CURRICULUM

FOR

MS GENERAL SURGERY

University College of Medicine & Dentistry

And
Institute of Postgraduate Medical Sciences

Faculty of Medicine & Dentistry

The University of Lahore
Lahore Pakistan

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TABLE OF CONTENTS

SR PAGE
DESCRIPTION
# #

1 NOMENCLATURE AND SITES OF LEARNING

2 MISSION AND VISION STATEMENTS

3 DURATION OF COURSE

5 AIMS OF THE PROGRAM

6 GENERAL LEARNING OUTCOMES

7 CURRICULUM ORGANIZATION AND STRUCTURE

8 YEAR-WISE PROGRAM STRUCTURE AND SKILLS ACQUIRED

9 SCHEME OF THE EXAMINATION

10 MANDATORY WORKSHOPS

11 PORTFOLIO

12 COMPETENCIES

13 ASSESSMENT

15 COURSE CONTENT OF MS GENERAL SURGERY

16 RECOMMENDED BOOKS AND OTHER REFERENCES

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A. Course Title
Master of Surgery in General Surgery

B. Vision
We are committed to developing skilled, confident, and ethical surgical
leaders who will advance the field of surgery and improve the health of
diverse communities. Through a comprehensive curriculum, hands-on
clinical experience, and mentorship, we aim to cultivate expertise, lifelong
learning, and a dedication to excellence in all aspects of surgical practice.

C. Mission Statement
Our mission is to train the next generation of surgeons to excel in patient
care, education, and research while fostering a culture of compassion,
integrity, and innovation.

D. Duration of course
The duration of MS General Surgery course shall be four (4) years with
structured training under the guidance of an approved supervisor.

E. Training Centers
a. University of Lahore Teaching Hospital (ULTH), Lahore.
b. Social Security Teaching Hospital (SSTH), Multan Road Lahore
c. Al-Khidmat Mansoorah Teaching Hospital (AKMTH), Lahore

F. Aim of the Program

The four-year Master of Surgery (MS) General Surgery program aims to
cultivate competent specialists who demonstrate expertise in evidence-
based practice, scholarship, leadership, teaching, and research. Upon
completion of the program, residents will be able to:
• Integrate and apply relevant knowledge to inform clinical decision-
making, ensuring:
i. Currency of knowledge through ongoing professional
development.
ii. Application of scientific evidence in practice.
iii. Contextualization of care to meet individual patient needs.

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G. Program Competencies
Upon completion of the training program, trainees pursuing an academic
pathway are expected to have attained comprehensive competence in all
domains. The specialized training component encompasses the following
key areas:
i. Integrate Knowledge into Clinical Practice:
1. Stay updated with the current knowledge and apply it effectively for
patient care.
2. Evaluate and incorporate new technologies while tailoring
approaches to individual patient needs and contexts.
ii. Perform Surgical Procedures Safely and Competently:
1. Demonstrate technical proficiency, manual dexterity, and
adaptability in skills.
2. Ensure safety for patients, self, and the team while continuously
improving surgical performance.
iii. Develop and Execute Effective Management Plans:
1. Accurately diagnose and manage using appropriate investigations
and risk assessment.
2. Address complexities and uncertainties with sensitivity to the
physical, cultural, and psychological needs of patients.
iv. Communicate Effectively and Collaborate in Interdisciplinary Teams
1. Provide clear, culturally sensitive information to patients and
families about treatment options, risks, and outcomes.
2. Collaborate effectively with healthcare teams to resolve conflicts
and optimize patient care.
3. Work effectively with professionals to develop care plans and know
when to refer patients to appropriate specialists.
v. Apply Evidence-Based Medicine and Research
1. Engage in lifelong learning through incorporating evidence in
practice.
2. Perform critically appraisals and research to add to body of scholarly
literature in the field.
vi. Exemplify Ethics & Professionalism
1. Adhere to ethical principles, respect informed consent and
confidentiality, and address medico-legal issues responsibly.
2. Reflect on personal and professional limitations, participate in
audits, and uphold workplace regulations and accountability.
vii. Exhibit Leadership and Resource Management
1. Balance patient care with system resources.
2. Lead clinical teams.
3. Ensure accurate documentation for optimal outcomes.
viii. Advocate for Patient and Community Health
1. Assist in policy and advocacy dialogues.
2. Conduct awareness campaigns related to the specialty.

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H. Program Structure

a. Year 1: Foundational Knowledge and Basic Surgical

Skills: Core surgical principles, basic sciences, and early clinical
exposure.
i. Theoretical Knowledge
• Applied anatomy, pathophysiology relevant to surgery.
• Principles of asepsis, sterilization, and infection control.
• Basics of surgical instruments, suturing techniques, and
wound care.
ii. Clinical Rotations
• Two (02) mandatory rotations of 02 months each in
Accident & Emergency department and SICU in
addition to the Surgery ward and Operation theatres.
• Accident & Emergency (Trauma and acute surgical
cases).
• Intensive care unit (ICU) basics and pre/post-operative
care.
iii. Skills Development
• Hands-on practice in minor procedures (e.g., incision
and drainage, wound suturing, dressing changes).
• Use of surgical simulators for basic laparoscopic and
endoscopic skills.
iv. Certifications & Workshops (To be completed in first two
years)
• Mandatory Basic Life Support (BLS) certification (First
year)
• ATLS or Equivalent certification.
• Mandatory workshops.

b. Year 2: Intermediate Clinical Skills and Subspecialty

Exposure
Enhanced clinical exposure and involvement in complex surgical
cases.
i. Theoretical Knowledge:
• Advanced pathophysiology of common surgical
diseases with up-to-date evidence-based justification of
the management of these diseases and perioperative
care.
• Basic interpretation of imaging and diagnostic
modalities (interpretation of hematological investigation,
X-ray, CT, MRI, ultrasound).
• Surgical ethics and medico-legal aspects.
ii. Clinical Rotations:
• Subspecialties: Orthopedics, Urology, Neurosurgery,
Plastic surgery, Pediatric surgery. ?Duration

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 • Subspecialties: Three (3) mandatory rotations of 02
months each in Orthopaedics, Urology and
Neurosurgery.
• Exposure to oncology and palliative care.
• Focus on elective and emergency surgeries
(appendectomy, hernia repair, etc.).
iii. Skills Development:
• First-assistant roles in major surgeries (e.g.,
cholecystectomy, bowel resections).
• Hands-on training in endoscopic and laparoscopic
procedures.
iv. Evidence Based Practice and Research
• Approved research proposal submission.
• Presentations at conferences and publication writing
skills.
• CPC Presentations.

c. Year 3: Advanced Surgical Skills and Independent Decision-

Making: Mastering advanced techniques and managing surgical
patients independently.
i. Theoretical Knowledge:
• Subspecialty-focused topics (vascular surgery, thoracic
surgery, pediatric surgery).
• Advanced critical care and organ transplantation basics.
(Liver and Kidney transplants).
• Evidence-based medicine and clinical trials.
ii. Clinical Rotations:
• Elective rotations in surgical oncology, Thoracic
surgery, and vascular surgery.
• Two (02) Elective rotations of 02 months each in any of
the following subspecialties: (Plastic surgery, Pediatric
surgery, Surgical oncology, Thoracic surgery, Vascular
surgery.
• Lead in managing ward patients and pre/post-operative
care.
• Participate in multidisciplinary team discussions.
iii. Skills Development:
• Perform common major surgeries under supervision
(e.g., colectomy, thyroidectomy).
• Advanced laparoscopic and robotic surgery training (if
available).
iv. Evidence based Practice and Research
• Regular audits of surgical cases for quality
improvement.
• Continue research activities with data analysis and
manuscript preparation.

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 d. Year 4: Leadership, Subspecialty Competence, and Research
Completion: Independent surgical practice, leadership, and finalizing
research projects.
i. Theoretical Knowledge:
• Revision of core surgical principles and subspecialty
content.
• Teaching methodologies and mentoring juniors.
• Updates in minimally invasive and robotic surgery.
ii. Senior resident responsibilities
• Managing surgical teams, conducting rounds, and
overseeing juniors.
• Skills development of junior colleagues and house
surgeons.
• Perform complex surgeries independently under
consultant supervision.
• Manage surgical emergencies and complications
confidently.
iii. Evidence based Practice and Research
• Presentation of research findings at national or
international conferences.
• Submission of research articles for degree
requirements.
• Teaching and mentoring junior residents and medical
students.

