ORL CURICULLUM

8/3/2019 ORL CURICULLUM

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Sudan Medical Specialization Board (SMSB)

Specialty of Otorhinolaryngology, Head and Neck Surgery

Programme Curriculum

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1. TITLE OF SPECIALITY:

1.1 Degree: Clinical MD in Otorhinolaryngology, Head and Neck Surgery

(Clinical MD ORL, HNS).

2. Introduction:

2-1. Rationale and justification:

Otorhinolaryngology, head and neck surgery is a specialty that deals with

medical and surgical diseases affecting the ear, nose, throat, head and neck. The

disease spectrum covers all ages, both sexes, medical and surgical problems related

to these structures. It is one of the most integrated specialties with other medical

and surgical specialties. Paeditrics ORL head and neck problems constitute a

considerable load in this specialty. Recent advances in the speciality include

endoscopic sinuses and skull base surgery is one of the most evolving and rapidly

growing new developments in this field.

The need for Otorhinolaryngologist in the Sudan is of great importance due to

the fact that the Sudan is a large country covering a vast area. The present number

of practicing specialists covers less than 25% of the need. This is due to the late

introduction of the specialty and that most of the qualified specialists preferred to

stay in the capital Khartoum in private practice or emigrated abroad.

Diseases of the ear nose and throat are very prevalent in the Sudan especially

chronic ear diseases and the different types of head & neck malignancies.

Nasopharyngeal carcinoma is the commonest head and neck tumor in the Sudan.

There is an increasing need for otorhinologists to train undergraduate and

postgraduate students whose numbers has appreciably increased lately.

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The need for high caliber qualified otolaryngologist cannot be over

emphasized.

This curriculum is based on the previously running curriculum, international,

regional and national similar curricula and revised by an expert committee.

2.2. Admission requirements:

2.2.1. Admission requirements for Part-one examination:

The candidate should:

1. Have an MBBS or its equivalent.

2. Have successful completion of internship.

3. Register with Sudan GMC.

4. Satisfy the registration regulations of SMSB.

5. Have spent 6 months after internship preferably in a surgical discipline.

6. Be recommended by two referees.

7. Be advised to attend Basic Sciences and Specialty Basic Sciences courses

run by SMSB or engaged in a self directed learning in Basic Sciences. This

will need a period of six months.

2.2.2. Admission requirements for Part-two:

The candidate should have:

1. Passed Part-one examination or its equivalent which is approved by the

specialty council.

2. Completed the specified training period.

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3. Completed the designated log book.

4. Passed thesis examination.

2.3. Duration of the programme:

The duration of the programme is a period of four (4) calendar years which starts

after obtaining registration with SMSB and includes rotation in allied specialties.

Training must be at sites accredited by SMSB.

2.4. The role and responsibilities of trainers and trainees:

2.4.1. Academic supervisor and trainer:

2.4.1.1. Academic supervisor: The academic supervisor is a university staff of a

professor or associate professor status or a consultant with postgraduate

qualification recognized by the SMSB who has at least ten years of experience

including experience in post graduate training and scientific writing.

2.4.1.2. Trainer: The trainer is a specialist with postgraduate qualification

recognized by the SMSB who has at least five years of experience in the specialty

and practicing in an approved setup.

2.4.1.3. Supervisors and trainers have the following responsibilities and are

expected:

- To ensure and monitor adequate training.

- To provide continuous helpful feedback (formative) regarding the

process of training.

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- To observe trainees performance and help the trainee to achieve the

objectives of the training programme.

- To participate actively in workshops and other activities conducted

by the SMSB.

- To establish direct contact with the council if any problem arises

during the training process, including the suitability of trainee.

- To supervise candidates thesis proposals and execution.

2.4.2. Trainee role and responsibilities:

Trainee should:

- Accept responsibility for his\her learning.

- Ensure that he\ she undertakes training.

- Accept the responsibility for the thesis and plan to execute it within

the designated time limits.

- Be responsible for arrangement of regular meetings with the

supervisor.

- Complete the entire requirement for the final examination.

- Provide feedback regarding the training.

- Submit yearly summary sheets of the logbooks duly filled and

signed by the supervisor.

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3. OBJECTIVES:

3.1. General objectives:

Graduation of high caliber qualified OtolaryngologistHead & Neck Surgeons

comparable to international standards; who can promote health for all patients,

deliver health service in a humane, evidence based & cost effective way, be

capable to carry out research & independent learning throughout life, work in team

with good management & leadership skills, maintain good relations with

colleagues, patients & other health professions, possess high moral & ethical

standards.

3.2. Specific Objectives:

3.2.3. Educational:

3.2.3.1. Cognitive:

At the end of the training programme the candidate should be able to acquire

appropriate knowledge and intellectual abilities including:

- Common and important ear, nose and throat diseases.

- General body effects caused by ear, nose and throat diseases and local ENT

manifestations of systemic diseases.

- Basic sciences: knowledge about body structure, function and

pathphysiological processes:

- Clinical sciences: knowledge relating to disease causation, manifestations

and management.

- Essential drugs: their proper use, side effects and interactions.

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- Social, economic and cultural factors related to disease and its causation,

management and prevention.

- Clinical reasoning: use, integrate and interpret information derived from

history and examination and to make a list of probable diagnoses.

