‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
#
Module/course ‫مودل‬
‫ کورس‬/
Core topics completed
‫مضامین عمده که تکمیل شده‬
1
Anatomy



Musculoskeletal
Basic Anatomy
Ear- Nose –Throat (see below)
2
Respiratory physiology

3
Fluid/electrolyte physiology

lung volumes - flow rates – pressures;
oxygen transport
Understand fluid status in your patient with
close attention during the operative and
post-operative period.
Identify and manage electrolyte
abnormalities.
Identify and manage acid-base disturbances.
Diagnose and manage common causes of
airway obstruction in the surgical patient.
Describe indications for and how to perform
surgical airways
Cricothyroidectomy
Open trachostomy
Describe indications for and be able to
perform orotracheal intubation.
Describe the appropriate level of
intraoperative monitoring for a given
patient.
Of Sepsis
Transplant (optional)
metabolic needs; caloric-protein-lipid
requirements;
fluids and micronutrients;
adaptation to starvation as compared to
response to surgical stress;
body response to surgical stress including
catabolic response and the need for
metabolic support;
enteral and parenteral feeding (indications,
complications and benefits of nutritional
support);

4
Airway management






5
Immunology
6
Nutrition







7
Sepsis and the inflammatory
response



metabolic and hemodynamic patterns
Recognize the high mortality associated with
sepsis.
Define criteria for diagnosis of sepsis and
SIRS.
Appreciate the key aspects of management
of sepsis including early goal directed
therapy, proper antibiotic coverage, and
appropriate surgical intervention (abscess,
prosthesis).
organ systems and surgical management;







Hemodynamics
Coronary Artery Disease (CAD);
Valvular disease;
Cardiomyopathy;
Cardiac arrest,
arrhythmias (as per ACLS protocols);
Chronic Obstructive Lung Disease (COPD);


9
Impact of age, pregnancy,
obesity, sepsis, and stress
Cardiac
10
Pulmonary
8
Instructor
Training
Type
‫نوع تریننگ‬
PGY
Page 1
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
11
Endocrine
12
Renal
13
Hepatic
14
Hematologic
15
Risk assessment strategies
and scores
16
Diagnostic modalities and
radiation safety
17
Medical treatments and
their impact on surgery
(Optional)





Diabetes;
Thyroid pathophysiology;
Parathyroid pathophysiology;
Adrenal pathophysiology;
Renal failure











Cirrhosis
Liver failure
Screening for diatheses
Hypocoagulable states
Hypercoagulable states
anesthetic risks
cardiac risks
ICU risk scores
trauma assessment including GCS
nutritional assessment
preoperative screening tests and their
limitations.
plain radiography;
ultrasound;
CT scan;
MRI technology;
fluoroscopy
immunosuppression;
cancer chemotherapy; radiotherapy;
common drugs with impact on hemostatic
function and how to correct their impact;
tribal customary medicine (alternative
medicine);
blood products (types, indications and
adverse reactions).
purpose and basis of staging;
basic principles of neoplastic transformation
including tumor growth and spread;
pathology requirements for appropriate
assessments;
definition of common pathological terms
such as but not limited to neoplasia,
malignancy, dysplasia, metaplasia and
atypia;
genetics of neoplasia and families at risk;
environmental carcinogens;
paraneoplastic syndromes;
principles of multi-modality therapy.
community and hospital acquired bacteria,
fungi and viruses; impact of blood borne
pathogens, including HIV, Hepatitis B and
Hepatitis C.
Describe the differences of healing by
primary closure, by delayed primary closure
and by secondary intention, and the
indications for each.
Recognize the various phases of wound
healing and the approximate time course
associated with each phase.
Describe the significance of epithelialization
and defense against contamination.
Describe clinical factors that may retard
healing.
Recognize and differentiate wounds, which



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




18
Cancer Care (Optional)




19
Management of common
infections
20
Wound healing










Page 2
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
21
Principles of prophylaxis
22
Principles of anesthesia
23
Pre and Post-operative care
have resulted in a loss of tissue and those,
which have not.

Recognize and differentiate clean vs.
infected wounds; which can be safely closed
primarily and those which cannot.

Describe the functions of a dressing.

Contrast “dehiscence” and “evisceration”
and describe their presentation and
management.

Assess a wound for signs of infection,
attending to the local heat, erythema, and
excessive pain; outline the management of
an infected surgical wound.

Describe the factors that lead to non-healing
chronic wounds.

Describe factors that lead to pressure ulcers
and treatment.

wound and systemic infection

thromboembolism (DVT, PE)

tetanus.

local anesthetic agents, indications, contraindications and administration;

regional anesthetics;

general anesthetics;

procedural sedation, indications, contraindications and administration;

complications arising from the
administration of anesthesia.

