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CURR ICULUM OUTL INEFOR GENERALSURGERY

2019-

2020

SCORE ® , INC .

Surgical Council on Resident Education

1617 John F. Kennedy Boulevard Suite 860

Philadelphia, PA 19103 1-877-825-9106

[email protected] www.surgicalcore.org

1

SCORE Curriculum Outline forGeneral Surgery

The SCORE Curriculum Outline for General Surgery is a list oftopics to be covered in a five-year general surgery residencyprogram. The outline is updated annually to remaincontemporary and reflect feedback from SCORE memberorganizations and specialty surgical societies. Topics are listed for all six competencies of the AccreditationCouncil for Graduate Medical Education (ACGME): patient care;medical knowledge; professionalism; interpersonal andcommunication skills; practice-based learning andimprovement; and systems-based practice. The patient caretopics cover 27 organ system-based categories, with eachcategory separated into Diseases/Conditions and Operations/Procedures. Topics within these two areas are then designatedas Core or Advanced. Changes from the previous edition are indicated in the Excelversion of this outline, available at www.surgicalcore.org. Notethat topics listed in this booklet may not directly match thosecurrently on the SCORE Portal — this outline is forward-looking, reflecting the latest updates. The Surgical Council on Resident Education (SCORE) is anonprofit consortium formed in 2006 by the principalorganizations involved in U.S. surgical education. SCORE’smission is to improve the education of general surgeryresidents through the development of a national curriculum forgeneral surgery residency training. The members of SCOREare:

American Board of Surgery

American College of Surgeons

American Surgical Association

Association of Program Directors in Surgery

Association for Surgical Education

Review Committee for Surgeryof the ACGME

Society of American Gastrointestinal

and Endoscopic Surgeons

2

®

PATIENT CARE CONTENTS BY CATEGORY

Abdomen – General............................................................9

Abdomen – Hernia............................................................10

Abdomen – Biliary.............................................................11

Abdomen – Liver...............................................................12

Abdomen – Pancreas.........................................................13

Abdomen – Spleen.............................................................14

Alimentary Tract – Esophagus.........................................15

Alimentary Tract – Stomach............................................16

Alimentary Tract – Small Intestine.................................17

Alimentary Tract – Large Intestine................................18

Alimentary Tract – Anorectal..........................................19

Endoscopy..........................................................................20

Breast...................................................................................21

Endocrine............................................................................22

Skin and Soft Tissue..........................................................23

Surgical Critical Care........................................................24

Trauma..........................................................................25-26

Vascular – Arterial Disease...............................................27

Vascular – Venous.............................................................28

Vascular – Access..............................................................29

Transplantation.................................................................30

Thoracic Surgery..............................................................31

Pediatric Surgery........................................................32-33

Plastic Surgery..................................................................34

Genitourinary....................................................................35

Gynecology and Obstetrics.............................................36

Head and Neck..................................................................37

DISEASES BY LEVEL.............................................................38

Core.....................................................................................38-41

Advanced............................................................................42-43

OPERATIONS BY LEVEL......................................................44

Core.....................................................................................44-46

Advanced............................................................................47-48

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MEDICAL KNOWLEDGE CONTENTS

Anesthesia...........................................................................49

Biostatistics and Evaluation of Evidence........................49

Fluids, Electrolytes and Acid-Base Balance...................49

Geriatric Surgery and End-of-Life Care........................49

Immunology.......................................................................50

Infection and Antimicrobial Therapy............................50

Minimally Invasive Surgery – Principles.......................50

Nutrition and Metabolism................................................50

Oncology and Tumor Biology..........................................51

Preoperative Evaluation and Perioperative Care..........51

Transfusion and Disorders of Coagulation.....................51

Wound Healing..................................................................51

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PROFESSIONALISM CONTENTSCompetition of Interests...................................................52

Truth Telling.......................................................................52

Confidentiality....................................................................52

Professional Obligations...................................................53

End-of-Life Issues..............................................................53

Substitute Decision Making..............................................53

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6.

INTERPERSONAL AND

COMMUNICATION SKILLS CONTENTSNon-Technical Skills for Surgeons...................................54

SPICE.....................................................................................54

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PRACTICE-BASED LEARNING ANDIMPROVEMENT CONTENTS

Quality Improvement.........................................................551.

5

SYSTEMS-BASED PRACTICE CONTENTSSystems-Based Practice......................................................561.

ABOUT THIS DOCUMENTSCORE was founded in 2006 by the leading organizationsinvolved in U.S. surgical education to answer the question,“What do we expect our residents to know and be able todo proficiently by the end of their training?” In 2004, theAmerican Board of Surgery began to develop a curriculumby listing the specific patient care competencies expectedof graduating general surgery residents. This effort wasexpanded into this document, with significant input fromthe Association of Program Directors in Surgery, as well asmany specialty surgical societies. This outline should not be viewed as static. It will continueto be reviewed annually to introduce new topics as needed,delete obsolete topics, or change the depth and breadth ofexisting topics. As the outline has evolved, many topicshave also been consolidated to more accurately describethe required knowledge.

6

THE SCORE PORTAL

The SCORE Portal (www.surgicalcore.org) has been createdto provide educational content and assessment in supportof the curriculum to general surgery residency programs.Learning “modules” are available on the portal for nearlyall of the topics listed in this booklet, with modules for thefew remaining topics to be posted in the near future.Changes from the previous edition are indicated in theExcel version of this outline, available atwww.surgicalcore.org. Modules on the portal contain learning objectives,discussion questions, and a variety of resource materials,including textbook chapters, videos and images. Multiple-choice questions are also available to assess residentknowledge. The portal also offers This Week in SCORE®(TWIS), a two-year schedule of topics to assist programs incovering the portal’s content. Each week a new topic isfeatured, along with related modules and a 10-questionquiz. To learn more about TWIS and the SCORE Portal,please visit www.surgicalcore.org.

