A specialty society of the Philippine College of Surgeonsrecognized by the Philippine Medical Association

Philippine Society of General Surgeons, Inc.

STANDARDIZED CURRICULUM(Outcome Based Education)

IN

GENERAL SURGERY

2017

Foreword

The PSGS Surgical Curriculum is intended to prepare our residents in training to becomecompetent practitioners, researchers, and administrators and to achieve these goals, the2012 iteration of the PSGS Curriculum utilized the conventional competency-based educationsystem. In recent years however, greater attention has been given to evaluating the outcomesof education to account for the returns in investments made in education. This increasingemphasis on accountability is a major reason for the rapid spread of various forms of outcome-based education in all fields including the surgical specialties.

Furthermore, recent regional developments aimed at improving global competitiveness ofour graduates such as the ASEAN Mutual Recognition Agreement, the ASEAN QualificationsReference Framework, our government issued Executive Order No. 85 s. 2012 - PhilippineQualifications Network and the CHED Memorandum Order No. 45 s. 2012 require our societyto comply with these national directives to ensure continued accreditation and recognition ofour training programs.

This new surgical curriculum is indeed a paradigm shift in the method of teaching and trainingour residents. An outcome-based curriculum means starting with a clear picture of what isimportant for our graduates to be able to do. Now it is our desired exit learning outcome forour graduates, what they can do after 5 years of surgical training, which was selected firstand the curriculum, instructional materials, and assessments created to support these intendedoutcomes. Therefore, henceforth all our curriculum and teaching decisions must be madebased on how best we can support and facilitate our desired outcomes.

These times are indeed quite exciting. Cognizant of all these evolving changes, we haveundertaken, as a society, to align the PSGS curriculum with the requirements for ASEANintegration. Adopting Outcome Based Education will undoubtedly place our fellows andgraduates at par with our fellow surgeons in the region and establish our globalcompetitiveness.

In behalf of the 2016 Board of Directors and the society, I would like to thank the Committeechair Dr. Deo Reyes and his members ..... who have dedicated their valuable time and effortfor the completion of the 2016 PSGS Standardized Outcome Based Curriculum in GeneralSurgery.

Domingo S. Bongala Jr, MD, FPCS, FACS, FPSGS, FPALESPresidentPSGS, 2016

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PrefaceFOURTH EDITION

The opportunities of our PSGS Fellows for foreign training in others countries like the US, Europe, India,Singapore and Vietnam and the available expertise in the Medical Health Profession Education andHealthcare Management greatly provided support in formulating revisions in this new curriculum. Theglobalization of healthcare and the focus on Patient Safety worldwide also guided the committee toaddress not only the improvements in cognitive and psychomotor skills needs of our learners as statedin Blooms Taxonomy of Learning but we also strengthened Values Formation. The goals of training arefocused on developing Safe, Competent and Ethical surgeons with basic clinical teaching abilities,knowledge in academic and clinical research and with good leadership and managerial skills. Thecurriculum is now divided in three broad topics namely Medical Knowledge, Patient Care and ProfessionalGrowth. We updated the medical knowledge parts and integrated new concepts, practice guidelinesand advancement in surgical technology. The patient care part is upgraded and updated based onglobally accepted practice. We added topics in professional growth to enhance value formation to thisfuture leader and managers of our society and most of all to make them good role models for the nextgenerations of trainees.

The new curriculum includes the following: 1) Clinical Nutrition

2) Clinical Teaching3) Patient Safety4) Professionalism5) Leadership & Management

The course content has also been updated based on recent global trends in health care.

The part of Minimal Invasive Surgery has been greatly enhanced based on standards of Society ofAmerican Gastrointestinal and Endoscopic Surgeons (SAGES) and European Association for EndoscopicSurgery (EAES).

The updates for MIS training had been collaboratively established with representatives from PhilippineAssociation of Laparoscopic and Endoscopic Surgeons (PALES).

The proposed revised curriculum was again presented in the PSGS Forum last August 6, 2011 for finalcomments and ratification.

We would like to extend our appreciation to the pioneer PSGS CST chairman, Dr Gabriel Martinez whosent several comments and recommendations for the improvement of the curriculum. We would like toextend also our warmest gratitude to the guidance and support of the PSGS Board most especially ourpresident, Dr. Ervin Nucum and our Director in charge, Dr Rex Madrigal in pursuing this endeavor. Wewould like to thank the generosity of B. Braun Medical Supplies through its continuing education arm,Aesculap Academy for its never-ending support to the Committee on Surgical Training since we startedwith the 3rd edition last 2005 until today. We also would like to give credit to Dr. Luisito Llido, one of thepioneers of Surgical Nutrition in our country for sharing his expertise not only in the curriculum but alsoto the training modules in this area.

Finally, I would like to send my deepest gratitude to the Committee on Surgical Training members mostespecially to Drs. Malen Gellido, Deo Reyes, Warren Roraldo and Michael James Busa who sacrificedtheir time and talents in attending almost all the meetings and fulfilling their respective tasks andassignments in this revision. You are a distinguished league of selfless and dedicated surgical educatorsand it is my great pleasure working with you.

Shirard Leonardo C. Adiviso MD, MHPEd, FPCS, FPSGSChairmanPSGS Committee on Surgical Training, 2011

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PrefaceFIFTH EDITION

The journey of revising the 2012 Curriculum for General Surgery was a humbling experience. The scopeof the undertaking necessitated a level of engagement that brought to fore the best of the societyfellows. Indeed the collective interest for training the next generation of surgeons is alive with muchpassion.The integration of the ASEAN states in 2015 opened up possibilities for surgeons: 1] a new level ofrecognition in training competitiveness and associated opportunities was provided; 2] the possibility ofmutually expanded practice was formalized and 3] unhampered exchange of expertise and technologywas laid out as policy.Multilateral workshops were conducted to assess the 2012 embodiment. Stakeholders found the contentto be locally relevant, regionally competitive complemented with well-constructed instructional designs.Historically, the 2012 Curriculum had a predominantly competency-based structure that emphasizedtechnical learning. To prepare and align with the ASEAN Mutual Recognition Arrangements (MRA),Outcome Based Education was adopted. This curriculum structure will implement a higher order oflearning in surgery.Surgeon roles in the Philippine context were updated and served as the starting point of the revisedcurriculum. The Filipino surgeon is meant to be: 1] a professional, competent and ethical practitioner ofsurgery; 2] an educator immersed in training residents as well as consistent in complementing surgicaltreatment with patient education; 3] a researcher keen to grow the body of relevant surgical knowledge;4] a leader / manager who possesses the ability to appreciate and respond to the challenges of practicewith a systems approach and lastly; 5] a social advocate able to drive nation-building through thepractice of surgery.After defining surgeon roles in relation to national needs, operational definitions were constructed basedon the core competencies needed and then matched with corresponding performance indicators.As the details were put in place, a curriculum map illustrated the timing and level of implementation.And lastly, an updated concept map aligned with the surgeon roles was crafted to present the curriculumstructure in a succinct illustration. The new curriculum will be invaluable in achieving program outcomesacross all training programs in the country.The new curriculum is cognizant that clinical material has become a concern for training programs. Assuch, emphasis was placed on simulation modalities to fill in this gap and optimize clinical work.Another highlight of the revision is the introduction of surgical endoscopy. This is meant to lay thefoundation for deeper learning of this relevant and emerging discipline.As the new curriculum is adopted, the Committee on Surgical Training will move on to develop qualityassessment tools that will assess procedures performed. These tools will collectively capture clinicaloutcomes of the trainees and the training programs with the intention of transcending the number ofprocedures performed as the sole indicator of competence. In the future, a more holistic grasp of trainingoutcomes is needed.I would like to take this opportunity to acknowledge the past committees that consolidated the output ofall the workshops that paved the way for this revision. Much appreciation is extended to the fellows whocontributed to the appended instructional designs, Drs. Josefina R. Almonte, Gabriel L. Martinez andRaymund Andrew G. Ong.My sincerest thanks to the Director-in Charge, Dr. Michael Co Del Mar for the constant support. To thecommittee members who devoted themselves to the journey; Drs. Shirard Leonardo C. Adiviso, MichaelJames C. Busa, Carlo Angelo C. Cajucom, Dindo J. Cajucom, Malen M. Gellido and Grace Emilie Z.Santiago. Your dedication for developing next generation surgeons is much appreciated.And lastly, to my mentors, Drs. Josefina R. Almonte, Armando C. Crisostomo and Alberto B. Roxas forguiding and showing me the way.The true measure of competence is training.

Deogracias Alberto G. Reyes, MD, MMAS, MBA, FPCS, FPSGS, FPALESChairmanAd Hoc Committee on the Revision of the Surgical Curriculum, 2016

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Dedication

This Manual is dedicated to our mentors who with their unselfish guidance ushered us tobecome the trainers and educators they wanted us to be;

To the trainers and training residents in General Surgery, may their pursuit of continuingsurgical education and quality surgical care endure and prevail over the challenges ofthe changing times;

To the unsung and unappreciated heroes of the surgical profession, may they furnish theinspiration for future generations of surgeons;

And to the future generations of General Surgeons, may you continue and uphold theideals of the surgical profession and become ethical, safe, and compassionate surgeons.

