Postgraduate School of Anaesthesiology and Intensive Care

Common training objectives (or common core)
Students must acquire the basics of clinical psychology, medical genetics, internal medicine, general surgery, neurology and paediatrics necessary for the completion of specialist training in the semiotics, diagnosis and treatment of pathologies pertaining to individual specialisations.
They must also acquire knowledge of the main laboratory tests on blood and tissues, radiology and neuroradiology imaging and their purpose and use in clinical and diagnostic assessment, prevention and monitoring of the structures and systems involved in anaesthesia and rehabilitation practices and in patients undergoing intensive, resuscitation and rehabilitation therapies

Core training objectives
Students must acquire specific knowledge of the physical, biochemical and pathophysiological phenomena necessary to correctly apply anaesthesia and perioperative medical techniques, to treat patients in pain, to manage the clinical criticality of both elective and emergency surgery, and to assist frail patients with appropriate care intensity, also outside the intensive care unit and within the field of hyperbaric medicine.
They must therefore develop the ability to assess risk and prepare candidate patients for surgery in elective or urgent/emergency situations, and/or for non-surgical diagnostic or therapeutic procedures. Students must also learn basic pathophysiological conditions, identifying methods to correct disorders that may influence the conduct of anaesthesia, the response to surgical, diagnostic and/or therapeutic manoeuvres and perioperative progress. They must be able to safely manage anaesthetic medication, airways and ventilation, and clinical risk during the different phases of induction, maintenance and awakening, including useful techniques for adequate pain management.
Students must be able to make choices based on risk assessment and know how to adopt different sedation techniques, general and/or locoregional anaesthesia, as well as the most appropriate monitoring procedure for patients? clinical conditions, in elective and in urgent/emergency situations, with both adult and paediatric patients.
They must acquire the theoretical knowledge and the practical ability to diagnose and treat all clinical conditions linked to perioperative medicine, polyvalent intensive care and specialised therapy, in accordance with national and European standards. They must learn and be able to use monitoring systems and prosthetic technologies capable of supporting vital functions in the operating room and in the post-operative recovery room, as well as in intensive care and during intra- and extra-hospital emergencies, including management of trauma, acute burn injuries and toxicological emergencies.
They must also learn to deal adequately with clinical situations related to acute and chronic pain, also in a multidisciplinary and hospice settings.
They must manage patient relationships appropriately, in order to prepare them accordingly for the intended procedure, as well as with the relatives of patients in critical conditions.
They must also learn to manage the organisational aspects regarding the safe transportation of critically ill patients in pre-intrahospital settings, as well as disaster medicine.
Lastly, they must obtain valid theoretical understanding of juridical and legal matters along with the bioethical implications associated with professional practice.

School-specific training objectives
Students must acquire the knowledge and skills to conduct appropriate and safe anaesthetic applications in all branches of surgery, both elective and urgent or emergency, in patients of all ages. To this end, they must learn the indications and timing for the most common surgical techniques used in general and specialist surgery, including transplants, and obstetrics; they must also be able to manage clinical risk, from preoperative assessment to postoperative care, applying the principles of perioperative medicine, pain treatment management, and the most suitable level of care intensity for postoperative recovery.
Students must be able to use and correctly interpret the main invasive and non-invasive techniques for monitoring respiratory, hemodynamic, neurological and metabolic parameters; they must also be able to deal with and manage primary intra-and extra-hospital medical emergency situations, be able to diagnose and treat the main conditions requiring intensive care, including the most common complications when managing critical patients, both medical and surgical as well as in extreme emergency conditions, such as in treating trauma, burns and the main cases of acute poisoning.
Students must therefore be able to diagnose and be familiar with the main techniques for supporting organs and functions; they must be able to manage critical airway conditions, by appropriately applying different models of artificial ventilation in the critical area, including exceptional environmental conditions (critical patient transportation and hyperbarism).
They must know the anatomical and physiological bases of the origin, conduction and perception of pain: they must know how to diagnose, implement a treatment plan, be familiar with the pharmacological characteristics and methods of analgesia, as well as have knowledge of non-pharmacological procedures and how to manage patients in chronic pain.
Students must be familiar with the indications for hyperbaric treatment and associated implementation methods, and be able to identify clinical cases in which such treatment is preferable, particularly in urgent-emergency conditions