Describe the complications of and be able to
order appropriately:
O Barbiturates
O Local anesthetics
O Neuromuscular blockade reversal agents
O Neuromuscular blockers
O Sedatives

Describe the role and indications for use of
epinephrine in local anesthesia.
Pre-operative assessment in traumatic injury:

Discuss primary assessment and emergency
management of patients with craniofacial
trauma.

Develop competence in determining which
patients require immediate surgical
intervention.

Develop competence in basic emergent
procedures especially those related to
airway management.
Pre-operative assessment in an elective procedure:

Recognize and understand common medical
co-morbidities that can affect a surgical
procedure.

Understand how to properly assess a patient
pre-operatively, and when to order
additional pre-operative testing.

Develop competency in the intra-operative
preparation of the patient for basic head and
neck procedures including patient
positioning, surgical prepping,
pharmacologic prophylaxis, premedication
and airway concerns.

Understand the indications for medical
Page 3
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives

24
Wound healing and wound
care
versus surgical treatment of nasal and
paranasal sinus disorders.
Pre-, intra-, peri-, and post-operative
management of patients undergoing
rhinologic and endoscopic skull base
procedures, including identification and
proper management of rhinologic
emergencies and complications.
Post operative management:

Discuss prevention of peri-operative cardiac
events.

Discuss proper fluid management and
appropriate use of blood products in the
postoperative patient.

Discuss the causes of postoperative fever.

Discuss the differential diagnoses for
patients with postoperative respiratory
difficulty.

Understand how to manage post-operative
pain.

Describe the differences of healing by
primary closure, by delayed primary closure
and by secondary intention, and the
indications for each.

Recognize the various phases of wound
healing and the approximate time course
associated with each phase.

Discuss the growth factors involved in
wound healing.

Describe the significance of epithelialization
and defense against contamination.

Describe clinical factors that may retard
healing.

Recognize and differentiate wounds, which
have resulted in a loss of tissue and those,
which have not.

Recognize and differentiate clean, cleancontaminated, contaminated and infected
wounds. Describe the wound management
based on the wound. Specifically what
wound can be safely closed primarily and
which ones cannot.

Describe the management of traumatic
wounds, including tetanus prophylaxis.

Assess a wound for signs of infection,
attending to the local heat, erythema, and
excessive pain; outline the management of
an infected surgical wound.

Describe the signs of necrotizing soft tissue
infection.

Obtain proper wound specimen for gram
stain and cultures.

Identify, differentiate and treat wound
complications of hematoma and seroma.

Identify wound dehiscence and
“evisceration” and initiate care.

Describe the functions of a dressing.

Debride and pack wounds and apply
dressings.

Perform extensive wound debridement
under supervision.
Page 4
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives



25
Basic anatomy






26
Epistaxis








Stridor




Discuss the specific recommendations for
management and prevention of
complications from animal and insect bites.
Describe the factors that lead to non-healing
chronic wounds.
Describe factors that lead to pressure ulcers
and treatment.
Describe the applied anatomy of the ear,
nose (including paranasal sinuses, anterior
and middle cranial fossa), mouth, pharynx,
larynx and neck.
Understand the basic sciences, as relevant to
the head and neck and upper-aerodigestive
system including its embryology, physiology,
pharmacology, pathology, microbiology,
biochemistry, genetics and immunology.
Conduct essential componnts of the basic
ear, nose, and throat physical exam and
review of symptoms.
Become competent in the otolaryngologic
history and physical examination with
particular emphasis on speech and swallow
function.
Understand and describe assessment
procedures such as audiologic tests,
electronystagmography, laryngoscopy, and
videostroboscopy.
Develop competency in the basic
interpretation of plan X-ray and CT imaging
of the nose, paranasal sinus and
anterior/middle cranial fossa.
Understand the blood supply of the nares
and sinuses, define Kiesselbach’s plexus.
Differentiate anterior and posterior bleeding
and know the common sources of bleeding
for each syndrome.
Understand the common etiologies of
epistaxis and list common risk factors and
associated medical conditions.
Understand the importance of the initial
assessment, including the need for airway
intervention, fluid resuscitation, and
cardiovascular stability.
Take a focused history and physical exam on
a patient with epistaxis.
Be comfortable with the initial management
of epistaxis including use of medications and
tamponade procedures, as well as obtaining
intravenous access.
List the treatment options for anterior
bleeding (cautery, nasal packing,
contralateral nares packing, thrombogenic
foams and gels) and understand when to
utilize each treatment method.
List the treatment options for posterior
bleeding.
Recognize the common signs and symptoms
in a patient suffering from stridor.
Understand the causes of stridor.
Describe and be proficient in establishing an
emergency airway.
Be able to do a focused history and physical
Page 5
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives

27
Malignant lesions






28
Rhinitis, rhinorrhea, and
nasal obstruction








29
Emergency care




30
Infections

exam on a patient presenting with stridor.
List the appropriate diagnostic testing
necessary once a patient is stabilized.
List the risk factors for developing cancer of
the tongue, oral cavity, pharynx and larynx.
Identify and describe common exam findings
of the oral cavity and pharynx including
malignant lesions and lesions resembling
malignancy.
Identify and describe common malignant
and benign laryngeal problems in adults.
Understand the pathophysiology of
malignancy (Squamous Cell Carcinoma,
Adenocarcinoma, Adenoid Cystic Cancer,
Chondrosarcoma).
List treatment options for the above listed
malignancies.
Recognize benign tumors like granular cell,
chondroma, and papillomas.
Define rhinitis and recognize the clinical
symptoms (sneezing, rhinorrhea, nasal
congestion, nasal itching).
Recognize and describe common causes of
rhinitis and rhinorrhea (allergic rhinitis, nonallergic rhinitis, occupational exposure,
structural abnormalities that could lead to
recurrent rhinitis or rhinorrhea).
List treatment options for rhinorrhea and
rhinitis.
Recognize the common symptoms
associated with nasal obstructions.
List the common etiologies causing nasal
obstruction.
Based on history and physical exam, be able
to form a thorough differential diagnosis and
initiate proper treatment for nasal
obstruction, rhinitis, and rhinorrhea.
Be able to perform anterior rhinoscopy.
Understand the role of CT scan in the
assessment of sinus pathology.
Describe and explain the work up and
treatment of otolaryngologic emergencies
such as airway obstruction, tracheotomy
care, caustic ingestion, deep neck abscesses,
and maxillofacial trauma.
Develop competence in determining which
patients require immediate surgical
intervention and which can be initially
managed conservatively or medically.
Develop competence in basic emergency
procedures, particularly those related to
airway and bleeding:
o
Surgical procedures
o
Endoscopic procedures
Be able to communicate your assessment
and treatment strategy to an attending
physician.
Describe typical patient presentations of
common infections such as acute sinusitis,
pharyngitis, and acute suppurative otitis
media and determine the best treatment
options for each disease process.
Page 6
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives



31
Tonsils and adenoids





32
Hoarseness and laryngitis






33
Tracheotomy and
tracheostomy






Diagnose and treat common infections of
the ears, nose, and throat, particularly acute
sinusitis, pharyngitis, and otitis media.
Know the indications for paranasal sinus
culture. Know how to perform paranasal
sinus cultures and washout techniques.
Understand bacterial resistance and list the
contributing factors responsible for
resistance development.
List and understand the indications for a
tonsillectomy in adults and children.
List the common complications to
tonsillectomy and adenoidectomy.
Describe and understand the pharyngeal
anatomy.
Be able to perform a focused history and
physical exam on a patient with special
attention to examination of the tonsils and
adenoids.
Recognize the clinical and physical exam
findings of a patient with a peritonsillar
abscess and understand the surgical
intervention.
Become familiar with common signs and
symptoms of hoarseness and laryngitis.
List the common causes of laryngitis (reflux,
allergic, autoimmune, infectious) both acute
and chronic.
Utilize a directed history and physical to
properly diagnose someone with
laryngitis/hoarseness.
Understand the anatomy of the larynx
including the hyoid bone, the nine laryngeal
skeleton cartilages, extrinsic and intrinsic
muscles as well as the blood and nerve
supply of all vital structures in the region.
Become competent in the diagnosis,
assessment, and management of patients
with voice disorders:
o
Spasmodic dysphonia (adductor
vs. abductor)
o
Paradoxical voice cord movement
o
Parkinson’s Disease
o
Tremor
Become competent in the diagnosis,
assessment, and management of patients
with laryngeal cancer. Know what kind of
cancer is the most common, and how it
metastasizes (direct spread, hematogenous,
or lymphatic).
List the indications for tracheotomy and
tracheostomy.
Be competent in performing a tracheotomy
or tracheostomy.
Understand the risks and complications of a
tracheotomy/tracheostomy.
List the important anatomy that the surgeon
needs to recognize when doing a
tracheotomy/tracheostomy.
List the contraindications (both relative and
absolute) to a tracheotomy/tracheostomy.
Understand the post-operative care required
Page 7
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives



34
Trauma











35
Swallowing disorders





of a tracheostomy tube.
Know the indications to change a
tracheostomy tube.
Understand how to change a tracheostomy
tube.
Know the characteristics of a patient who
can be decannulated and be able to perform
decannulation.
Describe the priorities involved in treating
patients with head and neck injuries.
Describe the mechanical and structural
properties of the facial skeleton as they
relate to fracture patterns in facial trauma.
Describe the concepts of primary bone
healing, malunion, nonunion and
osteomyelitis.
Discuss the advantages and disadvantages of
various techniques of treatment of facial
fractures including:
a.
Non-operative treatment
b.
Closed reduction
c.
Mandibulomaxillary fixation
d.
Open reduction with and without
fixations
e.
Intraoral splints
f.
External fixation
g.
Bone grafting
Describe complications of facial fracture
treatment (secondary deformities,
infections/osteomyelitis, malocclusion,
nonunions, malunions).
Describe the neuroanatomy, cranial nerve
anatomy and soft tissue anatomy pertinent
to facial fractures.
Recite the treatment of soft tissue injuries of
the head and face including parotid gland
and duct injuries, facial nerve injuries, and
lacrimal apparatus injuries.
Develop competence in determining which
patients require immediate surgical
intervention and master basic trauma
procedures particularly those related to
airway management:
Be able to perform a cricothyroidotomy.
Be able to interpret plain X-ray and CT
images of the nose, paranasal sinuses, and
anterior/middle cranial fossa in a trauma
patent.
Describe the treatment options, including
surgical and non-surgical, for patients
suffering from nasal fractures.
Understand the basic science principles
integral in swallowing.
Recognize the clinical presentation of a
patient with a swallowing disorder.
Perform a directed history and physical in a
patient complaining of dysphagia.
Differentiate oropharyngeal dysphagia from
esophageal dysphagia by history and
physical exam.
Recognize the difference between dysphagia
with solid food and liquids and understand
Page 8
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives

#
how this impacts your differential diagnosis.
Become competent in the diagnosis,
assessment and management of patients
with swallowing disorders:
a.
Structural defects vs. functional
deficits
b.
Zenker’s diverticulum
c.
Cricopharyngeal spasm
d.
Esophagitis/pharyngitis
Surgical Skills ‫کورس‬/‫مودل‬
Dates
Instructor
Training
Type
‫نوع تریننگ‬

1

1

1
Appropriate tissue handling during
surgery
Blunt and sharp dissection

1

1
Vascular control in elective and critical
situations
Closure of simple wounds

1

1

1

1
10
Application of appropriate wound
dressing
Urethral catheter insertion

1
11
Insertion of a nasogastric tube

1
12
Tourniquet application

1

1

1
1
2
3
4
5
6
7
8
9
13
14
Incision with sharp and energy-based
instruments
Knot tying
Suturing
Appropriate use of drains
Splint for bony injury or soft tissue
injury
Remove a superficial skin lesion
15
Drain a superficial abscess

1
16
Biopsy

1

1

1
Tube thoracostomy

Needle Cricothyroidotomy

Cricothyroidotomy or tracheostomy

Preparation of specimen for a
pathologist
Appropriate wound surveillance and
dressing care
Insertion of a nasogastric tube

1
1
1
1

1

1
17
18
19
20
21
22
23
24
#
Secure arterial and venous vascular
access
Needle thoracostomy
ENT Skills
Dates
Instructor
Training
PGY
Length
PGY
Length
Page 9
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
Type
‫نوع تریننگ‬
Neck abscess drainiage

Office and OR management of epistaxis

Excision of simple masses in the neck

Foreign body removal from nose and ear

Nasal endoscopy and anterior rhinoscopy

Flexible fiberoptic assessment of the
airway
Direct laryngoscopy/microlaryngoscopy

Bronchoscopy

Esophagoscopy

Tracheostomy

Tonsillectomy

External fixation of mandibular fracture

Submandibular gland excision

Surgical neck exploration and
aerodigestive tract repair in neck trauma
Flap closure of persistent tracheostomy

Caldwell Luc operation

Mastoidectomy

Endoscopic management of epistaxis


20
Office endoscopy of upper airway, biopsy,
and debridements
Internal fixation of maxillofacial fractures
#
Advanced ENT Skills
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Neck abscess drainage.
Office and OR management of
epistaxis.
Excision of simple masses in the neck.
Foreign body removal from nose and
ear.
Nasal endoscopy and anterior
rhinoscopy
Flexible fiberoptic assessment of the
airway
Direct
laryngoscopy/microlaryngoscopy
Bronchoscopy
Esophagoscopy
Tracheostomy
Tonsillectomy
External fixation of mandibular
fractures (dental wiring).
Submandibular gland excision
Surgical neck exploration and
aerodigestive tract repair in neck
trauma.
1-5
1-5
1-5
1-5
1-5
1-5

