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CHM Institute of Medical Sciences (CIMS) –Multan

Department Of Community Medicine

Study Guide

Objective:

To Produce Community Oriented Doctors by enabling them to practice

Community Medicine and Public Health in the light of PMC/ NUMS Curriculum

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COMMUNITY MEDICINE

Table of Contents

1. Overview of Community Medicine 3

2. Reading list 5

3. Integrated Syllabus 6

4. Academic Activities (LG’S & SG’ S) 11

5. Research Work 12

6. Assessment and evaluation 13

7. NUMS Table of Specification 14

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Overview of the Community Medicine

The Department of Community Medicine and Public Health, CIMS is an academic department

that provides a wide range of educational and research activities as Community medicine is the

science and art of assessing community health needs, introduction of comprehensive health

services and development of health programs to promote and protect the health of community as

a whole and vulnerable group in particular. It is complementary to clinical medicine which

focuses on the health of individuals and community members.

Professional Behavior

The Community Medicine provides the knowledge and equips the students for community

diagnosis, identification and prioritizes health problems in the community. This is to enable the

students to improve community's health by examining community’s social, economic, cultural,

ethnic, environmental, biological features for evaluating population health or disease. So, the

Community Medicine training program should enable the future physicians to use the population

health knowledge and skills to play leading and collaborative roles in the maintenance and

improvement of health system, wellbeing of any community in which they work, with a special

emphasis on Pakistani community.

Communication Skills: Learning the Process of sharing information with other individuals,

understanding types of communications like verbal e.g. talking, writing and non verbal e.g.

Dress, gestures, head movements, facial expressions etc.

Professional Expectations

The Community Medicine / Public Health educates learners and prepare medical undergraduates

to perform evidence based work (conduct researches) and play leadership role to provide

services and integrate the best care for the sick and healthy individuals for all in a medical

environment filled with trust, respect and accountability, emphasizing:

Doctor-family-patient relationship building

Evidence-based medicine study.

Practice relevance with advanced internet access and Community based education

Research to improve health care quality, cost and policies

Community partnerships that makes a difference.

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National / International role of Public Health Physician

These competencies allow the Community Medicine specialist to engage in a number of careers,

for example:

The practice of public health at a local, regional, national or international level

The planning and administration of health services, whether in institutions or in

government

Community-oriented clinical practice with an emphasis on health promotion and disease

prevention

The assessment and control of occupational and environmental health problems

Teaching and research

Evaluation and feedback

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Reading list

Assigned Text Books:-

1. J .E .Park 24th Edition.

2. Ilyas Ansari 8th Edition.

JOURNALS & PERIODICALS

1. WHO Forum and WHO chronicles

2. WHO Publications

3. Journal of Tropical Medicine and Hygiene

4. American Journal of Public Health

5. American Journal of Occupational Health

6. The British Journal of Nutrition

7. Brit. Med. J

8. Lancet

9. Journal of the College of Physicians & Surgeons

10. Journal of Ayub Medical College

GENERAL READING

1. Brig Iqbal Community Medicine 2018.

2. Brig Iqbal Biostatistics 2018 2 X 2.

3. Occupational Health, J.M. Harrington / F.S. Gill.

4. Public Health and Pediatric Medicine, Arthur E. Help.

5. Principles of Medical Statistics. Austin Bradford Hill and I.D. Hill. Basic Statistics for

Health Sciences Jon W. Kuzma, Mayfield Publishing Co.

6. Control of Communicable Disease in Man Edited by AS Bensenson, American Public Health

Association.

7. Community Health, Clark and Henderson.

8. Recent Advances in Community Medicine 2 and 3, Edited by Alwyn Smith.

9. Text Book of Community Medicine in South East Asia, WO Phoon, PCY Chen.

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INTEGRATED SYLLABUS COMMUNITY MEDICINE 4th YEAR PROFESSIONAL

MBBS

BLOCK I

1. CONCEPT OF HEALTH & DISEASE

o Concepts of Health (Physical, mental, social and spiritual dimensions)

o Primitive theories of disease causation

o Spectrum and Health and Disease

o Indicators of Health

o Responsibility for Health

o Concepts of Disease, its causation, natural history and levels of prevention

o Disease elimination, eradication, surveillance and control

2. INTRODUCTION TO PUBLIC HEALTH AND HEALTH SYSTEMS IN

PAKISTAN

o Background, Historic developments and concepts of Public Health

o “Health For All” background and progress

o National disease control policies, programme and strategies

o Health care System in Pakistan (the context of recent Devolution)

o Material, Human and financial resources management and leadership.

