Specialization – Internal medicine

The Internal Medicine is a core area of medicine – both in patient care as well as in research and teaching. It deals with the structure, function, and diseases of all organ systems of our body. A specialist in internal medicine (internist) is – with the involvement of scientific progress – on the prevention, detection, treatment, and rehabilitation of malfunctions, or failures of the following body systems specialist:

  • Vascular system (Angiology)
  • Metabolism and hormones (Endocrinology / Diabetology)
  • Digestive organs (Gastroenterology)
  • Blood and blood-forming organs (Hematology / Oncology)
  • Cardiovascular (Cardiology)
  • Kidney and urinary tract (Nephrology)
  • respiratory tract (Pulmonology)
  • skeleton and connective tissue (Rheumatology)

Each of these areas requires a special part of comprehensive medical care and some more in-depth knowledge and experience for specific issues. Therefore, each section has its own focus of internal medicine is a specific training (eg specialist in Internal Medicine and Cardiology). On the other hand, all focus on specific diseases is also complex interactions that lead on most medically ill to participate in various organs and make complex diagnostic considerations essential. In addition to the focus-internists, there is therefore also a cross-cutting specialist in internal medicine. This can be done in primary care and specialty care in the area to be active. It takes a kind of pilot function, coordinates, and controls as a “generalist” the diagnosis and treatment processes and refers to a focus on demand-internists. In his hands is where all the findings, investigations and treatment results.

The internal medicine is a central component in all of medicine and represents a link with all medical disciplines, as far as playing a role in internal diseases. Internist considered when medical care factors, such as the personal and family medical history, physical being and the psychosocial environment of the patient. In order to meet the patient as a whole, the supply is, therefore, an interdisciplinary focus. The internist in primary care internal medicine department works alongside the colleagues with a special emphasis on a close network of well-trained colleagues/colleagues of different disciplines (radiologists, surgeons, physiotherapists, etc.) together.

Specializations of internal medicine specialists

Under the new training needs fixing an aspiring specialist in internal medicine at the end of the 6-year-old medical student a 5-year education at a recognized training facility for a specified training completed order. To obtain a center of gravity has a 6-year training place. Are defined in the training regulations for examination and treatment procedures performed. At the end of the training period is reviewed in an oral examination of the acquisition of necessary knowledge, experience and skills. According to the current continuing education regulations are available for the following Internal Medicine Specialists:

  • Consultant / Specialist in internal medicine
  • Consultant / Specialist in Internal Medicine and Angiology: Angiologist
  • Consultant / Specialist in Internal Medicine and Endocrinology and Diabetology: endocrinologist/diabetologist
  • Consultant / Specialist in Internal Medicine and Gastroenterology: Gastroenterologist
  • Consultant / Specialist in internal medicine and hematology and oncology: hematologist/oncologist
  • Consultant / Specialist in Internal Medicine and Cardiology: Cardiologist
  • Consultant / Specialist in Internal Medicine and Nephrology: Nephrologist
  • Consultant / Specialist in Internal Medicine and Pulmonology: Lung Specialist
  • Consultant / Specialist in Internal Medicine and Rheumatology rheumatologist

Additionally, an internist acquires various additional qualifications, such as infectious diseases, emergency medicine, addiction medicine or tropical medicine.

10th Area of internal medicine
Basic training for the specialist competencies 01/10 to 09/10

Educational content

Knowledge, experience and skills in:

  • the general content of training for Sections B and C
  • health counseling, early detection of health problems including violence and addiction prevention, prevention, introduction and implementation of rehabilitative measures and aftercare
  • the detection and treatment of non-infectious, infectious, toxic and neoplastic and of allergic, immunologic, metabolic, and nutrition-related degenerative diseases also under consideration of the characteristics of this disease in older age
  • the basis of area-based tumor therapy
  • care of palliative care to be supplied, incoming patients
  • the indications, proper sample collection and handling of laboratory tests and classification of results in the disease patterns
  • geriatric syndromes and disease outcomes, including the age of pharmacotherapy in old age
  • psychogenic symptoms, reactions, and somato-psychosocial contexts including crisis intervention as well as the broad guidance and leadership of addicts
  • prevention and early detection measures
  • nutrition-related health disorders, including treatment and dietary advice and training
  • implementation and documentation of diabetic treatments
  • the foundations of hereditary diseases, including the indication for genetic counseling
  • the diagnosis and monitoring of physical therapy measures
  • the area-based drug therapy
  • the detection and treatment of acute emergencies, including life-saving measures
  • maintain the vital signs and resuscitation
  • evaluating the performance and resilience, the ability to work, vocational and earning capacity and the need for care
  • the intensive care basic care

Examination and treatment procedures

lectrocardiogram

ergometry

holter

Long-term blood pressure measurement

spirometric tests of lung function

Ultrasound examinations of the abdomen and retroperitoneum including urogenital

Ultrasound examinations of the thyroid

Doppler sonography of extracranial and supplying the extremities cerebral arteries

Venepuncture, catheterization techniques including the extraction of study material

10th Area of internal medicine
Basic training for the specialist competencies 01/13 to 09/13

Examination and treatment procedures

Infusion, transfusion, and blood replacement therapy, enteral and parenteral nutrition

Proctoscopy

10th Area of internal medicine
Basic training for the specialist competencies 01/13 to 09/13

Examination and treatment procedures

Infusion, transfusion, and blood replacement therapy, enteral and parenteral nutrition

Proctoscopy
Consultant / Specialist in internal medicine

Educational content

Knowledge, experience and skills in:

  • the contents of the basic training in the field of Internal Medicine
  • the prevention, diagnosis, counseling, and treatment for emerging health problems and diseases of internal organs
  • the detection and conservative treatment of vascular diseases including arterial, capillaries, veins and lymphatic vessels and their rehabilitation
  • the prevention, detection, and treatment of metabolic diseases including metabolic syndrome and other diabetes-associated diseases
  • the detection and treatment of diseases of the digestive organs, including their infection, such as viral hepatitis, bacterial infections of the intestinal tract
  • the detection and treatment of malignant and non-malignant diseases of the blood, blood-forming organs and lymphatic system
  • the detection and treatment of solid tumors
  • the detection and conservative treatment of congenital and acquired diseases of the heart, circulatory system, the blood vessels near the heart, the pericardium
  • the detection and conservative treatment of acute and chronic kidney and renal
  • high-pressure diseases and their sequelae
  • the detection and treatment of diseases of the lungs, respiratory tract, the mediastinum, pleura, including sleep-related breathing disorders and manifestations of an extrapulmonary and pulmonary disease
  • the detection and conservative treatment of rheumatic diseases including
  • inflammatory-rheumatic systemic diseases such as connective tissue diseases, the vasculitides, the inflammatory muscle diseases, and osteopathy
  • interdisciplinary cooperation, especially in multi-morbid patients with internal diseases
  • interdisciplinary indications for surgery, radiotherapy and nuclear medicine measures
  • the area-based infectious diseases including tuberculosis
  • the area-based nutrition counseling and dietetics, including enteral and parenteral nutrition
  • the functional significance of symptomatology and age-related changes and diseases and disabilities of old age and their therapy
  • the geriatric diagnostic method for detecting organ-and inter-related motor, emotional and cognitive functional limitations
  • the treatment of severely ill and dying patients, including palliative measures
  • basic supply of intensive care

Examination and treatment procedures

examination and treatment procedures based training

Doppler-/Duplex-research echocardiography and the heart and vessels near the heart

participation in bronchoscopy including bronchoalveolar lavage

esophago-gastro-duodenoscopy including interventional and emergency measures percutaneous endoscopic gastrostomy (PEG)

lower intestinoscopy including endoscopic hemostasis
thereof:
Proctoscopy

treatment of life-threatening conditions, maintenance, and restoration of endangered
vital functions using the methods of emergency and critical care, including intubation,
respiratory therapy and weaning from mechanical ventilation, including noninvasive
ventilation techniques, hemodynamic monitoring, shock treatment, creating central
access, defibrillation, pacemaker treatment,

the independent implementation of punctures, such as the bladder, pleura, abdominal
cavity, cerebrospinal fluid, liver, bone marrow, including bone dance

Consultant / Specialist in Internal Medicine and Angiology

Educational content

Knowledge, experience and skills in:

  • the contents of the basic training in the field of Internal Medicine
  • detection of conservative treatment of vascular diseases including arteries, capillaries, veins, and lymphatic vessels and interventional procedures and the rehabilitation
  • the physical and medical therapy including hämodiluierender and thrombolytic procedure
  • the local treatment of ischemia-induced tissue defects and venous
  • the treatment of peripheral lymph vessels
  • participation and evaluation of therapeutic catheter interventions eg intra-arterial thrombolysis, PTA, stent implantation, atherectomy, interventional
  • thromboembolectomy, brachytherapy
  • the assessment of radiographic findings at angiography (arteriography, venography)
  • interdisciplinary indication for surgery on the vessels, the preoperative diagnosis, and postoperative follow-up
  • basic supply of intensive care

Examination and treatment procedures

examination and treatment procedures based training

the invasive and noninvasive functional tests, thereof:

oscillographs / rheography

capillaroscopy

transcutaneous oxygen pressure measurements

Venous occlusion plethysmography

phlebodynamometry

rheological methods

ergometric method for determination of a walking distance

Doppler-/Duplex-examination, thereof:

limb arteries

supplying the limb veins

abdominal and retroperitoneal vessels

Extracranial vessels hirnzuführenden

Intracranial vessels

sclerotherapy of superficial varicose veins
Consultant / Specialist in internal medicine and endocrinology and Diabetology

Educational content

Knowledge, experience and skills in:

  • the contents of the basic training in the field of Internal Medicine
  • the prevention, detection, and treatment of endocrine diseases of the hormone-producing glands
  • the endocrine pancreas, especially of diabetes mellitus according to additional training
  • all the hormone-forming, orthotopically or heterotopically located glands, tumors, or paraneoplastic hormone production sites
  • the prevention, detection, and treatment of metabolic diseases including metabolic syndrome
  • diabetes-associated illnesses such as arterial hypertension, coronary heart disease, dyslipidemia
  • the treatment of secondary forms of diabetes and diabetes mellitus in pregnancy
  • early detection, treatment, and prevention of diabetes complications including diabetic foot ulcers
  • insulin treatment, including treatment of insulin
  • dietetics and nutrition advice in metabolic and endocrine diseases
  • the indications, methodology, implementation, and arrangement of the laboratory testing of hormone, diabetes and metabolism-specific parameters including their precursors, degradation products and antibodies
  • the detection and treatment of andrological diseases
  • structured training courses for type 1 – and type 2 diabetics with and without complications, for pregnant diabetic women as well as training for hypoglycemia
  • choice of career and family counseling in endocrine diseases
  • the diagnosis and evaluation of nuclear medicine in-vivo studies of endocrine organs
  • interdisciplinary indications for surgery, radiotherapy and nuclear medicine treatments
  • basic supply of intensive care

Examination and treatment procedures

examination and treatment procedures based training

ultrasound examinations, thereof:

Duplex-sonography in endocrine organs,

fine-needle aspiration

endocrinological laboratory diagnostics

osteodensitometry

indications, execution, and evaluation of the specific stimulation or suppression test in endocrine disorders

the endocrine pancreas

the hypothalamus

pituitary

the thyroid

the adrenal glands

the gonads
Consultant / Specialist in internal medicine and gastroenterology

Educational content

Knowledge, experience and skills in:

  • the contents of the basic training in the field of Internal Medicine
  • the detection and treatment of diseases of the digestive organs, including liver and pancreas and the focus-related infectious diseases, such as viral hepatitis, bacterial infections of the intestinal tract
  • interventional procedures including endoscopy
  • nutrition counseling and dietetics in diseases of the digestive organs, including enteral and parenteral nutrition
  • the specialist skills training Drug-related extra-tumor therapy integral part of training
  • recommending, implementing and monitoring the cytostatic, immunomodulatory, anti-hormonal therapy and supportive care for solid tumors of the focus including the control of complications occurring
  • participation in the interdisciplinary interventional procedures such as radiological and combined radiologic-endoscopic procedures such as transjugular liver biopsy, transjugular portosystemic shunt (TIPS), percutaneous transhepatic cholangiography (PTC) and drainage (PTD), PTD in the encounter with ERCP procedures and endosonographic examinations of the digestive tract
  • interdisciplinary indications for surgery, radiotherapy and nuclear medicine treatments
  • the detection and conservative treatment of diseases and proctology
  • indication for further treatment
  • basic supply of intensive care

Examination and treatment procedures

examination and treatment procedures based training

abdominal sonography including duplex sonography of abdominal and retroperitoneal vessels and ultrasound intervention

participation in EUS

esophago-gastro-duodenoscopy, thereof:

therapy

endoscopic Retrograde Cholangiopancreatography, thereof:

including experience in percutaneous therapeutic techniques (PTCD)

intestinoscopy

colonoscopy, thereof:

polypectomy

proctoscopy

interventional procedures in the upper and lower digestive tract including endoscopic hemostasis, Varizentherapie, thermal and laser photocoagulation, stent, and endoprothesenimplantation, polypectomy

participation in laparoscopies including minilaparoscopies

abdominal biopsies, including liver biopsies

function tests, such as manometry, pH monitoring of esophagus, H2 breath tests, breath tests C13

cytostatic, immunomodulatory, anti-hormonal therapy and supportive care cycles solid tumors of specialist expertise including the control of complications occurring

cycles of chemotherapy including subsequent monitoring

Consultant / Specialist in internal medicine and hematology and oncology

Educational content

Knowledge, experience and skills in:

  • the contents of the basic training in the field of Internal Medicine
  • the epidemiology, prevention, and prognosis of malignant disease assessment
  • the detection, treatment, and staging of diseases of the blood, the blood-forming organs and the lymphatic system, including hematologic malignancies, the solid tumors, humoral and cellular immune defects, congenital and acquired bleeding
  • diatheses and hyperkoagulopathics and of systemic chemotherapy
  • the indications, methodology, implementation, and evaluation of specific laboratory tests
  • function tests including peripheral blood, bone marrow, other body fluids and fine needle aspirations cytology
  • hemostatic studies and consultations including assessment of the blood- and thromboembolieattention
  • cytostatic, immunomodulatory, supportive and palliative treatment of solid tumors and hematologic malignancies, including high-dose therapy and the implementation and monitoring of cellular and immunological therapies of dietetics and nutrition advice including enteral and parenteral nutrition
  • interdisciplinary indications for surgery, radiotherapy and nuclear medicine treatments and their prognostic assessment
  • basic supply of intensive care

Examination and treatment procedures

examination and treatment procedures based training

treatment of patients with:

Systemic diseases

Solid tumors

cytostatic, immunomodulatory, supportive and palliative treatment cycles and subsequent monitoring at:

Solid tumors

Haematological malignancies

diagnostic findings of:

peripheral blood smears,

bone marrow

cytochemical stainings

immune cell differentiation

cytological specimens of other body fluids or fine needle aspirations

hematology-oncology diagnostics laboratory

sonographic studies in hematological and oncological diseases

bone marrow samples

punch biopsies
Consultant / Specialist in internal medicine and cardiology

Educational content

Knowledge, experience and skills in:

  • the contents of the basic training in the field of Internal Medicine
  • recognition as well as conservative and interventional treatment of congenital and acquired diseases of the heart, circulatory system, the blood vessels near the heart, the pericardium advice and guidance of cardiovascular patients in rehabilitation and their socio-medical evaluation for career resilience
  • implementation and evaluation of diagnostic cardiac catheterization
  • therapeutic coronary interventions, such as PTCA, stent implantations, rotablation
  • the screening, assessment and recording technique of X-ray findings in coronary angiography and coronary angiography
  • the assessment of valvuloplasty
  • interventional therapies for congenital and acquired diseases of the heart and vessels near the heart
  • the antiarrhythmic drug and instrumental diagnosis and treatment including defibrillation
  • pacemaker therapy and aftercare
  • the diagnosis and follow-up of cardioverter-defibrillators and ablation for treatment of heart rhythm disturbances
  • the interdisciplinary diagnosis and evaluation of nuclear medicine examinations and surgical treatments
  • basic supply of intensive care

Examination and treatment procedures

examination and treatment procedures based training

echocardiography including color Doppler, Thereof:

stress echocardiography

echo contrast studies

transesophageal echocardiography

right heart catheter examinations which may include loading

spiro-ergometry

left heart catheterization, including associated left ventricular coronary angiography and coronary angiography

long-term investigation process, such as ST-segment analysis, heart rate variability, late potentials

application / implantation of pacemaker probes / units

internal controls or cardioverter defibrillators (ICD)
Consultant / Specialist in Internal Medicine and Nephrology

Educational content

Knowledge, experience and skills in:

  • the contents of the basic training in the field of Internal Medicine
  • the detection and conservative treatment of acute and chronic kidney and renal high-pressure diseases and their sequel
  • the care of patients with renal replacement therapy
  • the dialysis procedure and analogous methods in acute kidney failure and chronic renal insufficiency, and with a disrupted plasma protein composition and poisoning including peritoneal dialysis and extracorporeal elimination methods
  • the indication for and involvement in kidney biopsies as well as classification of the findings in the disease
  • the diagnosis and treatment of connective tissue diseases and vasculatures with renal involvement in interdisciplinary cooperation
  • the indication for interventional procedures in disorders of the renal artery and urine flow, including kidney stones
  • an indication of the interdisciplinary nuclear medical examinations and surgical and radiotherapeutic treatment procedures, including renal
  • the care of patients before and after renal transplantation
  • nutrition counseling and nutrition in renal disease
  • basic supply of intensive care

Examination and treatment procedures

examination and treatment procedures based training

hemodialysis or analog process include acute hemodialysis, chronic hemodialysis,

peritoneal dialysis, continuous procedures, thereof:

plasma separation, apheresis, rheopheresetreatment

including renal sonography in renal transplant patients

Doppler-/Duplex-examination the renal vessels, including kidney transplantation

kidney biopsies as well as classification of the findings in the clinical picture

microscopies of urine, including quantification and differentiation of cells,

Consultant / Specialist in Internal Medicine and Pulmonology

Educational content

Knowledge, experience and skills in:

  • the contents of the basic training in the field of Internal Medicine
  • the detection and treatment of diseases of the lungs, airways, pulmonary vessels, the mediastinum, the pleura, the chest wall and respiratory muscles and the extrapulmonary manifestations of pulmonary disease
  • the detection and treatment of acute and chronic respiratory insufficiency
  • the disease through inhalation trauma and environmental toxicants as well as through job influences
  • the basics of sleep-related breathing disorders
  • the specialist skills training Drug-related extra-tumor therapy integral part of training
  • recommending, implementing and monitoring the cytostatic, immunomodulatory, anti-hormonal therapy and supportive care for solid tumors of the focus including the control of complications occurring
  • the hereditary diseases of the respiratory system
  • the infectious diseases respiratory diseases including tuberculosis
  • the detection and treatment of non-related allergic diseases
  • interdisciplinary indications for surgery, radiotherapy and nuclear medicine treatments
  • tobacco cessation and non-drug treatments such as patient education and
  • Medical Training Therapy
  • basic supply of intensive care

Examination and treatment procedures

examination and treatment procedures based training

sonographic diagnosis of lung, pleura, and thoracic structures, the right heart and the pulmonary circulation and transesophageal studies the mediastinum and examinations of transbronchial lung

flexible bronchoscopy, Thereof:

including broncho-alveolar lavage

biopsy techniques

pleural drainage and pleurodesis, as well as performing biopsies of plethorical lung or pulmonary lesions

participation in thoracoscopy and bronchoscopy with rigid instrumentation for interventional procedures

function studies of the respiratory system, thereof:

body plethysmography

provisions of the CO-transfer factor,

investigations of respiratory function and respiratory pumping mechanism

non-specific lower respiratory tract and test of the vegetative reactivity

blood gases and acid-base balance in arterial blood

spiro-ergometry exercise testing

nonspecific and allergen-mediated provocation tests, including maternity and

epicutaneous, cutaneous, intradermal and inhalation tests, including creating a treatment plan

desensitization

involvement in studies of pulmonary circulation including pulmonary artery catheter

inhalation therapy

long-term oxygen therapy

ventilator therapy, including home mechanical ventilation

cytostatic, immunomodulatory, anti-hormonal therapy and supportive care cycles

solid tumors of specialist expertise including the control of complications occurring cycles of chemotherapy including subsequent monitoring
Consultant / Specialist in Internal Medicine and Rheumatology

Educational content

Knowledge, experience and skills in:

  • the contents of the basic training in the field of Internal Medicine
  • the detection and conservative treatment of rheumatic diseases and osteopathies and in particular in immunosuppressive and modulatory drug therapy
  • inflammatory-rheumatic systemic diseases such as connective tissue diseases, the vasculitides, the
  • inflammatory muscle diseases, chronic arthritis and spondyloarthropathies and special pain therapy for rheumatic diseases
  • regulation and functional testing of orthoses and aids in rheumatic diseases
  • the indication for radiological investigation and classification of the findings in the disease
  • the indications, methodology, implementation, and arrangement of the laboratory testing of immunological parameters in the clinical picture
  • interdisciplinary indications for surgery, radiotherapy and nuclear medicine treatments
  • intensive medical care based on the African medicine

Examination and treatment procedures

examination and treatment procedures based training

sonography of the musculoskeletal system including arthrosonography

intraarticular punctures and injections of

synovial fluid analysis,

rheumatologyimmunology laboratory diagnostics, including autoantibodies in rheumatic diseases, for example, indirect Immunfluoresentechnic, ELISA, immunoblot antibody/pathogen components in cases of suspected postinfectious or rheumatic Disease eg erregerserologische tests, immunogenetic tests, such as HLAB 27Determination

capillary

osteodensitometry

the physical, physiotherapy and occupational therapy


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