The learning profile of the Specialist in Pediatrics is as follows:

In addition to general paediatrics, adolescentology, paediatric allergology and immunology, paediatric bronchopneumology, paediatric cardiology, paediatric endocrinology and diabetology, paediatric haemato-oncology, paediatric gastroenterology and hepatology, paediatric nutrition, clinical genetics, paediatric infectious diseases, hereditary metabolic diseases of the child, nephrology are specific cultural and professional areas of competence of this class. neonatology and neonatal intensive care, paediatric neurology, emergency paediatrics and intensive care, paediatric rheumatology, analgesic therapy and paediatric palliative care.

Learning objectives

In accordance with the European Board of Paediatrics (EBP), paediatrics specialists must possess a wealth of knowledge, obtained as part of a unitary training course,  consisting of two components, a common one (basic paediatric curriculum), preparatory to a subsequent one (specific training curriculum and elective paths), aimed at acquiring the professional baccalaureate, consolidating existing skills and acquiring new ones, in relation to professional and specialist paths: General Paediatrics-Territorial Primary Care, Paediatrics of Hospital Secondary Care and Paediatrics of Specialist Care, the latter chosen from those that the  School is able to offer.

Basic Paediatric Curriculum (three-year period)

For a total of 180 ECTS, the following contribute to the acquisition of the skills of the basic paediatric curriculum:

• Basic training activities
• The characterizing activities of the common pediatric trunk
• part of the specific characterizing activities of the Pediatrics typology (MED/38)
• part of related or supplementary training activities
• the "other" activities.

General learning objectives

The general educational objectives of the basic paediatric curriculum are divided into knowledge, professional skills and abilities in general paediatrics and in the various specialist areas of paediatrics. The learning objectives are:

1) Knowledge - Main social problems that can alter the normal child/parent relationship and psycho-physical and affective development; early indicators of pervasive developmental disorders, psycho-cognitive deficits and potentially "pathological" social behaviors; basic notions on language, hearing and learning disorders in general and on possible diagnostic-therapeutic pathways; principles of PBLS (Pediatric Basic Life Support); principles of hereditary diseases and main genetic diseases; auxological and psychomotor development; energy and nutritional requirements; hydro-electrolyte homeostasis and related pathological pictures; correct lifestyles and principles of disease prevention; elements of preventive medicine and screening (metabolic, auditory, endocrinological); Vaccinations; pain therapy and palliative care; classification of the abused child and the family/social conditions of risk; rights and duties of the child and his or her parents; basic elements of health policy; resources present in the area for the care of children suffering from chronic diseases and for family support.

2) Professional skills in the field of: medical ethics and clinical ethics; the clinical method (including clinical reasoning by problems); the differential diagnosis and the setting up of the diagnostic-therapeutic procedure for the main paediatric diseases; communication; teamwork; clinical practice based on "evidence-based pediatrics"; the methodology of scientific research; risk management and clinical governance; the methodology for continuing education; of the principles of care management as a single multidisciplinary team, in the hospital, in the specialist clinic and as territorial assistance.

3) Ability–Be able to take a paediatric medical history; build a family tree; perform the general and neurological objective examination; perform the otoscopic examination; interpret the results of laboratory and/or instrumental tests in different paediatric ages; fill in and manage medical documentation (paper and/or electronic); perform a venous and arterial blood sample in different pediatric ages; cannulate the umbilical vein and artery; cannulate a peripheral vein; perform bladder catheterization; place the nasogastric tube; perform a lumbar puncture and know how to interpret the findings of the fresh CSF examination; obtain a sterile urine sample for urine culture; detect vital parameters; perform PBLS maneuvers; manage the healthy newborn in the delivery room using the basic maneuvers of resuscitation of the newborn; administering parenteral medications; measure and interpret blood pressure at different ages; Perform the monitoring of income/expense balances and the calculation of diuresis.

4) Compulsory courses: pediatric basic life support; Pediatric Advanced Life Support; resuscitation in the delivery room.

Learning objectives for the individual areas of paediatrics (basic paediatric curriculum)

Adolescentology

Knowledge

Stages of adolescent development; psychosocial aspects: sexual identity, independence, ideals; common communication difficulties between adolescents and adults; adolescent sexuality (sex education and contraception); pregnancy; risky behaviour; sexually transmitted diseases; eating disorders; chronic diseases; suicide and attempted suicide; abuse; bullying; menstrual disorders.

Skills and Abilities

Staging of pubertal development and evaluation of bone maturation; know how to communicate with adolescents; know and know how to teach sex education to adolescents; know how to make the adolescent participate in the choices that affect his or her health.

Allergology

Knowledge

Allergic diseases and their clinical manifestations (in particular asthma, allergic rhinitis, atopic dermatitis, food allergy, anaphylaxis, drug allergy); indication for the execution of allergy tests (prick test, prick by prick test, patch test, specific IgE dosage); indications for carrying out provocation tests with food; principles of management of allergic disease and prevention of exacerbations; Principles of drug therapy.

Skills and Abilities

Ability to recognize allergic disease, to assess its severity, to set up the differential diagnosis and to propose a diagnostic-therapeutic procedure, recognizing when it is necessary to request the intervention of the specialist. Execution and interpretation of allergy tests; diagnosis and treatment of anaphylactic shock and prevention of recurrence.

Cardiology

Knowledge

Circulation of the fetus and newborn; prevention of bacterial endocarditis; main congenital heart diseases; major paediatric arrhythmias; symptoms and signs of heart failure in different pediatric ages and principles of cardio-circulatory resuscitation; diagnostic and follow-up tools for congenital heart disease and arrhythmias; principles of medical and surgical therapy of congenital heart disease; indications for echocardiography; drugs used in pediatric cardiology.

Skills and Abilities

Discrimination of physiological from pathological murmurs; ability to recognize the signs/symptoms of cardiovascular disease, to assess their severity, to set up the differential diagnosis, to propose a diagnostic-therapeutic procedure, identifying the need for specialist intervention; principles of interpretation of chest x-ray and ECG traces in different pediatric ages; vagal maneuvers (with supervision).

Dermatology

Knowledge

Pathophysiology of the main paediatric skin diseases; skin manifestations of systemic diseases of childhood; diagnostic and treatment principles of the main paediatric skin infections; principles of treatment of eczema and seborrheic dermatitis; main serious skin diseases of the paediatric age (epidermolysis bullosa, "Staphylococcus scalded skin syndrome", toxic epidermolysis, cellulitis); indications for skin biopsy.

