STUDY GUIDE - Lahore Guide Ssurgery.pdf · • Surgical infection • Antimicrobials and tetanus...

STUDY GUIDE

For students of 3rd, 4th and 5th years.

Department of Surgery

Lahore General Hospital

Ameer-Ud-Medical College/ PGMI

Lahore

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Table of Contents

.......................................................................................................................................................... 1

Rationale of the study guide .......................................................................................................... 3

Outcomes of each year .................................................................................................................. 4

Outcome at the end of 3rd year ...........................................................................................................................................4

Knowledge: ....................................................................................................................................................................4

Skill: ................................................................................................................................................................................4

Attitude: ..........................................................................................................................................................................4

Outcome at the end of 4th year. ..........................................................................................................................................4

Knowledge: ....................................................................................................................................................................4

Skill: ................................................................................................................................................................................4

Attitude: ..........................................................................................................................................................................5

Outcome at the end of 5th year. ..........................................................................................................................................5

Knowledge skill and attitude: .........................................................................................................................................5

Structure of the syllabus according to year of study. ................................................................. 6

Structure of 3rd year: ...........................................................................................................................................................6

SURGERY SYLLABUS and TIME TABLE AMC, LAHORE (YEAR 2018-19) ................................ 6

Structure of 4th year ......................................................................................................................................................... 10

SURGERY TOPICS FOR 4TH YEAR MBBS, AMC, LAHORE ...................................................... 10

Structure of 5th year ......................................................................................................................................................... 14

Lecture distribution MBBS Final Year 2019 ...................................................................... 14

Surgical unit 1 ............................................................................................................................................................ 14

Surgical unit 2 ............................................................................................................................................................ 14

Surgical unit 3 ............................................................................................................................................................ 14

Assessment ................................................................................................................................... 18

Assessment for 3rd year. .................................................................................................................................................. 18

Assessment of 4th year. ................................................................................................................................................... 18

Assessment of fine year: ................................................................................................................................................. 19

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Rationale of the study guide

Surgical diseases form a major part of the community health related problems.

Clinicians practicing in the community should be well aware about the importance of diagnosing

and managing these surgical problems. The medical graduates should have a sound knowledge

of pathogenesis, clinical presentation, investigations and lab diagnosis of all these diseases and

many more as discuses in this guide. This basic knowledge will help the students to integrate the

application of this skill in their clinical practice for timely diagnosis and successful management of

these patients. It is important to have a clear concept of these diseases like acute abdomen, peptic

ulcer disease, carcinoma breast and skin diseases. Infections are also common in hospital as well

as in the community. Malignancies are also quite common in our papulation. Our aim is to produce

safe primary health care doctors, who is the backbone of the health system and he should know

which surgical disease should be treated and the ones which need elective or urgent referral.

The 3rd, 4th and final years are 71.5 weeks (500 hrs.) program/course that presents surgical

approach to adult diseases. The overall objective is to train a clinician in appraisal, management

and/or referral of patients with surgical diseases. Achievement of this objective requires

knowledge, skills and attitudes blended in a carefully planned balanced curricular unit. This

curricular unit; the clerkship; accommodates specified content related to common surgical disease,

with learning strategies and assessment methodologies; all corresponding to each other in an

integrated manner.

This surgical teaching program offers the all MMBS students an opportunity to develop surgical

skills that are required by a clinician to diagnose a patient with a surgical problem in the

community. It is believed that after attending the clerkship program a student will be able to come

up to the expectations of community, colleagues and other stakeholder institutions.

This document will provide you the detailed syllabus, taught in all three years, the methodologies

use for the teaching and the assessment methods (timings and the structure of the assessment).

On the behalf of my Faculty, I welcome you all and wish you successful journey in the surgery and

life always

Prof Muhammad Farooq Afzal Head of surgery department. Lahore General hospital. Ameer-Ud-Din Medical college/PGMI Lahore

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Outcomes of each year

Outcome at the end of 3rd year

At the end of 3rd year students will be able to:

Knowledge:

• Explain the etiology and pathogenesis of common surgical conditions including metabolic

response to injury, shock, wound care, tissue repair and scars.

• Apply the knowledge to, prevent, diagnose and manage the common surgical conditions

and infections.

• Identify the risk factors for preventable diseases.

Skill:

• Practice the prophylactic measure to prevent infections and preventable diseases.

• Plan the preoperative and post-operative care of surgical patients

Attitude:

• Demonstrate effective communication skill strategies while interacting with the patients.

• Demonstrate teamwork and positive interaction with colleges.

• Demonstrate self-learning attitude and problem-solving skill.

Outcome at the end of 4th year.

