Upper GI SURGERY 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).

Knowledges

UGI Surgery requires documented knowledge in (DOPS):

Preoperative Management (KO)

Embryological, anatomical and physiological knowledge of thoracic and abdominal organs
Surgical, endoscopical and radiological anatomy of chest and abdomen
Relevant pharmacology
Relevant symptoms and physical signs of upper GI disease
Relevant non-invasive diagnostic tools; as ex. CECT / PET –CT, isotope scintigraphic investigations, upper GI contrast studies aso
Relevant invasive tools and their place in staging work-up, ex. Bronchocscopy, endoscopy, laparoscopy, thoracoscopy, esophageal functional assessment, FNA, EBUS, EUS aso.
Tests of respiratory, cardiac, renal and endocrine function. Patient information and documentation of informed consent
Assessment of fitness for anesthesia and surgery
Premedication and sedation

Intraoperative Care (KO)

Patient positioning
Prevention of nerve and other injuries in the anaesthetized patient

Postoperative Management (KO)

Pain control
Post-operative monitoring
Post-operative complications
Prevention, recognition and management of complications
Respiratory failure-recognition and treatment
Nutritional support-indications, techniques, total parenteral nutrition

Pancreas

Conditions (KO)

Pancreatic cysts
Splenic vein thrombosis
Pancreatitis, acute as chronic

Procedures (VOT)

Open and laparoscopic pancreatectomy (distal)

Spleen

Conditions (KO)

Postsplenectomy sepsis
Hemolytic anemias
Idiopathic thrombocytopenic purpura
Secondary hypersplenism and splenomegaly
Neoplasms of spleen
Splenic cysts

Procedures (VOT)

Open and laparoscopic splenectomy
Partial splenectomy/splenorrhaphy

Oesophagus

Conditions (KO)

Zenker’s diverticulum
Epiphrenic diverticulum
Hiatal hernia
Gastroesophageal reflux and Barrett’s esophagus
Dysphagia
Schatzki’s ring
Achalasia
Nutcracker esophagus
Foreign bodies
Mallory-Weiss syndrome
Diffuse esophageal spasm
Spontaneous esophageal perforation
Iatrogenic esophageal perforation
Chemical burns
Scleroderma connective tissue disorders
Benign neoplasms
Adenocarcinoma
Squamous cell carcinoma

Procedures (DOPS, VOT)

Diagnosis of gastroesophageal reflux (e.g. pH-metry)
Diagnosis of esophageal and gastric motility disorders (e.g. manometry)
Open and laparoscopic antireflux procedure
Open and laparoscopic repair of paraesophageal hernia
Repair/resection of perforated oesophagus
Total esophagectomy
Eesophagogastrectomy: Open and laparoscopic, achalasia operations
Endoscopical procedures, see later

Stomach

Conditions (KO)

Upside down stomach
Upper gastrointestinal bleeding
Gastric carcinoma (acquired as well as hereditary)
Duodenal ulcer with bleeding, perforation or obstruction
Gastric ulcer with bleeding, perforation or obstruction
Gastric polyps
Gastric lymphoma
Gastric carcinoid tumor
Stress gastritis
Morbid obesity
Bezoars and foreign bodies
Gastroparesis
Postgastrectomy syndromes
GIST
MALT

Procedures (VOT)

Percutaneous endoscopic gastrostomy
Jejunostomy
Open gastrostomy
Partial/total gastrectomy
Open and laparoscopic gastric resection
Repair of duodenal perforation
Haemostatic operations for bleeding ulcer
Pyloroplasty
Open and laparoscopic operation for morbid obesity
Revisional procedures for postgastrectomy syndromes

Flexible Endoscopy

Handling of endoscopes and hygienic measures (KO)

Procedures (VOT)

Flexible diagnostic esophago-gastroduodenoscopy
Interventional endoscopy (e.g. stenting, polypectomy, mucosectomy, RF treatment)
Endoscopical ultrasonography with advanced procedures, including biopsies
Therapeutic endoscopic interventions (e.g. polypectomy, dilatation)
Sclerotherapy and banding of esophageal varices
Treatment of gastrointestinal bleeding sites (injection, clipping. electrofulgeration)
Endoscopic mucosectomy

Minimal Invasive Surgery (VOT)

Techniques of establishing access for MIS (e.g. laparoscopy, SILS, NOTES, robotic assisted)
Detection and treatment of MIS complications
Instruments and technical devices (e.g. stapling)
Patient selection and indication for MIS (KO)
Suturing and stapling in MIS

Metabolic and Bariatric Surgery (DOPS, VOT)

Principles of metabolic and bariatric surgery (KO)
Pathophysiology and epidemiology of morbid obesity (KO)
Patient selection and indication for bariatric surgery (KO)
Surgical techniques in bariatric surgery
Detection and treatment of complications

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.

