Third Year Curriculum

(SRGGen-32) Theory of Basic Surgical Sciences

Hours/week: one hour/week

Objective

To enable the student to achieve the terminal objectives in the final sixth year of surgical course.

1. Introduction and history
Read of scope of modern surgery, outline development milestones of surgery and development of aseptic and anti-septic surgery.

2. Wound and repair

1. Wound: definitions, types, classifications, clinical features and management.
2. Scars: definitions, types,
3. Tissue repair: definitions, pathophysiology of wound and factors affect wound healing.

3. Wound infections

1. Pathophysiology, host response, local and systemic manifestation, route of infection.
2. Type of wound infection:
3. Abscess, cellulitis and lympangitis, erysiples, boil and carbuncles.
4. Definition, clinical features and management for each type.

4. Specific infections

1. Tetanus, gas gangrene, anthrax, tuberculosis, syphilis,   necrotizing fasciitis,   bacteremia and septicemia.
2. Discuss definition, pathophsiology, clinical features, investigations, treatment    and prophylaxis

5. Fluid and electrolyte balance
Recall fluid body compartment and volume regulation, water and electrolytes balance. Causes, clinical features and management of every electrolyte derangement.

6. Acid–base balance
Recall basic definitions of PH, acid-base balance and buffering systems, describe clinical effects of acidosis and alkalosis, outline various acid-base disorders and their management, outline concept of anion gap.

7. Surgical nutrition and metabolism
Recall the essential components of normal nutrition. Indication, types and complications of enteral and parenteral nutrition. Methods of assessment of nutritional status of surgical patients. Outline the concept of nitrogen balance. Review about mediators of metabolic response to trauma and its concept and the factors affect it.

8. Shock
Classifications and grading of shock. Causes and clinical features of every type of shock outline management and monitoring procedures and methods of resuscitation.

9. Hemorrhage and blood transfusion
List different type of hemorrhage, signs and symptoms of blood loss, assessment and management of degree of acute bleeding. Outline the indication of blood transfusion, various types of blood and blood products and their transfusion complications.

10. Tumor
Definitions, classification, concept of grading and staging, etiology, pathogenesis and behavior of benign and malignant tumors. List modality of spread of malignant tumors, ways of diagnosis and screening and methods of treatment

11. Ulcers, sinuses and fistulae
Definitions, classification, causes of each item, outline the clinical features, diagnosis and line of management.

12. Diabetic foot and gangrene
Etiology including precipitating factors, pathophysiology, clinical features, classification, investigations and management.

13. Hernias
Definitions, etiology and predisposing factors, classifications, clinical features, review methods of clinical examinations, differential diagnosis, management, complications of surgery and recurrence, this scenario is applied for every type of hernia.

14. Abdominal wall
Recall surgical anatomy of abdominal wall, outline the whole aspect of abdominal dehiscence (burst abdomen), review of incisional hernias, outline diseases of umbilicus congenital and acquired, recall synergistic infection of abdominal wall and neoplasm in particular desmoids tumors, also short review about diaphragm and hiatus hernia. 

Third Year Curriculum

(SRGSrg-3C) Clinical Teaching

8 Hours/week

Objectives

1. Writing a case sheet includes notes taken from patient and examination of the patient and records the physical signs.
2. Long case examination in the ward at the end of their clinical training.
3. Encouraging students to take case histories themselves and to the clinical examination and try to correlated and bind clinical facts together by method of exclusion to reach to reach to a diagnosis.
4. Stressing on the importance of surface anatomy.
5. The first half-an-hour should be left to the students to make their own rounds and prepare cases for discussion.
6. Teaching students the method of reaching to a diagnosis, differential diagnosis and some simple investigations and training them on the organized problem solving methods.
7. Stress on general physical examination.
8. Regional examination of different parts of the  body:-
9. Head and neck including thyroid gland.
10. Chest, breast and axilla.
11. Abdomen and internal viscera.
12. Extremities, includes movements and vascular system (capillaries).
13. Sex organs, perineum and rectal examination.
14. Hernias in different parts of the body, stressing on inguinal hernias.
15. Examination of lumps, ulcers and abscesses.
16. Examination of lymphatic system  with stress on regional lymph node and areas of drainage

Third Year Curriculum

(SRGPbl) Problem Based Learning (PBL) course
(SRGPbl-32)

8 Hours/week

Mission & objectives
The mission AND objectives of the Division of Undergraduate Education is  to support and enrich the academic and clinical experiences of undergraduate third year medical students so that they succeed, thrive and surgically oriented in solving common surgical problems and their management from A to Z. This problem-based method increases students' use of resources, improves their retention of information, and helps them develop time management skills. Although the students believe that the clerkship as a whole should offer more opportunities for hands-on experience, they found the PBL component of the clerkship highly motivating, intellectually stimulating, and experimentally satisfying.

