Standardized Curriculum in General Surgery 2012

MESSAGE
PSGS President 2006
Fully aware of the rapid expansion of new knowledge and new surgical techniques that
affect our training programs, the Committee on Surgical Training embarked on the
challenging task of revising our surgical curriculum.
As we remain committed to maintain an excellent General Surgery training program that keeps
abreast with the ongoing developments and progress in the practice of surgery, we have
remained sensitive to the limitations that affect each and every training program, allowing
enough opportunity for gradual adaptation before the full implementation of this revised
curriculum.
We have always prided our society by ensuring that all accredited training programs under
its watch will produce excellent clinical General Surgeons who are able to go out and practice
with confidence in any situation, both in ideal and not so ideal set up, and still adhere to
the tenets of sound surgical practice.
In order to achieve our goals, we have finally developed a strong and updated surgical
curriculum that would adequately arm our trainees with a comprehensive surgical
educational experience during their entire period of residency training.
I would like to express my sincerest thanks and gratitude to the members of the surgical
training committee, for their dedication, and to all who have in one way or another participated,
provided inputs and ideas; and for the comments and suggestions, and full support of all the
Fellows that led to the formulation of our new surgical curriculum.
I look forward to the continued success in its eventual implementation.
Arturo E. Mendoza, Jr., MD, FPSGS

President, 2006
MESSAGE
PSGS President 2007
Through the years, the Curriculum in General Surgery has evolved from its first edition in 1995 to
the present competency-based, resident-oriented educational curriculum. This 3rd edition, which
underwent extensive review, is the fruit of all efforts, shed through sweat and tears, of the
Committee on Surgical Training of the PSGS.
We can now confidently claim that this manual is truly reflective of our expectations from the
graduates of the training program and this will significantly help produce competent and sage
general surgeons.
Henceforth, this curriculum will now serve as the foundation, upon which the new Accreditation
Manual shall be made, which in turn shall take effect after the year 2007. With the completion of
these two vital documents, we will then see the fulfillment of an important aspect of our Societys
Vision-Mission.
It is fitting to express my heartfelt gratitude to all who contributed in making this document
something we can truly be proud of and something that will be relevant in the years to come.
Reynaldo M. Baclig, MD, FPSGS

President
PSGS 2007
MESSAGE
PSGS President 2011
Preface to the 1st Edition

One of the tasks assigned to the Committee on Surgical Training was the improvement of the Surgical
Curriculum.
Towards this goal, the 1991 Surgical Curriculum was re-oriented into a competency-based, residentoriented educational curriculum.
An educational curriculum contains the following basic elements (from Hilda Taba Curriculum
Development: Theory and Practice):
Objectives
Content (subject matter)
Teaching-Learning activities
Evaluation
To make it applicable to surgical residency programs, we have added the competencies or abilities that
residents need to develop, the organization of rotations in a four- or five-year program, and the resources
needed for training.
We have also formulated an Instructional Design that contains the basic elements. This pattern should be
used in designing various units of instruction (ex. trauma, burns, cancer, etc.)
The last part contains the Standardized Evaluation System for Residents, with the rating scales developed
to evaluate different competencies. A definition of terms used in the curriculum and evaluation follows
thereafter.
We certainly encourage all trainors to utilize this as the basic guide in teaching and evaluating residents in
training.
We recognize the critical role that trainors play in residency training. The quality of our graduates is
directly related to the dedication and commitment of the trainors, and to how well the curriculum is
implemented. Trauma, cancer and infections are national health concerns that should be emphasized.
We want trainees to be fully aware of the goals and objectives of the training program and the
competencies that they need to develop. Hopefully, this will motivate them to work hard towards the
attainment of the objectives, and acquisition of necessary competencies.
I would like to acknowledge the contributions of the members of the Board of Regents, Committee on
Surgical Training, Committee on Accreditation, and the Chairmen and Training Officers of the different
institutions.
I would like to give credit to Dr. Armand Crisostomo for his efforts in the formulation of the Standardized
Evaluation System for Residents.
Lastly, I would like to thank Dr. Tarlochan Kaur Pabla Gailan of the UP- National Teacher Training Center
of the Heath Professions for her critique and suggestions for improving the draft of the Surgical Curriculum
and Instructional Design.
JOSE Y. CUETO, Jr., MD, FPCS
Chairman
PCS Committee on Surgical Training, 1995
Preface to the 2nd Edition

This edition of the Surgical Curriculum and the Evaluation System arose out of a need to address
concerns raised by Trainers in general surgery and the surgical specialties. It is also the result of
feedbacks from the Residents in training.
In 1998, Drs. Josefina Almonte and Armand Crisostomo in cooperation with the PCS Committee
on Surgical Training (CST) and the Philippine Association of Training Officers in Surgery
(PATOS), conducted a survey on the Implementation of the Standardized Curriculum and the
Utilization of the PCS Standardized Evaluation System respectively. The results of these
surveys revealed the following:
1. The need to review the standardized surgical curriculum pertaining to the specialty
rotations to find out how the different programs can comply with the requirements of
the PCS.
2. The necessity for the various training programs to conduct a self-evaluation of their
program components i.e. objectives, products and resources.
3. Nearly all training programs agreed with the specific criteria utilized in the prescribed
rating scales and the number of anchor points in the evaluation system.
4. Despite its being assessed as valid, reliable, and useful, some programs found the
evaluation system difficult to implement due to inherent weaknesses in their programs
(lack of dedicated trainers/evaluators, poor quality of residents, poor structure of the
program, etc.).
In May of 1999, the PATOS conducted a Workshop on Program Evaluation for trainers in Subic.
On October 30, 1999, the CST met with representatives from the surgical specialties for a
multidisciplinary workshop to identify the minimum competencies of a general surgery resident
rotating in the specialties and to improve the Standardized Surgical Curriculum and Evaluation
System.
The outputs of the surveys and workshops were consolidated by the CST and incorporated into
this edition of the Surgical Curriculum for General Surgery.
GABRIEL L. MARTINEZ, MD, FPCS

Chairman
PCS Committee on Surgical Training, 2000
Preface to the 3rd Edition

The birth of the PSGS in 1999 and its subsequent assumption of the accreditation functions from
the PCS in 2002, paved the way for the eventual handover of the PCS Curriculum in General
Surgery to the PSGS. Realizing the need to keep pace with the rapid developments in surgical
education, knowledge and technology, the 2005 PSGS Board of Directors (BOD) directed the
PSGS Committee on Surgical Training (CST) to initiate the revision of the General Surgery
curriculum.
In September 2005, the PSGS-CST constituted itself into a Technical Working Group (TWG) to
identify areas that needed revision or improvement. Utilizing the existing curriculum as a
template, coupled with data from the various accredited training programs and the Philippine
Board of Surgery (PBS), a working model was presented to an expert panel for critique and
revision on July 5, 2006. The panel consisted of members of the PSGS BOD, PSGS
Accreditation Committee (AC), PSGS-CST and the Philippine Association of Training Officers in
Surgery (PATOS). This activity produced the Intended Learning Outcome (ILO) version of the
curriculum.
On August 5, 2006, during the PSGS 4th Annual Surgical Forum, the ILO-based curriculum, a
work in progress, was presented to the trainers representing the various training programs for
suggestions, revisions and comments. The trainers were given time to consult their training
programs and other stakeholders.
On October 14, 2006, after collating all available data, comments and suggestions from the
stakeholders, the PSGS-CST conducted a Workshop at the PCS Board Room to finalize the
Surgical Curriculum. In attendance were representatives from the various training programs,
PATOS, PSGS BOD, members of the PSGS Committee on Accreditation and PSGS-CST.
Resource persons who also acted as Facilitators were: Drs. Josefina R. Almonte, Armando C.
Crisostomo and Jose Y. Cueto, Jr. Taking into consideration the existing realities and the Social
Responsibility role of the PSGS, revisions were made and incorporated into the final draft of this
document.
On December 3, 2006, the final draft of the Surgical Curriculum was presented to the trainers and
stakeholders for ratification and adoption. With very minimal revisions in form, style and content,
this edition of the Surgical Curriculum was born.
I would like to thank the members of the Committee on Surgical Training, notably Dr. Shirard
Leonardo C. Adiviso, our advisers and resource persons, trainers and stakeholders for their
invaluable contribution and service towards the success of this endeavor.
GABRIEL L. MARTINEZ, MD, FPCS, FPSGS

Chairman
PSGS Committee on Surgical Training, 2005-2007
Preface to the 4th Edition

The opportunities of our PSGS Fellows for foreign trainings in others countries like the US,
Europe, India, Singapore and Vietnam and the available expertise in the Medical Health
Profession Education and Healthcare Management greatly provided support in formulating
revisions in this new curriculum. The globalization of healthcare and the focus in Patient Safety
worldwide also guided the committee to address not only the improvements in cognitive and
psychomotor skills needs of our learners as stated in Blooms Taxonomy of Learning but we also
strengthened in the Values Formation. The goals of training is focused in developing Safe,
Competent and Ethical surgeons with basic clinical teaching abilities,knowledge in academic
and clinical research and with good leadership and managerial skills. The curriculum is now
divided in three broad topics namely Medical Knowledge, Patient Care and Professional Growth.
We updated the medical knowledge parts and integrated new concepts, practice guidelines and
advancement in surgical technology. The patient care part is upgraded and updated based on
globally accepted practice. We added topics in professional growth to enhance value formation to
this future leader and managers of our society and most of all to make them good role models for
the next generations of trainees.
The new curriculum includes the following:
1) Clinical Nutrition
2) Clinical Teaching
3) Patient Safety
4) Professionalism
5) Leadership & Management
The course content has also been updated based on recent global trends in health care.
The part of Minimal Invasive Surgery has been greatly enhanced based on standards of Society
of American Gastrointestinal and Endoscopic Surgeons (SAGES) and European Association for
Endoscopic Surgery (EAES).
The updates for MIS training had been collaboratively established with representatives from
Philippine Association of Laparoscopic and Endoscopic Surgeons (PALES).
The proposed revised curriculum was again presented in the PSGS Forum last August 6, 2011
for final comments and ratification.
We would like to extend our appreciation to the pioneer PSGS CST chairman, Dr Gabriel
Martinez who sent several comments and recommendations for the improvement of the
curriculum. We would like to extend also our warmest gratitude to the guidance and support of
the PSGS Board most especially our president, Dr. Ervin Nucum and our Director in charge, Dr
Rex Madrigal in pursuing this endeavor. We would like to thank the generosity of B. Braun
Medical Supplies through its continuing education arm, Aesculap Academy for its never ending
support to the Committee on Surgical Training since we started with the 3 rd edition last 2005 until
today. We also would like to give credit to Dr. Luisito Llido, one of the pioneers of Surgical
7
Nutrition in our country for sharing his expertise not only in the curriculum but also to the training
modules in this area.
Finally, I would like to send my deepest gratitude to the Committee on Surgical Training members
most especially to Drs. Malen Gellido, Deo Reyes, Warren Roraldo and Michael James Busa who
sacrificed their time and talents in attending almost all the meetings and fulfilling their respective
tasks and assignments in this revision. You are a distinguished league of selfless and dedicated
surgical educators and it is my great pleasure working with you.
SHIRARD LEONARDO C. ADIVISO MD,MHPEd ,FPCS,FPSGS

Chairman, Committee on Surgical Training, 2011
Dedication
This
Manual is dedicated to our mentors who with their unselfish guidance

ushered us to become the trainers and educators they wanted us to be;
To the trainers and training residents in General Surgery, may their pursuit of
continuing surgical education and quality surgical care endure and prevail over the
challenges of the changing times;
To the unsung and unappreciated heroes of the surgical profession, may they
furnish the inspiration for future generations of surgeons;
And to the future generations of General Surgeons, may you continue and uphold
the ideals of the surgical profession and produce ethical, safe, and compassionate
surgeons.
ACKNOWLEDGEMENTS
To the members of the PSGS Board of Directors 2006 & 2007 for their support towards the
realization of this endeavor; to the Committee on Surgical Training 2005-2007 for their tireless
efforts and perseverance; to Drs. Armando C. Crisostomo, Jose Y. Cueto, Jr. and Josefina R.
Almonte who whole-heartedly collaborated with the Committee on Surgical Training to complete
this edition of the Standardized Surgical Curriculum; to the countless resource persons and
participants in the various workshops for their feedbacks and critiques; to our friends in the
pharmaceutical industry for their logistical and material support; and most importantly the PSGS
Secretariat, especially Ms. Angela Panlaqui, for their patience and perseverance despite the
odds.
TABLE OF CONTENTS
Message of PSGS President 2006
Preface to the 1st Edition
Preface to the 2nd Edition
Preface to the 3rd Edition
Preface to the 4th Edition
Dedication and Acknowledgements
1
2
3
4
5
6
7
9
Part I
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
Introduction
The Mission and Vision of the PSGS
The Surgical Curriculum
Concept map of goals of training
Goal of the Training Program
The General Objective of the Training Program
The Competencies
Levels of Training
Intended Learning Outcomes
The Course Content
Teaching-Learning Activities
Organization of Rotations
The Resources
Evaluation
11
13
14
15
15
15
16
16
16
19
31
32
33
34
Part II
The Instructional Design for the Surgical Curriculum
35
Part III
The Evaluation System for Residents
48
Appendices
52
Instructional Designs for Specialty Rotations
68
Glossary
96
10
PART I
I. INTRODUCTION
In 1991, the Philippine College of Surgeons, under Dr. Willie Lagdameo, formulated the
standardized surgical curriculum in two workshops. These workshops were participated in
by representatives of the Philippine College of Surgeons, Philippine Board of Surgery,
Chairmen and Training Officers, Chief Residents of different training institutions.
These were subsequently followed by a number of workshops addressing topics related to
the provisions of the surgical curriculum.
1.
Workshop on Accreditation at the Johnson & Johnson Compound, Paraaque, Rizal
2.
Workshop on Competencies at the Manila Garden Hotel
3.
Workshop on Standardized Evaluation, in Manila at Glaxo, Philippines, Pasong

Tamo Extension, Makati City and in Cebu City at the Cebu Midtown Hotel
4.
Mini-workshop on Accreditation at the Johnson & Johnson Compound in

Paraaque, Rizal
In the last workshop, problems in the interpretation of provisions of the surgical curriculum
and the requirements for accreditation were identified.
In addition, a survey of the descriptions of training programs was conducted to determine
whether standardization has been attained. The survey showed that, three years after the
workshop on the standardized curriculum, there was still lack of standardization of the
surgical curricula being followed by different institutions.
The PCS Committee on Surgical Training formed a Technical Sub-Committee to come up
with proposals to improve the curriculum. Essentially, what was done was to convert the
1991 Surgical Curriculum into a Competency-based Surgical Curriculum. The proposed
Surgical Curriculum was then presented, discussed, modified and finalized in a workshop
held at the PCS on November 19, 1994.
In 1995, the PCS started implementing the Standardized Surgical Curriculum in General
Surgery and Evaluation System for Residents. Three years later, in 1998, Dr. Josefina R.
Almonte presented the results of her survey on the Implementation of the Surgical
Curriculum while Dr. Armando C. Crisostomo presented the results of his survey on the
Utilization of the PCS Standardized Evaluation System.
The results of these surveys prompted the PCS Committee on Surgical Training to conduct
a workshop on October 30, 1999, to improve the Surgical Curriculum and Evaluation
System and to identify the competencies of the general surgery resident rotating in the
other surgical specialties. The outputs of the surveys and the workshops were processed
and incorporated into the 2nd edition of the Surgical Curriculum.
11
Upon the formation of the Philippine Society of General Surgeons (PSGS) in 1999, the
PCS handed over to it the task of accrediting general surgery programs and with that the
1995 Manual on Requirements and Procedures for Accreditation in General Surgery.
Thereafter, the PSGS embarked on the task of revising the Accreditation Manual. After a
series of workshops and consultations with stakeholders, the PSGS Manual on
Requirements and Procedures for Accreditation in General Surgery saw print.
Implementation began in 2004.
In August 2005, in response to the rapid growth in surgical education, technology and the
general surgical subspecialties, and the need to achieve uniformity in the implementation,
structure and duration of the training programs, the PSGS Board of Directors tasked the
Committee on Surgical Training to lay down the ground work for the eventual revision of
the Surgical Curriculum.
In September 2005, the PSGS-CST constituted itself as a Technical Working Group
(TWG) to revise the curriculum. Annual reports were reviewed, trainers were interviewed
and data provided by the Philippine Board of Surgery (PBS) were considered.
Data gathered revealed that thirty (30) of the 64 training programs are in government
hospitals. Due to some legal impediments, 15 of them are implementing the 4-year
curriculum; the remaining 49 programs are implementing the 5-year curriculum. The
absence of uniformity in specialty rotations and teaching-learning activities, coupled with
the lack of dedicated trainers/evaluators, due to the brain drain, have strained the ability
of some programs in maintaining the quality of their training. The average passing in the
PBS Residency In-Training Examination is 69.4%; in the Written Examination it is 68.1%
and in the Oral Examinations it is 51.0%. The PBS Credentials Committee reports
deficiencies in variety of cases and in some cases, lack of trainer supervision.
In July 2006, in a workshop attended by the PSGS BOD, members of the Committee on
Accreditation and the CST, the TWG submitted an Intended Learning Outcome (ILO)
based Preliminary Report. The product of this workshop was presented to the trainers in
August 2006. The same was given as a take home model for the trainers to critique, to
comment on and revise. Feedback sent via surface and electronic mails were incorporated
into a working model of the curriculum.
On October 14, 2006, another workshop attended by the PSGS BOD, members of the
Accreditation Committee, the CST and representatives of the various training programs,
was held at the PCS Building
On December 3, 2006, the final draft of the Surgical Curriculum, with very minimal
revisions in form and content, was adopted and approved by the body.
12
II. THE MISSION AND VISION OF THE PHILIPPINE SOCIETY OF GENERAL SURGEONS
Mission
We are a Fellowship of highly competent, safe, compassionate, and ethical
surgeons dedicated to pursue excellence in the art and science of General Surgery
as a distinct specialty, promote the welfare of its members, uphold the highest
standards of practice, and provide quality care to all surgical patients.
Vision
The Philippine Society of General Surgeons is the premier organization of General
Surgeons, highly esteemed and recognized for their pioneering achievements in
continuing surgical education, training, and research, dedicated to promote the
welfare of its members, to provide compassionate and quality health care, and
responsive to the needs of the community.
13
III.
THE SURGICAL CURRICULUM

A.
The Surgical Curriculum: What it is

As an educational document, the surgical curriculum serves as the written plan of
action for residency training. It contains the program of studies, the course content,
the planned learning experiences and the intended learning outcomes. It identifies
the resources needed for the program, and provides a system for assessing the
performance and the competence of residents.
B.
The Elements
1.
2.
3.
4.
5.
6.
7.
Statement of goals and objectives

Identification of competencies or abilities
Selection and organization of content
Teaching-learning activities and methods
Organization of Rotations
The learning resources
Evaluation
14
ELEMENTS OF THE SURGICAL CURRICULUM

A. Concept Map of PSGS Goals of Training
B. GOAL OF THE TRAINING PROGRAM

To train Residents in General Surgery to assume the following roles:
1. Primarily as CLINICIANS or MEDICAL PRACTITIONERS providing ethical , safe, and
competent patient care to individuals with surgical disorders in different settings such
as the community, the hospital, schools and different institution .This is focused on
principles of evidence based practice, patient safety, professionalism and
collaborative quality patient care.
It is desirable to prepare the Residents for the following roles:
2. As clinical and academic RESEARCHERS involved in the study of current and
relevant issues related to the practice of Medicine in general.
3. As MEDICAL EDUCATORS involved in teaching and training of students in Medicine
and other health professions. He will be exposed to the following roles of the
teacher namely: Information provider, facilitator, planner, role model, resource
developer and assessor.
4. As ADMINISTRATORS with excellent managerial and leadership skills involved in
managing and organizing the activities of institutions, organizations or departments of
the hospital.
C. THE GENERAL OBJECTIVE OF THE TRAINING PROGRAM

At the end of the Residency Training, the Graduate should have acquired clinical
competence in the diagnosis and management of surgical disorders.
15
D. The COMPETENCIES these are the ABILITIES that Residents in all levels of
training have to acquire and develop.
1. COGNITIVE DOMAIN
Knowledge
Comprehension
Intellectual Skills
Data-gathering
Analysis
Problem-solving
Decision-making
Critical thinking
2. PSYCHOMOTOR DOMAIN
Technical Skills
Communication Skills
3. AFFECTIVE DOMAIN
Interpersonal Skills
Professionalism
E. LEVELS OF TRAINING
Levels of Training
Level I
Junior Year
First Year
Level II
Intermediate Years:
Second Year
Third Year
Level III
Senior Years:
Fourth Year
Fifth Year
F. INTENDED LEARNING OUTCOMES

A.
At the end of the JUNIOR YEAR, the RESIDENT should be able to:
1.
COGNITIVE DOMAIN
1.1.
1.2.
Apply the principles of diagnosis and management of common general

surgical disorders.
Evaluate patients with surgical disorders
a.
b.
c.
Obtain an adequate history

Perform a thorough physical exam
Order pertinent laboratory and diagnostic exams
16
d.
e.
f.
g.
2.
PSYCHOMOTOR DOMAIN
2.1.
2.2.
3.
Demonstrate the proper attitudes and habits in the practice of surgery.

