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CURR ICULUM OUTL INEFOR GENERALSURGERY

SCORE®Surgical Council on Resident Education

1617 John F. Kennedy Boulevard Suite 860

Philadelphia, PA 19103 1-877-825-9106

[email protected] www.surgicalcore.org

2020-

2021

1

http://surgicalcore.org/

SCORE Curriculum Outline forGeneral Surgery

The SCORE Curriculum Outline for General Surgery is a list oftopics to be covered in a five-year general surgery residencyprogram. The outline is updated annually to remaincontemporary and reflect feedback from SCORE memberorganizations and specialty surgical societies. Topics are listed for all six competencies of the AccreditationCouncil for Graduate Medical Education (ACGME): patient care;medical knowledge; professionalism; interpersonal andcommunication skills; practice-based learning andimprovement; and systems-based practice. The patient caretopics cover 27 organ system-based categories, with eachcategory separated into Diseases/Conditions and Operations/Procedures. Topics within these two areas are then designatedas Core or Advanced. Changes from the previous edition are indicated in the Excelversion of this outline, available at www.surgicalcore.org. Notethat topics listed in this booklet may not directly match thosecurrently on the SCORE Portal — this outline is forward-looking, reflecting the latest updates.

The Surgical Council on Resident Education (SCORE) is anonprofit consortium formed in 2006 by the principalorganizations involved in U.S. surgical education. SCORE’smission is to improve the education of general surgeryresidents through the development of a national curriculum forgeneral surgery residency training. The members of SCOREare:

American Board of Surgery

American College of Surgeons

American Surgical Association

Association of Program Directors in Surgery

Association for Surgical Education

Review Committee for Surgeryof the ACGME

Society of American Gastrointestinal

and Endoscopic Surgeons

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®

PATIENT CARE CONTENTS

Abdomen – General............................................................9

Abdomen – Hernia............................................................10

Abdomen – Biliary.............................................................11

Abdomen – Liver...............................................................12

Abdomen – Pancreas.........................................................13

Abdomen – Spleen.............................................................14

Alimentary Tract – Esophagus.........................................15

Alimentary Tract – Stomach............................................16

Alimentary Tract – Small Intestine.................................17

Alimentary Tract – Large Intestine................................18

Alimentary Tract – Anorectal..........................................19

Endoscopy..........................................................................20

Breast...................................................................................21

Endocrine...........................................................................22

Skin and Soft Tissue.........................................................23

Surgical Critical Care........................................................24

Trauma..........................................................................25-26

Vascular – Arterial Disease..............................................27

Vascular – Venous.............................................................28

Vascular – Access..............................................................29

Transplantation.................................................................30

Thoracic Surgery...............................................................31

Pediatric Surgery........................................................32-33

Plastic Surgery..................................................................34

Genitourinary....................................................................35

Gynecology and Obstetrics.............................................36

Head and Neck..................................................................37

BY CATEGORY

1.

2.

3.

4.

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6.

7.

8.

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10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

DISEASES BY LEVEL.............................................................38

Core.....................................................................................38-41

Advanced............................................................................42-43

OPERATIONS BY LEVEL......................................................44

Core.....................................................................................44-46

Advanced............................................................................47-48

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MEDICAL KNOWLEDGE CONTENTS

Anesthesia...........................................................................49

Biostatistics and Evaluation of Evidence.......................49

Fluids, Electrolytes and Acid-Base Balance...................49

Geriatric Surgery and End-of-Life Care........................49

Immunology.......................................................................50

Infection and Antimicrobial Therapy............................50

Minimally Invasive Surgery – Principles......................50

Nutrition and Metabolism...............................................50

Oncology and Tumor Biology.........................................51

Preoperative Evaluation and Perioperative Care..........51

Transfusion and Disorders of Coagulation....................51

Wound Healing..................................................................51

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

4

PROFESSIONALISM CONTENTS

Ethical Issues in Clinical Surgery....................................521.

INTERPERSONAL AND

COMMUNICATION SKILLS CONTENTSNon-Technical Skills for Surgeons.................................53

Surgical Professionalism and Interpersonal

Communication Education............................................................53

1.

2.

PRACTICE-BASED LEARNING ANDIMPROVEMENT CONTENTS

Quality Improvement........................................................541.

5

SYSTEMS-BASED PRACTICE CONTENTSSystems-Based Practice.....................................................551.

ABOUT THIS DOCUMENTSCORE was founded in 2006 by the leading organizationsinvolved in U.S. surgical education to answer the question,“What do we expect our residents to know and be able todo proficiently by the end of their training?” In 2004, theAmerican Board of Surgery began to develop a curriculumby listing the specific patient care competencies expectedof graduating general surgery residents. This effort wasexpanded into this document, with significant input fromthe Association of Program Directors in Surgery, as well asmany specialty surgical societies. This outline should not be viewed as static. It will continueto be reviewed annually to introduce new topics as needed,delete obsolete topics, or change the depth and breadth ofexisting topics. As the outline has evolved, many topicshave also been consolidated to more accurately describethe required knowledge.

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THE SCORE PORTAL

The SCORE Portal (www.surgicalcore.org) has been createdto provide educational content and assessment in supportof the curriculum to general surgery residency programs.Learning “modules” are available on the portal for nearlyall of the topics listed in this booklet, with modules for thefew remaining topics to be posted in the near future.Changes from the previous edition are indicated in theExcel version of this outline, available atwww.surgicalcore.org.

