Regulations and Syllabus relating to icon

Regulations and Syllabus relating to


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College of Surgeons of East, Central & Southern Africa





Regulations and Syllabus relating to

Fellowship Training & Examination


FCSpaed(ECSA)

Fellowship in Paediatric Surgery


2009 edition


COSECSA, PO Box 1009, Arusha, Tanzania

Fax (+ 255) 27 2504125 email cosecsa@crhcs.or.tz

College of Surgeons of East Central and Southern Africa


College of Surgeons of East Central and Southern Africa


Fellowship examination in Paediatric Surgery leading to the qualification of FCSpaed(ECSA)


Contents


1 Introduction

2 Registration as a trainee

3 Training Requirements

4 Logbook

5 Application to sit Examination

6 Examination Format and Conduct

7 Syllabus



  1. Introduction


The College of Surgeons of East Central and Southern Africa awards Membership (MCS) and Fellowship (FCS) examinations. Approved trainee surgeons shall be trained in the hospitals of the region with guidance and support provided by the College.


The Fellowship examination in paediatric surgery leads to the qualification of Fellow of the College of Surgeons of East Central and Southern Africa, FCSpaed (ECSA). This fellowship is a recognition that the candidate has reached the level of knowledge, understanding and practice of surgery sufficient to practice independently at a consultant or specialist level. It should be recognised however that surgery is not a static art and fellows should continue to increase knowledge and skills by means of research, conferences meetings and reading.


2 Registration as a trainee


All candidates for the FCSpaed (ECSA) examination are required to register as trainees with the College. Applications to register as a trainee must be made on COSECSA application forms which are available from the College country representative (CCR)/COSECSA website. These should be completed and returned to the CCR accompanied by certified copies of certificates showing MCS or equivalent examination.


A registration fee of US$300 should be given to the CCR or his representative.

On receipt of the registration fee, the CCR will give the candidate:


i) a copy of the examination regulations and syllabus

ii) a log book

iii) a list of recognised hospitals and approved courses

iv) assessment forms to be filled in at the end of every training post by the trainee and the supervising consultant.

v) a recommended reading list for the relevant examination

vi) an application form to sit the examination

vii) a registration number which remains unique to the candidate


3 . Training requirements


3.1 Academic


Candidates for the fellowship examination in paediatric surgery should normally have passed the membership examination of this college and possess the diploma MCS-ECSA. Exemption to this requirement will be given to those who have passed an equivalent examination such as membership of one of the Royal Colleges of Surgeons of the United Kingdom or Ireland. The basic surgical training examinations of other colleges and institutions may also be acceptable but each one will have to be reviewed by the Examination and Training Committee of the College before exemption can be given.


3.2 Training Posts


Candidates will have to have spent 3 years in recognised supervised training posts after completing the requirements for MCS. Two of these three years has to be spent in large paediatric surgical units dealing with a broad spectrum of paediatric surgery. If the primary training centre has only one consultant, the trainee should spend at least one year at other sites. The remainder of the time can be spent in units specialising in other branches of paediatric surgery for example, urology, plastic surgery, ENT, neurosurgery, reconstructive surgery. Six months of the three years may be spent outside the region in a post that has been prospectively agreed with the Examination and Training Committee.


Candidates are reminded that it is in their interests to experience a wide spectrum of surgical disciplines.


Forms to fill in for each training post are provided for each candidate or may be downloaded from the COSECSA website.


4. Logbook


During the training period candidates must keep a logbook prospectively recording all their training experience. The book should be available for inspection at any time by the COSECSA Country Representative (CCR). Consolidation sheets should be filled in at the end of every post or annually for posts longer than one year, and a final consolidating sheet for the whole training period. The logbook should also contain details of all courses attended and the trainee and post assessment forms for the whole training period.


More detail on completing logbooks is provided in the logbook itself


Before submission to the examination the CCR should check the logbook for completion, fill in and sign a checklist which remains at the front of the logbook.


At the August council meeting, the CCR will hand over to the Examinations and Credentials Committee Panel head, a copy of the check list together with copies of the Training post assessment form, Trainee assessment form and the final consolidation sheet ( up to August ) of all the candidates taking the examination that year.


