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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In December 2019&#44; cases of atypical pneumonia emerged in the city Wuhan in China&#44; revealing as the etiologic agent a new coronavirus strain &#40;Sars-CoV-2&#41;&#46; The disease was denominated as Covid-19&#44; being declared a Public Health Emergency of International Concern by the World Health Organization on January 30&#44; 2020&#46; Since then&#44; it has spread to several countries and continents&#44; causing immeasurable impacts&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In face of this&#44; the healthcare systems needed to adapt to the new reality through the medical assistance reorganization&#44; postponing and &#47; or canceling elective outpatient visits and surgeries&#46; Dermatology was quite affected with a huge demand reduction&#44; which prioritized severe clinical conditions such as malignant skin neoplasms &#8212; basal cell carcinoma&#44; melanoma and squamous cell carcinoma &#8212; and chronic diseases such as psoriasis&#44; atopic dermatitis&#44; pemphigus&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient influx decrement represented a deep impact on the practical learning activities for the most Dermatology residency programs&#46; Thus&#44; resident doctors and preceptors needed to adopt innovative teaching and learning strategies&#44; such as the use of digital technologies&#44; through videoconferencing platforms and instant communication applications&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> However&#44; online education is not able to address all residency needs&#44; which presupposes the development of examination and diagnostic skills&#44; clinical decision confidence and expertise in dermatologic surgery&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Furthermore&#44; due to the intense patients flow to hospital services&#44; there was a shortage of both health supplies and health professionals&#46; Thus&#44; in some countries residents doctors were recruited of specialties other than internal medicine&#44; such as Dermatology&#44; to act in care of patients with Covid-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6</span></a> Hence&#44; the current literature has demonstrated an intense worrying&#44; understandable&#44; with the provision of human resources to attend the massive health demand during Covid-19 pandemic&#46; However&#44; some of these studies approach this topic under a shallow and immediatist overview&#44; such as Stoj et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> evoking deontological aspects to justify the idea of resident doctors as a &#8220;cheap labor&#8221;&#44; who need to be always available to health managers and health services&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless&#44; it is important to emphasize that medical residency does not consist of an employment or &#8220;compulsory job&#8221;&#44; instead it consists of the gold standard of medical training&#44; being essential to understand and value resident doctors as qualified professionals in specialized training&#46; Furthermore&#44; it is necessary to recognize the personal aspirations&#44; concerns&#44; and fears of Dermatology resident doctors&#44; as well as the intrinsic characteristics of this medical specialty training&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">From this perspective&#44; Adusumilli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> highlight the anxiety level among Dermatology resident doctors in the USA&#44; regarding to the allocation to non-dermatological medical services &#8212; such as emergency units and Covid-19 units &#8212; as well as in relation to the quality of their training and employability after residency completion&#46; This concern is relevant and legitimate&#44; considering that the major objective of Dermatology residency must be the training of dermatologists&#44; and not emergency or intensive care specialists&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Residency curriculum need to be preserved even during the pandemic&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> otherwise the formation of future specialists may be severely impacted&#46; In view of this atypical situation&#44; residency programs and medical entities must think long term&#44; establishing initiatives that rearrange the curriculum and assurance adequate training for dermatology resident doctors&#46; Among the possible strategies we propose the reorganization of residency internship scales with or without the extension of programs&#44; compensating the learning deficits during the pandemic&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">These decisions are fundamental and need to be widely discussed among preceptors&#44; directors and residents&#44; whereas society and health systems will also demand for well-trained dermatologists in the day after post-pandemic&#46;</p></span>"
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Letter to the Editor
El día después: el impacto de la pandemia COVID-19 en la residencia de Dermatología
The day after: the impact of COVID-19 pandemic on dermatology residency
I. Gonçalves Ferreira
Autor para correspondencia
iagof@ufcspa.edu.br

Corresponding author.
, M. Blessmann Weber
Universidad Federal de Ciencias de la Salud de Puerto Alegre Puerto, Alegre, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In December 2019&#44; cases of atypical pneumonia emerged in the city Wuhan in China&#44; revealing as the etiologic agent a new coronavirus strain &#40;Sars-CoV-2&#41;&#46; The disease was denominated as Covid-19&#44; being declared a Public Health Emergency of International Concern by the World Health Organization on January 30&#44; 2020&#46; Since then&#44; it has spread to several countries and continents&#44; causing immeasurable impacts&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In face of this&#44; the healthcare systems needed to adapt to the new reality through the medical assistance reorganization&#44; postponing and &#47; or canceling elective outpatient visits and surgeries&#46; Dermatology was quite affected with a huge demand reduction&#44; which prioritized severe clinical conditions such as malignant skin neoplasms &#8212; basal cell carcinoma&#44; melanoma and squamous cell carcinoma &#8212; and chronic diseases such as psoriasis&#44; atopic dermatitis&#44; pemphigus&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient influx decrement represented a deep impact on the practical learning activities for the most Dermatology residency programs&#46; Thus&#44; resident doctors and preceptors needed to adopt innovative teaching and learning strategies&#44; such as the use of digital technologies&#44; through videoconferencing platforms and instant communication applications&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> However&#44; online education is not able to address all residency needs&#44; which presupposes the development of examination and diagnostic skills&#44; clinical decision confidence and expertise in dermatologic surgery&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Furthermore&#44; due to the intense patients flow to hospital services&#44; there was a shortage of both health supplies and health professionals&#46; Thus&#44; in some countries residents doctors were recruited of specialties other than internal medicine&#44; such as Dermatology&#44; to act in care of patients with Covid-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6</span></a> Hence&#44; the current literature has demonstrated an intense worrying&#44; understandable&#44; with the provision of human resources to attend the massive health demand during Covid-19 pandemic&#46; However&#44; some of these studies approach this topic under a shallow and immediatist overview&#44; such as Stoj et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> evoking deontological aspects to justify the idea of resident doctors as a &#8220;cheap labor&#8221;&#44; who need to be always available to health managers and health services&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless&#44; it is important to emphasize that medical residency does not consist of an employment or &#8220;compulsory job&#8221;&#44; instead it consists of the gold standard of medical training&#44; being essential to understand and value resident doctors as qualified professionals in specialized training&#46; Furthermore&#44; it is necessary to recognize the personal aspirations&#44; concerns&#44; and fears of Dermatology resident doctors&#44; as well as the intrinsic characteristics of this medical specialty training&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">From this perspective&#44; Adusumilli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> highlight the anxiety level among Dermatology resident doctors in the USA&#44; regarding to the allocation to non-dermatological medical services &#8212; such as emergency units and Covid-19 units &#8212; as well as in relation to the quality of their training and employability after residency completion&#46; This concern is relevant and legitimate&#44; considering that the major objective of Dermatology residency must be the training of dermatologists&#44; and not emergency or intensive care specialists&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Residency curriculum need to be preserved even during the pandemic&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> otherwise the formation of future specialists may be severely impacted&#46; In view of this atypical situation&#44; residency programs and medical entities must think long term&#44; establishing initiatives that rearrange the curriculum and assurance adequate training for dermatology resident doctors&#46; Among the possible strategies we propose the reorganization of residency internship scales with or without the extension of programs&#44; compensating the learning deficits during the pandemic&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">These decisions are fundamental and need to be widely discussed among preceptors&#44; directors and residents&#44; whereas society and health systems will also demand for well-trained dermatologists in the day after post-pandemic&#46;</p></span>"
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