Indian Pediatrics 2001; 38: 847-862  

IAP Guidelines For Postgraduate Medical Education in Pediatrics

Compiled by R.N. Srivastava (Chairperson), S.K. Mittal, Vinod K. Paul (Convenor), S. Ramji on behalf of IAP Education Center.

Correspondence to: Dr. R.N. Srivastava, IAP Education Center, 4222-A Kala Kunj, 1, Ansari Road, Daryaganj, New Delhi 110 002, India.
Email: [email protected]

The need for a reappraisal and a critical evaluation of the Postgraduate (MD and DCH) training program in Pediatrics has been felt by the pediatric fraternity in the country for a long time. The process of reappraisal got an impetus when the Medical Council of India (MCI) requested the Indian Academy of Pediatrics (IAP) to suggest the syllabus and curriculum for postgraduate education in Pediatrics. The MCI set up a committee under the chairmanship of Dr. B.C. Chhaparwal to finalize the recommendations. The aims and objectives of the program have been re-examined in light of the growing importance of Pediatrics and Child Health, including adolescent health, in the national context. The present guidelines are the result of a series of workshops and consultations with heads of pediatric departments in the country initiated by the IAP Education center. The consensus document was finalized at the MCI supported CME cum workshop at Maulana Azad Medical College, New Delhi, in October 2000 (Annexure 1 provides the List of Participants).

It is also important to ensure minimum standards at Postgraduate training institutions to achieve uniformity in Postgraduate training. The IAP Education Center has suggested criteria for accreditation of Departments undertaking Postgraduate education (Annexure 2), and a list of essential equipment, which must be available at these institutions (Annexure 3). It is hoped that MCI will also adopt these guidelines.

(A) MD Pediatric Program

1. GOAL

The goal of MD course in Pediatrics is to produce a competent pediatrician who:

(i) recognizes the health needs of infants, children and adolescents and carries out professional obligations in keeping with principles of National Health Policy and professional ethics;

(ii) has acquired the competencies pertaining to pediatrics that are required to be practiced in the community and at all levels of health care system;

(iii) has acquired skills in effectively communicating with the child, family and the community;

(iv) is aware of the contemporary advances and developments in medical sciences as related to child health;

(v) is oriented to principles of research methodology; and

(vi) has acquired skills in educating medical and paramedical professionals.

2. Objectives

At the end of the MD course in Pediatrics, the student should be able to

(i) recognize the key importance of child health in the context of the health priority of the country;

(ii) practice the specialty of Pediatrics in keeping with the principles of professional ethics;

(iii) identify social, economic, environ-mental, biological and emotional determinants of child and adolescent health, and institute diagnostic, therapeutic, rehabilitative, preventive and promotive measures to provide holistic care to children;

(iv) recognize the importance of growth and development as the foundation of Pediatrics; and help each child realize her/his optimal potential in this regard;

(v) take detailed history, perform full physical examination including neuro-development and behavioral assessment and anthropometric measurements of the child and make clinical diagnosis;

(vi) perform relevant investigative and therapeutic procedures for the pediatric patient;

(vii) interpret important imaging and laboratory results;

(viii) diagnose illness in children based on the analysis of history, physical examination and investigative work up;

(ix) plan and deliver comprehensive treatment for illness in children using principles of rational drug therapy;

(x) plan and advise measures for the prevention of childhood disease and disability.

(xi) plan rehabilitation of children suffering from chronic illness and handicap, and those with special needs;

(xii) manage childhood emergencies efficiently;

(xiii) provide comprehensive care to normal, ‘at risk’ and sick neonates;

(xiv) demonstrate skills in documentation of case details, and of morbidity and mortality data relevant to the assigned situation;

(xv) recognize the emotional and behavioral characteristics of children, and keep these fundamental attributes in focus while dealing with them;

(xvi) demonstrate empathy and humane approach towards patients and their families and respect their sensibilities;

(xvii) demonstrate communication skills of a high order in explaining management and prognosis, providing counseling and giving health education messages to patients, families and communities;

(xviii) develop skills as a self-directed learner, recognize continuing educational needs; use appropriate learning resources, and critically analyze relevant published literature in order to practice evidence-based pediatrics;

(xix) demonstrate competence in basic concepts of research methodology and epidemiology;

(xx) facilitate learning of medical/nursing students, practicing physicians, para-medical health workers and other providers as a teacher-trainer;

(xxi) play the assigned role in the implementation of national health programs, effectively and responsibly;

(xxii) organize and supervise the desired managerial and leadership skills;

(xxiii) function as a productive member of a team engaged in health care, research and education.

