DRAFT FOR CONSULTATION

A curriculum for the early years of surgical training

Preface............................................................................................................................................ !ARL" "!ARS TRAININ# AND T$! COR! CURRICULU% & ....................................................' O(!R(I!)................................................................................................................................. ' PURPOS!S................................................................................................................................ * T$! TRAININ# PAT$)A"............................................................................................................ + T$! ASS!SS%!NT FRA%!)OR,............................................................................................... OUTCO%!.................................................................................................................................... ./ A SU%%AR" OF T$! ,!" S"LLA0US %ODUL!S IN T$! COR! CURRICULU% T$AT AR! R!1UIR!D OF ALL SUR#ICAL TRAIN!!S PRIOR TO !NTR" INTO ST ................................. T$! D!TAIL!D %ODUL!S OF T$! COR! SUR#ICAL S"LLA0US FOR ALL SUR#ICAL TRAIN!!S R!1UIR!D FOR !NTR" INTO ST ..........................................................................' %o2ule ..................................................................................................................................... .3 0asic sciences.......................................................................................................................... .3 %o2ule 4.................................................................................................................................... .5 Common Surgical Con2itions ................................................................................................... .5 %o2ule .................................................................................................................................... 4/ 0asic surgical s6ills................................................................................................................... 4/ %o2ule '.................................................................................................................................... 44 The assessment an2 management of the surgical 7atient........................................................44 %o2ule *.................................................................................................................................... 4 Peri8o7erati9e care.................................................................................................................... 4 %o2ule 3.................................................................................................................................... 43 Assessment an2 management of 7atients :ith trauma ;inclu2ing the multi7ly in<ure2 7atient= .................................................................................................................................................. 43 %o2ule +.................................................................................................................................... 45 Surgical care of the Pae2iatric 7atient.......................................................................................45 %o2ule 5.................................................................................................................................... 4%anagement of the 2ying 7atient.............................................................................................4%o2ule -.................................................................................................................................... 4Organ an2 Tissue trans7lantation............................................................................................ 4%o2ule./................................................................................................................................... / Professional 0eha9iour an2 Lea2ershi7.................................................................................... / ASS!SS%!NT OF T$! COR! CURRICULU%........................................................................... Learning agreements............................................................................................................. )or67lace 0ase2 Assessments............................................................................................ Pur7ose of )P0As................................................................................................................ Peer Assessment Tool........................................................................................................... '/ %ini Clinical !9aluation !>ercise...........................................................................................'. Case 0ase2 Discussion......................................................................................................... '. Direct O?ser9ation of Proce2ural S6ills ;DOPS=....................................................................'. Proce2ure8?ase2 Assessment............................................................................................... '4 The log ?oo6 of 7roce2ures................................................................................................... ' !>aminations............................................................................................................................. ' SP!CIALT" SP!CIFIC !L!%!NTS R!1UIR!D TO %!!T T$! ST CO%P!T!NC" IN AN" #I(!N SUR#ICAL DISCIPLIN!................................................................................................... '3 )hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in #eneral Surgery............................................................................................................................ '+ )hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in Urology.......................................................................................................................................... */ )hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in Car2iothoracic surgery.................................................................................................................. *

)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in Trauma an2 Ortho7ae2ic surgery ;T@O=.......................................................................................*+ )hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in Pae2iatric surgery......................................................................................................................... 3/ )hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in Plastic Surgery......................................................................................................................................... 3* )hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in Neurosurgery................................................................................................................................ 35 )hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in Otolaryngology ;!NT=................................................................................................................... +. )hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in %a>illofacial surgery ;O%FS=........................................................................................................ +' S!L!CTION INTO A SUR#ICAL DISIPLIN!...............................................................................+5

Preface
This is a com7etence ?ase2 curriculum. Its focus is on the traineeAs a?ility to 2emonstrate 6no:le2geB s6ills an2 7rofessional ?eha9iours that they ha9e acCuire2 in their training ;s7ecifie2 in the sylla?us= through o?ser9a?le ?eha9iours. It is not time82efine2 an2 allo:s these com7etences to ?e acCuire2 in 2ifferent time frames in some training 7rogrammes than in othersB 2e7en2ing u7on the structure of that 7rogramme. There are certain milestones or com7etency 7oints :hich allo: trainees to ?enchmar6 their 7rogress. A critical com7etency 7oint is ST at :hich 7ointB in 7racticeB trainees :ill ma6e a clear commitment to one of the nine SAC 2efine2 2isci7lines of surgery. This 2ocument contains the curriculum :hich must ?e com7lete2 in or2er to meet the entry reCuirements of ST irres7ecti9e of the training route follo:e2... The 2ocument containsB amongst other thingsB the sylla?us of the core s6illsB 6no:le2ge an2 7rofessional ?eha9iours :hich that are reCuire2 of successful can2i2ates in the %RCS e>amination. In a22itionB this curriculum refers to other reCuirements an2 assessments 2eman2e2 of surgeons :ishing to 7rocee2 into ST . The sylla?us is achie9a?le 9ia 2ifferent training 7rogrammes :hich 9ary ?et:een Post #ra2uate Deaneries. This 2ocument has ?een 7ro2uce2 for DCST an2 has ?een agree2 ?y the nine SACs follo:ing consultation.

EARLY YEARS TRAINING AND THE CORE CURRICULUM

OVERVIEW
Doctors :ho as7ire to a career in surgery :ill chooseB 2uring their trainingB to s7ecialise in one of the nine SAC 2efine2 surgical s7ecialtiesB namelyE8 car2iothoracicB general surgeryB neurosurgeryB oro8ma>illo8facial surgery ;O%FS=B otolaryngologyB 7ae2iatric surgeryB 7lastic surgeryB trauma an2 ortho7ae2ics ;T@O= urologyB

The curriculum for each of these s7ecialties is com7etency ?ase2 an2 the num?er of years ta6en to achie9e the com7etencies is merely in2icati9e. There are :ay 7ointsE entry to surgical training 8 CT. or ST.B entry to entirely s7ecialise2 training 8 ST e>it at CCT :ithin one of the nine 2efine2 surgical 2isci7lines. ST ;S7eciality Training= com7etencies refer to a ty7e of training :here the s7eciality element is integrate2 :ith the core element of s6illsB 6no:le2ge an2 7rofessional ?eha9iours from the start. CT ;core or generic training= assumes trainees enter a 7erio2 :here they may ?e e>7ose2 to a 9ariety of s7ecialities :hich may or may not ?e 2irectly rele9ant to their ultimate s7eciality choice. It is 7ossi?le for any trainee to transfer from one to another s7eciality 2isci7line of surgery 7ro9i2e2 they a= meet their e2ucational milestones in the core an2 ?= satisfy all the s7eciality reCuirements for ST entry in the s7ecialty of their choice. The 2ifferent training schemes offere2 ?y the Post #ra2uate Deaneries meet 2ifferent e2ucational nee2s an2 7ermit trainees to ma6e earlier or later final career choices ?ase2 on a?ility an2 7reference. The start of ST is a 6ey com7etency 7oint :hen can2i2ates 2emarcate their training from the more genericB to the more s7ecialise2 route. Currently all nine surgical s7ecialties ha9e se7arate curriculaB :hich each en9isage +85 in2icati9e years of training from ST.FCT.. These curricula :ere concei9e2 an2 :ritten ?efore 4//+ :ithin the conte>t of Grun throughA training as 7ro7ose2 ?y %%C. $o:e9erB :ithin the early years of trainingB much of the content of these 2ifferent curricula is common. The intention of this 2ocument is to ca7ture the commonalities an2 2elineate the s7eciality 2ifferences lai2 2o:n in the first t:o le9els of com7etency 2efine2 as ST. an2 ST4 in these s7eciality curricula. It is im7ortant to em7hasise that it is essential that can2i2ates must achie9e ?oth core an2 s7ecialty s7ecific com7etencies to ?e eligi?le to com7ete at the ST com7etency le9el. The core com7etencies reflect the com7etencies that ALL surgeons must 2emonstrateB :hile the s7ecialty s7ecific com7etencies reflect the early com7etencies rele9ant to an in2i9i2ual s7ecialty.

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PURPOSES
The 7ur7oses of early years surgical training areE8 .. To 7ro9i2e a ?roa2 ?ase2 initial training in surgery :ith attainment of core 6no:le2geB s6ills an2 7rofessional ?eha9iours rele9ant to the 7ractice of surgery in any s7ecialist surgical 2isci7line. This is 2efine2 :ithin the core sylla?us ;:hich is also the sylla?us of the %RCS=. 4. In a22ition it :ill 7ro9i2e early s7eciality training such that can2i2ates can select one on the nine surgical s7eciality o7tions an2 2emonstrate that they ha9e the 6no:le2geB s6ills an2 7rofessional ?eha9iours to enter s7ecialty training at ST entry le9el ;see ?elo:= in that surgical s7ecialty. The s7ecialty s7ecific elements are lai2 out in the s7ecialty s7ecific curriculaB an2 for con9enience a?stracte2 in this 2ocument. These s7eciality elements ;e>ce7t in otolaryngology & see = are NOT teste2 in the %RCS ?ut through )P0As in the first instanceB an2 su?seCuently through the Intercollegiate S7ecialty FRCS e>aminationsB :hich are ta6en to:ar2s the en2 of s7ecialty training. . In otolaryngologyB e>ce7tionallyB the DO$NS 2i7loma 2oes assess the s7ecialty s7ecific com7onents of the sylla?usB :hich are 2efine2 in more 2etail in a se7arate 2ocument. A22itionally can2i2ates :ill ?e continuously assesse2 on the contents of the core curriculum an2 their electe2 s7eciality s7ecific com7onent through :or67lace ?ase2 assessments ;)P0A= an2 structure2 re7orts from Assigne2 !2ucational Su7er9isors :hich in turn contri?ute to the Annual Assessment of Com7etency Progression ;ARCP=H this inclu2es the com7etencies e>7ecte2 of all 2octors inclu2ing surgeons to meet their o?ligations un2er #oo2 %e2ical Practice ;#%P= in or2er to remain license2 to 7ractice.

CANDIDATES WHOM WILL BECOME SURGICAL TRAINEES

Can2i2ates :ill ?e selecte2 after com7letion of Foun2ation com7etencies or their eCui9alents into either run through ST. or genericFtheme2 CT. 7osts. They :ill then ha9e to achie9e agree2 milestones in terms of College e>aminations an2 local ARCP arrangements in Deaneries :hich :ill inclu2e the 2escri?e2 :or6 7lace ?ase2 assessments. !ntry to ST :ill only 7rocee2 if the com7etencies 2escri?e2 in this 2ocument are achie9e2B irres7ecti9e of the training systemB ?e it run through or genericFtheme2 training.

ENTRY REQUIREMENTS
The spec f ca! "#s re$% re& "f a pers"# ' sh #( !" e#!er s%r( ca) !ra # #( are )a & "%! *e)"'

Pers"# Spec f ca! "# App) ca! "# !" e#!er Spec a)!+ Tra # #( a! ST,-CT, # a#+ & sc p) #e
Q%a) f ca! "#s E) ( * ) !+ Esse#! a) %00S or eCui9alent me2ical Cualification !ligi?le for full registration :ith the #%C at time of a77ointment !ligi?ility to :or6 in the U, !9i2ence of achie9ement of Foun2ation com7etences ?y time of a77ointment in line :ith #%C stan2ar2sF #oo2 %e2ical Practice Is u7 to 2ate an2 fit to 7ractise safely All a77licants to ha9e 2emonstra?le s6ills in :ritten an2 s7o6en !nglish a2eCuate to ena?le effecti9e communication a?out me2ical to7ics :ith 7atients an2 colleagues 2emonstrate2 ?y one of the follo:ingE a= that a77licants ha9e un2erta6en un2ergra2uate me2ical training in !nglishH or ?= ha9e the follo:ing scores in the aca2emic international !nglish Language Testing System ;I!LTS= & O9erall +B S7ea6ing +B Listening 3B Rea2ing 3B )riting 3. If a77licants ?elie9e they ha9e a2eCuate communication s6ills ?ut 2o not fit into one of these e>am7les they must 7ro9i2e su77orting e9i2ence %eets 7rofessional health reCuirements ;in line :ith #%C stan2ar2sF#oo2 %e2ical Practice= / !#ess T" Prac! se La#(%a(e S0 ))s Hea)!h A?ility to 7ro9i2e a com7lete em7loyment history No more than *. :ee6s in surgery ;not inclu2ing Foun2ation mo2ules=B ALL sections of a77lication form com7lete2 FULL" accor2ing to :ritten gui2elines 0e a?le to 7ractice as lai2 out in maintaining goo2 health in #%P Whe# E.a)%a!e&, A77lication form A77lication form A77lication form Inter9ie: F Selection centre4 A77lication form References A77lication form Inter9ie: F Selection centre

A77lication form Pre8em7loyment health screening A77lication form A77lication form

. 4

G:hen e9aluate2A is in2icati9eB ?ut may ?e carrie2 out at any time throughout the selection 7rocess A selection centre is a 7rocess not a 7lace. It in9ol9es a num?er of selection acti9ities that may ?e 2eli9ere2 :ithin the Unit of A77lication.

THE TRAINING PATHWAY

From the traineeAs 7ers7ecti9eB he or she :ill ?e a?le to un2erta6e surgical training 9ia 2iffering routes 2e7en2ing on :hich training scheme they choose or are selecte2 forB :ithin a School of Surgery in one of the Postgra2uate Deaneries in the Unite2 ,ing2om. .. For those trainees :ho are certain of their s7ecialty choiceB an2 :ho choose to enter Irun throughJ trainingB com7etiti9e entry into ST. :ill ?e 7ossi?le :ith run through training in their chosen s7ecialty to CCTB :here this is offere2 ?y the s7ecialty. This is currently the only route ?y :hich trainees can un2erta6e training in neurosurgery. Such a route still 2eman2s that in a22ition to s7eciality s7ecific com7etenciesB the core com7etencies common to all surgeons are attaine2 ?efore entering ST an2 these :ill ?e assesse2 through the %RCSB )P0As an2 satisfactory ARCPs. 4. For those trainees :ho are either uncertain of their chosen s7ecialtyB or :ho are una?le to gain entry to run8through trainingB a 7erio2 of generic surgical training :ill ?e necessary. During this 7erio2 they :ill attain core surgical 6no:le2geB s6ills an2 7rofessional ?eha9ioursB :hile sam7ling a num?er of surgical s7ecialties an2 ma6ing a 2ecision as to their 7referre2 s7ecialty or s7ecialties. It :ill ?e necessary in a22ition to attaining core com7etencies to ensure that they Ito7 u7J their s7eciality s7ecific com7etencies to ma6e them eligi?le to enter ST in their chosen s7eciality. They :ill then see6 to enter s7ecialty training at the entry ST le9el ?y com7etiti9e entry. O7en com7etition :ill test can2i2ates against SAC 2efine2 com7etencies for an entry ST trainee. This mo2el has a num?er of 7ossi?le 9ariants. It might ?e 7ossi?le to teach core com7letely :ithin a generic 7rogramme follo:e2 ?y s7eciality to7 u7 training later on in or2er to reach s7eciality entry ST le9el. Another 9ariant :oul2 organise generic training along a theme :hich su77orts ?oth core an2 an element of s7eciality s7ecific com7etencies contiguously. In 7racticeB it is en9isage2 that generic surgical training :ill run o9er an in2icati9e timescale of u7 to years ;CT.8 =. . Some early years trainees may :ish to 7ursue an aca2emic surgical career an2 :ill 2e9ote a significant 7ro7ortion or their time to a22itional aca2emic 7ursuits inclu2ing research an2 teaching. For the ma<ority this :ill lea2 ;later in s7ecialise2 training= to a 7erio2 of time in 2e2icate2 researchB resulting in the a:ar2 of a higher 2egree in a scientific area relate2 to their chosen s7ecialty. For others :ho :ish to re9ert to full time clinical trainingB this :ill also ?e 7ossi?leB 7ro9i2ing that the rele9ant clinical com7etencies are achie9e2. This 9ariety of routes to learning an2 training are 2esira?le as this :ill cater for a 2i9ersity of :ants an2 nee2s of 7otential surgeons of the futureB through offering choice an2 fle>i?ility. It also 7ermits Schools an2 Deaneries to offer 9ariety in their teaching an2 learning styles :hich :ill 7ro9i2e them :ith a uniCue im7rimatur :hich :ill a77eal to 2ifferent trainees in 2ifferent :ays. Diagram . summarises 7otential 7ath:ays that can a22ress the early yearAs curriculum.

Diagram . summarises 7otential 7ath:ays that can a22ress the early yearAs curriculum. Diagram .

THE ASSESSMENT /RAMEWOR1

This is 2etaile2 on 7ages >8> an2 sho:n 2iagrammatically in Diagram 4

Diagram 4

OUTCOME
The outcome of early years training is to achie9e the com7etencies reCuire2 of surgeons entering ST . These com7etencies inclu2eE Com7etence in the management of 7atients 7resenting :ith a range of sym7toms an2 electi9e an2 emergency con2itions as s7ecifie2 in the core sylla?us for surgery. Com7etence in the management of 7atients 7resenting :ith an a22itional range of electi9e an2 emergency con2itionsB as s7ecifie2 ?y the s7ecialty sylla?us for le9els ST. an2 ST4. Professional com7etences as s7ecifie2 in the sylla?us an2 2eri9e2 from #oo2 %e2ical Practice 2ocuments of #eneral %e2ical Council of the U,.

Ha. #( 2e! !he "%!c"2es "f !h s c%rr c%)%2 a s%r( ca) !ra #ee ' )) *e a*)e !" 7erform as a mem?er of the team caring for surgical 7atients. recei9e 7atients as emergencies an2 re9ie: 7atients in clinics an2 initiate management an2 2iagnostic 7rocesses ?ase2 on a reasona?le 2ifferential 2iagnosis. manage the 7erio7erati9e care of their 7atients an2 recognise common com7lications an2 either ?e a?le to 2eal :ith them or 6no: to :hom to refer. ?e safe an2 useful assistant in the o7erating room 7erform some sim7le 7roce2ures un2er minimal su7er9ision an2 7erform more com7le> 7roce2ures un2er 2irect su7er9ision

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A SUMMARY O/ THE 1EY SYLLABUS MODULES IN THE CORE CURRICULUM THAT ARE REQUIRED O/ ALL SURGICAL TRAINEES PRIOR TO ENTRY INTO ST34
All of this material :ill ?e teste2 in the %RCS ?ut may also ?e teste2 in the :or67lace. ,4 Bas c Sc e#ce 1#"')e&(e re)e.a#! !" s%r( ca) prac! ce Anatomy Physiology Pharmacology 8 in 7articular safe 7rescri?ing Pathological 7rinci7les un2erlying system s7ecific 7athology %icro?iology Diagnostic an2 inter9entional ra2iology These can all ?e conte>tualise2 :ithin the list of 7resenting sym7toms an2 con2itions outline2 in mo2ule 4. 54 C"22"# s%r( ca) c"#& ! "#s To assess an2 initiate in9estigation an2 management of common surgical con2itions :hich may confront any 7atient :hilst un2er the care of surgeonsB irres7ecti9e of their s7eciality. To ha9e sufficient un2erstan2ing of these con2itions so as to 6no: :hat an2 to :hom to refer in a :ay that an insightful 2iscussion may ta6e 7lace :ith colleagues :hom :ill ?e in9ol9e2 in the 2efiniti9e management of these con2itions. This 2efines the sco7e an2 2e7th of the to7ics in the generality of clinical surgery reCuire2 of any surgeon irres7ecti9e of their ST 2efine2 s7eciality. Bas c s%r( ca) s0 ))s To 7re7are oneself for surgery To safely a2minister a77ro7riate local anaesthetic agents To han2le surgical instruments safely To han2le tissues safely To incise an2 close su7erficial tissues accurately To tie secure 6nots To safely use surgical 2iathermy To achie9e haemostasis of su7erficial 9essels. To use a suita?le surgical 2rain a77ro7riately. To assist hel7fullyB e9en :hen the o7eration is not familiar. To un2erstan2 the 7rinci7les of anastomosis To un2erstan2 the 7rinci7les of en2osco7y The pr #c p)es "f assess2e#! a#& 2a#a(e2e#! "f !he s%r( ca) pa! e#! To assess the surgical 7atient. To elicit a history that is rele9antB conciseB accurate an2 a77ro7riate to the 7atientAs 7ro?lem. To 7ro2uce timelyB com7lete an2 legi?le clinical recor2s. To assess the 7atient a2eCuately 7rior to o7eration an2 manage any 7re8o7erati9e 7ro?lems a77ro7riately. To 7ro7ose an2 initiate surgical or non8surgical management as a77ro7riate.

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To ta6e informe2 consent for straightfor:ar2 cases.

