunction of each 4. describe the arrangement of the neurovascular structures and the lymphatics of the head and neck region 5. describe the embryological development of the head and neck region 6. apply the anatomical knowledge to recognize and solve clinical problems related to the structures in head and neck region 7. utilize a variety of resources (faculty, peers, textbooks, specimens, internet, etc.) to locate information on anatomy of the abdomen and pelvis and related clinical problems Osteology and radiology of the skull and vertebral column Module Content Anatomy of the scalp, face and temporomandibular joint Muscles and fasciae of the neck

Macroscopic and applied anatomy of the thyroid gland Macroscopic and applied anatomy of the salivary glands Anatomy of the oral cavity and salivary glands Anatomy of the nasal cavity and paranasal sinuses Anatomy of the larynx and pharynx

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Anatomy of the ear, eye and orbit Arrangement and distribution of the nerves, blood vessels and lymphatics of the head and neck region Development of the head and neck region

# Anatomy of the brain and other intracranial structures and the spinal cord and the related clinical anatomy done with the module on nervous system Teaching/Learning Lectures:24 hours; Dissections 36 hours; Demonstration of activities prosected specimens 4 hours (x3 groups); Practical 4 hours (2 sessions x2 hours x3 groups; each group divided into 3 small groups of ~ 15 students )[Topics: 1. Osteology, 2. Radiology] Problem-based tutorial 12 hours(x6 groups), Clinical case discussion 2 hours (x3 groups) [Topic: carcinoma of the thyroid gland] Details of teaching learning activities are attached (Annex I) Time Allocation Course duration: 8 weeks (Semester 3: Week1 – Week 8) Each weeks program will have, Lectures: 2-4 hours Tutorial: 2 hours Practical/ Demonstration of prosected specimens/ Clinical case discussion: 6 hours(2 hours*3 groups) Dissections/ small group activities (practical): 5 hours Assessment Formative assessments: Formative evaluation with immediate feedback on individual and group performance during dissections using mini-vivas Mid-semester formative assessment: - At the end of the 8th week of the 2nd semester - Integrated with the module on nervous system - MCQ; T/F type: 20 questions - OSPE: 15 stations x2 min per station 2nd MBBS examination: - At the end of the preclinical course

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- 60 MCQs; T/F type (3 hours), – 35/100 marks, 6 SEQs (3 hours) – 35/100 marks, OSPE 30 stations (x2min per station) – 30/100 marks - Contribution of regional anatomy of the head, neck and spine to each - MCQ: 8-10 questions - SEQ: 1 question - OSPE: 5-7 stations Recommended Find the appendix Reading/ References Coordinating Anatomy department

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Course : 3rd semester of the Medical Course Module No. : M2315 Module Title : Regional Anatomy 3B – Lower Limb Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. describe the musculoskeletal and neurovascular organization of the lower limb with reference to the functions of the lower limb 2. identify and describe the macroscopic, radiological and surface anatomy of the musculoskeletal and neurovascular structures of the lower limb 3. describe the anatomical basis of the common injuries of the lower limb relating to the clinical features, diagnosis and management of these injuries 4. apply the anatomical knowledge to recognize and solve clinical problems related to lower limb 5. utilize a variety of resources (faculty, peers, textbooks, specimens, internet, etc.) to locate information on anatomy of the lower limb and related clinical problems Module Content Osteology of the lower limb Anatomy of the gluteal region Anatomy of the hip joint Compartmental organization of the thigh and the leg Anatomy of the popliteal fossa and the knee joint Anatomy of the ankle joint and the foot Weight bearing and propulsion Arterial system of the lower limb and collateral circulation Venous drainage of the lower limb Nerve supply of the lower limb Radiological anatomy of the lower limb Applied anatomy of the skeletal and neurovascular injuries of the lower limb

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Teaching/Learning Lectures 10 hours; Dissections 20 hours; activities Demonstration of prosected specimens 2 hours (x3 groups) Practical: 4 hours (2 sessions x2 hours x 3 groups; each group divided into 3 small groups of ~ 15 students )[Topics: 1. Osteology, 2. Radiology] Problem-based tutorial – 8 hours (x6 groups) Time Allocation Course duration: 4 weeks (Semester 3: Week 9 - Week 12) Each weeks program will have, Lectures 2 hours Tutorial 2 hours Practical/ Demonstration of prosected specimens: 6 hours(2 hours x3 groups) Dissections/ small group activities (practical) 5 hours Details of teaching learning activities are attached (Annex I) Assessment Formative assessments: Formative evaluation with immediate feedback on individual and group performance during dissections using mini-vivas Mid-semester formative assessment: - At the end of the 13th week of 3rd semester - MCQ; T/F type 5 questions - OSPE 5 stations x2 min per station

2nd MBBS examination: - At the end of the preclinical course - 60 MCQs; T/F type (3 hours), – 35/100 marks, 6 SEQs (3 hours) – 35/100 marks, OSPE 30 stations (x2min per station) – 30/100 marks - Contribution of regional anatomy of the lower limb to each - MCQ: 8-10 questions - SEQ: 1 question OSPE: 5-7 stations Recommended Find the appendix

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Reading/ References Coordinating Anatomy department

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Appendix - Recommended Reading/ References for pre-clinical academic course

Anatomy

- Dissection manual 1. Patrick W. Tank. Grant's Dissector (Tank, Grant's Dissector), 16th ed. UK: Wolters Kluwer; 2O12. - Text books 1. Chummy S. Sinnatamb. Last's Anatomy: Regional and Applied, 12th ed. UK: Churchil Livingstone; 2O11. 2. Richard Drake, A. Wayne Vogl. Gray's Anatomy for Students, 3rd ed. UK: Churchill Livingstone; 2014. 3. B. D. Chaurasia. Human Anatomy, 6th ed. India: CBS publishers; 2013.

- Clinical Anatomy 1. Richard Snells. snell clinical anatomy by regions 9th ed. UK: Wolters Kluwers; 2014. 2. Harold Ellis, Vishy Mahadevan. Clinical Anatomy: Applied Anatomy for Students and Junior Doctors, 12 ed: Wiley-Blackwell; 2011. - Atlas 1. Anne M. R. Agur and Arthur F. Dalley. Grant’s Atlas of Anatomy, 13th ed. UK: Wolters Kluwer; 2012. 2. Peter H. Abrahams, Jonathan D. Spratt MA, Marios Loukas. McMinn and Abrahams' Clinical Atlas of Human Anatomy: 7th ed. Netherlands: Elsevier Health Sciences; 2015. - Histology 1. Barbara Young, Geraldine O’Dowd, Phillip Woodford. Wheater's Functional Histology: A Text and Colour Atlas, 6th ed.:Elsevier; 2013. - Embryology 1. Thomas W. Sadler. Langman's Medical Embryology , 12th ed. : Wolters Kluwer; 2011 2. Inderbir Singh. Human Embryology, 10th ed. India: Jaypee Brothers; 2005.

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- Neuroanatomy 1. Richard Snells. Clinical Neuroanatomy7th ed. UK: Wolters Kluwers; 2014.

Biochemistry

1. Denise R. Ferrier. Lippincott's Illustrated Reviews: Biochemistry, 6th ed. UK: Wolters Kluwer; 2013. 2. Victor W. Rodwell, David A. Bender, Kathleen M. Botham, Peter J. Kennelly, Anthony Weil. Harpers Illustrated Biochemistry, 30th ed.: Lange; 2015. 3. Sareen S. Gropper, Jack L. Smith. Advanced Nutrition and Human Metabolism, 6 ed. : Wadsworth; 2012 4. T.W. Wickramanayake. Food and Nutrition, 3rd ed. Colombo: Trumpet Publication; 1987 5. Professor TW Wickramanayake,. Nutrition throught the life cycle, 3rd ed.; 2007. 6. http://www.who.int/childgrowth/standards/en/

Physiology

1. John E. Hall. Guyton and Hall Textbook of Medical Physiology, 13th ed.: Elsivier; 2015. 2. Kim E. Barrett, Susan M. Barman,Scott Boitano, Heddwen Brooks. Ganong's Review of Medical Physiology, 25th ed.: Lange; 2015. 3. Kevin T. Strang, Hershel Raff, Kevin T. Strang, Hershel Raff Eric P. Widmaier. Vander's Human Physiology, 14th ed.: McGraw-Hill; 2013. 4. Linda Costanzo. Physiology, 5 ed.: Saunders; 2013. 5. Stewart Ira Fox. Human Physiology, 14th ed.: McGraw-Hill; 2015.

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Description of T/L activities

Lectures

 Conducted as interactive sessions in theory (power point/ OHP/ videos) Dissections

 Work as a professional team in small-groups  Self-directed learning process using a guiding manualand other resources such as prosected specimens, models, radiographs, internet  Take turns to function as leaders in the respective groups  Self and peer evaluation of performance  Formative types of mini assessments with immediate feedback by tutors Practical

 15 min interactive lecture prior to each practical session  Self-directed learning process using a handout  Tutors as facilitators for the student learning  Practicals to provide hand on experience on medical biochemical experiments Problem-based tutorials

 Small group learning and self-evaluation session  Tutors as facilitators for the small groups  Two to three clinical problems per session  Critically analyze the problem using the knowledge acquired through lectures/ dissections/ practical sessions  Explain the anatomical/ biochemical/ physiological basis of the given problems Fixed-learning modules

 Self-directed, active learning session  Presentation of material in the printed format for a pre-defined period of time (1 week)  Presentation of course content as well as the important supplementary material to enhance learning  Allows the learning at student’s own pace and time Small group discussion

 small group discussion on theory and hypothetical clinical conditions Clinical case discussion

 Analysis and interpretation and design basic management strategies for given hypothetical clinical conditions

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Student presentations and discussions

 Topics in curriculum are given to students and guided to present as power point presentations or any other presenting mode Student seminars

 Subject related topics are given and guided to do a literature survey, extract data, present to a scientific community

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6.3 Personal and Professional Development (PPD) Stream

Course : 1st, 2nd and 3rd Semesters of the Medical Course Module No. : M1113 Module Title : Personal and professional skills (PPD Stream) Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. gain a better understanding of themselves as persons 2. improve interpersonal skills by identifying their own strengths and weaknesses 3. improve study skills 4. follow accepted personal and professional behaviors

Module Content Section I - Adaptation to a new environment; stress management; coping skills; relaxation techniques - Self-esteem; build a positive self-image; how self- talk affects your attitude; learning to be happier with work; leverage attitudes for optimum performance in academia and carrier; setting goals and achieving them; overcoming distractions. - Reflective behaviour - impulse control and anger management - Conflict resolution

Section II - Learning; intelligence and thinking; dealing with examinations - Leadership, teamwork and group dynamics - Effective presentations - Study Skills: different study styles, ways to improve study skills and overcome weaknesses, resources for

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study skill development, directions for self- assessment on own progressions in studies, mind maps, peer learning and independent learning

Section III - Etiquette for a medical graduate (I); table manners; dress codes Teaching/Learning Lecture discussions / Small Group Discussions/ workshops activities Time Allocation 30 hours

Assessment OSPE/OSCE/ Group Presentations Recommended - Susan Nolen-Hoeksema, Geoffrey Loftus,Willem Reading/ Wagenaar. Atkinson & Hilgard's Introduction to References Psychology, 15th ed. UK: Cengage Learning.; 2009.

- Basant K. Puri, I. H. Treasaden. Sciences Basic to Psychiatry, 2nd ed. Edinburgh, UK: Churchill Livingstone; 1998.

- Barbara Fadem. Behavioral Science in Medicine, 2nd ed/ Kindle Edition. Philadelphia, USA: Lippincott Williams & Wilkins; 2012.

- S. R. Waldstein. Behavioral and Social Science in Medicine: Principles and Practice of Biopsychosocial Care. US: Springer; 2017. Coordinating Department of Psychiatry department

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Course : 5th Semesters of the Medical Course Module No. : M3113 Module Title : Professional skills and Primary Care (PPD Stream) Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. understand how illness affects individuals, their families and society at large 2. acquire good communication and documentation skills

Module Content - Common health beliefs and the experience of illness in the community - Family dynamics and family life cycle - Impact of disease and life events in the family - Special groups in society; psychological and social impact of disability - Communication skills in medical practice - Introduction to Family Medicine - Care of the elderly and the terminally ill - Medical records; prescription writing; referrals; medical certificates Teaching/Learning Lecture discussions / Small Group Discussions/ workshops/ activities Family study / clerkship

Time Allocation 15 hours

Assessment Continues assessment (field) during family study programme & clerkship Family study project report Viva voce Recommended - Susan Nolen-Hoeksema, Geoffrey Loftus,Willem Reading/ Wagenaar. Atkinson & Hilgard's Introduction to References Psychology, 15th ed. UK: Cengage Learning.; 2009.

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- James W. Kalat. Biological Psychology, 12th ed. Califonia: Wadsworth Co Inc; 2015.

- Basant K. Puri, I. H. Treasaden. Sciences Basic to Psychiatry, 2nd ed. Edinburgh, UK: Churchill Livingstone; 1998.

- Chantal Simon, Hazel Everitt, Francoise van Dorp, and Matt Burkes. Oxford Handbook of General Practice (Oxford Medical Handbooks), 4th ed. Oxford, UK: Oxford University Press; 2014.

- Convention on the Rights of Persons with Disabilities (CRPD) | United Nations Enable [Internet]. [cited 2017 Mar 30]. Available from: https://www.un.org/development/desa/disabilities/conventio n-on-the-rights-of-persons-with-disabilities.html Coordinating Department of Community Medicine department

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Course : 6th and 7th Semesters of the Medical Course Module No. : M3213 Module Title : Human Psychology and Behaviour (PPD Stream) Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 1. understand basic human psychology 2. set and achieve goals in life 3. acquire professional communication skills

Module Content Section I - Learning, memory and perception; - Values and attitudes; Stereotypes and prejudice - interpersonal attraction; attachment and bonding - normal physical development, cognitive and psycho- sexual development - personality Section II - Changing behavior - Counseling and breaking bad news - Care of the bereaved Section III - Gender, gender issues and human sexuality - Etiquette for a medical graduate (II); table manners; dress codes Teaching/Learning Lecture discussions / Small Group Discussions/ workshops activities Time Allocation 15 hours

Assessment OSPE/OSCE/ Group Presentations Recommended - Susan Nolen-Hoeksema, Geoffrey Loftus,Willem Reading/ Wagenaar. Atkinson & Hilgard's Introduction to References Psychology, 15th ed. UK: Cengage Learning.; 2009.

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- Basant K. Puri, I. H. Treasaden. Sciences Basic to Psychiatry, 2nd ed. Edinburgh, UK: Churchill Livingstone; 1998.

- Barbara Fadem. Behavioral Science in Medicine, 2nd ed/ Kindle Edition. Philadelphia, USA: Lippincott Williams & Wilkins; 2012.

- S. R. Waldstein. Behavioral and Social Science in Medicine: Principles and Practice of Biopsychosocial Care. US: Springer; 2017.

- Chantal Simon, Hazel Everitt, Francoise van Dorp, and Matt Burkes. Oxford Handbook of General Practice (Oxford Medical Handbooks), 4th ed. Oxford, UK: Oxford University Press; 2014.

Coordinating Department of Psychiatry department

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Course : 8th Semesters of the Medical Course Module No. : M4213 Module Title : Medical Ethics (PPD Stream) Prerequisites : Core / Optional : Core Intended learning Student should be able to: outcomes 3. recognize and distinguish an ethical issue from other issues (differentiate bioethics, law, culture and religion) 4. explain the principles of bioethics and how to balance these principles in practice 5. explain and apply the concepts of human dignity and human rights 6. justify decisions taking harms and benefits into account 7. understand the relationship between autonomy and individual responsibility 8. explain how the principle of consent is applied in different interventions and research 9. explain why patient privacy and confidentiality should be respected 10. recognize legitimate exceptions to confidentiality 11. identify and deal with the ethical issues involved in allocating scarce health care resources 12. identify different contexts and bases of discrimination and stigmatization and their implications 13. deal with cultural diversity and take into consideration cultural specificities (appropriate approach, positive inputs and limits) with respect to the fundamental principles of bioethics and human rights 14. explain the principle of protecting future generations 15. understand the legal and ethical framework within which doctors provide curative and preventive care

Module Content - Introduction to Bio Ethics and Medical Ethics - Harms and benefits in health care settings - Human dignity, rights and autonomy - Privacy, confidentiality and consent - Discrimination, stigmatization and justice - Principle of protecting future generations

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Teaching/Learning Lecture discussions / Small Group Discussions/workshops activities Time Allocation 15 hours

Assessment Written Assignment: Case discussion Recommended - Division of Ethics of Science and Technology- Reading/ UNESCO, 2008. Bioethics Core Curriculum References (SHS/EST/EEP/2008/PI/1/Rev) , UNESCO: Paris, 68 pp.

- UNESCO, 2005. Universal Declaration on Bioethics and Human Rights

- UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

- UNESCO, 2011. Casebook on Benefit and Harm, Bioethics Core Curriculum Casebook Series, No. 2, UNESCO: Paris, 140 pp.

- UNESCO, 2011. Bioethics Core Curriculum – Section 2: Study Materials , UNESCO: Paris, 92 pp. Coordinating Department of Medicine department

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6.4 Research in Medicine

Course : 5th to 8th Semesters of the Medical Course Module No. : M3516 Module Title : Research in Medicine Prerequisites: Core / Optional : Core Intended learning Students should be able to outcomes 1. conduct a comprehensive literature search on a health related topic 2. describe different research designs used in health research 3. design an appropriate research method to answer a health- related research question 4. write a research proposal based on an identified health related problem 5. collect data and analyze using appropriate methods 6. write a research report

Module Content The role of research in medicine and in other contexts related to medicine research design and the research process Setting research aim(s) and objectives Critically reviewing literature

Types of data: quantitative and qualitative Selecting samples Collecting data through observation, interviews and questionnaires Data interpretations Research Ethics Data presentation techniques and research report writing Teaching/Learning Lectures activities Small group discussions Online learning

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Time Allocation Lectures - 15 hours approval of the title and objectives from the scientific committee – 4 weeks Proposal writing and ethical approval -8 weeks data collection – 8 weeks data analysis, report writing – ( 14 weeks ) research presentation- during 8th semester Assessment Formative assessments Summative assessments 1. Research report and presentation

Recommended - Michael J. Campbell, T. D. V. Swinscow. Statistics at Square One, 11 ed. : Wiley Blackwell; 2010. Reading/ References - BMJ Books (latest edition)

Coordinating Community Medicine department

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6.5 Structure of the Para clinical academic programme 6.5.1 Parasitology

Course : 5th Semester of the Medical Course Module No. : M3517 Module Title : Introduction to medical parasitology parasitic infections of blood and circulatory system-1 Prerequisites : completed the module on structure and function of the cardiovascular system Core / Optional : Core Intended learning On completion of the module the students should be able to : outcomes 1. explain the terms and definitions used in Medical Parasitology 2. name the major parasitic infections of the Cardiovascular system 3. name the parasitic infections of the Cardiovascular system prevalent in Sri Lanka 4. discuss the historical background 5. make a diagnosis of based on the history, clinical examination and results of laboratory investigations 6. describe and discuss the transmission of the infection 7. discuss the epidemiology and social factors that promote transmission and the consequences 8. critically review the current control programs 9. advise patients and travelers effectively and efficiently regarding treatment, prevention and prophylaxis against these infections

Module Content Malaria – P. vivax, P .falciprum, P. ovale, P. malariae Each infection presented in the order of; - Geographical distribution - Morphology of the parasite

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- Location in host - Life cycle - Pathogenesis and pathology - Clinical features - Differential diagnosis - Investigations - Diagnosis - Management and treatment - Prevention and control - National Control Program Trypanosomiasis – Trypanosoma brucei brucei group. (as above, not in detail) Leishmaniasis – Leishmania donovani (as above, see also module no.M3632) Teaching and Lectures, Tutorials and practical demonstrations, learning activities Presentations by invited experts Time allocation Lectures 51/2 hours; Tutorial 11/2 hours; Demonstrations 11/2 hours Assessment Continuous Assessment, end of course assessment (3rd MBBS Part I) SEQs, OSPEs Recommended - Handouts (available in the library) Reading / - Gordon C. Cook, Alimuddin Zumla. Manson's Tropical References Diseases, 22 ed.: Saunders; 2008. - Edirisinghe, J. Sarath. Parasites of man. Rathmalana: Vishwa Leka publishers; 1999. Coordinating Department of Parasitology Department

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Course : 5th Semester of the Medical Course Module No. : M3518 Module Title : Parasitic infections of the lymphatic system Prerequisites : Completed the Module –Structure and functions of the lymphatic system Core / Optional : Core Intended learning On completion of the module the students should be able to; outcomes 1. name the major parasitic infections of the lymphatic system 2. discuss the historical background 3. make a diagnosis after formulating a differential diagnosis based on the history, clinical examination and results of laboratory investigations 4. describe and discuss the transmission of the infections 5. discuss the epidemiology and social factors that promote transmission and consequences 6. critically review the current control programs and provide your opinion to improve same 7. advise patients and travelers effectively and efficiently regarding treatment, prevention and prophylaxis against these infections Module Content Parasitic infections of the lymphatic system –Wuchereria bancrofti , Brugia malayi, Toxoplasma gondii (offered in the order under Intended learning outcomes) Teaching and Lectures, Tutorials, Laboratory demonstrations learning activities Time allocation Lecture 5 hours; Tutorials 11/2 hours; Practicals 11/2 hours Assessment Continuous Assessment, end of course assessment (3rd MBBS Part I), SEQs, OSPEs Recommended - Handouts (available in the library) Reading / - Gordon C. Cook, AlimuddinZumla. Manson's Tropical References Diseases, 22 ed.: Saunders; 2008. - Edirisinghe, J. Sarath. Parasites of man. Rathmalana: Vishwa Leka publishers; 1999. - Ralph Muller. Worms and disease: A manual of medical helminthology. : Heinemann Medical; 1975. Coordinating Department of Parasitology Department

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Course : 5th Semester of the Medical Course Module No. : M3519 Module Title : Parasitic infections of blood and circulatory system- 2 Parasitic infections causing diarrhea Prerequisites : Completed the module on structure and function of the Cardiovascular system and Gastrointestinal system Core / Optional : Core Intended learning On completion of the module the students should be able to; outcomes 1. name the major parasitic infections that cause diarrhea 2. discuss the historical background 3. make a diagnosis after formulating a differential diagnosis based on the history, clinical examination and results of laboratory investigations 4. describe and discuss the transmission of the infections 5. discuss the epidemiology and social factors that promote transmission and consequences 6. make a critical evaluation of the current control programs and propose ways of improving 7. advise patients and travelers regarding treatment, prevention and prophylaxis against these infections Module Content Watery diarrhea – Strongyloidiasis (recall), cryptosporidiosis (recall), Trichinosis (recall) Blood and mucus diarrhea – Amoebiasis (recall), Balantidiosis (recall),Trichuris dysentery syndrome (recall), Intestinal Schistosomiasis Steatorrhea – Giardiasis (recall), Severe Strongyloidiasis(recall) Teaching and 1,2 and 3 are offered as lecture discussions 21/2 hours; Practicals learning activities 11/2 hours Time allocation Assessment Continuous Assessment, end of course assessment (3rd MBBS Part I), SEQs, OSPEs

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Recommended - Handouts (available in the library) Reading / References - Gordon C. Cook, AlimuddinZumla. Manson's Tropical Diseases, 22 ed.: Saunders; 2008.

