Study & Evaluation Scheme of M.D. (Surgery) …tmu.ac.in/medical-college-research-centre/wp-content/uploads/sites/... · 35. Gall bladder and bile ducts: Surgical anatomy, physiology,

Study & Evaluation Scheme

of

M.D. (Surgery)

[Applicable for the Batch 2014-15 till revised]

TEERTHANKER MAHAVEER

UNIVERSITY Delhi Road, Moradabad, Uttar Pradesh-244001

Website: www.tmu.ac.in

Index

1. Aims and Objectives

2. Syllabus:

a. Theory

b. Practical

3. Teaching & Learning activities.

4. Thesis/Dissertation.

5. Evaluation and Assessment:

a. Formative Assessment

b. Internal Assessment

c. Summative Assessment

6. Suggested books.

7. Journals.

8. Model test papers.

9. Format of log book.

P.G. Curriculum

M. S. (General Surgery)

Approved by the Board of Studies, as per resolution no. 5 dated 06/03/2013

Aims & Objectives:

Aim:

The aim of imparting post graduate training course in Surgery is to produce a doctor, who has

been sufficiently trained and guided to practice the field of surgery effectively & confidently,

backed by sufficient scientific knowledge and skill.

During the training period, he will acquire sufficient scientific knowledge and Surgical skills to

deal with a given situation independently, both, during emergency & routine hours.

He will develop a keen interest in the subject & right attitude towards his patients.

He will imbibe, and conduct, the laid down medical and social ethics,as demanded by the

profession.

Will develop proper skills & temperament to interact with the attendants and relations of the

patient.

Will develop the right attitude and skills to interact with fellow colleagues, seniors and juniors,

and, thus act as a team leader.

Post graduate should learn about basic research methodology & publication of research

papers.

Will develop a passion to acquire newer & newer knowledge, and share it with colleagues as a

process of continuing learning & teaching.

General objectives of the training Course:

Objectives laid out to achieve the Goals of the course, constitute of right & sufficient

Knowledge of the subject, learn & develop correct surgical skills & adopt Ethics and & human

values, involved in surgical practice.

Keeping these objectives in view:

1. The Candidates should acquire sufficient clinical & operative competence in order to

practice the surgical specialty, both in emergency & elective hours.

2. They should acquire sufficient knowledge and experience to identify the areas, which need

proper referral at a proper time. They should develop the practice of following the

professional ethics.

3. They should be able to record full history, perform Physical Examination and make a

clinical diagnosis.

4. Should be able to perform the relevant investigations & therapeutic procedures.

5. Should be able to interpret the results of the investigations & relate them to the given

clinical situation.

6. Should be able to perform, basic surgical procedures, independently.

7. Should be able to manage, surgical trauma emergency, effectively.

8. Should demonstrate communication skills, in order to explain to the attendants, the

nature & likely course of the disease, plan of management, likely outcome, and the

prognosis.

9. Should develop the skills of self directed learning; update himself by attending Courses,

conferences and Seminars etc., relevant to surgery.

10. Should involve himself is teaching & guiding his juniors & other paramedical personnel &

undergraduate students.

11. Post graduate should learn about basic research methodology & publication of research

papers.

12. Should acquire sufficient knowledge & experience of clinical audit.

13. Should develop an understanding of research tools, in order to be able to conduct some

studies & prepare some research work for presentation & publication.

Syllabus:

It is recognized, that General surgery, today, mainly covers Gastro intestinal & Hepatobiliary

disorders, basic urological problems, abdominal wall, hernia trauma, Breast & Thyroid

disorders, and the knowledge of some common problems in allied specialties. During the

training period, efforts are always made, that adequate time is spent in teaching the students,

skill required for performing basic surgical procedures, and making them accustomed to

handling difficult trauma and critical patients.

Essential knowledge:

The postgraduates are required to acquire sound knowledge of the following topics. The list

includes topics found in most of the standard text books of surgery. The knowledge required

includes the basic sciences relevant to each topic. There is no intention to limit the knowledge

& operative experience.

Trainees, as part of their general surgery training, must not only acquire competence in

scheduled operations, but will also also have experience of other procedures from the sub

specialty departments. The PGs. should also be familiar with the recent advances, medicolegal

issues and current controversies.

