Curriculum

for the
Two Years’ Post Matric Competency Based

Diploma in
Operation Theater Technology

(New Scheme)

Punjab Medical Faculty

2013
Table of Contents

Page

Preface 2

General Outline 3

Section I: (Paper I) 7

Unit 1: Operation Theater Management 8

Unit 2: Equipments and Devices 10

Unit 3: Sterilization and Disinfection 12

Section II: (Paper II) 14

Unit 1: Surgical Assistance 15

Unit 2: Patient Care 17

Unit 3: Anesthesia Assistance 19

Practical Attachment: 21

 Recommended Reading for Teachers 24

 Acknowledgments 25

1
 Preface
After introduction of the new service structure for AHPs in 2012 the qualification
requirement for entry in service has been changed to a diploma of two years’ duration.
This decision has necessitated the development of curricula for the new scheme of
studies. The evolving health needs of the community, exponential advances in medical
and allied technologies and changes in health services provision, functions and
structure also demand continual and responsive changes in education and training
programs meant for AHPs. The revised curricula would carry out the following
important functions:
 link pre-service education and training with actual tasks AHPs have to perform
after being employed, especially in the public sector
 modernize training program by weeding out subjects that have become
obsolete and including subjects that are currently considered essential
 provide clarity on subjects and topics to be taught delimiting the breadth and
depth of teaching
 give clarity to examiners on what is to be tested and how
 stimulate critical faculties of both teachers and students to conceptualize
topics rather than memorizing them.
Focus of the new curricula would be on integration of tasks and multi-skilling of
students. Thus there would be a common knowledge base for all courses in the form of
a Core Course which would provide insight into essential technical knowledge besides
providing base for development of the education for Allied Health Sciences up to post
graduate level.
The new curriculum for Operation Theater Technology replaces and augments the
previous curricula for Operation Theater Assistant and Dialysis Technician. The goal of
this document has been to outline a common body of knowledge that is essential for
entry-level surgical technicians. Combined with the Core Course it will provide a broad
knowledge base for the technicians and provide opportunities for practical skill
development in the relevant field. This needs based curriculum places practical skills
development at high priority. Content and apprenticeship experiences is designed to
sequentially develop, apply, critically analyze, integrate, synthesize and evaluate
concepts and theories in the performance of surgical procedures.
There will be two papers to assess the knowledge gained and two practical / viva
examination to assess the concepts and skills. The papers are:
1 Paper I: Operation Theater Management; Equipments and Devices; Sterilization
and Disinfection
2 Paper II: Surgical Assistance; Patient Care; Anesthesia Assistance

2
 General Outline
Aim of this curriculum is to equip students with the relevant professional knowledge, skills
and techniques to enable them to apply their acquired expertise for efficient health service
delivery. At the end of training the student should be able exhibit the following general and
specific competencies:

A. General learning objectives

1. Act upon his / her job description ethically keeping in mind the requirements of
community and people at large.
2. Demonstrate empathy and humane approach towards communities and exhibit
interpersonal behavior in accordance with the societal norms and expectations.
3. Demonstrate sufficient understanding of basic sciences related to the
technology and be able to integrate such knowledge in his / her work.

B. Specific learning objectives:

The job of Surgical Technician is maintenance of theater; preparation, sterilization
and provision of OT instruments for surgical procedures; maintenance of OT
equipment; assistance to surgeon, anesthetist and OT nurse during surgical
procedures. Upon completion they will be able to:

i. Know aseptic techniques including tasks and responsibilities of the Central

Sterile Department and carry out sterile processing, including:
 SOPs for asepsis, soiled item transportation, decontamination,
sterilization, care of all surgical instruments, packaging processes,
"flash sterilization", different types of sterilization methods

ii. Choose and handle the right instrument for the specific procedure to be
done
 Prepare trolleys for various operations and ensure that all the
instruments likely to be needed for the particular operation are
available on the trolleys as per check list
 Ensure that equipments / instruments are regularly checked for
accuracy and any faults are reported

iii. Render necessary help in operation as required by the surgeon, anesthetist

and OT nurse

3
C. Distribution of Training Time
The two years’ program would be divided in three distinct parts (Papers). There will be
a ‘Core Course’ which would be common for all technologies. The examination for this
component will be taken at the end of first academic year. The teaching for specific
aspect of this technology will be divided in two sections; examination for these will be
held at the end of second academic year – however, teaching for specific techniques
will start from the first year.
A typical training day for students at training institutions routinely comprises of five
hours. Keeping a generous allowance of holidays and weekends, an academic year for
students would be 200 days. Therefore, 1000 teaching hours would be available in 12
months. In the new scheme of studies, for the Core Course the proportion of classroom
teaching and practical training (applied learning activities) would be 60:40; whereas this
proportion for the specific techniques would be 40:60 and the time allocations for
dividing teaching time between various topics, units and sub-units will be done
accordingly as depicted below:

