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1
CLINICAL STUDY GUIDE
DEPARTMENT OF SURGERY
MTI BACHA KHAN MEDICAL COLLEGE
MARDAN MEDICAL COMPLEX AND
TEACHING HOSPITAL
MARDAN
Session 2020-21
Note: This document is the property of Surgery Department, Bacha Khan Medical College, and in no way
be copied, printed or reproduced in any form with out the prior permission of the “Head of Surgery
Department, Bacha Khan Medical College.” This cannot be used for legal purposes.
DR. AJMAL KHAN, FCPS
PROFESSOR AND HEAD DEPARTMENT OF SURGERY
2
TABLE OF CONTENTS ........................................................................................................................ 2, 3
RATIONALE OF THE STUDY GUIDE……………………………………………………………………………………………………..4
VISION AND MISSION STATEMENT…………………………………………………………………………………………………….5
FACULTY DETAILS ............................................................................................................................. .6, 7
OUTCOMES OF EACH YEAR ................................................................................................................ 8-10
OUTCOME AT THE END OF 3RD YEAR…………………………………………………………………………………………………8
OUTCOME AT THE END OF 4TH YEAR…………………………………………………………………………………………………9
OUTCOME AT THE END OF FINAL YEAR. ............................................................................................ 10
STRUCTURE OF THE SYLLABUS ACCORDING TO YEAR OF STUDY......................................................... 11
STRUCTURE OF 3RD YEAR MBBS SYLLABUS………………………………………………………………………………………… 11
WARD ROTATION PLAN FOR 3 RD MBBS………………………………………………………………...12
LECTURE TIME TABLE AND WARD SCHEDULE 3RD YEAR (SESSION 2020-21) .................................. …….13, 15
STRUCTURE OF SYLLABUS4TH YEAR MBBS/BDS………………………………………………………………………………….16
LECTURE TIME TABLE AND WARD ROTATION SCHEDULE .......................................................... ………..18, 19
WARD ROTATION PLAN 4TH YEAR MBBS/BDS………………………………………………………………………………………20
STRUCTURE OF SYLLABUS 5TH YEAR MBBS ........................................................................................ .21,
22
LECTURE TIME TABLE FINAL YEAR MBBS………………………………………………………………...23
WARD ROTATION SCHEDULE FINAL YEAR MBBS………………………………………………………...24
WARD ROTATION FOR FINAL YEAR MBBS……………………………………………………………….25
OUTCOMES FOR 3RD YEAR BDS............................................................................................................ 27
STRUCTURE OF SYLLABUS FOR 3RD YEAR BDS……………………………………………………………………………………..28
TIME TABLE 3RD YEAR BDS................................................................................................................... 30
WARD SCHEDULE 3RD YEAR BDS ........................................................................................................... 31
ASSESSMENT………………………………………………………………………………………………………………………………………32, 33
3
DETAILED SYLLABUS 3RD YEAR MBBS……………………………………………………………………34
DETAILED SYLLABUS 4TH YEAR MBBS AND 3RD YEAR BDS .......................................................... ………..36, 7, 38
DETAILEDSYLLABUS FINAL YEAR MBBS…………………………………………………………………………………….39-40, 41
CLINICAL ROTATIONS............................................................................................................................. .42
ATTENDANCE AND PROGRESS REPORT ............................................................................................ 43
EXAM SETUP ................................................................................................................................. …44, 46
REFERRENCES ..................................................................................................................................... 47
4
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 discussed in this guide. This
basic knowledge will help the students to integrate the application of these skills in their clinical practice
for timely diagnosis and successful management of the patients. It is important to have a clear concept
of the 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
population. Our aim is to produce safe primary health care doctors, who is the backbone of the health
system and he/she 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 all MMBS/BDS 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 used
for the teaching and the assessment methods (timings and the structure of the assessment).
On behalf of my Faculty, I welcome you all and wish you successful journey in the surgery and life ahead
PROFESSOR DR AJMAL KHAN
HEAD DEPARTMENT OF SURGERY.
BACHA KHAN MEDICAL COLLEGE/MTI MMCTH. MARDAN
5
.
