CURRICULUM

OUTLINE
FOR
GENERAL SURGERY

2018–2019

Surgical Council on
Resident Education
1617 John F. Kennedy Boulevard
Suite 860
Philadelphia, PA 19103
1-877-825-9106
info@surgicalcore.org
www.surgicalcore.org
 SCORE Curriculum Outline for
General Surgery
The SCORE® Curriculum Outline for General
Surgery is a list of topics to be covered in a five-
year general surgery residency program. The
outline is updated annually to remain contempo-
rary and reflect feedback from SCORE member
organizations and specialty surgical societies.
Topics are listed for all six competencies of
the Accreditation Council for Graduate Medical
Education (ACGME): patient care; medical
knowledge; professionalism; interpersonal and
communication skills; practice-based learning
and improvement; and systems-based practice.
The patient care topics cover 27 organ system-
based categories, with each category separated
into Diseases/Conditions and Operations/
Procedures. Topics within these two areas are
then designated as Core or Advanced.
Changes from the previous edition are indi-
cated in the Excel version of this outline, avail-
able at www.surgicalcore.org. Note that topics
listed in this booklet may not directly match those
currently on the SCORE Portal — this outline is
forward-looking, reflecting the latest updates.

The Surgical Council on Resident Education

(SCORE) is a nonprofit consortium formed in
2006 by the principal organizations involved
in U.S. surgical education. SCORE’s mission
is to improve the education of general surgery
residents through the development of a national
curriculum for general surgery residency training.
The members of SCORE are:

American Board of Surgery

American College of Surgeons
American Surgical Association
Association of Program Directors in Surgery
Association for Surgical Education
Review Committee for Surgery
of the ACGME
Society of American Gastrointestinal
and Endoscopic Surgeons
 PATIENT CARE
CONTENTS Page

BY CATEGORY ............................................. 9
1. Abdomen – General ............................... 9
2. Abdomen – Hernia................................ 10
3. Abdomen – Biliary ................................ 11
4. Abdomen – Liver .................................. 12
5. Abdomen – Pancreas ........................... 13
6. Abdomen – Spleen ............................... 14
7. Alimentary Tract – Esophagus ............. 15
8. Alimentary Tract – Stomach ................. 16
9. Alimentary Tract – Small Intestine ........ 17
10. Alimentary Tract – Large Intestine........ 18
11. Alimentary Tract – Anorectal ................ 19
12. Endoscopy ............................................ 20
13. Breast ................................................... 21
14. Endocrine ............................................. 22
15. Skin and Soft Tissue............................. 23
16. Surgical Critical Care ............................ 24
17. Trauma ............................................25-26
18. Vascular – Arterial Disease .................. 27
19. Vascular – Venous ............................... 28
20. Vascular – Access ................................ 29
21. Transplantation ..................................... 30
22. Thoracic Surgery .................................. 31
23. Pediatric Surgery .............................32-33
24. Plastic Surgery ..................................... 34
25. Genitourinary ........................................ 35
26. Gynecology and Obstetrics .................. 36
27. Head and Neck ..................................... 37

DISEASES BY LEVEL .................................. 38

Core ......................................................38-41
Advanced ..............................................42-43

OPERATIONS BY LEVEL ............................ 44

Core ......................................................44-46
Advanced ..............................................47-48

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 MEDICAL KNOWLEDGE
CONTENTS

Page
1. Anesthesia ............................................49
2. Biostatistics and Evaluation of
Evidence ...............................................49

3. Fluids, Electrolytes and Acid-Base

Balance.................................................49

4. Geriatric Surgery and End-of-Life

Care ......................................................49

5. Immunology ..........................................50
6. Infection and Antimicrobial Therapy .....50
7. Minimally Invasive Surgery –
Principles ..............................................50

8. Nutrition and Metabolism ......................50

9. Oncology and Tumor Biology ...............50
10. Preoperative Evaluation and
Perioperative Care................................51

11. Transfusion and Disorders of

Coagulation ..........................................51

12. Wound Healing .....................................51

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 PROFESSIONALISM
CONTENTS
Page
1. Competition of Interests .......................52
2. Truth Telling..........................................52
3. Confidentiality .......................................52
4. Professional Obligations .......................53
5. End-of-Life Issues ................................53
6. Substitute Decision Making ..................53

INTERPERSONAL AND
COMMUNICATION SKILLS
CONTENTS
1. Non-Technical Skills for Surgeons .......54
2. SPICE ...................................................54

PRACTICE-BASED LEARNING
AND IMPROVEMENT
CONTENTS
1. Quality Improvement ............................55

SYSTEMS-BASED PRACTICE
CONTENTS
1. Systems-Based Practice ......................56

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 ABOUT THIS DOCUMENT
SCORE was founded in 2006 by the leading
organizations involved in U.S. surgical educa-
tion to answer the question, “What do we expect
our residents to know and be able to do profi-
ciently by the end of their training?” In 2004, the
American Board of Surgery began to develop
a curriculum by listing the specific patient care
competencies expected of graduating general
surgery residents. This effort was expanded into
this document, with significant input from the
Association of Program Directors in Surgery, as
well as many specialty surgical societies.
This outline should not be viewed as static.
It will continue to be reviewed annually to intro-
duce new topics as needed, delete obsolete top-
ics, or change the depth and breadth of existing
topics. As the outline has evolved, many topics
have also been consolidated to more accurately
describe the required knowledge.

THE SCORE PORTAL

The SCORE Portal (www.surgicalcore.org)
has been created to provide educational content
and assessment in support of the curriculum to
general surgery residency programs. Learning
“modules” are available on the portal for nearly
all of the topics listed in this booklet, with
modules for the few remaining topics to be
posted in the near future. Changes from the
previous edition are indicated in the Excel
version of this outline, available at
www.surgicalcore.org.
Modules on the portal contain learning objec-
tives, discussion questions, and a variety of
resource materials, including textbook chapters,
videos and images. Multiple-choice questions are
also available to assess resident knowledge. The
portal also offers This Week in SCORE® (TWIS),
a two-year schedule of topics to assist programs
in covering the portal’s content. Each week a
new topic is featured, along with related modules
and a 10-question quiz. To learn more about
TWIS and the SCORE Portal, please visit
www.surgicalcore.org.

