Introduction to Surgery 2 (SURG 636) Semester 171 M K ALAM MS FRCS Professor of Surgery AL MAAREFA COLLEGE

Aims To prepare professional clinicians with sound knowledge, skills, understanding and appropriate attitudes ready to qualify in the graduating examination. They should be ready to specialize and practice in the field of medical science of their choice.

Theoretical objectives To provide a broad based knowledge of diseases in the field of general surgery To provide basic knowledge of diseases in the field of surgical specialties

Clinical objectives Perform and demonstrate- history taking. Perform and demonstrate- clinical examination. Demonstrate skills to- interpret clinical signs. Record & produce- full & summarized history & clinical examinations. Demonstrate knowledge of common surgical diseases. Demonstrate skill to formulate a reasonable differential diagnoses.

Clinical objectives Justify investigations & interpret its findings. Show the need for careful, accurate and speedy decision making. Getting involved with surgical emergencies & critically ill patients. Skill to choose from- spectrum of surgical care ( operative vs non-operative). Demonstrate self-learning & use of different teaching aids Demonstrate dedication, concern, confidentiality of information. Demonstrate professional manners.

COURSE DESCRIPTION Surgery 2 (SURG 636) Six (6) weeks. 1st Rotation (R1)- Sun 17th Sept- Mon 23rd Oct 2017 2nd rotation (R2)- Tue 24th Oct- Mon 27th Nov 2017 3rd rotation (R3)- Tue 28th Nov - Mon 01st Jan 2018

Course plan Final examination Lectures & Tutorials -Sunday & Monday Hospital posting- Tuesday- Thursday 3rd week SUNDAY- Mid-Block examination Case presentation ( last Tutorial day) Final examination

Teaching Format Lectures Hospital posting Tutorials (Interactive sessions): Case scenarios/ interpretation of lab. results/ imaging studies/ spot diagnosis/ common instruments

Tutorial topics for students 1. Intervention radiology procedures in general surgery. Indications & patient preparation 2. How to prepare patients for general surgery procedures 3. Post-operative (recovery room & ward) management.

Principles of surgery General surgery Urology Thoracic surgery Syllabus Course will include topics from: Principles of surgery General surgery Urology Thoracic surgery Neurosurgery Plastic surgery Pediatric surgery Vascular surgery

Principles of Surgery Anaesthesia and pain management Sterilization, aseptic technique & operation room (Sutures, diathermy, drains, some instruments) Day surgery Principles of transplantation surgery

General Surgery Upper GI hemorrhage. Lower GI hemorrhage Small bowel obstruction Large bowel obstruction and colostomies Obstructive jaundice Bariatric surgery- surgical management of obesity Minimally invasive surgery

Urology General presentation, assessment and investigations of urinary tract diseases. Diseases of upper urinary tract (kidney & ureter) Diseases of lower urinary tract (bladder, prostate, urethra) Diseases of external genitalia: Circumcision, Congenital abnormalities of the penis, undescended testis (cryptorchidism), Torsion of the testis, Epididymo-orchitis, hydrocele, Varicocoele.

Thoracic surgery Diseases of oesophagus Mediastinum, and pleuro-pulmonary infections Presentation and management of: Bronchogenic carcinoma, other lung tumours including metastatic carcinoma, mesothelioma.

Paediatric surgery Common neonatal emergencies: Hirschsprung’s disease, Esophageal atresia, Imperforated anus, intestinal atresia, Pediatric emergencies: Acute appendicitis, intussusception, Meckel’s diverticulum, Foreign bodies, perianal sepsis Hernias, abdominal wall defects, undescended testis, childhood obesity

Vascular surgery 1. Arterial diseases- Acute &Chronic- 2 lectures Venous diseases & lymphatic diseases

Plastic surgery Management of burn Skin and subcutaneous tumours

Neurosurgery Management of head injury Intracranial tumours and infections

Lecture Timetable- Group 1, Group 2 & Group 3 ALMAAREFA COLLEGE Teaching program: SURG 2 (636) Semester 171 Lecture Timetable- Group 1, Group 2 & Group 3 Day 8 - 8.50 AM 8.50 - 9.40 AM Break 9.40 - 10 AM 10-10.50 10.50-11.40 Prayer 11.40-1PM 1-2 PM 2-3 PM 1st Week SUNDAY R1: 17-09-17 R2- 29-10-17 R3-10-12-17 Small bowel obstruction   Prof. AlSaigh Upper GI bleeding Introduction to Surgery 2 Prof. Alam Day Surgery Prof Alam Chronic Arterial disease Dr. Qaisar Venous & lymphatic diseases MONDAY R1: 18-09-17 R2- 30-10-17 R3-11-12-17 Lower GI bleeding Principles of transplantation surgery Sterilization, aseptic technique and operation room Acute limb ischemia Hernias, abdominal wall defects, undescended testis, childhood obesity Dr. S Mallick 2nd week R1: 24-09-17 R2- 05-11-17 R3-17-12-17 General presentation, assessment & investigations of urinary tract diseases Dr. M Turki Diseases of upper urinary tract (kidney & ureter) Diseases of oesophagus Dr. Waseem Hajjar Diseases of mediastinum & pleuro-pulmonary infections Management of head injury+ Raised ICP Dr. Safdar Intracranial tumors and infections R1: 25-09-17 R2- 06-11-17 R3-18-12-17 Diseases of lower urinary tract Diseases of external genitalia Surgical mgt. of morbid obesity in adults Anaesthesia & pain management(G3) Dr. Bilal Common neonatal emergencies Pediatric emergencies 3rd week R1: 1-10-17 R2- 12-11-17 R3-24-12-17 Management of Burn Dr. Shareef Management of skin & subcutaneous tumours, skin grafts Obstructive jaundice Introduction to minimally invasive surgery Prof AlSaigh Large bowel obstruction Bronchogenic carcinoma, other lung tumours, metastatic carcinoma & mesothelioma Dr. Waseem Hajjar R1: 2-10-17 R2- 13-11-17 R3-25-12-17 Case scenario- Breast lump Case scenario: Thyroid & other neck swellings Interpretation of common imaging studies

