تفاصيل المقرر

المقدمة


Every medical graduate should be equipped and qualified to deal with and manage surgical problems since such problems, whether emergency or elective are among the commonest a practising doctor meets. The scope of surgical sciences is rapidly increasing. The surgeon today often works as a member of a team and must frequently consultant and anaesthiologist, a bacteriologist, a radiologist and a biochemist. The development of closely integrated multidisciplinary groups such as nephrology, neurology and gastroenterology resulted in improved patient care. The role of the surgeon has been broadened to include organisation of trauma centres, advice on rapid trans port of the injured patient, prophylaxis of industrial road and domestic accidents, and prevention of and early diagnosis of cancer.
To understand all these developments and to be able to manage surgical problems and give the appropriate treatment and total care of the surgical patient, the surgical clerkship course offers the basic principles of surgery that all students should know before they come to practice.



المحتويات


SPECIFIC OBJECTIVES AND CONTENTS:-

Since the aim of the surgical clerkship is to make the student competent to deal with patients and since these present with clinical pictures rather than with disease entities, there is much more emphasis on problems in this clerkship. The specific objectives for most the common conditions are listed under these problems. Most of these problems are life-threatening and/or common in the community and fulfill the criteria for level I, where the student is expected to diagnose and manage alone or as part of a team management. Conditions or problems listed under level II are less prevalent and the student is expected to be familiar with diagnose, and refer for management. The specific objectives are listd under:

A./ Important specific basic surgical knowledge and the following :
Principles of Endoscopic surgery
Principles of organ Transplantation.
Principles of plastic surgery
Principles of cardio thoracic surgery

B./ Surgical emergencies
C./ Common problems
D./ Specific conditions

A. The following topics are regarded as basic to the understanding of surgical sciences. The student should be able to discuss its various aspects and apply this knowledge relevantly in surgical patients.

LEVEL I

1. Metabolic response to trauma, sepsis and starvation
2. Fluids and electrolytes and acid base disturbances and surgical nutrition
3. Shock
4. The use of blood and blood components
5. Inflammation, infection and antibiotics
6. Tissue healing
7. Preoperative care and assessment of patients
8. Operative care and assessment of patients
9. Post operative care and complications
10. Pain and analgesia
11. Theatre set up (sterilization and aseptic techniques)
12. The immune response in tissue transplantation and cancer
13. Cancer, spread and principles of treatment (surgery, radiotherapy, hormones and cytotoxic drugs)
14. Special medical problems in surgical patients e.g. diabetes mellitus, hypertension, heart failure and chronic lung disease.

EMERGENCY PROBLEMS

(1) The Critically Injured

Plan management promptly and properly according to the following priorities
1.1 Initial resuscitation: fat bedside during transport, and at casualty)
1.2 Evaluation and reassessment
1.3 Outline of definitive management

(2) Head Injuries

2.1 Mention the different types, discuss the possible mechanism and pathophysiology of head injuries.
2.2 Diagnose, detect on X-ray, and outline management of :
2.2.1 fissured fracture
2.2.2 depressed fracture
2.2.3 fracture base
2.3 Classify, describe the clinical features, and diagnose intracranial bleeding and outline the management and prognosis of each type
2.4 Outline the management of the unconscious patient under three headings:
2.4.1 Observation
2.4.2 Nursing
2.4.3 Indications for surgery

(3) Chest Injuries

3.1 Classify, discuss the mechanism, the pathophysiology and the clinical features of chest injuries
3.2 Diagnose and manage the possible complications

Level I

1. Fracture rib (isolated)
2. Flail chest (or stove-in-chest)
3. Pneumothorax
4. Haemothorax
5. Haemopericardium
6. Major vessel injury
7. Ruptured diaphragm
8. Broken bronchus
9. Ruptured oesophagus

Level II

1. Lacerations of the lung
2. Ruptured thoracic duct

(4) Abdominal Injuries

Discuss the mechanism of injury diagnose and outline the management of:
a- Ruptured hollow viscus
b- Intraperitoneal bleeding (such as ruptured spleen, liver and mesentry)

