Doctor of Medicine (MD)
1. Preamble
The University of Mauritius wishes to develop in collaboration with the Ministry of Health and Quality of
Life and University of Geneva a medical school of high quality that will help to improve the health care
system of the Republic of Mauritius, by enabling Mauritian authorities to have more control on the
quality of medical training of health care manpower. The school of Medicine will be responsive to local
needs as well as regional needs (humanitarian aspect) and will attract international students through the
quality of its teaching and curricula.
The first programme to be developed under the proposed Public School of Medicine is a full-fledged
medical undergraduate programme, in English medium, which will involve 3 partners: Faculty of
Medicine of University of Geneva (UNIGE), the University of Mauritius (UOM) and the Mauritian
Ministry of Health & Quality of Life (MOHQL).
The successful completion of a 6 year full-time medical undergraduate programme, in English medium,
undertaken in two parts: 3 years full-time for the Bachelor of Medicine followed by 3 years full-time for
the Master of Medicine programme will lead to the award of the Doctor of Medicine (Medicinae Doctor
or MD) degree. The programme will include a research dissertation prepared as from the 4th year and
submitted at the end of the 5th year. The 6th year will consist of 10 months of student internship in
hospitals. A comprehensive final examination will be held at the end of the 6th year after validation of
the student internship to examine whether the candidates master the knowledge, skills and attitudes as
well as the social competencies and behaviors required for practicing the medical profession.
Curricular contents are derived from the similar undergraduate programme offered by UNIGE. Students
need to successfully complete the Bachelor of Medicine part in order to register for Master of Medicine
part of the undergraduate medical programme. Students who succeed in the final year examination held
at the end of the 6th year will be awarded a MD (Doctor of Medicine) degree by UOM. Mention may be
made to the effect that the medical undergraduate programme was established in collaboration with
UNIGE. Students graduating with the MD degree will be eligible for pre-registration training as per the
requirements of the Medical Council of Mauritius or of Regulatory bodies elsewhere, in order to be able
to practice independently as registered medical practitioners. They can also thereafter engage in further
post-graduate clinical studies or choose a career in biomedical research.
2. General Objectives
The aim of our MD programme is to train medical professionals who combine clinical competence,
medical knowledge, proficiency in inter-personal and communication skills, ability to respond to the
psychosocial aspects in health-care and to keep abreast of new developments in the medical field.
The learning objectives in our MD programme are, similar to those in the medical undergraduate
programme offered by UNIGE, based on the Swiss Catalogue of Learning Objectives for Undergraduate
Medical Training - June 2008 (SCLO), prepared by the Working Group under a Mandate of the Joint
Commission of the Swiss Medical Schools (Web site: http://www.smifk.ch). The MD programme is
adapted to the local epidemiology and needs of Mauritius.
The SCLO is a catalogue of learning objectives listing knowledge, professional attitudes and clinical
skills for the medical profession. It relies for a substantial part on the “CanMEDS 2005 Framework”1
and on the British “Curriculum for the foundation years in postgraduate education and training”2,
using also other similar frameworks for Outcome-Based Medical Education such as the “ACGME
1
Outcome Project”3, the “Global Minimum Essential Requirements”4 of the Institute for International
Medical Education and the “Project Professionalism”5 of the American Board of Internal Medicine.
1 Frank, JR. (Ed). 2005. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa:
The Royal College of Physicians and Surgeons of Canada. http://rcpsc.medical.org/canmeds/CanMEDS2005/CanMEDS2005_e.pdf
2 The Foundation Program Committee of the Academy of Medical Royal Colleges, in co-operation with Modernising Medical Careers in the
Departments of Health. Curriculum for the foundation years in postgraduate education and training. Department of Health, 2004:9
3 Accreditation Council for Graduate Medical Education, http://www.acgme.org/Outcome/
4 Institute for International Medical Education, http://www.iime.org/gmer.htm
5 American Board of Internal Medicine, https://www.abim.org/pdf/publications/professionalism.pdf
At the end of their undergraduate education we expect the MD graduates to achieve competencies related
to the 7 roles embodied by competent physicians, described initially in the CanMEDS 2005 Framework1,
which are: Medical Expert (the central role), Communicator, Collaborator, Health Advocate, Manager,
Scholar and Professional. Roles to be fulfilled are the following:

Role of Medical Expert: medical graduates are expected to possess a defined body of knowledge,
clinical skills, procedural skills and professional attitudes, which are directed to patient care under
supervision. They should apply these competencies to collect and interpret information, make
proposals for clinical decisions, and carry out some defined diagnostic and therapeutic procedures.
Competencies: The physician is able to elicit a relevant, concise and accurate history from the
patient and other sources, conduct an effective physical examination, analyze and interpret data to
establish a differential and a working diagnosis and construct a management plan, carry out under
supervision relevant procedures and organize further investigations, demonstrate appropriate
medical data and information management, deliver good quality medical care and ensure patient
safety, demonstrate safe prescribing, foster infection control, promote health of patients and of the
community, access relevant information on diagnostic and therapeutic options and apply it under
supervision to clinical practice.

Role of Communicator: medical graduates are expected to enable patient-centered therapeutic
communication through partnership and effective dynamic interactions with patients, families,
caregivers, other professionals, and important other individuals. Communication skills are essential
for the functioning of a physician, effective communication is critical for optimal patient outcomes.
Competencies: The physician is able to develop rapport, trust, and ethical therapeutic relationships
with patients and families, accurately elicit and synthesize relevant information and perspectives of
patients and families, colleagues, and other professionals, accurately convey relevant information
and explanations to patients and families, colleagues and other professionals and foster the
development of a common understanding on issues, problems and to develop a shared plan of care,
convey effective oral and written information about a medical encounter.

Role of Collaborator: medical graduates are expected to work in partnership with others who have to
be appropriately involved in the care of individuals or specific groups of patients. This is increasingly
important in a modern multiprofessional environment, where patient-centered care is widely shared
by several teams in multiple locations.
Competencies: The physician is able to effectively consult with her/his supervisor and other
physicians and healthcare professionals, striving for good teamwork aiming at optimal patient care
and at patient safety, contribute effectively to other interdisciplinary team activities.

Role of Manager: medical graduates are expected to function as Managers when (under guidance by
their supervisors) they take everyday practice decisions involving resources. They have to make
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systematic choices when allocating finite healthcare resources and personal time, using information
technology.
Competencies: The physician is able to utilize personal time and resources effectively in order to
balance patient care, learning needs, and private activities outside the workplace, and to protect
her/his own health, use effectively under supervision finite healthcare resources, while acting in the
best interest of the patient, work effectively and efficiently in a healthcare organization, effectively
utilize information technology for patient care, self-learning and other activities, assure and improve
the quality of care and patient safety.

Role of Health Advocate: medical graduates are expected to recognize their duty and ability to
improve the overall health of their patients and the society they serve. Doctors identify advocacy
activities as important for the individual patient, for populations of patients and for communities.
Competencies: The physician is able to identify the important determinants of health that affect
individual and population health, so as to have basic abilities to contribute to improving individual
and societal health in the country where they practice, recognize issues, settings, circumstances, or
situations which require advocacy on behalf of patients, professions, or society.

Role of Scholar, medical graduates are expected to engage in a lifelong pursuit of mastery of their
domain of professional expertise. They recognize the need to be continually learning.
Competencies: The physician is able to develop, implement, and document a personal continuing
education strategy, apply basic principles of critical appraisal to sources of medical information.
This involves developing scientific curiosity and use of scientific evidence in clinical decision making,
facilitate the learning of patients, students and other health professional, contribute to the
development, dissemination, and translation of new knowledge and practices.

Role of Professional: medical graduates are expected to have a distinctive societal role as
professionals who are dedicated to the health and caring of others. The Professional Role is guided
by codes of ethics and a commitment to clinical competence and the embracing of appropriate
attitudes and behavior. Physicians are accountable to the society they serve.
Competencies: The physician is able to deliver under supervision high quality care, exhibiting
appropriate personal and interpersonal professional behavior, practice medicine in an ethically
responsible manner that respects the medical, legal and professional obligations of belonging to a –
in many respects - self-regulating body.
3. General Entry Requirements
As per General Entry Requirements for admission to the University for undergraduate degrees.
4. Programme Requirements
At least five GCE ‘O’ Level Passes, or equivalent, including Chemistry, Biology, Mathematics and
English Language, and GCE ‘A’ Level Passes, or equivalent, in three science subjects. The minimum
grades required at ‘A’ Level are A, A, B. An interview may be carried out for foreign students.
Additional requirement: students should be immunised against Hepatitis B.
5. Programme Duration:
Normal: 6 years (Bachelor of Medicine: 3 years; Master of Medicine: 3 years)
Maximum: 9 years (Bachelor of Medicine: 4 years maximum; Master of Medicine: 5 years maximum)
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6. Programme Description:
The Bachelor of Medicine (3 years full-time) is the first part of the undergraduate medical programme. It
is organised in compulsory semester block modules composed of different units and 4 optional modules
(one per semester as from Year 2) to be chosen from a list made available to students.
The first year is an introduction to the molecular, biological and psycho-social aspects underlying any
disease, the understanding of which contributes to practice of medicine based on scientific principles. It
integrates several scientific disciplines such as physics, chemistry, molecular and cell biology,
physiology, biochemistry, anatomy, histology, psychology etc…, which are required for the optimal
learning of basic medical sciences.
Year 1 programme consists mainly of lectures organized in themes progressing from simple molecules to
structures with increasing complexity such as cells, tissues, organs (Block Module A in Semester 1), body
systems and their regulation (Block Module B in Semester 2). In parallel, in both semesters, essential
notions of psychology, ethics, communication are introduced as well as study of the different phases of
life and interaction between the individual, society and disease (The Individual, Health and Society
Modules 1 & 2). Two Case Studies illustrate the importance of integration of basic medical sciences in
the practice of medicine. Medical statistics are taught in Semester 2.
The second and third years are organized in integrated multidisciplinary units in which students learn
basic medical sciences through the prism of medically related problems bearing on different systems, in
small-group tutorials. Studies are organised in Block Modules with different units in the following
sequence:
Year 2 Semester 1 (Block Module 1): Inflammation and cancer, digestive system, reproductive system.
Year 2 Semester 2 (Block Module 2): Cardiovascular, urinary, respiratory systems.
Year 3 Semester 1 (Block Module 3): Musculo-skeletal system and nervous system.
Year 3 Semester 2 (Block Module 4): Microbiology, defense and immune system against infections.
In addition to learning of basic medical sciences through problem-based learning in small groups, as well
as through lectures and practicals (use of virtual microscope in Histology/Pathology, DVD and 3D
imaging in anatomy), the different units in year 2 and year 3 integrate components of two longitudinal
programmes: Community Dimensions and Clinical Skills.

Community Dimensions (CD) covers proficiency in ambulatory medicine, medical ethics and public
health in Year 2 and Year 3; that training is completed by 4 half-day training sessions in primary
health care (TPHC) under the supervision of a medical practitioner in Year 2.

Clinical Skills (CS) is another longitudinal programme where attitudes and basic medical skills are
taught, as well as the doctor-patient relationship. Students benefit as from Year 2 from four
Formative Clinical Skills Stations on standardised patients under the individual supervision by a
clinician who provides immediate feedback on their performance in a portfolio kept by the students.
For each unit within the Block Modules a specific booklet describes in detail the activities (including
general and specific learning objectives, lectures, tutorials with list of problems for Problem-Based
Learning activities, list of references and resources for active learning), the CS and CD components to be
covered, names and contact details of the Unit Coordinator and tutors.
The last semester in Year 3 ends with a practical community survey (for 1 month) carried out as small
group work, results of which are presented as a poster, an oral presentation and as a written report.
In addition to the above, one optional module is required in each semester in Year 2 and Year 3. Optional
modules can be taught modules or practical-based. Students indicate their preferred options (up to 3) at
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the beginning of each year. Year 3 students are given priority over Year 2 students. Some modules are
on offer only in Year 3.
The Master of Medicine (3 years full-time) is the second part of the undergraduate medical programme.
Only students who have passed in the Bachelor of Medicine part can register in this part of the
programme.
In Year 1 Semester 1 of the Master of Medicine (1st semester in 4th Year), Module “Introduction to
Clinical Reasoning” (ICR) of 15 weeks duration, constitutes a transition between the Bachelor of
Medicine part and the Master of Medicine part consisting of “Learning in a Clinical Environment” (LCE)
units. In Module ICR students deal with complex problems for which there is a need for a multidisciplinary approach and a need to integrate knowledge acquired in Year 2 and 3 of the Bachelor
programme. Students are prepared for the next phase of their training in a clinical environment; they
learn clinical reasoning and management of a patient in different situations.
In Module ICR students learn to solve problems related to different clinical specialties (surgery,
pediatrics, internal medicine, community medicine & primary health care, psychiatry). Longitudinal
clinical problems that include follow-up of a patient and evolution of his/her condition over time enable
integration of several medical disciplines. Depending on the objectives and contents, problems are
situated in different clinical contexts (emergency, ambulatory care, admission, follow-up) and involve one
or more steps to allow students to acquire a systematic and sequential diagnostic approach. Students
work in small groups under the guidance of a clinical tutor, learning is completed by lectures and
seminars on topics bearing on transversal disciplines that are important in clinical medicine or on themes
that prepare them to learning in a clinical environment. The tutor steers and motivates the group, ensures
time management, guides students through the appropriate pathway to steps of clinical reasoning and
diagnostic process and provides a feedback to each student.
They also benefit during these 15 weeks from training in clinical skills and in community dimensions.
Specific booklets (one for lectures and seminars; one for problems as starting point for learning through
clinical problem solving in tutorials; and one for clinical skills and community dimensions), describe in
detail the learning objectives, the list of references and learning resources available as well as the names
and contact details of coordinator and tutors.
As from the end of 1st Semester in the 4th year, Module ICR is followed by 15 months of “Learning in
a Clinical Environment” (LCE) which comprises a total of 11 units of variable duration, bearing on
different medical disciplines. LCE is organized in 2 parts of unequal duration:

LCE Part 1 consists of 6 units run from the end of 4th Year Semester 1 to 5th Year Semester 1:
Internal Medicine & Pharmacology (8 weeks), Surgery (8 weeks with 4 weeks General Surgery & 4
weeks Orthopedic Surgery), Community Medicine & Primary Healthcare (8 weeks), Paediatrics (8
weeks), Psychiatry (4 weeks), Obstetrics & Gynecology (4 weeks).

LCE Part II consists of 5 units run in 5th Year Semester 2: Emergency Medicine & Intensive care (3
weeks); Neurology & Neuro-surgery (3 weeks), Dermatology (3 weeks), Ophthalmology (3 weeks),
Oto-Rhino-Laryngology (3 weeks).
In LCE units, the student is in contact with patients and can put to use previously acquired knowledge,
skills and competencies, and integrate them into the clinical practice specific to each medical discipline.
Student will be involved in different types of activities in LCE units: admission of patients; participation
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in ward rounds and in night duties; participation in interactive seminars and in tutorials bearing on clinical
problem solving.
Problems in tutorials included in LCE units are studied through “Learning Clinical Reasoning” or through
“Guided Case Study” (Case Presentation and Discussion by Students).
In the “Learning Clinical
Reasoning” format no preparation is needed beforehand, the aim is to increase the capacity to analyse,
interpret and summarise clinical data in common medical problems; students need to define the learning
objectives so as to enable targeted and efficient self-learning. The “Guided Case Study” is a format used
in LCE unit “Internal Medicine & Pharmacology”, students are provided with the case together with
specific questions one week before the tutorial. The new knowledge acquired through individual
preparation by the student for problem solving is discussed by the group. The aim of this type of exercise
is to enable students to acquire autonomy in the diagnosis process and patient management.
A specific booklet describes in detail for each LCE unit the learning objectives, activities, list of
references, names and contact details of tutors and supervisors. Organisation of the teaching formats in
different LCE units is supervised by a Master of Medicine Clinical Curriculum Committee.
Throughout Year 4 and Year 5 (1st and 2nd year Master of Medicine), in the ICR module and the different
LCE units, students benefit from learning in “Transversal” Disciplines such as pathology, radiology,
clinical pharmacology, legal medicine & ethics. These disciplines are useful for better understanding and
acquisition of skills and competencies in LCE units. Learning formats in the transversal disciplines vary
from self-learning guided by specific objectives set through clinical problem solving in LCE units, to
specific tutorials. Self-learning and revision material is provided in disciplines such as pathology and
radiology.
Each student works on a Project at Master level (375 to 450 hours) as from the beginning of the 4th year
under the supervision of a Project Supervisor and submits a dissertation at the end of the 5th academic
year. Students benefit from one afternoon every week during 4th and 5th years to work on their project and
from one whole additional month at the end of 5th Year for the writing up of their dissertations. The
Project may be a research project, a Case Study or a Literature Review on a specific topic. Topics may
vary from basic medical science, clinical medicine, legal medicine and ethics, medical humanities, health
economics, to medical education. Students should demonstrate through personal work the capacity for
critical thinking when analyzing a topic related to health or medicine, as well as clear and efficient
communication on a medically-related subject.
In the 6th year (Year 3 of Master of Medicine), students undergo rotations of 1 month duration or
more in disciplines of their choice as student interns for 10 months. They have the opportunity to acquire
practical experience under supervision and to further their knowledge in basic medical science and
clinical medicine in different disciplines chosen to suit their future professional plans. They can be called
upon to help their clinical supervisors in the tutoring of junior students. Part of the 6th year may be spent
in a doctor’s office.
At the end of the 6th year, students who have satisfactorily completed their clinical rotations and
successfully completed their Master thesis benefit from several weeks of revision and are allowed to sit
for the final comprehensive MD examination which is based on the “General Objectives”, the
“Competencies”, the “General Skills” and the “Problems as starting points for training”, listed in SCLO
(AnnextoMD).
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7. Assessment
Bachelor of Medicine (first part of the undergraduate medical programme).
Compulsory modules taught in a semester, except for case studies in Year 1, are assessed through
integrated examinations at the end of the same semester.
Optional modules are examined separately in the semester in which they are taught.
Pass mark in all examinations is 50%
Students who score <15% in any integrated examination are terminated.
A student who is sick or has been unable to take an examination for other valid reasons to the satisfaction
of the Dean of Faculty and Chairman of Senate will be required to take a Special Examination.
Students who fail an examination in a semester (including in the optional module) are allowed one resit
examination at the end of the academic year.
Students earn all marks in resit examinations (not pass mark only).
Students who fail in the resit examination for a particular semester are allowed to repeat that particular
semester, provided that they have not exceeded the time limit for the programme.
Students who repeat a semester and fail again in the end of semester examination are terminated.
In Year 1:


Semester 1 and Semester 2 integrated written examinations are in MCQ format, they are of 4 hour
duration in each semester (organized in 2 papers of 2 hour duration including 80 MCQ each) and
account for 100% of final marks for the semester.
Students must succeed in the two end of semester integrated written examinations to be promoted
to Year 2.
In Year 2 and Year 3:
Semester 1 and Semester 2 integrated written examinations include MCQ format based on clinical case
studies, they are of 3 hour duration and account for 80% of total marks obtained for the semester.
Practicals in anatomy, histology or pathology taught during a semester are assessed through an oral
examination of 1 hour duration at the end of the semester, which accounts for 20% of total marks
obtained for the semester.




Before they are allowed to undergo the written examination in Year 2 Semester 2, students need
to submit a structured report on training sessions in primary health care (TPHC), graded as
Satisfactory.
Clinical skills taught in a semester are assessed in the end of semester integrated written
examinations; they are also examined independently in an OSCE (observed structured clinical
examination) at the end of Year 3, of one hour duration consisting in 3 different stations with
Standardised Patients.
Before they are allowed to undergo the end of year OSCE examination at the end of Year 3,
students need to submit a portfolio for the 4 Formative Clinical Skills stations, graded as
Satisfactory.
Students in Year 3 Semester 2 who fail in the integrated written examinations for Module 4 or in
the OSCE examination need to resit only in the examination in which they failed.
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Year 2 students must succeed in the combined written and oral examinations at the end of each semester
and two optional modules to be promoted to Year 3.
Year 3 students need to pass the combined written and oral examinations at the end of both semesters, the
two optional modules, the OSCE examination and the practical community survey to complete the
Bachelor of Medicine part of the undergraduate medical programme, and become automatically eligible
to register in the Master of Medicine, the second part of the undergraduate medical programme.
Master of Medicine (the second part of the undergraduate medical programme).
In Year 4 and Year 5, students undergo individual summative assessments at the end of the semester in
which Module or units are organised.
Pass mark is 50% in all semester examinations in Year 4 and in Year 5, in Master dissertation and in MD
final examinations.
Students who score < 15 % in any examination are terminated.
Students earn all marks in resit examinations (not pass mark only).
A student who is sick or has been unable to take an examination for other valid reasons to the satisfaction
of the Dean of Faculty and Chairman of Senate will be required to take a Special Examination.
Module “Introduction to Clinical Reasoning”




Module is assessed at the end of the 1st semester in the 4th year through integrated written
examinations of 3 hour duration which include 90 MCQ based on small clinical problems.
Emphasis is laid on assessment of clinical reasoning and application of knowledge, not on factual
recall.
Students who fail in Module “Introduction to Clinical Reasoning” (ICR) in Year 4 Semester 1
may continue with the first “Learning in a Clinical Environment” (LCE) unit. They are offered a
resit examination after 3 to 4 weeks.
If they fail in the resit examination in ICR, they have to repeat the Module in the next academic
year.
If as repeaters, they fail again in ICR examinations, they are terminated.
Units in “Learning in a Clinical Environment” PART 1 are assessed individually, except for “Internal
Medicine and Pharmacology” and “Community Medicine and Primary Health Care” for which summative
assessment is combined.

Students are allowed to register for end of semester summative assessments in LCE Part I units
only if they have passed in Module ICR.

In LCE Part I units students are allowed to take end of semester examinations only if formative
assessment in the clinical setting is satisfactory.

Students who fail in one of the end of semester summative assessments of LCE Part I units are
allowed a resit examination in the unit failed. They may carry on with other LCE Part I units in
the meantime. If they fail in the resit examination, they repeat the LCE unit in which they failed.

Students who fail ≥ 2 summative assessments of LCE Part I units at the end of a semester are not
offered resit examinations; they need to repeat the LCE units in which they failed.