At the time of clinical and oral examination the logbook should be handed to the examination administration secretary. Candidates will not be allowed to sit for the examination if this is not done.


5. Application to sit Examinations


Candidates who are registered as trainees (see §2 above) may sit the examination at the end of their third year of FCS training provided that they have completed 36 months of training by that time. Application for the examination must be made by March 1st of the year of the examination. Candidates should submit a completed examination application form to the CCR with the examination fee of US$500. On receipt of the form and the fee, candidates will be informed by the CCR of the precise times dates and places for the exams.


By applying to the examination a candidate agrees to be bound by the rules and regulations of the College.


If a candidate withdraws from an exam more than 12 weeks before the exam is due, then the fee can be transferred to the next exam date. Fees will not normally be returned if the candidate withdraws permanently, unless due to special circumstances as determined by the college.


Candidates must pass the examination within four years of their first attempt. After this they will not be allowed to resit. A total of four attempts only will be allowed.


6 Examination Format and Conduct


The standards of the examination will be set by the examination committee, drawn from members of the council of the college, which will recommend those standards required by both examiners and candidates. A panel of examiners will chosen by the examination committee from amongst Fellows of the College for each examination. A register of examiners will be kept by the chairman of the examination committee. An examination board will be constituted for each diet of examinations, comprising the chairman of the examination committee, two members from each examination panel and at least one external examiner. The role of the external examiner(s) is to:


a) Moderate the written question papers

b) Assist with the examination of candidates

c) Assist with any pass/fail vivas

d) Provide external independent assessment of the examination

e) Report on the conduct of the examination to the examination committee


The exam comprises written, clinical and oral parts


The written FCSpaed (ECSA) exam will comprise two 2 hour papers. The first paper will consist of fifty 5 part short answer or MCQ questions. There will be +2 marks for a correct answer and -1 mark for a wrong answer. It will be marked out of 500. The second paper will comprise 10 compulsory short essays each marked out of 50. A minimum score of 500 out of 1000 (50%) will be required to pass.


Written examinations may be held in any of the countries of the region. In exceptional circumstances the examination committee may approve an examination site outside the region. The written examinations are held simultaneously on the first Wednesday of September, at a recognised examination centre with impartial invigilation.


The examination papers will be set by members of the examination committee and independently moderated by an external examiner. They will be sent to COSECSA administration office in Arusha by 1st March and will be stored confidentially there. One copy per candidate will then be sent by courier or secure delivery to a named country representative at all sites that are holding examinations 2-3 days before they are held.


After the examination the CCR will make photocopies of the candidates’ completed exam scripts for safekeeping, and send the originals by courier or secure delivery to the relevant panel chairman. Marking of the examination paper will be coordinated by the panel chairman.

The clinical and oral part of the examination will comprise the following:


An oral examination (viva) which will take place approximately 3 months after the multiple choice exam, in a country and at a site designated by the college. There will be two 30 minute orals examinations.


A clinical examination which will take place at the same time and at the same site as the oral. This will comprise six 20 minute cases.


A closed marking scheme will apply for clinicals and orals


35 unredeemable

40 just redeemable fail

45 bare fail

50 bare pass

55 clear pass

60 good pass

65 very good pass

70 excellent pass


Examiners will choose one of these marks.

Candidates have to pass the written, clinical and oral sections of the examination in order to pass overall. If a candidate scores a mean of 49% in one section and has over 50% in the other two sections then he or she will be given a pass/fail viva. The chairman of the examination panel will select two examiners, excluding those who had failed the candidate, together with an external examiner, to conduct this viva.


The chairman of the examination panel will endeavour to minimise the chance of a candidate being examined by an examiner from his or her own country.

The panel of examiners will give the results to the examination board who will meet on the day of examination. The board will then approve the results on behalf of Council and publish them.


For each candidate who fails the exam, the panel will allocate a Fellow of the College (usually a member of the panel) who will communicate with the candidate and offer advice as may be indicated. Details of marks will not be given. . If a candidate fails his clinical and oral examination then he may attempt the clinical and oral examination for a maximum of 2 more years without having to rewrite the written examination.


