DESCRIPTION

Training level involves intensive period of training and skills acquisition. Implies little or no previous experience as a surgical registrar.

EXPERIENCE

> 6 months full-time in surgical terms as SRMO

OR

> 3 month full-time in surgical terms plus other relevant experience all at SRMO or Registrar level, the combined total of which is > 6 months full-time

OR

Level 2 or greater in another area

DIAGNOSTIC

May possess limited diagnostic skills at entry.

MANAGEMENT

Resuscitation

- Resuscitation skills as outlined in Annexure A.

Procedural Skills

- May possess limited skills at entry but is rapidly acquiring those necessary for progression into higher grades. 

General

- Possess only limited knowledge of management of General Surgical problems & complications.  

DESCRIPTION

Competently functions unsupervised in the surgical sphere though may still be required to consult for the diagnosis and management of some presentations.

EXPERIENCE

>12 months full-time (or its part-time equivalent) as a Surgical Registrar

OR

> 6 months full-time (or its part-time of equivalent) as a Surgical Registrar plus other relevant experience all at SRMO or Registrar level, the combined total of which is > 12 months full- time (or it part-time equivalent)

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology, and radiological investigations in order to arrive at a diagnosis or differential diagnosis for a comprehensive range of surgical presentations, though assistance of referral may be required for the diagnosis of some presentations.

MANAGEMENT

Resuscitation

- Resuscitation skills as defined in Annexure A. 

Procedural Skills

- Competence in the following skills, this implies not just technical proficiency but, where applicable a knowledge of indications, contraindications plus complications and their management. 

- intercostal catheter
- needle cricothyrotomy  *
- venesection (adult & paediatric)
- peripheral venous access (adult & paediatric)
- urethral catheterisation
- proctoscopy
- nasogastric tube insertion
- nasal packing
- r/o ENT & subcutaneous foreign body
- uncomplicated suturing (lacerations superficial to fascia)

Operation Skills

Able to perform a limited number of minor surgical operations unassisted though assistance may be required for some. For example:

- uncomplicated suturing @ certain levels and sites
- rigid sigmoidoscopy
- incision and drainage of abcesses and haematomas
- excision of skin tumours & lipomas
- wedge resection of ingrown toenail
- vasectomy
- invasive tissue biopsy

Able to perform some major surgical operations, but with the presence, assistance and guidance of the VMO surgeon.

General

Able to initiate management for the majority of surgical presentations and routine and complicated post-operative care, although assistance or referral may be required for the management of more complex presentations and problems.

DESCRIPTION

Competently functions independently in the surgical sphere. Able to supervise more junior staff.

EXPERIENCE

> 24 months full-time (or its part-time equivalent) experience as Surgical Registrar.

OR

> 12 months full-time (or its part-time equivalent) experience as Surgical Registrar plus other relevant experience all at SRMO or Registrar Level, the combined total of which is > 24 months full- time (or its part-time equivalent).

AND

Must have attained level 2 or greater in at least one additional area.

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology and radiological investigations in order to arrive at a diagnosis or differential diagnosis for a comprehensive range of surgical presentations.

MANAGEMENT

Resuscitation

- Resuscitation skills as defined in Annexure A.

Procedural Skills

- Competence in the following skills. This implies not just technical proficiency but where applicable a knowledge of indications, contraindications plus complications and their management

- all skills specified at level 2 plus
- central venous access  
- pleural aspiration
- use of tourniquets/mast suit
- epistaxis balloon
- cricothyrotomy
- peripheral venous cutdown
- suprapubic catheterisation
- difficult urethrl catheterisations using introducers
- urethrogram
- peritoneal aspiration and lavage
- sengstaken-blackmore tube
- escharotomy
- complex suturing (involving structures deep to fascia)

Operative skills

able to perform all minor (as for Level 2) and a limited number of major surgical operations unassisted. i.e., without the presence of the VMO surgeon, though ssistance may be required for some of the latter. For example:

- complex suturing @ all levels & sites
- appendicectomy
- tracheostomy
- cholecystectomy
- varicose vein surgery
- embolectomies
- insertion of external ventricuar shunt
- haemorrhoidectomy
- herniorraphy
- amputations
- tendon repairs
- uncomplicated skin grafting
- rigid & flexible oesophagoscopy for removal of foreign bodies
- flexible sigmoidoscopy
- insertion of peritoneal dialysis catheter

Able to perform some major surgical operations, but with the presence, assistance and guidance of the VMO surgeon

General

- Able to provide initial management for all and ongoing management for the majority of surgical presentations and problems.

- able to initiate and carry through the management of complicated and uncomplicated post-operative cases including intra-operative complications.

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