Students who fail as repeaters in the end of semester summative assessment of any LCE Part I
unit are terminated.
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Name of LCE
Part I Unit
Conditions for validation of
Formative Assessment by LCE
Coordinator
≥ 80% attendance in tutorials and
“Internal
clinical activities.
Medicine and
Satisfactory
progress
at
3
Pharmacology” assessments on 4th, 6th, 7th or 8th
week performed by the clinical
(IMP)
supervisor based on observations of
patients admitted in the ward.
8 weeks
At least 1 case presentation and
duration
discussion in ad hoc tutorials.
“Community
Medicine and
Primary Health
Care”
(CMPHC)
8 weeks
duration
“Surgery”:
4 weeks in
General
Surgery &
4 weeks in
Orthopedic
Surgery
“Paediatrics”
8 weeks
duration
Format of Summative Assessment for the
unit at the end of the semester
Formative assessment needs to be validated in
each LCE unit.
Combined assessment for the two LCE units
IMP & CMPHC consists of 2 formats:
OSCE of 90 minutes duration using 6
stations with standardized patients:
3 stations of 12 min for IMP
3 stations of 12 min for CMPHC (2 min
between stations).
Stations bear on commonly occurring diseases.
If formative assessment is not Computer aided assessment of 3 hour
satisfactory, student may have to duration, using 120 MCQ based on clinical
case scenarios (imaging and lab results may be
repeat 8 weeks in this LCE Unit
included): 50 MCQ on Internal Medicine, 10
≥ 80% attendance in tutorials and MCQ on Clinical Pharmacology, 60 MCQ on
CMPHC, and on contents of Module ICR
clinical activities.
(Internal Medicine and Primary Health Care)
Management of ≥ 8 patients.
Satisfactory
performance
in
assessment of clinical skills and Performance in two units IMP and CMPHC is
assessed globally over the two types of
professional attitude.
summative assessment:
OSCE (40%) & MCQ (60%)
Logbook submitted for each clinical OSCE of 60 minutes duration using 4
training placement in surgery.
stations to assess clinical competencies.
Placements are validated separately
by the clinical supervisors based on Computer aided assessment (using Campus
logbook contents.
software) of 2 hour duration, using 80 MCQ
If a placement is not assessed as bearing on clinical cases to assess clinical
being satisfactory, the LCE unit reasoning.
Coordinator decides on corrective Performance is assessed globally over both
measures needed which may include types of summative assessment:
repeating the whole LCE unit
OSCE (40%) & MCQ (60%)
Demonstrate a professional attitude OSCE of 60 minutes duration (4 stations) to
during training and participate in assess clinical competencies: History taking,
≥80% of activities.
physical examination adapted to pediatrics, and
Submission of logbook.
management of the case.
Placement validated by the clinical Computer aided assessment of 2 hour
supervisor based on logbook duration using 80 MCQ on 2 clinical
contents assessed as satisfactory by problems to be solved and clinical scenarios to
the clinical supervisor: admission of test clinical reasoning: diagnosis, management
one patient, examination of a and prognosis of common pediatric disorders,
newborn, presentation of 2 cases including those of the newborn, of surgical and
observed when on call, follow-up of psychiatric disorders in children.
7 cases presented in bedside Performance is assessed globally over both
seminars & follow-up of two patients types of summative assessment.
admitted.
OSCE (50%) & MCQ (50%)
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“Psychiatry”
Participation in ≥80% of activities.
4 weeks
duration
Satisfactory performance in clinical
competence & professional attitude,
Presentation to the supervisor of a
clinical scenario bearing on one of
the 8 main pathologies studied in the
unit based on interview of a patient
by the student during the clinical
placement.
Main
pathologies:
depression,
bipolar
disorder,
anxiety,
schizophrenia, borderline, dementia,
eating disorders and addictions.
“ObstetricsGynecology”
4 weeks
duration
Participation in ≥80% of activities.
Satisfactory performance in clinical
competence & professional attitude.
OSCE of 30 minutes duration with a
standardized patient presenting one of the 8
main pathologies studied in the LCE unit.
Student assessed by two examiners on history
taking,
overall
mental
examination,
communication skills and attitude, diagnostic
hypotheses and global evaluation.
Examiners may ask other questions on
differential diagnoses.
Computer aided examination of 90 minutes
duration with 60 MCQ based on clinical
scenarios, and additional general questions.
Contents based on discipline related objectives
on psychiatry (excluding Pedopsychiatry).
Performance is assessed globally over both
types of summative assessment:
OSCE (50%) & MCQ (50%)
Computer aided examination of 2 hour
duration on Gynecology (one hour) and on
Obstetrics (one hour).
In each part, 15 MCQ bear on a clinical case
and on other topics.
They also include
radiology, pharmacotherapy, legal medicine
and ethics and interpretation of photographs
from the operative theatre.
Assessment in “Learning in a Clinical Environment” Part II units and in Transversal Disciplines takes
place at the end of Year 5 Semester 2:
Students are allowed to register for summative assessments in LCE Part II units only if they have passed
in Module ICR and in end of semester summative assessments of all LCE Part I units.
Five LCE Part II Units
“Neurology & NeuroSurgery”
“Emergency Medicine”
“Oto-Rhino-Laryngology”
Type of Summative Assessment at the end of year 5 Semester 2
Computer aided assessment of 1 hour duration with 40 MCQ bearing
on clinical scenarios. Themes examined correspond to objectives and
lectures in LCE unit booklet.
Computer assisted assessment of 1 hour duration with 40 MCQ bearing
on clinical scenarios, assessing the specificity of management of patients in
Emergency Medicine (vital signs using ABC concept; importance of team
work in emergency situations; rapid diagnosis and medical management in
patients suffering from polytrauma, shock, coma, respiratory distress, acute
chest pain, acute pain) and the legal and ethical aspects in Emergency
Medicine.
Computer assisted assessment of 1 hour duration with 40 MCQ bearing
on clinical scenarios. Assessment on ability to propose a diagnosis,
differential diagnoses, and to discuss treatment for each case. Themes
examined correspond to objectives and lectures in the LCE unit booklet.
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“Ophthalmology”
“Dermatology”
Three Transversal
Disciplines
“Pathology”
“Clinical Radiology”
“Legal Medicine and
Medical Ethics”
Computer assisted assessment of 1 hour duration with 40 MCQ bearing
on 2 to 3 clinical cases with photographic documents. Assessment on
ability to propose diagnosis hypotheses, differential diagnoses, treatment
modalities and prognosis. Themes examined correspond to discipline
oriented objectives pertaining to Ophthalmology and lectures in LCE unit
booklet.
Computer assisted assessment of 1 hour duration with 40 MCQ bearing
on clinical scenarios with photographs of patients. Assessment on ability to
describe elementary lesions, propose a diagnosis, differential diagnoses,
and treatment. Themes examined correspond to lectures in the LCE unit,
and objectives listed in discipline oriented objectives pertaining to
Dermatology in SCLO.
Type of Summative Assessment at the end of year 5 Semester 2
Computer assisted assessment of 90 min duration, with 60 MCQ
bearing on 9 to 10 clinical scenarios, and additional questions independent
from the clinical cases. Proportion of cases and questions are based on
proportion of lectures and tutorials bearing on different LCE: Internal
Medicine and Paediatrics (40%), Surgery (40%), Obstetrics and
Gynecology (10%), Neurology and Neurosurgery (10%).
Computer assisted assessment of 90 minutes duration on diagnostic
imaging (65%), nuclear imaging and radiotherapy (35%).
Oral examination by 2 examiners with questions on one case randomly
selected out of clinical cases bearing on objectives set in SCLO on Legal
Medicine and Medical Ethics. Student is allowed 30 minutes preparation
on the selected case where s/he is able to use books and lecture notes. Oral
Examination by two examiners is of 30 minutes duration: on the case
initially, additional questions are asked later on other topics.
Marks from individual summative assessments in the 5 LCE Part II units and in 3 transversal
disciplines are combined:
 Students should score ≥ 50% of marks combined for the 8 disciplines assessed.
 Students may however score less than pass mark in up to 2 of the 8 disciplines considered
individually, provided that the combined marks for the 8 disciplines are ≥ 50%
 Students who score < 50% in combined marks {for the 5 LCE Part II units and 3 transversal
disciplines} and students who score < 50% in 2 or more of the 8 disciplines assessed (even if
combined marks ≥ 50%) are offered a resit examination in all the LCE units and transversal
disciplines involved.
 If they fail the resit examination they can repeat the semester provided they have not exceeded the
maximum number of years in the programme.
Assessment of the Master dissertation submitted at the end of Year 5:
Dissertation is assessed independently by the supervisor and a second assessor as per University of
Mauritius Regulations. The mark of the student’s dissertation will be the weighted average of the marks
awarded by the supervisor (50%) and the second assessor (50%). This mark may change after moderation
by the External Examiner. Where the marks of the supervisor and second assessor for dissertation differ
by more than 10%, the Project Coordinator will request the Supervisor/Assessor to consult among
themselves so as to arrive at an agreed mark.
11
Evaluation is based on clear definition of the aim of study, description of study design, appropriately
referenced literature review, analysis and discussion of findings, limitations of the study, concise and
well-structured presentation.
Assessment in Year 6: Evaluation of Rotations in Master Year 3
Students are eligible to start their clinical rotations in Year 6 if they have passed in Module ICR, in
summative assessments of all LCE Part I and Part II units, and have submitted their Master dissertation.
Evaluations are performed during and at the end of the internship by the internship supervisors on a scale
from 1 to 3 (1: to improve; 2: Appropriate to expected level; 3: Above expectations) on aspects pertaining
to the seven “CanMed” roles (Professional, Medical Expert, Communicator, Collaborator, Manager,
Health Advocate, Scholar) and with regard to achievements of the specific objectives. A global
appreciation is given at the end of the internship for each rotation and student internship is validated or
not by the supervisor.
MD final examinations:
Year 6 students are considered to have completed the Master of Medicine part of the undergraduate
medical programme and are eligible for the final MD examinations if they have passed summative
assessments in Module ICR and in all LCE Part I and Part II units, if they have validated the Master
dissertation and if they have successfully completed all clinical rotations during a period of 10 months.
These students are allowed to undergo the final comprehensive MD examination based on “Problems as
starting points”, “Competencies” and “Clinical Skills” listed in the SCLO. Adequate representation in
dimensions is ensured such as setting (Inpatient/Outpatient), type of care (Preventive/ Emergency/ Acute/
Chronic/ Rehabilitation/ Palliative Care), age (Child/Adult/Elderly), and gender (Female/Male/Either).
MD examinations consist of two MCQ papers (marks are combined for the two papers) and one Objective
Structured Clinical Examination (OSCE) session using standardized patients.
MCQ papers are of 4 and half hours duration and composed of 150 MCQ each, bearing mostly on
problems or clinical scenarios and testing a spectrum of interdisciplinary knowledge and clinical skills.
 Problems as starting points in MCQ papers may be: general symptoms; metabolic alterations,
abnormal laboratory values; skin manifestations; head, face, neck; ear, nose, mouth, throat, voice;
eyes; breast, chest, heart, blood pressure, pulse; abdomen, stomach, bowels; pelvic symptoms,
urogenital problems; bones, joints, back, extremities; newborn, child, adolescent; elderly persons,
aging; disorders of consciousness, balance, orientation, gait, movement; mental, behavioural, and
psychological problems; other reasons for medical consultation or problems in medical care;
psychosocial and interpersonal problems; problems related to population.
 Competencies assessed in MCQ papers are: structure, function, pathophysiology, etiology,
epidemiology; diagnostic procedures; differential diagnosis, prognosis; management and
treatment modalities; preventive measures; social, legal, ethical, economical aspects; research and
evidence-based medicine principles; comprehensive, others.
The OSCE lasts half a day; it consists of 12 stations in which student perform a clinical activity on a
standardized patient: taking a history, diagnosis and management, communicating with the patient. It
enables to assess communication skills, clinical skills and knowledge.
12

Problems as starting points used in OSCE are those which occur commonly, or those which
necessitate immediate and adequate diagnosis and management. Emphasis is laid mostly on two
competencies: medical expert and communicator.
Students who fail in one of the two MD final examinations (MCQ examinations or OSCE) need to resit
only in the one they failed.
In case of failure in resit examinations one additional attempt is allowed in the next year provided
students have not exceeded the maximum number of years in the programme.
Students are awarded the MD degree if they have passed in both types of final MD examinations.
13
8. Grading:
Semester 1
Semester 2
Module or Unit
Block Module A
Block Module 1
Paper (80%) + Practical (20%)
Optional Module
Block Module 3
Paper (80%) + Practical (20%)
Optional Module
YEAR 1
YEAR 2
YEAR 3
Introduction to Clinical
Reasoning
YEAR 1
LCE Part I unit “Pediatrics”
YEAR 2
LCE Part I unit “Psychiatry”
LCE Part I unit “Obstetrics &
Gynaecology”
Bachelor of Medicine Part
Total
Module or Unit
Marks
100
Block Module B
90
Block Module 2
Paper (80%) + Practical (20%)
10
Optional Module
90
Block Module 4 paper
OSCE
10
Optional Module
Community Survey
Master of Medicine Part
60
LCE Part I unit “Internal Medicine
& Pharmacology”
LCE Part I unit “Surgery”
LCE Part I unit “Community
Medicine & Primary Health Care”
40
LCE Part II unit “ “Emergency
Medicine and Intensive Care”
20
LCE Part II unit “Neurology and
Neurosurgery”
20
LCE Part II unit “Ophthalmology”
LCE Part II unit “Oto-RhinoLaryngology”
LCE Part II unit “Dermatology”
Radiology
Pathology
Legal Medicine & Ethics
Master Project
Grade
Marks, x (%)
A+
A
B
C
F
≥ 80
70 ≤ x < 80
60 ≤ x < 70
50 ≤ x < 60
<50
Total
Marks
100
90
10
40
25
10
25
50
40
40
10
10
10
10
10
10
10
10
50
Grade S: satisfactory completion
Grade U: unsatisfactory completion
Classification of Award for Bachelor of Medicine programme & Master of Medicine programme
Pass: 50 ≤ x < 80
Distinction: ≥ 80
Classification of Award for MD:
Pass: x ≥ 50
(in both parts of the final examinations in Year 6)
14
9. Programme Plan- Bachelor of Medicine
Year 1
Semester 2
Semester 1
Code
Module Name
BMED 1101
(Unit)
Block Module A
From Molecules to
Cells
Unit From Cells to
Organs
The Individual,
Health and Society 1
Case Studies
(Unit)
BMED 1102
BMED 1003(Y)
L
T
P
Code
Module Name
120
58
14
BMED 1201
(Unit)
11
(Unit)
Block Module B
Unit From Organs to
systems
Unit Integration
74
36
BMED 1202
8
BMED 1003(Y)
BMED 1203
Code
Module Name
BMED 2101
Block Module 1
L
T
P
Code
Module Name
BMED 2201
Block Module 2
Introduction
12
18
(Unit)
Cellular Growth and
Aging
Nutrition, Digestion
and Metabolism
The Reproductive
System
Synthesis 1
18
29
7
(Unit)
18
30
8
(Unit)
Cardio-Vascular
System
Excretion and
Homeostasis
Respiratory System
22
34
14
(Unit)
Synthesis 2
15
8
Optional Module
25
(Unit)
BMED 2102
(Unit)
Placement TPHC
BMED 2202
Code
Module Title
BMED 3101
Block Module 3
(Unit)
(Unit)
BMED 3102
117
10
16
55
8
20
L
T
P
13
38
13
15
36
7
17
33
14
8
21
2
4 x 4h
Optional Module
25
Code
Module Title
L
T
P
BMED 3201
Block Module 4
Defence and
Immune System
Infections
18
39
4
32
73
Optional Module
Community Survey
25
21
15
Year 3
Semester 2
Semester 1
(Unit)
P
51
The Individual,
Health and Society 2
Case Studies
Medical Statistics
(Unit)
(Unit)
T
Year 2
Semester 2
Semester 1
(Unit)
L
L
T
P
Introduction to
Nervous System
Perception, Emotion,
Behaviour
Bones and Joints
4
19
10
(Unit)
49
83
27
(Unit)
8
20
10
Optional Module
25
BMED 3202
BMED 3203
L: Lectures
T: Tutorials
P: Practicals
Optional Modules may be lecture based, tutorial or practical based or a mix of those (specified in module outline as well as types of assessment)
TPHC: Training in Primary Health Care
15
[20]
10. Programme Plan- Master of Medicine
Master Year 1
Semester 1
Semester 2
Code
Module Name
MMED 1101
15 weeks
“Introduction to
Clinical Reasoning”
(L:65h: IS:100 h; T:85h)
Duration
L: Lectures
IS: Interactive Seminars
T: Tutorials
MMED 1000
Project
Code
Module Name
Duration
“Learning in Clinical Environment” (LCE) Part I starts in
end of Semester 1
MMED 1201
LCE Unit “Internal
Medicine”
(L:62h; IS:72h; T:30h)
8 weeks
MMED 1202
LCE Unit “Surgery”
(L:10h: IS:74h; T:36h)
8 weeks
MMED 1203
LCE Unit “Community
Medicine & Primary
Health Care”
(L:2h; IS=51h; T:44h)
8 weeks
MMED1000
Project
Master Year 2
Semester 1
Semester 2
“Learning in Clinical Environment” (LCE)
Part I continues with 3 additional units
“Learning in Clinical Environment” (LCE)
Part II
MMED 2101
LCE unit “Pediatrics”
(IS:93h; T:48h)
8 weeks
MMED 2201
LCE unit “Emergency
Medicine and Intensive
Care”
(IS:20h; T:20h)
3 weeks
MMED 2102
LCE unit “Psychiatry”
(IS:51h; T:23h)
4 weeks
MMED 2202
LCE unit “Neurology
and Neurosurgery”
(IS:43h; T:18h)
3 weeks
MMED 2103
LCE unit “ObstetricsGynecology”
(IS=14h; T:26h)
4 weeks
MMED 2203
LCE unit
“Ophthalmology”
(IS=8h; T:24h)
3 weeks
MMED 2204
LCE unit “Oto-RhinoLaryngology”
(L:34h; IS=2h; T:16h)
3 weeks
L: Lectures
IS: Interactive Seminars
T: Tutorials
MMED 2205
LCE unit
“Dermatology”
(L:32h; IS:17h; T:20h)
3 weeks
MMED1000
MMED1000
Project
Project
Master Year 3
Rotations as student interns in different disciplines for 10 months,
MD final examinations at the end of 6th year (2 theoretical papers and OSCE with 12 stations)
16
11. Outline Syllabus
This outline syllabus is not prescriptive and is intended to serve as a guide only.
BMED 1101- BLOCK MODULE A:
Unit “From Molecules to Cells”:
 Physics (is taught in both Modules A and B) :
Topics taught in physics in Year 1 were determined according to the learning needs of medical
students. Examples used help in better understanding of physiology and biological systems such as
intracellular diffusion, movement of fluid in the circulatory system, electrical transmission in nervous
fibres, body heat regulation, movement of rigid bodies, etc… Some imaging techniques are also
described: nuclear imaging, PET, X-Ray and MRI. Tutorials help students to test their
comprehension of topics taught, optional tutorials are offered depending on specific request from
students expressed on feedback forms made available to them after lectures.
Module A covers mechanics, thermal properties of matter, heat and temperature, thermodynamics,
electricity and electromagnetic waves.
 Inorganic Chemistry: Close link between chemistry and medicine; properties of matter;
transformation of matter; chemical reactions and energy; outcome of chemical reactions; application
of chemical balance to vital processes: proton transfer reactions, electron transfer reactions, substrate
transfer reactions; chemical kinetics; intermolecular interactions. Tutorials on colligative properties;
molecular recognition and osmotic pressure; stoechiometry, chemical transformations and energy
transfer; chemical equilibrium and reaction rates.
 Organic chemistry: Introduction to basic concepts in organic chemistry; different classes of organic
compounds and their structures, physical properties and reactions, provide a glimpse of the
importance of modern organic chemistry in medicine as illustrated by some important examples.
Topics covered are organic chemistry and medicine; lipids, steroids, alkanes, alkenes and arenes;
stereochemistry and carbohydrates; alcohols, ethers, phenolic compounds and carbohydrates;
aldehydes, ketones and carbohydrates; proteins, lipids, acids, esters and amides; amino acids and
nucleic acids.
 From DNA to protein: Deoxyribonucleotides and DNA; DNA replication; DNA mutations, DNA
repair, DNA recombination; genomic structure and content; chromatin; ribonucleotides and RNA;
transcription, maturation and mRNA transport; regulation of gene expression; amino acids, peptides,
proteins; protein synthesis, protein processing and function.
 Genetics: structure of the genome; principles of segregation and mendelian genetics; chromosomes
and karyotype; polymorphism and genetic variability; pathogenic mutations, genetic diseases,
oncogenetics, multifactorial complex phenotypes; DNA profiling; tutorial on genetic counseling and
genetic screening
 Biochemistry and Metabolism: Bioenergetics; enzymes; cell energetics; metabolic adaptation;
tutorials on calculations of concentrations; electrophoresis; enzymology
Unit “From Cells to Organs”:
 Cell architecture and intercellular communication: The lipid bilayer; secretion pathways;
membrane transport mechanisms; intracellular compartments; protein synthesis and intracellular
trafficking; receptors and secondary messengers; intercellular signaling mechanisms; adhesion
molecules; intercellular junctions; cell-matrix junctions; cytoskeleton and mitosis; cell cycle control.
 Tissue architecture: Epithelial tissue; connective tissue; nervous tissue: introduction, specialized
cells, migration and structure; bone tissue; muscle tissue: organization and types, contraction and
function;
17



Introduction to human anatomy: Types of bones; types of joints; types of muscles; types of blood
vessels; types of organs.
Developmental biology: Fertilization; 1st and 2nd weeks of embryonic development; third week of
embryonic development; fourth week of embryonic development; second month of embryonic
development; congenital malformations.
Practicals & Tutorials: Histology: introduction; epithelia; connective tissue; muscular tissue;
nervous tissue. Anatomy: the Hip. Bacterial growth and mutagenesis
BMED 1102- THE INDIVIDUAL, HEALTH AND SOCIETY 1:
Psychosocial dimensions in medicine, determinants of health, health and disease in medical history,
humanities in medicine; handicap and stigmatization, limitations: cure or care; health and disease in
statistics, neurosciences and ethology, interpersonal perspectives, neurosciences and language, medical
psychology and communication in primary health care, doctor patient relationship, medical psychology
and communication; seeking healthcare: socio-cultural aspects; health care systems and health care needs,
clinical decision in primary healthcare; clinical epidemiology: a tool for clinical decision, influence of
mindsets, gist of messages; decision process, instruments and potential biases; ethical dimensions and
medical deontology, ethical dimensions of the clinical decision; mental health psycho-social and public
health determinants.
BMED 1003 (Y) CASE STUDIES: Cystic Fibrosis and atherosclerosis are topics covered throughout
both semesters.
BMED 1201- BLOCK MODULE B
Unit “From Organs to Systems”:
 The Nervous System: Structural and functional organization of the central nervous system;
neurotransmission and plasticity; anatomical and functional neuro-imaging; embryonic and prenatal
brain development; autonomic nervous system.
 The Endocrine System: Structural and functional organization of the Hypothalamus-Pituitary Gland
system; Overview of other endocrine glands; thyroid hormones, growth hormone, prolactin; sex
hormones; Stress and the CRF-ACTH-glucocorticoid system.
 The Reproductive System: Anatomy of male and female reproductive systems; sex determination
and development; gametogenesis; the placenta; female reproductive physiology; male reproductive
physiology;
 The Digestive System: Microscopic structure and histo-physiology of the digestive system; overview
of the anatomy of the digestive system; embryologic development of the digestive system and
understanding of frequent malformations; the main physiological functions of the digestive system
(ingestion, digestion, secretion and absorption) and their regulation by the nervous and endocrine
systems. Normal gut flora. Overview of water absorption and treatment of dehydration. Overview
of digestion, absorption and metabolism of proteins, lipids and carbohydrates. Mechanisms of
glycemic control.

The Locomotor system: Anatomical and radiological study of bones; shoulder and hip joints; elbow
and knee joints; hand and foot joints
 The Urinary System: Anatomy; overview of renal function; the nephron as a functional unit;
embryonic development of the kidneys; glomerular filtration, clearance, reabsorption and secretion;
histology of nephrons, tubules, urothelium; regulation of extracellular fluid volume and sodium
exchange; calcium and phosphate homeostasis; water excretion and osmoregulation; acid-base
balance, potassium balance.
 The Circulatory System: Introduction to the organs forming part of the system, overview of the
circulatory system; blood; histology of components of the system; embryonic development, foetal
18




