Postgraduate School of Emergency Medicine and Critical Care Medicine

Integrated (i.e., core) training objectives
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 diseases. The trainee must acquire fundamental knowledge of the pathophysiology of various organs and systems, the theoretical and practical knowledge necessary to recognize diseases affecting the various body systems, the theoretical and practical knowledge of the main areas of instrumental and laboratory diagnostics related to the aforementioned diseases, and the ability to evaluate the connections and influences between internal medicine and specialists. Therefore, the trainee must 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 perspective. To this end, the trainee 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 of 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. Finally, the trainee must also have clinical and therapeutic knowledge of the most common pathologies covered by other categories of the class.

Basic Educational Objectives
The trainee must deepen and update their knowledge of the biological and genetic bases of diseases, the pathophysiological correlations between the functional alterations of various organs and systems and clinical syndromes, with particular reference to emergency clinical conditions, and knowledge of pharmacological and/or instrumental treatment protocols for emergencies.

General Training Objectives
The trainee must acquire knowledge (epidemiological, clinical, psychological, and ethical) and the methodology for a comprehensive and unified approach to solving complex health problems; develop clinical reasoning oriented toward problem-based analysis and resolution; understand the short-term prognosis of various pathologies and clinical syndromes; develop critical and analytical diagnostic skills (positive-evidence, etiological, and differential diagnosis), personally designing and verifying the diagnostic process; have a thorough understanding of the main diagnostic procedures and laboratory and instrumental investigations; deepen their knowledge of medications, including their pharmacological characteristics, indications, contraindications, interactions, and iatrogenic effects; develop the critical thinking skills necessary to apply the results of scientific research to individual cases; and be able to apply the methodology of experimental and therapeutic clinical research. Knowledge of the proper use of resources and budgets, and quality monitoring

Training Objectives of the School
The Resident must achieve full autonomy to operate within the integrated emergency and urgency system. Specifically: They must be able to participate in and manage out-of-hospital care and integrate information from pre-hospital interventions for rapid assessment and in-hospital treatment; they must be able to assess, resuscitate, stabilize, and treat any critical patient presenting to community facilities or hospitals, including determining the most appropriate hospital or treatment pathway; they must be able to prioritize interventions for multiple patients with different clinical conditions arriving simultaneously in the Emergency Department/Admissions Department in order to optimize treatment; they must be able to manage and manage airways; they must be able to assess the need for a more appropriate transfer, or plan an appropriate "action plan" and/or follow-up; they must be able to provide patients with the health education necessary for the prevention of illness and injury; They must be able to correctly use the diagnostic and therapeutic resources available in different settings; they must understand the principles for treating pediatric, geriatric, and pregnant patients; they must know the techniques for communicating effectively with patients, family members, and other professionals involved in patient care; they must possess the technical and organizational knowledge for managing disaster-related emergencies; they must understand the ethical principles involved in the medical decision-making process, including directives for continuation and life-sustaining treatment. The trainee must also be familiar with the legal and healthcare organizational aspects of the profession, as well as those of the National Health Service (SSN), with particular reference to the regulations relating to the integrated emergency-urgency system.

Specific areas of expertise for the Emergency Medicine specialist include: assessing the degree of urgency and/or care priorities in relation to all interfering clinical and environmental factors; assessing vital functions and emergency cardiopulmonary resuscitation maneuvers and therapies for patient stabilization; pathophysiology, functional and instrumental semiotics, clinical methodology, diagnosis, and emergency treatment (pharmacological and instrumental) of any pathology presenting as an emergency; epidemiology and management, within their area of ??expertise, of local emergencies, including catastrophes; knowledge and application of management principles for the purpose of optimizing resources and quality standards; etiopathogenetic, epidemiological, and clinical-therapeutic research applied to emergencies; accident prevention and health promotion.

Mandatory professional development activities to achieve the educational objectives of the Emergency Medicine program are:
- having participated, for at least 3 years, in medical activities?including day, night, and holiday on-call shifts?in Emergency and Admissions facilities and associated facilities identified within the training network;
- having compiled and signed at least 300 patient records from Emergency and Admissions facilities and associated facilities;
- having actively participated in the management of at least 50 major trauma patients and knowing how to manage the Trauma Team;
- having spent at least 3 weeks per year for at least 3 years on local emergency shifts;
- knowing how to perform electrocardiographic monitoring, blood pressure monitoring (both non-invasive and invasive), central venous pressure monitoring, and arterial oxygen saturation monitoring;
- have performed at least 10 airway clearances, 30 Ambu bag ventilations, and 20 emergency orotracheal intubations (*);
- know how to perform emergency surgical airway access: cricothyroidotomy (*);
- know how to perform invasive and non-invasive manual mechanical ventilation and ventilation with pressometric and volumetric ventilators (*);
- know how to administer various oxygen therapy modalities;
- have placed at least 20 central venous catheters (internal jugular, subclavian, and femoral) (*);
- have placed at least 10 intraosseous accesses (*);
- have placed at least 10 arterial cannulas (radial and femoral) (*);
- have interpreted at least 100 arterial blood gas analyses, with arterial blood sampling performed personally (*);
- have performed at least 5 direct and ultrasound-guided thoracenteses, with placement of needles and thoracostomy tubes (*);
- have placed at least 20 nasogastric tubes, including placement in comatose patients (*);
- know how to perform pericardiocentesis (*);
- have interpreted at least 50 chest X-rays, 20 plain abdominal X-rays, 50 bone X-rays, 20 CT scans (cranial, cervical, thoracic, abdominal), and 10 cranial MRIs;
- have performed and interpreted at least 40 ultrasound examinations for cardiac, thoracic, and abdominal emergencies (*);
- have performed and interpreted at least 30 venous and arterial Doppler ultrasounds (*);
- have performed and interpreted at least 200 ECGs;
- have performed at least 20 cardioversions (*) and 20 electrical defibrillations (*);
- have performed at least 20 external cardiac massages with the application of resuscitation maneuvers (*);
- have placed at least 10 external pacemakers and know how to place transvenous pacemakers (*);
- have performed at least 10 sedation-analgesia procedures;
- have administered at least 20 local anesthesia procedures;
- have disinfected and sutured at least 40 superficial wounds;
- know how to apply bandages, splints, and casts for immobilization of bone fractures (*);
- have performed at least 5 immobilizations for the prophylaxis of spinal cord injuries and pelvic fractures (*);
- know how to perform dislocation reduction (*);
- know how to perform lumbar punctures (*);
- have actively participated in the management of at least 20 acute strokes (*);
- have performed at least 20 bladder catheterizations (Foley catheter, suprapubic catheter) (*);
- have examined at least 10 patients with ophthalmic emergencies;
- have performed and interpreted at least 10 otoscopies (*);
- have performed at least 5 anterior and posterior tamponades for nosebleed control (*);
- have actively participated in at least 10 births (*);
- have the ability to perform decontamination procedures (skin and gastric, including the placement of nasogastric tubes for gastric and intestinal lavage) (*);
- have directly participated in the management and decision-making processes of the 118 operations center.
Learning of the professionalizing activities indicated with (*) may be done through simulation for a maximum of 30%.

The trainee may apply for the diploma after completing the professional development activities.

As part of their training, the trainee must learn the scientific foundations of the School's structure in order to achieve full maturity and professional competence. This includes adequate ability to interpret scientific innovations and critical thinking that allows them to effectively manage both their healthcare and their own 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.