Download MGR MBBS Final Year General Surgery Syllabus

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Syllabus for MBBS Part III Surgery
GOAL
The broad goal of the teaching of undergraduate students in surgery is to produce
graduates capable of delivering efficient first contact surgical care, by equipping them with
appropriate knowledge, skill and attitude.

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OBJECTIVE
a.Knowledge: At the end of the course, the student should be able to:
1. Describe aetiology, pathophysiology, principles of diagnosis and management of common
surgical problems including emergencies, in adults and children.
2. Define indications and methods for fluid and electrolyte replacement therapy including blood

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transfusion.
3. Define asepsis, disinfection and sterilization and recommended judicious use of antibiotics.
4. Describe common malignancies in the country and their management including prevention
5. Enumerate different types of anesthetic agents, their indications, mode of administration,
contraindications and side effects.

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6. Understand basic medical ethics, medicolegal aspects and communication
b. SKILLS
1. Obtain a proper relevant history and perform a humane and thorough clinical examination
including internal examinations (per-rectal) and examination of all organs / systems in adults and
children.

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2. Arrive at a logical working diagnosis after clinical examination.
3.Order appropriate investigations keeping in mind their relevance (need based) and cost
effectiveness.
4. Plan and institute a line of treatment which is need based, cost effective and appropriate for
common ailments taking into consideration:

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a. Patient,
b. Disease,
c. Socio-economic status,
5. Recognize situations which call for urgent or early treatment at secondary and tertiary centres
and make a prompt referral of such patients after giving first aid or emergency treatment.

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6. Demonstrate empathy and humane approach towards patients, relatives and attendants, by
effective communication skills, involving the patients' surgical condition its management and
outcome.
7. Develop a proper attitude towards, colleagues and other staff.

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c.Integrated Teaching
Vertical integration with Pathology(Normal and abnormal cells, Malignancy chronic infections
etc), Microbiology(Wound infections, Hospital acquired Infections, Resistance to antibiotics
etc), Anatomy( Applied anatomy of head and neck groin abdomen leg etc), Bio-chemistry(
Basis of diagnosis of conditions related to HPB, Tumour markers)

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Horizontal Integration with other surgical specialties such as plastic(ulcers skin cover scars
etc), urology( BPH with hernias etc),neurosurgery( trauma and head injuries)and pediatric
surgery(congenital surgical conditions etc)
TEACHING HOURS
Clinical PostingsTheory Teaching Hours

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26 Weeks
300 Hours
Introduction -2 weeks1) Didactic Lectures
- 200 hrs
A. Pre-Final

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40
B. Final
160
4weeks - Regular 2) Seminars
- 52 hrs

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8 weeks - Prefinal 3) Workshops/Video
Presentations - 18 hrs
12 weeks - Final 4) Group Discussions
- 30 hrs
TEACHING METHODOLOGY

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Involve observer ship in surgical teaching - Video demonstrations(clinical
examination and clinical cases), surgery exposes( pictorial teaching of surgical
conditions ) AV aids ? clinical and theory classes ? ward demonstrations at bedside
clinics(clinical signs) ? theory classes ? short answer tests( Theory of surgery) ?
evaluation? and continuous internal assessment(Clinical examination).

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THEORY SYLLABUS
The must know, desirable know, nice to know in the ratio of 60:30:10
vide annexure1
PRACTICAL SYLLABUS At a skills lab

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Laboratory Skills using aids- mannequins models etc. IV access Blood taking IM
injection Male and female catheterization.
REFERENCE LEARING BOOKS
1.
Bailey & Love's

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Short Practice of Surgery
2.
Das
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Clinical Methods in Surgery
3.
Hamilton Bailey's
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Demonstration of Physical Screening in Clinical Surgery

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4.
Pye's
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Surgical Handicraft.
THEORY EXAMINATION

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Paper III ? Surgery including Orthopedics
Section A
1. Essay
1 x 10 marks = 10 marks
2. Brief Answers

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3 x 5 marks = 15 marks
3. Short Notes
3 x 2 marks = 6 marks
-------------------------
Total 31 marks

