Surgery (Final)

Learning Outcomes

Learning Outcomes

Having successfully completed this module you will be able to:

• Take a history of the presenting complaint, relevant past surgical history, medication history, associated disease particularly those relevant to anaesthesia, and the social history, particularly family and home circumstances which may influence postoperative management
• Maintain appropriate attire and demeanour
• Describe how you would relate clinical disorders to patients and family
• Synthesise and communicate a differential diagnosis and proposed plan of management
• Understand the patient pathway in a surgical and operating theatre setting
• Develop good relationships with all members of the surgical team (medical and non-medical)
• Understand the management (incorporating the investigation and treatment) of commonly presenting surgical disorders, in both elective and acute settings
• Contribute to the care of patients and their families at the end of life including management of symptoms and safe and effective Teamworking
• Describe common surgical disorders
• Demonstrate understanding of basic sciences and pathology underlying common disorders relating to surgical patients
• Apply scientific method and approaches to medical research
• Demonstrate an appreciation of basic safety principles - for patients and staff - in the operating theatre
• Understand the process of developing and refining a differential diagnosis in a surgical context
• Demonstrate understanding of the roles of different team members within the inter-professional setting
• Develop an enquiring basis to learning and take responsibility for your own learning and your continuing professional development
• Examine normal and abnormal systems with particular reference to surgical disease
• Communicate effectively in the following ways: a.With the patients and their families b.With professional colleagues c.Written clinical record suitable for inclusion in case notes d.Formal oral case presentations to your colleagues and senior medical staff

Students are attached to one or more named consultant surgeons and their extended teams, and will gain exposure to general and specialist (breast and endocrine/urological/vascular) surgery. Experience in the clinical team includes emergency work.

There will be opportunities to revise clinical skills teaching, and ample opportunities for completing the practical procedures competency sign offs that are necessary to pass the Assessment and ILS module.

Students’ surgery learning modules will be located in one of the many clinical centres affiliated to the University of Southampton Faculty of Medicine (see separate list).

Details of these attachments and a course handbook will be available during module induction and on blackboard.

Students are required to record their attendance at:

• Theatre Sessions: more than 6

Include at least 3 different subspecialties: colorectal, hepatobiliary, oesophago-gastric, vascular, breast, urology and acute surgery

• Surgical Clinics: more than 6

Include at least 3 different subspecialties: colorectal, hepatobiliary, oesophago-gastric, vascular, breast, urology and acute surgery

This should include urgent cancer referrals and 2WW clinics

• 2 x Anaesthetics (from induction of anaesthesia to recovery)
• 2 x Multidisciplinary Team Meetings or case conferences
• 2 x observed informed consent

You are expected to clerk and present 20-30 cases during your final year surgical placement. This must include both elective and emergency inpatients and can also include outpatients. At least 3 of these patients should be followed through the hospital journey. You should include patients from a range of surgical subspecialties with different symptoms and clinical problems. This will mean that you need to see patients under other surgical subspecialty teams to ensure you get the full breadth of experience. You should briefly summarise the cases and reflect on the learning points, for example ethical, diagnostic, management, or communication challenges. These should be used to inform your further learning.

Common Procedures

You will have the opportunity to observe common operations and interventions. This will give you an understanding of surgical disease management and enable a smooth transition to become a Foundation Year Doctor

Although attendance at every procedure will not be possible, the procedures that you will be expected to understand are:

Upper GI

• Laparoscopic cholecystectomy
• OGD
• ERCP

Lower GI

• Flexible sigmoidoscopy and colonoscopy
• Bowel resection for cancer
• Haemorrhoidal procedures
• Interventions for perianal sepsis

Urololgy

• Diagnostic cystoscopy, stending, prostate surgery
• Scrotal surgery
• Nephrectomy

Vascular

• Abdominal aortic aneurysm repair
• Carotid endarterectomy
• Limb revascularisation (fem-pop/fem-distal)
• Interventional radiological procedure (stenting)

Breast

• Wide local excision
• Mastectomy
• Axillary clearance
• Reconstructive surgery

General

• Laparoscopic and open surgery
• Abdominal and groin hernias
• Minor surgery for skin lesions

Emergency

• Appendicectomy (laparoscopic)
• Laparotomy
• Abscess surgery

The module will be taught through a range of learning and teaching strategies which may include:

• Outpatient clinics, inpatient operating (elective and emergency), day case surgery and endoscopy
• Tutorials
• Patient and ward-based learning
• Guided self-study
• Satisfactory completion of the Learning Logbook
• 3 Assessments of Clinical Competence (ACCs)

Doctors work in shift patterns and rotas throughout much of their working lives and to prepare you for such working once you graduate, throughout your programme you will be expected to undertake placements in the evenings, at nights and at weekends. This will not be an onerous requirement and will be negotiated well in advance so that students with carers’ requirements will be able to ensure appropriate arrangements are in place for cover

Within this module there may be some core/compulsory activities that will take place in the evenings, nights or weekends therefore students will commitments that will be affected by these should be pro-active in securing details of these activities well in advance of the start of the module. In addition, many non core learning opportunities will be available during these times and students are encouraged to take advantage of them

Although students are NOT required to complete or pass 3 formative ACCs to complete this module, those who can evidence satisfactory marks in 3 ACCs will be able to use these for successful completion of the ACCs assessment component of the “Finals Assessment” module in final year. Students who complete all of their ACC assessment components in the Finals Assessment module through ACCs within other modules will be exempt from the ACC final examination (see Finals Assessment Module for further details).

The Learning Logbook

The purpose of this Learning Logbook is to record your activities during your surgical attachment. It should act as both a record of your clinical experience and a means of reflecting on your learning.

You are expected to clerk and present a minimum of 30 cases during your final year surgical attachment. This must include both elective and emergency inpatients and could also include outpatients. At least 3 of these patients should be followed through the hospital journey.

You will find space within your Learning Logbook to record your clinical experience during each of these interactions on a case-by-case basis.

You should briefly summarise the cases/clinical conditions seen within each section, and reflect on the learning points that each has afforded (for example any ethical, diagnostic, management, or communication challenge experienced).

These should be used to inform your further learning, and the Learning Logbook and its contents should then be discussed with your consultant at the end of your attachment as part of the assessment of your performance.

For assessments with no percentage contribution recorded, students will be assessed on a pass/fail basis.

Summative

This is how we’ll formally assess what you have learned in this module.

Referral

This is how we’ll assess you if you don’t meet the criteria to pass this module.