Skills and Abilities

Proposal of a diagnostic-therapeutic procedure for the main paediatric skin diseases, in the different age groups.

Endocrinology and diabetology

Knowledge

Regulation of receptors for peptide and steroid hormones; neuroendocrinology of the anterior and posterior pituitary gland; biosynthesis of steroid hormones; pathophysiology of the most common acute-onset endocrinological diseases; sexual differentiation; andrological pathologies; assessment of pubertal growth and development; obesity: diagnostic approach and prevention and related complications; type 1 diabetes mellitus; physiology of insulin and metabolic effects of insulin deficiency; Principles of management of the pediatric diabetic patient and knowledge of the different types of insulin.

Skills and Abilities

Ability to recognize signs/symptoms suggestive of endocrinological disorders, to assess their severity, to set up the differential diagnosis, the diagnostic-therapeutic process, identifying the need for specialist intervention; evaluation of the results of biochemical and radiological analyses and the most common tests used in diagnostic practice; execution and interpretation of an anthropometric assessment; staging of pubertal development; evaluation of blood glucose, ketonemia, glycosuria and ketonuria in an extemporaneous manner; management of diabetic ketoacidosis; use of stylus-injectors for the delivery of the different insulins.

Haemato-oncology

Knowledge

The most frequent benign haematological diseases; principles of treatment of the most common anemia and thrombocytopenias; interpretation of the most common haematological tests (blood count) by age group; warning signs and clinical pictures of the main paediatric neoplastic diseases; main clinical pictures of congenital and acquired bone marrow failure; indications and complications of bone marrow transplantation; the various types of transplantation available, the principles that regulate it and the essential elements of supportive care; biological markers of disease; principles of chemotherapy; legislation governing the transfusion of blood products, indications and precautions.

Skills and Abilities

Ability to recognize signs/symptoms suggestive of haemato-oncological disease, to assess its severity, to set up a correct differential diagnosis for prompt referral to the specialist; evaluation of peripheral blood smears and CSF smears under an optical microscope; Performing lumbar punctures.

Gastroenterology

Knowledge

The most frequent liver diseases (acute and chronic viral hepatitis, storage diseases, cirrhosis, cholestasis), pancreatic and gastrointestinal tract diseases (gastroenteritis, gastro-esophageal reflux, celiac disease, acute and chronic inflammatory bowel diseases, malabsorption, recurrent abdominal pain); signs and symptoms of gastro-enterological manifestations; gastro-enteric malformations; indications for laboratory, endoscopic, radiological and biopsy investigations; principles of treatment (dietary and pharmacological) of the main liver and gastroenterological diseases; Principles of management of gastrointestinal bleeding.

Skills and Abilities

Identification of the clinical picture of acute abdomen; ability to recognize signs/symptoms suggestive of gastroenterological and hepatic disease, assess its severity, set up the differential diagnosis, and propose a diagnostic-therapeutic procedure, identifying the need for specialist intervention; clinical-laboratory interpretation of dehydration and their correction; interpretation of the main laboratory and instrumental tests in gastroenterological and hepatic diseases.

Clinical genetics

Knowledge

Principles of heredity and genetic basis of hereditary diseases; clinical aspects of the most common chromosomal disorders and complex malformation syndromes; principles, significance, and clinical and ethical implications of genetic counseling and prenatal investigations; risk factors for fetal harm during pregnancy.

Skills and Abilities

Know how to perform pregnancy and family history for the identification of exogenous or endogenous risk factors for malformation syndromes (family history, exposure to external agents during pregnancy); to be able to draw and interpret the family tree; to be able to recognize the main signs of genetic diseases and dysmorphological syndromes.

Immunology

Knowledge

Development of the immune system; defects in adaptive and innate immunity and autoimmunity; immunological and genetic tests for the evaluation of immunodeficiency and autoimmune conditions; principles of medical and rehabilitative treatment in the various forms of immunodeficiency and autoimmunity; Significance and limitations of instrumental diagnostics in the various conditions of immunodeficiency and autoimmunity.

Skills and Abilities

Ability to recognize the signs and symptoms suggestive of immunodeficiency or autoimmunity, to assess their severity, to set up a correct differential diagnosis and to propose a diagnostic-therapeutic procedure, recognizing when it is necessary to request the intervention of the specialist.

Infectious diseases

Knowledge

Main defense mechanisms of the organism in the different stages of development; maternal-fetal mechanisms of transmission of infections; epidemiology, pathophysiology and natural history of the main infectious diseases of childhood; modern methods for microbiological diagnosis; rationale and indications for the use of antibiotic therapy and resistance mechanisms; principles of treatment of severe infections (meningitis, septic shock, complicated pneumonia, septic arthritis, osteomyelitis); indications, contraindications and complications of vaccinations; Recognition and therapy of septic shock.

Skills and Abilities

Formulation of a correct differential diagnosis, of a diagnostic-therapeutic procedure for the most common infectious diseases of childhood; indications for execution, methods of collection and storage of microbiological samples; interpretation of the outcome of microbiological investigations; prescription of a correct therapy for the most common infectious diseases of childhood.

Hereditary metabolic diseases

Knowledge

Main acute and chronic-progressive onset metabolic diseases of childhood (defects in carbohydrate, protein, vitamin, neurotransmitter metabolism, defect in energy metabolism, lysosomal metabolism and peroxisomal diseases); biochemical investigations; nutritional principles; fundamental notions for the management of acute metabolic decompensation; Natural history and long-term complications of major hereditary metabolic diseases.

Skills and Abilities

Recognize the warning signs and symptoms of hereditary metabolic diseases; correct interpretation of blood gas analysis and laboratory indices of dysfunction of carbohydrate, protein and lipid metabolism.

Nephrology

Knowledge

More frequent nephrological diseases in children (urinary infections, nephrosis, glomerulonephritis, uremic-hemolytic syndrome, acute renal failure); main malformative nephro-uropathies; indications for instrumental investigations in the nephro-urological field; general principles of therapy and management of patients with acute and chronic renal failure; indications for the surgical correction of the main malformative uropathies; Etiopathogenesis of enuresis and treatment principles.

Skills and Abilities

Collection of urinary history; recognize the signs/symptoms of nephro-urological disease; know how to propose a diagnostic-therapeutic procedure, identifying the need for the intervention of the specialist; interpretation of the main laboratory tests; treatment and follow-up of urinary infections; recognition of the picture of acute renal failure; execution and interpretation of the urine stick and the macroscopic and microscopic examination of the urine.

