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AETCOM

Dr Munish Kumar Kakkar

MD, MRCPCH (UK)
Prof & Head ,Dept of Pediatrics
M G Med College & Hospital, Jaipur

Learning objective Problem lies………….

At the end of the session , learner will be able to: A medical graduate is not -

1. understand overview of AETCOM competent enough,

2. Identify the need of AETCOM
3. Know the mission and objectives of AETCOM in all domain,
4. use template from AETCOM module
what s/he is suppose to be.

In Quality Medical College, one day, when two internees,

Unaddressed aspects of medical care who were on duty, were assaulted by the patient party on the
allegation of negligence to a patient. As per the opinion of the mob,
in present curriculum ? it flashed out that the patient was declared to be well in the morning,
and the patient died after two hours.

That’s why they assaulted the junior doctors

. …..where is the problem?

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Court cases
Graduate Medical Education Regulations,2017
Court - Observations: Goal
IMG possessing requisite knowledge , skill , attitude , values
Records do not contain consent for surgery and responsiveness, so that
Pt not explained of the disease he or she may function appropriately and effectively
No urgency to carry out surgery as a physician of first contact of the community
Consent for excision cannot be taken as while being globally relevant.
consent for surgery

Indian Medical Graduate “ROLES”

�Clinician - preventive, promotive , curative, palliative

and holistic care with compassion
Assessment
�Leader and member of the health care team –
collect, analyze, synthesize and communicate health data

�Communicator - patients, families, colleagues and community.

�Lifelong learner - continuous improvement.

� Professional - ethical, responsive and accountable.

How it is being learnt now ? explicit part

implicit part

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The Hidden Curriculum

PLANNED DELIVERED

The hidden curriculum consists of those things the student EXPERIENCED

EXPEERIENCED

learn through experience of attending college rather than

the stated educational objectives of such institutions .

Varies by training & context

Task ahead Patient need
Expert

Proficient
Competent

Advanced
beginner
Novice

Levels of competency
Mastery attribute- done independently under
The AETCOM Module
Performs supervision a pre-specified times - certification
P
Skill attribute – able to demonstrate complex procedure • MCI proposed
Shows How requiring thought, knowledge ,behavior
SH
Skill attribute – able to demonstrate steps • A case-based module
S Shows

Higher level of knowledge- able to discuss • Structured manual

KH Knows How

Knowledge attribute- enumerate or describe • Explicit way of learning “AETCOM” throughout

K Knows
the Four professional years
The acquired Highest level of competency specifies that
lower level has been already acquired

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Teach by example - Attitude Prof(year) 1st 2nd 3rd Year 4th Year

•Teaching?

•Modules Module 5 8 5 9
•Role play
Hours 34 35 25 45
•Project work

•Field trips

•Medical camps

•Voluntary services

Learning modules for Professional year I

Name of Background Level of Ethics/com assessment Number of Modules: 5 Number of hours: 34
competency/ munication
module(1st) hours
Module1.1 What does it mean to be a doctor?
What does it mean Concept of suffering K/KH(8hr) Ethics Written BACKGROUND
to be patient? and Pt perspective. /OSCE It is important for new entrants to get a holistic view of their profession,
(1.2) exploration of /viva its ups and downs, its responsibilities and its privileges.
empathy & healing It is important to start this discussion early in their careers when their minds
are still fresh with the thrill of joining medical school.
Such a discussion will help them remember the big picture through the
The Cadaver as Respect for cadaver K/KH/S(4hr) Ethics Written program and remind them why they have chosen to be doctors.
our first teacher as teacher or Pt /OSCE
( 1.5) /viva
/360 degree LEARNING EXPERIENCE
When: Professional year 1
The Foundation of Communication at SH(7hr) Communi Written
Hours: 8 (6 hours + 2 hours self directed learning)
communication -1 bedside cation /OSCE This session can be delivered by 4 inter-dependent learning experiences
( 1.4) /viva

Learning modules for Professional year I Panel Discussion -- AETCOM

1. An exploratory session with the students enquiring from them

Why they chose to become doctors and what do they think are the
privileges and the responsibilities of the profession.
What do they expect from society and what do they think society
expects from them?
What will they have to do and give up in order to meet
their own and society’s expectations.

This is preferably done in a small group discussion.

2. A facilitated panel discussion involving doctors who are at various stages of their
careers (senior, midlevel, young) where doctors share their experiences and also answer
questions from students.

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Learning modules for Professional year I

What does it mean to be doctor? - Panel Discussion
3. Self directed learning (2 hrs) where students write a report from reflection
based on sessions 1 & 2 and on other readings, TV series , movies
etc that they have chosen from the lay press about doctor experiences.

4. Introductory visit to the hospital / community medical centres (2 hrs)

5. A closure session with students to share their reflections based

on 1, 2, 3 and 4 that includes
what they plan to do in the next 5 years in order to
fulfill their professional and personal roles as doctors.

