new mrcs syllabus draft 16-06-09!1!1

8/13/2019 New MRCS Syllabus Draft 16-06-09!1!1

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DRAFT FOR CONSULTATIONA curriculum for the early years of surgical training

Preface............................................................................................................................................!ARL" "!ARS TRAININ# AND T$! COR! CURRICULU% & ....................................................'

O(!R(I!)................................................................................................................................. 'PURPOS!S................................................................................................................................ *

T$! TRAININ# PAT$)A"............................................................................................................+T$! ASS!SS%!NT FRA%!)OR,...............................................................................................-OUTCO%!.................................................................................................................................... /

A SU%%AR" OF T$! ,!" S"LLA0US %ODUL!S IN T$! COR! CURRICULU% T$AT AR!R!1UIR!D OF ALL SUR#ICAL TRAIN!!S PRIOR TO !NTR" INTO ST...............................

T$! D!TAIL!D %ODUL!S OF T$! COR! SUR#ICAL S"LLA0US FOR ALL SUR#ICALTRAIN!!S R!1UIR!D FOR !NTR" INTO ST......................................................................... '

%o2ule ....................................................................................................................................30asic sciences.......................................................................................................................... 3

%o2ule 4....................................................................................................................................5Common Surgical Con2itions ................................................................................................... 5%o2ule ....................................................................................................................................4/0asic surgical s6ills................................................................................................................... 4/%o2ule '....................................................................................................................................44The assessment an2 management of the surgical 7atient........................................................ 44

%o2ule *....................................................................................................................................4Peri8o7erati9e care.................................................................................................................... 4%o2ule 3....................................................................................................................................43

Assessment an2 management of 7atients :ith trauma ;inclu2ing the multi7ly inaminations............................................................................................................................. 'SP!CIALT" SP!CIFIC !L!%!NTS R!1UIR!D TO %!!T T$! ST CO%P!T!NC" IN AN"#I(!N SUR#ICAL DISCIPLIN!...................................................................................................'3)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in#eneral Surgery............................................................................................................................ '+)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST inUrology.......................................................................................................................................... */)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in

Car2iothoracic surgery..................................................................................................................*


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)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST inTrauma an2 Ortho7ae2ic surgery ;T@O=.......................................................................................*+)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST inPae2iatric surgery......................................................................................................................... 3/)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in PlasticSurgery......................................................................................................................................... 3*)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST inNeurosurgery................................................................................................................................ 35)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST inOtolaryngology ;!NT=................................................................................................................... +)hat may ?e e>7ecte2 of a trainee ?y the time they ?ecome eligi?le to commence ST in%a>illofacial surgery ;O%FS=........................................................................................................ +'S!L!CTION INTO A SUR#ICAL DISIPLIN!............................................................................... +5

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PrefaceThis is a com7etence ?ase2 curriculum. Its focus is on the trainees a?ility to 2emonstrate

6no:le2geB s6ills an2 7rofessional ?eha9iours that they ha9e acuire2 in their training ;s7ecifie2in the sylla?us= through o?ser9a?le ?eha9iours. It is not time82efine2 an2 allo:s thesecom7etences to ?e acuire2 in 2ifferent time frames in some training 7rogrammes than in othersB2e7en2ing u7on the structure of that 7rogramme. There are certain milestones or com7etency7oints :hich allo: trainees to ?enchmar6 their 7rogress. A critical com7etency 7oint is ST at:hich 7ointB in 7racticeB trainees :ill ma6e a clear commitment to one of the nine SAC 2efine22isci7lines of surgery.

This 2ocument contains the curriculum :hich must ?e com7lete2 in or2er to meet the entryreuirements of ST irres7ecti9e of the training route follo:e2... The 2ocument containsB amongstother thingsB the sylla?us of the core s6illsB 6no:le2ge an2 7rofessional ?eha9iours :hich that are

reuire2 of successful can2i2ates in the %RCS e>amination. In a22itionB this curriculum refers toother reuirements an2 assessments 2eman2e2 of surgeons :ishing to 7rocee2 into ST.

The sylla?us is achie9a?le 9ia 2ifferent training 7rogrammes :hich 9ary ?et:een Post #ra2uateDeaneries.

This 2ocument has ?een 7ro2uce2 for CST an2 has ?een agree2 ?y the nine SACs follo:ingconsultation.


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EARLY YEARS TRAINING AND THE CORE CURRICULUM

OVERVIEWDoctors :ho as7ire to a career in surgery :ill chooseB 2uring their trainingB to s7ecialise in one ofthe nine SAC 2efine2 surgical s7ecialtiesB namelyE8

car2iothoracicB

general surgeryB

neurosurgeryB

oro8ma>illo8facial surgery ;O%FS=B

otolaryngologyB

7ae2iatric surgeryB

7lastic surgeryB

trauma an2 ortho7ae2ics ;T@O=

urologyB

The curriculum for each of these s7ecialties is com7etency ?ase2 an2 the num?er of years ta6ento achie9e the com7etencies is merely in2icati9e. There are :ay 7ointsE

entry to surgical training 8 CT or STB

entry to entirely s7ecialise2 training 8 ST

e>it at CCT :ithin one of the nine 2efine2 surgical 2isci7lines.

ST ;S7eciality Training= com7etencies refer to a ty7e of training :here the s7eciality element isintegrate2 :ith the core element of s6illsB 6no:le2ge an2 7rofessional ?eha9iours from the start.CT ;core or generic training= assumes trainees enter a 7erio2 :here they may ?e e>7ose2 to a9ariety of s7ecialities :hich may or may not ?e 2irectly rele9ant to their ultimate s7eciality choice.It is 7ossi?le for any trainee to transfer from one to another s7eciality 2isci7line of surgery7ro9i2e2 they a= meet their e2ucational milestones in the core an2 ?= satisfy all the s7ecialityreuirements for ST entry in the s7ecialty of their choice. The 2ifferent training schemes offere2?y the Post #ra2uate Deaneries meet 2ifferent e2ucational nee2s an2 7ermit trainees to ma6eearlier or later final career choices ?ase2 on a?ility an2 7reference.

The start of ST is a 6ey com7etency 7oint :hen can2i2ates 2emarcate their training from themore genericB to the more s7ecialise2 route.

Currently all nine surgical s7ecialties ha9e se7arate curriculaB :hich each en9isage +85 in2icati9eyears of training from STCT. These curricula :ere concei9e2 an2 :ritten ?efore 4//+ :ithinthe conte>t of Grun through training as 7ro7ose2 ?y %%C. $o:e9erB :ithin the early years oftrainingB much of the content of these 2ifferent curricula is common. The intention of this2ocument is to ca7ture the commonalities an2 2elineate the s7eciality 2ifferences lai2 2o:n in thefirst t:o le9els of com7etency 2efine2 as ST an2 ST4 in these s7eciality curricula.

It is im7ortant to em7hasise that it is essential that can2i2ates must achie9e ?oth core an2s7ecialty s7ecific com7etencies to ?e eligi?le to com7ete at the ST com7etency le9el. The corecom7etencies reflect the com7etencies that ALL surgeons must 2emonstrateB :hile the s7ecialtys7ecific com7etencies reflect the early com7etencies rele9ant to an in2i9i2ual s7ecialty.

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PURPOSESThe 7ur7oses of early years surgical training areE8

. To 7ro9i2e a ?roa2 ?ase2 initial training in surgery :ith attainment of core 6no:le2geBs6ills an2 7rofessional ?eha9iours rele9ant to the 7ractice of surgery in any s7ecialistsurgical 2isci7line. This is 2efine2 :ithin the core sylla?us ;:hich is also the sylla?us ofthe %RCS=.

4. In a22ition it :ill 7ro9i2e early s7eciality training such that can2i2ates can select one onthe nine surgical s7eciality o7tions an2 2emonstrate that they ha9e the 6no:le2geB s6illsan2 7rofessional ?eha9iours to enter s7ecialty training at ST entry le9el ;see ?elo:= inthat surgical s7ecialty. The s7ecialty s7ecific elements are lai2 out in the s7ecialtys7ecific curriculaB an2 for con9enience a?stracte2 in this 2ocument. These s7eciality

elements ;e>ce7t in otolaryngology & see = are NOT teste2 in the %RCS ?ut through)P0As in the first instanceB an2 su?seuently through the Intercollegiate S7ecialtyFRCS e>aminationsB :hich are ta6en to:ar2s the en2 of s7ecialty training.

. In otolaryngologyB e>ce7tionallyB the DO$NS 2i7loma 2oes assess the s7ecialty s7ecificcom7onents of the sylla?usB :hich are 2efine2 in more 2etail in a se7arate 2ocument.

A22itionally can2i2ates :ill ?e continuously assesse2 on the contents of the core curriculum an2their electe2 s7eciality s7ecific com7onent through :or67lace ?ase2 assessments ;)P0A= an2structure2 re7orts from Assigne2 !2ucational Su7er9isors :hich in turn contri?ute to the Annual

Assessment of Com7etency Progression ;ARCP=H this inclu2es the com7etencies e>7ecte2 of all2octors inclu2ing surgeons to meet their o?ligations un2er #oo2 %e2ical Practice ;#%P= in or2erto remain license2 to 7ractice.

CANDIDATES WHOM WILL BECOME SURGICAL TRAINEESCan2i2ates :ill ?e selecte2 after com7letion of Foun2ation com7etencies or their eui9alents intoeither run through ST or generictheme2 CT 7osts. They :ill then ha9e to achie9e agree2milestones in terms of College e>aminations an2 local ARCP arrangements in Deaneries :hich:ill inclu2e the 2escri?e2 :or6 7lace ?ase2 assessments. !ntry to ST :ill only 7rocee2 if thecom7etencies 2escri?e2 in this 2ocument are achie9e2B irres7ecti9e of the training systemB ?e it

run through or generictheme2 training.

