‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
#
Module/course / ‫مودل‬
‫کورس‬
Core topics completed
‫مضامین عمده که تکمیل شده‬
1
Anatomy
2
Respiratory physiology







3
Fluid/electrolyte physiology








4
Airway management






5
Immunology
6
Nutrition







7
Sepsis and the inflammatory
response
Surgery



Instructor
Training
Type
‫نوع تریننگ‬
PGY
Musculoskeletal
Abdominal
Colorectal
Breast
Ear- Nose -Throat
Hand and Foot
lung volumes - flow rates – pressures;
oxygen transport
Fluid compartments and body water
component;
osmotic and volume regulation;
sodium (Na), potassium (K), calcium
(Ca), phosphorus (P) and magnesium
(Mg) metabolism;
regulation of acid-base
Appropriately manage preoperative and
postoperative fluid requirements
Be able to calculate maintenance fluid
requirements and adjust based on comorbid conditions
Be able to write orders for maintenance
fluids
Recognize and treat abnormalities in the
following electrolytes:
o
Calcium
o
Magnesium
o
Phosphate
o
Potassium
o
Sodium
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);
metabolic and hemodynamic patterns
goal directed therapies
Initiate appropriate evaluation of fever
Page 1
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives










8
Impact of age, pregnancy,
obesity, sepsis, and stress

9
Cardiac
10
Pulmonary







11
Endocrine
12
Renal
13
Hepatic
14
Hematologic
15
Risk assessment strategies and
scores
16
Diagnostic modalities and
radiation safety
Surgery





















and provide supportive management.
Discuss the indications for and
appropriate administration of
prophylactic antibiotics.
Discuss the development of bacterial
resistance.
Discuss the normal flora of various organ
systems.
Describe the common bacteria involved
in site specific infections.
Discuss the principles of prevention of
nosocomial infections, sterile technique
and universal precautions.
Discuss the common opportunistic
infections associated with
immunocompromised patients.
Order and interpret appropriate imaging
studies for localization of infection.
Discuss the principles of abscess
drainage.
Recognize the high mortality associated
with sepsis.
Define criteria for diagnosis of sepsis
and systemic inflammatory response
syndrome (SIRS) initiate appropriate
supportive treatment.
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);
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
Page 2
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
17
Medical treatments and their
impact on surgery (Optional)





18
Cancer Care (Optional)









19
Management of common
infections
20
Wound healing

21
Principles of prophylaxis
22
Principles of anesthesia










23
Pre and Post-operative care




Surgery
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.
classification of wounds; normal and
abnormal wound healing; factors that
alter wound healing.
wound and systemic infection
thromboembolism (DVT, PE)
tetanus.
local anesthetic agents, indications,
contra-indications 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.
Discuss which diagnostic tests are
appropriate for preoperative evaluation.
List Goldman’s criteria for cardiac risk in
patients undergoing non-cardiac
surgery.
Discuss prevention of peri-operative
cardiac events.
Discuss and manage riks of deep venous
thrombosis.
Page 3
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives







24
Complications in the surgical
patient









25
Wound healing and wound care











Surgery
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.
Discuss risk of infection perioperatively
and mitigation measures.
Discuss methods of pain control in the
postoperative patient.discuss
appropriate postoperative care and
issues with patients and families
Discuss immediate and long-term
follow-up issues with family members or
medical power-of-attorney as
appropriate
Arrange for appropriate postoperative
resources
cardiac (principles of advanced cardiac
life support);
shock;
multiple organ dysfunction syndrome;
respiratory failure (mechanical
ventilation);
stress gastritis;
postoperative ileus;
fat embolism;
Infections:
-spreading and necrotizing infections
- clostridium difficile;
- methicillin-resistant Staph. aureus;
- vancomycin-resistant Enterococci;
-common pathogens.
compartment syndromes (limb,
abdomen);
pressure sores;
delirium (psychiatric disorders);
stroke;
brain death
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.
Page 4
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
26
Pharmacologic agents used in
surgery
27
Trauma I:
survey
procedures/lines
Surgery
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.

