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AETCOM complete module list year-wise 1.1 to 4.4 NMC MBBS competencies
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Here is a detailed breakdown of the AETCOM module as per the NMC/MCI Competency-Based Medical Education (CBME) curriculum for Indian MBBS students.
AETCOM - Attitude, Ethics, and Communication Module
What is AETCOM?
AETCOM stands for Attitude, Ethics, and Communication. It is a longitudinal, integrated module introduced by the Medical Council of India (MCI) - now the National Medical Commission (NMC) - as part of the CBME curriculum launched in 2019. It runs across all four professional years and internship of the MBBS program.
The fundamental principle underlying AETCOM is: changing a person's attitude can change their behavior. It recognizes that soft skills - professional attitudes, ethical reasoning, and communication - are just as important as clinical knowledge for a competent doctor.
Why Was AETCOM Introduced?
The Indian Medical Graduate (IMG) is expected to fulfill five key roles:
- Clinician - Diagnoses and manages health problems
- Leader and member of the health care team - Works in inter-professional settings
- Communicator - Communicates effectively with patients, families, and colleagues
- Life-long learner - Commits to self-improvement and professional development
- Professional - Practices with integrity, empathy, and ethical grounding
Prior to AETCOM, medical ethics, behavioral science, communication skills, and managerial skills received inadequate formal attention in Indian medical education. AETCOM was created to address this gap systematically.
Structure of AETCOM
AETCOM is a longitudinal programme spread across the entire MBBS curriculum, including internship. It is NOT a standalone subject - it is integrated into the regular teaching-learning schedule of each professional year.
- 75% attendance in AETCOM sessions is mandatory for eligibility to appear in professional examinations.
- Total dedicated hours vary by year: ~34 hours in Year 1, with continued sessions in Years 2, 3, and 4.
- It contributes to both formative and summative assessment.
Module-wise Breakdown
PHASE I (First Professional Year) - 5 Modules
| Module | Topic | Key Competencies |
|---|---|---|
| 1.1 | What does it mean to be a doctor? | Identify and discuss the physician's role and responsibility to society and community |
| 1.2 | What does it mean to be a patient? | Enumerate and describe professional qualities and roles of a physician; demonstrate empathy |
| 1.3 | The Doctor-Patient Relationship | Demonstrate empathy in patient encounters; understand professional qualities of a physician |
| 1.4 | Foundations of Communication - 1 | Communicate to patients in a patient, respectful, non-threatening, non-judgmental and empathetic manner |
| 1.5 | The Cadaver as Our First Teacher | Demonstrate respect and follow correct procedures when handling cadavers and biological tissue |
Hours: ~34 hours across Year 1
Subject linkage: Modules 1.2 and 1.3 linked to Physiology; Module 1.5 linked to Anatomy; Module 1.4 linked to Biochemistry
PHASE II (Second Professional Year)
| Module | Topic | Key Competencies |
|---|---|---|
| 2.1 | Foundations of Communication - 2 | Active listening and data gathering; verbal and non-verbal communication skills |
| 2.2 | Foundations of Communication - 3 | Information sharing, counseling, breaking bad news |
| 2.3 | Introduction to Bioethics | Understand ethical principles (autonomy, beneficence, non-maleficence, justice) |
| 2.4 | Bioethics continued: Informed Consent | Obtain informed consent; understand valid consent elements |
| 2.5 | Bioethics continued: End-of-Life Issues | Manage ethical conflicts at end of life; DNR orders; patient autonomy vs. beneficence |
| 2.6 | Bioethics continued: Death and Dying | Communicate with patients/families about terminal illness and palliative care |
| 2.7 | Bioethics continued: Autonomy and Decision Making | Competency vs. capacity; surrogate decision making |
PHASE III (Third Professional Year)
| Module | Topic | Key Competencies |
|---|---|---|
| 3.1 | Foundations of Communication - 4 | Communicate diagnosis, management plan, and prognosis to patients and families |
| 3.2 | Foundations of Communication - 5 | Communication in special situations (breaking bad news, difficult conversations) |
| 3.3 | Medical Ethics and Professionalism | Ethical and professional conflicts; maintaining professional boundaries; codes of conduct |
| 3.4 | Research Ethics | Principles of research ethics; Helsinki declaration; IRB; plagiarism; authorship |
| 3.5 | Professionalism | Professional responsibility to patients, colleagues, and society; commitment to profession |
PHASE IV (Fourth Professional Year - Final MBBS)
| Module | Topic | Key Competencies |
|---|---|---|
| 4.1 | Foundations of Communication - 6 | Advanced communication skills in clinical settings; skills station assessment |
| 4.2 | Case Studies: Medico-Legal and Ethical Situations - Abortion/MTP Act | Identify, discuss, and defend medico-legal issues related to abortion and reproductive rights; Medical Termination of Pregnancy Act |
| 4.3 | Case Studies: Medico-Legal and Ethical Situations - Organ Transplantation | Ethical and legal aspects of organ donation; Human Organ Transplantation Act |
| 4.4 | Case Studies: Ethics, Empathy, and the Doctor-Patient Relationship | Demonstrate empathy in terminal illness; communicate care options in simulated environments; failure of therapy; termination of relationships |
Teaching-Learning Methods Used in AETCOM
AETCOM uses a variety of learner-centered, interactive methods rather than traditional lectures:
| Method | Purpose |
|---|---|
| Small group discussions (SGD) | Reflect and discuss ethical dilemmas, case scenarios |
| Large group sessions | Introduction to concepts, framing the topic |
| Role plays | Practice communication, empathy, breaking bad news |
| Standardized patient encounters | Simulate real doctor-patient interactions |
| Reflective writing / narratives | Students write personal reflections on experiences |
| Seminars / workshops | Deeper exploration of ethics and professionalism topics |
| Self-directed learning (SDL) | Independent reading and case preparation |
| Case studies | Apply ethical principles to real clinical scenarios |
| Early Clinical Exposure (ECE) | Hospital visits to observe and reflect on patient experiences |
| Clinical skills stations (OSCE) | Structured assessment of communication and professionalism |
Competency Levels in AETCOM
AETCOM uses a specific competency leveling system to define expected student performance:
| Code | Meaning |
|---|---|
| KH | Should know how (recall and explain) |
| SH | Should be able to demonstrate how (observed performance) |
Most communication and empathy competencies are at the SH level (performance-based), while knowledge of Acts and legal frameworks is at the KH level.