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

Pers"# Specfca!"#App)ca!"# !" e#!er Speca)!+ Tra##( a! ST,-CT, # a#+ &scp)#e

Esse#!a) Whe# E.a)%a!e&,

Q%a)fca!"#s %00S or eui9alent me2ical ualification A77lication form

E)(*)!+ !ligi?le for full registration :ith the #%C at time ofa77ointment!ligi?ility to :or6 in the U,

A77lication form

!9i2ence of achie9ement of Foun2ation

com7etences ?y time of a77ointment in line :ith#%C stan2ar2s #oo2 %e2ical Practice

A77lication form

Inter9ie: Selectioncentre4

Is u7 to 2ate an2 fit to 7ractise safely A77lication formReferences

All a77licants to ha9e 2emonstra?le s6ills in :rittenan2 s7o6en !nglish a2euate to ena?le effecti9ecommunication a?out me2ical to7ics :ith 7atientsan2 colleagues 2emonstrate2 ?y one of thefollo:ingEa= that a77licants ha9e un2erta6en un2ergra2uate

me2ical training in !nglishH or?= ha9e the follo:ing scores in the aca2emicinternational !nglish Language Testing System;I!LTS= & O9erall +B S7ea6ing +B Listening 3BRea2ing 3B )riting 3.If a77licants ?elie9e they ha9e a2euatecommunication s6ills ?ut 2o not fit into one of thesee>am7les they must 7ro9i2e su77orting e9i2ence

A77lication formInter9ie: Selectioncentre

%eets 7rofessional health reuirements ;in line :ith#%C stan2ar2s#oo2 %e2ical Practice=

A77lication formPre8em7loyment healthscreening

/!#ess T" Prac!se A?ility to 7ro9i2e a com7lete em7loyment historyNo more than * :ee6s in surgery ;not inclu2ingFoun2ation mo2ules=B

A77lication form

La#(%a(e S0))s ALL sections of a77lication form com7lete2 FULL"accor2ing to :ritten gui2elines

A77lication form

Hea)!h 0e a?le to 7ractice as lai2 out in maintaining goo2health in #%P

G:hen e9aluate2 is in2icati9eB ?ut may ?e carrie2 out at any time throughout the selection 7rocess4A selection centre is a 7rocess not a 7lace. It in9ol9es a num?er of selection acti9ities that may ?e 2eli9ere2 :ithin the

Unit of A77lication.

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THE TRAINING PATHWAYFrom the trainees 7ers7ecti9eB he or she :ill ?e a?le to un2erta6e surgical training 9ia 2ifferingroutes 2e7en2ing on :hich training scheme they choose or are selecte2 forB :ithin a School of

Surgery in one of the Postgra2uate Deaneries in the Unite2 ,ing2om.

. For those trainees :ho are certain of their s7ecialty choiceB an2 :ho choose to enter runthroughJ trainingB com7etiti9e entry into ST :ill ?e 7ossi?le :ith run through training in theirchosen s7ecialty to CCTB :here this is offere2 ?y the s7ecialty. This is currently the only route ?y:hich trainees can un2erta6e training in neurosurgery. Such a route still 2eman2s that in a22itionto s7eciality s7ecific com7etenciesB the core com7etencies common to all surgeons are attaine2?efore entering ST an2 these :ill ?e assesse2 through the %RCSB )P0As an2 satisfactory

ARCPs.

4. For those trainees :ho are either uncertain of their chosen s7ecialtyB or :ho are una?le to gainentry to run8through trainingB a 7erio2 of generic surgical training :ill ?e necessary. During this7erio2 they :ill attain core surgical 6no:le2geB s6ills an2 7rofessional ?eha9ioursB :hile sam7linga num?er of surgical s7ecialties an2 ma6ing a 2ecision as to their 7referre2 s7ecialty ors7ecialties. It :ill ?e necessary in a22ition to attaining core com7etencies to ensure that they to7u7J their s7eciality s7ecific com7etencies to ma6e them eligi?le to enter ST in their chosens7eciality. They :ill then see6 to enter s7ecialty training at the entry ST le9el ?y com7etiti9eentry. O7en com7etition :ill test can2i2ates against SAC 2efine2 com7etencies for an entry STtrainee.

This mo2el has a num?er of 7ossi?le 9ariants. It might ?e 7ossi?le to teach core com7letely:ithin a generic 7rogramme follo:e2 ?y s7eciality to7 u7 training later on in or2er to reachs7eciality entry ST le9el. Another 9ariant :oul2 organise generic training along a theme :hichsu77orts ?oth core an2 an element of s7eciality s7ecific com7etencies contiguously. In 7racticeB itis en9isage2 that generic surgical training :ill run o9er an in2icati9e timescale of u7 to years;CT8=.

. Some early years trainees may :ish to 7ursue an aca2emic surgical career an2 :ill 2e9ote asignificant 7ro7ortion or their time to a22itional aca2emic 7ursuits inclu2ing research an2teaching. For the mai?ility. It also7ermits Schools an2 Deaneries to offer 9ariety in their teaching an2 learning styles :hich :ill7ro9i2e them :ith a uniue im7rimatur :hich :ill a77eal to 2ifferent trainees in 2ifferent :ays.

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

+


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

5

Diagram


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THE ASSESSMENT /RAMEWOR1This is 2etaile2 on 7ages >8> an2 sho:n 2iagrammatically in Diagram 4

Diagram 4

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OUTCOMEThe outcome of early years training is to achie9e the com7etencies reuire2 of surgeons enteringST. These com7etencies inclu2eE

Com7etence in the management of 7atients 7resenting :ith a range of sym7toms an2

electi9e an2 emergency con2itions as s7ecifie2 in the core sylla?us for surgery.

Com7etence in the management of 7atients 7resenting :ith an a22itional range of

electi9e an2 emergency con2itionsB as s7ecifie2 ?y the s7ecialty sylla?us for le9els STan2 ST4.

Professional com7etences as s7ecifie2 in the sylla?us an2 2eri9e2 from #oo2 %e2ical

Practice 2ocuments of #eneral %e2ical Council of the U,.

Ha.#( 2e! !he "%!c"2es "f !hs c%rrc%)%2 a s%r(ca) !ra#ee ')) *e a*)e !"

7erform as a mem?er of the team caring for surgical 7atients.

recei9e 7atients as emergencies an2 re9ie: 7atients in clinics an2 initiate

management an2 2iagnostic 7rocesses ?ase2 on a reasona?le 2ifferential2iagnosis.

manage the 7erio7erati9e care of their 7atients an2 recognise common

com7lications an2 either ?e a?le to 2eal :ith them or 6no: to :hom to refer.

?e safe an2 useful assistant in the o7erating room

7erform some sim7le 7roce2ures un2er minimal su7er9ision an2 7erform morecom7le> 7roce2ures un2er 2irect su7er9ision

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A SUMMARY O/ THE 1EY SYLLABUS MODULES IN THE CORE

CURRICULUM THAT ARE REQUIRED O/ ALL SURGICALTRAINEES PRIOR TO ENTRY INTO ST34

All of this material :ill ?e teste2 in the %RCS ?ut may also ?e teste2 in the :or67lace.

,4 Basc Sce#ce 1#"')e&(e re)e.a#! !" s%r(ca) prac!ce

Anatomy

Physiology

Pharmacology 8 in 7articular safe 7rescri?ing

Pathological 7rinci7les un2erlying system s7ecific 7athology

%icro?iology

Diagnostic an2 inter9entional ra2iology

These can all ?e conte>tualise2 :ithin the list of 7resenting sym7toms an2 con2itions outline2 inmo2ule 4.

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

To assess an2 initiate in9estigation an2 management of common surgical con2itions

:hich may confront any 7atient :hilst un2er the care of surgeonsB irres7ecti9e of their

s7eciality. To ha9e sufficient un2erstan2ing of these con2itions so as to 6no: :hat an2 to :hom to

refer in a :ay that an insightful 2iscussion may ta6e 7lace :ith colleagues :hom :ill ?ein9ol9e2 in the 2efiniti9e management of these con2itions.

This 2efines the sco7e an2 2e7th of the to7ics in the generality of clinical surgery

reuire2 of any surgeon irres7ecti9e of their ST 2efine2 s7eciality.

Basc s%r(ca) s0))s

To 7re7are oneself for surgery

To safely a2minister a77ro7riate local anaesthetic agents

To han2le surgical instruments safely

To han2le tissues safely

To incise an2 close su7erficial tissues accurately

To tie secure 6nots

To safely use surgical 2iathermy

To achie9e haemostasis of su7erficial 9essels.

To use a suita?le surgical 2rain a77ro7riately.

To assist hel7fullyB e9en :hen the o7eration is not familiar.

To un2erstan2 the 7rinci7les of anastomosis

To un2erstan2 the 7rinci7les of en2osco7y

The pr#cp)es "f assess2e#! a#& 2a#a(e2e#! "f !he s%r(ca) pa!e#!

To assess the surgical 7atient.

To elicit a history that is rele9antB conciseB accurate an2 a77ro7riate to the 7atients

7ro?lem.

To 7ro2uce timelyB com7lete an2 legi?le clinical recor2s.

To assess the 7atient a2euately 7rior to o7eration an2 manage any 7re8o7erati9e

7ro?lems a77ro7riately.

To 7ro7ose an2 initiate surgical or non8surgical management as a77ro7riate.


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To ta6e informe2 consent for straightfor:ar2 cases.

Per6"pera!.e care "f !he s%r(ca) pa!e#!

To manage 7atient care in the 7eri8o7erati9e 7erio2.

To assess an2 manage 7reo7erati9e ris6.

To ta6e 7art in the con2uct of safe surgery in the o7erating theatre en9ironment.