(5) Musculoskeletal Injuries

5.1 Classify fractures in general and outline principle of treatment of simple and compound fractures
5.2 Describe the mechanism of injury the clinical features, diagnose and manage the following injuries and their specific complications:
5.2.1 Dislocation of the shoulder
5.2.2 Fracture humerus (neck, shaft and supracondylar)
5.2.3 Dislocation of the elbow
5.2.4 Fracture ulna and radius (fracture head of radius olecranon, shafts and lower third)
5.2.5 Colles fracture
5.2.6 Fracture scaphoid, lunate and perilunate dislocation and Bennet's fracture
5.2.7 Dislocation of the hip
5.2.8 Fracture femur (neck, shaft and supracondylar fracture)
5.2.9 Knee injuries (ruptured lateral ligaments, cruciates and meniscus tear and fracture patella)
5.2.10 Fracture tibia and fibula
5.2.11 Fracures and sprains around the ankle
5.2.12 Fracture calcaneum

(6) Fracture spine and cord injuries

Discuss the mechanism of injury, classify, diagnose and outline the management and prognosis of:
6.1 Cervical injuries
6.2 Dorsolumbar injuries
(7) Pelvic fractures

Describe the different types, the mechanism of injury and the management of each tuype and their possible complications.

(8) Urological injuries

Discuss the mechanism of injury, classify diagnose, request specific investigation and outline management and prognosis of:
8.1 Renal
8.2 Ureteric
8.3 Urethral injuries
8.4 Bladder injuries

(9) Hand injuries and infections

9.1 Describe the surgical anatomy of the hand and examine for tendon and nerve injuries
9.2 Outline principles of management of injuries of the hand
9.3 Describe the different

(10) Vascular Injuries

10.1 Examine the peripheral pulses properly whenever indicated
10.2 Differentiate between arterial and venous haemorrhage
10.3 Diagnose and outline the management of major vessel injury

(11) Ocular Injuries

Classify diagnose and outline the management of the different type of eye injury and their complications

(12) Burns and Scalds

12.1 Classify and assess the degree and extent of burns
12.2 Resuscitate the burnt patient
12.3 Outline thoroughly the immediate, delayed and late management of burns and their possible complications
12.4 Discuss the different types of skin grafting

(13) Epistaxis

13.1 Mention the causes of bleeding from the nose
13.2 Examine properly the nose and recognise the necessary instruments and equipment for diagnosis and management
13.3 Apply simple first aid methods for stopping the bleeding, request appropriate investigations and outline definitive management

(14) Upper GastroIntestinal Bleeding

14.1 Discuss the aetiology and surgical pathology, diagnose and request special investigations
14.2 Manage the acute phase properly
14.3 Outline subsequent management of the following conditions:
14.3.1 oesophageal varices and portal hypertension
14.3.2 bleeding peptic ulcer
14.3.3 acute gastric erosins
14.3.4 carcinoma of the stomach
14.3.5 oesophageal tears

(15) Acute Abdomen

Discuss the aetiology and pathophysiology, describe the clinical features diagnose and/or give the differential diagnosis and outline the management of :

a. Inflammatory conditions
Level I

1. Acute appendicitis and its complications
2. Acute cholecystitis and biliary colic
3. Acute pancreatitis and its complications
4. Pelvic inflammatory disease (e.g. salopingitis)
5. Adhesions and bands

Level II

1. Diverticulitis
2. Regional ileitis (chronic disease)
3. Mesenteric lymphadenitis
4. Meckel's diverticulitis

b. Perforations
Level I

1. Perforated hollow viscus such as peptic ulcer, typhoid ulcer ruptured carcinoma colon
2. Ruptured ectopic pregnancy

c. Medical conditions
Level I

1. Myocardial infarction
2. Lobar pneumonia and pleurisy

Level II

1. Diabetic crisis
2. Tabes dorasils

d. Bowel obstruction

Classify, discuss the aetiology and pathophysiology and describe the clinical features and request special investigations of the following conditions:
Level I

1. Obstructed and strangulated herniae
2. Sigmoid volvulvus
3. Intussusception (caeco-colic and ileo-colic)
4. Neoplastic conditions (carcinoma colon and rectum)
5. Adhesions and bands
6. Mesenteric thrombosis

Level II

1. Granulomatous bowel lesions such as tuberculosis and Crohn's disease
2. Manage the preoperatie and postoperative phase and outline the operative management of the above conditions