1-5
1-5
1-5
1-5
1-5
1-5
1-5
1-5

1-5
1-5
1-5
1-5
1-5

Core topics completed ‫مضامین‬
‫که تکمیل شده‬



1-5
Instructor
Training
Type
‫نوع تریننگ‬
PGY5
2-5
2-5

2-5
2-5

3-5

3-5

3-5

3-5
3-5
3-5
3-5
3-5






4-5
4-5
Page 10
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
15
16
17
18
19
20
Flap closure of persistent
tracheostomy
Caldwell Luc operation
Mastoidectomy
Endoscopic management of epistaxis
Office endoscopy of upper airway,
biopsy, and debridements.
Internal fixation of maxillofacial
fractures
Certification/Training
‫ تریننگ‬/ ‫تصدیق نامه‬





BLS
3
ACLS
4
ATLS

4-5
4-5
4-5
4-5

4-5
Certification of completion ‫بدست آوردن شهادت نامه‬

2



1
4-5


Complete H&P

Date(s) ‫تاریخ‬
Comments ‫نظریات‬
Obtain a detailed surgical history that is
appropriate for age, sex and clinical
problem.
Obtain and review relevant medical records
and reports.
Obtain information from prior
hospitalizations.
Know the patient’s other physicians.
Perform a detailed physical examination.
Develop a focused differential diagnosis.
Assess, document and manage perioperative
risk factors.
Document the treatment plan in the medical
record, including indications for treatment.
Page 11
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
Topic
Skills ‫مهارت های بخش‬
‫مراقبت جدی‬
Hospital Hygeine
o
o
o
o
Handwashing
asespsis
antisepsis
Lab 1
Lab 2
airway
lines
suturing
fracture care.
Admit orders,
Pre-op note and orders
Post-op note and orders
Operation reports
Transfer note & orders
Discharge note & orders
when appropriate
when inappropriate
Abdominal mass
Aortic aneurysm
Aortic dissection/rupture
Appendicitis
Atelectasis, lung contusion
Bowel gas patterns (Large vs. small intestine,
normal vs. abnormal vs. nonspecific)
Diaphragm abnormalities
Fractures
Free air in abdomen
Hemothorax, pneumothorax
Lung mass, mediastinal nodes
Paraesophageal hernia
Pleural effusion
Pneumonia
Pulmonary embolism
Pulmonary infiltrate
Spinal column fractures
Visceral abnormalities and injuries
Pancreatitis, pancreatic tumor
Bowel obstruction, ileus
Spleen laceration, splenic infarct
Hemoperitoneum, ascites
Liver tumors,cysts,laceration, hematoma
Biliary tree dilation, cholecystitis
retroperitoneal hematoma, tumors
Hernias: inguinal,femoral,umbilical and
incisional
colon tumors, diverticulitis, volvulus
Renal, ureteric and bladder stones (calculi)
o
o
o
o
o
Central venous line
Chest tube
Endotracheal tube
Nasogastric tube
Trachestomy
o
1
Computer skills
o
o
2
Skills Lab:
o
o
o
o
3
Documentation I:
o
o
o
4
Documentation II:
o
o
Consultation:
o
o
o
5
6
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Imaging I: Recognize
abnormalities
Instructor
‫تعداد پروسیجرهای‬
‫اجرا شده‬
‫چند سال تجربه‬
Evaluation
dates
PGY Year
7
Imaging II:
Appropriate placement
8
Chest Tubes
o
Nasogastric and Oraltracheal
o
9
10
Page 12
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
tubes
Peripheral and Central lines
o
Urinary Catheters
o
11
12
Medical Proficiency
Evaluater
1
Perform a complete/appropriate assessment of pt
2
Perform a complete consultation
3
Ensure patients receive appropriate end-of-life care
4
Formulate and implement a management plan
‫ چند سال تجربه‬Evaluation dates
Comments ‫نظرات‬
Demonstrate proficient and appropriate use of
5
procedural skills, indications, contraindications
Surigcal ICU issues
Core topics completed ‫مضامین‬
‫که تکمیل شده‬






