clinical study guide department of surgery mti bacha …

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CLINICAL STUDY GUIDE

DEPARTMENT OF SURGERY

MTI BACHA KHAN MEDICAL COLLEGE

MARDAN MEDICAL COMPLEX AND

TEACHING HOSPITAL

MARDAN

Session 2020-21

Note: This document is the property of Surgery Department, Bacha Khan Medical College, and in no way

be copied, printed or reproduced in any form with out the prior permission of the “Head of Surgery

Department, Bacha Khan Medical College.” This cannot be used for legal purposes.

DR. AJMAL KHAN, FCPS

PROFESSOR AND HEAD DEPARTMENT OF SURGERY

2

TABLE OF CONTENTS ........................................................................................................................ 2, 3

RATIONALE OF THE STUDY GUIDE……………………………………………………………………………………………………..4

VISION AND MISSION STATEMENT…………………………………………………………………………………………………….5

FACULTY DETAILS ............................................................................................................................. .6, 7

OUTCOMES OF EACH YEAR ................................................................................................................ 8-10

OUTCOME AT THE END OF 3RD YEAR…………………………………………………………………………………………………8

OUTCOME AT THE END OF 4TH YEAR…………………………………………………………………………………………………9

OUTCOME AT THE END OF FINAL YEAR. ............................................................................................ 10

STRUCTURE OF THE SYLLABUS ACCORDING TO YEAR OF STUDY......................................................... 11

STRUCTURE OF 3RD YEAR MBBS SYLLABUS………………………………………………………………………………………… 11

WARD ROTATION PLAN FOR 3 RD MBBS………………………………………………………………...12

LECTURE TIME TABLE AND WARD SCHEDULE 3RD YEAR (SESSION 2020-21) .................................. …….13, 15

STRUCTURE OF SYLLABUS4TH YEAR MBBS/BDS………………………………………………………………………………….16

LECTURE TIME TABLE AND WARD ROTATION SCHEDULE .......................................................... ………..18, 19

WARD ROTATION PLAN 4TH YEAR MBBS/BDS………………………………………………………………………………………20

STRUCTURE OF SYLLABUS 5TH YEAR MBBS ........................................................................................ .21,

22

LECTURE TIME TABLE FINAL YEAR MBBS………………………………………………………………...23

WARD ROTATION SCHEDULE FINAL YEAR MBBS………………………………………………………...24

WARD ROTATION FOR FINAL YEAR MBBS……………………………………………………………….25

OUTCOMES FOR 3RD YEAR BDS............................................................................................................ 27

STRUCTURE OF SYLLABUS FOR 3RD YEAR BDS……………………………………………………………………………………..28

TIME TABLE 3RD YEAR BDS................................................................................................................... 30

WARD SCHEDULE 3RD YEAR BDS ........................................................................................................... 31

ASSESSMENT………………………………………………………………………………………………………………………………………32, 33

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DETAILED SYLLABUS 3RD YEAR MBBS……………………………………………………………………34

DETAILED SYLLABUS 4TH YEAR MBBS AND 3RD YEAR BDS .......................................................... ………..36, 7, 38

DETAILEDSYLLABUS FINAL YEAR MBBS…………………………………………………………………………………….39-40, 41

CLINICAL ROTATIONS............................................................................................................................. .42

ATTENDANCE AND PROGRESS REPORT ............................................................................................ 43

EXAM SETUP ................................................................................................................................. …44, 46

REFERRENCES ..................................................................................................................................... 47

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RATIONALE OF THE STUDY GUIDE

Surgical diseases form a major part of the community health related problems. Clinicians practicing in

the community should be well aware about the importance of diagnosing and managing these surgical

problems. The medical graduates should have a sound knowledge of pathogenesis, clinical presentation,

investigations and lab diagnosis of all these diseases and many more as discussed in this guide. This

basic knowledge will help the students to integrate the application of these skills in their clinical practice

for timely diagnosis and successful management of the patients. It is important to have a clear concept

of the diseases like acute abdomen, peptic ulcer disease, carcinoma breast and skin diseases. Infections

are also common in hospital as well as in the community. Malignancies are also quite common in our

population. Our aim is to produce safe primary health care doctors, who is the backbone of the health

system and he/she should know which surgical disease should be treated and the ones which need

elective or urgent referral.

The 3rd, 4th and final years are 71.5 weeks (500 hrs.) program/course that presents surgical approach to

adult diseases. The overall objective is to train a clinician in appraisal, management and/or referral of

patients with surgical diseases. Achievement of this objective requires knowledge, skills and attitudes

blended in a carefully planned balanced curricular unit. This curricular unit; the clerkship;

accommodates specified content related to common surgical disease, with learning strategies and

assessment methodologies; all corresponding to each other in an integrated manner.

This surgical teaching program offers all MMBS/BDS students an opportunity to develop surgical skills

that are required by a clinician to diagnose a patient with a surgical problem in the community. It is

believed that after attending the clerkship program a student will be able to come up to the

expectations of community, colleagues and other stakeholder institutions.