- Edirisinghe, J. Sarath. Parasites of man. Rathmalana: Vishwa Leka publishers; 1999.

- Ralph Muller. Worms and disease: A manual of medical helminthology. : Heinemann Medical; 1975. Coordinating Department of Parasitology Department

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Course : 5th Semester of the Medical Course Module No. : M3520 Module Title : Parasitic infections of the gastro-intestinal system Prerequisites : Completed the module on structure and function of the Gastrointestinal system Core / Optional : Core Intended learning On completion of the module the students should be able to; outcomes 1. name the major parasitic infections of the Gastrointestinal system 2. name the parasitic infections of the Gastrointestinal system prevalent in Sri Lanka 3. discuss the historical background 4. make a diagnosis based on the history, clinical examination and results of laboratory investigations 5. critically review the epidemiological and social factors that promote malnutrition in children infected with above parasites in Sri Lanka 6. describe and discuss the transmission of the infection 7. discuss the epidemiology and social consequences 8. analyze the factors promoting transmission and plan a feasible and effective prevention and control program 9. discuss the preventive measures 10. advise patients and travelers regarding treatment, prevention and prophylaxis against these infections Module Content Intestinal Protozoan infections Intestinal Nematode infections Intestinal Cestode infections Intestinal Trematode infections Each infection presented in the order of; - Geographical distribution - Morphology of the parasite - Location in host - Life cycle

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- Pathogenesis and pathology - Clinical features - Differential diagnosis - Investigations - Diagnosis - Management and treatment - Prevention and control - National Control Programs if any Teaching and Lectures, Tutorials and practical demonstrations, learning activities Time allocation 1,2,3,4- Lectures 21/2 hours each; Practicals 21/2 hours each; Tutorials 11/2 hours each Assessment Continuous Assessment, end of course assessment (3rd MBBS Part I), SEQs, OSPEs Recommended - Handouts (available in the library) Reading / References - Gordon C. Cook, AlimuddinZumla. Manson's Tropical Diseases, 22 ed.: Saunders; 2008.

- Edirisinghe, J. Sarath. Parasites of man. Rathmalana: Vishwa Leka publishers; 1999.

- Ralph Muller. Worms and disease: A manual of medical helminthology. : Heinemann Medical; 1975. Coordinating Department of Parasitology Department

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Course : 6th Semester of the Medical Course Module No. : M3629 Module Title : Parasitic infections of the liver, Parasitic infections leading to anaemia, Parasitic infections causing pulmonary symptoms Prerequisites : Completed the Modules M3517, M3518, M3519 Core / Optional : Core Intended learning On completion of the module the students should be able to; outcomes 1. name the major parasitic infections of the liver 2. name the parasites that can cause anaemia 3. name the parasites that cause pulmonary symptoms 4. discuss the historical background 5. formulate a differential diagnosis based on the history, clinical examination and results of laboratory investigations in each case 6. describe and discuss the transmission of the infections 7. discuss the epidemiology and social consequences 8. discuss the current control programs 9. advise patients and travelers effectively and efficiently regarding treatment, prevention and prophylaxis against these infections

Module Content Parasitic infections of the liver – Fascioliasis (recall), Clonorchiasis (recall), Amoebic liver abscesses (recall), Hydatid cysts (recall), Schistosomiasis (recall),Kala Azar (recall) Parasitic infections leading to anaemia -Malaria (recall),Hookworm infection and disease (recall), Kala Azar(recall), Diphyllobothriasis (recall) Parasitic infections causing pulmonary symptoms Lofflers syndrome (recall), Tropical Pulmonary Eosinophilia (recall) , Visceral Larva Migrans (recall), Paragonimiasis (recall), Hydatid cysts (recall), Ruptured

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Amoebic liver abscesses (recall) Teaching and 1,2 and 3 are offered as lecture discussions – 4 hours; learning activities Practicals 11/2 hours Time allocation Assessment Continuous Assessment, end of course assessment (3rd MBBS Part I), SEQs, OSPEs Recommended - Handouts (available in the library) Reading / References - Gordon C. Cook, AlimuddinZumla. Manson's Tropical Diseases, 22 ed.: Saunders; 2008.

- Edirisinghe, J. Sarath. Parasites of man. Rathmalana: Vishwa Leka publishers; 1999.

- Ralph Muller. Worms and disease: A manual of medical helminthology. : Heinemann Medical; 1975. Coordinating Department of Parasitology Department

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Course : 6th Semester of the Medical Course Module No. : M3630 Module Title : Parasitic infections of the Central Nervous System, Parasitic Infections of the Eye, Parasitic infections of the urinary system Prerequisites : Completed the module on structure and function of the Central Nervous System, Eye, Urinary system Core / Optional : Core Intended learning On completion of the module the students should be able to; outcomes 1. name the major parasitic infections that cause lesions in the Central Nervous System, Eye and the Urinary system 2. discuss the historical background 3. make a diagnosis after formulating a differential diagnosis based on the history, clinical examination and results of laboratory investigations 4. describe and discuss the transmission of the infections 5. do a critically review of the epidemiology and social factors promoting spread of above infections and the consequences 6. discuss the current control programs 7. advise patients and travelers regarding treatment, prevention and prophylaxis against these infections Module Content Central Nervous System – Infections with Free living amoebae (not in detail),Malaria (recall), Cysticercosis (recall), Hydatid cysts (recall), Trypanosomiasis (recall) Eye – Toxoplasmosis (recall), Hydatid cysts (recall), Onchocerciasis and Loasis (recall), Free-living amoebic infections (recall) Urinary system – Trichomoniasis, Schistosomiasis (recall), Lymphatic filariasis (recall) Teaching and 1,2 and 3 are offered as lecture discussions 21/2 hours; learning activities Practicals 11/2 hours. Time allocation Assessment Continuous Assessment, end of course assessment (3rd MBBS

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Part I), SEQs, OSPEs Recommended - Handouts (available in the library) Reading / References - Gordon C. Cook, AlimuddinZumla. Manson's Tropical Diseases, 22 ed.: Saunders; 2008.

- Edirisinghe, J. Sarath. Parasites of man. Rathmalana: Vishwa Leka publishers; 1999.

- Ralph Muller. Worms and disease: A manual of medical helminthology. : Heinemann Medical; 1975. Coordinating Department of Parasitology Department

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Course : 6th Semester of the Medical Course Module No. : M3631 Module Title : Medical Entomology Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to; outcomes 1. name the medically important mosquitoes of Sri Lanka 2. describe the morphology of medically important mosquitoes, their breeding habits and sites and the life cycles 3. state the parasitic infections transmitted by these vectors and the mechanisms involved. 4. identify when given a specimen 5. provide a critical review of the preventive and control measures currently used in Sri Lanka and make suggestions to improve 6. describe and discuss the role of national and global control programs flies, lice, fleas, ticks and mites 7. state the medical importance 8. name the parasitic infections transmitted by each of the above groups 9. discuss the modes of transmission and their role as vectors 10. communicate effectively and efficiently your knowledge on prevention and control to the general public promoting advocacy Module Content Mosquitoes Culicines- Culex quinquefasciatus, Aedes eagypti, aedes albopictus, Mansonia uniformis and Mansonia annulifera Anophelines – Anopheles culicifacies Flies – House fly, Blue bottle fly, Sarcophagaspp. Tsetse fly, Sand fly, Black fly, Tabenids Lice – Head louse, body louse and Pthirus pubis Fleas –Combless fleas – Pulex irritans, Tunga penetrans

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Plague transmitters –Xenopsylla cheopsis and Astia, Combed fleas - Ctenochephalides canis, Nosopsyllus fasciatus Ticks – Hard ticks and soft ticks Mites – typhus transmitters Scabies – Parasite, morphology, life cycle, pathology, clinical features, diagnosis, treatment and prevention

Teaching and 1 to 7 are offered as lecture discussions and practicals learning activities Time allocation Lecture discussions 21/2 hours; Practicals 11/2 hours Assessment Continuous Assessment, end of course assessment (3rd MBBS Part I), SEQs, OSPEs Recommended - Handouts (available in the library) Reading / References - Gordon C. Cook, AlimuddinZumla. Manson's Tropical Diseases, 22 ed.: Saunders; 2008. Coordinating Department of Parasitology Department

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Course : 6th Semester of the Medical Course Module No. : M3632 Module Title : Parasitic infections leading to lesions in the skin and subcutaneous tissue Prerequisites : Completed the module on structure and function of the M3518, M3519, M3520 Core / Optional : Core Intended learning On completion of the module the students should be able to; outcomes 1. Cutaneous leishmaniasis 1.1 name the causative parasite in Sri Lanka 1.1 describe the geographical distribution in Sri Lanka 1.2 describe the clinical presentations 1.3 describe the laboratory investigation tools currently available in Sri Lanka 1.4 make a provisional diagnosis based on the history and clinical examination of a patient 1.5 make a definite diagnosis with based on the laboratory investigations 1.6 describe the transmission of infection to humans name the vector 1.7 state the methods of treatment available in Sri Lanka 1.8 communicate effectively and efficiently the preventive measures adopted by the public 1.9 identify the parasite in a stained smear / biopsy 1.10 analyze the environmental, social and economic factors that may contribute to dissemination of the disease leading to visceral disease 2. Infections with animal filariae 2.1 name the filarial worm that infects humans in Sri Lanka 2.2 outline the clinical consequences of infection with this parasite 2.3 arrive at a differential diagnosis followed by a definite diagnosis based on the history, results of physical examination and laboratory findings.

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2.4 outline the preventive measures 3. Cutaneous larva migrans CLM 3.1 name the causative organisms 3.2 describe the pathology in the above two conditions 3.3 describe the clinical presentation 4. Dracunculosis 4.1 identify the adult worm 4.2 identify the intermediate host 4.3 outline the life cycle 4.4 outline the clinical features of the infection 4.5 outline the preventive measures 5. Trichinellosis (recall – MPS 04) 6. Cysticercosis (recall – MPS 04) 7. Onchocerciasis (recall – MPS 04 8. Scabies (with MPS 07) Module Content Cutaneous leishmaniasis Animal filarial,infections Cutaneous Larva Migrans (CLM) Dracunculosis Trichinellosis Cysticercosis Onchocerciasis Scabies (with Module 07) Teaching and Lectures, Tutorials and practical demonstrations, learning activities Time allocation 1,2,3,4- Lectures 21/2 hrs each Practicals 21/2 hrs each Tutorials 11/2 hrs each Assessment Continuous Assessment, end of course assessment (3rd MBBS Part I), SEQs, OSPEs Recommended - Handouts (available in the library) Reading / References

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- Gordon C. Cook, AlimuddinZumla. Manson's Tropical Diseases, 22 ed.: Saunders; 2008.

- Edirisinghe, J. Sarath. Parasites of man. Rathmalana: Vishwa Leka publishers; 1999.

- Ralph Muller. Worms and disease: A manual of medical helminthology. : Heinemann Medical; 1975. Coordinating Department of Parasitology Department

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Course : 6th Semester of the Medical Course Module No. : M3633 Module Title : Zoonoses and insecticides Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to; outcomes 1. define the term ‘Zoonoses” 2. explain different types of zoonoses 3. state the different classes of insecticides and modes of application 4. explain the actions of each insecticide in general 5. state the specific insecticides and their uses in SriLanka 6. write a critical review of current National Control Programs highlighting the defects and methods of possible improvements Module Content Zoonoses - Domestic zoonoses, peri-domestic zoonoses and sylvatic zoonoses - Parasitic infections directly transmitted from pets, livestock and poultry and wild animals to humans, Insecticides - Organochlorines, organophosphates and carbamates - Insecticide formulations - Insecticides used medical practice - Insecticides used against vectors of parasitic infections Teaching and 1 and 2 are offered as lecture discussions 21/2 hours; learning activities Practicals 11/2 hours. Time allocation Assessment Continuous Assessment, end of course assessment (3rd MBBS Part I), SEQs, OSPEs Recommended - Handouts (available in the library) Reading / - References Gordon C. Cook, AlimuddinZumla. Manson's Tropical Diseases, 22 ed.: Saunders; 2008. Coordinating Department of Parasitology Department

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Course : 6th Semester of the Medical Course Module No. : M3634 Module Title : Common snakes of Sri Lanka , snake bites and envenomation Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to; outcomes 1. name the common non-venomous and venomous snakes of Sri Lanka 2. explain the characteristics of Colubrides, Elapids and Vipers 3. identify common venomous and a non-venomous snakes and name them (local and common names) when given specimens 4. state the important physiological and pharmacological effects of snake venom 5. diagnose snake bite poisoning, based on the history, clinical examination and results of laboratory investigations 6. compare and contrast the clinical features of an elapid and a viper envenomation 7. plan the management of a patient with an elapid and a viper bite poisoning 8. critically review the epidemiology and the social and cultural practices in the treatment of snake bite poisoning in Sri Lanka 9. communicate effectively the preventive measures, first aid and available treatment options in the local health institutions Module Content General features of snakes Colubrides, Elapids and Vipers, Constrictors and sea snakes Non-poisonous – Rat snake (Ptyas mucosus) Mildly poisonous – Cat snake (Boiga forsteni) Poisonous - Cobra (Naja naja naja), Ceylon Krait (Bungarus ceylonicus), Indian krait (Bungarus caeruleus), Hump-nosed viper (Hypnal hypnale), Saw- scaled viper (Echis carinatus),

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Russels viper (Vipera russeli) Constrictors – Python (Python molurus) Sea snakes Earth snakes Teaching and 1 to 8 are offered as lecture discussions 21/2 hours; learning activities Demonstrations and hands on exercises with mounted specimens (11/2) Time allocation Assessment Continuous Assessment, end of course assessment (3rd MBBS Part I), SEQs, OSPEs Recommended - Handouts (available in the library) Reading / References - Gordon C. Cook, AlimuddinZumla. Manson's Tropical Diseases, 22 ed.: Saunders; 2008.

- Anslem de Silva, Jayantha Jinasena. Snakes of Sri Lanka: A Coloured Atlas. Sri Lanka: Vijitha Yapa; 2009. Coordinating Department of Parasitology Department

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6.5.2 Microbiology Course : 5th Semester of the Medical Course Module No. : M3521 Module Title : General Microbiology Prerequisites : Core / Optional : Core Intended learning At the end of this module students should be able to outcomes 1. describe the basics of microbiology inclusive of history, classification, bacterial growth and genetics 2. describe the prokaryotic cell structure 3. perform Gram stain and identify organisms based on morphological characteristics 4. apply Kochs postulates to prove disease causation 5. select appropriate methods for sterilization and disinfection in the laboratory and in clinical practice 6. select appropriate antimicrobial agents for treatment Module Content Introduction to Microbiology - Landmark discoveries leading to the development of microbiology as a science - Characteristics of micro-organisms on which the classification is based - Bacterial growth curve - Growth requirements of bacteria - Culture media used for bacterial growth - Structure and functions of prokaryotic cell - Gram stain procedure - Differentiation of bacteria based on Gram stain and morphological appearance - Other staining methods used to identify bacterial structures Host-Microbe relationship, pathogenesis and proof of disease causation - Types of host-microbe interactions - Formation of microbe- human associations

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- Sources and reservoirs of infections - Differentiation between exogenous and endogenous infections - Currently known modes of transmission - Differences between communicable and non- communicable infectious diseases - Steps in microbial infection – attachment, invasion and mechanism of damage - Importance of proving disease causation - Kochs postulates Sterilization and disinfection - Mechanisms of action of methods used in sterilization and disinfection - Advantages, disadvantages and quality control - Selection of appropriate agents for cleaning /sterilizing/disinfecting Bacterial Genetics - Types of mutations – spontaneous and induced - Major forms of prokaryotic genetic exchange and their clinical importance Antibiotics - History of development of antimicrobials - Bactericidal and bacteriostatic agents - Types of antimicrobials and mechanisms of action of antimicrobials - Mechanisms of resistance - Epidemiology of antimicrobial resistance of specific organisms and its implications in therapy (MRSA, VRSA, ESBL etc.) - Selection of appropriate antimicrobial agents - Empiric therapy and prophylaxis - Antibiotics used in synergy - Application of Kochs postulates to prove disease

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causation - Limitations of applying Kochs postulates Teaching and Lectures 4 hours; Practicals 11 hours learning activities Time allocation 15 hours Assessment Continuous Assessment 03 (MCQ paper and Practical examination) Recommended - Greenwood David. Medical Microbology ,17th Edition, Reading / London: Churchill Livingstone References

- Richord Goering, Hazel Dockrell, Mark Zuckerman, Ivan Roitt, Peter L. Chiodini. Mim’s Medical Microbology 5th Edition, Saunders

- Geo F.Brooks, Karen C.Carroll, Jarwetz S.Butel, Stephen A.Morse. Jawetz, Melnickand Adelberg’s Medical Microbology. 27th Edition,Mcgraw-Hill, Lange Coordinating Microbiology Department

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Course : 5th Semester of the Medical Course Module No. : M3522 Module Title : Systemic Microbiology Prerequisites : Core / Optional : Core Intended learning At the end of this module, students should be able to outcomes 1. describe the pathogenecity of medically significant micro-organisms 2. relate clinical features to pathogenesis of microorganisms 3. select relevant laboratory investigations to establish an aetiological diagnosis 4. describe the epidemiology of infectious diseases 5. select appropriate antibiotics for treatment based on antibiotic sensitivity patterns and national guidelines 6. construct preventive strategies against infectious diseases 7. outline the functions of special preventive programmes for infectious diseases in Sri Lanka (eg.Tuberculosis and leprosy) Module Content Bacteriology - Staphylococci - Streptococci, enterococci - Gram positive bacilli - Small gram negative bacteria- parvobacteria - Legionella, Campylobacter - Neisseria, Moraxella - Vibrionaceae - Pseudomonas - Enterobacteriaceae – Shigella, Salmonella, Escherichia, Klebsiella, Proteus - Ricketssia, Mycoplasma - Spirochaetes - Mycobacteria and Actinomycetes - Chlamydia

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Virology - Introduction to virology - Viruses of respiratory tract - Pox viruses - Papilloma viruses - Slow viral infections - Retro virus and Human immunodeficiency virus - Herpes group of viruses - Mumps - Measles - Rubella - Enteroviruses - Arboviruses - Hepatitis viruses - Diarrhogenic virus - Rabies Mycology - Dermatophytes - Candida species - Aspergillus species - Systemic Fungi – Cryptococcus, Histoplasmosis, Pneumocystis infections Teaching and Lectures 44 hours; Practicals 14 hours; Tutorials 5 hours learning activities Time allocation Bacteriology - 33 hours Mycology - 04 hours Virology - 24 hours Total - 63 hours Assessment Continuous Assessment 04 (MCQ paper and OSPE) Recommended - Greenwood David. Medical Microbology ,17th Edition, Reading / London: Churchill Livingstone References