Appeals against results must be made in writing to the Council within 60 days of the completion of the examination. The President of the College will then appoint an impartial committee to investigate the appeal, and require a written report to be filed by the Chairmen of the examinations panel and board. The Appeals committee will then take all considerations and its own findings into account and recommend a decision which will remain final and binding.


This will comprise a written paper (MCQ and/or MEQ), clinical and oral components. Applications for examinations with fee of $250 should be given to COSECSA central office directly or via country representatives before the August COSECSA council meeting. The written part of the exam will normally be held in the candidate’s own country in September, and the clinical and oral part in November/December in the country where the COSECSA annual meeting is to be held.

7. Syllabus Core Syllab


DEFINITION


Paediatric Surgery is the field of medicine that encompasses a broad range of diseases and malformations, both operative and non operative, from the foetal period until the late teenage years. In addition to the body areas/systems covered by General Surgery, Paediatric Surgery also deals with non cardiac thoracic conditions and genito urinary and gynaecological problems in children. These are detailed in the Primary Objectives. Other topics that may be covered by Paediatric Surgery, under some circumstances, are listed in the Secondary Objectives.


^ GENERAL OBJECTIVES


The objectives of training in Paediatric Surgery are to develop a Paediatric Surgeon who can assume complete responsibility for the preoperative, operative, and postoperative management of the problems relegated to his/her area of special expertise and who can interact appropriately with other colleagues involved in the care of paediatric patients. Additionally, it is expected that the trainee in Paediatric Surgery will develop the sensitivity required to deal not only with children, but also with their families. Blended within these objectives will be those of an ethical and academic nature that will reflect the conscience of modern Paediatric Surgery and help shape its future. The summary objectives are to ensure that Paediatric surgeons maintain the leadership and direction of the profession of Paediatric Surgery.


Different geographic locations place different demands on Paediatric surgeons, and the African setting differs considerably from the Western settings where most training programs are found. Particularly, trained paediatric surgeons are typically rare in African countries, and therefore must fulfil a multitude of roles. They must of necessity be the final resource and authority in the surgical care of children in their country, dealing with an overwhelmingly referral practice. They must also fulfil a significant training role, helping train health care professionals at all levels in the care of children. Finally, they must be advocates for the care and safety of children, who by their nature are a vulnerable group unable to advocate for itself.


Not only are the demands placed on Paediatric surgeons different in the African setting, but the nature of their clinical practice is also different. Due to limited resources in prenatal and postnatal care, children with major surgical congenital anomalies often do not survive to reach the Paediatric Surgeon. On the other side, non-lethal congenital conditions are often not repaired promptly, presenting to the Paediatric surgeon as late, disabling conditions, often making their treatment more challenging.


Some educational objectives are considered mandatory and basic to the practice of Paediatric Surgery and will be referred to as Primary Objectives. Certain other objectives are considered desirable and appropriate to include under the umbrella of Paediatric Surgery, but are dependent on the environment in which the trainee will work. These are referred to as Secondary Objectives.

For both sets of objectives, comprehensive and thorough understanding of the subjects listed will be expected. This will include, where appropriate, embryology, anatomy, physiology, pathology, natural history (both pre  and postnatal), diagnosis and management.


^ GENERIC OBJECTIVES


Communication

The paediatric surgeon will be a good communicator, able to:

  • Obtain and synthesize relevant history from children, their families and the community.

  • Discuss appropriate information with parents / families and the health care team.

  • Demonstrate effective communication and listening skills.

  • Demonstrate an appreciation of the unique psychological needs of paediatric patients.

  • Demonstrate an appreciation of the unique relationship between paediatric patients and their families and be able to deal effectively and compassionately with family members by establishing therapeutic relationships.


Collaboration

The paediatric surgeon will be an effective team player, able to:

  • Consult effectively with other physicians and health care professionals.

  • Contribute effectively to other interdisciplinary team activities.

  • Use effectively the team approach in the management of critically and chronically ill patients, such as newborns with congenital anomalies and children with cancer, inflammatory bowel disease, or transplantation.


Management

As a care provider in settings with frequently limited resources, the paediatric surgeon should be able to:

  • Utilize resources effectively to balance patient care, learning needs, and outside activities.

  • Allocate finite health care resources wisely.

  • Work effectively and efficiently in a health care organization.