Assessment in AETCOM
Assessment is a core part of AETCOM's philosophy - not just for pass/fail, but for feedback and improvement.
Formative Assessment (Ongoing)
- Active participation in sessions, role plays, and SGDs
- Reflective notes and written narratives
- Logbook entries verified by faculty
- Observation of performance with structured feedback
Summative Assessment
- Written questions (short notes, SAQs) on legal Acts (MTP Act, Transplantation Act), ethical principles, and case-based questions
- OSCE / Skills station - Communicate a diagnosis, management plan, and prognosis to a simulated patient
- Creative writing exercises
- Performance at skills stations evaluated against defined competencies (Below / Meets / Exceeds expectations)
Key Ethical Principles Taught in AETCOM
- Autonomy - Patient's right to make informed decisions
- Beneficence - Acting in the patient's best interest
- Non-maleficence - Do no harm
- Justice - Fair distribution of healthcare resources and equitable treatment
These four principles (from the Beauchamp and Childress framework) form the ethical backbone of the AETCOM curriculum.
Important Medico-Legal Frameworks Covered
| Framework | Module |
|---|---|
| Informed Consent (elements and validity) | 2.4 |
| Do Not Resuscitate (DNR) orders | 2.5 |
| Medical Termination of Pregnancy (MTP) Act | 4.2 |
| Human Organ Transplantation Act | 4.3 |
| Research ethics - Declaration of Helsinki | 3.4 |
| IRB (Institutional Review Board) / IEC (Ethics Committee) | 3.4 |
| Adolescent healthcare decision-making | 4.2 |
Department-wise Integration (Year 1 Example, Updated 2024)
As per the NMC update of September 12, 2024, AETCOM modules are formally assigned to specific departments:
| Subject | Module(s) Assigned |
|---|---|
| Anatomy | Module 1.5 (Cadaver as first teacher) |
| Physiology | Modules 1.2 and 1.3 |
| Biochemistry | Module 1.4 |
This ensures that every basic science department participates in AETCOM delivery rather than it being siloed in one department.
Strengths and Challenges
Strengths
- Addresses a longstanding gap in Indian medical education
- Longitudinal design allows progressive deepening of concepts
- Learner-centered methods (role play, reflection) are more effective than lectures for attitude change
- Formally assessed - ensures student accountability
Challenges (acknowledged in published research)
- Inconsistent implementation across institutions
- Faculty may lack adequate training in facilitation techniques
- Assessment tools appear subjective; standardization is difficult
- Overcrowded curriculum leaves limited time for AETCOM sessions
- Limited published evidence on long-term behavioral change in graduates
Summary Table: AETCOM at a Glance
| Feature | Detail |
|---|---|
| Full form | Attitude, Ethics, and Communication |
| Introduced by | Medical Council of India (MCI) / NMC |
| Year of introduction | 2019 (CBME curriculum) |
| Duration | Longitudinal - all 4.5 years + internship |
| Year 1 hours | ~34 hours |
| Total modules | ~17 across 4 phases (1.1 to 4.4) |
| Assessment | Formative + Summative (OSCE, written, reflective) |
| Attendance required | 75% mandatory |
| Core domains | Attitude, Ethics, Communication, Professionalism |
| Framework for ethics | Beauchamp and Childress (4 principles) |
AETCOM represents a significant shift in Indian medical education - from knowledge-centric to competency- and values-centric training - preparing doctors who are not only clinically competent but also professionally responsible, ethically sound, and effective communicators. The NMC AETCOM official document is the primary reference for all module guidelines.
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