(16) Bleeding per rectum

Discuss the aetiology and surgical pathology, properly conduct and interpret P.R. and proctoscopy findings, diagnose and request relevant investigations and outline the management of the following conditions
16.1 Piles
16.2 Carcinoma of the rectum and the anal canal
16.3 Inflammatory bowel disease
16.4 Adenomatous polyps of the bowl

(17) Painful Ano-Rectal Conditions
Discuss the aetiology, surgical pathology, clinical presentation and management of:
Level I

1. Anal fissures
2. Perianal haematoma
3. Perianal abscess
4. Strangulated piles
5. Anal carcinoma

Level II

1. Pruritus ani
2. Proctalgia fugus

(18) Retention of Urine

18.1 Manage the acute phase i.e. establish a provisional diagnosis and relieve the retention
18.2 Discuss the aetiology, surgical pathology diagnose, investigate and outline the definitive treatment of :

Level I

1. Benign hypertrophy of the prostate
2. Carcinoma of the prostate
3. Stricture of the urethra (inflammatory and traumatic)
4. Bladder neck obstruction
5. Post-operative retention
6. Spinal cord and cauda equina lesions

Level II

1. Urethral valves
2. Prostatitis and prostatic abcess
3. Vesical and urethral calculi
4. Urethral stones and neoplasms

(19) Gangrene

19.1 Classify, discuss the aetiological factors and outline the management of the different types of gangrene
19.2 Discuss the bacteriology, pathology, clinical features and treatment (proplylactic and curative) of gas gangrene.

(20) Diabetic Sepsis
Discuss the precipitating factors diagnose and manage diabetic sepsis (prophylaxis and curative)

(21) Tetanus

21.1 Discuss the aetiology, pathology and clinical features and diagnose and give a differential diagnosis of a case of tretanus.
21.2 Discuss the management of tetanus i.e. prophylaxis and curative treatment

(22) Acute Infections:
Discuss the bacteriology, pathology diagnosis and management of cellulitis, abscesses, boils and carbuncles

(23) Acute Osteomyelitis:

23.1 Discuss the bacteriology, clinical presentation and differential diagnosis
23.2 Outline principles of management and possible complications
23.3 Discuss the pathology, presentation, X-ray appearances and management of chronic osteomyelitis.

(24) Cardiac Arrest
Discuss the different forms and the factors that lead to cardiac arrest. Diagnose (immediate recognition) and actively treat this condition. Discuss the principles of rescusitation.
(25) Paediatric Surgery
Discuss the aetiology and pathophysiology, request investigations and outline the management of:-

a. Emergencies
Level I

- Tracheoesophageal fistula or atresia
- Lobar emphysema
- Congenital diaphragnatic hernia
- Congenital pyloric stenosis
- Intestinal obstruction, atresia, meconium illeus, intussusception, Hirshspriug's disease etc.
- Peritonitis
- Anal atresias
- Examphalos
- Birth trauma (haemoperitoneum)
- Testicular torsion

b. Common conditions

- undescended testicles
- Hydrocephalus and meningococles
- Hydrocele

Level II

- Epispadias and hypospadias
- Enuresis
- Cleft lip and palate

c. Common problems

(1) Oral and pharyngeal swellings:
Discuss the pathology, describe the clinical presentation and outline the manegement of:

Level I

- Carcinoma of the lip
- Carcinoma of the tongue
- Carcinoma of the hypopharynx
- Nasopharyngeal and laryngeal carcinomas
- Laryngeal carcinoma

Level II

- Rannula
- Mucus retention cyst
- Lingual and sublingual dermoids
- Haemangiomad and lymphangioma
- Leukoplakia of the tongue
- Cervical rib

(2) Neck Swellings

2.1 Describe the applied surgical anatomy of the neck such as the muscles, fascial plains and traingles, the throid, the salivary glands and the cervical lymph nodes
2.2 Classify, discuss the aetiology, surgical pathology clinical features diagnosis and give the differential diagnosis and outline the management of:

Level I

- Goitre
- Cervical lymph node enlargement
- Salivary glands - infections calculi, and tumours
- Thyroglossal cyst and fistula
- Lingual thyroid