  • Utilize health care technology to optimize patient care, life long learning and other activities.

  • Demonstrate an appreciation of the economic factors that influence decision making and the impact of such factors on families.

  • Understand the principles and practice of quality assurance and improvement, and actively participate in hospital based quality assurance and improvement programs.


Health Advocacy

As a leader and spokesperson, the paediatric surgeon must be at all times an advocate for her/his patents and their families, being able to:

  • Identify the important determinants of health affecting patients, such as malnutrition and poverty.

  • Contribute effectively to improved health of patients and communities and injury prevention.

  • Recognize and respond to those issues where advocacy is appropriate, such as public education, vaccination and folic acid supplementation.

  • Contribute to health-maintenance advocacy for children, including such areas as travel safety, helmet use, children operating machinery and accessibility to firearms.


Scholarship

The paediatric surgeon is expected to promote the acquisition, synthesis and dissemination of knowledge in the profession, by being able to:

  • Develop, implement and monitor a personal continuing education strategy.

  • Critically appraise sources of medical information.

  • Facilitate learning of patients, housestaff / students and other health care professionals through formal and informal teaching opportunities.

  • Contribute to development of new knowledge to foster the academic growth of the specialty of Paediatric Surgery by participating in scholarly work.


Professionalism

The paediatric surgeon must be a model professional, able to:

  • Deliver highest quality care with integrity, honesty and compassion.

  • Exhibit appropriate personal and interpersonal professional behaviours.

  • Practise medicine ethically consistent with obligations of a physician.

  • Demonstrate sensitivity to age, gender, culture and ethnicity in dealing with patients and their families.

  • Understand the ethical principles as related to the complex issue of congenital abnormalities and as applied to children submitted to medical treatment, research, etc.

  • Recognize the importance of maintenance of competence and evaluation of outcomes.

  • Understand the legal issues related to consent, confidentiality, and refusal of treatment.


Specific Requirements


The specific training requirements are presented in outline form below. The detailed list of pathological conditions is found in Appendix 1. It must be stated, however, that that is NOT an all-inclusive list as the spectrum of the specialty is wide and continuously changing.


General surgery

Assessment and management of children with:

  • acute abdominal pathology

  • abdominal wall herniae

  • trauma (including APLS certification) and other critical illness


Neonatal

Assessment and management of neonates with:

  • acute abdominal pathology

  • abdominal wall defects

  • major index conditions e.g. Hirschsprungs disease, anorectal malformations, oesophageal atresia


Urological

Assessment and management of children with:

  • both upper and lower urinary tract abnormalities to include hypospadias

  • haematuria


Oncological

Assessment and management of children with:

  • oncological conditions


Tropical

Assessment and management of children with:

  • tropical and infectious diseases of surgical consequence.


Reconstructive

Assessment and management of children with:

  • cleft lip and palate

  • spina bifida and hydrocephalus

  • burn contractures

Other

Assessment and management of children with:

  • head and neck pathology

  • gynaecological conditions

  • endocrine anomalies



^ SKILLS OBJECTIVES


By the end of training, the resident should have acquired and demonstrate the following

generic skills, as they apply to a Paediatric surgical practice.

a. Surgical Skills

  • The resident is expected to be able to perform independently the full spectrum of operative interventions related to the primary Paediatric Surgery conditions listed above. Several additional areas of skill expertise are listed below.


b. Trauma

The Paediatric Surgery resident is expected to:

  • function as a trauma team leader

  • function as the operating surgeon for Paediatric multiple trauma patients, and as supervising surgeon in an operating room in which several specialty groups may be working simultaneously

  • have primary responsibility for the non operative care of the trauma patient including major burns

  • be able to obtain airway and vascular access in the trauma patient, and perform appropriate diagnostic procedures


c. Endoscopy

The resident should be familiar with the indications, techniques and complications of:

  • laryngoscopy, bronchoscopy

  • esophagoscopy / gastroscopy / duodenoscopy

  • laparoscopy

  • proctosigmoidoscopy / colonoscopy


d. Other Procedures

The resident should be familiar with the indications, techniques and complications of:

  • central line insertion (temporary and long term), implantable ports

  • tracheostomy



Appendix 1: PRIMARY KNOWLEDGE OBJECTIVES


1. Head and neck

Demonstrate knowledge of and the capacity to manage patients in relation to the knowledge of the differing patterns of disease, natural history, and responses to treatment of head and neck disease in children. This will include:

  • congenital lesions: thyroglossal duct cyst, branchial cleft cysts; sinuses and other remnants; cystic hygromas / lymphangiomas, hemangiomas

  • salivary glands (parotid, submaxillary): tumours, hemangiomas, inflammation/calculi

  • neck masses: inflammatory (acute and chronic adenitis); tumours (lymphoma, rhabdomyosarcoma, neuroblastoma, teratoma, (nasopharyngeal carcinoma); congenital torticollis

  • cranial trauma: diagnosis and emergency management including indications for increased intracranial pressure (ICP) monitoring, Glasgow Coma Scale (GCS)

  • cervical trauma: injuries to the oesophagus, trachea, blood vessels; airway management; tracheostomy; recognition and emergency management of cervical spine fractures


^ 2. Non Cardiac Thoracic Surgery

Demonstrate knowledge of and the capacity to manage patients in relation to the knowledge of the differing patterns of disease, natural history, and responses to treatment of non cardiac chest conditions in children. This will include:

  • oesophageal atresia and tracheoesophageal fistula (TOF): embryology, pathologic types, diagnosis, treatment, complications with their treatment

  • oesophageal achalasia, webs, stenosis (congenital and acquired), duplications

  • acquired oesophageal conditions: gastroesophageal reflux, (GOR) Barrett's oesophagus, hiatal hernia; strictures, perforations (cervical, distal), foreign bodies, lye ingestion

  • congenital lung lesions: cystic adenomatoid malformation (CCAM), pulmonary sequestration, lobar emphysema, blebs and spontaneous pneumothorax; hypoplasia and pulmonary hypertension

  • acquired lung lesions: emphysema, abscess/pneumatocele, empyema, chylothorax, pulmonary metastases, infiltrates in immunosuppressed patients, lung complications in cystic fibrosis (CF).

  • congenital airway lesions: stenosis, broncho  and tracheomalacia

  • acquired airway lesions: bronchial adenoma (carcinoids, etc.); recognition of foreign body aspiration

  • mediastinal lesions: cysts, tumors according to location (anterior, middle, posterior)

  • chest wall conditions: pectus excavatum and carinatum; tumors; reconstruction

  • diaphragmatic conditions: congenital diaphragmatic hernia (Bochdalek, Morgagni); diaphragmatic eventration and phrenic nerve palsy; trauma


3. Abdomen

Demonstrate knowledge of and the capacity to manage patients in relation to the knowledge of the differing patterns of disease, natural history, and responses to treatment of abdominal disease in children. This will include:

  • gastrointestinal physiologic issues: secretions, absorption, motility, blood supply; continence, defecation; short bowel syndrome, intestinal adaptation; physiologic testing (manometry, pH study)

  • gastric conditions: pyloric stenosis (including physiologic disturbances), antral web; spontaneous perforation, antral dysmotility; stress ulcer, gastritis and other forms of acid peptic disease

  • duodenal conditions: atresia, stenosis, webs (including windsock variant); diverticula, duplications; peptic ulcer

  • small intestinal conditions: malrotation, jejunoileal atresia / stenosis, meconium ileus and equivalent; Meckel's diverticulum and related vitelline duct anomalies; necrotizing enterocolitis (NEC); intussusception; duplications, mesenteric cysts; neoplasms; Crohn's disease; congenital bands, mesenteric defects, bowel obstruction

  • colonic conditions: appendicitis; inflammatory bowel disease, typhlitis; meconium plug syndrome, intestinal pseudo obstruction; Hirschsprung's disease, neuronal intestinal dysplasia; colonic atresia, polyps (juvenile, familial, adenomatous)

  • anorectal conditions: imperforate anus (and variants); fissures, abscesses, fistulae, condylomata, rectal prolapse; constipation, fecal incontinence

  • hepatic conditions: congenital and acquired liver cysts, trauma, tumors (see oncology section); portal hypertension; liver abscess

  • biliary conditions: biliary atresia, biliary hypoplasia; bile duct perforation, choledochal cyst; gallstones, acute / chronic cholecystitis; physiologic jaundice, cholestatic syndromes; liver transplantation (indications, complications, results)

