Clinical practice 6th year

A.A. 2021/2022
10
Crediti massimi
120
Ore totali
SSD
M-PSI/01 MED/01 MED/09 MED/18
Lingua
Inglese
Obiettivi formativi
The clinical practice course is organized along 3 semesters (1st and 2nd sem 5° year and 1st sem 6° year) and integrates several disciplines to provide the students with conceptual tools to properly manage major clinical presenting problems. The 6° year module integrates Internal medicine and General surgery with Exercise and Sport Medicine, General psychology and Medical statistics. Coherently with the first module of the course held in the 5th year,in the 6 year
Starting from a complex cases the differential diagnosis and the therapeutic aspects are addressed. By integrating the different discipines students are trained to identify the most appropriate clinical and diagnostic tests to formulate a correct diagnosis and start planning the appropriate treatment. The Exercise and Sport Medicine Module provides the students with conceptual tools to introduce lifestyle intervention programs (with particular focus on physical exercise and nutrition) to foster health/wellbeing and to prevent/treat major chronic non communicable diseases. Medical Statistic introduces the students to Methodology of clinical research: how to write and present a clinical research protocol. The General Psychology module focuses on the concept of patients' adherence, cultural and gender differences in patients management and care givers in health management.
Risultati apprendimento attesi
At the end of the 5th and 6th year module fo the course students are expected to:
- use appropriately the clinical judgment in the evaluation of patients with complex presenting problem and complex diseases
- use the appropriate use of clinical, laboratory, tests and exams findings
- know the predictors, barriers and facilitators of adherence, know the methods for improving patient's adherence
- be aware of the cultural factors impacting on patients choices
- know the principal etiopathogenetic mechanisms of chronic non communicable diseases are modified by lifestyle interventions
- know the basic clinical competencies in order to define cardio-metabolic risk and behaviors
- be able to prescribe lifestyle intervention programs, physical exercise and nutrition, in order to foster health/wellbeing and to prevent/treat major chronic non communicable diseases.
- know how to motivate subjects/patients to modify their lifestyle
- Be able to write and present a clinical research protocol
- set up of a proper patient's treatment
Programma e organizzazione didattica

Edizione unica

More specific information on the delivery modes of training activities for academic year 2021/22 will be provided over the coming months, based on the evolution of the public health situation.
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 will be organized at the end of the 1st semester of the 6th year, when the course will be completed, and will cover all the topics of Clinical Practice 5th year and Clinical Practice 6th year courses. Students' fulfillment of competencies will be assessed by 2 written tests and an oral session. It is mandatory to pass both the written test to be admitted to the oral examination.
WRITTEN EXAMINATION
1) Written test of General Surgery
A written test using multiple choices Q&A questionnaire. 40 questions, each question has 4 answers, and each answer can be true or false. The questionnaire will be prepared on the slides presented at the frontal lessons (uploaded in the University website for student access) and on the official Textbook. The written test will be considered valid when at least 75% of responses will be answered correctly.
2) Written test of the following disciplines:
Plastic Surgery; Thoracic Surgery; Urology; Clinical Pathology; General psychology; Pharmacology; MED-EF/01
10 questions with 4 answers for each discipline, with only one correct answer. To pass this test students must answer correctly to 6/10 questions in each module.
3) Oral examination of Internal Medicine and General Surgery
ORAL EXAMINATION
For each exam session, the oral examinations of Internal Medicine and General Surgery are scheduled in two separate dates.
An oral discussion with the Course Director and/or Collaborators focused on clinical cases, multi-disciplinary analysis, risk-benefit of various therapeutic alternatives and clinical/research speculations on surgical patients presenting with clinical conditions described in the synchronous and asynchronous learning material as well as in the suggested Textbook. Contents of the asynchronous activities (e.g. Surgery Blog) will be valued, as part of the general assessment of student's participation and acquired knowledge.
The final mark is the weighted average of the two marks obtained in the oral examinations of Internal Medicine and General Surgery.
Written tests and Oral examinations can be taken in different exam sessions. Once passed, the written tests and the oral examinations remain valid.For general information about Exams required skills see also the section "Expected Outcome" below.
BIOSTATISTICS ASSESSMENT
Student assessment is based on the evaluation of a presentation of the work conducted during the practical activities. Students are required to present a draft research protocol for a clinical trial or an observational study. The presentation will be made in the presence of selected components of the exam commission and other students. The presentations will be prepared by small groups of students (maximum 3) and will be divided equally among the group members.
Internal medicine
Programma
MODULE: INTERNAL MEDICINE
For each presenting problem:
· Identify the most appropriate tests to formulate a correct diagnosis
· Plan the appropriate treatment
PROGRAM:
TOPIC 1. Transition-of -Care
TOPIC 2. Innovative treatments
TOPIC 3. How to treat: pain (Recall different types of pain , Describe the general approach to pain treatment, Pain in the oncology setting, Treatment of oncological pain , Chronic pain in fibromyalgia , Drugs for fibromyalgic pain)
TOPIC 4. How to treat: Hypertension and Hypotension
TOPIC 5. Treatment of complex clinical cases
TOPIC 6. How to treat infection
EXPECTED LEARNING OUTCOMES:
At the end of the module students are expected to:
· use appropriately the clinical judgment in the evaluation of patients with complex presenting problem and complex diseases
· use the appropriate use of clinical, laboratory, tests and exams findings
· know the predictors, barriers and facilitators of adherence, know the methods for improving patient's adherence
· be aware of the cultural factors impacting on patients choices- know the principal etiopathogenetic mechanisms of chronic non communicable diseases are modified by lifestyle interventions
· know the basic clinical competencies in order to define cardio-metabolic risk and behaviors
· set up of a proper patient's treatment

