Courses
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Courses
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S.No. |
Name of the Course |
Details of Admission |
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1 |
MD |
Candidate has to qualify in the postgraduate entrance examination held by AIIMS Examination Cell twice a year. Number: Three every year. |
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2 |
Ph.D |
Candidate has to qualify in the Theory of Ph.D Entrance Examination held every 6 month by Examination section of AIIMS and then to qualify in viva-voice examination held by the Department. Candidate is advised to consult the concerned faculty before applying for Ph.D from this department. Candidates who have their own fellowship are given preference. Time period:3-5 years |
The curriculum of M.D. Course in Laboratory Medicine (SYLLABUS)
I. COURSE DESCRIPTION
1. Name of the Course :
Doctor of Medicine (MD) in Laboratory Medicine.
2. Duration of the Course
Three Years full-time residency
3. Recognition of the Course
Obtained from different Statutory Bodies at A .I. I. M. S
Also recognized by Medical Council of India
4. Eligibility for Admission
The essential qualification shall be MBBS Degree of any Indian University/Deemed University/Autonomous Institutions etc., as recognized by the Medical Council of India (MCI) or any other qualification of a foreign university that is recognized by the MCI and the concerned university as equivalent to the MBBS Degree.
5. Method of Selection
As per other MD course of AIIMS
6. Total number of Candidates
Not more than two per each semester to be admitted to the course and a total number in three years not exceeding twelve at any given time.
II. Prologue: Introduction to the Curriculum
The Laboratory services by tradition are practiced under the heading of ‘Clinical Pathology’ in most of hospitals / medical institutions in our country. These services are divided into 4 subdivisions: clinical biochemistry, clinical pathology, clinical hematology, and clinical microbiology. With advancement of technology, like automation and shift of various new investigations from research laboratory to routine laboratory, the management of laboratory investigations has acquired a new dimension and has now been grouped under a new discipline ‘Laboratory Medicine’. Further, this new discipline has been slowly encompassing many other important subdivisions engaged in diagnostic investigations. Thus, the discipline of Laboratory Medicine has soon becoming an important wing of patient care services not only in terms of screening and diagnosis of diseases but also in monitoring the course of the disease and management of patient.
This discipline encompasses three major objectives, namely, (1) Test Selection (2) Operational Aspects, (3) Interpretation of results. Although in most of the countries this discipline is entrusted only with operational aspect i.e., performing the tests, it has been now becoming an imperative that the discipline of Laboratory Medicine has a larger role to play in close and active collaboration with clinical disciplines regarding its two other objectives, namely test selection and interpretation of results. Other important aspects of this discipline are (i) quality assurance (ii) understanding of instrumentation including automation and their maintenance (iii) active participation in Medical Audit.
III. The Need and Scope
Residency in laboratory Medicine leading to MD degree is an integrated Five in One training (Clinical Chemistry, Clinical Pathology, Hematology, Microbiology and Laboratory management). Since the candidate has the holistic knowledge of the diagnostic disciplines there are subsequent academic, administrative and financial advantages.
a) Academic advantage
(i) The postgraduate can holistically correlate and interpret all the investigations from one patient which he is capable of carrying out at the operational site following test selection in clinical rounds.
(ii) The post graduate knows when and whom to refer for a very special super-specialty diagnostic opinion
b) Administrative advantage
The postgraduate can take up the work of any specialty when the other colleague is on leave. For example, if a specialist in microbiology goes on leave, a postgraduate in Lab Medicine can sign the microbiology reports.
c) Financial advantage
The Health Industry or the State has not to appoint four or five specialists for the diagnostic laboratory.
There is already a move to create the new discipline of Laboratory Medicine in most hospitals and Medical Institutions in India. Tata memorial Hospital, Bombay, and Safdarjung Hospital, Delhi, and various Corporate Hospitals have already opened up the Department of Laboratory Medicine. The postgraduates with M.D. in Laboratory Medicine could be absorbed in such departments.
Iv. AIM AND OBJECTIVES
The Aim of this curriculum is to train medical professionals who will be capable of planning and managing a multidisciplinary Laboratory attached to patient care systems, with the following objectives:
1. To acquire the knowledge of pathophysiology of diseases involving Biochemical, Hematology, Microbiological, Endocrinological & Immunological aspects.
2. Test Selection & Interpretation of results in context of a clinical condition along with concerned clinical specialty.
3. The operational knowledge for performing the laboratory investigations which include:
a. Instrumentation
b. Methodologies
c. Quality Assessment and Assurance
4. The requisite knowledge of:
a. Independent management of clinical Laboratory
b. Safety Measures in a Patient-care Laboratory
c. Cost Effectiveness of Tests
d. Personnel Management
V. OBJECTIVE DETAILS
A. BROAD OBJECTIVES TO BE ACHIEVED AT THE END OF THE COURSE
Cognitive Domain
1. Diagnosis of routine and complex clinical problems on the basis of Laboratory investigations.
2. Interpret laboratory data in relation to clinical findings with reasonable accuracy
3. Advice on the nature of appropriate specimens and the tests necessary to arrive at a diagnosis in a difficult or problematic case.
4. To be able to identify non-correlation and the causes of death due to diseases.
5. Should be able to teach Laboratory Medicine to undergraduates, postgraduates, nurses and paramedical staff including laboratory personnel.