  • splenic conditions: hereditary spherocytosis, thalassemia, sickle cell disease; red blood count (RBC) enzyme deficiencies (pyruvate kinase, hexose kinase); other hemolytic anemias, idiopathic thrombocytopenic purpura (ITP); Gaucher's disease, splenic cyst, lymphangioma, abscess

  • pancreatic conditions: cystic fibrosis; pancreas divisum, annular pancreas; pancreatitis (trauma, lipid, steroid, drug induced, gallstone induced, ductal anomaly); congenital cysts, pseudocysts, tumours, hyperinsulinism

  • abdominal wall conditions: gastroschisis, omphalocele and variants; hernias (umbilical, inguinal, epigastric, femoral, etc.); vitelline duct remnants; umbilical granuloma

  • abdominal trauma: intestinal trauma, lap belt injury; hepatic trauma (operative and non operative management, hemobilia); splenic trauma (non operative management, indications for surgery, splenorrhaphy, partial splenectomy, vaccines, prophylactic antibiotics, splenectomy risks)


^ 4. Genitourinary Tract Conditions

Demonstrate knowledge of and the capacity to manage patients in relation to the knowledge of the differing patterns of disease, natural history, and responses to treatment of genitourinary conditions in children. This will include:

  • penis: phimosis, paraphimosis, balanitis, circumcision (indications and contra indications, including complications and their treatment)

  • inguinoscrotal area: cryptorchidism, varicocele, hydrocele, acute scrotum (torsion, etc.)

  • bladder: exstrophy (bladder, cloacal); urachal anomalies

  • tumours: see oncology section

  • trauma: kidney, ureter, bladder with adequate knowledge of pelvic fractures and urethral injuries

  • kidney: ureteropelvic junction (UPJ) obstruction, duplex systems

  • ureter: vesicoureteral reflux (principles of therapy and correction), megaureter, ectopic ureter, ureterocele, ureteral duplication and associated problems, ureteroureterostomy

  • stones: kidney (open vs. endourologic therapy), ureteral, bladder including metabolic aspects

  • bladder: diverticulum, neurogenic bladder, bladder neck obstruction, bladder augmentation

  • urethra: hypospadias, epispadias, urethral valves (anterior and posterior)

  • urinary diversion: indications and techniques (vesicostomy, nephrostomy, ureterostomy, colonic conduit, continent diversions)

  • endoscopy of the urinary tract, urodynamics, evaluation of hematuria

  • peritoneal dialysis and hemodialysis access


^ 5. Gynaecologic Conditions

Demonstrate knowledge of and the capacity to manage patients in relation to the knowledge of the differing patterns of disease, natural history, and responses to treatment of gynaecologic conditions in children. This will include:

  • congenital conditions: vaginal atresia, hemato/hydro(metro)colpos, bifid vagina, duplex uterus, urogenital sinus

  • inflammatory conditions: pelvic inflammatory disease, vulvovaginitis, vulvar abscess, fusion labia minora

  • traumatic/mechanical conditions: vaginal laceration, child abuse; torsion (normal ovary, cyst, tumour)

  • neoplastic conditions: ovarian cysts (follicular, teratomatous, carcinomatous, serous, mucinous); ovarian solid tumours (yolk sac, teratoma, carcinoma, theca/lutein, arrhenoblastoma, dysgerminoma); vaginal and uterine tumors (yolk sac, rhabdomyosarcoma); vulvar lesions (cysts, nevi, hemangioma)


^ 6. Endocrine Anomalies

Surgeons will care in collaboration with other health care professionals for children with

endocrine anomalies. They must therefore demonstrate knowledge of and the capacity to manage patients with these conditions based on a knowledge of the differing patterns of disease, natural history, and responses to treatment. This will include:

  • thyroid problems: hyperthyroidism (diagnosis, medical therapy, management of thyroid storm, preparation for surgery, surgical techniques); thyroiditis; tumours (role of FNAC [fine-needle aspiratory cytology], other diagnostic techniques; therapy by type, multiple endocrine neoplasia syndromes); management of thyroid mass following neck irradiation; postoperative management (hypocalcemia, respiratory distress, hoarseness, follow up for malignancy)

