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Sudan Medical Specialization Board (SMSB)

Specialty of Otorhinolaryngology, Head and Neck Surgery

Programme Curriculum

1. TITLE OF SPECIALITY:
1.1 Degree: Clinical MD in Otorhinolaryngology, Head and Neck Surgery (Clinical MD ORL, HNS).

2. Introduction:
2-1. Rationale and justification: Otorhinolaryngology, head and neck surgery is a specialty that deals with medical and surgical diseases affecting the ear, nose, throat, head and neck. The disease spectrum covers all ages, both sexes, medical and surgical problems related to these structures. It is one of the most integrated specialties with other medical and surgical specialties. Paeditrics ORL head and neck problems constitute a considerable load in this specialty. Recent advances in the speciality include endoscopic sinuses and skull base surgery is one of the most evolving and rapidly growing new developments in this field. The need for Otorhinolaryngologist in the Sudan is of great importance due to the fact that the Sudan is a large country covering a vast area. The present number of practicing specialists covers less than 25% of the need. This is due to the late introduction of the specialty and that most of the qualified specialists preferred to stay in the capital Khartoum in private practice or emigrated abroad. Diseases of the ear nose and throat are very prevalent in the Sudan especially chronic ear diseases and the different types of head & neck malignancies. Nasopharyngeal carcinoma is the commonest head and neck tumor in the Sudan. There is an increasing need for otorhinologists to train undergraduate and postgraduate students whose numbers has appreciably increased lately.

The need for high caliber qualified otolaryngologist cannot be over emphasized. This curriculum is based on the previously running curriculum, international, regional and national similar curricula and revised by an expert committee.

2.2. Admission requirements:


2.2.1. Admission requirements for Part-one examination: The candidate should: 1. Have an MBBS or its equivalent. 2. Have successful completion of internship. 3. Register with Sudan GMC. 4. Satisfy the registration regulations of SMSB.
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Have spent 6 months after internship preferably in a surgical discipline.

6. Be recommended by two referees.


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Be advised to attend Basic Sciences and Specialty Basic Sciences courses run by SMSB or engaged in a self directed learning in Basic Sciences. This will need a period of six months.

2.2.2. Admission requirements for Part-two: The candidate should have:


1.

Passed Part-one examination or its equivalent which is approved by the specialty council.

2. Completed the specified training period.


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3. Completed the designated log book. 4. Passed thesis examination.

2.3. Duration of the programme: The duration of the programme is a period of four (4) calendar years which starts after obtaining registration with SMSB and includes rotation in allied specialties. Training must be at sites accredited by SMSB.

2.4. The role and responsibilities of trainers and trainees: 2.4.1. Academic supervisor and trainer:

2.4.1.1. Academic supervisor: The academic supervisor is a university staff of a professor or associate professor status or a consultant with postgraduate qualification recognized by the SMSB who has at least ten years of experience including experience in post graduate training and scientific writing. 2.4.1.2. Trainer: The trainer is a specialist with postgraduate qualification recognized by the SMSB who has at least five years of experience in the specialty and practicing in an approved setup. 2.4.1.3. Supervisors and trainers have the following responsibilities and are expected:
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To ensure and monitor adequate training. To provide continuous helpful feedback (formative) regarding the process of training.
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To observe trainees performance and help the trainee to achieve the objectives of the training programme.

To participate actively in workshops and other activities conducted by the SMSB.

To establish direct contact with the council if any problem arises during the training process, including the suitability of trainee.

- To supervise candidates thesis proposals and execution.

2.4.2. Trainee role and responsibilities: Trainee should:


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Accept responsibility for his\her learning. Ensure that he\ she undertakes training. Accept the responsibility for the thesis and plan to execute it within the designated time limits.

Be responsible for arrangement of regular meetings with the supervisor.

Complete the entire requirement for the final examination. Provide feedback regarding the training. Submit yearly summary sheets of the logbooks duly filled and signed by the supervisor.

3. OBJECTIVES:
3.1. General objectives: Graduation of high caliber qualified Otolaryngologist Head & Neck Surgeons comparable to international standards; who can promote health for all patients, deliver health service in a humane, evidence based & cost effective way, be capable to carry out research & independent learning throughout life, work in team with good management & leadership skills, maintain good relations with colleagues, patients & other health professions, possess high moral & ethical standards.

3.2. Specific Objectives: 3.2.3. Educational: 3.2.3.1. Cognitive: At the end of the training programme the candidate should be able to acquire appropriate knowledge and intellectual abilities including: - Common and important ear, nose and throat diseases.
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General body effects caused by ear, nose and throat diseases and local ENT manifestations of systemic diseases. Basic sciences: knowledge about body structure, function and

pathphysiological processes:
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Clinical sciences: knowledge relating to disease causation, manifestations and management. Essential drugs: their proper use, side effects and interactions.

- Social, economic and cultural factors related to disease and its causation, management and prevention.
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Clinical reasoning: use, integrate and interpret information derived from history and examination and to make a list of probable diagnoses. Formulating a working diagnosis. Requesting and justifying the appropriate investigations when needed. Interpreting the laboratory results and imaging investigations obtained. referral to other health professionals.

