Islamic Emirate of Afghanistan

Ministry of Public Health

Postgraduate Medical Education (PGME) Directorate

Curriculum
For

General Surgery
Residency Program

Revised
Revised in 2023
in 2023

Contact Details:
Directorate of Post Graduate Medical Education. 10th Street, Phase Wazir
Mohammad Akbar khan, District 9th Kabul Afghanistan.
Phone: 0093 (0)202301369,
Email: pgme@moph.gov.af
Contents
Section One: PGME Specialty Training Programs .................................................................................1
1.1: Introduction: .................................................................................................................................... 1
1.2: Vision of PGME: ............................................................................................................................... 1
1.3: Mission of PGME: ............................................................................................................................. 1
1.4: Core values ...................................................................................................................................... 2
1.6: List of PGME Specialty Training Programs: (Table 2) ........................................................................ 4
Section Two: General Surgery Training Program..................................................................................6
2.1-Introduction: ..................................................................................................................................... 6
2.2-Goals and Objectives of the General surgery Program ..................................................................... 9
2.2.1. GOAL: ........................................................................................................................................ 9
2.2.2. OBJECTIVE: ................................................................................................................................ 9
2.3-Structure of the Program: ............................................................................................................... 10
2.4: Roles & Responsibilities of Head of Department, Program director, Faculty and Resident: .......... 10
2.5: Educational Strategies: .................................................................................................................. 10
2.6: Core Competencies (Table 3): ........................................................................................................ 11
2.7: Teaching and Learning Methods: ................................................................................................... 12
2.8: Learning Resources in General Surgery domain:............................................................................ 12
Section 3: General Surgery Syllabus & Rotation Schedules ................................................................ 18
3.1 General Surgery Residency Program Syllabuses.............................................................................. 18
PGY 1..................................................................................................................................................... 18
GENERAL SURGERY ........................................................................................................................... 18
PGY-2 .................................................................................................................................................... 20
GENERAL SURGERY ........................................................................................................................... 20
PGY 3..................................................................................................................................................... 22
GENERAL SURGERY ........................................................................................................................... 22
PGY 4..................................................................................................................................................... 24
GENERAL SURGERY ........................................................................................................................... 24
PGY 5 (Chief resident) ........................................................................................................................... 26
GENERAL SURGERY ........................................................................................................................... 26
Clinical Procedure Cases Rotation Schedule From First – Fifth years .................................................... 28
Rotations ............................................................................................................................................... 34
General Surgery Rotations PGY 1-5 ............................................................................................... 49
PGY1 .............................................................................................................................................. 49
PGY2 .............................................................................................................................................. 49
PGY 3 ............................................................................................................................................. 49
PGY 5 ............................................................................................................................................. 50
Abbreviations:....................................................................................................................................... 51
REFERENCES:......................................................................................................................................... 52
Preface:
The post graduate medical directorate (PGME) under the sincere and cooperative leadership is being able
to serve the nation by providing Evidence and Competency based curriculum for the post graduate
residents of various specialties and subspecialities. This curriculum represents our commitment to
nurturing the new generations of healthcare professionals who will play a vital role in the wellbeing of our
nation.
The development of this curriculum is the result of the day and night efforts of PGME team with the
national and international faculty and precious input from the curriculum experts. For months the
curriculum committees were giving their inputs. The faculty were involved as content expert and their
experience put light on the sensitivities and requirements of the relevant field. The revise committee had
all the representatives and specialists from all fields of specialty. They were further divided in to medicine
core committee and surgical core committee. The core committee had responsibility to approve the
curriculum according to the required frame and checklist provided by PGME. Within three months of daily
meeting for hours we were able to finalize curriculum of thirty-eight specialties and subspecialities.
This is the first step taken towards standardization. In a rapidly evolving healthcare landscape, it is
imperative that our residents are equipped with the knowledge, skills, and values necessary to meet the
diverse and complex needs of our patients. This curriculum has been carefully crafted to align with the
unique challenges and opportunities we face in Afghanistan’s healthcare system.
Key Features of this Curriculum:
1. Competency Focus: Our curriculum centers on competencies, ensuring that residents not only
acquire knowledge but also demonstrate the ability to apply it effectively in clinical practice.
2. Cultural Sensitivity: Given our diverse population and cultural nuances, we emphasize the
importance of culturally competent care to promote understanding and trust among our patients.
3. Interdisciplinary Collaboration: Healthcare is a team effort. We encourage residents to
collaborate with other healthcare professionals to provide comprehensive, patient-centered care.
4. Continuous Improvement: This curriculum is designed for lifelong learners. Residents are
encouraged to engage in ongoing self-assessment and improvement, aligning with international best
practices.
We invite residents, faculty, and all stakeholders to embark on this educational journey with dedication
and enthusiasm. Together, we will shape the future of healthcare in Afghanistan, ensuring that our
patients receive the highest quality of care they deserve.
We extend our gratitude to all those who contributed to the development of this curriculum, and we look
forward to witnessing the positive impact it will have on healthcare in our nation.
Best regard
General Director of Post Graduate Medical Education
Preface

We are grateful to Allah (SWT) that provide this opportunity to PGME Directorate,
technical team, curriculum revise committee and curriculum core committee of the
Directorate of Specialization that revised the curriculum of 38 specialties and
subspecialties in three months of hard working and prepared them in accordance
with contemporary international standards that can use these curriculums in the
specialization training program to train and introduce professional specialists to the
society and serve underprivileged people of society.

The leadership of the Ministry of Public Health are grateful to the PGME
Directorate, the curriculum revise committees and the curriculum core committees
who have prepared the first evidence base and competency-based curriculum in
the Afghanistan.

Best Regard

Minister of Public Health

 Section One: PGME Specialty Training Programs
1.1: Introduction:
The postgraduate medical education (PGME) program of Afghanistan is struggling with its limited
resources to maintain the postgraduate medical education to the standard levels. With the help
of the hardworking and resilient faculty members, under the supervision of great leadership we
aim to bring transformation in the health and medical education system of Afghanistan to attain
the standard and required safe and quality patient care. According to the global health security
index (https://www.ghsindex.org/country/afghanistan) Afghanistan is on one hundred fifty-two
numbers, which means one of the lowest at each level of health system.
The need to revise our curriculum and address the issues at each level is necessary in the growing
competition that we are having with our neighbor countries. PGME program is providing
specialist doctors training in thirty-eight different disciplines. The residents are selected as per
requirements of the program.
The residents then undergo training under the guidance of trained and expert faculty, then they
are assessed for their competency by the PGME directorate before getting the license to practice
as specialist.

1.2: Vision of PGME:

We aim provision of high quality, safe patient centered care by education and facilitation of
sufficient number of specialists in each field of health having sound medical knowledge,
communication skills, collaborative approach, ethically and professionally sound, research
oriented and lifelong learner.

1.3: Mission of PGME:

Selection and facilitation of right number of postgraduate residents who are willing to actively
participate in learning process and are the agent of positive change in the society.

The specialists have empathic yet professional and evidence-based management approach
towards patients.

1
They work in collaboration having required communication skills, have quest of gaining new
knowledge and always are busy in scholarly activities, as lifelong learners.

1.4: Core values

While accomplishing our vision through our mission we will be upholding our core values which
are,

• Honesty, to create positive atmosphere based on trust and respect.

• Teamwork, to achieve our goal effectively by acting together, reducing individual tension.
• Ethical practice, to prioritize and justify the actions that impact the health and wellbeing
of patients, families and communities (world health organization)
• Professionalism, to improve clinical outcome and gain respect from the patients and
medical professionals.

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 Table 1: Goals & Objectives of Training Programs(CanMeds Roles)
Goal Objectives
Medical Experts To integrate and applying medical knowledge, clinical skills, and
professional values in the provision of high-quality and safe
patient-centered care
Communicators To form relationships with patients and their families that
facilitate the gathering and sharing of essential information for
effective health care.
Collaborator To work effectively with other health care professionals to
provide safe, high-quality, patient-centered care.
Leaders To contribute to a vision of a high-quality health care system
and take responsibility for the delivery of excellent patient care
through their activities as clinicians, administrators, scholars, or
teachers
Health Advocates To determine and understand needs, speak on behalf of others
when required, and support the mobilization of resources to
effect change through the expertise and influence they have.
Scholars/Researcher To demonstrate a lifelong commitment to excellence in practice
through continuous learning and by teaching others, evaluating
evidence, and contributing to research.
Professionals To exhibit ethical practice, high personal standards of behavior,
accountability to the profession and society, physician-led
regulation, and maintenance of personal health.

