Undergraduate Year 3 Curriculum for Surgical Posting

Department of Surgery Faculty of Medicine Universiti Kebangsaan Malaysia

CONTENTS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Directory of Staff Introduction Prerequisites Objectives Setting Contents Student Assessment Resource Materials Teaching-Learning Methodology Appendix 1 Appendix 2 Appendix 3 Timetable of General Surgical Units Timetable for 3rd Year Undergraduate Teaching Procedures & Logbook

DIRECTORY OF TEACHING STAFF Head of Department : Module head : No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Lecturer Prof Rohaizak Muhammad AP Naqiyah Ibrahim Miss Saladina Jaszle Mr Abdul Rahman Shakeer Prof Jasmi Ali Yaakub AP Lukman Rashid AP Razman Jarmin Mr Hairol Othman AP Ismail Sagap Mr Imtiaz Hamid AP Hanafiah Harunarashid Mr Mohd Azim Idris AP Zulkifli Zainuddin Mr Nazri Jemaan Mr Lee Boon Cheok Mr Badrulhisham Bahadzur Prof Thambidoorai Miss Dayang Anita Mr Azizi Abu Bakar Mr Toh Charng Jeng Mr Shanmugarajah Mr Ainul Syahrilfazli Jaafar Mr Zamrin Dimon A/P Razman Jarmin Mr Ainul Syahrilfazli Jaafar Specialty B&E B&E B&E UGI/MIS UGI/MIS UGI/MIS HPB HPB Colorectal Colorectal Vascular Vascular Urology Urology Urology Urology Paeds Paeds Neuro Neuro Neuro Neuro CTS Pager/Ext. 40541 32871 Email address rohaizak@mail.hukm.ukm.my naqiyah.ibrahim@gmail.com

40496 40454 40665 42663 32877 40667 40459 40503 42662 44879 40575 40668 42660 013341064 4 019652038 3 40448 40630

jasmi@mail.hukm.ukm.my drlukman@mail.hukm.ukm.my razman@mail.hukm.ukm.my hairol@mail.hukm.ukm.my drisagap@mail.hukm.ukm.my imtiazhamid@hotmail.com AJIMA98@streamyx.com zul_uro@yahoo.com mnj2567@yahoo.com lbc@hotmail.com badrul.com@gmail.com tdorai@gmail.com abazizi@gmail.com sparamasvaran@yahoo.com drainul@mail.hukm.ukm.my wanzam_2@yahoo.com ramzisham@hotmail.com akmal@mail.hukm.ukm.my

Mr Ramzisham CTS Mr Shahrul Akmal CTS Saat Dr Goh Eng Hong Plastic Surgery

YEAR 3 OBJECTIVES (standardized for all)

At the end of Year 3, students should be able to: 1. 2. 3. 4. 5. 6. clerk cases in a comprehensive and holistic manner perform basic investigations and procedures. communicate effectively as an individual, a leader and a team member of the healthcare profession. demonstrate a sense of responsibility in self development and life long learning discuss the health services provided by the district health officers, health clinics and hospitals. formulate a research proposal, conduct a survey, diagnose the main health problems in the community and conduct health promotion activities

SURGERY MODULE (FF3124) 2 INTRODUCTION

The surgical posting in the 3rd year of Universiti Kebangsaan Malaysia medical school is an 8-week posting with emphasis on professional and personal development (PPD) and self directed learning (SDL). The Department of Surgery is made up of general surgery and related surgical subspecialties such as neurosurgery, urology, and paediatric and cardiothoracic surgery. General surgery is further subdivided into the Breast and Endocrine Unit, Colorectal Unit, Hepatobiliary Unit, Upper Gastrointestinal / Minimally Invasive Surgery (MIS) Unit and Vascular Unit. Each unit is headed by a consultant (usually a Professor / Assoc. Professor / Senior lecturer) under whom there is a clinical specialist (lecturer), registrars and medical officers who are usually Master of Surgery (MS) postgraduate students as well as housemen. Students are distributed among lecturers in all the units whereby the main aim is exposure to general surgery with a secondary aim of exposure to the subspecialties. They will spend 7 weeks in general surgery and 1 week in the surgical subspecialties.