- Richord Goering, Hazel Dockrell, Mark Zuckerman, Ivan

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Roitt, Peter L. Chiodini. Mim’s Medical Microbology 5th Edition, Saunders

- Geo F.Brooks, Karen C.Carroll, Jarwetz S.Butel, Stephen A.Morse. Jawetz, Melnickand Adelberg’s Medical Microbology. 27th Edition,Mcgraw-Hill, Lange Coordinating Microbiology Department

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Course : 6th Semester of the Medical Course Module No. : M3635 Module Title : Immunology Prerequisites : Core / Optional : Core Intended learning At the end of this module, students should be able to outcomes 1. explain the basis of immunology 2. outline the organization of immune system 3. explain the role of each component of the immune system 4. state the disorders of immune system 5. apply immunological concepts for diagnosis, prevention and treatment of infectious diseases Module Content Introduction to Immunology and Immune system - Overview of immune system, the need for immune system, structure and functions - Innate immunity, mechanism of action and components of innate immunity - Complement system - Cytokines - Acquired immunity - Humoral immunity - Cell mediated immunity Clinical Immunology - Hypersensitivity - Tolerance and autoimmune disorders - Immunodeficiency - Immunity to infections - Methods of acquiring immunity and immunization Teaching and Lectures 15hours, Practicals 3 hours; Tutorials 1 hour learning activities Time allocation 19 hours Assessment Continuous Assessment 04 (MCQ paper and OSPE)

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Recommended - Greenwood David. Medical Microbology ,17th Edition, Reading / London: Churchill Livingstone References - Richord Goering, Hazel Dockrell, Mark Zuckerman, Ivan Roitt, Peter L. Chiodini. Mim’s Medical Microbology 5th Edition, Saunders

- Geo F.Brooks, Karen C.Carroll, Jarwetz S.Butel, Stephen A.Morse. Jawetz, Melnickand Adelberg’s Medical Microbology. 27th Edition,Mcgraw-Hill, Lange

- Abdul K. Abbas, Andrew H.H Lichtman,Shiv Pillai. Cellular and Molecular Immunology 8th Edition, Saunders, 2015

- Praveen Kumar, Michal Clark. Kumar andClark Clinical Medicine 9th Edition, Elsivier Coordinating Microbiology Department

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Course : 6th Semester of the Medical Course Module No. : M3636 Module Title : Clinical Microbiology Prerequisites : Core / Optional : Core Intended learning At the end of this module, students should be able to outcomes 1. list the organisms that cause infections in different body systems 2. analyze symptoms and signs for each body system to arrive at a differential diagnosis 3. select relevant investigations to establish an aetiological diagnosis 4. instruct and coordinate the patients and health care staff in order to collect and transport appropriate specimens for microbiological investigations 5. outline the essential steps for collection and transport of specimens 6. interpret the laboratory test results 7. evaluate clinical manifestations and results of investigation to arrive at an aetiological diagnosis 8. select appropriate antibiotics for treatment based on antibiotic sensitivity patterns and national guidelines 9. describe the principles of universal precautions and infection control Module Content Urinary Tract Infections Sexually Transmitted Infections Skin infections Bone and Joint Infections Upper and Lower Respiratory Tract Infections Abdominal, Gastro Intestinal Infections and Food poisoning Congenital Perinatal and Neonatal infections Central Nervous System Infections Hospital Acquired infections

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Infective Endocarditis Ear and Eye Infections Pyrexia of Unknown origin and sepsis Collection and transport of specimens Infection control Teaching and Lectures 15 hours; Practicals 6 hours; Tutorial 2 hours learning activities Time allocation 23 hours Assessment Continuous Assessment 04 (MCQ paper and OSPE) Recommended - Greenwood David. Medical Microbology ,17th Edition, Reading / London: Churchill Livingstone References - Richord Goering, Hazel Dockrell, Mark Zuckerman, Ivan Roitt, Peter L. Chiodini. Mim’s Medical Microbology 05th Edition, Saunders - Geo F.Brooks, Karen C.Carroll, Jarwetz S.Butel, Stephen A.Morse. Jawetz, Melnickand Adelberg’s Medical Microbology. 27th Edition,Mcgraw-Hill, Lange - Abdul K. Abbas, Andrew H.H Lichtman,Shiv Pillai. Cellular and Molecular Immunology 8th Edition, Saunders, 2015 - Praveen Kumar, Michal Clark. Kumar andClark Clinical Medicine 9th Edition, Elsivier Coordinating Microbiology Department

Final Assessment  3rd MBBS Part I MCQ Paper, SEQ Paper and OSPE 85% Examination  Continuous MCQ Paper and Practical Examination Assessment 03 15%  Continuous MCQ paper and OSPE Assessment 04

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6.5.3 Pharmacology

Course : 5th Semester of the Medical Course Module No. : M3523 Module Title : Introduction to pharmacology Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to : outcomes 1. list branches of Pharmacology. 2. describe the history of Pharmacology. 3. state the WHO definition of a drug. 4. explain the names used to identify a drug and state the advantages of using the generic name. 5. explain the terms- Generic name, Therapeutic group, Indications, Contraindications, Pharmacodynamics, Pharmacokinetics, Dose, Duration, Registration status and schedule, Half-life. 6. explain the terms Pharmacological effect, Therapeutic effect, Side effect, Toxic effect, Placebo effect, Efficacy, Safety, Quality, 7. explain benefits and risks of drug therapy. 8. describe drug-induced disease. 9. ExplainEvidence-based medicine, Essential medicines, Rational prescribing, Geriatric prescribing, Paediatric prescribing and Drug regulation acts. 10. describe drug information and compliance to drugs. Module Content Introduction to Pharmacology Adverse drug reactions and Drug allergy Evidence-based medicine and Essential medicines Rational prescribing, Geriatric prescribing and Paediatric prescribing Drug regulation acts, Complementary and Alternative medicines Compliance to drugs and Drug information

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Teaching and Lecture / Tutorial learning activities Time allocation Lecture 6 hours; Tutorial 6 hours Assessment Continuous Assessment 3, 3rd MBBS part II exam Recommended - Jayakody, R L. Foundation of pharmacology for students Reading / of medicine and allied health science. University of References Colombo: Faculty of Medicine, University of Colombo; 2009.

- James Ritter, Rod Flower, Graeme Henderson, Humphrey Rang. Rang & Dale's Pharmacology, 8 ed: Churchill Livingstone; 2015.

- Karen Whalen. Lippincott Illustrated Reviews: Pharmacology, 6 ed: Wolters Kluwer; 2014.

- Morris Brown Peter Bennett. Clinical Pharmacology, 11 ed.: Churchill Livingstone; 2012.

- British National Formulary (BNF), 57 ed. UK; 2009. Coordinating Pharmacology Department

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Course : 5th Semester of the Medical Course Module No. : M3524 Module Title : Discovery and development of drugs Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to : outcomes 1. describe the methods used in identifying compounds to be developed as drugs. 2. explain why drug development is a difficult process and the reasons for developing drugs. 3. explain the term pre-clinical trial and clinical trial 4. describe the pre-clinical safety and toxicity tests that are performed. 5. explain the role of animal testing in the drug development process. 6. state the ethical considerations about animal experimentation and how these issues are addressed. 7. describe how clearance is obtained for clinical (human) studies. 8. explain designs and different phases of clinical trials. List the objectives of each phase. 9. explain the principles and the limitations of phase 3 clinical trials. 10. explain how approval to market a drug is obtained. 11. explain the term research ethics and its relevance to pharmacology. 12. state the Hippocratic Oath and Helsinki declaration. 13. explain the terms autonomy, beneficence, non-maleficence, justice. 14. explain the importance of getting consent. 15. explain orphan drugs and diseases. Module Content Development of new drugs Pre-clinical and Clinical phases of drug evaluation

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Clinical trials Research ethics Teaching and Lecture / Tutorial learning activities Time allocation Lecture 4 hours; Tutorial 2 hours Assessment Continuous Assessment 3, 3rd MBBS part II exam Recommended - Jayakody, R L. Foundation of pharmacology for students Reading / of medicine and allied health science. University of References Colombo: Faculty of Medicine, University of Colombo; 2009.

- James Ritter, Rod Flower, Graeme Henderson, Humphrey Rang. Rang & Dale's Pharmacology, 8 ed: Churchill Livingstone; 2015.

- Karen Whalen. Lippincott Illustrated Reviews: Pharmacology, 6 ed: Wolters Kluwer; 2014.

- Morris Brown Peter Bennett. Clinical Pharmacology, 11 ed.: Churchill Livingstone; 2012.

- British National Formulary (BNF), 57 ed. UK; 2009. Coordinating Pharmacology Department

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Course : 5th Semester of the Medical Course Module No. : M3525 Module Title : General pharmacology Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to : outcomes 1. describe the terms Pharmacokinetics and Pharmacodynamics. 2. explain the individual processes of pharmacokinetics - Absorption - Distribution - Metabolism - Elimination 3. classify mechanisms of action of drugs and describe the individual types. 4. explain the terms - Placebo effects - Dose response - Potency - Therapeutic efficacy - Tolerance - Tachyphylaxis - Therapeutic index - Pharmacogenomics - Biological variations in drug response 5. interpret dose - response curves. 6. classify drug interactions and describe the individual types. Module Content Pharmacokinetics Pharmacodynamics Drug interactions Teaching and Lecture / Tutorial learning activities Time allocation Lecture 4 hours; Tutorial 4 hours Assessment Continuous Assessment 3, 3rd MBBS part II exam

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Recommended - Jayakody, R L. Foundation of pharmacology for students Reading / of medicine and allied health science. University of References Colombo: Faculty of Medicine, University of Colombo; 2009.

- James Ritter, Rod Flower, Graeme Henderson, Humphrey Rang. Rang & Dale's Pharmacology, 8 ed: Churchill Livingstone; 2015.

- Karen Whalen. Lippincott Illustrated Reviews: Pharmacology, 6 ed: Wolters Kluwer; 2014.

- Morris Brown Peter Bennett. Clinical Pharmacology, 11 ed.: Churchill Livingstone; 2012.

- British National Formulary (BNF), 57 ed. UK; 2009.

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Course : 6th Semester of the Medical Course Module No. : M3637 Module Title : Drugs affecting the nervous system Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to : outcomes 1. explain the pharmacology of - cholinergic drugs and anticholinergic drugs - adrenergic drugs, α and β receptor blockers - skeletal muscle relaxants 2. explain the pharmacological basis of pain management. 3. explain the pharmacological actions and clinical use of - local anesthetics - general anesthetics and pre-anesthetic medications 4. explain the pharmacological actions and clinical use of - Antidepressants - Antipsychotic drugs - Mood stabilizers - Anxiolytics - Hypnotics - Drugs for dementia - Drugs for Attention Deficit Hyperactivity Disorder 5. explain the pharmacological actions and clinical use of - Levodopa - Anticonvulsants - Drugs used in migraine 6. describe the pharmacology of drugs used in alcohol abuse. 7. plan a management (including pharmacological methods) of the diseases involving the nervous system and in psychiatric disorders. Module Content Drugs affecting the Autonomic nervous system Drugs affecting the peripheral nervous system Analgesics

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Local anesthetics General anesthetics Antidepressants Antipsychotic drugs Sedatives and hypnotics Drugs for dementia Drugs for Attention Deficit Hyperactivity Disorder Anti-Parkinson drugs Anticonvulsants Drugs used in migraine Drugs used in alcohol abuse Teaching and Lecture / Tutorial learning activities Time allocation Lecture 14 hours; Tutorial 8 hours Assessment Continuous Assessment 4, 3rd MBBS part II exam Recommended - James Ritter, Rod Flower, Graeme Henderson, Reading / Humphrey Rang. Rang & Dale's Pharmacology, 8 ed: References Churchill Livingstone; 2015.

- Karen Whalen. Lippincott Illustrated Reviews: Pharmacology, 6 ed: Wolters Kluwer; 2014.

- Morris Brown Peter Bennett. Clinical Pharmacology, 11 ed.: Churchill Livingstone; 2012.

- British National Formulary (BNF), 57 ed. UK; 2009.

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Course : 6th Semester of the Medical Course Module No. : M3638 Module Title : Drugs affecting the cardiovascular systems Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to : outcomes 1. state the classification of anti-hypertensive drugs. 2. describe the pharmacology of - Anticoagulants, Anti-platelet drugs, Thrombolytics - Vasodilators - Calcium channel blockers - Diuretics and Anti-diuretics - Anti-arrhythmic drugs - Anti-hyperlipidaemic drugs 3. describe the management of - Angina - Hypertension - Cardiac failure - Arrythmia - Hyperlipidaemia 4. plan a management (including pharmacological methods) of the diseases involving the cardiovascular system.. Module Content Anti-coagulants, Anti-platelet drugs, Thrombolytics Vasodilators Calcium channel blockers Anti-arrhythmic drugs Anti-dyslipidaemic agents Diuretics and Anti-diuretics

Teaching and Lecture / Tutorial learning activities Time allocation Lecture 12 hours; Tutorial 6 hours

Assessment Continuous Assessment 4, 3rd MBBS part II exam

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Recommended - James Ritter, Rod Flower, Graeme Henderson, Reading / Humphrey Rang. Rang & Dale's Pharmacology, 8 ed: References Churchill Livingstone; 2015.

- Karen Whalen. Lippincott Illustrated Reviews: Pharmacology, 6 ed: Wolters Kluwer; 2014.

- Morris Brown Peter Bennett. Clinical Pharmacology, 11 ed.: Churchill Livingstone; 2012.

- British National Formulary (BNF), 57 ed. UK; 2009.

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Course : 7th Semester of the Medical Course Module No. : M4743 Module Title : Drugs affecting the endocrine system Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to : outcomes 1. explain the pharmacological actions and clinical use of - Anterior and posterior pituitary hormones and related drugs - Adrenocortical hormones - Estrogens, progesterone and androgens - Oral contraceptives - Vitamin D, calcitonin - Insulin - Oral hypoglycaemic agents 2. discuss the management of diabetes. 3. plan a management (including pharmacological methods) of the diseases involving the endocrine system. Module Content Adrenocortical hormones Thyroid hormonesand anti-thyroid hormones Anti-diabetic drugs Sex hormones and Oral contraceptives Calcium and Phosphate metabolism Hypothalamic, anterior and posterior pituitary hormones Teaching and Lecture / Tutorial learning activities Time allocation Lecture 12 hours; Tutorial 8 hours Assessment Continuous Assessment 4, 3rd MBBS part II exam Recommended - James Ritter, Rod Flower, Graeme Henderson, Reading / Humphrey Rang. Rang & Dale's Pharmacology, 8 ed: References Churchill Livingstone; 2015.

- Karen Whalen. Lippincott Illustrated Reviews: Pharmacology, 6 ed: Wolters Kluwer; 2014.

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- Morris Brown Peter Bennett. Clinical Pharmacology, 11 ed.: Churchill Livingstone; 2012.

- British National Formulary (BNF), 57 ed. UK; 2009.

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Course : 8th Semester of the Medical Course Module No. : M4850 Module Title : Antibiotics Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to : outcomes 1. explain the term antibiotic. 2. list the classes of antibiotics. 3. explain the term ‘spectrum’. 4. explain the terms ‘bacteriostatic’ and ‘bactericidal’. 5. explain the factors affecting clinical effectiveness of antibiotics. 6. explain the factors that affect isolation of pathogenic organisms. 7. explain the significance of taking specimens in relation to antibiotic therapy. 8. explain how antibiotics act. 9. explain the terms ‘antibiotic therapy’ and ‘antibiotic prophylaxis’. 10. explain how antibiotics are selected. 11. describe the problems encountered with antibiotic use. 12. explain the mechanism of action, absorption, distribution, metabolism, excretion, adverse effects and cost effectiveness of each antibiotic. 13. plan a management (including pharmacological methods) of common types of infection and malignancies. Module Content Principles of antibiotic drug use and resistance PenicillinsandCephalosporins Aminoglycosides, Macrolides, Tetracyclines, Chloramphenicol Sulphonamides, Quinolones, Azoles Clinical use of antibiotics Anti-fungal and Anti-viral drugs Anti-tuberculosis drugs

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Anti-leprosy drugs Anti-malarial drugs, Anti-helminticsand Anti-protozoal agents Cancer chemotherapy Teaching and Lecture / Tutorial learning activities Time allocation Lecture 18 hours; Tutorial 14 hours Assessment 3rd MBBS part II exam Recommended - James Ritter, Rod Flower, Graeme Henderson, Reading / Humphrey Rang. Rang & Dale's Pharmacology, 8 ed: References Churchill Livingstone; 2015.

- Karen Whalen. Lippincott Illustrated Reviews: Pharmacology, 6 ed: Wolters Kluwer; 2014.

- Morris Brown Peter Bennett. Clinical Pharmacology, 11 ed.: Churchill Livingstone; 2012.

- British National Formulary (BNF), 57 ed. UK; 2009.

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Course : 8th Semester of the Medical Course Module No. : M4851 Module Title : Special Topics Prerequisites : Core / Optional : Core Intended learning On completion of the module the students should be able to : outcomes 1. Explain the pharmacological actions and clinical use of drugs used for - Asthma and Chronic Obstructive Pulmonary Disease - Diarrhea, Constipation and Vomiting - Peptic ulcer disease - Chronic liver disease - Skin and Eye 2. Explain the pharmacological actions and clinical use of - Vitamins - Hematinics - Intravenous fluids and Plasma expanders 3. Explain the pharmacological actions and clinical use of drugs used in the management of poisoning. 4. Explain the pharmacological basis of immunization and immunotherapy. Module Content Drugs used in the management of asthma andchronic obstructive pulmonary disease Autocoids Drugs for diarrhea, constipation and anti-emetics Drugs used in peptic ulcer disease Drugs used in chronic liver disease Vitamins Drugs used in anemia and other hematological disorders Drugs used on the skin and eye Drugs used in the management of poisoning Immunization Immunotherapy

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Intravenous fluids and Plasma expanders Teaching and Lecture / Tutorial learning activities Time allocation Lecture 20 hours; Tutorial 12 hours Assessment 03rd MBBS part II exam Recommended - James Ritter, Rod Flower, Graeme Henderson, Reading / Humphrey Rang. Rang & Dale's Pharmacology, 8 ed: References Churchill Livingstone; 2015.

- Karen Whalen. Lippincott Illustrated Reviews: Pharmacology, 6 ed: Wolters Kluwer; 2014.

- Morris Brown Peter Bennett. Clinical Pharmacology, 11 ed.: Churchill Livingstone; 2012.

- British National Formulary (BNF), 57 ed. UK; 2009.

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6.5.4 Forensic medicine

Course : 7th Semester of the Medical Course Module No. : M4749 Module Title : Injuries Prerequisites : Core / Optional : Core Intended learning To be able to outcomes 1. perform the medico-legal duties of a medical officer. 2. outline the medico-legal frame work and the relevant sections of the Penal Code. 3. examine victims and suspects in cases of assault, accidents, sexual assaults and other instances where medico-legal examinations are required. 4. describe the different injury patterns and circumstances under which they occur. 5. identify, document, interpret, and form an opinion on injuries caused by different agents in different circumstances 6. analyze the injuries and findings in given case scenarios in order to formulate opinions and reconstruction of events 7. perform a medico-legal autopsy, form an opinion, complete reports and submit to Courts. 8. assess the findings of the postmortem examinations to dealwith the possible challenges at the trial 9. give oral evidence in the court of law Module Content Introduction to forensic medicine and basic injuries.(3 hours) Regional injuries - Head, Neck, Facial, Thoracic and Abdominal injuries.(5 hours) - The mechanisms of causation, sequelae of injuries and category of hurt. (1 hour) - Classification of injuries for legal purpose.(2 hours)

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- Patterns of injuries, assault, self-inflicted, homicidal and accidental injuries.(1 hour) - Timing of injuries. (1 hour) - Pathology and pathophysiology of trauma.(1 hour) - History taking and examination of medico legal cases.(2 hours) - Transportation injuries.(3 hours) - Burns.(3 hours) - Firearm.(3 hours) - Asphyxial deaths.(3 hours) - Drowning.(1 hour) - Sexual offense (3 hours) - Criminal miscarriage (3 hours) - Child abuse (3 hours) - Infanticide and sudden infant death syndrome(2 hours) - Torture and deaths in custody.(1 hour) - Starvation and neglect.(1 hour) Teaching and learning activities Time allocation Lectures 42 hours; small group discussion 19 hours Assessment 3rd MBBS part 11 examination Theory Essay - 5 questions, 30 min each SEQ - 4 questions, 15 min each OSPE – 15 stations, 2.5 min each Recommended - Bernard Knight. Legal Aspects of Medical Practice, 5 ed. : Reading / Churchill Livingstone; 2015. References - Pekka Saukko,Bernard Knight . Knight's Forensic Pathology, 4 ed. : CRC Press; 2015.