Per 6"pera! .e care "f !he s%r( ca) pa! e#! To manage 7atient care in the 7eri8o7erati9e 7erio2. To assess an2 manage 7reo7erati9e ris6. To ta6e 7art in the con2uct of safe surgery in the o7erating theatre en9ironment. To assess an2 manage ?lee2ing inclu2ing the use of ?loo2 7ro2ucts. To care for the 7atient in the 7ost8o7erati9e 7erio2 inclu2ing the assessment of common com7lications. To assess an2 7lan 7erio7erati9e nutritional management. Assess2e#! a#& ear)+ !rea!2e#! "f !he pa! e#! ' !h !ra%2a To safely assess the multi7ly in<ure2 7atient. To safely assess an2 initiate management of 7atients :ith traumatic s6in an2 soft tissue in<ury chest trauma a hea2 in<ury a s7inal cor2 in<ury a?2ominal an2 urogenital trauma 9ascular trauma a single or multi7le fractures or 2islocations ?urns S%r( ca) care "f !he pae& a!r c pa! e#! To assess an2 manage chil2ren :ith surgical 7ro?lemsB un2erstan2ing the similarities an2 2ifferences from a2ult surgical 7atients. To un2erstan2 common issues of chil2 7rotection an2 to ta6e action as a77ro7riate. Ma#a(e2e#! "f !he &+ #( pa! e#! To manage the 2ying 7atient a77ro7riately. To manage the 2ying 7atient in consultation :ith the 7alliati9e care team. Or(a# a#& ! ss%e !ra#sp)a#!a! "# To un2erstan2 the 7rinci7les of organ an2 tissue trans7lantation. To assess ?rain stem 2eath an2 un2erstan2 its rele9ance to continue2 life su77ort an2 organ 2onation. Pr"fess "#a) *eha. "%r To 7ro9i2e goo2 clinical care To ?e a goo2 communicator To teach an2 to train To 6ee7 u7 to 2ate an2 6no: ho: to analyse 2ata To un2erstan2 an2 manage 7eo7le an2 resources :ithin the health en9ironment To 7romote goo2 $ealth To un2erstan2 the ethical an2 legal o?ligations of a surgeon

.4

THE DETAILED MODULES O/ THE CORE SURGICAL SYLLABUS /OR ALL SURGICAL TRAINEES REQUIRED /OR ENTRY INTO ST3
The sco7e of com7etence is 2efine2 ?y the list of su?<ects an2 to7ics outline2 a?o9e. The follo:ing 7anels 2etail the su?<ects an2 to7ics. The to7ic list in %o2ule 4 can ?e cross reference2 to any of the other %o2ules. In 7articular cross referencing %o2ule 4 :ith %o2ules . an2 ' may ?e 9ie:e2 as a ?lue7rint :hich :ill ?e a9aila?le on the :e? site. As has ?een note2 earlierH although the 2etail of these mo2ules is 7hrase2 in terms of 6no:le2ge an2 s6ill this curriculum is com7etence ?ase2. It is the 7ractical utilisation of 6no:le2ge an2 s6ill e9i2ence2 in ?eha9iour :hich is the focus. Possession of any 6no:le2ge or s6ill element is insufficient if it is not 2emonstrate2 satisfactorily in a 7rofessional conte>t. The a77ro7riate 2e7th an2 le9el of 6no:le2ge reCuire2 can ?e foun2 in e>em7lar te>ts ta?ulate2 ?elo:. )e e>7ect can2i2ates to ha9e mastery at the 2e7th :ithin the te>ts an2 to ?e a?le to ma6e use of that 6no:le2ge in the conte>t of surgical 7ractice 2efine2 in the Core Surgical Curriculum a?o9e. )e 2esire a 7rofessional a77roach from surgical trainees :ho :ill ?e e>7ecte2 to ha9e a 2ee7 un2erstan2ing of the su?<ectsB to the minimum stan2ar2 outlai2 ?elo:. It is e>7ecte2 that can2i2ates :ill rea2 ?eyon2 the te>ts ?elo: an2 to ma6e critical useB :here a77ro7riate of original literature an2 7eer scrutinise2 re9ie: articles in the relate2 scientific an2 clinical literature such that they can as7ire to an e>cellent stan2ar2 in surgical 7ractice. The te>ts are not recommen2e2 as the sole source :ithin their su?<ect matter an2 there are alternati9e te>t?oo6s an2 :e? information :hich may ?etter suit an in2i9i2ualAs learning style. O9er time it :ill ?e im7ortant for associate2 curriculum management systems to 7ro9i2e an e>7an2e2 an2 critically re9ie:e2 list of su77orting e2ucational material. T"p c A#a!"2+ Ph+s ")"(+ Pa!h")"(+ P"ss *)e Te7!*""0s "r "!her E&%ca! "#a) S"%rces LastKs AnatomyE Regional an2 A77lie2 ;%RCS Stu2y #ui2es= ?y R.D. Last an2 Chummy S #anongKs Re9ie: of %e2ical PhysiologyB 4 r2 !2ition ;Lange 0asic Science= Ro??ins 0asic PathologyE )ith STUD!NT CONSULT Online Access ?y (inay ,umar %00S %D FRCPathB A?ul ,. A??as %00SB Nelson Fausto %DB an2 Richar2 %itchell %D PhD Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULT Online Access ?y O. Dames #ar2en %0 Ch0 %D FRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh= FRACS;$on= FRCSC;$on= Professor 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition ?y Norman S. )illiams ;!2itor=B Christo7her D.,. 0ulstro2e ;!2itor=B P. Ronan OKConnell ;!2itor= Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULT Online Access ?y O. Dames #ar2en %0 Ch0 %D FRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh= FRACS;$on= FRCSC;$on= Professor 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition ?y Norman S. )illiams ;!2itor=B Christo7her D.,. 0ulstro2e ;!2itor=B P. Ronan OKConnell ;!2itor=

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Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULT Online Access ?y O. Dames #ar2en %0 Ch0 %D FRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh= FRACS;$on= FRCSC;$on= Professor 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition ?y Norman S. )illiams ;!2itor=B Christo7her D.,. 0ulstro2e ;!2itor=B P. Ronan OKConnell ;!2itor=

C"22"# s%r( ca) c"#& ! "#s

S%r( ca) S0 ))s Per 6"pera! .e care #c)%& #( cr ! ca) care

Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULT Online Access ?y O. Dames #ar2en %0 Ch0 %D FRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh= FRACS;$on= FRCSC;$on= ProfessorB An2re: ). 0ra2?ury 0Sc %0 Ch0 %D %0A FRCS!2 ProfessorB Dohn L. R. Forsythe %D FRCS;!2= FRCSB an2 Ro:an ) Par6s 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition ?y Norman S. )illiams ;!2itor=B Christo7her D.,. 0ulstro2e ;!2itor=B P. Ronan OKConnell ;!2itor= 0asic surgical s6ills course an2 curriculum ATLS course CriSP course Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULT Online Access ?y O. Dames #ar2en %0 Ch0 %D FRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh= FRACS;$on= FRCSC;$on= Professor 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition ?y Norman S. )illiams ;!2itor=B Christo7her D.,. 0ulstro2e ;!2itor=B P. Ronan OKConnell ;!2itor= Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULT Online Access ?y O. Dames #ar2en %0 Ch0 %D FRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh= FRACS;$on= FRCSC;$on= Professor 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition ?y Norman S. )illiams ;!2itor=B Christo7her D.,. 0ulstro2e ;!2itor=B P. Ronan OKConnell ;!2itor= Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULT Online Access ?y O. Dames #ar2en %0 Ch0 %D FRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh= FRACS;$on= FRCSC;$on= Professor 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition ?y Norman S. )illiams ;!2itor=B Christo7her D.,. 0ulstro2e ;!2itor=B P. Ronan OKConnell ;!2itor= Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULT Online Access ?y O. Dames #ar2en %0 Ch0 %D FRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh= FRACS;$on= FRCSC;$on= Professor 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition ?y Norman S. )illiams ;!2itor=B Christo7her D.,. 0ulstro2e ;!2itor=B P. Ronan OKConnell ;!2itor=

S%r( ca) care "f ch )&re#

Care "f !he &+ #(

Or(a# !ra#sp)a#!a! "#

.*

M"&%)e ,

Bas c sc e#ces
To acCuire an2 2emonstrate un2er7inning ?asic science 6no:le2ge a77ro7riate for the 7ractice of surgeryB inclu2ingE8 A77lie2 anatomyE ,no:le2ge of anatomy a77ro7riate for surgery PhysiologyE ,no:le2ge of 7hysiology rele9ant to surgical 7ractice PharmacologyE ,no:le2ge of 7harmacology rele9ant to surgical 7ractice centre2 aroun2 safe 7rescri?ing of common 2rugs PathologyE ,no:le2ge of 7athological 7rinci7les un2erlying system s7ecific 7athology %icro?iologyE ,no:le2ge of micro?iology rele9ant to surgical 7ractice ImagingE ,no:le2ge of the 7rinci7lesB strengths an2 :ea6nesses of 9arious 2iagnostic an2 inter9entional imaging metho2s A77lie2 anatomyE De9elo7ment an2 em?ryology #ross an2 microsco7ic anatomy of the organs an2 other structures Surface anatomy Imaging anatomy This :ill inclu2e anatomy of thora>B a?2omenB 7el9isB 7erineumB lim?sB hea2 an2 nec6 as a77ro7riate for surgical o7erations that the trainee :ill ?e in9ol9e2 :ith 2uring core training ;see %o2ule 4=. PhysiologyE #eneral 7hysiological 7rinci7les inclu2ingE $omeostasis Thermoregulation %eta?olic 7ath:ays an2 a?normalities 0loo2 loss an2 hy7o9olaemic shoc6 Se7sis an2 se7tic shoc6 Flui2 ?alance an2 flui2 re7lacement thera7y Aci2 ?ase ?alance 0lee2ing an2 coagulation Nutrition This :ill inclu2e the 7hysiology of s7ecific organ systems rele9ant to surgical care inclu2ing the car2io9ascularB res7iratoryB gastrointestinalB urinaryB en2ocrine an2 neurological systems. PharmacologyE The 7harmacology an2 safe 7rescri?ing of 2rugs use2 in the treatment of surgical 2iseases inclu2ing analgesicsB anti?ioticsB car2io9ascular 2rugsB anticoagulantsB res7iratory 2rugsB renal 2rugsB 2rugs use2 for the management of en2ocrine 2isor2ers ;inclu2ing 2ia?etes= an2 local anaesthetics. The 7rinci7les of general anaesthesia The 7rinci7les of 2rugs use2 in the treatment of common malignancies

O?<ecti9e

,no:le2ge

.3

PathologyE #eneral 7athological 7rinci7les inclu2ingE Inflammation )oun2 healing Cellular in<ury Tissue 2eath inclu2ing necrosis an2 a7o7tosis (ascular 2isor2ers Disor2ers of gro:thB 2ifferentiation an2 mor7hogenesis Surgical immunology Surgical haematology Surgical ?iochemistry Pathology of neo7lasia Classification of tumours Tumour 2e9elo7ment an2 gro:th inclu2ing metastasis Princi7les of staging an2 gra2ing of cancers Princi7les of cancer thera7y inclu2ing surgeryB ra2iothera7yB chemothera7yB immunothera7y an2 hormone thera7y Princi7les of cancer registration Princi7les of cancer screening The 7athology of s7ecific organ systems rele9ant to surgical care inclu2ing car2io9ascular 7athologyB res7iratory 7athologyB gastrointestinal 7athologyB genitourinary 2iseaseB ?reastB e>ocrine an2 en2ocrine 7athologyB central an2 7eri7heralB neurological systemsB s6inB lym7horeticular an2 musculos6eletal systems %icro?iologyE Surgically im7ortant micro organisms inclu2ing ?loo2 ?orne 9iruses Soft tissue infections inclu2ing cellulitisB a?scessesB necrotising fasciitisB gangrene Sources of infection Se7sis an2 se7tic shoc6 Ase7sis an2 antise7sis Princi7les of 2isinfection an2 sterilisation Anti?iotics inclu2ing 7ro7hyla>is an2 resistance Princi7les of high ris6 7atient management $os7ital acCuire2 infections ImagingE Princi7les of 2iagnostic an2 inter9entional imaging inclu2ing >8raysB ultrasoun2B CTB %RI. P!TB ra2iounucleoti2e scanning

.+

M"&%)e 5
O?<ecti9e

C"22"# S%r( ca) C"#& ! "#s

This section assumes that can2i2ates ha9e general me2ical com7etencies consistent :ith a 2octor lea9ing Foun2ation in the U,. It also assumes an ongoing commitment to 6ee7ing these s6ills an2 6no:le2ge u7 to 2ate as lai2 out in #%P. It is 7re2icate2 on the 9alue that surgeons are 2octors :ho carry our surgery an2 reCuire com7etencies. To 2emonstrate un2erstan2ing of the rele9ant ?asic scientific 7rinci7les for each of these surgical con2itions an2 to ?e a?le to 7ro9i2e the rele9ant clinical care as 2efine2 in mo2ules assessment an2 management as 2efine2 in %o2ules . an2 '. Presenting sym7toms or syn2romes To inclu2e the follo:ing con2itions A?2ominal 7ain A77en2icitis A?2ominal s:elling #astrointestinal malignancy Change in ?o:el ha?it Inflammatory ?o:el 2isease #astrointestinal Di9erticular 2isease haemorrhage Intestinal o?struction Rectal ?lee2ing A2hesions Dys7hagia A?2ominal hernias Dys7e7sia Peritonitis Daun2ice Intestinal 7erforation 0enign oeso7hageal 2isease Pe7tic ulcer 2isease 0enign an2 malignant he7aticB gall ?la22er an2 7ancreatic 2isease $aemorrhoi2s an2 7erianal 2isease A?2ominal :all stomata 0reast 2isease To inclu2e the follo:ing con2itions 0reast lum7s an2 ni77le 0enign an2 malignant ?reast lum7s 2ischarge %astitis an2 ?reast a?scess Acute 0reast 7ain Peri7heral 9ascular 2isease To inclu2e the follo:ing con2itions Presenting sym7toms or syn2rome Atherosclerotic arterial 2isease Chronic an2 acute lim? !m?olic an2 throm?otic arterial ischaemia 2isease Aneurismal 2isease (enous insufficiency Transient ischaemic attac6s Dia?etic ulceration (aricose 9eins Leg ulceration Car2io9ascular an2 7ulmonary To inclu2e the follo:ing con2itions 2isease Coronary heart 2isease 0ronchial carcinoma O?structi9e air:ays 2isease S7ace occu7ying lesions of the chest

To7ics

.5

#enitourinary 2isease To inclu2e the follo:ing con2itions Presenting sym7toms or syn2rome #enitourinary malignancy Loin 7ain Urinary calculus 2isease $aematuria Urinary tract infection Lo:er urinary tract 0enign 7rostatic hy7er7lasia sym7toms O?structi9e uro7athy Urinary retention Renal failure Scrotal s:ellings Testicular 7ain Trauma an2 ortho7ae2ics To inclu2e the follo:ing con2itions Presenting sym7toms or syn2rome Sim7le fractures an2 <oint 2islocations Traumatic lim? an2 <oint 7ain Fractures aroun2 the hi7 an2 an6le an2 2eformity 0asic 7rinci7les of Degenerati9e <oint Chronic lim? an2 <oint 7ain 2isease an2 2eformity 0asic 7rinci7les of inflammatory <oint 0ac6 7ain 2isease inclu2ing ?one an2 <oint infection Com7artment syn2rome S7inal ner9e root entra7ment %etastatic ?one cancer Common 7eri7heral neuro7athies an2 ner9e in<uries Disease of the S6inB $ea2 an2 Nec6 To inclu2e the follo:ing con2itions Presenting sym7toms or syn2rome 0enign an2 malignant s6in lesions Lum7s in the nec6 0enign an2 malignant lesions of the !7ista>is mouth an2 tongue U77er air:ay o?structions Neurology an2 Neurosurgery To inclu2e the follo:ing con2itions Presenting sym7toms or syn2rome S7ace occu7ying lesions from $ea2ache ?lee2ing an2 tumour Facial 7ain !n2ocrine To inclu2e the follo:ing con2itions Presenting sym7toms or syn2rome Thyroi2 an2 7arathyroi2 2isease Lum7s in the nec6 A2renal glan2 2isease Acute en2ocrine crises Dia?etes

.-

M"&%)e 3
O?<ecti9e

Bas c s%r( ca) s0 ))s

Pre7aration of the surgeon for surgery Safe a2ministration of a77ro7riate local anaesthetic agents AcCuisition of ?asic surgical s6ills in instrument an2 tissue han2ling. Un2erstan2ing of the formation an2 healing of surgical :oun2s Incise su7erficial tissues accurately :ith suita?le instruments. Close su7erficial tissues accurately. Tie secure 6nots. Safely use surgical 2iathermy Achie9e haemostasis of su7erficial 9essels. Use suita?le metho2s of retraction. ,no:le2ge of :hen to use a 2rain an2 :hich to choose. $an2le tissues gently :ith a77ro7riate instruments. Assist hel7fullyB e9en :hen the o7eration is not familiar. Un2erstan2 the 7rinci7les of anastomosis Un2erstan2 the 7rinci7les of en2osco7y Princi7les of safe surgery Pre7aration of the surgeon for surgery Princi7les of han2 :ashingB scru??ing an2 go:ning Immunisation 7rotocols for surgeons an2 7atients A2ministration of local anaesthesia Choice of anaesthetic agent Safe 7ractise Surgical :oun2s Classification of surgical :oun2s Princi7les of :oun2 management Patho7hysiology of :oun2 healing Scars an2 contractures Incision of s6in an2 su?cutaneous tissueE o LangerAs lines o Choice of instrument o Safe 7ractice Closure of s6in an2 su?cutaneous tissueE o O7tions for closure o Suture an2 nee2le choice Safe 7ractice ,not tying o Range an2 choice of material for suture an2 ligation o Safe a77lication of 6nots for surgical sutures an2 ligatures $aemostasisE o Surgical techniCues o Princi7les of 2iathermy Tissue han2ling an2 retractionE o Choice of instruments 0io7sy techniCues inclu2ing fine nee2le as7iration cytology

,no:le2ge

4/

Clinical S6ills

Use of 2rainsE o In2ications o Ty7es o %anagementFremo9al Princi7les of anastomosis Princi7les of surgical en2osco7y Pre7aration of the surgeon for surgery !ffecti9e an2 safe han2 :ashingB glo9ing an2 go:ning A2ministration of local anaesthesia Accurate an2 safe a2ministration of local anaesthetic agent Pre7aration of a 7atient for surgery Creation of a sterile fiel2 Antise7sis Dra7ing Pre7aration of the surgeon for surgery !ffecti9e an2 safe han2 :ashingB glo9ing an2 go:ning A2ministration of local anaesthesia Accurate an2 safe a2ministration of local anaesthetic agent Incision of s6in an2 su?cutaneous tissueE o A?ility to use scal7elB 2iathermy an2 scissors Closure of s6in an2 su?cutaneous tissueE o Accurate an2 tension free a77osition of :oun2 e2ges ,not tyingE o Single han2e2 o Dou?le han2e2 o Instrument o Su7erficial o Dee7 $aemostasisE o Control of ?lee2ing 9essel ;su7erficial= o Diathermy o Suture ligation o Tie ligation o Cli7 a77lication o Transfi>ion suture Tissue retractionE Tissue force7s Placement of :oun2 retractors Use of 2rainsE o Insertion o Fi>ation o Remo9al Tissue han2lingE A77ro7riate a77lication of instruments an2 res7ect for tissues 0io7sy techniCues S6ill as assistantE Antici7ation of nee2s of surgeon :hen assisting

Technical S6ills an2 Proce2ures

4.

M"&%)e 8
O?<ecti9e

The assess2e#! a#& 2a#a(e2e#! "f !he s%r( ca) pa! e#!
To 2emonstrate the rele9ant 6no:le2geB s6ills an2 attitu2es in assessing the 7atient an2 manage the 7atientB an2 7ro7ose surgical or non8surgical management. The 6no:le2ge rele9ant to this section :ill ?e 9aria?le from 7atient to 7atient an2 is co9ere2 :ithin the rest of the sylla?us & see common surgical con2itions in 7articular ;%o2ule 4=. As a trainee 2e9elo7s an interest in a 7articular s7eciality then the 7rinci7les of history ta6ing an2 e>amination may ?e increasingly a77lie2 in that conte>t. Surgical history an2 e>amination ;electi9e an2 emergency= Construct a 2ifferential 2iagnosis Plan in9estigations Clinical 2ecision ma6ing Team :or6ing an2 7lanning Case :or6 u7 an2 e9aluationH ris6 management Acti9e 7artici7ation in clinical au2it e9ents A77ro7riate 7rescri?ing Ta6ing consent for interme2iate le9el inter9entionH emergency an2 electi9e )ritten clinical communication s6ills Interacti9e clinical communication s6illsE 7atients Interacti9e clinical communication s6illsE colleagues

,no:le2ge

Clinical S6ills

44

M"&%)e 9

Per 6"pera! .e care

To assess an2 manage 7reo7erati9e ris6 To manage 7atient care in the 7eri8o7erati9e 7erio2 To con2uct safe surgery in the o7erating theatre en9ironment To assess an2 manage ?lee2ing inclu2ing the use of ?loo2 7ro2ucts To care for the 7atient in the 7ost8o7erati9e 7erio2 inclu2ing the assessment of common com7lications To assess an2 7lan 7erio7erati9e nutritional management Pre8o7erati9e assessment an2 managementE Car2iores7iratory 7hysiology Dia?etes mellitus an2 other rele9ant en2ocrine 2isor2ers Flui2 ?alance an2 homeostasis Renal failure Patho7hysiology of se7sis & 7re9ention an2 7ro7hyla>is Throm?o7ro7hyla>is La?oratory testing an2 imaging Ris6 factors for surgery an2 scoring systems Pre8me2ication an2 other 7reo7erati9e 7rescri?ing Princi7les of 2ay surgery Intrao7erati9e careE Safety in theatre inclu2ing 7atient 7ositioning an2 a9oi2ance of ner9e in<uries Shar7s safety DiathermyB laser use Infection ris6s Ra2iation use an2 ris6s TourniCuet use inclu2ing in2icationsB effects an2 com7lications Princi7les of localB regional an2 general anaesthesia Princi7les of in9asi9e an2 non8in9asi9e monitoring Pre9ention of 9enous throm?osis Surgery in he7atitis an2 $I( carriers Flui2 ?alance an2 homeostasis Post8o7erati9e careE Post8o7erati9e monitoring Car2iores7iratory 7hysiology Flui2 ?alance an2 homeostasis Dia?etes mellitus an2 other rele9ant en2ocrine 2isor2ers Renal failure Patho7hysiology of ?loo2 loss Patho7hysiology of se7sis inclu2ing SIRS an2 shoc6 %ulti8organ 2ysfunction syn2rome Post8o7erati9e com7lications in general %etho2s of 7osto7erati9e analgesia To assess an2 7lan nutritional management Post8o7erati9e nutrition !ffects of malnutritionB ?oth e>cess an2 2e7letion %eta?olic res7onse to in<ury

O?<ecti9e

,no:le2ge

%etho2s of screening an2 assessment of nutritional status %etho2s of enteral an2 7arenteral nutrition

$aemostasis an2 0loo2 Pro2uctsE %echanism of haemostasis inclu2ing the clotting casca2e Pathology of im7aire2 haemostasis e.g. haemo7hiliaB li9er 2iseaseB massi9e haemorrhage Com7onents of ?loo2 Alternati9es to use of ?loo2 7ro2ucts Princi7les of a2ministration of ?loo2 7ro2ucts Patient safety :ith res7ect to ?loo2 7ro2ucts CoagulationB 2ee7 9ein throm?osis an2 em?olismE Clotting mechanism ;(ircho: Tria2= !ffect of surgery an2 trauma on coagulation Tests for throm?o7hilia an2 other 2isor2ers of coagulation %etho2s of in9estigation for sus7ecte2 throm?oem?olic 2isease Princi7les of treatment of 9enous throm?osis an2 7ulmonary em?olism inclu2ing anticoagulation Role of (F1 scanningB CT7ulmonary angiogra7hyB D82imer an2 throm?olysis Place of 7ulmonary em?olectomy Pro7hyla>is of throm?oem?olismE Ris6 classification an2 management of D(T ,no:le2ge of metho2s of 7re9ention of D(TB mechanical an2 7harmacological Anti?ioticsE Common 7athogens in surgical 7atients Anti?iotic sensiti9ities Anti?iotic si2e8effects Princi7les of 7ro7hyla>is an2 treatment %eta?olic an2 en2ocrine 2isor2ers in relation 7erio7erati9e management Patho7hysiology of thyroi2 hormone e>cess an2 2eficiency an2 associate2 ris6s from surgery Causes an2 effects of hy7ercalcaemia an2 hy7ocalcaemia Com7lications of corticosteroi2 thera7y Causes an2 conseCuences of Steroi2 insufficiency Com7lications of 2ia?etes mellitus Causes an2 effects of hy7onatraemia Causes an2 effects of hy7er6alaemia an2 hy7o6alaemia Pre8o7erati9e assessment an2 managementE $istory an2 e>amination of a 7atient from a me2ical an2 surgical stan27oint Inter7retation of 7re8o7erati9e in9estigations %anagement of co mor?i2ity Resuscitation A77ro7riate 7reo7erati9e 7rescri?ing inclu2ing 7reme2ication Intra8o7erati9e careE

