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Curriculum of General Surgery Course (2013-2014)

Al-Azhar University Faculty of Medicine

Department of General Surgery

Curriculum of General Surgery Course (2013-2014)(1) Course title: General Surgery

(2) Code: 01 – 601 – surg.

(3) Allocated marks: 900 marks

(4) Total teaching hours: 450 hours

270 hours general surgery

180 hours special surgery

(5) Course duration: 8 months

5 months general surgery

3 months special surgery

(6) Course Director: Prof. Dr. Eshak Abd-Elaal and teaching and examination committee of

general surgery department.

(7) Teaching staff: 55 professors, 25 assistant professors, 40 lecturers, and 25 assistant lecturers.

I- AIMS OF THE COURSE• To provide the student with the knowledge, and skills which enable him/her to identify,

analyze, manage and/or refer clinical surgical problems in order to provide efficient, cost

effective and human/patient care.

• To provide the student with an appropriate background covering the common and/ or

important surgical emergencies.

• To enable the student to detect cancer at an early stage.

• To enable the development and application of appropriate professional attitudes, ethical

principles and communication skills.

II- INTENDED LEARNING OUTCOMES (ILOs)1- Knowledge and understanding:

On successful completion of the course, the student should be able to:

1- Describe the anatomy of surgically-important regions, organs and structures 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, outcome and

treatment plans for common and/or important surgical problems, with special emphasis on

emergencies and malignancies.

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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 postoperative care.

7- Describe the basic steps needed for the conduction of safe anesthesia.

8- Outline the physiologic effects of pain and the principles of its management.

2- Professional skills (Clinical and intellectual)

(2.1) Data acquisition

1- By the end of the course the student will be able to:

2- Obtain, perform and document a complete medical history and physical examination.

3- Perform an emergency-directed examination for patients with common surgical emergencies.

4- Utilize sources of information like medical records, patient's family/friends to augment

medical history.

(2.2) Data analysis and problem solving

By the end of the course the student will be able to:

1- Interpret patient symptoms and physical findings in terms of their anatomic, pathologic and

functional diagnostic significances.

2- Identify problems, prioritize them, and generate a list of differential diagnosis for each

problem.

3- Select the most appropriate and cost-effective diagnostic and therapeutic procedure for each

problem.

4- Interpret the results of commonly used diagnostic procedures.

5- Use the results of ail the tests ordered to modify the problem list and the differential diagnosis

accordingly.

6- Combine the clinical and investigational database, with the evidence-based knowledge and

the skill of deductive reasoning to be proficient in clinical problem-solving.

(2.3) Skills related to treatment strategies


1- Recognize patients with life/organ-threatening surgical conditions and perform appropriate

initial therapy.

2- Identify and outline management of patients with chronic surgical conditions requiring long-

term follow-up, rehabilitation and pain relief.

3- Perform routine bedside procedures.

4- Apply the principles of sterile techniques and infection control guidelines.

5- Achieve consensus with the patient or patient surrogate on the treatment plan selected.

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6- Monitor the effectiveness of therapy by identifying clinical and investigative parameters to be

used in assessing the patient's response to treatment and re-evaluate management plan

accordingly.

The levels of competence (of skills)

Level 1: Observe the clinical activity.

Level 2: Assist a colleague performing the clinical activity.

Level 3: Direct supervision by a senior colleague.

Level 4: Indirect supervision by a senior colleague.

Level 5: Independent performance of the entire activity.

(3) General skills and attitudes

By the end of the course the student will be able to gain:

(3.1) Communication skills

1- Conduct sincere and effective patient interviews, properly explain their condition and plan of

management, obtain consents and convey bad news in a professional way.

2- Write patient records and properly present them.

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

4- Work effectively and cooperatively in a team.

(3.2) life-long learning

Formulate a focused clinical question based on real or hypothetical case, search effectively

medical literature using electronic resources, retrieve appropriate information and appraise them using

the principles of evidence based medicine.

(3.3) Ethical behavior ,

1- Treat the patient as a person, respecting his confidentiality and deliver care in an honest,

considerate and compassionate manner

2- Advocate the patient's interests over his own.

3- Maintain a professional image, and practice a responsible attitude

4- Outline the ethical principles related to organ donation.

5- Discuss professional errors in an honest way.