- Dominick DiMaio,Vincent J.M. DiMaio. Forensic Pathology, 2001 ed.: CRC press; 2001.

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- N.Reddy. the Essentials of Forensic Medicine and Toxicology, 33 ed. India: Jaypee; 2014.

- W. D. S. McLay. Clinical Forensic Medicine, 3 ed. : Cambridge University Press; 1996.

- De Alwis , L.B.L. Lecture notes in forensic medicine - vol . I, II, III & IV : forensic pathology and forensic science, 1 ed. Sri Lanka: Mahabage; 2008.

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Course : 8th Semester of the Medical Course Module No. : M4858 Module Title : Death and death related issues, toxicology and medical ethics Prerequisites : Core / Optional : Core Intended learning To be able to outcomes 1. explain the methods in establishing the identity of the deceased or the living. 2. evaluate post mortem changes to estimate time since death. 3. visit and examine a scene of crime with a team, collect evidence and formulate conclusions. 4. describe the medico-legal investigations of sudden, unexplained, unexpected, obscure and suspicious deaths. 5. issue certificates/reports to courts. 6. identify the types and circumstances of poisoning/drug overdose. 7. apply principles of management of common poisons in Sri Lanka. 8. describe the action, tissue damage, the cause of death and the laboratory investigations in cases of poisoning/ drug overdose. 9. outline the principles of sampling, storage, chain of custody, analysis and interpretation of findings in suspected cases of poisoning and drug abuse/overdose. 10. apply the principles of ethics, rights and law to solve problems that arise during medical practice. 11. identify health care rights of individuals. 12. define the disciplinary procedure and the functions of the SLMC. Module Content Plant poisons. (1 ½ hour) Agrochemicals. (1 ½ hour) Drugs(therapeutic- aspirin ,PCM ,lithium ;drugs of abuse).

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(1hour) CorrosivesandMethyl alcohol. (2 hours) Heavy metals (Pb. As). (1 hour) Body fluid and tissue analysis in forensic practice.(2 hours) Drunkenness.(1 hour) Inquest procedure.(1 hour) Routine autopsy and technique(1 hour) Introduction to un natural deaths murder, homicide, accident suicide, cause of dead, mode of death and circumstances of death. (1 hour) Changes after death and estimation of time since death.(1 hour) Death and death related issues.(1 hour) Sudden natural deaths.(2 hours) Post mortem artifacts(1 hour) Negative autopsy.(1 hour) Identification for medico legal purposes(2 hours) Scene of crime and investigation of crime(1 hour) Trace evidence.(1 hour) Exhumation and excavation.(1 hour) Medical ethics- introduction and concepts(1 hour) Role and responsibilities of a doctor in maintaining relationships.(1 hour) Medical negligence.(1 hour) Medical malpractice (professional misconduct) and illegal medical practice.(1 hour) Testimonial capacity , testamentary capacity, fitness to pleased, dying declaration and dying deposition.(1 hour) Court procedure and expert testimony in Courts. (1 hour) Legal system of Sri Lanka (1 hour) Health care rights.(1 hour) Sri Lanka medical council.(1 hour)

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Teaching and learning activities Time allocation Lectures 32 hours; Clinical appointment 2 weeks; small group discussion 5 hours Assessment 3rd MBBS part 11 examination Theory Essay - 5 questions, 30 min each SEQ - 4 questions, 15 min each OSPE – 15 stations, 2.5 min each Recommended - Bernard Knight. Legal Aspects of Medical Practice, 5 ed. : Reading / Churchill Livingstone; 2015. References - Dominick Di Maio, Vincent J.M. Di Maio. Forensic Pathology, 2001 ed.: CRC press; 2001.

- N. Reddy. the Essentials of Forensic Medicine and Toxicology, 33 ed. India: Jaypee; 2014.

- W. D. S. McLay. Clinical Forensic Medicine, 3 ed. : Cambridge University Press; 1996.

- De Alwis , L.B.L. Lecture notes in forensic medicine - vol . I, II, III & IV : forensic pathology and forensic science, 1 ed. Sri Lanka: Mahabage; 2008.

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6.5.5 Pathology Course : 5th Semester of the Medical Course Module No. : M3526 Module Title : General Pathology Prerequisites : Completed the course on Anatomy, Biochemistry and Physiology Core / Optional : Core Intended learning On completion of the module students should be able to: outcomes 1. explain terms and definitions used in general pathology 2. describe the concepts of reversible and irreversible cell injury, necrosis and apoptosis, thrombosis and embolism, ischaemia and infarction, oedema, pathological calcification, amyloidosis 3. describe in detail the acute and chronic inflammatory responses including the macroscopical, cellular, microcirculatory and biochemical changes involved 4. describe the general pathological processes involved in tissue regeneration, repair, wound healing and fracture healing 5. discuss the clinical consequences of the general pathological concepts named above 6. discuss the general pathological processes in the context of a given clinical scenario Module Content The concepts are as follows: - Cell response to injury - Cellular adaptations - Intracellular accumulation and pigmentation - Necrosis - Apoptosis - Tissue response to injury which include acute and chronic inflammation - Tissue regeneration, repair, wound healing and fracture healing - Thrombosis and embolism

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- Ischaemia and infarction - Pathological calcification - Amyloidosis In relation to each of the above, the following facts (according to what is appropriate) will be presented - Causative factors - Pathogenesis - Pathology of the lesions - Varying morphological types - Outcome and complications - Clinical and laboratory manifestations Teaching and Lectures, Tutorials and Practical demonstrations learning activities Presentations by invited experts Time allocation Lecture 12 hours; Tutorials 3 hours; Demonstrations 3 hours Assessment Continuous Assessment, end of course assessment, 3rd MBBS Part II, SEQs, OSPEs Recommended - Lecture notes (available in the library) Reading / References - Vinay Kumar, Abul Abbas and Jon Aster. Robbins Basic Pathology, 9 ed.: Elsevier Wordmark; 2012.

- J. B. Walter. Walter & Israel General Pathology, 7 ed.: Elsivier; 1996.

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Course : 6th Semester of the Medical Course Module No. : M3639 Module Title : Tumour Pathology Prerequisites : Completed the module on general Pathology Core / Optional : Core Intended learning On completion of the module students should be able to: outcomes 1. define the terms Tumour, Hamartoma, Choristoma 2. differentiate neoplasia from hypertrophy, hyperplasia, metaplasia and dysplasia 3. explain tumour nomenclature according to biological behavior and histogenesis 4. explain the terms “grading” and “staging” of a malignant tumour and it’s clinical importance 5. compare and contrast benign and malignant tumour 6. explain the concept of multistep theory of oncogenesis, mode of damage and targets of damage to genetic material and concepts of initiation and promotion 7. explain the terms “monoclonality” and “tumour progression” 8. describe the processes of chemical carcinogenesis, viral oncogenesis and radiation oncogenesis 9. discuss the relationship between immunodeficiency and development of tumours 10. describe the importance of early diagnosis of tumours and the methods used with examples 11. describe the various methods of metastasis and the associated clinical features 12. differentiate carcinoma-in-situ from invasive tumour 13. describe paraneoplastic syndrome including causative factors and associated clinical problems 14. list different groups of tumour markers and explain their clinical use Module Content Dysplasia, tumour, hamartoma, choristoma

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Tumour nomenclature according to biological behavior and histogenesis Concepts of grading and staging of a tumour Macroscopy and clinical effects of benign and malignant tumour Multistep theory of oncogenesis Protective mechanisms of a cell to ward off neoplastic stimuli - Tumour suppressor genes - Apoptosis controlling genes - DNA repair genes Modes of damage and targets of genetic material in oncogenesis Concepts of pre-malignant lesions, monoclonality, tumour progression, recurrence, latent period. Chemical carcinogenesis - Viral oncogenesis - Radiation oncogenesis - Nutritional agents, hormones, chronic inflammatory diseases and inherited conditions associated with cancer - Immune surveillance as protection against cancer - Early diagnosis of tumour o Mammography o Pap smear o Fine-needle aspiration cytology - Spread of malignant tumour - Paraneoplastic syndrome Teaching and Lectures, Tutorials and Practical demonstrations learning activities Presentations by invited experts Time allocation Lecture 12 hours; Tutorials 3 hours; Demonstrations 3 hours Assessment Continuous Assessment, end of course assessment, 3rd MBBS Part II, SEQs, OSPEs Recommended - Lecture notes (available in the library) Reading /

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References - Vinay Kumar, Abul Abbas and Jon Aster. Robbins Basic Pathology, 9 ed.: Elsevier Wordmark; 2012.

- J. B. Walter. Walter & Israel General Pathology, 7 ed.: Elsivier; 1996.

Coordinating Pathology Department

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Course : 7th Semester of the Medical Course Module No. : M4743 Module Title : A. Gastro intestinal pathology and B. Musculoskeletal Pathology Prerequisites : Completed the course on Anatomy and Physiology of the Gastrointestinal System and Musculoskeletal System Core / Optional : Core Intended learning On completion of module M4743 A students should be able to: outcomes 1. describe pathology of inflammatory lesions, benign lesions and malignant lesions of the oral cavity and salivary glands 2. describe the pathology of the pre malignant lesions and benign neoplasms of the oesophagus 3. describe in detail the aetiology clinical effects, pathology and spread of squamous cell carcinoma of the oesophagus 4. outline the aetiological factors and pathology of adenocarcioma of the oesophagus 5. discuss the investigations available to detect oesophageal cancer 6. describe the aetiopathogenesis, pathology and complications of peptic ulcer disease 7. list the non neoplastic and neoplastic polyps of the stomach 8. describe the aetiological factors, clinical features, pathology and spread of gastric cancer 9. discuss the investigations available in the diagnosis of gastric disease 10. list the non neoplastic and neoplastic polyps of small and large intestine 11. describe the types of adenoma 12. briefly describe the familial polyposis syndromes 13. describe the epidemiology, aetiology, carcinogenesis, pathology, spread and prognosis of colorectal cancer 14. describe the pathological changes in the intestine and the complications of typhoid, tuberculosis, shigellosis and amoebiasis

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15. discuss the clinical manifestations common intestinal infections 16. describe the incidence, clinical features, pathogenesis, pathology and complications of idiopathic inflammatory bowel disease 17. describe extra intestinal manifestations of ulcerative colitis 18. compare and contrast Crohn’s disease and ulcerative colitis

On completion of Module M4743 B students should be able to: 19. describe the aetiology, pathogenesis, pathology and complications of pyogenic osteomyelitis and tuberculous osteomyelitis 20. list the common sites of osteomyelitis with regards to the age of the patient 21. describe the aetiology, pathogenesis and clinical manifestations of osteoporosis, osteomalacia,/rickets, Paget’s disease and hyperparathyroidism 22. describe how you would interpret the laboratory investigations with regards to the diagnosis of the above 23. describe the aetiology and morphology of common benign and malignant bone tumours 24. briefly describe the clinical presentations of the above and explain how radiological findings aid in the pathological diagnosis 25. describe the pathology of metastatic bone disease

Module Content Module M4743A - Benign lesions of the oral cavity - Malignant lesions of the oral cavity - Congenital oesophageal abnormalities - Inflammatory lesions of the oesophagus - Dysphagia - Pre malignant lesions of oesophagus

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- Squamous carcinoma of oesophagus - Adeno carcinoma of oesophagus - Normal structure and function of stomach - Congenital lesions of stomach - Peptic ulcer disease - Gastric polyps - Gastric carcinoma - Malabsorption syndrome - Congenital diseases of the intestine - Vascular diseases of the intestine - Neoplastic polyps of small and large intestine- The adenoma - Familial syndromes- small and large intestine - Adenoma carcinoma sequence - Colorectal adeno carcinoma - Carcinoid tumour - Tumours of appendix - Embryological defects of the anal canal - Inflammatory lesions of the anal canal o Anal fissure o Anal ulcer o Anal fistula - Crohn’s disease - Tuberculosis - Ulcerative colitis - Human immunodeficiency virus infection - Squamous carcinoma of anal canal - Other malignancies in the anal canal - Gut infections o Typhoid o Intestinal Tuberculosis o Shigellosis o Amoebiasis

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- Inflammatory bowel disease o Crohn’s disease o Ulcerative colitis Module M4743 B - Pyogenic osteomyelitis - Tuberculous osteomyelitis - Benign bone tumours o Osteoma o Osteoblastoma o Osteoid osteoma - Malignant bone tumours o Osteosarcoma o Chondrosarcoma o Ewing tumour - Metastatic bone disease - Metabolic bone diseases o Osteoporosis o Osteomalacia o Rickets o Paget’s disease o hyperparathyroidism Teaching and Lectures, Tutorials and Practical demonstrations learning activities Presentations by invited experts Time allocation Lecture 22 hours; Tutorials 4 hours; Demonstrations 3 hours Assessment Continuous Assessment, end of course assessment, 3rd MBBS Part II, SEQs, OSPEs Recommended - Lecture notes (available in the library) Reading / References - Vinay Kumar, Abul Abbas and Jon Aster. Robbins Basic Pathology, 9 ed.: Elsevier Wordmark; 2012.

- J. B. Walter. Walter & Israel General Pathology, 7 ed.: Elsivier; 1996.

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- Robin Reid Fiona Roberts Elaine MacDuff. Pathology Illustrated, 7 ed. : Churchill Livingstone ; 2011.

Coordinating Pathology Department

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Course : 7th Semester of the Medical Course Module No. : M4744 Module Title : A. Pathology of the Cardiovascular System and B. Pathology of the Central Nervous System Prerequisites : Completed the course on Anatomy and Physiology of the cardiovascular system and nervous system, completed modules on general pathology and tumour pathology Core / Optional : Core Intended learning On completion of module M4744A students should be outcomes able to: 1. define myocardial infarction 2. list causes of and risk factors for acute myocardial infarction 3. explain the relationship between Hypertension, Diabetes mellitus and Ischemic heart disease 4. explain the terms transmural infarction and a subendocardial infarction 5. describe the morphological changes, in the heart at the following time intervals after acute myocardial infarction - within 4 hours, after 4 to 12 hours, 12 to 24 hours, 1 to 3 days, 3 to 7 days, 7 to 14 days, 2 to 8 weeks 6. name the regions of the myocardium involved and procedure/s used to identify blockages of left circumflex coronary artery, left anterior descending artery, right coronary artery. 7. list the causes and types of pericarditis 8. describe the tumors of the pericardium and primary sites which could give rise to metastasis in the pericardium 9. describe the morphological appearances of the different types of pericarditis-serous, fibrinous, serofibrinous, purulent, caseous, haemorragic

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10. list the various valvular diseases (acquired, congenital) 11. explain the pathogenesis of rheumatic valvular disease and rheumatic carditis 12. describe the pathological features of pancarditis, acute and chronic rheumatic vegetations. 13. describe the appearance of Aschoff bodies in various stages 14. describe the other non infective causes and morphology of vegetations of endocarditis. 15. describe the types, aetiology, predisposing factors, pathogenesis, pathological changes ,complications and sequelae of bacterial endocarditis 16. define myocarditis 17. briefly describe the pathogenesis, aetiological factors, macroscopic and microscopic features, clinical features and complications of myocarditis and cardiomyopathy 18. list the common tumors of the heart and blood vessels 19. define the term aneurysm. 20. describe macroscopic classification and aetiological classification of aneurysms 21. describe pathogenesis, macroscopic and microscopic features, clinical effects , complications of atherosclerotic aneurysm, syphilitic aneurysm and dissecting aneurysm 22. describe mycotic aneurysm cerebral Berry aneurysm, circoid aneurysm, microaneurysm (Charcot-Bouchard), capillary microaneurysm (diabetic retinopathy) and cardiac aneurysms 23. define hypertension. 24. describe pathogenesis and types hypertension.

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25. describethe pathological changes , macroscopic and microscopic appearance that occur in the arterial system due to hypertension. 26. describe the pathological effects, macroscopic appearances, pathological basis of the clinical symptoms due to hypertension on following organs a. Blood vessels b. Heart c. Kidney d. Eyes e. Brain 27. describe the pathological effects of pulmonary hypertension. 28. define the term vasculitis 29. classify arterial inflammatory diseases 30. list the common types of vasculitides 31. describe common clinical signs, aetiological factors and pathophysiology of each clinical sign in arterial inflammatory diseases 32. outline the pathological changes and common clinical manifestations in Takayasu’s disease, Giant cell arteritis, Polyarteritis nodosa, Kawasaki’s disease, Wegener’s granulmatosis, Microscopic polyangiitis. 33. describe serological and heamatological changes, skin, renal and pulmonary manifestations , and pathophysiology of small vessel vasculitides 34. list Anti-neutrophil cytoplasmic antibody and non- antineutrophil cytoplasmic antibodyassociated small vessel vasculitides 35. describe the risk factors, their contribution, pathogenesis, major arteries involved,

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macroscopic and microscopic appearances, sequelae, complications, clinical effects of atherosclerosis. 36. describe the pathogenesis, main contributory factors, macroscopic and microscopic appearance of pulmonary oedema 37. define pulmonary hypertension 38. describe the main causes, complications of pulmonary hypertension 39. describe the pathogenesis ,and complications of pulmonary embolism 40. describe the pathology of a pulmonary infarct

On completion of module M4744B students should be able to: 41. describe the pathogenesis, risk factors, morphology, affected sites of brain and pathological effects in hypoxic and ischemic injury to the brain 42. list the causes of cerebral ischemia 43. describe the causes, risk factors, pathogenesis morphology and clinical features of cerebral infarction including venous infarction 44. list types, causes clinical features and lab investigations of cerebral hemorrhage 45. define terms ‘Encephalitis’ and ‘Meningitis’ 46. describe organisms, route of infection, macroscopy and microscopy, clinical features, complications of bacterial meningitis and cerebral abscess 47. describe tuberculosis, meningitis and syphilitic meningitis 48. list the routes of entry and common organisms and changes seen in brain in viral, fungal and parasitic

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infection of brain. 49. list Central Nervous System infections in immunocompromised patients 50. list primary brain tumours and tumours of peripheral nerves 51. describe pathogenesis, morphology and clinical features of primary and secondary brain tumours 52. list the methods available to detect brain tumours 53. describe types, mechanisms, examples macroscopic appearance of cerebral edema (vasogenic and cytotoxic) 54. define hydrocephalus 55. list the clinical features and systemic effects of raised intracranial pressure 56. list the types cerebral herniation describe macroscopic appearance, clinical features of transtentorial herniation and subfalcine herniation 57. describe the importance of tonsillar herniation

Module Content Module M4744A - Myocardial infarction - Ischaemic heart disease - Pericardial diseases o Acute pericarditis – serous, fibrinous, seropurulent, purulent o Hemorrhagic pericarditis o Adhesive pericarditis o Constrictive pericarditis o Chronic pericarditis o Pericardial tumours - Congenital valvular diseases

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- Rheumatic valvular diseases and rheumatic carditis - Infective endocarditis - Non-infective endocarditis - Myocarditis - Cardiomyopathy - Aneurysms o Dissecting aneurysm o Atherosclerotic aneurysm o Syphilitic aneurysm o Mycotic aneurysm o Cardiac aneurysm - Hypertension o Systemic hypertension o pulmonary hypertension o Malignant hypertension - Vasculitis o Secondary vasculitides o Takayasu’s diseases o Giant cell arteritis o Polyarteritis nodosa o Kawasaki’s disease o Small vessel vasculitides o Wegener’s granulamatosis o Microscopic polyangitis - Atherosclerosis - Pulmonary edema - Pulmonary hypertension

Module M4744B - Hypoxia and ischemic injury of brain - Cerebral ischemia - Brain infarction

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- Intracranial hemorrhage - Encephalitis and meningitis o Bacterial meningitis o Cerebral abscess o Tuberculous and syphilitic meningitis o Viral meningitis o Central Nervous System changes in Human immunodeficiency virus infection - Primary and secondary brain tumours - Tumours of peripheral nerves - Vasogenic cerebral edema - Cytogenic edema - Hydrocephalus - Cerebral herniation o Subfalcine herniation o Tonsillar herniation Teaching and learning Lectures, Tutorials and Practical demonstrations activities Presentations by invited experts Time allocation Lecture 18 hours; Tutorials 4 hours; Demonstrations 3 hours Assessment Continuous Assessment, end of course assessment, 3rd MBBS Part II, SEQs, OSPEs Recommended Reading / - Lecture notes (available in the library) References - Vinay Kumar, Abul Abbas and Jon Aster. Robbins Basic Pathology, 9 ed.: Elsevier Wordmark; 2012. - J. B. Walter. Walter & Israel General Pathology, 7 ed.: Elsivier; 1996.

