The specialist in Diseases of the Digestive System must have gained theoretical, scientific and professional knowledge in the field of epidemiology, pathophysiology, clinical and therapy of diseases and tumors of the digestive system, liver, biliary tract and exocrine pancreas. Specific areas of expertise include: the clinic of non-neoplastic and neoplastic diseases of the gastrointestinal tract, liver, biliary tract and exocrine pancreas, the execution of endoscopic procedures of the digestive tract, the pathophysiology of digestion and hepatic metabolism; the execution of other instrumental diagnostic procedures for which it is responsible; the prevention and treatment of non-neoplastic and neoplastic diseases of the gastrointestinal tract, liver, biliary tract and exocrine pancreas and the rehabilitation of patients who are affected.

Basic educational objectives: the student must acquire advanced knowledge of morphology and functionality of the gastrointestinal tract, liver, biliary tract and exocrine pancreas, master the biological, molecular and immunological bases of digestive functions and related pathologies, learn and apply techniques of gastroenterological, hepatic and nutritional physiology and pathophysiology;

Objectives of the general training: the resident must acquire the correct epidemiological approach and the methodological bases of the laboratory, clinic and therapy, as well as the ability to continuously renew their professional knowledge, also through the use of up-to-date information technology;

educational objectives specific to the type of School: the student must acquire advanced knowledge of the etiopathogenetic mechanisms that determine digestive diseases and their evolution; to know the pathophysiological bases of diseases of the gastrointestinal tract, liver, biliary tract and exocrine pancreas by actively participating in pathophysiological study activities and to be able to apply this knowledge in the interpretation of the clinical pictures of patients with hepatogastroenterological and pancreatic pathologies by placing them in a context of general patient framing; know and be able to interpret the anatomical-clinical and pathological bases of diseases and tumors of the gastrointestinal tract, liver, biliary tract and exocrine pancreas; acquire clinical and technical knowledge related to gastroenterological diagnostics and therapy and the ability to apply it correctly; perform fundamental and advanced diagnostic and therapeutic endoscopic procedures according to the rules of good clinical practice.; acquire theoretical and practical skills in laboratory and instrumental methods applied to the pathophysiology and clinic of digestive diseases with particular regard to cytohistopathology, immunological techniques, techniques for functional evaluation of the various tracts of the digestive system, liver and district circulation, gastroenterological imaging diagnostics; apply the most up-to-date knowledge for the epidemiological evaluation, prevention, diagnosis, therapy and rehabilitation of diseases of the digestive system; know the rules of good clinical practice and apply them in controlled clinical trials; to be able to evaluate the pathophysiological and clinical connections between digestive problems and problems of other organs and systems; participate in clinical activities that include, in the field of pathologies of the gastrointestinal tract, liver, biliary tract and exocrine pancreas, contributions to internal medicine, gastrointestinal surgery, diagnostic imaging, pathological anatomy, clinical oncology, pediatrics, clinical nutrition, nursing sciences.

Educational objectives specific to the type of School:

Specific areas of expertise include: the clinic of neoplastic and non-neoplastic diseases, the gastrointestinal tract, the liver, the biliary tract and the exocrine pancreas; the performance of endoscopic procedures of the digestive tract, both diagnostic and therapeutic, the pathophysiology of digestion, nutrition and hepatic metabolism; the execution of other instrumental diagnostic procedures for which the specialist is responsible; the prevention and treatment of non-neoplastic and neoplastic diseases of the gastrointestinal tract, liver, biliary tract and exocrine pancreas and the rehabilitation of patients who are affected.

Integrated training objectives (i.e. common trunk): the student must have acquired satisfactory theoretical knowledge and professional competence in the clinical and instrumental diagnosis and treatment, even in emergency-urgency conditions, of the most common internal pathologies. The student must acquire the fundamental knowledge of the pathophysiology of the various organs and systems, the theoretical and practical knowledge necessary for the recognition of diseases affecting the different systems of the body, the theoretical and practical knowledge of the main sectors of instrumental and laboratory diagnostics related to the aforementioned diseases, the acquisition of the ability to evaluate internal and specialist connections and influences. He must therefore be able to recognize the symptoms and clinical-functional signs with which diseases of various organs and systems manifest themselves, having acquired the fundamental diagnostic, therapeutic, psychological and ethical knowledge necessary for a global vision of the patient. To this end, the ability to clinically frame the patient on the basis of the anamnesis and physical examination must mature; develop critical and analytical diagnostic skills; become familiar with the main diagnostic procedures and laboratory-instrumental investigations; recognise and be able to deal with major medical emergencies; familiarize themselves with therapeutic resources in order to plan their optimal use and recognize their indications and contraindications, as well as the effects of interaction and possible iatrogenic accidents; acquire the fundamental notions relating to clinical research methodologies and pharmacological trials; know the fundamental problems related to prevention, public health and social medicine. The resident must have acquired satisfactory theoretical knowledge and professional competence in the recognition and treatment, in emergency-urgency conditions, of the most common pathologies. Finally, the resident must also know, from a clinical and therapeutic point of view, the most common pathologies of competence of the other types of the class.

The following are compulsory professionalizing activities for the achievement of the educational purposes of the type:

• have followed at least 250 patients distributed among the main gastroenterological, hepatic, biliary, pancreatic, nutritional pathologies, of which at least 1/3 of a neoplastic nature, participating initially, and therefore personally, under the supervision of the Tutors, in the collection of anamnestic and objective data, in the planning of adequate and appropriate diagnostic and therapeutic interventions based on knowledge derived from clinical evidence and in the critical evaluation of cases clinicians themselves;
• have presented at least 40 clinical cases in the School's educational meetings;
• have actively performed under supervision and acquired progressive autonomy to perform at least 200 esophago-gastroduodenoscopies with at least 20 esophageal variceal ligation, 25 hemostasis, and 25 polypectomies;
• have actively performed under supervision and acquired progressive autonomy in the execution of at least 200 total colonoscopies of which 1/3 completed by polypectomy operations;
• have actively participated in the execution of at least 30 ultrasound-guided liver biopsies and/or abdominal punctures;
• have actively participated in the execution of at least 200 diagnostic ultrasound scans of gastroenterological interest with a personal execution of at least 1/3;
• have actively participated in an adequate number of the following activities: therapeutic endoscopies; echo-endoscopies; retrograde cholangiopancreatography, placement of stents, dilation of stenosis and mucosectomies;
• have participated in an adequate number of manometric procedures;
• have conducted an adequate and appropriate number of clinical nutrition interventions (enteral and parenteral) under supervision;
• have conducted an adequate and appropriate number of proctology procedures under supervision;
• have participated in the clinical management of pre- and post-liver transplant patients.

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.