1.5: Goals and objectives:

We aim our specialists to exhibit the CanMeds roles and characteristics leading to safe and quality
patient centered care which are as the following (table 1):

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1.6: List of PGME Specialty Training Programs: (Table 2)
Table 2 showing the specialty and years of training
No# Specialty Years
1 Anesthesia 4
2 Cardiac surgery 3
3 Cardiology 3

4 Clinical Hematology 5

5 Clinical Pathology 4

6 Dermatology Adult 5

7 Dermatology Pediatric 5
8 Endodontics/ Stomatology 4
9 ENT Adults 4
10 ENT Pediatric 4
11 Family Medicine 4

12 Forensic Medicine 4
13 Gastroenterology 3
14 General Internal Medicine 4
15 General surgery 5
16 Hematopathology 4
17 Histopathology 4
18 Infectious diseases 4
19 Intensive Care Medicine 3
20 Nephrology 3
21 Neurosurgery 5
22 Obstetrics and Gynecology 4
23 Ophthalmology 4
24 Oral and Maxillofacial Surgery/Stomatology 4
25 Orthopedics Adults 5
26 Orthopedics Pediatric 5
27 Pediatric Dentistry/ Stomatology 4
28 Pediatric surgery 5
29 Pediatrics Medicine 4
30 Plastic and burn surgery 5
31 Prosthodontics/ Stomatology 4
32 Psychiatry 4

4
33 Pulmonology 3

34 Radiology 4

35 Thoracic Internal Medicine 3

36 Thoracic Surgery 5
37 Urology 5
38 Vascular surgery 5

5
 Section Two: General Surgery Training Program
2.1-Introduction:
The scope of general surgery
General surgery is a discipline that requires knowledge of and responsibility for the
preoperative, operative, and postoperative management of patients with a broad spectrum of
diseases, including those which may require nonoperative, elective, or emergency surgical
treatment. The certified general surgeon demonstrates broad knowledge and experience in
conditions affecting the:
1. Alimentary Tract (esophagus, stomach, small intestine, large intestine, rectum)
2. Abdomen and its Contents (liver, bladder, biliary tree, pancreas, spleen)
3. Breast, Skin and Soft Tissue
4. Endocrine System (thyroid, parathyroid, adrenal gland)
5. Surgical Critical Care
6. Surgical Oncology
7. Trauma
The field of general surgery as a specialty comprises, but is not limited to, the performance of
operations and procedures relevant to the content areas listed above. It is expected that the
certified surgeon will also have additional knowledge and experience relevant to the above
areas in the following categories:
Related disciplines, including anatomy, physiology, epidemiology, immunology, and pathology
(including neoplasia). Clinical care domains, including wound healing; infection and antibiotic
usage; fluid and electrolyte management; transfusion and disorders of coagulation; shock and
resuscitation; metabolism and nutrition; minimally invasive and endoscopic intervention
(including colonoscopy and upper endoscopy); appropriate use and interpretation of radiologic
diagnostic and therapeutic imaging; and pain management. In some circumstances, the
certified general surgeon provides care in the following disease areas. However, comprehensive
knowledge and management of conditions in these areas generally requires additional training.
Vascular Surgery, Pediatric Surgery, Thoracic Surgery, Burns, Solid Organ Transplantation
In unusual circumstances, the certified general surgeon may provide care for patients with
problems in adjacent fields such as obstetrics and gynecology, urology, and hand surgery.
Surgical training is a unique undertaking, combining the acquisition of an enormous body of
knowledge encompassing the clinical and basic sciences of surgery, the development of technical
skills and, above all, the mastery of clinical judgment and medical/surgical ethics.
IMPORTANCE OF UNDERSTANDING SURGICAL HISTORY It remains a rhetorical question
whether an understanding of surgical history is important to the maturation and continued
education and training of a surgeon. Conversely, it is hardly necessary to dwell on the heuristic

6
value that an appreciation of history provides in developing adjunctive humanistic, literary, and
philosophic tastes. Clearly, the study of medicine is a lifelong learning process that should be an
enjoyable and rewarding experience. For a surgeon, the study of surgical history can contribute
toward making this educational effort more pleasurable. Historical Relationship Between
Surgery and Medicine Despite outward appearances, it was actually not until the latter decades
of the 19th century that the surgeon truly emerged as a specialist within the whole arena of
medicine to become a recognized and respected clinical physician. Similarly, it was not until the
first decades of the 20th century that surgery could be considered to have achieved the status
of a bona fide profession. Before this time, the scope of surgery remained limited. That the
gradual evolution of surgery was superseded in the 1880s and 1890s by the rapid introduction
of startling new technical advances was based on a simple culminating axiom— the four
fundamental clinical prerequisites that were required before a surgical operation could ever be
considered a truly viable therapeutic procedure had finally been identified and understood: 1.
Knowledge of human anatomy 2. Method of controlling hemorrhage and maintaining
intraoperative hemostasis. Anesthesia to permit the performance of pain-free procedures 4.
Explanation of the nature of infection, along with the elaboration of methods necessary to
achieve an antiseptic and aseptic operating room environment. Surgeons experimented with
numerous antiseptic solutions, and various types of surgical dressing. A principle of wound
treatment entailing debridement and irrigation eventually evolved. Henry Dakin (1880-1952),
an English chemist, and Alexis Carrel (1873-1944; Fig. 1-8), the Nobel prize–winning French
American surgeon. Ascent of Scientific Surgery William Stewart Halsted (1852-1922), more than
any other surgeon, set the scientific tone for this most important period in surgical history (Fig.
1-7). He moved surgery from the melodramatics of the 19th-century operating theater to the
starkness and sterility of the modern operating room. By the late 1890s, the interactions of
political, scientific, socioeconomic, and technical factors set the stage for what would become a
spectacular showcasing of surgery’s newfound prestige and accomplishments. Surgeons were
finally wearing antiseptic looking white coats. World War I: Austria-Hungary and Germany
continued as the dominant forces in world surgery until World War I. However, results of the
conflict proved disastrous to the central powers (Austria Hungary, Bulgaria, Germany, and the
Ottoman Empire), especially to German-speaking surgeons. Europe took on a new social and
political look, with the demise of Germany’s status as the world leader in surgery a sad but
foregone conclusion. As with most armed conflicts, because of the massive human toll,
especially battlefield injuries, tremendous strides were made in multiple areas of surgery.
American college of surgeons: For American surgeons, the years just before World War I were
a time of active coalescence into various social and educational organizations. The most
important and influential of these societies was the American College of Surgeons, founded in
1913 by Franklin Martin (1857-1935), a Chicago-based gynecologist
MODERN ERA in surgery: Despite the global economic depression in the aftermath of World
War I, the 1920s and 1930s signaled the ascent of American surgery to its current position of
international leadership. Highlighted by educational reforms in its medical schools, Halsted’s

7
redefinition of surgical residency programs, and the growth of surgical specialties, the stage
was set for the blossoming of scientific surgery. Basic surgical research became an established
reality as George Crile (1864-1943), Alfred Blalock (1899-1964; Fig. 1-12), Dallas Phemister
(1882-1951), and Charles Huggins (1901-1997) became world-renowned surgeon-scientists.
History of surgery in Afghanistan: n Afghanistan, Iran, India, Greece, Rome, Egypt, and the
whole civilized world, people had information about medicine, and in each of these countries,
some people practiced medicine. The oldest Persian medical book of Alaniyyah on the facts of
medicine is written by Abu Mansoor Muwafq bin Ali al-Harawi, a copy of which is available in
the Austrian state library. The Sheikh Abu Ali Hossein bin Abdullah Sina, physician, philosopher
and great writer of Khorasan, who lived in the late 4th and early 5th century AH and died in 428
AH, wrote several books about medicine, wrote the most important medical work and his
famous book called Law was famous medical islamic book in medicine. Ibn sina used norcosis in
surgery in early 17th century in all European universities and hospitals. Also ibn sina was first
surgeon to completely excised malignant tumors and and the cavity was burned by iron and
high energy flames. In the history of the Islamic world and our dear country of Afghanistan,
besides Abu Ali Sina Balkhi Pik, there have been a number of other famous medical scholars,
such as Abto Bakr Muhammad bin Zakariai Razi, Nizami Samarkandi in Tayyab Jarjani, Jozjani
Qutbuddin Shirazi, Khwaja Nasiruddin Tosi, etc. Medicine has done great services in the book of
shahnama written by Rustam also the surgery was expressed and they were written about
Caesarean sections. In 1359) 1880 (AD), i.e., at the end of the Second Afghan-British War,
during the time of Amir Abbad Rahman Khan, attention was paid to contemporary medicine
and civilian and military hospitals, and in 1273 1894) AD, a pharmacy was established for the
first time in Kabul. In 1276 (1897 AD) Sardar Habibullah Khan and Nasrullah Khan built a
hospital in Kabul and they assumed the costs themselves. In 1291 (1912) there were only two
civilian and military hospitals in Kabul. At the beginning of the era of Amir Habibullah, two
Indian doctors named Ghulam Nabi Khan and Ghulam Muhammad Khan served in the court.
These two doctors, both of whom were surgeons.They could perform simple operations such as
stone, bladder, cataract, etc In 1293 (1914 AD), some abdominal surgeries were performed in
the governmental hospital of Kabul by a Turkish doctor named Ghirt Beyk. On the first day of
Scorpio in 1311, Faculty of Kabul was established as the first center of science and knowledge
of high results in Afghanistan by accepting eight students. Between the years 1314 and 1316,
the Aliabad Hospital and Mastorat were opened and the Faculty of Medicine was made
available. Ibn Sina Hospital, which had internal medicine, ear and throat. General surgery
services, was led by the Care Medien team, and its doctors were trained under the supervision
of the aforementioned team. They carried ibn sina in 1354 to Cumhuriyet Hospital, which
initially trained young doctors in the fields of internal medicine and surgery under Care
Medico's team to obtain specialization in Cumhuriyet Hospital. In 1369, Cumhuriyet Hospital
was accepted as a training hospitalThe first laparoscopic surgery in governmental hospital
started at Wazir mohammad Khan hospital in the (2011 ). The PGME Residency Program is
conducted under the PGME regulation of MoPH. General Surgery training is an important pillar of PGME
program and has been training and producing general surgeons to the community since it was

8
established. General surgery residency is a 5-year structured training program in PGME Directorate
approved specialty hospitals under guidance of certified trainers (faculty). All the residents will admit in
this program after fulfilling the entrance exam successfully. During the training, he/she will train in
general surgery and other relevant professionalities to get competence. After completion of program
and passing the final comprehensive exam, they will serve the general surgery services to all people of
Afghanistan who need surgery management. The General Surgery training program focuses on
knowledge, skills and attitudes.