- Formulating a working diagnosis.

- Outline and implement a sound management plan.

- Requesting and justifying the appropriate investigations when needed.

- Interpreting the laboratory results and imaging investigations obtained.

- Deciding whether the patient requires ambulatory care, hospitalization or

referral to other health professionals.

3.2.3.2. Psychomotor:

At the end of the training programme the candidate should be able to

perform the required skills competently and confidently including:

- Taking a thorough medical history.

- Conducting proper ORL, H & N and systemic examination and eliciting

important signs.

- Performing diagnostic procedures such as blood taking, aspiration, punch-

biopsy & lumber puncture.

- Performing basic skills procedures such as cannula fixation, NG tube

insertion, nasal and aural packs application, wound dressing & urinary

catheter insertion.

- Use of different ORL basic diagnostic instruments.

- Use of flexible and rigid nasopharyngoscopy and laryngoscope.

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- Use of the surgical microscope in the examination and management of ear

disease.

- Evaluation of facial nerve functions and lower cranial nerves.

- Ordering and interpreting audiological and audio-vestibular investigations.

- Ordering and interpreting conventional radiographic and imaging

investigations in ORL, H & N S.

- Performing therapeutic intervention procedures, ward and office procedures

such as tracheostomy, resuscitation techniques, veni-section & oxygen

administration (as shown in appendix 1).

- Performing emergency surgical operations (as provided in appendix 2).

- Performing elective surgical operations (as provided in appendix 3).- Presentation skills.

See annex 1, 2 & 3.

3.2.3.3. Affective:

At the end of the training programme the candidate should be able to develop

accepted attitudes including;

- Concern, respect, honesty, empathy, privacy and confidentiality towards

patients and their families.

- Appropriate communication and counseling skills.

- Work and maintain good relations and communications with medical

colleagues.

- Recognize the importance of team work and functions as an effective

member & leader.

- Taking the responsibility of teaching and training junior doctors and

auxiliary staff.

- Acceptable general appearance, attendance and punctuality.

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- Commitment and dedication.

- Ability to express his\ her ideas clearly and fluently.

- Problem solving and problem prioritization abilities.

- Understanding and respecting hospital regulations, administrative matters

and quality assurance.

- Ability to keep patients records and follow up sheets clear, consistent,

concise and accurate.

- Good decision making abilities.

- High moral and ethical standards.

- Advise the community on promoting health and preventing diseases.

- Probability of being an independent and life -long learner.

3.3. Research:

At the end of the training programme the candidate should be able to:

- Undertake research and publish findings.

- Use evidence based medicine & evidence based guidelines.

- Use appropriate research methodology and statistical methods.

- Interpret and use results of various research works.

3.4. Service:

At the end of the training programme the candidate should be able to:

- Promote health for all patients.

- Deliver health service in humane & cost effective way.

- Understand the social & governmental role in health services.

- Offer professional services to the society.

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- Understand health service management and health economics in rural areas.

4. CONTENTS:

4.1. The General organization of the programme:

Duration of training period is four (4) calendar years of which:

a) Three years in Otorhinolaryngology: these are six units of rotation each

consists of six months duration.

b) Six months rotation in allied specialties which consists of three rotations

each of two months duration as follows:

- Two compulsory rotations in maxillofacial surgery and plastic surgery

- An optional rotation in any of the following departments: neurosurgery,

peadiatrics surgery and general peadiatrics.

c) Candidate is allowed one month holiday per year.

d) Two months: one month Elective and one month for Thesis writing.

First year Second year Third year Fourth year

6 - month

rotation

6 - month

rotation

6 - month

rotation

6 - month

rotation

6 - month

rotation

6 - month

rotation

6 - month

rotation

6 - month

rotation

ORL, H &

N S.ORL, H &

N S.ORL, H &

N S.ORL, H &

N S.ORL, H &

N S.ORL, H &

N S.ORL, H &

N S.ORL, H &

N S.

Elective.

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Thesis

writing

4.2. Contents of part-one:

Basic sciences and applied basic sciences:

4.2.1. Anatomy:

Anatomy, histology and embryology of the:

Ear.

Nose and paranasal sinuses.

Larynx, trachea, bronchial tree.

Pharynx and oesophagus.

Thyroid and parathyroid glands.

Salivary glands.

Central and peripheral nervous system.

Spinal cord.

Skull base and pituitary gland.

General head and neck.

Lung and thorax.

Upper gastro-intestinal tract (GIT).

Related eye anatomy.

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Skin and skin appendages.

4.2.2. Physiology:

Body fluids and electrolytes.

Blood and blood constituents and haemopoetic system.

Temperature regulation.

Cardiovascular system.

Respiratory system.

Central nervous system (CNS) and special senses.

Endocrine system.

Renal system.

The immune system.

Gastro-intestinal tract (GIT).

The skin.

4.2.3. Pathology:

Normal cell function.

General body defense mechanisms.

Acute and chronic inflammation.

Healing and repair.

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Tumors: benign and malignant.

Congenital anomalies.

Immunology.

Genetics and Molecular Biology.

4.2.4. Bacteriology:

Viruses, bacteria, protozoa, helminthes infections.

Disinfection and sterilization.

Drug resistance.

Control of infection.

4.3. Contents of part-two:

Otology.

Neuro-otology.

Audiology.