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AcknowledgementsThe committee would like to acknowledge and thank the presidents who oversaw and thecommittee chairmen who crafted the past embodiments of the curriculum:

Arturo E. Mendoza, Jr., MD, FPSGSPresident, 2006

Reynaldo M. Baclig, MD, FPSGSPresident, 2007

Ervin H. Nucum, MD, FPSGSPresident, 2011

First EditionJose Y. Cueto, Jr., MD, FPCSChairmanPCS Committee on Surgical Training, 1995

Second EditionGabriel L. Martinez, MD, FPCSChairmanPCS Committee on Surgical Training, 2000

Third EditionGabriel L. Martinez, MD, FPCS, FPSGSChairmanPSGS Committee on Surgical Training, 2005-2007

Fourth EditionShirard Leonardo C. Adiviso MD, MHPEd , FPCS, FPSGSChairmanPSGS Committee on Surgical Training, 2011

Ad-Hoc Committee for the Revision of the Curriculum

Deogracias Alberto G. Reyes, MD, FPCS, FPSGSChairman

Shirard Leonardo C. Adiviso, MD, FPCS, FPSGSMichael James C. Busa, MD, FPCS, FPSGSCarlo Angelo C. Cajucom, MD, FPCS, FPSGSDindo J. Cajucom, MD, FPCS, FPSGSMalen M. Gellido, MD, FPCS, FPSGSGrace Emilie Z. Santiago, MD, FPCS, FPSGS

Michael Co. Del Mar, MD, FPCS, FPSGSDirector-in-charge

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Table of Contents

Foreword............ ......................................................................................................................... ii

PrefacesFourth Edition ........................................................................................................................ iiiFifth Edition ............................................................................................................................ iv

Dedication....... ............................................................................................................................ .v

Acknowledgements ..................................................................................................................... vi

1.1 Vision Mission of the Philippine Society of General Surgeons ..................................................11.1.1 Vision ...................................................................................................................................11.1.2 Mission ................................................................................................................................1

1.2 Description of the General Surgery Training Program ..............................................................11.2.1 Outcome Based Education ................................................................................................11.2.2 Elements of the Program ...................................................................................................21.2.2.1 Surgeon Roles .................................................................................................................21.2.2.2 Program Educational Outcomes / Objectives ...............................................................2

1. Demonstrate Clinical Competence .................................................................................21.2.2.3 Operational Definition of Program Educational Objectives ..........................................31.2.2.4 Learning Outcomes, Competency Standards and Performance Indicators ................41.2.2.5 Levels of Training ............................................................................................................71.2.2.6 Intended Learning Outcomes..........................................................................................7

Junior Resident ......................................................................................................................7Intermediate Resident ............................................................................................................8Senior Resident ......................................................................................................................8

1.2.2.7 Course Content ...............................................................................................................91.2.2.7.1 Principles of Basic Surgery .........................................................................................91.2.2.7.2 Clinical Surgery-General Surgery ..............................................................................131.2.2.7.3 Clinical Surgery - Other Specialties ..........................................................................181.2.2.7.4 Principles of Surgical Diagnostics ............................................................................191.2.2.7.5 Teaching-Learning Activities ......................................................................................201.2.2.7.6 Organization and Sequence of Rotations .................................................................211.2.2.7.7 Resources ..................................................................................................................221.2.2.8 Evaluation.......................................................................................................................231.2.2.8.1 Resident Performance ...............................................................................................231.2.2.8.2 The Program...............................................................................................................23

2.1 Surgeon Roles ...........................................................................................................................252.1.1 Clinician ...........................................................................................................................252.1.1.1 Junior Resident ..............................................................................................................252.1.1.2 Intermediate Resident ...................................................................................................302.1.1.3 Senior Resident .............................................................................................................362.1.1.4 Plastic Surgery ..............................................................................................................392.1.1.5 Pediatric Surgery ...........................................................................................................402.1.1.6 Orthopedic Surgery .......................................................................................................412.1.1.7 Neurosurgery Surgery ...................................................................................................432.1.1.8 Thoracic and Cardiovascular Surgery..........................................................................452.1.1.9 Urologic Surgery ............................................................................................................462.1.1.10 Trauma .........................................................................................................................472.1.1.11 Minimal Access Surgery ..............................................................................................482.1.1.12 Surgical Nutrition .........................................................................................................552.1.2 Educator ...........................................................................................................................572.1.3 Researcher ......................................................................................................................582.1.4 Leader-Manager-Professional .....................................................................................592.1.5 Social Advocate ..............................................................................................................60

2.2 Curriculum Map .........................................................................................................................61

3.1 Components of Evaluation ........................................................................................................623.1.1 Basic Theoretical Knowledge ..........................................................................................623.1.2 Clinical Competence ........................................................................................................633.1.3 Technical Skill ...................................................................................................................633.1.4 Attitudinal Competencies ..................................................................................................64

3.2 Minimum Pass Rating and Computation ..................................................................................64

3.3 Comprehensive External Residents Evaluation System (CERES)........................................65

3.4 PSGS Integrated Assessment In Minimal Access Surgery (PIAM) .........................................66

3.5 Observed Structured Assessment of Technical Skill (OSATS) .............................................67

3.6 National Surgical Specialty Assessment Test (NSSAT) ..........................................................67

3.7 Provisions for Feedback ...........................................................................................................68

Appendices ...................................................................................................................................69

APPENDIX I-A. Evaluation of Cognitive Competencies ..........................................................691.1 Junior Year ....................................................................................................................691.2 Intermediate Years ......................................................................................................701.3 Senior Years .................................................................................................................70

APPENDIX I-B. - Evaluation of Psychomotor Competencies .................................................701.1 Junior Year ......................................................................................................................701.1.1 Technical Skills / Pre-Op ............................................................................................701.1.2 Operative Skill .............................................................................................................701.1.3 Post-Operative Care ...................................................................................................71

1.2 Intermediate Years .........................................................................................................711.2.1 Pre-Op Care, Operative Performance and Post-Operative Care

of the Specialty Procedures .....................................................................................711.2.2 General Surgical Procedures .....................................................................................72

1.3 Senior Years ...................................................................................................................721.3.1 Selected Specialty Procedures ..................................................................................721.3.2 Radical and Complex General Surgical Operations .................................................731.3.3 Other Specialties ........................................................................................................731.3.4 Minimal Access Surgery .............................................................................................731.3.5 Surgical Endoscopy ....................................................................................................73

APPENDIX II-A. Rating Scale (Rubrics) for Oral Examinations ...................................................74

APPENDIX II-B. Rating Scale (Rubrics) for Overall Clinical Competence ...................................76

APPENDIX II-C. Rating Scale (Rubrics) for Technical Skills ........................................................79

APPENDIX II-D. Rating Scale (Rubrics) for Attitudinal Competencies .......................................81

APPENDIX II-E. OSATS Template for Diagnostic Laparoscopy ...................................................84

APPENDIX II-F. OSATS Template for Laparoscopic Appendectomy ............................................85

APPENDIX II-G. OSATS Template for Laparoscopic Cholecystectomy .......................................86

APPENDIX II-H. PASE Log Sheet for PEG Transfer ......................................................................87

APPENDIX II-I. PASE Log Sheet for Pattern Cut ..........................................................................88

APPENDIX II-J. PASE Log Sheet for Extracorporeal Knot ............................................................89

APPENDIX II-K. PASE Log Sheet for Intracorporeal Knot .............................................................90

APPENDIX III. Duration of Surgery By Nnis Operative Procedure Category ................................91

APPENDIX IV. Surgical Residents' Evaluation Sheet ...................................................................92

APPENDIX V. Sample Course Design: The Resident as an Educator ........................................94

APPENDIX VI. Sample Course Design: Basic Research and Evidence Based Surgery for General Surgery Residents ..............................................................................95

APPENDIX VII. Sample Course Design: Research Proposal for General Surgery Residents..................................................................................................97

APPENDIX VIII. Sample Course Design: Oral Presentation of a Research Paper for General Surgery Residents ..................................................................................99

APPENDIX IX. Guidelines and Criteria for Eligibility to Take the Certifying Examinations in General Surgery ................................................................................................... 100

ENDNOTES ................................................................................................................................ 103ENDNOTE I - History and Development of the Curriculum.................................................. 103ENDNOTE II - Basis of the Evaluation System as of 2012 Curriculum .............................. 105

References ................................................................................................................................ 106

1

Part 1

1.1 Vision Mission of the Philippine Society of General Surgeons

1.1.1 VisionTo be the globally-recognized organization of General Surgeons in the Philippines by 2020.

1.1.2 MissionEnsure the development of General Surgery as a premiere and distinct specialtyPursue world-class, competent, and ethical surgical education and training to our residents andfellows

Deliver safe and compassionate service to our patients.

1.2 Description of the General Surgery Training ProgramAs an educational document, the surgical curriculum serves as the written plan of action forgeneral surgery residency training program. It contains the program of studies, the course content,the planned learning experiences and the intended learning outcomes. It identifies the resourcesneeded for the program, and provides a system for assessing the performance and thecompetence of residents.

1.2.1 Outcome Based Education

Outcome-based education (OBE) "refers to clearly focusing and organizing everything in theeducation system around what is essential for all students to be able to do successfully at theend of their learning experiences. This means starting with a clear picture of what is importantfor students (residents) to be able to do, then organizing the curriculum, instruction andassessment to make sure that learning ultimately happens" (Spady, 1994).

Specification of outcomes reflects a "design-down" process from a broad perspective of whatis to be achieved by the students at the end of the curriculum to a more specific perspective ofwhat is to be achieved at different stages of the curriculum (L. Abarquez, 2010).