- Robin Reid Fiona Roberts Elaine MacDuff. Pathology Illustrated, 7 ed. : Churchill Livingstone ; 2011. Coordinating Department Pathology

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Course : 7th Semester of the Medical Course Module No. : M4745 Module Title : A. Endocrine Pathology and B. Pathology of the Respiratory System Prerequisites : Completed the course on Anatomy and Physiology of the endocrine and respiratory systems, completed the module on General Pathology and Tumour Pathology Core / Optional : Core Intended learning On completion of Module M4745A students should be outcomes able to: 1. list the disorders of thyroid function 2. list the causes and clinical features of hyperthyroidism and hypothyroidism 3. describe the pathogenesis and clinical features of Graves disease 4. list the types of thyroiditis 5. list the causes for diffuse enlargement of the thyroid gland, multi nodular goiter, solitary nodule of the thyroid 6. describe the pathogenesis, macroscopy and microscopy of Hashimoto’s thyroiditis 7. list the benign and malignant neoplasms of the thyroid 8. describe the pathology of follicular adenoma 9. describe the macroscopy and microscopy of , the clinical presentation and outcome of the histological types of thyroid carcinoma 10. list the causes of hyper and hypoparathyroidism 11. describe the clinical features and complications of hyper and hypoparathyroidism 12. describe the investigations helpful in the diagnosis and management of hypo and hyperparathyroidism 13. describe the pathogenesis and clinical features of

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congenital adrenal hyperplasia 14. list the causes for excessive secretion of cortisol 15. describe Cushing’s syndrome and list the clinical features and investigations 16. define primary and secondary hyperaldosteronism 17. describe the pathology and clinical features of Addisons disease, pheochromocytoma and neuroblastoma 18. describe multiple endocrine neoplasia syndrome with examples 19. list the causes for hyper secretion of anterior pituitary hormones 20. describe the macroscopy and microscopy of pituitary adenoma

On completion of Module M4745B the students should be able to:

21. describe macroscopic ,microscopic features and complications of acute bronchitis 22. define chronic bronchitis and describe the pathogenesis, predisposing factors, macroscopic, microscopic features and complications 23. define the terms chronic obstructive pulmonary diseaseand asthma 24. describe the pathogenesis, predisposing factors, cells and mediators involved, macroscopic, microscopic features, clinical features and complications of chronic obstructive pulmonary disease (asthma, chronic bronchitis, emphysema, bronchiectasis) - define the term pneumonia - describe the pathogenesis, macroscopic, microscopic features, clinical features and

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sequale of bronchopneumonia, lobar pneumonia and interstitial pneumonia - describe pathological and clinical classification, organisms causing pneumonia - describe the pathogenesis, macroscopic, microscopic features, clinical features and sequale of lobar pneumonia - describe the pathogenesis, macroscopic, microscopic features, clinical features and sequale of acute interstitial pneumonia - describe briefly Severe Acute Respiratory Syndrome (SARS) - describe the macroscopic, microscopic features and sequale of lung abscess - explain the terms “primary and secondary tuberculosis” - describe the pathogenesis, pathological lesions and sequalae of primary tuberculosis - describe the pathogenesis, macroscopic, microscopic features, clinical features modes of spread, diagnostic methods, and sequale of secondary tuberculous - describe histological types, site of occurrence, macroscopic and microscopic features, spread clinical features, diagnostic techniques and staging of lung carcinoma - expain the term lymphangitis carcinomatosa - describe the pathogenesis of pneumoconiosis - describe the pathology of anthracosis, silicosis and asbestosis - describe the pathogenesis, macroscopic , microscopic features of pulmonary oedema

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Module Content Endocrine pathology M4745 - Thyroid gland normal anatomy - Disorders of thyroid function- hyperthyroidism, hyperthyroidism - Grave’s disease - Thyroiditis  Acute thyroiditis  Granulomatous thyroiditis  Autoimmune thyroiditis  Riedel’s thyroiditis - Thyroid goiter - Hashimoto’s thyroiditis - Neoplasms of the thyroid - Thyroid carcinoma - Hypo and hyperparathyroidism - Congenital adrenal hyperplasia - Cushing’s syndrome - primary and secondary hyperaldosteronism - Addisons disease - pheochromocytoma and neuroblastoma - multiple endocrine neoplasia syndrome - abnormal secretion of anterior pituitary hormones - pituitary adenoma

Pathology of the respiratory systemM4745 - Acute bronchitis  Organism causing acute bronchitis  Microscopic and macroscopic features of acute bronchitis  Complications of acute bronchitis - Chronic bronchitis - Chronic obstructive pulmonary disease - Asthma

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- Bronchiectasis - Emphysema - Pneumonia  Lobar and broncho pneumonia  Acute interstitial pneumonia - Severe Acute Respiratory Syndrome - Lung abscess - Primary and secondary tuberculosis - Lung tumours  Benign tumours  Histological types of lung carcinoma - Lymphangitis carcinomatosa - Pneumoconiosis - Anthracosis - Silicosis - Pulmonary edema Teaching and learning Lectures, Tutorials and Practical demonstrations activities Presentations by invited experts Time allocation Lecture 16 hours; Tutorials 3 hours; Demonstrations 2 hours Assessment Continuous Assessment, end of course assessment, 3rd MBBS Part II, SEQs, OSPEs Recommended Reading / - Lecture notes (available in the library) References - Vinay Kumar, Abul Abbas and Jon Aster. Robbins Basic Pathology, 9 ed.: Elsevier Wordmark; 2012. - J. B. Walter. Walter & Israel General Pathology, 7 ed.: Elsivier; 1996. - Robin Reid Fiona Roberts Elaine MacDuff. Pathology Illustrated, 7 ed. : Churchill Livingstone ; 2011. Coordinating Department Pathology

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Course : 8th Semester of the Medical Course Module No. : M4852 Module Title : A. Chemical Pathology and B. Renal Pathology Prerequisites : Completed the course on Anatomy and Physiology of the genito urinary tract, completed the modules on general Pathology and Renal Pathology Core / Optional : Core Intended learning On completion of Module M4852A students should be able outcomes to: - describe and interpret the laboratory tests performed at the diagnosis, follow up and during management of complications of diabetes mellitus - describe the biochemical and hormonal changes that occur in the following conditions – hyperthyroidism, hypothyroidism, subclinical hypothyroidism, Graves disease, acromegaly,, Cushings syndrome, Addisons disease, diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion - explain the procedure and evaluate the results of the following tests- glucose suppression test, Synacthen test, dexamethasone suppression test, water deprivation test - differentiate the laboratory findings in cranial diabetes insipidus from nephrogenic diabetes insipidus - describe the biochemical changes occurring in a normal pregnancy and the biochemical changes involved in gestational diabetes and liver disease in pregnancy - interpret the results of biochemical tests done to establish the above abnormalities - list the causes of male and female infertility and list the biochemical markers useful in identifying the cause of female infertility - interpret the test results in the diagnostic work up of female infertility

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- list the various tumour markers and indicate the diseases associated with them - describe tumour lysis syndrome - describe diagnostic and prognostic implications of biochemical features associated with acute and chronic pancreatitis

On completion of Module M4852 B students should be able to: - list the common congenital anomalies and cystic diseases of the kidney and describe briefly the pathology - describe the predisposing factors, aetiology, pathogenesis, pathology clinical features and complications of acute and chronic pyelonephritis - list the types of primary glomerulonephritis and describe the aetiology, clinicopathological effects macroscopy and microscopy(light and electron) of acute proliferative glomerulonephritis and rapidly progressive glomerulonephritis - list the causes and describe the clinical response to glomerular injury in nephritic and nephrotic syndromes

- describe clinicopathological effects of chronic glomerulonephritis - describe the pathology of the glomerular changes in the secondary glomerular diseases - hypertension, diabetes mellitus,Systemic lupus erythematosus - list the common renovascular diseases and describe the pathology of the renal lesions caused - list the common causes of urinary tract obstruction - describe predisposing factors , pathogenesis and morphology and biochemistry of different types of urolithiasis - discuss the complications of urolithiasis

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Module Content Module M4852A - Chemical Pathology in endocrine diseases o diabetes mellitus o Pituitary hypothalamic axis and trophic hormones for pituitary o thyroid disorders, o growth hormone disorders, o adrenal failure o Cushing disease/syndrome o cranial and nephrogenic diabetes insipidus o syndrome of inappropriate antidiuretic hormone secretion o poly cystic ovarian disease - Chemical pathology in obstetrics and gynaecology o Biochemistry of normal and abnormal pregnancy o pregnancy related complications- diabetes and liver disease o Tumour markers of ovarian malignancy o male and female infertility - Chemical pathology for surgery o acute and chronic pancreatitis o Tumour markers associated with hepatocellular carcinoma, prostate carcinoma, gastrointestinal, thyroid and germ cell tumours, and their clinical importance Module M4852 B (renal pathology) - Pathology and inheritance of the following cystic diseases o Adult polycystic kidney disease o Infantile polycystic kidney disease - Infections of the kidney and urinary bladder o Acute pyelonephritis o Chronic pyelonephritis

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o Tuberculous pyelonephritis o Cystitis - Primary glomerular diseases o Minimal change glomerulonephritis o Rapidly progressive glomerulonephritis o Membranoproliferative glomerulonephritis o Membranous glomerulonephritis o Focal segmental glomerulo sclerosis o IgA nephropathy o chronic glomerulonephritis - Secondary glomerular diseases o glomerular lesions in benign and malignant hypertension o benign nephrosclerosis o renal lesions in diabetes mellitus and Systemic lupus erythematosus o renal lesions in amyloidosis - Renal vascular lesions o renal artery stenosis o renal infarction - Urolithiasis o obstructive uropathy o urolithiasis o urolithiasis - Tumours o Renal cell carcinoma o Nephroblastoma o Transitional cell carcinoma of the bladder

Teaching and Lectures, small group discussion and Practical demonstrations learning activities Presentations by invited experts Time allocation Lecture 20 hours; Tutorials 3 hours; Demonstrations 2 hours Assessment Continuous Assessment, end of course assessment, 3rd MBBS

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Part II, SEQs, MCQ, OSPEs Recommended - Lecture notes (available in the library) Reading / References - Vinay Kumar, Abul Abbas and Jon Aster. Robbins Basic Pathology, 9 ed.: Elsevier Wordmark; 2012.

- J. B. Walter. Walter & Israel General Pathology, 7 ed.: Elsivier; 1996.

- Praveen Kumar, Michal Clark. Kumar andClark Clinical Medicine 9th Edition, Elsivier Coordinating Pathology Department

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Course : 8th Semester of the Medical Course Module No. : M4853 Module Title : Haematology and lymphoreticular system Prerequisites : Completed the course on Anatomy and Physiology of blood and the reticuloendothelial system Core / Optional : Core Intended learning On completion of the module students should be able to: outcomes 1. recall haemopoiesis (erythropoiesis, granulopoiesis, thrombopoiesis and lymphopoiesis)- the sites, growth factors involved and their various clinical uses, processes with different stages and cells involved, investigations performed to study its abnormalities 2. recall the clinical features of anaemia and describe the adaptive responses to anaemia and morphological classification of anaemia 3. recall metabolism, dietary sources, stages and progression, mode of presentation and all changes involved in the red

cells in iron, vitamin B12 and folate deficiency 4. discuss the approach to diagnosis and principles of treatment of above deficiencies 5. discuss the differential diagnoses of hypochromic microcytic and macrocytic anaemia 6. describe the mode of inheritance, biochemical basis, clinical and laboratory features and treatment approaches to hereditary haemolytic anaemias and haemoglobinopathies 7. describe pathophysiology of haemolysis and discuss the laboratory features of acquired immune and non immune haemolytic anaemia 8. formulate a diagnostic work up for a patient presenting with haemolysis 9. describe the benign and malignant white cell disorders including their pathogenesis, clinical features and

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laboratory features 10. list the causes of pancytopenia and describe aetiology, investigations and management approach of aplastic anaemia 11. discuss the differential diagnoses of polycythaemia and thrombocytosis 12. describe the pathogenesis, clinical and laboratory manifestations, the natural history of chronic myeloproliferative disorders and current approaches to therapy 13. define paraproteinaemia and discuss the differential diagnoses 14. describe the pathology, clinical features and laboratory diagnosis, radiological features, diagnostic approach and treatment outline of multiple myeloma 15. describe the clinical presentation, methods of diagnosis and principles of treatment of hereditary and acquired bleeding disorders 16. state the blood products, their constituents and storage requirements and give a brief description on preparation 17. discuss the use of safe blood transfusion practices including the detection of transfusion reactions and approaches to management 18. describe the patterns of reactive changes in lymph nodes and give examples for each pattern 19. compare and contrast lymphoma and leukaemia 20. state the classification of Hodgkin Lymphoma, describe the basic histological features of Hodgkin Lymphoma and describe AnnArbor staging for Hodgkin Lymphoma 21. discuss the prognosis of each histological type of Hodgkin Lymphoma 22. outline the different systems used to classify Non-Hodgkin Lymphoma (details not necessary)

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23. list the differences between Hodgkin Lymphoma and Non- Hodgkin Lymphoma 24. describe how a lymph node biopsy should be sent to the laboratory for histology Module Content Haemopoiesis Anaemia- Definition, adaptive responses, clinical features, morphological classification and diagnostic approach Red cell abnormalities leading to anaemia - Deficiency anaemias (iron, vitamin B12, folate) - Haemolytic anemias(hereditary and acquired) - Haemoglobinopathies(thalassaemias and sickle cell anaemia) White cell abnormalities - neutrophilia, neutropenia, eosinophilia, monocytosis, lymphocytosis - The acute leukaemias - The chronic leukaemias - Pancytopenia and aplastic anaemia Myeloproliferative disorders - Primary Polycythaemia - Chronic myeloid leukaemia - Essential thrombocythaemia - Myelofibrosis Paraproteinaemia and multiple myeloma - Definition and causes of paraproteinaemia - multiple myeloma Bleeding disorders - The principles on tests for defects in the intrinsic, extrinsic and final common pathway of blood coagulation and laboratory work up of investigation of a bleeder - clinical manifestations, laboratory diagnosis and principles of management will be taught on the following diseases

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1. Immune thrombocytopenic purpura 2. Abnormal platelet function 3. Haemophilia A and B 4. VonWillebrand disease 5. Disseminated intravascular coagulation - Effects of vitamin K deficiency and liver disease on coagulation The following topics will be covered for Transfusion Medicine - Types of blood products, the preparation and their storage requirements, indications and dosage of transfusion products and the importance of cross matching - Identifying a transfusion reaction by clinical and lab features, management and prevention of transfusion reactions The following topics will be presented on the lymphoreticular system - Causes of generalized lymphadenopathy - Histological patterns of acute and chronic reactive lymphadenitis - Classification, histological criteria, staging and prognosis of Hodgkin lymphoma - Classification basic histological criteria of common forms and staging of non Hodgkin lymphoma

Teaching and Lectures, Tutorials and Practical demonstrations learning activities Presentations by invited experts

Time allocation Lecture 20 hours; Tutorials 7 hours; Demonstrations 4 hours

Assessment Continuous Assessment, end of course assessment, 3rd MBBS Part II, SEQs, OSPEs

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Recommended - Lecture notes (available in the library) Reading /

References - Vinay Kumar Abul Abbas Jon Aster. Robbins Basic Pathology, 9 ed.: Elsevier Wordmark; 2012.

- A. V. Hoffbrand, J. E. Pettit, P. A. H. Moss. Essential Haematology. : Wiley; 2001. Coordinating Pathology Department

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Course : 8th Semester of the Medical Course Module No. : M4854 Module Title : Breast Pathology, Pathology of the Male and Female Reproductive Tracts Prerequisites : Completed the course on Anatomy and Physiology of the Breast and Male and Female Reproductive Tracts, completed modules on general pathology and tumour pathology Core / Optional : Core Intended learning On completion of the module students should be able to: outcomes 1. list the congenital abnormalities of the breast 2. describe the pathogenesis and morphology of the inflammatory conditions of the breast 3. describe the morphology and the factors contributing to fibrocystic disease of the breast 4. describe the features of epithelial hyperplasia and discuss its significance 5. describe the pathological features of duct papilloma 6. describe the pathological features of in–situ-carcinoma of the breast 7. describe the macroscopy and microscopy of invasive ductal and lobular carcinoma 8. name other types of breast carcinoma 9. describe the clinical features, macroscopy and microscopy of Paget’s disease of the breast 10. describe the underlying pathology of Peau d’ orange appearance of the breast 11. describe the spread of breast carcinoma 12. describe the significance of hormone receptors in the treatment of breast carcinoma 13. describe the macroscopy and microscopy of the stromal tumours- fibroadenoma and phylloides tumour 14. discuss the types of biopsies performed in a patient with a breast lump

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15. describe the inflammatory conditions and tumours (benign and malignant) arising from the ureter 16. list the causes of obstruction of the ureter 17. briefly describe the congenital abnormalities of the urinary bladder 18. describe the predisposing factors, macroscopy and microscopy, clinical features and aetiological agents of cystitis 19. describe the aetiology, clinical features, macroscopy and microscopy and spread of transitional carcinoma of the bladder 20. briefly describe the WHO grading of urothelial neoplasias 21. describe the pathogenesis, macroscopy and microscopy, clinical features and complications of benign prostatic hyperplasia 22. describe the term prostatic intra epithelial neoplasia 23. list the aetiological factors for carcinoma of the prostate 24. describe the macroscopy and microscopy, staging, clinical features, outcome and spread of carcinoma of prostate 25. list the causes of testicular enlargement 26. briefly describe clinical features and pathology of acute epididymo-orchitis and tuberculous epididymo-orchitis 27. classify testicular neoplasia and list the tumour markers useful in the diagnosis 28. describe clinical manifestations, macroscopy and microscopy and the complications of testicular neoplasia 29. briefly describe chronic vulval dystrophies, inflammatory conditions of the vulva, vulval intraepithelial neoplasia and squamous cell carcinoma of the vulva 30. describe the pathogenesis, morphology of (all 3 grades)cervical intraepithelial neoplasia(CIN) and discuss the importance of screening for detection of cervical intraepithelial neoplasia

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31. describe clinical features, risk factors, morphology and spread of cervical carcinoma 32. give brief descriptions of morphology and clinical features of adenomyosis, endometriosis, endometrial hyperplasia 33. describe the clinical features and pathology of endometrioid adenocarcinoma 34. describe the pathological features of leiomyoma and leiomyosarcoma 35. list the cystic diseases of ovary and describe the clinical features, morphology and hormonal changes of polycystic ovarian syndrome 36. classify ovarian tumours according to the tissue of origin 37. describe the pathological features of surface epithelial tumours and germ cell tumours 38. describe the morphology of gestational trophoblastic tumour (complete, partial, invasive) 39. briefly describe the pathological features of choriocarcinoma Module Content inflammatory diseases of the breast fibrocystic changes of the breast tumors of the breast - carcinoma-in-situ - invasive ductal and lobular carcinoma - Pagets disease of the breast - Stromal tumors of the breast inflammatory conditions and tumours (benign and malignant) arising from the ureter congenital abnormalities of the urinary bladder cystitis transitional carcinoma of the bladder benign prostatic hyperplasia describe the term prostatic intra epithelial neoplasia carcinoma of the prostate

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list the causes of testicular enlargement acute epididymo-orchitis and tuberculous epididymo-orchitis testicular neoplasms Pathology of vulva - Chronic vulval dystrophies - Inflammatory conditions - Vulval intra epithelial neoplasia - Squamous cell carcinoma Pathology of cervix - Cervical intraepithelial neoplasia - Pap smear - Squamous cell carcinoma Pathology of the uterus - Endometritis - Adenomyosis - Endometriosis - Endometrial hyperplasia - Endometrioid adenocarcinoma - Leiomyoma - Leiomyosarcoma Pathology of the ovary - Non neoplastic cysts - Polycystic ovarian disease - Surface epithelial tumours (benign, border line, malignant) - Dysgerminoma - Teratoma (mature, immature) - Brenner tumour (benign, border line, malignant) Diseases of pregnancy - Gestational trophoblastic tumour - Complete hydatidiform mole, partial hydatidiform mole, invasive mole

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- Choriocarcinoma Teaching and Lectures, Tutorials and Practical demonstrations learning activities Presentations by invited experts Time allocation Lecture 12 hours; Tutorials 3 hours; Demonstrations 3 hours Assessment Continuous Assessment, end of course assessment, 3rd MBBS Part II, SEQs, OSPEs Recommended - Lecture notes (available in the library) Reading / References - Vinay Kumar Abul Abbas Jon Aster. Robbins Basic Pathology, 9 ed.: Elsevier Wordmark; 2012.