Course Curriculum, Description & Details

1. The primary teaching methodology of this course is problem-based learning (PBL). In this type of learning experience, students work with paper cases as though they were actual patients, using a method similar to that which they will later use as residents or practicing physicians.
2. The students make the decisions themselves,
3. Formulating differential diagnoses, eliciting relevant items from a history and physical examination,
4. Proceeding with a diagnostic work-up, and creating a treatment plan.
5. One of the primary features of Problem-Based Learning is that it is student-centered.  Student-centered refers to learning opportunities that are relevant to the students, the goals of which are at least partly determined by the students themselves. This does not mean that the teacher abdicates her authority for making judgments regarding what might be important for students to learn; rather, this feature places partial and explicit responsibility on the students shoulders for their own learning. 
6. Creating assignments and activities that require student input presumably also increases the likelihood of students being motivated to learn.
7. A common criticism of student-centered learning is that students, as novices, cannot be expected to know what might be important for them to learn, especially in a subject to which they appear to have no prior exposure. 
8. The literature on novice-expert learning does not entirely dispute this assertion; rather, it does emphasize that our students come to us, not as the proverbial blank slates, but as individuals whose prior learning can greatly impact their current learning.
9. Often they have greater content and skill knowledge than we (and they) would expect.  In any case, whether their prior learning is correct is not the issue.  Whatever the state of their prior learning, it can both aid and hinder their attempts to learn new information. 
10. It is therefore imperative that instructors have some sense of what intellectual currency the students bring with them.  One way to determine this is by being witness to how students go about addressing intellectual challenges, especially those that seem at variance with their current understanding.  Active, interactive, and collaborative learning, on which Problem-Based Learning is based, allows an instructor the rare opportunity to observe students learning processes.
11. The context for learning in PBL is highly context-specific.  It serves to teach content by presenting the students with a real-world challenge similar to one they might encounter were they a practitioner of the discipline.
12. Teaching content through skills is one of the primary distinguishing features of PBL.  More commonly, instructors introduce students to teacher determined content via lecture and texts.  After a specific amount of content is presented, students are tested on their understanding in a variety of ways.  PBL, in contrast, is more inductive: students learn the content as they try to address a problem.
13. The problems in PBL are typically in the form of cases, narratives of complex, real-world challenges common to the discipline being studied.  There is no right or wrong answer; rather, there are reasonable solutions based on application of knowledge and skills deemed necessary to address the issue. 
14. The solution therefore is partly dependent on the acquisition and comprehension of facts, but also based on the ability to think critically. 
15. Critical thinking refers to the ability to analyze, synthesize, and evaluate information, as well as to apply that information appropriate to a given context.  It is both critical and creative in that synthesis, in particular, requires the learner to take what information is known, reassemble it with information not known, and to derive a new body of knowledge.
16. Note that tutors not necessarily asking students to create new knowledge in the way more senior students dose; instead, asking students to create something that is at least new to them. (It is not uncommon, for even undergraduates to develop some pretty sophisticated and ingenious solutions.)
17. The instructor is not passive during student learning, but neither does he take the traditional role of sage on the stage.
18. The instructor's role can be to model different kinds of problem-solving strategies, sometimes referred to as cognitive apprenticeship learning.
19. PBL, by having students demonstrate for themselves their capabilities, can increase student’s motivation to tackle problems.

Time Table

1.  Meeting students on the basis of (1 hour weekly for a total of  12 weeks.(
2. Each problem chosen carefully from the commonest surgical cases the candidate might come across in the future.
3. At the first meeting hour the case is presented to the students with the least informative facts about the case that is enough to put the candidates in the picture via the help of the mentor.
4. Tasks will be assigned to each of the students at the first meeting
1. Anatomy related to the problem and necessary for orientation about the problem
2. Pathology and pathogenesis of the problem
3. Causes behind the problem
4. Clinical Features and Clinical signs
5. Investigations required for the problem
6. The preoperative, peroperative and postoperative management
7. The Surgical Treatment modalities and the basic surgical procedures
8. The postoperative complications that might happen after surgery
5. At the second hour meeting, the candidates should present their assignments in small groups to other student and candidates. At this time the tutor should put the informations provided by the candidates on the correct track
6. The third hour meeting is the final corrected presentation for solving each of the problems

Assessment of students

At the end of the PBL course and the presentations of problem management of each case, a final written short answer questions covering all the problems discussed of a total of 3 marks added to the 7 marks of the final clinical exam making the total clinical score of 10 marks.

Fourth Year Curriculum

(SRGGit-41) First Semester Gastroenterology

3 Hours/week

Objective
To teach the student the diseases of the gastrointestinal canal (GIT) from the mouth to the anus with the diseases of the liver and spleen, the clinical manifestation of these diseases, their investigation, diagnosis, treatment and prevention.

Subject

1. Diseases of the mouth and Tongue, Stomatitis, Gingivitis, Glossitis, ulcers, tumors, cysts
2. Esophagus. Congenital anomaly, F.B., Tumors, Surgical aspect of Achalasia, Reflux, Hiatus Hernia
3. Esophagus. Esophagitis, Dysphagia, Achalasia, Reflux, GERD, Hiatus hernia
4. Stomach and Duodenum: Acute dilatation, Surgical treatment of peptic ulcer
5. Stomach and Duodenum: Secretary tests, Radiology Endoscopy, Gastritis, Peptic ulcers
6. Tumors of stomach, post gastric surgery complications
7. Gastro-intestinal bleeding and its treatment
8. Liver: Investigations, Jaundice, Hepatitis, Cirrhosis, Portal hypertension
9. Spleen: Indications for surgery. Surgical aspect of portal hypertension
10. Liver: Injury, Abscess, Cysts including Hydatid cyst, Tumors
11. Gall bladder and Biliary tree: Investigations Congenital anomaly, Injuries, stones, Cholecystitis, Obstructive jaundice & Tumors.
12. Laparoscopy.
13. Small and Large bowel: Mal-absorption, Diarrhea, Coeliac disease, Tropical spru
14. Intestinal Lymphoma, Inflammatory bowel diseases, Irritable bowel.
15. Surgical aspect of inflammatory bowel diseases.
16. Intestinal obstruction: Types, paralytic ileus management.
17. Small Intestine fistulae, anal incontinence.
18. Mesentery and peritoneum: Peritonitis, Cysts, Subphrenic abscess.
19. Appendix: Appendicitis, Mass, Tumors.
20. Pancreas: Pancreatitis acute and chronic, cysts, Tumors Exocrine &Endocrine.
21. Benign and Malignant tumors Colon, rectum and anus.
22. Congenital anomaly of the Anus and rectum: Hirschsprung’s disease, Imperforated anus
23. Rectal prolaps, Injury, Pilonidal sinus.
24. Anal fissure, strictures, perianal abscess.
25. Hemorrhoids.

Assesment & examination

1. Midterm examination in the 7th – 8th week and it consist of 5 short assay questions for one hour. It's score is 30% of the final degree.
2. Final examination (70% of the total degree): it consist of 8 short assay questions, each one score 5 degrees (total 40% for the assay questions); and 60 most appropriate questions, each item followed by 5 statements and its score is 60% of the degree.

Fourth Year Curriculum

(SRGUro-42) Second Semester Urology

2 Hours/week

Mission

1. Definition of renal diseases, pathology, clinical presentations, diagnosis and best treatment.
2. Differentiation of renal diseases that can be treated medically from those that treated surgically, best surgical management and time to refer cases from medical to surgical therapy.

