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PCACS. Penn Center for Advanced Clinical Simulation. Integrated Surgical Skills Curriculum. Surgical Knowledge Manual Skills. PCACS: Penn Center for Advanced Clinical Simulation. PCACS. Residents Surgical Skills Curriculum. Medical Students Surgical Skills Curriculum. …

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PCACS

Penn Center for Advanced Clinical Simulation

Integrated

Surgical Skills

Curriculum

Surgical Knowledge

Manual Skills


PCACS: Penn Center for Advanced Clinical Simulation

PCACS

Residents

Surgical Skills

Curriculum

Medical Students

Surgical Skills

Curriculum

Surgical Skills

Curriculum


Integrated

Surgical Skills

Curriculum

Objectives

- Surgical Knowledge

- Manual Skills

Core Competence

- Medical Knowledge

- Patient Care

- Interpersonal and Communication Skills

- Professionalism

- Practice based learning

- Systems-Based Practice


Integrated

Surgical Skills

Curriculum

Team Members: 3 to 4 Residents:

One PGY 3 /Lab Res

One PGY 2

Two PGY 1



Week 1 Schedule

Concepts

Skills Drill

Interaction with

The Clinical Expert

Each Day

Self Directed Learning

Team Based Skills


Day 1 General Surgery

Concepts

Session 1: Introduction to Surgical Tools and Instruments

Session 2: Aseptic and Sterile Techniques

Session 3: Suture Material and Handling

Skills Drill

Session 4: Knot Tying Techniques

Interaction With the

Clinical Expert

Session 5: Video Interaction with Surgeon eg.

Excissional Biopsy

Self Directed Learning

Session 6: Self Directed Practice Session

Session 7: Group Dynamic Training Clinical Scenarios

eg. SCARED Session. Stanford Course on

Active Resuscitation Evaluation Decision Making

Team Based Skills


Day 2 Trauma

Concepts

Session 1: Brief Review ATLS Concepts

Session 2: Airway Management, Line Placement, ..

Session 3: Thoracotomy, Tube thoracostomy, ..

Skills Drill

Session 4: Chest Tube Placement (Trauma Man)

Trachs & Cricothyroid, (Trauma Man)

Central Line Placement (SimLab/TraumaMan)

Interaction With the

Clinical Expert

Session 5: Video Interaction with Trauma Surgeon

Video Review of Trauma Response Sessions

Self Directed Learning

Session 6: Self Directed Practice Session

Session 7: Group Dynamic Training Clinical Scenarios

(eg. Trauma Scenario Review c Trauma Surgeon)

Group Dynamic Training


Day 3 SCC

Concepts

Session 1: Understanding Ventilators

Session 2: Understanding Hemodynamic Monitoring

Skills Drill

Session 3: Central Line Placement , Intubation Skills

Interaction With the

Clinical Expert

Session 4: Case Scenario review with Surgical Critical Care Expert

Session 5: Self Directed Practice Session/SimMan

Self Directed Learning

Group Dynamic Training

Session 6: Review of Different Clinical Scenarios c SimMan

(Section I)


Day 3 SCC

Laerdal SimMan Features:

Extensive Practical Features Allows Individual and

Group Practice of multiple clinical scenarios

Airway features:

Cardiac functions:

CPR:

Blood Pressure:

Circulatory skills and IV drug administration:     

Sounds:

Genitalia for urinary catheterization:

Event log:

Easy to use scenario and trend tools:

Air supply available by two alternatives: Air compressor/regulator unit

Easy to use:

Portable: Easy storage and transportation.


Day 4 GI Surgery

Concepts

Session 1: Instrument Tie, Hand Tie

Two Hand Tie – Square Knot

Two Hand Tie – Surgeon’s Square Knot

Tow Hand Tie – Slip Knot

One Hand Tie -- Slip Knot

Skills Drill

Session 2: Stapling Instrumentation

Session 3: Suture and Skin stapling

Interaction With the

Clinical Expert

Session 4: Video Interaction with the Expert

Fascia/Abdominal Wound Closure

Self Directed Learning

Session 5: Self Directed Practice Session

Group Dynamic Training

Session 6: Review of Different Clinical Scenarios c SimMan

(Section II)


Day 5 GI Surgery

Session 1: Stapling Instrumentation

Session 2: Anastomosis in GI Tract

Concepts

Session 3: Inanimate Lab – Basic Ligation

-- Wedge Resection

-- Functional end-to-end Anastomosis

-- Bilroth II

-- Low Anterior Resection

Session 4: Synthetic Lab – Bowel Anastomosis

Skills Drill

Interaction With the

Clinical Expert

Session 5: Video Interaction with Clinical Surgeon

Performing Bowel Anastomosis

Session 6: Self Directed Practice Session

Self Directed Learning

Session 7: Expert procedure task analysis

Expert definition of most common errors for each step of procedure

Description of error prevention strategies and error rescue strategies

Group Dynamic Training


Week 2 Schedule

Concepts

Skills Drill

Interaction with

The Clinical Expert

Each Day

Self Directed Learning

Team Based Skills


Day 1 Plastic & Reconstructive

Concepts

Session 1: Scientific Basis of Wound Closure Techniques

Session 2: Concepts of Flaps and Tension Free Reconstruction

Session 3: Excision of benign skin lesions and closure of simple wounds

Excision of a hand ganglion.

