CURRICULUM

FOR

2 YEARS DIPLOMA PROGRAMME

IN

CHILD HEALTH
(DCH)

2007

UNIVERSITY OF HEALTH SCIENCES

LAHORE, PAKISTAN
SR. CONTENTS PAGE NO

1 Foreword 1
2 Aims and Objectives of the Course 3
3 Specific Learning Outcomes 4

4 Nomenclature and Duration 5

5 Eligibility Criteria for Admission 7

Recognition/Equivalence of the Degree and
6 8
Institution
7 Content Outline 9

8 Methods of Instruction/Course Conduction 19

9 Log Book 21
10 Literature Review 23
11 Examinations 24

12 Recommended Books 29
 FOREWORD
University of Health Sciences (UHS) Lahore was inaugurated by the
President of Pakistan on the 3rd of October 2002 with the vision to
explicitly address academic and research needs in the field of health
sciences and allied disciplines and to uplift their existing level to bring
them on a par with the international standards.

The mission of the University is to develop an intellectual nexus `to

provide excellence and innovation in medical education and research in
order to;

• Impart knowledge and skills to health care providers to enhance

their competence in providing community oriented and multi-
disciplinary patient -centered care
• Train and produce researchers and specialists in basic and
clinical medical sciences
• Establish and maintain continuing professional development
programmes for the faculty
• Provide trained professionals and scientists/researchers for the
field of Electro Medical/Bio-Medical disciplines
• Assure quality in health education and research at all levels

A university is the zenith of knowledge that imparts quality education

and awards degrees for extensive educational attainments in various
disciplines with attendant advancement for the development of
intellectual community. Protection of traditional knowledge, making
exploration about it and obtaining deep understanding of modern
technology and research techniques are some of the responsibilities of
any university.

UHS is running a number of courses in the field of health sciences in

Punjab. The list extends from undergraduate level courses up to the
doctorate level both in basic, clinical and allied health sciences.

Since its inception, certain vital tasks were taken into serious
consideration by UHS, for instance, curricula development and their
up-gradation were among the most important ones besides
introduction of contemporary educational programmes.

UHS has revised and finalized curricula for undergraduate Medical/

Dental Education, B.Sc Nursing, and Allied Health Sciences.

1
In keeping with its commitment for further improvement in the
standard of medical education, UHS has taken an initiative to modify
and improve one year postgraduate diploma courses to 2 years
structured training programmes.

I do not believe in selling an old product in a new packing with a fresh

label on it, just to do the job. Original products with actual outcomes
for the society must be guaranteed. Being the Vice Chancellor of a
public sector health university, I believe, it is my duty to remain
vigilant and committed to the cause of improvement of the
conventional medical and allied health sciences’ curricula on regular
basis. This will help produce technically sound professionals with
advanced knowledge and skills.

Presently, UHS has designed and facilitated curriculum development

committees for eleven clinical disciplines namely: DTCD, DPM, DMRT,
DOMS, DLO, Dip. Card, DCH, DCP, DGO, DMRD and DA.

This document precisely briefs the details of updated curriculum for

Diploma in Child Health (DCH) as prepared by the Experts’ Committee.

I am pleased to acknowledge the efforts made by Prof. I. A. Naveed,

the Department of Medical Education and the members of the
committee for DCH consisting of: Prof. Muhammad Yaqoob Kazi
(SIMS), Prof. Atta Ullah Mazgar (QAMC) and Prof. Pervaiz Akbar Khan
(NMC). The contributions made by them will go a long way in the
education and training of doctors in this field.

I hope, the revised course will be able to meet the needs of latest
trends in Paediatrics and will certainly produce competent mid-level
specialists in the field, which is the main objective of this programme.

Prof. M. H. Mubbashar
Hilal-e-Imtiaz, Sitara-e-Imtiaz
MB, FRCP, FCPS Psych, FRC Psych, DPM
Vice Chancellor/ Chief Executive
University of Health Sciences, Lahore

2
 AIMS AND OBJECTIVES OF THE COURSE
AIM

The aim of 2 years diploma programme in Child Health is to equip

medical graduates with relevant professional knowledge, skills and
ethical values to enable them to apply their acquired expertise at
primary and secondary health care organizations as non-academic
consultants.

