COMPETENCY BASED POSTGRADUATE TRAINING PROGRAMME

FOR MD (General Medicine)

Preamble

A postgraduate specialist in Internal Medicine having undergone the required training

should be able to recognize the health needs of the community, should be competent to handle
effectively all medical problems. He should be well versed with applied basic sciences and updated
on the recent advances pertaining to his specialty. The PG student should acquire the basic skills in
teaching of medical / para-medical students. He /she is also expected to know the principles of
research methodology and modes of accessing literature.

Competency based training programme aims to produce a post-graduate student who after
undergoing the required training should be able to deal effectively with the needs of the
community and should be competent to handle all problems related to his/her specialty including
recent advances. He / She should also acquire skill in teaching of medical / para-medical students
in the subject that he / she has received his/her training. He / She should be aware of his/her
limitations.

Thus the goal to all MD (General Medicine) Course is to produce a competent doctor
who:

1. Is aware of contemporary advances & developments in medical sciences as related to the

subject.
2. Has acquired the competencies pertaining to the subject that are required to be practiced in
the community and at all levels of health system.
3. Recognizes the health needs of subject and families and carries out professional obligations
in keeping with principles of the National Health Policy and professional ethics.
4. Is oriented to principles of research methodology.

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5. Has acquired skills in educating medical and paramedical professionals.
6. Has acquired skills in effectively communicating with the person, family and the
community.

SPECIFIC LEARNING OBJECTIVES

There is need of competency based learning. Core competencies are the essential knowledge,
values and skills vital to the successful performance of one’s job function i.e. effective practice of
medical care. Competence-based training is distinctly different from traditional teaching process.
Competence-based training focuses on learning by doing.
Competence in medicine has been defined as “the habitual and judicious use of communication,
knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for
the benefit of the individuals and communities being served”. Competence is not an achievement
but rather a habit of lifelong learning.
Ideally, the assessment of competence (what the student or physician is able to do) should
provide insight into actual performance (what he or she does habitually when not observed), as a
well as the capacity to adapt to change, find and generate new knowledge, and improve overall
performance. The specific learning objectives based on core competence are common to all
specialities. As an example of designing learning objectives in the seven domains of core
competence the practices in the University of Florida have been followed and are described below:

1. Professionalism
2. Patient care
3. Medical Knowledge
4. Practice-based learning and improvement
5. Interpersonal and Communication skills
6. Systems-based practice

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 7. Academic skills

COMPETENCY SPECIFIC COMPETENCIES AND CATEGORIES

LEARNING OBJECTIVES

1. Professionalism
1.1 Accepts personal responsibility for care of one’s patients, consistent with good work ethics
and empathy.
1.2 Demonstrates appropriate truthfulness and honesty with colleagues.
1.3 Recognized personal beliefs, prejudices, and limitations.
1.4 His / Her personal beliefs and prejudices should not come in the way of providing service.
1.5 Respects patient confidentiality at all times in verbal and written communication with
others.

2. Patient Care
History of and physical examination.
2.1.1 Demonstrates ability to obtain a comprehensive and focused
2.1.2 Demonstrates ability to perform a comprehensive and problem focused physical
examinations.

2.2 Information Management

2.2.1 Demonstrates mastery of the traditional organization of medical data in oral and written
presentations.
2.2.2 Demonstrates use and interpretation of diagnostic procedures and palsoratory data.

2.3 Procedural

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2.3.1 Demonstrates mastery of adequate medical record keeping.
2.3.2 Demonstrates knowledge of accessing data and information systems.
2.3.3 Demonstrates the ability to perform a specific set of procedures identified by the faculty.

3. Medical Knowledge
3.1 Core Discipline
3.1.1 Competencies unique to the discipline
3.1.2 Competencies derived from the clinical pre and para clinical subjects.

3.2 Problem Solving

3.2.1 Demonstrates the ability to identify and find information relevant to a clinical problem,
using consultation, texts, and the archival literature and electronic media.
3.2.2 Demonstrates the ability to generate an initial list of differential diagnoses given a specific
chief complaint and patient characteristics.
3.2.3 Demonstrates the ability to re-rank the differential diagnoses based on information gathered
from the history, physical, and auxiliary studies.
3.2.4 Demonstrates the ability to explain a mechanism for each aspect of a patient’s problem,
including biological, behavioral, and social aspects.
3.2.5 Demonstrates the ability to evaluate scientific / clinical information and critically analyze
conflicting data and hypotheses.

