NMC Guidelines For Competency-Based Training Programme For MD Aerospace Medicine

The purpose of PG education is to create specialists who would provide high quality health care and advance the cause of science through research & training.

The goal of the training programme for MD in Aerospace Medicine is to produce a post- graduate student who after undergoing the required training should be able to deal effectively with the needs of the community and should be competent to handle all problems related to his/her specialty including recent advances. The student should also acquire skill in teaching of medical/para-medical students in the subject that the student has received his/her training. The student should be aware of his/her limitations.

The purpose of this document is to provide teachers and learners illustrative guidelines to achieve defined outcomes through learning and assessment. This document was prepared by various subject-content specialists. The Reconciliation Board of the Academic Committee has attempted to render uniformity without compromise to purpose and content of the document. Compromise in purity of syntax has been made in order to preserve the purpose and content. This has necessitated retention of "domains of learning" under the heading "competencies".

SUBJECT SPECIFIC LEARNING OBJECTIVES

The post graduate student s are expected to attain high proficiency both in theoretical and practical aspects of Aerospace Medicine and other allied disciplines including operational aspects and recent advances. The objectives of post graduate training course would be to train a MBBS doctor who will:

• Practice efficiently and effectively Aerospace Medicine backed by scientific knowledge and skill base.
• Recognize the health needs of the subject and families and carries out professional obligations with empathy and a caring attitude and maintain high ethical standards.
• Continue to evince keen interest in continuing education in the specialty irrespective of whether he/she is in a teaching institution or is a practicing specialist.
• Be a motivated 'teacher' - defined as a specialist keen to share his knowledge and skills with colleagues, aircrew and students.
• Have skills and knowledge to undertake independent research
• Effectively communicate with the person, family and the community.

SUBJECT SPECIFIC OBJECTIVES

The specific learning objectives of this training programme for MD in Aerospace Medicine are based on core competencies. The following objectives are laid out to achieve the goals of the course. These objectives are to be achieved by the time the post graduate student completes the course.

The objectives may be considered under the subheadings:

(1) Cognitive domain (Knowledge)

(2) Affective domain (Human values, ethical practice and communication abilities)

(3) Psychomotor domain (skills)

SUBJECT SPECIFIC COMPETENCIES

Competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individuals and communities being served. Competence-based training focuses on learning by doing. Core competencies are the essential knowledge, values and skills vital to the successful performance of one's job function i.e. effective practice of medical care.

By the end of the course, the student should have acquired knowledge (cognitive domain), professionalism (affective domain) and skills (psychomotor domain) as given below:

A. Cognitive domain

This includes competencies with respect to the core discipline as well as problem-solving abilities.

The student should be able to:

(a) Demonstrate understanding of basic sciences relevant to this specialty.

• Identify social, economic, environmental and emotional determinants in a given case, and take them into account for planning therapeutic measures.
• Possess knowledge and competence to write aero-medical opinions on a wide variety of clinical cases.
• Be able to contribute meaningfully in all aspects of aircraft accident investigation especially aero-medical aspects and human factors.
• Possess comprehensive knowledge of flying clothing and life support systems of aircraft on base and update the same with regular interaction with technicians and aircrew.
• Identify aero-medical problems at a flying station/airline and offer appropriate solution.
• Advise regarding the management of the case and to carry out this management effectively. Update oneself by self study and by attending courses, conferences and seminars relevant to the specialty.
• Recognize conditions that may be outside the area of his specialty/competence and to refer them to the proper specialist.

B. Affective Domain (Human values, Ethical practice and Communication abilities)

• Demonstrate professionalism and adopt good ethical principles in all aspects of his/her practice. Professional honesty and integrity are to be fostered. Care is to be delivered irrespective of the social status, caste, creed or religion of the patient.

(b) Recognize personal beliefs, prejudices, and limitations.

• Develop interpersonal and communication skills, in particular the skill required to explain preventive health aspects and increase awareness of aero- medical concerns for aircrew.
• Provide leadership and get the best out of his team in a congenial working atmosphere.
• Apply high moral and ethical standards while carrying out human or animal research.
• Be humble and accept the limitations in his knowledge and skill to ask for help from colleagues when needed.
• Respect patient's rights and privileges including patient's right to confidentiality, information and right to seek a second opinion.