OBJECTIVES

DCH training should enable a student to:

1. Take a comprehensive and pertinent history of a patient

presenting with paediatric ailments
2. Perform detailed physical examination in a rational sequence
that is both technically correct as well as methodical
3. Elicit physical signs without discomfort to the patient
4. Evaluate patients in the setting of outpatients’ department,
hospital wards, ICUs and emergency
5. Order a set of relevant investigations considering availability,
diagnostic yield, cost-effectiveness, side effects and implications
for management
6. Comprehend Community Indicators related to child health
7. Aware of and can apply national and international guidelines for
treatment and assessment
8. Counsel patients and relatives in patient’s preferred language in
elective and emergency situations in keeping with the principles
of good communication skills, empathy and empowerment of
patients
9. Exhibit emotional maturity and stability, integrity, ethical values
and professional approach, sense of responsibility in day-to-day
professional activities
10. Take proper informed consent for physical examination and
ensure confidentiality and appropriate environment for physical
examination
11. Act as an independent specialist at community level/Tehsil and
District Headquarter Hospital
12. Show initiative and become life long self-directed learners
tapping on resources including clinical material, faculty, internet
and on-line learning programmes and library

3
 SPECIFIC LEARNING OUTCOMES
Following competencies will be expected from a student completing 2
years course in DCH, student should be able to:

1. Discuss etiology, pathogenesis, epidemiology and management

of disorders in paediatrics on topics mentioned in the list of
course contents
2. Discuss principles of basic sciences as applied to paediatrics such
as haemorrhage, blood transfusion, shock, re-hydration,
infection, antibiotics/drug therapies, inflammation, repair and
healing and sterilization of instruments
3. Formulate a working diagnosis and consider differential diagnosis
4. Decide and implement suitable treatments considering safety,
cost factors, complications and side effects
5. Perform minor paediatric clinica l procedures under supervision
6. Maintain follow-up of patients at appropriate intervals,
recognizing new developments and/or complications and offering
sensible management protocols
7. Identify common paediatric problems in a scientific manner
while keeping in mind the logical reasoning and a clear
understanding of their impact on human mind and body
8. Assess, classify and rehabilitate malnourished child
9. Understand clearly various Child Survival Programmes, their
relevance, needs and impact on community and the methodology
employed for implementation of all such programmes
10. Identify common chromosomal disorders and is able to provide
genetic counseling

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 NOMENCLATURE AND DURATION

NOMENCLATURE OF THE PROPOSED COURSE:

The name of diploma course should be retained as DCH. This name

has been recognized and established for the last many decades
worldwide. The duration of courses should be two years structured
training in a recognized department under an approved supervisor.

Course Title: D.C.H. (Diploma in Child Health)

Training Centers: Departments of Paediatrics (accredited by UHS)

in affiliated institutes of the University
of Health Sciences Lahore

Course Duration and Scheme of the Course:

Total Duration: 2 years structured training (6 months in Part I and

one & a half year in Part II) in a recognized department under the
guidance of an approved supervisor

Part I -SIX MONTHS

Theoretical Component

• Pathology
- General Pathology
- Basic Hematology
- Basic Microbiology (Sputum, pus, urine, stool, CSF,
aspirates)
• Principles of Pharmacology and therapeutics
• General, Community, Preventive and Social Paediatrics
• Nutrition
• Neonatology
• Behavioral Sciences
• Introduction to Biostatistics and Research

Clinical Component

• Emergency and ICU Care and regular ward duties

5
Part II- YEAR & a HALF

Theoretical Component

Specialty Oriented Training (both theoretical and clinical aspects)

Clinical Component

• OPD Training and ICU Care

• Ward Duties
• All basic procedures

6
 ELIGIBILITY CRITERIA FOR ADMISSION

DOCUMENTS REQUIRED FOR THE ADMISSION

1. Completed DCH application form

2. Copy of MBBS degree with mark sheets of professional
examinations and certificate of number of attempts in professional
examinations
3. Copy of PMDC registration certificate
4. Three latest passport size photographs
5. Reference letters from two consultants, with whom the applicant
has worked
6. Certificates of completion of required experience

GENERAL REQUIREMENTS

Candidates eligible for admission should have MBBS or equivalent

qualification, registered with PMDC and can fulfill one of the following
criteria:

a. One year experience in Paediatrics as medical officer/house

physician
b. One year experience in General Medicine as medical officer/house
physician
c. Six moths experience in Paediatrics and six months in allied
specialty

SPECIAL REQUIREMENTS

1. Securing pass percentage in the entry test as determined by the

UHS
2. Qualifying the interview successfully
3. Having up to the mark credentials as per UHS rules (no. of
attempts in each professional, any gold medals or distinctions,
relevant work experience, research experience in a recognized
institution, any research article published in a National or
International Journal)

REGISTRATION AND ENROLLMENT

• Total number of students enrolled for the course must not exceed 8
per unit
• UHS Lahore will approve supervisors for diploma courses
• Candidates selected for the courses will be registered with relevant
supervisors and enrolled with UHS

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 RECOGNITION/EQUIVALENCE OF THE DEGREE AND
INSTITUTION
After two years training course, candidate should be given status of
mid-level specialist equivalent to any other similar qualification.

