2010

GENERALMEDICINER

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Composed by:Syed Faisal BabarDepartment of Medical Education

Published: February, 2010

;;GGDDDD==??== GG>> HH@@QQKKAA;;AA99FFKK 99FF<< KKMMJJ??==GGFFKK HH99CCAAKKLL99FF**7th Central Street, Defence Housing Authority, Karachi-75500.Phone No. 99207100-10. UAN: 111-606-606. Fax No. 99266432

The College

Training & Examination Summary

General Information

Supervisor’s Role and Responsibilities

Trainee’s Roles and Responsibilities

Training Program

Syllabus

Useful Addresses and Telephone Numbers

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Contact Details:College of Physicians and Surgeons, Pakistan.7th Central Street, Phase II, D.H.A. Karachi - 75500.Phone: 99207100-10, UAN 111-606-606Facsimile: 99266450Website: www.cpsp.edu.pk

CONTENTS

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The College was established in 1962 through an ordinance of the

Federal Government. The objectives/functions of the College include

promoting specialist practice of Medicine, Obstetrics & Gynaecology,

Surgery, Dentistry, and other specialties by securing improvement of

teaching and training, arranging postgraduate medical, surgical and

other specialists training, providing opportunities for research, holding

and conducting examinations for awarding College diplomas and

admission to the Fellowship of the College.

Since its inception, the College has taken great strides in improving

postgraduate medical and dental education in Pakistan. Competency-

based structured Residency Programs have now been developed,

along with criteria for accreditation of training institutions, and for the

appointment of supervisors and examiners. The format of examinations

has evolved over the years to achieve greater objectivity and reliability

in methods of assessment. The recognition of the standards of College

qualifications nationally and internationally, particularly of its Fellowship,

has enormously increased the number of trainees, and consequently

the number of training institutions and the supervisors. The rapid

increase in knowledge base of medical sciences and consequent

emergence of new subspecialties have gradually increased the number

of CPSP fellowship disciplines to fifty three.

After completing two years of training during IMM, the trainees are

allowed to proceed to the advanced phase of FCPS training in the

specific specialty of choice for 2-3 years. However, it is mandatory to

qualify IMM examinations before taking the FCPS-II exit examinations.

THE COLLEGE

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The prospectii of Post IMM phase of each discipline have been

extensively revised and structured so as to delineate well defined

competencies to be achieved along with the level of participation.

These prospectuses have been complemented by color coded

Structured Visual Curriculum Display (SVCD) charts to be placed at

a prominent place in each training Unit. They help remind at a

glance the trainees and the supervisors about the competencies

and their levels to be achieved at a given time period along with the

minimum number of cases. They also describe the rotations to be

performed along with their duration and objectives, mandatory

workshops to be attended, and the requirements and deadlines for

submitting research synopsis and dissertation (or two research

articles in lieu of the dissertation as per CPSP rules).

The work performed by the trainee is also to be recorded in the

e-logbook. The purpose of the e-logbook is to ensure entries are

made on a regular basis and to avoid belated and fabricated

entries. It will hence promote accuracy, authenticity and vigilance

on the part of trainees and the supervisors. The College expects to

enforce e-logbook system from July 2010. However, the manual

logbook will also continue.

The average number of candidates taking CPSP examinations is

over 13,000 every year. The College conducts examinations for

FCPS I (11 disciplines), IMM, FCPS II (53 disciplines),

MCPS (18 disciplines) and DCPS (2 non-clinical disciplines).

A large number of Fellows and senior medical teachers from within

the country and overseas are involved at various levels of

examinations of the College.

The College, in its endeavor to decrease inter-rater variability and

increase fairness and transparency, is using TOACS (Task Oriented

Assessment of Clinical Skills) in IMM and FCPS-II Clinical

examinations. Inclusion of foreign examiners adds to the credibility

of its qualifications at an international level.

It is important to note that in the overall scenario of health delivery over

15,000 of the total functioning and registered health care specialists of

the country have been provided by the CPSP. To coordinate training

and examination, and provide assistance to the candidates stationed

in cities other than Karachi, the College has established 12 Regional

Centers (including five Provincial Headquarter Centres) in the country.

The five Provincial Headquarter Centers, in addition to organizing the

capacity building workshops/short courses also have facilities of

libraries, I.T, and evaluation of synopses and dissertations along with

providing guidance to the candidates in conducting their research work.

The training towards Fellowship can be undertaken in more than 130

accredited medical institutions throughout the country and 70 plus

accredited institutions abroad. The total number of departments

recognized in these institutions is over 1200 and the number of

Supervisors engaged in the training has crossed the figure of 2000.

These continuous efforts of the College have contributed well over

90% of specialist medical manpower of Pakistan and even more

importantly has developed a credible system of postgraduate medical

education for the country. The College strives to make its courses and

training programs ‘evidence’ and need ‘based’ so as to meet

international standards as well as to cater to the specialist healthcare

needs not only for this country but also for the entire region.

