Clinical practice 5th year_

A.Y. 2019/2020
17
Max ECTS
204
Overall hours
SSD
BIO/14 MED/05 MED/09 MED/18 MED/19 MED/21 MED/24
Language
English
Learning objectives
The clinical practice course will provide the students with conceptual tools to properly manage major clinical presenting problems. For each presenting problem the differential diagnosis and the therapeutic aspects will be addressed.
Expected learning outcomes
· Achievement of the basics of clinical judgment in the evaluation of patients with any of the presenting problems
· Management of complex differential diagnoses by the appropriate use of clinical, laboratory, tests and exams findings
· Set up of a proper patient's treatment
Course syllabus and organization

Single session

Prerequisites for admission
To attend the Clinical Practice course, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Assessment methods and Criteria
The exam of Clinical Practice will be organized at the end of the 1st semester of the 6th year, when the course will be completed.
Students' fulfillment of competencies at the end of the 6th year will be assessed by:
· A practical assessment of clinical skills
· A written test
An oral part based on the discussion of clinical cases.
Final formal examination at the end of the 6th year may be preceded by an intermediate evaluation test of General Surgery at the end of the 5th year. Also reviews and discussion on medical literature and/or specific clinical research topics could concur to the evaluation either at intermediate or final stage.
Pharmacology
Course syllabus
INTERNAL MEDICINE:
TOPIC 1. Less is more
TOPIC 2. Diagnostic tools
TOPIC 3. Clinical reasoning
TOPIC 4. Dyspnea: differential diagnosis
TOPIC 5. Chest pain: differential diagnosis
TOPIC 6. Irregular heart rhythm
TOPIC 7. Transient loss of consciousness (TLOC)
TOPIC 8. Approach to the adult with anemia: differential diagnosis
TOPIC 9. Coagulation Disorders
TOPIC 10. Jaundice
TOPIC 11. Altered hepatic function/edema/ascites
TOPIC 12. Weight disorders - overweight and obesity, Metabolic syndrome and diabetes
TOPIC 13. Uncommon abdominal pain: Relationship with rare diseases
TOPIC 14. Immune system disease
TOPIC 15. Geriatric medicine
TOPIC 16. Principles of Human genetics: Clinical cases
TOPIC 17. Value-based Health care
TOPIC 18. Palliative Medicine

GENERAL SURGERY:
Lecture 1 - GENERAL PRINCIPLES
Lecture 2 - ANESTHESIA AND MANAGEMENT OF PAIN
Lecture 3 - THE SURGICAL PATIENT- 1
Lecture 4 - THE SURGICAL PATIENT- 2
Lecture 5 - SHOCK AND PRINCIPLES OF RESUSCITATION
Lecture 6 - SURGERY FOR FUNCTIONAL DISEASES - ABDOMINAL WALL
Lecture 7 - FROM HUMAN HANDS TO ROBOTS IN SURGERY
Lecture 8 - SURGERY FOR FUNCTIONAL DISEASES - ESOPHAGUS
Lecture 9 - SURGERY FOR FUNCTIONAL DISEASES - ANAL CANAL
Lecture 10 - SURGERY FOR ACUTE INFLAMMATION
Lecture 11 - SURGICAL ONCOLOGY - GENERAL
Lecture 12 - SURGICAL ONCOLOGY - BREAST
Lecture 13 - SURGICAL ONCOLOGY - UPPER G.I.- 1
Lecture 14 - SURGICAL ONCOLOGY - UPPER G.I.- 2
Lecture 15 - SURGICAL ONCOLOGY - HEPATO-BILIO-PANCREATIC - 1
Lecture 16 - SURGICAL ONCOLOGY - HEPATO-BILIO-PANCREATIC - 2
Lecture 17 - SURGICAL ONCOLOGY - HEPATO-BILIO-PANCREATIC - 3
Lecture 18 - SURGICAL ONCOLOGY - LOWER G.I.- 1
Lecture 19 - SURGICAL ONCOLOGY - LOWER G.I.- 2
Lecture 20 - ACUTE ABDOMEN AND SURGICAL COMPLICATIONS

PHARMACOLOGY:
Lecture 1 - The neurobiological basis of pain and the mechanisms of chronification: a matter of neural plasticity
Lecture 2- Focus on opioids
Lecture 3 - Pharmacology of nociceptive pain
Lecture 4 - Pharmacology of neuropathic pain: the art of combination
Lecture 5 Cancer pain: not just palliation
Lecture 6: Drug-drug interactions: pain and beyond