III- METHODS OF TEACHING(1) Topics includes:

theoretical lectures, clinical cases, surgical anatomy, surgical pathology (jars),

operative procedures, special surgery and x-rays

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(2) Duration of Teaching

5 months = 270 hours general surgery

3 months = 180 hours special surgery

(3) Methods of Teaching

Lectures

Tutorials and surgical rounds

Attendance in the ED (emergency department), OR (operations rooms) and skills labs

(under preparation)

Special surgery rounds

(4) Place of Teaching

Lectures halls

Surgical wards, OPD (out-patient department), ED, OR, and skill labs (under

preparation)

Special surgery wards

(5) Time of the day

9:30 – 11:30 am = surgical rounds

12:00 – 1:30 pm = lecture

IV- SCHEDULE AND PLACE OF TEACHINGA. The total number of students are divided into smaller sub groups, each sub- group receive the

total surgery course separately

B. All the students should complete the surgery course within the 6 th year of study. The

subgroups will attend the surgery course synchronously and/or consequently. The course is

given on Sundays, Mondays, Tuesdays, Wednesdays, and Thursdays of every working week

C. The lectures are given in Halls at (Al Hussein and Bab- El Shareia Hospitals) From 12:00 to

1:30 pm. The hall is provided with writing boards, over head projectors, radio unit, and data-

show facilities. They are also properly aerated and illuminated

D. The surgical rounds are given in teaching rooms from 9:30 to 11:30 am with standard

equipment, overhead projectors, writing boards and data-show. They are also properly aerated

and illuminated.

Teaching in surgical wards includes:

Clinical demonstration

Bedside teaching

Staff round with active participation of students for clinical, ethical and communication skills

Observation of bedside procedures

Problem-solving sessions

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Seminars

Each Student must fulfill attendance of 10 cases and have them documented in a log book

Each student must attend at least 2 surgical operations and have them documented in the log book

ER rotations during the surgical round

V- COURSE CONTENT AND SPECIFCATIONSTopic Topics Weight Number of Lectures

1 Basic disease processes 3 % 52 Peri-operative care 3 % 53 Burns and principles of plastic surgery 2 % 24 Skin and subcutaneous tissues 2 % 25 Muscles, tendons, and fascia 1.5 % 26 Hand and foot 1.5 % 27 Vascular surgery 5 % 68 Lymphoreticular disorders 1 % 29 Head and neck 3 % 410 Breast 3 % 311 Endocrinal surgery 4 % 512 Esophagus 2 % 313 Stomach and duodenum 3 % 314 Liver 2 % 315 Biliary system 3 % 416 Pancreas 2 % 217 Spleen 2 % 218 Peritoneum, omentum and mesentery 1 % 219 Small and large intestine 6 % 720 Appendix 1 % 121 Anal canal 2 % 322 Abdominal wall and hernias 4 % 323 Review subjects 2 % 324 Pediatric surgery 5 % 525 Cardiothoracic surgery 2 % 326 Urology 5 % 1027 Testis and scrotum 2 % 328 Trauma 4 % 529 Orthopedic surgery 5 % 1030 Neuro-surgery 3 % 1031 Anesthesia and emergency medicine 8 % 2032 Minimal invasive and laparoscopic surgery 1 % 133 Ethics and communication skills 1 % 134 Surgical radiology 5 % 10

100% 152

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Course Specifications1. Basic disease processes (3 % of the course)

Intended learning outcomes: (ILOs)

1.1 Knowledge


Description Method of Teaching Assessment

1.1.1 Describe wound healing and management

Lectures,

Tutorials

&

Independent

Learning (IDL)

MCQ(multiple choice

questions),

SEQ

(Short Essay

questions) &

VIVA(oral exam)

1.1.2 Underline surgical infections

1.1.3 Underline surgical infection

1.1.4 Describe coagulations mechanism and disorders,

and methods of haemostasis

1.1.5 Outline principles of immunity and organ transplantation

1.1.6 Define principles of tumors pathology and management

1.2 Skills

By the end of this course the student will be able to:

The Skill Level of

Competence

Method of

Teaching

Assessment

1.2.1 Carry out wound examination and assessment 5 Clinical round &

Audio visuals

*OSCE ,

**OSPE &

Clinical

examination

1.2.2 Schedule nutritional requirements for surgical

patients

3

*OSCE=Objective and Structured Clinical Examination.

**OSPE=Objective and Structured Practical Examination.

1.3 Attitude

Description Method of teaching Assessment

1.3.1 Adopt general attitude reported in this surgery

course

Clinical round OSCE &

VIVA

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2- Perioperative care (3% of the course) Intended learning outcomes: (ILOs)2.1 Knowledge

By the end of the course the student will able toDescription Method of Teaching Assessment

2.1.1 Describe and match different types of preoperative assessment Lectures ,

Tutorials&

Independent Learning (IDL)

MCQ ,SEQ

&VIVA

2.1.2 Recognize blood component and transfusion

2.1.3 Discuss haemorrhage and shock2.1.4 Identify fluids, electrolytes, and acid base

balance2.1.5 Describe post-operative complication

2.2 SkillsBy the end of this course the student will be able to:

The Skill Level of Competence

Method of Teaching

Assessment

2.2.1 Review and interpret patients files information

5 Clinical round &

Audio visuals

Clinical examination ,

OSCE &OSPE

2.2.2 Take proper history and carry out general and local examination

5

2.2.3 Apply and IV line 22.2.4 Interpret investigations like blood, gases,

blood pH, and electrolytes

2.3 AttitudeDescription Method of teaching Assessment

2.3.1 Employ information gathering and giving with the patient, relatives and/or colleagues Clinical rounds ,student-

patient/actor interview

Clinical Exam

2.32 Take a consent

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3. Burns and principles of plastic surgery (2 % of the course) Intended learning outcomes: (ILOs)3.1 Knowledge