  • parathyroid conditions: hypoparathyroidism; hyperparathyroidism (primary, secondary, tertiary)

  • breast conditions: neonatal hypertrophy, mastitis; gynecomastia; nipple discharge; fibroadenoma, fibrocystic disease; cystosarcoma phyllodes; premature thelarche

  • gastrointestinal problems: gut hormones; all endocrine disorders affecting the gastrointestinal tract

  • pancreatic conditions: hyperinsulinism (newborn   adenoma vs. neonatal pancreatic dysplasia, diagnosis, medical and surgical treatment; older child   adenoma, hyperplasia); Tumours (islet cell tumours, VlPoma, gastrinoma including Zollinger Ellison (Z-E) syndrome); see also gastrointestinal and trauma sections

  • adrenal conditions: adrenocortical tumours (aldosteronoma   Conn's syndrome ; Cushing's syndrome  hyperplasia vs. carcinoma ; virilizing tumours) ; pheochromocytoma (diagnosis, sites including extra adrenal, bilateral, localization techniques, surgery   perioperative (peri op) blood pressure control, technique, search for multiple/extra adrenal tumours); also see section on tumours

  • testicular conditions: cryptorchidism; tumours   see genitourinary (GU) section

  • intersex conditions, including adrenogenital syndrome (variants, enzyme deficiencies, diagnosis and treatment), mixed gonadal dysgenesis, true and pseudo hermaphroditism; and testicular feminization syndrome.


7. Oncology

Surgeons will care in collaboration with other health care professionals for children with

cancer. They must therefore demonstrate knowledge of and the capacity to manage patients with these conditions based on a knowledge of the differing patterns of disease, natural history, and responses to treatment. This will include:

  • general principles: oncogenes, DNA flow cytometry (diploid, aneuploid); paraneoplastic and tumour associated syndromes (e.g., opso myoclonus); hyperthermia, immunotherapy, radiation biology, immunosuppression and opportunistic infections, cancer nutrition, chemotherapy and drug action; surgical complications of chemotherapy and bone marrow transplantation

  • renal tumors: Wilms' tumour, mesoblastic nephroma, nephroblastomatosis, adenocarcinoma

  • adrenal tumors: neuroblastoma, ganglioneuroblastoma, carcinoma

  • liver tumours: benign (hemangioma, hemangiomatosis, hemangioendothelioma, hamartoma, adenoma, focal nodular hyperplasia [FNH]); malignant (hepatoblastoma, hepatoma)

  • soft tissue sarcomas: rhabdomyosarcoma (all sites; principles of therapy according to site/histology), fibrosarcoma, leiomyosarcoma, liposarcoma, neurofibromas

  • teratomas: sacrococcygeal and gonadal tumours with embryology, pathology, familial teratomas, associated syndromes; other teratoma sites

  • lymphoma: Hodgkin's Disease; Non Hodgkin's Disease, including pathology (surface markers), sites, patterns of presentation including post transplantation/AlDS

  • bone tumours: osteogenic sarcoma and Ewing's sarcoma (including peripheral neuroendocrine tumors [PNET]) as they relate to Paediatric surgical intervention (rib resection, lung metastases, etc.)

  • gonadal tumours: see gynaecology and genitourinary sections


^ 8. Critical Care and Trauma

Surgeons will care in collaboration with other health care professionals for critically ill and injured children. They must therefore demonstrate knowledge of and the capacity to manage patients with these conditions based on a knowledge of the differing patterns of disease, natural history, and responses to treatment. This will include:

  • fluids and electrolytes: maintenance requirements, management of dehydration, third space loss; renal output, acid base equilibrium; correction of peri op electrolyte disturbances

  • shock: hypovolemic (hemodynamic monitoring, resuscitation, crystalloid vs. colloid), cardiogenic (inotropic agents, etc.), septic (hyperdynamic state, fluid resuscitation, antibiotics)

  • pulmonary physiology: normal lung function and volumes, ventilation/perfusion abnormalities; ventilators (pressure vs. volume cycled, positive end expiratory pressure [PEEP], continuous positive airway pressure [CPAP], intermittent mandatory ventilation [IMV], high frequency and jet ventilation); adult respiratory distress syndrome [ARDS]

