ࡱ> 68345g bjbjhh 7|\|\U2 8H|Rh (H H H 7!$ % RRRRRRR$VU X`3RM&7!7!M&M&3RH H HR---M&H H R-M& R--mMPH P87\*N"Q^R0RNlX*lXDPlXP4M&M&-M&M&M&M&M&3R3R-M&M&M&RM&M&M&M&lXM&M&M&M&M&M&M&M&M& > : Surgery Clerkship Objectives 2019-2020 Table of Contents TOPIC PAGE HYPERLINK \l "_GOALS_FOR_THE"Overarching Goals and Objectives. 2  HYPERLINK \l "GenSurg" General Surgery.. 10  HYPERLINK \l "Vascular" Vascular.. 22 HYPERLINK \l "_Orthopedic_Surgery_Knowledge"Orthopedics 24  HYPERLINK \l "Urology" Urology 27  HYPERLINK \l "Goals" GOALS FOR THE SURGICAL CLERKSHIP GOALS - The goal of the third-year Surgery clerkship is to prepare students to: identify diseases and situations in which surgical intervention is appropriate, prepare the patient for surgical intervention, and care for the patient after surgical intervention. It is a survey course of surgery in general rather than a course in General Surgery. Specifically, the overarching goals are:Under guidance of a surgeon-preceptor, we provide exposure to the breadth and depth of the surgical sciences by enabling students to function as a contributing member of the surgical team in in-patient and ambulatory settings. We introduce the principles of surgery and the rationale behind surgical therapeutic intervention through self-directed learning activities. We provide students with the opportunity to develop knowledge and skills necessary to provide patient care: to diagnose surgical diseases, and to determine criteria for surgical referral while fostering the development of lifelong learning skills. We foster student growth in the areas of communication skills, practice-based learning, medical ethics and moral reasoning, professionalism and social and community context of health care. We strive to emphasize the principles common to all surgical practice regardless of specialty area and when appropriate we present material in themes those reflect surgical principles.  SURGICAL CLERKSHIP OBJECTIVES PHYSICIANSHIP OBJECTIVES - Complementary to specific knowledge and skills objectives, students are expected to demonstrate ongoing growth in the area of interpersonal and communication skills, medical ethics and moral reasoning, practice-based learning and improvement and professionalism. During the surgery clerkship, the student will:Participate as members of a health care team and effectively communicate with members of the team. (clinical performance evaluations, 360 degree evaluation) SATBC-2 Participate in one ethics conference and be able to participate in a discussion of ethical principles as they apply to surgery: (attend one conference, complete one write-up) PBMR-1 Demonstrate the ability to acquire and apply scientific knowledge to a clinical problem in the small group setting: (seminar groups) Attend required conferences and complete the electronic log. (Attendance, log records, CPE) PBMR-5 Maintain professional dress and demeanor and develop professional relationships with peers, faculty and staff. (performance evaluations, professional points) PBMR-3  HISTORY AND PHYSICAL EXAM OBJECTIVES HISTORY and PHYSICAL OBJECTIVES - During the 8 week clerkship students will perform a focused history and physical exam on the specified number of real or simulated patients for the following presenting complaints. At the completion of the clerkship each student will be able to obtain a focused history and perform a focused physical exam for each complaint in a timely manner as assessed by Clinical Performance Appraisals and the OSCE. PCMC-2Physical ExamsSpecific Physical Examination ObjectivesResources Abdomen n=5 Musculoskeletal n=1 GU n=1 Vascular/Extremity n=1Abdominal complaint (may include abdominal pain, abnormal bowel or bladder function, abnormal test relating to the abdomen): 5 patients Demonstrate complete abdominal exam including inspection, auscultation, percussion and palpation Detect abnormal findings of abdominal exam including abnormal bowel sounds, masses, hernia, tenderness and guarding and describe their significance Musculoskeletal complaint (may include sprains, strains, fractures, tumor of bone/muscle, joint dysfuntion): 1 patient Demonstrate proper technique for a knee exam, identify normal and abnormal findings with Inspection, Effusion, Patellar Signs-crepitance, grind, apprehension sign, laxity, Tenderness Active and Passive Range of Motion. flexion, extension, Strength, Stability Meniscal Tests Demonstrate proper technique for a shoulder exam, identify normal and abnormal findings withInspection, Tenderness AC Joint, Acromium, Deltoid bursae, Range of Motion, flexion, extension, abduction, adduction, internal rotation and external rotation, Impingement tests, Strength of Rotator Cuff Demonstrate proper technique for a back exam, identify normal and abnormal findings with inspection of curvature (Scoliosis, kyphosis), Tenderness, Range of Motion:. neck flexion, extension, rotation, and lateral bending, back flexion, extension, and lateral bending. Straight leg raise, Reflexes, Sensation, Strength and be able to relate the findings to a specific nerve root level Male genital, prostate complaint: 1 patient including testicular, penile, scrotal and inguinal complaints Demonstrate male genital and hernia exam Identify abnormal prostate findings and their significance Detect hernia on exam Demonstrate patient education for self-testicular exam Vascular complaint: 1 patient (may include any patient when occlusion, ischemia, vascular dilation (aneurysm) or venous obstruction Demonstrate proper location and technique for listening for carotid bruit Demonstrate proper location and technique for palpating carotid, brachial, radial, femoral, popliteal, dorsalis pedis and posterior tibial pulses Demonstrate proper technique for palpating an abdominal aortic aneurysm Perform and calculate an ankle brachial index Evaluation perfusion of extremity after trauma Evaluate extremity for consideration of compartment Evaluation of extremity for DVTText/Electronic Adjuncts Bates AUA website Skill Sessions Ortho skills session GU PEX session (for students not rotating on GU) Didactic Sessions Acute Abdomen lecture Feedback Opportunities Direct Observation Clinical Opportunities Student Swap  SKILLS OBJECTIVES SKILLS OBJECTIVES - During