Postgraduate School of Paediatrics

Educational Objectives
In accordance with the European pediatric specialist training model (European Board of Paediatrics, EBP), pediatric specialists must possess a wealth of knowledge, acquired through a unified training program consisting of two components: a common one (core pediatric curriculum) that serves as a foundation for a subsequent one (specific training curriculum and elective courses). The curriculum aims to achieve professional maturity by consolidating existing skills and acquiring new ones, in relation to the professionalizing and specialized courses: General Pediatrics - Local Primary Care, Hospital Secondary Care Pediatrics, and Specialized Care Pediatrics, the latter chosen from those offered by the School.

Core Pediatric Curriculum (three-year program)
The acquisition of the core pediatric curriculum skills includes, for a total of 180 credits (ECTS):
- the core training activities
- the core pediatric activities
- part of the Characterizing activities specific to the Pediatrics program (MED/38)
- part of the related or supplementary training activities
- "other" activities

General Educational Objectives
The general educational objectives of the pediatric core curriculum are structured around knowledge, professional skills, and abilities in general pediatrics and the various specialized areas of pediatrics. The educational objectives are:
1) Knowledge - Main social issues that can alter the normal child/parent relationship and psychophysical and emotional development; early indicators of pervasive developmental disorders, psychocognitive deficits, and potentially "pathological" social behaviors; basic notions of language, hearing, and learning disorders in general, and possible diagnostic and therapeutic approaches; principles of PBLS (Pediatric Basic Life Support); principles of hereditary diseases and major genetic diseases; auxological and psychomotor development; energy and nutritional requirements; fluid and electrolyte homeostasis and related pathological conditions; healthy lifestyles and principles of disease prevention; elements of preventive medicine and screening (metabolic, auditory, endocrinological); vaccinations; Pain management and palliative care; assessment of maltreated children and family/social risk factors; rights and responsibilities of children and their parents; basic elements of health policy; resources available in the community for the care of children with chronic conditions and for family support.
2) Professional skills in: medical ethics and clinical ethics; clinical method (including problem-based clinical reasoning); differential diagnosis and diagnostic-therapeutic planning for major pediatric conditions; communication; teamwork; clinical practice based on evidence-based pediatrics; scientific research methodology; risk management and clinical governance; continuing education methodology; and the principles of managing care as a single multidisciplinary team, in hospitals, specialist clinics, and community care.
3) Skills ? Ability to: compile a pediatric medical history; construct a family tree; perform a general and neurological physical examination; Perform otoscopic examinations; interpret laboratory and/or instrumental test results at different pediatric ages; compile and manage clinical documentation (paper and/or electronic); perform venous and arterial blood sampling at different pediatric ages; cannulate the umbilical vein and artery; cannulate a peripheral vein; perform bladder catheterization; place a nasogastric tube; perform a lumbar puncture and interpret the findings of a fresh cerebrospinal fluid examination; obtain a sterile urine sample for urine culture; record vital signs; perform PBLS maneuvers; manage a healthy newborn in the delivery room using basic neonatal resuscitation maneuvers; administer parenteral medications; measure and interpret blood pressure at different ages; monitor input/output balances and calculate urine output.
4) Mandatory courses: pediatric basic life support; pediatric advanced life support; resuscitation in the delivery room.

Educational objectives for individual pediatric areas (core pediatric curriculum)
Adolescent Studies
Knowledge
Stages of adolescent development; psychosocial aspects: sexual identity, independence, ideals; common communication difficulties between adolescents and adults; adolescent sexuality (sex education and contraception); pregnancy; risky behaviors; sexually transmitted diseases; eating disorders; chronic diseases; suicide and attempted suicide; sexual abuse; bullying; menstrual disorders.
Skills and Abilities
Staging of pubertal development and assessment of bone maturation; ability to communicate with adolescents; knowledge and ability to teach sexual education to adolescents; ability to involve adolescents in decisions affecting their own health.

Allergology
Knowledge
Allergic diseases and their clinical manifestations (in particular asthma, allergic rhinitis, atopic dermatitis, food allergy, anaphylaxis, drug allergy); Indications for allergy testing (prick test, prick-by-prick test, patch test, specific IgE measurement); indications for food provocation testing; principles of allergic disease management and prevention of exacerbations; principles of pharmacological therapy.
Skills and Abilities
Ability to recognize allergic disease, assess its severity, establish a differential diagnosis, and propose a diagnostic-therapeutic pathway, recognizing when specialist intervention is necessary. Performing and interpreting allergy tests; diagnosis and treatment of anaphylactic shock and prevention of recurrences. Cardiology
Knowledge
Fetal and neonatal circulation; prevention of bacterial endocarditis; main congenital heart diseases; main pediatric arrhythmias; symptoms and signs of heart failure in different pediatric ages and principles of cardiocirculatory resuscitation; diagnostic and follow-up tools for congenital heart diseases and arrhythmias; Principles of medical and surgical treatment of congenital heart disease; indications for echocardiography; medications used in pediatric cardiology.
Skills and Abilities
Distinguishing between physiological and pathological murmurs; ability to recognize the signs and symptoms of cardiovascular disease, assess its severity, establish a differential diagnosis, propose a diagnostic-therapeutic pathway, and identify the need for specialist intervention; principles of chest x-ray and ECG interpretation at different pediatric ages; vagal maneuvers (under supervision).

Dermatology
Knowledge
Pathophysiology of the main pediatric skin diseases; cutaneous manifestations of systemic childhood diseases; diagnostic and treatment principles of the main pediatric skin infections; treatment principles for eczema and seborrheic dermatitis; main serious pediatric skin diseases (epidermolysis bullosa, Staphylococcus scalded skin syndrome, toxic epidermolysis, cellulitis); indications for skin biopsy. Skills and Abilities
Proposal of a diagnostic and therapeutic pathway for the main pediatric skin diseases, in different age groups.

