351 Corriculum

 

 

DEPARTMENT OF SURGERY

 SAUD UNIVERSITY

COLLEGE OF MEDICINE

RIYADH, K.S.A.

 

 

 

 

 

1430-1431

(2009-2010)

 

 

 

 

 

(ANNUAL SYSTEM)

 

 

 

SURGERY COURSE 351

ANNUAL SYSTEM

SCHOOL YEAR 1428-29

 

 

WELCOME TO THE DEPARTMENT OF SURGERY

 

 

Dear Student,

 

         It is our pleasure on behalf of the Department of Surgery to welcome you at the start of your course and wish you the best of luck with your studies.  It is our duty to see that the time is well spent and the course objectives are fully satisfied.  We have found the study of Surgery to be fascinating as well as gratifying.  We wish you experience the same feeling.

 

         Medical students are distinguished from students of other scientific studies by dealing with the human beings.  When entering the medical college, students are enthusiastic to reach this point.

 

         An important cornerstone in medicine is taking history and clinical examination of the patients to demonstrate the normal and abnormal signs.  Inspite of the advancement of medical investigations there will be no substitute to proper history taking and conducting clinical examination.

 

         Teaching in medicine is the result of the collaboration of three persons, the students, the teacher and the patient. However, out of these three the student is the most important.  He/she will stimulate the teacher to give more and by dealing with patients generally as a human being, will gain more cooperation and hence better findings.

 

         I look forward to both the teachers and the student of this course to a very fruitful period of their life.

 

KING SAUD UNIVERSITY

COLLEGE OF MEDICINE

KING KHALID UNIVERSITY HOSPITAL

 

DEPARTMENT OF SURGERY

 

COURSE NAME:    SURG. 351 (CLINICAL TEACHING & LECTURES)

 

CREDIT HOURS:   8 HOURS

 

1. A.            COURSE OBJECTIVES:

 

At the end of the course students will be able to:

 

1. Perform, record,  present, and discuss in detail skills of history taking of common surgical diseases.
2. Demonstrate knowledge of the symptoms and signs of common surgical diseases.
3. Demonstrate appropriate skills to conduct comprehensive clinical examination of surgical patients.
4. Demonstrate the appropriate ways to identify physical signs of common surgical diseases.
5. Formulate a reasonable differential diagnosis of surgical problems.
6. Adopt self learning techniques in particular with the use of the teaching laboratory aids.

 

1. B.            COURSE DURATION:

One academic year (i.e. 2 semesters)

 

1. C.            EVALUATION:

 

The evaluation of this course depends on the students’ behaviour and activity during the course is contributed by the following:

 

         MIDTERM                                                FINAL

1st Continuous Theory Exam    15% 2nd Continuous Theory Exam    15%                                            --------                                          30%

Final Written                         25% Final OSCE                            45%                                         ---------                                        70%

 

1. D.            ATTENDANCE:

As part of King Saud University Regulations, student must fulfill the minimum 75% attendance in both lectures and clinical teaching.  There will be a strict adherence to the rules and regulation of the college regarding that.

 

1. E.             CLINICAL TEACHING:

This is where art of medicine is learned.  You will be divided into small groups for this purpose to optimize your opportunities of learning.  Each group will have two (2) sessions weekly where case histories and physical examination are demonstrated and discussed.  It is expected that every student should participate in these sessions and your teacher will to that.

 

1. SKILL LAB:  The Skill Lab has been introduced this year.  Each male group will pass by Skill Lab.  One week will be during the Urology rotation and the other week will be during the General Surgery rotation.  There will be specific objectives for each Skill lab.  It is limited to male group this time because of a place issue, but soon will accommodate all groups.  These station will be part of the OSCE exam
   1. 1.            Students Grouping (Clinical Teaching):

a)    Male students will be divided into 2 groups (A & B) which will be sub-grouped into 10 groups.

b)   Female students (Group C) will be subdivided into 10 sub-groups.  Each group will rotate on monthly basis among teachers.

1. 2.            Clinical Timetable (Clinical Teaching):

 

GROUP A (MALE)		GROUP B (MALE)		FEMALES
Every Saturday	1-4 pm	Every Sunday	9-12 am	Every Sunday	1-4 pm
Every Monday	9-12 nn	Every Tuesday	1-4 pm	Every Tuesday	8-11 am

 

1. G.            UNIFORM AND DRESS:
   1. Male students – during clinical sessions males students must wear:

a)    Blue Scrub Suit (operative theatre uniform)

b)   White lab coat

c)    ID badge

 

1. 2.            Female Students

              As recommended by the Vice-Dean for Academic Affairs (please see attached recommendation), any student who does not fulfill this will receive a warning letter.  If pleased, she will be subjected to a penalty.