6. To carry out research on laboratory science related topics.
7. Maintain accurate records of tests results for reasonable periods of time so that these may be retrieved as and when necessary
8. Make and record observations systematically that is of use for archival purpose and for furthering the knowledge of Pathology.
9. Able to systematically write a paper and publish in a relevant journal.
10. Able to present a paper in a conference through an oral presentation and poster presentation.
11. Should be able to identify problems within and outside the laboratory pertaining to reliable test result and offer solutions thereof so that a high order of quality control is maintained.
12. Should be capable of effectively disposing laboratory waste to ensure minimization of risk to infection and accidents to laboratory personnel.
13. Able to supervise and work with subordinates and colleagues in a laboratory.
14. Subject himself/herself to continuing education and constantly update his/her knowledge of recent advances in Laboratory Medicine and allied subjects.
Psychomotor Domain
1. Able to perform most of the routine tests in a Laboratory including gross sampling of specimens, processing, and instrumentation.
2. Able to collect specimen by routinely performed non-invasive out-patient procedures such as venepuncture, finger-prick, and bone-marrow aspiration. It is implied that the complications of these procedures and handling of complications are apparent. Further, whenever necessary must be able to provide appropriate help to colleagues performing an invasive procedure.
3. Should be familiar with the operation, function and routine maintenance of equipment.
Affective Domain
1. Should be able to function as a part of a team that is essential for the diagnosis and management of a patient. He/she should therefore develop an attitude of cooperation with his/her colleagues so necessary for this purpose. It is implied that he/she will, whenever necessary, interact with the patient and the clinician or other colleagues to provide the best possible diagnosis or opinion.
2. Always adopt ethical principles and maintain proper etiquette in his/her dealings with patients, relatives and other health personnel.
3. Respect the rights of the patient including the right to information and second opinion.
4. Should seek and give second opinion only where necessary and is requested for.
5. Provide leadership and inspire members of the team with whom he/she is involved with in the fields of diagnostic, teaching and research.
6. Develop communication skills not only to word reports and professional opinions but also to interact with patients, relatives, peers and paramedical staff.
B. SPECIFIC LEARNING OBJECTIVES
At the end of the training in M. D. Laboratory Medicine, the candidate will be able to:
1. Discuss the etiology and the pathophysiological basis of diseases in children and adults.
2. Explain the salient aspect of epidemiology, clinical presentation and prognosis of these disorders
3. Discuss rationality of the treatment and diagnosis of the above disorders
4. Make rational and relevant selection of tests (biochemical/ hematological/ microbiological etc.)
5. Perform the specified important tests belonging to physiology, biochemistry, microbiology, pathology, hematology & immunology disciplines with a high order of mastery.
6. Plan and manage a large multidisciplinary laboratory services
7. Supervise and train technical staff of the laboratory
8. Modify/develop and establish newer techniques belonging to all subspecialties of laboratory medicine.
9. Simultaneous exercise on quality assessment and quality assurance in all laboratory services.
10. Explain the underlying principle and design of important laboratory, instruments, their use as well as maintenance of the same.
11. Take safety measures in performing tests.
12. Assess cost-effectiveness of laboratory tests including budgeting and auditing.
13. Design and implement research plans in the field of laboratory medicine
VI. THE SYLLABUS
Any postgraduate syllabus has no definite boundary. However, a tentative one for MD Laboratory Medicine could be as follows.
Organization of the Laboratory
i) Spatial organization: flooring, ventilation, air-conditioning, sanitation, drainage ii) disposal of waste iii) Lab. Safety: Prevention of Physical, Chemical & Biological Hazards. First Aid in Lab. Accidents. iv) Financing, Budgeting and cost accounting v) Management of Laboratory stores vi) Special reference to glassware, chemicals (AL, LR) & dangerous poisonous chemicals vii) Personal Management and Training of technical staff viii) Streamlining of in-put and output of lab investigations, specimen collection and dispatch of report ix) Computerization of laboratory services (LIS) x) Legal aspect of laboratory services.
Quality CONTROL & QUALITY Assurance
i) Source of errors in laboratory results a) Pre-instrumental b) Instrumental c) Post-instrumental. ii) Methods of detection of errors iii) Types of error iv) Corrective measures to minimize the errors v) Methods of documentation of the whole procedures vi) Onward transmission of the knowledge and skill to the other laboratory vii) Preparation of internal `control’ viii) Proficiency testing programme ix) Participation in E.Q.A.P. & principle of preparation of Biological Standards x) Procurements of ‘Standards’ and ‘Control’ for Hematology, Cl. Chemistry and Immunoassays xi) Quality assurance on Microscopic evaluation.
Instrumentation
To know the: i) Principle ii) Parts iii) Working manual and iv) Preventive maintenance of the following instruments.
A. Minor Instruments: i) Different types of Shakers, roller Mixer, Cyclomixer etc. ii) Thermometer iii) Different kinds of refrigerators (4°, -20°c, -80°C), iv) Incubators (including BOD incubator), v) Ovens, vi) Water-baths, vii) Distillation plant, viii) Deioniser plant, ix) RO System, x) Auto pipettes, xi) pH Meter, xii) Auto-dispensers xiii) Analytical Balance etc.
