During the training course, he/she must acquire and develop the basic and specific theoretical knowledge of the discipline, the technical ability and the attitude necessary to appropriately deal with, according to national and European standards, the clinical situations related to:

• peri-operative medicine and the management of General and Loco-Regional Anesthesia in the various branches of Surgery, in Obstetrics and for the various diagnostic and therapeutic procedures, including non-surgical ones;
• Intensity of Care Medicine, both for postoperative Intensive Care and in Multipurpose and Specialist Intensive Care;
• to the Therapy of Pain, both acute and chronic, as well as in the multidisciplinary field and for Palliative Care;
• Emergency Medicine, intra and extra-hospital, and Disaster Medicine;
• Hyperbaric Therapy;
• to Emergency Toxicology.

He must also acquire the ability:

• to communicate clearly and humanely with the patient and family members also regarding informed consent (not only in the preoperative context), the removal of organs and tissues for transplantation purposes and symptomatic therapeutic support for EOL (End of Life) patients;
• to interact positively with other specialists and other health professionals;
• possess skills in health organization and clinical governance, knowing the medico-legal aspects and appropriately managing clinical risk;
• to develop, also through simulation experiences, non-technical anesthesiological skills (ANTS);
• to pursue the objective of constantly updating their knowledge through research and continuous lifelong learning in the various areas of the discipline.

Basic learning objectives:

The student must acquire the specific knowledge of the physical, biochemical and pathophysiological phenomena necessary to correctly apply the techniques of anesthesia and peri-operative medicine, to treat the patient with pain, to manage clinical criticality in elective and emergency, and to assist the frail patient with appropriate intensity of care, even outside the intensive care unit and in the setting, of hyperbaric medicine.

He must therefore achieve the ability to assess the risk and prepare the patient candidate for elective or urgent/emergency surgery, and/or extra-surgical diagnostic or therapeutic procedures.

He must also know the basic pathophysiological conditions, identifying the methods of correction of disorders that may affect anesthesiological conduct, the response to surgical, diagnostic and/or therapeutic maneuvers and the peri-operative course.

They must be able to safely manage anesthesiological drugs, airways and ventilation, clinical risk in the different phases of induction, maintenance and awakening, including techniques useful for achieving adequate pain management.

The resident must be able to make choices based on risk assessment and be able to practice the different techniques of sedation, general and/or regional anesthesia, as well as monitoring techniques most suitable for the clinical conditions of the patient, in election and in urgency/emergency, both adult and pediatric.

He/she must acquire the theoretical knowledge and practical ability to diagnose and treat, according to national and European standards, all clinical conditions related to peri-operative medicine, multi-purpose intensive care and specialist care.

They must learn and know how to use monitoring systems and prosthetic techniques capable of supporting vital functions in the operating room and in the postoperative recovery area, as well as in intensive care and during emergencies, intra and extra-hospital, including the management of trauma, acute burn-induced pathology and toxicological emergencies.

They must also learn to deal adequately with clinical situations related to acute and chronic pain, including in multidisciplinary and hospice settings.

He must also appropriately manage the relationship with the patient, to prepare him adequately for the expected procedure, but also with the relatives of the patient in critical condition.

He must also learn to manage the organizational aspects related to the safe transport of the critical subject in the pre-hospital environment, and to disaster medicine.

Finally, it is necessary to obtain a valid theoretical basis regarding the juridical, medical-legal aspects and the bioethical implications inherent in the professional activity of the discipline.

General Areas of Expertise

A. Anesthesia and Peri-operative Medicine

The Resident must acquire the clinical skills necessary for the anesthesiological and peri-operative care of patients, including the ability to operate:

A.1) framing of the various pathologies, appropriate and rational use and interpretation of preoperative investigations useful for the evaluation and better preparation of the patient for surgery, application of fasting management and premedication guidelines in consideration of peri-operative risk; effective communication and interaction with patients for the purposes of consent and risk information;

A.2) appropriate choice and intraoperative management of anesthetic techniques and/or regional blocks in consideration of the surgical program and the relevant co-pathologies, considering the functions directly impacted by the techniques themselves; appropriate and safe use of all equipment (anesthesia, respiration, medical gases, invasive and non-invasive monitoring and measurements, etc.), of the imaging techniques applied, as well as of electrical and environmental safety measures;