Neonatology and Neonatal Intensive Care

Knowledge

Physiology and pathophysiology of the fetus and principles of monitoring; pathophysiology of prematurity and low birth weight; main signs and symptoms of the most common neonatal diseases: acute and chronic respiratory failure, malformative or functional cardiovascular disorders, neurological disorders, metabolic disorders, congenital and acquired infectious disease, malformative pathology, obstetric trauma; neonatal pathologies caused by maternal illness during pregnancy; principles of resuscitation in the delivery room and assisted ventilation; nutritional needs of premature babies, newborns and infants; physiology of breastfeeding, contraindications and how to prescribe a diet with an adapted formula; rules for taking medication while breastfeeding; signs and symptoms of life-threatening clinical pictures for the newborn; pharmacology and indications for the use of surfactant.

Skills and Abilities

Collection of gestational (obstetric) and perinatal medical history; physical examination of the newborn and assessment of gestational age; interpretation of the main clinical signs of pathology in the neonatal period; manoeuvres for the management of the healthy newborn in the delivery room, calculation of the Apgar index and essential resuscitation manoeuvres; execution of spinal tapses; cannulation of umbilical vessels; venous and arterial sampling in the newborn and heel pricking; ventilation with ambu (face mask) and airway suction.

Neurology

Knowledge

The stages of the child's psychomotor development and his pathological deviations; pathophysiology and clinical manifestations of the most important neurological pathologies of the developmental age; main malformation syndromes of the central nervous system (spina bifida in particular and its implications); pervasive developmental disorders; disability and implications for the child and his/her family; febrile seizures, epilepsies, and paroxysmal non-epileptic phenomena; dose adjustment, side effects, and interactions of antiepileptic drugs; hypotonia, dysfunction of peripheral nerves and muscles; principles of treatment of the main neurological emergencies (acute intracranial hypertension, state of illness, ischemic/haemorrhagic events); indications for neuroradiological (CT, MRI, angio-MRI) and neurophysiological (EEG, Evoked Potentials, EMG) diagnostics; Indications for performing lumbar puncture.

Skills and Abilities

Collection of neurological history (with particular reference to psychomotor development) and neurological examination in the different pediatric ages; ability to recognize signs/symptoms suggestive of neurological disease, to assess its severity, to set up a correct differential diagnosis and to propose a diagnostic-therapeutic procedure, identifying the need for specialist intervention; anti-comitial therapy in the acute phase; execution of spinal tapses.

Nutrition

Knowledge

Know the nutritional needs of the pediatric age, including the preterm and the baby for gestational age; know the elements of clinical and laboratory evaluation of nutritional status; know the nutritional needs in the various pathological conditions; know common eating problems; know the interactions between diet and diseases; definition of malnutrition; learn about the problems of alternative and vegetarian diets.

Emergency Pediatrics

Knowledge

The most common diseases that lead the child to emergency observation; the approach to the child in urgency-emergency according to physiological priorities; principles of stabilization of vital functions; efficacy, indications, contraindications, limitations, side effects, costs, of the different diagnostic and therapeutic interventions in an urgent context; most common clinical pictures of maltreatment and psychological, physical and sexual abuse; clinical pictures of psychiatric decompensation in developmental age; know the tools for assessing pain in children with acute pathology and the principles of treatment with pharmacological and non-pharmacological therapy.

Skills and Abilities

Differential diagnostics and therapeutic choices for clinical problems in an emergency context, using the laboratory, radiology, ancillary diagnostic services, specialist consultations, using drugs and emergency interventions in a reasoned manner; manage and stabilize, as part of a multidisciplinary team, children in critical condition; be autonomous in the use of the main tools for monitoring vital parameters; acquire manual skills, up to the execution independently, of the most common procedures in the emergency field (venous sampling/cannulation, arterial puncture, lumbar puncture, oxygen administration, reduction of radial capital dislocation); Properly measure and treat spontaneous and procedural pain in an emergency setting.

Pneumology

Knowledge

Pathophysiological mechanisms underlying coughing, dyspnea, noisy breathing (wheezing, stridor, snoring); upper and lower respiratory tract infections, bronchiolitis, inspiratory stridor, pneumonia, bronchiectasis, asthma and wheezing; rare diseases of pneumological interest; main allergic diseases associated with respiratory diseases: atopic dermatitis, allergic rhino-conjunctivitis, food allergies, anaphylaxis; indication for allergy tests (prick test, patch test, specific IgE assay), respiratory function (spirometry, resistance measurement, flow-volume curve in the uncooperative child), radiological investigations of the lung (chest x-ray, CT, MRI, scintigraphy).

Skills and Abilities

Detection and monitoring of vital parameters (oximetry); ability to recognize signs/symptoms of respiratory disease, to propose a diagnostic-therapeutic procedure, identifying the need for specialist intervention; interpretation of the results of laboratory and/or instrumental tests (prick test, patch test, specific IgE, spirometry, Mantoux intradermal analysis, blood gas analysis, sweat test); administration of inhaled drugs (by nebulization, MDI, PPE); airway aspiration; oxygen therapy.

Rheumatology

Knowledge

Main juvenile rheumatological diseases: chronic juvenile arthritis, systemic lupus erythematosus, dermatomyositis, scleroderma, vasculitis (Schoenlein-Henoch purpura and Kawasaki disease), rheumatic disease; symptoms and signs of rheumatological manifestations in systemic, metabolic and neoplastic diseases; diagnostic procedure of fevers of unknown or recurrent origin; clinical significance of autoantibodies (ANA, ENA, anti-cardiolipin, lupus anticoagulans); examination of the synovial fluid; instrumental and imaging diagnostics in rheumatological diseases (standard radiology, ultrasound, CT and MRI); therapeutic indications and side effects of non-steroidal anti-inflammatory drugs, corticosteroids, immunosuppressants and other drugs used in the treatment of rheumatological diseases in children (including intra-articular therapy); psychological aspects of chronic rheumatological diseases on the patient and his family.

Skills and Abilities

Execution of the joint and muscle physical examination; ability to recognize signs/symptoms suggestive of osteoarticular and/or rheumatological disease, to assess its severity, to set the differential diagnosis and to propose a diagnostic-therapeutic procedure, identifying the need for specialist intervention.