2.2-Goals and Objectives of the General surgery Program

2.2.1. GOAL:
The program encompasses training in general surgery and additional components and related
surgical specialties, and clinical research and thesis writing. The fundamental education goal of
the training program is to provide a complete education in the basic and clinical sciences of
general surgery, as well as clinical research, preparing the post-graduate for:

2.2.2. OBJECTIVE:
• The practice of clinical general surgery, and/or
• Further specialty education and training, and/or
• A career in academic, surgical/clinical research and teaching.

In summary, general educational goals of the General Surgery Residency program are as follows:

• The resident must acquire a fundamental knowledge base in the basic sciences applicable
to general surgery.
• The resident must acquire an extensive, sound knowledge base in the clinical science of
general surgery.
• The resident must develop, through technical training and operative experience, the
competence to execute the operative and non-operative procedures intrinsic to the
practice of general surgery.
• The resident must develop the necessary skills in clinical decision-making to become a
safe and effective practitioner of general surgery.
• The resident must demonstrate the desire and ability to care for his or her patients in a
competent, responsible, compassionate and ethical manner and to serve society by
always demonstrating professional integrity, intellectual honesty and social
responsibility.
• The resident must acquire knowledge and skills for performing clinical research with
thesis/article writing and critical appraisal of the literature.

9
2.3-Structure of the Program:
2.3.1: Entry criteria: the residents will be recruited after fulfilling the code and policies
mentioned in the PGME program Law.

2.3.2: Duration of training: The General surgery training program will run for five years
based on table 2. During that time the resident will spend half of the training program per year
in the surgery department, the remaining time of year will be rotations to other relevant
surgery discipline department. Except the fifth year will be in the general surgery department
without rotations.
This training will consist of:

• 37 months of training in general surgery department

• 23 months of 15 rotations in various departments.

2.3.3: Exit from the program is according to the code and policies mentioned in the PGME
program law.

2.4: Roles & Responsibilities of Head of Department, Program director, Faculty and
Resident: As per PGME Rules and regulations

2.5: Educational Strategies:

• This curriculum is based on competency-base medical education (CBME).
• A competency describes a key set of abilities required for someone to do their job. For
example, all future doctors must have a basic level of knowledge and ability to provide
patient care. Without these critical skills, one could not perform their job.
• It creates a shared model for residents, fellows, faculty members, programs, accrediting
bodies, and the public at large. Allows for better feedback, coaching, and reflection for
residents and fellows to create their own action plans for improvement.

10
2.6: Core Competencies (Table 3):
Table 3: The core competencies
Competency Objectives Domain
To provide patient care that is compassionate, evidence based,
appropriate, and effective for the treatment of health
Patient Care
problems and the promotion of health.

Knowledge, Skills, Attitudes & behaviors, Research, Reflection

To demonstrate the ability to manage patients
To demonstrate knowledge of established and evolving clinical,
Medical epidemiological and social behavioral sciences, biomedical as
Knowledge
well as the application of this knowledge to patient care
To investigate and evaluate their care of patients, to appraise
Practice-Based and assimilate scientific evidence, and to continuously improve
Learning and
patient care based on constant self-evaluation and life-long
Improvement
learning.
To demonstrate interpersonal and communication skills that
Interpersonal
result in the effective exchange of information and
and
Communication collaboration with patients, their families, and health
Skills
professionals
To demonstrate a commitment to carrying out professional

Professionalism responsibilities and the principles of professionalism.

Adherence to ethical principles.
demonstrate an awareness of and responsiveness to the larger
context and system of health care, as well as the ability to call
Systems-Based
Practice effectively on other resources in the system to provide optimal
health care

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2.7: Teaching and Learning Methods:
They will include some or all of them depending on the resources available. Aim is student
centered faculty led approach.

• Case based learning

• Bedside teaching and learning
• Morning reports
• Lectures
• Journal clubs
• Morbidity and mortality reports
• Learning using e-technology
• Logbook maintenance
• Incidence reporting
• Presentations in Journal club
• Simulation techniques
• Portfolio maintenance
• Feedback and audit
• Debate

2.8: Learning Resources in General Surgery domain:

1- Main References for final and comprehensive exams:

• Baily and Loves’ Surgery , last edition

• Shwart’z Priciale of Surgery last edition.
• Zollinger’s operative book last edition
• Snell’s clinical Anatomy
• ATLS, last edition

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 2- Supportive Reference books and materials:
• Sabiston Textbook of Surgery
• Farquharson's Operative Surgery
• Alfred Cuschieri, George Hanna-Essential Surgical Practice_ Higher Surgical Training in General
Surgery
• Maingot’s Abdominal Operations
• Advanced Trauma Operative Management (ATOM)
• Mattox Trauma Textbook
• Robbins and Cotran Pathologic Basis of Disease
• Master of surgery
• Green field text book of surgery
• Current of surgical therapy (CAMERON)
• Online lectures and seminars from the recommended sources
• Guidelines(Update)
• Journals (Peer-Reviewed)
• SRBS Manual of Surgery
• Chassin’s operative strategy in general surgery

2.9: Assessment , Evaluation & Feedback:

Assessment is the process whereby the Program Director, a faculty member, or
a preceptor assesses the performance of a resident. This is separate from
evaluation. An evaluation is the assignment of a score, grade, or relative rank
that rates their performance and compares them to other residents. Feedback
is the process by which the results of assessment or evaluation are
communicated to the resident along with suggestions on how he/she may
improve. The resident’s progress and performance must constantly be assessed
and constructive feedback provided; this is the most effective way for the
resident to learn and improve his/her clinical practice.

13
Assessment Tools:
A.Key to competency levels in clinical skills & procedures:
Level 1: Observer Status
Level 2. Assistant Status
Level 3. Perform under supervision of trainer
Level 4. Perform independently.
B. Competency-Based Assessment Methods (Table 4):

Table 4: Competency-Based Assessment Methods

Competency Competency based assessment options

In training exam

Medical knowledge Faculty work-based assessment

Simulated recall and charts

Work based assessment

Direct observation of procedure

Patient care & Faculty and peer assessment

procedural skills
Standardized assessment

Simulation

Informed self-assessment

Professionalism Multisource feedback, such as 360-degree evaluation

Patient experience survey

14
 Patient experience survey
Interpersonal &
communication Multi source feedback such as 360-degree evaluation
skills
regarding interprofessional skills

Audit and feedback of the medical record

Practice based
learning and Review of medical errors and patient safety events
improvement
Evidence based practice logs

Multi source feedback such as 360-degree evaluation

System based regarding interprofessional skills
practice
Assessment of cost-conscious care

C. Assessment by Basic Assessment Methods (Table 5):

Table 5: Assessment by Basic Assessment Methods

Assessment Tool/Method Targeted Competency

Multiple Competencies
Faculty Assessment (can be
interprofessional)

Patient Care & Procedural Skills

Interpersonal & Communication Skills

Direct Observation Medical Knowledge (In Vivo)

Professionalism

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 Professionalism

Interpersonal & Communication Skills

Multi-Source Feedback
System-Based Practice

Medical Knowledge

Practice-Based Learning & Improvement

Audit & Performance Data
(clinical & patient safety System-Based Practice
indicators)
Medical Knowledge

Patient Care & Procedural Skills

Simulation (if available) Interpersonal & Communication Skills

Medical Knowledge

Medical Knowledge
In-training Exam (if available)

Patient Care & Procedural Skills

Case or Procedural Logs
Practice-Based Learning & Improvement

Assessment by Logbook:
The Directorate of Post Graduate Medical Education Council has made
logbook mandatory for all residents of residency programs.
Each resident is allotted a registration number and makes entries of all work
performed and the academic activities undertaken in logbook on daily basis. The
concerned supervisor is required to verify the entries made by the resident. This
system ensures timely entries by the resident and prompt verification by the
supervisor. It also helps in monitoring the progress of residents and vigilance of
supervisors.