Level II

- Sublingual dermoid
- Bronchial cyst
- Cystic hygroma
- Cervical rib
- Sternomastoid tumour
- Carotid body tumour
- Spinal abscess
- Pharyngeal pouch

(3) A. Breast Lumps

3.1 Describe the surgical anatomy of the breast
3.2 Take a good history, examine, investigate and diagnose a lump in the breast
3.3 Discuss the aetiology, epidemiology, pathology methods of spread and staging of carcinoma of the breast
3.4 Outline the different methods of treatment of cancer of the breast and discuss the prognostic factors
3.5 Discuss the pathology and outline the management of:

Level I

- Fibroadenoma
- Fibrocystic disease (Fibroadenosis)
- Cysts and abscesses

Level II

- Galactocoele
- Gynaecomastia
- Cystosarcoma phylloides
- Fat Necrosis

B. Discharge from the Nipple
Discuss the aetiology, surgical pathology and outline the management of a case of discharge from the nipple.

(4) Dysphagia

Discuss the aetiology, pathophysiology clinical features diagnosis and management of:
- Reflex oesophagitis
- Carcinoma of the oesophagus
- Achalasia of the cardia

Level II

- Oesophageal webs
- Lower oesophageal ring
- Oesophageal diverticulum
- Extrinsic causes
- Diffuse apasm
- Scleroderma
- Neurological causes
- Globus hystericus

(5) Abdominal Pain

a. Pain in the right hypochondrium (R.H.)
5.1 Examine properly, ask for specific investigations diagnose and/or give the differential diagnosis of pain in the R.H.
5.2 Discuss the pathology and outline the management of:

Level I

- Herpes zoster
- Pleurisy

b. Epigastric pain
Discuss the aetiology, pathophysiology diagnose request relevant investigations and outline the management and possible complications of:
- Peptic ulcer
- Hiatus hernia
- Pancreatitis
- Gastritis and duodenitis
- Myocardial infarction

c. Loin pain

Discuss the aetiology, pathology, request relevant investigations and outline management of:
- Renal calculi and their complications
- Kidney infections

(6) Abdominal Mass

6.1 Describe the mass and discuss its differential diagnosis
6.2 Discuss the surgical pathology, clinical presentation, request special investigations and outline management and prognosis of:

a. Epigastric mass
Level I
- Carcinoma of the stomach
- Epigastric hernia
Level II
- Left lobe liver enlargement
-Pancreatic mass

b. Mass in the R.I.F.
Level I
- Appendicular mass
- Carcinoma of the caecum
- Tuberculosis of the ileocaecal junction
- Tubo ovarian mass
Level II
- Ectopic kidney
- Retroperitoneal tumours
- Actinomycosis
- Crohn's disease
- Psoas abscess

c. Renal mass
Level I
- Renal tumours
- Hydronephrosis
- Cysts of the kidney (polycystic disease, solitary cysts, hydatid cyst)
- Perinephric abscess
Level II
-Retroperitoneal tumoyrs

(7) Swellings of the Rectum

Discuss the aetiology, pathology and outline the management of:
Level I
- Carcinoma of the rectum
- Bilharzial granuloma'
- Rectal polyps
- Swellings pressing on the rectum such as carcinoma prostate, pelvic abscess, metastatic deposits

(8) Jaundice

8.1 Classify, discuss the aetiology and pathophysiology diagnose and request special investigations of a case of jaundice
8.2 Describe the clinical presentaiton and outline preoperative and postoperative management of surgical jaundice
Level I
- Gall-stones
- Carcinoma of the head of pancreas
- Carcinoma of the common bile duct
Level II
- Secondaries in porta hepatis
- Choledochal cyst
- Parasitic infestations (Ascaris)
- Chronic pancreatitis

(9) Inguio Scrotal Swellings

9.1 Describe the surgical anatomy of the inguinal and femoral canal
9.2 Discuss the surgical pathology diagnose and/or give the differential diagnosis and outline the management of:
Level I
- Inguinal hernias and complications
- Femoral hernia and its complications
- Vaginal hydrocele
- Testicular tumours
- Epididymo orchitis
- Heamatocele
Level II
- Varicocele
- Encysted hydrocele of the cord
- Spermatocele
- Seminoma