Clinical S6ills

4'

Safe con2uct of intrao7erati9e care Correct 7atient 7ositioning A9oi2ance of ner9e in<uries %anagement of shar7s in<uries Pre9ention of 2iathermy in<ury Pre9ention of 9enous throm?osis

Post8o7erati9e careE )riting of o7eration recor2s Assessment an2 monitoring of 7atientAs con2ition Post8o7erati9e analgesia Flui2 an2 electrolyte management Detection of im7en2ing organ failure Initial management of organ failure Princi7les an2 in2ications for Dialysis RecognitionB 7re9ention an2 treatment of 7ost8o7erati9e com7lications $aemostasis an2 0loo2 Pro2uctsE Recognition of con2itions li6ely to lea2 to the 2iathesis Recognition of a?normal ?lee2ing 2uring surgery A77ro7riate use of ?loo2 7ro2ucts %anagement of the com7lications of ?loo2 7ro2uct transfusion CoagulationB 2ee7 9ein throm?osis an2 em?olism Recognition of 7atients at ris6 A:areness an2 2iagnosis of 7ulmonary em?olism an2 D(T Role of 2u7le> scanningB 9enogra7hy an2 282imer measurement Initiate an2 monitor treatment of 9enous throm?osis an2 7ulmonary em?olism Initiation of 7ro7hyla>is Anti?ioticsE A77ro7riate 7rescri7tion of anti?iotics Assess an2 7lan 7reo7erati9e nutritional management Arrange access to suita?le artificial nutritional su77ortB 7refera?ly 9ia a nutrition team inclu2ing Dietary su77lementsB !nteral nutrition an2 Parenteral nutrition %eta?olic an2 en2ocrine 2isor2ers $istory an2 e>amination in 7atients :ith en2ocrine an2 electrolyte 2isor2ers In9estigation an2 management of thyroto>icosis an2 hy7othyroi2ism In9estigation an2 management of hy7ercalcaemia an2 hy7ocalcaemia Peri8o7erati9e management of 7atients on steroi2 thera7y Peri8o7erati9e management of 2ia?etic 7atients In9estigation an2 management of hy7onatraemia In9estigation an2 management of hy7er6alaemia an2 hy7o6alaemia Technical S6ills an2 Proce2ures Central 9enous line insertion Urethral catheterisation

4*

M"&%)e :

Assess2e#! a#& 2a#a(e2e#! "f pa! e#!s ' !h !ra%2a ; #c)%& #( !he 2%)! p)+ #<%re& pa! e#!=
Assess an2 initiate management of 7atients :ith chest trauma :ho ha9e sustaine2 a hea2 in<ury :ho ha9e sustaine2 a s7inal cor2 in<ury :ho ha9e sustaine2 a?2ominal an2 urogenital trauma :ho ha9e sustaine2 9ascular trauma :ho ha9e sustaine2 a single or multi7le fractures or 2islocations :ho ha9e sustaine2 traumatic s6in an2 soft tissue in<ury :ho ha9e sustaine2 ?urns Safely assess the multi7ly in<ure2 7atient. Conte>tualise any com?ination of the a?o9e 0e a?le to 7rioritise management in such situation as 2efine2 ?y ATLSB APLS etc #eneral Scoring systems for assessment of the in<ure2 7atient %a<or inci2ent triage Differences In chil2ren Shoc6 Pathogenesis of shoc6 Shoc6 an2 car2io9ascular 7hysiology %eta?olic res7onse to in<ury A2ult res7iratory 2istress syn2rome In2ications for using uncross matche2 ?loo2

O?<ecti9e

,no:le2ge

)oun2s an2 soft tissue in<uries #unshot an2 ?last in<uries Sta? :oun2s $uman an2 animal ?ites Nature an2 mechanism of soft tissue in<ury Princi7les of management of soft tissue in<uries Princi7les of management of traumatic :oun2s Com7artment syn2rome 0urns Classification of ?urns Princi7le of management of ?urns Fractures Classification of fractures Patho7hysiology of fractures Princi7les of management of fractures Com7lications of fractures Doint in<uries Organ s7ecific trauma

43

Patho7hysiology of thoracic trauma Pneumothora> $ea2 in<uries inclu2ing traumatic intracranial haemorrhage an2 ?rain in<ury S7inal cor2 in<ury Peri7heral ner9e in<uries 0lunt an2 7enetrating a?2ominal trauma Inclu2ing s7leen (ascular in<ury inclu2ing iatrogenic in<uries an2 intra9ascular 2rug a?use Crush in<ury Princi7les of management of s6in loss inclu2ing use of s6in grafts an2 s6in fla7s

Clinical S6ills

#eneral $istory an2 e>amination In9estigation Referral to a77ro7riate surgical su?s7ecialties Resuscitation an2 early management of 7atient :ho has sustaine2 thoracicB hea2B s7inalB a?2ominal or lim? in<ury accor2ing to ATLS an2 APLS gui2elines Resuscitation an2 early management of the multi7ly in<ure2 7atient S7ecific 7ro?lems %anagement of the unconscious 7atient Initial management of s6in loss Initial management of ?urns Pre9ention an2 early management of the com7artment syn2rome Central 9enous line insertion Chest 2rain insertion Diagnostic 7eritoneal la9age Urethral catheterisation Su7ra7u?ic catheterisation

Technical S6ills an2 Proce2ures

4+

M"&%)e > S%r( ca) care "f !he Pae& a!r c pa! e#!
O?<ecti9e To assess an2 manage chil2ren :ith surgical 7ro?lemsB un2erstan2ing the similarities an2 2ifferences from a2ult surgical 7atients To un2erstan2 the issues of chil2 7rotection an2 to ta6e action as a77ro7riate Physiological an2 meta?olic res7onse to in<ury an2 surgery Flui2 an2 electrolyte ?alance Thermoregulation Safe 7rescri?ing in chil2ren Princi7les of 9ascular access in chil2ren )or6ing 6no:le2ge of trust an2 Local Safeguar2ing Chil2ren 0oar2s ;LSC0s= an2 Chil2 Protection Proce2ures 0asic un2erstan2ing of chil2 7rotection la: Un2erstan2ing of Chil2renKs rights )or6ing 6no:le2ge of ty7es an2 categories of chil2 maltreatmentB 7resentationsB signs an2 other features ;7rimarily 7hysicalB emotionalB se>ualB neglectB 7rofessional= Un2erstan2ing of one 7ersonal roleB res7onsi?ilities an2 a77ro7riate referral 7atterns in chil2 7rotection Un2erstan2ing of the challenges of :or6ing in 7artnershi7 :ith chil2ren an2 families Recognise the 7ossi?ility of a?use or maltreatment Recognise limitations of o:n 6no:le2ge an2 e>7erience an2 see6 a77ro7riate e>7ert a29ice Urgently consult imme2iate senior in surgery to ena?le referral to 7ae2iatricians ,ee7 a77ro7riate :ritten 2ocumentation relating to chil2 7rotection matters Communicate effecti9ely :ith those in9ol9e2 :ith chil2 7rotectionB inclu2ing chil2ren an2 their families $istory an2 e>amination of the neonatal surgical 7atient $istory an2 e>amination of 7ae2iatric surgical 7atient Assessment of res7iratory an2 car2io9ascular status Un2erta6e consent for surgical 7roce2ures ;a77ro7riate to the le9el of training= in 7ae2iatric 7atients

,no:le2ge

Clinical S6ills

45

M"&%)e @
O?<ecti9e

Ma#a(e2e#! "f !he &+ #( pa! e#!

A?ility to manage the 2ying 7atient a77ro7riately. Palliati9e CareE #oo2 management of the 2ying 7atient in consultation :ith the 7alliati9e care team. Palliati9e CareE Care of the terminally ill A77ro7riate use of analgesiaB antiemetics an2 la>ati9es Princi7les of organ 2onationE Circumstances in :hich consi2eration of organ 2onation is a77ro7riate Princi7les of ?rain 2eath Un2erstan2ing the role of the coroner an2 the certification of 2eath Palliati9e CareE Sym7tom control in the terminally ill 7atient Princi7les of organ 2onationE Assessment of ?rain stem 2eath Certification of 2eath

,no:le2ge

Clinical S6ills

M"&%)e ?
O?<ecti9e

Or(a# a#& T ss%e !ra#sp)a#!a! "#

To un2erstan2 the 7rinci7les of organ an2 tissue trans7lantation Princi7les of trans7lant immunology inclu2ing tissue ty7ingB acuteB hy7eractute an2 chronic re<ection Princi7les of immunosu77ression Tissue 2onation an2 7rocurement In2ications for :hole organ trans7lantation

,no:le2ge

4-

The Professional 0eha9iour an2 lea2ershi7 elements are ma77e2 to the lea2ershi7 curriculum as lai2 out ?y the Aca2emy of %e2ical Royal Colleges. The assessment of these areas is a threa2 running through the curriculum an2 this ma6es them common to all of the 2isci7lines of surgery. For this reasonB assessment techniCues for this element of the curriculum are summarise2 in the final column.

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O*<ec! .e

#oo2 Clinical CareB to inclu2eE $istory ta6ing Physical e>amination Time management an2 2ecision ma6ing Clinical reasoning Thera7eutics an2 safe 7rescri?ing Patient as a focus of clinical care Area 84, Patient safety Infection control To achie9e an e>cellent le9el of care for the in2i9i2ual 7atient To elicit a rele9ant focuse2 history ;See mo2ules 4B B 'B*= To 7erform focuse2B rele9ant an2 accurate clinical e>amination ;See mo2ules 4B B'B*= To formulate a 2iagnostic an2 thera7eutic 7lan for a 7atient ?ase2 u7on the clinic fin2ings ;See mo2ules 4B B'B*= To 7rioritise the 2iagnostic an2 thera7eutic 7lan ;See mo2ules 4B B'B*= To communicate a 2iagnostic an2 thera7eutic 7lan a77ro7riately ;See mo2ules 4B B'B*= To 7ro2uce timelyB com7lete an2 legi?le clinical recor2s to inclu2e case8note recor2sB han2o9er notesB an2 o7eration notes To 7rescri?eB re9ie: an2 monitor a77ro7riate thera7eutic inter9entions rele9ant to clinical 7ractice inclu2ing non & me2ication ?ase2 thera7eutic an2 7re9entati9e in2ications ;See mo2ule .B4B B'B*= To 7rioritise an2 organise clinical an2 clerical 2uties in or2er to o7timise 7atient care To ma6e a77ro7riate clinical an2 clerical 2ecisions in or2er to o7timise the effecti9eness of the clinical team resource. To 7rioritise the 7atientAs agen2a encom7assing their ?eliefsB concerns e>7ectations an2 nee2s To 7rioritise an2 ma>imise 7atient safetyE To un2erstan2 that 7atient safety 2e7en2s on Area 84,

%ini C!LB C0DB %ini PATB %RCS an2 S7ecialty FRCS

The effecti9e an2 efficient organisation of care o $ealth care staff :or6ing :ell together o Safe systemsB in2i9i2ual com7etency an2 safe 7ractice To un2erstan2 the ris6s of treatments an2 to 2iscuss these honestly an2 o7enly :ith 7atients To systematic :ays of assessing an2 minimising ris6 To ensure that all staff are a:are of ris6s an2 :or6 together to minimise ris6 o To manage an2 control infection in 7atientsB inclu2ingE Controlling the ris6 of cross8infection A77ro7riately managing infection in in2i9i2ual 7atients )or6ing a77ro7riately :ithin the :i2er community to manage the ris6 7ose2 ?y communica?le 2iseases E7a2p)es Pa! e#! assess2e#! a#& O?tainsB recor2s an2 7resents accurate clinical &escr p!"rs history an2 7hysical e>amination rele9ant to the f"r C"re clinical 7resentationB inclu2ing an in2ication of S%r( ca) 7atientAs 9ie:s Tra # #( Uses an2 inter7rets fin2ings a2<uncts to ?asic e>amination a77ro7riately e.g. internal e>aminationB ?loo2 7ressure measurementB 7ulse o>imetryB 7ea6 flo: Res7on2s honestly an2 7rom7tly to 7atient Cuestions ,no:s :hen to refer for senior hel7 Is res7ectful to 7atients ?y o Intro2ucing self clearly to 7atients an2 in2icates o:n 7lace in team o Chec6s that 7atients comforta?le an2 :illing to ?e seen o Informs 7atients a?out elements of e>amination an2 any 7roce2ures that the 7atient :ill un2ergo C) # ca) reas"# #( In a straightfor:ar2 clinical case 2e9elo7s a 7ro9isional 2iagnosis an2 a 2ifferential 2iagnosis on the ?asis of the clinical e9i2enceB institutes an a77ro7riate in9estigati9e an2 thera7eutic 7lanB see6s a77ro7riate su77ort from others an2 ta6es account of the 7atients :ishes Rec"r& 0eep #( Is a?le to format notes in a logical :ay an2 :rites legi?ly A?le to :rite timelyB com7rehensi9eB informati9e letters to 7atients an2 to #Ps

T 2e 2a#a(e2e#! )or6s systematically through tas6s an2 attem7ts to 7rioritise Discusses the relati9e im7ortance of tas6s :ith more senior colleagues. Un2erstan2s im7ortance of communicating 7rogress :ith other team mem?ers Area 84, Pa! e#! safe!+ Partici7ates in clinical go9ernance 7rocesses Res7ects an2 follo:s local 7rotocols an2 gui2elines Ta6es 2irection from the team mem?ers on 7atient safety Discusses ris6s of treatments :ith 7atients an2 is a?le to hel7 7atients ma6e 2ecisions a?out their treatment !nsures the safe use of eCui7ment Acts 7rom7tly :hen 7atient con2ition 2eteriorates Al:ays escalates concerns 7rom7tly I#fec! "# c"#!r") Performs sim7le clinical 7roce2ures :hilst maintaining full ase7tic 7recautions Follo:s local infection control 7rotocols !>7lains infection control 7rotocols to stu2ents an2 to 7atients an2 their relati9es A:are of the ris6s of nosocomial infections.

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O*<ec! .e

Be #( a (""& c"22%# ca!"r N-A To inclu2eE Communication :ith 7atients 0rea6ing ?a2 ne:s Communication :ith colleagues C"22%# ca! "# ' !h pa! e#!s To esta?lish a 2octorF7atient relationshi7 characterise2 ?y un2erstan2ingB trustB res7ectB em7athy an2 confi2entiality To communicate effecti9ely ?y listening to 7atientsB as6ing for an2 res7ecting their 9ie:s a?out their health an2 res7on2ing to their concerns an2 7references To coo7erate effecti9ely :ith healthcare 7rofessionals in9ol9e2 in 7atient care To 7ro9i2e a77ro7riate an2 timely information to 7atients an2 their families Brea0 #( *a& #e's To 2eli9er ?a2 ne:s accor2ing to the nee2s of

P0AB DOPSB %ini C!LB %ini PAT an2 C0D

in2i9i2ual 7atients C"22%# ca! "# ' !h C"))ea(%es To recognise an2 acce7t the res7onsi?ilities an2 role of the 2octor in relation to other healthcare 7rofessionals. To communicate succinctly an2 effecti9ely :ith other 7rofessionals as a77ro7riate To 7resent a clinical case in a clearB succinct an2 systematic manner E7a2p)es Con2ucts a sim7le consultation :ith 2ue em7athy a#& an2 sensiti9ity an2 :rites accurate recor2s thereof &escr p!"rs Recognises :hen ?a2 ne:s must ?e im7arte2. f"r C"re A?le to ?rea6 ?a2 ne:s in 7lanne2 settings S%r( ca) follo:ing 7re7aratory 2iscussion :ith seniors Tra # #( Acce7ts hisFher role in the healthcare team an2 communicates a77ro7riately :ith all rele9ant mem?ers thereof

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Ca!e("r+ O*<ec! .e

Pr"fess "#a) Beha. "%r a#& Lea&ersh p

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%ini PATB Portfolio assessment at ARCP

Teaching an2 Training NFA To teach to a 9ariety of 2ifferent au2iences in a 9ariety of 2ifferent :ays To assess the Cuality of the teaching To train a 9ariety of 2ifferent trainees in a 9ariety of 2ifferent :ays To 7lan an2 2eli9er a training 7rogramme :ith a77ro7riate assessments E7a2p)es Pre7ares a77ro7riate materials to su77ort teaching a#& e7iso2es &escr p!"rs See6s an2 inter7rets sim7le fee2?ac6 follo:ing f"r C"re teaching S%r( ca) Su7er9ises a me2ical stu2entB nurse or colleague Tra # #( through a sim7le 7roce2ure PlansB 2e9elo7s an2 2eli9ers small grou7 teaching to me2ical stu2entsB nurses or colleagues

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,ee7ing u7 to 2ate an2 un2erstan2ing ho: to analyse information Inclu2ing !thical research !9i2ence an2 gui2elines Au2it Personal 2e9elo7ment

Area ,43

O*<ec! .e

E7a2p)es a#& &escr p!"rs f"r C"re S%r( ca) Tra # #(

To un2erstan2 the results of research as they relate to me2ical 7ractise To 7artici7ate in me2ical research To use current ?est e9i2ence in ma6ing 2ecisions a?out the care of 7atients To construct e9i2ence ?ase2 gui2elines an2 7rotocols To com7lete an au2it of clinical 7ractice At acti9ely see6 o77ortunities for 7ersonal Area ,43 2e9elo7ment To 7artici7ate in continuous 7rofessional Area ,43 2e9elo7ment acti9ities Defines ethical research an2 2emonstrates a:areness of #%C gui2elines Differentiates au2it an2 research an2 un2erstan2s the 2ifferent ty7es of research a77roach eg Cualitati9e an2 Cuantitati9e ,no:s ho: to use literature 2ata?ases Demonstrates goo2 7resentation an2 :riting s6ills Partici7ates in 2e7artmental or other local <ournal Area ,43 clu? Critically re9ie:s an article to i2entify the le9el of e9i2ence Atten2s 2e7artmental au2it meetings Contri?utes 2ata to a local or national au2it I2entifies a 7ro?lem an2 2e9elo7s stan2ar2s for a local au2it Descri?es the au2it cycle an2 ta6e an au2it through Area ,43 the first ste7s See6s fee2?ac6 on 7erformance from clinical su7er9isorFmentorF7atientsFcarersFser9ice users

%ini PATB C0DB Portfolio assessment at ARCPB %RCS an2 s7ecialty FRCS

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Pr"fess "#a) Beha. "%r a#& Lea&ersh p

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Area ,4, a#& ,45 Area 5

Ma#a(er #c)%& #( Self A:areness an2 self management Team8:or6ing Lea2ershi7 Princi7les of Cuality an2 safety im7ro9ement

O*<ec! .e

%anagement an2 N$S structure Se)f a'are#ess a#& se)f 2a#a(e2e#! Area ,4, a#& %ini PAT an2 C0D To recognise an2 articulate oneAs o:n 9alues an2 ,45 7rinci7lesB a77reciating ho: these may 2iffer from those of others To i2entify oneAs o:n strengthsB limitations an2 the im7act of their ?eha9iour

Area 845B 843B 848 Area 3

'

To i2entify their o:n emotions an2 7re<u2ices an2 un2erstan2 ho: these can affect their <u2gement an2 ?eha9iour To o?tainB 9alue an2 act on fee2?ac6 from a 9ariety of sources To manage the im7act of emotions on ?eha9iour an2 actions To ?e relia?le in fulfilling res7onsi?ilities an2 commitments to a consistently high stan2ar2 To ensure that 7lans an2 actions are fle>i?leB an2 ta6e into account the nee2s an2 reCuirements of others To 7lan :or6loa2 an2 acti9ities to fulfil :or6 reCuirements an2 commitments :ith regar2 to their o:n 7ersonal health Area 5 %ini PATB C0D an2 Portfolio assessment 2uring ARCP

Tea2 '"r0 #( To i2entify o77ortunities :here :or6ing :ith others can ?ring a22e2 ?enefits To :or6 :ell in a 9ariety of 2ifferent teams an2 team settings ?y listening to othersB sharing informationB see6ing the 9ie:s of othersB em7athising :ith othersB communicating :ellB gaining trustB res7ecting roles an2 e>7ertise of othersB encouraging othersB managing 2ifferences of o7inionB a2o7ting a team a77roach

Area 9 Lea&ersh p To 2e9elo7 the lea2ershi7 s6ills necessary to lea2 teams effecti9ely. These inclu2eE I2entification of conte>ts for change A77lication of 6no:le2ge an2 e9i2ence to 7ro2uce an e9i2ence ?ase2 challenge to systems an2 7rocesses %a6ing 2ecision ?y integrating 9alues :ith Area 845B 843 e9i2ence a#& 848 !9aluating im7act of change an2 ta6ing correcti9e action :here necessary Pr #c p)es "f $%a) !+ a#& safe!+ 2pr".e2e#! To recognise the 2esira?ility of monitoring 7erformanceB learning from mista6es an2 a2o7ting no ?lame culture in or2er to ensure high stan2ar2s of care an2 o7timise 7atient safety To critically e9aluate ser9ices Area 3 To i2entify :here ser9ices can ?e im7ro9e2 To su77ort an2 facilitate inno9ati9e ser9ice im7ro9ement Ma#a(e2e#! a#& NHS c%)!%re To organise a tas6 :here se9eral com7eting 7riorities may ?e in9ol9e2 To acti9ely contri?ute to 7lans :hich achie9e

