COPYRIGHTS AND AMENDMENTS. All rights reserved Saudi Commission for Health Specialties.

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4 COPYRIGHTS AND AMENDMENTS COPYRIGHTS AND AMENDMENTS All rights reserved Saudi Cmmissin fr Health Specialties. This material may nt be reprduced, displayed, mdified, r distributed withut prir written permissin f the cpyright hlder. N ther use is permitted withut prir written permissin f the Saudi Cmmissin fr Health Specialties. Any amendment t this dcument shall be apprved by the Specialty Scientific Cuncil and the Executive Cuncil f the cmmissin and shall be cnsidered effective frm the date f updating the electrnic versin f this curriculum published n the cmmissin website unless different implementatin date has been mentined. Fr permissin, cntact the Saudi Cmmissin fr Health Specialties, Riyadh, Kingdm f Saudi Arabia. Crrespndence: P.O. Bx: Pstal Cde: Cnslidated Cmmunicatin Center: Internatinal Cntact Call: Fax: Extensin: 1322 Website: Frmatted and Designed by: Manj Thmas Varghese, CMT/Salem Al Tamimi (SCFHS) 2 SAUDI BOARD PLASTIC SURGERY CURRICULUM

5 TABLE OF CONTENTS TABLE OF CONTENTS SAUDI BOARD 1 TABLE OF CONTENTS 3 ACKNOWLEDGEMENTS 5 INTRODUCTION 6 Minimum training requirements: Plastic surgery residency 7 Minimum training requirements in surgical fundatins (R1 and R2) 9 Surgical fundatin training 9 COMPETENCIES 11 Surgical fundatin cmpetencies (R1+R2) 11 Medical Expert 11 Cmmunicatr 19 Cllabratr 21 Manager 22 Health Advcate 22 Schlar 23 Prfessinal 24 Plastic surgery training (R3-6) 27 Specific learning bjectives 27 Junir Plastic Surgery Resident (R3 and R4) 27 Plastic Surgery Resident (R5 and R6). 27 Plastic surgery cmpetencies 27 Medical Expert 28 Cmmunicatr 42 Cllabratr 43 Manager 45 Health Advcate 46 Schlar 47 Prfessinal 48 TEACHING AND LEARNING 50 Academic curriculum 50 General academic activities 50 ASSESSMENT 72 Annual assessment 72 Cntinuus Appraisal Errr! Bkmark nt defined. Frmative Cntinuus Evaluatin 72 Summative Cntinuus Evaluatin 72 End-f-Year Examinatin 73 Part I Saudi Bard Plastic Surgery Examinatin 73 Final In-training Evaluatin Reprt (FITER)/Cmprehensive Cmpetency Reprt (CCR) 73 Final Plastic Surgery Saudi Bard Examinatin (Part II) 73 SAUDI BOARD PLASTIC SURGERY CURRICULUM 3

6 TABLE OF CONTENTS Certificatin 74 POLICIES AND PROCEDURES 75 Admissin requirements 75 Training requirements 75 Structure f the training 75 Junir Residency in general surgery training (R1,R2) 76 Junir Plastic Surgery Residency (R3, R4) 76 Plastic Surgery Residency (R5, R6) 76 Cntent f Training 77 Lg Bk: T-Res 77 Research activity 78 Residents Rights 78 Training centers 78 Private patients/private centers 78 Private patients in training centers 79 Evaluatin 79 Prmtin 79 APPENDICES 80 Evaluatin frms 80 4 SAUDI BOARD PLASTIC SURGERY CURRICULUM

7 ACKNOWLEDGEMENTS ACKNOWLEDGEMENTS The Plastic Surgery Residency Training team acknwledges the valuable cntributins and feedback frm the scientific cmmittee members in the develpment f this prgram. We extend special appreciatin and gratitude t all the members wh have been pivtal in the cmpletin f this bklet, especially the Scientific Cuncil, Curriculum Grup, and the Curriculum Specialists. We wuld als like t acknwledge that the CanMEDS framewrk is a cpyright f the Ryal Cllege f Physicians and Surgens f Canada, and many f the descriptins and cmpetencies have been acquired frm their resurces. SAUDI BOARD PLASTIC SURGERY CURRICULUM 5

8 INTRODUCTION INTRODUCTION Plastic Surgery is the branch f surgery that fcuses n the management f cmplex cmpsite tissue defects r defrmities. The wrd plastic is derived frm the Greek plastiks, meaning t mld r t give frm. The specialty is defined by its apprach t prblems and specialized surgical techniques rather than any ne anatmical area. There are tw main cmpnents: recnstructive surgery and csmetic r aesthetic surgery. Recnstructive Plastic Surgery is based n the cncept f restring bth the frm and functin f the affected regin f the bdy. Plastic surgens perate n mst areas f the bdy t crrect defrmities, which may be caused by cngenital birth defects, trauma, benign r malignant tumrs, infectins, and wund healing cmplicatins, bth simple and cmplex. Recnstructive surgery can invlve any tissue, but mst cmmnly invlves the skin, underlying sft tissue, and bne, as well as specific structures including nerves, bld vessels, and tendns. The knwledge and techniques f plastic surgery are well suited t the surgical care f certain cmplex anatmical regins, such as the hand, head and neck, and breast. Aesthetic (Csmetic) Plastic Surgery is an area f surgery in which the purpse is t imprve the appearance f a specific bdy regin, in the absence f any functinal prblem r defects caused by cngenital defrmity, trauma, r disease. This enhancement f appearance can imprve the patient s verall sense f well-being. The Saudi Plastic Surgery Training Prgram cnsists f 6 years f full-time supervised residency training in plastic surgery and its branches. The training institutin must be accredited by the Saudi Cmmissin fr Health Specialties (SCFHS) twards a Saudi Specialty Certificate in Plastic Surgery. Training shall be cmprehensive, including: 1) Burn care 2) Hand and upper extremity surgery 3) Pediatric plastic surgery and cranifacial surgery 4) Recnstructive surgery and micrsurgery 5) Csmetic surgery The trainees shall be actively invlved in patient care, with increasing respnsibility as experience and cmpetence are gained. The trainees will adhere t the rules and regulatins f the training prgram. Upn successful cmpletin f the prgram, the trainee will be awarded the Saudi Specialty Certificate in Plastic Surgery. The Saudi plastic surgery training prgram was established in the year 2001 in Riyadh. Since then, the prgram expanded in 2009 t include bth eastern and western prvinces in additin t the central prvince. At the time the prgram pened, there were a ttal f 5 accredited centers. Currently, there are 16 accredited training centers fr plastic surgery in the kingdm, which are utlined in the table belw: Lcatin Riyadh 7 Jeddah 5 East prvince 4 Number f Centers 6 SAUDI BOARD PLASTIC SURGERY CURRICULUM

