CORE CURRICULUM OUTLINE FOR VASCULAR SURGERY RESIDENTS COMPONENTS OF THE SCORE CURRICULUM RELATED TO THE CORE SURGICAL KNOWLEDGE EXPECTED OF INTEGRATED VASCULAR SURGERY RESIDENTS
MAY 2013
© 2013 The Surgical Council on Resident Education Inc. (SCORE®) All rights reserved.
TABLE OF CONTENTS (click to go to that page)
INTRODUCTION ..................................................................................................................................3 PATIENT CARE ....................................................................................................................................4 Category 1: Abdomen – General............................................................................................................... 4 Category 2: Abdomen – Hernia................................................................................................................. 4 Category 3: Abdomen – Biliary ................................................................................................................. 5 Category 4: Abdomen – Liver.................................................................................................................... 5 Category 5: Abdomen – Pancreas ............................................................................................................. 5 Category 6: Abdomen – Spleen ................................................................................................................ 6 Category 7: Alimentary Tract – Esophagus ............................................................................................... 6 Category 8: Alimentary Tract – Stomach .................................................................................................. 6 Category 9: Alimentary Tract – Small Intestine ........................................................................................ 7 Category 10: Alimentary Tract – Large Intestine ...................................................................................... 7 Category 12: Endoscopy............................................................................................................................ 8 Category 14: Endocrine ............................................................................................................................. 8 Category 15: Skin and Soft Tissue ............................................................................................................. 8 Category 16: Surgical Critical Care ............................................................................................................ 8 Category 17: Trauma................................................................................................................................. 9 Category 18: Vascular – Arterial Disease ................................................................................................ 11 Category 19: Vascular – Venous ............................................................................................................. 12 Category 20: Vascular – Access ............................................................................................................... 12 Category 21: Transplantation ................................................................................................................. 12 Category 22: Thoracic Surgery ................................................................................................................ 12 Category 24: Plastic Surgery ................................................................................................................... 13 Category 25: Genitourinary .................................................................................................................... 13 Category 27: Head and Neck................................................................................................................... 14 Category 28: Nervous System ................................................................................................................. 14 MEDICAL KNOWLEDGE ..................................................................................................................... 15 Category 1: Anesthesia ........................................................................................................................... 15 Category 2: Biostatistics and Evaluation of Evidence ............................................................................. 15 Category 3: Fluids, Electrolytes and Acid-Base Balance .......................................................................... 15 Category 4: Geriatric Surgery and End-of-Life Care ................................................................................ 15 Category 5: Immunology ......................................................................................................................... 16 Category 6: Infection and Antimicrobial Therapy ................................................................................... 16 Category 7: Minimally Invasive Surgery – Principles .............................................................................. 16 Category 8: Nutrition and Metabolism ................................................................................................... 16 Category 10: Pharmacology .................................................................................................................... 16 Category 11: Preoperative Evaluation and Perioperative Care .............................................................. 17 Category 12: Transfusion and Disorders of Coagulation ........................................................................ 17 Category 13: Wound Healing .................................................................................................................. 17
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INTRODUCTION EXPLANATION OF THE CURRICULUM OUTLINE This document contains a list of topics derived from the full SCORE Curriculum Outline for General Surgery Residency that represent the core surgical knowledge expected of residents who complete ACGME-accredited integrated vascular surgery residency programs. It also specifies the breadth and depth of knowledge expected for each topic. These topics, which are integral to the care of patients with vascular surgical problems, are divided into Patient Care and Medical Knowledge. The Patient Care topics relate to specific diseases and conditions, while the Medical Knowledge topics relate to systems and conditions that affect the body as a whole, (e.g., sepsis or coagulopathy). The Medical Knowledge category also includes topics on biostatistics, perioperative complications, and aspects of surgical critical care. The SCORE Curriculum Outline for General Surgery Residency is available on this page of the website of the American Board of Surgery (ABS). To learn more about SCORE, visit the SCORE Portal at www.surgicalcore.org.