VISION STATEMENT
Our aim is to produce safe primary health care doctors, who is the backbone of the health system and
he/she should know which surgical disease should be treated and the ones which need elective or
urgent referral
To provide an environment of continuous learning and inquiry
To create new knowledge about the effects of disease in humans
To educate, recruit and retain the best surgeons and scientists
To create an environment where surgical and scientific excellence, and
teamwork are valued
To promote and advance the highest moral and ethical standards in an
environment of compassion and critical appraisal
MISSION STATEMENT
To restore health through surgical intervention, remembering patient
dignity and comfort are integral to overall health
6
FACULTY DETAILS
General surgery
1. Professor Dr Mohammad Hussain surgical B unit
2. Professor Dr Ajmal Khan surgical B unit
3. Professor Dr Mukhtiar Ali surgical A unit
4. Assistant professor Dr Aurang zeb Khan surgical B unit
5. Assistant Professor Dr Tamjeed Gul surgical A unit
6. Assistant Professor Dr Ibrahim Shuja surgical B unit
7. Assistant Professor Dr Asif Imran surgical A unit
Orthopedic
1. Professor Dr Haziq Dad
2. Dr Zahir Khan
3. Tariq Ahmad
4. Dr Abdus Sammad
7
5.
Neurosurgery
1. Dr Naeem ul haq
2. Dr Gohar Ali
3. Dr Asghar khan
4. Dr Ishaq
Plastic surgery
Dr Zarar Niazi
Urology
Dr Zafar Ahmad
Pediatric surgery
Dr Javed Khan
STUDY GUIDE COMPILED BY
DR AURANGZEB KHAN
ASSISTANT PROFESSOR OF SURGERY FOCAL PERSON
CURRICULUM AND ACADEMICS
8
Outcomes of each year
Outcome at the end of 3rd year MBBS
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.
9
Outcome at the end of 4th year MBBS
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
• 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
10
Outcome at the end of 5th year MBBS
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.
11
Structure of the syllabus according to year of study
Syllabus of 3rd year MBBS:
SURGERY SYLLABUS and TIME TABLE (YEAR 2020-21) MBBS 3rd YEAR
Surgical Unit-A
• Surgical Nutrition
• Sterilization and Disinfection
• Surgical infection
• Antimicrobials and tetanus prophylaxis in surgery
• Wounds, ulcers, Tissue Repair and scars
• Burns and management
Surgical Unit-B
• Preoperative preparation of a surgical patient
• Post-operative care of a surgical patient
• Metabolic response to injury
• Shock
• Blood and blood products transfusion
• Fluid and Electrolyte and Acid base Disturbances
• Pain Relief
Time table
Surgical unit – A 1-11-2020 to 30-04-2021
Surgical unit – B 01-05-2021 to 30-09-2021
• 50 minutes lecture on every Thursday
12
• The feedback from students will be collected twice during the session.
• 4 week’s rotation in each in Surgery A and B wards. Twice per week and 3 hours per day (48 hours)
• The feedback will be collected once at the end of clinical rotation.
Ward rotation plan for 3rdyear MBBS students.
Clinical rotation: 10 days
Learning outcome for clinical teaching 4th year MBBS
Day Topics to be discussed
Facilitator Venue and teaching strategy
Out comes
1 Introduction and orientation personal safety protocols and prevention of infections
Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT
2 History taking prerequisite and history of trauma victim.
Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT Student shall be able to introduce him/herself to the patient and take consent for history taking.
3 History of pain and lump Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT Students shall be able to enquire all the parameters of pain and any lump/mass in history taking
4 History of lump, ulcers and other skin lesions
Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT Shall be able to take detailed history of lump, ulcers and other skin lesionsmethodologically reach a provisional diagnosis and exclude differentials
5 History of painful abdominal conditions
Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT Shall be able to take detailed history for painful abdominal conditions andenumerate differential diagnosis of painful abdominal conditions.
6 History of l abdominal mass and swellings
Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT Shall be able to take detailed history for abdominal masses and enumerate differential diagnosis of painful abdominal conditionswith special emphasis on surgical pathologies leading to abdominal mass.
7 History of limbs vascular and neurological disorders
Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT Student shall be able to take history of upper and lower limb with emphasis on vascular and neurological conditions
8 History of inguino-scrotal swelling masses and painful condition
Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT Shall be able to take detailed history for inguino -scrotal masses andpainfulinguino-scrotall conditionsenumerate differential diagnosis of painful inguino-scrotall conditionswith special emphasis on surgical pathologies of inguino- scrotal area like hernia/hydrocele /torsion/orchitis
9 History taking in surgical disease of Breast
Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT Shall be able to take detailed history of breast inflammatory and neo- plasplastic conditions.