%ini PATB C0D an2 Portfolio assessment 2uring ARCP

%ini PATB C0D an2 Portfolio assessment 2uring ARCP

%ini PATB C0D an2 Portfolio assessment 2uring ARCP

ser9ice goals To manage resources effecti9ely an2 safely To manage 7eo7le effecti9ely an2 safely To manage 7erformance of themsel9es an2 others To un2erstan2 the structure of the N$S an2 the management of local healthcare systems in or2er to ?e a?le to 7artici7ate fully in managing healthcare 7ro9ision E7a2p)es Se)f a'are#ess a#& se)f 2a#a(e2e#! Area ,4, a#& a#& ,45 O?tains 3/M fee2?ac6 as 7art of an assessment &escr p!"rs Partici7ates in 7eer learning an2 e>7lores f"r C"re lea2ershi7 styles an2 7references S%r( ca) Timely com7letion of :ritten clinical notes Tra # #( Through fee2?ac6 2iscusses an2 reflects on ho: a 7ersonally emotional situation affecte2 communication :ith another 7erson Learns from a session on time management Tea2 '"r0 #( Area 5 )or6s :ell :ithin the multi2isci7linary team an2 recognises :hen assistance is reCuire2 from the rele9ant team mem?er In9ites an2 encourages fee2?ac6 from 7atients Demonstrates a:areness of o:n contri?ution to 7atient safety :ithin a team an2 is a?le to outline the roles of other team mem?ers. ,ee7s recor2s u78to82ate an2 legi?le an2 rele9ant to the safe 7rogress of the 7atient. $an2s o9er care in a 7reciseB timely an2 effecti9e manner Su7er9ises the 7rocess of finalising an2 su?mitting o7erating lists to the theatre suite Lea&ersh p Com7lies :ith clinical go9ernance reCuirements of organisation Presents information to clinical an2 ser9ice managers ;eg au2it= Contri?utes to 2iscussions relating to rele9ant issues eg :or6loa2B co9er arrangements using clear an2 concise e9i2ence an2 information Q%a) !+ a#& safe!+ 2pr".e2e#! Un2erstan2s that clinical go9ernance is the o9er8 arching frame:or6 that unites a range of Cuality im7ro9ement acti9ities Partici7ates in local go9ernance 7rocesses %aintains 7ersonal 7ortfolio !ngages in clinical au2it 1uestions current systems an2 7rocesses Ma#a(e2e#! a#& NHS S!r%c!%res Area 9

Area 845B 843B 848

Area 3

Partici7ates in au2it to im7ro9e a clinical ser9ice )or6s :ithin cor7orate go9ernance structures Demonstrates a?ility to manage others ?y teaching an2 mentoring <uniorsB me2ical stu2ents an2 othersB 2elegating :or6 effecti9elyB $ighlights areas of 7otential :aste

M"&%)e ,A
Ca!e("r+ O*<ec! .e

Pr"fess "#a) Beha. "%r a#& Lea&ersh p

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%RCSB s7ecialty FRCSB C0DB %ini PAT

Pr"2"! #( (""& hea)!h NFA To 2emonstrate an un2erstan2ing of the 2eterminants of health an2 7u?lic 7olicy in relation to in2i9i2ual 7atients To 7romote su77orting 7eo7le :ith long term con2itions to self8care To 2e9elo7 the a?ility to :or6 :ith in2i9i2uals an2 communities to re2uce le9els of ill health an2 to remo9e ineCualities in healthcare 7ro9ision E7a2p)es Un2erstan2s that ICuality of lifeJ is an im7ortant a#& goal of care an2 that this may ha9e 2ifferent &escr p!"rs meanings for each 7atient f"r C"re Promotes 7atient self care an2 in2e7en2ence S%r( ca) $el7s the 7atient to 2e9elo7 an acti9e Tra # #( un2erstan2ing of their con2ition an2 ho: they can ?e in9ol9e2 in self management Discusses :ith 7atients those factors :hich coul2 influence their health

M"&%)e ,A
Ca!e("r+C

Pr"fess "#a) Beha. "%r a#& Lea&ersh p

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Area ,48

Pr"* !+ a#& E!h cs To inclu2e Acting :ith integrity %e2ical !rror %e2ical ethics an2 confi2entiality %e2ical consent Legal frame:or6 for me2ical 7ractise

O*<ec! .e

To uphold personal, professional ethics and Area ,48 values, taking into account the values of the organisation and the culture and beliefs of individuals To communicate openly, honestly and inclusively To act as a positive role model in all aspects of communication

%ini PAT an2 C0DB P0AB DOPSB %RCSB s7ecialty FRCS

 E7a2p)es a#& &escr p!"rs f"r C"re S%r( ca) Tra # #(

To take appropriate action where ethics and values are compromised To recognise an2 res7on2 the causes of me2ical error To res7on2 a77ro7riately to com7laints To 6no:B un2erstan2 an2 a77ly a77ro7riately the 7rinci7lesB gui2ance an2 la:s regar2ing me2ical ethics an2 confi2entiality as they a77ly to surgery To un2erstan2 the necessity of o?taining 9ali2 consent from the 7atient an2 ho: to o?tain To un2erstan2 the legal frame:or6 :ithin :hich healthcare is 7ro9i2e2 in the U, To recogniseB analyse an2 6no: ho: to 2eal :ith un7rofessional ?eha9iours in clinical 7racticeB ta6ing into account local an2 national regulations Un2erstan2 ethical o?ligations to 7atients an2 colleagues To a77reciate an o?ligation to ?e a:are of 7ersonal goo2 health Area ,48 Re7orts an2 rectifies an error if it occurs Area ,48 Partici7ates in significant e9ent au2its Area ,48 Partici7ates in ethics 2iscussions an2 forums A7ologises to 7atient for any failure as soon as an error is recognise2 Un2erstan2s an2 2escri?es the local com7laints 7roce2ure Recognises nee2 for honesty in management of com7laints Learns from errors Res7ect 7atientsA confi2entiality an2 their autonomy Un2erstan2 the Data Protection Act an2 Free2om of Information Act Consult a77ro7riatelyB inclu2ing the 7atientB ?efore sharing 7atient information Partici7ate in 2ecisions a?out resuscitation statusB :ithhol2ing or :ith2ra:ing treatment O?tains consent for inter9entions that heFshe is com7etent to un2erta6e ,no:s the limits of their o:n 7rofessional ca7a?ilities

ASSESSMENT O/ THE CORE CURRICULUM

The 7ur7ose of the assessment system is toE Determine :hether trainees are meeting the stan2ar2s of com7etence an2 7erformance s7ecifie2 at 9arious stages in the curriculum for surgical training Pro9i2e systematic an2 com7rehensi9e fee2?ac6 as 7art of the learning cycle. Determine :hether trainees ha9e acCuire2 the generic an2 s7ecialty8?ase2 6no:le2geB clinical <u2gementB o7erati9e an2 technical s6illsB an2 7rofessional s6ills an2 ?eha9iour reCuire2 to enter ST in any of the nine 2efine2 surgical s7ecialities. A22ress all the 2omains of #oo2 %e2ical Practice an2 conform to the 7rinci7les lai2 2o:n ?y the Postgra2uate %e2ical !2ucation an2 Training 0oar2. The in2i9i2ual com7onents of the assessment system areE The learning agreement )or67lace ?ase2 assessments co9ering s6illsB 6no:le2geB ?eha9iour an2 7rofessional ?eha9iour A log?oo6 of 7roce2ures un2erta6en :hich 7ro9i2es corro?orati9e e9i2ence of e>7erience An e>amination 2esigne2 to assess the 6no:le2ge an2 s6ills acCuire2 :ithin the generic curriculum. & the %RCS The assigne2 e2ucational su7er9isorsA re7ort Annual re9ie: of com7etence 7rogression. ;ARCP= Lear# #( a(ree2e#!s At each training inter9al ;usually si> months= a trainee :ill meet :ith their Assigne2 !2ucational Su7er9isor initiallyB 7art :ay through an2 finally to construct an2 ultimately sign off the outcome of a learning agreement. !ach learning agreement is 7re2icate2 ?y alrea2y acCuire2 e>7erience an2 com7etency signe2 off at 7re9ious ARCPs or on com7letion of Foun2ation or its eCui9alent. Their 7rinci7al 7ur7ose is to set an agen2a for a training inter9al an2 to agree milestones an2 assessment e7iso2es :hich :ill ?e use2 to formulate the e2ucational su7er9isorAs re7ort regar2ing the rate of 7rogression on the agree2 e2ucational tra<ectory. W"r0p)ace Base& Assess2e#!s The :or67lace ?ase2 assessments use2 2uring core training areE Peer assessment tool ;%ini8PAT= %ini8clinical e9aluation e>ercise ;%ini C!L= Case 0ase2 Discussion ;C0D= Direct O?ser9ation of Proce2ural S6ills in Surgery ;DOPS= Proce2ure ?ase2 assessment ;P0A= P%rp"se "f WPBAs )P0As ha9e the 7rimary 7ur7ose of 7ro9i2ing short loo7 fee2?ac6 ?et:een trainers an2 their trainees & a formati9e assessment to su77ort learning. They are 2esigne2 to ?e mainly trainee 2ri9en ?ut may ?e trainer triggere2. The num?er of ty7es an2 intensity of each ty7e of )P0A in any one assessment cycle :ill ?e initially 2etermine2 ?y the Learning Agreement fashione2 at the ?eginning of a training 7erio2 an2 regularly re9ie:e2. The intensity may ?e altere2 to reflect 7rogression an2 trainee nee2. For e>am7le a trainee in 2ifficulty :oul2 un2erta6e more freCuent assessments a?o9e an agree2 ?ase line for all trainees. In that sense )P0As meet the criterion of ?eing a2a7ti9e. In 7articular these :or67lace ?ase2 assessments are 2esigne2 toE Pro9i2e fee2?ac6 to trainers an2 trainees

The most im7ortant use of the :or67lace8?ase2 assessments is in 7ro9i2ing trainees :ith an o77ortunity to assess their o:n learning an2 use that assessment to inform an2 2e9elo7 their o:n 7ractice. !ach assessment is score2 only for the 7ur7ose of 7ro9i2ing meaningful fee2?ac6 on one encounter. The assessments shoul2 ?e 9ie:e2 as 7art of a 7rocess throughout trainingB ena?ling trainees to ?uil2 on assessor fee2?ac6 an2 chart their o:n 7rogress. Pro9i2e information for trainers an2 training su7er9isors to ai2 in their construction of training su7er9isors re7orts. Li6e all me2ical training 2isci7lines :e recognise that the use of assessments for learning as 7art of an o9erall assessment of learning has theoretical 2isa29antages. $o:e9er it is im7ortant that 7atient safety consi2erations are 7aramount an2 so ongoing monitoring is essential. These formati9e assessments of learning are also use2 as e9i2ence of 7rogression an2 so inform ;not 2ictate= the training su7er9isorAs re7ort :hich is the first a77raisal ste7 7rior to the ARCP. The ARCP is the 7rinci7al re9ie: of Learning :hich 2etermines 7rogression. Contri?ute to:ar2s a ?o2y of e9i2ence hel2 in the learning 7ortfolio an2 ma2e a9aila?le for the annual re9ie: of com7etence 7rogression ;ARCP= 7anel an2 7lanne2 e2ucational re9ie:s. All assessment 2ata is store2 in the traineeAs electronic 7ortfolio. Although the 7rinci7al role of :or67lace assessment is to su77ort learningB the summary e9i2ence :ill ?e use2 to inform the annual re9ie: 7rocess. This 7rocess results in 2ecisions to ho: :ell the trainee is 7rogressing. At the en2 of a 7erio2 of trainingB the traineeAs :hole 7ortfolio :ill ?e re9ie:e2. The accumulation of assessments for learning :ill ?e only one of a range of in2icators in an o9erall assessment of learning that inform the 2ecision as to satisfactory com7letion of that 7erio2 training at the annual re9ie: of com7etence 7rogression.

Peer Assessment Tool

The mini8PATB 7re9iously 2escri?e2 as 3/M assessment or multi8source fee2?ac6 ;%SF=B is a metho2 of assessing 7rofessional com7etence :ithin a team8:or6ing en9ironment an2 7ro9i2ing 2e9elo7mental fee2?ac6 to the trainee. The mini8PAT assessment is un2erta6en e9ery three years in s7ecialty training. For core training first occasion :ill ?e at entry le9el ;CT.= an2 for most the ne>t assessment :ill ?e at the time of entry to s7ecialty training ;ST =. It shoul2 ?e use2 more often if there are areas of concern. Surgical trainees :or6 as 7art of a multi87rofessional team :ith other 7eo7le :ho ha9e com7lementary s6ills. Trainees are e>7ecte2 to un2erstan2 the range of roles an2 e>7ertise of team mem?ers in or2er to communicate effecti9ely to achie9e high Cuality ser9ice for 7atients. %ini8PAT com7rises a self8assessment an2 assessments of a traineeAs 7erformance from a range of co8:or6ers. It uses u7 to .4 assessors :ith a minimum of 5. Assessors are chosen ?y the trainee an2 :ill al:ays inclu2e the assigne2 e2ucational su7er9isor an2 a range of colleagues co9ering 2ifferent gra2es an2 en9ironments ;e.g. :ar2B theatreB out7atients= ?ut not a2ministrators or 7atients. Fee2?ac6 is in the form of a 7eer assessment chart that ena?les com7arison of the self8 assessment :ith the collate2 9ie:s recei9e2 from co8:or6ers for each of the .3 com7etencies on a 387oint scale inclu2ing a glo?al rating. The com7etencies ma7 across to the stan2ar2s of #oo2 %e2ical Practice an2 to the core o?<ecti9es of the intercollegiate surgical curriculum. The assigne2 e2ucational su7er9isor :ill meet :ith the trainee to 2iscuss the fee2?ac6 on 7erformance in the mini8PAT. Trainees are not gi9en access to in2i9i2ual assessments. Assigne2 e2ucational su7er9isors sign off the traineeAs mini8PAT assessment an2 ma6e comments for the annual re9ie:. They can also recommen2 a re7eat mini8PAT. The metho2 ena?les serious concernsB such as those a?out a traineeAs 7ro?ity an2 healthB to ?e flagge2 u7 in confi2ence to the assigne2 e2ucational su7er9isorB ena?ling a77ro7riate action to ?e ta6en.

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Mini Clinical Evaluation Exercise

The mini8C!L is a metho2 of assessing s6ills essential to the 7ro9ision of goo2 clinical care an2 to facilitate fee2?ac6. It assesses the traineesA clinical an2 7rofessional s6ills on the :ar2B on :ar2 roun2sB in Acci2ent an2 !mergencyB or in out7atient clinics. It :as 2esigne2 originally ?y the American 0oar2 of Internal %e2icine ?ut has ?een conte>tualise2 to the surgical en9ironment. Trainees :ill ?e assesse2 on 2ifferent clinical 7ro?lems that they encounter from :ithin the curriculum in a range of clinical settings. Trainees are encourage2 to choose a 2ifferent assessor for each assessment ?ut one of the assessors must ?e the current assigne2 e2ucational su7er9isor. !ach assessor must ?e registere2 :ith ISCP an2 ha9e e>7ertise in the clinical 7ro?lem. The assessment in9ol9es o?ser9ing the trainee interact :ith a 7atient in a clinical encounter. The areas of com7etence co9ere2 inclu2eE history ta6ingB 7hysical e>aminationB 7rofessionalismB clinical <u2gementB communication s6illsB organisationFefficiency an2 o9erall clinical care. %ost encounters shoul2 ta6e ?et:een .*84/ minutes. Assessors 2o not nee2 to ha9e 7rior 6no:le2ge of the trainee. The assessorAs e9aluation is recor2e2 on a structure2 chec6list that ena?les the assessor to 7ro9i2e 2e9elo7mental 9er?al fee2?ac6 to the trainee imme2iately after the encounter. Fee2?ac6 :oul2 normally ta6e a?out * minutes.

Case Based Discussion

C0D :as 2e9elo7e2 for the foun2ation training 7erio2 an2 has ?een conte>tualise2 to the surgical en9ironment. This tool is 2esigne2 to assess clinical <u2gementB 2ecision8ma6ing an2 the a77lication of me2ical 6no:le2ge in relation to 7atient care in cases for :hich the trainee has ?een 2irectly res7onsi?le. The metho2 is 7articularly 2esigne2 to test higher or2er thin6ing an2 synthesis as it allo:s assessors to e>7lore 2ee7er un2erstan2ing of ho: trainees com7ileB 7rioritise an2 a77ly 6no:le2ge. C0D is not focuse2 on the traineesA a?ility to ma6e a 2iagnosis nor is it a 9i9a8style assessment. The 7rocess is a structure2B in82e7th 2iscussion ?et:een the trainee an2 assigne2 e2ucational su7er9isor a?out ho: a clinical case :as manage2 ?y the traineeH tal6ing through :hat occurre2B consi2erations an2 reasons for actions. 0y using clinical cases that offer a challenge to the traineeB rather than routine casesB the trainee is a?le to e>7lain the com7le>ities in9ol9e2 an2 the reasoning ?ehin2 choices they ma2e. It also ena?les the 2iscussion of the ethical an2 legal frame:or6 of 7ractice. It uses 7atient recor2s as the ?asis for 2ialogueB for systematic assessment an2 structure2 fee2?ac6. As the actual recor2 is the focus for the 2iscussionB the assessor can also e9aluate the Cuality of recor2 6ee7ing an2 the 7resentation of cases. %ost assessments ta6e no longer than .*84/ minutes. After com7leting the 2iscussion an2 filling in the assessment form the assigne2 e2ucational su7er9isor shoul2 7ro9i2e imme2iate fee2?ac6 to the trainee. Fee2?ac6 :oul2 normally ta6e a?out * minutes.

Direct Observation of Procedural Skills (DOPS)

The Surgical 9ersion of DOPS is use2 to assess the traineesA technicalB o7erati9e an2 7rofessional s6ills in a range of ?asic 2iagnostic an2 inter9entional 7roce2uresB or 7arts of 7roce2uresB 2uring routine surgical 7ractice an2 facilitate 2e9elo7mental fee2?ac6. Surgical DOPS is use2 in relati9ely sim7le en9ironments an2 7roce2ures an2 can ta6e 7lace in :ar2s or out7atient clinics as :ell as in the o7erating theatre. It is a surgical 9ersion of an assessment tool originally 2e9elo7e2 an2 e9aluate2 ?y the U, Royal Colleges of Physicians. The surgical DOPS form can ?e use2 routinely e9ery time the trainer su7er9ises a trainee carrying out one of the s7ecifie2 7roce2uresB :ith the aim of ma6ing the assessment 7art of

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routine surgical training 7ractice. The 7roce2ures reflect the 7roce2ures :hich are routinely carrie2 out at the traineesA :or67lace. The assessment in9ol9es an assessor o?ser9ing the trainee 7erform a 7ractical 7roce2ure :ithin the :or67lace. Assessors 2o not nee2 to ha9e 7rior 6no:le2ge of the trainee. The assessorAs e9aluation is recor2e2 on a structure2 chec6list that ena?les the assessor to 7ro9i2e 9er?al 2e9elo7mental fee2?ac6 to the trainee imme2iately after:ar2s. Trainees are encourage2 to choose a 2ifferent assessor for each assessment ?ut one of the assessors must ?e the current assigne2 e2ucational su7er9isor. %ost 7roce2ures ta6e no longer than .*84/ minutes. The assessor :ill 7ro9i2e imme2iate fee2?ac6 to the trainee after com7leting the o?ser9ation an2 e9aluation. Fee2?ac6 :oul2 normally ta6e a?out * minutes. The surgical DOPS form is score2 for the 7ur7ose of 7ro9i2ing fee2?ac6 to the trainee. The o9erall rating on any one assessment can only ?e com7lete2 if the entire 7roce2ure is o?ser9e2. A <u2gement :ill ?e ma2e at com7letion of the 7lacement as to the o9erall le9el of 7erformance achie9e2 in each of the assesse2 surgical 7roce2ures.

Procedure based Assessment

P0As assess traineesA technicalB o7erati9e an2 7rofessional s6ills in a range of s7ecialty 7roce2ures or 7arts of 7roce2ures 2uring routine surgical 7ractice u7 to the le9el of CCT. P0As 7ro9i2e a frame:or6 to assess 7ractice an2 facilitate fee2?ac6 in or2er to 2irect learning. The P0A :as originally 2e9elo7e2 ?y the Ortho7ae2ic Com7etence Assessment Pro<ect ;OCAP= for trauma an2 ortho7ae2ic surgery an2 has ?een further 2e9elo7e2 ?y the SACs for use in all surgical s7ecialties. The assessment tool uses t:o 7rinci7al com7onentsE A series of com7etencies :ithin si> 2omains. %ost of the com7etencies are common to all 7roce2uresB ?ut a relati9ely small num?er of com7etencies :ithin certain 2omains are s7ecific to a 7articular 7roce2ure. A glo?al assessment that is 2i9i2e2 into four le9els of o9erall glo?al rating. This gi9es the trainerAs 9ie: on the le9el to :hich com7lete2 elements of the P0A :ere 7erforme2. The highest rating is the a?ility to 7erform the 7roce2ure ;or selecte2 elements= to the stan2ar2 e>7ecte2 of a s7ecialist in 7ractice :ithin the N$S ;the le9el reCuire2 for the Certificate of Com7letion of Training 8 CCT=. The assessment form is su77orte2 ?y a :or6sheetB originally use2 as a 9ali2ating the tool. It contains 2escri7tors outlining e>am7les 2esira?le an2 un2esira?le ?eha9iours that assist the assessor in ma6ing <u2gements. The 7roce2ures chosen shoul2 ?e re7resentati9e of those that the trainee :oul2 normally carry out at that le9el an2 :ill ?e one of an in2icati9e list of 7roce2ures rele9ant to the s7ecialty ;selecte2 ?y the SAC=. The trainee generally chooses the timing an2 ma6es the arrangements :ith the assessor. Usually the assessor :ill ?e the traineeAs assigne2 e2ucational su7er9isorB ?ut it is antici7ate2 that other surgical consultants may ta6e on the assessment of certain 7roce2ures 2e7en2ing on the traineeAs :or6 7attern. Trainees are encourage2 to reCuest assessments on as many 7roce2ures as 7ossi?le :ith a range of 2ifferent assessors. Assessors 2o not nee2 to ha9e 7rior 6no:le2ge of the trainee. The assessor :ill o?ser9e the trainee un2erta6ing the agree2 sections of the P0A in the normal course of :or67lace acti9ity ;usually scru??e2=. #i9en the 7riority of 7atient careB the assessor must choose the a77ro7riate le9el of su7er9ision 2e7en2ing on the traineeAs stage of training. Trainees :ill carry out the 7roce2ureB e>7laining :hat they inten2 to 2o throughout. The assessor :ill 7ro9i2e 9er?al 7rom7ts to encourage the trainee to gi9e e>7lanationsB if reCuire2B an2 inter9ene if the Cuality of 7atient care is at ris6 of com7romise.

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T!e lo" book of #rocedures

This is a :e? ?ase2 com7ilation of all 7roce2ures :itnesse2 or 7erforme2 un2er 9arying 2egrees of su7er9ision 2uring the training inter9als. It is 9ali2ate2 ?y su7er9ising trainers after ?eing generate2 ?y trainees. It is :e? ?ase2 an2 2istinguishes ?et:een 7assi9e an2 acti9e in9ol9ement in ?oth o7erati9e an2 :ar2 ?ase2 7roce2ures as lai2 out in the curriculum.