(10) Haematuria:

Discuss the aetiology, take a good history request the relevant investigations, diagnose and outline the management of :
Level I
- Urinary bilharziasis
- Renal, ureteric and vesical calculi
- Renal and bladder tumours
- Infections
- Prostatic enlargement
- Traumatic
Level II
- Blood dycrasias
- Drugs

(11) Renal Failure
Discuss the aetiology, clinical presentation request special investigations and outline the management of acute and chronic renal failure

(12) The Swollen limb:

12.1 Describe the blood supply and lymphatic drainage of the lower limb
12.2 Discuss the surgical pathology, diagnose and outline the management of:
12.2.1 Deep vein thrombosis and its complications
12.2.2 Lymphoedema

(13) Skin Swelling and ulcers:

13.1 Describe the histology of the skin
13.2 Discuss the surgical pathology, diagnose and outline the management of:
Swellings:
- Lipoma
- Sebaceous cyst
- Dermoid cyst
- Pailloma
- Squamous cell carcinoma
- Basal cell carcinoma
- melanomas

Ulcers:
- Venous
- Arterial
- Traumatic
- Infective
- Neuropathic
- Neoplastic

(14) Backache and sciatica:

Discuss the aetiology, pathology clinical presentation and special investigations and outline the management of:
Level I
- Disc prolapse
- Tuberculosis of the spine
- Ankylosing spondylitis
- Secondary deposits in the spine
- Spondylosis

Level II
- Tumours of the vertebral column and spinal canals
- Infections - acute osteomyelitis
- Spondylosthesis
- Sacro-joint disease - Sacro-iliac joint disease

(15) Arthritis:

Discuss the aetiology, clinical presentation investigations and outline the management of :
Level I
- Osteoarthritis
- Pyogenic arthritis
- Tuberculous arthritis
- Rheumatoid arthritis
- Rheumatic fever
Level II
- Syphilitic (Charcoat's knee)
- Gonorrhoeal arthritis

(16) Sore throat

Discuss the aetiology, microbiology diagnosis and management of:
16.1 Tonsilitis and its complications
16.2 Dyphtheria and its complications
16.3 Pharyngitis, laryngitis
16.4 Ludwig's angina
(17) Upper Respiratory Tract Obstruction

17.1 Discuss the causes of upper respiratory tract obstruction and outline emergency management and definitive management of:
Level I
- Acute infections
- Oedema of the glottis
- Bilateral adductor cord paralysis
- Tumours - carcinoma of the larynx
- Cut throat

Level II
- Foreign bodies
- Chronic stenosis e.g. following tuberculosis
- Congenital webs
17.2 Discuss other indications for doing a tracheostomy

(18) Discharging Ear

Discuss the bacteriology, pathology, diagnosis and outline the management and possible complications of:
Level I
- External otitis
- Acute and chronic otitis media

Level II
- Problems of hearing
- Drugs effect on hearing

(19) Red Eye

Discuss the causes, diagnose and outline management of:
Level I
- Conjunctivitis
- Iritis
- Acute congestive glaucoma
Level II
-Classify, discuss the aetiology, clinical presentation and outline the management of catarract
-Discuss the pathology, clinical presentaiton and outline the management of a case of glaucoma.

COMMON SPECIFIC CONDITIONS:

1. Madura
Classify, discuss the aetiology, pathology clinical presentation and complications and outline the management of madura.
2. Varicose Veins
Discuss the aetiological factors diagnose and outline the management and possible complications of varicose veins

OUTLINE OF WORK

The training is constructed to emphasise basic sciences and surgical principles pertinent to the practice of surgery. The students will be assigned to consultant surgeons and work as part of the team. Duties and responsibilities will be assigned to the student and he will develop the experience in preoperative and postoperative management of patients. Students will aparticipate in all aspects of patients's management. They will share duties with the houseofficer, clerk patients, attend clinics, rounds and conferences do special procedures and assist in operations.
Students will be assigned to different supervisors to work with them for a parttime period of eight weeks and full time period of six weeks. Each student during this period should:-
a. contribute actively in the unit activities
b. clerk and present as many cases as possible
c. keep a log book that contains:
1- all the operations he saw and assisted in
2- all the skills he performed alone or under guidance or observed
3- twelve of the cases he clerked and presented during this period
d. see and take part in the management of emergencies and keep up to date casualty card
e. The supervisor shall:
1- organise to see his group repeatedly; and make sure that they are doing their evening duties
2- countersign their log book and casualty cards
3- continuously evaluate his students and present a final evaluation form for each student in his group