Modules on the portal contain learning objectives,discussion questions, and a variety of resource materials,including textbook chapters, videos and images. Multiple-choice questions are also available to assess residentknowledge. The portal also offers This Week in SCORE®(TWIS), a two-year schedule of topics to assist programs incovering the portal’s content. Each week a new topic isfeatured, along with related modules and a 10-questionquiz. To learn more about TWIS and the SCORE Portal,please visit www.surgicalcore.org.

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http://www.surgicalcore.org/

PATIENT CARE CLASSIFICATIONSYSTEMThe patient care curriculum topics are organized into 27organ-based categories. Within each category, the topicsare further separated into Diseases/Conditions andOperations/Procedures. The topics are then stratified intotwo levels using the same classifications: CORE – Diseases and procedures encountered in generalsurgery for which a graduate of training will possesssignificant knowledge and be able to providecomprehensive care, including procedural competency. ADVANCED – Diseases and procedures that are notconsistently part of general surgery practice for which agraduate of training should have sufficient knowledge tomake a diagnosis and provide initial management. In someinstances, graduates will have sufficient knowledge andexperience to provide comprehensive care.

8

Abdomen – General1.

Abdominal Pain – Acute and ChronicRectus Sheath Hematoma

Desmoids/FibromatosesPeritoneal Neoplasms

Diseases/Conditions

Core

Advanced

9

PATIENT CARE

Abdominal ExplorationPeritoneal Dialysis Catheter Insertion

Operations/Procedures

Core

https://www.surgicalcore.org/modulecontent.aspx?id=1000515






2. Abdomen – Hernia

Inguinal and Femoral HerniasMiscellaneous HerniasUmbilical and Epigastric HerniasVentral Hernia

Diseases/Conditions

Core

10

PATIENT CARE

Diaphragmatic Hernia – RepairInguinal and Femoral Hernia – RepairMiscellaneous Hernias – RepairVentral Hernia – Repair


Core









3. Abdomen – Biliary

Benign Biliary ObstructionBile Duct Injury – IatrogenicBiliary NeoplasmsCholecystitisCholedochal Cyst

Functional Biliary DisordersPrimary Sclerosing Cholangitis

Diseases/Conditions

Core

Advanced

11

PATIENT CARE

Cholecystectomy with or without CholangiographyCholecystostomyCholedochoenteric AnastomosisCommon Bile Duct Exploration and Choledochoscopy

Bile Duct Cancer – OperationBile Duct Injury, Iatrogenic – Acute RepairBile Duct Neoplasms – OperationGallbladder Cancer – OperationUltrasound of the Biliary Tree


Core

Advanced

















4. Abdomen – Liver

Hepatic AbscessHepatic Neoplasms – MetastaticPrimary Hepatic Neoplasms – Benign and Malignant

Cirrhosis/Portal Hypertension (Ascites)

Diseases/Conditions

Core

Advanced

12

PATIENT CARE

Hepatic Abscess – DrainageHepatic Biopsy

Hepatic Ultrasound – IntraoperativeSegmentectomy/Lobectomy


Core

Advanced









5. Abdomen – Pancreas

Cystic Lesions of the PancreasPancreatic Neoplasms – EndocrinePancreatic Neoplasms – ExocrinePancreatitis – Acute/Pancreatic Necrosis/Abscess

Intraductal Papillary Mucinous NeoplasmsPancreas DivisumPancreatitis – Chronic (Including HereditaryPancreatitis)/Pancreatic Insufficiency

Diseases/Conditions

Core

Advanced

13

PATIENT CARE

Pancreatectomy – DistalPancreatic DebridementPancreatic Pseudocyst – Drainage

Ampullary Resection for TumorPancreatectomy – TotalPancreatic Ultrasound – IntraoperativePancreaticoduodenectomyPancreatitis, Chronic – Operative Management


Core

Advanced
















6. Abdomen – Spleen

Hematologic Diseases of the SpleenSplenic Abscess, Cysts, and Neoplasms

Diseases/Conditions

Advanced

14

PATIENT CARE

Splenectomy


Core




7. Alimentary Tract – Esophagus

Esophageal Motility DisordersEsophageal Neoplasms – Benign and MalignantEsophageal PerforationGastroesophageal Reflux/Barrett EsophagusHiatal Hernias

Esophageal Caustic Ingestion and Foreign Bodies

Diseases/Conditions

Core

Advanced

15

PATIENT CARE

Antireflux Procedures

Cricopharyngeal Myotomy with ZenkerDiverticulum – ExcisionEsophageal Perforation – Repair/ResectionEsophagectomy/EsophagogastrectomyEsophagomyotomy (Heller)Paraesophageal Hernia – Repair


Core

Advanced













8. Alimentary Tract – Stomach

Gastric AdenocarcinomaGastric Foreign BodiesGastrointestinal Bleeding – UpperGISTs and Miscellaneous NeoplasmsMorbid ObesityPeptic Ulcer DiseaseStress Gastritis

Functional Disorders of the Stomach

Diseases/Conditions

Core

Advanced

16

PATIENT CARE

Gastrectomy – Partial/TotalGastroduodenal Perforation – RepairGastrostomyVagotomy and Drainage

Morbid Obesity – OperationPostgastrectomy Syndromes – Revisional Procedures


Core

Advanced















9. Alimentary Tract – Small Intestine

Enterocutaneous FistulaMeckel DiverticulumMesenteric Ischemia – Acute (Arterial, Venous, andNonocclusive) Paralytic Ileus Radiation EnteritisSmall Intestinal NeoplasmsSmall Intestinal Obstruction