3. Syllabus

General Guidelines. During the training period effort must always be made that adequate time is spent in discussing child health problems of public health importance in the country or a particular region.

3.1. Approach to Important Clinical Problems

3.1.1. Growth and development. Short stature, obesity, precocious and delayed puberty, developmental delay, impaired learning.

3.1.2. Neonatology. Normal newborn, low birth weight newborn, sick newborn.

3.1.3. Nutrition. Lactation management and complementary feeding, protein energy malnutrition (underweight, wasting, stunting) and micronutrient deficiencies, failure to thrive.

3.1.4. Cardiovascular. Murmur, cyanosis, congestive heart failure, systemic hypertension, arrhythmia, shock.

3.1.5. GIT and liver. Acute, persistent and chronic diarrhea, abdominal pain and distension, ascitis, vomiting, consti-pation, gastrointestinal bleeding, jaundice, hepatosplenomegaly and chronic liver disease, hepatic failure and encephalopathy.

3.1.6. Respiratory. Cough/chronic cough, noisy breathing, wheezy child, respiratory distress, hemoptysis.

3.1.7. Infections. Acute onset pyrexia, prolonged pyrexia with and without localizing sign, recurrent infections, nosocomial infections.

3.1.8. Renal. Hematuria/dysuria, bladder/bowel incontinence, voiding dys-functions, inguinoscrotal swelling, renal failure (acute and chronic).

3.1.9. Hematooncology. Lymphadeno-pathy, anemia, bleeding.

3.1.10. Neurology. Limping child, convul-sions, abnormality of gait, intracranial space occupying lesion, paraplegia, quadriplegia, large head, small head, floppy infant, acute flaccid paralysis, cerebral palsy and other neuromotor disability, headache.

3.1.11. Endocrine. Thyroid swelling, ambi-guous genitalia,obesity, short stature.

3.1.12. Skin/Eye/ENT. Skin rash, pigmen-tary lesions, pain/discharge from ear, hearing loss, epistaxis, refractory errors, blindness, cataract, eye discharge, redness, squint, proptosis.

3.1.13. Miscellaneous. Habit disorders, hyperactivity and attention deficit syndrome, arthralgia, arthritis, multi-ple congenital anomalies.

3.2. Disorders

(Definition, epidemiology, etiopathogenesis, presentation, complications, differential diag-nosis, and treatment).

3.2.1. Growth and development. Principles of growth and development, normal growth and development in childhood and adolescence, deviations in growth and development, sexual maturation and its disturbances.

3.2.2. Neonatology. Perinatal care, normal newborn, care in the labor room and resuscitation, low birth weight, pre-maturity, newborn feeding, common transient phenomena, respiratory distress, apnea, infections, jaundice, anemia and bleeding disorders, neurologic disorders, gastrointestinal disorders, renal disorders, malforma-tions, thermoregulation and its dis- orders, understanding of perinatal medicine.

3.2.3. Nutrition. Maternal nutritional disorders: impact on fetal outcome, nutrition for the low birth weight, breast feeding, infant feeding including complementary feeding, protein energy malnutrition, vitamin and mineral defi-ciencies, trace elements of nutritional importance, obesity, adolescent nutri-tion, nutritional management in diarrhea, nutritional management of systemic illnesses (celiac disease, hepatobiliary disorders, nephrotic syndrome), parenteral and enteral nutrition in neonates and children.

3.2.4. Cardiovascular. Congenital heart diseases (cyanotic and acyanotic), rheumatic fever and rheumatic heart disease, infective endocarditis, arrhyth-mia, diseases of myocardium (cardio-myopathy, myocarditis), diseases of pericardium, systemic hypertension, hyperlipidemia in children.

3.2.5. Respiratory. Congenital and acquired disorders of nose, infections of upper respiratory tract, tonsils and adenoids, obstructive sleep apnea, congenital anomalies of lower respiratory tract, acute inflammatory upper airway obstruction, foreign body in larynx, trachea and bronchi, subglottic stenosis (acute and chronic), trauma to larynx, neoplasm of larynx and trachea, bronchitis, bronchiolitis, aspiration pneumonia, GER, acute pneumonia, recurrent and interstitial pneumonia, suppurative lung disease, atelectasis, lung cysts, emphysema and hyper-inflation bronchial asthma, pulmonary edema, bronchiectasis, pleural effusion, pulmonary leaks, mediastinal mass.