المنسقون



المطلوبات


ALL THE PREVIOUS COURSES IN PHASE 1 & II


الأهداف


1) GENERAL OBJECTIVES

The aim of the surgical clerkship is to reinforce and extend the basic knowledge and skills already learned in the previous years of medical education to enable the student to assume increasing responsibility for care of the surgical patient with appropriate supervision. The student will be able to work as part of a profession team and participate in all activities with a sense of committment to the best utilization of his/her knowledge towards comprehensive care of the patient.

The objectives of the surgical clerkship are divided within the three domains i.e.
- Cognitive domain.
- Affective domain.
- Psychomotor domain.

PREFACE

The surgical clerkship is meant to reinforce and extend the student's basic knowledge and skills already learned in the previous years of medical education to enable the student to assume increasing responsibility for comprehensive care of the surgical patient (i.e. care that encompasses a patient's emotional, family, and society problems as well as his organic pathology).
Most of the objectives in this clerkship are set in the form of problems or conditions or statements. These are leveled as I and II.

LEVEL I:

Includes all conditions which are common and/or serious and/or preventable which the student is expected to discuss diagnose and manage alone or as part of team management.

LEVEL II:

Includes conditions which are less common and/or less serious which the student is expected to discuss, diagnose and refer for management.
The objectives and the leveling of these objectives should be no means limit the student's reading and learning experience. In this area, of rapidly growing medical sciences there is no limit to what a good student can learn and do. The learning experience is mostly the student's own responsibility. At every stage in medical education it is the student himself, the individual, who must make the major effort.
This booklet is only a guide to the student and staff and it is not meant to cover all aspects of basic surgical knowledge. It is hoped that the student will make the best out of it. It is impossible to import the entire content of surgical sciences to the student a fair knowledge of the principles of the fundamental subject of surgery, and a power to use the instruments and methods of his profession; to give him the right attitude; and above all to put him in a position to continue his own education which he has only begun in the medical school.

1/ THE COGNITIVE DOMAIN:

Performances varying from simple recall to highly original ways of synthesising data and solving problems.

2/ THE AFFECTIVE DOMAIN:

Performance emphasizing feelings and emotions, interest, attention and qualities of character and conscience.

3/ THE PSYCHOMOTOR DOMAIN:

Performance emphasizing skills requiring neuromuscular coordination. At the end of the surgical clerkship the student should be able to:-
1- Take a careful history, properly perform physical examination, apply the necessary laboratory procedures and X-ray examination and use the medical records to reach a logical diagnosis of a surgical problem by synthesizing all the data collected.
2- Discuss the pathology and diagnose and/or give the differential diagnosis of most of the common surgical diseases.
3/ Discuss the different methods of therapy of a surgical illness with reasons for selection of surgical therapy in specific patients and disease entities and determine the anatomic and physiologic consequences of surgical intervention.
4/ Discuss total care of the surgical patient i.e. preoperative assessment and care, anesthetic techniques and post operative care and complications.
5/ Discuss the basic considerations in surgery such as metabolic response to trauma, shock, fluid and electrolyte and acid-base balance, the use of blood and blood components in surgery, surgical nutrition, tissue healing, surgical infections and the use of antibiotics, cancer spread and principles of treatment, pain and its management and pulmonary and cardiovascular failure and management.

AFFECTIVE GOALS:

1- The student will be able to understand the emotional effects of surgical intervention and be sympathetic with his patients. He will consider the patient's social and economic background and family relationships in planning for therapy. He will fell the responsibility for correction of environmental factors which have caused the illness or which adversely effect patient's recovery.
2- The student will be able to work as a member of the surgical team, respond to rapid adjustment demanded by surgical illness and accept responsibility for night or emergency work.

SKILLS:

The student will acquire common manual techniques and procedures used for diagnosis and therapy. Many of the simple procedures should have been done by the student before. These skills are best developed and perfected under supervision of the surgical team. A representative list of motor skills essential to the surgical experience is listed below in order of priority.

