Overview
The purpose of the initial stage (early years CT1 - 2) is to allow the trainee to develop the basic and fundamental surgical skills common to all surgical specialties, together with a few specialty-specific surgical skills.
The outcome of early years training is to achieve the competences required of surgeons entering ST3. These competences include:
- the management of patients presenting with a range of symptoms and elective and emergency conditions as specified in the core syllabus for surgery.
- the management of patients presenting with an additional range of elective and emergency conditions, as specified by the specialty component of the early years syllabus.
- professional competences as specified in the syllabus and derived from Good Medical Practice guidance of the General Medical Council of the UK
By the end of CT2 trainees, including those following an academic pathway, will have acquired generic skills in team working and management of specialty-specific patient cases to a level that will allow them to:
- perform as a member of the team caring for surgical patients
- receive patients as emergencies, review patients in clinics and initiate management and diagnostic processes based on a reasonable differential diagnosis
- manage the peri-operative care of patients and recognise common complications and either be able to deal with them or know to whom to refer
- be a safe and useful assistant in the operating room
- perform some simple procedures under minimal supervision and perform more complex procedures under direct supervision
- have professional skills consistent with their level of training
In addition they will have attained the knowledge, skills and behaviour as defined in the following (common) modules of the syllabus:
Module 1: Basic science knowledge relevant to surgical practice (These can all be contextualised within the list of presenting symptoms and conditions outlined in module 2)
- Anatomy
- Physiology
- Pharmacology - in particular safe prescribing
- Pathological principles underlying system specific pathology
- Microbiology
- Diagnostic and interventional radiology
Module 2: Common surgical conditions
- To assess and initiate investigation and management of common surgical conditions that may confront any patient whilst under the care of surgeons, irrespective of their specialty
- To have sufficient understanding of these conditions so as to know what and to whom to refer in such a way that an insightful discussion may take place with colleagues who will be involved in the definitive management of these conditions
This defines the scope and depth of the topics in the generality of clinical surgery required of any surgeon irrespective of their ST3 defined specialty
Module 3: Basic surgical skills
- To prepare oneself for surgery
- To administer appropriate local anaesthetic agents safely
- To handle surgical instruments safely
- To handle tissues safely
- To incise and close superficial tissues accurately
- To tie secure knots
- To safely use surgical diathermy
- To achieve haemostasis of superficial vessels
- To use a suitable surgical drain appropriately
- To assist helpfully, even when the operation is not familiar
- To understand the principles of anastomosis
- To understand the principles of endoscopy
Module 4: The principles of assessment and management of the surgical patient
- To assess the surgical patient
- To elicit a history that is relevant, concise, accurate and appropriate to the patient's problem
- To produce timely, complete and legible clinical records
- To assess the patient adequately prior to operation and manage any pre-operative problems appropriately
- To propose and initiate surgical or non-surgical management as appropriate
- To take informed consent for straightforward cases
Module 5: Peri-operative care of the surgical patient
- To assess and manage preoperative risk
- To manage patient care in the peri-operative period
- To conduct safe surgery in the operating theatre environment
- To assess and manage bleeding including the use of blood products
- To care for the patient in the post-operative period including the assessment of common complications
- To assess, plan and manage post-operative fluid balance
- To assess and plan perioperative nutritional management
Module 6: Assessment and early treatment of the patient with trauma
- To safely assess the multiply injured patient
- To safely assess and initiate management of patients with:
- traumatic skin and soft tissue injury
- chest trauma
- a head injury
- a spinal cord injury
- abdominal and urogenital trauma
- vascular trauma
- a single or multiple fractures or dislocations
- burns
Module 7: Surgical care of the paediatric patient
- To assess and manage children with surgical problems, understanding the similarities and differences from adult surgical patients
- To understand common issues of child protection and to take action as appropriate
Module 8: Management of the dying patient
- Ability to manage the dying patient appropriately.
- To understand consent and ethical issues in patients certified DNAR (do not attempt resuscitation)
- Palliative Care: Good management of the dying patient in consultation with the palliative care team.
Module 9: Organ and tissue transplantation
- To understand the principles of organ and tissue transplantation
- To assess brain stem death and understand its relevance to continued life support and organ donation
Module 10: Health promotion
- General aspects
- Obesity
- Dementia
- Exercise and physical fitness.