Core Course 500

Section I (Paper I) 750

Section II (Paper II) 750

Total 2000

The marks distribution for this diploma would be:

Subject Marks

First Year

Core Course 100

Viva 100

Second Year

Section I 100

Section II 100

Practical / Viva Section I 100

Practical / Viva Section II 100

Total: 600

4
D. Essential Teaching Requirements
I. Training requirements/instructional methodologies (Process)
a. Teaching staff will be given in-service training as recommended by PMF from
time to time.
b. Teachers will use a combination of interactive programmed instructions
(non-IT), class teaching with exercises using audiovisual aids, mini-lectures,
group discussions, simulations and case studies as instructional/teaching
methodologies.
c. IT will be employed for teaching where necessary.
d. A combination of English and Urdu languages will be used as medium of
instruction.
e. Teachers will encourage students to ask questions; they will encourage
debate and discussion in class to inspire and hone thinking skills of students.
Students will be given the opportunity to engage in activities that promote
divergent thinking skills. Students will be encouraged to work independently,
as well as in small groups and as a whole class, to form creative associations
of ideas across discipline lines.

II. Practical learning component

As prime objective of the training program is to develop practical skills, an extended

clinical attachment is its essential part. The student will rotate amongst various
sections including different operation theaters, ICU and sterilization department
and his/her attendance will be recorded on a logbook to be signed by supervisors.
Teachers will ensure that students are given chance to practice activities under
supervision that are relevant to the topic being taught in class in order for them to
develop relevant practical skills.

The detail of specifications for the institution imparting education according to the
new scheme of studies, including the facilities for practical attachment, is available
in ‘New Affiliation Criteria’ for such institutions.

F Organization of Units of Curriculum

The different units presented in the subsequent sections would comprise of the
following components, not essentially in the sequence depicted below:
a. Learning Focus (contents, hours, weightage for assessment)
b. Rationale
c. Scope
d. Learning Objectives (aims and learning outcomes)
e. Practical Learning Component (where applicable)

5
G Revisions and Updating of Curriculum
The curricula are ever evolving organic documents. Regular reviews and revisions
are, therefore, essentially required to keep them in pace with modern needs; topics
that are required now might outlive their utility in a few years. Updating curricula
therefore forms the basis for quality teaching as well as professional competence of
technicians. This would be ensured by technology-wise panels of experts notified by
the Health Department.

6
 SECTION 1

(Paper I)

Unit 1 Operation Theater Management

Unit 2 Equipments and Devices

Unit 3 Sterilization and Disinfection

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 Unit I

Operation Theater Management

1. Rationale

The Operation Theatre Technician has a very significant role in management of

Operation Room. He should have knowledge of various administrative procedures
for smooth functioning of operation department.

2. Scope

The content will prepare student in the issues related to care of OT before, during
and after a surgical procedure. The focus would also be on development of correct
attitudes in OT and on economizing OT resources.

3. Learning Objectives

After completing this section the students will be able to:

i. Understand the organization and functioning of Operation Theater
ii. Appropriately administer Operation Theater and manage its resources

… Continued

8
Operation Theater Management

Learning Focus
i. Introduction to operating department 10 hours

ii. Organization and design: the operation room suite, single and
8 hours
multiple theatre units

iii. The surgical team: required attributes; OT etiquette and protocols 8 hours

iv. Duties of OT technician 4 hours

v. Admission & transfer procedure 4 hours

vi. Essential documentation: informed consent forms 4 hours

vii. Care of operating room – before, during & after surgery 10 hours

viii. Lighting and ventilation requirements 6 hours

ix. Humidity and heating requirements 8 hours

x. Electrical and fire safety 10 hours

xi. Prevention of physical, electrical, chemical injuries/hazards to patient 6 hours

xii. Tissue Disposal 6 hours

xiii. Economizing theater resources 6 hours

Class Room Teaching 100 hours

Practical Attachments 150 hours
Total Teaching 250 hours
Weightage for assessment 35%

9
 UNIT 2
Equipments and Devices

1. Rationale

The Operation Theatre Technician has the responsibility of handling and maintaining
various equipments available in the operation theater. He must, therefore, possess
knowledge and skills to manage such equipment and devices.

2. Scope
The content will provide a thorough understanding of the machinery employed in
OT; this will also include maintenance and minor repairs of this machinery.