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 PATIENT CARE
CLASSIFICATION SYSTEM

The patient care curriculum topics are orga-

nized into 27 organ-based categories. Within each
category, the topics are further separated into
Diseases/Conditions and Operations/Procedures.
The topics are then stratified into two levels using
the same classifications:

• CORE – Diseases and procedures encountered in

general surgery for which a graduate of training
will possess significant knowledge and be
able to provide comprehensive care, including
procedural competency.

• ADVANCED – Diseases and procedures that are

not consistently part of general surgery practice
for which a graduate of training should have
sufficient knowledge to make a diagnosis and
provide initial management. In some instances,
graduates will have sufficient knowledge and
experience to provide comprehensive care.

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-8-
 PATIENT CARE

1. Abdomen – General

Diseases/Conditions
Core
• Abdominal Pain – Acute and Chronic
• Rectus Sheath Hematoma

Advanced
• Ascites - Chylous
• Peritoneal Neoplasms

Operations/Procedures
Core
• Abdominal Exploration
• Intra-abdominal Abscess - Drainage
• Peritoneal Dialysis Catheter Insertion

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2. Abdomen – Hernia

Diseases/Conditions
Core
• Inguinal and Femoral Hernias
• Miscellaneous Hernias
• Umbilical and Epigastric Hernias
• Ventral Hernia

Operations/Procedures
Core
• Diaphragmatic Hernia - Repair
• Inguinal and Femoral Hernia - Repair
• Miscellaneous Hernias - Repair
• Ventral Hernia - Repair

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3. Abdomen – Biliary

Diseases/Conditions
Core
• Benign Biliary Obstruction
• Bile Duct Injury - Iatrogenic
• Biliary Neoplasms
• Cholecystitis
• Choledochal Cyst

Advanced
• Functional Biliary Disorders
• Primary Sclerosing Cholangitis

Operations/Procedures
Core
• Cholecystectomy with or without
Cholangiography
• Cholecystostomy
• Choledochoenteric Anastomosis
• Common Bile Duct Exploration and
Choledochoscopy

Advanced
• Bile Duct Cancer - Operation
• Bile Duct Injury, Iatrogenic - Acute Repair
• Bile Duct Neoplasms - Operation
• Gallbladder Cancer - Operation
• Ultrasound of the Biliary Tree

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4. Abdomen – Liver

Diseases/Conditions
Core
• Hepatic Abscess
• Hepatic Neoplasms – Metastatic
• Primary Hepatic Neoplasms – Benign and
Malignant

Advanced
• Cirrhosis/Portal Hypertension (Ascites)

Operations/Procedures
Core
• Hepatic Abscess - Drainage
• Hepatic Biopsy

Advanced
• Hepatic Ultrasound - Intraoperative
• Segmentectomy/Lobectomy

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5. Abdomen – Pancreas

Diseases/Conditions
Core
• Cystic Lesions of the Pancreas
• Pancreatic Neoplasms - Endocrine
• Pancreatic Neoplasms - Exocrine
• Pancreatitis - Acute/Pancreatic Necrosis/Abscess

Advanced
• Intraductal Papillary Mucinous Neoplasms
• Pancreas Divisum
• Pancreatitis - Chronic (Including Hereditary
Pancreatitis)/Pancreatic Insufficiency

Operations/Procedures
Core
• Pancreatectomy - Distal
• Pancreatic Debridement
• Pancreatic Pseudocyst - Drainage

Advanced
• Ampullary Resection for Tumor
• Pancreatectomy - Total
• Pancreatic Ultrasound - Intraoperative
• Pancreaticoduodenectomy
• Pancreatitis, Chronic – Operative Management

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6. Abdomen – Spleen

Diseases/Conditions
Advanced
• Hematologic Diseases of the Spleen
• Splenic Abscess, Cysts, and Neoplasms

Operations/Procedures
Core
• Splenectomy

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7. Alimentary Tract – Esophagus

Diseases/Conditions
Core
• Esophageal Motility Disorders
• Esophageal Neoplasms – Benign and
Malignant
• Esophageal Perforation
• Gastroesophageal Reflux/Barrett’s Esophagus
• Hiatal Hernias
Advanced
• Esophageal Caustic Ingestion and
Foreign Bodies

Operations/Procedures
Core
• Antireflux Procedures
Advanced
• Cricopharyngeal Myotomy with
Zenker’s Diverticulum - Excision
• Esophageal Perforation - Repair/Resection
• Esophagectomy/Esophagogastrectomy
• Esophagomyotomy (Heller)
• Paraesophageal Hernia - Repair

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8. Alimentary Tract – Stomach

Diseases/Conditions
Core
• Gastric Adenocarcinoma
• Gastric Foreign Bodies
• Gastrointestinal Bleeding - Upper
• GIST and Miscellaneous Neoplasms
• Morbid Obesity
• Peptic Ulcer Disease
• Stress Gastritis

Advanced
• Functional Disorders of the Stomach

Operations/Procedures
Core
• Gastrectomy - Partial/Total
• Gastroduodenal Perforation - Repair
• Gastrostomy
• Vagotomy and Drainage

Advanced
• Morbid Obesity - Operations
• Postgastrectomy Syndromes - Revisional
Procedures

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9. Alimentary Tract – Small
Intestine

Diseases/Conditions
Core
• Crohn Disease - Surgical Management
• Enterocutaneous Fistula
• Meckel’s Diverticulum
• Mesenteric Ischemia - Acute (Arterial, Venous,
and Nonocclusive)
• Paralytic Ileus
• Pneumatosis
• Radiation Enteritis
• Small Intestinal Neoplasms
• Small Intestinal Obstruction

Advanced
• Enteric Infections/Blind Loop Syndrome
• Short Bowel Syndrome

Operations/Procedures
Core
• Adhesiolysis
• Ileostomy and Ileostomy Closure
• Small Intestinal Resection