By the end of the course the student will be able to:Description Method of Teaching Assessment

3.1.1 Define aetiology and degree of burns Lectures ,Tutorials &


MCQ ,SEQ

&VIVA

3.1.2 Describe complications of burns3.1.3 Recognize management of burns3.1.4 Delineate principles of skin coverage



Method of Teaching

Assessment

3.2.1 Schedule fluid formulas of burn patient 5 Clinical round &Audio visuals

OSCE ,OSPE &

Clinical exam3.2.2 Employ assessment of burn patient 5


3.3.1 Adopt general attitude in surgery department Clinical round Clinical Exam

4. Skin and subcutaneous tissues (2 % of the course)

Intended learning outcomes: (ILOs)4.1 Knowledge


4.1.1 Recognize benign lesions of the skin and subcutaneous tissue

Lectures ,Tutorials &


MCQ ,SEQ &VIVA4.1.2 Define precancerous skin lesions

4.1.3 Describe malignant neoplasm of the skin



Method of Teaching

Assessment

4.2.1 Take history and to do physical examination of different skin lesions

5 Clinical round &Audio visuals

Clinical exam ,OSCE & OSPE

4.2.2 Made differential diagnosis and therapeutic decision of different skin

5


4.3.1 Adopt general attitude in surgery Clinical round Clinical exam

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5. Muscle, tendon and fascia (1.5 % of the course)



5.1.1 Define carpal tunnel syndrome, dupuytren’s contracture, Volkmann’s ischaemic contracture, chronic tendinitis Lectures, Tutorials &


MCQ ,SEQ &VIVA

5.1.2 Identify chronic bursitis5.1.3 Describe soft tissue sarcomas



Method of Teaching

Assessment

5.2.1 Assess and make a differential diagnosis of soft tissue swelling

5 Clinical round & Audio visuals

Clinical exam, OSCE & OSPE


5.3.1 Adopt general attitude of surgery department like applying ethical principles to clinical work such as to display patience and kindness

Clinical rounds Clinical exam

6. Hand and foot (1.5 % of the course) Intended learning outcomes: (ILOs)6.1 Knowledge


6.1.1 Describe surgical anatomy of the hand and foot Lectures ,

Tutorials &Independent Learning

(IDL)

MCQ ,

SEQ &VIVA

6.1.2 Discuss the principles of management of hand and foot infections

6.1.3 Outlines the principles of hand and foot injuries management

6.1.4 Define swellings of the hand and foot and in growing toe nail



Method of Teaching

Assessment

6.2.1 Demonstrate surgical anatomy of the hand and foot


VIVA ,Clinical exam, OSCE & OSPE6.2.2 Diagnose common hand infections and

swellings5


6.3.1 Communicate to other colleagues for consultation and counseling

Clinical rounds & review of patient file

Clinical exam

9


7. Vascular Surgery (5 % of the course)



7.1.1 Identify acute and chronic, ischemia, aneurism, and A.V fistulas



MCQ ,

SEQ &

VIVA

7.1.2 Describe diabetic foot infection and gangrene7.1.3 Recognize venous thrombosis, varicose veins7.1.4 Define leg and foot ulcers7.1.5 Delineate lymphoedema and lymphgaringiomas



Method of Teaching

Assessment

7.2.1 Take proper history and carryout physical examination of patients with ischemia and varicose veins



7.2.2 Make a differential diagnosis of a swollen limb, leg, and foot ulcers

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7.3.1 Proper communication with the patients, relatives, and colleagues includes breaking of bad news

Clinical rounds &Student-patient/actor

interview

Clinical exam

8. lympho-reticular disorders (1 % of the course)



8.1.1 Identify different causes of lymphadenopathy Lectures ,Tutorials &


MCQ ,SEQ &

VIVA

8.1.2 Discuss inflammatory disorders of lympho-reticular system

8.1.3 Describe neoplastic disorder of lympho-reticular system, including but not limited to lymphomas and leukemia



Method of Teaching

Assessment

8.2.1 Take proper history and carryout physical examination of lymph node enlargement 5

Clinical round &Audio visuals

Clinical exam ,OSCE, OSPE

8.2.2 Make a differential diagnosis of localized and generalized lymphadenopathy 5


8.3.1 Adopt general attitude in surgery department Clinical rounds Clinical exam

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9. Head and neck (3 % of the course)



9.1.1 Identify causes and management of oral and tongue ulcers



MCQ ,

SEQ &

VIVA

9.1.2 Identify causes and management of major salivary gland inflamation, calculi and neoplasms

9.1.3 Identify causes and management of cervical lymphadenopathy

9.1.4 Outline causes and management of mandibular swellings9.1.5 Discuss DD of neck swellings



Method of Teaching

Assessment

9.2.1

Take proper history and carryout physical examination of salivary disorder 5 Clinical round &

