THIS IS AN EVOLVING DOCUMENT.

The College of Physicians and Surgeons Pakistan

would appreciate any criticism, suggestions, advice from the
readers and users of this document. Comments may be sent in
writing or by e-mail to the CPSP at:

Directorate of National Residency Program (DNRP)

College of Physicians and Surgeons Pakistan (CPSP)
7th Central Street, Defence Housing Authority, Karachi-75500.
[email protected]
 CONTENTS

About the College 01

CPSP Competency Model 04

General Regulations 11

Supervisor Roles and Responsibilities 14

Resident Roles and Responsibilities 16

Training Program 17

Syllabus 19

Core Competencies 21

Assessment 42

FELLOWSHIP TRAINING
 ABOUT THE
COLLEGE
The College was established in 1962 through an ordinance
of the Federal Government. The objectives/functions of the
College include promoting specialist practice of Medicine,
Obstetrics & Gynaecology, Surgery and other specialties by
securing improvement of teaching and training, arranging
postgraduate medical, surgical and other specialists training,
providing opportunities for research, holding and conducting
examinations for awarding College diplomas and admission to
the Fellowship of the College.
Since its inception, the College has taken great strides in
improving postgraduate medical and dental education in
Pakistan. Competency- based structured Residency Programs
have now been developed, along with criteria for accreditation
of training institutions, and for the appointment of supervisors
and examiners. The format of examinations has evolved over
the years to achieve greater objectivity and reliability in
methods of assessment. The recognition of the standards of
College qualifiations nationally and internationally, particularly
of its Fellowship, has enormously increased the number of
trainees and consequently the number of training institutions
and the supervisors. The rapid increase in knowledge base
of medical sciences and consequent emergence of new
subspecialties have gradually increased the number of CPSP
fellowship disciplines to seventy five including specialties in
dentistry. After completing two years of core training during
IMM, the trainees are allowed to proceed to the advance phase
of FCPS training in the specifi specialty of choice for 2-3 years.
However, it is mandatory to qualify IMM examination before
taking the FCPS-II exit examination. The work performed by the
trainee is to be recorded in the e-Iogbook on daily basis. The
purpose of the e-Iog is to ensure that the entries are made on a
regular basis and to avoid belated and fabricated entries. It will
hence promote accuracy, authenticity and vigilance on the part
of trainees and the supervisors.

FELLOWSHIP TRAINING 1
The average number of candidates taking CPSP examinations
each year is to a minimum of 32,000. The College conducts
examinations for FCPS-I (11 groups of disciplines), IMM,
FCPS-II (75 disciplines), MCPS (22 disciplines), including MCPS
in Health Professions Education and Health Care System
Management. A large number of Fellows and senior medical
teachers from within the country and overseas are involved at
various levels of examinations of the College.
The College, in its endeavor to decrease inter-rater variability
and increase fairness and transparency, is using TOACS (Task
Oriented Assessment of Clinical Skills) in IMM and FCPS-II
Clinical examinations. Inclusion of foreign examiners adds to
the credibility of its qualifiations at an international level. It is
important to note that in the overall scenario of health delivery
over 85% of the total functioning and registered health care
specialists of the country have been provided by the CPSP. To
coordinate training and examination, and provide assistance
to the candidates stationed in cities other than Karachi, the
College has established 14 Regional Centers (including five
Provincial Headquarter Centers) in the country. The five
Provincial Headquarter Centers, in addition to organizing the
capacity building workshops/short courses also have facilities
of libraries, I.T, and evaluation of synopses and dissertations
along with providing guidance to the trainees in conducting
their research work. The training towards Fellowship can be
undertaken in more than 245 accredited medical institutions
throughout the country and 74 accredited institutions abroad.
The total number of trainees in these institutions is over 26,893
who are completing residency programs with around 4,104
supervisors. These continuous efforts of the College have
even more importantly developed a credible system of
postgraduate medical education for the country. The College
strives to make its courses and training programs ‘evidence’ and
‘needs based’ so as to meet international standards as well as to
cater to the specialist healthcare needs not only for this country
but also for the entire region.

Prof. Zafar Ullah Chaudhry

President
College of Physicians and Surgeons Pakistan

2 FELLOWSHIP TRAINING
 FELLOWSHIP DISCIPLINES
The College lays down the training programmes and holds
examination for the award of Fellowship in the following
disciplines:
Disciplines for 1st Fellowship
1. Anatomy 24. Nuclear Medicine
2. Anesthesiology 25. Obstetrics and Gynaecology
3. Biochemistry 26. Operative Dentistry
4. Cardiac Surgery 27. Ophthalmology
5. Cardiology 28. Oral & Maxillofacial Surgery
6. Chemical pathology 29. Orthodontics
7. Clinical Haematology 30. Orthopedic Surgery
8. Community Medicine 31. Otorhinolaryngology (ENT)
9. Dermatology 32. Paediatric Surgery
10. Diagnostic Radiology 33. Paediatrics
11. Emergency Medicine 34. Periodontology
12. Family Medicine 35. Pharmacology
13. Forensic Medicine 36. Physical Medicine & Rehabilitation
14. Gastroenterology 37. Physiology
15. Haematology 38. Plastic Surgery
16. Histopathology 39. Prosthodontics
17. Immunology 40. Psychiatry
18. Medicine 41. Pulmonology
19. Medical Oncology 42. Radiotherapy
20. Microbiology 43. Surgery
21. Nephrology 44. Thoracic Surgery
22. Neurology 45. Urology
23. Neurosurgery 46. Virology
Disciplines for 2nd Fellowship
1. Breast Surgery 16. Paediatric Critical Care
2. Child and Adolescent Psychiatry Medicine
3. Cardio-Thoracic Anesthesiology 17. Paediatric Gastroenterology
4. Clinical Cardiac Electrophysiology Hepatology & Nutrition
5. Community and Preventive 18. Paediatric Haematology Oncology
Paediatrics 19. Paediatrics Infectious Diseases
6. Critical Care Medicine 20. Paediatric Nephrology
7. Developmental and Behavioural 21. Paediatric Neurology
Paediatrics 22. Paediatric Ophthalmology
8. Endocrinology 23. Pain Medicine
9. Gynecological Oncology 24. Reproductive Endocrinology and
10. Infectious Diseases Infertility
11. Interventional Cardiology 25. Rheumatology
12. Maternal & Fetal Medicine (MFM) 26. Surgical Oncology
13. Neonatal Paediatrics 27. Urogynaecology
14. Orbit & Oculoplastics 28. Vitreo Retinal Ophthalmology
15. Paediatric Cardiology 29. Vascular Surgery

FELLOWSHIP TRAINING 3
 CPSP
COMPETENCY
MODEL
College of Physicians and Surgeons Pakistan has moved to
competency-based medical education and has developed its
own competency model shown below. A generic explanition of
the model is given below and it is expected that all its residency
training programmes follow the components of this model in
accordance to the requirements of each specialty.

Patient or population care occupies the pivotal center. Patient

care includes all clinical skills such as history taking, physical
examination, ordering investigations, making diagnoses and
managing the care. The inner leaves of the model represent
the five major competencies directly related to patient care,
while the three competencies in the outer circle are mega-
competencies related to patient care and also incorporate
education, professionalism, leadership, advocacy and
population health.
By the end of the Residency Programme, residents are expected
to acquire these competencies and their constituent learning
outcomes, and provide promotive, preventive, curative and
rehabilitative patient-centered (or population-centered) care.