- Outline and implement a sound management plan.


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- Deciding whether the patient requires ambulatory care, hospitalization or

3.2.3.2. Psychomotor: At the end of the training programme the candidate should be able to perform the required skills competently and confidently including:
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Taking a thorough medical history. Conducting proper ORL, H & N and systemic examination and eliciting important signs. Performing diagnostic procedures such as blood taking, aspiration, punchbiopsy & lumber puncture. Performing basic skills procedures such as cannula fixation, NG tube insertion, nasal and aural packs application, wound dressing & urinary catheter insertion. Use of different ORL basic diagnostic instruments.

- Use of flexible and rigid nasopharyngoscopy and laryngoscope.

- Use of the surgical microscope in the examination and management of ear disease. - Evaluation of facial nerve functions and lower cranial nerves.
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Ordering and interpreting audiological and audio-vestibular investigations. Ordering and interpreting conventional radiographic and imaging investigations in ORL, H & N S.

Performing therapeutic intervention procedures, ward and office procedures such as tracheostomy, resuscitation techniques, veni-section & oxygen administration (as shown in appendix 1). Performing emergency surgical operations (as provided in appendix 2). Performing elective surgical operations (as provided in appendix 3).

- Presentation skills. See annex 1, 2 & 3.

3.2.3.3. Affective: At the end of the training programme the candidate should be able to develop accepted attitudes including;
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Concern, respect, honesty, empathy, privacy and confidentiality towards patients and their families. Appropriate communication and counseling skills. colleagues.

- Work and maintain good relations and communications with medical Recognize the importance of team work and functions as an effective member & leader.
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Taking the responsibility of teaching and training junior doctors and auxiliary staff.

- Acceptable general appearance, attendance and punctuality.


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- Commitment and dedication.


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Ability to express his\ her ideas clearly and fluently. Problem solving and problem prioritization abilities. Understanding and respecting hospital regulations, administrative matters and quality assurance. Ability to keep patients records and follow up sheets clear, consistent, concise and accurate.

- Good decision making abilities. - High moral and ethical standards.


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Advise the community on promoting health and preventing diseases. Probability of being an independent and life -long learner.

3.3. Research: At the end of the training programme the candidate should be able to:
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Undertake research and publish findings.

- Use evidence based medicine & evidence based guidelines. - Use appropriate research methodology and statistical methods. - Interpret and use results of various research works. 3.4. Service: At the end of the training programme the candidate should be able to: - Promote health for all patients.
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Deliver health service in humane & cost effective way. Understand the social & governmental role in health services.

- Offer professional services to the society.

Understand health service management and health economics in rural areas.

4. CONTENTS:
4.1. The General organization of the programme: Duration of training period is four (4) calendar years of which:
a)

Three years in Otorhinolaryngology: these are six units of rotation each consists of six months duration.

b)

Six months rotation in allied specialties which consists of three rotations each of two months duration as follows: - Two compulsory rotations in maxillofacial surgery and plastic surgery - An optional rotation in any of the following departments: neurosurgery, peadiatrics surgery and general peadiatrics.

c) d)

Candidate is allowed one month holiday per year. Two months: one month Elective and one month for Thesis writing.

First year
6 - month rotation rotation

Second year
rotation rotation

Third year
rotation rotation

Fourth year
rotation rotation

6 - month 6 - month 6 - month 6 - month 6 - month 6 - month 6 - month

ORL, H & ORL, H & ORL, H & ORL, H & ORL, H & ORL, H & ORL, H & ORL, H & N S. N S. N S. N S. N S. N S. N S. N S. Elective.

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Thesis writing

4.2. Contents of part-one: Basic sciences and applied basic sciences: 4.2.1. Anatomy:

Anatomy, histology and embryology of the:


Ear. Nose and paranasal sinuses. Larynx, trachea, bronchial tree. Pharynx and oesophagus. Thyroid and parathyroid glands. Salivary glands. Central and peripheral nervous system. Spinal cord. Skull base and pituitary gland. General head and neck. Lung and thorax. Upper gastro-intestinal tract (GIT). Related eye anatomy.

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Skin and skin appendages.

4.2.2. Physiology:

Body fluids and electrolytes. Blood and blood constituents and haemopoetic system. Temperature regulation.

Cardiovascular system. Respiratory system.

Central nervous system (CNS) and special senses.

Endocrine system. Renal system. The immune system. Gastro-intestinal tract (GIT). The skin.

4.2.3. Pathology:

Normal cell function. General body defense mechanisms.

Acute and chronic inflammation.

Healing and repair.


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Tumors: benign and malignant.

Congenital anomalies.

Immunology.

Genetics and Molecular Biology.

4.2.4. Bacteriology:

Viruses, bacteria, protozoa, helminthes infections. Disinfection and sterilization.

Drug resistance. Control of infection.

4.3. Contents of part-two:

Otology. Neuro-otology. Audiology.

Rehabilitation of the deaf.

Laryngology. Voice and speech disorders and rehabilitation.

Head and Neck Neoplasia.

General surgical principles.


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General head and neck surgery and complications. Facial plastic surgery.