Accreditation related issues of the Institution:

1. Faculty
Properly qualified teaching staff in accordance with the
requirements of Pakistan Medical and Dental Council (PMDC)

2. Adequate Space
Including class-rooms (with audiovisual aids), computer lab and
pathology lab

3. Library
Departmental library should have latest editions of recommended
books on Paediatrics, reference books for each subspecialty like;
Paediatric Gastroenterology, Cardiology, Nephrology, Neurology,
Haematology, Oncology, Infectious Diseases, Neonatology,
Endocrinology, Pulmonology, General Pathology, Pharmacology
and latest journals (two National and one International)

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 CONTENT OUTLINE

Part I DCH

A. PATHOLOGY
1. General Pathology

Cell Injury and adaptation

Cell Injury
• Reversible and Irreversible Injury
• Fatty change, Pigmentation, Pathologic calcification
• Necrosis and Gangrene
Cellular adaptation
• Atrophy, Hypertrophy,
• Hyperplasia, Metaplasia, Aplasia
Inflammation
• Acute inflammation --- Vascular changes, Chemotaxis,
Opsonization and Phagocytosis
• Enlist the cellular components and chemical mediators of
acute inflammation
• Differentiate between exudates and transudate
• Chronic inflammation
• Etiological factors, Granuloma
Cell repair and wound healing
• Regeneration and Repair
• Healing--- steps of wound healing by first and second
intention
• Factors affecting healing
• Enlist the complications of wound healing
Haemodynamic disorders

• Define and classify the terms Edema, Haemorrhage,

Thrombosis, Embolism, Infarction & Hyperaemia
• Define and classify Shock with causes of each.
• Describe the compensatory mechanisms involved in shock
• Describe the pathogenesis and possible consequences of
thrombosis
• Describe the difference between arterial and venous
emboli
Neoplasia
• Dysplasia and Neoplasia
• Differences between benign and malignant neoplasms
• Enlist the common etiological factors for neoplasia
• Define and discuss the different modes of metastasis
• TNM staging system and tumor grade

9
 Immunity and Hypersensitivity

2. Basic Haematology

•Introduction to Haematology.
• Review of vascular system and Blood Constituents.
• Origin and Development of Blood cells, Maturation of
Erythrocytes and erythrocyte count.
o Blood formation:
• Intrauterine.
• Extrauterine.

o Factors which govern Haematopoiesis.

o Principles of Normal cell Maturation.
o Erythrocytes
o Maturation of Leukocytes, Leukocyte Count.
• Origin.
• Functions and biological Properties.
• Maturation of Granulocytic Series.
• Maturation of Lymphocytic Series.
• Maturation of Monocytic Series.
o Haemoglobin:
• Definitions of terms.
• Metabolism of Haemoglobin.
• Significance of Haematocrit AND ESR
• Definition and principle of test procedures:
§ 1. Micro 2. Macro.
• Blood Transfusion
• Cross matching techniques
• Infections and blood transfusions
• Complications of blood transfusion
Antiglobulin tests:
• Direct Coomb's
• Indirect Coomb's
Rh Antibody tests:
Erythroblastosis Foetalis:
• Causes:
• Rh incompatibility
• Diagnosis and Management
• ABO incompatibility
• Diagnosis and Management
Salient Pathophysiological and Clinical Features Of:
• Megaloblastic anemia.
• Red cell membrane defect: hereditary spherocytosis.

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 • Red cell enzymopathies.
• Thalassemia: Sickle cell anemia.
• Abnormal hemoglobins.
• Immune hemolytic anemias.
• Clotting and bleeding abnormalities
• Important /common leukemias

3. Basic Microbiology

• History and introduction to Microbiology

• Microbiology, Physiology, Life Cycle and Classification
and parasites.
• Role of Microbes In Various Human Diseases
• Infection source
• A brief account of the classification of microorganisms .
• Morphology: Identification of various shapes of bacteria
and viruses under the microscope.
• Distribution, size, motility, reproduction and functions of
bacteria and viruses.
• Effects of environment upon bacteria and viruses.
• Sterilization and disinfection. Definition, use of physical
and chemical disinfectants.
• Infection and immunity pathogenicty, pathology of
infection, resistance and natural immunity, antigens and
antibodies.
• Common Bacterial and viral diseases of man.
• Spores, Yeast and moulds.
• Nosocomial Infections
• Bacterial Growth and Death
• Important Viruses
• Important Parasites
• Sterilization and disinfection
• Immunization
• Use Of Investigation And Procedures In Laboratory
• Sputum, Urine, Stool, Cerebrospinal Fluid(CSF), Pus,
Aspirates