4. Practice-Based Learning and Improvement

4.1 Physician Scholar

4.1.1 Demonstrates the ability to analyze the quality and implications of medical literature and
apply new knowledge in the delivery of health care.

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4.1.2 Demonstrates an interest and ability to identify future areas of inquiry in medical research.
4.1.3 Demonstrates enthusiasm and positive attitude in the educational process and participates
fully in educational activities.

5. Interpersonal and Communication Skills

5.1 Human Relationships

5.1.1 Demonstrates knowledge of or appropriately inquires about family and support systems.
5.1.2 Demonstrates an effective system for identifying and addressing ethical, cultural, and
spiritual issues associated with health care delivery
5.1.3 Demonstrates knowledge or applies an understanding of psychological, social, and
economic factors which are pertinent to the delivery of health care.
5.1.4 Accurately assesses a patient’s exportations and assumptions in accessing the health care
system.
5.1.5 Effectively engages the patient and / or family in verbal communications.

6. System – Based Practice

6.1 Health Care Management

6.1.1 Demonstrates a practical, efficient and cost effective approach to diagnosis and treatment
planning and recognizes its social and economic impact.
6.1.2 Demonstrates the ability to engage the patient family in diagnosis and therapeutic treatment
planning.
6.1.3 Demonstrates the ability to recognize and outline initial treatment for patient with life
threatening emergencies regardless of etiology.
6.1.4 Demonstrates knowledge of alternative medicine options and understands their role in
health care delivery (AYUSH).

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6.2 Health Service Delivery
6.2.1 Demonstrates knowledge of health care financing and applies it in assisting patient to
access the best possible care.
6.2.2 Utilizes knowledge of population based and evidence based medicine in making patient
management decisions.
6.2.3 Utilizes knowledge of managed care systems in making patient treatment plans and health
care maintenance plans.
6.3 Health Care Team approach to health care delivery.
6.3.1 Demonstrates an understanding of the roles and competencies of other health care
providers.
6.3.2 Demonstrated the ability to engage other health care professionals.
6.3.3 Demonstrates the ability to follow and lead in a team approach to health care delivery in the
delivery of health care.

7. Academic Skills

7.1 Familiarity with basic research methodology, epidemiology, basic information technology
skills.
7.2 Planning the protocol of a thesis, its execution and final report.
7.3 Review of literature
7.4 Conducting clinical sessions for undergraduate medical students, nurses and paramedical
workers.
7.5 Desirable; writing and presenting a paper

CURRICULUM

Duration of the course

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The course of the study shall be for three years.

1.1 Biostatistics and research methodology

Types of study design, calculation of adequate sample size and its significance, basic
concepts of biostatistics as applied to health science – mean., Mode, median, S.D., analysis
of variance and correlations – Students ‘t’ test, Chi square test, Fisher’s exact test, Non-
parametric tests of significance, One-way and two-way analysis of variance, Multivariate
analysis, Survival analysis-log rank test, Relative risk calculation – Odd’s ratio, familiarity
with commonly used statistical software.
1.2 Ability to perform Computer application
Microsoft office (Microsoft word, excel, power point, one poin), Internet, Searching
scientific databases (e.g. Pubmed, Medline, Cochrane reviews).

1.3 Thesis writing

To do review of articles, reference writing

1.4 Able to access and apply Recent Advances in Medicine

2. SUBJECT SPECIFIC THEORETICAL COMPETENCIES

Knowledge

• Describe etiology, pathophysiology, and principles of diagnosis and management of all

medical problems including emergencies in adults related to internal Medicine;

• Demonstrate understanding of basic sciences relevant to his specialty and knowledge of

recent advances ;

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 • Identify social, economic, environmental and emotional determinants in a given case, and
take them into account for planning therapeutic measures;

• Recognize conditions that may be outside the area of his/her specialty/competence and to
refer them to the appropriate specialist;

• Advise regarding the management of the case and to carry out this management effectively;

• Update oneself by self-study and by attending courses, conferences and seminars relevant
to the specialty;

• Teach and guide his/her team, colleagues and other students; and

• Undertake audit, use information technology tools and carry out research, both basic and
clinical, with the aim of publishing his/her work and presenting at scientific forums.