Enteric Infections/Blind Loop SyndromeShort Bowel Syndrome

Diseases/Conditions

Core

Advanced

17

PATIENT CARE

AdhesiolysisCrohn Disease – Surgical ManagementIleostomy and Ileostomy ClosureSmall Intestinal Resection


Core
















10. Alimentary Tract – Large Intestine

AppendicitisC. difficile ColitisColitis – IschemicColon CancerColonic PolypsColonic Volvulus and ObstructionDiverticulitisGastrointestinal Bleeding – Lower

Functional Disorders of the IntestinePolyposis Syndromes

Diseases/Conditions

Core

Advanced

18

PATIENT CARE

AppendectomyColectomy – PartialColectomy – Total and SubtotalColostomy and Colostomy ClosureUlcerative Colitis – Surgical Management


Core

















11. Alimentary Tract – Anorectal

Anal CancerAnal Dysplasia and STDsAnal FissureAnorectal Abscess and FistulaeHemorrhoidsRectal Cancer

Fecal IncontinenceRectal Prolapse

Diseases/Conditions

Core

Advanced

19

PATIENT CARE

Anal Sphincterotomy Anorectal Abscess – DrainageAnorectal Fistula – RepairHemorrhoids – ManagementPerianal Condylomas – Excision

Anal Cancer – ExcisionRectal Cancer – Abdominoperineal Resection and PelvicExenterationRectal Cancer – Transanal ResectionRectal Prolapse – Repair


Core

Advanced



















12. Endoscopy

20

PATIENT CARE

Bronchoscopy and Bronchoalveolar LavageEsophagogastroduodenoscopyLower GI Endoscopy


Core




13. Breast

Atypical Hyperplasia and Lobular Carcinoma in SituBenign Disease – Fat Necrosis, Fibrocystic Breast Changes,and Radial ScarBenign Inflammatory Disease – Mastitis, Abscess, and MondorDiseaseBreast Cancer – HereditaryBreast Cancer – InflammatoryBreast Cancer – Invasive Carcinoma (Ductal, Lobular, AllVariants)Breast Cancer – Paget Disease of the NippleBreast Disease During Pregnancy and LactationBreast MassDuctal Carcinoma in SituFibroadenoma and Phyllodes TumorsMale Breast Disease – Gynecomastia and Breast CancerNipple Discharge and Intraductal PapillomaRadiographic Abnormalities

Postmastectomy Reconstruction Options

Diseases/Conditions

Core

Advanced

21

PATIENT CARE

Axillary Sentinel Lymph Node Biopsy and LymphadenectomyDuct ExcisionExcisional Breast Biopsy and Partial MastectomyMastectomy – Simple, Modified Radical, and RadicalPercutaneous Breast Biopsy and Cyst Aspiration


Core





















14. Endocrine

Adrenal Mass – IncidentalHyperaldosteronism – PrimaryHypercortisolism – Cushing Syndrome/DiseaseHyperparathyroidismHyperthyroidismHypothyroidism – PostoperativePheochromocytomaThyroid CancerThyroid NoduleThyroiditis

Adrenal CancerMultiple Endocrine NeoplasiasParathyroid Cancer

Diseases/Conditions

Core

Advanced

22

PATIENT CARE

ParathyroidectomyThyroidectomy – Partial or Total

AdrenalectomyUltrasound of the Thyroid


Core

Advanced


















15. Skin and Soft Tissue

CellulitisHidradenitisMelanoma and NeviNecrotizing Soft Tissue InfectionsNonmelanoma Skin CancersParonychia and FelonPilonidal Cyst/SinusSoft Tissue Masses – Evaluation

Lymphedema/LymphangitisPressure UlcerSoft Tissue Sarcomas

Diseases/Conditions

Core

Advanced

23

PATIENT CARE

Melanoma – Wide ExcisionPilonidal CystectomySentinel Lymph Node Biopsy for MelanomaSkin/Soft Tissue Lesions – Excisional and Incisional BiopsySoft Tissue Infections – Incision, Drainage, Debridement

Ilioinguinal-Femoral LymphadenectomySoft Tissue Sarcoma – Resection


Core

Advanced



















16. Surgical Critical Care

Abdominal Compartment SyndromeAcute Respiratory Distress Syndrome (ARDS)AnaphylaxisBrain DeathCardiac ArrestCardiac Arrhythmias – CommonCardiac Failure and Cardiogenic ShockDerangements of Electrolytes and Acid-Base BalanceEndocrine DysfunctionHepatic Failure and Hepatorenal SyndromeHypovolemic ShockHypoxemic Syndromes (Pulmonary Embolism,Pneumonia)Neurogenic ShockNeurologic DysfunctionPain, Agitation, and DeliriumRenal FailureRespiratory FailureSepsis and Septic Shock

Organ Donors and Selection Criteria

Diseases/Conditions

Core

Advanced

24

PATIENT CARE

Intubation and Difficult AirwayNutritional SupportUltrasound Use for Intravascular AccessVascular Access

