Published: 14/08/2019

General, urological and gynaecological surgery (incorporating peri-operative care of the elderly)

This unit includes all aspects of elective and emergency general, urological and gynaecological surgery. It is anticipated that this unit of training will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the entire duration of Core Level training and that these should be achievable in most general hospitals at this level. 

Learning outcomes:

  • To gain knowledge, skills and experience of the perioperative anaesthetic care of patients requiring elective and emergency general, urological and gynaecological surgery
  • To gain understanding of the perioperative management of patients requiring intra-abdominal laparoscopic surgery and the particular issues related to anaesthetic practice, demonstrating the ability to manage such straightforward cases in adults under distant supervision
  • To be able to recognise and manage the perioperative complications associated with intra-abdominal surgery that are relevant to anaesthesia
  • To gain understanding of special peri-operative needs of elderly, frail patients

Core clinical learning outcomes:

  • Deliver safe perioperative anaesthetic care to uncomplicated ASA 1-3 adult patients requiring elective and emergency surgery such as body surface surgery, appendicectomy and non-complex gynaecological surgery under distant supervision
  • Manage a list with uncomplicated ASA 1-3 adults for similar elective surgery under distant supervision

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C.

Knowledge

 Competence

Description

Assessment methods

GMP

GU_BK_01

Outlines the principles of preoperative assessment of patients undergoing major and minor surgery, including guidelines on the appropriateness of simple tests [i.e. NICE guidelines]

A,C,E

1,2

GU_BK_02

Describes the anaesthetic management of straightforward common surgical procedures and their complications, including but not limited to: 

  • Body surface surgery including breast procedures and thyroid surgery  
  • Urological procedures including TURP and its management [including the TURP syndrome] and procedures on the kidney and urological tract
  • Laparoscopic surgery including but not exclusively:
    • Diagnostic laparoscopy
    • Laparoscopic and open cholecystectomy
  • Intra-abdominal major general surgery procedures including but not exclusively:
    • Elective colorectal resection 
    • Elective and emergency surgery for peptic ulcer disease
  • Endoscopic procedures on the GI and GU tracts including, but not exclusively:
    • OGD; flexible and rigid
    • Sigmoidoscopy, Colonoscopy
    • Cystoscopy
  • Gynaecology
    • Elective laparoscopic and open procedures on the uterus
    • Elective and Emergency procedures in patients in early pregnancy such as ERPC and salpingoophorectomy for ectopic pregnancy

A,C,E

1,2,3,4

GU_BK_03

Explains the physical and physiological effects of laparoscopic surgery including the effects of positioning [e.g Trendelenberg / reverse Trendelenberg, specifically in the setting of laparoscopic surgery]

A,C,E

1

GU_BK_04

Describes the principles of the anaesthetic management of patients with renal failure for non-transplant surgery, including care of shunts

A,C,E

1,2,3,4

GU_BK_05

Describes the principles of management of non-fasted patients requiring emergency surgery for whatever reason 

A,C,E

1,2

GU_BK_06

Explains transfusion issues in different surgical procedures

C,E

1,2

GU_BK_07

Recalls/describes the management of major haemorrhage 

A,C,E

1,2

GU_BK_08

Recalls/explains the relevance of metabolism and nutrition in the perioperative period

A,C,E

1,2

GU_BK_09

Explains the specific problems of anaesthesia for non-obstetric surgery in the pregnant patient

A,C,E

1,2

GU_BK_10

Recalls the factors associated with regurgitation and airway protection during common surgical procedures

A,C,E

1,2

GU_BK_11

Recalls/describes the anaesthetic implications of abnormal body weight, including morbid obesity

A,C,E

1,2

GU_BK_12

Describes the NCEPOD classifications and explains the importance of these in delivering surgical care to patients

A,C,E

1,2

GU_BK_13

Recalls/describes the peri-operative care of the elderly

A,C,E

1,2
Skills

Competence

Description

Assessment

Method

GMP

GU_BS_01

Demonstrates the ability to form an appropriate perioperative management plan for ASA 1-3 surgical patients requiring all types of surgery

A,C,D

1,2,3,4

GU_BS_02

Demonstrates the ability to recognise when more complex perioperative assessment and /or optimisation is required 

A,C,D

1,2,3,4

GU_BS_03

Demonstrates the ability to identify the high risk emergency surgical patient and initiate early management/optimisation

A,C,D,M

1,2,3,4

GU_BS_04

Demonstrates the ability to deliver safe perioperative anaesthetic care to ASA1-3 patients for straightforward surgical procedures e.g. body surface surgery, appendicectomy, ERPC

A,C,D,L,M

1,2,3,4

GU_BS_05

Demonstrates the ability to manage an elective surgical list with uncomplicated ASA 1-3 adults for straightforward body surface and lower abdominal surgery under distant supervision [Examples of such cases on lists would be:

  • General surgical: hernia repair; ‘superficial lumps/bumps’; non-complex appendectomy
  • Gynaecology: non-complex total abdominal hysterectomy; hysteroscopy; minor superficial surgery  

L,M

1,2,3,4

GU_BS_06

Demonstrates sensitive handling of patients with cognitive disturbances/communication problems

A,D,M

1,3,4

GU_BS_07

Shows sensitive handling of patient with cognitive impairment

A,D,M

1,2,3,4