Surgery Curriculum

Surgery

Curriculum

Preface

T he Egyptian Fellowship Board and the General Surgery scientific council worked col-

laboratively to make this curriculum available for trainees’ guidance and support.

Postgraduate medical education world wide are now governed by sets of academic stan-

dards that describe the qualities and abilities of graduates. In addition, there are standards

for The training processes , trainers’ selection and methods of assessment. standards en-

sure transparency and clarify expectations.

The Egyptian fellowship board has already defined and published its standards for the gen-

eral and professional competencies expected from our graduates in different specialties

upon successful completion of training. These expectations are clearly reflected in the

general surgery curriculum.

The curriculum describes what trainees will know and be able to do upon completion of

training. In additions, methods of teaching and learning needed to deliver the curriculum

are outlined. The curriculum also describes in details, expectations from trainees during

their rotations in “The training rules and regulations section”. Methods of assessment and

examination regulations are also available in the last section of the curriculum.

All topics covered during practical and theoretical study are outlined in tables. This will

help trainees to guide their readings and their choice of learning activities. In addition, all

required clinical cases and operative procedures are listed together with expected level of

performance at various stages of training

To help our trainees and maximize benefit, we provided a guide in the logbook for manda-

tory courses and operative experiences that must be attended and performed by trainees

each year. The Egyptian fellowship board will work closely with the general surgery scien-

tific council to organize the obligatory courses at appropriate training stages.

We hope that all our trainees, trainers and educational supervisors will follow the provided

guides and cooperate with the Egyptian Fellowship Board and the General Surgery Scien-

tific Council to ensure the proper implementation of this curriculum . Esmat Ahmed Sheba

Secretary General

Higher Committee of Medical Specialties

Acknowledgement

The general surgery curriculum and logbook has been created through collaboration

between the General Surgery scientific council and the Egyptian fellowship curricu-

lum committee. The following members of the general surgery scientific council

have made substantial contribution to the curriculum development as subject matter

experts

The Egyptian fellowship curriculum committee has made significant contribution to

the curriculum through collaboration with the council in the design and formulation of

the curriculum educational structure. The Member who participated in The work is

The Committees consulted international and national curricula in gen-

eral surgery. The external references for the development of this curricu-

lum are:

1. The general surgery curriculum approved by the Joint Committee

on Surgical Training. UK 2007

2. The Royal Australasian College of surgeons curriculum and log-

book 2006

3. The previous surgical curriculum issued by the Egyptian Board

2005

4. Postgraduate Medical Education and Training Board UK

(Guidelines for curriculum development 2006)

5. Guidelines and forms for curriculum development issued by the

Egyptian Fellowship Board 2007

Professor Dr Samir Galal, Professor of Surgery, Cairo University and Head of

the General Surgery scientific council

Professor Dr Ahmed Shehata , Professor of Surgery , Al Azhar University

Professor Dr Eman Abd El Raouf Mohammed ,Professor of Pediatric Hema-

tology, Cairo University and the educational advisor of the Egyptian board

General Surgery Curriculum Egyptian Fellowship Board

7

CONTENTS …………………

Preface and acknowledgements………………………………………………………..…………….

The structure and regulations of surgical training………………………………………………………

Rationale and aims of the curriculum………..………………………………………….…………

Intended learning outcomes…..…………………………………………………………………………..

Teaching and training methods….…………………………………………………………………………………

Basic sciences syllabus……………………... ……………………………………...…………………………

Basic surgical skills…...……………………………………………………………………………………………..

Gastrointestinal surgery………...…………………………………………………………………………….

Surgical emergencies……………………...…………………………………………………………………...

Orthopedic surgery……………………………….……………………………………………………...……...

Reticuloendothelial system……………….…………………..…………………………………………….

Skin and subcutaneus tissues…………………………..……………………………………………………

Surgical oncology (clinical skills)…………..…………………………………………………………….

Endoscopy……………………………………………………….. ……………………………………………………

Vascular surgery……………………………………………………………………………………………………..

Urogenital surgery………………………………………………………………………………………………..

Breast surgery…………………………………………………………………………………………………………

Endocrine surgery…………………………………………………………………………………………………

Salivary glands………………………………………………………………………………………………………..

Regulations and methods of assessment………………………………………………………...

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General surgery curriculum Egyptian Fellowship Board

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The Structure of the general surgery Training Program

The Egyptian Fellowship Board requires five years of supervised training pro-

gram that must be conducted in accredited hospitals before sitting for the

final examination. It also requires the presentation of a short thesis or audit

project on a subject approved by the supervisors. A list of accredited hospi-

tals will be announced yearly by the board. During the entire training pro-

gram, the candidate must be dedicated full time and must be responsible for

patient care under supervision. The program has the following requirements

for trainees who are affiliated to MOHP:

1. Graduation from medical school and successful completion of the pre-

registration house officers' year.

2. Enrollment in the Ministry of health and population residency program

as an general surgery resident

3. Trainees, who finished their master degree in surgery will join the pro-

gram from its third year and are exempted from the first part exam. It is

to be noted that this rule only applies for those who get the master

within five years. If more than five years passed, they must resite for the

first part exam.

4. Trainees who finished their surgery diploma might join the program

from its second year. However, they must site for the first part exam.

The trainee should spend the first year of training in general surgery practice

that might include pediatric surgery. during this period he will work as a full

time resident.

During the second and third years of training, trainees must get experience

in different surgical specialties mentioned in the curriculum. The training

centers should have surgical specialties' clinics and operative services that

ensure full coverage of all cases and operative procedures mentioned in the

curriculum.

First year

Important notice

Trainees must pass successfully all the foundation courses before being

promoted to the second year of training. Full information about founda-

tion courses is available at the EF website and administration office

Second and third years


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Trainees will have rotations in different surgical specialties as follows:

The fourth and fifth years of training should be spent in general surgery prac-

tice, so that trainees would have chances to apply what they learnt in previous

years and will be capable of training and supporting their junior colleagues.

Their obligations, duties and responsibilities will be matching their experience,

level of training and available supervision. It is to be noted that trainees who

do not have the opportunity to rotate in surgical specialties during the third

year of training, will spend their fourth year in surgical specialties rotations.

1. Trainees must attend at least 75% of lectures on surgical subjects.

2. They should be actively involved and fully responsible for patient care

including sharing in making decisions about diagnosis and manage-

ment under supervision of the consultants.

3. They must attend 75% of weekly meetings including clinical rounds, tuto-

rials, journal clubs and morbidity and mortality meetings

4. Their performance will be monitored and evaluated by trainers and a re-

port of their performance will be issued on monthly basis to the Egyptian

Fellowship Board.

5. All trainees will work as residents in the training specialty and they must

fulfill all residents jobs defined by supervisors and trainers

6. They should be responsible under supervision for outpatient and in pa-

tients' routine work and must take supervised shifts according to hospital

regulations.

Fourth and fifth years

Trainees duties and obligations

Two months in neurosurgery

Two months in cardiac surgery

Three months in vascular surgery

Two months in pediatric surgery

Two months in ICU

Four months in orthopedic surgery

Three months in emergency surgery

Four months in urosurgery

Two months in plastic surgery& burn

unit


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a. The trainee will be responsible for supervised admission of patients from the surgery outpatient clinics or emergency department. b. He will share in the completion of the following documents and activities under supervision for each case:

Complete history and physical examination form.

Investigation requests, (laboratory, radiology, pathology, etc.).

Results of the investigations.

Plan of management.

