Course/Curriculum Prepared for Waho

COURSE/CURRICULUM PREPARED FOR WAHO

1. NAME AND TITLE

HIGHER TRAINING IN SURGERY AND SURGICAL SUB-SPCIALTIES FOR THE WEST AFRICAN SUB-REGION

2. AIMS

The aim of the College of Surgeons is to train high calibre surgeons to provide accessible high quality surgical services throughout the subregion.

3. LEARNING OBJECTIVES

GENERAL EDUCATIONAL OBJECTIVES

By the end of his over-all training in the Residency programme, each resident in Surgery should be able to:

1. Obtain, at first consultation, as complete a data base (History, Physical Examination) and Laboratory data) as is compatible with the urgency and complexity of the patient’s problems.

2. Recognise within the database, problems that:

(a). require further investigation or

(b) require therapeutic or supportive intervention.

3. Investigate clinical problems using relevant tests and other appropriate tools in order to clearly define the patient’s problems.

4. Interprete clinical findings and the results of diagnostic investigations, and by a clear process of deductive reasoning reach appropriate decision on clinical management and therapeutic intervention.

5. Perform all common operative procedures required for the restoration and/or maintenance of health for the individual patient.

6. Explain and defend the rationale of, and the technique and procedureemployed in standard surgical operations.

7. Effect adequate post-operative care and full rehabilitation of his patient.

8. Demonstrate a clear, knowledge of the pathology, pathophysiology, clinical features, management options and result of therapy of common surgical diseases.

9. Provide effective supervision for his junior professional colleagues in their performance of simple surgical procedures.

10. Teach surgical concepts and operating skills to Junior colleagues.

11. Explain concepts of surgical diagnosis and treatment not only to his patients, but also to other members of the health team, so as to facilitate successful surgical care.

12. Demonstrate problem-solving ability by designing and implementing a simple research project relevant to the needs of his local environment.

13. Demonstrate general management competence in the appropriate use of resources (man, materials and money) to achieve effective surgical care.

14. Provide effective and purposeful leadership of the surgical team.

15 Ability to set up, organise and manage surgical services in any health care facility.

4. ADMISSION REQUIREMENTS

Admission into the Residency Training Programme in Surgery is open to all medical practitioners with basic medical degrees registrable with the relevant National body for the regulation of Medical and Dental practice. There may other peculiar national requirement that may need to be fulfilled.

A pass in the surgery specialty primary examination is mandatory for admission.

5. COURSE DURATION

The duration of the courses shall be as follows:

Part I/Membership: 24-36 months

Part II/Fellowship: 24 - 48 months depending on the sub-specialty

6. COURSE STRUCTURE

PRIMARY

The Primary Fellowship examination seeks to establish the Candidate’s trainability in Surgery by certifying that he is able to demonstrate adequate knowledge of basic medical sciences as applied to surgery in

(a) Human Anatomy (including cell biology, histology, embryology and osteology)

(b) Human Physiology (including biochemistry and pharmacology)

Part I/Membership : This shall last for a minimum of 24months for Part I and 36 months for Membership

(a)The core postings for Part I include

Trauma (Accident and Emergency or Casualty or Emergency Medicine): 6 months.

General Surgery: 6 months

Urology: 3 months

Orthopaedics: 3 months

Anaesthesia: 3 months

Candidates are to select a 3-month elective rotation from any of the following

cardiothoracic surgery, neurosurgery, paediatric surgery or plastic and reconstructive surgery.

(b) Core Postings for Membership:

General Surgery 12 months

Orthopaedics/Trauma including Accident and Emergency 6months

Urology 3months

Anaesthesia and Intensive care 3months

Cardiothoracic surgery 3 months

Paediatric Surgery 3 months

Neurosurgery 3months

Plastic and Reconstructive surgery 3 months

COURSE STRUCTURE FOR THE PART II/FELLOWSHIP FINAL EXAMINATION

The sub-specialties in surgery are the following:

GENERAL SURGERY

ORTHOPAEDICS

PAEDIATRIC SURGERY

UROLOGY

BURNS, PLASTIC AND RECONSTRUCTIVE SURGERY

CARDIOTHORACIC SURGERY

NEUROSURGERY

1. GENERAL SURGERY

Following successful completion of the Part I /Membership examination, the candidate wanting to train in GENERAL SURGERY should seek admission into an accredited hospital for training in this specialty.

The training is for a period of 24-36 months and training is in various aspects of general surgery.

Each candidate should keep a daily and up to date record of operative procedures he/she participates in during this period of training, using the prescribed logbook for general surgery published by the Faculty.

During this period, the candidate is encouraged to attend the integrated revision course in surgery regularly organized by the College.

Each candidate shall carry out a research project and write a dissertation which shall form part of his/her final assessment for the award of the Fellowship (Guidelines for dissertation – Appendix I).