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10. Alimentary Tract – Large
Intestine

Diseases/Conditions
Core
• Appendicitis
• C. difficile Colitis
• Colitis - Ischemic
• Colon Cancer
• Colonic Polyps
• Colonic Volvulus and Obstruction
• Diverticulitis
• Gastrointestinal Bleeding - Lower
• Ulcerative Colitis - Surgical Management

Advanced
• Functional Disorders of the Intestine
• Polyposis Syndromes

Operations/Procedures
Core
• Appendectomy
• Colectomy - Partial
• Colectomy - Total and Subtotal
• Colostomy and Colostomy Closure

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11. Alimentary Tract – Anorectal

Diseases/Conditions
Core
• Anal Cancer
• Anal Dysplasia and STDs
• Anal Fissure
• Anorectal Abscess and Fistulae
• Hemorrhoids
• Rectal Cancer

Advanced
• Fecal Incontinence
• Rectal Prolapse

Operations/Procedures
Core
• Anal Sphincterotomy - Internal
• Anorectal Abscess - Drainage
• Anorectal Fistula - Repair
• Hemorrhoids - Management
• Perianal Condylomas - Excision

Advanced
• Anal Cancer - Excision
• Rectal Cancer - Abdominoperineal Resection
and Pelvic Exenteration
• Rectal Cancer - Transanal Resection
• Rectal Prolapse - Repair

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12. Endoscopy

Diseases/Conditions
Advanced
• Aerodigestive Tract Foreign Bodies

Operations/Procedures
Core
• Bronchoalveolar Lavage and Bronchoscopy
• Colonoscopy
• Esophagogastroduodenoscopy
• Lower GI Endoscopy

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13. Breast

Diseases/Conditions
Core
• Atypical Hyperplasia and Lobular Carcinoma In
Situ
• Benign Disease - Fat Necrosis, Fibrocystic
Breast Changes, and Radial Scar
• Benign Inflammatory Disease - Mastitis,
Abscess, and Mondor Disease
• Breast Cancer - Hereditary
• Breast Cancer - Inflammatory
• Breast Cancer - Invasive Carcinoma (Ductal,
Lobular, All Variants)
• Breast Cancer - Paget’s Disease of the Nipple
• Breast Disease During Pregnancy and Lactation
• Breast Mass
• Ductal Carcinoma In Situ
• Fibroadenoma and Phyllodes Tumors
• Male Breast Disease - Gynecomastia and Breast
Cancer
• Nipple Discharge and Intraductal Papilloma
• Radiographic Abnormalities

Advanced
• Postmastectomy Reconstruction Options

Operations/Procedures
Core
• Axillary Sentinel Lymph Node Biopsy and
Lymphadenectomy
• Duct Excision
• Excisional Breast Biopsy and Partial Mastectomy
• Mastectomy - Simple, Modified Radical, and
Radical
• Percutaneous Breast Biopsy and Cyst
Aspiration

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14. Endocrine

Diseases/Conditions
Core
• Adrenal Mass - Incidental
• Hyperaldosteronism - Primary
• Hypercortisolism - Cushing Syndrome/Disease
• Hyperparathyroidism
• Hyperthyroidism
• Hypothyroidism - Postoperative
• Pheochromocytoma
• Thyroid Cancer
• Thyroid Nodule
• Thyroiditis

Advanced
• Adrenal Cancer
• Multiple Endocrine Neoplasias
• Parathyroid Cancer

Operations/Procedures
Core
• Parathyroidectomy
• Thyroidectomy - Partial or Total

Advanced
• Adrenalectomy
• Ultrasound of the Thyroid

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15. Skin and Soft Tissue

Diseases/Conditions
Core
• Cellulitis
• Hidradenitis
• Melanoma and Nevi
• Necrotizing Soft Tissue Infections
• Non-Melanoma Skin Cancers
• Paronychia and Felon
• Pilonidal Cyst/Sinus
• Soft Tissue Masses - Evaluation

Advanced
• Decubitus Ulcer
• Desmoids/Fibromatoses
• Lymphedema/Lymphangitis
• Soft Tissue Sarcomas

Operations/Procedures
Core
• Melanoma - Wide Local Excision
• Pilonidal Cystectomy
• Sentinel Lymph Node Biopsy for Melanoma
• Skin/Soft Tissue Lesions - Excisional and
Incisional Biopsy
• Soft Tissue Infections - Incision, Drainage,
Debridement

Advanced
• Ilioinguinal-Femoral Lymphadenectomy
• Soft Tissue Sarcoma - Resection

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16. Surgical Critical Care

Diseases/Conditions
Core
• Abdominal Compartment Syndrome
• Anaphylaxis
• Acute Respiratory Distress Syndrome (ARDS)
• Brain Death
• Cardiac Arrest
• Cardiac Arrhythmias - Common
• Cardiac Failure and Cardiogenic Shock
• Derangements of Electrolytes and Acid-Base
Balance
• Endocrine Dysfunction
• Hepatic Failure and Hepatorenal Syndrome
• Hypovolemic Shock
• Hypoxemic Syndromes (PE, Pneumonia)
• Neurogenic Shock
• Neurologic Dysfunction
• Postoperative Delirium
• Renal Failure
• Respiratory Failure
• Sepsis and Septic Shock

Advanced
• Organ Donors and Selection Criteria

Operations/Procedures
Core
• Intubation and Difficult Airway
• Nutritional Support
• Ultrasound Use for Intravascular Access
• Vascular Access

Advanced
• Noninvasive and Invasive Cardiac Pacing

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17. Trauma

Diseases/Conditions
Core
• Burns
• Chest Wall, Pleural and Diaphragm Injuries
• Cardiac Injury
• Colon and Rectal Injury
• Duodenal and Pancreatic Injury
• Esophageal Injury
• Frostbite and Hypothermia
• Gastric and Small Intestinal Injury
• Geriatric Trauma
• Hepatic Injury
• Initial Assessment and Management of Trauma
• Lower Urinary Tract Injuries
• Pediatric Trauma
• Pelvic Fractures and Retroperitoneal Hematoma
• Splenic Injury
• Tracheobronchial and Lung Injury
• Trauma in Pregnancy
• Upper Aerodigestive Tract Injury
• Upper Urinary Tract Injuries
• Vascular Injury - Abdomen
• Vascular Injury - Extremities
• Vascular Injury - Neck
• Vascular Injury - Thorax

Advanced
• Bite and Envenomation Injuries
• Brachial Plexus Injury
• Extremity Injuries
• Head Injury - Penetrating and Closed
• Smoke Inhalation Injury and Carbon Monoxide
Poisoning
• Spine Fracture

- 25 -
17. Trauma (cont.)