To assess an2 manage ?lee2ing inclu2ing the use of ?loo2 7ro2ucts.

To care for the 7atient in the 7ost8o7erati9e 7erio2 inclu2ing the assessment of common

com7lications.

To assess an2 7lan 7erio7erati9e nutritional management.

Assess2e#! a#& ear)+ !rea!2e#! "f !he pa!e#! '!h !ra%2a

To safely assess the multi7ly in


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THE DETAILED MODULES O/ THE CORE SURGICAL SYLLABUS/OR ALL SURGICAL TRAINEES REQUIRED /OR ENTRY

INTO ST3

The sco7e of com7etence is 2efine2 ?y the list of su?


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Ra&")"(+ Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULTOnline Access?y O. ames #ar2en %0 Ch0 %D

FRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh=FRACS;$on= FRCSC;$on= Professor

0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition?yNorman S. )illiams;!2itor=BChristo7her .,. 0ulstro2e;!2itor=BP. Ronan OKConnell;!2itor=

C"22"# s%r(ca) c"#&!"#s Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULTOnline Access?y O. ames #ar2en %0 Ch0 %DFRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh=FRACS;$on= FRCSC;$on= ProfessorB An2re: ). 0ra2?ury0Sc %0 Ch0 %D %0A FRCS!2 ProfessorB ohn L. R. Forsythe%D FRCS;!2= FRCSB an2 Ro:an ) Par6s0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition?yNorman S. )illiams;!2itor=BChristo7her .,. 0ulstro2e;!2itor=BP. Ronan OKConnell;!2itor=

S%r(ca) S0))s 0asic surgical s6ills course an2 curriculum

Per6"pera!.e care #c)%(cr!ca) care

ATLS courseCriSP coursePrinci7les an2 Practice of SurgeryE )ith STUD!NT CONSULTOnline Access?y O. ames #ar2en %0 Ch0 %DFRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh=FRACS;$on= FRCSC;$on= Professor


S%r(ca) care "f ch)&re# Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULTOnline Access?y O. ames #ar2en %0 Ch0 %DFRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh=FRACS;$on= FRCSC;$on= Professor


Care "f !he &+#( Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULTOnline Access?y O. ames #ar2en %0 Ch0 %DFRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh=FRACS;$on= FRCSC;$on= Professor0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition?yNorman S. )illiams;!2itor=BChristo7her .,. 0ulstro2e

;!2itor=BP. Ronan OKConnell;!2itor=Or(a# !ra#sp)a#!a!"# Princi7les an2 Practice of SurgeryE )ith STUD!NT CONSULT

Online Access?y O. ames #ar2en %0 Ch0 %DFRCS;#lasgo:= FRCS;!2in?urgh= FRCP ;!2in?urgh=FRACS;$on= FRCSC;$on= Professor0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2ition?yNorman S. )illiams;!2itor=BChristo7her .,. 0ulstro2e;!2itor=BP. Ronan OKConnell;!2itor=

*
http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/Principles-Practice-Surgery-STUDENT-CONSULT/dp/0443101574/ref=sr_1_1?ie=UTF8&s=books&qid=1244883709&sr=1-1http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connell


16/82

M"&%)e , Basc sce#ces

O?B a?2omenB 7el9isB 7erineumB lim?sB hea2an2 nec6 as a77ro7riate for surgical o7erations that the trainee :ill ?e in9ol9e2:ith 2uring core training ;see %o2ule 4=.

PhysiologyE#eneral 7hysiological 7rinci7les inclu2ingE

$omeostasis

Thermoregulation

%eta?olic 7ath:ays an2 a?normalities

0loo2 loss an2 hy7o9olaemic shoc6

Se7sis an2 se7tic shoc6

Flui2 ?alance an2 flui2 re7lacement thera7y

Aci2 ?ase ?alance

0lee2ing an2 coagulation

Nutrition

This :ill inclu2e the 7hysiology of s7ecific organ systems rele9ant to surgicalcare inclu2ing the car2io9ascularB res7iratoryB gastrointestinalB urinaryBen2ocrine an2 neurological systems.

PharmacologyE

The 7harmacology an2 safe 7rescri?ing of 2rugs use2 in the treatment

of surgical 2iseases inclu2ing analgesicsB anti?ioticsB car2io9ascular2rugsB anticoagulantsB res7iratory 2rugsB renal 2rugsB 2rugs use2 forthe management of en2ocrine 2isor2ers ;inclu2ing 2ia?etes= an2 localanaesthetics.

The 7rinci7les of general anaesthesia

The 7rinci7les of 2rugs use2 in the treatment of common malignancies

3


17/82

PathologyE#eneral 7athological 7rinci7les inclu2ingE

Inflammation

)oun2 healing Cellular inocrine an2

en2ocrine 7athologyB central an2 7eri7heralB neurological systemsBs6inB lym7horeticular an2 musculos6eletal systems

%icro?iologyE

Surgically im7ortant micro organisms inclu2ing ?loo2 ?orne 9iruses

Soft tissue infections inclu2ing cellulitisB a?scessesB necrotising

fasciitisB gangrene

Sources of infection

Se7sis an2 se7tic shoc6

Ase7sis an2 antise7sis

Princi7les of 2isinfection an2 sterilisation

Anti?iotics inclu2ing 7ro7hyla>is an2 resistance

Princi7les of high ris6 7atient management

$os7ital acuire2 infections

ImagingE

Princi7les of 2iagnostic an2 inter9entional imaging inclu2ing >8raysB

ultrasoun2B CTB %RI. P!TB ra2iounucleoti2e scanning

+


18/82

M"&%)e 5 C"22"# S%r(ca) C"#&!"#s

O?


19/82

#enitourinary 2iseasePresenting sym7toms or syn2rome

Loin 7ain

$aematuria

Lo:er urinary tract

sym7toms

Urinary retention

Renal failure

Scrotal s:ellings

Testicular 7ain

To inclu2e the follo:ing con2itions

#enitourinary malignancy

Urinary calculus 2isease

Urinary tract infection 0enign 7rostatic hy7er7lasia

O?structi9e uro7athy

Trauma an2 ortho7ae2icsPresenting sym7toms or syn2rome

Traumatic lim? an2


20/82

M"&%)e 3 Basc s%r(ca) s0))s

O?


21/82

Use of 2rainsE

o In2ications

o Ty7es

o %anagementremo9al

Princi7les of anastomosis

Princi7les of surgical en2osco7y

Clinical S6ills Pre7aration of the surgeon for surgery

!ffecti9e an2 safe han2 :ashingB glo9ing an2 go:ning

A2ministration of local anaesthesia

Accurate an2 safe a2ministration of local anaesthetic agent

Pre7aration of a 7atient for surgery

Creation of a sterile fiel2

Antise7sis

Dra7ing

Technical S6illsan2 Proce2ures

Pre7aration of the surgeon for surgery

!ffecti9e an2 safe han2 :ashingB glo9ing an2 go:ning

A2ministration of local anaesthesia

Accurate an2 safe a2ministration of local anaesthetic agent

Incision of s6in an2 su?cutaneous tissueEo A?ility to use scal7elB 2iathermy an2 scissors

Closure of s6in an2 su?cutaneous tissueE

o Accurate an2 tension free a77osition of :oun2 e2ges

,not tyingE

o Single han2e2

o Dou?le han2e2

o Instrument

o Su7erficial

o Dee7

$aemostasisE

o Control of ?lee2ing 9essel ;su7erficial=

o Diathermy

o Suture ligation

o Tie ligation

o Cli7 a77lication

o Transfi>ion suture

Tissue retractionE

Tissue force7s

Placement of :oun2 retractors Use of 2rainsE

o Insertion

o Fi>ation

o Remo9al

Tissue han2lingE

A77ro7riate a77lication of instruments an2 res7ect for tissues

0io7sy techniues

S6ill as assistantE

Antici7ation of nee2s of surgeon :hen assisting

4


22/82

M"&%)e 8 The assess2e#! a#& 2a#a(e2e#! "f !he s%r(ca) pa!e#!

O?amination may ?e increasingly a77lie2 in that conte>t.

Clinical S6ills

Surgical history an2 e>amination ;electi9e an2 emergency=

Construct a 2ifferential 2iagnosis Plan in9estigations

Clinical 2ecision ma6ing

Team :or6ing an2 7lanning

Case :or6 u7 an2 e9aluationH ris6 management

Acti9e 7artici7ation in clinical au2it e9ents

A77ro7riate 7rescri?ing

Ta6ing consent for interme2iate le9el inter9entionH emergency an2

electi9e

)ritten clinical communication s6ills Interacti9e clinical communication s6illsE 7atients

Interacti9e clinical communication s6illsE colleagues

44


23/82

M"&%)e 9 Per6"pera!.e care

O?is

Throm?o7ro7hyla>is

La?oratory testing an2 imaging

Ris6 factors for surgery an2 scoring systems

Pre8me2ication an2 other 7reo7erati9e 7rescri?ing

Princi7les of 2ay surgery

Intrao7erati9e careE

Safety in theatre inclu2ing 7atient 7ositioning an2 a9oi2ance of ner9eincess an2 2e7letion

%eta?olic res7onse to in


24/82

%etho2s of screening an2 assessment of nutritional status

%etho2s of enteral an2 7arenteral nutrition

$aemostasis an2 0loo2 Pro2uctsE %echanism of haemostasis inclu2ing the clotting casca2e