CORE POSTINGS These shall be the core postings;

a. Surgical Oncology [including Breast diseases, Surgical endocrinology and Skin / soft tissue lesions] - 6 months

b. Gastroenterology [including upper GIT, Colo-proctology, Laparoscopic and Endoscopic Surgery] - 12months

c. Hepatopancreaticobiliary surgery [may be combined with Gastroenterology but ideally should have a separate unit] - 6 months

ELECTIVE POSTING: The remaining 12 months should be undertaken in 4 of the following areas:

(a) Burns & Plastic Surgery 3 months

b. Paediatric Surgery 3 months

c. Orthopaedics/Trauma 3 months

d. Neuro Surgery 3 months

e. Urology 3 months

f. Cardio thoracic/Vascular Surgery 3 months

2. ORTHOPAEDICS

Following successful completion of the Part I/Membership examination, the candidate wanting to train in ORTHOPAEDICS should seek admission into an accredited hospital for training in this specialty.

The training is for a period of 24-36 months and training is in various aspects of Orthopaedic surgery.

Each candidate should keep a daily and up to date record of operative procedures he/she participates in during this period of training, using the prescribed logbook for Orthopaedic surgery published by the faculty.

During this period, the candidate is encouraged to attend the revision course in Orthopaedic surgery regularly organized by the college. Each candidate should keep a daily and up to date record of operative procedures he/she participates in during this period of training, using the prescribed logbook for Orthopaedic surgery published by the faculty.

The training period shall be 24-36 months made up of 24-30months of core postings and 6 months of elective postings.

The Core postings are

(a) Trauma

(b) Arthroplasty

(d) Paediatric Orthopaedics

(e) Spine

The elective postings are

Orthopaedic oncology

Burns and Plastic surgery

3. UROLOGY

Following successful completion of the Part I/Membership examination, the candidate wanting to train in Urology should seek admission into an accredited hospital for training in this specialty.

The training is for a period of 24-36 months and training is in various aspects of Urology.

Each candidate should keep a daily and up to date record of operative procedures he/she participates in during this period of training, using the prescribed logbook for Urology published by the faculty.

During this period, the candidate is encouraged to attend the revision course in Urology regularly organized by the College.

There will be 24-30 months of core postings and 6 months of elective postings

The core postings are

(a) General Urology

(b) Andrology and Male infertility

(d) Reconstructive Urology

(e) Endo-urology

(f) Urological oncology

(g) Urodynamics

(h) Female Urology

The elective postings are

(a) Nephrology

(b) Plastic surgery

(d) Radiation medicine

(e) Transplantation surgery

4. PAEDIATRIC SURGERY

Following successful completion of the Part I/Membership examination, the candidate wanting to train in Paediatric Surgery should seek admission into an accredited hospital for training in this specialty.

The training is for a period of 36 months and training is in various aspects of Paediatric surgery.

Each candidate should keep a daily and up to date record of operative procedures he/she participates in during this period of training, using the prescribed logbook for Paediatric Surgery published by the faculty.

During this period, the candidate is encouraged to attend the revision course in Paediatric Surgery regularly organized by the College.

The rotations are as follows:

(a) General Paediatric surgery.

(b) Neonatology

(d) Paediatric Urology

(e) Plastic surgery

(f) Thoracic surgery

(g) Oesophageal surgery

(h) Paediatric Neurosurgery

(i) Head and neck Surgery

(j) Gastro-intestinal surgery

(k) Transplant Surgery

(l) Paediatric oncology

(m) Minimally invasive Paediatric Surgery (endoscopy, laparoscopy, VATS)

5. BURNS, PLASTIC AND RECONSTRUCTIVE SURGERY

Following successful completion of the Part I/Membership examination, the candidate wanting to train in Burns, Plastic and Reconstructive Surgery should seek admission into an accredited hospital for training in this specialty.

The training is for a period of 36 months and training is in various aspects of Burns, Plastic and Reconstructive Surgery

Each candidate should keep a daily and up to date record of operative procedures he/she participates in during this period of training, using the prescribed logbook for Burns, Plastic and Reconstructive Surgery . During this period, the candidate is encouraged to attend the revision course in Burns, Plastic and Reconstructive Surgery regularly organized by the College.

The rotations are as follows:

(a) General Plastic Surgery

(b) Trauma Surgery

(d) Paediatric plastic Surgery

(e) Oncological Surgery

(f) Hand Surgery

(g) Reconstructive and aesthetic plastic Surgery

(h) Reconstructive genitalia Surgery

(i) Microsurgery

6. CARDIOTHORACIC SURGERY

Following successful completion of the Part I/Membership examination, the candidate wanting to train in Cardiothoracic Surgery should seek admission into an accredited hospital for training in this specialty.