6. A white coat ceremony in the Foundation Course.

RESOURCES
Whitcomb ME. Academic Medicine 2007 82: 917

Hybrid PBL model

AETCOM

Dr Munish Kumar Kakkar

MD, MRCPCH (UK)
Prof & Head ,Dept of Pediatrics
M G Med Col & Hospital, Jaipur

Name of Background Level of Ethics/co assessment Name of Background Level of Ethics/com assessment
competency/ mmunicat module (3rd ) competency/ munications
module(2nd) hours hours
ion
The foundation Fundamentals of bioethics KH (2hr) Ethics Written Fiduciary duty Human being or KH (5hr) Ethics Written/OSCE
of Bio ethics like autonomy, beneficence /viva (3.5) machine /viva/WPBA
(2.2) , non malefiscence, justice

Health care is Role of a doctor in KH (2hr) Ethics Written Confidentiality Identify,discuss KH (5hr) communication Written/OSCE
a right healthcare delivery system / viva (3.4) and defend soc /viva
(2.3) cult ,med legal&
ethical

The foundation of To provide effective S(7hr) Communic Written Foundation of Effective SH (7hr) communication Written/OSCE
communication-2 communication ation /OSCE /viva communication-3 communication /viva/WPBA
(2.1) ( 3.1)

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AG
Day 11 Day 12 Day 13 Day 14 Day 15 Day 16

Time
17.09.19 18.09.19 19.09.19 20.09.19 21.09.19 23.09.19
Tue Wed Thurs Fri Sat Mon
Name of Background Level of Ethics/com assessment S32 S37 S41 S46 S50 S54
competency/ munications
module(3rd ) BI 3.1 PY 1.5 AN 79.1 to 79.6 ECE- Hospital visit AETCOM 1.4 Part II PY 3.8,1.8

8 -9am
hours Reactions of Transport across the Embryology Bioelectric Potential AP
Monosaccharides & cell 4th – 8th Weeks / RMP
Disaccharides AG SM AG
MS
Medical ethics med legal ,socio K/KH/SH(6hr) Ethics Written/OSCE S33A S33 B S42A S42B
economic and /viva BI 11.6 AN 66.1, 66.2 BI 11.16 PY 11.13

9 – 11am
Colorimetry and Basic tissues Observe auto General Examination
ethical issues of spectro photometry Histology of analyser and use of MAMTA
organ donation BF connective tissue QC
JMS SG
S34 S38 S43 S 47 S 51 S55
Dealing with Thanatology K/KH/SH(6hr) Ethics Written/OSCE AN 7.1 to 7.8 CM 1.2 AN 10.3, 10.4 AN 10.5,10.6 AN 10.10 to 10.13 PY 3.7, 3.13 (VI-IM, HI –

11-12noon
Nervous system: Concepts of disease Axilla - II Case Discussion – 1 Gross Anatomy AN) Structure of
death and euthnasia /viva Peripheral Nervous MSR SG Thoracic outlet Scapular region muscle and Muscle
system syndrome AM proteins
SG Large Group: LH MAMTA
AK
S35 S39 S44 S48 S52 S56
AN 9.2 AN 10.1 to 10.2 AN 10.5, 10.6 BI 3.1 BI 5.1 AN 10.10
Med negligence Identify/ defend K/KH/SH(7hr) Ethics Written/OSCE

1 – 2pm
Pectoral Region - II Gross Anatomy Brachial plexus Carbohydrate – Proteins – Definition, Gross Anatomy
medico legal /viva SM Axilla I JMS polysaccharides Importance & Deltoid region
RPB BF Classification SM
issues & way to RS
protect S36 S40 S45 S49BF S53 S57
AN 9.2 AN 10.3 AN 10.3 – 10.13 AN 10.3-10.13 Physiology tutorials AN 10.8.10.9
Dissection Dissection – Axilla - I Dissection – Axilla - Dissection: AG Dissection

2- 4pm
Pectoral region II Brachial plexus Scapular region

Day 17 Day 18 Day 19 Day 20 Day 21 Day 22 Day 23 Day 24

24.09.19 25.09.19 26.09.19 27.09.19 30.09.19 1.10.19 3.10.19 4.10.19
Tue Wed Thurs Fri Mon Tue Thurs Fri Day 25 Day 26 Day 27 Day 28 Day 29 Day 30 Day 31
Time

