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DR. RAJENDRA PRASAD GOVT. MEDICAL COLLEGE KANGRA AT TANDA DEPARTMENT OF SURGERY CURRICULUM AND SYLLABUS FOR POST GRADUATES 1. Goals The goal of MS course in Surgery is to produce a competent surgeon who: 1. has acquired the competence pertaining to surgery that is required to be 2. practiced in the community and at all levels of health care system 3. has acquired the skills to manage the patients of trauma effectively. 4. has acquired skill in effectively communicating with patient and his attendants. 5. has the desired surgical skills to independently operate on elective and 6. emergency cases 7. is aware of the latest developments in the field of surgery 8. is oriented to principles of research methodology 9. has acquired skills in educating medical and paramedical professionals. 11. 2. 2. Objectives At the end of the MS course in surgery, the student should be able to 1. practice the specialty of surgery in keeping with the principles of professional ethics 2. recognize and identify the various surgical problems institute diagnostic, therapeutic, rehabilitative and preventive measures to provide holistic care to the patient 3. take detailed history, perform full physical examination and make clinical diagnosis 4. perform relevant investigative and therapeutic procedures interpret important imaging and laboratory results 5. independently perform basic surgical procedures 6. manage surgical trauma emergency efficiently 7. demonstrate empathy and human approach towards patients and their families. 8. demonstrate communication skills of a high order in explaining management and prognosis, providing counseling and giving health education to patients, families and communities, 9. develop skills as a self-directed learner, recognize continuing educational needs, use appropriate learning resources, and critically analyze relevant published literature in order to practice evidence-based surgery 10. facilitate learning of medical/nursing students, practicing physicians, paramedical health workers and other providers as a teacher/trainer 11. organize and supervise the desired managerial and leadership skills Curriculum Post graduate curriculum shall consist of: I. Theoretical learning a. Seminars b. Journal clubs c. C M E ' s d. C P C ' s e. Self learning 2. Clinical skills a. Detailed history writing of indoor patients b. Ward rounds c. Grand rounds d. Case presentations e. Case discussions in OPD 3. Operative skills a. Dressing in OPD & indoor OR bedside procedures b. Minor OT procedure c. Proctology procedure d. Major OT procedure 4. Thesis writing tinder guidance of guide & co-guides a. Thesis protocol submission within 3 months of admission b. Submission of thesis 6 months before appearing in examination Note; a. Every candidate shall carry out work on an assigned research project under the guidance of a recognized postgraduate teacher, the project shall be written and submitted in the form of a Thesis. b. Every candidates shall submit thesis plan to the University within time frame set by university. c. Thesis shall be submitted to the University six months before the commencement of theory examination. d. The student will (i) Identify a relevant research problem (ii) conduct a critical review of literature; (iii) formulate a hypothesis; (iv) determine the most suitable study design; (v) state the objectives of the study; (vi) prepare a study protocol; (vii) undertake a study according to the protocol; (viii) analyze and interpret research data, and draw conclusions; (ix) write a research paper. 5. Communication skills a. Seminars b . Journal clubs c . Ward rounds/Grand rounds presentation d . Case presentations 6. Training in research methodology a) Lectures/seminars from community medicine regarding scientific statistics. b) General issues in conducting research c) Quantitative research methods d) Qualitative research methods Three year period will be divided in six semesters as follows; 1st Semester 1. Thesis Protocol submission. 2. Seminar presentation of basic sciences. 3. History writing of indoor patients. 4. Assisting in ward work a. Sampling. b. Dressing. c. Minor surgical procedures. d. Observing ward round presentation 5. . In minor OT a. Assisting in minor operation and day care procedures. b. Assisting in proctology procedures. c. Dressing in dressing room. 6. In major OT a. Assisting as 2nd assistant. 