MODULE: EXERCISE AND SPORT MEDICINE
The Exercise and Sport Medicine Module will provide the students with conceptual tools to introduce lifestyle intervention programs (with particular focus on physical exercise and nutrition) to foster health/wellbeing and to prevent/treat major chronic non communicable diseases.
PROGRAM:
· Achievement of a beginners level of the understanding of how the principal etiopathogenetic mechanisms of chronic non communicable diseases are modified by lifestyle interventions
· Achievement of the basic clinical competencies in order to define cardio-metabolic risk and behaviors
· Acquisition of the most important competencies to prescribe lifestyle intervention programs (with particular focus on physical exercise and nutrition) in order to foster health/wellbeing and to prevent/treat major chronic non communicable diseases.
· Acquisition of the core competencies to motivate subjects/patients to modify their lifestyle
· Achievement of a beginners level of the understanding of etiopathogenetic mechanisms of stress and functional syndromes and acquisition of the basic competencies to manage these conditions particularly using lifestyle modification programs
LEARNING OBJECTIVES:
TOPIC 1: From cardiometabolic risk to lifestyle management to prevent/treat chronic non communicable diseases
TOPIC 2: Principles of behavioral medicine to improve lifestyle: from "what" to "how"
TOPIC 3: Prescription of exercise program
TOPIC 4: Prescription of nutrition program
TOPIC 4: Lifestyle, Stress and Functional Syndromes