I. Teaching & Learning

The teaching and learning activities of the trainees in a clinical program is a
continuous process. The activities and techniques used during the training
period will ensure a structured plan where all trainees get equal opportunity
to learn from the faculty, staff and their peers. The guided training will
include:

• Morning Meetings: Focus on case discussions, recent admissions,

and complications.
• Ward Rounds: Led by consultants; include critical patient discussions
and teaching.
• Simulation Lab: Practice hands-on techniques like suturing,
laparoscopic skills, or simulation scenarios.
• Clinical-Pathological Conference: Regular Multidisciplinary
discussions on complex cases as per schedule.
• Journal Club: Critical appraisal of research articles.
• Morbidity and Mortality Meetings: The meetings are held to ensure
learning from all complications and trying to improve outcomes if the
same or similar scenario is encountered again.
• Innovation strategies: Use of OMP (One-Minute Preceptor) and
SNAPP (Summarize, Narrow, Analyze, Propose, Plan) to enhance
clinical teaching.

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 • Teaching Responsibilities: Residents shall contribute to clinical
teaching for junior residents, medical students and Allied health
professionals.
• Guest lectures.
• Sustainable Developmental Goals related activities: SDG related
hospital and community awareness activities.
• Workshops and conferences: Departmental, hospital and university
based workshops and conferences to be attended at least twice a
year.
• Development of departmental protocol: Trainees are the integral
part of the department and are involved in reviewing and updating the
departmental protocols in line with practice guidelines.

J. Assessment & Evaluation

This structured program ensures residents acquire the knowledge, skills, and
professionalism required to become competent, independent surgeons
ready to handle diverse clinical challenges. The assessment of the trainee is
performed throughout the training program that includes formative and
summative assessments. Assessment of training shall be a continuous
process throughout the training period and shall consist of Formative
assessments (Continuous internal assessment) and Summative
assessments after 02 years of the training (Intermediate examination) and at
the end of the training of 04 years (Final examination). The details of the
assessments is provided in the rules and regulations of MS/MD Programs.

a. Assessment Tools and Areas

Multiple tools shall be used for assessment for cognitive, psychomotor and
affective domain of trainee learning experiences. These include but are not
limited to:
o Multiple Choice Questions
o Reflective logs
o Mini-CEX (Mini Clinical Evaluation Exercise)
o DOPS (Direct Observation of Procedural Skills)
o CBD (Case-Based Discussion)
o PBA (Procedure Based Assessment)
o MSF (Multiscore Feedback)
o CPC Presentation Assessment
o Journal Club Presentation
o Self-Assessment by the student
o Punctuality
o Ward work
o Participation in interactive sessions
o Peer Assessment
o Department morning meeting Review
o Supervisors’ end of rotation report
o Supervisors’ Annual trainee assessment report

b. Continuous Trainee Assessment

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 Regular CBDs, DOPS, Mini-CEX, PBA, TOACS), and skill assessments,
Assessments of CPC and Journal club presentations and performance
evaluation in departmental meetings

c. Portfolio development
Each trainee shall develop a comprehensive portfolio recording all training
and learning activities and used to track the progress throughout the training
program. This will include detailed records of all training and procedures
performed (minor, major, and assisted) along with documentation of
reflective practice and feedback from supervisors using various assessment
tools including supervisors’ end of rotation report and supervisors’ annual
trainee assessment report related to all competencies.

d. Summative Assessment
This comprises of two examinations. (Detailed scheme is provided in the
regulations)
o Intermediate Examination: including Theory examination (MCQs),
Research proposal Evaluation, TOACS, CBD and Portfolio
Evaluation.
o Final Examination: Comprehensive examination, including Theory
examination (MCQs & SEQs), TOACS, Clinical Examination,
Evaluation of Research Publications and Portfolio, based on program
objectives.

e. Research and Publications

At least (02) research article published in a PM&DC/HEC approved Journals
by the end of the program. Publications in SCOPUS / WOS journals is
encouraged and will get extra credits.

K. Mandatory Workshops
Each candidate of MD/MS program would attend 04 mandatory workshops that
include:
1. Clinical Research
2. Proposal writing & Publishing
3. Ethics & Professionalism
4. Digital literacy

L. Mandatory Rotations
02 Mandatory rotations as below:
1. Accident & Emergency department (03 months)
2. SICU (03 months)

Mandatory rotations will be in the following specialties:

1. Orthopedic surgery (02 months)
2. Pediatric surgery (02 months)
3. Plastic surgery (02 months)
4. Neurosurgery (02 months)
5. Urology (02 months)

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03 Mandatory rotations in following sub-specialties:
1. Orthopaedics (02 months)
2. Urology (02 months)
3. Neurosurgery (02 months)

02 Elective rotations in any 02 of following sub-specialties:

1. Plastic surgery (02 months)
2. Pediatric surgery (02 months)
3. Surgical oncology (02 months)
4. Thoracic surgery (02 months)
5. Vascular surgery (02 months))

M. Research Experience
MS General surgery degrees shall be research-oriented degree and the trainee
shall be required to have published at least 02 research articles in PM&DC /
HEC approved journals based on approved research proposal of which at least
01 article must be original research publication. The active research component
program shall ensure meaningful, supervised research experience with
appropriate protected time for each resident while maintaining the essential
clinical experience. Research productivity by the program faculty and by the
residents will be required, including publications in PM&DC / HEC approved
Journals. Residents must learn the design and interpretation of research
studies, responsible use of informed consent, and research methodology, and
collection and interpretation of data, research ethics involving human subjects
and peer review process. The program shall provide instruction in the critical
assessment of new therapies and of the surgical literature. Trainees’ shall be
guided and supervised by the qualified staff members during the conduct of
research.

N. PORTFOLIO
The residents must maintain a portfolio and get it signed regularly by the
supervisor. A complete and duly certified portfolio should be part of the
requirement to sit for MS General surgery examination. Portfolio should include
the record of required assessments at the appropriate level of competence as
specified in the curriculum in addition to full log of training duly verified by the
supervisor as specified in the training program.

O. Clinical Competence Levels

Trainees are expected to reach a level of competence in different years of
training as specified in the training program. Trainees progress through different
stages of learning from observing initially to becoming independent performers.
The level of competency is graded as:

1. Observe
2. Assist
3. Perform under Direct Supervision

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 4. Perform Independently
5. Supervise others

P. FOUNDATIONAL COURSE OUTLINE

• Module 1: Applied Anatomy & Histology
o In-depth regional and applied anatomy of the thorax, abdomen, pelvis,
perineum, limbs, spine, head, and neck, including key gross relations
and surface anatomy essential for surgical access and procedures.
o Comprehensive knowledge of the human musculoskeletal system,
encompassing bones, joints, and major muscle groups.
o Applied histological characteristics of tissues and organ systems.
o Developmental anatomy and congenital abnormalities of:
▪ Cardiovascular system
▪ Respiratory system
▪ Gastrointestinal tract and abdominal wall
▪ Urogenital system
▪ Nervous system
▪ Musculoskeletal system
▪ Endocrine system
o Imaging anatomy

• Module 2: Applied Physiology & Critical Care

o Comprehensive knowledge of human physiology with normal
functioning and abnormal functioning of the different body system with
their impact on individual
o Metabolic response to trauma
o Pain management
o Fluid, electrolyte, and acid-base balance and disorders
o Shock, transfusion of blood and blood products, hemostasis
o Coagulation disorders and anticoagulation
o Nutrition
o Respiratory physiology, gas exchange, and arterial blood gases
o Cardiovascular physiology
o Blood and coagulation
o Gastrointestinal tract functions
o Hepatobiliary and pancreatic functions
o Endocrine system functions
o Urogenital tract and renal failure
o Growth and metabolism
o Nervous system
o Intensive and high dependency care units
o Critical care in the perioperative period
o Monitoring critically ill patients
o Supplemental oxygenation
o Ventilatory support
o Care of high-risk patients and patients with comorbidities
o Burns
o Trauma, including principles of damage control surgery

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 o Sepsis and systemic inflammatory response
o Immune system
o Multi-organ dysfunction and failure
o Dialysis
o Terminal care and brain death

• Module 3: Applied Biochemistry

o Will be having major focus on normal metabolic pathways and their
malfunction in different congenital and acquired condition
manifesting as metabolic diseases and their impact on human being
o Membrane biochemistry
o Tissue metabolism
o Gene expression and protein synthesis
o Enzymes and biological catalysis
o Bioenergetics and ATP generation
o Carbohydrate metabolism
o Lipid metabolism
o Nitrogen metabolism
o Biotechnology and molecular biology, emphasizing recombinant DNA
techniques in medicine and cancer molecular biology

• Module 4: Applied Pharmacology

o Mechanisms of drug action
o Pharmacokinetics and pharmacodynamics of key drugs
o Drug use in special circumstances
o Drugs used in anesthesia
o Analgesics
o Antibiotics
o Diuretics
o Anticoagulants
o Chemotherapeutic agents
o Drugs for common respiratory, cardiovascular, nervous,
gastrointestinal, endocrine, urogenital, blood, and immunological
disorders in surgical patient management