This document will provide you the detailed syllabus, taught in all three years, the methodologies used

for the teaching and the assessment methods (timings and the structure of the assessment).

On behalf of my Faculty, I welcome you all and wish you successful journey in the surgery and life ahead

PROFESSOR DR AJMAL KHAN

HEAD DEPARTMENT OF SURGERY.

BACHA KHAN MEDICAL COLLEGE/MTI MMCTH. MARDAN

5

.

VISION STATEMENT

Our aim is to produce safe primary health care doctors, who is the backbone of the health system and

he/she should know which surgical disease should be treated and the ones which need elective or

urgent referral

To provide an environment of continuous learning and inquiry

To create new knowledge about the effects of disease in humans

To educate, recruit and retain the best surgeons and scientists

To create an environment where surgical and scientific excellence, and

teamwork are valued

To promote and advance the highest moral and ethical standards in an

environment of compassion and critical appraisal

MISSION STATEMENT

To restore health through surgical intervention, remembering patient

dignity and comfort are integral to overall health

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FACULTY DETAILS

General surgery

1. Professor Dr Mohammad Hussain surgical B unit

2. Professor Dr Ajmal Khan surgical B unit

3. Professor Dr Mukhtiar Ali surgical A unit

4. Assistant professor Dr Aurang zeb Khan surgical B unit

5. Assistant Professor Dr Tamjeed Gul surgical A unit

6. Assistant Professor Dr Ibrahim Shuja surgical B unit

7. Assistant Professor Dr Asif Imran surgical A unit

Orthopedic

1. Professor Dr Haziq Dad

2. Dr Zahir Khan

3. Tariq Ahmad

4. Dr Abdus Sammad

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5.

Neurosurgery

1. Dr Naeem ul haq

2. Dr Gohar Ali

3. Dr Asghar khan

4. Dr Ishaq

Plastic surgery

Dr Zarar Niazi

Urology

Dr Zafar Ahmad

Pediatric surgery

Dr Javed Khan

STUDY GUIDE COMPILED BY

DR AURANGZEB KHAN

ASSISTANT PROFESSOR OF SURGERY FOCAL PERSON

CURRICULUM AND ACADEMICS

8

Outcomes of each year

Outcome at the end of 3rd year MBBS

At the end of 3rd year students will be able to:

Knowledge:

• Explain the etiology and pathogenesis of common surgical conditions including metabolic response to

injury, shock, wound care, tissue repair and scars.

• Apply the knowledge to, prevent, diagnose and manage the common surgical conditions and

infections.

• Identify the risk factors for preventable diseases.

Skill:

• Practice the prophylactic measure to prevent infections and preventable diseases.

• Plan the preoperative and post-operative care of surgical patients

Attitude:

• Demonstrate effective communication skill strategies while interacting with the patients.

• Demonstrate teamwork and positive interaction with colleges.

• Demonstrate self-learning attitude and problem-solving skill.

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Outcome at the end of 4th year MBBS

At the end of 4th years students will be able to:

Knowledge:

• Integrate the basic science knowledge with clinical sciences in order to describe the pathogenesis,

clinical presentations, investigations, lab diagnosis, and management of common surgical disorders

mentioned in syllabus below.

• Develop a problem-solving approach in diagnosing various types of surgical emergencies.

• Exhibit the knowledge of various clinical aspects of malignancies while developing a problem-solving

approach.

Skill:

• Identify morphological features of common surgical diseases

• Conduct detailed history and examination (specific and general) of common surgical problems

• Make a provisional diagnosis of common surgical problems

Attitude:

• Demonstrate effective communication skill strategies.

• Display the personal attributes of compassion, honesty and integrity in relationships with patients,

families, communities and the medical profession.

• Demonstrate a professional attitude, team building spirit and good communication skills through

effective participation in collaborative problem solving, especially in small group exercises directed

towards understanding the gastrointestinal disorders

10

Outcome at the end of 5th year MBBS

Knowledge skill and attitude:

At the end of surgical clinical rotations and lectures, the final year MBBS students will be able to:

• Understand the basic principles of surgical diagnosis, investigations and treatment.

• Apply the basic concepts formed in earlier academic years to clinical clerkship

• Develop effective history taking skills

• Perform clinical examination independently

• Treat common surgical diseases in the community

• Understand the principles of pre-operative and post- operative surgical care

• identify the common surgical complications and formulate their management

• Provide initial management in surgical emergencies

• Decide about the referral of a patient with surgical problem/emergencies for expert opinion/

management.

• Understand the importance of surgical site infections and their prevention

• Perform minor surgical procedures under supervision

• Communicate effectively with the patient and colleagues observing the principles of counseling,

breaking bad news, anger and conflict management

• Observation of important surgical procedures lays the foundation for house job.

• Shadowing the house surgeon will provide the medical students the platform to learn day to day

activities on surgical floor.

