Government Medical College, Bhavnagar

Subject curriculum

CURRICULUM OF STUDIES FOR UNDER GRADUATE AND
POSTGRADUATE STUDENTS

General Surgery

Institutional Goal:

The goal of postgraduate medical education in Surgery shall be to produce a competent specialist and / or a medical teacher:

(1) Who shall carry out professional obligations ethically?

(2) Who shall have mastered most of the competencies; pertaining to Surgery;

that are required to be practiced at the secondary and the tertiary levels of

the health care delivery system.

(3) Who shall be aware of the contemporary advances and developments in

General Surgery.

(4) Who shall have acquired a spirit of scientific inquiry and is oriented to the

principles of research methodology and epidemiology, and also possesses

the attitude for continued self learning and to seek further expertise.

(5) Who shall have acquired the basic skills in teaching of the medical and

paramedical professionals.

(6) Have personal characteristics and attitudes such as personal integrity,

sense of responsibility and dependability and ability to show concern for

his / her collegues, patients and other person with whom he / she is

working.

Departmental Goal.

The goals of three year degree course in General Surgery would be to train a M.B, B.S doctor who after the satisfactory of the course (M.S.); should be able to :

Diagnose and treat independently ; common surgical conditions ; both acute and chronic – in children and adults.

Plan various Laboratory test for surgical conditions and interpret the results.

Identify and manage patients of Hemorrhagic; Septicaemic and other types of Shock.

Maintain patent air-way and resuscitate;

(i) A critically injured patient

(ii) A patient with Cardiac Respiratory Failure

(iii) A Drowning Case.

Monitor patients of Head, Chest, Spinal and Abdominal injuries; both adults and children.

Provide primary care for a patient of Burns.

Acquire principle of Operative Surgery; including pre-operative and post-operative care and monitoring.

Treat open wound including preventive measures against Tetanus and Gas gangrene.

Identify congenital anomalies and treat / refer tem for appropriate management.

Objective:

The following objectives are laid out to achieve the goals of the course. These

objectivemay be considered under the following headings.

1. Knowledge (Cognitive domain)

2. Skills (Psychomotor domain)

3. Attitudes, communication skills, human values and ethical practice.

Essential Knowledge:

At the end of the training the candidate must be able to

* Demonstrate understanding of basic sciences relevant to Surgery.

* Describe the management of common and uncommon surgical ailments belonging tovarious branches of Surgery, at all ages requiring Operative Interventions with a basic knowledge of the etiology, Pathophysiology and the surgical treatment of the condition.

* Describe the theory of underlying etiology, mechanism and management of the conditionsrequiring resuscitation.

* Demonstrate understanding of the theoretical basis of Polytrauma and the science of Resuscitation.

* Recognize the conditions that may be outside the area of his competence and refer them to an appropriate specialist.

* Update himself / herself by self study and by attending courses, conferences and seminars relevant to Surgery.

* Teach and guide his team colleagues and students.

* Demonstrate understanding of medicolegal aspect of Surgery.

* Demonstrate basic knowledge of the administrative aspects of Operating room complex.

* Undertake audit, use information technology tools and carryout

research, both basic and clinical with the aim of publishing the work

and presenting the same at various scientific fora.

Course Content :

It includes topics not only of Surgery but also those aspects of the other branches ofMedicine relevant to Surgery viz. Medicine and its allied subjects. Surgery and its allied branches, Anesthesia, Pediatrics, Obstetrics &Gynecology, Orthopedics, ENT, Dentistry, Radiology, Ophthalmology, applied anatomy, Physiology, Pathology, Pharmacology, Microbiology etc. It is intended as a guide to the candidates andit is not comprehensive. As and when there is newer development, it becomes eligible for inclusion. Hence, the candidates should be familiar themselves with the current contents of the scientific journals and reviews of major topics in Surgery.

In addition to the skills referred above, the M.S. candidate should have performed the following OPERATIONS at the end of three (3) years.

Debridement and suturing of Open wounds.
Incision & Drainage of Abscess.
Venesetio and C.V.P catheter insertion.
Excision of Sebaceous cys and Lipoma.
Biopsy of surface Malignancy.
Urethral catheterization and Nasogastric intubation.
Circumcision and Reduction of Paraphimosis.
Meatotomy&Meatoplasty.
Vasectomy &Vaso-Vasoplasty.
Pleural &Peritonal tapping.
Diagnostic Proctoscopy&Sigmoidoscopy.
Operations on Hydrocel.
Endotracheal intubation.
Tracheostomy &cricothyroidotomy.
Chest – Tube Insertion.( I.C.D.)
Laparotomy.
Appendicectomy.
Resection and anastomosis of small intestine colon.
Right and left hemicolectomy.
Suprapubic and Millins’ Prostatectomy.
Pyelolithotomy, Nephrolithotomy, Ureterolithotomy&Cystolithotomy.
Percutaneous Nephrostomy.
Partial and total amputation of Penis.
Cervical lymph node biopsy.
Hemi- Partial and Total thyroidectomy.
Superficial and Deep Parotidectomy.
Excision of Submandibular salivary gland.
Incision and drainage of Quinsy.
Simple ; Radical & Modified Radical Mastectomy.(M.R.M)
Below – knee and above – knee Amputations.
Emergenty Burr-hole and craniotomy.
V.P. Shunt and Excision of Meningocele.
Repair of Cleft-lip and Cleft-palate.
Repair of Hypospasias.
Splenectomy
Surgery for Liver Trauma.
Haemorrhoidectomy and Excision of fistula and fissure –in-Ano.
Hernia Repair ( Inguinal; Femoral & Incisional )
Orchidectomy.
Excision of Varicocele.
Skin grafting.
Gastric Surgery – Peptic perforation; Partial and total Gastrectomy; Gastrojejuostomy with vagotomy; Pyloric stenosis.
Cholecystectomy; Choledocholithotomy; Biliary-Enteric anastomosis.
Thoracotomy for Trauma.
Emergency Colostomy.
Pancreatic Surgery – Pseudocyst of Pancreas and Distal Pancreactomy.
Surgery for Varicose Veins.
Lumbar and Cervical Sympathectomy.
Emergency Vascular Repair.
Urethral dilatation.