Endocrinology and Diabetology
Knowledge
Regulation of peptide and steroid hormone receptors; neuroendocrinology of the anterior and posterior pituitary gland;
biosynthesis of steroid hormones; pathophysiology of the most common acute-onset endocrine diseases; sexual differentiation; Andrological disorders; assessment of growth and pubertal development; obesity: diagnostic approach and prevention and related complications; type 1 diabetes mellitus; insulin physiology and metabolic effects of insulin deficiency; principles of management of pediatric diabetic patients and knowledge of the different types of insulin.
Skills and Abilities
Ability to recognize signs and symptoms suggestive of endocrine disorders, assess their severity, establish a differential diagnosis, establish a diagnostic and therapeutic pathway, and identify the need for specialist intervention; evaluate the results of biochemical and radiological analyses, and the most common tests used in diagnostic practice; perform and interpret an anthropometric assessment; stage pubertal development; assess glycemia, ketonemia, glycosuria, and ketonuria extemporaneously; manage diabetic ketoacidosis; use of pen injectors to deliver different insulins.

Hemato-Oncology
Knowledge
The most common benign hematological diseases; principles of treatment for the most common anemias and thrombocytopenias; interpretation of the most common hematological tests (complete blood count) by age group; warning signs and clinical presentations of the main pediatric neoplastic diseases; main clinical presentations of congenital and acquired bone marrow failure; indications and complications of bone marrow transplantation; the various types of transplant available, the principles governing it, and the essential elements of supportive care; biological markers of disease; principles of chemotherapy; regulations governing the transfusion of blood products, indications, and precautions.
Skills and Abilities
Ability to recognize signs and symptoms suggestive of hemato-oncological disease, assess its severity, and establish a correct differential diagnosis for prompt referral to a specialist; light microscopic evaluation of peripheral blood and cerebrospinal fluid smears; and performing lumbar punctures.

Gastroenterology
Knowledge
The most common liver diseases (acute and chronic viral hepatitis, storage diseases, cirrhosis, cholestasis), pancreatic diseases, and gastrointestinal tract diseases (gastroenteritis, gastroesophageal reflux disease, celiac disease, acute and chronic inflammatory bowel disease, malabsorption, recurrent abdominal pain); signs and symptoms of gastrointestinal manifestations; gastrointestinal malformations; indications for laboratory, endoscopic, radiological, and biopsy investigations; principles of treatment (dietary and pharmacological) for major liver and gastroenterological diseases; principles of management of gastrointestinal bleeding.
Skills and Abilities
Identification of the clinical picture of acute abdomen; ability to recognize signs and symptoms suggestive of gastroenterological and liver disease, assess its severity, establish a differential diagnosis, and propose a diagnostic and therapeutic pathway, identifying the need for specialist intervention; Clinical and laboratory interpretation of dehydration symptoms and their treatment; interpretation of the main laboratory and instrumental tests in gastroenterological and liver diseases.

Clinical Genetics
Knowledge
Principles of heredity and the genetic basis of inherited diseases; clinical aspects of the most common chromosomal disorders and complex malformation syndromes; principles, significance, and clinical and ethical implications of genetic counseling and prenatal testing; risk factors for fetal damage during pregnancy.
Skills and Abilities
Knowledge of pregnancy and family history to identify exogenous or endogenous risk factors for malformation syndromes (familial history, exposure to external agents during pregnancy); know how to draw and interpret a family tree; know how to recognize the main signs of genetic diseases and dysmorphic syndromes.

Immunology
Knowledge
Development of the immune system; defects of adaptive and innate immunity and autoimmunity; immunological and genetic tests for the evaluation of immunodeficiency and autoimmunity conditions; principles of medical and rehabilitative treatment for various forms of immunodeficiency and autoimmunity; Significance and limitations of instrumental diagnostics in various immunodeficiency and autoimmune conditions.
Skills and Abilities
Ability to recognize the signs and symptoms suggestive of immunodeficiency or autoimmunity, assess its severity, establish an accurate differential diagnosis, and propose a diagnostic-therapeutic pathway, recognizing when specialist intervention is necessary.

Infectious Diseases
Knowledge
Main defense mechanisms of the body during different stages of development; maternal-fetal mechanisms of infection transmission; epidemiology, pathophysiology, and natural history of the main infectious diseases of childhood; modern methods for microbiological diagnosis; rationale and indications for the use of antibiotic therapy and resistance mechanisms; principles of treatment of severe infections (meningitis, septic shock, complicated pneumonia, septic arthritis, osteomyelitis); indications, contraindications, and complications of vaccinations; recognition and treatment of septic shock.
Skills and Abilities
Formulation of a correct differential diagnosis and diagnostic and therapeutic pathway for the most common childhood infectious diseases; indications for testing, methods for collecting and preserving microbiological samples; interpretation of microbiological test results; prescription of appropriate therapy for the most common childhood infectious diseases.

Hereditary Metabolic Diseases
Knowledge
Major acute-onset and chronic-progressive metabolic diseases of childhood (metabolism disorders of carbohydrates, proteins, vitamins, and neurotransmitters, energy metabolism disorders, lysosomal metabolism disorders, and peroxisomal disorders); biochemical tests; nutritional principles; fundamental notions for the management of acute metabolic decompensation; natural history and long-term complications of the main hereditary metabolic diseases.
Skills and Abilities
Recognize the warning signs and symptoms of hereditary metabolic diseases; Correct interpretation of blood gas analysis and laboratory indicators of glucose, protein, and lipid metabolism dysfunction.

Nephrology
Knowledge
Most common pediatric nephrological diseases (urinary tract infections, nephrosis, glomerulonephritis, hemolytic uremic syndrome, acute renal failure); main malformative nephro-uropathies; indications for instrumental investigations in nephro-urology; general principles of therapy and management of patients with acute and chronic renal failure; indications for surgical correction of the main malformative uropathies; etiopathogenesis of enuresis and treatment principles.
Skills and Abilities
Collecting a urinary history; recognizing the signs and symptoms of nephro-urological disease; proposing a diagnostic and therapeutic pathway, identifying the need for specialist intervention; interpreting the main laboratory tests; treatment and follow-up of urinary tract infections; Recognition of acute renal failure; execution and interpretation of urine dipsticks and macroscopic and microscopic examination of urine.

Neonatology and Neonatal Intensive Care
Knowledge
Fetal physiology and pathophysiology and monitoring principles; pathophysiology of prematurity and low birth weight; main signs and symptoms of the most common neonatal diseases: acute and chronic respiratory failure, malformative or functional cardiovascular disorders, neurological disorders, metabolic disorders, congenital and acquired infectious diseases, malformative diseases, obstetric trauma; neonatal diseases caused by maternal illness during pregnancy; principles of resuscitation in the delivery room and assisted ventilation; nutritional needs of premature babies, newborns, and infants; physiology of breastfeeding, contraindications and prescription of a formula diet; rules for taking medications during breastfeeding; signs and symptoms of life-threatening conditions for the newborn; pharmacology and indications for the use of surfactant.
Skills and Abilities
Collection of gestational (obstetric) and perinatal medical history; Physical examination of the newborn and assessment of gestational age;
interpretation of the main clinical signs of pathology in the neonatal period; management of the healthy newborn in the delivery room, calculation of the Apgar score, and essential resuscitation procedures; spinal tap; cannulation of the umbilical vessels; venous and arterial sampling in the newborn and heel prick; ventilation with a face mask and airway suctioning.