5.10.19 9.10.19 10.10.19 11.10.19 14.10.19 15.10.19 16.10.19

S58 S63 S67 S72 S 75 S79 S83 S87 Sat Wed Thurs Fri Mon Tue Wed
BI 5.1, 11.16, 11.19 AN 10.12(VI-OR) PY 3.4, 3.6(VI-AS, PA) ECE- PY 3.10, 3.12(VI-IM) CM 1.3 AETCOM Module 1.1 ECE- Hospital visit S 91 S94 (AITo - Anemia) S 99 S 103 S 107 S112 S 116
Amino acids, Shoulder joint NMJ & Transmission Hospital visit Types & grades of Disease Dynamics Exploratory session AETCOM Module 1.1 PY 2.4 BI 9.3 ECE- hospital visit AETCOM 1.1- Part I AN 13.3,13.4 AN 12.7-12.12
Structure and functions of RBC. Protein – targeting, sorting, Exploratory Session Other joints of upper limb Palm II
8-9 am

classification, reactions, SM AG muscle contraction AJ Erythropoiesis –I disorders SM RPB

Chromatography AG AG MS
MS

S 95A (AITo - Anemia) ) S95B (AITo - Anemia) S 108A S108B (AITo - Anemia) S117 A
PY 2.11( VI-PA) PY 2.12,2.13( VI-PA) Community Medicine PY 2.12, 2.13( VI-PA)
RBC Count Hb, PCV and blood indices , Tutorials Reticulocyte Biochemistry tutorials
9-11 am

AG Reticulocyte, ESR MSR count/Osmotic Fragility

MAMTA MAMTA
S59A S59B S 68 A S68 B S 80 A S 80 B BF
PY 3.14 AN 67.1-67.3 PY 11.13 AN 68.1-68.3 PY 3.14 Biochemistry Tutorials
Ergography Histology General Examination - Histology Ergography IL SS
S96 (AITo - Anemia) S 100 (AITo - Anemia) S 104 (AITo - Anemia) S 109 S113 S118
MAMTA Basic tissues IL Basic tissues BS
PY 2.4,2.5 BI 5.2, 6.12(HI-PY, VI -PA,IM) BI 6.5 (VI-IM) AN 12.2 AN 12.3-12.6 CM 1.5
11-12noon

Muscle MAMTA Nervous Tissues Erythropoiesis –II Structure & function Vitamins B12 & Folic acid Radial Nerve and Radial Palm I Prevention and control of disease
RPB SG BS of Hb & Myoglobin SS Artery SG AJ
RS JMS

S 92 (AITo - Anemia) S 97 S 101 (AITo - Anemia) S 105 (AITo - Anemia) S 110 S 114 S 119
S60 S64 S 69 S73 S76 S81 S84 S88 PY 2.1, 2.2(HI-BI) AN 13.3 BI 5.2, 6.12(HI-PY, VI -PA,IM) BI 6.9,6.10 (HI-PY,VI -IM) (AITo - Anemia) AN 12.2 BI 2.1
PY 3.8,3.13 , 3.17 (VI- PY 3.9 PY 3.5, 3.6( VI-AS, PH, PY 3.11, 3.15(HI-BI) BI 5.1 BI 4.1 (VI-IM) AN 12.1,12.2 BI 9.1 Components of blood, Plasma Elbow joint & anastomosis Abnormal Hb – its genetic basis Iron metabolism CM 8.3 Nerves and Vessels of Enzymes- classification, coenzymes
1-2pm

proteins AK MS BF Prevention of anaemia Forearm RS

IM, HI –AN) Molecular basis of PA) Changes during muscle Proteins – structure Lipids – Front of forearm Functions and RA RV SM
properties of muscle , skeletal muscle Drugs acting at NMJ & contraction & Exercise Isoelectric pH, phospholipids, SG components of ECM
SDC contraction MG Metabolism Denaturation, cholesterol, RS S93 (AITo - Anemia) S98 S102 S 106 S 111 (AITo - Anemia) S 115 S 120
RA AG MAMTA MAMTA sequencing lipoproteins CM 8.1,8.3 AN 13.3-13.5 Physiology Tutorials Anatomy tutorials PY 2.5 AN 12.3-12.12 AN 12.12-12.15
MS BF Definition & Global burden of Dissection of elbow joint & other MAMTA JMS AITo – Anaemia – Dissection of palm Dissection
2 – 4pm
2-4 pm

anemia joints of Upper Limb Discussion by IM dept SG Palm – II

RV RPB MAMTA AK

Day 32 Day 33 Day 34 Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Day 42 Day 43 Day 44 Day 45
17.10.19 18.10.19 19.10.19 21.10.19 22.10.19 23.10.19 24.10.19 25.10.19 28.10.19 29.10.19 30.10.19 31.10.19 1.11.19 2.11.19
Time
Time

Thurs Fri Sat Mon Tue wed Thurs Fri Mon Tue Wed Thurs Fri Sat

S 121 S 124 ECE- hospital visit5 S 128 S 132 S 137 S141 S 146 S 150 S 155 S158 S159 S160 S161 S163
8-9 am

