peads teacher mannual
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TEACHING SCHEDULE FOR 4TH
YEAR
MBBS STUDENTS
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Lec.#
Topics Teacher
1 Introduction of Paediatrics course content
Dr. Yasmeen / Dr. Shazia Memon
2 History and Examination of Paediatrics
Dr. Yasmeen / Dr. Shazia Memon
3
Common Paediatrics Problems in PakistaniChildren
Dr. Yasmeen / Dr. Shazia Memon
4 State of worlds and Pakistani Childrens
Dr. M. Akram Shaikh / Dr. Farzana
5 EPI and update on vaccines
Dr. M. Akram Shaikh / Dr. Farzana
6 Introduction to IMNCI
Dr. M. Akram Shaikh / Dr. Farzana
7 Essential Newborn care
Dr. M. Akram Shaikh / Dr. Farzana
8 Breast Feeding and IYCF
Dr. Yasmeen / Dr. Shazia Memon
TIME TABLE FOR 4 YEAR LECTURES LIST
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FOURTHYEARTEACHINGSCHEDULEWITHINTE
GRATIONOFIMNCI
COURSECONTENT
IMNCIHANDBOOK/CLINICAL
TEACHING
PRACTICALWO
RKGROUP
DISCUSS
TEACHIN
GAID
METHODOLOGY
1.HistoryTaking
GeneralPaediatricHistoryand
Introductionto:
Ask/Look/Listen
IntroductiontoCase
recording
form
GroupDemonstration
2.IntroductionofIMNCI&
WallCharts
TheIntegratedcasemanagementprocess
selectingappropriatecasemanagement
chart
FillingofCaseReco
rdingForm
Chartbooklets
WallchartDemon
stration
3.GeneralPhysicalExamination
ClinicalMethodsofExamination
UsingChartbooklets&caserecording
form
DemonstrationofCl
inicalSigns
WallchartDemon
stration
4.ExaminationofCNS.
LethargicandUnconsciousCh
ild
ExaminationandD/D
DemonstrationofGeneralDanger
Sign.
VideoandBedsid
eTeaching
5.ExaminationofCVS
ClinicalPresentationoncongenitaland
acquiredHeartDisease
Anemia,CyanosisandSignsof
RespiratoryDistress
BedsideTeaching
6.AbdominalExamination
ClinicalmethodofExaminatio
n
ClassificationandManagementof
Diarrhea
SignsofDehydrationandI.V
Management
VideoandBedsid
eTeaching
7.ExaminationofRespiratory
System
AssessandClassifyChildwithCoughor
DifficultBreathing
Wheeze&counting
Respiratory
Rate/ChestIndrawi
ng
VideoandBedsid
eTeaching
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ACADEMIC CALENDAR
EIGHTH SEMESTER [FOURTH YEAR MBBS]
BATCH 2007-08
Classes will start from 01st
July 2011
Classes will end on 29th
October 2011
Preparation leaves (+Eid-ul-Azha) 30th
Oct to 20th
Nov 2011
Theory + OSPE Examination (+Ashura) 21st
to Nov to 17th
Dec 2011
Semester Break / Winter Vacation 18th
to 31st
December 2011
8th Semester [4th Year] MBBS Batch 2007-08
DATE
EYE ORT
HO UROLOGYPLASTIC
SURGERYI II III
03 July to 19 July 2011 B1 B2 B3 B4 B5 B6
20 July to 06 Aug 2011 B2 B1 B4 B5 B6 B3
08 Aug to 06 Sep 2011 B5 B6 B1 B2 B3 B4
07 Sep to 24 Sep 2011 B6 B5 B2 B3 B4 B1
26 Sep to 11 Oct 2011 B3 B4 B5 B6 B1 B2
12 Oct to 29 Oct 2011 B4 B3 B6 B1 B2 B5
ENTPAEDS
DER
MA
NEURO
SURGERY
CARDIO
LOGY
I II03 July to 19 July 2011 A1 A2 A3 A4 A5 A6
20 July to 06 Aug 2011 A2 A3 A1 A5 A6 A4
08 Aug to 06 Sep 2011 A3 A1 A2 A6 A4 A5
07 Sep to 24 Sep 2011 A4 A5 A6 A1 A2 A3
26 Sep to 11 Oct 2011 A5 A6 A4 A2 A3 A1
12 Oct to 29 Oct 2011 A6 A4 A5 A3 A1 A2
THE NINTH SEMESTER CLASSES WILL START FROM: 2nd
JANUARY 2012
SCHEDULE OF HOPITAL POSTING
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TEACHING SCHEDULE FOR
FINAL YEAR MBBS STUDENTS
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Department of Pediatrics
Liaquat University of Medical and Health Sciences, Jamshoro
List of Lectures
No Topic Unit Signature
1 Introduction to the Paediatrics subject I
2 Staus of Children in Pakistan / Sindh II
3Introduction to Infectious Diseases in Children in Pakistan and
National GuidelinesI
4 Introduction to Integrated Management of a Sick Child II
5 Introduction to Standard Operating Procedures / National Guidelines I
6 Disease Surveillance II
7 Integrated Case Management (Introduction to Case Management Form) I
8 Emergency Triage II
9 Check for general danger signs I
10 Facility Based management of general danger signs II
11 Septic Meningitis / Encephalitis / Cereberal Malaria TMB I
12 Cough or Difficult Breathing II
13 Facility Based management of cough and dificult breathing I
14 Approach to child with wheeze / Asthma II
15 Diarrheas, causes and classification I
16 Facility based management of diarrhoea II
17 Persistant diarrhoea I
18 Fever IMNCI Classification II
19 Facility based management of childhood fever I
20 Malaria and measles II
21 UTI I
22 Dengue fever II
23 Case definitions and Immunization Schedule in EPI I
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24 Polio and AFP surveilance II
25 Childhood Tuberculosis I
26 Diphtheria, Tetanus, Pertussis II
27 Hepatitis B I
28 Updates on Vaccine preventable diseases II
29 Hepatitis A, Rota Virus Diarrhea I
30 Typhoid II
31 Mumps, Rubella I
32 Approach to child with palmar pallor II
33 Anemias I
34 Newborn feeding (breast feeding) IYCF / ENCC II
35 Young infant feeding IYCF I
36 Check for malnutrition II
37 CMAM I
38 Severe malnutrition SAM/ CC pathway II
39 Micronutrient deficiencies Vitamin A deficiency/ Rickets/ Zinc I
40 Essential newborn care II
41 Birth asphyxia & resuscitation I
42Small baby (LBW & Preterm) problems & management/
Kangaroo careII
43 Neonatal jaundice I
44 IMNCI less than 2 months II
45 Facility based management of danger signs in newborn I
46 Neonatal Sepsis / Meningitis II
47 Approach to neonate with seizures I
48 Birth trauma / common congenital malformations II
49 Approach to a child with edema / nephrotic syndrome I
50 Approach to a child with haematuria / AGN II
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51 Management of renal failure (ARF / CRF) I
52 Bleeding disorders II
53 Leukemia I
54 Thalassemia II
55 Approach to a child with short stature / hypothyroidism I
56 Down syndrome II
57 Acyanotic Heart Diseases VSD, ASD, PDA I
58 Cyanotic Heart Diseases TOF, TGA II
59 Rheumatic fever / RHD I
60 Afebrile seizures (Epilepsy) II
61 Cerebral palsy I
62 Approach to a child with haematemesis / CLD II
63 Approach to a child with behavioral problems I
64 Convention of child rights / child abuse II
65 Poisoning I
66 Practical procedures II
67 MCQ Test I + II
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FINAL PROFESSIONAL MBBS
NEW COURSE 2010-2011
----------------------------------------------------------PAEDIATRICS MCQ PAPER TOTAL MARKS 100
----------------------------------------------------------
FIFTY TRUE OR FALSE QUESTIONS
TABLE OF SPECIFICATION (TOS)
Table of specification (TOS)A. Neonatology 10
1. Neonatal mortality rate in Pakistan and its causes
2. Small baby ( preterm / low birth weight / small for dates )
3. Sepsis
4. Birth asphyxia, resuscitation
5. Essential care of newborn (ENC)
6. Neonatal jaundice
7. Convulsion
8. Bleeding / hematological problems
9. Congenital malformations
10. Young infant IMNCI
B. National Programs 101. Under 5 mortality rate and infant mortality rate in Pakistan , causes and achieving MDG
42. MNCH (IMNCI)3. EPI & NON EPI Vaccines
4. CMAM / SAM
4. Micronutrient Initiative
5. Malaria6. Tuberculosis
7. National guidelines on child rights
C. Emergency Peadiatrics 21. B.L.S
2. Shock
3. Coma3. Emergency triage
D. Respiratory System 3
1. Cough or difficult breathinga. Pneumonia
b. Asthma
c. Croup
d. Throat problem2. Pleural effusion3. Pneumo-thorax
4. Reparatory failure
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E. Gastro Intestinal System 3
