Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Aug 2018

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
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Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : JC01 - JC06 Full Version

Implementation of Competency Based Medical Education Curriculum in Paediatrics for Phase 2 MBBS Undergraduates- A Descriptive Study

Published: January 1, 2023 | DOI:
S Revathy, V Sandhya, R Prabhavathi, Chejety Rakesh Reddy, M Govindaraj

1. Senior Resident, Department of Paediatrics, Dr. B.R. Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India. 2. Assisstant Professor, Department of Paediatrics, Dr. B.R. Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India. 3. Assisstant Professor, Department of Paediatrics, Dr. B.R. Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India. 4. Junior Resident, Department of Paediatrics, Dr. B.R. Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India. 5. Professor, Department of Paediatrics, Dr. B.R. Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India.

Correspondence Address :
R Prabhavathi,
706, Favourite Elegance Apartments, Near Ambedkar Medical College, Bengaluru-560032, Karnataka.


Introduction: Adoption of Competency Based Medical Education-Undergraduate (CBME-UG) curriculum is made mandatory in medical colleges by National Medical Commission (NMC). CBME-UG curriculum enumerates the expected knowledge and skills in detail and it focuses more on observable outcomes that are important in day-to day medical practice. This curriculum holds the teacher as well as learner equally responsible in running the educational programme.

Aim: To put forth the approach adopted in implementation of CBME-UG curriculum for phase 2 MBBS students in paediatric subject.

Materials and Methods: This article describes the steps applied in transforming the traditional structured teaching method to the CBME method for undergraduate phase 2 MBBS students in the Department of Paediatrics at Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India, during January 2021 to December 2021. The duration of one year was divided into preimplementation phase (three months) and implementation phase (nine months). The faculty of the department, a coordinator to overview the programmeme, the postgraduate residents, and the students of phase 2 MBBS were the stakeholders identified in order to run the CBME-UG educational programmeme.

Results: Preimplementation phase consisted of designing the department module and sensitisation of involved stakeholders. The contents of the module were curriculum planner for three years, time-table plan for phase II MBBS students, structuring of teaching sessions, designing the assessment method, and designing the feedback method. Implementation phase during clinical postings for the phase II MBBS students incorporated the strategies designed in preimplementation phase. The teaching sessions, assessment, the feedback sessions, and student-doctor programmeme were implemented with realistic and feasible planning.

Conclusion: The CBME curriculum was successfully implemented among undergraduate second year medical students in term of student feedback and performance. It was noted that appropriate planning and sensitisation of students as well as the teachers, helped in running the programme smoothly.


Student feedback, Teaching module, Educational programme

Medical education in India was centered more around time-bound learning approach, didactic lecture teaching methods and there was less of patient based learning (1). Introduction of Competency Based Medical Education (CBME) in India will in contrast increase the focus of medical education on patient outcome, de-emphasise time based learning and emphasise on being learner centered. The CBME curriculum enumerates the expected knowledge and skills in detail and it focuses more on observable outcomes that are important in day to day medical practice. This curriculum holds the teacher as well as learner equally responsible in running the educational programme (1).

Adoption of Competency Based Medical Education Undergraduate (CBME-UG) curriculum is made mandatory in medical colleges by National Medical Commission (NMC). An Entrustable Professional Activity (EPA) is a unit of professional work that the Indian medical graduate should be able to execute unsupervised (2). Competencies designed by the NMC (for CBME-UG subject wise) comprise of components such as knowledge, skills and attitudes which are necessary to ensure that every Indian medical graduate has completed the expected EPA’s. In view of increasing violence and medico-legal allegations against doctors it is important to work on these aspects of ensuring quality of medical education. Several Indian articles have emphasised on importance of transformation to CBME and possible hurdles that will be encountered during this transformation (2),(3). Need for this change was foreseen even a decade ago by Singh T et al., as stated in a study conducted by them to identify as to which pedagogic themes should be incorporated under faculty development programmemes in India (4). Also, few studies have stressed on need for a module to successfully implement CBME programmeme in an institute (5),(6),(7).