Preoperative assessment and preparation

Operative consent and invasive procedures consent

Operative records

Postoperative orders

Daily progress notes

Order and medication sheets

Order of he necessary diagnostic procedures

Discussion of the case with the trainer and consultants

Discharge summaries.

Sick leaves and medical reports.

The Trainee should inform the senior staff of any high risk patient admission

The trainee should attend the outpatient clinics related to mandatory sur-gical rotations and its subspecialties as requested by trainers and supervi-sory staff.

He should also attend operative sessions in outpatients or day surgery units

The trainees must attend and participate in the mandatory academic and clinical activities of the department. Attendance and participation should not be less than 75% of the total number of activities within any training rota-tion / period including.

Daily morning endorsement meetings.

Clinical round presentation, at least once weekly to cover various top-ics, problems, research, etc.

Journal club meeting.

Surgical morbidity/mortality conferences and audit sessions

the trainee must keep a Logbook where he record all activities and skills per-formed and learned during the training program. The activities should be dated and categorized to whether been performed by the trainee him/herself or as an assistant or participant. Each activity registered in the Log book should be counter signed by the trainer and finally the educational supervisor. The Trainer and educational supervisor must sign the completed Logbook.

During the hospital rotations

1. The admitted patients

3. Mandatory clinical and academic activities

2. Outpatient clinics & day surgery units

4. The log book


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The trainee must undertake at least one research project or audit during the training program under the guidance and supervision of a nominated supervi-sor (nominated by the scientific council). Such project or mini thesis should be written before the trainee is accepted for admission to the final certifying ex-amination.

The trainee should have completed satisfactorily the rotations described in the structure of the program and performed him/herself and assisted in the vari-ous requested procedures and operations.

According to Ministry of Health and Population regulation

Performance of the trainee will be evaluated on regular and continuous basis. The evaluation process should involve all aspects of the training in-cluding theoretical, clinical and operative procedures skills as well as the attendance and participation.

The trainers who are required to write confidential reports of the perform-ance of each trainee should evaluate the trainee periodically. The trainee should not be allowed to proceed in the training program and move to the next stage of training unless he/she attains a satisfactory level of per-formance acceptable to the responsible trainer and educational supervisor.

The trainee shall not be allowed to proceed to year 3 before successfully passing the first part exam

It is not permissible to interrupt such a structural training program except in major unavoidable circumstances. Such circumstances should be convincing and approved by the Secretary General. The Interruption once approved should not be for more than one year. Interruption of the training program for more than one year shall result in dismissal from the program and cancellation of the preceding training period.

5. The research or audit project

6. Before the completion of the training program

General rules and regulations

a. Holidays and on call duties

b. Evaluation procedures

Interruption of training


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Rational statement

The purpose of this curriculum is to describe the knowledge, skills, behav-

iors and attitudes expected from general surgeons upon completion of

training in The Egyptian General Surgery Fellowship.

The curriculum also describes the methods of teaching and learning that

will be used to facilitate the delivery of curriculum. In addition, it high-

lights the different methods of trainee's performance evaluation that are

going to be used whether formative or summative. The curriculum con-

tents have been formulated through the following methods:

1. Revision of previous Egyptian Fellowship surgery curriculum

2. Revision of international curricula for postgraduate training in sur-

gery. We specifically mention the Royal college of surgery curricu-

lum approved by the PMETB in 2007 and the Australian Royal col-

lege of surgery curriculum

3. Consultation of experts in the field of surgery and other related spe-

cialties.

The curriculum then was re-revised by representative members for the

general surgery scientific council and approved by the council in April

2008

Aims of the Surgery Fellowship training

To provide the trainee with the knowledge, and skills which en-able him/her to identify, assess, manage and/or refer elective surgi-cal problems in order to provide cost effective and human patient care.

To provide the trainees with an appropriate theoretical and practi-cal knowledge and skills covering the common and / or important surgical emergencies.

To enable the development and application of appropriate profes-sional attitudes, ethical principles and communication skills

Curriculum aim


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General intended learning outcome

By the end of training in general surgery fellowship program, gradu-

ates of the program must have the following knowledge, skills, behav-

iors and attitudes

Knowledge and understanding.

1. Describe the anatomy of surgically-important regions, organs and struc-

tures of the body.

2. Describe the etiology, pathogenesis and pathology of important and/ or

common surgical diseases.

3. Discuss the clinical manifestations, complications, diagnostic modalities, out-

comes and treatment plans for common and/or important surgical prob-

lems, with special emphasis on emergencies and malignancies.

4. Explain the methods of screening and early detection of cancer.

5. Recognize the ethical principles that govern decision-making in surgical

practice.

6. Discuss the principles and practice of preoperative preparation and postop-

erative care.

7. Discuss different modalities for management of pain related to surgery.

Skills

8. Obtain, perform and document a complete medical history and physical

examination for surgical patients.

9. Perform an emergency - directed examination for patients with common

surgical emergencies.

10. Utilize sources of information like medical records, patient’s family/friends to

augment medical and surgical history.

11. Interpret patient symptoms and physical findings in terms of their anatomic,

pathologic and functional diagnostic significances.

12. Identify problems, prioritize them, and generate a list of differential diagno-

sis for each problem.

13. Select the most appropriate and cost-effective diagnostic and therapeutic

procedure for each problem.

14. Identify medical and investigative parameters to be used in assessing the

patient’s response to intervention and re-evaluate management plan ac-

cordingly.

Communication skills

15. Conduct sincere and effective patient interviews, properly explain the con-

dition and plan of management, obtain consents and convey bad news in

a professional way

16.Write patient records and properly present them.


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15

17. Communicate, consult and respect the role of other health-care providers.

18. Work effectively and cooperatively in a team.

Life-long learning

19. Search effectively electronic resources to find valid appropriate informa-

tion and use them in management of surgical cases.

Ethical behavior

20. Respect Patients confidentiality and deliver care in an honest, considerate

and compassionate manner.

21. Appropriately and ethically get informed consent for indicated surgical

interventions.

22. Recognize the ethical principles related to organ donation.

23. Discuss professional errors in an honest way.

Teaching will be conducted using the following techniques

Clinical rounds and clinical days.

Bedside teaching.

Grand surgical rounds with active participation of trainees in

case presentations.

Apprenticeship teaching in the operative theatre.

Outpatient and inpatients work.

Journal clubs

Workshops and training courses.


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Basic science syllabus


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Applied surgical anatomy Blood vessels :

For the following arteries and their corresponding veins, trainees

should describe, the course , relations , surface anatomy , branches

and collateral circulation.

Arteries:

Common carotid – internal carotid – external carotid – aorta – in-

nominate.

Subclavian – axillary – brachial – radial – ulnar- common iliac – exter-

nal iliac – internal iliac – femoral – popliteal –anterior tibial – post tibial

– peroneal – dorsalis pedis

All corresponding veins.

Nerves:

for all the following nerves, trainees should describe , their course ,

relations , surface anatomy and branches.

Nerves

Cranial nerves-Sympathetic trunk-Brachial plexus – radial nerve – me-

dian nerve - ulnar nerve – circumflex nerve – musculocutaneous

nerves.

Lumbar plexus – femoral nerve – obturator nerve – sciatic nerve –

Tibial nerve – common peroneal nerve.

Lymphatic:

Cervical lymph nodes. Axillary , inguinal , Abdominal , Mediastinal ,

and Breast lymphatics

Muscles:

for the following muscles, trainees should have describe; origin – in-

sertion – nerve supply – function – surgical significance.