PREREQUISITES 1. 2. 3. Good understanding of basic biomedical sciences Basic clinical skills (history taking and physical examination) Basic PPD skills

MODULE OBJECTIVES At the end of the 8-week posting, students should have the knowledge, skills and right attitude to be able to:

1. 2. 3.

take a history and perform a physical examination on the surgical patient competently and present the cases confidently. discuss the provisional as well as differential diagnoses. a) b) request for relevant investigations, justify these investigations, and,

c) 4. a) b)

interpret the results of basic investigations (eg lab tests) outline the management plan for surgical patients, and identify the various factors which can potentially influence clinical decision making.

5. 6.

perform simple, invasive clinical procedures (such as phlebotomy, intravenous access, asepsis and sterility, wound care etc.) a) b) demonstrate familiarity with the surgical ward environment, outpatient setting and operating theatres, and comply with ward rules and regulations.

7. 8. 9. 10.

discuss the principles of surgical practice, ethics and medico-legal issues in the management of surgical patients. apply basic medical sciences (especially clinical anatomy, physiology, pathology and pharmacology) to clinical situations of the surgical patient. demonstrate appropriate skills in dealing with uncertainty, death and dying. communicate effectively in day-to-day professional interactions with patients, relatives and fellow healthcare professionals. contribute as a team member and appreciate the multidisciplinary approach in patient care. demonstrate a sense of responsibility in their personal and professional conduct

11. 12.

SETTING

Department of Surgery, 8th floor Hospital UKM Lectures and Tutorials are given on a weekly basis in the department by both lecturers and trainee lecturers. There are also weekly housemen CME, surgical update presentations every fortnight as well as monthly postgraduate revision course and histopathological meetings. The students are encouraged to attend these meetings. There are also a surgical skills lab where basic suturing and knotting can be thought are taught and a room where students get to practise clinical examination using mannikins.

Surgical Wards (2 hours per day) There are 2 dedicated general surgical wards on the 5th floor with a total number of 56 beds. There are also the high dependency and intensive care wards. The setting for bedside teaching will be in the wards on a daily basis from morning and afternoon ward rounds. Students are expected to tag along with the housemen on days where their respective teams are on call and present the cases the following day. Outpatient Clinics (2 hours per week) Located on the ground floor, these clinics tend to be quite busy, therefore teaching is usually conducted at the very end of the clinic session although the students do sit in and observe the doctor-patient relationship and can learn about the common outpatient surgical conditions. Students are expected to clerk in new cases and present them to the lecturers and trainee lecturers. Students are expected to attend at least 2 outpatient sessions with their respective teams and 2 sessions each with the other 3 teams. Operating Theatres (2 hours per session) There are elective, emergency, day care and minor OT surgery operating theatres. The operating theatres can accommodate a much smaller number of students at any one time (3-4) so as to reduce infection rate in surgical patients. Students are expected to at least attend 2 sessions of each operating theatre during their 8-week posting. Scrubbing and donning operating gowns will be taught during the practical workshop. Accident & Emergency Department (A & E) (1 hours per session) Students are expected to at least attend 2 sessions with the medical officers at the A&E Department to experience first-hand emergency situations involving surgical patients as well as exposing them to emergency medicine. Toilet and suturing, as well as wound care, are abundant in this department. Radiology Department (1 hour per week) A series of tutorials on imaging investigations are provided for by our radiology colleague in the radiology department. Endoscopy Unit (2 hours per session) Students are expected to attend at least 2 sessions during their posting. Both upper and lower endoscopy as well as ERCPs should be seen to appreciate these procedures.