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PATIENT CARE CLASSIFICATIONSYSTEMThe patient care curriculum topics are organized into 27organ-based categories. Within each category, the topicsare further separated into Diseases/Conditions andOperations/Procedures. The topics are then stratified intotwo levels using the same classifications: CORE – Diseases and procedures encountered in generalsurgery for which a graduate of training will possesssignificant knowledge and be able to providecomprehensive care, including procedural competency. ADVANCED – Diseases and procedures that are notconsistently part of general surgery practice for which agraduate of training should have sufficient knowledge tomake a diagnosis and provide initial management. In someinstances, graduates will have sufficient knowledge andexperience to provide comprehensive care.

8

Abdomen – General

1.

Diseases/Conditions

Core

Abdominal Pain – Acute and ChronicRectus Sheath Hematoma

Advanced

Peritoneal Neoplasms

9

PATIENT CARE

Operations/Procedures

Core

Abdominal ExplorationPeritoneal Dialysis Catheter Insertion

2. Abdomen – Hernia Diseases/Conditions

Core

Inguinal and Femoral HerniasMiscellaneous HerniasUmbilical and Epigastric HerniasVentral Hernia

10

PATIENT CARE


Core

Diaphragmatic Hernia – RepairInguinal and Femoral Hernia – RepairMiscellaneous Hernias – RepairVentral Hernia – Repair

3. Abdomen – Biliary Diseases/Conditions

Core

Benign Biliary ObstructionBile Duct Injury – IatrogenicBiliary NeoplasmsCholecystitisCholedochal Cyst

Advanced

Functional Biliary DisordersPrimary Sclerosing Cholangitis

11

PATIENT CARE


Core

Cholecystectomy with or without CholangiographyCholecystostomyCholedochoenteric AnastomosisCommon Bile Duct Exploration and Choledochoscopy

Advanced

Bile Duct Cancer – OperationBile Duct Injury, Iatrogenic – Acute RepairBile Duct Neoplasms – OperationGallbladder Cancer – OperationUltrasound of the Biliary Tree

4. Abdomen – Liver Diseases/Conditions

Core

Hepatic AbscessHepatic Neoplasms – MetastaticPrimary Hepatic Neoplasms – Benign and Malignant

Advanced

Cirrhosis/Portal Hypertension (Ascites)

12

PATIENT CARE


Core

Hepatic Abscess – DrainageHepatic Biopsy

Advanced

Hepatic Ultrasound – IntraoperativeSegmentectomy/Lobectomy

5. Abdomen – Pancreas Diseases/Conditions

Core

Cystic Lesions of the PancreasPancreatic Neoplasms – EndocrinePancreatic Neoplasms – ExocrinePancreatitis – Acute/Pancreatic Necrosis/Abscess

Advanced

Intraductal Papillary Mucinous NeoplasmsPancreas DivisumPancreatitis – Chronic (Including HereditaryPancreatitis)/Pancreatic Insufficiency

13

PATIENT CARE


Core

Pancreatectomy – DistalPancreatic DebridementPancreatic Pseudocyst – Drainage

Advanced

Ampullary Resection for TumorPancreatectomy – TotalPancreatic Ultrasound – IntraoperativePancreaticoduodenectomyPancreatitis, Chronic – Operative Management

6. Abdomen – Spleen Diseases/Conditions

Advanced

Hematologic Diseases of the SpleenSplenic Abscess, Cysts, and Neoplasms

14

PATIENT CARE


Core

Splenectomy

7. Alimentary Tract – Esophagus

Diseases/Conditions

Core

Esophageal Motility DisordersEsophageal Neoplasms – Benign and MalignantEsophageal PerforationGastroesophageal Reflux/Barrett’s EsophagusHiatal Hernias

Advanced

Esophageal Caustic Ingestion and Foreign Bodies

15

PATIENT CARE


Core

Antireflux Procedures

Advanced

Cricopharyngeal Myotomy with Zenker’sDiverticulum – ExcisionEsophageal Perforation – Repair/ResectionEsophagectomy/EsophagogastrectomyEsophagomyotomy (Heller)Paraesophageal Hernia – Repair

8. Alimentary Tract – Stomach Diseases/Conditions

Core

Gastric AdenocarcinomaGastric Foreign BodiesGastrointestinal Bleeding – UpperGISTs and Miscellaneous NeoplasmsMorbid ObesityPeptic Ulcer DiseaseStress Gastritis

Advanced

Functional Disorders of the Stomach

16

PATIENT CARE


Core

Gastrectomy – Partial/TotalGastroduodenal Perforation – RepairGastrostomyVagotomy and Drainage

Advanced

Morbid Obesity – OperationPostgastrectomy Syndromes – Revisional Procedures

9. Alimentary Tract – Small Intestine Diseases/Conditions

Core

Crohn Disease – Surgical ManagementEnterocutaneous FistulaMeckel’s DiverticulumMesenteric Ischemia – Acute (Arterial, Venous, andNonocclusive) Paralytic Ileus Radiation EnteritisSmall Intestinal NeoplasmsSmall Intestinal Obstruction