A.3) evaluation and support of vital functions, management of intra- and post-operative clinical safety (airway risk, choice of strategies to be adopted in cases of intubation and/or ventilation difficulties, risk of aspiration and peri-operative respiratory complications, cardiovascular risk, infectious risk, etc.);

A.4) management of the decision-making process related to the discussion of alternatives with the patient, the surgeon and other colleagues; adequate management of clinical documentation and optimization of postoperative care in cooperation with other doctors and nurses;

A.5) knowledge and use of a wide variety of equipment, having learned the principles of operation, the meaning of the variation of the measured parameters and the possible errors of the different monitoring techniques, invasive and non-invasive, of neurological, respiratory, cardiocirculatory, metabolic parameters as far as pertaining to the various clinical situations in question.

At the end of the course, the student must:

have participated in the preoperative discussion and risk assessment of at least 1000 clinical cases;

have taken part, also collaborating with specialists from other disciplines, in the preoperative treatment of at least 50 cases suffering from pathologies that may postpone the surgical act of choice;

have adequately planned the preparation for the elective intervention;

know the effects of premedication and its consequences on the pre-intra- and post-operative course;

have acquired experience in the practice of sedation and general anesthesia for the various diagnostic and therapeutic procedures in hospitalization, Day Surgery, Outpatient Anesthesia, even outside the SO (NORA, Non Operative Room Anesthesia – MAC, Monitored Anesthesia Care), such as for interventional bronchoscopy, digestive endoscopies, radiological and cardiological diagnostic-interventional, radiotherapy etc;

have acquired basic and specific skills in vascular access, in particular in central and arterial venous catheterization;

have acquired skills in basic and advanced techniques for airway and respiratory safety  ;

have acquired basic experience in loco-regional anesthetic techniques in elective and urgent situations and mastery of central and peripheral regional blocks for ultrasound-guided and non-ultrasound-guided anesthesia and analgesia (peripheral nerve blocks, lumbar and thoracic epidural blocks, spinal techniques and combined spinal-epidural techniques), knowing how to manage their complications;

have treated at least 1000 patients, including those of neonatal and pediatric age and very old age, performing at least: 50 sedations, 500 general anesthesias, 25 epidural anesthesias, 50 subarachnoid anesthesias, 20 peripheral nerve blocks, with the following minimums in the areas listed below:

- General surgery: 100 operations;

- Obstetrics and Gynecology: 30 operations (at least 10 caesarean sections);

- Orthopedic surgery: 30 operations;

- Otorhinolaryngology 20 interventions;

in addition to having practiced at least 100 anesthesiological procedures distributed among the surgical specialties of:

- Pediatric Surgery,

-Neurosurgery

- Thoracic-cardio-vascular surgery,

- Ophthalmology,

-Urology

-Plastic surgery.

The student must have knowledge of the technological principles of anesthesiological equipment and the related regulations:

• know and have used a wide variety of invasive and non-invasive monitoring techniques;
• have participated in the clinical use of ultrasound instruments and acquired basic knowledge of ultrasonographic techniques in the anesthesiological field;
• know and use the main equipment appropriately and safely, controlling working and environmental conditions and applying checklists and risk management strategies to prevent errors and adverse events;
• maintain patient homeostasis with all procedures, including peri-operative management of fluids, electrolytes, glucose and temperature, management of massive blood loss and coagulopathies, knowing how to safely use blood and its derivatives, and knowing the appropriate techniques for the management of venous cannulation;
• have observed the application of circulation and extracorporeal oxygenation techniques;
• have applied correct criteria and appropriate discharge scores from the SO and PACU (Post Anesthesia-Care Unit), including the indication at the appropriate level of postoperative care;
• having followed the postoperative course of at least 300 clinical cases, preventing and correctly treating acute pain, postoperative nausea/vomiting, as well as participating in postoperative follow-up and critical management;
• have applied technical and equipment monitoring and know how to manage basic operation;
• know and be able to apply techniques for maintaining normothermia;
• know the strategies of clinical risk management, acquiring skills and ANTS also thanks to the use of simulation, even with high fidelity.

B. Critical and emergency medicine

The student must acquire the ability to manage (* the learning of professionalizing activities can take place through simulation for a maximum percentage of 50%):

B.1) the most common life-threatening medical emergencies, with basic and advanced management of the critical pre- and in-hospital medical emergency, having performed cardiopulmonary resuscitation in simulation and in the clinic;

B.2) trauma, in the pre- and in-hospital phase, and the initial treatment of the burn, including organizational aspects;

B.3) the airway in critical condition;

B.4) the complex organization of care in cases of mass accidents and disasters (disaster medicine);

B.5) emergency monitoring and measurements.