9 INTRODUCTION The prgram has expanded frm accepting 2 r 3 residents per year in 2002 t accepting 8 t 9 residents cuntry-wide in the last few years ( ). Thrugh 2014, there are 29 residents wh have cmpleted the prgram. The mst cmmnly encuntered cases in plastic surgery in the kingdm have been: 1) Hand and upper extremity trauma 2) Burns 3) Cleft lip and palate 4) Peripheral nerve surgery, e.g., carpal tunnel surgery 5) Bdy cnturing, e.g., surgery fllwing massive weight lss 6) Cancer recnstructin: breast, head, and neck cancer 7) Breast plastic surgery 8) Csmetic surgery The Saudi plastic surgery prgram fllws The Canadian Medical Educatin Directives fr Specialists (CanMEDS) framewrk, which ffers a mdel f physician cmpetencies that emphasizes nt nly medical expertise but als multiple additinal nn-medical expert rles that aim t better serve the needs f sciety. The main gal f the Saudi Plastic Surgery Residency Training Prgram is t graduate well-trained and qualified plastic surgens wh will be able t lk after patients independently. The prgram is carried ut in accredited, well-equipped centers t allw the residents t develp apprpriate cmpetence in the perid suggested. The prgram is under the auspices f the SCFHS rules and regulatins. Minimum training requirements: Plastic surgery residency The ttal duratin is six years (72 mnths) f apprved residency training in plastic surgery. 1) In each year there are 13 blcks 2) The duratin f each blck is 4 weeks 3) One blck (4 weeks) is the annual vacatin 4) The ther 12 blcks is are used fr rtatins Training Perids A. Tw years (24 clinical rtatin blcks and 2 vacatin blcks) f fundatinal training in surgery that meets the requirements f the SCFHS curriculum. This perid must be apprved by the plastic surgery prgram directr in cnjunctin with the Surgical Fundatins prgram crdinatr. This initial perid f pstgraduate training must include: 1. Mandatry rtatins: 1.1. A minimum f 6 blcks in general surgery 1.2. A minimum f 3 blcks in critical care 1.3. A minimum f 3 blcks in emergency medicine 1.4. A minimum f 3 blcks in plastic surgery 1.5. A minimum f 3 blcks in rthpedic surgery SAUDI BOARD PLASTIC SURGERY CURRICULUM 7

10 INTRODUCTION 2. Elective rtatins The resident can chse three rtatins, with n duplicatin f any f the fllwing: 2.1. Tw blcks in vascular surgery 2.2. Tw blcks in pediatric surgery 2.3. Tw blcks in ENT, head and neck service 2.4. Tw blcks f ral surgery in a facial trauma center 2.5. Tw blcks in dermatlgy Applicants wh successfully fulfill the abve rtatins and pass the required exams will successfully advance t the 3rd year f plastic surgery residency. The bard f surgery shuld prmte the resident t becme an R3. B. Fur years f residency training in plastic surgery, which must include: 1. Six blcks f respnsibility as a senir resident 2. Expsure t the fllwing fields in plastic surgery while in plastic surgery rtatins: 2.1. Burns 2.2. Hand and upper extremity 2.3. Breast plastic and recnstructive surgery 2.4. Pediatric plastic surgery and cranifacial surgery 2.5. Head and neck tumrs and recnstructin 2.6. Lwer extremity recnstructin 2.7. Trunk and genitalia recnstructin 2.8. Skin and sft tissue tumrs 2.9. Recnstructive micrvascular surgery Csmetic surgery NOTES The SCFHS Certificatin in Plastic Surgery requires all f the fllwing: 1) Successful cmpletin f a tw-year SCFHS Surgical Fundatins curriculum; 2) Successful cmpletin f the SCFHS Principles f Plastic Surgery examinatin (first part f the Saudi bard exam); 3) Successful cmpletin f a six-year SCFHS accredited prgram in plastic surgery; 4) Successful cmpletin f the SCFHS examinatin in plastic surgery; and 5) Successful cmpletin f at least ne schlarly prject related t plastic surgery, as cnfirmed by the prgram directr. The six-year prgram utlined abve is t be regarded as the minimum training requirement. Additinal training may be required r recmmended by the prgram directr t ensure that clinical cmpetence has been achieved. Training must incrprate the principle f graded increasing respnsibility. residency is defined as the six-mnth perid in which the resident is regularly entrusted with the respnsibility fr preperative, perative, and pstperative care, including difficult and challenging prblems in plastic surgery. The senir resident shall be in charge f a plastic surgery unit; n ther resident r fellw shall impede direct cmmunicatin between the senir resident and the attending staff plastic surgen. 8 SAUDI BOARD PLASTIC SURGERY CURRICULUM

11 INTRODUCTION Minimum training requirements in surgical fundatins (R1 and R2) This perid must include the fllwing training, which will be cunted as part f the parent specialty training: 1) A minimum f 6 blcks in general surgery 2) A minimum f 3 blcks in critical care 3) A minimum f 3 blcks in emergency medicine 4) A minimum f 3 blcks in plastic surgery 5) A minimum f 3 blcks in rthpedic surgery In additin, the abve-described elective rtatins must be cmpleted. NOTES: It is expected that the Surgical Fundatins prgram directr and the parent prgram directr will cllabratively develp the series f rtatins that will allw the trainee t meet the Objectives f Training in Surgical Fundatins. Surgical fundatin training Definitin Surgical Fundatins encmpasses the cre fundatinal surgical cmpetencies that are required fr the specialty f plastic surgery. Surgical Fundatin training is the initial perid f pstgraduate training that is required t acquire the knwledge, skills, and attitudes underlying the basics f surgical practice in general and preparatin fr further training in plastic surgery. Fr the purpse f clarity, a Surgical Fundatins resident refers t any surgical resident in R1 r R2 r a resident n remediatin wh has nt fulfilled the bjectives f training. These bjectives refer t exit cmpetencies fr which a Surgical Fundatins resident must be evaluated by the end f R2. NOTE: At the discretin f the Surgical Fundatins and hme prgram directrs, residents wh fail t meet these bjectives at the end f R2 may r may nt cntinue training. Hwever, a remediatin plan must be put in place. These bjectives f training must be achieved by the end f the third year f training (i.e., by R3). Successful cmpletin f the Principles f Surgery (POS; first part f the Saudi bard exam) examinatin has been designated as ne f the means t evaluate the attainment f the bjectives f Surgical Fundatins; hwever, if a candidate fails the POS exam but all ther bjectives are met, he r she may be allwed t cntinue in their hme specialty given that this exam has t be passed befre prmting the resident frm R3 t R4. Gals Upn cmpletin f the Surgical Fundatins training perid, a Surgical Fundatins resident is expected t demnstrate cmpetence in the management f surgical patients as utlined in this dcument. SAUDI BOARD PLASTIC SURGERY CURRICULUM 9