OBE can simply be considered as a process of learning, instruction or training that "begins withthe end in mind." The PSGS and its mission and vision in general and individual training programsin particular, largely define what kind of general surgeons have to be trained in order to bestserve the needs of Philippine Society or be adaptable in the global setting. The goals in thiscurriculum are what we want our residents to ultimately be, through achievement of more specificobjectives per year level; the necessary training and learning activities of which are designed,planned, funded and implemented using resources meaningfully aimed at attaining saidobjectives and goals.

The Surgical Curriculum

2

By utilizing the OBE method, we are assured that our training process and consequently ourgraduates are at par with current global standards; specifically addressing our need to alignwith the Association of Southeast Asian Nations (ASEAN) qualifications framework, in anticipationof the impending ASEAN integration.

1.2.2 Elements of the Program

1.2.2.1 Surgeon Roles

1.2.2.2 Program Educational Outcomes / Objectives

1. Demonstrate clinical competence 2. Communicate effectively 3. Lead and manage healthcare teams 4. Engage in research activities 5. Collaborate with inter-professional teams 6. Utilize systems-based approach to healthcare 7. Engage in continuing personal and professional development 8. Adhere to ethical, professional and legal standards 9. Demonstrate nationalism, internationalism and dedication to service10.Create models and processes of social accountability

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1.2.2.3 Operational Definition of Program Educational Objectives

Program Educational Objectives / Outcomes Operational Definition

NOTE: must be higher order skills/outcomes

1. Demonstrate clinical competence

2. Communicate effectively

3. Lead and manage health care teams

4. Engage in research activities

5. Collaborate with inter-professional teams

6. Uti l ize systems-based approach tohealthcare

7. Engage in continuing personal andprofessional development

8. Adhere to ethical, professional and legalstandards.

9. Demonstrate nationalism, internationalismand dedication to service

10. Create models and processes of socialaccountability

Competently manage clinical conditions of surgical patientsin various settings. Includes Patient care, Medicalknowledge, and Technical procedural skills

Convey information, in written, oral and para-verbal formats,across all types of audiences, venues and media in amanner that can be easily understood

Initiate planning, organizing, implementation, and evaluationof health programs and facilities,

Provide clear direction, inspiration, and motivation to thehealthcare team/community

Utilize current and critically-appraised research evidencein decision making as practitioner, educator or researcher,

Participate in research activities.

Effectively work in teams with co-physicians and otherprofessionals in managing clients, institutions, projects, andsimilar situations

Utilize systems-based approach in actual delivery of care,including but not limited to, Safety and Quality in HealthCare, Physician Advocacy, Health Insurance, Health CareEconomics, Transition of Care, Different Health CareSystems, Pay for Performance, Patient-centered Home, andChronic Care.

Network with relevant partners in solving general healthproblems

Update oneself through a variety of avenues for personaland professional growth to ensure quality healthcare andpatient safety.

Adhere to national and international codes of conduct andlegal standards that govern the profession.

Demonstrate love for one's national heritage; participate innation-building, Respect for other cultures and commitmentto serve humanity.

Address the priority health concerns of the patients, families,community, region and nation by adhering to the principlesof relevance, equity, quality, and cost effectiveness in thedelivery of healthcare.

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1.2.2.4 Learning Outcomes, Competency Standards and Performance Indicators

Learning Outcomes

1. Competently manageclinical conditions invarious settings

2. Convey information, inwritten, oral and otherformats, across alltypes of audiences,venues and media in amanner that can beeasily understood

3. A. Initiate planning,organizing,implementation, andevaluation of programsand health facilities,

B. Provide cleardirection,inspiration, andmotivation to thehealthcare team/community

Competency Standards

Given a clinical situation in any setting/workplace, the surgical resident should beable to:1. Establish effective rapport2. Obtain accurate history3. Perform thorough physical examination4. Formulate appropriate diagnostic plan

including a list of differential diagnosisand established clinical diagnosis

5. Develop and implement a patient-centered management plan

6. Maintain accurate and completemedical records

7. Refer cases appropriately8. Humbly accepts limitations

Given various settings and purposes, thesurgical resident should be able to:1. Listen actively to process information2. Explain clearly relevant information to

patient and family3. Secure patient's cooperation and

consent4. Communicate effectively with other

health professionals and stakeholders5. Utilize information technology

efficiently6. Convey messages effectively using

various forms of communication

Given a program to manage or a healthteam to lead, the surgical resident shouldbe able to:1. Initiate planning, organizing,

implementation and evaluation ofprograms and health facilities.

2. Provide clear direction, inspiration andmotivation to the healthcare team

Performance Indicators

1. Comprehensive portfolio ofactivities enumerating successfulclinical cases and problemssolved, clinical proceduresperformed, including those withcomplications and how they wereresolved,

2. Satisfactory performance in theResidency In-TrainingExaminations or any similar orparallel activity.

3. Certificate of satisfactorycompletion of surgical training inthe hospital and/or appropriatespecialized health care facility.

1. Submit actual communication,plan, lesson plan, presentationfor public or lay forum, etc.,educating a given audience onselected health issues

2. Competently use information andcommunication technology in thepresentations for better, and moreconvenient exchange

1. Submission of actualorganization and managementplan implemented to addresscertain health issues or problemsduring formal surgical training

2. Actual statements of support,policy statements, and positionpapers calling on selectedconstituents to support givenhealth issues

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Learning Outcomes

4. A. Utilize currentresearch evidence indecision-making aspractitioner, educator orresearcher,

B. Participate inresearch activities.

5. Effectively work inteams with co-physicians and otherprofessionals orinstitutions, in patientcare

6. A. Utilize systems-based approach inactual delivery of care,

B. Network with relevantpartners in solvinggeneral healthproblems

7. Update oneself througha variety of avenues forpersonal andprofessional growth toensure qualityhealthcare and patientsafety.

Competency Standards

Given different data and information, thesurgical resident should be able to:1. Critically appraise relevant literature2. Apply research findings into practice

appropriately

Given a clinical dilemma, the surgicalresident should be able to:1. Formulate sound, relevant. and viable

research questions2. Consider an appropriate research

design3. Gather data systematically,4. Apply appropriate statistical analysis,5. Write a cohesive research paper, and6. Disseminate research outputs

Given different scenarios, the surgicalresident should be able to collaborateappropriately with other healthcareproviders and other health professionalgroups to adequately take care of patientsand related concerns

Given a clinical situation in any setting/workplace, the surgical resident should beable to:1. Relate social determinants to health

and illness,2. Utilize each component of the health

system for optimum care3. Advocate for partnership with related

government and non-governmentagencies

4. Advocate patient safety and qualityhealth care utilizing rational healtheconomic realities

Given different scenarios in any workplace,the surgical resident should be able to:1. Pursue lifelong learning and personal

growth,2. Acquire transferrable skills3. Demonstrate integrity, humility,

compassion, gender-sensitivity,resourcefulness

Performance Indicators

1. Present a comprehensiveresearch portfolio

2. Submit actual critical appraisalsof relevant literature,

3. Submit copies of researchprojects or publications ofcompleted or proposed or on-going, etc. researches

1. Show certificates of membershipto selected and relevantprofessional societies,

2. Present a portfolio of casesreferred and co-managed withother physicians andprofessionals

1. Identify relevant health carefacilities in strategic geographicplaces for efficient delivery ofcare,

2. Enumerate lists of actualpartners that have been involvedin health care delivery from thenational, to regional, and locallevels

3. Proofs of Patient Safety andQuality Health Care practices

1. Proofs of active participation in aseries of continuing professionaldevelopment programs in relevantareas,

2. Completion of formal or informal,short- or long-term training orstudies to enhance clinicalmanagement

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Learning Outcomes

8. Adhere to national andinternational codes ofconduct and legalstandards that governthe profession.

9. Demonstrate love forone's national heritage,respect for othercultures andcommitment to service

10. Adhere to the principlesof relevance, equity,quality, and costeffectiveness in thedelivery of healthcare topatients, families, andcommunities

Competency Standards

Given different scenarios in any workplace,the surgical resident should be able to:

1. Demonstrate professionalism,2. Comply with ethical and legal

standards, and3. Adhere to the Oath of Professionals

and the Hippocratic Oath

Given different scenarios in any setting/workplace, the surgical resident should beable to:1. Demonstrate responsible citizenship2. Exhibit cultural competence3. Serve with dedication

Given different scenarios in any setting/workplace, the surgical resident should beable to:1. Address the health needs of the

patients, family, and communitythrough health promotion, diseaseprevention, cure, rehabilitation, andend-of-life care.

2. Utilize clinical practice guidelines,quality assurance methods to providehigh quality care,

3. Deliver quality care to all patientsregardless of socio-economic status,political affiliations, religious belief,ethnicity and gender, and

4. Utilize appropriate resources in theapplication of evidence-based data.

Performance Indicators

1. Proof of no pendingadministrative, legal, or medico-legal case,

2. Service record to a relevantfacility where professionalpractice is accredited andrecognized

3. Membership in the officialorganizations of medicalpractitioners, civil or governmentservice, etc.

1. Certificates of participation incommunity and civicorganizations, medical missions,etc.

2. Proof of Nation-building activities3. Evidence of other services

rendered to the public,professional groups, etc.