Rehabilitation of the deaf.

Laryngology.

Voice and speech disorders and rehabilitation.

Head and Neck Neoplasia.

General surgical principles.

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General head and neck surgery and complications.

Facial plastic surgery.

Reconstructive head and neck surgery.

Skull base surgery.

Peadiatric ORL.

Anesthesia and anesthetic techniques in ORL Head & Neck surgery.

Pharmacology in ORL.

4.4. The Residency programme

4.4.1. General structure (see 4.1).

4.4.2. Contents (see annex: Appendix 1, 2 & 3).

5. METHODS OF TEACHING AND TRAINING:

1- Teaching ward rounds.

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2- Surgical out-patients clinics.

3- Operative theatres.

4- Morbidity and mortality meetings and discharge clinics (Audit).

5- Self-directed learning.

6- Lectures.

7- Group discussion and tutorials.

8- Audio-vestibular laboratory.

9- Clinico-pathological conferences.

10- Symposia and seminars.

11- Journal club meetings.

12- Workshops; including research methodology, scientific writing and computer

science applications.

13- Papers presented and published.

14-Temporal bone surgery course.

15-Endoscopic sinus surgery course.

16- Facial plastic surgery course.

17-Head and neck reconstructive surgery course.

18- Skull base surgery course.

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6. RSOURCES:

6.1 Accredited staff.

6.2 Accredited training sites.

6.3 Temporal bone dissection laboratory.

6.4 Rhinology endoscopic sinus surgery & skull base laboratory.

6.5 Audio- vestibular facilities.

6.6 Speech therapy & speech rehabilitation units.

6.7. Basic Skills laboratory.

6.8. Classical and Electronic Libraries.

7. METHODS OF STUDENT ASSESSMENT:

7.1 Part one examination:

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Examination is held twice yearly with six months interval and consists of:

7.1.1. Written paper:

I. Consists of ninety (90) stems MCQs of the best answer response-

type questions.

II. Questions covering the basic and applied sciences in anatomy,

physiology, microbiology, biochemistry, genetics, molecular

biology and pathology.

III. Time allowed is two & a half (2) hours.

IV. Total mark is 80.

V. MPL applied.

7.1.2.OSPE:

Objective Structured Practical Examination (OSPE):

I. Consists of twenty (20) stations of basic and clinically-related basic

sciences.

II. MPL applied.

III. Total mark is 20.

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IV. Time allowed 1 hour.

7.2 Part two examination:

7.2.1. Thesis examination:

A research proposal relevant to a major subject of specialization must be submitted

to the Research and Thesis Committee of the specialty council after the first six

months of training for approval. Thesis should be submitted for evaluation six

month before the date of the final part II examination.

General rules:

1. A supervisor and a co-supervisor are assigned for each candidate.

2. Thesis should be handled to the external examiner 1 2 months prior to the

thesis examination date.

3. Thesis examination is held by a committee composed of an external

examiner, a co-examiner and one of the supervisors.

4. Candidate is allowed half an hour for presentation.

5. Candidate who passes thesis examination will be issued a certificate to this

effect. This certificate will form part of the documents to be submitted for

taking the final written examination.

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7.2.2. Written paper: Total marks hundred (100).

A.Paper one: Response-type questions:

I. Consists of ninety (90) stems MCQs of the best answer response-type

questions.

II. Time allowed is two & a half (2) hours.

III. Questions covering rhinology, otology, audiology, neuro-otology,

laryngology, peadiatric ORL and head and neck surgery.

IV. MPL applied.

V. Total mark is sixty (60).

B.Paper two: Supply-type questions:

I. Consists of five to ten (5-10) problem solving and modified essay

questions.

II. All questions are obligatory.

III. Time allowed is two hours.

IV. Each question is answered on a separate booklet.

V. MPL applied.

VI. Total mark is forty (40).

General Rules:

Both types of written examinations are administered in the same day.

Answered on the basis of the answer key.

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Candidates can compensate in the written part of the examination.

Candidates have to pass written examination to be allowed to sit for the

clinical part.

7.2.3.Clinical examination: Total marks are hundred (100).

A. OSCE: Objective Structured Clinical Examination:

I. Consists of twenty (20) stations of clinical and clinically-related

materials in ORL H & N Surgery.

II. Time allowed is 1 -2 hours.

III. Total marks twenty (20) constitute twenty percent (20%) of the clinical

examination marks.

IV. MPL applied.

B. Clinical examination: consists of:

I. One long case.

- Total mark is forty (40).

- Pass mark is 60%.

- Time allowed for history & examination is 30 minutes.

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- Time allowed for discussion is 30 minutes.

II. Three short cases.

- Total mark is forty (40).

- Time allowed 30 minutes; 10 minutes each case.

- Cases are targeting different areas in the specialty.

- Pass mark is 60%.

General Rules:

- Candidate can compensate in clinical examination.

- Candidate is evaluated by at least two examiners.

- Each examiner has independent rating check lists.

- Vito cases should be justified and agreed upon.

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- Candidates who fail the clinical examination are offered two more attempts

without sitting for the written part within 6 12 month period according to

the examination committee and the external examiner recommendations.

- Candidates who fail the clinical examination for the third time have to re-sit

for the written part.

