Clinical Practice 6th Year

A.Y. 2022/2023
10
Max ECTS
120
Overall hours
SSD
M-PSI/01 MED/01 MED/09 MED/18
Language
English
Learning objectives
The clinical practice course is organized along 3 semesters (1st and 2nd sem 5° year and 1st sem 6° year) and integrates several disciplines to provide the students with conceptual tools to properly manage major clinical presenting problems. The 6° year module integrates Internal medicine and General surgery with Exercise and Sport Medicine, General psychology and Medical statistics. Coherently with the first module of the course held in the 5th year,in the 6 year
Starting from a complex cases the differential diagnosis and the therapeutic aspects are addressed. By integrating the different discipines students are trained to identify the most appropriate clinical and diagnostic tests to formulate a correct diagnosis and start planning the appropriate treatment. The Exercise and Sport Medicine Module provides the students with conceptual tools to introduce lifestyle intervention programs (with particular focus on physical exercise and nutrition) to foster health/wellbeing and to prevent/treat major chronic non communicable diseases. Medical Statistic introduces the students to Methodology of clinical research: how to write and present a clinical research protocol. The General Psychology module focuses on the concept of patients' adherence, cultural and gender differences in patients management and care givers in health management.
Expected learning outcomes
At the end of the 5th and 6th year module fo the course students are expected to: - use appropriately the clinical judgment in the evaluation of patients with complex presenting problem and complex diseases - use the appropriate use of clinical, laboratory, tests and exams findings - know the predictors, barriers and facilitators of adherence, know the methods for improving patient's adherence - be aware of the cultural factors impacting on patients choices - know the principal etiopathogenetic mechanisms of chronic non communicable diseases are modified by lifestyle interventions - know the basic clinical competencies in order to define cardio-metabolic risk and behaviors - be able to prescribe lifestyle intervention programs, physical exercise and nutrition, in order to foster health/wellbeing and to prevent/treat major chronic non communicable diseases. - know how to motivate subjects/patients to modify their lifestyle - Be able to write and present a clinical research protocol - set up of a proper patient's treatment.
Single course

This course cannot be attended as a single course. Please check our list of single courses to find the ones available for enrolment.

Course syllabus and organization

Single session

Responsible
Prerequisites for admission
To attend the Clinical Practice course, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Assessment methods and Criteria
The exam will be organized at the end of the 1st semester of the 6th year, when the course will be completed, and will cover all the topics of Clinical Practice 5th year and Clinical Practice 6th year courses. Students' fulfillment of competencies will be assessed by two written tests and two oral sessions. Written tests and Oral examinations can be taken in different exam sessions (the only prescribed order is for General Surgery, i.e. students must pass the written test to be allowed to take the oral exam). Once passed, the written tests and the oral examinations remain valid.
WRITTEN EXAMINATION
1) Written test of General Surgery
A written test using multiple choices Q&A questionnaire. 40 questions, each question has 4 answers, and each answer can be true or false. The questionnaire will be prepared on the slides presented at the frontal lessons (uploaded in the University website for student access) and on the official Textbook. The written test will be considered valid when at least 75% of responses will be answered correctly.
2) Written test of the following disciplines:
Plastic Surgery; Thoracic Surgery; Urology; Clinical Pathology; General psychology; Pharmacology; MED-EF/01
10 questions with 4 answers for each discipline, with only one correct answer. To pass this test students must answer correctly to 6/10 questions in each module.
ORAL EXAMINATION
For each exam session, the oral examinations of Internal Medicine and General Surgery are scheduled in two separate dates. To take the oral examination of General Surgery students must have already passed the Written test of general Surgery.
An oral discussion with the Course Director and/or Collaborators focused on clinical cases, multi-disciplinary analysis, risk-benefit of various therapeutic alternatives and clinical/research speculations on surgical patients presenting with clinical conditions described in the synchronous and asynchronous learning material as well as in the suggested Textbook. Contents of the asynchronous activities (e.g. Surgery Blog) will be valued, as part of the general assessment of student's participation and acquired knowledge
Attendance is required to be allowed to take the exam. Unexcused absence is tolerated up to 34% of the course activities. University policy regarding excused illness is followed.
Registration to the exam through SIFA is mandatory.
Internal medicine
Course syllabus
MODULE: INTERNAL MEDICINE
At the end of the module students are expected to:
· use appropriately the clinical judgment in the evaluation of patients with complex presenting problem and complex diseases
· use the appropriate use of clinical, laboratory, tests and exams findings
· know the predictors, barriers and facilitators of adherence, know the methods for improving patient's adherence
· be aware of the cultural factors impacting on patients choices- know the principal etiopathogenetic mechanisms of chronic non communicable diseases are modified by lifestyle interventions
· know the basic clinical competencies in order to define cardio-metabolic risk and behaviors
· set up of a proper patient's treatment

