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TRANSCRIPT
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OBSTETRICS & GYNAECOLOGY
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About the College 1
Introduction 3
MCPS examination 4
General Regulations 5
Examination schedule 7
Training programme 10
Syllabus 14
Useful Addresses and Telephone Numbers 20
THIS IS AN EVOLVING DOCUMENT.
The College of Physicians and Surgeons Pakistan would appreciate any criticism, suggestions,
advice from the readers and users of this document. Comments may be sent in writing or by
e-mail to the CPSP at:
National Directorate Residency Program (NDRP)College of Physicians and Surgeons Pakistan (CPSP)
7th Central Street, Defence Housing Authority, [email protected]
Published: January, 2015
COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN7th Central Street, Defence Housing Authority, Karachi-75500.Phone No. 99207100-10 UAN: 111-606-606 Fax No. 99266432
1PROSPECTUS MCPS
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ABOUT THECOLLEGE
The College was established in 1962 through an
ordinance of the Federal Government. The objectives/
functions of the College include promoting specialist
practice of Medicine, Surgery, Obstetrics & Gynaecology
and other specialties by securing improvement of
teaching and training, arranging postgraduate medical,
surgical and other specialists training, holding and
conducting examinations for awarding postgraduate
degrees of the College, admission to the Fellowship of
the College, and to provide for research.
Since its inception, the College has taken great strides in
the direction of improving postgraduate medical and
dental education in Pakistan. Structured training
programs along with criteria for accrediatation of training
institutions, and for the appointment of supervisors and
examiners have been developed. The format of
examinations has evolved over the years to achieve
objective and reliable methods of assessment. The
recognition of the standards of College qualifications
nationally and internationally, has enormously increased
the number of trainees, and consequently the number of
training institutions and the supervisors. This increasing
demand coupled with advancement in medical sciences
has gradually increased the number of fellowship
disciplines to seventy two and of membership to twenty
two.
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The average number of candidates taking CPSPexaminations each year is to a minimum of 25,000. TheCollege conducts examinations for FCPS I (11 groups ofdisciplines), IMM, FCPS II (72 disciplines), MCPS (22disciplines), including MCPS in HPE and MCPS inHCSM. A large number of Fellows and senior medicalteachers from within the country and overseas areinvolved at various levels of examinations of the College.
To coordinate the training and examination, and toprovide assistance to the candidates stationed at placesother than Karachi; College has established 14 RegionalCenters Including five Provincial Headquarter Centres inthe country. The five Provincial Headquarter Centers inaddit ion to organizing the capacity buildingworkshops/short courses also have facilities of librariesand I.T.
It is important to note that in the overall scenario ofhealth care delivery service, out of the total functioningand registered health care specialists in the country,over 85% have been provided by the CPSP. The Collegestrives to continue its efforts in making its courses andtraining programs evidence and need based so as tomeet international standards as well as to cater to thespecialist healthcare needs not only for this country butalso for the entire region.
Prof. Zafar Ullah ChaudhryPresident
College of Physicians and Surgeons Pakistan
3PROSPECTUS MCPS
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INTRODUCTION
The College of Physicians and Surgeons Pakistan has
always designed its postgraduate training programs
keeping in consideration the national and international
needs. In Pakistan attempts have been made to improve
the health status of the people through availability of
trained personnel, adequate supply of medicines and
establishment of greater number of health facilities.
However, much more needs to be done in this respect.
The main health related problems facing Pakistan are
preventable communicable and non-communicable
diseases, severe malnutrition and high incidence of birth
resulting in high infant and maternal mortality. It is
evident from the dismal health related statistics that
efforts should be directed at improving healthcare
facilities at the primary and secondary care levels. A
need was therefore felt to train a group of mid level
specialists who can provide quality services at these
centers. The curriculum and training for MCPS have
been developed to achieve this objective.