 

1. H.            SUGGESTED TEXTBOOKS:
   1. 1.        CLINICAL:
      1. An introduction to the symptoms and signs of surgical disease by Norman Browse
      2. Churchill, pocketbook of differential diagnosis

By: A. Raftery E. Lim, Edition 2001

1. 2.                 THEORY:

a)   Essential of General Surgery, latest edition by Peter Lawrence 

b)   Essential of Surgical Specialties, latest edition by Peter Lawrence 

 

Surgery Course 351

Department of Surgery

Course Outline

 

I.    Objectives of 351 Surgical Course

 

General Objectives:

 

1. Students who successfully complete the course are expected to be able to demonstrate the clinical skills and methods required to clinically define common surgical diseases.

 

1. Students will have the ability to adopt a problem solving approach to common surgical diseases.

 

Specific Objectives:

 

                  At the end of the course students will be able to:

 

               i.         Perform, record, present, and discuss in detail skills of history taking of common surgical diseases.

 

ii.      Demonstrate knowledge of the symptoms and signs of common surgical diseases.

 

1. Demonstrate appropriate skills to conduct comprehensive clinical examination of surgical patients.

 

1. Demonstrate the appropriate ways to identify physical signs of common surgical diseases.

 

1. Formulate a reasonable differential diagnosis of surgical problems based on history and physical examination.

 

1. Demonstrate a basic knowledge of common and urgent surgical problems.

 

1. Adopt self learning techniques in particular with the use of the teaching laboratory aids.

 

Surgery Course 351

Department of Surgery

Course Outline

Page 2

 

II.   Course content:

 

General Guidelines:

 

• the course contain a theoretical and a clinical part, that should work in harmony toward the set objectives rather than two separate courses.

 

• the course will be clinically oriented in its two parts.

 

• the theoretical part consist of 2 lectures per week, the students will be divided into three groups – two male and one female, each group will have a separate schedule, according to the college regulations.

 

• the clinical part consist of 2 clinical sessions per week.

 

• the course is composed of 8 credits hours in the medical school curriculum.

 

Clinical Sessions:

 

• the clinical sessions is the main part of the course, where students will learn in it the principles of history taking, clinical examination and problem solving approach for the common surgical diseases.

 

• Students will be divided into sub-groups, with an average of 10 students in each group.

 

• The clinical sessions will be composed of:

 

• bed-side teaching sessions.

 

• clinical skill laboratory sessions.

 

• surgical clinic sessions.

 

• surgical emergency sessions.

 

• All the 4 different clinical allocations will serve the main objectives of the course.

 

 

• Detailed distribution of students will be arranged accordingly.

 

 

 

Lectures:

 

• Theoretical lectures will serve to give more explanation of the clinical practice in a problem based approach.

 

• The   objective   of   each lecture (syllabus) will be clearly identified (see appendix I).

 

• The suggested table of lectures as listed below:

 

PRINCIPLES OF SURGERY 

 

1	Introduction to mechanisms of trauma and treatment
2	Specific organ trauma
3	Sterilization and operation room set-up
4	History of surgery
5	Surgical Infections and antibiotics
6	Wounds and wound healing
7	I.V. Fluids and acid base disorder
8	Blood products and transfusion
9	Shock and metabolic response to surgery
10	Injuries due to burn
11	Nutrition of the surgical patient
12	General complications of surgery
13	Principles of surgical oncology

 

NEUROSURGERY

14	Presentation and management of raised intracranial pressure (intracranial tumours, infection & hemorrhage
15	Common congenital neurosurgical diseases

 

VASCULAR

16	Venous disorders/lymphatic disorders (Compartment Syndrome)
17	Management of atherosclerotic disease
18	Vascular investigations

 

UROLOGY

19	Presentation of the common urinary tract disorder
20	Emergency and urology
21	Common urogenital tumours including adrenals
22	Presentation & management of common pediatric urinary tract anomalies & vesicoureteric  reflux

 

