A Study of the General Surgery Curriculum

Jose Mario Amado M. Pingul, MD
Reynaldo O. Joson, MD
2006

Specific Learning (Behavioral) Objectives

After studying the latest General Surgery Curriculum being recommended by the Philippine Society of General Surgeons and Department of Surgery of Ospital ng Maynila, the general surgery resident to be must be able to:

1. Answer the following questions:
1.1 What is a curriculum?

Ans: A curriculum is an educational document which contains the general program of studies for the learners or students.

1.2 What are the elements of a curriculum?

Ans:
Learning objectives
Content
Learning activities and resources
Evaluation

1.3 What is a general surgery curriculum?

Ans: A general surgery curriculum is an educational document that contains the general program of studies for general surgeons to be.

1.4 What are the elements of a general surgery curriculum?

Ans:
Learning objectives
Content
Learning activities and resources
Evaluation

1.5 What is an instructional design?

Ans: An instructional design is an educational document which by common usage may mean the same thing as a curriculum. However, to make a difference between a curriculum and an instructional design, if a curriculum spells out the general program of studies, an instructional design lays out the strategies and procedures on how the program of studies is to be achieved. In other words, curriculum is more general and instructional design is more specific. Furthermore, instructional design is cascaded from the curriculum.

1.6 What are the elements of an instructional design?

Ans:
Learning objectives
Content
Learning activities and resources
Evaluation

1.7 What is a lesson plan?

Ans: A lesson plan is an educational document which strictly speaking can be synonymous with curriculum and instructional design in the sense that they are all written educational plans. However, to make a difference among curriculum, instructional design, and lesson plan, lesson plan is the most specific or smallest educational plan, usually on a learning session of an hour or two; curriculum is the most general or most encompassing or biggest educational plan; whereas instructional design is between curriculum and lesson plan in terms of scope. Just as an instructional design is cascaded from the curriculum, a lesson plan is cascaded from an instructional design.

1.8 What are the elements of a lesson plan?

Ans:
Learning objectives
Content
Learning activities and resources
Evaluation

2. Make a table illustrating the similarities and differences among curriculum, instructional design, and lesson plan.

Currriculum Instructional
Design Lesson Plan
Similarities
Educational document (written) YES YES YES
Program of study YES YES YES
Elements SAME SAME SAME

Differences
Scope of plan Most general
Most encompassing More specific Most specific
Smallest scope (1-2 hour session)
Cascading sequence Source of cascade From curriculum From instructional design




3. Enumerate the five (5) competencies expected of a wholistic general surgeon to enable him/her to effectively contribute to health development in the community.
Ans: Surgeon-clinician-operator
Surgeon-community problem solver
Surgeon-educator-learner
Surgeon-researcher
Surgeon-administrator

4. Enumerate the three (3) conventional domains considered in formulating learning objectives for learners/students/residents.

Ans: Cognitive domains
Psychomotor domains
Attitude domains

5. Enumerate at least five (5) general psychomotor skills expected of a wholistic general surgeon.

Ans: Surgeon-clinician-operator
Technical skills in doing physical examination
Technical skills in operating and assisting operations
Technical skills in medical recording
Technical skills in medical presentation
Communication skills
Communication skills (with patients)
Communication skills (with colleagues)
Interpersonal skills
Interpersonal skills (with patients)
Interpersonal skills (with colleagues)

6. Enumerate at least five (5) general desirable habits or attitude expected of a wholistic general surgeon.

Ans: Self-directed learning habit
Ethical and moral values
Empathy
Humility (accepts limitations)
Honesty

7. Define the scope of the specialty known as general surgery in the Philippines as defined by the Philippine Society of General Surgeons.


7.1 Scope in terms of region/system/organ/tissue as “must possess”
Ans: Head and Neck
Breast
Abdomen and Hernia
Skin and Soft Tissue

7.2 Scope in terms of types of operative skills as “must possess”
Ans: Diagnostic operative skills
Biopsy
Endoscopy
Therapeutic operative skills
For diseases that fall within the scope of the general surgery in terms of region (head and neck; breast; abdomen and hernia; skin and soft tissue)

7.3 Scope in terms of types of diseases as “must possess competencies to manage”
Ans: Trauma
Tumor
Infections
Deformity

7.4 Scope in terms of “nice to possess, to have, or to be exposed to”
Ans: Other surgical subspecialties –
Pediatric Surgery
Orthopedic Surgery
Plastic and Reconstructive Surgery
Urology
Neurosurgery
Thoracic and Cardiovascular Surgery
Gynecologic Surgery

8. Make a table illustrating the use of appropriate teaching-learning activities (at least 2 each) for the different conventional domains of learning objectives(cognitive or knowledge domain; psychomotor domain; and attitude domain).

Domain Teaching-learning activities
Cognitive or knowledge Lecture; small-group discussion; independent study; problem-solving and decision-making activities
Psychomotor Demo-return demo – simulated and actual practicums
Attitude Role playing; stimulus for attitude development


9. Make a table illustrating the appropriate use of teaching-learning activities for the following psychomotor skills:
9.1 Problem-solving and decision-making skills in patient management
9.2 Operative skills
9.3 Preop and postop management skills
9.4 Medical recording skills
9.5 Medical presentation skills
9.6 Interpersonal skills
9.7 Team-work skills
9.8 Communication skills
9.9 Research skills
9.10 Administrative skills
9.11 Surgical educator skills
9.12 Public health educator skills
9.13 Self-directed learning skills

Psychomotor skills Teaching-learning activities
Problem-solving and decision-making skills in patient management Simulated and actual cases for problem-solving and decision-making
Operative skills Animal and actual patients being operated by learners
Preop and postop management skills Simulated and actual cases for preop and postop management skills
Medical recording skills Simulated and actual cases for medical recording skills
Medical presentation skills Actual medical presentations
Interpersonal skills Simulated and actual scenarios for interpersonal skills development
Team-work skills Simulated and actual scenarios for team-work skills
Communication skills Actual communication experience
Research skills Actual research experience
Administrative skills Actual administrative experience
Surgical educator skills Actual teaching experience
Public health educator skills Actual teaching experience
Self-directed learning skills Problem-based learning


10. Enumerate at least five (5) essential resource materials that can be used in learning surgical patient management process.