12 INTRODUCTION Residents must demnstrate the requisite knwledge, skills, and attitudes fr effective patientcentered care and service t a diverse ppulatin. In all aspects f specialist practice, the resident must be able t address issues f gender, sexual rientatin, age, culture, ethnicity, and ethics in a prfessinal and cmpassinate manner. Surgical Fundatins must prvide pprtunities fr residents t achieve the cmpetencies utlined in these bjectives. Training must prvide the resident with graduated respnsibility fr the management f surgical patients under apprpriate supervisin. 10 SAUDI BOARD PLASTIC SURGERY CURRICULUM

13 COMPETENCIES COMPETENCIES Surgical fundatin cmpetencies (R1+R2) At the cmpletin f the first tw years (24 mnths) f Surgical Fundatins training, the resident will have acquired the fllwing cmpetencies, as detailed in CanMED framewrk: 1) Medical Expert 2) Cmmunicatr 3) Cllabratr 4) Manager 5) Health Advcate 6) Schlar 7) Prfessinal Medical Expert Definitin Medical Expert is the central physician rle in the CanMEDS framewrk. As a Medical Expert, the Surgical Fundatins resident will integrate all f the CanMEDS rles, applying medical knwledge, clinical skills, and prfessinal attitudes in their prvisin f patient-centered care. Key and Enabling Cmpetencies By the end f Surgical Fundatins training, the Surgical Fundatins resident will be able t: 1) Demnstrate the ability t perfrm a cnsultatin, integrating all f the CanMEDS rles t prvide ptimal, ethical, and patient-centered medical care. Perfrm a cnsultatin, including: Cnduct and present well-dcumented assessments Prepare recmmendatins in written and/r verbal frm in respnse t a request frm anther health care prfessinal Demnstrate cmpassinate and patient-centered care 2) Establish and maintain clinical knwledge, skills, and attitudes apprpriate t surgical practice Apply knwledge f the clinical, sci-behaviral, and fundamental bimedical sciences relevant t surgical practice during the assessment f a patient, including: Anatmy Relevant anatmy t all basic surgical appraches: Surgical anatmy t head and neck, upper extremity, trunk including chest and abdmen, genitalia and lwer extremity. Physilgy Impact f age n specific rgan systems as it relates t surgical management Impact f pregnancy n specific rgan systems as it relates t surgical management Obesity and the impact f besity n rgan systems Effect f besity n the surgical patient Respiratry system Lung vlumes, flw rates, and pressures Gas exchange SAUDI BOARD PLASTIC SURGERY CURRICULUM 11

14 COMPETENCIES Oxygen transprt and carbn dixide eliminatin Hemstasis Physilgy f cagulatin and management f cagulpathy Fluid and electrlyte physilgy Fluid cmpartments and bdy water cmpnents Osmtic and vlume regulatin Sdium (Na), Ptassium (K), Calcium (Ca), Phsphrus (P), and Magnesium (Mg) metablism Regulatin f acid-base balance Circulatry system Hemdynamics f the cardivascular system Immunlgy f sepsis and transplantatin Nutritin Metablic needs Calric, prtein, and lipid requirements, fluids, and micrnutrients Adaptatin t starvatin as cmpared t respnse t surgical stress Bdy respnse t surgical stress Metablic respnses, including the catablic respnse, need fr metablic supprt, and endcrine changes nt mediated by the neurendcrine axis Mediatrs and cells invlved in the metablic respnse Neurendcrine axis Sepsis and the inflammatry respnse Metablic and hemdynamic patterns Mediatrs and cells in sepsis and inflammatin Impact n rgan systems Sepsis and the inflammatry respnse in majr burn patients. Disease states in rgan systems and their impact n the surgical patient Cardiac Crnary artery disease (CAD) Valvular disease Cardimypathy Cardiac arrest and arrhythmias, as per advanced cardivascular life supprt (ACLS) prtcls Pulmnary Chrnic bstructive lung disease (COLD) Renal Renal failure Endcrine Diabetes Physilgical cmplicatins Management f hyp- and hyperglycemia Thyrid pathphysilgy Parathyrid pathphysilgy Adrenal pathphysilgy Hepatic Cirrhsis Liver failure Hematlgic Screening fr diatheses Hypcagulable states 12 SAUDI BOARD PLASTIC SURGERY CURRICULUM