For each presenting problem:
· Identify the most appropriate tests to formulate a correct diagnosis
· Plan the appropriate treatment
PROGRAM:
TOPIC 1. Transition-of -Care
TOPIC 2. Innovative treatments
TOPIC 3. How to treat: pain (Recall different types of pain , Describe the general approach to pain treatment, Pain in the oncology setting, Treatment of oncological pain , Chronic pain in fibromyalgia , Drugs for fibromyalgic pain)
TOPIC 4. How to treat: Hypertension and Hypotension
TOPIC 5. Treatment of complex clinical cases
TOPIC 6. How to treat infection

MODULE: EXERCISE AND SPORT MEDICINE
The Exercise and Sport Medicine Module will provide the students with conceptual tools to introduce lifestyle intervention programs (with particular focus on physical exercise and nutrition) to foster health/wellbeing and to prevent/treat major chronic non communicable diseases.
EXPECTED LEARNING OUTCOMES:
· Exercise and Sport Medicine: definitions, differences and clinical importance
· Health, Wellbeing, Prevention and Lifestyle Medicine
· Effects of lifestyle interventions on main etiopathogenetic mechanisms of chronic non communicable diseases: a translational approach
· Importance of exercise medicine in chronic non communicable disease (cardiometabolic diseases, cancer, functional syndromes, etc)
· Cardiometabolic risk and lifestyle assessment
· Patient's assessment in order to prescribe lifestyle intervention programs (with particular focus on physical exercise and nutrition)
· Definition of specific clinical goals and personalized medicine in lifestyle interventions
· Exercise prescription: Modality (endurance, strength, flexibility, balance), aerobic and anaerobic, Intensity (definition of training heart rate), frequency, duration, progression
· Nutrition program prescription
· Synergies between exercise and nutrition programs
· Principles of behavioral medicine: how to motivate patients to modify lifestyle
· Stress and Functional Syndromes: definitions, clinical implications and management
PROGRAM:
· Achievement of a beginners level of the understanding of how the principal etiopathogenetic mechanisms of chronic non communicable diseases are modified by lifestyle interventions
· Achievement of the basic clinical competencies in order to define cardio-metabolic risk and behaviors
· Acquisition of the most important competencies to prescribe lifestyle intervention programs (with particular focus on physical exercise and nutrition) in order to foster health/wellbeing and to prevent/treat major chronic non communicable diseases.
· Acquisition of the core competencies to motivate subjects/patients to modify their lifestyle
· Achievement of a beginners level of the understanding of etiopathogenetic mechanisms of stress and functional syndromes and acquisition of the basic competencies to manage these conditions particularly using lifestyle modification programs
LEARNING OBJECTIVES:
TOPIC 1: From cardiometabolic risk to lifestyle management to prevent/treat chronic non communicable diseases
TOPIC 2: Principles of behavioral medicine to improve lifestyle: from "what" to "how"
TOPIC 3: Prescription of exercise program
TOPIC 4: Prescription of nutrition program
TOPIC 4: Lifestyle, Stress and Functional Syndromes
Teaching methods
FOR ALL MODULES: Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
Teaching Resources
Harrison's Principles of Internal Medicine, 20th Edition, McGraw Hill, 2018 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
· UP To Date - Evidence Based Clinical Decision Support resource
· ACSM's Guidelines for Exercise Testing and Prescription. 2018, 10th ed
· Up to Date-Evidence based clinical decision support resources
General surgery
Course syllabus
GENERAL SURGERY
Topic 1 - SURGICAL PRINCIPLES AND INDICATION IN GENERAL PRACTICE (SUM-UP)
· Surgical principles and main indications (overview on General Surgery course of 5th year)
· Complications in the surgical patient. Risk prediction
· Bedside surgical procedures
· Day Surgery and Surgical outpatient practice
Topic 2 - SEMINAR: SURGERY IN THE ELDERLY (PROS AND CONS)
Case presentations and multidisciplinary discussion
Ageism can affect clinical pathway. Lessons learned from different surgical and non surgical procedures
· Physiologic reserve. Cardiovascular-Respiratory-Renal-Hepatobiliary changes with age
· Risk factors, Energy requirements. Bed rest. Prognostic scores
· Competitive risk and life expectancy
Topic 3 - SEMINAR: ENDOCRINE SURGERY AND NEUROENDOCRINE TUMORS
Case presentations and multidisciplinary discussion
· Neuroendocrine
· Thyroid & Parathyroids
· Adrenal gland and endocrine pancreas
Topic 4 - SURGERY FOR MORBID OBESITY
· Magnitude of the problem
· Evaluation of the obese patient
· Medical vs. Surgical therapy: indications for bariatric surgery
· Mechanism of action of bariatric surgery
· Pre and post-operative care
· Operative procedures
Topic 5 - SEMINAR: SURGERY AND INFECTIONS (PRINCIPLES, GUIDELINES)
Case presentations and multidisciplinary discussion
· Principles of surgical infections and antibiotic use
· Guidelines for pre-operative prophylaxis and postoperative treatment
· Soft tissue infections, surgery for abscesses
· Burn and wound management
· Case presentations and multidisciplinary discussion
Topic 6 - TRANSPLANTATION AND IMMUNOLOGY
· Transplantation immunobiology and immunosuppression
· Liver transplantation
· Kidney transplantation
· Pancreas and small bowel transplantation)
Teaching methods
METODI DIDATTICI
FOR ALL MODULES: Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
GENERAL SURGERY MODULE:
Synchronous learning: Formal lessons delivered by the Course Director, Faculty and Invited Experts will be delivered as formal lectures, seminars, video sessions, video tutorial and clinical case discussions focused on the topics summarized below in the detailed program.
Asynchronous learning: As described in details in the Program below asynchronous learning will be developed through a Surgery Blog (SUB) activated and made accessible to all registered students and professors participating to the course. Each week a real clinical case will be uploaded and opened to groups and individual discussion (Case of the Week). Each Group will be asked to stick to pre-assigned format for case analysis. Contributions to the Surgery Blog will be valued as part of the general assessment of student's participation and acquired knowledge over time.
Teaching Resources
Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 20th Edition Elsevier 2017
Medical statistic
Course syllabus
MEDICAL STATISTIC
PART 1
· Introductory Lecture. Statistical Inference and methodology of clinical research.
· Lecture: How to write a research protocol: Introduction to the CONSORT statement and presentation of a research protocol template (Background, Goal, Methods, Sample Size)
PART 2
· Write and present your research protocol
· Small group work and final presentation
Teaching methods
FOR ALL MODULES: Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
Teaching Resources
J. Mark Elwood, "Critical Appraisal of Epidemiological Studies and Clinical Trials", 3rd Edition, Oxford University Press
· CONSORT Statement (www.consort-statement.org)
General psychology
Course syllabus
PSYCHOLOGY