Inner Leaves:
1. Knowledge and Critical Thinking
2. Technical Skills
3. Communication Skills
4. Teamwork
5. Research

4 FELLOWSHIP TRAINING
 Outer Leaves:
6. Professionalism
7. Pedagogy
8. Advocacy

1. Knowledge and Critical Thinking

• Demonstrate application of wide and current readings to
critical thinking and problem solving
• Relate the alteration of body function to the presenting
condition
• Interpret and integrate history and examination findings to
arrive at an appropriate provisional and credible
differential diagnoses
• Sequentially order, justify and interpret appropriate
investigations
• Apply knowledge and reasoning skills to
• Analyze data for problem identification and to rule in
and rule out contending conditions
• Synthesize and evaluate solutions for decision-making
in solving familiar and less familiar problems based on
best current evidence
• Prioritize different problems within a time frame.
• Select, outline and provide, with evidence-based
justifications, appropriate pharmacological and
non-pharmacological management strategies
• Assess new medical knowledge and apply it to resolve
patient problems (Evidence-based practice)
• Apply quality assurance procedures in daily work.
(Professionalism)
• Demonstrate shared-decision-making with the patient
or family
• Provide cost-effective care while ordering investigations
and in management
• Use resources appropriately
• Demonstrate awareness of bio-psycho-social factors in
assessment and management of a patient.

FELLOWSHIP TRAINING 5
2. Technical Skills
• Demonstrate International Patient Safety Goals (IPSG)
• Demonstrate competent performance of all required
technical skills and procedures in the specialty, including:
• Obtaining informed consent
• Preoperative planning
• Pre-interventional care and preparation
• Intra-Intervention technique including exposure and
closure, global and task specific items, and
communication and team skills
• Post-interventional care
• Follow-up Care.

3. Communication Skills
• Written Communication Skills
• Maintain clear, concise, accurate and updated medical
records
• Write clear, focused, evidence-based and logical
management plans and discharge summaries
• Write respectful, clear and focused letters and referrals
to other colleagues.
• Verbal Communication Skills: Demonstrate
• Effective interpersonal communication skills: clear,
considerate and sensitive towards patients, their
relatives, other health professionals and the public, and
towards students
• Non-verbal communication skills:
• Empathy and respect towards patients and their
relatives
• Effective counseling of the patient and the family with
cultural sensitivity: explain options, educate them and
promote joint decision-making.
• Appropriate verbal and body language on the campus
and all work situations including seminars, bedside
sessions, outpatient sessions and others
• Respect and tolerance for all health care professionals,
including peers, juniors and seniors
• Clear, focused and logical presentation of cases.

6 FELLOWSHIP TRAINING
 4. Teamwork
• Demonstrate constructive team-communication skills.
• Facilitate collaborative group interaction as a team
member to build strong teams demonstrating respect,
tolerance and interdependence.
• Support other team members to grow
• Demonstrate willingness to assume responsibility and
leadership as needed.

5. Research
• Interpret and use results of various research studies
(critical appraisal)
• Conduct a research study individually or in a group by
using appropriate
• Selection of research question(s) and objectives
• Research design and statistical methods to answer the
research question
• Ethical and R&RC approval of the synopsis
• Demonstrate competence in academic writing by writing
an appropriate dissertation and/or publishing research
article(s) as a step towards resolving issues or concerns in
their specialty
• Guide others in conducting research by advising about
research methodology including study designs and
statistical methods
• Demonstrate clear, focused and logical presentations of
their research.

6. Professionalism
• Demonstrate the highest level of personal integrity:
honesty, punctuality, regularity, timely task completion
• Deal with all patients in a non-discriminatory,
prejudice- free manner, demonstrating the same level of
care for every human being irrespective of gender, age,
ethnic background, culture, socioeconomic status and
religion
• Establish a trusting relationship with patients, their
relatives and care-givers
• Deal with all patients with honesty, empathy and
compassion, putting patients’ needs first (altruism)

FELLOWSHIP TRAINING 7
• Facilitate transfer of information important for promotion
of health, prevention and management of disease
• Encourage questioning by the patient and be receptive to
feedback
• Pursue self-directed and life-long learning. Keep abreast
of medical literature and assess new knowledge and apply
it to resolve patient problems
• Know one’s limitations and ask for help as needed from
colleagues, consultations or referrals
• Apply quality assurance procedures for improvement in
daily work
• Be a role model for others.

Ethics
• Maintain patient autonomy by demonstrating shared-
decision-making with the patient and/or family
• Obtain informed consent, maintain patient confidentiality
and do no harm
• Provide cost-effective care while ordering investigations
and in management and use resources appropriately.

Leadership
• Demonstrate accountability for their decisions and actions,
and that of their team
• Demonstrate willingness to assume leadership role(s)
when needed in given situations or events (rush call/code).
• Change and bring about change as necessary, as a leader
or supportive leader.

7. Pedagogy
Should be able to demonstrate competence in teaching skills:
• Effective clinical/community-based teaching
• Some evidence of acquisition of theory regarding learning
and education
• Practice some of the best teaching methods.

8 FELLOWSHIP TRAINING
 8. Advocacy
Advocacy is needed at multiple levels
• Advocacy for the Patient
• Doctors and nurses are the advocates of the patients,
otherwise patients are likely to be lost in the system.
All care should be timely, putting patients first.

• Advocacy for the Practice

• Working in a service or practice, doctors must highlight
limitations and issues
• They must identify solutions for the problems, and
recommend and implement improvements for the
practice(s) and institutional system(s).

• Advocacy for the Health System and Society

• Know one’s role in the Health System(s) and build
strong referral systems
• Keep patient and community interests paramount,
above one’s own personal or professional interest
• Demonstrate advocacy for elimination of the social
determinants of health
• Demonstrate advocacy for prevention of serious
illnesses of their specialty/sub-specialty.

• For the Profession

• Strive for building trust in the public for your profession
• Demonstrate improvement and enhancement of
profession, specialty and sub-specialty
• Be conscientious gate-keepers of their profession,
specialty and subspecialty.

FELLOWSHIP TRAINING 9
AWARD OF FELLOWSHIP
Fellowship of the College of Physicians and Surgeons Pakistan
is awarded to those applicants who have:
• a recognized medical degree;
• completed one year house job in a recognized institution
• passed the relevant FCPS Part I Examination;
• registered with the Registration & Research Cell (R&RC);
• undergone specified years of supervised accredited
training on whole time basis.
• passed IMM examination in Surgery
• obtained approval of dissertation / two research articles
(related to the specialty) published / accepted for
publication in CPSP approved journal(s)
• completed entries in e-logbook along with validation by
the supervisor;
• declared successful in examinations carried out by the
Examination Department of the CPSP
• elected by the College Council

TRAINING ENQUIRES AND REGISTRATION

All trainees should notify the College in writing of any change
of address and proposed changes in training (such as change of
supervisor, change of department, break in training etc) as soon
as possible.of address and proposed changes in training (such
as change of supervisor etc) as soon as possible.

10 FELLOWSHIP TRAINING
 GENERAL
REGULATIONS
The following regulations shall apply to all the candidates
taking the FCPS-II Examination. Candidate will be admitted to
the examination in the name (surname and other names)
as given in the MBBS degree. CPSP will not entertain any
application for change of name on the basis of marriage/
divorce/deed.

ELIGIBILITY REQUIREMENTS FOR ENTERING THE POST IMM

TRAINING PROGRAM IN GENERAL SURGERY
• Passed FCPS-I in Surgery and Allied/allowed exemption
• Completed two years R&RC registered training as per
Intermediate Module (IMM) Curriculum

DURATION OF TRAINING IN GENERAL SURGERY

• Total duration of the training is 4 years divided into two
phases (IMM & advance specialty training), all of which is
to be undertaken after passing FCPS I, and after registration
with R&RC and with an approved Supervisor at a CPSP
accredited unit/institution.
• The first two years of training, inclusive of rotations
constitutes Intermediate Module (IMM), at the end of
which the trainee becomes eligible to appear in the
Intermediate Module examinaton in Surgery.
• After completing training for Intermediate Module (IMM),
trainee proceeds to post Intermediate Module phase of
training in General Surgery for two years.
• Passing of IMM examination is one of the eligibility
requirements to appear in FCPS-II examination.
• All training inclusive of rotations is to be completed one
month before the date of theory examination for FCPS-II

FELLOWSHIP TRAINING 11
ROTATION
In the years 3 & 4 the trainee should spend twenty four months
of residency training in a CPSP approved General Surgery Unit.
However, during this period an optional rotation as an elective
of 03 months may be selected subject to the availability of slot,
discretion of the supervisor, and willingness of the PG trainee.
Only one elective can be selected out of the list mentioned
below:
• Urology
• Paediatric Surgery
• Critical Care
Rotation will begin on the first of the month for prescribed time
period

APPROVED TRAINING CENTRES

Training must be undertaken in units/departments/institutions
approved by the College.
A current list of approved locations is available from the
College and its regional offices as well as on the College
website: www. cpsp.edu.pk.