15 COMPETENCIES Hypercagulable states Indicatins, cmplicatins and benefits fr nutritinal supprt, including enteral and parenteral feeding Assessment and mnitring f malnurished surgical/burn patients Risk assessment strategies and scres Anesthetic risks Cardiac risk assessment ICU risk assessment Trauma assessment, including Glasgw cma scale Nutritinal assessment Preperative screening tests and their limitatins Diagnstic mdalities, including their technlgy, indicatins, and limitatins Plain radigraphy Ultrasund Cmputed tmgraphy (CT) scan Magnetic resnance imaging (MRI) technlgy Flurscpy Nuclear Medicine Psitrn emissin tmgraphy (PET) scan Other emerging technlgies Radiatin safety principles as they apply t patients and practitiners Medical treatments and their impact n the surgical management f a patient Immunsuppressin Chemtherapy Raditherapy Cmmn drugs that impact hemstatic functin and hw t crrect their impact Cmplementary and alternative medicine Bld prducts and derivatives, including types, indicatins, and adverse reactins Onclgy Purpse and basis f staging and grading Basic principles f neplastic transfrmatin, including tumr grwth and spread Pathlgy requirements fr apprpriate assessments Definitin f cmmn pathlgical terms, including but nt limited t neplasia, malignancy, dysplasia, metaplasia, and atypia Genetics f neplasia Genetics f families at risk Rle f envirnmental carcingens Paraneplastic syndrmes Principles f multi-mdality therapy Psychlgical and scial impact f cancer n individuals and families Trauma Principles f advanced trauma life supprt (ATLS) r principles f trauma care, including initial management Cmmn infectin Cmmunity and hspital acquired bacteria, fungi, and viruses Impact f bldbrne pathgens, including HIV, Hepatitis B, and Hepatitis C Transplantatin/implantatin Descriptin f autgraft, xengraft, and allgraft Graft rejectin - mechanisms and types Implants SAUDI BOARD PLASTIC SURGERY CURRICULUM 13

16 COMPETENCIES Principles f cmpatibility Bilgical reactin/rejectin Demnstrate an understanding f the cnduct f a surgical prcedure Principles f patient safety Principles f management f the patient and surgical team, with respect t bldbrne pathgens Needle stick injury Mucsal expsure Smke plume inhalatin Wund healing Classificatin f wunds Nrmal wund healing Abnrmal wund healing Factrs that alter wund healing Principles f energy surces Electr-cautery Laser Emerging energy surce mdalities Principles f prphylaxis Wund and systemic infectin Thrmbemblism Tetanus Principles f anesthesia, analgesia, and sedatin Lcal anesthetic agents: indicatins, cntra-indicatins, and administratin Reginal anesthetics General anesthetics Prcedural sedatin: indicatins, cntra-indicatins, and administratin Cmplicatins arising frm the administratin f anesthesia Demnstrate an understanding f rutine pstperative patient care, including Fluid management Wund care Pain management Pathphysilgy and types f pain Cmmn analgesic medicatins Patient-cntrlled analgesia Reginal analgesia, including epidural Demnstrate an understanding f the pathphysilgy and cmplicatins in the surgical patient Cardiac Principles f advanced cardiac life supprt Cardiac failure Ischemic heart disease Arrhythmia Circulatry shck Distributive Cardigenic Hypvlemic Obstructive Multiple rgan dysfunctin syndrme Pulmnary 14 SAUDI BOARD PLASTIC SURGERY CURRICULUM

17 COMPETENCIES Respiratry failure Basic mechanism, indicatins, cntra-indicatins, and cmplicatins f mechanical ventilatin Pulmnary emblism Fat emblism Genit-urinary Cngenital anmalies Vascular Deep venus thrmbsis (DVT) Arterial ischemia Endcrine Glycemic cntrl Thyrid strm Adrenal insufficiency Syndrme f inapprpriate antidiuretic hrmne secretin (SIADH) Skin Pressure sres Neurlgic Delirium and altered mental status Transient ischemic attack (TIA) and strke Principles f brain death assessment Psychiatric Anxiety and depressin Psychlgical and emtinal respnse t sensitive disrders Pst-traumatic stress disrders Gastrintestinal Stress gastritis Pstperative Ileus Cmmn pst-surgical infectins, including surveillance, preventin, and judicius use f antibitics Pulmnary Vascular catheter Urinary Partitis Surgical site infectin, including incisinal and rgan/space Spreading and necrtizing infectins Hematgenus infectins Types f bacteria Clstridium difficile Multi-antibitic-resistant pathgens Methicillin-resistant Staphylcccus aureus Multi-resistant gram-negative bacilli Vancmycin resistant enterccci Cmmn pathgens in the specific surgical site Cmpartment syndrmes Abdminal Limb Delayed wund healing SAUDI BOARD PLASTIC SURGERY CURRICULUM 15

18 COMPETENCIES 3) Perfrm a cmplete and apprpriate assessment f a surgical patient Elicit a histry and perfrm a physical examinatin that is relevant, cncise, and accurately cnveys the patient s cntext and preferences fr the purpses f preventin and health prmtin, diagnsis, and/r management Identify risk factrs fr disease r diagnses Identify aspects that may affect the surgical management f the patient Identify physical, mental, and psychscial issues that may impact pst-perative care Identify pprtunities fr risk management and preventin Select medically apprpriate investigative methds in a resurce-effective and ethical manner, including but nt limited t: Preperative screening tests Labratry tests and imaging Demnstrate effective clinical prblem slving and judgment t address patient prblems, including interpreting available data and integrating the infrmatin t generate differential diagnses and management plans 4) Use preventive and therapeutic interventins effectively Frmulate and implement a cmprehensive management plan in cllabratin with patients and their families fr the fllwing clinical situatins: Preperative evaluatin and ptimizatin f the patient with the fllwing cnditins: Cardiac disease Arrhythmias Ischemic heart disease Valvular heart disease Heart failure Mypathy Pulmnary disease Respiratry failure Chrnic lung disease (CLD) Kidney disease Acid base disrders Electrlyte disrders (sdium, ptassium, calcium, phsphrus, magnesium) Renal insufficiency Liver disease Cirrhsis and its cmplicatins Liver failure Endcrine disease Diabetes Thyrid disease Adrenal disrders Disrders f hemstasis Pregnancy Mrbid besity Malnutritin Patients with immunsuppressin HIV Immun-suppressant drugs Chrnic disease states 16 SAUDI BOARD PLASTIC SURGERY CURRICULUM