EXPECTED LEARNING OUTCOMES:
· Exercise and Sport Medicine: definitions, differences and clinical importance
· Health, Wellbeing, Prevention and Lifestyle Medicine
· Effects of lifestyle interventions on main etiopathogenetic mechanisms of chronic non communicable diseases: a translational approach
· Importance of exercise medicine in chronic non communicable disease (cardiometabolic diseases, cancer, functional syndromes, etc)
· Cardiometabolic risk and lifestyle assessment
· Patient's assessment in order to prescribe lifestyle intervention programs (with particular focus on physical exercise and nutrition)
· Definition of specific clinical goals and personalized medicine in lifestyle interventions
· Exercise prescription: Modality (endurance, strength, flexibility, balance), aerobic and anaerobic, Intensity (definition of training heart rate), frequency, duration, progression
· Nutrition program prescription
· Synergies between exercise and nutrition programs
· Principles of behavioral medicine: how to motivate patients to modify lifestyle
· Stress and Functional Syndromes: definitions, clinical implications and management
Metodi didattici
FOR ALL MODULES: Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
GENERAL SURGERY MODULE:
Synchronous learning: Formal lessons delivered by the Course Director, Faculty and Invited Experts will be delivered as formal lectures, seminars, video sessions, video tutorial and clinical case discussions focused on the topics summarized below in the detailed program.
Asynchronous learning: As described in details in the Program below asynchronous learning will be developed through a Surgery Blog (SUB) activated and made accessible to all registered students and professors participating to the course. Each week a real clinical case will be uploaded and opened to groups and individual discussion (Case of the Week). Each Group will be asked to stick to pre-assigned format for case analysis. Contributions to the Surgery Blog will be valued as part of the general assessment of student's participation and acquired knowledge over time.
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
· ACSM's Guidelines for Exercise Testing and Prescription. 2018, 10th ed
· Up to Date-Evidence based clinical decision support resources
General surgery
Programma
Topic 1 - SURGICAL PRINCIPLES AND INDICATION IN GENERAL PRACTICE (SUM-UP)
· Surgical principles and main indications (overview on General Surgery course of 5th year)
· Complications in the surgical patient. Risk prediction
· Bedside surgical procedures
· Day Surgery and Surgical outpatient practice
Topic 2 - SEMINAR: SURGERY IN THE ELDERLY (PROS AND CONS)
Case presentations and multidisciplinary discussion
· Physiologic reserve. Cardiovascular-Respiratory-Renal-Hepatobiliary changes with age
· Risk factors, Energy requirements. Bed rest. Prognostic scores
· Competitive risk and life expectancy
Topic 3 - SEMINAR: ENDOCRINE SURGERY AND NEUROENDOCRINE TUMORS
Case presentations and multidisciplinary discussion
· Neuroendocrine
· Thyroid & Parathyroids
· Adrenal gland and endocrine pancreas
Topic 4 - SURGERY FOR MORBID OBESITY
· Magnitude of the problem
· Evaluation of the obese patient
· Medical vs. Surgical therapy: indications for bariatric surgery
· Mechanism of action of bariatric surgery
· Pre and post-operative care
· Operative procedures
Topic 5 - SEMINAR: SURGERY AND INFECTIONS (PRINCIPLES, GUIDELINES)
Case presentations and multidisciplinary discussion
· Principles of surgical infections and antibiotic use
· Guidelines for pre-operative prophylaxis and postoperative treatment
· Soft tissue infections, surgery for abscesses
· Burn and wound management
· Case presentations and multidisciplinary discussion
Topic 6 - TRANSPLANTATION AND IMMUNOLOGY
· Transplantation immunobiology and immunosuppression
· Liver transplantation
· Kidney transplantation
· Pancreas and small bowel transplantation)
Metodi didattici
FOR ALL MODULES: Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
GENERAL SURGERY MODULE:
Synchronous learning: Formal lessons delivered by the Course Director, Faculty and Invited Experts will be delivered as formal lectures, seminars, video sessions, video tutorial and clinical case discussions focused on the topics summarized below in the detailed program.
Asynchronous learning: As described in details in the Program below asynchronous learning will be developed through a Surgery Blog (SUB) activated and made accessible to all registered students and professors participating to the course. Each week a real clinical case will be uploaded and opened to groups and individual discussion (Case of the Week). Each Group will be asked to stick to pre-assigned format for case analysis. Contributions to the Surgery Blog will be valued as part of the general assessment of student's participation and acquired knowledge over time.