Lectures

1. Urinary tract imaging
2. Congenital anomalies of kidney and ureter
3. Congenital anomalies of urinary bladder and urethra
4. Urinary tract infections
5. Vesico - ureteral reflux (VUR)
6. Genitourinary tuberculosis and bilharziasis
7. Minimal invasive Urology; Endourology,  Laparoscopy, and
8. Robotic surgery
9. Urinary lithiasis
10. Obstructive uropathy
11. Tumors of the urinary bladder
12. Tumors of the kidney and ureter
13. Carcinoma of prostate
14. Benign prostatic hyperplasia
15. Benign disorders of the testicle
16. Tumors of the testis
17. Male infertility and sexual dysfunction
18. Renal transplantation
19. Introduction; anatomy and physiology of the kidney
20. Acute renal failure
21. Chronic renal failure
22. Nephritic and nephrotic syndromes
23. Glomerulonephritis
24. Glomerulopathies associated with systemic diseases
25. Diabetic nephropathy and hypertensive nephropathy
26. Drugs and the kidney

Assessment

1. Mid exam (25 %)
2. Short quizzes (5 %)
3. Final theory exam (70 %)
4. There is no clinical exam.

Fourth Year Curriculum

(SRGSrg-4C) Clinical Course

2 hours/day (4 days/week x 6 weeks/group)
2 groups/semester

Mission

1. To learn students clinical examinations in general surgery.
2. Discuss diseases theoretically, clinically and the best surgical management.
3. Re-training the students about taking history and refreshing what they learned in the third year.

Clinical sessions

1. Breast examination
2. Thyroid examination
3. Examination of abdomen (including liver, gallbladder, anal, spleen, intestine)
4. Hernia and haemmorhoid exam.
5. Surgical drains, ulcers,

Assessment

1. Final clinical exam at the end of course (70%)
2. Final theory exam at the end of course (15%)
3. Clinical evaluation by lecturer (10%)
4. 2 case presentations/each student (5%)

                  

Fifth Year Ophthalmology Curriculum

(SRGOpt-52) Second Semester Theory Course

2 hours/week

Objectives

1. Acquiring knowledge of the clinical anatomy of the eye.
2. to know the essentials of the common eye diseases
3. to know the basic investigations used in diagnosing eye diseases
4. to know the ways of treatment and prevention of common eye diseases

Lectures

1. Refractive errors (The optical system of the eye, myopia, hyperopia, astigmatism, anisometropia, accommodation, presbyopia, contact lenses).
2. Eye lid disorders (trichiasis, allergic eye lid diseases, eye lid infection - herpes simplex, herpes zoster, benign nodules and cysts, chalazion, stye, marginal blepharitis, malignant tumors - basal cell carcinoma, squamous cell carcinoma, melanoma,  ectropion, entropion, ptosis)
3. Orbital eye disorders (Trauma orbital hemorrhage, blow out fracture,  Infection: orbital cellulitis, preseptal cellulitis, Tumours: rhabdomyo-sarcoma, cavernous hemangioma, thyroid eye disease)
4. Conjunctival diseases (Applied anatomy ; bacterial conjunctivitis; viral conjunctivitis; chlamydial conjunctivitis; allergic conjunctivitis; conjunctival degenerations; pigmented conjunctival lesions; non pigmented conjunctival tumours).
5. Corneal and sclera diseases I (Applied corneal anatomy; bacterial keratitis; fungal keratitis; herpes simplex keratitis; herpes zoster keratitis; corneal abrasion; corneal laceration; corneal foreign body; chemical corneal injury; keratoconus).
6. Glaucoma (Definition; aqueous pathophysiology; tonometry; gonioscopy; optic nerve assessment; visual field assessment; primary open angle glaucoma; primary narrow angle glaucoma; congenital glaucoma; glaucoma medical therapy; laser in glaucoma).
7. Retinal detachment (Applied anatomy, rhegmatogenous retinal detachment, tractional retinal detachment, exudative retinal detachment, treatment of retinal detachment).
8. Corneal and sclera diseases II (Exposure keratopathy, keratoconjunctivitis sicca, keratoplasty, refractive surgical procedures, episcleritis, scleritis).
9. Retinal vascular diseases I (Diabetic retinopathy, Central retinal vein occlusion, Branch retinal vein occlusion, Amaurosis fugax, Central retinal artery occlusion).
10. Crystalline lens disorders (Pathogenesis of cataract, causes of cataract, types of cataract surgery, congenital cataract, Ectopia lentis).
11. Retinal diseases II (Hypertensive retinopathy, retinitis pigmentosa, Age related macular degeneration, myopic maculopathy).
12. Uveitis (Anatomical classification, clinical classification, etiological classification, clinical features, differential diagnosis, complications, treatment, Hyphema)
13. Neuroophthalmology I (Optic neuritis, optic atrophy, anterior ischemic optic neuropathy, compressive optic neuropathy, alcohol tobacco amblyopia, papilledema).
14. Lacrimal diseases (Applied anatomy, congenital nasolacrimal duct obstruction, dacryocystitis, canaliculitis).
15. Neuroophthalmology II (Oculomotor nerve palsy, Abducent nerve palsy, Trochlear nerve palsy, drug induced optic neuropathy).
16. Intraocular tumors (Retinoblastoma, Choroidal melanoma, Metastatic carcinoma).
17. Eye trauma (Terminology of eye trauma, general outlines of treatment, Blunt trauma, anterior segment complications of blunt trauma, posterior segment complications of blunt trauma, Penetrating trauma).
18. Squint (Introduction, infantile esotropia, accommodative esotropia, exotropia, exophoria, hypertropia, hypotropia).
19. Laser in ophthalmology (Properties of laser light, Laser tissue interaction, Choice of laser wavelength).

Assessment & Examinations

1. Midterm exam  30 degrees, including MCQ and Assay questions
2. Final exam  70 degrees, including MCQ and Assay questions

Fifth Year Ophthalmology Curriculum

(SRGOpt-5C) Second Semester Clinical Course

27 hours/3week

Objevtive

1. The student should become familiar with the clinical anatomy of the eye.
2. To know the different eye examination instruments and how to use them e.g. the ophthalmoscope and the slit lamp.
3. To recognize the important eye diseases, their way of presentation and the basic steps in treatment.
4. At the end of the course, the student should have acquired the basic skills in eye examination and to recognize the different signs of eye diseases.
5. The student should also witness one minor and one major live eye surgery during the course.

Skills to be acquired

1. Eye examination by the Slit lamp
2. Retinal examination by the direct ophthalmoscope
3. Examination of ocular movement

Procedures to be witnessed

1. Minor surgical procedure: chalazion removal
2. Major procedure : cataract removal
3. Intraocular pressure measurement by tonometry
4. Refraction

Cases to be seen

1. Conjunctivitis
2. Keratitis
3. Uveitis
4. Cataract
5. Squint
6. Glaucoma

Topic discussion

1. Red eye
2. Diabetic retinopathy
3. Trauma

Student assessment and examination

1. There is a check list of the topics that the students should know.
2. At the end of the course there is an oral exam including few OSCE slides.