10 Formative assessment log books
Dr. Muhammad Ibrahim Shuja
Ward/OPD/OT Students should be able to greet the patient take consent take appropriate
13
history in the context of surgical patient presentation
Note:.
Monday Wednesday and Friday the venue is OPD.
Tuesday, Thursday venue is operation theatre/ ward
14
MEDICAL TEACHING INSTITUTION
BACHA KHAN MEDICAL COLLEGE MARDAN
Lecture/Practical Time Table For 3rd Year MBBS Student (Session 2020-21)
w.e.f 01/10/2020 Lecture Theater No:02
DAYS
08:00AM-09:00AM
09:00AM-10:00AM
10:00AM-12:00PM
12:00AM-01:00PM
01:00AM-03:00AM
05:00PM—08:00PM
Monday
Pathology
Dr.Mohtasim Billah
Forensic Medicine
Dr.Shagufta Khalid
Hospital Work
EYE
Dr M.Tariq
Practical/Tutorial 1. Pathology (Group-A)
Dr.Bakhtawar /Iram
Evening Hospital Work
2.Pharmacology (Group-B) Dr. Waseem Bukhari
Dr. Husnain
Tuesday
ENT Dr.Imad
Pathology Dr.Aisha Gohar
Hospital Work
Pharmacology Dr.S.M.Khan Jadoon
Practical/Tutorial
1.Pharmacology (Group-A) Dr. Waseem Bukhari Dr. Husnain
Evening Hospital Work
2. Pathology (Group-B)
Dr.Bakhtawar
Wednesday
Pharmacology
Dr.Somia Afzal
Pharmacology
Dr.Halima Sadia
Hospital Work
Pathology
Dr.Zahir Shah
Practical/Tutorial 1. Pathology (Group-A)
Dr.Mehreen Yousaf
Evening Hospital Work
2.Pharmacology (Group-A) Dr. Zahid / Dr. Tufail
Thursday
Pathology
Dr. M.Manzoor
ENT
Dr.Sana Ullah
10:00AM
11:00AM
Pharmacology Dr. S.M-Jadoon
Lecture Theater No.03
11:00AM
12:00PM
Forensic Medicine
Dr.Zaheer Lecture T.No.03
12:00PM
01:00PM
Forensic Medicine
Dr.Abdullah Dr. Taimur
Practical/Tutorial 1.Pharmacology (Group-A)
Dr.Haleema Sadia
Evening Hospital Work
2. Pathology (Group-B) Dr.Mehraan Yousaf
Friday
EYE Dr.Shafqat Ali Shah
Pathology Dr.Nadia
Pharmacology Dr.Imtiaz -Ud- Din
Community Medicine Dr.Huma/ Dr. Fatima
Forensic Medicine Dr.Khalid K Dr.Abdullah
Half Day
Evening Hospital Work
Associate Dean Clinical Associate Dean
BKMC
15
WARD ROTATION SCHEDULE THIRD YEAR MBBS
BKMC SESSION
MEDICAL TEACHING INSTITUTION
BACHA KHAN MEDICAL COLLEGE MARDAN
Time Table For 3rd Year MBBS Hospital ward Duties (Session 2020-21)
(w.e.f 01/10/2020) Medical Surgery Gynae ENT EYE Forensic
Medicine
Pediatrics
(B) (B) (B)
01/10/2019 To 31/10/2019 A B C D E F G
01/11/2019 To 03/12/2019 B C D E F G A
04/12/2019 Winter Vacation Break 23rd
Dec,2019 To 31st Dec,2019
To 15/01/2020
C D E F G A B
16/01/2020 To 18/02/2020 D E F G A B C
19/02/2020 To 24/03/2020 Sports Week 25/03/2020 To
31/03/2020
E F G A B C D
Spring Vacation Break
1st April,2020 To 10th
April,2020
11/04/2020 To 12/05/2020
F G A B C D E
13/05/2020 To 15/06/2020 Summer Vacation Break
15,June,2020 To
31stAugust,2020
G A B C D E F
Associate Dean Clinical Associate Dean BKMC
16
Structure of syllabus 4th year MBBS/BDS
SURGERY TOPICS FOR 4TH YEAR MBBS/BDS
SURGICAL UNIT-A (1/10/2020 to 1/6/2021)
1. Principles of oncology
2. Skin and Subcutaneous tissue
3. Malignant Tumors of skin
4. Lymph edema and its management
5. Venous disorders
6. Arterial disorders
7. Transplantation
8. Pre-Operative care of the surgical patient’s
9. Post op complications, recognition and management
O General
O Specific
10. Head, Face and Neck
O.Developmental abnormalities of face, palate, lips.