B. Major Instruments: i) Photoelectric Colorimeter, ii) Spectrophotometer, iii) Centrifuge machines (table top, high speed, micro centrifuge, cold centrifuge), iv) Blood Cell Counter v) ELISA Reader, vi) Autoanalysers vii) Flame-photometer viii) Blood Gas Analyser ix). Microscopes: Light, Fluorescent, Dark ground, Phase contrast x) Scanning and Transmission Electron microscopy, xi) Electrophoresis apparatus, xii) Densitometer, xiii) Culture hood, Biosafety hood, xiv) PCR machines, all kinds
C. The principle and working manual of following techniques : i) Chromato- graphy of different kinds particularly HPLC and GLC ii) Flow Cytometry iii) Beta & Gamma Counting
Clinical Biochemistry
A). Physical Chemistry
Theory (Knowledge) : Mol wt, Atomic wt, Eq. wt, Log table & Periodic table. Water of crystallization, Colloid, Crystalloid, Osmolality, Osmolarity, Normality, Specific gravity etc.
Practical (Skill): i) Preparation of standard, normal & molar solution ii) Preparation of buffers iii) Preparation of Laboratory reagents iv) Handling of corrosives, poisonous chemicals.
B) Clinical Biochemistry:
Theory (Knowledge):i) Carbohydrate Chemistry: Identification, Metabolism and disorders of metabolism; Diabetes Mellitus, Hypoglycemia ii) Structure, function and physiological roles of different proteins. Metabolism. Hypo- and Hyperproteinemia iii) Amino acids & related metabolites, Aminoaciduria iv) Glycoproteins, proteoglycans and collagen and ther disorders, v) Porphyrins, porphyria, vi) Lipids, lipoproteins, apoproteins. vii) Enzymology: diagnostic values of enzymes & isozymes in health and disease viii) Acid-base and Electrolyte imbalance and regulation ix) Tumor-markers x) DNA-RNA chemistry; xi) Vitamins, & Trace elements and other important metals xii) Biochemistry of various body fluids.
Practical (Skill): Students are supposed to be familiar with various Profiles of investigations, e.g., Cardiac. Renal, Liver profile etc. i) Manual method of estimation of sugar, urea, bilirubin, protein (total and fractional), creatinine, cholesterol, uric acid, amylase, acid and alkaline phosphatase ii) Automated method of estimation of: a)Above chemicals b) SGOT, SGPT, LDH, CPK, Calcium, Phosphate etc. iii) Measurement of Blood pH & Arterial blood gases iv) Electrolyte estimation (Na, K, Ca, Cl.) v) Lipids, apo-proteins and lipoproteins vi) Tumor markers vii) Chemical analysis of body fluids (CSF, Peritoneal fluid) viii) Practical on Quality assurance in a clinical chemistry laboratory.
Counselling: Pre-test and Post-test counselling of the patients. Medical auditing.
C) Endocrine Chemistry
Theory(Knowledge) & Practical (Skill): i) Hormones: chemistry, metabolism, physiology and pathology ii)Endocrine Function Tests (Theory & Practical) iii) Hormone Assay, RIA iv) Ligand Binding Assays
Counselling: Pre-test and Post-test counselling of the patients
Clinical Pathology (Clinical microscopy of body fluids)
Theory (Knowledge) and Practical (Skill): Physical, Chemical and Microscopic examination of various excretory / secretary fluids e.g. (i) Urine (ii) CSF (iii) Peritoneal, pleural, pericardial, synovial, and amniotic fluids (v) Semen (vii) Sputum and (viii) faeces etc.
Counselling: Pre test and Post test counseling of the patients
Clinical Haematology & Transfusion Medicine
A. Clinical Hematology
Theory (Knowledge): i) Detection and typing of anemia ii) Polycythemia iii) Neutrophilia, Eosinophilia, Basophilia, Lymphocytosis, Neutropenia, Lymphopenia, Agranulocytosis iv) Leukemia diagnosis, classification, clinicopathological correlation v) Thrombocytosis, thrombocytopenia, platelet function vi) Investigation of bleeding disorders vii) Investigation of prothrombotic states viii)Automation in hematology ix)Bone marrow physiology and pathology.
Practical (Skill): i) Collection, transport and processing of blood samples for different hematological investigations ii) Performance of routine hemogram, Hb, TLC, DLC, ESR. iii) Preparation staining and interpretation of peripheral blood smear iv) Aspiration of bone marrow, preparation of touch smear and bone biopsy. Staining and interpretation of marrow v) Cytochemistry of blood smear and bone marrow smear and their interpretation vi) Serum iron, folate and B12 estimation vii) Hemolytic studies e.g. osmotic frangibility, sickling test, estimation of HbF, HbA2, Coomb’s test vii) Leucocyte function test viii) Screening coagulation and DIC studies. BT, CT, PT, APTT, Clot stability ix) Investigation of prothrombotic states. Protein C, Protein S, Antithrombin III, Lupus anticoagulant x) Demonstration of common blood parasites.
Counseling: Pre-test and Post- test counseling of the patients.