REGISTRATION AND SUPERVISION

All training must be supervised and undertaken on whole time
basis. The residents are required to register with the R&RC
and submit the name of their supervisor. The supervisor will
normally be a Fellow of the College. Only that training will be
accepted which is done under a CPSP approved supervisor.
The residents are not allowed to work simultaneously in any
other department/institutions for financial benefit and/or for
another academic qualification.

RESEARCH
One of the training requirements is a dissertation or two
research papers on a topic related to the field of specialization.
Synopsis of the dissertation or titles of must be approved from
the Registration & Research Cell (R&RC) of CPSP before starting
the research work. The dissertation must be submitted for
approval to the R&RC before or during the first six months of
fourth year of training program.

12 FELLOWSHIP TRAINING
 MANDATORY WORKSHOPS
All mandatory workshops should have been attended during
first two years of training (IMM), and therefore no workshop
is mandatory during 3rd & 4th years of training. However, the
trainee will be required to attend any workshop/s (ATLS/ACLS)
as may be introduced by the CPSP and as available.

E-LOGBOOK
The CPSP council has made e-logbook system mandatory for
all Residency program trainees inducted from July 2011. Upon
registration with R&RC each trainee is allotted a registration
number and a password to log on and make entries of all work
performed and the academic activities undertaken in e-logbook
on a daily basis. The concerned supervisor is required to verify
the entries made by the trainee. This system ensures timely
entries by the trainee and prompt verification by the supervisor.
It also helps in monitoring the progress of trainees and the
vigilance of the supervisors.

FELLOWSHIP TRAINING 13
 ROLE AND
RESPONSIBILITIES OF
SUPERVISOR
Supervision of a resident is a multifaceted job. Arbitrarily the
task is divided into the following components for the sake of
convenience. This division is by no means exhaustive or rigid. It
is merely meant to give semblance to this abstract and versatile
role.

EXPERT TRAINER
• This is the most fundamental role of a supervisor. S/he has
to not only ensure and monitor adequate training but also
provide continuous helpful feedback (formative) regarding
the progress of the training
• This would entail observing the resident’s performance
and rapport with all the people within his/her work
environment
• S/he should teach the residents and help them overcome
the hurdles during the learning process
• It is the job of the supervisor to make the residents
develop the ability to interpret findings in their patients
and act suitably in response
• The supervisor must be adept at providing guidance in
writing dissertation / research articles (which are essential
components of training)
• Every supervisor is required to participate actively in
Supervisors’ workshops, conducted regularly by CPSP, and
do his/her best to implement the newly acquired
information/skills in the training. It is his/her basic duty
to keep abreast of the innovations in the field of expertise
and ensure that this information percolates to residents of
all years under him/her

14 FELLOWSHIP TRAINING
 RELIABLE LIAISON
• The supervisor must maintain regular contact with the
College regarding training and the conduct of various
mandatory workshops and courses
• It is expected that the supervisor will establish direct
contact with relevant quarters of CPSP if any problem
arises during the training process, including the suitability
of resident
• S/he must be able to coordinate with the administration of
his/her institution/organization in order to ensure that his/
her residents do not have administrative problems
hampering their training

PROFICIENT ADMINISTRATOR
• The supervisor must ensure that the residents regularly fill
their e-logbook
• S/he must provide quarterly feedback regarding each
resident through e-log system
• S/he might be required to submit confidential reports on
resident’s progress to the College
• The supervisor should notify the College of any change in
the proposed approved training program
• In case the supervisor plans to be away for more than two
months, he/she must arrange satisfactory alternate
supervision during the period

FELLOWSHIP TRAINING 15
 ROLE AND
RESPONSIBILITIES OF
RESIDENT
Given the provision of adequate resources by the institution,
residents should
• accept responsibility for their own learning and ensure
that it is in accord with the requirements of the particular
discipline
• play an informed role in the selection of the supervisor
• seek reasonable infrastructure support from their
institution and supervisor, and use this support effectively
• ensure that all outlined aspects of training are covered
during the defined training period
• work with their supervisors in writing the
synopsis/research proposal and submit the
synopsis/research proposal by the end of first year of their
registration with the R&RC
• accept responsibility for the dissertation and plan to
execute the research within the time limits defined
• be responsible for arranging regular meetings with the
supervisor to discuss and document progress. If the
supervisor is not able/willing to meet with the resident on
a regular basis, he/she must notify the College
• provide the supervisor with word processed updated
synopsis and dissertation drafts (ensure it has been
checked for spelling, grammar and typographical errors,
prior to submission) and provide the raw data to the
supervisor if required
• submit completed dissertation to R&RC or evidence of
publication/acceptance for publication of two research
papers in CPSP approved journal(s) or JCPSP six months
before the completion of (last year of) training. The
resident should be the first or second author of both
papers and the synopsis of both papers must have a prior
approval of R&RC
• follow the College complaint procedure if serious problem
arises
• complete all requirements for sitting an examination

16 FELLOWSHIP TRAINING
 TRAINING
PROGRAMME
CURRICULUM: AIMS AND OBJECTIVES

The aim of the Fellowship Programme in General Surgery is to

produce specialists in the field who have attained the required
competencies.

OBJECTIVES
At the end of the training for FCPS in General Surgery a resident
shall be able to:
• Initially assess the patients seeking surgical treatment for
their problems by:
• Obtaining pertinent history.
• Performing correct physical examinations.
• Formulating a working diagnosis.
• Deciding whether the patient requires:
• Ambulatory care or hospitalization.
• Referral to other health professionals.
• Emergency care including life saving measures.
• Manage patients requiring surgical treatment as follows:
• Plan an enquiry strategy i.e. order appropriate
investigations and interpret the results.
• When required, perform specified surgical procedures
independently and competently.
• Deal effectively and promptly with complications which
may occur during the course of disease or treatment.
• Maintain records of patients including summarization
and indexing.
• Seek consultation when needed.
• Carry out effective and efficient management of
emergency situations.
• Undertake research and publish findings.
• Acquire new information; assess its utility and make
appropriate applications.
• Recognize the role of teamwork and function as an
effective member/ leader of the team.

FELLOWSHIP TRAINING 17
• Advise the community on matters related to promoting
health and preventing disease.
• Train para-professionals and other/junior members of the
team.

18 FELLOWSHIP TRAINING
 SYLLABUS
Attention to the topics listed below will ensure that the
resident has covered to a substantial degree, those areas that
are considered as essential core knowledge.

It is understood that each trainee will not have the opportunity

to become proficient in all skills during the training program.
However, each trainee should endeavor to at least observe
every procedure being performed and, if possible, to
participate in it as actively as possible.

Principles of Surgery
Homeostasis, hemorrhage, transfusion, shock, infection, trauma
in general, endocrine and metabolic responses to injury, fluid,
electrolyte and nutritional management, wound healing and
care, burns, tissue transplantation, anaesthesia, complications
of Surgery, physiological monitoring of patients, pre and post
operative care.

Surgery of the Head and Neck, Face and Neurosurgery

Congenital anomalies, tumours of head and neck, infections,
head injury, intracranial lesions, thyroid, parathyroid, lymph
nodes and lymphatics, spinal cord, and peripheral nerves,
cervical spine, oral cavity, salivary glands, teeth and gums.