At the end of the course, the student must:

know triage and know how to implement monitoring and measurements during the emergency treatment of patients with acute respiratory, cardiocirculatory, neurological and metabolic diseases, acquiring skills and ANTS also thanks to the use of simulation, even at high fidelity (*);

have participated in at least 20 basic cardiopulmonary resuscitation (CPR) and 20 advanced CPR in adult subjects (*);

have participated in at least 5 basic CPRs and 5 advanced CPRs in paediatric patients (*);

have placed at least 50 central venous catheters, even with ultrasound-guided technique;

have placed arterial needle cannulas and interpreted at least 100 arterial blood gas analyses;

have practiced at least 5 thoracentesis with placement of thoracostomic tubes (*);

know how to appropriately use techniques and devices recommended for the management of the airways in emergencies and in critical conditions, also knowing how to practice emergency access to the trachea (*);

know how to perform invasive and non-invasive ventilation with different types of interface and ventilator;

have interpretative skills of diagnostic imaging, even in traumatized patients;

have participated in the clinical use of ultrasound instruments and acquired basic knowledge of ultrasonic-graphic techniques in urgency-emergency (*);

have participated in the intra- and inter-hospital transfer of at least 10 critically ill patients;

have knowledge of the advanced out-of-hospital rescue activity and the management and decision-making processes of the 118 operations center and the organization of the system that operates in situations of mass accidents and catastrophes.

C.  General Resuscitation and Intensive Care

The ability to practice is expected to:

C.1) Medical therapy for different levels of care and peri-operative intensity of the critically ill patient;

C.2) General (multipurpose) and specialist Intensive Care (ICU);

C.3) Airway management and intensive respiratory care, including the use of bronchoscopy;

C.4) Knowledge of a wide variety of equipment, having discussed the principles of operation, the meaning of the variation of the measured parameters and the possible errors of the different monitoring techniques, invasive and non-invasive, of neurological, respiratory, cardiocirculatory, metabolic parameters as far as pertaining to the various clinical situations in question, acquiring skills and ANTS also thanks to the use of simulation, even high-fidelity.

At the end of the course, the resident must have carried out at least two years of professional activity in multipurpose and specialized Intensive Care and Intensive Care and be able to treat patients admitted to the ICU, defining clinical problems, evaluating indicators of organic dysfunctions, developing diagnostic strategies in relation to comorbidity conditions and current complicating factors, being able to manage specific treatment plans, including short-term and long-term prognosis. Indicatively, it must:

have participated in the evaluation of critically ill patients and followed their clinical evolution on the basis of the main prognostic indices;

have taken part in the treatment of at least 100 critically ill patients in the various specialist sectors and in the main conditions of intensive care, recognizing and having mastered the specific aspects of monitoring, venous and arterial vascular access and cardiovascular support, airway access, equipment management, including CRRT and respiratory assistance (from oxygen therapy to invasive and non-invasive mechanical ventilation);

have mastered the management of artificial nutrition suitable for the needs of the main clinical pictures;

have mastery in the management of infusion and electrolyte therapies appropriate for each type;

know how to apply suitable protocols to prevent and monitor the risk of infections in intensive care and know how to use appropriate antibiotic therapy and antifungal therapy protocols;

know and apply the basic principles of intensive care, including post-operative care in general and specialist surgery and obstetrics for critically ill patients of all ages, including pediatric patients;

know the ethical principles involved in EOL (End Of Life) conditions in relation to national legislation and be able to participate, under supervision, in decisions to revoke or refuse intensive treatment;

having participated in the operations to ascertain death with neurological and cardiac criteria;

have participated in the clinical management of potential organ donors and in any organ and tissue procurement procedures;

know the crisis management strategies, also acquired thanks to the use of advanced simulation;

have taken part in the organizational meetings of the ICU and clinical audit team, understanding the organization of the Resuscitation and Intensive Care units and the complexity of appropriate management in relation to resources, quality of care, as well as the humanization of treatment in the critical area.

D. Medicine and Pain Therapy - Palliative Care

Include:

D.1) Acute and postoperative pain therapy; knowledge of the techniques and drugs indicated for the therapeutic optimization of postoperative pain and prevention of chronic postoperative pain;

D.2) Management of acute and chronic pain within a multidisciplinary network;

D.3) Management of the palliative care pathway.