Accordingly, the syllabus involves, broadly, as follows:

Theory:

Applied basic sciences: It Includes: Applied Anatomy, Physiology, Biochemistry, Microbiology,

Pharmacology & Pathology, as found in current text books.

General Surgery topics:

1. History of Surgery

2. Fluid & electrolyte Balance.

3. Acid Base metabolism

4. Blood Transfusion & Transfusion products

5. Path physiology & management of shock.

6. Informed consent & Medicolegal issues

7. Molecular biology & Genetics.

8. Diagnostic and interventional radiology

9. Preparing a patient for surgery

10. Anaesthesia and pain management

11. Acute life support and critical care (ACLS/ATLS).

12. Nutrition

13. Wounds, tissue repair and scars

14. Basic surgical skills and anastomosis

15. Wound infection

16. Cysts, Ulcers and sinus

17. Parasitic infections

18. Sterilization, precautions and theatre safety

19. Principles of laparoscopic surgery

20. AIDS

21. Organ Transplantation

22. Principles of oncology

23. Day care surgery

24. An approach to surgical audit

25. Surgical ethics

26. Clinical trials and statistics

27. Disorders of salivary glands: Anatomy, Clinical features, examination, investigations,

medical and surgical treatment of its stones, infections and tumors.

28. Pharynx, Larynx, and Neck: Anatomy, Physiology, Clinical features, Investigations,

diagnosis and emergency management of airway obstruction and tumors.

29. Thyroid: Development, Anatomy, Physiology, investigations, medical and surgical

treatment of thyroid diseases.

30. Parathyroid and adrenal glands: Surgical concept of parathyroid and adrenal disorders,

investigations role of surgery and management of their tumors.

31. Breast: Surgical anatomy, investigations anomalies management of benign and malignant

breast disorders.

32. Stomach and Duodenum: Anatomy, pathophysiology, clinical features, investigations,

management of benign and malignant disorders.

33. Liver: Anatomy, physiology, clinical features, investigations, management of liver trauma,

infections, tumors.

34. Spleen: Anatomy, pathology, clinical features, investigations management of splenic

trauma.

35. Gall bladder and bile ducts: Surgical anatomy, physiology, clinical features, investigations,

treatment of Gall stones and tumours.

36. Pancreas: Infections, tumours, injuries.

37. Peritoneum, Omentum, Mesentery and retroperitoneal space.

38. Small intestines and Large intestines.

39. Intestinal obstruction.

40. Vermiform appendix.

41. Rectum.

42. Anus and anal canal.

43. Hernia, Umblicus and abdominal wall.

44. Post operative care.

45. Accident Emergency surgery.

46. Warfare injuries,

47. Maxillofacial injuries.

48. Oral and Oropharyngeal cancer.

49. Plastic and reconstructive surgery: Skin grafting, Flaps, principles of soft tissue coverage,

hypospadias, principles of microvascular surgery with special reference to vessel repair,

Burns, Cleft lip & palate,

50. Neurosurgery: Craniocerebral trauma (Head injury), Spinal injuries Elective neurosurgery–

Brain tumours Spinal cord tumours Hydrocephalus , Spinal dysrhaphism.

51. Thorax-: Surgical anatomy and physiology, investigations, role of surgery in management

of chest trauma and surgical oncology as applied to chest surgery.

52. Oesophagus: Anatomy, physiology, Clinical features investigations, treatment of benign

and malignant disorders.

53. Cardiac surgery: Role of surgery in cardiac diseases, investigations, management.

54. Arterial disorders: Nature of occlusive arterial disease, acute arterial occlusion, severely

ischemic limb, aneurysm diseases, Clinical features, investigations, treatment options

55. Venous disorders: Venous anatomy, physiology, varicose veins, DVT, venous insufficiency

and ulcers.

56. Lymphatic disorders: lymphangitis, lymphoedema, lymphadenopathy.

57. Paediatric Surgery: Soft tissue tumours, Causes of neonatal obstruction, Ano rectal

malformation, Hypertrophic pyloric stenosis Undescended testis, Torsion testis,

Hirschsprung’s disease, Oesophageal atresia with trachea-oesophageal fistula, Wilm’s

tumour, malrotation of Gut.