Trauma
Assessment and management of trauma patients with multiple
injuries.

Genito-Urinary System
Investigations, kidney, ureter, bladder, prostate, penis, urethra,
scrotum, testes, epididymis, vas deferens, varicocele,
congenital anomalies.

Thorax
Thoracic inlet, chest wall, breast, pleura, mediastinum, lungs,
heart, large vessels, thymus, diaphragm, oesophagus.

FELLOWSHIP TRAINING 19
Abdomen
Anterior and posterior abdominal wall, omentum, mesentery,
peritoneum including peritoneal cavity, hernias,
retroperitoneum, pelvis. Gynaecology as related to surgical
conditions.

Liver, gall bladder, bile ducts, pancreas, spleen, stomach,

duodenum, jejunum, small intestine, appendix, colon, rectum,
anal canal and perineum.

Special Group
Vascular surgery (central and peripheral), lymphatics and
lymph nodes. Paediatric surgery including congenital
anomalies. Endocrine glands including suprarenals, skin and
subcutaneous tissues. Principles of reconstructive surgery,
organ transplantation, immunology and oncology.

20 FELLOWSHIP TRAINING
 CORE COMPETENCIES
The clinical skills, which a specialist must have, are varied and
complex. A complete list of the same necessary for trainees and
trainers is given in the following pages. It is arranged year wise
and the level of competence to be achieved is given below:
1. Observer Status
2. Assistant Status
3. Performed Under Supervision
4. Performed Under Indirect Supervision
5. Performed Independently

Note: Levels 4 and 5 for practical purposes are almost

synonymous

FELLOWSHIP TRAINING 21
 22
THIRD YEAR
Total # of
03 months 06 months 09 months 12 months
Cases

patient management 5 25 5 25 5 25 5 25 100

• elicit pertinent history
• perform physical examination
• order appropriate investigations
• interpret results of investigations
• assess for fitness to undergo surgery
• decide & implementing appropriate treatment
• communicate effectively with patients,
families and the health team
• maintain accurate and appropriate records
presentation skills: 1 long case/week 5 5 5 5 5 5 5 5 20
presentation skills: 2 short cases/week 5 10 5 10 5 10 5 10 40
postoperative management and monitoring 4 20 4 20 5 20 5 20 80

FELLOWSHIP TRAINING
FELLOWSHIP TRAINING
THIRD YEAR
Total # of
03 months 06 months 09 months 12 months
Cases

preparation for surgery 5 20 5 20 5 20 5 20 80

taking informed consent
preoperative preparation and optimization for 4 - 4 - 5 - 5 - -
various surgical procedures
observance of aseptic techniques 5 - 5 - 5 - 5 - -
positioning of patient on operation table 3 - 3 - 4 - 4 - -
for: perianal surgery, thoracotomy, laparotomy,
renal surgery, head & neck surgery,
surgical procedure on the back
use of common surgical instruments & 4 20 4 20 5 20 5 20 80
appliances (including endoscopic instruments)
use of suture materials in different surgical 5 20 5 20 5 20 5 20 80
procedures/stappling devices and techniques

23
 THIRD YEAR

24
Total # of
03 months 06 months 09 months 12 months
Cases

general surgical procedures & management

debridement, wound excision, closure/suture 3 10 3 10 4 10 4 10 40
of wound (excluding repair of special tissues
like nerves and tendons)
incision and drainage of abscesses (excluding 4 10 4 10 4 10 4 10 40
deep seated abscesses in peritoneum and other
serous cavities)
lumbar puncture 4 1 4 1 5 1 5 1 4
nasogastric intubation 5 10 5 10 5 10 5 10 40
fnac & tru cut biopsy 4 1 4 1 4 1 4 1 4
biopsy of lymph nodes 3 2 3 2 4 2 4 2 8
biopsy of skin lesions, subcutaneous lumps or 4 2 4 2 5 2 5 2 8
swellings
excision of soft tissue tumours and cysts 3 4 3 4 4 4 4 4 16
split skin graft 2 1 2 2 3 1 3 2 6
proctoscopy and interpretation of findings 3 2 3 2 4 3 4 3 10
gastroscopy 2 2 2 2 2 2 3 2 8
colonoscopy 2 1 2 2 3 1 3 2 6
proctosigmoidoscopy 3 2 3 2 4 2 4 2 8
liver biopsy 2 1 2 1 2 1 3 1 4
percutaneous needle aspiration under 3 1 3 1 4 1 4 1 4

FELLOWSHIP TRAINING
ultrasound guidance ct scan
surgery for ingrowing toe nail 3 1 3 1 4 1 4 1 4
 THIRD YEAR
Total # of
03 months 06 months 09 months 12 months Cases

abdominal operations
opening and closing abdomen 3 2 3 2 4 2 4 2 8

FELLOWSHIP TRAINING
inguinal hernia repair 3 3 3 3 4 3 4 3 12
ventral & incisional hernia repair (open and 2 2 3 2 3 2 3 2 8
laparoscopic)
haemorrhoids 3 3 3 3 4 3 4 3 12
fissure in ano 3 3 3 3 4 3 4 3 12
fistulae 3 3 3 3 4 3 4 3 12
appendicectomy (open) 4 5 4 5 5 5 5 5 20
cholecystectomy (open) 3 3 3 3 4 2 4 2 10
oesophagectomy 2 1 2 1 2 1 2 1 4
intestinal resection and anastomosis 3 2 3 2 4 2 4 2 8
stoma formation & reversal 3 1 3 1 4 1 4 1 4
laparoscopic surgery 2 4 2 4 2 4 2 4 16
laparoscopic cholecystectomy 2 2 2 2 2 2 3 2 8
laparoscopic hernia repair 2 1 2 1 2 1 3 1 4
use of stappling guns 2 1 2 1 2 1 2 1 4
heller cardiomyotomy 2 0 2 1 2 0 2 1 2
hiatal hernia repair 2 0 2 1 2 0 2 1 2
gastrectomy (total & distal) 2 1 2 1 2 1 2 1 4
gastrojejunostomy 2 1 2 1 3 1 3 1 4
surgery for perforated duodenal ulcer 2 1 3 1 3 1 4 1 4
surgery for bleeding ulcer 2 1 2 1 3 1 3 1 4

25
cbd exploration & repair 2 1 2 1 3 1 3 1 4
 THIRD YEAR

26
03 months 06 months 09 months 12 months Total # of
Cases

abdominal operations
choledochoduodenostomy and 2 1 2 1 3 1 3 1 4
hepaticojejunostomy
choledochal cyst excision and reconstruction - - 2 1 - - 2 1 2
open and laparoscopic surgery for hydatid cyst 2 1 2 1 2 1 3 1 4
liver
elective open and laparoscopic spleenectomy 2 1 2 1 3 1 3 1 4
spleenectomy in trauma 2 1 2 1 3 1 3 1 4
pancreaticoduodenectomy (whipple) - - 2 1 - - 2 1 2
tripple bypass for advanced carcinoma pancrease 2 1 2 1 3 1 3 1 4
distal pancreatectomy - - 2 1 - - 3 1 2
pancreaticojejunostomy for chronic pancreatitis - - 2 1 - - 3 1 2
right, left & total colectomy 2 1 2 1 3 1 3 1 4
sigmoid colectomy 2 1 2 1 3 1 3 1 4
low anterior resection 2 1 2 1 3 1 3 1 4
apr 2 1 2 1 3 1 3 1 4
surgery for inflamatory bowel disese - - 2 1 - - 3 1 2
laparoscopic appendicectomy 2 2 2 2 3 1 3 1 6
pilonoidal sinus surgery 2 2 2 2 3 1 3 1 6
stappled haemorhoidectomy 2 1 2 1 3 1 3 1 4
laparotomy for peritonitis (enteric perforation etc) 2 2 2 2 3 2 3 2 8