Pathology of im7aire2 haemostasis e.g. haemo7hiliaB li9er 2iseaseB

massi9e haemorrhage

Com7onents of ?loo2

Alternati9es to use of ?loo2 7ro2ucts

Princi7les of a2ministration of ?loo2 7ro2ucts

Patient safety :ith res7ect to ?loo2 7ro2ucts

CoagulationB 2ee7 9ein throm?osis an2 em?olismE

Clotting mechanism ;(ircho: Tria2= !ffect of surgery an2 trauma on coagulation

Tests for throm?o7hilia an2 other 2isor2ers of coagulation

%etho2s of in9estigation for sus7ecte2 throm?oem?olic 2isease

Princi7les of treatment of 9enous throm?osis an2 7ulmonary em?olism

inclu2ing anticoagulation

Role of (1 scanningB CT7ulmonary angiogra7hyB D82imer an2

throm?olysis

Place of 7ulmonary em?olectomy

Pro7hyla>is of throm?oem?olismE Ris6 classification an2 management of D(T

,no:le2ge of metho2s of 7re9ention of D(TB mechanical an2

7harmacological

Anti?ioticsE

Common 7athogens in surgical 7atients

Anti?iotic sensiti9ities

Anti?iotic si2e8effects

Princi7les of 7ro7hyla>is an2 treatment

%eta?olic an2 en2ocrine 2isor2ers in relation 7erio7erati9e management

Patho7hysiology of thyroi2 hormone e>cess an2 2eficiency an2

associate2 ris6s from surgery

Causes an2 effects of hy7ercalcaemia an2 hy7ocalcaemia

Com7lications of corticosteroi2 thera7y

Causes an2 conseuences of Steroi2 insufficiency

Com7lications of 2ia?etes mellitus

Causes an2 effects of hy7onatraemia

Causes an2 effects of hy7er6alaemia an2 hy7o6alaemiaClinical S6ills Pre8o7erati9e assessment an2 managementE

$istory an2 e>amination of a 7atient from a me2ical an2 surgical

stan27oint

Inter7retation of 7re8o7erati9e in9estigations

%anagement of co mor?i2ity

Resuscitation

A77ro7riate 7reo7erati9e 7rescri?ing inclu2ing 7reme2ication

Intra8o7erati9e careE

4'


25/82

Safe con2uct of intrao7erati9e care

Correct 7atient 7ositioning

A9oi2ance of ner9e inamination in 7atients :ith en2ocrine an2 electrolyte

2isor2ers

In9estigation an2 management of thyroto>icosis an2 hy7othyroi2ism

In9estigation an2 management of hy7ercalcaemia an2 hy7ocalcaemia

Peri8o7erati9e management of 7atients on steroi2 thera7y

Peri8o7erati9e management of 2ia?etic 7atients

In9estigation an2 management of hy7onatraemia

In9estigation an2 management of hy7er6alaemia an2 hy7o6alaemia

Technical S6illsan2 Proce2ures

Central 9enous line insertion

Urethral catheterisation

4*


26/82

M"&%)e :Assess2e#! a#& 2a#a(e2e#! "f pa!e#!s '!h !ra%2a

;#c)%( !he 2%)!p)+ #


27/82

Patho7hysiology of thoracic trauma

Pneumothora>

$ea2 in


28/82

M"&%)e > S%r(ca) care "f !he Pae&a!rc pa!e#!

O?7erience an2 see6a77ro7riate e>7ert a29ice

Urgently consult imme2iate senior in surgery to ena?le referral to

7ae2iatricians

,ee7 a77ro7riate :ritten 2ocumentation relating to chil2 7rotection matters

Communicate effecti9ely :ith those in9ol9e2 :ith chil2 7rotectionB inclu2ing

chil2ren an2 their families

Clinical

S6ills

$istory an2 e>amination of the neonatal surgical 7atient

$istory an2 e>amination of 7ae2iatric surgical 7atient

Assessment of res7iratory an2 car2io9ascular status Un2erta6e consent for surgical 7roce2ures ;a77ro7riate to the le9el of

training= in 7ae2iatric 7atients

45


29/82

M"&%)e ? Or(a# a#& Tss%e !ra#sp)a#!a!"#O?


30/82

The Professional 0eha9iour an2 lea2ershi7 elements are ma77e2 to the lea2ershi7 curriculum aslai2 out ?y the Aca2emy of %e2ical Royal Colleges. The assessment of these areas is a threa2running through the curriculum an2 this ma6es them common to all of the 2isci7lines of surgery.For this reasonB assessment techniues for this element of the curriculum are summarise2 in the

final column.

M"&%)e, Pr"fess"#a) Beha."%r a#& Lea&ershp Mapp#( !"Lea&ershpC%rrc%)%2

Assess2e#!!ech#$%e

Ca!e("r+ #oo2 Clinical CareB to inclu2eE

$istory ta6ing

Physical e>amination

Time management an2 2ecision ma6ing

Clinical reasoning Thera7eutics an2 safe 7rescri?ing

Patient as a focus of clinical care

Patient safety

Infection control

Area 84,

O*cellent le9el of care for the in2i9i2ual7atient

To elicit a rele9ant focuse2 history ;See mo2ules 4B

B 'B*=

To 7erform focuse2B rele9ant an2 accurate clinicale>amination ;See mo2ules 4BB'B*=

To formulate a 2iagnostic an2 thera7eutic 7lan for a

7atient ?ase2 u7on the clinic fin2ings ;See mo2ules4BB'B*=

To 7rioritise the 2iagnostic an2 thera7eutic 7lan

;See mo2ules 4BB'B*=

To communicate a 2iagnostic an2 thera7eutic 7lan

a77ro7riately ;See mo2ules 4BB'B*=

To 7ro2uce timelyB com7lete an2 legi?le clinical recor2sto inclu2e case8note recor2sB han2o9er notesB an2o7eration notes

To 7rescri?eB re9ie: an2 monitor a77ro7riatethera7eutic inter9entions rele9ant to clinical 7racticeinclu2ing non & me2ication ?ase2 thera7eutic an27re9entati9e in2ications ;See mo2ule B4BB'B*=

To 7rioritise an2 organise clinical an2 clerical 2uties in

or2er to o7timise 7atient care

To ma6e a77ro7riate clinical an2 clerical 2ecisions inor2er to o7timise the effecti9eness of the clinical teamresource.

To 7rioritise the 7atients agen2a encom7assing their?eliefsB concerns e>7ectations an2 nee2s

To 7rioritise an2 ma>imise 7atient safetyE

To un2erstan2 that 7atient safety 2e7en2s on

Area 84,

%ini C!B C0DB%ini PATB%RCS an2S7ecialty FRCS

/


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o The effecti9e an2 efficient organisation of

careo $ealth care staff :or6ing :ell together

o Safe systemsB in2i9i2ual com7etency an2

safe 7ractice

To un2erstan2 the ris6s of treatments an2 to

2iscuss these honestly an2 o7enly :ith 7atients

To systematic :ays of assessing an2 minimising

ris6

To ensure that all staff are a:are of ris6s an2 :or6

together to minimise ris6

To manage an2 control infection in 7atientsB inclu2ingE

Controlling the ris6 of cross8infection A77ro7riately managing infection in in2i9i2ual

7atients

)or6ing a77ro7riately :ithin the :i2er community

to manage the ris6 7ose2 ?y communica?le 2iseases

E7a2p)esa#&&escrp!"rsf"r C"reS%r(ca)

Tra##(

Pa!e#! assess2e#!

O?tainsB recor2s an2 7resents accurate clinical

history an2 7hysical e>amination rele9ant to theclinical 7resentationB inclu2ing an in2ication of7atients 9ie:s

Uses an2 inter7rets fin2ings a2amination a77ro7riately e.g. internal e>aminationB?loo2 7ressure measurementB 7ulse o>imetryB 7ea6flo:

Res7on2s honestly an2 7rom7tly to 7atient

uestions

,no:s :hen to refer for senior hel7

Is res7ectful to 7atients ?y

o Intro2ucing self clearly to 7atients an2

in2icates o:n 7lace in teamo Chec6s that 7atients comforta?le an2

:illing to ?e seeno Informs 7atients a?out elements of

e>amination an2 any 7roce2ures that the7atient :ill un2ergo

C)#ca) reas"##(

In a straightfor:ar2 clinical case 2e9elo7s a

7ro9isional 2iagnosis an2 a 2ifferential 2iagnosis onthe ?asis of the clinical e9i2enceB institutes an

a77ro7riate in9estigati9e an2 thera7eutic 7lanBsee6s a77ro7riate su77ort from others an2 ta6esaccount of the 7atients :ishes

Rec"r& 0eep#(

Is a?le to format notes in a logical :ay an2 :rites

legi?ly

A?le to :rite timelyB com7rehensi9eB informati9e

letters to 7atients an2 to #Ps


32/82

T2e 2a#a(e2e#!

)or6s systematically through tas6s an2 attem7ts to

7rioritise

Discusses the relati9e im7ortance of tas6s :ith

more senior colleagues.

Un2erstan2s im7ortance of communicating

7rogress :ith other team mem?ers

Pa!e#! safe!+

Partici7ates in clinical go9ernance 7rocesses

Res7ects an2 follo:s local 7rotocols an2 gui2elines

Ta6es 2irection from the team mem?ers on 7atient

safety

Discusses ris6s of treatments :ith 7atients an2 isa?le to hel7 7atients ma6e 2ecisions a?out theirtreatment

!nsures the safe use of eui7ment

Acts 7rom7tly :hen 7atient con2ition 2eteriorates

Al:ays escalates concerns 7rom7tly

I#fec!"# c"#!r")

Performs sim7le clinical 7roce2ures :hilst

maintaining full ase7tic 7recautions

Follo:s local infection control 7rotocols !>7lains infection control 7rotocols to stu2ents an2

to 7atients an2 their relati9es

A:are of the ris6s of nosocomial infections.