16
Recording in the logbook can be done in 3 categories in 3 forms:
. Form A: Case Log (Recording patient diagnosis & management)
. Form B: Procedure or Operation Log
. Form C: Academic Activities Log
FORMAT OF EXAMINATION: AS PER PGME RULES and regulations

17
 Section 3: General Surgery Syllabus & Rotation Schedules
3.1 General Surgery Residency Program Syllabuses

PGY 1

GENERAL SURGERY
Duration: 7 months

First four months Second four months Third four months

A- Knowledge TOPICS A- Knowledge TOPICS A- Knowledge TOPICS
Anatomy of The Back Anatomy of Thorax • Anatomy of Pelvis
Anatomy of Upper Limb Anatomy of thoracic cavity • Anatomy of pelvic cavity
Anatomy of Thorax, part 1 Anatomy of Abdomen • Anatomy of Perineum
Anatomy of Thoracic Wall Anatomy of abdominal wall • Anatomy of Lower limb
Metabolic response to injury Anatomy of Abdomen • Anatomy of Head and
• Mediators of the Anatomy of abdominal cavity Neck
metabolic response to Anatomy of Pelvis, Tissue and molecular diagnosis
injury Anatomy of pelvic wall • Reason for assessment
• Metabolic change after Basic surgical skills of tissue
trauma • Positioning on the • Tissue specimens
• Changes in body operating table • Principle of microscopic
composition following • Preparation of the surgical diagnosis
injury site • Assessment
Shock, hemorrhage and • Surgical exposure and • Diagnostic molecular
transfusion. wound approximation pathology
• Shock • Wound closure and • Autopsy
• Pathophysiology suturing technique Principle of oncology
• Classification of shock • Electrosurgery • What is cancer
• Clinical consequence of • Topical hemostatic agents • Causes of cancer
shock • Drains in surgery • Management of cancer
• Haemorrhage Diagnostic imaging Surgical audit and research
• Degree of hemorrhage • Diagnostic imaging • Audit or research
and classification • Imaging in orthopedic • Forming a team
• Hemorrhage resuscitation surgery • Analyzing a scientific
• Shock resuscitation • Imaging in major trauma article
• Transfusion • Imaging in abdominal • Presenting and
Wound healing and tissue repair surgery publishing an article
• Normal wound healing in Gastrointestinal endoscopy • Evidence based surgery
skin • The modern endoscopic Ethics and law in surgical
• Abnormal wound healing unit practice
• Types of wound healing • Upper gastrointestinal • Respect for autonomy
• Wound management endoscopy

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 • Chronic wounds • Endoscopic assessment of • Disclosure prior to
• Acute wounds small bowel consent
Tissue engineering and • ERCP • Further practical
regenerative repair • Colonoscopy application of clinical law
Surgical infection • Endoscopic ultrasound in surgical practice
• History of surgical Principle of minimal access • The role of the court
infection surgery • Transplantation
• Microbiology of • Minimal access • Research
infections approaches Human factors, patient safety and
• Presentation of surgical • Surgical trauma in open quality improvement
infections minimal invasive and • Human factors
• Prevention of surgical robotic surgery • Patient safety
infection • Limitation of minimal • Patient safety and the
surgeon: professional
• Antimicrobial treatment access surgery
responsibility
of surgical infection • Robotic surgery • Quality improvement
Tropical infections and • Perioperative planning for Global health and surgery
infestations minimal access surgery • Access to surgical care
• Amoebiasis • Post operative care • The global surgical
• filariasis workforce
• Hydatid disease • Essential surgery through
• Leprosy surgical healthcare delivery
• Mycetoma platforms.
• Tropical chronic
pancreatitis
• Tuberculosis of small
intestine
• Typhoid

B- Procedures
• Removal of drains
• Superficial wound debridement B- Procedures
• Suture removal B- Procedures
and necrotomy
• IV access line placement • Primary and secondary
• DPC
• Foley Catheter, NGT and rectal wound closure
• Removal of small superficial
tube insertion and removal • Abscess incision and
skin lesions and tumors
• CPR drainage
• History and examination of the
• Dressings and change
abdomen
dressings

19
 PGY-2

GENERAL SURGERY
Duration: 6 months

First four months Second four months Third four month

A- Knowledge TOPICS A- Knowledge TOPICS A- Knowledge TOPICS
Introduction to trauma Disaster surgery
Preoperative care including high risk • definition of trauma • common feature of
surgical patient • the management of trauma major disaster
• Patient assessment • assessment and response • definitive management
• Common perioperative • the response to trauma • disaster plans
problems and management • local protocols and Conflict surgery
• Physical fitness guidelines • ethical and legal
• Consent • conclusion consideration
• Assessment of risk Early assessment and management • medical support roles
• Arrangement an elective of severe trauma • principle of war surgery
theatre list • identification of severe • damage control surgery
• Perioperative assessment trauma • weapon effects
for emergency surgery • role of trauma team • management of gunshot
Day case surgery • primary survey wounds
• Selection criteria • secondary survey • blast injury
• Delivery of day surgery • damage control surgery • infection
• Emergency day surgery versus early total care
Anesthesia and pain relief Traumatic brain injury Skin and subcutaneous tissue
• Key principle of anesthesia • intracranial pressure • functional anatomy and
• Preparation for anesthesia • classification of head injury physiology of skin
• General anesthesia • traumatic brain injury in the • pathophysiology of skin
• Pain child and subcutaneous tissue
Postoperative care including Torso and pelvic trauma • skin tumors
perioperative optimization • injury mechanism • vascular lesion
• Prehabilitation associated with torso • wounds
• trauma Plastic and reconstructive surgery
• postoperative observation • thoracic injury • surgical anatomy of the
• postoperative complication • emergency thoracic survey skin
• systemic specific • abdominal injury • wound healing
complication • individual organ injury • aberrant healing
• general postoperative • the pelvis • wound dressing
complication • damage control surgery • reconstructive treatment
• general postoperative • abdominal compartment • microsurgery
problem and management syndrome • flap monitoring
• enhanced recovery The neck and spine Burns
• anatomy of the spine and • pathophysiology of burn
cord injury to the skin
• patient assessment • injury to the airway and
• diagnostic imaging lungs
• specific spinal injury

20
Nutrition and fluid therapy • evaluation of spinal cord • other life threating
• physiological responses to injury events with major burn
nutritional impairment Maxillofacial trauma • immediate care of the
• nutritional assessment • emergency assessment and burn patient
• fluid and electrolyte management • assessment of the burn
replacement • specific injuries wound
• nutritional requirements Extremity trauma • fluid resuscitation
• effects of intestinal • diagnosis • treating the burn wound
resection on absorption • description and • additional aspect of
• artificial nutritional support classification of the injury treating the burned
• fracture healing patient
• treatment by fracture • non thermal burn injury
location
• treatment by region
• specific pediatric injury
• compartment syndrome

B- Procedures B- Procedures B Procedures

• Surgical technique
• Abdominal wall incision • Removal of drains • Surgical knot
and closure • Superficial wound • Laparotomy
• Tissue dissection debridement and necrotomy • Fasciotomy
• Biopsy • DPC • Incision and drainage of
• DPL • Removal of small superficial abscess
• skin lesions and tumors • Chest tube insertion
• Skin incision and closure •

21
 PGY 3

GENERAL SURGERY
Duration: 7 months

First four months Second four months Third four months

Knowledge TOPICS Knowledge TOPICS Knowledge TOPICS
The abdominal wall, hernia and The vermiform appendix Pediatric trauma (ATLS)
umbilicus • Anatomy • Types and patterns of injury
• The abdominal wall • Acute appendicitis • Unique characteristics of
• Abdominal hernia • Neoplasm of the pediatric patients
• Specific hernia types appendix and • Airway
• Ventral hernia pseudomyxoma • Breathing
• Umbilical conditions in peritoneum • Circulation and shock
adults Abdominal and pelvic trauma • Cardiopulmonary resuscitation
• General infections of the (ATLS) • Chest trauma
abdominal wall • Anatomy of the • Abdominal trauma
The peritoneum, mesentry, greater abdomen • Head trauma
omentum and retroperitoneal space • Mechanism of injury • Spinal cord inury
• Development of the • Assessment and • Musculoskeletal trauma
mesentry and peritoneum management • Child maltreatment
• Anatomy of peritoneum Transfer to definitive care (ATLS) • Prevention
• The peritoneum • Determining the need
• Peritonitis for transfer Geriatric trauma(ATLS)
• Tumor of the peritoneum • Treatment before • Mechanism of injury
• Peritoneal inclusion cyst transfer • Primary survey with
• Intraperitoneal abscess • Transfer responsibility resuscitation
formation • Modes of transportation • Specific injury
• The mesentry Transfer protocols • Special circumstance
• Vascular abnormality of the Head trauma (ATLS) Trauma in pregnancy and intimate
mesentry • Anatomy review partner violence (ATLS)
• Rotational disorders • Physiology review • Anatomical and physiological
• Mesenteric cysts • Classification of head alterations of pregnancy
• Tumor of mesentry injury • Mechanism of injury
• The Greater omentum • Primary survey and • Severity of injury
• The retroperitoneal space resuscitation • Assessment and treatment
and retroperitoneum • Secondary survey • Perimortem caesarean section
Initial assessment and management • Diagnostic procedures Intimate partner violence
of trauma patient (ATLS) • Medical therapy for Ocular trauma (ATLS)
• Prehospital phase brain injury • Anatomy review
• Hospital phase • Surgical management • Assessment
• Airway maintainance with • Prognosis • Specific ocular injuries
restriction of the cervical • Brain death Hypothermia and heat injuries (ATLS)
spine motion Spine and spinal cord trauma • Cold injury
• Breathing and ventilation (ATLS) • Systemic hypothermia
• Circulation with hemorrhage • Anatomy and physiology • Heat injury
control