CONTENTS

Topics to be covered include: In Detail Trauma ABC of trauma Chest injury Head injury Blunt abdominal trauma Burns Endocrine Goitre Differentiated thyroid Ca Thyrotoxicosis Thyroglossal cyst Adrenal tumours Breast Breast Ca - infiltrating Breast fibroadenoma Breast abscess Upper GI Upper GI bleeding Oesophageal Ca Achalasia Reflux oesophagitis Peptic ulcer disease Gastric Ca Hepatobiliary Hepatoma Metastatic liver disease Liver cirrhosis Portal hypertension Liver abscess Obstructive jaundice Ascending cholangitis Gallstone disease Pancreatitis Ca head of pancreas Colorectal In Principle Endocrine Complications of thyroid surgery Hyper/hypothyroidism Hyperparathyroidism Undifferentiated thyroid Ca Breast Breast Ca in-situ Phyllodes tumour Pagets disease Duct ectasia Fibroadenosis Mastitis Upper GI Barretts oesophagus Oesophageal corrosive injuries Gastric lymphoma Pancreatic pseudocyst Pancreatic abscess Colorectal Familial adenomatous polyposis Colonic polyps Sigmoid volvulus Inflammatory bowel disease Angiodysplasia Anal fissure Fistula in ano Anal carcinoma GI tuberculosis Urology Prostate Ca Paediatric Surgery Inguinoscrotal swelling in Aware of Endocrine Carcinoid tumour Insulinoma Adrenocortical Ca Thymoma Mediastinal mass Thyroiditis Branchial cyst and fistula Upper GI Hiatus hernia Hepatobiliary Hepatic encephalopathy Benign liver tumours Hepatolithiasis Colorectal Rectal prolapse Anal sphincter injury Chronic constipation Radiation proctitis Ischaemic colitis Paediatric Surgery Hydrocephalus Recurrent abdominal pain in childhood Surgical causes of respiratory distress in newborns Common abdominal tumours in children

Lower GI bleeding Acute intestinal obstruction Colorectal Ca Diverticular disease Acute appendicitis Anorectal abscess Haemorrhoids Stomas Hernia Inguinal Femoral Incisional Paraumbilical Complications Vascular Peripheral vascular disease Venous insufficiency Deep venous thrombosis Pulmonary embolism Abdominal aortic aneurysm Urology Genitourinary calculi Renal Ca Bladder Ca Benign prostatic hyperplasia Testicular torsion Testicular Ca Hydrocoele Urinary tract infection Plastic Surgery Skin ulcers Oral ulcers Salivary gland tumours Skin tumours Cutaneous abscesses Cutaneous lesions

childhood Billous vomiting in newborns Intestinal obstruction in children Pyloric stenosis

STUDENT ASSESSMENT

Prerequisites Log book is completed, signed and submitted 2 case write-ups are completed, signed and corrected Attendance throughout the whole posting has been satisfactory (at least 80%) Students who fail to fulfill the above criteria will be barred from the examination and considered to have failed the surgical posting. A. Continuous assessment (refer to appendix for assessment form) i) Long Case Presentations (10%) students are required to obtain the clinical competency form and present a supervised long case to their respective supervisors and marks will be given according to the indices shown on the form ii) Case Write-ups (10%) 2 case write ups iii) Mentor assessment and logbook (10%) Completed logbooks are given a maximum score of 10. B. Theory End-of-semester Theory Examination The end-of-semester theory examination is in the form of MCQ (OBAs and EMQs) and Key feature questions (KFQ) C. Clinical End-of-semester Clinical Examination (OSCE) Students are rotated through a series of examination stations which test their history taking, examination skills and interpretative skills where simulated and real patients, slides and instruments are used. Breakdown of marks: Continuous Assessment End-of-semester Theory Examination End-of-semester Clinical Examination 30% 35% 35%

RESOURCE MATERIALS Please include edition (should be the latest) Recommended Textbooks:

1.

Principles and Practice of Surgery OJ Garden, AW Bradbury, and JLR Forsythe Churchill Livingstone Lecture Notes on General Surgery Harold Ellis and Roy Calne Blackwell Science Essential Surgery Burkitt & Quick Churchill Livingstone Symptoms & Signs of Surgical Disease Norman & Browse Bailey & Loves Short Textbook of Surgery Mann, Russell & Williams

2.

3.

4. 5.