• Module 5: Applied General & Systemic Pathology

o General pathological principles
▪ Inflammation
▪ Wound healing and specialized tissue healing
▪ Cellular injury and tissue death, including necrosis, apoptosis,
gangrene, and infarction
o Vascular disorders
o Disorders of growth, differentiation, and morphogenesis
o Immunology
o Hematology
o Principles of neoplasia and oncology:
▪ Tumor classification
▪ Tumor development and metastasis
▪ Cancer staging and grading

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 ▪ Cancer therapies (surgery, radiotherapy, chemotherapy,
immunotherapy, hormone therapy)
▪ Cancer registration
▪ Cancer screening
o Pathology of organ systems relevant to surgical care:
▪ Cardiovascular, respiratory, gastrointestinal, genitourinary,
central and peripheral nervous, skin, lympho-reticular, and
musculoskeletal systems
o Pathology of the breast, endocrine, and exocrine glands
o Transplantation (Kidney, Liver)
o Biopsy specimen handling
o Microbiology in surgical practice:
o Surgically important microorganisms
o Soft tissue infections (cellulitis, abscesses, necrotizing fasciitis)
o Gangrene
o Infection sources
o Sepsis and septic shock
o Asepsis and antisepsis
o Disinfection and sterilization principles
o Antibiotic prophylaxis and resistance
o High-risk patient management
o Hospital-acquired infections

• Module 6: Imaging
o Core knowledge of diagnostic and interventional imaging in surgical
disorders
o Diagnostic and interventional imaging techniques
o Basic interpretation of X-rays, ultrasound, contrast imaging, CT, MRI,
PET, and radionuclide scanning

• Module 7: Biostatistics & Research Methodology

o Introduction to biostatistics and research
o Statistics and computing in research
o Principles of research design and clinical trial analysis
o Criteria for quality research
o Ethics in health research
o Scientific paper writing
o Critical appraisal of research
o Use of SPSS in research
o Plagiarism

• Module 8: Behavioral Sciences/Ethics/Professionalism/Attitudes

o Models of healthcare
o Communication skills
o Interdisciplinary and multidisciplinary management
o Leadership and team management
o Counseling
o Informed consent
o High-risk consent
o Information exchange

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 o Breaking bad news
o Crisis and disaster management
o Conflict resolution
o Conflict of interest
o Medical ethics, professionalism, and doctor-patient relationships
o Psychological aspects
o Ethical and legal obligations
o Teaching and training principles
o Keeping up-to-date with evidence-based information
o Managing people and resources in healthcare
o Promoting good health and community-based surgical practice
o Hippocratic Oath
o Medico-legal aspects in surgery
o Surgical outcomes
o Evaluation and critical appraisal of surgical research
o Multidisciplinary team approach
o Decision-making in surgery
o Clinical audit
o Evaluation of technical and pharmaceutical innovations
o Health service management and economic aspects of surgical care

• Module 9: Basic Principles of General Surgery

o History of surgery
o Preoperative patient preparation
o Principles of operative surgery
o Asepsis, sterilization, and antiseptics
o Surgical infections and antibiotic usage
o Fundamentals of anesthesia and pain Management
o Acute Life Support and critical care
o Pathophysiology and management of shock
o Fluid and electrolyte balance, acid-base metabolism
o Hemostasis and blood transfusion
o Trauma assessment, poly-trauma, triage, basic and advanced trauma
management
o Accident and emergency surgery
o Wound healing and management
o Nutrition and metabolism
o Burn management principles
o Principles of surgical oncology
o Laparoscopy and endoscopy fundamentals
o Organ transplantation
o Informed consent and medico-legal issues
o Molecular biology and genetics
o Common surgical procedures
o Management of cysts, sinuses, fistulae, abscesses, nodules
o Basic plastic and reconstructive surgery
o Principles of diagnostic and interventional radiography
o Interpretation of conventional and advanced radiographic procedures

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Q. CLINICAL COURSE OUTLINE
1. COMMON SURGICAL SKILLS
o Incision of Skin and Subcutaneous Tissue
▪ Understanding Langer’s lines
▪ Mechanisms of healing
▪ Appropriate choice of instruments
▪ Ensuring safe surgical practice
o Closure of Skin and Subcutaneous Tissue
▪ Various closure options
▪ Selection of sutures and needles
▪ Ensuring safe and effective practice
o Knot Tying Techniques
▪ Selection of suitable materials
▪ Single-handed and double-handed techniques
▪ Superficial and deep knot tying
o Tissue Retraction
▪ Choosing appropriate instruments
▪ Placement of wound retractors
▪ Correct use of self-retaining retractors
▪ Utilization of tissue forceps
o Use of Drains
▪ Indications for use
▪ Types of drains
▪ Techniques for insertion, fixation, and management/removal
o Incision Techniques
▪ Proficiency in using scalpels, diathermy, and scissors
o Wound Closure Techniques
▪ Ensuring accurate and tension-free apposition of wound edges
o Hemostasis
▪ Techniques to control superficial bleeding vessels
▪ Use of hemostatic agents
o Preoperative Assessment and Management
▪ Risk assessment and stratification of co-morbidities
▪ Pathophysiology of blood loss and sepsis
▪ Identifying surgical risk factors
▪ Principles of day surgery and comorbidity management
o Intraoperative Care
▪ Ensuring safety in the operating theatre
▪ Sharps safety and proper use of diathermy and lasers
▪ Managing infection and radiation risks
▪ Needle prick injury protocols
▪ Proper use of tourniquets
▪ Principles of local, regional, and general anesthesia
o Postoperative Care
▪ Monitoring postoperative patients
▪ Management of postoperative analgesia and fluid/electrolyte
balance
▪ ABG’s interpretation and management
▪ Early detection and management of organ failure

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 ▪ Addressing operation-specific complications
▪ Critical care principles
o Blood Products Management
▪ Understanding components of blood and alternatives
▪ Managing complications of blood product transfusion, especially
in children
▪ Safe blood transfusion
▪ Massive blood transfusion protocol.
o Antibiotic Management
▪ Identifying common pathogens in surgical patients
▪ Understanding antibiotic sensitivities and side-effects
▪ Principles of prophylaxis and treatment
▪ SSI’s types, detection, management and prevention.
▪ Sepsis – SIRS
▪ Nosocomial infection
o Assessment of Multiply Injured Patients
▪ Conducting comprehensive history and examination
▪ Appropriate investigations
▪ Resuscitation and early management
▪ Referring to relevant surgical subspecialties
o Technical Skills
▪ Central venous line insertion
▪ Chest drain insertion
▪ Diagnostic peritoneal lavage
o Management of Bleeding Diathesis
▪ Corrective measures such as warming and packing
▪ Understanding the clotting mechanism
▪ Interpretation of clotting profile
▪ Investigating thrombophilia and coagulation disorders
▪ Managing thromboembolic diseases
▪ Anticoagulation therapies including heparin and warfarin
▪ Role of V/Q scanning, CT angiography, and thrombolysis
▪ Pulmonary embolectomy awareness
▪ Recognizing symptoms and signs of pulmonary embolism and
DVT
▪ Utilizing duplex scanning, venography, and d-dimer measurement
▪ Initiating and monitoring treatment

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2. Surgical Management of Common Congenital and Acquired Surgical
Conditions
o Understand relevant basic scientific principles for surgical conditions
o Conduct thorough history taking and physical examinations for
elective, emergency, and trauma patients
o Identify surgical disorders and formulate differential diagnoses
o Suggest appropriate investigations to confirm diagnoses
o Propose relevant perioperative clinical care plans
o Make decisions for curative or palliative surgical care
o Provide appropriate surgical or palliative care
o Identify and manage complications
o Formulate follow-up plans
o Make end-of-life decisions and understand brain death and organ
donation.
o Suggest screening and prevention measures
3. Gastrointestinal Diseases
o Abdominal wall hernia
o Peritoneal and mesenteric disorders
o Perianal and rectal diseases
o Acute abdominal emergencies (adhesions, peritonitis, perforation)
o Benign and malignant diseases of the esophagus, stomach,
intestines, liver, gall bladder, pancreas, and spleen
o Stomas
o Acute gynecological pathologies
4. Breast Diseases:
o Benign and malignant breast disorders, including male breast
conditions
5. Vascular Diseases:
o Common congenital anomalies
o Intermittent claudication, ischemic rest pain, gangrene, and ischemic
ulceration
o Acute limb ischemia (embolism, thrombosis)
o Leg ulceration, venous thromboembolism, varicose veins, swollen leg
o Pulsatile abdominal mass
o Transient ischemic attacks and stroke
o Atherosclerotic arterial disease, embolic and thrombotic arterial
occlusion
o Diseases of veins and lymphatics, lymphedema
o Vascular and neuropathic consequences of diabetes
o Abdominal and peripheral arterial aneurysms
o Amputations and rehabilitation
6. Cardiovascular and Pulmonary Diseases:
o Benign and malignant lung diseases, obstructive and restrictive lung
diseases, respiratory infections, lung neoplasms, pleural diseases
o Cardiovascular conditions: cardiac trauma, tamponade, valvular heart
diseases, coronary artery bypass graft complications, vascular grafts
7. Genitourinary Diseases (Males and Females):
o Benign and malignant disorders of the kidneys, ureters, bladder,
prostate, seminal vesicles, scrotum, testis, urethra, and penis