FELLOWSHIP TRAINING
diagnostic laparoscopy and biopsy 2 1 2 1 3 1 3 1 4
 THIRD YEAR

FELLOWSHIP TRAINING
Total # of
03 months 06 months 09 months 12 months Cases

thoracic surgery
chest intubation (tube throacostomy) 5 4 5 4 5 4 5 4 16
emergency thoracotomy 3 2 3 2 4 2 4 2 8
diagnosis and management of life threatening 3 2 3 2 4 2 4 2 8
chest trauma (tension pneumothorax, open
pneumothorax, massive haemothorax, flail chest)
management of empyema thorax 2 1 3 1 3 1 3 1 4
rib resection 3 2 3 2 4 2 5 2 8
vascular surgery
surgery for varicose veins 5 3 5 3 5 3 5 3 12
embolectomy 4 3 4 3 5 3 5 3 12
vascular repair 4 2 4 2 5 2 5 2 8
principles of thromboprophylaxis 4 3 4 3 5 3 5 3 12
management of dvt 3 1 3 1 4 1 4 1 4

27
 28
THIRD YEAR
Total # of
03 months 06 months 09 months 12 months
Cases

surgery of head, neck and other areas

breast operations 4 4 5 4 5 4 5 4 16
thyriod, parathyroid 4 4 5 4 5 4 5 4 16
salivary glands and jaws 4 3 4 3 5 3 5 3 12
parotid surgery 3 1 3 1 4 2 4 2 6
anaesthesia & critical care
airway maintenance and passing of 2 2 2 2 3 2 3 2 8
endotracheal tube
local & regional anaesthesia 5 2 5 2 5 2 5 2 8
spinal & epidural anaesthesia 3 1 3 1 4 1 5 1 4
principles of ga/anaesthetic machines 5 - 5 - 5 - 5 - -
management of pain 5 - 5 - 5 - 5 - -
anaesthetic agents and muscle relaxant 5 - 5 - 5 - 5 - -
ippr and other methods of artificial respiration 3 4 3 4 4 4 4 4 16
cpr 5 3 5 3 5 3 5 3 12
fluid and electrolyte balance 4 3 5 3 5 3 5 3 12
monitoring devices 3 2 4 2 4 2 5 2 8
inotropic agents 3 2 3 2 4 2 5 2 8
replacement of nutrition 3 1 3 1 4 1 4 1 4
placement of cvp line 2 1 3 1 4 1 4 1 4

FELLOWSHIP TRAINING
 THIRD YEAR
Total # of
03 months 06 months 09 months 12 months
Cases

urology

FELLOWSHIP TRAINING
uretheral catheterization using soft and hard 5 10 5 10 5 10 5 10 40
catheters
uretheral dilatation 3 5 3 5 3 5 4 5 20
suprapubic puncture 4 2 4 2 5 2 5 2 8
meatotomy 3 2 4 2 5 3 5 3 10
circumcision 4 5 4 5 5 5 5 5 20
orchedopexy 3 2 3 2 4 2 4 2 8
varicocelectomy 3 2 3 2 4 2 4 2 8
hydrocelectomy 3 2 3 2 4 2 4 2 8
orchidectomy 3 2 3 2 4 2 4 2 8
prostatectomy 2 1 2 1 2 1 3 1 4
vesicolithotomy 3 1 3 1 4 1 4 1 4
renal stones surgery 3 1 3 1 4 1 4 1 4
orthopaedic surgery
application of splints, pop casts, skin traction 3 10 3 10 4 10 4 10 40
tendon repairs 3 1 3 2 4 1 4 2 6
amputations 3 1 3 1 4 2 4 2 6
diagnosis and management of compartment 3 1 3 1 3 1 3 1 4
syndrome

29
 30
THIRD YEAR
Total # of
03 months 06 months 09 months 12 months
Cases

neurosurgery
management of head injury 2 2 3 2 3 2 4 2 8
care of unconscious patient 3 1 3 1 3 1 4 1 4
paediatric surgery
rectal polypectomy 3 2 3 1 4 2 4 2 8
inguinal herniatomy 2 2 3 1 3 1 4 1 5
orchedopexy 2 2 3 1 3 1 4 1 5
circumcision in infants 3 2 3 2 4 2 4 2 8
fluid and electrolyte requirement 3 2 3 2 4 2 4 2 8

FELLOWSHIP TRAINING
FELLOWSHIP TRAINING
THIRD YEAR
03 months 06 months 09 months 12 months Total # of
Cases

trauma management
burn management 4 1 4 1 4 1 4 1 4
controlling haemorrhage 4 10 4 10 5 10 5 10 40
fast 2 3 3 3 3 3 4 3 12
trauma management atls/acls 4 15 4 15 5 15 5 15 60
application of cervical collar 4 3 4 3 5 3 5 3 12
log roll of patient 4 3 4 3 5 3 5 3 12
tracheostomy / cricothyroidotomy 3 1 3 2 4 1 4 2 6
damage control laparotomy 2 1 3 1 3 1 4 1 4
laparotomy for penetrating injuries 2 2 3 2 3 2 4 2 8
conservative management of blunt abdominal 3 2 3 2 4 2 4 2 8
trauma
management of blast injuries & mass casuality - - - - 2 1 3 1 2

31
 32
FOURTH YEAR
Total # of
15 months 18 months 21 months 24 months
Cases

patient management 5 25 5 25 5 25 5 25 100

• elicit pertinent history
• perform physical examination
• order appropriate investigations
• interpret results of investigations
• assess for fitness to undergo surgery
• decide & implementing appropriate treatment
• communicate effectively with patients,
families and the health team
• maintain accurate and appropriate records
presentation skills: 1 long case/week 5 5 5 5 5 5 5 5 20
presentation skills: 2 short cases/week 5 10 5 10 5 10 5 10 40
postoperative management and monitoring 4 20 4 20 5 20 5 20 80

FELLOWSHIP TRAINING
FELLOWSHIP TRAINING
FOURTH YEAR
Total # of
15 months 18 months 21 months 24 months
Cases

preparation for surgery 5 20 5 20 5 20 5 20 80

taking informed consent
preoperative preparation and optimization for 4 - 4 - 5 - 5 - -
various surgical procedures
observance of aseptic techniques 5 - 5 - 5 - 5 - -
positioning of patient on operation table 3 - 3 - 4 - 4 - -
for: perianal surgery, thoracotomy, laparotomy,
renal surgery, head & neck surgery,
surgical procedure on the back
use of common surgical instruments & 4 20 4 20 5 20 5 20 80
appliances (including endoscopic instruments)
use of suture materials in different surgical 5 20 5 20 5 20 5 20 80
procedures/stappling devices and techniques

33
 FOURTH YEAR

34
Total # of
15 months 18 months 21 months 24 months Cases

general surgical procedures & management

debridement, wound excision, closure/suture of 4 10 4 10 5 10 5 10 40
wound (excluding repair of special tissues like
nerves and tendons)
incision and drainage of abscesses (excluding 5 10 5 10 5 10 5 10 40
deep seated abscesses in peritoneum and other
serous cavities)
lumbar puncture 4 1 4 1 5 1 5 1 4
nasogastric intubation 5 10 5 10 5 10 5 10 40
fnac & tru cut biopsy 5 1 5 1 5 1 5 1 4
biopsy of lymph nodes 4 2 4 2 5 2 5 2 8
biopsy of skin lesions, subcutaneous lumps or 4 2 4 2 5 2 5 2 8
swellings
excision of soft tissue tumours and cysts 4 4 4 4 5 4 5 4 16
split skin graft 3 1 3 2 4 1 4 2 6
proctoscopy and interpretation of findings 4 2 4 2 5 3 5 3 10
gastroscopy 2 2 2 2 3 2 3 2 8
colonoscopy 2 1 2 2 3 1 3 2 6
proctosigmoidoscopy 3 2 4 2 5 2 5 2 8
liver biopsy 2 1 3 1 3 1 4 1 4
percutaneous needle aspiration under 3 1 3 1 4 1 4 1 4