Accept own limitations
At the end of the INTERMEDIATE YEARS (second and third years), the RESIDENT
should be able to:
1.
COGNITIVE DOMAIN
1.1.
1.2.
C.
Perform minor surgical procedures

Assist in the performance of surgical procedures done by consultants
and other residents
AFFECTIVE DOMAIN
3.1.
3.2.
B.
Formulate a logical diagnosis

Formulate treatment plan
Refer appropriately
Provide continuing care
Apply the principles of diagnosis and management of GS and surgical

specialty disorders
Evaluate and manage patients
a.
Obtain an adequate history
b.
Perform a thorough physical exam
c.
Order pertinent laboratory and diagnostic exams
d.
Formulate a logical diagnosis
e.
Formulate treatment plan
f.
Implement treatment plan
g.
Refer appropriately
h.
Provide continuing care
2.
PSYCHOMOTOR DOMAIN
2.1. Perform or assist in the performance of surgical procedures
3.
AFFECTIVE DOMAIN
3.1. Demonstrate the proper attitudes and habits in the practice of surgery
3.2. Accept own limitations
At the end of the SENIOR YEAR, (fourth and fifth years) the Graduate should be
able to:
1.
COGNITIVE DOMAIN
1.1. Apply the principles of diagnosis and management of GS and surgical
specialty disorders
17
1.2.
Provide pre-operative, intra-operative and post-operative care to all

patients falling under all fields of surgery
2.
PSYCHOMOTOR DOMAIN
2.1. Perform or assist in the performance of surgical procedures
3.
AFFECTIVE DOMAIN
3.1. Demonstrate the proper attitudes and habits in the practice of Surgery
3.2. Accept own limitations
18
G. THE COURSE CONTENT
This deals with the subject matter that the residents have to learn. Traditionally, the course
content has been divided into basic and clinical topics. This follows the sequence of simple
to complex, basic to clinical. There is cumulative learning as one goes from the earlier
years to later years. Basic pre-requisites are mastered before more complicated topics
and tasks are tackled.
The residents have to acquire knowledge and comprehension of facts, concepts,

principles, and theories before they can apply them.
The application and integration of basic concepts and principles into actual clinical practice
are the main goals. It follows that the residents are expected to master the common
surgical problems and disorders that they will encounter in their future role as Surgeons.
19
A.
BASIC SURGERY
1.
FLUIDS AND ELECTROLYTES

a.
Normal composition of body fluids
b.
Fluid and electrolyte imbalance
Volume deficit and excess
Concentration changes
c.
Acid base imbalance
Respiratory acidosis/alkalosis
Metabolic acidosis/alkalosis
d.
Principles of fluid and electrolyte therapy
Parenteral solutions
Preoperative fluid therapy
Intraoperative and Postoperative fluid therapy
2.
SHOCK & RESUSCITATION

a.
Definition
b.
Pathophysiology
c.
Types of shock
d.
Treatment
3.
SURGICAL NUTRITION
a.
Nutrition risk assessment
Subjective Global Assessment
b.
Nutritional Intervention
Oral feeding
Enteral feeding
Parenteral feeding
c.
Complications related to Nutritional support
d.
Nutritional Immunomodulation
4.
ENDOCRINE AND METABOLIC RESPONSE TO INJURY

a.
Central nervous system and endocrine changes
b.
Metabolic changes
Energy, CHO, fat and protein-metabolism
Starvation
Metabolic effects of injury
Blood coagulation
c.
Acid-base balance, water and electrolyte metabolism
d.
Oxygen transport
e.
Organ system changes
5.
WOUND HEALING
a.
Physiology of wound healing
Phases of wound healing
b.
Factors affecting healing
c.
Wound care
d.
Wound closure
20
BLEEDING AND BLOOD TRANSFUSION

a.
Biology of normal hemostasis
b.
Blood coagulation
Intrinsic pathway
Extrinsic pathway
Fibrinolytic system
c.
Clinical tests for hemostasis
d.
Clinical defects in hemostasis -manifestations and treatment
e.
Blood transfusion
Replacement/Component therapy
Indications
Complications
7.
BURNS
a.
Classification according to extent & depth
b.
Systemic changes
c.
Therapy
Airway
Fluid resuscitation, Rule of Nines, Brookes and Parkland
formulae
Burn wound care, skin grafting
Complications
8.
SURGICAL ONCOLOGY
a.
Molecular Biology and Oncogenesis
a.
Pathology
b.
Clinical Manifestations of Cancer
c.
Diagnosis and Staging
d.
Multidisciplinary management options
Surgery
Radiotherapy
Chemotherapy
Immunotherapy
Targeted therapy
Hormonal therapy
e.
Prognosis
f.
Long-term care and follow-up
9.
TRAUMA
a.
Epidemiology, Patterns of injury and Prevention
b.
Basic Life Support and Triage
c.
Principles of Management
Primary Survey
Resuscitation
Secondary Survey
Definitive Management
21
d.
e.
f.
g.
e.
Management of Specific Injuries

Head
Neck
Chest
Abdomen
Extremities
Others
Approach to the multiply injured patient
Care of the critically ill trauma patient
Rehabilitation
Mass casualty and disaster management
10.
CRITICAL CARE
a.
Physiologic Monitoring
b.
Specific Conditions
SIRS
Sepsis
MODS
MOF
ARDS
DIC
c.
Vascular Access
Peripheral
Central
d.
Metabolic Support
11.
SURGICAL INFECTION
a.
Sepsis, Asepsis and Antisepsis
b.
General Principles of Diagnosis, Antibiotic and Surgical Therapy
c.
Antibacterial / Antifungal /Anti-Viral Drugs: Classification,
Principles, Therapy
d.
Specific Infections
Streptococcal
Staphylococcal
Gram negative infections
Anaerobic infection
Fungal infections
AIDS
Viral Hepatitis
e.
Surgical Aspects of Treatment
12.
PRINCIPLES OF IMMUNOLOGY AND TRANSPLANTATION

a.
Immunosuppression
b.
Clinical Tissue and Organ Transplantation
c.
Organ Preservation
22
B.
13.
SURGICAL COMPLICATIONS
a.
Recognition
b.
Diagnosis
c.
Management
14.
MINIMALLY INVASIVE SURGERY

a.
Principles of MIS
Physiologic response to Pneumoperitoneum
b.
Equipment
c.
Energy sources
Electrosurgical safety
d.
Operating room set-up
e.
Ergonomics and Instrumentation
f.
Basic Skills
Looping
Clipping
Ligation In-continuity
Endo-dissection
Extra/Intra-corporeal tying
Endo-suturing
g.
Basic Laparoscopic procedures
Diagnostic Laparoscopy
Laparoscopic Cholecystectomy
Laparoscopic Appendectomy
15.
PERIOPERATIVE CARE
a.
Patient preparation
b.
Co-morbidities and risk assessment
c.
Pain control
16.
PATIENT SAFETY AND PROFESSIONALISM
CLINICAL SURGERY-GENERAL SURGERY

1.
HEAD AND NECK

a.
b.
c.
d.
Anatomy and Physiology

Clinical Presentation
Diagnostics
Specific Condition
Congenital Masses
Thyroglossal cysts
Teratomas
Branchial clefts
Vascular tumors
Hygromas
23
Noncongenital lesions
Papillomas
Polyps
Dermoid tumors
Rhabdomyomas and Neurofibromas
Chemodectomas
e.
f.
2.
THE THYROID AND PARATHYROID GLANDS

a.
b.
c.
d.
e.
f.
3.
Malignancy
General Principles epidemiology, risk factors, clinical work-up,
therapeutic considerations
Neck cancer
- triangles of the neck
- staging TNM
- surgical treatment- radical neck dissection
Nasal Cavity and Paranasal sinuses
Nasopharynx
Oropharynx
Salivary Glands
Treatment
Follow up

Diagnostics
Specific Conditions
Hyperthyroidism/hypothyroidism
Thyroid neoplasms
Papillary
Follicular
Medullary
Anaplastic cancers
Hyperparathyroidism / hypoparathyroidism
Parathyroid neoplasms
Treatment
Follow up
THE BREAST
a.
b.
c.
d.

Diagnostics
Specific Conditions
Benign
Cystic changes
Breast infections
Fibroadenoma
Ductal papilloma
24
Malignant
e.
f.
4.
Congenital
Treatment
Follow up
Skin and Soft Tissue Tumors

a.
b.
c.
Diagnostics
d.
Specific Conditions
Benign
e.
f.
5.
Gynecomastia
Galactocoele
Ductal carcinoma
In situ
Invasive
Lobular carcinoma
In situ
Invasive
Special types of carcinoma
Sarcoma
Phyllodes Tumor
Malignant
Treatment
Follow up
ABDOMINAL WALL DEFECTS AND HERNIAS

a.
b.
c.
d.
e.

Diagnostics
Specific Conditions
Umbilical
Indirect inguinal
Direct inguinal
Femoral
Sliding
Ventral
Incisional
Others
Treatment
Open Tissue Repair
Open Mesh Repair
Laparoscopic Approach
TAPP
TEP
25
f.
6.
THE ESOPHAGUS
a.
b.
c.
d.
e.
f.
7.
8.
Follow up

Diagnostics
Specific Conditions
Motility disturbances
Diverticulae
Esophageal Strictures (Benign)
Esophageal Perforation
Esophageal varices
Malignant Tumors
Adenocarcinoma
Squamous Cell
Others
Treatment
Follow up
THE STOMACH AND DUODENUM

a.
b.
c.
d.

Diagnostics
Specific Conditions
Peptic Ulcer Disease and its Complications
Gastric varices
Gastric Malignancies
Morbid Obesity
e.
f.
Treatment
Follow up
THE SMALL-INTESTINE, COLON, RECTUM AND ANUS

a.
b.
c.
d.

Diagnostics
Specific conditions
Polyps
Intestinal Obstruction
Intestinal Tuberculosis
Amoebic Colitis
Typhoid Enteritis
Diverticular Disease
Crohns disease & ulcerative colitis
Volvulus
26
e.
f.
9.
THE LIVER, GALLBLADDER AND BILIARY TREE

a.
b.
c.
d.
e.
f.
10.
Rectal Prolapse
Intussusception
Malignant conditions of the small intestines
Surgical lesions of the appendix appendicitis, etc.
Short Bowel Syndrome
Colonic malignancies
Rectal Malignancies
Hemorrhoids, Abscesses and Fistula-in-ano
Anal Carcinoma
Condyloma Acuminata
Trauma
Others
Treatment
Follow up
Anatomy and physiology

Diagnostics
Specific Conditions
Liver abscesses
Liver Cysts
Benign hepatic tumors
Primary and metastatic cancer of the liver
Portal Hypertension
Gallstones
Acute and chronic cholecystitis
Cholangitis
Cholangiocarcinomas
Choledochal cysts
Trauma
Others
Treatment
Follow up
THE PANCREAS & SPLEEN

a.
b.
c.
d.

Diagnostics
Specific Conditions
Pancreatitis
Cysts & Pseudocysts
Pancreatic tumors
Hypersplenism
Trauma
27
e.
f.
Treatment
Follow up
11. ACUTE SURGICAL ABDOMEN

a.
b.
c.
d.
e.
C.
Definition
Clinical manifestations
Conditions which may mimic or give rise to acute surgical
abdomen
Approach to patients with suspected acute surgical abdomen
Principles of surgical management
CLINICAL SURGERY SUBSPECIALTY SURGERY

Objective: At the end of the specialty rotations, the resident should be able to
recognize and institute initial management for common and life or limb-threatening
specialty problems.
1.
PEDIATRIC SURGERY
a.
b.
c.
2.
PLASTIC SURGERY
a.
b.
c.
d.
3.
Perioperative Care
Common Pediatric Surgical Conditions
Acute Abdomen Appendicitis, GI bleeding,
Obstruction in older children
Inguino-Scrotal Problems
Neonatal Surgical Emergencies Imperforate Anus,
Intestinal obstruction, abdominal wall defects, TEF,
Diaphragmatic hernia
Congenital Masses - Thyroglossal cysts,
Teratomas, Branchial clefts, vascular tumors, Hygromas
Technical considerations in skin grafts & flaps

Management of maxillofacial trauma
Congenital anomalies
Cleft lip and palate
Cosmetic surgery Principles
Scar revision
Rhinoplasty
Blepharoplasty
Mammoplasty
UROLOGY
a.
b.
c.
Anatomy and Physiology of GUT

Diagnosis
Disease Conditions and Treatment
28
Urinary calculi
Tumors Renal, Bladder, Prostatic, Testicular
Urologic Trauma
Other Urologic Emergencies
- Anuria due to obstructive uropathy, bilateral,
outlet obstruction including neurogenic bladder
- Acute scrotum (testicular torsion)
4. ORTHOPEDICS
a.
b.
c.
d.
e.
f.
Orthopedic Trauma
Fractures
Common long bone fractures
Hand injuries
Orthopedic infection Septic arthritis, osteomyelitis,
Potts Disease
Bone and Soft tissue neoplasms of the extremities
Congenital orthopedic deformities, Scoliosis
Diagnostic: FNAB, Superficial joint aspiration (elbow and
knee)
Technical considerations: casting, splinting, traction
techniques
5. THORACIC AND CARDIOVASCULAR SURGERY

a.
b.
c.
d.
e.
f.
Anatomy and Physiology of the Heart & Lungs

Common Surgical Conditions
Trauma
Peripheral Vascular injury
Diaphragmatic injury
Neoplasms
Lung primary and metastatic
Metastatic
Mediastinal tumors
Infections
Empyema thoracis
Common Vascular conditions
Peripheral vascular occlusive disease
Varicose veins
Abdominal aortic aneurysm
Common Cardiac Conditions
Pericardial effusion
6. NEUROSURGERY
a.
b.
Anatomy and Physiology of the CNS

Common surgical conditions
29
c.
D.
Recognition and initial management of increased

ICP- trauma, space-occupying lesions
Trauma low velocity gun shot wounds
Indications for use and interpretation of diagnostic testsskull x-ray, CT, angiogram
PRINCIPLES OF SURGICAL DIAGNOSTICS:

1.
Laboratory work ups
Blood Chemistry
Immunohistochemistry
Tumor Markers
Others
2.
Imaging Studies
X-ray
Ultrasound
CT scan
MRI
PET scan
Nuclear Scintigraphy
3.
Endoscopy
4.
Laparoscopy
5.
Biopsy
30
H. TEACHING-LEARNING ACTIVITIES
To achieve the wide range of training objectives-cognitive, psychomotor, affective; the
program has to provide relevant learning experiences.
The activities should focus on the development of higher cognitive-skills like problemsolving and decision-making.
Technical skills should be refined appropriate to the level of training.
The proper attitudes and values needed in the practice of Surgery should be enhanced.
The competencies and abilities acquired by the residents should be demonstrated in how
patients are managed, how procedures are performed, and how cases are presented and
discussed.
1.
Patient Management
Patient Care in the hospital setting
Wards & Emergency Room
Operating Room & Recovery Room
Intensive Care Unit
Outpatient Clinics
Community Service & Surgical Missions
2.
Presentation and Discussion in the classroom setting

Pre-and post-op Conference
Mortality/Morbidity Conference
Journal Club
Didactic lectures
Multidisciplinary Conferences
Ward rounds
Grand Rounds
Interdisciplinary Tumor Conferences
3.
Skills Acquisition and Demonstration in the Hospital Setting

Skills Laboratory
Operating Room
Emergency Room
Intensive Care Facilities
Outpatient Clinics
Wards
31
I. ORGANIZATION & SEQUENCE OF ROTATIONS

The guiding principle: There must be a definite structure and sequence in the
organization of rotations:
Training programs must be five (5) years or sixty (60) months in duration; at least forty-five
(45) months will be spent in General Surgery (GS) and fifteen (15) months will be spent in
the other specialties.
General Surgery will include: Surgery for Trauma, Critical Care & Nutrition, Out-patient
Clinics, Emergency Room, Surgical Oncology, and Minimal Access Surgery
Specialty Surgery will include: Neurosurgery, Urology, Plastic and Reconstructive
Surgery, Pediatric Surgery, Orthopedic Surgery and TCVS.
The length of the rotations will be guided by an Instructional Design for that particular
rotation. The rotations may be combined & interchanged but these must be limited to
the Residency Levels indicated.
Conferences in Surgical Pathology and Radiology & Other Imaging Modalities are to be
conducted in lieu of rotations in these specialties.
There will be three (3) Residency Levels of Training: Junior, Intermediate and Senior
Level.
The rotations will be as follows:
Resident Level
Junior
Intermediate
Year
Level
I
General Surgery
II
III
General Surgery, Out-patient Clinics, Emergency Room

Plastic & Reconstructive Surgery, Pediatric Surgery,
Orthopedic Surgery, Urologic Surgery, Neurosurgery,
Thoracic and Cardiovascular Surgery
IV
&
V
Surgery for Trauma,

General Surgery (Critical Care & Nutrition, Minimal
Invasive Surgery, Surgical Oncology)
&
Senior
Rotations*
*Note: Please refer to Instructional Designs for each year level on pages 35-46
32
J. THE RESOURCES
In order to attain the objectives of residency training, there are resources that
should be provided.
There must be a sufficient number of trainers, to oversee the implementation of the
program, to participate in the teaching-learning activities, and to evaluate the
residents in training.
There must be adequate hospital facilities and clinical material to expose the
residents to the common surgical problems, provide them hands-on experience in
diagnosis and management, give them opportunity to develop, not only the
knowledge and skills, but the proper values and attitudes in the practice of Surgery.
A.
THE HOSPITAL
1.
Bed Capacity
2.
Outpatient Facilities
3.
Pathology Services
4.
Radiology Services
5.
Ultrasound
6.
Blood bank or facilities for blood storage
7.
Medical Library
8.
Emergency Room
9.
Operating Room
10.
Recovery Room
11.
Critical Care Facilities
12.
Tumor Board and Hospital Tumor Registry
13.
Major Clinical departments
14.
Clinical material
B.
The FACULTY
1.
2.
3.
C.
The Chairman
The Training Officer / Training Committee
The Consultant Staff - Minimum of 3 PSGS Fellows
The CASE MATERIAL volume of cases per program is at least 100 major
cases/5 residents/year with sufficient variety
33
K. EVALUATION
A.
THE RESIDENTS PERFORMANCE

Evaluation Method
Measurement Tool
B.
1.
Basic theoretical knowledge
Written Exams
Oral Exams
2.
Clinical Competence
Direct Observation
Rating Scales
Record Review
3.
Technical Skills
Direct Observation
Rating Scales
Record Review
4.
Attitudinal Competencies
Direct Observation
Rating Scales
Critical Incident Reports
THE PROGRAM
Components
1.
2.
3.
The structure
The activities
The resources
Visit by the PSGS Committee

on Accreditation
Annual Report
34
PART II
INSTRUCTIONAL DESIGN
Junior Resident
Level I (First Year)
Rotation: General Surgery
INTENDED
LEARNING
OUTCOMES
CONTENT
At the end of the FIRST year, the

RESIDENT should be able to:
1. COGNITIVE
1.1. Discuss the
principles of
diagnosis and management of
common
general
surgical
disorders.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Surgical Anatomy,
Physiology, General
Pathology
Ward Procedures
Wound Healing
Endocrine, Metabolic and
Immunologic Response to
Injury.
Fluids and Electrolytes
Shock and Resuscitation
Bleeding and Blood
Transfusion
Principles of Surgical
Infections and antibiotics;
Asepsis and Antisepsis
Surgical Complications
Trauma Epidemiology &
Prevention, Extrication&
Trans- port, Triage, Patterns
of Injury, Basic Life Support,
Scoring System, Trauma
Center
Minimally Invasive Surgery
Advantages and
Disadvantages of MIS
Approach,
Pathophysiology of
Pneumoperitoneum,
Pathophysiology of
General Anesthesia,
Operating room set-up,
Equipment, Optical
devices, Instrumentation
for Access, Equipment for
creating domain, Energy
Sources, Ergonomics,
Basic Skills
Surgical Oncology refer to
Curriculum
Basic Surgical Nutrition
Fluid & Nutrition
Requirements
Nutrition screening and
Risk Assessment
LEARNING
ACTIVITIES
Large Group Learning