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 o Acute and chronic gynecological conditions relevant to general
surgery
o Urinary diversions
o Renal transplantation
8. Skin Diseases:
o Benign and malignant conditions of the skin and associated glands
o Burns
9. Diseases of the Head and Neck:
o Benign and malignant conditions
o Congenital anomalies
o Maxillofacial conditions
o Oral cavity disorders
o Pharynx and larynx disorders
o Tongue disorders
o Salivary gland disorders
o Neurovascular disorders
o Head and neck trauma
o Neurovascular tumors
10. Neurology and Neurosurgery:
o Common congenital anomalies
o Space-occupying lesions
o Cranial and peripheral nerve palsies
o Cerebral abscess
o Meningitis
o Brain death
11. Endocrine Diseases:
o Common congenital anomalies
o Multiple endocrine neoplasia
o Thyroid and parathyroid disorders
o Adrenal gland diseases
o Abdominal endocrine disorders
o Diabetes
o Morbid obesity and bariatric surgery
o Endocrine crises
12. Diseases of the Lympho-Reticular System:
o Acute and chronic inflammatory conditions
o Lymphadenopathy
o Benign and malignant lympho-reticular conditions
o Lymphedema
o Immunosuppression
13. Trauma and Orthopedics:
o Basic and Advanced Trauma Life Support
o Compartment syndrome
o Gunshot and blast injuries
o Damage control surgery
o Torso trauma
o Disaster management
o Congenital bone and joint anomalies
o Degenerative and inflammatory joint diseases
o Fracture and dislocation management

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 o Pelvic fractures
o Bone and joint infections
o Spinal conditions
o Metastatic bone cancer
o Metabolic bone diseases
o Peripheral neuropathies
o Diabetic foot
o Amputations and rehabilitation
o Sports injuries
o Pediatric and geriatric trauma
o Trauma in pregnancy

R. Procedural Skills
The following list, while not exhaustive, represents a minimal set of desirable
procedures the trainee is expected to perform. Trainees should aim for maximal
operative exposure, depending on the surgeries performed in their units. The
Objectives in all cases are:
o Evaluate and manage trauma and acute surgical emergencies
o Undertake critical care
o Apply principles of general surgical procedures and techniques
o Perform minor operative procedures
o Perform common major general surgical operations independently
o Identify intraoperative and postoperative complications
o Manage intraoperative and postoperative complications
o Provide appropriate care of wounds
o Provide appropriate care of surgical drains and tubes

1. Critical Care
o Vascular access
o Central venous catheterization and central venous pressure
monitoring
o Catheterization of the radial and femoral artery
o Endotracheal intubation
o Tracheostomy, Cricothyroidotomy
o Real-time ultrasound technique for vascular localization
o Administration of oxygen and related devices
o Airway management
o Arterial blood gas analysis and correction of acid-base abnormalities
o Peripheral and total parenteral nutrition
o Ventilatory support – principles, techniques, pitfalls
o Image-guided procedures of surgical relevance
o Thoracentesis
o Paracentesis
o Pericardiocentesis
o Nasogastric tube placement
o Urinary catheterization
o Suprapubic cystostomy
o Critical care for acute renal failure
o Patient-controlled analgesia and epidural analgesia

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 o Measurement of compartment pressures (abdomen, extremity)
o Defibrillation and cardioversion

2. Emergency Room Procedures

o Tetanus prophylaxis
o Focused Assessment Sonography in Trauma (FAST) and Extended
FAST
o Diagnostic peritoneal lavage
o Suturing of lacerations
o Drainage of abscesses
o Wound debridement and excision
o Reduction and plaster application for simple fractures and
dislocations
o Anal dilatation and sphincterotomy
o Phimosis and paraphimosis

3. Minor Surgical Procedures

o Biopsies
o Excision of swellings
o Excision of sinuses and fistulas
o Day case surgical procedures
o Circumcision
o Ingrown toenail management
o Proctosigmoidoscopy
o Hemorrhoidal injection sclerotherapy and band ligation
o Vasectomy

4. Major Surgical Procedures:

o Open and laparoscopic laparotomy
o Open and laparoscopic cholecystectomy
o Common bile duct exploration
o Biliary-enteric bypass and drainage
o Excision of liver cysts
o Management of metastatic liver disease
o Liver resections
o Splenectomy and splenic preservation
o Pancreatic cystogastrostomy
o Pancreatic resections
o Abdominal wall and groin hernia repair
o Oesophagectomy
o Procedures for oesophageal motility disorders
o Gastrectomy
o Gastroenterostomy
o Esophagogastric de-vascularization
o Portosystemic shunts
o Segmental resection and anastomosis of the bowel
o Intestinal stricturoplasty
o Enterocutaneous fistulas
o Meckel’s diverticulectomy
o Laparotomy for obscure gastrointestinal bleeding

P a g e 20 | 43
 o Hemicolectomy
o Subtotal and total colectomy
o Proctocolectomy
o Hartman's procedure
o Anterior resection
o Abdominoperineal resection
o Panproctocolectomy
o Rectal pouches
o Stomas and reversal of stomas
o Rectal prolapse
o Rectal polyps
o Anal sphincterotomy
o Fistulectomy
o Hemorrhoidectomy
o Rectovesical and rectovaginal fistula repair
o Procedures for pilonidal sinus
o Endoscopy
o Mastectomy
o Axillary sampling and clearance
o Breast lump excision, microdochectomy, major duct excision (cone
excision)
o Thyroidectomy (subtotal, near-total, and total)
o Parathyroid exploration
o Neck lymph node dissection (radical, selective, regional)
o Adrenalectomy
o Excision of parotid and submandibular glands
o Excision of benign and malignant skin lesions
o Block dissection of groin nodes
o Procedures for peritoneal metastases (cytoreduction, HIPEC)

5. Emergency Surgery:
o Trauma laparotomy and damage control surgery
o Exploratory laparotomy
o Management and repair of oesophageal perforation
o Laparotomy for intestinal obstruction
o Laparotomy for intestinal perforation
o Pancreatic necrosectomy
o Splenectomy and splenic preservation
o Liver repair and resections
o Closure of peptic ulcer perforation
o Management of bleeding peptic ulcer
o Typhoid enteric perforation
o Resection and anastomosis of the bowel
o Management of obstructed and strangulated hernias
o Appendectomy
o Management of appendicular mass and abscess
o Amputations
o Embolectomy
o Vascular repair
o Nerve and tendon repair

P a g e 21 | 43
 o Trauma thoracotomy
o Emergency laparotomy in pediatric abdominal emergencies
o Emergency laparotomy in gynecological emergencies

6. Subspecialties
• Orthopaedics and Trauma:
o Reduction and splinting of common long bone fractures
o Reduction of major joint dislocations
o Plaster and splinting techniques
o Management of compartment syndrome
o Fasciotomy
o Pelvic fractures
o Spinal trauma
• Neurosurgery:
o Monitoring of intracranial pressure
o Care of scalp wounds – sutures and dressings
o Management of depressed skull fractures
o Intracranial hematoma management
o Ventriculoperitoneal shunts
• Urology & Transplantation:
o Circumcision
o Management of phimosis and paraphimosis
o Perirenal abscess management
o Pyelolithotomy
o Nephrectomy
o Ureterolithotomy
o Cystolithotomy
o Ureteric and vesical repair
o Prostatectomy
o Transurethral resection of the prostate
o Procedures for hydrocele
o Procedures for varicocele
o Testicular biopsy
o Scrotal exploration for testicular torsion
o Orchidopexy
o Orchidectomy
o Suprapubic cystostomy
o Urethral repair
o Excision and related procedures for Fournier gangrene
o Peritoneal dialysis
o Transplant surgery
• Pediatric Surgery:
o Abdominal access techniques
o Emergency laparotomy
o Vascular access in pediatric patients
o Cleft lip and palate repair
o Intussusception management
o Management of congenital hypertrophic pyloric stenosis
o Inguinal herniotomy
o Abdominal wall hernia repair