At the end of the Course, the Resident must possess:

knowledge of the anatomy and pathophysiology of the nociceptive system;

ability to perform an adequate anamnesis and algological examination and to interpret consequential tests;

ability to apply validated scales and questionnaires to identify the type of pain and to assess the effectiveness of treatment;

ability to measure and document the evolution of pain with specific equipment;

knowledge and competence of basic therapies, pharmacological treatments and multimodal analgesias, including non-pharmacological techniques;

knowledge of pain treatment strategies, including non-pharmacological and invasive ones;

knowledge of the indications for the use of physical and psychological therapies, loco-regional blocks, the implantation of devices for the administration of drugs and electrostimulators;

technical competence of neuraxial blocks, plexus blocks and peripheral nerve blocks for acute and chronic pain;

ability to recognize and describe complications of interventional procedures and their treatment;

management skills of the patient taking opioids for chronic pain;

skills and ANTS acquired also thanks to the use of simulation, even with high fidelity.

At the end of the course, the resident must have managed at least 50 patients with acute postoperative pain in the various surgical areas; at least 10 patients with chronic pain (diagnostic framework, setting of the therapeutic plan, evaluation of the effectiveness of the treatment, follow-up); performed at least 25 analgesic epidurals, 10 spinal accesses and 10 peripheral nerve blocks.

They should also possess knowledge of communication techniques to inform patients and family members of treatment options, goals of care, and end-of-life care.

He will have to know the clinical-therapeutic paths of palliative care, having acquired the ability to manage pharmacological and non-pharmacological techniques, to control the symptoms of the patient in the terminal phase, the ability to work in a network and in a multidisciplinary and multiprofessional environment, knowing how to communicate appropriately with other health professionals.

E. Hyperbaric therapy

Includes:

E.1) Evaluation and preparation of the patient to undergo hyperbaric treatment;

E.2) Hyperbaric treatment in emergency/urgency;

E.3) Monitoring, measurement and assistance in extraordinary environments.

The student must know the principles and the main indications for a wide variety of equipment applied to diving and hyperbaric medicine, discuss the principles of operation, the meaning of the variation of the measured parameters and the possible errors of the different monitoring techniques, invasive and non-invasive, of neurological, respiratory, cardiocirculatory, metabolic parameters as far as pertaining to the various clinical situations in question.

The Hyperbaric Therapy Centers do not have a parallel distribution to the Schools on the national territory; the acquisition of professional activities can be achieved with a period of training at the reference centre, also by adopting regional and interregional framework agreements between Schools; skills and ANTS can also be acquired through the use of simulation, even at high fidelity.

At the end of the course, the student must:

know the indications and contraindications to treatment with hyperbaric oxygen in election and emergency;

know the problems related to the diagnosis and treatment of diving diseases;

know the possibilities of monitoring and measurement in extraordinary environments;

know the safety and fire prevention regulations relating to extraordinary environments;

have taken part in the evaluation, preparation and management of the treatment of at least 20 patients

having discussed with the staff the nursing protocols during hyperbaric therapy;

know how to prepare measures for the prevention of risks associated with hyperbaric treatment for scheduled and urgent treatments;

having discussed as a team the protocols for the treatment of diving pathologies.

F. Emergency toxicology

It includes the ability to operate:

F.1) clinical-toxicological interventions in ICUs or in other structures dedicated to the management of urgency-emergency, including Poison Control Centres;

F.2) main treatments for substances of abuse;

F.3) laboratory diagnostics and integrated therapeutic conduct.

At the end of the course, the resident must know an adequate variety of techniques useful for diagnosing and treating, with integrated multimodal protocols, the most frequent clinical toxicology emergencies.

He must have discussed the principles of application, the meaning of the variation of the measured parameters and the possible errors of the different monitoring indications of the various clinical situations, acquiring skills and ANTS also thanks to the use of simulation, even at high fidelity.

During the course, the student must:

have followed the diagnostic and therapeutic itinerary of at least 10 clinical cases of acute intoxication or poisoning with insufficiency of vital functions;

know the clinical-therapeutic paths of the main intoxications and poisonings.

G. Non-technical anesthesiological skills (ANTS)

Are:

G.1) Task Management: planning and preparing; prioritize; to provide for and maintain standards; identify and use resources.