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Structure of the syllabus according to year of study

Syllabus of 3rd year MBBS:

SURGERY SYLLABUS and TIME TABLE (YEAR 2020-21) MBBS 3rd YEAR

Surgical Unit-A

• Surgical Nutrition

• Sterilization and Disinfection

• Surgical infection

• Antimicrobials and tetanus prophylaxis in surgery

• Wounds, ulcers, Tissue Repair and scars

• Burns and management

Surgical Unit-B

• Preoperative preparation of a surgical patient

• Post-operative care of a surgical patient

• Metabolic response to injury

• Shock

• Blood and blood products transfusion

• Fluid and Electrolyte and Acid base Disturbances

• Pain Relief

Time table

Surgical unit – A 1-11-2020 to 30-04-2021

Surgical unit – B 01-05-2021 to 30-09-2021

• 50 minutes lecture on every Thursday

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• The feedback from students will be collected twice during the session.

• 4 week’s rotation in each in Surgery A and B wards. Twice per week and 3 hours per day (48 hours)

• The feedback will be collected once at the end of clinical rotation.

Ward rotation plan for 3rdyear MBBS students.

Clinical rotation: 10 days

Learning outcome for clinical teaching 4th year MBBS

Day Topics to be discussed

Facilitator Venue and teaching strategy

Out comes

1 Introduction and orientation personal safety protocols and prevention of infections

Dr. Muhammad Ibrahim Shuja

Ward/OPD/OT

2 History taking prerequisite and history of trauma victim.


Ward/OPD/OT Student shall be able to introduce him/herself to the patient and take consent for history taking.

3 History of pain and lump Dr. Muhammad Ibrahim Shuja

Ward/OPD/OT Students shall be able to enquire all the parameters of pain and any lump/mass in history taking

4 History of lump, ulcers and other skin lesions


Ward/OPD/OT Shall be able to take detailed history of lump, ulcers and other skin lesionsmethodologically reach a provisional diagnosis and exclude differentials

5 History of painful abdominal conditions


Ward/OPD/OT Shall be able to take detailed history for painful abdominal conditions andenumerate differential diagnosis of painful abdominal conditions.

6 History of l abdominal mass and swellings


Ward/OPD/OT Shall be able to take detailed history for abdominal masses and enumerate differential diagnosis of painful abdominal conditionswith special emphasis on surgical pathologies leading to abdominal mass.

7 History of limbs vascular and neurological disorders


Ward/OPD/OT Student shall be able to take history of upper and lower limb with emphasis on vascular and neurological conditions

8 History of inguino-scrotal swelling masses and painful condition


Ward/OPD/OT Shall be able to take detailed history for inguino -scrotal masses andpainfulinguino-scrotall conditionsenumerate differential diagnosis of painful inguino-scrotall conditionswith special emphasis on surgical pathologies of inguino- scrotal area like hernia/hydrocele /torsion/orchitis

9 History taking in surgical disease of Breast


Ward/OPD/OT Shall be able to take detailed history of breast inflammatory and neo- plasplastic conditions.

10 Formative assessment log books


Ward/OPD/OT Students should be able to greet the patient take consent take appropriate

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history in the context of surgical patient presentation

Note:.

Monday Wednesday and Friday the venue is OPD.

Tuesday, Thursday venue is operation theatre/ ward

14

MEDICAL TEACHING INSTITUTION

BACHA KHAN MEDICAL COLLEGE MARDAN

Lecture/Practical Time Table For 3rd Year MBBS Student (Session 2020-21)

w.e.f 01/10/2020 Lecture Theater No:02

DAYS

08:00AM-09:00AM

09:00AM-10:00AM

10:00AM-12:00PM

12:00AM-01:00PM

01:00AM-03:00AM

05:00PM—08:00PM

Monday

Pathology

Dr.Mohtasim Billah

Forensic Medicine

Dr.Shagufta Khalid

Hospital Work

EYE

Dr M.Tariq

Practical/Tutorial 1. Pathology (Group-A)

Dr.Bakhtawar /Iram

Evening Hospital Work

2.Pharmacology (Group-B) Dr. Waseem Bukhari

Dr. Husnain

Tuesday

ENT Dr.Imad

Pathology Dr.Aisha Gohar

Hospital Work

Pharmacology Dr.S.M.Khan Jadoon

Practical/Tutorial

1.Pharmacology (Group-A) Dr. Waseem Bukhari Dr. Husnain


2. Pathology (Group-B)

Dr.Bakhtawar

Wednesday

Pharmacology

Dr.Somia Afzal

Pharmacology

Dr.Halima Sadia

Hospital Work

Pathology

Dr.Zahir Shah

Practical/Tutorial 1. Pathology (Group-A)

Dr.Mehreen Yousaf


2.Pharmacology (Group-A) Dr. Zahid / Dr. Tufail

Thursday

Pathology

Dr. M.Manzoor

ENT

Dr.Sana Ullah

10:00AM

11:00AM

Pharmacology Dr. S.M-Jadoon

Lecture Theater No.03

11:00AM

12:00PM

Forensic Medicine

Dr.Zaheer Lecture T.No.03

12:00PM

01:00PM

Forensic Medicine

Dr.Abdullah Dr. Taimur

Practical/Tutorial 1.Pharmacology (Group-A)