C. Psychomotor domain

During the course, the student should develop the following skills:

• Possess ability and competence to take a proper clinical history, examine the patient, perform essential diagnostic procedures and order relevant tests and interpret them to come to a reasonable diagnosis about the clinical condition.
• Perform common procedures relevant to the specialty.

(c) In the core competence domain of system-based practice,

(i) Demonstrate a practical, efficient and cost-effective approach to health care management,

(ii) Utilize knowledge in the field of health service delivery,

(iii) Demonstrate ability to follow the health care team approach to health care delivery.

• Provide basic and advanced life saving support services (BLS and ALS) in emergency situations.

(e) Demonstrate use of information management and procedural systems.

• Demonstrate practice-based learning and improvement and be a physician scholar.
• Possess academic skills and be able to teach and conduct clinical sessions, be familiar with research methodology and execute a thesis, write and present papers.
• Undertake independent sizing and fitment and care of aircrew clothing.

Syllabus

During the training period, the student should undergo training in the following course contents:

Course contents

The course contents will be in four parts:

Part I: Basic Sciences

• Aeronautics including Aerodynamics and principles of flight, Navigation, Navigational aids and Aeroengines.
• Applied Physics including Atmospheric Physics, Cabin pressurization, Acceleration forces, Vibration stress, Impact and Crash forces, Ejection trajectory analysis, Thermal Stress, Refrigeration, Effects of Noise, illumination, Optics and Radiation Space Physics.
• Bio-medical engineering including Basic of Electronics, Instrumentation systems, principles of physiological monitoring systems and their application, biochemistry, familiarization of electro-medical equipments in use in Aerospace Medicine, Electrical safety, element of biomechanics - solid and fluid mechanics.
• Medical statistics related biomedical research-descriptive studies, relations and predictions of variables, parametric and non- parametric tests.
• General physiology including cardiopulmonary physiology, mechanics of respiration, hemodynamics, regulatory mechanisms, functional assessment and ageing.
• Metabolic and endocrine biochemistry including bioenergetics and metabolism of carbohydrates, lipids, proteins and amino acids, enzymes used in clinical diagnostics, free radicals and nutrition.
• Neuro-physiology including mechanics of sensory perception integration, reticular activating system, limbic system and physiology of emotions.

Part II: Aerospace Physiology

• High altitude physiology including respiratory physiology in flight, hypoxia and prevention, oxygen systems, decompression sickness. Rapid decompression, aero-medical problems in high altitude operations, hyper- baric oxygen medicine.
• Environmental physiology including thermal stress, thermal regulation and prevention of thermal effects.
• Acceleration physiology including G-LOC, SACM, Anti-G suit, PBG, cardiovascular and respiratory changes during acceleration, protection against +Gz, effects of –Gz, Transverse and lateral G.
• Fundamentals of space physiology simulation of micro G, conditioning, training and evaluation, life support systems, escape and survival, weightlessness, space sickness, countering gravitational and thermal stresses, vector cardiology in space environment, animal based experiments, extra vehicular activity in space and rescue.
• Physiology of women in aviation.

Part III: Applied Aerospace Medicine

• History of Aerospace Medicine
• Spatial Disorientation - static and dynamic, illusions, prevention, newer concepts.
• Human engineering including ergonomics and anthropometry, spinal evaluation, cockpit design and instrument layout, cabin work station layout, work load studies, aids for vision enhancement, ejection and escape systems survival aids - PSP, snow, land and sea survival, air casualty evacuation and disaster management, crash investigation.
• Human factors in civil and military aviation, CRM, human errors, hazards and flight safety.
• Design and aero-medical evaluation of flying clothing and life support systems as applicable to civil and military aircraft and aero-medical equipment.
• Civil aviation medicine including ICAO medical policies, DGCA India medical organization and policies, licensing medical examinations, flight duty time limitations, traffic and approach, air hygiene and sanitation, catering, epidemiological and immunological problems; IHO, air ambulance and air hospitals, long range and ultra long range airline operations.
• Preventive and Social Medicine including environment and health, pollution - air and water, sanitation and purification, occupational health of air and ground crew, health education and communication, NBC warfare and protection, non-communicable diseases, family welfare and immunization.
• Aero-medical problems in air-to-air refueling, long duration fighter flying, sustained operations and exercises, international exercises, UN Missions for peace keeping.