G.2) Team work: coordinating activities with team members; exchange information; use authority and assertiveness; assessing skills; support others.

G.3) Situation awareness: collecting information; recognize and understand; anticipate

G.4) Decision Making: identify options; balance risks and benefits; revalue.

This training area develops a system of markers, defined as non-technical behaviors, which contribute to making performance within the system represented by the work environment, higher or lower than the expected standard in terms of technical competence.

During the training course, the principles of non-technical anesthesia non-technical skills, relational, interpersonal and organizational skills must be acquired, also through in situ and/or high-fidelity simulation techniques, in the many contexts of professional development, especially in crisis situations with potential rapid clinical evolution.

At the end of the course, the student must:

be able to make decisions in the course of clinical action, based on experience or new information, both in elective conditions and in crisis situations;

develop and maintain dynamic situational awareness on the perception of the elements of the environment (patient, team, time, monitoring...) and anticipate what could happen in the evolution of the case;

manage resources and organize tasks to achieve goals;

know how to communicate effectively and know how to work in any role in a team context, to ensure effective support to the team itself.

H. Quality, Management and Health Economics, Research, Ethics and Development of Professionalism

At the end of the course, the resident:

H.1) Formulates clinical decisions in compliance with ethical and legal principles; communicates effectively with patients and their families (doctor-patient relationship); involves patients and/or their delegates in decisions concerning therapy and treatment; involves colleagues from other different specialties in the decision-making process regarding care and treatment; maintains accurate and legible folders, and documentation of clinical activities; respects privacy, dignity, confidentiality and legal constraints in the use of patient data; supports and participates in activities concerning professional and specialty development. In the context of a multidisciplinary team, it provides palliative and end-of-life therapies and applies the ethical and legal guided processes of refusal and withdrawal of treatments.

H.2) Knows the principles of Quality Systems and Clinical Governance and has the basics of health economics

H.3) He/she is active in deepening knowledge, in applying self-learning, in research.

During the training course, the student must acquire the skills to ensure the quality of his or her work, as well as appropriate knowledge in health economics, understanding basic statistical, ethical and economic concepts. They must be able to assess the benefit of applying research findings to clinical practice. He must therefore acquire:

knowledge of evidence-based medicine and the levels of evidence;

knowledge of common statistical tests and statistical application to a research project with analysis of results, monitoring and surveillance after the study;

knowledge of the ethical principles and legal responsibilities of the Ethics Committee;

ability to produce a scientific publication by developing attitudes of critical reading of research publications, presenting posters and communications at national and international conferences;

to develop learning techniques in small groups and to work according to good clinical practices;

understand, and where relevant, participate in Quality Assurance (QA) processes in clinical practice, as the necessary basis for continuous professional development;

apply local in-hospital, national and European recommendations to their work, knowing the programs for quality and safety (checklists, patient identification, communicable diseases, etc....);

to become aware of one's limits and to be able to seek help when necessary;

effectively organize their work with a multidisciplinary team;

know the relevant European infrastructures as well as their own and local national infrastructures and their role in their continuous improvement;

understand managerial and administrative responsibilities in the health sector;

be able to participate in clinical trials and have participated in the drafting of scientific papers, knowing the rules governing clinical trials.

Specialist Areas of Expertise

1. Obstetric anesthesia

During the training course, the resident must acquire clinical skills and skills in anesthesiological therapy and peri-operative care of pregnant women, as well as know how to rescue the newborn. These include the following skills:

• knows the physiology of pregnancy, labor and childbirth;
• has a thorough understanding of the methods available for pain relief during labor and delivery, including cesarean section;
• he must be able to choose and perform appropriate analgesia during labor;
• must demonstrate skill in the management of birth complications and anesthesia for childbirth;
• he must be able to perform resuscitation of the newborn;
• manages the safe administration of general or regional anesthesia and peri-operative therapy in obstetric patients;
• he must be able to manage the high-risk woman in labor;
• establishes professional contact with the group of gynaecologists and midwives.