circulation; cardiac function; regulation of the peripheral circulatory function; heart-vessels coupling;
heart failure; blood pressure regulation.
The Respiratory System: Overview of organs in the system; histology of the respiratory tract and
lungs; embryonic development; overview of respiration; biophysical aspects of breathing; regulation
of respiration; oxygen and carbon dioxide transport; interaction between respiratory system and
kidneys in acid-base regulation.
Pharmacology: General concepts in study of drug metabolism and drug effects; pharmacokinetics
and pharmacodynamics; drug absorption; drug distribution; drug metabolism; drug excretion; doseresponse curves; efficacy and potency; agonists and antagonists; therapeutic index; tolerance;
addiction and cure.
Physics: Module B covers nuclear physics, elastic and mechanic waves; geometrical optics; fluid
dynamics.
Practicals:
Anatomy practicals: Spine; skull; face; shoulder and hip; elbow and knee; foot and hand; thorax.
Histology practicals: blood and different types of blood vessels.
Unit “Integration”:
Haemophilia and Haemorrhagic disorders: haemostasis and anomalies in haemostasis, coagulation and
fibrinolysis, genetics of haemorrhagic disorders and psycho-social dimensions, treatment of coagulation
disorders. Physical activity and health, adaptative mechanisms to efforts in healthy individuals.
Metabolic syndrome, lipid metabolism and physical activity in prevention and treatment of obesity.
Bone metabolism and growth, regulation of minerals, mechanisms of fractures and healing; bones grafts
and biomechanics. Defence mechanisms: infections; tissues, cells and molecules involved in acute
inflammatory response. Mechanisms of immunological response. Acute and chronic rejection of
incompatible renal transplant, HLA system, cytotoxic T lymphocytes, immunologic tolerance.
BMED 1202-INDIVIDUAL, HEALTH AND SOCIETY 2: Different ages in life: meeting a baby, a
child, an adolescent; parenthood, bonding, baby’s development, trauma, stress and consequences; limits
between normal and pathologic in adolescence; family planning, contraception, at risk behaviours;
building up of an adult life; psycho-social development, sexuality and reproduction; maturity, aging,
crises and deaths; neuropsychobiology and ageing. Health system organization, access to health care,
health insurance system, health and law: medical deontology; equity in health care, humanitarian rights,
health and human rights. Reflecting on a socio-sanitary problematic, chronic diseases, non medical
determinants of health, role of general practitioner in health promotion, emotional factors and health;
stress and environment, professional environment; adaptive mechanisms to stress; community vision;
relation of trust in the doctor; bio-psychosocial vision and summary of main messages.
BMED 1203-MEDICAL STATISTICS:
Understanding principles of data analysis used in scientific publications read by medical practitioners.
Critical reading of articles, introduction to clinical epidemiology. Descriptive statistics, sampling
techniques, confidence intervals, normal curve. Inferential statistics, null hypothesis, type I and type II
errors, p-values, power of test and sample size. Randomised clinical trials, commonly used tests (T-test,
Mann-Whitney and Chi-2). Variance analysis and linear regression. Relative risk in prospective studies,
prevalence, incidence and survival analyses. Case-control studies, odds ratio, logistic regression, paired
tests. Diagnostic tests: specificity and sensitivity, predictive values and ROC curves. Meta-analyses:
systematic review, Cochrane collaboration. Agreement between observers and correlations.
19
BMED 2101- BLOCK MODULE 1 (5 units)
Unit “Introduction”: Through activities in this first unit, student will be familiarized with different types
of learning: Problem-Based Learning, Clinical Skills and Community Dimension. S/he will be
familiarized with the assessment methods and rules of the programme, will learn to use library and elearning resources for self-learning. In the unit student will be introduced to virology, flu viruses,
picornaviruses including polio virus. CS: Introduction to medical consultation. CD: History of Medicine:
Body and medical models against old and emerging infections; humanities in medicine and medical
consultation.
Unit “Cell Growth and Ageing”: In this unit, using previous knowledge of basic sciences, student will
be able to define, analyse, explain the following: tissue regeneration and tissue repair in epithelia and
connective tissue; molecules and cells involved in acute inflammation; normal cell cycle and its
regulation by cyclins and inhibitors; examples of abnormalities in cell cycle (psoriasis); cell proliferation
(retinoblastoma, polyposis and colon carcinoma); molecular, biochemical and cellular mechanisms
involved in cell senescence and genetic aspects. Practicals in histology of skin and annexes, colon,
appendix and uterine cervix, acute appendicitis, colonic polyposis and carcinoma, in situ cervical cancer,
psoriasis and skin wound repair. CS: Introduction to medical consultation; wound care, simple wound
dressing; checking vital signs; studying basic skin lesions. CD: epidemiology: What is clinical
epidemiology, how useful is it?
Unit “Nutrition, Digestion and Metabolism”: Through problems presented in this unit student will
acquire and apply knowledge in the following basic medical sciences: structure and function of the
gastro-intestinal tract, motility, secretion, digestion and absorption; metabolism of carbohydrates, lipids
and proteins; neuro-hormonal regulation of the gut and of the main metabolic pathways; mechanisms
leading to alterations of the gut and of metabolic pathways; drugs acting on gastro-intestinal tract.
Practicals: macroscopic and microscopic morphology of the digestive tract, histopathology of the
digestive system. CS: Radiology 1: introduction to radiological exams, CT and MRI; doctor-patient
relationship; digestive semiology: introduction to clinical examination of the abdomen; biliary disorders
and hepatic failure; constipation and diarrhea. CD: epidemiology: risks associated with obesity;
introductory session to training in primary health care.
Unit “Reproduction”: In this unit student will learn and apply knowledge in anatomy, physiology and
pathology of the male and female reproductive systems; embryonic and foetal development of the
reproductive systems; pregnancy and delivery; genetic and hormonal aspects with examples of disorders
affecting the reproductive system; psychosocial dimensions of problems related to sex and reproduction;
world demographic dimension of reproductive problems (contraception, abortion). Practicals on
morphology, clinical anatomy of male and female organ systems; histology of male and female organs,
placenta, adrenal glands, mammary gland, pituitary gland; histopathology. CD: epidemiology: assessing
a diagnostic test; case-control study, assessing risk factors; plenary session on training in primary health
care.
Unit “Module Synthesis 1”: Problems and lectures presented in this unit enable the student to apply and
integrate knowledge acquired in previous units such as: histology and histo-pathology, metabolic outcome
of enzymatic defects in regulation of hepatic glucose output; structure, biosynthesis and interconversion
of steroid hormones; role of androgens in genital organ differentiation; monogenic hereditary disorders
and autosomal recessive transmission; etiology of main congenital malformations; integration and
regulation of metabolic pathways (carbohydrates, lipids and amino-acids); pharmacology principles and
drugs. CS: Systematic laboratory investigation strategy to assay an organ disorder or malfunction;
20
summing up the semiology of digestive system; performing injections. CD: epidemiology: randomised
clinical trial, assessing outcome of an intervention.
BMED 2102: OPTIONAL MODULE
BMED 2201- BLOCK MODULE 2 (4 units)
Unit “Heart and Blood Vessels”: In this unit student will acquire and apply knowledge in the following
basic medical sciences: structure and function of the cardiovascular system; embryonic and foetal
development of the heart and vessels; haemostasis and coagulation; lipoprotein metabolism; common
cardiovascular disorders; pharmacological basis of cardiovascular treatment; main risk factors and
prevention of cardiovascular diseases. Practicals: systematic, topographic and clinical anatomy of the
heart; microscopic morphology of the cardiovascular system, ECG and phonocardiogram; normal blood
count; examples of pathologies of CVS; histopathology of CVS. CS: lower limb ischaemia;
thromboembolic disease, venous circulation; examination of the heart: history taking, inspection,
palpation, introduction to auscultation. CXR and Doppler; Doctor-Patient Relation: starting the
interview, empathy; Formative Station 1: Digestion. CD: About assisting death; 1st placement training
session in primary health care (TPHC).
Unit “Excretion and Homeostasis”: In this unit student will acquire and apply knowledge in the
following basic medical sciences: morphology, embryology and pathology of the kidney and urinary tract;
renal physiology; patho-physiology of renal failure; physiology and pathophysiology of the urinary tract.
Practicals: gross anatomy and microscopy of the urinary tract. CS: Training in cardiac semiology, history
taking and urologic examination, history taking and physical examination of a nephritic syndrome;
specificity and sensitivity in laboratory investigations; radiology: introduction to ultrasound examination.
CD: occupational health: cadmium and renal toxicity; plenary session on TPHC.
Unit “Respiratory System” or “Lungs and Respiratory Tract”: In this unit student will learn and apply
knowledge in anatomy and function of the respiratory system; mechanics of breathing and lung volumes;
ventilation and gaseous exchange in alveoli; regulation of breathing and respiratory reflexes; clinical
symptoms and pathology of lung and bronchi; defence mechanisms of respiratory system; psycho-social
repercussions of lung disorders, prevention of smoking; main drugs used for disorders affecting the
respiratory system. Practicals: Anatomy of the respiratory system; lung volume measurements and
respiratory mechanics; histology of the respiratory system; chemical aspects of respiration. CS: training
in cardiologic semiology; respiratory semiology; nuclear imaging, lung function in pulmonary embolism
and lung cancer; emergency medicine: cardiopulmonary arrest; Formative Station 2: cardiology. CD:
occupational asthma; pulmonary fibrosis of occupational origin.
Unit “Module Synthesis 2”: student will be able to recall and integrate knowledge acquired in previous
units, he/she will thus be able to define, analyse, explain and interrelate the following: blood pressure
regulation including reflexes and neuro-hormonal mechanisms involved, pharmacology of
neurotransmitters and hormones; role of renin-angiotensin-aldosterone system in fluid volume and blood
pressure regulation, implications in cellular and functional changes occurring in chronic cardio-vascular
diseases; physio-pathology, pharmacology and epidemiology of HBP; heart rate regulation. Practicals:
pH homeostasis in extracellular compartment. CS: injections, dilution modalities and learning to insert a
Venflon cannula; dyspnoea of cardiac versus bronchopulmonary origin; emergency medicine:
cardiovascular resuscitation according to Basic Life Support (BLS) concept; Formative Station 2 (bis):
cardiology. CD: health problems due to exposure to solvents; 3 placement training sessions in TPHC.
BMED 2202: OPTIONAL MODULE
21
BMED 3101- BLOCK MODULE 3 (3 units):
Unit “Introduction to the Nervous System”: student will be able to define, explain and interrelate
through study of clinical problems encountered in the unit, the following phenomena: anatomy of the
spine and the limbs, development, structure and function of components of the peripheral nervous system;
introduction to neuro-anatomy; mechanisms involved in muscular contraction, neural mechanisms of
motor control and muscle relaxing drugs; adaptation to effort in aerobic and anaerobic conditions, energy
sources involved in muscle contraction; mechanisms and consequences of pathologies affecting muscles,
neuromuscular junctions and peripheral nervous system; mechanisms of pain perception and analgesic
drugs. Practicals in anatomy and radiology of the nervous system, physiology of the nervous system. CS:
General principles of history taking and clinical examination of locomotor system (osteoarthritis of the
hip, rheumatoid arthritis), and of the spine (cervical, dorsal, lumbar portions); student learns bladder
catheterization on a mannequin.
Unit “Perception, Emotions and Behaviour”: student will acquire and apply knowledge in structure
and function of the nervous system, symptoms and main syndromes resulting from nervous system
dysfunction, principles in topography and syndromic classification; clinical neurological examination in
an ambulatory care setting; functional organization of the central nervous system, physiology involved in
memory, conscience, emotions, thought, programming etc… alterations in psychiatric problems;
neuroanatomy and neurochemistry of cerebral networks involved in higher cognitive brain functions;
Hypotheses on biological mechanisms underlying some psychiatric disorders; pharmacologic basis of
treatment of psychiatric disorders. Practicals: neurohistology; neuroanatomy and neuropathology;
neurophysiology. CS: Student learns to examine the motor system and reflexes, sensitive system and
cortical areas, cranial nerves, coordination, balance and walking; psychiatric symptoms: cases of anxiety
problems, depression, delirium and hallucinations. Revision training in lung, technical skills, neurology,
urology. Doctor-patient relationship: providing medical explanations. Formative Station 3: Circulating
System. CD: Ethics: issues related to autonomy such as confidentiality, consent and refusal of treatment,
autonomy and veracity; ethical considerations above the doctor-patient relations, medico-legal
implications in psychiatry, action to be taken in case of death of an individual, humanities and epilepsy,
medical confidentiality and disclosure of information to a third party.
Unit “Bones and Joints”: student will be able to define, explain and interrelate through study of clinical
problems encountered in the unit, the following: anatomy of the spine and limbs, radiology, bone nuclear
imaging, magnetic resonance imaging, CT scan imaging; embryologic development, structure and
function of components of the locomotor system; uric acid metabolism and drugs used to treat gout;
introduction to pathologies such as fractures, luxations, sprains, osteo-arthritis, gout, scoliosis, problems
affecting intervertebral discs; phosphate and calcium metabolism; socio-economic impact of fractures in
the elderly person, and of pain. Practicals in anatomy and radiology, histology and embryology of
osteochondral and bone tissues. CS: history taking and clinical examination of the upper limb (shoulder,
elbow, wrist and hand) and of the lower limb, they learn to examine patients with fibromyalgia;
emergency medicine: assessing vital signs (ABCDE) in a major trauma patient admitted in hospital
(examination of head and neck of the patient).
BMED 3102: OPTIONAL MODULE
22
BMED 3201- BLOCK MODULE 4 (2 units + Community Project)
Unit “Defences and Immunity”: through the problems presented in this Unit, the student should acquire
and apply knowledge on general concepts of the physiopathology of immuno-inflammatory disorders and
some haematological diseases; immune and non-immune defense mechanisms (innate and adaptive
immunity); cellular and humoral mediators of defense systems; organs and overall architecture of the
lymphopoietic and hematopoietic system; immediate and delayed hypersensitivity, anaphylactic shock,
desensitisation; autoimmune and inflammatory reactions,; oncogenes and chromosomal translocations;
graft versus host disease; tolerance and loss of tolerance; genetics of immunodeficiency; monoclonal
gammapathies; treatment of chronic myeloid leukemia; spleen and reticulo-endothelial system;
vasculitis; immunomodulating treatment, steroid hormones; immunosuppressive drugs; main symptoms
of the most frequent infections.
Practicals on histology of lymphoid system, examples of
immunohistopathology. CS: Semiology of the lymphatic system, clinical examination of ganglion
surfaces and the spleen, review of anatomy of the principal lymphatic draining network; technical skills:
blood transfusion and the patient, inserting an IV line; emergency medicine: paediatric resuscitation;
revision training in locomotion, in urology. CD: Economy and health system, health care market and
health costs, health insurance.
Unit “Infections”: Student should be capable of defining, analysing, explaining and inter-relating the
phenomena observed in the problems of the unit by exploiting the following knowledge: structure,
physiology and genetics of bacterial pathogens; mechanisms of bacterial virulence; varieties of structure
and strategies of multiplication and propagation of viruses; epidemiology of transmission of infections;
pathogenesis of infections and their complications; role of the host (favourable conditions, defences);
mechanisms by which viruses and bacteria avoid host defence; epidemics and prevention of infections;
mode of action of the principal anti-infectious agents and of development of resistance, appropriate
choice of antibiotics and best usage; biology of protozoan parasites and their strategies to avoid the
immune system; Plasmodium; septic shock; fungal infections; respiratory infections in childhood;
infections and oncogenesis; principal elements of vaccinal protection. CS: summarizing semiology in
angiology, in respiration, in urology and nephrology, in locomotor system, in neurology, in circulatory
system, in digestive system. Doctor-patient relation: explanations, when relation is difficult. Technical
skills: Bacterial laboratory analyses performed in doctor’s office: throat swab, urine sampling technique,
Gram stain technique. Nosocomial infections and measures for prevention of transmission. Practical
training sessions in emergency medicine, in neurology. Formative Station 4: Neurology. CD: Economy
and health system: incentives and constraints in medical practice, burden of disease, quality and safety
aspects of health care; history of medicine: moral medicine and racism, syphilis as the “the other’s
disease” in XV-XX century.
Unit “Community Project”: choice of problem to investigate, planning and implementing the project,
summing up and presentation of project, poster exposition. In lunch meetings students learn about the
following topics: preparing a report, a poster, a presentation, taking care of the homeless, living with a
handicap, health follow-up of migrants, violence against women, the family and detention, living with
breast cancer, violence by the police: interaction between the police force and health care workers.
BMED 3202: OPTIONAL MODULE
23
OUTLINE OF OPTIONAL MODULES:
Optional Modules offered in Year 2 and Year 3
ELBM2301– Functional genomics applied to biomedical science. 25 hours.
This module will provide students with an appreciation of how knowledge on gene sequence and
expression can be used to better understand normal and deficient cellular pathways, to develop novel
diagnostic tools and to design efficient drug-based or gene-targeted therapy. The following topics will be
covered: introduction to the ‘omics: genomics, transcriptomics, proteomics; basic techniques of
functional genomics; profiling of gene and protein expression; biomarker discovery; applications in
cancer, diabetes, antibiotic resistance, infectious disease; pharmacogenomics. Assessment: 50%
continuous assessment (seminar-based) + 50% end of semester exams
ELBM2302– Nanomedicine: 25 hours
This module provides an overview of the applications of polymeric materials in the field of medicine.
Emphasis is laid on nanomedicine, that is, the applications of nanotechnology to medicine and will
involve topics such as diagnostics, medical imaging, drug delivery, scaffolds and tissue engineering.
Topics covered: introduction to biomedical polymers, definition and properties of nanomaterials;
diagnostics and medical imaging, scaffolds and tissue engineering, drug delivery. Assessment: end of
semester examinations.
ELBM2303– Health Research Methodology and Ethics: 25 hours
This module will familiarise students with the scientific research process, its implications in health
research, and with ethical and regulatory issues related to research. Topics covered: research design; use
of animals in experimental procedures; overview of existing international guidelines for biomedical
research involving human subjects; for epidemiological studies; bioethics and human rights, human
genome and human rights, genetics and medicine. They will learn the roles and functions of human
ethics committees that review biomedical research, and on ethics considerations in the design of health
research projects. Students will work on case studies. Assessment: 50% continuous assessment (seminarbased) + 50% end of semester examinations (case study).
ELBM2304– Application of statistical softwares in the medical field: 25 hours
In this module students will be familiarized with use of statistical softwares to input and edit data,
produce graphics and implement statistical methods to describe and analyse medical data. Emphasis will
be made on appropriate interpretation of output. Students will work on a wide range of different types of
practical problems. Students will be examined through practical assessments.
Optional Modules offered in Year 3 only:
ELBM3001 – Emerging and re-emerging tropical infections: 25 hours
Students will acquire knowledge of pathogens that occur in certain regions of the world, particularly in
tropical countries. They should be able to prevent, diagnose and treat travel-related infections. They
should understand the public health importance of reducing the risk of such infections being introduced or
spreading in the country. Infections covered will include viral haemorrhagic fevers, arthropod-borne
virus infections, Nipah virus infection, rabies, emerging respiratory viral infections, leptospirosis,
melioidosis, rickettsioses, helminthic infections. Vaccines and other preventive measures for travellers.
Investigation of the returning ill traveller. Challenges in controlling infection in developing countries in
the community and in healthcare institutions. Assessment: end of semester examinations.
24
ELBM3002- Transfusion Medicine: 25 hours
This module will familiarise students with transfusion medicine which cuts across all medical disciplines,
students will learn about various blood and blood products available, organisation and function of Blood
Centres and hospital transfusion practice, transfusion procedures, clinical use of blood, adverse
transfusion reactions and their management, alternatives to blood transfusion, quality systems and blood
safety. The module will familiarise the student with the concept of haemovigilance and biovigilance.
Assessment: end of year semester examinations.
25
MMED 1101- Module “Introduction to Clinical Reasoning”
Lectures: SCLO: how to use it; Principles of access to computerized medical files/Processing health
information and protection of privacy; Pharmacology; Psychiatry; Pediatrics; Ophthalmology; Primary
health care; ENT; Dermatology; Quality Assurance in Healthcare; Legal Medicine and Ethics.
Interactive seminars: Anemia; thrombocytopenia; clinical microbiology; empiric antibiotic treatment;
anticoagulation in clinical practice; thyroid gland; pituitary gland; hypercalcemia; dyslipidemia;
preparation to learning in a clinical environment; medical confidentiality and humanities in medicine;
Pathology: Pulmonary infections, adenocarcinoma of the colon, atherosclerosis neurodegenerative
diseases ; Radiotherapy; Radiology; Pediatric semiology; Patient education; Semiology of diabetes;
Semiology of thyroid dysfunction; ECG interpretation; Clinical cardiology; Basics in ophthalmologic
examination; Assessing function: geriatric example; General physical examination of the adult; Blood gas
analyses; Blood transfusions; Laboratory analyses; History taking in a young adult; Bucco-dental
examination; Basic ENT examination; Quality Assurance in Healthcare; Palliative care; Legal Medicine.
Tutorials on clinical reasoning bearing on problems presented in a stepwise manner: Diagnosis and
management of hyperthyroidism in a young woman; community acquired pneumonia in a young female;
change in bowel habits with rectal bleeding in an adult male; acute pain in the right iliac fossa in a young
woman; failure to thrive in a 15 month old baby; unexplained fever in young child <3 years old); fever
and vomiting in a baby; diabetic keto-acidosis in a young child; loss of weight, increased cough and
dyspnea in a 63 years old smoker with chronic bronchitis; uncontrolled hypertension in a 62 year old
male; acute chest pain in an adult hypertensive male smoker; acute abdominal pain and shock in a
hypertensive adult; abdominal aortic aneurysm in a hypertensive male adult; evaluating cardiovascular
risk in a patient with a family history of myocardial infarction; history of falls in an elderly female
patient; urinary incontinence and urgency in an elderly female; somatic, emotional complaints, sleep
disturbances and fatigue in a young female adult; venous thrombosis and painful respiration (pulmonary
embolism) in an adult male; chronic fatigue syndrome in an adult female; acute episode of right
hemiplegia and aphasia in a 60 year old male; acute confusional state in an elderly person with cognitive
impairment; chronic headache with aura in a young woman; head trauma, loss of consciousness and
headache in a young female adult; acute groin pain in a female adult (aseptic necrosis of hip bone);
chronic groin pain in male adult (degenerative hip condition); hip trauma in an elderly person; gradually
increasing pain in the groin in an adult male (bone metastases).
Learning in Clinical Environment Part I (Units of variable duration: 4 to 8 weeks)
MMED 1201-LCE unit “Internal Medicine” (8 weeks)
Interactive Seminars: Laboratory tests: Thyroid tests, Sodium & potassium, pulmonary function; full
blood count, blood gas, urinary test, blood coagulation tests, ECG; Legal Medicine and Ethics: Clinical
Research Ethics and Medical Ethics, Medical error, investigating an incident; Medical Humanities: “The
doctor and the dying person”, “Frustrations in the therapeutic relationship”; Pathology: Proteinuria (renal
biopsy), Jaundice (liver biopsy), Non-Hodgkin lymphoma (lymph node biopsy) and Hodgkin lymphoma,
Bone Marrow biopsy, Hodgkin Lymphoma, Follicular hyperplasia, Myocardial Infarction, Lung
carcinoma, lung diseases; Pharmacology: Prescribing and selection of medication; Clinical
pharmacology: Polypharmacy, Adaptation of doses, Undesirable effects of medication (diabetes
treatment); Diabetology: follow-up of a diabetic patient, diagnosis and management of Acute renal
failure; therapeutic pharmacology: drugs used in gastro-enterology; Healthcare process and clinical paths;
Immunosuppressive drugs; Interstitial lung diseases; Systemic inflammatory diseases; Antitumor drugs;
Spondylitis; Radiology: Review of normal CXR, cardiac and pericardial diseases, Mediastinal, pleural
and parietal pathology, Imaging of the urinary tract, Imaging of inflammatory osteo-arthritis, Rhumatoid
26
Arthritis, Gout, Imaging of the thyroid and adrenal glands, Alveolar pattern and and lung infections,
interstitial pattern, Lung nodule, bronchial syndrome and atelectasia, lung cancer; Radiology seminars in
the service (Chest X ray and CT scan of thorax).
Seminars: Complete clinical examination; Semiology at the bedside; Medical Consultations; Angiology;
Cardiology; Integration; ECG; Taking history and clinical examination of the cardiovascular and
respiratory system, of the digestive system; of the lymphatic system, of the locomotor system; of the
neurological system; of the renal system, semiology in urology and nephrology; respiratory problems;
thyroid problems; examination of the diabetic patient and prevention of diabetic foot.
Tutorials bear on diagnosis and management of 15 problems: sudden loss of consciousness; acute
dyspnea; episode of sub-acute dyspnea and tightness of chest in a patient with chronic obstructive
pulmonary disease; nephritic syndrome in an adult diabetic patient; jaundice and fatigue in a female adult;
hypokalemia and metabolic acidosis with an episode of viral gastro-enteritis; fatigue and anemia; fever,
loss of appetite and general feeling of illness; hyponatremia; risk factor stratification after a myocardial
infarction; low back pain; febrile lymphadenopathy; meningitis in adult splenectomised patient;
complications of Rhumatoid Arthritis; chronic diarrhea.
MMED 1202-LCE unit “Surgery” (8 weeks)
Lectures: Sutures; Using hydro-alcoholic solution as surgical antiseptic agent for the hands; Plaster of
Paris Casts; Anesthesiology.
Interactive seminars (“Learning Clinical Reasoning” or “Guided Case Study” format): Legal Medicine
and Ethics: Informed Consent for treatment. Anesthesiology: on pre-operative medical evaluation, giving
main information elements necessary to get informed consent; preparation of patient for anesthesia,
procedures, risks and complications of anesthesia. General Surgery: Acute epigastric pain (biliary colic);
Fever, abdominal pain (inflammatory disorders of the gut); Persistent epigastric pain (stomach cancer);
Acute bleeding from the gut; Complications in digestive surgery; Organ failure (organ transplant).
Orthopedic Surgery: Surgical treatment in osteo-arthritis; Management of a fracture; Diagnostic
methodology in soft tissue trauma: knee sprain; Influence of the foot in determining walking
characteristics; The spine: growth and aging; Septic Osteo-arthritis-amputation-ortheses; Wrist pain;
Elbow pain. Cardiovascular Surgery: Acute breathlessness and palpitations-Mitral stenosis; Acute lower
limb ischemia; chronic lower limb ischemia; abdominal aortic aneurysm; Aortic dissection. Thoracic
Surgery: Asymptomatic Mediastinal mass; Differential diagnosis and management of haemoptysia;
Primary hyperparathyroidism, hypercalcemia; Thoracic trauma; Adrenal tumor (pheochromocytoma).
Urology: Renal stones; Trauma of kidney and urinary tract; Prostate cancer; Urinary incontinence.
Maxillo-Facial Surgery: Fractures of the facial cranium; Fracture of jaw. Plastic Surgery: Facial tissue
injury; chronic wound in anterior chest wall. Pathology: Cancer of oesophagus, stomach and duodenum;
Aortic pathology; Macroscopic haematuria; Urinary retention of prostatic origin; testicular mass;
Introduction to autopsy; Thyroid nodules; Macroscopic pathology; Ulcerative Colitis, Inflammatory
Bowel Diseases; Bone tumours; Arthritis. Radiology: Cardiovascular: imaging in lower limb ischemia,
aortic aneurysms and aortic dissections; Orthopedic: Imaging in arthritis affecting large joints, in bone
metastases, and myeloma; Digestive: cancers, Liver, biliary tract and pancreas, Inflammatory bowel
diseases; Urology: Imaging renal stones, renal and urinary tract tumours, of the scrotum; Oncology:
radiotherapy; Gynaecology: pelvic cancers.
Tutorials on clinical problems: in General Surgery: inguinal hernia and intestinal obstruction; acute
epigastric pain (acute pancreatitis); fever and abdominal pain (diverticulitis); morbid obesity; renal