o Partnership in Health, NGOs, International agencies

o Community mobilization

3. EPIDEMIOLOGY AND DISEASE CONTROL

GENERAL EPIDEMIOLOGY AND RESEARCH

o Definition, historical background and uses

o Basic measures in Epidemiology

o Epidemiological Approaches / Methods / Studies

o Investigation of Epidemic

o Screening and Community diagnosis

o Research and Survey methodology

4. DYNAMICS OF INFECTIOUS DISEASE TRANSMISSION

o Basic Blocks / Definitions

o Agent, Host and environment

o Modes of disease transmission

o Prevention and Control including immunization and Chemoprophylaxis

5. BIOSTATISTICS

o Concepts and uses

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o Data and its types

o Rates, ratios and proportions

o Collection and registration of vital events in Pakistan

o Sources of health related statistics

o Methods of data presentation (tables, graphs & diagrams)

o Measures of central tendency, (Mean, Median, Mode)

o Measures of dispersion (Range, Standard deviation, Standard error)

o Normal curve

o Interpretation of data (t-test and Chi-square test)

o Sampling

o Health Management Information System

BLOCK II

6. EPIDEMIOLOGY, CONTROL AND PREVENTION OF INFECTIOUS

DISEASES OF PUBLIC HEALTH IMPORTANCE

o Diseases transmitted through inhalation

o Diseases transmitted through Faeco – oral route

o Arthropod borne diseases

o Diseases of animals conveyed to man

o Diseases in to direct contact

7. WASTE DISPOSAL

o Contents, hazards and safety measures for solid and liquid wastes.

o Domestic Waste disposal

o Industrial waste management

o Hospital waste management

8. MENTAL HEALTH

o Concept. Common mental health problems, their causes, prevention and control

o Juvenile delinquency

9. BEHAVIORAL SCIENCES AND LIFESTYLE

o Concept, attitudes, health and illness behaviour

o Drug abuse, addiction and smoking

o Child abuse and child labour

o Role of physical exercise in health and disease

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10. INFORMATION, EDUCATION AND COMMUNICATION (IEC)

o Concept. Aims and objectives

o Approaches used in public health

o Contents, principles and stages of health education

o Communication methods, barriers and Skills in health education

o Planning, organizing and evaluating a health education programme

o Social Marketing

11. ARTHROPODS AND THEIR PUBLIC HEALTH IMPORTANCE (Entomology)

o Control of Arthropods of medical importance and their control

o Common arthropod borne diseases

o Insecticides and their public health importance

12. PREVENTION AND CONTROL OF PARASITIC DISEASES OF PUBLIC HEALTH

IMPORTANCE

BLOCK III

13. DEMOGRAPHY & POPULATION DYNAMICS

o Concept, demographic principles and demographic processes

o Census, definition, methodology, types

o Fertility and mortality rates

o Population Pyramid and its interpretation

o Demographic Transition, Demographic Trap and its public health importance

o Demographic and social implication of high population growth

o Social Mobilization

o Urbanization

14. FOOD AND NUTRITION

o Concepts (Nutrition, Nutrients, Food, Diet). Food groups and their function. Role of

fiber in diet.

o Balanced Diet

o Dietary requirements of normal human being at different stages of life.

o Malnutrition at all stages of life. Types, causes and prevention.

o Common nutritional problem of Public health importance and their prevention and

control.

o Food hygiene, Pasteurization, fortification, additives & adulteration and preservation

o Food Poisoning

o Assessment of nutritional status of a Community

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15. EPIDEMIOLOGY, CONTROL AND PREVENTION OF NON - INFECTIOUS

DISEASES OF PUBLIC HEALTH IMPORTANCE

o Hypertension

o Coronary heart disease

o Cancers

o Injuries

o Diabetes mellitus

o Obesity

o Acute Rheumatic fever and heart disease

16. REPRODUCTIVE, MATERNAL AND CHILD HEALTH

o Safe Motherhood and its components.