Fifth Year Radiology Curriculum

(SRGRad-52) Second Semester Theory Course

2hours/week

First: Radiodaignosis & imaging (26 lectures).
Second: Radiotheray & isotopes (3 lectures).

Objectives

1. To demonstrate the physical principles of radiation, its biological effects with respect to its hazards & protection.
2. To demonstrate the physical principles of ultrasound & MRI.
3. To know the normal radiographic anatomy & the normal variants & how each body system is approached radiologically.
4. To know how to make proper request for radiological investigations.
5. To know the different available radio-diagnostic imaging modalities in respect to their values & limitations.
6. To learn the appropriate preparation of the patients undergoing radiological investigations.
7. To know the indications, limitation, contraindications of the common radiological investigations.
8. To know the appearances of the radiological changes of the different diseases of the body.
9. To know the applications of the radiological investigations at each system of the body including the contrast media.
10. to learn the most economical approaches (quick, least hazardous, easy, & may be less invasive investigations) to reach the diagnosis of different diseases & their follow up before going up to the most sophisticated investigations if needed.
11. To know the usage of radiological facilities in therapeutic procedures (interventional radiology).

Lectures

1. Introduction

1. Aims & objectives of radiology.
2. The imaging department.
3. Basic principles of X-ray, ultrasound, radio-nuclide imaging, CT & MRI.  
4. Indications, limitations, & contraindications of x-ray, ultrasound, radionuclide imaging, CT & MRI.
5. Contrast medium used in radiology.
6. X-ray hazards & radiation protection.

2. Respiratory system I, II, III

1. Radiological anatomy of the lungs.
2. Investigations in chest diseases.
3. Chest x-ray technique & procedure, interpretation of normal chest x-ray.
4. Diseases of the chest with normal chest x-ray.
5. Radiological signs of lung disease (Silhouette sign, air space filling, pulmonary collapse, spherical shadows, cavitation, calcification, hilar enlargement, line & widespread shadows).
6. Diseases of the pleura.
7. Diseases of the mediastinum.
8. specific lung diseases (pneumonia, Lung abscess, Pulmonary TB, Pulmonary Hydatid, Diseases of the airway, Pulmonary embolism, Bronchogenic carcinoma, Pulmonary metastases, Pulmonary lymphoma, RDS & ARDS, Chest trauma, Radiation pneumonitis, Cystic fibrosis).
9. Diseases of the diaphragm.

3. The cardio-vascular system I, II

1. Investigations of the cardiovascular system.
2. Radiological evidence of heart disease: (Heart size & shape, evidence of pericardial disease, pulmonary vessels).
3. Specific heart disease (Heart failure, Valvular heart disease, ischemic heart disease, congenital heart disease).
4. Diseases of the aorta.
5. Dextrocardia.

4. Plain abdomen

1. General considerations.
2. Normal findings in plain abdominal films.
3. Interpretation of abnormal plain abdominal film: (Bowel dilatation, Gas outside bowel lumen, Ascitis, Abdominal calcifications).

5. Gastro-intestinal tract I, II

1. Normal radiographic anatomy.
2. Types of contrast study of the GIT
3. Specific radiological terms in GIT diseases.
4. Diseases of the esophagus.
5. Diseases of the stomach small bowel.
6. Diseases of the large bowel.

6. Liver, spleen & pancreas

1. Normal radiographic anatomy & investigations of hepatobiliary system.
2. Diseases of the liver & biliary system.
3. Radiological investigations of the spleen.
4. Radiological investigations & diseases of the pancreas.

7. Peritoneal cavity & retroperitonium

1. Diseases of the peritoneum (ascitis, peritoneal tumors, intra-peritoneal abscesses)
2. Investigations of the retro-peritoneum.
3. Diseases of the retro-peritoneum (retro-peritoneal lymphadenopathy, disease of the adrenal gland, retro-peritoneal tumors, aortic aneurysm, retro-peritoneal hematoma, retro-peritoneal & psoas abscesses)

8. Urinary tract I, II

1. Investigations of the urinary tract
2. Urinary calculi & Nephrocalcinosis.
3. Urinary tract obstruction.
4. Renal paranchymal masses (simple renal cyst, Angiomyolipioma, Renal cell carcinoma).
5. Urothelial tumor.
6. Infection (acute & Emphysematous pyelonephritis, Renal & perinephric abscess, Pyonephrosis, Renal TB, Chronic pyelonephritis).
7. Vesico-ureteric reflux.
8. Renal trauma.
9. Chronic renal failure.
10. Congenital variation of the urtinary tract.
11. Diseases of the UB, diseases of the prostrate, diseases of the Urethra.
12. Diseases of the Sacrotum & testes.

9. Female genital tract

1. Investigations & normal radiographic anatomy.
2. Specific diseases of the female genital tract (ovarian masses, uterine masses, pelvic inflammatory disease, endometriosis).
3. Ultrasound appearance of normal uterine pregnancy.
4. Ectopic pregnancy.

10. Breast imaging

1. Investigations of breast.
2. Normal radiographic anatomy.
3. Specific diseases of the breast (simple cyst, fibroadenoma, breast carcinoma).

11. Radiology of bone diseases I, II, III

1. Plain radiographic Signs of bone diseases
2. Classification of bone diseases.
3. Radiological assessment of solitary bone lesion.
4. Malignant bone tumors: (Osteosarcoma, Chondrosarcoma, Ewing s sarcoma, Giant cell tumor).
5. Benign tumors & tumor like lesion.
6. Bone infection (Osteomeylitis, TB).
7. Multiple focal bone lesions (bone metastases & multiple myeloma).
8. Generalized decrease in bone density.
9. Generalized increase in bone density.
10. Acromegally.
11. Radiology of bone trauma.

12. Radiology of joint diseases

1. Imaging techniques of joint diseases.
2. Plain radiographic Signs of joint diseases
3. Arthritis (rheumatoid arthritis, osteoarthritis, pyogenic arthritis).
4. Avascular necrosis.

13. Radiology of the spine I, II

1. Imaging investigations of the spine
2. Anatomical review.
3. Plain radiographic Signs of spinal abnormality.
4. Specific diseases of the spine: (Metastases, lymphoma & Myeloma, spinal infection, spinal trauma, degenerative disc disease, Spinal stenosis, Ankylosing spondylitis, Spinal dysraphysim, spinal cord compression).

