DIVISION OF SURGERY DEPARTMENT OF SURGICAL SCIENCES FACULTY OF HEALTH SCIENCES UNIVERSITY OF STELLENBOSCH MMED (CHIR) ACADEMIC PROGRAMME 2013
INTRODUCTION The MMed (Chir) programme embraces a period of 5 years designed to equip the trainee (Registrar) for specialist practice in the field of general Surgery. As of the end of 2014, this will become a purely academic degree, since there will be a unitary exit examination for registration as a specialist Surgeon, this being the final examination of the College of Surgeons of South Africa (FCS[SA]). The philosophy of this Division with respect to surgical training is both informal and enabling; there are no rigid rules for the conduct of day-to-day activities an ethical, mature and responsible approach on the part of the trainee, as an independent medical practitioner, is assumed as a given. Furthermore, teaching staff, while always available for advice or direct assistance, expect initiative and inquiry, rather than the burden of didactic teaching. An integral part of training is to be a trainer; teaching of interns and undergraduate students, in the course of service delivery and providing optimal patient care, is a fundamental responsibility of Registrars in this Division. Page 2 of 9
AIMS OF THE PROGRAMME To equip the trainee, at the completion of 5 years of study, with the theoretical knowledge, practical ability and interpersonal skills for fulltime or independent specialist surgical practice. To enable the trainee to develop the attitudes and abilities necessary to become an independent learner and to accept the responsibility for lifelong continuing professional development. To equip the trainee to plan, conduct, interpret and publish independent research in the field of Surgery. EXPECTED OUTCOMES OF THE PROGRAMME Generic Outcomes: 1. The student should possess a broad knowledge of:- i) Current state-of-the-art developments in medicine in general. ii) iii) iv) Ethical principles as applicable to surgery and the practice of medicine in general. An interdisciplinary approach to patient evaluation and care. Epidemiological and statistical principles and their application in analysing scientific data. v) Humanitarian and socio-economic issues governing the overall practice of surgery and medicine in general. 2. The student should have the ability to:- i) Identify and solve problems in such a way that it will be clear that decisions are reached by way of critical and creative thinking. ii) iii) iv) To perform his/her work and interact with patients and fellow workers in a way that demonstrates the exemplary application of professional values. Ability to effectively co-operate with other people as member of a health care team. To organise and manage himself/herself and his/her activities in a responsible and efficient manner. v) Collect, analyse, organise and critically evaluate information, and to extrapolate beyond given data to new, broader issues. vi) To communicate effectively, orally or in writing, using statistics, audio-visual aids and other information technology as appropriate. Specific Outcomes: The MMed (Chir) graduate will have: Page 3 of 9
i) Thorough knowledge and understanding of anatomy, physiology and general pathology as applicable to the practice of surgery. ii) iii) Detailed knowledge and understanding of general surgical principles and intensive care, and a broad knowledge and understanding of basic patient care in all surgical disciplines. Detailed knowledge of those components of gastro-intestinal and abdominal surgery, vascular surgery, head-neck and breast surgery, surgical intensive care, trauma surgery, burn-wound care and paediatric surgery falling within the ambit of specialist surgical practice and a broad knowledge and understanding of the principles of highly-specialised care within the foregoing fields, including diagnostic approaches, pre- and postoperative surgical care and technical operative surgery. MODULES The University of Stellenbosch has completed a process of Modularising all postgraduate programmes. The MMed (Chir) Modules were already de facto in place and are as follows: 1) Basic Sciences Study of Anatomy, Physiology and General Pathology as relevant to the practice of Surgery. Successful completion of this Module is largely dependant on self-study, although the relevant Disciplines within the Faculty (Anatomy and Histology, Medical Physiology and Biochemistry and Anatomical Pathology) do offer tutorial programmes in the respective subjects. Registrars are advised to avail themselves of these opportunities for more formal teaching in the Basic Sciences. The Module is completed by passing the MMed (Chir) Part Ia examination. This examination is offered in June and November of each year and consists of separate written and vica voce examinations in each of the 3 subjects. All 3 subjects should be attempted initially, but only those subjects failed need to be repeated at a later date. Two of the 3 subjects must be passed within 18 months of first registration and all 3 within two years. Students not meeting these deadlines will only be allowed to continue by special dispensation of the Faculty Board, on recommendation of the MMed (Chir) programme committee and the Faculty s Committee for Postgraduate Education. Exemption from the MMed (Chir) Part Ia examination in its entirety will be granted to a trainee who has passed the primary examination of the FCS(SA). These examinations are held in March and September of each year and consist of multiple choice question papers. All components of the College primary must be passed at a single attempt, i.e. portions of the examination in which a candidate was successful will not be exempted at a subsequent attempt. 2) Surgical Principles Study of the principles of Surgery in general and principles of the Surgical speciality disciplines. Page 4 of 9