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1. Anaesthesia

2. Anatomy

3. Biochemistry

4. Cardiac Surgery

5. Cardiology

6. Chemical Pathology

7. Community Medicine

8. Dermatology

9. Diagnostic Radiology

10. Family Medicine

11. Forensic Medicine

12. Gastroenterology

13. General Surgery

14. Haematology

15. Histopathology

16. Immunology

17. Medical Oncology

18. General Medicine

19. Microbiology

20. Nephrology

21. Neurology

22. Neurosurgery

23. Nuclear Medicine

24. Obstetrics and Gynaecology

25. Operative Dentistry

26. Ophthalmology

27. Oral Surgery

28. Orthodontics

29. Otorhinolaryngology (ENT)

30. Orthopedic Surgery

31. Paediatrics

32. Paediatric Surgery

33. Periodontology

34. Pharmacology

35. Physiology

36. Physical Medicine & Rehabilitation

37. Plastic Surgery

38. Prosthodontics

39. Psychiatry

40. Pulmonology

41. Radiotherapy

42. Thoracic Surgery

43. Urology

44. Virology

Training and Examinations Summary

The College lays down the training programs and holds examination for theaward of Fellowship in the following disciplines:

Disciplines for 2nd Fellowship

Disciplines for 1st Fellowship

1. Cardiothoracic Anaesthesiology

2. Critical Care Medicine

3. Endocrinology

4. Infectious Diseases

5. Neonatal Paediatrics

6. Paediatric Cardiology

7. Paediatric Ophthalmology

8. Rheumatology

9. Vitreo Retinal Ophthalmology

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Fellowship of the College of Physicians and Surgeons Pakistan isawarded to those applicants who are declared successful inexaminations carried out by the Examination Department of theCPSP, and elected by the College Council and have:● a recognized medical degree● completed a one year house job in a recognized institution● passed the relevant FCPS Part I Examination● registered with the RTMC● qualified in IMM exams● undergone specified years of supervised accredited training

It is important to note that all applicants must undergo aformal examination before being offered fellowship of therelevant specialty, except in case of fellowship withoutexamination and honorary fellowship.

TRAINING ENQUIRIES AND REGISTRATION

All trainees should notify the College in writing of any change ofaddress and proposed changes in training (such as change ofSupervisor, change of department, break in training etc) as soon aspossible.

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REGISTRATION AND TRAINING

GENERAL REGULATIONSThe following regulations apply to all the candidates taking theFCPS-II Examination.

Candidate will be admitted to the examination in the name (surnameand other names) as given in the MBBS degree. CPSP will notentertain any application for change of name on the basis ofmarriage / divorce /deed

ELIGIBILITY REQUIREMENTS FOR ENTERING FCPS PART IITRAINING PROGRAM IN MEDICINE

- Passed FCPS Part I in Medicine/allowed exemption- Completed two years RTMC registered training as per

Intermediate Module Curriculum

EXEMPTION FROM FCPS PART-IAn application for exemption from FCPS Part-I must be submitted tothe College with all the relevant documents and a bank draft for theprescribed fee.

After due verification, the College may grant exemption fromFCPS Part-I to those applicants who have acquired any of thefollowing qualifications in Medicine:

- Diplomat American Board of Specialties- FCPS Part-I, Bangladesh.

In all other cases, after proper scrutiny and processing, the Collegeshall decide acceptance or rejection of the request for exemptionfrom FCPS-I on case to case basis.

All applicants who are allowed exemption will be issued anEXEMPTION CERTIFICATE on payment of exemption fee. The dateof issue of the exemption certificate will be considered as the date ofpassing FCPS I examination. A copy of this certificate will have to beattached with the application for appearing in FCPS II examination.

GENERALINFORMATION

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APPROVED TRAINING CENTRESTraining must be undertaken in units/departments/institutionsapproved by the College. A current list of approved locations isavailable from the College and its regional offices, as well as on theCollege website: www.cpsp.edu.pk.

REGISTRATION AND SUPERVISIONAll training must be supervised and Trainees are required to notify theRTMC in case of any change of supervisor. Any training undertakenwithout RTMC registration is not accepted as valid by the CPSP.

The supervisor will normally be a Fellow of the College. Howeveranother supervisor may be accepted if there is no Fellow available tooffer appropriate supervision. Non-Fellows must be approved by theCollege as supervisor.

Normally, only one supervisor is nominated, and if the Trainee spendssignificant periods working in an area where the supervisor has nopersonal involvement, the supervisor must certify that suitablesupervision is being provided. The nomination of more than onesupervisor is needed only if the Trainee divides the year between twoor more unrelated units, departments or institutions.

DURATION OF TRAINING IN MEDICINE● Total duration of the training is 4 years divided into two phases

(IMM & advanced specialty training), all of which is to beundertaken after passing FCPS I, and after registration withRTMC and with an approved Supervisor at a CPSP accreditedunit/institution.

● The first two years of training, inclusive of rotations, willconstitute the Intermediate Module (IMM), at the end of whichthe trainee will have to appear in the Intermediate Moduleexaminaton in Medicine.

