Checklists for Clinical Examinations in General Surgery

By Gamal Eldin Hussein A El Shallaly

This book can be studied by undergraduate students preparing for their MBBS exams in surgery, and by postgraduate surgeons in training preparing for the MD exam in general surgery and the MRCS exams. The aim of this book is to make the assessment of medical students fair, structured, and objective. It can also be used as a training and review book by the students to improve their skills in history taking, clinical examination, and communication. It also teaches them to acquire a methodological and systematic approach to solve and manage clinical problems. It aims to complement, not replace, main textbooks in surgery.

• Language: English
• Publisher: Austin Macauley Publishers
• Release date: Mar 1, 2024
• ISBN: 9781398490840

Gamal Eldin Hussein A El Shallaly

Prof. Gamal Eldin Hussein A. El Shallaly (FRCSEd, MMAS, CertTHE) QUALIFICATIONS Fellowship of the Royal College of Surgeons of Edinburgh, United Kingdom (FRCSEd) Master in Minimal Access Surgery (MMAS), University of Dundee, United Kingdom Certificate in Teaching in Higher Education (CertTHE), University of Dundee, United Kingdom POSITIONS Currently, Professor and head of department of surgery, College of Medicine and Health Sciences (CMHS), National University (NU), Oman Deputy Vice Chancellor, Karary University, Omdurman, Sudan Professor of Surgery and Head Department, Faculty of Medicine, Alzaiem Alazhari University (AAU), Khartoum North (Bahry), Sudan Consultant in General & laparoscopic Surgery and Gastroenterological Endoscopies Head of Curriculum Committee for MD in General Surgery, Sudan Medical Specialisation Board (SMSB) Director of the Centre for Continuous Development of Medical and Health Education (2012–2015) Director of Gastrointestinal Endoscopy Department (Khartoum North Teaching Hospital (KNTH) Head of the Research and Ethics Committee KNTH Representative of the Sudan Medical Council, and Chief External Examiner MBBS examinations Examiner with the Royal College of Surgeons of Edinburgh in the MRCS part B examination Fellowship and Membership of International Institutes and Learned Societies Fellow of the Royal College of Surgeons of Edinburgh, United Kingdom (FRCSEd) Member of the Faculty of Surgical Trainers of the Royal College of Surgeons of Edinburgh (MFSTEd) Fellow of the College of Surgeons of East, Central and South Africa (COSECSA), and former: Member of the European Association for Endoscopic Surgery (EAES) Member of the Association of Surgeons of Great Britain and Ireland (ASGBI) Member of the Association of Upper Gastroenterological surgeons (AUGIS), UK Member of the Association of Laparoscopic Surgeons of the United Kingdom (ALS) Member of the Royal Academy of Higher Education of the United Kingdom (AHE) Member of the executive committee of the Sudanese Association of Surgeons (SAS) 2008–2010 A list of free publications and presentations can be found by searching google using author’s first and surnames.

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About the Author

Prof. Gamal Eldin Hussein A. El Shallaly (FRCSEd, MMAS, CertTHE)

Qualifications

Fellowship of the Royal College of Surgeons of Edinburgh, United Kingdom (FRCSEd)

Master in Minimal Access Surgery (MMAS), University of Dundee, United Kingdom

Certificate in Teaching in Higher Education (CertTHE), University of Dundee, United Kingdom

Positions

Currently, Professor and head of department of surgery, College of Medicine and Health Sciences (CMHS), National University (NU), Oman

Deputy Vice Chancellor, Karary University, Omdurman, Sudan

Professor of Surgery and Head Department, Faculty of Medicine, Alzaiem Alazhari University (AAU), Khartoum North (Bahry), Sudan

Consultant in General & laparoscopic Surgery and Gastroenterological Endoscopies

Head of Curriculum Committee for MD in General Surgery, Sudan Medical Specialisation Board (SMSB)

Director of the Centre for Continuous Development of Medical and Health Education (2012–2015)

Director of Gastrointestinal Endoscopy Department (Khartoum North Teaching Hospital (KNTH)

Head of the Research and Ethics Committee KNTH

Representative of the Sudan Medical Council, and Chief External Examiner MBBS examinations

Examiner with the Royal College of Surgeons of Edinburgh in the MRCS part B examination