The syllabus is identical to that of the FCS(SA) Intermediate. (See College Website: www.collegemedsa.co.za) Again, successful completion of this Module depends largely upon self-study. A weekly seminar on topics within the syllabus is, however, held every Tuesday at 16:00 (see Annexure A for topics on rotation and weekly Academic Programme for specific topic and venue). All Registrars within Modules 1 and 2 ( intermediate ) are expected to attend. Completion of the Module is by passing the MMed (Chir) Part Ib examination. This examination is offered in June and November of each year and consists of separate written and oral examinations in the Principles of Surgery and the Principles of the Surgical Speciality Disciplines. This examination must be passed as a whole, i.e. success in one or other component cannot be carried forward to a future attempt. The examination can only be attempted at a minimum of 18 months after registration and must be passed within 3½ years, unless special dispensation is granted by the Faculty Board, again on the recommendation of the relevant Committees. Exemption from the MMed (Chir) Part Ib examination in its entirety will be granted to a trainee who has passed the intermediate examination of the FCS(SA). This examination is held in March-May and September-October of each year and also consists of two separate multiple choice papers and viva voce examinations. Admission to this examination requires the candidate to be in possession of a current Advanced Trauma Life Support (ATLS) certificate. Page 5 of 9
3) Clinical Surgery This Module spans the 5 year programme and covers the knowledge of all aspects of Surgical Pathology, Clinical and Operative Surgery and Surgical Care expected of a specialist Surgeon. Teaching of this Module is continuous and largely in-service. Cross-departmental academic activities are as follows:- i) 07:30 meeting every Monday, Tuesday, Wednesday & Thursday in Surgical tearoom, E3, Tygerberg Hospital. ii) Vascular Radiology meeting, every Friday 07:30, Surgical tearoom, E3, Tygerberg Hospital. iii) Surgical Radiology meeting, every Monday 13:00, Radiology Seminar Room, C4B, Tygerberg Hospital. iv) Surgical tutorial every Tuesday 17:00, Seminar Room 4056, Division of Surgery. Topics cover the whole field of Surgery in 2½ yearly cycles (see Annexure B for topics and weekly Academic Programme for current topics). v) Wednesday afternoon Academic Programme: 14:00 Business Meeting 14:30 Morbidity and Mortality Meeting 15:00 Journal Reading (see Annexure C for sequence of Presenters) 15:30 Clinical Case Presentation (see Annexure D for rotations) 16:30 Academic Ward Round (see Annexure E for rotations) On one Wednesday per month, the aforegoing programme will not apply, and after the Business and Morbidity & Mortality Meetings there will be a Combined Surgery/Pathology Seminar at 15:30 in the "Weber" Room, Dept. Anatomical Patology, 10th Floor, Tygerberg Hospital. A pre-defined topic will be jointly presented by a Registrar from this Department and a colleague from the Division of Anatomical Pathology (See Annexure F for rotation of unit responsibilities and weekly Programme for specific topics). This is followed by a Surgical Anatomy Seminar at 16:15 in Seminar Room 4056, Faculty of Health Sciences. After each Wednesday afternoon cycle is completed, the next Wednesday afternoon will be devoted to reviewing Registrar research activities. The Wednesday following this, the academic programme is replaced by a social afternoon. Apart from the foregoing activities, which all Registrars are expected to attend, individual units in the Division also have certain unit-specific academic activities. These are primarily for attendance by trainees rotating in the particular unit, but other Registrars are welcome to attend (see weekly Academic Programme for details). Completion of this Module (and the examination component of the MMed (Chir) degree) is achieved by passing the MMed (Chir) Part II examination. This examination is offered in April and November each year and consists of Page 6 of 9