Muscles

Strap muscles – sternomastoid – scalenus anterior – scalenus medius

– scalenus posterior – levator scapulae.

Pectoralis major & minor – deltoid - biceps brachi – brachialis – triceps

– latissimus dorsi.


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Muscles of the ant abdominal wall.

Psoas major – quadratus lumborum – iliacus.

Diaphragm.

Intercostal muscles.

Sartorius – gracilis – quadriceps femoris – tensor fascia lata – biceps

femoris – semitendinosus – semimembranosus – adductors – gas-

trocnemius – soleus. Gluteus maximus, medius, minimus and Levator

anni muscle.

Anatomy of the inguinal canal.

Anatomy of the Femoral canal.

Anatomy of the breast:

The salivary glands: Parotid – submandibular.

Head and neck:

1. Deep fascia.

2. Triangles of the neck.

3. Thyroid & parathyroid glands.

4. Parotid & submandibular salivary glands.

5. Larynx

6. Trachea.

G I T

The trainee should describe; Anatomical location, relations, blood sup-

ply, lymphatic drainage, nerve supply of:

1. Pharynx.

2. esophagus.

3. Stomach.

4. Duodenum.

5. Small bowel.

6. Large bowel & appendix.

7. Rectum.

8. Anal canal.

9. Liver – gall bladder – biliary system – pancreas

10.Spleen

11.adrenal glands.


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Urogenital anatomy

1. Kidney.

2. Ureter.

3. Urinary bladder.

4. Urethra.

5. Scrotum – testis – epididymis.

6. Ovary.

Thorax anatomy

Trachea – bronchi – lungs

Surgical Physiology

Water & electrolyte balance:

1. Hyponatremia.

2. Hypernatraemia.

3. Hypokaliemia.

4. Hyperkaliemia.

Acid base balance

1. Acidosis: Respiratory & metabolic.

2. Alkalosis: Respiratory & metabolic

Physiological response to stress

Shock:

1. Hypovolemic.

2. Neurogenic.

3. Anaphylactic.

4. Septic.

Blood transfusion – transfusion of blood products.


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21

Surgical hematosis:

1. 1ry Hemostasis: vasoconstriction – platelet functions.

2. 2ry

Hemostasis: Coagulation and Fibrinolysis.

3. Disorders of hemostasis

Congenital.

Acquired:

1. Liver disease.

2. Vit. K deficiency.

3. DIC.

4. Massive transfusion.

5. Platelets abnormalities.

Surgical Nutrition:

Metabolism in normal persons (starvation& hypercatabolic states).

Squeal of under nutrition.

Assessment of malnutrition.

Enteral nutrition.

T.P.N.: Indications – complications.

The endocrine system

Physiology and function of

1. Thyroid gland

2. Parathyroid glands

3. Suprarenal cortex and medulla

Surgical Pathology

Acute inflammation: Vascular & cellular events.

Boil – cellulitis – abscess – carbuncle – necrotizing fasciitis.

Gas gangrene – septicemia.

Chronic inflammation: T.B.

Wound healing:

Stages of wound healing, types, factors affecting wound healing

and complications of wound healing


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22

Surgical oncology:

1. The Etiology and epidemiology of malignant disease

2. The Environmental and genetic factors in carcinogenesis

3. The risk factors for malignant disease

4. The Terminology used in The field of cancer epidemiology

5. The Prognosis and natural history of malignant disease

6. The Mechanisms and patterns in local, regional and distant spread

7. The Differences between hereditary and sporadic cancers

8. Diseases predisposing to cancer e.g. inflammatory bowel disease

9. The basic Genetics of hereditary malignant diseases

10. The principles of Cancer biology

11. The principles of Tumor immunology

12. The basic principles of cancer treatments including surgery, radio-

therapy, chemotherapy, endocrine therapy and immunotherapy

13. The methods of evaluation of response to treatment

14. The possible adverse effects of treatment and interaction with surgi-

cal management

Surgical Immunology:

Antigen antibody reaction.

Types of rejection.

Immuno suppression.

Renal – hepatic – cardiac – pancreatic transplantation. (indications

and complications).


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23

General Surgery Curriculum

Describe the principles of skin and subcutaneous incisions and surgical handling.

1. Incise superficial tissues accurately with suitable instruments.

2. Close superficial tissues accurately.

3. Tie secure knots.

4. Achieve homeostasis of superficial vessels.

5. Use suitable methods of retraction.

6. Use drains appropriately.

7. Handle tissues gently with appropriate instruments.

Basic Surgical Skills

Knowledge

Skills


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26

Upon completion of surgical training, Trainees should be able to: 1. Recall the surface anatomy and the anatomy of internal organs

relevant to upper gastrointestinal surgery 2. Outline the etiology, pathology, clinical presentation and differen-

tial diagnosis of the mentioned key upper GIT surgical conditions 3. Discuss the methods of investigations and management of theses

cases (including operative and non operative management) 4. Explain the details of operative procedures needed to treat emer-

gent and elective esophago-gastric disorders 5. Describe the pre and post-operative care for patients affected by

these conditions including the management of post-operative complications

6. Assess patients with complains suggestive of upper GIT surgical problems and timely identify emergency presentations

7. Stabilize and resuscitate indicated cases (included the management of shock )

8. Request appropriate investigations to diagnose the condition and involve senior colleagues

9. Initiate medical management in cases that are not indicated for sur-gery and refer for appropriate specialty

10.Perform adequately preoperative assessment 11.Observe, assist in or perform under supervision the esophagogas-

tric procedures mentioned in the procedure list according to the stage of training

12.Manage the postoperative care and timely identify post-operative complications

Esophagus-gastric surgical conditions

Knowledge

Skills

Key Upper GIT Surgical Conditions Emergency esophagogastric conditions

perforated peptic ulcer upper gastrointestinal bleeding rupture esophagus food bolus occlusion of The esophagus acute gastric volvulus

elective esophagogastric conditions hiatus hernia gastric and esophageal malignancy motility disorders of the upper GIT


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27

Mouth: Glossitis – leukoplakia.

Carcinoma of the lips – tongue, cheek & floor of mouth.

Pharynx: Pharyngeal pouch – carcinoma.

Oesophagus: Motility disorders: Achalasia.

Corrosive injuries.

Diverticula.

Gastro oesophageal reflux disease.

Carcinoma of the esophagus .

Stomach & Duodenum:

1.CHPS

2.Acute gastric dilatation.

3.Acute gastritis & erosions.

4.Peptic ulcer disease

5.Carcinoma of the stomach

6.Complications of gastric operations.

7.Surgery for obesity.

8.Upper gastro intestinal hemorrhage

1. Closure of perforated peptic ulcer (gastro-duodenum)

2. Local excision of gastric lesions

3. Oesophageal dilatation and stenting

4. Staging laparoscopy

5. Esophagectomy

6. Total and subtotal gastrectomy

7. Laparoscopic anti-reflux surgery

8. Open anti-reflux surgery

9. Repair of para-oesophageal hiatus hernia

10. Heller’s myotomy ,open and laparoscopic

11. Long oesophageal myotomy

12. Pharyngeal pouch

13. Endoscopic control of upper GIT bleeding

14. Variceal banding/sclerotherapy

15. reduction of gastric volvulus

16. feeding gastrostomy and jejunostomy

The trainee level of participation in these procedures is de-

tailed in the logbook

Upper GIT Topics

Operative Procedures


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28

1. Describe aetiology, applied anatomy, clinical presentation and di-agnosis of the following common ano-rectal conditions.