E7a2 #a! "#s

I#!r"&%c! "#8 Core surgical trainees :ill ta6e the %RCS e>amination. The %RCS :ill assess 6no:le2ge an2 s6ills that are encom7asse2 :ithin the generic com7onent of the core curriculum an2 is ?lue7rinte2 to the curriculum. It is ine9ita?le that although this is an assessment of the generic curriculumB the assessment :ill ta6e 7lace :ithin a s7ecialty conte>t. The :ritten com7onent consists of a %C1 an2 !%I ;!>ten2e2 matching item Cuestions= com?ine2 into a single 7art A. These t:o com7onents a22ress 6no:le2ge an2 a77lie2 6no:le2ge in the generality of surgery. Part 0 consists of an O?<ecti9e Structure2 Clinical !>amination ;OSC!=. The 7recise 2esign an2 structure are 7ro9i2e2 in a77en2i> A. The o9erall 2esign of the OSC! tests s6ills an2 a77lie2 6no:le2ge as 2etaile2 ?elo:. It is inno9ati9e in that it has some o7tional elements :hich 7ermit some choice in the conte>ts of :hich the core s6ills an2 6no:le2ge may ?e teste2. This is e>7laine2 in more 2etail ?elo:. In a22ition to the 7art A anatomical assessments the OSC! also 7ro9i2es can2i2ates :ith the o77ortunity to 2emonstrate their three 2imensional anatomical 6no:le2ge in the conte>t of their li6ely future surgical careerB :ithout losing the 9ital nee2 to ensure a thorough o9erall gri7 of generic three 2imensional surgical anatomy. 0oth Parts A an2 0 must ?e com7lete2 to 7ass the %RCS. Trainees :ill ty7ically ta6e the e>amination to:ar2s the en2 of the CT4FST. yearB :hich has the follo:ing a29antagesE If the can2i2ate is unsuccessfulB there :ill ?e an o77ortunity to re8sit the e>amination 2uring CT FST4B 7rior to entry to ST . Progression to ST :ill NOT 0! POSSI0L! unless the %RCS is achie9e2. Such timing :ill fit :ell :ith the timeta?le currently in 7lace for selection into ST . A 2"re &e!a )e& &escr p! "# "f !he sc"pe a#& f"r2a! "f !he MRCS e7a2 #a! "# The 7ur7ose of the %RCS e>amination is to 2etermine that trainees ha9e acCuire2 the 6no:le2geB s6ills an2 attri?utes reCuire2 for the generic com7onent of core training in surgery an2B for trainees follo:ing the Intercollegiate Surgical Curriculum ProgrammeB to 2etermine their a?ility to 7rogress to higher s7ecialist training in surgery. The %RCS e>amination consists of t:o 7artsB A @ 0. Although 2i9i2e2 into t:o 7artsB the Intercollegiate %RCS is a single e>amination. Par! A The %RCS Part A is a machine8mar6e2B multi7le choiceB :rittenB e>amination testing 6no:le2ge. It consists of t:o 7a7ersB each of t:o hoursA 2urationB ta6en on the same 2ay. The mar6s for ?oth 7a7ers are com?ine2 to gi9e a total mar6 for Part A. To achie9e a 7ass the can2i2ate :ill ?e reCuire2 to 2emonstrate a minimum le9el of 6no:le2ge in each of the t:o 7a7ersB in a22ition to achie9ing or e>cee2ing the 7ass mar6 set for the com?ine2 total mar6 for Part A. The 7a7ers co9er generic surgical sciences an2 a77lie2 6no:le2geB inclu2ing the core 6no:le2ge reCuire2 in all nine s7ecialties. Paper , 6 App) e& Bas c Sc e#ce4 This 7a7er consists of . * Cuestions an2 em7loys the single ?est ans:er ;S0A= formatB each Cuestion containing fi9e 7ossi?le ans:ers of :hich there is only one single ?est ans:er.

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Paper 5 6 Pr #c p)es "f S%r(er+6 #6Ge#era)4 This 7a7er consists of . * Cuestions an2 em7loys the e>ten2e2 matching Cuestions ;!%1= format. !ach theme contains a 9aria?le num?er of o7tions an2 clinical situations. Only one o7tion :ill ?e the most a77ro7riate res7onse to each clinical situation. It is 7ossi?le for one o7tion to ?e the ans:er to more than one of the clinical situations. Par! B The +e))"' s %#&er %r(e#! re. s "# f"r !he PMETB app) ca! "# The %RCS Part 0 is an O?<ecti9e Structure2 Clinical !>amination ;OSC!=. The OSC! :ill normally consist of si>teen e>amine2 stations. These stations :ill ?e 2i9i2e2 into fi9e ?roa2 content areas as follo:sE Anatomy an2 surgical 7athology ; stations= Surgical s6ills an2 7atient safety ;4 stations= Communication s6ills ; stations= A77lie2 surgical science an2 critical care ; stations= Clinical s6ills in history ta6ing an2 7hysical e>amination ;* stations=.

T:el9e of the .3 e>amine2 stations are Gmanne2A an2 four are Gunmanne2A. Some of the stations :ill ha9e t:o e>aminers an2 some one. In stations :ith t:o e>aminersB each e>aminer :ill normally ?e e>amining 2ifferent as7ects of a can2i2ateAs 7erformance. Spec a)!+ c"#!e7! s!a! "#s The OSC! is 2esigne2 for can2i2ates in the generality 7art of their s7eciality training an2 t:el9e of the .3 e>amine2 stations are GgenericA. $o:e9erB to meet the emerging intentions of trainees :ith regar2 to future career 7rogressionB an2 to accommo2ate 2ifferent 7atterns of s7ecialty trainingB four of the .3 e>amine2 stations are 7resente2 :ithin a s7ecialty conte>tE one in the ?roa2 content area of anatomy an2 surgical 7athologyB one in clinical s6ills ;history ta6ing= an2 t:o in clinical s6ills ;7hysical e>amination=. The s7ecialty conte>ts areE hea2 an2 nec6 trun6 an2 thora> lim?s ;inclu2ing s7ine= neurosciences. Can2i2ates must s7ecify their choice of s7ecialty conte>t stations at the time of a77lication to the e>amination. Their choice 2etermines the same s7ecialty conte>t area for anatomy an2 surgical 7athologyB clinical s6ills ;history ta6ing= an2 one of the clinical s6ills ;7hysical e>amination= stations. Can2i2ates must choose a 2ifferent s7ecialty conte>t area for the secon2 clinical s6ills ;7hysical e>amination= station. It is im7ortant to em7hasise that this o7tional element is sim7ly to ?e a?le to 2emonstrate generic s6ills an2 some 6no:le2ge an2 its a77lication in a conte>t most familiar to the can2i2ates. It is not to test 2ee7 6no:le2ge in 2esignate2 s7eciality areas. )e ?elie9e that this is a uniCue feature of the ne: e>amination an2 one that caters ?est for the 9ariety an2 choice in?uilt into our ne: a77roach to early yearAs surgical training. N4B4 THE CHOICE O/ SPECIALITY CONTEDT STATIONS IS NOT DELINEATED IN THE AWARD O/ MRCS4 S%ccessf%) ca#& &a!es a)) are a'ar&e& e7ac!)+ !he sa2e & p)"2a as a 2eas%re "f !he r c"re s%r( ca) c"2pe!e#c es4

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D"2a #s In a22ition to the fi9e ?roa2 content areas e>amine2 in the OSC!B si> 2omains ha9e ?een i2entifie2 :hich encom7ass the 6no:le2geB s6illsB com7etencies an2 7rofessional characteristics of the com7etent surgeon. These 2omains ma7 to #%CAs #oo2 %e2ical Practice ;#%P= an2 are assesse2 in the OSC!. They are as follo:sE Clinical 6no:le2geE the clinical 6no:le2ge s7ecifie2 in the sylla?usH the a?ility to un2erstan2B synthesise an2 a77ly 6no:le2ge in a clinical conte>t. Clinical s6illE the ca7acity to a77ly soun2 clinical 6no:le2geB s6ill an2 a:areness to a full in9estigation of 7ro?lems to reach a 7ro9isional 2iagnosis. Technical s6illE the a?ility to 7erform manual tas6s relate2 to surgery :hich 2eman2s manual 2e>terityB han2Feye coor2ination an2 9isual8s7atial a:areness. CommunicationE the a?ility to assimilate informationB i2entify :hat is im7ortant an2 con9ey it to others clearly using a 9ariety of metho2sH the ca7acity to a2<ust ?eha9iour an2 language ;:rittenFs7o6en= as a77ro7riate to the nee2s of 2iffering situationsH the a?ility acti9ely an2 clearly to engage the 7atientF carerF colleague;s= in o7en 2ialogue. Decision ma6ingB 7ro?lem sol9ingB situational a:areness an2 <u2gementE the 2emonstration of effecti9e <u2gement an2 2ecision ma6ing s6illsH the consi2eration of all a77ro7riate facts ?efore reaching a 2ecisionH the ca7acity to thin6 ?eyon2 the o?9ious an2 to ma>imise information efficientlyH ?eing alert to sym7toms an2 signs suggesting con2itions :hich might 7rogress or 2e8 sta?iliseH ?eing a:are of o:n strengthsFlimitations an2 6no:ing :hen to as6 for hel7. Organisation an2 7lanningE the a?ility to accommo2ate ne: or changing information an2 use it to manage a clinical 7ro?lemH to antici7ate an2 7lan in a29anceH to 7rioritise conflicting 2eman2s an2 ?uil2 contingenciesH 2emonstrate effecti9e time management. The si> 2omains are assesse2 9ia the .3 stations of the OSC!. !ach station :ill assess u7 to four 2ifferent 2omainsB as 2escri?e2 a?o9e.

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SPECIALTY SPECI/IC ELEMENTS REQUIRED TO MEET THE ST3 COMPETENCY IN ANY GIVEN SURGICAL DISCIPLINE
N0E The follo:ing 7ages summarise the reCuirements of in2i9i2ual s7ecialties. !ntry reCuirements to ST 7u?lishe2 ?y in2i9i2ual s7ecialties an2 a77ro9e2 ?y P%!T0 shoul2 ?e regar2e2 as the 7rimary 2ocument :here there is any 2iscre7ancy. For surgery most of the reCuirements are common for all nine 2isci7lines an2 are 2escri?e2 in the ta?le ?elo:. The 2etails for each s7eciality s7ecific ST. an2 4 section are 2escri?e2 inclu2ing the time e>7ecte2 to ?e s7ent in that 2isci7line 2uring early years training such that a can2i2ate is eligi?le for ST entry. If a can2i2ate :ishes to change from one 2isci7line to another at any stage ?efore entry into ST this may 7rolong their training as com7letion of the man2atory 7erio2 in the s7eciality is still a reCuirement as :ell as com7leting all the early years e2ucational goals lai2 out ?elo:. In 7ractice any :ish to la22er from one 2isci7line of surgery to another is easier the earlier the 2ecision is ma2e an2 in 7ractice once selecte2 into ST changing 2isci7line :ill ?e e>tremely 2ifficult an2 time consuming.

E) ( * ) !+ f"r e#!r+ #!" ST3

These ?uil2 on the entry reCuirements for entry into ST.FCT.. Criteria for entry are e>7an2e2 u7on on 7ages +5 8 5. App) ca! "# re$% re2e#!s !" e#!er Spec a)!+ Tra # #( a! ST3 # a#+ & sc p) #e Esse#! a) %00S or eCui9alent me2ical Cualification Successful com7letion of %RCS or eCui9alent at time of a77lication !ligi?le for full registration :ith the #%C at time of a77ointment !ligi?ility to :or6 in the U, !9i2ence of achie9ement of Foun2ation com7etences ?y time of a77ointment in line :ith #%C stan2ar2sF #oo2 %e2ical Practice !9i2ence of achie9ement of !arly years com7etencies in core training. !9i2ence of achie9ement of ST. s7eciality s7ecific com7etences in surgery at time of a77ointment !9i2ence that a can2i2ate :ill reasona?ly ha9e a 7ros7ect of achie9ing ST4 s7eciality s7ecific com7etences ?y August of the year of a77lication Is u7 to 2ate an2 fit to 7ractise safely All a77licants to ha9e 2emonstra?le s6ills in :ritten an2 s7o6en !nglish a2eCuate to ena?le effecti9e communication a?out me2ical to7ics :ith 7atients an2 colleagues 2emonstrate2 ?y one of the follo:ingE a= that a77licants ha9e un2erta6en un2ergra2uate Whe# E.a)%a!e&3 A77lication form A77lication form A77lication form Inter9ie: F Selection centre' A77lication form Inter9ie: F Selection centre A77lication form Inter9ie: F Selection centre A77lication form References A77lication form Inter9ie: F Selection centre

Q%a) f ca! "#s E) ( * ) !+

/ !#ess T" Prac! se La#(%a(e S0 ))s

G:hen e9aluate2A is in2icati9eB ?ut may ?e carrie2 out at any time throughout the selection 7rocess A selection centre is a 7rocess not a 7lace. It in9ol9es a num?er of selection acti9ities that may ?e 2eli9ere2 :ithin the Unit of A77lication.
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'3

Hea)!h Career Pr"(ress "#

Esse#! a) me2ical training in !nglishH or ?= ha9e the follo:ing scores in the aca2emic lnternational !nglish Language Testing System ;I!LTS= & O9erall +B S7ea6ing +B Listening 3B Rea2ing 3B )riting 3. If a77licants ?elie9e they ha9e a2eCuate communication s6ills ?ut 2o not fit into one of these e>am7les they must 7ro9i2e su77orting e9i2ence %eets 7rofessional health reCuirements ;in line :ith #%C stan2ar2sF#oo2 %e2ical Practice= A?ility to 7ro9i2e a com7lete em7loyment history At least 4' monthsA e>7erience* in surgical training ;not inclu2ing Foun2ation mo2ules=B of :hich a s7ecifie2 7erio2 of time in the s7eciality a77lie2 for ?y August of the year of a77ointment. The s7ecifie2 time 7erio2 is 2escri?e2 ?elo: for each of the surgical 2isci7lines ALL sections of a77lication form com7lete2 FULL" accor2ing to :ritten gui2elines

Whe# E.a)%a!e&

A77lication form Pre8em7loyment health screening A77lication form

App) ca! "# C"2p)e! "#

A77lication form

#i9en that entry at the ST le9el of com7etency must 7ermit an in2i9i2ual to 7rogress in their chosen s7ecialityB then it is im7erati9e that the com7etencies of all ST entrants are at the same le9el. This is also 7refera?le in the s7eciality element also. $o:e9er it nee2s to ?e 7ragmatically recognise2 that gi9en a rich an2 9arie2 choice of early years 7rogrammesB ha9ing e9eryone at e>actly the same le9el in terms of the 2etails of their )P0As :ill ?e e>tremely 2ifficult to achie9eB although all must meet a minimum stan2ar2. Trainees :ho ha9e ?een selecte2 2es7ite some reme2ia?le an2 i2entifie2 ga7s in their s7eciality s7ecific curriculum com7etencies as 2eman2e2 o9erall for ST 7rogression must ensure these are 2ealt :ith e>7e2itiously 2uring ST . All these ga7s must ?e a22resse2 ?y the time of a ST ARCP as 7art of their o9erall 7ermission to 7rogress to ST'. They must ?e s7ecifically a22resse2 through local learning agreements :ith e2ucational su7er9isors. Trainees :ith i2entifie2 ga7s must ?e accounta?le to the training 7rogramme 2irectors :hom in turn must a22ress this as 7art of their re7ort to the ARCP 7rocess. The # #e #& . &%a) !"p %p re$% re2e#!s f"r each & sc p) #e are &escr *e& *e)"'4

Wha! 2a+ *e e7pec!e& "f a !ra #ee *+ !he ! 2e !he+ *ec"2e e) ( *)e !" c"22e#ce ST3 # Ge#era) S%r(er+
*

Any time 7erio2s s7ecifie2 in this 7erson s7ecification refer to full time eCui9alent

'+

In or2er to meet the <o? s7ecifications of an ST trainee an early years trainee must ta6e a clear role in the #eneral Surgery teamB managing clinic an2 :ar2 ?ase2 7atients un2er su7er9isionB inclu2ing the management of acute a2missions. They :ill nee2 to ?e a?le to ta6e 7art in an out7atient clinic an2 see ?oth ne: an2 ol2 7atients themsel9es :ith the consultant a9aila?le for a29ice. Therefore in early years trainingB IN ADDITION to the generic com7etencies for all surgeonsB it is necessary to a22ress the s7ecifics of a 2e9elo7ing interest in #eneral Surgery 2uring these years. This means s7en2ing .4 months in #eneral Surgery :ith a77ro7riate su?8s7ecialty e>7erience in a ser9ice :hich gi9es trainees access to the a77ro7riate learning o77ortunities. Also ?y the time a trainee enters ST they nee2 to ?e familiar :ith the o7erating room en9ironment ?oth :ith res7ect to electi9e an2 emergency cases. Trainees must atten2 %DT an2 other De7artmental meetings an2 :ar2 roun2sB 7re7are electi9e o7erating lists ;?oth in7atient an2 2ay8case=B an2 actually 7erform some surgery un2er a77ro7riate su7er9ision. They must manage all 7atients in the :ar2 en9ironmentB ?oth 7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management of common com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the generic curriculumB 7articularly mo2ule 4. The range of con2itions a trainee nee2s to manage is lai2 out ?elo: an2 in the 2e7th 2emonstrate2 in a te>t ?oo6 such as 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition
by Norman S. )illiams (Editor), Christo7her D.,. 0ulstro2e (Editor), P. Ronan OKConnell (Editor)

,4 E)ec! .e (e#era) s%r(er+ To ?e a?le to 2iagnose an2 manage a range of electi9e con2itions 7resenting to general surgeons inclu2ing a77ro7riate in9estigation an2 treatment. This shoul2 inclu2e 7rimary a?2ominal :all herniaeB lesions of the cutaneous an2 su?cutaneous tissues an2 uncom7licate2 long sa7henous 9aricose 9eins 54 E)ec! .e s%*spec a)!+ s%r(er+ To ?e a?le to assess an2 initiate management of 7atients 7resenting :ith common con2itions electi9ely to su?s7ecialty clinics. This shoul2 inclu2e gall stonesB u77er an2 lo:er gastrointestinal tract cancersB ?reast lum7s an2 9ascular insufficiency. 34 Ac%!e a*&"2e# To ?e a?le to assess an2 7ro9i2e the early care of a 7atient 7resenting :ith acute a?2ominal sym7toms an2 signs. This shoul2 inclu2e localise2 an2 generalise2 7eritonitis ;Acute chlecystitisB acute 2i9erticulitisB acute 7ancreatitisB 9isceral 7erforationB acute a77en2icitis an2 acute gynaecological con2itions=B o?struction ;small an2 large ?o:el & o?structe2 herniaeB a2hesionsB colonic carcinoma= an2 localise2 a?2ominal 7ain ;?iliary colicB non8s7ecific a?2ominal 7ain=. 84 A*&"2 #a) Tra%2a To ?e a?le to assess an2 7ro9i2e the early care of a 7atient :ith sus7ecte2 a?2ominal trauma. This shoul2 inclu2e 7rimary an2 secon2ary sur9ey. 94 Ac%!e Vasc%)ar D s"r&ers To ?e a?le to recognise assess an2 7ro9i2e the early care of a 7atient 7resenting :ith ru7tures a?2ominal aortic aneurysm an2 acute arterial insufficiency. :4 Ac%!e Ur")"( ca) c"#& ! "#s To ?e a?le to 7ro9i2e the early care of a 7atients 7resenting :ith acute urological con2itions inclu2ing acute urinary retentionB ureteric colicB urinary tract infection an2 acute testicular 7ain >4 S%perf c a) Seps s

'5

To ?e a?le to 2iagnose an2 manage inclu2ing a77ro7riate in9estigations su7erficial an2 common acute se7tic con2itions inclu2ing su?cutaneous a?scessB cellulitisB ingro:ing toe nailB 7erianal an2 7ilono2al a?scess an2 ?reast a?scess. To ?e a:are of gas gangrene an2 necrotising fasciitis

Ear)+ Years !ra # #( # Ge#era) S%r(er+

Pro9i2e e>7erience in the early care of 7atients :ith common general surgery 7ro?lemsE The common emergency 7ro?lems are acute a?2omenB a?2ominal traumaB acute 9ascular 2isor2ersB acute urological con2itions an2 su7erficial se7sis. The common electi9e 7ro?lems inclu2e a?2ominal :all herniaB lesions of the cutaneous an2 su?cutaneous tissuesB 7rimary long sa7henous 9aricose 9einsB gall ?la22er 2iseaseB u77er an2 lo:er gastrointestinal tract cancersB 9ascular insufficiency an2 ?reast lum7s. Pro9i2e some o7erati9e e>7erience of electi9e a?2ominal :all hernia re7airB 7rimary 9aricose 9ein surgeryB e>cision of ?enign su?cutaneous lesions an2 localise2 malignant s6in lesions an2 intra8a?2ominal surgery 0asic science rele9ant to the management of 7atients :ith the common electi9e an2 emergency 7ro?lemsB ;inclu2ing anatomyB 7hysiologyB 7harmacologyB an2 ra2iology= 1#"')e&(e Clinical 7resentation an2 7athology of common electi9e an2 emergency con2itions. Princi7les of management of 7atients 7resenting :ith the common electi9e an2 emergency 7ro?lems Pre8o7erati9e an2 7osto7erati9e assessment of 7atients :ith electi9e an2 emergency 7resentations of general surgical con2itions. This shoul2 inclu2e assessment of co8 mor?i2ity in the conte>t of the 7lanne2 surgical 7roce2ure. %anagement of flui2 ?alance an2 nutritional su77ortH 7osto7erati9e analgesiaH throm?o7ro7hyla>isH :oun2 management. Assessment an2 7lanning in9estigation of ne: an2 follo:8u7 7atients in out7atient clinics. Assessment an2 management of 7atients :ith emergency con2itions inclu2ing 7rimary an2 secon2ary sur9ey an2 2etermining a77ro7riate in9estigations.