Operations/Procedures
Core
• Abdominal Exploration for Trauma
• Cardiac Injury - Repair
• Duodenal and Pancreatic Injury - Operations
• Esophageal Injury - Repair
• Exploratory Laparoscopy
• Exploratory Laparotomy
• Focused Assessment with Sonography for
Trauma (FAST)
• Gastrointestinal Tract Injury - Repair
• Hepatic Injury - Packing and Repair/Resection
• Lower Extremity Fasciotomy
• Neck Exploration for Injury
• Splenectomy/Splenorrhaphy
• Urinary Tract Injuries - Operations
• Vascular Injuries - Operations
• Wounds, Major - Debride/Suture

Advanced
• Tendon - Repair
• Thermal Injuries - Operations

- 26 -
18. Vascular – Arterial Disease

Diseases/Conditions
Core
• Acute Thrombosis and Ischemia
• Cerebrovascular Disease
• Compartment Syndromes
• Diabetic Foot Infections
• Peripheral Arterial Emboli
• Peripheral Vascular Occlusive Disease

Advanced
• Aortic Dissection
• Arterial Aneurysms - Aortic
• Arterial Aneurysms - Peripheral
• Arterial Aneurysms - Visceral
• Nonatherosclerotic Occlusive Diseases
• Renal Artery Disease
• Thoracic Outlet Syndrome
• Vascular Graft Infections

Operations/Procedures
Core
• Amputations - Lower Extremity
• Embolectomy/Thrombectomy - Arterial
• Lower Extremity Bypass

Advanced
• Abdominal and Aortoiliac Aneurysm - Repair
• Aortoiliac Reconstruction for Occlusive Disease
• Carotid Endarterectomy
• Endovascular Intervention Principles
• Extra-anatomic Bypass
• Mesenteric Occlusive Disease - Operation
• Peripheral Aneurysms - Repair
• Superior Mesenteric Artery Embolectomy/
Thrombectomy
• Ultrasound in the Diagnosis and Management of
Vascular Diseases

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19. Vascular – Venous

Diseases/Conditions
Core
• Evaluation of the Swollen Leg
• Thrombophlebitis
• Varicose Veins
• Venous Stasis/Chronic Venous Insufficiency
• Venous Thromboembolism

Operations/Procedures
Core
• Vena Caval Filter - Insertion
• Venous Insufficiency/Varicose Veins - Operation

- 28 -
20. Vascular – Access

Diseases/Conditions
Core
• Vascular Access for Dialysis

Operations/Procedures
Core
• Arteriovenous Graft/Fistula
• Vascular Exposure - Principles
• Venous Access Devices - Insertion

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21. Transplantation

Diseases/Conditions
Advanced
• Organ Preservation

Operations/Procedures
Advanced
• En Bloc Abdominal Organ Retrieval
• Live Donor Hepatectomy
• Live Donor Nephrectomy
• Liver Transplantation
• Pancreas Transplantation
• Renal Transplantation

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22. Thoracic Surgery

Diseases/Conditions
Core
• Pleural Effusion/Empyema
• Pneumothorax and Pleurodesis

Advanced
• Chylothorax
• Mediastinal Tumors and Cysts
• Mediastinitis
• Malignant Tumors of the Lung: Primary and
Metastatic
• Superior Vena Cava Syndrome

Operations/Procedures
Core
• Exploratory Thoracotomy - Open and
Thoracoscopic
• Partial Pulmonary Resections - Open
and Thoracoscopic
• Tube Thoracostomy and Thoracentesis

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23. Pediatric Surgery

Diseases/Conditions
Core
• Abdominal Mass
• Abdominal Pain - Acute
• Appendicitis
• Gastrointestinal Bleeding - Lower
• Hypertrophic Pyloric Stenosis
• Inguinal Hernia
• Intussusception
• Malrotation
• Meckel Diverticulum
• Umbilical Hernia

Advanced
• Biliary Atresia
• Choledochal Cysts
• Congenital Aganglionosis (Hirschsprung
Disease)
• Congenital Diaphragmatic Hernia
• Cryptorchidism
• Esophageal Atresia/Tracheoesophageal Fistula
• Gastroschisis/Omphalocele
• Imperforate Anus
• Necrotizing Enterocolitis
• Neonatal Small Bowel Obstruction

Operations/Procedures
Core
• Inguinal Hernia - Repair
• Intussusception - Operation
• Malrotation - Operation
• Meckel Diverticulum - Excision
• Pyloromyotomy
• Umbilical Hernia - Repair

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23. Pediatric Surgery (cont.)