O.Oral cavity including tongue.
O.Neck lumps including lymph nodes
11. Surgical Audit
12. Day Case Surgery
13. Plastic Surgery
SURGICAL UNIT-B (15/07/2021 to 28/08/2021)
Trauma Initial management of trauma patient)
• Thoracic trauma and its management
• Abdominal injuries and its management
17
• Head trauma and its management
• Musculoskeletal trauma and its management
• Compartment Syndrome
• Disaster Management
Chest Wall & Thorax
Surgical Management of Ischemic heart disease
Anesthesia
Pediatrics’ Surgery
• The lectures of surgery in 4th year are 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.
18
TIME TABLE FOURTH YEAR MBBS
BKMC MARDAN
Valid from
Due to covid pandemic restrictions continuous changes are made in time table.
Displayed on notice board
19
WARD ROTATION PROGRAM SESSION 4TH YEAR MBBS-----
- -
BKMC MARDAN
Valid from---- -
Due to covid pandemic restrictions continuous changes are made in time table.
Displayed on notice board
20
Ward rotation plan for 4th year MBBS students.
Clinical rotation: 10 days
Learning outcome for clinical teaching 4th year MBBS
Day Topics to be discussed
Facilitator Venue and teaching strategy
Out comes
1 Introduction and orientation Dr. TamjeedGul Ward/OPD/OT
2 History taking Dr. TamjeedGul Ward/OPD/OT Student shall be able to Elicit focused history to assess patient with surgical problem
3 General physical examination Dr. TamjeedGul Ward/OPD/OT Students shall be able to do general physical examination of all body systems in simple and complex situations in all ages and consider the findings in the context of surgical patient presentation
4 Examination of lump, ulcers and other skin lesions
Dr. ZararNiazi Ward/OPD/OT Shall be able to examine these lesion methodologically reach a provisional diagnosis and exclude differentials
5 Examination of abdomen Dr. TamjeedGul Ward/OPD/OT Shall be able to follow all necessary steps of abdominal examination and reproduce the same under observation.
6 Examination of head and neck Dr. TamjeedGul Ward/OPD/OT Shall be able to examine neck for all surgical pathologies
7 Examination of upper and lower limb
Dr. ZararNiazi Ward/OPD/OT Student shall be able to examine the upper and lower limb with emphasis on vascular and neurological examination.
8 Inguino-scrotal examination Dr. TamjeedGul Ward/OPD/OT Shall be able to examine theinguino scrotal area methodologically, reach a provisional diagnosis of scrotal/groin surgical pathologies and exclude differentials.
9 Breast examination Dr. TamjeedGul Ward/OPD/OT Shall be able to take consent for breast examination and follow the protocols for breast examination.
10 Formative assessment log books
Dr. TamjeedGul Ward/OPD/OT Students should be able to take appropriate history and demonstrate general physical and systemic examination of all body systems in simple and complex situations in all ages and consider the findings in the context of surgical patient presentation
Note:
Monday the venue is ward.
Tuesday, Thursday the venue is OPD.
Wednesday and Friday venue is operation theatre.
21
Syllabus of final year MBBS
Lecture distribution MBBS Final Year 2021
Surgical unit A
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
7. Esophagus
8. Stomach and duodenum
9. The benign and malignant disorders of small intestines and small bowel obstruction
10. Management of upper GI Bleed
11.Peritoneum, retro peritoneum and mesentery
12. Abdominal wall hernias (inguinal, femoral, paraumbilical and incisional)
13. Scrotum and testis
14. Acute abdomen, causes, diagnosis and management.
15. Principals of laparoscopy
Surgical unit B
1. Anatomy of large intestine.
2. Clinical features of large intestine diseases.
3. Appendix.
4. Inflammatory bowel disease.
5. Diverticulitis and its complication.
6. Management of lower GI bleed.
22
7. Pediatric surgery
8. Ileostomy and colostomy.
9. Benign and malignant tumors of large intestine including large bowel obstruction.
10. The benign and malignant condition of rectum, the anus and anal canal.
• There will be thrice a week lecture in final year, for 50 minutes
• 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.