1. Comprehensive portfolio ofgraduate: enumeratingsuccessful clinical cases andproblems solved, clinicalprocedures performed, includingthose with complications andhow they were resolved

2. Proof of involvement and activeparticipation in various health orsocially-relevant communityendeavors,

3. Comprehensive portfolio ofawards, commendations, publicrecognitions of excellent servicesrendered.

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1.2.2.5 Levels of Training

Level I

Level II

Level III

Junior Year

Intermediate Years

Senior Years

First Year

Second YearThird Year

Fourth YearFifth Year

1.2.2.6 Intended Learning Outcomes

Junior ResidentAt the end of the JUNIOR YEAR, the RESIDENT should be able to:

COGNITIVE DOMAIN1. Apply the principles of diagnosis and management of common general surgical disorders.2. Evaluate patients with surgical disorders

a. Obtain an adequate historyb. Perform a thorough physical examinationc. Order pertinent laboratory and diagnostic examinationsd. Formulate a logical diagnosise. Formulate treatment planf. Refer appropriatelyg. Provide continuing care

PSYCHOMOTOR DOMAIN1. Perform minor surgical procedures2. Assist in the performance of surgical procedures done by consultants and other residents

AFFECTIVE DOMAIN1. Demonstrate the proper attitudes and habits in the practice of surgery.2. Accept own limitations.

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Intermediate ResidentAt the end of the INTERMEDIATE YEARS (second and third years), the RESIDENT should beable to:

COGNITIVE DOMAIN1. Apply the principles of diagnosis and management of GS and surgical specialty disorders2. Evaluate and manage patients

a. Obtain an adequate historyb. Perform a thorough physical examinationc. Order pertinent laboratory and diagnostic examinationsd. Formulate a logical diagnosise. Formulate a treatment planf. Implement treatment plang. Refer appropriatelyh. Provide continuing care

PSYCHOMOTOR DOMAIN1. Perform or assist in the performance of surgical procedures

AFFECTIVE DOMAIN1. Demonstrate the proper attitudes and habits in the practice of surgery2. Accept own limitations

Senior ResidentAt the end of the SENIOR YEAR, (fourth and fifth years) the Graduate should be able to:

COGNITIVE DOMAIN1. Apply the principles of diagnosis and management of GS and surgical specialty disorders2. Provide pre-operative, intra-operative and post-operative care to all patients falling under all

fields of surgery

PSYCHOMOTOR DOMAIN1. Perform or assist in the performance of surgical procedures

AFFECTIVE DOMAIN1. Demonstrate the proper attitudes and habits in the practice of Surgery2. Accept own limitations

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1.2.2.7 Course Content

This deals with the subject matter that the residents have to learn. Traditionally, thecourse content has been divided into basic and clinical topics. This follows thesequence of simple to complex, basic to clinical. There is cumulative learning asone goes from the earlier years to later years. Basic pre-requisites are masteredbefore more complicated topics and tasks are tackled.

The residents have to acquire knowledge and comprehension of facts, concepts,principles, and theories before they can apply them.

The application and integration of basic concepts and principles into actual clinicalpractice are the main goals. It follows that the residents are expected to masterthe common surgical problems and disorders that they will encounter in their futurerole as surgeons.

In this edition of the curriculum, the course content has been aligned along the fiveintended roles of the surgeon to naturally flow into the program outcomes and theeventual learning objectives.

1.2.2.7.1 PRINCIPLES of BASIC SURGERY

1. FLUIDS AND ELECTROLYTESa. Normal composition of body fluidsb. Fluid and electrolyte imbalance

Volume deficit and excessConcentration changes

c. Acid base imbalanceRespiratory acidosis/alkalosisMetabolic acidosis/alkalosis

d. Principles of fluid and electrolyte therapyParenteral solutionsPreoperative fluid therapyIntraoperative and Postoperative fluid therapy

10

2. SHOCK & RESUSCITATIONa. Definitionb. Pathophysiologyc. Types of shockd. Treatment

3. SURGICAL NUTRITIONa. Nutrition Risk Assessment

Subjective Global Assessmentb. Nutritional Intervention

Oral feedingEnteral feedingParenteral feeding

c. Complications Related to Nutritional Supportd. Nutritional Immunomodulation

4. ENDOCRINE AND METABOLIC RESPONSE TO INJURYa. Central nervous system and endocrine changesb. Metabolic changes

Energy, carbohydrate, fat and protein-metabolismStarvationMetabolic effects of injuryBlood coagulation

c. Acid-base balance, water and electrolyte metabolismd. Oxygen transporte. Organ system changes

5. WOUND HEALINGa. Physiology of wound healing

Phases of wound healingb. Factors affecting healingc. Wound cared. Wound closure

6. BLEEDING AND BLOOD TRANSFUSIONa. Biology of normal hemostasisb. Blood coagulation

Intrinsic pathwayExtrinsic pathwayFibrinolytic system

c. Clinical tests for hemostasisd. Clinical defects in hemostasis -manifestations and treatmente. Blood transfusion

Replacement/Component therapyIndications

Complications

11

7. BURNSa. Classification according to extent & depthb. Systemic changesc. Therapy

AirwayFluid resuscitation, Rule of Nines, Brooke's and Parkland formulaeBurn wound care, skin graftingComplications

8. SURGICAL ONCOLOGY1. Molecular Biology and Oncogenesis2. Pathology3. Clinical Manifestations of Cancer4. Diagnosis and Staging5. Multidisciplinary Management options

i. Surgeryii. Radiotherapyiii. Chemotherapyiv. Immunotherapyv. Targeted therapyvi. Hormonal therapy

6. Prognosis7. Long-term care and follow-up

TRAUMA1. Epidemiology, Patterns of Injury and Prevention2. Basic Life Support and Triage3. Principles of Management

Primary SurveyResuscitationSecondary SurveyDefinitive Management

4. Management of Specific InjuriesHeadNeckChestAbdomenExtremitiesOthers

5. Approach to the multiply-injured patient6. Care of the critically-ill trauma patient7. Rehabilitation8. Mass casualty and disaster management

12

CRITICAL CARE1. Physiologic Monitoring2. Specific Conditions

SIRSSepsisMODSMOFARDSDIC

3. Vascular AccessPeripheralCentral

4. Metabolic Support

SURGICAL INFECTION1. Sepsis, Asepsis and Antisepsis2. General Principles of Diagnosis, Antibiotic and Surgical Therapy3. Antibacterial / Anti-fungal /Anti-viral Drugs: Classification, Principles, Therapy4. Specific Infections

StreptococcalStaphylococcalGram-negative infectionsAnaerobic infectionFungal infectionsAIDSViral hepatitis

5. Surgical Aspects of Treatment

PRINCIPLES OF IMMUNOLOGY AND TRANSPLANTATION1. Immunosuppression2. Clinical Tissue and Organ Transplantation3. Organ Preservation

SURGICAL COMPLICATIONS1. Recognition2. Diagnosis3. Management

MINIMAL ACCESS SURGERY1. Principles of MAS2. Physiologic response to pneumoperitoneum3. Equipment4. Energy sources5. Electrosurgical safety6. Operating room set-up

13

7. Ergonomics and instrumentation8. Basic Skills

a. Loopingb. Clippingc. Ligation In-continuityd. Endo-dissectione. Extra/Intra-corporeal tyingf. Laparoscopic suturing

9. Basic Laparoscopic Proceduresa. Diagnostic Laparoscopyb. Laparoscopic Cholecystectomyc. Laparoscopic Appendectomy

PRINCIPLES OF ENDOSCOPY1. Optics

a. Rigidb. Flexible

2. Diagnostic Endoscopy3. Therapeuitic Endoscopy4. Indications5. Compications of Endoscopy

PERIOPERATIVE CAREa. Patient preparationb. Co-morbidities and risk assessmentc. Pain control

PATIENT SAFETY AND PROFESSIONALISM

1.2.2.7.2 CLINICAL SURGERY-GENERAL SURGERY1. HEAD AND NECK

a. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

I. Congenital MassesThyroglossal cystsTeratomasBranchial cleftsVascular tumorsHygromas

II. Non-congenital LesionsPapillomasPolypsDermoid tumorsRhabdomyomas and NeurofibromasChemodectomas

14

III. MalignancyGeneral principles epidemiology, risk factors, clinical work-up, therapeutic

considerationsNeck cancer

- triangles of the neck- staging - TNM- surgical treatment- radical neck dissection

Nasal Cavity and Paranasal SinusesNasopharynxOropharynxSalivary Glands

IV. TreatmentV. Follow-up

2. THYROID AND PARATHYROID GLANDSa. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

Hyperthyroidism/hypothyroidismThyroid neoplasms

PapillaryFollicularMedullaryAnaplastic cancers

Hyperparathyroidism / hypoparathyroidismParathyroid neoplasms

e. Treatmentf. Follow-up

3. BREASTa. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

Benign Cystic changesBreast infectionsFibroadenomaDuctal papillomaGynecomastiaGalactocoele

Malignant Ductal carcinomaIn situInvasive

Lobular carcinoma

15

In situInvasive

Special types of carcinomaSarcoma

Phyllodes tumorCongenital

e. Treatmentf. Follow-up

4. SKIN AND SOFT TISSUE TUMORSa. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

BenignMalignant

e. Treatmentf. Follow-up

5. ABDOMINAL WALL DEFECTS AND HERNIASa. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

UmbilicalIndirect inguinalDirect inguinalFemoralSlidingVentralIncisionalOthers

e. TreatmentOpen tissue repairOpen mesh repairLaparoscopic approach

TAPPTEP

f. Follow-up

6. ESOPHAGUSa. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

Motility disturbances

16

DiverticulaeEsophageal strictures (Benign)Esophageal perforationEsophageal varicesMalignant tumors