● After completing training for IMM, trainee has to undergo postIMM advanced training in the specialty for years 3 & 4.

● Passing of IMM examination is one of the eligibilityrequirements to appear in FCPS-II examination.

● All training inclusive of rotations is to be completed one monthbefore the date of theory examination for FCPS-II.

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ROTATIONSRotations will begin on the first of the month for prescribed time period.In the year 3rd & 4th, out of the rotations mentioned below, threerotations of two months each have to be carried out, excluding thosedone earlier in 1st & 2nd year of training: 1. Intensive care medicine (Mandatory)2. Cardiology (Mandatory, if not done during IMM) 3. Neurology4. Nephrology5. Pulmonology6. Psychiatry7. Dermatology8. Endocrinology9. Oncology

COMPONENTS OF TRAININGMandatory Workshops

All mandatory workshops should be attended during the first two yearsof training. Therefore no workshop is mandatory during the 3rd & 4thyear of training. However the trainee will be required to take anyworkshop as may be introduced by the CPSP.

Research (Dissertation / Two Papers)

One of the training requirements for fellowship trainees is adissertation or two research papers on a topic related to the fieldof specialization. Synopsis of the dissertation or research papersmust be approved from the Research & Evaluation Unit (REU) ofCPSP before starting the research work. The dissertation orresearch paper must be submitted for approval to the REU beforeor during first six months of fourth year of training program.

Logbook

Trainees are required to maintain a logbook in which entries of allacademic / professional work done during the period of training shouldbe made on a daily basis and should be signed by the supervisor.Completed and duly certified logbook will form a part of the applicationfor appearing in FCPS II Medicine examination.

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E-logbook

The CPSP council has decided to introduce E-logbook system for

all trainees in FCPS from January 2009. Upon registration with

RTMC each trainee is allotted a registration number and a

password to log on to the e-logbook on the CPSP website. The

trainee is required to enter all work performed and the academic

activities undertaken in the logbook on daily basis. The concerned

supervisor is required to verify the entries made by the trainee. This

system ensures timely entries by the trainee and prompt verification

by the supervisor. It also helps in monitoring the progress of

trainees and vigilance of supervisors.

GENERAL REQUIREMENTS

Training should incorporate the principle of gradually increasingresponsibility, and provide each trainee with a sufficient scope,volume and variety of experience in a range of settings that includeinpatients, outpatients, emergency and intensive care.

Instructional Methodology

Teaching occurs using several methods that range from formallectures to planned clinical experiences. Aspects covered willinclude knowledge, skills and practices relevant to thediscipline in order to achieve specific learning outcomes andcompetencies.

The theoretical part of the curriculum presents the current body ofknowledge necessary for practice. This can be imparted usinglectures, grand teaching rounds, clinico-pathological meetings,morbidity/mortality review meetings, literature reviews andpresentations, journal clubs, conferences and seminars alongwith self directed learning.

Clinical learning is organized to provide appropriate expertiseand competence necessary to evaluate and manage commonclinical problems. Demonstration in outpatient clinics andwards and procedural skill training on simulators, mannequinsand patients are all practical training modalities.

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ROLE AND RESPONSIBILITIES

Training held under the aegis of CPSP is compulsorily supervised. Asupervisor is a CPSP Fellow or a specialist with relevant postgraduatequalifications recognized by the CPSP.

Supervision is a multifaceted task and essential for the comprehensivegrooming of a trainee. The task is arbitrarily divided into the followingcomponents for the sake of convenience. This division is by no meansexhaustive or rigid. It is merely meant to give semblance of order tothis comprehensive yet abstract and versatile role of the supervisor.

EXPERT TRAINER

● The most fundamental role of a supervisor is to ensure andmonitor adequate training and also provide continuous helpfulfeedback (formative) to the trainee regarding the progress of thetraining.

● This entails observing the trainee's performance and rapport withall the people within his work environment.

● He / she should teach the trainee and help him / her overcomethe hurdles during the learning process.

● It is the job of the supervisor to make the trainee develop theability to interpret findings in his patients and suitably act inresponse.

● The supervisor must be adept at providing guidance in writingsynopsis and dissertation / research articles which are essentialcomponents of training.

● Every supervisor is required to participate in Supervisors'workshops, conducted regularly by CPSP, and do his/her best toimplement the newly acquired information/ skills in the training. Itis his basic duty to keep abreast of the innovations in his field ofexpertise and ensure that this information percolates to trainees ofall years under him/ her.

SUPERVISOR’S

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LIAISON WITH CPSP

● The supervisor should maintain regular contact with the

College regarding training and the conduct of various

mandatory workshops and courses.

● It is expected that the supervisor will contact CPSP if any

problem arises during the training process, including the

suitability of a trainee.

● They must be able to coordinate with the administration of

their institutions/ organizations in order to ensure that the

trainees do not face any administrative problem hampering

their training.