7.2.4. Formative assessment:

These are hospital based clinical assessment methods including:

- 7.2.4.1. Mini-CAX (Clinical Assessment Exercise annex 4).

- 7.2.4.2. Surgical DOPS (Direct Observation of Procedural Skills annex 5).

- 7.2.4.3. CBD (Case Based Discussion annex 6).

- 7.2.4.4. End of year examination (EYE annex 7).

- 7.2.4.5. Mock clinical examination.

8. EVALUATION OF TRAINING:

The programme is continuously evaluated through the followings:

8.1. Evaluation of the training centers.

8.2. Evaluation of the training programme:

8.2.1. Internal evaluations.

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8.2.2. External evaluations.

8.2.3. Reports & feedback of trainees.

8.2.3. Reports & feedback of trainers.

8.3. Evaluation of the trainers.

9. DEGREE AWARDED:

The Degree Awarded is Clinical Medical Doctorate in Otorhinolaryngology, Head

and Neck Surgery. (Clinical MD in ORL, H N S).

10. LIST OF REFERENCES AND OTHER RESOURCES:

10.1. References for part one:

- Clinical Anatomy by Regions. 8th. Edition. R. Snell. Wolter Kluwer\

Lippincott Williams & Wilkins 2008.

- Last Anatomy Regional and Applied. McMinn. Churchill Livingstone.

- Clinical Anatomy. H. Ellis.

- A Color Atlas of Human Anatomy. McMinn & Hutchings. Wolf Medical

Publications Ltd. Blackwell Scientific Publications.

- Grays Atlas of Anatomy. International Edition. Drake, Vogal, Mitchell,

Tibbitts & Richardson. Churchill Livingstone 2008.

- Concise Human Physiology. Sukker, Munshid & Ardawi. Blackwell Science.

- Textbook of Medical Physiology. Guyton & Hall. Saunders 2000.

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- MUIRS Textbook of Pathology 14th. LEVISON, READ, Harrison &

Fleming. Edward Arnold (Publisher) Ltd. 2008.

- General Pathology 16th. Edition. Walter & Israel. Churchill Livingstone.

- Robbins Basic Pathology 8th

Edition. Kumar, Abbas, Fausto & Mitchell.

Saunders 2007.

10.2. References for part two:

- Scott-Brown's Otorhinolaryngology: Head and neck surgery. The 7th edition

by. Michael Gleeson.

- Essential Otolaryngology, 8th edition by K J Lee. McGraw Hill 2003.

- Cummings Otolaryngology - Head and Neck Surgery 5th edition

Flint, Paul W. , Haughty, Bruce H. , Lund, Valerie J. publisher Mosby

- Head and Neck Surgery: Otolaryngology Byron J. Bailey .

- CURRENT Diagnosis & Treatment in Otolaryngology Head & Neck

Surgery by Anil K Lalwani. McGraw Hill 2004.

- Otolaryngology Head & Neck surgery, Clinical Reference Guide. R. Pasha

Publisher Singular Thomson learning.

- Rob & Smiths Operative Surgery. 4th. Edition. Ballantyne & Morrison.

1. Ear.

2. Nose & Throat.

3. Head and Neck.

Butterworth. 1986.

- Stell and Maran Head and Neck Surgery. 4th. Edition. Watkinson, Gase &

Wilson 2000.

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11. ANNEX:

11.1. In Ward & Office Procedures

11.2. Minor & Emergency Surgical Procedures.

11.3. Major Surgical Procedures.

11.4. Mini - CAX Form.

11.5. Surgical DOP Form.

11.6. CBD Form.

11.7. EYE Form.

11.7. Rotation evaluation form.

11.8. Training report form.

11.9. List of publications of the trainers.

11.10. List of approved student thesis titles & publications.

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Appendix 1: In Ward & Office Procedures.

No. ProceduresLevel of competence

First

Year

Second

Year

Third

Year

Fourth

Year

1 Care of tracheostomy tube 5 5 5 5

2 Nasogastric tube insertion. 5 5 5 5

3 Post-operative dressing 5 5 5 5

4 Anterior nasal packing 5 5 5 5

5 Posterior nasal packing 4 5 5 5

6 Ear dressing 4 4 5 5

7 Ear microscopy 2 3 4 5

8 Syringing of ear 4 5 5 59 Flexible & rigid nasopharyngoscopy & laryngooscopy 2 3 4 5

10 Removal of foreign body in ear, nose or throat 3 4 5 5

11 Lumbar puncture 5 5 5 5

12 Pure Tone Audiometry (P.T.A.) 2 3 4 5

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Level of competence:

1. Observer status.

2. Assistant status.

3. Performed under direct supervision.

4. Performed under indirect supervision. The supervisor must be readily available if needed.

5. Performed independently.

Appendix 2: Minor & Emergency Surgical Procedures.