B. PRINCIPLES OF PHARMACOLOGY & THERAPEUTICS

C. GENERAL, COMMUNITY, PREVENTIVE & SOCIAL

PEDIATRICS
1. Orientation/state of Child Health
2. Primary Health Care
3. Community Diagnosis (Types & Questionnaire Development)

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4. Role of Environment & Social Factors in Child Health
5. Safe Motherhood
6. Growth & Development in Children
7. Immunization (EPI & Surveillance)
8. Malnutrition (Assessment & Rehabilitation)
9. Nutritional Surveillance
10. Role of Vitamin A in Child Health
11. Role of Zinc in Maternal Child Health (MCH)
12. Baby Friendly Hospital
13. Save the Newbom Initiative
14. Breast Feeding & Lactation Management
15. Infant Nutrition
16. Communicable Diseases in Paediatrics
17. Parasitic Diseases in Children
18. Maternal & Neonatal Tetanus
19. Polio Eradication
20. Millennium Development Goals
21. HIV / AIDS & Child Health
22. Child Labour
23. Adoption
24. Care of Handicapped
25. Adolescent Health
26. Health Education, Counseling & Communication Skills
27. Genetic Counseling

D. NUTRITION

1. Malnutrition (Assessment & Rehabilitation)

2. Nutritional Surveillance
3. Role of Vitamin A in Child Health
4. Role of Zinc in Maternal Child Health (MCH)
5. Baby Friendly Hospital
6. Save the Newbom Initiative
7. Breast Feeding & Lactation Management
8. Infant Nutrition

E. NEONATOLOGY
1. Scope of Neonatology (definitions, neonatal, perinatal periods, live
birth, still birth, abortion, legal viability, infant mortality, neonatal
and perinatal mortality, morbidity, long term handicaps)
2. Organization of neonatal services, primary, secondary and
tertiary level care, system of referral

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 3. Reviewing Role of obstetricians, Lady Health Visitors (LHVs),
Traditinal Birth Attendants (TBAs), nurses, concept of coordinated
team work during perinatal period
4. Obstetric history and birth history including antenatal, natal and
postnatal periods, maternal illnesses in relation to neonatal
problems
5. Routine history, examination of new born (weight, length, head
circumference, normal newborn examination, congenital
anomalies, birth injuries, detailed examination along with
checklist, neonatal reflexes)
6. Detailed categorization of the new born {term, pre-term, post-
term, gestational assessment, Accurate Gestational Age (AGA),
Small for Gestational Age (SGA), Large for Gestational Age (LGA),
Intrauterine Growth Retardation (IUGR), scoring system,
intrauterine growth charts)
7. Neonatal hypothermia (Pathophysiology, prevention and
management techniques)
8. Organization of neonatal unit including neonatal equipment,
appropriate adaptation at village, tehsil and district level)
9. Feeding of the newborn (breast feeding, formula feeding,
techniques, types of formulas, lactation failure, par-enteral
nutrition)
10. Birth anomalies (skeletal, visceral, systemic, associations,
syndromes)
11. Neonatal infections (septicemia, early onset, late onset, congenital
TORCH, nasocomial patterns, prevention, investigations,
treatment, sequel, neonatal meningitis, localized infections
(umbilicus, eye, skin, diarrhoea)
12. Neonatal Jaundice - etiology, type, diagnosis, management,
prognosis
13. Respiratory Distress - common causes, manifestations,
management referral
14. Cyanosis in newborn, recognition, differential diagnosis,
management, referral
15. Seizures in the newborn, types, etiology, management,
outcome, neonatal tetanus
16. Metabolic Problems: hypoglycemia, hypocalcaemia, other
metabolic derangements, management
17. Anaemia in the newborn, causes, management
18. Hemorrhagic disease of the new born, other bleeding disorders
19. Neonatal surgical diseases (Necrotizing Enterocolitis, Gut
Obstruction, Oesophageal Atresia & Tracheo-Oesophageal (TE)
Fistula, Diaphragmatic
Hernia, Imperforate Anus, Hirschsprung Disease)

