Roles: The surgeon exercises his/her profession in accordance with the EU regulations, and the national and regional regulations, within the National Health Service and in private structures. His/her purpose is to maintain, or help to achieve, the complete health state (a complete psycho-physical and social wellbeing) of persons and of society. In the execution of his/her professional activities, he/she cooperates, in a team, with other health professionals, keeping high his/her ability to interact and to coordinate the work of the interprofessional group (with other health professionals) and the intraprofessional one (with other physicians) where he/she is operating.
In order to fulfil this role, he/she should have a strong identity of his/her professional role. This includes a clinical competence, that is the usual and proper use of knowledge, communication skills, technical abilities, clinical reasoning, emotions, and values to repeatedly think of in his/her daily work activities for the wellbeing of the individual or the community he/she is taking care of, the commitment to pursue an accurate professional update, health promotion, adherence to ethical principles specific of the profession and to values, such as personal integrity, honesty, altruism, humility, the respect for diversity, frankness, and the respect for conflicts of interest.
Therefore, the physician has to keep a constant commitment towards his/her patients, being able to apply the best clinical practices in respect of a high ethical profile; towards society, being able to understand and meet its expectations on the theme of healthcare assistance; towards the profession's duties, respecting its rules and the codes of professional conduct; and the commitment to keep his/her psychophysical wellbeing state, with the purpose to improve his/her ability to take care of patients' health.
Higher responsibility levels and levels of coordination of the interprofessional and intraprofessional work groups, where he/she will operate, can be achieved by acquiring other competences by means of further training paths, such as Specialisation Programmes, Regional Schools of Training for General Practitioners, PhDs, and Second Level Professional Master Courses.
Competences: The competences connected to the roles of a physician have been decided in accordance with the international criteria established by "CanMEDS Physician Competency Framework," that is the current international reference point. According to the idea of "continuum" outlined in CanMEDS, the following competences will be acquired at an initial level, as above-mentioned.
The competences should be the ones of an expert physician, able to put the patient in the middle of a high quality treatment, that is safe for the very patient, on the basis of his/her updated knowledge, clinical abilities, and professional values. Then, he/she should be able to collect the information from the patient and interpret them, as well as make clinical decisions leading to the right diagnosis and the specific therapeutic interventions. He/she should know well the limits of his/her profession. His/her decisions must be based on the best clinical practices and scientific evidences, taking into account patient's wills and the economic resources of the health service of the country where he/she is operating. His/her clinical practice should then be extremely update, ethical, and able to guarantee an effective use of the resources, and it should be performed in close cooperation with the patient and his/her family, the other members of the intraprofessional and interprofessional work groups, and the whole community. Degree Course's essential task is to supply the update technical competences and to inform on their constant future update, as well as to verify their acquisition by means of the usual evaluative procedures.
In order to exercise the profession, it is essential to be an expert physician, and this leads to other competences intrinsically connected among them, as follows:
A capable communicator
He/she should be able to establish a relationship with the patient and his/her family, so to facilitate the collection and the sharing of the information needed for an effective treatment. Therefore, he/she will be able to examine the symptoms related to the pathology, listening to what the patient tells about his/her illness. He/she should be able to explore patient's viewpoint on his/her idea of illness, his/her fears and health expectations, taking into account the gender differences. The physician should be able to put his/her scientific knowledge in the specific patient's context, his/her socio-economic situation, past and present life, job, scholastic and cultural level, being able to detect special states connected to the social and psychological sphere. In order to put the patient in the middle of the treatment, it is very important to share one's decisions, so to align the health need with the patient's wills, values, and preferences. The development of communication skills is an integral part of the courses' core curriculum and is evaluated in the related exams.
A good collaborator
The physician should be able to efficiently and effectively work with the other members of the intraprofessional and interprofessional groups, with the purpose to supply a safe, high quality, and patient-centred assistance. The proper collaboration requires relations based on confidence, respect, and sharing, able to ensure continuity to the treatment. This requires the sharing of knowledge, points of view, and responsibilities, and the willingness to learn one from the other.
The physician will be able to work with the other members of the group to contribute to a view focused on the treatment's high quality, taking on himself/herself the responsibility of its proper supply to patients. Therefore, the physician will be able to effectively contribute to the development of an ever-improving healthcare activity, by searching for an efficient cooperation with the other players of the health service, at local, regional, and national levels, and with a view to globalisation.