Reconstructive head and neck surgery.

Skull base surgery.

Peadiatric ORL.

Anesthesia and anesthetic techniques in ORL Head & Neck surgery.

Pharmacology in ORL.

4.4. The Residency programme 4.4.1. General structure (see 4.1). 4.4.2. Contents (see annex: Appendix 1, 2 & 3).

5. METHODS OF TEACHING AND TRAINING:


1- Teaching

ward rounds.
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2- Surgical

out-patients clinics. theatres. and mortality meetings and discharge clinics (Audit). learning.

3- Operative 4- Morbidity

5- Self-directed 6- Lectures. 7- Group

discussion and tutorials. laboratory. conferences.

8- Audio-vestibular

9- Clinico-pathological 101112-

Symposia and seminars. Journal club meetings. Workshops; including research methodology, scientific writing and computer

science applications.
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Papers presented and published. bone surgery course. sinus surgery course.

14-Temporal

15-Endoscopic 16-

Facial plastic surgery course. and neck reconstructive surgery course.

17-Head

18- Skull base surgery course.

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6. RSOURCES:

6.1 Accredited staff. 6.2 Accredited training sites. 6.3 Temporal bone dissection laboratory. 6.4 Rhinology endoscopic sinus surgery & skull base laboratory. 6.5 Audio- vestibular facilities. 6.6 Speech therapy & speech rehabilitation units. 6.7. Basic Skills laboratory. 6.8. Classical and Electronic Libraries.

7. METHODS OF STUDENT ASSESSMENT:

7.1 Part one examination:

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Examination is held twice yearly with six months interval and consists of:

7.1.1. Written paper: I. Consists of ninety (90) stems MCQs of the best answer responsetype questions.
II.

Questions covering the basic and applied sciences in anatomy, physiology, microbiology, biochemistry, genetics, molecular biology and pathology.

III. IV. V.

Time allowed is two & a half (2) hours. Total mark is 80. MPL applied.

7.1.2. OSPE: Objective Structured Practical Examination (OSPE):


I.

Consists of twenty (20) stations of basic and clinically-related basic sciences.

II. III.

MPL applied. Total mark is 20.

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IV.

Time allowed 1 hour.

7.2 Part two examination:

7.2.1. Thesis examination: A research proposal relevant to a major subject of specialization must be submitted to the Research and Thesis Committee of the specialty council after the first six months of training for approval. Thesis should be submitted for evaluation six month before the date of the final part II examination. General rules: 1. A supervisor and a co-supervisor are assigned for each candidate. 2. Thesis should be handled to the external examiner 1 2 months prior to the thesis examination date. 3. Thesis examination is held by a committee composed of an external examiner, a co-examiner and one of the supervisors. 4. Candidate is allowed half an hour for presentation. 5. Candidate who passes thesis examination will be issued a certificate to this effect. This certificate will form part of the documents to be submitted for taking the final written examination.

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7.2.2. Written paper: Total marks hundred (100). A. Paper one: Response-type questions: I. Consists of ninety (90) stems MCQs of the best answer response-type questions. II. III. Time allowed is two & a half (2) hours. Questions covering rhinology, otology, audiology, neuro-otology, laryngology, peadiatric ORL and head and neck surgery.
IV.

MPL applied. Total mark is sixty (60).

V.

B. Paper two: Supply-type questions:


I.

Consists of five to ten (5-10) problem solving and modified essay questions.

II. III.
IV. V.

All questions are obligatory. Time allowed is two hours. Each question is answered on a separate booklet. MPL applied. Total mark is forty (40).

VI.

General Rules: Both types of written examinations are administered in the same day.

Answered on the basis of the answer key.


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Candidates can compensate in the written part of the examination. Candidates have to pass written examination to be allowed to sit for the clinical part.

7.2.3. Clinical examination: Total marks are hundred (100). A. OSCE: Objective Structured Clinical Examination: I. Consists of twenty (20) stations of clinical and clinically-related materials in ORL H & N Surgery. II.
III.

Time allowed is 1 -2 hours. Total marks twenty (20) constitute twenty percent (20%) of the clinical examination marks.

IV.

MPL applied.

B. Clinical examination: consists of:


I. -

One long case. Total mark is forty (40).

- Pass mark is 60%. - Time allowed for history & examination is 30 minutes.
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II.

Time allowed for discussion is 30 minutes. Three short cases.

- Total mark is forty (40).


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Time allowed 30 minutes; 10 minutes each case. Cases are targeting different areas in the specialty. Pass mark is 60%.

General Rules: - Candidate can compensate in clinical examination.


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Candidate is evaluated by at least two examiners. Each examiner has independent rating check lists. Vito cases should be justified and agreed upon.

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- Candidates who fail the clinical examination are offered two more attempts without sitting for the written part within 6 12 month period according to the examination committee and the external examiner recommendations. - Candidates who fail the clinical examination for the third time have to re-sit for the written part.