FELLOWSHIP TRAINING
ultrasound guidance / ct scan
surgery for ingrowing toe nail 4 1 4 1 5 1 5 1 4
 FOURTH YEAR
Total # of
15 months 18 months 21 months 24 months Cases

abdominal operations
opening and closing abdomen 3 2 3 2 4 2 4 2 8

FELLOWSHIP TRAINING
inguinal hernia repair 3 3 3 3 4 3 4 3 12
ventral & incisional hernia repair (open and 2 2 3 2 3 2 3 2 8
laparoscopic)
haemorrhoids 3 3 3 3 4 3 4 3 12
fissure in ano 3 3 3 3 4 3 4 3 12
fistulae 3 3 3 3 4 3 4 3 12
appendicectomy (open) 4 5 4 5 5 5 5 5 20
cholecystectomy (open) 3 3 3 3 4 2 4 2 10
oesophagectomy 2 1 2 1 2 1 2 1 4
intestinal resection and anastomosis 3 2 3 2 4 2 4 2 8
stoma formation & reversal 3 1 3 1 4 1 4 1 4
laparoscopic surgery 2 4 2 4 2 4 2 4 16
laparoscopic cholecystectomy 2 2 2 2 2 2 3 2 8
laparoscopic hernia repair 2 1 2 1 2 1 3 1 4
use of stappling guns 2 1 2 1 2 1 2 1 4
heller cardiomyotomy 2 0 2 1 2 0 2 1 2
hiatal hernia repair 2 0 2 1 2 0 2 1 2
gastrectomy (total & distal) 2 1 2 1 2 1 2 1 4
gastrojejunostomy 2 1 2 1 3 1 3 1 4
surgery for perforated duodenal ulcer 2 1 3 1 3 1 4 1 4
surgery for bleeding ulcer 2 1 2 1 3 1 3 1 4

35
cbd exploration & repair 2 1 2 1 3 1 3 1 4
 FOURTH YEAR

36
Total # of
15 months 18 months 21 months 24 months Cases

abdominal operations
choledochoduodenostomy and 2 1 2 1 3 1 4 1 4
hepaticojejunostomy
choledochal cyst excision and reconstruction - - 2 1 - - 3 1 2
open and laparoscopic surgery for hydatid cyst 2 1 2 1 3 1 4 1 4
liver
elective open and laparoscopic spleenectomy 2 1 3 1 3 1 4 1 4
spleenectomy in trauma 2 1 3 1 3 1 4 1 4
pancreaticoduodenectomy (whipple) - - 2 1 - - 2 1 2
tripple bypass for advanced carcinoma pancrease 2 1 2 1 3 1 3 1 4
distal pancreatectomy - - 2 1 - - 3 1 2
pancreaticojejunostomy for chronic pancreatitis - - 2 1 - - 3 1 2
right, left & total colectomy 2 1 3 1 3 1 4 1 4
sigmoid colectomy 2 1 3 1 3 1 4 1 4
low anterior resection 2 1 2 1 3 1 4 1 4
apr 2 1 3 1 3 1 4 1 4
surgery for inflamatory bowel disese - - 2 1 - - 3 1 2
laparoscopic appendicectomy 2 2 3 2 3 2 4 2 8
pilonoidal sinus surgery 2 2 3 2 4 2 5 2 8
stappled haemorhoidectomy 2 1 3 1 3 1 4 1 4
laparotomy for peritonitis (enteric perforation etc) 2 2 3 2 3 2 4 2 8

FELLOWSHIP TRAINING
diagnostic laparoscopy and biopsy 2 1 2 1 3 1 4 1 4
 FOURTH YEAR

FELLOWSHIP TRAINING
Total # of
15 months 18 months 21 months 24 months Cases

thoracic surgery
chest intubation (tube throacostomy) 5 4 5 4 5 4 5 4 16
emergency thoracotomy 3 2 3 2 4 2 4 2 8
diagnosis and management of life threatening 3 2 4 2 5 2 5 2 8
chest trauma (tension pneumothorax, open
pneumothorax, massive haemothorax, flail chest)
management of empyema 2 1 3 1 3 1 3 1 4
rib resection 3 2 3 2 4 2 5 2 8
vascular surgery
surgery for varicose veins 3 3 4 3 5 3 5 3 12
embolectomy 3 3 4 3 5 3 5 3 12
vascular repair 3 2 4 2 5 2 5 2 8
principles of thromboprophylaxis 3 3 4 3 5 3 5 3 12
management of dvt 3 1 4 1 4 1 5 1 4

37
 38
FOURTH YEAR
Total # of
15 months 18 months 21 months 24 months
Cases

surgery of head, neck and other areas

breast operations 4 4 5 4 5 4 5 4 16
thyriod, parathyroid 3 4 4 4 5 4 5 4 16
salivary glands and jaws 3 3 4 3 5 3 5 3 12
parotid surgery 3 1 3 1 4 2 4 2 6
anaesthesia & critical care
airway maintenance and passing of 3 2 3 2 4 2 5 2 8
endotracheal tube
local & regional anaesthesia 5 2 5 2 5 2 5 2 8
spinal & epidural anaesthesia 3 1 3 1 4 1 5 1 4
principles of ga/anaesthetic machines 5 - 5 - 5 - 5 - -
management of pain 5 - 5 - 5 - 5 - -
anaesthetic agents and muscle relaxant 5 - 5 - 5 - 5 - -
ippr and other methods of artificial respiration 3 4 3 4 4 4 4 4 16
cpr 5 3 5 3 5 3 5 3 12
fluid and electrolyte balance 4 3 5 3 5 3 5 3 12
monitoring devices 3 2 4 2 4 2 5 2 8
inotropic agents 3 2 3 2 4 2 5 2 8
replacement of nutrition 3 1 3 1 4 1 4 1 4
placement of cvp line 3 1 4 1 5 1 5 1 4

FELLOWSHIP TRAINING
 FOURTH YEAR
Total # of
15 months 18 months 21 months 24 months Cases

FELLOWSHIP TRAINING
urology
uretheral catheterization using soft and hard 5 10 5 10 5 10 5 10 40
catheters
uretheral dilatation 3 5 3 5 3 5 4 5 20
suprapubic puncture 4 2 4 2 5 2 5 2 8
meatotomy 3 2 4 2 5 3 5 3 10
circumcision 4 5 4 5 5 5 5 5 20
orchedopexy 3 2 4 2 5 2 5 2 8
varicocelectomy 3 2 4 2 5 2 5 2 8
hydrocelectomy 3 2 4 2 5 2 5 2 8
orchidectomy 3 2 4 2 4 2 5 2 8
prostatectomy 2 1 3 1 4 1 4 1 4
vesicolithotomy 3 1 4 1 4 1 5 1 4
renal stones surgery 3 1 3 1 4 1 5 1 4
orthopaedic surgery
application of splints, pop casts, skin traction 3 10 4 10 5 10 5 10 40
tendon repairs 3 1 3 2 4 1 4 2 6
amputations 3 1 4 1 5 2 5 2 6
diagnosis and management of compartment 3 1 4 1 5 1 5 1 4
syndrome

39
 40
FOURTH YEAR
Total # of
15 months 18 months 21 months 24 months
Cases

neurosurgery
management of head injury 2 2 3 2 4 2 4 2 8
care of unconscious patient 3 1 3 1 4 1 5 1 4
paediatric surgery
Rectal polypectomy 3 2 4 1 4 2 5 2 8
Inguinal herniatomy 2 2 3 1 4 1 5 1 5
Orchedopexy 2 2 3 1 4 1 5 1 5
Circumcision in infants 3 2 3 2 4 2 5 2 8
Fluid and electrolyte requirement 3 2 3 2 4 2 5 2 8