Discuss the specific recommendations
for management and prevention of
complications from animal and insect
bites.

Describe the factors that lead to nonhealing chronic wounds.

Describe factors that lead to pressure
ulcers and treatment.

Analgesics

Antibiotics

Anticoagulants

Antiemetic

Antihypertensive

Corticosteroids

Diuretics

Gastric acid-reducing drugs

Laxatives

Nonsteroidal anti-inflammatory drugs
(NSAIDs)

Oral hypoglycemic agents

Sedatives

Discuss the implications and
complications of hepatic or renal
insufficiency and extremes of age on the
use of various drugs.

Identify common drug interactions.

ATLS review

Identify and resuscitate patients from
shock

Interpret data from primary and
secondary surveys

List injuries most commonly missed on
primary and secondary surveys.

Identify surgical emergencies, initiate
definitive management in a trauma
patient.
Review insertion of: (see Skills)

Chest tubes
Page 5
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
Trauma II:
tests
imaging
management
28










Surgical Skills ‫کورس‬/‫مودل‬
#
1
Conduct of a surgical
procedure
Module/Plan




2
3
4
5
6
7
8
Incision with sharp and energybased instruments
Knot tying
Suturing


Appropriate tissue handling
during surgery
Blunt and sharp dissection

Vascular control in elective and
critical situations
Closure of simple wounds

Application of appropriate
wound dressing
Urethral catheter insertion


12
Insertion of a nasogastric tube

13
Tourniquet application

16
17
Biopsy
Surgery
principles of patient safety;
principles of management of patient
and surgical team with respect to blood
borne pathogens (needle stick injury,
mucosal exposure, cautery smoke);
cautery and emerging energy sources;
procedure planning (appropriate
instruments and supplies);
calling for help.

10
15
PGY


Splint for bony injury or soft
tissue injury
Remove a superficial skin
lesion
Drain a superficial abscess
Training
Type
‫نوع تریننگ‬

Appropriate use of drains
14
Instructor

9
11
Nasogastric tubes
Orotracheal tubes
Peripheral/central lines
Urinary catheters
Order and interpret screening
radiographs and CT scans.
Discuss options for rapid assessment of
intra-abdominal bleeding.
Identify and initiate treatment of
neurologic injuries:
Traumatic brain injuries
Spinal fractures
Describe the symptoms, signs, diagnosis
and management of the acute abdomen




Page 6
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
18
19
20
21
22
23
24
25
#
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26


Tube thoracostomy

Needle Cricothyroidotomy

Cricothyroidotomy or
tracheostomy
Preparation of specimen for a
pathologist
Appropriate wound
surveillance and dressing care
Insertion of a nasogastric tube

Advanced Skills
1
2
3
4
5
6
7
8
9
#
Secure arterial and venous
vascular access
Needle thoracostomy



Core topics completed ‫مضامین که تکمیل‬
‫شده‬
Instructor
Training
Type
‫نوع تریننگ‬
PGY
Anorectal procedures (simple)

Anoscopy

Appendectomy

Breast biopsy

Digital amputation

Doppler to evaluate arterial

Drawing arterial blood

Drawing blood from a peripheral

Dressing: wet to dry; open
abdomen
Examination under anesthesia

Excision of benign lesions of skin
and subcutaneous tissues
Incision and drainage of an
abscess
Insertion of central venous
catheters
Insertion of chest tube

2-5
2-5

2-5

2-5

Insertion of nasogastric tube

Insertion of gastrostomy tubes

Laparotomy

Resection and anastomosis of GI
tract
Ileostomy, colostomy
(defunctioning, end)
Lymph node biopsy

2-5
2-5
3-5
3-5
3-5

3-5

Paracentesis

Removal of foreign bodies

Repair of simple lacerations

Repair of umbilical and inguinal
hernias
Skin grafts

3-5
3-5
3-5
3-5
3-5
Thoracentesis
Senior Resident to
Master
Surgery
2-5
2-5
2-5
2-5
2-5
2-5
2-5
2-5
2-5