7.2.4. Formative assessment: These are hospital based clinical assessment methods including:
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7.2.4.1. Mini-CAX (Clinical Assessment Exercise annex 4). 7.2.4.2. Surgical DOPS (Direct Observation of Procedural Skills annex 5). 7.2.4.3. CBD (Case Based Discussion annex 6). 7.2.4.4. End of year examination (EYE annex 7). 7.2.4.5. Mock clinical examination.

8. EVALUATION OF TRAINING:

The programme is continuously evaluated through the followings: 8.1. Evaluation of the training centers. 8.2. Evaluation of the training programme: 8.2.1. Internal evaluations.

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8.2.2. External evaluations. 8.2.3. Reports & feedback of trainees. 8.2.3. Reports & feedback of trainers. 8.3. Evaluation of the trainers.

9. DEGREE AWARDED:
The Degree Awarded is Clinical Medical Doctorate in Otorhinolaryngology, Head and Neck Surgery. (Clinical MD in ORL, H N S).

10. LIST OF REFERENCES AND OTHER RESOURCES:


10.1. References for part one:
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Clinical Anatomy by Regions. 8th. Edition. R. Snell. Wolter Kluwer\ Lippincott Williams & Wilkins 2008.

Last Anatomy Regional and Applied. McMinn. Churchill Livingstone.

- Clinical Anatomy. H. Ellis.


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A Color Atlas of Human Anatomy. McMinn & Hutchings. Wolf Medical Publications Ltd. Blackwell Scientific Publications.

- Grays Atlas of Anatomy. International Edition. Drake, Vogal, Mitchell, Tibbitts & Richardson. Churchill Livingstone 2008. - Concise Human Physiology. Sukker, Munshid & Ardawi. Blackwell Science. - Textbook of Medical Physiology. Guyton & Hall. Saunders 2000.

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MUIRS Textbook of Pathology 14th. LEVISON, READ, Harrison & Fleming. Edward Arnold (Publisher) Ltd. 2008.

General Pathology 16th. Edition. Walter & Israel. Churchill Livingstone. Robbins Basic Pathology 8th Edition. Kumar, Abbas, Fausto & Mitchell. Saunders 2007.

10.2. References for part two:


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Scott-Brown's Otorhinolaryngology: Head and neck surgery. The 7th edition by. Michael Gleeson. Essential Otolaryngology, 8th edition by K J Lee. McGraw Hill 2003. Cummings Otolaryngology - Head and Neck Surgery 5th edition Flint, Paul W. , Haughty, Bruce H. , Lund, Valerie J. publisher Mosby Head and Neck Surgery: Otolaryngology Byron J. Bailey . CURRENT Diagnosis & Treatment in Otolaryngology Head & Neck Surgery by Anil K Lalwani. McGraw Hill 2004. Otolaryngology Head & Neck surgery, Clinical Reference Guide. R. Pasha Publisher Singular Thomson learning. Rob & Smiths Operative Surgery. 4th. Edition. Ballantyne & Morrison. 1. Ear. 2. Nose & Throat. 3. Head and Neck. Butterworth. 1986.

Stell and Maran Head and Neck Surgery. 4th. Edition. Watkinson, Gase & Wilson 2000.

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11. ANNEX:
11.1. In Ward & Office Procedures 11.2. Minor & Emergency Surgical Procedures. 11.3. Major Surgical Procedures. 11.4. Mini - CAX Form. 11.5. Surgical DOP Form. 11.6. CBD Form. 11.7. EYE Form. 11.7. Rotation evaluation form. 11.8. Training report form. 11.9. List of publications of the trainers. 11.10. List of approved student thesis titles & publications.

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Appendix 1: In Ward & Office Procedures.

No. 1 2 3 4 5 6 7 8 9 10 11 12

Procedures
Care of tracheostomy tube Nasogastric tube insertion. Post-operative dressing Anterior nasal packing Posterior nasal packing Ear dressing Ear microscopy Syringing of ear Flexible & rigid nasopharyngoscopy & laryngooscopy Removal of foreign body in ear, nose or throat Lumbar puncture Pure Tone Audiometry (P.T.A.)

Level of competence
First Year 5 5 5 5 4 4 2 4 2 3 5 2 Second Year 5 5 5 5 5 4 3 5 3 4 5 3 Third Year 5 5 5 5 5 5 4 5 4 5 5 4 Fourth Year 5 5 5 5 5 5 5 5 5 5 5 5

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Level of competence:

1. Observer status. 2. Assistant status. 3. Performed under direct supervision. 4. Performed under indirect supervision. The supervisor must be readily available if needed. 5. Performed independently.