Advanced
• Branchial Cleft Anomaly - Excision
• Chest Wall Deformity - Repair
• Diaphragmatic Hernia - Repair
• Esophageal Atresia/Tracheoesophageal
Fistula - Repair
• Hirschsprung Disease - Operation
• Imperforate Anus - Operation
• Intestinal Atresia/Stenosis - Repair
• Meconium Ileus - Operation
• Necrotizing Enterocolitis - Operation
• Omphalocele/Gastroschisis - Repair
• Orchiopexy
• Thyroglossal Duct Cyst - Excision

- 33 -
24. Plastic Surgery

Operations/Procedures
Core
• Complex Wound Closure
• Skin Grafting

- 34 -
25. Genitourinary

Diseases/Conditions
Core
• Hydrocele
• Scrotal Pain and Masses

Advanced
• Acute Urinary Retention
• Genitourinary Neoplasms

Operations/Procedures
Core
• Cystostomy
• Nephrectomy

- 35 -
26. Gynecology and Obstetrics

Diseases/Conditions
Core
• Ectopic Pregnancy
• Pelvic Inflammatory Disease

Advanced
• Gynecologic Neoplasms

Operations/Procedures
Core
• Hysterectomy and Salpingo-oophorectomy
• Surgical Considerations in the Pregnant
Patient

Advanced
• Cesarean Section

- 36 -
27. Head and Neck

Diseases/Conditions
Core
• Neck Mass - Evaluation
• Upper Airway Obstruction

Advanced
• Oral Cavity/Pharynx, Laryngeal, and Salivary
Gland Cancer

Operations/Procedures
Core
• Lymph Node Biopsy
• Tracheostomy

Advanced
• Modified Neck Dissection
• Parotidectomy

- 37 -
 DISEASES/CONDITIONS BY LEVEL
Diseases/Conditions - CORE
Abdomen - General
Abdominal Pain - Acute and Chronic
Rectus Sheath Hematoma
Abdomen - Hernia
Inguinal and Femoral Hernias
Miscellaneous Hernias
Umbilical and Epigastric Hernias
Ventral Hernia
Abdomen - Biliary
Bile Duct Injury - Iatrogenic
Benign Biliary Obstruction
Biliary Neoplasms
Cholecystitis
Choledochal Cyst
Abdomen - Liver
Hepatic Abscess
Hepatic Neoplasms - Metastatic
Primary Hepatic Neoplasms - Benign and Malignant
Abdomen - Pancreas
Cystic Lesions of the Pancreas
Pancreatic Neoplasms - Endocrine
Pancreatic Neoplasms - Exocrine
Pancreatitis - Acute/Pancreatic Necrosis/Abscess
Alimentary Tract - Esophagus
Esophageal Motility Disorders
Esophageal Neoplasms - Benign and Malignant
Esophageal Perforation
Gastroesophageal Reflux/Barrett’s
Esophagus Hiatal Hernias
Alimentary Tract - Stomach
Gastric Adenocarcinoma
Gastric Foreign Bodies
Gastrointestinal Bleeding - Upper
GIST and Miscellaneous Neoplasms
Morbid Obesity
Peptic Ulcer Disease
Stress Gastritis
Alimentary Tract - Small Intestine
Enterocutaneous Fistula
Meckel’s Diverticulum
Mesenteric Ischemia - Acute (Arterial, Venous, and
Nonocclusive)
Paralytic Ileus
Pneumatosis
Radiation Enteritis
Crohns Disease - Surgical Management
Small Intestinal Neoplasms
Small Intestinal Obstruction
Alimentary Tract - Large Intestine
Appendicitis
C. difficile Colitis
Colitis - Ischemic
Colon Cancer
Colonic Polyps
Colonic Volvulus and Obstruction
Diverticulitis
Gastrointestinal Bleeding - Lower
Ulcerative Colitis - Surgical Management

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Diseases/Conditions - CORE (Cont.)
Alimentary Tract – Anorectal
Anal Cancer
Anal Dysplasia and STDs
Anal Fissure
Anorectal Abscess and Fistulae
Hemorrhoids
Rectal Cancer
Breast
Atypical Hyperplasia and Lobular Carcinoma in Situ
Benign Disease - Fat Necrosis, Fibrocystic Changes, and
Radial Scar
Benign Inflammatory Disease - Mastitis, Abscess, and
Mondor Disease
Breast Cancer - Hereditary
Breast Cancer - Inflammatory
Breast Cancer - Invasive Carcinoma (Ductal, Lobular, All
Variants)
Breast Cancer - Paget's Disease of the Nipple
Breast Disease During Pregnancy and Lactation
Breast Mass
Ductal Carcinoma in Situ
Fibroadenoma and Phyllodes Tumors
Male Breast Disease: Gynecomastia and Breast Cancer
Nipple Discharge and Intraductal Papilloma
Radiographic Abnormalities
Endocrine
Adrenal Mass - Incidental
Hyperaldosteronism - Primary
Hypercortisolism - Cushing
Syndrome/Disease
Hyperparathyroidism
Hyperthyroidism
Hypothyroidism - Postoperative
Pheochromocytoma
Thyroid Cancer
Thyroid Nodule
Thyroiditis
Skin and Soft Tissue
Cellulitis
Hidradenitis
Melanoma and Nevi
Necrotizing Soft Tissue
Infections
Non-Melanoma Skin Cancers
Paronychia and Felon
Pilonidal Cyst/Sinus
Soft Tissue Masses - Evaluation
Surgical Critical Care
Abdominal Compartment Syndrome
Anaphylaxis
Acute Respiratory Distress Syndrome (ARDS)
Brain Death
Cardiac Arrest
Cardiac Arrhythmias - Common
Cardiac Failure and Cardiogenic Shock
Derangements of Electrolytes and Acid Base Balance
Endocrine Dysfunction
Hepatic Failure and Hepatorenal Syndrome
Hypovolemic Shock
Hypoxemic Syndromes (PE, Pneumonia)
Neurogenic Shock
(continued next page)

- 39 -
Diseases/Conditions - CORE (Cont.)
Surgical Critical Care (cont.)
Neurologic Dysfunction
Postoperative Delirium
Renal Failure
Respiratory Failure
Sepsis and Septic Shock
Trauma
Burns
Chest Wall, Pleural and Diaphragm Injuries
Cardiac Injury
Colon and Rectal Injury
Duodenal and Pancreatic Injury
Esophageal Injury
Frostbite and Hypothermia
Gastric and Small Intestinal Injury
Geriatric Trauma
Hepatic Injury
Initial Assessment and Management of Trauma
Lower Urinary Tract Injuries
Pediatric Trauma
Pelvic Fractures and Retroperitoneal Hematoma
Splenic Injury
Tracheobronchial and Lung Injury
Trauma in Pregnancy
Upper Aerodigestive Tract Injury
Upper Urinary Tract Injuries
Vascular Injury - Abdomen
Vascular Injury - Extremities
Vascular Injury - Neck
Vascular Injury - Thorax
Vascular - Arterial Disease
Acute Thrombosis and Ischemia
Cerebrovascular Disease
Compartment Syndromes
Diabetic Foot Infections
Peripheral Arterial Emboli
Peripheral Vascular Occlusive Disease
Vascular - Venous
Evaluation of the Swollen Leg
Thrombophlebitis
Varicose Veins
Venous Stasis/Chronic Venous Insufficiency
Venous Thromboembolism
Vascular - Access
Vascular Access for Dialysis
Thoracic Surgery
Pleural Effusion/Empyema
Pneumothorax and Pleurodesis
Pediatric Surgery
Abdominal Mass
Abdominal Pain - Acute
Appendicitis
Gastrointestinal Bleeding - Lower
Hypertrophic Pyloric Stenosis
Inguinal Hernia
Intussusception
Malrotation
Meckel's Diverticulum
Umbilical Hernia