Audio visuals

Clinical exam ,OSCE &

OSPE9.2.2

Make a differential diagnosis of oral ulcers and neck swelling

5

9.2.3

Demonstrate dangerous area of the face 5


9.3.1 Adopt general attitude in surgery department Clinical round Clinical exam

10. Breast (3 % of the course)

Intended learning outcomes: (ILOS)10.1 Knowledge


10.1.1 Describe surgical anatomy, anomalies and inflammatory condition of the breast



MCQ ,

SEQ &VIVA

10.1.2 Discuss benign breast diseases10.1.3 Discuss breast cancer



Method of Teaching

Assessment

10.2.1 Take proper history and carry out physical examination of breast lesions 5

Clinical round & audio visuals

Clinical exam, OSCE &

OSPE


10.3.1 Adopt general attitude in surgery department including but not limited to breaking of bad news and taking informed consent

Clinical round Clinical exam

11


11. Endocrinal surgery (4 % of the course)



11.1.1 Describe surgical anatomy of thyroid, parathyroid gland, and anomalies Lectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

11.1.2 Describe physiology of thyroid and parathyroid11.1.3 Discuss goiter11.1.4 Outline thyroid neoplasm11.1.5 Discuss hyper and hypoparathyroidism11.1.6 Describe applied surgical anatomy and physiology of

suprarenal gland11.1.7 Underline suprarenal tumors11.1.8 APUD cells



Method of Teaching

Assessment

11.2.1 Take proper history and carryout physical examination of different thyroid diseases 5

Clinical round, audio visuals

Clinical exam, OSCE, OSPE



12. esophagus (2 % of the course)



12.1.1 Describe surgical anatomy and physiology of the oesophagus Lectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

12.1.2 Define corrosive esophageal injury12.1.3 Identify neuro-muscular esophageal abnormalities12.1.4 Recognize hiatus hernia12.1.5 Describe carcinoma of the esophagus 12.1.6 Summarize causes of dysphagia



Method of Teaching

Assessment

12.2.1 Take proper history 5 Clinical round &Audio visuals

Clinical exam ,OSCE & OSPE12.2.2 Interpret different diagnostic tools 5



12


13. Stomach and duodenum (3 % of the course)



Description Method of Teaching Assessment13.1.1 Describe surgical anatomy and physiology of the stomach

and duodenum Lectures ,Tutorials &


MCQ ,

SEQ &VIVA

13.1.2 Define acute gastric dilatation13.1.3 Discuss peptic ulcer disease131.4 Underline complications of gastric operations13.1.5 Describe neoplasms of the stomach



Method of Teaching

Assessment

13.2.1 Take proper history and carry out physical examination



13.2.2 Interpret different diagnostic tools 513.3 Attitude

Description Method of teaching Assessment13.3.1 Adopt general attitude in surgery department Clinical round Clinical exam

14. The liver (2 % of the course)



14.1.1 Describe surgical anatomy and physiology of the liver and portal circulation Lectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

14.1.2 Define different diagnostic tools of the liver14.1.3 Describe infections of the liver14.1.4 Delineate liver cirrhosis in surgery14.1.5 Discuss management portal hypertension14.1.6 Describe management liver tumors



Method of Teaching

Assessment

14.2.1 Take proper history and carryout physical examination of patient with liver disease 5 Clinical round &

Audio visuals


OSPE14.2.2 Interpret the laboratory data and imaging

results5

14.2.3 Make diagnostic and therapeutic decisions 4


14.3.1 General attitude reported in this surgery course


13


15. Biliary system (3 % of the course) Intended learning outcomes: (ILOs)15.1 Knowledge


15.1.1 Describe surgical anatomy and physiology of biliary system Lectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

15.1.2 Define radiological investigations and anomalies of biliary system

15.1.3 Discuss gall stones15.1.4 Describe cholecystitis15.1.5 Discuss common bile duct stones and structures15.1.6 Describe different types of jaundice15.1.7 Define carcinoma of gall bladder and bile ducts



Method of Teaching

Assessment

15.2.1 Take proper history and carryout physical examination 5 Clinical round &

Audio visuals


OSPE15.2.2 Interpret diagnostic tools 515.2.3 Differentiate between types of jaundice 5




16. Pancreas (2 % of the course) Intended learning outcomes: (ILOs)16.1 Knowledge


16.1.1 Describe surgical anatomy and physiology of pancreas Lectures ,Tutorials &


MCQ ,

SEQ &VIVA

16.1.2 Discuss acute pancreatitis and pancreatic pseudocyst16.1.3 Define chronic pancreatitis16.1.4 Describe pancreatic neoplasms



Method of Teaching

Assessment


Audio visualsClinical exam ,OSCE & OSPE16.2.2 Interpret the laboratory data and imaging

results5




14


17. Spleen (2 % of the course)

Intended learning outcomes: (ILOs)17.1 KnowledgeBy the end of the course the student will be able to:

Description Method of Teaching Assessment17.1.1 Identify causes of enlarged spleen (splenomegally)



MCQ ,

SEQ &

VIVA

17.1.2 Define splenic cysts, abscess and neoplasms17.1.3 Outline DD of enlarged spleen17.1.4 Define hyperspleenism; its causes and management17.1.5 Discuss splenic injury and its management



Method of Teaching

Assessment


Audio visualsClinical exam ,OSCE & OSPE17.2.2 Interpret different diagnostic tools 5




18. Peritoneum, omentum, and mesentery (1 % of the course)



18.1.1 Describe surgical anatomy and physiology of peritoneum, omentum, mesentery Lectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

18.1.2 Describe generalized and localized septic peritonitis18.1.3 Describe tuberclous peritonitis18.1.4 Underline perintoneal tumors, mesenteric cysts and

mesenteric lymphadenitis18.1.5 Outline retroperitoneal, fibrosis, infections and tumors



Method of Teaching

Assessment

18.2.1 Take proper history and carryout systemic abdominal examination 5

Clinical round & audio visuals

Clinical exam, OSCE & OSPE




15


19. The small and large intestine (6 % of the course)



19.1.1 Describe surgical anatomy and physiology of the intestineLectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

19.1.2 Describe general principles of colon surgery19.1.3 Identify intestine stomas, intestinal fistulae, and intestinal

diverticular19.1.4 Describe inflammatory bowel diseases19.1.5 Discuss intestinal tumors19.1.6 Discuss intestinal obstruction19.1.7 Recognize rectal prolapsed



Method of Teaching

Assessment


Clinical round &

Audio visualsClinical exam , OSCE & OSPE19.2.2 Make a diagnostic and therapeutic decision

based on clinical judgment 4


19.3.1 Adopt general attitude reported in this surgery course


20. Appendix (1 % of the course)



20.1.1 Describe surgical anatomy and physiology of the appendixLectures ,


(IDL)

MCQ ,

SEQ &VIVA

20.1.2 Discuss acute appendicitis20.1.3 Recognize chronic appendicitis20.1.4 Delineate neoplasm of the appendix



Method of Teaching

Assessment

20.2.1 Take proper history and carryout systematic abdominal examination 5

Clinical round &Audio visuals Clinical exam ,

OSCE & OSPE20.2.2 Elicit special tests of appendicitis 520.2.3 Calculate and interpret Alvarado score 5




16


21. The anal canal (2 % of the course) Intended learning outcomes: (ILOs)21.1 Knowledge


21.1.1 Describe surgical anatomy and physiology of anal canalLectures ,


(IDL)

MCQ ,

SEQ &VIVA

21.1.2 Discuss pilonidal sins, and fissure, haemorroids and anorectal abscess

21.1.3 Discuss anal fistula21.1.4 Describe fecal incontinence



Method of Teaching

Assessment

21.2.1 Take proper history and carryout systemic abdominal examination especially PIR examination


Clinical exam , OSCE & OSPE

21.2.2 Interpret different diagnostic tools4

21.3 AttitudeDescription Assessment Assessment

21.3.1 Adopt ethical principles to clinical work such as respecting patients, kindness, privacy and dignity

Clinical round Clini

cal exam

21.3.2 Adopt other general attitude

22. Abdominal wall and hernia (4 % of the course) Intended learning outcomes: (ILOs)22.1 Knowledge


22.1.1 Describe surgical anatomy and physiology of abdominal wall and inguinal region Lectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

22.1.2 Define abdominal incisions

22.1.3 Describe abdominal wall swellings22.1.4 Recognize umbilical disorders22.1.5 Describe principles of external abdominal hernias22.1.6 Discuss inguinal hernias, umbilical, paraumbilical, femoral

epigastric and incisional hernias22.1.7 Define rare types of hernias



Method of Teaching

Assessment

22.2.1 Take proper history and carryout systemic abdominal examination 5 Clinical round &

Audio visualsClinical

exam ,OSCE & OSPE

22.2.2 Elicit tests for diagnosis of hernia 5


22.3.1 Adopt general attitude reported in this Clinical round Clinical exam

17


surgery course23. Review subjects (2 % of the course)



23.1.1 Describe acute abdomenLectures ,


(IDL)

MCQ ,SEQ &VIVA

23.1.2 Discuss upper gastro-intestinal haemorrhage23.1.3 Discuss lower gastro-intestinal haemorrhage23.1.4 Outline postoperative vomiting and distension



Method of Teaching

Assessment


Clinical round &

Audio visualsClinical exam , OSCE &OSPE23.2.2 Make differential diagnosis between

various causes of acute abdomen and gastro-intestinal bleeding

5




24. Pediatric surgery (5 % of the course)



24.1.1 Outline general principles of pediatric surgeryLectures ,

Tutorials &


MCQ ,SEQ &

VIVA

24.1.2 Describe congenital anomalies of the face, lips, and palate24.1.3 Identify congenital diaphragmatic hernias, esophageal

atresia, congenital hypertrophic pyloric stenosis, neo-natal intestinal obstruction and imperforate anus

