Surgery

Core Generalist#

Knowledge#

CG.K.1#

Discuss the diagnosis and initial/non-surgical management for conditions that require surgical treatment

CG.K.2#

Describe standard precautions and sterile technique

CG.K.3#

Identify infection control practices

CG.K.4#

Illustrate knowledge of anatomy, physiology and pathology for common surgical conditions

CG.K.5#

Discuss common surgical procedures and techniques

Skills#

CG.S.1#

Demonstrate elementary surgical skills, including;

scrub, gown and glove
standard precautions
instrumentation
using sutures, surgical knots, needles
surgical wounds and tissue handling
insertion and care of wounds and drains
splinting and immobilisation
local anaesthetic

CG.S.2#

Competently perform a range of minor surgical procedures and investigations and provide post-operative management:

suture and repair of lacerations
curettage of skin lesions
removal of palpable and foreign bodies
incision and drainage of cutaneous abscess
wound management including debridement and dressings
cauterisation or freezing of skin lesions
incision biopsy of skin lesions
punch biopsy of skin lesions
toenail ablation
wedge excision of toenail bed
removal of a toenail
drain a perianal haematoma/abscess
drain a thrombosed pile
removal of foreign body from auditory canal
syringe external auditory canal
aural toilet
insert wicks into ear canal
examine the nares with a speculum and distinguish between anterior and posterior bleeding
manage epistaxis
remove foreign body from nose
management of a surgical drain, including vacuum assisted
removal of skin staples
nasogastric drainage
intercostal underwater seal drain insertion
pleural tap

CG.S.3#

Diagnose and determine appropriate management plans for hospital in-patients with surgical conditions, depending on the condition and local clinical services capabilities:

local management
local management with consultation
further investigations
undertake conservative measures as appropriate
undertake operative measures as appropriate
arrange for referral and transfer

CG.S.4#

Perform the following skills:

primary and secondary trauma survey
cannulation
fluid replacement
electrolyte balance assessment and replacement
blood transfusion
blood gas analysis

CG.S.5#

Manage the pre and post-operative care for a patient undergoing surgery locally

CG.S.6#

Recognise, stabilise and, as appropriate, arrange transfer and evacuation of patients with surgical emergencies and severe trauma

Attributes#

At.1#

Accountability

At.11#

Integrity

At.15#

Reflection

Advanced Specialised#

Knowledge#

AS.K.1#

Detail anatomy and physiology relevant to domains of surgical practice in the curriculum

AS.K.2#

Discuss selection criteria, protocols, principles and limitations of the diagnostic procedures tests and interpret their results

AS.K.3#

Describe basic principles for:

emergency ultrasound
procedural sedation
endoscopy
surgical technique
laparoscopy
laparotomy

AS.K.4#

Identify potential surgical complications including possible failure of the surgical procedures listed in this curriculum, describe the signs and symptoms of these complications and outline appropriate rescue plans

AS.K.5#

Discuss management plans and algorithms for common potential variations for common procedures eg when an ovarian pathology or bowel cancer is found for a case that was thought to be appendicitis

Skills#

AS.S.1#

Provide general management of surgical illnesses and complications:

fluid and electrolyte balance
standard ABCDE prioritisations
nutrition
management of shock
wound management and wound healing
pain management – pre-emptive, operative, post-operative and emergency
fracture/dislocation management including principles of fixation
recovery and mobilisation planning.
maintain or re-establish basic bodily functions

AS.S.2#

Order or perform a range of diagnostic procedures:

basic blood tests
Focused Assessment with Sonography for Trauma (FAST) ultrasound of abdomen
plain x-rays – interpretation for emergency purposes pending definitive reporting, including adult and paediatric chest, spine, abdomen and extremities
CT scans – interpretation to help guide emergency treatment pending a definitive report (considerations around emergency use of contrast)
ultrasound examination of the pregnant uterus and pelvis, including diagnosis of acute emergency events such as ectopic pregnancy and ruptured viscera
lumbar puncture
endoscopy

AS.S.3#

Undertake a judicious pre-surgical assessment that considers both surgical and non-surgical factors, including:

age, weight and health of patient
degree of urgency
local clinical services capabilities
own skill set
if surgical intervention is required
possible alternative diagnoses or pathologies
whether to refer or manage locally
whether to liaise with specialist surgeon regarding management options
retrieval services available and likely time to definitive care, should a retrieval be considered

AS.S.4#

Consider alternative diagnoses and their implications for care in current medical setting

AS.S.5#

Perform appraisal of whether surgical care should be undertaken and if this should be non-definitive (intermediate) or definitive surgical care

AS.S.6#

Perform damage control techniques to control haemorrhage, prevention of contamination and protection from further injury, for presentations where surgical intervention is not safe, eg in the following presentations:

intra-abdominal haemorrhage
appendicitis
open fracture

AS.S.7#

Consider the appropriate mode of anaesthetic for the case, consulting with the Anaesthetist as required