the 8 week clerkship students will perform the following skills on the specified number of real or simulated patients. At the completion of the clerkship each student will be able to perform these skills in a controlled setting with supervision as assessed by clinical performance appraisal by the nurse instructor and OSCE. PCMC-4SKILLSpecific Knowledge ObjectivesResourcesDrain removal (N = 2) Dressing change (N= 5) Gowning and Gloving (N = 10) Informed consent (N = 1) Insertion of urethral catheter (N = 2) Interpret of body imaging (N=13) NG tube insertion and removal (N=2) Oral presentation of patient (N = 10) Progress notes / Procedure notes (n = 10) Skin closure, knot tying (n=1) Venepuncture / IV insertion (n = 1) Demonstrate appropriate technique for removal of drain or chest tube Demonstrate appropriate technique for aseptic dressing change Demonstrate appropriate technique for hand scrub and sterile self gown and glove List the components of informed consent Observe the informed consent process Demonstrate sterile placement of urethral catheter in male or female Recognize normal and the following abnormal findings on imaging studies. Plain films: N = 5 Chest x-ray: pneumothorax, hemothorax/effusion, rib fracture, widened mediastinum Abdominal films: normal gas pattern, ileus, small bowel obstruction, free air Spine: normal c-spine, fracture, arthritis Fractures of long bones Computed tomography images: N = 5 CT abdomen: normal aorta, liver, bowel, appendix, free air, aneurysm, ruptured aneurysm, small or large bowel obstruction, appendicitis, pancreatic mass, liver mets, urolithiasis, hydronephrosis Non-contrast CT head: normal, sub-dural hematoma, epidural hematoma, midline shift, fracture Other body imaging: N = 3 Ultrasound of gall bladder stones, findings of cholecysititis HIDA scan: interpretation for cholecystitis, choledocholithiasis, bile leak Mammogram: normal, speculated mass, microcalcifications Demonstrate appropriate technique for placing NG tube Give accurate and concise oral presentations of clinic and ward surgical patients Write accurate and appropriately thorough daily progress notes. Write accurate and complete procedure notes. Demonstrate simple closure of skin including suture selection and knot tying Place or remove skin staples Demonstrate appropriate technique for placing iv or venepunctureText/Electronic Adjuncts Video files Wound Management Lecture Purple book for description of all notes and presentations Small Group/Sim Sessions Orientation Sessions Tubes/drains/NG Gowning/gloving Foley placement Suture session OR simulation Dressings Small Group Sessions IV/venipuncture ABI Open Session Imaging Interpretation Ortho skills session Normal anatomy imaging.northwestern.edu/m1m2/  KNOWLEDGE OBJECTIVES KNOWLEDGE OBJECTIVES -At the completion of the 8-week surgery clerkship, the student should be have studied the following material at least ONCE via clinical encounter, didactic sessions, seminar sessions, simulation OR through self study from recommended texts and WISE-MD modules. Specific enabling objectives for this area are found later in this document. These objectives are assessed on the Clinical Performance Appraisals, in Seminar, on the Midterm and National Board of Medical Examiners Subject Examination. General Acute abdomen Non-operative sources of abdominal pain Gastrointestinal bleeding Benign gastrointestinal disease GI malignancy: Anorectal disease: Breast disease: Reflux:  Endocrine disorders: 1 patient Hernias Trauma / Shock: Arterial vascular disease: Venous disease: Obesity: Wound: Benign or malignant lung nodule: Coronary artery disease, valve disease: Musculoskeletal Back Complaint: Joint Complaint:  Injury, Fracture: Orthopedic Infection: Orthopedic Trauma Urology Prostate problem: Urinary complaint: Urologic Infection:  Urologic Cancer: Scrotal complaint: Voiding complaint:   HYPERLINK \l "GenSurg" General Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesShock/TraumaShock Define shock and list the three most commonly encountered types of shock List hemodynamic features (i.e. systemic vascular resistance, cardiac output, etc.), diagnostic tests, and physical findings which differentiate each type of shock. For each category of shock, outline the general principles of fluid, pharmacologic and surgical intervention Trauma Identify the correct sequence of priorities of emergency medical care to be followed in assessing the multiply injured patient Explain the treatment guidelines and techniques to be used in the initial resuscitation of the trauma patient and in the definitive care phase of treatment. Identify each of the following common life-threatening chest injuries; describe underlying physiology: o Tension pneumothorax o Open pneumothorax o Massive hemothorax o Flail chest o Cardiac tamponade Define the following potentially life-threatening injuries and discuss their initial management: o Pulmonary contusion o Aortic disruption o Tracheobronchial disruption o Esophageal disruption o Diaphragmatic disruption o Myocardial contusion Outline supportive diagnostic and therapeutic actions for abdominal trauma, including the indications and contraindications for diagnostic peritoneal lavage Outline general principles of management in the transportation and/or transfer of the trauma patient.Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions General Surgery Knowledge Objectives Specific Knowledge ObjectivesResourcesAcute AbdomenAppendicitis List the signs, symptoms, and differential diagnosis of acute appendicitis, and describe how diseases which mimic it may be differentiated. Outline the diagnostic workup of a patient with suspected appendicitis and describe the laboratory findings which would tend to confirm the diagnosis Biliary Tract List several diseases and risk factors known to predispose to gallstones Contrast the signs, symptoms, laboratory findings, and treatment plan of biliary colic (chronic cholecystitis), with those of acute cholecystitis List the appropriate diagnostic tests used for acute cholecystitis, biliary colic, obstructive jaundice, and cholangitis, as well as the limitations and potential complications of each Describe the natural history of a young patient with asymptomatic gallstones Contrast the liver enzyme abnormalities in obstructive jaundice and viral hepatitis, and list a differential diagnosis for obstructive jaundice Describe the symptoms and signs of choledocholithiasis; differentiate from cholecystitis Define cholangitis and outline the diagnostic evaluation and management of a patient with symptoms suggestive of cholangitis Define Gallstone ileus and Charcots triad Small Bowel Obstruction Describe common etiologies, signs and symptoms of small intestinal mechanical obstruction and contrast them with those of paralytic ileus Describe the complications of small intestinal obstruction, including fluid and electrolyte shifts, vascular compromise of the small intestine, and sepsis Outline the appropriate laboratory test and x-rays to be employed in the diagnostic evaluation of a patient with a suspected small intestinal obstruction Large Bowel Obstruction List signs, symptoms, and diagnostic aids for evaluating presumed large bowel obstruction List at least four causes of colonic obstruction in the adult patient including the frequency of each cause Outline a plan for diagnostic studies, preoperative management, and treatment of volvulus; of impaction; of obstructing colon cancer. Perforated Viscous List signs and symptoms of a perforated viscous List the differential diagnosis for perforated viscous Describe history that would help to differentiate between conditions in this differential Outline appropriate steps in initial treatment and diagnosis of a patient with perforated viscous. Text/Electronic Adjuncts Doherty Copes Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions General Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesNon-operative sources of abdominal pain Pancreatitis List four etiologies of pancreatitis Describe the clinical presentation of a patient with acute pancreatitis, including a description of indications for surgical intervention List at least five potential early and late complications of acute pancreatitis Describe the criteria used to predict the prognosis for acute pancreatitis. Describe four potential adverse outcomes of chronic pancreatitis, as well as diagnostic approach, surgical treatment options and management. Describe the mechanism of pancreatic pseudocyst formation and list five symptoms and physical signs of pseudocysts. Describe the diagnostic approach to a patient with a suspected pancreatic pseudocyst. Describe the natural history of an untreated pancreatic pseudocyst, as well as the medical and surgical options for treating a patient with a pancreatic pseudocyst. Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions General Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesGastrointestinal bleeding-Heme - positive stool; state their significance with regard to the level of the bleeding source. -Differentiate the clinical presentations of acute and chronic gastrointestinal bleeding -Differentiate the presentations of bleeding from upper and lower GI sources -Given a patient with gastrointestinal hemorrhage, outline according to priority the steps of assessment and initial management, including the following: o General systemic evaluation o Correction of hypovolemia o Verification of bleeding (nasogastric tube, rectal examination) o Management triage (prompt surgery vs. further studies) o Diagnostic methods for upper gastrointestinal hemorrhage -(endoscopy, angiography, barium studies) -Outline sequence for lower gastrointestinal hemorrhage evaluation (proctosigmoidoscopy, angiography, barium studies) -In order of frequency, list the most common causes of upper and lower gastrointestinal bleeding in the general population, in the adult (age 16 years and above) and in the infant (birth to 2 years). -List criteria for surgical intervention in a patient with gastrointestinal hemorrhage Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions General Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesBenign gastrointestinal diseaseDiverticular Disease Describe the clinical findings of diverticular disease of the colon. List five complications of diverticular disease and describe when surgical management is indicated For a patient with left lower quadrant pain, list the differential diagnosis, describe initial management, diagnostic studies and indications for medical versus surgical treatment Inflammatory Bowel Disease Describe the most common clinical presentations of a patient with Crohns disease. List the complications (including extra-intestinal manifestations) of Crohns disease which may require surgical therapy Outline a diagnostic approach to a patient with symptoms and signs of Crohns disease Differentiate the presentation, pattern of involvement, pathology, x-ray findings, treatment and complications of Crohns disease and ulcerative colitis. What is the pre-malignant potential in each? Describe the role of surgery in the treatment of patients with ulcerative colitis who have the following complications: intractability, toxic colitis, cancer, perforation and bleeding. Explain the role of surgery in the treatment of patients with Crohns disease who have the following complications: fistula, bleeding and stricture Outline the non-operative therapy of ulcerative colitis and Crohns disease. Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions General Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesReflux/EsophagusGERD / Esophagus Define hiatus hernia and explain its association with reflux esophagitis Describe the pathophysiology predisposing to reflux esophagitis Describe the symptoms of reflux esophagitis and discuss the diagnostic procedures used for confirmation of the condition Outline the indications for medical versus operative management of esophageal reflux; describe the most common anti-reflux operative procedure List the common esophageal diverticula, their location, their symptomatology and pathogenesis Define dysphagia, odynophagia, pyrosis and globus hystericus Describe the pathophysiology and symptoms of achalasia; outline the management options Outline the differential diagnosis and diagnostic evaluation of a patient with dysphagia Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions General Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesAnorectal DiseaseAnal Fissure / Fistula Outline the principles of management of patients with fistula-in-ano. Define anal fissure and discuss its clinical presentation, diagnosis, and treatment. Hemorrhoids Explain the anatomy of hemorrhoids, including the four grades encountered clinically; differentiate internal and external hemorrhoids. List the etiological factors and predisposing conditions in the development of hemorrhoidal disease Outline the principles of management of patients with symptomatic external and internal hemorrhoids, including the roles of non-operative and operative management Perianal Infections Explain the role of anal crypts in perianal infection and describe the various types of perianal infections Outline the symptoms and physical findings of patients with perianal infections Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions General Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesHernias  Describe the anatomic and developmental differences between indirect and direct inguinal hernias Name three clinical conditions which may predispose the development of inguinal hernias. Discuss the relative frequency of indirect, direct, and femoral hernias by age and sex. Define sliding hernia, incarcerated hernia, strangulated hernia, Hesselbachs triangle. Describe the clinical presentation, distinctive features, and surgical treatment of femoral hernia. Outline the principles of management of a patient with an incarcerated inguinal hernia. Differentiate etiology, natural history, complications, and treatment of umbilical hernia in the infant and in the adult . Describe four factors contributing to the development of incisional hernia Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions General Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesSkin ObesityBurns Classify the depth of burn injury and differentiate first, second, third and fourth degree burns. Calculate total body surface area burned using the rule of nines List the causes, signs and symptoms of inhalation injury Using the Parkland formula, calculate the fluid resuscitation of burn patients, including composition, volume and timing of fluid Identify patients who require specialized burn center management Define the maximum extent to which a patient can be burned and still be managed on an outpatient basis. Wound Healing Describe the sequential steps of wound healing and the approximate time course associated with each. Identify the non-healing or inflamed wound and propose management Contrast the uses of absorbable and non-absorbable suture Identify clinical factors that may retard wound healing Describe the rationale for the use of closed suction drainage of wounds Explain complications of morbid obesity Explain the criteria for considering surgery for morbid obesity. Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions General Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesEndocrine Disorders Parathyroid List the diseases, signs and symptoms associated with hypercalcemia Outline the workup of a patient with hypercalcemia, including an algorithm for the diagnosis of hyperparathyroidism Differentiate between primary, secondary, and tertiary hyperparathyroidism and discuss the role of surgery in each Describe the complications which may occur after parathyroid surgery Discuss the differences in appearance and treatment of parathyroid adenoma versus hyperplasia Describe the treatment of hypercalcemic crisis Describe the most common causes, symptoms, signs and of hypoparathyroidism and pseudohypoparathyroidism Describe the multiple endocrine adenoma syndromes which involve the parathyroid. Thyroid List the differential diagnosis and outline the workup of a patient with a thyroid nodule. List the risk factors for carcinoma of the thyroid gland Explain the common presenting symptoms and physical findings of a patient with thyroid carcinoma Contrast the role of surgery in treating patients with hyperthyroidism with medical treatment and radioactive agents; include a discussion of complication of each modality Explain the preoperative preparation of a patient who is to undergo surgery for hyperthyroidism. Describe the presentation and treatment of thyroid storm Describe the multiple endocrine adenoma syndrome that involves the thyroid gland and discuss its clinical significanceText/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions  HYPERLINK \l "Vascular" Vascular Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesVascular Surgery Coronary artery disease/ Valve disease Abdominal Aortic Aneurysm List risk factors for AAA and describe who should be screened Describe the diagnostic tests for AAA Describe the risk of aneurysm rupture at 4, 5 and 6 cm and describe indications for surgery Compare and contrast open and endovascular aneurysm surgery with respect to indications to treat and complications Describe other common locations of aneurysms. Acute and Chronic Limb Threatening Ischemia Describe the classic presenting symptoms for acute arterial ischemia of the extremity including the 6 Ps Describe the most common etiologies for acute ischemia including embolic and thrombotic causes; differentiate the history and PE findings of thrombosis vs. embolism Describe the classic symptoms of rest pain including characteristics and location. List risk factors for atherosclerosis Outline the role of physical exam, non-invasive testing and arteriography for lower extremity ischemia Draw the anatomy of the lower extremity arterial system Cerebrovascular Disease Describe the symptoms of cerebrovascular disease including amaurosis fugax, transient ischemic attacks and stroke. Describe the appropriate diagnostic evaluation of symptoms of cerebrovascular disease or a bruit and indications for surgery Compare and contrast medical therapy, surgery and stenting for average risk asymptomatic, symptomatic and high risk patients Claudication Describe the symptoms of claudication including character and location of pain (Lawrence SS pp. 307-310, 443) Outline the appropriate work up of claudication including the role of physical exam, non-invasive testing and arteriogram. (Lawrence SS pp.307) Describe the treatment of claudication including the role of a