22
 • Disability • Documentation of spinal Trauma care during mass casualty,
• Exposure cord injury austere, and operational environments
• Adjuncts to the primary • Specific types of spine (ATLS)
survey with resuscitation injury • Mass casualty care
• Secondary survey • Radiographic evaluation • Military trauma care
• Adjuncts to the secondary • General management Disaster preparedness and
survey Musculoskeletal trauma(ATLS) response(ATLS)
• Reevaluation • Primary survey and • Phases of the disaster
• Definitive care resuscitation management
Airway and ventilation management • Adjuncts to primary • Triage of the disaster victims
of trauma patient (ATLS) survey • Evacuation, decontamination
• Airway • Secondary survey • Specific injury types
• Ventilation • Limb- threatening Atls and trauma team resource
• Airway management injury management (ATLS)
• Management of oxygenation • Principle of • Trauma team configuration
• Management of ventilation immobilization • Role and responsibility of the
• • Pain control team leader
Shock of trauma (ATLS) • Occult skeletal injuries • Effective leadership
• Shock pathophysiology Thermal injuries (ATLS) • Role and responsibility of team
• Initial patient assessment • Primary survey and members
• Hemorrhagic shock resuscitation of patient • Managing conflict
• Initial management of with burn Triage scenarios (ATLS)
hemorrhagic shock • Patient assessment Skills in ATLS
• Blood replacement • Secondary survey and
Thoracic trauma (ATLS) relate adjuncts
• Primary survey ( life threating • Unique burn injury
injuries) •
• Secondary survey

B- Procedures B- Procedures B- Procedures

• Appendectomy
• Repair of the ventral • Repair of the epigastric • Perianal abscess incision and
hernia hernia drainage
• • Loop ileostomy
• Repair of the umbilical Repair of inguinal
hernia with mesh • End ileostomy
hernia
• Transverse colostomy
• Repair of the inguinal • Pilonidal sinus excision
• Hartman colostomy
hernia( tissue repair) • Feeding tube insertion •
• Repair of inguinal hernia • Breast abscess drainage
with mesh

23
 PGY 4

GENERAL SURGERY
Duration: 8 months

First four months Second four months Third four months

Knowledge TOPICS Knowledge TOPICS Knowledge TOPICS
Functional disorder of the intestine The large intestine The Gall bladder and bile ducts
▪ Applied anatomy and ▪ Anatomy and physiology ▪ Surgical anatomy and physiology
physiology of the large intestine ▪ Imaging
▪ Tests of intestinal function ▪ Tumors of the large ▪ Choledochal cyst
▪ Acute adynamic neuromuscular intestine ▪ Cholelithiasis
states of the small intestine ▪ Malignant colorectal ▪ Tumors of the bile ducts
with dilatation: Ileus carcinoma ▪ Primary sclerosing cholangitis
▪ Acute adynamic state of the ▪ Colitis ▪ Parasitic infestation of the biliary
large intestine with dilatation: ▪ Diverticular disease tract
Acute colonic pseudo- ▪ Volvulus The liver
obstruction ▪ Colostomies ▪ Anatomy of the liver
▪ Chronic impairment of The rectum ▪ Acute and chronic disease
intestinal motility with ▪ Anatomy of the rectum ▪ Investigation in liver disease
dilatation of the small intestine: ▪ Clinical feature of rectal ▪ Liver trauma
intestinal pseudo-obstruction disease ▪ Portal hypertension
▪ Chronic impairment of the ▪ Injuries of rectum ▪ Chronic liver disease
intestinal motility with ▪ Rectal prolapse ▪ Infective condition of the liver
dilatation of the large intestine: ▪ Proctitis ▪ Liver tumors
Mega colon and mega rectum ▪ Rectal polyps Intestinal obstruction
▪ Chronic impairment of ▪ Benign rectal lesions ▪ Classification
intestinal motility without ▪ Carcinomas ▪ Pathophysiology
dilatation The Anus and anal canal ▪ Special types
▪ Irritable bowel syndrome ▪ Anatomy and physiology ▪ Chronic large bowel obstruction
The small intestine of the anal canal ▪ Adynamic obstruction
▪ Anatomy of the small intestine ▪ Examination of the anus
▪ Physiology of the small ▪ Congenital abnormalities
intestine ▪ Incontinence
▪ Inflammatory bowel disease ▪ Anal fissure
▪ Connective tissue disorders ▪ Hemorrhoids
▪ Vascular anomaly of the small ▪ Anorectal abscess
intestine ▪ Fistula in ano
▪ Conditions causing ▪ Malignant tumors
malabsorption ▪ Non-malignant strictures
▪ Enterocutaneous fistula and stenosis
▪ Short bowel syndrome Inflammatory bowel disease
▪ ▪ Acute colitis
▪ Crohn disease

24
 B- Procedures B- Procedures B- Procedures
• Open cholecystectomy • Repair of femoral hernia ▪ Resection of small intestine
• Cholecystostomy • Repair of recurrent inguinal ▪ Entero-enterostomy
• Biopsy of liver hernia ▪ Parastomal hernia repair
• Splenectomy • Repair of incisional hernia ▪ sigmoidectomy with
• Simple mastectomy • Incisional hernia mesh repair colostomy
• Sentinel lymph node dissection( • Obstructed/strangulated ▪ hemorrhoidectomy
breast ) hernia procedures ▪ fistulectomy
• Axillary dissection ( breast ) • Closure of perforated ▪ sphincterotomy
• Gastrostomy duodenal ulcers ▪ feeding tube insertion
▪ pilonidas sinus operations

25
 PGY 5 (Chief resident)

GENERAL SURGERY
Duration: 10 months

First four months Second four months Third four months

Knowledge TOPICS Knowledge TOPICS Knowledge TOPICS

The Esophagus The pancreas The thyroid Gland
▪ surgical anatomy and ▪ Anatomy and physiology ▪ Surgical anatomy
physiology ▪ Investigations ▪ Physiology of Thyroid
▪ investigation of esophageal ▪ Congenital abnormalities ▪ Thyroid Enlargement
disease ▪ Injury of the pancreas ▪ Hyperthyroidism
▪ gastro-esophageal reflux ▪ Pancreatitis ▪ Neoplasms of the thyroid
disease ▪ Carcinoma of the pancreas ▪ Thyroiditis
▪ barret esophagus The spleen The parathyroid Gland
▪ motility disorders and ▪ Anatomy and physiology of ▪ Anatomy of the parathyroid
diverticula spleen gland
▪ esophageal perforation ▪ Splenomegaly and ▪ Primary
▪ caustic injury hypersplenism hyperparathyroidism
▪ neoplasms of the esophagus ▪ Neoplasms ▪ Secondary
the stomach The Breast hyperparathyroidism
▪ Anatomy of the stomach ▪ Comparative and surgical ▪ Tertiary
and duodenum anatomy hyperparathyroidism
▪ Physiology of the stomach ▪ Investigation for breast ▪ Parathyroid carcinoma
and duodenum symptoms ▪ Persistent
▪ Investigations of stomach ▪ Benign breast disease hyperparathyroidism
and duodenum ▪ The nipple ▪ Recurrent
▪ Helicobacter pylori ▪ Carcinoma of the breast hyperparathyroidism
▪ Peptic ulcer The Adrenal Gland and abdominal
▪ Melena and hematochezia endocrine disorders
▪ Gastric outlet obstruction ▪ Anatomy and physiology
▪ Gastric cancers ▪ Incidentaloma
▪ Duodenal tumors ▪ Disorders of the cortex
Bariatric and metabolic surgery ▪ Adrenal insufficiency
▪ Metabolic surgery ▪ Adrenal hemorrhage
▪ Principle of setting up a ▪ Disorders of the adrenal
bariatric and metabolic medulla and diffuse
surgery service neuroendocrine system
▪ Surgery of the adrenal gland
▪ Pancreatic neuroendocrine
tumor
▪ Neuroendocrine tumors of
stomach and small intestine
▪ Multiple endocrine
neoplasia