- Robin Reid Fiona Roberts Elaine MacDuff. Pathology Illustrated, 7 ed. : Churchill Livingstone ; 2011. Coordinating Pathology Department

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6.5.6 Community Medicine

Course : 5th Semester of the Medical Course Module No. : M3527 Module Title : Demography Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. define the term Demography 2. list and describe the sources of demographic data in Sri Lanka 3. describe the basic measures in demography 4. list, define and calculate the fertility measures and mortality measures used in demography 5. describe the concept of population growth and compare growth rates of different countries 6. define and describe the terms “Demographic transition”, “Age dependency ratio”, “Demographic dividend” and “Life Expectancy” 7. describe the fertility transition and demographic transition in Sri Lanka in terms of reasons and its implications 8. critically appraise the validity of demographic data of different sources in Sri Lanka Module Content The “Demography” module covers the following topics. - Introduction to demography - Age structure and population transition - Fertility and mortality - Life expectancy and quality of life - Migration and health - Urbanization and health - Special populations Teaching and Lectures learning activities Small group discussions

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Tutorials Online learning Time allocation Lectures 14 hours; Tutorials 2 hour Assessment Formative assessments 1. Assignments 2. OSPHE 3. Online/offline quizzes Summative assessments 1. Theory - 1 hour paper 2. Clerkship programme - OSPHE Recommended - Ageing Population in Sri Lanka: Issue and Future Reading / Prospects, Colombo, UNFPA Publication: 7-43. (2004) References - Demographic and Health Survey 2006/7 - Census of Population and Housing 2012 - Final Report - Park, K. "Park's textbook of preventive and social medicine." (2007) Coordinating Community Medicine Department

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Course : 5thSemester of the Medical Course Module No. : M3528 Module Title : Introduction to Biostatistics Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. describe a data set using descriptive statistics 2. summarize and present data using measures of central tendency and measures of dispersion 3. apply basic inferential statistical methods and draw conclusions from such analysis 4. critically appraise the statistical analysis in the scientific literature Module Content The “Introduction to Biostatistics” module covers the following topics. - Type of data - Variables - Summarization and presentation of data - Measures of central tendency - Measures of dispersion - Normal Distribution, Standard Normal Distribution and Z test - Sampling - Significance testing and inferential statistics Teaching and Lectures learning activities Small group discussions Tutorials Online learning Time allocation Lectures 13 hours; Tutorials 4 hours Assessment Formative assessments 1. Assignments 2. OSPHE 3. Online/offline quizzes

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Summative assessments 1. Theory - 1 hour paper 2. Clerkship programme - OSPHE Recommended - Statistics at Square One, 11th Edition. Michael J. Reading / Campbell, T. D. V. Swinscow. 2010, BMJ Books References - Principles of Epidemiology in Public Health Practice, 3rd Edition. An Introduction to Applied Epidemiology and Biostatistics, Centers for Disease Control and Prevention (CDC), Atlanta, GA - Epidemiology in Medicine by Charles H. Hennekens, Julie Buring - Basic Epidemiology 2nd Edition (Bonita R, Beaglehole R, Kjellstrom T), World Health Organization Coordinating Community Medicine Department

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Course : 6th Semester of the Medical Course Module No. : M3640 Module Title : Maternal and Child Health Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. describe the concept of safe motherhood and discuss the importance of provision of maternal care at different stages in pregnancy 2. describe the classification, epidemiology, investigation and prevention of maternal deaths and discuss its impact to family and community 3. describe the concepts of “Early Childhood Care and Development”, “Infant and Young Child Feeding”, “Growth Monitoring and Promotion”, immunization in relation to maternal and child health programme in Sri Lanka 4. discuss the current health status of the maternal and child health in Sri Lanka and discuss the future challenges to be met 5. discuss sexual and reproductive health as a means of providing a continuum of care during the life cycle of individuals and discuss the role of gender with regard to reproductive health 6. discuss biological/social factors related to family planning and acquire knowledge, skills and attitudes to conduct family planning counseling 7. describe the Sri Lankan school health programme, the concept of health promoting school and discuss how the school child can be utilized to enhance health of the community 8. describe the current health status and future challenges of adolescents in Sri Lanka

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9. critically evaluate the services provided by the National Family Health Programme, Sri Lanka 10. apply the knowledge and skills acquired in relation to maternal and child health to promote the health of an allocated family Module Content The “Maternal and Child Health” module covers the following topics. - Maternal and Child Health in global agenda - Introduction to Family Health Programme - Safe Motherhood - Maternal care - Maternal mortality - Newborn care - Infant and young child feeding - Growth Monitoring and Promotion - Early Childhood Care and Development - Sexual and reproductive health - Family planning - Gender and health - Health of school children - Adolescent health Teaching and Lectures learning activities Small group discussions Tutorials Online learning Time allocation Lectures 28 hours; Tutorials 4 hours Assessment Formative assessments 1. Assignments 2. OSPHE 3. Online/ offline quizzes Summative assessments 1. Theory - 2 hour paper 2. Family study - project report and viva voce

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3. Clerkship programme - OSPHE Recommended - Maternal care package –A guide to Field Healthcare Reading / workers – FHB, 2011 References - National Guidelines for Maternal Care - Ministry of Health, 2013 - Breast Feeding Counseling: A Training Course – WHO 1993 - Training Manual on Integrated Early Childhood Care and Development – GOSL, UNICEF, 2004 - Decision Making Tool for Family Planning Clients and Providers – WHO, 2005 - Family Planning Counseling: Training Manual – UNFPA, 2007 Coordinating Community Medicine Department

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Course : 6thSemester of the Medical Course Module No. : M3641 Module Title : Basic Epidemiology Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. describe the concept of epidemiology 2. discuss probable sources of error and methods of minimizing errors in such data 3. describe and be able to compute measures of disease frequency 4. describe and calculate measures of risk of exposure 5. state the principles underlying and the application of different study designs 6. describe the concepts of measurement of test performance of screening tests 7. describe the basic epidemiological concepts in establishing causation 8. critically appraise the epidemiological methods in the scientific literature Module Content The “Basic Epidemiology” module covers the following topics. - Introduction to epidemiology - Measures of disease frequency - Measures of association - Observational studies - Experimental studies - Errors in epidemiological studies - Causation - Screening - Introduction to clinical epidemiology Teaching and Lectures

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Medical curriculum 2016 learning activities Small group discussions Tutorials Online learning Time allocation Lectures 14 hours; Tutorials 2 hours Assessment Formative assessments 1. Assignments 2. OSPHE 3. Online/offline quizzes Summative assessments 2. Theory - 1 hour paper 3. Clerkship programme - OSPHE Recommended - Principles of Epidemiology in Public Health Practice,3rd Reading / Edition. An Introduction to Applied Epidemiology and References Biostatistics, Centers for Disease Control and Prevention (CDC), Atlanta, GA - Basic Epidemiology 2nd Edition (Bonita R, Beaglehole R, Kjellstrom T), World Health Organization - British Medical Journal -Epidemiology series Articles 1- 12 - Methods in Epidemiologic Research, 1st edition (Ian Dohoo, Wayne Martin and Henrik Stryhn) - Epidemiology in Medicine by Charles H. Hennekens, Julie Buring Coordinating Community Medicine Department

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Course : 6th Semester of the Medical Course Module No. : M3642 Module Title : Public Health in Practice I (Family Study) Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. use clinical knowledge and skills to identify diseases, health related issues and risk factors in individuals in the allocated families 2. acquire knowledge and skills to assess causation, complications, management and prevention of identified issues 3. practically involve in management of the identified diseases or risk factors 4. acquire knowledge and skills and use them for prevention of diseases and risk factors in individuals 5. promote health of each family member and the family unit using concepts and principals of public health and primary healthcare 6. use life cycle approach and care provided by public health services during specific stages of lifecycles to promote health of the allocated family. 7. develop learning skills on self-studying, abstracting relevant and reliable information for evidence based practices, and using technology for learning purposes. 8. develop skills on communication and counseling, creativity, team work, leadership and scientific writing. 9. respect different attitudes, views, cultural and social norms of people and working together within ethical framework, empowering and facilitating them to achieve health goals.

Module Content The “Public Health in Practice module I” addresses following important public health aspects. - Maternal care including antenatal, intra natal and post natal

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care - Child Health - Adolescent Health - Elderly care - Occupational Health - Environmental Health - Communicable Disease Prevention - Non Communicable Disease Prevention - Health Promotion Teaching and Small group discussions learning activities Direct supervision by facilitators Field work Time allocation Field work 96 hours; Small Group Discussions 24 hours Assessment Formative assessments - Activity plans for family visits - Quarterly Progress reports Summative assessments - Family study; project report and viva voce Recommended All relevant material in other Community Medicine modules Reading / References Coordinating Community Medicine Department

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Course : 7th Semester of the Medical Course Module No. : M4746 Module Title : Applied Epidemiology and Communicable Diseases Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. apply basic epidemiological tools in practice 2. describe complex interactions between man, agent and the environment in disease causation 3. describe the four levels of prevention 4. describe the principles of communicable disease prevention 5. describe the steps, procedure and analysis of outbreak investigation in communities 6. describe the principles of infectious disease surveillance system and identify the disease surveillance system in Sri Lanka 7. list the important communicable diseases in the world, region and in Sri Lanka 8. describe the epidemiology of specific communicable diseases of public health relevance in the world, region and in Sri Lanka 9. describe the national programmes available for the prevention and control of communicable diseases in Sri Lanka 10. discuss the application of principles of applied epidemiology for effective control/prevention of specific communicable diseases of public health relevance Module Content The “Applied Epidemiology and Communicable Diseases” module covers the following aspects. - Epidemiological triad and principals of disease prevention - Principles of communicable disease prevention - Outbreak investigation - Disease surveillance - One health approach in epidemiology - Health in emergencies - Epidemiology, prevention and control ofDengue, Leptospirosis, Typhus, Typhoid, Leishmaniasis, Vaccine

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preventable diseases, Leprosy, Cholera, Tuberculosis, Malaria, Sexually Transmitted Infections (STI), Emerging and reemerging infectious diseases Teaching and Lectures learning activities Small group discussions Tutorials Online learning Time allocation Lectures 14 hours; Tutorials 2 hours Assessment Formative assessments 1. Assignments 2. OSPHE 3. Online/ offline quizzes Summative assessments 1. Theory - 1 hour paper 2. Family study - project report and viva voce 3. Clerkship programme - OSPHE Recommended - Principles of Epidemiology in Public Health Practice,3rd Reading / Edition. An Introductionto Applied Epidemiology and References Biostatistics, Centers for Disease Control and Prevention (CDC), Atlanta, GA - Basic Epidemiology 2nd Edition (Bonita R, Beaglehole R, Kjellstrom T), World Health Organization - Methods in Epidemiologic Research, 1st edition (Ian Dohoo, Wayne Martin and Henrik Stryhn) - Web sites of individual campaigns - Annual reports of special campaigns - Annual Health Bulletin Coordinating Community Medicine Department

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Course : 7th Semester of the Medical Course Module No. : M4747 Module Title : Non-Communicable Disease Epidemiology Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. describe the classification of non-communicable diseases 2. list the important non-communicable diseases in the world, region and in Sri Lanka 3. describe the epidemiology of specific non-communicable diseases and important risk factors of public health relevance in the world, region and in Sri Lanka 4. describe the national programmes available for the prevention of non-communicable diseases in Sri Lanka 5. discuss the application of principles of applied epidemiology for effective prevention of specific non- communicable diseases of public health relevance 6. apply the knowledge to control and prevent relevant non- communicable diseases in an allocated family Module Content The “Non Communicable Disease Epidemiology” module covers the following topics. - Chronic Non Communicable Diseases Cancer epidemiology: breast, cervical, bronchial and oral cancers Cardio vascular diseases Diabetes Mellitus Chronic renal diseases Chronic respiratory diseases - Acute Non Communicable Diseasess - Mental health - National Non Communicable Diseases programme

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- Non Communicable Disease surveillance - Alcohol and tobacco Teaching and Lectures learning activities Small group discussions Tutorials Online learning Time allocation Lectures 14 hours; Tutorials 2 hours Assessment Formative assessments 1. Assignments 2. OSPHE 3. Online/ offline quizzes Summative assessments 1. Theory - 1 hour paper 2. Family study - project report and viva voce 3. Clerkship programme – OSPHE Recommended - Global status report non communicable diseases-2010 Reading / - Scaling up action against non communicable diseases: References How much will it cost? WHO - WHO report on global tobacco epidemic 2011 - Brief profile on tobacco control in Sri Lanka-ministry of Health Care and Nutrition - Prevention and control of selected NCDs in Sri Lanka- Policy Options and Action. 2010. - Michael Engelgau, Kyoko Okamoto, Kumari Vinodhani Navaratne and Sundararajan Gopalan. - WHO. Diet, Physical Activity and Health. Geneva: World Health Organization, 2002 - Low- and Middle-Income Countries From Burden to “Best Buys”: Reducing the Economic Impact of Non- Communicable Diseases Coordinating Community Medicine Department

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Course : 7thSemester of the Medical Course Module No. : M4748 Module Title : Community Nutrition Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. describe the concepts of nutrition, healthy diet and dietary reference intakes 2. describe the direct and indirect methods used for nutritional assessment at individual level and population level 3. describe the concepts of malnutrition, double burden of malnutrition 4. describe the classification, epidemiology and public health significance of macronutrient malnutrition in Sri Lanka 5. critically discuss the causative factors of malnutrition in the Sri Lankan context 6. describe the magnitude, distribution and public health significance of micronutrient deficiencies in Sri Lanka 7. discuss the necessity and the contents of National Nutrition Policy of Sri Lanka 8. discuss the health and non-health interventions for malnutrition in Sri Lanka 9. conduct nutritional assessment and plan for appropriate nutritional interventions of an allocated family Module Content The “Community Nutrition” module covers the following topics. - Basic concepts in nutrition - Food Based Dietary Guidelines - Nutritional assessment - Malnutrition: Classification, Prevalence, Causes, Implications - Micronutrient deficiencies

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- National Nutrition Policy - Nutritional interventions – health and non health

Teaching and Lectures learning activities Small group discussions Tutorials Online learning Time allocation Lectures 14 hours; Tutorials 2 hours Assessment Formative assessments 1. Assignments 2. OSPHE 3. Online/ offline quizzes Summative assessments 1. Theory - 1 hour paper 2. Family study - project report and viva voce 3. Clerkship programme - OSPHE Recommended 1. Food Based Dietary Guidelines -Nutrition Division, Reading / Ministry of Health References 2. National Nutrition Policy -Ministry of Health. 3. Desk Review on Nutrition Surveys 2006-2011 - Nutrition Co ordination Division/UNICEF 4. Maternal care package –A guide to Field Healthcare workers - FHB 2011 5. Guidelines for NCD prevention -Ministry of Health. 6. Demographic and Health Survey (DHS) 2006-07. 7. Assessment of Anaemia Status in Sri Lanka – MRI. 8. Management of severe under nutrition- Manual for health workers in Sri Lanka- Ministry of Health 2007 Coordinating Community Medicine Department

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Course : 8thSemester of the Medical Course Module No. : M4855 Module Title : Occupational and Environmental Health Prerequisites : Core / Optional : Core Intended To be able to, learning 1. discuss the basic concepts of occupational health; hazard, risk, outcomes risk assessment and control and prevention 2. describe the classification and adverse health effects of different occupational hazards 3. discuss the methods available for hazard control and prevention 4. describe the occupational health related legislature in Sri Lanka 5. describe the occupational health services available in Sri Lanka 6. critically discuss the occupational hazards and preventive and control measures adopted in a work setting 7. describe the basic concepts in environmental health 8. describe the legislation and programmes available for prevention of environmental pollution 9. apply the knowledge to identify the occupational and environmental health problems of the members of an allocated family Module The module covers following topics. Content - Basic concepts in occupational health - Healthy work place - Legislations and programmes to improve health in working places - Basic concepts in environmental health - Environmental pollutants - Control and prevention of air, water, soil and noise pollution - Legislations and programmes to prevent environmental pollution Teaching Lectures and learning Small group discussions

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Medical curriculum 2016 activities Tutorials Online learning Time Lectures 14 hours; Tutorials 2 hours allocation Assessment Formative assessments 1. Assignments 2. OSPHE 3. Online/ offline quizzes Summative assessments 1. Theory - 1 hour paper 2. Family study - project report and viva voce 3. Clerkship programme – OSPHE Recommend - David Koh, Chia Kee Seng. Textbook of Occupational Medicine Practice, 2 ed. : World Scientific. ed Reading /

References - Harvey Checkoway, Neil E. Pearce, and David Kriebe. Research Methods in Occupational Epidemiology: World Scientific.

- Agudelo-Suárez AA, Ronda-Pérez E, Benavides FG. Occupational health. In: Migration and health in the European Union [Internet]. 2011 . Available from: http://www.who.int/occupational_health/regions/en/oehemhealthc areworkers.pdf

- MedicineJoseph LaDou.Current Occupational and Environmental: McGraw Hill Medical, 4th edition, 2007.

- Robert J. McCunney Paul P. Rountree , Cheryl S. Barbanel . A Practical Approach to Occupational and Environmental Medicine, 3 ed. Singapoore: World Scientific; 2003.

- Linda Rosenstock Mark Cullen Carl Brodkin Carrie Redlic. Textbook of Clinical Occupational and Environmental Medicine. : Saunders; 2004

Coordinating Community Medicine Department

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Course : 8th Semester of the Medical Course Module No. : M4856 Module Title : Public Health in Practice II (Clerkship Programme) Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. describe the hierarchy of public health system in Sri Lanka 2. describe the roles and responsibilities of a Medical Officer of Health (MOH) and to appraise the functions, roles and responsibilities of other health care professionals in Public health filed practice 3. incorporate the theoretical knowledge on 4. public health to critically appraise public health issues in the field practice area 5. critically appraise public health programmes and 6. the work of public health workers as the major force of health of the community 7. develop a plan of action to address a given public health problem based on the available resources in the field practice area 8. conduct health promotion programmes for a given target population on identified priority health issues 9. develop skills on peer learning and inter professional learning Module Content The “Public Health in Practice II” module includes following field visits/appointments/lecture discussions. - Medical Officer of Health Office - Supervisory Public Health Inspector, Supervisory Public Health Nursing Sister, Supervisory Public Health Midwife - Public Health Midwife - Public Health Inspector - Regional director of health service office / Regional Epidemiologist/Medical Officer -Maternal and Child Health

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- Field polyclinic - Well Woman Clinic - School health programme - Medical registrar - Food sanitation (with Public Health Inspector) - Water Purification - Factory visit - Home for the Elders - Care of the disabled - Medical Statistics Unit - Divisional Hospital - Research methodology workshop - Journal club - Epidemiological study Teaching and Field work learning activities Lectures Small group discussions Time allocation Lectures 40 hours; Field work 40 hours Assessment Formative assessments - Group presentations - Health promotion programmes - OSPHE Summative assessments - Clerkship programme - OSPHE Recommended All relevant material in other Community Medicine modules Reading / References Coordinating Community Medicine Department

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Course : 8th Semester of the Medical Course Module No. : M4857 Module Title : Public Health in Practice III Prerequisites : Core / Optional : Core Intended learning To be able to, outcomes 1. describe the concepts of health, primary health care and health promotion 2. describe the concept of social determinants of health and discuss the implications of SDH in promoting health 3. describe the basic concepts in public health ethics 4. critically discuss the MIS in Sri Lanka 5. describe the basic concepts in health economics 6. describe the role of public health in special situations/disaster management Module Content The Public Health in Practice module covers the following topics. - Primary health care and Health - Social determinants of health - Public health ethics - Health systems and healthcare management - Planning, monitoring and evaluation in public health - Public health in special situations/disaster management - Management Information System and International Classification of Diseases - Health economics - Overview of public health programmes in Sri Lanka Teaching and Lectures learning activities Small group discussions Tutorials Online learning Time allocation Lectures 14 hours; Tutorials 2 hours Assessment Formative assessments

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- Assignments - OSPHE - Online/ offline quizzes Summative assessments - Theory - 1 hour paper - Family study - project report and viva voce - Clerkship programme - OSPHE Recommended - The Ottawa Charter for Health Promotion Reading / - Draft Sri Lanka National Health Promotion Policy References - Health Education Bureau: Services - Environmental Health in Emergencies and Disasters - Practical Guide – WHO. - Humanitarian Charter and Minimum Standards in Humanitarian Response – Sphere Project Handbook 2011. Coordinating Community Medicine Department

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6.6 Structure of the Clinical academic programme

6.6.1 Medicine

Broad learning Outcomes

At the end of Medicine appointment students should be able to

1. obtain a relevant history in order to compose a rational differential diagnosis, with the intention of selecting appropriate diagnostic tool, and manage accordingly 2. communicate effectively with patient’s families, colleagues and others. 3. demonstrate a commitment to research, adopt evidence based practice, and demonstrate ability to retrieve, manage and utilize biomedical information for solving problems 4. recognize the need for multidisciplinary involvement when necessary 5. demonstrate the qualities required to sustain lifelong learning 6. carry out professional responsibilities with adherence to ethical principles and an understanding of the legal implications of practice 7. function as a team member and a leader in an inter professional team to provide safe and effective patient care

Learning outcomes of 1st Medicine appointment To demonstrate basic ability in history taking and examinations, knowledge regarding management of common medical problems.