Related or additional objectives
Students must be familiar with the administrative and managerial procedures of the discipline, including related medical-legal bioethical implications, in compliance with the safety standards, quality and pertinence of the care provided, and with particular reference to interdisciplinary interaction in the areas of perioperative medicine, pain therapy and palliative care networks, transplants, intensive care, emergency, disaster medicine, and underwater and hyperbaric medicine.
The mandatory training activities (Core Competencies) required to achieve the course-specific educational aims are identified Related or additional objectives

Students must be familiar with the administrative and managerial procedures of the discipline, including related medical-legal bioethical implications, in compliance with the safety standards, quality and pertinence of the care provided, and with particular reference to interdisciplinary interaction in the areas of perioperative medicine, pain therapy and palliative care networks, transplants, intensive care, emergency, disaster medicine, and underwater and hyperbaric medicine.
The mandatory training activities (Core Competencies) required to achieve the course-specific educational aims are identified by the following Training Areas:

General Core Competencies by area:
A. Anaesthesia and perioperative medicine
B. Critical emergency medicine
C. Resuscitation and intensive care
D. Pain Medication and Management - Palliative care
E. Hyperbaric therapy
F. Emergency toxicology
G. Anaesthetists? Non-Technical Skills (ANTS)
H. Quality, Management and Economics of healthcare, ethics, research and professional development

Specialist Core Competencies by area:
1. Obstetric anaesthesia
2. Airway Management
3. Thoracic and cardiovascular anaesthesia
4. Neuroanaesthesia
5. Paediatric anaesthesia
6. NORA/Outpatient Anaesthesia
7. Multidisciplinary pain management

General Core Competencies by area:
A. Anaesthesia and perioperative medicine
Students must acquire the clinical skills necessary for anaesthetic and perioperative patient care, including the ability to:
A.1) recognize the various pathologies, make adequate and rational use and interpret useful preoperative tests to assess and best prepare the patient for surgery, apply fasting and premedication guidelines in view of perioperative risk, communicate effectively and interact with patients for the purpose of informed consent;
A.2) appropriately assess and manage intraoperative anaesthetic techniques and/or regional blocks in view of the surgical programme and relevant co-pathologies, considering the functions directly affected by the techniques themselves, make appropriate and safe use of all equipment (anaesthetic, respiratory, medical gases, invasive and non-invasive monitoring and measurements etc.), applied image techniques, as well as electrical and environmental safety measures;
A.3) assess and support vital functions, manage intra- and post-operative clinical safety (airway risk, appropriate strategies in case of intubation and/or ventilation difficulties, risk of aspiration and perioperative respiratory complications, cardiovascular problems, risk of infections, etc.);
A.4) manage the decision-making process, discussing alternatives with the patient, the surgeon and other colleagues, appropriately manage clinical documentation and optimize postoperative care in cooperation with other doctors and nurses;
A.5) know and use a wide variety of equipment, having learned the operating principles, the significance of measured parameter variations and possible errors in various invasive and non-invasive monitoring techniques, as well as neurological, respiratory, cardiovascular and metabolic parameters pertaining to the various clinical situations in question.
At the end of the course, students must have: participated in the preoperative discussion and risk assessment of at least 1,000 clinical cases; taken part, also in collaboration with specialists from other disciplines, in the preoperative treatment of at least 50 cases affected by pathologies that may delay the chosen surgical procedure; appropriately planned and prepared the chosen surgical procedure; learned the effects of premedication and its consequences in pre-, intra- and post-operative phases; acquired experience in sedation and general anaesthesia practice for various diagnostic and treatment procedures in hospitalisation, Day Surgery, Outpatient Anaesthesia, as well as outside the SO (NORA, Non-operating Room Anaesthesia - MAC, Monitored Anaesthesia Care), such as interventional bronchoscopy, digestive endoscopy, diagnostic-interventional radiology and cardiology, radiotherapy etc.; acquired basic and specific skills in vascular access, in particular arterial and central venous catheterisation; acquired skills in basic and advanced techniques for airway and respiratory safety; acquired basic experience in locoregional anaesthetic techniques in elective and emergency situations and in central and peripheral regional blocks for anaesthesia and analgesia, both ultrasound-guided and not (peripheral nerve blocks, lumbar and thoracic epidural blocks, spinal and combined spinal techniques - epidurals), while knowing how to manage any complications; treated at least 1,000 patients, including new-born, paediatric and geriatric, carrying out at least: 50 sedations, 500 general anaesthesia, 25 epidural anaesthesia, 50 spinal anaesthesia, 20 peripheral nerve blocks, with at least the following in the areas listed below:
- General surgery - 100 operations;
- Obstetrics and Gynaecology - 30 operations (at least 10 caesarean sections);
- Orthopaedic surgery - 30 operations;
- Otolaryngology - 20 operations;
in addition to having practiced at least 100 anaesthesia procedures distributed across the following surgical specialties:
- Paediatric surgery
- Neurosurgery
- Thoracic-cardiovascular surgery
- Ophthalmology
- Urology
- Plastic Surgery