Neurology
Knowledge
The stages of psychomotor development in children and their pathological deviations; pathophysiology and clinical manifestations of the most important neurological disorders of developmental age; major malformation syndromes of the central nervous system (especially spina bifida and its implications); pervasive developmental disorders; disabilities and implications for the child and their family; febrile seizures, epilepsies, and paroxysmal non-epileptic phenomena; dose adjustment,
side effects and interactions of antiepileptic drugs; hypotonia, peripheral nerve and muscle dysfunction; Treatment principles for major neurological emergencies (acute intracranial hypertension, status malaise, ischemic/hemorrhagic events); indications for neuroradiological (CT, MRI, MRI angiography) and neurophysiological (EEG, evoked potentials, EMG) diagnostics; indications for lumbar puncture.

Skills and Abilities
Collecting a neurological history (with particular emphasis on psychomotor development) and neurological examination at different pediatric ages; ability to recognize signs/symptoms suggestive of neurological disease, assess its severity, establish an appropriate differential diagnosis, and propose a diagnostic-therapeutic pathway, identifying the need for specialist intervention; anti-seizure therapy in the acute phase; performance of spinal taps.

Nutrition
Knowledge
Understanding the nutritional needs of pediatric patients, including preterm infants and infants small for gestational age; knowledge of the clinical and laboratory assessment of nutritional status; Understand nutritional needs in various pathological conditions; understand common nutritional problems; understand the interactions between diet and disease; define malnutrition; and understand the issues surrounding alternative and vegetarian diets.

Emergency Pediatrics
Knowledge
The most common conditions that require children to be observed in the emergency department; the approach to children in the emergency department according to physiological priorities; principles of stabilizing vital functions; efficacy, indications, contraindications, limitations, side effects, and costs of various diagnostic and therapeutic interventions in an emergency setting; the most common clinical presentations of maltreatment and psychological, physical, and sexual abuse; clinical presentations of psychiatric disorders in developmental age; knowledge of pain assessment tools in children with acute illnesses and the principles of treatment with pharmacological and non-pharmacological therapies.
Skills and Abilities
Differential diagnosis and treatment decisions for clinical problems in an emergency setting, using the laboratory, radiology, ancillary diagnostic services, specialist consultations, and the judicious use of medications and emergency interventions; managing and stabilizing children in critical condition as part of a multidisciplinary team; Be independent in the use of the main vital signs monitoring tools; acquire manual skills, including the ability to independently perform the most common emergency procedures (venous sampling/cannulation, arterial puncture, lumbar puncture, oxygen administration, radial head dislocation reduction); correctly measure and treat spontaneous and procedural pain in an emergency setting.

Pneumology
Knowledge
Pathophysiological mechanisms underlying cough, dyspnea, noisy breathing (wheezing, stridor, snoring); upper and lower respiratory tract infections, bronchiolitis, inspiratory stridor, pneumonia, bronchiectasis, asthma, and wheezing; rare diseases of pulmonary interest; major allergic conditions associated with respiratory diseases: atopic dermatitis, allergic rhinoconjunctivitis, food allergies, anaphylaxis; Indications for allergy testing (prick test, patch test, specific IgE measurement), pulmonary function testing (spirometry, resistance measurement, flow-volume curve in uncooperative children), and pulmonary radiology (chest x-ray, CT scan, MRI, scintigraphy). Skills and Abilities
Detection and monitoring of vital signs (saturation pulse oximetry); ability to recognize signs/symptoms of respiratory disease, propose a diagnostic and therapeutic course, and identify the need for specialist intervention; interpretation of laboratory and/or instrumental test results (prick test, patch test, specific IgE, spirometry, Mantoux intradermal reaction, blood gas analysis, sweat test); administration of inhaled medications (via nebulization, MDI, DPI); airway suctioning; oxygen therapy.

Rheumatology
Knowledge
Main rheumatic diseases in children: juvenile chronic arthritis, systemic lupus erythematosus, dermatomyositis, scleroderma, vasculitis (Henoch-Schoenlein purpura and Kawasaki disease), rheumatic disease; symptoms and signs of rheumatic manifestations in systemic, metabolic, and neoplastic diseases; diagnostic workup of fevers of unknown origin or recurrent fevers; clinical significance of autoantibodies (ANA, ENA, anticardiolipin, lupus anticoagulants); synovial fluid examination; instrumental and imaging diagnostics in rheumatic diseases (standard radiology, ultrasound, CT, and MRI); therapeutic indications and side effects of nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressants, and other drugs used in the treatment of rheumatic diseases in children (including intra-articular therapy); psychological aspects of chronic rheumatic diseases on the patient and their family.
Skills and Abilities
Performing joint and muscle physical examinations; ability to recognize signs and symptoms suggestive of osteoarticular and/or rheumatic disease, assess its severity, establish a differential diagnosis, and propose a diagnostic-therapeutic pathway, identifying the need for specialist intervention.

Pain Relief and Palliative Therapy
Knowledge
Pathophysiology of pain; tools for measuring pain; principles of pharmacological and non-pharmacological treatment of acute, procedural, and chronic pain; pharmacology and side effects of the main analgesic drugs; concepts of chronicity and terminality in pediatrics; principles for a comprehensive assessment and treatment approach to pain; criteria for palliative care in pediatrics; psychological needs of patients receiving palliative care and their families; community resources available to patients receiving palliative care.
Skills and Abilities
Diagnostic assessment of pain symptoms; Use of pain measurement tools at different pediatric ages, in different clinical conditions, and in response to treatment; treatment of the most common painful manifestations in children.

Mandatory professional development activities in the core pediatric curriculum:
- Care for 50 healthy newborns and 50 newborns with medical conditions, with direct responsibility and increasing autonomy.
- Perform 500 outpatient visits for acute or emergency problems, with direct responsibility and increasing autonomy.
- Perform 300 outpatient visits, with direct responsibility and increasing autonomy, of which at least 1/3 are dedicated to prevention and health education.
- Perform 500 specialist visits, with direct responsibility and increasing autonomy, distributed across the areas listed above.