1. Skull & brain I, II
2. Imaging investigations of the skull & brain
3. Normal radiographic anatomy of the skull & brain.
4. Specific brain disorders: (brain tumors, stroke, infection, multiple sclerosis).
5. Radiology of head injury.

15. Sinuses, orbit & neck I, II

1. Imaging techniques & diseases of the para-nasal sinuses.
2. Imaging techniques & diseases of the orbit.
3. Imaging techniques & diseases of the salivary glands.
4. Imaging techniques & diseases of the thyroid & para-thyroid gland.

16. Angiography

1. Definition, indications, principles & complications of arteriograpy.
2. Indications of venography.
3. Specific vascular disorders (Aneurysms, Atheroma, arterio-venous fistula & malformation, Stenosis & Fibromuscular hyperplasia, Thrombosis & Embolism, vascular Tumors).

1. Interventional radiology
2. Vascular interventional procetures.
3. Percutaneous needle biopsy.
4. Percutaneous drainage of abscess & fluid collections.
5. Interventions in urinary obstruction.
6. Interventions in biliary obstruction. 

Assessment:

1. Midterm exam.
2. daily unexpected  quizzes

Fifth Year Radiology Curriculum

(SRGRad-5C) Second Semester Clinical Course

45 hours (3hours/week)

Session 1: Introduction

• Introduction to the radiology department.
• Clinical tour in different units of the radiology department (conventional x-ray, digital x-ray, contrast studies, U/S, CT & MRI).
• Review of the basic principles of each unite.

Session 2 & 3: Chest

• Position, technique & views of the chest x-ray.
• Interpretation of normal chest x-ray.
• Clinical discussion of different pathological conditions of the chest with their x-ray & other imaging appearances:

-Lobar & bronchopneumonia.
-Pulmonary TB.
-Pleural effusion.
-Pneumothorax.
-Emphysema & chronic bronchitis.
-Carcinoma of the bronchus.
-Pulmonary metastases.
-Mediastinal masses.
-Heart failure.
-Valvular heart disease.
-Pericardial disease.

Session 4: Plain abdomen

• Position & technique plain abdominal x-ray.
• Interpretation of plain abdominal films.
• Clinical discussion of different pathological conditions of the chest with their x-ray & other imaging appearances:

-Pneumoperitoneum.
-Intestinal obstruction.
-Paralytic ileus.

Session 5 & 6: GIT

• Contrast studies of the GIT, contrast medium used, preparation, way of examination & contraindications of each study.
• Normal radiographic anatomy of the GIT.
• Radiological signs of GIT diseases in contrast studies.
• Clinical discussion of different pathological conditions of the GIT with their x-ray & other imaging appearances:

-Esophageal strictures.
-Esophageal carcinoma.
-Gastric & duodenal ulcers.
-Gastric carcinoma.
-Small & large bowel strictures.
-Intestinal TB.
-Ulcerative colitis & crohn s disease.
-Radiation colitis.
-Colonic carcinoma.

Session 7: Biliary system

• Different radiological procedures in the hepato-biliary system (PTC, T-tube cholangiogram, ERCP, & MRCP).
• Radiological signs of bilairy dilatation.
• Clinical discussion of different pathological conditions of the biliary system with their x-ray & other imaging appearances:

- Radio-opaque & Radio-lucent stones.
-Gas in the biliary system.
-Carcinoma of the pancreatic head.

Session 8: Urinary system

• KUB: way of examination & interpretation.
• IVU: preparation, techniques, contrast medium used, preparation, way of examination, contraindications & interpretation of IVU.
• Clinical discussion of different pathological conditions of the urinary with their x-ray & other imaging appearances:

-Radio-opaque & radio-lucent renal, ureteric & bladder stones.
-Hydronephrosis.
-Common congenital anomalies.
-Solitary kidney.
-Csytography, ascending urethrography & voiding cysto-urethrograhy: way of examination & clinical applications.
-Vesico-ureteric reflux.
-Double J stent.

Session 9: Female genital tract

• Hystero-salpingography: methods of examination interpretation of normal & abnormal films.
• Mammography of the female breast: technique & interpretation of normal & abnormal films.

Session 10 & 11: Bone & joints

• Plain x-ray: views taken & way of interpretation.
• Radiological description of bone lesion.
• Clinical discussion of different pathological conditions of the bone with their x-ray & other imaging appearances:

-Periosteal reaction & bone infection.
-Bone tumors
-Special types of fractures (avulsion, pathological, Salter_Harris fractures).
-The most common joint diseases.

Session 12: Brain

• Different radiological procedures in the skull & brain (Plain x-ray, CT, MRI).
• Clinical discussion of different pathological conditions of the brain with their x-ray & other imaging appearances:

-Head injury.
-Cerebral infarction.
-Cerebral hemorrhage.
-Extra-dural, sub-dural & sub-arachnoid hemorrhage.
-Common brain tumors.
MRA & MRV of cerebral vessels.

Session 13: Spine

• Radiological procedures of the spine (x-ray, MRI).
• Radiological anatomy of the spine.
• Clinical discussion of different pathological conditions of the spine with their x-ray & other imaging appearances:

-Spinal infection.
-Spinal fractures.
-Degenerative disc disease.

Session 14: Ultrasound

• Normal abdominal Ultrasound examination.
• Clinical discussion of different pathological conditions of the abdomen in U/S examination:

-Hepatomegally & spleenomegally.
-GS & renal stones.
-Ascitis.
-Hydronephrosis.
-Para-aortic lymphadenopathy

Session 15: MRI

• Basic principles of MRI.
• Parameters of MRI (T1WI, T2WI, proton density WI).
• Sequences of MRI (spine echo, gradient echo, inversion recovery, fat suppression, FLAIR).

ASSESSMENT
Final slide examination at the end of the course.