1. Diarrhea
a. Acute diarrheab. Persistent diarrhea
c. Dysenteries
d. WHO management plans A, B and C2. Abdominal pain
5. Constipation6. Celiac disease
F. Liver 21. Infectious Hepatitis A, B, C, D, E
2. Hepatic Encephalopathy
3. Chronic liver disease4. Liver abscess
5. Wilson Disease
G. CNS lethargic or unconscious child D/D and management 31. Convulsions and coma
2. Meningitis / encephalitis / cerebral malaria.
3. Cerebral palsy4. Developmental delay
5. Space occupying lesion (brain abscess and brain tumor)
6. Epilepsy
H. Cardio vascular system 21. A cyanotic heart diseases ( VSD, ASD, PDA)
2. Cyanotic congenital heart disease ( TGA, TOF)
3. Management of cardiac failure4. Myocarditis
5. Infective endocarditis
6. Rheumatic fever
I. Infectious diseases 4Approach to child with fever
1. EPI Target Disease
a. Poliomyelitisb. Childhood Tuberculosis
c. Diphtheria
d. Pertusis( whooping cough )e. Tetanus and Neonatal Tetanus
f.. HIB ( Pneumonia and Meningitis)
g.. Measlesh. Hepatitis B
2. NonEPI target Diseasesa. Pneumonia and meningitis ( Pneumococcal Vaccine)b. Enteric fever
c.. Chicken pox
d. Rota virus diarrhea
e. Influenza Virusf.. Measles, Mumps and Rubella ( MMR)
g. Hepatitis A
h. Cervical cancer
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3. Vaccine Research
a. Malaria
b. HIVc. Hepatitis C
J. Renal Disease / Nephrology 3
Approach to child with edema and haematuria1. Urinary infections
2. Nephrotic syndrome3. Acute Glomerulonephritis
4. Acute Renal failure5. Chronic kidney disease
5. Hyper tension
K. Hematological Diseases and Oncology 31. Anemia iron deficiency and others
2. Hemolytic especially thallasemia
3. I.T.P and bleeding disorder4. Coagulation disorders Hemophilia
5. Leukemia / lymphoma
6. Aplastic Anemia
L. Nutrition 2
1. Breast feeding ( ENC/ IYCF), infant nutrition(IYCF), growth monitoring
2. Classification of malnutrition according to CMAM3. SAM, Underweight, Marasmus , Kwashiorkor
4. Chronic malnutrition ,short stature
5. Micronutrientsa. Rickets
b. Vitamin A deficiency,
c. Zinc
M. Chromosomal Disorders 11. Downs Syndrome2. Turners syndrome
N. Endocrines and Connective Tissues Disorders 1
1. Diabetes mellitus
2. Hypothyroidism
3. Rheumatoid arthritis
4. Systemic lupus erythmatosis
5. Kawasaki disease
O. Miscellaneous 11. Common behavioral problems in children.
2. Poisoning
a. Kerosene oilb. Organophosphorus
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DRAFT
Date
Day
CourseContent/
Subject/Topic
Practical/GroupWork
M
ethodology
MaterialRequired
ReferenceManual
ClinicalSigns
Seen
No.of
Student
Facilitator
Name&
Signature
1
PaediatricHistory
IntorductiontoIMNCIChart
Bookletandcaserecordform
sickchildage2monthsupto5
years(Ward/Indoor)
Dem
onstrationon
Wallchart
IMNCIChartfor
Age2monthsupto
5years
IMNCIModuleA
2
GeneralPhysical
Examination
Demonstrationoncase
recordingform.Practice
checkingGeneralDanger
Signs.Ex:A(Indoor)
Dem
onstrationon
Pa
tient&Wall
chart
IMNCICase
RecordingFormfor
Age2monthsupto
5years,ExamKit-1
IMNCIModuleB
FacilitatorGuide
3
ApproachtoChildwith
ConvulsionsorAp
proach
toChildwithComa
CheckforGeneralDanger
Signs.CNSExamination
(MotorSystem)(Indoor)
Dem
onstrationon
Patient
IMNCIWallChart,
ExamKit-2
IMNCIModuleB
Clinicalmethods(Bedside
Technics)
4
Meningitis/Encep
halitis
andCereberalMa
laria.
Casepresented
by
Students
DemonstrationofNeck
stiffness.MotorSystem&
CranialNerves(Indoor)
Dem
onstrationon
Patient
IMNCIWallChart.
ExaminationKit-2
IMNCIModuleB
FacilitatorGuide
5
ApproachtoChildwith
CoughorDifficult
Breathing
AssessandClassifyChild
withCoughorDifficult
Breathing(OPD)
Dem
onstrationon
Patient/Wallchart
Pneu
moniaSection
IMNCIWallChart/
Video
IMNCIModuleB
6
DifferentialDiagnosisof
chroniccough,W
heeze
andTuberculo
sis
TreattheChildwithAsthma/
TB(OPD)
Dem
onstrationon
Patient/Wallchart
UseofNebulizer
withVentolin
Solution.
Bronchodilator,
Peakflowmeter&
StethExamKit-3
IMNC
IModuleBforAsthma
&TB(NationalGuideline)
7
AssessandClassifyChild
withDiarrhea
AbdominalExamination
DemonstrationofSignsof
SevereDehydration(Shock)&
PlanC(Indoor)
Dem
onstrationon
Patient/Annexure
PlanC
Pa
ssingofN/G
Tube
IMNCIChart,
AnnexureofPlanC,
Inj.RingerLactate,
N/Saline,IVCannula,
DripSet,NGTube&
ORS,ExamKit-4+7
IMNC
IModuleB,WHOPocket
handbook
FinalYearMBBS
ClinicalTeachingSch
edule
DepartmentofP
aediatrics,LUMHS
Jamsh
oro
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8
Caseprese
ntationof
Diarrheab
yStudent
Counseling,Demonstrationof
FeedingSchedulesonwallchart
forPersistentDiarrhea,
ManagementPlanA&B(OPD
)
Smallgroup
discussionwith
studentsonpatient
withcase
recordingform
IMNCICharts,
AnnexureofPlanA
&B,ORS2
packets,Water1
liter,Measuring
container,Spoon&
Cup
IMNCIModuleB
MotherCard
9
AssessandC
lassifyFever
DemonstrationofClinicalsigns
/
casesofMalaria,SeverePalmar
Pallor/NeckStiffness/
SplenomegalyorRashes(OPD
)
Lecture&Chart
Demonstration&
Smallgroup
discussionwith
studentsonPatient
withCaserecording
form
IMNCICharts,
NationalMalaria
Guideline,Lab.
Reports
IMNCIModuleB,WHOPocket
handbook
10
VideoEx
erciseU
Ward/SeminarRoom
VideoExerciseU
Multimedia,Video
USB,Computer,Case
RecordingForm
IMNCIModuleB
11
AssessandC
lassifyChild
withEarProblem,Throat
Prob
lem
DemonstrationofSignsforEar
problem,Demonstrationof
SignsforThroatproblem(OPD
)Demonstrationon
Patient&onWall
chart
IMNCIChart,Case
RecordingForm,
Tonguedepressor,
Torch
IMNCIModuleB
12
PracticefromExercises
A,B,E,F,H,IandM
WrittenExercise(Indoor)
Exercisefollowed
byIndividual
Feedback
WrittenExercise,
ChartBookletand
CaseRecordingForm
IMNCIModuleB
13
Practicalapproachto
Malnouris
hedChild
Practicaldemonstrationon
Anthropometry(MUAC&Z
-
Score)&GrowthChart
(OTP/OPD)
Demonstrationon
Patient
IMNCICharts,Z-
ScoreChart,Growth
Chart,Weight
Machine
NationalCMAMGuidelines
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14
ApproachtoChild
with
Malnutrition.Introduction
toSAM
DemonstrationofSignsof
Malnutrition&Vitamin
deficiencies.(NSC/Ward)
Lecture&
Practical
Demonstrationon
Patient&Wall
Chart
IMNCICharts,
ExaminationKit-5&
Photograph
IMNCIModuleB
Ma
nagementofSAM,WHO
Guidelines
15
ApproachtoChild
with
Anemia
DemonstrationforAnemia,
PalmarPallor,Blood
Transfusions,DataInterpretation
(OPD/Indoor)
Demonstrationon
Patient&Clinical
C
aseSenario
ExaminationKit-1,
LabReports
IM
NCIModuleB,Nelson
T
extbookofPaediatrics
16
EPI&NonEPIVacc
ines.
