The Specialist in Medical Oncology must have developed and matured the theoretical, scientific and professional knowledge, specific skills and abilities necessary for the diagnosis, treatment, follow-up and global assistance of the cancer patient in the various stages of the disease. Specific areas of expertise include clinical methodology, specific and supportive drug therapy in oncology, doctor/patient communication and palliative medicine. The specialist in Medical Oncology must also have acquired direct experience in the most relevant laboratory diagnostic methodologies and clinical trials.

Basic learning objectives: the student must learn the fundamental knowledge of cellular and molecular biology and must acquire advanced knowledge of the etiopathogenetic mechanisms that determine the development of neoplastic disease; learn the theoretical knowledge and clinical practice necessary for the diagnosis and treatment of the most common diseases in the medical area; acquire the fundamental knowledge in the laboratory sectors applied to oncology including cytomorphology, histopathology and clinical pathology and in the field of diagnostic imaging, and be able to provide the main diagnostic interpretations;

Objectives of the general training: the resident must acquire methodological skills related to clinical logic, decision-making strategies, patient management that guarantee a global and unitary (holistic) approach to the solution of the problems that the various specialists may encounter in their professional practice;

Educational objectives of the type of School: the student must:

• know and be able to apply the principles of epidemiology and preventive medicine in the field of oncology;
• acquire the advanced theoretical and clinical knowledge necessary for the diagnosis, care, treatment and follow-up of cancer patients;
• acquire the theoretical and practical knowledge related to the different therapeutic possibilities in integrated treatments in oncology;
• know how to recognize and treat the symptoms of the terminal phase and plan and manage the care of the terminally ill patient and his family;
• deepen the knowledge necessary to allow a correct relationship and effective doctor/patient communication;
• to acquire advanced theoretical and practical knowledge in the field of cellular, molecular and experimental oncology in order to apply them to the diagnosis and clinic of neoplastic pathology.

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:

• the setting up of the diagnostic and staging itinerary in at least 250 patients with neoplasia, discussing with the teaching staff the indications and limits of laboratory investigations, molecular biology, diagnostic imaging, nuclear medicine, cytology and histology in the various tumors;
• the choice of the therapeutic program in at least 250 patients, discussing with the teaching staff the possible efficacy, side effects and feasibility of the proposed scheme on an inpatient, day hospital or outpatient basis and taking care of the correct setting of high-cost target molecular therapies (monoclonal antibodies, small tyrosine kinase inhibitors, cancer vaccines and gene therapy, cytokines and growth factors) in compliance with current procedures, appropriateness and cost optimization, based on knowledge of biomarkers as prognostic indicators, and predictive in the choice of personalized treatment and, finally, in the awareness of the potential of translational research, as an important implementation process in patient care;
• the carrying out, in the first two years under supervision in the following three years always with greater autonomy until it is completely independent, of informative interviews with patients and/or their relatives in at least 250 cases in various stages of illness, discussing the psychological, ethical and medico-legal aspects;
• the choice of treatment of complications, antiblastic treatments and supportive therapy in at least 150 cancer patients;
• the choice of treatment of oncological emergencies (haemorrhages, metabolic disorders, compressions, etc.) in at least 50 cancer patients;
• the choice of palliative treatment (pain therapy, etc.) in at least 100 patients in the terminal phase;
• participation in multidisciplinary teams for the planning of integrated chemo-radiotherapy treatments;
• the divisional or interdivisional guard for at least 30 shifts in total, assuming personal responsibility (with the possibility of consulting the guardian) in the shifts of the last two years.

The student must also:

• have personally performed the following invasive maneuvers in sufficient numbers: paracentesis, thoracentesis, bone biopsies;
• have directly followed the conduct, according to the rules of good clinical practice, of at least five controlled clinical trials, including multicenter ones, knowing how to deal with ethical, regulatory and legal problems, correctly report the criteria for the definition of response to therapy and the evaluation and classification of toxicity, acquiring experience in obtaining informed consent from the patient and using the tools to assess the quality of life in the respect for the significance of biomarkers, the role and function of Ethics Committees and the regulatory and oversight mechanisms exercised by government authorities;
• have attended the following facilities: Department of Internal Medicine and/or Medical Specialties, for at least six months; Radiotherapy department/service, for at least two months; Medical Oncology department/day-hospital continuously for at least four years;
• know and be able to apply the most advanced techniques of molecular oncology to oncological diagnostics.

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.