Fifth Year ENT Curriculum

(SRGEnt-51) First Semester Theory Course

24 hours (1hour/week)

Lectures & Syllabus

1. Surgical anatomy and applied physiology of the nose paranasal sinses.
2. Radiology and endoscopy of the nose and paranasal sinuses.
3. Congenital malformation and injuries of the nose and paranasal sinuses.
4. Infection of the nose and paranasal sinuses and their management
5. Nasal allergy and vasomotor rhinitis.
6. Epistaxis.
7. Tumors of the nose and paranasal sinuses.
8. Surgical anatomy and applied physiology of pharynx and esophagus.
9. Inflammation of the mouth and pharynx.
10. Ulcers.
11. Tonsillitis and Adenoid is-Adenoid hyper atrophy.
12. Tonsillitis and Adenoidectomy, indications and complications.
13. Tumors of the nasopharynx and hypopharynx-Dyspagia.
14. Surgical anatomy and applied of the Larynx.
15. Congenital malformations and injuries of the Larynx.
16. Acute and chronic Laryngitis.
17. Hoarseness.
18. Stridor.
19. Tumors of the Larynx.
20. Lump in the Neck.
21. Surgical anatomy of the ear –labyrinth.
22. Physiology of hearing and vestibular system.
23. Hearing impairment and audio logical assessment.
24. Vertigo and neurological assessment
25. Congenital malformation, trauma and neoplasm of the ear.
26. Otitis media Acute, chronic and secretory.   
27. Complications of the middle ear infections
28. Principles of middle ear surgery.
29. Otosclerosis.
30. Mienier's disease.
31. B.P.P.V
32. Vestibular neuronitis  

Assessment

• Mid-term exam 30%
• Final exam (MCQ & ASSAY)70%

Fifth Year ENT Curriculum

(SRGEnt-5C) First & Second Semester Clinical Course

3 hours/day x 5 days/3week/group

The Course

• Details about the E.N.T History ,clinical examination & short notes about ENT instruments: All students receive a topic for PB
• Qine a chance for the entire student to carcinoma an ENT pallet.
• Qine short note about the importance of audiometer & the clinical the produce of  the end of the 3rd week  a full clinical armament of each student done by:
• Short care armament.
• Instrument ant.
• Oral extermination.   
• Clinical approaches. 

Assessment:

Clinical case discussion at the end of the course(100%)

Fifth Year Surgical Emergency Curriculum

(SRGSub-52) Second Semester Clinical Course

30 hours (2 hours/week)

Objectives

• Student will be oriented about variable surgical emergencies, their management, and complication.
• How to deal with traumatized patients.

Topics
1. Anesthesia (3 lectures)

• Introduction, Types of anesthesia, general, local and regional, mode of action of anesthesia.
• ASA (American Society of Anesthesiologists classification)
• Pre medications, Induction of anesthesia, maintenance and recovery.
• Monitoring tools, Endotracheal intubation, Regional anesthesia indications and contraindications.
• Recovery  room, Post operative care, Post operative complications
• Intensive care unit
• Pediatric anesthesia

2. Head and spine injury (2 lectures)

• Introduction and definitions
• Pathology of injury
• Classification and types
• Management including diagnosis, assessment and treatment whether medical or surgical.

3. Cardiothoracic surgery (7 lectures)

A. Vascular trauma

• Peripheral vascular anatomy
• Types of trauma
• Soft signs and hard signs
• Clinical examination, investigation and management
• Types of surgery
• Squally of trauma

B. Chest trauma

• Types of trauma
• Incidence
• Classification according to the organ of the chest
• Rules of management
• Indications of surgery
• Complications of the chest trauma

C. Venous diseases

• Venous ulcer, definition, etiology, investigations, management, indications for surgery
• Varicose vein, definition, etiology clinical examination investigations , management, types of surgery and complications
• Deep venous disease, deep veins thrombosis, definition, etiology, clinical examination, investigations, prophylaxis, therapeutic modalities, complications.

D. Lymphatic disorders

• Surgical anatomy, physiology, lymphatic infections, lymphadema (causes and types), clinical examination, investigations, management, indication for surgery and complications.

E. Gangrene

• Definition, etiology, clinical examination, investigations management, types of amputation.
• Sympathectomy, types of sympathectomy cervical and lumber, indications and contraindications

F. Abdominal aortic aneurysm

• Definition, types, incidence, presention, investigations, management, types of surgery, complications of AAA, complications of surgery.

4. Urological trauma (2 lectures)

A. Trauma to the upper urinary tract (kidney and ureter).

Objectives
The student should:
1. Define the Golden Hour and its surgical importance in multiple trauma patients.

• List the types and mechanisms of renal /or ureteral trauma.
• Define the grading system of renal trauma.
• State the clinical presentations, diagnostic features, and management of renal /or ureteral trauma in the setting of multiple trauma.  
• Describe the surgical goals, indications and principles of renal /or ureteral trauma in the setting of multiple trauma.  
• Determine the early and late complications of renal /or ureteral trauma.

B. Trauma to the lower urinary tract (urinary bladder and urethra).

Objectives
The student should:

• Describe essential anatomical facts of urinary bladder and urethra in male and female that are related to trauma settings.
• List the types and mechanisms of urinary bladder and urethral trauma.
• State the clinical presentations, diagnostic features, and management of urinary bladder and urethral trauma in the setting of multiple traumas.
• Describe the surgical goals, indications and principles of urinary bladder and urethral trauma in the setting of multiple traumas.
• Determine the early and late complications of urinary bladder and urethral trauma.

5. Plastic surgery (3 lectures)

A. Burn injuries

• Definition, etiology (physical, chemical), pathology, local and systemic effects, burn severity and depth, indication for hospital admission, management, complications, surgical management

B. Pressure sore

• Definition, epidemiology, etiology, pathophysiology, clinical features and staging, management, complications,

C. Skin graft and flaps

• Wounds, methods of closure of skin defects, wound healing by repithelialization, skin grafts (definition, classification, uses, and methods of retrieving, donor sites, care and survival)
• Skin flaps(definition, types, uses, methods of retrieving)

6. Head and neck surgery (2 lectures)

• Anatomy and triangles of the neck, cervical lymphadenopathy, thyroglossal cyst, branchial cyst, cystic hygroma, pharyngeal pouch, carotid body tumor,
• Salivary glands, anatomy, pathology, infections, tumors and surgical management

7. Breast surgery (3 lectures)

• Anatomy physiology, congenital diseases, inflammatory conditions, benign lesions, malignant breast diseases, male breast diseases

8. Multi injured patient (1 lecture)

• Definition, mechanism of injury, ATLS (first aid, secondary aids, tertiary aids), triage.

9. Abdominal trauma (2 lectures)

• Mechanism of injury , resuscitation, definite management (liver spleen, bowel, mesentery, retroperitoneal injuries) complications

Assessment

• Mid-term exam 30%
• Final exam 70%

Fifth Year Orthopedic Curriculum

(SRGOrt-51) First Semester Theory Course

30 hours (2 hours/week)

Objectives

• Upgrade student’s knowledge about orthopedic diseases and fractures including pathology and causes.
• Identify best way of diagnosis and treatment of different pathologies
• Improve student’s skills in diagnosing and solving problems.

