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

tology, Cairo University and the educational advisor of the Egyptian board
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
General Surgery Curriculum Egyptian Fellowship Board
CONTENTS ……
Preface and acknowledgements………………………………………………………..……………. 3-5

The structure and regulations of surgical training………………………………………………………
9
Rationale and aims of the curriculum………..………………………………………….………… 13
Intended learning outcomes…..………………………………………………………………………….. 14
Teaching and training methods….…………………………………………………………………………………
15
Basic sciences syllabus……………………... ……………………………………...………………………… 17
Basic surgical skills…...…………………………………………………………………………………………….. 23
Gastrointestinal surgery………...……………………………………………………………………………. 25
Surgical emergencies……………………...…………………………………………………………………... 35
Orthopedic surgery……………………………….……………………………………………………...……... 44
Reticuloendothelial system……………….…………………..……………………………………………. 48
Skin and subcutaneus tissues…………………………..…………………………………………………… 49
Surgical oncology (clinical skills)…………..……………………………………………………………. 51
Endoscopy……………………………………………………….. …………………………………………………… 52
Vascular surgery…………………………………………………………………………………………………….. 53
Urogenital surgery……………………………………………………………………………………………….. 59
Breast surgery………………………………………………………………………………………………………… 63
Endocrine surgery………………………………………………………………………………………………… 67
Salivary glands……………………………………………………………………………………………………….. 70
Regulations and methods of assessment………………………………………………………... 71
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General surgery curriculum Egyptian Fellowship Board
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…………………… The Structure of the general surgery

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…………………… Training Program
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…………………… The Egyptian Fellowship Board requires five years of supervised training pro-
………………….. gram that must be conducted in accredited hospitals before sitting for the
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………………….. 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-
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tals will be announced yearly by the board. During the entire training pro-
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………………….. gram, the candidate must be dedicated full time and must be responsible for
…………………… patient care under supervision. The program has the following requirements
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for trainees who are affiliated to MOHP:
………………….. 1. Graduation from medical school and successful completion of the pre-
…………………… registration house officers' year.
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…………………… 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-
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…………………… 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
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…………………… first part exam.
………………….. 4. Trainees who finished their surgery diploma might join the program
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from its second year. However, they must site for the first part exam.
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………………….. First year
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………………….. The trainee should spend the first year of training in general surgery practice
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………………….. that might include pediatric surgery. during this period he will work as a full
…………………… time resident.
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………………….. Important notice
…………………… Trainees must pass successfully all the foundation courses before being
………………….. promoted to the second year of training. Full information about founda-
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………………….. tion courses is available at the EF website and administration office
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………………….. Second and third years
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………………….. During the second and third years of training, trainees must get experience
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………………….. in different surgical specialties mentioned in the curriculum. The training
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centers should have surgical specialties' clinics and operative services that
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…………………… ensure full coverage of all cases and operative procedures mentioned in the
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curriculum.
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……………………. Trainees will have rotations in different surgical specialties as follows:

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…………………….  Four months in orthopedic surgery
 Two months in neurosurgery
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…………………….  Three months in emergency surgery
 Two months in cardiac surgery
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…………………….  Four months in urosurgery
 Three months in vascular surgery
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 Two months in plastic surgery& burn
…………………….  Two months in pediatric surgery
……………………. unit
…………………….  Two months in ICU
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……………………. Fourth and fifth years
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……………………. The fourth and fifth years of training should be spent in general surgery prac-
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……………………. 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.
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……………………. Their obligations, duties and responsibilities will be matching their experience,
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level of training and available supervision. It is to be noted that trainees who
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……………………. do not have the opportunity to rotate in surgical specialties during the third
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……………………. year of training, will spend their fourth year in surgical specialties rotations.
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……………………. Trainees duties and obligations
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……………………. 1. Trainees must attend at least 75% of lectures on surgical subjects.
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……………………. 2. They should be actively involved and fully responsible for patient care
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including sharing in making decisions about diagnosis and manage-
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……………………. ment under supervision of the consultants.
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……………………. 3. They must attend 75% of weekly meetings including clinical rounds, tuto-
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……………………. rials, journal clubs and morbidity and mortality meetings
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……………………. 4. Their performance will be monitored and evaluated by trainers and a re-
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port of their performance will be issued on monthly basis to the Egyptian
……………………. Fellowship Board.
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……………………. 5. All trainees will work as residents in the training specialty and they must
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……………………. fulfill all residents jobs defined by supervisors and trainers
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……………………. 6. They should be responsible under supervision for outpatient and in pa-
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……………………. tients' routine work and must take supervised shifts according to hospital
……………………. regulations.
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…………………… During the hospital rotations