Methodofnotifyingto
EDO
HealthforCommunicable
Diseases/AFP
DemonstrationofVaccine
Vials&Vaccinesyringes,
Poliosurveillance,Checking
Immunizationstatus&
recordingonImmunization
Cards
(OPD/EPI)
Demonstration/
Measles
Classificationon
IMNCIChart
VaccineVials,
Syringes,
VaccinationCard,
EDOInformation
form&Recording
Form
ImmunizationinPractice
IMNCIModuleB,F
17
PhotographExcercies
D,J,K,L,O,P
Individualassignment
followedbygroupdiscussion
(Indoor/Ward)
Identificationof
IMNCI
Photographs
Multimedia&Soft
copyofIMNCI
Photograph
IMNCIModuleB
18
NeonatalHistory
+
Examination
IntroductiontoChartbooklet
&Caserecordingform
Sick
childageLessthan2Months
(Indoor/Nursery)
Demonstrationon
Patient
IMNCICharts,Case
recordingformage
lessthan2months
IMNCImoduleF
19
WHOEssentialNew
born
Care
PracticalSessiononEssential
NewbornCare(Indoor)
Demonstrationon
Patient/RolePlay
LaborRoom,
PostnatalWard
PC
PNCGuideSectionJ
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20
BirthAsp
hyxia
PracticalSessiononDummy
onResuscitation
(Indoor/SkillLab)
Demonstrationon
Dummy
Dummy&
Resuscitation
trolley,AmbuBag,
ExamKit-6
WHO-ENCCmanual
ManagementofChildwith
seriousinfectionorsevere
malnutrition(WHO)
21
PracticalApproachto
SmallB
aby
ExaminationofSmallBaby
(Preterm&LBW)&
IntroductionofBallard
scoring
(Indoor/Nursery)
Demonstrationon
SmallBaby
accordingtoPCPNC
Guide&Clinical
CaseSenario
PCPNCguiedeJ2to
J8andneonatal
examform
PCPNCGuideSectionJ
BallordScoringForm,Nelson
TextBookofPaediatrics
22
Checkforp
ossible
Infection
Demonstrationoncounting
RespiratoryrateinNeonates,
signsofPossibleInfection
(OPD)
CheckforPossible
Infection/Wall
Chart
Demonstration
IMNCIChart,
ExaminationKit&
CaseRecording
Form
IMNCIModuleF
23
NeonatalJaundice
DemonstrationofJaundiceon
Patient
(OPD)
Demonstrationon
Patient/WallChart
IMNCIChart&
CaseRecording
Form
IMNCIModuleFNelson
textbookofPaediatrics
24
ChecktheYoungInfant
forfeedingproblem,
Assessmentof
Breastfeeding
CounseltheMotherabout
Breastfeedingproblems,
DemonstrationonSignsof
Positioning,Attachment&
SucklingonYoungInfant
(OPD/SeminarRoom)
Demonstrationon
Breastfeeding
Assessment
Multimedia,Video
onBreastfeeding
IMNCIModuleE,F
25
MethodsofBreastfeeding
replacement(C
up
feeding)
CheckforFeed
ing
ProblemorLowWeight
PracticalSessiononCup
Feeding,AssesstheChild
Feeding&IdentifyFeeding
Problem,Counselingon
Feedingproblem
(Indoor/Nursery)
Demonstrationon
Patient/RolePlay,
Demonstrationon
Patient/RolePlay
Cup,Spoon,
ArtificialBreast,
IMNCIChart
Feedingduring
Illnes
IYCF,ENCCManuals,
IMNCIModuleE,FIYCF
Guidelines
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26
Identifyth
eTreatmentfor
alltheClassifications,
Identifyth
ePre-referral
treatment&treatmentfor
thosePatientswhere
referralisnotpossible
DemonstrationonIdentifying
&givingtreatment,writing
prescriptionnote,treating
localinfections,
DemonstrationongivingPre-
referraltreatment(IM,IV&
Perrectal),writingreferral
note(OPD)
Demonstrationon
Patient/Wall
Chart,
Demonstrationon
Patient/Wall
Chart/RolePlay
IMNCIChart,
Drugsusedin
IMNCIStrategy,
IMNCIChart,IM&
IVDrugsusedin
IMNCIOPD
IMNCIModuleC,IMNCI
ModuleC
27
Communication&
counseling
skills,Need
forwhentoreturn
immediate
ly,Counselthe
motheraboutherown
Health,Fo
llow-upcare
forSickChild,Follow-up
careforSickYoung
Infant
CounseltheMothertogive
Oraldrugs,TeachtheMoth
er
totreatLocalinfectionat
home,whentoreturn
immediately,UseofMothe
r
Card,Practical
demonstrationonfewcases
(OPD)
Demonstrationon
fewcases.
Exercise/Role
Play/WallChart,
Demonstrationon
Patient/WallChart
MotherCard,
IMNCIChartfor
demonstration
IMNCIModuleE,G,IMNCI
ModuleE,G
28
Student
Evaluationon
MCQsandCaseScenario
MCQsandCaseScenario
(SeminarRoom)
Lecture
presentation/
Photographs&
Videos
Photographs&
Videos
IMNCI/UNICEF/WHO/
NelsonTextbookof
Paediatrics
29
ApproachtoChildwith
Rash,Purpuricspots,
Bleedingdisorders
DemonstrationofPatient
withAplasticAnemiaITP
or
Leukemia(Indoor)
Demonstrationon
Patient/Long
Case,Data
Interpretation
DataInterpretation,
Photographsand
Lab.Reports
NelsonTextbookof
Paediatrics
30
ApproachtoChildwith
Oedema/Ascites,
Nephro
ticSyndrome
ExaminationforAscites,
AsciticFluidTap(Indoor)
Demonstrationon
Patient/LongCase
BPAppratus,
Photographsand
Labreports
NelsonTextbookof
Paediatrics
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31
ApproachtoChildwith
Jaundice
CaseofHepatitis,Updateson
prevention/Management
(OPD)
Dem
onstrationon
Patient/LongCase
ExaminationKit-1
N
elsonTextbookof
Pae
diatricsandNational
guidelineforHepatitis-B&C
32
PaediatricRadiology
X-Ray(Indoor)
X-Ray
Demonstration
X-Rays&
Illumonator
33
ApproachtoChildwith
CereberalPalsy/M
ental
Retardation
Demonstrationof
DevelopmentalAssessment
(OPD/Physiotherapy
department)
Dem
onstrationon
Patient/ShortCase
ExaminationKit-
1+2,Photographs
andvideos
N
elsonTextbookof
Paediatrics
34
ApproachtoChildwith
CongenitalHeartD
isease
DemonstrationofCVS
Examination(Indoor)
Dem
onstrationon
Patient/ShortCase
ExaminationKit-1,
Photographs
N
elsonTextbookof
Paediatrics
35
PatientwithOddF
acies,
DownSyndrome
CounselingforChronic
problems(Indoor/OPD)
Dem
onstrationon
Patient
Photographs
N
elsonTextbookof
Paediatrics
36
PatientwithDiabetes
Ketoacidosis
Glucometer/Demonstration
InsulinSyringes/Injection
Techniques(Indoor)
Lectureon
M
anagement
protocolonDKA
ExaminationKit-1
N
elsonTextbookof
Paediatrics
37
Instrumentsand
Procedures
PassingofN/Gtube,LP
Procedureetc(Indoor)
Dem
onstrationon
Dummy
InstrumentTray
WH
OPocketHandbook
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Lesson Plan
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Day 1
Topic : Paediatric History (Indoor)
Introduction to Case Recording Form and chart booklet.
Time : 2 hours & 30 minutes
Facilitator introduces the topic and assign practical /clinical task. 30 min
Student: Each Student takes the history and fills Case Recording Form. 1 hour
Group discussion, on history taking according to form filled by student. 1 hour
Learning objectives:Students should able to:
Take a Paediatric history.
Knows components of history and how to elaborate each component
To integrate IMNCI assessment and classification with Paediatric history and examination.
Fill the case recording form and classify the illness according to IMNCI.
Askthe questions required to assess the childs feeding.
Do a systemic enquiry.
Make a provisional diagnosis and differential diagnosis on the basis of history.
Clinical Skill Learnt:
Use basic Communication skills to take a relevant history of a child according to disease.
Able to fill the case recording form for general danger signs.
Able to enquire about each main-symptom individually
Facilitator/Instructor Procedure for Clinical work:
Demonstration of taking history on a patient
Facilitator/Instructor Procedure for Practical work:
Wall chart Demonstration
Introduction of recording form
MATERIAL REQUIRED
Paediatric history journal/ form with format /outline of Paediatric history.
IMNCI Wall chart
IMNCI Chart booklet
Case recording form
Pencil
Eraser
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Lesson Plan
Day 2
Topic: General .physical examination (Indoor)
Time: 2 hours & 30 minutes
Facilitator introduces the topic and assign practical /clinical task. 30 min
Student: Each Student perform general physical examination on child under supervision ofco-facilitator. 1hour
and discuss the findings in subgroups. 1 hour
Learning objectives: Student should be able to:
Describe the general look of patient .
Identify general danger signs.
Assess childs Nutrional status.
Pick up congenital anomalies/any dysmorphism.
Do a head to toe examination includes vitals, anthropometric measures, identify/ anemia,
cyanosis, edema, clubbing, dehydration
Able to perform the lymph node, back and ENT examination.
Clinical skill learnt
Is able to take the informed consent and perform general physical examination. Assessment of General look, method to take vitals i-e Respiration, Pulse rate
Temperature, anthropometric measurement, Jaundice, cyanosis, & clubbing,
Able to identify nutritional status, and check for nutritional edema. Assess the dehydration and can advice plan of rehydration according to status.
Check for anemia and classify the anemia accordingly.
Facilitator/Instructor Procedure for Clinical work:
o Demonstrate the assessment a child with general danger sign
o Demonstration on performing general physical examination
Facilitator/Instructor Procedure for Practical work:
o Show students how to use the information on childs history written in recording
form
MATERIAL REQUIRED
Printed proforma or format of general physical examination.
Wall chart & Chart booklet
Case recording form
Torch, Pencil, Measuring Tape
SD chart & MUAC tape.
Weighing scale &Height /length scale
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Lesson Plan
Day 3 Approach to a child with convulsion or Coma (Indoor)
Time: 2 hours & 30 minutes
Facilitator introduces the topic and assign practical /clinical task. 30 min
Students take the history and performs examination on a patient. 1 hour
Case presentation/ Group discussion 1hour
Learning objectives: Student should be able to:
Take relevant history of a child with convulsion or coma and fill the recording forms
and perform a relevant examination.
Identify general danger signs.
Assess the level of consciousness by AVPU scale.