Topics

1. Fractures and Joint Injuries

• The management of major injuries
• Principle of fractures.
• Injuries of the shoulder, upper arm and elbow.
• Injuries of the forearm and wrist.
• Hand injuries.
• Injuries of the spine.
• Injuries of the pelvis.
• Injuries of the hip and femur.
• Injuries of the knee and leg.
• Injuries of the ankle and foot.

2. General Orthopedics

• Orthopedic diagnosis.
• Infection.
• Rheumatic disorders.
• Crystal deposition disorders.
• Osteoarthritis.
• Osteonecrosis and related disorders

3. Orthopedic surgery

• Acute Osteomyelitis
• Genetic disorders
• Rheumatic disorders
• Hand congenital and acquired deformities
• Neuromuscular disorders
• Congenital foot deformities
• Chronic Osteomyelitis
• Crystal deposition disorders
• Peripheral nerve injuries
• Wrist disorders
• Metabolic and endocrine disorders
• Elbow disorders
• Hip disorders
• Bone Tumors
• Shoulder and pectoral girdle disorders
• Bone Tumors
• Hand disorders
• Cervical disorders
• Scoliosis and kyphosis
• Knee disorders
• Intervertebral disc prolapsed
• Orthopedic operations
• Knee joint swelling
• Hand infections
• Torticolis
• Deformities of toes
• Soft tissue tumors
• Ankylosing spondylitis
• Spondylolysthesis

Assessment

• Short unexpected quizzes.
• Mid-term short assay exam.
• Final exam (single choice questions)

Fifth Year Orthopedic Curriculum

(SRGOrt-5C) Second Semester Clinical Course

45 hours (3 hours/week/group)

Objectives
The students able to diagnose and deal with different fractures in the emergency conditions, different orthopaedic diseases and pathologies, peripheral nerves, and spinal disorders.

Topics

• Radiology slides and Oral discussion:
• Common Skeletal Trauma
• Medical Training in consultative clinics
• Discussion about common problems in bone and joint injuries: e.g. Open fractures, wound types, and muscular injuries
• Conservative and surgical treatment methods of fractures
• Fractures complications and treatment
• The inflammations in orthopedic and fractures surgery: Signs, Investigations,
• Treatment methods and complications
• Common cases in orthopedic and fractures: DDH, Congenital foot anomalies…
• Clinical tour in orthopedic and fractures ward
• A tour in Emergency room
• Clinical assessment for the end of training

Assessment
Clinical exam at the end of the course.

Sixth Year Clinical Training Curriculum
(SRGSrg-6C)

1.5 hour clinical attachment & lecturers in the ward/day
4 hours clinical round & discussion with lecturers in groups/day

Objectives

Candidates should acquire

• A basis of essential factual  knowledge and understanding of principles related to the structure and function of the human body;
• An understanding of principles in the analysis of human behavior and social function in relation to health and disease;
• A capacity to apply scientific knowledge and attitude in the analysis of problems at each stage of the educational process;
• A capacity and motivation for continuing  independent learning;
• An understanding of disease process and mechanism in structural and functional terms together with a grasp of their clinical manifestations and treatment;
• Essential skill and acquisition and interpretation of clinical observation ;
• A capacity to communicate with patients and relatives, with medical colleagues and members of other health professions ;
• An understanding of professional responsibility in relation to individuals and the community.
• It is also that many fields of basic endeavor exist in surgery; gastrointestinal surgery, cardiovascular surgery, neurosurgery, urology, orthopedic surgery. On the other hand, there are some areas such as general field of trauma and response to injury.

Goal
Ultimately, the broad goal of surgical education must be to provide personnel to meet the community needs in the area of health care. In common practical clinical situations, the new graduate should be ready, by personal intervention, to avert disaster. The graduate should be able to decide upon and implement management that will avoid unnecessary disability or loss of life, but would not be expected to undertake continuing sole responsibility for complex management problems.
The graduate should assume the role in the first instance in the hospital environment, to provide sufficient factual knowledge and practical skills to enable the recognition of clinical problems and to allow correct decision to be made about management in the great majority of cases.

Fundmentals & requirments
In order to achieve these objectives, the candidates should be able to demonstrate an understanding of the basic surgical principles and of general and specific topics in surgery;

• Demonstrate an ability to take a good history and to elicit physical signs. The candidate should be able to record this information in a lucid way and keep the surgical record of the patient so that its contents are readily appreciated. The candidate should specify any important problems that need attention and develop appropriate plans for management. The candidate must demonstrate a particular continuing concern for the patient's progress, and an awareness of the specific effects of investigations and therapy.
• Understand the principles underlying the healing of wounds their care and protection.
• Having a working knowledge of the role of asepsis, antisepsis, antibiotics and surgical intervention in the management of those infections that may occur in the surgical ward. The candidate must understand the problem of wound infection, how it may be prevented, and the principles of treatment if it does occur.
• Have a clear understanding of the general metabolic response to injury.
• Have a working knowledge of fluid and electrolyte balance so as to be able to anticipate and correct fluid problems in patients. The candidates must be experienced in the setting up insertion and maintenance of intravenous infusions.
• Understand the principles of homeostasis and the indications for the transfusion of blood and other osmotic reactive fluids, and must know the complications of such infusions.
• Understand the problem of shock from any cause, particularly those related to hypovolemia and sepsis.
• Have a clear plan for resuscitation practices to be employed in the emergency department and elsewhere in the hospital.
• Have an understanding of both local and general anesthesia and the management of the unconscious and multiple trauma patients. The candidate must know how to maintain an airway and must understand the problems of artificial ventilation. The candidate should understand thoroughly the pre, perioperative, and postoperative management of patients. The candidate should know which tests are essential for the procedure being planned, and should ensure that these are performed and the results appreciated before operation. The candidate should be able to manage the immediate postoperative care of most patients. The candidate should understand the principles of pain relief in both the acute and chronic situations.
• Understand the management of common fractures and dislocations.
• Be able to undertake the care of patients with burns both in the emergency department and the wards.
• Understand the significance of nutrition in surgical patients. In particular, the candidate must understand how and when feeding may be introduced following surgery and the indications for and problems associated with enteral and parenteral feeding.
• Be aware of principles of surgical research, and should have an understanding of experimental design and of the principles behind clinical trials.
• Have a good knowledge of both benign and malignant disease of the breast.
• Have a working knowledge of those endocrine conditions which may influence surgical procedures or which may require surgical procedures for their treatment. In particular the management of diabetes in relation to surgery, and the complications.
• Have a particular knowledge of the disorders affecting the gastrointestinal tract. The candidate must appreciate those problems that may present as an acute abdomen. The candidates must understand the investigations of such patients and the preparation necessary for procedures such as open surgery, laparoscopy, gastrointestinal endoscopy and radiology. The candidates must understand the management of nasogastric tubes and drain tubes, and must be able to introduce such tubes in patients.
• Understand the principles of thoracic surgery, with particular reference to chest injuries and their management. The candidates should be able to introduce intercostal catheters and manage underwater surgical drains.
• Understand the principles of cardiac surgery.
• Have a working knowledge of peripheral vascular surgery in relation to both venous and arterial disease. This includes investigations, management of vascular emergencies and diabetic angiopathy.
• Have a working knowledge of the common urological problems, and should understand the pathogenesis and management of urinary tract obstruction, infection and calculus. The candidate must be able to introduce urethral catheters and should understand the principles of prolonged catheter drainage.
• Have a sound knowledge of the principles of neurosurgery. The candidate should have an understanding of the neurosurgical observations related to pathological processes of head injury, spinal cord injuries and their manifestations and management.
• Have knowledge of the principles of plastic and reconstructive surgery.
• Develop a good knowledge of the common diseases of the Ear, Nose and Throat, and competent be competent in the examination of this area, understanding problems, diagnosis and management of infections and tumors of the region.
• Develop a sound knowledge of the common diseases affecting the Eye.