CLASSIFICATION SYSTEM The Patient Care curriculum topics are organized into 24 organ system-based categories with category topics further separated into diseases/conditions and operations/procedures. Each category may not include both diseases/conditions and/or operations/procedures. The topics are stratified as follows: Disease/Conditions (two levels)
BROAD – A resident should be able to care for all aspects of disease and provide comprehensive management.
FOCUSED – A resident should be able to make the diagnosis, provide initial management/stabilization but is not expected to be able to provide comprehensive management.
Operations/Procedures (three levels)
ESSENTIAL – COMMON – Frequently performed operations for which procedure specific competency is expected by the end of training.
ESSENTIAL – UNCOMMON – Uncommon, often urgent, operations not typically done in substantial numbers. Specific procedure competency required by end of training (but may not be attained by case volume alone).
COMPLEX – Generic familiarity with these procedures is required but not competence in individual procedures.
N.B.: The Patient Care modules on the SCORE Portal are geared for the expectations of general surgery residents; the information in them may exceed the breadth and depth of expectations of integrated vascular surgery residents. This curriculum outline includes vascular surgery topics within Categories 18-20 that are categorized as BROAD and ESSENTIAL – COMMON for general surgery residents. A separate curriculum outline of vascular surgery topics relevant to both integrated and independent vascular surgery trainees is currently under development. Page 3 of 17
CORE CURRICULUM OUTLINE FOR VASCULAR SURGERY RESIDENTS
PATIENT CARE Category 1: Abdomen – General Diseases/Conditions BROAD • Abdominal Pain - Acute • Intra-abdominal Abscess • Rectus Sheath Hematoma FOCUSED • Abdominal Pain - Chronic • Ascites - Chylous • Bacterial Peritonitis - Spontaneous
Operations/Procedures ESSENTIAL – COMMON • Diagnostic Laparoscopy • Exploratory Laparotomy - Laparoscopic • Exploratory Laparotomy - Open • Peritoneal Dialysis Catheter Insertion ESSENTIAL – UNCOMMON • Intra-abdominal Abscess – Open Drainage
Category 2: Abdomen – Hernia Diseases/Conditions BROAD • Femoral Hernia • Inguinal Hernia • Ventral Hernia
Operations/Procedures ESSENTIAL – COMMON • Inguinal and Femoral Hernia - Open Repair • Ventral Hernia - Open Repair COMPLEX • Abdominal Wall Reconstruction - Components Separation
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Category 3: Abdomen – Biliary Diseases/Conditions BROAD • Cholecystitis - Acalculous • Cholecystitis - Acute • Cholecystitis - Chronic FOCUSED • Acalculous Cholecystitis and Biliary Dyskinesia • Cholangitis • Choledocholithiasis • Jaundice - Obstructive • Pancreatitis - Biliary
Operations/Procedures ESSENTIAL – COMMON • Cholecystectomy with or without Cholangiography - Laparoscopic • Cholecystectomy with or without Cholangiography - Open
Category 4: Abdomen – Liver Diseases/Conditions FOCUSED • Budd-Chiari Syndrome • Cirrhosis/Portal Hypertension (Ascites) • Esophageal Varices • Hepatic Failure and Hepatorenal Syndrome • Hepatitis - Viral (Occupational Risk)
Operations/Procedures COMPLEX • Portal-systemic Shunt
Category 5: Abdomen – Pancreas Diseases/Conditions FOCUSED • Pancreatitis - Acute/Pancreatic Necrosis/Abscess
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Category 6: Abdomen – Spleen Diseases/Conditions BROAD • Postsplenectomy Sepsis • Splenic Abscess FOCUSED • Hemolytic Anemias • Hypersplenism - Secondary and Splenomegaly • Idiopathic Thrombocytopenic Purpura
Operations/Procedures ESSENTIAL – COMMON • Splenectomy - Open ESSENTIAL – UNCOMMON • Splenectomy/Splenorrhaphy – Partial