Noninvasive and Invasive Cardiac Pacing


Core

Advanced

























17. Trauma

BurnsCardiac InjuryChest Wall, Pleural and Diaphragm InjuriesColon and Rectal InjuryDuodenal and Pancreatic InjuryEsophageal InjuryFrostbite and HypothermiaGastric and Small Intestinal InjuryGeriatric TraumaHepatic InjuryInitial Assessment and Management of TraumaLower Urinary Tract InjuriesPediatric TraumaPelvic Fractures and Retroperitoneal HematomaSplenic InjuryTracheobronchial and Lung InjuryTrauma in PregnancyUpper Aerodigestive Tract InjuryUpper Urinary Tract InjuriesVascular Injury – AbdomenVascular Injury – ExtremitiesVascular Injury – NeckVascular Injury – Thorax

Bite and Envenomation InjuriesBrachial Plexus InjuryExtremity InjuriesSmoke Inhalation Injury and Carbon Monoxide PoisoningSpine FractureTraumatic Brain Injury

Diseases/Conditions

Core

Advanced

25

PATIENT CARE






























17. Trauma (cont.)

Abdominal Exploration for TraumaCardiac Injury – RepairDuodenal and Pancreatic Injury – OperationsEsophageal Injury – RepairFasciotomyFocused Assessment with Sonography for Trauma (FAST)Gastrointestinal Tract Injury – RepairHepatic Injury – Packing and Repair/ResectionNeck Injuries – ManagementSplenectomy/SplenorrhaphyUrinary Tract Injuries – OperationsVascular Injuries – OperationsWounds, Major – Debride/Suture

Hand Tendon RepairsThermal Injuries – Operations


Core

Advanced

26

PATIENT CARE
















18. Vascular – Arterial Disease

Acute Thrombosis and IschemiaCerebrovascular DiseaseCompartment SyndromesDiabetic Foot InfectionsPeripheral Arterial EmboliPeripheral Vascular Occlusive Disease

Acute Aortic DissectionAortic DissectionArterial Aneurysms – AorticArterial Aneurysms – PeripheralArterial Aneurysms – VisceralNonatherosclerotic Occlusive DiseasesRenal Artery DiseaseThoracic Outlet SyndromeVascular Graft Infections

Diseases/Conditions

Core

Advanced

27

PATIENT CARE

Amputations – Lower ExtremityEmbolectomy/Thrombectomy – Arterial

Abdominal and Aortoiliac Aneurysm – RepairAortoiliac Reconstruction for Occlusive DiseaseCarotid EndarterectomyEndovascular Intervention PrinciplesExtra-anatomic BypassGraft-enteric Fistula – ManagementLower Extremity BypassMesenteric Occlusive Disease – OperationPeripheral Aneurysms – RepairSuperior Mesenteric Artery Embolectomy/ ThrombectomyUltrasound in the Diagnosis and Management of VascularDiseases


Core

Advanced








https://www.surgicalcore.org/Search.aspx?q=Aortic+Dissection





















19. Vascular – Venous

Evaluation of the Swollen LegThrombophlebitisVaricose VeinsVenous Stasis/Chronic Venous InsufficiencyVenous Thromboembolism

Diseases/Conditions

Core

28

PATIENT CARE

Vena Caval Filter – InsertionVenous Insufficiency/Varicose Veins – Operation


Core







20. Vascular – Access

Vascular Access for Dialysis

Diseases/Conditions

Core

29

PATIENT CARE

Arteriovenous Graft/FistulaVascular Exposure – PrinciplesVenous Access Devices – Insertion


Core





21. Transplantation

Organ Preservation

Diseases/Conditions

Advanced

30

PATIENT CARE

En Bloc Abdominal Organ RetrievalLive Donor HepatectomyLive Donor NephrectomyLiver TransplantationPancreas TransplantationRenal Transplantation


Advanced








22. Thoracic Surgery

Pleural Effusion/EmpyemaPneumothorax and Pleurodesis

ChylothoraxMalignant Tumors of the Lung: Primary and MetastaticMediastinal Tumors and CystsMediastinitis Superior Vena Cava Syndrome

Diseases/Conditions

Core

Advanced

31

PATIENT CARE

Exploratory Thoracotomy – Open and ThoracoscopicPartial Pulmonary Resections – Open and ThoracoscopicTube Thoracostomy and Thoracentesis


Core












23. Pediatric Surgery

Abdominal MassAbdominal Pain – AcuteAppendicitisGastrointestinal Bleeding – LowerHypertrophic Pyloric StenosisInguinal HerniaIntussusceptionMalrotationMeckel DiverticulumUmbilical Hernia

Aerodigestive Tract Foreign BodiesAnorectal MalformationsBiliary AtresiaCholedochal CystsCongenital Aganglionosis (Hirschsprung Disease)Congenital Diaphragmatic HerniaCryptorchidismEsophageal Atresia/Tracheoesophageal FistulaGastroschisis/OmphaloceleNecrotizing EnterocolitisNeonatal Small Bowel Obstruction

Diseases/Conditions

Core

Advanced

32

PATIENT CARE

Inguinal Hernia – RepairIntussusception – OperationMalrotation – OperationMeckel Diverticulum – ExcisionPyloromyotomyUmbilical Hernia – Repair


Core












http://www.surgicalcore.org/modulecontent.aspx?id=162853
















23. Pediatric Surgery (cont.)

Anorectal Malformations - OperationBranchial Cleft Anomaly – ExcisionChest Wall Deformity – RepairCongenital Diaphragmatic Hernia - RepairDiaphragmatic Hernia – RepairEsophageal Atresia/Tracheoesophageal Fistula – RepairGastroschisis/Omphalocele – RepairHirschsprung Disease – OperationIntestinal Atresia/Stenosis – RepairMeconium Ileus – OperationNecrotizing Enterocolitis – OperationOrchiopexyThyroglossal Duct Cyst – Excision