AdenocarcinomaSquamous cell carcinomaOthers

e. Treatmentf. Follow-up

7. STOMACH AND DUODENUMa. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

Peptic ulcer disease and its complicationsGastric varicesGastric malignanciesMorbid obesity

e. Treatmentf. Follow-up

8. SMALL-INTESTINE, COLON, RECTUM AND ANUSa. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

PolypsIntestinal obstructionIntestinal tuberculosisAmoebic colitisTyphoid enteritisDiverticular diseaseCrohn's disease and ulcerative colitis

VolvulusRectal prolapseIntussusceptionMalignant conditions of the small intestinesSurgical lesions of the appendix (appendicitis, etc.)Short bowel syndromeColonic malignanciesRectal malignanciesHemorrhoids, abscesses and fistula-in-anoAnal carcinomaCondyloma acuminata

17

TraumaOthers

e. Treatmentf. Follow-up

9. LIVER, GALLBLADDER AND BILIARY TREEa. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

Liver abscessesLiver cystsBenign hepatic tumorsPrimary and metastatic cancer of the liverPortal hypertensionGallstonesAcute and chronic cholecystitisCholangitisCholangiocarcinomasCholedochal cystsTraumaOthers

e. Treatmentf. Follow-up

10.THE PANCREAS AND SPLEENa. Anatomy and Physiologyb. Clinical Presentationc. Diagnosticsd. Specific Conditions

PancreatitisCysts and pseudocystsPancreatic tumorsHypersplenismTrauma

e. Treatmentf. Follow-up

11.ACUTE SURGICAL ABDOMENa. Definitionb. Clinical manifestationsc. Conditions which may mimic or give rise to acute surgical abdomend. Approach to patients with suspected acute surgical abdomene. Principles of surgical management

18

1.2.2.7.3 CLINICAL SURGERY - OTHER SPECIALTIESObjective: At the end of the specialty rotations, the resident should be able to recognize andinstitute initial management for common and life or limb-threatening specialty problems.

1. PEDIATRIC SURGERYa. Perioperative Careb. Common Pediatric Surgical Conditions

Acute Abdomen - Appendicitis, GI bleeding, Obstruction in older childrenInguino-Scrotal ProblemsNeonatal Surgical Emergencies - Imperforate anus, intestinal obstruction, abdominal

wall defects, TEF, diaphragmatic herniac. Congenital Masses - Thyroglossal cysts, teratomas, branchial clefts, vascular tumors,

hygromas

2. PLASTIC SURGERYa. Technical considerations in skin grafts and flapsb. Management of maxillofacial traumac. Congenital anomalies

Cleft lip and palated. Cosmetic surgery - Principles

Scar revisionRhinoplastyBlepharoplastyMammoplasty

3. UROLOGYa. Anatomy and Physiology of GUTb. Diagnosisc. Disease Conditions and Treatment

Urinary calculiTumors - Renal, Bladder, Prostatic, TesticularUrologic TraumaOther Urologic Emergencies- Anuria due to obstructive uropathy, bilateral, outlet obstruction including neurogenic

bladder- Acute scrotum (testicular torsion)

4. ORTHOPEDICSa. Orthopedic Trauma

FracturesCommon long bone fracturesHand injuries

b. Orthopedic infection - Septic arthritis, osteomyelitis, Pott's Diseasec. Bone and Soft tissue neoplasms of the extremitiesd. Congenital orthopedic deformities, Scoliosis

19

e. Diagnostic: FNAB, Superficial joint aspiration (elbow and knee)f. Technical considerations: casting, splinting, traction techniques

5. THORACIC AND CARDIOVASCULAR SURGERYa. Anatomy and Physiology of the Heart & Lungsb. Common Surgical Conditions

TraumaPeripheral Vascular injuryDiaphragmatic injury

c. NeoplasmsLung - primary and metastaticMetastaticMediastinal tumors

d. InfectionsEmpyema thoracis

e. Common Vascular ConditionsPeripheral vascular occlusive diseaseVaricose veinsAbdominal aortic aneurysm

f. Common Cardiac ConditionsPericardial effusion

6. NEUROSURGERYa. Anatomy and Physiology of the CNSb. Common Surgical Conditions

Recognition and initial management of increased ICP- trauma, space-occupyinglesions

Trauma - low velocity gunshot woundsc. Indications for use and interpretation of diagnostic tests-skull x-ray, CT, MRI, angiogram

1.2.2.7.4 PRINCIPLES OF SURGICAL DIAGNOSTICS1. Laboratory Work ups

Blood ChemistryImmunohistochemistryTumor MarkersOthers

2. Imaging StudiesX-rayUltrasoundCT scanMRIPET scanNuclear Scintigraphy

20

3. EndoscopyRigidFlexible

4. Laparoscopy5. Biopsy

1.2.2.7.5 Teaching-Learning ActivitiesTo achieve the wide range of training objectives cognitive, psychomotor, affective; the programhas to provide relevant learning experiences.

The activities should focus on the development of higher cognitive skills like problem-solvingand decision-making.

Technical skills should be refined appropriate to the level of training.

The proper attitudes and values needed in the practice of Surgery should be enhanced.

The competencies and abilities acquired by the residents should be demonstrated in how patientsare managed, how procedures are performed, and how cases are presented and discussed.

1. Patient ManagementPatient Care in the Hospital Setting

Wards & Emergency RoomOperating Room & Recovery RoomIntensive Care UnitOutpatient ClinicsCommunity Service & Surgical Missions

2. Presentation and Discussion in the "Classroom" SettingPre-and post-op ConferencesMortality/Morbidity ConferenceJournal ClubDidactic LecturesMultidisciplinary ConferencesWard RoundsGrand RoundsInterdisciplinary Tumor Conferences

3. Skills Acquisition, Simulation and Demonstration in the Hospital SettingSimulation and Skills LaboratoryOperating RoomEmergency RoomIntensive Care FacilitiesOutpatient ClinicsWards

21

1.2.2.7.6 Organization and Sequence of RotationsThe guiding principle: There must be a definite structure and sequence in the organization ofrotations:

• Training programs must be five (5) years or sixty (60) months in duration; at least forty-five (45) months will be spent in General Surgery (GS) and fifteen (15) months will bespent in the other specialties.

• Junior and 5th year residents should stay with their mother institution.

• Length of the rotations to other specialties will be left to the discretion of the department(GS) in terms of exposure and competence.

• The length of the rotations will be guided by an Instructional Design for each rotation. Therotations may be combined and interchanged but these must be limited to the ResidencyLevels indicated.

• General Surgery will include: Surgery for Trauma, Head and Neck Surgery, ColorectalSurgery, Critical Care and Nutrition, Out-patient Clinics, Emergency Room, SurgicalOncology, and Minimal Access Surgery

• Rotations to other specialties will include: Critical Care and Nutrition, Neurosurgery,Orthopedic Surgery, Pediatric Surgery, Plastic and Reconstructive Surgery, Thoracic andCardiovascular Surgery and Urologic Surgery

• Conferences in Surgical Pathology and Radiology & Other Imaging Modalities are to beconducted in lieu of rotations in these specialties.

• There will be three (3) Residency Levels of Training: Junior, Intermediate and SeniorLevels.

22

The rotations will be as follows:

Resident Level

Junior

Intermediate

Senior

Year Level

I

I I

&

III

IV&V

Rotations*

General Surgery

General Surgery, Out-patient Clinics, Emergency RoomCritical Care and Nutrition, Neurosurgery, OrthopedicSurgery, Pediatric Surgery, Plastic and ReconstructiveSurgery, Thoracic and Cardiovascular Surgery andUrologic Surgery

Surgery for Trauma,General Surgery (Minimal Access Surgery, SurgicalOncology)

1.2.2.7.7 ResourcesAS PRESCRIBED IN THE ACCREDITATION MANUALIn order to attain the objectives of general surgery residency training program, there are resourcesthat should be provided.

There must be a sufficient number of trainers, to oversee the implementation of the program, toparticipate in the teaching-learning activities, and to evaluate the residents-in-training.

There must be adequate hospital facilities and clinical materials to expose the residents to thecommon surgical problems, provide them hands-on experience in diagnosis and management,give them opportunity to develop, not only the knowledge and skills, but the proper values andattitudes in the practice of Surgery.

A. THE HOSPITAL 1. Bed Capacity 2. Outpatient Facilities 3. Pathology Services 4. Imaging Services 5. Blood bank or facilities for blood storage 6. Medical Library 7. Emergency Room 8. Operating Room 9. Recovery Room10.Critical Care Facilities11. Endoscopic Capability12.Tumor Board and Hospital Tumor Registry

23

13.Major clinical departments14.Clinical material15.Simulation and skills laboratory capability

B. The FACULTY1. The Chairman - PSGS fellowship or PCS fellowship2. The Training Officer - Board-certified, PSGS Fellow and a member of PATOS in

good standing3. Training Committee4. The Consultant Staff - Minimum of 5 PSGS Fellows for every 10 residents

C. The CASE MATERIAL - volume of cases per program is at least 170 cases / 5 residents /year with sufficient variety

1.2.2.8 Evaluation

1.2.2.8.1 Resident Performance

Basic Theoretical Knowledge

Clinical Competence

Technical Skills

Attitudinal Competencies

Evaluation MethodMeasurement Tool

Written ExaminationsOral Examinations

Direct ObservationRating Scales (Rubrics - Appendix II)Record Review

Direct ObservationRating Scales (Rubrics - Appendix II)Simulation Skills (Appendix II-H to K)Record Review

Direct ObservationRating Scales (Rubrics - Appendix II)Critical Incident ReportsPeer Evaluation

The structure

The activities

The resources

Visit by the PSGS Committee on Accreditation

Visit by the PSGS Committee on Accreditation

Annual Report

1.2.2.8.2 The Program

24

Part 2

The surgeon’s role has evolved from Clinician, which signifies the inner circle of the three circlemodel in healthcare education involving the task or the "technical intelligence" (what the surgeonis able to do).