Learning outcomes of 2ndand 3rd Medicine appointment To demonstrate ability in comprehensive history taking, examination, interpretation and planning of the management of basic medical problems

Learning outcomes of Professorial Medicine appointment To be competent in management of medical problems and medical emergencies

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Learning outcomes Cardiology appointment be able to take a complete history describe the clinical features, complications, sequale, investigations andplan of management for common cardiological conditions.

Learning outcomes Respiratory appointment be able to take a complete history describe the clinical features, complications, squeal, investigations and plan of management for respiratory diseases.

Learning outcomes Neurology appointment be able to take a complete history describe the clinical features, complications, squeal, investigations and plan of management for common neurological conditions.

Learning outcomes Rheumatology appointment be able to take a complete history describe the clinical features, complications, squeal, investigations and plan of management for common rheumatological conditions.

Learning outcomes Dermatology appointment be able to take a complete history describe the clinical features, complications, squeal, investigations and plan of management for common dermatological conditions

Learning outcomes Oncology appointment Be able to take a complete history describe the clinical features, complications, squeal, investigations and plan of management for common malignancies

Learning outcomes Sexually Transmitted Diseases appointment Be able take a history and carry out clinical examination of male and female genitalia in order to detect common sexually transmitted diseases. Be able to describe the clinical features, complications, squeal, investigations and principle of treatment of common sexually transmitted diseases

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Course content Cardiology 1. Stable angina 2. Acute coronary syndrome (Unstable Angina /Non ST Segment Elevation Myocardial Infarction/ST Segment Elevation Myocardial Infarction) 3. Heart failure 4. Common arrhythmias (Atrial fibrillation/ Supraventricular tachycardia/ventricular tachycardia/ventricular fibrillation) 5. Common valvular disorders 6. Infective endocarditis 7. Emergencies a. Management of Acute coronary syndrome including thrombolysis in ST Segment Elevation Myocardial Infarction b. Management of Acute Pulmonary Oedema c. Cardio pulmonary resuscitation d. Management of bradyarrhythmias and tachyarrhythmias 8. Procedures a. Thrombolysis b. Trans thoracic and trans oesophageal echocardiography c. Exercise ECG d. DC cardioversion e. Holter monitoring f. Temporary pace maker insertion g. Coronary angiogram Respiratory 1. Bronchial asthma 2. Chronic obstructive pulmonary disease 3. Pneumonia 4. Pulmonary tuberculosis 5. Bronchial carcinoma 6. Interstitial lung disease 7. Pleural effusion 8. Respiratory emergencies

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9. Management of acute exacerbation of Bronchial asthma /Chronic obstructive pulmonary disease a. Pneumothorax a. Pulmonary embolism 10. Procedures a. Nebulization b. Usage of different types of inhalers c. Pleural aspiration and biopsy d. Intercostal tube insertion e. Bronchoscopy f. Direct observation therapy in tuberculosis 11. Investigations a. Chest radiograph b. CT chest c. Lung function tests d. Interpretation of pleural fluid analysis e. Mantaoux test Neurology 1. Epilepsy 2. Stroke 3. Speech disorders 4. Headache 5. Common cranial nerve and spinal root lesions 6. Peripheral neuropathy 7. Common gait disorders 8. Spinal cord compression 9. Meningitis and encephalitis 10. Parkinson’s disease 11. Myasthenia gravis 12. Motor neuron disease and syringomylia 13. Neurological Emergencies : a. Unconscious patient b. Status epilepticus c. Acute stroke

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d. Meningitis/Encephalitis e. Respiratory muscle paralysis 14. Neurological investigations and imaging a. Lumbar puncture (does) b. Tensilon test (Shows how) c. Nerve conduction study (knows) d. EEG (knows) e. EMG (knows) f. X-ray(knows) g. CT(knows) h. MRI(knows) Rheumatology 1. Rheumatoid arthritis 2. Osteoarthritis 3. Sero- negative arthritis (spondyloarthropathies) 4. Connective tissue diseases such as Systemic lupus erythematosus 5. Crystal arthropathies such as gout 6. Rehabilitation Dermatology 1. Eczema and Glandular Diseases 2. Nail Disease 3. Follicular Disease 4. Dermatologic Infections (Bacterial, Viral, Fungal) 5. Dermatologic eruptions of Insects and Infestations 6. Papulosquamous and Inflammatory Diseases 7. Benign and Malignant skin lesions Oncology 1. Breast cancer Cervical cancer Oesophageal cancer Thyroid cancer Lung cancer Head and neck cancer treatment modalities 2. paraneoplastic syndrome

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3. Tumor markers 4. cancer prevention 5. cancer screening-cervical, breast, colo-rectal 6. educate / make public awareness regarding self-breast examination, well women clinic, self-oral cavity examination 7. palliative care of cancer patients Sexually 1. Syphilis transmitted 2. Gonorrhea diseases 3. Herpes 4. Genital warts 5. Human immunodeficiency virus 6. Trichomoniasis 7. Non gonococcal urethritis 8. Candidiasis 9. Chancroid counsel suspected and diagnosed patients with common Sexually transmitted diseases Medical 1. Acute ST elevation myocardial infarction emergency 2. Other acute coronary syndromes 3. Acute left ventricular failure 4. Arrhythmia- tachyarrhythmia 5. Arrhythmia- bradyarrhythmia 6. Hypertensive Emergencies 7. Acute respiratory failure 8. Acute severe asthma 9. Pneumothorax 10. Haematemesis 11. An unconscious patient 12. Stroke 13. Seizure 14. Acute renal failure 15. Snake bite envenoming 16. Organophosphate poisoning

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17. Paracetomol over dose 18. Hypokalaemia and hyperkalaemia 19. Diabetes keto acidosis 20. Dengue shock syndrome or hemorrhagic shock

Time Allocation

Teaching/Learning Activity Time allocation

Lectures 74 h

Clinical Rotation

1st appointment 4 weeks (Peripheral hospital)

2nd appointment 6weeks (T. H. Anuradhapura)

3rd appointment 6weeks (T. H. Anuradhapura)

Professorial appointment 8 weeks (Professorial Unit)

Ward classes , seminars , workshops, assignments

Assessment

Component Marks/100

Theory SEQ (6 questions 3 h) 20

Common MCQ (2 h) 20

Clinical Long case 20

Short cases 20

Continuous Assessment OSCE, Portfolio and 20 3600assessment

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Recommended reading/ references (most recent editions) 1. Praveen Kumar, Michal Clark. Kumar and Clark Clinical Medicine 9th Edition, Elsivier. 2. Graham Douglas Fiona Nicol Colin Robertson. Macleod's Clinical Examination. UK: Churchill Livingstone; 2013. 3. Macleod’s Clinical Examination youtube videos (https://www.youtube.com/playlist?list=PLGESeMFkgqnxC3Yvkgq7_sdfUs zaRvlpr)

4. Nicholas Talley Simon O’Conno. Clinical Examination, 7 ed. Australia: Churchill Livingstone; 2013. 5. Dan Longo, Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. Harrison's Principles of Internal Medicine, 18 ed. UK: McGraw-Hill Education; 2017.

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6.6.2 Paediatrics

Broad learning Outcomes

The aim of undergraduate paediatric training is to nurture and train medical undergraduates to become competent and confident medical graduates who will be able to deliver comprehensive paediatric patient care to satisfy the international accredited standards.

On completion of the clinical programme in paediatrics, students should be able to

1. obtain a comprehensive history, elicit physical signs and interpret findings and come to a reasonable diagnosis/ differential diagnoses and management plan for paediatric problems. 2. Manage paediatric emergencies 3. function as a team member and leader in an inter professional team to provide safe and effective patient care 4. engage in lifelong learning in order to improve patient care based on scientific evidence 5. demonstrate a commitment to carrying out professional responsibilities with adherence to ethical principles and an understanding of the legal implications of practice

Outcomes for 1st paediatric appointment basic ability gather patient related information through history taking and examination and to gain knowledge to recognize paediatric problems and its management.

Outcomes for 2ndpaediatric appointment To demonstrate ability in history taking, examination, interpretation.planning of the basic management of paediatric problems

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Outcomes for professorial paediatric appointment To be competent in gathering patient related information and interpret them to facilitate planning the management of paediatric patients sufficient for a competent and confident House Officer.

Course content

Perinatal Medicine: - Examination of the newborn - Neonatal resuscitation - Respiratory distress in the newborn - Prematurity and low birth weight - Birth asphyxia,Neonatal convulsions and Hypoglycaemia - Neonatal Infections and Sepsis - Neonatal Jaundice

Cardiology: - Evaluation of a heart murmur - Congenital cyanotic heart diseases - Congenital acyanotic heart diseases - Rheumatic Heart Disease - Kawasaki Disease - Infective endocarditis - Heart Failure

Respiratory Diseases: - Upper respiratory tract infections - Lower respiratory tract infections - Bronchial asthma - Tuberculosis - bronchiolotis

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Gastro-intestinal tract Disorders: - Acute gastroenteritis - Blood and mucous diarrhoea - Chronic diarrhea - Constipation and Encopresis - Malabsorption - Biliary atresia - Neonatal Hepatitis - Cirrhosis of liver

Nephrology: - Congenital abnormalities - Urinary tract infections - Evaluation of a Child with proteinuria - Evaluation of a Child with haematuria - Acute kidney injury - Chronic renal failure

Neurology: - Seizure disorders - Evaluation child with development delay - Floppy baby - Central Nervous System infections - Headache - Evaluation child with abnormal occipital frontal circumference (macrocephaly, microcephaly)

Haematological Disorders: - Evaluation of a child with anaemia - Haemolyticanaemias - Nutritional anaemia - Evaluation of a child with a bleeding disorder

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- Haemoglobinopathies

Endocrinology: - Hypothyroidism, Hyperthyroidism and Parathyroid disorders - Diabetes mellitus - Adrenal disorders - Puberty (Precocious puberty/Delayed puberty) - Pituitary disorders - Evaluation child with short stature

Musculoskeletal Disorders: - Congenital abnormalities of bones and joints - Myopathies and Motor Neurone Diseases - Evaluation of child with arthritis

Infections: - Vaccines and immunizations - Tuberculosis - Hepatitis A and B - Dengue fever

Oncology: - leukaemia - Neuroblastoma - Nephroblastoma - Brain tumours - Lymphomas - Soft tissue sarcomas - Bone tumours - retinoblatomas

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Emerging trends and broad health challenges - Non-communicable diseases - Child accidents - Child abuse - Public health responsibilities - Current health policy and quality issues

Nutrition - Failure to thrive - Nutrition and nutritional disorders - Rickets - Neonatal feeding - Preterm feeding

Other Special Topics: - Genetics - Childhood Obesity - Common Paediatric Skin Conditions - Growth and development

Time Allocation

Teaching/Learning Activity Time allocation

Lectures 73 h

After lecture SEQ assessment

Clinical Rotation

1st appointment 4 weeks

2nd appointment 4 weeks

Professorial appointment 8 weeks

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Periodic ward classes

Daily MCQ programme

Daily SEQ programme

Daily OSCE programme

Morning presentation

Tutorials

Portfolio

Method of Assessment

1. Continuous assessment Portfolio – End of Professorial Paediatric appointment OSCE

2. Written Papers Assessment Scheduled after completion of final year clinical course Structured Essay Questions – 6 questions in 3 hours Combined MCQ and SBA paper in 2 hours by the UGC.

3. Clinical Assessment a. A long case – the student will be given a patient with clinical problems that could be discussed as a long case. The student will be allowed to be with the patient for 40 minutes to acquire a thorough history, examination and record his/her findings on paper. There will be another 10 minutes to complete the records and plot the anthropometric measurements with centiles. Then he/she will be given 20 minutes to present, interpret, discuss the management plan, in front of a two examiner panel. b. Two short cases – one short cases have to be done by the candidate during 20 minutes (10 minutes for each short case )with another two examiner panel.

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Component Marks /100 Written Papers SEQ (5Q, 3h) 20 Common MCQ (2h) 20 Clinical Long case 20 Short cases 20 Continuous Assessment OSCE, Portfolio and 20 3600assessment

Recommended reading/ references (most recent editions): Books 1. Kliegman, R., & Nelson, W. E. Nelson Textbook of Pediatrics: Saunders; 2007. 2. Lissauer, T., & Carroll, W. Illustrated Textbook of Paediatrics: Elsevier Health Sciences UK; 2017. 3. Michael Swash, Michael Glynn. Hutchison's clinical methods. Edinburgh: Saunders Elsevier. 4. Graham Douglas Fiona Nicol Colin Robertson. Macleod's Clinical Examination. UK: Churchill Livingstone; 2013. 5. Neil McIntosh, Peter Helms, Rosalind Smyth and Stuart Logan. Forfar and Arneil's Textbook of Pediatrics, 7th ed. Churchill Livingstone; 2008. 6. Janet M Rennie and Giles Kendall. A Manual of Neonatal Intensive Care, 5th ed. CRC Press; 2013 7. Advanced Paediatric Life Support th 8. A Paediatric Vade-Mecum, 14 edition 9. Immunization Handbook, 3rd ed. Epidemiology Unit, Ministry of Health, Sri Lanka; 2012 10. Guidelines for Management of Tuberculosis in Children. National Programme for Tuberculosis Control and Chest Diseases, Ministry of Health, Sri Lanka.

Journals/ Periodicals 1. Ceylon Medical Journal 2. Sri Lanka Journal of Child Health 3. Quarterly Epidemiological Report - Sri Lanka Epidemiological Unit

E resources 1. AACAP (American Academy of Child Adolescent Psychiatry: http://www.aacap.org/) 2. WHO | HINARI: www.who.int/hinari/

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3. PubMed /emedicine 4. American heart association: http://www.heart.org/HEARTORG/ 5. Guidelines - Brit Thoracic: www.brit-thoracic.org.uk/guidelines.aspx 6. American Academy of Pediatrics: www.aap.org/ ‎

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6.6.3. Gynaecology and Obstetrics curriculum

General Objectives

The purpose of undergraduate training in obstetrics and gynaecology is to prepare medical students for internship, subsequently to practice medicine as a skilled doctor and encourage students to pursue a career in Obstetrics and Gynaecology as specialists and researchers.

On completion of clinical training in Obstetrics and Gynaecology students should be able to, 1. obtain a relevant history, elicit physical signs and interpret those findings and come to a reasonable diagnosis / differential diagnoses and management plan of common or important conditions specific to women’s health or affecting pregnant women 2. manage obstetric and gynaecological emergencies. 3. work in primary health care delivery system in Sri Lanka in improving women’s and maternal health of the community with relatively limited resources 4. perform both pre-operative and post-operative assessment of surgical patients and management 5. demonstrate adequate knowledge on operative theatre practices, universal precautions, sterilization and disinfection procedures, assist in surgery and handle basic instruments. 6. demonstrate the ability to perform basic obstetric and gynaecological procedures under supervision 7. function as a team member and a leader in an inter professional team to provide safe and effective patient care 8. recognize the need for multidisciplinary involvement when necessary 9. demonstrate the qualities required to sustain lifelong learning in order to improve patient care based on scientific evidence 10. demonstrate the ability to communicate and counsel patients and colleagues about sensitive topics such as menstrual problems, sexual problems, teenage pregnancies, sexual abuse and breaking bad news. 11. identify the role of audit and research to improve the quality of women’s health

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Outcomes of 1st obstetrics and gynaecology appointment to demonstrate basic ability in taking a history and performing general and specific examinations relevant to obstetrics and gynaecology, and acquire basic knowledge in common obstetric and gynecological problems.

Outcomes of 2nd obstetrics and gynaecology appointment to demonstrate ability in taking a history and performing general and specific examinations relevant to obstetrics and gynaecology

Outcomes of professorial obstetrics and gynaecology appointment to be competent in management of common obstetrics and gynaecology problems at basic level to become a competent and confident house officer with correct attitudes

Course content

Obstetrics 1. Physiological changes in pregnancy 2. Routine antenatal care 3. Antenatal screening 1. Biochemical screening 2. Ultrasound screening 3. Invasive prenatal diagnosis 4. Normal labour and delivery 1. Normal labour 2. Induction of labour 3. Analgesia and anaesthesia in labour 4. Fetal monitoring 5. Abnormal labour 1. Abnormal labour patterns 2. Malpresentations and malpositions in labour 3. Instrumental delivery 6. Vaginal birth after caesarean section 7. Breech presentation 8. Multiple pregnancy

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9. Rhesus isoimmunisation 10. Medical disorders in pregnancy 1. Cardiac disease 2. Respiratory diseases 3. Diabetes mellitus 4. Haematological conditions 5. Autoimmune conditions 6. Renal diseases 7. Hypertensive disorders in pregnancy 8. Urinary tract infection 11. Late pregnancy complications 1. Preterm labour 2. Pre-labour rupture of membranes 3. Antepartum haemorrhage 4. Intra uterine fetal death 5. Prolonged pregnancy 12. Fetal growth restriction 13. Postpartum 1. Perineal trauma 2. Mental health in the puerperium 3. Neonatal assessment and resuscitation 4. Post partum pyrexia 14. Obstetrics emergencies 1. Maternal collapse - obstetric and non-obstetric causes 2. Postpartum haemorrhage 3. Uterine inversion 4. Eclampsia 5. Shoulder dystocia 6. Cord prolapse 7. Amniotic fluid embolism

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Gynaecology 1. Menstrual cycle [Reproductive transitions] 1. Puberty and Menarche 2. Delayed and precocious puberty 3. Menstrual dysfunction in adolescence 4. Menopause, hormone replacement therapy 5. Postmenopausal bleeding 2. Menstrual disorders 1. Heavy menstrual bleeding 2. Fibroids and endometrial polyps 3. Polycystic Ovarian syndrome, hirsutism and virilism 4. Premenstrual syndrome 5. Clinical evaluation and management of amenorrhoea 3. Endometriosis and adenomyosis 4. Fertility and conception 1. Normal conception 2. Female infertility 3. Male infertility 4. Assisted reproduction 5. Reproductive ageing and ovarian reserve 5. Sexual problems in gynaecology 6. Urinary incontinence 7. Urogenital prolapse 8. Benign ovarian tumoursandovarian malignancy 9. Cervical screening and Cancer 10. Endometrial hyperplasia and Cancer 11. Palliative care 12. Problems in early pregnancy 1. Hyperemesis gravidarum 2. Miscarriage 3. Pregnancy of unknown location 4. Gestational trophoblastic disease 13. Pelvic inflammatory disease

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Time Allocation

Teaching/Learning Activity Time allocation

Lectures 60 hr

Clinical Rotation

ObstetricsandGynaecology 1 4 Weeks

ObstetricsandGynaecology 2 4 Weeks

ObstetricsandGynaecology- 8 Weeks Professorial appointment

Periodic ward classes

ObstetricsandGynaecology tutorials

Seminars and workshops

Method of Assessment

Component Marks/100

Theory SEQ (5Q- 2 h) 20

Common MCQ (2 h) 20

Clinical Obstetrics case 20

Gynaecology case 20

Continuous Assessment OSCE, Portfolio and 20 3600assessment

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Recommended reading/ References

1) Ippokratis sarris, susan bewley. Training in Obstetrics and Gynaecology the Essential Curriculum , 1 ed. India: OUP; 2009. 2) Enda McVeigh , John Guillebaud, Roy Homburg , Sabaratnam Arulkumaran . Oxford Handbook of Obstetrics and Gynaecology, 3 ed. India: OUP; 2015. 3) Royal College of Obstetrician andGynaecologists’ Guidelineshttps://www.rcog.org.uk/guidelines 4) Sri Lankan College of Obstetrician andGynaecologists’ Guidelines:http://sljog.sljol.info/articles/abstract/10.4038/sljog.v35i4.6598/ 5) Family Health bureau – Guidelines http://fhb.health.gov.lk/web/index.php?option=com_phocadownload&view=categ ory&id=8&Itemid=149&lang=en 6) NICE Guidelines- United kingdom 7) https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice- guidelines/types-of-guideline

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6.6.4. Surgery Curriculum

Course Objectives

On successful completion of the Surgery program, students should be able to; 1. obtain a comprehensive history, elicit physical signs and interpret those findings and come to a reasonable diagnosis/ differential diagnoses and management plan 2. demonstrate appropriate ability for the prevention and management of health problems and the promotion of health among all age groups in relation to surgical conditions, both emergency and non-emergency situations. 3. perform both pre-operative assessment of surgical patients and post operative management 4. demonstrate adequate knowledge on operative theatre practices, universal precautions, sterilization and disinfection procedures, assisting a surgery and handle basic instruments. 5. perform simple surgical procedures under supervision 6. function as a team member and leader in an inter professional team for safe and effective patient care 7. demonstrate the qualities required to sustain lifelong learning in improve patient care based on scientific evidence 8. demonstrate a commitment to carrying out professional responsibilities with adherence to ethical principles and an understanding of the legal implications of practice 9. identify the role of surgical audit and research to improve the quality of surgical care