2. Airway Management

During the training course, the resident must acquire clinical skills and skills in airway management and respiratory assistance. These include the following skills:

• predict the risk of difficulties in airway management through the use of appropriate indicators and scores;
• manage both expected and unexpected difficult airways, knowing the use of standard and alternative devices, including video and fibroscopy tools, knowing how to apply them appropriately and knowing the recommended strategies and algorithms;
• manage situations of oxygenation and difficult ventilation and carry out the appropriate maneuvers in case of CICO (Cannot Intubate Cannot Oxygenate);
• manage the airway in emergency situations, including trauma and know the safety strategies of airway management in intensive care and in the critically ill patient;
• manage extubation safely in difficult conditions and/or after airway interventions;
• adequately manage anesthesia and airway in shared procedures, ensuring respiratory safety during laryngeal, thoracopulmonary, surgical and percutaneous tracheostomy surgery, as well as for operative laryngoscopy/bronchoscopy;
• know the different tracheostomy techniques, acquire the basic practice and know the strategies to prevent short and long-term complications;
• know the techniques of airway management in pediatric patients;
• Learn about anesthetic care for laser surgery in the airways, including jet-ventilation.

3. Thoracic and cardio-vascular anesthesia

During the training course, the resident must acquire the knowledge and skills related to anesthesiological and peri-operative therapy of patients in thoracic and cardiovascular surgery. These include the following skills:

• evaluation of the limits of operability for lung resection and selection of patients who need preoperative preparation and treatment;
• awareness of peri-operative risk factors and specific postoperative complications in thoracic surgery;
• management of anesthetic aspects in mono-pulmonary ventilation;
• acute and chronic pain management strategies in thoracic surgery, including epidural, paravertebral and intercostal blocks;
• knowledge of emergencies in thoracic or cardiovascular procedures and their management;
• basic anesthesiological knowledge of cardiopulmonary bypass;
• expertise in invasive monitoring for thoracic and cardiovascular surgery including pulmonary artery catheterization and transesophageal echocardiography;
• knowledge of the basic principles and anesthesiological and therapeutic techniques used for severe impairment of cardiac function in high-risk patients, for patients planning a cardiac or lung transplant, for patients with congenital heart disease, and   for those with implanted stimulators or cardioversion devices;
• Ability to manage anesthesia for major vascular surgery, including emergency procedures.

4.  Neuroanesthesia

During the training course, the resident must acquire clinical skills and skills in the anesthesiological and peri-operative therapy of patients undergoing surgery and interventions concerning intracranial, spinal, and surrounding structures. These include the following skills:

• pre- and post-operative evaluation of the neurosurgical patient;
• choosing the appropriate monitoring for neurosurgery is aware of the patient's position for neurosurgical interventions;
• knowledge and strategies for brain protection and intracranial pressure control;
• management of the patient with increased intracranial pressure;
• knowledge and ability to analyze the risks and benefits of anesthesiological techniques available for all aspects of neurosurgery and neuroradiology.

5. Pediatric anesthesia

During the training course, the resident must acquire clinical skills and competencies in anesthesia and peri-operative therapy of pediatric patients, as well as the basics of intensive critical care in pediatric age. These include the following skills:

• knowledge of the implications of the differences between child and adult, anatomy, physiology and pharmacology;
• knowledge of the pediatric aspects of monitoring, equipment, and vascular access, airway management, essential for the safe management of general anesthesia from induction to awakening, including the management of surgical urgency-emergency in children;
• knowledge of the techniques useful for pain control, the clinical aspects necessary for the management of fluids and the therapy of the main criticalities and risks in the pediatric patient;
• knowledge of the resuscitation of newborns and children in all emergency situations;
• knowledge and ability to manage the responsibility of transporting all children and infants to a higher facility of competence;
• Ability to communicate with the necessary empathy with children and their relatives, including the ability to manage the practice of information for the purposes of consent.

6. NORA/Outpatient Anesthesia

During the training course, the resident must acquire clinical skills and skills in anesthesiological therapy to assist patients in places other than the operating room (NORA: Non Operative Room Anesthesia) and for Outpatient Surgery. These include the following skills:

• ability to manage and provide anesthesia outside the operating room, taking into account the logistics of the facility, the type of patient (children, the elderly, etc.....), and the type of procedure;
• knowledge of the requirements necessary to ensure safety and appropriately conduct the preoperative assessment for the purposes of case selection and management, assessing anaesthesiological and peri-operative risks and knowing the relevant legislation and guidelines;
• competence in applying the principles of safety during radiographic techniques, magnetic resonance imaging and all other minimally invasive diagnostic or therapeutic procedures required in places other than the operating room.