B. Transfusion Medicine
Theory (Knowledge): It is expected that students should possess knowledge of the following aspects of Transfusion Medicine.
i) Basic immunohematology ii)ABO and Rh grouping iii)Clinical significance of other blood groups iv)Transfusion therapy including the use of whole blood, RBC concentrates and Blood component therapy v) Rationale of pre-transfusion testing vi)Transfusion transmitted Infections vii)Adverse reactions to transfusion of blood and blood components viii) Quality control in blood bank
Practical (Skill): i) Selection and bleeding of donors ii) ABO and Rh grouping iii) Resolving ABO grouping problems by secretor status in saliva and expanded panel iv) Familiarity with Antibody screening by; a) LISS (Low-ionic salt solution) b) Enzymes c) AHG (Anti-Human Globulin) v) Steps to be taken if the above are positive vi) Demonstrate familiarity with Cross-matching by; a) LISS (Low-ionic salt solution) b) Enzymes c) AHG (Anti-Human Globulin) vii) Steps to be taken if there is incompatibility viii) Preparation of blood components i.e. Cryoprecipitate, Platelet concentrate, Fresh Frozen Plasma, Single Donor Plasma, Red Blood Cell concentrates ix) Demonstrate familiarity with Antenatal and Neonatal work a) Direct antiglobulin test b) Antibody screening and titer c) Selection of blood for exchange transfusion x) Demonstrate familiarity with principle and procedures involved in ; a) Resolving ABO grouping problems b) Identification of RBC antibody c)Investigation of transfusion reaction d) Testing of blood for presence of ; (i)HBV (Hepatitis B Virus Markers) (ii) HCV (Hepatitis C Virus Markers) (iii) HIV (Human Immunodeficiency Virus markers) (iv) VDRL, xi) Investigation of hemolytic jaundice of adult and new born
Counseling: Pretest and Posttest counseling of the patients.
Clinical Microbiology
Theory (Knowledge): i) Medically important microbes in general. Enterobacteriaceae and other gram negative bacilli like Salmonella, Shigella, Ecoli etc. Gram positive cocci & bacilla and Mycobacteria, in particular. Their general behavior, life history, metabolism, genetics and mode of infection. ii) Epidemiology of infectious diseases iii) Hospital Acquired Infections/Nosocomial infections iv) Medically important parasites v) Medically important viruses vi) Medically important fungi vii) Systemic Microbiology: Gastroenteritis and bacterial food poisoning, Septicemia, wound infection, burn associate infections, U.T.I., R.T.I., C.N.S. infection including meningitis, encephalitis, STDs/ AIDS, opportunistic infections, congenital infections and infections in vulnerable groups e.g. AIDS patients, Cancer patients, Geriatrics, Premature babies, Pregnancy and post transplantation etc. (viii) Immunity to microbial diseases (ix) Vaccines for infectious disease (x) Laboratory acquired infections
(xi) Diagnosis & Prevention of infection (xii) Lab. Safety: Blood borne disease including-Viral Hepatitis & HIV, Air borne infections, Universal precautions, Principals of Bio-safety (xiii) Medico-Legal aspects of infectious diseases including postmortem findings and evidence based opinion on criminal cases in regard to infections/vaccines.
Practical (Skill): i) Methods of collection, transportation and techniques used for clinical samples: a) Blood b) Bone marrow, Splenic, Liver, Lymph Node aspirates c) CSF, Pus from closed cavities & open wounds d) Urine e) Stool f) Semen g) Sputum h) Saliva i) Swabs (nasal, pharyngeal, rectal, conjunctival etc.) ii) Demonstration of Microscopy (all types) iii) Commonly used stains in microbiology: Grams, Giemsa, Romanowsky, A.F.B, Kinyouns’, Albert’s special stains for spores, capsules, inclusion bodies, parasites & fungi iv) Culture Media: their preparation, inoculation, and uses v) Antibiotic sensitivity testing including automation in Microbiology and Interpretation of antibiograms vi) Serological tehcniques e.g. Widal, VDRL, CFT, ID, ELISA, IFA, RIA etc. In-vitro demonstration of CMI, Complement cycles, Blast transformation, Monoclonal antibodies, skin test and others vii) Biochemical tests for microbial identification viii) Serotyping of microbes ix) Bed side tests: FNA, intradermal tests, cord blood, lumber puncture etc. x) Animal inoculation studies xi) Egg inoculation, cell culture studied for the diagnosis of viral & other microbial infection xii) Human parasites including Protozoa, Nematodes, Cestodes and Trematodes and their diagnosis by gross, microscopic and serological & culture techniques. Diagnosis of amoebiasis, giadiasis, Leeishmaniasis, Toxoplasmosis & Malaria xiii) Fungal infections in human and their diagnosis xiv) Hospital infection surveillance. Maintenance of strains.
Counseling: Pretest and Post test counseling of the patients.
Clinical Immunology
Theory (Knowledge):
Physiology of Immune System ; i) Hypersensitivity Reactions ii) Autoimmune Diseases iii) Transplantation Immunology iv)Host-Parasite interaction
Practical (Skill): i) Demonstration of T and B cell. ii)Functional evaluation of T and B cell. iii) Immunoglobin estimation iv) Serological techniques like (a) CFT (b) Agglutination test (c) IHA & (d) ELISA with particular, reference to microbial serology, interleukins, ANF, RF, CRP (v) Radioimmunoassay vi) Immunoglobulins in health and disease vii) Complements in health and disease
Clinical Physiology
Theory (Knowledge) and Practical (Skill) of ORGAN FUNCTION TESTS: i) Liver function test ii) Kidney function test iii) Gastric function test iv) Pancreatic function test v) Splenic function test vi) Tests for Malabsorption vii) Respiratory function test viii) Cardiac function test ix) Endocrine function test
Molecular Biology
Theory (Knowledge) and Practical (Skill)
Structure of DNA & RNA, Genetic configuration of commonly used Genomic vectors/host and their uses in molecular biology, blotting technology (Southern, Northern, Western), DNA hybridization, RNA hybridization, Polymerase Chain Reaction (PCR) and its variants in various diseases, LCR (Ligase Chain Reaction), NASBA (Nucleic acid sequence based amplification), Micro-assay technology, Chromosomal analysis, HLA typing, Principles of Bioassays, Bio-chips, Cell culture technology.