26
 B- Procedures B- Procedures B- Procedures
• Esophagectomy • Diaphragmatic hernia repair • Common bile duct exploration
• Gastrojejunstomy • Closure of the colostomy • Choledcolithotomy
• Pyloroplasty • Colon anastomosis • Choledcoduodenostomy
• Vagotomy ( Truncal ) • Intestinal resection and • Hepaticojejunstomy
• Hemigastrectomy, Billroth I anastomosis • Liver hydatid cyst operations
method • Colectomy, Right • Liver resections
• Hemigastrectomy, Billroth II • Colectomy, Left • Choledochal cyst operations
• Fundoplication • Rectal prolapse operations • Drainage of cyst or pseudocyst
• Paraesophageal hernia repair • Laprascopic cholecystectomy of the pancreas
• Hiatal hernia repair • Laprascopic appendectomy • Pancreatic jejunstomy
• cardiomyotomy • Laprascopic inguinal hernia • Whipple’s operation
• Percutaneous Endoscopic repair •
Gastrostomy • Laprascopic abdominal wall • Pancreaticoduodenctomy
• Exploratory Laparotomy for hernia • Resection of the tail of
trauma or acute abdomen • Modified radical mastectomy pancreas
• Excision of intraabdominal • Total pancreatictomy
masses and lesions • Thyroidectomy, subtotal
• Open Adrenalectomy

27
 Clinical Procedure Cases Rotation Schedule From First – Fifth years
First year

03 Months 06 Months 09 Months 12 Months

Procedures
Total

Level Cases Level Cases Level Cases Level Cases of

cases

Patient management

Eliciting Pertinent History/Physical Exam 1 30 2 30 3 30 4 30 120

Removal of drains 1 5 2 5 2 5 3 5 20

Superficial wound debridement and 1 5 2 5 2 5 3 5 20

necrectomy

DPC 1 5 2 5 2 5 3 5 20

Removal of small superficial skin lesions and 1 5 2 5 2 5 3 5 20

tumors

Primary and secondary wound closure 1 5 2 5 3 5 4 5 20

Abscess incision and drainage 1 5 2 5 3 5 4 5 20

Dressings and change dressings 1 5 2 5 3 5 4 5 20

Suture removal 1 5 2 5 3 5 4 5 20

IV access line placement 1 5 2 5 3 5 4 5 20

Foley Catheter, NGT and rectal tube insertion 1 5 2 5 3 5 4 5 20

and removal

CPR 1 5 2 5 3 5 4 5 20

28
 Second year

15 Months 18 Months 21 Months 24 Months

Procedures Total

Level Cases Level Cases Level Cases Level Cases of

cases

Patient management

Eliciting Pertinent History/Physical Exam 4 30 4 30 4 30 4 30 120

Abdominal wall incision and closure 1 5 2 5 2 5 2 5 20

Tissue dissection 1 5 2 5 2 5 2 5 20

Biopsy 1 5 2 5 2 5 2 5 20

DPL 1 5 2 5 2 5 2 5 20

Appendectomy 1 5 2 5 2 5 2 5 20

Removal of drains 4 5 4 5 4 5 4 5 20

Superficial wound debridement and 4 5 4 5 4 5 4 5 20

necrectomy

DPC 4 5 4 5 4 5 4 5 20

Removal of small superficial skin lesions and 4 5 4 5 4 5 4 5 20

tumors

Skin incision and closure 1 5 2 5 3 5 4 5 20

29
 Third year

27 Months 30 Months 33 Months 36 Months

Procedures
Total of
Level Cases Level Cases Level Cases Level Cases
Cases

Patient management

Eliciting Pertinent History/Physical Exam 4 30 4 30 4 30 4 30 120

Feeding tube insertion 1 5 2 5 2 5 2 5 20

Incisional hernia repair 1 5 2 5 2 5 2 5 20

Recurrent inguinal hernia repair 1 5 2 5 2 5 2 5 20

Femoral hernia repair 1 5 2 5 2 5 2 5 20

Pilonidal sinus excision 1 5 2 5 2 5 2 5 20

Biopsy 3 5 3 5 4 5 4 5 20

DPL 3 5 3 5 4 5 4 5 20

Appendectomy 3 5 3 5 4 5 4 5 20

Abdominal wall incision and closure 3 5 3 5 4 5 4 5 20

Uncomplicated Umbilical, paraumbilical, 3 5 3 5 4 5 4 5 20

epigastric hernia repair

Inguinal hernia repair 3 5 3 5 4 5 4 5 20

Tissue dissection 3 5 3 5 4 5 4 5 20

Hemorrhoidectomy 1 5 2 5 3 5 4 5 20

Perianal abscess incision and drainage 1 5 2 5 3 5 4 5 20

30
 Fourth year

27 Months 30 Months 33 Months 36 Months

Procedures
Total of
Level Cases Level Cases Level Cases Level Cases
Cases

Patient management

Eliciting Pertinent History/Physical Exam 4 30 4 30 4 30 4 30 120

Operations for anal fissure 1 5 2 5 2 5 2 5 20

Operations for perianal fistula 1 5 2 5 2 5 2 5 20

Exploratory laparotomy for trauma or 1 5 2 5 2 5 2 5 20

acute abdomen

Colostomy, Ileostomy and their closure 1 5 2 5 2 5 2 5 20

(reversal)

Cholecystectomy 1 5 2 5 2 5 2 5 20

Splenectomy 1 3 2 3 2 3 2 3 12

Feeding tube insertion 3 3 3 3 4 3 4 3 12

Incisional hernia repair 3 5 3 5 4 5 4 5 20

Recurrent inguinal hernia repair 3 5 3 5 4 5 4 5 20

Femoral hernia repair 3 5 3 5 4 5 4 5 20

Obstructed/strangulated hernia 3 5 3 5 4 5 4 5 20
procedures

Pilonidal sinus excision 3 5 3 5 4 5 4 5 20

Excisional biopsy of benign breast lesions 1 5 2 5 3 5 4 5 20

Fifth year
Procedures
27 Months 30 Months 33 Months 36 Months

31
 Total of
Level Cases Level Cases Level Cases Level Cases
Cases

Patient management

Eliciting Pertinent History/Physical Exam 4 30 4 30 4 30 4 30 120

Operations on choledochal cyst 1 2 2 2 2 2 2 2 10

Enterobiliary anastomosis 1 2 2 2 2 2 2 2 10

Thyroidectomy 1 4 2 4 2 4 2 4 16

Whipple’s operation 1 2 2 2 2 2 2 2 8

Laparoscopic cholecystectomy 1 5 2 5 2 5 2 5 20

Cardiomyotomy 1 2 2 2 2 2 2 2 8

Fundoplication 1 2 2 2 2 2 2 2 8

Modified radical mastectomy 1 3 2 3 2 3 2 3 12

Esophagectomy 1 2 2 2 2 2 2 2 8

Duodenal procedures 1 3 2 3 2 3 2 3 12

Excision of intraabdominal masses and 1 5 2 5 2 5 2 5 20

lesions

Gastrectomy 1 2 2 2 2 2 2 2 8

Liver resections 1 2 2 2 2 2 2 2 8

Procedures for rectal prolapse 1 5 2 5 2 5 2 5 20

Hiatal hernia repair 1 3 2 3 2 3 2 3 12

Operations for anal fissure 3 5 3 5 4 5 4 5 20

Operations for perianal fistula 3 5 3 5 4 5 4 5 20

Exploratory Laparotomy for trauma or 3 5 3 5 4 5 4 5 20

acute abdomen

Graham’s patch for perforated peptic 2 5 3 5 4 5 4 5 20

ulcer

Gastric drainage procedures 2 2 3 2 4 2 4 2 8

Drainage of liver abscess 2 5 3 5 4 5 4 5 20

32
Intestinal resection and anastomosis 2 5 3 5 4 5 4 5 20

Colostomy, Ileostomy and their closure 3 5 3 5 4 5 4 5 20

Cholecystectomy and CBD exploration 3 5 3 5 4 5 4 5 20

Splenectomy 2 3 3 3 4 3 4 3 20

Pyloroplasty 2 3 3 3 4 3 4 3 20

Vagotomy 2 2 3 2 4 2 4 2 20

Simple mastectomy 2 5 3 5 4 5 4 5 20

Gastroenterostomy 2 3 3 3 4 3 4 3 12

Operations for liver hydatid disease 2 5 3 5 4 5 4 5 12

Operations for pancreatic pseudocyst 2 2 2 3 4 2 4 2 12

Laparoscopic appendectomy 1 20 2 20 3 10 4 10 60

Laparoscopic cholecystectomy 1 10 2 20 3 20 4 10 60

33
Rotations
Rotations Two months Rotations
Level Cases

Anesthesia
1. Pre-anesthetic examination and preparation 1,2,3
2. General anesthesia, components of anesthesia 1,2,3
3. Local and regional anesthesia 1,2,3,4
4. Respiratory insufficiency 1,2,3
5. Cardiac arrest 1,2,3
6. Basic postoperative reanimation 1,2,3
7. Post-operative reanimation of the critical patient 1,2,3