Specific Training Curriculum and Elective Pathways (two-year program)
To achieve the educational objectives of the specific training curriculum and elective paths, the following compete for a total of 120 credits:
- Part of the core activities specific to the Pediatrics category (MED/38)
- Part of the related or complementary activities
- Final exam.

The final two-year training objectives are aimed at consolidating and deepening existing skills, acquiring new ones, and developing the specific professional and cultural profile required of pediatricians who will work in community primary care or hospital secondary care, or in one of the pediatric specialist areas established by the School of Specialization, listed below:
Adolescentology; Dermatology; Endocrinology and Diabetology; Hematology-Oncology; Gastroenterology and Hepatology; Clinical Genetics; Immunology; Infectious Diseases; Hereditary Metabolic Diseases; Nephrology; Neonatology and Neonatal Intensive Care; Neurology; Emergency Pediatrics; Pulmonology; Rheumatology; Pain Management and Palliative Care.
These objectives are divided into:
- training objectives common to all physicians in specialist training;
- training objectives pertaining to the specific professional field.

General Educational Objectives
1) Cultural Acquisitions: Cultural consolidation of the information listed for the three-year basic program.
2) Professional and Methodological Skills;
2.1) Gain awareness: of the pediatrician's role as defender of the rights of children and their families and as the primary guarantor of the full expression of their potential; of the influence of the environment on children's health; of personal educational responsibilities in practicing their profession towards younger colleagues, patients, and their families; of the ethical implications of medical practice; of one's own human and professional limitations in seeking appropriate advice, when necessary; of the importance of communication with members of the healthcare team, with the child, and with their family; of the medicolegal implications of one's work and the regulations governing medical practice; of the legislation supporting sick children and their families; of the implications, in terms of public finances, of one's medical choices; of the social context in which they work; and of ethnic and cultural differences.
2.2) Acquire: the clinical methodology for arriving at a correct diagnosis and making the necessary operational decisions, understanding clinical reasoning models, critically utilizing bibliographic sources, clinical algorithms, and computerized diagnostic systems; knowledge and practice of the principles of clinical governance.
3) Practical and manual skills. Independently manage (under tutorial supervision):
paper or electronic materials of clinical relevance (records, consultation requests, test requests, prescriptions); formulate a correct differential diagnosis and establish a diagnostic-therapeutic and follow-up pathway for the most common pediatric pathologies, both general and specialized; prescribe medications, anticipate side effects, and plan appropriate follow-up; assess pain symptoms and manage pain therapy; implement the initial procedures necessary for managing urgent and clinical emergencies; manage healthy full-term newborns in the delivery room and nursery; Seeking advice from specialist doctors and managing relationships with them; communicating and teaching, within their area of expertise, younger doctors in training; managing (with prior support from a tutor) the relevant medical and healthcare team; communicating with the child (where appropriate) and his or her family; the discharge phase and coordinating any home support measures; critically interpreting guidelines and scientific articles; planning a continuing self-training project; planning interventions aimed at implementing the quality policy and clinical risk principles; actively participating in the design and implementation of a research program (e.g., a specialist thesis).

Training Objectives for Professional and Specialty Areas
General Pediatrics - Primary Care
The training curriculum is aimed at training pediatricians with general pediatrics skills to provide coordinated care in the community for newborns, children, and adolescents, both healthy and those with acute and chronic illnesses. Trainees pursuing this field must be able to care for healthy children throughout their various stages of growth and development, promoting healthy lifestyles and identifying deviations from the norm early. They must also be able to recognize and manage the main acute and chronic pathologies of developmental age (both organic and psychological), making appropriate use of specialized outpatient services and/or hospitalization, and maintaining continuity of care for patients with chronic conditions that flare up.

Knowledge
1) In-depth study and consolidation of the cultural acquisitions already listed in the core pediatric curriculum in relation to the areas of general pediatrics and the most representative specialist areas of primary care: general pediatrics; adolescentology; auxo-endocrinology; nutrition; allergology; bronchopulmonology; dermatology; infectious diseases; nephrology; gastroenterology; neuropediatrics; child neuropsychiatry; pain management and palliative care.
2) Specific cultural acquisitions related to:
the importance of prevention interventions (primary and secondary) and screening; ethnopediatrics; organizational models of community medicine, single- and/or multi-professional teamwork; demand management, resource management, and promotion of appropriate care; hospital-community integration, multidisciplinarity, and the relationship with social services and schools; and issues related to patient transition from pediatric to adult care.

Skills
1) Please refer to the general and specialized areas listed above for the definition of skills related to child care in a primary care setting.
2) Specific skills acquired include:
recognizing when it is necessary and appropriate to request hospitalization and referring the patient to the pediatric emergency room; interacting with other community facilities on the one hand and with specialized centers on the other, in implementing care plans that ensure continuity of care for patients, particularly those with chronic illnesses; recognizing and managing social, relational, ethnic, and psychological issues that can interfere with the health of children and adolescents; providing prevention interventions (particularly vaccinations), promoting healthy lifestyles, and educating families about nutrition; recognizing risky behaviors, both for health issues (physical, mental, relational, and social), and for non-adherence to treatment in the case of chronic illness; managing demand and facilitating patient and family participation in the care plan (empowerment); work in single- or multi-professional teams to achieve shared objectives;

Mandatory training areas
General and specialized pediatric departments and clinics; family pediatrician offices; community services
Professional training activities. Care for patients with increasing responsibility until they reach independence:
- inpatients and/or outpatients for general and specialized pediatric problems: at least 150
- outpatients for acute problems and/or emergencies: at least 150
- requiring screening, prevention, and health education: at least 150
- with developmental, behavioral, or psychosocial issues, or those affected by chronic diseases and/or social risks: at least 50
Carry out, with increasing responsibility until they reach independence:
- telephone consultations/triage: at least 50
- vaccinations: at least 20
- health checks: at least 100
- chronic health checks: 20
- newborn care: at least 10
- prescriptions for diseases or diagnostics: at least 100
- certificates and reports: 50
- diagnostic self-help activities: 50

General Pediatrics - Secondary Care
The training curriculum is aimed at developing the professional skills required for managing pediatric patients and their families during hospitalization. These skills relate to the care of:
children with severe acute illnesses or exacerbated chronic illnesses requiring complex and/or semi-intensive hospital care; healthy and pathological newborns; and children admitted to the hospital in urgent/emergency situations.
This is complemented by specific organizational and management knowledge and skills, essential for conducting hospital practice effectively, efficiently, with quality, and safely, while maintaining an awareness of the system in which they operate. Knowledge
1) Develop and consolidate the knowledge already listed in the core pediatric curriculum in relation to the following areas:
general pediatrics; emergency pediatrics; neonatology and neonatal intensive care; and the specialist areas most representative of the pathologies that lead to hospitalization, such as pulmonology, neurology, gastroenterology, and cardiology. Infectious diseases; pain therapy and palliative care.
2) Specific cultural acquisitions related to:
the main management systems of a healthcare organization; the main hospital organizational models; Clinical Governance strategies, methods, and tools.