3.2.6. Gastrointestinal and liver diseases. Diseases of mouth, oral cavity and tongue, disorders of deglutition and esophagus, peptic ulcer disease, H. pylori infection, foreign body, congenital pyloric stenosis, intestinal obstruction, malabsorption syndrome, acute and chronic diarrhea, irritable bowel syndrome, ulcerative colitis, Hirsch-sprung’s disease, anorectal mal-formations, liver disorders: hepatitis, hepatic failure, chronic liver disease, Wilson’s disease, Budd-Chiari syn-drome, metabolic diseases of liver, cirrhosis and portal hypertension.

3.2.7. Nephrologic disorders. Acute and chronic glomerulonephritis, nephrotic syndrome, hemolytic uremic syn-drome, urinary tract infection, VUR and renal scarring, renal involvement in systemic diseases, renal tubular disorders, con-genital and hereditary renal dis-orders, renal and bladder stones, posterior ure-thral valves, hydroneph-rosis, voiding dysfunction, enuresis, undescended testis, Wilm’s tumor, fluid-electrolyte disturbances.

3.2.8. Neurologic disorders. Seizure and non seizure paroxysmal events, epilepsy and epileptic syndromes of childhood, meningitis, brain abscess, coma, acute encephalitis and febrile encephalo-pathies, Guillain-Barre syndrome, neurocysticercosis and other neuro-infestations, HIV encephalopathy, SSPE, cerebral palsy, neurometabolic disorders, mental retardation, learning disabilities, muscular dystrophies, acute flaccid paralysis and AFP surveillance, ataxia, movement disorders of child-hood, CNS tumors, malformations.

3.2.9. Hematology and oncology. Deficiency anemia, hemolytic anemia, aplastic anemia, pancytopenia, disorders of hemostasis, thrombocytopenia, blood component therapy, transfusion related infections, bone marrow transplant/ stem cell transplant, acute and chronic leukemia, myelodysplastic syndrome, Hodgkin disease, non-Hodgkin’s lymphoma, neuroblastoma, hyper-coagulable states.

3.2.10. Endocrinology. Hypopituitarism/hyperpituitarism, Diabetes insipidus, pubertal disorders, hypo- and hyper-thyroidism, hypo- and hyperparathy-roidism, adrenal insufficiency, Cushing’s syndrome, adrenogenital syndromes, diabetes mellitus, hypogly-cemia, short stature, failure to thrive, gonadal dysfunction and intersexuality, pubertal changes and gynecological disorders.

3.2.11. Infections. Bacterial, viral, fungal, para-sitic, rickettssial, mycoplasma, Pneumo-cystis carinii infections, chlamydia, protozoal and parasitic, tuberculosis, HIV, nosocomial infections, control of epidemics and infection prevention.

3.2.12. Emergency and critical care. Emergency care of shock, cardio-respiratory arrest, respiratory failure, congestive cardiac failure, acute renal failure, status epilepticus, fluid and electrolyte disturbances and its therapy, acid-base disturbances, poisoning, accidents, scorpion and snake bites.

3.2.13. Immunology and rheumatology. Arthritis (acute and chronic), connec-tive tissue disorders, disorders of immunoglobulins, T and B cell dis-orders, immunodeficiency syn-dromes.

3.2.14. ENT. Acute and chronic otitis media, conductive/sensorineural hearing loss, post-diphtheritic palatal palsy, acute/chronic tonsillitis/adenoids, allergic rhinitis/sinusitis, foreign body.

3.2.15. Skin diseases. Exanthematous illnesses, vascular lesions, pigment disorders, vesicobullous disorders, infections: pyogenic, fungal and parasitic; Steven-Johnson syndrome, eczema, seborrheic dermatitis, drug rash, urticaria, alopecia, icthyosis.

3.2.16. Eye problems. Refraction and accommodation, partial/total loss of vision, cataract, night blindness, chorio-retinitis, strabismus, conjunctival and corneal disorders, retinopathy of pre-maturity, retinoblastoma, optic atrophy, papilledema.

3.2.17. Behavioral and psychological dis-orders. Rumination, pica, enuresis, encopresis, sleep disorders, habit disorders, breath holding spells, anxiety disorders, mood disorders, temper tantrums, attention deficit hyperactivity disorder, infantile autism.