AS.S.8#

Recognise and implement a management plan for surgical complications, including:

management of post-operative haemorrhage and infection
management of incision wound infection/abscess
management of wound dehiscence
identification and management of vascular insufficiency or deep vein thrombosis, including appropriate preventative strategies
management for complications such as pulmonary embolus
perforation/obstruction, pneumothorax, spinal headache, pressure sores
medical complications following surgery – respiratory (eg infective pneumonia, aspiration), cardiac (eg arrhythmias, MI) renal (eg ARF, hyper and hypo kalemia), neurological (eg CVA, delirium), GI (eg ileus, constipation)
complications of therapeutics – allergy/anaphylaxis, toxicity, drug interactions, GI bleeding, dystonic reactions, neuroleptic malignant syndrome, transfusion reactions, under or over-hydration, over-anticoagulation

AS.S.9#

Demonstrate basic skills:

emergency ultrasound
procedural sedation
gastroscopy & colonoscopy - required to fulfil requirements of the Conjoint Committee for Recognition of Training in Gastrointestinal Endoscopy (CCRTGE)
surgical technique
laparoscopy
laparotomy
surgical audit
risk assessment

AS.S.10#

Manage abdominal presentations:

Abdominal wall mass or pain: hernia repair
Acute right and left lower quadrant pain: appendicitis, adnexal/ovarian disease, diverticular disease, constipation
Gastrointestinal bleeding (upper and lower)
Gastrointestinal screening and surveillance (upper and lower)
Perianal presentations haemorrhoids, infections, warts, pilonidal sinuses, anal fissures

AS.S.11#

Manage non-abdominal presentations:

Integumentary lesions: skin, nail, subcutaneous lesions, ganglia, lipoma, digital amputation, burns cellulitis, skin flap and skin graft closure
Wound: dressings, excision and suture, drainage and debridement, drainage and packing
Fertility: vasectomy
Genitourinary disease: acute testicular torsion, epididymitis, phimosis, circumcision
Breast lump: triple assessment and referral
Hand/limb: carpal tunnel release, hand trauma/infection, extensor tendon repair, compartment syndrome upper and lower limb

AS.S.12#

Consider also undertaking DRANZCOG advanced training during or after Fellowship training to be able to manage complications of pregnancy, including:

Complications of labour and delivery: operative vaginal delivery, caesarean section, perineal trauma, uterine inversion, postpartum haemorrhage, retained placenta, advanced labour and risk management, neonatal resuscitation
First trimester pain and bleeding: uterine bleeding: dilation, curettage and hysteroscopy (pregnant and non-pregnant), ectopic pregnancy, and
Tubal ligation

AS.S.13#

Obtain specific approval and training from supervisor before undertaking new procedures

AS.S.14#

Undertake special training or accreditation as required to perform additional skills to address community needs

Attributes#

At.1#

Accountability

At.19#

Self-reliance

At.11#

Integrity

Conditions requiring surgical treatment#

Skin: benign and malignant skin lesions, skin infections (impetigo, cellulitis, abscesses, boils, haematomata)
Acute abdomen: appendicitis, biliary colic, cholelithiasis cholangitis, pancreatitis, oesophagitis/G.U./D.U., inflammatory bowel disease, renal causes, aortic/vascular aneurysm disease, diverticulitis/ischaemic colitis, acute infective diarrhoeal illness, perforate viscus, strangulated hernia, visceral perforation and peritonitis
Anorectal: perianal haematoma, perianal abscess, tumours of the colon
Respiratory: pneumothorax, upper and lower airway obstruction, pleural effusion and haemothorax, pericardial effusion, perforated oesophagus/Boerhaave’s syndrome, rib fractures
Urinary: acute urinary retention, renal tract tumour, renal tract calculus, renal trauma, urinary tract infections, torsion of testis
Neurosurgical: closed head injury, acute and chronic subdural haematoma, tumours of the central nervous system (CNS), vascular disasters of the CNS, berry aneurysm, arteriovenous malfunction, trauma to the spinal cord and peripheral nerves, intracranial haemorrhage
Ophthalmological: sudden loss of vision, non-penetrating ocular trauma, corneal foreign bodies, corneal abrasion, hyphema, lens dislocation, retinal detachment, penetrating eye wounds, eyelid and skin tumours, trauma and infections
Vascular: acute peripheral vascular occlusive disease/threatened limb, deep vein thrombosis, varicose veins, abdominal aortic aneurysm, venous ulceration and deep venous incompetence
ENT: tympanic perforation, aural foreign bodies, otitis externa, tumours of the ear, nasal foreign bodies, nasal polyps and tumours, sinusitis, maxillary, and other sinuses, medical nasal conditions, throat and pharynx conditions, uvular oedema, tonsillitis/quinsy, glottic and pharyngeal foreign bodies, epiglottitis, acute and chronic sinusitis
Fractures: skull, cervical spine, orbit, zygoma, face, jaw, thoracic and lumbar spine, clavicle, ribs, pelvis, neck of humerus, supracondylar humerus, head of radius, mid forearm, distal forearm including Colles’, Smith’s, metacarpals especially scaphoid, digits, femur, tibia, Potts fracture, calcaneus, metatarsals
Crush injuries: systemic complications (fat embolism), compartment syndrome
Dislocations: jaw (temporomandibular joint), shoulder - anterior/posterior, patella, interphalangeal joints, lunate, femur, ankle