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Course Content

Vascular system

Occlusive arterial diseases Limbs, carotid, Cardiovascular system, (acute and chronic) mesenteric Thrombosis/embolism Aneurysms Mainly Abdominal aortic aneurysm, pseudoaneurysms, peripheral aneurysms in various places Varicose veins As a common venous problem Deep vein thrombosis Identify risk factors, Diagnosis,Importance of prophylaxis, treatment Lymphatic disorders Lymphadenopathy, surgical excisions, lymphoedema, lymphangitis Vascular trauma Importance of ischaemia , limb salvage Gastro-enterology

Symptomatology and investigations of the Gastrointestinal tract Overview of salivary glands Benign and malignant diseases, salivary calculi, infections, inflammation Carcinoma of the oesophagus and As a model of dysphagia, as a disease of stomach Loss of weight with retained appetite

Peptic ulcer disease and Gastro Dyspepsia, oesophagitis, Diffential oesophageal reflux disease Diagnoses epigastric pain, acute/chronic gastritis, gastric/duodenal ulcers, Medical/ surgical treatment modalities, Helicobacter pylorias a cause Upper Gastro intestinal bleeding Peptic ulcer disease, varices, carcinomas, duodenal bleeds, vascular malformations, importance of endoscopy in management,

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acute treatment and management Lower Gastro intestinalbleeding Malignancies, Inflammatory bowel disease, bowel ischaemia, diverticulosis, vascular malformation, endoscopy, angiogram, short and long term treatment and management Pancreatitis – acute/chronic Causes, diagnosis, management Gall stone disease Cholecystitis, obstructive jaundice, cholangitis, pancreatitis Carcinoma of pancreas and biliary Biliary obstruction, as an Gastrointestinal system cancer Peritonitis Appendicitis, Cholecystitis, gynaecological causes, bowel perforations, trauma Colorectal carcinoma as a model for carcinogenesis screening and surveillance Intestinal obstruction Include gastric outlet obstruction, small bowel Large bowel emergencies Bleeding, perforations, closed loop obstructions, volvulus, megacolon, colitis Colorectal tumours Ano-rectal non malignant diseases Anal tissue, fistula, Haemorrhoid, pilonoidal sinus, perianal abscess Hernias Internal and external, existing defects and incisional Urology

Urinary tract infection Simple/complicated Urinary tract infection, recurrence, fistulae, , Foreign body associated infections cystitis, pyelonephritis, pyonephrosis, importance of drainage, prostatis and epididymal

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infections Bladder dysfunctions Incontinence and retention Urolithiasis and nephrolithasis Types of stones, stones + Urinary tract infections, obstructions and consequences, long term effects, treatment options Urological tumours Renal, urothelial, overview of management, associated complications Prostate disease –benign/malignant Benign prostatic hyperplasia and Prostate carcinoma, importance of Prostate- specific antigen/Digital rectal examination. Cancer screening, Transurethral resection of the prostateandTransurethral resection of the prostate syndrome

Testicular problems Maldescent/non-descended testis/torsion /infection/tumours Orthopaedics Introduction to orthopaedics Fractures dislocations and their management Spinal injuries Cervical spine/ thoracic/ lumbar Bone and joint infections Bone tumours Back pain Paediatric orthopaedic problems Osteoarthritis and osteoporosis Breast Benign breast disease Benign breast conditions,Aberrations in the Normal Development and Involution of the breast, fibroadenoma, adenosis, periductal mastitis, duct ectasia, Cysts,

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Breast infection

Breast carcinoma Lobular/ductal, overview Ductal carcinoma in situ, Sentinel Lymph Node Biopsy, Breast-conserving surgery, Screening, other modalities of treatment, Reconstruction

Thyroid and endocrine Benign thyroid diseases Multinodular Goiter,Solitary Thyroid Nodule,Iry and IIry toxicosis, myxoedema, aerodigestive ways compression, complication Thyroid cancers Papillary, follicular, medullary , anaplastic Ca lymphoma, Investigations management options Other endocrine diseases Adrenal, parathyroid, endocrine pancreas Paediatric surgery Overview of common paediatric surgical Pyloric stenosis, Malrotation, Tracheo problems oesophageal fistula, Hirschpurng disease, imperforated anus Basic surgical principles Wound healing and management Physiological response to trauma Endocrine, neurological, metabolic Surgical infections/sepsis Shock and management Fluid and electrolyte balance/acid base balance Nutrition in surgery Overview of pre-op preparation Post-op care and pain relief Terminal care and palliation Surgical ethics and consent/Breaking bad news

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Trauma ABC of trauma Initial assessment and resuscitation Head, chest , abdominal and pelvis injuries Faciomaxillary injuries Burns Anaesthesia Principles of anaesthesia General, Local, regional complications Different types- General,local,regional ENT and Eye Common ear problems Wax, Otitis media with effusion, Acute Otitis Media, Chronic Suppurative Otitis Media, Vertigo, Benign Paroxysmal Positional Vertigo, Hearing impairment, Foreign bodies etc; Nasal allergy and sinusitis Nasal trauma and epistaxis Tonsils and adenoids Laryngopharyngeal disorders Common eye problems Neurosurgery Intra-cranial tumours Increase Intra cranial pressure Head injuries Cardio-thoracic surgery Outline Ischemic Heart Disease and Ischemic heart disease/ Congenital heart congenital heart disease disease, Coronary artery bypass grafting, valve replacements Trauma – tamponade Surgery related pulmonary problems Trauma – flail chest, haemo pneumothorax, contusions,

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hydrothorax/empyema, lung abscess, overview lung Continuous Assessment, drainage of pleural cavity

Time Allocation

Teaching/Learning Activity Time allocation

Lectures 78 hours

Clinical Rotation

Surgery I 8 weeks

Surgery II 8 weeks

Surgery Professorial appointment 8 weeks

Neurosurgery 2 weeks

Orthopedic surgery 4 weeks

Otolaryngology 2 weeks

Ophthalmology 2 weeks

Anesthesiology 2 weeks

Urology 2weeks

Periodic ward classes As directed by the department /supervisor

Surgery tutorials As directed by the department /supervisor

Seminars and workshops As directed by the department /supervisor

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Method of Assessment

Component Marks/100

Theory SEQ (10Q- 3 h) 20

Common MCQ (2 h) 20

Clinical Long case 20

Short cases (around 3) 20

Continuous Assessment OSCE, OSVE, 20 Portfolio and 3600assessment

Recommended reading/ References

1. Williams N, Bulstrode C, O'Connell PR. Bailey and Love's Short Practice of Surgery. Boca Raton,FL: CRC Press. . 2. Michael Swash, Michael Glynn. Hutchison's clinical methods. Edinburgh: Saunders Elsevier. 3. Lumley JSP, D'Cruz AK, Hoballah JJ, Scott-Connor CEH. Hamilton Bailey's Physical Signs: Demonstrations of Physical Signs in Clinical Surgery. Boca Raton, FL: CRC Press. 4. Scott PR, Williamson RCN, Waxman BP. Scott: An Aid to Clinical Surgery. Edinburgh: New York: Churchill Livingstone. 5. Norman L Browse’s Introduction to The Symptoms and Signs of Surgical Disease

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6.6.5. Psychiatry

Broad Learning Outcome

The main purpose of undergraduate psychiatry training is to prepare the medical students to handle common psychiatric problems and emergencies as skillful, competent and confident doctors.

On completion of clinical programme in psychiatry, students should be able to

1. obtain a comprehensive history, do a mental state examination, elicit physical signs, request appropriate investigations, interpret those findings and come to a reasonable diagnosis/ differential diagnoses, aetiological formulation and management plan 2. manage common psychiatric illnesses 3. manage psychiatric emergencies 4. demonstrate good communication skills that will facilitate psychiatric assessment, explaining the diagnosis, procedures, management options and possible outcomes to the patients and their families, as well as counseling of the patients and their families 5. deliver holistic care to the patients and their families 6. function as a team member and a leader in a multidisciplinary professional team to provide safe and effective patient care 7. recognize the need for inter disciplinary involvement and referrals 8. demonstrate the qualities required to sustain lifelong learning in order to improve patient care based on scientific evidence 9. demonstrate a commitment to carrying out professional responsibilities with adherence to ethical principles and an understanding of the legal implications of practice 10. demonstrate familiarity with the resources available and pathways to treat mentally ill patients including involuntary admission and treatment under Mental Health Act 11. identify the role of audit and research to improve the quality of patient care

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Outcomes of the 1st Psychiatry appointment to demonstrate a basic ability in history taking, mental state examination, physical examinations and requesting appropriate investigations, interpretation of these finding and planning of the basic management of common psychiatric problems.

Outcomes of the professorial Psychiatry appointment To be competent in coming to an aetiological formulation, management of psychiatric problems and to become a competent and confident house officer with correct knowledge, skills and attitudes.

Course content 1. Concepts of mental illness 2. Signs and symptoms of psychiatric disorders 3. Classification of Mental and Behavioural Disorders 4. Psychiatric assessment 5. Ethics, civil law and mental Health law 6. Psychopharmacology 7. Delirium and other organic brain disorders 8. Dementia 9. Mental and behavioural disorders due to use of alcohol 10. Treatment of alcohol disorders 11. Other substance use disorders 12. Schizophrenia 13. Treatment of psychosis 14. Bipolar disorder 15. Unipolar depression 16. Treatment of mood disorders 17. Suicide and deliberate self-harm, risk assessment 18. Anxiety disorders and treatment strategies 19. Obsessive compulsive disorder 20. Reaction to Stress and bereavement 21. Somatoform and conversion disorders 22. Eating Disorders

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23. Sleep and its disorders 24. Perinatal psychiatry 25. Disorders of adult personality and behavior 26. Sexual dysfunction 27. Gender identity disorders and disorders of sexual preference 28. Learning disability (Mental retardation) 29. Child psychiatry –disorders of psychological development 30. Child psychiatry- behavioural and emotional disorders 31. Forensic psychiatry 32. Managing an aggressive patient 33. Medically unexplained symptoms

Time allocation Teaching/Learning Activity Time allocation Lectures 45 h Clinical rotation Psychiatry 1 4 weeks Psychiatry 2 (Professorial 8 weeks appointment) Tutorials / As directed by the department problem based learning sessions /supervisor Ward classes As directed by the department /supervisor Training in clinical skills As directed by the department /supervisor Seminars/ workshops As directed by the department /supervisor Home visits of patients As directed by the department /supervisor Visits to community resource centers As directed by the department /supervisor Case book As directed by the department /supervisor

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Method of assessment

Continuous assessment Casebook - A pre-requisite for sitting the final exam. Needs 50% or above, but marks will not contribute to the final MBBS.

End of Professorial Psychiatry appointment OSCE: 5 OSCE’s on assessment, diagnosis, treatment and communicating skills in the management of psychiatry patients (Marks allocation according to the table below)

Written Papers Assessment (Marks allocation according to the table below) Scheduled after completion of final year clinical course. Structured Essay Questions – 6 questions in 2 hours Common MCQ paper -20 T/F and 30 SBA in 2 hours by the UGC.

Clinical Assessment (Marks allocation according to the table below) A long case – the student will be given a patient with clinical problems that could be discussed as a long case.The student will be allowed to be with the patient for 40 minutes to acquire a thorough history, mental state examination, relevant physical examination and record his/her findings on paper. Then he/she will be given 20 minutes to present, interpret, and discuss the management plan, in front of a two examiner panel.

Shortcase - 1 Short case OR OSCE’s will also be held at final MBBS clinical exam (in addition to end of appointment OSCE’s)

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Marks allocation

Component Marks /100 Written Papers SEQ (5Q, 3 h) 25 Common MCQ 25 20 True/False and 30 Single Best Answer questions (2 h) Clinical Long case 25 40 min with the patient, 20 min with examiner Short case (1 Short Case or 15 OSCE’s) 10 min Continuous Assessment OSCE (end of appointment) 10

Recommended reading

1. Michael Gelder, Richard Mayou, John Geddes. Psychiatry: An Oxford Core Text. : OUP; 2005. 2. Varuni de Silva, Raveen Hanwella. Handbook of Clinical Psychiatry: A Practical Guide. Chennai: Kumaran Book House; 2012 3. The ICD 10, Classification of Mental and behavioural Disorders 4. Philip Cowen, Paul Harrison, Tom Burns. Shorter Oxford Textbook of Psychiatry , 6 ed. : OUP; 2012.

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6.6.6. Marking system of the final examination

Marking system of the final examination of Medicine, Surgery, Paediatrics, Psychiatry, Gynaecology and Obstetrics

All components will be marked out of 100 initially and incorporated in to the final 100% proportionately. The guidelines for the initial mark out of 100 will be as. <50.00  failure ≥50.00  pass >69.50  distinction The following marks determine the overall outcome in a student’s success in clinical examination To pass the clinical examination the student needs to acquire the following Percentages Overall 50% Theory  45% Clinical 50% A student who obtains an overall mark of 70% or above will be awarded a distinction.

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6.7 Skills Expected from a Medically Qualified Graduate

A list of skills expected from a graduate when he/she completes the degree programme. Categorized levels of skills Level Skill level 1- Can perform independently (does) 1 Skill level 2 - Can perform under supervision (shows how) 2 Skill level 3 - Has seen the procedure (knows) 3 Not exposed 0

A General Skills 1 2 3 0

1. Ability to elicit a complete history √ Ability to carry out complete general 2. √ examination 3. Examination of systems √ Ability to interpret history with respect to 4. √ examination 5. Neonatal examination √ 6. Performing a developmental assessment √

7. Assessment of Bishops score √ 8. Mental state examination √ 9. Assessment of cognitive functions √ Risk assessment (including Suicide risk 10. √ assessment) 11. Use of a stethoscope √ 12. Measurement of blood pressure √ 13. Setting up blood transfusion √ 14. Venesection of blood donor √ 15. Preparation of a blood film √ 16. Estimation of Packed Cell Volume √ 17. Estimation ofErythrocyte Sedimentation Rate √ 18. Hemoglobin estimation √

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19. Grouping of blood and Direct Testing √ Collection and transport of specimens for 20. √ microbiological (e.g. blood and urine culture) Collection, storage and transport of a stool 21. sample for virology (Optional. Should be done √ if there is a patient.) 22. Urine ward test for protein √ 23. Urine ward test for reducing substances √ 24. Universal precautions √ 25. Giving intravenous injections √ Giving intramuscular injections √ Giving subcutaneous injections √ BCG administration, storage and transport (A 26. session will be arranged at the vaccination √ clinic.) 27. Inserting an intravenous cannula √ 28. Setting up an intravenous infusion √ 29. Cardio - pulmonary resuscitation √ 30. Bag and mask ventilation √ 31. External chest compression √ 32. Tracheal chest compression √ 33. Neonatal resuscitation √ Maintaining a paediatric Glasgow Coma Scale 34. (Optional. Should be done if there is a √ patient.) 35. Cardio version and Defibrillation √ 36. Measurement of height and weight in children √ 37. Use of an infantometer and stadiometer √ 38. Measurement of occipito-frontal and mid-arm √ circumference 39. Inserting naso-gastric tube √ 40. Urinary catheterization √ 41. Performing auroscopy and funduscopy √

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42. Nebulization √ 43. Use of a tongue depressor, √ 44. Nasal speculum and laryngeal mirror √ 45. Examination of the neck including and √ assessment of thyroid status 46. Types of insulin and injection devices √

47. Administration of Desferrioxamine √ 48. Estimate capillary blood sugar √ Corneal reflex, light reflex, testing visual 49. acuity, colour vision and visual fields √ (confrontation) Ophthalmoscopy, auroscopy assessment of 50. √ hearing (Weber's and Rinne's test) Request appropriate radiological 51. √ investigations and interpretation 52. Basic Physiotherapy (ie: postural drainage √ andquadriceps exercise) 53. Writing of patient management plan √ 54. Using adrenaline in anaphylaxis √ 55. Contents of the emergency cart √ 56. Hemlich's maneuver √ 57. Maintaining a Glasgow Coma Scale √ 58. Maintaining a fluid balance chart √ 59. Arterial Blood Gas analysis ( specimen √ collection and transport ) 60. Measuring and charting the temperature √ 61. Use of antibiotics √ 62. Filling of diagnosis card √ 63. Writing of medical certificates √ 64. Writing of death certificates √ 65. Medico legal Requirements √ 66. Rehabilitation in general √

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67. Confirmation of death and Declaration of √ death forms according to International Classification of Diseases (lCD) 68. Ability to do physical examination √ 69. Ability to gather data and present relevant √ information 70. Clear and legible and methodical √ documentation 71. Ability to be flexible regarding the working √ hours 72. Transportation of a sick child √

73. Setting up and maintaining an oxytocin √ infusion 74. Maintaining partograms √ 75. Routine pre-operative assessment of patients √ Pre-operative control of chronic diseases eg: 76. diabetes ,hypertension ,ischemic heart disease, √ asthma 77. Relief of pain √ 78. Management of bladder ,bowel ,skin √ 79. Management of colostomy √ 80. Rehabilitation √

B Communication skills 1 2 3 0 1. Breaking bad news √ 2. Updating relatives √ 3. Writing referral letters √ 4. Writing case summary √ 5. Oral presentation of cases √ 6. Letter to general practitioner about patient √

7. Post-natal advice √ 8. Advising clients on contraception √

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Advice on convalescence(after common basic 9. √ surgical procedures-eg: hernia, laparotomy) 10. Psycho education/health education √ 11. Provide counselling √ 12. Teaching of Relaxation techniques √ 13. Giving cognitive behaviour therapy √ Communication with special groups 14. Mentally ill patients √ 15. Children √ 16. Terminally ill patients √ 17. Human immunodeficiency virus Patients √ 18. Non-English speaking patients √ 19. Drug addicts √ 20. Alcoholics √ 21. Aggressive patients √ 22. Victims of sexual abuse √ 23. Victims of child abuse √ 24. Victims of domestic violence √ 25. Deliberate self-harm √

C Procedures 1 2 3 0 1. Measuring the Peak Flow Rate (PFR) √ 2. Connecting an ECG monitor and Doing a 12 √ lead ECG 3. Collection of midstream sample of urine √ 4. Endotracheal intubation √ 5. Arterial puncture √ 6. Lumbar puncture √ 7. Pleural aspiration √ 8. Peritoneal tap √ 9. High bowel washout √

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10. Peritoneal dialysis √ 11. Gastric lavage √ 12. Pituitary and adrenal function tests √ 13. Aspiration of joint and intra-articular injection √ 14. Insertion of a central venous line √ 15. Performing supra-pubic aspiration √ 16. Insertion of an umbilical catheter √ 17. Haemodialysis √ 18. Skin biopsy √ 19. Liver biopsy √ 20. Renal biopsy √ 21. Pleural biopsy √ 22. Bone marrow biopsy √ 23. Artificial ventilation √ 24. Aerosol inhalation √ 25. Endoscopy (Gastrointestinal and bronchoscopy) √ 26. 20WBCT √ 27. Ultrasound, CT and MRI scanning √ 28. Contrast studies of the Gastrointestinal and √ Genitourinary tracts 29. EEG, EMG and Nerve Conduction Studies √ 30. Echocardiogram, Exercise ECG, Coronary √ Angiogram, Holter Monitoring 31. Spirometry √ 03 32. Exchange transfusion √

33. Membrane sweep √ 34. Conducting normal vaginal deliveries √ 35. Performing and repairing an episiotomy √ 36. Preparing patients for ceasarean section √ 37. Assisting for ceasarean section √ 38. Forceps Delivery √ 39. Ventouse Delivery √

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40. Twin Delivery √ 41. Breech Delivery √ 42. Manual Removal of Placenta √ 43. Repair of Perineal tear √ 44. Speculum examination √ 45. Performing a Pap smear test √ 46. Insertion of a vaginal ring pessary √ 47. Dressing of wounds √ 48. Bandaging √ 49. Removal of sutures √ 50. Performing a cut down √ 51. Insertion of intercostal tubes √ 52. Care of pressure points √ 53. Removal of intercostal tubes √ 54. Electro-convulsive therapy (ECT) √ 55. De-escalation √ 56. Controlled restraint and Rapid tranquilization √

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6.8 Public Health Elective Programme for medical undergraduates

Goal: The goal of the Public Health Elective, is to provide opportunities to undergraduate medical students to widen their knowledge on applied public health work, public health research and expose students to new career opportunities.

Programme: This four-week elective combines both didactics and field work in public health settings throughout the Anuradhapura district. It is offered once per year. Students will be engaged in outbreak investigation, public health planning and all field activities with the department members. They will be engaged in guided public health work during this period and will be given an assignment to complete within a four weeks period. This assignment will have a research component and essential scientific literature search. The didactive sessions will be directly related to the assignments. In addition, they will provide guidance to present undergraduate trainees and will be involved in public health training process.

Entry requirements: Final year Medical Students awaiting the professorial appointments with at least a second lower class in 3rd MBBS part II examination will be eligible. Those who are with a distinction in Community Medicine will be preferred.

Selection process: Number of positions available will be around 4-6. A selection interview will be conducted by the course coordinator.

Upon completion of the elective programme, a certificate of completion will be awarded to successful trainees.

Public Health Elective Programme Page 232

FMAS, RUSL

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