Introduction to Surgery 1 (SURG 633) Semester 171 M K ALAM MS;FRCS Professor of Surgery Al Maarefa Medical College

Theoretical Objectives To provide: A broad based knowledge of Basic Surgical Principles. Abroad based knowledge of Common Surgical Diseases. (Epidemiology, aetiology, risk factors, pathophysiology, classification, clinical presentation, differential diagnosis, investigations, overall management, specific treatment, complications and prognosis).

Clinical Objectives Perform & demonstrate skills of: History taking. Clinical examination. Interpretation of clinical signs. Recording & presenting- history & clinical examination findings. Symptoms & signs of common surgical diseases. To formulate a differential diagnoses. Investigation & management of surgical diseases/emergency.

Clinical Objectives Perform & demonstrate : Self-learning & use of different teaching aids. The spirit of dedication & concern. Professional behavior in dealing patients & their relatives. Respect patient’s wishes, and privacy. Importance of confidentiality of patient’s information. Communication skill- with patient & their families in simple language.

Semester 171 1st Rotation (R1)- Sun 17th Sept- Mon 23rd Oct ‘17 2nd rotation (R2)- Tues 24th Oct-Thurs 30th Nov ‘17 3rd rotation (R3)- Sun 03 Dec.-Mon 08th Jan 2018

Course plan - R1, R2, R3 Week 1: Lectures Lecture/Tutorial-Thursday Week 2 -5/6 Hospital posting, Mid-Block examination: SUNDAY of Week 3 Case presentation & logbook submission- Last tutorial day Final examination

Lectures Number of lectures (30). Duration of lectures: 50 minutes. Lecture topics and its ILOs are listed.

Lecture topics: Principles of Surgery 1. Shock: 2. Nutritional support of surgical patients: 3. Fluid/electrolytes disorders, acid base disorder, IV fluids: 4. Metabolic response to injury: 5. Hemostasis (coagulation defects, blood products & blood transfusion) 6. Wounds and wound healing, wound management: 7. Surgical infections & antibiotics: 8. Investigation of surgical patients: 9. Trauma (2 lectures) 10. Preoperative assessment and management: 11. Post-operative care and complications: 12. Principles of surgical oncology:

Lecture topics: General Surgery 13. Acute abdomen. (2 lectures) 14. Gallbladder & biliary tract disease: 15. Diseases of stomach and duodenum: 16. Diseases of small bowel: 17. Diseases of large bowel including rectum: 18. Common neck swellings: 19. Diseases of thyroid gland: 20. Diseases of adrenal and parathyroid: 21. Liver diseases: 22. Diseases of pancreas: 23. Diseases of spleen. 24. Diseases of the breast: 25. Common ano-rectal diseases: 26. Abdominal wall and hernia: 27. Diseases of peritoneum and retroperitoneal space

Tutorials 1st -5th week Venue: ALMAAREFA Medical College Interactive sessions. History & clinical examination (Different systems & body regions) Laboratory data interpretations. Imaging study interpretations. Case presentation- One interesting case seen during hospital posting.

Lectures & Tutorials schedule – Rotation 1 & Rotation 3 TEACHING PROGRAM SURG 1(633) SEMESTER 171 Lectures & Tutorials schedule – Rotation 1 & Rotation 3 Day & Date 8-8.50 AM 8.50-9.40 AM Break 10-10.50 AM 10.50-11.40 AM Prayer 11.40-1PM 1-3 PM Tutorial SUNDAY R1- 17-09-17   R3- 03-12-17 Introduction to Surgery 1. Prof. Alam Metabolic response to injury Prof Alam Wounds & Healing. Prof. AlSaigh Fluid/Electrolyte & Acid-Base disorders, IV fluids Dr. Al Ghamdi H/E of Neck Dr. Ahmad Al Ghamdi MONDAY R1-18-09-17 R3 04-12-17 Shock Nutritional support in surgical patients Trauma (1) Trauma (2). H/E of Breast TUESDAY R1-19-09-17 R3- 05-12-17 Diseases of spleen Diseases of thyroid gland Dr. Akily Diseases of adrenal & parathyroid Haemostasis & Coagulation defects H/E of Thyroid gland WEDNESDAY R1- 20-09-17 R3- 06-12-17 Abdominal wall and hernias Diseases of peritoneum & retroperitoneal space Small bowel diseases Prof. Salamah Post-operative care & complications Prof Salamah H/E of Swelling & Ulcers THURSDAY R1- 21-09-17 R3- 07-12-17 Gallbladder & biliary tract diseases Dr. Hamad Qahtani Liver diseases Diseases of pancreas Diseases of stomach & duodenum H/E of Hernias

Investigation of surgical patients Dr. Al Ghamdi DAY & DATE Lecture 8 - 8.50 AM Lecture 8.50 - 9.40 AM BREAK 9.40- 10AM Lecture 10 - 10.50 AM 10.50 - 11.40 AM PRAYER TUTORIAL 1 PM - 4 PM THURSDAY R1 28-09-17   R3- 14-12-17 Investigation of surgical patients Dr. Al Ghamdi Preoperative assessment Diseases of large bowel & rectum Common anorectal diseases H/E OF ABDOMEN Prof. AlSaigh R1 05-10- 17 R3- 21-12-17 Common neck swellings Prof Alam Principles of Surgical Oncology Surgical infection & antibiotics Dr. Akily Diseases of breast Prof AlSaigh H/E of extremities R1 12-10-17 R3- 28-01-18 Lab. data interpretation H/E of perineal diseases Interpretation of common imaging studies Dr. Al Ghamdi R1 19-10-17 R3-04-01-18 Acute abdomen(I) Acute abdomen (II) Case presentation by students Prof AlSaigh, Prof Alam & Dr. Ahmed Al Ghamdi