Students must: have knowledge of the technological principles of anaesthesia equipment and the relevant legislations;
be familiar with and have used a wide variety of invasive and non-invasive monitoring techniques;
have participated in the clinical use of ultrasound instruments and acquired basic knowledge of ultrasound anaesthesia techniques;
be familiar with and know how to use the main equipment in an appropriate and safe manner, checking working and environmental conditions and applying check-lists and risk management strategies to prevent errors and adverse events;
maintain patients' homeostasis throughout all procedures, including perioperative management of fluids, electrolytes, glucose levels and temperature, management of massive blood loss and coagulopathies, by knowing how to safely use blood and its derivatives, and being familiar with the appropriate techniques for managing venous cannulation;
have observed the application of extracorporeal oxygenation and circulation techniques;
have applied correct criteria and appropriate discharge scores from the SO and the PACU (Post Anaesthesia-Care Unit), including indicating the appropriate level of postoperative care;
have followed the postoperative course of at least 300 clinical cases, correctly preventing and treating acute pain, postoperative nausea/vomiting, as well as participating in postoperative follow-up and management of critical conditions;
have carried out technical monitoring and equipment use, and know how to manage these basic operations;
be familiar with and be able to apply normothermic maintenance techniques;
be familiar with clinical risk management strategies, acquiring skills and ANTS thanks also to the use of simulation, including high-fidelity.

B. Critical emergency medicine
Students must acquire the ability to manage (*training can take place through simulation for a maximum percentage of 50%):
B.1) the most common life-threatening medical emergencies, with basic and advanced management of pre- and intra-hospital critical medical emergencies, having performed cardiopulmonary resuscitation (in simulation and in the clinic);
B.2) trauma, in both pre- and intra-hospital phases, and initial burn treatment, including organisational aspects;
B.3) airways in critical condition;
B.4) the complex organisation of aid in cases of mass casualties and disasters (disaster medicine);
B.5) monitoring and measurements in emergencies.
At the end of the course students must:
have knowledge of triage and be able to carry out monitoring and measurements during emergency treatment of patients with acute respiratory, cardiovascular, neurological and metabolic conditions, acquiring skills and ANTS thanks also to the use of simulation, including high-fidelity (*);
have participated in at least 20 basic cardiopulmonary resuscitations (CPR) and 20 advanced CPR in adults (*);
have participated in at least 5 basic CPR and 5 advanced CPR in paediatric patients (*);
have positioned at least 50 central venous catheters, including the ultrasound-guided technique;
have positioned arterial needle cannula and interpreted at least 100 arterial blood gas tests;
have practiced at least 5 thoracenteses with positioning of thoracostomy tubes (*);
know how to use recommended techniques and devices for airway management in an emergency and in critical conditions, as well as how to conduct emergency tracheal access (*);
know how to perform invasive and non-invasive ventilation with different interface and ventilator types;
have diagnostic imaging interpretative skills, also with traumatised patients;
have participated in the clinical use of ultrasound instruments and acquired basic knowledge of ultrasound techniques in urgency-emergency situations (*);
have participated in the intra- and inter-hospital transfer of at least 10 critically ill patients;
have knowledge of advanced out-of-hospital first aid and of the managerial and decision-making processes of the 118 (emergency) operations centre and the organisation of mass casualties and disaster management systems.