This article highlights the on-field application of the instructions provided by Medical Council of India (MCI) for implementation of CBME-UG curriculum (8). It discusses how department learning module can be developed to implement the CBME-UG curriculum in each department and importance of identification of stakeholders involved in this educational programmeme along with early sensitization of these stakeholders about their responsibilities in this transformation. It also lays emphasis on sequencing the milestones over three years in form of curriculum planner for the learner to achieve the expected competencies. Hence, present study aimed to describe the steps applied in transforming the traditional structured teaching method to the CBME method for undergraduate phase 2 MBBS students in the Department of Paediatrics.

Material and Methods

This descriptive study was conducted to describe the steps applied in transforming the traditional structured teaching method to the CBME method for UG phase 2 MBBS students in the Department of Paediatrics, Dr BR Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India, during January 2021 to December 2021. No ethical issues involved in this educational programme.

The methodology was framed adopting the recommendations provided in one of the articles describing the design and implementation of the competency based medical education training programme for medical oncology residents in Canada (9). Incorporating the recommendations, the duration of one year, January 2021 to December 2021 was divided with pre implementation of phase three months and implementation phase of nine months.

Preimplementation phase: It focused on recognisation and early engagement of the stakeholders to run this educational programme. Stakeholders being faculty of Department of Paediatrics (eight), a Department Co-ordinator to overview the programme, postgraduate residence in the Department (five) and the students of phase 2 MBBS (n=91). Selection of competencies and categorisation of them under different phases was important part of framing learning module. Developing teaching, assessment and feedback systems that is realistic and practical was also important focus of Preimplementation phase.

Implementation phase: It was during the period when the students were posted in batches for clinical postings: duration of postings was two weeks for each batch.


I) Preimplementation phase

This consisted of developing department module and sensitisation of the stakeholders.

A. Developing department module

Following are contents incorporated in the module:

a) Curriculum planner for 3 year: As per the Rajiv Gandhi University of Health Sciences ( the study institute is affiliated to this university) timetable (10), the students attend the clinical postings of two weeks in MBBS 2nd year (phase 2), three weeks in MBBS 3rd year (phase 3 part 1) and eight weeks in MBBS final year ( phase 3 part 2). The lectures (40 hours), and small group discussion sessions (64 hours i.e 32 hours sessions) are divided among the phase 3 part 1 and phase 3 part 2 academic years. (Table/Fig 1),(Table/Fig 2),(Table/Fig 3) shows the curriculum planner developed in the department module for the three years based on allotted hours of clinical posting and theory for the subject of paediatrics.

b) Timetable for phase 2 MBB S students: Total of 91 students reported for the clinical posting, and were grouped into six batches (out of 100, 91 students were eligible to enter phase 2 after phase 1 exams). Each batch attended two weeks of clinical posting (10 effective days). Following was the timetable framed for them:

Day 1-Overview of growth in children
Day 2-Developmental milestones
Day 3-Complementary feeding and dietary history
Day 4-Breastfeeding
Day 5-Immunisation
Day 6-Normal newborn care
Day 7-Vital signs in paediatrics
Day 8-Paediatrics case sheet writing
Day 9-Objective Structured Clinical Examination (OSCE) internal assessment and feedback
Day 10-Repeat assessment for students who have not passed the examination previous day.

Signing log books; checking of student doctor programmeme performance.

Students were informed to do self-directed learning on the topic-Recommended Dietary Allowance (RDA) and dietary sources of all vitamins’ on day1 of clinical postings. Paediatrics topics for Self Directed Learning (SDL) were chosen from the list of competencies given by NMC. The students were provided with list of reliable sources (textbooks and articles) from which they could read and understand the topic. These topics were assessed as one of stations in OSCE assessment.

c) Structuring of teaching sessions planned for MBB S 2nd year (phase 2) students: During the two weeks of clinical posting, the duration of three hours in each session was divided into four parts.