2. Describe the different medical and surgical therapeutic interven-tions that are available to treat these conditions.

3. Describe the indications , contraindications and complications that might arise during the management of these conditions.

the indications , contraindications and compli-cations that might arise during the management of these conditions.

1. Assess, request appropriate investigations and use medical and sur-gical treatment for the above mentioned conditions.

2. Perform any of the Following techniques for the management of haemorrhoids.

Rubber band ligation. injection sclerotherapy infrared coagulation Operative haemorrhoidectomy.

3. Manage competently the complications that might arise from any of the these procedures.

4. Perform abscess drainage through perineal region. 5. Perform the following procedures for pilonidal disease :

Pilonidal sinus – lay open. Pilonidal sinus – excision and suture.

6. Perform anal skin tag and wart excision.

Colo-rectal surgery

1. Anorectal conditions

Knowledge

Skills

Hemorrhoids. Anal fissure. Abscess and fistulae. Hidradenitis Suppurativa. Pruritis ani. Fecal incontinence


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29

1. Describe the aetiology, epidemiology and clinical presentation of co-

lorectal cancer and polyps. 2. Outline the principles of colorectal cancer screening. 3. Describe the methods of diagnosis of colorectal cancer including

methods of staging and prognostic factors. 4. Define the indications and contraindications to surgery, various op-

erative techniques and pre-post operative care. 5. Recognize the clinical presentation of colorectal cancer. 6. Diagnose colorectal and anal cancer cases. 7. Assess patients for different prognostic factors. 8. Manage patients suffering from colorectal and anal cancer. 9. Observe, assist in or perform the following procedures according to the stage of training

Hartmann's procedure. Colectomy (It, Rt or Sigmoid). Colostomy – construction. Ileostomy – construction. A-P resection



Colorectal Surgery

2. Colorectal Neoplasia

Knowledge

Skills

Procedure


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30

3. Colo-rectal Stoma

1.Recall the indication, complications and management of different types of stomas.

2.Recognize the basic physiology of stomas and its effect on medica-tions and food absorption.

1.Perform pre-operative evaluation and post-operative care for stomas. 2.Perform stoma constructions and closure… procedure. 3.Recognize and mange complications related to stomas. 4.Manage fluid and electrolyte abnormalities.

5.Educate patients about stoma expectations, output precautions and

day to day care.

1. Describe the aetiology, epidemiology, clinical manifestations and differentiate between the following bowel diseases.

Ulcerative colitis. Crohn's disease Ischemic colitis. Infectious colitis

2. Outline the management options for inflammatory bowel diseases including in emergency situations .

3. Describe the indication, contraindications, operative techniques and post-operative management including the management of complications.

4. Recognize the clinical presentation of important inflammatory bowel disease.

5. Initiate medical treatment of Crohn's disease and ulcerative colitis in consultation with gastroenterologist.

6. Observe or perform under supervision different surgical procedures indicated for treatment of Crohn's disease

Knowledge

Skills

4. Inflammatory Bowel Diseases

Knowledge

Skills


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31

1. Describe the aetiology, clinical presentation, methods of diagnosis

and initial treatment of the following benign colonic conditions . 2. Recognize clinical patterns and presenting symptoms of benign

colonic diseases. 3. Request appropriate investigations in appropriate sequence. 4. Initiate medical management when appropriate. 5. Recognize indications for surgical interventions and arrange for

peri-operative care.

5. Benign colonic conditions

Knowledge

Skills

Diverticular disease Colonic volvulus. Rectal bleeding Rectal trauma


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32

Upon completion of surgical training, Trainees should be able to: 1. Outline the etiology, pathology, clinical presentation and differen-

tial diagnosis of the mentioned key hepatopancreaticobilliary con-ditions

2. Explain the causes and mechanisms of liver trauma 3. Discuss the methods of investigations and management of theses

cases (including operative and conservative management) 4. Outline the details of operative procedures needed to treat acute

and elective hepatopancreaticobilliary conditions 5. Describe the pre and post-operative care for patients affected by


6. Assess patients with complains suggestive of hepatopancreaticobil-

liary conditions and timely identify emergency presentations 7. Stabilize and resuscitate indicated cases (included the manage-

ment of shock ) 8. Request appropriate investigations to diagnose the condition and

involve senior colleagues 9. Decide for the need of operative versus conservative management 10. Perform adequately preoperative assessment 11. Observe, assist in or perform under supervision the hepatopan-

creaticobilliary procedures mentioned in the procedure list accord-ing to the stage of training

12. Manage the postoperative care and timely identify post-operative complications

Hepatobiliary surgical conditions

Knowledge

Skills

Key Hepatobiliary Surgical Conditions Emergency gallstone diseases

1. biliary colic 2. acute cholecystitis 3. cholangitis

liver trauma and injuries of the biliary tract acute pancreatitis elective hepatobiliary and pancreatic diseases

1. gall stones 2. pancreatic cancer and cysts 3. gall bladder cancer 4. liver Cysts 5. liver metastasis


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33

Trainees should observe, assist in or perform under supervision or inde-pendently the following hepatobiliary surgical procedures (see log-book) 1. Cholecystectomy (open and laparoscopic)

2. CBD-exploration

3. Cholecystostomy

4. Liver trauma (hemostasis- debridement– packing)

5. Repair of biliary duct injuries

6. Hepaticojejunostomy

7. ERCP

8. Biliary and pancreatic stenting

9. Pancreatic debridement

10. Drainage of pancreatic pseudocyst

11. All types of pancreatectomy

12. Porto-systemic shunt

13. Left or right hepatectomy

14. Segmental liver resection

Hepatobiliary topics and lectures

1.Complex liver injuries 2.Hydatid disease 3.Management of primary & secondary hepatic and choledochal neo-plasm

4.Chronic liver disease 5.Hepatitis 6.Liver failure 7.Pancreatic insufficiency 8.Pancreatitis acute and chronic

9.Pancreatic neoplasm

10.Imaging and endoluminal ultrasound

Hepatobiliary and pancreatic Operative Procedures


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36

1. Describe the applied anatomy relevant to the injury of abdomen,

thorax, soft tissues and skeleton. 2. Discuss the pathogenesis and pathophysiology of shock. 3. Explain the concept of high energy & energy transfer injury. 4. Recall the indications, contraindications, peri-operative care and

complications of the following emergency procedures. Laparotomy. Thoracotomy.

5. Outline the etiology, pathophysiology and management of sepsis and peritonitis.

6. Discuss indications and use of blood product transfusion. 7. Describe congenital and acquired coagulations disorders that

might be encountered in trauma patients. 8. Assess and initiate management in case of blunt and penetrating

trauma of the abdomen, thorax soft tissue and skeleton. 9. Recognize injuries that require management by other specialties. 10. Perform resuscitation "CPR" according to ATLS principles. 11. Use different techniques to stop bleeding 12. Assess and recognize vascular injuries and limb ischemia. 13. Manage hollow organ injury.

Technical skills/ operative procedures in trauma

14. Observe, assist in or perform the following procedures according to the stage of training

Traumatic Surgical Emergency

Knowledge

Skills

Central venous lines insertion Diagnostic peritoneal lavage. Laparotomy. Laparoscopy Chest drain insertion. Lateral thoracotomy. Splenectomy. Liver trauma (hemostasis- debridement– packing) Pancreatectomy Small bowel resection. Construction of ileostomy. Construction of colostomy.


