Curriculum & Syllabus

Curriculum

The “Knowledge” and “Knowledge and Skills” required by UGI Surgery are closely related to other specialties. UGI surgeons collaborate with all other surgical specialties and a variety of non-surgical specialties like e.g. anesthesia, intensive care medicine, emergency medicine, radiology, pediatrics, gastroenterology, internal medicine, geriatrics, rehabilitation medicine. UGI Surgery is often performed in specialized centers. But, even out from a specialized center, a UGI surgeon should possess the multi-specialty knowledges and skills to carry out required interventions safely.

The UGI surgeon must have acquired and must maintain specialized “Knowledges” and “Knowledges and Skills” (precisely defined in this additional catalogue) relating to the diagnosis, preoperative, operative and postoperative management in the following areas of primary responsibility:

This syllabus is a congregate of the knowledge and skills of a visceral upper gastrointestinal surgeon and a thoracic surgeon, since the two working groups (WG) under each UEMS section has decided to join each other.

The Upper Gi Surg syllabus comprehensively describes "Knowledges " and "Knowledges and Skills" (= basis for an individual "LUGI-book") mandatory for the qualification as F.E.B.S./F.E.B.T.S. UGI Surg.

The syllabus is at that time not a complete curriculum that gives a structured educational plan but provides a crude orientation and a framework around which preparation for the qualification as F.E.B.S./F.E.B.T.S. UGI Surg can be structured and within the syllabus some parts can be exchanged as transferable skills for each division as long as a core curriculum is maintained.

The syllabus should not be viewed as static but will be continuously revised and updated by the members of the committee. It is noted that research and changes in medicine may lead to significant changes in theory and clinical practice and by that will influence the content of the syllabus. New topics will be introduced and obsolete topics may be deleted. The candidates are expected to update their level according to the recent surgical practice and scientific literature.

To achieve the qualification as F.E.B.S./F.E.B.T.S. UGI Surg "Knowledges" have to be documented and provided for Eligibility and are assessed by Examination.

The Syllabus

"Knowledges and Skills" have to be documented and proved in the UGI-book for Eligibility and may be additionally assessed by examination. For pragmatical reasons the individual UGI-books are scrutinized in the Eligibility process taking into consideration the various national requirements and local situations.

By that provisional arrangements are provided: if e.g. "flexible endoscopy" is not part of UGI Surg in a distinct country, the candidate may omit this section in "Knowledges and Skills" without consequences for the Eligibility process, but approval of "Knowledge" in e.g. "flexible endoscopy" will be mandatory for the Examination. This procedure is also valid for e.g. "bariatric surgery" or "diaphragmatic surgery" and others.

The UGI surgeon is the expert from the highly specialized centres within gastric, cardia and oesophageal surgery. Thus knowledge includes benign surgical diseases, elective as acute, traumas and cancer diseases. Due to considerable diversity of the diseases encompassed within the subspeciality it is important the UGI specialist has sufficient knowledge of newest developments in the field, concerning diagnostic work-up, indications for surgery, surgical technique, including early endoscopical treatment of premalignant diseases, minimal invasive techniques and he/she must be proficient in open procedures.

Within the acute surgery the UGI surgeon must be capable of receiving, resuscitating, diagnose and treat the acute upper gastrointestinal diseases in an evidence based manner.

Within treatment of benign diseases (in highly specialized centres) the UGI surgeon must be able to diagnose, work up and treat benign illnesses in oesophagus, transition zone and stomach in an evidence based manner.

Within treatment of malignant diseases (in highly specialized centres) the UGI surgeon must cooperate with the Multi-Disciplinary Team (MDT) to be able to diagnose, work up and treat malignant and pre malignant illnesses in the oesophagus, transition zone, and stomach in an evidence based manner.

It is expected that the UGI surgeon has a thorough knowledge concerning the different radiological diagnostic modalities and invasive radiological treatment methods, ultrasonography and endoscopic methods.

Endoscopy on an advanced level is relevant for the UGI surgical field and knowledge in diagnostics and treatment in the continuation of competences attained during the board certification must be secured.

Furthermore, the UGI surgeon is supposed to have a high degree of knowledge in advanced endoscopic surgery in the upper gastrointestinal tract (oesophagus, transition zone and stomach).

Scientific knowledge and research capability is mandatory.

The competence for these procedures (could be e.g., knowledge of ablative procedures, stent treatments, EMR, ESD etc.) should be attained by education in departments with a large volume and high expertise in the field. It should furthermore be documented that the competence is being maintained by exposure to a sufficient number of procedures per year.

Assessment of skills should be done by mentor/rater judgement as

• Knowledge of (KO)
• Direct Observation of Practical Skills (DOPS): performance in different situations, ex. Surgical teamleader, MDT conference team leader ex.
• Visual observation of Operative Technique (VOT).
• In the following the text is mandatory skills for both  the MJC partners. Some aspects are supplementary knowledge for the partners  of the MJC (red text Thoracic surgery, green text visceral surgery).

Knowledge

UGI Surgery requires documented knowledge in (DOPS):

Pancreas

Spleen

Oesophagus

Stomach

Flexible Endoscopy

• Handling of endoscopes and hygienic measures (KO)

Thorax

The surgical anatomy and pathology of the heart, great vessels, air passages, chest wall, diaphragm and thoracic viscera and the applied cardio-respiratory physiology relevant to clinical examination, interpretation of special investigations and understanding of disorders of cardio-respiratory function caused by disease, injury and surgical intervention.

Paediatric (KO) 

Oncology

The applied basic sciences relevant to the understanding of the clinical behaviour, diagnosis and treatment of neoplastic disease (KO)

Radiology (DOPS,VOT)

• Diagnostic and therapeutic interventional radiological methods (KO)
• Interventional radiological assisted implantation of prostheses and stents into organs and other structures
• X-ray guided detection of foreign bodies
• Sonographically guided identification and treatment of unpalpable lesions

Evaluation & Quality (DOPS)

• Decision-making in surgery
• Clinical audit
• Statistics and computing in surgery
• Documentation
• Principles of research and design and analysis of clinical trials
• Critical evaluation of innovations-technical and pharmaceutical
• Health Service management and economic aspects of surgical care
• Medical/legal ethics and medico-legal aspects of surgery
• Psychological effects of surgery and bereavement
• Rehabilitation
• Screening programs
• Quality control and quality management
• CIRS (Critical Incident Reporting System)
• Implementation of clinical studies
• Legal aspects
• Communication with patients, relatives and colleagues

Level of knowledge (DOPS and VOT)

Assessment of skills should be done by rater judgment as Direct Observation of Practical Skills (DOPS) and by observation of Operative Technique (VOT).