3. Learning Objectives
After completing this section the students will be able to:
i. Conduct a comprehensive and appropriate equipment check.
ii. Identify and take appropriate action when confronted with equipment-
related malfunctions, and
iii. maintain service records

… Continued

10
Equipments and Devices

Learning Focus
i. Electro-medical / electrosurgical equipment used in O.T. Use and care
10 hours
of electronic equipment – grounding system

ii. O.T. lights: uses, types, lamps etc; shadow less lighting – features,
8 hours
types; direct, semi direct, indirect lighting; emergency lighting

iii. Monitoring equipments: cardiac monitors, pulse oxymeter 8 hours

iv. Defibrillators 6 hours

v. Electrosurgery: structure, block diagram, types; safety precautions;

15 hours
bipolar diathermy machines; harmonic scalpel; LigaSure

vi. Fiber-optic endoscopy: introduction, types, procedures and care of

8 hours
instruments

vii. Operating microscopes: principle, parts, use and care 4 hours

viii. Gas Cylinders; medical gas pipeline systems & manifold room 3 hours

ix. Suction machines 3 hours

x. Handling, fixing and troubleshooting of equipments 10hours

Class Room Teaching 75 hours

Practical Attachments 125 hours
Total Teaching 200 hours
Weightage for assessment 25%

11
 Unit 3

Sterilization and Disinfection

1. Rationale

Maintaining utmost asepsis is the foundation of modern surgery. The OT Technician

should be well versed with different techniques for maintaining an infection free OT
environment and ensuring sterilization of instruments used during the surgical
processes.

2. Scope

The content will cover the concepts of infection, cross-infection and asepsis. The
student will build upon the knowledge gained during the core course and will be
enabled to employ different sterilization and asepsis techniques in appropriate
manners.

3. Learning Objectives

After completing this subsection, the students will be able to:

i. Taking precautions to prevent the spread of infection
ii. Ensuring the cleaning of the Operation Theatre prior to operations
iii. Cleaning, packing, sterilization, maintenance and storage of instruments and
other equipment used in Operation Theatre
iv. Manage sterile stock

… Continued

12
Sterilization and Disinfection

Learning Focus
i. Definition of cross infection; modes and types 8 hours

ii. Principles of microbial control: prevention of cross infection to the

7 hours
patient and surgical team

iii. Some common infective conditions; gangrene and tetanus – causes

7 hours
and prevention

iv. Definition of sterilization, disinfection, antiseptic, aseptic, carrier

10 hours
state

v. General principles of sterilization; types of sterilizations

a. Sterilization by gaseous chemicals
b. Sterilization by gamma radiation
c. Chemical sterilization & disinfection; use of different anti- 20 hours
septic chemotherapeutic agents
d. Sterilization by filtration
e. Sterilization by dry and moist heat

vi. Designing sterilization process; methods of instrument sterilization;

10 hours
preparation & packing

vii. Auto clave for instrument, linen and perishable items; working
8 hours
principle, main parts and maintenance

viii. Environmental disinfection: cleaning and disinfection of Operating

8 hours
Room

ix. Detergents, types and uses 4 hours

x. Scrubbing and its methods 4 hours

xi. Central sterile supply department (CSSD) 5 hours

xii. Handling of infectious hospital waste 5 hours

xiii. Self protection; gown, gloves, shoes, dress 4 hours

Class Room Teaching 100 hours

Practical Attachments 200 hours

Total Teaching 300 hours

Weightage for assessment 40%

13
 SECTION 2

(Paper II)

Unit 1 Surgical Assistance

Unit 2 Patient Care

Unit 3 Anesthesia Assistance

14
 Unit 1

Surgical Assistance
1. Rationale

Providing assistance during surgical procedures is the prime duty of Operation

Theater Technician. Therefore, the technician must understand the role and use of
instruments & tools used for minor and major operations.

2. Scope

The student will be apprised about different types of surgical instruments and tools.
Emphasis would be on development of skills for organizing and supplying
instruments for minor and major procedures related to different branches of
surgery

3. Learning Objectives

After completing this sub-section, the students will be able to:

i. Receiving the patient in to the department; lifting, transferring and positioning
of patients
ii. Know the role of various instruments and their use in minor & major surgeries
iii. Preparing equipment and instrument sets for specific operations
iv. Providing supplies for the surgical team

… Continued

15
Surgical Assistance

Learning Focus

i. Reception and preparation of patient for surgical procedure 6 hours

ii. Classification of instruments and apparatus: disposable/non disposable 6 hours

iii. General instruments: scalpel, scissors, forceps, knives, hooks, retractors

6 hours
etc.