2nd Semester 1. Thesis research study. 2. Seminar presentation. 3. Journal club presentation. 4. History writing of indoor patients. 5. Ward works a. Sampling. b. Dressing. c. Minor surgical procedures. d. Observing ward rounds/ ward round presentation. 6. In minor OT a. Assisting in minor OT. b. Doing selective procedures independently under supervision. c. Proctology procedures under supervision. d. Dressings. e. Short case discussion in OPD. 7. In major OT a. Assisting as 2nd assistant. During first year the resident will work under direct supervision of the 2nd & 3rd year residents/senior residents and consultant on call. He/she will be responsible for taking detailed history, examination of patients as per the file record and send appropriate investigations as advised by the seniors and making discharge cards. Initially all procedures are to be observed and then done under supervision of seniors and during 2nd / 3rd year can do procedures independently. In 2nd year, resident is posted in emergency, Surgical ICU and specialties. In 3rd year, resident is also encouraged to make independent decisions in management of cases and perform surgery independently. He /she is also involved in teaching of undergraduate students. 3rd Semester 1. Thesis work. 2. Seminar presentation. 3. Case presentation. 4. History writing of indoor patients. 5. Ward works. 6. Presentation of ward rounds. 7. Minor OT procedures under supervision. 8. Major OT procedures a. Assisting as lst assistant in selected operations. b. Assisting as 2 nd assistant. 4th Semester 1. Same as 3" semester. 2. 3 months posting in super-specialities (3 week each in Neurosurgery, Urology, CTVS & plastic surgery in IGMC Shimla). 5th Semester 1. Completion of thesis. 2. Journal club. 3. Case presentation. 4. Ward round/ grand round presentation. 5. Minor OT procedures. 6. Major OT procedures. a. As I st assistant. b. Selected surgeries independently under supervision. 7. Teaching of under graduates. 6th Semester 1. Same as 5th semester 2. Examination Note:- 1. Apart from the above learnings the post graduates will be attending: i. Clinico-pathological conference- weekly. ii. CME's as & when being Conducted in the institution and one at the national level & guest lectures. iii. Mortality meeting- fortnightly. iv. Conference- at least one national level conference in last year. 2. There will be theoretical & clinical appraisal at the end of each semester. 3. TEACHING ROSTER 1. Seminar- weekly (every Tuesday 3:00 PM to 4:00 PM). 2. Journal Club- weekly (every Saturday 3:00 PM to 4:00 PM). 3. Case presentation- weekly (every Wednesday 3:00 PM to 4:00 PM). 4. Statistical meet/ Data review meet & interesting case presentation monthly. 5. Ward round presentation daily. 6. Grand round presentation- twice weekly. 7. Postgraduates will maintain a log book of seminar presentations, journal clubs, case presentations, clinical case; surgical procedures assisted & performed and get it duly signed by the teachers/ consultants. 8. Clinico-pathological conference weekly (every Thursday3:00 PM to 4:00 PM). 9. CMEs from time to time. 10. teaching to undergraduates in 5th and 6th semester. 11. Presentation of short cases in OPD. 12. Appraisal at the end of each semester. IV. Job Responsibilities During first year, the resident should work under direct supervision of the 2nd & 3rd year residents/senior residents and consultant on call. He/she will be responsible for taking detailed history, examination of patients as per the file record and send appropriate investigations as advised by the seniors and making discharge cards. Initially all the procedures are to be observed and then performed under supervision of seniors and during 2nd / 3rd year should do procedures independently. In 2nd year, resident should be posted in emergency, Surgical ICU and specialties concerned. In 3rd year, resident is encouraged to make independent decisions in management of cases and perform surgery independently. He /she is involved in teaching of undergraduate students. V. Assessment All the PG residents are assessed daily for their academic activities and also periodically. 