‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY 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 relevant to urology
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.
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
Diagnose and manage common causes of
airway obstruction in the surgical patient.
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);


Diabetes;
Thyroid pathophysiology;


9
Impact of age, pregnancy,
obesity, sepsis, and stress
Cardiac
10
Pulmonary
11
Endocrine
8
Urology
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
UROLOGY core objectives – Please see resident manual for off-service objectives
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)



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
have resulted in a loss of tissue and those,
which have not.










18
Cancer Care (Optional)




19
Management of common
infections






20
Wound healing





Urology
Page 2
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives

21
Principles of prophylaxis
22
Principles of anesthesia
23
Transplant/Implant
24
Complications in the
surgical patient
Urology
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.
Transplantation:

description of grafts (autograft, xenograft,
allograft)

rejection (hyperacute, acute cellular and
chronic).
Implantation:

principles of compatibility, biological
reaction/rejection.

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;
Page 3
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives

Pre and Post-operative care
25
Basic urologic anatomy
26
Benign prostatic
hypertrophy
27
Hematuria
28
Incontinence
Urology
brain death
Pre-operative evaluation

Discuss the pre-operative assessment of
trauma, endoscopic, and open surgery
patients.
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.

Understand the anatomy of the
genitourinary tract in both males and
females.

List and recognize common genetic
abnormalities of the genitourinary tract.

Understand the clinical consequences of the
common abnormalities of the genitourinary
tract.

Properly order the correct urological
radiographic and laboratory tests.

Correctly analyze and interpret common
urological labs and radiographic tests.

List the risk factors for BPH.

Describe the pathogenesis of BPH.

Recognize the common signs and symptoms
of BPH.

Perform an appropriate history and physical
exam to thoroughly investigate BPH.

List the labs and radiology tests needed to
confirm the diagnosis of BPH, and be able to
properly interpret the test results.

Outline treatment options for BPH
(medications and surgery) as well as discuss
the risks and benefits of each treatment
option.

List the causes of hematuria, both
microscopic and gross hematuria.

Recognize the symptoms that can
accompany hematuria.

List the laboratory and radiographic studies
needed to fully evaluate hematuria and be
able to properly interpret them.

Perform a focused history and physical exam
to evaluate hematuria.

Understand all the treatment options for
every possible cause of hematuria.

Understand the appropriate follow-up after
a negative hematuria evaluation.

Define incontinence and list the three major
types.

Understand the pathogenesis for each
individual cause of incontinence.

Perform a focused history and physical exam
to evaluate the different causes of
Page 4
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives


29
Prostate cancer





30
Renal colic and urinary
stone disease





31
Renal mass




32
Acute scrotum






Urology
incontinence.
List all pertinent laboratory and radiographic
diagnostic tests necessary to evaluate
incontinence.
Understand the risks and benefits of all
incontinence treatment options.
Identify the risk factors for prostate cancer.
Understand the incidence and epidemiology
of prostate cancer.
Be able to do a directed history and physical
exam in a patient suspected of having
prostate cancer.
Be able to interpret all laboratory and
radiographic tests required to diagnose
prostate cancer.
Be able to counsel a patient on all of the
treatment options for prostate cancer, to
include staging, prognosis, and risks and
benefits of all available treatment options
for a given patient’s prostate cancer.
Recognize the common signs and symptoms
associated with renal stones.
Understand the pathophysiology stone
development.
List the risk factors for the development of
renal stones.
Be able to interpret all laboratory and
radiographic tests required to make the
diagnosis of renal stones.
List the treatment options for renal stones,
understand their risks and benefits and be
able to counsel a patient on his or her
options.
Form a differential diagnosis for a renal
mass.
Perform a directed history and physical
exam in a patient with a renal mass.
Understand the different laboratory and
radiographic tests needed to properly
diagnosis a renal mass.
List the treatment options for renal masses,
understand their risks and benefits, and be
able to counsel a patient on his or her
options.
Recognize the signs and symptoms of an
acute scrotum.
Understand the consequences of delayed
treatment of acute scrotum.
Be able to do a focused history and physical
exam to determine the etiology of an acute
scrotum.
Form a differential diagnosis of an acute
scrotum (testicular torsion, severe infectious
epididymitis, Fournier’s gangrene, torsion of
the appendix testis, trauma, testicular
cancer, inguinal hernia, and mumps).
List the necessary laboratory and
radiographic studies required for evaluation
of acute scrotal pain.
List and understand all the treatment
options for testicular torsion, severe
infectious epididymitis, and Fournier’s
Page 5
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
gangrene.
33
Urethral obstruction/acute
urinary retention
34
Urethral stricture
35
Urinary tract infections
36
Varicocele
37
Urologic emergencies
Urology

Recognize the common signs and symptoms
of urethral obstruction and acute urinary
retention.