Materiale di riferimento
· Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 20th Edition Elsevier 2017
· Additional material is provided by the slide-presentation used during frontal lessons and seminars, uploaded in the Ariel platform of the University for student access
Medical statistic
Programma
PART 1
· Introductory Lecture. Statistical Inference and methodology of clinical research.
· Lecture: How to write a research protocol: Introduction to the CONSORT statement and presentation of a research protocol template (Background, Goal, Methods, Sample Size)
PART 2
· Write and present your research protocol
· Small group work and final presentation
Metodi didattici
FOR ALL MODULES: Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
GENERAL SURGERY MODULE:
Synchronous learning: Formal lessons delivered by the Course Director, Faculty and Invited Experts will be delivered as formal lectures, seminars, video sessions, video tutorial and clinical case discussions focused on the topics summarized below in the detailed program.
Asynchronous learning: As described in details in the Program below asynchronous learning will be developed through a Surgery Blog (SUB) activated and made accessible to all registered students and professors participating to the course. Each week a real clinical case will be uploaded and opened to groups and individual discussion (Case of the Week). Each Group will be asked to stick to pre-assigned format for case analysis. Contributions to the Surgery Blog will be valued as part of the general assessment of student's participation and acquired knowledge over time.
Materiale di riferimento
· J. Mark Elwood, "Critical Appraisal of Epidemiological Studies and Clinical Trials", 3rd Edition, Oxford University Press
· CONSORT Statement (www.consort-statement.org)
General psychology
Programma
Lecture 1 - Patients' Adherence I
· Definition and method to measure adherence
· Predictors, barriers and facilitators of adherence
Lecture 2 - Patients' Adherence II
· Psychological theories of adherent behavior
· Methods for improving people's adherence
· Examples of applications
Lecture 3 - Cultural and gender differences in patients management
· Cultural difference in the therapeutic alliance
· The role of cultural factors on patients choices
· Age as cultural factor
· Gender difference and gender bias in clinical practice
Lecture 4 - Care givers in health management
· The role of care-giver in patients management
· Predictors, barriers, facilitators and risk of care-givers' involvement
Metodi didattici
FOR ALL MODULES: Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
GENERAL SURGERY MODULE:
Synchronous learning: Formal lessons delivered by the Course Director, Faculty and Invited Experts will be delivered as formal lectures, seminars, video sessions, video tutorial and clinical case discussions focused on the topics summarized below in the detailed program.
Asynchronous learning: As described in details in the Program below asynchronous learning will be developed through a Surgery Blog (SUB) activated and made accessible to all registered students and professors participating to the course. Each week a real clinical case will be uploaded and opened to groups and individual discussion (Case of the Week). Each Group will be asked to stick to pre-assigned format for case analysis. Contributions to the Surgery Blog will be valued as part of the general assessment of student's participation and acquired knowledge over time.
Materiale di riferimento
· Papers provided during lessons.
Additional material, in particular to online content, will be made available during the course.
Moduli o unità didattiche
General psychology
M-PSI/01 - PSICOLOGIA GENERALE - CFU: 1
Lezioni: 12 ore
Docente: Mazzocco Ketti

General surgery
MED/18 - CHIRURGIA GENERALE - CFU: 3
Lezioni: 36 ore

Internal medicine
MED/09 - MEDICINA INTERNA - CFU: 4
Lezioni: 48 ore

Medical statistic
MED/01 - STATISTICA MEDICA - CFU: 2
Lezioni: 24 ore

Docente/i
Ricevimento:
Su appuntamento previo contatto via e-mail
Campus Cascina Rosa, Via Vanzetti 5, Milano
Ricevimento:
previo appuntamento da concordare via e-mail
Ricevimento:
concordato su richiesta via email
concordato su richiesta via email
Ricevimento:
16:00
Ospedale Maggiore Policlinico, Padiglione Granelli II Piano, Ambulatorio Epatologia e Malattie Metaboliche e del Fegato
Ricevimento:
previo appuntamento da concordare via e-mail
Servizio Medicina dell'Esercizio, IRCCS Istituto Auxologico Italiano, via Pier Lombardo 22
Ricevimento:
Previo appuntamento da concordarsi tramite mail
Istituto Nazionale Tumori, Via Venezian n.1
Ricevimento:
previo appuntamento
Istituto Europeo di Oncologia, Via Ripamonti 435
Ricevimento:
previo appuntamento da concordare via e-mail