O*<ec! .e

C) # ca) S0 ))s

Chest 2rain insertion Central 9enous line insertion Su7ra7u?ic catheter insertion Nee2le ?io7sy inclu2ing Fine nee2le as7iration Rigi2 sigmoi2osco7y !>cision ?io7sy of ?enign s6in or su?cutaneous lesions Tech# ca) Ingro:ing toenail & a9ulsion F :e2ge resection F 7henolisaton S0 ))s a#& !>cision ?io7sy malignant s6in lesion Pr"ce&%res Out7atient treatment of haemorrhoi2s 0reast lum7 e>cision In2uction of 7neumo7eritoneum for la7arosco7y O7en an2 close mi2line la7arotomy incision A77en2icectomy Inguinal hernia re7air Primary 9aricose 9ein surgery

'-

Assess2e#! The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 then scrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?e inclu2e2 in a 7ortfolio :hich :oul2 contri?ute as e9i2ence in su?seCuent a77lications to enter ST . S7ecific e9i2ence inclu2es Assess2e#! !+pe DOPS a selection of ty7es an2 num?ers of each ty7e accor2ing to learning agreements S%*<ec! Urethral catheterisation. Su7ra7u?ic catheterisation Chest 2rain insertion Central 9enous line insertion Nee2le ?io7sy inclu2ing Fine nee2le as7iration Rigi2 sigmoi2osco7y !>cision ?io7sy of ?enign s6in or su?cutaneous lesions Ingro:ing toenail & a9ulsion F :e2ge resection F 7henolisaton !>cision ?io7sy malignant s6in lesion Out7atient treatment of haemorrhoi2s 0reast lum7 e>cision In2uction of 7neumo7eritoneum for la7arosco7y O7en an2 close mi2line la7arotomy incision Case 0ase2 Discussion C!L P0As Training Su7er9isors re7ort ARCP for each s7ecifie2 training inter9al %RCS One 7er attachment Clinical assessment of 7atients :ith common con2itions A77en2icectomy Inguinal hernia re7air Primary 9aricose 9ein surgery !9i2ence2 ?y the a?o9e )P0As As 7er local Deanery s7ecifications Le.e) "f ach e.e2e#! Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete !9i2ence that some 7rogression has ?een achie9e2 in these technical 7roce2ures

Com7lete Com7lete A9erage le9el 4 Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST

#eneric sylla?us

Com7lete

Wha! 2a+ *e e7pec!e& "f a !ra #ee *+ !he ! 2e !he+ *ec"2e e) ( *)e !" c"22e#ce ST3 # Ur")"(+

*/

In or2er to meet the <o? s7ecifications of an ST trainee an early years trainee must ta6e a clear role in the Urology teamB managing clinic an2 :ar2 ?ase2 7atients un2er su7er9isionB inclu2ing the management of acute urological a2missions. They :ill nee2 to ?e a?le to ta6e 7art in an out7atient clinic an2 see 7atients themsel9es :ith the consultant a9aila?le for a29ice. Therefore in early years trainingB IN ADDITION to the generic com7etencies for all surgeonsB it is necessary to a22ress the s7ecifics of a 2e9elo7ing interest in Urology 2uring these years. This means s7en2ing 38.4 months in Urology in a ser9ice :hich gi9es trainees access to the a77ro7riate learning o77ortunities. Also ?y the time a trainee enters ST they nee2 to ?e familiar :ith the o7erating room en9ironment ?oth :ith res7ect to electi9e an2 emergency cases. Trainees must atten2 %DT an2 other De7artmental meetings an2 :ar2 roun2sB 7re7are electi9e o7erating lists ;?oth in7atientB 2ay8case an2 en2osco7y=B an2 actually 7erform some surgery un2er a77ro7riate su7er9ision. They must manage all 7atients in a Urology :ar2 en9ironmentB 7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management of common com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the generic curriculumB 7articularly mo2ule 4. The ra#(e "f c"#& ! "#s a !ra #ee #ee&s !" 2a#a(e are )a & "%! *e)"' a#& # !he &ep!h &e2"#s!ra!e& # a !e7! *""0 s%ch as Lecture Notes in Urology ?y Dohn Peter 0lan2yB 7u?lishe2 ?y )iley an2 0lac6:ell inclu2eE8 ,4 Ur #ar+ !rac! ca)c%) To ?e a?le to 7ro9i2e the early care of a 7atient 7resenting :ith the sym7toms suggesti9e of urinary tract calculi inclu2ing on:ar2 referral 54 /%#c! "#a) %r")"(+ To ?e a?le to 7ro9i2e the early care of a 7atient 7resenting :ith lo:er urinary tract sym7toms an2 2ysfunction inclu2ing on:ar2 referral To ?e a?le to 7ro9i2e the early care of a 7atient 7resenting :ith urinary tract o?struction inclu2ing on:ar2 referral To 2iagnose an2 initiate management of a 7atient 7resenting :ith acute or chronic urinary retention 34 Ur #ar+ !rac! #fec! "# To ?e a?le to 7ro9i2e the early care of a 7atient 7resenting :ith urinary tract infections inclu2ing on:ar2 referral :hen a77ro7riate To ?e a?le to 7ro9i2e the early care of a 7atient 7resenting :ith e7i2i2ymitis an2 scrotal a?scess inclu2ing on:ar2 referral :hen a77ro7riate 84 Ur")"( ca) "#c")"(+ To ?e a?le to 7ro9i2e the early care of a 7atient :ith sus7ecte2 urological cancer inclu2ing on:ar2 referral 94 Trea!2e#! "f re#a) fa )%re To ?e a?le to 7ro9i2e the early care of a 7atient 7resenting :ith renal failure inclu2ing on:ar2 referral :hen a77ro7riate :4 Tes! c%)ar pa # a#& s'e)) #( To ?e a?le to 7ro9i2e the early care of a 7atients 7resenting :ith acute testicular 7ain or testicular s:elling

*.

Ear)+ Years !ra # #( # Ur")"(+

Pro9i2e e>7erience in the early care of 7atients :ith common genitourinary 7ro?lemsE The common emergency 7ro?lems are urinary tract infection affecting the ?la22er an2 6i2neyB ureteric or renal colicB urinary retentionB urinary tract o?structionB renal failure an2 acute testicular 7ain. The common electi9e 7ro?lems inclu2e lo:er urinary tract sym7toms in menB urinary tract infection affecting the ?la22er an2 6i2neyB haematuriaB testicular s:elling an2 other 7atients in :hom urological malignancy is sus7ecte2. Pro9i2e some o7erati9e e>7erience of scrotal surgery an2 circumcisionB together :ith some e>7erience of straightfor:ar2 lo:er urinary tract en2osco7y. 0asic science rele9ant to the management of 7atients :ith the common electi9e an2 emergency genitourinary 7ro?lemsB ;inclu2ing anatomyB 7hysiologyB 7harmacologyB 7athology an2 ra2iology= 1#"')e&(e Princi7les of management of 7atients 7resenting :ith the common electi9e an2 emergency genitourinary 7ro?lems Detaile2 initial management of 7atients 7resenting the common urological 7ro?lems inclu2ing on:ar2 referral C) # ca) S0 ))s AssessmentB in9estigation an2 initial management of 7atients 7resenting :ith common electi9e an2 emergency urological con2itions

O*<ec! .e

Urethral catheterisation. Su7ra7u?ic catheterisation Fle>i?le cystosco7y Rigi2 cystosco7y Tech# ca) Rigi2 cystosco7y :ith ?io7sy an2 2iathermy S0 ))s a#& Rigi2 cystosco7y an2 retrogra2e ureterogram Pr"ce&%res Rigi2 cystosco7y an2 insertion DD stent Testicular fi>ation for torsion of the testicle $y2rocele surgery !>cision of e7i2y2ymal cyst Circumcision

Assess2e#! The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 then scrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?e inclu2e2 in a 7ortfolio :hich :oul2 contri?ute as e9i2ence in su?seCuent a77lications to enter ST . S7ecific e9i2ence inclu2es

*4

Assess2e#! !+pe DOPS a selection of ty7es an2 num?ers of each ty7e accor2ing to learning agreements

S%*<ec! Urethral catheterisation. Su7ra7u?ic catheterisation Fle>i?le cystosco7y Testicular fi>ation for torsion of the testicle Rigi2 cystosco7y Circumcision Rigi2 cystosco7y :ith ?io7sy an2 2iathermy Rigi2 cystosco7y an2 retrogra2e ureterogram Rigi2 cystosco7y an2 insertion DD stent $y2rocele surgery !>cision of e7i2y2ymal cyst Circumcision One 7er attachment Clinical assessment of 7atients :ith common urological con2itions $y2rocele e>cision !9i2ence2 ?y the a?o9e )P0As As 7er local Deanery s7ecifications

Le.e) "f ach e.e2e#! Com7lete Com7lete Com7lete Com7lete !9i2ence that some 7rogression has ?een achie9e2 in these technical 7roce2ures

Case 0ase2 Discussion C!L P0As Training Su7er9isors re7ort ARCP for each s7ecifie2 training inter9al %RCS

Com7lete Com7lete A9erage le9el 4 Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST

#eneric sylla?us

Com7lete

Wha! 2a+ *e e7pec!e& "f a !ra #ee *+ !he ! 2e !he+ *ec"2e e) ( *)e !" c"22e#ce ST3 # Car& "!h"rac c s%r(er+
In or2er to meet the <o? s7ecifications of an ST trainee an early years trainee must ta6e a clear role in the car2iothoracic teamB managing clinicB car2iac intensi9e care an2 :ar2 ?ase2 7atients un2er su7er9isionB inclu2ing the management of acute a2missions. They :ill nee2 to ?e a?le to ta6e 7art in an out7atient clinic an2 see 7atients themsel9es :ith the consultant a9aila?le for a29ice.

Therefore in early years trainingB IN ADDITION to the generic com7etencies for all surgeonsB it is necessary to a22ress the s7ecifics of a 2e9elo7ing interest in Car2iothoracic surgery 2uring these years. This means s7en2ing 38.4 months in car2iothoracic surgery in a ser9ice :hich gi9es trainees access to the a77ro7riate learning o77ortunities. Also ?y the time a trainee enters ST they nee2 to ?e familiar :ith the o7erating room en9ironment ?oth :ith res7ect to electi9e an2 emergency cases. Trainees must atten2 %DT an2 other De7artmental meetings an2 :ar2 roun2sB 7re7are o7erating lists ;an2 actually 7erform some surgery un2er a77ro7riate su7er9ision. They must manage all 7atients in a :ar2 en9ironmentB 7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management of common com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the generic curriculumB 7articularly mo2ule 4. The ra#(e "f c"#& ! "#s a !ra #ee #ee&s !" 2a#a(e are )a & "%! *e)"' a#& # !he &ep!h &e2"#s!ra!e& # a !e7! *""0 s%ch as Chi6:e DB 0e22o: !B #len9ille 0. Car2iothoracic Surgery O>for2 Uni9ersity Press 4//3. .. %anagement of a 7ost surgical 7atient on the critical careB high 2e7en2ency an2 7ost o7erati9e :ar2s. To ?e a?le to manageB :ith a77ro7riate su7er9isionB such a 7atient. 4. %anagement of a car2iac surgical 7atient inclu2ing o7erati9e management as a77ro7riate an2 :ith su7er9ision . !9aluation an2 management of a 7atient un2ergoing thoracic surgery inclu2ing o7erati9e management :ith su7er9ision :here a77ro7riate '. To un2erstan2 the scienceB technology an2 7ractical a77lications of car2io7ulmonary ?y7assB myocar2ial 7rotection an2 circulatory su77ort.

*'

Ear)+ Years !ra # #( # Car& "!h"rac c S%r(er+

O*<ec! .e To acCuire e>7erience in the management of a 7ost surgical 7atient on the critical careB high 2e7en2ency an2 7ost o7erati9e :ar2s. To ?e a?le to manageB :ith a77ro7riate su7er9isionB such a 7atient. To 7artici7ate un2er su7er9ision in the o7erati9e management of car2iothoracic 7atients 0asic science rele9ant to the management of 7atients :ith car2iothoracic 2isease ;inclu2ing anatomyB 7hysiologyB 7harmacologyB 7athology an2 ra2iology= Princi7les of management of 7atients 7resenting :ith the common electi9e an2 emergency car2iothoracic 2iseaseB inclu2ing 7ost o7erati9e an2 intensi9e care 1#"')e&(e S7ecific 6no:le2ge relating to the 7rinci7les of car2io7ulmonary ?y7ass an2 myocar2ial management an2 their conseCuences. Inclu2es an un2erstan2ing of the rele9ant eCui7ment an2 technology

C) # ca) S0 ))s

$istory an2 e>amination of the 7ost8o7erati9e an2 critically ill 7atient Analysis an2 inter7retation of 7ost o7erati9e an2 critical care charts an2 2ocumentation. RecognitionB e9aluation an2 treatment of haemo2ynamic a?normalitiesE RecognitionB e9aluation an2 treatment of 9entilatory a?normalitiesE RecognitionB e9aluation an2 treatment of multiorgan 2ysfunctionE

Prac! ca) S0 ))sC Use of 2efi?rillator Practical use of inotro7es an2 9asoacti9e 2rugs Princi7les of the use of intra aortic ?alloon 7um7 !chocar2iogra7hy inclu2ing TO! Arterial cannulation Tech# ca) S0 ))s Central 9enous cannulation a#& Pr"ce&%res Pulmonary artery catheterisation Opera! .e Ma#a(e2e#!C Sa7henous 9ein har9est %e2ian Sternotomy Chest as7iration Chest 2rain insertion an2 management

**

Assessment
The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 then scrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?e inclu2e2 in a 7ortfolio :hich :oul2 contri?ute as e9i2ence in su?seCuent a77lications to enter ST . S7ecific e9i2ence inclu2es Assess2e#! !+pe DOPS a selection of ty7es an2 num?ers of each ty7e accor2ing to learning agreements S%*<ec! Arterial cannulation Central 9enous cannulation Pulmonary artery catheterisation Sa7henous 9ein har9est Chest as7iration Chest 2rain insertion an2 management %e2ian Sternotomy Le.e) "f ach e.e2e#! Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete !9i2ence that some 7rogression has ?een achie9e2 in these technical 7roce2ures Com7lete Com7lete

Case 0ase2 Discussion C!L

One 7er attachment Clinical e>amination of the car2io9ascular system Clinical e>amination of the res7iratory system Inter7retation of an !C# in a clinical conte>t Sa7henous 9ein har9est !9i2ence2 ?y the a?o9e )P0As As 7er local Deanery s7ecifications

P0As Training Su7er9isors re7ort ARCP for each s7ecifie2 training inter9al %RCS

A9erage le9el ' Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST

#eneric sylla?us

Com7lete

*3

Wha! 2a+ *e e7pec!e& "f a !ra #ee *+ !he ! 2e !he+ *ec"2e e) ( *)e !" c"22e#ce ST3 # Tra%2a a#& Or!h"pae& c s%r(er+ ;TEO=
In or2er to meet the <o? s7ecifications of an ST trainee an early years trainee must ta6e a clear role in the T @ O surgical teamB managing clinic an2 :ar2 ?ase2 7atients un2er su7er9isionB :ith an em7hasis on trauma 7atients. They :ill nee2 to ?e a?le to ta6e 7art in a fracture clinic an2 see 7atients themsel9es :ith the consultant a9aila?le for a29ice. This :ill mean the trainee un2erstan2ing 7rotocols an2 7olicies of the fracture ser9ice :hich is a 7i9otal element of Trauma an2 Ortho7ae2ic 7ractice in general. Therefore in early years trainingB IN ADDITION to the generic com7etencies for all surgeonsB it is necessary to a22ress the s7ecifics of a 2e9elo7ing interest in T @ O 2uring these years. This means s7en2ing one year in T @ O in a ser9ice :hich gi9es trainees access to the a77ro7riate learning o77ortunities. Also ?y the time a trainee enters ST they nee2 to ?e familiar :ith the trauma o7erating room en9ironment an2 ha9e also o?ser9e2 some electi9e 7racticeB although the latter is sim7ly 2esira?le. It is essential that early years trainees gain o7erati9e e>7erience in the management of sim7le an6le fractures an2 fractures of the femoral nec6 as these are e>tremely common. Trainees must atten2 morning trauma meetings an2 :ar2 roun2sB 7re7are o7erating lists for traumaB atten2 trauma o7erating sessions an2 actually 7erform some surgery un2er a77ro7riate su7er9isionB an2 manage all 7atients in a T @ O :ar2 en9ironmentB 7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management of common T @ O com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the generic curriculumB 7articularly mo2ule 4. The range of con2itions a trainee nee2s to manage are lai2 out ?elo: an2 in the 2e7th 2emonstrate2 in a te>t ?oo6 such as Apley's System of Orthopaedics and Fractures by Louis Soloman, David Warwick, and Selvadurai Nayagam inclu2e ,4 S 2p)e frac!%res a#& & s)"ca! "#s To ?e a?le to 7ro9i2e the early care of the in<ure2 inclu2ing the management of sim7le fractures an2 2islocations 54 S"f! ! ss%e #<%r es To ?e a?le to recognise an2 manage soft tissue in<ury inclu2ing s7rainsB contusionsB crushing an2 sim7le :oun2s 34 A#0)e frac!%res To ?e a?le to un2erstan2 an2 recogniNe the 9arying 7atterns of an6le fractures inclu2ing their initial an2 2efiniti9e management. 84 Pr"7 2a) fe2"ra) frac!%res # !he e)&er)+ To ?e a?le to un2erstan2 an2 recogniNe the 9arying fracture 7atternsB 7re2is7osing causesB in9estigationB o7erati9e management an2 reha?ilitation of 7ro>imal femoral fracture 7atients. 94 D s!a) ra& a) frac!%res To ?e a?le to un2erstan2 an2 recognise the 9arying fracture 7atternsB 7re2is7osing causesB o7erati9e management ;mani7ulationB cast treatmentB ,8:ire fi>ation an2 ORIF= an2 reha?ilitation of 2istal ra2ial fractures.

*+

Ear)+ Years !ra # #( # Tra%2a a#& Or!h"pae& c S%r(er+

O*<ec! .e Pro9i2e e>7erience in the early care of the in<ure2B learn to manage sim7le fractures an2 2islocations an2 ha9e some e9i2ence of o7erati9e e>7erience as the surgeon in an6le an2 e>tra ca7sular hi7 fractures Anatomy an2 7hysiology of the locomotor system an2 s7inal cor2 Un2erstan2ing of imaging techniCues ;e.g. %RIB CTB ?one scanB USS= as a77lie2 to ?one an2 musculos6eletal soft tissues Patho87hysiology of ?one healing. Princi7les of management of fractures. Inclu2ing the 7rinci7les of internal an2 e>ternal fi>ation of long ?one an2 7eri8articular fractures Princi7les of management of <oint 2islocations Princi7les in the management of o7en (s close2 fractures Princi7les of %anagement of 7athological fractures Details of management of an6le an2 hi7 fractures inclu2ing classification an2 2efiniti9e treatment !>amination of the lim?s an2 <oints Perform a neurological e>amination in the 7resence of a ner9e root com7ression or s7inal in<ury Inter7retation of 7lain ra2iogra7hs A?ility to 2escri?e a fractureF 2islocation from an > ray Classification of close2 an2 o7en fracturesB AssessmentB in9estigation an2 management of lo: 9elocity close2 fractures an2 2islocations encountere2 in a fracture clinic. A?ility to 7rescri?e reha?ilitation an2 :or6 :ith the hos7ital an2 community ?ase2 inter2isci7linary team

1#"')e&(e

C) # ca) S0 ))s

Close2 mani7ulation an2 re2uction of sim7le fractures an2 2islocations. Tech# ca) TechniCues of immo?ilisation inclu2ing casting an2 safe s7lintage of these in<uries S0 ))s a#& Sim7le an6le an2 or olecranon fracture fi>ation un2er su7er9ision Pr"ce&%res Surgical fi>ation of e>tra ca7sular fractures of the femoral nec6 un2er su7er9ision. Performance of a hemiarthro7lasty un2er su7er9ision

Assess2e#!

*5

The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 then scrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?e inclu2e2 in a 7ortfolio :hich :oul2 contri?ute as e9i2ence in su?seCuent a77lications to enter ST . S7ecific e9i2ence inclu2es Assess2e#! !+pe DOPS a selection of ty7es an2 num?ers of each ty7e accor2ing to learning agreements Case 0ase2 Discussions C!L P0As S%*<ec! A77lication of a secon2ary cast Close2 re2uction of a fracture Remo9al of a , :ire Intra articular in<ection of a 6nee or shoul2er De?ri2ing a sim7le :oun2 O7ening an2 closure of a :oun2 Le.e) "f ach e.e2e#! Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete A9erage le9el 4 A9erage le9el 4 A9erage le9el 4 Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST

One 7er attachment !>am7les of e>amination of Shoul2erB S7ine ;inclu2ing neurological e>amination=B !l?o:B $an2 an2 )ristB $i7B ,neeB An6leB Foot An6le fracture fi>ation Fi>ation of an e>tra ca7sular fracture $emi arthro7lasty of the hi7 !9i2ence2 ?y the a?o9e )P0As As 7er local Deanery s7ecifications

Training Su7er9isors re7ort ARCP for each s7ecifie2 training inter9al %RCS

#eneric sylla?us

Com7lete

*-

Wha! 2a+ *e e7pec!e& "f a !ra #ee *+ !he ! 2e !he+ *ec"2e e) ( *)e !" c"22e#ce ST3 # Pae& a!r c s%r(er+
In or2er to meet the <o? s7ecifications of an ST trainee an early years trainee must ta6e a clear role in the Pae2iatric surgical team managing clinic an2 :ar2 ?ase2 chil2ren an2 their 7arents an2 carers un2er su7er9isionB inclu2ing the management of acute 7ae2iatric surgical a2missions. They :ill nee2 to ?e a?le to ta6e 7art in an out7atient clinic an2 see 7atients :ith their carers themsel9es :ith the consultant a9aila?le for a29ice. Therefore in early years trainingB IN ADDITION to the generic com7etencies for all surgeonsB it is necessary to a22ress the s7ecifics of a 2e9elo7ing interest in Pae2iatric surgery 2uring these years. This means s7en2ing 38.4 months in 7ae2iatric surgery in a ser9ice :hich gi9es trainees access to the a77ro7riate learning o77ortunities. Also ?y the time a trainee enters ST they nee2 to ?e familiar :ith the o7erating room en9ironment ?oth :ith res7ect to electi9e an2 emergency cases. Trainees must atten2 %DT an2 other De7artmental meetings an2 :ar2 roun2sB 7re7are electi9e o7erating lists ;?oth in7atientB 2ay8case an2 en2osco7y=B an2 actually 7erform some surgery un2er a77ro7riate su7er9ision. They must manage all 7atients in a Pae2iatric :ar2 en9ironment as 7art of the 7ae2iatric care teamB 7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management of common com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the generic curriculumB 7articularly mo2ule 4. The range of con2itions a trainee nee2s to manage are lai2 out ?elo: an2 in the 2e7th 2emonstrate2 in a te>t ?oo6 such as 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition
by Norman S. )illiams (Editor), Christo7her D.,. 0ulstro2e (Editor), P. Ronan OKConnell (Editor)

,4 Bas c sc e#ce To un2erstan2 the ?asic anatomy that surgeons :ill encounter 2uring the management of chil2ren an2 the em?ryology relate2 to congenital anomalies. To un2erstan2 the normal 7hysiological 7rocesses at 2ifferent ages. To un2erstan2 the effects of 2isease an2 trauma on these 7rocesses To un2erstan2 surgical 7athology that can affect chil2ren at 2ifferent ages. 54 Ch )& ' !h a*&"2 #a) pa # To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith a?2ominal 7ain inclu2ing a77ro7riate communication :ith rele9ant family or carers To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith intussusce7tion inclu2ing a77ro7riate communication :ith rele9ant family or carers 34 The ."2 ! #( ch )& To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith 9omiting inclu2ing a77ro7riate communication :ith rele9ant family or carers

3/

84 Tra%2a # ch )&re# A77ro7riate communication :ith rele9ant family or carers 94 Ch )& ' !h (r" # c"#& ! "#s To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith groin 7athology ;inclu2ing un2escen2e2 testisB herniaB hy2rocele an2 7ainful s:ellings of the genitalia= inclu2ing a77ro7riate communication :ith rele9ant family or carers :4 A*&"2 #a) 'a)) pa!h")"(+ To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith inclu2ing a?normalities of the a?2ominal :all ;inclu2ing um?ilical herniaB su7ra8um?ilical hernia an2 e7igastric hernia= inclu2ing a77ro7riate communication :ith rele9ant family or carers >4 Pae& a!r c %r")"(+ To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith inclu2ing a?normalities of the urinary tract ;inclu2ing urinary tract infection an2 haematuria= inclu2ing a77ro7riate communication :ith rele9ant family or carers @4 Ch )& ' !h C"#s! pa! "# To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith consti7ation inclu2ing a77ro7riate communication :ith rele9ant family or carers ?4 Hea& "r #ec0 s'e)) #( To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith a s:elling of hea2 or nec6 inclu2ing a77ro7riate communication :ith rele9ant family or carers ,A4 E2er(e#c+ pae& a!r c s%r(er+ To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith a su7erficial a?scess inclu2ing a77ro7riate communication :ith rele9ant family or carers To ?e a?le to assess an2 initiate management of a chil2 7resenting :ith an ingro:ing toe8nail inclu2ing a77ro7riate communication :ith rele9ant family or carers & This 2istinguishes the anatomical an2 clinical features :hich ma6es the management of chil2ren s7ecial.