24.1.4 Outline anomalies of genitourinary tract24.1.5 Underline childhood tumors



Method of Teaching

Assessment


Clinical round &

Audio visualsClinical exam , OSCE & OSPE24.2.2 Make a diagnostic and therapeutic decision

based on clinical judgment 4


24.3.1 Deal properly with the mother, keep respecting her and evaluate well her worry about her ill child


18


25. Cardiothoracic surgery (2 % of the course)


By the end of the course the student will be able to:Description Method of

TeachingAssessment

25.1.1 Identify empyema, bronchogenic carcinoma and pulmonary metastases Lectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

25.1.2 Describe post-operative pulmonary complications25.1.3 Recognize cardiac arrest and CPR25.1.4 Describe pulmonary embolism25.1.5 Outline mediastinal tumors25.1.6 Underline principles of cardiac surgery25.1.7 Enumerate causes of haliptosis



Method of Teaching

Assessment

25.2.1 Take proper history and carryout systematic cardiothoracic examination 5

Clinical round Clinical exam , OSCE & OSPE




26. urology (5 % of the course)



26.1.1 Identify symptoms, examination and investigations of genitourinary tract diseases Lectures ,

Tutorials &


MCQ ,SEQ &

VIVA

26.1.2 Outline urinary tract infections26.1.3 Describe obstructive uropathy26.1.4 Delineate renal neoplasms26.1.5 Describe carcinoma of urinary bladder and prostate cancer



Method of Teaching

Assessment

26.2.1 Take proper history and carryout systemic abdominal examination 5 Clinical round &

Audio visualsClinical exam , OSCE & OSPE26.2.2 Interpret different diagnostic tools 5




19


27. The testis and scrotum (2 % of the course)



27.1.1 Describe development and congenital anomalies of the testis



MCQ ,

SEQ &

VIVA

27.1.2 Identify torsion of spermatic cord and inflammatory conditions of testis and spermatic cord

27.1.3 Describe disease of tunica vaginalis27.1.4 Describe varicocele, epididymal cyst and spermatocele27.1.5 Recognize neoplasms of the testis



Method of Teaching

Assessment


Clinical round &

Audio visualsClinical exam , OSCE & OSPE27.2.2 Make a differential diagnosis of inguino-

scrotal and scrotal swellings 527.3 Attitude

Description Method of teaching

Assessment

27.3.1 Respect patient privacy, dignity, social and legal valuesClinical round

Clinical exam27.3.2 Adopt other general attitude in surgery department

28. Trauma (4 % of the course) Intended learning outcomes: (ILOs)28.1 Knowledge


28.1.1 Discuss general principles of traumaLectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

28.1.2 Discuss head injuries28.1.3 Recognize maxilla-facial injuries28.1.4 Describe injuries of the neck28.1.5 Discuss chest trauma28.1.6 Discuss abdominal and pelvis trauma28.1.7 Describe trauma to extremities including nerve and

vascular injuries



Method of Teaching

Assessment

28.2.1 Act properly with trauma 5 Clinical round &Audio visuals

OSCE ,OSPE & VIVA28.2.2 Apply basic life support 5


28.3.1 Act properly as a member of trauma team and to gain the Clinical rounds OSCE, VIVA

20


attitude of trauma team29. Orthopedic surgery (5 % of the course)



29.1.1 Describe general principles of orthopedic surgeryLectures ,

Tutorials &


MCQ ,SEQ &

VIVA

29.1.2 Identify injuries of upper limb29.1.3 Recognize injuries29.1.4 Identify infections of bones and joints29.1.5 Outline bone tumors and cysts29.1.6 Recognize deformities of bones and joints



Method of Teaching

Assessment

29.2.1 Take proper history and carryout physical examination of bone diseases


Clinical exam, OSCE &

OSPE29.2.2 Act properly with trauma patients 529.3 Attitude

Description Assessment29.3.1 Act properly as a member of trauma team and to gain the attitude of

trauma teamOSCE, VIVA

30. Neurosurgery (3 % of the course)



30.1.1 Describe scalp injuries, skull fractures, and intracranial injuries Lectures ,

Tutorials &


MCQ,SEQ &

VIVA

30.1.2 Identify hydrocephalus30.1.3 Recognize bran abscess and intra cranial tumors30.1.4 Describe nerve injuries and repair30.1.5 Describe neurofibromatosis

30.2 Skills By the end of this course the student will be able to:


Method of Teaching

Assessment

30.2.1 Take proper history and carryout physical examination for different cases of neurosurgery


Clinical exam ,OSCE &OSPE

30.2.2 Interpret different diagnostic tools 4


30.3.1 Gain the attitude of trauma team and other general attitude


21


31. Anesthesia and emergency medicine (8 % of the course)

Intended learning outcomes: (ILOs)31.1 Knowledge:


31.1.1 Describe preoperative assessment and premedication Lectures ,

Tutorials &


MCQ ,

SEQ &

VIVA

31.1.2 Describe principles of general anesthesia31.1.3 Identify regional anesthesia31.1.4 Describe special anesthesia31.1.5 Describe airway management



Method of Teaching

Assessment

31.2.1 Take proper history and carryout physical examination for good preoperative assessment

5 Clinical round &

Audio visuals

OSCE &

OSPE31.2.2 Interpret different laboratory investigations 531.2.3 Apply endo tracheal intubation 1

31.3 AttitudeDescription Method of

teachingAssessment

31.3.1 Adopt general attitude in emergency medicine Clinical rounds OSCE

32. Minimal invasive and laparoscopic surgery (1 % of the course)



32.1.1 Identify general principles of minimal invasive and laparoscopic surgery

Lectures ,


(IDL)

MCQ ,

SEQ &VIVA

32.1.2 Describe advantage, disadvantage and complications32.1.3 Recognize operative principles of laparoscopic surgery32.1.4 Identify obesity and general principles of bariatric surgery



Method of Teaching

Assessment

32.2.1 Identify laparoscopic instruments and their use 5 Clinical round & Audio visuals

OSPE

32.3 AttitudeDescription Assessment

32.3.1 Adopt self learning attitude and websites search VIVA

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33. Ethics and communications skills (1 % of the course)



33.1.1 Describe general medicinal ethics Lectures ,


(IDL)

MCQ ,

SEQ &VIVA

33.1.2 Recognize doctor-patient interview prencipals and how to set up an objective and structured interview

33.1.3 Identify information gathering and information giving33.1.4 Describe Islamic Code of medicinal ethics



Method of Teaching

Assessment

33.2.1 Communicate properly with the patient(how to set up an objective and structured unterview), break bad news ,dealing with angry patient and/or relatives


OSCE ,OSPE & Clinical

exam

33.2.2 Take informed consent 5

33.3 Attitude:Description Method of

teachingAssessment

33.3.1 Adopt general ethics and communications Clinical round Clinical exam

34. Surgical radiology (5 % of the course)



34.1.1 Identify gastro-intestinal tract radiology Lectures ,Tutorials &


MCQ ,SEQ &

VIVA

34.1.2 Recognize urinary tract radiology34.1.3 Identify orthopedic radiology34.1.4 Review chest x-ray34.1.5 Identify arteriography and mammography



Method of Teaching

Assessment

34.2.1 Interpret different radiology investigations 3 Clinical round & Audio visuals

OSPE & VIVA


34.3.1 Adopt general attitude reported in this surgery course Clinical round Clinical exam

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35. Review of surgical anatomy



35.1.1 Review surgical anatomy of the head and neck Lectures ,Tutorials &


MCQ ,SEQ &

VIVA

35.1.2 Review surgical anatomy of the abdomen and pelvis35.1.3 Review surgical anatomy of the upper and lower limb35.1.4 Review surgical anatomy of the thorax and neuro anatomy



Method of Teaching

Assessment

35.2.1 Identify basic anatomy on models and cadavers 5 Clinical round &Audio visuals

OSPE35.2.2 Apply surgical anatomy in OR as much as

possible3

35.3 AttitudeDescription Assessment

35.3.1 Adopt general attitude reported in this course OSPE

List (1): Clinical Cases History taking and clinical examination

Swellings (lipomas, sebaceous cyst, …)

Thyroid diseases and other neck swellings

Breast lesions

Hernias

Scrotal and inguino scrotal swellings

Ulcers

Peripheral veins and varicose ulcer

Lymphadenopathy

Edema of the limbs

Abdominal case

Jaundice of surgical importance

Peripheral nerve injuries

Parotid swellings

List (2): Operative Surgery Types of structures, needles and stitches

General surgery:-

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- Thyroidectomy

- Mastectomy

- Hernia operation

- Sympathectomy

- Amputation

- Operations for varicose vein

- Venous cut down

- Sebaceous cyst and other subcutaneous swellings

- Management of abscess

- Tracheostomy

GIT surgery

- Abdominal incisions

- Gastrostomy

- Resection and anastomosis

- Splenectomy

- Cholecystectomy

- Exploration of CBD

- Appendicectomy

- Colostomy &iliostomy

- Haemorrhoidectomy

- Operations for anal fissure

Urinary tract surgery

- Renal incisions

- Nephrostomy

- Nephrectomy

- Nephrolithotomy

- Uretero-lithotomy

- Cystolithotomy

- Prostatectomy

- Circumcision

- Orcheopixy

- Varicocelectomy

- Hlydrocelectomy

Types of surgical instruments and their uses

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Types of tubes and drains and their uses

Sterilization process, instrumental, personal and environmental

List (3): Surgical pathology (jars)