19 COMPETENCIES Pst-transplant states Trauma Thermal injury Majr categries f shck Infectins Unexpected periperative bleeding, bth surgical and nnsurgical in nature Prphylaxis Antibitic Thrmbemblic Immunizatin, including tetanus Demnstrate effective, apprpriate, and timely applicatin f preventive and therapeutic interventins fr pstperative management f patients with: Uneventful pstperative curse Cmplicated pstperative curse Apprach t a patient with fever Cardiac disrders Ischemia Arrhythmias Heart failure Pulmnary disease Aspiratin pneumnia Hspital-acquired pneumnia Pulmnary emblus Respiratry insufficiencies Pneumthrax Kidney disease Oliguria r anuria Renal failure Electrlyte and acid-base disrders Vascular disease: Deep venus thrmbsis Gastr-intestinal (GI) disease GI bleeding Ileus Sepsis Catheter sepsis Superficial surgical site infectin Deep surgical site infectin Cmpartment syndrmes Abdminal Limb Fat emblism Pressure sres Recgnitin f cmplicatins frm perative psitining Ensure apprpriate infrmed cnsent is btained fr therapies Ensure patients receive apprpriate end-f-life care 5) Demnstrate prficient and apprpriate use f prcedural skills Ensure apprpriate infrmed cnsent is btained fr prcedures, including the discussin f apprpriate pstperative care and issues with patients and families SAUDI BOARD PLASTIC SURGERY CURRICULUM 17

20 COMPETENCIES Pre-prcedural skills Apprpriate usage f imaging Demnstrate prficiency and selectivity in rdering apprpriate imaging tests with sufficient attentin t clinical details Demnstrate an apprach t the interpretatin f cmmn and simple imaging mdalities, including: Plain chest X-ray Plain views f the abdmen Cmmn crss-sectinal imaging Rutine trauma imaging Ultrasund Demnstrate effective, apprpriate, and timely perfrmance f a surgical prcedure while maintaining patient and team safety Apply the cncept f aseptic technique as it is used fr all prcedures Gather and manage the availability f apprpriate instruments and materials fr minr prcedures Obtain apprpriate assistance Maintain universal precautins Demnstrate understanding f the steps t take when there has been a break in universal precautins r a ptential cntaminatin Demnstrate apprpriate patient psitining Prepare the perative site Cleanse the perative site Apprpriately hand-cleanse, gwn, and glve Demnstrate apprpriate draping Deliver pre-prcedural anesthesia/analgesia if apprpriate Strictly adhere t patient safety guidelines, including the Wrld Health Organizatin (WHO) 5 steps fr patient safety in perative therapy Prcedural skills Demnstrate the applicatin f anatmic knwledge as it relates t the surgical prcedure in which the resident is participating Demnstrate apprpriate use f perative assistance Recgnize when t use perative assistance as necessary fr the safe and effective perfrmance f perative prcedures Demnstrate understanding f persnal technical limitatins Direct assistants Demnstrate effective perative assistance Demnstrate hw t prvide perative assistance as necessary fr the safe and effective perfrmance f perative prcedures Take directin frm a lead surgen Demnstrate the apprpriate use f cmmn surgical instruments, including but nt limited t needle drivers, retractrs, frceps, clamps, electrcautery, scalpel, and scissrs Demnstrate the apprpriate chice and use f suture materials Perfrm the fllwing surgical skills Incisin using sharp and energy-based instruments Knt tying Suturing Apprpriate tissue handling during surgical prcedures, paying attentin t the preservatin f tissue vitality 18 SAUDI BOARD PLASTIC SURGERY CURRICULUM

21 COMPETENCIES Blunt and sharp dissectin withut injury t adjacent structures Vascular cntrl in elective and critical situatins Clsure f simple wunds Apprpriate use f drains Applicatin f apprpriate wund dressing Urethral catheter insertin Insertin f a nasgastric tube Turniquet applicatin Splint fr bny injury r sft tissue injury Remve a superficial skin lesin Drain a superficial abscess Bipsy (the specifics f tissue type and anatmic lcatins can be designated as apprpriate t the surgical specialty and will be utlined in the relevant OTR) Secure arterial and venus vascular access in critical and nn-critical situatins Demnstrate the ability t perfrm the fllwing prcedures in critical situatins Needle thracstmy Tube thracstmy Needle cricthyridtmy Cricthyridtmy r trachestmy Central line insertin Pst-prcedural skills Preparatin and handling f specimens fr presentatin t a pathlgist Perfrm apprpriate wund surveillance and dressing care Dcument and disseminate infrmatin related t prcedures perfrmed and their utcmes, including perative reprts and ther recrds Ensure adequate fllw-up is arranged fr prcedures perfrmed Plan and discuss apprpriate pstperative care and issues with patients and families Discuss immediate and lng-term fllw-up issues with family members r medical pwer-f-attrney as apprpriate Arrange fr apprpriate pstperative resurces Cmmunicatr Definitin As a Cmmunicatr, the Surgical Fundatins resident will effectively facilitate the dctr-patient relatinship and the dynamic exchanges that ccur befre, during, and after the medical encunter. Key and Enabling Cmpetencies By the end f Surgical Fundatins training, the Surgical Fundatins resident will be able t: 1) Develp rapprt, trust, and ethical therapeutic relatinships with patients and families Effectively identify and explre issues t be addressed in a surgical patient encunter, including but nt limited t the patient s cntext and preferences, which include items t be addressed such as age, ethnicity, gender, family, and religius beliefs. Recgnize that being a gd cmmunicatr is a cre clinical skill fr surgens and that effective physician-patient cmmunicatin can fster patient adherence t treatment regimens, imprved clinical utcmes, patient satisfactin, and physician satisfactin. Establish psitive therapeutic relatinships with patients and their families that are characterized by understanding, trust, respect, hnesty, and empathy. SAUDI BOARD PLASTIC SURGERY CURRICULUM 19

22 COMPETENCIES Encurage discussin, questins, and interactin in the encunter. Engage patients, families, and relevant health care prfessinals in the develpment f a plan f care using shared decisin-making. Respect patient cnfidentiality, privacy, and autnmy. Demnstrate an understanding f the risk f breaching patient cnfidentiality as a result f new technlgies such as telehealth, internet, r digital strage and transmissin devices. Listen effectively Be aware f and respnsive t nnverbal cues Facilitate a structured clinical encunter effectively 2) Accurately elicit and synthesize relevant infrmatin and the perspectives f patients and families, clleagues, and ther prfessinals Gather infrmatin abut a disease and abut a patient s beliefs, cncerns, expectatins, and illness experience Seek ut and synthesize relevant infrmatin frm ther surces, such as a patient s family, caregivers, and ther prfessinals 3) Cnvey relevant infrmatin and explanatins accurately t patients and families, clleagues, and ther prfessinals Deliver infrmatin t patients, patients families, clleagues, and ther prfessinals in a humane manner and in such a way that it is understandable and encurages discussin and participatin in decisin-making Plan and discuss apprpriate periperative care and issues with patients and families preperatively Prvide infrmed discharge as it relates t the prcedures being perfrmed Discuss fllw-up issues with family members r medical pwer-f-attrney as apprpriate Educate the patient and family cncerning alternatives t surgical and nn-surgical care Demnstrate effective cmmunicatin using newer technlgies 4) Develp a cmmn understanding n issues, prblems, and plans with patients, families, and ther prfessinals t develp a shared plan f care Respect diversity and differences in decisin-making, including but nt limited t the impact f: Gender Religin Cultural beliefs Age Sexual rientatin Sciecnmic status Address challenging cmmunicatin issues effectively, including: Obtaining infrmed cnsent Delivering bad news Disclsing adverse events Discussing end-f-life care Discussing rgan dnatin Addressing anger, cnfusin, and misunderstanding Language barriers 20 SAUDI BOARD PLASTIC SURGERY CURRICULUM