The middle circle is the attitude or "emotional intelligence" and "analytical and creativeintelligence" (how the surgeon approaches his practice) is the role of Educator -Researcher.

The outermost circle which is professionalism or "personal intelligence" (the surgeon asprofessional) namely the roles of Leader, Manager and Social Advocate which is the right persondoing it. The last three guides the curriculum on the roles of the surgeon within the health servicesand how he pursues his personal development as he matures in his career.

The model shown is based on three dimensions of the surgeon's role.

Instructional Design

how the surgeonapproaches his

practice"doing things right"

what the surgeonis able to do

doing the right thing"

the surgeon asprofessional

" the right persondoing it"

25

The five roles are the outcomes of surgical training and the curriculum map has summarizedthese.

The instructional design below will guide the trainer for the accomplishment of basic prerequisitesfor the role as clinician while the other instructional designs will provide for the rest of the outcomes(roles) of surgical training.

2.1 Surgeon Roles

2.1.1 Clinician

2.1.1.1 Junior Resident

Junior ResidentLevel I (First Year)Rotation: General Surgery

At the end of the FIRST year,the RESIDENT should beable to:

1. COGNITIVE1.1. Discuss the principles of

diagnosis andmanagement of commongeneral surgical disorders.

INTENDEDLEARNING

OUTCOMES

EVALUATION

Written ExamsOral examinations

CONTENT LEARNINGACTIVITIES

RESOURCES

1. Surgical Anatomy,Physiology, GeneralPathology

2. Ward Procedures3. Wound Healing4. Endocrine, Metabolic

and ImmunologicResponse to Injury.

5. Fluids and Electrolytes6. Shock and Resuscitation7. Bleeding and Blood

Transfusion8. Principles of Surgical

Infections and antibiotics;Asepsis and Antisepsis

9. Surgical Complications10. Trauma - Epidemiology

& Prevention,Extrication& Trans- port,Triage, Patterns of Injury,Basic Life Support,Scoring System, TraumaCenter

11. Minimal Access Surgery -Advantages andDisadvantages of MASApproach,Pathophysiology ofPneumoperitoneum,Pathophysiology ofGeneral Anesthesia,Operating room set-up,Equipment, Opticaldevices, Instrumentationfor Access, Equipment forcreating domain, EnergySources, Ergonomics,Basic Skills

12. Surgical Oncology - referto Curriculum

Large Group Learning

1. Grand rounds2. Pre-and Postoperative

Conferences3. Mortality and

MorbidityConferences

4. Admitting rounds/Endorsement

5. Lectures6. Journal Club7. Interdisciplinary

Tumor Conference8. Ward rounds9. Workshops in

Research Methodology& Critical Appraisal ofLiterature

Small Group Learning

1. Group Discussion2. Group Tutorial3. Brainstorming

Independent Learning

1. Individual Study2. Self-Instructional

Materials

1. Textbooks

Principles of SurgeryAnatomySurgical AnatomyPhysiologyPathologyProblem-orientedSurgical DiagnosisEvidence Based

Surgery2. Access to all PCS/PSGS

Evidence basedguidelines

3. Textbooks and manualsof nutrition

4. Audio Video Equipment5. Journals

PJSSForeign journals

6. Consultant Staff7. Internet8. CD on Minimal Access

Surgery9. ICD 10 Manual10. Committee on Research11. PSGS Training

Resource Manual inMinimal Access Surgery,Deogracias AG Reyes 1sted. Katha PublishingInc.

12. The SAGES Manual:Fundamentals ofLaparoscopy,Thoracoscopy and GIEndoscopy 2nd Ed.,Carol E.H. Scott -Cooner (ed.)

26

1.2. Discuss WHO PatientSafety Framework basedon the WHO PatientSafety Curriculum.

A. Discuss how to effectivelycommunicate to patient

B. Discuss how to prevent,identify and/or manage"near miss" injuries oradverse events.

C. Demonstrate how to worksafely in the workplace

D. Applies evidence basedpractice and updatedinformation technology

E. Discuss medication safety

F. Applies Infection Controlprinciples.

1.3. Demonstrate knowledgeof the principles ofResearch Methodologyand Critical Appraisal ofLiterature.

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

13. Basic Surgical Nutrition -Fluid & NutritionRequirementsNutrition screening andRisk Assessment

14. Patient SafetyAppropriateCommunicating SkillsCommunicating RisksOpen DisclosuresObtaining ConsentsDelivering bad newsRespect to cultural andreligious diversityRecognizing reportingand managing near missand adverse eventsManaging risksUnderstanding healthcare errorsManaging complaints

Showing leadership andbeing team playerUnderstanding complexhealth organizationUnderstanding humanfactorsProviding continuity ofcareManaging fatigue andstress

Employing available bestevidence based practiceUsing informationtechnology to enhancesafety

Preventing wrong patient,drug, dose, route, timingin medicationRational antibiotic use

5 moments ofhandwashingPreventing surgical siteinfection

15. Basic surgical skills16. Research Methods &

Critical Appraisal ofLiterature

Lecturette

Demonstration

Role Playing

Simulation

13. Mastery of Endoscopicand LaparoscopicSurgery, 3rd Ed.,Nathaniel J. Soper, LeeL. Swanstrom, W.Stephen Eubanks

Direct ObservationOral examination

27

2. PSYCHOMOTOR

2.l. Evaluate surgicalpatients

a. Obtain an adequatehistory

b. Perform a thoroughphysical exam

c. Order pertinentlaboratory anddiagnostic exams

d. Formulate a logicaldiagnosis

e. Formulate treatmentplan

f. Refer appropriatelyg. Provide continuing

care

2.2. Perform minor surgical procedures

2.3. Assist in the performanceof surgical proceduresdone by consultants andother residents

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

1. Signs and Symptoms ofDiseases

2. Diagnostic Procedures

3. Principles ofmanagement of patientswith diseases of the:a. Alimentary tractb. Abdomen and its

contentsc. The breastd. The head and necke. The vascular systemf. The endocrine system,

skin and soft tissues

A. Pre-operative care:Optimization

B. Pre-operative Skills1. Biopsy

IncisionalExcisionFNAB

2. Venous access3. Intubation

Endotracheal NGT Foley catheter

4. EndoscopyProctosigmoidoscopyAnoscopyLaryngoscopy

Operative Skills1. I & D2. Local anesthetic

infiltration3. Local excision of surface

lesions4. Cricothyroidotomy5. Tracheostomy6. DPL7. Aspiration of body

cavitiesThoracentesisPericardiocentesisParacentesis

8. Assisting Operations9. Circumcision10. Electrocautery of warts11. Simple appendectomy

Post-operative Care1. Wound care2. Care of tubes, drains

catheters3. Stoma care

1. Indications andcontraindications

2. Complications - detectionand management

3. Gowning and gloving;patient preparation

Ward and OPD work

1. Performing minorsurgical operations

1. Assisting in surgicalprocedures

2. Independent Learning

Individual Study Self-Instructional

Materials

1. Ward / OPD patients2. Radiology facilities3. Central Laboratory4. Consultant Staff

1. Operating Roomfacilities

2. Outpatient facilities3. Pathology4. Atlas of Operative Technique5. PCS Basic & Advanced

Surgical Skills CDManual

6. Surgical Skills Lab(optional)

1. Consultant staff2. ER, RR, Critical care

facilities3. Case material4. Textbook on

Complications ofSurgical Operations

5. Internet6. Demonstration7. Teaching aids, videos, audio tapes

Observation using ratingscale (rubrics)

Direct Observation usingrating scale (rubrics)Record ReviewLogbook or Records

Direct ObservationRating scale (rubrics)Incident Reports

Direct ObservationRating scale (rubrics)Incident Reports

Direct ObservationRating scale (rubrics)Incident Reports

28

2.4. Perform CPR

2.5. Perform Nutritionscreening andassessment

2.6. Demonstrate basicprinciples of MinimalInvasive Surgery

2.7. Discuss WHO PatientSafety Framework

A. Display effectivecommunication topatient

B. Demonstrate how toprevent, identify and/or manage "nearmiss" injuries oradverse events.

C. Demonstrate how towork safely in theworkplace

D. Apply evidence-basedpractice and updatedinformationtechnology

E. Apply principles ofmedication safety

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

Basic Life Support

Perform SubjectiveGlobal Assessment andCompute for Caloric & FluidRequirements

1. Identification of MISinstruments

2. Proper care of MIS equipment and Instruments3. Setting up the MIS

equipment4. Patient positioning and

securing5. Energy sources and safety6. Basic skills in a training

box7. Camera navigation

1. AppropriateCommunicating Skills

2. Communicating Risks3. Open Disclosures4. Obtaining Consents5. Delivering bad news

6. Respect to cultural andreligious diversity

7. Recognizing , reportingand managing near missand adverse events

8. Managing risks

9. Understanding healthcare errors

10. Managing complaints

11. Showing leadership andbeing team player

12. Understanding complexhealth organization

13. Understanding humanfactors

14. Providing continuity ofcare

15. Managing fatigue andstress

16. Employing availablebest evidence-basedpractice

1. CPR training2. Return demonstration

1. Instructors2. BLS Workshop3. Training mannequins

4. PSGS TrainingResource Manual inMinimal Access Surgery,Deogracias AG Reyes 1sted. Katha PublishingInc.

5. The SAGES Manual:Fundamentals ofLaparoscopy,Thoracoscopy and GIEndoscopy 2nd Ed.,Carol E.H. Scott -Cooner (ed.)

6. Mastery of Endoscopicand LaparoscopicSurgery, 3rd Ed.,Nathaniel J. Soper, LeeL. Swanstrom, W.Stephen Eubanks

7. Laparoscopic tower andinstruments

8. Pelvic Trainor9. Skills Lab

Direct Observation

Rating scale (rubrics)