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Section B ( Orthopaedics)
1. Essay
1 x 10 marks = 10 marks
2. Brief Answers

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3 x 5 marks = 15 marks
3. Short Notes
2 x 2 marks = 4 marks
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Total 29 marks

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Paper IV? Surgery including Anaesthesia
Question
Marks
Long question

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1 x 10 marks = 10 marks
Case scenario
1 x 10 marks = 10 marks
Brief Answers
6 x 5 marks = 30 marks

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Short Notes
5 x 2 marks = 10 marks
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Total - 60 marks
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PRACTICAL EXAMINATION
Surgery
1. Long case 1 no
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=
30 marks(45 minutes)
2.Short case 2 nos
15 x 2
=

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30 marks(30 minutes)
3.OSCE 3nos
5x3
=
15 marks(10-15 minutes)

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-----------------------
Total - 75 marks
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eg of OSCE one station to be interactive with a patient or role play
Long Case ( History 5,Clinical signs 5 Diagnosis 5 Investigations 5 Discussion 5

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Management 5)
Short Case ( Diagnosis 5, Investigations 5, Management 5 )
Orth
1.Short case
2 no

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10 x 2
=
20 marks
2.OSCE
1 no

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5 x 1
=
5 marks
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Total - 25 marks

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Eg of OSCE to be observed as student examines
Viva Voce as present 20 marks(15 for surgery 5 for ortho)
5 marks each
1. X-rays

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2. Operative surgery and instruments
3. Pathology Specimens
Ortho ? 5 marks
FORMATIVE ASSESSMENT
QUARTERLY REPORT WITH ATTENDANCE MANDATORY FROM THIRD YEAR

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ONWARDS
INTERNAL ASSESSMENTS ( 60 marks )
Third semester
-
10 marks- One test ( Theory 5 and Practical 5)

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(First 12 Chapters Bailey and Love)
Fifth and Seventh semester
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15 marks ? one test (Theory 10 and Practical 5)
(Chapters 13-32)

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Eighth and Ninth semester
-
25 marks ? two tests (Theory 15 and Practical 10)
(Chapters 42, 43,48Neck,49-81)

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Log Book
-
10 marks
INTERNAL ASSESSMENTS TEST UNIT WISE TO BE DONE
Suggested guidelines for conduct of OSCE for continuous assessment during clinical course

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see annexure 2 ? To conduct Clinical Examination Model for IA at the end of the every final
year posting by the concerned unit.
MEDICAL ETHICS INCLUDING
Consent for surgery
Dangerously ill patient intimation

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Human rights including confidentiality
Syllabus -Annexure 1
Part I
PRINCIPLES
1. Must know

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a. Shock and blood transfusion
b. Wounds, tissue repair and scars
c. Basic surgical skills
d. Surgical infection
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Prophylactic antibiotics
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Bacteria involved in surgical infection
e. Patient Safety
f. Surgery in the tropics

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Amoebiasis
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Ascariasis
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Filiarsis
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Hydatid cyst
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Leprosy

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Typhoid
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Tuberculosis
2. Desirable to know

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a. Metabolic response to injury
b. Anastomosis
c. Principles of paediatric surgery
d. Principles of oncology
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e. Clinical research
f. Surgical ethics and law
g. Surgery in the tropics
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Poliomyletis

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Tropical Chronic Pancreatitis
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Mycetoma
3. Nice to know

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a. Principles of laparoscopic and robotic surgery
b. Surgical audit
Part II
Investigations and Diagnosis
Must Know

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a. Tissue Diagnosis
b. Diagnostic investigation X-ray, USG
Desirable to know
a. Diagnostic imaging CT, MRI
Nice to know

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a. Gastrointestinal Endoscopy
Part III
Peri-operative Care
Must Know
a. Preoperative Preparation

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b. Basic Anaesthesia
c. Nutritional fluid therapy
d. Post operative Care
Desirable to know
a. Care in the operating room

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b. Perioperative management of high risk patient
Nice to know
a. Day care surgery
Part IV Trauma
Must Know

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a. Early assessment and management of Trauma
b. Burns
c. Tarso Trauma
Desirable to know
a. Emergency Neurosurgery