walking program, medications, angioplasty and surgery. (Lawrence SS pp.307-308) List the two FDA approved medications for claudication Describe the importance of risk factor reduction and smoking cessation in claudicants, and describe methods to support smoking cessation. Venous Disease Swollen leg / DVT / Pulmonary Embolism (Lawrence GS pp. 476-477) List risk factors for thromboembolism Describe the symptoms of DVT, PE, and chronic venous insufficiency Outline the evaluation of a swollen leg List the three most common tests for diagnosis of a pulmonary embolism. Differentiate what clinical situations favor each. Describe the treatment of DVT and pulmonary embolism including the role of unfractionated heparin, low molecular wt. heparin, warfarin (coumadin) and vena cava filters Describe the indications for placement of a vena cava filter Describe the post-phlebitic syndrome Describe the typical appearance and location of a venous ulcer. Explain the role of compression stockings in the treatment of DVT and chronic venous insufficiency. Varicose Veins (Lawrence GS pp. 477-479) Explain when to refer a patient for the treatment of varicose veins List the three main complications of varicose veins. Coronary Artery Disease Describe the indications for surgery Describe the risk factors that increase operative mortality. Outline cardiac risk assessment for non-cardiac surgery. Valvular heart disease Describe the pathophysiology of common valvular disorders Contrast the risks and benefits of porcine and mechanical heart valves Outline anticoagulant management of patients with prosthetic heart valvesText/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions  HYPERLINK \l "Ortho" Orthopedic Surgery Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesBack Complaints Cervical radiculo-/myelo- pathy Describe the presentation of cervical radiculopathy and myelopathy Outline radiographic evaluation and treatment options for radiculopathy and myelopathy Lumbar radiculopathy Describe the presentation of lumbar radiculopathy Outline radiographic evaluation and treatment options for lumbar radiculopathy Herniated/ Degenerative disc disease Describe the typical neurologic presentation of L5 or L5-S1 herniated disc (Lawrence SS pp. 279- 281) Outline the diagnostic evaluation and management algorighm for herniated disc Foot complaint Describe the presentation/diagnosis of each of the following and explain the non-operative and operative treatments for each: Hammer toe Bunion Corn Wart Ingrown toenail Mortons neuroma Injury/Fracture Define open fracture vs. closed fracture (Lawrence SS pp.242) Identify typical mechanism of injury, appropriate radiologic evaluation and treatment modalities for the following fractures: Hip Tibial shaft Colles Scaphoid Joint Complaints Shoulder Explain the signs, symptoms, diagnostic work up and treatment options for: Shoulder dislocation Frozen shoulder AC separation Rotator cuff tear Rotator cuff impingement syndrome Knee Describe the signs, symptom, diagnostic workup and treatment options for: Torn meniscus Torn ACL Loose body Arthritis Sprain Dislocation: Describe the signs, symptoms, diagnostic workup and treatment options for dislocations of the: Shoulder Finger Hip Elbow Ortho Infection Outline the differential diagnoses, work up and treatment options for the following orthopedic infections: o Osteomyelitis (Lawrence SS pp.272-273) o Septic arthritis o Cellulitis (Lawrence SS pp.114, 191) o Felon (Lawrence SS pp.163, 174-175) o Paronychia (Lawrence SS pp.163) Ortho Trauma Spinal Trauma (Lawrence SS pp.321) Describe central cord syndrome Describe anterior spinal artery syndrome Describe Brown-Sequard syndrome Define spinal instability Emergencies (Lawrence SS pp.253-255) Explain why these are emergencies and describe treatment options for: o Hemodynamically unstable blunt pelvic trauma o Talar neck fracture o Fracture evolving into ischemia o Fracture evolving into neurologic deficit o Long bone fracture - open.Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions  HYPERLINK \l "Urology" Urology Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesBenign Prostatic Hyperplasia (BPH) Genital Complaints: Urinary problems:  Define which zone of the prostate is commonly involved by this process. List the common obstructive and irritative voiding symptoms associated with BPH. Describe a method by which the severity of symptoms can be quantified. Describe the normal dimensions of the prostate gland and how changes in size can be communicated. Explain the adjunctive role of post-void residual assessment, pressure/flow urodynamic testing, transrectal ultrasound measure of prostatic size, and cystoscopy in the evaluation of these patients. Describe the role of alpha-blockers and 5 alpha reductase inhibitors in the medical management of BPH. List the indications for surgical management of BPH. Describe conceptual differences between transurethral resection of the prostate (TURP) and open prostatectomy for the management of BPH. Penile Conditions: Define phimosis and paraphimosis; discuss the management of each condition. Describe management of balanitis and balanitis xerotica obliterans (BXO) Benign Scrotal Conditions Describe the pathophysiology underlying testicular torsion; describe the common presenting signs and symptoms; outline the basic workup for suspected torsion; discuss the rationale for surgical management. List the common scrotal masses which exhibit brilliant transillumination on physical examination; describe their presenting signs and symptoms; outline common management options. Describe ways to distinguish epididymitis (or epididymo-orchitis) from testicular torsion and testicular tumor. Explain why a scrotal hernia is almost always associated with an indirect rather than a direct inguinal hernia. Hematuria List the common causes of gross hematuria. Describe the potential distinctions between initial, terminal, and total hematuria. Define microscopic hematuria. Outline the standard urologic workup for hematuria. Construct the differential diagnosis of a filling defect on a contrast study of the urinary tract. Kidney Stones/Urolithiasis List the common radiopaque stones involving the urinary tract. List the common radiolucent