Ans: Reading materials on the topic
Textbooks
Journals
Self-instructional programs
Observation/analysis of patient management processes of consultants
Observation/analysis of patient management processes of colleagues /
peers
Simulated patient problem-solving and decision-making
Actual patient problem-solving and decision-making

11. Make a table illustrating the use of appropriate evaluation tools (at least 2 each) for the different conventional domains of learning objectives (cognitive or knowledge domain; psychomotor domain; and attitude domain).

Domain Evaluation tools
Cognitive or knowledge Written exam; oral exam
Psychomotor Practical exam:observation with rating scale; record review (eg medical recording; mortality and morbidity review)
Attitude Observation with rating scale; critical incident report


12. Make a table illustrating the appropriate use of evaluation tools for the following psychomotor skills:
12.1 Problem-solving and decision-making skills in patient management
12.2 Operative skills
12.3 Preop and postop management skills
12.4 Medical recording skills
12.5 Medical presentation skills
12.6 Interpersonal skills
12.7 Team-work skills
12.8 Communication skills
12.9 Research skills
12.10 Administrative skills
12.11 Surgical educator skills
12.12 Public health educator skills
12.13 Self-directed learning skills

Psychomotor skills Evaluation tools
Problem-solving and decision-making skills in patient management Practical exam; review of records
Operative skills Practical exam; review of records
Preop and postop management skills Practical exam; review of records
Medical recording skills Practical exam; review of records
Medical presentation skills Practical exam; review of records
Interpersonal skills Observation with rating scale; critical incident report
Team-work skills Observation with rating scale; critical incident report
Communication skills Practical exam; review of records
Research skills Practical exam; review of records
Administrative skills Practical exam; review of records
Surgical educator skills Practical exam; review of records
Public health educator skills Practical exam; review of records
Self-directed learning skills Observation with rating scale; critical incident report

13. Compare the similarities and differences (advantages and disadvantages) between norm- and criterion-referenced standards used in evaluating learners/students/residents for assessing accomplishment or non-accomplishment of competencies / passing or failing a learner / promotion or nonpromotion of a resident.

Ans: Norm-referenced and criterion-referenced systems are standards in interpreting scores of students in an evaluation tool.

Norm-referenced system uses relative standards whereas criterion-referenced system uses absolute standards.

Criterion-referenced system uses objectives as basis of interpretation.

In norm-referenced system, the passing grade is decided after the exam whereas in criterion-referenced system, the passing grade is decided before the exam.

Criterion-referenced system is preferred in evaluating physicians and surgeons because of the sensitivity of the responsibilities and competencies expected by the community.
It is a good indicator of level of mastery attained by students.


14. Based on Philippine Society of General Surgeons’ recommendation, make a table illustrating the parameters and criteria or standards to be used in passing or failing (promotion or nonpromotion) of surgical residents.


Evaluation Component MPL
Basic Theoretical Knowledge 50%
Clinical Competencies 50%
Technical Skills 50%
Attitudinal Competencies 50%

15. Based on OMMC Department of Surgery policies, make a table illustrating the parameters and criteria or standards to be used in passing or failing (promotion or nonpromotion) of surgical residents.

General Surgery Residents’ Annual Performance Report

Residents Governance
Team Player
Work Ethics Service Training Research PBS-RITE
Cognitive Skills Attitude

Legend:
P – Pass F – Fail Inc – Incomplete NA – Not Applicable

Guides:

Governance – Performance as a chief resident and other assigned administrative functions

Service – Number of complaints (external and internal); morbidity and mortality

Training – Knowledge (Written and oral exams)

Training – Skills and Attitude (PCS-prescribed Clinical-Attitude-Technical skills rating scale; oral-practical exams)

Research – Research paper requirements and quality

NOTE: Resident must have a passing grade in all parameters to be eligible for promotion or graduation.


16. Construct a table illustrating methods on how to evaluate a general surgery curriculum and its implementation.

Elements to be evaluated What to evaluate Methods of evaluation
(by external evaluators)
Input
(Structure) Presence of a structured general surgery curriculum
Presence of adequate learning resource facilities Review of records
Site visit and inspection and checking
Process Implementation of curriculum being done according to plan
Output Presence of effective and efficient results of implementation of curriculum

17. Enumerate the elements that will be evaluated by external accrediting agencies in a general surgery program.

Ans: The curriculum and its implementation
Learning resources

18. Using a table, describe the recommendation of the Philippine Society of General Surgeons as regards organization of rotation of residents vis-à-vis level of training.

For 5-year Program

Year Level Rotations
1st General Surgery
2nd-3rd Other Surgical Subspecialties and General Surgery
4th-5th General Surgery

For 4-year Program

Year Level Rotations
1st General Surgery
2nd General Surgery and Other Surgical Subspecialties
3rd General Surgery and Other Surgical Subspecialties
4th General Surgery