Human values, Ethical practice and Communication abilities

• Adopt ethical principles in all aspects of his/her practice. Professional honesty and
integrity are to be fostered. Care is to be delivered irrespective of social status, caste,
creed or religion of the patient;

• Develop communication skills, in particular the skill to explain various options available
in management and to obtain a true informed consent of the patient;

• Provide leadership and get the best out of his/her team in a congenial working
atmosphere;

• Apply high moral and ethical standards while carrying out human or animal research;

• Be humble and accept the limitations in his/her knowledge and skill and to ask for help

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 from colleagues when needed; and

• Respect patient’s rights and privileges including patient’s right to information and right
to seek a second opinion.

Core Competences

• The core competences grouped as communication abilities, clinical assessment skills,

laboratory and other procedural abilities, and interpretation skills are given in Appendix I.

These are defined for each subject in their devoted chapters. Reference books of the
speciality are provided for each subject.

3. SUBJECT SPECIFIC PRACTICE-BASED OR PRACTICAL COMPETENCIES

Levels of Training

The Medical Council of India Postgraduate Regulations 2000, has recommended that training be
structured and graded responsibilities be given. A model for structured training is suggested and is
given in Appendix II. The graded responsibility for clinical and procedural competencies are
categorized as under:

a. For clinical and procedural competencies:

• Observes the procedure (O)

• Assists a senior performing the procedure (A)

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 • Able to perform with assistance or under supervision (PA)

• Able to perform independently (PI)

b. For interpretation abilities

• Able to interpret findings or results in consultation with a senior (PA)

• Able to interpret independently the findings / results (PI)

c. For competencies related to communication and interpretation abilities

Three categories are suggested:

• Level I for beginners;

• Level 2 for intermediate level; and

• Level 3 at advanced level

Example Appendix III

Theoretical competencies are to be translated in to practical competencies. Practice based

competencies can then be organized to develop subject specific Log Book to be maintained
by every postgraduate student.
Subject specific practice based competencies arranged under following heads:

Name/ Description of practice based competencies Expected quantum

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 TEACHING AND LEARNING METHODS

Didactic lectures are of least importance; seminars, journal clubs, symposia, reviews,
clinico-pathological exercises and guest lectures should get priority for theoretical knowledge.
Bedside teaching, grand rounds, interactive group discussions and clinical demonstrations should
be the hallmark of clinical / practical learning. Students should have hands-on training in
performing various procedures and ability to interpret various tests / investigations. Exposure to
newer specialized diagnostic/ therapeutic procedures concerning his subject should be given.

The principle means of training is learning by doing. While trainees will always contribute
to the service in the teaching hospital, their priority must be training. It is equally essential that the
workload , in both emergency and external rotations like cardiology, neurology and other
subspecialties is sufficient to provide the range and intensity of experience required for satisfactory
training. The postgraduates should be given responsibility in a graded manner in the three year
course.

Importance should be attached to consultant ward rounds especially in conjunction with

emergency admissions. Supervision of work in outpatients should cover the whole range of work
in the unit. It is particularly necessary to attend sub-specialty and symptom specific clinics. The
development of independent skills is an important facet of postgraduate training. Joint meetings
with physician colleagues, e.g. radiologists and pathologists play a valuable part in training.

The training techniques and approach should be based on principles of adult learning. It
should provide opportunities initially for practicing skills in controlled or simulated situations.
Repetitions would be necessary to become competent or proficient in a skill. The more realistic the
learning situation, the more effective will be the learning. Clinical training should include
measures for assessing competence in skills being taught and providing feedback on progress

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towards a satisfactory standard of performance. Time must be available for academic work and
audit. Trainee should be involved in teaching undergraduates.

1. Lecture

2. Discussion

3. Student Directed Learning

4. Case Based Learning

5. Role Playing

6. Simulated Patient Lab

7. Electronic & Computer Simulators

8. Web Based

ASSESSMENT

WHAT TO ASSESS?