P a g e 22 | 43
 o Repair of obstructed and strangulated abdominal wall and groin
hernias
o Orchidopexy
o Management of cystic hygroma
o Hemangioma treatment
o Pediatric intestinal obstruction management
o Treatment of imperforate anus
o Rectal prolapse management
o Rectal polyp management
• Cardiovascular Surgery:
o Vascular access and exposure techniques
o Vascular repairs and grafts
o Management of vascular aneurysms
o Vascular access for dialysis
o Treatment of varicose veins
o Management of arteriovenous malformations
o Arteriovenous fistula creation and repair
o Pericardiocentesis
o Median sternotomy
o Principles of coronary artery bypass graft (CABG)
o Principles of valvular heart repair
• Plastic Surgery:
o Excision and reconstruction of benign and malignant skin lesions
o Split and full-thickness skin grafting
o Common skin flap procedures
o Release of contractures
o Cosmetic and reconstructive plastic surgical procedures
o Tissue expansion techniques
o Breast oncoplastic procedures
o Breast reconstruction procedures
o Reduction and augmentation mammoplasty
• Thoracic Surgery:
o Elective and emergency thoracotomy
o Thoracostomy and chest tube management
o Lung resections
o Management of empyema thoracis
o Decortication procedures
o Diaphragm repair
o Diaphragmatic hernia repair

P a g e 23 | 43
 S. Core Surgical Skills and their level of competence across
four years with assessment tools

SKILLS 1ST YEAR 2ND Year 3RD YEAR 4TH YEAR Assessment
Tool
Level of Level of Level of Level of
Competency Competency Competency Competency
PATIENT MANAGEMENT
Eliciting pertinent history Mini-CEX
3 4 4 5
/CBD
Performing physical Mini-CEX
3 4 4 5
examination /CBD
Ordering appropriate
Mini-CEX
investigations an 3 4 4 4
/CBD
interpretation
Assessing for fitness to Mini-CEX
3 4 4 4
undergo surgery /CBD
Deciding and
Mini-CEX
implementing appropriate 3 3 4 4
/CBD
treatment
Pre-op, intra-op care Mini-CEX /
3 3 4 4
PBA
Post-op management Mini-CEX /
3 4 4 4
and monitoring PBA
ABG’s analysis and
3 4 4 5 Mini-CEX
management
Nutritional assessment
3 4 4 5 Mini-CEX
and management
Maintain accurate and Mini-CEX
3 4 4 5
appropriate records /CBD
Fluid and electrolyte Mini-CEX
imbalance and 3 4 4 5 /CBD
management
Presentation skills: long Mini-CEX
3 4 4 4
case /CBD
Presentation skills: short Mini-CEX
3 4 4 4
case /CBD
PREPARATION FOR SURGERY
Pre-op preparation of
various surgical
procedures, Aseptic Mini-CEX /
3 4 4 4
techniques, Positioning of PBA /CBD
the patient for diagnostic
and operative procedures
Handling of common
surgical/endoscopic 2 3 4 4 DOPS/PBA
instruments

P a g e 24 | 43
Usage of different suture
materials/stapling 2 3 4 4 DOPS/PBA
devises and techniques
SURGICAL PROCEDURES AND MANAGEMENT
Airway maintenance and
ETT intubation, use of
2 3 4 4 DOPS
ventilator, monitoring
devises
Management of head Mini-CEX /
2 3 4 4
trauma CBD
Burn management 2 3 4 4 DOPS
Controlling of
2 3 4 4 DOPS
hemorrhage
Trauma management Course
2 3 4 4
ATLS/ACLS Certificate
BLS, CPR, care of Course
3 4 4 5
unconscious patient Certificate
IPPR and other methods
2 3 3 4 DOPS
of artificial respiration
Wound healing and peri-
2 3 3 4 DOPS
op complications
Stoma care 2 3 4 5 DOPS
Appropriate use of
2 3 3 4 Mini-CEX
ionotropic agents
Debridement, wound
excision, closure/suture 2 3 4 5 DOPS
of wound
Application of splints,
2 4 4 4 DOPS
POP casts, skin traction
Urethral catherization
4 4 4 5 DOPS
and removal
OG, NG tube, drain
4 4 4 4 DOPS
placement and removal
I&D of abscesses
(excluding deep seated 2 3 4 4 DOPS
abscess)
Tendon Repair 1 2 3 4 DOPS/PBA
Nerve repair 1 2 3 4 DOPS/PBA
Muscle repair 1 2 3 4 DOPS/PBA
Correct use of self-
2 3 4 4 DOPS/PBA
retaining retractors
Lumber puncture 3 4 4 4 DOPS/PBA
Excision of soft tissues
tumors and cysts, IGTN 3 3 4 4 DOPS/PBA
(surface surgery)

P a g e 25 | 43
Excision biopsy of skin
2 3 4 4 DOPS/PBA
lesions
Placement of CVP 2 3 4 4 DOPS/PBA
Circumcision 2 3 3 4 DOPS/PBA
Skin Grafting 1 2 3 3 DOPS/PBA
Tissue Flaps 1 2 3 3 DOPS/PBA
Percutaneous needle
aspiration under USG 1 2 3 3 DOPS/PBA
guidance/CT
Bladder Repair 1 2 3 4 DOPS/PBA
Sub-platysmal flap raise 2 3 4 4 DOPS/PBA
MRM flap raise 2 3 4 4 DOPS/PBA
Excision of
Subcutaneous lumps and 2 3 3 4 DOPS/PBA
swellings
Biopsy of skin lesions
2 3 3 4 DOPS/PBA
and lymph nodes
ABDOMINAL SURGERY
Hiatal hernia repair 1 2 2 3 DOPS/PBA
Ventral Hernia repair 2 3 3 4 DOPS/PBA
Inguinal Hernia repair 2 3 3 4 DOPS/PBA
Femoral Hernia repair 1 2 3 3 DOPS/PBA
Opening and closing of
2 3 4 4 DOPS/PBA
abdomen
Hemorrhoidectomy,
2 2 3 4 DOPS/PBA
rectal polyp excision
LIS 2 2 3 4 DOPS/PBA
Fistulectomy/seton
2 2 3 4 DOPS/PBA
placement
Ischiorectal abscess and
other perianal abscess 2 3 3 4 DOPS/PBA
I&D
Rectopexy 1 2 2 3 DOPS/PBA
Pilonidal sinus surgery 1 2 3 4 DOPS/PBA
Laparoscopic surgery 1 2 3 4 DOPS/PBA
Liver resection (Trauma,
Liver abscess, Hydatid 1 2 2 3 DOPS/PBA
cyst, pyogenic abscess)

P a g e 26 | 43
Other Hepatobiliary
1 2 3 3 DOPS/PBA
surgeries
Pancreaticoduodenectom
y, pancreatojejunostomy,
1 1 1 2 DOPS/PBA
Pancreatectomy,
necrosectomy
Splenectomy (elective
open, laparoscopic) + (in 1 2 2 3 DOPS/PBA
trauma)
Adrenalectomy 1 2 2 3 DOPS/PBA
Proctoscopy and its
1 3 4 5 DOPS/PBA
interpretations
Colonoscopy 1 2 3 3 DOPS/PBA
Gastroscopy 1 2 3 3 DOPS/PBA
Proctosigmoidoscopy 1 2 3 3 DOPS/PBA
Open Appendectomy 1 3 4 4 DOPS/PBA
Open Cholecystectomy 1 2 3 4 DOPS/PBA
CBD exploration and
1 2 2 3 DOPS/PBA
repair
Hepaticojejunostomy,
choledochoduodenostom 1 2 2 3 DOPS/PBA
y
Choledochal cyst
excision and 1 2 2 3 DOPS/PBA
reconstruction
Gastrojejunostomy 1 2 3 4 DOPS/PBA
Gastrectomy 1 2 3 4 DOPS/PBA
Tube gastrostomy 1 2 3 4 DOPS/PBA
Feeding jejunostomy 1 2 3 4 DOPS/PBA
Hartman’s Procedure 1 2 3 4 DOPS/PBA
Stoma Formation 1 2 3 4 DOPS/PBA
Reversal of stomas 1 2 3 4 DOPS/PBA
Radical colonic
1 2 2 3 DOPS/PBA
resections
Total
1 2 2 3 DOPS/PBA
colectomy/Proctectomy
Radical rectal resection 1 2 2 3 DOPS/PBA
Gastrectomy 1 2 2 3 DOPS/PBA
Primary repair of Gut
1 2 3 4 DOPS/PBA
perforations
Esophagectomy 1 2 3 2 DOPS/PBA