1. General Principles i. the assessment is valid, objective, and reliable. ii. it covers cognitive, psychomotor and affective domains. iii. formative, continuing and summative (final) assessment is also conducted in theory as well as practicals. In addition, thesis is also assessed separately. 2. Log book Record of work in the form of log book tog book to be maintained by each candidate and to be counter signed by unit incharge and head of department every month at data review meet. 3. Formative Assessment The formative assessment is continuous as well as end-of-term. The former is being based on the feedback from the senior residents and the consultants concerned. All the consultants of the unit in which resident is working will give marks based on performance. These marks will be summated over a period of tenure. End-of-term assessment is held at the end of each semester (upto the 5th semester). Formative assessment will not count towards pass/fail at the end of the program, but will provide feedback to the candidate. 4. Internal Assessment The performance of the Postgraduate student during the training period should be monitored throughout the course and duly recorded in the log books as evidence of the ability and daily work of the student. Marks should be allotted out of 50 as followed. Sr. No. Items Marks a. Personal Attributes 10 b. Clinical Work 10 c. Academic activities 10 d. End of term theory examination 10 e. End of term practical examination 10 Personal attributes: a. Behavior and Emotional Stability: Dependable, disciplined, dedicated, stable in emergency situations, shows positive approach. b. Motivation and Initiative: Takes on responsibility, innovative, enterprising, does not shirk duties or leave any work pending. c. Honesty and Integrity: Truthful, admits mistakes, does not cook up information, has ethical conduct, exhibits good moral values, loyal to the institution: d. Interpersonal Skills and Leadership Quality: Has compassionate attitude towards patients and attendants, gets on well with colleagues and paramedical staff, is respectful to seniors, has good communication skills. 10Clinical Work: Availability: Punctual, available continuously on duty, responds promptly oncalls and takes proper permission for leave. a. b. Diligence: Dedicated, hardworking, does not shirk duties, leaves no work pending, does not sit idle, competent in clinical case work up and management. c. Academic ability: Intelligent, shows sound knowledge and skills. participates adequately in academic activities, and performs well in oral presentation and departmental tests. a. Clinical Performance: Proficient in clinical presentations and case discussion during rounds and OPD work up. Preparing Documents of the case history/examination and progress notes in the file (daily notes, round discussion, investigations and management) Skill of performing bed side procedures and handling emergencies. Academic Activity: Performance during presentation at Journal club/ Seminar/Case discussion/Stat meeting and other academic sessions. Proficiency in skills as mentioned in job responsibilities. End of term theory and practical examination: Conducted at end of 1st, 2nd year and after 2 years 9 months Marks for personal attributes and clinical work should be given annually by all the consultants under whom the resident was posted during the year. Average of the three years should be put as the final marks out of 10. Marks for academic activity should be given by the all consultants who have attended the session presented by the resident. The Internal assessment should be presented to the Board of examiners for due consideration at the time of Final Examinations. Summative Assessment: a. Ratio of marks in theory and practical will be equal. b. the pass percentage will be 50%. c. Candidate will have to pass theory and practical examinations separately Theory Examination (Total— 400) Paper Title Marks Paper 1: Basic sciences as applied to Surgery 100 Paper 2: Principles and practice of Surgery 100 Paper 3: Operative Surgery 100 Paper 4: Recent advances in Surgery 100 Practical Examination and Viva voce (Total=400) 1.ong Case (s) - One 150 Short Case (s) -Three x 50 —150 internal assessment 50 Table viva Surgical pathology 10 X-ray 10 Operative 20 Instruments 10 Suggested Books Bailey & Love's- Short Practice of Surgery Farquaharson's Text Book of General Surgery Current Surgical Diagnosis & Treatment S.Das Manual on Clinical Surgery Hamilton Bailey