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
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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
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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
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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
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PRACTICE-BASED LEARNING ANDIMPROVEMENT CONTENTS
Quality Improvement........................................................541.
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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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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.
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Abdomen – General1.
Abdominal Pain – Acute and ChronicRectus Sheath Hematoma
Desmoids/FibromatosesPeritoneal Neoplasms
Diseases/Conditions
Core
Advanced
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PATIENT CARE
Abdominal ExplorationPeritoneal Dialysis Catheter Insertion
Operations/Procedures
Core
2. Abdomen – Hernia
Inguinal and Femoral HerniasMiscellaneous HerniasUmbilical and Epigastric HerniasVentral Hernia
Diseases/Conditions
Core
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PATIENT CARE
Diaphragmatic Hernia – RepairInguinal and Femoral Hernia – RepairMiscellaneous Hernias – RepairVentral Hernia – Repair
Operations/Procedures
Core
3. Abdomen – Biliary
Benign Biliary ObstructionBile Duct Injury – IatrogenicBiliary NeoplasmsCholecystitisCholedochal Cyst
Functional Biliary DisordersPrimary Sclerosing Cholangitis
Diseases/Conditions
Core
Advanced
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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
Operations/Procedures
Core
Advanced
4. Abdomen – Liver
Hepatic AbscessHepatic Neoplasms – MetastaticPrimary Hepatic Neoplasms – Benign and Malignant
Cirrhosis/Portal Hypertension (Ascites)
Diseases/Conditions
Core
Advanced
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PATIENT CARE
Hepatic Abscess – DrainageHepatic Biopsy
Hepatic Ultrasound – IntraoperativeSegmentectomy/Lobectomy
Operations/Procedures
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
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PATIENT CARE
Pancreatectomy – DistalPancreatic DebridementPancreatic Pseudocyst – Drainage
Ampullary Resection for TumorPancreatectomy – TotalPancreatic Ultrasound – IntraoperativePancreaticoduodenectomyPancreatitis, Chronic – Operative Management
Operations/Procedures
Core
Advanced
6. Abdomen – Spleen
Hematologic Diseases of the SpleenSplenic Abscess, Cysts, and Neoplasms
Diseases/Conditions
Advanced
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PATIENT CARE
Splenectomy
Operations/Procedures
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
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PATIENT CARE
Antireflux Procedures
Cricopharyngeal Myotomy with ZenkerDiverticulum – ExcisionEsophageal Perforation – Repair/ResectionEsophagectomy/EsophagogastrectomyEsophagomyotomy (Heller)Paraesophageal Hernia – Repair
Operations/Procedures
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
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PATIENT CARE
Gastrectomy – Partial/TotalGastroduodenal Perforation – RepairGastrostomyVagotomy and Drainage
Morbid Obesity – OperationPostgastrectomy Syndromes – Revisional Procedures
Operations/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
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PATIENT CARE
AdhesiolysisCrohn Disease – Surgical ManagementIleostomy and Ileostomy ClosureSmall Intestinal Resection
Operations/Procedures
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
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PATIENT CARE
AppendectomyColectomy – PartialColectomy – Total and SubtotalColostomy and Colostomy ClosureUlcerative Colitis – Surgical Management
Operations/Procedures
Core
11. Alimentary Tract – Anorectal
Anal CancerAnal Dysplasia and STDsAnal FissureAnorectal Abscess and FistulaeHemorrhoidsRectal Cancer
Fecal IncontinenceRectal Prolapse
Diseases/Conditions
Core
Advanced
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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
Operations/Procedures
Core
Advanced
12. Endoscopy
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PATIENT CARE
Bronchoscopy and Bronchoalveolar LavageEsophagogastroduodenoscopyLower GI Endoscopy
Operations/Procedures
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
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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
Operations/Procedures
Core
14. Endocrine
Adrenal Mass – IncidentalHyperaldosteronism – PrimaryHypercortisolism – Cushing Syndrome/DiseaseHyperparathyroidismHyperthyroidismHypothyroidism – PostoperativePheochromocytomaThyroid CancerThyroid NoduleThyroiditis
Adrenal CancerMultiple Endocrine NeoplasiasParathyroid Cancer
Diseases/Conditions
Core
Advanced
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PATIENT CARE
ParathyroidectomyThyroidectomy – Partial or Total