1. Grand rounds
2. Pre and
Postoperative
Conferences
3. Mortality and
Morbidity
Conferences
4. Admitting rounds/
Endorsement
5. Lectures
6. Journal Club
7. Interdisciplinary
Tumor Conference
8. Ward rounds
9. Workshops in
Research
Methodology
& Critical Appraisal
of
Literature
Small Group Learning
1. Group Discussion
2. Group Tutorial
3. Brainstorming
Independent Learning
1. Individual Study
2. Self-Instructional
Materials
Lecturette
Demonstration
Role Playing
Simulation
1.2.
Discuss
WHO
Patient
14. Patient Safety Appropriate
35
RESOURCES
1. Textbooks
Principles of Surgery
Anatomy
Surgical Anatomy
Physiology
Pathology
Problem-oriented
Surgical Diagnosis
Evidence Based
Surgery
2. Access to all PCS/PSGS
Evidence based guidelines
3. Textbooks and
manuals of nutrition
4. Audio Video Equipment
5. Journals
PJSS
Foreign journals
6. Consultant Staff
7. Internet
8. CD on Minimal Access
Surgery
9. ICD 10 Manual
10.Committee on Research
11. The SAGES Manual:
Fundamentals of
Laparoscopy,
Thoracoscopy and GI
Endoscopy 2nd Ed.,
Carol E.H. Scott
Cooner (ed.)
Mastery of
Endoscopic and
Laparoscopic
Surgery, 3rd Ed.,
Nathaniel J. Soper,
Lee L. Swanstrom,
W. Stephen Eubanks
EVALUATION
Written Exams
Oral examinations
Direct Observation
Oral examination
Safety Framework based on the

WHO Patient Safety Curriculum.
A.
Discuss how to
effectively
communicate to
patient
B.
Discuss how to
prevent, identify
and/or manage near
miss injuries or
adverse events.
C.
Demonstrate how to
work safely in the
workplace
Communicating Skills
Communicating Risks
Open Disclosures
Obtaining Consents
Delivering bad news
Respect to cultural and religious
diversity
Recognizing reporting and
managing near miss and
adverse events
Managing risks
Understanding health care
errors
Managing complaints
Showing leadership and being
team player
Understanding complex health
organization
Understanding human factors
Providing continuity of care
Managing fatigue and stress
D.
Applies evidence
based practice and
updated information
technology
Employing available best

evidence based practice
Using information technology to
enhance safety
E.
Discuss medication
safety
Preventing wrong patient, drug,

dose, route ,timing in
medication
Rational antibioitic use
F.
Applies Infection
Control principles.
5 moments of handwashing
Preventing surgical site
infection
1.3. Demonstrate knowledge of

the
principles
of
Research
Methodology and Critical Appraisal
of Literature.
2. PSYCHOMOTOR
2.l. Evaluate surgical patients
a.
b.
c.
d.
e.
f.
g.
Obtain an adequate
history
Perform a thorough
physical exam
Order pertinent
laboratory and
diagnostic exams
Formulate a logical
diagnosis
Formulate treatment
plan
Refer appropriately
Provide continuing
Care
2.2. Perform minor surgical

procedures
15. Basic surgical skills

16.Research Methods &
Critical Appraisal of Literature
1. Signs and Symptoms of

Diseases
Ward and OPD work
1. Ward / OPD patients

2. Radiology facilities
3. Central Laboratory
4. Consultant Staff
1. Performing minor
surgical operations
1. Operating Room
facilities
2. Outpatient facilities
3. Pathology
4. Atlas of Operative
Technique
5. PCS Basic & Advanced
2. Diagnostic Procedures
Observation using
rating scale
3. Principles of management of
patients with diseases of the:
a. Alimentary tract
b. Abdomen and its
contents
c. The breast
d. The head and neck
e. The vascular system
f. The endocrine system,
skin and soft tissues
A.
B.
Pre-operative care:
Optimization
Pre-operative Skills
1. Biopsy
Incisional
Excision
FNAB
36
Direct Observation
using rating scale
Record Review
Logbook or
Records
2.3.Assist in the performance of

surgical procedures done by
consultants and other
residents
2.4. Perform CPR

2.5. Perform Nutrition screening
and assessment
2.6. Demonstrate basic principles

Of Minimal Invasive Surgery
2. Venous access
3. Intubation
Endotracheal
NGT
Foley catheter
4. Endoscopy
Proctosigmoidoscop
y
Anoscopy
Laryngoscopy
Operative Skills
1. I & D
2. Local anesthetic infiltration
3. Local excision of surface
lesions
4. Cricothyroidotomy
5. Tracheostomy
6. DPL
7. Aspiration of body cavities
Thoracentesis
Pericardiocentesis
Paracentesis
8. Assisting Operations
9. Circumcision
10. Electrocautery of warts
11. Simple appendectomy
Post-operative care
1. Wound care
2. Care
of
tubes,
drains
catheters
3. Stoma care
1. Indications and
contraindications
2. Complications detection
and management
3. Gowning and gloving; patient
preparation
Basic Life Support
Perform Subjective
Global Assessment and Compute
for Caloric & Fluid Requirements
Surgical Skills CD
Manual
6. Surgical Skills Lab
(optional)
1. Assisting in surgical
procedures
2. Independent
Learning
Individual Study
Self-Instructional
Materials
1. CPR training
2. Return
demonstration
1. Consultant staff
2. ER, RR, Critical care
facilities
3. Case material
4. Textbook on
Complications of
Surgical Operations
5. Internet
6. Demonstration
7. Teaching aids, videos,
audio tapes
1. Instructors
2. BLS Workshop
3. Training mannequins
4. The SAGES Manual:

Fundamentals of
Laparoscopy,
Thoracoscopy and GI
Endoscopy 2nd Ed.,
Carol E.H. Scott
Cooner (ed.)
1. Identification of MIS
instruments
2. Proper Care of MIS
equipment and Instruments
3. Setting up the MIS equipment
4. Patient positioning and
securing
5. Energy sources and safety
6. Basic skills in a training box
7. Camera Navigation
5. Mastery of
Endoscopic and
Laparoscopic
Surgery, 3rd Ed.,
Nathaniel J. Soper,
Lee L. Swanstrom, W.
Stephen Eubanks
6. Laparoscopic tower
and instruments
Direct Observation
Rating Scales
Incident Reports
Direct Observation
Rating Scales
Incident Reports
Direct Observation
Rating Scales
Incident Reports
Direct Observation
Rating Scales
Checklist
Same as above
Same as above
Patient
Satisfaction
Survey
Critical
Incident Report
Peer Review
7. Pelvic Trainor
8. Skills Lab
2.7. Discuss WHO Patient Safety
Framework
A.
Display effective
communication to
patient
1. Appropriate
2. Communicating Risks
3. Open Disclosures
4. Obtaining Consents
5. Delivering bad news
37
B.
Demonstrate how to
prevent, identify
and/or manage near
miss injuries or
adverse events.
6. Respect to cultural and

religious diversity
7. Recognizing , reporting and
adverse events
8. Managing risks
C.
Demonstrate how to
work safely in the
workplace
9. Understanding health care

errors
10. Managing complaints
11. Showing leadership and
being team player
D.
Applies evidence
based practice and
updated information
technology
12. Understanding complex

health organization
13. Understanding human
factors
14. Providing continuity of care
E.
F.
Apply principles of
medication safety
Applies Infection
Control principles.
15. Managing fatigue and

stress
16. Employing available best
17. Using information
technology to enhance
safety
18. Preventing wrong patient,
drug, dose, route, timing in
medication
19. Rational antibiotic use
20. 5 moments of hand
washing
21. Preventing surgical site
infection
22. Rational Use of Antibiotics
3. AFFECTIVE
3.1. Demonstrate the proper
attitudes and habits in the
practice of surgery
1.
2.
3.
4.
5.
6.
7.
8.
3.2. Shows ethical practices
in the workplace
Expresses commitment to life
long learning.
Intellectual Integrity
Moral, Ethical value
Reliability / Responsibility
Appropriate
Bedside
Decorum
/
Relationship
w/patient
Study / Work habits
Relationship with co-health
workers & superiors
Emotional maturity reaction to
emergency or stress
Social Responsibility
1.
2.
3.
4.
Simulation
Role Modeling
Mentoring
Resident as
Teacher program
38
1. Written Hospital
Policies and
Procedures
2. Hospital Manual on
Resident decorum
3. Faculty Members as
Direct Observation
Rating Scales
Checklist
Incident Reports
1. OSCE
2. Faculty Mentorship
& Role Modeling
with self reflection
in professionalism
3. Chart Review
role model
4. Code of Ethics of the
Medical Profession
5. PMA code of Ethics
6. PCS code of Ethics
4. Chart Audit
5. Global Evaluation
Form
6. Patient
Satisfaction
Survey
7. Peer Review
39
Intermediate Level Resident

Level II & III (Second & 3rdYear)
Rotations: General Surgery, Plastic Surgery,
Pediatric Surgery, Orthopedics,
Neurosurgery, TCVS, and Urology
INTENDED LEARNING
OUTCOMES
At the end of the SECOND and THIRD
year, the RESIDENT should be able
to:
1. COGNITIVE
1.1. Provide initial care to patients
with acute abdomen , trauma &
other life threatening surgical
conditions
1.2. Provide comprehensive care to
patients consulting for common
surgical disorders in out patient
setting.
1.3. Apply the principles of the
following in the management of
a surgical disease.
1.3.1.
Surgical Pathology
1.3.2.
Imaging modalities
(Radiology, CT-scan,
MRI, ultrasound,
mammography,
nuclear scan )
1.3.3.
Surgical Endoscopy
1.3.4.
Surgical Oncology
1.3.5.
Surgical Critical Care
1.3.6.
Minimal Access
Surgery
1.3.7.
Trauma
1.4. Demonstrate knowledge of the
disorders in the other surgical
specialties.
1.4.1.
Pediatric Surgery
1.4.2.
Plastic Surgery
1.4.3.
Urology
1.4.4.
Orthopedics
1.4.5.
Neurosurgery
1.4.6.
Thoracic &
Cardiovascular
1.5. Given a patient with complex
General Surgery or
subspecialty problem, the
resident should be able to
formulate a comprehensive
management plan
CONTENT
1. Surgical diseases requiring

medium surgical operations.
2. ER & OPD procedures
3. Common medium
complex procedures
4. Surgical Pathology
5. Surgical Imaging
6. Minimally Invasive
Surgery
Patient Selection
Preoperative work up
and evaluation
Methods of Access
&pneumoperitoneum
Prevention of
complications in
Laparoscopy
Laparoscopic
Endosuturing &
Extracorporeal Tying
Diagnostic
Laparoscopy
Indications for
Laparoscopic
Appendectomy and
Cholecystectomy
7. Surgical Oncology
Diagnosis & staging
Multimodal approach
Pre operative Adjuvant

Treatment
Surgical extirpation
Post operative
Adjuvant Therapy
Palliative Care
8. Surgical Critical Care &
Nutrition
Care of the Critically-ill

patient
Nutritional support in
critical illness, surgery,
trauma, sepsis
Nutritional assessment
Nutritional support
(parenteral & enteral)
LEARNING
ACTIVITIES
RESOURCES
Structured Supervised
Rotation ER, OPD,
OR, Ward duties
1. Textbook of Surgery
Written Exam
2. Textbook of Trauma
Direct Observation
3.Textbook of Pathology
Records Review
4.Textbook of Radiology
& Imaging Modalities
Incident Reports
1. Grand rounds
2. Pre and
3. Postoperative
Conferences
4. Mortality and
Morbidity
5. Admitting rounds
6. Census
7. Lecturette
8. Journal Club
Tumor Conference
10. Clinicopathological
correlation during
surgical conferences
11. Correlative
Radiology
Conferences
Participation in
Postgraduate
Courses &
Workshops
1.
2.
3.
4.
5.
Group Discussion
Group Tutorial
Brainstorming
Ward Rounds
ER Consultations
Individual Study
Self-Instructional
Materials
40
5.Textbook in Surgical
Ultrasound
6. The SAGES
Manual:
Fundamentals of
Laparoscopy,
Thoracoscopy and
GI Endoscopy 2nd
Ed., Carol E.H.
Scott Cooner
(ed.)
7. Mastery of
Endoscopic and
Laparoscopic
Surgery, 3rd Ed.,
Nathaniel J. Soper,
Lee L. Swanstrom,
W. Stephen
Eubanks
8. PCS BEST Course
9. PCS Evidencebased guidelines in
common surgical
diseases
10. PCS Cancer Facts &
Figures
11. Atlas of Surgical
Operations
12. Emergency Room
13. Pathology service
14. Radiology service
15. Blood Bank
16. PCS IONS Manual
17. Textbooks
Pediatric surgery
Plastic surgery
Urology
Orthopedics
Neurosurgery
TCVS
EVALUATION
Surgical Critical
Care
Surgical nutrition
Surgical Oncology
Trauma
9. Trauma Advanced
trauma care
10. Common Surgical
Conditions in:
A.
B.
Pediatric Surgery
Common pediatric
surgical conditions
Vascular access
Inguinal hernia /
hydrocoele
Imperforate anus,
other causes of
intestinal obstruction
Abdominal trauma
Appendicitis
Intussusception
Rectal polyps
Soft tissue tumors
18.
19.
20.
21.
Journals
Outpatient facilities
Medical Library
ER, RR, Critical
Care facilities
22. PCS critical care &
nutrition basic &
advanced
workshops
23. Audiovisual
facilities
24. Internet
Plastic
Burns
Basal cell
Carcinoma
Squamous cell
carcinoma
Melanoma
Pressure sores /
decubitus ulcers
A. Urology
Common urologic
disorders
Hydrocoele
Benign Prostatic
Hypertrophy
Testicular torsion
Urolithiases
Kidney & bladder
trauma
D. Orthopedics
Fractures (closed /
open, long bones,
digits, etc.)
Joint and
ligamentous
injuries,
(dislocations,
internal knee
derangements,
sprains, etc)
Bone tumors: benign
and malignant
Infections
(osteomyelitis,
diabetic foot, joint
abscess, deep
palmar abscess,
felon, etc.)
Evaluate
musculoskeletal
pain (low back
pains, cervical
strain, etc)
41
E.
Neurosurgery
Principles of
management of
patients with
diseases of the
central, peripheral,
and autonomic
nervous systems
including their
supporting
structures and
vascular supply
Common
neurosurgical
conditions
Recognition and
initial management
of increased
intracranial
pressure such as
in trauma, space
occupying lesion.
Head and spine
trauma
F. Thoracic and
Cardiovascular Surgery
Principles of management
of patients with
Hydrothorax
(includes
hemothorax &
pyothorax)
Pneumothorax
Blunt & penetrating
thoracic injuries
Peripheral vascular
injuries
1.6. Discuss clinical teaching and
evaluation principles.
1.6.1.
1.6.2.
1.6.3.
1.6.4.
1.6.5.
Formulate a simple
instructional design
for a teaching
learning activity.
Design a complete
lecture plan
Discuss the different
small group learning
activities
clinical teaching
method.
clinical evaluation
method.
A. Instructional design (ID)

Definition
Parts of ID
Preparation
B. Lecture
Definition
Body
Styles
Making it effective
C. Small Group Learning
Definition
Activities
Conduct
D. Clinical Teaching
Principles
Activities
Conduct
Audit
E. Clinical evaluation
Written exam
OSCE
42
2. PSYCHOMOTOR
2.1.
2.2.
2.3.
2.4.
2.5.
2.6.
2.7.
Perform minor, medium and

major procedures.
Correlate pathologic
process with clinical course
of the disease
Interpret and correlate
imaging modality pictures
with disease process.
Render emergency trauma
care and resuscitation
Demonstrate preparation in
endoscopy & minimal
access surgical procedures
Assist and perform open
and minimally invasive
surgical specialty
procedures
Assist co-workers during
surgical procedures
Direct observation
by checklist and
rating scales
Critical incident
report
In Addition to Junior Level
Skills
2.
1.
2.
Surgical Endoscopy
Laryngoscopy
Proctosigmoidoscopy
Exposure to flexible
endoscopy
Setting up of lap
tower
Basic MIS Skills

- Tissue Grasping
- Blunt Dissection
- Clipping
- Looping
- Ligation Incontinuity
- Scissors
- Specimen
Extraction
- Suturing
Techniques
- Stapling
Techniques
- Extra Corporeal
and Intra
corporeal knots
(Roeder, Meltzer)
3.
4.
Perform medium
operations
Assist major
operations
Skills lab
Animate and
inanimate
Supervised
exposure to
endoscopy &
laparoscopy
2.Emergency Room
3.Surgical Wards
4.Radiology Service
Radiologic , Ultrasound
& Imaging Modalities
5.Pathology service
7.Actual & Simulated

Patients
8.Simulated laboratories
/ venues
-Inanimate/animate
specimens
Surgery
Instruments &
trocars
Scopes
Energy sources
Laparoscopy
Machine
Accredited PSGS
workshops
Teaching Audio
and Video facilities
3. General surgical procedures

such as:
1.Operating Room
6. Phil. Society of
Ultrasound in Surgery
lectures & handouts
Trouble shooting
Instruments
reprocessing and
maintenance
Video Editing
2.8 Demonstrate principles of

clinical teaching and evaluation in
training junior residents, clinical
interns and clerks.
1.
10. OPD clinic

11.Specialty Clinics
Hernia repair
Thyroid & parathyroid
surgery
Mastectomy
Open
Cholecystectomy
with or without CBD
exploration
Splenectomy
Skin and soft tissue:
Wide Excision
GI anastomoses and
ostomies
Repair of perforated
bowel
Resection of
Intestines and colon
Exploratory
Laparotomy for
ruptured
appendicitis
Hemorrhoidectomy
and Fistulectomy,
Sphincterotomy
12.Teaching tapes, CDs

13. Atlas of Surgical
Operations
14.Simulated venues /
laboratory
15.PCS IONS Manual
16.PCS advanced
surgical skills CD
manual
43
Direct observation
Reports
CERES
4. Trauma operative
management of traumatic
injuries; perform FAST, if
available
5. Surgical Critical Care &
Nutrition
Compute for the caloric
and protein
requirements surgical
or otherwise critically ill
patients
CV access for
hyperalimentation
6.Surgical Oncology
Recommended surgical
procedures for specific
tumor sites.
7. Urology
Hydrocoelectomy
Nephrectomy for
trauma
Suprapubic
cystostomy
Cystolithotomy
Orchidopexy/
orchiecomy for
testicular torsion
8. Pediatric Surgery
Saphenous vein
cutdown
Herniotomy/
Hydrocoelectomy
Colostomy
Explor lap for trauma,

acute abdomen,
Obstruction,
Intussusception,
Appendectomy
9. Orthopedics
Open fractures: initial

debridement and
irrigation,
immobilization
Closed reduction of:

Common Closed
Fractures: clavicular,
Colles, tibial,
phalangeal
Dislocation: shoulder,
elbow, hip
Amputation and
disarticulation for
various indications
Soft tissue tumors

FNAB, marginal
excision of superficial
tumors
Common orthopedic
procedures prep and
draping splinting,
casting, traction,
taping
After-care of common
orthopedic problems
44
Spine immobilization
10. Plastic and Reconstructive

Surgery
Making the proper

incisions
Harvesting of skin
grafts
Skin grafting
Cleft lip repair
Flaps
Burn care
11. Neurosurgery
Cranial
decompression for
trauma (burr- hole
and
drainage/craniotomy
for epidural
hematoma)
12. Thoracic and Cardiovascular
Surgery
Thoracostomy
Pleurodesis for
malignant effusion
Percutaneous
transthoracic needle
biopsy
Thoracotomy for
thoracic trauma:
Pericardiostomy/
pericardiotomy
/pericardiocentesis
Vascular repair for

trauma
Vascular access:
subclavian vein
catherization, A-V
fistula
Vein stripping
13. Post-operative care
Wound care
Care of tubes, drains

catheters
Stoma care
Care of complications
Nutrition support
3. AFFECTIVE
3.1.
Demonstrate
the
attitudes and habits
practice of surgery
proper
in the
1.
2.
3.
4.
5.
6.
7.
8.
Moral, Ethical value
Appropriate bedside
decorum / Relationship
w/patient
Study / Work habits
workers & superiors
Emotional maturity reaction
to emergency or stress
45
Direct
Observation
Rating Scales
Incident Reports
Senior Level Resident