Develop a differential diagnosis for acute
urinary retention and urethral obstruction
for men and women.

Perform a focused history and physical exam
in a patient experiencing acute urinary
retention or urethral obstruction.

List all the causes of acute urinary retention
and urethral obstruction.

Master the initial acute management of a
patient with acute urinary retention and
urethral obstruction including placement of
a foley or subrapubic catheter.

List the causes and risk factors for urethral
stricture in men and women.

Understand the basic anatomy of the urinary
tract in men and women.

Be able to perform a focused history and
physical in patients with urethral stricture.

Understand the indications for treatment in
patients with urethral stricture.

List the treatment options for patients with
urethral stricture and understand the risks
and benefits of each treatment option.

Recognize the common signs and symptoms
of UTIs.

Perform a focused history and physical in a
patient with a suspected UTI.

List the common risk factors for UTIs in men
and women.

List the common organisms known to cause
UTIs.

Understand the anatomical considerations
for UTIs.

List the different treatment options for a
UTI.

Understand normal scrotal anatomy.

Recognize the common signs and symptoms
of varicocele.

Be able to perform a directed history and
physical exam in a patient suspected of
having a varicocele.

List the laboratory and radiographic tests
required to diagnosis a varicocele.

Understand the treatment options for
varicocele including the risks and benefits of
each treatment option.
•Fournier’s gangrene:

Recognize the physical exam findings
and common patient clinical
presentation of Fournier’s Gangrene.

Recognize Fournier’s Gangrene as a life
threatening condition and the need for
immediate intervention.

Know the risk factors for the
development of Fournier’s Gangrene.

List the common organisms
responsible for Fournier’s Gangrene.
Page 6
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives

List the surgical and medical therapies
for Fournier’s Gangrene.
•Acute urinary retention:

Recognize the signs and symptoms of a
patient presenting with acute urinary
retention.

List the common causes of acute
urinary retention.

Recognize the consequences of
untreated or slowly treated acute
urinary retention.

Know the indications for treatment and
list the treatment options, both
medical and surgical, for acute urinary
retention.
•Priapism:

Define priapism.

Recognize the clinical presentation of
priapism.

List the risk factors for priapism.

Understand the consequences of
untreated priapism.

List the treatment options for a patient
with priapism.
•Testicular Torsion:

Recognize the clinical signs and
symptoms of a patient presenting with
testicular torsion.

List the risk factors for the
development of testicular torsion.

Understand the consequences of
untreated testicular torsion.

List the treatment options for testicular
torsion.
•Paraphimosis:

Recognize the clinical signs and
symptoms of a patient presenting with
paraphimosis.

List the risk factors for the
development of paraphimosis.

List the treatment options for a patient
presenting with paraphimosis.
#
1
Surgical Skills ‫کورس‬/‫مودل‬
Conduct of a surgical procedure
Dates




Urology
Instructor
Training
Type
‫نوع تریننگ‬
PGY
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
Page 7
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
2
Incision with sharp and energy-based
instruments
Knot tying


supplies);
calling for help.
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
11
Application of appropriate wound
dressing
Urethral catheter insertion

1
12
Insertion of a nasogastric tube

1
13
Tourniquet application

1

1

1
3
4
5
6
7
8
9
10
14
15
Suturing
Appropriate use of drains
Splint for bony injury or soft tissue
injury
Remove a superficial skin lesion
16
Drain a superficial abscess

1
17
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
18
19
20
21
22
23
24
25
#
Secure arterial and venous vascular
access
Needle thoracostomy
Urologic Surgical Skills
1
2
3
4
5
6
7
Dates
Instructor
Training
Type
‫نوع تریننگ‬
PGY
Basic suturing; suture removal; staple
removal; drain removal
Bladder irrigation: manual and continuous