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b. Maxillofacial Surgery
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c. Plastic & Reconstruction Surgery
Nice to know
a. Plastic & Reconstruction Surgery

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Part V Skin and sub-cutaneous tissue
Must Know
a. Functional Anatomy and physiology
b. Skin
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Benign
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Malignant
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Vascular lesion

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Wounds
Nice to know
a. Practical and ethical issue
Part VI Head and neck

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Must Know
a. Oropharangeal cancer
b. Disorders of salivary gland
c. Pharynx, larynx and neck
Desirable to know

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a. Cleft lip
b. Cleft palate
Nice to know
a. Elective neurosurgery
Part VIIBreast & Endocrine

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Must Know
a. The Thyroid
b. The Breast
Desirable to know
a. Parathyroid gland

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b. Adrenal gland
Nice to know
a. Other surgical Endocrine Disorders
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Part X Vascular

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Must Know
a. Arterial Disorder
Arterial stenosis & occlusion
Gangrene
Amputation

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Vasospastic conditions
b. Venous Disorder
Anatomy of venous system of the limbs and venous pathology
Varicose veins
Venous thrombosis

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Leg ulceration
Venous Injury
c. Lymphatic Disorder
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Anatomy, Physiology of the lymphatic system

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Lymphodema
Desirable to know
a. Angiography
b. Operation for arterial stenosis and occlusion

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c. Therapeutic Embolization
d. Aneurysm
e. Duplex ultrasound
f. Congenital venous anomalies
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Axillary vein thrombosis
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Venous tumor
Nice to know
a. Endovascular Procedure

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b. Endovenous Laser Ablation
c. Lymphedema Surgeries
Part IX Abdomen
Must know
a. History and Examination of the abdomen

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b. Abdominal Wall Hernia and Umbilical Hernia
c. Ventral Hernia
d. Oesophageal stricture, Achalasia and Carcinoma Surgical anatomy
e. Stomach and Duodenum
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f. The liver
g. The Gall bladder and bile duct
h. The small and large Intestine
i. Intestinal Obstruction
j. Vermiform appendix

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k. The Rectum
l. The anus anal
Desirable to known
a. The Peritoneal, Omentum, Mesentery and Retroperitoneal space
b. The Oesophagus- GERD, Perforation, Congenital Anomaly, FB, Patho physiology

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c. Liver- Trauma, Portal Hypertension
d. The Spleen
e. The Pancreas
Nice to Know
a. Bariatric Surgery

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b. Liver Surgeries
c. Laparoscopic Hernia Repair
Part X
Genito-Urinary
Must Know

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a. Urinary Symptoms and Investigations
Urinary Symptoms
Investigation of Urinary tract
Anuria
b. The kidney and Ureter

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Surgical Anatomy
Congenital Anomaly
Hydronephrosis
Renal Calculi
Ureteric Calculus

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Neoplasm of Kidney
c. The Prostate
d. Urethra and Penis
e. Testis & Scrotum
f. Urinary bladder

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Desirable to know
a. Seminal vessels
b. Dialysis
c. Injuries of kidney and ureter
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d. Carcinoma of bladder
e. Urinary Diversion
f. Male factor Infertility
Nice to know
a. Laparoscopic Renal surgery

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b. PCNL, URS
c. Endoscopic surgery - Uethrotomy and TURP
Part XI
Transplantation
Must Know

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a. Historical prospective
b. Graft Rejection
Desirable to know
a. Immuno-suppressive therapy
b. Organ Donation

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Nice to know
a. HLA Matching
b. Tissue Typing
c. Kidney, Liver, Pancreas and other Transplantation
Surgical Instruments

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Must know
a. Common instruments used in surgery
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Model OSCE weekly tests-Annexure 2
1st Mandatory Observed Clinical Case 15 minutes

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First Clinical Year - 1st surgical posting best done weekly by any teacher
Student's Name :
Department / Unit :
MOCC Date :
Case :Any Case

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Attributes
Poor
Satisfactory
Good
Excellent

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Ethics (Introduction of self,
explaining the examination
procedures etc.)
History taking under
supervision