Online Materials : 1. 2. 3. 4. Surgical Tutor (www.surgical-tutor.org.uk) emedicine (www.emedicine.com) MDConsult (via HUKM library website) E-learning website( www.medicine.ukm.my/e.learning )

9 A. 1.

TEACHING-LEARNING METHODOLOGY WEEKLY LECTURES 9 topics (1 and hours 1 hours each session) Lecture 1 (Week 1 Day 1)

History & physical examination in the surgical patient (video presentation) Lecturers in-charge Mr Imtiaz / Mr Hairol Specific Learning Objectives The lecture should enable the students to: 1. 2. observed how to take a history from the surgical patient observed how to examine the surgical patient with emphasis on the abdomen, breast,neck and lower limbs. Lecture 2 (Week 1)

2.

Perioperative Management
Lecturers in charge Mr Shaker / Mr Azim Specific Learning Objectives The lecture should enable the students to: 1. 2. 3. 4. 5. 6. 7. 8. explain the principle of obtaining consent discuss the principle of bowel preparation discuss the principle of DVT prophylaxis discuss the principle of prophylactic antibiotics list the post-operative complications in general list the different types of post-operative analgesia outline the principles of stoma care discuss the management of intravenous fluids

3.

Lecture 3 (Week 2)

Common Neurosurgical Conditions/Head Injury

Lecturers in charge Mr Azizi / Mr Toh/ Mr Sanmugarajah / Mr Syahril Specific Learning Objectives The lecture should enable the students to: 1. 2. 3. 4. 5. 4. outline the management of traumatic head injury relate the pathophysiology of hydrocephalus discuss the principle of management of neurosurgical infections principles of intracranial tumours relate the pathophysiology of spinal cord compression Lecture 4 (Week 3)

Common Urological Conditions

Lecturers in charge Mr Zulkifli / Mr Nazri / Mr Lee Boon Cheok/ Mr Badrul Specific Learning Objectives The lecture should enable the students to: 1. explain the causes of renal, ureteric, bladder and urethra injury 2. identify the signs and symptoms of each component of genitourinary trauma 3. describe the methods of investigation in patients suspected to have genitourinary trauma 4. outline the management of genitourinary trauma

5.

Lecture 5 (Week 4)

Common Plastic Surgical Conditions/Burns

Lecturers in charge Visiting Consultant/ Mr Goh Eng Hong Specific Learning Objectives The lecture should enable the students to: 1. 2. 3. 4. 6. outline the management of burn injury describe the common skin tumours and its management outline the management of salivary gland tumour describe the principle of skin cover Lecture 6 (Week 5)

Nutrition in Surgery (with dietitian)

Lectures in charge AP Lukman / Miss Birinder Specific Learning Objectives The lecture should enable the students to: 1. explain and perform nutritional assessment 2. relate the history taking and physical examination of nutritional assessment in the surgical patient 3. explain the basic nutritional requirements 4. explain the nutritional requirements in abnormal condition 5. explain the indication for nutritional support 6. describe the methods and routes of nutritional support 7. explain the complications of nutritional support 8. relate the role of monitoring in nutritional support

7.

Lecture 7 (Week 6)

Trauma Chest and Abdomen

Lectures in charge Mr Zamrin / Mr Ramzi / Mr Shahrul Specific Learning Objectives The lecture should enable the students to: 1. explain the pathophysiology of traumatic pneumothorax, haemothorax, lung contusion, flail chest and cardiac tamponade 2. define the common injuries in chest trauma 3. identify the signs and symptoms of pneumothorax, haemothorax, lung contusion, flail chest and cardiac tamponade 4. describe the chest X-rays for the features above 5. outline the basic resuscitation and immediate management of these traumas

8.

Lecture 8 (Week 7)

Common Surgical Procedures

Lectures in charge AP Razman / AP Naqiyah Specific Learning Objectives The lecture should enable the students to: 1. correlate the history taking and physical examination in a patient with breast lump by listing the differential diagnoses accordingly. 2. explain the meaning of triple assessment in approaching the patient with a breast lump. 3. explain the difference between fine needle aspiration and tru cut biopsy for pathological diagnosis in the patient with a breast lump. 4. explain the difference between the need for mammogram and ultrasound of the breast in assessing the patient with a breast lump.

9.