58. Urology: Urinary stmptoms, investigations of urinary tract, Anuria, Urological injuries,

Tumours of urinary tract, Pyelonephritis /pyonephrosis / perinephric abscess, G U

Tuberculosis, Prostatic hypertrophy, Hypospadias, testicular tumours, Scrotal disease,

Urinary stone disease, Hydronephrosis/Pyeloplasty, Transplantation/ harvesting kidney,

Urinary diversion, Infertility /vasectomy, Peritoneal dialysis / CAPD / Haemodialysis,

Practical 1. History and Examination: History taking and examination as relevant to general surgery.

2. Monitoring skills: Temperature recording, Blood sampling, Cardio – respiratory monitoring,

Pre and post operative patient monitoring and management accordingly.

3. Therapeutic skills: Tracheostomy, Chest tube insertion, Wound suturing , Catheterization,

Ryle’s tube insertion, Airway management , Nasogastric feeding, Endotracheal intubation,

Cardio-pulmonary resuscitation, Venepuncture and establishment of vascular access,

4. Administration of fluids,blood & blood components, Parenteral nutrition , Common

dressings, Abscess drainage, Basic principles of rehabilitation, bed sore management.

5. Diagnostic skills: Interpretation of X – Rays /CT Scan / MRI, Ultrasonographic

abnormalities and laboratory tests.

6. Surgical Skills: Observation of general layout and working of operation theatre,

understanding the importance of management and maintaining the sanctity of OT,

Scrubbing, Sterilisation and working of OT instruments & equipment eg. Electrocautery,

Laparoscopic set etc. Shifting of OT patients, pre operative workup of patients,

acquisition of basic surgical skills to perform minor /medium surgeries independently

(Suprapubic cystostomy, Uretheral dilatation, Cystolithotomy, Varicocoelectomy,

Orchidectomy, Ureterolithotomy, Excision of cyst, Incision and drainage of abscess,

Excision of breast lump, Surgery of Hydrocoele,

7. Appendectomy, Herniotomy, Hernia repair, Umbilical hernia repair, Exploratory

laparotomy, Closure of perforation, Gut resection, Intestinal anastomosis, Ileostomy,

Colostomy, Haemorrhoidectomy, Fistulectomy, Fissurectomy, Nephrectomy,

Cholecystectomy ,Circumcision Skin grafting, Tracheostomy etc. )

8. Assist in major surgeries, handling of all types of surgical emergencies ,postoperative

management of patients in recovery rooms, ICU and wards.

9. Waste disposal

10. Laparoscopy and GI Endoscopy

11. Cystoscopy

12. Craniotomy

Teaching and learning Activities:

General principles: Acquiring of practical competencies, being the keystone of medical

education, post graduate training is skill oriented.

Learning in post graduate program is essentially self directed and primarily emanates from

clinical & academic work. The formal sessions are merely meant to supplement this core

effort. Most of the teaching is conducted within the unit, by the consultants and senior

residents of the respective unit. In addition to bed side teaching rounds in the department,

other learning activities suggested are:

• Case presentations,

• Journal clubs,

• Seminars,

• Surgical Audit

• Clinical meetings ,

• Morbidity and Mortality meetings

• Interdepartmental meetings particularly with department of pathology & Radiology,

• Grand teaching rounds

• Central sessions, as & when held by the college.

All these sessions are attended by the faculty members. All the P.G. students are supposed to

attend these sessions, except the ones posted in surgical ICU and emergency.

All the teaching sessions are assessed by the consultants, at the end of the session, for

internal assessment. All the activities are recorded in the log book.

The ward rounds are both service and teaching rounds. The service rounds should be taken

daily, for the care of the patients. The grand rounds should be taken by every unit for teaching

purpose, at least twice a week.

In third year, the postgraduate students take undergraduate classes, preferably in the

evenings. This will help them to prepare and make them confident in clinical presentation.

This way, the undergraduate students, also shall get encouraged to clarify their queries and

enhance their clinical acumen.

The interdepartmental meetings, especially between Pathology, Radiology and

Gastroenterology should be held, at least once a month, and their entries should be made in

the Log book.

CME:

It is recommended that at least 2 state level/ Zonal, CME programmes, and one National

level conference, should be attended by each student, in their three years tenure.

Posting:

During first month, the resident will fully acquaint himself with the hospital working and

patient management protocols, in all the indoor segments including Casualty, ICU wards, labs,

Radiology &inter departal referrals / consultation protocols. They should also utilize this

period to identify their thesis project.