Diseases/Conditions

Advanced

33

PATIENT CARE













24. Plastic Surgery

Complex Wound ClosureSkin Grafting


Core

34

PATIENT CARE



25. Genitourinary

HydroceleScrotal Pain and Masses

Acute Urinary RetentionGenitourinary Neoplasms

Diseases/Conditions

Core

Advanced

35

PATIENT CARE

CystostomyNephrectomy


Core







26. Gynecology and Obstetrics

Ectopic PregnancyPelvic Inflammatory Disease

Gynecologic Neoplasms

Diseases/Conditions

Core

Advanced

36

PATIENT CARE

Hysterectomy and Salpingo-oophorectomySurgical Considerations of the Pregnant Patient

Cesarean Section


Core

Advanced







27. Head and Neck

Neck Mass – EvaluationUpper Airway Obstruction

Oral Cavity/Pharynx, Laryngeal, and Salivary Gland Cancer

Diseases/Conditions

Core

Advanced

37

PATIENT CARE

Lymph Node BiopsyTracheostomy

Modified Neck DissectionParotidectomy


Core

Advanced








DISEASES/CONDITIONS BY LEVEL

Diseases/Conditions – CORE

Abdomen – GeneralAbdominal Pain – Acute and ChronicRectus Sheath Hematoma Abdomen – HerniaInguinal and Femoral HerniasMiscellaneous HerniasUmbilical and Epigastric HerniasVentral Hernia Abdomen – BiliaryBenign Biliary ObstructionBile Duct Injury – IatrogenicBiliary NeoplasmsCholecystitisCholedochal Cyst Abdomen – LiverHepatic AbscessHepatic Neoplasms – MetastaticPrimary Hepatic Neoplasms – Benign and Malignant Abdomen – PancreasCystic Lesions of the PancreasPancreatic Neoplasms – EndocrinePancreatic Neoplasms – ExocrinePancreatitis – Acute/Pancreatic Necrosis/Abscess Alimentary Tract – EsophagusEsophageal Motility DisordersEsophageal Neoplasms – Benign and MalignantEsophageal PerforationGastroesophageal Reflux/Barrett EsophagusHiatal Hernias Alimentary Tract – StomachGastric AdenocarcinomaGastric Foreign BodiesGastrointestinal Bleeding – UpperGISTs and Miscellaneous NeoplasmsMorbid ObesityPeptic Ulcer DiseaseStress Gastritis Alimentary Tract – Small IntestineEnterocutaneous FistulaMeckel DiverticulumMesenteric Ischemia – Acute (Arterial, Venous, and Nonocclusive)Paralytic IleusRadiation EnteritisSmall Intestinal NeoplasmsSmall Intestinal Obstruction

38

PATIENT CARE



Alimentary Tract – Large IntestineAppendicitisC. difficile ColitisColitis – IschemicColon CancerColonic PolypsColonic Volvulus and ObstructionDiverticulitisGastrointestinal Bleeding – Lower

Alimentary Tract – AnorectalAnal CancerAnal Dysplasia and STDsAnal FissureAnorectal Abscess and FistulaeHemorrhoidsRectal Cancer BreastAtypical Hyperplasia and Lobular Carcinoma in SituBenign Disease – Fat Necrosis, Fibrocystic Changes, and Radial ScarBenign Inflammatory Disease – Mastitis, Abscess, and Mondor DiseaseBreast Cancer – HereditaryBreast Cancer – InflammatoryBreast Cancer – Invasive Carcinoma (Ductal, Lobular, All Variants)Breast Cancer – Paget Disease of the NippleBreast Disease During Pregnancy and LactationBreast MassDuctal Carcinoma in SituFibroadenoma and Phyllodes TumorsMale Breast Disease: Gynecomastia and Breast CancerNipple Discharge and Intraductal PapillomaRadiographic Abnormalities EndocrineAdrenal Mass – IncidentalHyperaldosteronism – PrimaryHypercortisolism – Cushing Syndrome/DiseaseHyperparathyroidismHyperthyroidismHypothyroidism – PostoperativePheochromocytomaThyroid CancerThyroid NoduleThyroiditis

Skin and Soft TissueCellulitisHidradenitisMelanoma and NeviNecrotizing Soft Tissue InfectionsNonmelanoma Skin CancersParonychia and FelonPilonidal Cyst/SinusSoft Tissue Masses – Evaluation

39

PATIENT CARE



Surgical Critical CareAbdominal Compartment SyndromeAcute Respiratory Distress Syndrome (ARDS)AnaphylaxisBrain DeathCardiac ArrestCardiac Arrhythmias – CommonCardiac Failure and Cardiogenic ShockDerangements of Electrolytes and Acid Base BalanceEndocrine DysfunctionHepatic Failure and Hepatorenal SyndromeHypovolemic ShockHypoxemic Syndromes (Pulmonary Embolism, Pneumonia)Neurogenic ShockNeurologic DysfunctionPain, Agitation, and DeliriumRenal FailureRespiratory FailureSepsis and Septic Shock