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1. The admitted patients
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a. The trainee will be responsible for supervised admission of patients from
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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
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 Operative records
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 Postoperative orders
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…………………..  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
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…………………… 2. Outpatient clinics & day surgery units
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…………………..  The trainee should attend the outpatient clinics related to mandatory sur-
…………………… gical rotations and its subspecialties as requested by trainers and supervi-
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sory staff.
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…………………..  He should also attend operative sessions in outpatients or day surgery
…………………… units
………………….. 3. Mandatory clinical and academic activities
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………………….. 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-
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ics, problems, research, etc.
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…………………..  Journal club meeting.
……………………  Surgical morbidity/mortality conferences and audit sessions
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…………………… 4. The log book
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…………………… 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
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supervisor. The Trainer and educational supervisor must sign the completed
Logbook.
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……………………. 5. The research or audit project

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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-
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amination.
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……………………. 6. Before the completion of the training program
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……………………. 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.
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General rules and regulations
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……………………. a. Holidays and on call duties
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……………………. According to Ministry of Health and Population regulation
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……………………. b. Evaluation procedures
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…………………….  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
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attendance and participation.
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 The trainers who are required to write confidential reports of the perform-
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……………………. 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
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Interruption of training
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……………………. 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.
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…………………… Rational statement

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……………………  The purpose of this curriculum is to describe the knowledge, skills, behav-
………………….. iors and attitudes expected from general surgeons upon completion of
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………………….. 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-
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………………….. 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:
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………………….. 1. Revision of previous Egyptian Fellowship surgery curriculum
…………………… 2. Revision of international curricula for postgraduate training in sur-
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gery. We specifically mention the Royal college of surgery curricu-
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………………….. lum approved by the PMETB in 2007 and the Australian Royal col-
…………………… lege of surgery curriculum
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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
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…………………… general surgery scientific council and approved by the council in April
………………….. 2008
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………………….. Curriculum aim
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………………….. Aims of the Surgery Fellowship training
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 To provide the trainee with the knowledge, and skills which en-
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………………….. 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
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………………….. surgical emergencies.
……………………  To enable the development and application of appropriate profes-
………………….. sional attitudes, ethical principles and communication skills
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General intended learning outcome
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……………………. By the end of training in general surgery fellowship program, gradu-
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……………………. ates of the program must have the following knowledge, skills, behav-
……………………. iors and attitudes
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……………………. Knowledge and understanding.
……………………. 1. Describe the anatomy of surgically-important regions, organs and struc-
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……………………. tures of the body.
……………………. 2. Describe the etiology, pathogenesis and pathology of important and/ or
……………………. common surgical diseases.
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……………………. 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.
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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
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practice.
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……………………. 6. Discuss the principles and practice of preoperative preparation and postop-
……………………. erative care.
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7. Discuss different modalities for management of pain related to surgery.
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……………………. Skills
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……………………. 8. Obtain, perform and document a complete medical history and physical
……………………. examination for surgical patients.
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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
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……………………. augment medical and surgical history.
……………………. 11.Interpret patient symptoms and physical findings in terms of their anatomic,
……………………. pathologic and functional diagnostic significances.
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……………………. 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
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……………………. procedure for each problem.
……………………. 14.Identify medical and investigative parameters to be used in assessing the