Skills
1) Please refer to the general and specialized areas listed above for the definition of skills related to the care of patients hospitalized for acute illnesses and healthy and pathological newborns.
2) Specific skills include:
efficiently organizing the simultaneous care of large flows of patients hospitalized with heterogeneous pathologies, recognizing priorities and ensuring their safety; working in a team, with clarity and respect for roles; interacting with the local community on the one hand and with Specialist Centers on the other in implementing treatment plans that ensure continuity of care for patients with chronic illnesses; correctly coding discharge diagnoses and understanding the meaning of this process; reading and interpreting activity and planning data (budget); designing care pathways as a tool for clinical governance and clinical risk prevention.
Mandatory training areas
General and specialized Pediatrics departments with large caseloads and complex care requirements; Pediatric Emergency Department; Neonatal Pathology Departments; Territorial services.

Professional development activities:
- Hospitalized patients for general and specialized pediatric problems: at least 200
- Patients with specialized pediatric pathology: at least 150
- Outpatients for acute or emergency problems: at least 150
- Healthy newborns (delivery room and nursery): at least 50
- Resuscitation in the delivery room: 10
- Pathological newborns: at least 50
- Newborns undergoing intensive care: at least 20

Pediatric Specialties
The training curriculum is aimed at further acquiring general pediatric skills and providing specific cultural and professional development in one pediatric specialty area. This curriculum can be considered preparatory to a subsequent Advanced Training program, designed to develop the subspecialist pediatrician.

The skills in this area include:
- consolidation of the general pediatrics knowledge acquired in the first three years, with specific reference to secondary care;
- deepening of knowledge and professional skills in the chosen specialty, for a more thorough care of children affected by conditions pertaining to that specialty;
- in-depth training in clinical research through direct and personal involvement in research projects.
For the knowledge and practical skills to be acquired, please refer to the provisions for the two-year training program in the specific areas.

Mandatory training areas
Pediatric departments with recognized expertise in the pediatric specialties listed below.
It is desirable that for each specialty, the acquisition of knowledge of the adult evolution of conditions that arise during developmental age be required.

Adolescent Studies
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area. Practical and manual acquisitions will enable students to:
Interpret the specific emotional, mental, and physical health needs of adolescents; discuss sexuality issues with adolescents; provide appropriate advice on contraception, including emergency contraception, to prevent teenage pregnancy; discuss sensitive adolescent health issues such as smoking habits, alcohol and other substance abuse, and sexual activity, including in relation to specific conditions such as asthma, diabetes mellitus, cystic fibrosis, and physical disabilities; support adolescents in the self-management of acute and chronic illnesses and identify those who wish to participate or not participate; manage adolescents with employment difficulties in relation to any physical disabilities; Plan and manage the transition from pediatric to adult care for adolescents with chronic conditions, recognizing the importance of the role of multidisciplinary team members in the success of the transition process itself; plan and manage the care pathway for adolescents with eating disorders; plan and manage the care pathway for adolescents who are victims of abuse or bullying; recognize and manage adolescents with menstrual disorders, including polycystic ovary syndrome; recognize and manage adolescents with varicocele or gynecomastia.

Professional development activities:
- Outpatients: at least 50
- Inpatients: at least 20
- Patients with eating disorders: at least 10
- Patients with chronic conditions: at least 10

Allergology
Cultural Acquisitions
Deepening and consolidation of the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and manual acquisitions - Independently manage (with tutorial supervision)
The diagnostic process, differential diagnosis, and therapeutic approach of the main allergic diseases of childhood (IgE and non-IgE-mediated food allergy, anaphylaxis, acute and chronic urticaria, allergic rhinoconjunctivitis, allergic asthma, atopic dermatitis); the prescription of rapid epinephrine, where indicated; dietary prescriptions;
the prescription of specific immunotherapy; the performance of a food challenge test; establishing the diagnostic pathway for drug allergies and any drug challenge tests; and requests for specialized management needed by the allergic child.

Professionalizing Activities:
- Outpatients: at least 80
- Inpatients: at least 50
- Allergy tests (prick, patch, prick-by-prick): at least 30
- Food or drug challenge tests: at least 10
- Spirometry: at least 30
- Bronchodilation tests: at least 20
- Exercise tests: at least 10

Cardiology
Cultural Acquisitions
Deepening and consolidation of the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and Manual Acquisitions - Independently manage (under tutorial supervision):
interpretation of symptoms and clinical signs of possible cardiac disease, particularly with regard to auscultation; interpretation of ECG abnormalities at different pediatric ages; reading chest x-rays performed for cardiac reasons; Performing a two-dimensional echocardiogram, limited to its ability to differentiate normal from pathological findings; initial treatment procedures for heart failure, cardiac arrest, and serious arrhythmias (e.g., paroxysmal supraventricular tachycardia); monitoring patients after cardiac catheterization; prescribing medications commonly used in pediatric cardiology; and coordinating care, including with local health facilities.

Professional development activities:
- Outpatients: at least 100
- Inpatients: at least 10
- ECGs: 50
- Echocardiograms: at least 50
- Cardiac catheterizations (assistance): 10

Dermatology
Cultural acquisitions
Deepening and consolidation of the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and manual acquisitions - Independently manage (with tutorial supervision):
the semiological interpretation of skin diseases, with particular reference to rare ones (epidermolysis bullosa, Staphylococcus scalded skin syndrome, toxic epidermolysis); the diagnostic process, differential diagnosis, and therapeutic approach of the main skin diseases of childhood; skin biopsy; the prescription of topical medications, particularly the various steroid-based preparations; and the general care of a child with a skin disease.