Dr.Haleema Sadia


2. Pathology (Group-B) Dr.Mehraan Yousaf

Friday

EYE Dr.Shafqat Ali Shah

Pathology Dr.Nadia

Pharmacology Dr.Imtiaz -Ud- Din

Community Medicine Dr.Huma/ Dr. Fatima

Forensic Medicine Dr.Khalid K Dr.Abdullah

Half Day


Associate Dean Clinical Associate Dean

BKMC

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WARD ROTATION SCHEDULE THIRD YEAR MBBS

BKMC SESSION

MEDICAL TEACHING INSTITUTION

BACHA KHAN MEDICAL COLLEGE MARDAN

Time Table For 3rd Year MBBS Hospital ward Duties (Session 2020-21)

(w.e.f 01/10/2020) Medical Surgery Gynae ENT EYE Forensic

Medicine

Pediatrics

(B) (B) (B)

01/10/2019 To 31/10/2019 A B C D E F G

01/11/2019 To 03/12/2019 B C D E F G A

04/12/2019 Winter Vacation Break 23rd

Dec,2019 To 31st Dec,2019

To 15/01/2020

C D E F G A B

16/01/2020 To 18/02/2020 D E F G A B C

19/02/2020 To 24/03/2020 Sports Week 25/03/2020 To

31/03/2020

E F G A B C D

Spring Vacation Break

1st April,2020 To 10th

April,2020

11/04/2020 To 12/05/2020

F G A B C D E

13/05/2020 To 15/06/2020 Summer Vacation Break

15,June,2020 To

31stAugust,2020

G A B C D E F

Associate Dean Clinical Associate Dean BKMC

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Structure of syllabus 4th year MBBS/BDS

SURGERY TOPICS FOR 4TH YEAR MBBS/BDS

SURGICAL UNIT-A (1/10/2020 to 1/6/2021)

1. Principles of oncology

2. Skin and Subcutaneous tissue

3. Malignant Tumors of skin

4. Lymph edema and its management

5. Venous disorders

6. Arterial disorders

7. Transplantation

8. Pre-Operative care of the surgical patient’s

9. Post op complications, recognition and management

O General

O Specific

10. Head, Face and Neck

O.Developmental abnormalities of face, palate, lips.

O.Oral cavity including tongue.

O.Neck lumps including lymph nodes

11. Surgical Audit

12. Day Case Surgery

13. Plastic Surgery

SURGICAL UNIT-B (15/07/2021 to 28/08/2021)

Trauma Initial management of trauma patient)

• Thoracic trauma and its management

• Abdominal injuries and its management

17

• Head trauma and its management

• Musculoskeletal trauma and its management

• Compartment Syndrome

• Disaster Management

Chest Wall & Thorax

Surgical Management of Ischemic heart disease

Anesthesia

Pediatrics’ Surgery

• The lectures of surgery in 4th year are twice per week.

• Feedback is taken twice during the whole year.

• The surgical rotation is 4 days a week for a month.

• The surgical clinical rotation is 5 hours per day

• Feedback is taken at the end of clinical rotation.

18

TIME TABLE FOURTH YEAR MBBS

BKMC MARDAN

Valid from

Due to covid pandemic restrictions continuous changes are made in time table.

Displayed on notice board

19

WARD ROTATION PROGRAM SESSION 4TH YEAR MBBS-----

- -

BKMC MARDAN

Valid from---- -



20

Ward rotation plan for 4th year MBBS students.



Day Topics to be discussed

Facilitator Venue and teaching strategy

Out comes

1 Introduction and orientation Dr. TamjeedGul Ward/OPD/OT

2 History taking Dr. TamjeedGul Ward/OPD/OT Student shall be able to Elicit focused history to assess patient with surgical problem

3 General physical examination Dr. TamjeedGul Ward/OPD/OT Students shall be able to do general physical examination of all body systems in simple and complex situations in all ages and consider the findings in the context of surgical patient presentation

4 Examination of lump, ulcers and other skin lesions

Dr. ZararNiazi Ward/OPD/OT Shall be able to examine these lesion methodologically reach a provisional diagnosis and exclude differentials

5 Examination of abdomen Dr. TamjeedGul Ward/OPD/OT Shall be able to follow all necessary steps of abdominal examination and reproduce the same under observation.

6 Examination of head and neck Dr. TamjeedGul Ward/OPD/OT Shall be able to examine neck for all surgical pathologies

7 Examination of upper and lower limb

Dr. ZararNiazi Ward/OPD/OT Student shall be able to examine the upper and lower limb with emphasis on vascular and neurological examination.

8 Inguino-scrotal examination Dr. TamjeedGul Ward/OPD/OT Shall be able to examine theinguino scrotal area methodologically, reach a provisional diagnosis of scrotal/groin surgical pathologies and exclude differentials.