Part IV: Clinical Aerospace Medicine

• Internal Medicine including cardiovascular, respiratory, nervous and renal systems, gastroenterology, hepatology and metabolic disorders, rheumatological disorders, common medical disorders in aircrew, drugs and the flier.
• Aviation ophthalmology including physiology of vision and colour vision, optics, refraction and optometry, common eye disease, visual problems in aero-medical evaluation of ophthalmic disorders.
• Aviation otolaryngology including noise stress and conservation of hearing, vestibular functions, disorientation and their assessment, vestibular habituation, otitic and sinus barotraumas, deafness and sensory neural hearing loss, speech intelligibility, air sickness and its desensitivity.
• Aviation neuro-physiology including psychosis and neurosis, personality disorders, alcohol and drug dependence, psychosexual disorders, suicidal behavior, psychiatric emergencies, behavior therapy, biofeedback, sleep disorders, aviation related topics - head injury, fear of flying and aircrew selection.
• Aviation psychology including personality traits and assessment, aircrew selection, cognitive processes and abilities, principles of learning, stress management, motivation, low motivation for flying and its evaluations and applied aspects of behavioral sciences.
• Aviation pathology and toxicology, including collection, preservation and dispatch of specimens, histological findings, accident reconstruction and investigation, identification of avian blood in aircraft accidents, chemical pathology, hematology, clinical pathology.

• Radiology including Radiodiagnosis and assessment of head, neck, spinal and other skeletal injuries following accident, abnormalities of skeletal system, radiodiagnostic methods in cardiopulmonary, gastro-intestinal disorders, radiation hazards in Aviation, medical evaluation including investigations, diagnosis and disposal of medical, surgical and other disabilities in aircrew. Importance of postmortem radiological investigations in aircraft accident investigations.

TEACHING AND LEARNING METHODS

The detailed break-up of teaching hours (Theory and Practical) for the three-year MD course is given as Appendix B.

(a) 1^st year

(i) Number of hours for teaching: 714 hours

(ii) Number of hours of practicals /Demonstrations: 542 hours

(iii) Common Training Programme (as listed below)

(b) 2

^nd Year

(i) Clinical attachment to Teaching Hospital (Dept of Medicine): 24 weeks

(ii) Local /Outstation visits: (7 weeks) as below (Illustrative):

Each visit has an objective and the same is spelt out during the pre-visit briefing to the post graduate students and also to the units they are visiting. One instructor from this Institute accompanies the post graduate students during the tour. The post-visit debrief covers aspects learnt and whether terminal learning objectives achieved. The post graduate students fill out 'end of visit' proforma towards this assessment.

(iii) Rotation:

Postings- Department Activity: Students are attached to all the departments on rotation. During this period, they take part in all the routine activities of the department, including training of aircrew, testing of aero-medical equipment, procedures and research. Clinical specialists at IAM conduct clinics in the afternoon.

Rotations suggested

Educational visit - 7 weeks

Attachment to Teaching Hospital - 24 weeks

Departmental Attachments - 13 weeks

Clinical Attachments - 4 weeks

Aviation Psychiatry - 1 week

Aviation Ophthalmology - 1 week

Aviation Otorhinolaryngology - 1 week

Aviation Psychology - 1 week

• Assigned duties: The post graduate students perform assigned duties in the form of referrals in MEC, preflight and sick report at ASTE, preflight at NFTC and sick report at IAM SMC.

• Common Training Programme (as listed below)

• MD Thesis: Collection and collation of data.

(c) 3^rd Year

(i) MD Thesis: Collection and collation of data, submitting of MD Dissertation.

(ii) Preparation for Examination.

(iii) Common Training Programme (as listed below)

(iv) Clinical attachment to various departments as per Appendix 'A' given below: For clinical attachments, clinical specialists at teaching hospital / IAM will conduct clinics.

(v) Departmental attachments (including Medical Evaluation Centre) as per

Appendix A.

Rotations suggested

Departmental Attachments - 34 weeks MEC - 5 weeks

Acceleration + Spatial Disorientation - 4 + 3 weeks HAP + Hyperbaric Medicine - 4 + 3 weeks Environmental + Space Physiology - 4 + 3 weeks Human Engineering + NVG - 4 + 3 weeks Biophysics/Biomedical engineering - 1 week

Clinical Attachments - 10 weeks

Aviation Psychiatry - 2 weeks

Aviation Ophthalmology - 2 weeks

Aviation Otorhinolaryngology - 2 week s

Aviation Psychology - 2 weeks

Clinical Aviation Medicine - 1 week

Aviation Pathology - 1 week

Appendix 'A'

Teaching - Learning Programme

During the training programme, patient safety is of paramount importance; therefore, skills are to be learnt initially on the models, later to be performed under supervision followed by performing independently; for this purpose, provision of skills laboratories in medical colleges is mandatory.