Endocrinology and Diabetology
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and manual acquisitions ? independently manage (with tutorial supervision):
the diagnostic process, differential diagnosis, and therapeutic approach of the main endocrine diseases of childhood: hypothyroidism and hyperthyroidism; thyroid nodules; precocious and delayed puberty; short stature, growth retardation, andriological diseases, excessive growth; hyperglycemia and hypoglycemia; fluid and electrolyte disturbances;
auxological examination at all ages, including use of the "body mass index";
diabetic ketoacidosis, hypoglycemia, and situations of altered fluid and electrolyte balance associated with endocrine disorders; the design of dynamic tests; the interpretation of endocrine test results; Dietary, pharmacological, and lifestyle recommendations for obese patients at risk of developing early metabolic syndrome; prescribing insulin and dietary therapy; providing lifestyle advice (particularly regarding social, sports, and sexual activity); and properly evaluating the self-monitoring diary for patients with diabetes mellitus; providing accurate information on the issues of diabetes in relation to the patient's environment (family, school, sports); using a blood glucose monitor and interpreting the recorded data;
managing insulin pumps for diabetic patients; and prescribing contraceptives.

Professionalizing activities:
- Outpatients: at least 100 cases
- Diagnostic workup of patients with possible endocrine disorders: at least 50
- Endocrine emergencies: at least 5
- Diabetic ketoacidosis: at least 5
- Prescription of therapy for patients with precocious puberty: at least 5
- Patients with GH deficiency: at least 5
- Prescription of therapy to induce puberty: at least 5

Hemato-Oncology
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and manual acquisitions ? independently manage (with tutorial supervision):
the diagnostic process, differential diagnosis, and therapeutic approach of the most common benign hematological disorders (anemia, thrombocytopenia, neutropenia, bleeding diathesis ? von Willibrand disease) and oncological disorders; the staging processes of the most common childhood oncological diseases; the prescription of blood products and management of possible transfusion reactions; conditions of fever and neutropenia, and in particular the initial procedures necessary to correct septic shock; conditions of acute and chronic thrombocytopenia, disseminated intravascular coagulation, thrombosis, and external hemorrhage; Performing a bone marrow aspiration, a therapeutic lumbar puncture, and a bone marrow biopsy; microscopic examination of peripheral blood, bone marrow, and cerebrospinal fluid smears; daily care of patients undergoing chemotherapy and bone marrow transplantation; major hemato-oncological emergencies (septic shock, spinal compression, tumor lysis syndromes, or hyperleukocytosis); pain relief and palliative therapy (where necessary); discussions (always under supervision) with the patient and their family; and discharge of patients with hemato-oncological conditions.
Professionalizing activities:
- Outpatients: at least 100 cases
- Inpatients: at least 50
- Peripheral blood smear reporting: at least 50
- Bone marrow aspirate reporting: at least 20
- Therapeutic lumbar punctures: at least 10
- Bone marrow aspirates: at least 10
- Bone marrow biopsies: 5

Gastroenterology
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialty area.
Practical and manual acquisitions ? independently manage (with tutorial supervision):
the diagnostic process, differential diagnosis, and treatment approach for the main liver diseases (acute and chronic viral hepatitis, storage diseases, cirrhosis, cholestasis), pancreatic diseases, and gastrointestinal diseases (GERD, acute and chronic inflammatory bowel disease, celiac disease, malabsorption, recurrent abdominal pain); the diagnostic assessment of patients with jaundice; diagnostic and therapeutic interventions for vomiting, diarrhea, and chronic constipation; the diagnostic approach for gastrointestinal bleeding, particularly regarding the recognition of serious and potentially fatal conditions and the implementation of initial interventions; Indications for pH-impedance analysis and esophageal manometry, intestinal and hepatobiliary scintigraphy, breath tests, intestinal permeability tests, upper and lower intestinal endoscopy, radiological and histological examinations. Recognition of clinical conditions of surgical interest; and breath tests.
Professionalizing activities:
- Outpatients: at least 80
- Inpatients: at least 50
- pH-impedance analysis: at least 5
- Digestive endoscopies (assistance): at least 10
- Esophageal manometry: at least 10
- Anorectal manometry: at least 5
- Liver biopsies (assistance): at least 5

Clinical Genetics
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and manual acquisitions ? independently manage (with tutorial supervision):
recognition of the main malformation syndromes (Down syndrome, Turner syndrome, etc.); disease communication; consultations required to formulate appropriate genetic counseling and to present possible indications for voluntary termination of pregnancy.
Professionalizing activities:
- Outpatients: at least 50
- Dysmorphological assessment of newborns and infants: at least 20
- Genetic counseling: at least 20
- Teratology consultations: at least 5

Immunology
Cultural Acquisitions
Understand the fundamental stages of immune system development and function; understand the various conditions associated with immune system dysfunction; understand the significance, limitations, and indications of the main in vitro immunological tests for both adaptive immunity (T lymphocytes and B lymphocytes) and innate immunity (neutrophils, NK cells, toll-like receptors, cytokines); understand the significance, limitations, and indications of the main genetic tests useful for identifying primary immunodeficiencies; understand the various conditions of immune system hyperactivity, ranging from allergic diseases to autoimmune and autoinflammatory diseases; understand the genetic associations of the main allergic, autoimmune, and connective tissue diseases. Practical and manual acquisitions ? independently manage (with tutorial supervision):
The main primary immunodeficiencies and understand their basic therapeutic implications; in particular, the student must be able to recognize clinical emergencies and conditions requiring OMT; The main allergic diseases, including their diagnostic features and therapeutic measures; the main autoimmune and connective tissue diseases, including their diagnostic features and therapeutic measures; the main vasculitis, including their diagnostic features and therapeutic measures; the main autoinflammatory diseases, including their diagnostic features and therapeutic measures;
Professionalizing activities:
- Outpatients: at least 30
- Inpatients: at least 20