Besides these skills the post-graduate candidate will have 3 (three) months rotation in allied subjects like Casualty ; Urology ; Neuro-Surgery and Plastic Surgery.

Teaching and learning activities

The candidate pursuing the course (M.S.) will work in the institution as a full time student. Every candidate shall attend teaching and learning activities during each year as prescribed by the department and not remain absent from work without valid reasons.

A list of teaching and learning activities to acquire essential knowledge and skills is given below.

a) Lectures:

Dialectic lectures will be kept to a minimum. They will however be employed for teaching certain topics like:

Biostatics.
Research Methods.
Medical Code of Conduct and Medical Ethics.
Communication skills etc.

These topics will be taken up in the first few weeks of I-year. Integrated Lectures will be taken up by multidisciplinary teams of selected topics e.g. Jaundice; Diabetes Mellitus; Surgical problems in Pregnancy; Acid-Base balance etc.

b) Post-graduate students will do ward round/work every

day.

This is absolutely necessary to impart the every detail and progress of the

illness. The Post-graduate student will remain on call round the clock.

c) Journal Club:

d) Subject Seminar:

e) Clinical Pathological conference:

f) Inter Departmental meetings:

g) Teaching skills:

Post graduate students will teach under graduate students (e.g. Ward

procedures,dressing, clinicalexaminations & emergency management of

patients) by taking demonstration, bed side clinics, tutorials, lectures etc.

Record of their participation should be kept in log book.

h) Continuing Medical Education Programs (CME):

i) Dissertation.

CURRICULUM for M.S (GENERAL SURGERY)

1. History of Surgery

2. Response to Injury – wound healing & management of wound infections.

3. Fluid & electrolytes disturbances & acid-base balance.

4. Parenteral nutrition.

5. Burns – Shock; Haemorrhage; Blood transfusion; Plasma volume

expanders; Pain relief.

6. Injury – cold, bites, stings, immunology & allergy.

7. Infections – Acute & Chronic.

8. Tumours – benign & malignant.

9. Ulcers, Sinuses, Fistula, Fissures.

10.Cancers & cancer biology.

11.Hospital infections – Sterilization, asepsis & antisepsis.

12.Reticulo-endothelial system – Lymphatics& lymph gland obstruction &

tumours of Lymphaticsystem.

13. Diabetes Mellitus & Surgery.

14.Vascular diseases – Gangrene & venous thrombosis, Varicose veins,

Venous & arterial anastomosis.

15. Tropical diseases – Surgical aspects of Tuberculosis, Amoebiasis,

Filariasis, Hydatid Diseases, Mycetoma, Leprosy, Typhoid, Tetanus.

Salivary gland – infections & neoplasm.
Jaw and oral cavity – benign & malignant lesions.
Neck – branchialcyst,CysticHygroma, Thoracic outlet compression syndrome.
Thyroid gland – Goitres & Thyroid neoplasm.
Parathyroid glands and its diseases.
Breast – Gynaecomastic, Fibroadenoma, Fibroadenosis, Infections & malignancy of breast.
Thoracic surgery – Chest trauma, Empyema, Abscesses, Pneumonectomy& Carcinoma Lung.
Mediastinum and its space – occupying lesions.
C.A.B.S and Pericardial Surgery.
Cardiac arrest.
Aortic aneurysm and Peripheral Vascular Diseases.
Oesophagus – Congenital Lesions – Achalasia Cardia, Injuries, Stricture & Carcinoma.
Lesions of Stomach & duodenum – Peptic ulcer and its complications, Carcinoma of stomach, Hypertrophic pyloric stenosis.
Portal Hypertension and Hemetesis.
Lesions of small intestine – Colon & Rectum.
Lesions of Vermiform Appendix.
Peritonitis, Pelvic abscess and Retro-peritoneal Space.
Groin – Hernias and all types of Abdominal wall Hernias.
Congenital Anomalies of Rectum and anal canal and its Operative Treatment.
Liver Abscess, Cyst, Tumours, Portal Hypertension.
Biliary system and its congenital anomalies, Cholelithiasis, Obstructive Jaundice, Acute & Chronic cholecystitis.
Pancreas – Acute & chronic pancreatitis, Pancreatic Tumours, Pseudocyst of Pancreas.
Splenomegaly, Hypersplenism, Splenic trauma.
Acute abdomen and its management.
Urianary tract – Investigations, Anuria, Acute Retension of Urine, Hematuria, Trauma, Neoplasm of Urinary System, Congenital Anomalies, Urolithiasis, Urinary Tract Infections, Tuberculosis, Benign & Malignant Enlargement of Prostate.
Male Genital System – Congenital Anomalies, Hydrocele, Epididymo-Orchitis, Tumours of Testis, Stricture Urethra, Ca Penis.
Family planning Operations, Vasectomy &Vaso-vasal anastomosis.
Organ transplantations – Kidney transplantation, Immunosupression, Haemo and Peritoneal Dialysis, Chronic Renal Failure.
Neuro-Surgery – Head injury and its management, Scalp, Skull & Brain injury, Hydrocephalus, Intracranial space occupying lesions, Spinal bifida, Paraplegia, Spinal Tumours, Spinal Injuries, Tuberculosis of Spines, Peripheral Nerve Injuries, Tumours.
Recent Development in Surgery.
Statistics.