• Class Room Teaching: As mentioned above during the first year.

(b) The following teaching and learning methods to be used:

(i) Lectures

(ii) Discussions

(iii) Student Directed Learning

(iv) Case Based Learning

(v) Role Playing

(vi) Simulated Patient Lab

(vii) Electronic and Computer Simulators

(viii) Web Based

• Training in teaching skills: The students take classes for various courses in Aviation Medicine including the Primary course in Aerospace Medicine, Operational Training in Aerospace Medicine (OPTRAM) courses for Aircrew and courses for Medical Assistants.

Common Training Programme

• Clinical Training: The clinical training for post graduate students is arranged at the institute, Command Hospital (AF) Bangalore. The thrust on clinical skills is to equip the post graduate students the wherewithal to apply the practical aspects of medicine to their beneficiaries. They will perform DMO duties in the hospitals during the entire course period.

• Participation in departmental activities: Students are attached to the departments on rotation. During this period, they take part in all the routine activities of the department, including training of aircrew, testing of aero-medical equipment and procedures and research.
• Journal Clubs: A journal club is arranged every fortnight. The students cover recent journal articles by rotation.
• Clinico-Pathological Meetings and Conferences: Students attend clinical presentations and meetings every week and the routine clinico- pathological meeting at the Command Hospital, Air Force every month. They attend the yearly conference of the Indian Society of Aerospace Medicine. In addition, they are encouraged to attend other symposia/seminars on aviation medicine.
• Inter-departmental Meetings: These are arranged fortnightly.

• Thesis: The student must complete one thesis project as a part of training under a university recognized guide.
• Log Book: Log books will be maintained and shall be checked and assessed periodically by the faculty members imparting the training.
• A postgraduate student of a postgraduate degree course in broad specialities/super specialities would be required to present one poster presentation, to read one paper at a national/state conference and to present one research paper which should be published/accepted for publication/sent for publication during the period of his postgraduate studies so as to make him eligible to appear at the postgraduate degree examination.

• Department should encourage e-learning activities.
• MEC Attachments: Attachments to MEC is a part of the training schedule to enable the student's ability to understand the medical evaluation process. This helps the post graduate students in applying the principles of Clinical Aerospace Medicine to individual cases and appreciate the aero-medical dispositions of ab-initio and trained aircrew. The post graduate students give opinions for medical board on variety of clinical cases under the supervision of the specialist concerned. Also, the post graduate students meet the President, MEC every morning for brief plan for the day and for the discussions on the previous day's cases and the rationale for their disposal.

(k) Practicals

As per details given in Appendix 'A'.

ASSESSMENT

Assessment and Monitoring

The various domains of competence are assessed in an integrated, coherent, and longitudinal fashion with the use of multiple methods and provision of frequent and constructive feedback. Habit of mind and behavior, acquisition and application of knowledge and skills, communication, professionalism, clinical reasoning and judgment in uncertain situations, teamwork, practice-based learning and improvement and systems- based practice are assessed.

FORMATIVE ASSESSMENT, during the training programme

Formative assessment should be continual and should assess medical knowledge, patient care, procedural & academic skills, interpersonal skills, professionalism, self directed learning and ability to practice in the system.

General Principles

Internal Assessment should be frequent, cover all domains of learning and used to provide feedback to improve learning; it should also cover professionalism and communication skills. The Internal Assessment should be conducted in theory and clinical examination.

Quarterly assessment during the MD training should be based on:

1. Journal based / recent advances learning

2. Patient based /Laboratory or Skill based learning

3. Self directed learning and teaching

4. Departmental and interdepartmental learning activity

5. External and Outreach Activities / CMEs

The student to be assessed periodically as per categories listed in postgraduate student appraisal form (Annexure I).

SUMMATIVE ASSESSMENT, at the end of the course,

The summative examination would be carried out as per the Rules given in

POSTGRADUATE MEDICAL EDUCATION REGULATIONS, 2000.