• Introductory lecture was taken to improve the students’ knowledge about the topic planned for the day (cognitive domain)
• Demonstration of psychomotor domain (history elicitation, bedside skills, procedural skills) and affective domain (counselling skills) by the teachers and observation by students.
• Assisting students perform the above psychomotor and affective domain skills on real patients or under stimulated environment.
• Verbal feedback by the teacher to the student about their performance.

d) Designing assessment method for phase 2 MBB S (11),(12),(13): When designing the assessment method for the above-mentioned phase 2 MBBS syllabus, the following were taken into consideration:

• Certifiable skills, during assessment.
• Selection of other observable skills which need direct observation during assessment.
• Using assessment elements that are easy to use in the workplace with the available resources i.e. patients, simulations (11), available time, infrastructure, number of faculty available for the assessment.

OSCE was considered to be an ideal method for assessment (14)

e) Designing the feedback systems (2),(15): Feedback systems were designed considering following requirements:

• Bidirectional feedback
• Needs to be on-going process starts from first step of learning to attaining the competence (14).
• Well timed feedback soon after learning activity which will help the learner to initiate remedial measures as the learning event is still fresh in their mind (14).
• Feedback to be given in an objective manner, rather than being subjective or judgemental (14).

Incorporating the above requirements two levels of feedback systems were designed:

Teacher to Learner-Verbal feedback based on first hand observation during teaching and assessment.

Learner to Teacher-feedback documented as Google forms designed by senior faculty.

(Associate Professor in Department of Paediatrics)

B) Sensitisation of the involved stakeholders (6):

Teachers have undergone faculty development programmeme conducted in this institution.

• Meeting was conducted to sensitise the teachers about how this new educational programmeme helps in the implementation. Here is an example on how to put forth the planner in such a department meeting [pdf-1].
• Both learners and teachers were sensitised that achieving the targeted competency is on-going process which is spanned over three learning years. Here is the example of sample framework to achieve the competency which was used to sensitise the stakeholders how the curriculum works (Table/Fig 4).

The learners were sensitised to use logbook and maintain the documentation periodically, the use of reflection section by learners is equally important in improving their skills.

II) Implementation

a. Teaching sessions: Immunisation session implementation, (Table/Fig 5) shows how the preimplementation plan had been applied during the teaching session.

b. Assessment- the content of OSCE is depicted in (Table/Fig 6). Ten OSCE stations were prepared for the assessment. Exam was conducted in batches of approximately 15 students. Total 81, out of 91 students took the OSCE. Each student was given the same scenario.

Example Task: A 4-year-old female child was brought by the mother-Elicit the developmental history and demonstrate the developmental milestones (this child with parent was available in OSCE station and the student reads the task and performs what is required).

Examiner was provided with the checklist used to evaluate the student objectively (Table/Fig 7).

The mean score for this station (OSCE station 7) of one of the batches (14 students ) was 4.1. mean scores for OSCE stations 1,2,3,4,5,6,8,9,10 were 3.5, 2.3, 3.0, 4.2, 3.76, 3.46, 3.1, 3.9, 3.4, respectively.

c. Feedback: Teacher to student-Incorporating the preimplementation requirements, verbal feedback at each level from learning to attaining the competency was as implemented (Table/Fig 8).

Student to teacher-Google feedback form was given to the students to know their feedback about the teaching sessions and assessments [pdf-2].

The responses were enclosed [Excel sheet 1].

d. Students Doctor programme: This is a new concept introduced by NMC for CBME curriculum. The goal of learner doctor programmeme is to provide learners with experience of longitudinal patient care, being a part of healthcare system and hands-on care of patients in Outpatient Department (OPD) and Inpatient Department (IPD) setting. Focuses of learner doctor method in phase 2 are: History taking, physical examination, assessment of change in clinical status, communication and patient education.

During the implementation of this programmeme for phase-2 students, a checklist was prepared as per the guidelines given by NMC [pdf-3] (8). Each student was assigned a patient during their clinical posting in paediatrics. They were explained about the programmeme and were instructed to complete the requirements of checklist given to them. At the end of their posting, logbook was checked by the designated faculty for its completeness and quality of report on the patient assigned. Verbal feedback was given to students regarding the same.