9 Breast examination Dr. TamjeedGul Ward/OPD/OT Shall be able to take consent for breast examination and follow the protocols for breast examination.

10 Formative assessment log books

Dr. TamjeedGul Ward/OPD/OT Students should be able to take appropriate history and demonstrate general physical and systemic examination of all body systems in simple and complex situations in all ages and consider the findings in the context of surgical patient presentation

Note:

Monday the venue is ward.

Tuesday, Thursday the venue is OPD.

Wednesday and Friday venue is operation theatre.

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Syllabus of final year MBBS

Lecture distribution MBBS Final Year 2021

Surgical unit A

1. The thyroid and parathyroid glands, The adrenal glands

2. Disorders of the salivary gland

3. Benign and malignant conditions of breast

4. Liver Spleen Gall bladder and bile duct

5. Benign and malignant condition of pancreas

6. Bariatric surgery

7. Esophagus

8. Stomach and duodenum

9. The benign and malignant disorders of small intestines and small bowel obstruction

10. Management of upper GI Bleed

11.Peritoneum, retro peritoneum and mesentery

12. Abdominal wall hernias (inguinal, femoral, paraumbilical and incisional)

13. Scrotum and testis

14. Acute abdomen, causes, diagnosis and management.

15. Principals of laparoscopy

Surgical unit B

1. Anatomy of large intestine.

2. Clinical features of large intestine diseases.

3. Appendix.

4. Inflammatory bowel disease.

5. Diverticulitis and its complication.

6. Management of lower GI bleed.

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7. Pediatric surgery

8. Ileostomy and colostomy.

9. Benign and malignant tumors of large intestine including large bowel obstruction.

10. The benign and malignant condition of rectum, the anus and anal canal.

• There will be thrice a week lecture in final year, for 50 minutes

• The feedback about teachings will be taken from the students bi annually.

• The students will come to surgical wards daily in small groups, for 3.5 weeks.

• Students during ward rotations will shadow house officers in ER twice weekly.

• Students will attend the evening round daily.

23

LECTURE TIME TABLE FINAL YEAR MBBS SESSION ----

2020-2021---

BKMC MARDAN

Valid from---- -



24

WARD ROTATION PROGRAM FINAL YEAR MBBS SESSION

------2020-2021----- BKMC MARDAN

VALID FROM - -



25

Ward rotation plan for 5th year MBBS students.



Day activity resource person

1 orientation to the unit what photo calls personal safety protocol and prevention of infection policies

PROFESSOR

2 DPR are taking upper GI bleed dysphagia odynophagia + skills

PROFESSOR

3 urolithiasis hematuria + skills PROFESSOR

4 Acute abdomen and abdominal examination +surgical radiology

PROFESSOR

5 Breast lump skills counseling skills breaking bad news

PROFESSOR

6 neck lump examination hypothyroidism and hyperthyroidism parathyroid pheochromocytoma

PROFESSOR

7 chest trauma examination workout and Management

PROFESSOR

8 Burns management, ulcers, cyst and lump

Dr. Zarar Niazi

9 Diabetic foot examination workup and Management

Dr.ZararNiazi

10 skin soft tissue flaps and grafts complications

Dr.ZararNiazi

11 abdominal trauma liver spleen kidney

12 assessment + feedback

26

Final year daily schedule surgical B ward

Day activity resource person

1 orientation to the unit what photo calls personal safety protocol and prevention of infection policies

PROFESSOR

2 history examination and management of inguino scrotal swelling

PROFESSOR

3 History examination of bleeding PR differential diagnosis and Management

PROFESSOR

4 history of jaundice causes examination and management of obstructive jaundice

PROFESSOR

5 History, examination of acute and chronic ischemic limb. Management of ischemia varicose veins and varicose ulcers

PROFESSOR

6 History, examination and management of intestinal obstruction/ intestinal perforation and secondary bacterial peritonitis.

PROFESSOR

7 Wound types and surgical site infection

PROFESSOR

8 Fluid management of surgical pediatrics patients

PROFESSOR

9 History, examination and management of congenital anomalies in pediatrics

PROFESSOR

10 OT protocol /instruments handling /scrubbing gowning

PROFESSOR

11 Stomas/ tubing/drains/misconnections/ potential hazards

PROFESSOR

12 assessment + feedback

27

OUTCOME FOR 3RD YEAR BDS.

At the end of 3rd year BDS students will be able to:

Knowledge:

• Integrate the basic science knowledge with clinical sciences in order to describe the pathogenesis,

clinical presentations, investigations, lab diagnosis, and management of common surgical disorders

mentioned in syllabus below.

• Develop a problem-solving approach in diagnosing various types of surgical emergencies.

• Exhibit the knowledge of various clinical aspects of malignancies while developing a problem-solving

approach.

Skill:

• Identify morphological features of common surgical diseases

• Conduct detailed history and examination (specific and general) of common surgical problems

• Make a provisional diagnosis of common surgical problems

Attitude:

• Demonstrate effective communication skill strategies.

• Display the personal attributes of compassion, honesty and integrity in relationships with patients,

families, communities and the medical profession.