Curriculum

A. PROGRAME DURATION (Time Table)

Candidates should have a 15 weeks full time surgery practice as a mandatory requirement:

• Six weeks attending, working and training at the General Surgery Ward.
• One week attending, working and training at the radiology ward
• Two weeks attending, working and training at the Urosurgery Ward.
• Two weeks attending, working and training at the Orthopedic Surgery Ward.
• One week attending, working and training at the Neurosurgery Ward.
• One week attending, working and training at the cardiothoracic surgery Ward.
• One week attending, working and training at the anesthesia & respiratory Care Unit.
• One week attending, working and training at the Emergency department and training life support skills.

B. RESPONSIBILITIES & REQUIRMENTS

• Candidates allocated to number of beds and will be responsible for the patients admitted.
• A full history, examination, investigations and plan for each patient should recorded in each patient records and data.
• Participate in preparing patients for surgery and post operative care.
• Play an active role in management of patients treated conservatively.
• Presentation of the cases at the morning rounds and their progress to the clinical tutor daily.
• Attending the surgery outpatient clinic and help managing patients once weekly and assist in the bed side investigations and minor surgeries.
• Have to attend the major surgery theater once weekly for learning the antiseptic technique, theater discipline and be familiar with the operative skills.
• Candidates have to work with interns and assist them at the emergency room once per week
• Each candidate assigned a seminar subject and has to do the presentation and attend other seminars presentations.
• Candidates have to attend and participate in the discussion at the scientific meetings held by the department of surgery:

• Surgical pathology monthly.
• Mortality conference monthly.
• Journal club meeting monthly.
• Clinical interesting case presentation weekly.
• Daily morning meeting.

THE SURGERY RESEARCH PROGRAME

General Objective

The candidates should have an understanding of the contributions made by surgical research to current practice, and should be aware of current research activities in the surgical field.

Specific Objectives

The candidate should have a general understanding of:

• the nature of surgical research, including the definition of the problems and objectives, the design of research protocols, and the methods of analysis of work performed
• clinical trials as scientific experiments, including trial design, data handling and interpretation, and application of trials in clinical practice and the effects of clinical experimentation
• The value of surgical journals, including the ability to undertake a critical assessment of scientific papers and to retrieve surgical information.

THE RESEARCH SURGICAL ETHICS AND DISCIPLINE

This course fosters professional development, strengthens ethical sensitivity and reasoning ability, and enhances knowledge and understanding of the complexities of existing ethics guidelines. This course focuses on the role of human participants and the intersection of research with clinical practice and public health. Students participate in therapeutic misconception, cultural and socioeconomic factors that bear on international research collaborations. The ethics of authorship and plagiarism are explored. The course expands upon required curriculum, enabling students to gain substantial insight into research ethics. Students responded favorably to the initial offering of the course.

COMMUNICATION SKILLS

Much of the art of surgical practice lies in communication. Candidates who communicate well are able to identify a patient problem more rapidly and accurately.
These should include:

• Maintaining good eye contact.
• Checking the patient's prior knowledge or understanding.
• Active listening.
• Encouraging verbal and non-verbal communication.
• Avoiding jargon.
• Eliciting and addressing the patient's agenda.
• Ability to discuss difficult issues.
• Going at a pace that is comfortable for the patient.

SURGICAL CLINICAL ETHICS

Candidates should be aware of areas of ethics, which are;

• Clinical ethics, deal with the relationship between clinicians and individual patients.
• Public health ethics deal with the health issues of groups of people-the community.
• Research ethics deal with issues related to clinical research.

SURGICAL PRACTICE EDUCATIONAL SEMINARS

A core requirement for candidates - This seminar exposes the student to the skills and strategies needed for successful understanding by investigating a wide variety of educational topics. Seminar presentations and discussions of topics essential to enhancing the awareness and professional success of students roles and responsibilities, teacher- student relations, preparing effective presentations and effective teaching.

ASSESSMENT AND EVALUATION 
A. At the end of the surgical course training

• Short cases examination of at least four cases including general surgery patients and other major  branches of surgery
• Written single choice examination of a total of 25 stems covering all branches of surgery.
• Objective Structural Clinical Exam (OSCE), a ten stations exam covering all branches of surgery.

This examination makes 20% of the total mark.

B. Final Examination at the end of the year

• Short cases examination of at least four cases including general surgery patients and other major branches of surgery (20%)
• Written exam (20%)
• Written single choice examination covering all branches of surgery of a total of 60 % of the final written exam score.
• Written clinical cases examination of a total of 40% of the final written exam score.
• Objective Structural Clinical Exam (OSCE), a ten stations exam covering all branches of surgery (20%)
• Oral exam by a committee including Examiners from all the major and subspecialties related to surgery (20%)

These final tests make 80% of the total final score.