3.

Ear)+ Years !ra # #( # Pae& a!r c s%r(er+

S%* T"p c O*<ec! .e A#a!"2+ To un2erstan2 the ?asic anatomy that surgeons :ill encounter 2uring the management of chil2renB an2 the em?ryological 2e9elo7ment of anatomical systems. CARDIOVASCULARC !m?ryogenesis of heart an2 ma<or 9esselsB an2 formation of the lym7hatic system Common anatomical 9ariations of heart cham?ersB 9al9es an2 ma<or 9essels Surgical anatomy of heart an2 ma<or arteries O 9eins in thora>B nec6B a?2omen an2 groins RESPIRATORYC !m?ryogenesis of trachea an2 ?ronchial tree Lung 2e9elo7ment Common anatomical 9ariations of res7iratory tree an2 lungs to inclu2e 9ascular anomalies Surgical anatomy of 7leuraB lung an2 trachea an2 ?ronchial tree GASTROINTESTINAL TRACT AND ABDOMINAL WALLC !m?ryogenesis of the #IT to inclu2e formation of the soli2 organsB anorectumB an2 a?2ominal :all Common anatomical 9ariations in the formation of the #IT an2 a?2ominal :all Surgical anatomy of the #IT an2 its relations to other systems RENALC !m?ryogenesis of the u77er an2 lo:er renal tract to inclu2e male an2 female genital 2e9elo7ment Common anatomical 9ariations of the renal tract an2 genitalia Surgical anatomy of the renal tractB an2 associate2 genital structures to inclu2e relationshi7s to other systems NEUROLOGICALC !m?ryogenesis of the ?rain an2 s7inal cor2B an2 of the su77orting structures ;s6ullB 9erte?ral column= Common anatomical 9ariations of the ?rain an2 s7inal cor2 Surgical anatomy of the ?rainB s7inal cor2 an2 ma<or somatic ner9es ;to inclu2e relationshi7s to other systems= MUSCULO S1ELETALC !m?ryogenesis of the s6eleton an2 muscle 2e9elo7ment Common anatomical 9ariations of s6eleton Surgical anatomy of s6eleton :here rele9ant to other systems S%* T"p c O*<ec! .e C) # ca) To ?e a?le to assess a chil2 7resenting acutely :ith acute surgical 7athology ;see e>am7les ?elo:= as the sus7ecte2 2iagnosis or To ?e a?le to assess a chil2 7resenting acutely :ith non acute surgical 7athology ;see e>am7le ?elo:= as the sus7ecte2 2iagnosis To ?e a?le to assess a chil2 7resenting :ith a?2ominal 7ain either acutely or through the OP clinic. 9omiting either acutely or through the OP clinic. Ggroin 7athologyA

1#"')e&(e

34

a?normalities of the a?2ominal :all a?normalities in the urinary tract consti7ation as the 7rimary 7resenting sym7tom hea2Fnec6 s:elling as the 7rimary 7resenting sym7tom

To ?e a?le to formulate a 2ifferential 2iagnosis an2 an in9estigation an2 management 7lan To ?e a?le to treat the chil2 a77ro7riately u7 to an2 inclu2ing o7erati9e inter9ention if reCuire2 To ?e a?le to communicate the a?o9e information at the reCuire2 le9el to 7atientsF7arentsF other team mem?ers 1#"')e&(e # (e#era) In9estigation 7rotocols an2 local 9ariations thereof Differential 2iagnosis Place an2 9alue of in9estigations Place of o7erati9e inter9entionB an2 associate2 outcomes Patterns of sym7toms an2 relation to li6ely 7athology an2 age of chil2 %e2ical management In2ications for surgery 1#"')e&(e # par! c%)ar Causes of o?struction Pyloric 2isease Intussusce7tion Significance of ?ile staine2 9omiting $ernia $y2rocele Un2escen2e2 Testis Penile inflammatory con2itions Scrotal con2itions Urinary tract infection $aematuria Causes an2 7rinci7les of management of consti7ation Ingro:ing toe nail Common s:ellings of the nec6 in chil2ren The normal 2e9elo7ment of the fores6in Li6ely effects of 2ifferent ty7es of trauma an2 relation to age of chil2

1#"')e&(e

C) # ca) S0 ))s

Tech# ca) S0 ))s a#& Pr"ce&%res

A?ility to assess ill chil2 A?ility to assess ill chil2 inclu2ing an assessment of se9erity of 2ehy2ration. A?ility to communicate :ith ill chil2B 7arents an2 carers A?ility to form a 9ia?le in9estigation an2 treatment 7lan A?ility to communicate :ith all rele9ant grou7s A77en2icectomy Pyloromyotomy 0asicB A29ance2 Life Su77ort s6ills Inguinal herniotomy ;non8neonatal= Um?ilical an2 7erium?ilical hernia re7air Surgery for hy2rocoele Pre7ucio7lasty Circumcision Surgery for un2escen2e2 testis

Surgery for acute scrotum Insertion of su7ra87u?ic catheter Cystourethrosco7y In gro:ing toenail surgery

Assess2e#! The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 then scrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?e inclu2e2 in a 7ortfolio :hich :oul2 contri?ute as e9i2ence in su?seCuent a77lications to enter ST . S7ecific e9i2ence inclu2es Assess2e#! !+pe DOPS a selection of ty7es an2 num?ers of each ty7e accor2ing to learning agreements Case 0ase2 Discussion C!L P0As S%*<ec! Insertion of a su7ra7u?ic catheter Ingro:ing toe nail surgery Circumcision Suction rectal ?io7sy %anual e9acuation of stool !UA Rectum Anal stretch Pae2iatric A29ance2 Life su77ort four 7er si> months of attachment $istory ta6ing from a chil2 an2 their carers !>amining a chil2 A77en2icectomy Inguinal herniotomy Pyloromyotomy Surgery for hy2rocele Re7air of um?ilical hernia !9i2ence2 ?y the a?o9e )P0As As 7er local Deanery s7ecifications Le.e) "f ach e.e2e#! Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete A9erage le9el 4 A9erage le9el 4 A9erage le9el 4 A9erage le9el 4 A9erage le9el 4 Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST

Training Su7er9isors re7ort ARCP for each s7ecifie2 training inter9al %RCS

#eneric sylla?us

Com7lete

3'

Wha! 2a+ *e e7pec!e& "f a !ra #ee *+ !he ! 2e !he+ *ec"2e e) ( *)e !" c"22e#ce ST3 # P)as! c S%r(er+4
In or2er to meet the <o? s7ecifications of an ST trainee an early years trainee must ta6e a clear role in the Plastic Surgery teamB managing clinic an2 :ar2 ?ase2 7atients un2er su7er9isionB inclu2ing the management of acute 7lastic surgery a2missions. They :ill nee2 to ?e a?le to ta6e 7art in out7atient clinics an2 see 7atients themsel9es :ith the consultant a9aila?le for a29ice. Therefore in early years trainingB IN ADDITION to the generic com7etencies for all surgeonsB it is necessary to a22ress the s7ecifics of a 2e9elo7ing interest in Plastic Surgery 2uring these years. This means s7en2ing 38.4 months in Plastic Surgery in a ser9ice :hich gi9es trainees access to the a77ro7riate learning o77ortunities. Also ?y the time a trainee enters ST they nee2 to ?e familiar :ith the o7erating room en9ironment ?oth :ith res7ect to electi9e an2 emergency cases. Trainees must atten2 %DT an2 other De7artmental meetings an2 :ar2 roun2sH 7re7are electi9e o7erating lists ;?oth in7atient an2 2ay8case=B an2 actually 7erform some surgery un2er a77ro7riate su7er9ision. They must manage all 7atients in a Plastic Surgery :ar2 en9ironmentB 7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management of common com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the generic curriculumB 7articularly mo2ule 4. The ra#(e "f c"#& ! "#s a !ra #ee #ee&s !" 2a#a(e are )a & "%! *e)"' a#& # !he &ep!h &e2"#s!ra!e& # a !e7! *""0 s%ch as P)as! c S%r(er+ *+ Gra** a#& S2 !h ;:!h E& ! "#= "r /%#&a2e#!a)s "f P)as! c S%r(er+ *+ McGre("r ;,A!h E& ! "#= .. Assessment an2 2iagnosis of han2 trauma cases an2 inclu2ing o7erati9e management in some cases :ith a77ro7riate su7er9ision as a77ro7riate 4. Assessment an2 initial management of ?urns an2 scal2s in chil2ren an2 a2ults. . )oun2 management inclu2ing com7le> an2 contaminate2 :oun2s an2 in9ol9ing ?oth conser9ati9e an2 o7erati9e management. '. Assessment an2 initial management of cases of lo:er lim? trauma in9ol9ing com7oun2 fractures :ith soft tissue 2amageB s6in lossB ma<or ner9e an2For 9essel in<ury. *. Diagnosis an2 management of s6in lesionsB inclu2ing s6in malignancy. 3. Com7etence in the use of general 7lastic surgery techniCues in reconstruction inclu2ing s6in graftingB N87lastyB flat ele9ation an2 relate2 techniCues. !arly com7etence in the use of the o7erating microsco7e. +. %anagement of common electi9e 7lastic surgical 7roce2ures.

3*

Ear)+ Years !ra # #( # P)as! c S%r(er+

O*<ec! .e To gain e>7erience in early care of 7atients :ith the follo:ingE Thermal in<uryB soft tissue traumaB inclu2ing han2B lim? an2 facial in<uries. S6in an2 soft tissue tumours inclu2ing malignancy Common electi9e 7roce2ures as lai2 out in the curriculum 0asic science rele9ant to management of common emergency an2 electi9e 7lastic surgery con2itions inclu2ing anatomyB 7hysiologyB 7athology an2 7harmacology. ,no:le2ge of rele9ant imaging techniCues. Princi7les of 7atient management rele9ant to common emergency an2 electi9e 7lastic surgical con2itions. A?ility to systematically un2erta6e e>amination of the han2 an2 u77er lim?. A?ility to carry out initial assessment an2 management of ?urns cases reCuiring resuscitation. A?ility to 2iagnose common s6in tumours inclu2ing malignancy. !>7loration of traumatic :oun2s inclu2ing han2 trauma cases. Re7air of 2i9i2e2 han2 e>tensor ten2on. Re7air of 2i9i2e2 2igital ner9e. S7lit an2 full thic6ness s6in grafting. !>cision of s6in an2 soft tissue lesions. Some a?ility to use o7erating microsco7e.

1#"')e&(e

C) # ca) S0 ))s

Tech# ca) S0 ))s

33

Assess2e#! The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 then scrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?e inclu2e2 in a 7ortfolioB :hich :oul2 contri?ute as e9i2ence in su?seCuent a77lications to enter ST . S7ecific e9i2ence inclu2es Assess2e#! !+pe DOPS a selection of ty7es an2 num?ers of each ty7e accor2ing to learning agreements Case 0ase2 Discussion mini C!L S%*<ec! Assessment of ?urn surface area. !>7lorationB 2e?ri2ement an2 closure of :oun2 $ar9esting s7lit s6in graft $ar9esting of full thic6ness s6in graft Re7air of 2i9i2e2 e>tensor ten2on Re7air 2i9i2e2 2igital ner9e !>cision an2 closure of sim7le s6in lesions At least . 7er attachment Clinical assessment of in<ure2 han2 Clinical assessment of ?urns 7atient Some common 7lastic surgical 7roce2ures Le.e) "f ach e.e2e#! Com7lete Com7lete Com7lete Com7lete Le9el Le9el 4F Com7lete Com7lete Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST !9i2ence that 7rogression has ?een ma2e 2uring attachment Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST Com7lete

P0As

Training Su7er9isors re7ort ARCP for each s7ecifie2 training inter9al %RCS

!9i2ence2 ?y a?o9e )P0As As 7er local Deanery s7ecifications

#eneric sylla?us

3+

Wha! 2a+ *e e7pec!e& "f a !ra #ee *+ !he ! 2e !he+ *ec"2e e) ( *)e !" c"22e#ce ST3 # Ne%r"s%r(er+4
At 7resent ;3F/-=B neurosurgery continues :ith run through training that is s7ecialty s7ecific. %ost trainees :ill ?e entering ST from neurosurgery 7rogramsB although it is ho7e2 that in timeB some GCoreA trainees :ill ?e attracte2 into the s7ecialty from attachments in CST4. $o:e9erB those that 2o so :ill nee2 to a22ress the issue of com7etencies outsi2e of surgery ;C9=. In or2er to meet the <o? s7ecifications of an ST traineeB an early years trainee must ta6e a clear role in the Neurosurgery teamB managing clinic an2 :ar2 ?ase2 7atients un2er su7er9isionB inclu2ing the management of acute Neurosurgical a2missions. They :ill nee2 to ?e a?le to ta6e 7art in an out7atient clinic an2 in some centres see 7atients themsel9es :ith the consultant a9aila?le for a29ice. Therefore in early years trainingB IN ADDITION to the generic com7etencies for all surgeonsB it is necessary to a22ress the s7ecifics of a 2e9elo7ing interest in Neurosurgery 2uring these years. This means s7en2ing 38.4 months in neurosurgery in a ser9ice :hich gi9es trainees access to the a77ro7riate learning o77ortunities. They :ill also ha9e to ha9e com7lete2 ether a 3 months mo2ule in clinical neurologyB or four months of neurology an2 four in an allie2 clinical neuroscience such as neuro8intensi9e care. Also ?y the time a trainee enters ST they nee2 to ?e familiar :ith the o7erating room en9ironment ?oth :ith res7ect to electi9e an2 emergency cases. Trainees must atten2 %DT an2 other De7artmental meetings an2 :ar2 roun2sB 7re7are electi9e o7erating lists ;?oth in7atientB 2ay8case=B an2 :ill ?e e>7ecte2 to ha9e 7erforme2 some surgery un2er a77ro7riate su7er9ision. They must manage all 7atients in a neurosurgery :ar2 en9ironmentB 7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management of common com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the generic curriculumB 7articularly mo2ule 4. The ra#(e "f c"#& ! "#s a !ra #ee #ee&s !" 2a#a(e are )a & "%! *e)"' a#& # !he &ep!h &e2"#s!ra!e& # a !e7! *""0 s%ch as C) # ca) Ne%r"s%r(er+ ;L #&sa+=B Sch2 &e0 a#& S'ee! "r Y"%2a#s Cranial traumaE inclu2ing the resuscitationB assessmentB in9estigation an2 continuing care of hea28in<ure2 7atientsH the 7re9ention an2 2etection of secon2ary intracranial an2 systemic insultsH insertion of an intracranial 7ressure monitorH ?urr8hole 2rainage of a chronic su?2ural haematomaH S7inal TraumaE the resuscitation an2 assessmentB in9estigation an2 care of 7atients suffering s7ine in<uries. The initial e>ternal sta?ilisation of the s7ine inclu2ing 7lacement of s6ull traction. S7ontaneous intracranial haemorrhageE inclu2ing the resuscitationB assessment an2 in9estigation of 7atients suffering a su?arachnoi2 haemorrhageH the management of 7ost8haemorrhagic

35

hy2roce7halusH the 2etection an2 management of 2elaye2 cere?ral ischaemiaH the management of systemic com7licationsH 2iagnostic lum?ar 7uncture. $y2roce7halusE in 7articular the management of hy2roce7halus com7licating intracranial haemorrhageB hea2 in<ury an2 intracranial s7ace8occu7ying lesionsH insertion an2 ta77ing of CSF reser9oirsH insertion an2 maintenance of lum?ar an2 e>ternal 9entricular 2rains. Intracranial tumoursE inclu2ing the assessment an2 7eri8o7erati9e management of 7atients :ith intracranial tumoursH the 2etection an2 management of 7ost8o7erati9e cere?ral s:ellingB intracranial haematomas an2 intracranial se7sisH the management of 7ost8o7erati9e seiNuresH the management of 7ost8o7erati9e meta?olic an2 en2ocrine 2isor2ers. Acute s7inal 2isor2ersE inclu2ing the assessment an2 7eri8o7erati9e management of 7atients 7resenting :ith s7inal cor2B cau2a eCuina an2 s7inal root com7ressionE the management of s7inal shoc6H the :ar2 management of 7atients :ith s7inal insta?ilityH the 2etection an2 initial management of 7osto7erati9e com7lications inclu2ing com7ressing haematomasB CSF fistula an2 s7inal se7sis.

T"p c

Ear)+ Years Ne%r"s%r(er+ Provide ex#erience in t!e earl$ care of #atients %it! common neurosur"ical #roblems& T!e common emer"enc$ #roblems are brain and s#ine trauma' s#ontaneous intracranial !aemorr!a"e inc( Sub arac!noid !aemorr!a"e and !$#ertensive intracerebral !aematomas' Acute !$droce#!alus Mana"ement of acute raised intracranial #ressure from brain tumours( E#ile#s$( Acute s#inal cord and nerve root com#ression and cauda e)uina s$ndrome( T!e common elective #roblems include assessment and mana"ement of various brain tumours' t!e investi"ation and mana"ement t!ereof( T!e mana"ement and investi"ation of #atients %it! e#ile#s$' stroke and movement disorders( T!e mana"ement investi"ation and assessment of #atients %it! s#inal de"enerative disease includin" s#inal stenosis and disc #rotrusions( S#inal tumours of all t$#es( Provide some o#erative ex#erience of as#ects of all of t!ese( 0asic science rele9ant to the management of 7atients :ith the common electi9e an2 emergency ?rain an2 s7ine 7ro?lemsB ;inclu2ing anatomyB 7hysiologyB 7harmacologyB 7athology an2 ra2iology=

O*<ec! .e

1#"')e&(e

Princi7les of management of 7atients 7resenting :ith the common electi9e an2 emergency ?rain an2 s7ine 7ro?lems Detaile2 initial management of 7atients 7resenting the common neurosurgical 7ro?lems inclu2ing on:ar2 referral

C) # ca) S0 ))s

AssessmentB in9estigation an2 initial management of 7atients 7resenting :ith common electi9e an2 emergency neurosurgical con2itions

3-

Insertion of ICP ?olt 0urr hole 2rainage of CSD$ 0asic craniotomy fla7 7osition an2 7roce2ures Ta77ing of CSF reser9oirs an2 shunts Tech# ca) S0 ))s Lum?ar 7uncture a#& Pr"ce&%res Part of 7lacement of 9entriculo 7eritoneal shunts Placement of !(DAs Positioning an2 safety of 7atients for s7ine 7roce2ures ;lum?ar= Some 7art of sim7le s7inal 2ecom7ressi9e 7roce2ures

Assess2e#! The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 then scrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?e inclu2e2 in a 7ortfolio :hich :oul2 contri?ute as e9i2ence in su?seCuent a77lications to enter ST . The s7ecific <o? s7ecifications for entry into ST are sho:n in a77en2i> LL. Com7letion of the %RCS is man2atory 2uring the same 7erio2 S7ecific e9i2ence inclu2es Assess2e#! !+pe DOPS a selection of ty7es an2 num?ers of each ty7e accor2ing to learning agreements Case 0ase2 Discussion C!L P0As Training Su7er9isors re7ort ARCP for each s7ecifie2 training inter9al %RCS S%*<ec! 0urr hole for CSD$ Thera7euticF2iagnostic LP Insert Lum?ar 2rain !>ternal 9ent 2rain Insert C(P line Placement of s6ull traction Placement of image gui2ance fi2ucials an2 set u7 Placement of craniotomy One 7er attachment Clinical assessment of 7atients :ith common Neurosurgical con2itions Craniotomy for trauma !9i2ence2 ?y a?o9e )P0As As 7er local Deanery s7ecifications Le.e) "f ach e.e2e#! ' F'

4 4F 4F Com7lete Com7lete A9erage le9el 4 Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST Com7lete2