This booklet provides information to the trainees and
supervisors regarding training requirements and
assessment strategy for the MCPS in
Obstetrics & Gynaecology.
MCPS EXAMINATION
The College conducts MCPS examination in thefollowing 22 disciplines:
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1. Anaesthesiology
2. Clinical Pathology
3. Community Medicine
4. Dermatology
5. Diagnostic Radiology
6. Family Dentistry
7. Family Medicine
8. Forensic Medicine
9. Military Medicine
10. Obstetrics & Gynaecology
11. Operative Dentistry
12. Ophthalmology
13. Oral Surgery
14. Orthodontics
15. Otorhinolaryngology
16. Paediatrics
17. Periodontology
18. Prosthodontics
19. Psychiatry
20. Pulmonology
21. Health ProfessionsEducation (HPE)
22. Health Care SystemsManagement (HCSM)
GENERAL REGULATIONSThe following regulations apply to all candidates enteringfor MCPS examination:
Candidate will be admitted to the examination in thename (surname and other names) as given in the MBBSdegree. CPSP will not entertain any application forchange of name on the basis of marriage/ divorce / deed.
REGISTRATION AND SUPERVISIONAll trainings must be supervised, and trainees arerequired to register with the RTMC within 30 days of thestart of the training for MCPS. In case of delay inregistration, the start of training will be considered fromthe date of receipt of application by the RTMC.Registration forms are available with RTMC and at theRegional Centers. They can also be downloaded fromthe CPSP Website. Training is compulsorily monitoredby an approved supervisor who is a CPSP fellow or aspecialist with relevant postgraduate qualifications andrequisite experience, registered with the RTMC.
APPROVED TRAINING CENTRESTraining must be undertaken in units, departments andinstitutions approved by the College. A current list ofapproved institutions is available from the College and itsRegional Centres as well as on the Collegewebsite: www.cpsp.edu.pk
DURATION OF TRAININGThe duration of training for MCPS is two years; MCPSexamination is taken on completion of the specifiedtraining and other requirements. 5PROSPECTUS MCPS
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MANDATORY WORKSHOPSAll candidates wil l attend following Mandatory
Workshops and present certificate of attandence before
they can be allowed to take the MCPS examination:
1. Introduction to Computer and Internet
2. Primary Surgical Skills
3. Communication Skills
4. Basic Life Support (BLS)
ELIGIBILITY REQUIREMENTS FORMCPS EXAMINATION
l MBBS or equivalent qualification registered with thePMDC.
l One year house job in an institution recognized bythe CPSP.
l Registered with the Registration and TrainingMonitoring Cell (RTMC).
l Completed two years of post RTMC registeredtraining under an approved supervisor in aninstitution recognized by the CPSP. A certificate ofcompletion of training must be submitted, verifyingthat the rotational training in the specified disiciplinesfor the required period has also been undertaken.
l To have made regular entries and completede-logbook.
l Submitted certificates of attendance of mandatoryworkshops.
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EXAMINATION SCHEDULE
l The MCPS theory examination in Obstetrics &Gynaecology are held twice a year.
l Theory examinations are held in different cities of thecountry depending on the number of candidates at acenter. Presently the centres are Abbottabad,Bahawalpur, Faisalabad, Hyderabad, Islamabad,Karachi, Lahore, Larkana, Nawabshah, Multan,Peshawar and Quetta. The College’s decision to holdtheory/clinical examinations depends on the numberof candidates in a city and candidates will beinformed accordingly.
l Clinical examination will held for those candidateswho have qualified in theory.
l English is the medium of examination for thetheory/practical/clinical and viva examinations.
l Any change in the centres, dates and format of theexamination will be notified by the College before theexamination.
l Each successful candidate in the MCPS examinationshall be granted MCPS diploma after being electedby the College Council and payment of registrationfee and other dues as per rules of the College.
l A competent authority appointed by the College hasthe power to debar any candidate from anyexamination if it is satisfied that such a candidate isnot a fit person to take the College examination forusing unfair means/misconduct or other disciplinaryreasons.
