Peads Teacher Mannual

8/12/2019 Peads Teacher Mannual

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DRAFT


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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


3

Common Paediatrics Problems in PakistaniChildren


4 State of worlds and Pakistani Childrens

Dr. M. Akram Shaikh / Dr. Farzana

5 EPI and update on vaccines


6 Introduction to IMNCI


7 Essential Newborn care


8 Breast Feeding and IYCF


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


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.


o Demonstrate the assessment a child with general danger sign

o Demonstration on performing general physical examination


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


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.


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


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.


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.


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


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


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


Day-6: Approach to child with chronic cough, asthma &

tuberculosis. Approach to child with Wheeze (OPD)


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


Day-7: Assess and classify child with Diarrhea and Shock (Indoor)


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


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


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


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


Day-8: Case presentation on Diarrhea by students (OPD)


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


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


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.


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


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


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.


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.


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.


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)


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


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


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


Day-15: Approach to child with anemia (Indoor / Outdoor)


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


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.


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


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


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


Basic communication skills to take a relevant history, identify vaccine vials and give

vaccines, checking Immunization status


Demonstrate how to assess Immunization status of a child


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


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


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.


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


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)


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


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


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


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.


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


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


Day 22: Check for Possible Infection in Young Infant (OPD)


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


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


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.


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


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


Material Required

Multimedia, video on breast feeding recording forms


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Lesson plan


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


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


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


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


Skill to identify those patients who need follow up care

Communication skills to ask about new problems


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


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


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.


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.


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)


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.


- 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.


- 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


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)


Facilitator introduces topic & assigns clinical tasks 30 min

Student:

Perform clinical tasks under supervision in sub-group 1hr

Group discussion/ case presentation 1hr


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.


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.


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


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


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.


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.


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.

Documents

Peads Teacher Mannual