Know the differential diagnosis of child with convulsion/ coma
To give the pre-referral treatment.
Know how to investigate him
Treat the child with convulsion or coma.
Facilitator/Instructor Procedure for Clinical work:
o Demonstrate the assessment of a child with general danger sign
o Communication skills to take a relevant history of child with convulsion or coma
o Checksigns of meningeal irritation, and to perform motorexamination of central nervous system.
o Knows pre-referral treatment of very severe disease
Facilitator/Instructor Procedure for Practical work:
Show students how to use the information on childs history which is already
written on recording form.
MATERIAL REQUIRED
Wall chart Chart booklet
Case recording form
N/G Tube No. 5,6 & 8
D/Syringe 5 &10ml
Normal saline ampoule
Stethoscope
CNS examination kit.
Pre-referral drug tray
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Lesson Plan
Final year MBBS Small Group Teaching
Day-4: Meningitis/Encephalitis and Cerebral Malaria (Indoor)
Time: 2 hours and 30 minutes.Facilitator Introduces the topic and assigns clinical task 45 minutes
Student takes the history and performs examination of patient with possible CNS infection1 hour
Case presentation 45 min
Learning Objectives: Students should be able to:
Take a relevant history and perform relevant clinical examination.
Describe different causes of CNS infection in children.
Knows the investigation required to conform clinical diagnosis
Knows the treatment of common CNS infection.
Describe the complication of Meningitis / Encephalitis and Cerebral Malaria.
Facilitator/Instructor Procedure for Clinical work:
Take the history and performs CNS examination e.g able to check for neck stiffness,
GCS, cranial nerves, signs of meningeal irritation, motor system.
Knows the pre-referral treatment.
Treat the patient with Meningitis / Encephalitis and Cerebral Malaria in health facility.
Facilitator/Instructor Procedure for Practical work:
Wall chart demonstration
MATERIAL REQUIRED
IMNCI Wall chart
IMNCI Chart booklet
IMNCI Case recording form
CNS Examination kit.
Measuring tape, Hammer, Torch.
Disposable tongue depressor
Thermometer
Kit for lumber puncture procedure.
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Lesson Plan
Day-5: Approach to child with cough or Difficult Breathing (OPD)
Time: 2 hours and 30 minutes
Facilitator Introduces the topic and assigns practical /Clinical task 30 minutes
Student takes the history and performs examination of a patient with cough or difficulty in
breathing. 1 hour
Case Presentation 1 hour
Learning Objectives:
Student should be able to
Assess and classify a child with cough and difficult breathing.
Take a relevant history, fills the recording form and perform respiratory examination.
Identify general dangers signs, is able to count respiratory rate and lower chest indrawning
and to recognize wheeze and stridor. Classify the child with cough and difficult breathing.
Describe how to investigate child with cough and difficult breathing.
Treat the child in primary health facility and referral center.
Clinical skills learnt:
Communication skills to take a relevant history of a child with cough and difficult breathing,
counting of respiratory rate in one minute and to define fast breathing.
Differentiates normal breathing from chest indrawing
Differentiates between wheeze and stridor.
Performs Respiratory system examination.
Use nebulizer or inhaler to treat the wheeze
Facilitator/Instructor Procedure for Clinical work:
Demonstrate the assessment of a child with cough or difficult breathing, Stridor and fastbreathing
Supervise closely first time students count childs breathing, look for chest indrawing and
listen for stridor
Facilitator/Instructor Procedure for Practical work:
Show how to use information in child history on recording form
Assign the patient, observe and assist as needed while students assess and classify
Facilitator Procedure:
MATERIAL REQUIRED
IMNCI Wall chart
IMNCI Chart booklet
IMNCI Case recording form
Stethoscope.
Measuring tape.
Tongue depressor.
Nebulizer /inhalers
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Lesson Plan
Final year MBBS Small Group Teaching
Day-6: Approach to child with chronic cough, asthma &
tuberculosis. Approach to child with Wheeze (OPD)
Time: 2 hours and 30 minutes
Facilitator Introduces the topic and assigns practical /Clinical task 45 minutes
Students takes history and perform physical examination form child with chronic
cough/recurrent wheeze, or clinically suspected pulmonary TB 1 hour
Group Discussion on history and positive examination findings in subgroups with co-facilitators.
45 minutes
Learning Objectives: Student should be able to
Takes a relevant history, fills the recording form and perform relevant clinical
examination on the child with chronic cough or recurrent wheeze.
Knows about the different causes of wheezing in children.
Knows how to investigate child with chronic cough/recurrent wheeze or suspected
case of tuberculosis.
Is able to treat the child wheeze in primary health care facility.
Knows about the use Nebulizer machine, Peek flow meter, and inhalers.
Knows the questions and clinical signs to be looked for in asthma according to PPA
asthma guidelines and TB according to Keninth Jhon,s criteria and national TBguidelines.
Facilitator/Instructor Procedure for Clinical work
Communication skills to take a relevant history of a child with wheeze, can identify
wheeze, knows about different causes of wheeze, Is able to differentiate
between wheeze and stridor.
Performs respiratory system examination.
Facilitator/Instructor Procedure for Practical work
Demonstrate use of Nebulizer, use of peek flow meter and use ofinhaler
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
Ventolin solution
Nebulizer
Inhaler
Peek flow meter
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Lesson Plan
Final year MBBS Small Group Teaching
Day-7: Assess and classify child with Diarrhea and Shock (Indoor)
Time: 2 hours and 30 minutes
Facilitator Introduces diarrhea, severe dehydration and shock 30 minutes
Student Performs clinical examination of a patient with diarrhea and assess severe dehydration
and shock.. 1 hour
Group Discussion 45 min
Video 15 min
Learning Objectives:
Student should be able to assess and classify child with diarrhea and shock
Takes a relevant history, fills the recording form and perform relevant clinical examination
shock.
Able to identify general danger sign.
Describe etiology and complication of diarrhea including shock.
Knows how to investigate child with diarrhea
To manage the child in community and health facility by treatment plan C
Facilitator/Instructor Procedure for Clinical work:
Communication skills to take a relevant history of a child with diarrhea and shock, able to
assess lethargic or unconsciousness, restlessness, or irritable, sunken eyescapillary refill time and severity of shock.
Observe child for not able to drink or drink poorly, drink eagerly or Thirsty
To identify skin pinch whether goes very slowly or slowly. Observe a child receiving Intravenous fluid in severe dehydration
Facilitator/Instructor Procedure for Practical work:
Demonstrate the assessment of a child with diarrhea
Demonstrate how to prepare ORS,
MATERIAL REQUIRED
Wall chart IMNCI
Chart booklet
Case recording form
Pen, Pencil, Eraser, cuter, Board and marker
ORS, water, cup and spoon
Inj. Ringer lactate, N/saline, dopamine, I.V cannula, Drip set, N/G Tube
Oxygen stethoscope, B.P apparatus.
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Lesson Plan
Final year MBBS Small Group Teaching
Day-8: Case presentation on Diarrhea by students (OPD)
Time: 2 hours and 30 minutes
Facilitator Introduces the diarrhea management using plan A & B 30 minutes
Student
Group Discussion on demonstration of feeding schedule for persistent diarrhea and counseling
1 hour
Student will fill the case recording form of diarrhea and discus with co-facilitator
1 hour
Learning Objectives:
Student should be able to assess and classify child with diarrhea
Takes a relevant history, fills the recording form and perform relevant clinical
examination.
Recognize the clinical sign of no dehydration or some dehydration.
Feeding management of child with persistent diarrhea.
To treat child in community and health facility
Facilitator/Instructor Procedure for Clinical work:
Communication skills to take a relevant history of a child with diarrhea
Counseling learnt about feeding a child with persistent diarrhea. Demonstrate technique of doing skin pinch
Treat child with no dehydration (Plan A) and some dehydration with (Plan B) in healthfacility.
Facilitator/Instructor Procedure for Practical work:
Demonstrate the assessment of a child with diarrhea
Assign patients to students
Demonstrate how to prepare ORS and calculate amount of ORS in diarrhea at
different age groups and weight.
MATERIAL REQUIRED
Wall chart IMNCI
Chart booklet
Case recording form Pen, Pencil, Eraser, cuter, Board and marker ORS, water, cup and spoon.
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LESSON PLAN VIDEO EXERCISE U (Indoor)
Day 10: Approach to child 2 months up to 5 years.
Time: 2 hours and 30 minutesFacilitator Introduces the topic and assigns practical / clinical task
30 minutes
StudentPerforms outdoor / Fill the case recording forms / practical task under supervision insub group. 1 hour
Group Discussion / Case Presentation /Video 1 hour
Learning Objectives:-
Asking the mother about the childs problems.
Checking for general danger signs.
Asking the mother about.
Cough or difficult breathing Diarrhea
Sore throat
Ear problem
Fever
Check for malnutrition.
Check for anemia.
Asses breast feeding.
Filling the case recording form properly.
Circle the general danger signs properly.
Tick ( ) either Yes or No.
Material Required:-
LCD / TV
DVD / USB
Case recording form
Pencil, Pen, Eraser, Cutter.
Summary /Clinical skills learned:-
Now you have learn to:
Ask questions from mother.
Identify the general danger signs.
Asking the mother about cough or difficult breathing, diarrhea, Fever,
Sore throat, ear problem. Check for malnutrition.
Check for anemia.
Asses breast feeding.
