Brazil Exchange Program
Third-year residents are encouraged to participate in a long-standing exchange program, which was established by Dr. Diaz with the Department of Dermatology at the University of Sao Paulo in Brazil. Current interested third-year residents are to contact Dr. Luis Diaz about this unique educational opportunity.
The faculty of medicine at the University of Sao Paulo opened in 1912 and the Department of Dermatology began its academic activities in 1916. Renowned members of the university have made important contributions in clinical and basic research, among them Professor A. Carini (Pneumocystis Carini), Professor A. Bovera, Professor S. Taylor-Darling, Professor Lambert and Professor Lambert-Mayer. Four outstanding individuals have headed the department: Professor A. Lindenberg (1912-1929), Professor J. Aguiar-Pupo (1930-1960), Professor S.A.P. Sampiao (1961-1989), and Professor Evandro A. Rivitti (1990-present).
The Department of Dermatology at the University of Sao Paulo is the largest dermatology-training program in Brazil and Latin America. The missions of the department are teaching, patient care, and research. There are 25 faculty members, 24 dermatology residents, and 7 postdoctoral fellows. Many of the faculty members are former trainees of dermatological programs in the United States and Europe. There is a strong emphasis in the postdoctoral program to train future academicians. The department is divided in active divisions, i.e., clinical dermatology, pediatric dermatology, dermatological and cancer surgery, cryotherapy, dermatopathology, tropical medicine, and immunodermatology. An expert faculty member heads each unit.
The Dermatology Outpatient Service at the Hospital das Clinicas (http://www.ncnet.usp.br/) attends more than 300 patients per day. The census of patients seen in the dermatology clinic service from 1987 through 1990 is as follows: 48,302 (1987); 46,962 (1988); 59,648 (1989); and 73,298 (1990). The department maintains an active inpatient service of approximately 30 patients providing specialized therapy for such diseases as leprosy, leishmaniasis, lupus, endemic pemphigus (fogo selvagem), chromoblastomycosis, blastomycosis, and lymphomas.
Sao Paulo is one of the largest cities in the world with a population that approximates 18 million and the University Hospital is the premier referral center for the city of Sao Paulo.
History of Dermatology Residency Exchange Program: The faculty of the Department of Dermatology of the University of Sao Paulo has maintained, for several years, a close association with Dr. Luis A. Diaz’s research team on Fogo Selvagem. It began when Dr. Diaz was a faculty member at the University of Michigan (1976-1982) and continued when he joined the Dermatology Department at Johns Hopkins University (1982-1998). The aims of these interactions were focused on research and training opportunities for junior faculty members of both departments. As a result of these efforts, both departments have benefited from grants and subcontracts from the National Institutes of Health (NIH) to support research in Fogo Selvagem. Faculty members from the University of Sao Paulo and U.S. universities benefited from these interactions as well.
The International Residency Exchange Program for dermatology residents officially began at the Medical College of Wisconsin in 1992 when Dr. Diaz was serving his tenure as Professor and Chairman of the Dermatology Department at that institution (1989-1999). This program moved to The University of North Carolina at Chapel Hill in 2000 when Dr. Diaz was appointed as Professor and Chairman of the Dermatology Department.
The close and productive interactions between academic departments of two major universities will continue to benefit both programs. The exchange program stands as an example of a multinational effort for the advancement of dermatology education in two countries. From Brazil we offered training opportunities in the U.S. to Dr. Ciro Martins, Dr. Justin Roscoe, Dr. Giles Landman, Dr. V. Aoki, Dr. H. Friedman, Dr. R. Rocha, and Dr. G. Hans. Dr. Martins is an Assistant Professor of Dermatology at Johns Hopkins University; Dr. Roscoe is a board certified dermatologist in Maryland, and the rest of the visiting scientists are dedicated to academic careers in Brazil. Several investigators from the U.S. have also enjoyed these interactions, including Dr. G. Anhalt (Johns Hopkins University), Dr. T. Russell, Dr. Fairley, Dr. Neuberg, B. Drolet (faculty members of the Medical College of Wisconsin), and Dr. J.R. Stanley (Professor and Chair of Dermatology at the University of Pennsylvania).
The Resident Exchange Program: Senior residents from both departments are allowed to spend 1 month in the exchange facility, i.e., Sao Paulo or Chapel Hill. The exchange program is not mandatory. Upon arrival, the dermatology resident is incorporated into the respective residency program. This program provides the opportunity for residents from each program to visit the other institution and to participate fully in the various aspects of the teaching program of each department. The residents from both institutions are able to learn and appreciate a culture of each country and most important to learn aspects of dermatology in areas difficult to reproduce in their own institutions. For example, the teaching of tropical dermatology is unique in Sao Paulo and it is unmatched in any other U.S. Dermatology Program. The exchange program is voluntary for our residents.
The Department of Dermatology of the University of Sao Paulo provides free housing for our residents during their stay in Brazil. The apartment in Sao Paulo is furnished and within walking distance of the University Hospital. The UNC Department of Dermatology also provides free housing to Brazilian dermatology residents. This facility is also furnished and is located on a free bus line convenient to UNC Hospitals.
U.S. dermatology residents have benefited from the exposure to the practice of dermatology in a country outside the U.S. The Brazilians are generous and gracious hosts and our residents have found this rotation to be a real highlight in their educaitonal experience. Many have remarked that the experience gained during this rotation was a real benefit in taking their exams for the American Board of Dermatology. There have been more than 25 U.S. residents (Medical College of Wisconsin, University of Rochester, Duke University, Stanford University, and The University of North Carolina at Chapel Hill) that have visited the Sao Paulo program and a similar number of Brazilian residents that have come to our U.S. institutions.
This program won an award for Excellence in Education from the American Academy of Dermatology in 1993. The award consisted of a trophy and a $4,000 check, which was divided equally between the two institutions.
Educational Objectives for UNC Dermatology Residents:
- Learning experience in tropical dermatology. Our residents will be seeing patients suffering from all forms of leprosy, leishmaniasis, superficial and deep fungal infections, and endemic pemphigus foliaceus.
- Learning features of skin diseases that are unique to Brazil. Similar diseases are seen in the U.S., but in their milder forms because patients seek medical attention sooner than their Brazilian counterparts. Severe forms of psoriasis, lupus, pemphigus vulgaris, lymphomas, etc. are commonly housed in the inpatient service of the University Hospital in Sao Paulo.
- Learning and understanding the health systems applied to patient care in Brazil.
- Learning the culture of another country.
Educational Objectives for USP Dermatology Residents:
- Learning and comparing clinical dermatology as is practiced in the U.S. with Brazil.
- Increasing their English proficiency.
- Comparing the health care systems: Brazilian and U.S.
- Learning the U.S. culture.
Other Aspects of the Exchange Program: Dermatology residents participating in the exchange program will be working as “Observers” when visiting each training facility. They will not be involved in direct patient care. Health related risks for visitors to Sao Paulo are the same as those found in any large city around the world. Vaccination against tropical diseases is not required, only if planning to visit the Amazon regions. The language spoken in Brazil is Portuguese. The majority of dermatology residents and faculty from the Department of Dermatology of the University of Sao Paulo communicate well in English. Dermatology residents from Brazil are encouraged to obtain health insurance before coming to the U.S. UNC residents must complete the required health insurance forms before traveling to Brazil.