The various domains of competence should be assessed in an integrated, coherent, and longitudinal
fashion with the use of multiple methods and provision of frequent and constructive feedback.

1. Habit of mind and behavior

2. Acquisition and application of knowledge and skills
3. Communication
4. Professionalism
5. Clinical reasoning and judgment in uncertain situations
6. Teamwork
7. Practice-based learning and improvement
8. Systems-based practice

HOW TO ASSESS?

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Assessment of Competence

The summative assessment occurs to ensure that competence goals have been achieved. Criterion-
referenced assessment should be adopted for testing the acquisition of competencies i.e the level of
competency to be achieved is determined before the learning process is initiated. Assessment
should ensure the desired mastery of skills as shown in appendices.

Postgraduate Examination (50% marks for theory and 50% marks for practical)
The candidate has to secure 50% marks in theory (papers) and practical clinical examination (each)
in order to pass the examination.

Thesis to be submitted by each candidate at least 6 months before the commencement of

theory examination. Acceptance of thesis shall be a precondition for the candidate to appear
for the final examination.

Theory:
Part I : At the end of first year, there should a theory paper on Applied basic sciences* (internal)
Part II: At the end of final year, there will be four papers of 3 hours each.(100 marks each)
1. Principles and Practice of Medicine
2. Medicine and allied specialties including pediatrics, dermatology &
psychiatry
3. Tropical Medicine & Infectious Diseases
4. Recent Advances in Medicine

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Effort should be made to construct and use problem based short answer and essay questions, which
should cover the whole spectrum of syllabus. Model answers / checklists including key-points
should be given to the paper checkers.

* The topics assigned to the different papers are generally evaluated under those sections.
However, a strict division of the subject may not be possible and some overlapping of topics are
inevitable. Students should be prepared to answer overlapping topics.

Clinical / Practical
At the end of first and second year, practical clinical examinations to be conducted
allocating 25% of the total marks to each of these examinations.** Remaining 50% of the
marks to be assigned to final practical / clinical examinations at the end of third year.

The first and second year examinations to be conducted using Objective structured clinical
examinations (OSCE) and other methods of work-based assessment (e.g. mini-CEX). The
assessments should include history taking, physical examination, interpretation,
communication and procedural skills. More advanced skills to be assessed as the training
progresses.

This assessment at the end of second year will include mid-term presentation and
evaluation of thesis work.
The final clinical examination (500 +100) should include:
• 4 semi-long cases pertaining to all major systems (60 x 4 = 240)
• 08 OSCE stations for clinical, procedural and communication skills (15x 8 = 120)
• Minimum of 4 spotters (clinical) (20 x 4 = 80)
• Viva-voce (should include thesis) – marks to be added to theory (100)
• Log Book Records and day-to-day observation during the training.( 60)

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 *Candidate who is not able to clear theory paper at end of 1st year should be allowed to
take the paper again at end of second year.

** The practical examination at the end of first year may be conducted by Internal
examiners only. While at the end of second year there should be at least one external
examiner.

The candidate should clear both theory and clinical exams with minimum pass marks
of 50 %.

There should not be more than 6 candidates for each day, in case the examiners are
only four, i.e. two external and two internal examiners.

1. FORMATIVE ASSESSMENT, NAMELY, ASSESSMENT DURING THE RESIDENCY

PROGRAMME

Competency Method of Evaluation Evaluators (s)

I. Professionalism * 360-degree assessment Peers, teachers

** Standardized patient assessment supervising
teacher

II. Patient Care * Case presentation Supervising

Clinician

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 * OSCE Teacher

** Incognito standardized Supervising

clinician

** Global rating with comments Unit

incharge
at the end of rotation

III. Medical Knowledge * MCQ Supervising

teacher

* Essay type question

Supervising
teacher

* OSCE
Supervising
teacher

* Oral examination Supervising

teacher

IV. Practice-Based Learning * Journal Club Teachers

* Seminar presentation Teachers

V. Interpersonal and * Seminar presentation Teachers

communicating Learning

VI. Systems-Based practice ** Standardized patient Supervising

assessment clinician

* Oral examination
Supervising
Teacher

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 * Peer reviews Peers

VII. Academic Skills * Journal Club Teachers

** Taking lecture
Supervising
teacher

* Phase I – Could be implemented immediately

** Phase II – Could be introduced after phase I assessment is established.

2. END ASSESSMENT, NAMELY, ASSESSMENT AT THE END OF TRAINING

Competency Method of Evaluation Evaluators (s)

