The Specialist in Internal Medicine must have acquired theoretical, scientific and professional knowledge in the fields of medical pathophysiology, functional and instrumental medical semiotics, clinical methodology, evidence-based medicine, general medical practice and medical therapy with specific expertise in emergency medicine and first aid, geriatrics and gerontology, allergology and clinical immunology.
The objectives are:
The resident must acquire knowledge of epidemiology, methodology and physical, laboratory and instrumental methods, including nuclear medicine, as well as bioimaging diagnostics;
must be able to use modern research methodologies of scientific knowledge and information, acquire the tools for their critical evaluation and know how to apply them appropriately in different clinical conditions;
The resident must be able to assess the indication and expected utility and critically select appropriate diagnostic tools and pathways, including specialist expertise;
The resident must know how to interpret the results of laboratory, instrumental, bio-imaging, endoscopic and pathological histology examinations;
The resident must acquire in-depth knowledge of the most common diseases and chronic non-communicable diseases;
The resident must acquire knowledge of relatively rare diseases;
The resident must be able to use the most appropriate clinical tools and investigations independently in order to recognise different morbidities and to use the most effective therapies rationally;
The resident must be able to prescribe, in the light of the risk/benefit and cost/effectiveness profiles, the most appropriate pharmacological treatment, non-pharmacological treatment and/ or surgery in the different clinical conditions of specific competence of Internal and General Medicine;
The resident must be able to manage therapeutic regimens for the treatment of atheroembolic diseases including anticoagulant therapy and possible haemorrhagic complications;
The resident must be able to identify its role and share decision-making responsibility in the conditions of specialist and multidisciplinary competence in order to ensure continuity of care;
The resident must also be able to recognize the most common disorders and he must be able to choose the modalities of diagnostic and treatment and distinguish the conditions that require specialist advice from those that can be solved directly by the internist;
He must be able to recognize early and subject, within the limits of available instrumental and environmental resources, to the most effective initial treatment, including resuscitation, patients in emergency clinical conditions of more frequent encounter;
The resident must be able to conduct pharmacological therapies and the most common instrumental treatments required in critical patients;
He must be able to handle particular dietary regimens, and know how to practice enteral and parenteral nutrition;
The resident must also learn to compare his or her ideological and moral motivations and positions with the ethics that care for the human person imposes, and must have a clear representation of the progressive development of medicine from naturalistic origins and scientific medicine;
The resident must know the legal and health organization aspects of the profession, as well as those of the NHS;
The resident must be able to give the appropriate indications for the full use of the NHS structures, in relation to the expressed needs and according to the characteristics of social groups, territory and living and working environment, respecting the criteria of good clinical practice;
The resident must know the basic methodological principles of health management, work organization and health economics;
the resident must acquire full knowledge of the pathophysiology of critical conditions;
the resident must have adequate experience in the application of pharmacological, nutritional and instrumental treatments to critical patients; must be able to manage the safe transfer of critical patients to the most appropriate environment for their disease. To this end, you must have participated in the following maneuvers: cardiac defibrillation, oxygen therapy (methods of administration), ventilatory assistance (mechanical and manual ventilation), placement of a central venous catheter, gastric and intestinal, also in the comatose patient, bleeding tamponade;
The resident must be able to recognize and discriminate between conditions of urgency and actual or potential emergency, including those of a toxic or traumatic nature, and must be able to identify the cause as far as possible;
The resident must to know how to implement all available measures to ensure the maintenance of vital functions;
He must to know how to make the essential laboratory and instrumental tests;
The resident must be able to know how to identify the conditions of specialized or multidisciplinary competence: To be able to play the role due to their specific competence in diagnostic and therapeutic team activities.
Compulsory professional activities to achieve the educational objectives of the typology are:
- have drawn up and countersigned 100 medical records of patients hospitalized or outpatient personally followed. The records shall include a complete physical examination including, but not limited to, nutritional status assessment and, where appropriate, rectal and/or vaginal examination;
-Where necessary, he must have taken care of the proper preparation of samples and the sending to the laboratory of biological liquids with the appropriate request for analysis;
- have participated in at least 50 internal consultations in external departments, specialized or territorial,
- have interpreted at least 50 electrocardiographic examinations to be able to diagnose the most common disorders of rhythm, conduction and repolarization;
- have personally performed the following invasive manoeuvres (at least 5 each): paracentesis, thoracentesis, blood gas analysis, cytosuction of different organs and apparatus, assisted ventilation, spinal needle aspiration;
- have participated in the execution of instrumental investigations (at least 40 in total) as Doppler of large arterial and venous vessels, echocardiography, ergometry, endoscopy, scintigraphy, tests of respiratory function, allergological diagnostics;
- have acquired competence in basic and advanced cardiopulmonary resuscitation techniques (BLS and ACLS) and have participated or performed at least 2 resuscitation maneuvers on patient or dummy;
- have directly performed 50 ultrasound examinations to be able to interpret the images of internal interest (neck, thyroid, breast, chest, digestive system, liver and bile ducts, pancreas, spleen, kidneys and adrenal glands, bladder);
- have discussed with the specialist at least 10 echocardiographic examinations and 5 angiographic examinations; - have discussed with the specialist at least 10 histopathological preparations; have discussed with the specialist at least 20 CT or NMR scans of the brain;
- have discussed with the specialist at least 30 between Rx chest, Rx spine, Rx digestive system;
- have participated in at least 20 shifts of divisional or interdivisional guard, assuming responsibility in first person (with possibility of consultation of the guardian) in the last two years' shifts;
- have directly followed the conduct of at least three controlled clinical trials, in accordance with good clinical practice.