23
LECTURE TIME TABLE FINAL YEAR MBBS SESSION ----
2020-2021---
BKMC MARDAN
Valid from---- -
Due to covid pandemic restrictions continuous changes are made in time table.
Displayed on notice board
24
WARD ROTATION PROGRAM FINAL YEAR MBBS SESSION
------2020-2021----- BKMC MARDAN
VALID FROM - -
Due to covid pandemic restrictions continuous changes are made in time table.
Displayed on notice board
25
Ward rotation plan for 5th year MBBS students.
Clinical rotation: 12 days
Learning outcome for clinical teaching 5th year MBBS
Day activity resource person
1 orientation to the unit what photo calls personal safety protocol and prevention of infection policies
PROFESSOR
2 DPR are taking upper GI bleed dysphagia odynophagia + skills
PROFESSOR
3 urolithiasis hematuria + skills PROFESSOR
4 Acute abdomen and abdominal examination +surgical radiology
PROFESSOR
5 Breast lump skills counseling skills breaking bad news
PROFESSOR
6 neck lump examination hypothyroidism and hyperthyroidism parathyroid pheochromocytoma
PROFESSOR
7 chest trauma examination workout and Management
PROFESSOR
8 Burns management, ulcers, cyst and lump
Dr. Zarar Niazi
9 Diabetic foot examination workup and Management
Dr.ZararNiazi
10 skin soft tissue flaps and grafts complications
Dr.ZararNiazi
11 abdominal trauma liver spleen kidney
12 assessment + feedback
26
Final year daily schedule surgical B ward
Day activity resource person
1 orientation to the unit what photo calls personal safety protocol and prevention of infection policies
PROFESSOR
2 history examination and management of inguino scrotal swelling
PROFESSOR
3 History examination of bleeding PR differential diagnosis and Management
PROFESSOR
4 history of jaundice causes examination and management of obstructive jaundice
PROFESSOR
5 History, examination of acute and chronic ischemic limb. Management of ischemia varicose veins and varicose ulcers
PROFESSOR
6 History, examination and management of intestinal obstruction/ intestinal perforation and secondary bacterial peritonitis.
PROFESSOR
7 Wound types and surgical site infection
PROFESSOR
8 Fluid management of surgical pediatrics patients
PROFESSOR
9 History, examination and management of congenital anomalies in pediatrics
PROFESSOR
10 OT protocol /instruments handling /scrubbing gowning
PROFESSOR
11 Stomas/ tubing/drains/misconnections/ potential hazards
PROFESSOR
12 assessment + feedback
27
OUTCOME FOR 3RD YEAR BDS.
At the end of 3rd year BDS 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
• 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
28
SYLLABUS FOR 3RD YEAR BDS.
SURGERY TOPICS FOR 3RD YEAR BDS, BKMC
SURGICAL UNIT-A (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
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-B (26/11/2020 to 28/2/2020)
Trauma Initial management of trauma patient
• Thoracic trauma and its management
• Abdominal injuries and its management
29
• Head trauma and its management
• Musculoskeletal trauma and its management
• Compartment Syndrome
• Disaster Management
Chest Wall & Thorax
Surgical Management of Ischemic heart disease.
Anesthesia
Pediatrics’ Surgery
• The lectures of surgery in 3rd year BDS are 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.
30
TIME TABLE 3RD BDS SESSION
BKMC MARDAN
Valid from
Due to covid pandemic restrictions continuous changes are made in time table.
Displayed on notice board
31
WARD ROTATION PROGRAM 3RD YEAR BDS SESSION-------
- -
BKMC MARDAN
Valid from---- -
Due to covid pandemic restrictions continuous changes are made in time table.
