Postgraduate Specialization of Internal 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 molecular biology, etiopathogenesis, pathophysiology, and pathology to achieve a full understanding of the phenomenological unity of various disease processes. This enables them to interpret the nature of clinical phenomena in their entirety based on the pathophysiological relationships between different organs and systems.

General Educational Objectives
The trainee must acquire knowledge of epidemiology, methodology, and physical, laboratory, and instrumental semiotics, including nuclear medicine, as well as bioimaging diagnostics. They must also utilize modern research methodologies for scientific knowledge and information, acquire the tools for their critical evaluation, and be able to apply them appropriately in a wide variety of clinical conditions.

Educational Objectives of the School
The resident must be able to assess the indication and expected utility and critically select the appropriate diagnostic tools and pathways, including those within the scope of specialist expertise; and interpret the results of laboratory, instrumental, bioimaging, endoscopy, and pathological histology tests. They must acquire in-depth knowledge of the most common diseases and chronic noncommunicable diseases; they must acquire knowledge of relatively rare diseases. They must be able to independently use the most appropriate clinical tools and investigations to recognize various disease conditions and rationally implement the most effective therapies. They must be able to prescribe, based on risk/benefit and cost/effectiveness profiles, the most appropriate pharmacological, non-pharmacological, and/or surgical treatments for the various clinical conditions within the specific scope of Internal and General Medicine. They must be able to manage therapeutic regimens for the treatment of atherothromboembolic diseases, including anticoagulant therapy and possible bleeding complications. They must be able to identify their role and share decision-making responsibility within specialized and multidisciplinary settings, ensuring continuity of care. They must also be able to recognize the most common specialized disorders and choose the appropriate diagnostic and treatment modalities, distinguishing between conditions requiring specialist consultation and those that can be addressed directly by an internist. They must be able to recognize patients with the most frequently encountered clinical emergencies early and, within the limits of available equipment and resources, provide the most effective initial treatment, including resuscitation, within the most effective initial treatment options available. They must be able to administer pharmacological therapies and the most common instrumental treatments required in critically ill patients. They must be able to manage specific dietary regimens and practice enteral and parenteral nutrition.

The trainee must also understand and compare their motivations and ideological and moral positions with the ethics required for human care. They must have a clear understanding of the progressive development of medicine from its naturalistic and healing origins to scientific medicine. Residents must be familiar with the legal and organizational aspects of the profession, as well as those of the National Health Service (SSN). They must be able to provide appropriate guidance for the full use of SSN facilities, based on the expressed needs and the characteristics of social groups, the local area, and the living and working environment, in compliance with the criteria of good clinical practice. They must be familiar with the fundamental methodologies of healthcare management, work organization, and healthcare economics.

Residents must acquire a thorough understanding of the pathophysiology of critical conditions; they must have acquired adequate experience in the application of pharmacological, nutritional, and instrumental treatments in critically ill patients; and they must be able to manage the safe transfer of critically ill patients to the most appropriate environment for their condition. To this end, they must have participated in the following procedures: cardiac defibrillation, oxygen therapy (administration methods), ventilatory assistance (mechanical and manual ventilation), central venous catheter placement, gastric and intestinal probing, including in comatose patients, and hemorrhage tamponade.

The trainee must be able to recognize and distinguish between urgent and actual or potential emergencies, including those of a toxic or traumatic nature. They must be able to identify the cause, implement all available measures to ensure the maintenance of vital functions, and be able to make recommendations for essential laboratory and instrumental tests. They must be able to identify conditions requiring specialist or multidisciplinary expertise. They must be able to fulfill the role appropriate to their specific expertise in diagnostic and therapeutic team activities.


Mandatory professional development activities to achieve the educational objectives of this type of training include:
- having compiled and countersigned 100 medical records of inpatients or outpatients personally cared for; the records must include a complete physical examination that includes, among other things, an assessment of nutritional status and, where indicated, a rectal and/or vaginal examination. Where necessary, the practitioner must have properly prepared samples and sent biological fluids to the laboratory with the appropriate analysis request;
- having participated in at least 50 internal medicine consultations at external, specialist, or regional departments;
- having interpreted at least 50 electrocardiograms sufficient to diagnose the most common arrhythmias, conduction, and repolarization disorders;
- Have personally performed the following invasive procedures (at least 5 each): paracentesis, thoracentesis, blood gas sampling, cytological aspirates of various organs and systems, assisted ventilation, bone marrow aspiration;
- Have participated in instrumental investigations (at least 40 in total) such as Doppler ultrasound of the major arteries and veins, echocardiography, exercise testing, endoscopy, scintigraphy, respiratory function tests, and allergy diagnostics;
- Have acquired expertise in basic and advanced cardiopulmonary resuscitation techniques (BLS and ACLS) and have participated in or performed at least 2 resuscitation procedures on a patient or manikin;
- Have directly performed 50 ultrasound examinations capable of interpreting images of internal medicine interest (neck, thyroid, breast, chest, digestive system, liver and biliary tract, pancreas, spleen, kidneys and adrenal glands, bladder);
- have discussed at least 10 echocardiographic examinations and 5 angiographic examinations with the specialist;
- have discussed at least 10 histopathological preparations with the specialist;
- have discussed at least 20 brain CT or MRI scans with the specialist;
- have discussed at least 30 chest X-rays, spine X-rays, and digestive tract X-rays with the specialist;
- have participated in at least 20 divisional or interdivisional on-call shifts, assuming direct responsibility (with the possibility of consulting the supervisor) for the shifts in the last two years;
- have directly supervised the conduct, in accordance with good clinical practice, of at least 3 controlled clinical trials.

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

As part of their training, the trainee will be expected to 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 assistance and their own development. This training 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.