3-5
3-5

Core topics completed ‫مضامین که تکمیل‬
‫شده‬
Length
Instructor
Training
Type
‫نوع تریننگ‬
PGY5
Page 7
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
1
2
3
4
5
6
7
8
9
10
Appendectomy: open or
laparoscopic
Cholecystectomy: open or
laparoscopic
Common bile duct exploration or
repair
Distal pancreatectomy

5

5

5

Splenectomy: open or
laparoscopic
Gastro-intestinal tract: resection
or repair
Breast: incision, total resection,
partial resection
Thyroid: total resection, partial
resection
Trauma exploration and repair:
head; neck; chest; abdomen;
pelvis for genito-urinary organs;
limbs
Arteries and veins: exploration
and repair

5
5

5

5

5

5

5
Surigcal ICU issues
1
Types of Shock
2
Catheters
3
Ventilation
4
Vasopressors
5
Blood Component therapies
6
Transfusion
7
Criticaly ill complications
8
Nutrition
Core topics completed ‫مضامین که تکمیل‬
‫شده‬












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
Instructor
Training
Type
‫نوع تریننگ‬
PGY
See ICU objectives for more
Surgery
Page 8
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
Certification/Training
‫ تریننگ‬/ ‫تصدیق نامه‬
Certification completion ‫بدست آوردن شهادت نامه‬



Complete H&P





1
2
BLS
3
ACLS
4
ATLS
Topic
Skills ‫مهارت های‬
‫بخش مراقبت جدی‬
Hospital Hygeine
o
o
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
Imaging I: Recognize
abnormalities
7
Surgery
o
o
o
o
o
o
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.
Instructor
‫تعداد پروسیجرهای‬
‫اجرا شده‬
‫چند سال تجربه‬
Evaluation
dates
PGY Year
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)
Page 9
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
Imaging II:
Appropriate placement
8
Chest Tubes
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
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
9
Nasogastric and
Oraltracheal tubes
o
Peripheral and Central
lines
o
10
11
Urinary Catheters
o
12
Medical Proficiency
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
Evaluater
‫ چند سال تجربه‬Evaluation dates
Comments ‫نظرات‬
Demonstrate proficient and appropriate use of
5
procedural skills, indications, contraindications
Surgery
Page 10
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery 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:
o
o
o
o
o
o
5
Surgery
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
colorectal cancer.
Describe the clinical findings of diverticular disease, differentiating the symptoms and
Page 11
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
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
o
o
o
o
o
o
o
o
o
Liver cysts:
o
9
o
10
Surgery
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:

Life cycle and epidemiology of Echinococcus
Know the four species of Echinococcus that cause infection in humans and the
Page 12
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
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
o
o
Peritonitis:
o
o
o
13
Surgery
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).
Perform a careful physical examination.
Obtain appropriate labs and radiologic studies to aide in diagnosis.
Page 13
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
o
o
o
o
Small and Large Bowel
Obstruction:
14
o
o
o
Breast Disease:
o
o
o
o
o
o
15
Surgery
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 14
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
Surgery core objectives - Please see resident manual for off-service objectives
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 General Surgery residency program, residents will take a common
year of instruction with their peers from the Otolaryngology, 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 General Surgery 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
of instruction.
PGY-2 schedule
General Surgery doctor in ER: 3 mon
General Surgery ward: 3 months
Orthopedic Surgery: 2 months
Radiology / Ultrasound: 1 month
Critical Care (ICU): 1 month
Anesthesia: 1 month
Exam: 1 month
PGY-2 skills
Develop enhanced proficiency in the provision of pre-operative and post-operative care.
Establish 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 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 General Surgeon.
PGY-3 schedule
General Surgery ward: 6 months
Obstetrics and Gynecology: 2 mon
Neurosurgery: 2 months
Endoscopy: 1 month
Exam: 1 month
PGY-4 schedule
General Surgery: 6 months
Plastic Surgery: 2 months
Burn Sugery: 1 month
Urology: 2 months
Exam: 1 month
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 schedule
General Surgery (chief resident): 4
mon
Thoracic Surgery: 3 months
Research: 4 month
Exam/ MoPH dissertation: 1 month
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.
Surgery
Page 15