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Answering Questions on
history
Overall performance
/100
*Key for performance:

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<50% - Poor
50-60% - Satisfactory
60-80% - Good
>80% - Excellent
For guidance only

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Mandatory narrative on deficiencies noted. Feedback to be given to the student:
Ethics
History
Interaction with examiner
Preceptor's Name

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Signature
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Continuous Assessment in Surgery
2nd Mandatory Observed Clinical Case
First Clinical Year ? 2nd surgical posting best done weekly by any teacher

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Student's Name :
Department / Unit :
MOCC Date :
Case : A swelling and ulcer
Attributes

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Poor
Satisfactory
Good
Excellent
Ethics (washing hands,

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Introduction of self,
explaining the examination
procedures etc.)
History given
Student to ask 2 questions

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Inspection ? Description
Palpation ? Method
Differential diagnosis
Interaction with examiner
Overall performance

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/100
*Key for performance:
<50% - Poor
50-60% - Satisfactory
60-80% - Good

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>80% - Excellent
For guidance only
Mandatory narrative on deficiencies noted. Feedback to be given to the student:
Interaction
Differential

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Ethics
History
Inspection
Palpation
with

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diagnosis
examiner
Preceptor's Name
Signature
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Continuous Assessment in Surgery
Mandatory Observed Clinical Case
2nd clinical year conducted once
Duration : 20 minutes
Student's Name :

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Department / Unit :
MOCC Date :
Case Diagnosis :
Total Marks
Obtained Marks

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Observed History taking (5
5 marks
minutes)
Observed Examination technique (5
5 marks

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minutes)
Differential Diagnosis (2 minutes)
2 marks
Discussion on Investigations ? Details of technique, equipment,
3 marks

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materials/dyes used, procedure etc. (3 minutes)
Details of operative/therapeutic procedure ? Anaesthesia (type drugs,
5 marks
dosages etc), Incisions, Drains, Sutures, Complications etc. (5 minutes)
General Comments during the posting :

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Attitude, Punctuality, Ethical conduct, appropriately dressed etc.
5 marks
Total Marks : /25
Mandatory Narrative on deficiencies noted (additional sheets can be used)
Examination

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Details of operative
General
History
Diagnosis
Investigation

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technique
procedure
Comments
Preceptor's Name
Signature

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Continuous Assessment in Surgical Posting
Mandatory Observed Clinical Case ? Final Year weekly exam 15 minutes by any teacher
Student Name :
Department / Unit :

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MOCC Date :
Case Diagnosis :
Attributes
Poor
Satisfactory

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Good
Excellent
Approach to patient
History to be given
4 relevant questions by

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student on history
Physical examination
technique
Correlating history and
physical findings to

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formulate diagnosis
Discussion including
investigations and
treatment
Overall performance

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/100
*Key for performance:
<50% - Poor
50-60% - Satisfactory
60-80% - Good

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>80% - Excellent
Mandatory narrative on deficiencies noted. Feedback to be given to the student:
Physical
Correlating
Approach to patient

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History
Discussion
Examination
history
Preceptor's Name

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Signature
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Annexure 3
CRRI ORIENTATION
PERFORM

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PERFORM
ASSIST
OBSERVE
SKILLS
WITH

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THE
INDEPENDENTLY
SUPERVISION EXPERT
Obtain a proper relevant
yes

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history and perform a
humane and thorough
clinical examination, internal
examination( perrectal and
pervaginal) and

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examinations of all organs /
Systems in adults and
children
Arrive at a logical working
yes

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diagnosis after clinical
examination
Order appropriate tests
yes
keeping in mind their

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relevance and cost
effectiveness
Write the complete case
yes
record with all necessary

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details
Write a proper discharge
yes
summary with all relevant
information

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Obtain an informed consent
yes
for any examination /
procedure
At the end of the session ,

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yes
the learners should be able
to perform the following
Start an IV line and monitor
yes

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infusion
Start and monitor blood
yes
transfusion
Venous cut down

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yes
Manage a CVP line
yes
Conduct CPR( Cardio
yes