Repair of divided hand extensor tendon

Skills Drill

Session 5: Video Interaction with Clinical Surgeon

Performing Plastic Procedure/ Flap

Interaction With the

Clinical Expert

Self Directed Learning

Session 6: Self Directed Practice Session

Session 7: Expert procedure task analysis,

Expert definition of most common errors for each step of procedure

Description of error prevention strategies and error rescue strategies

Group Dynamic Training


Day 2 Vascular Surgery

Concepts

Session 1: Anatomy Review for Vascular Access

Session 2: Concepts of Vascular Anastomosis

Skills Drill

Session 3: Practical Session Vascular Anastomosis (I)

Session 4: Video Interaction with Clinical Surgeon

Expert Performing Vascular Anastomosis

Interaction With the

Clinical Expert

Self Directed Learning

Session 5: Self Directed Practice Session

Session 6: Expert procedure task analysis,

Expert definition of most common errors for each step of procedure. Description of error prevention strategies and error rescue strategies

Group Dynamic Training


Day 3 Basic Laparoscopy

  • Session 1: Key Skills in Laparoscopic Surgery

  • Port Placement

  • Camera and scope manipulation

  • Abdominal access and insufflation

    • Ergonomics

  • Session 2: Sharp and blunt dissection

  • Clip application electrosurgery

  • Looping

  • Tissue extraction

  • Port Site Closure

  • Concepts

    Skills Drill

    Interaction With the

    Clinical Expert

    Session 3: Video Interaction with Clinical Surgeon

    Expert Performing Lap Chole

    Self Directed Learning

    Session 4: Self Directed Practice Session

    Group Dynamic Training

    Session 5: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 4 Vascular Surgery II

    Concepts

    Session 1: Anatomical Consideration for Vascular Incisions

    Session 2: Concepts of Endovascular Techniques

    Skills Drill

    Session 3: Practical Session Vascular Anastomosis (II)

    Session 5: Video Interaction with Clinical Surgeon

    Expert Performing Central Vascular Procedure/AAA

    Interaction With the

    Clinical Expert

    Self Directed Learning

    Session 6: Self Directed Practice Session

    Group Dynamic Training

    Session 7: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 5 Intermediate Laparoscopy

    Concepts

    Session 1: Techniques necessary to overcome the visual demands in laparoscopic surgery

    - Effective equipment and instrument positioning using ergonomic principles

    - Laparoscopic Energised Dissection

    Skills Drill

    Session 2: Laparoscopic suturing and knot tying

    Tumbled square knot using laparoscopic instruments to safely ligate a vessel

    Pick up an endoscopic needle and make a bite through tissue

    Form a surgeon’s knot using laparoscopic needle holders

    Demonstrate optimal bite placement and knot tying technique during

    laparoscopic tissue approximation

    Interaction With the

    Clinical Expert

    Session 3: Video Interaction with Clinical Surgeon

    Expert Performing Lap Band/ Gastric Bypass

    Self Directed Learning

    Session 4: Self Directed Practice Session

    Session 5: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies

    Group Dynamic Training


    Week 3 Schedule

    Concepts

    Skills Drill

    Interaction with

    The Clinical Expert

    Each Day

    Self Directed Learning

    Team Based Skills


    Day 1 Thoracic Surgery

    Concepts

    Session 1: Anatomical Consideration for Thoracic Surgery

    Session 2: Thoracic Surgical Techniques

    Skills Drill

    Session 3: Animal Lab Lobectomy

    Session 4: Video Interaction with Clinical Surgeon

    Expert Performing Lobectomy/Thoracic Procedure

    Interaction With the

    Clinical Expert

    Self Directed Learning

    Session 5: Self Directed Practice Session

    Group Dynamic Training

    Session 6: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 2 Thoracic Surgery

    Concepts

    Session 1: Anatomical Consideration for Thoracic Surgery

    Session 2: Concepts of VATS

    Skills Drill

    Session 3: Animal Lab VATS

    Session 4: Animal Lab Nissen

    Session 5: Video Interaction with Clinical Surgeon

    Expert Performing VATS Procedure

    Interaction With the

    Clinical Expert

    Self Directed Learning

    Session 6: Self Directed Practice Session

    Group Dynamic Training

    Session 7: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 3 Colorectal Surgery