stones involving the urinary tract. Define the most common underlying etiology for calcium oxalate stone formation. List the 3 inherently narrow areas of the urinary tract where stones are likely to obstruct. Describe the common presenting signs and symptoms of renal/ureteral colic. Outline the standard workup for patients with symptomatic urolithiasis. Outline the optimal management of urolithiasis, obstruction, and fever. Describe which patients are best treated with conservative management. Differentiate which patients with urolithiasis need to be referred to a urologist Describe the components of a metabolic stone evaluation. Describe potential medical therapies that can be of value in the prevention of uric acid stone formation. Explain the potential medical therapies that can minimize calcium oxalate stone formation. Hydronephrosis / Congenital and Acquired Obstruction of the Urinary Tract Describe the changes in physiology as obstruction progresses from acute to chronic. List the common symptoms and signs of acute urinary obstruction. Explain common presentations of congenital hydronephrosis. List the anatomic levels of obstruction and congenital and acquired pathology at each level. Describe the pathophysiology and management of post-obstructive diuresis. Describe the work-up and management of congenital hydronephrosis. Explain the concept of nonobstructive hydronephrosis. Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions Surgery in General Knowledge Objectives TOPICSpecific Knowledge ObjectivesResourcesBenign and Malignant Tumors Gastrointestinal Malignancy Colorectal Cancer / Polyps Describe the recommendations for colon cancer screening) Describe the typical presentation of a patient with cancer of the right colon, left colon, rectum, or anus Describe the staging procedures for colon and rectal cancer Describe common sites of metastases Identify features of a polyp that suggest malignant potential Pancreatic Neoplasms ) Describe the symptoms, physical signs, laboratory findings, and diagnostic workup of a pancreatic mass on the basis of the location of the tumor in the pancreas (head vs. tail Esopahgeal Neoplasms: List the symptoms suggestive of an esophageal malignancy Outline a plan for diagnostic evaluation of a patient with a suspected esophageal tumor. Breast Disease Describe recommendations for screening mammography cancers List common risk factors for benign breast disease and breast cancer List diagnostic modalities and discuss their sequence in the workup of a patient with a breast mass; with nipple discharge. Describe the treatment for a fibroadenoma and fibrocystic disease List and the types of breast cancer and explain their clinical staging List the treatment options for local, regional and systemic breast cancer and describe when each is indicated (surgical, non-surgical, combined). Benign or malignant lung nodule Construct a diagnostic plan for a pulmonary nodule Explain pulmonary function tests as they relate to morbidity risk of pulmonary resection Skin Lesions Contrast the gross morphologic and pathologic differences between benign and malignant nevi and explain the approach to diagnosis. Distinguish gross pathologic differences between basal and squamous cell carcinomas and melanoma and list predisposing causes and likely areas of clinical sites Distinguish the natural history, the curability, and the propensity to metastasize of basal and squamous cell carcinomas Describe medical and surgical therapies available for both types of skin cancer Urologic Malignancies: Bladder Cancer Transitional Cell Carcinoma (TCCa) of the Urothelium Describe the common presenting signs and symptoms of urothelial TCCa List the risk factors associated with this disease. Outline an appropriate workup for patients with suspected bladder cancer. Outline an appropriate workup for patients with suspected upper tract TCCa. Describe the management options for superficial bladder cancer. Describe the management options for muscle-invasive bladder cancer. Describe the standard management for TCCa involving the renal collecting system and proximal ureter. Explain potential management options for TCCa involving the ureter. Outline an appropriate staging workup for patients with urothelial cancer Renal Cancer Renal Cell Carcinoma (RCCa) List the classical triad of symptoms associated with RCCa. Describe ways in which to distinguish cystic and solid masses originating within the renal parenchyma. Explain reasons for the limited utility of percutaneous renal biopsy. Outline the standard staging workup for presumed RCCa. Describe a clinical situation in which observation of a solid renal mass may be indicated. List some of the potential indications for an attempt at nephron-sparing surgery. Outline potential management options for the treatment of metastatic RCCa. Testicular Cancer List those patients at highest risk for developing testis cancer. Describe common presenting signs and symptoms. Explain the importance of monitoring alpha fetoprotein (AFP), beta-human chorionic gonadotropin (beta-HCG) and LDH levels in patients with testicular cancer. Explain reasons why an inguinal rather than scrotal orchiectomy is proper management of the primary tumor. Outline the standard staging workup for any patient with confirmed testicular cancer. Outline the management options for low stage seminoma. Outline the management options for advanced stage seminoma. Discuss the management options for low stage mixed germ cell tumors. Discuss the management options for advanced-stage mixed germ cell tumors. Describe the pathophysiology underlying ejaculatory dysfunction following a retroperitoneal lymph node dissection. Penile Cancer Describe those patients at greatest risk for the development of penile cancer. Define the presenting signs and symptoms of this disease. Discuss the potential viral etiology for penile cancer. Prostate nodule / cancer Carcinoma of the Prostate (CaP) Define that zone of the prostate most often involved in neoplastic transformation. Describe those findings on the DRE (digital rectal examination) that may be associated with CaP. Explain the importance of prostate-specific antigen (PSA) testing in the diagnosis, staging, and treatment of patients with CaP. Describe the technique of transrectal ultrasound-guided needle biopsies of the prostate and its rationale for the detection of CaP. Describe the staging options available for the evaluation of patients with biopsy-confirmed CaP. Outline the potential management options for patients with organ-confined disease. Discuss the role of androgen ablation in the management of advanced-stage CaP. Describe some of the therapeutic options available for patients with hormone-refractory CaP. Explain the underlying etiology for spinal cord compression associated with CaP and its proper management. Text/Electronic Adjuncts Doherty Case Files Surgery 101 - podcast Didactics Small Group/Sim Sessions     Page  PAGE 21 of  NUMPAGES 33  !"