iv. Needles, ligature and suture materials: introduction, cat guts

(preparation, sizes, handling), absorbable and non absorbable ligatures
and sutures, natural materials (silk warm gut, silk threads, linen cotton
12 hours
their sizes and classes) Nylon, polyester, polyethylene,
polyepreypelene, metallic wire, metal clips as sutures and as ligatures;
storage and handlings of suture materials

v. Definitions of operations, position of the patient, types of incisions,

general instruments used during elective and emergency operations
related to surgical gastroenterology, gynecology & obstetrics, urology,
66 hours
neurosurgery, oncology, cardiovascular surgeries, ophthalmology, ENT,
orthopaedics, paediatric surgery, plastic surgery, and organ
transplantation etc.

vi. Biopsy kits; care of biopsy specimen/ procedure for sending specimen
for biopsy and fluid for culture: preservation, labeling, transport to 4 hours
Pathology dept

Class Room Teaching 100 hours

Practical Attachments 200 hours

Total Teaching 300 hours

Weightage for assessment 40%

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 Unit 2
Patient Care

1. Rationale
Being a member of surgical team, the Operation Theatre Technician must
understand the basic principles of surgery. This would develop an understanding of
rationale of different procedures s/he is assisting.

2. Scope
The content provides basic knowledge of common surgical conditions. It also gives
understanding of care of patient before, during and after the surgical procedure.
Special emphasis would be on first aid management and emergency life saving
procedures.

3. Learning Objectives
After completing this unit, the students will be able to:
i. Understand the common surgical conditions
ii. Manage wounds and apply dressings
iii. Provide first aid and emergency basic life care

… Continued

17
Patient Care

Learning Focus

i. Introduction and evolution of surgery 4 hours

ii. Common surgical conditions: ulcers, sinuses, fistulas, cysts, tumors 10 hours

iii. Wound management: First Aid, Dressings/ Bandages 10 hours

iv. Fracture: Splints, P.O.P 6 hours

v. Introduction, sign, symptoms and first aid management of:

a. Hemorrhage
10 hours
b. Burns
c. Shock

vi. Special precautions in handlings patients with sepsis, blood borne

8 hours
infection – Hep.B, HCV, HIV etc

vii. Post-op care of patient

a. Position
b. Monitoring
6 hours
c. Recovery
d. Transportation
e. IV line and drain care

viii. Blood Transfusion: Blood storage, grouping, cross matching, blood

8 hours
products etc; common blood reactions

ix. Fluids, infusions (chemistry, indication and complications) 6 hours

x. Basic Life Support

a. Protection and maintenance of patient airway
 Natural or artificial respiration
 Assisted by emergency oxygen 10 hours
b. The movement of blood through the beating of heart
c. The emergency measure of CPR
d. Automated external defibrillator or AED

Class Room Teaching 90 hours

Practical Attachments 165 hours

Total Teaching 250 hours

Weightage for assessment 35%

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 Unit 3

Anesthesia Assistance
1. Rationale
Being a member of multi-disciplinary surgical team, the Operation Theater
Technician is supposed to provide assistance to the anesthetist as well. This role is
more significant in the environment of relative shortage of qualified anesthetists.

2. Scope
Content will cover the basics of anesthesia techniques. Students will be acclimatized
with anesthesia related gadgetry and their skills will be developed for assisting the
anesthetist. However, the actual administration of anesthesia will be out of bond for
the technicians.

3. Learning Objectives
After completing this unit, the students will be able to:
i. Identify and understand the use of anesthetic equipment
ii. Be aware of various types of agents and drugs used during anesthesia
iii. Caring for patient and assisting the anesthetist during procedures

… Continued

19
Anesthesia Assistance

Learning Focus

i. Introduction to Anesthesia Technology – types of anesthesia 10 hours

ii. Role of Anesthesia Care Team – specific duties of OT Technician 4 hours

iii. Anesthetic agents, types and uses 12 hours

iv. Types & use of sedative, hypnotic, pre-anesthetic and other groups of
6 hours
drugs ??