Analgesic and palliative therapy

Knowledge

Pathophysiology of pain; instruments for measuring pain; principles of pharmacological and non-pharmacological therapy of acute, procedural and chronic pain; pharmacology and side effects of the main analgesic drugs; concepts of chronicity and terminality in the pediatric field; principles for a global evaluation and therapeutic approach to pain; criteria for palliative therapy in pediatrics; psychological needs of the patient in palliative care and his family; local resources available to patients in palliative care.

Skills and Abilities

Diagnostic framing of the pain symptom; use of pain measurement tools in different pediatric ages, in different clinical conditions and in response to treatment; treatment of the most common painful manifestations of the child.

Compulsory professionalizing activities of the basic pediatric curriculum:

• follow with direct responsibility and increasing autonomy 50 healthy newborns and 50 pathological newborns
• to carry out 500 outpatient consultations for acute or emergency problems with direct responsibility and increasing autonomy
• carry out 300 outpatient visits with direct responsibility and increasing autonomy, of which at least 1/3 are dedicated to prevention and health education
• carry out 500 specialist visits with direct responsibility and increasing autonomy distributed among the areas listed above.

Curriculum of Specific Training and Elective Paths (two-year course)

To achieve the training objectives of the specific training curriculum and elective courses, a total of 120 ECTS compete for:

• part of the specific characterizing activities of the Pediatrics typology (MED/38)
• part of related or supplementary activities
• final exam.

The training objectives of the final two-year period are aimed at consolidating and deepening the skills already in place, at acquiring new ones, at tracing the specific professional and cultural profile that the pediatrician who will work in the field of territorial primary care or hospital secondary care or in one of the specialized pediatric areas prepared by the School of Specialization must possess. below:
adolescentology; dermatology; endocrinology and diabetology; haemato-oncology; gastroenterology and hepatology; clinical genetics; immunology; infectious diseases; hereditary metabolic diseases; nephrology; neonatology and neonatal intensive care; neurology; emergency paediatrics; pneumology; rheumatology; analgesic and palliative therapy.

These objectives are divided into:

 - training objectives common to all doctors in specialist training;

 - training objectives in a specialist-professional field.

General learning objectives

1. Cultural acquisitions: cultural consolidation of what has been listed for the basic three-year period.

• Professional and methodological skills;
  • 2.1) To become aware: of the role of the paediatrician as a defender of the rights of the child and his or her family and as the primary guarantor of the full expression of the child's potential; the influence of the environment on the health of the child; personal educational responsibilities in practising one's profession towards younger colleagues, the patient and his/her family; the ethical implications of medical activity; of their human and professional limitations in order to seek, if necessary, adequate advice; the importance of communication with the members of the health team, with the child and with his family; the medical-legal implications of one's work and the legislation that regulates medical practice; legislation to support sick children and their families; the implications, in terms of public finance, of one's medical choices; the social context in which it operates; of ethnic-cultural differences.
  • 2.2) Acquire: the clinical methodology to arrive at a correct diagnosis and the necessary operational decisions, knowing the models of clinical reasoning, critically using bibliographic sources, clinical algorithms, computerized diagnostic systems; the culture and practice of the principles of "clinical governance".
• Practical and manual skills: Manage independently (after tutorial supervision):
  • paper or telematic material of clinical relevance (record, request for advice, tests, prescriptions); the formulation of a correct differential diagnosis and the setting up of a diagnostic-therapeutic and follow-up procedure for the most common general and specialist paediatric pathologies; therapeutic prescription, knowing how to anticipate side effects and planning adequate follow-up; the evaluation of the pain symptom and the management of analgesic therapy; the implementation of the first procedures necessary for the management of urgent and clinical emergency situations; the management of the healthy newborn born at term, in the delivery room and in the nursery; the request for advice from medical specialists and the management of the relationship with them; communication and teaching, as far as their competence is concerned, to younger doctors in training; the management (subject to the tutor's support) of the medical health team to which they belong; communication with the child (where appropriate) and with his/her family; the discharge phase and the coordination of any home support measures; the critical interpretation of guidelines and scientific articles; the planning of a continuous self-training project; the planning of interventions aimed at implementing the quality policy and the principles of clinical risk; active participation in the design and conduct of a research programme (e.g. specialisation thesis).

•  

  Learning objectives for professional and specialist fields

  General Pediatrics - Primary Care

  The training curriculum is aimed at training paediatricians with general paediatrics skills, to provide coordinated assistance in the local area to infants, children and adolescents, both healthy and with acute and chronic diseases. The doctor in training who orients himself towards this area must be able to take care of the healthy child in his or her various stages of growth and development, promoting correct lifestyles and catching deviations from the norm at an early stage. They must also be able to recognise and manage the main acute and chronic pathologies of the developmental age (both organic and psychological), making appropriate use of specialist outpatient services and/or hospitalisation, maintaining continuity of care in patients suffering from chronic diseases that flare up.

  Knowledge

  1) In-depth study and consolidation of the cultural acquisitions already listed in the basic paediatric curriculum in relation to the areas of general paediatrics and the most representative specialist areas of primary care: general paediatrics; adolescentology; auxo-endocrinology; nutrition; allergology; broncho-pulmonology; dermatology; infectious diseases; nephrology; gastroenterology; neuropaediatrics; child neuropsychiatry; analgesic therapy and palliative care.

  2) Specific cultural acquisitions related to:

  the importance of prevention (primary and secondary) and screening interventions; ethnopediatrics; the organisational models of local medicine, single and/or multi-professional teamwork; the management of demand, the management of resources and the promotion of the appropriateness of care; hospital-territory integration, multidisciplinarity and the relationship with social services and schools; the problems of the patient's transition from pediatric care to that of the adult doctor.

  Skills

  1) Reference is made to the general and specialized areas listed above for the definition of skills related to child care in a primary care context.