The post-graduate examination should be in 3 parts:

1. Thesis

Every post graduate student shall carry out work on an assigned research project under the guidance of a recognised Post Graduate Teacher, the result of which shall be written up and submitted in the form of a Thesis. Work for writing the Thesis is aimed at contributing to the development of a spirit of enquiry, besides exposing the post graduate student to the techniques of research, critical analysis, acquaintance with the latest advances in medical science and the manner of identifying and consulting available literature.

Thesis shall be submitted at least six months before the Theory and Clinical / Practical examination. The thesis shall be examined by a minimum of three examiners; one internal and two external examiners, who shall not be the examiners for Theory and Clinical examination. A post graduate student shall be allowed to appear for the Theory and Practical/Clinical examination only after the acceptance of the Thesis by the examiners.

2. Theory Examination

The examinations shall be organised on the basis of 'Grading'or 'Marking system' to evaluate and to certify post graduate student 's level of knowledge, skill and competence at the end of the training. Obtaining a minimum of 50% marks in 'Theory' as well as 'Practical' separately shall be mandatory for passing examination as a whole. The examination for M.D./ MS shall be held at the end of 3rd academic year. An academic term shall mean six month's training period.

There shall be four theory papers:

Paper 1: Basic Medical Sciences

Paper 2: Aerospace Physiology

Paper 3: Applied Aerospace Medicine

Paper 4: Clinical Aerospace Medicine & Advances in Aerospace Medicine

3. Practical/Clinical and Oral/viva voce Examination consists of:

(a) Long Case:

One long case from any of the following departments: Medicine, Psychiatry,

ENT, Eye and Orthopedics

(b) Short Case:

Two short cases from any of the following departments: Medicine, Psychiatry, ENT, Eye and Orthopedics (2x25 marks)

(c) Aviation Practical

Oral/viva voce examination shall be comprehensive enough to test the post graduate student's overall knowledge of the subject.

Viva Voce Examination shall aim at assessing depth of knowledge, logical reasoning, confidence and oral communication skills as under:

(a) Examination of all components of syllabus

(b) Pedagogy

A topic is given to each student in the beginning of clinical examination. The student is asked to give a presentation on the topic for 8-10 minutes.

Recommended Reading:

Books (latest edition)

1. JA Gillies. Textbook of Aviation, Physiology, Pergamon Press, Oxford

2. Stanely Roscoe. Aviation Psychology, Iowa State Uty Press, Ames IA

3. Wesley E Woodson. Human Factors Design Hand Book, McGraw-Hill, New York

4. Albert L Wchninger. Principles of Bio Chemistry, CBS, arrangement with Worth Publisher New York, Delhi

5. Smith EL, Hiee RL. Principles of BioChemistry Mammalian Bio-n Chemistry, Inter-national Edition, McGraw-Hill Book, Singapore

6. Michel Loeb. Noise and Human Efficiency, John Wiley and Sons.

7. Earl W Weiner David C Nagal. Human Factors in Aviation, Academic Press INC, New York.

8. Wiener EL, Nagel Dc. Human Factors In Aviation, Academic Press Inc, New York

9. Best and Taylor. Physiological Basis of Medical Practice, Williams and Wilkins, Baltimore, USA.

10. Barrett. Text Book of Immunology, F A Davis Co, Philedelphia.

11. Ballantyon Groovg. Synopsis of Scott Brown Otorhinolaryngology, Butterworth and Co, UK.

12. Mark S, Sanders Ernest J McCornik. Human Factors in Engineering and Design, 7^th Edition, McGraw Hills, New York.

13. Morgan CT, King Ra, Robinsons NM. Introduction to Psychology, TMH, New Delhi.

14. Alan Stokes, Kristen Kite. Flight Stress: Stress Fatigue and Performance in Aviation, Avebury, Cambridge.

15. Aitkenetal. Behaviour Science for Health Professionals, W B Saunders, New York.

16. Antia and Abraham. Clinical Dietetics and Nutrition, Oxford Uty Press, New Delhi.

17. Alan G Keir. Scott Brown Otorhinolaryngology, Butterworth and Co, UK .

18. Lislie Cormwell, Fredj Weibell, Erich A Pfeiffer. Bio-Medical Instrumentation and Measurement, PHI, New Delhi.

19. Abramsky. Multiple Sclerosis, Dunitz Martin limited, New York.

20. YC Fung. Fundamental of Bio Mechanics Springer, New York.

21. Anirban Biswas. Audio Vestibulometry, India.

22. Frank H Hawkins. Human Factors in Flight, Ashgate, Oxford UK.

23. David C Priston, Barbara E Shapiro. Electromyography and Neuromuscular order, clinical electrophysiology co-relation. Butterworth Heinnmann, UK.