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37

Head Trauma

1. Outline the major anatomical landmarks of the head and the physi-

ology of cerebral perfusion and intracranial pressure

2. Explain the intracranial consequences of head injury

3. Describe radiological changes expected in head trauma

4. Recognize and risk stratify patients presenting with head injury and

use different methods for neurological status assessment.

5. Apply the ABCDE approach in management, while taking care to

prevent secondary brain injury

6. Promptly consults neurosurgery and other indicated disciplines and

optimize team work for the management of serious cases

7. Manage patients presenting with scalp laceration and minor head

injury

8. Interpret imaging studies performed in the ER for head injury pa-

tients

9. Identify cases with suspected violence or abuse as a cause for head

injury and notify appropriate authorities

1. Recall the anatomy of intrathoracic organs and the surface anatomy of

the thorax 2. Outline the pathophysiology and possible consequences of chest trauma 3. Summarize the clinical manifestations, investigations needed and initial

management and consultation plan in case of life threatening chest Trau-mas

4. Recognize patients presenting with the following chest injuries and imme-diately stabilize according to the ATLS principles

tension and open pneumothorax

flail chest

hemothorax

rib and sternal fractures

cardiac tamponade

aortic injury

diaphragmatic hernia

pulmonary or myocardial contusion 5. Consult cardiothoracic surgery or another involved disciplines in the ap-

propriate time and avoid delays

6. Undertake needle thoracentesis and insert intercostal tube drains.

Knowledge and skills

Knowledge and Skills

Chest Trauma


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38

Injuries of the Urinary Tract

1. Define the anatomy of the urinary tract and mechanisms of injury. 2. Explain the steps of initial management within the care of multiply

injured patients. 3. Recognize and initiate management of urinary tract injuries in con-

sultation with urologist. Renal injuries. Ureteric injuries. Bladder injuries. Urethral injuries.

4. Perform suprapubic catheter insertion.

1. Describe the anatomy of major vascular structures 2. Explain the mechanism of acute arterial injury and situations where

arterial injury may occur. 3. Recall indications for investigations and steps of initial manage-

ment. 4. Assess patients and diagnose arterial injury. 5. Control bleeding. 6. Diagnose and manage potential complications of injury

Blood loss. Compartment syndrome. Nerve injury. Venous injury.

Procedural Skills

1. Assist in arterial trauma operations.

2. Perform fasciotomy.

Knowledge and skills

Vascular Injury

Knowledge

Skills


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39

1. Describe the etiology, bacteriology and precipitating factors for the following :

a. Carbuncle. b. Superficial abscess. c. Cellulitis. d. Paronychial infected ingrown toe nail.

2. Outline the clinical presentation of the above mentioned conditions and their medical management. 3. Discuss the etiology and physiological basis of gas gangrene and necrotizing infectious. 4. List possible clinical disorders and risk group that are more suscepti-ble to these conditions. 5. Describe mechanisms of septic shock, its clinical presentation, diag-nosis and management options

1. Assess and manage patients presenting with superficial abscess.

2. Take history and perform physical examination for patients present-ing with necrotizing infections and recognize warning signs

3. Perform radical excision surgery Observe, assist in or perform the following procedures according to stage of training and available supervision 1. Abscess drainage. 2. Excisional biopsy of benign skin lesion. 3. In growing toe nail avulsion / wedge. resection / phenolization.

4. Gas gangrene and necrotizing fasciitis debridement.

5. Fournier gangrene procedure.

Non Traumatic Surgical Emergency

Knowledge

Skills

Procedure

1. Superficial sepsis &necrotizing infections


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40

2. Peritonitis and acute abdomen

1. Describe the anatomy of the abdomen and pelvis. 2. Discuss the etiology, pathophysiology and treatment of intraperi-

toneal sepsis. 3. List the conditions which don't require surgery.

4. Recognize the pathophysiology and management of septic shock 5. Assess, investigate and differentiate patients presenting with acute

abdomen 6. Diagnose and treat peritonitis cases. 7. Differentiate cases according to severity of illness and when medi-

cal treatment is not effective. 8. Manage complications of peritonitis.

Acute peritonitis

Anatomy of subphrenic spaces.

Subphrenic abscess

Pelvic abscess

T.B. peritonitis.

Ascites

Observe, assist in or perform the following procedures according to stage of training and available supervision:

Central venous line insertion Laparotomy Laparoscopy

Knowledge

Skills

Procedure

Topics


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41

3. Acute appendicitis

5. Describe the natural history of appendicitis and its patho-physiology.

6. Discuss its clinical presentation, expected complications and the effect of sepsis.

7. Recognize the indications, contraindication and details of surgical intervention.

5. Assess, diagnose and manage competently patients presenting

acute appendicitis.

6. Perform complete pre end post operative care. 7. Perform Appendicectomy operation 1. Describe the applied anatomy of the pelvis 2. Recognize acute presentation of gynecological disorders. 3. Outline the causes and clinical presentation of gynecological con-

ditions that could be presented as surgical emergencies including pelvic inflammatory disease . Endometriosis. intraabdominal hemorrhage secondary to ovarian cyst

or ectopic pregnancy.. 4. Brief on the principles of management of theses conditions 5. Assess, investigate and diagnose acute abdomen cases with pos-

sibility of gynecological emergency. 6. Perform diagnostic laparoscopy or emergency laparotomy when

indicated. 7. Recognize and manage within a team of specialists iatrogenic in-

jury to other organs that happen during gynecological surgery.

Knowledge

Skills

Knowledge

4. Acute gynecological disorders

Skills


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42

1

1. Describe the etiology, clinical presentation and differential diagno-

sis of acute intestinal obstruction. 2. Discuss different treatment options. 3. Assess and appropriately investigate patients for possibility of acute

intestinal obstruction. 4. Perform adequate resuscitation if indicated. 5. Perform emergency laparotomy. 6. Provide adequate nutritional support. 1. Describe the anatomy of inguinal region including inguinal canal,

femoral canal, abdominal wall and related structures. 2. Discuss the pathophysiology of strangulated hernia. 3. Outline the indications, procedures and preoperative care for dif-

ferent types of strangulated hernia: Strangulated inguinal hernia. Strangulated femoral hernia. Strangulated incisional hernia.

4. Discuss post-operative care and complications of hernia repair. 5. Take history, examine and investigate patients to identify different

types of strangulated hernia. 6. Perform resuscitation if indicated. 7. Adequately manage post operative complications. Observe, assist in or perform the following procedures if indicated and according to the level of supervision provided by trainers and consult-ants

Small bowel resection. Inguinal, Femoral, and Incisional hernia repair.

Skills

5. Acute Intestinal Obstruction

Knowledge

6. Strangulated Hernia

Skills

Knowledge

Procedures


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43

1. Discuss the pathophysiology of blood loss and its sequences. 2. Explain the causes of gastro-intestinal bleeding, clinical presenta-

tion and indications for various investigations. 3. Outline the principles of coagulopathy. 4. Discuss the initial management strategies for patients presented

with acute gastro-intestinal hemorrhage 1. Perform clinical assessment of patients with GIT bleeding. 2. Immediately recognize shocked or hypotensive cases and start

resuscitation. 3. Initiate appropriately investigations like endoscopy or others. 4. Perform with assistance indicated surgical procedure to stop

bleeding. 5. Provide adequate post-operative care and recognize complica-

tions like rebleeding. 6. Perform the following procedures to diagnose the case of bleed-

ing. Diagnostic gastroscopy. Flexible sigmoidoscopy.