$&(:<AJOPQopqƻxpaxTxI>hhOJQJhh>MOJQJh h>M0J OJQJjh OJQJUh OJQJjh OJQJUhh*&5>*CJ\aJhh*&5CJ\aJh-5>*CJ\aJhh*&5CJ\aJhh*&OJQJh*&5CJ$\aJ$hL15CJ$\aJ$h-5CJ$\aJ$h J5CJ$\aJ$hrzh*&5CJ$\aJ$'(:;<OPH L M N O P Q R S T gd @ 7$8$H$^@ gd>Mgd>Mgd$a$gdT7$8$H$^T`gd*& 7$8$H$^gd*&$a$gd$7$8$H$^a$gd*&   ! 8 @ D E H I c d e m n   ٵѐٵvٵgjh OJQJUjch OJQJUhh OJQJjh OJQJUhhOJQJhhSOJQJh h>M0J OJQJjh OJQJUh OJQJjh OJQJUh OJQJhh>MOJQJhOJQJ(  ! " ; G H I L M N O S T U l m n p^N@hY3h>M5>*CJaJh h>M5CJ(OJQJaJ(#h h>M0J 5CJ(OJQJaJ(.jqh h 5CJ(OJQJUaJ(h h 5CJ(OJQJaJ((jh h 5CJ(OJQJUaJ(h>Mh>MCJ\aJ h0h>M hSh>MhOJQJhhSOJQJhh>MOJQJh h>M0J OJQJjh OJQJUT   ?wwwww  & F$IfgdShkd$$Ifl 3!4 t0644 laytS $IfgdU&gd>Mgd   $ 8 ^ p    >?9op #>HQWq}~RXYZ[_ҥҥҥ hdph1h1h>M5>*CJaJhY3h>M5>*CJaJhdph>M5hxh>M5 hdph>M hR&h>Mh>M5B*phhU&h>M h>M5hR&h>M5<p$If^`gdSgd>MhkdS$$Ifl 3!4 t0644 laytSpqQYZ $IfgdS  & F$IfgdShkd$$Ifl 3!4 t0644 laytSZ[\^_C $IfgdSgd>Mhkd=$$Ifl 3!4 t0644 laytS tu:BCDSFPQJKd+ B Q !»»»¡š¡“ˆhh>MCJaJ h,h>M h_cgh>MhhS>* h.>h>Mhh>MB*ph h*h>Mhh>M>*hhS5hh>M5>*\ h*&h>Mhh>M6h>M h,'h>Mhh>M55CDS|yy $IfgdS $7$8$H$Ifgdnkd$$Ifl 3x3 t0644 lap ytQ`WWWWWWWWW $IfgdSkd4$$IflF 3H B t06    44 lapyt QJK{Tl+w$If^`gd $IfgdS $IfgdS$If^`gd$7$8$H$If^gd U ! " ( ) * 6 7 8 9 : ; < = > ? $IfgdS & F `p$7$8$H$If^``pgd$7$8$H$If^gd? @ A B Q R g h _VVVVVVVV $IfgdSkd$$Ifl4F 3`H `B t06    44 lapyt Vkd$$Ifl4F 3 H B t06    44 lapyt $IfgdS !!Mkdd$$Ifl4F 3 H B t06    44 lapyt $IfgdDj $IfgdS!!!!/!1!E!P!Q!w!!!!!!"A""""""""""##.#/#V#W#x######$$$$$&$($L$M$$$$$K%p%&&&&&&'''̷ⷭ⦷ h,h>MhhS5\hh>M5\hh>M5>*\ h*&h>Mhh>M6 h,'h>Mhh>M5h>M5>*CJaJ h2uch>Mh>M<!!!!0!1!"VQQQgd>Mkd#$$Ifl4F 3 H B t06    44 lapyt $IfgdS"""""yy $IfgdS $7$8$H$Ifgdnkd$$Ifl 3x3 t0644 lap yt""""""##.#`RIIIRIR $IfgdS $7$8$H$Ifgdkdd $$IflF 3H B t06    44 lapyt.#/#V#W#x#y#z#{#|#}#~################## $7$8$H$Ifgd $IfgdS######$$&$'$($L$M$$$$$#%$%L%q%r%%%&&& $7$8$H$Ifgd $IfgdS&g&&&&'';(U((())P)Q))))**_*|*}** $IfgdS & F$7$8$H$Ifgd $7$8$H$Ifgd & F$7$8$H$Ifgd''((!(:(;(O(T(())P)Q)))**^*|*****++m,,,,,,,,-........... /q/r/z/{/%0貪誔 h_9h>Mh5fh>M56 hR&h>Mh7h>M6 h,'h>MhR&h>M5 h>M5h>M5>*CJaJhDjhh>M>*hhS>*hh>M5\hh>M5h>M h,h>Mhh>MOJQJ^J3*******+=+>+?+@+A+B+C+D+E+F+G+ $IfgdSG+H+I+J+K+_VVV $IfgdSkd $$Ifl4F 3`H `B t06    44 lapytK+L+M+N+g+h+}+++_VVVVVII  & F $Ifgd $IfgdSkd $$Ifl4F 3 H B t06    44 lapyt+++++++++ , ,$,9,h,  & F$Ifgd  & F $Ifgd $IfgdS h$If^hgd  & F $Ifgd h,i,j,l,m,,,._ZZZZZI$If^`gdSgd>Mkd $$Ifl4F 3 H B t06    44 lapyt...... //3/E/O/Q/r/}$If^`gdS $IfgdShkdS $$Ifl 3x3 t0644 laytS r/{///////#0$0%0f{kd $$Ifl0 3c t0644 laytS $IfgdS & F]$If^`]gdS %050F0X0Y0n0000 & F]$If^`]gdS $IfgdSh$If^h`gdS  & F$IfgdS$If^`gdS%0500000'1*1+1,1E1F1G1k1l1m1n1t1111133 777ͽ͓̓xppbWbWKh*&h>M5CJ(aJ(hh>MCJaJhh>M5CJ\aJhh>M5hh>M5>*\hDVh>M5CJ(OJQJaJ(#hDVh>M0J 5CJ(OJQJaJ(.jhDVh 5CJ(OJQJUaJ(hDVh 5CJ(OJQJaJ((jhDVh 5CJ(OJQJUaJ(h>MCJ\aJh>M h_9h>MhLCh>M56000sh$If^h`gdS{kdK $$Ifl0 3c t0644 laytS00000001&1 $IfgdShkd $$Ifl 3x3 t0644 laytS&1'1(1*1+1m1n1t111rm_VV $IfgdS $7$8$H$Ifgdgd @ 7$8$H$^@ gd>Mgd>M{kdC$$Ifl0 3c t0644 laytS 111112333`WIIIIII $7$8$H$Ifgd $IfgdSkd7$$IflF 3H B t06    44 lapyt33<444444 5n55555566 7%7-7.797:7;7<7 $IfgdS$7$8$H$If^gd $7$8$H$Ifgd<7=7S7T7U7V7W7X7Y7Z7Vkd$$Ifl4F 3`H `B t06    44 lapyt $IfgdS Z7[7e7f7g7h7i7j7k7l7 $IfgdS l7m7n7o77_VVV $IfgdSkd$$Ifl4F 3 H B t06    44 lapyt77777777_ZZZZLC $IfgdS $7$8$H$Ifgdgd>Mkdg$$Ifl4F 3 H B t06    44 lapyt777777777'959<<>>?@S@AAAAAABB>B?B@BFBnBoBBBBBFF8FnFxFFFFFFFFF GGKKK"LFLGLHLNLvLwLLLLN7NkNܽܲܲܽh*&h>M5CJ(aJ(hh>MCJaJhh>M5CJ\aJhh>M5>* h*&h>Mhh>M5hh>M5>*\h>Mhxh>M5CJ(aJ(A77778(9<>@@@AWkd&$$IflF 3H B t06    44 lapyt $IfgdS AAAAAAAAAAAAAAAAAAA $IfgdSAAAAAAAAAA_VVVVVVVV $IfgdSkd$$Ifl4F 3`H `B t06    44 lapyt AAAAAABVkd$$Ifl4F 3 H B t06    44 lapyt $IfgdSBBBB?B@BFBdB_ZZZZLC $IfgdS $7$8$H$Ifgdgd>MkdV$$Ifl4F 3 H B t06    44 lapytdBnBoBBbCC DDErEFWkd$$IflF 3H B t06    44 lapyt $IfgdS FFF8F9FAFBFMFNFOFPFfFgFhFiFjFkF $IfgdSkFlFmFnFxFyFzF{F|F}F_VVVVVVVV $IfgdSkd$$Ifl4F 3`H `B t06    44 lapyt }F~FFFFFFVkd$$Ifl4F 3 H B t06    44 lapyt $IfgdSFFFFFFFF_ZZZZLC $IfgdS $7$8$H$Ifgdgd>MkdE$$Ifl4F 3 H B t06    44 lapytFFFGKKKKKKKWkd$$IflF 3H B t06    44 lapyt $IfgdS KKKKKKKKKKKK $IfgdS KKKKKKKKLL_VVVVVVVV $IfgdSkd$$Ifl4F 3`H `B t06    44 lapyt LLLLLLVkdu$$Ifl4F 3 H B t06    44 lapyt $IfgdSLL L"LGLHLNLlL_ZZZZLC $IfgdS $7$8$H$Ifgdgd>Mkd4$$Ifl4F 3 H B t06    44 lapytlLvLwLL`MNPQQQRWkd$$IflF 3H B t06    44 lapyt $IfgdS kNlNPPQhRRRRRRRRRUnVVVVVVVVVWWCYWY!ZZZZZZZZ[[^^^^^^^^_ʵʵæ隖| h*&h hh 5hh 5>*\h h*&h 5CJ(aJ(hh>M5>*CJ\aJhh>M5CJ\aJ h*&h>Mhh>M5hh>M5>*\h*&h>M5CJ(aJ(h>Mhh>MCJaJh^^CJaJ.RR R RRRRR/R0R1R2R3R4R $IfgdS 4R5R6R7RARBRCRDRERFR_VVVVVVVV $IfgdSkd$$Ifl4F 3`H `B t06    44 lapyt FRGRHRIRJRKRdRVkdd$$Ifl4F 3 H B t06    44 lapyt $IfgdSdReRfRhRRRRR_ZZZZLC $IfgdS $7$8$H$Ifgdgd>Mkd#$$Ifl4F 3 H B t06    44 lapytRRRRTUUUVVVWkd$$IflF 3H B t06    44 lapyt $IfgdS VVVVVV5V6V7V8V9V:V;VV?VIVJVKVLVMVNV_VVVVVVVV $IfgdSkd$$Ifl4F 3`H `B t06    44 lapyt NVOVPVQVjV_VVV $IfgdSkdS$$Ifl4F 3 H B t06    44 lapytjVkVlVnVVVVV_ZZZZLC $IfgdS $7$8$H$Ifgdgd>Mkd $$Ifl4F 3 H B t06    44 lapytVVVV Z!Z"Z;ZMkd#$$Ifl4F 3 H B t06    44 lapytZZZ[[\^^6^7^?^Wkd#$$IflF 3H B t06    44 lapyt $IfgdS ?