o Family Planning

o Emergency Obstetric Care

o Maternal morbidly and mortality, causes, prevention and control

o Infant care

o Growth and development, Growth chart (Road to Development Chart)

o Infant morbidly and mortality causes, prevention and control

o Breast feeding common causes

o Child Care, Preventive Pediatrics, Integrated Management of Childhood Illness

(IMCI)

o Adolescent health

o Reproductive tract infections, guidelines for management of STD’s

17. ENVIRONMENTAL HEALTH SCIENCES

Air

Composition of Air

Purification of Air

Air pollution

Diseases due to air pollution, their prevention and control

Water

o Sources and daily requirements of water

o Water pollution : Its causes, prevention and control

o Purification of water

o Water quality Standards

o Diseases due to polluted water(water borne diseases)

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Climate

o Climate and weather

o Global environmental concerns

o Green house effect, depletion of ozone layer, Acid rains

o Effects of Hot climate on health: their prevention and control

o Effects of Extreme Cold climate on health: prevention and control

o Health at high altitude – importance of atmospheric pressure

o Humidity and health

Healthful housing

Urban and rural slums, Refugee camps and hostels

Radiation

o Sources, types

o Hazards of Radiation and its prevention and control

Noise

o Definition, causes

o Measurement and Acceptance levels

o Hazards of Noise : types, prevention and control

18. OCCUPATIONAL HEALTH

o Concepts, of occupational health

o Occupational medicine and occupational hygiene

o Ergonomics and its importance

o Occupational hazards : Principles of prevention and control

o General principles of occupational diseases prevention

o Organization of Occupational health services

o Health Insurance and Social Security Schemes

19. SNAKE BITES: PERSONAL PROTECTION AND MANAGEMENT

20. DISASTER

o Definition, Classification

o Epidemic of communicable diseases, Man Made Disasters, Accidents, NBC

o Magnitude and effects of disaster and Public Health consequences

o Disaster : preparedness and management

21. MANAGEMENT SCIENCE AND PUBLIC HEALTH

o Introduction to Management and planning in Health Care

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ACADEMIC ACTIVITIES

a. Lectures / large group interactive sessions LGIS

o For the lectures / seminars / demonstrations, weekly / monthly teaching schedule is

followed

o The regular lectures are structured laying special emphasis on the important aspects

relevant to the 4th Professional MBBS Exam and Common Public Health Problems in

Pakistan in line with PMC/ NUMS Curriculum

o The lectures to be delivered by the Professor, Associate and Assistant Professors and

vetted by the HOD.

o The lectures are mostly problem solving oriented with active involvement / participation

of the students. Maximum utilization of the teaching aids i.e. multimedia, overhead

projector, models, black/white board TV /CD player, computer and VCD player etc is

made at the end of each lecture, the students are free to ask any question regarding the

lecture

b. SGIS Demonstrations / Field Training Program o Demonstrations / Field Training Program is displayed in the department for the

information of the students and concerned teachers.

o Demonstrators teach / conduct the demonstrations / tutorials under supervision of

concerned Assistant Professor.

o A class of 100 students is divided into groups of 25 students for small group interactive

sessions in demonstration

o Whole Class Field Visits in first and second and third modules as per NUMS curriculum

c. Field Visits

1. Household Survey

2. Visit to Family Planning Centre

3. Visit to Primary Health Care Facility: BHU / RHC

4. Visit to Visit to Rehabilitation Centre

5. Visit To Waste Management Centre

6. Visit to NGO

7. Visit to School

8. Visit to Factory

9. Skill Development / Demographic, and Statistical work.

d. Practical Manual

A practical manual is maintained by writing a brief report on practices block wise, field

visits and by pasting the Public Health related news published in the print media and making

a proper index of the Titles. Students are required to give the references of the news cuttings,

their own comments and suggestions. Manual is checked by the concerned faculty member

and evaluated.

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Research Work

A mandatory research projects are conducted by the students under the

supervision of the faculty which are evaluated in Professional examinations.

The class is divided into four research batches, after approval of the research

topics by the HOD; they conduct the research and submit a written report to the

HOD for evaluation.