Category 7: Alimentary Tract – Esophagus Diseases/Conditions FOCUSED • Dysphagia • Esophageal Motility Disorders other than Achalasia (e.g., connective tissue disorders) • Mallory-Weiss Syndrome
Category 8: Alimentary Tract – Stomach Diseases/Conditions BROAD • Gastrointestinal Bleeding - Upper • Peptic Ulcer Disease with Bleeding • Stress Gastritis FOCUSED • Duodenal Ulcer • Gastric Ulcer • Peptic Ulcer Disease with Obstruction • Peptic Ulcer Disease with Perforation • Postgastrectomy Syndromes
Operations/Procedures ESSENTIAL – COMMON • Gastrostomy - Open COMPLEX • Duodenal Perforation – Repair
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Category 9: Alimentary Tract – Small Intestine Diseases/Conditions BROAD • Mesenteric Ischemia - Acute (Arterial, Venous and Non-occlusive) • Paralytic Ileus • Small Intestinal Obstruction FOCUSED • Short Bowel Syndrome
Operations/Procedures ESSENTIAL – COMMON • Adhesiolysis - Open • Feeding Jejunostomy - Open • Ileostomy Closure • Small Intestinal Resection - Open ESSENTIAL – UNCOMMON • Superior Mesenteric Artery Embolectomy/Thrombectomy COMPLEX • Ileostomy
Category 10: Alimentary Tract – Large Intestine Diseases/Conditions BROAD • Appendicitis - Acute • Clostridium Difficile-associated Diarrhea • Colitis - Ischemic • Diverticulitis • Gastrointestinal Bleeding - Lower • Obstruction - Large Intestinal FOCUSED • Colonic Volvulus • Diverticular Bleeding
Operations/Procedures ESSENTIAL – COMMON • Appendectomy - Open • Colectomy, Partial - Open • Colostomy COMPLEX • Colostomy Closure Page 7 of 17
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Category 12: Endoscopy Operations/Procedures COMPLEX • Bronchoalveolar Lavage • Bronchoscopy • Laryngoscopy • Proctoscopy
Category 14: Endocrine Diseases/Conditions FOCUSED • Addisonian Crisis • Adrenal Mass • Pheochromocytoma
Category 15: Skin and Soft Tissue Diseases/Conditions BROAD • Cellulitis • Necrotizing Soft Tissue Infections • Paronychia • Surgical Site Infection FOCUSED • Decubitus Ulcer • Lymphedema/Lymphangitis
Operations/Procedures ESSENTIAL – COMMON • Skin/Soft tissue Lesions - Excisional and Incisional Biopsy • Soft Tissue Infections - Incision, Drainage, Debridement COMPLEX • Soft Tissue Sarcoma – Resection
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Category 16: Surgical Critical Care Diseases/Conditions BROAD • Abdominal Compartment Syndrome • Anaphylaxis • Cardiac Arrhythmias - Common • Cardiac Failure • Cardiogenic Shock • Coagulopathy • Derangements of Electrolytes and Acid-Base Balance • Endocrine Dysfunction • Gastrointestinal Failure • Hepatic Failure • Hypovolemic Shock • Neurogenic Shock • Neurologic Dysfunction • Pneumonia - Hospital Acquired • Renal Failure • Respiratory Failure • Septic Shock
Operations/Procedures ESSENTIAL – COMMON • Airway Management/Ventilator Management • Arterial Catheter Placement • Central Venous Catheter Placement • Compartment Pressures (Abdomen, Extremity) - Measurement • Defibrillation and Cardioversion • Endotracheal Intubation • Enteral Feeding Tube Placement • Oxygen Administration Devices • Paracentesis • Pulmonary Artery Catheter Placement • Thoracentesis • Ultrasound Use for Intravascular Access • Urinary Catheterization COMPLEX • Cardiac Pacing
