Course description
Theoretical aspects in surgery will include the principles of general surgery and problems of gastrointestinal, hepatobiliary, genitourinary, cardio thoracic, breast, peripheral vascular, central nervous, endocrine and lymph reticular system. The emphasis will be given to integrated learning including coordinating the theory classes with other departments, if possible. Moreover, there will be concurrent bedside clinical teaching in order to make teaching learning more effective.
Observing surgical procedures in the operation theatres and teaching common surgical cases in outpatient department and the minor operation theater will provide exposure in building surgical skill.
The course is of four and half year plus one year of compulsory rotating internship.
First year: The students will be able to take surgical history and acquire communication skills.
Second year: Student will be able to perform clinical examination and continue to practice communication
Third year: In this clinical posting the students will learn to manage surgical cases.
Fourth Year: The students continue to develop their skills in clinical examination, diagnosis and management by examining patients in one zonal hospital (3 weeks) and two district hospitals (3 weeks each) during field practice under supervision and guidance from their teachers during the second half of the fourth year.
Fifth year: During junior internship the students will spend a four-week surgical ward attachment and work as junior member of the surgical team. Students will get opportunity to correlate theoretical and practical knowledge with actual bedside clinical situation, and have practical experience in making diagnosis, carrying out necessary investigations and managing surgical cases, all under supervision. Students will also do 24 hours surgical duty along with other residents of the department.
A further two-week period is allocated separately for placement in the emergency department and this will provide opportunity to deal with acute surgical emergencies and enable the students to develop the surgical skill required for their management.
Internship
The students undergo a compulsory rotation for 3 months in surgery. The aim of this rotation is to enhance their clinical reasoning and simple surgical skills learnt previously and to learn therapeutic procedures so as to prepare them for independent practice and management in the future.
General Objectives
Students will be able to
- define the principles of general surgery and achieve the surgical knowledge of the various surgical conditions
- take clinical history and do proper examination
- diagnose and manage common surgical conditions
- diagnose and manage common life threatening surgical emergencies
- refer complicated and uncommon cases to appropriate referral hospital/ consuItants.
Specific objectives
Students will be able to
- communicate, counsel and take informed consent from the patients and their families
- take appropriate history of illness from the patient and their relatives
- perform thorough general clinical examination and interpret the findings
- order relevant investigations, justify and interpret them.
- interpret all the data and come to a provisional diagnosis
- list differential diagnosis for the diagnosis
- describe the management appropriate to the diagnosis
- describe common surgical emergencies and outline appropriate strategies to manage them.
- describe common life threatening emergencies and be able to manage it
- undertake life saving measures like cardiopulmonary resuscitation and insertion of chest drainage tube
- perform procedures like:
- Catheterization
- Thoracic paracentesis
- Abdominal paracentesis
- Lumbar puncture
- Incision and drainage
- counsel the patient and the family on disease process, management and follow up care.
- counsel the patient, family and the community on health promotion and prevention of diseases.
General Surgery: Following are the topics of general surgery
Unit I
Hemorrhage
Students will be able to
- describe the cause, type and source of the bleeding; assess the blood loss in relation to the clinical condition of the patient.
- outline the principles of bleeding (bearing in mind conditions such as hemorrhagic diathesis); administer first aid treatment to the patient with active bleeding; make reasonable judgment concerning active surgical investigation in such a patient.
- describe the principles of blood grouping, cross matching and blood transfusion, their indications and hazards.
Shock
Students will be able to
- list the causes, the patho-physiology of shock, and correlate the clinical features with the degree of shock, and describe the compensatory mechanisms involved in preventing shock.
- initiate treatment of shock and correct fluid and electrolyte and pH imbalance; describe the role of drugs like steroid, antibiotics, and analgesics.
Fluid, electrolyte and acid base imbalance
Students will be able to
- recall the distribution of fluid and electrolytes in various body compartments, their composition, daily requirement, and balance and routes of administration.
- assess the clinical state and outline patho-physiology of fluid, electrolyte and pH
- imbalance and describe the principles of treatment of any imbalance.
Unit II
Sterilization and disinfections
Students will be able to
- define the principles of sterilization;
- define the types of sterilizing agents and techniques including dry heat, moist heat, boiling, water at high pressure and temperature (autoclaving), radiation and chemical agents; their uses in common surgical practice; their advantages and disadvantages
Suture materials
Students will be able to
- describe the type of sutures, uses, advantages, disadvantages and different types of anastomosis.
Inflammation and infection
Students will be able to
- define inflammation and describe the causes, stages, mode of spread, outcome and treatment of inflammation;
- describe the types and routes of infection, the types of pathogens and their virulence;
- describe the prevention of infection, e.g., immunization, and aseptic techniques adopted to prevent infection and cross infection;
- describe the importance of isolation of pathogens by culture and sensitivity, treatment with specific chemotherapeutic agents and antisera, and their toxicity.
Wound healing
Students will be able to
- describe the types of wound, nature of wound e.g., clean, infected, contaminated wound; understand the time elapsed since sustaining such wounds; actively participate in treating such a patient.
- recall the mechanism of wound healing and list the indications of primary closure, secondary closure, debridement, wound excision and skin grafting.
