Medicine and Surgery - Roma Azienda Ospedaliera Sant'Andrea

SEVERINO PERSECHINO
GIORGIO SESTI
PAOLO MENE'
MARCO SALVETTI
PASQUALE PARISI
ALBERTO RICCI
MAURIZIO POMPILI
MONICA ROCCO
ALBERTO SIGNORE
MATTIA FALCHETTO OSTI
ALESSANDRO BOZZAO
FEDERICA MAZZUCA
EMANUELE BARBATO
CARMINE SAVOIA
MARCO FRANCONE

At the end of the practical-evaluation internship, the student:
It puts into practice the good practices of the doctor-patient relationship, knows how to manage the reception and structure the consultation: interview, report, information, clarity, acquisition of consent
He has the ability to collect his medical history and to perform an objective examination in an outpatient and home setting
He knows and is able to apply clinical reasoning: he is able to identify the reasons for the request for help and the nature and priority of the problem
He is able to assess urgencies and to identify the need for hospitalization
Is able to propose diagnostic hypotheses and to identify the first level diagnostic tests with greater sensitivity and specificity to confirm or not the hypotheses
He is able to interpret laboratory tests
e is able to interpret the reports of diagnostic imaging tests
It focuses on the decision-making processes related to the prescription of a correct treatment and on the request for a specialist consultancy
He is able to know how to carry out monitoring activities on the patient's adherence to therapy and to plan monitoring and follow up
He knows the problems of the chronic patient with comorbidity in multi-pharmacological therapy
He demonstrates knowledge about the organization of the National and Regional Health Service and about the main bureaucratic and prescriptive rules
He is able to use the computerized medical record and knows the information systems of the National and Regional Health Service
He can indicate prevention actions, health promotion and healthy lifestyles
He respects the start and end shift times, suitably fits the role, brings with you everything you need
He demonstrates knowledge and awareness of the rules of organization and functioning of the doctor's office
He interacts correctly with the secretarial and nursing staff of the general practitioner
He demonstrates an active and collaborative attitude: he asks questions, proposes activities

During the medical area clinical training (TPVES), the student is expected to progressively acquire and demonstrate the following professional and practical competences, under appropriate supervision:

A. Clinical and Diagnostic Skills
Collect a comprehensive medical history, including personal, familial, and social background.
Perform a complete physical examination, with correct methodology and patient-centered communication.
Recognize and interpret signs and symptoms of common internal medicine diseases.
Measure and interpret vital signs (heart rate, respiratory rate, blood pressure, temperature, oxygen saturation).
Perform basic diagnostic procedures such as:
Venipuncture and capillary blood sampling;
Electrocardiogram (ECG) recording and preliminary interpretation;
Urinalysis and rapid bedside diagnostic tests;
Peak flow or spirometry under supervision.
Participate in the formulation of diagnostic hypotheses and in planning appropriate investigations (laboratory and imaging).

B. Therapeutic and Procedural Skills
Collaborate in the implementation of pharmacological and non-pharmacological treatments, understanding indications, contraindications, and side effects.
Ensure safe drug administration, under supervision, by oral, intravenous, or other routes.
Monitor therapy effectiveness and adverse reactions.
Apply infection prevention and control measures, including hand hygiene and use of PPE.
Participate in fluid therapy management and monitoring of fluid balance.
Recognize and manage, under supervision, urgent and emergency situations (e.g., shock, respiratory failure, chest pain, arrhythmias).

C. Communication and Teamwork Skills
Communicate clearly and empathetically with patients and families.
Present clinical cases to tutors and colleagues using structured methods (SOAP, SBAR, or problem-oriented presentation).
Collaborate within interdisciplinary teams, respecting the roles of healthcare professionals.
Participate in ward rounds, clinical meetings, and case discussions.

D. Professional Attitude and Ethics
Demonstrate professionalism, responsibility, and confidentiality in all clinical activities.
Apply ethical principles in patient care, including respect for autonomy and informed consent.
Maintain accurate, complete, and legible clinical documentation.
Reflect on personal performance and identify areas for improvement through self-evaluation and tutor feedback.
At the end of the medical area clinical training (TPVES), the student will be able to:
Knowledge and understanding
Describe the pathophysiological mechanisms, clinical presentation, and natural history of the main internal medicine diseases.
Understand the diagnostic and therapeutic pathways for acute and chronic medical conditions, integrating clinical, laboratory, and instrumental findings.
Explain the principles of pharmacological and non-pharmacological treatment, including monitoring of efficacy and safety.
Applying knowledge and understanding
Perform a focused clinical history and complete physical examination in adult patients with medical conditions.
Identify clinical problems, formulate diagnostic hypotheses, and plan appropriate diagnostic tests.
Participate in clinical decision-making and contribute to patient management under supervision.
Apply basic procedures of medical practice (e.g., venipuncture, ECG recording, blood pressure measurement, interpretation of vital signs).
Making judgements
Recognize clinical priorities and emergencies in internal medicine.
Assess the severity and evolution of disease through observation and monitoring.
Integrate ethical, clinical, and safety principles in decision-making and patient care.
Communication skills
Communicate effectively and empathetically with patients and families, collecting relevant information and providing explanations in understandable language.
Collaborate appropriately within the multiprofessional healthcare team, respecting roles and competencies.
Present and discuss clinical cases clearly and logically.
Learning skills
Demonstrate self-directed learning, curiosity, and openness to feedback during clinical practice.
Utilize scientific literature, clinical guidelines, and evidence-based tools to support reasoning and clinical decisions.
Reflect critically on clinical experiences to improve professional performance and lifelong learning.