FELLOWSHIP TRAINING
FELLOWSHIP TRAINING
FOURTH YEAR
Total # of
15 months 18 months 21 months 24 months Cases

trauma management
burn management 4 1 4 1 5 1 5 1 4
controlling haemorrhage 4 10 5 10 5 10 5 10 40
trauma management atls/acls 4 15 5 15 5 15 5 15 60
fast 3 3 4 3 5 3 5 3 12
application of cervical collar 4 3 4 3 5 3 5 3 12
log roll of patient 4 3 4 3 5 3 5 3 12
tracheostomy / cricothyroidotomy 4 1 4 2 5 1 5 2 6
damage control laparotomy 3 1 3 1 4 1 5 1 4
laparotomy for penetrating injuries 3 2 4 2 4 2 5 2 8
conservative management of blunt abdominal 4 2 4 2 5 2 5 2 8
trauma
management of blast injuries 2 1 3 1 3 1 4 1 4

41
ASSESSMENT
FORMATIVE ASSESSMENT
College of Physicians and Surgeons Pakistan, in order to
implement competency based education in letter and spirit, is
introducing Work Placed Based Assessment (WPBA) in addition
to institutional/ departmental assessments. To begin with
college is introducing Mini-CEX and DOPS to ensure that the
graduates are fully equipped with the clinical competencies.

Mini Clinical Evaluation Exercise (Mini-CEX)

During advance phase of training (FCPS-II) in General Surgery
one Mini-CEX in each quarter on any of the following topics is
to be conducted as under:
• Mini-CEX is entirely a formtive tool of assessment and is to
be accompanied with constructive feedback
• Each Mini-CEX encounter extends for about 20 minutes
with 05 minutes for feedback and further action plan
• In case of unsatisfactory performance of the resident, a
remedial has to be completed within stipulated time frame
• All topics given below are to be covered
• Non-compliance by the resident has to be reported in
quarterly feedback.
• The performace is reported online on the prescribed form
(sample give below)

Topics:
• Thyroid
• Breast
• Peripheral Arterial Disease
• External hernias
• Abdominal masses / obstructive jaundice / GI bleed /
sub-acute intestinal obstruction
• Head and neck (parotid gland, Submandibular gland, neck
nodes and masses)
• Limb Swellings and ulcers
• Varicose veins
• Testicular swellings

42 FELLOWSHIP TRAINING
 MINI CLINICAL EVALUATION EXERCISE (CEX)
Specialty:
Time Duration = 20 mins (15 mins assessment and 5 mins feedback)
P L E A S E C O M P L E T E T H E Q U E S T I O N N A I R E BY F I L L I N G /C H E C K I N G A P P R O P R I AT E B O X E S

Assessor: Assessment Date:

Resident`s Name:
Hospital Name: R&RC Number:
Year of Residency: R1 R2 R3 R4 R5
Quarter: 1st 2nd 3rd 4th
Setting: Ward Outdoor (Hospital/Community) Other:
Diagnosis of Patient: Patient Age: Sex:
Clinical Area:
Complexity of Case/ Procedure: Low/Easy Moderate/Average High/Difficult N/A
Focus of Clinical Encounters: History taking Physical Examination Management
Communication Skills Other:
Please grade the following areas on the Below Expectations Satisfactory Above Expectation Excellent
Not Observed /
given scale: Applicable
1 2 3 4 5
Informed Consent of patient
Interviewing Skills
Systematic Progression
Presentation of positive & significant
negative findings
Justification of actions
Professionalism
Organization/Efficiency
Overall clinical competence

Assessor’s Satisfaction with Mini-CEX:

(Low) 1 2 3 4 5 (High)
Resident’s Satisfaction with Mini-CEX:
(Low) 1 2 3 4 5 (High)

Strengths Suggestions for Improvements

Encounter to be repeated YES NO

Signature

FELLOWSHIP TRAINING 43
GUIDELINES
Competence Assessed Descriptor of a Satisfactory Performance

History Taking Facilitates patient’s narration, effectively

uses appropriate leads to obtain accurate
history, appropriately comprehends verbal
and non-verbal cues

Clinical Examination Performs examination in logical sequence

with satisfactory time management in the
context of clinical problem. Gives clear
and appropriate commands to the patient
and is sensitive to patient’s comfort

Professionalism Acts in an ethical manner, exhibits respect,

compassion, empathy, wins patient’s trust
and maintains confidentiality and legality

Clinical Judgement Makes logical diagnosis, orders necessary

investigations considering cost, availability
and risks

Counselling Skills Communicates in audible simple language,

patiently listens to the patient’s concerns,
reaffirms patient’s understanding and
summarises conclusion

Organisation/Efficiency Efficient, time bound, prioritises logically

Feedback
The purpose of the feedback is purely formative; to provide
insights that help trainee make adjustments and enhance
performance in future and ultimately for the final / exit
summative assessment. Quarterly feedback will translate into
inculcating a life long gradual change in attitudes, behaviours
and process of learning. Supervisor are requested to:
• Provide feedback during the session
• Maintain privacy and confidentiality as much as possible
• Keep in mind social and ethical implications
• Use positive and encouraging communication strategies
• Focus on precise performance and behaviour and not on
person

44 FELLOWSHIP TRAINING
 • Avoid derogatory comments and remarks
• Encourage trainee’s feedback on the self-performance and
teaching programme in specific context
• Conclude , with mutual agreement on future adjustments
and learning to improve performance in the task at hand

Direct Observation of Procedural Skills (DOPS)

During advance phase of training (FCPS-II) in General Surgery
the one DOPS in each quarter on any of the following topics is
to be conducted as under:
• DOPS is entirely a formtive tool of assessment and is to be
accompanied with constructive feedback
• Each DOPS encounter extends for about 20 minutes with
05 minutes for feedback and further action plan
• In case of unsatisfactory performance of the resident, a
remedial has to be completed within stipulated time frame
• All topics given below are to be covered
• Non-compliance by the resident has to be reported in
quarterly feedback.
• The performace is reported online on the prescribed form
(sample give below)

Topics:
• Fine needle aspiration cytology
• Suturing
• Core/true cut biopsy
• ABGS sampling
• Incisional & excisional biopsy under local anaesthesia
• CVP line
• Endotracheal intubation
• Excision ingrown toe nail under local anaesthesia
• Basic laparoscopic skills (preferably on simulators where
available)

FELLOWSHIP TRAINING 45
 DIRECT OBSERVATION OF PROCEDURAL SKILLS (DOPS)
Specialty:
Time Duration = 20 mins (15 mins assessment and 5 mins feedback)
P L E A S E C O M P L E T E T H E Q U E S T I O N N A I R E BY F I L L I N G /C H E C K I N G A P P R O P R I AT E B O X E S

Assessor: Assessment Date:

Resident`s Name:

Hospital Name: R&RC Number:

Year of Residency: R1 R2 R3 R4 R5

Quarter: 1st 2nd 3rd 4th

Setting: O.T. Procedure Room Other:

Diagnosis of Patient: Patient Age: Sex:

Name of Procedure:
Complexity of Case/ Procedure: Low/Easy Moderate/Average High/Difficult N/A

Number of times procedure performed by Resident:

Please grade the following areas on the Below Expectations Satisfactory Above Expectation Excellent
Not Observed /
given scale: Applicable
1 2 3 4 5
Indications, anatomy & steps of procedure
Informed consent, with explanation of
procedure and complications
Preparation for procedure
Use of Anesthesia, Analgesia or sedation
Observance of asepsis
Safe use of instruments
Use of accepted techniques
Management of unexpected event (or seeks help)
Post-procedure instructions to patient and staff
Professionalism
Overall ability to perform whole procedure

Assessor’s Satisfaction with DOPS:

(Low) 1 2 3 4 5 (High)

Resident’s Satisfaction with DOPS:

(Low) 1 2 3 4 5 (High)

Strengths Suggestions for Improvements

Encounter to be repeated YES NO

Signature

46 FELLOWSHIP TRAINING
 GUIDELINES
Competence Assessed Descriptor of a Satisfactory Performance

Indications, Anatomy Adequately enumerates major indications

and Steps of the procedure. Ably marks the important
anatomical landmarks and performs the
procedure observing major steps

Informed Consent with Takes informed consent in a simple and

Explanation of the audible tone, adequately explains the
Procedure and the salient features of the procedure and
Complications anticipated complications to the patient’s
satisfaction

Preparation of the Adheres to the recommended aseptic and

Procedure scrubbing techniques

Use of Anaesthesia, Knows the dose and site of anaesthesia.