- 40 -
Diseases/Conditions - CORE (Cont.)
Genitourinary
Hydrocele
Scrotal Pain and Masses
Gynecology and Obstetrics
Ectopic Pregnancy
Pelvic Inflammatory Disease
Head and Neck
Neck Mass - Evaluation
Upper Airway Obstruction

- 41 -
Diseases/Conditions - ADVANCED
Abdomen - General
Peritoneal Neoplasms
Abdomen - Biliary
Functional Biliary Disorders
Primary Sclerosing Cholangitis
Abdomen - Liver
Cirrhosis/Portal Hypertension (Ascites)
Abdomen - Pancreas
Intraductal Papillary Mucinous Neoplasms
Pancreas Divisum
Pancreatitis - Chronic (Including Hereditary
Pancreatitis)/Pancreatic Insufficiency
Abdomen - Spleen
Hematologic Diseases of the Spleen
Splenic Abscess, Cysts and Neoplasms
Alimentary Tract - Esophagus
Esophageal Caustic Ingestion and Foreign Bodies
Alimentary Tract - Stomach
Functional Disorders of the Stomach
Alimentary Tract - Small Intestine
Enteric Infections/Blind Loop Syndrome
Short Bowel Syndrome
Alimentary Tract - Large Intestine
Functional Disorders of the Intestine
Polyposis Syndromes
Alimentary Tract - Anorectal
Fecal Incontinence
Rectal Prolapse
Endoscopy
Aerodigestive Tract Foreign Bodies
Breast
Postmastectomy Reconstruction Options
Endocrine
Adrenal Cancer
Multiple Endocrine Neoplasias
Parathyroid Cancer
Skin and Soft Tissue
Decubitus Ulcer
Desmoids/Fibromatoses
Lymphedema/Lymphangitis
Soft Tissue Sarcomas
Surgical Critical Care
Organ Donors and Selection Criteria
Trauma
Bite and Envenomation Injuries
Brachial Plexus Injury
Extremity Injuries
Head Injury - Penetrating and Closed
Smoke Inhalation Injury and Carbon Monoxide Poisoning
Spine Fracture
Vascular - Arterial Disease
Aortic Dissection
Arterial Aneurysms - Aortic
Arterial Aneurysms - Peripheral
Arterial Aneurysms - Visceral
Nonatherosclerotic Occlusive Diseases
Renal Artery Disease
(continued next page)

- 42 -
Diseases/Conditions - ADVANCED (Cont.)
Vascular - Arterial Disease (cont.)
Thoracic Outlet Syndrome
Vascular Graft Infections
Transplantation
Organ Preservation
Thoracic Surgery
Chylothorax
Mediastinal Tumors and Cysts
Mediastinitis
Malignant Tumors of the Lung: Primary and Metastatic
Superior Vena Cava Syndrome
Pediatric Surgery
Biliary Atresia
Choledochal Cysts
Congenital Agangliosis (Hirschsprung Disease)
Congenital Diaphragmatic Hernia
Cryptorchidism
Neonatal Small Bowel Obstruction
Esophageal Atresia/Tracheoesophageal Fistula
Gastroschisis/Omphalocele
Imperforate Anus
Necrotizing Enterocolitis
Genitourinary
Acute Urinary Retention
Genitourinary Neoplasms
Gynecology and Obstetrics
Gynecologic Neoplasms
Head and Neck
Oral Cavity/Pharynx, Laryngeal, and Salivary Gland Cancer

- 43 -
OPERATIONS/PROCEDURES BY LEVEL
Operations/Procedures - CORE
Abdomen - General
Abdominal Exploration
Intra-abdominal Abscess - Drainage
Peritoneal Dialysis Catheter Insertion
Abdomen - Hernia
Diaphragmatic Hernia - Repair
Inguinal and Femoral Hernia - Repair
Miscellaneous Hernias - Repair
Ventral Hernia - Repair
Abdomen - Biliary
Cholecystectomy with or without Cholangiography
Cholecystostomy
Choledochoenteric Anastomosis
Common Bile Duct Exploration and Choledochoscopy
Abdomen - Liver
Hepatic Abscess - Drainage
Hepatic Biopsy
Abdomen - Pancreas
Pancreatectomy - Distal
Pancreatic Debridement
Pancreatic Pseudocyst - Drainage
Abdomen - Spleen
Splenectomy
Alimentary Tract - Esophagus
Antireflux Procedures
Alimentary Tract - Stomach
Gastrectomy - Partial/Total
Gastroduodenal Perforation - Repair
Gastrostomy
Vagotomy and Drainage
Alimentary Tract - Small Intestine
Adhesiolysis
Ileostomy and Ileostomy Closure
Small Intestinal Resection
Alimentary Tract - Large Intestine
Appendectomy
Colectomy - Partial
Colectomy - Total and Subtotal
Colostomy and Colostomy
Closure
Alimentary Tract - Anorectal
Anal Sphincterotomy - Internal
Anorectal Abscess - Drainage
Anorectal Fistula - Repair
Hemorrhoids - Management
Perianal Condylomas - Excision
Endoscopy
Bronchoalveolar Lavage and Bronchoscopy
Esophagogastroduodenoscopy
Lower GI Endoscopy
Breast
Axillary Sentinel Lymph Node Biopsy and
Lymphadenectomy
Duct Excision
Excisional Breast Biopsy and Partial Mastectomy
Mastectomy - Simple, Modified Radical, and Radical
Percutaneous Breast Biopsy and Cyst Aspiration