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Lesson Plan
Day 12 : Day of assessment
Written EXERCISES (Indoor)Time: 2 hours and 30 minutes
Facilitator Introduces the topic and assigns practical /clinical task 30 minutes
Student
Fill the case recording forms 1 hour
Group Discussion 1 hour
Learning Objectives:-
To assess the students ability to assess and classify the illness according to IMNC in 2 months to
5 years.
. Material Required:-
LCD / TV
DVD / USB
Case recording form
Pencil, Pen, Eraser, Cutter.
Summary /Practical skills learned:-
Assessment and classification of illness according to IMNCI.
Filling the case recording form properly.
EXERCISE A
Case 1: Salina
Salina is 15 months old. She weighs 8.5kg. Her temperature is 38.5C.
The health worker asked, What are the childs problems? The mother said, Salina has
been coughing for 4 days, and she is not eating well. This is Salinas initial visit for this problem.
The health worker checked Salina for general danger signs. He asked, Is Salina able to
drink or breastfeed? The mother said, No Salina does not want to breastfeed. The health worker gave
Salina some water. She was too weak to lift her head. She was not able to drink.
Next he asked the mother, Is she vomiting? The mother said, No. Then he asked. Has
she had convulsions? The mother said, No
The health worker looked to see if Salina was lethargic or unconscious. When the health
worker and the mother were talking, Salina watched them and looked around the room. She was not
lethargic or unconscious. She is not convulsing now.
Now fill the case recording form and classify the illness and identify the treatment .
EXERCISE B.
Case 1: Gul
Gul is 6 months old. He weighs 5.5kg. His temperature is 38C. His mother said he has
cough for 2 days. The health worker checked for general danger signs. The mother said that Gul is able to
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breastfeed. He has not vomited during this illness. He has not convulsions and is not convulsing now. Gul
is not lethargic or unconscious.
The health worker said to the mother, I want to check Guls cough. You said he has
cough for 2 days now. I am going to count his breaths. He will need to remain calm while. I do this.
The health worker counted 58 breaths per minute. He did not see chest indrawing. He did
not hear stridor. He did not hear wheeze.
Now fill the case recording form and assess and classify the sick child
EXERCISE E
Case 1: Paro
Paro has diarrhea for five days. He has no blood in the stool. He is irritable his eyes are
sunken. His father and mother also think that paros eyes are sunken. The health worker offers Paro some
water, and the child drinks eagerly. When the health worker pinches the skin on the childs abdomen. It
goes back slowly.
Now fill the case recording form and assess and classify the sick child
EXERCISE F
Case 4: Heera
Heera is 3 years old. She weighs 10kg. He temperature is 37C. Her mother came today because
Heera has a cough and diarrhea.
She does not have any general danger signs. The health worker assessed her for cough or
difficult breathing. She has cough for 3 days. He counted 36 breaths per minute. She does not have chest
indrawing or stridor or wheeze.
When the health worker asked how long Heera has diarrhea, the mother said, For more than 2
weeks. There is no blood in the stool. Heera is irritable during the visit, but her eyes are not sunken. She
is able to drink, but she is not thirsty. A skin pinch goes back immediately.
EXERCISE H
Case 1: Ghori
Ghori has fever off and on for two days and has complained of a sore throat. He has no
general danger signs, no difficult breathing and he has not been coughing. He did not have diarrheoa. His
mother brought him to you today because he is refusing to eat, although he is still able to drink clear
soup. Ghori is four year old, he weights 16kg.
You feel Ghors neck and find that his glands are swollen and tender. He has red
enlarged tonsils. He has white exudates on his throat. His temperature is 39.7C.
Now fill the case recording form and assess and classify the sick child
EXERCISE I
Case 1: Hira
Hira is 3 years old. She weighs 13kg. He temperature is 37.5C. Her mother came to the
clinic today because Hera has felt hot for the last 2 days. She was crying last night and complained that
her ear is hurting.
The health worker checked and found no general danger signs.
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Hira does not have cough or difficult breathing. Se does not have diarrhea. Her malaria
risk is high. Her fever was classified as Malaria.
Next the health worker asked about Hiras ear problem. The mother said she is sure Hira
has ear pain. The child cried most of the night because her ear hurt. There has been discharge coming
from Hiras ear on and off for about a year, said the mother. The health worker did not see any pus
draining from the childs ear. He felt behind the childs ears and felt tender swelling behind one ear.
Now fill the case recording form and assess and classify the sick child
EXERCISE M
Case 3: Atika
Atika is 5 months old. She weighs 5kg.Her temperature is 36.5C. Her family brought her to the clinic
because she feels hot and has had cough for 2 days.
She is able to drink. She has not vomited or had convulsions, and is not lethargic or unconscious.
The health worker said, I am going to check her cough now. The health worker counted 43 breaths per
minute. There was no chest indrawing and no stridor or wheeze when Atika was calm.Atika did not have diarrhea,Sore throat or ear infection.
Now, I will check her fever, said the health worker. Atika lives in an area where many cases of malaria
occur all year long (high malaria endemicity). Her mother said. Atika has felt hot off and on for 2 days.
She has not had measles within the last 3 months. She does not have stiff neck or runny nose.
Atika has a generalized rash. Her eyes are red. She has mouth ulcers. They are not deep and extensive.
She does not have pus draining from the eye. She does not have clouding of the cornea.
Now fill the case recording form and assess and classify the sick child.
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Lesson PlanFinal year MBBS Small Group Teaching
Day-14: Approach to child with malnutrition and Introduction to
CMAM (Indoor)
Time: 2 hours and 30 minutes
Lead Facilitator introduces the topic and assigns practical /clinical task. 30 min
Student
Demonstration of signs of Malnutrition and Vitamin deficiencies 30 min
Lecture and practical demonstration on patient and wall chart 40 min
Video and photographs 30 min
Reassemble in class with lead facilitator and case presentation 20 min
Learning Objectives:
Student should be able to assess and classify a child with mal-nutrition.
Takes a relevant history, fill the recording form and perform relevant clinical examination.
Student should be able to demonstrate visible severe wasting or edema of both feet,determine weight for age, height/ length and able to measure mid upper arm circumference
(MUAC)
How to use standard deviation reference card
How to approach and investigate the child with malnutrition and to treat the child in thecommunity at OTP and health facility by using critical care pathway form.
Clinical skills learnt:
Communication skills to take a relevant history of a child with malnutrition, Examination
of child like able to decide for visible severe wasting
Bilateral pedal edema
Determine weight for age
Able to measure the height / length
Able to use the standard deviation (SD) reference card
Knows the use of critical care pathway form
Facilitator/Instructor Procedure for Clinical work: Demonstrate how to check for malnutrition
Assign patients to students, observe and assess as needed while students assess and classify. Demonstrate the technique of assessing edema of both feet
Facilitator/Instructor Procedure for Practical work:
Demonstrate how to use weight for age chart Conduct practice for students who do not know how to Zero the scale to get an accurate
reading.
MATERIAL REQUIRED
IMNCI charts and Chart booklets
Case recording form
Examination kit-2
TV. DVD Player for video demonstration
Photographs
Z-score chart
Weighing Scale
Stadio meter, RUTF
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Lesson Plan
Final year MBBS Small Group Teaching
Day-15: Approach to child with anemia (Indoor / Outdoor)
Time: 2 hours and 30 minutes
Facilitator introduces the topic and assigns practical /clinical task 30 minutesStudent- Take history & perform clinical examination of child with anemia
1 hour
Case Presentation Group Discussion 1 hour
Learning Objectives:
Student should be able to:
Take a relevant history, fills case the recording form and perform relevant clinical
examination.
Differentiate between different causes of anemia in children i.e Iron deficiency, Vitamin
B12 and folate deficiency, Thalasemia, Hemolytic anemia and aplastic anemia.
Describe how to investigate child with anemia, knows the appropriate investigations required
to confirm the cause of anemia
Treat the child in community and at health facility.
Knows the indication of blood transfusion in anemic patient.
Write blood transfusion note.
Facilitator/Instructor Procedure for Clinical work:
Communication skills to take a relevant history of a child with anemia, checking for
palmar pallor, & differentiate between some palmar pallor and severe palmar
pallor.
Check signs of heart failure due to severe anemia such as gallop rhythm, edema, liverenlargement and fine basal crackles on auscultation
Treat the child with anemia in community & at health facility.
Demonstrate how to check for anemia
Demonstrate how to differentiate between some and severe palmer pallor
Facilitator/Instructor Procedure for Practical work:
Assign patients to students, observe and assess as needed while students assess and classify.
Interpret blood complete picture report.
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
Different blood complete picture reports
Blood transfusion set
Syp. Iron
Inj. Furesomide
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Lesson PlanFinal year MBBS Small Group Teaching
Day-16: EPI and Non EPI Vaccines. Method of notifying to EDO
Health for Communicable diseases/ AFP (OPD)
Time: 2 hours and 30 minutesFacilitator introduces the topic 30 minutes
Facilitator give demonstration of Vaccine Vials, Vaccine Syringes, Polio surveillance, Checking
Immunization status 30 minutes
Student
Performs outdoor practical task under supervision in sub group& fill the case
recording form of a child for immunization status & need of 1 hour
Vaccination on that day & thereafter.