I. Professionalism * MCQ Examiner

** Standardized patient assessment

II. Patient Care * OSCE Examiner

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 ** Clinical evaluation exercise
Examiner
(CEX) or video review
** Incognito standardized patient
Examiner

III. Medical Knowledge * MCQ Examiner

** Key-feature and script-
Examiner
Concordance questions
* Shot-answer questions
Examiner
* Structured essays
Examiner
* Oral examination
Examiner

IV. Practice-Based Learning ** Key-featured and script- Examiner

Concordance questions
* Oral examination
Examiner

V. Interpersonal and * 360-degree assessment Examiner

Communication Skills

VI. Systems-Based practice ** Standardized patient assessment Examiner

VII. Academic Skills ** Key-features and script-

Examiner
Concordance questions
* Short-answer questions
Examiner

* Phase I – Could be immediately implemented

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** Phase II – Could be introduced after phase I assessment is established.

Appendix I

List of Essential Competencies for M.D. in General Medicine

Note:

1. List of essential competencies that every postgraduate candidate should acquire by the end of the
course have been identified and classified as:

• Clinical assessment skills;

• Procedural skills;

• Laboratory-diagnostic abilities;

• Interpretation abilities; and

• Communication abilities

2. The figures shown are suggestive and minimum numbers.

Competency list

Description of competencies Number

Clinical Assessment Skills (All PI)

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 • Elicit a detailed clinical history 100

• Perform a thorough physical examination of all the 100

systems

Number at end of item indicates minimum number of supervised and documented skills.

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 Description of Competencies Number
Procedural skills (All PI)
• Test dose 10
• Mantoux test 10
• Sampling for fluid cultures 10
• IV – Infusions 10
• Intravenous injections 50
• Intravenous cannulation 50
• ECG recording 50
• Pleural tap 30
• Lumbar puncture 30
• Resuscitation BLS 30,ALS 10

• Central line insertion, CVP monitoring 10

• Blood and blood component (platelet,
10
FFP etc) transfusions
• Arterial puncture for ABG 20
• Fine needle aspiration cytology (FNAC) from
20
palpable lumps
Bone marrow aspiration and biopsy 20
Abdominal paracentesis - diagnostic
20
Pericardiocentesis 05
Joint fluid aspiration 05
Liver biopsy 10
Nerve/ muscle/ skin/ kidnev/ pleural biopsy 10

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 Ultrasound abdomen, echocardiography 10

Upper GI endoscopy, if possible

List of PA skills:
• Peritoneal dialysis
Observes the procedure (O) 5
• Subdural, ventricular tap if possible 2

Respiratory management (All PI):

• Nebulization 50
• Inhaler therapy 20
• Oxygen delivery 50

Critically ill person (All PI)

• Monitoring a sick person 50
• Endotracheal intubation 10
• CPR 10
• Using a defibrillator 10
• Pulse oximetry 10
• Feeding tube/Ryle’s tube, stomach wash 10
• Urinary catheterization – male and female 10
• Prognostication 10
• Intercostal tube placement with underwater seal 10
• Sedation 10

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 • Analgesia 20

List of PA skill:
• Assessment of brain death 10

Laboratory-Diagnostic Abilities (All PI)

• Urine protein, sugar, microscopy 10
• Peripheral blood smear 10
• Malarial smear 10
• Ziehl Nielson smear-sputum, gastric aspirate 10
• Gram’s stain smear-CSF, pus 10
• Stool pH, occult blood, microscopy 10
• KOH smear 2
• Cell count – CSF, pleural, peritoneal, any serous 20
fluid

Interpretation Skills (All P1)

• Clinical data (history and examination findings), formulating a differential diagnosis in

order of priority, using principles of clinical decision making, plan investigative work-up,
keeping in mind the cost-effective approach i.e. problemsolving and clinical decision-
making
• Blood, urine, CSF and fluid investigations - hematology, biochemistry
• X-ray chest, abdomen, bone and joints
• ECG
• Treadmill testing