Advanced

Enteric Infections/Blind Loop SyndromeShort Bowel Syndrome

17

PATIENT CARE


Core

AdhesiolysisIleostomy and Ileostomy ClosureSmall Intestinal Resection

10. Alimentary Tract – Large Intestine

Diseases/Conditions

Core

AppendicitisC. difficile ColitisColitis – IschemicColon CancerColonic PolypsColonic Volvulus and ObstructionDiverticulitisGastrointestinal Bleeding – LowerUlcerative Colitis – Surgical Management

Advanced

Functional Disorders of the IntestinePolyposis Syndromes

18

PATIENT CARE


Core

AppendectomyColectomy – PartialColectomy – Total and SubtotalColostomy and Colostomy Closure

11. Alimentary Tract – Anorectal Diseases/Conditions

Core

Anal CancerAnal Dysplasia and STDsAnal FissureAnorectal Abscess and FistulaeHemorrhoidsRectal Cancer

Advanced

Fecal IncontinenceRectal Prolapse

19

PATIENT CARE


Core

Anal Sphincterotomy Anorectal Abscess – DrainageAnorectal Fistula – RepairHemorrhoids – ManagementPerianal Condylomas – Excision

Advanced

Anal Cancer – ExcisionRectal Cancer – Abdominoperineal Resection and PelvicExenterationRectal Cancer – Transanal ResectionRectal Prolapse – Repair

12. Endoscopy

20

PATIENT CARE


Core

Bronchoscopy and Bronchoalveolar LavageEsophagogastroduodenoscopyLower GI Endoscopy

13. Breast Diseases/Conditions

Core

Atypical Hyperplasia and Lobular Carcinoma in SituBenign Disease – Fat Necrosis, Fibrocystic Breast Changes,and Radial ScarBenign Inflammatory Disease – Mastitis, Abscess, and MondorDiseaseBreast Cancer – HereditaryBreast Cancer – InflammatoryBreast Cancer – Invasive Carcinoma (Ductal, Lobular, AllVariants)Breast Cancer – Paget’s Disease of the NippleBreast Disease During Pregnancy and LactationBreast MassDuctal Carcinoma in SituFibroadenoma and Phyllodes TumorsMale Breast Disease – Gynecomastia and Breast CancerNipple Discharge and Intraductal PapillomaRadiographic Abnormalities

Advanced

Postmastectomy Reconstruction Options

21

PATIENT CARE


Core

Axillary Sentinel Lymph Node Biopsy and LymphadenectomyDuct ExcisionExcisional Breast Biopsy and Partial MastectomyMastectomy – Simple, Modified Radical, and RadicalPercutaneous Breast Biopsy and Cyst Aspiration

14. Endocrine Diseases/Conditions

Core

Adrenal Mass – IncidentalHyperaldosteronism – PrimaryHypercortisolism – Cushing Syndrome/DiseaseHyperparathyroidismHyperthyroidismHypothyroidism – PostoperativePheochromocytomaThyroid CancerThyroid NoduleThyroiditis

Advanced

Adrenal CancerMultiple Endocrine NeoplasiasParathyroid Cancer

22

PATIENT CARE


Core

ParathyroidectomyThyroidectomy – Partial or Total

Advanced

AdrenalectomyUltrasound of the Thyroid

15. Skin and Soft Tissue Diseases/Conditions

Core

CellulitisHidradenitisMelanoma and NeviNecrotizing Soft Tissue InfectionsNonmelanoma Skin CancersParonychia and FelonPilonidal Cyst/SinusSoft Tissue Masses – Evaluation

Advanced

Desmoids/FibromatosesLymphedema/LymphangitisPressure UlcerSoft Tissue Sarcomas

23

PATIENT CARE


Core

Melanoma – Wide ExcisionPilonidal CystectomySentinel Lymph Node Biopsy for MelanomaSkin/Soft Tissue Lesions – Excisional and Incisional BiopsySoft Tissue Infections – Incision, Drainage, Debridement

Advanced

Ilioinguinal-Femoral LymphadenectomySoft Tissue Sarcoma – Resection

16. Surgical Critical Care Diseases/Conditions

Core

Abdominal Compartment SyndromeAnaphylaxisAcute Respiratory Distress Syndrome (ARDS)Brain DeathCardiac ArrestCardiac Arrhythmias – CommonCardiac Failure and Cardiogenic ShockDerangements of Electrolytes and Acid-Base BalanceEndocrine DysfunctionHepatic Failure and Hepatorenal SyndromeHypovolemic ShockHypoxemic Syndromes (PE, Pneumonia)Neurogenic ShockNeurologic DysfunctionPain, Agitation, and DeliriumRenal FailureRespiratory FailureSepsis and Septic Shock

Advanced

Organ Donors and Selection Criteria

24

PATIENT CARE


Core

Intubation and Difficult AirwayNutritional SupportUltrasound Use for Intravascular AccessVascular Access

Advanced

Noninvasive and Invasive Cardiac Pacing

17. Trauma Diseases/Conditions

Core

BurnsChest Wall, Pleural and Diaphragm InjuriesCardiac InjuryColon and Rectal InjuryDuodenal and Pancreatic InjuryEsophageal InjuryFrostbite and HypothermiaGastric and Small Intestinal InjuryGeriatric TraumaHepatic InjuryInitial Assessment and Management of TraumaLower Urinary Tract InjuriesPediatric TraumaPelvic Fractures and Retroperitoneal HematomaSplenic InjuryTracheobronchial and Lung InjuryTrauma in PregnancyUpper Aerodigestive Tract InjuryUpper Urinary Tract InjuriesVascular Injury – AbdomenVascular Injury – ExtremitiesVascular Injury – NeckVascular Injury – Thorax