two written papers, clinical cases, an OSCE and oral examinations in Surgical Pathology and general Surgery, as well as Surgical Anatomy and Operative Surgery. The examination may not be attempted before 4 years of registration and should be passed within 5 years. Trainees not passing the examination within this period, may, at the discretion of the Faculty Board, prolong their registration as a postgraduate student of the University until such reasonable time as is required to achieve this. Extension of time as a registered MMed (Chir) student does not, however, guarantee that the individual will remain employed by the Provincial Government as a Registrar, or in any other capacity. Exemption from the MMed (Chir) Part II examination in its entirety will be granted to a trainee who has passed the FCS(SA) Final examination. This examination is held in March-May and September-October of each year and consists of two written papers, clinical cases, an OSCE and pathology/general and anatomy/operative surgery orals. Candidates applying to sit this examination are required to submit a logbook documenting adequate exposure to operative surgery and formative assessments during their training. All Registrars should, therefore, maintain a prospective logbook and have this signed off at the end of each rotation. 4) Research Assignment This Module also spans the 5 year programme and involves clinical- or laboratory research output under the guidance of a Consultant Supervisor. Submission of a completed Assignment is a sine qua non for award of the MMed (Chir) degree, whether the candidate has passed the MMed (Chir) Part II examination, or has been exempted from this by passing the FCS(SA) Final examination. The mark awarded for the Assignment constitutes 25% of the final MMed (Chir) mark. The Assignment should preferably be presented in the format of a manuscript suitable for publication in a scientific journal, but the style of a postgraduate dissertation is also acceptable. Completed Assignments must be handed to the Departmental Chairperson by 15 October for December graduation, or 15 January for graduation in March. Assignments already published, or accepted for publication in a peer-reviewed scientific journal automatically achieve a pass mark. Further evaluation thus merely determines the actual mark awarded. Completed Assignments not yet published or accepted for publication are subjected to review by both internal and external examiners. Registrars, in collaboration with a member of the Consultant staff, should identify a research topic and present a protocol at an early stage of their training so as to ensure sufficient time for data collection and writing up the work. As previously mentioned, one academic session per quarter is devoted to review of each Registrar s research progress. Since the University recognizes all College of Surgeons examinations as MMed (Chir) equivalents, there exists the possibility that a trainee can exit the Page 7 of 9
programme on the strength of passing the FCS(SA) Final alone, i.e., not having completed this Module and, therefore, not having been awarded the MMed (Chir) degree. Mechanisms exist to prevent this from occurring, but it has never been necessary to invoke these. All Registrars admitted to the MMed (Chir) programme enter on the expressed understanding that they will complete a research Assignment and this obligation will always remain something which is met voluntarily, rather than enforced. After mid-2014, it will not be possible to register as a specialist Surgeon with the Health Professions Council without a certificate issued by the Head of the Division stating that the candidate s Research Assignment has been satisfactorily completed. MMED (CHIR) VS FCS(SA) Both of these qualifications are currently recognised by the Health Professions Council for registration as a specialist Surgeon (after mid-2014 this will no longer be the case for the MMed(Chir)). The University of Stellenbosch recognises all College examinations and trainees are encouraged to preferentially attempt the College examinations. Trainees who elect (or are obliged) to sit MMed (Chir) examinations should be under no illusion that these are any easier ; if anything they are more difficult and searching than the FCS(SA) equivalents. Any innuendo that the MMed (Chir) examination route is the soft option is, therefore, unfounded. FORMATIVE ASSESSMENT Consultant staff meet on a quarterly basis to assess the progress of each Registrar. Satisfactory continuous evaluation ( 50%) is necessary to allow a Registrar to attempt any MMed (Chir) or FCS(SA) examination. Feedback of such assessments will be provided and may include an interview with the Divisional Head and relevant Consultants in the event of an unsatisfactory evaluation, or any specific areas of concern. PRACTICAL ROTATIONS Service delivery and practical teaching occurs within specific Units or Firms. These Units, together with the minimum period of time a Registrar will rotate in each during the five year period of training, are as follows:- Page 8 of 9
UNIT MINIMUM Surgical Gastroenterology Vascular Surgery Head-, Neck- and Breast Surgery Surgical Intensive Care Paediatric Surgery Trauma Surgery Burns Gastro-enterology/GIT endoscopy Surgical Admissions Ward Peripheral General Surgical Rotation(s) [Paarl and/or Karl Bremer Hospital(s)] 18 months 6 months 6 months 9 months Page 9 of 9