During first year of their training, the students will work under direct supervision of their

seniors / senior residents and consultants on call. They will be responsible for taking detailed

history, examination of patient, record the findings in the indoor files of the patients, send the

required investigations as advised by their seniors, and making discharge cards. Initially all the

procedures are observed and assisted. They learn pre & post operative protocols.

During second year, the residents start performing suitable procedures independently and at

the same time they are posted in emergency and ICU for a minimum period of one month.

During the same year they are rotated in surgical super specialties for a period of 6-8 weeks

each.

During third year, the resident is encouraged to make independent decisions in the

management of patients and perform surgery independently. He/she is also involved in

teaching undergraduates and paramedical students.

Thesis / Dissertation

The dissertation is aimed to train a PG student in research methods and techniques. It

includes identification of a problem, formulation of a hypothesis, search and review of

literature, getting acquainted with recent advances, designing of a research study, collection

of data, critical analysis, comparison of results and drawing conclusions.

Every candidate shall carry out work on an assigned research project under the guidance of a

recognized postgraduate teacher who acts as a guide to his thesis. A coguide may be

included, provided the work requires substantial contribution from a sister department. The

coguide also shall be a recognized postgraduate teacher.

The project on completion, shall be written and submitted in the form of a Thesis. Every

candidate shall submit the plan of the proposed dissertation work to the university, after

clearance from ethics / research committee, within the time frame, set by the university, for

registration. The candidate shall start working on the thesis work from the earliest possible

time, after approval of his thesis plan.

The Thesis should be written under the following headings:

• Introduction

• Aims and objectives

• Review of literature

• Material and methods

• Results

• Discussion

• Conclusion

• Summary.

• References.

• Tables.

• Annexures.

Four copies of thesis, thus prepared, shall be submitted to the university, six months before

the commencement of theory examination. The thesis shall be valued by examiners,

appointed by the university. Approval of thesis is an essential precondition for appearing in

the university examination.

Change of guide:

In the event of a registered guide, leaving the college for any reason, or in the event of death

of a guide, guide may be changed, with the prior permission from the university.

Evaluation and Assessment

All the PG students shall be evaluated and assessed, on day to day basis, as well as

periodically. Assessment shall be both formative and summative.

Formative Assessment:

The formative assessment is a continuous as well as end of term. The former is based on

feedback from the senior residents and the consultants concerned. All the consultants of the

unit, in which the resident is working, will give marks, based on performance. These marks will

be summated over a period of tenure. End of term assessment is held at the end of each year.

Formative assessment will not count towards pass / fail at the end of the programme, but will

provide feedback to the candidate.

Internal Assessment:

The performance of the Postgraduate student, during the training period, should be

monitored throughout the course and duly recorded in the log books as evidence of the ability

and work of the student. Marks should be allotted out of 100 as follows:

Sr.No. Items Marks

1 Personal Attributes 20

2 Clinical Work 20

3 Academic activities 20

4 End of term theory examination 20

5 End of term practical examination 20

1. Personal attributes:

• Behavior and Emotional Stability: Dependable, disciplined, stable in emergency situation,

show positive approach.

• Motivation and Initiative: Takes on responsibility, innovative, enterprising, does not shirk

duties or leave any work pending.

• Honesty and Integrity: Truthful, admits mistakes, does not cook up information, has

ethical conduct, exhibits good moral values, loyal to the institution.

• Interpersonal Skills and Leadership Quality: Has compassionate attitude towards patients

and attendants, gets on well with colleagues and paramedical staff, is respectful to

seniors, has good communication skills.

2. Clinical Work:

• Availability: Punctual, available continuously on duty, responds promptly on calls and

takes proper permission for leave.

• Diligence: Dedicated, hardworking, does not shirk duties, leaves no work pending, does

not sit idle, competent in clinical case work up and management.

• Academic ability: Intelligent, shows sound knowledge and skills, participates adequately in

academic activities, and performs well in oral presentation and department tests.

• Clinical Performance: Proficient in clinical presentations and discussion during rounds and

OPD work. Preparing Documents of the case history/examination and progress notes in

the file (daily notes, round discussion, investigations and management). Skill of performing

bed side procedures.