^@^K^L^M^N^d^e^f^g^h^i^j^ $IfgdS j^k^l^m^w^x^y^z^{^|^_VVVVVVVV $IfgdSkdr$$$Ifl4F 3`H `B t06    44 lapyt |^}^~^^^^^Vkd1%$$Ifl4F 3 H B t06    44 lapyt $IfgdS^^^^^^^^_ZUUG>> $Ifgd $7$8$H$Ifgdgd gd>Mkd%$$Ifl4F 3 H B t06    44 lapyt^^^^^^^^^`RIIIIII $Ifgd $7$8$H$Ifgdkd&$$IflF 3H B t06    44 lapyt^^^__________z___~``+a,a;aaa#b]bbbb $7$8$H$Ifgd $Ifgd___*a;abbccccccccdd$dffijXjYjZjcjjjjjºº٧qcZh>M5CJ(aJ(h h>M0J 5CJ(aJ(h h 0J 5CJ(aJ( j,h 5CJ(UaJ(h 5CJ(aJ(jh 5CJ(UaJ(h>Mhh >* h*&h hh 5hh 5>*\h*&h 5CJ(aJ(h hh CJaJhh 5CJ\aJhh 5>*bcc/c0c8c9cDcEcFcGc]c^c_c`cacbcccdc $Ifgd $7$8$H$Ifgddcecfcgcqcrcsctcucvc_VVVVVVVV $Ifgdkda'$$Ifl4F 3`H `B t06    44 lapyt vcwcxcyczc{ccVkd ($$Ifl4F 3 H B t06    44 lapyt $Ifgdcccccccc_ZZZLCC $Ifgd $7$8$H$Ifgdgd kd($$Ifl4F 3 H B t06    44 lapytcccdddddd`RIIIIII $Ifgd $7$8$H$Ifgdkd)$$IflF 3H B t06    44 lapytdddd d d d d dddddddddddd%ddWeee1fff $7$8$H$Ifgd $IfgdfffXggg[hh iiiiiiiiiijjjjj j j j $Ifgd $7$8$H$Ifgd j j jjjjjjjj_VVVVVVVV $IfgdkdP*$$Ifl4F 3`H `B t06    44 lapyt jjj j!j"j;jVkd+$$Ifl4F 3 H B t06    44 lapyt $Ifgd;jMkd+$$Ifl4F 3 H B t06    44 lapytjjjjjjkk6kllooppr&s vvvvlwwSxTxxxxxxyyyyyǼǼǼǼǼǼǼǼǸ{iYh h>M5CJ(OJQJaJ(#h h>M0J 5CJ(OJQJaJ(.j/h h 5CJ(OJQJUaJ(h h 5CJ(OJQJaJ((jh h 5CJ(OJQJUaJ(h>Mhh>MCJaJhh>M5CJ\aJhh>M>*h h >* h*&h>Mhh>M5hh>M5>*\"jjjjjjjjjjj`WWWWWWWWW $IfgdSkd-$$IflF 3H B t06    44 lapyt jjjjjjjjjjjjjjjjjjjjjjjjjjjjj $IfgdSjjjjjjjjjjjjjjjkk7kwkkkrlll9mm5n]n $7$8$H$Ifgd $IfgdS]nnooo pppqlqq+rdrrrr@shsssUt #dd$If]#^dgd d$If]^dgd $If]gd $7$8$H$IfgdUtt>ueuu v6v|vvvv1wlwwwxTx $7$8$H$Ifgdd$If]^dgd d$If]^dgd d$If]^dgd $"dd$If]^dgdTxmxnxvxwxxxxxxxxxxxxx $IfgdSxxxxxxxxxx_VVVVVVVV $IfgdSkd-$$Ifl4F 3`H `B t06    44 lapyt xxxxxxxVkdq.$$Ifl4F 3 H B t06    44 lapyt $IfgdSxxxxyyy=y_ZZUZG> $IfgdS $7$8$H$Ifgdgdgd>Mkd0/$$Ifl4F 3 H B t06    44 lapyt=yGyHyIyYyyyyz,zWIIIII $7$8$H$Ifgdkd\0$$IflF 3H B t06    44 lapyt $IfgdSyGyHyIyyyz,zzz{{d|u|X}u}1~6~~~K[s.=Kׂ͂؂@AcϺpehh>M5>*\h h>M5CJ(OJQJaJ(#h h>M0J 5CJ(OJQJaJ(.jK3h h 5CJ(OJQJUaJ(h h 5CJ(OJQJaJ((jh h 5CJ(OJQJUaJ(h h>Mhh>MCJaJhh>M5CJ\aJ h*&h>Mhh>M5',z`zzz>{{{||(|1|8|?|Q|d|e|u||}5}9}G}O}X}Y} & F $7$8$H$Ifgd$7$8$H$If^gd $7$8$H$IfgdY}Z}[}l}}}}} ~1~~~~~~~)4=CK[+Q$7$8$H$If^gd $7$8$H$IfgdQstŀ./01Vˁ/Lefnoz{ $IfgdS $7$8$H$Ifgd$7$8$H$If^gd{|} $IfgdS _VVVVVVVV $IfgdSkd1$$Ifl4F 3`H `B t06    44 lapyt ʂVkd1$$Ifl4F 3 H B t06    44 lapyt $IfgdSʂ˂̂͂΂ςЂт҂ӂԂ_ZZZZZZZZZgd>Mkd2$$Ifl4F 3 H B t06    44 lapyt ԂՂւׂ6@ $IfgdS $7$8$H$Ifgdgdgd>M@Adefghij`RIIIIII $IfgdS $7$8$H$Ifgdkd3$$IflF 3H B t06    44 lapytcds!a|3}p!IJg˔ȗzܚtşן0==ԧTUúóۨەhxhh>M>* h*&h>Mhh>M5>*\ h /h>Mh>M5CJ(aJ(h*&h>M5CJ(aJ(hh>MCJ\aJh>Mhh>M5CJ\aJhh>M5hh>MCJaJ7jklmnopqrs $7$8$H$Ifgd $IfgdSGV %\I}2!NĊ $7$8$H$Ifgd $IfgdSĊab}RHۍ/j֎3}яM8pq $IfgdS $7$8$H$Ifgd $IfgdS‘̑͑ΑϑБё_VVVVVVVV $IfgdSkdn4$$Ifl4F 3`H `B t06    44 lapyt ёґӑԑՑ֑Vkd-5$$Ifl4F 3 H B t06    44 lapyt $IfgdS!?I_ZZZLCC $IfgdS $7$8$H$Ifgdgd>Mkd5$$Ifl4F 3 H B t06    44 lapytIJg˔ȗ`WWWWWWWWW $IfgdSkd6$$IflF 3H B t06    44 lapyt ȗɗyz ,ܚ#Y5{(tu $IfgdS $7$8$H$Ifgd۝DŞ$xşןLY(o0>ɣ> $IfgdS $7$8$H$IfgdYyۥbgԧէ !"# $IfgdS $7$8$H$Ifgd#$%&012345_VVVVVVVV $IfgdSkd]7$$Ifl4F 3`H `B t06    44 lapyt 56789:SVkd8$$Ifl4F 3 H B t06    44 lapyt $IfgdSSTUWXZ[]^_TOMOMOMgdT $$(@&gd kd8$$Ifl4F 3 H B t06    44 lapytUVXY[\^_afgmnpquvhxhSh-CJaJmHnHujhThSCJUaJhThSCJaJhvjhvU^`a $$(@&gd $a$gdTgdT51h0:p*&= /!"#$% DyK _GOALS_FOR_THEqDyK GenSurgsDyK  VascularDyK _Orthopedic_Surgery_KnowledgeqDyK UrologymDyK Goalss$$If!vh#vx3:V l t065!4ytSs$$If!vh#vx3:V l t065!4ytSs$$If!vh#vx3:V l t065!4ytSs$$If!vh#vx3:V l t065!4ytS$$If!vh#vx3:V l t065x3p yt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vx3:V l t065x3p yt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyts$$If!vh#vx3:V l t065x3ytS$$If!vh#v#vc:V l t0655cytS$$If!vh#v#vc:V l t0655cytSs$$If!vh#vx3:V l t065x3ytS$$If!vh#v#vc:V l t0655cytSqDyK GenSurg$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pytsDyK  Vascular$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pytmDyK Ortho$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pytqDyK Urology$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l t065H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt$$If!vh#vH #vB#v:V l4 t06++5H 5B5pyt "s666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ OJPJQJ_HmH nH sH tH L`L *&Normal$CJOJPJQJ_HaJmH sH tH ^@^ & Heading 1$$@&!B*CJ OJPJQJ^JaJ ph6_^@^ >M Heading 2$$(@&!B*CJOJPJQJ^JaJph6_DA D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List `O` *&Style Left: 0" Hanging: 0.5" ^`0jj *& Table Grid7:V044 T0Header !>/!> T0 Header CharOJPJQJ^J4 @24 T0Footer !>/A> T0 Footer CharOJPJQJ^J@@R@ 9= List Paragraph ^m$V/aV &Heading 1 Char!B*CJ OJPJQJ^JaJ ph6_V/qV >MHeading 2 Char!B*CJOJPJQJ^JaJph6_B' B S0Comment ReferenceCJaJ<< S0 Comment TextCJaJR/R S0Comment Text CharCJOJPJQJ^JaJ@j@ S0Comment Subject5\^/^ S0Comment Subject Char5CJOJPJQJ\^JaJP PS0Revision$CJOJPJQJ_HaJmH sH tH HH S0 Balloon TextCJOJQJ^JaJR/R S0Balloon Text CharCJOJPJQJ^JaJ6U`6 0 Hyperlink >*B*phFV F 0FollowedHyperlink >*B*phPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VvnB`2ǃ,!"E3p#9GQd; H xuv 0F[,F᚜K sO'3w #vfSVbsؠyX p5veuw 1z@ l,i!b I jZ2|9L$Z15xl.(zm${d:\@'23œln$^-@^i?D&|#td!6lġB"&63yy@t!HjpU*yeXry3~{s:FXI O5Y[Y!}S˪.7bd|n]671. tn/w/+[t6}PsںsL. J;̊iN $AI)t2 Lmx:(}\-i*xQCJuWl'QyI@ھ m2DBAR4 w¢naQ`ԲɁ W=0#xBdT/.3-F>bYL%׭˓KK 6HhfPQ=h)GBms]_Ԡ'CZѨys v@c])h7Jهic?FS.NP$ e&\Ӏ+I "'%QÕ@c![paAV.9Hd<ӮHVX*%A{Yr Aբ pxSL9":3U5U NC(p%u@;[d`4)]t#9M4W=P5*f̰lk<_X-C wT%Ժ}B% Y,] A̠&oʰŨ; \lc`|,bUvPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!R%theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] ' 1114 !'%07kN_jycUUWXZ^fmvT pZCQ? !"".##&*G+K++h,.r/%000&113<7Z7l777AAABdBFkF}FFFKKLLlLR4RFRdRRVU](40:  !!""g%q%,,34??LB_BMMM#M$M.M3O6OPPlTxT^^Ug^g_gdgjjllRm[mlotooobqjqlqqqsqxqqszs9u?uGuMuyyyy| |V}a}ǀbt3A=K'5O]^lˌՌ̎ĒȒђے" ՕٕÖ×8;tx]abfUWXZ[]^`a'++HHUUlisijj/z0zV}a}~~Yb۝UWXZ[]^`a333333333333&@AP!Hn"T$/8^p   # > Q W q } ~ ~ JJ))""###+)l):/:/99N>N>CCDDFFkFlFHHJJNNQRQRLVLVVMfY=]2uc_cg\`nc+u4vxP&%*xDjq^*tt$O&D7bgO^^K_ry}vS 5\TL1AUW@&&&&8@Unknown G*Ax Times New Roman5Symbol3. *Cx ArialM AdobePiStdCalibri7.@CalibriG=  jMS Mincho-3 fgK=   jMS Gothic-3 00009. ")Segoe UI?= *Cx Courier New;WingdingsA$BCambria Math"1h#T2s{W'Ug!Q"g!Q"!0JQHP $P*&2! xx Julia Corcoran Burke, JasonD         Oh+'0   @ L X dpxJulia Corcoran Normal.dotmBurke, Jason7Microsoft Office Word@>/@T$E@o@#Q!g՜.+,D՜.+,\ hp  4Feinberg School of Medicine Department of Surgery"Q  Title0 8@ _PID_HLINKSA<uyUrologyOrtho Vascular|dGenSurgGoalsuy Urology# _Orthopedic_Surgery_Knowledge Vascular|dGenSurg[p_GOALS_FOR_THE  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"$%&'()*,-./0127Root Entry F V\9Data 91TableXWordDocument7SummaryInformation(#DocumentSummaryInformation8+CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q