Area 84,

M"&%)e,

Pr"fess"#a) Beha."%r a#& Lea&ershp Mapp#( !"Lea&ershpC%rrc%)%2

Assess2e#!!ech#$%e

Ca!e("r+ Be#( a (""& c"22%#ca!"r

To inclu2eE Communication :ith 7atients

0rea6ing ?a2 ne:s

Communication :ith colleagues

N-A

O*


33/82

in2i9i2ual 7atients

C"22%#ca!"# '!h C"))ea(%es

To recognise an2 acce7t the res7onsi?ilities an2

role of the 2octor in relation to other healthcare7rofessionals.

To communicate succinctly an2 effecti9ely :ith

other 7rofessionals as a77ro7riate

To 7resent a clinical case in a clearB succinct an2

systematic manner

E7a2p)esa#&&escrp!"rsf"r C"reS%r(ca)Tra##(

Con2ucts a sim7le consultation :ith 2ue em7athy

an2 sensiti9ity an2 :rites accurate recor2s thereof

Recognises :hen ?a2 ne:s must ?e im7arte2.

A?le to ?rea6 ?a2 ne:s in 7lanne2 settingsfollo:ing 7re7aratory 2iscussion :ith seniors

Acce7ts hisher role in the healthcare team an2

communicates a77ro7riately :ith all rele9antmem?ers thereof

M"&%)e,

Pr"fess"#a) Beha."%r a#& Lea&ershp Mapp#( !"Lea&ershpC%rrc%)%2

Assess2e#!!ech#$%e

Ca!e("r+ Teaching an2 Training NAO*


34/82

O*


35/82

To i2entify their o:n emotions an2 7re


36/82

ser9ice goals

To manage resources effecti9ely an2 safely

To manage 7eo7le effecti9ely an2 safely

To manage 7erformance of themsel9es an2 others

To un2erstan2 the structure of the N$S an2 the

management of local healthcare systems in or2erto ?e a?le to 7artici7ate fully in managinghealthcare 7ro9ision

E7a2p)esa#&&escrp!"rsf"r C"reS%r(ca)Tra##(

Se)f a'are#ess a#& se)f 2a#a(e2e#!

O?tains 3/M fee2?ac6 as 7art of an assessment

Partici7ates in 7eer learning an2 e>7lores

lea2ershi7 styles an2 7references

Timely com7letion of :ritten clinical notes

Through fee2?ac6 2iscusses an2 reflects on ho: a7ersonally emotional situation affecte2communication :ith another 7erson

Learns from a session on time management

Tea2 '"r0#(

)or6s :ell :ithin the multi2isci7linary team an2

recognises :hen assistance is reuire2 from therele9ant team mem?er

In9ites an2 encourages fee2?ac6 from 7atients

Demonstrates a:areness of o:n contri?ution to7atient safety :ithin a team an2 is a?le to outlinethe roles of other team mem?ers.

,ee7s recor2s u78to82ate an2 legi?le an2 rele9ant

to the safe 7rogress of the 7atient.

$an2s o9er care in a 7reciseB timely an2 effecti9e

manner

Su7er9ises the 7rocess of finalising an2 su?mitting

o7erating lists to the theatre suite

Lea&ershp Com7lies :ith clinical go9ernance reuirements of

organisation

Presents information to clinical an2 ser9ice

managers ;eg au2it=

Contri?utes to 2iscussions relating to rele9ant

issues eg :or6loa2B co9er arrangements usingclear an2 concise e9i2ence an2 information

Q%a)!+ a#& safe!+ 2pr".e2e#!

Un2erstan2s that clinical go9ernance is the o9er8

arching frame:or6 that unites a range of ualityim7ro9ement acti9ities

Partici7ates in local go9ernance 7rocesses

%aintains 7ersonal 7ortfolio

!ngages in clinical au2it

1uestions current systems an2 7rocesses

Ma#a(e2e#! a#& NHS S!r%c!%res

Area ,4, a#&,45

Area 5

Area 9

Area 845 843848

Area 3

3


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Partici7ates in au2it to im7ro9e a clinical ser9ice

)or6s :ithin cor7orate go9ernance structures

Demonstrates a?ility to manage others ?y teaching

an2 mentoring


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To take appropriate action where ethics and

values are compromised

To recognise an2 res7on2 the causes of me2ical

error

To res7on2 a77ro7riately to com7laints

To 6no:B un2erstan2 an2 a77ly a77ro7riately the

7rinci7lesB gui2ance an2 la:s regar2ing me2icalethics an2 confi2entiality as they a77ly to surgery

To un2erstan2 the necessity of o?taining 9ali2

consent from the 7atient an2 ho: to o?tain

To un2erstan2 the legal frame:or6 :ithin :hich

healthcare is 7ro9i2e2 in the U,

To recogniseB analyse an2 6no: ho: to 2eal :ith

un7rofessional ?eha9iours in clinical 7racticeBta6ing into account local an2 national regulations

Un2erstan2 ethical o?ligations to 7atients an2

colleagues

To a77reciate an o?ligation to ?e a:are of

7ersonal goo2 health

E7a2p)esa#&&escrp!"rsf"r C"re

S%r(ca)Tra##(

Re7orts an2 rectifies an error if it occurs

Partici7ates in significant e9ent au2its

Partici7ates in ethics 2iscussions an2 forums

A7ologises to 7atient for any failure as soon as an

error is recognise2

Un2erstan2s an2 2escri?es the local com7laints

7roce2ure

Recognises nee2 for honesty in management of

com7laints

Learns from errors

Res7ect 7atients confi2entiality an2 their

autonomy

Un2erstan2 the Data Protection Act an2 Free2om

of Information Act Consult a77ro7riatelyB inclu2ing the 7atientB ?efore

sharing 7atient information

Partici7ate in 2ecisions a?out resuscitation statusB

:ithhol2ing or :ith2ra:ing treatment

O?tains consent for inter9entions that heshe is

com7etent to un2erta6e

,no:s the limits of their o:n 7rofessional

ca7a?ilities

Area ,48Area ,48Area ,48

5


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ASSESSMENT O/ THE CORE CURRICULUMThe 7ur7ose of the assessment system is toE

Determine :hether trainees are meeting the stan2ar2s of com7etence an2 7erformances7ecifie2 at 9arious stages in the curriculum for surgical training

Pro9i2e systematic an2 com7rehensi9e fee2?ac6 as 7art of the learning cycle.

Determine :hether trainees ha9e acuire2 the generic an2 s7ecialty8?ase2 6no:le2geB

clinical 7erience

An e>amination 2esigne2 to assess the 6no:le2ge an2 s6ills acuire2 :ithin the generic

curriculum. & the %RCS

The assigne2 e2ucational su7er9isors re7ort

Annual re9ie: of com7etence 7rogression. ;ARCP=

Lear##( a(ree2e#!sAt each training inter9al ;usually si> months= a trainee :ill meet :ith their Assigne2 !2ucationalSu7er9isor initiallyB 7art :ay through an2 finally to construct an2 ultimately sign off the outcome ofa learning agreement. !ach learning agreement is 7re2icate2 ?y alrea2y acuire2 e>7eriencean2 com7etency signe2 off at 7re9ious ARCPs or on com7letion of Foun2ation or its eui9alent.Their 7rinci7al 7ur7ose is to set an agen2a for a training inter9al an2 to agree milestones an2assessment e7iso2es :hich :ill ?e use2 to formulate the e2ucational su7er9isors re7ortregar2ing the rate of 7rogression on the agree2 e2ucational tra


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The most im7ortant use of the :or67lace8?ase2 assessments is in 7ro9i2ing trainees :ith ano77ortunity to assess their o:n learning an2 use that assessment to inform an2 2e9elo7 theiro:n 7ractice. !ach assessment is score2 only for the 7ur7ose of 7ro9i2ing meaningful fee2?ac6on one encounter. The assessments shoul2 ?e 9ie:e2 as 7art of a 7rocess throughout trainingB

ena?ling trainees to ?uil2 on assessor fee2?ac6 an2 chart their o:n 7rogress.

Pro9i2e information for trainers an2 training su7er9isors to ai2 in their construction of trainingsu7er9isors re7orts. Li6e all me2ical training 2isci7lines :e recognise that the use ofassessments for learning as 7art of an o9erall assessment of learning has theoretical2isa29antages. $o:e9er it is im7ortant that 7atient safety consi2erations are 7aramount an2 soongoing monitoring is essential. These formati9e assessments of learning are also use2 ase9i2ence of 7rogression an2 so inform ;not 2ictate= the training su7er9isors re7ort :hich is thefirst a77raisal ste7 7rior to the ARCP. The ARCP is the 7rinci7al re9ie: of Learning :hich2etermines 7rogression.

Contri?ute to:ar2s a ?o2y of e9i2ence hel2 in the learning 7ortfolio an2 ma2e a9aila?le for theannual re9ie: of com7etence 7rogression ;ARCP= 7anel an2 7lanne2 e2ucational re9ie:s. Allassessment 2ata is store2 in the trainees electronic 7ortfolio. Although the 7rinci7al role of:or67lace assessment is to su77ort learningB the summary e9i2ence :ill ?e use2 to inform theannual re9ie: 7rocess. This 7rocess results in 2ecisions to ho: :ell the trainee is 7rogressing. Atthe en2 of a 7erio2 of trainingB the trainees :hole 7ortfolio :ill ?e re9ie:e2. The accumulation ofassessments for learning :ill ?e only one of a range of in2icators in an o9erall assessment oflearning that inform the 2ecision as to satisfactory com7letion of that 7erio2 training at the annualre9ie: of com7etence 7rogression.

Peer Assessment ToolThe mini8PATB 7re9iously 2escri?e2 as 3/M assessment or multi8source fee2?ac6 ;%SF=B is ametho2 of assessing 7rofessional com7etence :ithin a team8:or6ing en9ironment an2 7ro9i2ing2e9elo7mental fee2?ac6 to the trainee. The mini8PAT assessment is un2erta6en e9ery threeyears in s7ecialty training. For core training first occasion :ill ?e at entry le9el ;CT= an2 for mostthe ne>t assessment :ill ?e at the time of entry to s7ecialty training ;ST=. It shoul2 ?e use2 moreoften if there are areas of concern.