  • nutrition: normal caloric requirements by age groups, carbohydrate, fat and protein contributions and concentrations, vitamins, trace elements, minerals; nutritional assessment techniques; enteral vs. parenteral nutrition; enteral formulas, defined diets; parenteral nutrition (peripheral vs. central solutions, techniques, complications

  • coagulation: normal coagulation cascade; management of specific coagulation disorders (hemophilia, von Willebrand's disease, diffuse intravascular and consumptive coagulopathy, fibrinolysis, sick platelet syndrome, idiopathic thrombocytopenia purpura, thrombosis; effects of heparin, anti platelet agents, thrombolytics

  • anesthesia: inhalation agents, muscle relaxants, recognition and management of malignant hyperthermia; differential diagnosis and treatment of cardiac arrest during surgery; management of postoperative pain in infants and children

  • trauma: demographics, epidemiology; recognizable patterns of injury (i.e., seat belt syndrome, patterns of child abuse); initial priorities; principles of operative and non operative management of head, neck, chest, abdomen, pelvis, genitourinary and extremity trauma

  • burns: pathophysiology of severe burn injury; fluid resuscitation (initial and maintenance); nutritional management


9. Neonatology

Surgeons will care in collaboration with other health care professionals for premature and ill

newborns. They must therefore demonstrate knowledge of and the capacity to manage patients with these conditions based on a knowledge of the differing patterns of disease, natural history, and responses to treatment. This will include:

  • physiology of the premature infant: comparison with small for gestational age infants, complications, fluid requirements, thermal neutrality, response to cold, metabolic rate, renal function, hepatic immaturity, formulas and caloric requirements, etc.

  • hyperbilirubinemia: physiology, phototherapy, exchange transfusion, cholestasis hypoglycemia, hypocalcemia

  • intracranial bleeding: staging, techniques of diagnosis, site of blood, management, outcome newborn respiratory distress syndrome: etiology, diagnosis, treatment, complications

  • neonatal sepsis: immune status (comparison of premature and full term infant), diagnostic workup, bacteriology, treatment, pharmacokinetics


^ 10. Skin and Subcutaneous Tissues

The paediatric surgeon will demonstrate knowledge of and the capacity to manage patients in relation to the following knowledge of the differing patterns of disease, natural history, and responses to treatment of cutaneous and subcutaneous conditions in children. This will include:

  • skin and subcutaneous lesions (nevi, nevus sebaceous, pilomatrixoma, juvenile melanoma; hemangioma, lymphangioma, lipoma; dermoid and epidermoid cyst),

  • ingrown toenails and paronychia;

  • pilonidal sinus and abscess;


^ 11. Tropical and infectious disease

The paediatric surgeon will demonstrate knowledge in the diagnosis and surgical management of tropical and other infectious diseases, including:

  • amoebiasis and its complications;

  • various helminthiases;

  • HIV/AIDS and tuberculosis;

  • Noma (cancrum oris)

  • Other bacterial and parasitic infections affecting children.


^ SECONDARY KNOWLEDGE OBJECTIVES


A. Plastic Surgery

  • head and neck: contractures, facial anomalies, wounds, cleft lip / palate

  • skin: frostbite, soft tissue injury, wound healing, wound management

  • hand: infection, lacerations (recognition of nerve and tendon injury)

  • burns: recognition and management of burn wound infection (including wound biopsy techniques); burn wound excision; use of skin substitutes; burn rehabilitation, (including psychological effects and recovery)

  • techniques: skin grafting, microsurgery, use of flaps and Z plasty


B. Orthopedics

  • traumatic: pulled elbow, major long bone injury (femur, humerus, supracondylar fracture, Volkman's ischemic contracture, ankle, wrist injury, knee injury and dislocation, compartment syndrome

  • acquired: osteochondritis dissecans, slipped capital femoral epiphysis

  • congenital: club foot; scoliosis

  • tumours (osteogenic sarcoma, Ewing's tumour): concepts of limb salvage, chemotherapy


C. Neurosurgery

  • spina bifida, tethered cord

  • V P (ventriculoperitoneal) shunting and its complications

  • midline dermoid lesions





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