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patient’s response to intervention and re-evaluate management plan ac-
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……………………. cordingly.
……………………. Communication skills
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……………………. 15.Conduct sincere and effective patient interviews, properly explain the con-
……………………. dition and plan of management, obtain consents and convey bad news in
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……………………. a professional way
……………………. 16.Write patient records and properly present them.
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…………………… 17.Communicate, consult and respect the role of other health-care providers.
………………….. 18.Work effectively and cooperatively in a team.
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Life-long learning
…………………… 19.Search effectively electronic resources to find valid appropriate informa-
………………….. tion and use them in management of surgical cases.
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………………….. Ethical behavior
…………………… 20.Respect Patients confidentiality and deliver care in an honest, considerate
………………….. and compassionate manner.
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………………….. 21.Appropriately and ethically get informed consent for indicated surgical
…………………… interventions.
………………….. 22.Recognize the ethical principles related to organ donation.
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………………….. 23.Discuss professional errors in an honest way.
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………………….. Teaching will be conducted using the following techniques
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 Clinical rounds and clinical days.
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……………………  Bedside teaching.
…………………..  Grand surgical rounds with active participation of trainees in
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………………….. case presentations.
……………………  Apprenticeship teaching in the operative theatre.
…………………..  Outpatient and inpatients work.
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…………………..  Journal clubs
……………………  Workshops and training courses.
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Basic science syllabus
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……………………. Applied surgical anatomy
…………………….  Blood vessels :
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……………………. For the following arteries and their corresponding veins, trainees
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……………………. should describe, the course , relations , surface anatomy , branches
……………………. and collateral circulation.
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……………………. Arteries:
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……………………. Common carotid – internal carotid – external carotid – aorta – in-
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……………………. nominate.
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Subclavian – axillary – brachial – radial – ulnar- common iliac – exter-
……………………. nal iliac – internal iliac – femoral – popliteal –anterior tibial – post tibial
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……………………. – peroneal – dorsalis pedis
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……………………. All corresponding veins.
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…………………….  Nerves:
……………………. for all the following nerves, trainees should describe , their course ,
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……………………. relations , surface anatomy and branches.
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……………………. Nerves
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……………………. Cranial nerves-Sympathetic trunk-Brachial plexus – radial nerve – me-
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dian nerve - ulnar nerve – circumflex nerve – musculocutaneous
……………………. nerves.
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……………………. Lumbar plexus – femoral nerve – obturator nerve – sciatic nerve –
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……………………. Tibial nerve – common peroneal nerve.
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…………………….  Lymphatic:
……………………. Cervical lymph nodes. Axillary , inguinal , Abdominal , Mediastinal ,
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……………………. and Breast lymphatics
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…………………….  Muscles:
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……………………. for the following muscles, trainees should have describe; origin – in-
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sertion – nerve supply – function – surgical significance.
……………………. Muscles
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……………………. Strap muscles – sternomastoid – scalenus anterior – scalenus medius
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……………………. – scalenus posterior – levator scapulae.
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……………………. 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.
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………………….. Diaphragm.
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………………….. Intercostal muscles.
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………………….. Sartorius – gracilis – quadriceps femoris – tensor fascia lata – biceps
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femoris – semitendinosus – semimembranosus – adductors – gas-
…………………… trocnemius – soleus. Gluteus maximus, medius, minimus and Levator
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…………………… anni muscle.
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……………………  Anatomy of the inguinal canal.
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……………………  Anatomy of the Femoral canal.
…………………..  Anatomy of the breast:
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…………………..  The salivary glands: Parotid – submandibular.
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…………………..  Head and neck:
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………………….. 1. Deep fascia.
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2. Triangles of the neck.
…………………… 3. Thyroid & parathyroid glands.
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…………………… 4. Parotid & submandibular salivary glands.
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…………………… 5. Larynx
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…………………… 6. Trachea.
…………………..  GIT
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………………….. The trainee should describe; Anatomical location, relations, blood sup-
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………………….. ply, lymphatic drainage, nerve supply of:
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………………….. 1. Pharynx.
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2. esophagus.
…………………… 3. Stomach.
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…………………… 4. Duodenum.
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…………………… 5. Small bowel.
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…………………… 6. Large bowel & appendix.
………………….. 7. Rectum.
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………………….. 8. Anal canal.
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………………….. 9. Liver – gall bladder – biliary system – pancreas
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………………….. 10.Spleen
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11.adrenal glands.
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…………………….  Urogenital anatomy