    Concepts

    Session 1: Anatomical Consideration Colorectal Surgery

    Session 2: Concepts of Bowel Anastomosis in Colorectal

    Skills Drill

    Session 3: Practical Session Bowel Anastomosis

    Session 4: Video Interaction with Clinical Surgeon

    Expert Performing Colon Surgery

    Interaction With the

    Clinical Expert

    Self Directed Learning

    Session 5: Self Directed Practice Session

    Group Dynamic Training

    Session 6: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 4 Colorectal Surgery

    Concepts

    Session 1: Anatomical Consideration for Colon Surgery

    Session 2: Concepts of Laparoscopic Colon Surgery

    Skills Drill

    Session 3: Animal Lab Laparosocopic Right Colectomy

    Session 5: Video Interaction with Clinical Surgeon

    Expert Performing Lap Colectomy

    Interaction With the

    Clinical Expert

    Self Directed Learning

    Session 6: Self Directed Practice Session

    Group Dynamic Training

    Session 7: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 5 Endocrine Surgery

    Concepts

    Session 1: Anatomical Consideration for Endocrine/Oncology

    Session 2: Concepts of Lap Adrenalectomy

    Skills Drill

    Session 3: Practical Session Advanced Laparoscopy

    Session 5: Video Interaction with Clinical Surgeon

    Expert Performing Thyroid/Adrenal Procedure

    Interaction With the

    Clinical Expert

    Self Directed Learning

    Session 6: Self Directed Practice Session

    Group Dynamic Training

    Session 7: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Week 4 Schedule

    Concepts

    Skills Drill

    Interaction with

    The Clinical Expert

    Each Day

    Self Directed Learning

    Team Based Skills


    Day 1 Surgical Oncology

    Concepts

    Session 1: Anatomical Consideration for Endocrine/Oncology

    Session 2: Concepts of Thyroidectomy/Sarcoma/Melanoma

    Skills Drill

    Session 3: Practical Session Advanced Laparoscopy

    Session 4: Video Interaction with Clinical Surgeon

    Expert Performing Thyroid/Sarcoma/Melanoma

    Interaction With the

    Clinical Expert

    Session 5: Self Directed Practice Session, Allgoritmus

    for Sarcoma, Thyroid Mass, Melanoma

    Self Directed Learning

    Group Dynamic Training

    Session 6: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 2 Breast Surgery

    Concepts

    Session 1: Anatomical Consepts in Breast Surgery

    Session 2: Anatomical Concepts of Axillary LN Dissection

    Sentinel LN Biposy

    Skills Drill

    Session 3: Practical Session

    Lumpectomy, Sentinel LN Biopsy, Mastectomy

    Session 4: Video Interaction with Clinical Surgeon

    Expert Performing Lumbectomy, Sentinel LN Dissection,

    Interaction With the

    Clinical Expert

    Session 5: Self Directed Practice Session, Allgoritmus

    for Breast Mass

    Self Directed Learning

    Group Dynamic Training

    Session 6: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 3 Transplant Surgery

    Session 1: Anatomical Consepts in Liver Resections

    Session 2: Anatomical Concepts of Kidney, Liver Txpl

    Concepts

    Session 3: Practical Session

    Liver Resection in Wet Lab (Animal)

    Skills Drill

    Interaction With the

    Clinical Expert

    Session 4: Video Interaction with Clinical Surgeon

    Expert Performing Hepatic Lobecotmy, Txpl…

    Session 5: Self Directed Practice Session, Algorithms

    for Transplant Rejection

    Self Directed Learning

    Group Dynamic Training

    Session 6: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 4 Pediatric Surgery

    Session 1: Anatomical Aspects of common Pediatric Procedures

    Session 2: Surgical Techniques in Pediatric surgery

    Concepts

    Session 3: Review of common pediatric procedures with

    Inclusion of skills directed technical aspects

    Skills Drill

    Interaction With the

    Clinical Expert

    Session 4: Video Interaction with Clinical Surgeon

    Expert Performing Pediatric Surgery

    (Hernia, Pyloromyotomy, Volvulus, …)

    Session 5: Self Directed Practice Session, Algorithms

    for Pediatric Case Presentations

    Self Directed Learning

    Group Dynamic Training

    Session 6: Expert procedure task analysis,

    Expert definition of most common errors for each step of procedure

    Description of error prevention strategies and error rescue strategies


    Day 5 Objective Skills Assessment

    • Formal content testing of subjects

    • Objective Structured Assessment of Technical Skills (OSATS)

    • Imperial College Surgical Assessment Device (ICSAD)

    • Multiple Objective Measures of Skills (MOMS)

    • Intraoperative Critical Event Management (ICEMAN)






























    Skills Center : University Of Toronto Skills Center Center

    Prep / Storage Room

    Lab Area





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