First

Year

Second

Year

Third

Year

Fourth

Year

1 Tracheotomy\ laryngotomy 3 4 5 5

2 Tracheostomy 4 5 5 5

3 Nasal cautery ( chemical, electrical and endoscopic ) 3 4 5 5

4 Sub-mucosal diathermy 3 4 5 5

5 Anterior proof puncture 3 4 5 5

6 Drainage of deep neck space abscesses 3 4 5 5

7 Drainage of peri-tonsillar abscess (Quinsy) 3 4 5 5

8 Drainage of parotid abscess 3 4 5 59 Surgical dressings 5 5 5 5

10 Excision of benign lumps & lymph node 4 5 5 5

11 Punch biopsy under local anesthesia for oral,

oropharyngeal & nasopharyngeal lesions & tumors

2 3 4 5

12 Incisional biopsy under general anesthesia for oral 2 3 4 5

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oropharyngeal lesions & tumors

13 Drainage of septal hematoma\ abscess 3 4 5 5

14 Drainage of hematoma auris. 3 4 5 5

15 Removal of foreign body in ear, nose or throat under

general anaesthesia

3 4 5 5

16 Arterial ligation and ligation of primary tonsillar

haemorrhage

2 3 4 5

17 Removal of intra-oral salivary duct stone 2 3 4 5

Appendix 3: Major Surgical Procedure.


First

Year

Second

Year

Third

Year

Fourth

Year

1 Removal of foreign body under general anaesthesia 2 3 4 5

2 Endoscopic removal of foreign body 2 3 4 5

3 Direct laryngoscopy: diagnostic & therapeutic; foreign body

removal & Microlaryngoscopy

3 4 5 5

4 Rigid oesophagoscopy: diagnostic & therapeutic; foreign

body removal & dilatation

3 4 5 5

5 Rigid bronchoscopy: diagnostic & therapeutic 3 4 5 5

6 Reduction of nasal fractures 2 3 4 5

7 S.M.R and septoplasty 2 2 3 4

8 Rhinoplasty 1 1 1 2

9 Nasal polypectomy (classical) 2 3 4 5

10 Turbinate surgery. 2 3 4 5

11 Intranasal antrostomy 2 3 4 5

12 Caldwell-Luc operation. 1 2 3 4

13 Ethmoidectomy (external) 1 2 3 4

14 Lateral rhinotomy and facial degloving 1 2 3 415 Endoscopic sinus surgery (ESS) 1 2 3 3

16 Maxillectomy ( partial and radical ) 1 2 3 4

17 Cleft lip and palate 1 1 1 2

18 Thyroglossal cyst operation and thyroidectomy 2 3 4 5

19 Submandibular Salivary gland excision 2 3 4 5

20 Parotidectomy: superficial and radical 1 2 3 4

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21 Mandibulectomy,mandibulotomy 1 1 2 2

22 Laryngectomy: partial & total and Laryngofissure 1 2 3 3

23 Neck dissection 1 2 2 3

24 Local, regional & axial flap and skin grafting 1 1 2 3

25 E.U.M. & Myringotomy VT. 2 3 4 5

26 Mastoidectomy (cortical, modified and radical) 1 2 3 4

27 Myringoplasty and tympanoplasty 1 2 3 428 Stapedectomy 1 1 2 2

29 Otoplasty 1 1 2 2

30 Cochlear implant 1 1 1 2

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Annex 4: Mini-CAX (Clinical Assessment Exercise) SMSB

Trainee name Educational supervisor

Training center Specialty

Training hospital Year of training 1 2 3 4

Clinical setting for this assessment OPD In

patient

A/E OR ICU Other

(specify)

Diagnosis of the case

Focus of clinical caseto be assessed

History Examination Other(specify)---------------

Below

expectation

Border

line

Meets

expectation

Above

expectation

Unable to

comment

1. History taking

2.Physical examination

3.Communication skills

4.Clinical judgment

5.Professionalism

6.Organization

7.Overall clinical care

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What has been done good Suggestion for development

Action agreed to be done

Time taken for observation Time taken for feedback

Assessor .. Signature Date

Mini-CAX (Clinical Assessment Exercise) SMSB

The Mini-CAX is a method of assessing skills essential to the provision of good clinicalcare and to facilitate feedback.

It assesses the trainees clinical and professional skills on the ward, in Accident and

Emergency, in outpatient clinics or other clinical setting.

Trainees will be assessed on different clinical problems that they encounter from within

the curriculum in a range of clinical settings.

Trainees are encouraged to choose a different assessor for each assessment but one of the

assessors must be his educational supervisor.

The assessment involves observing the trainee interact with a patient in a clinical

encounter.

The areas of competence covered include: history taking, physical examination,

professionalism, clinical judgement, communication skills,organisation and overall

clinical care.

Most encounters should take between 15-20 minutes.

Assessors do not need to have prior knowledge of the trainee.

The assessors evaluation is recorded on a structured checklist that enables the assessor to

provide developmental verbal feedback to the trainee immediately after the encounter.

Feedback would normally take about5 minutes.

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Annex 5: Direct Observation of Procedural Skills (Surgical

DOPS) SMSB



Training hospital Year of

training

1 2 3 4

Name of procedure of procedure

Difficulty index Easy Average Difficult

Below

expectation

Border

line

Meets

expectation

Above

expectation

U/C

1. Describes indications,

anatomy & details of

procedure

2.Obtain inform consent

after explanation

3. Prepares to procedure

according to agreedprotocol.

4.Demonstrate good

asepsis and safe use

instrument/sharps

5.Perform the technical

aspects in line with

guidelines

6.Deals with anyunexpected events or

seeks help

7.Complete required

documentation

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8. Issues clear

postoperative instruction

to patients/staff

9. Communicates with

patients and staff

professionally

10. Overall ability to

perform the whole

procedure




Assessor name . Assessor

position.