Knowledge

Skills

7. GIT bleeding


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44

1

1. Outline the basic histology and physiological functions of the skin 2. Discuss causes, mechanisms and types of burns 3. Describe the pathological sequelae and complications of burns 4. Assess patients presented with various types of burns and estimate

burn severity through depth and surface area 5. Manage burns appropriately both at systemic and local level 6. Recognize and manage burn complications both systemic and

local

1. Explain The general principles for the diagnosis and management

of fractures and joint injuries 2. Outline The clinical presentation, diagnosis and management of

common and important upper and lower extremities musculoskele-tal injuries and pelvic and spinal injuries

3. Outline the etiology, clinical presentation and basics of manage-ment of bone and joint infections (both acute and chronic)

4. Recall the etiology, presentation and principles of management of bone tumors

By the end of training , trainees should assist in and perform the fol-lowing procedures:

Safe reduction of shoulder dislocation

Application of above elbow POP

Safe reduction of distal radius fracture

Application of below elbow POP and short arm back slap

Safe reduction of dislocation of elbow and pulled elbow

Application of figure of 8 bandage, broad arm sling, Collar and Cuff

or U shaped slab

Fasciotomy for forearm compartment syndrome

Safe reduction of pharyngeal dislocation

Safe reduction of simple phalangeal fracture

Application of hand splint

Splinting for fracture femur

Skin and skeletal traction

Skills

Burns

Knowledge

Orthopedic Surgery

Knowledge

Procedural Skills


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45

Reduction of patellar dislocation

Reduction of knee dislocation in case of limb threatening vascular

compromise

Application of knee immobilizer

Arthrocentesis

Reduction of ankle lesions that needs urgent reduction

Application of above and below knee POP

Fasciotomy for leg compartment syndrome

Application of pelvic splint "Hammock"

Immobilization of fracture spine "log roll”

1. Mechanisms of injury Types of fractures Healing of fractures and factors affecting it Complications of fractures Management of fractures Fractures of (clavicle-humerus-Colles– Pelvis– neck

of femur-shaft of femur-Tibia) 1. Acute osteomyelitis (etiology-pathology-clinical picture

and treatment) 2. Chronic osteomyelitis 3. T.B osteitis 4. Pyogenic arthritis 5. Hyperparathyroidism 6. Osteoporosis 7. Bone tumors (pathology-clinical pictures-management) 8. The spine

Fractures T.B Disc prolapse

Topics

Reticuloendothelial system

Lesions of the skin and

subcutaneous tissue

Hernia

Surgical Oncology

Surgical Endoscopy


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48

. 1. Outline the general characteristics of lymphatic conditions that

might need surgical support. Non Hodgkin's lymphoma. Lymphadenopathy. Hodgkin's disease.

2. Describe different staging classification. 3. Explain the indications for elective splenectomy, emergency sple-

nectomy and expected complications..

4. Plain for appropriate diagnostic tests in consultation with hematolo-

gists Observe, assist or perform the following procedures according to stage of training and available supervision

Lymph node biopsy from various anatomical sites. Lives biopsy. Splenectomy. Laparoscopic lymph node biopsy

5.

Knowledge/ skills

Procedural Skills

Reticuloendothelial System


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49

Lesions of the skin and subcutaneous tissues

1. Outline the anatomical features and histology of skin and subcuta-neous tissues

2. Describe the Pathology and clinical features of common lesions, such as naevi, sebaceous cysts and basal cell papillomas

3. Discuss the Treatment of benign lesions of skin and subcutaneous tissues including Techniques of local anesthesia and methods of non-surgical treatments.

4. Diagnose benign lesions of skin and subcutaneous tissues using

appropriate Examination technique 5. Identify lesions that require treatment, either surgical or medical 6. Treat benign lesions of skin and subcutaneous tissues Use appropriately different Local anesthetic techniques Perform excision biopsy for benign skin or subcutaneous lesion

1. Discuss the anatomy, histopathology and natural history of Basal

cell carcinoma, Squamous cell carcinoma and malignant mela-noma

2. Diagnose and treat appropriately small basal call carcinomas. 3. Diagnose squamous cell carcinoma and refer appropriately if

large. 4. Diagnose malignant melanoma and refer appropriately.

Perform excision biopsy of malignant skin lesions

Skills

Knowledge

1. Benign lesions of skin and subcutaneous tissue

Procedure

Skills

Knowledge

Malignant Lesions of the skin and subcutaneous tissues

Procedure


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50

Elective hernia

1. Discuss the Anatomy of inguinal region , femoral canal, abdominal wall and related structures

2. Outline the Relationship of structure to function 3. Describe the Natural history of abdominal wall hernia including

presentation, course and possible complications 4. Discuss various Treatment options and current methods of operative

repair including open mesh and laparoscopic mesh 5. Outline the risk/benefit of each procedure and possible complica-

tions 6. Assess and diagnose patients presenting with abdominal wall her-

nia, including inguinal, femoral, epigastric, umbilical, Para umbilical and incisional hernias

7. Manage perioperative care in hospital and on follow-up

Observe, assist in or Perform the following procedures according to

the level of training and available supervision Epigastric hernia repair

Femoral hernia repair

Incisional hernia repair

Inguinal hernia repair

Repair of umbilical hernia

Repair of recurrent hernia

Skills

Knowledge

Procedure


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51

Other Abdominal wall masses

1. Outline the Pathology of acute and chronic abdominal wall masses including Hematoma, Sarcoma and Desmoid Tumors

2. Describe the Principles of management in each case

3. Recognize that a swelling is in the abdominal wall and Initiate ap-propriate investigation

4. Conservatively Manage hematomas 5. Make appropriately specialist referral

1. Recognize symptoms and signs suggestive of cancer and Initiate

appropriate diagnostic and staging investigations for common

solid tumors

2. Perform prognostic assessment for patients with common solid

tumors

3. Recognize the role of surgery and when it is indicated

4. Diagnose and treat side effects and complications of surgical

treatment

5. Recognize side effects of other treatment modalities and consult

oncologists

6. Perform the following procedure

Lymph node biopsy-groin and axilla

Skills

Knowledge

Surgical Oncology

Skills


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52

By The end of training and endoscopy course, trainees should have ade-quate knowledge of:

The Structure and function of an endoscope, processor and accessories, including diathermy

The Medical and legal issues concerning consent and provision of infor-mation

The Sedative and analgesic drugs used in endoscopy, their anticipated side-effects and how to manage them

The Indications and complications of common endoscopic procedures

The principles of patients' preparations for endoscopy 1. Clean and disinfect equipment 2. Consent a patient for endoscopy 3. Safely and effectively sedate a patient for endoscopy 4. Monitor appropriately before, during and after procedure

Use equipment in accordance with manufacturer's instructions

Perform Proctoscopy

Perform rigid sigmoidoscopy

Assist in diagnostic gastroscopy

Attend a basic skills course in Flexible sigmoidoscopy

Knowledge/Topics

Procedure

Skills

Endoscopy


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53


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54

By the end of training, trainees should have adequate knowledge of: 1. The anatomy of arteries supplying The lower limb 2. The etiology, precipitating factors, pathophysiology and clinical

manifestations of acute limb ischemia 3. The diagnostic workup and differential diagnosis 4. The indications, techniques and potential complications of different

emergency interventions Thrombolysis Thrombectomy Embolectomy Amputation

4. Potential late complications of different interventions and followup management

9. Take focused history and perform vascular examination 10.Use (under observation) duplex ultrasound in the diagnosis of

acute limb ischemia 11.Interpret the results of angiogram 12.Choose appropriately the type of intervention 13.Participate as an observer or assistant in the following emergency

procedures for acute limb ischemia Embolectomy Thrombolysis Thrombectomy Amputation