3. Academic Activity: Performance during presentation at Journal club/ Seminar/ Case

discussion/clinical meetings and other academic sessions.

4. End of term theory examination conducted at end of every semester. Semester

examination every 6months (*5) +one pre university.

5. End of term practical/oral examinations after 2 years 9 months. Minimum of 40% marks

obtained in the internal assessment, needed to appear in university exams.

Mark for personal attributes and clinical work should be given annually by all the consultants,

under whom the resident was working during the year. Average of the three years should be

put as the final marks put of 20.

Marks for academic activity should be given by the all the consultants, who have attended the

session presented by the resident.

Summative Assessment

• Ratio of marks in theory and practical’s will be equal.

• The pass percentage will be 50%.

• Candidate will have to pass theory and practical examinations separately.

A. Theory Examination (Total=400)

Paper Title Marks

Paper 1: Basic sciences as applied to Surgery 100

Paper2: Principles and Practice of general Surgery (excluding GIT) 100

Paper 3: Operative Surgery & GIT 100

Paper 4: Recent advances in Surgery 100

B. Practical Examination and Viva voce (Total =400)

Long Case - One 150

Short Case (s) - Three×50 150

C. Viva –voce shall carry 100 marks as under:

X-rays / Investigations……………………………………… 25

Specimen / Surgical pathology………………………….. 25

Instruments ------------------------------------- 25

Operative surgery ------------------------------------- 25

Every candidate should maintain a log book to record all the activities performed during

training course. Format of log book is attached with curriculum.

Suggested Books

Core Books:

1. Bailey & Love’s Short Practice of Surgery

2. Farquaharson’s Text Book of Operative Surgery

3. Current Surgical Diagnosis & Treatment

4. S. Das Manual of Clinical Surgery

5. Pye’s Surgical Handicraft

Reference Books:

1. Hamilton Bailey Demonstration of clinical signs symptoms in Surgery

2. Emergency Surgery By Baily H.

3. Dudley’s Atlas of General Surgery

4. Mastery of Surgery by Baker R J Vol. I & II

5. Schwartz Principles of Surgery

6. Recent Advances , Tayler

7. Sabiston text book of Surgery

8. Maingot’s Abdominal Operations

9. Oxford Text Book of Surgery Vol. I,II & III by Morris and Wood

10. S. Das Text Book on Short cases

11. Mastery of Thoracic Surgery

12. Text Book of Hepatobiliary Surgery—Blumgart

13. Text Book of Colorectal Surgery by Corman Marwin L.

14. Laparoscopic Surgery Technique Darsi

15. Zollinger Atlas of Surgical Operations

16. Surgery of Alimentary Tract Vol I & II Shackelford

Journals

1. Annals of Surgery

2. Archives of Surgery

3. British Journal of Surgery

4. Journal of Neurosurgery

5. Journal of Neurosurgery-Spine

6. Journal of Neurosurgery –Pediatrics

7. Journal of Plastic, Reconstructive and Aesthetic Surgery

8. Journal of Trauma

9. Journal of Urology

10. Neurosurgery Clinics of North America

11. Plastic & Reconstructive Surgery

12. Surgery

13. Surgical clinics of North America

14. Urological Clinics of North America

15. Indian Journal of Surgery

16. Journal of Minimal Access Surgery

17. Journal of Indian Association of Peadiatric Surgery

18. Indian Journal of Burns

19. Indian Journal of Thoracic and Cardiac Surgery

20. Journal of Emergency Trauma Shock

21. Current problems in Surgery.

Model Question Paper

M S (General Surgery)

Paper—1

Basic Sciences as Applied to Surgery

Max. Marks: 100 Time allowed –3 Hours

• Attempt All Questions

• Answer each question & its parts in Sequential order

• Draw diagrams , where necessary

1. Define shock, classify and discuss in detail the management of haemorragic shock? (20)

2. Discuss in detail the stages of wound healing and factors affecting wound healing. (20)

3. Describe briefly:

a. Patho physiological changes of portal hypertension. (10)

b. Management of haemothorax. (10)

c. Chemical sterilization. (10)

4. Write short notes on:

a. Surgical anatomy of thyroid. (5)

b. Lymphatic drainage of breast. (5)

c. Surgical anatomy of inguinal canal. (5)

d. Branchial cyst. (5)

e. Hypokalemia. (5)

f. Fluid therapy in burns. (5)