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Category 17: Trauma Diseases/Conditions BROAD • Aortic Injury • Blunt Trauma • Cardiac Tamponade • Colon and Rectal Injury • Frostbite and Hypothermia • Geriatric Trauma • Hemothorax - Injury-related • Hepatic Injury • Pelvic Fractures • Penetrating Trauma • Pneumothorax - Injury-related • Pulmonary Contusion • Pulmonary Laceration • Renal Injury • Retroperitoneal Hematoma • Small Intestinal Injury • Splenic Injury • Ureteral Injury • Vascular Injury - Abdomen • Vascular Injury - Extremities • Vascular Injury - Neck • Vascular Injury - Thorax FOCUSED • Bladder Injury • Diaphragmatic Injury • Esophageal Injury • Extremity Fractures and Traumatic Amputations • Head Injury - Penetrating and Closed • Laryngeal and Tracheal Injury • Myocardial Contusion • Nerve Injury - Neck • Pancreatic and Duodenal Injury • Pediatric Trauma • Pharyngeal and Cervical Esophageal Injury • Rib Fractures • Spine Fracture Page 10 of 17
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• Sprains, Strains, and Dislocations • Sternal Fractures • Tracheal and Bronchial Injury • Trauma in Pregnancy
Operations/Procedures ESSENTIAL – COMMON • Focused Abdominal Sonography for Trauma (FAST) • Temporary Closure of the Abdomen • Wounds, Major - Debride/Suture ESSENTIAL – UNCOMMON • Abdominal Aorta or Vena Cava Injury - Repair • Cardiac Injury - Repair • Carotid Artery Injury - Repair • Exploratory Laparotomy • Fasciotomy for Injury • Neck Exploration for Injury • Splenectomy/Splenorrhaphy • Thoracoscopy for Management of Hemothorax • Truncal and Peripheral Vessels - Repair COMPLEX
• Hepatic Injury - Packing and Repair • Hepatic Injury - Resection • Pancreatic Injury - Operation • Pancreatic Injury - Resection • Renal Injury - Repair/Resection • Thoracic Aorta, Innominate, Subclavian Injury – Repair • Ureteral Injury - Repair
Category 18: Vascular – Arterial Disease Diseases/Conditions BROAD • Acute Arterial Thrombosis • Acute Limb Ischemia • Aortic Thrombosis • Aortoiliac Disease • Cerebrovascular Disease • Compartment Syndromes • Diabetic Foot Infections • Peripheral Arterial Emboli • Peripheral Vascular Disease and Claudication Page 11 of 17
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Operations/Procedures ESSENTIAL – COMMON • Amputations - Lower Extremity • Carotid Endarterectomy • Embolectomy/Thrombectomy - Arterial
Category 19: Vascular – Venous Diseases/Conditions BROAD • Thrombophlebitis - Acute and Suppurative • Varicose Veins • Venous Stasis/Chronic Venous Insufficiency • Venous Thrombosis/Pulmonary Embolism
Operations/Procedures ESSENTIAL – COMMON • Vena Caval Filter - Insertion • Venous Insufficiency/Varicose Veins - Operation
Category 20: Vascular Access Diseases/Conditions BROAD • Vascular Access for Dialysis • Venous Access for Long-Term Therapy
Operations/Procedures ESSENTIAL – COMMON • Arteriovenous Graft/Fistula • Percutaneous Vascular Access • Venous Access Devices – Insertion
Category 21: Transplantation Diseases/Conditions BROAD • Brain Death FOCUSED • Opportunistic Infections
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Category 22: Thoracic Surgery Diseases/Conditions BROAD • Hemothorax • Pleural Effusion/Empyema • Pneumothorax FOCUSED • Chylothorax • Pericarditis • Superior Vena Cava Syndrome • Tracheoinnominate Fistula
Operations/Procedures ESSENTIAL – COMMON • Chest Tube Placement and Management ESSENTIAL – UNCOMMON • Exploratory Thoracotomy - Open and Thoracoscopic COMPLEX • Empyema - Open Drainage • Pericardial Window for Drainage
Category 24: Plastic Surgery Operations/Procedures ESSENTIAL – COMMON • Skin Grafting COMPLEX • Composite Tissue Transfer • Scars and Resultant Deformities – Revision
Category 25: Genitourinary Diseases/Conditions FOCUSED • Ureteral Injury - Iatrogenic
Operations/Procedures ESSENTIAL – UNCOMMON • Nephrectomy • Ureteral Injury, Iatrogenic – Repair
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Category 27: Head and Neck Diseases/Conditions BROAD • Upper Airway Obstruction
Operations/Procedures ESSENTIAL – COMMON • Tracheostomy ESSENTIAL – UNCOMMON • Cricothyroidotomy
Category 28: Nervous System Diseases/Conditions BROAD • Pain, Acute - Management FOCUSED • Pain, Chronic - Management