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F. BEHAVIOURAL SCIENCES

1. Bio-Psycho-Social (BPS) Model of Health Care

2. Use of Non-medicinal Interventions in Clinical
Practice
• Communication Skills
• Counselling
• Informational Skills
3. Crisis Intervention/Disaster Management
4. Conflict Resolution
5. Breaking Bad News
6. Medical Ethics, Professionalism and Doctor-Patient
Relationship
• Hippocratic Oath
• Four Pillars of Medical Ethics (Autonomy,
Beneficence, Non-malficence and justice)
• Informed Consent and Confidentiality
• Ethical Dilemmas in a Doctor’s Life

7. Delivery of Culturally Relevant care and Cultural

Sensitivity
8. Psychological aspects of Health and Disease
• Psychological Aspect of Health
• Psychological Aspect of Disease
• Stress and its management
• Psychological aspect of Pain
• Psychological Aspect of Aging

G. Introduction to Biostatistics and Research

1. Introduction to Bio-Statistics
2. Introduction to Bio- Medical Research
3. Why research is important?
4. What research to do?
• Selecting a Field for Research
• Drivers for Health Research
• Participation in National and International Research
• Participation in Pharmaceutical Company Research
• Where do research ideas come from
• Criteria for a good research topic

5. Ethics in Health Research

6. Writing a Scientific Paper

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 7. Making a Scientific Presentation
8. Searching the Literature

Part II DCH

A. INFECTIOUS DISEASES
1. Malaria
2. Enteric Fever
3. EPI Diseases {Polio, TB , Pertussis, Diphtheria, Tetanus, Hepatitis}
4. Child with Rash
5. Worm Infestations
6. Pyrexia of Unknown Origin (PUO)
7. Tuberculosis
8. Shigellosis
9. Cholera
10. Chicken Pox
11. Mumps
12. Antibiotic Therapy

B. HAEMATOLOGY & ONCOLOGY

1. Clinical Approach to Anaemia
2. Iron Deficiency Anaemia
3. Thalassaemia
4. G6PD Deficiency / Haemolytic Anaemias
5. Aplastic Anaemia
6. Thrombocytopenic Purpura
7. Clinical Approach to a Bleeding Child
8. Haemophilia & Von-Willebrand Disease
9. Acute Lymphoblastic Leukaemia
10. Lymphoma / Hodgkin's Lymphoma
11. Wilm's Tumour / Neuroblastoma

C. RESPIRATORY DISEASES
1. Pneumonia
2. Bronchiolitis
3. Bronchial Asthma
4. Pleural Effusion / Empyema
5. Pulmonary Tuberculosis
6. Pneumothorax
7. Croup
8. Foreign Body Inhalation
9. Otitis Media

D. GASTROENTEROLOGY & HEPATOLOGY

1. Hepatitis A, B, C, D, E.

15
 2. Neonatal Hepatitis
3. Chronic / Autoimmune Hepatitis
4. Chronic Liver Disease / Cirrhosis
5. Hepatic Encephalopathy
6. Liver Abscess
7. Portal Hypertension
8. Clinical Approach to Bleeding from Upper / Lower GIT
9. Acute Diarrhoea & its Complications
10. Chronic / Persistent Diarrhoea
11. Malabsorption / Coeliac Disease
12. Inflammatory Bowel Disease
13. Ascites
14. D/D Abdominal Mass
15. Recurrent Abdominal Pain
16. Wilson's Disease
17. Constipation
18. Gastroesophageal Reflux
19. Acid Peptic Disease

E. NEPHROLOGY
1. Urinary Tract Infection
2. Acute Renal Failure
3. Chronic Renal Failure
4. Nephrotic Syndrome
5. Hematuria / Proteinuria; Clinical Approach
6. Acute Glomerulonephritis
7. Obstructive Uropathy
8. Urolithiasis

F. CARDIOVASCULAR DISEASES
1. Heart Failure
2. Cyanotic Congenital Heart Disease {Tetrology Of Fallot (TOF)}
3. Acyanotic Congenital Heart Diseases {Ventricular Septal Defect
(VSD), Patent Ductus Arteriosis (PDA), Atrioseptal Defects (ASD)}
4. Rheumatic Fever
5. Hypertension
6. Viral Myocarditis
7. Common Rhythm Disorders {Paroxysmal Atrial Tachycardia (PAT)}

G. ENDOCRINE DISEASES
1. Short Stature
2. Hypothyroidism
3. Congenital Adrenal Hyperplasia
4. Ambiguous Genitalia
5. Diabetes Mellitus

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6. Hypoparathyroidism
7. Addison's Disease
8. Obesity & Cushing’s Syndrome

