Specific Standards of Accreditation for Residency
Programs in General Surgery
2010
INTRODUCTION
The purpose of this document is to provide program directors and surveyors with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in General Surgery. This document should be read in conjunction with the General
Standards of Accreditation, the Objectives of Training and the Specialty Training Requirements in General Surgery.
STANDARD B1: ADMINISTRATIVE STRUCTURE
There must be an appropriate administrative structure for each residency program.
Please refer to Standard B1 in the General Standards of Accreditation for the interpretation of this standard. The program director in General Surgery must sit on the Surgical Foundations coordinating committee of the university.
STANDARD B2: GOALS AND OBJECTIVES
There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents.
The general goals and objectives for General Surgery are outlined in the Objectives of
Training and the Specialty Training Requirements in General Surgery. Based upon these
general objectives, each program must develop rotation specific objectives suitable for that particular program, as noted in Standard B2 of the General Standards of Accreditation. Methods to determine if rotation specific objectives are being met should be employed on a regular basis.
STANDARDB3: STRUCTURE AND ORGANIZATION OF THE PROGRAM
There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfil the educational requirements and achieve competence in the specialty.
The structure and organization of each accredited program in General Surgery must be consistent with the specialty training requirements as outlined in the Objectives of Training and the Specialty Training Requirements in General Surgery.
Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to their level of training, ability, and experience for the management of surgical patients.
In addition to offering the components noted in the specialty training requirements all accredited programs in General Surgery must offer community-based learning experiences.
STANDARD B4: RESOURCES
There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the Royal College or CFPC specialty training requirements.
In those cases where a university has sufficient resources to provide most of the training in General Surgery but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.
Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to General Surgery.
1. Teaching Faculty
There must be a sufficient number of qualified faculty to supervise residents at all levels and in all aspects of the specialty. The faculty should include a nucleus of full-time equivalent surgeons as clinical teachers. The Program Director must hold Royal College certification in General Surgery or other acceptable or equivalent qualifications.
2. Number and Variety of Patients
The number and variety of patients available to the program in all teaching facilities must consistently be sufficient to meet the educational needs of the residents.
3. Clinical Services Specific to General Surgery Surgical Services
Surgical services participating in the General Surgery program should be organized into clinical teaching services, each with an adequate number of patients available for teaching and administered by a staff director to whom the senior resident is responsible. The physicians attached to each clinical teaching service must hold Royal College certification in either General Surgery or other acceptable or equivalent qualifications.
Personal operative experience, ultimately including the major procedures in the specialty, must be provided under appropriate supervision. Each resident must keep an electronic record of all operative procedures in which he or she has participated either as assistant or operating surgeon.
a. Ambulatory
In-patient and outpatient clinical teaching services should be integrated, so far as possible, in order to provide continuity of management of patients both in and out of hospital. Organized clinics or other facilities, whether general or specialized in nature, must provide opportunities for pre-admission investigation and post-discharge follow-up of general surgical patients in all surgical categories mentioned below.
b. Gastrointestinal Surgery
Teaching facilities for training in this field should have a close relationship with a gastroenterology service, preferably with an accredited residency program in Gastroenterology. Access or referral to a transplantation service is desirable. Residents must be provided opportunity to acquire competence in endoscopy of the upper and lower gastrointestinal tract and should keep a record of endoscopic procedures performed. Residents must acquire competence in standard abdominal laparoscopic procedures and be experienced with appropriate advanced laparoscopic techniques. In addition to standard facilities for radiological investigation of the gastrointestinal tract, special facilities for angiographic studies, nuclear medicine imaging and ultrasound, CT and MRI scanning must be available.
c. Surgical Oncology
Experience must be provided for residents in the oncology of the breast, endocrine and lymphatic systems, skin, soft tissues, and head and neck as it applies to neck masses. Active teaching services must be available to admit the necessary volume of patients for surgical treatment of such neoplastic diseases. Interdisciplinary tumour clinics and conferences are an important feature of this phase of training, and a close relationship with radiation, and medical oncology is essential such that the respective roles of these treatment modalities are understood.
d. Surgical Endocrinology
Provision must be made for experience in surgical management of endocrine diseases including thyroid and adrenal glands.
