This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.

Surgical care may be defined as the body of knowledge, skills and attitudes necessary to evaluate and manage conditions and disorders requiring operative intervention.

Attitudes

The resident should develop attitudes that encompass the following:

1. Recognition of the importance of family physician and surgeon collaborating as partners in the evaluation of and decision making for the care of surgical patients.

2. Awareness of the principles involved in differentiating the causative origin of clinical symptoms resulting in the need for medical versus surgical intervention.

3. Sensitivity to the patient's and family's concerns and anxieties regarding the potential need for surgical intervention.

Knowledge

1. Basic principles of surgical diagnosis

   Basic surgical anatomy

   Wound physiology, care and healing processes

   Clinical assessment, including history, physical examination, laboratory evaluation and differential diagnosis of key signs and symptoms of surgical conditions

   Invasive versus noninvasive diagnostic tests

   Anesthesia

   Premedication

   Agents

   Routes of administration

   Toxicity

   Resucitation mentods

   Recognition of surgical emergencies

   Ethical and legal considerations

   Informed consent

   Quality of life

   End-of-life issues

2. Preoperative assessment

   Surgical risk assessment

   Comorbid diseases

   Antibiotic prophylaxis

   Patient preparation (bowel, etc.)

3. Intraoperative care

   Basic principles of asepsis and sterile technique

   Patient monitoring

   Fluid management

   Blood requirements

   Temperature control

   Use of basic surgical instruments

4. Postoperative care

   Routine

   Wound care

   Patient mobilization

   Nutritional management

   Pain management

   Suctions and drains

   Common complications

   Fever work-up and management

   Wound dehiscence

   Urinary retention

   Hemorrhage

   Pneumonia

   Atelectasis

   Fluid overload

   Transfusion reaction

   Thrombophlebitis

   Pulmonary embolism

   Oliguria

   Respiratory insufficiency

   Ileus

   Infection

   Shock

   Long-term follow-up

5. Outpatient surgery

   Patient selection

   Conscious sedation

   Postoperative observation principles

   Follow-up

6. Office care of common conditions

   Lumps and bumps

   Simple lacerations

   Superficial burns

7. Approach to the care of common surgical conditions

   Abscesses

   Aortic aneurysm

   Appendicitis

   Arterial insufficiency

   Benign neoplasia

   Bowel obstruction

   Breast masses

   Carpal tunnel syndrome

   Colon cancer

   Coronary artery disease (obstruction)

   Cysts and hematomas

   Diverticuli

   Gallbladder disease

   Ganglia

   Gastrointestinal hemorrhage

   Hemorrhoids

   Hernias

   Intervertebral disk herniation

   Lung cancer

8. Shared management of common general surgical conditions

   Anal fistula, fissure or perianal abscess

   Carcinoma

   Esophageal varices

   Fasciitis

   Incarcerated hernia

   Intussusception

   Malabsorption

   Obstruction

   Pancreatic disease

   Polyposis

   Regional enteritis

   Ruptured viscus

   Ulcerative colitis

9. Organ donation and transplantation

Skills

1. Preoperative assessment

   Surgical risk evaluation

   Physical assessment

   Radiographic assessment

   Noninvasive diagnostic procedures

   Invasive diagnostic procedures

   Paracentesis

   Nasogastric lavage

   Peritoneal lavage

   Thoracentesis

   Tube thoracostomy

   Bladder aspiration

   Central venous access (central venous pressure, Swan-Ganz catheter)

   Venous cutdown

   Arterial puncture/catheterization

   Needle aspiration/biopsy technique

2. Emergent surgical techniques

   Cricothyroidotomy

   Needle thoracostomy

   Pericardiocentesis

3. Intraoperative skills

   Preparation and draping of operative field

   First assist at major surgery

   Basic use of surgical instruments

   Incision and dissection

   Exposure/retraction

   Hemostasis

   Estimation of blood loss

   Fluid replacement

   Wound closure

   Technique selection (ligature, staples, adhesives)

   Suture selection

   Drains

   Dressings

4. Postoperative care

   Suture removal

   Dressing changes

   Drain removal

5. Minor surgical techniques

   Local anesthesia

   Simple excision

   Incision and drainage of cysts and abscesses

   Aspiration

   Ear piercing

   Foreign body removal

   Minor burns

   Vasectomy

   Cauterization/electrodesiccation

   Punch biopsy

   Wound debridement

   Enucleation/excision of external thrombotic hemorrhoid

   Rectal polyp removal

   Nail surgery

Implementation

The implementation of this curriculum segment should combine a minimum of two months of block rotations and longitudinal learning experiences throughout the 36 months of training. The curricular content should be required and integrated into the conference schedule and into teaching activities in the family practice center. Relevant materials should be prominent in the residency library.