The training is for a period of 36 months and training is in various aspects of CardiothoracicSsurgery Each candidate should keep a daily and up to date record of operative procedures he/she participate in during this period of training, using the prescribed logbook for Cardiothoracic Surgery published by the Faculty.

During this period, the candidate is encouraged to attend the revision course in Cardiothoracic Surgery regularly organized by the college

The rotations are as follows:

(a) General Thoracic surgery

(b) Cardiac surgery

(d) Cardiology and Pulmonary medicine

(e) Intensive care and cardiothoracic anaesthesia

(f) Transplant surgery

(g) General surgery

(h) Video-assisted thoracic/Robotic surgery

(i) Cardio pulmonary imaging

(j) Paediatric Cardiothoracic Surgery

7. NEUROSURGERY

Following successful completion of the Part I/Membership examination, the candidate wanting to train in Neurosurgery should seek admission into an accredited hospital for training in this specialty.

The training is for a period of 36 months and training is in various aspects of Neurosurgery. Each candidate should keep a daily and up to date record of operative procedures he/she participates in during this period of training, using the prescribed logbook for Neurosurgery published by the Faculty.

During this period, the candidate is encouraged to attend the revision course in Neurosurgery regularly organized by the College

The rotations are as follows:

(a) General Neurosurgery

(b) Neuroanatomy

(d) Neuro-ophthalmology

(e) Neuro-otology

(f) Neuroradiology

(g) Neurology

(h) Psychiatry

(i) Neurotrauma

(j) Neuro-oncology

(k) Vascular surgery

(l) Spine surgery

(m) Paediatric neurosurgery

(n) Stereotatic surgery

7. COURSE CONTENT

PRIMARY

1.1 Anatomy

1.1.1 Head and Neck

The scalp

Topography of the anterior and lateral regions of the neck

The root of the neck

Pharynx, Larynx

The face and its vascularisation

The infratemporal and pterygopalatine fossae

The temporo-mandibular joint

The orbit

The buccal cavity, tongue , palate and major salivary glands

Development and morphology of the thyroid, thymus, parathyroid glands and tonsils

Osteology of the skull and the cervical vertebrae

1.1.2 Neuro-Anatomy

The brain major divisions surface anatomy

The cranial nerves

The meninges, venous sinuses, cerebral vessels

Spinal cord and its centres

Anatomy of the circulation of cerebrospinal fluid

Essentials of development of the brain and spinal cord

1.1.3 Thorax and Diaphragm

Anatomy of the thoracic wall with particular consideration of mammary gland

The thoracic cavity and its contents

Osteology of the thoracic cage

The strength of the spinal column

Development of the diaphragm

1.1.4 Abdomen

Anatomy of the abdominal wall, particularly the postero-lateral, inguinal and umbilical regions

Development, gross anatomy and microscopic structure of the abdominal viscera

1.1.5 Pelvis and Perineum

The development, gross anatomy and microscopic structure of pelvic viscera and the perineum

Development of the urogenital system

1.1.6 The Limbs

Osteology of the limb bones

The pelvic and shoulder girdles

Gross anatomy and cutaneous innervations of the upper and lower extremities with emphasis on segmental innervations

Classification and description of joints of the body

1.2 Histology and Intracellular Anatomy

Microscopic structure of normal tissues

Intracellular anatomy

Correlative normal and pathological anatomy

Basic principles of histochemistry

Brief introduction of electron microscopy

Genetic influences in development as applied to surgery

Radiological anatomy of the body relevant to clinical surgery

1.2.2 Human Embryology as a basis for understanding various congenital malformations:

of the Central Nervous System

the Cardiovascular System

the gastrointestinal tract

the genitourinary tract

the respiratory System

and the Musculo skeletal System.

1.3 APPLIED PHYSIOLOGY (INCLUDING BIOCHEMISTRY, CHEMICAL PATHOLOGY AND PHARMACOLOGY)

1.3.1 General Physiological Principles

· Structure of living matter: Biological integration

o The living cell, functions and changes in its mechanisms

o Function of nucleoproteins in the integration of the cell as a unit of living matter

1.3.2 Energy Changes in the Living System

· Thermodynamics of the living organism and its potential energy status

· Oxygen utilization of the living cell

· Heat production and heat loss (basal metabolism, specific dynamic action, regulation of body temperature)

· Homeostasis

1.3.3 General considerations in Water, Electrolytes and Acid-Base Balance

· Distribution of water and electrolytes in extra and intracellular spaces of the body

· Brief survey of biological transport of water and solutes

· Water and electrolyte balance

o Causes and effects of dehydration and oedema

o Sodium and Potassium metabolism

1.3.4 Acid-Base Balance

· pH Regulation

o pH of the body fluids and buffer systems of the body

o Respiratory acidosis and alkalosis as encountered in surgical practice

o Metabolic acidosis and alkalosis as encountered in surgical practice