PROFICIENT ADMINISTRATOR

● He/ she must ensure that the trainees have completed the

logbooks and authenticate them on a regular basis.

● They are expected to provide assessment reports to the

College at the end of each year or training period. These

reports are used to evaluate a trainee's performance. It should

indicate if training has been followed satisfactorily. The report

must also contain positive and deficient aspects of the

trainee's performance and any extra academic endeavors

made by the trainees. Prolonged absences must also be

mentioned in sufficient detail. It is essential that each report be

discussed and signed both by the trainer and the trainee

before it is sent to the College.

● The supervisors might be required to submit confidential

reports on trainee's progress to the College.

● The supervisor should notify the College of any change in the

proposed approved training program.

● In case the supervisor plans to be away for more than two

months, he/ she must arrange satisfactory alternate

supervision during the period.

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ROLE AND RESPOSIBILITIESGiven the provision of adequate resources by the institution, Traineesshould accept responsibility for their own learning and ensure that itis in accord with the relevant requirements. The trainee should:

1. investigate sources of information about the program andpotential Supervisor and play an informed role in the selection ofthe Supervisor.

2. seek reasonable infrastructure support from their institution andSupervisor, and use this support effectively.

3. ensure that they undertake training diligently.

4. accept responsibility for the dissertation, and plan and executethe research within the time limits defined (six months before thefinal exams).

5. be responsible for arranging regular meetings with thesupervisor to discuss any hindrance to progress anddocumenting the progress. If the supervisor is not able/willing tomeet the student on a regular basis, the student should notifythe College.

6. provide the supervisor with word-processed dated synopsis anddissertation drafts that have been checked for spelling, grammarand typographical errors, prior to submission.

7. ensure that the supervisor has all the relevant raw data prior tosubmission of dissertation.

8. ensure that no intellectual property rights have been violated atany time (i.e. plagiarisms is to be absolutely avoided).

9. submit the completed Dissertation or publish two researchpapers in the CPSP approved journal six months before finalexams.

10. follow the College complaint procedures if serious problemsarise

11. complete all requirements for taking an examination.

12. feedback regarding the training post should be sent to theCollege on the prescribed Confidential form.

TRAINEE’S

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CURRICULUM

No academically sound institution would bank on a static curriculum. Acurriculum should be documented, objective, evolving and sustainable(DOES). CPSP also endeavors to use a format which has scope fortransition and yet is relevant to the needs of the time. The curriculumdocumented below is not rigid and all embracing. It is intended to givea holistic view of the requirements of the discipline in general. TheFellowship training program focuses on a few key pegs of viabletraining: knowledge, skills and attitudes. CPSP is inclined to follow anoutcome based curricular format, which is a blend of behavioral andcognitive philosophies of curriculum development.

Following is a global and extensive, yet not total, list of learningoutcomes recommended by the College.

Learning outcomes relating to:

COGNITION

The learning outcomes will all be at the application level since that isthe gold standard. Therefore, the candidate will be able to:1. relate how body function gets altered in disease states.2. request and justify investigations and plan management for

medical disorders.3. assess new medical knowledge and apply it to their setting.4. apply quality assurance procedures in their daily work.

SKILLS

Written Communication Skills

The trainee will be able to:1. correctly write updated medical records, which are clear,

concise and accurate.2. write clear management plans, discharge summaries and

letters for outpatients after referral from a colleague.3. demonstrate competence in academic writing.

TRAININGPROGRAM

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Verbal Communication Skills

The trainee will be able to:1. establish professional relationships with patients and their

relatives or caregivers in order to obtain a history, conduct a physical examination and provide appropriate management.

2. demonstrate usage of appropriate language in seminars,bedside sessions, outpatients and other work situations.

3. demonstrate the ability to communicate clearly, consideratelyand sensitively with patients, relatives, other healthprofessionals and the public.

4. demonstrate competence in presentation skills.

Examination Skills

The trainee will be able to:1. perform an accurate physical and mental state examination in

complex medical problems often involving multiple systems.2. interpret physical signs after physical examination so as to

formulate further management plans.

Patient Management Skills

The trainee will be able to:1. interpret and integrate the history and examination findings and

arrive at an appropriate differential diagnosis and finaldiagnosis.

2. demonstrate competence in problem identification, analysis andmanagement of the problem at hand by the use of appropriate. resources, interpretation of lab results and other investigations.

3. prioritize different problems within a time frame.

SKILLS IN RESEARCH

The trainee will be able to:1. use evidence based medicine and evidence based guidelines.2. conduct research individually by using appropriate research

methodology and statistical methods.3. correctly guide others in conducting research by advising about

study designs, research methodology and statistical methodsthat are applicable.

4. interpret and use results of various research articles.