TraumaBurnsCardiac InjuryChest Wall, Pleural and Diaphragm InjuriesColon and Rectal InjuryDuodenal and Pancreatic InjuryEsophageal InjuryFrostbite and HypothermiaGastric and Small Intestinal InjuryGeriatric TraumaHepatic InjuryInitial Assessment and Management of TraumaLower Urinary Tract InjuriesPediatric TraumaPelvic Fractures and Retroperitoneal HematomaSplenic InjuryTracheobronchial and Lung InjuryTrauma in PregnancyUpper Aerodigestive Tract InjuryUpper Urinary Tract InjuriesVascular Injury – AbdomenVascular Injury – ExtremitiesVascular Injury – NeckVascular Injury – Thorax

Vascular – Arterial DiseaseAcute Thrombosis and IschemiaCerebrovascular DiseaseCompartment SyndromesDiabetic Foot InfectionsPeripheral Arterial EmboliPeripheral Vascular Occlusive Disease

40

PATIENT CARE



Vascular – VenousEvaluation of the Swollen LegThrombophlebitisVaricose VeinsVenous Stasis/Chronic Venous InsufficiencyVenous Thromboembolism

Vascular – Access Vascular Access for Dialysis Thoracic SurgeryPleural Effusion/Empyema Pneumothorax and Pleurodesis Pediatric SurgeryAbdominal MassAbdominal Pain – AcuteAppendicitisGastrointestinal Bleeding – LowerHypertrophic Pyloric StenosisInguinal HerniaIntussusceptionMalrotationMeckel DiverticulumUmbilical Hernia

GenitourinaryHydroceleScrotal Pain and Masses

Gynecology and ObstetricsEctopic PregnancyPelvic Inflammatory Disease Head and NeckNeck Mass – EvaluationUpper Airway Obstruction

41

PATIENT CARE


Diseases/Conditions – ADVANCED

Abdomen – GeneralDesmoids/FibromatosesPeritoneal Neoplasms Abdomen – Biliary Functional Biliary DisordersPrimary Sclerosing Cholangitis Abdomen – LiverCirrhosis/Portal Hypertension (Ascites) Abdomen – PancreasIntraductal Papillary Mucinous NeoplasmsPancreas DivisumPancreatitis – Chronic (Including Hereditary Pancreatitis)/Pancreatic

Insufficiency Abdomen – SpleenHematologic Diseases of the SpleenSplenic Abscess, Cysts and Neoplasms Alimentary Tract – EsophagusEsophageal Caustic Ingestion and Foreign Bodies Alimentary Tract – StomachFunctional Disorders of the Stomach Alimentary Tract – Small Intestine Enteric Infections/Blind Loop Syndrome Short Bowel Syndrome Alimentary Tract – Large IntestineFunctional Disorders of the IntestinePolyposis Syndromes Alimentary Tract – Anorectal Fecal Incontinence Rectal Prolapse

BreastPostmastectomy Reconstruction Options EndocrineAdrenal CancerMultiple Endocrine NeoplasiasParathyroid Cancer Skin and Soft TissueLymphedema/LymphangitisPressure UlcerSoft Tissue Sarcomas Surgical Critical CareOrgan Donors and Selection Criteria

42

PATIENT CARE


Diseases/Conditions – ADVANCED

TraumaBite and Envenomation InjuriesBrachial Plexus InjuryExtremity InjuriesSmoke Inhalation Injury and Carbon Monoxide PoisoningSpine FractureTraumatic Brain Injury Vascular – Arterial DiseaseAcute Aortic DissectionArterial Aneurysms – AorticArterial Aneurysms – PeripheralArterial Aneurysms – VisceralNonatherosclerotic Occlusive DiseasesRenal Artery DiseaseThoracic Outlet Syndrome Vascular Graft Infections TransplantationOrgan Preservation Thoracic SurgeryChylothoraxMalignant Tumors of the Lung: Primary and MetastaticMediastinal Tumors and CystsMediastinitisSuperior Vena Cava Syndrome Pediatric SurgeryAerodigestive Tract Foreign BodiesAnorectal MalformationsBiliary AtresiaCholedochal CystsCongenital Agangliosis (Hirschsprung Disease)Congenital Diaphragmatic HerniaCryptorchidismEsophageal Atresia/Tracheoesophageal FistulaGastroschisis/OmphaloceleNecrotizing EnterocolitisNeonatal Small Bowel Obstruction GenitourinaryAcute Urinary RetentionGenitourinary Neoplasms Gynecology and ObstetricsGynecologic Neoplasms Head and NeckOral Cavity/Pharynx, Laryngeal, and Salivary Gland Cancer

43

PATIENT CARE

OPERATIONS/ PROCEDURES BY LEVEL

Operations/Procedures – CORE

Abdomen – General Abdominal Exploration Peritoneal Dialysis Catheter Insertion Abdomen – Hernia Diaphragmatic Hernia – RepairInguinal and Femoral Hernia – Repair Miscellaneous Hernias – Repair Ventral Hernia – Repair Abdomen – BiliaryCholecystectomy with or without CholangiographyCholecystostomyCholedochoenteric AnastomosisCommon Bile Duct Exploration and Choledochoscopy Abdomen – LiverHepatic Abscess – DrainageHepatic Biopsy Abdomen – PancreasPancreatectomy – DistalPancreatic DebridementPancreatic Pseudocyst – Drainage Abdomen – SpleenSplenectomy Alimentary Tract – Esophagus Antireflux Procedures Alimentary Tract – StomachGastrectomy – Partial/TotalGastroduodenal Perforation – RepairGastrostomyVagotomy and Drainage