• Demonstrate a professional attitude, team building spirit and good communication skills through

effective participation in collaborative problem solving, especially in small group exercises directed

towards understanding the gastrointestinal disorders

28

SYLLABUS FOR 3RD YEAR BDS.

SURGERY TOPICS FOR 3RD YEAR BDS, BKMC

SURGICAL UNIT-A (1/3/2019 to 31/5/2019)

1. Principles of oncology

2. Skin and Subcutaneous tissue

3. Malignant Tumours of skin

4. Lymph edema and its management

5. Venous disorders

6. Arterial disorders

7. Transplantation

8. Pre-Operative care of the Surgical patients

Post op complications, recognition and management

o General

o Specific

• Head, Face and Neck

o Developmental abnormalities of face, palate, lips.

o Oral cavity including tongue.

o Neck lumps including lymph nodes

• Surgical Audit

• Day Case Surgery

• Plastic Surgery

SURGICAL UNIT-B (26/11/2020 to 28/2/2020)

Trauma Initial management of trauma patient

• Thoracic trauma and its management

• Abdominal injuries and its management

29

• Head trauma and its management

• Musculoskeletal trauma and its management

• Compartment Syndrome

• Disaster Management

Chest Wall & Thorax

Surgical Management of Ischemic heart disease.

Anesthesia

Pediatrics’ Surgery

• The lectures of surgery in 3rd year BDS are twice per week.

• Feedback is taken twice during the whole year.

• The surgical rotation is 4 days a week for a month.

• The surgical clinical rotation is 5 hours per day

• Feedback is taken at the end of clinical rotation.

30

TIME TABLE 3RD BDS SESSION

BKMC MARDAN

Valid from



31

WARD ROTATION PROGRAM 3RD YEAR BDS SESSION-------

- -

BKMC MARDAN

Valid from---- -



32

ASSESSMENT

Assessment of 3rd year MBBS

NO ASSESSMAENT ASSESSMENT TOOL NUMBER AND TIME OF TEST

1 LOW STAKE ASSESSMENT

SHORT ASSAY QUESTIONS

At the end of each topic mentioned in the syllabus 3 class tests One will be short assay question and 10 MCQs.


Mini CEX. To assess history taking and communication skills

One at the end of ward rotation

ASSESSMENT OF 4TH YEAR MBBS/ 3RD YEAR BDS

NO ASSESSMENT ASSESSMENT TOOL NUMBER AND TIME OF ASSESSMENT TOOL


SHORT ASSAY QUESTIONS AND MCQs

At the end of each topic mentioned in the syllabus 6 class tests One will be short assay question and 10 MCQs.


Mini CEX. To assess history taking and communication skills And examination skills

One at the end of ward rotation

33

Assessment of final year MBBS

NO ASSESSMENT ASSESSMENT TOOL NUMBER AND TIME OF ASSESSMENT TOOL


SHORT ASSAY QUESTIONS AND MCQs

At the end of each topic mentioned in the syllabus 9 class tests Two will be short assay question and 10 MCQs.