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ATTITUDESTowards Patients

The trainee will be able to:1. establish a positive relationship with all patients in order to

ease illness and suffering.2. facilitate the transfer of information important to the

management and prevention of disease. 3. demonstrate awareness of bio-psycho-social factors in the

assessment and management of a patient. 4. demonstrate sensitivity in performing any examination. All such

encounters should be chaperoned. It is important to explain tothe patient why an intimate examination is necessary and whatthe examination will involve. The patient's permission must beobtained and, where possible, the patient should be invited tobring a relative or friend. The patient should have privacy todress and undress. The discussion should be kept relevant andavoid unnecessary personal comments. Questions andfeedback should be encouraged throughout and at the end ofthe session.

5. consistently show consideration of the interests of the patient &the community as paramount, and these interests should neverbe subservient to one's own personal or professional interest.

Towards Self Development

The trainee will be able to:1. demonstrate, consistently, respect for every human being

irrespective of ethnic background, culture, socioeconomicstatus or religion.

2. deal with patients in a non-discriminatory and prejudice-freemanner.

3. deal with patients honestly and with compassion.4. demonstrate flexibility and willingness to adjust appropriately to

changing circumstances.5. foster the habit and principle of self-education and reflection in

order to constantly update and refresh knowledge and skillsand as a commitment to continuing education.

6. recognize stress in one self and others.7. deal with stress and support medical colleagues and allied

health workers.8. handle complaints including self-criticism or criticism by

colleagues or patients.9. understand the importance of obtaining and valuing a second

opinion.

Towards Society

The trainee will be able to:1. understand the social and governmental aspects of health care

provision.2. offer professional services while keeping the cost effectiveness

of individual forms of care in mind.3. apply an understanding of hospital and community-based

resources available for patients and care givers in rural areas.4. demonstrate an understanding of health service management

and health economics in rural areas.5. understand the use of 'telemedicine' in practicing health.

OBJECTIVES

At the end of the training for FCPS in Medicine a trainee shall be able to:1. Initially assess the patients seeking medical advice for

their problems by:● obtaining pertinent history.● performing appropriate physical examinations correctly.● formulating a working diagnosis.● deciding whether the patient requires:

- ambulatory care or hospitalization.- referral to other health professionals.

2. Manage patients requiring treatment:● plan an enquiry strategy i.e. order appropriate investigations

and interpret the results.● decide and implement suitable treatment.● maintain follow-up of patients at required intervals.● maintain records of patients.

3. Undertake research and publish findings.4. Acquire new information; assess its utility and make

appropriate applications.5. Recognize the role of teamwork and function as an effective

member/leader of the team.6. Advise the community on matters related to promoting

health and preventing disease. 7. Train paraprofessionals and other junior members of the team.

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SYLLABUS

General Medicine1. Pleural aspiration 2. Peritoneal aspiration3. Lumbar auncture4. Nasogastric intubation5. Uretheral catheterization6. Recording and reporting ECG 7. Proctoscopy8. Endotracheal intubation9. Insertion of CVP lines10. Arterial puncture11. Liver biopsy12. Pleural biopsy 13. Joint aspiration14. Bone marrow aspiration15. Renal biopsy16. Haemodialysis17. Upper G.I. endoscopy18. Colonoscopy19. Bronchoscopy20. Abdominal ultrasound21. Exercise tolerence test22. Echocardiography23. CAT scan head24. Electroencephalography (EEG )25. Electromyography/Nerve conduction studies(EMG/NCS)26. Chest intubation

Cardiology1. Prevention of cardiac diseases2. Coronary heart disease, Congenital heart diseases3. Acute rheumatic fever, Rheumatic heart disease4. Valvular heart disease5. Infective endocarditis

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6. Dizziness/syncope and palpitation

7. Arrythmias

8. Haemodynamic disturbances

9. Hypotension and shock

10. Basic life support, Advance cardiac life support

11. Heart failure

12. Myocarditis cardiomyopathies

13. Pericarditis

14. Pulmonary hypertension

15. Hypertension (including drugs, hypertensive emergencies,

resistant hypertension)

16. Cardiac patient and surgery

17. Cardiac patient and pregnancy

18. Drugs used for the management of these disorders

Hematology and Medical Oncology

1. Anemias

2. Haemoglobinopathies

3. Neutropenia, Neutropenic sepsis

4. Bone marrow failure

5. Transfusion of blood products

6. Leukemia

7. Lymphomas and other myeloproliferative disorders

8. Multiple myeloma

9. Disorders of hemostasis

10. Platelet disorders

11. Bleeding disorders, Disseminated intravascular coagulation

12. Hypercoagulable state, Anticoagulation

13. Prevention of cancer, Staging of cancer

14. Oncological emergencies

15. Hypercalcemia

16. Malignant effusions

17. Drugs used for the management of these disorders

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Blood Vessels and Lymphatics1. Arterial diseases(aneurysms, arteriopathies, occlusive and

vasomotor disorder)2. Venous disease3. Diseases of lymphatic and lymphadenopathy4. Drugs used for the management of these disorders

Musculoskeletal, Allergic and Immunological Disorders1. Degenerative and crystal induced arthopathies2. Osteoporosis3. Osteoarthritis4. Autoimmune disease - SLE, Scleroderma, Polymyositis,