3.2.18. Social pediatrics. National health programs related to child health, child abuse and neglect, child labor, adoption, disability and rehabilitation, rights of the child, national policy of child health and population, juvenile delinquency.

3.2.19. Genetics. Chromosomal disorders, single gene disorders, multifactorial/polygenic disorders, genetic diagnosis, and prenatal diagnosis.

3.2.20. Orthopedics. Major congenital ortho-pedic deformities, bone and joint infections: pyogenic, tubercular, and common bone tumors.

3.3. Skills

3.3.1. History and examination. History taking including psychosocial history, physical examination including fundus examination, newborn examination, including gestation assessment; thermal protection of young infants, nutritional anthropometry and its assessment, assessment of growth, use of growth chart, SMR rating, develop-mental evaluation, communication with children, parents, health function-aries and social support groups; and genetic counseling.

3.3.2. Bedside procedures

(a) Monitoring skills: Temperature record-ing, capillary blood sampling, arterial blood sampling.

(b) Therapeutic skills: Hydrotherapy, nasogastric feeding, endotracheal intubation, cardiopulmonary resuscita-tion (pediatric and neonatal), adminis-tration of oxygen, venepuncture and establishment of vascular access, administration of fluids, blood, blood components, parenteral nutrition, intraosseous fluid administration, intrathecal administration of drugs, common dressings, abscess drainage and basic principles of rehabilitation.

(c) Investigative skills: Lumbar puncture, ventricular tap, bone marrow aspira-tion, pleural, peritoneal, pericardial and subdural tap, biopsy of liver and kidney, collection of urine for culture, urethral catheterization, supra-pubic aspiration.

3.3.3. Bedside investigations. Hemoglobin, TLC, ESR, peripheral smear staining and examination, urine: routine and microscopic examination, stool micro-scopy including hanging drop prepara-tion, examination of CSF and other body fluids, Gram stain, ZN stain, shake test on gastric aspirate.

3.3.4. Interpretation of  X-rays of chest, abdomen, bone and head; ECG; ABG findings; CT scan.

3.3.5. Understanding of  common EEG patterns, audiograms, ultrasonographic abnormalities and isotope studies.

3.4. Basic Sciences

Embryogenesis of different organ systems especially heart, genitourinary system, gastro-intestinal tract, applied anatomy of different organs, functions of kidney, liver, lungs, heart and endocrinal glands. Physiology of micturi-tion and defecation, placental physiology, fetal and neonatal circulation, regulation of tempera-ture (especially newborn), blood pressure, acid base balance, fluid electrolyte balance, calcium metabolism, vitamins and their functions, hematopoiesis, hemostasis, bilirubin meta-bolism. Growth and development at different ages, puberty and its regulation, nutrition, normal requirements of various nutrients. Basic immunology, bio-statistics, clinical epidemio-logy, ethical and medicolegal issues, teaching methodology and managerial skills, pharmaco-kinetics of commonly used drugs, microbial agents and their epidemiology.

3.5. Community and Social Pediatrics

National health nutrition programs, nutrition screening of community, prevention of blindness, school health programs, prevention of sexually transmitted diseases, contraception, health legislation, national policy on children, adolescence, adoption, child labor, juvenile delinquency, government and non-government support services for children, investigation of adverse events following immunization in the community, general principles of prevention and control of infections including food borne, waterborne, soil borne and vector borne diseases, investigation of an outbreak in a community.

4.0 TEACHING PROGRAM

4.1. General Principles

· Acquisition of practical competencies being the keystone of postgraduate medical education, postgraduate training should be skills oriented.

· Learning in postgraduate program should be essentially self-directed and primarily emanating from clinical and academic work. The formal sessions are merely meant to supplement this core effort.

4.2. Formal Teaching Sessions

In addition to bedside teaching rounds, at least 5 hours of formal teaching per week are a must. The departments may select a mix of the following sessions:

Additional sessions on basic sciences, biostatistics, research methodology, teaching methodology, health economics, medical ethics and legal issues related to pediatric practice are suggested.

Note: These additional sessions may be organized as an institutional activity for all postgraduates.

4.3. Rotations

The postgraduate student should rotate through all the clinical units in the department. In addition, following special rotations should be undertaken:

Must

· Neonatology
(including perinatology) - 6 months [maximum 9 months]

· Intensive Care/Emergency - 3 months

Posting in Out patient Services of the following specialties is recommended for the duration indicated below:

Note: In addition the candidates may be posted to allied specialities such as cardiology, neurology, etc. (depending on facilities available locally) for appropriate training.