Signature . Date

...

Surgical DOPS

(Direct Observation of Procedural Skills) SMSB

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DOPS is used to assess the trainees technical, operative and professional

skills in a range of basic diagnostic and interventional procedures, or parts

of procedures, during routine surgical practice and facilitate developmental

feedback.

DOPS is used in simpler environments and procedures and can take place in

wards or outpatient clinics as well as in the operating theatre.

DOPS form can be used routinely every time the trainer supervises a trainee

carrying out one of the specified procedures, with the aim of making the

assessment part of routine surgical training practice.

The assessment involves an assessor observing the trainee perform a

practical procedure within the workplace.

Assessors do not need to have prior knowledge of the trainee.

The assessors evaluation is recorded on a structured checklist that enables

the assessor to provide verbal developmental feedback to the trainee

immediately afterwards. Trainees are encouraged to choose a different

assessor for each assessment but one of the assessors must be the current

assigned educational supervisor. Most procedures take no longer than 15-20

minutes.

The assessor will provide immediate feedback to the trainee aftercompleting the observation and evaluation. Feedback would normally take

about 5 minutes.

DOPS form is scored for the purpose of providing feedback to the trainee.

The overall rating on any one assessment can only be completed if the

entire procedure is observed. A judgement will be made at completion of

the placement as to the overall level of performance achieved in each of the

assessed surgical procedures.

Annex 6: Case Based Discussion (CBD) SMSB

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Training hospital Year of

training

1 2 3 4

Clinical setting for this

assessment

OP

D

In

patien

t

A/

E

OR IC

U

Other (specify)

-------------------

Diagnosis of the case

Focus of clinical

case to be

assessed

a. Medical

record

keeping

b. Clinical

assessment

c.

Management

d.

Professionalis

m

Unsatisfactor

y

Good V.

good

Outstandin

g

Unable to

comment

1. Medical record

keeping

2. Clinical

assessment

3.Investigation &Referrals

4.Treatment

5.Professionalism

6.Follow up

&planning

7.Overall clinical

care

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Assessor name Signature

Date..

Case Based Discussion

This method is designed to assess clinical judgement, decision-making andthe application of medical knowledge in relation to patient care in cases for

which the trainee has been directly responsible.

The method is particularly designed to test higher order thinking and

synthesis as it allows assessors to explore deeper understanding of how

trainees compile, prioritise and apply knowledge. CBD is not focused on

the trainees ability to make a diagnosis nor is it a viva-style assessment.

The process is a structured, in-depth discussion between the trainee andassigned educational supervisor about how a clinical case was managed by

the trainee; talking through what occurred, considerations and reasons for

actions.

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Using complex clinical cases allow the trainee to explain the complexities

involved and the reasoning behind choices.

It also enables the discussion of the ethical and legal framework of practice.

It uses patient records as the basis for dialogue, for systematic assessment

and structured feedback.

As the actual record is the focus for the discussion, the assessor can also

evaluate the quality of record keeping and the presentation of cases.

The assessor would normally be the trainees AES but could include other

consultant trainers.

Assessors should know when and how to use CBDs and be expert in the

clinical problem/task.

Assessors need not have prior knowledge of the trainee and in some

instances it may be important that they do not.

In general, however, assessments of this kind will be carried out by

consultant trainers since they provide useful insights on the training that is

required.

Given the great variation in the rate of progress between individuals,

absolute numbers of assessments are not prescribed.

In clinical practice a number of observed performances, even if completed

to a satisfactory level, are insufficient if not underpinned by adequate

experience.

There is no limited numbers specified and it will be a matter of judgement

for assigned educational supervisors and annual review panels to determine

whether the experience element is sufficient when signing off their reports.

Ideally, trainees and supervisors should use the assessment instruments

during every training exercise i.e. at every possible opportunity.

The great benefit of WBAs such as the CBD is that by obliging the trainer

to review the performance of the trainee across the full range of

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components involved in the management of a case, a comprehensive picture

of the trainees strengths and weaknesses can be obtained and kept under

review during the whole placement.

Each CBD should represent a different clinical problem covered by the

curriculum and have come from a range of clinical settings.

The process may be initiated by the AES or the trainee, but it remains the

responsibility of the trainee to take a proactive approach and to ensure that

sufficient exercises are completed.

The exercise comprises an in-depth discussion between the trainee and

assigned educational supervisor about clinical cases with which the trainee

has been involved.

A quiet area may be preferred in some circumstances for a one-to-oneinterview, but used appropriately, a case presentation at a clinical meeting

can provide an excellent setting.

Should take no longer than 15 minutes and should be concluded with a

debriefing, feedback and completion of the CBD form.

Annex 7: End Year Examination (EYE)

1. Introduction:

Assessment and examinations drive trainees learning.

The idea is to make sure that the trainees are acquiring the necessary knowledge

and s kills before being promoted to the next year

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2. Pre-requisite for the exam.

Actively enrolled trainee in the programme.

Attendance should not be less than 75%.

Have satisfactory end of year report.

3. Assessment components and their weight:

40% Training reports.

60% End of year exam.

A trainee will be promoted when passing each component by it is own, and the

total aggregate is equal or above 60%.

4. What eyes, test?

Eye1 testing knowledge, BOF

Eye2 testing application of knowledge, PS,MEQ

Eye3 testing relevant Knowledge, Skills and attitude, OSCE.