Conditions (KO)

Pneumothorax/tension pneumothorax
Anastomotic insufficiency
Gastric conduit necrosis
Cardiac tamponade
Hemothorax
Pleural effusion/empyema
Mediastinitis
Chylothorax
Superior vena cava syndrome
Oesophageal foreign bodies
Oesophageal disruption
Empyema thoracis
Complications of thoracic operations
Tracheo et bronchoesophageal fistula
Malignant disease of the lungs and bronchi

Procedures (DOPS, VOT)

Chest tube placement
Techniques of thoracotomy (muscle-sparing lateral and standard postero-lateral)
Techniques for resection of oesophagus and reconstruction
Cervicotomies
Bronchoscopy, thoracoscopy, endoscopy
Exploratory thoracotomy
Thoracoscopy with or without biopsy
Transthoracic repair diaphragmatic hernia
Drainage of empyema
Sternotomy
Clam-shell incision

Paediatric (KO)

Conditions (KO)

Correctable life-threatening congenital abnormalities
Hypertrophic pyloric stenosis
Esophageal atresia
Tracheoesophageal fistula
Foreign bodies of the trachea/oesophagus
Congenital diaphragmatic hernia

Procedures (DOPS, VOT)

Pyloromyotomy
Open and laparoscopic antireflux procedure
Repair diaphragmatic hernia

Oncology

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

Clinico-pathological staging of cancer and premalignant states (DOPS)
Principles of cancer treatment by: surgery, radiotherapy, chemotherapy, immunotherapy, hormone therapy
Pain therapy management
Terminal care of cancer patients and palliation

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).

Oesophagus – Cardia (GE junction)

Optimization of patients to esophagus- GE resection including selection and diagnostic work-up of the patient (DOPS)
Evaluation and decision making concerning surgical resectability (DOPS)
Strategies in order to increase the resectability (KO)
Techniques and the extent of endoscopic treatment of acute, premalignant and malignant diseases in the esophagus (DOPS)
Techniques and the extent of R0 resection of malignant tumours in oesophagus, GEJ and stomach(DOPS;VOT)
Techniques used for bariatric surgery (by-pass, gastric sleeve) (KO)
Techniques used in reflux surgery (KO)
Techniques used in surgery for para-oesophageal hernias (DOPS)
Techniques used at surgery/endoscopy of achalasia (lap Heller myotomy, POEM) (DOPS)
Treatment of complications; abscesses, bleeding, anastomosis insufficiency and infections (DOPS)
Perioperative care (DOPS)

Stomach

Optimization of patients for esophagus- cardia resection including selection and diagnostic work up of the patient (DOPS)
Evaluation and decision making concerning surgical resectability. (DOPS)
Strategies in order to increase the resectability. (KO)
Techniques and the proportion of endoscopic treatment for acute, premalignant and malignant diseases in the stomach (DOPS)
Techniques and the extent of R0 resection of malignant tumours in the stomach (DOPS;VOT)
Techniques used for bariatric surgery (by-pass, gastric sleeve) (KO)
Techniques used for reflux surgery (KO)
Techniques used for surgery for para esophageal hernias (DOPS )
Basic techniques in laparoscopic resection of above mentioned illnesses (KO)
Treatment of complications: abscesses, bleeding, anastomotic leakage, leakage of the duodenal stump and infections (DOPS)
Perioperative care (DOPS)

Lars Bo Svendsen, DMSci
Chairman, MJC Upper GI Surgery

Toni Lerut, MD, PhD
Co- chairman, MJC Upper GI Surgery (thorax)

Philippe Nafteux,MD,PhD
Chairman of the UEMS Board of Upper GI Surgery

Username
Password