23 COMPETENCIES Cultural differences 5) Effectively cnvey ral and written infrmatin abut a medical encunter Maintain clear, cncise, accurate, and apprpriate recrds (e.g., written r electrnic) f clinical encunters and plans Present verbal reprts f clinical encunters and plans Cllabratr Definitin As a Cllabratr, the Surgical Fundatins resident will wrk effectively as part f a health care team t achieve ptimal patient care. Key and Enabling Cmpetencies By the end f Surgical Fundatins training, the Surgical Fundatins resident will be able t: 1) Participate effectively and apprpriately as part f an inter-prfessinal and interdisciplinary health care team Describe the surgen s rles and respnsibilities t ther prfessinals Describe the elements f a gd cnsultatin Recgnize ne s wn limitatins and when help is needed frm thers Respect the rles and respnsibilities f ther prfessinals within the health care team Recgnize and respect the diversity f rles, respnsibilities, and cmpetencies f ther prfessinals in relatin t their wn Wrk with thers t assess, plan, prvide, and integrate care fr individual patients r grups f patients Arrange fr the apprpriate pstperative resurces t be available Arrange fr apprpriate pstperative allied health care assistance as necessary Wrk with thers t assess, plan, prvide, and review ther tasks, such as research prblems, educatinal wrk, educatinal prgram review, r administrative respnsibilities Participate effectively in inter-prfessinal team meetings Enter int interdependent relatinships with ther prfessins fr the prvisin f quality care Describe the principles f team dynamics in perative and nn-perative envirnments Respect team ethics, including cnfidentiality, resurce allcatin, and prfessinalism Demnstrate prgressive leadership in a health care team, as apprpriate Use a preperative team checklist t imprve patient safety 2) Wrk with ther health prfessinals effectively t prevent, negtiate, and reslve cnflicts Demnstrate a respectful attitude twards ther clleagues and members f a team Wrk with ther prfessinals t prevent cnflicts Emply cllabrative negtiatin t reslve cnflicts Respect differences and address misunderstandings and limitatins in ther prfessinals Recgnize ne s wn differences, misunderstandings, and limitatins that may cntribute t inter-prfessinal tensin SAUDI BOARD PLASTIC SURGERY CURRICULUM 21

24 COMPETENCIES Manager Definitin As a Manager, the Surgical Fundatins resident will participate in health care rganizatin, making decisins abut allcating resurces, and cntributing t the effectiveness f the health care system. Key and Enabling Cmpetencies By the end f Surgical Fundatins training, the Surgical Fundatins resident will be able t: 1) Demnstrate an understanding f the influences that affect the wrkings f the health care system at varius levels, including an understanding f: Hspital gvernance Operating rm gvernance Wrker s cmpensatin main plicies Public Health issues relating t the mandatry reprting f diseases 2) Participate in activities that cntribute t the effectiveness f their health care rganizatins and systems Participate in systemic quality prcess evaluatin and imprvement, such as patient safety initiatives Describe the structure and functin f the health care system as it relates t their surgical practice, including the rles f physicians Describe principles f health care financing 3) Manage their practice and career effectively Set pririties and manage time t balance patient care, practice requirements, utside activities, and persnal life Emply infrmatin technlgy apprpriately fr patient care Demnstrate an understanding f the intrductin f new technlgies and the need fr: Health technlgy assessment Educatin Credentialing 4) Allcate finite health care resurces apprpriately Recgnize the imprtance f just allcatin f health care resurces, balancing effectiveness, efficiency, and access with ptimal patient care Health Advcate Definitin As a Health Advcate, the Surgical Fundatins resident will respnsibly use their expertise and influence t advance the health and well-being f individual patients, cmmunities, and ppulatins. Key and Enabling Cmpetencies By the end f Surgical Fundatins training, the Surgical Fundatins resident will be able t: 1) Respnd t individual patient health needs and issues as part f patient care Identify the health needs f an individual patient 22 SAUDI BOARD PLASTIC SURGERY CURRICULUM

25 COMPETENCIES Recgnize pprtunities fr advcacy, health prmtin, and disease preventin with individuals fr whm they prvide care, such as identifying: Child abuse Elder abuse Dmestic vilence Smking cessatin Substance abuse Patient behavirs that place them at risk fr injury r disease Disadvantaged ppulatins Recgnize the imprtance f rgan transplantatin Identificatin f ptential dnrs Identify pprtunities t advcate fr apprpriate screening 2) Describe and respnd t the health needs f the cmmunities that they serve Demnstrate an understanding f hw they may affect surgical disease prevalence 3) Prmte the health f individual patients, cmmunities, and ppulatins Describe an apprach t implementing a change in a determinant f health f the ppulatins that they serve Describe hw public plicy impacts the health f the ppulatins served Describe the ethical and prfessinal issues inherent in health advcacy, including altruism, scial justice, autnmy, integrity, and idealism Appreciate the pssibility f cnflict inherent in their rle as a health advcate fr a patient r cmmunity, similar t that f a manager r gatekeeper Describe the rle f the medical prfessin in advcating cllectively fr health and patient safety 4) Prmte and participate in patient safety Describe ways t prevent injury Apprpriate safety equipment fr wrk and leisure pursuits Errr preventin system in the perating rm Schlar Definitin As a Schlar, the Surgical Fundatins resident will demnstrate a lifelng cmmitment t reflective learning, as well as the creatin, disseminatin, applicatin, and translatin f medical knwledge. Key and Enabling Cmpetencies By the end f Surgical Fundatins training, the Surgical Fundatins resident will be able t: 1) Maintain and enhance prfessinal activities thrugh nging learning Describe the principles f lifelng learning Describe the principles and strategies fr implementing a persnal knwledge management system Pse an apprpriate learning questin Access and interpret relevant evidence, including an apprpriate literature search Integrate new learning int practice Evaluate the impact f any change in practice SAUDI BOARD PLASTIC SURGERY CURRICULUM 23