Surgical trainees :or6 as 7art of a multi87rofessional team :ith other 7eo7le :ho ha9ecom7lementary s6ills. Trainees are e>7ecte2 to un2erstan2 the range of roles an2 e>7ertise of

team mem?ers in or2er to communicate effecti9ely to achie9e high uality ser9ice for 7atients.%ini8PAT com7rises a self8assessment an2 assessments of a trainees 7erformance from a rangeof co8:or6ers. It uses u7 to 4 assessors :ith a minimum of 5. Assessors are chosen ?y thetrainee an2 :ill al:ays inclu2e the assigne2 e2ucational su7er9isor an2 a range of colleaguesco9ering 2ifferent gra2es an2 en9ironments ;e.g. :ar2B theatreB out7atients= ?ut nota2ministrators or 7atients.

Fee2?ac6 is in the form of a 7eer assessment chart that ena?les com7arison of the self8assessment :ith the collate2 9ie:s recei9e2 from co8:or6ers for each of the 3 com7etencies ona 387oint scale inclu2ing a glo?al rating. The com7etencies ma7 across to the stan2ar2s of #oo2

%e2ical Practice an2 to the core o?


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Mini Clinical Evaluation ExerciseThe mini8C! is a metho2 of assessing s6ills essential to the 7ro9ision of goo2 clinical care an2to facilitate fee2?ac6. It assesses the trainees clinical an2 7rofessional s6ills on the :ar2B on:ar2 roun2sB in Acci2ent an2 !mergencyB or in out7atient clinics. It :as 2esigne2 originally ?y the

American 0oar2 of Internal %e2icine ?ut has ?een conte>tualise2 to the surgical en9ironment.

Trainees :ill ?e assesse2 on 2ifferent clinical 7ro?lems that they encounter from :ithin thecurriculum in a range of clinical settings. Trainees are encourage2 to choose a 2ifferent assessorfor each assessment ?ut one of the assessors must ?e the current assigne2 e2ucationalsu7er9isor. !ach assessor must ?e registere2 :ith ISCP an2 ha9e e>7ertise in the clinical7ro?lem.

The assessment in9ol9es o?ser9ing the trainee interact :ith a 7atient in a clinical encounter. Theareas of com7etence co9ere2 inclu2eE history ta6ingB 7hysical e>aminationB 7rofessionalismB

clinical tualise2 to the

surgical en9ironment. This tool is 2esigne2 to assess clinical 7lore 2ee7er un2erstan2ing of ho: trainees com7ileB7rioritise an2 a77ly 6no:le2ge. C0D is not focuse2 on the trainees a?ility to ma6e a 2iagnosisnor is it a 9i9a8style assessment.

The 7rocess is a structure2B in82e7th 2iscussion ?et:een the trainee an2 assigne2 e2ucationalsu7er9isor a?out ho: a clinical case :as manage2 ?y the traineeH tal6ing through :hat occurre2Bconsi2erations an2 reasons for actions. 0y using clinical cases that offer a challenge to thetraineeB rather than routine casesB the trainee is a?le to e>7lain the com7le>ities in9ol9e2 an2 the

reasoning ?ehin2 choices they ma2e. It also ena?les the 2iscussion of the ethical an2 legalframe:or6 of 7ractice. It uses 7atient recor2s as the ?asis for 2ialogueB for systematicassessment an2 structure2 fee2?ac6. As the actual recor2 is the focus for the 2iscussionB theassessor can also e9aluate the uality of recor2 6ee7ing an2 the 7resentation of cases.

%ost assessments ta6e no longer than *84/ minutes. After com7leting the 2iscussion an2 fillingin the assessment form the assigne2 e2ucational su7er9isor shoul2 7ro9i2e imme2iate fee2?ac6to the trainee. Fee2?ac6 :oul2 normally ta6e a?out * minutes.

Direct Observation of Procedural Skills (DOPS)

The Surgical 9ersion of DOPS is use2 to assess the trainees technicalB o7erati9e an27rofessional s6ills in a range of ?asic 2iagnostic an2 inter9entional 7roce2uresB or 7arts of7roce2uresB 2uring routine surgical 7ractice an2 facilitate 2e9elo7mental fee2?ac6. SurgicalDOPS is use2 in relati9ely sim7le en9ironments an2 7roce2ures an2 can ta6e 7lace in :ar2s orout7atient clinics as :ell as in the o7erating theatre. It is a surgical 9ersion of an assessment tooloriginally 2e9elo7e2 an2 e9aluate2 ?y the U, Royal Colleges of Physicians.

The surgical DOPS form can ?e use2 routinely e9ery time the trainer su7er9ises a traineecarrying out one of the s7ecifie2 7roce2uresB :ith the aim of ma6ing the assessment 7art of

'


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routine surgical training 7ractice. The 7roce2ures reflect the 7roce2ures :hich are routinelycarrie2 out at the trainees :or67lace.

The assessment in9ol9es an assessor o?ser9ing the trainee 7erform a 7ractical 7roce2ure :ithin

the :or67lace. Assessors 2o not nee2 to ha9e 7rior 6no:le2ge of the trainee. The assessorse9aluation is recor2e2 on a structure2 chec6list that ena?les the assessor to 7ro9i2e 9er?al2e9elo7mental fee2?ac6 to the trainee imme2iately after:ar2s. Trainees are encourage2 tochoose a 2ifferent assessor for each assessment ?ut one of the assessors must ?e the currentassigne2 e2ucational su7er9isor. %ost 7roce2ures ta6e no longer than *84/ minutes. Theassessor :ill 7ro9i2e imme2iate fee2?ac6 to the trainee after com7leting the o?ser9ation an2e9aluation. Fee2?ac6 :oul2 normally ta6e a?out * minutes.

The surgical DOPS form is score2 for the 7ur7ose of 7ro9i2ing fee2?ac6 to the trainee. Theo9erall rating on any one assessment can only ?e com7lete2 if the entire 7roce2ure is o?ser9e2.

A 7ecte2 of a s7ecialist in 7ractice :ithin the N$S ;the le9el reuire2 for theCertificate of Com7letion of Training 8 CCT=.

The assessment form is su77orte2 ?y a :or6sheetB originally use2 as a 9ali2ating the tool. Itcontains 2escri7tors outlining e>am7les 2esira?le an2 un2esira?le ?eha9iours that assist theassessor in ma6ing 7laining :hat they inten2 to 2o throughout. The assessor :ill 7ro9i2e 9er?al7rom7ts to encourage the trainee to gi9e e>7lanationsB if reuire2B an2 inter9ene if the uality of7atient care is at ris6 of com7romise.

'4


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T!e lo" book of #roceduresThis is a :e? ?ase2 com7ilation of all 7roce2ures :itnesse2 or 7erforme2 un2er 9arying 2egreesof su7er9ision 2uring the training inter9als. It is 9ali2ate2 ?y su7er9ising trainers after ?einggenerate2 ?y trainees. It is :e? ?ase2 an2 2istinguishes ?et:een 7assi9e an2 acti9e

in9ol9ement in ?oth o7erati9e an2 :ar2 ?ase2 7roce2ures as lai2 out in the curriculum.

E7a2#a!"#sI#!r"&%c!"#8 Core surgical trainees :ill ta6e the %RCS e>amination. The %RCS :ill assess6no:le2ge an2 s6ills that are encom7asse2 :ithin the generic com7onent of the core curriculuman2 is ?lue7rinte2 to the curriculum. It is ine9ita?le that although this is an assessment of thegeneric curriculumB the assessment :ill ta6e 7lace :ithin a s7ecialty conte>t.

The :ritten com7onent consists of a %C1 an2 !%I ;!>ten2e2 matching item uestions=com?ine2 into a single 7art A. These t:o com7onents a22ress 6no:le2ge an2 a77lie2 6no:le2ge

in the generality of surgery.

Part 0 consists of an O?amination ;OSC!=. The 7recise 2esign an2structure are 7ro9i2e2 in a77en2i> A. The o9erall 2esign of the OSC! tests s6ills an2 a77lie26no:le2ge as 2etaile2 ?elo:. It is inno9ati9e in that it has some o7tional elements :hich 7ermitsome choice in the conte>ts of :hich the core s6ills an2 6no:le2ge may ?e teste2. This ise>7laine2 in more 2etail ?elo:. In a22ition to the 7art A anatomical assessments the OSC! also7ro9i2es can2i2ates :ith the o77ortunity to 2emonstrate their three 2imensional anatomical6no:le2ge in the conte>t of their li6ely future surgical careerB :ithout losing the 9ital nee2 toensure a thorough o9erall gri7 of generic three 2imensional surgical anatomy.

0oth Parts A an2 0 must ?e com7lete2 to 7ass the %RCS.

Trainees :ill ty7ically ta6e the e>amination to:ar2s the en2 of the CT4ST yearB :hich has thefollo:ing a29antagesE

If the can2i2ate is unsuccessfulB there :ill ?e an o77ortunity to re8sit the e>amination

2uring CTST4B 7rior to entry to ST.

Progression to ST :ill NOT 0! POSSI0L! unless the %RCS is achie9e2.

Such timing :ill fit :ell :ith the timeta?le currently in 7lace for selection into ST.

A 2"re &e!a)e& &escrp!"# "f !he sc"pe a#& f"r2a! "f !he MRCS e7a2#a!"#The 7ur7ose of the %RCS e>amination is to 2etermine that trainees ha9e acuire2 the6no:le2geB s6ills an2 attri?utes reuire2 for the generic com7onent of core training in surgeryan2B for trainees follo:ing the Intercollegiate Surgical Curriculum ProgrammeB to 2etermine theira?ility to 7rogress to higher s7ecialist training in surgery.