Anatomic Pathology
Theory (Knowledge) and Practical (Skill) of Biopsy, Processing of tissue
Theory: Basic and General Pathology like Degeneration Necrosis, Inflammation, Growth disorders, Circulatory disturbance, Hypersensitivity reaction, Deficiency disease, Organ failure.
Histopathology techniques, Cytopathology technique, Histochemistry technique, Immuno-histochemistry techniques, Electron Microscopy
Histopathological interpretation of endometrial biopsy, common skin biopsies, lymph node biopsy, common benign and malignant tumors, common liver lesions, common renal lesions.
Clinical Medicine
In the course of 3 years residency, the students are expected to interact with clinical disciplines continuously during the ward round, pre-test and post-test counseling of the patients, in clinical round, combined round and clinico pathological conference.
i) For every case, they are encouraged for independently history taking, examination and assessment of the patients, formulation of panel of tests, sending samples along with requisition forms to the routine or emergency lab services. The patient may be in the OPD, casualty, general or private wards, intensive care units, operation theatre of different specialties of surgery. ii) They are expected to participate in post-test and pre-test counseling with patients or their relatives and clinico-pathological correlation of laboratory results. iii) Constant interaction with the clinical resident are also encouraged to make the latter aware of: a) The pre-instrumental sources of error in laboratory result b) Limitation of laboratory results in patient management. ‘Meet the Lab’ session clinician, in this content is a very useful learning opportunity.
VII. EXPOSURE TO RESEARCH
All efforts are made so that research methodology is apparent at the end of the course. It is an accepted norm at AIIMS that a student submits a Thesis six months prior to examination as a partial fulfillment to the award of the degree of MD (Laboratory Medicine). Students are also encouraged to present papers in conferences and publish papers in peer reviewed journals. Due emphasis is laid on the importance of obtaining ethical clearance from appropriate committees for both animal and human studies.
A separate course for training in research methodology may not be necessary. The required skill is usually acquired largely depending on the topic of research. The following points are guidelines to what may be expected of the student at the end of the course.
1. Recognize a research problem – basic or applied.
2. Clearly state the objectives in terms of what is expected to be achieved in the end.
3. Plan rational approaches with appropriate controls with full awareness of the statistical validity of the size of experimental material.
4. Carry out most of the technical procedures required for the study.
5. Accurately and objectively record on systematic lines the results and observations made.
6. Analyse the data with the aid of an appropriate statistical analysis, if necessary.
7. Interpret the observations in the light of existing knowledge and highlight in what ways the study has advanced existing knowledge on the subject and what further remains to be done.
8. Take photomicrographs, of a quality fit for publication in an international journal.
9. Write the thesis or a scientific paper in accordance with the prescribed instructions, as expected of international standards.
VIII. TRAINING METHODS
The training programme is designed to enable the student to acquire a capacity to learn and investigate for himself, to synthesize and integrate a set of facts and develop a faculty to reason. The curriculum programme and scheduling of postings are done in such a way that the students are given opportunities to embrace the above broad objectives.
The student himself accomplishes much of the learning. Interactive discussions are preferred over didactic sessions.
The student are blend as an integral part of the activities of an academic department that usually revolves around three equally important basic functions of teaching, research and service.
The following is a rough guideline to various teaching/learning activities that are employed.
1. Collection of specimens.
2. Sampling of specimens.
3. Instrumentation
4. Discussion during routine activities such as during signing out of cases.
5. Presentation and work-up of cases including the identification of special stains and ancillary procedures needed.
6. Clinico-pathological conferences.
7. Intradepartmental and interdepartmental conferences related to case discussions.
8. Conferences, Seminars, Continuing Medical Education (CME) Programmes.
9. Journal Club.
10. Research Presentation and review of research work.
11. Guest and in-house lectures.
12. Participation in workshops, conferences, and presentation of papers etc.
13. Laboratory work.
14. Use and maintenance of equipment
15. Maintenance of records
16. Teaching undergraduates and paramedical staff.
IX. Structured Training Programme
(Time Schedule of Posting during Residency)
Interaction with Clinical Colleagues
It needs to be emphasized that the Department of Laboratory Medicine caters for both Routine and Emergency (round the clock) services to the main hospitals as well as to the various centers. During the course of 3 years and particularly during their emergency posting the students are expected to interact with clinical disciplines continuously during the ward round. Pre-test and post-test counseling of the patients are advised. Residents are encouraged to take the ward round at least once a week with respective Head of the Department of Pediatrics and Medicine
Weekly Intradepartmental Journal club.
Weekly Intradepartmental Case discussion
There will be weekly intradepartmental rounds and case discussion on selected cases whose investigations have been done over the week in different sections of the laboratory, particularly with the following departments, Medicine, Pediatrics, Surgery, Gastroenterology, Endocrinology, Gynae and obstetrics, Neurology, Casualty and I. C. U.