  2) Specific acquisitions are to know:

  recognize when it is necessary and appropriate to request hospitalization, refer the patient to the pediatric emergency room; interact with other territorial structures on the one hand and with the Specialist Centres on the other, in the implementation of care plans that guarantee continuity of care for patients, particularly those with chronic diseases; recognise and manage social, relational, ethnic and psychological problems that may interfere with the health of children and adolescents; providing prevention interventions (in particular vaccinations), promoting healthy lifestyles and training families in the nutritional field; recognize risk behaviors both for health problems (physical, psychological, relational and social), and for non-adherence to therapy in the case of chronic disease; govern demand and facilitate the participation of the patient and family in the care project (empowerment); working in mono or multi-professional teams to achieve shared goals;

  Compulsory training areas

  General and specialist paediatrics wards and outpatient clinics; family pediatricians' offices; Local services;

  Professionalizing activities. Follow patients with increasing responsibility to the point of autonomy:

  • inpatients and/or outpatients for general and specialist paediatrics problems: at least 150
  • outpatient clinics for acute problems and/or emergencies: at least 150
  • in need of screening, prevention and health education: at least 150
  • with developmental, behavioural or psychosocial problems, or suffering from chronic diseases and/or social risk: at least 50

   

  Perform with increasing responsibility to the point of autonomy:

  • telephone consultation-telephone triage: at least 50
  • Vaccinations: at least 20
  • Health assessments: at least 100
  • Chronic health assessments: 20
  • Taking charge of the newborn: at least 10
  • Prescriptions for pathologies or diagnostics: at least 100
  • Certificates and reports: 50
  • Diagnostic self-help activities: 50

   

  General Pediatrics - Secondary Care

  The training curriculum is aimed at the acquisition of professional skills for the management of the pediatric patient and his family in hospitalization.

  These responsibilities are related to taking charge:

  of the child with a severe acute illness or with a chronic exacerbated illness requiring complex and/or semi-intensive hospital care; of the healthy and pathological newborn; of the child who enters the hospital in urgent/emergency conditions.

  In addition to this, there is specific organizational and managerial knowledge/skills, which are fundamental for the conduct of hospital practice with effectiveness, efficiency, quality, safety, and in the awareness of the system in which one operates.

  Knowledge

  1) In-depth study and consolidation of the cultural acquisitions already listed in the basic paediatric curriculum in relation to the areas of:

  general paediatrics; emergency paediatrics; neonatology and neonatal intensive care; the most representative specialist areas of the pathologies that lead the child to hospitalization as pulmonology; neurology; gastroenterology; cardiology; infectious diseases; analgesic therapy and palliative care.

  2) Specific cultural acquisitions related to:

  the main management systems of a healthcare company; the main hospital organisational models; strategies, methods and tools of Clinical Governance.

  Skills

  1) Reference is made to the general and specialized areas listed above for the definition of the competences relating to the care of the patient hospitalized for acute illness and of the healthy and pathological newborn.

  2) Specific acquisitions are the ability to:

  efficiently organise the simultaneous care of large flows of patients hospitalised with heterogeneous pathologies, recognising priorities and ensuring their safety; working in a team, with clarity and respect for roles; interact with the territory on the one hand, with the Specialist Centers on the other in the implementation of therapeutic plans that guarantee the continuity of care for patients with chronic diseases; correctly codify discharge diagnoses and understand the meaning of this act; reading and interpretation of activity and planning data (budget); to design care pathways as a tool for clinical governance and clinical risk prevention.

  Compulsory training areas

  General and specialist paediatrics departments with a wide range of cases and complexity of care; Paediatric Emergency Department; Neonatal Pathology Departments; Territorial services.

  Professional activities:

  • hospitalized for general and specialist paediatrics problems: at least 200
  • with specialist paediatric pathology: at least 150
  • outpatient clinics for acute problems or emergencies: at least 150
  • Healthy infants, (delivery room and nursery): at least 50
  • Resuscitation in the delivery room: 10
  • pathological newborns: at least 50
  • Infants in intensive care at least 20

   

  Paediatric specialities

  The training curriculum is aimed at the further acquisition of general pediatric skills and a particular cultural and professional deepening in a field of pediatric specialties. This curriculum can be considered preparatory to a subsequent one of Higher Education, intended to shape the sub-specialist paediatrician.

  The skills in this area are related:

  • the consolidation of the knowledge of general paediatrics acquired in the first three years, with specific reference to secondary care;
  • the deepening of knowledge and professional skills in the chosen specialist field, in order to better take care of the child suffering from pathologies pertaining to the same specialist sector;
  • in-depth training in clinical research through direct and personal involvement in research projects.

   

  For the knowledge and practical acquisitions to be achieved, please refer to what has been defined for the two-year training period in specific areas.

  Compulsory training areas

  Paediatric wards with recognised activities in paediatric specialties, listed below.

  It is desirable that for each specialist area there will be the acquisition of knowledge of the evolution in adulthood of pathologies arising in developmental age.

  Adolescentology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical acquisitions and manuals to know:

  Interpret the specific emotional, mental and physical health needs of adolescents; discuss issues concerning sexuality with the adolescent; provide appropriate advice on contraception, including emergency contraception, to prevent pregnancy in adolescence; discuss sensitive health issues in adolescence such as tobacco smoking, alcohol and other substance abuse, sexual activity also in relation to specific conditions such as asthma, diabetes mellitus, cystic fibrosis and physical disability; to support adolescents in the self-management of acute and chronic diseases and to identify those who wish to practice it or not to practice it; manage adolescents with work difficulties in relation to any physical disabilities; plan and manage the transition from pediatric to physician care of adolescents with chronic diseases, being clear about the value of the role of multidisciplinary team members in the success of the transition process itself; plan and manage the care pathway for adolescents with eating disorders; plan and manage the care pathway for adolescents who are victims of abuse or bullying; recognize and manage the adolescent with menstrual disorders, including polycystic ovary syndrome; recognize and manage the adolescent with varicocele or gynecomastia.

  Professional activities:

  • outpatients: at least 50
  • hospitalized patients: at least 20
  • patients with eating disorders: at least 10
  • patients with chronic disease: at least 10

   

  Allergology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions - Manage independently (subject to tutorial supervision)

  The diagnostic process, differential diagnosis and therapeutic approach of the main allergy diseases of the developmental age (IgE and non-IgE-mediated food allergy, anaphylaxis, acute and chronic urticaria, allergic rhino-conjunctivitis, allergic asthma, atopic dermatitis); the prescription of epinephrine ready, where indicated; dietary prescriptions;
  the prescription of specific immunotherapy; the execution of a food triggering test; the setting up of the diagnostic procedure for drug allergy and any triggering tests with drugs; the requests for specialized management that the allergic child needs.
   

  Professional activities:

  • Outpatients: at least 80
  • hospitalized patients: at least 50
  • allergy tests (prick, patch, prick by prick): at least 30
  • food or drug triggering tests: at least 10
  • spirometry: at least 30
  • bronchodilation test: at least 20
  • Stress tests: at least 10

   

  Cardiology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions - Manage independently (after tutorial supervision):

  the interpretation of symptoms and clinical signs of a possible cardiac pathology, especially with regard to auscultation; the interpretation of ECG abnormalities in different pediatric ages; chest X-ray reading performed for cardiological reasons; the execution of a two-dimensional echocardiography limited to the ability to differentiate normal findings from pathological ones; the initial procedures for the treatment of heart failure, cardio-circulatory arrest and severe arrhythmias (e.g. paroxysmal supraventricular tachycardia); monitoring of the patient after cardiac catheterization; the prescription of drugs commonly used in pediatric cardiology; the coordination of care also with local structures.