8. Pain and Analgesia 1,2,3,4

9. Deliver seminars/conference 3,4
10. pre-anesthesia checkup 1,2,3,4
11. local anesthesia 1,2,3
12. regional anesthesia (spinal, epidural, regional block) 1,2,3
13. general anesthesia 1,2,3
14. endotracheal intubation, 1,2,3
15. NG tube insertion 1,2,3,4
16. postoperative reanimation 1,2,3,4
17. Care of patient during anesthesia 1,2,3
18. Attend relevant lectures, conferences 2,3,4

34
 Rotations one months Rotations
Level Cases

Intensive Care Unit (ICU):

1. Airway management 1,2,3

2. Cardiopulmonary resuscitation 1,2,3

3. Acute respiratory failure 1,2,3

4.
5. Diagnosis and management of shock 1,2,3
6. Fluid management 1,2,3,4
7.
8. Basic trauma and burn support 1,2,3
9. Electrolyte and metabolic disturbance 1,2,3,4
10. Transfusion 1,2,3,4
11.
12. Neurological support 1,2,3,4
13. Ethic in critical care medicine 1,2,3,4
14. ICU visit Deliver seminars/conference 1,2,3,4

15. Primary and secondary evaluation of critical patient 1,2,3

16.
1. Care and monitoring of ICU patient 1,2,3,4
2. Physical exam of GCS scoring of coma patient 1,2,3,4
3. Conduct of CPR on coma in case of cardiac arrest 1,2,3
4. andpulmonary arrest
Upper airway management and intubation 1,2,3
5. Attend relevant lectures, conferences 3,4

35
 Rotations Two months Rotations
Level Cases

Imaging
1. Ultrasound 1,2,3,4

2. Radiology 1,2,3,4
3. CT Scan 1,2,3
4. MRI 1,2,3
5. Common Pathological Findings (with respect to general 1,2,3
surgery) in Abdominal and Pelvic MRI
6. Patient preparation for radiography 1,2,3,4
7. Contrast x-rays (e.g. fistulography) 1,2,3
8. FAST and e-FAST 1,2,3,4
9. Report writing 1,2,3
10. Attend relevant lectures, conferences 3,4
11. Deliver seminars/conference 3,4

36
 Rotations Two months Rotations
Level Cases

Orthopedics and Traumatology

6. History and physical examination of orthopedic patient 1,2,3

7. Common investigations required for orthopedic patients 1,2,3
8. Degenerative states of bones and joints 1,2,3
9. Deformities of bones and joints 1,2,3
10. Infections of bone and soft tissue 1,2,3,4
11. Neoplasms of bone and soft tissue 1,2
12. Traumatology 1,2,3
13. Upper Extremity Trauma 1,2,3
14. Lower Extremity Trauma 1,2,3
15. Pelvic Trauma 1,2
16. Polytrauma Patient 1,2,
17. Assessment and first aid to trauma patient 1,2,3
18. Soft tissue wound management (tendon, muscle, fascia) 1,2,3,
19. Reduction of dislocations 1,2,3
20. Reduction of fractures 1,2,3
21. Apply plaster (slabs, POP etc) 1,2,3,4
22. Removal of plaster 1,2,3,4
23. Ortho-traumatology operative cases 1,2
24. Amputation 1,2,3
25. Attend relevant lectures, conferences 3,4
26. Deliver seminars/conference 3,4

37
 Rotations one month Rotations
Level Cases

Intensive Care Unit (ICU2):

1. Life threatening infections 1,2,3
2. Nutrition support in ICU patient 1,2,3
3.
4. Acid base balance disturbances 1,2,3
5. Prevention and treatment of acquired pneumonia 1,2,3
6. Sepsis and septic shock 1,2,3,4
7.
8. ARDS and COPD 1,2,3
9. Diabetic ketoacidosis 1,2,3
10.
11. Diagnosis and treatment of Cardiac arrhythmias 1,2,3
1. Use of anticoagulants for prevention and treatment of 1,2,3
thrombosis
12. ICU visit 1,2,3
13. Central vein catheterization and its management 1,2,3
14. Gasomtry and using I-state machine 1,2,3
15. Introduction to Artificial (mechanical) ventilation 1,2,3
16. Cardioversion and pacing in cardiac arrhythmias 1,2,3
17. Central vein care and determine central vein pressure 1,2,3
18. Nutritional assessment and weight of ICU patient 1,2,3
19. Attend relevant lectures, conferences 1,2,3,4
20 Deliver seminars/conference 1,2,3,4
21

38
 Rotations One months Rotations
Level Cases

Endoscopic
2. History of endoscopy 1,2,3,4
3. Principles of Endoscopy 1,2,3,4
4.
5. Patient preparation for endoscopy 1,2,3,4
6. Indications and contraindications for endoscopy 1,2,34,
7. EGD 1,2,3
8. Recto-Sigmoidoscopy 1,2,3
9. simple endoscopic procedures: 1,2,3
10.
11. Biopsy 1,2,3
12. Cauterization 1,2
13. Polypectomy 1,2
14. Attend relevant lectures, conferences 1,2,3,4
15. Deliver seminars/conference 1,2,3,4

39
 Rotations One months Rotations
Level Cases

Burn Surgery
1. Skin Anatomy and Physiology 1,2,3,4
2. Pathophysiology of Burns 1,2,3,4
3. Initial Treatment of Burns 1,2,3,4
4. Inhalation Injury 1,2,3
5. Wound Care 1,2,3,4
6. Nutrition 1,2,3,4
7. Outcomes of burn 1,2,3
8. Electrical Burns 1,2,3
9. Chemical Burns 1,2,3
10. Radiation Burn 1,2,3
11. Morning report and visits 1,2,3
12. History and physical exam of burn patient 1,2,3,4
13. Assessment and first aid to burn patient 1,2,3,4
14. Calculate IV fluids for first 24 hours and maintenance IV fluid 1,2,3,4
15. Burn wound management 1,2,3,4
16. Debridement 1,2,3,4
17. Dressings 1,2,3,4
18. Early and delayed SSG 1,2,3
19. Burn in-patient care 1,2,3,4
20. Attend relevant lectures, conferences 1,2,3
21. Deliver seminars/conference 1,2,3

40
 Rotations One months Rotations
Level Cases

Forensic Medicine
1. Basic of Legal medicine 1,2,3
2.
3. Criminal cases assessment and management 1,2,3
4.
5. Basics of autopsy 1,2,3
6.
7. Death cases assessment, marking and procedures 1,2
8. Criminal cases history taking and diagnosis 1,2,3,4
9.
10. Management of criminal cases 1,2,3
11.
12. Autopsy procedure 1,2
13. Autopsy report to give 1,2,3
14. Death cases marks of identifications 1,2

41
 Rotations One months Rotations
Level Cases

Neurosurgery
1. Head Trauma 1,2,3
2. Neck and Spine Trauma 1,2,3
3. Peripheral Nerve Trauma 1,2,3
4. Diagnostic Investigations 1,2,3
5. Stroke 1,2,3
6. Spinal Degenerative Conditions 1,2
7.
8. History and physical exam of Neurosurgery patient 1,2,3,4
9. Assessment and first aid to Neuro-trauma patient 1,2,3,4
10. Neurosurgery operative cases 1,2
11. Peripheral nerve repair 1,2,3
12. Follow-up of neurosurgery patient 1,2,3,4
13. Calculate IV fluids for first 24 hours and maintenance IV fluid 1,2,3,4
14. lectures, conferences 1,2,3,4

42
 Rotations Two months Rotations
Level Cases

Pediatric Surgery
1. Anatomic and Physiologic in Pediatric Surgery 1,2,3,4

2. History and Physical Examinations in Pediatric Surgery 1,2,3,4

4. Patient
Trauma in Children 1,2,3
3.
5. Inguinal Hernia 1,2,3
6. Hydrocele 1,2,3
7. Undescended testis 1,2,3
8. Inguino-scrotal Surgical Conditions 1,2,3
9. Umbilical Hernia 1,2,3
10. Acute Abdomen 1,2,3
11. Rectal Prolapse and Rectal Bleeding 1,2
12. Common Congenital Malformations 1,2
13. Assessment and first aid to pediatric surgery patient 1,2,3,4
14.
15. Calculate IV fluids for first 24 hours and maintenance IV 1,2,3,4
17. fluids for conferences
lectures, pediatric patient 1,2,3,4
16.
18. pediatric surgery operative cases 1,2,3,4

43
 Rotations Two months Rotations
Level Cases

Obstetrics and Gynecology:

1. History and physical exam of Obstetrics/gynecology patient 1,2,3,4

2. Female pelvic anatomy and physiological changes during 1,2,3,4

pregnancy
3. Pre and Post-partum hemorrhage and their management 1,2,3

4. Pelvic Infections and PID 1,2,3,4

5. Surgery During Pregnancy 1,2,3

6. Ovarian Cyst Torsion 1,2,3
7. Common Obstetric Surgical Procedures 1,2,3
8. Morning report and visits 1,2,3,
9. Assessment and first aid to OB/Gynecology emergency cases 1,2,3
10. Cesarean operation 1,2,3