The %RCS e>amination consists of t:o 7artsB A @ 0. Although 2i9i2e2 into t:o 7artsB theIntercollegiate %RCS is a single e>amination.

Par! AThe %RCS Part A is a machine8mar6e2B multi7le choiceB :rittenB e>amination testing 6no:le2ge.

It consists of t:o 7a7ersB each of t:o hours 2urationB ta6en on the same 2ay. The mar6s for ?oth7a7ers are com?ine2 to gi9e a total mar6 for Part A. To achie9e a 7ass the can2i2ate :ill ?ereuire2 to 2emonstrate a minimum le9el of 6no:le2ge in each of the t:o 7a7ersB in a22ition toachie9ing or e>cee2ing the 7ass mar6 set for the com?ine2 total mar6 for Part A. The 7a7ersco9er generic surgical sciences an2 a77lie2 6no:le2geB inclu2ing the core 6no:le2ge reuire2 inall nine s7ecialties.

Paper , 6 App)e& Basc Sce#ce4This 7a7er consists of * uestions an2 em7loys the single ?est ans:er ;S0A= formatB eachuestion containing fi9e 7ossi?le ans:ers of :hich there is only one single ?est ans:er.

'


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Paper 5 6 Pr#cp)es "f S%r(er+6#6Ge#era)4This 7a7er consists of * uestions an2 em7loys the e>ten2e2 matching uestions ;!%1=format. !ach theme contains a 9aria?le num?er of o7tions an2 clinical situations. Only one o7tion:ill ?e the most a77ro7riate res7onse to each clinical situation. It is 7ossi?le for one o7tion to ?e

the ans:er to more than one of the clinical situations.

Par! B The +e))"' s %#&er %r(e#! re.s"# f"r !he PMETB app)ca!"#The %RCS Part 0 is an O?amination ;OSC!=. The OSC! :illnormally consist of si>teen e>amine2 stations. These stations :ill ?e 2i9i2e2 into fi9e ?roa2content areas as follo:sE

Anatomy an2 surgical 7athology ; stations=

Surgical s6ills an2 7atient safety ;4 stations=

Communication s6ills ; stations=

A77lie2 surgical science an2 critical care ; stations= Clinical s6ills in history ta6ing an2 7hysical e>amination ;* stations=.

T:el9e of the 3 e>amine2 stations are Gmanne2 an2 four are Gunmanne2. Some of the stations:ill ha9e t:o e>aminers an2 some one. In stations :ith t:o e>aminersB each e>aminer :illnormally ?e e>amining 2ifferent as7ects of a can2i2ates 7erformance.

Speca)!+ c"#!e7! s!a!"#sThe OSC! is 2esigne2 for can2i2ates in the generality 7art of their s7eciality training an2 t:el9eof the 3 e>amine2 stations are Ggeneric. $o:e9erB to meet the emerging intentions of trainees

:ith regar2 to future career 7rogressionB an2 to accommo2ate 2ifferent 7atterns of s7ecialtytrainingB four of the 3 e>amine2 stations are 7resente2 :ithin a s7ecialty conte>tE one in the?roa2 content area of anatomy an2 surgical 7athologyB one in clinical s6ills ;history ta6ing= an2t:o in clinical s6ills ;7hysical e>amination=.

The s7ecialty conte>ts areE

hea2 an2 nec6

trun6 an2 thora>

lim?s ;inclu2ing s7ine=

neurosciences.

Can2i2ates must s7ecify their choice of s7ecialty conte>t stations at the time of a77lication to thee>amination. Their choice 2etermines the same s7ecialty conte>t area for anatomy an2 surgical7athologyB clinical s6ills ;history ta6ing= an2 one of the clinical s6ills ;7hysical e>amination=stations. Can2i2ates must choose a 2ifferent s7ecialty conte>t area for the secon2 clinical s6ills;7hysical e>amination= station. It is im7ortant to em7hasise that this o7tional element is sim7ly to?e a?le to 2emonstrate generic s6ills an2 some 6no:le2ge an2 its a77lication in a conte>t mostfamiliar to the can2i2ates. It is not to test 2ee7 6no:le2ge in 2esignate2 s7eciality areas. )e?elie9e that this is a uniue feature of the ne: e>amination an2 one that caters ?est for the9ariety an2 choice in?uilt into our ne: a77roach to early years surgical training.

N4B4 THE CHOICE O/ SPECIALITY CONTET STATIONS IS NOT DELINEATED IN THEAWARD O/ MRCS4 S%ccessf%) ca#&&a!es a)) are a'ar&e& e7ac!)+ !he sa2e &p)"2a as a2eas%re "f !her c"re s%r(ca) c"2pe!e#ces4

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D"2a#sIn a22ition to the fi9e ?roa2 content areas e>amine2 in the OSC!B si> 2omains ha9e ?eeni2entifie2 :hich encom7ass the 6no:le2geB s6illsB com7etencies an2 7rofessional characteristicsof the com7etent surgeon. These 2omains ma7 to #%Cs #oo2 %e2ical Practice ;#%P= an2 are

assesse2 in the OSC!. They are as follo:sE

Clinical 6no:le2geE the clinical 6no:le2ge s7ecifie2 in the sylla?usH the a?ility to un2erstan2Bsynthesise an2 a77ly 6no:le2ge in a clinical conte>t.Clinical s6illE the ca7acity to a77ly soun2 clinical 6no:le2geB s6ill an2 a:areness to a fullin9estigation of 7ro?lems to reach a 7ro9isional 2iagnosis.Technical s6illE the a?ility to 7erform manual tas6s relate2 to surgery :hich 2eman2s manual2e>terityB han2eye coor2ination an2 9isual8s7atial a:areness.CommunicationE the a?ility to assimilate informationB i2entify :hat is im7ortant an2 con9ey it toothers clearly using a 9ariety of metho2sH the ca7acity to a2


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SPECIALTY SPECI/IC ELEMENTS REQUIRED TO MEET THEST3 COMPETENCY IN ANY GIVEN SURGICAL DISCIPLINE

N0E The follo:ing 7ages summarise the reuirements of in2i9i2ual s7ecialties. !ntryreuirements to ST 7u?lishe2 ?y in2i9i2ual s7ecialties an2 a77ro9e2 ?y P%!T0 shoul2 ?eregar2e2 as the 7rimary 2ocument :here there is any 2iscre7ancy. For surgery most of thereuirements are common for all nine 2isci7lines an2 are 2escri?e2 in the ta?le ?elo:. The2etails for each s7eciality s7ecific ST an2 4 section are 2escri?e2 inclu2ing the time e>7ecte2 to?e s7ent in that 2isci7line 2uring early years training such that a can2i2ate is eligi?le for STentry. If a can2i2ate :ishes to change from one 2isci7line to another at any stage ?efore entryinto ST this may 7rolong their training as com7letion of the man2atory 7erio2 in the s7eciality isstill a reuirement as :ell as com7leting all the early years e2ucational goals lai2 out ?elo:. In7ractice any :ish to la22er from one 2isci7line of surgery to another is easier the earlier the

2ecision is ma2e an2 in 7ractice once selecte2 into ST changing 2isci7line :ill ?e e>tremely2ifficult an2 time consuming.

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

These ?uil2 on the entry reuirements for entry into STCT. Criteria for entry are e>7an2e2u7on on 7ages +5 8 5

App)ca!"# re$%re2e#!s !" e#!er Speca)!+ Tra##( a! ST3 # a#+ &scp)#e

Esse#!a) Whe# E.a)%a!e&3

Q%a)fca!"#s %00S or eui9alent me2ical ualificationSuccessful com7letion of %RCS or eui9alent attime of a77lication

A77lication form

E)(*)!+ !ligi?le for full registration :ith the #%C at time ofa77ointment!ligi?ility to :or6 in the U,

A77lication form

!9i2ence of achie9ement of Foun2ationcom7etences ?y time of a77ointment in line :ith#%C stan2ar2s #oo2 %e2ical Practice

A77lication formInter9ie: Selectioncentre'

!9i2ence of achie9ement of !arly yearscom7etencies in core training.!9i2ence of achie9ement of ST s7eciality s7ecificcom7etences in surgery at time of a77ointment


!9i2ence that a can2i2ate :ill reasona?ly ha9e a7ros7ect of achie9ing ST4 s7eciality s7ecificcom7etences ?y August of the year of a77lication


/!#ess T" Prac!se Is u7 to 2ate an2 fit to 7ractise safely A77lication formReferences

La#(%a(e S0))s All a77licants to ha9e 2emonstra?le s6ills in :rittenan2 s7o6en !nglish a2euate to ena?le effecti9ecommunication a?out me2ical to7ics :ith 7atientsan2 colleagues 2emonstrate2 ?y one of thefollo:ingEa= that a77licants ha9e un2erta6en un2ergra2uate


G:hen e9aluate2 is in2icati9eB ?ut may ?e carrie2 out at any time throughout the selection 7rocess'A selection centre is a 7rocess not a 7lace. It in9ol9es a num?er of selection acti9ities that may ?e 2eli9ere2 :ithin theUnit of A77lication.

