GENERAL SURGERYGENERAL OBJECTIVES:The objectives of training in general surgery fall into three groups:
The fully-trained general surgeon is expected to function competently in the initial management of conditions that, in major centres, fall within the realm of other surgical specialties. These include: The principles and procedures in the management of the critically ill or traumatized surgical patient; respiratory, renal, coagulation, and liver failure in the surgical patient; management of common fractures; hand nerves; upper and lower urinary tract injuries; tracheostomy; "burrholes" as well as the placement of tongs for skeletal traction. In order to deal effectively with these disorders, a comprehensive knowledge of the following subjects is essential:
General surgery residents, at the end of their training, will be able to perform the commoner procedures in general surgery safely and competently, and will have the ability and confidence to deal with unexpected findings at operation. They will also have the training and experience to undertake less common procedures but will have the humility and common sense to know when the patient's best interests are served by referral to another surgeon. They will be expected to be competent in endoscopy including upper and lower gastrointestinal endoscopy and laparoscopic procedures. Residents will be expected to know how to manage a neck mass and how to do a careful neck dissection. The apprenticeship in surgical technique requires carefully relating responsibility to experience, moving from less difficult procedures to complex management problems.
A very important objective of training is to foster the development of the following characteristics:
An
ability to adapt to innovations and changes in general surgery which will
occur during a 30 to 35 year career.
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CONTENT
AND ORGANIZATION OF THE RESIDENCY PROGRAM
There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty. The content and organization of each accredited program in general surgery must be consistent with the specialty training requirements. Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to their level of training, ability, and experience for the management of surgical patients. In addition to offering the components noted in the specialty training requirements all accredited programs in general surgery must offer community-based learning experiences. RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in general surgery.In those cases where a university has sufficient resources to provide most of the training in general surgery but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to general surgery.
There must be a sufficient number of qualified faculty to supervise residents at all levels and in all aspects of the specialty. The faculty should include a nucleus of full-time equivalent surgeons as teachers.
The number and variety of patients available to the program in all teaching facilities must consistently be sufficient to meet the educational needs of the residents as well as other students.
Surgical services participating in the general surgery program should be organized into clinical teaching services, each with an adequate number of patients available for teaching and administered by a staff director to whom the senior resident is responsible. The physicians attached to each clinical teaching service must hold certification in either general surgery or other acceptable qualifications. Personal operative experience, ultimately including the major procedures in the specialty, must be provided under appropriate supervision. Each resident should keep a validated record of all operative procedures in which he or she has participated either as assistant or operating surgeon.
In-patient and out-patient clinical teaching services should be integrated, so far as possible, in order to provide continuity of management of patients both in and out of hospital. Organized clinics or other facilities, whether general or specialized in nature, must provide opportunities for pre-admission investigation and post-discharge follow-up of general surgical patients in all categories mentioned below.
Teaching units for training in this field should have a close relationship with a gastroenterology service, preferably with an accredited residency program in gastroenterology. The facilities of a gastrointestinal function laboratory and a full range of endoscopy must be available. Residents must be provided opportunity to acquire competence in endoscopy of the upper and lower gastrointestinal tract and should keep a validated record of endoscopic procedures performed. Residents must acquire competence in standard abdominal laparoscopic procedures and be experienced with appropriate advanced laparoscopic techniques. In addition to standard facilities for radiological investigation of the gastrointestinal tract, special facilities for angiographic studies, nuclear medicine imaging and ultrasound, CT and MRI scanning must be available. Combined conferences with the gastroenterology service are a desirable part of the program.
Experience must be provided for residents in the oncology of the breast, endocrine and lymphatic systems, skin, soft tissues, and head and neck. Active teaching services must be available to admit the necessary volume of patients for surgical treatment of such neoplastic diseases. Interdisciplinary tumour clinics and conferences are an important feature of this phase of training, and a close relationship with radiation therapy, chemotherapy, and tumour immunology is essential. The respective role of these treatment modalities must be clearly understood.
During training each resident must serve on units admitting patients for surgical management of endocrine diseases, especially of the thyroid and parathyroid glands, pancreas, and adrenals. A close working relationship with a medical endocrinology service is essential.