transplant in diabetic patient with end-stage renal failure; in Orthopedic Surgery: fracture of femur;
pathological fracture; ankle sprain; wrist fracture (fracture of the scaphoid); in Cardiovascular Surgery:
deep vein thrombosis; stenosis of the internal carotid artery; in Thoracic Surgery: spontaneous
27
pneumothorax, discovery of a solitary pulmonary nodule; solitary thyroid nodule; in Urology: painless
haematuria (neoplastic origin and others); benign and malignant scrotal swelling; prostatic hyperplasia
and acute urinary retention; Maxillo-Facial Surgery: fracture of jaw; Plastic Surgery: burn injuries to the
face and upper limbs.
MMED 1203- LCE unit “Community Medicine and Primary Health Care” (8 weeks)
Lectures: Presentation of the unit; lessons learnt from the unit.
Interactive seminars: demonstrating ability to search for information on a health problem; summarizing
the main points of diagnoses, active problems and management plans of a patient; working with local /
national guidelines and protocols; giving teaching presentations to students and other health
professionals; informing patient and family, colleagues and other professionals on findings and checking
understanding; Clinical case presentations; Conducting a medical interview: from theory to practice; One
patient, one life, one culture; What should we do when the patient does not express himself/herself or
speaks very little in our language?; Practice in a doctor’s office: viewing a consultation through a film;
socio-economic determinants of health; Tobacco cessation; Gender and health; Quality of Health Care;
Wound treatment; Immobilisation and Ortheses; Pharmacology: Painkillers, prescription of antibiotics in
ambulatory care, screening for drug interactions; Radiology: degenerative disorders of the spine. Legal
Medicine: Persons exposed to violent situations: management by the ambulatory care physician and
medico-legal aspects, Health, personal responsibility and social exclusion, Fitness and aptitude to drive a
vehicle.
Tutorials bearing on 22 problems: suspected case of abuse of alcohol; acute pain and swelling of the knee
(gout); periodical health check-up and preventive medicine; recurrent heartburn; dizziness/vertigo in an
elderly female; chest pain or tightness of chest in ambulatory medicine; dysuria and pollakiuria;
management of HBP and primary prevention of cardiovascular disease; three presentations for back pain:
common low back pain, spondylodiscitis, vertebral fracture in osteoporosis; sore throat, cold and cough,
chronic cough; illicit drug abuse and dependence; differential diagnosis of mononucleosis with
lymphadenopathy, support for HIV positive patient, treatment of AIDS disease; chronic low back pain;
abdominal pain in a female adolescent: differential diagnosis, identification of risk behaviours; recognise
a sprained ankle on the basis of history and clinical examination; acute diarrhea, chronic abdominal pain
and altered bowel habits in a traveler; diagnosis and management of type 2 diabetes; cough and dyspnea
and wheezing respiration; snoring, fatigue, excessive daytime sleepiness (sleep apnea syndrome);
undernutrition in an elderly woman; pre-operative medical evaluation; fever in return travelers: malaria,
typhoid, dengue fever.
MMED 2101- LCE unit “Pediatrics” (8 weeks)
Interactive sessions: Introduction to the unit; Supervision of admission of a patient; Clinical presentation;
Radiology: Common pediatric pulmonary disorders; Common pediatric abdominal disorders; Common
pediatric neurological disorders; Common pediatric musculo-skeletal disorders; Clinical seminars:
breastfeeding, acute abdomen, recognizing severity of symptoms in children, Airway obstruction (foreign
bodies), precocious puberty, side effects of immunization: by what mechanisms?, Fracture in children,
Medical ethics and adolescents, Battered child and child protection, Legal medicine and ethics in
pediatrics, Clinical pathology, Sudden Infant Death Syndrome liver disorders in children, Genetics;
Preventive health at school, Screening for hearing deficits in newborn and children, Eyesight screening in
children, Physical activity and child health, public health aspects; Paedopsychiatry: Case presentation,
Introduction, clinical semiology in children and adolescents, Autism and other developmental disorders,
Risk factors for psychoses in adolescents, Function and eating disorders in children and adolescents,
Parenting problems, Neurotic disorders in children and adolescents, Attention deficit with or without
28
hyperactivity and learning disorders in children and adolescents, Personality disorders in children and
adolescents, Substance abuse in children and adolescents, Depression in the baby, in the child and the
adolescent, Special environmental situation in children and adolescent: disease and mourning, Summary
of 1 week in Pedopsychiatry. Bedside Seminars with children above 18 months, with children<18
months; in Orthopedic Surgery, in General Surgery, in Cardiology; on call in Pediatric Emergency
Service, Pedopsychiatry seminar in day hospital.
Tutorials bearing on 16 problems: management of a normal newborn; the sick newborn, neonatal
adaptation and non specific symptoms; respiratory distress of an infant or of a child; nonspecific
presentation of heart disease in an infant; acute abdomen in children; limp/pain in lower extremity in a
child; an acute skin rash occurring after a meal; differential diagnosis in irritable/crying infant:
intussusception of bowel v/s colic; congenital malformation of the urinary tract and urinary tract
infection; suspicion of epilepsy or psychological problems; define growth and pubertal development in
normal adolescents; child with purpura (severe thrombocytopenia); excessive weight gain in an
adolescent; distressed child (anxiety) who cannot sleep before going to school; speech and language
disorders in childhood as part of global developmental delay; individual and community dimensions in
school health;
Self-learning: Immunisations, Exanthema, upper respiratory tract disorders, asthma, cardiac auscultation,
cardiac malformations, common forms of anemia, food allergies, pediatric skin disorders, electrolyte
balance, growth, puberty, nephritic syndrome, pediatric surgery, influence of maternal health on the
foetus, complications of traumatic delivery, examination of a normal newborn, resuscitation in a newborn,
neonatalogy, breastfeeding and baby feeding, bronchitis, bronchiolitis, whooping cough, rhinitis, angina,
acute cervical adenitis, sinusitis, otitis, pneumonia, pseudo-croup, asthma attack, conjunctivitis,
meningitis, headache, abdominal pain, gastro-enteritis, urinary infection, unexplained fever, fits with
fever, gingivostomatitis, impetigo, diaper rash, anaphylaxis.
MMED 2102- LCE unit “Psychiatry” (4 weeks)
Interactive sessions: Presentation of unit, feedback on unit 1st week, feedback on unit 2nd week,
Introduction to psychotherapy, Psychotherapy models, clinical pharmacology in psychiatry; Legal
Medicine and Ethics: Informed consent, coercive treatment and use of restraints in psychiatry, Dangerous
status and forced admission to hospitals, tutelary measures, Patients Rights, Clinical Case presentations,
Integration with basic medical sciences (serotoninergic and central adrenergic systems; neurobiology of
stress and its relationship with mood and anxiety; functional neuroanatomy of psychiatric disorders;
neuroimaging in cognitive impairments in schizophrenia and dementia; mechanisms of individual
differences in drug response), Role of social determinants in the course and outcome of mental illness.
Bedside seminars: Cases of depression, Bipolar disorder, Phobic disorder, Schizophrenia, Emotionally
unstable personality disorder, borderline type, Dementia, Feeding behavioural disorders, Addictive
disorder.
Tutorials bearing on 11 problems: Investigation of a brief psychotic disorder; sexual dysfunction;
Diagnosis and choice of treatment in post-traumatic stress disorder resulting from an accident resulting in
severe physical injury; mental retardation and autism in adults; dissociative disorders and adjustment
disorders; diagnosis and treatment of social phobia; obsessive-compulsive disorder; Transition from
adolescence to adulthood: psychopathological aspects; Management of a patient presenting a psychiatric
disorder placed in a general socio-medical institution; impact of interpersonal relationships on depressive
episodes; diagnosis and treatment of sleep disorders.
29
MMED 2103- LCE unit “Obstetrics-Gynecology” (4 weeks)
Interactive seminars: Legal Medicine and Ethics: abortion viewed from ethical angle, legal angle and
from medical humanities angle. Pathology: Pathology of the uterine cervix; Screening and prevention of
cancers; a Breast nodule; Ovarian tumour. Radiology: Breast Imaging; Breast cancer and pelvic cancer.
Tutorials bearing on 13 problems: screening for gynecological and breast cancers in asymptomatic and
healthy women; acute abdomen, fever, purulent leucorrhoea; breast tumor in a young female; cervical
cancer; pregnancy induced hypertension, preeclampsia; preterm labor; foetal malformation; Hemorrhage
in third trimester of pregnancy; Secondary amenorrhea with galactorrhea; pelvic pain (ectopic
pregnancy); secondary infertility, primary dysmenorrhoea, secondary painful coitus; request for
contraception, vulvar lesions, parents unaware of patient’s visit; screening and diagnosis of gestational
diabetes mellitus.
Learning in Clinical Environment Part II (Units of 3 weeks duration each)
MMED 2201- LCE unit “Emergency Medicine and Intensive Care”
Interactive seminars: Haemodynamics, Sepsis, Radiology in non traumatic emergencies, CXR, Abdomen;
Radiology in traumatic emergencies: abdomen, limbs; Metabolic disorders; Deaths in A&E; Respiratory
physiopathology; Stopping treatment, futile treatment, Poisoning; Cerebral circulation and conscious
state; Disaster Medicine; Legal Medicine.
Tutorials bearing on 5 problems: polytrauma; state of shock; chest pain; acute respiratory distress and
respiratory failure; coma.
MMED 2202- LCE unit “Neurology and Neurosurgery”
Interactive seminars: Neuropaediatrics, Neuromuscular-reeducation, Clinical case presentations,
Pharmacology; Pathology; Radiology: cerebral vascular lesions, sub-arachnoid hemorrhage, intra-cerebral
hemorrhage, etiology, radiologic management, cerebral tumors: tumoral syndrome, radio-semiology,
localizations and etiologies, ischaemic cerebral lesions, diagnostic timing, etiology, white matter disease
or leucoencephalopathy, spinal cord lesions: spinal cord injury, tumor, trauma, ischaemia; Legal Medicine
and Ethics: Cerebral death; Bioethics; Pharmacology; Neuropaediatrics; Neuro-immunology; Doppler;
EEG, EMG; Neuropsychology; Bedside seminars.
Tutorials bearing on 6 problems: patient with multiple sclerosis; cerebellar syndrome; myelopathy;
muscle weakness; seizures; Parkinson disease.
MMED 2203- LCE unit “Ophthalmology”:
Tutorials bearing on 6 problems: Loss of vision and strabismus in children, senescent eye, retinal vessel
diseases, red eye, uveitis.
Interactive seminars: Revisions, Clinical skills
MMED 2204- LCE unit “Oto-Rhino-Laryngology”
Lectures: Anatomy, Radiology, Otology, Cervico-facial surgery, Rhinology.
Interactive seminar: practical ENT.
Tutorials bearing on 8 problems: earache; vertigo; eye swelling; nosebleed; swelling in the neck;
dysphonia; swelling beneath the chin; sore throat.
30
MMED 2205- LCE unit “Dermatology”
Lectures: Pediatrics, Introduction to dermatopathology, angiomas, Bacterial diseases (STDs); Bullous
disorders; Eczema; Mycosis; Dermatoses of the face; granulomatosis; Melanoma; Proctological diseases,
Viral infections; Psoriasis; skin cancer; Toxic dermatitis; Panniculitis; Systemic diseases.
Seminar with patient in OPD; Bedside seminars; Interactive sessions: preparation for examinations;
clinical cases, Photo sessions. Practicals: Dermatopathology.
Tutorials bearing on 10 problems: dandruff problem; bullous disorder, acne; dermatitis of the face;
sexually transmitted disease; “a black nail”; “the tobacco seller”; “recurrent skin disorder”; “a very
demanding mother”; “one train can hide 2 others”.
Transversal Disciplines (taught in “Learning in Clinical Environment” units)
MMED 3001- Legal Medicine and Medical Ethics”
Transversal discipline taught in all LCE Part I and Part II units, assessed individually and marks are
combined with those of LCE part II units.
MMED 3002- Pathology
Transversal discipline taught in all LCE Part I and Part II units, assessed individually and marks are
combined with those of LCE part II units.
MMED 3003- Clinical Radiology
Transversal discipline taught in all LCE Part I and Part II units, assessed individually and marks are
combined with those of LCE part II units.
MMED 1000- Project
Students identify the topic of the project and a supervisor at the start of Year 4 (1 st semester in 1st Year of
Master part of the programme), they work on the dissertation throughout Year 4 and Year 5, and submit at
the end of Year 5. The Project may be a research project, a Case Study or a Literature Review on a
specific topic. Topics may vary from basic medical science, clinical medicine, legal medicine and ethics,
medical humanities, health economics, to medical education. Project is assessed independently by the
supervisor and a second assessor.
31
Annex to MD
EXCERPTS from SCLO
SCLO: Swiss Catalogue of Learning Objectives for Undergraduate Medical Training - June
2008 prepared by the Working Group under a Mandate of the Joint Commission of the Swiss
Medical Schools (Web site: http://www.smifk.ch).
1
Annex to MD
TABLE OF CONTENTS
1-General Objectives in SCLO.............................................................................................................. 4
COMPETENCIES AS MEDICAL EXPERT: The physician is able to: ............................................................ 4
COMPETENCIES AS COMMUNICATOR: The physician is able to: ........................................................... 6
COMPETENCIES AS COLLABORATOR: The physician is able to: ............................................................. 7
COMPETENCIES AS MANAGER: The physician is able to: ...................................................................... 8
COMPETENCIES AS HEALTH ADVOCATE: The physician is able to: ........................................................ 8
COMPETENCIES AS SCHOLAR: The physician is able to: ........................................................................ 9
COMPETENCIES AS PROFESSIONAL: The physician is able to: ............................................................. 10
2-Problems as Starting Points for Training in SCLO ........................................................................ 11
3-General Skills in SCLO ..................................................................................................................... 13
History taking .................................................................................................................................... 13
Information / management ............................................................................................................... 14
Examination ...................................................................................................................................... 14
Procedures ........................................................................................................................................ 15
4-Clinical Pictures (and Further Knowledge) in SCLO ............................................................. 16
INTERNAL MEDICINE: CLINICAL PICTURES .......................................................................................... 16
INTERNAL MEDICINE: FURTHER KNOWLEDGE .................................................................................... 19
PHARMACOTHERAPY: FURTHER KNOWLEDGE ................................................................................... 20
SURGERY: CLINICAL PICTURES............................................................................................................ 20
SURGERY: FURTHER KNOWLEDGE...................................................................................................... 23
PEDIATRICS: CLINICAL PICTURES ........................................................................................................ 24
PEDIATRICS: Further Knowledge ........................................................................................................ 26
GYNECOLOGY – OBSTETRICS: CLINICAL PICTURES .............................................................................. 27
GYNECOLOGY – OBSTETRICS: FURTHER KNOWLEDGE ........................................................................ 28
PSYCHIATRY: CLINICAL PICTURES ....................................................................................................... 29
PSYCHIATRY: FURTHER KNOWLEDGE ................................................................................................. 30
OPHTHALMOLOGY: CLINICAL PICTURES ............................................................................................. 30
OPHTHALMOLOGY: FURTHER KNOWLEDGE ....................................................................................... 31
2
Annex to MD
DERMATOLOGY: CLINICAL PICTURES.................................................................................................. 32
DERMATOLOGY: FURTHER KNOWLEDGE ........................................................................................... 33
OTORHINOLARYNGOLOGY (Ear, Nose & Throat: ENT): CLINICAL PICTURES......................................... 33
OTORHINOLARYNGOLOGY (Ear, Nose & Throat: ENT): FURTHER KNOWLEDGE................................... 34
RADIOLOGY AND NUCLEAR MEDICINE: FURTHER KNOWLEDGE ......................................................... 35
PUBLIC HEALTH, INSURANCE- AND OCCUPATIONAL MEDICINE: FURTHER KNOWLEDGE .................... 36
FORENSIC MEDICINE: CLINICAL PICTURES .......................................................................................... 39
FORENSIC MEDICINE: FURTHER KNOWLEDGE .................................................................................... 39
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1-General Objectives in SCLO
COMPETENCIES AS MEDICAL EXPERT: The physician is able to:
 elicit a relevant, concise and accurate history from the patient and other sources
The physician demonstrates clear history taking and communication with patients, their families and other
carers and seeks information from other sources, differentiating the concepts of ‘illness’ as the patient’s
story and of ‘disease’ as the medical history of a health disorder.
The physician clarifies the patient’s expectations and requests for the encounter and elicits information on
both the somatic and psychological aspects of her/his symptoms and complaints as well as the patient’s
situation, her/his understanding and concerns, social and cultural background and illness experience.
The physician shows knowledge of common typical presenting symptoms and complaints, even when less
explicit and in early stages of disease.
 conduct an effective physical examination
The physician explains the examination procedure, gains appropriate consent for the examination and
minimizes patient discomfort.
The physician masters clinical examination techniques to elicit relevant clinical signs and uses a
coordinated approach to the examination respecting patient dignity.
The physician performs a targeted or a detailed examination corresponding to the patient’s symptoms and
the actual diagnostic question.
 analyze and interpret data to establish a differential and a working diagnosis and construct
a management plan
The physician analyzes and interprets the collected information and establishes a problem list with a
differential diagnosis in the order of likelihood and urgency, and establishes a principal working diagnosis
taking into account the different epidemiology of disease presentations in primary and secondary care.
The physician takes into consideration relevant context and background of the patient, including family,
social, cultural and spiritual factors.
The physician constructs a management plan based on the interpretation of the collected data, including
further investigations and treatments and consecutive requests/instructions to other healthcare
professionals, keeping open the option of a wait-and-see approach.
The physician appreciates positive or negative predictive value of symptoms and signs, and of findings
from ancillary tests obtained in clinical data collection, and their dependency on the prevalence of the
target disease.
 carry out under supervision relevant procedures and organize further investigations
The physician carries out specific investigative or therapeutic procedures as outlined in the section
“General Skills”.
The physician weighs risks and benefits for the patient before undertaking any investigation or procedure.
The physician explains to the patient the arguments for further investigations, their risks and benefits and
the specific procedure.
 demonstrate appropriate medical data and information management
The physician synthesizes the relevant information and reports on her/his findings and her/his proposals
concerning the management plan in a concise form to her/his supervising physician and other healthcare
professionals.
The physician records accurate, logical, comprehensive and pertinent accounts of history, physical
examination, investigations, management plan and follow up that are structured, timed, dated and
personally attributable with the understanding that they might be read by the patient.
The physician takes into account the medico-legal importance of good record-keeping and data
protection.
The physician structures reports clearly to communicate findings and outcome of illness episodes.
 deliver good quality medical care and ensure patient safety
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The physician demonstrates knowledge of the relevant structures and functions of the human body from
molecular level to the individual as a whole in its social context, in its different phases of development
and the range from normal to pathological condition.
The physician demonstrates awareness of the scientific base and conceptual framework of modern
medicine, its perception in society and its historical evolution over time.
The physician demonstrates up-to-date knowledge of the evidence-based standard of medical care for
common ailments and illnesses and of the basic urgent interventions.
The physician applies her/his knowledge in daily work by diagnosing and treating the common conditions
and mastering the basic urgent interventions.
The physician informs patient and family, colleagues and other professionals in a readily comprehensible
way, encouraging discussion and participation in decision-making.
The physician pays attention to the importance of continuity of care and of patient information transfer
e.g. from inpatient to outpatient setting.
The physician allows patients sufficient time to talk, express concerns and to ask questions, listens
actively.
The physician seeks advice promptly when unable to answer a patient’s query or concerns. The physician
supports self-management by patients.
The physician demonstrates an understanding of the social and cultural background of patients and takes
it into account in her/his clinical work.
The physician shows awareness of possible consequences of disease for family members and further
environment (including workplace) of the patient.
The physician identifies the main information elements that have to be transmitted to the patient in order
to get her/his informed consent on a medical act and respects patient’s rights to refuse treatment.
The physician takes particular care in dealing with vulnerable patients such as children, severely ill and
dying patients and patients with mental ill-health.
The physician considers appropriateness of interventions according to patient’s wishes, severity of illness
and chronic or co-morbid diseases.
The physician respects patient’s wishes for confidentiality.
The physician explains criteria for issuing ‘Do Not Attempt Resuscitation’-orders and the level of
experience required to issue them.
The physician recognizes personal limits of expertise and decides appropriately if and when other
professionals are needed to contribute to a patient’s care.
The physician acts appropriately when a medical error has occurred.
The physician is sensitive to situations where patients are unhappy with aspects of care and seeks to
remedy concerns.
The physician demonstrates basic knowledge of detection and appropriate management of medical errors.
 demonstrate safe prescribing
The physician prescribes drugs, oxygen, fluids and blood products appropriately, clearly and
unambiguously with date and signature clearly visible.
The physician considers drug costs when prescribing.
The physician applies the principles of safe prescribing for children and elderly people and in the context
of pregnancy and breastfeeding, hepatic or renal dysfunction or heart failure.
The physician explains and applies the principles of therapeutics in treatment of pain, palliative and endof-life care.
The physician shows awareness of possible drug interactions and of adequate tools to reduce prescribing
errors.
The physician monitors therapeutic effects and compliance, and appropriately adjusts treatments and
dosages and encourages patient compliance.
The physician identifies patients who are not responding as expected to any investigative or treatment
measure and takes appropriate and timely action.
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Annex to MD
The physician shows awareness of the importance to notify drug monitoring agencies in the case of a
possible significant adverse drug reaction.
The physician shows understanding of common complications and side effects of treatments / procedures
and gives the patient appropriate information, instructions and warnings.
The physician shows awareness of the importance of security issues in respect of prescription forms.
 foster infection control
The physician describes the principles and sources of cross infection.
The physician minimizes the risk of transferring infection through personal behavior, including
appropriate hand hygiene.
The physician avoids posing risk to patients by personal (infectious) health problems.
 promote health of patients and the community
The physician recognizes and uses opportunities to counsel for disease prevention and to promote health.
The physician shows basic counseling skills explaining to patients, as appropriate, the possible effects of
lifestyle, including the effects of diet, nutrition, smoking, alcohol and illicit drugs.
The physician recommends screening tests and immunizations appropriately.
 access relevant information on diagnostic and therapeutic options and apply it under
supervision to clinical practice
The physician, starting from a patient problem, elaborates an appropriate clinical question and efficiently
searches for an answer in the literature, using appropriate sources of information.
The physician actively accesses relevant evidence and demonstrates basic ability to appraise the quality of
evidence from different sources in the literature and proposes appropriate conclusions for patient care to
the supervising physician.
COMPETENCIES AS COMMUNICATOR: The physician is able to:
 develop rapport, trust, and ethical therapeutic relationships with patients and families
The physician shows recognition that good communication is a core clinical skill for physicians that can
foster patient and physician satisfaction, compliance, and improve clinical outcomes.
The physician shows awareness of nonverbal cues in encounters with patients and acts appropriately.
The physician chooses a suitable setting with necessary support when giving complicated or bad news.
The physician deals with the help from senior colleagues appropriately with angry or dissatisfied patients
or relatives.
The physician seeks assistance when dealing with patients with special communication needs, e.g.
language or speech problem.
The physician demonstrates an ability to anticipate patients’ needs; explains clearly and checks
understanding.
The physician balances appropriately distance and proximity with the patient and shows appropriate level
of emotional involvement.
 accurately elicit and synthesize relevant information and perspectives of patients and
families, colleagues, and other professionals
The physician demonstrates clear history taking and communication with patients, their families and other
carers and seeks information from other sources, differentiating the concepts of ‘illness’ as the patient’s
story and of ‘disease’ as the medical history of a health disorder.
The physician clarifies the patient’s expectations and requests for the encounter and elicits information on
both the somatic and psychological aspects of her/his symptoms and complaints as well as the patient’s
situation, her/his understanding and concerns, social and cultural background and illness experience.
The physician explores, respectfully and without judgment, the social and family context of the patient’s
health needs and preferences.
 accurately convey relevant information and explanations to patients and families, colleagues
and other professionals and foster the development of a common understanding on issues,
problems and plans to develop a shared plan of care
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The physician informs patient and family, colleagues and other professionals in a readily comprehensible
way, encouraging discussion and participation in decision-making.
The physician ensures that relatives of acutely ill or unconscious patients are being supported and that
relatives, if not present, are notified by someone competent.
The physician explains to the patient the arguments for further investigations, their risks and benefits and
the specific procedure.
The physician allows patients sufficient time to talk, express concerns and to ask questions, listens
actively.
The physician takes particular care in dealing with vulnerable patients such as children, severely ill and
dying patients and patients with mental ill-health.
The physician identifies effectively problems to be addressed in a patient encounter, including the
patient’s context, concerns and preferences.
The physician shows basic counseling skills explaining to patients, as appropriate, the possible effects of
lifestyle, including the effects of diet, nutrition, smoking, alcohol and illicit drugs.
The physician communicates in an efficient way with all team members to ensure shared understanding of
patients’ problems and to foster continuity of care.
 convey effective oral and written information about a medical encounter
The physician synthesizes the relevant information and reports on her/his findings and her/his proposals
concerning the management plan in a concise form to her/his supervising physician and other healthcare
professionals.
The physician records accurate, logical, comprehensive and pertinent accounts of history, physical
examination, investigations, management plan and follow up that are structured, timed, dated and
personally attributable with the understanding that they might be read by the patient
The physician structures reports clearly to communicate findings and outcome of illness episodes.
COMPETENCIES AS COLLABORATOR: The physician is able to:

effectively consult with her/his supervisor and other physicians and healthcare
professionals, striving for good teamwork aiming at optimal patient care and at patient
safety
The physician synthesizes the relevant information and reports on her/his findings and her/his proposals
concerning the management plan in a concise form to her/his supervising physician and other healthcare
professionals.
The physician discusses treatment options including relative risks and benefits with the supervising
physician and colleagues.
The physician recognizes personal limits of expertise and decides appropriately if and when other
professionals are needed to contribute to a patient’s care.
The physician communicates in an efficient way with all team members to ensure shared understanding of
patients’ problems and to foster continuity of care.
The physician demonstrates good handover practice and ensures continuity of care when going off duty,
accurately summarizing the main points of patients’ diagnoses, active problems, and management plans.
The physician cross-checks ambiguous instructions and actions with a senior physician.
The physician pays attention to the importance of continuity of care and of patient information transfer
e.g. from inpatient to outpatient setting.
The physician seeks and welcomes appraisal from patients and colleagues on the quality of her/his work
and copes with feedback, even when negative.
 contribute effectively to other interdisciplinary team activities
The physician displays effective team working skills and describes her/his personal role and
responsibilities in the team.
The physician supports nursing staff in designing and implementing monitoring or calling criteria
concerning her/his patients.
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Annex to MD
The physician seeks out opportunities to discuss the evidence base of clinical decision making and
clinical care with colleagues and other professionals.
The physician shows understanding of the need for collective responsibility for health care of individuals
and for health promoting interventions both of which require a multidisciplinary approach and partnership
with the patient and the population served.
COMPETENCIES AS MANAGER: The physician is able to:

utilize personal time and resources effectively in order to balance patient care, learning
needs, and private activities outside the workplace, and to protect her/his own health
The physician employs effective time management, plans and prioritizes her/his work.
The physician delegates or calls for help in time when she/he is falling behind.
The physician recognizes excessive stress or early symptoms of illness and seeks appropriate help to
protect patients, being aware that own performance may be affected by personal stress and illness.
The physician takes care of her/his own health at work by using adequate protection measures and
keeping her/his own immunizations up-to-date.
 use effectively under supervision finite healthcare resources, while acting in the best interest
of the patient
The physician shows awareness of possible conflict between health needs of individual patients and the
health needs of the community.
The physician demonstrates and adequately applies in daily work knowledge of the economical and legal
basis of the healthcare systems in which s/he operates.
The physician assesses effectiveness, appropriateness and efficiency of medical practice and acts
accordingly.
 work effectively and efficiently in a healthcare organization
The physician explains the roles and responsibilities of physicians (including her/his own) and other
professionals in the Mauritian healthcare system.
The physician gives in broad terms an overview of the structure and organization of the Mauritian
healthcare system.
 effectively utilize information technology for patient care, self-learning and other activities
The physician explains the principles of medical data and information management, especially measures
for security of data.
The physician retrieves patient-specific information from the clinical data system at her/his workplace.
The physician searches, collects, organizes and interprets health and biomedical information from
different databases and sources.
The physician describes examples for use of information and communication technology to assist in
diagnostic, therapeutic and preventive measures for the patient, and for surveillance and monitoring
health status (E-Health).
 assure and improve the quality of care and patient safety
The physician shows awareness of the limits of medical care.
The physician demonstrates basic knowledge of detection and appropriate management of medical errors.
The physician recognizes personal limits of expertise and decides appropriately if and when other
professionals are needed to contribute to a patient’s care.
The physician seeks and welcomes appraisal from patients and colleagues on the quality of her/his work
and copes with feedback, even when negative.
The physician gives examples of how the quality of health care is monitored, advanced and assured.
COMPETENCIES AS HEALTH ADVOCATE: The physician is able to:

identify the important determinants of health that affect individual and population health,
so as to have basic abilities to contribute to improving individual and societal health in the
country where s/he works.
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The physician recognizes and assesses the risk factors and the positive, healing resources of a specific
patient and takes action to foster the resources and coping abilities and to minimize the risks.
The physician recognizes and assesses the health and illness behavior of a specific patient and integrates
health promotion on an individual basis as part of the encounter.
The physician demonstrates knowledge of her/his role and ability to take appropriate action in disease,
injury and accident prevention and protecting, maintaining and promoting the health of individuals,
families and community.
The physician appreciates the potential conflict between the roles of health advocate for a patient or the
community with that of gatekeeper.
 recognize issues, settings, circumstances, or situations which require advocacy on behalf of
patients, professions, or society
The physician identifies health needs of a community based on epidemiological data.
The physician describes in broad lines how current public policies affect the health of the populations
served.
The physician strives for equity in the provision of health care.
COMPETENCIES AS SCHOLAR: The physician is able to:
 develop, implement, and document a personal continuing education strategy
The physician regularly assesses personal learning needs and plans her/his education, recognizes errors
and attempts to learn from them.
The physician strives to evaluate the outcome of learning and implements new competencies in her/his
practice.
 apply basic principles of critical appraisal to sources of medical information. This involves
developing scientific curiosity and use of scientific evidence in clinical decision making
The physician demonstrates knowledge of general principles and methods of scientific medical research
and their evolution over time.
The physician demonstrates knowledge of principles of critical appraisal and basic statistics.
The physician demonstrates awareness of the scientific base and conceptual framework of modern
medicine, its perception in society and its historical evolution over time.
The physician demonstrates up-to-date knowledge of the evidence-based standard of medical care for
common ailments and illnesses and of the basic urgent interventions.
The physician, starting from a patient problem, elaborates an appropriate clinical question and efficiently
searches for an answer in the literature, using appropriate sources of information.
The physician actively accesses relevant evidence and demonstrates basic ability to appraise the quality of
evidence from different sources in the literature and proposes appropriate conclusions for patient care to
the supervising physician.
The physician seeks out opportunities to discuss the evidence base of clinical decision making and
clinical care with colleagues and other health professionals.
The physician shows ability to work with local / national guidelines and protocols and demonstrates a
critical approach in doing this.
The physician demonstrates understanding that decisions in medical practice often are complex and based
on uncertainty and probability data.
 facilitate the learning of patients, students and other health professionals
The physician shows basic teaching skills in presentations for students and other health professionals.
The physician assesses and reflects on a teaching encounter and provides constructive feedback.
 contribute to the development, dissemination, and translation of new knowledge and
practices
The physician shows readiness and ability to participate in collaborative research projects.
The physician participates in the dissemination of new knowledge and practices among colleagues and
other collaborators and its translation into daily practice.
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COMPETENCIES AS PROFESSIONAL: The physician is able to:

deliver under supervision high quality care, exhibiting appropriate personal and
interpersonal professional behavior.
The physician maintains and enhances appropriate knowledge, skills and professional behavior.
The physician shows awareness of cultural, societal and spiritual/religious issues that impact on the
delivery of care.
The physician shows awareness that in the course of history the perception in society and by the patients
of the role of the physician is changing.
The physician shows interest in the patient’s experiences relating to illness, care and interactions with the
healthcare system.
The physician demonstrates knowledge and respect of the rights of all patients.
The physician demonstrates understanding of the threats to autonomy and dignity of patients that may
result from the illness setting.
The physician recognizes that the patient’s wishes and preferences are central for medical decision
making.
The physician takes into account the principles and limits of patient confidentiality as defined by
professional practice standards and the law, e.g. only shares clinical information, whether spoken or
written, with the patient’s consent and respects the patient’s right not to know.
The physician demonstrates an appropriate, caring attitude with consistently high standards of
professional behavior, including honesty, integrity, accountability, commitment, compassion, empathy
and altruism.
The physician maintains an appropriate balance between personal and professional roles and shows
awareness of possible conflicts of interest.
The physician strives for equity in the provision of health care.
 practice medicine in an ethically responsible manner that respects the medical, legal and
professional obligations of belonging to a – in many respects - self-regulating body
The physician shows awareness of the ethical dimension of medical practice and clinical decisionmaking.
The physician shows understanding of the function of ethics and appreciates the difference between ethics
and morality as well as between ethics, politics and law.
The physician shows knowledge that there are ethical codes relevant to her/his daily practice and that
there is a professional code of conduct issued by the Medical Council of Mauritius and she/he
demonstrates the ability to find these codes when needed and to apply them to pertinent problems.
The physician demonstrates knowledge of legal regulations and professional codes of conduct relevant for
her/his daily clinical practice and the ability to apply them to pertinent problems.
The physician fulfills the regulatory and legal obligations required for daily clinical practice.
The physician shows awareness of possible conflict between health needs of individual patients and the
health needs of the community.
The physician continuously develops her/his sensitivity to ethical issues arising in the healthcare context
and reflects on her/his own position and its premises especially concerning end of life issues.
The physician shows knowledge that there are different theoretical approaches to medical ethics (such as
contractualist-based, principlist-based, patient rights-based, virtue-based or care ethics-based approaches).
The physician searches for an appropriate solution to an ethical problem considering the perspectives of
others.
The physician copes with misconduct in an appropriate manner.
The physician identifies the ethical principles and values emerging in a given clinical situation or in a
research-project and identifies the conflicts of ethical principles and values.
The physician identifies the ethical principles in decisions regarding discontinuation or withholding of
life-support measures.
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Annex to MD
2-Problems as Starting Points for Training in SCLO
Here, a problem is defined as a symptom, sign or test result of a patient with which the physician may
be confronted.
The physician is able to assess a patient presenting this problem in a well structured way, and to establish
a differential diagnosis. S/he is able to propose appropriate diagnostic, therapeutic, social, preventive and
other measures, and to provide urgent intervention in case of a life-threatening problem.
Problems were selected if they occur frequently even though rare, rapid and appropriate intervention
may be life- saving or non-intervention might be harmfulE. They are a cause of excessive emotional
distress for the patient. Problems which are life-threatening and require urgent intervention are marked
with an upper case E.
General symptoms
Loss of bloodE; overweight / feeling too fat; loss of weight, emaciation; loss of appetite; malnutrition;
fatigue; excessive daytime sleepiness (EDS); general feeling of illness; enlarged lymph nodes
(lymphadenopathy); fever; fever in the immunocompromised host / recurrent fever; hypothermiaE;
hyperthermiaE; abnormal perspiration; flushing; excessive thirst / excessive fluid intake (polydipsia);
dehydratationE ; unexpected, sudden death of unknown etiology and non-natural deathE.
Metabolic alterations and abnormal laboratory values
Hyperglycemia / diabetes mellitus; hypoglycemia; abnormal serum calcium / phosphate; abnormal pH of
blood; abnormal serum lipids; abnormal liver function tests; abnormal serum potassium / magnesium;
abnormal serum sodium; abnormalities of white blood cells; anemia; polycythemia / elevated
hemoglobin; hypoxia, hypoxemia; hypercapnia / hypocapnia; proteinuria; renal failure.
Skin manifestations
Paleness; cyanosis; jaundice (icterus), including neonatal jaundice; acute swelling and/or changing color
of body partsE; skin inflammation; skin eruptions, skin rash; acne; boils; increased bleeding tendency
(hemorrhagic diathesis); itching; skin blisters; insect sting; wounds; burn / cold injuryE; electrical trauma;
skin ulcers; mole (naevus); change of skin pigmentation; skin tumors; excess hair (hirsutism);
lack of hair (alopecia) , excess loss of hair; abnormalities of the nails
Head, face, neck
Headache, recurring / chronic; headache, sudden / newE; facial pain; lack of / diminished facial
movement; lockjaw (trismus); trauma to the headE including cerebral trauma; face injuries; toothache;
neck pain; stiffness of neck; swelling in the neck; goiter.
Ear, nose, mouth, tongue, throat, voice
Ear ache; discharge from ear; loss of hearing, slow / sudden; ringing in the ears (tinnitus); nose bleed
(epistaxis); nasal obstruction; nasal discharge; snoring; abnormalities of lips / tongue / mouth; increased
secretion of saliva; dry mouth / dry throat; fetor oris (halitosis); sore throat; problems with denture;
alteration of voice (hoarseness / aphonia / dysphonia).
Eyes
Slow loss of vision; sudden partial / temporary loss of vision / loss of visual field ; squint (strabismus);
night-blindness; floating objects in the eye; light flashes (photopsia); double vision (diplopia);
photophobia; acute eye painE / burning in the eye; foreign body / sandy feeling in the eye; itching eye; red
eye; tearing eye; eye obscured by pus or mucus; blepharospasm; abnormal eye movements; abnormalities
of pupils; exophthalmos (proptosis); trauma to the eye; swollen eyes / swollen eyelids.
E
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Annex to MD
Breast, chest, heart, blood pressure, pulse
Breast: sense of weight / pain / tension; breast: change in size / outline / symmetry; gynecomastia; breast
lump; breast: retracted skin / nipple; breast: discharging nipple, including galactorrhea; breast: eczema of
nipple / areola; swollen axilla; wheezing respiration; dyspneaE ; apneaE; increased respiratory frequency
painful respiration; cough; hemoptysis; tightness of the chest, chest discomfort; chest painE; chest trauma;
pleural effusion; palpitations; irregular pulse / bradycardia / tachycardiaE; pulseless patientE; high blood
pressure; low blood pressure; vascular injuries.
Abdomen, stomach, bowels
Food intolerance; disorder of food passage, including dysphagia; regurgitation, belching of undigested
food; swallowed foreign body; bloated abdomen / swollen sensation in abdomen; abdominal mass;
abdominal trauma; heartburn (pyrosis); epigastric pain; nausea / vomiting; abdominal painE; flatulence;
diarrhea; constipation; hematemesis / moelenaE; altered color or consistency of feces / blood / mucus /
pus in feces; alteration of defecation pattern; painful defecation; fecal incontinence (encopresis); rectal
blood loss; anal itching / anal pain.
Pelvic symptoms, urogenital problems
Dysuria; disordered micturation; urinary incontinence (enuresis); altered appearance of urine; loin painE;
swelling in groin; scrotal painE; scrotal mass / swelling; urethral discharge; anomaly of male external
genitalia; painful coitus (dyspareunia); erectile / ejaculatory dysfunction; premenstrual syndrome;
disorders of menstruation / of menstrual cycle; dysmenorrheal; pelvic pain; pelvic mass; uterine prolapse /
pelvic relaxation; mid cycle pain; vaginal bleeding: intermenstrual / postmenopausal / during pregnancyE /
post partum; vaginal discharge; abnormal female external genitalia; premature menopause; complaints
related to the menopause, including flushing; request for contraception; request for delaying
menstruation; suspicion of pregnancy; request for genetic counseling; request for abortion; infertile
couple; high risk pregnancy; poor / excessive weight gain in pregnancy; fever during pregnancy;
hypertension during pregnancy; abdominal pain during pregnancy; edema during pregnancy; lack of fetal
movement; loss of amniotic fluid; premature labor.
Bones, joints, back, extremities
Acute pain in limbsE; typical fractures: radius / scaphoid / finger / humerus / clavicle / vertebra / ribs /
femur / pelvis / ankle; laceration, open wound; traumatic amputation of limbE; wound with delayed
healing or infection; contusion, soft tissue bruising; distortion of joint: ankle / hand; dislocation of joint:
shoulder / finger; shoulder trauma; knee injury; trauma to the back including spinal cord trauma;
polytraumaE; swollen or painful joints; deformities of joints; morning stiffness; reduction of strength
and/or joint motility; muscular pain (myalgia) / cramps; back pain; abnormal gait; abnormal posture;
exercise-induced leg pain (claudication); leg edema / generalized edema; leg ulcers; pain / burning /
numbness in the feet.
Newborn, child, adolescent
Irritable / crying infant; hypotonic / floppy infant; diaper rash; problems with breast feeding; failure to
thrive in infancy and childhood; refusal to eat / drink in infancy and childhood; enuresis / encopresis in
infancy and childhood; limp / pain in lower extremity in children; motor / mental retardation /
developmental delay in infancy and childhood; abnormal growth: slowing / acceleration; sudden infant
death; precocious puberty / delayed puberty; hyperactive child.
Elderly persons, aging
Cognitive impairment in elderly person; elderly patient dependent in basic activities of daily living; falls
in elderly person; failure to thrive and malnutrition in elderly person; hearing / vision impairment in
elderly person; immobility, bedridden patient; mobility impairment in elderly person; pain in elderly
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Annex to MD
person; polypharmacy in elderly person; sexual dysfunction in elderly person; sleep disorder in elderly
person; social isolation in elderly person; urinary incontinence in elderly person.
Disorders of consciousness, balance, orientation, gait, movement
Dizziness / vertigo: acuteE / chronic; impairment / loss of consciousness, coma E; falls; twitch, convulsion,
seizure; acute paralysis, including hemiplegiaE; tingling (paresthesia); change in sense of touch in the skin;
abnormal involuntary movements: tremor / dyskinesia / tic disorders
Mental, behavioral and psychological problems
Disorder of speech / of language; acute change in behaviourE / personality; obsessive-compulsive
symptoms; aggressive and violent behavior towards others; autoaggressive behavior / risk of suicide;
self-neglect; loss of initiative and interest; change in emotions and moods; nervousness / tension / anxiety
/ acute stress; agitation; confusion; forgetfulness, disorders of memory; disorder of attention and
concentration; insomnia / sleep-wake cycle disturbances; abuse of alcohol; smoking, use of tobacco;
abuse of medicines; illicit drug abuse and dependence; suspicion of poisoningE.
Other reasons for medical consultation or problems in medical care
Infant and child immunization / periodic health examination for infants and children; request for checkup, health examination / for immunization; counseling / immunizations, before / after trip to foreign
(tropical) country; pre-operative medical evaluation; request for medical certificate; psychological /
physical / sexual abuse; fear of cancer / of heart disease / of HIV / of venereal disease / of other serious
disease; terminal disease, the dying patient.
Psychosocial and interpersonal problems
Loss / death / illness of someone close; problems at work / concerning work conditions; absenteeism,
non-attendance (school / work); financial problems of patient / unemployment; problems in relationship
with parents / partner / child.
3-General Skills in SCLO
Level 2 (routine): The physician is able to explain the skill (principle, indication, contraindication,
burden, possible complications, getting informed consent, documentation). S/he has acquired enough
routine to perform the skill correctly without supervision.
Level 1 (Some practical experience): The physician is able to explain the skill (principle, indication, contraindication, burden, possible complications, getting informed consent, documentation) and has
performed the skill several times under supervision (if necessary with simulator).
History taking
Level 2: Clarifying the patient’s expectations and requests for the encounter; taking detailed, systematic
history of somatic and psychological aspects of symptoms and complaints, the patient’s situation, her/his
understanding and concerns, social and cultural background and illness experience; taking targeted,
hypothesis-directed history; taking history from third party; noting and reacting to nonverbal cues; taking
occupational and workplace history; taking psychoactive substance history.
Level 1: Taking psychiatric history; communicating with and taking history from severely ill or dying
patients; taking history in patients with special communication needs, e.g. language or speech problems;
drawing a family tree (pedigree); taking history in travel-related medical problem; identifying hazardous
behavior and dangerous lifestyle.
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Annex to MD
Information / management
Level 2: Informing patient and family, colleagues and other professionals on findings and checking
understanding; recording findings in patient file; filling-in prescription forms; summarizing the main
points of diagnoses, active problems and management plans of a patient.
Level 1: Elaborating a clinical question and searching for its solution in the literature; handling phone
call from or to patient or third person; breaking bad news to patients and family; giving main information
elements necessary to get informed consent; writing letters for transfer or discharge of patient; counseling
patients related to lifestyle (diet, physical activity, nutrition, smoking, alcohol, illicit drugs); prescribing
measures in treatment of pain, palliative and end-of-life care; filling-in a death certificate; diagnostic
coding; clarifying with nursing staff monitoring and calling criteria concerning patients; retrieving
patient-specific information from clinical data system; working with local / national guidelines and
protocols; giving teaching presentations to students and other health professionals; conservative
management of self-limiting disease („wait and see“);perform house call and assess psycho-social,
economic and hygienic situation, including risk factors for fall; giving advice about contraception and
post-coital interception.
Examination
Level 2: assessment of general condition (habitus and posture, symmetry and mobility of body, nutritional
state, mood and mental status); assessment of vital functions (body temperature, respiration, pulse rate,
blood pressure, venous pressure); recording of anthropometric data (height, weight, body mass index
[BMI], skull circumference, waist and hip circumference); assessment of skin and mucous membranes
(signs of anemia, cyanosis, jaundice, edema, dehydration); examination of peripheral and central arterial
pulses, detection of arterial bruits; examination of lymph node areas; detailed description of skin lesions;
description of nails, scalp and visible mucous membranes; testing for dermographism; description of
eyelids and of eyelashes; description of conjunctivae, including fornix; description of pupil, direct
reaction to light and convergence; fundoscopy, bringing the fundus into focus; assessment of visual acuity
and of visual fields (with Donders confrontation test); inspection and palpation of auricle and adjacent
region (mastoid); inspection of external auditory canal and tympanic membrane with otoscope; hearing
tests with whispering, conversational voice and tuning fork; inspection and palpation of nose and face;
inspection of lips, oral cavity and oral pharynx including teeth, tongue, base of tongue, pharyngeal arches,
tonsils, and inspection of excretory ducts of parotid glands (Stenon’s duct) and submandibular glands
(Warthin‘s duct); assessment of voice and speech including recognition of aphasia; external inspection
and palpation of larynx; inspection, palpation and auscultation of cervical structures, thyroid, carotid
arteries and lymph nodes; inspection of shape and movement of chest and testing for tenderness on
compression and/or percussion; assessment of respiratory chest expansion by inspection, palpation and
measurement of chest circumference; palpation of tactile fremitus; palpation of apex beat (heart);
percussion of lungs including respiratory shifting of diaphragm; auscultation of lungs; auscultation of
heart; inspection and palpation of breasts including regional lymph nodes; inspection of abdomen;
auscultation of abdomen (bowel sounds, bruits); percussion of abdomen (liver, Traube’s area, bladder
dullness); palpation of abdomen (abdominal wall, colon, liver, spleen, aorta, abdominal masses); eliciting
abdominal tenderness, rebound tenderness and guarding; eliciting shifting abdominal dullness; eliciting
renal tenderness; examination of spine, spine mobility and paravertebral muscles standing and supine
(kyphosis, scoliosis, lateral tilt, Schober procedure, position-dependent pain); eliciting tendon reflexes
(triceps, biceps, knee, ankle) and plantar response; assessment of passive muscle stretch, inspection of
muscle bulk, muscle tone, muscle strength and involuntary movements; inspection of gait (normal, on
heels, hopping in one place); testing of coordination (finger-to-nose, heel-to-shin, heel-to-toe, diadochokinesis); assessment of sense of light touch and sense of pain; testing for meningeal irritation; assessment
of orientation in space and time;
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Level 1: assessment of patients with medical emergencies and after trauma; assessment of basic and
instrumental activities of daily living; assessing indication and contraindications for surgical intervention;
assessment of attention, thought (form and content), perception, affect and psychomotor behavior;
evaluating decision-making capacity in cognitively impaired person; (forensic) examination of persons
under the influence of alcohol and/or drugs; clinical diagnosis of death; estimation of time of death
(livores, rigor mortis, rectal temperature); skin inspection with magnifying glass; description of upper
eyelid after eversion; description of width of palpebral fissure; description of sclerae and corneae,
including with fluorescein; determination of sensation to touch of cornea; description of iris; recognition
and description of nystagmus; description of position and movement of eyes (corneal reflex images, cover
test); description of lens, anterior chamber, media of the eyes (transillumination); description of optic disc
and retinal vessels (discrimination normal-abnormal); estimation of intra-ocular pressure by palpation;
assessment of color vision with Ishihara tables; test of tubal function (motility of ear drum); assessment of
nasal obstruction and anterior rhinoscopy; palpation of floor of the mouth, cheeks, tonsils and base of
tongue; inspection and (bimanual) palpation of parotid and submandibular glands; palpation of head and
cervical spine, testing for mobility, tenderness and neck stiffness; examination of bones, joints and
muscles of shoulder girdle; eliciting abdominal fluid thrill; testing for inguinal hernia by inspection and
palpation (also during increased abdominal pressure) of groin / hernial orifices; external inspection and
palpation of (peri)anal area; rectal examination in male (anus, rectum, prostate gland, sacrum) and
subsequent inspection of glove; inspection and palpation of penis and scrotum (testes, epidydimis, spermatic cord) including transillumination of scrotum; inspection and palpation of female external genitalia
(vulva, perineum); palpation, percussion and axial compression of spine for tenderness and pain;
examination of iliosacral joints and pelvis including muscles (mobility, pain, atrophies); assessing shape,
function, motility and tenderness of upper extremities (elbow, wrist, finger joints and relevant structures
and muscles); assessing shape, motility, stability and tenderness of lower extremities and relevant
structures and muscles (ankle and knee, meniscus signs, position of patella, patella function and relief);
assessing axes of legs on standing (genu valgum, genu varum); assessing feet on standing (pes planus, pes
valgus); assessment of capillary pulse and refill; testing for arterial insufficiency (Ratschow-Test);
assessing varicose veins with Trendelenburg test and Perthes test; assessment of function of cranial
nerves; eliciting complex reflexes: abdominal, anal, masseter, snout, grasp; Romberg‘s test, Unterberger‘s
test; recovering of balance after push; assessment of sense of temperature, sense of vibration and position
sense; assessment of discriminative sensations (e.g.stereognosis); testing for cervical and lumbar radicular
signs; assessment of level of consciousness by means of Glasgow coma scale; assessment of memory,
Mini Mental Status, Clock test; speculum examination: inspection of vagina and cervix (with simulator);
bimanual examination: palpation of vagina, cervix, uterine corpus, ovaries (with simulator); rectal
examination in female: anus, rectum, palpation of pouch of Douglas and uterus (with simulator);
inspection of abdomen of pregnant woman; recording Apgar score.
Procedures
Level 2: basic life support for adults: assessment, breathing, circulation, defibrillation (Automatic
External Defibrillation) until arrival of professional emergency medical personnel (simulator); using
appropriate hand hygiene at workplace; venipuncture; finger prick; performing and reading of urine stick
test; measurement of expiratory peak flow; removal of wound sutures; taking a throat swab; instillation of
eye drops; application of eye ointment; preparation to watch / to assist in operating theatre (scrub-up,
gown up, put on sterile gloves, etc.); attendance in theatre at various operations; intravenous injection and
cannulation; subcutaneous and intramuscular injection; patient instruction for mid-stream urine sample
collection; taking an electrocardiogram at rest; using and giving instructions to use metered dose inhalers,
spacers and nebulizers; application of bandage; flooding and rinsing ocular tissue; ear irrigation; wound
cleaning.
Level 1: advanced cardiac life support (basic cardiac rhythm algorithms, with simulator); assessment and
initial care of external injuries (wounds, bleeding, burns, sprains, dislocations, fractures); assessment of
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trauma patients according to the ABCDE (advanced trauma life support - ATLS); transport of casualty;
stopping hemorrhage (direct pressure, pressure point, pressure bandage, tourniquet); pre-operative
preparation of operative field for minor surgery, asepsis and antisepsis; infiltration anesthesia; preparation
and examination of urinary sediment; spirometry; application of eye dressing; stitching of skin incisions
and lacerations; application of a sling; clamping of umbilical cord / separation of placenta from child;
assessment of fetal heart rate during pregnancy.
4-Clinical Pictures (and Further Knowledge) in SCLO
Clinical Pictures: Definition of levels
Level 2 (Be able to cope with in practice): The physician is able to take a history and perform a physical
examination in a structured way. She/he is able to consider the clinical picture as a diagnosis and
recognizes and actively searches for the typical complaints and signs. She/he proposes appropriate
diagnostic and therapeutic possibilities to her/his supervising physician considering its epidemiology and
relevant pathology (including histology, pathophysiology and psychodynamics). She/he explains the
diagnostic and therapeutic possibilities to the patient in an appropriate way.
Level 1 (Be able to recognize the possible relevance): If appropriate, the physician considers this clinical
picture as a possible diagnosis. S/he can define this clinical picture in broad terms without knowing
details
Further Knowledge: Definition of levels
Level 2 (Be able to cope with in practice): The physician is capable to use this knowledge in interpreting
findings, counseling on preventive measures and treating the patient.
Level 1 (This indicates an overview level): The physician is capable to roughly define the concept or
describe the procedure including indication and contraindication.
S/he is able to recognize its possible relevance in a given clinical situation.
S/he has seen the correct performance of the procedure (live, by simulator, video or other media).
List of CLINICAL PICTURES IN DISCIPLINE RELATED OBJECTIVES
INTERNAL MEDICINE: CLINICAL PICTURES
Auto-immune, rheumatological and skeletal disorders:
Level 2:Arthritis, monoarticular; arthritis, rheumatoid; arthritis, septicE; arthritis, viral; arthritis, psoriatic;
arthritis reactive, Reiter‘s disease (arthritis, urethritis and conjunctivitis); bone metastases; carpal tunnel
syndrome; Dupuytren‘s contracture; erythema nodosum; fibromyalgia; frozen shoulder, periarthropathia
humeroscapularis; gout; pseudogout; Marfan syndrome; osteomalacia; osteomyelitis, acute / chronic;
osteoporosis; polymyalgia rheumatic; temporal arteritis, giant cell arteritis; osteoarthrosis deformans;
aseptic necrosis of bone, including Osgood-Schlatter / Perthes; epicondylitis lateral / medial; prepatellar /
olecranon bursitis; chondromalacia patellae; genu varum / genu valgum; Achilles tendinitis; pes planus;
reflex sympathetic dystrophy (Sudeck), complex regional pain syndrome; rheumatic fever; intervertebral
disc, hernia ofE; low back pain, common; spinal deformation (kyphosis, scoliosis, lordosis, including
juvenile kyphosis = Scheuermann‘s disease); ankylosing spondylitis; septic spondylitis, spondylodiscitisE;
spinal canal stenosis (cervical, lumbar); spondylarthrosis, spondylosis; spondylolisthesis; lupus
erythematosus systemic.
Level 1: achondroplasia; antiphospholipid antibody syndrome; arthritis, juvenile chronic; Behcet‘s
disease; erythema multiforme and Stevens-Johnson syndrome; Morton neuralgia; osteogenesis imperfect;
Paget‘s disease of bone, osteitis deformans; polymyositis / dermatomyositis; myositis, infectious;
epiphyseal instability / epiphysiolysis; periarthropathia coxae; congenital foot deformity; spondylolysis;
Sjögren‘s disease (sicca syndrome with arthritis, LE, scleroderma); systemic sclerosis, progressive
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(scleroderma); polyarteritis nodosa / Churg-Strauss syndrome / Takayasu‘s disease; Wegener‘s
granulomatosis.
Hematological disorders
Level 2: AgranulocytosisE; anemia from iron deficiency; anemia associated with chronic diseases; anemia
hemolytic; anemia, macrocytic; hemophilia A+B; lymphomas (Hodgkin‘s / non-Hodgkin); leukemia,
acute; leukemia, chronic lymphocytic; leukemia, chronic myeloid; myeloma; polycythemia;
thrombocytopenia.
Level 1: Anemia, aplastic / hypoplastic; coagulation, disseminated intravascular; hemoglobinopathies;
thrombocytosis; Von Willebrand‘s disease; Waldenström‘s macroglobulinemia.
Immunological / allergic reactions
Level 2: Anaphylactic reactionE.
Endocrinological and metabolic disorders
Level 2: Adreno-cortical failure in adultsE; Cushing‘s syndrome, hypercortisolism; diabetes mellitus type
1; diabetes mellitus type 2; diabetes mellitus, acute complications ofE; diabetes mellitus, chronic
complications of; hypoglycemiaE; hyperaldosteronism, primary including Conn‘s syndrome;
pheochromocytoma; hyperthyroidism in adults; hypothyroidism in adults; thyroiditis; goiter, nodular /
diffuse, including solitary nodules and thyroid carcinoma; dyslipoproteinemia / hyperlipoproteinemia;
obesity.
Level 1: acromegaly; diabetes insipidus; hyperparathyroidism; hypoparathyroidism; hypogonadism;
pituitary failure; pituitary tumors; multiple endocrine neoplasia syndromes (MEN-syndromes); tumor
with ectopic production of hormones; porphyrias.
Neurological disorders
Level 2: Seizures, absence / complex partial (non-convulsive seizure manifestations); seizures,
generalized; status epilepticusE; seizures, focal epileptic; AIDS, neurological complications; alcohol
intoxicationE; paroxysmal benign positional vertigo (cupulo- and canalolithiasis); spinal cord, acute
transverse lesion of (including Brown-Séquard)E; cauda equina syndrome; cerebral palsy; peripheral palsy
/ paralysis of facial nerve (idiopathic, borreliosis, viral, traumatic, neoplastic); borreliosis, Lyme disease;
extradural hemorrhage; subdural hemorrhage; subarachnoid hemorrhageE; intracerebral hemorrhage;
transient ischemic attack (TIA)E; cerebral infarction including extracranial obstruction; cerebral venous
thrombosis (e.g.thrombosis of the sinus sagitalis superior)E; raised intracranial pressure; Guillain-Barré
syndrome and related disordersE; hydrocephalus with normal pressure; Menière’s disease; metastases in
brain; spinal tumors including metastases; meningitis / encephalitis in adultsE; migraine and related
disorders (cluster headache, migraine aura without headache); dementia in Alzheimer’s disease; dementia,
vascular (including multi-infarct dementia, subcortical dementia); multiple sclerosis; myasthenia gravis
and related disorders; spina bifida / neural tube defects (including myelomeningocele); polyneuropathy;
peroneal palsy; radicular syndromes, cervical / lumbar; Parkinsonian syndromes; Parkinson’s disease;
intoxication by psychotropic and illicit drugs (including heroin, cocaine, amphetamine)E; consciousness,
disturbances of (Glasgow-Coma Scale)E; syphilis; tension headache; head trauma (minor traumatic brain
injury [mTBI] / concussion / contusion / epidural hematoma / subdural hematoma)E; trigeminal neuralgia;
vestibular function, sudden loss of (vestibular neuritis)E; Wernicke-Korsakoff‘s encephalopathy, organic
amnesic syndromeE; organic confusional stateE.
Level 1: amyotrophic lateral sclerosis; acute cerebellar syndromes (gait ataxia, limb ataxia, nystagmus,
abnormal Romberg); autonomic nervous system, disorders of (including secondary, side effect of drugs);
brain death; transverse myelitis and related (non traumatic) myelopathies; bulbar palsy; cranial nerves
disorders; prion diseases, Creutzfeldt-Jakob’s disease; degenerative nervous system disease, subacute
combined (dementia and other neurological signs); encephalopathies (metabolic, endocrine, autoimmune,
mitochondrial); prefrontal neuropsychiatric syndromes; herpes simplex-encephalitis; Horner‘s syndrome;
Huntington‘s disease; lead poisoning; mental retardation; glioma; meningioma; brain abscess; dementia
of frontal type; Lewy body dementia; dementia in neurological diseases; muscular dystrophy; narcolepsy;
neurofibromatosis (Recklinghausen‘s disease); neurogenic bladder; neuropathies, peripheral; brachial
plexus, neuropathy of; brachial plexus and peripheral nerves, injury of; radial nerve palsy; ulnar nerve
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palsy; myopathies, chronic / subacute; restless legs; tremor, essential and symptomatic; vascular
encephalopathy; vestibular function, sudden loss of (vestibular neuritis); brain stem infarction
(Wallenberg‘s syndrome); whiplash injury; somnambulism, night terrors and nightmares (parasomnia).
Vascular diseases
Level 2: aneurysm of thoracic / of abdominal aorta (including dissection and rupture)E; aortic
regurgitation; aortic stenosis; mitral regurgitation; mitral stenosis; tricuspid regurgitation; arterial
embolism; deep vein thrombosis; thrombophlebitis; thrombosis, arterialE; atherosclerosis (disseminated);
angina pectorisE; angina pectoris, unstableE; myocardial infarctionE; claudication; cardiac arrhythmias;
sinus tachycardia; supraventricular premature beat; supraventricular tachycardia in adults; atrial
fibrillationE; atrial flutter; atrio-ventricular heart block, completeE; ventricular tachycardiaE; ventricular
fibrillationE; ventricular premature beat; bundle branch block; cardiogenic shockE; cardio-respiratory
arrestE; endocarditis, bacterialE; heart failure, left / right ventricular failureE; hypertension in adults;
hypertension, secondary; pericarditis; Raynaud‘s disease / Raynaud‘s phenomenon; shockE.
Level 1: ventricles, aneurysm of; atrial septal defect; ventricular septal defect; cardiomyopathy;
coarctation of the aorta; myocarditis; pulmonary hypertension, cor pulmonale.
Respiratory disorders
Level 2: Sarcoidosis; bronchial asthma, acute / chronicE; atelectasis; chronic obstructive pulmonary
disease (COPD), bronchitis chronic; bronchitis, acute; empyema (pleura); hyperventilation syndromeE;
lung carcinoma; metastases in lung; lung emphysema; lung infarction; pleurisy; pneumonia, community
acquired, in adults; pneumothorax, including tension pneumothoraxE; pulmonary embolism; respiratory
failure, hypoventilationE; sleep apnea syndrome obstructive / central; tracheitis, acute / chronic.
Level 1: adult respiratory distress syndrome (ARDS); bronchiectasis; lung abscess; lung disease,
interstitial; lung fibrosis; mediastinitis; mesothelioma; pulmonary disease, allergic.
Gastrointestinal disorders
Level 2: Stomatitis, recurrent aphthous; candidiasis, mouth / throat (thrush); stomatitis, herpetic; reflux
oesophagitis including Barrett‘s oesophagus; tumors of oesophagus, malignant; oesophageal varices;
hernia of diaphragm (including hiatal hernia) in adults; gastritis; peptic ulcer, including helicobacter
infection; bleeding, gastricE; tumors, gastric; perforation of stomachE; duodenal ulcer, including
perforation; coeliac disease; colitis / enterocolitis / gastroenteritis infectiousE; colon, carcinoma of; colon,
polyps; inflammatory bowel disease (including ulcerative colitis, Crohn’s disease); diverticulosis /
diverticulitis; abdominal pain, chronic / irritable bowel syndrome; ileus (mechanical / paralytic / proximal
/ distal)E; malabsorption; polyposis of colon, familial; proctitis; pseudomembraneous colitis; rectal
prolapse / anal prolapseE; anal fissures; haemorrhoids; typhoid fever.
Level 1: Achalasia; oesophagus, spasm of; Mallory-Weiss syndrome (oesophagus, mucosal tear); pyloric
stenosis, acquired; carcinoid tumors; ischemic colitis; angiodysplasia of colon; megacolon, toxic;
Zollinger-Ellison syndrome.
Disorders of liver, gall bladder and pancreas
Level 2: Hepatitis, viral; hepatitis, alcoholic; hepatitis chronic; cirrhosis of the liver; echinococcosis; liver
tumor, secondary (metastases); portal hypertension / ascites; liver failure; cholecystitis, acuteE;
chole(docho)lithiasis including biliary colic; pancreatitis, acuteE; pancreatitis, chronic (including
pseudocysts); pancreatic carcinoma.
Level 1: liver abscess; liver tumor, primary; Budd-Chiari syndrome (occlusion of hepatic vein);
carcinoma of gallbladder / of bile ducts; endocrine pancreatic tumors; cystic fibrosis in adults.
Renal disorders
Level 2: carcinoma of bladder; urinary tract infection (cystitis / urethritis / pyelonephritis) in adults;
glomerulonephritis, acute; glomerulonephritis, chronic; nephrotic syndrome in adults; urolithiasis / renal
colic in adultsE; renal failure, acute in adultsE; renal failure, chronic in adults.
Level 1: Goodpasture‘s syndrome; nephritis, interstitial; polycystic kidney disease.
Geriatrics
Level 2: hypertension in old age; decubital ulcer; osteoporosis; fractures of hipE; spine, fractures /
dislocations ofE; degeneration of macula (eye), age dependent; presbyacusis; sexual dysfunction;
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dementia in Alzheimer‘s disease; dementia, vascular (including multi-infarct dementia, subcortical
dementia); depressive episode in adultsE; recurrent depressive disorder in adultsE; depression in adults
with somatic symptomsE; deliriumE; Parkinsonian syndromes.
Level 1: Lewy body dementia; dementia of frontal type.