Displayed on notice board
32
ASSESSMENT
Assessment of 3rd year MBBS
NO ASSESSMAENT ASSESSMENT TOOL NUMBER AND TIME OF TEST
1 LOW STAKE ASSESSMENT
SHORT ASSAY QUESTIONS
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 MBBS/ 3RD YEAR BDS
NO ASSESSMENT ASSESSMENT TOOL NUMBER AND TIME OF ASSESSMENT TOOL
1 LOW STAKE ASSESSMENT
SHORT ASSAY QUESTIONS AND MCQs
At the end of each topic mentioned in the syllabus 6 class tests One will be short assay question and 10 MCQs.
2 LOW STAKE ASSESSMENT
Mini CEX. To assess history taking and communication skills And examination skills
One at the end of ward rotation
33
Assessment of final year MBBS
NO ASSESSMENT ASSESSMENT TOOL NUMBER AND TIME OF ASSESSMENT TOOL
1 LOW STAKE ASSESSMENT
SHORT ASSAY QUESTIONS AND MCQs
At the end of each topic mentioned in the 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 conducted byBKMC. Comprising: MCQ= SEQ= OSCE=
At the end of final year
34
DETAILED SYLLABUS 3RD YEAR MBBS
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
none
1 Surgical Nutrition
Lecture 1 Assistant professor or above
MCQ
2 Sterilization and Disinfection
Lecture 1 Assistant professor or above
MCQ
3 3 Surgical infection
Lecture 5 Assistant professor or above
MCQ and short essay question
4 Antimicrobials and tetanus prophylaxis in surgery
Lectures 3 Assistant professor or above
MCQ and short essay question
Low stake class assessment
5 Wounds, ulcers, Tissue Repair and scars
Lectures 4 Assistant professor or above
MCQ and short essay question
6 Burns and management
Lectures and SGD
5 Assistant professor or above
MCQ and short essay question
7 Preoperative preparation of a surgical patient
SGD Lectures 3 DO DO
8 Post-operative care of a surgical patient
DO 3 DO DO
Low stake class assessment
35
9 Metabolic response to injury
Lectures 3 DO MCQ
10 Shock Lectures and SGD
5 DO SEQ and MCQ
11 Blood and blood product transfusion
SGD 3 DO MCQ
12 Fluid and electrolyte and acid base disturbances
Lectures 2 DO MCQ
13 Pain relief SGD 2 DO MCQ and SEQ
Low stake class assessment
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Detailed syllabus 4th year MBBS/BDS
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 Assistant professor or above
MCQs
2 Skin and subcutaneous tissues
DO 6 DO SEQs
3 Infection DO 1 DO SEQs
4 Surgical site infections
DO 2 DO MCQs
5 Skin tumor DO 1 DO MCQ
6 Gas gangrene DO 1 DO SEQs
7 Malignant melanoma
DO 1 DO MCQs
8 Cysts and others IGTN
DO 1 DO MCQs
Class test
Lymph edema and its management
9 lymphedema Lectures 1 DO MCQs
ARTERIAL DISORDERS
10 Hemorrhagic shock
Lectures and SGD
1 DO SEQs
11 Arterial occlusion-1
Lectures and SGD
1 DO SEQs
12 Arterial occlusion -2
Lectures and SGD
1 DO MCQs
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13 Critical limb ischemia and gangrene
Lectures and SGD
1 DO MCQs
14 Amputation Lectures and SGD
1 DO MCQs
15 Aneurysm Lectures and SGD
1 DO SEQs
VENOUS DISORDERS
16 VERICOSE VEINS/deep vein incompetence
LECTURE 1 Assistant professor or above
MCQs
17 DVT/leg ulceration
Lecture 1 DO MCQs
18 Transplantation Lecture 1 DO MCQs
19 Pre-operative care of surgical patient
DO 1 DO SEQs
CLASS TEST
20 Post op complications, recognition and management