A. SKILLS THAT THE STUDENT MUST DO ALONE:

- give lM and l.V. injections
- set up drips and transfuse appropriate fluids via veins
- use the opthalmoscope, auroscope and laryngoscope
- perform manual examination per rectum and per vaginum
- perform local and digital block anaesthesia
- introduce a nasogastric tube
- suture wounds with appropiate needles and suture materials
- dress wounds
- drain an abscess
- perform external cardiac massage
- perform artificial respiration and mouth to mouth breathing
- Remove superficial foreign bodies
- Open achalazion

B. SKILLS THAT THE STUDENT MUST DO UNDER GUIDANCE:

- Do a venous cutdown
- Group and cross-match blood
- perform proctoscopy and take rectal biopsy
- pass a urethral catheter
- Set simple fractures in plaster, fram or sling
- Assist in operations such as appendicectomy, hernial repair, haemorrhoidectomy etc.

C. SKILLS THAT STUDENT MUST OBSERVE AS A DEMONSTRATION:

- Introduce an endotracheal tube
- Aspirate fluid from pleural and peritoneal cavities
- perform a lumbar puncture and spinal anesthesia
- Set up tidal drainage of the bladder
- Manage an emergency tracheotomy
- Introduce an intercostals drain



طرق التدريس


1 Rotation Post
Students are posted to different units in the department of surgery. They spent 14 weeks in the surgical clerkship divided as such:
General surgery 7 weeks
Urology 2 weeks
Orthopaedics 2 weeks
Anaesthesiology 1 week
Ottolaryngology 1 week
Ophthalmology 1 week

2 Inpatient work
In the units of general surgery urology and orthopaedics student, will be assigned beds. They will clerk their patients, identify their problems and share in their management and their follow up. Out of all the cases the student clerked he will collect five cases in general surgery 3 cases in urology and 3 cases in orthopaedics and keep their records in his log book.

3 Ward Rounds
Students will attend the ward rounds conducted by the unit team. The students shall present their cases during these rounds and discuss them with the consultant and medical officers. Students should be prepared to discuss the pathology, diagnosis and management of their patients. There will be one or two grand rounds each week.

4 Outpatient work
Students will work in the outpatient department with the surgical house officer in charge. They interview patients examine them, identify their problems and discuss their management. They will clerk those patients who need to be admitted.

5 Referred Clinics
Students will attend with the consultant in charge the referred surgical outpatient once a week. They will interview examine and discuss the management of patients with the consultant and his team.

6 Night Duties
Each student will be assigned to do night duty once a week with the unit in charge of the day. Students will avail themselves from 2.00 p.m. to 6.00 a.m. next day for emergency calls with the house officer on call.

7 Operating theatre
With the small numbers each unit will have a (maximum of 6 students at a time) students are expected to be present in the operation room with their unit. They shall attend most of the operations and assist in some of them such as appendicectomy, herniorraphy, haemorrhoidectomy, fistulectomy etc.

8 Tutorials, Seminars Lecture-discussions
All the students in the surgical clerkship meet with a tutor at the end of the day from 12 noon to 1.30 p.m. (except on Wednesday) to discuss a problem or a topic.

9 Clinoco-pathological Conferences X-ray sessions and Surgical Journal Club
These will be held in the evenings once or twice every week. Interesting cases will be discussed and pathologists will share in the discussion. A review of interesting articles in surgical journals will be presented by students at the beginning of these meetings.

10 Hospital Clinical Meeting and Surgical Discharge Clinic
Students will attend these weekly held meetings in the hospital on Thursdays from 10.30 a.m. to 2.00 p.m.