Lecture 9 (Week 8)

Common Paediatric Surgical Conditions

Lecturers in-charge Prof Thambidoorai / Miss Marjmin Specific Learning Objectives The lecture should enable the students to: 1. explain the signs and symptoms, diagnosis and treatment of inguinal scrotal swelling and umbilical hernia 2. explain the principle and management of acute abdominal pain such as acute appendicitis and intussuception 3. explain the basic principle of pyloric stenosis 4. explain the clinical presentation of neonatal intestinal obstruction particularly Hirschprungs disease and malrotation 5. explain the examination of anorectal anomalies 6. explain the importance of early diagnosis of biliary atresia and jaundice 7. relate the diaphragmatic hernia to respiratory distress

B.

SELF-DIRECTED LEARNING SESSIONS / ELEARNING (2.5 hours each session) Total contact hours = 2.5 X 8 = 20 hours Online self-directed learning (SDL) and student led seminar with group presentations.

Topic Approach to the patient with a breast lump

Specific Learning Objectives At the end of the session, the student should be able to The session should enable students to: 1. obtain proper history of breast diseases. 2. explain breast examination. 3. list the differential diagnoses (such as fibroadenoma, carcinoma etc). 4. list the relevant investigations (such as ultrasound/mammogram, FNAC, biopsy). 5. list the management options (such as excision, conservative treatment, mastectomy etc).

Approach to the patient with a neck lump

The session should enable students to: 1. obtain proper history of neck lump; 2. explain neck examination; 3. list the differential diagnoses (such as cervical lymph node enlargement, goiter, branchial cyst etc). 4. list the relevant investigations (such as ultrasound/CT scan; FNAC or biopsy). 5. list different management options (such as conservative treatment, thyroidectomy or excision of lump including chemotherapy in lymphoma and antituberculous therapy in tuberculosis).

Approach to the patient with acute abdomen

The session should enable students to: 1. obtain proper history on acute abdomen; 2. explain abdominal examination; 3. list the differential diagnoses (such as appendicitis, perforated viscus, acute pancreatitis, acute cholecystitis, ischaemic bowel, etc). 4. list the relevant investigations (such as FBC, serum amylase, ultrasound/CT abdomen, diagnostic laparoscopy, etc). 5. list treatment options in acute abdomen (ie conservative treatment or surgery).

Approach to the patient with The session should enable students to: abdominal mass 1. obtain relevant history pertaining to abdominal mass 2. explain abdominal examination; 3. list the differential diagnoses (such as causes of hepatosplenomegaly, gastrointestinal malignancy, abdominal aortic aneurysm, etc). 4. list the relevant investigations (such as ultrasound/CT scan of the abdomen; endoscopic examination with biopsy). 5. list the management options of either surgical excision or non-surgical. Approach to the patient with gastrointestinal bleeding The session should enable students to: 1. obtain relevant history of gastro-intestinal bleeding; 2. explain abdominal examination; 3. list the differential diagnoses (such as bleeding peptic ulcer, gastric malignancy, oesophageal varices, etc). 4. list the relevant investigations (including FBC, coagulation profile, upper gastrointestinal endoscopy, etc). 5. list the management options - conservative versus surgical.

Approach to the patient with jaundice

The session should enable students to: 1. obtain the relevant history of the jaundiced patient; 2. explain abdominal examination; 3. list the differential diagnoses (such as haemolytic disorder [prehepatic], acute hepatitis [hepatic], choledocholithiasis, Ca head of pancreas [posthepatic]). 4. list the relevant investigations (such as LFTs, ultrasound of the hepatobiliary system, ERCP). 5. list the management depending on cause ie conservative versus surgical.

Approach to the patient with intestinal obstruction

The session should enable students to: 1. obtain the relevant history of intestinal obstruction; 2. explain abdominal examination; 3. list the differential diagnoses for small and large bowel obstruction; functional versus mechanical causes. (Common causes: adhesions, hernia or gastrointestinal malignancy). 4. list the relevant investigations (including blood investigations, radiological investigations). 5. list the management options, depending on cause; conservative versus surgical.

Approach to the patient with limb ischaemia

The session should enable students to: 1. obtain the relevant history of limb ischaemia; 2. explain vascular examination; 3. list the differential diagnoses (such as acute or chronic limb ischaemia secondary to peripheral vascular disease, embolism or trauma). 4. list the relevant investigations (including Doppler ultrasound, angiogram etc). 5. list the management options (such as conservative, embolectomy, bypass, amputation, etc). 6. explain the role of prevention and modification of risk factors.