Appendix 2: Minor & Emergency Surgical Procedures. Level of competence


First Year 3 4 3 3 3 3 3 3 5 4 2 2 Second Year 4 5 4 4 4 4 4 4 5 5 3 3 Third Year 5 5 5 5 5 5 5 5 5 5 4 4 Fourth Year 5 5 5 5 5 5 5 5 5 5 5 5

No. Procedures
1 2 3 4 5 6 7 8 9 10 11 12 Tracheotomy\ laryngotomy Tracheostomy Nasal cautery ( chemical, electrical and endoscopic ) Sub-mucosal diathermy Anterior proof puncture Drainage of deep neck space abscesses Drainage of peri-tonsillar abscess (Quinsy) Drainage of parotid abscess Surgical dressings Excision of benign lumps & lymph node Punch biopsy under local anesthesia for oral, oropharyngeal & nasopharyngeal lesions & tumors Incisional biopsy under general anesthesia for oral

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13 14 15 16 17

oropharyngeal lesions & tumors Drainage of septal hematoma\ abscess Drainage of hematoma auris. Removal of foreign body in ear, nose or throat under general anaesthesia Arterial ligation and ligation of primary tonsillar haemorrhage Removal of intra-oral salivary duct stone

3 3 3 2 2

4 4 4 3 3

5 5 5 4 4

5 5 5 5 5

Appendix 3: Major Surgical Procedure. No. Procedures


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Removal of foreign body under general anaesthesia Endoscopic removal of foreign body Direct laryngoscopy: diagnostic & therapeutic; foreign body removal & Microlaryngoscopy Rigid oesophagoscopy: diagnostic & therapeutic; foreign body removal & dilatation Rigid bronchoscopy: diagnostic & therapeutic Reduction of nasal fractures S.M.R and septoplasty Rhinoplasty Nasal polypectomy (classical) Turbinate surgery. Intranasal antrostomy Caldwell-Luc operation. Ethmoidectomy (external) Lateral rhinotomy and facial degloving Endoscopic sinus surgery (ESS) Maxillectomy ( partial and radical ) Cleft lip and palate Thyroglossal cyst operation and thyroidectomy Submandibular Salivary gland excision Parotidectomy: superficial and radical

Level of competence
First Year 2 2 3 3 3 2 2 1 2 2 2 1 1 1 1 1 1 2 2 1 Second Year 3 3 4 4 4 3 2 1 3 3 3 2 2 2 2 2 1 3 3 2 Third Year 4 4 5 5 5 4 3 1 4 4 4 3 3 3 3 3 1 4 4 3 Fourth Year 5 5 5 5 5 5 4 2 5 5 5 4 4 4 3 4 2 5 5 4

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21 22 23 24 25 26 27 28 29 30

Mandibulectomy,mandibulotomy Laryngectomy: partial & total and Laryngofissure Neck dissection Local, regional & axial flap and skin grafting E.U.M. & Myringotomy VT. Mastoidectomy (cortical, modified and radical) Myringoplasty and tympanoplasty Stapedectomy Otoplasty Cochlear implant

1 1 1 1 2 1 1 1 1 1

1 2 2 1 3 2 2 1 1 1

2 3 2 2 4 3 3 2 2 1

2 3 3 3 5 4 4 2 2 2

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Annex 4: Mini-CAX (Clinical Assessment Exercise) SMSB


Trainee name Training center Training hospital Clinical setting for this assessment OPD Educational supervisor Specialty Year of training In patient A/E 1 OR 2 ICU 3 4

Other (specify)

Diagnosis of the case Focus of clinical case History to be assessed Below expectation 1. History taking 2.Physical examination 3.Communication skills 4.Clinical judgment 5.Professionalism 6.Organization 7.Overall clinical care Examination Other(specify) --------------Above expectation Unable to comment

Border line

Meets expectation

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What has been done good Action agreed to be done

Suggestion for development

Time taken for observation

Time taken for feedback

Assessor .. Signature Date

Mini-CAX (Clinical Assessment Exercise) SMSB


The Mini-CAX is a method of assessing skills essential to the provision of good clinical

care and to facilitate feedback. It assesses the trainees clinical and professional skills on the ward, in Accident and Emergency, in outpatient clinics or other clinical setting. Trainees will be assessed on different clinical problems that they encounter from within the curriculum in a range of clinical settings. Trainees are encouraged to choose a different assessor for each assessment but one of the assessors must be his educational supervisor. The assessment involves observing the trainee interact with a patient in a clinical encounter. The areas of competence covered include: history taking, physical examination, professionalism, clinical judgement, communication skills,organisation and overall clinical care. Most encounters should take between 15-20 minutes. Assessors do not need to have prior knowledge of the trainee. The assessors evaluation is recorded on a structured checklist that enables the assessor to provide developmental verbal feedback to the trainee immediately after the encounter.
Feedback would normally take about5 minutes.

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Annex 5: Direct Observation of Procedural Skills (Surgical DOPS) SMSB


Trainee name Training center Training hospital Educational supervisor Specialty Year of training 1 2 3 4

Name of procedure Difficulty index Easy Below expectatio n 1. Describes indications, anatomy & details of procedure 2.Obtain inform consent after explanation 3. Prepares to procedure according to agreed protocol. 4.Demonstrate good asepsis and safe use instrument/sharps 5.Perform the technical aspects in line with guidelines 6.Deals with any unexpected events or seeks help 7.Complete required documentation
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of procedure Average Border line Meets expectati on Difficult Above expectatio n U/C

8. Issues clear postoperative instruction to patients/staff 9. Communicates with patients and staff professionally 10. Overall ability to perform the whole procedure

What has been done good

Suggestion for development

Action agreed to be done

Time taken for observation

Time taken for feedback

Assessor name . Assessor


position.

Signature . Date ...