9. Perform fasciotomy for management of complications

Skills

Knowledge/Topics

Vascular Surgery

1. Acute limb ischemia


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55

By the end of training, trainees should have adequate knowledge of: 1. The pathology of atherosclerosis and risk factors for arterial diseases 2. The clinical presentation, natural history and diagnostic workup of

chronic limb ischemia 3. The role of angioplasty in the management of limb ischemia 4. Indications for surgical management, the details of different surgical

techniques and potential complications 5. The principles of medical management , including the manage-

ment of hypertension , hyperlipidemia and the role of antiplatelet drugs

6. Types and indications for amputations and its associated complica-tions

9. Take focused history and perform vascular examination 10.Use (under observation) duplex ultrasound in the diagnosis of

chronic limb ischemia 11.Interpret the results of angiogram 12.Choose appropriately the type of surgical intervention or if angio-

plasty is indicated 13.Manage conservatively chronic limb ischemia if indicated 14.Participate as an observer or assistant in the following surgical pro-

cedures: aorto femoral bypass Lower limb femoro-femoral cross over graft

9. Participate as assistant or observer in lower limb amputation ( digits,

below knee, above knee)

Skills

Knowledge/Topics

Vascular Surgery

2. Chronic lower limb ischemia


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56

1. Outline the clinical picture, risk factors and investigations re-

quested in a case of suspected arterial or aortic aneurysm

(whether ruptured or not)

2. Describe the management plan including operative procedures

and principles of postoperative care

3. Take focused history and perform appropriate clinical examination

for patients with suspected arterial or aortic aneurysm

4. Order investigations to diagnose the condition

5. Assess , timely diagnose and initiate management of patients with

possibility of ruptured aortic aneurysm and involve immediately

vascular surgeons.

6. Observe or assist in operations for corrections

7. Share as a team member in the postoperative care of patients

Skills

Knowledge

Vascular Surgery

3. Arterial and aortic aneurysm


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57

1. Outline the anatomy of the venous system 2. Discuss the etiology, clinical presentation and complications of

varicose veins 3. List the indications for surgery

4. Examine the venous system of the lower limb 5. Appropriately select patients who require surgery and arrange for

preoperative investigations 6. Manage cases by non operative interventions if surgery is not indi-

cated 7. Perform the following procedures either under supervision or in-

dependently ligation stripping

1. Arterial injuries.

2. Acute ischemia.

3. Chronic ischemia

4. Arterial aneurysms

5. A.V. fistula

6. Diabetic foot.

7. Abdominal aortic aneurysm

8. Deep Venous thrombosis

9. Pulmonary embolism

Skills

Knowledge

Vascular Surgery

4. Venous diseases

Vascular Topics


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58

Venous thromboembolism

Knowledge

Skills

1. Discuss the physiology and pathophysiology of coagulation. 2. Outline the effect of surgery and trauma on coagulation. 3. Recall the causes and clinical presentation of thrombophilias. 4. Explain common methods for diagnosis of venous thrombosis 5. Discuss the principles of treating and prophylaxis for venous throm-

boembolism. 6. Identify clinical symptoms and signs suggestive of DVT and pulmo-

nary embolism and recognize patients at risk. 7. Appropriately use various diagnostic modalities and consult hema-

tologists if indicated 8. Initiate and monitor treatment for various venous thrombotic con-

ditions and be aware of the importance of prophylaxis.


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60

Upon completion of surgical training, Trainees should be able to: 1. Recall the surface anatomy and the anatomy of urinary system

and male genital tract 2. Outline the etiology, pathology, clinical presentation and differ-

ential diagnosis of the common and important urological condi-tions

3. Discuss the methods of investigations and management of the-ses cases (including operative and non operative management)

4. Explain the details of operative procedures needed 5. Describe the pre and post-operative care for patients affected by


6. Assess patients with urological complains and timely identify emergency presentations

7. Request appropriate investigations to diagnose the condition and involve urology specialists

8. Perform adequately preoperative assessment 9. Observe, assist in or perform under supervision the urology pro-

cedures mentioned in the procedure list according to the stage of training


Embryology & congenital anomalies of the urogenital system.

Trauma to the urinary system

Acute inflammatory conditions:

1. Acute pyelonephritis.

2. Acute cystitis.

3. Acute prostatitis.

Chronic inflammatory problems:

1. T.B.: Renal – ureteric – urinary bladder – epididymo orchitis.

2. Bilharziasis: Urinary bladder – spermatic cord & testis.

3. Filariasis: Spermatic cord & testis.

Calcular disease:

Skills

Knowledge

Urogenital Surgery

Topics & lectures


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61

Obstructive uropathy:

1. Hydronephrosis

2. Stricture of the urethra

3. Benign prostatic hyperplasia

Neoplasms of the urinary system:

1. Renal cell carcinoma and nephroblastoma.

2. Carcinoma of the urinary bladder.

3. Carcinoma of the prostate.

Scrotum & Testicles:

1. Undescended testis: Etiology – complications – treatment

2. Acute epididymo orchitis.

3. Chronic inflammatory conditions: T. B. – bilharziasis – filariasis.

4. Varicocele and hydrocele

5. Testicular neoplasms

1. Nephrectomy

2. Ureterolithotomy

3. Radical cystectomy and urinary diversion

4. Urethral catheterization

5. Suprapubic catheterization

6. Male circumcision

7. Hydrocele repair

8. Epididymal cyst excision

9. Orchidopexy

10. Orchidectomy



Procedure


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64

Upon completion of surgical training, Trainees should be able to: 1. Recall the anatomy, physiology, development and evolution of the

breast 2. Summarize breast changes during pregnancy and lactation 3. Outline the etiology, clinical presentation and differential diagnosis

of nipple problems 4. Discuss the epidemiology, risk factors, pathology, staging and

prognosis of breast cancer 5. Explain the rationale underlying breast cancer screening programs 6. Take clinical history and perform breast

examination for patients presenting with breast or nipple com-plains

7. Request appropriate investigations or imaging procedures needed to diagnose the condition

8. Provide medical management in cases that are not indicated for surgery and refer for appropriate specialty

9. Involve plastic surgery, oncology specialists and radiotherapy in cases of breast cancer

10. Perform adequately preoperative assessment 11. Observe, assist in or perform under supervision the procedures

mentioned in the procedure list according to the stage of training 12. Manage the postoperative care including postoperative complica-

tions

Anatomy of the breast

Problems of lactation: Milk engorgement – acute mastitis – breast

abscess.

Mammary duct ectasia.

Fibrocystic disease.

Gynecomastia

nipple discharge

Benign breast neoplasms.