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EXAMINATION FEE
l Fee deposited for a particular examination shall notbe carried over to the next examination in case ofwithdrawal/absence/exclusion.
l Application along with the prescribed examination feeand required documents should be submitted latestby the last date notified for the purpose before eachexamination.
l The details of examination fee and fee for change ofcentre, subject, etc. shall be notified before eachexamination.
l All fee are payable by bank draft/pay order made outto the “College of Physicians & Surgeons Pakistan”.Personal cheques and postal orders are notaccepted. However fee can be paid in cash at theaccounts department of the CPSP at Karachi or atspecified branches of UBL in most cities.
Refund of feel After submitting an application for examination, if a
candidate decides not to appear, a written request forthe same should be submitted up to the last date ofthe receipt of application. In such cases the refund isadmissible to the extent of 75% of fee only. Norequest for refund will be accepted after the last dateof receipt of the application.
l In case the application for examiantion of a candidate isrejected by the CPSP, 75% of the examination fee willbe refunded, after deducting 25% as processingcharges. No refund will be made, for fee paid for anyother reason, e.g. late fee, change of centre/subject fee.
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FORMAT OF EXAMINATIONThe MCPS examination comprises of:I. Theory:
Paper I 10 SAQs 3 hoursPaper II 100 MCQs 3 hours
75 Single Best MCQs and 25 EMQs
II. Clinical:- 02 Long cases
One each of Obstetrics & Gynaecology- TOACS
15 Stations 7 minutes each 09 Obstetrics 06 Gynaecology
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TTRRAAIINNIINNGG PPRROOGGRRAAMMMMEE
Objectives of the training programmeAt the end of the training for MCPS in Obstetrics &Gynaecology the candidate shall be able to:
l Manage correctly pregnant women from conceptionto post natal period which includes:- Counselling individuals in the preconception
period.- Examining the pregnant women correctly and
skillfully at appropriate intervals.- Counseling for breast feeding. - Detecting pre-existing problems in pregnant
women e.g. heart disease, diabetes etc.- Detailed knowledge of heath status of mothers
and neonates in Pakistan. - Knowledge of Millenium Development Goods
(MDGs) 4 & 5, and Pakistanis progress towardsthem.
- Detecting and treating any complicationsoccurring during the course of pregnancy whichmay be hazardous to the health of the motheror child.
- Conducting the delivery at the most appropriatetime and by the most appropriate methodkeeping in view the best interests of bothmother and child.
- Dealing with the problems of mother and childoccurring in the post natal period.
- Advising mothers regarding child spacing andfamily limitation, postpartum and post abortionfamily planing including PPIUCD.
- Understanding the issues of nutrit ion,adolescence child abuse and domestic violenceand take appropriate actions where indicated.
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l Manage cases with symptoms relating to the female
genital tract by:
- Obtaining pertinent history.
- Performing physical examination correctly and
skillfully.
- Requesting appropriate investigations.
- Interpreting the results of investigations
correctly.
- Distinguishing those that require medical
treatment from those requiring surgical
treatment.
- Performing those surgical procedures
competently which an MCPS in Obstetrics &
Gynaecology is expected to perform.
(see overleaf).
- Dealing with complications that may arise
during or following treatment and especially
acute obstetrical emergencies.
- Asking for the advice of other specialists
whenever necessary.
- Advising patients post treatment.
l Distinguish between those patients that can be
managed personally from those requiring referral.
l Refer patients who need services of other health
professionals.
l Collaborate with other health care workers as a
member of the team and when required act as a
capable leader of a health care team.
l Maintain up to date records of all patients.
ProceduresAn MCPS in Obstetrics & Gynaecology is expected to be
competent to perform the following procedures
independently.