Demonstration of Clinical signs & Symptoms in surgery _ Emergency Surgery By Bail Dudley's Atlas of General Surgery Pye's Surgical Handicraft Mastery of Surgery by Baker R.J Vol. 1 & H Schwartz-Principles of Surgery Recent Advances, Tayler Sabiston Text Book of Surgery, Part I & II Maingot's Abdominal Operations Oxford Text Book of Surgery Vol.!,!! & III by Morris and Wood S.Das Text Book on Surgical Short Cases Mastery of Thoracic Surgery Text Book of Hepatobiliary Surgery-Blumgart Textbook Colorectal Surgery by Corman Marvin L. Laparoscopic Surgery Technique-Darsi Zollinger Altas of Surgical Operation Surgery of Alimentary Tract Vol 1 & 2 Shackelford Journals Annals of Surgery Archives of Surgery British Journal of Surgery Journal of Neurosurgery Journal of Neurosurgery : Spine Journal of Neurosurgery : Pediatrics Journal of Plastic , Reconstructive and Aesthetic Surgery Journal of Trauma Journal of Urology Neurosurgery clinics of North America Plastic & Reconstructive Surgery Surgery Surgical Clinics of North America Urologic Clinics of North America _ Indian Journal of Surgery Journal of Minimal Access Surgery Journal of Indian Association of Paediatric Surgery Indian Journal of Burns Indian Journal of Thoracic and Cardio vascular Surgery Journal of Emergency Trauma and Shock Current problems in Surgery Model Test Papers MODEL QUESTION PAPER MS (Surgery) Paper-i Basic sciences as applied to surgery Max. Marks: 100 Time: 3 hrs Attempt ALL questions Answer each question & its pans in SEQUENTIAL ORDER ALL questions cony equal marks Illustrate your answer with SUITABLE DIAGRAMS 1 Describe in detail the surgical anatomy of liver. II Describe the normal sequential rotation of gut in fetal life and consequences of malrotation of gut. III Describe pathophysiological changes of portal hypertension. IV Explain Development and surgical anatomy of thyroid. V Explain Surgical anatomy of inguinal canal in relation to hernia formation. VI Explain Embroyology, clinical features and its implication for treatment of Branchial cyst. VII Discuss Lymphatic drainage of breast. V111 Surgical anatomy of anal canal in relation to fistula in ano. IX Describe ano-rectal malformation. X Describe surgical anatomy of venous system of leg. MODEL QUESTION PAPER MS (Surgery) Paper-11 Principles and practice of Surgery Max. Marks:I00 Time: 3 hrs Attempt ALL questions Answer each question & its parts in SEQUENTIAL ORDER ALL questions carry equal marks Illustrate your answer with SUITABLE DIAGRAMS I Describe in brief hypovolemic shock, its pathophysiology and management. II Describe pathology, clinical presentation and surgical management of carcinoma stomach. III Describe etiology and management of hydronephrosis IV Elaborate pathology, clinical features, investigations and treatment of BHP V Describe development pathology, clinical features and management of APKD VI Explain ANDI of breast VII Compare Acute VS chronic arterial occlusion VIII Describe the management of deep bums IX Describe general principles of management of blunt abdominal injury X Describe clinical features and management of liver abscess MODEL QUESTION PAPER MS (Surgery) Paper-Ill Operative Surgery Mar. Malt: 100 Time: 3 hrs Attempt ALL questions Answer each question & its parts in SEQUENTIAL ORDER ALL questions carry equal marks Illustrate your answer with SUITABLE DIAGRAMS I Describe the indications, techniques and complications of neck dissections. II Describe indications, techniques and complications of esophagectomies. III Enumerate types of and describe any one of the Liver resections IV Enumerate the Complications of TPC with IPAA V Classification and management of Bile duct Injuries VI Describe Thoracic outlet syndrome VII I Low will you manage a case of Buerger's disease VIII Enumerate various Abdominal incisions and discuss their advantage and complications IX Describe the complications of Transurethral Prostate resection X Describe Damage control surgery MODEL QUESTION PAPER MS (Surgery) Paper-I V Recent advances in Surgery Max. Marks:100 Time: 3 hrs Attempt ALL questions Answer each question & its parts in SEQUENTIAL ORDER ALL questions carry equal marks Illustrate your answer with SUITABLE DIAGRAMS I Describe the use of radio frequency in surgery II Discuss Recent advances in the treatment of carcinoma breast. III \Vhat is N.O.T.E.S and its