24. Murray RK, Granner PK. Harpers BioChemistry, Appleton and Range, Connecticut, USA.

25. Kawleen Mohan and Sylvion Escott Shemp. Krause's' Food, Nutrition and diet therapy, WB Saunders Company, Philadelphia.

26. Vyas and Ahuja. Textbook of P.G Psychiatry, BI Churchill Livingston, Prithvi Book Srores, Bangalore.

27. Ronald Bodley Scott. Prices Text book of Medicine, Oxford University Press, Edinburgh.

28. Albert P Malvino. Electronic Principles, TMH, India.

29. Willian F Ganong. Review of Medical Physiology, Appleton and Lange, Singapore.

30. Sadock and Sadock. Comprehensive Textbook of Psychiatry, Lippincort Williams and Wilkins, Phiedelphia

31. Aurthur C Guyton and John E Hall. Text book of Medical Physiology, Saunders Elsviers, New York

32. John Ernsting and Peter. Aviation Medicine: Part I: The pressure EnvironmentPart II: Biodynamics, Part III: Thermal Stress and Survival, Hodder and Arnold, UK.

33. Chirstopher Haslett. Davidson's Principles and Practice of Medicine, Churchill Livingtone, Edinburgh.

34. John Ernsting, Anthony N Nicholson and David J Rainford. Aviation Medicine Part 1: Aviation Physiology and Aircrew Systems, Part III: Operational Aviation Medicine, Hodder and Arnold, UK.

35. Selvendy. Handbook of Human Factors and Ergonomics, John Wiley and Sons, New York.

36. John Ernsting. Aviation Medicine, Hodder and Arnold, UK.

37. Kanski. Clinical Ophthalmology, Elsevier, London.

38. SJH Miller. Parsons Diseases of the Eye, Elsevier, London

39. Benno M Nigg and Walter Herzog. Bio-Mechanic of Muscular Skeletal System, Wiley, University of Calicagara, Canada, New York.

40. Jeffary R Davis. Fundamentals of Aerospace Medicine Section II: Physiology in the flight environment, Lippincort Williams and Wilkins, New York

Journals

03-05 intenational Journals and 02 national (all indexed) journals

References and Reports (latest editions)

1. JA Gillies. Textbook of Aviation Physiology, Pergamon Press, Oxford.

2. JC Guignard and PF King. AGARD - Aero medical aspects of vibration and noise.

3. Hilgard CR, Atkinson RC Atkinson RL. Introduction to Psychology, Oxford University, New Delhi.

4. Anastasi Anee. Psychological Testing, Prentice Hall, New York.

5. Mohanty GS. Aviation Psychology, Institute of Flight Safety, New Delhi.

6. Bernstein Roy, Srull, Wickens. Psychology, Illinois, 1262/-, Houghton Mifflin Company.

7. Carson RC, Butcher JN. Abnormal Psychology and Modern Life, Harper Collins Publishers Inc

8.Report by Undersea and Hyperbaric Medical Society Guidelines for Clinical Multiplace Hyperbaric facilities (1994), Undersea and Hyperbaric Medical Society

9. D Health and DR Williams. High Altitude Medicine and Pathology, Oxford University Press, Oxford.

10.Ed MJ Griffin. Handbook of Human Vibration, Academic Press

11. G Oriani, A Marrani F Wattel (1996), Handbook of Hyperbaric Medicine, Berlin, Springer Verlag,

12. Enrico M Camporesi. Hyperbaric Oxygen Therapy : a Committee report, Undersea and Hyperbaric Medical Society.

13. Ed Gavriel Salvendy. Handbook of Human Factors and Ergonomics, John Wiley and Sons, New York

14. Michael P Ward JS Miledge and JB West. High Altitude Medicine and Physiology, Hodder and Arnold, New York

Appendix B: Detailed break-up of teaching hours (Theory and Practical) for the 3- year MD course