Lectures & Tutorials schedule – Rotation 2 TEACHING PROGRAM SURG 1(633) SEMESTER 171 Lectures & Tutorials schedule – Rotation 2 Date & Day 8-8.50 AM 8.50-9.40 AM Break 10-10.50 AM 10.50-11.40 AM Prayer 11.40-1PM 1-3 PM Tutorial   24-10-17 (Tuesday) Introduction to Surgery 1. Prof. Alam Metabolic response to injury Prof Alam Wounds & Healing. Prof. AlSaigh Fluid/Electrolyte & Acid-Base disorders, IV fluids Dr. Al Ghamdi H/E of Neck Dr. Ahmad Al Ghamdi 25-10-17 (Wednesday) Shock Nutritional support in surgical patients Trauma (1) Trauma (2). H/E of Breast 26-10-17 (Thursday) Diseases of spleen Diseases of thyroid gland Dr. Akily Diseases of adrenal & parathyroid Haemostasis & Coagulation defects H/E of Thyroid gland 29-10-17 (Sunday) Abdominal wall and hernias Diseases of peritoneum & retroperitoneal space Small bowel diseases Prof. Salamah Post-operative care & complications Prof Salamah H/E of Swelling & Ulcers 02-11-17 Gallbladder & biliary tract diseases Dr. Hamad Qahtani Liver diseases Diseases of pancreas Diseases of stomach & duodenum H/E of Hernias

Lecture, Tutorials & Case presentations Surg. 1 Sem. 171 Rotation 2 DAY & DATE Lecture 8 - 8.50 AM Lecture 8.50 - 9.40 AM BREAK 9.40- 10AM Lecture 10 - 10.50 AM 10.50 - 11.40 AM PRAYER TUTORIAL 1 PM - 4 PM THURSDAY 09-11-17 Investigation of surgical patients Dr. Al Ghamdi Preoperative assessment   Diseases of large bowel & rectum Common anorectal diseases H/E OF ABDOMEN Prof. AlSaigh & perineal diseases 16-11-17 Common neck swellings Prof Alam Principles of Surgical Oncology Surgical infection & antibiotics Dr. Akily Diseases of breast Prof AlSaigh H/E of extremities Prof. AlSaigh 23-11-17 Lab. data interpretation Interpretation of common imaging studies Dr. Al Ghamdi Acute abdomen- 1& 2 Case presentation by students Prof AlSaigh, Prof Alam & Dr. Ahmed Al Ghamdi

Hospital postings Surgical units: 4 weeks (Week 2-5). Attend: in-patient, operating room, emergency room & OPD. Actively participate: History/examination, & differential diagnosis Present patient’s history, examination findings & participate in case discussion with in-charge clinicians or deputies. Follow up & interpret investigation results (blood, imaging) . Discuss management plan and attend operations.

Hospital posting Surg. 1 Semester 171 Day 8 AM to 4 PM SUN   HOSPITAL POSTING MON TUE WED THURSDAY TUTORIAL

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)

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 component: MCQ : 45 questions - 15 Marks

FINAL EXAMINATIONS- Sem. 171 R1- Sun 22 Oct & Mon 23 Oct 2017 R2- Wed 29 Nov& Thu 30 Nov 2017 R3- Sun 07 Jan & Mon 08 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 ( Thursday) on real patients in hospital

BLUEPRINT FOR MCQs 2-3 2-3 3-4 1-2 1-3 Metabolic response to injury Lecture Topics Number of MCQs - 45 Midblock exam Number of MCQs- 30 End-block exam Metabolic response to injury 2-3 2. Shock 3. Nutritional support of surgical patients: 4. Fluid/electrolytes disorders, acid base disorder, IV fluids  2-3 5. Hemostasis, coagulation defects, blood products & blood transfusion: 6. Wounds and wound healing, wound management 7. Surgical Infections & antibiotics Investigation of surgical patients 9. Trauma and multiple injury 3-4 10. Preoperative assessment and management 11. Post-operative care and complications 12. Principles of surgical oncology   1-2 13. Acute abdomen 14. Gallbladder & biliary tract disease 15. Diseases of stomach and duodenum 16. Diseases of small bowel 17. Diseases of large bowel including rectum 18. Common neck swellings 1-3 19. Diseases of thyroid gland 20. Diseases of adrenal and parathyroid 21. Liver diseases 22. Diseases of pancreas 23. Diseases of spleen 24. Diseases of the breast 25. Common ano-rectal diseases 26. Abdominal wall and hernia 27. Diseases of peritoneum & retroperitoneal space 28. Tutorial topics BLUEPRINT FOR MCQs

Recommended Books: (Latest Editions) 1.Browse’s Introduction to The Symptoms and Signs of Surgical Disease 2.Principles and Practice of Surgery: Editors Garden, Bradbury, Forsythe and Parks Pocket Books: 1. Churchill’s pocket book- Surgery by Raftery and Delbridge 2. Oxford’s Handbook of Surgery

THANK YOU & GOOD LUCK!