Other components of exam may be added to, or replace the above if being

approved by the SMSB scientific council.

These EYES are based on the objectives of the rotation of the respective

year.

5. Who carry the exam?

The exam should be held at the head quarter of the training center. Supervised by

the chairman & TPD and invigilated by ESs & CTs.

6. How frequent are the eyes?

EYE 1, by the end of year one

EYE 2, by the end of year two

EYE 3, by the end of year three

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The time during the academic year should be fixed and known to all. Preferably

after the 2ed part examination.

Passing first part examination will exempt the trainee from EYE, if both exams

occur on the same year. E.g. In Emergency Medicine council the 1st part

examination is usually taken by the end of year 2,

7. Examinations

EYE1 & EYE2 are constructed by the examination committees of their

respective specialty council. It is a unified exam for all centers.

EYE3 is constructed by the examination committees of their respective

specialty council, together with center training officials [TPD, ED, CT].

8. What happen if candidate fails an EYE?

He is allowed to retake the exam after justifiable period from TPD not more

than 6 months.

9. Exception to the EYES

In case of two/three years subspecialty programme, only EYE 1/EYE1 and

EYE2 is/are going to be conducted.

2. The scientific council will approve the suggested format raised by the

examination committee of the specialty council.

First part examination will exempt from EYE, if both occur on the same year.

E.g. In Emergency Medicine council 1st part examination is taken by the end of

year 2,

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nnex 8: Rotation Evaluation Form

Name

Specialty

Training Centre

Hospital

Academic year 1 2 3 4

Name of Rota

Rotation

Clinical Trainer

Educational Supervisor

Training Programme Director

Date

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43

Rotation:Unsatisfactory

1Deficient

2Good

3V.Good

4Outstanding

5N / A

1. The number of in-patients casesseen was appropriate.

2. Inpatients cases demonstrated abroad range of clinical problems.

3. The number of out-patients casesseen was appropriate.

4. Outpatient cases demonstrated abroad range of clinical problems.

5. The opportunity to see acuteemergency cases.

6. The opportunity to seeconsultations.

7. Ward rounds.

8. Clinical Meetings / Lectures

9. Journal Club

10. Audit ( e.g. Morbidity / Mortality )

11. Clear learning objectives.12. The number of proceduresadequate.13. Demonstration & Supervision oftechniques.14. Level of responsibility in patientcare.

15. Patient management.

16. Quality of teaching on rotation.

17. My total workload wasappropriate for the time available.

18. Adequate feedback from

consultant / trainer on performance.19. Support and supervision wasavailable and adequate.

20. Opportunity to do research.

Overall Quality of Rotation

Comments:Strengths:

Areas for Improvement


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Annex 9: Training Report Form

1. Basic Information

Name

Year of training 1 2 3 4

Specialty

Rota

Date started

Date ended

Training Centre

Hospital

Clinical trainer

Educational supervisor

Training programme director

2. Weekly Timetable

1 Saturday

2 Sunday

3 Monday

4 Tuesday

5 Wednesday

6 Thursday

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3. Details of On-Call Rota

4. Dates of Appraisal Meetings with Supervisor

45

Start of the shift Mid-shift End of the shift

Date

Review of training

report

Portfolio

Other issues


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5. Dates of Assessments by Educational Supervisor and Other Assessors

File copies of completed assessment forms and logbook summaries in your

portfolio.

Assessment

(date & assessor)

Start of the

shift

Mid-shift End of the

shift

1 Clinical Skills

2 Procedural Skills

3 Decision-Making

4 Other assessments:

(Specify)

6. Details of Audit

The following project was agreed at the first meeting and evaluated at the end:

File copies of any presentations or publications in your portfolio.

Objective

Evaluation

7. Educational Achievements

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File a copy of your in-house educational programme and attendance plus any

certificates for courses or exams in your portfolio

Dates Description of Course or Exam (and Outcome)

1

2

3

4

8. Absence from Training

Document any periods of absence from your post except for annual and study

leave e.g. sick leave, maternity leave, and compassionate leave.

Dates Reason for Absence

1

2

3

9. Summary by Educational Supervisor at Last Meeting

Overall strengths

Areas for development after review of portfolio

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PDP

Educational objectives

Hospital-based clinical assessments

Educational achievements

Significant events

Periods of absence

10. Suggested Learning Objectives for Next Post

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11. Signatures

Registrar Name Educational Supervisor

Signature Signature

Date Date

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PROF.OSMAN M.ELMUSTAFA PUBLICATIONS

1- The Causative Organisms of Otomycosis in Sudanese Patients.

O.M. El Mustafa and N.E.Ahmed. JABMS Vol. 1 No. 4 October 1999

page 67-69.

2- Bronchial Foreign Bodies in Sudanese Children. O.M. El Mustafa.

Journal of the Arab Board of Medical Specialization (JABMS) vol. 1 No.

4 October 1999 page 83-84.

3- Otomycosis in Gezira (Sudan) O.M.El Mustafa. Saudi Journal of Oto-

Rhino-laryngology Head and Neck Surgery Vol 2 No. 2 July 2000 page

87-90.

4- Indications for Emergency tracheostomy. O.M.El Mustafa. Saudi

Medical Journal 2000; Vol. 21(12) page 1194-1195.