26 COMPETENCIES Dcument the learning prcess using methds such as: Surgical lgs Learning prtflis 2) Critically evaluate medical infrmatin and its surces, and apply this apprpriately t practice decisins Describe the principles f critical appraisal, including statistics and epidemilgy Critically appraise retrieved evidence t address a clinical questin Discuss ways t integrate critical appraisal cnclusins int clinical care 3) Facilitate the educatin f patients, families, students, residents, ther health prfessinals, the public, and thers Describe principles f learning relevant t medical educatin Develp the skills t educate medical students, fellw clleagues, and ther health care prfessinals Identify cllabratively the learning needs and desired learning utcmes f thers Select effective teaching strategies and cntent t facilitate thers learning Effectively deliver a lecture r frmal presentatin Assess and reflect n a teaching encunter Prvide effective feedback Describe the principles f ethics with respect t teaching 4) Demnstrate an understanding f the principles f disseminatin f new knwledge Demnstrate apprpriate presentatin skills, including frmal, infrmal, and written presentatins 5) Demnstrate an understanding f the use f infrmatin technlgy t enhance surgical practice, including: Cmputers Presentatin sftware Persnal digital assistant (PDA) Simulatin and ther technlgies Prfessinal Definitin As a Prfessinal, the Surgical Fundatins resident is cmmitted t the health and well-being f individuals and sciety thrugh ethical practice, prfessin-led regulatin, and high persnal standards f behavir. Key and Enabling Cmpetencies By the end f Surgical Fundatins training, the Surgical Fundatins resident will be able t: 1) Demnstrate a cmmitment t their patients, prfessin, and sciety thrugh ethical practice Exhibit apprpriate prfessinal behavirs in practice, including hnesty, integrity, cmmitment, cmpassin, respect, and altruism Demnstrate the ability t be bjective in treating patients regardless f their sciecnmic status r ther factrs Demnstrate and maintain a cmmitment t delivering the highest quality care 24 SAUDI BOARD PLASTIC SURGERY CURRICULUM

27 COMPETENCIES Recgnize and apprpriately respnd t ethical issues encuntered in practice Manage cnflicts f interest Demnstrate an awareness f the influence f industry n practice and training Recgnize the principles and limits f patient cnfidentiality as defined by prfessinal practice standards and the law Maintain apprpriate relatinships with patients and families Recgnize the duality f being a learner as well as a practitiner Demnstrate an understanding f the rle f apprpriate supervisin 2) Demnstrate a cmmitment t their patients, prfessin, and sciety thrugh participatin in prfessin-led regulatin Demnstrate knwledge and an understanding f the prfessinal, legal, and ethical cdes f practice Fulfill the regulatry and legal bligatins required f current practice Demnstrate accuntability t prfessinal regulatry bdies Recgnize and respnd t thers unprfessinal behavirs in practice Participate in peer review 3) Demnstrate a cmmitment t physician health and sustainable practice Balance persnal and prfessinal pririties t ensure persnal health and a sustainable practice Strive t heighten persnal and prfessinal awareness and insight Recgnize ther prfessinals in need and respnd apprpriately Demnstrate an awareness f the risks assciated with the high stress envirnments in which surgens wrk Demnstrate an understanding f ccupatinal risks and their management Prmte a healthy lifestyle and demnstrate awareness f persnal at risk behavirs Substance abuse Expsure t infectin Sleep deprivatin Demnstrate an understanding f techniques fr stress reductin SAUDI BOARD PLASTIC SURGERY CURRICULUM 25

28 COMPETENCIES Demnstrate the ability t perfrm a cnsultatin, integrating all f the CanMEDS Rles t prvide ptimal, ethical, and patientcentered medical care The knwledge, skills, and attitudes underlying the basics f surgical practice in general and preparatin fr further training in plastic surgery. Establish and maintain clinical knwledge, skills, and attitudes apprpriate t surgical practice Perfrm a cmplete and apprpriate assessment f a surgical patient Use preventive and therapeutic interventins effectively Develp rapprt, trust, and ethical therapeutic relatinships with patients and families Accurately elicit and synthesize relevant infrmatin and perspectives f patients and families, clleagues, and ther prfessinals Cnvey relevant infrmatin and explanatins accurately t patients and families, clleagues, and ther prfessinals Develp a cmmn understanding n issues, prblems, and plans with patients, families, and ther prfessinals t develp a shared plan f care Participate Demnstrate an Respnd t Maintain and effectively and understanding f individual patient enhance apprpriately n an the influences that health needs and prfessinal inter-prfessinal affect the wrkings issues as part f activities thrugh and interdisciplinary f the health care patient care nging learning health care team system at varius levels Wrk with ther health prfessinals effectively t prevent, negtiate, and reslve cnflict Participate in activities that cntribute t the effectiveness f their health care rganizatins and systems Manage their practice and career effectively Allcate finite health care resurces apprpriately Describe and respnd t the health needs f the cmmunities that they serve Prmte the health f individual patients, cmmunities, and ppulatins Prmte and participate in patient safety Critically evaluate Demnstrate a medical infrmatin cmmitment t and its surces, and their patients, apply this prfessin, and apprpriately t sciety thrugh practice decisins participatin in prfessin-led regulatin Facilitate the educatin f patients, families, students, residents, ther health prfessinals, the public, and thers Demnstrate an understanding f the principles f disseminatin f new knwledge Demnstrate a cmmitment t their patients, prfessin, and sciety thrugh ethical practice Demnstrate a cmmitment t physician health and sustainable practice 26 SAUDI BOARD PLASTIC SURGERY CURRICULUM