- 44 -
Operations/Procedures - CORE (Cont.)
Endocrine
Parathyroidectomy
Thyroidectomy - Partial or Total
Skin and Soft Tissue
Melanoma - Wide Local Excision
Pilonidal Cystectomy
Sentinel Lymph Node Biopsy for Melanoma
Skin/Soft Tissue Lesions - Excisional and Incisional Biopsy
Soft Tissue Infections - Incision, Drainage, Debridement
Surgical Critical Care
Intubation and Difficult Airway
Nutritional Support
Ultrasound Use for Intravascular Access
Vascular Access
Trauma
Abdominal Exploration for Trauma
Cardiac Injury - Repair
Duodenal and Pancreatic Injury - Operations
Esophageal Injury - Repair
Focused Assessment with Sonography for Trauma (FAST)
Gastrointestinal Tract Injury - Repair
Hepatic Injury - Packing and Repair/Resection
Lower Extremity Fasciotomy
Neck Exploration for Injury
Splenectomy/Splenorrhaphy
Urinary Tract Injuries - Operations
Vascular Injuries - Operations
Wounds, Major - Debride/Suture
Vascular - Arterial Disease
Amputations - Lower Extremity
Embolectomy/Thrombectomy - Arterial
Lower Extremity Bypass
Vascular - Venous
Vena Caval Filter - Insertion
Venous Insufficiency/Varicose Veins - Operation
Vascular - Access
Arteriovenous Graft/Fistula
Vascular Exposure - Principles
Venous Access Devices - Insertion
Thoracic Surgery
Exploratory Thoracotomy - Open and Thoracoscopic
Partial Pulmonary Resections - Open and Thoracoscopic
Tube Thoracostomy and Thoracentesis
Pediatric Surgery
Inguinal Hernia - Repair
Intussusception - Operation
Malrotation - Operation
Meckel's Diverticulum - Excision
Pyloromyotomy
Umbilical Hernia - Repair
Plastic Surgery
Complex Wound
Closure
Skin Grafting
Genitourinary
Cystostomy
Nephrectomy

- 45 -
Operations/Procedures - CORE (Cont.)
Gynecology and Obstetrics
Hysterectomy and Salpingo-oophorectomy
Surgical Considerations in the Pregnant Patient
Head and Neck
Lymph Node
Biopsy
Tracheostomy

- 46 -
Operations/Procedures - ADVANCED
Abdomen - Biliary
Bile Duct Cancer - Operation
Bile Duct Injury, Iatrogenic - Acute Repair
Bile Duct Neoplasms - Operation
Gallbladder Cancer - Operation
Ultrasound of the Biliary Tree
Abdomen - Liver
Hepatic Ultrasound - Intraoperative
Segmentectomy/Lobectomy
Abdomen - Pancreas
Ampullary Resection for Tumor
Pancreatectomy - Total
Pancreatic Ultrasound - Intraoperative
Pancreaticoduodenectomy
Pancreatitis, Chronic - Operative Management
Alimentary Tract - Esophagus
Cricopharyngeal Myotomy with Zenker's Diverticulum -
Excision
Esophageal Perforation - Repair/Resection
Esophagectomy/Esophagogastrectomy
Esophagomyotomy (Heller)
Paraesophageal Hernia - Repair
Alimentary Tract - Stomach
Morbid Obesity - Operations
Postgastrectomy Syndromes - Revisional Procedures
Alimentary Tract - Small Intestine
Stricturoplasty for Crohn’s Disease
Alimentary Tract - Large Intestine
Coloproctectomy - Total (with Ileorectal Pull-Through)
Alimentary Tract - Anorectal
Anal Cancer - Excision
Rectal Cancer - Abdominoperineal Resection and Pelvic
Exenteration
Rectal Cancer - Transanal Resection
Rectal Prolapse - Repair
Endocrine
Adrenalectomy Ultrasound of the Thyroid
Skin and Soft Tissue
Ilioinguinal-Femoral Lymphadenectomy
Soft Tissue Sarcoma - Resection
Surgical Critical Care
Noninvasive and Invasive Cardiac Pacing
Trauma
Tendon - Repair
Thermal Injuries - Operations
Vascular - Arterial Disease
Abdominal and Aortoiliac Aneurysm - Repair
Aortoiliac Reconstruction for Occlusive Disease
Carotid Endarterectomy
Endovascular Intervention Principles
Extra-anatomic Bypass
Graft-enteric Fistula - Management
Mesenteric Occlusive Disease - Operation
Peripheral Aneurysms - Repair
Superior Mesenteric Artery Embolectomy/Thrombectomy
Ultrasound in the Diagnosis and Management of Vascular
Diseases

- 47 -
Operations/Procedures - ADVANCED (Cont.)
Transplantation
En Bloc Abdominal
Organ Retrieval
Live Donor
Hepatectomy
Live Donor
Nephrectomy
Liver Transplantation
Pancreas Transplantation
Renal Transplantation
Pediatric Surgery
Branchial Cleft Anomaly - Excision
Chest Wall Deformity - Repair
Diaphragmatic Hernia - Repair
Esophageal Atresia/Tracheoesophageal Fistula - Repair
Hirschsprung's Disease - Operation
Imperforate Anus - Operation
Intestinal Atresia/Stenosis - Repair
Meconium Ileus - Operation
Necrotizing Enterocolitis - Operation
Omphalocele/Gastroschisis - Repair
Orchiopexy
Thyroglossal Duct Cyst - Excision
Gynecology and Obstetrics
Cesarean Section
Head and Neck
Modified Neck Dissection