Level IV & V (Fourth and Fifth Year)
Rotations: General Surgery, Trauma, Critical
Care, Minimal Access Surgery, Surgical
Oncology
INTENDED LEARNING
OUTCOMES
At the end of the FOURTH and FIFTH
year, the RESIDENT should be able
to:
1. COGNITIVE
1.1. Apply the principles of
diagnosis and management of all
General Surgical disorders.
CONTENT
1. Basic Surgery
2. General & Cancer Surgery
1. Grand rounds
2. Pre and
3. Postoperative
Conferences
4. Mortality and Morbidity
5. Admitting rounds
6. Census
7. Lecturette
8. Journal Club
9. Interdisciplinary Tumor
Conference
10. Clinicopathological
correlation during
surgical conferences
11. Correlative Radiology
Conferences
12. Postgraduate Course
13. Trauma Audit
3. Specialty Surgery
1.2. Apply the principles of
diagnosis and management of all
surgical specialty disorders
1.3. Demonstrate knowledge in the
definitive and continuing
management of the trauma
patient.
1.4. Demonstrate knowledge in the
critical management of the
multiply injured patient
1.5.1. Apply the principles of

minimally invasive surgery in
basic & advanced surgical
procedures.
1.5.2. Discuss the prevention and
management of complications
in Minimally Invasive Surgery
LEARNING
ACTIVITIES
4. Trauma
Diagnostic modalities
Trauma radiology, FAST,
DPL
Definitive Management of
Trauma Injuries; Intensive
care and rehabilitation;
critical care
Polytrauma management
Mass casualty and disaster
management
Surgery in:
Cholecystectomy with
IOC
Acute Abdomen
Colon and Rectum
Hernia (Inguinal &
Ventral )

1. Group Discussion
2. Group Tutorial
3. Brainstorming
4. Ward Rounds
5. ER Consultation
1.6.Apply the principles of quality and

ethical surgical practice
1.7.Discuss the professional
behaviors
1.
2.
3.
4.
5.
6.
7.
Altruism
Compassion
Humility
Appropriate Physical
and Social Demeanor
Good Leadership
Qualities
Responsible
Accountable
Competent
Effective
communicator
Punctual
Constructive
Collaborative
Ethical
Commitment to
Excellence
1. Individual Study
2. Self-Instructional
Materials
1. Independent Learning
Lectures
2. Workshop & Symposia
in professionalism
3. Conferences
46
RESOURCES
1. Textbook of
Trauma
2. Audiovisual
facilities
3. Postgraduate
courses
4. PCS BEST Course
5. Textbook of Critical
Care
6. Manual in Nutrition
7. Training seminars
8. Medical Library
9. Internet
10. Textbooks on
Research
Methodology &
Designs
11. Workshops on
Critical Appraisal of
Literature
12. Journals
14. Emergency Room
15. Medical Library
16. Radiology service
17. Laboratory service
18. RR, CCU
19. Audiovisual aids
20. Internet
21. ATLS Manuals
22. Postgraduate
courses
23. Consultant Staff
EVALUATION
Written Exams
Oral Exams
Incident Reports
IONS Forms
Cognitive
- Standardized
assessment
tool
- Pre/post testing
of knowledge
- Standardized
evaluation after
conference
- Chart records &
portfolio
1.8 Apply principles of leadership

and management
1)Discuss learners institutional
organizational chart.
2) Discuss the organization s
vision & mission
8.
9.
Types of Organization
Formulating Vision and
Mission / Core Values
10. Leadership Skills
11. Managerial Skills
12. Strategic Planning
(SWOT technique)
1. Lecturette
1.
2.
2. Small Group Learning

3.
3. Mentorship
4.
3) Establish simple strategic plan

and financial management for the
organization.
2. PSYCHOMOTOR
2.1. Perform (selected per
category) major and complex
general surgical procedures
2.2.
Perform selected surgical

specialty procedures
2.3.
Assist consultants during

surgical procedures
2.4.
Assist junior and

intermediate residents
during surgical procedures
2.5.
Manage multiple organ

system traumatic injuries
2.6.
Apply critical care principles

in the continuing care of the
trauma patient.
2.7.
Demonstrate techniques in
the management of the
multiply injured patient.
2.8.
Oral Examination
Practical
Examination
-
In Addition to Junior &

Intermediate Level skills:
1. Clinical exposure
2. Supervised operations
1. More complex and radical

operations in general
surgery and the surgical
specialties such as:
Radical Mastectomy
Neck dissections and
combined operations
Parotid and other salivary
gland operations
Esophageal surgery
Gastric surgery with or
without vagotomy
Radical Gastrectomy
Liver resections
Biliary-enteric bypass
Pancreatectomy
Colectomies, abdominoperineal resection
Portosystemic procedures
Ileal conduit
Major amputations
Adrenalectomy
3. Independent Learning
2. Trauma
Perform Focused
Assessment with
Sonography in Trauma
(FAST)
Multiple casualty
Hospital/ER Triage
Multiple organ system
injuries
Care of the Critically
Injured patient
Participate in mass casualty

and disaster management
drills
1.
2.
3.
CCU
Operating Room
Consultant Staff
Individual Study
Self-Instructional
Materials
1.
2.
3.
4.
Drills
Workshops
Disaster preparedness
Mass casualty
capability building
5.
Wet Clinics
6.
Dry firing
7.
Animal models
8.
Simulation exercises
2.9.
Demonstrate proper
techniques in the use of staplers
in gastrointestinal operations.
2.10. Perform basic minimally
invasive surgery
Resource
Persons
John Maxwell
Leadership
books
Books in
Organization &
Management
Trainor
1. Emergency Room
2. NDCC-PCS MOA
3. Internet
1. Teaching videos
2. Simulators
3. Minimally Invasive Surgery

Diagnostic Laparoscopy
Laparoscopic
Cholecystectomy
Lapararoscopic
Appendectomy
47
Vision Missio
Strategic
Management
Financial
Management
Logbook Entries
CERES
Incident Reports
Direct Observation
3. AFFECTIVE
1.
2.
3.
4.
5.
6.
7.
8.
Intellectual integrity
Moral, Ethical Value
Reliability/ Responsibility
Bedside decorum
relationship w/ patient
Study/ Work habits
Relationship with Cohealth workers
Emotional maturity
Reaction to emergency or
stress
Social responsibility
48
PART III
EVALUATION SYSTEM FOR RESIDENTS IN GENERAL SURGERY
Background Information
This evaluation system is based upon the following:
1. The recommendations of a PCS workshop on Standardized Comprehensive Plan for
Evaluation of Residents in Surgery held at Nikko Manila Garden on September 12, 1992.
This was participated in by representatives from the Board of Regents, Committee on
Residents & Scholars, Phil. Board of Surgery, Department Chairmen, Training Officers and
Chief Residents of various selected institutions, with the technical assistance of Dr.
Angeles T. Alora of NTTC-HP.
2. Careful, detailed research on principles of evaluation process and appropriate use of
evaluation instruments for different competencies.
3. Expert technical assistance from the NTTC-HP.
4. Deliberations by the PCS Committee on Surgical Training.
5. Pilot testing of the rating scales from July 1, 1993 December 31, 1993 in the following
hospitals
1. Rizal Medical Center
2. FEU-NRMF Hospital
3. Chinese General Hospital
6. 1998 surveys on The Implementation of the Standardized Surgical Curriculum and The
Utilization of the PCS Standardized Evaluation System.
7. Multi-disciplinary Workshop on The Improvement of the Surgical Curriculum and
Standardized Evaluation System conducted October 30, 1999
The evaluation of the performance of residents in general surgery shall be based upon 4
major components, namely:
1. Basic theoretical knowledge
2. Clinical competence
3. Technical skills
4. Attitudinal competencies
1. Basic theoretical knowledge shall be evaluated by means of comprehensive, objective
written examinations. At least one (ideally, two) written examination shall be given to all
residents each year, aside from the PSGS required Residency In - Service Training
Examination. The scope or content coverage of the written examination shall be based
on the cognitive competencies per year level shown in Appendix I-A.
Since the cognitive competencies of a resident are expected to be cumulative as he
progresses from junior year to intermediate to senior year level, it is recommended that the
examination be designed in such a way that the resident is required to answer questions in
a cumulative fashion also. Thus, the first portion of the test shall include items covered
49
under intermediate year cognitive competencies and shall be answered by intermediate

and senior level residents only. The last portion of the test shall cover senior level
cognitive competencies and will be answered by senior level residents only.
1.1.
Oral Examinations - Integration and application of basic theoretical knowledge into

theoretical surgical decision-making or problem-solving shall be tested by means of
oral examinations. These oral exams shall be based on simulated clinical problems
appropriate for the year level of training and shall be given at least once a year to all
senior level residents or every after specialty rotation for intermediate level
residents. This comprises 40% of the grade for senior level residents.
A rating scale for evaluation during a simulated oral examination is shown in
Appendix II-A and shall be used for evaluation of performance in the oral exam.
1.2.
PSGS required Residency In Service Training Examination comprises 50%

of grade for Junior level residents and 30% of grade for Senior level residents.
1.3.
Departmental Written Examinations comprises 50% of grade for Junior level

residents and 30% of grade for Senior level residents.
The specific number of items to be given in the written and oral examinations per year level
as well as the proportional weight to be given to these exams (as well as the PBS InService exam) in the computation of scores under Basic Theoretical knowledge shall be left
to the discretion of the individual training program.
2. Overall clinical competence shall be evaluated by means of an observational rating scale
(see Appendix II-B) based on a careful and close observation of the residents behavior
and performance in actual clinical setting. Evaluation shall be done as frequently as
possible (a minimum of quarterly or end of rotation evaluation is recommended). In
addition, as many sources of evaluation (or raters) as possible should be obtained to
improve reliability. These include: Mortality/Morbidity statistics, Clinical outcome reports,
feedbacks from consultants, co-residents, peers and even self-evaluation. Only trainers
who can answer 5 out of the 6 criteria may qualify as raters. The proportion of weights to
be given to the different rotations and different raters in the computation of scores under
clinical competence shall be left to the discretion of the training program.
3. Technical skills in the performance of surgical procedures and operations shall be
evaluated by means of supervised observation of the residents as they perform the
procedure/operation. Technical mastery is obtained in stages: the trainee starts learning by
assisting in operations, then a period wherein the trainee is closely supervised when doing
a surgical procedure and finally when the trainee is allowed to independently perform a
surgical procedure of varying complexities and problems.
The specific procedures/operations to be performed and evaluated per year level are listed
in Appendix I-B. The rating scale for evaluating the technical skill as demonstrated by the
resident as he performs each procedure/operation is shown in Appendix II-C. Ideally, the
rating scale shall be accomplished by the rater who observed and supervised the
procedure/operation immediately upon conclusion of the operation.
50
The resident shall be evaluated on as many procedures appropriate for his level of training
as possible. Only trainers who have supervised or carefully observed the residents during
the performance of the procedure or can answer 6 out of 8 criteria shall qualify as raters.
The results of evaluation shall be collated and reported preferably on a quarterly or end of
rotation basis. The Comprehensive External Residents Evaluation System (CERES)
conducted by the chapter may be utilized as an additional evaluation tool.
The duration of operation refers to what is acceptable within the institution. The NNIS
Operative Procedure Category T-duration listing (see Appendix III), may be used as a
guide.
Since expertise and proficiency in the performance of technical procedures are obtained
with progressive experience, it is suggested that greater weight be given to evaluations
made towards the end of a rotation rather than at the beginning.
The specific number of procedures and percent weights to be given to each procedure and
type of rater (Consultant, senior resident and peer) shall be left to the discretion of the
training program.
4. Attitudinal competencies shall be evaluated by means of an observational rating scale
based on prolonged, periodic evaluation of a residents behavior demonstrated in actual
work setting. The rating scale is shown in Appendix II-D. Only trainers who have had the
opportunity to carefully observe the residents behavior over a prolonged period of time, or
can answer a minimum of 6 out of 8 criteria in the rating scale, may qualify as raters. The
observational rating scale shall be accomplished by as many raters as possible at least
quarterly or at the end of each rotation.
Again, the percent weights to be given to different sets of evaluation in the computation of
a residents attitudinal performance shall be left to the discretion of the training program
MINIMUM PASS LEVEL (MPL)
A minimum pass level (MPL) shall be set for each major component of the evaluation per year of
training and shall be set at 50% for each component for all year levels.
Evaluation Component
First Year MPL to Senior Year
Basic Theoretical Knowledge
50%
Clinical Competence
50%
Technical Skills
50%
50%
51
It is suggested that any resident, whose performance at the end of the year falls below the
minimum pass level set in any single evaluation component shall be subjected to appropriate
remedial measures or not recommended for promotion to a higher level of training. It must be
emphasized that all 4 major component competencies expected of a surgeon are equally and
individually important. Thus, serious deficiencies (failure to achieve minimum requirements) in
one aspect of the evaluation cannot and should not be overcome by adequate performance in
another aspect.
COMPUTATION OF TOTAL SCORES. Weights shall be given to each of the 4 major evaluation
components per year level of training to arrive at a total score for each resident.
Basic Theoretical Knowledge
20%
Clinical Competence
40%
Technical Skills
20%
20%
100%
It is recommended that the total scores be utilized more for ranking residents per year level. This
may be utilized to help reach decisions on merit awards, chief residency positions, provision of
salaried positions, etc. and not to decide on whether a resident is performing satisfactorily or not.
PROVISIONS FOR FEEDBACK
The detailed record of each residents performance shall be regularly collated and updated by a
Training Committee chaired by the training officer. In addition, they should regularly meet with
the residents (preferably individually) in order to fully inform them of the status of their
performance, point out areas of strengths and weaknesses and specify areas of improvement.
Measures for remedial or rehabilitative work should also be instituted for residents who fail to
meet minimum standards.
Residents shall be made aware of the criteria and basis for their evaluation so that they may be
fully conscious of the expectations with regard their performance.
52
APPENDIX I -A
EVALUATION OF COGNITIVE COMPETENCIES

The following cognitive competencies are to be evaluated at different year levels with the
corresponding evaluation tools to be used.
JUNIOR YEAR
1. Basic knowledge of surgical anatomy, physiology, pathology, oncology, metabolism, wound
healing, shock and critical care, resuscitation, immunology and organ transplantation, fluids
and electrolytes, nutrition, trauma, burns and surgical infection.
2. Principles of diagnosis of common surgical disorders
2.1.
Special diagnostic procedures ultrasound, CT scan, plain x-rays, contrast studies,
MRI, intra-op cholangiogram
2.2.
Endoscopic procedures esophagoscopy, gastroscopy, laryngoscopy,
bronchoscopy, proctosigmoidoscopy, colonoscopy, choledochoscopy.
3. Interpretation of basic diagnostic and laboratory examinations like CBC, urinalysis, blood
chemistry, chest x-ray, plain abdominal x-ray, IVP, barium enema, upper GI series, Gram
staining, culture and sensitivity.
4. Principles of operative surgery
4.1.
Asepsis and antisepsis
4.2.
Identification and function of instruments
4.3.
Sutures and knots types, properties, indications for use
5. Sound understanding of pre-operative, intra-operative and post-operative care of patients with
common surgical problems.
5.1.
Pre-operative care
a. Evaluation of operative risk
b. Preparation of patients (e.g. bowel prep, prep of toxic goiter, etc.)
5.2.
Intra-operative care
5.3.
Post-operative care
a. Wound care-dressings, local wound care, management of wound infection
b. Drains, tubes and catheters types, care, indications for use, timing of removal
c. Stomas types , care, appliances, complication
d. Management of ileus
e. Recognition of complications
6. Knowledge of research methodology & critical appraisal of literature
53
INTERMEDIATE YEARS
1.
2.
3.
4.
5.
6.
7.
All first year competencies

Working knowledge of critical care and trauma principles
Principles of diagnosis and management of common general surgical problems
Principles of diagnosis and management of common subspecialty surgical conditions
Basic knowledge of surgical pathology, radiology and other imaging modalities
Surgical decision-making
Designing research studies
SENIOR YEARS
1.
2.
3.
4.
5.
All competencies of junior and intermediate years

Comprehensive knowledge of all surgical conditions within the scope of general surgery
Surgical decision-making
Management of the critically-ill patient
At least one (1) research paper submitted prior to end of training
54
APPENDIX I B
EVALUATION OF PSYCHOMOTOR COMPETENCIES

JUNIOR RESIDENT LEVEL
1.
2.
Technical Skills
Pre-op
1. Surface biopsy
Incisional
Excisional
FNAB
Core Needle
2. Venous access
Venous cutdown
3. Airway access
Nasotracheal
Endotracheal
4. Endoscopy
Proctosigmoidoscopy
Anoscopy
Laryngoscopy
5. Catheterization
1.3.
Operative Skill
I&D
Local anesthetic infiltration bleeding
Local excision of surface lesions mangled digits
Debridement of skin infection
Carbuncle and superficial pressure ulcers
5. Aspiration of body activities
Thoracentensis
Superficial
Pericardiocentesis
Paracentesis
6. Assisting operations
7. Circumcision
8. Electrocautery of warts
9. Knot tying and wound closure
10. CPR
11. Simple appendectomy
1.5.
Wound care
Care of tubes, drains & catheter
Stoma care
INTERMEDIATE RESIDENT LEVEL

In Addition to Junior Level:
1.
1.4.
Post-operative care
1.
2.
3.
Pre-op care, operative performance and postoperative care of the following procedures
1.1.
Urology
Hydrocoelectomy
Nephrectomy for trauma
Orchidopexy/orchiectomy for testicular
torsion
Suprapubic cystostomy
Cystolithotomy
1.2.
Pediatric Surgery
Saphenous vein cutdown
Herniotomy/hydrocoelectomy
Colostomy
Exploratory laparotomy for trauma, acute
abdomen,
Orthopedics
Open fractures initial debridement and
irrigation, immobilization
Closed Reduction of :
Common closed fractures clavicular, tibial,
Phalangeal dislocation: shoulder, elbow, hip
Amputation and disarticulation above

elbow, BKA for mangled extremities and
profusely bleeding tumors; Phalangeal
fractures
Soft tissue tumors FNAB, marginal

excision, superficial tumors
Diagnostic aspiration and arthrotomy of

joints
Common orthopedic procedures

Prep and draping
Splinting, casting, traction, taping
After-care of common orthopedic

Problems
Spine immobilization
1.
2.
3.
4.
3.
obstruction, appendectomy
intussusception, polypectomy
1.6.
2.
Neurosurgery
Cranial decompression for trauma (burr-hole
and drainage/craniectomy for epidural
hematoma)
Thoracic and Cardiovascular Surgery

Thoracostomy
Percutaneous transthoracic needle biopsy
Pericardiostomy/ Pericardiotomy /
Pericardiocentesis
Vascular: repair for trauma (Peripheral

Vessel)
Vascular access: subclavian vein, AV

Fistula, IJ catherer insertion
Plastic and Reconstructive Surgery

Skin grafting
Cleft lip repair
General Surgical Procedures

2.1.
2.2.
2.3.
2.4.
2.5.
2.6.
2.7.
2.8.
2.9.
Tracheostomy
Open Hernia repair
Simple Mastectomy
Open Cholecystectomy
Skin and soft tissue: Wide Excision
Tube gastrostomy, Tube jejunostomy,
GI Ostomies
Simple Adhesiolysis
Exploratory Laparotomy for ruptured
appendicitis
2.10. Hemorrhoidectomy, Fistulectomy/Fistulotomy,
Ligation of Intersphincteric Fistular Tract
(LIFT) Procedure, Sphincterotomy
2.11. Excision of thyroglossal duct cyst
2.12. Simple Bowel Repair
55
APPENDIX I-B
EVALUATION OF PSYCHOMOTOR COMPETENCIES
SENIOR RESIDENT LEVEL

In Addition to Junior and Intermediate level
1. Selected specialty procedures such as:
1.1. Ileal conduit
1.2. Major amputations
1.3. Adrenalectomy (optional)
2. Radical and Complex General Surgical Operations such
as:
1.1. Thyroidectomy, Parathyroidectomy
1.2. Breast Surgery (BCS, MRM, Partial
Mastectomy, Subcutaneous Mastectomy,
Axillary Lymph Node Dissection, Sentinel
Node Biopsy)
1.3. Neck dissections and combined operations of the
Head and Neck
1.4. Parotid and other salivary gland operations
1.5. Esophageal surgery
1.6. Gastric Surgery
1.7. Liver resections
1.8. Biliary-enteric bypass
1.9. Pancreatectomy
1.10.Bowel resection / anastomosis
1.11.Abdomino- perineal resection
1.12.Portosystemic procedures
3.
4.
Subspecialty
3.1. Thoracotomy
3.2. Major vascular repair
3.3. Others
4.1. Diagnostic Laparoscopy
4.2. Laparoscopic Cholecystectomy
4.3. Laparoscopic Appendectomy
56
Appendix II-A
RATING SCALE FOR
ORAL EXAMINATIONS
1 poor
1.
2 marginal
4 good
3 - satisfactory
5 very good
6 - excellent
KNOWLEDGE BASE
[
Not Observed
1 [
Poor knowledge
of basic science
and clinical
information
expected for
appropriate
discussion of
case.
Has difficulty
recalling basic
science & clinical
information
expected for
appropriate
discussion of case
Occasionally has
difficulty recalling
basic science and
clinical information
and has difficulty
correlating
available data to
the clinical
situation
Has good recall of

basic science and
clinical
information is able
to correlate
available data to
the clinical
situation
Knowledge base
in basic science
and clinical
information is
broad and
comprehensive
but is not up to
date with current
literature
Knowledge base
in basic science
and clinical
information is
broad and
comprehensive,
is up to date
even with current
literature
2. APPROPRIATE DIFFERENTIAL DIAGNOSIS/PROBLEM LIST