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• ABG analysis
• CT scan chest and abdomen
• CT scan head and spine
• MRI
• Barium studies
• IVP, VUR studies
• Ultrasound abdomen
• Pulmonary function tests
• Immunological investigations
• Echocardiographic studies

Interpretation under supervision (PA)

• Hemodynamic monitoring
• Nuclear isotope scanning
• MRI spectroscopy / SPECT
• Ultrasound guided aspiration and biopsies

Communication skills (All PI) (Level 1, Level 2 and Level 3)

• While eliciting clinical history and performing physical examination

• Communicating health, and disease

• Communicating about a seriously ill or mentally abnormal
• Communicating death
• Informed consent
• Empathy with patient and family members
• Referral letters, and replies

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• Discharge summaries
• Death certificates
• Pre-test counseling for HIV
• Post-test counseling for HIV
• Pedagogy -teaching students, other health functionaries-lectures, bedside clinics, discussions
• Health education - prevention of common medical problems, promoting healthy life-style,
immunization, periodic health screening, counseling skills in risk factors for common
malignancies, cardiovascular disease, AIDS
• Dietary counseling in health and disease
• Case presentation skills including recording case history/examination, preparing follow-up
notes, preparing referral notes, oral presentation of new cases/follow-up cases
• Co-coordinating care - team work (with house staff, nurses, faculty etc. )
• Linking patients with community resources
• Providing referral
• Genetic counseling

Others

• Demonstrating

- professionalism

- ethical behavior

(humane and professional care to patients)

• Utilization of information technology

- Medline search, Internet access, computer usage

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 • Research methodology

- designing a study
- interpretation and presentation of scientific data

• Self-directed learning

- identifying key information sources

- literature searches

- information management

• Therapeutic decision-making

- managing multiple problems simultaneously

- assessing risks, benefits and costs of treatment options

- involving patients in decision-making

- selecting specific drugs within classes

- rational use of drugs

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Appendix II

Illustration of Structured Training

Time Period Description/Levels Content Responsibilities

1st Month Orientation Basic cognitive - Combined duties

skills - Supervised procedures
I year Beginners Procedural abilities* - History sheet writing
OPD & ward work -Clinical abilities,
- Procedural abilities (PA,
PI)*,
- Laboratory-diagnostic
(All PI)
- Communication skills
O,A,PA
- BLS & ACLS
II Year Intermediate Intermediate degree - Independent duties
of cognitive abilities - All procedures
- Respiratory management
Specialised abilities (All PI)
procedural skills - Communication skills
PA, PI
Emergency - Writing thesis
- Teaching UGs
III year Special skills - Advanced levels of
independent duties,
Intensive critical - casualty calls,

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 care - ICU, NICU,
- UG teaching

• Specialized skills include exchange transfusions, intercostal tubes, peritoneal dialysis,

defibrillation/ cardioversion etc.
• Levels of cognitive skills basic to higher degrees are best illustrated by the following:

Basic: history taking, diagnosis/differential diagnosis, points for and against each diagnosis;

Intermediate: detailed discussion on differentials, analysis and detailed interpretation of clinical

and laboratory data;

Advanced: analysis and synthesis of clinical material, concepts including research ideas

* See Competence List

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Appendix III

An Illustration of Levels of Communication Ability

Level 1

The beginner will be able to, in case of written communication, e.g. make descriptive hospital
progress notes. In settings involving patients, the student will demonstrate competence in oral
communication in patients who are "cooperative", are from the same culture and language and do
not pose difficult challenges to student, for example, an altered state of consciousness.

Level 2

The intermediate level student will meet the criteria for effective written communication of a
formal nature, e.g. presentation of formal reports, assignments etc. The student will demonstrate
competence in oral communication in the context of small group discussions, seminar
presentations etc. In case of patient care settings, the encounter may be of more difficult nature,
e.g. breaking bad news, disclosing malignancy or dealing with somewhat resistant, emotional, and
`uncooperative' patient or with interference from external factors e.g., noise or patient in pain.