Checklist

Same as above

Same as above

Patient SatisfactionSurvey

CriticalIncident Report

Peer Review

29

F. Apply InfectionControl principles.

3. AFFECTIVE

1. Demonstrate the properattitudes and habits inthe practice of surgery

2. Shows ethical practicesin the workplace

Expresses commitment to lifelong learning.

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

17. Using informationtechnology to enhancesafety

18. Preventing wrong patient,drug, dose, route, timingin medication

19. Rational antibiotic use

20. 5 moments of handwashing

21. Preventing surgical siteinfection

22. Rational Use ofAntibiotics

1. Intellectual Integrity2. Moral, Ethical value3. Reliability /

Responsibility4. Appropriate Bedside

Decorum / Relationshipwith patient

5. Study / Work habits6. Relationship with co-

health workers & superiors7. Emotional maturity

reaction to emergency orstress

8. Social Responsibility

1. Simulation2. Role Modeling3. Mentoring4. "Resident as Teacher"

program

1. Written Hospital Policiesand Procedures

2. Hospital Manual onResident decorum

3. Faculty Members as rolemodel

4. Code of Ethics of theMedical Profession

5. PMA Code of Ethics6. PCS Code of Ethics

Direct ObservationRating scale (rubrics)ChecklistIncident Reports

1. OSCE2. Faculty Mentorship &

Role Modeling with selfreflection inprofessionalism

3. Chart Review4. Chart Audit5. Global Evaluation Form

6. Patient SatisfactionSurvey

7. Peer Review

30

2.1.1.2 Intermediate Resident

Intermediate Level Resident

Level II & III (Second & 3rd Year)

Rotations: General Surgery, PlasticSurgery, Pediatric Surgery,Orthopedics, Neurosurgery, TCVS,and Urology

At the end of the SECONDand THIRD year, theRESIDENT should be able to:

1. COGNITIVE

1. Provide initial care topatients with acuteabdomen, trauma &other life-threateningsurgical conditions

2. Provide comprehensivecare to patientsconsulting for commonsurgical disorders inoutpatient setting.

3. Apply the principles ofthe following in themanagement of asurgical disease.

3.1. Surgical Pathology3.2. Imaging modalities

(Radiology, CT-scan,MRI, ultrasound,mammography,

nuclear scan )3.3. Surgical Endoscopy3.4. Surgical Oncology3.5. Surgical Critical Care3.6. Minimal Access

Surgery3.7. Trauma

4. Demonstrate knowledgeof the diagnosis andmanagement ofdisorders in the othersurgical specialties.

4.1. Pediatric Surgery4.2. Plastic Surgery4.3. Urology4.4. Orthopedics4.5. Neurosurgery4.6. Thoracic &

CardiovascularSurgery

5. Given a patient withcomplex GeneralSurgery or subspecialtyproblem, the residentshould be able toformulate acomprehensivemanagement plan

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

1. Surgical diseasesrequiring mediumsurgical operations.

2. ER & OPD procedures3. Common medium -

complex procedures4. Surgical Pathology5. Surgical Imaging6. Minimally Invasive

SurgeryPatient SelectionPreoperative work upand evaluationMethods of Access &pneumoperitoneumPrevention ofComplications inLaparoscopyLaparoscopicEndosuturing &Extracorporeal TyingDiagnostic LaparoscopyIndications forLaparoscopicAppendectomy andCholecystectomy

7. Surgical OncologyDiagnosis & stagingMultimodal approachPre - operative AdjuvantTreatmentSurgical extirpationPost - operativeAdjuvant TherapyPalliative Care

8. Surgical Critical Care &Nutrition

Care of the Critically-illpatientNutritional support incritical illness, surgery,

trauma, sepsisNutritional assessmentNutritional support

(parenteral & enteral)

9. Trauma - Advanced trauma care

Structured SupervisedRotation - ER, OPD, OR,Ward duties

Large Group Learning

1. Grand rounds2. Pre and3. Postoperative Conferences4. Mortality and Morbidity5. Admitting rounds6. Census7. Lecturette8. Journal Club9. Interdisciplinary

Tumor Conference10. Clinicopathological correlation during

surgical conferences11. Correlative

Radiology Conferences Participation in

PostgraduateCourses &Workshops

Small Group Learning

1. Group Discussion2. Group Tutorial3. Brainstorming4. Ward Rounds5. ER Consultations

Independent LearningIndividual StudySelf-InstructionalMaterials

1. Textbook of Surgery

2. Textbook of Trauma

3. Textbook of Pathology

4. Textbook of Radiology &Imaging Modalities

5. Textbook in SurgicalUltrasound

6. PSGS TrainingResource Manual inMinimal Access Surgery,Deogracias AG Reyes 1sted. Katha PublishingInc.

7. The SAGES Manual:Fundamentals ofLaparoscopy,Thoracoscopy and GIEndoscopy 2nd Ed.,Carol E.H. Scott -Cooner (ed.)

8. Mastery of Endoscopicand LaparoscopicSurgery, 3rd Ed.,Nathaniel J. Soper, LeeL. Swanstrom, W.Stephen Eubanks

9. PCS BEST Course10. PCS Evidence-based

guidelines in commonsurgical diseases

11. PCS Cancer Facts &Figures

12. Atlas of SurgicalOperations

13. Emergency Room14. Pathology service15. Radiology service16. Blood Bank17. PCS IONS Manual18. Textbooks19. Pediatric surgery20. Plastic surgery21. Urology22. Orthopedics

Written Exam

Direct Observation

Records Review

Incident Reports

31

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

10. Common Surgical Conditions in:

A. Pediatric SurgeryCommon pediatricsurgical conditionsVascular accessInguinal hernia /hydrocoeleImperforate anus,other causes ofintestinalobstructionAbdominal traumaAppendicitisIntussusceptionRectal polypsSoft tissue tumors

B. PlasticBurnsBasal cellcarcinomaSquamous cellcarcinomaMelanomaPressure sores /Decubitus ulcers

C. UrologyCommon urologicdisordersHydrocoeleBenign ProstaticHypertrophyTesticular torsionUrolithiasesKidney & bladdertrauma

D. OrthopedicsFractures (closed /open, long bones,digits, etc.)Joint andligamentousinjuries,(dislocations,internal kneederangements,sprains, etc)Bone tumors:benign andmalignantInfections(osteomyelitis,diabetic foot, jointabscess, deeppalmar abscess,felon, etc.)Evaluatemusculoskeletalpain (low backpains, cervicalstrain, etc)

23. Neurosurgery24. TCVS25. Surgical Critical Care26. Surgical nutrition27. Surgical Oncology28. Trauma

29. Journals30. Outpatient facilities31. Medical Library32. ER, RR, Critical Care

facilities33. PCS critical care &

nutrition basic &advanced workshops

34. Audiovisual facilities35. Internet

32

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

E. NeurosurgeryPrinciples ofmanagement ofpatients withdiseases of thecentral, peripheral,and autonomicnervous systemsincluding theirsupportingstructures andvascular supplyCommonneurosurgicalconditionsRecognition andinitialmanagement ofincreasedintracranialpressure - such asin trauma, spaceoccupying lesion.Head and spinetrauma

F. Thoracic and Cardiovascular

Surgery

Principles ofmanagement

of patients withHydrothorax(includeshemothorax &pyothorax)PneumothoraxBlunt & penetrating

thoracic injuriesPeripheral vascularinjuries

A. Instructional design (ID)DefinitionParts of IDPreparation

B. LectureDefinitionBodyStylesMaking it effective

C. Small Group LearningDefinitionActivitiesConduct

D. Clinical TeachingPrinciplesActivitiesConductAudit

6. Discuss clinical teachingand evaluation principles.

6.1. Formulate a simpleinstructional design fora teaching learningactivity.

6.2. Design a completelecture plan

6.3. Discuss the differentsmall group learningactivities

6.4. Discuss the differentclinical teachingmethod.

6.5. Discuss the differentclinical evaluationmethod.

33

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

E. Clinical EvaluationWritten examinationOSCEDirect observation bychecklist and ratingscale (rubrics)Critical incident report

In Addition to Junior LevelSkills

1. Surgical EndoscopyLaryngoscopyProctosigmoidoscopyExposure to flexibleendoscopy

2. Minimal Access SurgerySetting up of lap towerBasic MAS Skills- Tissue Grasping- Blunt Dissection- Clipping- Looping- Ligation In-continuity- Scissors- Specimen Extraction- Suturing Techniques- Stapling Techniques- Extra - Corporeal and