Surgical DOPS (Direct Observation of Procedural Skills) SMSB

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DOPS is used to assess the trainees technical, operative and professional skills in a range of basic diagnostic and interventional procedures, or parts of procedures, during routine surgical practice and facilitate developmental feedback. DOPS is used in simpler environments and procedures and can take place in wards or outpatient clinics as well as in the operating theatre. DOPS form can be used routinely every time the trainer supervises a trainee carrying out one of the specified procedures, with the aim of making the assessment part of routine surgical training practice. The assessment involves an assessor observing the trainee perform a practical procedure within the workplace. Assessors do not need to have prior knowledge of the trainee. The assessors evaluation is recorded on a structured checklist that enables the assessor to provide verbal developmental feedback to the trainee immediately afterwards. Trainees are encouraged to choose a different assessor for each assessment but one of the assessors must be the current assigned educational supervisor. Most procedures take no longer than 15-20 minutes. The assessor will provide immediate feedback to the trainee after completing the observation and evaluation. Feedback would normally take about 5 minutes. DOPS form is scored for the purpose of providing feedback to the trainee. The overall rating on any one assessment can only be completed if the entire procedure is observed. A judgement will be made at completion of the placement as to the overall level of performance achieved in each of the assessed surgical procedures.

Annex 6: Case Based Discussion (CBD) SMSB


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Trainee name Training center Training hospital

Educational supervisor Specialty Year of training 1 2 3 4

Clinical setting for this assessment

OP D

In A/ patien E t

OR IC U

Other (specify) -------------------

Diagnosis of the case Focus of clinical case to be assessed a. Medical record keeping b. Clinical assessment c. Management d. Professionalis m

Unsatisfactor y 1. Medical record keeping 2. Clinical assessment 3.Investigation & Referrals 4.Treatment 5.Professionalism 6.Follow up &planning 7.Overall clinical care

Good

V. good

Outstandin g

Unable to comment

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What has been done good

Suggestion for development

Action agreed to be done

Time taken for observation

Time taken for feedback

Assessor name Signature Date..

Case Based Discussion


This method is designed to assess clinical judgement, decision-making and the application of medical knowledge in relation to patient care in cases for which the trainee has been directly responsible. The method is particularly designed to test higher order thinking and synthesis as it allows assessors to explore deeper understanding of how trainees compile, prioritise and apply knowledge. CBD is not focused on the trainees ability to make a diagnosis nor is it a viva-style assessment. The process is a structured, in-depth discussion between the trainee and assigned educational supervisor about how a clinical case was managed by the trainee; talking through what occurred, considerations and reasons for actions.

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Using complex clinical cases allow the trainee to explain the complexities involved and the reasoning behind choices. It also enables the discussion of the ethical and legal framework of practice. It uses patient records as the basis for dialogue, for systematic assessment and structured feedback. As the actual record is the focus for the discussion, the assessor can also evaluate the quality of record keeping and the presentation of cases. The assessor would normally be the trainees AES but could include other consultant trainers. Assessors should know when and how to use CBDs and be expert in the clinical problem/task. Assessors need not have prior knowledge of the trainee and in some instances it may be important that they do not. In general, however, assessments of this kind will be carried out by consultant trainers since they provide useful insights on the training that is required. Given the great variation in the rate of progress between individuals, absolute numbers of assessments are not prescribed. In clinical practice a number of observed performances, even if completed to a satisfactory level, are insufficient if not underpinned by adequate experience. There is no limited numbers specified and it will be a matter of judgement for assigned educational supervisors and annual review panels to determine whether the experience element is sufficient when signing off their reports. Ideally, trainees and supervisors should use the assessment instruments during every training exercise i.e. at every possible opportunity. The great benefit of WBAs such as the CBD is that by obliging the trainer to review the performance of the trainee across the full range of
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components involved in the management of a case, a comprehensive picture of the trainees strengths and weaknesses can be obtained and kept under review during the whole placement. Each CBD should represent a different clinical problem covered by the curriculum and have come from a range of clinical settings. The process may be initiated by the AES or the trainee, but it remains the responsibility of the trainee to take a proactive approach and to ensure that sufficient exercises are completed. The exercise comprises an in-depth discussion between the trainee and assigned educational supervisor about clinical cases with which the trainee has been involved. A quiet area may be preferred in some circumstances for a one-to-one interview, but used appropriately, a case presentation at a clinical meeting can provide an excellent setting. Should take no longer than 15 minutes and should be concluded with a debriefing, feedback and completion of the CBD form.

Annex 7: End Year Examination (EYE)


1. Introduction:

Assessment and examinations drive trainees learning. The idea is to make sure that the trainees are acquiring the necessary knowledge and s kills before being promoted to the next year
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2. Pre-requisite for the exam. Actively enrolled trainee in the programme. Attendance should not be less than 75%. Have satisfactory end of year report. 3. Assessment components and their weight: 40% Training reports. 60% End of year exam. A trainee will be promoted when passing each component by it is own, and the total aggregate is equal or above 60%.