At the end of 4th years students will be able to:

Knowledge:

• Integrate the basic science knowledge with clinical sciences in order to describe the

pathogenesis, clinical presentations, investigations, lab diagnosis, and management of

common surgical disorders mentioned in syllabus below.

• Develop a problem-solving approach in diagnosing various types of surgical emergencies.

• Exhibit the knowledge of various clinical aspects of malignancies while developing a

problem-solving approach.

Skill:

• Identify morphological features of common surgical diseases

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• Conduct detailed history and examination (specific and general) of common surgical

problems

• Make a provisional diagnosis of common surgical problems

Attitude:

• Demonstrate effective communication skill strategies.

• Display the personal attributes of compassion, honesty and integrity in relationships with patients, families, communities and the medical profession.

• Demonstrate a professional attitude, team building spirit and good communication skills

through effective participation in collaborative problem solving, especially in small group

exercises directed towards understanding the gastrointestinal disorders

Outcome at the end of 5th year.

Knowledge skill and attitude:

At the end of surgical clinical rotations and lectures, the final year MBBS students will be able to:

• Understand the basic principles of surgical diagnosis, investigations and treatment. • Apply the basic concepts formed in earlier academic years to clinical clerkship • Develop effective history taking skills • Perform clinical examination independently • Treat common surgical diseases in the community • Understand the principles of pre-operative and post- operative surgical care • identify the common surgical complications and formulate their management • Provide initial management in surgical emergencies • Decide about the referral of a patient with surgical problem/emergencies for expert opinion/

management. • Understand the importance of surgical site infections and their prevention • Perform minor surgical procedures under supervision • Communicate effectively with the patient and colleagues observing the principles of counseling,

breaking bad news, anger and conflict management • Observation of important surgical procedures lays the foundation for house job. • Shadowing the house surgeon will provide the medical students the platform to learn day to day

activities on surgical floor.

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Structure of the syllabus according to year of

study.

Structure of 3rd year:

The syllabus taught will be as follow

SURGERY SYLLABUS and TIME TABLE AMC,

LAHORE (YEAR 2018-19)

MBBS 3rd YEAR

Surgical Unit-I

• Surgical Nutrition

• Sterilization and Disinfection

• Surgical infection

• Antimicrobials and tetanus prophylaxis in surgery

Surgical Unit-II

• Wounds, ulcers, Tissue Repair and scars

• Burns and management

• Preoperative preparation of a surgical patient

• Post-operative care of a surgical patient

Surgical Unit-III

• Metabolic response to injury

• Shock

• Blood and blood products transfusion

• Fluid and Electrolyte and Acid base Disturbances

• Pain Relief

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Time table

Surgical unit – I 1-11-2018 to 28-02-2019

Surgical unit – II 01-03-2019 to 31-05-2019

Surgical unit – III 01-06-2019 to 30-09-2019

• 50 mins lecture on every Thursday

• The feedback from students will be collected twice during the session.

• 3.5 weeks rotation in surgical wards. Twice per week and 5 hours per day. (35 hours)

• The feedback will be collected once at the end of clinical rotation.

Structure of 4th year

The syllabus taught will be as follow

SURGERY TOPICS FOR 4TH YEAR MBBS, AMC,

LAHORE

SURGICAL UNIT-I

(1/3/2019 to 31/5/2019)

1. Principles of oncology

2. Skin and Subcutaneous tissue

3. Malignant Tumours of skin

4. Lymph edema and its management

5. Venous disorders

6. Arterial disorders

7. Transplantation

8. Pre-Operative care of the Surgical patients

SURGICAL UNIT-II

(1/6/2019 to 31/8/2019) Post op complications, recognition and management

o General

o Specific

• Head, Face and Neck

o Developmental abnormalities of face, palate, lips.

o Oral cavity including tongue.

o Neck lumps including lymph nodes

• Surgical Audit

• Day Case Surgery

• Plastic Surgery

SURGICAL UNIT-III

(26/11/2018 to 28/2/2019)

Trauma Initial management of trauma patient)

• Thoracic trauma and its management

• Abdominal injuries and its management

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• Head trauma and its management

• Musculoskeletal trauma and its management

• Compartment Syndrome

• Disaster Management

Chest Wall & Thorax

Surgical Management of Ischemic heart disease.

Anesthesia

Pead’s Surgery

• The lectures of surgery in 4th year is twice per week.

• Feedback is taken twice during the whole year.

• The surgical rotation is 4 days a week for a month.

• The surgical clinical rotation is 5 hours per day

• Feedback is taken at the end of clinical rotation.

Structure of 5th year

The syllabus taught in final year will be:

Lecture distribution MBBS Final Year 2019

Surgical unit 1

1. The thyroid and parathyroid glands, The adrenal glands 2. Disorders of the salivary gland

3. Benign and malignant conditions of breast 4. Liver Spleen Gall bladder and bile duct

5. Benign and malignant condition of pancreas 6. Bariatric surgery

Surgical unit 2

1. Esophagus

2. Stomach and duodenum 3. The benign and malignant disorders of small intestines and small bowel

obstruction 4. Management of upper GI Bleed 5. Peritoneum, retroperitoneum and mesentery

6. Abdominal wall hernias (inguinal, femoral, paraumbilical and incisional) 7. Scrotum and testis

8. Acute abdomen, causes, diagnosis and management. 9. Principals of laparoscopy 10. Pediatric surgery

Surgical unit 3

1. Anatomy of large intestine. 2. Clinical features of large intestine diseases.

3. Appendix.

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4. Inflammatory bowel disease. 5. Diverticulosis and its complication.

6. Management of lower GI bleed. 7. Ileostomy and colostomy.

8. Benign and malignant tumors of large intestine including large bowel obstruction. 9. The benign and malignant condition of rectum, the anus and anal canal.

• There will be thrice a week lecture in final year, for 50 mins

• The feedback about teachings will be taken from the students bi annually.

• The students will come to surgical wards daily in small groups, for 3.5 weeks.

• Students during ward rotations will shadow house officers in ER twice weekly.

• Students will attend the evening round daily.

Assessment

Assessment for 3rd year.

NO. Assessment Assessment tools Number and time of

test

1 Low stake assessment Short assay questions

and MCQs

At the end of each topic mentioned in the

syllabus

3 class tests

One will be short assay question and 10

MCQs.

2 Low stake assessment

Mini CEX. To assess history

taking and communication skills

One at the end of ward rotation

Assessment of 4th year.

No. Assessment Assessment tool Number and time of

test

1 Low stake assessment Short essay questions

And MCQs


syllabus

6 class tests

One will be short assay question and 10

MCQs.

2 Low stake assessment Mini CEX One at the end of

ward rotation

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Assessment of fine year:

No. Assessment Assessment tool Number and time of

test.

1 Low stake assessment Short essay questions

And MCQs


syllabus

9 class tests

Two will be short assay question and 10

MCQs.

2 Low stake assessment

OSCE=12 MCQ= 10 Long case

assessment= 1 Short cases=2

At the end of clinical rotation

3 Low stake assessment OSCE=21 stations At the end of final year

4 High stake assessment

Final exam by UHS. Comprising:

MCQ= SEQ=

OSCE=

At the end of final year.

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Detailed syllabus 3rd year

No. Topic Instructional strategy

Number of lectures

Resource person

Assessment tool

Orientation to syllabus and ward, ER and

Theater round

1 Assistant professor or above

1 Surgical Nutrition

Lectures 3 Assistant professor or above

MCQ

2 Sterilization and

Disinfection

Lecture 3 Assistant professor or above

MCQ

3 Surgical infection

Lecture 5 Assistant professor or above

MCQ and short essay question

4 Antimicrobials and

tetanus

prophylaxis in

surgery



Low stake class assessment

5 Wounds, ulcers,

Tissue Repair and

scars



6 Burns and

management

Lectures and SGD



7 Preoperative

preparation of a

surgical patient

SGD Lectures



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8 Post-operative

care of a surgical

patient

Lectures and SGD




9 Metabolic

response to injury


MCQ

10 Shock Lectures and SGD



11 Blood and blood

products

transfusion

SGD 3 Assistant professor or above

MCQ

12 Fluid and

Electrolyte and

Acid base

Disturbances


MCQ

13 Pain Relief SGD 2 Assistant professor or above



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Detailed syllabus 4th year

Number Topic and subtopic Teaching strategy Number

of lectures

Resource person

Assessment tool

Orientation to ward and syllabus Question answer session Ward OPD and ER round

1 surgical oncology

Lectures

2

Associate professor or above

MCQ

2 Skin and subcutaneous

tissues 6

Short essay question

3 Infection. 1 Short essay

question 4 SURGICAL SITE INFECTIONS 2 MCQ

5 Gas gangrene 1 Short essay

question 6 Skin tumor 1 MCQ

7 MALIGNANT MELANOMA

1 MCQ

8 CYSTS & OTHERS In growing toe nail

1 MCQ

Class test

Lymph edema and its management

9 Lymphoedema Lecture 1 Associate professor or above

MCQ

Arterial disorders

10 Hemorrhagic Shock

Lectures and SGD

1



11 Arterial Occlusion -1 1 Short essay

question

12 Arterial Occlusion-2 1 MCQ

13 Critical limb

Ischemia/ Gangrene 1 MCQ

14 Amputation 1 MCQ

15 Aneurysm

1


Venous disorders

16 Varicose veins Lecture 1 MCQ

23

17 Deep vein Incompetence

/leg Ulceration 1


MCQ

18 Transplantation 1 MCQ

19 Pre-operative care of surgical patient

1 Short essay

question

Class test

20

Post op complications,

recognition and

management

Lectures

5



21

• Head, Face and Neck

o Developmental

abnormalities

of face, palate,

lips.