Group Discussion 30 minutes
Learning Objectives:
Student should be able to:
know about EPI and non EPI vaccines
Take a relevant history, fills the recording form
Knows about indications and contra-indications of different vaccines
EPI Schedule of Immunization
Checking the status of immunization
Know about Polio surveillance Describe the method of notifying to EDO health for communicable diseases/ AFP
Importance of vaccination card
Facilitator/Instructor Procedure for Clinical work:
Basic communication skills to take a relevant history, identify vaccine vials and give
vaccines, checking Immunization status
Facilitator/Instructor Procedure for Practical work:
Demonstrate how to assess Immunization status of a child
Assign patients to students, observe and assess as needed while students assess and classify.
Method of notifying to EDO Health for communicable diseases/AFP
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
Vaccine vials
Syringes
Vaccination cards
EDO information form
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Lesson Plan
Final year Small group Teaching
Day 17: Photograph Exercise D, J, K, L, O, P (Indoor)
Time: 2 hours and 30 minutesFacilitator Introduces the example of photograph related to IMNCI photo guideline
30 minutes
Student
Student should be able to identify clinical signs from the photographs/ practical task
under supervision in sub group. 1 hour
Group Discussion 1 hour
Learning Objectives:-
To assess the students ability to identify different clinical signs taught in IMNCI
Summary / Practical work:-
Knows & identify different clinical signs to properly classify the illness according to
IMNCI : like
Signs of dehydration
Identify the skin rashes
Identify Sign of malnutrition
Identify pus discharge from eyes and other signs of Vitamin A deficiency
Identify edema on both feet
Identify palmer pallor
Material Required:-
Case recording form/Plan paper
Pencil, Pen, Eraser, Cutter.
Photograph book
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Lesson Plan
Day 18 Topic: Neonatal History and Examination (Indoor)
Time : 2 hours & 30 minutes
Facilitator introduced the topic and assign practical /clinical task. 30 min
Student takes history & perform indoor clinical task/ practical task under
Supervision in subgroups. 1 hour
Case presentation / Group discussion, 1 hour
Learning objectives:
Students should able to:
Take a relevant history and knows components of antenatal, natal and postnatal history
and how to elaborate each component. Knows how to fill the case recording form of 0-2 months
Do a head to toe examination includes vitals, anthropometric measures; identify anemia,cyanosis, edema, dehydration.
Pick up congenital anomalies
Counsel parents regarding problem of neonate and follow up visits.
Facilitator/Instructor Procedure for Clinical work:
Basic communication skills to take neonatal history.
Identify general danger sign
Inquire about each main-symptom individually Identify General look, take vitals i-e Respiration, Pulse rate, Temperature,
anthropometric measurement, assess anemia, Jaundice, cyanosis, edema,
dehydration & congenital malformations.
Demonstrate young infant with as many signs of very severe disease as available; severechest indrawing, grunting, fast breathing, convulsion, not feeding well, fever or low body
temerature
Facilitator/Instructor Procedure for Practical work:
Demonstrate assessment of a young infant for very severe disease
Assign patients to students, observe and assess as needed while students assess and classify
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
Pencil
Eraser
Thermometer
Measuring Tape
Weighing scale
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Lesson Plan
Final year MBBS Group Teaching
Day-19: WHO, Essential Newborn Care (Indoor)
Time: 2 hours and 30 minutes
Facilitator Introduces the topic assign practical /clinical task 30 minutes
Student:
Performs indoor/clinical/ practical task under supervision in sub group. 1 hour
Topic from ENCC to be covered in this session
1. Introduction to PCPNC guide
2. Immediate care at the time of Birth
3. Routine newborn care includes keeping the baby warm
Group Discussion 30 minutes
Learning Objectives:
Student should be able to
Use PCPNC guide session related to ENCC
Perform the routine newborn care
Give immediate care to newborn at the time of delivery
Facilitator/Instructor Procedure for Clinical work:
Counsel the mother for the routine newborn care in the neonatal ward or
postnatal ward.
Give immediate care to newborn at the time of delivery
Facilitator/Instructor Procedure for Practical work:
Use the PCPNC guide sessions and following the commands of cross reference.
MATERIAL REQUIRED
PCPNC Guideline
Neonatal examination forms of ENCC.
Nursery/Labour Room
Hand washing facility
D/Gloves
Gown
Mask
Cap
Mother/Dummy
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Lesson Plan
Final year MBBS Small group Teaching
Day 20: Approach to a neonate with birth asphyxia (Indoor)
Time: 2 hours and 30 minutes.
Facilitator introduces the topic and assigns practical
and clinical tasks. 30 minutes
Students:Take history and perform examination of neonate with birth asphyxia
1 hourcase presentation and demonstration on neonatal resuscitation
1 hour
Learning objectives: Students should be able to
Define and recognize birth asphyxia.
Takes history, fill recording form andperform neonatal examination.
Relate and interpret Apgar score.
Knows the importance of initiation of breathing at the time of birth.
Knows the importance of resuscitation by delivering personnel.
Knows and able to count respiratory rate, counts heart rate.
Recognizes cyanosis, pallorness and differentiate b/w lethargy, unconsciousness andnormal movements and decreased movements.
Knows and able to interpret staging of HIE.
Is able to recognize and identify various effects of asphyxia on body systems i.e. CNS,renal, GIT, CVS.
Resuscitate when needed.
Knows to investigate various effects of birth asphyxia.
Able to give supportive care and treat neonates with birth asphyxia and its complications.
Facilitator/Instructor Procedure for Clinical work:
Basic communication skills to take history and perform examination.
Count respiratory rate in one minute
Recognize cyanosis, pallorness.
Asses a newborn with lethargy and unconsciousness.
Differentiate normal movements from those of convulsions and decreased
movements. Check tone in a new born.
Knows about complications of asphyxia on individual system of body and theirmanagement
Facilitator/Instructor Procedure for Practical work:
Interpret Apgar score.
Knows about HIE staging.
Knows Bag and Mask and method of using them during resuscitation.
Material Required:
Resuscitation Trolley, Dummy, AMBU Bag and Masks of different size
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Lesson plan
Final year MBBS Small group Teaching
Day 22: Check for Possible Infection in Young Infant (OPD)
Time: 2 hours and 30 minutes.
Facilitator introduces the topic and assigns practical
and clinical tasks. 30 minutes
Students:Take history fills recording form and performs relevant examination of a Young
Infant with susceptible neonatal sepsis 1 hourCase presentation and Group discussion /video 1 hour
Learning objectives: Students should be able to:
Asses and classify the young infant for possible infections.
Takes history, fill recording form and perform examination of young infant Recognize lethargy/ unconsciousness and bulging fontanel and knows to take
temperature.
Knows and able to count respiratory rate, recognizes severe chest in drawings, nasalflaring and grunting.
Identify umbilical redness and pus draining and identify skin pustules.
Knows to investigate young infant for possible infection.
Treat young infant for possible infection in community and health facility.
Knows the importance of universal precautions and clean cutting of umbilical cord
Facilitator/Instructor Procedure for Clinical work:
Communication skills to take history and perform examination.
Take one minute respiratory rate and repeat if fast breathing.
Differentiates b/w mild chest in drawings from severe one, lethargy,
unconsciousness.
Accurate method to look for bulging fontanel and differentiate normal
movements from those of convulsions and decreased movements.
Demonstrate young infant with as many signs of very severe disease as available;severe chest indrawing, grunting, fast breathing, convulsion, not feeding well, fever
or low body temperature
Facilitator/Instructor Procedure for Practical work:
Demonstrate assessment of a young infant for very severe disease Assign patients to students, observe and assess as needed while students assess and classify
Material Required:
IMNCI Chart bookletRecording form
Photograph/ Video
Multimedia
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LESSON PLAN
Final Year MBBS Small group Teaching
Day 24: Check the young Infant for feeding problem, Assessment
of Breast Feeding (OPD)Time: 2 hours & 30 minutes
Facilitator introduces the topic & assigns practical/ clinical task 30min
STUDENT: take history and examination of young infant with feeding problems and
assessment of breast feeding under supervision in subgroup 1hr
Group discussion/ / video 1hr
LEARNING OBJECTIVES: Students should be able to:
Assess young infant for feeding problem & able to assess how infant breast feeds.
Take a relevant history, fill recording form & perform relevant clinical examination.
Explain advantages of exclusive breast feeding, and knows how breast feeding works
Explain 4 key points of good attachment & position recognize signs of good & poor
attachment & positioning.
Demonstrate & teach correct position & attachment & different positions of mother to
hold the baby.
Facilitator/Instructor Procedure for Clinical work:
Communication skills to take relevant history about feeding problem and asses breast
feeding.
Demonstrate a normal young infant feeding well, emphasizing the signs of attachment andsuckling
Supervise students closely to be sure they assess breastfeeding and counsel the mother
correctly
Skill to demonstrate the mother correct positioning and attachment
Facilitator/Instructor Procedure for Practical work:
Counseling skills to tell mother the importance of breast feeding
Demonstrate how to counsel mother about correct positioning and attachment according to
steps on young infant chart
Assign patients to students, observe and assess as needed while students assess and classify.
Material Required
Multimedia, video on breast feeding recording forms
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Lesson plan
Final year MBBS Small group Teaching
Day 25: Check for feeding problem or low weight. And methods of
Breast Feeding Replacement (Cup feeding) (Indoor)Time: 2 hours and 30 minutes.
Facilitator introduces the topic and assigns practical/clinical task.