Advanced

Bite and Envenomation InjuriesBrachial Plexus InjuryExtremity InjuriesHead Injury – Penetrating and ClosedSmoke Inhalation Injury and Carbon Monoxide PoisoningSpine FractureTraumatic Brain Injury

25

PATIENT CARE

17. Trauma (cont.) Operations/Procedures

Core

Abdominal Exploration for TraumaCardiac Injury – RepairDuodenal and Pancreatic Injury – OperationsEsophageal Injury – RepairFasciotomyFocused Assessment with Sonography for Trauma (FAST)Gastrointestinal Tract Injury – RepairHepatic Injury – Packing and Repair/ResectionNeck Injuries – ManagementSplenectomy/SplenorrhaphyUrinary Tract Injuries – OperationsVascular Injuries – OperationsWounds, Major – Debride/Suture

Advanced

Hand Tendon RepairsThermal Injuries – Operations

26

PATIENT CARE

18. Vascular – Arterial Disease Diseases/Conditions

Core

Acute Thrombosis and IschemiaCerebrovascular DiseaseCompartment SyndromesDiabetic Foot InfectionsPeripheral Arterial EmboliPeripheral Vascular Occlusive Disease

Advanced

Aortic DissectionArterial Aneurysms – AorticArterial Aneurysms – PeripheralArterial Aneurysms – VisceralNonatherosclerotic Occlusive DiseasesRenal Artery DiseaseThoracic Outlet SyndromeVascular Graft Infections

27

PATIENT CARE


Core

Amputations – Lower ExtremityEmbolectomy/Thrombectomy – ArterialLower Extremity Bypass

Advanced

Abdominal and Aortoiliac Aneurysm – RepairAortoiliac Reconstruction for Occlusive DiseaseCarotid EndarterectomyEndovascular Intervention PrinciplesExtra-anatomic BypassGraft-enteric Fistula – ManagementMesenteric Occlusive Disease – OperationPeripheral Aneurysms – RepairSuperior Mesenteric Artery Embolectomy/ ThrombectomyUltrasound in the Diagnosis and Management of VascularDiseases

19. Vascular – Venous Diseases/Conditions

Core

Evaluation of the Swollen LegThrombophlebitisVaricose VeinsVenous Stasis/Chronic Venous InsufficiencyVenous Thromboembolism

28

PATIENT CARE


Core

Vena Caval Filter – InsertionVenous Insufficiency/Varicose Veins – Operation

20. Vascular – Access Diseases/Conditions

Core

Vascular Access for Dialysis

29

PATIENT CARE


Core

Arteriovenous Graft/FistulaVascular Exposure – PrinciplesVenous Access Devices – Insertion

21. Transplantation Diseases/Conditions

Advanced

Organ Preservation

30

PATIENT CARE


Advanced

En Bloc Abdominal Organ RetrievalLive Donor HepatectomyLive Donor NephrectomyLiver TransplantationPancreas TransplantationRenal Transplantation

22. Thoracic Surgery Diseases/Conditions

Core

Pleural Effusion/EmpyemaPneumothorax and Pleurodesis

Advanced

ChylothoraxMediastinal Tumors and CystsMediastinitis Malignant Tumors of the Lung: Primary and MetastaticSuperior Vena Cava Syndrome

31

PATIENT CARE


Core

Exploratory Thoracotomy – Open and ThoracoscopicPartial Pulmonary Resections – Open and ThoracoscopicTube Thoracostomy and Thoracentesis

23. Pediatric Surgery Diseases/Conditions

Core

Abdominal MassAbdominal Pain – AcuteAppendicitisGastrointestinal Bleeding – LowerHypertrophic Pyloric StenosisInguinal HerniaIntussusceptionMalrotationMeckel’s DiverticulumUmbilical Hernia

Advanced

Aerodigestive Tract Foreign BodiesBiliary AtresiaCholedochal CystsCongenital Aganglionosis (Hirschsprung Disease)Congenital Diaphragmatic HerniaCryptorchidismEsophageal Atresia/Tracheoesophageal FistulaGastroschisis/OmphaloceleImperforate AnusNecrotizing EnterocolitisNeonatal Small Bowel Obstruction

32

PATIENT CARE


Core

Inguinal Hernia – RepairIntussusception – OperationMalrotation – OperationMeckel’s Diverticulum – ExcisionPyloromyotomyUmbilical Hernia – Repair

23. Pediatric Surgery (cont.)

Diseases/Conditions

Advanced

Branchial Cleft Anomaly – ExcisionChest Wall Deformity – RepairDiaphragmatic Hernia – RepairEsophageal Atresia/Tracheoesophageal Fistula – RepairGastroschisis/Omphalocele – RepairHirschsprung Disease – OperationImperforate Anus – OperationIntestinal Atresia/Stenosis – RepairMeconium Ileus – OperationNecrotizing Enterocolitis – OperationOrchiopexyThyroglossal Duct Cyst – Excision

33

PATIENT CARE

24. Plastic Surgery


Core

Complex Wound ClosureSkin Grafting

34

PATIENT CARE

25. Genitourinary

Diseases/Conditions

Core

HydroceleScrotal Pain and Masses

Advanced

Acute Urinary RetentionGenitourinary Neoplasms

35

PATIENT CARE


Core

CystostomyNephrectomy

26. Gynecology and Obstetrics

Diseases/Conditions

Core

Ectopic PregnancyPelvic Inflammatory Disease

Advanced

Gynecologic Neoplasms

36

PATIENT CARE


Core

Hysterectomy and Salpingo-oophorectomySurgical Considerations of the Pregnant Patient