C. Resuscitation and intensive care
Students are expected to have the skills to practice:
C.1) Medical treatment for different levels of intensity of care and perioperative care in critical patients;
C.2) General (multi-purpose) and specialist Intensive Care (ICU);
C.3) Airway and intensive respiratory assistance management, including the use of bronchoscopy;
C.4) Knowledge of a wide variety of equipment, having learned the operating principles, the significance of measured parameter variations and possible errors in various invasive and non-invasive monitoring techniques, as well as neurological, respiratory, cardiovascular and metabolic parameters pertaining to the various clinical situations in question, acquiring skills and ANTS thanks also to the use of simulation, including high-fidelity.
At the end of the course, students must have carried out at least two years of specialist training activity in Resuscitation and General and specialised intensive care and be able to treat ICU in-patients, identifying clinical problems, evaluating organ dysfunction indicators, developing diagnostic strategies regarding comorbid conditions and current complicating factors, and being able to manage specific treatment plans, including short and long term prognosis. Indicatively, students must:
have participated in the evaluation of critically ill patients and followed their clinical development on the basis of primary prognostic indices;
have participated in the treatment of at least 100 critically ill patients in various specialist areas and principle intensive conditions, recognising and mastering the specific aspects of monitoring venous and arterial vascular access and cardio-circulatory support, airway access, equipment management, including CRRT and respiratory assistance (from oxygen therapy to invasive and non-invasive mechanical ventilation);
have mastered artificial nutrition management suited to the needs of the main clinical subjects;
have mastered the management of appropriate fluid and electrolytic therapies by type;
know how to apply suitable protocols to prevent and monitor the risk of infections in intensive care and know how to use appropriate antibiotic treatment and antifungal therapy protocols;
be familiar with and able to apply the basic principles of intensive care, including post-operative in both general and specialist surgery and obstetrics for critically ill patients of all ages, including paediatric patients;
know the ethical principles involved in EOL (End Of Life) care with regard to national legislation and be able to participate, under supervision, in making decisions to revoke or refuse intensive treatment;
have participated in the process of determining death based on neurological and cardiac criteria;
have participated in the clinical management of potential organ donors and in all organ and tissue removal procedures;
be familiar with crisis management strategies, acquired also thanks to the use of advanced simulation;
have taken part in intensive care and clinical audit team organisational meetings, including the organisation of Resuscitation and Intensive Care units and the complexity of appropriate management in relation to resources and quality of care, as well as the humanisation of critical care treatment.

D. Pain Medication and Management - Palliative care
Includes:
D.1) Acute and postoperative pain therapy; knowledge of techniques and medication used for optimising postoperative pain management and prevention of chronic postoperative pain;
D.2) Management of acute and chronic pain within a multidisciplinary network;
D.3) Management of the palliative care pathway.
At the end of the course, students must have:
knowledge of the anatomy and pathophysiology of the nociceptive system;
the ability to carry out adequate medical histories and algological evaluations and to interpret subsequent test results;
the ability to apply scales and validated questionnaires to identify the type of pain and to evaluate treatment effectiveness;
the ability to measure and document the evolution of pain using specific equipment;
knowledge and competence of basic therapies, pharmacological treatments and multimodal analgesia, including non-pharmacological techniques;
knowledge of pain treatment strategies, including non-invasive non-pharmacological treatment;
knowledge of indicators for the use of physical and psychological therapies, locoregional blocks, device implantation for the administration of medication and electro stimulators;
technical understanding of neuraxial, plexus and peripheral nerve blocks for acute and chronic pain;
the ability to recognise and define the complications of surgical procedures and their treatment;
the ability to manage patients taking opioids for chronic pain;
skills and ANTS, acquired also thanks to the use of simulation, including high-fidelity.
At the end of the course, students must have managed at least 50 patients with acute postoperative pain in various surgical settings; at least 10 patients with chronic pain (diagnosing, establishing a treatment plan, evaluating treatment effectiveness, following-up); performed at least 25 epidural administrations, 10 spinal epidural accesses and 10 peripheral nerve blocks.
They must also have appropriate communication techniques to inform patients and family members of treatment options, care goals and end-of-life care.
They will have to know the clinical-therapeutic pathways of palliative care, having acquired the ability to manage pharmacological and non-pharmacological techniques, to control the patient's symptoms in the terminal stage, the ability to work in a network and in a multidisciplinary and multi-professional context, knowing how to communicate appropriately with other healthcare professionals.

