The Internal Medicine Specialist must have gained theoretical, scientific and professional knowledge in the fields of medical pathophysiology, functional and instrumental medical semeiotics, clinical methodology, evidence-based medicine, general medical clinic and medical therapy with specific expertise in emergency medicine and first aid, geriatrics and gerontology, allergology and clinical immunology.

basic training objectives: the student must deepen and update his knowledge in the field of molecular biology, etiopathogenesis, pathophysiology and pathology to achieve full awareness of the phenomenological unity of the different morbid processes in order to interpret the nature of clinical phenomena in their entirety on the basis of the pathophysiological relationships between different organs and systems;

objectives of the general training: the student must acquire knowledge of epidemiology, methodology and physical, laboratory and instrumental semeiotics, including nuclear medicine, as well as bioimaging diagnostics. They must also use modern methodologies for researching scientific knowledge and information, acquire the tools for their critical evaluation and know how to apply them appropriately in the most diverse clinical conditions;

educational objectives of the type of School: the Specialising student must be able to assess the expected indication and usefulness and critically choose the appropriate diagnostic tools and pathways, including those of specialist competence; and to interpret the results produced by laboratory, instrumental, bioimaging, endoscopy and pathological histology tests; must acquire in-depth knowledge of the most common diseases and chronic non-communicable diseases; must acquire knowledge of relatively rare diseases; in full autonomy, he must know how to use the most appropriate clinical tools and investigations to recognize the different morbid pictures and rationally use the most effective therapies; must be able to prescribe, in the light of the risk/benefit and cost/effectiveness profiles, the most appropriate pharmacological, non-pharmacological and/or surgical treatment in the various clinical conditions of specific competence of Internal and General Medicine; must be able to manage therapeutic regimens for the treatment of arterial-thrombo-embolic diseases including anticoagulant therapy and possible bleeding complications; must be able to identify their role and share decision-making responsibility in conditions of specialist and multidisciplinary competence in order to ensure continuity of care; he must also be able to recognize the most common disorders of a specialized nature and be able to choose the methods of in-depth diagnosis and treatment and be able to distinguish the conditions that require specialist advice from those that can be solved directly by the internist; must be able to recognize early and subject, within the limits of available instrumental and environmental resources, to the most effective initial treatment, including resuscitation, patients in the most frequently encountered emergency clinical conditions; must be able to conduct drug therapies and the most common instrumental treatments necessary in critically ill patients; he must know how to manage particular diets, and know how to practice enteral and parenteral nutrition.

The student must also learn and compare his motivations and his ideological and moral positions with the ethics that the care of the human person imposes and must have a clear representation of the progressive development of medicine from naturalistic and thaumaturgical origins to scientific medicine. The Resident must know the legal and health organization aspects of the profession, as well as those of the NHS; must be able to give the appropriate indications for the full use of the NHS facilities, in relation to the needs expressed and according to the characteristics of social groups, the territory and the living and working environment, in compliance with the criteria of good clinical practice; must know the methodological fundamentals of health management, work organisation and health economics.

The Resident must acquire full knowledge of the pathophysiology of critical conditions; must have gained adequate experience in the application of pharmacological, nutritional and instrumental treatments in critically ill patients; must be able to manage the safe transfer of critical patients to the most suitable environment for the pathology from which they are suffering. To this end, he must have participated in the performance of the following maneuvers: cardiac defibrillation, oxygen therapy (methods of administration), ventilatory assistance (mechanical and manual ventilation), placement of a central venous catheter, gastric and intestinal probing, even in the comatose patient, hemorrhage plugging.

The Resident must be able to recognize and be able to discriminate between conditions of urgency and real or potential emergency, including those of a toxic or traumatic nature, be able to identify the cause if possible, be able to implement all available measures to ensure the maintenance of vital functions, be able to make indications for essential laboratory and instrumental tests, Be able to identify the conditions of specialist or multidisciplinary competence: be able to play the role due to their specific competence in the diagnostic and therapeutic activities of the team.

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:

• having drawn up and countersigned 100 medical records of inpatient or outpatient patients personally followed; The charts must include a complete physical examination that includes, among other things, the evaluation of nutritional status and, where indicated, rectal and/or vaginal examination. Where necessary, he must have taken care of the appropriate preparation of samples and the sending of biological fluids to the laboratory with the appropriate request for analysis;
• have participated in at least 50 internal medicine consultations in external, specialist or territorial departments,
• have interpreted at least 50 electrocardiographic examinations to be able to diagnose the most common rhythm, conduction and repolarization disorders;
• have personally performed the following invasive manoeuvres (at least 5 each): paracentesis, thoracentesis, blood gas sampling, cytoaspirates of various organs and systems, assisted ventilation, bone marrow fine needle aspiration;
• have participated in the execution of instrumental investigations (at least 40 in total) such as Doppler ultrasound of the large arterial and venous vessels, echocardiography, ergometry, endoscopy, scintigraphy, respiratory function tests, allergy diagnostics;
• have acquired competence in basic and advanced cardiopulmonary resuscitation techniques (BLS and ACLS) and have participated in or performed at least 2 resuscitation maneuvers on a patient or dummy;
• have directly performed 50 ultrasound examinations to be able to interpret the images of internal medicine interest (neck, thyroid, breast, chest, digestive system, liver and biliary tract, pancreas, spleen, kidneys and adrenals, bladder);
• have discussed with the specialist at least 10 echocardiographic examinations and 5 angiographic examinations;
• have discussed with the specialist at least 10 histopathological preparations;
• have discussed with the specialist at least 20 brain CT or MRI;
• have discussed with the specialist at least 30 between chest x-ray, spine x-ray, digestive system x-ray;
• have participated in at least 20 divisional or interdivisional guard shifts, assuming personal responsibility (with the possibility of consulting the guardian) in the shifts of the last two years;
• have directly followed the conduct, according to the rules of good clinical practice, of at least 3 controlled clinical trials.

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.