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……………………. 1. Kidney.
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……………………. 2. Ureter.
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……………………. 3. Urinary bladder.
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4. Urethra.
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……………………. 5. Scrotum – testis – epididymis.
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……………………. 6. Ovary.
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…………………….  Thorax anatomy
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……………………. Trachea – bronchi – lungs
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……………………. Surgical Physiology
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…………………….  Water & electrolyte balance:
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……………………. 1. Hyponatremia.
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2. Hypernatraemia.
……………………. 3. Hypokaliemia.
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……………………. 4. Hyperkaliemia.
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…………………….  Acid base balance
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……………………. 1. Acidosis: Respiratory & metabolic.
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2. Alkalosis: Respiratory & metabolic
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…………………….  Physiological response to stress
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…………………….  Shock:
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……………………. 1. Hypovolemic.
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2. Neurogenic.
……………………. 3. Anaphylactic.
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……………………. 4. Septic.
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…………………….  Blood transfusion – transfusion of blood products.
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…………………… Surgical hematosis:

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…………………… 1. 1ry Hemostasis: vasoconstriction – platelet functions.
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2. 2ry Hemostasis: Coagulation and Fibrinolysis.
………………….. 3. Disorders of hemostasis
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…………………..  Congenital.
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…………………..  Acquired:
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………………….. 1. Liver disease.
…………………… 2. Vit. K deficiency.
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…………………… 3. DIC.
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…………………… 4. Massive transfusion.
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…………………… 5. Platelets abnormalities.
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…………………… Surgical Nutrition:
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……………………  Metabolism in normal persons (starvation& hypercatabolic states).
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……………………  Squeal of under nutrition.
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……………………  Assessment of malnutrition.
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 Enteral nutrition.
…………………..  T.P.N.: Indications – complications.
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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
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).
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
23
General Surgery Curriculum

……………………
…………………..
…………………… Basic Surgical Skills
…………………..
……………………
………………….. Knowledge
……………………
…………………..
……………………  Describe the principles of skin and subcutaneous incisions and
………………….. surgical handling.
……………………
…………………..
……………………
………………….. Skills
……………………
………………….. 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.
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
26
…………………….
…………………….
Esophagus-gastric surgical conditions
…………………….
…………………….
……………………. Knowledge
…………………….
…………………….
……………………. 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
…………………….
……………………. Skills
…………………….
…………………….
……………………. 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
…………………….
…………………….
…………………….
……………………. 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
…………………….
27
……………………
…………………..
……………………
Upper GIT Topics
…………………..
…………………… 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
……………………
…………………..
……………………
…………………..
Operative Procedures
……………………
………………….. 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
……………………
…………………..
28
…………………….
…………………….
……………………. Colo-rectal surgery
……………………. 1. Anorectal conditions
…………………….
…………………….
…………………….
…………………….
Knowledge
…………………….
……………………. 1. Describe aetiology, applied anatomy, clinical presentation and di-
…………………….
…………………….
agnosis of the following common ano-rectal conditions.
…………………….
……………………. Hemorrhoids.
……………………. Anal fissure.
……………………. Abscess and fistulae.
……………………. Hidradenitis Suppurativa.
……………………. Pruritis ani.
…………………….
Fecal incontinence
…………………….
…………………….
…………………….
……………………. 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.
Skills
…………………….
…………………….
…………………….
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.
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
29
…………………… Colorectal Surgery