Alimentary Tract – Small IntestineAdhesiolysis Crohn Disease – Surgical ManagementIleostomy and Ileostomy ClosureSmall Intestinal Resection Alimentary Tract – Large IntestineAppendectomyColectomy – PartialColectomy – Total and SubtotalColostomy and Colostomy ClosureUlcerative Colitis – Surgical Management

Alimentary Tract – Anorectal Anal SphincterotomyAnorectal Abscess – Drainage Anorectal Fistula – Repair Hemorrhoids – Management Perianal Condylomas – Excision

44

PATIENT CARE



EndoscopyBronchoalveolar Lavage and BronchoscopyEsophagogastroduodenoscopy Lower GI Endoscopy BreastAxillary Sentinel Lymph Node Biopsy and LymphadenectomyDuct ExcisionExcisional Breast Biopsy and Partial MastectomyMastectomy – Simple, Modified Radical, and RadicalPercutaneous Breast Biopsy and Cyst Aspiration

EndocrineParathyroidectomyThyroidectomy – Partial or Total Skin and Soft Tissue Melanoma – Wide ExcisionPilonidal CystectomySentinel Lymph Node Biopsy for MelanomaSkin/Soft Tissue Lesions – Excisional and Incisional Biopsy Soft Tissue Infections – Incision, Drainage, Debridement Surgical Critical Care Intubation and Difficult AirwayNutritional SupportUltrasound Use for Intravascular Access Vascular Access

TraumaAbdominal Exploration for Trauma Cardiac Injury – RepairDuodenal and Pancreatic Injury – Operations Esophageal Injury – RepairFasciotomyFocused Assessment with Sonography for Trauma (FAST)Gastrointestinal Tract Injury – RepairHepatic Injury – Packing and Repair/ResectionNeck Injuries – ManagementSplenectomy/SplenorrhaphyUrinary Tract Injuries – Operations Vascular Injuries – Operations Wounds, Major – Debride/Suture

Vascular – Arterial Disease Amputations – Lower ExtremityEmbolectomy/Thrombectomy – Arterial Vascular – VenousVena Cava Filter InsertionVenous Insufficiency/Varicose Veins – Operation

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PATIENT CARE



Vascular – AccessArteriovenous Graft/Fistula Vascular Exposure – PrinciplesVenous Access Devices – Insertion

Thoracic SurgeryExploratory Thoracotomy – Open and ThoracoscopicPartial Pulmonary Resections – Open and ThoracoscopicTube Thoracostomy and Thoracentesis Pediatric SurgeryInguinal Hernia – RepairIntussusception – Operation Malrotation – OperationMeckel Diverticulum – ExcisionPyloromyotomyUmbilical Hernia – Repair

Plastic SurgeryComplex Wound ClosureSkin Grafting GenitourinaryCystostomyNephrectomy

Gynecology and Obstetrics Hysterectomy and Salpingo-oophorectomy Surgical Considerations in the Pregnant Patient Head and Neck Lymph Node BiopsyTracheostomy

46

PATIENT CARE


Operations/Procedures – ADVANCED

Abdomen – BiliaryBile Duct Cancer – OperationBile Duct Injury, Iatrogenic – Acute RepairBile Duct Neoplasms – OperationGallbladder Cancer – OperationUltrasound of the Biliary Tree Abdomen – LiverHepatic Ultrasound – Intraoperative Segmentectomy/Lobectomy Abdomen – Pancreas Ampullary Resection for TumorPancreatectomy – TotalPancreatic Ultrasound – Intraoperative PancreaticoduodenectomyPancreatitis, Chronic – Operative Management

Alimentary Tract – EsophagusCricopharyngeal Myotomy with Zenker Diverticulum – ExcisionEsophageal Perforation – Repair/Resection Esophagectomy/Esophagogastrectomy Esophagomyotomy (Heller) Paraesophageal Hernia – Repair Alimentary Tract – StomachMorbid Obesity – OperationsPostgastrectomy Syndromes – Revisional Procedures

Alimentary Tract – AnorectalAnal Cancer – ExcisionRectal Cancer – Abdominoperineal Resection and Pelvic ExenterationRectal Cancer – Transanal ResectionRectal Prolapse – Repair EndocrineAdrenalectomy Ultrasound of the Thyroid Skin and Soft Tissue Ilioinguinal-Femoral Lymphadenectomy Soft Tissue Sarcoma – Resection Surgical Critical CareNoninvasive and Invasive Cardiac Pacing TraumaHand Tendon RepairsThermal Injuries – Operations

47

PATIENT CARE


Operations/Procedures – ADVANCED

Vascular – Arterial DiseaseAbdominal and Aortoiliac Aneurysm – Repair Aortoiliac Reconstruction for Occlusive DiseaseCarotid EndarterectomyEndovascular Intervention Principles Extra-anatomic BypassGraft-enteric Fistula – Management Lower Extremity BypassMesenteric Occlusive Disease – Operation Peripheral Aneurysms – RepairSuperior Mesenteric ArteryEmbolectomy/Thrombectomy Ultrasound in the Diagnosis and Management of Vascular Diseases

TransplantationEn Bloc Abdominal Organ RetrievalLive Donor HepatectomyLive Donor NephrectomyLiver TransplantationPancreas TransplantationRenal Transplantation Pediatric SurgeryAnorectal Malformations - Operation Branchial Cleft Anomaly – ExcisionChest Wall Deformity – RepairCongenital Diaphragmatic Hernia - RepairDiaphragmatic Hernia – RepairEsophageal Atresia/Tracheoesophageal Fistula – RepairGastroschisis/Omphalocele – RepairHirschsprung Disease – OperationIntestinal Atresia/Stenosis – RepairMeconium Ileus – OperationNecrotizing Enterocolitis – OperationOrchiopexyThyroglossal Duct Cyst – Excision Gynecology and ObstetricsCesarean Section Head and NeckModified Neck DissectionParotidectomy

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PATIENT CARE

Anesthesia1.

