Surgical Foundations
Welcome to Surgical Residency!
The following is an outline of the Surgical Foundations Program at MUN’s Faculty of Medicine, and advice on how to navigate your way successfully and efficiently through the program and into a brilliant surgical career.
What is Surgical Foundations?
SF is a national program administered by the Royal College of Physicians and Surgeons of Canada. It is a mandatory program for all surgical residents in Canada (general, ortho, vascular, plastics, neuro, obs/gyn, cardiac, urology). It encompasses the foundational knowledge that is common to all surgeons and completion of the program is mandatory before the Royal College will allow you to sit for your final licensure examinations. The typical length of completion of the program should be approximately 18 months.
Here at Memorial University, we typically have 10 surgical residents per year. These 10 are usually comprised of four (4) residents studying General Surgery, four (4) studying Obstetrics and Gynecology and two (2) studying Orthopedics.
For further information on Surgical Foundations Program accreditation, visit the Royal College of Physicians and Surgeons of Canada:
Curriculum
Surgical Foundations started as a Competency by Design curriculum in July 2018.
Our Curriculum Map outlines how all the competencies are developed through different modes of teaching and learning including recorded lectures, anatomy sessions, clinical skills sessions, critically ill patient scenarios, task trainer stations, didactic lectures and demonstrations, and through professional development activities.
Objectives of Learning Experiences
Surgical Foundations Entrustable Professional Activities (effective 2021)
- This document is the list of Entrustable Professional Activities (EPAs). An EPA is a key task of a discipline (i.e. specialty or subspecialty) that an individual can be trusted to perform in a given health care context, once sufficient competence has been demonstrated. The EPAs are divided up into "Transition to Discipline" EPAs and "Foundations of Discipline" EPAs. The "Transition to Discipline" EPAs are designed as a transition from being a medical student to a surgical resident. They are basic activities, and should be accomplished within the first three months of residency. The Foundations of Discipline EPAs are more extensive, and should roughly take 18 months to complete.
- These EPAs are mapped to clinical rotations:
- This is an extensive document outlining the breadth of knowledge the Royal College of Physicians and Surgeons of Canada feels is essential to all physicians on a path to a surgical career.
Curriculum Delivery
Transition to Discipline EPAs (TTD EPAs)
Every July we hold a boot camp. This is when we run a couple of clinical simulation scenarios and a skills station for suturing, chest tube insertion, central lines and surgical airway. The EPA document stipulates that many of the TTD EPAs can be accomplished in simulation. This allows the residents to get off to a quick start on getting through this part of the curriculum.
Foundations of Discipline EPAs (FOD EPAs)
These are accomplished through clinical rotations throughout the first 18-24 months of residency (or quicker if you are keen!). Beware the trauma EPA (EPA#2) for ortho and obs/gyn residents. We have arranged for you to do your surgical rotation at the HSC specifically for the trauma exposure so you can accomplish that EPA. If you finish your HSC surgery rotation without completing that EPA it could be hard to get trauma exposure elsewhere in your curriculum.
Surgical Foundations Competencies
Our video lecture series is designed to ensure that the learning objectives in the entire competency document are covered. We have traditionally had a lecture series to deliver this content but the low number of residents in the program, people post call, people out of town has often led to low turnouts at the lectures so we've decided on a different approach to this part of the curriculum. We have constructed a virtual lecture series consisting of a series of PowerPoint presentations voiced over by the lecturer on each topic. There will be approximately 40-50 lectures posted over the year on our website with a new one posted every week. We'll provide you with the email of the lecturer for that week to provide an avenue for asking questions and feedback. Posted to our website will be a PowerPoint presentation with the lecture titles, probable presenter, and the specific competency the lecture covers. I've constructed the lecture series such that the entire competency document is covered.
Assessment
Documenting EPAs
We have started this year to use the MUNCAT app for collection of observations for EPAs. The competency committee meets quarterly to review your progress and ensure you are on the right track. If we feel you are falling behind you will get emails from Dr. Wells (chair of competency committee) to give specific feedback. All emails will also be sent to the program director of your home program to keep them in the loop.
A couple of important points about getting observations:
- Getting observations on your activities should be part of your daily routine. Don't be afraid to ask your supervisors.
- Senior residents can evaluate you too. Up to 50% of your evaluations can be from PGY4s or 5s.
Exam
The Surgical Foundations exam is administered in the Fall of your second year (about 14 months into your residency).
The sources used for the exam are:
- Sabiston and Schwartz textbooks
- Sabiston, D., & Townsend, C. (2012). Sabiston textbook of surgery : The biological basis of modern surgical practice. (19th ed. / [edited by] Courtney M. Townsend Jr. ... [et al.].. ed.). Philadelphia, PA: Elsevier Saunders.
- Schwartz, S., & Brunicardi, F. (2015). Schwartz's principles of surgery (10th ed., McGraw-Hill's AccessMedicine). New York, N.Y.: McGraw-Hill Education LLC.
- ATLS handbook
- Advanced trauma life support student course manual (10th ed.). (2018). Chicago: American College of Surgeons.
- Royal College Ethics Modules
- Royal College of Physicians and Surgeons of Canada. (2020). Bioethics Curriculum. Royal College of Physicians and Surgeons of Canada.
- Canadian Blood Services Professional Education Module
- Canadian Blood Services. (2019). Professional Education. Canadian Blood Services.
A practice exam will be run every summer for those writing that year. Practice exam questions will also be forwarded to lecturers to include in their virtual lectures. The pass rate is generally around 90% for first time text takers, but you have to put the work in early. It's too much material to leave until the last minute.
Program Completion
Once you have successfully completed the Surgical Foundations exam and achieved all the EPAs, you will officially graduate from Surgical Foundations. You will receive a certificate of completion from Memorial University, and a notice will be sent to the Royal College.
Contact Information
Program Director
Dr. Michael Hogan, MD, MMedEd, FRCSC, FACS
General Surgery/Hepatobiliary and Pancreatic Surgery
Associate Professor of Surgery, Memorial University
Staff Surgeon, Eastern Health
surgicalfoundations@mun.ca
Program Administrator
Ms. Jennifer Moran
Discipline of Surgery
Faculty of Medicine
Memorial University
Telephone: (709) 864-6487
jbragg@mun.ca