7. Multidisciplinary pain management

During the training course, the resident must acquire clinical skills and skills in the multidisciplinary management of pain therapy and palliative care. These include the following skills:

• knowledge of the legislation relating to pain therapy and palliative care (Law 38/2010, Memorandum of Understanding of 25 July 2012) and subsequent additions;
• knowledge of the characteristics of the pain therapy network and of the diagnostic and therapeutic pathways that guarantee continuity of care between the nodes of the network;
• knowledge of basic and specialized palliative care interventions;
• ability to pharmacological and non-pharmacological management (locoregional anesthesia techniques) of acute postoperative pain;
• ability to manage chronic pain in both pharmacological and non-pharmacological ways (spinal neuromodulation techniques, thermal injury techniques, etc.);
• ability to diagnose the pathophysiological mechanisms of chronic pain;
• knowledge of the pathophysiological principles of chronic and evolutionary pathologies, for which there are no therapies or when these are inadequate or ineffective for the purpose of stabilizing the disease or ensuring survival for a significant period;
• ability to appropriately manage and modulate the symptoms of a patient with terminal illness;
• multidisciplinary and multiprofessional interaction skills in the integrated management of patients with chronic pain and patients in palliative care;
• ability to communicate with family members and with the patient suffering from chronic pain or palliative care.

Educational objectives of the type of School:

The resident must acquire knowledge and skills to conduct appropriate and safe anesthetic treatment in all branches of surgery, whether elective or urgent or emergency, for the patient of all ages. To this end, he/she must know the indications and times of the most commonly adopted surgical techniques in general surgery, in specialized surgery, including transplantation, and in obstetrics; it must also be able to manage clinical risk, from preoperative to postoperative assessment, by applying the principles of perioperative medicine, managing pain treatment, and the most appropriate level of intensity of care for the postoperative period.

The resident must be able to use, interpreting them correctly, the main invasive and non-invasive monitoring techniques, relating to respiratory, hemodynamic, neurological and metabolic parameters; they must also be able to deal with and be able to manage the main situations of health emergencies within and outside hospitals, be able to diagnose and treat the main pictures of intensive care, including the most common complications observed in the management of the critical patient, both medical and surgical, and in extreme emergency conditions, such as in trauma rescue, burns and in the main pictures of acute intoxication.

The student must therefore be able to diagnose and know the main techniques of support of organs and functions, must be able to manage airway criticalities, applying the different models of artificial ventilation in the critical area in a suitable manner, including extraordinary environmental conditions (transport of critical subjects and hyperbarism).

The resident must know the anatomical and physiological bases of the genesis, conduction and perception of pain, must be able to make diagnoses, know how to set up the therapeutic plan, know the pharmacological characteristics and methods of use of analgesics, as well as know the non-pharmacological procedures and know how to manage the chronicity of the patient with pain.

The resident must know the indications for hyperbaric treatment and how to perform them, as well as be able to diagnose the clinical pictures for which the treatment must be considered elective, particularly in urgent-emergency conditions.

Related and supplementary objectives:

The student must know the management and managerial methods of the discipline, including the related bioethical, medical-legal implications in compliance with the rules of safety, quality and appropriateness of the care provided, with particular regard to interdisciplinary interaction in the fields of peri-operative medicine, the pain therapy network and the palliative care network, transplant medicine, intensive care, emergency, disaster medicine, diving and hyperbaric medicine.

The compulsory professionalizing activities (Core Competencies) for the achievement of the educational purposes of the typology are identified by the Training Areas, classified as:

General areas of expertise:

A. Anesthesia and Peri-operative Medicine

B. Critical and emergency medicine

C. Resuscitation and Intensive Care

D. Medicine and Pain Therapy - Palliative Care

E. Hyperbaric therapy

F. Emergency toxicology

G. Non-Technical Anesthesiological Skills (ANTS)

H. Quality, Management and Health Economics, Ethics, Research and Development of Professionalism

In all areas, skills and ANTS can also be acquired through the use of simulation, both in situ and at high fidelity. The student will be able to compete for the diploma after completing the professionalizing activities.

As part of the training course, the student will have to learn the scientific bases of the type of School in order to achieve full maturity and professional competence that includes an adequate ability to interpret scientific innovations and critical knowledge that allows him to consciously manage both assistance and his own updating; In this context, participation in meetings, congresses and the production of scientific publications and periods of attendance in qualified Italian and foreign institutions useful for his/her training may be envisaged.