The present study explains necessary steps to be taken to do feasible implementation rather than just an on-paper protocol. Prior understanding of limitations and strengths at institutional level will help in proper strategy framing and implementation of CBME undergraduate curriculum. Developing curriculum planner subject wise becomes important to ensure that all competencies in curriculum are covered and that clinical postings and skill lab postings rotation align with the competencies requiring direct observation (9). Sequencing the 398 Specific Learning Objectives (SLO) in a more meaningful way to take the Indian medical graduate through hierarchical manner of learning-understanding interpretation and application.

Competency based undergraduate curriculum is a learner centred approach. It gives greater flexibility for students to attain the competencies at their pace. Teaching and learning becomes a more accountable process when compared to traditional methods. A cross-sectional descriptive study involving students from 74 colleges across India was conducted to assess learners’ perspective of the newer curriculum components in the phase 1 MBBS. This study showed nearly 75% students felt that the concepts of early clinical exposure, foundation course, attitude ethics and communication sessions were useful, hence proving that this new innovation is most welcome by the students (16).

Though, many curriculum implementation support programmemes and medical education technology teaching programmemes have been conducted nationwide, there are still no uniform guidelines on how to practically apply the SLO’s to teaching the long spanned subjects like paediatrics, obstetrics and gynaecology, medicine and surgery. Faculty development is also at premature stage as most of medical faculty still do not prioritise curriculum planning (4),(17),(18). Hence, designing and implementation is a lot cumbersome and time consuming process. The teaching session design described in this article is alomst comparable to Gagne’s instructional design in applying theory to teaching practice The gagne’s nine events of instructions includes 1) gaining attention of listeners 2) informing the learner of the objective 3) stimulating recall of prerequisite learning 4) presenting the stimulus 5) providing learning guidance 6) eliciting the performance 7) providing feedback about performance corrections 8) assessing the performance and 9) enhancing retention and transfer (15).

The postgraduate residents were also involved in conducting these interactive sessions. Prior discussion them about the session planning and involving them in process of teaching enhanced the self-esteem of our postgraduate residents (19) Formal training of residents in teaching CBME-UG (20) curriculum, will provide more effective manpower in managing the classes (10). Each paediatrics unit must consist of one professor, one associate professor, two assistant professors and three senior residents in order to effectively continue the CBME teaching along with patient care. There is a need for recruiting academic advisors in each department to guide the faculty and the learner through this CBME programmeme and ensure its consistent functioning (15). Newer methods of teaching such as small group discussion, clinical videos and case scenario based discussion, demonstration of affective and psychomotor skills bedside or under simulated atmosphere and self-directed learning make knowledge application more appreciable and learner centered. Components of CBME such as, self directed learning and student doctor programme, shift the responsibility of learningfrom the teachers to the students. Formative assessment methods are more powerful tools because they direct the students’ learning efforts towards learning outcomes at the level of understanding, interpretation and application which are always retained longer and have greater transfer value at workplace (1),(2),(21),(22).


Lack of alignment and integration in the above conducted teaching programmeme was a drawback. Though, the concept of alignment and integration is one of the main focus of CBME, its initiation requires preparedness of all the individual departments.


Competency based medical education-undergraduate curriculum implementation was successful in term of student feedback and performance. It was noted that appropriate planning and sensitisation of students as well as the teachers, helped in running the programme smoothly. The department module which was developed, aided in the thorough understanding of the strengths and limitations in running the CBME programme for the undergraduates. Strengthening of feedback systems through proper validation and reliability checks is also the need of the hour. Further, research must be carried out to identify tools which can be used to continuously evaluate the effectiveness of implementation. This will facilitate the incorporation necessary changes in response to real time challenges.


Authors are grateful to all the department faculty members and postgraduate residents whose cooperation have made this curriculum implementation a success.


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DOI and Others

DOI: 10.7860/JCDR/2023/57002.17257

Date of Submission: Apr 09, 2022
Date of Peer Review: Jun 25, 2022
Date of Acceptance: Sep 26, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

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