5.0 Thesis

5.1. Objectives

By carrying out a research project and presenting his work in the form of thesis, the student will be able to:

(i) Identify a relevant research question; (ii) conduct a critical review of literature; (iii) formulate a hypothesis; (iv) determine the most suitable study design; (v) state the objectives of the study; (vi) prepare a study protocol; (vii) undertake a study according to the protocol; (viii) analyze and interpret research data, and draw conclusions; (ix) write a research paper.

5.2. Guidelines

While selecting thesis topics, following should be kept in mind:

(i) The scope of study should be limited so that it is possible to conduct it within the resources and time available to the student; (ii) the emphasis should be on the process of research rather than the results; (iii) the research study must be ethically appropriate; (iv) the protocol, interim progress as well as final presentation must be made formally to the entire department; (v) only one student per teacher/thesis guide; (vi) there should be periodic departmental review of the thesis work as per following schedule:

5.3. General observations

• There should be a training program on research methodology for existing faculty to build their capacity to guide research.

• Within 2 months of thesis submission the candidate should be communicated the acceptance/rejection of the thesis.

• The thesis should be sent to at least 2 reviewers and rejected if only both reject it.

6.0 Assessment

It is strongly recommended that all those involved in teaching and examinations attend workshop on "Educational Science Technology for Medical Teachers" conducted by several medical institutions in the country.

6.1. General principles

• The assessment should be valid, objective, and reliable.

• It must cover cognitive, psychomotor and affective domains.

• Formative, continuing and summative (final) assessment should be conducted in theory as well as practicals/clinicals. In addition, thesis should be assessed separately.

6.2. Overall weightage

Internal assessment	40% [equally divided into theory and practi-cal domains]
Final summative examination	60% [equally divided into theory and practi-cal domains]

6.2.1. Formative

The formative assessment should be continuous as well as end-of-term. The former should be based on the feedback from the senior residents/registrars and the consultants concerned. End-of-term assessment should be held at the end of each semester (upto the 5th semester). Formative assessment will not count towards pass/fail at the end of the program, but will provide feedback to the candidate.

6.2.2. Internal assessment

Proposed Internal Assessment

Items

Weightage(%)

Timing of assessment

1. Personal attributes*

15

Ongoing after each clinical
posting

2. Clinical skills and performance

-do-

3. Academic activities
(journal club, seminars, case discussion)

4. End of term theory exami-nation**
(I year, II  year, 2 years and 9 months)

5. End of term practical exam
(Case - 50%, Spots/OSCE - 25%, Viva  - 25%)

* Personal attributes

• Availability: Punctual, available continu-ously on duty, responds promptly to calls, takes proper permission for leave.

• Sincerity and motivation: Dependable, honest, admits mistakes, does not falsify information, exhibits good moral values, loyal to institution, has initiative, takes on responsibilities, goes beyond routine work, exhibits keen desire to learn.

• Diligence and performance: Dedicated, hardworking, does not shirk duties, leaves no work pending, does not sit idle, competent in clinical case work up and management (where applicable), skilled in procedures, proficient in record keeping and file work.

• Academic ability: Intelligent, shows sound knowledge and skills, participates ade-quately in academic activities, and performs well in oral presentation and departmental tests.

• Inter-personal skills: Has compassionate attitude towards patients, gets on well with colleagues and paramedical staff, respectful to seniors.

**Syllabus for end term theory assessment

I year - General pediatrics, growth and development, nutrition, Bio-statistics, infectious disease, neonatology.

II year - Approach to clinical disorders and emergencies.

III year - Whole syllabus.

6.2.3. Summative Assessment

• Ratio of marks in theory and practicals will be equal.

• The pass percentage will be 50%.

• Candidate will have to pass theory and practical examinations separately.

6.2.3.1. Theory

* Cluster-I - Nutrition, growth and deve-lopment, immunization, infectious disease, genetics, immunology, rheumatology, psychiatry and behavioral sciences, skin, eye, ENT, adolescent health, critical care, accidents and poisoning.

** Cluster-II - Neurology and disabilities, nephrology, hematology-oncology, endo-crinology, gastroenterology and hepatology, respiratory and cardiovascular disorders.

In each paper there should be 10 short essay questions (SEQ).