Researches (2018-2019)

Ser. No

Research Topics Class Batches Co- Supervisor Supervisor

1 Assessment of knowledge in

the community about risk

factors and late effects of

hypertension

MBBS- 4th Year

Batch – B1

Dr. Sana

Rehman

Prof. Dr.

Muhammad

Razzaq Malik

2 Assessment of factors

affecting student

concentration in the class

room

MBBS- 4th Year

Batch – A1

Asst. Prof. Dr.

shah Nawaz

Ateeque

Prof. Dr.

Muhammad

Razzaq Malik

3. Knowledge, Attitude and

practices of pregnant women

towards Antenatal care in

CMH Multan.

MBBS- 4th Year

Batch – A2

Dr. Mustansar

Billah

Prof. Dr.

Muhammad

Razzaq Malik

4. Assessing knowledge, and

attitude of community

towards dengue

MBBS- 4th Year

Batch – B2

Dr. Sumera, Dr

Sidra and Dr IZA

Prof. Dr.

Muhammad

Razzaq Malik

Researches for the present session are under process.

As and when students report in the classes, research topics will be finalized, and student

guide book will be updated.

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ASSESSMENT & EVALUATION:

Annual Examination

Distribution of Marks In Community Medicine

Sections Total Marks

Theory 150

Paper Community Medicine (SEQ and MCQ) 135

Internal Assessment 15

Practical 150

Viva /OSPE 135

Internal assessment 15

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NUMS Table of Specification (TOS)

TABLE OF SPECIFICATIONS (2020)

COMMUNITY MEDICINE 4th Professional Examination: Theory

Time Allowed =03 hrs. (Including MCQs)

Marks of theory paper =70

Internal assessment =15

Total marks =150

Pass Marks =75

65 x MCQs (65 Marks) Time = 1 hour

15 Mins

Q. No. 1,2,3,4,5,6,7,8,9,10

3 x SAQs/SEQs (Recall) = 7 marks

each

7 x SAQs/SEQs (Application) = 7

marks each

Total Marks (10 Questions) = 70

Time = 1 hour 45 Mins

S.No Topic Number of MCQs(65)

Recall:17

Application: 48

(1Mark each)

Number of

SAQs/SEQs (10)

(7 mark each)

1. General Epidemiology, Infectious

disease epidemiology,

Screening of diseases,

11 1

2. Biostatistics, HMIS, concept of

health and disease

9 1

3. Medical ethics, Primary Health

care, Leadership, SDGs

03 1

4. General immunology, Personal

hygiene, Travel Medicine,

Communicable Diseases including

Entomology,

Parasitology, hospital acquired

infections, emerging and

12 2

15

re-emerging diseases, Hospital

waste management,

5. Health education, Social and

behavioral sciences, Drug

Addiction, Smoking, , Mental

health, Accidents and

Injuries,

05 1

6. Environmental health, Snake bite,

Occupational health,

Disasters Management

06 1

7. Health programs in Pakistan,

Health planning and management,

Health System in Pakistan,

International health (partners in

health)

02 1

8. Non- Communicable diseases,

Nutrition, School and

dental health services

08 1

9. Demography, MCH (Reproductive

health and preventive

pediatrics, geriatrics) and family

planning

09 1

Total 65 (65 Marks) 10 (70 Marks)

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Table of specifications for Pre-Annual/ Annual Professional

Exam: Practical

Practical = 135

Internal Assessment = 15

Total marks = 150

Pass Marks = 75

Gen Viva Voce Practical Total

OSPE Project /Research/Collective

60 50 25 135

BREAKDOWN OF VIVA

1. Total of four examiners = 15 marks with each examiner = 15x4 = 60

2. OSPE : Total 10 stations(5 marks each, 4 minutes)

a. Unobserved stations – 8 x5 = 40 marks

b. Observed and interactive stations - 2 x5 = 10 marks

Theory: Internal Assessment (IA) Calculation

A B C D

Roll No

Name

All Blocks/ Pre annual Exams or any other exam

Total Marks of internal assessment Out of 15

Total Marks Sum of Marks obtained x15/ sum of total marks in all internal exams

Practical: Internal Assessment Calculation

A B C D

Roll No Name

OSPE /All Class tests throughout the year /Pre annual practical Exams or any other exam

Total Marks of internal assessment Out of 15

Sum of Marks obtained x 15/ sum of total marks in all internal exams