Dermatomyositis5. Polymyalgia rheumatica6. Monoarthritis, Infective arthritis7. Polyarthritis, Pain syndromes8. Seronegative spondyloarthritides9. Rheumatoid arthritis and its variants10. Vasculitic syndrome11. Atopic disorders12. Anaphylaxis, urticaria, angioedema13. Immunodeficiency disorders14. Immunosupressives / Immunomodulating therapies15. Drugs used for the management of these disorders

Pulmonolgy1. Prevention of respiratory diseases2. Cough, Haemoptysis, Dyspnea3. Pneumonias, Lung abscess4. Bronchiectasis5. Bronchial asthma, COPD6. Pulmonary tuberculosis7. Pleural effusion, Pneumothorax8. Lung cancer9. Interstitial lung disease and fibrosis, Occupational lung disease10. Deep Venous Thrombosis/Pulmonary embolism11. ARDS/ Respiratory failure12. Oxygen therapy, Assisted ventilation13. Breathing disorders during sleep14. Drugs used for the management of these disorders

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GI Tract and Liver1. Nausea, Vomiting, Hiccups, Dyspepsia2. GERD, Dysphagia3. Esophageal motility disorders4. Upper GI bleed, Oesophageal varices5. Gastritis, NSAID gastritis6. Peptic ulcer disease7. Diarrhea, Malabsorption syndrome8. Coelic disease9. Irritable bowel syndrome10. Inflammatory bowel disease11. Intestinal motility disorders, Constipation12. Antibiotic associated colitis13. Diverticulitis14. Lower GI and rectal bleed15. GI cancers16. Abdominal distension17. Jaundice, Acute hepatitis, Chronic hepatitis, Chronic liver disease18. Portal hypertension19. Decompensated cirrohsis20. Encephlopathy, Fulminant liver failure21. Diseases of pancreas, Gallblader and spleen22. Drugs used for the management of these disorders

Nephrology1. Acute renal failure, Chronic renal failure2. Glomerulopathies3. Nephronic syndrome, Proteinuria4. Haematuria5. Urinary infections, Cystic diseases of Kidney6. Tubulointerstitial diseases7. Multisystem diseases with kidney involvement8. Drugs and kidney9. Renal replacement therapy10. Hypertension and kidney11. Urinary tract malignancies12. Kidney and pregnancy13. Drugs used for the management of these disorders

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Dermatology1. Cellulitis2. Cutaneous drug reactions3. Herpes zoster4. Disseminated herpes simplex5. Pruritis6. Cutaneous manifestations of systemic disease7. Drugs used for the management of these disorders

Geriatrics1. Acute confusion2. Falls3. Hypothermia4. Deterioration in mobility5. Uninary incontinence6. Drugs used for the management of these disorders

Neurology1. Headache, Facial pain, Discogenic Neck pain2. Meningitis, Encephalitis, Brain abscess3. Epilepsy4. Intracranial space occupying lesions5. Benign intracranial hypertention6. Raised intracranial pressure7. TIAs, Stroke, Weakness and paralysis8. Sub-archnoid haemorrahage, Coma9. Parkinsonism, Spasticity, Other movement disorders10. Dementia11. Multiple sclerosis12. Polyneuropathy13. Motor neuron diseases14. Subacute combined degenration of spinal cord15. Disorders of neuromuscular transmission, Myopathies, Periodic

paralysis16. Non metastatic complications of malignant disease17. Drugs used for the management of these disorders

Infections, Disorders due to Physical agents andEnvironment1. Fever of unknown origin2. Sepsis syndrome3. Infections in immunocompromised host4. Nosocomial infections5. Infections due to resistant organisms, MRSA, Mycobacterium6. HIV, AIDS, Sexually transmitted diseases7. Infections in drug users8. Food poisoning, Acute Infectious diarrhoea9. Active immunization against infections10. Bacillary dysentery, Travelers diarrhea11. Typhoid and paratyphoid fevers12. Malaria13. Giardiasis, Amebiasis14. Leishmaniasis, Toxoplasmosis15. Helminthic infections16. Viral diseases17. Rabies18. Ricketsial diseases19. Fungal diseases20. Bacterial diseases21. Chlamydial and spirochetal diseases22. Antibiotics, antiviral drugs, anti fungal drugs,23. Anti tuberculous drugs, Drug reaction, Desensitization24. Disorders due to physical agents and environment25. Effects of heat and cold, electric shock, drowning, insect bite,

snake bite, carbon monoxide26. Drugs used for the management of these disorders

Fluid, Electrolytes, Acid Base Disorders and Poisoning1. Hypo and hyper natremia2. Hypo and hyper kalemia3. Hypo and hyper calcemia4. Disorders of magnesium and phosphorus5. Acid base disorders6. Hyperosmolar disorders, anion gap7. Fluid management8. Poisoning9. Drugs used for the management of these disorders

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Endocrinology, Diabetes Mellitus, Lipid Disorders,Nutrition1. Diabetes melitus, Diabetic emergencies, hypoglycemic state