GEN. SURGERY

23	Differential diagnosis of abdominal pain (acute & chronic)
24	Presentation & management of biliary obstruction and biliary stones
25	Differential diagnosis of abdominal masses & abdominal hernias
26	Presentation & management of common surgical diseases of the stomach and duodenum
27	Presentation & management of common surgical diseases of the small and large bowel (include appendix and rectum)
28	Presentation & management of common neck swellings and the thyroid gland & parathyroid glands
29	Presentation & management of portal hypertension & common surgical diseases of the liver
30	Presentations & management of common breast diseases
31	Pancreatic problem
32	Presentation & management of common anorectal conditions
33	Superficial swelling (lumps & pumps)

 

PEDIATRIC

34	Presentation & management of common neonatal surgical emergencies
35	Presentation & management of acute abdomen in children
36	Presentation & management of pediatric inguinoscrotal conditions and acute scrotum

 

PLASTIC

37	Presentation & management of common peripheral nerve injuries
38	Presentation & management of common congenital plastic surgery & hand diseases
39	Presentation & management of common skin & soft tissue tumours

 

THORACIC

40	Presentation & management of common esophageal diseases
41	Presentation & management of common thoracic diseases

 

CARDIAC

42

Presentation & management of common cardiac surgical diseases

 

 

III.      Assessment of Students:

 

A. Theory:

 

• Each lecturer will provide 5 single answer and 5 x 5 true and false questions for each lecture yearly, with a difficulty grade for each questions:

a.  Difficult    b.  Average     c.  Easy

• The questions will be reviewed by the course committee for  any possible improvement.
• Questions which do not meet the set objectives of the lecture  will not be approved and the lecturer will be asked to provide another set of questions.
• After approval of the questions by the committee they will be included in the exam bank.
• There will be 2 continuous exam and one final exam.
• Each continuous assessment exam will be composed of 60 single answer questions and (20x5) True and False Questions.
• Final examination will be composed of 100 single answer and (40x5) true and false questions.
  • 50% of the questions should be (grade B=average)
  • 25% (grade A=difficult) and 25% (grade C=easy)
  • After each exam the questions paper will be analyzed in one of the programmes designed for that, and the question bank will be reviewed accordingly.

 

B.  Clinical

 

• The final clinical exam will be an OSCE Exam where different stations will be conducted at the end of the year, different objectively made stations to test different clinical skills will be constructed. 

 

 

 

1. C.   Distribution of Marks:    

 

 

70%

 

30%

 

 

15%

 

 

1^ST CONT.

 

 

 

 

 

Role of the staff members:

 

A. Residents and Registrars:

 

      Although teaching skills is part of the training for the residents, the 351 course teaching need experienced teachers to know the needed information for the student level, accordingly, residents and registrars are not going to be involved in the teaching of 351 surgical course and session can’t be handed over to them.

 

 

 

 

 

B. Senior  Registrars:

 

1)  They will be involved in the clinical teaching according to the need per speciality

2)  They will help in invigilation of the theoretical examinations

3)  They will not be involved in the clinical examinations

4)  They will not be asked to give theoretical lectures

 

C. Non-teaching staff consultants:

 

1. They will be always involved in the clinical teaching
2. They will be asked to conduct one clinical session per week
3. They might be asked to help in the clinical examinations according to the need.
4. They will help in invigilation of the theoretical examinations.

 

D. Clinical Tutors (Clinical Teaching Staff):

 

 

 

1)  They will conduct one clinical session per week

2)  They might be asked to give some lectures

3)  They will be involved in the clinical examination

 

 

E. Teaching Staff:

 

 

 

1.  They will conduct one clinical session per week                  

2.  They will give an average of 3-9 lectures per year

1. They will conduct the clinical examination
2. They will prepare the multiple choice questions bank
3. They will invigilate in the theory examinations

 

 

F. 351 Course Committee:

1.  Organization of the course with a specific objective for each member

2.  Upgrading the course

3.  Identifying points of difficulties and solve them

4.  351 Course Committee are:

 

         a.  Dr. Mohammed Al-Naami, Chairman

         b.  Dr. Mohammed Al-Akeely

         c.  Dr. Gamal Khairy

         d.  Dr. Ahmad Zubaidi

         e.  Dr. Omer El-Farouk

         f.  Dr. Sherif El-Watidy

         g. Dr. Mohammad Al-Omar

         h. Dr. Saquib Mallick

         i.  Dr. Abdulrahman Al-Zahem

         j.  Dr. Ayman Al-Jazaeri

        

 

G. 351 Course Organiser:

 

1. Chair the 351 course committee

2.  Be responsible for the course organization. The day to day teaching will be the responsibility of each teaching staff according to the schedule.