current status IV Describe T.E.M.S V Give an overview of treatment of Ulcerative colitis VI Discuss the recent advances in Treatment of varicose veins VII Outline Uses and advantages of robotic surgery VIII Discuss the recent advances in abdominal compartment syndrome IX Describe the latest concepts in the management of BHP X Describe the recent advances in management of carcinoma esophagus Syllabus for Post Graduate Students Basic Sciences 1. Surgical anatomy & Rotation of gut 2. Surgical anatomy of liver and biliary system 3. Surgical anatomy of stomach 4. Surgical anatomy of thyroid 5. Surgical anatomy of renal system 6. Surgical anatomy of breast and lymphatic drainage 7. Surgical anatomy of groin and scrotum S. Surgical anatomy of head and neck and lymphatic drainage 9. Autonomic Nervous system 10. Physiology of gastric secretions II. Physiology of thyroid gland 12. Physiology of Jaundice 13. Acid base, fluids and electrolytes balance and its management. 14. Blood brain barrier 15. Dynamics of blood and lymph flow 16. Principle of macroscopic examination and sampling 17. Examination, description and sampling of specimen 18. Special investigative procedure 19. Stains, special stains and immunohistochemistry 20. Surgical pathology report 21. Microscope function 17 Principles of Surgery 1. Introduction & history of Surgery 2. Preparing patient for surgery and postoperative complications 3. Diagnostic and interventional radiology 4. Anaesthesia and pain management 5. Fluid and electrolyte balance/ Acid base balance. 6. Shock and management of hacmorrhagic & hypovolemic shock 7. Blood transfusion and component therapy 8. Inflammation/SIRS/MOP 9. Nutrition 10. Wound tissue repair and scars 11. Basic surgical skills and principals of laparoscopic surgery 12. Surgical wound infection and theatre technique 13. Infections: Tetanus, TB, Gas gangrene, Necrotising fasciitis, Cellulitis 14. AIDS & Surgery 15. Warfare injuries 16. Emerging technologies in surgery - Electronic robotics 17. Tumor biology & tumor markers 18. Electrosurgery 19. Parasitic diseases: Ascariasis, Amoebiasis, Cysticercosis, I lydatid disease 20. Cysts, ulcers & sinuses 21. Transplantation 22. Principals of oncology 23. Day surgery and surgical ethics 24. Surgical audit 25. Evidence based surgery Skin & Subcutaneous tissue 1. Skin: callosities, warts, corns, infection Vascular disorder 1. Arterial disorders 2. Venous disorders 3. Lymphatic disorders including lymphomas Trauma 1. Introduction to trauma 2. 3. 4. 5. 6. 7. 8. Assessment & management of trauma Head inj ury Neck & spine injuries Injuries to face and mouth Injuries to chest & abdomen Extremity trauma Burns 9. Disaster management Head, neck & spine 1. Elective neurosurgery 2. Cleft lip & palate 3. Oropharynx, larynx & neck 4. Oropharyngeal cancer 5. Salivary glands 6. Branchial apparatus and its anomalies Gastrointestinal system 1. Stomach and Duodenum: Congenital hypertrophic pyloric stenosis, Trichobezoar, acute dilatation of stomach, Duodenal ileum. Peptic ulcer disease. Gastric neoplasms\GIST 2. Small intestine: Tuberculosis, Crohn's disease. Intestinal obstruction. Tumors. 3. Large intestine: Hirschsprung's disease/ Megarectum/ Non- megacolon, Diverticulosis, Ulcerative colitis and Tumors. 4. Appendix: Inflammation & Tumors 5. Peritonitis: classification, etiology and management. 6. Rectum and anal canal: Development, Surgical anatomy, Lymphatic drainage, Congenital anomalies, injuries, Foreign bodies, Pruritis ani, Fissure in ano, Haemorrhoids, Incontinence, Strictures, Prolapse and Carcinoma Rectum and anal canal. 7. Gall Bladder: Development, Congenital anomalies, Cholelithiasis and Cholecystitis, Choledocholithiasis, choledochal cyst, Stricture, carcinoma, CBD and gall bladder carcinoma 8. Pancreas: Inflammation and Tumors 9. Liver: Abscess, Hydatid disease, Neoplasm 10. Portal hypertension and surgical spleen Genito-urinary system 1. Kidney and Ureter: Development, Congenital anomalies, Injuries, Urolithiasis, Hydronephrosis, Renal Tuberculosis, Pyonephrosis and Perinephric Abscess and Neoplasms 2. Lower urinary tract: Injuries, Stricture Urethera, REP & Prostatic calculi, Carcinoma Prostate, Bladder Tumors and Carcinoma Penis 3. Testis: Congenital anomalies, Varicocele, Flydrocele, Idiopathic gangrene scrotum and Tumors 4. Male Infertility Breast I. Breast: Surgical anatomy Lymphatic drainage, Congenital anomalies. Fibroadenosis 2. Breast: Inflammation 3. Breast: Benign tumors & cysts 4. Breast: Malignant tumors 5. Breast: Reconstruction Endocrinal surgery 1. 