C.

PRACTICAL SKILL WORKSHOPS (1/2 day sessions) These sessions cover: - principles and practice of asepsis/sterility and wound management - examination techniques on mannequin (breast, PR, catheterization, RT insertion) - intravenous access and basic suturing Students are expected to attend 3 sessions on sterility, wound management and examination technique. They will have a hands-on experience and will be supervised Total contact hours = 3 hours

D. E.

CLINICAL CONFERENCE & MEETINGS (see Appendix 2) Total contact hours = 8 X 5 = 40 hours (CPC and housemen CME) BEDSIDE TEACHING minimum 2 hours per week Total contact hours = 2 X 8 = 16 hours Students are divided into groups of 7-8 students under 2 lecturers. There are a minimum of 2 sessions per week whereby students are trained in the basic clinical skills from clerking, physical examination and patient management. Students are expected to clerk these cases and discuss them in small groups before the session. Each session lasts at least 1 hour. Students are required to participate and will be assessed based on their participation and attendance in these sessions. During these sessions, the emphasis is on critical thinking and communication skills. WARD ROUNDS, WARD WORK AND OPERATING THEATRE Students are expected to attend ward rounds at 2pm according to their respective teams. They are expected to know about the patient and to present the cases during ward rounds. Students are expected to tag along with the house officers for procedures and ward work. The students are also expected to attend operating sessions according to the schedule given. At the end of the posting, students should be able to: 1. 2. 3. 4. 5. 6. 7. take the history and perform physical examination of the surgical patient take the history and examine the surgical patient formulate the provisional and differential diagnoses discuss the management plan perform routine simple procedures (such as venepuncture, urinary cathetherization and wound dressing) demonstrate familiarity with the common procedures performed in the surgical ward (such as chest drain insertion) appreciate common surgical operative procedures

F.

Contact Hours per Posting Surgical rounds (2 hours per day) Clinics (2 hours per week) Operating theatre (2 x 2 hours per session) Accident and Emergency (1.5 x 2 hours per session) Radiology (1x7 hours per week) Endoscopy (2 x 2 hours per session) E-learning (2.5 x 8 hours per session) Lectures (1.5 x 9 hours per session) Bedside Teaching (2x 8 hours per week) Practical Skill Workshops CME and Meetings (5 hours per week) Total

Hours per posting 80 hours 16 hours 4 hours 3 hours 7 hours 4 hours 20 hours 13.5 hours 16 hours 3 hours 40 hours 206.5 hours

Appendix 1

TIMETABLE FOR THE GENERAL SURGICAL UNITS Attached Appendix 2 Timetable for 3rd Year Undergraduate Teaching (per academic year) Teaching Groups: 1. Prof Rohaizak/Mr Nazri/Mr Shaker 2. Prof Jasmi/Mr Yahya/Mr Ramzi 3. Prof Thambidoorai/Mr Zamrin/Miss Marjmin 4. Mr Ismail/ Mr Badrul/Mr Shahrul 5. Mr Razman/Mr Azim/Mr Shan 6. Mr Zamrin/Mr Lukman /Mr Teoh 7. Mr Azizi/Miss Naqiyah/ 8. Mr Zulkifli/Mr Imtiaz/Mr Hairol Students are also divided into 5 clinical attachment groups for ward rounds, clinics, OT & endoscopy exposure. A. B. C. D. E. Breast & Endocrine Upper Gastrointestinal & Minimally Invasive Surgery Hepatobiliary Colorectal Vascular

Year 3 Timetable

WEEK GROUP 1

1 Subspecialty

2 WR ( HPB ) D/C OT Minor OT Scope Subspecialty

3 WR ( HPB ) HPB - clinic wed - OT WR ( HPB ) D/C OT Minor OT Scope Subspecialty

4 WR ( HPB ) ENB - clinic thurs - OT WR ( HPB ) HPB - clinic wed - OT WR ( ENB ) D/C OT Minor OT Scope Subspecialty

5 WR ( HPB ) ENB - clinic fri - OT WR ( HPB ) ENB - clinic thurs - OT WR ( ENB ) HPB - clinic wed - OT WR ( ENB ) D/C OT Minor OT Scope Subspecialty

