Fundamentals of Surgery Curriculum

What is the Fundamentals of Surgery Curriculum?

A program of the Division of Education, the Fundamentals of Surgery Curriculum is an interactive, case-based, online course designed for PGY-1 residents. 

The Fundamentals of Surgery Curriculum was initiated as a program of the Division of Education of the American College of Surgeons to present a basic surgical curriculum for all first-year surgery residents.

In the virtual environment of this case-based, interactive course, learners manage real cases, explore and perform a variety of diagnostic and therapeutic options, tasks, and are guided through a safe and effective way of managing the problems they will confront in real life practice. Safe practice in a virtual environment allows learners to experience a wider range of cases than they encounter in their individual institutions within the constraints of the work-hours restriction.

Release date to be announced soon.

Why should a Residency Program use the Fundamentals of Surgery Curriculum?

Working in this virtual environment

• builds confidence in PGY-1 residents
• allows residents to experiences cases in a virtual environment before encountering them in their practice
• creates communities of learners who have “experienced” the same cases
• provides material to supplement a program’s other education curriculum
• exposes residents to cases they may not encounter during their training
• can be done anywhere, at any time, on any computer that has Internet access
• provides a way for program directors to track the progress of their residents

What will the residents be required to do in the Fundamentals of Surgery Curriculum?

Residents will be required to manage problems normally encountered in the daily work of a first year surgical resident, including intra-abdominal hemorrhage, nausea, chronic pain, ventilator dependency, and altered mental status. They have access to information in the patient’s virtual chart (items that would be expected to be in the patient’s chart). Information obtained in taking a history and performing a physical examination, in addition to results of ordered tests, is stored in the virtual chart that can be be accessed at any time during the scenario. 

Feedback is provided for each response, providing case-specific information and containing educational material to further enrich the experience. For example, if an incorrect diagnosis is chosen, an explanation is given about what the resident has learned in the course of the evaluation that excludes that diagnosis as well as under what circumstances the diagnosis would be correct. After the feedback has been read, the response is categorized appropriately (for example, as critical, potentially helpful, or not relevant). Residents are required to identify all critical or correct or required responses prior to being allowed to proceed to the next component of the scenario.

Education in the core competencies is part of the curriculum, including consideration of appropriate interaction with other members of the patient care team and communication with the patients and their families. Each item in the list from which the resident selects tests for the virtual patient is rated by its relative expense; and Residents are encouraged to consider cost-effective care. 

Description of the Course

The Fundamentals of Surgery Curriculum will contain approximately 20 hours of interactive, online course material divided into 11 modules.

• Preoperative Assessment
• On-Call Issues
  • Emergency Department Evaluation of Abdominal Pain
  • Postoperative Hypotension
  • Postoperative Fever
  • Postoperative Oliguria
  • Postoperative Nausea and Vomiting
• Pain Control
• Unresponsive/Agitated Patients
• Respiratory Management
• Gastrointestinal Conditions
• Wound Management
• Nutritional Support
• Fluids and Electrolytes
• Cardiac Conditions
• Safety Issues

Each module will contain scenarios appropriate to the subject matter that is presented. Scenarios can be completed in 10-15 minutes, so busy surgical residents can finish them in a reasonable period of time.

The content for the Fundamentals of Surgery Curriculum is based on the material in the ACS publication Successfully Navigating the First Year of Surgical Residency: Essentials for Medical Students and PGY-1 Residents. Scenarios undergo repeated review by teams that include program directors, surgical educators, and leaders in all surgical specialties. It is recommended that trauma be taught using ATLS^©, an established and successful program.

If evidence is available for clinical decisions, it is utilized and referenced. When evidence is absent, expert opinion has been used to design a scenario that presents one safe and effective way of managing the problem. Residents are informed of this prior to taking the course and are encouraged to discuss anything that varies from the practice in their institution with their program director. The procedures modeled in this course do not represent a standard of care.

The Fundamentals of Surgery Curriculum will be delivered online and hosted by an outsourced learning management system. Residents may repeat the scenarios as often as they wish. The scenarios include aspects of all six Core Competencies identified by the ACGME. A variety of reports about the progress of their residents will be available to program directors. 