29 COMPETENCIES Plastic surgery training (R3-6) Specific learning bjectives CanMEDS physician cmpetency framewrk Gals Upn cmpletin f training, a resident is expected t be a cmpetent specialist in plastic surgery, capable f assuming a cnsultant s rle in the specialty. The resident must acquire a wrking knwledge f the theretical basis f the specialty, including its fundatins in the basic medical sciences and research. Residents must demnstrate the requisite knwledge, skills, and attitudes fr effective patientcentered care and service t a diverse ppulatin. In all aspects f specialist practice, the graduate must be able t address issues f gender, sexual rientatin, age, culture, ethnicity, and ethics in a prfessinal manner. Junir Plastic Surgery Resident (R3 and R4) The verall bjective f this stage is t expse the resident t all fields f plastic surgery. During the first 2 years (R3 and R4), the resident will be supervised when perfrming simple and less cmplicated prcedures and allwed t participate in majr plastic prcedures. The resident will rtate fr 3 rtatin blcks in the apprved centers f the reginal prgram. The resident can rtate in the same center mre than nce, based n the requirements f the prgram and the decisin f the prgram directr. The plastic surgery R3 and R4 residents may take calls as senir r junir residents, depending n the individual center plicy. Plastic Surgery Resident (R5 and R6). At this stage the resident shuld acquire the skills and the knwledge t becme a cmpetent plastic surgen at the time f graduatin. The resident rtates fr a minimum f 6 blcks rtatins in the apprved centers f the reginal prgram. He/she can hwever, rtate in the same center mre than nce based n the requirements f the prgram. Rtatins length can be changed t 3 blcks perid if the prgram directr sees a benefit in that fr the resident. The resident shuld als fulfill the rle f the chief resident f the divisin f plastic surgery in any f the recgnized training hspital fr at least 6 blcks prir t graduatin. Plastic surgery cmpetencies At the cmpletin f training, the resident will have acquired the fllwing cmpetencies and will functin effectively as a: SAUDI BOARD PLASTIC SURGERY CURRICULUM 27

30 COMPETENCIES Medical Expert Definitin As Medical Experts, Plastic Surgens integrate all f the CanMEDS Rles, applying medical knwledge, clinical skills, and a prfessinal attitude in their prvisin f patient-centered care. The Medical Expert is the central physician rle in the CanMEDS framewrk. Key and Enabling Cmpetencies Plastic surgens are able t: 1) Functin effectively as cnsultants, integrating all f the CanMEDS rles t prvide ptimal, ethical, and patient-centered medical care Perfrm a cnsultatin effectively, including the presentatin f well-dcumented assessments and recmmendatins in written and/r verbal frm in respnse t a request frm anther health care prfessinal, including recgnitin, diagnsis, management, and apprpriate cunseling Demnstrate effective use f all CanMEDS cmpetencies relevant t plastic surgery Apply knwledge f all frms f acute and chrnic wunds and recnstructive defects in all areas f the bdy Respnd apprpriately t emergency situatins Manage the periperative and pstperative care f a patient Manage a patient s prgress thrugh the cmplexities f the health care system Identify and apprpriately respnd t relevant ethical issues arising in patient care Priritize prfessinal duties when faced with multiple patients and prblems Demnstrate cmpassinate and patient-centered care Recgnize and respnd t the ethical dimensins f medical decisin-making Demnstrate medical expertise in situatins ther than patient care, including but nt limited t prviding expert legal testimny r advising gvernments, as needed. 2) Establish and maintain clinical knwledge, skills, and attitudes apprpriate t their practice Apply knwledge f the clinical, sci-behaviral, and fundamental bimedical sciences relevant t plastic surgery. The resident will demnstrate knwledge f: PRINCIPLES OF PLASTIC SURGERY Advanced principles f wund healing Advanced principles f wund care Advanced principles f wund clsure Skin grafting Tissue grafting, including but nt limited t cartilage, bne, fat, tendn, nerve, muscle, fascia, and bld vessels Skin flaps Muscle flaps and cmpsite flaps Transplant bilgy Tissue expansin Micrsurgery Energy surces used in plastic surgery, including but nt limited t: Electrcautery Lasers Ultrasund 28 SAUDI BOARD PLASTIC SURGERY CURRICULUM

31 COMPETENCIES Radifrequency systems Standard pwer equipment, including but nt limited t: drills, saws, dermatmes, and lipsuctin devices Endscpy and ther techniques specific t plastic surgery prcedures Bimaterials, including but nt limited t: Human bld prducts Tissue allgrafts Tissue xengrafts EMERGENCY, PERIOPERATIVE, AND POSTOPERATIVE CARE Principles f: Advanced Trauma Life Supprt (ATLS) Aseptic technique and rutine precautins Lcal anesthesia Cnscius sedatin Early pstperative patient care, bth medical and surgical Establishing pririties in the care f a patient with multi-system trauma Apprpriate medical supprt and investigatin fr a traumatized patient requiring emergency surgery Apprpriate preperative investigatin and cllabratin with ther cnsultants prir t prceeding with any surgery, emergent r elective Develpment f treatment plans, including surgical and nn-surgical therapies, that recgnize the ptential psych-scial impact f the cnditin and its management n the patient and family Obtaining apprpriate infrmed cnsent frm patients and/r guardians prir t any medical r surgical treatment, emergent r elective Identificatin f pst-surgical cmplicatins, lcal and systemic, with apprpriate investigatin and the use f cnsultants t prmptly develp and intrduce treatment plans HEAD AND NECK Detailed surgical anatmy f the head and neck Principles f anatmic and functinal defects (frm all causes) f the head and neck, including but nt limited t scalp, skull, frehead, perirbital (eyelids and rbit), cheeks, nse, lips, ears, midfacial and mandibular skeletn, facial nerves, upper airway, and digestive tract Vascular and lymphatic malfrmatins f the head and neck Tumrs f the head and neck (bth benign and malignant) and their surgical and adjuvant management Infectius, inflammatry, and degenerative prcesses that cause significant dysfunctin r disfigurement in the head and neck Applicatin f aesthetic unit principles in facial recnstructin HAND AND UPPER EXTREMITY Anatmy and physilgic functin f the hand, including vascular, musculskeletal, nervus, and cutaneus systems Diagnsis and management f the fllwing cnditins: Cmmn develpmental abnrmalities f the upper extremity and their systemic assciatins Dupuytren s disease SAUDI BOARD PLASTIC SURGERY CURRICULUM 29