‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO 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 orthopedics
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
Ortho
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
ORTHO 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





Ortho
Page 2
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO 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
Ortho
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
ORTHO core objectives – Please see resident manual for off-service objectives

Pre and Post-operative care
25
Assessment of basic
diagnostic radiographs
(See Imaging I-II skills)
26
Pre and Post-operative care
in Orthopedics
27
Orthopedic procedures
28
Musculoskeletal infections
Ortho
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.
Be able to adequately order and properly interpret the
following tests:

Conventional bone x-rays

Fluoroscopy
Understand the indications, contraindications and risks
of the following procedures. Be able to properly order
them when indicated and to discuss the implications of
the findings of each:

Computed tomography CT)

MRI

Understand the principles of pre and post-op
care for common orthopedic problems and
be able to demonstrate to the satisfaction of
the orthopedic staff.
Knowledge of the common postoperative complications
and the management of these complications to include:

Wound, joint, soft tissues and implanted
material infection

Abnormal bleeding

Deep venous thrombosis, pulmonary
embolism

Fat embolism

Pressure sores

Joint ankylosis

Compartment syndromes
Understand the indications, risks, and alternatives of
these typical orthopedic procedures, and gain
experience as available, under direct supervision:

Splinting and taping of common injuries

Application of traction

Casting and cast management

Open reduction and fixation of fractures

Arthrocentesis

Injection of steroids

External fixation device placement and
management
Osteomyelitis;
septic arthritis;
Mycobacterium Tuberculosis of the spine/arthritis:

Describe the epidemiology and risk factors
for these infections.

Understand the relevant anatomy based on
location of infection.

Describe the pathophysiology of infection
Page 4
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO core objectives – Please see resident manual for off-service objectives








29

Biceps tendinopathy and tendon rupture:
o
Acute treatment
o
Physical therapy

Clavicle fractures:
o
Describe the classification and
location of clavicle fractures:
Group I
Group II
Group III




Frozen shoulder (adhesive capsulitis):
o
Acute treatment
o
Physical therapy
o
Subacromial injection and intraarticular dilation (hydroplasty)

Glenohumeral osteoarthritis:
o
Acute treatment
o
Physical therapy
o
Glenohumeral joint injection

Rotator cuff tendinopathy and tears:
o
Differentiate rotator cuff
tendinopathy versus rotator cuff
tears:
Acute treatment to include
adjunct therapy
Physical therapy
Subacromial injection




Shoulder
Ortho
based on the type.
Discuss the differential diagnosis of these
infections.
Discuss the clinical presentation of these
infections.
Perform a thorough physical examination.
Order the appropriate laboratory and
radiology studies and be able to adequately
interpret.
Understand the medical management for
each of these infections.
Understand the indications for surgical
management.
Describe appropriate follow-up care and
complications if left untreated.
Acromioclavicular (AC) Joint Injuries:
o
Type I AC joint injury
o
Type II AC joint injury
o
Type III AC joint injury
o
Type IV AC joint injury
o
Type V AC joint injury
o
Type VI AC joint injury
Shoulder dislocations:
o
Anterior shoulder dislocation
o
Posterior shoulder dislocation
o
Inferior shoulder dislocation
o
Immobilization
o
Operative treatment
o
Rehabilitation
o
Patient education
Page 5
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO core objectives – Please see resident manual for off-service objectives

Shoulder impingement:
o
Acute treatment
o
Physical therapy
o
Subacromial injection

Superior labral anterior-posterior (SLAP)
lesion

Special tests for the shoulder: Understand
the indications; be able to perform and
interpret the following physical exam
maneuvers:
o
o
o
o
o
o
o
o
o
o
o
Apley scratch test
Apprehension test
Cross arm test
Drop arm test
Empty can test
Hawkin’s test
Neer test
Push off test
Speed’s Maneuver
Spurling test
Subacromial
impingement
o
Sulcus sign
o
Yergason Test
Carpal Tunnel Syndrome:

Acute therapy

Wrist splinting

Physical therapy

Glucocorticoid injection
DeQuervain’s Tenosynovitis:

Acute therapy

Thumb and Wrist splinting

Glucocorticoid injection
Ganglion Cyst:

Aspiration and glucocorticoid injection.