Gynaecological
Evacuation of the products of conception. Suction evacuation of uterus - manual & electronic Dilatation and curettage (diagnostic).Cauterization.Polypectomy and cervical biopsy.Marsupialization of Bartholin’s cyst.Mini laparotomy (tubal ligation).Hysterosalpingography.Take smears for cytology.Insert ring pessaries.Insert intra uterine contraceptive devices/implants.Laparotomy for ectopic pregnancies & ovarian tumorsAbdominal hysterectomiy for benign condition
Obstetrical
Medical induction of labourArtificial rupture of membranesPudendal blockNormal deliveryOutlet forceps deliveryVacuum extractionManagement of shoulder dystocia Assisted breech deliveryTwin deliveryRepair of pereneal tears / episiotomy
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Lower segment caesarean sectionRepair of ruptured uterus Application of B-Lynch suture Obstetric hysterectomy
Manual removal of placenta.Resuscitation of the new born.Post partum tubal ligation.
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SSYYLLLLAABBUUSSThe outline of various topics given in this syllabus is aguide to what at the moment are considered to beimportant topics which the candidate is expected toknow. This is to help both the candidate and theexaminer in defining the minimum boundaries of MCPSexamination.
Anatomy
Female genital tract: vulva, vagina, uterus, fallopiantubes, ovaries, broad ligament, pelvic cellular tissues,pelvic musculature, pelvic blood vessels, lymphaticsystem, nerve supply.Bony pelvis: normal and abnormal.Foetal skull.Breast.
Physiology
The student should have general knowledge of appliedPhysiology with particular emphasis on physiology ofmenstruation, conception, pregnancy, lactation,endocrinology and Cardiovascular system.
General Pathology
Basic principles of inflammation, coagulation, thrombosisand embolism, derangements of body fluids, neoplasia,deficiency diseases, anaemia, haemorrhage, shock,bacterial, fungal and viral diseases.
Pharmacology
Knowledge of medicines used in conditions relating toObstetrics & Gneacology.
Knowledge of special considerations about use of drugs in:- Pregnant women - Mothers of breast-fed babies
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GynaecologyNormal anatomy of the female genital tract andcongenital malformations. Diseases of vulva, vagina,cervix, body of the uterus, fallopian tubes and ovaries,both benign and malignant. Displacements of the uterusand uterovaginal prolapse. Infections and injuries of thefemale genital tact.
Complications of early pregnancy e.g. abortions, ectopicpregnancy and trophoblastic disease. Endometriosis andadenomyosis. Gynaecological endocrinology. Adolescentgynaecology. Infertility and contraception. Disorders ofmenstruation. Urinary Problems.
Gynaecological operations and principles of endoscopiesand cytopathology, principles of chemotherapy andradiotherapy in Gynaecological cancers. Diagnosis ofGynaecological cancer.
ObstetricsAntenatal care Risk Scoringl Obstetrical complications of pregnancy e.g. multiple
pregnancy, hydramnios, PET, eclampsia, IUD,malpresentation, prematurity, postmaturity,obstetrical haemorrhage.
l Basic obstetric ultrasound scanning.l Non obstetrical complications of pregnancy e.g. Rh
incompatibility, cardiac disease, diabetes mellitus,anaemia, jaundice, other medical and surgical diseases,including dengue fever.
l Normal labour, preterm labour, intrapartum monitoring,induction of labour, complications includingmalpresentations, prolonged labour and disproportion.
l Postpartum haemorrhage and other third stagecomplications. 15
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l Use of misoprostol for prevention of PPH,dosageaccording to FIGO recommendation.
l Normal and abnormal puerperium, obstetricprocedures, breast disorders (inverted and crackednipples, breast engorgement, breast abscess)resuscitation of the newborn, neonatal jaundice,Respiratory Distress Syndrome (RDS), care of lowbirth weight neonate.
Emergency Obstetric Care (EMOC), both basic andcomprehensive. National(Pak) indicators for maternaland child heatlh.