6.1.3.2. Practicals

Two external and two internal examiners should conduct the examinations

• Case I 20%

Case II (newborn) 20%
Case III 20%
Case IV (ambulatory/emergency care)  20%

•  Viva on defined areas by

each examiner separately 20%

(B) Diploma in Child Health (DCH) Program

1.0. General Guidelines

Despite inclusion of Pediatrics as a subject of examination at the undergraduate level, DCH courses would need to be continued in view of the limited number of seats for MD Pediatrics in various medical colleges and the need of large number of Pediatricians required to man health services at various levels including the community health centers and district hospitals. However, DCH seats should be converted to MD seats wherever possible.

Clinical rotation should be appropriately reduced, for example, neonatology for 4-6 months instead of 6-9 months. The syllabus pertaining to research methodology, biostatistics etc. included in the MD course should be omitted for the DCH course. Contents should lay less emphasis on basic sciences and much greater emphasis on commonly encountered pediatric problems such as nutrition, infections, social and preventive pediatrics etc. Principle of assessment i.e., formative (internal) and summative (external) assessment would remain the same as for MD course. Final examination should be the same as for MD except that it would have only 3 theory papers.

2.0. Goal

The goal of DCH program is to produce a competent pediatrician who:

(i) recognizes the health needs of infants, children and adolescents and carries out professional obligations in keeping with principles of national health policy and professional ethics;

(ii) has acquired the competencies pertaining to pediatrics that are required to be practiced in the community and secondary levels of health care system;

(iii) has acquired skills in effectively communicating with the child, family and the community;

(iv) is aware of the contemporary advances and developments in medical sciences as related to child health; and

(v) has acquired skills in educating medical and paramedical professionals.

3.0. Learning Objectives

At the end of the DCH course, the student should be able to:

(i) recognize the key importance of child health in the context of the health priority of the country;

(ii) practice the specialty of Pediatrics in keeping with the principles of professional ethics;

(iii) identify social, economic, environmental, biological and emotional determinants of child and adolescent health, and institute diagnostic, therapeutic, rehabilitative, preventive and promotive measures to provide holistic care to children;

(iv) recognize the importance of growth and development as the foundation of Pediatrics and help each child realize her/his optimal potential in this regard;

(v) take detailed history, perform full physical examination including neurodevelop-mental and behavioral assessment and anthropometric measurements in the child and make clinical diagnosis;

(vi) perform relevant investigative and thera-peutic procedures for the pediatric patient;

(vii) interpret important imaging and labora-tory results;

(viii) diagnose illness in children based on the analysis of history, physical examination and investigate work up;

(ix) plan and deliver comprehensive treat-ment for illness in children using principles of rational drug therapy;

(x) plan and advise measures for the prevention of childhood disease and disability;

(xi) plan rehabilitation of children suffering from chronic illness and handicap, and those with special needs;

(xii) manage childhood emergencies effi-ciently;

(xiii) provide comprehensive care to normal, ‘at risk’ and sick neonates;

(xiv) demonstrate skills in documentation of case details, and of morbidity and mortality data relevant to the assigned situation;

(xv) recognize the emotional and behavioral characteristics of children, and keep these fundamental attributes in focus while dealing with them;

(xvi) demonstrate empathy and humane approach towards patients and their families and keep their sensibilities in high esteem;

(xvii) demonstrate communication skills of a high order in explaining management and prognosis, providing counseling and giving health education messages to patients, families and communities;

(xviii) develop skills as a self-directed learner, recognize continuing educational needs, use appropriate learning resources, and critically analyze relevant published literature in order to practice evidence-based pediatrics;

(xix) play the assigned role in the imple-mentation of National Health Programs, effectively and responsibly;

(xx) organize and supervise the desired managerial and leadership skills;

(xxi) function as a productive member of a team engaged in health care, research and education.

Annexure 1: List of Participants

Dr. N.K. Arora,
Additional Professor of Pediatrics,
All India Institute of Medical Sciences,
New Delhi 110 029.

Dr. Arvind Bagga,
Associate Professor of Pediatrics,
All India Institute of Medical Sciences,
New Delhi 110 029.

Dr. Jagdish Chandra,
Professor of Pediatrics,
Lady Hardinge Medical College,
New Delhi 110 001.

Dr. Krishan Chugh,
Consultant Pediatrician,
Sir Ganga Ram Hospital,
New Delhi 110 060.

Dr. Urmilla Jhamb,
Associate Professor,
Department of Pediatrics,
Maulana Azad Medical College,
New Delhi 110 002.