v. Patient preparation before anesthesia 6 hours

vi. Stages of anesthesia; patient management during anesthesia 8 hours

vii. Anesthesia machine – parts, block diagram etc. 8 hours

viii. Emergency intubation equipment and techniques 5 hours

ix. Set-up and use of complex anesthesia equipment ?? 5 hours

x. Maintenance of anesthesia equipment for proper functioning 6 hours

Class Room Teaching 70 hours

Practical Attachments 130 hours

Total Teaching 200 hours

Weightage for assessment 25%

20
 Practical Attachment

The extensive internship will reinforce the classroom learning and enable the student to
understand how to handle the workload in different disciplines of surgical technology. It
is this aspect of the course that will determine the level of professionalism students will
display after employment. This period will be interspersed with learning of theory.
During the two year of this program the students will be placed in different operation
theaters and related sections on a roster basis to gain practical experience in relevant
areas under supervision of tutor technicians and the surgical instructors. If a particular
specialty is not available in the hospital, collaboration with other hospitals will be
sought to provide adequate experience to students.
On the availability of the following sections, the student will get a rotation amongst
them.
General Surgery
Minor OT
Emergency
Obstetrics & Gynaecology
ENT/ Ophthalmology
Orthopaedics
Anaesthesia
ICU
Sub-specialties

Students will maintain a record of their attachment in the ‘Practical Note Books’ (one
for each section), the last portion of which would be designed as a ‘Log Book’ which
shall be a work diary and record. Special mention shall be made of the procedures, if
any, conducted by the candidate. This diary shall be scrutinized and certified by the
Head of the Department and Head of the Institution, and presented in the practical
/viva examination.
The scope of practical attachment would be:

A. IDENTIFICATION OF INSTRUMENTS AND PREPARATIONS OF TROLLEYS

i. Emergency
1. Laparotomy Set
2. Thoracotomy Set
3. Suprapubic Cystostomy
4. Chest Intubation
5. Venesection
6. Appendiectomy
7. Fracture fixation
8. Burr Hole
9. Wound Debridement

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ii. Elective
1. Cholecystectomy
2. Thyroidectomy
3. Herniotomy + Herniorraphy
4. Mastectomy.
5. Nephrectomy
6. Vesicolithotomy
7. Prostatectomy
8. S.M.R
9. Tonsillectomy
10. Mastoidectomy
11. Cataract Surgery
12. Retinal Surgery
13. Orbital Surgery
14. Caesarian Section
15. Hysterectomy
16. Dilation and Currettage
17. Haemorrhoidectomy
18. Fistulectomy
19. Joint Replacement
20. Spinal + Epidural Block
21. Laparoscopic surgery (Trolley)

B. IDENTIFICATION OF MATERIALS
 Identification of different suture Material
o Plain and chromic Catgut
o Prolene
o Vicryl
o Pollydioxanone
o Silk
o Nylon

 Different Type of Fluids

o Isotonic Fluids -5% D/W
- NaCI
- D/S
- Ringers

o Plasma Expander
- Haemaccel
- Gelatundin
- Albumin

 Hypodermic needles, syringes and cannulas

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  Appliances
- Endotracheal Tubes
- Air Way
- Ambu Bag
- Maggill's Forceps
- Nasogastric Tube
- Foley's catheter
- Intra-venous cannulae
- Nelaton's Catheter
- Tracheostomy Tube
- Surgical Gloves
- Proctoscope
- Sigmoidoscope

C. STERILIZATION & ANTI SEPSIS

 Identification + use of different Antiseptic Solutions e.g Pyodine, Spirit,
Cidex, Savalon etc.

D. BASIC HANDLING OF MACHINES / INSTRUMENTS

 Anesthesia
 Ventilator
 Diathermy
 Suction
 Monitors
 Delicate instruments
 Proctoscope
 Sigmoid scope
 Gastro scope
 Colonoscopy
 Bronchoscope
 Cystoscope
 Laparoscope

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RECOMMENDED BOOKS

1. Handbook of Operation Theatre Techniques: Publisher, Jaypee

2. Operating Room Technique - Berry and Kohn's; Publisher: Mosby Elsevier Health
Science
3. Operating Room Technique – Raymond John Brigden
4. The Operating Room Aide; Publisher: Career Pub
5. Surgical Nursing and Technique: A book for nurses, dressers, house surgeons – Charles
Plumley: Childe

24
Acknowledgments

Preparation of this new curriculum was indeed a gigantic task, especially in the very
limited time available for this assignment. Its accomplishment would not have been
possible without concerted efforts of many professional colleagues.
Grateful acknowledgement is hereby made to the following members of Panel of
Experts for Operation Theater/Surgical Technology for their contributions and
feedback:

1. Prof Masood Rashid (Convenor) Prof of Surgery AIMC

2. Prof. Mujeeb Ahmad Prof of ENT SIMS

3. Dr Sikandar Gondal Asstt Prof PGMI

4. Dr Fawad Karim Senior Registrar AIMC / JHL

I am also indebted to Dr Ahsan Mahmood Gondal, Registrar PMF for providing

assistance in completion of this task.

August – 2013 Dr Arshed Usmani

Secretary
Punjab Medical Faculty

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