Postgraduate School of Community Medicine and Primary Care

Integrated training objectives (i.e., core curriculum):
The trainee must have acquired satisfactory theoretical knowledge and professional competence in the clinical and instrumental diagnosis and treatment, including emergency and urgent conditions, of the most common internal medicine, oncology, and organ system diseases,
including chronic degenerative diseases such as pulmonary, neurological, nephrological, cardiac, hematological, orthopedic, gastroenterological, endocrine-metabolic, and rheumatological diseases, as well as infectious diseases, as well as conditions of progressive polymorbidity related to aging. The trainee must acquire fundamental knowledge of the pathophysiology of the various organs and systems, the theoretical and practical knowledge necessary for recognizing diseases affecting the various body systems, theoretical and practical knowledge of the main areas of instrumental and laboratory diagnostics related to the aforementioned diseases, and the ability to assess the connections and influences between internal medicine and specialists. They must therefore be able to recognize the clinical and functional symptoms and signs of diseases affecting various organs and systems, having acquired the fundamental diagnostic, therapeutic, psychological, and ethical knowledge necessary for a comprehensive patient assessment.
To this end, they must develop the ability to clinically assess the patient based on the medical history and physical examination; develop critical and analytical diagnostic skills; become familiar with the main diagnostic procedures and laboratory and instrumental investigations; recognize and be able to address major medical emergencies; familiarize themselves with therapeutic resources to plan their optimal use and recognize their indications and contraindications, as well as the effects of interactions and potential iatrogenic effects; acquire fundamental knowledge related to clinical research methodologies and pharmacological trials; and understand the fundamental issues related to prevention, public health, and social medicine.
The trainee must have acquired satisfactory theoretical knowledge and professional competence in the recognition and treatment, in emergency situations, of the most common pathologies.
The trainee must also progressively acquire the diagnostic and therapeutic skills necessary for the care and clinical management of complex patients in all phases of chronic, unfavorable-progressing diseases; the ability to communicate clearly and compassionately with patients and families regarding informed consent, possible therapeutic support, and clinical decisions for symptom management, including end-of-life care; the ability to interact with other specialists and other healthcare professionals; skills in healthcare organization and clinical governance; and knowledge of research and evidence-based medicine in various disciplines. They must therefore hone their theoretical knowledge and professional expertise in recognizing and treating advanced stages of illness and the end of life, especially with regard to identifying the timely and progressive transition from active to palliative care. They must also be able to interact effectively with specialists in all phases of the aforementioned diseases, including incurable clinical conditions, having developed particular skills in assessing and treating conditions characteristic of their advanced stages.
Finally, the trainee must also have clinical and therapeutic knowledge of the most common pathologies covered by the other categories of the class.


1.401 / 5.000
Basic training objectives:
The trainee must understand and use epidemiological and sociological methodologies to assess the health needs of individuals, families, and communities, and the appropriateness and effectiveness of healthcare interventions; understand resource planning and management methodologies in primary healthcare services; understand the basics of computer and statistical methods for information processing, monitoring community health, assessing the impact of actions and interventions, and conducting research using modern computerized criteria; understand the fundamental principles of population genetics and acquire the ability to use genetic testing for diagnostic and preventive purposes; understand the main psychological functions and the methods and techniques of interpersonal communication; and understand and acquire the principles of medical ethics and clinical bioethics for the appropriate management of individuals, families, and communities.

General training objectives:
The trainee must acquire knowledge of methodology and physical, instrumental, and laboratory semiotics; Must utilize modern clinical and management research methodologies and acquire the ability to critically evaluate and apply them appropriately in various clinical and organizational settings.

Educational objectives of the School:
The trainee must know and apply appropriate methods to: analyze the multidimensional health needs of individuals, families, and communities; select appropriate diagnostic pathways, interpret test results, and prescribe appropriate pharmacological, medical, and surgical treatments; develop personalized care plans with varying levels of care; organize primary care interventions at home, in outpatient, residential, and semi-residential settings, integrated with hospital care as needed; work in teams and coordinate interdisciplinary units to implement unified care processes; manage primary care services with a view to comprehensive care for individuals, families, and communities; manage services with a view to implementing quality; organize and coordinate clinical audits, effectiveness, efficiency, and quality assessments, and economic analyses within the primary care network; activate the participation of individuals, families, and communities in protecting individual and collective health; plan and implement health education interventions for individuals, families, and communities for the purposes of prevention and health promotion.
The trainee must also understand the issues related to drug, alcohol, and tobacco addictions, the etiopathogenetic mechanisms underlying their onset, possible interventions for prevention, diagnosis, treatment, and social reintegration, and methods for activating a network of services for comprehensive patient care. He or she must be familiar with the major psychiatric disorders, possible interventions for prevention, diagnosis, and treatment, and methods for activating a network of services for comprehensive patient care. He or she must be familiar with disability, its assessment methods, and comprehensive patient care to promote maximum independence and social participation. He or she must be familiar with the pathophysiology of old age, possible interventions for preventing dependence, diagnosing, and treating the major chronic diseases associated with this age group, and methods for activating a network of services for comprehensive care of dependent elderly individuals. He or she must be familiar with the infectious disease with the greatest social impact and the methods for patient care, particularly those related to home and/or residential care. must be knowledgeable about issues related to maternal and child health and primary care services for women, children, and families, with particular attention to the activities of family counseling centers, family and community pediatric services, and child neuropsychiatry.