Women’s rights to reproductive & sexual Health(WRRSH), Ethics, medicolegal issues.
Clinical skillsThe clinical skills which a specialist must have are variedand complex. Complete list will be very long and is notconsidered necessary for organizing a trainingprogramme. Some examples which are a sub-sample ofthe whole, follow. These are to be taken as guidelinesrather than definitive requirements.
Key to competency levels in clinical skills:
1. Observer status2. Assistant status3. Performed under direct supervision4. Performed independently
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A candidate is expected to attain the given level ofcompetence by the end of each year as follows:
OOBBSSTTEETTRRIICCSSA. Antenatal (OPD and ward)
Level of competence
6 12 24 minimummth mth mth number
Eliciting pertinent history 4 4 4 200
Performing physical examination 3 4 4 200
Requesting appropriate investigations 3 3 4 200
Interpreting the results of investigations 3 3 4 100
Deciding and implementing appropriate 2 3 4 100treatment
Managing immediate complications 2 3 4 50
Maintaining follow up 3 4 4 100
Using ultrasound (basic) 1 2 3 50
Foetal monitoring (including 25 CTG) 3 3 4 100
B. Intrapartum (labour room)
Level of competence
6 12 24 minimummth mth mth number
Assessment on admission 2 3 4 200Induction of labour 2 3 4 30Management of normal labour 3 4 4 100Performing and repairing episiotomy 3 4 4 30
Repair of vaginal and perineal tears 2 3 4 10(including 3rd degree tears)Repair of cervical tears 1 2 3 -
Immediate management of post partum 2 3 4 10haemorrahageOutlet forceps delivery 2 3 4 5Vacuum extraction 2 3 4 5Caesarian section 2 3 4 20Repair of ruptured uterus* 1 1 2 -Obstetric hysterectomy* 1 1 2 -
Correction of inverted uterus (acute)* 1 1 2 -
* The candidates should be rotated through other institutions if required
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C. PostnatalLevel of competence
6 12 24 minimum
mth mth mth number
Resuscitation of neonate 3 4 4 50
Examination of neonate 3 4 4 50
Contraception advice 3 4 4 50
Insertion of IUCD 2 4 4 10PPIUCD
Counseling for breast feeding
GGYYNNAAEECCOOLLOOGGYYA. Gynaecology (OPD and ward)
Level of competence6 12 24 minimum
mth mth mth number
Eliciting pertinent history 3 4 4 50
Performing physical examination 3 4 4 50
Requesting appropriate investigations 3 4 4 50
Interpreting the results of investigations 2 4 4 30
Deciding and implementing 2 4 4 20
appropriate treatment
Managing immediate complications 2 4 4 30
Maintaining follow up 3 4 4 50
Taking Pap smear 3 4 4 20
Arranging assessment by an 3 4 4 30
anaesthetist
Preoperative preparation of patients 3 4 4 30
Inserting ring pessaries 2 4 4 02
Hysterosalpingography (injection of dye) 2 4 4 02
Cauterization of cervix/cryosurgery 2 4 4 02
B. Operative skills
B1 - General skillsLevel of competence
6 12 24 minimummth mth mth number
Scrubbing 4 4 4 30
Preoperative preparation of patients 4 4 4 30
Opening and closing abdomen 2 4 4 15
B2 - OperationsLevel of competence
6 12 24 minimummth mth mth number
Evacuation of retained products of 3 4 4 05
conception
Dilatation and curettage 3 4 4 05
Cervical biopsy 2 4 4 02
Polypectomy 2 4 4 02
Marsupialization / drainage of 1 2 4 01Bartholin’s cyst
Mini laparotomy (for tubal ligation) 2 3 4 01
Post partum tubal ligation at C-section 2 4 4 03
Laparotomy for ectopic pregnancy 2 3 4 02
E-LOGBOOKThe CPSP council has made e-logbook mandatory for allresidency program trainees, including membership,inducted from July 2011 onwards. Upon registration withRTMC each trainee is allotted a registration number anda password to log on to the e-logbook on the CPSPwebsite. The trainee is required to enter all workperformed and the academic activities undertaken in thee-logbook on daily basis. The concerned supervisor isrequired to verify the entries made by the trainee. Thissystem ensures timely entries by the trainee and promptverification by the supervisor. It also helps in monitoringthe progress of trainees and vigilance of supervisors.