  Professional activities:

  • Outpatients: at least 100
  • hospitalized patients: at least 10
  • ECG: 50
  • echocardiograms: at least 50
  • Cardiac catheterizations (assistance): 10

   

  Dermatology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions - Manage independently (after tutorial supervision):

  the semiological interpretation of skin diseases with particular reference to rare ones (epidermiolysis bullosa, "Staphylococcus scalded skin syndrome", toxic epidermolysis); the diagnostic process, the differential diagnosis and the therapeutic approach of the main skin diseases of the developmental age; skin biopsy; the prescription of topical drugs, in particular the various steroid-based preparations; the general care of a person in developmental age suffering from a skin disease.

  Endocrinology and diabetology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the diagnostic process, the differential diagnosis and the therapeutic approach of the main endocrinological diseases of the developmental age: hypo- and hyperthyroidism; thyroid nodules; precocious and delayed puberty; short stature, growth retardation, andriological pathologies, excessive growth; hyper- and hypoglycemia; hydro-electrolyte disorders;
  auxological examination at all ages of life, also with reference to the use of the "body mass index";
  diabetic ketoacidosis, hypoglycemia and situations of altered hydro-electrolyte balance associated with endocrinopathy; setting up dynamic tests; the interpretation of endocrinological test results; the dietary, pharmacological and lifestyle prescriptions of the obese patient at risk of developing an early metabolic syndrome; the prescription of insulin and dietary therapy, the formulation of lifestyle advice (especially with regard to social, sporting and sexual activity) and the correct evaluation of the self-control diary in patients with diabetes mellitus; correct information on the problems of diabetic disease in relation to the environment surrounding the patient (family, school, sport); the application of the glycemic holter and the interpretation of the recorded data;
  the management of insulin pumps for diabetic patients; the prescription of contraceptive therapies.

   

  Professional activities:

  • Outpatients: at least 100 cases
  • diagnostic pathway of patients with possible endocrinopathy: at least 50
  • endocrinological emergency: at least 5
  • diabetic ketoacidosis: at least 5
  • prescription therapy in patients with precocious puberty: at least 5
  • patients with GH deficiency: at least 5
  • prescription of therapy to induce puberty: at least 5

   

  Haemato-oncology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the diagnostic procedure, differential diagnosis and therapeutic approach of the most common benign haematological diseases (anaemia, thrombocytopenia, neutropenia, haemorrhagic diatheses – von Willibrand disease) and oncological diseases; the staging processes of the most common oncological diseases of childhood; the prescription of blood products and managing any transfusion reactions; the conditions of fever and neutropenia and in particular the first procedures necessary to correct septic shock; conditions of acute and chronic thrombocytopenia, disseminated intra-vascular coaugulation, thrombosis, external haemorrhage; the execution of a bone marrow aspirate, a therapeutic spinal cord and an osteo-medullary biopsy; the microscopic reading of smears of peripheral blood, bone marrow blood and CSF; the daily care of a patient undergoing chemotherapy and bone marrow transplantation; the main haemato-oncological emergencies (septic shock, spinal compression, tumour lysis or hyperleukocytosis syndromes); analgesic and palliative therapy (where necessary); the interview (always with supervision) with the patient and his family; the discharge of the patient with haemato-oncology disease.

  Professional activities:

  • Outpatients: at least 100 cases
  • hospitalized patients: at least 50
  • Peripheral blood smear report: at least 50
  • Reporting of bone marrow aspirates: at least 20
  • therapeutic spinal tapses: at least 10
  • bone marrow aspirates at least 10
  • bone marrow biopsies: 5

   

  Gastroenterology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the diagnostic process, differential diagnosis and therapeutic approach of the main liver diseases (acute and chronic viral hepatitis, storage diseases, cirrhosis, cholestasis), pancreatic and gastrointestinal tract (GERD, acute and chronic inflammatory bowel diseases, celiac disease, malabsorption, recurrent abdominal pain); the diagnostic classification of the patient with jaundice; diagnostic-therapeutic interventions in the state of vomiting and diarrhea and chronic constipation; the diagnostic setting of gastro-intestinal bleeding, especially with regard to the recognition of serious and potentially fatal situations and the implementation of the first intervention measures; the indication for the execution of pH-impedance and esophageal manometry, intestinal and hepato-biliary scintigraphy, breath-test, intestinal permeability test, endoscopy of the upper and lower intestinal tract, radiological and histological examinations. the recognition of clinical pictures of surgical interest; the execution of the breath test.

  Professional activities:

  • Outpatients: at least 80
  • hospitalized patients: at least 50
  • pH-impedance meters: at least 5
  • Digestive endoscopies (assistance): at least 10
  • Esophageal manometry: at least 10
  • anorectal manometry: at least 5
  • Liver biopsies (assistance): at least 5

   

  Clinical genetics

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the recognition of the main malformative syndromic pictures (Down syndrome, Turner syndrome, etc.); the communication of illness; the counseling required for the formulation of the appropriate genetic advice and for the presentation of possible indications for a voluntary interruption of pregnancy.

  Professional activities:

  • outpatients: at least 50
  • dysmorphological evaluation of the newborn and infant: at least 20
  • Genetic counseling: at least 20
  • teratology consultations: at least 5

   

  Immunology

  Cultural acquisitions

  Know the fundamental stages of the development and functioning of the immune system; know the various conditions associated with a defect in the functioning of the immune system; know the meaning, limits and indications of the main in vitro immunological tests both with regard to adaptive immunity (T lymphocytes and B lymphocytes) and innate immunity (neutrophils, NK cells, Toll-like Receptors, cytokines); know the meaning, limits and indications of the main genetic tests useful for the identification of primary immunodeficiencies; know the various conditions of hyperactivity of the immune system ranging from allergic diseases to autoimmune and autoinflammatory diseases; know the genetic associations of the main allergic, autoimmune and connective diseases.
  Practical and manual acquisitions – manage independently (after tutorial supervision):
  The main primary immunodeficiencies and know their general therapeutic implications; in particular, he/she must be able to recognize urgent clinical situations and pathologies that can be initiated for OMT; the main allergic diseases, knowing the diagnostic elements and therapeutic measures; the main autoimmune and connective diseases, knowing the diagnostic elements and therapeutic measures; the main vasculitis, knowing the diagnostic elements and therapeutic measures; the main auto-inflammatory diseases, knowing the diagnostic elements and therapeutic measures;

