Learning objectives
First Dublin descriptor: knowledge and understanding
At the end of the course, students must have sufficient knowledge of the definition and field of application of palliative care and simultaneous care. They must be aware of the most appropriate ways of responding to the care needs of patients with advanced oncological or non-oncological illness. They must understand the objectives of palliative medicine, in terms of improving quality of life and comfort of patients with advanced illness, in a holistic, multidimensional and multidisciplinary manner. They must also know the most appropriate ways of approaching patients and relatives of patients with unfavorable prognosis. Finally, they must have knowledge of the main legal and ethical issues at the end of life.
Second Dublin descriptor: applied knowledge and understanding
Students must be able to apply the principles of palliative care in defining the care pathways and therapeutical plans more suitable for a series of common clinical scenarios involving patients with unfavorable prognosis: patients with off-therapy cancer, patients with end-stage dementia, patients with disabling chronic illness in advanced stage.
Third Dublin descriptor: making judgements
Students must be able to formulate proposals of care pathways and treatments in different common scenarios of chronic advanced disease or off-therapy cancer, following the principles of multidisciplinarity and multidimensionality of palliative medicine.
Fourth Dublin descriptor: communication skills
Students must prove to have acquired a sufficient level of mastery of specific medical jargon. They must be also able to communicate unfavorable prognoses effectively and empathically, putting themselves in the attitude of listening needs and wishes of patients and their relatives.
Fifth Dublin descriptor: learning skills
At the end of the course, students must prove to be able to appropriately apply the general principles of palliative medicine also in clinical situations not encountered before.
Prerequisites
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Course unit content
The internship module is a fundamental part of the Integrated Course of Internal Medicine and Geriatrics. Its aim is to make students learn the practical approach to internal and general medicine patients, representing a mainstay for practicing the physician’s profession.
During internship, clinical cases will be discussed in medical and geriatric wards at the bedside, to give students practical epidemiologic, physio-pathologic, clinical and therapeutic knowledge on a wide range of medical pathologies of cardiologic, endocrine-metabolic, hematologic, rheumatologic, pneumologic, nephrologic, gastroenterologic interest. An integrated approach will be used. The peculiarity of the geriatric approach at both hospitalized and community-dwelling older patients will be particularly emphasized.
In this internship module, the healthcare problems of patients with advanced end-stage diseases, approaching and of life, will be particularly considered. These issues will be considered not only from the clinical-therapeutical point of view, but also from a diagnostic (how to recognize oncologic and non-oncologic patients needing palliative care), relational and ethical perspective. Concepts like quality of life, personalization of care, patient and caregiver information, family support, symptom control, terminal sedo-analgesia will be considered.
Full programme
Bedside discussion of clinical cases about cardiovascular diseases, respiratory diseases, endocrine-metabolic diseases, neurological diseases, gastroenteric diseases, kidney diseases, rheumatic diseases. Particular emphasis will be given to patients with rare diseases, geriatric patients with multimorbidity and frailty and patients with advanced diseases requiring palliative support.
Bibliography
1) Harrison's Principles of Internal Medicine, XVIII° ed. Mc Graw Hill ed.
2) Rugarli, Medicina Interna sistematica VI° ed, elsevier ed.
Teaching methods
Practical activity with discussion of clinical cases at the patient’s bedside in a hospital ward or in an online virtual classroom.
In case of restrictions due to the COVID-19 pandemic, the practical internship will be substituted with online live seminars, with active discussion of clinical cases between professors and small groups of students.
Assessment methods and criteria
An oral test will start from the description of a specific patient, and the student will discuss in a critical fashion the different diagnostic options in order to reach a specific diagnosis, that will be followed by the definition of a therapeutical approach.
This test will allow to evaluate the knowledge as well as the clinical skill of the student
Other information
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2030 agenda goals for sustainable development
Objective 3 - Health and wellbeing