…………………..
…………………… 2. Colorectal Neoplasia
…………………..
……………………
…………………..
…………………… Knowledge
…………………..
……………………
………………….. 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.
…………………..
……………………
………………….. Skills
……………………
…………………..
…………………… 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
…………………..
……………………
…………………..
…………………… Procedure
…………………..
……………………
…………………..  Hartmann's procedure.
……………………  Colectomy (It, Rt or Sigmoid).
…………………..  Colostomy – construction.
……………………
 Ileostomy – construction.
…………………..
……………………  A-P resection
…………………..
…………………… The trainee level of participation in these procedures is de-
…………………..
…………………… tailed in the logbook
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
30
…………………….
…………………….
……………………. 3. Colo-rectal Stoma
…………………….
…………………….
…………………….
…………………….
Knowledge
…………………….
……………………. 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.
…………………….
……………………. Skills
…………………….
…………………….
……………………. 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.
…………………….
…………………….
……………………. 4. Inflammatory Bowel Diseases
…………………….
…………………….
…………………….
…………………….
……………………. 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.
…………………….
……………………. Skills
…………………….
…………………….
…………………….
…………………….
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
…………………….
…………………….
31
……………………
………………….. 5. Benign colonic conditions
……………………
…………………..
……………………
……………………
…………………..
…………………… 1. Describe the aetiology, clinical presentation, methods of diagnosis
………………….. and initial treatment of the following benign colonic conditions .
……………………
…………………..
……………………
…………………..
 Diverticular disease
……………………  Colonic volvulus.
…………………..  Rectal bleeding
……………………  Rectal trauma
…………………..
……………………
…………………..
……………………
………………….. Skills
……………………
………………….. 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.
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
32
…………………….
…………………….
Hepatobiliary surgical conditions
…………………….
…………………….
…………………….
……………………. 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
…………………….
…………………….
……………………. Skills
…………………….
…………………….
……………………. 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
…………………….
…………………….
…………………….
……………………. 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
…………………….
33
……………………
………………….. Hepatobiliary and pancreatic
……………………
………………….. Operative Procedures
……………………
…………………..
…………………… 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
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
36
…………………….
…………………….
…………………….
Traumatic Surgical Emergency
…………………….
…………………….
…………………….
……………………. 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.
…………………….
……………………. Skills
…………………….
……………………. 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
…………………….
…………………….
…………………….
…………………….  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.
…………………….
…………………….
37
……………………
Head Trauma
…………………..
……………………
…………………..
Knowledge and skills
……………………
…………………..
……………………
………………….. 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
……………………
…………………..
…………………… Chest Trauma
…………………..
……………………
………………….. Knowledge and Skills
……………………
………………….. 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.
38
……………………. Injuries of the Urinary Tract

…………………….
…………………….
……………………. Knowledge and skills
…………………….
…………………….
…………………….
……………………. 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.
…………………….
…………………….
……………………. Vascular Injury
…………………….
…………………….
…………………….
…………………….
……………………. 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.
…………………….
……………………. Skills
…………………….
…………………….
……………………. 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.
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
39
Non Traumatic Surgical Emergency

……………………
…………………..
……………………
…………………..
…………………… 1. Superficial sepsis &necrotizing infections
…………………..
……………………
……………………
…………………..
…………………… 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
……………………
………………….. Skills
……………………
…………………..
…………………… 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
…………………..
……………………
…………………..
Procedure
…………………… 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.
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
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
…………………….
…………………….
……………………. Skills
…………………….
…………………….
……………………. 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.
…………………….
……………………. Topics
…………………….
…………………….
 Acute peritonitis
…………………….
…………………….  Anatomy of subphrenic spaces.
…………………….
…………………….  Subphrenic abscess
…………………….
…………………….  Pelvic abscess
…………………….
…………………….
 T.B. peritonitis.
…………………….  Ascites
…………………….
…………………….
……………………. Procedure
…………………….
…………………….
……………………. Observe, assist in or perform the following procedures according to
……………………. stage of training and available supervision:
…………………….
…………………….  Central venous line insertion
…………………….  Laparotomy
…………………….  Laparoscopy
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
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.
……………………
………………….. Skills
……………………
………………….. 5. Assess, diagnose and manage competently patients presenting
…………………… acute appendicitis.
…………………..
…………………… 6. Perform complete pre end post operative care.
………………….. 7. Perform Appendicectomy operation
……………………
…………………..
……………………
…………………..
4. Acute gynecological disorders
……………………
…………………..
…………………..
……………………
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
…………………..
…………………… Skills
…………………..
……………………
………………….. 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.
……………………
…………………..
……………………
…………………..
……………………
…………………..
42
…………………….
…………………….
5. Acute Intestinal Obstruction
1
…………………….
…………………….
…………………….
……………………. 1. Describe the etiology, clinical presentation and differential diagno-
……………………. sis of acute intestinal obstruction.
……………………. 2. Discuss different treatment options.
…………………….
…………………….
……………………. Skills
…………………….
……………………. 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.
…………………….
…………………….
……………………. 6. Strangulated Hernia
…………………….
…………………….
…………………….
……………………. 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.
…………………….
……………………. Skills
…………………….
…………………….
……………………. 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.
…………………….
……………………. Procedures
…………………….
…………………….
……………………. 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.
…………………….
…………………….
…………………….
43
…………………… 7. GIT bleeding

