This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.
Surgical care may be defined as the body of knowledge, skills and attitudes necessary to evaluate and manage conditions and disorders requiring operative intervention.
Attitudes
The resident should develop attitudes that encompass the following:
- Recognition of the importance of family physician and surgeon collaborating as partners in the evaluation of and decision making for the care of surgical patients.
- Awareness of the principles involved in differentiating the causative origin of clinical symptoms resulting in the need for medical versus surgical intervention.
- Sensitivity to the patient's and family's concerns and anxieties regarding the potential need for surgical intervention.
Knowledge
- Basic principles of surgical diagnosis Basic surgical anatomy
Wound physiology, care and healing processes
Clinical assessment, including history, physical examination, laboratory evaluation and differential diagnosis of key signs and symptoms of surgical conditions
Invasive versus noninvasive diagnostic tests
Anesthesia
Premedication
Agents
Routes of administration
Toxicity
Resucitation mentods
Recognition of surgical emergencies
Ethical and legal considerations
Informed consent
Quality of life
End-of-life issues
- Preoperative assessment Surgical risk assessment
Comorbid diseases
Antibiotic prophylaxis
Patient preparation (bowel, etc.)
- Intraoperative care Basic principles of asepsis and sterile technique
Patient monitoring
Fluid management
Blood requirements
Temperature control
Use of basic surgical instruments
- Postoperative care Routine Wound care
Patient mobilization
Nutritional management
Pain management
Suctions and drains
Common complications
Fever work-up and management
Wound dehiscence
Urinary retention
Hemorrhage
Pneumonia
Atelectasis
Fluid overload
Transfusion reaction
Thrombophlebitis
Pulmonary embolism
Oliguria
Respiratory insufficiency
Ileus
Infection
Shock
Long-term follow-up
- Outpatient surgery Patient selection
Conscious sedation
Postoperative observation principles
Follow-up
- Office care of common conditions Lumps and bumps
Simple lacerations
Superficial burns
- Approach to the care of common surgical conditions Abscesses
Aortic aneurysm
Appendicitis
Arterial insufficiency
Benign neoplasia
Bowel obstruction
Breast masses
Carpal tunnel syndrome
Colon cancer
Coronary artery disease (obstruction)
Cysts and hematomas
Diverticuli
Gallbladder disease
Ganglia
Gastrointestinal hemorrhage
Hemorrhoids
Hernias
Intervertebral disk herniation
Lung cancer
- Shared management of common general surgical conditions Anal fistula, fissure or perianal abscess
Carcinoma
Esophageal varices
Fasciitis
Incarcerated hernia
Intussusception
Malabsorption
Obstruction
Pancreatic disease
Polyposis
Regional enteritis
Ruptured viscus
Ulcerative colitis
- Organ donation and transplantation
Skills
- Preoperative assessment
Surgical risk evaluation
Physical assessment
Radiographic assessment
Noninvasive diagnostic procedures
Invasive diagnostic procedures
Paracentesis
Nasogastric lavage
Peritoneal lavage
Thoracentesis
Tube thoracostomy
Bladder aspiration
Central venous access (central venous pressure, Swan-Ganz catheter)
Venous cutdown
Arterial puncture/catheterization
Needle aspiration/biopsy technique
- Emergent surgical techniques
Cricothyroidotomy
Needle thoracostomy
Pericardiocentesis
- Intraoperative skills
Preparation and draping of operative field
First assist at major surgery
Basic use of surgical instruments
Incision and dissection
Exposure/retraction
Hemostasis
Estimation of blood loss
Fluid replacement
Wound closure
Technique selection (ligature, staples, adhesives)
Suture selection
Drains
Dressings
- Postoperative care
Suture removal
Dressing changes
Drain removal
- Minor surgical techniques Local anesthesia
Simple excision
Incision and drainage of cysts and abscesses
Aspiration
Ear piercing
Foreign body removal
Minor burns
Vasectomy
Cauterization/electrodesiccation
Punch biopsy
Wound debridement
Enucleation/excision of external thrombotic hemorrhoid
Rectal polyp removal
Nail surgery
Implementation
The implementation of this curriculum segment should combine a minimum of two months of block rotations and longitudinal learning experiences throughout the 36 months of training. The curricular content should be required and integrated into the conference schedule and into teaching activities in the family practice center. Relevant materials should be prominent in the residency library.