6 WR ( HPB ) CR - clinic tue - OT WR ( HPB ) ENB - clinic fri - OT WR ( ENB ) ENB - clinic thurs - OT WR ( ENB ) HPB - clinic wed - OT WR ( CR ) D/C OT Minor OT Scope Subspecialty

7 WR ( HPB ) MIS - clinic mon - OT WR ( HPB ) CR - clinic tue - OT WR ( ENB ) ENB - clinic fri - OT WR ( ENB ) ENB - clinic thurs - OT WR ( CR ) HPB - clinic wed - OT WR ( CR ) D/C OT Minor OT Scope Subspecialty

8 WR ( HPB ) Vasc - clinic wed - OT WR ( HPB ) MIS - clinic mon - OT WR ( ENB ) CR - clinic tue - OT WR ( ENB ) ENB - clinic fri - OT WR ( CR ) ENB - clinic thurs - OT WR ( CR ) HPB - clinic wed - OT WR ( MIS ) D/C OT Minor OT Scope Subspecialty

WR ( HPB ) Vasc - clinic wed - OT WR ( ENB ) MIS - clinic mon - OT WR ( ENB ) CR - clinic tue - OT WR ( CR ) ENB - clinic fri - OT WR ( CR ) ENB - clinic thurs - OT WR ( MIS ) HPB - clinic wed - OT WR (Vasc ) D/C OT Minor OT Scope Lecture 1 Lecture 2 A&E Radiology HCME Sur Updates PGRC

WR ( ENB ) Vasc - clinic wed - OT WR ( ENB ) MIS - clinic mon - OT WR ( CR ) CR - clinic tue - OT WR ( CR ) ENB - clinic fri - OT WR ( MIS ) ENB - clinic thurs - OT WR (Vasc ) HPB - clinic wed - OT Lecture 3 A&E Radiology HCME Sur Updates PGRC

WR ( ENB ) Vasc - clinic wed - OT WR ( CR ) MIS - clinic mon - OT WR ( CR ) CR - clinic tue - OT WR ( MIS ) ENB - clinic fri - OT WR (Vasc ) ENB - clinic thurs - OT Lecture 4 A&E Radiology HCME Sur Updates PGRC

WR ( CR ) Vasc - clinic wed - OT WR ( CR ) MIS - clinic mon - OT WR ( MIS ) CR - clinic tue - OT WR (Vasc ) ENB - clinic fri - OT Lecture 5 A&E Radiology HCME Sur Updates PGRC

WR ( CR ) Vasc - clinic wed - OT WR ( MIS ) MIS - clinic mon - OT WR (Vasc ) CR - clinic tue - OT Lecture 6 A&E Radiology HCME Sur Updates PGRC

WR ( MIS ) Vasc - clinic wed - OT WR (Vasc ) MIS - clinic mon - OT Lecture 7 A&E Radiology HCME Sur Updates PGRC

WR (Vasc ) Vasc - clinic wed - OT Lecture 8 A&E Radiology HCME Sur Updates PGRC

ALL GROUPS

Lecture 9 A&E Radiology HCME Sur Updates PGRC

Notes : Lecture 1 - Monday 9am - 11am Lecture 2 - 9 - Wed 9am - 10 am WR - ward round HPB - Hepatobiliary ENB - Endocrine and Breast CR - Colorectal MIS - Minimally invasive and general Vasc - Vascular Scope - Endoscopic suite (scope and ERCP) Sur Updates - Surgical updates mon 8 am HCME - Houseman CME (wed 12 pm) Subspecialty - follow the timetable subspecialty

SURGICAL SUBSPECIALTY PROGRAMME

a.

Duration of Posting

1 week posting. Lecturers : Urology : Mr Zulkifli Zainuddin Mr Mohd Nazri Jamaan Mr Lee Boon Cheok Mr Badrulhisham Bahadzor Mr Azizi Abu Bakar Mr Toh Charng Jeng Mr Shanmugarajah Mr Ainul Syahrilfazli Jaafar Prof Thambidoorai Ms Marjmin Osman Visiting Consultant Dr Goh Eng Hong

Neurosurgery

Paediatric Surgery Plastic & Burns

: :

b.