G. RHEUMATIC & ORTHOPEDIC DISEASES

1. Osteomyelitis
2. Septic Arthritis
3. Limping Child
4. Juvenile Rheumatoid Arthritis
5. Systemic Lupus Erythematosis
6. Henoch Schonlein Purpura
7. Dermatomyositis
8. Kawasaki Disease

H. NEUROLOGIC & NEUROMUSCULAR DISEASES

1. Bacterial Meningitis
2. CNS Tuberculosis
3. Space Occupying Lesions (SOL) / Brain Tumors
4. Epilepsy & Status Epilepticus
5. Febrile Fits
6. Mental Retardation
7. Hemiplegia
8. Muscle Dystrophies
9. Floppy Infant
10. Microcephaly
11. Cerebral Palsy
12. Guillain Barre Syndrome {Acute Idiopathic Polyneuritis (AIP)}
13. Hydrocephalus
14. Neural Tube Defects

I. METABOLIC, STORAGE & GENETIC DISORDERS

1. Rickets - Calcium Metabolism
2. Down's Syndrome
3. Congenital Malformations
4. Inborn Errors of Metabolism
5. Storage Disorders (General Approach)
6. Phenylketonuria, Tyrosinaemia
7. Mucopolysaccharidosis
8. Galactosaemia

J. CHILD PSYCHIATRY
1. General approach to common behavior disorders
2. Autism
3. Enuresis / Encopresis
4. Attention Deficit Disorder

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 5. Adolescent Behavior Disorders

K. TOXICOLOGY
1. General Principles of Management
2. Kerosene Oil Poisoning
3. Snakebite
4. Insecticide Poisoning
5. Corrosive Poisoning
6. Opioid Poisoning

L. CHILD ABUSE
1. Child Rights
2. Child Abuse
3. Child Labour

M. PAEDIATRIC SURGERY
1. Understanding Common Surgical Cases (Emergencies, Initial
2. Management, Referral)
3. Cleft Palate/Lip
4. Acute Abdomen (Appendicitis, Intestinal Obstruction,
Intussusception, Atresia, Malrotation)
5. Esophageal Atresia & Tracheo-Oesophageal (TE) Fistula
6. Hirschsprung’s Disease
7. Inguinal Hernia / Hydrocoele
8. Undescended Testis
9. Club Foot
10. Imperforate Anus
11. Congenital Hypertrophic Pyloric Stenosis
12. Diaphragmatic Hernia
13. Rectal Polyp, Prolapse, Anal Fissure
14. Congenital Dislocation of Hips
15. Circumcision

N. DERMATOLOGY
1. Common Skin Infections {Scabies, Impetigo, Staphylococal
Scalded Skin Syndrome (SSSS)}
2. Eczema (Including Atopic)
3. Common Fungal Infections

O. MISCELLANEOUS
1. Immunodeficiency
2. Anaphylaxis & Allergies

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 METHODS OF INSTRUCTION/COURSE CONDUCTION
As a policy, active participation of students at all levels will be
encouraged.
Following teaching modalities will be employed:

1. Lectures
2. Seminar Presentation and Journal Club Presentations
3. Group Discussions
4. Grand Rounds
5. Clinico-pathological conferences
6. SEQ as assignments on the content areas
7. Skill teaching in ICU, emergency and ward settings
8. Self study, assignments and use of internet
9. Bedside teaching rounds in ward
10. OPD & Follow up clinics
11. Long and short case presentations

In addition to the conventional teaching methodologies following

interactive strategies will also be introduced to improve both
communication and clinical skills in the upcoming consultants:

1.1. Monthly Student Meetings

Each affiliated medical college approved to conduct training for DCH

will provide a room for student meetings/discussions such as:

a. Journal Club Meeting

b. Core Curriculum Meetings
c. Skill Development

a. Journal Club Meeting

Two hours per month should be allocated to the presentation and

discussion of a recent journal article related to Paediatrics. The article
should be critically evaluated and its applicable results should be
highlighted, which can be incorporated in clinical practice. Record of all
such articles should be maintained in the relevant department of each
medical college. Students of different medical colleges may be given
an opportunity to share all such interesting articles with each other.

b. Core Curriculum Meetings

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All the core topics of DCH should be thoroughly discussed during these
sessions. The duration of each session should be at least two hours
once a month. It should be chaired by the chief student (elected by
the students of the relevant diploma). Each student should be given an
opportunity to brainstorm all topics included in the course and to
generate new ideas regarding the improvement of the course structure

c. Skill Development

Two hours twice a month should be assigned for learning and

practicing clinical skills.