[
Not Observed
3.
Does not know

how to use data
to obtain
differential
diagnosis or
problem list.
Frequently has
difficulty using
data to obtain
differential
diagnosis or
problem list
Occasionally has
difficulty using
available data to
obtain differential
diagnosis;
identifies problem
list
Evaluates
available data to
obtain adequate
differential
diagnosis;
identifies problem
list
Evaluates
available data
logically and
systematically to
obtain adequate
differential
diagnosis;
identifies
problem list
Efficiently
analyzes
available data;
synthesizes
information to
arrive at a
differential
diagnosis;
identifies
problem list
USE AND INTERPRETATION OF DIAGNOSTIC TESTS

[
Not observed
Does not know

what diagnostic
tests to request.
Does not know
how to interpret
simple basic
laboratory tests
Requested
diagnostic tests
are grossly
incomplete and
irrelevant; Has
difficulty
interpreting
simple, basic lab
tests.
Some important
diagnostic tests
are overlooked;
has occasional
difficulty
interpreting basic
lab tests.
57
Diagnostic tests
requested are
complete. Has
occasional
difficulty
interpreting basic
laboratory tests.
Diagnostic test
requested are
complete;
important tests
are included and
interpreted
correctly
Diagnostic tests
are exhaustive &
maximizes
information
gained.
Alternative tests
are planned out.
Tests are
interpreted
precisely
including
complicated &
difficult test
results.
4.
TREATMENT PLANNING
[
Not Observed
5.
Treatment plan is
incomplete and
inappropriate and
does not know
important
procedures/
treatment
modalities
Treatment plan is
incomplete or
inappropriate
important
procedures/treat
ment modalities
are frequently
overlooked
Treatment plan is
fairly complete
and appropriate
but important
procedures
treatments are
over-looked
occasionally.
Treatment plan is
complete and
appropriate
important
procedures/
treatments are
included but with
no alternative
plan
Treatment plan is
complete,
thorough and
precise with
appropriate
important
procedures/
treatment
included has
some difficulty
coming up with
alternative plans
Treatment plan is
comprehensive
thorough and
precise; suggests
appropriate
alternative plans.
COMMUNICATION SKILLS
[
Not observed
6.
Very poor
communication
skills, can not
explain his
thoughts and
perception in a
clear and
organized
manner.
Lacks
communication
skills, has
difficulty
explaining his
thoughts and
perception in a
clear and
organized
manner
Tries to
communicate and
explain his
thoughts and
perceptions;
occasionally
unclear or
disorganized;
may be verbose
Able to
communicate and
explain his
thoughts and
perceptions but is
sometimes
disorganized
Communicates
effectively and
clearly
Highly articulate;
communicates
effectively &
clearly; chosen
words are
appropriate,
well-organized
and concise
(direct to the
point}
INTELLECTUAL INTEGRITY
[
Not Observed
Intellectually
dishonest,
consistently tries
to extract self out
of a situation,
blames others for
mistakes
Frequently tries
to extract self
out of situations,
occasionally
accept mistakes
but refuses to
accept limitations
Occasionally tries
to extract self out
of situations,
accepts mistakes
but refuses to
accept limitations
58
Demonstrates
intellectual
honesty but
sometimes
refuses to accept
limitations
Intellectually
honest; humbly
accepts and
corrects personal
mistakes or
limitations
without
hesitation.
Intellectually
honest, humbly
accepts personal
mistakes or
limitations w/o
hesitation. Tries
to learn from it.
Appendix II-B
RATING SCALE FOR OVERALL CLINICAL COMPETENCE
1 poor
1.
Not Observed
2.
4 good
5 very good
6 excellent
1 [
Grossly
inaccurate
History and/or PE
History and PE
fairly complete
but some
important
information and
findings are
missing making a
diagnosis difficult
History and PE
complete for a
correct diagnosis
but with some
subtle
information
missing
History & PE are

complete &
accurate
pertinent and
important
information are
included
History & PE
obtained is
thorough and
precise
History and PE
are thorough and
precise and able
to obtain other
important
information and
PE maneuvers
even for rare
cases
USE AND INTERPRETATION OF DIAGNOSTIC TESTS

]
Not Observed
3.
[
3 satisfactory
DATA BASE (HISTORY & PE)

[
2 marginal
Requested
diagnostic tests
are grossly
incomplete or
irrelevant; Has
difficulty
interpreting
simple, basic lab
tests.
Some important
diagnostic tests
are overlooked;
has occasional
difficulty
interpreting basic
lab tests.
Diagnostic test
are complete;
important tests
are included and
interpreted
correctly but
some
unnecessary
tests included
rendering it not
cost effective
Diagnostic test
are complete;
important tests
are included and
interpreted
correctly
Diagnostic tests
are exhaustive
and cost
effective,
alternative tests
are planned out
as results are
received. Tests
are interpreted
correctly
Diagnostic tests
are exhaustive
and cost
effective,
alternative tests
are planned out
as results are
received. Tests
are interpreted
correctly.
Understands the
use and
interpretation of
special tests
DIAGNOSIS & JUDGMENT / DECISION MAKING

]
Not observed
Has difficulty
making correct
diagnosis or
decisions even in
simple clinical
situations.
Decisions are
irrational &
haphazard
Has some
difficulty making
correct diagnosis
or decisions in
common clinical
situations
Establishes
correct diagnosis
in common
surgical problems
most of the time
but needs
improvement in
making judgment
59
Establishes
correct diagnosis
or makes clear &
rational decisions
in common
clinical situations
Establishes
correct diagnosis
both common
and difficult
cases but needs
some guidance in
judgment for the
difficult cases
Diagnosis &
decisions are
consistently
correct, wellfounded and
comprehensive,
even in difficult
clinical situations
4.
[
PATIENT TREATMENT & MANAGEMENT (PRE & POST-OP)

]
Not Observed
5.
[
6.
Management and
treatment
strategies are
haphazard even
in common
surgical
problems,
bordering on
negligence in the
care of patients
Common
problems are
managed poorly
and haphazardly;
rarely contributes
constructively to
management of
difficult problems
Common
problems are
managed
satisfactorily; but
has difficulty in
managing difficult
problems in a
rational and
independent
manner
Common
problems are
managed
appropriately and
show enthusiasm
to learn and
contribute in
difficult cases
Common
problems are
managed
appropriately and
efficiently;
contributes well
to management
of difficult
problems
Consistently
constructive and
self-reliant in
approach to
management of
simple and even
most difficult
problems
Unable to
prepare oral
presentations on
time. Referrals
are disorganized
and inaccurate
Reports are
disorganized,
poorly integrated
and difficult to
follow
Reports are fairly

accurate and
understandable;
occasionally
disorganized or
misses some
important details
Reports are
communicated
clearly and
accurate
Is able to report
precisely and
comprehensively;
Includes
additional minor
information that
are crucial to
patient
management
Oral
presentations
include reports
on current
literature and is
able to correlate
and apply such
knowledge in the
actual clinical
setting
RECORD-KEEPING ABILITY
]
Not Observed
7.
[
ORAL PRESENTATIONS/ REPORTS/ REFERRALS
Not observed
Written records/
reports are
incomplete,
inaccurate,
Disorganized,
difficult to
understand
Has to be
constantly
reminded to
complete
records/reports
Written
records/reports
are fairly
complete with
occasional
inaccuracies;
important items
are sometimes
omitted; does
record keeping in
his own initiative
Major items
necessary are
recorded
completely,
accurately and
legibly on own
initiative
Written records /
reports are
thorough,
comprehensive
and concise
Written records /
reports are
comprehensive
and concise,
problems are
explained in detail
and updated daily
based on the
changes in the
patients condition
AFTER CARE
]
Not observed
Grossly neglects
the appropriate
after care (e.g.
tubes, drains,
wounds)
Occasionally
neglects
appropriate after
care or neglects
some minor
important parts of
after care (e.g.
tubes, drains,
wounds)
Does after care

on own initiative
however, needs
guidance in the
proper
management
(e.g. tubes,
drains and
wounds)
60
Provides
appropriate and
acceptable after
care (e.g. tubes,
drains, wounds)
has some
difficulty caring
for complicated
situations
After care is
comprehensively
and meticulously
provided; even in
complicated or
difficult situation
After care is
comprehensive
even in
complicated
cases, preventive
measures for
post-op
complications are
instituted and if
present is
recognized early
and measures are
done to manage
the complications
properly
Appendix II-C
RATING SCALE FOR TECHNICAL SKILLS
1 poor
2 marginal
3 satisfactory
4 good
5 very good
6 - excellent
1. PATIENT PREPARATION
[
Not observed
2.
Patient grossly
inadequately
prepared.
Patient prepared
but some
important steps
in patient
preparation
overlooked or
omitted
Some minor
steps in patient
preparation for
procedure are
overlooked or
omitted but of no
consequence to
the procedure
All Important,
major steps in
patient
preparation are
performed
Patient is
prepared for the
procedure. All
important major
steps and almost
all minor steps in
patient
preparation are
performed
Patient wellprepared for

procedure and
includes
attention to minor
details
PREPARATION OF EQUIPMENT
[
Not observed
5.
Fails to organize
needed
equipment and
instruments
essential to the
surgery. Cannot
proceed with
procedure
Fails to organize
some important
equipment,
instruments
&
supplies but may
still proceed with
the surgery
Fails to prepare
some minor
equipment,
instruments &
supplies.
Absence does
not affect
surgery.
Organizes and
prepares all
equipment,
instruments &
supplies
essential to
procedure as
much as the
hospital or
patient can
provide
Organizes and
prepares all
equipment,
instruments, and
supplies essential
to the procedure
Equipment,
supplies and
instruments are
prepared
comprehensively;
includes
alternative
equipment for
unexpected
findings
OBSERVANCE OF BASIC SURGICAL PRINCIPLES

[
Not observed
Failed to observe
and carry out
basic surgical
principles
throughout the
procedure posing
danger to the
patient.
Has major lapses

in observance of
basic surgical
principles in
some part of the
procedure and
not immediately
recognized. Has
to be reminded.
Has major lapses

but immediately
rectifies the
situation.
61
Has occasional
lapses and is of
no consequence
to the procedure.
Observed basic
surgical
principles
throughout the
procedure
Paid strict and

meticulous
attention to basic
surgical
principles
throughout the
procedure
4. TECHNICAL DEXTERITY
[
Not observed
5.
Movements are
grossly
imprecise, and
poorly
coordinated
Movements are
frequently
imprecise or not
well coordinated
Movements
occasionally
imprecise or not
well-coordinated
Movements are
accurate and
well-coordinated
Movements
highly precise
and coordinated
but shows
awkwardness in
difficult phases of
the procedure
Movements are
highly precise &
well-coordinated I
even in difficult
phases of
procedure
GENERAL CONDUCT OF PROCEDURE

[
Not observed
Frequently omits
major steps in
performing
procedure;
disorganized;
sequence
frequently
incorrect.
Hazardous to the
patient.
Occasionally
missed some
major steps in
procedure;
somewhat
disorganized;
some minor
inaccuracies in
sequence but will
not be hazardous
to patient
Occasionally
missed some
major steps but
operation was
done in the
proper sequence.
No consequence
to the patient.
Performed major
steps of
procedure and in
the proper
sequence
All steps (major &

minor of the
procedure were
performed
precisely,
thoroughly and in
clockwork
fashion
All steps were

performed
precisely,
thoroughly, in
sequence.
Unexpected
events handled
correctly
6. INTRA-OPERATIVE JUDGMENT
[
Not observed
Cannot make a
decision even in
simple
procedures and
findings
Finds difficulty
making
appropriate
judgments or
decisions even in
simple
procedures and
findings
Has occasional
difficulty making
appropriate
judgments or
decisions as
procedure
unfolds or
progresses in
simple
procedures
Is able to make
appropriate
judgments or
decisions based
on operative
findings in
uncomplicated
procedures; has
some difficulty in
complicated
situations
Able to make
precise judgment
or decision on
operative findings
with minimal
supervision even
in difficult or
complicated
situations
Makes precise
and proper
decisions
independently in
all intra-op
findings;
anticipates
complications
7. DURATION OF PROCEDURE
[
Not observed
Unable to
complete the
procedure alone
Completes
procedure thrice
the acceptable
time frame
Completes the
procedure twice
the prescribed
time.
62
Completes
procedure just
beyond the
prescribed time
Completes
procedure within
allotted period of
time
Completes
procedure
significantly
shorter than
allotted period of
time
Appendix II-D
RATING SCALE FOR ATTITUDINAL COMPETENCIES
1 poor
2 - marginal
4 good
3 - satisfactory
5 very good
6 - excellent
1. INTELLECTUAL INTEGRITY
[
Not Observed
1 [
Intellectually
dishonest;
provides
misleading
information
meant to deceive
and protect
himself; does not
accept his
limitations
Shows
inconsistency in
intellectual
honesty; has a
tendency to be
dishonest
especially when
under pressure
Intellectually
honest in most
situations, will
not volunteer
incriminating
information on
anyone unless
asked
Demonstrates
intellectual
integrity and
honesty; accepts
limitations
Demonstrates
intellectual
honesty even in
difficult situation;
accepts
limitations
without hesitation
and makes
conscious effort
to improve on
them.
Intellectually
honest with
consistency,
volunteers
information without
second thoughts
even if self
incriminating
2. MORAL / ETHICAL VALUES

[
Not Observed
1 [
Known to
engage
frequently in unethical practices
inconsistent with
accepted norms
& values
Has loose
understanding/d
elineating
between ethical
and unethical
medical values
and practices
Can understand
/ delineate
between ethical
and unethical
medical values
and practices but
sometimes has a
tendency to do
unethical
practices
Demonstrates
occasional
lapses in
maintaining
ethical values
and uprightness
Practices are
ethically and
morally consistent
with accepted
norms
Highly ethical and

morally upright;
provides an
excellent example
to peers and
subordinates
3. RELIABILITY/RESPONSIBILITY
[
Not Observed
1 [
Irresponsible,
unreliable; needs
repeated
reminders of
assignment; does
less than
prescribe work
Performs duties
and
responsibilities
but has to be
reminded. Work
sometimes not
finished on time
Performs duties
and
responsibilities
that are assigned
to him. Works
enough just to get
by. Complains
when given extra
work
63
Performs duties
promptly and
efficiently
without being
reminded,
Willing to do
additional work
when asked
Performs duties
promptly and
efficiently without
being reminded;
is resourceful
and innovative;
takes initiative to
spend additional
time
When done with

own duties has
initiative to take
on additional
work. Motivates
co-workers to
perform well
4. BEDSIDE DECORUM/ RELATIONSHIP WITH PATIENTS

[
1 [
Not Observed
Tactless and
disrespectful of
patients feelings
and privacy;
antagonizes and
generates
negative feelings
from patients
Shows respect
and sensitivity
towards patients
and relatives,
however has
difficulty
controlling
personal feelings
to difficult
patients
Shows respect
and sensitivity
towards patients
and relatives
feelings, tends to
be superficial,
relates well only
to interesting
patients
Respectful of
patients &
relatives, relates
effectively and
establishes good
rapport with
patients, has
some problems
handling difficult
situations
Considerate and
sensitive to
patient & relative
feelings,
establishes
rapport with all the
types of handling
patients
Compassionate
and caring,
commands
respect and able
to mediate in
misunderstanding
s between
patients/relatives
and hospital
workers
5. STUDY/WORK HABITS
[
Not Observed
1 [
Fails to
demonstrate
know-ledge of
required reading
or
accomplishment
of assigned
work; fails to
attend rounds
and conferences
Shows
inconsistency in
demonstrating
knowledge of
required
readings,
occasionally fails
to accomplish
assigned work.
Sometimes
absent from
rounds and
conferences
Demonstrates
adequate
knowledge of
required reading,
needs to be
reminded to
accomplish
assigned work,
occasionally late
for rounds and
conferences
Demonstrates
knowledge of
required &
supplemental
readings;
accomplishes
assigned work
efficiently and
promptly; regularly
attends rounds &
conferences
Extensively
knowledgeable of
required and
supplemental
material takes
initiative to learn
more about
patients
condition, never
absent from
rounds &
conferences
Volunteers self
for additional
research work
and presentation
in conferences,
knows each
individual
patients
condition and is
ready for rounds
ahead of
everyone else
6. RELATIONSHIP WITH CO-HEALTH WORKERS AND SOCIETY

[
Not Observed
1 [
Uncooperative,
disrespectful or
disobedient to
superiors, actions
often thoughtless
and cause
unnecessary
stress to others in
health team
Has a tendency
to show
arrogance
especially
towards his
juniors,
occasionally
shows disrespect
to superiors
Usually
cooperative,
generally does own
work that neither
helps nor hinders
the work of others
Cooperative,
respectful and
works well with
others
Highly motivated
and professional,
elicit cooperation
from other team
members, admired
by co-workers
Earns respect
from his coworkers whether
his senior or
junior and is able
to lead by
example, shows
fairness in the
treatment of his
juniors
7. EMOTIONAL MATURITY/ REACTION TO EMERGENCY OR STRESS

[
Not Observed
1 [
Breaks down
into panic and
hysterics during
stressful
situations
causing
confusion in the
workplace
Emotionally
unstable; reaction inappropriate
to situation;
cannot cope with
stresses of even
ordinary
situations
Generally stable
personality with
occasional lapses
of confidence in his
ability to handle
common situations
64
Emotionally
stable but has
difficulty coping
with the stresses
of extraordinary,
complex or
highly stressful
situations
Stable and
confident even in
the most
demanding or
stressful situations
Emotionally
stable and in
times of stress
and emergency
is able to take
over and place
the situation
under control.
8. ACCEPTS OWN LIMITATIONS

[
Not Observed
1 [
Arrogant, fails to
call for help
jeopardizing
welfare of
patient; fails to
recognize
limitations
Delays too much

before calling for
help when the
need arises
sometimes
putting the
welfare of the
patient into
jeopardy
Occasionally calls
for help when the
need arises;
sometimes takes
welfare of patient
into consideration.
65
Generally takes
welfare of
patients into
consideration
but with
occasional
hesitation to call
for help when
the need arises
Calls for help

whenever the need
arises and
generally takes
welfare of patients
into consideration
Humble,
prioritize
patients welfare
and always calls
for help when
the need arises,
recognizes own
limitations
Appendix III
Duration of Surgery by NNIS Operative Procedure Category
(American J Infection Control 1992: 20(5):271 274, PJSS Apr Jun 1994: 49 (2):56)
th
T- cut point representing the 75 percentile for each operation

Procedure Category
T duration (hours)
Coronary artery bypass graft

Cardiac surgery
Other cardiovascular system
Thoracic surgery
Other respiratory system
Appendectomy
Bile duct, liver or pancreatic surgery
Cholecystectomy
Colon surgery
Gastric surgery
Small bowel surgery
Laparotomy
Other digestive system
Limb amputation
Spinal fusion
Open reduction of fracture
Joint prosthesis
Other musculoskeletal system
Cesarean section
Abdominal hysterectomy
Vaginal hysterectomy
Other obstetrical procedures
Nephrectomy
Prostatectomy
Other genitourinary system
Head and neck surgery
Other ear, nose, mouth, pharynx
Craniotomy
Ventricular shunt
Other nervous system
Herniorrhaphy
Mastectomy
Organ transplant
Skin graft
Splenectomy
Vascular surgery
Other endocrine system
Other eye
Other hemic and lymphatic systems
5
5
2
3
1
1
4
2
3
3
3
2
3
1
3
2
3
2
1
2
2
1
3
4
4
4
3
4
2
2
2
2
7
2
2
3
2
2
2
Other integumentary system
66
APPENDIX IV
SURGICAL RESIDENTS EVALUATION SHEET
Rotation: _______________________ Period covered: _______________To_______________
Evaluator: ______________________ Position: __________________________________
Signature______________________
Instructions: Kindly indicate on the spaces provided for, your evaluation of each residents
performance based on the different criteria. Ratings should be indicated as follows:
NO
1
2
Not observed
Poor
Marginal
3 - Satisfactory
4 - Good
5 very good
6 excellent
For more detailed definition of each rating, please consult the attached sheet. Indicating NO on
more than 2 items in each general criteria may invalidate your evaluation.
RESIDENT
I. CLINICAL COMPETENCE
Resident
1
Resident
2
Resident
3
Resident
4
Resident
1
Resident
2
Resident
3
Resident
4
1. Data Base (History taking & PE)

2. Use and Interpretation of Diagnostic
Tests
3. Diagnosis
4. Patient Treatment and Management
5. Oral Presentations/Reports/Referrals
6. Record keeping ability
7. After care
Total Score for Clinical Competence
% Rating for Clinical Competence
II. ATTITUDINAL COMPETENCE