Lecture 1 - Patients' Adherence I
· Definition and method to measure adherence
· Predictors, barriers and facilitators of adherence
Lecture 2 - Patients' Adherence II
· Psychological theories of adherent behavior
· Methods for improving people's adherence
· Examples of applications
Lecture 3 - Cultural and gender differences in patients management
· Cultural difference in the therapeutic alliance
· The role of cultural factors on patients choices
· Age as cultural factor
· Gender difference and gender bias in clinical practice
Lecture 4 - Care givers in health management
· The role of care-giver in patients management
· Predictors, barriers, facilitators and risk of care-givers' involvement
Teaching methods
FOR ALL MODULES: Interactive lectures, Clinical cases, Seminars, Discussion on clinical cases, Case studies
Synchronous learning: video conferences, interactive webinars, chat-based online discussions and lectures
Asynchronous learning: audio-video based (pre-recoreded, multimedia platforms); text-based (e-mail, electronic documents, discussion boards, blogs); mixed (virtual libraries, social networks)
Teaching Resources
Psychology:
Papers provided during lessons.
Additional material, in particular to online content, will be made available during the course.
· Additional material is provided by the slide-presentation used during frontal lessons and seminars, uploaded in the Ariel platform of the University for student access
General psychology
M-PSI/01 - GENERAL PSYCHOLOGY - University credits: 1
Lessons: 8 hours
: 4 hours
Professor: Mazzocco Ketti
General surgery
MED/18 - GENERAL SURGERY - University credits: 3
Lessons: 24 hours
: 12 hours
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 4
Lessons: 32 hours
: 16 hours
Medical statistic
MED/01 - MEDICAL STATISTICS - University credits: 2
Lessons: 16 hours
: 8 hours
Professor: Ambrogi Federico
Educational website(s)
Professor(s)
Reception:
On appointment (email)
Laboratorio di Statistica Medica, Biometria ed Epidemiologia "G.A. Maccacaro", Via Celoria 22, Milano
Reception:
On appointment (send an email)
Exercise Medicine Units, IRCCS Istituto Auxologico Italiano, via Pier Lombardo 22