List of skills to be learnt during these sessions is as follows:

1. Communication skills
2. Physical Examination related to Paediatrics
3. Practical Skills i.e, use of relevant clinical instruments
4. Presentation Skills: Power-point, lectures, small group discussions,
article presentation etc.
5. Research and Scientific Writing
6. Management of Paediatric Emergencies in Primary Care
7. For acquisition of procedural skills like Venous Cannulation, Lumbar
Puncture, Pleural Tap, Peritoneal Tap, Endotracheal Intubation,
Cardiopulmonary Resuscitation, Exchange Transfusions, Emergency
Pneumothorax Drainage (Needle Aspiration), opportunities during
ward postings should be availed

1.2 Annual Grand Meeting

Once a year all students enrolled for DCH should be invited to the
annual meeting at UHS Lahore.
One full day will be allocated to this event. All the chief students from
affiliated institutes will present their annual reports. Issues and
concerns related to their relevant diploma courses will be discussed.
Feedback should be collected and suggestions should be sought in
order to involve students in decision making.
The research work done by students and their literary work may be
displayed.
In the evening an informal gathering and dinner can be arranged. This
will help in creating a sense of belonging and ownership among
students and the faculty.

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 LOG BOOK
The trainees must maintain a log book and get it signed regularly by
the supervisor. A complete and duly certified log book should be part
of the requirement to sit for DCH examination. Log book should
include adequate number of diagnostic and therapeutic procedures,
routine and emergency management of patients, case presentations in
CPCs, journal club meetings and literature review.

Proposed Format of Log Book is as follows:

Candidate’s Name: _________________________________

Roll No. _____________

PROCEDURES:

1. Venous Cannulation
2. Lumbar Puncture
3. Pleural Tap
4. Peritoneal Tap
5. Endotracheal Intubation
6. Cardiopulmonary Resuscitation
7. Exchange Transfusions
8. Emergency Pneumothorax Drainage (Needle Aspiration)

Sr.# Date Name of Patient, Age, Diagnosis Procedure Supervisor’s

Sex & Admission No. Performed Signature
1
2

Emergencies Handled

Sr. Date Name of Patient, Age, Diagnosis Procedure/ Superviso

# Sex & Admission No. Manageme r’s
nt Signature
1
2

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Case Presented

Sr.# Date Name of Patient, Age, Case Presented Supervisor’s

Sex & Admission No. Signature
1
2

Seminar/Journal Club Presentation

Sr.# Date Topic Supervisor’s

signature
1
2

Evaluation Record
(Excellent, Good, Adequate, Inadequate, Poor)

Method of Evaluation
Sr.# Date (Oral, Practical, Theory) Rating Supervisor’s
Signature
1
2

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 LITERATURE REVIEW
Students will be assigned a clinical problem most commonly
encountered in the relevant specialty and will be specifically trained to
review literature in the relevant field and write a ‘Review of an
Article’ comprising of:

• Topic
• Introduction
• Discussion of the reviewed literature
• Conclusion
• References

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 EXAMINATIONS
Assessment

It will consist of action and professional growth oriented student-

centered integrated assessment with an additional component of
informal internal assessment, formative assessment and
measurement-based summative assessment.

Student-Centered Integrated Assessment

It views students as decision-makers in need of information about

their own performance. Integrated Assessment is meant to give
students responsibility for deciding what to evaluate, as well as how to
evaluate it, encourages students to ‘own’ the evaluation and to use it
as a basis for self-improvement. Therefore, it tends to be growth-
oriented, student-controlled, collaborative, dynamic, contextualized,
informal, flexible and action-oriented.

In the proposed curriculum, it will be based on:

• Self Assessment by the student

• Peer Assessment
• Informal Internal Assessment by the Faculty

Self Assessment by the Student

Each student will be provided with a pre-designed self-assessment

form to evaluate his/her level of comfort and competency in dealing
with different relevant clinical situations. It will be the responsibility of
the student to correctly identify his/her areas of weakness and to take
appropriate measures to address those weaknesses.

Peer Assessment

The students will also be expected to evaluate their peers after the
monthly small group meeting. These should be followed by a
constructive feedback according to the prescribed guidelines and
should be non-judgmental in nature. This will enable students to
become good mentors in future.

Informal Internal Assessment by the Faculty

There will be no formal allocation of marks for the component of

Internal Assessment so that students are willing to confront their
weaknesses rather than hiding them from their instructors.

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It will include:

a. Punctuality
b. Ward work
c. Monthly assessment (written tests to indicate particular
areas of weaknesses)
d. Participation in interactive sessions

Formative Assessment

Will help to improve the existing instructional methods and the

curriculum in use

Feedback to the faculty by the students:

After every three months students will be providing a written feedback

regarding their course components and teaching methods. This will
help to identify strengths and weaknesses of the relevant course,
faculty members and to ascertain areas for further improvement.