Infectious diseases (not mentioned elsewhere)
Level 2: AIDS in adults; cytomegaly; diarrheal diseases, acute infectious (including traveler‘s diarrhea);
erysipelasE; parasitic bowel infestations (giardia, toxocaria, entamoeba, helminths); herpes simplex;
varicella / herpes zoster; mononucleosis, infectious; influenza; lymphangitis, acute / lymphadenitis, acute;
malariaE; tetanusE; toxoplasmosis; tuberculosis; nosocomial infections; infections in the
immunocompromised hostE; sepsisE.
Level 1: Amoebiasis; cat scratch disease; cholera; rickettsioses; schistosomiasis; leptospirosis, Weil‘s
disease; staphylococcal / streptococcal toxic shock syndrome; clostridium difficile infection; Whipple‘s
disease; brucellosis; dengue fever; filariasis; botulism; poliomyelitis; rabies.
Poisonings
Level 2: carbon monoxide poisoningE; paracetamol overdose / intoxicationE.
Vitamin deficiency
Level 2: Vitamin deficiencies
INTERNAL MEDICINE: FURTHER KNOWLEDGE
Geriatrics
Level 2: prescribing in the elderly (pharmacokinetic and dynamic variables and principles of adaptation of
dosing); elderly, abuse and neglect of; old age, nonspecific or atypical presentation of disease.
Level 1: demography and epidemiology of ageing (on global, national, and regional level); long-term
institutional and home care, principles of; multimorbidity in old age, concept and consequences of;
rehabilitation in the disabled elderly (role of).
Infectious diseases
Level 1: antibiotic resistance; list of reportable infectious diseases
End of life issues
Level 1: direct euthanasia / indirect euthanasia / assisted suicide; palliative sedation; advance directives.
Information / management
Level 1: management of polymorbid and chronic patient; assessment of work capacity; prescription of
physical therapy; prescription of occupational therapy; assessment of aptitude to drive including minimal
medical standards for drivers; assessment of aptitude to dive; logistics of laboratory work-up in outpatient
practice, preanalytics.
Examination
Level 1: International Classification of Functioning, Disability and Health (ICF); establishing the cause
and manner of death at the place of death.
Procedures
Level 1: Rapid streptoccocal test; assisted ventilation, continuous positive airway pressure (CPAP),
intermittent positive pressure ventilation ((IPPV), pressure controlled ventilation (PCV); Heimlich
maneuver; periarticular injection; intraarticular injection; insertion of bladder catheter in male and female
(transurethral and suprapubic); inserting a nasogastric tube; application of enema; preparation and
examination of blood film; preparation and assessment of Gram stain; bone marrow aspiration; joint fluid
aspiration; synovial biopsy and analysis (cell count, crystals, gram); biopsy of muscle, kidney, liver;
gastroduodenoscopy, colonoscopy, bronchoscopy; fine needle aspiration for cytology; arterial puncture;
puncture of pleural and peritoneal space, aspiration of fluid; lumbar puncture; haemodialysis / peritoneal
dialysis / renal transplantation; electroencephalogram (EEG); electromyogram (EMG); exercise
electrocardiogram; 24-hour electrocardiogram (Holter ECG); assessing peripheral arterial circulation by
Doppler occlusion pressure.
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PHARMACOTHERAPY: FURTHER KNOWLEDGE
Inter-individual variability and individualized treatment
Level 2: pharmacokinetic parameters in the adult, loading and maintenance doses under normal
conditions; prescribing during pregnancy and breast feeding (safe drugs for common conditions, risks of
drugs); principles of prescribing in childhood based on body weight and body surface area; prescribing in
the elderly (pharmacokinetic and dynamic variables and principles of adaptation of dosing); drug-drug
interactions (basic pharmacokinetic and pharmacodynamic mechanisms, common drug interactions, use
of reference CYP P450 tables); prescribing in renal disease (pharmacokinetic changes, drug dosing, adaptations depending on the creatinine clearance).
Level 1: pharmacological concept: potency of drugs; efficacy; therapeutic index; drug administration
routes and pharmaceutical forms; therapeutic drug monitoring (indications, modalities, principles of
dosing adaptations, timing and blood sampling, detection of incorrect laboratory results); prescribing in
infancy; influence on drug metabolism of gender, diet, tobacco and alcohol, naturally occurring and
polluting substances (including enzyme induction and inhibition); ways of influences of genomics on
pharmacokinetics and pharmacodynamics and its association with interindividual variability in efficacy
and toxicity; prescribing in liver disease (pharmacokinetic and pharmacodynamic changes, drugs best
avoided, hepatotoxic drugs, estimation of initial and maintenance doses according to hepatic drug
clearance); prescribing in heart failure (pharmacokinetic and pharmacodynamic changes, optimal route of
drug administration, drugs best avoided in cardiac disease, cardiotoxic drugs, adaptation of initial and
maintenance doses in heart failure).
Drug safety, prevention and identification of adverse events
Level 2: adverse drug events (frequency, classification, detection and prevention, risk factors, drug
allergy, drug toxicity, importance of toxic drug metabolites, information to patients); main antidotes in
drug poisoning; common acute intoxications (sedatives, antidepressants, opiates, opioids, paracetamol,
aspirin); prescribing, legal principles.
Level 1: definition of pharmacovigilance (causality assessment, reporting); supportive measures in drug
poisoning and measures to enhance drug clearance; drug approval, roles of regulatory authorities
Principles of therapeutics
Level 2: Placebo effect (mechanism, importance in clinical research, ethical implications); sources of
information on drug treatment;
Level 1: Principles for choice of a drug in a class; criteria for status as over-the-counter drug; selfmedication (frequency, symptoms and diseases suitable for, advice to patients); development of new
drugs (preclinical development; phases of clinical trials); pharmaco-economics: Defined Daily Dose
(DDD), pricing and cost effectiveness of drugs; pharmaceutical market (industrial, economic, legal and
political factors); drug efficacy, efficiency and effectiveness, definition of therapeutic progress (based on
drug usefulness vs. existing drugs); drug-marketing (innovative molecule, me-too molecule, new
indication for established drug, new formulation, new treatment methods, biased information).
SURGERY: CLINICAL PICTURES
Inflammation and infection
Level 2: bites by animal; fasciitis; gangrene; gas gangreneE; nosocomial infections; tetanusE.
Skin and soft tissues
Level 2: malignant melanoma; burnsE; furuncle / carbuncle; trauma to soft tissue; compartment
syndromeE; ulcers, arterial / venous; decubital ulcer; diabetes mellitus, skin lesions including foot ulcer;
hematoma of skin and soft tissue; keloid.
Level 1: crush syndrome of skin and soft tissues; radiation ulcer; pilonidal sinus, abscess of (dermoid
cyst); sarcoma of soft tissue including rhabdomyosarcoma; tendon sheath, inflammation of.
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Brain and peripheral nerves (neurosurgery)
Level 2: head trauma (minor traumatic brain injury [mTBI] / concussion / contusion / epidural hematoma
/ subdural hematoma)E; intracerebral hemorrhageE; subarachnoid hemorrhageE; intracranial pressure,
elevated (acute / chronic)E.
Level 1: arteriovenous malformation in brain / hemangioma, cerebral; brain and peripheral nerves,
neurosurgically relevant infection; brain tumors, benign / malignant; hydrocephalus in newborn and
cerebral malformations.
Skull, face, mouth, jaw
Level 2: Candidiasis, mouth / throat (thrush); glossitis; leukoplakia / leukokeratosis (diseases of
transitional epithelia); odontogenic abscess; dental caries; injuries to teethE; face and jaw emergencies:
vital risks, obstruction of upper airways, haemorrhagesE; consciousness, disturbances of (Glasgow-Coma
Scale)E; peripheral palsy / paralysis of facial nerve (idiopathic, borreliosis, viral, traumatic, neoplastic);
trismus, restrictions in opening of mouthE; luxation of jaw; fracture of jaw; fracture of the nasal pyramid.
Level 1: Arteriovenous malformation in brain / hemangioma, cerebral; brain and peripheral nerves,
neurosurgically relevant infection; brain tumors, benign / malignant; hydrocephalus in newborn and
cerebral malformations; gingivitis / periodontitis; lip frenulum, short; micrognathia / macrognathia;
odontogenic maxillary sinusitis; pharynx and oral cavity, tumors of; sialolithiasis of salivary glands; cleft
lip, jaw, palate; face injury; fractures of the facial craniumE; fracture of skull / of skullbase; fracture of
temporal bone (longitudinal / transverse)E; post-concussional syndrome.
Spine
Level 2: dislocations of spine, fracturesE; hernia of intervertebral discE; spinal deformation (kyphosis,
scoliosis, lordosis, including juvenile kyphosis = Scheuermann‘s disease); spondylarthrosis, spondylosis;
spondylitis, spondylodiscitisE; spondylolisthesis; spina bifida / neural tube defects (including
myelomeningocele); spinal canal stenosis (cervical, lumbar); spinal cord, acute transverse lesion of
(including Brown-Séquard)E; spinal tumors including metastases.
Level 1: whiplash injury; spondylolysis.
Localized disturbances of muscle and bone
Level 2: bone metastases; pathological fracture; ganglion of wrist; aseptic necrosis of bone, including
Osgood-Schlatter / Perthes; osteomyelitis, acute / chronic.
Level 1: lesion of articular cartilage; primary bone tumors; epiphyseal instability / epiphysiolysis; lesion
of joint capsule.
Wound- and fracture healing
Level 2: injuries from polytraumaE; pseudoarthrosis; reflex sympathetic dystrophy (Sudeck), complex
regional pain syndrome; wound abscess.
Breast
Level 2: mastitis; gynaecomastia; breast, cysts / benign breast tumors; mastopathia, cystic, chronic;
malignant disorders of breast.
Chest
Level 2: thorax contusionE; hematothorax; pneumothorax, including tension pneumothoraxE.
Level 1: chest malformation / funnel chest / chicken breast; sternum fractures.
Trachea, bronchi
Level 2: aspirationE; foreign body aspiration (larynx, trachea and bronchi)E.
Lung
Level 2: lung carcinoma; metastases in lung.
Level 1: lung contusion; respiratory distress syndrome; mediastinal tumors.
Diaphragm
Level 2: hernia of diaphragm (including hiatal hernia) in adults
Level 1: rupture of diaphragm
Heart
Level 2: mitral regurgitation; mitral stenosis; tricuspid regurgitation; aortic regurgitation; aortic stenosis.
Level 1: cardiac tamponadeE; contusion of heart.
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Arteries
Level 2: cerebral infarction including extracranial obstructionE; pulmonary embolism; arterial embolism;
aneurysm of thoracic / of abdominal aorta (including rupture, dissection)E; occlusion / stenosis of artery in
aorto-iliacal region; renal artery stenosis and consequences; occlusion / stenosis of arteries of lower
extremities; Raynaud’s disease / Raynaud’s phenomenon.
Level 1: Buerger’s disease (thrombangitis obliterans); subclavian steal syndrome; thoracic outlet
syndrome; open / closed traumatic vascular lesions.
Veins
Level 2: caval vein syndromesE; deep vein thrombosis; varicosis / venous insufficiency / leg ulcers / stasis
ulcer.
Lymphatic vessels
Level 2: chronic lymphadenitis; acute lymphangitis/ acute lymphadenitis; primary / secondary
lymphedema.
Oesophagus
Level 2: oesophageal varices; oesophagus, corrosive lesion (acid, base, stenosis)E; malignant
tumors of oesophagus.
Level 1: achalasia; diverticulum of oesophagus (including Zenker‘s diverticulum); oesophageal rupture;
injuries and perforations of oesophagus; strictures of oesophagus; Mallory-Weiss syndrome (esophagus,
mucosal tear).
Stomach and duodenum
Level 2: peptic ulcer, including helicobacter infection; perforation of stomachE; duodenal ulcer, including
perforation; foreign body in stomach / in duodenum; complications of gastrectomy (postgastrectomy
syndrome); gastric dilatationE; gastrointestinal haemorrhageE; hypertrophy or stenosis of pylorus; gastric
tumors.
Level 1: Zollinger-Ellison syndrome.
Jejunum, ileum
Level 2: Meckel‘s diverticulum
Level 1: carcinoid tumors; jejunum and ileum, benign tumors / malignant tumors; volvulus of small
intestine, congenital malrotation.
Colon
Level 2: abdominal trauma (including perforation and organ lesion)E; carcinoma of colon; diverticulosis /
diverticulitis; colon, polyps; polyposis of colon, familial; pseudomembranous colitis; inflammatory bowel
disease (including ulcerative colitis, Crohn‘s disease).
Level 1: enterocolitis, necrotizing in adults; Hirschsprung`s disease (megacolon, congenital).
Rectum and anus
Level 2: anal (or perianal) abscess; anal fissures; condylomata acuminata anal / perianal / penis / vulva /
vagina / cervix; fistula of rectum / of anus; haemorrhoids; proctitis; rectal prolapse / anal prolapseE; rectal
cancer.
Liver
Level 2: cirrhosis of the liver; echinococcosis; liver injuryE; secondary liver tumor (metastases); portal
hypertension / ascites
Level 1: liver abscess; primary liver tumor.
Gallbladder / gall ducts
Level 2: acute cholecystitisE; chole(docho)lithiasis including biliary colic; strictures of bile ducts.
Level 1: bile ducts, injury to (including strictures, bilioma); bile fistula (internal / external); carcinoma of
gallbladder / of bile ducts; gallbladder hydrops / gallbladder empyema / gallbladder perforation; ileus
from gallstone.
Pancreas
Level 2: pancreatic carcinoma; acute pancreatitisE; chronic pancreatitis (including pseudocysts)
Spleen
Level 2: spleen, rupture / subcapsular hemorrhageE; splenomegaly and “hematologic“ spleen.
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Annex to MD
Abdominal wall and hernias
Level 2: hernia of linea alba (including epigastric hernia, diastasis rectus abdominis); femoral hernia;
incarcerated herniasE; incisional hernia; inguinal hernia in adults; umbilical hernia.
Acute abdomen
Level 2: acute abdomenE; acute appendicitisE; ileus (mechanical / paralytic / proximal / distal)E;
perforation of intestineE; peritonitisE; pelvic Inflammatory disease (PID: adnexitis / salpingitis / tuboovarian abscess).
Level 1: Douglas’abscess; intussusception of bowel, invagination; mesenteric infarction; subphrenic
abscess.
Kidneys, urinary tract and prostate
Level 2: carcinoma of the prostate; urinary tract infection (cystitis / urethritis / pyelonephritis) in adults;
prostatic hyperplasia; prostatitis; urinary retentionE; urolithiasis / renal colic in adultsE; vesico-ureteric
reflux; Wilms tumor, nephroblastoma.
Level 1: congenital malformations of kidneys / of ureter / of urethra; (traumatic) lesions of kidney and
distal urinary tract; renal cell carcinoma; urothelial tumors.
Male genitals
Level 2: cryptorchidism, undescended testicle; epididymitis / orchitis; epispadia / hypospadia; erectile
dysfunction; phimosis / paraphimosisE; spermatocele / hydrocele / varicocele; lesion of testicle and scrotal
content (including torsion of testicle)E.
Level 1: infertility / subfertility (female and male); pelvic trauma, urethral injury; testicular cancer.
Thyroid and parathyroids
Level 2: goiter, nodular / diffuse, including solitary nodules and thyroid carcinoma; hyperthyroidism in
adults;
Level 1: hyperparathyroidism; hypoparathyroidism; multiple endocrine neoplasia syndromes (MENsyndromes).
Endocrinology
Level 2: Cushing‘s syndrome, hypercortisolism; hyperaldosteronism, primary including Conn‘s
syndrome; pheochromocytoma.
Level 1: endocrine pancreatic tumors; pituitary tumors.
Neck, shoulder girdle and upper extremities
Level 2: Torticolis; carpal tunnel syndrome; Dupuytren’s contracture; finger disorder: mallet finger; loss
of finger nail; lesion of finger tendons (including button hole deformity); fracture of clavicle; fracture of
shoulder / of humerus; fractures of fingers and thumb and lesions of capsule, tendons and ligaments;
fractures of radius / of ulna; fractures of wrist and lesions of capsule, tendons and ligaments; frozen
shoulder, periarthropathia humeroscapularis; epicondylitis lateral / medial; luxation of shoulder;
panaritium, paronychia; subungual hematoma.
Level 1: midline / lateral branchial cysts / fistulas; fractures of elbow and lesions of capsule, tendons and
ligaments; phlegmon of flexor tendon of hand; lesions of shoulder ligament (including rotator cuff).
Pelvis and lower extremities
Level 2: congenital dysplasia of hip / congenital dislocation of hip; fractures of hipE; fractures of femurE;
fractures of knee and lesions of capsule, tendons and ligamentsE; lesions of meniscus medial / lateral;
fractures of tibiaE; fractures of fibulaE; fractures of ankle and lesions of capsule, tendons and ligamentsE;
fractures of toes; osteoarthritis of hip; dislocation of patellaE; genu varum / genu valgum; gonarthritis;
prepatellar / olecranon bursitis; patellary cartilage, abnormal; instability of ankle; hallux valgus; hammer
toe; rupture of Achilles tendon; Achilles tendinitis; ingrown toenail; pes planus.
Level 1: congenital foot deformity; necrosis of femoral head; fractures of pelvis; marching fracture (foot);
osteochondritis dissecans; tarsal tunnel syndrome.
SURGERY: FURTHER KNOWLEDGE
Surgical instruments / wounds
Level 2: wound characteristics; wound dressing, types of bandages, indications for dressings.
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Annex to MD
Level 1: basic knowledge of surgical instruments
Anesthesiology
Level 2: anesthetics (by inhalation or injection), mechanism of action of anesthetics, induction of
anesthesia, opiates, opiate-antagonists, muscle relaxants; risks and complications of anesthesiaE; fluid,
volume, and blood replacement, treatment of shock; postoperative phase including analgesia.
Level 1: preoperative risk assessment; preparation of patient for anesthesia; preoperative medication;
procedures for general anesthesia; non-invasive and invasive monitoring.
Transplantation
Level 1: definition of autograft, isograft, allograft and xenograft transplantation; organ transplantations
(selections of donors and patients); complications of transplantation: graft rejection, infection.
Disaster medicine, mass disaster
Level 1: Traffic mass disaster (road, air); chemical accident; mass intoxications; epidemiological disaster
due to infections; principles of triage; medical risks in disasters; psychiatric and psychological aspects in
disaster situations; special traumatic patterns in disasters (landslide, earthquake, floods, fire disaster, crush
injury); splints in disaster situations; analgesia in disaster situations; cold injuries in disaster situations.
Information / management
Level 1: prescription of physical therapy
Examination
Level 1: assessing peripheral arterial circulation by Doppler occlusion pressure
Procedures
Level 1: examination of male genitalia and interpretation of semen examination in infertility; tracheal
intubation; assisted ventilation, continuous positive airway pressure (CPAP), intermittent positive
pressure ventilation (IPPV), pressure controlled ventilation (PCV); wound debridement with scalpel and
scissors; gastro-duodenoscopy, colonoscopy, bronchoscopy; biopsy of muscle, kidney, liver; urodynamic
examination; urethral swab; incision and drainage of abscess; repositioning of closed fracture; prehospital
management of fracture; reduction of joint dislocation; nail removal and nail bed cauterization; insertion
of bladder catheter in male and female (transurethral and suprapubic); inserting a nasogastric tube;
colostomy, changing the bag; application of enema; puncture of pleural and peritoneal space, aspiration of
fluid; joint fluid aspiration; regional anesthesia: spinal, epidural, nerve block; lumbar puncture.
PAEDIATRICS: CLINICAL PICTURES
Accidents, poisonings, emergencies
Level 2: Acute abdomenE; accidental ingestion / inhalation in childrenE; acute life threatening event
(ALTE) in infantsE; disturbances of consciousness (Glasgow-Coma Scale)E; injuries to teethE;
epiglottitisE; seizures in children, febrileE; fever as an emergency in childrenE; foreign body aspiration
(larynx, trachea and bronchi)E; meningitis / encephalitis in childrenE; pain as an emergency in childrenE;
shock, septic shock, septicemias in childrenE; lesion of testicle and scrotal content (including torsion of
testicle)E.
Level 1: breath-holding spells in children; intussusception of bowel, invagination; sudden infant death
syndrome.
Cardiovascular disorders
Level 2: hypertension in children; rheumatic fever; innocent heart murmur; coarctation of aorta,
congenital;
Level 1: atrial septal defect; ventricular septal defect; cardiomyopathy; supraventricular tachycardia in
children; congenital complete heart block; persistent ductus arteriosus; pulmonary stenosis (obstruction to
right ventricular outflow) in children; tetralogy / pentalogy of Fallot; transposition of great arteries in
infants.
Respiratory disorders
Level 2: bronchial asthma, acute / chronicE; cystic fibrosis in children and adolescents.
Level 1: adenoidal and tonsillar hypertrophy; bronchopulmonary dysplasia
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Annex to MD
Diseases and malformations of kidneys and urinary tract
Level 2: phimosis / paraphimosisE; enuresis, primary / secondary; nephrotic syndrome in children; vesicoureteric reflux;
Level 1: adhesions of labia; hymen, imperforate, in childhood; Fanconi syndrome (kidney);
glomerulonephritis in children; hemolytic uremic syndrome; hydronephrosis; renal failure, acute / chronic
in children; urethral valves (malformation); urolithiasis / renal colic in children;
Haemato-oncologic disorders
Level 2: anemia from iron deficiency; acute leukemia; lymphomas (Hodgkin‘s / non-Hodgkin);
thrombocytopenic idiopathic purpuraE.
Level 1: aplastic / hypoplastic anemia; haemoglobinopathies; nephroblastoma; neuroblastoma; sarcoma of
soft tissue including rhabdomyosarcoma.
Diseases of the endocrine organs
Level 2: cryptorchidism, undescended testicle; Cushing’s syndrome, hypercortisolism; diabetes mellitus
type 1 / type 2 in childrenE;
Level 1: adreno-cortical failure in children; adrenogenital syndrome; diabetes insipidus; hypothyroidism,
neonatal and infantile; pituitary failure.
Metabolic disorders
Level 2: dehydration in childrenE; hyperglycemia in childhood; hypoglycemiaE; rickets.
Level 1: hypocalcemia in neonates and children
Gastrointestinal disorders
Level 2: gastroesophageal reflux in children; Meckel’s diverticulum; coeliac disease; inguinal hernia in
childrenE; constipation in children; anal fissures.
Level 1: hiatal hernia in children; congenital pyloric stenosis; Hirschsprung’s disease (megacolon,
congenital); milk protein intolerance in children.
Neurological disorders
Level 2: seizures, partial / generalized in childrenE; cerebral palsy; retinoblastoma in children and adults.
Level 1: absence attacks, typical, in children; infantile spasms; spinal muscular atrophy; headache,
migraine in children; brain tumors, benign / malignant; myopathy; neurofibromatosis (Recklinghausen‘s
disease);
Psychiatry of childhood and adolescence
Level 2: eating disorders in childhood.
Level 1: attention deficit and hyperactivity disorder (ADHD, ADHS); autism; psychic reaction of children
to chronic disease; psychic reaction of children to parental divorce; depression in children; dyslexia;
encopresis; parent - child relationship, disorders; mutism; psychoses of the child and adolescent;
psychosomatic disorders in children (non specific symptoms: abdominal pain, headache, fatigue);
somnambulism, night terrors and nightmares (parasomnia); speech and language disorders in childhood,
including stuttering; tic disorders.
Orthopedic disorders
Level 2: aseptic necrosis of bone including Osgood-Schlatter, Perthes; spinal deformation (kyphosis,
scoliosis, lordosis, including juvenile kyphosis = Scheuermann‘s disease); synovitis of hip, transient.
Level 1: achondroplasia; craniosynostosis in infants; Ewing‘s sarcoma; osteogenesis imperfecta;
osteosarcoma.
Skin diseases
Level 2: acne, hydradenitis suppurativa; atopic / constitutional eczema; rash from diaper; urticaria;
hemangioma of skin; pediculosis capitis and pubis; scabies.
Level 1: seborrheic dermatitis in children.
Neonatology
Level 2: epispadia / hypospadia; hemorrhagic disease of the newborn; spina bifida / neural tube defects
(including myelomeningocele); perinatal asphyxiaE; apnea in infantE; respiratory distress in infantsE;
rhesus / ABO incompatibility.
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Annex to MD
Level 1: common birth injuries; choanal atresia; cleft lip, jaw, palate; congenital torticolis; atresia in
newborn (esophageal, intestinal, biliary, anal); volvulus of small intestine, congenital malrotation;
congenital malformations of kidneys / of ureter / of urethra; congenital dislocation of the hip; congenital
foot deformity; conjunctivitis in newborn; cataract in children; diaphragmatic hernia of newborn;
necrotizing enterocolitis in infants; meconium aspiration; meconium ileus; hyaline membrane disease in
newborn; hydrocephalus in newborn and cerebral malformations; infant, small for gestational age;
macrosomia in neonates; erythema toxicum in newborn; milia in infants; mongolian spot; neonatal
meningitis; neonatal pneumonia; seizures in neonates; sepsis in neonates; omphalocele; postmature infant;
prematurity of infant.
Pathologies during pregnancy with consequences on the newborn
Level 1: oligohydramnios; hydramnios.
Growth and pubertal disturbances
Level 2: failure to thrive in children; growth disorder, short stature / tall stature; obesity; Marfan
syndrome.
Level 1: gynecomastia in puberty; menstrual cycle, dysfunction of in adolescence; premature thelarche /
pubarche; puberty, precocious / delayed; Klinefelter syndrome; Turner syndrome, gonadal dysgenesis;
genitalia, ambiguous, mixed gonadal dysgenesis.
Immunological and allergic disorders
Level 2: rhino-conjunctivitis, allergic / rhinosinusitis, allergic; allergy to insects / allergy to food; lupus
erythematosus systemic.
Level 1: purpura, Henoch-Schonlein (subgroup of hypersensitivity vasculitides); hypogammaglobulinemia / agammaglobulinemia; immunodeficiency syndromes; AIDS in children; arthritis, juvenile
chronic; Kawasaki syndrome (mucocutaneous lymph node syndrome).
Infectious diseases
Level 2: bacteremia; meningococcemiaE; orbit, inflammation of / orbital cellulitisE; conjunctivitis;
impetigo; lymphangitis, acute / lymphadenitis, acute; otitis media, acute, viral / bacterial; otitis media,
chronic, with effusion (glue ear) / with central perforation of tympanic membrane; otitis, external; rhinitis,
rhinosinusitis, acute; candidiasis, mouth / throat (thrush); stomatitis, herpetic; peritonsillar abscess /
retropharyngeal abscessE; scarlet fever; viral croup (pseudocroup, laryngitis subglottica)E; tracheitis, acute
/ chronic; bronchiolitisE; pneumonia, community acquired, in childrenE; whooping coughE; rubella;
varicella / herpes zoster; mononucleosis, infectious; measles; mumps (epidemic parotitis); tetanusE; colitis
/ enterocolitis / gastroenteritis infectiousE; urinary tract infection (cystitis, urethritis) in children; orchitis /
epididymitis; vulvovaginitis in children; balanitis.
Level 1: arthritis, septic / arthritis, reactive in children; brain abscess; erythema infectiosum, fifth disease;
exanthema subitum (roseola); mastoid abscess / purulent otomastoiditisE; rhinitis, rhinosinusitis, chronic;
diphtheria, including diphtheric croup; poliomyelitis;
PAEDIATRICS: Further Knowledge
Genetics
Level 1: chromosomal abnormalities (21, 13, 18); principles of genetic transmission; prenatal diagnostics
(indications, methods); genetic counseling.
Pathologies during pregnancy with consequences on the newborn
Level 2: pregnancy complications due to pre-existing maternal disease (diabetes mellitus, hypertension,
epilepsy).
Level 1: pregnancy, adverse effects of maternal medication on fetus; pregnancy and substance abuse, e.g.
alcohol, nicotine, heroin and cannabis; pregnancy, complications due to infectious diseases
(toxoplasmosis, other infectious microorganisms, rubella, cytomegaly, herpes simplex = TORCH);
adverse effects of ionizing radiation on fetus.
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Annex to MD
General growth and development (including normal variation)
Level 2: metabolic and endocrine disorders, screening for in infants (Guthrie); physiological jaundice in
infants; physiology of lactation; formula feeding and alimentation in the first year of life; fluid and food
requirements as a function of age; cardiovascular system (heart rate, blood pressure), maturation of in
infants; maturation of urinary and rectal sphincter function; lung and heart activity, variants of norm in
children; main parameters of growth (weight, length, head circumference) and of maturation;
psychomotor development; pubertal development.
Level 1: main parameters of intrauterine growth and intrauterine maturation; maturation of lungs and
adaptation to extrauterine life; fetal circulation and adaptation to extrauterine life; maturation of liver
functions; maturation of skeleton; maturation of teeth; vitamin D supplementation in newborn; APGARScore; immune system, passive transfer of immunity; breast-feeding, techniques and frequent problems;
maturation of respiratory system (respiratory rate, type of respiration); gastro-intestinal system (changes
in first year of life); hematopoiesis (fetal and adult hemoglobin levels, variations of red cell mass);
language development; intellectual development after language development; regulation of body
temperature in children; adolescent, cognitive and social development; role of affective bonding as a
function of age.
Social and preventive pediatrics
Level 2: well child care; abuse and neglect in childhoodE; common accidents in children; immunizations
recommended by WHO/in Mauritius;
Level 1: dental care in children; screening for scoliosis in childhood; mental retardation; physical exercise
(including in children with chronic diseases); physical, sensory and social handicaps; principal causes of
death in children and adolescents.
Psychiatry of childhood and adolescence
Level 2: risk factors associated with suicide in childhood and adolescence.
Level 1: school difficulties; sleep-related problems in childhood; antisocial behavior in children.
Examination
Level1: physical examination of newborn and infant; developmental screening tests (e.g. Denver);
gestational age assessment and growth category in newborn; investigation of battered children; screening
test of visual acuity in infants and small children; screening test of hearing in infants and small children.
Procedures
Level1: basic life support in children: assessment, breathing, circulation, defibrillation (Automatic
External Defibrillation) until arrival of professional emergency medical personnel (simulator); orotracheal
intubation in children; neonatal resuscitation; peripheral venous access in children; intraosseous infusion;
blood sampling (capillary, venous, arterial) in infants and newborn; insertion of bladder catheter in male
and female (transurethral and suprapubic); urine collection by urinary bladder puncture; application of
enema; lumbar puncture; bone marrow aspiration; puncture of pleural and peritoneal space, aspiration of
fluid; paracentesis.
GYNAECOLOGY–OBSTETRICS: CLINICAL PICTURES
Adnexae
Level 2: benign adnexal tumors; carcinoma of ovary; ectopic pregnancyE; pelvic inflammatory disease
(PID: adnexitis / salpingitis / tubo-ovarian abscess); torsion / rupture of adnexal tumor / of ovarian cyst;
urinary retentionE.
Body of the uterus
Level 2: endometrial carcinoma; benign uterine tumors (fibroids, polyps); uterine descent, descensus of
uterus; uterine prolapse / vaginal vault prolapse.
Level 1: trophoblast disorders (hydatidiform mole, choriocarcinoma); congenital malformations of body
of the uterus.
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Annex to MD
Cervix
Level 2: carcinoma of cervix; pre-malignant disorders of cervix; cervicitis (herpes, chlamydia,
gonorrhea).
Vagina
Level 2: vaginal carcinoma; vaginitis / colpitis (candidiasis, bacterial vaginosis, trichomoniasis)
Level 1: cystocele / cysto-urethrocele / rectocele / enterocele; fistula of vagina (vesico-vaginal / ureterovaginal / recto-vaginal); atrophic vaginitis.
Vulva
Level 2: abscess of hair follicle / of sebaceous gland; carcinoma of vulva; condylomata acuminata anal /
perianal / penis / vulva / vagina / cervix; cyst of Bartholin / abscess of Bartholin‘s gland; dystrophy of
vulva (craurosis vulvae); vulvitis (candidiasis / herpes-simplex / pediculosis pubis).
Breasts
Level 2: breast, cysts / benign breast tumors; malignant disorders of breast; inflammation of breast.
Endocrine gynecological disorders
Level 2: endometriosis; menopause, climacteric syndrome and osteoporosis; polycystic ovary syndrome
(metabolic syndrome); premenstrual disorders / amenorrhea / oligomenorrhea / dysmenorrheal.
Level 1: hirsutism and virilization; hyperprolactinemia and galactorrhea.
Genetic disorders
Level 1: genitalia, ambiguous, mixed gonadal dysgenesis; Turner syndrome, gonadal dysgenesis.
Miscellaneous gynecological disorders
Level 1: foreign body in female internal genitalia; traumatic gynecological injuries; infertility, subfertility
(female and male).
Pregnancy
Level 2: abortion, spontaneous; abruptio placentae; blood group incompatibility in pregnancy; cervical
incompetence in pregnancy; gestational diabetes mellitus; hyperemesis gravidarum; iron deficiency
anemia in pregnancy; multiple pregnancy; placenta praevia; placental insufficiency; pregnancy induced
hypertensive disorders (pregnancy induced hypertension, preeclampsia, eclampsia)E; urinary tract
infection in pregnancy; pyelitis in pregnancy; threatened abortion.
Level 1: intrauterine fetal demise; ascending intra-amniotic infection (chorioamnionitis); hydramnios;
oligohydramnios.
Delivery
Level 2: unstable lie of fetus / malposition after 36 weeks; hypoxia of fetus during deliveryE; placenta,
retained in delivery / postpartum; postdate delivery (placental insufficiency); preterm delivery (PTD) /
preterm premature rupture of membranes (PPROM)E; rupture of perineum / of cervix uteri / of uterus in
delivery; shoulder-dystocia in delivery.
Level 1: umbilical cord presentation / umbilical cord prolapsed.
Postpartum and puerperium
Level 2: postpartum haemorrhage from uterusE; thrombophlebitis; deep vein thrombosis; pulmonary
embolism; arterial embolism; incontinence of feces / of urine in puerperium; mastitis in puerperium;
nipple, cracked in puerperium; inflammation of pelvis postpartum and in puerperium (including endomyo-metritis, salpingitis, pelvoperitonitis, perimetritis); postpartum depression; postpartum psychosis.
Level 1: involution and subinvolution of puerperal uterus.
GYNAECOLOGY–OBSTETRICS: FURTHER KNOWLEDGE
Contraception / pregnancy / delivery
Level 2: prevention of neural tube defects (NTD); contraception; pregnancy complications due to preexisting maternal disease (diabetes mellitus, hypertension, epilepsy); pregnancy induced maternal disease
(gestational diabetes mellitus, cholestasis, dermatosis); physiology of delivery; termination of pregnancy.
Level 1: basal temperature curve; screening for infectious diseases in pregnancy; prenatal screening for
chromosomal disorders; prenatal ultrasound screening for malformations, intrauterine growth retardation;
invasive prenatal diagnosis of genetic disorders, infections, anemia; pregnancy, complications due to
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Annex to MD
infectious diseases (toxoplasmosis, other infectious microorganisms, rubella, cytomegaly, herpes simplex
= TORCH); pathological course of delivery.
Examination
Level 1: combined recto-vaginal examination: palpation of recto-vaginal septum; internal examination in
early pregnancy; obstetric examination (assessment of cervix, dilatation, membranes, presentation of
fetus, descent); palpation of abdomen in pregnancy: fundal height, Leopold‘s manoeuvre, external
assessment of position; physical examination of newborn and infant; inspection of placenta and
examination of umbilical cord; postpartum examination: fundal height, placenta loose / retained; estimate
of blood loss after delivery; assessment of lochia; breasts in puerperium: inspection, lactation.
Procedures
Level 1: preparation and assessment of Gram stain; genital discharge: vaginal swab, microscopic
examination with saline or potassium hydroxide; insertion of intrauterine device (IUD); examination of
male genitalia and interpretation of semen examination in infertility; curettage; laparoscopy; pregnancy
test in urine; ultrasound examination during pregnancy; pelvic examination during pregnancy; attending
woman in labor; inspection and support of perineum; induction of labor by drugs or by artificial rupture
of membranes; cardiotocography (CTG): performance and interpretation; caesarean section; episiotomy;
assisted vaginal delivery; fetal blood sampling; receive / hold newborn; aspiration of mouth / throat of
newborn infant; delivery of placenta; assist and check mother and newborn.
PSYCHIATRY: CLINICAL PICTURES
Psychiatry of childhood and adolescence
Level 2: learning disorders; eating disorders in childhood;
Level 1: attention deficit and hyperactivity disorder (ADHD, ADHS); autism; mental retardation; tic