30 minutes
Students:Take history and perform relevant examination of baby with feeding problems or
low weight under supervision in sub groups. 1 hour
Group discussion / Video 1 hour
Learning objectives: Students should be able to
Assess child for feeding problems or low weight.
Takes relevant history, fill recording form and perform relevant examination.
Weigh the child, and determine weight for age on growth chart
Advise on replacement or supplement feeding
List conditions in which cup feeding needed and its importance in small babies
List the advantages of cup feeding, estimate volume of milk to give to a baby accordingto weight
Demonstrate how to cup feed safely, demonstrate how to prepare a cup hygienically forfeeding, explain the requirements for clean & safe feeding.
Know the disadvantages of bottle feeding and how to express mother milk
Facilitator/Instructor Procedure for Clinical work:
Communication skills to take relevant history and perform relevant examination.
Weigh the child
Demonstrate a normal young infant feeding well, emphasizing the signs ofattachment and suckling
Supervise students closely to be sure they assess breastfeeding and counsell themother correctly
Facilitator/Instructor Procedure for Practical work:
Hand washing
Determine weight for age on a growth chart
Calculation of amount of milk to give to babies, hand washing, method of cup
feeding. Demonstrate how to counsel mother about correct positioning and attachment according to
steps on young infant chart
Assign patients to students, observe and assess as needed while students assess and classify.
Materials required:
IMNCI wall chart, Weight machine & weight for age chart, cup, spoon and Model of breast
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LESSON PLAN
FINAL YEAR MBBS SMALL GROUP TEACHING
DAY 27
Communication &counseling skills need for when to return immediately,
counsel the mother about her own health. And follow up care of sick
child and young infant (OPD)
TIME 2 hours and 30 minutes
Lead Facilitator introduces the topic and assign practical/clinical task.
30 minutes
STUDENTSWall chart demonstration and practical task under supervision in subgroup
1 hour
Group discussion and role play 1 hour
LEARNING OBJECTIVES: Students should be able to
Identify those who need follow up care in OPD / IPD
Assess any new problems on follow up
Classify the problems according to chart booklet.
Assess the previous problem and classify it according to follow up modules and treat them
as per need. Assess the response of drugs
Select the appropriate drug for that classification
Counsel the mother to give oral drug and to treat local infection at home
Counsel the mother when to return immediately by using mother card
Facilitator/Instructor Procedure for Clinical work:
Skill to identify those patients who need follow up care
Communication skills to ask about new problems
Facilitator/Instructor Procedure for Practical work:
Counseling skills to tell mothers when to return immediately
Classify the problems according to chart booklet.
Assess the previous problem and classify it according to follow up modules and treat themas per need.
Know the list of drugs for relevant classification
Know how to check mother understanding
Counsel the mother about her own health
MATERIAL REQUIRED:
IMNCI Chart Booklet, Drug Tray & Mother Card
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LESSON PLAN
FINAL YEAR MBBS SMALL GROUP TEACHING
DAY 28
APPROACH TO CHILD WITH MICRONUTRIENT
DEFICIENCY (Indoor)
TIME 2 hours and 30 minutes
Lead Facilitator introduces the topic and assign practical/clinical task.
30 minutes
STUDENTS
Take history of child with micronutrient deficiency and perform general physicaland relevant examination 1 hour
Case presentation and group discussion/ 1 hour
LEARNING OBJECTIVES: students should able to
Know the definition and importance of micronutrients
Know the name , daily requirement of common micronutrient
Take relevant history and general physical examination and investigate the micronutrient
deficiency Identify the signs of vitamin A and D deficiency (Rickets)
Prevention and treatment of micronutrient deficiency
CLINICAL SKILL LEARNT
Communication skills to take relevant history
Identify the signs of micronutrient deficiency (Vitamin A and D)
Prevent and treat the micronutrient deficiency.
MATERIAL REQUIRED
WHO guidelines
Patient or Photograph booklet to assess the signs of micronutrient deficiency.
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LESSON PLAN
Final Year MBBS Small group Teaching.
DAY -29 Approach to a child with rashes, Purpura and bleeding
disorder (Indoor)
TIME: 2 Hour 30 minutes
Facilitator introduces the topic and assist practical and clinical task in 30 minutes
STUDENT: take history of patient with bleeding disorders and perform general physical andrelevant examination 1 hour
Case presentation and group discussion 1 hour.
LEARNING OBJECTIVE Student should be able
To take relevant history of bleeding disorders.
To identify and differentiate rashes of bleeding diathesis like petechiae, bruises andpurpuras
To do general physical examination including distribution and extent of rashes
To investigate and interpret different Laboratory investigation including Bleeding time,PT, APTT, and Blood CP
Facilitator/Instructor Procedure for Clinical work:
To take relevant history of bleeding disorders.
To do general physical examination including distribution and extent of rashes
Examination skills to differentiate different type of rashes
Facilitator/Instructor Procedure for Clinical work:
Interpretation of data regarding bleeding diathesis
Material Required:
Photographs of different common rashes.
Different lab reports for interpretation.
Examination kit
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Lesson plan
Final year MBBS Small group teaching.
DAY-30 Approach to a child with Oedema and Ascites (OPD)
TIME 2 Hour 30 min
Facilitator introduces the topic and assist clinical / practical task.
30 min.
STUDENT. Takes history of a child with edema or ascots and performs general physical and
clinical examination. Individually and under supervision in sub group 1hour
Group discussion case presentation (Nephrotic syndrome) 1 hour
Learning Objective:
Student should able to take relevant history, including age at presentation, mode ofonset, specific system and organ involved.
Is able to perform GPE and relevant systemic examination and clinical signs like fluidthrill and shifting dullness.
Should know the common renal, hepatic, nutritional and cardiac causes of oedema andascites.
Student should investigate and interpret ate different type of lab investigation includingurine/ DR, ascetic/ DR, blood CP, Ultrasound abdomen, total protein AG ratio,24 hour
urinary protein.
Is able to know the management of nephritic syndrome.
Facilitator/Instructor Procedure for Clinical work:
Student communicates properly and take history and be able to differentiate new casefrom relapse.
Able to do GPE, abdominal examination; especially relevant systemic
examination like fluid thrill and shifting dullness.
Should be able to assess & classify different grades of edema and as cites.
Is able to counsel parents about course of disease and long term management ofnephrotic syndrome.
Facilitator/Instructor Procedure for Practical work:
Student should investigate and interpret ate different type of lab investigation includingurine/ DR, ascetic/ DR, blood CP, Ultrasound abdomen, total protein AG ratio,24 hoururinary protein.
Should know the common renal, hepatic, nutritional and cardiac causes of oedema andascites.
Reads and interprets the laboratory data
Material Required:
Photograph of oedema and ascites
Laboratory reports
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Examination kit
LESSON PLAN
DAY 31: Approach to child with Jaundice (OPD)
Time: 2 hours and 30 minutes.
Facilitator introduces topic and assigns clinical tasks. 30 minutesStudent:Assess a child with jaundice under supervision in sub group and individually.
1 hour
Group Discussion / Case Presentation. 1 hour
Learning objectives:
Students should be able to:- Take relevant history of a child with jaundice.
- Do general physical & relevant systemic examination like examination ofsclera, liver, GIT & CNS.
- Know the associated clinical features of jaundice Like anemia, hematemesis,
behavioral changes etc.
- Know the causes of jaundice, like viral hepatitis A,B & C, Drug induced &
autoimmune hepatitis or hemolytic anemia.
- Know how to investigate the child for jaundice & interpret LFT (prothrombin
time, S. albumin level), bilirubin levels, viral profile, serology, CBC, retic
count.
- Know the management of acute viral hepatitis, hepatic encephalopathy &
chronic hepatitis.
Facilitator/Instructor Procedure for Clinical work:
- Know the importance of relevant history & examination.
- Take relevant history of a child with jaundice.
- Do general physical & relevant systemic examination like examination of
sclera, liver, GIT & CNS.- Know the associated clinical features of jaundice Like anemia, hematemesis,
behavioral changes etc.
Facilitator/Instructor Procedure for Practical work:
- Know the mode of spread/route of infection of different hepatitis.
- Know the ways to prevent hepatitis
- Know how to investigate the child for jaundice & interpret LFT (prothrombin
time, S. albumin level), bilirubin levels, viral profile, serology, CBC, retic
count.
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LESSON PLAN
Final Year MBBS Small group Teaching
Day 32: Pediatric Radiology (Indoor)
Time: 2hours
Venue: Ward Class room
Learning Objectives:
Students should able to:
Know the importance of view, exposure ,translucency, density, normal organs and
mediastinum on x-ray chest
Is able to recognize abnormal chest x ray findings of common problems like: Pneumonic
consolidation, Tuberculosis, Effusion, collapse, Pneumothorax, Cardiomegaly and
abnormal shape of Heart
To make a differential diagnosis on radiological findings
SKILLS
To hold the x-ray in proper position
Correlate the abnormalities with clinical findings
To operate the illuminators
MATERIAL REQUIRED
X-ray films & illuminator
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LESSON PLAN
Day 33: Approach to child with cerebral palsy (OPD /
Physiotherapy Department)
Time: 2 hours and 30 minutes
Facilitator introduces topic & assigns clinical tasks 30 min
Student:
Perform clinical tasks under supervision in sub-group 1hr
Group discussion/ case presentation 1hr
Learning Objectives:
Students should be able to know the definition, incidence and prevalence of cerebralpalsy.