A health defender
In this role, the physician should put his/her experience and influence at the service of community in order to improve its general state of health and wellbeing. For this purpose, health improvement must not be limited to the treatment of the disease, but it necessarily include the prevention of the disease, in health promotion and protection. This also implies equity in health promotion, in that individuals and community should not be disadvantaged on the basis of ethnic group, gender, sexual orientation, age, social class, economic status, and education. Physicians will supply support to patients, in order for them to be able to know and benefit from the National Health Service and to receive assistance in the proper ways and times. The courses of Medical-Scientific Methodology are the best way to acquire the Medical Deontology, that is essential for the student to develop his/her social role.
The physician should work hard to achieve and maintain the excellence in the clinical practice by means of a lifelong education, and should be able to teach to his/her colleagues, making evidence-based scientific decisions and actively contributing to clinical renovation by using, too, the translational scientific research. Physicians will pursue excellence in their daily work by actively interacting with other colleagues too, and by looking for confirmations in patients' satisfaction and safety. They will be able to correctly integrate the international scientific evidences with the clinical practice applied to the single patient, including into the decision patient's preferences and values.
The physician should take on himself/herself the commitment to the care of health and wellbeing of single patients and community, by means of a proper ethical conduct, high standards of professional conduct, and responsibilities towards profession and society, keeping a lifestyle that does not discredit the medical profession. In this role it is very important to be aware of one's professional identity, and it is required a perfect mastery of medicine's art, science, and practice. He/she should be aware that the professional role should completely reflect what the modern society expects from him/her, that is clinical competence, responsibility towards the professional updating, health promotion, and the complete adherence to ethical standards and values, such as personal integrity, altruism, humility, the respect for others and for diversity, frankness, and the respect for possible conflicts of interest.
Professional Opportunities: The physician, after passing the state qualifying examination and the registration into the Professional Register of Surgeons and Odontologists, will be able to work in public and private hospitals. He/she can also work in other local ASL structures, such as day hospitals, hospices, Residential Care Homes (RSA), services for drug addicts (SerT), services for pathological addicts (SerD), psychiatric institutions, centres for disabled people, and long-term care structures. He/she can operates in Institutions of Scientific Recovery and Care (IRCCS) and universities, or can be a freelance professional.
Graduates can pursue an academic career or a research one, in universities, in public institutions, or in private organisations.
In order to operate in the National Health Service, it is necessary to get the Specialisation degree, that can be obtained by enrolling in and attending the courses of the Specialisation Schools; in order to be shortlisted as general practitioners, it is necessary to attend the Regional Schools of Training for General Practitioners.
In order to access the Specialisation Schools, it is necessary to pass a national examination, and in order to access the Regional Schools, it is necessary to pass a regional examination.
The consultation on the educational project for the a.y. 2018/19 of the single-cycle Masters Degree Programmes in Medicine and Surgery took place with the meeting with the Association of Surgeons and Dentists of Province of Rome on 19 April 2018.
Moreover, a meeting with the Italian Association of Private Hospital System (AIOP Lazio) was held on 13 April 2018.
Indications by the interfaculty "Medical Education" Committee have been taken into account too; within this Committee, the practitioners involved in the Sapienza University training operate.
Furthermore, the indications by the Association for Medical Education in Europe (AMEE) have been adopted - within this Association, some teachers of Sapienza University actively participate - as well as the indications by the Italian Society of Medical Pedagogy, whose President is one of the Sapienza teachers.
From these meetings it came to light that the project of the above-mentioned Masters Degree Programmes in Medicine and Surgery are properly organised to meet the educational needs highlighted during the meetings.
Furthermore, the roles and competences specific of the professional profile of a surgeon - recently updated - are adequately described, representing, thus, a basis clear enough to define the learning outcomes expected in relation to the Dublin Descriptors.
The expected learning outcomes - both general and specific - planned in the system are coherent with the professional needs, so to guarantee that graduates' preparation could satisfy the greater needs of society and labour market (training demand).
In the meeting with the Association of Surgeons, it was positively evaluated the excellent organisation of the pre-degree orientation, that has an overall catalogue even greater than the previous year, integrated with the initiatives about the projects of alternation school-work, centred both on the preparation of the minimum knowledge needed to access the Course of Medicine and Surgery, and on the motivational and attitudinal aspects needed for the profession of a surgeon.