Infectious Diseases
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and manual acquisitions ? independently manage (with tutorial supervision):
the diagnostic process, differential diagnosis, and therapeutic approach for the most common childhood infectious diseases; the prescription of first-line antibiotics for treatment or prophylaxis; the diagnostic process for patients with recurrent infections; implementation of measures to control the transmission of infections; indications for infection prevention, especially in hospital-based settings; notification of infectious diseases in accordance with the law; antibiotic therapy in immunocompromised patients; septic shock and the main adverse reactions to antibiotics, including anaphylactic attacks; vaccination plans.
Professionalizing activities:
- Outpatients: at least 30
- Newborns with congenital and perinatal infections: at least 20
- Inpatients (including consultations): at least 30

Hereditary Metabolic Diseases
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and manual acquisitions ? independently manage (with tutorial supervision):
the diagnostic process, differential diagnosis, and therapeutic approach of the main hereditary metabolic diseases (defects in carbohydrate, protein, vitamin, and neurotransmitter metabolism, defects in energy metabolism, lysosomal metabolism, and peroxisomal diseases); the diagnostic process in a newborn with suspected metabolic disease, including in emergency situations; the recognition and initial treatment of metabolic emergencies; the recognition and correction of acid-base disorders; the selection of biological fluids for testing and their preservation for transport to the laboratory;
the coordination of multidisciplinary care of children with metabolic diseases, through interaction with dietitians and other specialists.
Professionalizing activities:
- Outpatients: at least 40
- Inpatients: at least 20
- Metabolic disorders: at least 10

Nephrology
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialty area.
Practical and manual acquisitions ? independently manage (with tutorial supervision):
interpretation of laboratory tests (in relation to age and body size), nephro-urological function tests, and the most common instrumental tests (renal ultrasound; radioisotope studies); differential diagnosis, diagnostic workup, and treatment approach for the main nephrological diseases of childhood (urinary tract infections, nephrotic syndromes, acute nephritis, renal stones, tubular disorders, acute and chronic renal failure); differential diagnosis and diagnostic and treatment approach for end-stage renal failure (including the principles of peritoneal dialysis and hemodialysis); management of life-threatening clinical conditions (hyperkalemia); Differential diagnosis, diagnostic workup, and initial therapeutic approach to pediatric hypertension; issues related to ureterovesical malformations and the most common forms of hereditary nephropathy; diagnostic workup of enuresis and other symptoms of bladder damage (dysuria, stranguria, pollakiuria); diagnostic workup of findings of glomerular and tubular damage (proteinuria and hematuria); dietary recommendations for children with nephropathy.

Professional development activities:
- Outpatients: at least 50 cases
- Inpatients: at least 30
- Patients with acute renal failure: at least 10
- Dialysis patients (hemodialysis and peritoneal dialysis): at least 10
- Renal biopsy (assistance/observation): at least 5

Neonatology and Neonatal Intensive Care
Cultural acquisitions
Deepening and consolidation of the cultural acquisitions listed in the core pediatric curriculum in relation to this specialty area
Practical and manual acquisitions ? independently manage (with tutorial supervision):
differential diagnosis, diagnostic workup and therapeutic approach to the main pathologies of preterm and full-term newborns: acute and chronic respiratory failure, cardiovascular disorders of a malformative or functional nature (congenital heart disease, PDA, persistence of fetal circulation, hypotensive RDS and shock), neurological disorders (convulsions, hypoxic-ischemic syndrome, intracranial hemorrhages, periventricular leukomalacia), metabolic disorders (hyperbilirubinemia, hypoglycemia, hypocalcemia, inborn errors of metabolism), congenital and acquired infectious pathology (TORCH infections, neonatal sepsis and meningitis), malformative pathology (cardiac, neurological, diaphragmatic hernia, most frequent genetic syndromes: trisomy 13, 18, 21), obstetric trauma (clavicle fracture, brachial plexus injury, cephalohematomas); resuscitation in the delivery room; adaptation phenomena in healthy newborns aged 34-37 SG in the postpartum period (respiratory distress, hypoglycemia, hypocalcemia, polycythemia, hyperbilirubinemia) and the principles of treatment; the use of the bassinet for neonatal transport; the performance of cerebral ultrasound; the diagnostic approach to pneumothorax, indications for drainage and the execution of drainage itself; physiological and pathological jaundice, outlining an appropriate diagnostic and therapeutic pathway; the placement of a laryngeal mask, endotracheal intubation, the administration of surfactant and the setting of ventilatory support; the initial treatment of bleeding; the evaluation and possible correction of fluid and electrolyte balance; the cannulation of an umbilical vein and artery, the placement of a percutaneous venous access, the performance of an arterial blood gas analysis; Interpretation of laboratory tests in accordance with the neonatal stage and the most commonly used radiological findings (chest x-ray, brain ultrasound); interpretation of screening tests and knowledge of the next steps to take in the event of a positive result; indication for admission to a neonatal intensive care unit; discharge of a newborn requiring home care (e.g., oxygen therapy).

Professionalizing activities:
- Outpatients: at least 100
- Healthy newborns: at least 200
- Newborns on assisted ventilation: at least 20
- Neonatal transport: at least 5
- Prescription (supervised) of total parenteral nutrition: at least 20
- Resuscitation in the delivery room: at least 10
- Newborns in the Neonatal Intensive and Semi-Intensive Care Unit: at least 30 cases
- Umbilical vein cannulation: at least 10
- Tracheal intubation*: at least 10
- Arterial blood gas analysis: at least 10
*Also on a mannequin

Neurology
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialty area.
Practical and hands-on learning ? independently manage (under tutorial supervision):
the differential diagnosis, diagnostic workup, and treatment approach for the main neurological disorders of childhood: regression or arrest of psychomotor development, learning disabilities, intellectual disability, speech and hearing impairment, cerebral palsy, seizures/epilepsy, meningism, encephalitis, acute encephalopathies, hydrocephalus, altered consciousness, headache, syncope, focal neurological signs, movement disorders (ataxia, chorea, tics), muscle hypotonia (both in neonatal and later life), peripheral neuropathy, myopathy, neurocutaneous syndromes (neurofibromatosis, tuberous sclerosis), neural tube defects, and other cerebral and cranial malformations (e.g., craniosynostosis); the initial diagnostic workup of a patient with a central nervous system tumor; Recognition and initial treatment of neurological emergencies/urgency situations such as severe head trauma, intracranial hypertension, seizures, status malaise, cerebral vascular accidents, and any requests for consultation and/or intensive care support; fundus oculi assessment for the diagnosis of intracranial hypertension; EEG reading; request for laboratory and instrumental tests and interpretation of findings (EEG, CT scan, and brain MRI); coordination of the continuity of care needs of children with complex pathologies and disabilities, in collaboration with the local network.