CLINICAL PATHOLOGY:
Lecture 1 - From cellular to molecular diagnosis
Lecture 2 - From bench to bedside and return
Lecture 3 - Examples of new diagnostic tools
Lecture 4 - Clinical cell diagnostic

PLASTIC SURGERY:
Lecture 1 - Burns
Lecture 2 - Wound management
Lecture 3 - Fat grafting
Lecture 4 - Breast reconstruction

MODULE: THORACIC SURGERY
Lecture 1 - Lung cancer: epidemiology, aetiology and clinical approach (diagnosis and treatments)
Lecture 2 - Malignant pleural mesothelioma
Lecture 3 - Other thoracic malignancies (mediastinum, chest wall and diaphragm)
Lecture 4 - Regenerative Medicine in Thoracic Surgery
Lecture 5 - Interventional pneumology in the diagnosis, staging and treatment of lung cancer"
Lecture 6 - Personalized medicine in lung cancer: genetic and immunological treatment"

UROLOGY
Lecture 1 - SYNDROMES IN UROLOGY: ACUTE RETENTION OF URINE, HAEMATURIA, OBSTRUCTIVE RENAL FAILURE, INCONTINENCE
Lecture 2 - UROLITHIASIS
Lecture 3 - UROTHELIAL & KIDNEY CANCER
Lecture 4 - TESTICULAR & PROSTATE CANCER
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
PHARMACOLOGY:
· Wall and Melzack's textbook of pain 6th edition 2013 Elsevier Saunders
· Essential pain pharmacology. The prescriber's guide H. Smith and M. Pappagallo 2012 Cambridge University pain
CLINICAL PATHOLOGY:
· Coleman-Tsongalis, Molecular Pathology, Elsevier 2018
PLASTIC SURGERY:
· Grabb and Smith's Plastic Surgery, Wolters Kluwer
THORACIC SURGERY:
· Shields' General Thoracic Surgery by Joseph LoCicero III MD 8th Edition, Wolters Kluwer
· Pearson's Thoracic and Esophageal Surgery Churchill Livingstone last Edition
UROLOGY:
· Smith & Tanagho's GENERAL UROLOGY, Jack W. McAninch & Tom F. Lue, 18th or 19th Edition
GENERAL AND ABDOMINAL SURGERY:
Significant material and all slides used during frontal lessons and seminars are uploaded in the Ariel platform for student access.
· Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 20th Edition Elsevier 2017
INTERNAL MEDICINE:
· Harrison's Principles of Internal Medicine, 20th Edition, McGraw Hill, 2018 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
· UP To Date - Evidence Based Clinical Decision Support resource
Clinical pathology
Course syllabus
Lecture 1 - From cellular to molecular diagnosis
Lecture 2 - From bench to bedside and return
Lecture 3 - Examples of new diagnostic tools
Lecture 4 - Clinical cell diagnostic
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
· Coleman-Tsongalis, Molecular Pathology, Elsevier 2018
Internal medicine
Course syllabus
TOPIC 1. Less is more
TOPIC 2. Diagnostic tools
TOPIC 3. Clinical reasoning
TOPIC 4. Dyspnea: differential diagnosis
TOPIC 5. Chest pain: differential diagnosis
TOPIC 6. Irregular heart rhythm
TOPIC 7. Transient loss of consciousness (TLOC)
TOPIC 8. Approach to the adult with anemia: differential diagnosis
TOPIC 9. Coagulation Disorders
TOPIC 10. Jaundice
TOPIC 11. Altered hepatic function/edema/ascites
TOPIC 12. Weight disorders - overweight and obesity, Metabolic syndrome and diabetes
TOPIC 13. Uncommon abdominal pain: Relationship with rare diseases
TOPIC 14. Immune system disease
TOPIC 15. Geriatric medicine
TOPIC 16. Principles of Human genetics: Clinical cases
TOPIC 17. Value-based Health care
TOPIC 18. Palliative Medicine
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
· Harrison's Principles of Internal Medicine, 20th Edition, McGraw Hill, 2018 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
· UP To Date - Evidence Based Clinical Decision Support resource
General surgery
Course syllabus