- 48 -
 MEDICAL KNOWLEDGE

1. Anesthesia

• Anesthesia, General - Agents and Techniques

• Anesthesia, Regional and Local - Agents and
Techniques
• Best Practices in Prescribing Opioids
• Choice of Anesthesia
• Conscious Sedation - Agents and Techniques
• Intraoperative Monitoring and Common
Intraoperative Problems
• Nerve Blocks - Digital and Peripheral
• Pain, Acute - Management
• Pain, Chronic - Management

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
• Outcomes
• Research Design
• Surveys and Qualitative Research
• Tests of Significance

3. Fluids, Electrolytes, and Acid-Base

Balance

• Hypocalcemia and Hypercalcemia

• Hypokalemia and Hyperkalemia
• Hyponatremia and Hypernatremia
• Magnesium and Phosphorous Disorders

4. Geriatric Surgery and End-of-Life Care

• Advance Directives, DNR Orders, and Power of

Attorney
• Frailty
• Goal Setting with Elderly Patients and Families
• Palliative and Hospice Care
• Perioperative Management of Geriatric Patients
- 49 -
5. Immunology

• Components of the Immune System

• Immune Response to Injury and Infection
• Surgery and Surgical Conditions in Immuno-
compromised Hosts
• Transplant Immunology

6. Infection and Antimicrobial Therapy

• Antimicrobial Stewardship
• Diagnostic Approach to Infection
• Infections - Hospital-Acquired
• Infections - Opportunistic
• Intra-abdominal Abscess
• Intra-abdominal Infections
• Prevention and Treatment of Surgical Site
Infection
• Preoperative Assessment and Management of
Coexisting Infection

7. Minimally Invasive Surgery – Principles

• Minimally Invasive Surgery (MIS) Principles

• Robotic Surgery - Principles
• Safe Use of Surgical Energy

8. Nutrition and Metabolism

• Effect of Surgery, Illness and Injury on Nutritional

Requirements
• Nutritional Assessment
• Nutritional Pharmacology and Immunonutrition
• Nutritional Requirements

9. Oncology and Tumor Biology

• Adjunctive Therapy for Cancer

• Genetic Susceptibility
• Screening and Biomarkers
• Tumor Immunology

- 50 -
10. Preoperative Evaluation and
Perioperative Care

• Common Postoperative Problems

• Evaluation of Surgical Risk
• Management of Perioperative Risk
• Postoperative Pain Management
• Prophylaxis of Venous Thromboembolism
• Ventilatory Support/Management

11. 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
Crossmatch, and Component Therapy

12. Wound Healing

• Wound Closure and Postoperative Care

• Wound Healing

- 51 -
 PROFESSIONALISM

1. Ethical Issues in Clinical Surgery:

Competition of Interests

• Accepting Gifts from Vendors

• Clinical Research
• Confronting Problem Behavior
• Non-Patient Care Obligations
• Personal Investments
• Refusal to Care for Patients
• Reimbursement Incentives

2. Ethical Issues in Clinical Surgery:

Truth Telling

• Dealing with Complications and Poor

Outcomes
• Informed Consent
• Listening and the Surgeon-Patient
Relationship
• Respecting Cultural Diversity and Individual
Sensitivities
• Truth Telling and the Surgeon-Patient
Relationship
• Use of the Internet and E-mail for
Communication

3. Ethical Issues in Clinical Surgery:

Confidentiality

• Concern for the Safety of Identifiable Others

• Conversations about Patients in Public
• Duty to Report Patients to Public
Authorities
• Relaying Genetic Test Results to Family
Members
• Revealing Confidential Information
• Surgeons Infected with Blood-Borne Diseases

- 52 -
4. Ethical Issues in Clinical Surgery:
Professional Obligations

• Obligations to Other Professionals

• Obligations to Patients: Commitment
• Obligations to Patients: Competence
• Obligations to Society: Allocation of Resources
• Obligations to Society: Teaching and Learning
Surgery

5. Ethical Issues in Clinical Surgery:

End-of-Life Issues

• Advance Directives and the Surgical Patient

• DNR Orders in the Operating Room
• Euthanasia and Physician-assisted Suicide
• Futility
• Maintaining Contact
• Palliative Care
• Talking About Death
• Withdrawing and Withholding Treatment

6. Ethical Issues in Clinical Surgery:

Substitute Decision Making

• By What Criteria Should Substitute Decision

Makers Decide?
• Substitute Decision Makers and DNR Orders
• Substitute Decisions for Children
• Unclear Competence and Decision-Making
Capacity
• Who Decides When the Patient Cannot?

- 53 -
 INTERPERSONAL AND
COMMUNICATION SKILLS

1. Non-Technical Skills for Surgeons (NOTSS)

• Cognitive Skills (Situation Awareness and

Decision Making)
• Social Skills (Communication, Teamwork and
Leadership)

2. Surgical Professionalism and Interpersonal

Communication Education (SPICE)

• Admitting Mistakes - Ethical Choices and

Reasoning
• Advanced Communication Skills for Surgical
Practice
• Cultural Diversity - Working Through the
Barriers of Language and Differing Customs
• Delivering Bad News - Your Chance to Become
a Master Surgeon
• Giving and Getting Feedback
• Managing Your Career - Making the
Professional and Personal Choices that will
Define You
• Medical Errors and Apology
• Safe Handoff of Patient Care Duties
• The Stress of Surgical Practice - The Signs of
Stress, Depression, and Suicide in You and
Your Surgical Colleagues
• Working with Professionals Around You - Team
Communication and Respect

- 54 -
 PRACTICE-BASED LEARNING
AND IMPROVEMENT

1. Quality Improvement

• Inspiring a Healthy Culture for Patient Care

• Local Engagement in Quality Improvement
• Problem-Based Quality Improvement
• Understanding the Data and Methods to
Evaluate Performance

- 55 -
 SYSTEMS-BASED PRACTICE

1. Systems-Based Practice

• Advocating for Quality Patient Care

• Coordinating Patient Care
• Cost Awareness and Risk-Benefit Analysis
• Identifying Systems Errors - Root Cause
Analysis
• Working Effectively in Various Healthcare
Delivery Settings and Systems
• Working in Interprofessional Teams