1-5

Bladder scan for residual urine

Cystoscopy with retrograde pyelogram
and stent placement
Foley catheter placement including
difficult Foley placement
Management of Foley catheter related
problems
Minor penile surgeries (including
circumcision)

1-5
1-5
1-5

1-5

1-5

1-5
Urology
Page 8
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Minor scrotal surgeries (including
vasectomy)
Suprapubic tube change

1-5

Suprapubic tube placement

Urethral dilation

Properly interpret all important urological
radiology and laboratory studies
Rigid cystoscopy, retrograde pyelography

1-5
1-5
1-5
1-5
Make and repair flank, anterior
abdominal, and thoraco-abdominal
incisions
Independent performance of:
circumcision
Independent performance of: orchidopexy

2-5
2-5

2-5

Independent performance of:
communicating, hydrocele, torsion testes
Independent performance of scrotal
surgery
Independent performance of incision to
flank and pelvis
Independent performance of
nephrectomy for trauma
Radical nephrectomy

2-5
2-5

2-5

2-5

2-5

Cystectomy

Ureter or bladder repair

Hypospadias repair

Urinary diversion

Orchiectomy for cancer

4-5
4-5
4-5
4-5
4-5
4-5
Surigcal ICU issues
1
Types of Shock
2
Catheters
3
Ventilation
4
Vasopressors
5
Blood Component therapies
6
Transfusion
7
Criticaly ill complications
Urology

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
Instructor
Training
Type
‫نوع تریننگ‬
PGY
Page 9
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
8
Nutrition



Line sepsis
Pressure ulcers
Upper gastrointestinal bleeding


Indications
options
See ICU objectives for more
Certification/Training
‫ تریننگ‬/ ‫تصدیق نامه‬
Certification of 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
Urology
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.
Page 10
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
Documentation I:
o
o
o
o
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
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
7
Imaging II:
Appropriate placement
8
Chest Tubes
o
9
Nasogastric and Oraltracheal
tubes
o
Peripheral and Central lines
o
Urinary Catheters
o
10
11
12
Urology
Page 11
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
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
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
Appendicitis:
o
o
o
o
o
o
o
3
Urology
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.
Page 12
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
o
o
o
o
o
Biliary tract disease:
o
o
o
o
o
o
o
o
o
4
Colon:
o
o
o
o
5
o
Cholelithiasis (Acute
cholecystitis):
o
o
o
o
o
o
o
o
o
6
o
o
Gastrointestinal bleeding:
o
o
o
o
o
o
7
Hernias:
o
o
o
8
Urology
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
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, x-ray
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.
Page 13
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
o
o
o
o
o
Jaundice
9
o
o
o
o
o
o
o
o
o
o
o
o
o
Liver cysts:
o
o
o
o
o
o
o
10
Pancreatitis:
o
o
o
o
o
o
o
o
o
o
11
Peptic ulcer disease:
12
Urology
o
o
o
o
o
o
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 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.
Page 14
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
o
o
o
o
o
o
o
o
o
Peritonitis:
o
o
o
o
o
o
o
13
Small and Large Bowel
Obstruction:
14
o
o
o
Breast Disease:
o
o
o
o
o
o
15
Urology
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.
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 15
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
UROLOGY core objectives – Please see resident manual for off-service objectives
Urology 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 Urology residency program, residents will take a common year of
instruction with their peers from the Otolaryngology, Orthopedic and General 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 Urology 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
Neurosurgery: 1 month
Urology Emergency: 4 months
Radiology: 1 month
General surgery: 2 months
Critica; Care: 1 month
Obstetrics and gynecology: 1 month
Orthopedic surgery: 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
Urology: 4 months
Radiology: 1 month
General surgery: 1 month
Obstetrics and gynecology: 2 months
Plastic surgery: 1 month
Nephrology: 1 month
Endoscopy/endourology: 1 month
Exam: 1 month
PGY-4 schedule
Endoscopy/endourology: 6 months
General surgery: 1 month
Obstetrics and gynecology: 1 month
Thoracic surgery: 2 months
Plastic surgery/burn care: 1 month
Exam: 1 month
PGY-5 schedule
Urology (chief resident): 6 months
Urology research: 5 months
Exam/MoPH monograph: 1 month
month
Urology
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 Urologic 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 16