1
Types of Shock
2
Catheters
3
Ventilation
4
Vasopressors
5
6
Blood Component therapies
Transfusion


7
Criticaly ill complications
8
Nutrition













Instructor
Training
Type
‫نوع تریننگ‬
PGY
Anaphylactic
Cardiogenic
Hemorrhagic
Neurogenic
Septic
venous and arterial catheters;
interpret data, and direct
therapy
indication
modes
weaning
medications
indications
indications
indications
minor and major transfusion
reactions
Aspiration
Deep vein thrombosis
Line sepsis
Pressure ulcers
Upper gastrointestinal bleeding
Indications
options
See ICU objectives for more
Page 13
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
TOP 15 Must Know Surgical
Issues
o
o
o
Abdominal pain – Acute
abdomen:
o
o
o
o
o
o
1
o
o
Anorectal disease:
o
o
o
2
o
o
o
o
Appendicitis:
3
o
o
o
o
o
o
o
o
Biliary tract disease:
o
o
o
o
4
Colon:
5
o
o
o
o
o
Describe a systematic approach to the history in the assessment of the acute abdomen.
Understand the different types of abdominal pain (visceral, parietal, referred);
characterization of abdominal pain (onset, provocative, quality, radiation, site,
symptoms of pain, time course).
Outline the specific ways that the physical examination is different in the assessment of
the acute abdomen than it is in the benign abdomen.
Identify the immediate life threatening conditions of abdominal pain:
Abdominal aortic aneurysm, mesenteric ischemia, perforation of gastrointestinal tract,
acute bowel obstruction, volvulus, ectopic pregnancy, placental abruption, myocardial
infarction, splenic rupture, hemoperitoneum and massive intraabdominal hemorrage
List the differential diagnosis of localized tenderness in the epigastrium and each of the
four abdominal quadrants.
Describe the signs/symptoms, pathogenesis, diagnosis and management of the common
causes of the acute abdomen.
Describe the role of the peritoneum in intra-abdominal inflammatory processes.
Describe the presentation and management of conditions that commonly present as an
acute abdomen that do not require surgical therapy.
State the etiological factors in the development of hemorrhoidal disease, including the
roles of diet, pregnancy, and occupation.
Describe the symptoms and physical findings of patients with internal and external
hemorrhoids.
Outline the principles of management of patients with symptomatic external
hemorrhoids and symptomatic internal hemorrhoids.
Outline the symptoms, physical findings of patients with perianal infections and
pilonidal disease.
Describe the symptoms and physical findings of patients with fissure-in-ano and outline
the principles of management.
Understand the pathogenesis of the inflammatory process of appendicitis.
Identify the clinical manifestations of appendicitis.
Be able to perform a careful physical examination.
Know how to elicit the following signs: McBurney’s point, Rovsing’s, Psoas and
Obturator signs.
Obtain appropriate labs and radiologic studies to aide in diagnosis.
Know the differential diagnosis of acute appendicitis.
Understand the operative indications for appendicitis.
Understand the medical and surgical management of appendicitis.
List the complications of acute appendicitis if left untreated.
List the common types of gallstones and describe the pathophysiology involved in their
formation.
Describe the signs and symptoms in a patient with biliary colic. Contrast these
symptoms with those of acute cholecystitis.
List the tests commonly used in the diagnosis of calculus biliary tract disease. Describe
the indications for, limitations of, and potential complications of each test.
List the complications which can occur from biliary calculi.
Outline the medical and surgical management of a patient with acute cholecystitis.
Describe the symptoms and signs of chloedocholithiaisis; describe the management of
this problem.
Compare and contrast the liver enzyme abnormalities in obstructive jaundice and viral
hepatitis.
List the most common bacteria found in cholecystitis and cholangitis.
Discuss the risk factors for colorectal cancer.
Identify the common symptoms of colorectal cancer.
Discuss the evaluation and treatment of colorectal cancer.
Discuss the role of radiotherapy and chemotherapy in management of patients with
Page 14
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
o
o
o
o
o
Cholelithiasis (Acute
cholecystitis):
o
o
o
o
o
o
o
o
o
6
o
o
Gastrointestinal bleeding:
o
o
o
o
7
o
o
o
Hernias:
o
o
o
o
o
o
o
8
Jaundice
9
o
o
o
o
o
o
o
o
o
Liver cysts:
10
o
colorectal cancer.
Describe the clinical findings of diverticular disease, differentiating the symptoms and
signs of uncomplicated and complicated diverticulitis.
Discuss non-operative management of diverticular disease.
Discuss operative therapy for diverticular disease i.e. uncomplicated and complicated.
Differentiate ulcerative colitis and Crohn’s disease of the colon in terms of history, xray findings, prognosis and risk of cancer
Define the following:

Acute cholecystitis

Acalculous cholecystitis

Chronic cholecystitis
Understand the pathogenesis of the inflammatory process of acute cholecystitis
Identify the clinical manifestations of acute cholecystitis
Perform a careful physical examination