E. Hyperbaric therapy
Includes:
E.1) Evaluation and preparation of patients requiring hyperbaric treatment;
E.2) Hyperbaric treatment in emergency/urgency;
E.3) Monitoring, measuring and providing aid in extreme environments.
Students must be familiar with the principles and main indicators for a wide variety of equipment used for underwater and hyperbaric medicine, have discussed the operating principles, the significance of measured parameter variations and possible errors in various, invasive and non-invasive, monitoring techniques, as well as neurological, respiratory, cardiovascular and metabolic parameters pertaining to the various clinical situations in question.
Hyperbaric Therapy Centres are not distributed equally to Schools across Italy; professional training can be completed through a training period at the reference centre, and by adopting regional and interregional framework agreements between schools; skills and ANTS may also be acquired thanks to the use of simulation, including high-fidelity.
At the end of the course students must:
be familiar with the indications and contraindications to both elective and urgent hyperbaric oxygen treatment;
be aware of any potential issues relating to the diagnosis and treatment of underwater diseases;
know the monitoring and measurement procedures in extreme environments;
know the safety and fire prevention regulations relating to extreme environments;
have taken part in the evaluation, preparation and management of the treatment of at least 20 patients
have discussed nursing protocols during hyperbaric therapy with the staff;
know how to adopt risk prevention measures associated with both planned and urgent hyperbaric treatments;
have discussed treatment protocols for underwater diseases in team.

F. Emergency toxicology
Includes the ability to carry out:
F.1) clinical-toxicological operations in ICU or in other urgent/emergency management units, including Poison Control Centres;
F.2) main treatments for abused substances;
F.3) laboratory diagnosis and integrated therapies.
At the end of the course, students must be familiar with an adequate variety of techniques for diagnosing and treating, using integrated multimodal protocols, the most frequent clinical toxicology emergencies.
They must have discussed the operating principles, the significance of measured parameter variation and possible errors in various clinical situations, acquiring skills and ANTS thanks also to the use of simulation, including high-fidelity.
During the course students must:
have followed the diagnostic and therapeutic workup of at least 10 clinical cases of acute poisoning or poisoning with vital function failure;
know the clinical-therapeutic pathways for the primary cases of intoxication and poisoning.

G. Anaesthetists? Non-Technical Skills (ANTS)
Defined as:
G.1) Task Management: plan and prepare; prioritise; provide and maintain standards; identify and use resources.
G.2) Team work: coordinate activities with team members; exchange information; use authority and assertiveness; evaluate skills; support others.
G.3) Situation awareness: collect information; recognise and understand; predict.
G.4) Decision Making: identify options; balance risks and benefits; reassess.
This training area develops a system of markers, defined as non-technical behaviours, which contribute to making the performance within the system, represented by the work environment, higher or lower than the expected standard of technical competence.
During the training programme, students must acquire the principles of Anaesthetists' Non-Technical Skills, relational, interpersonal and organisational skills, including through in-situ and/or high-fidelity simulation techniques, in the many contexts of professional development, especially in crisis situations with potential rapid clinical evolution.
At the end of the course students must:
be able to make decisions during clinical care, based on experience or new information, both in elective conditions and in crisis situations;
develop and maintain active awareness of the situation and its environmental factors (patient, team, timings, monitoring) and anticipate what could happen as the case unfolds;
manage resources and organise duties to achieve goals;
know how to communicate effectively and take on any role in a team context to effectively support the team itself.