#eneric sylla?us

+/

Wha! 2a+ *e e7pec!e& "f a !ra #ee *+ !he ! 2e !he+ *ec"2e e) ( *)e !" c"22e#ce ST3 # O!")ar+#(")"(+ ;ENT=4
In or2er to meet the <o? s7ecifications of an ST trainee an early years trainee must ta6e a clear role in the Otolaryngology teamB managing clinic an2 :ar2 ?ase2 7atients un2er su7er9isionB inclu2ing the management of acute a2missions. They :ill nee2 to ?e a?le to ta6e 7art in an out7atient clinic an2 see ?oth ne: an2 ol2 7atients themsel9es :ith the consultant a9aila?le for a29ice. Therefore in early years trainingB IN ADDITION to the generic com7etencies for all surgeonsB it is necessary to a22ress the s7ecifics of a 2e9elo7ing interest in Otolaryngology 2uring these years. This means s7en2ing .4 months in Otolaryngology :ith a77ro7riate su?8s7ecialty e>7erience in a ser9ice :hich gi9es trainees access to the a77ro7riate learning o77ortunities. Also ?y the time a trainee enters ST they nee2 to ?e familiar :ith the o7erating room en9ironment ?oth :ith res7ect to electi9e an2 emergency cases. Trainees must atten2 %DT an2 other De7artmental meetings an2 :ar2 roun2sB 7re7are electi9e o7erating lists ;?oth in7atient an2 2ay8case=B an2 actually 7erform some surgery un2er a77ro7riate su7er9ision. They must manage all 7atients in the :ar2 en9ironmentB ?oth 7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management of common com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the generic curriculumB 7articularly mo2ule 4. The ra#(e "f c"#& ! "#s a !ra #ee #ee&s !" 2a#a(e s )a & "%! *e)"' a#& # !he &ep!h &e2"#s!ra!e& # a !e7! *""0 s%ch as 7777777 ;ref= #c)%&e ,4 E)ec! .e "!")"(+ To un2erstan2 the aetiologyB 7resenting sym7tomsB signs an2 management of common con2itions inclu2ing 2eafness in a2ultsB facial 7aralysisB tinnitusB traumaB 2iNNinessB mi22le ear infectionsB non infecti9e con2itions of the e>ternal ear an2 infecti9e con2itions of the e>ternal ear. 54 Pae& a!r c "!")ar+#(")"(+ To un2erstan2 the aetiologyB 7resenting sym7tomsB signs an2 management of common con2itions inclu2ing nec6 massesB air:ay 2isor2ersB congenital 2eformities affecting the hea2 an2 nec6B 2eafness e>clu2ing otitis me2ia an2 its com7licationsB facial 7alsyB otitis me2ia an2 its com7licationsB 2isor2ers of the e>ternal earB nose an2 sinus infectionsB inflammatory nasal 2iseaseB nasal 7oly7sB foreign ?o2ies in the ear nose an2 throatB e7ista>isB trauma to the hea2 an2 nec6B 2isease of the tonsils an2 a2enoi2sB oncology an2 s7eech an2 language 2e9elo7ment. 34 D sease "f !he hea& a#& #ec0 To un2erstan2 the aetiologyB 7resenting sym7tomsB signs an2 management of common con2itions inclu2ing congenital a?normalities of the hea2 an2 nec6B oral 7athologyB air:ay o?structionB 9oice 2isor2ersB 2isor2ers of s:allo:ingB slee7 relate2 ?reathing 2isor2ersB a2enoi2 an2 tonsillar 7athologyB ?enign an2 neo7lastic sali9ary glan2 2iseaseB thyroi2 an2 7arathyroi2 2iseaseB malignancies in the u77er aero2igesti9e tract e>clu2ing the oral ca9ityB craniocer9ical trauma in a2ultsB cer9ical se7sisB lym7ha2eno7athy an2 other nec6 lum7s. 84 E)ec! .e Rh #")"(+ To un2erstan2 the aetiologyB 7resenting signsB sym7toms an2 management of common con2itions inclu2ing congenital a?normalitiesB nose an2 sinus infections an2 inflammationB nasal 7oly7sB facial 7ainB e7ista>isB nasal trauma an2 2eformityB rhinological oncologyB granulomatous con2itionsB se7torhino7lasty inclu2ing some un2erstan2ing of the role of cosmetic surgery an2 reconstruction.

+.

94 E2er(e#c+ "!")ar+#(")"(+ To un2erstan2 the aetiologyB 7resenting signsB sym7toms an2 management of common con2itions inclu2ing sim7le e7ista>isB otitis e>ternalB foreign ?o2ies in the earB nose an2 oro7haryn>B acute oro7haryngeal infections an2 sim7le fractures of the facial s6eleton.

Ear)+ Years !ra # #( # O!")ar+#(")"(+ ;ORL= Provide ex#erience in t!e earl$ care of #atients %it! common otolar$n"olo"ical #roblems& The common emergency 7ro?lems are sim7le e7ista>isB otitis e>ternaB foreign ?o2ies in the earB nose an2 oro7haryn>B acute oro7haryngeal infections an2 sim7le fractures of the facial s6eleton The common electi9e 7ro?lems inclu2e ontologicalB rhinologicalB hea2 an2 nec6 an2 7ae2iatric con2itions Pro9i2e some o7erati9e e>7erience of electi9e otolaryngology inclu2ing en2osco7ic an2 microsco7ic e>amination :ith ?io7sy as a77ro7riate of the earsB nose an2 throat An acCuisition of ?asic surgical s6ills in 2isor2ers of the earsB noseB throat hea2 an2 nec6 an2 u77er aero2igesti9e tract 0asic science rele9ant to the management of 7atients :ith the common electi9e an2 emergency 7ro?lemsB ;inclu2ing anatomyB 7hysiologyB 7harmacologyB an2 ra2iology= Clinical 7resentation an2 7athology of common electi9e an2 emergency con2itions. Princi7les of management of 7atients 7resenting :ith the common electi9e an2 emergency 7ro?lems Pre8o7erati9e an2 7osto7erati9e assessment of 7atients :ith electi9e an2 emergency 7resentations of general surgical con2itions. This shoul2 inclu2e assessment of co8mor?i2ity in the conte>t of the 7lanne2 surgical 7roce2ure. %anagement of flui2 ?alance an2 nutritional su77ortH 7osto7erati9e analgesiaH throm?o7ro7hyla>isH :oun2 management. Assessment an2 7lanning in9estigation of ne: an2 follo:8u7 7atients in out7atient clinics. Assessment an2 management of 7atients :ith emergency con2itions inclu2ing 7rimary an2 secon2ary sur9ey an2 2etermining a77ro7riate in9estigations. Endosco#ic or microsco#ic examination %it! bio#s$ as a##ro#riate of t!e ears' nose and t!roat *asal cauter$ +orei"n bod$ removal from t!e ear canal' nose and oro#!ar$nx Microsuction of t!e ears Draina"e of a )uins$ ,eduction of sim#le nasal fractures

O*<ec! .e

1#"')e&(e Tech# ca) S0 ))s a#& Pr"ce&%res

C) # ca) S0 ))s

The 2etaile2 DO$NS sylla?us is 7u?lishe2 as a se7arate ?oo6 ref Assess2e#!

+4

The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 then scrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?e inclu2e2 in a 7ortfolio :hich :oul2 contri?ute as e9i2ence in su?seCuent a77lications to enter ST . In Otolaryngology trainees must achie9e ?oth the %RCS an2 the DO$NS ;Di7loma of $ea2 an2 Nec6 Surgery= e>aminations in or2er to ?e eligi?le to enter ST . The %RCS can ?e o?taine2 ?y successfully ta6ing 7arts A an2 0 of the %RCS e>aminationB or ?y successfully ta6ing 7art A of the %RCS together :ith 7arts A an2 0 of the DO$NS e>amination. The DO$NS can ?e only o?taine2 ?y ta6ing 7art A an2 Part 0 of the DO$NS e>amination. S7ecific e9i2ence inclu2es Assess2e#! !+pe DOPS a selection of ty7es an2 num?ers of each ty7e accor2ing to learning agreements S%*<ec! A2ult Rigi2 Nasal !n2osco7y Aural microsuction 0io7sy small oral or s6in lesion Changing tracheostomy tu?e Drainage of 7eritonsillar a?scess !7ista>is !7ley %anoeu9re Fine Nee2le As7iration Cytology Fle>i?le Nasoen2osco7y Fle>i?le nasolaryngosco7y %yringotomy an2 insertion of grommet Pac6ing of nose Positional Test for 2iagnosis of 9ertigo ;Di> $all7i6e Test= Re2uction of sim7le nasal fractures Remo9al of foreign ?o2y from nose of chil2 One 7er attachment Clinical assessment of 7atients :ith common con2itions !lecti9e a2ult tracheostomy !>cision nec6 no2e Nasal 7oly7ectomy Rigi2 Laryngosco7y Tonsillectomy !9i2ence2 ?y the a?o9e )P0As As 7er local Deanery s7ecifications #eneric sylla?us Le.e) "f ach e.e2e#! Com7lete

Case 0ase2 Discussion C!L P0As

Com7lete Com7lete A9erage le9el 4

Training Su7er9isors re7ort ARCP for each s7ecifie2 training inter9al %RCSFDO$NS

Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST Com7lete

Wha! 2a+ *e e7pec!e& "f a !ra #ee *+ !he ! 2e !he+ *ec"2e e) ( *)e !" c"22e#ce ST3 # Ma7 ))"fac a) s%r(er+ ;OM/S=
In or2er to meet the <o? s7ecifications of an ST trainee an early years trainee must ha9e ha2 e>7erience of :or6ing as a 6ey mem?er of the oral @ %a>illofacial Surgical ;O%FS= team. !>7erience shoul2 ?e gaine2 an2 com7etencies 2emonstrate2 ;IN ADDITION to the generic com7etencies for all surgeons= inE )ar2 careB out7atient clinicsB recei9ing an2 managing O%FS emergency 7atientsB %DT meetings. O7erati9e e>7erience shoul2 inclu2e e>7osure to surgical air:ay managementB surgical oncologyB orthognathic surgeryB ma>illofacial trauma ;har2 @ soft tissue= an2 2entofacial se7sis. Trainees shoul2 2emonstrate com7etencies in 2ento8al9eolar surgery the o7erati9e management of sim7le facial lacerationsB the out7atient management of 2ento8facial se7sis. Trainees must atten2 clinical meetings an2 :ar2 roun2sB 7re7are o7erating lists for traumaB atten2 trauma o7erating sessions an2 actually 7erform some surgery un2er a77ro7riate su7er9isionB an2 manage all 7atients in an O%FS :ar2 en9ironmentB 7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management of common O%FS com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the generic curriculumB 7articularly mo2ule 4. The ra#(e "f c"#& ! "#s a !ra #ee #ee&s !" 2a#a(e are )a & "%! *e)"' a#& # !he &ep!h &e2"#s!ra!e& # a !e7! *""0 s%ch as ,4 Tra%2a To ?e a?le to 7ro9i2e the early care of the in<ure2 inclu2ing the management of sim7le fractures an2 soft tissue in<uries. 54 De#!"6a).e")ar s%r(er+ To ?e a?le to i2entify manage a range of 2ento8al9eolar con2itions 34 O#c")"(+ To un2erstan2 the 7athology an2 7ro9i2e assessment of 7atients :ith sus7ecte2 hea2 an2 nec6 cancer. 84 De#!"fac a) Seps s To ?e a?le to recognise an2 manage 2entofacial se7sisB a77ro7riately in9estigate an2 ?e 7articularly a:are of the assessment of the air:ay.

Ear)+ Years !ra # #( # OM/S !ra # #(

+'

O*<ec! .e

Pro9i2e e>7erience in the early care of the in<ure2B learn to manage sim7le facial fractures an2 soft tissue in<uries. Anatomy an2 7hysiology of the hea2 an2 nec6 Un2erstan2ing of imaging techniCues ;e.g. %RIB CTB ?one scanB USS= as a77lie2 to hea2 @ nec6 Patho87hysiology of ?one healing. Princi7les of management of fractures. Princi7les of :oun2 healing Princi7les of the management of 2ento8al9eolar trauma !>amination of the hea2 @ nec6 Perform a neurological e>amination an2 assessment of hea2 in<ury. Inter7retation of 7lain ra2iogra7hs Assessment an2 imme2iate management of 2ento8al9eolar trauma Closure of sim7le facial lacerations Placement 7lates for sim7le man2i?ular fracture

1#"')e&(e

C) # ca) S0 ))s

Tech# ca) S0 ))s a#& Pr"ce&%res

Ear)+ Years !ra # #( # OM/S

Ca!e("r+ O*<ec! .e Dento8Al9eolar surgeryFintra8oral soft tissue #ain e>7erience in the 2iagnosis an2 surgical management of common 2ento8 al9eolar 7ro?lems an2 intra8oral soft tissue lesions AnatomyB em?ryology an2 7hysiology teeth an2 su77orting structures Un2erstan2ing of intra8oral imaging techniCues inclu2ing 7lain ra2iology an2 cone ?eam ct scanning 1#"')e&(e Princi7les of the management of o2ontogenic cystsB im7acte2 teethB 7erira2icular surgery an2 im7lantology. Princi7les of incisionalB e>cisional an2 nee2le ?io7sy techniCues

C) # ca) S0 ))s

Assessment of 7atients 7resenting :ith 2ento8al9eolar an2 intra oral mucosal signs an2 sym7toms.

Tech# ca) S0 ))s a#& Pr"ce&%res

Dental e>tractionsB surgical remo9al of teeth an2 ?urie2 rootsB surgical management of o2ontogenic cysts. Intra oral ?io7sies

+*

Ear)+ +ears !ra # #( # OM/S

Ca!e("r+ O*<ec! .e Oncology #ain e>7erience in the 2iagnosis an2 surgical management of common 2ento8 al9eolar 7ro?lems an2 intra8oral soft tissue lesions Princi7les of the management of 7remalignant an2 malignant con2itions affecting the hea2 an2 nec6. Princi7les of the use of ra2iothera7y an2 chemothera7yB an2 their com7lications. 1#"')e&(e Princi7les in the use of sym7tom control me2ication an2 techniCues in the care of the 2ying 7atient Un2erstan2ing the im7ortance of the nutritional state of oncology 7atients

C) # ca) S0 ))s

0rea6ing ?a2 ne:s Assessment of oncology 7atients Un2erstan2ing the legal moral an2 ethical consi2erations :hen ma6ing en2 of life 2ecisions Assessment of the surgical air:ay an2 trachaeostomy care

Tech# ca) S0 ))s a#& Pr"ce&%res

Placement of naso8 an2 oro8 gastric fee2ing tu?es Changing an esta?lishe2 tracheostomy

Ear)+ Years !ra # #( # OM/S

Ca!e("r+ O*<ec! .e 1#"')e&(e Denta8Facial Se7sis #ain e>7erience in the 2iagnosis an2 surgical management of 2ento8 facial infections Princi7les of the 2iagnosis management of 2ento8facial se7sis ;?acterialB 9iral @ fungal= Princi7les of the use of antimicro?ial agents. Princi7les of the surgical management of 2ento8facial se7sis

+3

C) # ca) S0 ))s

Assessment of facial an2 2ental 7ain Assessment of 2ento8facial se7sis :ith 7articular reference to the management of the air:ay

Tech# ca) S0 ))s a#& Pr"ce&%res

Intra8oral 2rainage of a?scesses un2er local or to7ical anaesthesia !>7osure to the surgical techniCues of e>tra8oral 2rainage of collections !sta?lishing 2rainage of an a?scess 9ia a tooth.

Assess2e#! The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 then scrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?e inclu2e2 in a 7ortfolio :hich :oul2 contri?ute as e9i2ence in su?seCuent a77lications to enter ST . S7ecific e9i2ence inclu2es Assess2e#! !+pe DOPS a S%*<ec! Closure of sim7le facial laceration. Le.e) "f ach e.e2e#! Com7lete

++

selection of ty7es an2 num?ers of each ty7e accor2ing to learning agreements Case 0ase2 Discussion C!L P0As

Placement of 7lates for fracture2 man2i?le

Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete Com7lete A9erage le9el 4 A9erage le9el 4 A9erage le9el 4 A9erage le9el 4 Com7lete Com7lete2 to le9el e>7ecte2 of can2i2ate entering ST Com7lete

One 7er attachment !>am7les of e>amination for E Facial traumaB hea2 an2 nec6 oncologyB 2ento8facial se7sis an2 2ento8 al9eolar con2itions %an2i?ular fracture 7late 7lacement Dento8facial se7sis case Intra oral 2rainage Oncology case Intraoral ?io7sy Dento8al9eolar case remo9al im7acte2 :is2om tooth !9i2ence2 ?y a?o9e )P0As As 7er local Deanery s7ecifications

Training Su7er9isors re7ort ARCP for each s7ecifie2 training inter9al %RCS

#eneric sylla?us

SELECTION INTO A SURGICAL DISIPLINE

This 2ocument has lai2 out the 7otential careers 7ath:ays for early years training u7 to an2 inclu2ing the ?roa2 outlines of selection into surgery an2For its nine SAC 2efine2 2isci7lines. The res7onsi?ility for setting stan2ar2s an2 criteria for selection out of Foun2ation in the U, or its eCui9alent stan2ar2 for those from o9erseas rests :ith the Royal Colleges of Surgery :hich o7erates in this case through the DCST an2 its nine SACs. Postgra2uate Deaneries an2 their schools of surgery are res7onsi?le for running training schemes an2 for recruitment an2 selection at all le9els of 7re CCT training inclu2ing into ST.FCT. an2 ST .

+5

The reCuirements for STFCT.are lai2 out on 7age 3 an2 for ST on 7age ./. Selection ta6es 7lace in the coreFtheme2B run through an2 ST in selection centres run either ?y in2i9i2ual Deaneries an2 Schools or in clusters arrange2 either ?y 2isci7line or colla?orations ?y a series of schools. Some of these clusters aim for a national selection 7rocess for the :hole of a 2isci7line ;for e>am7leB urologyB car2iothoracic surgery an2 neurosurgery an2 others through 7ractical 7ro?lems 7ose2 ?y siNe an2 9olume to regionally orientate2 grou7s ;for e>am7le #eneral an2 Trauma an2 Ortho7ae2ic surgery. This is 7art of ongoing :or6 an2 e9aluation. The <u2gements are ma2e accor2ing to nationally agree2 stan2ar2s ta?ulate2 ?elo:. The criteria a77ly to ?oth le9els of entry an2 2ifferent le9els of 2e7th 2e7en2ing on the stage of a77lication ;CT.FST. or ST = are cali?rate2 through selector training ?efore selection centres ta6e 7lace.

SELECTION CRITERIA Esse#! a) C) # ca) S0 ))s Technical ,no:le2ge @ Clinical !>7ertiseE Ca7acity to a77ly soun2 clinical 6no:le2ge @ <u2gement @ 7rioritise clinical nee2 Demonstrates a77ro7riate technical com7etence @ e9i2ence of 2e9elo7ment of e>cellent 2iagnostic s6ills @ <u2gement (ali2ate2 log?oo6 2ocumentation of surgical e>7osure to 2ate Aca&e2 c Research S0 ))s Research S0 ))sC Demonstrates un2erstan2ing of the ?asic 7rinci7les of au2itB clinical ris6 management @ e9i2ence8?ase2 7ractice Un2erstan2ing of research ?asic research 7rinci7lesB metho2ology @ ethicsB :ith 7otential to contri?ute to research Teach #(C !9i2ence of contri?uting to teaching @ learning of

Des ra*)e Personal Attri?utesE Sho:s a7titu2e for 7ractical s6illsB e.g. han28 eye co8or2inationB 2e>terityB 9isuo8s7atial a:areness Atten2ance at rele9ant coursesB e.g. ATLSB 0asic Surgical S6ills or eCui9alent

Whe# E.a)%a!e&: A77lication form Inter9ie: F Selection centre References

!9i2ence of rele9ant aca2emic @ research achie9ementsB e.g. 2egreesB 7riNesB a:ar2sB 2istinctionsB 7u?licationsB 7resentationsB other achie9ements !9i2ence of acti9e 7artici7ation in au2it !9i2ence of 7artici7ation in ris6 management an2For clinicalFla?oratory research

A77lication form Inter9ie: F Selection centre

G:hen e9aluate2A is in2icati9eB ?ut may ?e carrie2 out at any time throughout the selection 7rocess

+-

SELECTION CRITERIA others Pers"#a) S0 ))s F%&(e2e#! %#&er Press%reC Ca7acity to o7erate effecti9ely un2er 7ressure @ remain o?<ecti9e in highly emoti9eF7ressurise2 situations A:areness of o:n limitations @ :hen to as6 for hel7 C"22%# ca! "# S0 ))sC Ca7acity to communicate effecti9ely @ sensiti9ely :ith othersB a?le to 2iscuss treatment o7tions :ith 7atients in a :ay they can un2erstan2 Pr"*)e2 S"). #(C Ca7acity to thin6 ?eyon2 the o?9iousB :ith analytical an2 fle>i?le min2 Ca7acity to ?ring a range of a77roaches to 7ro?lem sol9ing S !%a! "# A'are#essC Ca7acity to monitor an2 antici7ate situations that may change ra7i2ly A77lication form Inter9ie: F Selection centre References

SELECTION CRITERIA Esse#! a)

Des ra*)e

Whe# E.a)%a!e&>

G:hen e9aluate2A is in2icati9eB ?ut may ?e carrie2 out at any time throughout the selection 7rocess

5/

SELECTION CRITERIA Pers"#a) S0 ))s Dec s "# Ma0 #(C ;c"#! #%e&G= Demonstrates effecti9e <u2gement an2 2ecision8 ma6ing s6ills Lea&ersh p E Tea2 I#.").e2e#!C Ca7acity to :or6 effecti9ely in a multi8 2isci7linary team @ 2emonstrate lea2ershi7 :hen a77ro7riate Ca7acity to esta?lish goo2 :or6ing relations :ith others Or(a# sa! "# E P)a## #(C Ca7acity to manage time an2 7rioritise :or6loa2B ?alance urgent @ im7ortant 2eman2s an2 follo: instructions Un2erstan2s im7ortance @ im7act of information systems Pr"* !+ Pr"fess "#a) I#!e(r !+C Ta6es res7onsi?ility for o:n actionsB 2emonstrates res7ect for the rights of all. Demonstrates a:areness of ethical 7rinci7lesB safetyB confi2entiality @ consent A:are of im7ortance of ?eing the 7atientsA a29ocateB clinical go9ernance @ res7onsi?ilities of an N$S em7loyee

A77lication form Inter9ie: F Selection centre References

A77lication form Inter9ie: F Selection centre References

5.

SELECTION CRITERIA C"22 !2e#! T" Lear# #( E De.e)"p2e#!C Spec a)!+ Sho:s realistic insight into urology an2 the 2eman2s of a surgical lifestyle Demonstrates 6no:le2ge of training 7rogramme @ commitment to o:n 2e9elo7ment Sho:s critical @ enCuiring a77roach to 6no:le2ge acCuisitionB commitment to self8 2irecte2 learning @ reflecti9eFanalytical a77roach to 7ractice

!>tracurricular acti9ities F achie9ements rele9ant to a 7articular 2isci7line

A77lication form Inter9ie: F Selection centre References

54