4. What eyes, test? Eye1 testing knowledge, BOF Eye2 testing application of knowledge, PS,MEQ Eye3 testing relevant Knowledge, Skills and attitude, OSCE. Other components of exam may be added to, or replace the above if being approved by the SMSB scientific council. These EYES are based on the objectives of the rotation of the respective year. 5. Who carry the exam? The exam should be held at the head quarter of the training center. Supervised by the chairman & TPD and invigilated by ESs & CTs.

6. How frequent are the eyes?


EYE 1, by the end of year one EYE 2, by the end of year two EYE 3, by the end of year three

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The time during the academic year should be fixed and known to all. Preferably

after the 2ed part examination.


Passing first part examination will exempt the trainee from EYE, if both exams

occur on the same year. E.g. In Emergency Medicine council the 1st part examination is usually taken by the end of year 2,

7. Examinations

EYE1 & EYE2 are constructed by the examination committees of their

respective specialty council. It is a unified exam for all centers.


EYE3 is constructed by the examination committees of their respective

specialty council, together with center training officials [TPD, ED, CT]. 8. What happen if candidate fails an EYE? He is allowed to retake the exam after justifiable period from TPD not more than 6 months.

9. Exception to the EYES In case of two/three years subspecialty programme, only EYE 1/EYE1 and EYE2 is/are going to be conducted. 2. The scientific council will approve the suggested format raised by the examination committee of the specialty council.
First part examination will exempt from EYE, if both occur on the same year.

E.g. In Emergency Medicine council 1st part examination is taken by the end of year 2,

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nnex 8: Rotation Evaluation Form


Name Specialty Training Centre Hospital Academic year Name of Rota Rotation Clinical Trainer Educational Supervisor Training Programme Director Date 1 2 3 4

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Rotation: 1. The number of in-patients cases seen was appropriate. 2. Inpatients cases demonstrated a broad range of clinical problems. 3. The number of out-patients cases seen was appropriate. 4. Outpatient cases demonstrated a broad range of clinical problems. 5. The opportunity to see acute emergency cases. 6. The opportunity to see consultations. 7. Ward rounds. 8. Clinical Meetings / Lectures 9. Journal Club 10. Audit ( e.g. Morbidity / Mortality ) 11. Clear learning objectives. 12. The number of procedures adequate. 13. Demonstration & Supervision of techniques. 14. Level of responsibility in patient care. 15. Patient management. 16. Quality of teaching on rotation. 17. My total workload was appropriate for the time available. 18. Adequate feedback from consultant / trainer on performance. 19. Support and supervision was available and adequate. 20. Opportunity to do research. Overall Quality of Rotation Comments: Strengths:

Unsatisfactory Deficient Good V.Good Outstanding 1 2 3 4 5

N/A

Areas for Improvement

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Annex 9: Training Report Form


1. Basic Information Name Year of training Specialty Rota Date started Date ended Training Centre Hospital Clinical trainer Educational supervisor Training programme director 1 2 3 4

2. Weekly Timetable 1 2 3 4 5 6 Saturday Sunday Monday Tuesday Wednesday Thursday

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3. Details of On-Call Rota

4. Dates of Appraisal Meetings with Supervisor Start of the shift Date Review of training report Portfolio Other issues Mid-shift End of the shift

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5. Dates of Assessments by Educational Supervisor and Other Assessors File copies of completed assessment forms and logbook summaries in your portfolio. Assessment (date & assessor) 1 Clinical Skills Start of the shift Mid-shift End of the shift

Procedural Skills

Decision-Making

Other assessments: (Specify)

6. Details of Audit The following project was agreed at the first meeting and evaluated at the end: File copies of any presentations or publications in your portfolio. Objective Evaluation

7. Educational Achievements
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File a copy of your in-house educational programme and attendance plus any certificates for courses or exams in your portfolio Dates 1 2 3 4 Description of Course or Exam (and Outcome)

8. Absence from Training Document any periods of absence from your post except for annual and study leave e.g. sick leave, maternity leave, and compassionate leave. Dates 1 2 3 Reason for Absence

9. Summary by Educational Supervisor at Last Meeting Overall strengths

Areas for development after review of portfolio

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PDP

Educational objectives

Hospital-based clinical assessments Educational achievements

Significant events

Periods of absence

10. Suggested Learning Objectives for Next Post

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11. Signatures Registrar Name Educational Supervisor

Signature

Signature

Date

Date

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PROF.OSMAN M.ELMUSTAFA PUBLICATIONS


1The Causative Organisms of Otomycosis in Sudanese Patients. O.M. El Mustafa and N.E.Ahmed. JABMS Vol. 1 No. 4 October 1999 page 67-69. 2Bronchial Foreign Bodies in Sudanese Children. O.M. El Mustafa. Journal of the Arab Board of Medical Specialization (JABMS) vol. 1 No. 4 October 1999 page 83-84. 3Otomycosis in Gezira (Sudan) O.M.El Mustafa. Saudi Journal of OtoRhino-laryngology Head and Neck Surgery Vol 2 No. 2 July 2000 page 87-90. 4Indications for Emergency tracheostomy. O.M.El Mustafa. Saudi