H. Quality, Management and Economics of healthcare, ethics, research and professional development
At the end of the course students must:
H.1) Make clinical decisions respecting ethical and legal principles; communicate effectively with patients and their families (doctor-patient relationship); involve patients and/or their representatives in decisions regarding therapy and treatment; involve colleagues from other different specialties in the decision-making process for care and treatment; maintain accurate and legible records, and documentation of clinical activities; respect privacy, dignity, confidentiality and legal constraints in the use of patient data; support and participate in activities relating to professional development and the area of specialty. In the context of a multidisciplinary team, provide palliative and end-of-life care and employ ethical and legal processes for the refusal and withdrawal of treatments.
H.2) Know the principles of Quality Systems and Clinical Governance and possess basic knowledge of health economics.
H.3) Be active in increasing personal knowledge, applying self-learning and research.
During the training programme, students must acquire the skills to ensure professional work quality, as well as appropriate knowledge of healthcare economics, understanding ethical and economic basic statistical concepts. They must be able to recognise the benefit of applying research results to clinical practice. Therefore, they must:
acquire knowledge of evidence-based medicine and levels of evidence;
acquire knowledge of common statistical tests and statistical application to research projects including the analysis of results, monitoring and surveillance post-study;
acquire knowledge of the ethical principles and legal responsibilities of the ethics committee;
acquire the ability to write scientific papers by developing critical reading skills of research publications, presenting posters and reports at national and international conferences;
develop small group learning techniques and work according to good clinical practice;
understand, and where relevant, participate in Quality Assurance (QA) processes in clinical practice, as a necessary basis for continuous professional development;
apply local intra-hospital, national and European recommendations to their work, with knowledge of quality and safety programmes (checklists, patient identification, infectious diseases, etc.);
gain awareness of personal limitations and be able to seek help when needed;
effectively organise their work within a multidisciplinary team;
know relevant European, national and local infrastructures and their role in their continuous improvement;
have an understanding of managerial and administrative responsibilities in the healthcare sector;
be able to participate in clinical trials and have participated in the drafting of scientific papers, with knowledge of the rules governing clinical trials.