Professionalizing activities:
- Outpatients: at least 150
- Inpatients: at least 60
- EEG and/or video EEG: at least 50
- Neuroradiological examinations: at least 60
- Neurophysiological examinations (VEP, EMG): at least 20
- Lumbar puncture*: at least 10
*Also on a mannequin

Emergency Pediatrics
Cultural Acquisitions
Deepening and consolidation of the cultural acquisitions listed in the core pediatric curriculum in relation to this specialty area.

Practical and manual acquisitions ? Independently manage (with tutorial supervision):
emergency situations requiring care for children with critically compromised vital signs;
differential diagnosis for clinical problems in an emergency setting, correctly using the laboratory, radiology, ancillary diagnostic services, specialist consultations, and correctly interpreting the results; the main tools for monitoring vital signs; the most common resuscitation procedures (particularly for cardiopulmonary arrest, septic, cardiogenic, and hemorrhagic shock, status de malaise, and coma); initial management of children with multiple trauma, particularly with regard to the involvement of a dedicated multidisciplinary team; initial management of children with acute psychotic attacks; the therapeutic process for illnesses requiring urgent observation, understanding the efficacy, indications, contraindications, side effects, and costs of various interventions, and knowing how to correctly administer prescriptions; Coordinating the continuity of care for acutely ill children, from initial presentation to hospitalization to follow-up after discharge; and acting as a team leader in managing critically ill children.

Professionalizing activities:
- Emergency room visits: at least 200
- Patients on OBI: at least 50
- Patients in intensive care: at least 10
- Arterial puncture: at least 10
- Mask ventilation*: at least 10
- Cardioversion/defibrillation*: 5
- Basic/advanced cardiopulmonary resuscitation*: at least 5
- Radial head dislocation reduction: at least 5
*Also on a mannequin

Pulmonology
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialty area.
Practical and manual acquisitions ? independently manage (with tutorial supervision):
respiratory diseases of childhood: inspiratory stridor, upper respiratory tract infections, ear infections, laryngitis, and epiglottitis, recurrent respiratory infections, viral bronchiolitis, pneumonia (and possible complications), bronchiectasis, tuberculosis, asthma, recurrent wheezing in preschool children, cystic fibrosis, bronchopulmonary dysplasia, and primary ciliary dyskinesia; differential diagnosis and diagnostic-therapeutic process of the main allergic conditions associated with respiratory diseases of childhood (atopic dermatitis, allergic rhinoconjunctivitis, food allergy); Initial treatment of respiratory emergencies such as foreign body aspiration, epiglottitis, anaphylactic attacks involving the upper airways, and asthma attacks; the rational use of antibiotics in respiratory infections; treatment of asthmatic patients during acute phases of the disease and during symptom-remitting phases; education of asthmatic children and their families; initial interpretation of chest X-rays and CT scans; arterial blood gas analysis and interpretation of the results; interpretation of bronchoalveolar lavage, bronchial brushing, and transbronchial biopsy; follow-up and complications of bronchodysplasia; treatment of exacerbations in children with cystic fibrosis; performance and interpretation of spirometry and pulmonary function tests in infants and preschool children (e.g., flow-volume loop, measurement of respiratory resistance using the Rint technique, forced oscillometry); Measurement and interpretation of lung volumes; performance and interpretation of bronchodilation tests and exercise stress tests; proper administration of inhalation therapy; performance and reporting of prick and prick-by-prick tests.

Professional activities:
- Outpatients: at least 100
- Inpatients: at least 100
- Spirometry: at least 30
- Bronchodilation tests: at least 20
- Chest X-rays and CT scans: at least 10
- Measurement and interpretation of lung volumes: at least 10
- Exercise stress test: at least 10
- Skin prick test: at least 15

Rheumatology
Cultural Acquisitions
Deepening and consolidating the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and manual acquisitions ? independently manage (under tutorial supervision):
the differential diagnosis, diagnostic workup, and initial therapeutic approach of the main juvenile rheumatic diseases: juvenile idiopathic arthritis, systemic lupus erythematosus, dermatomyositis, scleroderma, vasculitis (particularly Henoch-Schoenlein purpura and Kawasaki disease), acute articular rheumatism; the diagnostic workup of fevers of unknown origin; the clinical interpretation of autoantibody levels (ANA, ENA, anticardiolipin, lupus anticoagulants) and other laboratory tests used for the diagnostic assessment of
rheumatological diseases; diagnostic and therapeutic arthrocentesis of at least two large joints (knee and ankle);
the regulations governing the use of biological drugs (knowing their indications, limitations, and side effects); communicating with the patient and their family and developing an educational and behavioral plan related to coexistence with a rheumatic disease (especially for adolescent patients); and recommending a possible psychological support plan.

Professional development activities:
- Outpatients: at least 30
- Inpatients: at least 20
- Arthrocentesis (assistance): at least 5

Pain and palliative care
Cultural acquisitions
Deepening and consolidation of the cultural acquisitions listed in the core pediatric curriculum in relation to this specialized area.
Practical and manual acquisitions ? independently manage (with tutorial supervision):
Diagnostic and therapeutic procedures for acute, procedural, and chronic pain in children; Diagnosis and management of various issues related to chronic and/or terminal illnesses (oncological, neurological, cardiac, metabolic), with high care complexity; Prescribing the main analgesic medications (including opioids) and measures to control side effects; Indication of non-pharmacological analgesic therapies; Organization of supportive care for pain management; Protected discharge of patients eligible for palliative care; Palliative care techniques for children with complex chronic and terminal illnesses, both in hospital and at home; Application of a comprehensive therapeutic approach to the suffering of children and their families; Communication with children experiencing pain or eligible for palliative care; Prioritization of the child's and family's problems;
Formulation of achievable care goals shared by the child and family. the evaluation of the effectiveness of the healthcare intervention, of the management, organizational and cost aspects.

Professionalizing Activities
- Outpatients: at least 20
- Pain consultations (inpatients): at least 20
- Palliative care patients: at least 10
- Participation in Multi-Professional District Evaluation Units (participation): at least 10

The resident may apply for the diploma after completing the professionalizing activities.
As part of the training program, the resident must learn the scientific foundations of the School's approach to achieve full maturity and professional competence. This includes adequate ability to interpret scientific innovations and a critical understanding that allows them to consciously manage both care 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.