Understand the indications for surgical
management.
30
Kienbock’s Disease:

Lichtman’s modification of Stahl’s
classification of plain radiographs.
Fractures of carpal (scaphoid, lunate) and wrist
(radius, ulnar) bones:

Understand perilunate and scapholunate
dislocations.

Understand scapholunate advanced collapse
(SLAC) and scaphoid non-union advanced
collapse (SNAC).
Upper extremity: hand and
wrist
Ortho

Metacarpal and phalanges fracture

Osteoarthritis of hands

Radial Tunnel Syndrome

Rheumatoid Arthritis
Page 6
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO core objectives – Please see resident manual for off-service objectives
Trigger finger (stenosing flexor tenosynovitis):

Acute therapy

Immobilization

Physical therapy

Glucocorticoid injection

31
Upper extremity: elbow
32
Lower extremity: hip
33
Lower extremity: knee
Ortho
Ulnar Nerve Entrapment
Special tests for the hand and wrist:
o
Durkan carpal compression
test
o
Finkelstein’s test
o
Froment’s sign
o
Grind test
o
Lunotriquetral shear test
o
McMurray’s test
o
Phalen maneuver
o
1. Scaphoid compression
and shift test
o
2. Supination lift test
o
3. Tinel’s sign
o
4. Watson’s test

Elbow dislocation:

Lateral and medial epicondylitis
Ligamentous injuries

Medial collateral ligament

Lateral collateral ligament
Nerve entrapment

Medial nerve entrapment

Radial nerve entrapment

Ulnar nerve entrapment

Nursemaid’s elbow (Radial head
subluxation)

Olecranon bursitis
Special tests for the elbow:

Valgus and Varus test

Avascular necrosis of the hip (osteonecrosis)

Femur fracture (proximal) and femoral neck
fracture

Iliopsoas Tendinitis

Labral tear

Pelvic fracture

Osteoarthritis of the hip

Slipped Capital Femoral Epiphysis (SCFE)
Trochanteric bursitis

Glucocorticoid injection
Special tests for the Hip:
o
Faber or Patrick Test
o
Piriformis syndrome
o
Thomas Test
o
Trendelenburg test

Avascular necrosis of the femoral condyle
(osteonecrosis)

Bursitis of knee

Fractures of lower extremity (distal femur,
patella, tibial plateau)

Iliotibial band syndrome

Knee dislocations (Tibiofemoral)
Ligamentous tears of the knee:

Anterior Cruciate ligament tears

Posterior Cruciate ligament tear
Page 7
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO core objectives – Please see resident manual for off-service objectives



Medical collateral ligament injury
Lateral collateral ligament injury
Medial meniscal tear





Osteoarthritis of the knee
Osteochondritis Dissecans of knee and ankle
Patellofemoral Pain syndrome
Popliteal cyst
Patellar tendinitis
Special Tests for the knee:
o
Anterior and posterior drawer
test
o
Lachman test
o
McMurray’s test
o
Noble’s test
o
Ober’s test
o
McMurray’s test
o
Thumb sign
o
Valgus and Varus stress test
o
Wilson’s test
Achilles tendinopathy and rupture
Ankle Sprain/fracture
Freiberg’s disease
Hallux Valgus
Jones’s Fracture
Plantar Fasciitis
Retrocalcaneal bursitis
Tarsal tunnel syndrome
Special tests for ankle and foot:
o
Anterior and drawer test
o
External rotation test
o
Inversion test
o
Neuroma test
o
Ottawa Ankle rule
o
Talar tilt
o
Thompson’s test
Cervical Radiculopathy
Cervical Spine Fracture
Cervical Spondylosis
Diffuse Idiopathic Skeletal Hyperostosis
(DISH)
Thoracic Outlet Syndrome
Special Tests for the neck
o
Spurling test
o
Waddell’s sign
o
Inversion test
o
Neuroma test
o
Ottawa Ankle rule
o
Talar tilt
o
Thompson’s test
Ankylosing Spondylitis (AS)
Back Strain
Cauda Equina Syndrome
Compression fracture
Disk herniation (Lumbar Radiculopathy)
Osteoarthritis of spine
Spinal Infection
Spondylolisthesis and Spondylolysis
Special Tests for the Spine:
o
Nerve roots and their action
o
Straight leg sign