Advanced

Cesarean Section

27. Head and Neck

Diseases/Conditions

Core

Neck Mass – EvaluationUpper Airway Obstruction

Advanced

Oral Cavity/Pharynx, Laryngeal, and Salivary Gland Cancer

37

PATIENT CARE


Core

Lymph Node BiopsyTracheostomy

Advanced

Modified Neck DissectionParotidectomy

DISEASES/CONDITIONS BY LEVEL

Diseases/Conditions – CORE Abdomen – GeneralAbdominal Pain – Acute and ChronicRectus Sheath Hematoma Abdomen – HerniaInguinal and Femoral HerniasMiscellaneous HerniasUmbilical and Epigastric HerniasVentral Hernia Abdomen – BiliaryBenign Biliary ObstructionBile Duct Injury – IatrogenicBiliary NeoplasmsCholecystitisCholedochal Cyst Abdomen – LiverHepatic AbscessHepatic Neoplasms – MetastaticPrimary Hepatic Neoplasms – Benign and Malignant Abdomen – PancreasCystic Lesions of the PancreasPancreatic Neoplasms – EndocrinePancreatic Neoplasms – ExocrinePancreatitis – Acute/Pancreatic Necrosis/Abscess Alimentary Tract – EsophagusEsophageal Motility DisordersEsophageal Neoplasms – Benign and MalignantEsophageal PerforationGastroesophageal Reflux/Barrett’sHiatal Hernias Alimentary Tract – StomachGastric AdenocarcinomaGastric Foreign BodiesGastrointestinal Bleeding – UpperGISTs and Miscellaneous NeoplasmsMorbid ObesityPeptic Ulcer DiseaseStress Gastritis Alimentary Tract – Small IntestineCrohn Disease – Surgical ManagementEnterocutaneous FistulaMeckel’s DiverticulumMesenteric Ischemia – Acute (Arterial, Venous, and Nonocclusive)Paralytic IleusRadiation EnteritisSmall Intestinal NeoplasmsSmall Intestinal Obstruction

38

PATIENT CARE


Diseases/Conditions – CORE Alimentary Tract – Large IntestineAppendicitisC. difficile ColitisColitis – IschemicColon CancerColonic PolypsColonic Volvulus and ObstructionDiverticulitisGastrointestinal Bleeding – LowerUlcerative Colitis – Surgical Management Alimentary Tract – AnorectalAnal CancerAnal Dysplasia and STDsAnal FissureAnorectal Abscess and FistulaeHemorrhoidsRectal Cancer BreastAtypical Hyperplasia and Lobular Carcinoma in SituBenign Disease – Fat Necrosis, Fibrocystic Changes, and Radial ScarBenign Inflammatory Disease – Mastitis, Abscess, and Mondor DiseaseBreast Cancer – HereditaryBreast Cancer – InflammatoryBreast Cancer – Invasive Carcinoma (Ductal, Lobular, All Variants)Breast Cancer – Paget's Disease of the NippleBreast Disease During Pregnancy and LactationBreast MassDuctal Carcinoma in SituFibroadenoma and Phyllodes TumorsMale Breast Disease: Gynecomastia and Breast CancerNipple Discharge and Intraductal PapillomaRadiographic Abnormalities EndocrineAdrenal Mass – IncidentalHyperaldosteronism – PrimaryHypercortisolism – Cushing Syndrome/DiseaseHyperparathyroidismHyperthyroidismHypothyroidism – PostoperativePheochromocytomaThyroid CancerThyroid NoduleThyroiditis Skin and Soft TissueCellulitisHidradenitisMelanoma and NeviNecrotizing Soft Tissue InfectionsNonmelanoma Skin CancersParonychia and FelonPilonidal Cyst/SinusSoft Tissue Masses – Evaluation

39

PATIENT CARE


Diseases/Conditions – CORE Surgical Critical CareAbdominal Compartment SyndromeAnaphylaxisAcute Respiratory Distress Syndrome (ARDS)Brain DeathCardiac ArrestCardiac Arrhythmias – CommonCardiac Failure and Cardiogenic ShockDerangements of Electrolytes and Acid Base BalanceEndocrine DysfunctionHepatic Failure and Hepatorenal SyndromeHypovolemic ShockHypoxemic Syndromes (PE, Pneumonia)Neurogenic ShockNeurologic DysfunctionPain, Agitation, and DeliriumRenal FailureRespiratory FailureSepsis and Septic Shock TraumaBurnsChest Wall, Pleural and Diaphragm InjuriesCardiac InjuryColon and Rectal InjuryDuodenal and Pancreatic InjuryEsophageal InjuryFrostbite and HypothermiaGastric and Small Intestinal InjuryGeriatric TraumaHepatic InjuryInitial Assessment and Management of TraumaLower Urinary Tract InjuriesPediatric TraumaPelvic Fractures and Retroperitoneal HematomaSplenic InjuryTracheobronchial and Lung InjuryTrauma in PregnancyUpper Aerodigestive Tract InjuryUpper Urinary Tract InjuriesVascular Injury – AbdomenVascular Injury – ExtremitiesVascular Injury – NeckVascular Injury – Thorax Vascular – Arterial DiseaseAcute Thrombosis and IschemiaCerebrovascular DiseaseCompartment SyndromesDiabetic Foot InfectionsPeripheral Arterial EmboliPeripheral Vascular Occlusive Disease