AdrenalectomyUltrasound of the Thyroid
Operations/Procedures
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
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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
Operations/Procedures
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
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PATIENT CARE
Intubation and Difficult AirwayNutritional SupportUltrasound Use for Intravascular AccessVascular Access
Noninvasive and Invasive Cardiac Pacing
Operations/Procedures
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
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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
Operations/Procedures
Core
Advanced
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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
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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
Operations/Procedures
Core
Advanced
19. Vascular – Venous
Evaluation of the Swollen LegThrombophlebitisVaricose VeinsVenous Stasis/Chronic Venous InsufficiencyVenous Thromboembolism
Diseases/Conditions
Core
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PATIENT CARE
Vena Caval Filter – InsertionVenous Insufficiency/Varicose Veins – Operation
Operations/Procedures
Core
20. Vascular – Access
Vascular Access for Dialysis
Diseases/Conditions
Core
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PATIENT CARE
Arteriovenous Graft/FistulaVascular Exposure – PrinciplesVenous Access Devices – Insertion
Operations/Procedures
Core
21. Transplantation
Organ Preservation
Diseases/Conditions
Advanced
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PATIENT CARE
En Bloc Abdominal Organ RetrievalLive Donor HepatectomyLive Donor NephrectomyLiver TransplantationPancreas TransplantationRenal Transplantation
Operations/Procedures
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
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PATIENT CARE
Exploratory Thoracotomy – Open and ThoracoscopicPartial Pulmonary Resections – Open and ThoracoscopicTube Thoracostomy and Thoracentesis
Operations/Procedures
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
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PATIENT CARE
Inguinal Hernia – RepairIntussusception – OperationMalrotation – OperationMeckel Diverticulum – ExcisionPyloromyotomyUmbilical Hernia – Repair
Operations/Procedures
Core
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
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PATIENT CARE
24. Plastic Surgery
Complex Wound ClosureSkin Grafting
Operations/Procedures
Core
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PATIENT CARE
25. Genitourinary
HydroceleScrotal Pain and Masses
Acute Urinary RetentionGenitourinary Neoplasms
Diseases/Conditions
Core
Advanced
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PATIENT CARE
CystostomyNephrectomy
Operations/Procedures
Core
26. Gynecology and Obstetrics
Ectopic PregnancyPelvic Inflammatory Disease
Gynecologic Neoplasms
Diseases/Conditions
Core
Advanced
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PATIENT CARE
Hysterectomy and Salpingo-oophorectomySurgical Considerations of the Pregnant Patient
Cesarean Section
Operations/Procedures
Core
Advanced
27. Head and Neck
Neck Mass – EvaluationUpper Airway Obstruction
Oral Cavity/Pharynx, Laryngeal, and Salivary Gland Cancer
Diseases/Conditions
Core
Advanced
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PATIENT CARE
Lymph Node BiopsyTracheostomy
Modified Neck DissectionParotidectomy
Operations/Procedures
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
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PATIENT CARE
DISEASES/CONDITIONS BY LEVEL
Diseases/Conditions – CORE
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
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PATIENT CARE
DISEASES/CONDITIONS BY LEVEL
Diseases/Conditions – CORE
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
DISEASES/CONDITIONS BY LEVEL
Diseases/Conditions – CORE
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 BY LEVEL
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
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PATIENT CARE
DISEASES/CONDITIONS BY LEVEL
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
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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
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PATIENT CARE
OPERATIONS/ PROCEDURES BY LEVEL
Operations/Procedures – CORE
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
OPERATIONS/ PROCEDURES BY LEVEL
Operations/Procedures – CORE
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
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PATIENT CARE
OPERATIONS/ PROCEDURES BY LEVEL
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
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PATIENT CARE
OPERATIONS/ PROCEDURES BY LEVEL
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
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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