BI 2.3 AETCOM Module 1.1 AN 12.12-12.15 BI 10.3(VI-OG, SU, PA) PY 2.7 BI6.5 (VI-IM) PY2.9 (VI-PA) Biochemistry Theory Revision ANATOMY PHYSIOLOGY BIOCHEMISTR ECE-Hospital AETCOM
Enzymes-kinetics, Dorsum of hand Immunoglobulins & Platelets synthesis and Vitamins K & Thiamin Blood group I MS IA/IL IA/IL Y IA/IL visit Module 1.2
8-9 am

mechanism, factors affecting SM Electrophoresis function RS

enzyme activity BF AG AG
MS S 151 A S 151B
PY 2.11 PY 2.11,2.13 (VI-PA)
9-11 am

S 117B S 133A S 133B S 142A S 142B Blood Group BT/CT &Platelet Count
PY 2.12( VI-PA) PY 2.11( VI-PA) BI 2.2,11.13 PY 2.11( VI-PA) AN 70.1,70.2 MAMTA MAMTA
9-11 am

ESR IL TLC Est of SGOT,SGPT DLC Histology of Lymphoid

AG MAMTA RS MAMTA organs
JMS S152 S 156 S162
AN 13.1-13.7 Anatomy Revision IL-Physio
11-12 noon

S 122 S125 S 129 S134 S 138 S143 S 147

BI 2.4 (VI-PA,IM) BI 2.6 (VI-PA,IM) PY 2.6 PY 2.10 BI10.3,10.4,10.5 (HI-PY, VI - BI 6.5 (VI-IM) AN 80.1-80.7 Osteology & Radiological AK BS
Enzyme inhibition Enzyme regulation WBC leucopoiesis & Humoral Immunity OG, MI, SU,PA,IM,PE) Vitamins – riboflavin & Niacin Embryology Placenta and
11-12 noon

Anatomy
MS BF functions RA Immune response & BF Fetal membranes
BS vaccine SM SG
MS
S 153 S 157ECE P2 S164
BI 6.2 PY 2.5 (VI-PA; HI -BI) IL-Anat
1 -2 pm

S 123 ECE A2 S 126 S 130 S 135 S 139 S144 S 148

AN 12.12-12.15 Carpel AN 13.5,13.6 BI.2.5,11.17 (VI-PA,IM) PY2.10 AN 13.5,13.6 PY2.8 (VI-PA) AN 10.4,11.3 Reactions involving Hemophilia AM
Tunnel Syndrome(Small Osteology & Radiological Isoenzymes , Enzymes of Cellular Immunity Osteology & Radiological Hemostasis Veins & lymphatics of upper nucleotides RA
1 -2 pm

Group) Anatomy upper limb clinical importance SS Anatomy Anticoagulants limb RS

RPB JMS RS SG Disorders AK
MAMTA S 154
PY 2.8 (VI-PA)
2-4 pm

S 127 S 131 S 136 S 140 S 145 S149

BI 2.7 (VI-PA,IM) Physiology Tutorial AN 12.12-12.15 AN 13.5,13.6 Anatomy Tutorial AN 13.6 Seminar – Immunity
2-4 pm

Biochemistry charts RA Dissection of dorsum of hand Surface Anatomy of upper JMS Surface Anatomy of upper RA
SS SM limb limb
2-

RPB SG

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Kalamazoo communication skill rating scale

Breaking a bad news (6 steps) SPIKES
criteria score
Step 1 S- Setting up interview Builds relationship

Step 2- P-assessing Pt perception Opens in discussion

Gathers information
Step 3- I-obtaining the pt’s Invitation
Understands pt perspective
Step 4- K-giving knowledge and information to the patient Shares information
Step 5- E-addressing pt’s Emotions with empathetic responses Manages flow
Overall rating
Step 6- S-Strategy and summary
Rating--Poor 1-3 , satisfactory 4-6 , superior 7-10

Thank you

Doctor – Patient encounter Breaking a bad news( 6 steps)

1. Building the doctor patient relationship Goals
2. Opening the discussion � To provide intelligible information and educate the
pt/attendents regarding the disease process.
3. Gathering information
� To support the patient by employing skills to reduce the
4. Understanding the patient’s perspective emotional impact
� To develop a strategy in the form of a treatment plan with
5. Sharing information
the input and cooperation of the patient.
6. Reaching agreement on problems and plans
� To support the relatives/attendents in accepting the event.

7. Providing closure

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Summary
Name of Topic: Number of competencies: Court cases
Number of procedures that require certification :
Prerequisite knowledge for topic from previous phases: .

S Competencies Domain Core Suggested Suggested Court - Observations:

N K/S/A/C K/KH/S Y/S Teaching assessment Integration
/P Learning method
Method
Records do not contain consent for surgery
Pt not explained of the disease
No urgency to carry out surgery
Consent for excision cannot be taken as consent for surgery