Unit III
Ulcer, sinus and fistula
Students will be able to
- describe the types, causes of ulcers, sinus and fistulae and distinguish between ulcer, sinus or fistulae by thorough clinical examination;
- request general and specific investigations relating to ulcers, sinuses and fistulae and outline their surgical treatment.
Surgical nutrition
Students will be able to
- describe the principles of nutritional assessment of the patient, types of surgical nutrition, their indications and complications.
Unit IV
Neoplasm
Students will be able to
- define and differentiate between benign and malignant tumors, mode of spread, clinical staging and histological grading of malignant and potentially malignant tumors.
- describe and perform various investigations including tissue biopsy.
- describe various modalities of treatment and their outcome.
- describe the principle of pain management and palliative care in terminally ill patients.
Unit V
Organ transplantation
Students will be able to
- describe the principles of organ transplantation.
Minimal access surgery (MAS)
Students will be able to
- describe the principles and application of minimal access surgery, its advantages and disadvantages.
Diseases of upper gastrointestinal tract
Esophagus
Students will be able to
- describe the anatomy of the esophagus; outline the pathophysiology, clinical features, general and specific investigations, and principles of treatment of foreign body esophagus, cardiospasm, esophageal varices, strictures, esophagitis, carcinoma of esophagus.
Stomach and duodenum
Students will be able to
- describe the anatomy of the stomach and duodenum; outline the pathophysiology, clinical features, general and specific investigations, and principles of treatment of peptic ulcer and its complications, benign and malignant tumors of stomach and duodenum.
Diseases of lower gastrointestinal tract
Small bowel
Students will be able to
- describe the anatomy of the small bowel; outline the pathophysiology, clinical features, general and specific investigations, and principles of treatment benign and malignant tumors of small bowel.
Colorectal and anus
Students will be able to
- describe the anatomy of the large bowel; outline the pathophysiology, clinical features, general and specific investigations, and principles of treatment benign and malignant tumors of large bowel, benign condition of rectum and anus e.g., fistula, fissure, hemorrhoids, abscesses.
- describe the principles of surgical management of inflammatory bowel disease.
- describe the anatomy of appendix; outline the pathophysiology, clinical features, general and specific investigations, and principles of treatment of acute appendicitis.
Diseases of hepatobiliary and pancreatic system
Students will be able to
- recall the anatomy of hepatobiliary and pancreatic system; outline the pathophysiology, clinical features, general and specific investigations, and principles of treatment.
Liver
Students will be able to
- differentiate between inflammatory and infective conditions of liver e.g., hepatitis, liver abscesses, hydatid cysts.
- differentiate between benign and malignant tumors of liver.
- describe the surgical management of portal hypertension.
- describe the principle of liver transplantation.
Biliary Tract
Students will be able to
- differentiate between benign and malignant conditions of gall bladder and bile duct e.g., acute and chronic cholecystitis, cholelithiasis, gall bladder carcinoma, and choledocholithiasis.
Pancreas
Students will be able to
- differentiate between acute pancreatitis and chronic pancreatitis and their complications.
- differentiate between endocrine and exocrine tumors of pancreas.
Abdominal wall, peritoneum and peritoneal cavity
Students will be able to
- examine, investigate, diagnose and manage hernia, congenital or acquired, internal or external, inguinal, incisional, femoral, epigastric, umbilical or paraumbilical, lumber, obturator, gluteal, diaphragmatic, paraesophageal hernia.
- examine, investigate, diagnose and manage infective conditions and tumors of abdominal wall.
- describe the causes of ascites, types of benign and malignant mesenteric tumors, acute peritonitis, its causes and management.
Emergency medicine and Trauma
Students will be able to
- describe the principles of advanced trauma life support and primary trauma care.
- They must be able to use triage and be to identify the patient with life threatening injuries and manage them urgently.
- differentiate between the mechanism of blunt and penetrating trauma
- describe the compartment syndrome and its management
- describe the management of abdominal trauma, including liver, spleen, intestines.
Note: Trauma to head, spine, chest and genitourinary system will be covered by the concerned subspecialty.
Cardio thoracic surgery
This is a specialized branch of surgery and students are expected to know the following common conditions, their investigations, diagnosis and management.
Lungs and chest wall
Students will be able to
- recall the surgical anatomy of respiratory system Describe the various investigations of respiratory system e.g., chest x-ray, bronchoscopy, bronchography.
- outline the principles of management of chest injuries, fractured ribs, surgical emphysema, pneumothorax, hemothorax, chylothorax, hydrothorax, flail chest.
- describe the surgical management of the infective conditions of the lungs tuberculosis, bronchiectesis, empyema thoracis, lung abscess, hydatid cyst.
- describe the surgical management of benign and malignant tumors of lungs.
- list the differential diagnosis and management of mediastinal masses.
Heart:
Students will be able to
- describe the principals of cardiac surgery, special methods of investigations, radiology, echocardiography, cardiac catheterization, cardiopulmonary resuscitation, pericardial effusion, cardiac temponade, pericarditis, and their treatment.
- differentiate congenital and acquired heart disease and their surgical management.