To participate effectively in the clinical training and professional practice (TPVES) in the medical area, students are expected to have acquired the following prerequisites:
Foundational knowledge of human anatomy, physiology, biochemistry, and general pathology.
Understanding of the basic mechanisms of disease, including inflammation, infection, and hemodynamic and metabolic alterations.
Basic knowledge of pharmacology, with particular reference to the main drug classes used in internal medicine.
Familiarity with the principles of clinical reasoning, medical history taking, and physical examination.
Competence in measuring vital signs and performing fundamental clinical procedures (e.g., venipuncture, ECG recording).
Awareness of ethical principles, patient safety, and professional responsibility in clinical practice.
Basic communication skills to interact appropriately with patients, caregivers, and members of the healthcare team.
These prerequisites ensure that students can integrate theoretical knowledge and practical skills during supervised clinical experience, applying safe and evidence-based medical practice.

The Medical Area Clinical Training (TPVES) aims to provide students with supervised clinical experience in the hospital and outpatient settings of Internal Medicine and related disciplines, promoting the integration of theoretical knowledge with practical and professional skills.

The programme includes direct patient care activities, clinical reasoning exercises, and participation in multidisciplinary teams. Students will progressively develop autonomy in clinical practice under tutor supervision.

Contents and Clinical Areas
The clinical training covers the following thematic and clinical areas:

General Internal Medicine
Clinical approach to the patient with complex and multisystem diseases.
Management of acute and chronic conditions (e.g., hypertension, diabetes, COPD, heart failure).
Principles of hospital admission, diagnostic work-up, and discharge planning.

Cardiology and Vascular Medicine
Assessment and management of chest pain, dyspnea, syncope, arrhythmias.
Recognition and monitoring of acute coronary syndromes and heart failure.
Interpretation of electrocardiograms (ECG) and basic echocardiographic findings.

Respiratory Diseases
Evaluation of patients with respiratory symptoms: cough, dyspnea, hemoptysis.
Diagnosis and management of pneumonia, asthma, COPD, and respiratory failure.
Use and interpretation of oximetry, arterial blood gases, and spirometry.

Endocrine and Metabolic Diseases
Diagnosis and management of diabetes mellitus and acute metabolic emergencies.
Recognition of thyroid and adrenal disorders.
Nutritional and lifestyle management in endocrine diseases.

Gastroenterology and Hepatology
Approach to abdominal pain, jaundice, gastrointestinal bleeding, and altered liver function tests.
Principles of nutrition, hydration, and hepatic failure management.

Nephrology and Fluid-Electrolyte Disorders
Assessment of renal function, urine output, and fluid balance.
Recognition and management of acute kidney injury and chronic kidney disease.
Indications for dialysis and monitoring of electrolyte disturbances.

Infectious Diseases
Recognition and management of sepsis and systemic inflammatory response syndrome.
Principles of antimicrobial therapy and infection control.
Prevention of healthcare-associated infections (HAIs).

Hematology and Oncology
Recognition of anemia, coagulation disorders, and leukopenia.
Approach to oncologic patients: diagnosis, complications, and palliative care principles.

Emergency and Critical Care (in the medical setting)
Initial evaluation and stabilization of patients with acute medical emergencies.
Basic and advanced life support (BLS, ALS) and management of shock, respiratory distress, and acute metabolic crises.

Learning Activities
Participation in ward rounds and case discussions.
Supervised patient interviews, physical examinations, and chart reviews.
Clinical data interpretation (ECG, laboratory results, imaging reports).
Observation and participation in diagnostic and therapeutic procedures.
Compilation of clinical records and discharge summaries under supervision.
Attendance at seminars, clinical conferences, and multidisciplinary meetings.

Expected Outcomes
At the end of the training period, the student should be able to:
Conduct a structured clinical assessment and problem-oriented evaluation.
Integrate clinical findings with laboratory and imaging data for diagnostic reasoning.
Participate in decision-making processes and develop initial clinical autonomy.
Demonstrate professional behavior, empathy, and teamwork skills in all settings.