Fellowship and Membership of International Institutes and Learned Societies

Fellow of the Royal College of Surgeons of Edinburgh, United Kingdom (FRCSEd)

Member of the Faculty of Surgical Trainers of the Royal College of Surgeons of Edinburgh (MFSTEd)

Fellow of the College of Surgeons of East, Central and South Africa (COSECSA), and former:

Member of the European Association for Endoscopic Surgery (EAES)

Member of the Association of Surgeons of Great Britain and Ireland (ASGBI)

Member of the Association of Upper Gastroenterological surgeons (AUGIS), UK

Member of the Association of Laparoscopic Surgeons of the United Kingdom (ALS)

Member of the Royal Academy of Higher Education of the United Kingdom (AHE)

Member of the executive committee of the Sudanese Association of Surgeons (SAS) 2008–2010

A list of free publications and presentations can be found by searching google using author’s first and surnames.

Dedication

This work is dedicated to the souls of my parents, everyone who taught me, all the undergraduate medical students, postgraduate trainees in surgery and to my colleague surgeons and medical educators.

Copyright Information ©

Gamal Eldin Hussein A El Shallaly 2024

The right of Gamal Eldin Hussein A El Shallaly to be identified as author of this work has been asserted by the author in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publishers.

Any person who commits any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

The medical information in this book is not advice and should not be treated as such. Do not substitute this information for the medical advice of physicians. The information is general and intended to better inform readers of their health care. Always consult your doctor for your individual needs.

A CIP catalogue record for this title is available from the British Library.

ISBN 9781398490833 (Paperback)

ISBN 9781398490840 (ePub e-book)

www.austinmacauley.com

First Published 2024

Austin Macauley Publishers Ltd®

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E14 5AA

Acknowledgement

The support of all the staff members at the department of surgery, Faculty of Medicine, University of Alzaem Alazhari, is highly acknowledged.

I am also indebted to Mr Ahmed Ismael and his colleagues at the Sudan currency printing press for their excellent professional work in publishing my books.

Special thanks goes to the team at Austin Macauley Publishers for the great effort they made to publish and distribute this book to make it globally available.

Prefaces

Preface to the Twelfth Edition

I am indebted to my students and colleagues for keeping advising me and keeping using this book in their preparation for both under- and post-graduate exams in surgery. The Covid-19, year 2020 resulted in halting the publication of this new edition. In addition, the hyperinflation of prices impeded the production. However, by the grace of God and the support of my students and colleagues this edition will be published. A great reception of the chapter on images in surgery made me expand it in this edition. All other chapters have been reviewed and kept up to date.

Preface to the Eleventh Edition

In this edition, I introduce the chapter of images in surgery. These are radiological images and photos of patients having common surgical diseases. They are common exam questions that can be encountered in e.g. the OSCE, OSPE and CCE. The images are in black and white to keep the publishing cost down and hence the book price for the students. There is also a new topic in the MRCS communication skills chapter on how to deal with angry patients and relatives.

Preface to the Tenth Edition

By the grace of God, this book is gaining popularity by both under- and postgraduate students. I am grateful to Prof. Joseph Cumming for contributing a chapter on communication skills in the MRCS OSCE. This edition has been fully revised. Chapters have been added on of cervical lymph nodes, parotid swelling and diabetic septic foot.

Preface to the Ninth Edition

This edition has been revised and an important chapter on ‘Proctalgia’ is added to the ‘History Stations’. Hope this book continues to bridge a gap in the needs of both undergraduate and postgraduate students in surgery.

Preface to the Eighth Edition

By the Grace of God, the 7th edition was accepted by the same vigour of the previous editions, and more topics were requested by the ever-increasing readers of this book. This edition comes with revision of all chapters, with addition of abdominal aortic aneurysm, and chapters on neurological examination of the lower limb, and venous disorders including varicose veins examination and management.

Preface to the Seventh Edition

This edition has benefited from the continued feedback of my students who recommended the addition of a chapter on vascular surgery. The chapter on thyroid has been revised and management of thyroid tumours added. Other additions include: A checklist for acute appendicitis (in the annexes), as well as Sengstaken tube and surgical scrubbing (in the instruments and basic skills chapter).