  Professional activities:

  • outpatients: at least 30
  • hospitalized patients: at least 20

   

  Infectious diseases

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the diagnostic process, the differential diagnosis and the therapeutic approach of the most common infectious diseases of childhood; the prescription of first-choice antibiotics for treatment or prophylaxis; the setting of the diagnostic procedure in patients with recurrent infections; implementation of measures to control the transmission of infections; indications for the prevention of infections, especially in the nosocomial field; the notification of a communicative infectious disease in accordance with the law; antibiotic therapy in the immunosuppressed patient; the state of septic shock and the main adverse reactions to antibiotic drugs, including anaphylactic crises; Vaccination plans.

  Professional activities:

  • outpatients: at least 30
  • Infants with connatal and perinatal infections: at least 20
  • Hospitalized patients (including consultations): at least 30

   

  Hereditary metabolic diseases

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the diagnostic procedure, differential diagnosis and therapeutic approach of the main hereditary metabolic diseases (defects in carbohydrate, protein, vitamin, neurotransmitter metabolism, defect in energy metabolism, lysosomal metabolism and peroxisomal diseases); the diagnostic procedure in a newborn with suspected metabolic disease, even in emergency situations; the recognition and initial treatment of conditions of metabolic urgency; the recognition and correction of acid-base balance disorders; the choice of biological liquids to be subjected to investigation and the methods of storing them for transport to the laboratory;
  the coordination of the multidisciplinary care of the child with metabolic disease, through interaction with dietitians and other specialists.

  Professional activities:

  • outpatients: at least 40
  • hospitalized patients: at least 20
  • metabolic imbalances: at least 10

   

  Nephrology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the interpretation of laboratory tests (in relation to age and body size), nephro-urological function tests and the most common instrumental tests (renal ultrasound; radioisotope studies); the differential diagnosis, the diagnostic procedure and the therapeutic approach of the main nephrological diseases of the developmental age (urinary infections, nephrotic syndromes, acute nephritis, kidney stones, tubulopathies, acute and chronic renal failure); the differential diagnosis and diagnostic and therapeutic pathway of end-stage renal failure (including the principles of peritoneal dialysis and hemodialysis); the management of life-threatening clinical conditions (hyper-kalemia); the differential diagnosis, diagnostic procedure and initial therapeutic approach of arterial hypertension in children; the problems of uretero-bladder malformations and the most common forms of hereditary nephropathies; the diagnostic process of enuresis and other symptoms of bladder damage (dysuria, stranguria, pollakiuria); the diagnostic procedure of findings of glomerular and tubular damage (proteinuria and hematuria); dietary prescriptions in nephropathic children.

  Professional activities:

  • outpatients: at least 50 cases
  • hospitalized patients: at least 30
  • patients in acute renal failure: at least 10
  • patients on dialysis (hemodialysis and peritoneal dialysis): at least 10
  • Renal biopsy (care/observation): at least 5

   

  Neonatology and Neonatal Intensive Care

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the differential diagnosis, diagnostic procedure and therapeutic approach of the main pathologies of the preterm and full-term infant: acute and chronic respiratory failure, malformative or functional cardiovascular disorders (congenital heart disease, PDA, persistence of fetal circulation, hypotensive SDR and shock), neurological disorders (seizures, hypoxic-ischemic syndrome, intracranial haemorrhages, peri-ventricular leukomalacia), metabolic disorders (hyperbilirubinemia, hypoglycemia, hypocalcemia, inborn errors of metabolism), congenital and acquired infectious disease (TORCH infections, sepsis and neonatal meningitis), malformative pathology (cardiac, neurological, diaphragmatic hernia, most frequent genetic syndromes: trisomy 13, 18, 21), obstetric trauma (clavicle fracture, brachial plexus injury, cephalohematomas); resuscitation in the delivery room; the adaptation phenomena of healthy infants of 34-37 SG in the postpartum period (respiratory distress, hypoglycemia, hypocalcemia, polycythemia, hyperbilirubinemia) and the principles of treatment;
  the use of the cradle for neonatal transport; performing brain ultrasound; the diagnostic approach to pneumothorax, indications for drainage and the execution of the drainage itself; physiological and pathological jaundice, tracing an adequate diagnostic and therapeutic process; the placement of the laryngeal mask, endotracheal intubation, the administration of surfactant and the setting of ventilatory support; the initial treatment of bleeding; the evaluation and possible correction of the hydro-electrolyte balance; cannulation of an umbilical vein and artery, placement of a percutaneous venous access, performance of arterial blood gas analysis;
  the interpretation of laboratory tests in accordance with the neonatal period and of the most commonly used radiological findings (chest x-ray, brain ultrasound); the interpretation of the screenings and knowledge of the next steps to be taken in the event of a positive result; the indication for admission to a Neonatal Intensive Care Unit; the discharge of a newborn in need of home care (e.g. oxygen therapy).
   

  Professional activities:

  • Outpatients: at least 100
  • healthy infants: at least 200
  • Infants on assisted ventilation: at least 20
  • Neonatal transport: at least 5
  • prescription (tutoring) of total parenteral nutrition: at least 20
  • Resuscitation in the delivery room: at least 10
  • newborn in Intensive Care and Semi-Intensive Care Neonatal: at least 30 cases
  • umbilical vein incanulation: at least 10
  • Tracheal intubation*: at least 10
  • arterial blood gas analysis: at least 10

  *Also on mannequin

  Neurology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the differential diagnosis, the diagnostic procedure and the therapeutic approach of the main neurological pathologies of the developmental age: regression or arrest of psycho-motor development, learning disorders, mental retardation, speech and hearing disorders, cerebral palsy, seizures/epilepsy, meningismus, encephalitis, acute encephalopathies, hydrocephalus, conditions of altered state of consciousness, headache, syncope, focal neurological signs, movement disorders (ataxia, chorea, tics), muscle hypotonia (both in the neonatal period and in later ages), peripheral neuropathy, myopathy, neurocutaneous syndromes (neurofibromatosis, tuberous sclerosis), neural tube defects and other cerebral and cranial malformations (e.g. craniosynostosis); the initial diagnostic process of a patient with central nervous system neoplasia; the recognition and initial treatment of clinical situations of neurological urgency/emergency such as severe head injury, intracranial hypertension, seizures, illness, cerebral vascular accidents, the possible request for advice and/or intensive support; the evaluation of the fundus oculi for the diagnosis of intracranial hypertension; EEG reading; the request for laboratory and instrumental investigations and the interpretation of reports (EEG, CT scan and brain MRI); the coordination of the continuity of the care needs of children with complex pathologies and disabilities, in collaboration with the territorial network.