Lecture 5 SEQs
21 Head, Face and Neck O.Developmental abnormalities of face, palate, lips. o. Oral cavity including tongue. o.Neck lumps including lymph nodes
Lectures 6 DO MCQs
CLASS TEST
22 SURGICAL AUDIT LECTURES 3 DO MCQs
23 DAY CASE SURGERY
LECTURES 3 DO SEQs
24 PLASTIC SURGERY
LECTURES 5 DO MCQs
CLASS TEST
25 Thoracic trauma and its management
LECTURES 4 Assistant professor or above
SEQs
26 Abdominal injuries and its management
LECTURES 5 Assistant professor or above
SEQs
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CLASS TEST
27 Head trauma and its management
lectures 3 Assistant professor or above
MCQs and SEQs
28 Musculoskeletal trauma and its management
DO 4 DO MCQs
29 Compartment syndrome
lectures 2 DO MCQs and SEQs
30 Disaster management
Lectures 2 DO MCQs
31 Surgical Management of Ischemic heart disease. Anesthesia
Lectures 2 DO MCQs and SEQs
32 Pediatrics surgery
lectures 3 DO MCQs and SEQs
CLASS TEST
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Detailed syllabus of final year MBBS
N TOPIC LEARNING STRATEGY
RESOURCE PERSON NUMBER OF LECTURE S
ASSESSMEN T TOOL
Orientation to ward, OPD, ER and OR Description of syllabus and details of competencie s to be achieved One lecture and 1st day of ward
1 THE THYROID AND PARATHYROID GLANDS THE ADRENAL GLANDS
LECTURES AND BED SIDE TEACHING AND OMP
PROFESSOR/ASSOCIA TE PROFESSOR
9 MCQ AND SEQ
2 DISORDERS OF THE SALIVARY GLANDS
LECTURES AND SGD, BED SIDE TEACHING AND OMP
DO 5 MCQ AND SEQ
CLASS TEST
3 BENIGN AND MALIGNANT CONDITIOS OF BREAST
DO DO 5 DO
4 LIVER,SPLEEN, GALLBLADER AND BILE DUCTS
DO DO 9 DO
CLASS TEST
5 BENIGN AND MALIGNANT CONDITIONS OF PANCREASE
DO DO 6 MCQ AND SEQ
6 BARIATRIC SURGERY DO DO 3 DO
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CLASS TEST
7 ESOPHAGUS DO DO 4 MCQ AND SEQ
8 STOMACH AND DUODENUM DO DO 4 DO CLASS TEST
9 The benign and malignant disorders of small intestines and small bowel obstruction
DO DO 4 MCQ AND SEQ
1 0
Management of upper GI Bleed
DO DO 3 DO
1 1
Peritoneum, retroperitoneum and mesentery
DO DO 3 DO
CLASS TEST
1 2
Abdominal wall hernias (inguinal, femoral, paraumbilical and incisional)
DO DO 4 MCQs AND SEQs
1 3
Scrotum and testis DO 4
1 4
Acute abdomen, causes, diagnosis and management.
LECTURES AND SGD, BED SIDE TEACHING AND OMP
PROFESSOR/ASSOCIA TE PROFESSOR
4 MCQs AND SEQs
1 5
PRINCIPLES OF LAPAROSCOPY LECTURES AND SGD, BED SIDE TEACHING AND OMP
PROFESSOR/ASSOCIA TE PROFESSOR
3 MCQs AND SEQs
1 6
PEDIATRIC SURGERY LECTURES AND SGD, BED SIDE TEACHING AND OMP
PROFESSOR/ASSOCIA TE PROFESSOR
4 DO
CLASS TEST
1 7
ANATOMY OF LARGE INTESTINE
LECTURES AND SGD, BED SIDE TEACHING AND OMP
PROFESSOR/ASSOCIA TE PROFESSOR
3 MCQs AND SEQs
1 8
Clinical features of large intestine diseases.
DO DO 5 DO
1 9
APPENDIX DO DO 3 DO
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CLASS TEST
2 0
INFLAMMATORY BOWEL DISEASE
LECTURES AND SGD, BED SIDE TEACHING AND OMP
PROFESSOR/ASSOCIA TE PROFESSOR
4 MCQs AND SEQs
2 1
DIVERTICULOSIS AND ITS COMPLICATION/MANAGEME NT
DO DO 4 DO
2 2
MANAGEMENT OF LOWER GI BLEED
DO DO 4 DO
2 3
ILEOSTOMY AND COLOSTOMY
DO DO 4 DO
CLASS TEST
2 4
Benign and malignant tumors of large intestine including large bowel obstruction.