Anesthesia, General – Agents and TechniquesAnesthesia, Regional and Local – Agents and TechniquesBest Practices in Prescribing OpioidsChoice of AnesthesiaConscious Sedation – Agents and TechniquesIntraoperative Monitoring and Common IntraoperativeProblemsNerve Blocks – Digital and PeripheralPain, Acute – Management Pain, Chronic – Management

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MEDICAL KNOWLEDGE

2. Biostatistics and Evaluation of Evidence

Clinical TrialsEvaluating the Quality and Applicability of a StudyHow Data is Expressed and SummarizedLevels of EvidenceOutcomesResearch Design in Outcome and Health ServicesResearchSurveys and Qualitative ResearchTests of Significance

3. Fluids, Electrolytes, and Acid-Base Balance

Hypocalcemia and HypercalcemiaHypokalemia and HyperkalemiaHyponatremia and HypernatremiaMagnesium and Phosphorus Disorders

4. Geriatric Surgery and End-of-Life Care

Advance Directives, DNR Orders, and Power of AttorneyFrailtyGoal Setting with Elderly Patients and FamiliesPalliative and Hospice CarePerioperative Management of Geriatric Patients



























5. Immunology

Components of the Immune SystemImmune Response to Injury and InfectionSurgery and Surgical Conditions in Immunocompromised HostsTransplant Immunology

50

MEDICAL KNOWLEDGE

6. Infection and Antimicrobial Therapy

Antimicrobial Agents in Surgical InfectionsAntimicrobial StewardshipDiagnostic Approach to InfectionInfections – Hospital-AcquiredInfections – Opportunistic Intra-abdominal InfectionsPreoperative Assessment and Management of CoexistingInfectionPrevention and Treatment of Surgical Site Infection

7. Minimally Invasive Surgery – Principles

Minimally Invasive Surgery (MIS) PrinciplesRobotic Surgery – PrinciplesSafe Use of Surgical Energy

8. Nutrition and Metabolism

Effect of Surgery, Illness and Injury on NutritionalRequirementsNutritional AssessmentNutritional Pharmacology and ImmunonutritionNutritional Requirements




















9. Oncology and Tumor Biology

Adjunctive Therapy for CancerGenetic SusceptibilityScreening and BiomarkersTumor Immunology

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MEDICAL KNOWLEDGE

10. Preoperative Evaluation and Perioperative Care

Common Postoperative ProblemsEvaluation of Surgical RiskManagement of Perioperative RiskPostoperative Pain ManagementProphylaxis of Venous ThromboembolismVentilatory Support/Management

11. Transfusion and Disorders of Coagulation

Evaluation of Ongoing Bleeding and Laboratory Assessment ofCoagulationInherited and Acquired Disorders of CoagulationNormal Mechanisms of Hemostasis and CoagulationTransfusion – Indications, Risks, Type and Crossmatch, andComponent Therapy

12. Wound Healing

Wound Closure and Postoperative CareWound Healing

















Ethical Issues in Clinical Surgery1.

Advance Directives Approaching Ethical Issues in Surgery Decision-Making CapacityDo Not Resuscitate Ethics in Global Surgery and Volunteerism FutilityInformed Consent Medical Decisions for Pediatric Patients Surrogate Decision Making Withdrawing and Withholding Life-SustainingTreatments

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PROFESSIONALISM



















1. Non-Technical Skills for Surgeons (NOTSS)

Cognitive Skills (Situation Awareness and Decision Making)Social Skills (Communication, Teamwork and Leadership)

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INTERPERSONAL AND COMMUNICATION SKILLS

Admitting Mistakes – Ethical Choices and ReasoningAdvanced Communication Skills for Surgical Practice – and TheChallenge of Informed ConsentCultural Diversity – Working Through the Barriers of Languageand Differing CustomsDelivering Bad News – Your Chance to Become a MasterSurgeonGiving and Getting FeedbackManaging Your Career – Making the Professional and PersonalChoices that Define YouMedical Errors and ApologySafe Handoff of Patient Care DutiesThe Stress of Surgical Practice – The Signs of Stress,Depression, and Suicide in You and Your Surgical ColleaguesWorking with Professionals – Team Communication andRespect

2. Surgical Professionalism and

Interpersonal Communication Education (SPICE)













Quality Improvement1.

Inspiring a Healthy Culture for Patient CareLocal Engagement in Quality ImprovementProblem-Based Quality ImprovementUnderstanding the Data and Methods to Evaluate Performance

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PRACTICE-BASED LEARNING AND IMPROVEMENT





Systems-Based Practice1.

Advocating for Quality Patient CareCoordinating Patient CareCost Awareness and Risk-Benefit AnalysisIdentifying Systems Errors – Root Cause AnalysisWorking Effectively in Various Healthcare Delivery Settingsand Systems Working in Interprofessional Teams

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SYSTEMS-BASED PRACTICE







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