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Am Fam Physician. 1999;60(3):1030-1036

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:

  1. 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.

  2. Awareness of the principles involved in differentiating the causative origin of clinical symptoms resulting in the need for medical versus surgical intervention.

  3. Sensitivity to the patient's and family's concerns and anxieties regarding the potential need for surgical intervention.

Knowledge

  1. 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

  2. Preoperative assessment

    Surgical risk assessment

    Comorbid diseases

    Antibiotic prophylaxis

    Patient preparation (bowel, etc.)

  3. Intraoperative care

    Basic principles of asepsis and sterile technique

    Patient monitoring

    Fluid management

    Blood requirements

    Temperature control

    Use of basic surgical instruments

  4. 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

  5. Outpatient surgery

    Patient selection

    Conscious sedation

    Postoperative observation principles

    Follow-up

  6. Office care of common conditions

    Lumps and bumps

    Simple lacerations

    Superficial burns

  7. 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

  8. 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

  9. Organ donation and transplantation

Skills

  1. 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

  2. Emergent surgical techniques

    Cricothyroidotomy

    Needle thoracostomy

    Pericardiocentesis

  3. 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

  4. Postoperative care

    Suture removal

    Dressing changes

    Drain removal

  5. 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.

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