11. Hysterectomy 1,2,3

12. Ovarian cyst surgical management 1,2,3
13. Attend relevant lectures, conferences 1,2,3,4
14. Deliver seminars/conference 1,2,3,4
15. Acute Abdominal Pain in Early and During Pregnancy 1,2,3,4

44
 Rotations One months Rotations
Level Cases

Plastic surgery
1. Participate in morning report and visits 1,2,3

2. History and physical exam of plastic surgery patient 1,2,3,4

3. plastic surgery operative cases 1,2,3
4. Follow-up of plastic surgery patient 1,2,3,4
5. Attend outpatient clinic 1,2,3
6. Attend relevant lectures, conferences 1,2,3,4
7. Deliver seminars/conference 1,2,3,4
8. Principles of Plastic surgery 1,2,3,4
9. Skin Grafting 1,2,3
10. contractures 1,2
11. flaps 1,2,3
12. Tissue Expansion 1,2,3
13. Ethics of esthetic surgery 1,2,3

45
 Rotations Two months Rotations
Level Cases

Urology
1. Surgical Anatomy and Physiology 1,2,3,4

2. History and physical exam of urology patient 1,2,3,4

3. Symptoms and Sings and Investigations of Urologic Disorders 1,2,3
4. Trauma to Kidney, Ureter, Bladder, Urethra, Penis, Testes 1,2,3,
5. Acute Urinary Retention 1,2,3,4
6. Testicular Torsion 1,2,3,4

7. Frounier’s Gangrene 1,2,3

8. Phemosis and Paraphemosis 1,2,3

9. Epiddymo-orchitis 1,2,3,4

10. Prostatitis 1,2,3,4

11. Pyelonephritis 1,2,3,4

12. BPH 1,2,3

13. Urethral Strictures 1,2,3
14. Retroperitoneal Fibrosis 1,2,
15. Scrotal Masses 1,2,3
16. Hydrocele, Varicolcele, Spermatocele 1,2,3,4
17. Urinary Tract Stones 1,2
18. Bladder Cancer 1,2

19. Kidney Cancer 1,2

20. Prostate Cancer 1,2
21. Testicular Cancer 1,2
22. Hydrocele 1,2,3,4
23. Attend relevant lectures, conferences 1,2,3,4
24. Urological trauma 1,2,

25. Endourology cases 1,2

26. Testicular torsion 1,2,3
27. Urethral catheterization for urethral strictures, trauma and 1,2,3
difficult catheterization

46
 Rotations Two months Rotations
Level Cases

Chest surgery
1. Morning report and visits 1,2,3
2. History and physical exam of chest surgery 1,2,3,4
3. chest surgery operative cases: 1,2,3
4. a. outpatient
Attend Emergency/elective
clinic chest tube insertion 1,2,3
b. Removal of chest tube
5. Follow-up of chest surgery
c. Emergency patientand hemostasis
thoracotomy 1,2,3,4
6. d. relevant
Attend Thoracocenthesis (pleurocenthesis,
lectures, conferences 1,2,3,4
7. pericardiocenthesis)
Deliver seminars/conference 1,2,3,4
e. Emergency bronchoscopy for foreign body removal
8. Surgical Anatomy and Physiology 1,2,3,4
9. Investigations for chest surgery 1,2,3,4
10. Approach to Chest Trauma 1,2,3
11. Pleural Disease 1,2,3,
12. Pneumothorax 1,2,3
13. Pleural Effusion 1,2,3,4
14. Empyema 1,2,3
15. Inhaled Foreign Bodies and Airway Obstruction 1,2,3
16. Lung Cysts and Abscess 1,2,3
17. Lung Cancer 1,2
18. Mediastinal Diseases 1,2,3
19. Surgery for Pulmonary TB 1,2,3

47
 Rotations Two months Rotations
Level Cases

Vascular surgery
1. Morning report and visits 1,2,3

2. Clinic and Investigation of vascular patient 1,2,3,4

3. General Approach to Vascular Trauma 1,2,3

4. Operative Principles Neck Injuries 1,2,3

5. Thoracic Vascular Injuries 1,2,3

6. Abdominal Vascular Injuries 1,2,3

7. Peripheral Vascular Trauma 1,2,3

8. Aneurismal Vascular Disease 1,2

9. Arterial Occlusive Disease 1,2,3

10. Atherosclerosis, Arterial Stenosis and Occlusion 1,2,3

11. Acute Thromboembolism 1,2,3

12. Mesentric Artery Disease 1,2,

13. Arteritis and Vasospastic Conditions 1,2,3

14. Venous Insufficiency and Varicose Veins 1,2,3

15. Deep Vein Thrombosis 1,2,3

16. Phlebitis and Thrombophlebitis 1,2,3

17. General Approach to Vascular patient 1,2,3

18. History and physical exam of vascular surgery patient 1,2,3

19. Emergency/elective vascular repairs including grafts 1,2,

20. Thrombectomy 1,2,3

21. Varicose vein surgery 1,2

22. Attend outpatient clinic 1,2,3

23. Follow-up of vascular surgery patient 1,2,3

24. Attend relevant lectures, conferences 1,2,3,4

25. Deliver seminars/conference 1,2,3,4

48
C. mandatory workshops
• Research methodology and Biostatistics syllabus including in the first year of residency
of all training programs
• Communication skills
• IT Workshop
• Basic life support

D. Other workshops according to specialty (PALS/ALSO/ABLS/ACLS )

General Surgery Rotations PGY 1-5

PGY1
Rotations Duration
(Months)
General surgery 7 months

General surgery basics I 6 months

Trauma-I 1 month
Imaging 2 months
Anesthesia 2 months
ICU 1 month

PGY2

Rotations Duration(Months)

G. Surgery 6 months
G. surgery Basic II 5 months
Trauma II 1 month
Orthopedics and traumatology 2 months
ICU 2 1month
Endoscopy 1month
Legal medicine 1 month
Burn surgery 1 month

PGY 3
Rotations Duration(Months)

49
 General surgery 7 months
Neurosurgery 1 months
Pediatric surgery 2 month
OB/GYN 1 months
Plastic Surgery 1month

PGY 4
Rotations Duration(Months)

General surgery 8 months

Urology 2 months
Chest surgery 2months

PGY 5
Rotations Duration
(Months)
General surgery 10 months
Vascular Surgery 2 months

50
Abbreviations:
1. PGME = Post Graduation Medical Education
2. DPC = Delayed Primary closure
3. DPL = Diagnostic Peritoneal Lavage
4. CPR = Cardio pulmonary Resuscitation
5. OB/GYN= Obstetrics/Gynecology
6. IV = Intra Venous
7. ICU = Intensive Care Unit
8. IT = Informative Technology
9. ANDI = Aberrations of Normal Development and Involution
10. BPH = Benign Prostatic Enlargement
11. GI = Gastro Intestinal
12. CNS = Central Nervous system
13. TB = Tuberculosis
14. ATLS = Advance Trauma Life Support
15. HIV = Human Immunosuppressive Virus
16. POP = Plaster of Paris
17. ARDS = acute respiratory distress syndrome
18. COPD = Chronic Obstructive Pulmonary Disease
19. EGD = Esophago gastro duedenoscopy
20. MRI = Magnetic Resonance Imaging
21. CT SCAN= Computed Tomography Scan
22. FAST = Focused assessment with sonography in trauma
23. GCS = Glasco coma scale
24. SSIs = Surgical Site Infections
25. ATOM = Advanced Trauma Operative Management
26. CBME = competency-base medical education
27. HOD = Head of Department
28. ENT = Ear Nose and Throat
29. ATLS = Advance Trauma Life Support
30. ABLS = Advance Burn Life Support

51
REFERENCES:
1- MS General Surgery Curriculum, University of Health Sciences, Lahore City,
2- General Surgery Curriculum, Pgme, Kabul – Afghanistan 2016
3- Curriculum Development for Postgraduation Medical Education, Third Edition, John
Hopkins University, Usa – 2016
4- Introducing Competency – Based Postgraduate Medical Education In The Netherlands-
2018
5- Patricia A. Thomas, David E Karim, Mark T. Hughers and Belinda Y. (2012) Curriculum
development for Medical education. A six step approach Third edition, John Hopkin
university press.
6- Laura Edgar, Sydney Mclean, Saen O. Hogan, Stan Hamstra. (2020) The milestones
Guidebook. Accredidated council for graduate medical education.
7- Shrijana S. Ashis Shrestha, Jay Narayan Shah, Rajesh Nath Gongal (2021) Competency
based Postgraduate residency program at Patan Academy of Health Sciences, Nepal.
Medical Education (2008; 30 248-253) https://doi.org/10.33314/jnhrc.v19i1.3263
8- Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015 Physician Competency Framework.
Ottawa: Royal College of Physicians and Surgeons of Canada; 2015

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