The specialist in Rheumatology must have gained theoretical, scientific and professional knowledge in the field of pathophysiology and clinical of rheumatic diseases; The sector has expertise in functional and instrumental semeiotics, clinical methodology and therapy of rheumatological pathology. Specific areas of expertise are the pathophysiology and clinic of rheumatic diseases, both those affecting the musculoskeletal system and those affecting the connective tissues spread throughout the body, as well as the semiotics and clinic of rheumatic diseases of a degenerative, phlogistic, dysmetabolic, infectious, post-infectious, autoimmune nature, both with localized and systemic expression.

For the Postgraduate School of Rheumatology (divided into four years of course), the educational objectives are:

Basic educational objectives: the acquisition of fundamental knowledge of morphology and pathophysiology of connective tissues and of the musculoskeletal and articular system, in order to know the biological bases of the pathophysiology and clinic of rheumatic diseases;

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

specific training objectives of the type of School: acquisition of theoretical knowledge and clinical skills (diagnostic, therapeutic and rehabilitative) and instrumental-laboratory skills (also with flow cytometric techniques) for the treatment of pathologies of connective tissues and the musculoskeletal and articular system, also for emergencies-urgencies of rheumatological interest; acquisition of clinical skills mainly concern the physical and instrumental se-meiotics of rheumatic diseases, the immunopathology of rheumatic diseases, rheumatological imaging diagnostics (ultrasound, capillaroscopy, bone densitometry, scintigraphy), clinical pharmacology, pharmacotherapy and hydropinotherapy of rheumatic diseases, physical medicine, orthopaedic therapy, rehabilitation and occupational therapy of rheumatic diseases; acquisition of knowledge of Medical Statistics and Epidemiology adequate to recognize the social implications of rheumatic diseases.

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:

• acquisition of general technical skills for the clinic of rheumatological diseases, personally following at least 400 cases of rheumatological pathology.

In these cases, the student must:

• follow at least 100 cases of a systemic nature, actively participating in the collection of anamnestic data, carrying out the objective examination, proposing the planning of rational diagnostic and therapeutic interventions, critically evaluating the clinical data;
• carry out clinical activity in the Rheumatology ward by carrying out at least 40 shifts of active on-call and filling out at least 20 resignation letters (co-signed);
• carry out clinical activities in an outpatient clinic of Rheumatology by performing at least 300 visits;
• carry out clinical activities relating to the procedures for the treatment and monitoring of at least 20 patients undergoing treatment with biological drugs, followed for at least one year;
• acquire the ability to discuss clinical cases in a documented and analytical way, exposing at least 5 cases of rheumatic diseases;
• directly perform at least 20 arthrocentesis with relative examination of the synovial fluid and at least 40 joint and periarticular infiltrations for therapeutic purposes, of which at least 10 under ultrasound guidance;
• critically evaluate the results of at least 400 laboratory tests related to rheumatological pathology, of which at least 100 autoantibody profiles;
• acquire the ability to recognize the most common histological pictures inherent to rheumatological pathology through participation in at least 5 clinical-pathological conferences and direct involvement in the presentation of at least 1 case;
• perform muscle-tendon and joint ultrasound scans and periungual capillaroscopy, assisting in the execution of at least 100 ultrasound examinations and personally performing at least 40 in multiple districts, and assisting in the execution of at least 50 capillaroscopies and personally performing at least 20, demonstrating, and, therefore, being able to correctly interpret the results of each of the 2 techniques;
• acquire the ability to analytically and critically interpret the results of bone densitometry, also in relation to the knowledge of the technical methods of execution;
• acquire the ability to correctly recognize and interpret radiograms, scintigraphy, CT, MRI and all other diagnostic imaging techniques related to rheumatological pathology;
• To acquire and interpret the main clinical data concerning primarily patients with chronic inflammatory joint diseases.

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.