Level 3

The advanced level student will meet the criteria for effective written communication with a
publication such as a dissertation or a manuscript for a paper. The oral competence is demonstrated
by competence such as presentation in formal professional meetings, or conferences. In settings

29
involving patients either in hospitals or clinics, the student would be able to encounter patients with
impaired level of consciousness, or hostility or speech impairment. The student should be able to
use interview therapeutically.

It may be mentioned that the above is only illustrative and not exhaustive. Teachers should prepare
list of such situations varying from, 'least difficult" to "most difficult" which will help in organising
teaching-learning activities and assessment.

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Appendix IV

Model Check-list for Evaluation of Journal Review Presentations

Name of the Student: Name of the Faculty/Observer. Date:

Sl. No. Item for observation Poor Below Average Good Very good
during presentation average
0 1 2 3 4

1. Article chosen was

2. Extent of understanding of scope &

objectives of the paper by the candidate
3. Whether cross references have been
consulted
4. Whether other relevant publications
consulted
5. Ability to respond to questions on the
paper/subject
6 Audio-visual aids used effectively

7 Ability to defend the paper

8 Clarity of presentation

9 Any other observation

Total score

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32
Appendix V

Contracting in education

One of the ways to increase learning transfer is "contracting" with trainees about the
implementation of their action plan. In competence based training context, a contract means a non-
legal pledge to carry out the predetermined learning activities by the trainee. e.g. to perform ‘X’
number of procedures or to report back on difficult cases as well as action by clinical trainer (to
provide help in overcoming barriers, to facilitate). The following elements help ensure contracts to
be effective:

1. Early commitment - commitment for goals (action plan) in the beginning of

training.

2. Setting realistic goals -i.e. goals that are realistic, time-phased and measurable.

3. Opportunities for discussion of action plans with peers and feedback.

4. Monitoring procedures - through observation, and other means.

It must be recognized that implementation of competency-based training either in part or in toto,

will alter the usual modes of training. Educational activities, record-keeping systems, time
schedules may all have to change, but the most significant modification will be those of faculty and
student attitudes and practices. These must shift in a manner that emphasizes learning rather than
teaching. The training institutions must also support the change. Such changes may require more
efforts than usual. Therefore, preparations of teachers, students and institutions become essential.

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Teacher

Teachers have to assume three 'new' roles. The first is that of a planner, probably the most difficult
and time consuming. The most important planning task is to plan instructional units that must build
systematically and sequentially towards the goals. The second new role is that of manager of
instructional resources, guiding students towards achievement of competencies, specifying time
periods when teachers are available to assist individual students, provide and prepare assessment
procedures and standards of satisfactory level of performance. The third role is that of evaluator. It
is essential to have training programs (faculty development) to orient teachers on concept of
competency-based training.

Student

If this curriculum model is to succeed, students too must adopt new roles. One essential change
would be willingness to join with teachers in thoughtful discussion about learning objectives,
competencies and instructional strategies. The others would be to assume greater personal
responsibilities for learning that is a central component of competency-based system, and
establishment of an educational contract (Appendix V) specifying the competencies to be achieved
at different periods of the course.

The Institution

Tyler (1970) has noted that even those curriculum changes that show great initial promise are often
abandoned after a few years, largely because of the institution's failure to make those changes in
structure and functioning that will support and promote a dynamic process of curriculum

34
development. The institutions must adopt strategies and tactics to facilitate such plan, which
include mobilizing resources, undertaking reorientation of management and training of trainers.

Summary

Competency-based training differs from the traditional training process to which we are
accustomed. It is learning by doing. It is based on principles of adult learning, teacher assuming the
role of a facilitator and on social learning theory i.e., when conditions are favorable and non-
threatening, a person learns most rapidly and effectively. It addresses the issue of content and
relevance. It provides opportunity for independent pacing. It incorporates a variety of learning
experiences designed to serve clearly defined competencies, employs an assessment system aimed
at maximizing the opportunity for all to succeed (criterion-based). It envisages greater commitment
by teachers to the facilitation of individual student learning and will require students to accept the
responsibility for their own learning. For the adoption and success of the concept of competency-
based training, preparation of teachers, students and institutions is essential.

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