Rugarli medicina interna sistematica - EdizioniEdra

Harrison’s Principles of Internal Medicine. 21st edition

Scientific articles related to topics included in the program will be recommended as a study tool for integrative purposes to frontal lessons and adopted text.

The Medical Area Clinical Training (TPVES) takes place in accredited hospital wards and outpatient clinics belonging to the Department of Internal Medicine and its subspecialties (Cardiology, Respiratory Medicine, Endocrinology, Nephrology, Gastroenterology, Infectious Diseases, Hematology, and Emergency Medicine).

The training is carried out under the supervision of clinical tutors and academic coordinators, ensuring gradual acquisition of clinical autonomy and responsibility.

Organization and Duration
The TPVES is organized as rotations through different medical units, allowing students to experience the full spectrum of internal medicine practice.
Each rotation includes structured learning activities, clinical duties, and tutor-guided sessions.
The total duration corresponds to the number of CFU (ECTS credits) assigned to the medical area training, distributed across the academic year according to the curriculum plan.
Students are required to complete a minimum number of clinical hours (as specified by the course regulations) to be admitted to the final evaluation.

Daily Clinical Activities
During the clinical rotation, students are expected to:
Attend ward rounds and actively participate in patient management discussions;
Perform clinical history taking and physical examination under supervision;

Contribute to diagnostic and therapeutic planning;
Observe and assist in diagnostic procedures (ECG, blood sampling, imaging, etc.);
Participate in emergency management simulations or real cases under tutor supervision;

Complete and update the clinical logbook documenting cases, procedures, and reflections.
Students are encouraged to maintain a professional attitude at all times, respecting ethical standards, patient confidentiality, and hospital regulations.

Teaching and Supervision
Each student is assigned to a clinical tutor (MD specialist) responsible for guidance, supervision, and formative feedback.
Regular tutorial meetings are organized to discuss clinical cases, verify learning objectives, and address difficulties encountered during training.
Seminars, bedside teaching, and interdisciplinary sessions complement clinical exposure.

Attendance and Participation
Attendance is mandatory for all clinical activities.
Absences must be justified and compensated in agreement with the tutor and academic coordinator.
Active participation and professional behavior are essential components of the final evaluation.

Documentation and Evaluation
Students must maintain a clinical portfolio/logbook, validated by the tutor at the end of each rotation.
The final evaluation is based on continuous assessment, direct observation, and the achievement of specific learning outcomes.
Successful completion of the TPVES grants the corresponding credits (CFU/ECTS) required for progression in the medical curriculum.

Mandatory

The assessment of the Medical Area TPVES aims to verify the progressive acquisition of clinical, professional, and relational competences through direct observation, tutor feedback, and structured evaluation tools.

Evaluation focuses on both knowledge application and professional behavior in real clinical settings, according to the Dublin Descriptors and the national standards for clinical training.

Assessment Methods and Tools
Direct observation and supervision
Tutors and clinical preceptors observe the student during patient care activities, evaluating clinical reasoning, technical skills, and professional conduct.
Continuous formative feedback is provided throughout the training period.
Structured clinical assessment (Mini-CEX, DOPS, CbD)
Short, focused evaluations of clinical encounters, procedures, or case discussions, using validated tools:
Mini Clinical Evaluation Exercise (Mini-CEX) – assessment of history taking, physical exam, and communication;
Direct Observation of Procedural Skills (DOPS) – assessment of clinical procedures (e.g., venipuncture, ECG);
Case-Based Discussion (CbD) – evaluation of reasoning and management of specific cases.
Portfolio or Logbook review

Each student maintains a clinical logbook documenting patients seen, procedures performed, and reflections on learning experiences.
Tutors review and validate the logbook to confirm competence progression.

Final evaluation interview
Conducted at the end of the rotation to assess the student’s ability to integrate theoretical knowledge and clinical experience.

Evaluation Criteria
Students are assessed based on the following dimensions:
Clinical competence: accuracy of history and examination, diagnostic reasoning, interpretation of clinical data;
Technical skills: execution of basic procedures and adherence to safety standards;
Professionalism: responsibility, ethics, empathy, respect for patients and colleagues;
Communication skills: clarity, empathy, and teamwork;
Critical thinking and self-assessment: ability to reflect on errors, seek feedback, and plan improvement.

Outcome and Grading
The overall judgment is expressed as “Passed/Not Passed”, based on the achievement of minimum standards in all areas of competence.
The final evaluation is recorded in the student’s clinical portfolio, validated by the clinical tutor and the academic coordinator.
Exceptional performance may be noted as “with distinction”, according to faculty criteria.

Ongoing evaluation during attendance in the wards

• Theoretical and practical activity lasting one month (approximately 100 hours), to be carried out according to a schedule agreed upon with the tutor and the ward team.
  • Books: Scientific papers and thematic clinical studies.