The Intercollegiate Surgical Curriculum

Transcription

1 The Intercllegiate Surgical Curriculum Educating the surgens f the future Cre Surgical Training Frm Octber 2013 Including Simulatin Apprved 3 July 2013 Page 1 f 25

2 Cre Surgical Training Syllabus (Initial Stage) Apprved 3 July 2013 Page 2 f 25

3 Cntents Initial Stage Overview... 6 Mdule Mdule Mdule Mdule Mdule Mdule Mdule Mdule Mdule Apprved 3 July 2013 Page 3 f 25

4 Initial Stage Overview The purpse f the initial stage (early years CT1-2) is t allw the trainee t develp the basic and fundamental surgical skills cmmn t all surgical specialties, tgether with a few specialty-specific surgical skills. The utcme f early years training is t achieve the cmpetences required f surgens entering ST3. These cmpetences include: Cmpetence in the management f patients presenting with a range f symptms and elective and emergency cnditins as specified in the cre syllabus fr surgery. Cmpetence in the management f patients presenting with an additinal range f elective and emergency cnditins, as specified by the Cardithracic Surgery specialty cmpnent f the early years syllabus. Prfessinal cmpetences as specified in the syllabus and derived frm Gd Medical Practice guidance f the General Medical Cuncil f the UK By the end f CT2, trainees, including thse fllwing an academic pathway, will have acquired t the defined level generic skills t allw team wrking and management f specialty-specific patient cases s as t: perfrm as a member f the team caring fr surgical patients receive patients as emergencies and review patients in clinics and initiate management and diagnstic prcesses based n a reasnable differential diagnsis manage the periperative care f their patients and recgnise cmmn cmplicatins and either be able t deal with them r knw t whm t refer be a safe and useful assistant in the perating rm perfrm sme simple prcedures under minimal supervisin and perfrm mre cmplex prcedures under direct supervisin In additin they will have attained the knwledge, skills and behaviur as defined in the fllwing (cmmn) mdules f the syllabus: Mdule 1: Basic Science Knwledge relevant t surgical practice (These can all be cntextualised within the list f presenting symptms and cnditins utlined in mdule 2) Anatmy Physilgy Pharmaclgy - in particular safe prescribing Pathlgical principles underlying system specific pathlgy Micrbilgy Diagnstic and interventinal radilgy Mdule 2: Cmmn surgical cnditins T assess and initiate investigatin and management f cmmn surgical cnditins which may cnfrnt any patient whilst under the care f surgens, irrespective f their speciality. T have sufficient understanding f these cnditins s as t knw what and t whm t refer in a way that an insightful discussin may take place with clleagues whm will be invlved in the definitive management f these cnditins. This defines the scpe and depth f the tpics in the generality f clinical surgery required f any surgen irrespective f their ST3 defined speciality Mdule 3 Basic surgical skills Apprved 3 July 2013 Page 4 f 25

5 T prepare neself fr surgery T safely administer apprpriate lcal anaesthetic agents T handle surgical instruments safely T handle tissues safely T incise and clse superficial tissues accurately T tie secure knts T safely use surgical diathermy T achieve haemstasis f superficial vessels. T use a suitable surgical drain apprpriately. T assist helpfully, even when the peratin is nt familiar. T understand the principles f anastmsis T understand the principles f endscpy including laparscpy Mdule 4: The principles f assessment and management f the surgical patient T assess the surgical patient T elicit a histry that is relevant, cncise, accurate and apprpriate t the patient s prblem T prduce timely, cmplete and legible clinical recrds. T assess the patient adequately prir t peratin and manage any preperative prblems apprpriately. T prpse and initiate surgical r nn-surgical management as apprpriate. T take infrmed cnsent fr straightfrward cases. Mdule 5: Peri-perative care f the surgical patient T manage patient care in the peri-perative perid. T assess and manage preperative risk. T take part in the cnduct f safe surgery in the perating theatre envirnment. T assess and manage bleeding including the use f bld prducts. T care fr the patient in the pst-perative perid including the assessment f cmmn cmplicatins. T assess, plan and manage pst-perative fluid balance T assess and plan periperative nutritinal management. Mdule 6: Assessment and early treatment f the patient with trauma T safely assess the multiply injured patient. T safely assess and initiate management f patients with traumatic skin and sft tissue injury chest trauma a head injury a spinal crd injury abdminal and urgenital trauma vascular trauma a single r multiple fractures r dislcatins burns Mdule 7: Surgical care f the paediatric patient T assess and manage children with surgical prblems, understanding the similarities and differences frm adult surgical patients. T understand cmmn issues f child prtectin and t take actin as apprpriate. Mdule 8: Management f the dying patient T manage the dying patient apprpriately. T understand cnsent and ethical issues in patients certified DNAR (d nt attempt resuscitatin) T manage the dying patient in cnsultatin with the palliative care team. Mdule 9: Organ and tissue transplantatin T understand the principles f rgan and tissue transplantatin. Apprved 3 July 2013 Page 5 f 25

6 T assess brain stem death and understand its relevance t cntinued life supprt and rgan dnatin. Mdule 10: Prfessinal behaviur T prvide gd clinical care T be a gd cmmunicatr T teach and t train T keep up t date and knw hw t analyse data T understand and manage peple and resurces within the health envirnment T prmte gd Health T understand the ethical and legal bligatins f a surgen In additin they will have attained the knwledge, skills and behaviur as defined in the fllwing (general surgery specific) mdules f the syllabus: 1. Elective general surgery T be able t diagnse and manage a range f elective cnditins presenting t general surgens including apprpriate investigatin and treatment. This shuld include primary abdminal wall herniae, lesins f the cutaneus and subcutaneaus tissues and uncmplicated lng saphenus varicse veins 2. Elective subspecialty surgery T be able t assess and initiate management f patients presenting with cmmn cnditins electively t subspecialty clinics. This shuld include gall stnes, upper and lwer gastrintestinal tract cancers, breast lumps and vascular insufficiency. 3. Acute abdmen T be able t assess and prvide the early care f a patient presenting with acute abdminal symptms and signs. This shuld include lcalised and generalised peritnitis (Acute chlecystitis, acute diverticulitis, acute pancreatitis, visceral perfratin, acute appendicitis and acute gynaeclgical cnditins), bstructin (small and large bwel bstructed herniae, adhesins, clnic carcinma) and lcalised abdminal pain (biliary clic, nn-specific abdminal pain). 4. Abdminal Trauma T be able t assess and prvide the early care f a patient with suspected abdminal trauma. This shuld include primary and secndary survey. 5. Acute Vascular Disrders T be able t recgnise assess and prvide the early care f a patient presenting with ruptures abdminal artic aneurysm and acute arterial insufficiency. 6. Acute Urlgical cnditins T be able t prvide the early care f a patients presenting with acute urlgical cnditins including acute urinary retentin, ureteric clic, urinary tract infectin and acute testicular pain 7. Superficial Sepsis T be able t diagnse and manage including apprpriate investigatins superficial and cmmn acute septic cnditins including subcutaneus abscess, cellulitis, ingrwing te nail, perianal and pilndal abscess and breast abscess. T be aware f gas gangrene and necrtising fasciitis Apprved 3 July 2013 Page 6 f 25

7 Mdule 1 Objective Basic sciences T acquire and demnstrate underpinning basic science knwledge apprpriate fr the practice f surgery, including:- Applied anatmy: Knwledge f anatmy apprpriate fr surgery Physilgy: Knwledge f physilgy relevant t surgical practice Pharmaclgy: Knwledge f pharmaclgy relevant t surgical practice centred arund safe prescribing f cmmn drugs Pathlgy: Knwledge f pathlgical principles underlying system specific pathlgy Micrbilgy: Knwledge f micrbilgy relevant t surgical practice Imaging: Knwledge f the principles, strengths and weaknesses f varius diagnstic and interventinal imaging methds Applied anatmy: Develpment and embrylgy Grss and micrscpic anatmy f the rgans and ther structures Surface anatmy Imaging anatmy This will include anatmy f thrax, abdmen, pelvis, perineum, limbs, spine, head and neck as apprpriate fr surgical peratins that the trainee will be invlved with during cre training (see Mdule 2). Assessment technique Curse cmpletin certificate MRCS Areas in which simulatin shuld be used t develp relevant skills Strngly recmmended: Life supprt Critical care Desirable Anatmy Team-Based Human Factrs Knwledge Physilgy: General physilgical principles including: Hmestasis Thermregulatin Metablic pathways and abnrmalities Bld lss and hypvlaemic shck Sepsis and septic shck Fluid balance and fluid replacement therapy Acid base balance Bleeding and cagulatin Nutritin This will include the physilgy f specific rgan systems relevant t surgical care including the cardivascular, respiratry, gastrintestinal, urinary, endcrine and neurlgical systems. Apprved 3 July 2013 Page 7 f 25

8 Pharmaclgy: The pharmaclgy and safe prescribing f drugs used in the treatment f surgical diseases including analgesics, antibitics, cardivascular drugs, antiepileptic, anticagulants, respiratry drugs, renal drugs, drugs used fr the management f endcrine disrders (including diabetes) and lcal anaesthetics. The principles f general anaesthesia The principles f drugs used in the treatment f cmmn malignancies Can describe the effects and ptential fr harm f alchl and ther drugs including cmmn presentatins, wide range f acute and lng term presentatins (e.g. trauma, depressin, hypertensin etc.), the range f interventins, treatments and prgnses fr use f alchl and ther drugs. Pathlgy: General pathlgical principles including: Inflammatin Wund healing Cellular injury Tissue death including necrsis and apptsis Vascular disrders Disrders f grwth, differentiatin and mrphgenesis Surgical immunlgy Surgical haematlgy Surgical bichemistry Pathlgy f neplasia Classificatin f tumurs Tumur develpment and grwth including metastasis Principles f staging and grading f cancers Principles f cancer therapy including surgery, raditherapy, chemtherapy, immuntherapy and hrmne therapy Principles f cancer registratin Principles f cancer screening The pathlgy f specific rgan systems relevant t surgical care including cardivascular pathlgy, respiratry pathlgy, gastrintestinal pathlgy, geniturinary disease, breast, excrine and endcrine pathlgy, central and peripheral, neurlgical systems, skin, lymphreticular and musculskeletal systems Micrbilgy: Apprved 3 July 2013 Page 8 f 25

9 Surgically imprtant micr rganisms including bld brne viruses Sft tissue infectins including cellulitis, abscesses, necrtising fasciitis, gangrene Surces f infectin Sepsis and septic shck Asepsis and antisepsis Principles f disinfectin and sterilisatin Antibitics including prphylaxis and resistance Principles f high risk patient management Hspital acquired infectins Imaging: Principles f diagnstic and interventinal imaging including x-rays, ultrasund, CT, MRI. PET, radiunucletide scanning Apprved 3 July 2013 Page 9 f 25

10 Mdule 2 Cmmn Surgical Cnditins Objective This sectin assumes that trainees have general medical cmpetences cnsistent with a dctr leaving Fundatin in the UK. It als assumes an nging cmmitment t keeping these skills and knwledge up t date as laid ut in GMP. It is predicated n the value that surgens are dctrs wh carry ur surgery and require cmpetence. Assessment technique Certificate f successful cmpletin f curse MRCS Areas in which simulatin shuld be used t develp relevant skills Tpics T demnstrate understanding f the relevant basic scientific principles fr each f these surgical cnditins and t be able t prvide the relevant clinical care as defined in mdules assessment and management as defined in Mdules 1 and 4. Presenting symptms r syndrmes T include the fllwing cnditins Abdminal pain Appendicitis Abdminal swelling Gastrintestinal Change in bwel malignancy habit Inflammatry bwel Gastrintestinal disease haemrrhage Diverticular disease Rectal bleeding Intestinal Dysphagia bstructin Dyspepsia Adhesins Jaundice Abdminal hernias Peritnitis Intestinal perfratin Benign esphageal disease Peptic ulcer disease Benign and malignant hepatic, gall bladder and pancreatic disease Haemrrhids and perianal disease Abdminal wall stmata Breast disease Breast lumps and nipple discharge Acute Breast pain Peripheral vascular disease Presenting symptms r syndrme T include the fllwing cnditins Benign and malignant breast lumps Mastitis and breast abscess T include the fllwing cnditins Athersclertic Strngly recmmended: Basic surgical skills Basic laparscpic skills Fracture treatment (Cardithracic Surgery, Plastic Surgery: Anastmsis, Angigraphy, Vascular ultrasund, surgical appraches t fractures) Desirable Imaging interpretatin Apprved 3 July 2013 Page 10 f 25

11 Chrnic and acute limb ischaemia Aneurismal disease Transient ischaemic attacks Varicse veins Leg ulceratin Cardivascular and pulmnary disease Geniturinary disease Presenting symptms r syndrme Lin pain Haematuria Lwer urinary tract symptms Urinary retentin Renal failure Scrtal swellings Testicular pain Trauma and rthpaedics Presenting symptms r syndrme Traumatic limb and jint pain and defrmity Chrnic limb and jint pain and defrmity Back pain arterial disease Emblic and thrmbtic arterial disease Venus insufficiency Diabetic ulceratin T include the fllwing cnditins Crnary heart disease Brnchial carcinma Obstructive airways disease Space ccupying lesins f the chest T include the fllwing cnditins Geniturinary malignancy Urinary calculus disease Urinary tract infectin Benign prstatic hyperplasia Obstructive urpathy T include the fllwing cnditins Simple fractures and jint dislcatins Fractures arund the hip and ankle Basic principles f Degenerative jint disease Basic principles f inflammatry jint disease including bne and jint infectin Cmpartment syndrme Spinal nerve rt entrapment and spinal crd cmpressin Metastatic bne cancer Cmmn peripheral neurpathies and Apprved 3 July 2013 Page 11 f 25

12 nerve injuries Disease f the Skin, Head and Neck Presenting symptms r syndrme Lumps in the neck Epistaxis Upper airway bstructins Neurlgy and Neursurgery Presenting symptms r syndrme Headache Facial pain Cma Endcrine Presenting symptms r syndrme Lumps in the neck Acute endcrine crises T include the fllwing cnditins Benign and malignant skin lesins Benign and malignant lesins f the muth and tngue T include the fllwing cnditins Space ccupying lesins frm bleeding and tumur T include the fllwing cnditins Thyrid and parathyrid disease Adrenal gland disease Diabetes Mdule 3 Basic surgical skills Assessment technique Objective Preparatin f the surgen fr surgery Safe administratin f apprpriate lcal anaesthetic agents Acquisitin f basic surgical skills in instrument and tissue handling. Understanding f the frmatin and healing f surgical wunds Incise superficial tissues accurately with suitable instruments. Clse superficial tissues accurately. Tie secure knts. Safely use surgical diathermy Achieve haemstasis f superficial vessels. Use suitable methds f retractin. Knwledge f when t use a drain and which t chse. Handle tissues gently with apprpriate instruments. Assist helpfully, even when the peratin is nt familiar. Understand the principles f anastmsis WBA- PBA, CBD, DOPS Areas in which simulatin shuld be used t develp relevant skills Apprved 3 July 2013 Page 12 f 25

13 Understand the principles f endscpy Knwledge Principles f safe surgery Preparatin f the surgen fr surgery Principles f hand washing, scrubbing and gwning Immunisatin prtcls fr surgens and patients Administratin f lcal anaesthesia Chice f anaesthetic agent Safe practise Surgical wunds Classificatin f surgical wunds Principles f wund management Pathphysilgy f wund healing Scars and cntractures Incisin f skin and subcutaneus tissue: Langer s lines Chice f instrument Safe practice Clsure f skin and subcutaneus tissue: Optins fr clsure Suture and needle chice Safe practice Strngly recmmended: Basic surgical skills (Paediatric Surgery Strngly recmmended: Basic suturing and wund management) (Cardithracic Surgery, Plastic Surgery Desirable: Anastmsis, Endscpy) Knt tying Range and chice f material fr suture and ligatin Safe applicatin f knts fr surgical sutures and ligatures Haemstasis: Surgical techniques Principles f diathermy Tissue handling and retractin: Chice f instruments Bipsy techniques including fine needle aspiratin cytlgy Clinical Skills Use f drains: Indicatins Types Management/remval Principles f anastmsis Principles f surgical endscpy 4 Preparatin f the surgen fr surgery Effective and safe hand washing, glving and gwning Administratin f lcal anaesthesia Accurate and safe administratin f lcal anaesthetic agent 4 Preparatin f a patient fr surgery Creatin f a sterile field Antisepsis Apprved 3 July 2013 Page 13 f 25

14 Technical Skills and Prcedures Draping 4 Preparatin f the surgen fr surgery Effective and safe hand washing, glving and gwning 4 Administratin f lcal anaesthesia Accurate and safe administratin f lcal anaesthetic agent 4 Incisin f skin and subcutaneus tissue: Ability t use scalpel, diathermy and scissrs 4 Clsure f skin and subcutaneus tissue: Accurate and tensin free appsitin f wund edges 4 Knt tying: Single handed Duble handed Instrument Superficial Deep 3 Haemstasis: Cntrl f bleeding vessel (superficial) Diathermy Suture ligatin Tie ligatin Clip applicatin Transfixin suture 4 Tissue retractin: Tissue frceps Placement f wund retractrs 3 Use f drains: Insertin Fixatin Remval 3 Tissue handling: Apprpriate applicatin f instruments and respect fr tissues Bipsy techniques 4 Skill as assistant: Anticipatin f needs f surgen when assisting Mdule 4 Objective The assessment and management f the surgical patient T demnstrate the relevant knwledge, skills and attitudes in assessing the patient and manage the patient, and prpse surgical r Assessment technique Examinatins- MRCS Areas in which simulatin shuld be used t develp relevant skills Apprved 3 July 2013 Page 14 f 25

15 Knwledge Clinical Skills nn-surgical management. The knwledge relevant t this sectin will be variable frm patient t patient and is cvered within the rest f the syllabus see cmmn surgical cnditins in particular (Mdule 2). As a trainee develps an interest in a particular speciality then the principles f histry taking and examinatin may be increasingly applied in that cntext. 4 Surgical histry and examinatin (elective and emergency) 3 Cnstruct a differential diagnsis 3 Plan investigatins 3 Clinical decisin making 3 Team wrking and planning 3 Case wrk up and evaluatin; risk management 3 Active participatin in clinical audit events 3 Apprpriate prescribing 3 Taking cnsent fr intermediate level interventin; emergency and elective 3 Written clinical cmmunicatin skills 3 Interactive clinical cmmunicatin skills: patients 3 Interactive clinical cmmunicatin skills: clleagues Strngly recmmended: Life Supprt Critical Care ATLS / APLS Desirable: Team wrking Human Factrs Apprved 3 July 2013 Page 15 f 25

16 Mdule 5 Objective Knwledge Peri-perative care T assess and manage preperative risk T manage patient care in the peri-perative perid T cnduct safe surgery in the perating theatre envirnment T assess and manage bleeding including the use f bld prducts T care fr the patient in the pst-perative perid including the assessment f cmmn cmplicatins T assess, plan and manage pst-perative fluid balance T assess and plan periperative nutritinal management Pre-perative assessment and management: Cardirespiratry physilgy Diabetes mellitus and ther relevant endcrine disrders Fluid balance and hmestasis Renal failure Pathphysilgy f sepsis preventin and prphylaxis Thrmbprphylaxis Labratry testing and imaging Risk factrs fr surgery and scring systems Pre-medicatin and ther preperative prescribing Principles f day surgery Intraperative care: Safety in theatre including patient psitining and avidance f nerve injuries Sharps safety Diathermy, laser use Infectin risks Radiatin use and risks Turniquet use including indicatins, effects and cmplicatins Principles f lcal, reginal and general anaesthesia Principles f invasive and nninvasive mnitring Preventin f venus thrmbsis Surgery in hepatitis and HIV carriers Fluid balance and hmestasis Pst-perative care: Pst-perative mnitring Cardirespiratry physilgy Fluid balance and hmestasis Diabetes mellitus and ther relevant Assessment technique WBA Curse test cmpletin certificate Areas in which simulatin shuld be used t develp relevant skills Strngly recmmended: Basic surgical skills Life Supprt Critical Care (Paediatric Surgery: Safe surgery) Desirable Human Factrs Team-wrking Apprved 3 July 2013 Page 16 f 25

17 endcrine disrders Renal failure Pathphysilgy f bld lss Pathphysilgy f sepsis including SIRS and shck Multi-rgan dysfunctin syndrme Pst-perative cmplicatins in general Methds f pstperative analgesia T assess and plan nutritinal management Pst-perative nutritin Effects f malnutritin, bth excess and depletin Metablic respnse t injury Methds f screening and assessment f nutritinal status Methds f enteral and parenteral nutritin Haemstasis and Bld Prducts: Mechanism f haemstasis including the cltting cascade Pathlgy f impaired haemstasis e.g. haemphilia, liver disease, massive haemrrhage Cmpnents f bld Alternatives t use f bld prducts Principles f administratin f bld prducts Patient safety with respect t bld prducts Cagulatin, deep vein thrmbsis and emblism: Cltting mechanism (Virchw Triad) Effect f surgery and trauma n cagulatin Tests fr thrmbphilia and ther disrders f cagulatin Methds f investigatin fr suspected thrmbemblic disease Principles f treatment f venus thrmbsis and pulmnary emblism including anticagulatin Rle f V/Q scanning, CTpulmnary angigraphy, D-dimer and thrmblysis Place f pulmnary emblectmy Prphylaxis f thrmbemblism: Risk classificatin and management f DVT Knwledge f methds f preventin f DVT, mechanical and pharmaclgical Antibitics: Cmmn pathgens in surgical Apprved 3 July 2013 Page 17 f 25

18 patients Antibitic sensitivities Antibitic side-effects Principles f prphylaxis and treatment Metablic and endcrine disrders in relatin periperative management Pathphysilgy f thyrid hrmne excess and deficiency and assciated risks frm surgery Causes and effects f hypercalcaemia and hypcalcaemia Cmplicatins f crticsterid therapy Causes and cnsequences f Sterid insufficiency Cmplicatins f diabetes mellitus Causes and effects f hypnatraemia Causes and effects f hyperkalaemia and hypkalaemia 3 Pre-perative assessment and management: Histry and examinatin f a patient frm a medical and surgical standpint Interpretatin f pre-perative investigatins Management f c mrbidity Resuscitatin Apprpriate preperative prescribing including premedicatin Clinical Skills 3 Intra-perative care: Safe cnduct f intraperative care Crrect patient psitining Avidance f nerve injuries Management f sharps injuries Preventin f diathermy injury Preventin f venus thrmbsis 3 Pst-perative care: Writing f peratin recrds Assessment and mnitring f patient s cnditin Pst-perative analgesia Fluid and electrlyte management Detectin f impending rgan failure Initial management f rgan failure Principles and indicatins fr Dialysis Recgnitin, preventin and treatment f pst-perative cmplicatins 3 Haemstasis and Bld Prducts: Recgnitin f cnditins likely t lead t the diathesis Recgnitin f abnrmal bleeding Apprved 3 July 2013 Page 18 f 25

19 during surgery Apprpriate use f bld prducts Management f the cmplicatins f bld prduct transfusin Technical Skills and Prcedures 3 Cagulatin, deep vein thrmbsis and emblism Recgnitin f patients at risk Awareness and diagnsis f pulmnary emblism and DVT Rle f duplex scanning, vengraphy and d-dimer measurement Initiate and mnitr treatment f venus thrmbsis and pulmnary emblism Initiatin f prphylaxis 3 Antibitics: Apprpriate prescriptin f antibitics 3 Assess and plan preperative nutritinal management Arrange access t suitable artificial nutritinal supprt, preferably via a nutritin team including Dietary supplements, Enteral nutritin and Parenteral nutritin 3 Metablic and endcrine disrders Histry and examinatin in patients with endcrine and electrlyte disrders Investigatin and management f thyrtxicsis and hypthyridism Investigatin and management f hypercalcaemia and hypcalcaemia Peri-perative management f patients n sterid therapy Peri-perative management f diabetic patients Investigatin and management f hypnatraemia Investigatin and management f hyperkalaemia and hypkalaemia 2 Central venus line insertin 4 Urethral catheterisatin Desirable (Paediatric Surgery Strngly recmmended) Mdule 6 Objective Assessment and management f patients with trauma (including the multiply injured patient) Assess and initiate management f patients with chest trauma wh have sustained a head Assessment technique WBA Curse test and certificate Areas in which simulatin shuld be used t develp relevant skills Apprved 3 July 2013 Page 19 f 25

20 injury wh have sustained a spinal crd injury wh have sustained abdminal and urgenital trauma wh have sustained vascular trauma wh have sustained a single r multiple fractures r dislcatins wh have sustained traumatic skin and sft tissue injury wh have sustained burns Safely assess the multiply injured patient. Cntextualise any cmbinatin f the abve Be able t priritise management in such situatin as defined by ATLS, APLS etc It is expected that trainees will be able t shw evidence f cmpetence in the management f trauma (ATLS / APLS certificate r equivalent). Knwledge General Scring systems fr assessment f the injured patient Majr incident triage Differences In children Shck Pathgenesis f shck Shck and cardivascular physilgy Metablic respnse t injury Adult respiratry distress syndrme Indicatins fr using uncrss matched bld Wunds and sft tissue injuries Gunsht and blast injuries Stab wunds Human and animal bites Nature and mechanism f sft tissue injury Principles f management f sft tissue injuries Principles f management f traumatic wunds Strngly recmmended: Life Supprt Critical Care Wund management ATLS / APLS Desirable: Team-wrking Human Factrs Trauma management Apprved 3 July 2013 Page 20 f 25

21 Burns Cmpartment syndrme Classificatin f burns Principle f management f burns Fractures Classificatin f fractures Pathphysilgy f fractures Principles f management f fractures Cmplicatins f fractures Jint injuries Clinical Skills Organ specific trauma Pathphysilgy f thracic trauma Pneumthrax Head injuries including traumatic intracranial haemrrhage and brain injury Spinal crd injury Peripheral nerve injuries Blunt and penetrating abdminal trauma Including spleen Vascular injury including iatrgenic injuries and intravascular drug abuse Crush injury Principles f management f skin lss including use f skin grafts and skin flaps General 4 Histry and examinatin 3 Investigatin 3 Referral t apprpriate surgical subspecialties 4 Resuscitatin and early management f patient wh has sustained thracic, head, spinal, abdminal r limb injury accrding t ATLS and APLS guidelines 4 Resuscitatin and early management f the multiply injured patient 3 Specific prblems Management f the uncnscius patient Initial management f skin lss Initial management f burns Preventin and early management f the Apprved 3 July 2013 Page 21 f 25

22 Technical Skills and Prcedures cmpartment syndrme 2 Central venus line insertin 3 Chest drain insertin 2 Diagnstic peritneal lavage 4 Urethral catheterisatin 2 Suprapubic catheterisatin Desirable Mdule 7 Objective Knwledge Surgical care f the Paediatric patient T assess and manage children with surgical prblems, understanding the similarities and differences frm adult surgical patients T understand the issues f child prtectin and t take actin as apprpriate Physilgical and metablic respnse t injury and surgery Fluid and electrlyte balance Thermregulatin Safe prescribing in children Principles f vascular access in children Wrking knwledge f trust and Lcal Safeguarding Children Bards (LSCBs) and Child Prtectin Prcedures Basic understanding f child prtectin law Understanding f Children's rights Wrking knwledge f types and categries f child maltreatment, presentatins, signs and ther features (primarily physical, emtinal, sexual, neglect, prfessinal) Understanding f ne persnal rle, respnsibilities and apprpriate referral patterns in child prtectin Understanding f the challenges f wrking in partnership with children and families Assessment technique Areas in which simulatin shuld be used t develp relevant skills WBA MRCS Strngly recmmended: Critical Care Child prtectin Desirable Team-wrking Recgnise the pssibility f abuse r maltreatment Recgnise limitatins f wn knwledge and experience and seek apprpriate expert advice Urgently cnsult immediate senir in surgery t enable Apprved 3 July 2013 Page 22 f 25

23 Clinical Skills referral t paediatricians Keep apprpriate written dcumentatin relating t child prtectin matters Cmmunicate effectively with thse invlved with child prtectin, including children and their families 3 Histry and examinatin f the nenatal surgical patient 3 Histry and examinatin f paediatric surgical patient 3 Assessment f respiratry and cardivascular status 3 Undertake cnsent fr surgical prcedures (apprpriate t the level f training) in paediatric patients Apprved 3 July 2013 Page 23 f 25

24 Mdule 8 Objective Knwledge Clinical Skills Management f the dying patient Ability t manage the dying patient apprpriately. T understand cnsent and ethical issues in patients certified DNAR (d nt attempt resuscitatin) Palliative Care: Gd management f the dying patient in cnsultatin with the palliative care team. Palliative Care: Care f the terminally ill Apprpriate use f analgesia, antiemetics and laxatives Principles f rgan dnatin: Circumstances in which cnsideratin f rgan dnatin is apprpriate Principles f brain death Understanding the rle f the crner and the certificatin f death 3 Palliative Care: Symptm cntrl in the terminally ill patient 3 Principles f rgan dnatin: Assessment f brain stem death Certificatin f death Assessment technique Areas in which simulatin shuld be used t develp relevant skills MRCS Desirable Team-wrking Human Factrs (Paediatric Surgery Strngly recmmended: Ethical issues Palliative care Cmmunicatin) Mdule 9 Objective Knwledge Organ and Tissue transplantatin T understand the principles f rgan and tissue transplantatin Principles f transplant immunlgy including tissue typing, acute, hyperactute and chrnic rejectin Principles f immunsuppressin Tissue dnatin and prcurement Indicatins fr whle rgan transplantatin Assessment technique Areas in which simulatin shuld be used t develp relevant skills MRCS Apprved 3 July 2013 Page 24 f 25

25 Apprved 3 July 2013 Page 25 f 25