Dr. Madulika Kabra,
Associate Professor of Pediatrics,
All India Institute of Medical Sciences,
New Delhi 110 029.

Dr. Sushil Kabra,
Associate Professor of Pediatrics,
All India Institute of Medical Sciences,
New Delhi 110 029.

Dr. Veena Kalra,
Professor of Pediatrcs,
All India Institute of Medical Sciences,
New Delhi 110 029.

Dr. R.K. Marwaha,
Additional Professor,
Department of Pediatrics,
Post Graduate Institute of Medical Education
and Research,
Chandigarh 160012.

Dr. S.K. Mittal,
Director Professor and Head,
Department of Pediatrics,
Maulana Azad Medical College,
New Delhi 110 002.

Dr. Dilip  Mukherjee,
Consultant Pediatrician,
Rama Krishna Mission Hospital,
9/1, Ramnath Pal Road,
Calcutta 700 023.

Dr. V.K. Paul,
Additional Professor of Pediatrics,
Department of Pediatrics,
All India Institute of Medical Sciences,
New Delhi 110 029.

Dr. K. Rajeshwari,
Assistant Professor,
Department of Pediatrics,
Maulana Azad Medical College,
New Delhi 110 002.

Dr. A.K. Dutta,
Director  Profeesor & Head,
Department of Pediatrics,
Lady Hardinge Medical College,
New Delhi 110 001.

Dr. A.K. Deorari,
Additional Professor,
All India Institute of Medical Sciences,
New Delhi 110 029.

Dr. A.P.  Dubey,
Professor of Pediatrics,
Maulana Azad Medical College,
New Delhi 110 002.

Dr. Piyush Gupta,
Reader, Department of Pediatrics,
University College of Medical Sciences,
Delhi 110 095.

Dr. S. Ramji,
Professor,
Department of Pediatrics,
Maulana Azad Medical College,
New Delhi 110 002.

Dr. H.P.S. Sachdev,
Professor,
Department of Pediatrics,
Maulana Azad Medical College,
New Delhi 110 002.

Dr. R.N. Salhan,
Consultant  Pediatrician,
CI/1233, Vasant Kunj,  New Delhi 110 065.

Dr. B. Shivananda,
Professor and Head,
Department of Pediatrics,
Bangalore Medical College,
Bangalore.

Dr. Daljeet Singh,
Professor and Head,
Dayanand Medical College,
Ludhiana 141 001.

Dr. Tejinder Singh,
Reader in  Pediatrics,
Christian Medical College,
Ludhiana 141 001.

Dr. R.N. Srivastava,
Consultant Pediatric Nephrologist,
Apollo Hospital, New Delhi 110 044.

Dr. A.D. Tewari,
Professor and Head,
Department of Pediatrics,
Rohtak Medical College, Rohtak, Haryana.

Dr. Sangeeta Yadav,
Professor,
Department of Pediatrics,
Maulana Azad Medical College,
New Delhi 110 002.

Dr. T.P. Yadav,
Consultant Pediatrician,
R.M.L. Hospital,
New Delhi.

Requisites

IAP norm

1. FACILITIES

(a)Beds (Indoor)

General

At least  50 pediatric beds and at least  10
bedded level II neonatal unit. (NNF norms)
As per MCI norms 30-50 beds. 
3 Teachers (headed by Professor / Reader)

Pediatrics Unit

Maximum:  2 PGs  per year / unit; overall PG
strength to  be in the  ratio of 4-6 beds per
post graduate student and/or 1 PG student to
PG  Teacher

Newborn Unit

Essential: Level II neonatal unit  as per NNF norms
Desirable: Level III Nursery

Sub-specialties Units

At least 2 well developed subspecialties other than
Neonatology.
[Evidence to be provided in the form of
specialty clinics, laboratory services,
publications, CME  programs, etc.]

Pediatrics ICU

Essential: 4-bedded ICU with ventilatory facilities

Diarrhea  Treatment Unit/ or equivalent

Essential

Day Care Unit (blood transfusion,
chemotherapy, biopsies,
procedures)

Desirable

(b) Out patient  services

General OPD

Minimum 50 outpatients per day
PG attendance in OPD –
Minimum: 2 days or 6 hours per week
Maximum: 3 days or 12 hours per week

Speciality Clinics

At least 3 specialty clinics per week

(c) Emergency/casualty

24 hours

(d) Community Field Practice Area
Institutional / Departmental

Desirable (Essential by 2005)

(e) Laboratory

Side Laboratory: Hemogram, smear for malarial
parasite, Gram stain, CSF examination, urine routine
examination.