Weekly Combine seminar with residents of Pathology Dept.
Weekly combined round and grand round of AIIMS
In weekly combined round and grand round of the AIIMS the residents of Laboratory Medicine will actively participate for discussion on the investigative aspects of the case presented.
A. Duration of posting in different sections of Laboratory Medicine: (26 months)
Orientation in three sections : 03 months (One month in each section)
Emergency Laboratory/Casualty : 06 months
Clinical Microbiology & : 05 months
Fluid and excretion Laboratory
Hematology : 05 months
Clinical Chemistry : 05 months
Writing Thesis : 02 months
In thesis, special emphasis will be laid on quality assurance, management of lab, medical audit and development of newer and simpler technology.
B. Posting in other specialty of AIIMS Labs : (10 months)
Blood Bank : 2 months
Hematology Department : 2 months
Pathology : 2 months
Microbiology Deptt. : 2 months
R. I. A. Lab., HLA lab, : 2 months
Clinical Immunology Lab & :
Biotechnology lab, Nuclear Medicine
X. THE DETAILS OF EVALUATION AND CONDUCTING EXAMINATIONS
A standardized scheme of evaluation is adopted to assess the candidates in any teaching programme. Both formative and summative evaluations are followed.
Internal (Formative) Assessment
Internal Assessment in fact is done everyday to assess the training and to identify the weakness as well as the strength of the candidate. Thus appropriate corrective methods can be adopted at the right time so that a well-trained and competent laboratory specialist worthy of a postgraduate degree is available for the society.
1. However a formal assessment is recorded at the end of every posting and reviewed every six months.
2. Research work is assessed or reviewed every six months. The protocol and the final results are presented to the entire department.
3. For evaluation of presentations, evaluation sheets may be incorporated for the purpose of assessment. The following points are usually considered in the scheme such as seminars and journal clubs:
1. Choice of article/topic (unless specifically allotted)
2. Completeness of presentation
3. Clarity and cogency of presentation
4. Understanding of the subject and ability to convey the same
5. Whether relevant references have been consulted
6. Ability to convey points in favour and against the subject under discussion
7. Use of audio-visual aids
8. Ability to answer questions
9. Time scheduling
10. Overall performance
In the case of specific posting similar points may be assessed with regard to knowledge and skills.
It is also usual that the candidates are assessed on the AFFECTIVE aspect of the training particularly with regard to the following:
1. Ability to get along with colleagues
2. To conduct with patients and nursing staff in a dignified way
During Formative Assessment Grading are done in one of the following ways:
(i) Awarding actual marks:
(ii) Awarding scores: 0 = Poor
1 = Below average
2 = Average
3 = Above average
4 = Good
(iii) Awarding grades
A+ = 90% - 100%
A = 80% - 89%
A- = 75% - 79%
B+ = 70% - 74%
B = 60% - 69%
B- = 50% - 59%
C = < 50%
The grades are endorsed by more than one faculty member or an average obtained by pooling the grades of different faculty members. This is conveyed to the candidate periodically (at least once in every six months) so that the candidate knows where he or she stands.
FINAL (Summative) ASSESMENT
The final examination is held at the end of three years of the training programmes. This would include assessment of the thesis and a formal examination on the theoretical and practicals aspects of the specialty of Laboratory Medicine.
Examiners –
At present for conducting the postgraduate Examination at AIIMS, there are four (4) examiners two Internals and two Externals. As laboratory medicine encompasses a multidisciplinary forum, the care will be taken to select examiners who are specialized in different aspect of laboratory investigations so that the entire spectrum is covered during final examination.
1. The thesis/dissertation are evaluated by at least two external examiners well versed in the topic studies. It is therefore recommended that thesis/dissertation be submitted for evaluation six months prior to the theory and practical examinations. The results of the evaluation are made available prior to the practical examinations.
2. The examination will include:
a. Theory
b. Practical
c. Viva Voce
3. THEORY
4. Theory papers of 100 marks each
Paper I (Basic Pathology and Clinical Pathology)
Etiology and Pathogenetic Mechanisms of diseases.
Basic pathological processes. Degeneration, Necrosis, Inflammation, Circulatory disturbances, Disorders of Growth including Neoplasia, Metabolic disorders, Organ failure etc.
Factors which determine the course of diseases, and genesis of complications
Various diagnostic techniques to arrive at diagnosis and laboratory follow up of diseases,Physiology and Pathology of Immune system. Complement function, Hypersensitivity reaction, Immune complex diseases, Autoimmune disease. Transplantation pathology, Tissue typing. HLA and disease
Chromosal and Genetic disorders
Antenatal Diagnosis of diseases
Radionucleide Studies
Organ Function tests in different Pathological conditions:
Gastric function test,
Pancreatic function test
Liver function test
Intestinal function tests , Malabsorption syndrome
Kidney function test
Endocrine function tests.
Placental function test
Pregnancy test and related investigations
Tumor Markers: Diagnostic and Prognostic values
Collection, Transport and Examination of Body fluids
Physical chemical and microscopic examination of Urine, Cerebrospinal fluid, Pleural, Peritoneal and Synovial fluids.
Examination of Semen
Examination of Sputum
Examination of Fistula’s fluid.
Examination of Amniotic fluid
Flow cytometry: Technique and applications
Some diagnostic techniques for Anatomic pathology
FNAC technique, Papanecoulau and Giemsa stain
Technique of grossing, different histopathological staining techniques, Frozen section.