Preface to the Sixth Edition

The work on this edition started almost after the 5th edition was published. This is because of the continuous scrutiny of this work and the useful comments of keen readers. I am also pleased that postgraduate students have found it useful in preparing for the OSCE and clinical exam of the MD in general surgery, as well as for Part B MRCS. In this edition, all previous chapters were reviewed and many subjects added, such as staging, treatment of breast cancer, and surgical scrubbing in the breast and basic skills chapters, respectively. Brand new chapters such as cervical lymph node examination, haematuria, and peripheral nerve examination are introduced. Hope this book continues to be up to the expectations of students and surgeons.

Preface to the Fifth Edition

l am always grateful to the warm welcome of each new edition by both the students and surgeons. This new edition has included all the suggestions I received from students and teachers.

In this edition a new chapter has been added, and previous ones have been revised. I have responded to students’ suggestions by adding a chapter on instruments and basic skills. This chapter has the potential to expand in the future to involve static OSCE stations and ViPSCE. Hope this book continues to be up to the reader’s expectations, and hope to continue receiving your feedback for improvement.

Preface to the Fourth Edition

By the grace of God, the third edition (2012) has also been rapidly taken with high vigour and enthusiasm by medical students, surgeons, and medical educators.

When these checklists were introduced many years ago, the aim was to make the classical clinical exams (long/short case style) more structured and objective. At this moment in time, the Objective Structured Clinical Examination (OSCE) has replaced the classical examination in almost all Sudanese Schools of Medicine. Hence, the position and importance of this book has, by the grace of God, been even more enforced as it fills a gap in the current literature available to medical students. Its simple language, systematic organisation and small size made it a popular companion to medical students. It can be placed comfortably in the lab coat pocket of medical students during their rounds in the hospital or during their group discussion. This great acceptance has encouraged me to include more topics.

One of the important and new issues in medical education and exams is communication. These skills are indispensable to doctors and trainees who deal with patients every day. A new chapter has been added to deal with some important aspects of communication skills such as informed consent and breaking bad news. Checklists on these skills are included to help trainers who design the examination, and help students to pass the objective structured examination (OSCE).

Every chapter has been revised. More topics and checklists have been added in the orthopaedic chapters including shoulder joint.

I must stress again the aim of this book is to help in preparation for the exam, and not to replace important references in surgery, a list of which is to be found at the back of this edition. It is my pleasure and honour to introduce this edition, and hope to receive your feedback.

Preface to the Second Edition

The first edition was a great success and was accepted graciously by examiners and students in many Sudanese medical schools. The system of clinical checklists presented in this book has been adopted by the department of surgery at Alzaem Alazhari University as the main reference for the development of the score sheets used in assessment in the Objective Structured Clinical Examination (OSCE). The OSCE itself has been adopted as a system of clinical assessment of final year medical students in surgery following the publication of the first edition of this book in 2009.

In the second edition, many chapters have been reviewed, in the light of the experience gained at clinical examinations conducted, not only by our faculty, but also by other universities. New chapters have been added, such as the ‘History stations’ and ‘Annexes’. History stations include scenarios where students are assessed in the skills of history taking in conditions such as ‘Dysphagia’ and ‘Rectal Bleeding’, where physical examination either may not reveal a lot or cannot be permitted in the exam. Since good history taking can be crucial in reaching a clinical diagnosis, the skill of history taking is included in other chapters also, such as the one on thyroid, gall bladder, and benign prostatic hyperplasia, to mention but a few examples.

The chapter of Annexes provides examples of scoring sheets that could be adopted from the various chapters of this book. These sheets can be used by examiners to assess the students performing their clinical examinations whether in the form of OSCE or in the conventional way. We believe that using checklists in the conventional examination will transform it into a structured form, adding a lot to its validity and fairness.

Introduction

Introducing checklists to the clinical examinations, used in Sudanese and other medical schools, is an attempt to make this method of assessment of medical students fair, structured, and reproducible. Marking the clinical short and long cases have suffered from being unstructured, subjective, and sometimes highly biased.

Clinical checklists can also be used in teaching and training. They help the students learn what skills of history taking and physical examinations are required to master. Checklists also include sections on discussing differential diagnoses, investigation, and treatment options. Development of checklist requires team work and continuous monitoring and modifications in the light of development of medical and surgical sciences.

In the open marking system, using the checklist method allows examiners to be more precise in determining student’s marks. This is especially important at both open ends; at the top (A=75 and above) and the bottom (F=less than 50). It can make a big difference for a high achiever to get for example