34
Lower extremity: ankle and
foot




35

Neck








36
Spine
Ortho
Page 8
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO core objectives – Please see resident manual for off-service objectives

Waddell’s sign
Surgical Skills ‫کورس‬/‫مودل‬
#
1
Conduct of a surgical procedure
Dates




2
Incision with sharp and energy-based
instruments
Knot tying


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
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

1
1
1
1
18
19
20
21
22
23
Secure arterial and venous vascular
access
Needle thoracostomy
Preparation of specimen for a
pathologist
Ortho

Page 9
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO core objectives – Please see resident manual for off-service objectives
24
25
#
Appropriate wound surveillance and
dressing care
Insertion of a nasogastric tube


Orthopedic Surgical Skills
1
2
3
4
5
6
7
8
9
10
11
12
Instructor
Training
Type
‫نوع تریننگ‬
PGY

1-5

1-5

Simple casting and cast management

Splinting and taping of common injuries

Application of traction

Closed reduction and stabilization of
fractures
Compartment release upper and lower
limb

1-5
1-5
1-5
1-5
1-5

4-5
Arthrocentesis

Open reduction and fixation of fractures

Arthroplasty

Spine surgery

4-5
4-5
4-5
4-5
1
Types of Shock
2
Catheters
3
Ventilation
4
Vasopressors
5
Blood Component therapies
7
1
Dates
Evaluation and assessment of patients
with orthopedic disease and thorough
physical exam
Understand indications and risks of and
alternatives to typical orthopedic
procedures
Basic Fracture care
Surigcal ICU issues
6
1
Transfusion
Criticaly ill complications
Ortho
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





Instructor
Training
Type
‫نوع تریننگ‬
PGY
Page 10
Length
Length
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO core objectives – Please see resident manual for off-service objectives
8


Nutrition
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
Documentation I:
o
o
o
4
Ortho
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
Page 11
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO core objectives – Please see resident manual for off-service objectives
Documentation II:
o
o
Consultation:
o
o
o
5
6
o
o
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
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
Ortho
Page 12
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO 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
Ortho
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 13
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO 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
Ortho
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 14
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO 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
Ortho
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 15
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO 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
Ortho
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 16
‫ماموریت تربیوی ناتو در افغانستان‬
‫ریاست صحیه‬
NKC ‫تیم مشاورین تعلیمات صحی – کمپ‬
‫روغتون شهید سردار محمد داود خان‬
ORTHO core objectives – Please see resident manual for off-service objectives
Ortho 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
Pediatric orthopedics: 2 months
Traumatology: 3 months
Critical Care: 1 month
General surgery: 2 months
Radiology: 1 month
Orthopedic techniques: 1 month
Plastic surgery/burn care: 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
Neurosurgery: 2 months
Ortho/soft tissue/sport: 2 months
Physiotherapy: 1 month
Vascular surgery: 1 month
Radiology: 1 month
Orthopedic hand surgery: 2 months
Orthopedic foot surgery: 2 months
Exam: 1 month
PGY-4 schedule
Neurosurgery: 2 months
Ortho infection/tumour: 2 months
Amputation/rehabilitation: 2 months
Ortho complex reconstruction: 3
months
Elective surgery: 2 months
Exam: 1 month
PGY-5 schedule
Orthopedic surgery (chief resident): 2
months
Pediatric orthopedic surgery (chief
resident): 2 months
Traumatology (chief resident): 2
months
Elective surgery/research: 2 months
Exam/MoPH monograph: 4 months
Ortho
PGY-3 skills
Continue to develop technical skills necessary for the performance of more complex surgical
procedures in Orthopedic surgery
Establish a knowledge base, judgement 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 an Orthopedic surgeon
PGY-4 skills
Master technical skills necessary for the performance of more complex surgical procedures in
Orthopedic 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 17