Lecture 1 - GENERAL PRINCIPLES
Lecture 2 - ANESTHESIA AND MANAGEMENT OF PAIN
Lecture 3 - THE SURGICAL PATIENT- 1
Lecture 4 - THE SURGICAL PATIENT- 2
Lecture 5 - SHOCK AND PRINCIPLES OF RESUSCITATION
Lecture 6 - SURGERY FOR FUNCTIONAL DISEASES - ABDOMINAL WALL
Lecture 7 - FROM HUMAN HANDS TO ROBOTS IN SURGERY
Lecture 8 - SURGERY FOR FUNCTIONAL DISEASES - ESOPHAGUS
Lecture 9 - SURGERY FOR FUNCTIONAL DISEASES - ANAL CANAL
Lecture 10 - SURGERY FOR ACUTE INFLAMMATION
Lecture 11 - SURGICAL ONCOLOGY - GENERAL
Lecture 12 - SURGICAL ONCOLOGY - BREAST
Lecture 13 - SURGICAL ONCOLOGY - UPPER G.I.- 1
Lecture 14 - SURGICAL ONCOLOGY - UPPER G.I.- 2
Lecture 15 - SURGICAL ONCOLOGY - HEPATO-BILIO-PANCREATIC - 1
Lecture 16 - SURGICAL ONCOLOGY - HEPATO-BILIO-PANCREATIC - 2
Lecture 17 - SURGICAL ONCOLOGY - HEPATO-BILIO-PANCREATIC - 3
Lecture 18 - SURGICAL ONCOLOGY - LOWER G.I.- 1
Lecture 19 - SURGICAL ONCOLOGY - LOWER G.I.- 2
Lecture 20 - ACUTE ABDOMEN AND SURGICAL COMPLICATIONS
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
Significant material and all slides used during frontal lessons and seminars are uploaded in the Ariel platform for student access.
· Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 20th Edition Elsevier 2017
Plastic surgery
Course syllabus
Lecture 1 - Burns
Lecture 2 - Wound management
Lecture 3 - Fat grafting
Lecture 4 - Breast reconstruction
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
· Grabb and Smith's Plastic Surgery, Wolters Kluwer
Thoracic surgery
Course syllabus
Lecture 1 - Lung cancer: epidemiology, aetiology and clinical approach (diagnosis and treatments)
Lecture 2 - Malignant pleural mesothelioma
Lecture 3 - Other thoracic malignancies (mediastinum, chest wall and diaphragm)
Lecture 4 - Regenerative Medicine in Thoracic Surgery
Lecture 5 - Interventional pneumology in the diagnosis, staging and treatment of lung cancer"
Lecture 6 - Personalized medicine in lung cancer: genetic and immunological treatment"
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
· Shields' General Thoracic Surgery by Joseph LoCicero III MD 8th Edition, Wolters Kluwer
· Pearson's Thoracic and Esophageal Surgery Churchill Livingstone last Edition
Urology
Course syllabus
Lecture 1 - SYNDROMES IN UROLOGY: ACUTE RETENTION OF URINE, HAEMATURIA, OBSTRUCTIVE RENAL FAILURE, INCONTINENCE
Lecture 2 - UROLITHIASIS
Lecture 3 - UROTHELIAL & KIDNEY CANCER
Lecture 4 - TESTICULAR & PROSTATE CANCER
Teaching methods
Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies. Clerkship attendance and sufficient exposure to practice (i.e. simulation lab, formal patients examination at bedside, training of basic medical-surgical techniques etc.) will be registered, as clinical teaching will be based also on direct participation of the students to different aspects of the hospital life.
Teaching Resources
· Smith & Tanagho's GENERAL UROLOGY, Jack W. McAninch & Tom F. Lue, 18th or 19th Edition
Clinical pathology
MED/05 - CLINICAL PATHOLOGY - University credits: 1
Lessons: 12 hours
Professor: Dozio Elena
General surgery
MED/18 - GENERAL SURGERY - University credits: 5
Lessons: 60 hours
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 7
Lessons: 84 hours
Pharmacology
BIO/14 - PHARMACOLOGY - University credits: 1
Lessons: 12 hours
Plastic surgery
MED/19 - PLASTIC SURGERY - University credits: 1
Lessons: 12 hours
Thoracic surgery
MED/21 - THORACIC SURGERY - University credits: 1
Lessons: 12 hours
Professor: Petrella Francesco
Urology
MED/24 - UROLOGY - University credits: 1
Lessons: 12 hours