Know how to perform the Murphy’s sign
Obtain appropriate labs and radiologic studies to aide in diagnosis
Know the differential diagnosis of acute cholecystitis
Understand the operative indications for acute cholecystitis
Understand the medical and surgical management of acute cholecystitis
List the complications of acute cholecystitis if left untreated
Define hematemesis, hematochezia, melena, and guaiac positive stool; state their
significance with regard to the level of the bleeding source.
Outline the resuscitation plan for a hypotensive patient with a major GI hemorrhage.
Given a patient with upper and lower GI hemorrhage, outline according to priority, the
steps of assessment and initial management once resuscitation has been completed.
In order of frequency, list the most common causes of upper and lower GI bleeding in
the general population, in the adult (age 16 years and above), and in the infant (birth to
2 years).
Outline the work-up of the adult patient presenting with occult blood on rectal exam.
List criteria for surgical intervention in a patient with GI hemorrhage.
Provide a definition of a hernia and understand the incidence of various types of
hernias.
Describe the epidemiology, pathogenesis and classification of hernias.
Specifically, define the various locations of hernias on the abdominal wall. Understand
the different types of hernias (reducible, incarcerated, strangulated, and sliding) at each
anatomic site.
Differentiate a direct, indirect, and femoral hernia of the groin and define the anatomic
relationship between them.
Describe the clinical manifestations of hernias based on location.
Describe the abdominal and groin exam and the findings associated with the different
types of hernias.
Obtain appropriate labs and radiologic studies to aide in diagnosis.
Know the differential diagnosis of hernias.
Identify the types of hernia repair used for common abdominal wall hernias.
Understand the potential complications of hernia repair.
Describe the medical management of hernias based on location.
Understand the anatomy and physiologic abnormalities of the different types of
diaphragmatic and hiatal hernias.
Define obstructive jaundice.
Describe the pathophysiology of obstructive jaundice.
List the causes of obstructive jaundice.
Describe the clinical manifestations of obstructive jaundice.
Know the differential diagnosis of jaundice.
Understand the operative indications for obstructive jaundice.
Understand the medical and surgical management of obstructive jaundice.
List the complications of obstructive jaundice if left untreated.
Know the classification of hepatic cysts with specific focus on Echinococcal (hydatid)
cysts.
Understand the pathogenesis of Echinococcal (hydatid) cysts:
Page 15
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
o
o
o
o
o
o
o
o
o
o
Pancreatitis:
o
o
o
o
o
o
o
o
o
o
11
Peptic ulcer disease:
o
o
o
o
o
o
o
o
o
o
o
o
o
12
Peritonitis:
13
o
o
o

Life cycle and epidemiology of Echinococcus
Know the four species of Echinococcus that cause infection in humans and the
geographic distribution.
Identify the clinical manifestations of Echinococcus not only in the liver but in the lung
and other organs:

Describe what symptoms occur with cyst rupture
Perform a careful physical examination in a patient suspected of being infected with
Echinococcus.
Obtain appropriate labs and radiologic studies to aide in diagnosis.
Know the differential diagnosis of liver cysts.
Understand the operative indications for Echinococcal cysts.
Understand the medical and surgical management of Echinococcal cysts:

Specifically, know the various surgical techniques and the risks of
each.

Specifically, know the chemotherapy agents used to medically treat
Echinococcus.
List the complications of Echinococcal cysts if left untreated.
Understand prevention of Echinococcal cysts.
Define acute and chronic pancreatitis:

Describe the differences between acute and chronic pancreatitis.
Understand the etiology of acute and chronic pancreatitis.
Describe the pathogenesis of acute and chronic pancreatitis.
Describe the risk factors for acute and chronic pancreatitis.
Identify the clinical manifestations of acute and chronic pancreatitis.
Be able to perform a careful physical examination.
Obtain appropriate labs and radiologic studies to aide in the diagnosis of pancreatitis.
Know how to predict the severity and classification of acute pancreatitis:

Know Ranson’s criteria

Know Apache II score
Know the differential diagnosis of acute and chronic pancreatitis.
Understand the medical and surgical management of acute and chronic pancreatitis:

Understand the different therapeutic approach between acute and
chronic pancreatitis
Understand the operative indications for acute and chronic pancreatitis and potential
complication of surgery
Understand the complications of acute and chronic pancreatitis if left untreated
Define peptic ulcer disease.
Understand the epidemiology and pathogenesis of peptic ulcer disease.
Describe the risk factors for peptic ulcer disease.
Identify the clinical manifestations of peptic ulcer disease.
Be able to perform a careful physical examination.
Obtain appropriate labs and radiologic studies to aide in diagnosis.
Know the differential diagnosis of peptic ulcer disease.
Understand the medical and surgical management of peptic ulcer disease.
Understand the operative indications for peptic ulcer disease and potential complication
of surgery.
Understand the complications of peptic ulcer disease and the specific treatment for
each:

Bleeding

Perforation

Penetration
Gastric outlet obstruction
Define spontaneous bacterial peritonitis (SBP):

Know the common organisms associated with SBP.
Understand the pathogenesis of the spontaneous bacterial peritonitis (SBP).
Know the risk factors of spontaneous bacterial peritonitis (SBP):

Understand the clinical and laboratory features that are associated
with an increased risk of spontaneous bacterial peritonitis (SBP).
Identify the clinical manifestations of spontaneous bacterial peritonitis (SBP).
Page 16
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
o
o
o
o
o
o
Small and Large Bowel
Obstruction:
14
o
o
o
Breast Disease:
o
o
o
o
o
o
15
Perform a careful physical examination.
Obtain appropriate labs and radiologic studies to aide in diagnosis.
Know the differential diagnosis of spontaneous bacterial peritonitis (SBP).
Understand the medical management of spontaneous bacterial peritonitis (SBP):

