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.
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
By the end of the course the student will be able to:
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.
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
(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 TEACHING
A. 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 6th 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
· 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 SPECIFCATIONS
Topic / Topics Weight / Number of Lectures1 / Basic disease processes / 3 % / 5
2 / Peri-operative care / 3 % / 5
3 / Burns and principles of plastic surgery / 2 % / 2
4 / Skin and subcutaneous tissues / 2 % / 2
5 / Muscles, tendons, and fascia / 1.5 % / 2
6 / Hand and foot / 1.5 % / 2
7 / Vascular surgery / 5 % / 6
8 / Lymphoreticular disorders / 1 % / 2
9 / Head and neck / 3 % / 4
10 / Breast / 3 % / 3
11 / Endocrinal surgery / 4 % / 5
12 / Esophagus / 2 % / 3
13 / Stomach and duodenum / 3 % / 3
14 / Liver / 2 % / 3
15 / Biliary system / 3 % / 4
16 / Pancreas / 2 % / 2
17 / Spleen / 2 % / 2
18 / Peritoneum, omentum and mesentery / 1 % / 2
19 / Small and large intestine / 6 % / 7
20 / Appendix / 1 % / 1
21 / Anal canal / 2 % / 3
22 / Abdominal wall and hernias / 4 % / 3
23 / Review subjects / 2 % / 3
24 / Pediatric surgery / 5 % / 5
25 / Cardiothoracic surgery / 2 % / 3
26 / Urology / 5 % / 10
27 / Testis and scrotum / 2 % / 3
28 / Trauma / 4 % / 5
29 / Orthopedic surgery / 5 % / 10
30 / Neuro-surgery / 3 % / 10
31 / Anesthesia and emergency medicine / 8 % / 20
32 / Minimal invasive and laparoscopic surgery / 1 % / 1
33 / Ethics and communication skills / 1 % / 1
34 / Surgical radiology / 5 % / 10
100% / 152
Course Specifications
1. Basic disease processes (3 % of the course)
Intended learning outcomes: (ILOs)
1.1 Knowledge
By the end of the course the student will be able to:
Description / Method of Teaching / Assessment1.1.1 / 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 / Assessment1.2.1 / 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 / Assessment1.3.1 / Adopt general attitude reported in this surgery course / Clinical round / OSCE &
VIVA
2- Perioperative care (3% of the course)
Intended learning outcomes: (ILOs)
2.1 Knowledge
By the end of the course the student will able to
Description / Method of Teaching / Assessment2.1.1 / 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 shock
2.1.4 / Identify fluids, electrolytes, and acid base balance
2.1.5 / Describe post-operative complication
2.2 Skills
By the end of this course the student will be able to:
The Skill / Level of Competence / Method of Teaching / Assessment2.2.1 / 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 / 2
2.2.4 / Interpret investigations like blood, gases, blood pH, and electrolytes
2.3 Attitude
Description / Method of teaching / Assessment2.3.1 / 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
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 / Assessment3.1.1 / Define aetiology and degree of burns / Lectures ,
Tutorials &
Independent Learning (IDL) / MCQ ,
SEQ
VIVA
3.1.2 / Describe complications of burns
3.1.3 / Recognize management of burns
3.1.4 / Delineate principles of skin coverage
3.2 Skills
By the end of this course the student will be able to:
The Skill / Level of Competence / Method of Teaching / Assessment3.2.1 / Schedule fluid formulas of burn patient / 5 / Clinical round &
Audio visuals / OSCE ,
OSPE &
Clinical exam
3.2.2 / Employ assessment of burn patient / 5
3.3 Attitude
Description / Method of teaching / Assessment3.3.1 / 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
By the end of the course the student will be able to:
Description / Method of Teaching / Assessment4.1.1 / Recognize benign lesions of the skin and subcutaneous tissue / Lectures ,
Tutorials &
Independent Learning (IDL) / MCQ ,
SEQ &
VIVA
4.1.2 / Define precancerous skin lesions
4.1.3 / Describe malignant neoplasm of the skin
4.2 Skills
By the end of this course the student will be able to:
The Skill / Level of Competence / Method of Teaching / Assessment4.2.1 / 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 Attitude
Description / Method of teaching / Assessment4.3.1 / Adopt general attitude in surgery / Clinical round / Clinical exam
5. Muscle, tendon and fascia (1.5 % of the course)
Intended learning outcomes: (ILOs)
5.1 Knowledge
By the end of the course the student will be able to:
Description / Method of Teaching / Assessment5.1.1 / Define carpal tunnel syndrome, dupuytren’s contracture, Volkmann’s ischaemic contracture, chronic tendinitis / Lectures, Tutorials &
Independent Learning (IDL) / MCQ ,
SEQ &
VIVA
5.1.2 / Identify chronic bursitis
5.1.3 / Describe soft tissue sarcomas
5.2 Skills
By the end of this course the student will be able to:
The Skill / Level of Competence / Method of Teaching / Assessment5.2.1 / Assess and make a differential diagnosis of soft tissue swelling / 5 / Clinical round & Audio visuals / Clinical exam, OSCE & OSPE
5.3 Attitude
Description / Method of teaching / Assessment5.3.1 / 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)