Ileo-ileal intussusception

Ileo-ileal instussusception with a Mickel’s divorticulum

Cancer colon

Cancer stomach

Cancer rectum

Chronic calcular cholecystitis with solitary cholesterol stone

Chronic calcular cholecystitis with and impacted stone at its neck

Chronic cholecystitis with chronic appendicitis

Renal cell carcinoma

Renal tuberculosis

Carcinoma of urinary bladder

Seminoma of the testis

Adenoma of benign prostatic hyperplasia

Rupture spleen

Breast cancer

Multinodular goiter

Melanoma

T.B of the epididymis

List (4): Special surgery courses Orthopedics

Urology

Neurosurgery

Anesthesiology

Emergency medicine critical care

Radiology

List (5): Bedside skills IV, IM and SC injections

Insertion of IV cannulas

Insertion of urinary catheter

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PIR/PV examination

Insertion of a nasogastric tube

Methods of wound closure

VI- ASSESSMENT AND EVALUATIONA) Grading System

Grading Marks

6th year attendance 20

Round-end exam 100

Special surgery rounds 60

Final Written Paper 1 (short essay) 180

Final Written Paper 2 180

Long Case (clinical exam) 90

2 short cases (clinical exam) 90

Jars (surgical pathology) 45

Operative surgery 45

Surgical anatomy 45

VIVA 45

Total 900

The minimum passing score is 540, provided at least 108 are obtained in the written

exam

Passing grades are:

- Excellent if 85% or more

- Very good if 75% to < 85%

- Good if from 65% to < 75%

- Fair if from 60% to < 65%

- Failed if less than 60%

Attendance criteria

The minimum acceptable attendance in the surgical rounds is 75%. Students who fail

to attend that percentage of activities will not be allowed to take the end of term

examination and the marks allocated for this exam would be recorded as a proportion

from the final written score

The student is not allowed entry to the special surgery exam if his absence exceeds 5

days

Students need to attend at least 60% of their rounds to be able to sit for the final

examination

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The student is expected to present at least 1 seminary, and 6 clinical cases. This

attendance should be documented in the students logbook and countersigned by the

tutor giving the class

He is required to attend 10 emergency cases, attend 5 staff rounds and 2 operations

during his rotation. This attendance should be documented in the students logbook and

countersigned by at least an assistant lecturer

B) Assessment tools

Tool Purpose: Assessment of:

Written examination Knowledge and understanding

Clinical examination (long case) Clinical and intellectual skills and general skills and attitudes

Clinical examination (OSCE) Data acquisition

Oral examination Knowledge and understanding

x-ray, anatomy Knowledge and data analysis

ER attendance Data acquisition and skills related to treatment strategies

Clinical presentation Skills related to treatment strategies, general skills and attitude

Staff rounds Skills related to treatment strategies, general skills and attitude

Seminars Skills related to treatment strategies, general skills and attitude

OR attendance Skills related to treatment strategies, general skills and attitude

C) Examination description

Written exam: 2-day examination, each for 3 hours and consists of:

o Short essay questions representing 60% of the mark

o Problem solving questions representing 20% of the mark

o MCQ representing 20% of the mark

Clinical exam (long case): the student is allowed 20 minutes with the patient during

whom he is expected to take a history and perform a general and local examination.

Then the examiner asks the student to demonstrate specific parts of the examination,

interpretation of findings, different diagnoses, management plan as well as any related

surgical knowledge

Clinical examination (Objective Structural Clinical Examination [OSCE]): this would

include 6 stations, 4 with patients and 2 with investigations related to the case, and the

student is allowed 7 minutes with the patients to perform a local examination and

evaluated meanwhile by the examiner. Another station will be an investigation (x-ray,

ultrasound, lab result … etc.) that can be related to the case, with and MCQ on this

investigation

Oral exam:

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o The student is allowed to pick one or more topic for the operative talk and

then he is asked by the examiner to present his knowledge in this topic

o The student is given a pathology specimen jar(s) and is asked to identify the

specimen and asked about the theoretical knowledge related to it.

X-ray and anatomy: 12 stations (8: x-rays, 4: anatomy) each station has 5 true or false

questions

Log book (seminar, clinical cases, emergency cases, staff rounds, and OR attendance)

SUGGESTED REFERENCES

1. Bailey and Love’s Short Practice of Surgery

2. Current Surgical Diagnosis and Treatment

3. Browse NL: An introduction to the Symptoms and Signs of Surgical Disease

4. Website: www.medscap.com

Prepared by:

Dr.Mohammad A. Saeid

Assist. Prof. In general surgery

Dr. Mohammad Arafat Dr. Abdulfattah El-Sheikh

Lecturer in general surgery Lecturer in oncosurgery

Reviewed by:

Teaching and Examination Committee.

Prof. Dr.Ahmad El-Kholy; committee chairman.

Approved by:

Prof. Dr.Eshak Abdulaal ; Head of surgery department.

Prof. Dr.Magdy Mahmuod ; Sec. gen. of surgery department.

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