Students should be able to identify the causes of cerebral palsy.
Students are able to understand the importance of preventable causes of cerebral palsylike birth asphyxia and know the importance of timely and correct resuscitation of
newborn.
Should be able to understand the importance of fetal hypoxia and immediate perinatal
problems at the time of birth
They should be able to know the different types of cerebral palsy.
They should be able to identify acute & chronic problems related to C.P & their
management.
Facilitator/Instructor Procedure for Clinical work:
Ability to take a proper relevant antenatal, peri natal and immediate post partum details
of history.
Ability to examine CNS and development of a child with cerebral palsy.
Facilitator/Instructor Procedure for Practical work:
Ability to differentiate between various grades and severity of mental retardation and
physical handicap of a child with cerebral palsy
Counseling with parents to discuss acute, recurrent and long-term problems like
spasticity, seizures, aspiration pneumonia and their management.
Ability to understand the importance of multidisciplinary approach and parental
understanding of the concept of long term management.
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Lesson plan
Final Year MBBS Small group Teaching.
Day 34: Approach to child with congenital heart disease (Indoor)
Time : 2 hours and 30 minutes
Facilitator introduces the topic and assign practical /clinical task
30 minutes
Students take history of patient with congenital heart disease and perform related and
Cardiovascular system examination 1 hour
Case presentation and group discussion 1 hour
Learning Objective : Student should be able
To perform the examination of a child with congenital heart disease, like, counting heart rate,
take B.P, character of pulse, recognize cyanosis, sign of heart failure, in older children JVP,
recognize 1st and 2nd heart sound, and recognize murmur.
To differentiate cardiac & respiratory distress.
To investigate child with congenital heart disease.
To know the supportive management of congenital heart disease
To know the management of CCF
Facilitator/Instructor Procedure for Clinical work:
To take history of a child with congenital heart disease
Cardiovascular system Examination
Examination of pericardium of infant/ child with cong: heart disease.
To differentiate cyanotic and a cyanotic heart diseases, and identify general danger signs
Facilitator/Instructor Procedure for Practical work:
To investigate child with congenital heart disease.
Material Required
Recording forms, Examination Kit
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LESSON PLAN
Dysmorphic Features (Down Syndrome)
Final Year MBBS Small Group Teaching
Day 35: Approach to a child with Dysmorphic feature/Down
Syndrome (Indoor / Outdoor)Clinical demonstration on: Patients /Photograph.
Time: 2 hours and 30 minutes.
Facilitator Introduces topic & assigns practical / clinical task 30 minute.
Student take history and perform examination of child with dysmorphic features
1 hour
Group discussion / case presentation / photographs 1 hour.
LEARNING OBJECTIVES: Student should be able to
Define that what the Dysmorphic feature are.
Take relevant history, and relevant general and systemic physical examination.
Know about terms and glossary about Dysmorphic feature.
Know about clinical features of Down syndrome.
Student should be able to counsel about chronic problem related the Down syndrome.
Student should be able to counsel about genetic problem.
Student should know that what the investigations to perform for Down syndrome are.
Facilitator/Instructor Procedure for Clinical work:
Communication and counseling skills to take relevant history to do physical examination
and genetic counseling.
Recognize features of Down syndrome on a patient.
Facilitator/Instructor Procedure for Practical work: Knows common stigmas of odd facies suspect and understand the importance of early
recognition of newborn features of common problems presenting with dysmorphism like
Down syndrome and cretininism.
Communication skills to counseling about problems with Down syndrome.
Counseling for families to understand the risk in next pregnancy and prevent birth of nextbaby with similar problems
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GROUP CHECKLIST OF CLINICAL SIGNSSick Child Age 2 Months Up To 5 Years
Not able to drink orbreastfeed
Vomits everything History of convulsions(with this illness)
Lethargic orUnconscious
Convulsions (in the Clinic) Fast breathing Chest indrawing Wheezing
Stridor in calm child Restless and Irritable Sunken eyes Drinking poorly
Drinking eagerly, thirsty Very slow skin pinch Slow skin pinch Stiff neck
Runny nose Enlarge tender,lymph nodes in neck
Red enlarged Tonsills White exudate onThroat
Generalize rashes ofmeasles
Red eyes Mouth Ulcers Deep and ExtensiveMouth ulcers
Pus draining from eyes Clouding of Cornea Pus draining from ear Tender swelling behind
the ear
Visible severe wasting Severe Palmer pallor Some Palmer Pallor Edema of both feet
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GROUP CHECKLIST OF CLINICAL SIGNSAge 0 to 2 Months
Mild chest indrawing inyoung infant (normal)
Fast breathing inyoung infant
Severe chest indrawingin young infant
Nasal flaring
Grunting Bulging fontenelle Umblical rednessextending to the skin
Red umblicus ordraining Pus
Many or severe skinpustules
skin pustules Lethargic or unconscious
Less than normalmovement
No attachment at all Not well attachedto breast
Good attachment Not sucking at all
Not sucking effectively Sucking effectively Thrush
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CLINICAL SESSION & PRACTICAL PROCEDURES
ACTIVITIES TEACHER SIGNATURE
Presentation of seminar on IMNCI topic
Role play
Practical skills / practical session on IMNCI
Video / Photograph
Given I/M Injection / Observe
Positioning and attachment of baby forbreastfeeding
Plotting on growth chart and use of Z-score chart
Technique of measuring MUAC
Prepare ORS and use of different treatment plans
Prepare First dose of antibiotic
Perform skin pinch
Dry ear by wicking
Treat local infection
Measure the temperature
Fill in EPI card in under 5 OPD / Well baby clinic
Use of nebulizer
Counsel the mother for nutrition IYCF / OTP
Use of mother card
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FORMATIVE EVALUATION FORM FOR FINAL YEAR STUDENTS
SUMMATIVE EVALUATION FORM FOR FINAL YEAR STUDENTS
Theory(MCQs)
100
Practical / OSPE (A+B) 100
(A) Internal Evaluation20%
(B) OSPE80%
AttendanceMarks in
MCQMarks in
OSPE
Marks inClinical
Evaluation
General / RecordingForm
5% 20% 50% 15% 10%
(B) OSPE will include 15 to 20stations:
50% clinical stations
50% static stations
Weight age of OSPEStations:
IMNCI 30%
Neonatology 20%
Other topics 50%
OSPE station will include:
1. Case Scenario
2. X-ray and Instruments
3. Counselling
4. Communication Skills
5. Procedures
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LEAD FACILITATORS GROUP SUMMARY
Group :
Dates:
Unit:
Number of Students in Group:
Number of facilitators:
Names of Lead Facilitators:
Total Working days:
Total Teaching hours:
Hours of IMNCI teaching:
Indoor Hours :
Outdoor Hours:
Theory sessions number and hours:
Practical Sessions number and hours:
Clinical Sessions number and hours:
Maximum number of patients assessed by students
Average number of patients assessed by students
Seminars
Projects:
Maximum number of classifications seen:
Average number of classifications seen:
Maximum number of signs seen by students:
Average number of signs seen by students:
Did each student have?
Recording forms: 2M- 5Years Young infant
Chart Booklets:
History forms and Journal
Maximum attendance :
Average attendance of group:
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Total Marks In group assessment:
Written
Clinical Skills Observed
IMNCI Marks:Written
Clinical Skills Observed
Average Marks MCQ
Maximum Marks
MCQ
OSPE
Average grades of group:
Comments and observations of lead facilitator:
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Material Required for Final Year M.B.B.S Class Teaching Purpose
1. IMNCI Facilitators Guide for all modules
2. IMNCI Facilitators Inpatient Guide
3. IMNCI Facilitators Outpatient Guide
4. IMNCI Chart 2 months to 5 years (Wall chart)5. IMNCI Chart 0 - 2 months (Wall chart)
6. IMNCI Chart Booklets and Photograph Books
7. IMNCI case record forms 2 months to 5 years and 0 - 2 months
8. PCPNC guide and neonatal examination forms of ENCC
9. Multimedia, Video, CDs, USB, Computer, Soft copy of IMNCI Photographs, Video
on Breastfeeding, Artificial Breast.
10. Blood CP reports, Urine DR reports, CSF reports, LFT reports and Serum Electrolyte
reports etc for data interpretation assessment.
11. Examination Kit-1: Equipments for General Physical Examination including
Thermometer, Torch, Tongue depressor, Measuring Tap, B.P apparatus, Stethoscope
and stop watch
12. Examination Kit-2 comprising of Equipment for CNS Examination measuring Tape,
Hammer, Fundoscope, Disposable tongue depressor, Torch, B.P Apparatus, Tuning
fork, Thermometer, color Tags, different swabs for sense of smell.
13. Examination Kit-3 Nebulizer, Peak flow meter, Inhaler, Stethoscope, Ventoline
Solution, N/saline Ampoules and stop watch
14. Examination kit-4 for plan A& B of rehydration: ORS Packets, Measuring
containers, Spoon, and Cups, water 1 liter for preparing ORS
15. Examination Kit-5: Z-Score chart, Growth chart, MUAC Tap, Torch, Thermometer,
Glucometer, Sugar water, and plummpy nuts for appetite test.
16. Examination Kit-6: Dummy, Resuscitation Trolley, Ambu Bag for neonatal
resuscitation
17. Examination Kit-7 for plan C of rehydration: Ringer Lactate Intravenous solution,
I.V Cannula, Drip set, N.
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