OSCE=12 MCQ= 10 Long case assessment= 1 Short cases=2

At the end of clinical rotation


OSCE=21 stations At the end of final year

4 HIGH STAKE ASSESSMENT

Final exam by conducted byBKMC. Comprising: MCQ= SEQ= OSCE=

At the end of final year

34

DETAILED SYLLABUS 3RD YEAR MBBS

NO TOPIC INSTRUCTIONAL STRATEGY

NUMBER OF LECTURES

RESOURCE PERSON

ASSESSMENT TOOL

Orientation to syllabus and ward, ER and Theater round

1 Assistant professor or above

none

1 Surgical Nutrition

Lecture 1 Assistant professor or above

MCQ

2 Sterilization and Disinfection


MCQ

3 3 Surgical infection


MCQ and short essay question

4 Antimicrobials and tetanus prophylaxis in surgery

Lectures 3 Assistant professor or above


Low stake class assessment

5 Wounds, ulcers, Tissue Repair and scars

Lectures 4 Assistant professor or above


6 Burns and management

Lectures and SGD

5 Assistant professor or above


7 Preoperative preparation of a surgical patient

SGD Lectures 3 DO DO

8 Post-operative care of a surgical patient

DO 3 DO DO


35

9 Metabolic response to injury

Lectures 3 DO MCQ

10 Shock Lectures and SGD

5 DO SEQ and MCQ

11 Blood and blood product transfusion

SGD 3 DO MCQ

12 Fluid and electrolyte and acid base disturbances

Lectures 2 DO MCQ

13 Pain relief SGD 2 DO MCQ and SEQ


36

Detailed syllabus 4th year MBBS/BDS

Number Topic and subtopic

Teaching strategy

Number of lectures

Resource person

Assessment tool

Orientation to ward and syllabus Question answer session Ward OPD and ER round

1 surgical oncology lectures 2 Assistant professor or above

MCQs

2 Skin and subcutaneous tissues

DO 6 DO SEQs

3 Infection DO 1 DO SEQs

4 Surgical site infections

DO 2 DO MCQs

5 Skin tumor DO 1 DO MCQ

6 Gas gangrene DO 1 DO SEQs

7 Malignant melanoma

DO 1 DO MCQs

8 Cysts and others IGTN

DO 1 DO MCQs

Class test

Lymph edema and its management

9 lymphedema Lectures 1 DO MCQs

ARTERIAL DISORDERS

10 Hemorrhagic shock

Lectures and SGD

1 DO SEQs

11 Arterial occlusion-1

Lectures and SGD

1 DO SEQs

12 Arterial occlusion -2

Lectures and SGD

1 DO MCQs

37

13 Critical limb ischemia and gangrene

Lectures and SGD

1 DO MCQs

14 Amputation Lectures and SGD

1 DO MCQs

15 Aneurysm Lectures and SGD

1 DO SEQs

VENOUS DISORDERS

16 VERICOSE VEINS/deep vein incompetence

LECTURE 1 Assistant professor or above

MCQs

17 DVT/leg ulceration

Lecture 1 DO MCQs

18 Transplantation Lecture 1 DO MCQs

19 Pre-operative care of surgical patient

DO 1 DO SEQs

CLASS TEST

20 Post op complications, recognition and management

Lecture 5 SEQs

21 Head, Face and Neck O.Developmental abnormalities of face, palate, lips. o. Oral cavity including tongue. o.Neck lumps including lymph nodes

Lectures 6 DO MCQs

CLASS TEST

22 SURGICAL AUDIT LECTURES 3 DO MCQs

23 DAY CASE SURGERY

LECTURES 3 DO SEQs

24 PLASTIC SURGERY

LECTURES 5 DO MCQs

CLASS TEST

25 Thoracic trauma and its management

LECTURES 4 Assistant professor or above

SEQs

26 Abdominal injuries and its management

LECTURES 5 Assistant professor or above

SEQs

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CLASS TEST

27 Head trauma and its management

lectures 3 Assistant professor or above

MCQs and SEQs

28 Musculoskeletal trauma and its management

DO 4 DO MCQs

29 Compartment syndrome

lectures 2 DO MCQs and SEQs

30 Disaster management

Lectures 2 DO MCQs

31 Surgical Management of Ischemic heart disease. Anesthesia

Lectures 2 DO MCQs and SEQs

32 Pediatrics surgery

lectures 3 DO MCQs and SEQs

CLASS TEST

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Detailed syllabus of final year MBBS

N TOPIC LEARNING STRATEGY

RESOURCE PERSON NUMBER OF LECTURE S

ASSESSMEN T TOOL

Orientation to ward, OPD, ER and OR Description of syllabus and details of competencie s to be achieved One lecture and 1st day of ward

1 THE THYROID AND PARATHYROID GLANDS THE ADRENAL GLANDS

LECTURES AND BED SIDE TEACHING AND OMP

PROFESSOR/ASSOCIA TE PROFESSOR

9 MCQ AND SEQ

2 DISORDERS OF THE SALIVARY GLANDS

LECTURES AND SGD, BED SIDE TEACHING AND OMP

DO 5 MCQ AND SEQ

CLASS TEST

3 BENIGN AND MALIGNANT CONDITIOS OF BREAST

DO DO 5 DO

4 LIVER,SPLEEN, GALLBLADER AND BILE DUCTS

DO DO 9 DO

CLASS TEST

5 BENIGN AND MALIGNANT CONDITIONS OF PANCREASE

DO DO 6 MCQ AND SEQ

6 BARIATRIC SURGERY DO DO 3 DO

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CLASS TEST

7 ESOPHAGUS DO DO 4 MCQ AND SEQ

8 STOMACH AND DUODENUM DO DO 4 DO CLASS TEST

9 The benign and malignant disorders of small intestines and small bowel obstruction

DO DO 4 MCQ AND SEQ

1 0

Management of upper GI Bleed

DO DO 3 DO

1 1

Peritoneum, retroperitoneum and mesentery

DO DO 3 DO

CLASS TEST

1 2

Abdominal wall hernias (inguinal, femoral, paraumbilical and incisional)

DO DO 4 MCQs AND SEQs

1 3

Scrotum and testis DO 4

1 4

Acute abdomen, causes, diagnosis and management.



4 MCQs AND SEQs

1 5

PRINCIPLES OF LAPAROSCOPY LECTURES AND SGD, BED SIDE TEACHING AND OMP


3 MCQs AND SEQs

1 6

PEDIATRIC SURGERY LECTURES AND SGD, BED SIDE TEACHING AND OMP


4 DO

CLASS TEST

1 7

ANATOMY OF LARGE INTESTINE



3 MCQs AND SEQs

1 8

Clinical features of large intestine diseases.

