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Creating New Borders for Clinical Rotations Abroad

For many medical residents, a clinical rotation abroad presents an opportunity to learn more about their specialty while providing crucial medical care to communities in need. However, many of these rotations often only go one way:  residents from the United States travel to a foreign country for a few weeks and then they leave, unsure of what, if any, lasting impact their time will have on the community or their medical careers.

But four years ago, Jules Lipoff, MD, an assistant professor of Clinical Dermatology and his colleague, Rudolf Roth, MD, a professor of Dermatology, sought to change that dynamic. Lipoff and Roth forged a partnership between Penn and the Instituto de Dermatología y Cirugia de Piel (INDERMA), a dermatology residency training program in near Guatemala City, Guatemala. 

Unlike traditional clinical rotations abroad, the Penn-INDERMA program was built on the idea of an equal education exchange between the two programs, meaning that not only would Penn Dermatology residents spend time in Guatemala, but INDERMA residents would come to Philadelphia for clinical rotations and lectures.

“This is a truly reciprocal exchange,” Lipoff said. “We’ve connected these two programs, expanding the care offered to patients in both locations and fostering a dialogue between trainees from both programs. They learn from their experiences in other countries as well as from each other.”

Dermatologic diseases have a significant health burden around the world, but in resource-limited settings, these diseases can be overlooked or overshadowed by more immediate disease outbreaks. There is also a lack of awareness about dermatological care in these regions, meaning that many patients are often diagnosed at much later stages than in more developed countries.

“Through this program, we hope to teach Penn residents about the challenges to providing care with limited resources and technology, as well as educate the patient population about some of these diseases, like skin cancer or other skin infections,” Lipoff said.

INDERMA residents have much to learn and much to offer patients and colleagues during their time in Philadelphia. They spend time in clinics speaking Spanish with patients here as well working with physicians and residents to offer insights on how to provide care with limited resources. And Penn residents have much to learn from them, both as part of rotations in Philadelphia and in Guatemala.

“Getting to know the INDERMA residents who came to Philadelphia was a great preface to my time in Guatemala,” said Ata Moshiri, MD, a Dermatology resident at Penn. “The experience really opened my eyes to the fact that we are members of a truly global community in medicine. The way we practice in the United States is often very different than how people do things in the rest of the world. More importantly, I think the lessons of working in resource-limited settings make you a better, more practical physician no matter where you practice.”

Residents from Philadelphia spend time in clinics treating patients in the Lake Atitlán region of Guatemala, an underserved area home to an indigenous Mayan population with limited access to health care.

“The most memorable experiences were with the people of Guatemala themselves, who are extraordinarily generous, kind, and accepting,” Moshiri said. “My favorite clinic day was in San Lucas Toliman when the principal of a local elementary school brought 40 children all at once for evaluation, all of whom had very dry skin. They were smiling broadly when they entered the makeshift clinic space and made sure to give us hugs and high fives as they left.”

Penn residents and faculty also work with INDERMA physicians to offer lectures, training, and insights into practices used in the United States.

“As a resident here in Guatemala, this was a great opportunity for me to learn about different techniques and gain knowledge from my counterparts at Penn,” said Kenneth Salazar, MD, an INDERMA medical resident. “We should all make an effort to learn from colleagues around the world in order to be better doctors.”

Since 2013, four Penn residents and three attending physicians have visited INDERMA and eight INDERMA residents and three attending physicians have visited Philadelphia.

“Our goal for the program is to build a framework for long-term programs and partnerships, including becoming a part of the year-round Penn-Guatemala Health Initiative,” Lipoff said. “What this program really showcases is that there are health disparities around the world, both in Guatemala and here in Philadelphia. We have a unique opportunity to address these inequities, improving health care and expanding educational horizons for medical trainees at the same time.”

Lipoff and colleagues recently published their initial programmatic successes from the Penn-INDERMA exchange program in the Journal of the American Academy of Dermatology. To learn more about the Penn-Guatemala Health Initiative and other international programs offered in the Perelman School of Medicine visit


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