P a g e 27 | 43
Intestinal Resection and
1 2 3 4 DOPS/PBA
Anastomosis
Exploratory Laparotomy 1 2 3 4 DOPS/PBA
Fundamentals of
laparoscopic surgery,
2 3 3 4 DOPS/PBA
Principles and instrument
handling
Diagnostic Laparoscopy
2 3 3 4 DOPS/PBA
and biopsy
Use of stapling guns 1 2 3 4 DOPS/PBA
Surgery on scrotum and
2 2 3 4 DOPS/PBA
testes
Orchidopexy,
2 2 3 4 DOPS/PBA
orchidectomy
Hydrocoele repair 2 2 3 4 DOPS/PBA
Laparoscopic
1 2 3 4 DOPS/PBA
Cholecystectomy
Laparoscopic Hernia
1 2 2 4 DOPS/PBA
Repair
Laparoscopic
1 2 3 4 DOPS/PBA
Appendectomy
Debridement of different
2 3 4 4 DOPS/PBA
wounds
Amputations of upper
1 2 3 4 DOPS/PBA
limb and lower limb

P a g e 28 | 43
 THORACIC SURGERY
Chest tube insertion 2 2 3 4 DOPS/PBA
Intercostal Needle
2 2 3 4 DOPS/PBA
aspiration
Pleurectomy 1 1 1 2 DOPS/PBA
Bronchoscopy,
1 2 2 2 DOPS/PBA
Mediastinoscopy, VATS
Sternotomy, Elective
1 2 2 3 DOPS/PBA
Thoracotomy
Emergency Thoracotomy 1 2 2 3 DOPS/PBA
Rib Resection 1 2 2 3 DOPS/PBA
Diaphragmatic laceration
1 2 2 3 DOPS/PBA
and rupture repair
Lung laceration and
1 2 2 3 DOPS/PBA
rupture repair
Esophageal rupture and
1 1 2 2 DOPS/PBA
perforation repair
Anti-reflux surgery 1 1 2 2 DOPS/PBA

HEAD AND NECK AND TORSO SURGERY

Positioning for different
3 4 4 5 DOPS/PBA
procedures
Excision biopsy of breast
2 3 4 4 DOPS/PBA
lump
MRM with axillary
1 2 3 3 DOPS/PBA
dissection
Excision of fibroadenoma 2 3 4 4 DOPS/PBA
Mastectomy 1 2 3 4 DOPS/PBA
lumpectomy 2 3 3 4 DOPS/PBA
I & D of breast abscesses 2 3 4 5 DOPS/PBA
Microdochectomy 2 2 3 4 DOPS/PBA
Hadfield Operation 2 2 3 4 DOPS/PBA
Tru-cut biopsy and FNAC 2 3 4 5 DOPS
Management of neck
1 2 3 3 DOPS
Trauma
Interpretations of scans,
Mini-CEX,
labs and basic 3 4 4 4
DOPS
management

Page 29 of 43
Excision biopsy of
2 3 3 4 DOPS/PBA
cervical lymph nodes
Thyroidectomy 1 2 3 4 DOPS/PBA
Parathyroidectomy 1 2 3 3 DOPS/PBA
Radical neck dissection 1 1 3 3 DOPS/PBA
Sistrunk Procedure 1 2 3 3 DOPS/PBA
Superficial and total
1 2 3 3 DOPS/PBA
Parotidectomy
Submandibular gland
1 2 3 4 DOPS/PBA
excision
Tracheostomy 1 2 3 4 DOPS/PBA
Excision of Branchial
1 2 3 3 DOPS/PBA
cysts and fistula
Drainage of cervical
1 2 3 4 DOPS/PBA
abscess
Esophagectomy 1 1 3 2 DOPS/PBA
Soft tissue surgeries on
1 2 3 4 DOPS/PBA
face
Cricothyrotomy 1 2 3 4 DOPS/PBA
GYNAECOLOGY & OBSTETRICS SURGERY
Anterior perineal surgery 1 2 3 4 DOPS/PBA
Salpingo-oopherectomy 1 2 3 3 DOPS/PBA
Hysterectomy 1 2 3 3 DOPS/PBA
VASCULAR SURGERY
Surgery for varicose
2 2 3 4 DOPS/PBA
veins
Controlling of
Hemorrhage, principle of
2 3 4 4 DOPS
thromboprophylaxis,
management of DVT
Endarterectomy 1 1 2 3 DOPS/PBA
Embolectomy 1 2 3 4 DOPS/PBA
Vascular Repair 1 2 3 3 DOPS/PBA
Vascular Anastomosis 1 2 3 3 DOPS/PBA
vascular reconstruction 1 2 3 3 DOPS/PBA
endovascular intervention 1 1 2 2 DOPS/PBA
Aneurysm repair 1 1 2 2 DOPS/PBA

Page 30 of 43
Saphenofemoral junction
ligation, Stripping the long 1 2 3 4 DOPS/PBA
saphenous vein,
ANAESTHESIA
Local anesthesia
4 4 4 5 DOPS
Spinal and epidural
1 2 3 4 DOPS
anesthesia
Principles of
2 3 4 4 Mini-CEX
GA/anesthetic machines
Management of pain 3 4 4 5 DOPS
Anesthetic agents and Mini-CEX
1 2 2 3
Muscle relaxants /DOPS
Pre-anesthesia Mini-CEX
1 2 4 4
assessment /DOPS

Page 31 of 43
 T. ROTATION-WISE COMPETENCIES

SKILLS Competency Assessment

Level Tool
ORTHOPAEDICS SURGERY
History and physical examination and appropriate Mini-CEX
4
management /CBD
Ordering appropriate investigations and Mini-CEX
3
interpretation /CBD
Pre-op, intra-op, post-op care Mini-CEX
3
/CBD
Manipulation of fractures 3 DOPS
Application of POP casts, splints, backslap 4 DOPS
Tendon repair 3 DOPS
Muscle repair 3 DOPS
Nerve repair 3 DOPS
Ligament repair 3 DOPS
Intra-lesional steroid injection 3 DOPS
Aspiration of any joint fluid 3 DOPS
Management of nerve compression/entrapment,
3 DOPS
compartment syndrome
Bone debridement, sequestration, saucerization 3 DOPS/PBA
Arthroscopy 2 DOPS/PBA
Arthrotomies, Knee replacement 2 DOPS/PBA
Fracture fixation 2 DOPS/PBA

PLASTIC SURGERY
History and physical examination and appropriate Mini-
4
management CEX/CBD
Ordering appropriate investigations and Mini-
4
interpretation CEX/CBD
Pre-op, intra-op, post-op care Mini-
4
CEX/CBD
Keloid excision 4 DOPS/PBA
Basic Stitching skills 4 DOPS
Cyst, Lipoma, Papilloma excision, non-healing
3 DOPS/PBA
ulcers on face
Cyst, Lipoma, Papilloma excision, non-healing
4 DOPS/PBA
ulcers on other body parts

Page 32 of 43
Tendon, muscle, ligament repair 3 DOPS/PBA
Skin grafting 2 DOPS/PBA
Flaps (local, pedicle, pectoralis major,
2 DOPS/PBA
cervicofacial)
Septorhinoplasty, Blepharoplasty, Otoplasty, face
lift, breast augmentation & reduction, 2 DOPS/PBA
Abdominoplasty, Hypospadias
Vascular And nerve repair 2 DOPS/PBA
Burn Management 3 DOPS
Excision/grafting for burn 2 DOPS/PBA
Contracture release 2 DOPS/PBA
Amputation 3 DOPS/PBA
Syndactyl release and skin grafting 3 DOPS/PBA
Peri-anal and sphincter repair 2 DOPS/PBA
Basic dressing 4 DOPS
Advance dressing 3 DOPS
UROLOGY
History and physical examination and appropriate Mini-CEX
4
management /CBD
Ordering appropriate investigations, Mini-CEX
4
interpretation and making diagnosis /CBD
Pre-op, intra-op, post-op care Mini-CEX
4
/CBD
Urethral catheterization 4 DOPS
Urethral dilation 3 DOPS
Circumcision 3 DOPS/PBA
Suprapubic puncture 3 DOPS
Nephrectomy, Cystectomy, Prostectomy, scrotal
exploration, Vesicolithotomy, Bladder Repair,
2 DOPS/PBA
Surgery on scrotum and testes, Urethroplasty,
ureter repair, orchidectomy, orchidopexy
NEUROSURGERY
History and physical examination and appropriate Mini-CEX
4
management /CBD
Ordering appropriate investigations and Mini-CEX
4
interpretation /CBD
Pre-op, intra-op, post-op care Mini-CEX
4
/CBD