Release date to be announced soon.

Surgical Education in Core Competencies

The American College of Surgeons Division of Education has made a commitment to addressing the competencies of interpersonal and communication skills, systems-based practice, professionalism, and practice-based learning and improvement, as well as medical knowledge and patient care. These six competencies were identified by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties. The Fundamentals of Surgery Curriculum will incorporate educational material relating to the aforementioned competencies within its interactive patient scenarios.

History of the Fundamentals of Surgery Curriculum

The Fundamentals of Surgery Curriculum was initiated as a program of the Division of Education of the American College of Surgeons in 2005 to present a basic surgical curriculum for all first-year surgery residents. The Surgical Council on Resident Education (SCORE), a voluntary consortium of six organizations—the American Board of Surgery (ABS), the American College of Surgeons (ACS), the American Surgical Association (ASA), the Association of Program Directors in Surgery (APDS), the Association for Surgical Education (ASE), and the Residency Review Committee of the Accreditation Council on Graduate Medical Education (RRC-S)—with responsibility for resident education, was organized in 2006. At its initial meeting in November, 2006, in Philadelphia, SCORE began developing a standardized curriculum in general surgery to span the period from medical school to practice. SCORE endorsed the continued development of the Fundamentals of Surgery.

Educational Goal

The educational goal of the Fundamentals of Surgery Curriculum is to ensure that the surgical resident has encountered the most common situations they will face and has learned a safe way to approach each problem. The program creates a realistic environment. The learner sees an image of the patient and is offered the opportunity to take a history, review records, order tests, and perform a physical examination. They receive feedback for every choice they make. They are not allowed to complete a case until they do so successfully; and the course is designed so that the only way to be successful is to follow a critical thinking model. Additionally, instruction on the Core Competencies is embedded within each scenario. If they are responsible for dire consequences, they are required to start over again, not an option in real life. Opportunities to make “classic errors” are embedded within the scenarios.

The critiques, supporting a decision or providing information on why it may not be the best one for this patient at this time, provide opportunities for self-assessment in a safe environment. Hopefully, if the resident has difficulty that they cannot resolve, they will seek help from their supervisors, use provided reference materials, and then try again. Program directors can use the cases as the subject for discussions and other educational experiences. The ultimate value of this course is that upon completion, each PGY-1 will have diagnosed and recommended treatment for scores of patients, practicing the critical thinking required for optimal outcomes every time. In order to allow the learner to investigate various treatment alternatives and receive feedback, enhancing the educational value of the cases, the course is not graded; but personal feedback is provided on how many responses were questionable or incorrect. The program directors have access to the fact that the resident has successfully completed each case. 

Specific Outcomes and Objectives

After successful completion of the Curriculum,

1. The PGY-1 will internalize the critical thinking skills modeled in the Fundamentals of Surgery Curriculum that apply to patient evaluation and will apply them when evaluating every patient encountered, including situations not encountered previously.
2. The PGY-1 will have experienced cases they may not encounter during their training.
3. The PGY-1 will build self-confidence in their abilities and judgments, and will exhibit greater confidence as measured by an increase in their scores on a self-evaluation survey over their pre-course scores.
4. After successful completion of the Fundamentals of Surgery Curriculum, PGY1s will exhibit superior and appropriate teamwork behavior in the context of the patient care team, interacting professionally with other members of the patient care team in order to provide optimal patient care.

Fundamentals of Surgery Curriculum Steering Committee

Staff

Fundamentals of Surgery Curriculum

Patricia J. Numann, MD, FACS
Curriculum Director

Richard E. Welling, MD, FACS
Associate Curriculum Director

Donald Andrew Risucci, PhD
Research Director

Division of Education

Ajit K. Sachdeva, MD, FACS, FRCSC
Director

Patrice Gabler Blair, MPH
Associate Director

Marsha Pfingsten
Administrator, Fundamentals of Surgery Curriculum

Shana Cobb
Administrative Assistant

The Fundamentals of Surgery Curriculum Brochure will be available online soon.

Revised October 22, 2007

Fundamentals of Surgery Curriculum

Committees and Task Forces

Division of Education