o Oral cavity

including

tongue.

o Neck lumps

including

lymph nodes

6 MCQ

Class test

22 Surgical Audit

Lectures

3 Associate professor or above

MCQ

23 Day Case Surgery

3 Short essay

question

24 Plastic Surgery

5 MCQ

Class test

25

Thoracic trauma and its

management

Lectures


26 Abdominal injuries and

its management 5

Class test

27 Head trauma and its

management

Lectures


MCQ and short essay

question

28 Musculoskeletal trauma

and its management 4 MCQ

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29 Compartment Syndrome 2 MCQ and

short essay question

30 Disaster Management 2 MCQ

31 Surgical Management of

Ischemic heart disease.

Anesthesia

2 MCQ and


32 Pead’s Surgery 3 MCQ and


Class test

25

Detailed syllabus of final year

No. Topic Learning strategy

Resource person

Number of lectures

Assessment tool

Orientation to ward, OPD, ER and OR Description of syllabus and details of competencies to be achieved

One lecture and 1st day of ward

1 The thyroid and

parathyroid glands the adrenal glands

Lectures and SGD,

bed side teaching and OMP

Professor of surgery

9 MCQ and


2 Disorders of the salivary

gland 5

MCQ and short essay

question

Class test

3 Benign and malignant conditions of breast

5 MCQ and


4 Liver Spleen Gall bladder

and bile duct 9

MCQ and short essay

question

Class test

5 Benign and malignant condition of pancreas

6 MCQ and


6 Bariatric surgery 3 MCQ and


Class test

7 Esophagus 4 MCQ and


8 Stomach and duodenum 4 MCQ and


Class test

9

The benign and malignant

disorders of small intestines and small bowel

obstruction

4 MCQ and


10 Management of upper GI

Bleed 3

MCQ and short essay

question

26

11

Peritoneum,

retroperitoneum and mesentery

3 MCQ and


Class test

12

Abdominal wall hernias (inguinal, femoral,

paraumbilical and incisional)

4 MCQ and


13 Scrotum and testis 4 MCQ and


14 Acute abdomen, causes,

diagnosis and

management.

4 MCQ and


15 Principals of laparoscopy 3 MCQ and


16 Pediatric surgery 4 MCQ and


Class test

17 Anatomy of large intestine. 3 MCQ and


18 Clinical features of large

intestine diseases. 5

MCQ and short essay

question

19 Appendix. 3 MCQ and


Class test

20 Inflammatory bowel

disease. 4

MCQ and short essay

question

21 Diverticulosis and its

complication. 4

MCQ and short essay

question

22 Management of lower GI

bleed. 4

MCQ and short essay

question

23 Ileostomy and colostomy. 4 MCQ and


Class test

27

24

Benign and malignant

tumors of large intestine including large bowel

obstruction.

4 MCQ and


25 The benign and malignant condition of rectum, the

anus and anal canal.

5 MCQ and


Class test

28

Clinical rotations

No. Class Recourse person

Ward days Time Instructional strategies

1 Class 3rd year Dr. Imran Khokhar SU-1 Dr. Saeed Mahmood SU-2 Dr. Falak Sheer SU-3

Wednesday Thursday

10:30am-2:30pm

Bed side teachings in wards. Problem based teachings SGD OMP in OPD Role plays for communication skills

2 Class 4th year Dr. Tausief Fatima SU-1 Dr. Ajmal SU-2 Dr. Shabir Ahmed SU-3

Monday Tuesday Friday Saturday

10:30am-2:30pm

Bed side teachings in wards. Case based teachings SGD OMP in OPD Role plays for communication skills

3. Final year Prof. Farooq Afzal SU-1

10:30am-2:30pm

Bed side teachings in wards.

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Prof. Afsir Ali Bhatti SU-2 Associate. Professor Dr. Amina SU-3

3:00 Pm- 7:00 Pm

Case based teachings Team based teachings Shadowing of the house officer SGD OMP in OPD Role plays for communication skills Skill lab teachings

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References:

Text book.

Bailey and Love Short practice of surgery

Reference books.

Higher Surgical Training in General Surgery by Alferd Cuschieri

SCHWARTZ'S PRINCIPLES OF SURGERY

Clinical methods.

Normal L Browse’s introduction to the symptoms and signs of surgical diseases.

STUDY GUIDE - Lahore Guide Ssurgery.pdf · • Surgical infection • Antimicrobials and tetanus...

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