As established in the meetings held during the a.y. 2017/18, now to this project the Association of Surgeons will also participate with specific meetings carried out for High School students within the projects "Walking to Medicine" and "Vivi una Mattina Universitaria."
In the 19 April meeting it was reaffirmed Association's interest in these projects, with the direct participation of the Association of Surgeons and Dentists of Rome.
Therefore, these projects will be conducted, and integrated with new projects of alternation school-work, during the next a.y. 2018/19 too.
In order to strengthen and improve the professional figure - as already established in the previous meetings - for all the Masters Degree Programmes in Medicine and Surgery, have been made uniform the 2 ECTS dedicated to General Medicine, placed in their most natural destination about Internal Medicine and/or Community Medicine, integrating these activities in the existing integrated courses of the Programmes in Medicine and Surgery.
According to the last year meeting, common programmes on topics proposed by the Association of Surgeons have been developed, such as chronicity, the delicate patient, the pain relief therapy, the communication with the patient, the inter-professional and trans-professional communications, the quality of healthcare, and the courses of treatment.
The actions to be taken will be aimed at strengthening these topics for the next academic year too, integrating these topics with the ones connected to the themes of global health.
In the19 April 2018 meeting with the Association of Surgeons, it was decided to implement their last year proposals, by means of a more coordinated cooperation between Sapienza University and the Association of Surgeons of Rome on the project "Medicina di Prossimità;" moreover, it was decided to pay a greater educational attention towards the local healthcare structures, implementing the current actions with the themes connected to the "global health," and activating an elective course on such a subject that may include a wide involvement of the Association and of civil organisations, and that is open to every student of all Masters Degree Programmes in Medicine and Surgery.
Furthermore, it was decided to implement the educational activities on advanced simulations, in order to improve the students' practical and decisional abilities, fully using the new potentialities of the advanced simulation labs, that have been recently completed inside the University with the contribute of Fondazione Roma.
The themes related to general medicine will be taken into consideration, as well as those connected to the palliative therapies, the pain relief therapy, and the care for people in the last days of life; the themes related to translational scientific research and the topics dedicated to precision medicine will be included.
These topics will have to be handled locally.
Following the Association's suggestion, it was decided to implement, too: students' knowledge on the themes related to the therapeutic-diagnostic treatments; the cooperation with the ASL-handled Day-care Centres and Rehabilitation Day-care Centres; the knowledge on appropriateness of diagnostics and therapy in accordance with it is established in the Essential Healthcare Levels (LEA) of the NHS; a greater importance given to the knowledge on inappropriate admission, the prescriptive inappropriateness, the proper error handling in medicine, the use of BEERS criteria on medication prescription, that are considered particularly useful to a curriculum in geriatrics.
These activities will be implemented also by planning elective educational activities that can be organised easily and allow to update speeder the students, without waiting for innovative themes inside the didactic organisation for the a.y. 2018/19 that would reach the students in future years.
More in detail, the Association proposes to organise an elective three-hour didactic module on the subject of local medical-legal certification.
It was decided to organise, for the sixth-year students, in the next academic year an elective three-hour course on this topic, handled by the Association of Surgeons and supplied as a certificated online course.
These projects, proposed as a pedagogical innovation by the interfaculty Committee of Medical Education (Pharmacy and Medicine, Medicine and Dentistry, Medicine and Psychology), have been shared with the Association of Surgeons and will be implemented in the educational activities of the Programmes of Medicine and Surgery of three Sapienza faculties.
In the 13 April 2018 meeting with the AIOP Lazio, it was reaffirmed the agreement established in 2013 aimed at improve the occupation of the new graduates at the structures connected to the AIOP Lazio.
This agreement must be further implemented in its application. Furthermore, it was reaffirmed the importance to propose to the students elective internships at residential care homes, hospices, psychiatric structures, centres for disabled, and long hospitalisation structures.
The AIOP, too, sharing the project "Medicina di Prossimità" approved last year, shares the usefulness of and approves the pedagogical initiatives on the deepening of themes about global health and social inequalities, along with the project on the implementation of activities connected to the advanced simulation, with the purpose to improve the manual abilities and the reasoning ones of students, by means of specific simulation programmes, also in relation to the new potentialities of Sapienza University on the subject.