DO DO 5 DO

1 9

APPENDIX DO DO 3 DO

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CLASS TEST

2 0

INFLAMMATORY BOWEL DISEASE



4 MCQs AND SEQs

2 1

DIVERTICULOSIS AND ITS COMPLICATION/MANAGEME NT

DO DO 4 DO

2 2

MANAGEMENT OF LOWER GI BLEED

DO DO 4 DO

2 3

ILEOSTOMY AND COLOSTOMY

DO DO 4 DO

CLASS TEST

2 4

Benign and malignant tumors of large intestine including large bowel obstruction.



4 MCQs AND SEQs

2 5

The benign and malignant condition of rectum, the anus and anal canal

DO DO 5 DO

CLASS TEST

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Clinical rotations

NO CLASS RESOURSE PERSON

WARD DAYS TIME INSTRUCTIONAL STRATEGIES

1 CLASS 3RD DR Bed side YEAR MBBS AURANGZEB teachings in KHAN SU 1 wards. , DR ASIF Problem based IMRAN SU 2 teachings DR IBRAHIM SGD SHUJA SU 1 OMP in OPD Role plays for communication skill

2 CALSS 4TH DR TAMJEED Bed side YEAR MBBS GUL SU1 teachings in AND 3RD YEAR DR IBRAHIM wards. BDS SHUJA SU 2 CASE based DR ASIF teachings IMRAN SU 3 SGD DR OMP in OPD AURANGZEB Role plays for SU4 communication skill

3 FINAL YEAR PROF DR M Bed side MBBS HUSSAIN SU1 teachings in PROF DR wards. AJMAL KHAN Case based SU2 teachings ASSOCIATE Team based PROF DR teachings MUKHTIAR ALI Shadowing of the house officer SGD OMP in OPD Role plays for communication skills Skill lab teachings

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Attendance and progress cards

A total of 75% attendance is to be shown in lectures and hospital duties, failing

which the student is not allowed sitting in the final surgery exam as per University

rules, so please keep a good record of attendance in the ward as well as in the

lectures. Progress card has to be complete and signed by the respective teacher.

This internal assessment has 10% marks in the exams in theory as well as practical.

Case History Books

These are available from the college. This has space for history writing for3rd, 4th,

5th year MBBS separately. Please make sure they complete their required histories

while they are on surgical ward duty. This shall be checked and signed by the SR

surgery on their last day in the ward.

STUDENTS PERFORMANCE &RECORD OF CLINICAL WORK (PORTFOLIO)

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Exam Setup

Final professional Surgery examination has the following components

Total marks: 500

Minimum Pass Marks: 250 (Including marks of internal assessment)

Theory:

Total Theory Marks= 200

Paper A: 90 Marks (45 marks MCQs and 45 marks SEQs)

Paper B: 90 Marks (45 marks MCQs and 45 marks SEQs)

Internal Assessment Theory:

Total 20 marks (10 percent of 200)

Practical Exam: Total Practical Marks=300 Marks

Part 1

Stations:Total Marks = 120

OSCE (Objectively Structured Clinical Exam) Stations, Total Stations =15

Interactive Stations = 7 (70 marks), Static Stations = 5 (50 marks),

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Rest Station= 3 (No marks)

Part 2: Long case --70 marks(35 marks with each examiner)

Part 3: Short case -- 80 marks (40 marks with each examiner)

Four short cases will be included each with 20 Marks

Internal assessment practical: 30 Marks (10 percent of 300)

Syllabus for theory paper

There are two Surgery papers A and B each of 90 marks. Each paper has 12 Short essay questions. Student

has to attempt 9 questions with a good choice. All questions carry equal marks that are 5. .Student writes

each question on a separate page in the answer book. Each answer book is factitiously numbered by the

university and centralized marking is carried out by different examiners in KMU.From 2014onwards the

theory paper include 45 MCQs, each carry 1 mark.

Surgery Paper A

Injuries and diseases of bones and joints, muscles, tendons, and bursae, deformities, Head and

spine, central and peripheral nervous system, Face, Lips and palate, Teeth, gums, Jaws, Nose and orbit,

Mouth, Tongue, Cheeks, Salivary glands, Neck, Thyroid, Parathyroid, Thymus and Adrenal glands and all

other endocrine system, Breast, Pharynx, Larynx. Acute infection and wounds, Chronic infectious disease

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and Parasites, Tumors and cysts, Hemorrhage, Blood transfusion and Shock, Fluids, electrolytes and acid

base balance, Skin, Burns, Arteries and veins, Lymphatics and lymph nodes, Infection.

Surgery Paper B

Thorax, Esophagus, Stomach and duodenum, Spleen, Liver and extra hepatic biliary system,

Pancreas, Peritoneum. Intestines including intestinal obstruction, Vermiform appendix, Rectum and anal

canal, umbilicus and abdominal wall, genitourinary system

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References:

Text book.

Bailey and Love Short practice of surgery

Reference books .

Higher Surgical Training in General Surgery by Alferd Cuschieri

SCHWARTZ'S PRINCIPLES OF SURGERY

Clinical methods .

Normal L Browses’ introduction to the symptoms and signs of surgical diseases.

clinical study guide department of surgery mti bacha …

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