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pulmonary resuscitation)
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Basic life support / ITLS
yes
Endotracheal intubation

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yes
Pass nasogastric tube
yes
Perform digital rectal
yes

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examination and proctoscopy
Urethral catheterization
yes
Dressing of the wounds/
yes

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ulcers
Suturing of simple wounds
yes
Remove small subcutaneous
yes

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swellings
Various types of biopsies
yes
Relieve pneumothorax
yes

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Infiltration , surface and
yes
digital nerve blocks
Incise and drain superficial
yes

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abscesses
Manage lacerated wounds
yes
Control external
yes

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haemorrhage
Vasectomy
yes
Circumcision
yes

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Surgery for hydrocele
yes
Surgery for hernia
yes
Injection / banding of piles

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yes
Management of shock
yes
Assessment and
yes

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management of burns
The candidate shall observe
yes
all the operations performed
by the surgeons by assisting

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and observing surgeons
during general surgical
posting
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SKILLS for Interns

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1. Obtain a proper relevant history and perform a humane and thorough clinical examination
including internal examinations (per-rectal and per-vaginal) and examinations of all
organs / systems in adults and children.
2. Arrive at a logical working diagnosis after clinical examination.
3. Order appropriate investigations keeping in mind their relevance (need based) and cost

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effectiveness.
4. Plan and institute a line of treatment which is need based, cost effective and appropriate
for common ailments taking into consideration :
a. Patient,
b. Disease,

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c. Socio-economic status,
d. Institutional / Governmental guidelines.
5. Recognize situations which call for urgent or early treatment at secondary and tertiary
centres and make a prompt referral of such patients after giving first aid or emergency
treatment.

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6. Demonstrate empathy and humane approach towards patients, relatives and attendants.
7. Develop a proper attitude towards patients, colleagues and other staff.
8. Demonstrate interpersonal and communication skills befitting a surgeon in order to discuss
the illness and its outcome with patient and family.
9. Establish rapport and talk to patients, relatives and community regarding all aspects of

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medical care and disease.
10. Write a complete case record with all necessary details.
11. Write a proper discharge summary with all relevant information.
12. Write a proper referral note to secondary or tertiary centres or to other surgeons with all
necessary details.

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13. Assess the need for and issue proper medical certificate to patients for various purposes.
14. Maintain an ethical behavior in all aspects of medical practice.
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15. Appreciate patient's right to privacy.
16. Obtain informed consent for any examination / procedure.

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17. Be able to do surface marking of common superficial arteries, veins, nerves and viscera.
18. Assess and manage fluid / electrolyte and acid base imbalance.
19. Adopt universal precautions for self protection against HIV and hepatitis and counsel
patients.
20. Start i.v. line and infusion in adults, children and neonates.

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21. Do venous cutdown.
22. Give intradermal / S.C. / I.M. / I.V. injection.
23. Insert and manage a C.V.P. line.
24. Conduct C.P.R. ( Cardiopulmonary resuscitation ) and first aid in newborns, children and
adults including endotracheal intubation.

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25. Pass a nasogastric tube.
26. Pass a stomach tube and do stomach wash.
27. Perform vasectomy.
28. Perform circumcision.
29. Perform reduction of paraphimosis.

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30. Do Proctoscopy.
31. Do injection and banding of piles.
32. Incise and drain superficial abscesses; Do dressings.
33. Manage superficial wounds and do suturing of superficial wounds & wound toilet.
34. Remove small cutaneous / subcutaneous swellings.

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35. Control external haemorrhage.
36. Catheterize bladder in both males and females.
37. Perform nerve blocks like infiltration, digital, pudendal, paracervical and field block.
38. Relieve tension pneumothorax by inserting a needle.
39. Insert a flatus tube.

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40. Provide first aid to patients with peripheral vascular failure and shock.
41. Assess degree of burns and administer emergency management.
Text Book of choice. Bailey and Love (26th edition at present). The student must know what is,
desirable know, nice to know in the ratio of 60:30:10 as per the Bailey and Love'slatest textbook
and this is included here along with Basic skills to be learned.

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LOG BOOK
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