Clinical practice 5th year (clerkship)

A.A. 2019/2020
5
Crediti massimi
125
Ore totali
SSD
MED/09 MED/18 MED/21 MED/24
Lingua
Italiano
Obiettivi formativi
Students are trained to the basic surgical and medical skills through attendance in the ward and in the operating room. Students attend the departments of General Surgery, Thoracic surgery, Urology and Internal medicine. During the clerkship students are involved in an overview of Internal Medicine, urology and its subspecialties through rotation (organized by work shifts) in clinics, ward work, and operating room. Practical activities are used to consolidate technical and soft knowledge and skills developed during frontal lectures through:
- Ward round and clinical examination of admitted patients
- Execution of a complete physical examination and recognition of partological pictures
-Discussion of possible differential diagnoses and related exams prescrition
- Setting of a therapeutic scheme
- Physical examination of operated patients
- Multidisciplinary meeting attendance
- Operating room attendance
- Endoscopy service attendance.
Risultati apprendimento attesi
Students are expected to achieve general and specific requirements:
- Surgical hand scrub
- Management of sterility during surgery
- Surgical incision and principles of hemostasis
- How a wound is sutured
- Peripheral venous cannulation
- Physical examination of the abdomen
- Wound care
- Management of abdominal drainage
- Discussion of thoracic surgery clinical cases
- Basic knowledge of standard thoracic surgery steps
- Knowledge of guidelines and basic principles to correctly address prognostic perspective of patients suffering form lung cancers.
how to take general and urologic histories and physicals (including digital rectal examination)
- how to manage patients affected by renal pain (medical therapy, bladder and kidney ultrasound, interpretation of radiological exams, indications for surgical treatment)
- how to manage patients affected by hematuria (acute treatment with bladder irrigation, bladder and kidney ultrasound, diagnostic cystoscopy)
- how to make a differential diagnosis between anuria and urinary retention (including bladder and kidney ultrasound)
- how to insert a urethral catheter and eventually perform the urethral catheterization
Programma e organizzazione didattica

Edizione unica

Prerequisiti
To attend the Clinical Practice course, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Modalità di verifica dell’apprendimento e criteri di valutazione
The exam of Clinical Practice will be organized at the end of the 1st semester of the 6th year, when the course will be completed.
Students' fulfillment of competencies at the end of the 6th year will be assessed by:
· A practical assessment of clinical skills
· A written test
An oral part based on the discussion of clinical cases.
Final formal examination at the end of the 6th year may be preceded by an intermediate evaluation test of General Surgery at the end of the 5th year. Also reviews and discussion on medical literature and/or specific clinical research topics could concur to the evaluation either at intermediate or final stage.
Internal medicine
Programma
Internal medicine:
Clinical approach to admitted patients: execution of a complete physical examination and recognition of pathological pictures, discussion of possible differential diagnoses and related exams prescription, setting of a therapeutic scheme. Multidisciplinary meeting attendance.

Surgery
Clinical approach to surgical patient:
Operating Room Attendance: Surgical hand scrub, management of sterility during surgery. Assist to surgical incision and principles of hemostasis, wound suture, peripheral venous cannulation.
Physical examination of operated patients: physical examination of the abdomen, wound care, management of abdominal drainage
Basic knowledge of standard thoracic surgery steps
Clinical approach to patients suffering form lung cancers.
Clinical approach and physical examination to patients affected by renal pain (kidney ultrasound, interpretation of radiological exams, indications for surgical treatment), patients affected by hematuria (acute treatment with bladder irrigation, bladder and kidney ultrasound, diagnostic cystoscopy), patients with anuria and urinary retention
Assist and eventually perform the urethral catheterization.
Metodi didattici
To attend the Clinical Practice course, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Materiale di riferimento
· Harrison's Principles of Internal Medicine, 20th Edition, McGraw Hill, 2018 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
· UP To Date - Evidence Based Clinical Decision Support resource
Thoracic surgery
Programma
The course is based on a strong integration of different disciplines, thus the program of the single disciplines cannot be extracted form the program of the whole course which is reported in module Internal medicine.
Metodi didattici
To attend the Clinical Practice course, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Materiale di riferimento
· Shields' General Thoracic Surgery by Joseph LoCicero III MD 8th Edition, Wolters Kluwer
· Pearson's Thoracic and Esophageal Surgery Churchill Livingstone last Edition
Urology
Programma
The course is based on a strong integration of different disciplines, thus the program of the single disciplines cannot be extracted form the program of the whole course which is reported in module Internal medicine.
Metodi didattici
To attend the Clinical Practice course, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Materiale di riferimento
· Smith & Tanagho's GENERAL UROLOGY, Jack W. McAninch & Tom F. Lue, 18th or 19th Edition
General surgery
Programma
The course is based on a strong integration of different disciplines, thus the program of the single disciplines cannot be extracted form the program of the whole course which is reported in module Internal medicine.
Metodi didattici
To attend the Clinical Practice course, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Materiale di riferimento
Significant material and all slides used during frontal lessons and seminars are uploaded in the Ariel platform for student access.
· Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 20th Edition Elsevier 2017
Moduli o unità didattiche
General surgery
MED/18 - CHIRURGIA GENERALE - CFU: 2
Clerkship (att.prof.): 50 ore

Internal medicine
MED/09 - MEDICINA INTERNA - CFU: 1
Clerkship (att.prof.): 25 ore

Thoracic surgery
MED/21 - CHIRURGIA TORACICA - CFU: 1
Clerkship (att.prof.): 25 ore

Urology
MED/24 - UROLOGIA - CFU: 1
Clerkship (att.prof.): 25 ore

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