Paper—2

Principles and Practice of General surgery (Excluding GIT)





1. Describe the clinical features, investigations and management of locally advanced

carcinoma of breast. (20)

2. Classify Venous diseases and discuss in detail Deep Venous thrombosis. (20)

3. Describe briefly

a. Management of hydronephrosis. (10)

b. Renal tuberculosis. (10)

c. ANDI of breast. (10)

4. Write Short notes on:

a. Bladder stones (5)

b. Prostate Specific Antigen (5)

c. Third degree burns. (5)

d. Primary survey in trauma. (5)

e. Amoebic liver abscess. (5)



Paper—3

General Surgery & GIT




• Draw diagrams, where necessary.

1. Describe the clinical features, investigations and management of lower GI bleed. (20)

2. Describe clinical features, investigations and management of carcinoma colon. (20)


a. Portal Hypertension. (10)

b. Laparoscopic Cholecystectomy. (10)

c. Mesenteric Cyst. (10)

4. Write short notes on

a. Buergers disease. (5)

b. Appendicitis. (5)

c. Fistula in Ano. (5)

d. Damage control surgery. (5)

e. Rectal Prolapse. (5)

f. Achlasia Cardia. (5)



Paper—4

Recent Advances in Surgery





1. Describe the Recent advances in the management of carcinoma breast. (20)

2. Describe recent advances in the treatment of Varicose veins. (20)


a. Advantages of robotic surgery. (10)

b. Latest Concepts in management of BPH. (10)

c. Recent trends in Laparoscopic surgery. (10)

4. Write short notes on :

a. Recent investigations in the management of Carcinoma Esophagus. (5)

b. N.O.T.E.S (5)

c. Energy Sources in Surgery. (5)

d. Abdominal Compartment Syndrome. (5)

e. Mondors disease. (5)

f. Complications of TURP. (5)

Format of Log Book

Teerthanker Mahaveer Medical College &Research Centre

(A college of Teerthanker Mahaveer University)

Approved by Medical Council of India & Govt. of India

LOG BOOK FOR M.S. (General Surgery)

Name of the PG Student : __________________________________

Name of the PG Guide : __________________________________

Bagarpur, Delhi Road, Moradabad – 244001 (U.P)

Tel: 0591 – 2360000, Telefax: 0591 – 2360077, 2487444,

E-mail: [email protected]

Web: www.tmu.ac.in

PERSONAL BIODATA

NAME OF THE CANDIDATE:

NAME OF THE INSTITUTE:

YEAR AND MONTH OF REGISTRATION:

NAME OF THE P.G TEACHER:

FATHER’S NAME:

PERMANENT ADDRESS OF THE CANDIDATE:

DATE OF BIRTH OF THE CANDIDATE:

EDUCATION QUALIFICATIONS:

S.N. DEGREE INSTITUTE/

UNIVERSITY

YEAR OF PASSING

1.

2.

3.

4.

5.

PASSPORT

SIZE

PHOTOGRAPH

POSTING SCHEDULES

FIRST YEAR

S. N. FROM TO PLACE OF POSTING REMARKS SING. OF I/C

SECOND YEAR


THIRD YEAR


JOURNAL CLUBS

TERM AND YEAR HELD ATTENDED REMARKS

1.

2.

3.

4.

5.

6.

________________________________________________________________________

.

SHORT TALKS/SEMINARS CONDUCTED BY THE CANDIDATE

S.NO. TOPIC DATE REMARKS OF GUIDE

1.

2.

3.

4.

5.

6.

7.

OPERATIVE PROCEDURES PERFORMED. A ----- Assisted to seniors.

S. no. Name of the procedure

B ----- Assisted to Juniors.


C ----- Performed independently.


CME/CONFERENCES/WORKSHOPS ATTENDED

S. no. Date Name of the Event Attended

PUBLICATIONS IF ANY

S. no. Name of the Article Name of the Journal

DISSERTATION DETAILS

NAME OF THE TOPIC ---

NAME OF THE GUIDE---

NAME OF THE CO-GUIDE--- (IF ANY)

DATE OF APPROVAL BY ETHICS COMMITTEE ---

SIGN.OF GUIDE. SIGN. OF CO-Guide: SIGN. OF HOD