Summative Assessment

It will be carried out at the end of the programme to empirically

evaluate cognitive, psychomotor and affective domains in order to
award diplomas for successful completion of courses.

Eligibility to Appear in Final Examination

- Only those candidates will be eligible to take final examination,

who have passed Part 1 examination (after 6 months of
education) and have completed two years of
structured/supervised training programme.
- Students who have completed their log books and hold
certificates of 75% attendance should be allowed to sit for the
exam
- Application for the final examination can be made with
recommendation of the supervisor
- Only those candidates who qualify in theory will be called for
clinical examination

25
DCH Examination

Part I DCH

Topics included in paper 1

1. Pathology (25 MCQs)

a. General Pathology (10 MCQs)
b. Basic Hematology (10 MCQs)
c. Basic Microbiology (5 MCQs)
2. Principles of Pharmacology and Therapeutics (10 MCQs)
3. Community and Preventive Paediatrics (20 MCQs)
4. Nutrition (10 MCQs)
5. Neonatology (20 MCQs)
6. Behavioral Sciences (10 MCQs)
7. Biostatistics and Research (05 MCQs)

Components of the Part-1 examination

MCQ Paper 100 One Best Type

Total Marks 100 Marks

Part II DCH

Topics included in paper 1

1. Infectious Diseases
2. Haematology and Oncology
3. Respiratory Diseases
4. Gastroenterology and Hepatology
5. Nephrology
6. Cardiovascular Diseases
7. Endocrine Diseases
8. Rheumatic and Orthopaedic Diseases
9. Neurologic and Neuromuscular Diseases

Topics included in paper 2

1. Metabolic, Storage and Genetic Disorders

2. Child Psychiatry
3. Dermatology

4. Immunodeficiency and Anaphylaxis & Allergies

5. Toxicology
6. Child Abuse

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7. Paediatric Surgery

Part II Examination

Theory

Paper I 100 Marks 3 Hours

10 SEQs (No Choice) 50 Marks
50 MCQs 50 Marks

Paper II 100 Marks 3 Hours

10 SEQs (No Choice) 50 Marks
50 MCQs 50 Marks

The candidates who pass in theory papers, will be eligible to appear in

the clinical & viva voce.

OSCE 90 Marks

10 stations each carrying 9 marks of 10 minutes duration; each

evaluating performance based assessment with five of them
interactive

Clinical 90 Marks

Four short cases each carrying 15 marks and one long case of 30
marks.

Components of the Part II examination

Theory paper 1 100 marks

Theory paper 2 100 marks

Clinical/Oral 180 marks

Log Book 20 marks

Total Marks 400

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A panel of four examiners from Paediatrics (Two internal and two
external) will be appointed for practical examination.

Each component of practical examination will be assessed by two

examiners, awarding marks simultaneously and independently. The
final score awarded will be an average score, as agreed by both
examiners.

Pass Percentage and Other Regulations Regarding Examination

- Criterion referenced assessment principles will be used

- 20 marks for the log book will be included in the OSCE
component
- 60 % marks will be a pass score in each component. Each
candidate must pass in every component separately
- Candidate failing in any one component will have to re-sit the
entire examination
- A maximum of 5 attempts to sit for the examination will be
allowed, to be availed within 3 calendar years of the first
attempt
- Re-admission in DCH course is not permissible under any
circumstances
- The results will be announced according to the rules and
regulations set by the Examination Branch of UHS Lahore

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 RECOMMENDED BOOKS
1. Paediatric Association. Textbook of Paediatrics of Pakistan
(latest Edition).
2. Nelson. Essentials of Paediatrics (Latest Edition).
3. Current Paediatrics, Diagnosis and Treatment. 6th Ed.
4. Lissauer T. and Clayden G. Illustrated Textbook of Paediatrics.
2nd Ed.
5. Hull D. Hospital Paediatrics (Latest Edition)
6. Khan S. R. Hand Book of Clinical Paediatrics (Latest Edition).
7. Rana M. H., Ali S. Mustafa M. A Handnook of Behavioural
Sciences for Medical and Dental Students. Lahore: University of
Health Science; 2007.
8. Fathalla M. F. and Fathalla M. M. F. A Practical Guide for Health
Researcher. Cairo: World Health Organization; 2004.

Reference Books

1. Nelson Textbook of Paediatrics. 17th Ed.

2. Forfar & Arneil’s Textbook of Paediatrics. 6th Ed

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