The trainee must also gain experience in the following professional areas:
- Protected hospital discharge: in-depth knowledge and acquisition of appropriate methods for organizing, managing, and monitoring hospital discharge procedures for patients requiring continuity of care in the community. To this end, the trainee must have participated in the planning of at least 20 hospital discharge procedures with scheduled access to home or residential care;
- Integrated Home Care: in-depth knowledge and acquisition of appropriate methods for organizing, managing, and monitoring coordinated medical, nursing, and social care home care interventions. To this end, the trainee must have participated in the planning of at least 10 social and health-related ADI interventions;
- Management of complex patients in the network of services: in-depth knowledge and acquisition of appropriate methods for organizing, managing, and monitoring integrated activities for the comprehensive care of the elderly, psychiatric patients, disabled individuals, and families with multiple problems within the network of community services, linked to the hospital as needed.
To this end, the trainee must have participated in the planning of at least 10 interventions and have followed their evolution over time;
- Implementation of quality in primary services: knowledge and acquisition of appropriate methods for planning and implementing quality improvement interventions in primary care, whether in-home, outpatient, semi-residential, or residential. To this end, the trainee must have participated in the planning and development of at least 5 quality development interventions.
The trainee may apply for the diploma after completing the professional development activities.
As part of the training program, the trainee must learn the scientific foundations of the School's typology in order to achieve full maturity and professional competence, including an adequate ability to interpret scientific innovations and a critical understanding
that allows them to consciously manage both care and their own professional development. This may include participation in meetings, conferences, the production of scientific publications, and periods of attendance at qualified Italian and foreign institutions useful for their training.

Mandatory professional development activities to achieve the educational objectives of this type of program include:
- having performed care activities in the Medical Area departments, General Medicine, Medical Specialties, Pediatrics, and Neurosciences. During this period, the candidate must have directly participated in care activities involving at least 100 patients, including assessments of the patient's overall clinical situation, functional aspects, and autonomy, including in relation to their living environment, and finally, the preparation of at least 20 protected hospital discharge plans for patients requiring community-based continuity of care;
- having completed at least 20 shifts in emergency and urgent care services, such as medical-surgical, general, and/or pediatric emergency rooms, in 118 services, and community-based continuity of care;
- having provided care in general practitioners' offices, having personally participated in the care of at least 360 patients, including at least 120 home visits, involvement in at least 80 integrated home care plans, and participation in at least 30 multidimensional assessment units;
- having provided care to children with special needs and vulnerable and multi-problem families, both in local maternal and child health facilities, caring for at least 30 patients with chronic or rare diseases, disabilities, and/or known abuse or poor care, and in the offices of private pediatricians, having supervised the care of at least 20 pediatric patients;
- having provided care in non-hospital intermediate residential facilities and semi-residential facilities, such as community hospitals, hospices, residential care homes, and semi-residential rehabilitation facilities, caring for at least 50 patients;
- have performed care activities in mental health and addiction treatment facilities, with participation in the care of at least 20 patients;
- have performed care activities in facilities for the disabled, with participation in the care of at least 20 patients;
- have participated in planning, organizing, managing, and evaluating diagnostic, treatment, and care pathways, focusing on the primary care system and on continuity of care across different care and living environments. During the same period, the candidate must:
- have followed the care pathways of at least 30 complex patients;
- have participated in the planning and management of information flows within the primary care network and regional health information systems;
- have participated in actions aimed at managing, developing, and training staff; in the drafting and discussion of budget plans, training plans, and service reorganization; in projects aimed at verifying and/or improving the quality of interventions within the primary care network; and in the design, implementation, and evaluation of community-based health education interventions.