…………………..
……………………
…………………..
…………………..
…………………… 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.
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
44
…………………….
…………………….
Burns
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
…………………….
…………………….
……………………. Skills
…………………….
……………………. 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
…………………….
…………………….
……………………. Orthopedic Surgery
…………………….
…………………….
…………………….
……………………. 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
…………………….
…………………….
…………………….
Procedural Skills
…………………….
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
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”
…………………..
……………………
………………….. Topics
……………………
…………………..
…………………… 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
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
 Reticuloendothelial system
 Lesions of the skin and
subcutaneous tissue
 Hernia
 Surgical Oncology
 Surgical Endoscopy
48
…………………….
…………………….
Reticuloendothelial System
…………………….
…………………….
……………………. Knowledge/ skills
…………………….
……………………. .
……………………. 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
…………………….
…………………….
……………………. Procedural Skills
…………………….
……………………. 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.
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
49
Lesions of the skin and subcutaneous tissues

……………………
…………………..
……………………
………………….. 1. Benign lesions of skin and subcutaneous tissue
……………………
…………………..
…………………..
…………………… 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.
……………………
………………….. Skills
……………………
…………………..
……………………
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
……………………
………………….. Procedure
……………………
…………………..
……………………  Use appropriately different Local anesthetic techniques
…………………..  Perform excision biopsy for benign skin or subcutaneous lesion
……………………
…………………..
……………………
…………………..
Malignant Lesions of the skin and subcutaneous tissues
……………………
…………………..
…………………..
……………………
………………….. 1. Discuss the anatomy, histopathology and natural history of Basal
…………………… cell carcinoma, Squamous cell carcinoma and malignant mela-
…………………..
……………………
noma
………………….. Skills
……………………
…………………..
…………………… 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.
…………………..
……………………
………………….. Procedure
……………………
…………………..
……………………  Perform excision biopsy of malignant skin lesions
…………………..
50
……………………. Elective hernia