Medical Journal 2000; Vol. 21(12) page 1194-1195. 5An Experience of Rigid Oesophagoscopy in 294 cases. O.M. El Mustafa. Saudi Medical Journal 2001; Vol 22(2). Page 176-177. 6Sideropenic Dysphagia in Sudanese Patients. O.M. El Mustafa. JABMS. Vol 3; No. 1 Jan 2001 page 96-99. 7Acute poisoning with Hair-dye containing ParaphenylenediamineGezira Experience. page 99-102. 8Psychiatric Manifestations in Haidrye Poisoning. Diaa E.El Gaily and O.M. El Mustafa. J.A.B.M.S. Vol 3 No. 2 April 2001, page 96-98. O.M. El Mustafa. JABMS Vol 3 No. 2 April 2001,

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Oesophageal Carcinoma in Sudanese Patients. A retrospective Study of 84 cases O.M. El Mustafa. A.A. Badie and O.K. Saeed. The Saudi Journal of ORL, H and N Surgery. Vol 3 No. 2 July 2001, page 48-50.

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10

A case of Waardenburg syndrome Type II. Observed at Gezira, Sudan. O.M. El Mustafa. The Saudi Journal of ORL, H and N. Surgery. Vol 3 No. 2 July 2001, page 70-71.

11.

Oesophageal Foreign Bodies: A retrospective Study of 220 cases O.M. El Mustafa. JABMS. Vol 3 No. 4, Oct. 2001, page 99-102.

12.

Lingual Granuloma Garvidarum: A case report. O.M. El Mustafa and A.A. Badie SMJ 2001; Vol 22(12) page 1130-1132.

13.

Aetiological Factors of Profound Sensorineural Deafness in Sudanese Children. O.M. El Mustafa. & A.B. Habour. The Saudi Journal of ORL H and N. Surgery. Vol 4 No. 1, Jan 2002, page 9-12.

14.

She Wants It Done. A.B. Habour and O.M. El Mustafa, Saudi Journal of Family and Community Medicine (SAFCM); Vol 9 No. 1, Apr. 2002; page 41-45.

15.

Carcinoma of the tongue in a patient with Sideropenic Dysphagia: A case report. O.M. El Mustafa. JABMS Vol 4 No. 4, Oct. 2002, page 3941..

16.

Spontaneous Cure of an Oropharyngeal Hamartoma. O.M. El Mustafa and A.A. Badie; SMJ 2003; Vol 24(1), page 104.

17.

A Giant Lingual Pyogenic Granuloma, O.M. El Mustafa SMJ; 2003 Vol. 24(1), page 1425.

18.

Aetiology of Bilateral Recurrent Laryngeal Nerve Paralysis in Sudanese Patients. O.M. El Mustafa JABMS; Vol 5 No. 1, Jan. 2003; page 22-24.

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19.

Blunt Laryngeal Trauma in Sudanese Agricultural Workers: Two Cases Report. O.M. El Mustafa, Gezira Journal of Health Sciences (GJHS) 1,1, 2003.

20. Low Frequency of Deafness associated GJB2 Variants in Kenya and Sudan and Novel GJB2 Variants. NG Mohamed, M. Schmidt, M.M.A. Magzoub, M. Macharia, O.M. El Mustafa, E. Winkler, G. Ruge, R.D. Horstmann, C.G. Meyer et al. Human Mutation, Mutation in Brief #687(2004) Online. 21. Clinical presentation of hypo pharyngeal tumors in Sudanese patients. El Mustafa O.M. and Albalasi A.K.K.. JABMS, Vol.7(1) 2005, p. 38-41 22. Grade 1 Nasal Septal Chondrosarcoma : A Case Report. El Mustafa O M . Abdullah H A And Albalasi AKK.JABMS Vol.7 (4) 2005 p367-369. 23. Patterns of Head and Neck Malignancies in Central Sudan-Study of 314 Cases. Abuidris DO, Elhaj AHA, Elgayli EM and El Mustafa OM.Sudan JMS Vol.3 No.2,June 2008 p 105-108. 24. Histopathological Patterns of Nasopharyngeal Carcinoma in Sudan. Abuidris DO,Elgayli EM, Elhaj AHA and El Mustafa OM. Saudi Med J 2008; Vol 29 (7) p 179-182. 25. Angiofibroma in Sudanese Patients.MunaAAbdulRahim, Nagat A El Awad and El Mustafa OM.JABMS.Vol 9 No 4,2008,page 43-46. 26. Clinical Features of Nasopharyngeal Carcinoma in Sudan : Study of 103 Cases. Elhaj Abusufian HA, Abuidris DO, Elgayli EM and El Mustafa OM. JABHS,Vol 10,No 2, 2009 page 43-47.

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27. A Clinical Experience with Sharp Bronchial Foreign Bodies in Sudanese Patients. El Mustafa OM and Osman WN. Sudanese Journal of Public Health, April 2009,Vol 4,No 2,page 256-258. 28. Nasopharyngeal Hemangiopericytoma in a Sudanese Child :A Literature Review and A Case Report. El Mustafa OM ,Osman WN and Ishag MY. Sudan JMS,Vol 5, No 1,March 2010 page 63-65.

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