3.  Write an Annual Report to the Head of the Department about the progress of the course throughout the year.

 

 

1. IV.          Assessment of the course:

1. The course will be assessed by the teaching staff, organizing committee and the students.

 

2. A questionnaire will be designed for all those concerned to identify all possible points for improvement.

 

3. An annual assessment of the course will be made.

 

 

 

 

Specific objectives of  UROLOGY lectures:

 

1. 1.     Investigations of the urinary tract

 

                   Objectives:

1. Learn about principles of common urological investigation: (urine tests,  urethral discharge, renal function tests, KUB, IVP, VCUG, AUG, U/S, C-T Scan, MRI, flowrate, urodynamic study).
2. Learn how a normal investigation would look like and how this investigation should be interpreted.

 

 

2. Presentation of common upper urinary tract disorders and urolithiasis.

 

 

                   Objectives:

                            a.     Identify systematic manifestation of renal disorders.

                           b.     Learn how to differentiate between local and referral renal and ureteric pain, and learn clinical sings of renal & ureter pathologies.

                            c.     Learn about differential diagnosis of renal masses (hydronephrosis, renal tumours, renal abscess, renal cysts, perinephric hematoma).

                           d.     Learn about clinical signs related to urotlithiasis.

                            e.     Learn an outline of investigations for patient with urolithiasis.

                            f.     Learn an outline of the treatment of urolithiasis witout going in details.

 

 

 3. Presentation of common lower urinary tract disorders and the prostate

 

 

 

                   Objectives:

1. Learn about symptoms related to the act of urination (frequency, nocturia, urgency, dysuria,enuresis).
2. Learn abut symptoms of bladder outlet obstruction (hesistancy, poor stream, drippling, urgency, acute urinary retention, chronic urinary retention, interruption of urinary stream, sense of residual urine, cystitis).
3. Learn about symptoms of urinary incontinence (full incontinence, stress incontinence, urge incontinence, overflow incontinence).
4. Learn about symptoms related to the change in urine colour or smell (cloudy urine, pnematuria, dyturia, bloody urine, idiopathic urethritis).
5. Learn about clinical signs related to lower urinary tract disease (palpable bladder, bladder mass, rectal examination, prostatic signs).
6. Learn about important neurologic signs related to urological diseases.
7. Learn about symptoms and signs of benign prostatic hyerplesia and the prostate symptom score.
8. Outline the needed investigations (laboratory studies, uroflowmetry, imaging studies, ultrasound) without going in specific details.
9. Outline the treatment plan and natural course without going to specific details.

 

 

4. Presentation and management of common scrotal and testicular disorders

 

                Objectives:

a. Learn about differential diagnosis of common scrotal disorder   (testicular tumours, varicocele, hydrocele, hematocele, spermatocele).

1. Learn about clinical signs of acute and chronic epididimororchitis.
2. Learn how to outline the needed investigations.
3. Learn the basics of treatment without going in details.

 

 

5. Presentation and management of common infections of the urinary tract

 

Objectives:

a. Learn about symptoms and signs of common infections of the urinary tract (pyelonephitis, T.B., bilharziasis, recurrent cystitis, sexually transmitted disease, acute and chronic prostatitis).

b. Learn an outline about the investigations of suspected urinary tract infection.

1. Learn an outline about treatment of urinary tract infections without going in details.

 

 

6. Common urogenital tumours

 

Objectives:

a. Learn about the symptoms and signs of common urogenital tumours.

1.Renal cell carcinoma of the kidney.

2.Transitional cell carcinoma of the bladder

3.Adenocarcinoma of the prostate

b. Outline the needed investigations.

   c. Outline the planning of management without going in the details.

 

 

7.   Presentation and management of common pediatric urinatry tract anomalies and vesicoureteric reflux.

 

Objectives:

1. Learn about clinical presentation of common pediatric urogenital anomalies (PUJO, VUJO, duplication anomalies, PUV, MCDK).
2. Learn about presentation of UTI and VUR in children.
3. Outline the needed investigations.
4. Outline the basics of treatment.