40

PATIENT CARE


Diseases/Conditions – CORE Vascular – VenousEvaluation of the Swollen LegThrombophlebitisVaricose VeinsVenous Stasis/Chronic Venous InsufficiencyVenous Thromboembolism Vascular – Access Vascular Access for Dialysis Thoracic SurgeryPleural Effusion/Empyema Pneumothorax and Pleurodesis Pediatric SurgeryAbdominal MassAbdominal Pain – AcuteAppendicitisGastrointestinal Bleeding – LowerHypertrophic Pyloric StenosisInguinal HerniaIntussusceptionMalrotationMeckel's DiverticulumUmbilical Hernia GenitourinaryHydroceleScrotal Pain and Masses Gynecology and ObstetricsEctopic PregnancyPelvic Inflammatory Disease Head and NeckNeck Mass – EvaluationUpper Airway Obstruction

41

PATIENT CARE


Diseases/Conditions – ADVANCED Abdomen – GeneralPeritoneal Neoplasms Abdomen – Biliary Functional Biliary DisordersPrimary Sclerosing Cholangitis Abdomen – LiverCirrhosis/Portal Hypertension (Ascites) Abdomen – PancreasIntraductal Papillary Mucinous NeoplasmsPancreas DivisumPancreatitis – Chronic (Including Hereditary Pancreatitis)/Pancreatic

Insufficiency Abdomen – SpleenHematologic Diseases of the SpleenSplenic Abscess, Cysts and Neoplasms Alimentary Tract – EsophagusEsophageal Caustic Ingestion and Foreign Bodies Alimentary Tract – StomachFunctional Disorders of the Stomach Alimentary Tract – Small Intestine Enteric Infections/Blind Loop Syndrome Short Bowel Syndrome Alimentary Tract – Large IntestineFunctional Disorders of the IntestinePolyposis Syndromes Alimentary Tract – Anorectal Fecal Incontinence Rectal Prolapse BreastPostmastectomy Reconstruction Options EndocrineAdrenal CancerMultiple Endocrine NeoplasiasParathyroid Cancer Skin and Soft TissueDesmoids/FibromatosesLymphedema/LymphangitisPressure UlcerSoft Tissue Sarcomas Surgical Critical CareOrgan Donors and Selection Criteria

42

PATIENT CARE


Diseases/Conditions – ADVANCED TraumaBite and Envenomation InjuriesBrachial Plexus InjuryExtremity InjuriesSmoke Inhalation Injury and Carbon Monoxide PoisoningSpine FractureTraumatic Brain Injury Vascular – Arterial DiseaseAortic DissectionArterial Aneurysms – AorticArterial Aneurysms – PeripheralArterial Aneurysms – VisceralNonatherosclerotic Occlusive DiseasesRenal Artery DiseaseThoracic Outlet Syndrome Vascular Graft Infections TransplantationOrgan Preservation Thoracic SurgeryChylothoraxMediastinal Tumors and CystsMediastinitisMalignant Tumors of the Lung: Primary and MetastaticSuperior Vena Cava Syndrome Pediatric SurgeryAerodigestive Tract Foreign BodiesBiliary AtresiaCholedochal CystsCongenital Agangliosis (Hirschsprung Disease)Congenital Diaphragmatic HerniaCryptorchidismEsophageal Atresia/Tracheoesophageal FistulaGastroschisis/OmphaloceleImperforate AnusNecrotizing EnterocolitisNeonatal Small Bowel Obstruction GenitourinaryAcute Urinary RetentionGenitourinary Neoplasms Gynecology and ObstetricsGynecologic Neoplasms Head and NeckOral Cavity/Pharynx, Laryngeal, and Salivary Gland Cancer

43

PATIENT CARE

OPERATIONS/ PROCEDURES BY LEVEL

Operations/Procedures – CORE Abdomen – General Abdominal Exploration Peritoneal Dialysis Catheter Insertion Abdomen – Hernia Diaphragmatic Hernia – RepairInguinal and Femoral Hernia – Repair Miscellaneous Hernias – Repair Ventral Hernia – Repair Abdomen – BiliaryCholecystectomy with or without CholangiographyCholecystostomyCholedochoenteric AnastomosisCommon Bile Duct Exploration and Choledochoscopy Abdomen – LiverHepatic Abscess – DrainageHepatic Biopsy Abdomen – PancreasPancreatectomy – DistalPancreatic DebridementPancreatic Pseudocyst – Drainage Abdomen – SpleenSplenectomy Alimentary Tract – Esophagus Antireflux Procedures Alimentary Tract – StomachGastrectomy – Partial/TotalGastroduodenal Perforation – RepairGastrostomyVagotomy and Drainage Alimentary Tract – Small IntestineAdhesiolysisIleostomy and Ileostomy ClosureSmall Intestinal Resection Alimentary Tract – Large IntestineAppendectomyColectomy – PartialColectomy – Total and SubtotalColostomy and Colostomy Closure Alimentary Tract – Anorectal Anal Sphincterotomy – Internal Anorectal Abscess – Drainage Anorectal Fistula – Repair Hemorrhoids – Management Perianal Condylomas – Excision