1.
2.
3.
4.
Moral/ Ethical Values
Bedside decorum/Relationship with
patients
5. Study / Work Habits
6. Relationship with Co-Health
Workers and Society
7. Emotional Maturity / Reaction to
67
Emergency or stress
8. Accepts own limitations
Total Score for Attitudinal Competence
% Rating for Attitudinal Competence
(Total Score/Maximum Possible Score x
100)
III. TECHNICAL SKILLS
Resident
1
1. Patient Preparation
2. Preparation of Equipment
3. Basic Surgical Principles
4. Technical Dexterity
5. Organization and Sequence
6. Operative Judgment
7. Duration of procedure
Total Score for Technical Skills
% Rating for Technical Skills
(Total Score/Maximum Possible Score x
100)
68
Resident
2
Resident
3
Resident
4
APPENDIX V
INSTRUCTIONAL DESIGNS FOR SURGICAL SPECIALTY ROTATIONS

PLASTIC SURGERY
OBJECTIVE
At the end of the rotation, the
learner should be able to:
1. Cognitive
1.1 Demonstrate knowledge of
the diagnosis and
management of common
surgical skin disorders &
malignancies.
CONTENT
Common Surgical Skin
disorders:
Burns
Basal cell
Carcinoma
Squamous cell ca
Melanoma
Pressure sores/
Decubitus ulcers
1.2 Given a patient with plastic

management plan.
LEARNING ACTIVITIES
I. Large Group Learning
1. Grand rounds
2. Pre and
3. Postoperative
Conferences
5. Admitting rounds
6. Census
7. Lecturette
8. Inter disciplinary Tumor
Conference
RESOURCES
1. Operating room
facilities / in patient
facilities
EVALUATION
Written exam
3. Pathology
4.Textbooks
Plastic surgery
Anatomy
Clinical Pathology
II. Small Group Learning

1. Group Discussion
2. Group Tutorial
3. Brain Storming
III. Independent Learning
Given a patient, the learner

should be able to:
2. Psychomotor
2.1 Resuscitate and
manage burn patients
2.3 Apply the appropriate
incisions & margins of
Incisions
1. Making the proper

Incision
2. Harvesting of skin
Grafts
3. Skin grafting
4. Cleft lip repair
5. Flaps
6. Burn care.
3.1. Demonstrating professional

behavior in conducting
evaluation of patient
3.2. Humility to recognize &
accepts own strengths &
limitations and knows when
to ask helps to a plastic
surgeon.
1. Pre and Postoperative

Conferences
2. Lecturette
3. Pathology
1. Group Discussion
2. Group Tutorial
4.Textbooks
Surgery
Plastic
1. Individual Study
2. Self Instructional
Materials
1. Intellectual Integrity
- practices
intellectual
honesty
2. Appropriate bedside
decorum
3. Team work
cooperate with other
team members
4. Emotional maturity
stable even in most
stressful situation
5. Empathy stress
6. Social responsibility
1. Operating room
Facilities
2.4 Demonstrate when and

how to use skin grafts and
flaps.
3. Affective
1. Individual Study
Materials
IV. Activities in plastic

surgical subspecialty
(requiring each residents to
perform or assist in adequate
number of patients)
I. Small Group Learning
1. Small Group Discussion
2. Small Group Tutorial
3. Preceptorial
4. Simulation
II. Individualized Learning
1. Independent study of
supplemental materials
69
Direct observation
-
Rating scales
Checklist
Incident
reports
5. Surgery
Consultant Staff
6. Plastic surgery
instruments
Sutures
Dermatome or
humbly knife
1. Personal experiences
of mentors & experts
The Healing Cut
2. Bioethics books
3. Simulated & actual
Patients
4. Role modeling of
Mentors
5. Clinical Practice
Guidelines for plastic
surgery
Direct observation
with attitude scale
Patient Evaluation
Anecdotal records
Incident reports
PEDIATRIC SURGERY
Objective
should be able to :
1. Cognitive
1.1. Demonstrate knowledge of the
common pediatric surgical
conditions
1.2 Apply the principles of
perioperative care
a) Fluid & electrolytes
b) Nutrition
c) Antibiotic Utilization
Content
Common pediatric
surgical conditions:
Vascular access
Inguinal hernia /
hydrocoele
Imperforate anus,
other causes of
intestinal obstruction
Abdominal trauma
Appendicitis
Intussusception
Rectal polyps
Soft tissue tumors
Given a patient with pediatric

subspecialty problem, the resident
should be able to formulate a
comprehensive management plan.
Teaching- Learning
Activities
I. Rotations in pediatric
Surgery
1. Grand rounds
2. Pre and
3. Postoperative
Conferences
5. Admitting rounds
6. Census
7. Lecturette
Conference
1. Group Discussion
2. Group Tutorial
3. Brain Storming
Resources
1.
2.
3.
4.
5.
6.
7.
8.
9.
Textbooks
Journals
Operating room
/ Outpatient
facilities
Pathology
services
Radiology
services &
ultrasound
Medical library
ER, RR, Critical
care facilities
Pediatric
Surgery Experts
CD of Pediatric
surgery cases
Evaluation
Written exam
Oral Examination
2. Psychomotor
Assist or perform common pediatric
surgical procedures
1. Individual Study
Materials
1. Vascular Access
2. Herniotomy/
Hydrocoelectomy
3. Thoracostomy
4. Explore lap for
trauma acute
abdomen,
obstruction,
appendectomy,
intussusception,
polypectomy
1. Lecturette
2. Film Showing
Demonstration
1. Small Group
Discussion
3. Simulation
4. Assisting or performing
actual pediatric surgery
operations
III. Activities in pediatric
surgical subspecialty
(requiring each residents to
perform or assist in adequate
number of patients)
3. Affective
3.1 Demonstrate the proper
attitudes and habits in the practice
of pediatric surgery
3.2 Humility to accept own
limitations & knows when to refer to
pediatric specialist
1. Intellectual integrity
2. Moral, Ethical Value
3. Reliability /
Responsibility
4. Bedside decorum/
relationship with patient
5. Study/Work habits
6. Relationship with Cohealth workers
Reaction to emergency
or stress

1. Small Group
Discussion
3. Preceptorial
4. Simulation
- Independent study of
70
1. Operating room
facilities
3. Pathology
4. Radiological
facilities
5. Consultant staff
6. ER, RR, Critical
care
7. Case material
8. Record review
9. Log book
OR record
10.Pediatric Surgery
Atlas
Direct observation
Record review
Logbooks
OR record
1. Ward rounds
2. Ward work
3. ER consultation
4. OPD consultation
5. Operating room
Direct observation
Rating scale
Incident reports
ORTHOPEDICS
Objectives
Given an orthopedic patient , the
learner should able to:
1. Cognitive
Content
1. Fractures (closed /
open, long bones, digits,
etc.)

the diagnosis and
orthopedic disorders
2. Joint and ligamentous

injuries, (dislocations,
internal knee
derangements, sprains,
etc)
1.2 Demonstrate the principles

of immobilization
3. Bone tumors: benign

and malignant
1.3 Apply principles of

radiographic diagnostic
procedures
plain x-ray, CT, MRI
4. Infections
(osteomyelitis, diabetic
foot, joint abscess, deep
palmar abscess, felon,
etc.)
1.4 Demonstrate use of

common orthopedic
instruments/appliances
1.5 Given a patient with
orthopedic subspecialty
problem, the resident should
be able to formulate a
comprehensive management
plan.
Given an actual patient, the
learner should be able to :
2. Psychomotor Skills:
To perform or assist in common
orthopedic procedures in
emergency and elective settings
5. Evaluate
musculoskeletal pain
(low back pains, cervical
strain, etc)
Learning
Activities
1. Lecturette
2. Weekly Census
Conference
3. Trauma Census
4. Mortality & Morbidity
Conference
5. Film Showing
6. Multi -disciplinary
Conference
7. Monthly audit of in and
out patient orthopedic
patients
2. Ward Rounds
3. Preceptorship
4. ER Conference
- Individual Study Period
1. Fractures
closed reduction of
common fractures
(Colles, clavicle,
phalangeal, etc.) and
immobilization
- open Fx initial
debridement,
Irrigation and
Immobilization
2. Joint dislocations
reduction of
shoulder, elbow, hip
and phalangeal
dislocation
3. Do diagnostic
maneuvers for
internal knee
derangements and
other joints
4. Do disarticulation &
amputations for
various Indications
5. Soft tissue tumors FNAB,
marginalexcision of
superficial tumors
6. Common orthopedic
procedures prep and
draping, splinting,
casting, traction,
taping
7. After-care of common
orthopedic problems
8. Spine immobilization

1. Lecturette
2. Film Showing
3. Demonstration
1. Small Group
Discussion
3. Simulation
4. Assisting in actual
Orthopedic operations
III. Activities in orthopedic
subspecialty (requiring each
residents to perform or assist
in adequate number of
patients
71
Resources
1. Journals
Evaluation
Written Exam
2. Operating room /
Outpatient
facilities
3. Pathology
services
4. Radiology
services CT
Scan, MRI
5. Medical library
6. ER, RR, Critical
care facilities
7. Orthopedic
surgeons
8. CD of orthopedic
surgical
operations cases
9. Orthopedic Atlas
1. Operating room
facilities/ in patient
facilities
2. Outpatient
facilities
3. Pathology
4. Radiological
facilities
5. Consultant staff
6. ER, RR, Critical
care
7. Case material
8. Record review
Log book
OR record
9. Orthopedic Atlas
Direct observation
Rating scale
Checklist
3. Affective
3.1 Demonstrate proper attitude and
interest in learning orthopedic
procedures that can be useful in
general surgery practice
limitations & knows when to refer to
orthopedic specialists
1. Intellectual Integrity practices intellectual

honesty
2. Appropriate Bedside
Decorum
3. Team work
team members
stable even in most
stressful situation
5. Empathy stress

3. Preceptorial
4. Simulation
- Independent study of
72
1. Personal
experiences of
mentors & experts
The Healing Cut
2. Bioethics books
patients
4. Role modeling of
Mentors
Guidelines for
orthopedic
conditions
Direct observation
Rating scale
Checklist
Incident Reports
NEUROSURGERY
OBJECTIVE
Given a patient , the learner
should be able to:
1. Cognitive
1.1 Apply knowledge of
anatomy & physiology of
the central & peripheral
nervous system
1.2 Apply the principles of
prevention, diagnosis,
evaluation and recognition
of common neurosurgical
disorder.
2. Demonstrate knowledge of
the diagnosis and management
of common neurosurgical
disorders
CONTENT
1.1 Central nervous
system, peripheral nervous
system and autonomic
nervous systems including
their supporting structures
and vascular supply
1.2 Common neurosurgical
conditions
1.3 Recognition and initial
management of increased
intracranial pressure
such as in trauma, space
occupying lesion.
1.4 Trauma low velocity
gun shot wound
3.Determine indications for use

and interpretation of common
diagnostic test skull x-ray, CT,
MRI, Angiogram laboratories
LEARNING ACTIVITIES
EVALUATION
1.
Textbooks
Written
1. Grand rounds
2. Pre and
3. Postoperative
Conferences
5. Admitting round
6. Census
7. Lecturette
Conference
2.
Journals
Oral exam
3.
Operating room /
Outpatient facilities
4.
Pathology services
5.
Radiology services
CT Scan, MRI
6.
Medical library
7.
ER, RR, Critical care

facilities
8.
Neurosurgical
Experts
9.
CD of Neurosurgical
cases

1. Group Discussion
2. Group Tutorial
3. Brain Storming
1. Individual Study
Materials
4. Formulate a logical
diagnosis, treatment plan &
continuing care of common
neurosurgical conditions
RESOURCES
10. Neurosurgical Atlas
5. Given a patient with

neurosurgical subspecialty
problem, the resident should be
able to formulate a
plan.
2. Psychomotor
2.1 Perform the following:
Primary Survey
Resuscitation
Secondary Survey
Initial and / or
Definitive
Management
2.2 Provide Early Proper

Medications
2.3 Perform or assist neuro surgical procedures
Cranial decompression for

trauma (burr- hole and
drainage/craniectomy for
epidural hematoma

1. Lecturette
2. Film Showing
3. Demonstration
3. Simulation
neurosurgical operations
Activities in neurosurgical
subspecialty (requiring each
residents to perform or assist
in a number of patients)
73
1. Operating room
facilities / inpatient
facilities
3. Pathology
4. Radiological facilities
5. Consultant staff
6. ER, RR, Critical care
7. Case material
1. Record review
2. Log book
3. OR record
4. Neurosurgical Atlas
Direct
observation
Rating scale
Checklist
3. Affective
3.1Demonstrates the proper
practice of neurosurgery
3.2 Humility to recognize &
limitations and knows when to
ask helps to a neurosurgeon
specialist.

honesty
Decorum
3. Team work cooperate
with other team
members
stable even in most
stressful situation
5. Empathy Stress

1.
2.
3.
4.
Small Group Discussion

Small Group Tutorial
Preceptorial
Simulation

Independent study of
74
The Healing Cut
2. Bioethics books
patients
4. Role modeling of
Mentors
Guidelines for
neurosurgical
conditions
Direct
observation
Rating scale
Checklist
Incident
Reports
THORACIC & CARDIOVASCULAR SURGERY

OBJECTIVE
1. Cognitive
1.1 Demonstrate knowledge
of the diagnosis and
thoracic & cardiovascular
disorders
thoracic & cardiovascular
management plan.
CONTENT
1.Hydrothorax (includes
hemothorax & pyothorax)
2.Pneumothorax
3.Blunt thoracic injury
4.Penetrating thoracic &
peripheral vascular injury
5.Varicose veins
TEACHING-LEARNING
ACTIVITIES
1. Grand rounds
Conferences
3. Mortality and
Morbidity
4. Admitting rounds
5. Census
6. Lecturette
Conference
RESOURCES
EVALUATION
1. Textbooks
Written exam
2. Journal
Oral Exam
Review of patient
outcome (charts,
logbooks)
4. Pathology services
5. Radiology services
6. Medical library
7. ER, RR, OR, Critical
Care Facilities
8. Consultant staff
1. Group Discussion
2. Group Tutorial
3. Brain Storming
1. Individual Study
Materials
2. Psychomotor
Perform or assist thoracic
and cardiovascular
procedures
1. Thoracentesis
2. thoracostomy
3. Pleurodesis for
malignant effusion
4. percutaneous
5. transthoracic needle
6. biopsy
7. thoracotomy,
8. pericardiostomy/
9. pericardiotomy/
10. pericardiocentesis for
11. thoracic trauma:
12. vascular repair for
13. trauma
14. vascular access:
15. subclavian vein
16. catherization, AV
fistula
17. - vein stripping

1. Lecturette
2. Film Showing
3. Demonstration
1. Small Group
Discussion
3. Simulation
neurosurgical
operations
1. Operating
Room Facilities
in patient
out patient
2. Outpatient
facilities
3. Pathology
4. Radiological
facilities
5. Consultant Staff
6. ER, RR, Critical
Care
7. Case Material
Direct observation
Checklist
-
Rating scale
Record review
Logbooks
OR Records
Activities in thoracic &

cardiovascular specialty
Perform previously listed
procedures & assist in
different thoracic and
Cardiovascular
procedures
3. Affective
3.1 Demonstrate the
proper attitudes and
habits in the practice
of thoracic &
cardiovascular
limitations & knows
when to refer to TCVS
specialist
3.Reliability/Responsibility
4. Bedside Decorum
Relationship w/ patient
5. Study/work habits
or stress

1. Small Group
Discussion
3. Preceptorial
4. Simulation
supplemental
materials
75
The Healing Cut
2. Bioethics books
Simulated & actual
patients
3. Role modeling of
Mentors
Guidelines for TCVS
conditions
Direct observation
- Rating scale
- Checklist
Incident reports
UROLOGY
OBJECTIVES
At the end of the module,
the learner should be able
to;
I. Cognitive
1.1 Demonstrate knowledge
of the diagnosis and
urologic disorders in the
other surgical specialties.
CONTENT
Common urologic
disorders
- Hydrocoele
- Benign Prostatic
Hypertrophy
- Testicular torsion
- Nephro,uretero &
cystolithiasis
- Kidney & bladder
trauma
LEARNING ACTIVITIES
1. Grand rounds
Conferences
3. Mortality and
Morbidity
4. Admitting rounds
5. Census
6. Lecturette
RESOURCES
Textbooks Of Urology
EVALUATION
Practical Exam
Written Exam
1. Campbells
2. Gillen & Waters adult
& pediatric Urology
3. Smiths Urology
4. Textbooks on
Ultrasound & Basic
Radiology

urologic subspecialty
problem, the resident should
be able to formulate a
plan.
1. Group Discussion
2. Group Tutorial
3. Brain Storming
1. Individual Study
Materials
2. Psychomotor
Perform or assist in common
urologic surgical procedures
UROLOGY
3. Affective
1. Demonstrating
professional behaviour in
conducting evaluation of
patient
2 Humility to accept own
limitations & knows when to
refer to TCVS specialist
Hydrocoelectmy
nephrectomy for
trauma
suprapubic
cystostomy
cystolithotomy
orchidopexy/
orchiectomy for
testicular torsion
3.Reliability/Responsibility
4. Bedside Decorum
Relationship w/ patient
5. Study/work habits
or stress

1. Grand rounds
Conferences
3. Mortality and
Morbidity
4. Admitting rounds
5. Census
6. Lecture
different urologic
procedures
1. Group Discussion
2. Group Tutorial
3. Brain Storming
1. Individual Study
Materials
1. Role Playing
2. Simulation
76
Textbooks
Urology
Pathology
Ultrasound
Direct observation
X-ray , Ultrasound &

Imaging Modalities
Incident reports
Record review
1. Ward work
2. Ward work
3. ER consultation
4. OPD consultation
5. Operating Room
Actual & Simulated
Patients
Rating scales
Checklists
Direct observation
with attitude scale
Patient Evaluation
Anecdotal records
Incident reports
TRAUMA
Objective
should be able to :
Cognitive
1.
Apply the principles of

triage
2.
Apply the principles of

initial assessment and
resuscitation
3.
Formulate a
comprehensive
diagnostic and
treatment plan
including complications
and rehabilitation
4. Apply the principles of

4.1Critical Care
4.2 Rational use of
Antibiotics
4.3 Surgical Nutrition
4.4 Surgical
Bacteriology
2. Psychomotor
learner should be able to
perform the following :
2.1 Manage multiple
organ system
traumatic injuries
2.2. Apply critical care
principles in the
continuing care of
the trauma patient.
2.3. Demonstrate
techniques in the
management of the
polytrauma patient.
Teaching- Learning
Activities
Content
1. Trauma
Epidemiology &
Prevention,
Extrication & Transport, Triage, Patterns
of Injury, Basic Life
Support, Scoring
System, Trauma
Center
2. Perioperative Care
of Traumatic Injuries
3.Trauma Definitive
Management of
Traumatic Injuries;
Intensive care and
rehabilitation;
critical care
- Polytrauma
management
- Mass casualty and
disaster management
Trauma
- Multiple casualty
Hospital/ER Triage
- Multiple organ system
injuries
- Care of the Critically
Injured patient
1. Grand rounds
Conferences
4. Admitting rounds
5. Census
6. Lecturette
1. Group Discussion
2. Group Tutorial
3. Brain Storming
Resources
Evaluation
Basic Life Support
Written Exam
ATLS
Oral Examination
Textbooks in Trauma
Outcome
Measures
Trauma Treatment
Guidelines
PJSS
Nutrition Guidelines
Surgical Infection
Guidelines
Basic Life Support
Basic Life Support
Practical exam
ATLS
Direct observation by
Textbooks in Trauma
Trauma Treatment
Guidelines
PJSS
Nutrition Guidelines
Surgical Infection
Guidelines
1. Individual Study
Materials

Lecturette
Film Showing
Demonstration
Small Group Discussion

Small Group Tutorial
Simulation
Assisting in actual
operations in trauma.

different multiple organ
system injuries procedures
2.4. Participate in mass

casualty and disaster
management drills
77
Checklist
Rating scale
3. Attitude
3.1 During the session of
simulated procedures
& the actual operation,
the learner should be
able to demonstrate
appropriate behaviors
in a trauma situation.
3.2 Humility to recognize
& accept own strengths
& limitations and know
when to ask help from
a trauma surgeon.

honesty
Decorum
3. Team work cooperate
with other team
members
stable even in most
stressful situation
5. Empathy
Medico legal Books
Direct observation
Bioethics Books
Checklist
Rating Scale
Role Model Mentors
Simulated & Actual

Patients

1. Small Group
Discussion
3. Preceptorial
4. Simulation
78
Incident Reports
MINIMAL ACCESS SURGERY

(Basic Laparoscopy & Diagnostic Laparoscopy)
Objective
I.
Content
Teaching & Learning