5- An Experience of Rigid Oesophagoscopy in 294 cases. O.M. El

Mustafa. Saudi Medical Journal 2001; Vol 22(2). Page 176-177.

6- Sideropenic Dysphagia in Sudanese Patients. O.M. El Mustafa. JABMS.

Vol 3; No. 1 Jan 2001 page 96-99.

7- Acute poisoning with Hair-dye containing Paraphenylenediamine-

Gezira Experience. O.M. El Mustafa. JABMS Vol 3 No. 2 April 2001,

page 99-102.

8- Psychiatric Manifestations in Haidrye Poisoning. Diaa E.El Gaily and

O.M. El Mustafa. J.A.B.M.S. Vol 3 No. 2 April 2001, page 96-98.

9- Oesophageal Carcinoma in Sudanese Patients. A retrospective Study of 84 cases

O.M. El Mustafa. A.A. Badie and O.K. Saeed. The Saudi Journal of ORL, H and

N Surgery. Vol 3 No. 2 July 2001, page 48-50.

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10 A case of Waardenburg syndrome Type II. Observed at Gezira, Sudan.

O.M. El Mustafa. The Saudi Journal of ORL, H and N. Surgery. Vol 3

No. 2 July 2001, page 70-71.

11. Oesophageal Foreign Bodies: A retrospective Study of 220 cases O.M.

El Mustafa. JABMS. Vol 3 No. 4, Oct. 2001, page 99-102.

12. Lingual Granuloma Garvidarum: A case report. O.M. El Mustafa and

A.A. Badie SMJ 2001; Vol 22(12) page 1130-1132.

13. Aetiological Factors of Profound Sensorineural Deafness in Sudanese

Children. O.M. El Mustafa. & A.B. Habour. The Saudi Journal of ORL H

and N. Surgery. Vol 4 No. 1, Jan 2002, page 9-12.

14. She Wants It Done. A.B. Habour and O.M. El Mustafa, Saudi Journal of

Family and Community Medicine (SAFCM); Vol 9 No. 1, Apr. 2002;

page 41-45.

15. Carcinoma of the tongue in a patient with Sideropenic Dysphagia: A

case report. O.M. El Mustafa. JABMS Vol 4 No. 4, Oct. 2002, page 39-

41..

16. Spontaneous Cure of an Oropharyngeal Hamartoma. O.M. El Mustafa

and A.A. Badie; SMJ 2003; Vol 24(1), page 104.

17. A Giant Lingual Pyogenic Granuloma, O.M. El Mustafa SMJ; 2003 Vol.

24(1), page 1425.

18. Aetiology of Bilateral Recurrent Laryngeal Nerve Paralysis in Sudanese

Patients. O.M. El Mustafa JABMS; Vol 5 No. 1, Jan. 2003; page 22-24.

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19. Blunt Laryngeal Trauma in Sudanese Agricultural Workers: Two Cases

Report. O.M. El Mustafa, Gezira Journal of Health Sciences (GJHS) 1,1,

2003.

20. Low Frequency of Deafness associated GJB2 Variants in Kenya and Sudan

and Novel GJB2 Variants. NG Mohamed, M. Schmidt, M.M.A. Magzoub,

M. Macharia, O.M. El Mustafa, E. Winkler, G. Ruge, R.D. Horstmann, C.G.

Meyer et al. Human Mutation, Mutation in Brief #687(2004) Online.

21. Clinical presentation of hypo pharyngeal tumors in Sudanese patients. El

Mustafa O.M. and Albalasi A.K.K.. JABMS, Vol.7(1) 2005, p. 38-41

22. Grade 1 Nasal Septal Chondrosarcoma : A Case Report. El Mustafa O M .

Abdullah H A And Albalasi AKK.JABMS Vol.7 (4) 2005 p367-369.

23. Patterns of Head and Neck Malignancies in Central Sudan-Study of 314

Cases. Abuidris DO, Elhaj AHA, Elgayli EM and El Mustafa OM.Sudan

JMS Vol.3 No.2,June 2008 p 105-108.

24. Histopathological Patterns of Nasopharyngeal Carcinoma in Sudan. Abuidris

DO,Elgayli EM, Elhaj AHA and El Mustafa OM. Saudi Med J 2008; Vol 29

(7) p 179-182.

25. Angiofibroma in Sudanese Patients.MunaAAbdulRahim, Nagat A El Awad

and El Mustafa OM.JABMS.Vol 9 No 4,2008,page 43-46.

26. Clinical Features of Nasopharyngeal Carcinoma in Sudan : Study of 103

Cases. Elhaj Abusufian HA, Abuidris DO, Elgayli EM and El Mustafa OM.

JABHS,Vol 10,No 2, 2009 page 43-47.

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27. A Clinical Experience with Sharp Bronchial Foreign Bodies in Sudanese

Patients. El Mustafa OM and Osman WN. Sudanese Journal of Public

Health, April 2009,Vol 4,No 2,page 256-258.

28. Nasopharyngeal Hemangiopericytoma in a Sudanese Child :A Literature

Review and A Case Report. El Mustafa OM ,Osman WN and Ishag MY.

Sudan JMS,Vol 5, No 1,March 2010 page 63-65.

Documents

ORL CURICULLUM