e. Trauma
There must be at least one teaching facility admitting a substantial number of patients who have serious injuries. The facility responsible for major trauma must have a plan for the management of major trauma patients based on a well-organized multidisciplinary team and embracing the emergency department and an intensive care unit equipped to handle major trauma. Each resident must have major responsibility in handling injuries to the trunk and viscera, blood vessels, and soft tissues, on both an emergency and definitive basis. The program must provide for such residents a close concurrent contact with relevant surgical specialties, especially cardiovascular and thoracic surgery, neurosurgery, plastic surgery, orthopedic surgery, and urology.
f. Thoracic Surgery
Provision must be made for experience in thoracic surgery. This may be achieved by close cooperation with a program in Cardiac Surgery, Thoracic Surgery, or a general surgery service that includes an adequate volume of thoracic surgery.
g. Vascular Surgery
Provision must be made for experience in vascular surgery, both the diagnostic and therapeutic aspects. This experience may be obtained either on a general surgery service with adequate volumes of vascular surgery or by rotation to a vascular surgery service.
h. Pediatric General Surgery
The program must have access to pediatric surgery. Residents should be instructed by Pediatric General Surgeons. There must be opportunities to manage pediatric surgical patients in an emergency department which includes trauma patients, a neonatal intensive care unit, pediatric intensive care units, and ambulatory and in-patient pediatric teaching units.
i. Critical Care
Each resident must have ample opportunity to be responsible for surgical patients undergoing treatment in intensive care units. Residents should have experience in following their own patients while in intensive care units, and in addition must have a rotation to an adult intensive care unit. Such units must be organized for teaching with appropriate levels of supervision and responsibility for the care of the critically ill patient. j. Emergency Departments
There must be systematic supervision of residents at both junior and senior levels to ensure expertise in the initial management of all types of surgical emergencies presented in the emergency department. Experience in providing a consultative service is an important feature of such training.
k. Community Learning Experiences
Community surgery experiences must be available to provide a learning environment with appropriate supervision and evaluation based on rotation specific objectives. This assumes administrative support and linkages with the program.
4. Supporting Services - Clinical, Diagnostic, Technical
There must be appropriate liaison with teaching services in internal medicine, pediatrics, anesthesiology, anatomical or general pathology, and diagnostic radiology. Hospitals with a major role in the general surgery program should also be engaged in medical undergraduate teaching.
STANDARD B5: CLINICAL, ACADEMIC AND SCHOLARLY CONTENT OF THE PROGRAM
The clinical, academic and scholarly content of the program must be appropriate for university postgraduate education and adequately prepare residents to fulfill all of the CanMEDS/CanMEDS-FM Roles of the specialist. The quality of scholarship in the program will, in part, be demonstrated by a spirit of enquiry during clinical discussions, at the bedside, in clinics or in the community, and in seminars, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.
Please refer to Standard B5 in the General Standards of Accreditation and the Objectives of
Training, the Specialty Training Requirements in General Surgery and the CanMEDS
Framework for the interpretation of this standard. Each program is expected to develop a curriculum for each of the CanMEDS roles, which reflects the uniqueness of the program and its particular environment. Specific additional requirements are listed below.
1. Medical Expert
In addition to the General Standards of Accreditation, the following requirements apply: - There must be an organized system of educational rounds and seminars to review the
basic and practical aspects of the discipline. Where appropriate these should be multi-disciplinary, especially in the area of oncology.
2. Communicator
The General Standards of Accreditation apply to this section. 3. Collaborator
The General Standards of Accreditation apply to this section. 4. Manager
The General Standards of Accreditation apply to this section. 5. Health Advocate
The General Standards of Accreditation apply to this section. 6. Scholar
In addition to the General Standards of Accreditation, the following requirements apply: - There must be sufficient human and other resources to support the requirements for
scholarly projects. A systematic approach to the review and interpretation of the specialty literature in General Surgery must be provided.
7. Professional
The General Standards of Accreditation apply to this section.
STANDARD B6: EVALUATION OF RESIDENT PERFORMANCE
There must be mechanisms in place to ensure the systematic collection and interpretation of evaluation data on each resident enrolled in the program.
Please refer to Standard B6 in the General Standards of Accreditation for the interpretation of this standard.
Adopted by Council - 98 04
Revised – Education Committee – 06 11 16 Revised – SSRC – June 2010