Immune histochemistry and immunofluorescent techniques.
Exposure to technique of electron microscopy
Learning the Essence of histopathological reporting
Cytology to distinguish benign from malignant lesions
Recent Advances in Clinical Pathology
Quality Assurances in general: Principle and Methods
Laboratory Organization, Management, Laboratory Safety, Purchase procedure and Development
Paper II (Clinical Biochemistry)
Biochemical basis of disease (Molecular Medicine).
Carbohydrate: Digestion, Absorption, Metabolism.
Classification, Identification, Estimation and Disorders of metabolism.
Proteins: Digestion, Absorption, Metabolism
Classification, Structure, Biosynthesis and Disorders of amino acids and proteins metabolism.
Lipids and Lipoproteins: Digestion, Absorption, Metabolism, Estimation and diagnostic significance. Apoproteins. Disorders of Lipid Metabolism
Inborn errors of Metabolism
DNA and RNA chemistry, Structure, Biosynthesis ,gene expression
Enzymes: Kinetics, cofactor, inhibitors and diagnostic enzymology.
Isoenzymes of clinical importance
Blood gases and Acid base imbalances
Estimation and importance of Serum and Urine electrolytes, Various electrolyte imbalances
Serum tumor markers: Biochemistry
Hormones: Chemistry and Metabolism. Estimation of thyroid, reproductive and protein and other hormones
Porphyrins
Trace elements, vitamins etc
Immunology
Immunoglobulins, lymphokines, leukotrienes , prostaglandins, complement system
Immunotechniques
Chemistry of Body fluids like, CSF, urine, pleural and peritoneal fluids.
Clinical chemistry of digestive system: gastric, pancreatic and intestinal juices and various estimation
Analytical Instruments in a clinical chemistry laboratory including Microtechniques
Automation: Steps, types, advantages, disadvantages, limitation and scope (advances)
Quality Assurance in a clinical chemistry laboratory.
Laboratory Safety
Recent advance in techniques and in clinical chemistry
Paper III (Clinical Microbiology and Immunology)
Systemic and taxonomic classification of medically important bacteria, viruses, fungi and Parasites
Principles of Metabolism, Molecular biology of bacteria
Sterilization, collection, transportation and processing of fecal, urine, semen, sputum, blood and other body fluids for various investigations.
Epidemiology of Infectious Diseases including molecular epidemiology
Hospital Acquired Infections and their control including universal precautions and prevention of infection in health care workers.
Systemic Microbiology.
CNS infections including meningitis and encephalitis, Respiratory tract Infections including pulmonary tuberculosis, Gastroenteritis and hepatobilliary infection, Infections of Cardiovascular system, urinary tract infections, Sexually transmitted diseases including HIV/AIDS, Torch complex and tegumentary infections.
Immunity of Microbial infections both cellular and humoral, including various cytokines.
Principles and development of Vaccines and adjuvants including Extended Programme of Immunization
Antibiograms
Various methods of Infectious disease diagnosis including conventional, serological, molecular and animal inoculation techniques.
Quality Assurance
Automation in Clinical Microbiology laboratory
Recent Advances in Microbiology and Immunology
For example,Newly Emerging infectious Disease
Recent advances in molecular biology: NASBA, Ligase Chain Reaction (LCR), Polymerase Chain Reaction (PCR), Fluorescent In-situ-Hybridization (FISH), Gene Sequencing
Vaccine development to prevent HIV infection
Sigma factor in tuberculosis
Chemokines in HIV infection
Third generation cephalosporins
Multidrug resistance in Mycobacterium
Paper IV (Hematology and part of Transfusion Medicine)
Syllabus for Hematology
Normal Hemopoiesis
Anemia, causes, types, diagnosis, monitoring
Polycythemia
Hemoglobinopathies, Thalassemia and Porphyria
Leucocytosis causes and various types, Leukopenic state.
Leucocyte functions
Leukemia, diagnosis, classification, clinicopathological correlation.
Thrombocythemia, Thrombocytopenia, Platelet function disorders.
Myloproliferative and Lymphoproliferative disorders
Investigation of Bleeding disorders. DIC studies
Bone marrow physiology and pathology
Examination and assessment of Bone marrow for different hematological disorders
Blood and Bone marrow parasites
Macrophase disorders
Hematological abnormalities in Systemic disorders
Quality assurance in Hematology
Automation in hematology
Recent Advances in Hematology
Syllabus for Blood banking (Transfusion Medicine)
Selection of Donors and Collection of blood and its storage
Screening for Transfusion-mediated diseases
Grouping and cross matching
Major and minor blood groups.
Various transfusion reactions and their investigations.
Investigation of Hemolytic Jaundice of adult and new born.
Blood Components: Preparation, Storage and Use
Quality assurances.