Activities
Resources
Evaluation
PRINCIPLES
COGNITIVE
1. To identify and discuss the
advantages of MIS approach
1. Pain
2. Cosmesis
3. Surgical Stress
4. Hospital stay and return
to normal activity
5. Superior clinical
outcome (procedure
based)
6. Better visualization

disadvantages of MIS approach
1. Mechnical Limitation
(limited degrees of
movement, fulcrum
effect), lost tactile
feednack, disruption of
the visual-motor axis, 2D vision, "narrow"
endoscopic view
2. Loss of depth
perception
3. Role of technology in
addressing limitations
of MIS
4. Fatigue syndrome
5. Chronic surgeon
morbidities
(neuropraxia, vision
pathologies,
musculoskeletal
injuries)
6. Cost implications

different pathophysiologic
response to general anesthesia
1. Respiratory
implications of general
anesthesia
2. Circulatory implications
of general anesthesia

pathophysiology of
pneumoperitoneum
1.
2.
Lecture
Small group
discussion
1. Lecture
2. Small group
discussion
3. Instructional
video
4. Case discussion
1. Respiratory / ventilatory
implications of
Carboperitoneum
2. Circulatory implications
Carboperitoneum
3. Ideal gas
characteristics for
insufflation (risks for
gas embolism)
4. Ideal insufflation rate
and pressure
5. To identify and discuss

criteria for patient selection in
minimal access procedures
79
The SAGES Manual:

Fundamentals of
Laparoscopy,
Thoracoscopy and GI
Endoscopy 2nd Ed., Carol
E.H. Scott-Cooner (ed.)
Mastery of Endoscopic
and Laparoscopic
Surgery, 3rd Ed.,
Nathaniel J. Soper, Lee L.
Swanstrom, W. Stephen
Eubanks
Written Exam
Oral Exam
Objective
Structured
Clinical Exam
6. Pre-operative work-up and

evaluation
7. Complications and Risk
Management
8. Indications for Conversion
PSYCHOMOTOR
1. To demonstrate the basic
techniques in overcoming the
mechanical limitations of MIS in
a trainer box
Trainer Box exercises
The SAGES Manual:

Fundamentals of
Laparoscopy,
Thoracoscopy and GI
and Laparoscopic
Surgery, 3rd Ed., Nathaniel
J. Soper, Lee L.
Eubanks
Training Box
Laparoscopic tower and
instruments
Objective
Structured Clinical
Exam (OSCE)
Return Demo
Checklist
Evaluation
1. Lecture
2. Small group
discussion
3. Instructional video
4. Case discussion
The SAGES Manual:

Fundamentals of
Laparoscopy,
Thoracoscopy and GI
and Laparoscopic
J. Soper, Lee L.
Eubanks
Siegel B, Golub RM, Laurie
A et. al.; Technique of
Ultrasonic Detection and
Mapping, of Abdominal
Wall Adhesions. Surgical
Endoscopy; 1991:5;161165
Written Exam
Oral Exam
Objective
Structured Clinical
Exam (OSCE)
2. To demonstrate the basic

camera navigation skills in a
trainer box
II.
ACCESS AND
MANIPULATION
COGNITIVE
1.
To identify and discuss

the pertinent anatomy to
access in MIS
1.1To identify and
discuss the varied
closed and open MIS
access techniques
1.2To identify and
discuss techniques
to confirm
intraperitoneal
placement of ports
2.
3.
To describe and discuss

the Abdominal wall lift
techniques as an
alternative to
Carboperitoneum
The describe and discuss

the different concepts in
port ergonomics and
strategy
1. Anatomy of the
Umbilicus and anterior
abdominal wall
2. Closed Access (Veress
Needle)
3. Open / Direct Peritoneal
Access (Hasson,
Scandinavian)
4. Visually guided access
5. Port size
6. Saline Drop Test,
Aspiration Test,
Abdominal Sounding,
UTZ-Visceral slide
7. Abdominal wall lift
techniques as an
alternative
1.
2.
3.
4.
Manipulation angle
Azimuth angle
Elevation angle
Fascial Closure
(indications and
techniques)
80
Hanna GB, Shimi,

Cuschieri A. Optimal Port
Locations for Endoscopic
Intracorporeal Knotting.
Surgical Endoscopy.
1997:11:397-401
Hanna GB, Shimi,
Cuschieri A. Influence of
Direction of View, Targetto-Endoscopic Distance
and Mnipulation Angle on
Endoscopic Knot Tying.
Br. J. Surg. 1997;84:14601464
Hanna GB, Shimi,
Cuschieri A. Task
Performance in
Endoscopic Surgery in
Influenced by Location of
the Image Display. Ann
Surg. 1998;227:481-484
Helgstrand F, Rosenberg
J, Kehlet H, Bisgaard T.
Low Risk of Trocar Site
Hernia Repair After 12
Years After Primary
Laparoscopic Surgery.
Surgical Endoscopy. 2011
Critical Safety Steps

4.
5.
To identify and discuss

the critical steps in the
identified basic
manipulation skills
To describe the use and

formation of intra and
extra corporeal knots in
MIS
1.
2.
3.
4.
5.
6.
7.
8.
9.
Tissue grasping
Blunt Dissection
Clipping
Looping
Ligation in Continuity
Scissors
Specimen Extraction
Suturing Techniques
Stapling Techniques
1.
Extra-Corporeal and
Intracorporeal knots
(Roeder, Meltzer)
1.
3.
4.
Closed Access
(Veress Needle)
Open / Direct
Peritoneal Access
(Hasson,
Scandinavian)
Visually guided access
Port size
Manipulation angle
Azimuth angle
Elevation angle
PSYCHOMOTOR
1.
To demonstrate the proper

technique in establishing
direct peritoneal access
(open technique) in a box
trainer and clinical material
2.
2.

technique in inserting
working ports in box trainer
exercises and clinical
material
1.
2.
3.
3.

application of port strategy in
a box trainer and clinical
material for the basic MIS
procedures
Critical Safety Steps

1. Tissue grasping
2. Blunt Dissection
3. Clipping
4. Looping
Trainer Box exercises
81
The SAGES Manual:

Fundamentals of
Laparoscopy,
Thoracoscopy and GI
Mastery of Endoscopic and
Laparoscopic Surgery, 3rd
Ed., Nathaniel J. Soper,
Lee L. Swanstrom, W.
Stephen Eubanks
Training Box

instruments
Objective
Structured
Clinical Exam
(OSCE)
Return Demo
Checklist
Evaluation
4.
III.
To consistently demonstrate
the basic MIS skills identified
and corresponding safety
steps in a box trainer and
clinical material
5.
6.
7.
8.
9.
10.
Ligation in Continuity
Scissors
Specimen Extraction
Suturing Techniques
Stapling Techniques
Extra-Corporeal and
Intracorporeal knots
(Roeder, Meltzer)
1.
Video System (video

systems, color
systems)
Light Source (fiber
optics, halogen,
xenon)
Insufflator
Suction / Irrigator
Display systems (CRT,
LCD, Plasma, HD, 3D)
EQUIPMENT AND
INSTRUMENTATION
COGNITIVE
1. To identify and describe the
basic operation of the different
elements of the Laparoscopic
tower
2.
3.
4.
5.
1.1. To identify and discuss

basic video editing and
associated equipment /
software
2. To describe and discuss the
technical and ergonomic
considerations for the varied
MIS instrumentation
2.1. To describe and discuss
the proper application of
the varied MIS
instrumentation
2.2. To describe and discuss
proper instrument reprocessing, sterilization
and maintenance in MIS
3. To decribe the basic concepts
of energy sources used in
surgical procedures
3.1. To identify and describe

the specific
considerations in safely
applying electrosurgical
modalities in MIS
procedures
4. To identify and discuss basic
optics applied to endoscopic
technology in MIS
4.1. To discuss the
implications of lost
depth perception and
varied display systems
6.
Basic video editing

and associated
equipment / software
1.
Hand Instruments
(design considerations
and ergonomics)
Atraumatic
Non-Atraumatic
Suturing Devices
Retractors
Access
Instrumentation
(trocars)
2.
3.
4.
5.
6.
1.
Energy sources
(radiofrequency
current, monopolar,
bipolar cautery,
electrothermal bipolar
vessel sealer,
ultrasonic shears and
lasers)
2.
Electro-surgical safety
1.
Optics and Endoscopy
2.
Depth perception and

visual technology
Display systems (CRT,
LCD, Plasma, HD, 3-
3.
1. Lecture
2. Small group
discussion
3. Instructional video
4. Case discussion
82
Hanna GB, Shimi,

Cuschieri A. Optimal Port
Locations for Endoscopic
Intracorporeal Knotting.
Surgical Endoscopy.
1997:11:397-401
Hanna GB, Shimi,
Cuschieri A. Influence of
Direction of View, Targetto-Endoscopic Distance
and Mnipulation Angle on
Endoscopic Knot Tying.
Br. J. Surg.
1997;84:1460-1464
Hanna GB, Shimi,
Cuschieri A. Task
Performance in
Endoscopic Surgery in
Influenced by Location of
the Image Display. Ann
Surg. 1998;227:481-484
Written Exam
Oral Exam
Objective
Structured Clinical
Exam
in MIS
5. To enumerate and describe

the proper operating room setup for MIS procedures
D)
1.
2.
3.
4.
5.
Equipment positioning
Patient positioning
Securing the patient
Monitoring modalities
Sequential
Compression Devices
1.
Video System (video

systems, color
systems)
Light Source (fiber
optics, halogen,
xenon)
Insufflator
Suction / Irrigator
Display systems
(CRT, LCD, Plasma,
HD, 3-D)
PSYCHOMOTOR
1. To set-up the laparoscopic
tower for basic
laparoscopic procedures
2.
2. To trouble shoot the
common technical
problems encountered in
basic MIS
3. To edit video of basic

laparoscopic procedures to
illustrate the salient points
4. To use appropriate MIS

instrumentation based on
tasks in trainer box
material
3.
4.
5.
1.
Basic video editing

and associated
equipment / software
1.
Hand Instruments
(design
considerations and
ergonomics)
Atraumatic
Non-Atraumatic
Suturing Devices
Retractors
Access
Instrumentation
(trocars)
2.
3.
4.
5.
6.
5. To demonstrate proper reprocessing, sterilization and

instrument maintenance
after performing MIS
procedures
6. To properly set-up and
safely apply surgical energy
sources in trainer box
material
1.
2.
7. To consistetly set-up the

operating room for basic
laparoscopic procedures
1.
2.
3.
4.
5.
1. Trainer Box
exercises
2. Laparoscopy
Mock-set-up
3. Operative Cases
Energy sources
(radiofrequency
current, monopolar,
bipolar cautery,
electrothermal
bipolar vessel sealer,
ultrasonic shears
and lasers)
Electro-surgical
safety
Equipment
positioning
Patient positioning
Securing the patient
Monitoring
modalities
Sequential
Compression
Devices
83
The SAGES Manual:

Fundamentals of
Laparoscopy,
Thoracoscopy and GI
and Laparoscopic
J. Soper, Lee L.
Eubanks
Training Box
instruments
Objective
Structured Clinical
Exam (OSCE)
Return Demo
Checklist
Evaluation
IV.
BASIC LAPAROSCOPIC
PROCEDURE
COGNITIVE
1. To describe and discuss
diagnostic laparoscopy as a
procedure and its clinical
role in the management of
surgical diseases

laparoscopic appendectomy
as a modality for the
treatment of uncomplicated
acute appendicitis
1. Non-therapeutic
diagnostic laparoscopy
2. Cancer Staging
3. Biopsy
4. Evaluation of Ascites
5. Evaluation of Tumors
for Resectability
6. Chronic Abdominal
Pain
1.
2.
3.
4.
1.
2.
3.
4.

laparoscopic
cholecystectomy as a
modality in the treatment of
uncomplicated
cholecystolithiasis
5.
6.
1.
2.
3.
4.
Lecture
Small group
discussion
Instructional
video
Case discussion
The SAGES Manual:

Fundamentals of
Laparoscopy,
Thoracoscopy and GI
Endoscopy 2nd Ed.,
Carol E.H. Scott-Cooner
(ed.)
and Laparoscopic
Surgery, 3rd Ed.,
Nathaniel J. Soper, Lee L.
Swanston, W. Stephen
Eubanks
Written Exam
Oral Exam
Objective
Structured Clinical
Exam
Status of laparoscopic
appendectomy in
clinical practice
Relative
contraindications
Operative Steps
Follow-up
Indications
Contra-indications
Operative steps
Indications for IntraOperative
Cholangiogram
Indications for
Conversion
Follow-up
PSYCHOMOTOR
1. To safely demostrate the
competencies required to
perform a diagnostic
laparoscopy
2. To safely demostrate the

competencies required to
perform laparoscopic
appendectomy in
uncomplicated cases
1.
2.
3.
4.
1.
2.
3.
4.
5.
Access techniques
Port-site closure
Bowel Manipulation
Camera Navigation
1. Trainer Box
exercises
2. Laparoscopy
Mock-set-up
3. Operative Cases
Access techniques
Port-site closure
Dissection of the
hepatoduodenal
ligament
"Critical View of
Safety"
Clipping of
structures (cystic
duct and cystic
artery)
84
The SAGES Manual:

Fundamentals of
Laparoscopy,
Thoracoscopy and GI
and Laparoscopic
J. Soper, Lee L.
Eubanks
Training Box
instruments
Objective
Structured
Clinical Exam
(OSCE)
Return Demo
Checklist
Evaluation
SURGICAL NUTRITION LEVEL 1

LEVEL 1
INTENDED LEARNING
CONTENT
OUTCOMES
At the end of the first year the resident should be able to:
COGNITIVE
1.1.Discuss the principles of
1. The cell and cellular
diagnosis of malnutrition and
environment
management of malnutrition
2. Injury process, endocrine,
related problems and
metabolic and immunologic
complications
response to Injury.
1.2 Learn the principles of
3. Wound Healing
nutrition as applied in the
4. Fluids and Electrolytes status
surgical process and patient
in normal and injury/disease
management
states
5. Shock, resuscitation and
cellular response
6. Nutrition in surgery
a) Nutrition screening
b) Nutrition assessment
and risk leveling
c) Nutrition care
planning
d) Implementation of
nutrition care plan
e) Monitoring of nutrition
care process
f)
Reassessment
7.Immunonutrition/
pharmaconutrition
8. Surgical Complications:
pathophysiology and
management
9. Trauma: pathophysiology and
management
10. ERAS: Early recovery after
surgery
11. Surgical Oncology: nutrition
implications and principles of
nutrition management
12. Transplantation nutritional
implications
13. Obesity surgery nutrition
implications
14. Pediatric surgery nutrition
implications
1.2 Discuss WHO Patient Safety 1. Patient Safety Appropriate
- Framework based on the WHO
Patient Safety Curriculum
3. Open Disclosures
(A)Discuss how to effectively
religious diversity
communicate to patient
7. Recognizing reporting and
(B) Discuss how to prevent,
identify and/or manage near
adverse events
miss injuries or adverse events. 8. Managing risks
9. Understanding health care
(C) Applies evidence based
errors
practice and updated
10. Managing complaints
information technology
11. Showing leadership and
being team player
(D) Discuss medication safety
12. Understanding complex
health organization
(E) Applies Infection Control
13. Understanding human
principles.
factors
14. Providing continuity of care
LEARNING
ACTIVITIES
RESOURCES
Group Learning
Textbooks
1.
2.
3.
4.
5.
6.
7.
8.
9.
Lectures
Nutrition surveillance
of surgical patients
reporting
Pre and Postoperative
Conferences
Mortality and Morbidity
Conferences especially
with nutrition related
problems
Admitting rounds/
Endorsement to
include nutrition
surveillance
Journal Club
Interdisciplinary
Conference
Ward rounds with focus
on surgical nutrition
Workshops in
Research Methodology
& Critical Appraisal of
Literature

1) Group Discussion
2) Group Tutorial
3) Brainstorming
1) Individual Study
2)Self-Instructional Materials
85
Principle of Surgery
Anatomy
Surgical Anatomy
Physiology
Pathology
Problem-oriented
Surgical Diagnosis
Evidence Based
Surgery
Materials of the
Philippine Society
of Parenteral and
Enteral Nutrition in
clinical nutrition
ASPEN and ESPEN
guidelines to
enteral and
parenteral
nutrition
Access to all
PCS/PSGS
Evidence based
guidelines
Textbooks and
manuals of nutrition
Audio Video Equipment
Journals
a) PJSS
b) Journals in
clinical nutrition
EVALUATION
Written Exams
Oral examinations
Direct Observation
15.
16.
17.
18.
19.
20.

the principles of Research
Methodology and Critical
Appraisal of Literature
PSYCHOMOTOR
2.1 Evaluate surgical patients
a. Nutrition screening
b. Nutrition assessment and risk
leveling
c. Nutrition care plan for the
surgical patient
d. Nutrition care plan
implementation
e. Order pertinent laboratory
and diagnostic exams
f. Refer appropriately
g. Provide continuing care
2.2. Perform surgical

nutrition process
1.
2.
Managing fatigue and

stress
Using information
safety
Preventing wrong patient,
drug, dose, route ,timing in
medication
Rational antibiotic use
5 moments of hand
washing
infection
Research Methods &
Literature
Identify data in the surgical
nutrition database that will
be used for research
purposes which includes
required statistics like
morbidity and mortality,
hospital days, differences
in days, morbidity and
mortality with and without
malnutrition or with or
without complications
1.
Signs and symptoms of

diseases
2. Surgical nutrition process
procedures
3. Nutrition changes and
principles of nutrition
management of patients
with diseases of the
alimentary tract
abdomen and its

contents,
the breast (d) the

head and neck
the vascular system
endocrine system,
skin and soft tissues
transplants
Pre-operative care:
Optimization through the
surgical nutrition process
Ward and OPD work
a.
b.
c.
1. Performing surgical
nutrition process
Pre-operative and postoperative

Skills
1. Oral supplementation
methods
2. Tube feeding access:
NGT placement
Nasojejunal
Gastrostomy
Jejunostomy
3. Venous access
Central
Peripheral
Monitoring of the surgical
nutrition process
Calorie counting
86
Ward / OPD
patients
Laboratory tests
Consultant Staff
Policies, guidelines,
procedure on
nutrition
management from
the Philippine
Society of Parenteral
and Enteral Nutrition
Observation
using rating
scale
- Direct Observation
using rating scale
Record
Review
Logbook or
Records
AFFECTIVE
Demonstrate the
proper
attitudes and habits in
the practice of surgery
and surgical nutrition
1.
2.
3.
4.
5.
6.
7.
8.
3.2 Shows ethical
practices in the
workplace
3.3 Expresses
commitment to lifelong learning.
method
Nitrogen balance
Serum albumin, prealbumin
Indirect calorimetry
Moral, rthical value
Appropriate Bedside
Decorum / Relationship
w/patient
Study / Work habits
workers & superiors
Direct Observation
Rating Scales
Checklist
Incident Reports
Simulation
Role Modeling
Mentoring
Resident as Teacher
program
87
Written Hospital
Policies and
Procedures
Hospital Manual on
Resident decorum
Faculty Members
as role model
Code of Ethics of
the Medical
Profession
PMA code of Ethics
PCS code of Ethics
OSCE
Faculty mentorship &
role modeling with
self reflection in
professional
Chart Review
Chart Audit
Global Evaluation
Form
Patient Satisfaction
Survey
Peer Review
SURGICAL NUTRITION LEVEL 2

LEVEL 1
INTENDED LEARNING
CONTENT
LEARNING
OUTCOMES
ACTIVITIES
At the end of the second to the fifith year the resident should be able to:
COGNITIVE
1.1.Review and discuss the
Review of the following:
PARTICIPATES IN:
principles of diagnosis of
9. The cell and cellular
malnutrition and management of
environment
Group Learning
malnutrition related problems
10. Injury process, endocrine,
10. Lectures
and complications
metabolic and immunologic 11. Nutrition surveillance
response to Injury.
of surgical patients
1.2 Identify nutrition associated
11. Wound Healing
reporting
or nutrition related problems in
12. Fluids and Electrolytes
surgical patients
status in normal and
Conferences
injury/disease states
13. Shock, resuscitation and
Conferences especially
cellular response
with nutrition related
14. Nutrition in surgery
problems
15. Nutrition screening
14. Admitting rounds/
16. Nutrition assessment and
Endorsement to
risk leveling
include nutrition
17. Nutrition care planning
surveillance
18. Implementation of nutrition
15. Journal Club
care plan
19. Monitoring of nutrition care
Conference
process
17. Ward rounds with focus
20. Reassessment
on surgical nutrition
21. Immunonutrition/
18. Workshops in
pharmaconutrition
Research Methodology
22. Surgical Complications:
& Critical Appraisal of
pathophysiology and
Literature
management
23. Trauma: pathophysiology
Small Group
and management
Learning
24. ERAS: Early recovery after
1. Group
surgery
Discussion
25. Surgical Oncology: nutrition
2. Group Tutorial
implications and principles
3. Brainstorming
of nutrition management
26. Transplantation
Independent
nutritional implication
Learning
27. Obesity surgery nutrition
1) Individual
implication
Study
28. Pediatric surgery nutrition
2)Selfimplications
Instructional
Materials
3) Material in
clinical nutrition
from Philippine
Society of
Parenteral and
Enteral Nutrition
(PHILSPEN)
1.2 Review and implement
WHO Patient Safety Framework based on the WHO
Patient Safety Curriculum
a) Show effective
communication to patient
b) Able to prevent, identify

and/or manage near miss
Review the following

1. Patient Safety Appropriate
3. Open Disclosures
religious diversity
7. Recognizing reporting and
adverse events
8. Managing risks
88
RESOURCES
Textbooks
Principle of Surgery
Anatomy
Surgical Anatomy
Physiology
Pathology
Problem-oriented
Surgical Diagnosis
Evidence Based
Surgery
Materials of the
Philippine Society
of Parenteral and
Enteral Nutrition in
clinical nutrition
ASPEN and ESPEN
guidelines in
enteral and
parenteral
nutrition
Access to all
PCS/PSGS
Evidence based
guidelines
Textbooks
and manuals
of nutrition
Audio Video Equipment
Journals
c) PJSS
d) Journals in
clinical nutrition
EVALUATION
Written Exams
Oral examinations
Direct Observation
injuries or adverse events.
9.
c)
Applies evidence based