Demonstration of Various Techniques used in Surgery.

Clinical Meetings and Cases Related to Surgery.

Journal Reading.

Demonstrations of Surgical Instruments including Endoscopes and Laparoscopes.

Investigations Procedures like USG; PTC; IVP; Cystoscopy; USG guided biopsy etc.

Year Wise schedule of Training for Residents

Structured Training

Time Period	Description / Levels	Content	Responsibilities
1st year 1st six months 1st year 2nd six months	Orientation Beginners Intermediate	Basic cognitive skills. Procedural abilities OPD & ward work Intermediate degree of cognitive abilities specialized procedural skills	History sheet writing & accurate clinical diagnosis. Pre operative investigations & their interpretation. Emergency management & resuscitation. Ward & OPD discipline. Dressings of wounds & management of colostomy/ Communication with patients &patients relatives. Communications with Allied department like Radiology, Pathology, Microbiology& Blood Bank. Independent performance of minor operations e.g. Incision & drainage of abscess, Paronychia, Breast abscess etc. Excision of lipoma, Sebaceous cyst, Dermoid cyst, Debridement, Fasciotomy. Under superciison – Closer of Laparotomy incision, Appendicectomy, Hydrocelectomy, Circumcision, I.C.D insertion, Tracheostomy, CVP cannulation etc.
2nd year	Intermediate	Intermediate degree of cognitive abilities specialized procedural skills Emergency	Rotation - 3 months Casualty with specific purpose to manage Polytrauma& Handle Medico legal cases. - 3 months each in Neurosurgery, Plastic surgery & Urology.
3rd year	Final	Special skills Intensive critical care	Advanced levels of independent duties, Casualty calls, Independent performance of laparotomy for Peritonitis, Intestinal obstruction, Stangulated Inguinal Hernia, Emergency craniotomy, Cystoscopy, Gastroscopy, Colonoscopy Planned operations like MRM, Pyelolithotomy, Subtotal thyroidectomy, Cholecystectomy, Prostatectomy, Strippig of Varicose veins, G.J.Vagotomy, Right hemicolecomy, Right transverse colostomy etc. - Undergraduate teaching.

Interpretation

Clinical data ( history & examination findings), formulating a differential diagnosis in order of priority, using principles of clinical decision making, plan investigatve work-up, keeping in mind the cost-effective approach i.e. problem-solving and clinical decision-making.
Blood, urine, hematology, biochemistry.
X-ray chest, abdomen, bone & joints.
ECG.
Treadmill testing.
ABG analysis.
CT scan chest and abdomen.
CT scan head and spine.
MRI, MRCP, MRA
Barium studies.
IVP, VUR studies.
Ultrasound abdomen.
Ultrasound guided aspiration and biopsies.

* Communication Skills

While eliciting clinical history and performing physical examination.
Communicating health and disease.
Communicating about a seriously ill or mentally abnormal
Communicating death
Informed consent
Sympathy with patient and family members.
Referral letters and replies.
Discharge summaries.
Death certificates.
Pre – counseling for HIV
Post – counseling for HIV
Pedagogy – teaching students, other health functionaries – lectures, bedside clinics, discussions
Dietary counseling in health and disease
Case presentation skills including recording case history / examination, preparing follow-up notes , preparing referral notes, oral presentation of new cases / follow-up cases.
Coordinating care ( with house staff, nurses, faculty etc.)
Linking patients with community resources.
Providing referral
Genetic counseling

Log book

Every candidate shall maintain a work diary and record his/her participation in the training programmes conducted by the department such as journal reviews seminars etc. Special mention will be made of the presentation by the candidate as well as details of clinical / operative procedures conducted by the candidate.

Training in other sub specialties includes;

Plastic surgery
Urology
Neurology
Laparoscopic and Endoscopic surgery