  Professional activities:

  • outpatients: at least 150
  • Hospitalized patients: at least 60
  • EEG and/or video EEG: at least 50
  • reading neuroradiological examinations: at least 60
  • neurophysiological examinations (ENP, EMG): at least 20
  • Lumbar puncture*: at least 10

  *Also on mannequin

  Emergency paediatrics

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  emergency situations in which it is necessary to assist children with critical impairment of vital parameters;
  differential diagnostics for clinical problems in an emergency context, correctly using the laboratory, radiology, ancillary diagnostic services, specialist consultations, and correctly interpreting the results; the main tools for monitoring vital parameters; the most common resuscitation procedures (in particular with regard to cardio-pulmonary arrest, septic, cardiogenic and haemorrhagic shock, the state of illness and coma pictures); the initial management of the polytraumatized child, in particular with regard to the involvement of the dedicated multidisciplinary team; the initial management of the child with acute psychotic crisis; the therapeutic process for diseases that lead the child to observation with an urgent nature, knowing the efficacy, indications, contraindications, side effects, costs of the various interventions and knowing how to carry out correct prescriptions; the coordination of the continuity of care of the child with acute illness, from initial presentation to admission to follow-up after discharge; the role of team leader in the management of the child in critical condition.

  Professional activities:

  • Emergency room visits: at least 200
  • patients in OBI: at least 50
  • ICU patients: at least 10
  • arterial puncture: at least 10
  • Mask ventilation*: at least 10
  • cardioversion/defibrillation*: 5
  • Basic/advanced cardiorespiratory resuscitation*: at least 5
  • reduction of radial capital dislocation: at least 5

  *Also on mannequin

  Pneumology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  respiratory diseases of the developmental age: inspiratory stridor, upper respiratory tract infections, otitis, laryngitis and epiglottitis, recurrent respiratory infections, viral bronchiolitis, pneumonia (and possible complications), bronchiectasis, tuberculosis, asthma, recurrent wheezing in preschool children, cystic fibrosis, bronchopulmonary dysplasia, primary ciliary dyskinesia; the differential diagnosis and the diagnostic-therapeutic process of the main allergic conditions associated with respiratory diseases of the developmental age (atopic dermatitis, allergic rhino-conjunctivitis, food allergy); the initial treatment of respiratory urgency/emergency conditions such as inhalation of a foreign body, epiglottitis, anaphylactic crises with participation of the upper airways, asthma attacks; the rational use of antibiotics in respiratory infections; the treatment of asthmatic patients in the acute phases of the disease and in the phases of remittance of symptoms; the education of asthmatic children and their families; the first interpretation of chest x-ray and CT scan; the execution of an arterial blood gas analysis and the interpretation of the result; the interpretation of broncho-alveolar lavage, bronchial brushing and trans-bronchial biopsy; the follow-up and complications of bronchodysplasia; the treatment of exacerbations of children with cystic fibrosis; the execution and interpretation of spirometry, respiratory function tests in infants and pre-school children (e.g. flow-volume curve, measurement of respiratory resistance with the RINT technique, forced oscillometry); measurement and interpretation of lung volumes; the execution and interpretation of the bronchodilation test and the stress test; the correct execution of inhalation therapy; the execution and reporting of and by prick tests.

  Professional activities:

  • Outpatients: at least 100
  • Hospitalized patients: at least 100
  • spirometry: at least 30
  • bronchodilation test: at least 20
  • Chest x-ray and CT scan: at least 10
  • Measurement and interpretation of lung volumes: at least 10
  • Stress tests: at least 10
  • Prick Test: at least 15

   

  Rheumatology

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the differential diagnosis, the diagnostic procedure and the initial therapeutic approach of the main juvenile rheumatological diseases: juvenile idiopathic arthritis, systemic lupus erythematosus, dermatomyositis, scleroderma, vasculitis (in particular Schoenlein-Henoch purpura and Kawasaki disease), acute joint rheumatism; the diagnostic procedure of fevers of unknown origin; the clinical interpretation of the dosage of auto-antibodies (ANA, ENA, anti-cardiolipin, lupus anticoagulans) and other laboratory tests used for the diagnostic classification of rheumatological diseases; diagnostic-therapeutic arthrocentesis of at least 2 large joints (knee and ankle);
  the legislation that regulates the use of biological drugs (knowing the indications, limits and side effects of these drugs); communication with the patient and his/her family and the development of an educational and behavioral plan in relation to coexistence with a rheumatological disease (especially for the adolescent patient); the indication of a possible psychological support plan.

  Professional activities:

  • outpatients: at least 30
  • hospitalized patients: at least 20
  • Arthrocentesis (assistance): at least 5

   

  Analgesic and palliative therapy

  Cultural acquisitions

  In-depth study and consolidation of the cultural acquisitions listed in the basic paediatric curriculum in relation to this specialist area.

  Practical and manual acquisitions – Manage independently (subject to tutorial supervision):

  the diagnostic and therapeutic process of acute, procedural and chronic pain situations in children; the diagnosis and management of the various problems related to chronic and/or terminal diseases (oncological, neurological, cardiological, metabolic), with high care complexity; the prescription of the main analgesic drugs (including opioids) and measures to control side effects; the indication of non-pharmacological analgesic therapies; the organization of supportive therapy for pain management; the protected discharge of patients who are candidates for palliative care; palliation techniques for children with complex chronic diseases and in a state of terminality, both in hospital and at home; the application of a global therapeutic approach to the suffering of the child and his family; communication with the child with painful symptoms or a candidate for palliative therapies; prioritization between the problems of the child and family members; the formulation of care objectives that can be achieved and shared by the child and family members; the evaluation of the effectiveness of the assistance intervention, of the managerial, organizational and cost aspects.

  Professional activities

  • outpatients: at least 20
  • analgesic consultations (hospitalized patients): at least 20
  • patients in palliative care: at least 10
  • Participation in Multi-Professional District Assessment Unit (participation): at least 10

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.