Operations/Procedures ESSENTIAL – UNCOMMON • Nerve Block - Digital
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MEDICAL KNOWLEDGE Category 1: Anesthesia • Anesthesia, General - Agents and Techniques • Anesthesia, Regional and Local - Agents and Techniques • Choice of Anesthesia • Conscious Sedation - Agents and Techniques • Intraoperative Monitoring and Common Intraoperative Problems • Postoperative Pain Management
Category 2: Biostatistics and Evaluation of Evidence • Clinical Trials • Evaluating the Quality and Applicability of a Study • How Data is Expressed and Summarized • Levels of Evidence • Research Design • Surveys and Qualitative Research • Tests of Significance
Category 3: Fluids, Electrolytes and Acid-Base Balance • Body Fluid Compartments and Fluid Homeostasis • Hypocalcemia and Hypercalcemia • Hypokalemia and Hyperkalemia • Hyponatremia and Hypernatremia • Magnesium and Phosphorous Disorders • Maintenance Fluid and Electrolyte Therapy • Normal Acid-Base Regulation and Acid-Base Disorders
Category 4: Geriatric Surgery and End-of-Life Care • Advanced Directives, DNR Orders, and Power of Attorney • Functional Decline of Aging • Goal Setting with Elderly Patients and Families • Medication and Dosing Issues in the Elderly • Natural and Clinical Impact of Physiologic Effects Associated with Aging • Palliative and Hospice Care • Postoperative Delirium • Preoperative Evaluation of Geriatric Patients
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Category 5: Immunology • Components of the Immune System • Immune Response to Injury and Infection • Surgery and Surgical Conditions in Immunocompromised Hosts
Category 6: Infection and Antimicrobial Therapy • Healthcare-acquired Infections • Host Defense and Infection • Infection Control - Avoiding Risk to Self and Others • Infections - Bacterial, Common • Infections - Diagnostic Approach • Infections - Fungal, Common • Infections - Viral, Common • Pathophysiology of Sepsis • Principles of Antimicrobial Resistance • Sepsis/SIRS Syndrome • Surgical Site Infections and Prophylaxis
Category 7: Minimally Invasive Surgery – Principles • MIS Equipment and Troubleshooting • Principles and Techniques of Abdominal Access • Robotic Surgery - Principles
Category 8: Nutrition and Metabolism • Effect of Surgery, Illness, and Injury on Nutritional Requirements • Nutrition, Enteral - Technique • Nutrition, Parenteral - Technique • Nutritional Assessment, Indications, and Choice of Route for Nutritional Support • Nutritional Pharmacology and Immunonutrition • Nutritional Requirements • Nutritional Support - Long-Term
Category 10: Pharmacology • Adverse Effects of Drugs Commonly Used in Surgical Patients • Principles of Pharmacokinetics, Pharmacodynamics, and Monitoring of Drug Levels
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Category 11: Preoperative Evaluation and Perioperative Care • Common Postoperative Problems • Evaluation of Surgical Risk • Perioperative Management of the Patient on Steroids • Perioperative Management of the Therapeutically Anticoagulated Patient • Perioperative Prophylaxis for Venous Thromboembolism
Category 12: Transfusion and Disorders of Coagulation • Evaluation of Ongoing Bleeding and Laboratory Assessment of Coagulation • Inherited and Acquired Disorders of Coagulation • Normal Mechanisms of Hemostasis and Coagulation • Transfusion – Indications, Risks, Type and Cross-match, and Component Therapy
Category 13: Wound Healing • Disturbances of Wound Healing and Chronic Wounds • Physiology of Normal Wound Healing • Wound Care - Adjunctive • Wound Care - Post-operative • Wound Closure
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