Key facts

The specialist in Diseases of the Respiratory System must have gained theoretical, scientific and professional knowledge in the field of pathophysiology, clinical, prevention and treatment of diseases of the respiratory system, lung neoplasms, respiratory failure, tuberculosis, respiratory allergy and sleep-related respiratory disorders. Areas of specific expertise include prevention, pathophysiology, physical and instrumental semiotics, clinical methodology, pathology, diagnostics (including interventional pulmonology methodologies), pharmacological and instrumental therapy (including interventional pneumology, non-invasive mechanical ventilation, intensive care and rehabilitation techniques for diseases of the respiratory system).

Basic training objectives: the training specialist must perfect the fundamental knowledge of biology, biochemistry, physics, morphology, physiology, general pathology, genetics and microbiology in order to acquire further knowledge on the biological and functional bases of diseases of the respiratory system;

objectives of the general training: the training specialist must learn the fundamental elements of biology, etiopathogenesis, pathophysiology and pathology and achieve awareness of the phenomenological coexistence of the different morbid processes and acquire knowledge of epidemiology, methodology and physical, laboratory and instrumental semiotics, as well as diagnostic imaging, including ultrasound techniques and nuclear medicine;

training objectives specific to the type of School: the training specialist must acquire:

• advanced knowledge of the etiopathogenetic mechanisms that determine the development of diseases of the respiratory system and knowledge of respiratory pathophysiology;
• technical and theoretical knowledge in all laboratory sectors applied to respiratory diseases with particular regard to cytohistopathology, immunoallergological techniques, techniques for assessing the function of the various tracts of the respiratory system and pulmonary cardiohemodynamics;
• practical methodological knowledge in functional diagnostics of breathing with particular regard to the evaluation of thoraco-pulmonary mechanics, intrapulmonary gas exchanges, ventilation regulation mechanisms, pulmonary hemodynamics, respiratory disorders in sleep, monitoring techniques of the critically ill patient and methods for assessing respiratory disability;
• knowledge and interpretative skills in diagnostic imaging and in the various diagnostic techniques pertaining to diseases of the respiratory system;
• adequate skills in interventional pulmonology to independently manage the endoscopic diagnostics and therapy of the airways, pleural cavity and respiratory districts that can be explored with video-endoscopic methods including the execution of biopsies in the various sites, the sampling of bronchoalveolar lavage fluid and the use of complementary and innovative techniques for the diagnosis and treatment of respiratory diseases;
• theoretical knowledge and clinical practice necessary to treat the main pathologies that constitute a respiratory emergency condition with particular competence in the intensive and sub-intensive treatment of patients with critical respiratory failure; adequate skills to promote any action aimed at early recognition and management of patients with acute and chronic respiratory failure, the most common emergencies in internal medicine and critical diseases, apply mechanical ventilation, formulate and administer special diets enterally and parenterally;
• theoretical and practical knowledge of the pathophysiology of breathing during sleep and the influence of sleep on different respiratory diseases; acquisition of clinical practice for the recognition, diagnosis and treatment of sleep-related respiratory disorders;
• theoretical and practical knowledge necessary for the epidemiological evaluation, prevention, clinical-instrumental diagnostics, therapy (in its various forms) of lung neoplasms; must know and be able to apply the relevant rules of good clinical practice
• knowledge of rehabilitation techniques and methods of assessment of disability with particular regard to respiratory diseases, with acquisition of the clinical practice necessary for the management of the critically ill patient, especially with regard to nutrition, physiokinesitherapy and weaning from mechanical ventilation;
• knowledge necessary for epidemiological assessment, prevention, microbiological, immunological and clinical-instrumental diagnostics, therapy and rehabilitation of tuberculosis and infectious diseases of the respiratory system; must know and be able to apply the relevant rules of good clinical practice and prophylaxis;
• knowledge necessary for the epidemiological evaluation, instrumental clinical diagnostics and treatment of cystic fibrosis and its various clinical problems, must know the rules of good clinical practice and must be able to apply them in controlled clinical trials;
• necessary knowledge of the rules of good clinical practice and must be able to apply them in clinical trials;
• ability to analyze one's own motivations, with full awareness of one's own moral presuppositions, and to relate them to the ethical and deontological norms that the care of the human person imposes;
• fundamental knowledge of the legal and health organization aspects of the profession, with adequate representation of the ethical implications of medical developments.

Integrated training objectives (i.e. common trunk): the student must have acquired a 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 student 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 student 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:

a) have followed at least 150 cases of respiratory pathology in inpatient wards or in DH, having personally drawn up and countersigned both the medical record (anamnesis, physical examination, planning of diagnostic and therapeutic interventions) and the discharge report (epicrisis), with the presentation of at least 10 cases in the formal meetings of the school;

b) have followed at least 100 cases of respiratory pathology in the outpatient clinic with the execution, when indicated, of the most common functional and immuno-allergological tests;

c) have actively participated in at least 100 specialist consultancy visits;

d) have participated in at least 70 on-call / underguard shifts, assuming personal responsibility in the shifts of the last 2 years (tutor consultation);

e) have followed at least 80 sessions of interventional pulmonology by videoendoscopy and have personally performed at least 30 of them;

f) have performed and correctly interpreted at least 200 complete functional examinations of breathing;

g) have actively participated in the management of at least 50 cases of severe chronic respiratory failure in its various clinical-developmental phases with the acquisition of the related therapeutic practices, including those of intensive care, and semi-intensive care.

h) have participated in the execution of at least 3 randomized clinical trials;

i) have actively participated in the management of at least 30 cases of pneumo-oncology including the phases of chemotherapy, radiotherapy, biological therapies;

l) 70 Thoracic imaging (X-RAY, CT, MRI, PET): Interpretation and discussion with the Tutor of paradigmatic cases.

m) 50 Reversibility and bronchostimulation tests to be performed independently.

n) 200 arterial blood gas analysis.

o) 150 bloodless oximetry monitoring

p) 40 6-min walking test to be performed independently (execution and reporting)

q) 30 independent polysomnographies (execution, tracing extrapolation, interpretation and reporting)

r) 30 Mantoux-style intradermal tests or biological tests indicating TB infection (to be performed and evaluated independently).

s) 15 exploratory pleural punctures/thoracentesis also in guided ultrasound/medical thoracoscopy, 30 thoracic ultrasounds, 10 placements of pleural drains in assistance.

t) 5 cardiopulmonary exercise tests.

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 a 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.