2. Diseases of hypothalmus, Pituitary gland

3. Disorders of thyroid and parathyroid glands

4. Adrenocortical deficiency

5. Cushing syndrome

6. Clinical uses of corticosteroids

7. Dyslipidemias

8. Metabolic bone disease

9. Nutrition, Enteral and parenteral

10. Drugs used for the management of these disorders

CLINICAL COMPETENCIESThe clinical competencies, a specialist must have, are varied andcomplex. A list of the core procedural competencies including thoserequired during training in the Department of Medicine and thedeparments during rotations is given below. The level ofcompetencies to be achieved each year is specified according to thekey, as follows:

1. Observer status

2. Assistant status

3. Performed under supervision

4. Performed under indirect supervision

5. Performed independently

Note: Levels 4 and 5 for practical purposes are almost synonymous

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ROTATIONAL TRAINING

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Endotracheal Intubation 4 6Insertion of CVP line 4 6Arterial puncture 3,4 4Mechanical ventilation 3,4 4Cardio Pulmonary 3,4 4Resuscitation (CPR)Blood gases interpretation 4 4

Thrombolysis in acute MI 4 6Management of arrythmias - 4 4Drug / DefibrillationECG recordings & reporting 4 6Exercise tolerence test (ETT) 2,3 2Echocardiography 1,2 4Cardio Pulmonary 4 2Resuscitation (CPR)

Pleural Aspiration 4 3Pleural Biopsy 1 1Chest intubation 2 2Bronchoscopy 2 2Lung function test 2 2

CAT Scan head 1,2,3 4Magnetic resonance 2 2Imaging (MRI) brain/spineElectroencephalography (EEG) 2 2Electromyography/ 1 2Nerve conduction studies (EMG/NCS)

COMPETENCY LEVELS IN ROTATIONAL TRAINING

Level Cases

INTENSIVE CARE

CARDIOLOGY

PULMONOLGY

NEUROLOGY

PROCEDURES

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Endotracheal Intubation 4 6Peritoneal Aspiration 4 4Liver Biopsy 3,4 2Upper GI Endoscopy 2,3 2Colonoscopy / Sigmoidoscopy 2 2Variceal banding / Sclerothrepy 1 2

Chemotherapy 1,2 4Radiotherapy 1 2

Thyroid scan and Radi-iodine treatment 1 2

Haemodialysis 2,3 6Renal Biopsy 1 2Insertion of double lumen catheter 3,4 4Peritoneal Dialysis 2 2

Psychotherapy Sessions 1 2Electro convulsive therpy (ECT) 1 2

COMPETENCY LEVELS IN ROTATIONAL TRAINING

Level Cases

GASTROENTEROLOGY

ONCOLOGY

ENDOCRINOLOGY

NEPHROLOGY

PSYCHIATRY

PROCEDURES

ASSESSMENT

ELIGIBILITY REQUIREMENTS FOR FCPS-II IN MEDICINE EXAMINATION:

The eligibility requirements for candidates appearing in FCPS-II examination in Medicine are:1. To have passed FCPS Part-I in Medicine and allied, or been

granted official exemption.2. To have undertaken four years of the specified training in Medicine,

all of which should be after passing FCPS Part-I (a certificatetestifying attendance is obligatory for admittance to examination) inan institution recognized by the CPSP

3. To provide a certificate of attendance of mandatory workshops.4. To submit a completed and duly attested logbook.5. To provide a certificate of having passed the Intermediate Module in

Medicine.6. To provide a certificate of approval of dissertation or acceptance of

two research papers for publication in CPSP approved journals,synopsis of which were earlier approved by the RTMC.

FORMAT OF EXAMINATIONS:

Theory ExaminationThe written examination will comprise of two theory papers of 3 hoursduration each:Paper I 10 Short Essay Question - SEQsPaper II 75 One Best type of MCQs

25 Extended Matching type - EMQs

Clinical Examination:Only those candidates who pass the theory examination will be eligible toappear in the clinical examination. Detailed instructions will be sentout to all candidates who pass the theory exam regarding thedate and particulars of the clinical exam.

The clinical examination consists of:1. TOACS (Task Oriented Assessment of Clinical Skills) - 14 to 16

stations 2. Long case - One 3. Short cases - Four

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EXAMINATION SCHEDULE:

1. The Fellowship theory examination in Medicine will be held twice

a year.*

2. Theory examinations are held in various cities of the country

usually at Abbottabad, Bahawalpur, Faisalabad, Hyderabad,

Islamabad, Karachi, Lahore, Larkana, Nawabshah, Multan,

Peshawar, Quetta and Rawalpindi centres. The College shall

decide where to hold clinical examination depending on the

number of candidates in a city and shall inform the candidates

accordingly.*

3. English shall be the medium of examination for the theory and

clinical examinations.

4. The College will notify of any change in the centres, the dates and

format of the examination.