Page 33 of 43
Aseptic techniques Mini-CEX
4
/CBD
Positioning of the patient for different surgical
4 DOPS
procedures
To learn the surface anatomy of brain areas and Mini-CEX
4
brain ventricular systems /CBD
To understand the brain major venous and Mini-CEX
4
arterial structure /CBD
To learn dermatomal and myotome and visceral Mini-CEX
4
neuronal segments /CBD
To know the significance of microorganisms in Mini-CEX
4
causing infection in neurosurgical patients /CBD
The neurosurgical patients care, pre-operative,
Mini-CEX
operative, and post-operative, care of 4
/CBD
unconscious patient
Understanding the indications of laboratory and Mini-CEX
4
imaging in neurosurgery cases /CBD
Rehabilitation follow up of neurosurgery cases Mini-CEX/
4
CBD
Simulation surgery practice before real
4 DOPS
neurosurgery operation
understanding the current available neurosurgery Mini-CEX
4
instruments /CBD
understanding the current available neurosurgery Mini-CEX
4
medication /CBD
Minor head injuries requiring surgery 3 DOPS/PBA

PEDIATRIC SURGERY
History and physical, surgical examination and Mini-CEX
4
appropriate management /CBD
Ordering appropriate investigations and Mini-CEX
4
interpretation /CBD
Pre-op, intra-op, post-op care Mini-CEX
4
/CBD
Pediatric doses Mini-CEX
4
/CBD
Suturing 4 DOPS
Dressing of infected wound 4 DOPS
Manually reducing a Hernia 4 DOPS
Herniotomy, orchidopexy 2 DOPS/PBA
Circumcision 3 DOPS/PBA
Managing circumcision bleed 3 DOPS
Examining hypospadias Mini-CEX
3
/CBD
How to investigate intestinal obstruction 4 DOPS

Page 34 of 43
Abscess incision & drainage 3 DOPS/PBA
Cervical Lymph node biopsy 2 DOPS/PBA
Tongue tie(ankyloglossia) 2 DOPS/PBA
Orchidopexy 2 DOPS/PBA
Passing chest tube 2 DOPS
Closing abdomen after laparotomy 3 DOPS/PBA
Neonatal investigation for intestinal obstruction 4 DOPS/PBA
Neonatal Laparotomy 2 DOPS/PBA

U. Assessment Blueprint for Summative Examination

1. Assessment
1.1. Continuous Trainee Assessment (CTA)
CTA of the candidate shall be based on the Assessment of the Training portfolio,
Supervisor’s end of rotation reports and supervisor’s annual Assessment report.
1.1.1. Continuous Internal “Workplace Based Assessments” will be done
by the supervisor / faculty members or other assessors as per
policy, that may be based on but not limited to:
1.1.1.1. Generic and Specialty Specific Competency Assessments
1.1.1.2. Assessment of Candidates' Training Portfolio including
assessment of competencies using appropriate assessment
tools including:
1.1.1.2.1. Mini-CEX (Mini Clinical Evaluation Exercise)
1.1.1.2.2. DOPS (Direct Observation of Procedural Skills)
1.1.1.2.3. CBD (Case-based Discussion)
1.1.1.2.4. PBA (Procedure Based Assessment)
1.1.1.2.5. MSF (Multisource Feedback)
1.1.1.2.6. CPC Presentation Assessment
1.1.1.2.7. Journal Club Presentation Assessment
1.1.1.2.8. Department morning meeting Review
1.1.1.2.9. Supervisor’s End of Rotation Report
1.1.1.2.10. Supervisor’s Annual Trainee Assessment Report
1.1.1.3. The supervisor shall submit the trainee annual assessment
reports to the Faculty Department Committee. The
recommendations of the Faculty Department Committee shall
be submitted to Head, IPMS.
1.1.1.4. The Head, IPMS, shall submit the Continuous Trainee
Assessment score through the Dean, FM&D / Principal,
UCMD to the Controller of Examination of the University.
Score of Continuous Trainee Assessment once submitted

Page 35 of 43
 shall be final and cannot be changed subsequently under any
circumstances.
1.1.1.5. Continuous Trainee Assessment will have weightage in both
Intermediate and Final Examinations.
1.2. Intermediate Examination - 500 Marks
Intermediate examination would be conducted for the candidates getting
training in all MD/MS programs during the program.
1.2.1. To appear in Intermediate Examination, a candidate shall be
required to submit following through Head, IPMS:
1.2.1.1. Certificate of achieving at least 80% attendance in the training
program.
1.2.1.2. Minimum 60 % score in Continuous Trainee Assessment.
1.2.1.3. Candidate remained on institution roll during the period
approved for appearing in examination.
1.2.1.4. Certificate of completion of mandatory certifications and
workshops.
1.2.1.5. Certificate of completion date of 02 years training for both four
year programs or five years programs signed by Supervisor /
Head of Department of parent department and that of the
Head of Department where rotations are done (if prescribed
in the curriculum).
1.2.1.6. Approval letter of Research Proposal.
1.2.1.7. Evidence of payment of examination fee as prescribed by the
University from time to time.
1.2.1.8. Examination Forms complete in all aspects shall be submitted
to the Controller of Examinations through Head, IPMS.
1.2.1.9. The examination fee once deposited cannot be refunded /
carried over to the next examination under any
circumstances.
1.2.1.10. Intermediate Examination will be held twice a year in February
/ March and August / September. However, the IPMC may
change the schedule if required.
1.2.1.11. The Intermediate Examination will comprise of a Theory
Examination and Clinical Examination.
1.2.1.12. The total marks of Intermediate Examination shall be 500.
This shall include following components in which a candidate
must score at least 60% marks in each to be declared pass:
1. Continuous Trainee Assessment 100 Marks
2. Theory Examination 200 Marks
3. Clinical Examination 200 Marks
1.2.2. Continuous Trainee Assessment (100 Marks)
CTA shall be based on the cumulative assessment of two years in
accordance with the details in clause 9.1 of Rules & regulations.

Page 36 of 43
 1.2.3. Theory Examination (200 Marks)
Theory examination shall be based on the prescribed curriculum
1.2.3.1. The theory examination will consist of:
a. Multiple Choice Questions (MCQ’s).09 marks shall be 150 Marks
from Clinical Research.
b. Research Proposal Evaluation 50 Marks
1.2.3.2. The candidates scoring 60% marks shall be declared pass
and shall be eligible to appear in the clinical examination.
1.2.4. Clinical Examination (200 Marks)
1.2.4.1. After passing theory examination, the students shall become
eligible for taking clinical examination.
1.2.4.2. Clinical Examination will consist of:
a. Task Oriented Assessment of Clinical Skills (TOACS). 120 Marks
There will be 12 observed stations of 10 marks each
b. Case-based Discussion. There will be 02 stations of 15 30 Marks
marks each.
c. Portfolio Evaluation 50 Marks
1.2.4.3. Candidates scoring 60% marks in aggregate shall be declared
pass in the Clinical examination.
1.2.4.4. A maximum of three (03) consecutive attempts after becoming
eligible whether availed or un-availed to pass Clinical
examination will be permitted. However, in case of failure to
pass Clinical examination within stipulated attempts the credit
of passing the written examination shall stand withdrawn and
candidate shall have to take written examination, afresh.
1.2.4.5. A candidate shall be declared pass in intermediate examination
after passing CTA, theory and clinical examination,
independent of each other.
1.3. Final Examination
Final examination would be conducted for the candidates completing
training in MD/MS programs.
1.3.1. To appear in Final Examination, a candidate shall be required to
submit following through Head, IPMS:
1.3.1.1. Certificate of completion date of 04 or 05 Years training duly
signed by Supervisor, Head of parent Department and that of
the Head of Department where rotations were done. (if
prescribed in the curriculum).
1.3.1.2. Minimum 60 % score in Continuous Trainee Assessment.
1.3.1.3. Candidate remained on institution roll during the period required
for appearing in examination.
1.3.1.4. Result card showing that the candidate has passed
intermediate Examination.