44

PATIENT CARE


Operations/Procedures – CORE EndoscopyBronchoalveolar Lavage and BronchoscopyEsophagogastroduodenoscopy Lower GI Endoscopy BreastAxillary Sentinel Lymph Node Biopsy and LymphadenectomyDuct ExcisionExcisional Breast Biopsy and Partial MastectomyMastectomy – Simple, Modified Radical, and RadicalPercutaneous Breast Biopsy and Cyst Aspiration EndocrineParathyroidectomyThyroidectomy – Partial or Total Skin and Soft Tissue Melanoma – Wide ExcisionPilonidal CystectomySentinel Lymph Node Biopsy for MelanomaSkin/Soft Tissue Lesions – Excisional and Incisional Biopsy Soft Tissue Infections – Incision, Drainage, Debridement Surgical Critical Care Intubation and Difficult AirwayNutritional SupportUltrasound Use for Intravascular Access Vascular Access TraumaAbdominal Exploration for Trauma Cardiac Injury – RepairDuodenal and Pancreatic Injury – Operations Esophageal Injury – RepairFasciotomyFocused Assessment with Sonography for Trauma (FAST)Gastrointestinal Tract Injury – RepairHepatic Injury – Packing and Repair/ResectionNeck Injuries – ManagementSplenectomy/SplenorrhaphyUrinary Tract Injuries – Operations Vascular Injuries – Operations Wounds, Major – Debride/Suture Vascular – Arterial Disease Amputations – Lower ExtremityEmbolectomy/Thrombectomy – Arterial Lower Extremity Bypass Vascular – VenousVena Cava Filter InsertionVenous Insufficiency/Varicose Veins – Operation

45

PATIENT CARE


Operations/Procedures – CORE Vascular – AccessArteriovenous Graft/Fistula Vascular Exposure – PrinciplesVenous Access Devices – Insertion Thoracic SurgeryExploratory Thoracotomy – Open and ThoracoscopicPartial Pulmonary Resections – Open and ThoracoscopicTube Thoracostomy and Thoracentesis Pediatric SurgeryInguinal Hernia – RepairIntussusception – Operation Malrotation – OperationMeckel's Diverticulum – ExcisionPyloromyotomyUmbilical Hernia – Repair Plastic SurgeryComplex Wound ClosureSkin Grafting GenitourinaryCystostomyNephrectomy Gynecology and Obstetrics Hysterectomy and Salpingo-oophorectomy Surgical Considerations in the Pregnant Patient Head and Neck Lymph Node BiopsyTracheostomy

46

PATIENT CARE


Operations/Procedures – ADVANCED Abdomen – BiliaryBile Duct Cancer – OperationBile Duct Injury, Iatrogenic – Acute RepairBile Duct Neoplasms – OperationGallbladder Cancer – OperationUltrasound of the Biliary Tree Abdomen – LiverHepatic Ultrasound – Intraoperative Segmentectomy/Lobectomy Abdomen – Pancreas Ampullary Resection for TumorPancreatectomy – TotalPancreatic Ultrasound – Intraoperative PancreaticoduodenectomyPancreatitis, Chronic – Operative Management Alimentary Tract – EsophagusCricopharyngeal Myotomy with Zenker's Diverticulum – ExcisionEsophageal Perforation – Repair/Resection Esophagectomy/Esophagogastrectomy Esophagomyotomy (Heller) Paraesophageal Hernia – Repair Alimentary Tract – StomachMorbid Obesity – OperationsPostgastrectomy Syndromes – Revisional Procedures Alimentary Tract – AnorectalAnal Cancer – ExcisionRectal Cancer – Abdominoperineal Resection and Pelvic ExenterationRectal Cancer – Transanal ResectionRectal Prolapse – Repair EndocrineAdrenalectomy Ultrasound of the Thyroid Skin and Soft Tissue Ilioinguinal-Femoral Lymphadenectomy Soft Tissue Sarcoma – Resection Surgical Critical CareNoninvasive and Invasive Cardiac Pacing TraumaHand Tendon RepairsThermal Injuries – Operations

47

PATIENT CARE


Operations/Procedures – ADVANCED Vascular – Arterial DiseaseAbdominal and Aortoiliac Aneurysm – Repair Aortoiliac Reconstruction for Occlusive DiseaseCarotid EndarterectomyEndovascular Intervention Principles Extra-anatomic BypassGraft-enteric Fistula – Management Mesenteric Occlusive Disease – Operation Peripheral Aneurysms – RepairSuperior Mesenteric ArteryEmbolectomy/Thrombectomy Ultrasound in the Diagnosis and Management of Vascular Diseases TransplantationEn Bloc Abdominal Organ RetrievalLive Donor HepatectomyLive Donor NephrectomyLiver TransplantationPancreas TransplantationRenal Transplantation Pediatric SurgeryBranchial Cleft Anomaly – ExcisionChest Wall Deformity – RepairDiaphragmatic Hernia – RepairEsophageal Atresia/Tracheoesophageal Fistula – RepairGastroschisis/Omphalocele – RepairHirschsprung's Disease – OperationImperforate Anus – OperationIntestinal Atresia/Stenosis – RepairMeconium Ileus – OperationNecrotizing Enterocolitis – OperationOrchiopexyThyroglossal Duct Cyst – Excision Gynecology and ObstetricsCesarean Section Head and NeckModified Neck DissectionParotidectomy

48

PATIENT CARE

Anesthesia1.