5. A competent authority appointed by the College has the power to

debar any candidate from any examination if it is satisfied that

such a candidate is not a fit person to take the College

examination because of using unfair means in the examination,

misconduct or other disciplinary reasons.

6. Each successful candidate in the Fellowship examination shall be

entitled to the award of a College Diploma after being elected by

the College Council and payment of registration fee and other dues.

EXAMINATION FEE:

1. Fees deposited for a particular examination shall not be carried

over to the next examination in case of withdrawal/ absence/

exclusion/ any other reason under normal circumstances.

2. Applications along with the prescribed examination fees and

required documents must be submitted by the last date notified

for this purpose before each examination.

3. The details of examination fee and fees for change of centre,

subject, etc. shall be notified before each examination.

*The CPSP reserves the right to alter dates, postpone examinations or change venue in

the interest of safety and well being of its staff, invigilators and / or candidates.

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REFUND OF FEE:

1. If, after submitting an application for examination, a candidate

decides not to appear, a written request for a refund must be

submitted before the last date for withdrawl with the receipt of

applications. In such cases a refund is admissible to the extent

of 75% of fee only. No request for refund will be accepted after

the closing date for receipt of applications.

3. Fee deposited for a particular examination shall not be carried

over to the next examination in case of withdrawal /

absence/exclusion.

4. If an application is rejected by the CPSP, 75% of the

examination fee will be refunded, the remaining 25% being

retained as a processing charge. No refund will be made for

fee paid for any other reason, e.g. late fee, change of

centre/subject fee, etc.

Note: The candidate is required to fill a self explanatory 'feedback

proforma' at the end of the clinical examination. This will help the

College in making future examination more candidate friendly.

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1. Regional Offices of the CPSP

MUZAFFARABADCMH MuzaffarabadAzad Kashmir TEL: 058810 - 43307FAX: 058810 - 43902Email: ssgr-brehman@cpsp.edu.pk

ABBOTTABAD

Ayub Hospital ComplexAbbottabadTEL: 0992-383330Email: rc_abbottabad@cpsp.edu.pk

PESHAWARHayatabad Medical ComplexPhase IV, Hayatabad,PeshawarUAN: 091-111-666-666TEL: 091-9217011, 091-9217320-1FAX: 091-9217062Email: rc_peshawar@cpsp.edu.pk

ISLAMABADP.I.M.S, Ravi Road, Sector G- 8/ 3Islamabad. UAN: 051-111-666-666TEL: 051-9262590-1, FAX: 051-9262592Email: rc_islamabad@cpsp.edu.pk

FAISALABADPunjab Medical CollegeFaisalabadUAN: 041-111-666-666TEL: 041-9210131, 9210366-8FAX: 041-9210224il:rc_faisalabad@cpsp.edu.pk

LAHORE

Next to INMOL, HospitalNew Muslim Town, Block-DLahore. UAN: 042-111-666-666TEL: 042- 9231320-8 FAX: 042- 9231327Email: rc_lahore@cpsp.edu.pk

MULTAN

Nishtar Medical College,Distt. Jail Road, Opp Circuit House, Multan. UAN: 061-111-666-666TEL: 061-9200946, 9200952Email: rc_multan@cpsp.edu.pk

BAHAWALPUR

Quaid-e-Azam Medical CollegeBahawalpurTEL: 062- 9250461Email: rc_bahawalpur@cpsp.edu.pk

NAWABSHAH

Peoples Medical College for GirlsNawabshahTEL: 0244-9370271, 9370479FAX: 0244-9370478Email: rc_nawabshah@cpsp.edu.pk

LARKANA

Chandka Medical CollegeLarkanaTEL: 074 – 9410726Email: rc_larkana@cpsp.edu.pk

USEFUL ADDRESSESAND TELEPHONENUMBERS

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HYDERABAD

Liaquat University Hospital, Jamshoro

Hyderabad

TEL: 022-3877393

Email: rc_hyderabad@cpsp.edu.pk

KARACHI

2.

UAN – 021-111-606-606

● Examination (FCPS Part I)9207100 -10 Ext: 311

● Examination (FCPS Part II)9207100 -10 Ext: 215

● Department of Medical Education9207100 -10 Ext: 305

● Registration, Training & Monitoring Cell9207100 -10 Ext: 320

For further Information visit theCollege website at :www.cpsp.edu.pk

QUETTA

CPSP Bolan Medical College

Sandeman Civil Hospital

TEL: 081- 9202424Email: rc_quetta@cpsp.edu.pk

3. Saudi ArabiaRIYADH Saudi Commission for HealthSpecialities,Diplomatic Quarter, P.O. Box 94656Riyadh -11614, KSA.TEL: 966-1-4822415 Ext: 156/141

966-2-6401000 Ext: 25843Email: medexam5@scfhs.org

4. NepalKATHMANDUT.U. Institute of MedicineMaharajganj, Kathmandu, NepalTEL: 977-1- 416224Email: cpsp@iomdit.org.np

Departments of CPSP Karachi OVERSEAS CPSP CENTRES