2. 3. 4. 5. Thyroid: Surgical anatomy, Developmental anomalies and functions Thyroid: Euthyroid conditions Thyroid: Dysfunctions Thyroid: Tumors Parathyroid and Adrenals: Surgical diseases Thoracic Surgery 1. Oesophagus: Development congenital anomalies, Injuries, Stricture, Cardia achalasia, Reflux oesophagitis and Tumors 2. Diaphragm: Congenital defects and Hiatus hernia 3. Heart: Cardiac arrest, Valvular heart disease 4. Chest: Empyema thoracis, chest wall tumors, Mediastinal Tumor, 5. Surgical aspects of congenital and acquired heart diseases-introduction Neurosurgery 1. 2. 3. 4. Congenital anomalies of skull, Encephlocele, I lydrocephalus Spinal dysrephism Intracranial space occupying lesions Trauma Plastic Surgery 1. Wounds and scars 2. B u r n s 3. 4. 5. Skin grafting. Skin cysts, Tumors, Precancerous lesions, Leprosy !land: Congenital anomalies and anatomy, Infections, Dupuytren's contracture and injuries 6. Face: Congenital & Developmental anomalies, cleft lip/palate and injuries 7. Jaw Tumors 8. Oral cancer, Carcinoma tongue, Carcinoma lip 9. Congenital & Developmental anomalies of lower urinary tract 10. Nerve injuries 11. Lymphedema & Filiariasis Operative Surgery I. Introduction principals, nomenclature, suture material type of knots/sutures 2. Sterilization asepsis and antisepsis 3. Preoperative care and complications 4. Postoperative care and complications 5. Biopsy and its types 6. Management of wound repair of various type of tissue viz nerve, tendon, artery and vein 7. Drainage of abscess viz Parotid, breast and ischio-rectal 8. Spaces of hand and drainage of hand abscesses 9. Operation of various hernias 10. Abdominal incisions and exploratory laparotomy 11. Gasterostomy, Vagotomy, Gastrojejunostomy, Pyloroplasty & Partial Gasrectomy 12. I lemicolectomy, colostomy, eaccostomy, enterostomy, APR 13. Resection of bowel and anastomosis, operations for obstruction 14. A p p e n d i c e ct o my 15. Operations for liver abscess, Hydatid disease, subphrenic/pelvic abscess, pseudopancreatic cyst 16. Cholecystectomy, cholecystostomy, biliary injury and exploration of CBD 17. Basics of Laparoscopy & instruments 18. Operations for fistula in ano, haemorrhoids, rectal prolapsed 19. Catheterization, Urethral dilatation, Suprapubic cystolithotomy 20. Rupture urethra & uretheroplasty 21. Operations of prostate 22. Operations for hydrocele, varicoccle, testicular tumor/orchidectomy 23. Operations for phimosis, paraphimosis, pinhole meatus (meatotomy), Carcinoma penis 24. Vasectomy/ Recanalisation 25. Operations for kidney 26. Operations for Ureter 27. Oper at i ons f or t hyr oi d 28. Operations for varicose veins, 29. Operation for arterial thrombosis, repair of arterial injuries and lumbar and cervical sympathectomies 30. T r a c h e o s t o m y 31. Intercoastal drainage and rib resection 32. Skin grafting, amputation and biopsy/ release of contracture 33. I n s t r u m e n t s 34. Operation for salivary gland 35. Operation for adrenals 36. Operation for cleft lip and palate 37. Surgery of breast and axilla 38. Emergency laprotomy Recent advances I. Bacterial translocation in surgical patients 2. Optimization of high risk surgical patients 3. Abdominal tuberculosis 4. Malignant melanoma update 5. Intestinal fistula management 6. Inguinal hernia repair- update 7. Standards in the treatment of pancreatic disease 8. Morbid obesity 9. Diagnostic laparoscopy in staging GI malignancy 10. Adjuvant therapy in colorectal cancer 11. Adjuvant therapy in carcinoma breast 12. Role of radiotherapy in Carcinoma Breast 13. Development in live donor renal transplantation 14. Strategies of breast cancer prevention 15. N O T E S 16. Pancreas and islet transplantation 17. Liver transplantation 18. Thyroid cancer 19. Parathyroid Surgery 20. Blood transfusion and other approaches 21. Abdominal compartment syndrome 22. Repair of incisional hernia 23. Nutrition in acute pancreatitis 24. Treatment of pancreatic pscudocyst 25. Biliary tract injuries 26. Liver trauma update 27. Extra anatomical bypass for leg ischemia 28. Diabetic foot and ulceration 29. Uses of laser in surgery 30. Surgical training for post graduates