المصادر


1) Human Resources:

1.1 Surgeons including Orthopaedic Urologist, E.N.T.
Paediatrics, Plastic surgeons and ophthalmologists
1.2 Pathologists
1.3 Anatomoists
1.4 Anaesthestists and Assistants
1.5 Radiologist
1.6 House officers
1.7 Sisters
1.8 Theatre staff
1.9 Nursing staff

2 Physical Resources:

1 Wad Medani Hospital: Surgical wards, lecture theatre, operating theatres and outpatient department
2 Wad Medani Health Centres
3 Equipment and materials
- Tape slide projector
- Tape slide on surgical topics (see Appendix II)
- Videos
- Multimedia



وسائل التقويم


1 Tutors report on clinical performance and fulfillment of assignments - students will be rated as excellent, good satisfactory, unsatisfactory and poor
2 The log book and the casualty card
(these two will form 10% of the total mark)
3 Written: MCQs 10%
Single best answer 10%
4 Essays examination 15%
5 Clinical examination (PACES) 40%
6 Objectively Structured Clinical Examination (OSCE) 15%



المراجع


1. المعين في الجراحة السريرية ـ سكوت Aids to Clinical Surgery – Scott
2. الممارسة المختصرة للجراحة ـ بيلى ولوف Short Practice of Surgery Baily & Love
3. نظام جراحة العظام ـ ج ـ أبلى System of Orthopaedics- G. Aply
4. الخطوط العريضة للكسور وامراض العظام أ ـ كروفوردOutline of Fractures & orthopaedics. A. Crawford
5. العلامات الجسمية للجراحة السريرية Physical signs in Clinical Surgery H. Baily
6. علم المسالك البولية المهتدى بالمشاكل Problem oriented Urology G.Belail
7. principles & practice of surgery مختصر كوسيري .
8. Smith general Urology
9. Introduction to symptoms & signs (Browse)


الجدول الزمني

FACULTY MEMBERS BEDSIDE TEACHING TUESDAY: 24/1/2017 8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 25/1/2017
FACULTY MEMBERS
DISCHARGE CLINIC

THURSDAY: 26/1/2017
FACULTY MEMBERS
BEDSIDE TEACHING

TUESDAY: 31/1/2017
8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 1/2/2017
LONGITUDINAL WEDNSDAY: 8/2/2017
FACULTY MEMBERS DISCHARGE CLINIC THURSDAY: 9/2/2017
FACULTY MEMBERS
BEDSIDE TEACHING

TUESDAY:14/2/2017
8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: :15/2/2017
FACULTY MEMBERS BEDSIDE TEACHING TUESDAY: 21/2/2017 8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 22/2/2017

LONGITUDINAL
WEDNSDAY: 28/2/2017
FACULTY MEMBERS
BEDSIDE TEACHING

SUNDAY: 4/3/2017
8:00- 12:00 PM
FACULTY MEMBERS
BEDSIDE TEACHING

TUESDAY: 6/3/2017
8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 7/3/2017
FACULTY MEMBERS DISCHARGE CLINIC THURSDAY: 8/3/2017
FACULTY MEMBERS BEDSIDE TEACHING TUESDAY: 13/3/2017 8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 14/3/2017
FACULTY MEMBERS BEDSIDE TEACHING TUESDAY: 20/3/2017 8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 21/3/2017
FACULTY MEMBERS
BEDSIDE TEACHING

SUNDAY:25/3/2017
8:00- 12:00 PM
FACULTY MEMBERS
BEDSIDE TEACHING

TUESDAY: 27/3/2017
8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 28/3/2017
FACULTY MEMBERS DISCHARGE CLINIC THURSDAY: 29/3/2017
FACULTY MEMBERS
BEDSIDE TEACHING

TUESDAY: 3/4/2017
8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 4/4/2017
FACULTY MEMBERS DISCHARGE CLINIC THURSDAY: 5/4/2017
FACULTY MEMBERS BEDSIDE TEACHING TUESDAY: 10/4/2017 8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 11/4/2017
FACULTY MEMBERS BEDSIDE TEACHING TUESDAY: 17/4/2017 8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 18/4/2017
FACULTY MEMBERS
BEDSIDE TEACHING

TUESDAY: 24/4/2017
8:00-12:00 pm

LONGITUDINAL
WEDNSDAY: 25/4/2017
FACULTY MEMBERS
BEDSIDE TEACHING

THURSDAY: 26/4/2017
8:00-12:00 pm
ELECTIVE TUESDAY: 1/5/2017

ELECTIVE
WEDNSDAY: 2/5/2017
FACULTY MEMBERS CLINICAL EXAMINATION THURSDAY: 3/5/2017 8:00-2:00 pm

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