Specialist Core Competencies by area:
1. Obstetric anaesthesia
During the training programme, students must acquire clinical skills and expertise in anaesthesia and perioperative care for pregnant women, as well as first aid for new-borns. These include the following skills:
- know the physiology of pregnancy, labour and childbirth
- have in-depth knowledge of pain relief methods available during labour and delivery, including caesarean section
- be able to choose and give appropriate analgesia during labour
- demonstrate skills in managing childbirth complications and anaesthesia during labour
- be able to perform neonatal resuscitation
- manage the safe administration of general or regional anaesthesia and perioperative care for obstetric patients
- be able to manage high risk parturients
- establish professional contact with the group of gynaecologists and midwives
2. Airway Management
During the training programme, students must acquire clinical skills and expertise in airway management and respiratory care. These include the following skills:
- predict risks of airway management difficulties using appropriate indicators and scores;
- manage anticipated and unanticipated difficult airways, knowing how to use standard and alternative devices, including video and fibroscope, and how to apply them appropriately with knowledge of recommended strategies and algorithms;
- manage situations of oxygenation and difficult ventilation and perform appropriate manoeuvres in cases of CICO (Can't Intubate Can't Oxygenate);
- manage airways in emergency situations, including trauma, and be familiar with airway management safety strategies in intensive care and for critical patients;
- manage extubation safely in difficult conditions and/or after airway intervention;
- adequately manage anaesthesia and the airways in shared procedures, ensuring respiratory safety during laryngeal surgery, thoracic-pulmonary surgery, surgical and percutaneous tracheostomy, and operative laryngoscopy/bronchoscopy;
- be familiar with different tracheostomy techniques, acquire basic practice and know the strategies to prevent short or long term complications;
- be familiar with techniques to manage airways in paediatric patients;
- be familiar with anaesthesia for laser surgery in the airways, including jet-ventilation.
3. Thoracic and cardiovascular anaesthesia
During the training programme, students must acquire knowledge and skills related to anaesthetic and perioperative care for patients undergoing thoracic and cardiovascular surgery. These include the following skills:
- evaluation of surgical limitations for lung resection and the selection of patients requiring preoperative preparation and treatment;
- awareness of perioperative risk factors and specific postoperative complications in thoracic surgery;
- management of anaesthetic aspects in monopulmonary ventilation;
- management strategies for acute and chronic pain in thoracic surgery, including epidural, paravertebral and intercostal nerve blocks;
- knowledge of emergency thoracic or cardiovascular procedures and how to manage them;
- basic anaesthetic knowledge for cardiopulmonary bypass;
- invasive monitoring skills for thoracic and cardiovascular surgery including pulmonary artery catheterisation and transoesophageal echocardiography;
- knowledge of the basic principles and the anaesthetic and therapeutic techniques used for serious cardiac function impairment in high risk patients, for patients in preparation of a heart or lung transplant, for patients with congenital heart disease, and for those with implanted stimulators or cardioversion devices;
- ability to manage anaesthesia for major vascular surgery, including emergency procedures.
4. Neuroanaesthesia
During the training programme, students must acquire clinical skills and expertise for the anaesthetic and perioperative care of patients undergoing surgery and operations involving intracranial, spinal, and surrounding structures. These include the following skills:
- pre- and post-operative evaluation of the neurosurgical patient;
- choice of appropriate neurosurgical monitoring and knowledge of patient positioning for neurosurgical interventions;
- knowledge and strategies for brain protection and intracranial pressure management;
- management of patients with increased intracranial pressure;
- knowledge and ability to analyse the risks and benefits of available anaesthetic techniques for all aspects of neurosurgery and neuroradiology.
5. Paediatric anaesthesia
During the training programme, students must acquire clinical skills and expertise in anaesthesia and perioperative care of paediatric patients, as well as the basics for the intensive care of critical conditions in children. These include the following skills:
- knowledge of the anatomical, physiological and pharmacological implications of the differences between children and adults;
- knowledge of paediatric aspects of monitoring, equipment, vascular access, and airway management, indispensable for the safe management of general anaesthesia from induction to awakening, including the management of urgent-emergency surgery for children;
- knowledge of useful pain control techniques, and of the clinical aspects necessary for the management of fluids and treatment of the main critical conditions and risks in paediatric patients;
- knowledge of resuscitation for new-borns and children in any emergency situation;
- knowledge and ability to manage the responsibility of transporting all children and infants to specialised facilities;
- ability to communicate compassionately with children and their relatives, including the capacity to provide information for consent purposes.
6. NORA/Outpatient Anaesthesia
During the training programme, students must acquire the clinical skills and expertise in anaesthesia to treat patients in places other than the operating room (NORA: Non Operative Room Anaesthesia) and Outpatient Surgery. These include the following skills:
- ability to manage and provide anaesthesia outside the operating room, taking into account the logistics of the facility, the type of patient (children, the elderly, etc. ...), and the type of procedure;
- knowledge of the necessary requirements to guarantee safety and appropriately carry out preoperative assessment for the purpose of selecting and managing cases, assessing anaesthetic and perioperative risks, and observing regulations and reference guidelines;
- competence in applying principles of safety during radiographic techniques, magnetic resonance imaging and all other minimally invasive diagnostic or therapeutic procedures required in places other than the operating room.
7. Multidisciplinary pain management
During the training programme, students must acquire clinical skills and expertise in the multidisciplinary management of pain therapy and palliative care. These include the following skills:
- knowledge of the legislation regarding pain therapy and palliative care (Law 38/2010, Memorandum of Understanding 25 July 2012) as supplemented;
- knowledge of the characteristics of the pain therapy network and of the therapeutic-diagnostic pathways which guarantee continuity of care between the network nodes;
- knowledge of basic and specialist palliative care interventions;
- pharmacological and non-pharmacological management skills (locoregional anaesthesia techniques) of acute postoperative pain;
- pharmacological and non-pharmacological management skills (spinal neuromodulation techniques, thermolesion techniques) of chronic pain;
- ability to diagnose the pathophysiological mechanisms of chronic pain;
- knowledge of the pathophysiological principles of chronic and evolving pathologies, for which there is no treatment or when treatment is inadequate or ineffective for the purpose of stabilising the disease or to guarantee survival for a significant period;
- ability to manage and appropriately modulate the symptoms of patients with end-stage disease;
- multidisciplinary and multi-professional interaction skills in the integrated management of patients with chronic pain and patients in palliative care;
- ability to communicate with family members and patients suffering from chronic pain or in palliative care.
In all fields, skills and ANTS can also be acquired thanks to the use of both in-situ and high-fidelity simulation. Students will be able to present themselves for the diploma after completing the professional training activities.
Through training, students must acquire the school-specific scientific competencies so as to fully develop their professional skills, including the ability to critically interpret scientific innovation in order to responsibly manage both assistance and their personal development in the field. Within this context, they may be required to attend meetings and conferences, write scientific papers or spend time in Italian or foreign specialist institutions for further relevant training.