LECTURES AND SGD, BED SIDE TEACHING AND OMP
PROFESSOR/ASSOCIA TE PROFESSOR
4 MCQs AND SEQs
2 5
The benign and malignant condition of rectum, the anus and anal canal
DO DO 5 DO
CLASS TEST
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Clinical rotations
NO CLASS RESOURSE PERSON
WARD DAYS TIME INSTRUCTIONAL STRATEGIES
1 CLASS 3RD DR Bed side YEAR MBBS AURANGZEB teachings in KHAN SU 1 wards. , DR ASIF Problem based IMRAN SU 2 teachings DR IBRAHIM SGD SHUJA SU 1 OMP in OPD Role plays for communication skill
2 CALSS 4TH DR TAMJEED Bed side YEAR MBBS GUL SU1 teachings in AND 3RD YEAR DR IBRAHIM wards. BDS SHUJA SU 2 CASE based DR ASIF teachings IMRAN SU 3 SGD DR OMP in OPD AURANGZEB Role plays for SU4 communication skill
3 FINAL YEAR PROF DR M Bed side MBBS HUSSAIN SU1 teachings in PROF DR wards. AJMAL KHAN Case based SU2 teachings ASSOCIATE Team based PROF DR teachings MUKHTIAR ALI Shadowing of the house officer SGD OMP in OPD Role plays for communication skills Skill lab teachings
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Attendance and progress cards
A total of 75% attendance is to be shown in lectures and hospital duties, failing
which the student is not allowed sitting in the final surgery exam as per University
rules, so please keep a good record of attendance in the ward as well as in the
lectures. Progress card has to be complete and signed by the respective teacher.
This internal assessment has 10% marks in the exams in theory as well as practical.
Case History Books
These are available from the college. This has space for history writing for3rd, 4th,
5th year MBBS separately. Please make sure they complete their required histories
while they are on surgical ward duty. This shall be checked and signed by the SR
surgery on their last day in the ward.
STUDENTS PERFORMANCE &RECORD OF CLINICAL WORK (PORTFOLIO)
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Exam Setup
Final professional Surgery examination has the following components
Total marks: 500
Minimum Pass Marks: 250 (Including marks of internal assessment)
Theory:
Total Theory Marks= 200
Paper A: 90 Marks (45 marks MCQs and 45 marks SEQs)
Paper B: 90 Marks (45 marks MCQs and 45 marks SEQs)
Internal Assessment Theory:
Total 20 marks (10 percent of 200)
Practical Exam: Total Practical Marks=300 Marks
Part 1
Stations:Total Marks = 120
OSCE (Objectively Structured Clinical Exam) Stations, Total Stations =15
Interactive Stations = 7 (70 marks), Static Stations = 5 (50 marks),
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Rest Station= 3 (No marks)
Part 2: Long case --70 marks(35 marks with each examiner)
Part 3: Short case -- 80 marks (40 marks with each examiner)
Four short cases will be included each with 20 Marks
Internal assessment practical: 30 Marks (10 percent of 300)
Syllabus for theory paper
There are two Surgery papers A and B each of 90 marks. Each paper has 12 Short essay questions. Student
has to attempt 9 questions with a good choice. All questions carry equal marks that are 5. .Student writes
each question on a separate page in the answer book. Each answer book is factitiously numbered by the
university and centralized marking is carried out by different examiners in KMU.From 2014onwards the
theory paper include 45 MCQs, each carry 1 mark.
Surgery Paper A
Injuries and diseases of bones and joints, muscles, tendons, and bursae, deformities, Head and
spine, central and peripheral nervous system, Face, Lips and palate, Teeth, gums, Jaws, Nose and orbit,
Mouth, Tongue, Cheeks, Salivary glands, Neck, Thyroid, Parathyroid, Thymus and Adrenal glands and all
other endocrine system, Breast, Pharynx, Larynx. Acute infection and wounds, Chronic infectious disease
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and Parasites, Tumors and cysts, Hemorrhage, Blood transfusion and Shock, Fluids, electrolytes and acid
base balance, Skin, Burns, Arteries and veins, Lymphatics and lymph nodes, Infection.
Surgery Paper B
Thorax, Esophagus, Stomach and duodenum, Spleen, Liver and extra hepatic biliary system,
Pancreas, Peritoneum. Intestines including intestinal obstruction, Vermiform appendix, Rectum and anal
canal, umbilicus and abdominal wall, genitourinary system
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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 Browses’ introduction to the symptoms and signs of surgical diseases.