disorders; psychic reaction of children to chronic disease; depression in children; psychic reaction of
children to parental divorce; dyslexia; encopresis; disorders of mother-child relationship, mutism;
psychoses of the child and adolescent; psychosomatic disorders in children (non specific symptoms:
abdominal pain, headache, fatigue); sleep-related problems in childhood; speech and language disorders
in childhood, including stuttering.
Organic mental disorders
Level 2: dementia in Alzheimer‘s disease; dementia, vascular (including multi-infarct dementia,
subcortical dementia); deliriumE; organic confusional stateE; Wernicke-Korsakoff‘s encephalopathy,
organic amnesic syndromeE.
Level 1: dementia of frontal type; Lewy body dementia; dementia in neurological diseases; organic
hallucinosis; organic psychotic disorders; organic personality disorder; postconcussional syndrome.
Psychoactive substance abuse
Level 2: intoxication by psychotropic and illicit drugs (including heroin, cocaine, amphetamine)E; alcohol
intoxicationE; psychoactive substances, harmful use and dependence syndromes; withdrawal statesE.
Schizophrenia and related disorders
Level 2: schizophrenia, paranoid, hebephrenic, catatonic, undifferentiated; postpartum psychosis.
Level 1: residual schizophrenia; acute polymorphic psychotic disordersE; induced delusional disorder
(folie à deux); schizoaffective disorders.
Mood disorders
Level 2: manic episodeE; depressive episode in adultsE; depression in adults with somatic symptomsE;
postpartum depression; bipolar affective disorder in adultsE; recurrent depressive disorder in adultsE.
Level 1: mania with psychotic symptomsE; depression in adults with psychotic symptomsE; cyclothymia;
dysthymia.
Neurotic and related disorders
Level 2: agoraphobiaE; panic disorderE; generalized anxiety disorderE; somatization disorder, somatoform
autonomic dysfunction, somatoform pain disease.
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Annex to MD
Level 1: phobia, social; phobia, specific; obsessive-compulsive disorder; acute stress reaction; posttraumatic stress disorder / enduring personality changes after catastrophic experience; adjustment
disorders; dissociative disorders; hypochondrial disorder; neurasthenia; depersonalization-derealization
syndrome.
Behavioral syndromes with somatic factors
Level 2: anorexia nervosaE; bulimia nervosa; sleep disorder; sexual dysfunction; abuse of nondependence-producing substances (antidepressants, laxatives, analgesics, antacids, vitamins, steroids or
hormones, specific herbal or folk remedies)E;
Level 1: somnambulism, night terrors and nightmares (parasomnia).
Adult personality and behavioral disorders
Level 2: aggressive behaviorE; suicideE.
Level 1: paranoid personality disorder; schizoid personality disorder; dissocial personality disorder;
emotionally unstable personality disorder, impulsive type; emotionally unstable personality disorder,
borderline type; histrionic personality disorder; anankastic personality disorder; anxious personality
disorder; dependent personality disorder; personality changes, enduring, after psychiatric illness;
gambling, pathological; pyromania; kleptomania; trichotillomania; transsexualism; problems of sexual
preference, gender identity disorder; factitious disorder (intentional feigning of physical or psychological
signs and symptoms).
PSYCHIATRY: FURTHER KNOWLEDGE
Psychiatry of childhood and adolescence
Level 2: risk factors associated with suicide in childhood and adolescenceE.
Level 1: antisocial behavior in children
Treatment
Level 2: side effects of psychotropic drugs.
Level 1: managing patients with aggressive or suicidal behavior; non pharmacological somatic psychiatric
treatment (light therapy, electroconvulsive therapy, sleep deprivation); systemic, psychodynamic and
cognitive behavioral therapy.
Legal aspects
Level 2: coercive treatment, forced admission to hospital.
Level 1: legal aspects of personality (Droits de la personnalité).
Examination
Level 1: assessment of ability to judge (capacité de discernement).
OPHTHALMOLOGY: CLINICAL PICTURES
Eyelids
Level 2: blepharitis; chalazion; ectropion; entropion; epicanthus (eyelids); eyelid laceration; eyelid tumor,
e.g. basal cell carcinoma; hordeolum; lagophthalmos; ptosis; trichiasis (eyelashes grow inwards);
xanthelasma of eyelid.
Lacrimal apparatus
Level 2: dacryocystitis.
Level 1: dacryostenosis; lacrimal duct, laceration.
Conjunctiva
Level 2: conjunctiva, foreign bodyE; conjunctivitis; pterygium; subconjunctival hemorrhage.
Cornea
Level 2: burns of cornea by alkali / by acid / by heatE; cornea, foreign bodyE; cornea, superficial lesions of
(actinic keratitis, erosion, contact lenses)E; keratitis, keratitis with corneal ulcer; keratitis, dendritic
(herpes).
Level 1: corneal edema; kerato-conjunctivitis sicca; keratoconus.
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Anterior chamber
Level 2: hyphema (eyes)E; hypopyon (eyes)E.
Lens
Level 2: cataract in adults.
Level 1: lens dislocation; pseudophakia (artificial lens).
Iris and ciliary body
Level 2: iridocyclitis, iritis.
Vitreous fluid
Level 1: vitreous hemorrhage (eye).
Retina
Level 2: degeneration of macula (eye), age dependent; hypertensive retinopathy; retina: vessel occlusion /
bleeding; retinal detachmentE; retinoblastoma in children and adults; scleritis / episcleritis.
Optic disc and optic nerve
Level 2: optic disc cupping; optic neuropathy, e.g. optic neuritis; papilledema, e.g. increased intracranial
pressure.
Level 1: optic nerve atrophy.
Choroid
Level 1: chorioretinitis; choroid, neoplasms of (melanoma, metastases).
Eyeball
Level 2: contusion of eyeballE; endophthalmitisE; eyeball trauma: contusion / perforation / intraocular
foreign bodyE.
Level 1: buphthalmos (hydrophthalmos).
Orbit
Level 2: orbit, inflammation of / orbital cellulitisE.
Level 1: fracture of orbit (blow-out fracture); tumor of orbit.
Refraction and accommodation
Level 2: hypermetropia (eyes); myopia; presbyopia.
Level 1: astigmatism.
Vision and visual fields
Level 2: amblyopia; hemianopsia, bitemporal / homonymous; scotoma.
Level 1: night-blindness.
Glaucoma
Level 2: glaucoma, acute; glaucoma, simple.
Level 1: glaucoma, secondary.
Squint
Level 1: nystagmus; strabismus
Underlying diseases
Level 2: eye disorders due to diabetes mellitus; eye disorders due to hyperthyroidism (Graves disease).
OPHTHALMOLOGY: FURTHER KNOWLEDGE
Examination
Level 1: inspection lacrimal apparatus; assessment of binocular vision; perimetry; slit-lamp examination
of the eye; intra-ocular pressure, measurement by aplanation tonometer or non-contact-tonometer;
assessment of refraction, subjective and objective (refractometry, keratometer); screening test of visual
acuity in infants and small children; examination with Amsler panes.
Procedures
Level 1: measurement of lacrimal production; removal of foreign body with swab (if necessary by
eversion of upper eyelid); cornea, removal of foreign body and debris; removal of contact lens from the
eye.
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DERMATOLOGY: CLINICAL PICTURES
Viral infections
Level 2: condylomata acuminata anal / perianal / penis / vulva / vagina / cervix; herpes simplex; varicella
/ herpes zoster; warts, human papilloma virus HPV, molluscum contagiosum.
Bacterial infections
Level 2: borreliosis, Lyme disease; erysipelasE; folliculitis; furuncle / carbuncle; impetigo; staphylococcal
scaled skin syndrome (SSSS, toxic shock syndrome).
Level 1: lepra.
Fungal infections
Level 2: candidiasis; dermatophytic disease (fungal infection of skin); pityriasis versicolor.
Parasitic infections
Level 2: pediculosis capitis and pubis; scabies; sting of insects / insect bites;
Level 1: leishmaniasis, cutaneous
Sexually transmitted diseases (not mentioned elsewhere)
Level 2: AIDS, cutaneous manifestations of; chlamydial infection; gonorrhea; herpes genitalis; syphilis;
vaginitis / colpitis (candidiasis, bacterial vaginosis, trichomoniasis); urethritis, nonspecific.
Level 1: sexually transmitted disease STD (ulcer soft, lymphgranuloma vernerum, granuloma inguniale)
Allergic and non-allergic intolerance reactions
Level 2: allergic contact dermatitisE; angio-oedemaE; atopic / constitutional eczema; dermatitis from
diaper; drug rashE; erythema nodosum; seborrheic eczema in adults; toxic / irritant contact dermatitisE;
toxic epidermal necrolysis; urticariaE.
Level 1: erythema multiforme and Stevens-Johnson syndrome; purpura, Henoch-Schonlein (subgroup of
hypersensitivity vasculitides).
Auto-immune and bullous dermatoses
Level 2: lupus erythematosus cutaneous.
Level 1: polymyositis / dermatomyositis; dermatosis autoimmune-bullous; systemic sclerosis, progressive
(scleroderma).
Alterations of pigmentation
Level 2: lentigo simplex; vitiligo.
Level 1: neurofibromatosis (Recklinghausen‘s disease).
Diseases of skin appendages
Level 2: nail dystrophies (psoriasis / lichen planus / mycoses).
Level 1: nail dyschromias.
Genodermatoses
Level 1: xeroderma pigmentosum (genodermatosis)
Granulomatous diseases
Level 1: granuloma annulare; sarcoidosis, cutaneous lesions.
Papular and erythematosquamous disorders
Level 2: prurigo; psoriasis
Sebaceous gland diseases
Level 2: acne, hydradenitis suppurativa; diabetes mellitus, skin lesions including foot ulcer.
Level 1: dermatitis, perioral, rosacea; paraneoplastic dermatological syndromes.
Photodermatoses and physically induced dermatoses
Level 2: actinic dermatitis; burnsE; dermatitis, solar; actinic keratosis.
Level 1: pernio / frost bites / chilblains; photodermatoses in a broad sense.
Benign tumors and naevi
Level 2: hemangioma of skin; keloid; lipoma; nevus cell nevus; nevus flammeus; seborrheic keratosis.
Level 1: histiocytoma; urticaria pigmentosa, cutaneous mastocytosis.
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Premalignant and malignant skin lesions
Level 2: leukoplakia / leukokeratosis (diseases of transitional epithelia); Bowen‘s disease; basalioma,
spinalioma, squamous cell carcinoma; lentigo maligna; malignant lymphoma of the skin; malignant
melanoma.
Level 1: Paget‘s disease of the breast; skin metastases caused by internal tumors.
Proctological diseases
Level 2: anal fissures; haemorrhoids.
Psychodermatoses
Level 1: dermatitis artefacta; psychogenic pruritus.
Vascular diseases
Level 2: decubital ulcer; lymphangitis, acute / lymphadenitis, acute; varicosis / venous insufficiency / leg
ulcers / stasis ulcer.
DERMATOLOGY: FURTHER KNOWLEDGE
Dermatologic therapy
Level 1: basics of dermatologic therapy (topical, systemic, physical, galenic, specific drugs).
Examination
Level 1: identification of parasite in skin and hair.
Procedures
Level 1: preparation and assessment of fungal and bacterial swabs and smears; preparation and
assessment of Gram stain; patch test; intracutaneous test; punch biopsy.
OTORHINOLARYNGOLOGY (Ear, Nose & Throat: ENT): CLINICAL PICTURES
External ear
Level 2: earwax, impacted; foreign body in external auditory canalE; erysipelas of external ear; otitis,
external; furunculosis of the external auditory canal.
Level 1: exostosis, hyperostosis in external ear; perichondritis of auricle; ear, laceration of, injury to
external auditory canalE; ear, prominent auricle (bat ear, lop ear).
Middle ear
Level 2: otitis media, acute, viral / bacterial; otitis media, chronic, with effusion (glue ear) / with central
perforation of tympanic membrane; otogenic meningitisE; Eustachien tube dysfunction.
Level 1: cholesteatoma; mastoid abscess / purulent otomastoiditisE; otogenic brain abscess; thrombosis of
lateral sinus from inflammation of middle ear; otosclerosis; barotrauma of middle earE; traumatic
perforation of tympanic membraneE.
Inner ear and vestibular organ
Level 2: acoustic trauma and noise-induced hearing loss; ototoxic hearing loss; presbyacusis; benign
paroxysmal positional vertigo (cupulo- and canalolithiasis); Menière‘s disease; motion sickness
(kinetosis).
Level 1: acoustic neurinoma (vestibular schwannoma); fracture of temporal bone (longitudinal /
transverse)E; labyrinthitis; vestibular function, sudden loss of (vestibular neuritis)E.
Nose, paranasal sinus, anterior skullbase
Level 2: furuncle of the nose; nasal polyposis; rhinitis, rhinosinusitis, acute; rhino-conjunctivitis, allergic /
rhinosinusitis, allergic; basalioma, spinalioma, squamous cell carcinoma; epistaxisE; fracture of the nasal
pyramid; nasal septum, deviation.
Level 1: rhinitis, rhinosinusitis, chronic; fractures of the facial craniumE; fracture of orbit (blow-out
fracture); choanal atresia.
Oral cavity, pharynx, hypopharynx
Level 2: cheilitis angularis (Perlèche); herpes labialis; candidiasis, mouth / throat (thrush); stomatitis,
herpetic; stomatitis, recurrent aphthous; mononucleosis, infectious; pharyngitis, acute / chronic; scarlet
fever; tonsillitis, streptococcal (including complications: glomerulonephritis, rheumatic fever, chorea
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minor); peritonsillar abscess / retropharyngeal abscessE; Bowen‘s disease; teeth, injuries toE; sleep apnea
syndrome obstructive / central.
Level 1: gingivitis / periodontitis; leukoplakia, hairy of the border of the tongue in AIDS; abscess of the
floor of the mouth (including of dental origin); pressure sores from dental prostheses; agranulocytotic
angina; diphtheria, including diphteric croupE; Plaut-Vincent angina (trench mouth), acute necrotizing
ulcerative gingivitis; tonsillogenic septicemiaE; pharynx and oral cavity, tumors of; oral cavity and
pharynx, thermal and caustic lesions ofE; tongue bite / piercing of tongueE; traumatic lesions of the
palateE; cleft lip, jaw, palate; tongue, norm variants of; dysgeusia / ageusia; foreign body in
hypopharynxE; ranula (mucus retention cyst sublingual gland).
Salivary glands
Level 2: mumps (epidemic parotitis)
Level 1: parotitis, marantic; parotitis, suppurative; sialolithiasis of salivary glands; pleomorphic adenoma
(benign mixed tumor) and other benign tumors of salivary glands; tumors of salivary gland, malignant;
Sjögren‘s disease (sicca syndrome with arthritis, LE, scleroderma).
Oesophagus
Level 2: oesophageal varices; oesophagus, corrosive lesion (acid, base, stenosis)E.
Level 1: diverticulum of oesophagus (including Zenker‘s diverticulum); oesophagus, injuries and
perforations of; foreign body in oesophagusE; oesophagus, strictures of; oesophageal rupture.
Cervico-facial region
Level 2: peripheral palsy / paralysis of facial nerve (idiopathic, borreliosis, viral, traumatic, neoplastic).
Level 1: midline / lateral branchial cysts / fistulas; enlarged cervical lymph nodes (inflammatory,
metastatic); cervico-facial tumors benign (including simple goiter).
Larynx, vocal cords, tracheo-bronchial system
Level 2: epiglottitisE; tracheitis, acute / chronic; viral croup (pseudocroup, laryngitis subglottica)E;
laryngeal carcinoma, clinical symptoms of; foreign body aspiration (larynx, trachea and bronchi)E.
Level 1: laryngitis acute; laryngitis, chronic; tracheomalacia; palsy of recurrent laryngeal nerve, unilateral
/ bilateral; vocal cord paralysis, neurologic syndromes causing it; tumors of the larynx; vocal cord and
larynx: nodules / cysts / polyps / papillomas; laryngeal trauma, external, blunt / sharp (with fractures of
cartilage and structural displacements)E; larynx and trachea, thermal / corrosive injuries ofE.
OTORHINOLARYNGOLOGY (Ear, Nose & Throat: ENT): FURTHER KNOWLEDGE
Hearing disorders
Level 2: hearing loss, conductive; hearing loss, sensory neural;
Level 1: hearing loss, congenital / acquired; hearing loss, retrocochlear; hearing loss, central; hearing aid
fitting; cochlea implantation.
Vestibular dysfunction
Level 2: vestibular ototoxicity; vestibular dysfunction, peripheral / central.
Level 1: definition of vertigo and disequilibrium; nystagmus; vestibular compensation.
Examination
Level 1: ear microscopy; posterior rhinoscopy; testing of the act of swallowing; indirect pharyngolaryngoscopy.
Procedures
Level 1: tympanometry and measurement of stapedius reflex; pure tone audiogram and speech
audiometry; acoustic evoked potentials; induced nystagmus (rotation, optokinetic, caloric); endoscopy of
nasal cavity; endoscopy of pharynx; direct fiber optic laryngoscopy; bronchoscopy; endoscopy of the
oesophagus; coniotomy; tracheotomy; tracheal intubation; emergency treatment of acute dyspnea in
patients with tracheal canulla; anterior tamponade in nose; treatment of hemorrhage after tonsillectomy;
CPAP-ventilation; fine needle aspiration for cytology.
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RADIOLOGY AND NUCLEAR MEDICINE: FURTHER KNOWLEDGE
Physics of X-ray and types of radiation used
Level 1: components of environmental radiation; basic physics of the X-ray process; production of
radiation: generator, tube; types of radiation; radiation attenuation law; principles of X-ray detection.
Physics of nuclear medicine
Level 1: radio-isotopes and radio-tracers; physical / biological half-life in nuclear medicine; principles of
gamma ray detection: scintigraphy, SPECT, PET.
Principles of radio-oncology
Level 2: natural tumor development, tumor classification and TNM principles.
Level 1: techniques in radio-oncology; treatment planning in radio-oncology.
Risks from exposure to ionizing radiation
Level 2: explaining risks of radiological imaging to patients
Level 1: calculation of effective and organ dose in radiation; exposure situations and associated radiation
risks for population, individual person, health professional, patient.
Legislation on imaging data and radiation protection
Level 2: practical X-ray protection.
Level 1: legal regulations on imaging data; radiation protection law; administration of radioactive
isotopes: radiation protection of patient and environment; personal protection and monitoring: dose limits,
typical dose to staff, associated risks, precautions.
Conventional radiography
Level 1: technical parameters of conventional radiography: scatter, contrast, viewing window, use of
grids, X-ray detection; conventional radiographic examinations using contrast agents.
Computed Tomography (CT)
Level 1: technical parameters of Computed Tomography (CT): detector, image generation, enhancement,
Hounsfield units; CT-guided intervention (CT-fluoroscopy); indications for Computed-Tomography.
Ultrasonography (US)
Level 2: advantages and drawbacks of US versus other imaging modalities.
Level 1: technical parameters of Ultrasonography (US): image formation, Doppler effect, probe
Magnetic Resonance Imaging (MRI)
Level 2: indications and contraindications, safety considerations of MRI
Level 1: technical parameters of Magnetic Resonance Imaging (MRI): magnetism, radiofrequency,
relaxation time, signal characteristics of tissues.
Special uses of radiology
Level 1: interventional radiology: classification, indications and risks
Contrast media
Level 2: contrast media: adverse effects, prevention and treatment.
Level 1: contrast media: types, indications and contraindications.
Organ related radiopathology
Level 2: conventional radiopathology of the lung: alveolar consolidation, interstitial disease, pulmonary
nodules and masses; conventional radiopathology of pleural, extra-pleural, mediastinal, hilar and chest
wall conditions; conventional radiopathology of bones and joints: osteoporosis, bone metastasis,
osteomalacia, pseudarthrosis, osteoarthrosis deformans, loss of joint space; conventional radiology of
fractures of extremities: clavicle, shoulder, humerus, radius, ulna, wrist (distal radius), fingers, femur,
knee, tibia, fibula, toes; conventional radiology of the spine: compression fracture, scoliosis, kyphosis.
Practice of imaging procedures
Level 1: standard radiological exam of chest: performance; standard radiological exam of extremities:
performance; abdominal ultrasonography (US): performance; computed tomography (CT): performance;
magnetic resonance imaging (MRI): performance.
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PUBLIC HEALTH, INSURANCE- AND OCCUPATIONAL MEDICINE: FURTHER
KNOWLEDGE
Basic terms and concepts of public health
Level 2: important definitions and concepts: health and disease, salutogenesis and pathogenesis, causation
and association, the individual, the population, public health, epidemiology, clinical epidemiology, social
medicine, preventive medicine, environmental medicine, health services, health economics, public health
policy, health care, health promotion, health behavior; approaches and strategies of prevention: primary,
secondary and tertiary prevention; structural and individual-level prevention strategies; population
approach and high-risk approach; concepts in social medicine and social epidemiology: social class,
socio-economic status, social mobility, gender, ethnicity, social networks, cultural changes.
Level 1: explanations for differences in health and utilization of healthcare services of population groups,
according to age, sex, social status, ethnicity.
Epidemiology
Level 2: measures of disease frequency: prevalence, incidence, incidence rate, cumulative incidence
(risk); measures of association: relative measures (risk ratio, rate ratio, odds ratio); absolute measures
(risk difference, number needed to treat / harm, attributable risk); observational and experimental study
designs, their advantages and disadvantages and areas of application: case series, cross-sectional studies,
case-control studies, cohort studies, randomized controlled trials, systematic reviews, meta-analysis;
critical appraisal of study methodology, internal and external validity of results: systematic error
(selection bias, information bias); confounding and how to deal with it (age standardization, stratification,
multivariable analysis); diagnostic and screening tests: sensitivity, specificity, positive and negative
predictive values, likelihood-ratio, pre-test probability, post-test probability;
Level 1: applications of epidemiology: descriptive and analytical approaches; types of bias in the
evaluation of diagnostic and screening tests (partial verification bias, differential verification bias);
influence of the patient spectrum and pre-test probability on the interpretation of test; results; types of
bias in the evaluation of screening programs (lead time bias, length bias, overdiagnosis bias).
Biostatistics
Level 2: type of variables: categorical (binary, nominal, ordinal) and numerical (discrete, continuous);
describing data and their variability: frequency, proportion, mean, standard deviation, median; histogram,
box-plot, scatter plot, survival curve; estimation: standard errors (of a mean, difference between two
means, proportion, difference between two proportions), confidence intervals; hypothesis testing: null
and alternative hypotheses; interpretation of P values; relation between P values and confidence intervals.
Demography, health indicators and data sources
Level 2: important indicators: birth rate, various death rates, life expectancy, years of life lost, health
related quality of life, DALY (disability adjusted life year), QALY (quality adjusted life year); major
causes of death, according to age, sex, social status, ethnicity; importance of different causes in relation to
years of life lost.
Level 1: trends in health indicators in Mauritius, demographic predictions, comparison with other
countries; important data sources in Mauritius: population census, birth- and death-registers, health
surveys, hospital statistics, Mauritius household surveys by Statistics Bureau.
The Mauritian healthcare system
Level 2: funding of healthcare in Mauritius: funders (the state, private insurance, out of pocket payments);
sources of costs (out-patient and in-patient healthcare providers, medicines); Trends and determinants of
health care spending.
Level 1: definition of the term healthcare system; responsibilities of the state: surveillance, health
promotion, and disease prevention; education, occupations and research. Role of non-governmental
organizations (self-help groups, disease-specific organizations); responsibilities and organization of
healthcare providers: out-patient care (doctors, midwives and nurses in private practice, managed care
group practices, pharmacists); providers of care in public and private hospitals, hospital out-patient clinics
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Annex to MD
and nursing homes; international comparisons of different types of healthcare systems; models of
reimbursement for healthcare provision: fee-for-service, fee-per-case, prospective or retrospective lump
sum payments; costs and benefits of interventions: direct, indirect and intangible costs.
Prevention and health promotion
Level 2: counseling of individuals: model of behavior change; stages of change, stage-appropriate advice;
epidemiology, preventive recommendations and approaches to intervention regarding exercise, nutrition,
alcohol consumption, smoking and sexual behavior.
Level 1: population-based public health strategies: general principles, appropriate setting of priorities,
feasibility, evaluation; population-based primary prevention: general principles, mass campaigns and
targeted interventions, structural and individual-based strategies; secondary prevention: general
principles, screening programs, criteria for assessing the appropriateness of screening, current
recommendations for screening; principles of primary and secondary prevention in primary health care,
opportunistic screening; ethical issues related to public health interventions (for example screening),
prioritization and equity in health care; salutogenesis: important behavior-related (exercise, nutrition,
relaxation, safer sex) and psychosocial resources (health competence, coping, sense of coherence, social
support); pathogenesis: important behavior-related risk factors (smoking, alcohol, obesity) and
psychosocial burdens (stress, critical life events); lifestyle and health behavior: role of cultural influences
and the social environment; health promotion: Ottawa Charta (levels of action, strategies), health
promotion in defined settings (for example schools, communities, workplaces, hospitals); prevention and
health promotion: important institutions and programs in Mauritius (national health goals, plans of action
by Ministry of Health & Quality of Life, national campaigns); opportunities and barriers; considerations
at the political level.
Chronic and degenerative diseases, accidents
Level 1: epidemiology (prevalence, incidence, mortality, years of life lost) in Mauritius, international
comparisons, and strategies for the prevention of: cardiovascular diseases, diabetes, cancer (lung, breast,
colon, prostate, melanoma), musculoskeletal diseases, respiratory diseases and allergies, mental health
problems, addiction, accidents; life course approach to health: specific risks, health problems and
preventive measures for children, adolescents and young adults, middle-aged adults and the elderly.
Environmental medicine, methodological aspects
Level 1: estimating human exposure to environmental pollution (methods of measuring, semiquantitative
procedures, indicators, dosage and safety limits); evaluating health risks due to environmental factors
from the point of view of the individual and of society as a whole.
Physical, chemical and radiological hazards
Level 1: sources, trends, distribution and health consequences of: outdoor air pollutants (particulate
matter, ozone, nitrogen dioxide); indoor air pollutants (passive smoking, radon, asbestos, formaldehyde,
solvents and mould); non-ionizing and ultraviolet radiation; ionizing radiation; noise pollution; water- and
soil-pollutants (nitrates, heavy metals, production and quality of drinking water in Mauritius); sources,
trends, distribution and health consequences of greenhouse gases and climate change.
International health
Level 1: international priorities for health and health care: UN Millennium Development Goals;
strengthening health systems; Global Fund to fight for AIDS, TB and Malaria; essential health
interventions; primary health care for all; major causes of disease and death in infancy and the neonatal
period, under-5s, adults in different parts of the world; determinants of international differences in health:
poverty, hunger, population growth, education, differences in income, gender differences, environment,
conflicts, access to medical resources.
Infectious diseases, basic terms and concepts
Level 2: important definitions and concepts: virulence, resistance, pathogenicity, transmissibility;
contamination, colonization, infection, carrier; incubation period, latent period, infectious period;
exposure, primary and secondary attack rate, reproductive number (Ro), herd immunity; endemic,
epidemic, pandemic, sporadic case, outbreak; surveillance, notification; zoonosis, reservoir, vector,
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vehicle; chemoprophylaxis, immunization, vaccination, active immunization, passive immunization;
emerging and re-emerging infections.
Level 1: laws: international health regulations; law on epidemic diseases; notification regulations;
epidemiological surveillance: national and international notification requirements (who reports what,
when, and to whom); advantages and disadvantages of different surveillance systems; steps in the
recognition, investigation and control of outbreaks.
Epidemiology and prevention of infectious diseases
Level 1: epidemiology (incidence, prevalence, mortality and years of life lost, route of transmission, risk
factors) in Mauritius, international comparison, and strategies for the prevention of major infectious
diseases: food-borne infections; vaccine preventable infections; nosocomial infections; HIV and sexually
transmitted infections; zoonoses; travel-related infections (travelers’ diarrhea, malaria, amoebiasis,
hepatitis, yellow fever, rabies, Dengue fever, typhoid fever, tuberculosis, legionnaire’s disease, cholera,
HIV and sexually transmitted infections); healthcare-related infections (hepatitis, HIV, tuberculosis,
influenza, varicella, parvoviruses).
Preventive strategies for infectious diseases
Level 2: vaccination (characteristics, indications, contraindications, side-effects, storage, means of
delivery and usage of vaccines for routine administration and specific indications): viral: poliomyelitis,
MMR, hepatitis A, hepatitis B, influenza, varicella, tick-borne encephalitis; bacterial: tetanus, diphtheria,
pertussis, hemophilus influenzae B, meningococcus C, BCG, typhoid fever, pneumococcal infection;
general preventive measures in hospitals: hand washing, asepsis, sterilization, disinfection, isolation;
specific precautions for specific risk procedures (surgical interventions, urinary catheters, intravascular
catheters, endoscopy).
Level 1: benefits and risks of vaccination: vaccine efficacy, vaccination coverage, vaccination campaigns,
vaccination failure, adverse events, cost-effectiveness; chemoprophylaxis (recommended medications,
contraindications and indications) for: meningococcal meningitis, tuberculosis, endocarditis, malaria,
toxoplasmosis, pneumocystis jiroveci (carinii)-pneumonia in the immune-suppressed, pre- and postexposure prophylaxis of HIV infection; principles and indications for chemoprophylaxis in individuals
and during epidemics; other measures: border medical examinations and mass screening, needle
exchange programs, testing of drinking water, prohibition to work in an occupation (for example handling
food).
Occupational medicine, basic terms and concepts
Level 2: steps in the investigation of a suspected occupation-related health problem in an individual or a
group; regulations for health protection and promotion in the occupational and accident insurance law.
Level 1: important definitions and concepts: occupational medicine, occupational disease, occupationrelated illnesses; principles of primary, secondary and tertiary prevention in the workplace.
Occupational diseases
Level 2: occupational workplace history-taking, and important work-place hazards (noise,
electromagnetic fields, vibration, lead, mercury, solvents, carbon monoxide, aromatic amines, asbestos,
wood dust, benzene).
Work and health
Level 2: ergonomics: workplace layout and environmental influences, including working at a computer
terminal, in an open-plan office, person-machine interactions; psychosocial factors and stress, including
conditions of work, new work forms, bullying, burnout, unemployment, stress-associated diseases;
Level 1: health-promoting organization of the workplace: work tasks and organization, including working
in groups, working time, regulation of coffee and lunch breaks; company health management: absence
(determining and maintaining the ability to work), addiction, health promotion; epidemiology of:
accidents in the place of work for specific occupations in Mauritius; major work-related diseases, in
different occupations; epidemiology and health and social consequences of shift- and night-work, work
during pregnancy, part-time work.
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Annex to MD
Insurance medicine, basic terms and concepts
Level 2: insurance medicine-related duties of treating physicians; independent medical examiner.
Level 1: liability principles: finality principle, causality principle.
Legal aspects of working as a physician
Level 2: determination of the degree of incapacity to work; requirements for informed consent of
patients.
Level 1: physicians’obligations: to treat, to protect confidential data, to report and to give information (if
appropriate); principles of physicians’ liability (malpractice).
FORENSIC MEDICINE: CLINICAL PICTURES
Dead body
Level 2: death, possibility of sham death / apparent death (forensic aspects); death signs (livores / rigor /
decomposition / time of death); death, estimation of time of (by postmortem changes); autopsy, forensic
indications for and duty of notification of death to police / to judge.
Level 1: death, (forensic) establishment of manner of death (accident / suicide / homicide / natural death /
undetermined death).
Legal aspects of injury
Level 2: abuse, maltreatment (maltraitance) forensic aspects.
Level 1: classification of injury in law (mild injury / severe injury / intention / negligence).
Forensic traumatology
Level 2: trauma, blunt to the skin / to long bones / to head (forensic aspects); asphyxia (forensic aspects);
aspiration and drowning (forensic aspects); injuries (in traffic) of pedestrians (forensic aspects); injuries
(in traffic) of vehicle passengers (forensic aspects).
Level 1: physical and biomechanical principles of injury; injury, self inflicted / mutilation, self-inflicted /
second party-inflicted injury / accidental injury (forensic aspects); shaken baby syndrome (forensic
aspects); injuries by sharp objects (forensic aspects); bite wounds (forensic aspects); gun shots (forensic
aspects); strangulation, types of (forensic aspects); choking, death by (forensic aspects); injury, thermal
(forensic aspects); electrical injury (forensic signs).
Death of a child
Level 1: sudden infant death syndrome; still-birth (forensic aspects); battered child syndrome.
Sexual offences
Level 2: sexual abuse in child (forensic aspects); sexual abuse in adult (forensic aspects).
Parentage testing
Level 2: parentage, uncertain (forensic aspects)
Injuries due to chemical causes
Level 2: intoxication by gases: CO, CO2, CN, H2S (forensic aspects); intoxication by psychotropic and
illicit drugs (including heroin, cocaine, amphetamine)E; alcohol intoxication (forensic aspects).
Level 1: intoxication by cyanide; intoxication by plant poisons (including mushrooms) and by animal
bites and stings.
FORENSIC MEDICINE: FURTHER KNOWLEDGE
Professional duties and responsibilities
Level 2: formal and legal pre-requisites of a medical certificate; coercive treatment, forced admission to
hospital; medical duties in emergencies.
Level 1: abortion (legal aspects); legal aspects of personality.
Interference / injury due to chemical cause
Level 2: metabolism of ethanol / blood level of ethanol.
Level 1: pathways of poisons; principles of intoxication.
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Annex to MD
Forensic traumatology
Level 1: traffic injuries: biomechanics.
Examination
Level 1: establishing the cause and manner of death at the place of death; examination of the eyes in dead
body (double ectropination of the eyelids); anogenital examination in living person and dead body for
forensic purposes; estimation of wound age in living person and dead body for forensic purposes;
establishment of identity of dead persons in mass disaster; identification of dead body (establishment of
identity of dead person); legal external inspection of dead body; external examination of dead body;
diagnosis of cerebral death; examination and documentation of wounds and ecchymoses in living person
and dead body; investigation of battered children; assessment of ability to judge; assessment of current
fitness to drive e.g. under the influence of alcohol, drugs, disease or fatigue; assessment of aptitude to
drive including minimal medical standards for drivers.
Procedures
Level 1: sampling of blood and urine for toxicological analysis; collection of specimens from dead body
and protection of biological evidence; sampling of vaginal-, anal- and skin-swabs for DNA-analysis;
sampling of blood and buccal swabs for DNA-analysis.
40