…………………….
…………………….
…………………….
…………………….
Knowledge
…………………….
……………………. 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
…………………….
……………………. Skills
…………………….
…………………….
…………………….
……………………. 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
…………………….
…………………….
…………………….
……………………. Procedure
…………………….
…………………….
…………………….  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
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
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
…………………..
…………………… Surgical Oncology
…………………..
……………………
…………………..
……………………
…………………..
Skills
……………………
…………………..
…………………… 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
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
52
…………………….
…………………….
…………………….
……………………. Endoscopy
…………………….
…………………….
…………………….
……………………. Knowledge/Topics
…………………….
……………………. 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
…………………….
……………………. Skills
…………………….
…………………….
……………………. 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
…………………….
…………………….
…………………….
…………………….
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
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
53
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
54
Vascular Surgery
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….1. Acute limb ischemia
…………………….
…………………….
…………………….
……………………. Knowledge/Topics
…………………….
…………………….
……………………. 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
…………………….
…………………….
……………………. Skills
…………………….
…………………….
……………………. 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
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
55
Vascular Surgery
……………………
…………………..
……………………
…………………..
……………………
2. Chronic lower limb ischemia
…………………..
……………………
…………………..
……………………
…………………..
Knowledge/Topics
……………………
…………………..
……………………
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)
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
56
Vascular Surgery
…………………….
…………………….
…………………….
…………………….
…………………….
3. Arterial and aortic aneurysm
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
……………………. 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
…………………….
…………………….
…………………….
…………………….
Skills
…………………….
……………………. 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
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
57
Vascular Surgery
……………………
…………………..
……………………
…………………..
……………………
4. Venous diseases
…………………..
……………………
…………………..
……………………
…………………..
Knowledge
……………………
…………………..
……………………
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
……………………
…………………..
……………………
Skills
…………………..
……………………
………………….. 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
…………………..
……………………
…………………..
…………………… Vascular Topics
…………………..
……………………
………………….. 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
……………………
…………………..
……………………
…………………..
……………………
…………………..
58
…………………….
……………………. Venous thromboembolism
…………………….
…………………….
…………………….
…………………….
……………………. 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.
…………………….
…………………….
…………………….
Skills
…………………….
……………………. 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.
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
59
……………………
…………………..
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…………………..
60
…………………….
……………………. Urogenital Surgery
…………………….
…………………….
…………………….
…………………….
…………………….
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
…………………….
…………………….
…………………….
Skills
…………………….
……………………. 6. Assess patients with urological complains and timely identify
……………………. emergency presentations
……………………. 7. Request appropriate investigations to diagnose the condition
…………………….
…………………….
and involve urology specialists
……………………. 9. Observe, assist in or perform under supervision the urology pro-
……………………. cedures mentioned in the procedure list according to the stage
……………………. of training
…………………….
10. Manage the postoperative care and timely identify post-
…………………….
……………………. operative complications
…………………….
……………………. Topics & lectures
…………………….
…………………….
…………………….  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:
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
…………………..
…………………… Procedure
…………………..
……………………
………………….. 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
…………………..
……………………
…………………..
……………………
…………………..
The trainee level of participation in these procedures is de-
…………………… tailed in the logbook
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
63
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
64
…………………….
……………………. The Breast:
…………………….
…………………….
…………………….
…………………….
…………………….
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
…………………….
…………………….
……………………. Skills
…………………….
…………………….
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
……………………. 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
…………………….
……………………. Topics
…………………….
…………………….
…………………….
…………………….
 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
…………………….
65
……………………
…………………..
Operative Procedure
……………………
………………….. 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
…………………..
……………………
…………………..
……………………
Key Breast Conditions
…………………..
……………………
…………………..  Breast pain and nodularity
……………………  Breast abscess
…………………..  Breast lump
…………………… 1. benign
………………….. 2. malignant
……………………
 Nipple problems
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
……………………
…………………..
68
…………………….
Endocrinology and Endocrine Surgery
…………………….
…………………….
…………………….
…………………….
…………………….
……………………. 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
…………………….
…………………….
…………………….
Skills
…………………….
……………………. 6. Assess patients presenting with neck swellings or endocrine surgi-
…………………….
…………………….
cal conditions
……………………. 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
…………………….
…………………….
…………………….
Key endocrine conditions
…………………….
…………………….  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
…………………….
…………………….
69
……………………
………………….. Topics and Lectures
……………………
………………….. 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
……………………
………………….. Operative Procedures
……………………
…………………..
…………………… 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
……………………
…………………..
……………………
…………………..
70
…………………….
Salivary Glands
…………………….
…………………….
…………………….
…………………….
Knowledge
…………………….
…………………….
……………………. 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
…………………….
……………………. these conditions including the management of post-operative com-
……………………. plications
…………………….
……………………. Skills
…………………….
…………………….
……………………. 4. Assess patients presenting with salivary gland swellings or inflamma-
……………………. tion
……………………. involve seniors and appropriate specialties
…………………….
…………………….
6. Identify conditions that are not indicated for surgery
……………………. 8. Observe, assist in or perform under supervision the following proce-
……………………. dures according to the stage of training
…………………….  Parotidectomy
…………………….  Submandibular sialadenectomy
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
71
Methods
……………………and regulations of assessment
…………………..
……………………
…………………..
…………………… 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.
…………………..
…………………… 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
……………………
…………………..
…………………… 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.
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.
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:
…………………..
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 .
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
…………………….
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Surgery Curriculum

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Surgery Curriculum

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Surgery

Esmat Ahmed Sheba

 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

The Egyptian fellowship curriculum committee has made significant contribution to

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

The Committees consulted international and national curricula in gen-

Preface and acknowledgements………………………………………………………..……………. 3-5

…………………… The Structure of the general surgery

……………………. Trainees will have rotations in different surgical specialties as follows:

…………………… During the hospital rotations

……………………. 5. The research or audit project

…………………… Rational statement

……………………  Muscles of the ant abdominal wall.

…………………….  Urogenital anatomy

…………………… Surgical hematosis:

General Surgery Curriculum

…………………… Colorectal Surgery

……………………. Injuries of the Urinary Tract

Non Traumatic Surgical Emergency

…………………… 7. GIT bleeding

Lesions of the skin and subcutaneous tissues

……………………. Elective hernia

Other Abdominal wall masses

……………………  Obstructive uropathy:

……………………. 1. Radiological interpretations

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