Page 37 of 43
 1.3.1.5. Evidence of payment of examination fee as prescribed by the
university from time to time. The examination fee once
deposited cannot be refunded / carried over to the next
examination under any circumstances.
1.3.1.6. Certificate of achieving 80% attendance in the training program.
1.3.1.7. Completed Portfolio.
1.3.1.8. Submission of certified copy of at least 01 published research
article and certified copy of second research article with letter
of acceptance for publication as per criteria in clause 8.5 of
Rules & Regulations.
1.3.1.9. Final Examination will be held twice a year in February / March
and August / September. However, the IPMC may change the
schedule if required.
1.3.2. The Final Examination will comprise of a Theory, Clinical Examination
and evaluation of 02 relevant Research Publications as per criteria in
clause 8.5 of Rules & Regulations.
1.3.2.1. Total Marks of Final Examination shall be 1,000. This shall
include following components in which a candidate must score
at least 60% marks in each to be declared pass;
a. Continuous Trainee Assessments (CTA) 200 Marks
b. Evaluation of Research Articles 200 Marks
c. Theory Examination 200 Marks
d. Clinical Examination 400 Marks
1.3.3. Continuous Trainee Assessment (200 Marks)
CTA shall be based on the cumulative assessment of four / five
years as the case may be in accordance with the details in
clause 9.1 of Rules & Regulations.
1.3.4. Evaluation of Research Publications (200 Marks)
1.3.4.1. Consideration of research publications shall be rated on the
basis of following criteria:
a. 02 relevant research articles in PM&DC / HEC 120 Marks
approved Journal as specified in clause 8.5 of Rules &
Regulations.
b. Publication of article in Q rated journal. 40 Marks
Q1 Journal 20 Marks
Q2 Journal 15 Marks
Q3 Journal 10 Marks
Q4 Journal 05 Marks
c. Study Type 40 Marks
Clinical Trial 25 Marks
Systematic 15 Marks
review
Meta-Analysis 15 Marks

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 1.3.4.2. The candidate scoring 60% marks in
evaluation of the research publication shall be declared pass in this
component and exempted from this component in subsequent
attempts till award of degree.
1.3.5. Theory Examination (200 Marks)
1.3.5.1. The theory examination shall comprise of two papers;
a. Paper 1 shall comprise of Multiple Choice Questions 100 Marks
(MCQ’s).
b. Paper 2 shall comprise of ten (10) Structured Essay 100 Marks
Questions (SEQs), each carrying 10 marks. One (01)
questions shall be from Clinical Research
1.3.5.2. Candidates scoring 60% marks in aggregate of paper 1 and
paper 2 of the theory examination will be declared pass and will
become eligible to appear in the Clinical Examination.
1.3.6. Clinical Examination (400 Marks)
1.3.6.1. Clinical Examination will evaluate patient care
competencies in detail. A panel of four to six examiners will be
appointed by the Rector, UOL. The examination will be based on:
Clinical Examination Part – I
a. Task Oriented Assessment of Clinical Skills (TOACS). 120 Marks
There will be 12 observed stations of 10 marks each.
b. Case-based Discussion. (CBD) There will be 02 30 Marks
stations of 15 marks each.
c. Portfolio Evaluation 75 Marks
Clinical Examination Part – II
d. 01 Long Case 75 Marks
e. 04 Short Cases of 25 marks each. 100 Marks
1.3.6.2. The candidates scoring 60% marks in Clinical Examination
Part – I and 60 % marks in Clinical Examination Part – II separately
shall be declared pass in the Clinical examination.
1.3.6.3. Candidate who pass theory examination, shall be allowed a
maximum of four consecutive attempts whether availed or un-availed
to pass Clinical examination. However, in case of failure to pass
Clinical examination within stipulated attempts the credit of passing the
written examination shall stand withdrawn and candidate shall have to
take entire examination including theory examination, afresh.
1.3.6.4. The candidates passing in either of the two parts of clinical
examination (Part – I and Part - II) shall be exempted from the relevant
component in the allowed number of subsequent attempts for clinical
examinations until he / she has to appear in the theory examination
again.

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1.4. Declaration of Result & Award of Degree
1.4.1. A candidate having declared successful in all the components of
examination i.e. Continuous Trainee Assessment, Theory, Clinical
and research publications shall be declared pass and shall be
conferred degree in the prescribed manner.

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V. RECOMMENDED READINGS

ANATOMY:
1. Understanding General Anatomy By Tassaduq Hussain. 19th Edition
(2022) Prince Book Depot. Wolters Kluwer.
2. Langman's Medical Embryology By T.W. Sadler Phd. 15th Edition (2023)
Wolters Kluwer.
3. Snell's Clinical Anatomy By Regions By Lawrence E. Wineski Phd 10th
Edition (2018) Wolters Kluwer.
4. Junqueira's Basic Histology Text and Atlas By Anthony L. Mescher 16 th
Edition (2021) Mcgraw Hill.
5. Snell’s Clinical Neuroanatomy By Ryan Splittgerber Ph.D. 8th Edition
(2018) Wolters Kluwer.

PHYSIOLOGY:
1. Guyton and Hall Textbook of Medical Physiology By John E. Hall.14th
Edition (2020) Elsevier.
2. Ganong’s Review of Medical Physiology, 26th Edition.

RESEARCH METHODOLOGY:
1. The Medical Research Handbook, planning a research project. Amar-
Singh HSS, Azman Abu Bakar and Sondi Sararaks. © 2008, Kuala
Lumpur. Online available at URL,
http://www.crc.gov.my/wpcontent/uploads/documents/researchHa
ndBook.pdf.

BEHAVIORAL SCIENCES:
1. Rana M.H., Ali S. Mustafa M.A. Handbook of Behavioral Sciences for
Medical and Dental students. Lahore: university of Health Sciences.
2. Handbook of Behavioural Sciences By Mowadat H Rana 3 rd Edition
(2016) Allied Book Company.

PHARMACOLOGY:
1. Lippincott Illustrated Reviews: Pharmacology By Karen Whalen. 8th
Edition (2022) Wolters Kluwer.

PATHOLOGY:
1. Jawetz, Melnick, & Adelberg's Medical Microbiology By Stefan Riedel.
28th Edition (2019) Mcgraw-Hill Education.
2. Hoff brand’s Essential Haematology By Victor Hoffbrand. 8th Edition
(2019) Wiley-Blackwell.
3. Robbins Basic Pathology By Vinay Kumar 11th Edition (2017) Elsevier.
4. Clinical Chemistry: Principles, Techniques, And Correlations By Michael
L. Bishop 9th Edition (2023) Jones And Bartlett.

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SURGERY:

Clinical:
1. Browse’s introduction to the symptoms and signs of surgical disease, ,
4th Edition – Norman L. Browse.
2. Churchill, pocketbook of differential diagnosis, 3rd Edition - A. Raftery E.
Lim, Edition 2001.
Theory:
1. Essential of General Surgery, latest edition by Peter Lawrence.
2. Essential of Surgical Specialties, latest edition by Peter Lawrence.
Operative Surgery:
1. General Surgery. Rob & Smith.
2. General Surgery Bailey & love.
3. Mastery of surgery.

OTHER REFERENCES FOR EXTRA READING:

1. Bailey & Love’s Short Practice of Surgery by: H. Bailey & R.J. McNeil.
2. Scott: An Aid to Clinical Surgery by: HAF Dudley and BP Waxman.
3. Principles of Surgery, 7th Edition by Seymour I. Schwartz, 1999.
4. Essential Surgery 1990 by: H. George Burkit and B. O’Donnel.
5. Principle and Practice Surgert by Forrest, Carter, Macleod.
6. Clunie GJA, Tjandra JJ, Thomas R.S.J. Textbook of Surgery, 2nd edn
Blackwell Science Asia, Melbourne, 2001. ISBN 0867930233.
7. Clunie GJA, Tjandra JJ, Ross H. MCQ's and Short Answer Questions
for Surgery. Blackwell Science Asia, Melbourne, 1999. Paperback. ISBN
0867930101. www.blacksci.co.uk/australi/books.htm.
8. Forrest AP, Carter DC, MacLeod IB. Principles and Practice of Surgery.
9. A Surgical Supplement to Davidson's Principles and Practice of
Medicine, 3rd edn. Churchill Livingstone, Edinburgh, 1995. ISBN
i. 0443048606 www.us.elsevierhealth.com.
10. Hunt PS, Marshall VC. Clinical Problems in General Surgery.
11. Butterworths, Sydney, 1991. ISBN 0409492132. This
publication is out of print and only available second hand.
12. Morris PJ, Malt RA. Oxford Textbook of Surgery, 2nd edn.
Oxford University Press, New York, 2001. ISBN 0192628844
(three volume set). mnemosyne.oup-usa.org/medical.
13. Williamson R. An Aid to Clinical Surgery, 6th edn. Churchill
Livingstone, Edinburgh, 1998. ISBN 044305603X.
14. Surgery: Pretest Self-Assessment and Review. ISBN:
0071359540. Publisher: McGraw-Hill, 2000, 9th Edition.

SURGICAL ATLASES:
1. Operative Surgery, Principles and Techniques by Paul Nora.
2. Atlas of General Surgery, 3rd Edition by Carter.
3. Mastery of Surgery by Nyhus and Baker.
4. An Atlas of Surgical Operations by Zollinger and Zollinger.
5. Operative Orthopedics, 7th Edition by Campbell.

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6. Vascular Surgery, 4th Edition by Robert Rutherford (2 volumes).
7. Johnson’s Surgery of the Chest by Waldhausen and Pierce.

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