Intra - corporeal knots(Roeder, Meltzer)

Trouble shootingInstrumentsreprocessing andmaintenanceVideo Editing

3. General surgicalprocedures such as:

Hernia repairThyroid & parathyroidsurgeryMastectomyOpenCholecystectomy

with or without CBD exploration

SplenectomySkin and soft tissue:Wide ExcisionGI anastomoses andostomiesRepair of perforatedbowelResection of Intestinesand colonExploratory Laparotomyfor rupturedappendicitisHemorrhoidectomy andFistulectomy,Sphincterotomy

2. PSYCHOMOTOR

1. Perform minor, mediumand major procedures.

2. Correlate pathologicprocess with clinicalcourse of the disease

3. Interpret and correlateimaging modality pictureswith disease process.

4. Render emergencytrauma care andresuscitation

5. Demonstrate preparationin endoscopy andminimal access surgicalprocedures

6. Assist and perform openand minimally invasivesurgical specialtyprocedures

7. Assist co-workers duringsurgical procedures

2.8 Demonstrate principles ofclinical teaching andevaluation in trainingjunior residents, clinicalinterns and clerks.

1. Perform mediumoperations

2. Assist major operations3. Skills lab - Animate and

inanimate4. Supervised exposure to

endoscopy &laparoscopy

1. Operating Room

2. Emergency Room

3. Surgical Wards

4. Radiology ServiceRadiologic, Ultrasound& Imaging Modalities

5. Pathology service

6. Phil. Society ofUltrasound in Surgerylectures & handouts

7. Actual & SimulatedPatients

8. Simulated laboratories/ venues- Inanimate/animate

specimens

9. Minimal Access SurgeryInstruments & trocarsScopesEnergy sourcesLaparoscopy

MachineAccredited PSGSworkshopsTeaching Audio andVideo facilities

10. OPD clinic

11. Specialty Clinics

12. Teaching tapes, CDs

13. Atlas of SurgicalOperations

14. Simulated venues /laboratory

15. PCS IONS Manual

16. PCS advanced surgicalskills CD manual

Direct observationReportsCERES

34

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

4. Trauma - operativemanagement oftraumatic injuries;perform FAST, ifavailable

4. Trauma - operativemanagement oftraumatic injuries;perform FAST, ifavailable

5. Surgical Critical Care &Nutrition

Compute for the caloricand proteinrequirements surgical orotherwise critically illpatientsCV access forhyperalimentation

6. Surgical OncologyRecommended surgicalprocedures for specifictumor sites.

7. UrologyHydrocoelectomyNephrectomy for traumaSuprapubic cystostomyCystolithotomyOrchidopexy/orchiecomy fortesticular torsion

8. Pediatric SurgerySaphenous veincutdownHerniotomy/HydrocoelectomyColostomyExplor lap for trauma,acute abdomen,Obstruction,Intussusception,Appendectomy

9. OrthopedicsOpen fractures: initialdebridement andirrigation,immobilizationClosed reduction of:common closedfractures: clavicular,Colles', tibial,phalangealDislocation: shoulder,elbow, hipAmputation anddisarticulation - forvarious indicationsSoft tissue tumors -FNAB, marginalexcision of superficialtumors

35

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

Common orthopedicprocedures prep anddraping splinting,casting, traction, tapingAfter-care of commonorthopedic problemsSpine immobilization

10. Plastic andReconstructiveSurgery

Making the properincisionsHarvesting of skin graftsSkin graftingCleft lip repairFlapsBurn care

11. NeurosurgeryCranial decompressionfor trauma (burr- holeand drainage/craniotomy for epiduralhematoma)

12. Thoracic andCardiovascular Surgery

ThoracostomyPleurodesis formalignant effusionPercutaneoustransthoracic needlebiopsyThoracotomy forthoracic trauma:Pericardiostomy/pericardiotomy/pericardiocentesisVascular repair fortraumaVascular access:subclavian veincatherization, A-VfistulaVein stripping

13. Post-operative careWound careCare of tubes, drainscathetersStoma careCare of complicationsNutrition support

1. Intellectual Integrity2. Moral, Ethical value3. Reliability /

Responsibility4. Appropriate bedside

decorum / Relationshipwith patient

5. Study / Work habits6. Relationship with co-

health workers & superiors7. Emotional maturity

reaction to emergency orstress

8. Social responsibility

3. AFFECTIVE3.1. Demonstrate the proper

attitudes and habits in thepractice of surgery

DirectObservationRating scale (rubrics)Incident Reports

36

2.1.1.3 Senior Resident

Senior Level Resident

Level IV & V (Fourth and Fifth Year)Rotations: General Surgery,Trauma, Critical Care, MinimalAccess Surgery, Surgical Oncology

At the end of the FOURTHand FIFTH year, theRESIDENT should be able to:

1. COGNITIVE1.1. Apply the principles of

diagnosis andmanagement of allGeneral Surgicaldisorders.

1.2. Apply the principles ofdiagnosis andmanagement of allsurgical specialtydisorders

1.3. Demonstrate knowledgein the definitive andcontinuingmanagement of thetrauma patient.

1.4. Demonstrate knowledgein the criticalmanagement of themultiply injured patient

1.5.1. Apply the principles ofMinimal Access Surgeryin basic and advancedsurgical procedures.

1.5.2. Discuss the preventionand management ofcomplications inMinimal Access Surgery

1.6. Apply the principles ofquality and ethicalsurgical practice

1.7. Discuss the professionalbehaviors

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

1. Basic Surgery

2. General & CancerSurgery

3. Specialty Surgery

4. TraumaDiagnostic modalitiesTrauma radiology,FAST, DPLDefinitive Managementof Trauma Injuries;Intensive care andrehabilitation; criticalcarePolytraumamanagementMass casualty anddisaster management

5. Minimal Access Surgeryin:

Cholecystectomy withIOCAcute AbdomenColon and RectumHernia (Inguinal &Ventral)

1. Altruism2. Compassion3. Humility4. Appropriate Physical and

Social Demeanor5. Good Leadership

QualitiesResponsibleAccountable

Large Group Learning

1. Grand rounds2. Pre-and3. Postoperative

Conferences4. Mortality and Morbidity5. Admitting rounds6. Census7. Lecturette8. Journal Club9. Interdisciplinary Tumor

Conference10. Clinicopathological

correlation duringsurgical conferences

11. Correlative RadiologyConferences

12. Postgraduate Course13. Trauma Audit

Small Group Learning

1. Group Discussion2. Group Tutorial3. Brainstorming4. Ward Rounds5. ER Consultation

Independent Learning

1. Individual Study2. Self-Instructional

Materials

1. Independent LearningLectures

1. Textbook of Trauma2. Audiovisual facilities3. Postgraduate courses4. PCS BEST Course5. Textbook of Critical Care6. Manual in Nutrition7. Training seminars8. Medical Library9. Internet10. Textbooks on Research

Methodology & Designs11. Workshops on Critical

Appraisal of Literature12. Journals13. Outpatient facilities14. Emergency Room15. Medical Library16. Radiology service17. Laboratory service18. RR, CCU19. Audiovisual aids20. Internet21. ATLS Manuals22. Postgraduate courses23. Consultant Staff

Written Exams

Oral Exams

Incident Reports

IONS Forms

37

1.8 Apply principles ofleadership andmanagement

1) Discuss learner'sinstitutionalorganizational chart.

2) Discuss the organization 'svision and mission

3) Establish simple strategicplan and financialmanagement for theorganization.

2. PSYCHOMOTOR

1. Perform (selected percategory) major andcomplex generalsurgical procedures

2. Perform selectedsurgical specialtyprocedures

3. Assist consultantsduring surgicalprocedures

4. Assist junior andintermediate residentsduring surgicalprocedures

INTENDEDLEARNING

OUTCOMES

CONTENT LEARNINGACTIVITIES

RESOURCES EVALUATION

CompetentEffective communicatorPunctualConstructiveCollaborative

6. Ethical7. Commitment to

Excellence8. Types of Organization9. Formulating Vision and

Mission / Core Values10. Leadership Skills11. Managerial Skills12. Strategic Planning (SWOT technique)

In Addition to Junior &Intermediate Level skills:

1. More complex andradical operations ingeneral surgery and thesurgical specialties suchas:

Radical MastectomyNeck dissections andcombined operationsParotid and othersalivary glandoperationsEsophageal surgeryGastric surgery with orwithout vagotomyRadical GastrectomyLiver resectionsBiliary-enteric bypassPancreatectomyColectomies,abdomino-perinealresectionPortosystemicproceduresIleal conduitMajor amputationsAdrenalectomy

2. Workshop & Symposia inprofessionalism

3. Conferences

1. Lecturette

2. Small Group Learning

3. Mentorship

1. Clinical exposure2. Supervised operations

3. Independent Learning

Individual Study Self-Instructional

Materials

1. Resource Persons2. John Maxwell

Leadership books3. Books in Organization &

Management4. Trainor

1. CCU2. Operating Room3. Consultant Staff

Cognitive- Standardized

assessment tool- Pre/post testing of

knowledge- Standardized

evaluation afterconference

- Chart records &portfolio

Oral Examination

Practical Examination

- Vision - Mission- Strategic

Management- Financial

Management

Logbook EntriesCERESIncident ReportsDirect Observation