There must be at least one teaching unit admitting a substantial number of patients who have serious injuries. The facility responsible for major trauma must have a plan for the management of major trauma patients based on a well-organized multidisciplinary team and embracing the emergency department and an intensive care unit equipped to handle major trauma. Each resident must have major responsibility in handling injuries to the trunk and viscera, blood vessels, and soft tissues, on both an emergency and definitive basis. The program must provide for such residents suitable rotations or at least a close concurrent contact with relevant surgical specialties, especially cardiovascular and thoracic, neurosurgery, plastic, orthopedic, and urological surgery.
All residents should have experience in thoracic surgery. This may be achieved by close cooperation with a program in cardiac surgery, thoracic surgery, or a general surgery service that includes an adequate volume of thoracic surgery.
Provision must be made for experience in vascular surgery, both the diagnostic and therapeutic aspects. This experience may be obtained either on a general surgery service with adequate volumes of vascular surgery or by rotation to a vascular surgery service.
The program must have access to pediatric surgery. Residents should be instructed by pediatric general surgeons. There must be opportunities to manage pediatric surgical patients in an emergency department which includes trauma patients, a neonatal unit, intensive care units, and ambulatory and in-patient pediatric teaching services.
Each resident must have ample opportunity to be responsible for surgical patients undergoing treatment in intensive care units. Residents should have experience in following their own patients while in intensive care units, and in addition should have a seconded rotation to an adult intensive care unit. Such units must be organized for teaching with appropriate levels of supervision and responsibility for the care of the critically ill patient.
There must be systematic supervision of residents at both junior and senior levels to ensure expertise in the initial management of all types of surgical emergencies presented in the emergency department. Experience in providing a consultative service is an important feature of such training.
Community surgery experiences must be available to provide a learning environment with appropriate supervision and evaluation based on rotation specific objectives. This assumes administrative support and linkages with the program.
Liaison with other Specialties and Subspecialties There must be appropriate liaison with teaching services in internal medicine, pediatrics, anesthesia, anatomical or general pathology, and diagnostic radiology. Hospitals with a major role in the general surgery program should also be engaged in medical undergraduate teaching. ACADEMIC
AND SCHOLARLY ASPECTS OF THE PROGRAM:
The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.
Organized scholarly activities such as lectures and seminars, technical demonstrations, and journal clubs, in addition to teaching rounds and special conferences must be a regular part of the program.
The academic program must include organized teaching in the basic and clinical sciences relevant to the specialty. This should include definitive teaching in the basic sciences and principles of surgery in general, and also the advanced scientific and clinical knowledge essential to the practice of general surgery in those areas outlined in the preceding section.
The academic program must ensure that residents gain an understanding of the basic principles and practice of biomedical ethics as it relates to general surgery.
The program must ensure that residents learn effective communication skills for interacting with patients and their families, colleagues, co-workers from other disciplines, and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place.
Residents must be given opportunities to develop effective skills in collaborating with all members of the patient care team.
Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.
Residents must be given opportunities to develop skills in management as applied to general surgery such as efficient practice and records management and the ethical use of health care resources. Residents should also be prepared for their role as a health care advocate.
The program must provide residents with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments of surgery.
There must be a faculty member with the responsibility to facilitate the involvement of residents in research and other scholarly work. The academic program must provide the opportunity for residents to learn biostatistics and the critical appraisal of research methodology and medical literature. Such teaching must include issues related to age, gender, culture, and ethnicity in research protocols and data presentation and discussion. Residents should be encouraged to participate in clinical research during the course of the residency program.
A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.
All programs must promote development of skills in self-assessment and self-directed life-long learning. To promote this end, the program should provide opportunities for residents to attend conferences outside their own university. |
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SPECIALTY REQUIREMENTS: Training should incorporate the principle of graded increasing responsibility. The term "approved" throughout this section means "approved by the candidate's program director and the Credentials Committee". Senior residency is
defined as a year in which the resident is regularly entrusted with the
responsibility for pre-operative, operative, and post-operative care,
including the most difficult problems in general surgery. The senior
resident shall be in charge of a general surgical unit. No other resident
shall intervene between the senior resident and the attending staff
surgeon. |
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PROGRAMS (WITH TRAINING REQUIREMENTS): Master
of Surgery(M.S):
Thirty six months of approved residency training. Doctor
of Philosophy(Ph.D):
Sixty months(five years)of approved residency training. |