10.
11.
d)
Discuss medication
safety
12.
e)
Applies Infection Control

principles.
13.
14.
15.
16.
17.
18.
19.
20.
1.3 Demonstrate knowledge and

implementation of the principles
of Research Methodology and
Critical Appraisal of Literature
1.4 Involved or primary
investigator in research in
surgical nutrition
PSYCHOMOTOR
2.1 Evaluate surgical patients
1. Nutrition screening
2. Nutrition assessment and
risk leveling
3. Nutrition care plan for the
surgical patient
4. Nutrition care plan
implementation
5. order pertinent laboratory
and diagnostic exams
6. refer appropriately
7. provide continuing care
2.2. Perform surgical

nutrition process
1.
2.
1.
Understanding health
care errors
Managing complaints
Showing leadership and
being team player
Understanding complex
health organization
Understanding human
factors
Providing continuity of
care Managing fatigue
and stress
Using information
safety
drug, dose, route ,timing
in medication
5 moments of hand
washing
infection
Research Methods &
Literature
Identify data in the
surgical nutrition database
that will be used for
research purposes which
includes required
statistics like morbidity
and mortality, hospital
days, differences in days,
morbidity and mortality
with and without
malnutrition or with or
without complications
Signs and symptoms of

diseases
2. Choices of surgical
nutrition process
procedures
3. Nutrition changes and
principles of nutrition
management of patients
with diseases of the
alimentary tract
abdomen and
its contents,
the breast (d)

the head and
neck
the vascular
system
endocrine
system, skin
and soft tissues
transplants
Pre-operative care:
Optimization through the
surgical nutrition process
Pre-operative and
postoperative Skills
4. Oral supplementation
methods
Ward and OPD work
1. Performing
surgical nutrition
process
89
Ward / OPD
patients
Laboratory tests
Consultant Staff
Policies, guidelines,
procedure on
nutrition
management from
the Philippine
Society of Parenteral
and Enteral Nutrition
Observation using rating

scale
- Direct Observation using

rating scale
Record Review
Logbook or Records
5.
Tube feeding access:

a. NGT placement
b. Nasojejunal
c. Gastrostomy
d. Jejunostomy
6. Venous access
a
Central
b. Peripheral
Monitoring of the surgical
nutrition process
a. Calorie counting
method
b. Laboratories
c. Nitrogen balance
d. Serum albumin,
pre-albumin
e. Indirect
calorimetry
AFFECTIVE
Demonstrate the proper
practice
1.
2.
3.
4.
5.
6.
7.
8.
3.2 Shows ethical
practices in the
workplace
3.3 Expresses
commitment to lifelong learning.
Direct Observation
Rating Scales
Checklist
Incident Reports
Moral, rthical value
Appropriate Bedside
Decorum / Relationship
w/patient
Study / Work habits
workers & superiors
Simulation
Role Modeling
Mentoring
Resident as Teacher
program
90
Written Hospital
Policies and
Procedures
Hospital Manual on
Resident decorum
Faculty Members as
role model
Code of Ethics of the
Medical Profession
PMA code of Ethics
PCS code of Ethics
OSCE
Faculty mentorship &
role modeling with self
reflection in
professional
Chart Review
Chart Audit
Global Evaluation
Form
Patient Satisfaction
Survey
Peer Review
CLINICAL TEACHING
Intended
Learning Outcome
After the end of the training the
Cognitive:
1) Formulate a simple
instructional design for a
teaching learning activity.
Content
1) Instructional design (ID)

definition
parts of ID
preparation
Teaching-Learning
Strategies
2) Design a complete lecture
plan .
3) Discuss the different small

group learning activities
4) Discuss the different clinical

teaching method.
5) Discuss the different clinical

evaluation method.
Psychomotor:
1) Apply the instructional design
in the clinical setting.
2) Deliver an effective lecture.
2) Lecture
definition
body
styles
making it effective
3) Small Group Learning
definition
activities
conduct
4) Clinical Teaching
principles
activities
conduct
audit
5) Clinical evaluation
written exam
OSCE
direct observation by
checklist and rating
scales
critical incident report
Same
4) Apply the evaluation methods

in the clinical setting.
Affective:
2) Humility to recognize &

limitations and knows when to
ask helps from a mentor.
UP-NTTC Self
Instructional Materials in :
1) Instructional Design
2) How To Give a Good
Lecture
3) Small Group Learning
Books in Microteaching
PATOS workshops and
materials
PSGS Clinical Teaching
Workshop
3) Conduct the different small

group learning activities in the
clinical setting.
1) Demonstrating professional
behavior in conducting clinical
teaching and evaluation
Resources
Same
1) Intellectual Integrity practices intellectual
honesty
2) Appropriate bedside
decorum
3) Team work
team members
91
Evaluation
1) Practical Exam
2) Direct observation by:
- checklist
-rating scale
4) Emotional maturity
stable even in most
stressful situation
5) Empathy
92
PROFESSIONALISM
Intended Learning
Outcome
After the residency the
learner should be able
to :
Discuss the
professional behaviours
Content
Teaching-Learning
Activities
Evaluation
Cognitive
1) standardized assessment
tool
2) pre/post testing of
knowledge
3) Standardized evaluation
after conference
4) Chart records & portfolio
Altruism
Compassion
Humility
Appropriate Physical and Social
Demeanor
Good Leadership Qualities
-Responsible
-Accountable
-Competent
-Effective communicator
-Punctual
-Constructive
-Collaborative
White Coat Ceremony
Written Hospital Policies and

Procedures
Cognitive
Hospital Manual on Resident

decorum
Clinical
PMA code of Ethics
Clinical
Ethical
Commitment to Excellence
Simulation
Role Modeling
Mentoring
Resident as Teacher
program
PCS code of Ethics
1) OSCE
2) Faculty Mentorship &
Role Modeling with self
reflection in professionalism
3) Chart Review
4) Chart Audit
5) Global Evaluation Form
6) Patient Satisfaction
Survey
7) Peer Review
Relationship with Patients
Lectures
Workshop & Symposia in
professionalism
Conferences
Relationship with Co Health

workers
Shows ethical practices
in the workplace
Resources
Humility
Emotional Maturity
Expresses commitment
to lifelong learning.
93
Faculty Members as role

model
Code of Ethics of the Medical
Profession
PATIENT SAFETY
Intended Learning Outcome
Content
Teaching-Learning
Activities
Resources
Evaluation
After the session the learner

should be able to:
Cognitive:
1) Demonstrate effective
communication to patient
Appropriate Communicating
Skills
Communicating Risks
Open Disclosures
Obtaining Consents
Delivering bad news
Respect to cultural and
religious diversity
Recognizing reporting and
adverse events
Large group learning

lecturette
WHO Patient Safety

curriculum
Direct Observation using

checklist and rating scale
Small group learning

small group
discussion
simulation
role playing
preceptorship and
mentorship
Joint Commission
International Accreditation
guideline
Critical Incident Report
Independent learning
To Err is Human Building a

Safer Environment
PCS Evidence Based
Guidelines
Surgical Safety Checklist
2) Discuss how to prevent,

identify and/or manage near
miss injuries or adverse
events.
3) Demonstrate how to work

safely in the workplace
4) Applies evidence based

5) Discuss medication safety
Managing risks
Understanding health care
errors
same
Patient Safety Articles
same
Textbooks and Journals
Managing complaints
Patient Safety Officer
Showing leadership and

being team player
Understanding complex
health organization
Understanding human factors
Providing continuity of care
Managing fatigue and stress
Faculty Members as role

model
Skills laboratory

Using information technology
to enhance safety
drug, dose, route ,timing in
medication
5 moments of hand washing
infection
6) Applies Infection Control

principles.
Psychomotor :
1) Demonstrate the proper
conduct of Patient Safety
Checklist
WHO-PCS patient safety

checklist
2) Demonstrate the following

skills in simulated setting:
- Basic Surgical Skills
- Intermediate Surgical Skills
- MIS Skills
Basic instrumentation
MIS instrumentation
Sutures
Basic suturing
Bowel suturing
Vascular suturing
MIS endosuturing
94
Attitude
1) Demonstrate ethical
practice and behavior.
Maintain fitness in the

workplace
Ethical practice
Bedside decorum
2)
Updates in surgical education

, technology and skills
Expresses commitment to
lifelong learning.
3) Shows ethical practices in

the workplace
95
LEADERSHIP AND MANAGERIAL SKILLS

Intended Learning
Outcomes
At the end of the
session the learner
should be able to:
1. Discuss learners
institutional
organizational
chart.
2. Discuss the
organization s
vision & mission
3. Assume the role
of the leader and
manager
4. Establish simple
strategic plan for
the organization.
5. Discuss Financial
Planning in
Healthcare.
Content
Teaching Learning
Activities
Types of
Organization
Lecturette
Formulating Vision
and Mission /
Core Values
Small Group
Learning
Leadership Skills
Managerial Skills
Strategic Planning
(SWOT
technique)
Health Economics
Resources
Resource Persons
Oral Examination
John Maxwell
Leadership books
Practical Examination
Books in
Organization &
Management
Mentorship
Trainors
96
Evaluation
1. Vision Mission
2. Strategic
Management
3. Financial
Management
GLOSSARY
I. DEFINITION OF TERMS
a.
Attitudes - encompasses awareness, feelings, opinions, interests, appreciation, beliefs,

values, ethics and sentiments.
b.
Behavior - the observable actions, responses, manners, activities and conduct of a person.
c.
Brainstorming - intensive discussion in which spontaneous suggestions are uncritically

received.
d.
Competency - behavior or performance that learners must be able to demonstrate, with a

defined level of proficiency or mastery.
e.
Content - refers to the subject matter and topics to be learned.
f.
Curriculum - a program of study, a series of planned activities intended to bring about

specific learning outcomes
g.
Group discussion - discussion in which the topic & direction are controlled student or
member.
h.
Group Tutorial - discussion wherein topic & direction are given by the tutor but the
organization & content are determined by students.
i.
Knowledge - refers to information, facts, concepts, ideas, principles, procedures and

processes one needs to acquire; it encompasses the cognitive domain of education.
j.
Mentorship - developmental relationship between a more experienced mentor and a less

experienced partner referred as mentee or protg. The mentor assumes multiple roles to
bring enhancement of mentees professional, personal & psychological development. The
mentor may be a role model, advocate, adviser, sponsor, developer of skills & intellect,
facilitator & resource provider.
k.
Objectives - the desired abilities, attributes, characteristics, level of performance to be

attained.
l.
Preceptorship - a program involving a surgeon-trainee visiting an experienced surgeons

facility to observe and assist in a live surgery case & tour the facility.
Includes:
Observation / assisting in live surgery
Training on the safe & effective use of instruments
Discussion of instrumentation & equipment organization while touring the facility
97
m.
Proctorship - a program involving a surgeon-trainer visiting the trainee facility to assist with
trainees first cases. The surgeon may or may not be able to scrub in on the case
depending on the specific facilitys rules.
Includes:
1. Assistance in performing cases.
2. Training on the safe and effective use of instruments.
n.
Psychomotor Skills refers to the ability to perform techniques, procedures, processes,

and operations.
o.
Small group learning - an educational process in which a group of Individuals, interact with
one another to achieve educational objectives (critical thinking, communication skills
& ability to perform as a team members & leaders) & to maintain itself as a group.
p.
Simulation - duplication of real situation in form of a problem & students adopt

appropriate roles or statuses.
98
II.
DEFINITION OF TERMS USED IN THE STANDARDIZED RESIDENTS EVALUATION
A. Overall Clinical Competence

1. Database history and physical examination findings complete and accurate
2. Diagnostic Tests complete, exhaustive, cost-effective tests utilized and
interpreted correctly
3. Diagnosis, Judgment correct diagnosis and rational clinical decisions
4. Treatment, Management appropriate and efficient management of problems
5. Oral Presentation, Reports, Referrals precise, comprehensive, organized reporting
6. Record Keeping complete, accurate, comprehensive written records
7. After Care post-operative management
B. Attitudinal Competence
1. Intellectual Integrity - demonstration of intellectual honesty
2. Moral/Ethical Values demonstration of moral and ethical uprightness.
3. Reliability/Responsibility performance of duty with efficacy, resourcefulness and
initiative.
4. Relationship with Patients establishment of good patient rapport, demonstration of
compassion
5. Study/Work Habits demonstration of knowledge of required and supplemental readings.
6. Relationship w/ co-Health Workers & Society - professionalism, maintenance of a healthy,
respectful and motivated working relation with peers, respect for authority.
7. Emotional Maturity Reaction to Stress demonstration of stability and confidence in
common and stressful situations.
8. Accepts own limitations demonstrates ability to take the welfare of the patient into
consideration; calls for assistance/help when need arises.
99
C. Technical Skills
1. Technical Dexterity precision, smoothness and coordination of movements; execution of
surgical maneuvers.
2. Intra-operative Judgment ability to make precise decisions based on findings; ability to
anticipate problems that may arise.
3. Duration of Procedure ability to complete a surgical procedure within a reasonable and
acceptable length of time.
100
BOARD OF DIRECTORS
2006
2007
Arturo E. Mendoza, Jr., MD

Reynaldo M. Baclig, MD
George G. Lim, MD
Ramon S. Inso, MD
Joselito D. Almendras, MD
Edgar A. Baltazar, MD
Alex E.L. Cerrillo, MD
Giovanni A. De Los Reyes, MD
Nilo C. De Los Santos, MD
Jaime B. Lagunilla, MD
Ervin H. Nucum, MD
Enrico P. Ragaza, MD
Roberto A. Sarmiento, MD
Arnulfo D. Seares, Jr., MD
Jackson D. Soriano, MD
President
Vice-President
Secretary
Treasurer
Directors
Reynaldo M. Baclig, MD
Ramon S. Inso, MD
Edgar A. Baltazar, MD
Ervin H. Nucum, MD
Samuel R. Bacuteng, MD
Esteban V. Belmes, MD
Kenneth S. Chan, MD
Roberto M. de Leon, MD
Giovanni A. de los Reyes, MD
Teodoro J. Herbosa, MD
Jaime B. Lagunilla, MD
Rex A. Madrigal, MD
Tomas J. Monteverde III, MD
Alberto P. Paulino, Jr., MD
Enrico P. Ragaza, MD
PSGS COMMITTEE ON SURGICAL TRAINING

2005
Chairman
Members
Director
In-Charge
Gabriel L. Martinez, MD
Shirard Leonardo C. Adiviso,
MD
Erwin B. Alcazaren, MD
Hernan C. Ang, MD
Michael C. Brillantes, MD
Nelson F. Lim, MD
Edgar T. Manalastas, MD
Manuel A. Oliveros, MD
Alfred N. Potenciano, MD
Ariel S. Ramos, MD
Vitus R. Talla, MD
Wilfredo Y. Tayag, MD
2006
2007
MD
Hernan C. Ang, MD
Michael C. Brillantes, MD
Alfonso C. Danac, MD
Nelson F. Lim, MD
Romel T. Menguito, MD
Ariel S. Ramos, MD
Robert C. So, MD
Ma. Concepcion C. Vesagas,
MD
MD
Hernan C. Ang, MD
Nelson F. Lim, MD
Robert C. So, MD
Ma. Concepcion C. Vesagas,
MD
Ramon S. Inso, MD
Ramon S. Inso, MD
Ramon S. Inso, MD
101
2011 Board of Directors

Ervin H. Nucum, MD
President
Alberto P. Paulino, Jr., MD
Vice President
Renato R. Montenegro, MD
Secretary
Domingo S. Bongala, Jr., MD
Treasurer
Directors
Stephen O. Bullo, MD
Edgardo F. Fernandez, MD
Edwin M. Gonzaga, MD
Vitus S. Hobayan, Jr., MD
Rafael L. Jocson, MD
Leopold G. Lucero, MD
Rex A. Madrigal, MD
Allan B. Melicor, MD
Rodrigo D. Segui, MD
Alex L. Tan, MD
Demie O. Tidon, MD
2011 Committee on Surgical Training

Shirard Leonardo C. Adivisio, MD
Chairman
Rex A. Madrigal, MD
Director-In-Charge
Members
Michael James C. Busa, MD
Malen M. Gellido, MD
Ernest Jerome A. Pagdanganan, MD

Nolan E. Pecho, MD
Deogracias Alberto G. Reyes, MD
Warren M. Roraldo, MD
102

Standardized Curriculum in General Surgery 2012

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Standardized Curriculum in General Surgery 2012

Diunggah oleh

Hak Cipta:

Format Tersedia

MESSAGE

PSGS President 2006

Arturo E. Mendoza, Jr., MD, FPSGS

Reynaldo M. Baclig, MD, FPSGS

Preface to the 1st Edition

Preface to the 2nd Edition

GABRIEL L. MARTINEZ, MD, FPCS

Preface to the 3rd Edition

GABRIEL L. MARTINEZ, MD, FPCS, FPSGS

Preface to the 4th Edition

SHIRARD LEONARDO C. ADIVISO MD,MHPEd ,FPCS,FPSGS

Manual is dedicated to our mentors who with their unselfish guidance

Instructional Designs for Specialty Rotations

Workshop on Accreditation at the Johnson & Johnson Compound, Paraaque, Rizal

Workshop on Competencies at the Manila Garden Hotel

Workshop on Standardized Evaluation, in Manila at Glaxo, Philippines, Pasong

Mini-workshop on Accreditation at the Johnson & Johnson Compound in

THE SURGICAL CURRICULUM

The Surgical Curriculum: What it is

Statement of goals and objectives

ELEMENTS OF THE SURGICAL CURRICULUM

B. GOAL OF THE TRAINING PROGRAM

C. THE GENERAL OBJECTIVE OF THE TRAINING PROGRAM

F. INTENDED LEARNING OUTCOMES

Apply the principles of diagnosis and management of common general

Obtain an adequate history

Demonstrate the proper attitudes and habits in the practice of surgery.

Perform minor surgical procedures

Formulate a logical diagnosis

Apply the principles of diagnosis and management of GS and surgical

Provide pre-operative, intra-operative and post-operative care to all

G. THE COURSE CONTENT

The residents have to acquire knowledge and comprehension of facts, concepts,

FLUIDS AND ELECTROLYTES

SHOCK & RESUSCITATION

ENDOCRINE AND METABOLIC RESPONSE TO INJURY

BLEEDING AND BLOOD TRANSFUSION

Management of Specific Injuries

PRINCIPLES OF IMMUNOLOGY AND TRANSPLANTATION

MINIMALLY INVASIVE SURGERY

PATIENT SAFETY AND PROFESSIONALISM

CLINICAL SURGERY-GENERAL SURGERY

HEAD AND NECK

Anatomy and Physiology

THE THYROID AND PARATHYROID GLANDS

Anatomy and Physiology

Anatomy and Physiology

Skin and Soft Tissue Tumors

ABDOMINAL WALL DEFECTS AND HERNIAS

Anatomy and Physiology

Anatomy and Physiology

THE STOMACH AND DUODENUM

Anatomy and Physiology

THE SMALL-INTESTINE, COLON, RECTUM AND ANUS

Anatomy and Physiology

THE LIVER, GALLBLADDER AND BILIARY TREE

Anatomy and physiology

THE PANCREAS & SPLEEN

Anatomy and Physiology

11. ACUTE SURGICAL ABDOMEN

CLINICAL SURGERY SUBSPECIALTY SURGERY

Technical considerations in skin grafts & flaps

Anatomy and Physiology of GUT

5. THORACIC AND CARDIOVASCULAR SURGERY