No. of students per week

8-9 students per week

c.

Weekly Timetable
Time am Monday Clinic (Paediatric Surgery) Ward (Paediatric Surgery) Tuesday Ward & Burns Unit (Plastics) Ward (Urology) Wednesday OT (Urology & Plastic Surgery) OT (Urology) Thursday OT(Paediatric Surgery) Ward (Neurosurgery) Friday OT (Neurosurgery) CME

pm

d.

Teaching-Learning Methodology

Clinic i. Bedside Teaching ii. Case Discussion iii. Radiograph Discussion Ward i. ii. iii. iv. OT i. ii. iii. Clerk cases Ward rounds Observe procedures Assisting doctors in ward Clerk cases day before surgery (for Urology & Neurosurgery) Present cases before operation begins Topic discussions during surgery

E-learning i. Core knowledge according to syllabus

e.
ii. iii.

Assessment
MEQs OSCEs

f.

Syllabus

Urology Urinary calculus Bladder outflow obstruction & prostate cancer Haematuria & Genitourinary tumours (Renal, Urothelial tract, Testes) Trauma Neurosurgery Traumatic head injury Hydrocephalus Spinal cord compression Common intracranial tumours Neurosurgical infections Paediatric Surgery Gastrointestinal obstruction in newborns Common tumours in paediatric surgery Inguinal scrotal anomalies

Plastic & Burns Burns injury & management Common skin tumours Salivary gland tumours Principle of skin cover

g.

Notes

Should there be a public holiday, the group of students affected will join in the other group scheduled for the following week. Appendix 3 Procedures & Logbook Procedures students are expected to observe and have performed at least once by the end of their posting: Phlebotomy Insertion of peripheral venous cannula Nasogastric tube insertion Urethral cathetherization Wound dressings Procedures students are expected to observe by the end of their posting: Per rectal examination Thoracic & abdominal paracentesis Intercostal drain insertion Incision & drainage of abscess Excision biopsies of lumps Proctoscopy and banding of haemorrhoids Appendicectomy Fine needle aspiration cytology (FNAC) Tru-cut biopsy Endoscopic procedures Toilet & suture

UNIVERSITI KEBANGSAAN MALAYSIA

SURGICAL CASE REPORT

STUDENT NAME: MATRIC NO: SUPERVISOR: YEAR / GROUP :

ASSESSMENT OF SURGICAL CASE REPORT: Core Clinical Component

History Examination Investigation Diagnosis/Differential Diagnoses Management and progress of patient /10 /10 /10 /10 /10 Discussion References Preventive and community health Referral letter Prescription /5 /5 /5 /10 /5

Professionalism
Communication issues Ethical issues Critical thinking /10 /10 /10 MARKS FOR CORE CLINICAL COMPONENT Reflective writing - lifelong learning - professional judgment /5 /5

/ 80 / 40

MARKS FOR PROFESSIONALISM COMPONENT

TOTAL SCORE =

/1200

Jabatan Surgeri Fakulti Perubatan Universiti Kebangsaan Malaysia

Gambar

PENILAIAN POSTING SURGERI TAHUN 3 Nama: No. Matrik: Sesi: Tarikh mula posting: Tarikh akhir posting: KEHADIRAN Memuaskan (lebih dari 80%) Tidak memuaskan (kurang dari 80%) Ulasan (jika berkenaan) Supervisor:
A. Case Write Up:

Case write up 1 (80) Case write up 2 (80) Average mark Converted mark (10%)

B. Supervisor Assessment:

Log Book (40) Presentation Skills (20) Diagnostic Ability (10) Participation in group discussion (10) Clinical knowledge (20) Total score (100) Converted mark (10%)

C. Long Case Assessment:

Mark (20) Converted score (10%) Total Score: Part A (10%) Part B (10%) Part C (10%) Total score THEORY MCQ AND KFQ CLINICAL OSCE 35% 35%

Comments from mentor:

Signature: