INTERNSHIP OF PALLIATIVE CARE
Learning outcomes of the course unit
The internship has the main objective of giving students knowledge about the comprehensive management of patients affected by the more common pathologies of internal medicine. At the end of the course the student will be able:
to delineate a diagnostic work plan for any single patient;
to formulate a differential diagnosis on the basis of the clinical examination and the evaluation of laboratory and instrumental exams;
to delineate a therapeutic approach (both pharmacologic and not) to the acute phase of the disease and eventually for its chronic phase;
to be able to know and apply preventive treatments.
Namely, by the end of this internship module students will be able:
- To make adverse prognoses and recognize terminal illness in both oncologic and non-oncologic patients
- To know the basics of palliative medicine and of the situations requiring palliative support
- To recognize and treat the main symptoms of patients with advanced end-stage disease and adverse prognosis (pain, vomiting, fatigue, constipation, anuria, hypotension, mental confusion, delirium, stupor)
- To approach patients with adverse prognosis, and their relatives
- To know the basics of the clinical management of end of life in terminal patients, and know the main bioethical and legal aspects correlated with these situations
Knowledge of semeiotics and clinical methodology, physiopathology and pharmacology.
Course contents summary
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.
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.
1) Harrison's Principles of Internal Medicine, XVIII° ed. Mc Graw Hill ed.
2) Rugarli, Medicina Interna sistematica VI° ed, elsevier ed.
Practical activity with discussion of clinical cases at the patient’s bedside in a hospital ward.
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