Vascular and lymphatic system
Students will be able to
- recall the anatomy and physiology of vascular system
- describe the peripheral vascular diseases -Buerger’s disease, Raynaud’s disease, arteriosclerosis, diabetic gangrene.
- list the causes and describe the management of acute arterial occlusion.
- describe the principles of amputation
- describe deep vein thrombosis, pulmonary embolism, infarction, varicose veins.
- recall the anatomy and physiology of the lymph node and lymph vessels, their function and different conditions such as lymphangitis, lymphoedema, filariasis and their management; acute and chronic lymphadenitis-specific or nonspecific e.g., tubercular lymphadenitis.
- describe different conditions that are encountered in surgical practice that require surgical management including lymphoma Hodgkin’s and Non Hodgkin lymphoma.
- describe the causes and management of splenomegaly e.g., tropical, idiopathic thrombocytopenic purpura, congenital spherocytosis.
9. Breast and endocrine system
Student will be able to
- describe the anatomy, physiology and different conditions involving breast, e.g., abscess, benign and malignant tumors and their management.
- recall the anatomy, physiology and the hormone secretion of the endocrine glands;
- describe the clinical presentation, diagnosis, investigations and management of the following conditions;
- describe the hypo and hyperthyroidism, goiter and tumors of the thyroid
- describe the hypo and hyperfunction of adrenal glands and tumors of adrenal
- describe hyperparathyroidism and tetany;
- enumerate the diseases of pituitary gland that are encountered in surgical practice, e.g., gigantism, acromegaly
- describe the common conditions of thymus, testes (hypogonadism and impotence), pancreas and ovaries.
Central nervous system
Students will be able to
- examine the central nervous system
- diagnose and manage different types of head, spine and peripheral nerve injuries, hydrocephalus, space occupying lesion of the brain and spinal cord
- diagnose and manage neurological emergencies.
Urology
Introductory Urology
Students will be able to
- describe the applied anatomy and review the physiology
- describe the symptomatology of genitourinary system.
- deal with the Common urological emergencies
- manage the common urological problems e.g., urinary retention, hematuria, ureteric colic, scrotal pain.
Kidney
Students will be able to
- describe the common diseases, their clinical features, examination, diagnosis and treatment of the kidneys
- describe the congenital anomalies, cystic diseases, stones, trauma, tumor and infection.
Ureter
Students will be able to
- describe the common diseases, their clinical features, examination, diagnosis and treatment
- describe the congenital anomalies, calculi, trauma and malignancy
Bladder
Students will be able to
- describe the common diseases, their clinical features, examination, diagnosis and treatment
- describe the congenital anomalies, infection, calculi, trauma, malignancy, voiding disorders.
Prostate
Students will be able to
- describe the common diseases, their clinical features, examination, diagnosis and treatment of benign prostatic enlargement, malignancy, infection.
Urethra
Students will be able to
- describe the common diseases, their clinical features, examination, diagnosis and treatment
- describe the congenital anomalies, trauma and stricture, infection.
Scrotum/ Testes
Students will be able to
- describe the common diseases, their clinical features, examination, diagnosis and treatment
- describe the congenital anomalies, malignancy, infection, trauma
- describe the procedure of vasectomy and recanalisation.
Penis
Students will be able to
- describe the common diseases, their clinical features, examination, diagnosis and treatment
- describe the congenital anomalies, trauma, infection, malignancy, phimosis and paraphimosis.
Renal transplantation
Students will be able to
- discuss the indication of renal transplantation.
Plastic surgery and Burns
Students will be able to
- describe broadly the development of Plastic Surgery and its fields
- describe the development of face
- identify the types of cleft lip and palate
- instruct the parents with a cleft child the timing of surgery, feeding, post operative care and speech therapy
- describe the clinical and radiological feature of maxillofacial injury, fracture of zygoma, maxilla and mandible
- outline the treatment of these fractures
- describe the various types of skin grafts and their differences
- describe the characteristic of a wound which is ready for grafting
- describe the various types of skin cancers
- outline their management
- describe the types, degree and percentage of burns
- outline the pathophysiology, specially the fluid and electrolyte imbalance
- calculate the fluid requirement of a particular patient and institute treatment, e.g, crystalloids, plasma, blood, antibiotic, analgesics and nutrition
- recall the complications and their treatment and prevention including skin grafting
CLINICAL PRACTICE
- Fifth year (Junior Interns) will observe.
- Interns will do under supervision.
Students will be able to
- take appropriate surgical history, examine patients and record all relevant findings on history sheet.
- investigate and assist in the treatment, monitor patients’ condition.
- interpret the reports of special investigations; advise surgical or conservative treatment; evaluate the after treatment.
- assist residents and/or consultants to evaluate critically ill patients and provide supportive help when necessary.
- evaluate preoperative patients; prepare patients for operation; assist surgeon with operation; observe and assist nursing staff with postoperative management of patients.
- be familiar with commonly used surgical procedures, techniques and equipment.
- perform certain minor surgical procedures under supervision and assist surgeon and resident with any procedures being done in the general or special wards.
- assist surgeon and/or residents to provide counseling concerning treatment and follow up care.