Anesthesia, General – Agents and TechniquesAnesthesia, Regional and Local – Agents and TechniquesBest Practices in Prescribing OpioidsChoice of AnesthesiaConscious Sedation – Agents and TechniquesIntraoperative Monitoring and Common IntraoperativeProblemsNerve Blocks – Digital and PeripheralPain, Acute – Management Pain, Chronic – Management

49

MEDICAL KNOWLEDGE

2. Biostatistics and Evaluation of Evidence

Clinical TrialsEvaluating the Quality and Applicability of a StudyHow Data is Expressed and SummarizedLevels of EvidenceOutcomesResearch DesignSurveys and Qualitative ResearchTests of Significance

3. Fluids, Electrolytes, and Acid-Base Balance

Hypocalcemia and HypercalcemiaHypokalemia and HyperkalemiaHyponatremia and HypernatremiaMagnesium and Phosphorous Disorders

4. Geriatric Surgery and End-of-Life Care

Advance Directives, DNR Orders, and Power of AttorneyFrailtyGoal Setting with Elderly Patients and FamiliesPalliative and Hospice CarePerioperative Management of Geriatric Patients

5. Immunology

Components of the Immune SystemImmune Response to Injury and InfectionSurgery and Surgical Conditions in Immunocompromised HostsTransplant Immunology

50

MEDICAL KNOWLEDGE

6. Infection and Antimicrobial Therapy

Antimicrobial StewardshipDiagnostic Approach to InfectionInfections – Hospital-AcquiredInfections – Opportunistic Intra-abdominal InfectionsPrevention and Treatment of Surgical Site InfectionPreoperative Assessment and Management of CoexistingInfection

7. Minimally Invasive Surgery – Principles

Minimally Invasive Surgery (MIS) PrinciplesRobotic Surgery – PrinciplesSafe Use of Surgical Energy

8. Nutrition and Metabolism

Effect of Surgery, Illness and Injury on NutritionalRequirementsNutritional AssessmentNutritional Pharmacology and ImmunonutritionNutritional Requirements

9. Oncology and Tumor Biology

Adjunctive Therapy for CancerGenetic SusceptibilityScreening and BiomarkersTumor Immunology

51

MEDICAL KNOWLEDGE

10. Preoperative Evaluation and Perioperative Care

Common Postoperative ProblemsEvaluation of Surgical RiskManagement of Perioperative RiskPostoperative Pain ManagementProphylaxis of Venous ThromboembolismVentilatory Support/Management

11. Transfusion and Disorders of Coagulation

Evaluation of Ongoing Bleeding and Laboratory Assessment ofCoagulationInherited and Acquired Disorders of CoagulationNormal Mechanisms of Hemostasis and CoagulationTransfusion – Indications, Risks, Type and Crossmatch, andComponent Therapy

12. Wound Healing

Wound Closure and Postoperative CareWound Healing

Ethical Issues in Clinical Surgery:Competition of Interests

1.

Accepting Gifts from VendorsClinical Research – Case 1Clinical Research – Case 2Clinical Research – Case 3Confronting Problem BehaviorNon-Patient Care ObligationsPersonal InvestmentsRefusal to Care for PatientsReimbursement Incentives – Case 1Reimbursement Incentives – Case 2Reimbursement Incentives – Case 3

52

PROFESSIONALISM

Concern for the Safety of Identifiable OthersConversations about Patients in PublicDuty to Report Patients to Public AuthoritiesRelaying Genetic Test Results to Family MembersRevealing Confidential InformationSurgeons Infected with Blood-Borne Diseases

3. Ethical Issues in Clinical Surgery: Confidentiality

Dealing with Complications and Poor OutcomesInformed ConsentListening and the Surgeon-Patient RelationshipRespecting Cultural Diversity and Individual SensitivitiesTruth Telling and the Surgeon-Patient RelationshipUse of the Internet and E-mail for Communication – Case 1Use of the Internet and E-mail for Communication – Case 2

2. Ethical Issues in Clinical Surgery: Truth Telling

4. Ethical Issues in Clinical Surgery: Professional Obligations

Obligations to Other ProfessionalsObligations to Patients: CommitmentObligations to Patients: CompetenceObligations to Society: Allocation of ResourcesObligations to Society: Teaching and Learning Surgery

53

PROFESSIONALISM

By What Criteria Should Substitute Decision Makers Decide?Substitute Decision Makers and DNR OrdersSubstitute Decisions for ChildrenUnclear Competence and Decision-Making CapacityWho Decides When the Patient Cannot?

6. Ethical Issues in Clinical Surgery: Substitute Decision Making

Advance Directives and the Surgical PatientDNR Orders in the Operating RoomEuthanasia and Physician-assisted SuicideFutilityMaintaining ContactPalliative CareTalking About DeathWithdrawing and Withholding Treatment

5. Ethical Issues in Clinical Surgery: End-of-Life Issues

1. Non-Technical Skills for Surgeons (NOTSS)

Cognitive Skills (Situation Awareness and Decision Making)Social Skills (Communication, Teamwork and Leadership)

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INTERPERSONAL AND COMMUNICATION SKILLS

Admitting Mistakes – Ethical Choices and ReasoningAdvanced Communication Skills for Surgical PracticeCultural Diversity – Working Through the Barriers of Languageand Differing CustomsDelivering Bad News – Your Chance to Become a MasterSurgeonGiving and Getting FeedbackManaging Your Career – Making the Professional and PersonalChoices that will Define YouMedical Errors and ApologySafe Handoff of Patient Care DutiesThe Stress of Surgical Practice – The Signs of Stress,Depression, and Suicide in You and Your Surgical ColleaguesWorking with Professionals Around You – TeamCommunication and Respect

2. Surgical Professionalism and

Interpersonal Communication Education (SPICE)

Quality Improvement1.

Inspiring a Healthy Culture for Patient CareLocal Engagement in Quality ImprovementProblem-Based Quality ImprovementUnderstanding the Data and Methods to Evaluate Performance

55

PRACTICE-BASED LEARNING AND IMPROVEMENT

Systems-Based Practice1.

Advocating for Quality Patient CareCoordinating Patient CareCost Awareness and Risk-Benefit AnalysisIdentifying Systems Errors – Root Cause AnalysisWorking Effectively in Various Healthcare Delivery Settingsand Systems Working in Interprofessional Teams

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SYSTEMS-BASED PRACTICE

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