4th Week SUNDAY R1: 8-10-17 R2- 19-11-17 R3-31-12-17 Intervention radiology procedures in general surgery. Indications & patient preparation   Presentation by students (Gr 1) Case scenario: A trauma patient Prof Alam How to prepare patients for general surgery procedures Presentation by students (Gr 2) MONDAY R1: 9-10-17 R2- 20-11-17 R3-01-01-18 Case scenario: Complications of abdominal surgery Examples of laparoscopic surgery procedures. Prof. AlSaigh Post-operative (recovery room & ward) management. Presentation by students (Gr 3) 5th Week R1: 15-10-17 R2- 26-11-17 R3-07-01-18 Case scenario- Acute abdomen Dr. Akeely Spot diagnosis Interpretation of common laboratory investigations R1: 16-10-17 R2- 27-11-17 R3-08-01-18 Prof. Alam Case presentation by students Prof Alam / Prof AlSaigh Prof Alam / Prof AlSaigh

Hospital postings 3 days- fully spent in the hospital. (Tuesday-Thursday)

Hospital postings Surgical units: In-patient, operating room, emergency room & OPD .Actively participate in history taking, physical examination and discussing differential diagnosis. Present case history, physical examination and participate in case discussion with in-charge clinicians. Expected to master history taking and perform clinical examination on surgical patients as well as participating in patient-care related activities. Follow up and interpret investigation (blood, imaging) results. Discuss management plan & attend surgery with the treating team.

Hospital postings Maintain a logbook- document all patients seen, procedures attended/participated (signed by a consultant/ registrar/ tutor.) Display professional behavior at all time. Must abide by the hospital rules. Must strictly adhere to the confidentiality of patients and hospital. Must follow the dress code. Carry own pen torch and stethoscope.

SKILLS/PROCEDURES- AT HOSPITAL History & examination of different organ systems Study of imaging studies Interpretation of laboratory investigations Nasogastric tube Wound drains Wound care IV line PR exam Prostate examination Proctoscopy Suturing Urinary catheterization (Male & Female) Colostomy care (if available)

Examinations Final exams: Mid block exam: 45-MCQ s 30- MCQs Case scenario Slide show OSCE Clinical examination (2 short cases)

Marks distribution Mid-Block examination- 15 Marks Case presentation (5) + logbook (5)- 10 Marks Log book evaluation- attendance, h/e of pts., case presentation, skills attended/participated & tutor signature Final examination- 75 Marks

MID-BLOCK EXAMINATIONS R1 – Sunday 1st October 2017 R2 - Sunday 12th November 2017 R3 - Sunday 17th December 2017 Exam components: MCQ : 45 questions - 15 Marks

FINAL EXAMINATIONS R1- Sun 22 Oct & Mon 23 Oct 2017 R2 Sun 26 Nov & Mon 27 Nov 2017 R3 – Sun 31 Dec & Mon 01 Jan 2018 Examination components: MCQ: 30 questions - 10 Marks 2. Slide Show: 5 slides - 10 Marks (Each slide 2 marks) 3. Case scenarios: (2cases) - 10 Marks (Case slides/scenario & questions) 4. OSCE: (5 stations) - 25 Marks (X-ray, lab results, specimens, instruments, clinical pictures, history taking, clinical examination) 5. Clinical examination: 20 marks on real patients in hospital

BLUEPRINT FOR MCQs MCQs- 45 Mid-block exam MCQs- 30 End-block exam 1-2 Lecture Topics MCQs- 45 Mid-block exam MCQs- 30 End-block exam Anaesthesia and pain management   1-2 Sterilization, aseptic technique and operation room (Sutures, diathermy, drains, laparoscopic surgery) 2-3 3. Day surgery 4. Principles of transplantation surgery 5. Upper GI hemorrhage 3-5 6. Lower GI hemorrhage 7. Small bowel obstruction 8. Large bowel obstruction and colostomies 9. Obstructive jaundice 10. Surgical management of morbid obesity in adults 11. General presentation, assessment &investigations of urinary tract diseases. 3-4 12. Diseases of upper urinary tract (kidney & ureter) 13. Diseases of lower urinary tract (bladder, prostate, urethra) 14. Diseases of external genitalia: Circumcision, Congenital abnormalities of the penis, undescended testis (cryptorchidism), Torsion of the testis, Epididymo-orchitis, hydrocele, Varicocoele. 15. Diseases of oesophagus 16. Mediastinum, and pleuro-pulmonary infections 17. Presentation and management of: Bronchogenic carcinoma, other lung tumours including metastatic carcinoma, mesothelioma. 1-3 18. Management of head injury 19. Intracranial tumours and infections 20. Management of burn 21. Skin and subcutaneous tumours, 22. Common neonatal emergencies: Hirschsprung’s disease, Esophageal atresia, Imperforated anus, intestinal atresia, 23. Pediatric emergencies: Acute appendicitis, intussusception, Meckel’s diverticulum, Foreign bodies, perianal sepsis 24. Hernias, abdominal wall defects, undescended testis, childhood obesity 25. Chronic arterial diseases 26. Acute arterial ischemia 27. Venous disease and lymphedema 28. Tutorial topics 4-6 29. Minimally Invasive Surgery BLUEPRINT FOR MCQs

Thank you!