The College reserves the right to alter/amend anyrules / regulations. Any decision taken by the Collegeon the interpretation of these regulations will be bindingon the applicant. 19PROSPECTUS MCPS
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USEFUL ADDRESSES AND TELEPHONE NUMBERS
1. Regional Offices of the CPSP
MUZAFFARABAD
CMH Muzaffarabad Azad KashmirTEL: 05822-920998Email:[email protected]
ABBOTTABAD
Ayub Hospital ComplexAbbottabadTEL: 0992-383330Email: [email protected]
PESHAWARHayatabad Medical ComplexPhase IV, Hayatabad,PeshawarUAN: 091-111-666-666TEL: 091-9217011, 091-9217320-1FAX: 091-9217062Email: [email protected]
ISLAMABAD
P.I.M.S, Ravi Road, Sector G- 8/ 3Islamabad. UAN: 051-111-666-666TEL: 051-9262590-1, FAX: 051-9262592Email: [email protected]
FAISALABAD
Punjab Medical CollegeFaisalabadUAN: 041-111-666-666TEL: 041-9210131, 9210366-8FAX: 041-9210224 Email: [email protected]
LAHORE
Next to INMOL, HospitalNew Muslim Town, Block-DLahore. UAN: 042-111-666-666TEL: 042- 99231320-8 FAX: 042- 99231327Email: [email protected]
MULTAN
Nishtar Medical College,Distt. Jail Road, Opp Circuit House, Multan. UAN: 061-111-666-666TEL: 061-9200946, 9200952Email: [email protected]
BAHAWALPUR
Quaid-e-Azam Medical CollegeBahawalpurTEL: 062-9250461Email: [email protected]
NAWABSHAH
Peoples Medical College for GirlsNawabshahTEL: 0244-9370271, 9370479FAX: 0244-9370471Email: [email protected]
LARKANA
Chandka Medical CollegeLarkanaTEL: 074-4752726Email: [email protected]
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HYDERABADAdjacent to Sir Cowasji JehangirInstitute of Psychiatry, Hyderabad, Sindh.TEL: 022-2114556FAX: 022-2114557Email: [email protected]
KARACHI
2.
UAN – 021-111-606-606
l Department of Medical Education99207100 -10 Ext: 235/240
l Examination (FCPS Part I)99207100 -10 Ext: 311
l Examination (FCPS Part II)99207100 -10 Ext: 215
l Registration, Training & Monitoring Cell99207100 -10 Ext: 345 & 324
For further Information: Phone: 99207100-10 UAN 111-606-606 Facsimile: 99266450Website: www.cpsp.edu.pk
QUETTA
Near Cenar Hospital,
Off: Brewery Road, Quetta
TEL: 081-9213434 & 081-2913435
FAX: 081-9213437Email: [email protected]
3. Saudi ArabiaRIYADH Saudi Council for Health SpecialitiesDiplomatic Quartre P.O.Box 94656,Riyadh - 11614.Kingdom of Saudi ArabiaCity: RiyadhCountry: Kingdom of Saudi ArabiaTEL: 966-1-4822415 ext:156/141FAX: 966-1-4884146
4. NepalKATHMANDUInstitute of Medicine, Maharajgunj,Kathmandu, NepalCity: KathmanduCountry: NepalTEL: 00977-1-4416224FAX: 00977-1-4416224Email: [email protected]
Departments of CPSP Karachi OVERSEAS CPSP CENTRES