Recent Advances
B. PRACTICAL EXAMINATION is conduced for two days:
|
Date & Time |
Exercise |
Resident I |
Resident II |
|
First day 09-10 AM 10-11 AM 11-12 AM 12-01 PM 1.00-1.30 Lunch 1.30-2.30 PM 2.30-3.15 PM 3.15-4.00 PM 4.00-4.45 PM |
Clinical Pathology case discussion Microbiology sample processing Microbiology slide spotting Transfusion Medicine Practical
Hematology & Path. slide drill Cl. Chemistry Ex. 1 Cl. Chemistry Ex. 2 Cl. Chemistry Ex. 3 Cl. Chemistry Ex. 4
Continue Micrbiol. Processsing |
|
|
|
Second Day 9.15- 9.45 AM 9.45-10.30 AM
10.30-11.00AM 11.00-11.45AM 12.30-1.30 PM 1.30-2.15 PM Lunch 2.15-3.00 PM 3.00-5.00 PM |
Bleeding disorder Exercise & Practical Prothrombine Time/Platelet count CSF Exercise and analysis Urine examination Stool Examination Serology Exercise
Microbiol. processing follow up Grand Viva |
|
|
B.VIVA VOCE – During two days of practical examination viva voce will be conducted on selection, operational and interpretative aspects of tests performed. Grand viva will be on day 2 at the end for 2 hours.
XI. RECOMMENDED READING MATERIALS
Periodicals
1. The American Journal of Clinical Pathology
2. Indian Journal of Pathology and Microbiology
3. National Medical Journal, India
4. Archives of Pathology and Laboratory Medicine
5. Laboratory Medicine
6. Journal of Clinical Pathology
7. Laboratory Investigation
8. The American Journal of Pathology
9. The American Journal of Hematology
10. British Journal of Hematology
11. Blood
12. Seminars in Hematology
13. Seminars in Diagnostic Pathology
14. Journal of Clinical Microbiology
15. The Journal of Parasitology
16. Parasitology
17. Tuberculosis
18. Virology
19. Year Book Series
20. Recent Advances Series
21. Reviews in biochemistry
22. J. Biol. Chemistry
23. Hepatology
24. Biochemistry
25. J. Immunol Methods
26. Nature
27. Science
Books
1. Clinical Diagnosis and Management by Laboratory Methods, Henry JB, WB Saunders. (Indian Edition, Eastern Press, Bangalore).
2. Clinical Laboratory Medicine, Editor Kenneth D. McClatchey, Lippincott Williams & Wilkins.
3. Laboratory Medicine Test Selection and Interpretation, Ed. Joan H. Howanitz & Peter J.Howanitz. Churchill Livingstone.
4. An Introduction to Clinical Laboratory Science, Clerc.
5. Widmann’s Clinical Interpretation of Laboratory Tests, Sacher.
6. Clinical Laboratory Science Education & Management, Wallace.
7. Most Commons in Pathology and Laboratory Medicine, Goljan.
8. Advances in Pathology and Laboratory Medicine, Graham.
9. Interpretation of Diagnostic Tests, Wallace.
10. Delmar’s Guide to Laboratory & Diagnostic Test, Deniels.
11. A Manual of Laboratory & Diagnostic Tests, Fischbach.
12. General Pathology JB Walter, MS Israel. Churchill Livingstone, Edinburgh.
13. Robin’s Pathologic Basis of Disease Ramzi S. Cotran, Vinay Kumar, Stanley L Robbins WB Saunders Co., Philadelphia.
14. William’s Hematology Beutler E, Lichtmann MA, Coller BS, Kipps TJ, McGraw Hill, New York.
15. Postgraduate Hematology Hoffbrand AV, Lewis SM, Tuddenham EGD, Butterworth Heinemann, Oxford.
16. Wintrobe’s Clinical Hematology, Lee GR, Foerster J, Lupeus J, Paraskevas F, Gveer JP, Rodgers GN, Williams & Wilkins, Baltimore.
17. Practical Hematology, Dacie JV, Lewis SM, Churchill Livingstone, Edinburgh.
18. Bone Marrow Pathology, Bain BJ, Clark DM, Lampert IA, Blackwell Science, Oxford.
19. Leukemia Diagnosis – A guide to the FAB Classification, Bain BJ, JB Lippincott, Philadelphia.
20. Fundamental of Clinical Chemistry, N. W. Teitz WB Saunders Company, Philadelphia.
21. Varley’s Practical Clinical Biochemistry, JR Mc Murray, DM McLaunchlan, Heinemann Professional publishing, Oxford.
22. A New Short Textbook of Chemical Pathology, Baron.
23. Glossary of Biochemistry and Molecular Biology, Glick.
24. Diagnostic Microbiology, Bailey & Scott’s.
25. Principles of Bacteriology, Virology and Immunity, Topley & Wilson’s.
26. Medical Microbiology, Mackie and McCartney.
27. Medical Microbiology and Immunology, Levinson, Jawetz.
28. Genes, Benjamin Lewin.
29. Immunology, Roitt, Brostoff, Male, Bailliere Tindall, Churchill Livingstone, Mosby, W.B. Saunders.
30. Harrison’s Principles of Internal Medicine, McGraw Hill
XII. EPILOGUE
1. At the end it is better said that no curriculum is Final. It requires constant updating and change, which commensurates with the changing need of the Institution and the Country.
2. Maintenance of a logbook for the Residents, as we maintain in our department, is probably the best way to keep track of their record of training. The Log book is available from the Dept. of Laboratory Medicine and from Academic section of AIIMS.
3. What we envisage is the TRANSFORMATION of Laboratory Science in such a way that MD Laboratory Medicine remains its basic post graduate degree followed by superspecialization with DM degree in Histopathology/Cytology, Hematology, Microbiology/ Virology, Clinical Chemistry etc. (Reference: Hospital Administration, (1997), 34 (1&2), pp. 51-57.