Analgesia and Sedation Uses the recommended dosage, and route
of analgesia and sedation when deemed
necessary

Use of Instruments Selects proper instruments at required

points of the procedure and uses them in a
correct manner.

Use of Accepted Follows the recommended steps of the

Technique procedure in a controlled sequence and
flow

Management of Vigilantly picks up unaccepted events ,

Unaccepted Events or knows his ability and limitation, stops and
Seeks Help seeks help in difficult situation/s

Post Procedure Gives and explains post procedure care /

Instructions to the instructions to the patient . guides
Patients regarding hospital policy for minor post
procedure issues

Professionalism Acts in an ethical manner, exhibits respect,

compassion, empathy, wins patient’s trust
and maintains confidentiality and legality

FELLOWSHIP TRAINING 47
Feedback
The purpose of the feedback is purely formative; to provide
insights that help trainee make adjustments and enhance
performance in future and ultimately for the final/exit
summative assessment. Quarterly feedback will translate into
inculcating a lifelong gradual change in attitudes, behaviours
and process of learning. Supervisor are requested to:
• Provide feedback during the session
• Maintain privacy and confidentiality as much as possible
• Keep in mind social and ethical implications
• Use positive and encouraging communication strategies
• Focus on precise performance and behaviour and not on
person
• Avoid derogatory comments and remarks
• Encourage trainee’s feedback on the self-performance and
teaching programme in specific context
• Conclude , with mutual agreement on future adjustments
and learning to improve the task at hand

48 FELLOWSHIP TRAINING
 SUMMATIVE ASSESSMENT
The Eligibility Requirements for Candidates Appearing in
FCPS-II are:
• To have passed FCPS-I in Surgery and Allied, or been
granted official exemption.
• To have undertaken four years of the specified training in
Surgery, all of which should be after passing FCPS-I
(a certificate testifying attendance is obligatory for
admittance to examination) in an institution recognized by
the CPSP
• To provide a certificate of attendance of mandatory
workshops.
• To submit a completed and duly attested logbook.
• To provide a certificate of having passed the Intermediate
Module in Surgery.
• To provide a certificate of approval of dissertation or
acceptance of two research papers for publication in CPSP
approved journals, synopsis of which were earlier
approved by the R&RC.

EXAMINATION SCHEDULE
• The FCPS-II theory examination will be held twice a year.
• Theory examinations are held in various cities of the
country usually at Abbottabad, Bahawalpur, Faisalabad,
Hyderabad, Islamabad, Karachi, Lahore, Larkana, Multan,
Peshawar, Quetta and Rawalpindi, centres. The College
shall decide where to hold oral/practical examination
depending on the number of candidates in a city and shall
inform the candidates accordingly.
• English shall be the medium of examination for the theory/
practical/ clinical and viva examinations.
• The College will notify of any change in the centres, the
dates and format of the examination.
• A competent authority appointed by the College has the
power to debar any candidate from any examination if it
is satisfied that such a candidate is not a fit person to take
the College examination because of using unfair means in
the examination, misconduct or other disciplinary reasons.

FELLOWSHIP TRAINING 49
• Each successful candidate in the Fellowship examination
shall be entitled to the award of a College Diploma after
being elected by the College Council and payment of
registration fees and other dues.

EXAMINATION FEES
• Fees deposited for a particular examination shall not be
carried over to the next examination in case of withdrawal/
absence/exclusion.
• Applications along with the prescribed examination fees
and required documents must be submitted by the last
date notified for this purpose before each examination.
• The details of examination fee and fees for change of
centre, subject, etc. shall be notified before each
examination.

REFUND OF FEES
If after submitting an application for examination, a resident
decides not to appear, a written request for a refund must be
submitted before the last date for withdrawal with the receipt
of applications. In such cases a refund is admissible to the
extent of 75% of fees only. No request for refund will be
accepted after the closing date for receipt of applications.
If an application is rejected by the CPSP, 75% of the
examination fee will be refunded, the remaining 25% being
retained as a processing charge. No refund will be made for fees
paid for any other reason, e.g. late fee, change of centre/subject
fee, etc.

FORMAT OF EXAMINATIONS
Every candidate applying for the fellowship of the College of
Physicians and Surgeons Pakistan must pass both parts of the
Fellowship examination unless exemption is approved. Since
the College is continually seeking to improve its examinations,
changes are likely from time to time and candidates will be
notified in advance of such changes.

PART-I THEORY EXAMINATION

Paper-I: 100 Single Best type (MCQs)
Paper-II: 100 Single Best type (MCQs)

50 FELLOWSHIP TRAINING
 PART II CLINICAL EXAMINATION
The Clinical section comprises of two components:
• First Component:
• TOACS
• Second Component:
• One Long Case
• Four Short Cases

FORMAT OF TOACS
Task Oriented Assessment of Clinical Skills (TOACS) has been
introduced since November, 2001 in FCPS examinations.
All stations are required to be “Interactive”. At these stations,
the candidates will be required to perform a task, for example,
taking history, performing clinical examination, counseling,
assembling an instrument or any other task. One examiner
will be present at each interactive station and will rate the
performance of the candidate and ask questions testing critical
thinking and problem-solving skills.

FORMAT OF LONG CASE

Each candidate will be allotted one long case and allowed 30
minutes for history taking and clinical examination. Candidates
should take a careful history from the patient (or relative) and
after a thorough physical examination identify the problems
which the patient presents with. During the period a pair of
examiners will observe the candidate. In this section the
candidates will be assessed on the following areas:

Interviewing Skills
• Introduces one self. Listens patiently and is polite with the
patient
• Is able to extract relevant information

Clinical Examination Skills

• Takes informed consent
• Uses correct clinical methods in a systematic manner
(including appropriate exposure and re-draping)

FELLOWSHIP TRAINING 51
Case Presentation / Discussion
• Presents skillfully
• Gives correct findings
• Gives logical interpretations of findings and discusses
differential diagnosis
• Enumerates and justifies relevant investigations
• Outlines and justifies treatment plan (including
rehabilitation)
• Discusses prevention and prognosis
• Has knowledge of recent advances relevant to the case
• During case discussion the candidate may ask the
examiners for laboratory investigations which shall be
provided, if available. Even if they are not available and
are relevant, candidates will receive credit for the
suggestion

FORMAT OF SHORT CASES

Candidates will be examined in at least four short cases for a
total of 40 minutes jointly by a pair of examiners. Candidates
will be given a specific task to perform on patients, one case at
a time.
During this part of the examination, the candidate will be
assessed in:

Clinical Examination Skills

• Takes informed consent
• Uses correct clinical methods
• Examines systematically

Discussion
• Gives correct findings
• Gives logical interpretations of findings
• Justifies diagnosis/es
As the time for this section is short, the answers given by the
candidates should be precise, succinct and relevant to the
patient under discussion.

THE COLLEGE RESERVES THE RIGHT TO ALTER/AMEND ANY

RULES/REGULATIONS
Any decision taken by the College on the interpretation of these
regulations will be binding on the applicant.

52 FELLOWSHIP TRAINING
 PUBLISHED: 3 JULY 2021

COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN

7th Central Street, Defence Housing Authority, Karachi-75500.
Phone No. 9926400-10, UAN: 111-606-606, Fax No. 99266432