Specifically, understand prophylaxis therapy and indications in
spontaneous bacterial peritonitis (SBP).
List the complications of spontaneous bacterial peritonitis if left untreated.
Know small and large bowel obstruction including pathogenesis, causes, risk factors, clinical
manifestations, physical examination, lab and x-ray confirmation, differential diagnosis,
operative indications for small and large bowel obstruction and medical and surgical
management.
Understand the pathogenesis of breast cancer.
Recognize the common clinical manifestations of breast cancer (Lump, nipple
discharge, lymph node enlargement).
Develop a differential diagnosis for breast lumps and list the four major categories
(fibroadenoma, fibrocystic disease, carcinoma).
List four major risk factors for breast cancer.
Complete a focused physical exam in a patient with suspected breast cancer.
List the various labs and radiological studies required for full evaluation of a breast
lump, including breast cancer screening guidelines.
Be able to properly interpret a mammogram.
Understand the operative indications when evaluating a breast lump/mass.
Master the various surgical techniques: lumpectomy, mastectomy, radical mastectomy,
sentinel lymph node dissection.
Page 17
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ENT core objectives – Please see resident manual for off-service objectives
ENT Resident Expectations ‫توقوعات از دوکتوران دوره تخصص‬
PGY-1 schedule
General orientation: 1 month
Orthopedic/trauma surgery: 2 months
General surgery: 1 month
ENT surgery: 1 month
Vascular/thoracic surgery: 1 month
Plastic surgery/burn care: 1 month
Critical care: 1 month
Emergency: 1 month
Radiology: 1 month
Exam: 1 month
PGY-1 Skills
During the first year of the Otolaryngology residency program, residents will take a common
year of instruction with their peers from the General Surgery, Urology and Orthopedic Surgery
residency programs. This year of training is known as the Foundations of Surgery Program. The
resident will attend all surgery required lectures and conferences. While the resident will
administratively fall under the Otolaryngology Program Director, evaluations and rotation
assessments will be completed by the directors of each specific rotation. The purpose of the
first year is to provide the resident with a foundation of surgical knowledge and basic surgical
technique. Please refer to the Foundations of Surgery program for a description of the course
PGY-2 schedule
Head and Neck service: 4 months
Rhinology, otology, facial plastics: 3
months
Pediatric ENT: 3 months
Radiology CT: 1 month
Exam: 1 month
PGY-2 skills
Develop enhanced proficiency in the provision of pre-operative and post-operative care
Establisk a knowledge base and skill proficiency for the management of the critically ill surgical
patient
Increased skill in operative technique required for procedures of increasing surgical complexity
Formulate plans of care based on acquired information
Understand decision making processes used in the care of surgical patients
Develop a post-operative plan of care
Develop knowledge and skills necessary to function as the trauma team leader
Provide house coverage for consultations and emergency room admissions
PGY-3 schedule
Head and neck service: 2 months
Rhinology, otology, facial plastics: 2
months
Laryngology: 2 months
Radiology MRI: 1 month
Neurotology: 2 months
Research: 2 months
Exam: 1 month
PGY-4 schedule
Head and neck service: 3 months
ENT subspecialties: Rhinology,
otology, facial plastics: 3 months
Pediatric ENT: 3 months
Research: 2 months
Exam: 1 month
PGY-5 schedule
Head and neck service chief: 3
months
Rhinology, otology, facial
plastics chief: 3 months
Neurotology chief: 3 months
Research chief: 2 months
Exam/MoPH monograph: 1
month
of instruction.
PGY-3 skills
Continue to develop technical skills necessary for the performance of more complex surgical
procedures in general surgery.
Establish a knowledge base, judgment and interpersonal skills necessary to function as a
surgical consultant.
Teach junior residents in the emergency room, wards, and operating room.
Competently manage a house-staff team in the peri-operative care of the patient.
Work with the attending physician on development of post-operative plan.
Master the details of pre-operative preparation of a hospitalized patient or an outpatient.
Demonstrate the personal and professional responsibility, leadership skills, and interpersonal
skills necessary for independent practice as a ENT Surgeon.
PGY-4 skills
Master technical skills necessary for the performance of more complex surgical procedures in
general surgery.
Provide clinical and administrative leadership for residents and students assigned to surgical
services.
Act as a mentor for junior surgical residents.
Learn more advanced surgical techniques.
PGY-5 skills
Continue to master technical skills necessary for the performance of all surgeries.
Achieve the full competence (including knowledge, skills, and attitudes) of a board eligible
surgeon.
Function as faculty.
Page 18