Central / Department Laboratory : blood gases;
blood chemistry; Facilities for culture of body fluids,
CSF and Blood, Urine.
Specialized tests (hepatic, renal function tests);
radiology (plain, radiocontrast)‚ computerized
tomography and ultrasonography; EKG.

Blood Bank

24 hours

Autopsy

24 hours (desirable)

(g) Special procedures/facilities

Bone marrow aspiration, liver, kidney and muscle 
biopsies, exchange  transfusion, peritoneal dialysis,
neonatal ventilation, pediatric ventilation, parenteral
nutrition, CVP monitoring (desirable)

(h) Access desirable for

G I Endoscopy
Echocardiography
EEG
BERA

(i) Equipment

Neonatal

As per NNF norms for Level - II Nursery
(Annexure 3)

Other

List enclosed (Annexure 3)

(j) Teaching / audio library

Major important  text and reference books
Subscription to at least 3 National and
4 International pediatric journals.
Facilities for computerised literature search

Computers

Accessible to all  PG  Students

Photocopying

Desirable to have one for the department

Paging

Desirable

Seminar Room (Department)

Essential

Overhead Projector

Essential

Slide Projector

Essential

LCD/Video Facility

Desirable.

2. Staff

(a) Faculty

Strength

Minimum 5 faculty members to form a PG
teaching department.
One student per PG teacher per year as in MCI
norm.
Maximum 2 MD and one DCH per unit per
year

Teacher/Supervisors

As per MCI norms, 3 teachers per unit.
PG teacher to have atleast 8 years teaching
experience

Time spent by teachers in College/hospital

Minimum: 6 hours / working  day. On call cover by rotation.

(b) Registrars/Senior Residents (Full Time)

Qualifications

MD Pediatrics

Strength

Pediatrics:2 SRs for each units
Neonatology:1 SR for 10 beds
NICU (Level 3):3 SRs
PICU:3 SRs 

(c) Nursing

General

1 Staff nurse for 3 beds in each shift (Desirable-
Nurses Incharge to be trained in pediatrics),
Sister I/C, ANM

NICU/PICU

1 staff nurse for 2 beds in each shift (Desirable-Nurse
incharge to be trained in neonatology/critical care)

OPD

1 Staff Nurse per 50 OPD Patients

(d) Other Staff

Stenotypist 1 (per unit)
Storekeeper 1
Clerk 1
Peon 1

Technical*

Dietician/Nutritionist 1 
Child Psychologist 1
Occupational Therapist 1
Speech Therapist 1
Social Worker 1
Public Health Nurse 1
O.T. Assistant 1 (for NICU/PICU)

Pediatric Research Laboratory

Biochemist 1

(Separate / Integrated with
Central  Research Laboratory)

Laboratory Technician 1
Laboratory Assistant 1

Pediatric Bed Side Laboratory
( one per 50 beds)

Lab Technician 1
Lab Assistant 1

Community Extension Projects

Medical Officers 2
Community Health Workers 3
Lady Health Visitors 3

*Minimum for Each PG department of 50-100 beds.
 Add  one more of each of the technical staff for every 100 additional beds.

(a) General

Objective of PG Programme

Essential

Content and schedule of training for 3 years

Essential

Resident Manual

Desirable

Resident’s log book to include monthly
entries and internal assessment

Essential

(b) Learning Opportunities

As detailed under PG teaching program

Annexure 3: List of Essential Equipment for Postgraduate Departments
(including Level II Nursery)

1.

Weighing machines

2.

Infantometer

3.

B.P. apparatus

4.

Oxygen hoods

5.

Laryngoscope

6

Ophthalmoscope and otoscope

7.

Self inflating  resuscitation bags

8.

Nebulizers

9.

Infusion pumps

10.

Radiant warmer

11.

Incubator/ warming beds

12.

Phototherapy units

13.

Monitors

(a)Cardio/respiratory  monitor

(b)Blood pressure monitor (non invasive)

(c)Apnea  monitor

(d)Pulse oximeter

(e)Oxygen analyser

14.

Ventilators:  neonatal and pediatric

15.

Side-laboratory facilities

Microscopy

Hematologic counts 

Blood smear  examination,

Blood sugar (by dextrostix)