'3


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

me2ical training in !nglishH or?= ha9e the follo:ing scores in the aca2emiclnternational !nglish Language Testing System

;I!LTS= & O9erall +B S7ea6ing +B Listening 3BRea2ing 3B )riting 3.If a77licants ?elie9e they ha9e a2euatecommunication s6ills ?ut 2o not fit into one of thesee>am7les they must 7ro9i2e su77orting e9i2ence

Hea)!h %eets 7rofessional health reuirements ;in line :ith#%C stan2ar2s#oo2 %e2ical Practice=

A77lication formPre8em7loyment healthscreening

CareerPr"(ress"#

A?ility to 7ro9i2e a com7lete em7loyment historyAt least 4' months e>7erience*in surgical training

;not inclu2ing Foun2ation mo2ules=B of :hich as7ecifie2 7erio2 of time in the s7eciality a77lie2 for?y August of the year of a77ointment. The s7ecifie2time 7erio2 is 2escri?e2 ?elo: for each of the -surgical 2isci7lines

A77lication form

App)ca!"# C"2p)e!"# ALL sections of a77lication form com7lete2 FULL"accor2ing to :ritten gui2elines

A77lication form

#i9en that entry at the ST le9el of com7etency must 7ermit an in2i9i2ual to 7rogress in theirchosen s7ecialityB then it is im7erati9e that the com7etencies of all ST entrants are at the samele9el. This is also 7refera?le in the s7eciality element also. $o:e9er it nee2s to ?e 7ragmaticallyrecognise2 that gi9en a rich an2 9arie2 choice of early years 7rogrammesB ha9ing e9eryone ate>actly the same le9el in terms of the 2etails of their )P0As :ill ?e e>tremely 2ifficult to achie9eBalthough all must meet a minimum stan2ar2.

Trainees :ho ha9e ?een selecte2 2es7ite some reme2ia?le an2 i2entifie2 ga7s in their s7ecialitys7ecific curriculum com7etencies as 2eman2e2 o9erall for ST 7rogression must ensure these

are 2ealt :ith e>7e2itiously 2uring ST. All these ga7s must ?e a22resse2 ?y the time of a STARCP as 7art of their o9erall 7ermission to 7rogress to ST'. They must ?e s7ecifically a22resse2through local learning agreements :ith e2ucational su7er9isors. Trainees :ith i2entifie2 ga7smust ?e accounta?le to the training 7rogramme 2irectors :hom in turn must a22ress this as 7artof their re7ort to the ARCP 7rocess.

The ##e #&.&%a) !"p %p re$%re2e#!s f"r each &scp)#e are &escr*e& *e)"'4

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

*Any time 7erio2s s7ecifie2 in this 7erson s7ecification refer to full time eui9alent

'+


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In or2er to meet the 7erience in a ser9ice :hich gi9es trainees access to the a77ro7riate learning o77ortunities.

Also ?y the time a trainee enters ST they nee2 to ?e familiar :ith the o7erating roomen9ironment ?oth :ith res7ect to electi9e an2 emergency cases.

Trainees must atten2 %DT an2 other De7artmental meetings an2 :ar2 roun2sB 7re7are electi9eo7erating lists ;?oth in7atient an2 2ay8case=B an2 actually 7erform some surgery un2era77ro7riate su7er9ision. They must manage all 7atients in the :ar2 en9ironmentB ?oth7reo7erati9ely an2 7ost o7erati9ely. This inclu2es recognising an2 initiating the management ofcommon com7lications an2 emergenciesB o9er an2 a?o9e those alrea2y lai2 out in the genericcurriculumB 7articularly mo2ule 4.

The range of con2itions a trainee nee2s to manage is lai2 out ?elo: an2 in the 2e7th2emonstrate2 in a te>t ?oo6 such as 0ailey an2 Lo9eKs Short Practice of Surgery 4*th !2itionby Norman S. )illiams(Editor), Christo7her .,. 0ulstro2e(Editor), P. Ronan OKConnell(Editor)

,4 E)ec!.e (e#era) s%r(er+To ?e a?le to 2iagnose an2 manage a range of electi9e con2itions 7resenting to generalsurgeons inclu2ing a77ro7riate in9estigation an2 treatment. This shoul2 inclu2e 7rimarya?2ominal :all herniaeB lesions of the cutaneous an2 su?cutaneous tissues an2 uncom7licate2long sa7henous 9aricose 9eins

54 E)ec!.e s%*speca)!+ s%r(er+To ?e a?le to assess an2 initiate management of 7atients 7resenting :ith common con2itionselecti9ely to su?s7ecialty clinics. This shoul2 inclu2e gall stonesB u77er an2 lo:er gastrointestinaltract cancersB ?reast lum7s an2 9ascular insufficiency.

34 Ac%!e a*&"2e#To ?e a?le to assess an2 7ro9i2e the early care of a 7atient 7resenting :ith acute a?2ominalsym7toms an2 signs. This shoul2 inclu2e localise2 an2 generalise2 7eritonitis ;Acute chlecystitisBacute 2i9erticulitisB acute 7ancreatitisB 9isceral 7erforationB acute a77en2icitis an2 acutegynaecological con2itions=B o?struction ;small an2 large ?o:el & o?structe2 herniaeB a2hesionsBcolonic carcinoma= an2 localise2 a?2ominal 7ain ;?iliary colicB non8s7ecific a?2ominal 7ain=.

84 A*&"2#a) Tra%2aTo ?e a?le to assess an2 7ro9i2e the early care of a 7atient :ith sus7ecte2 a?2ominal trauma.This shoul2 inclu2e 7rimary an2 secon2ary sur9ey.

94 Ac%!e Vasc%)ar Ds"r&ersTo ?e a?le to recognise assess an2 7ro9i2e the early care of a 7atient 7resenting :ith ru7turesa?2ominal aortic aneurysm an2 acute arterial insufficiency.

:4 Ac%!e Ur")"(ca) c"#&!"#sTo ?e a?le to 7ro9i2e the early care of a 7atients 7resenting :ith acute urological con2itionsinclu2ing acute urinary retentionB ureteric colicB urinary tract infection an2 acute testicular 7ain

>4 S%perfca) Sepss

'5
http://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connellhttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Norman%20S.%20Williamshttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=Christopher%20J.K.%20Bulstrodehttp://www.amazon.co.uk/exec/obidos/search-handle-url?_encoding=UTF8&search-type=ss&index=books-uk&field-author=P.%20Ronan%20O%27Connell


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To ?e a?le to 2iagnose an2 manage inclu2ing a77ro7riate in9estigations su7erficial an2 commonacute se7tic con2itions inclu2ing su?cutaneous a?scessB cellulitisB ingro:ing toe nailB 7erianalan2 7ilono2al a?scess an2 ?reast a?scess. To ?e a:are of gas gangrene an2 necrotising fasciitis

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

O*7erience in the early care of 7atients :ith common general surgery7ro?lemsE

The common emergency 7ro?lems are acute a?2omenB a?2ominal traumaB

acute 9ascular 2isor2ersB acute urological con2itions an2 su7erficial se7sis.

The common electi9e 7ro?lems inclu2e a?2ominal :all herniaB lesions of the

cutaneous an2 su?cutaneous tissuesB 7rimary long sa7henous 9aricose9einsB gall ?la22er 2iseaseB u77er an2 lo:er gastrointestinal tract cancersB

9ascular insufficiency an2 ?reast lum7s.

Pro9i2e some o7erati9e e>7erience of electi9e a?2ominal :all hernia re7airB 7rimary9aricose 9ein surgeryB e>cision of ?enign su?cutaneous lesions an2 localise2malignant s6in lesions an2 intra8a?2ominal surgery

1#"')e&(e

0asic science rele9ant to the management of 7atients :ith the common electi9e an2emergency 7ro?lemsB ;inclu2ing anatomyB 7hysiologyB 7harmacologyB an2 ra2iology=

Clinical 7resentation an2 7athology of common electi9e an2 emergency con2itions.

Princi7les of management of 7atients 7resenting :ith the common electi9e an2emergency 7ro?lems

C)#ca)S0))s

Pre8o7erati9e an2 7osto7erati9e assessment of 7atients :ith electi9e an2 emergency7resentations of general surgical con2itions. This shoul2 inclu2e assessment of co8mor?i2ity in the conte>t of the 7lanne2 surgical 7roce2ure.%anagement of flui2 ?alance an2 nutritional su77ortH 7osto7erati9e analgesiaHthrom?o7ro7hyla>isH :oun2 management.

Assessment an2 7lanning in9estigation of ne: an2 follo:8u7 7atients in out7atient

clinics.Assessment an2 management of 7atients :ith emergency con2itions inclu2ing7rimary an2 secon2ary sur9ey an2 2etermining a77ro7riate in9estigations.

Tech#ca)

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

Chest 2rain insertionCentral 9enous line insertionSu7ra7u?ic catheter insertionNee2le ?io7sy inclu2ing Fine nee2le as7irationRigi2 sigmoi2osco7y!>cision ?io7sy of ?enign s6in or su?cutaneous lesionsIngro:ing toenail & a9ulsion :e2ge resection 7henolisaton

!>cision ?io7sy malignant s6in lesionOut7atient treatment of haemorrhoi2s0reast lum7 e>cisionIn2uction of 7neumo7eritoneum for la7arosco7yO7en an2 close mi2line la7arotomy incision

A77en2icectomyInguinal hernia re7airPrimary 9aricose 9ein surgery

'-


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Assess2e#!The s7eciality elements of the early years :ill all ?e assesse2 7rimarily in the :or67lace an2 thenscrutinise2 in the Annual Re9ie: of Com7etency Progression. All these 2ocuments :oul2 ?einclu2e2 in a 7ortfolio :hich :oul2 contri?ute as e9i2ence in su?seuent a77lications to enter

ST.

S7ecific e9i2ence inclu2es

Assess2e#!!+pe

S%*


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In or2er to meet the


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

O*7erience in the early care of 7atients :ith common genitourinary7ro?lemsE

The common emergency 7ro?lems are urinary tract infection affecting the?la22er an2 6i2neyB ureteric or renal colicB urinary retentionB urinary tracto?structionB renal failure an2 acute

new mrcs syllabus draft 16-06-09!1!1

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