Carcinoma of the breast

The Breast:

Knowledge

Skills

Topics


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65

Trainee should observe, assist in or perform the following proce-dures according to stage of training and available supervision: Treatment of breast abscess

Fine needle aspiration cytology

TruCut biopsy

Excision of breast lump

Mastectomy

Wide excision of breast tumors

Axillary dissection

Breast reconstruction

Breast pain and nodularity Breast abscess Breast lump

1. benign 2. malignant

Nipple problems

Operative Procedure

Key Breast Conditions


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68

Upon completion of surgical training, Trainees should be able to: 1. Outline the anatomy of the neck, neck triangles and endocrine

glands 2. Describe the etiology, pathology, clinical presentation and differ-

ential diagnosis of the mentioned key endocrine surgical condi-tions

3. Discuss the methods of investigations and management of theses cases (including medical and operative management).

4. Explain the details of operative procedures needed to treat thy-roid, parathyroid and adrenal disorders

5. Describe the pre and post-operative care for patients affected by these conditions including the management of post-operative complications

6. Assess patients presenting with neck swellings or endocrine surgi-

cal conditions 7. Request appropriate investigations to diagnose the condition and

involve endocrine specialists or otolaryngologists appropriately 8. Identify conditions that are not indicated for surgery and refer for

appropriate specialty 9. Perform adequately preoperative assessment 10. Observe, assist in or perform under supervision the procedures

mentioned in the procedure list according to the stage of training 11. Manage the postoperative care and timely identify post-operative

complications

Neck swellings for D.D Thyroid diseases

1. Thyroid swelling 2. Thyrotoxicosis

Parathyroid diseases 1. Hypoparathyroidism 2. Hyperparathyroidism

Adrenal diseases 1. Adrenal swellings 2. Hypo and hyperadrenalism

Multiple endocrine neoplasia syndrome Pancreatic endocrine tumors

Endocrinology and Endocrine Surgery

Knowledge

Skills

Key endocrine conditions


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69

Thyroid gland:

1. Functions of the thyroid hormone.

2. Simple enlargement of the thyroid gland: physiological col-

loid, nodular goitre.

3. Hypothyroidism.

4. Hyperthyroidism.

5. Benign & malignant tumors of the thyroid gland.

6. Investigations: Thyroid function tests – ultrasound – C. T. scan

– radioistope scan – FNAC.

Parathyroid glands:

1. Function of the parathyroid hormone & Ca metabolism.

2. Hyperparathyroidism.

3. Hypoparathyroidism.

Suprarenal cortex:

1. Functions of aldosterone & corticosteroids.

2. Conn's syndrome.

3. Cushing syndrome

4. Addison's disease.

Supra renal medulla:

1. Function of catecholamines

2. Pheochromocytoma

Trainees must observe, assist in or perform independently the

following surgical procedures according to the stage of training

and available supervision

1. Thyroid lobectomy 2. thyroidectomy 3. Thyroglossal cystectomy 4. Parathyroidectomy 5. Adrenalectomy

Topics and Lectures

Operative Procedures


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70

Upon completion of surgical training, Trainees should be able to: 1. Outline the anatomy of the parotid and submandibular glands 2. Describe the etiology, pathology, clinical presentation and methods

of diagnosis of Acute parotitis Submandibular sialadenitis Autoimmune parotitis Salivary stones Salivary glands’ neoplasms (benign and malignant)

1. Discuss the methods of management of theses cases (including medical and operative management).

2. Explain the details of operative procedures needed to treat these

conditions

3. Describe the pre and post-operative care for patients affected by

these conditions including the management of post-operative com-plications

4. Assess patients presenting with salivary gland swellings or inflamma-

tion 5. Request appropriate investigations to diagnose the condition and

involve seniors and appropriate specialties 6. Identify conditions that are not indicated for surgery 7. Perform adequately preoperative assessment 8. Observe, assist in or perform under supervision the following proce-

dures according to the stage of training Parotidectomy Submandibular sialadenectomy


Salivary Glands

Knowledge

Skills


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71

the general rules and regulations of assessment approved by the

Egyptian fellowship board and published at the training handbook

and at the board web site applies for the general surgery specialty.

In addition to the successful completion of the training program, all

candidates must successfully pass three exams in order to get the fel-

lowship certificate.

First part Exam

The first part exam is a written exam. Trainees are allowed to sit for

the first part exam after six months of training. Each candidate has

three chances to pass the exam and one more additional chance

may be granted in some special circumstances approved by the

secretary general of the higher committee of medical specialties.

It is to be noted that after one year of training each time the candi-

date choose not to enter the exam will be calculated as one of his

three attempts.

Second part exam

The second part exam is a written exam. Trainees are allowed to sit

for the second part exam after passing successfully the first part

and after completion of the training period (five years). In addition,

each candidate must submit his logbook for final assessment. The

logbook requirements must all be completed and signed by the

trainer and educational supervisor. The candidate shall also submit

his audit or research project before the final exam. The project

must be approved by supervisors and a committee representative

to the scientific council.

Each candidate has three chances to pass the exam and one

more additional chance may be granted in special approved cir-

cumstances.

Pre-requisites for entering the first part exam Trainees should pass the following courses in order to be eligible for the first part exam

1. Local TOEFEL with a score of at least 500 2. Computer courses in word processing, PowerPoint and internet

Methods and regulations of assessment


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72

The third part exam

The third part exam is a clinical, practical and oral exam. Candidates

who pass successfully the second part are allowed to sit for the third

part. Again, each candidate has three chances to pass the third part

exam and an additional fourth chance may be granted in special ap-

proved circumstances.

Holders of The master degree of general surgery are exempted from

the first part exam, if no more than five years have passed since they got

their master degree.

structure of the examination The first part exam aims to test trainee's knowledge in basic science as it

applies to general surgery (first part syllabus mentioned in the curricu-

lum).

The structure of the first part exam: PART I examination

consists of two papers:

Paper I (2 hours): Multiple choice questions with a single best

answer format.

Paper II (2 hours): short answer and /or problem solving ques-

tions

The second part exam aims to test trainees' knowledge , interpretative

and patients’ management skills in general surgery. In this exam all the

curriculum will be covered.

The structure of the second part exam: Part II examina-

tion consists of four papers:

Two MCQ papers each two hours in duration. In both papers, facts,

problem solving and patients’ management skills are going to

be assessed. You will choose one best answer in each question

Two short assay papers each two hours in duration. They cover all

Subtopics listed in the curriculum. Questions will assess Trainees'

knowledge about various surgical diseases and their manage-

ment.


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73

The structure of the third part exam: part III exam is a

clinical , practical and oral exam and is composed of the following

components:

Clinical exam

The clinical exam remains the most important part of the examina-

tion as the long case evaluate the potential performance of the

candidate in surgical practice while short cases assess clinical ex-

amination and history taking skills . Passing this component of the

exam independently is essential for certification.

1. Long Clinical Case : the candidate is observed in silence for the first

part of the examination by two examiners where he/she is taking

the history from the patient and performing physical examination

and then The examiner asks him to present the findings in the his-

tory and examination and discuss his plan for management of the

case . Marks are given according to a predetermined weighting of

the components of the exam.

2. Short case examination: Each candidate examines two or more pa-

tients. The examiners evaluate his abilities to correctly elicit and in-

terpret physical signs or his abilities to take focused clinical history.

An agreed marking system is used to ensure objectivity and fairness

of the exam.

3. VIVA (the oral exam): This examination will follow the clinical exam

and consists of two parts, each of 20 minutes duration.

Surgical Pathology and operative surgery session.

Principles of Surgery and emergency surgery session. Each session will be conducted by one pair of Examiners, ten minutes

for each examiner. The oral exam is based on a set of topics with

opening and supplementary questions. The questions cards are pre-

pared in advance together with the expected ideal answer and allo-

cated marks.

4. OSCE: the Objective structures Clinical Examination is composed of

15-20 stations each station can focus on one of the following:


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74

1. Radiological interpretations

2. Surgical Jars

3. Problems solving and interpretation of investigations

4. Medical ethics

Every station should be designed and approved by three examiners . The

model answer to every question in every station should be approved by

all examiners .

Surgery Curriculum

Documents

professor of surgery

curriculum development

curriculum available

egyptian board

surgery curriculum preface

orthopedic surgery

gastrointestinal surgery

vascular surgery