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12.02.2014

Family Ties: Dermatology Programs Draw Miami and Pisa Closer Together

Five thousand miles and 1,000 years of architecture separate pre-Renaissance Pisa and modern Miami, but a pair of dermatologist brothers — born in Tuscany and raised in South Florida — has bridged the gaps between the two cities with medical conference and student-exchange program initiatives.

Paolo Romanelli, M.D., associate professor of dermatology and cutaneous surgery, was just a boy in 1977 when his father, a professor of cardiology, medicine and geriatrics at the University of Pisa Medical School, moved the family to America. Renzo Romanelli, M.D., joined the faculty of what was then the University of Miami School of Medicine as a voluntary professor of medicine and taught here until his retirement in 2000.

Paolo Romanelli and his younger brother, Marco, returned to Pisa for their medical education. Marco Romanelli, M.D., Ph.D., remained, and today he is associate professor of dermatology at the University of Pisa.

“Several years ago, my brother and I began talking about holding an annual conference with faculty members from both of our departments,” said Paolo Romanelli. “We created the two-day International Dermatologic Galilei Symposium, which is held in Pisa each year during the last week of June, and which focuses on the latest research, treatments and techniques for psoriasis, acne and cosmetic dermatology.”

The first conference, held in 2005, was a great success, as was its successor the following year. In the course of their work, the brothers learned that one of Marco Romanelli’s colleagues, hematologist-oncologist Mario Petrini, M.D., was a close friend of Miller School Dean Pascal J. Goldschmidt, M.D. The two had become acquainted years earlier during a fellowship. In 2007, Goldschmidt, Senior Vice President for Medical Affairs and CEO of UHealth, traveled to Pisa and gave a presentation at the conference.

“The Dean was very supportive of the conference and how it was bringing the two medical schools together,” said Paolo Romanelli. “He suggested adding a student exchange program. Students could spend a month between their first and second years to attend the conference and shadow medical practitioners from a variety of disciplines. The recession was just beginning, however, so it was difficult to find funding. Still, I knew it was an idea that was just waiting for the right student to come along.”

It was a three-year wait, but in the fall of 2010, Carla Maffeo, M.D., knocked on Romanelli’s office door. Maffeo, then a first-year student, is now a Miller School graduate and a general medicine intern completing a transitional year at St. Vincent’s Medical Center in Bridgeport, Conn., before she enters an anesthesiology residency at Emory University Hospital in Atlanta. Her entire family was from Italy, she spoke Italian and she wanted to know if there were exchange opportunities in Pisa for medical students. She was the student Romanelli had been waiting for, and she was persistent.

“I called my brother and said, ‘We have to do this,’” recalled Romanelli, laughing. “‘She comes here every day.’”

The two physicians and a third brother, Pietro, a business executive who has been supportive of his brothers’ educational efforts, each agreed to put up €1,000 to help cover Maffeo’s travel costs. At the beginning of June, she was on an airplane bound for Italy.

“The opportunity basically fell in my lap,” said Maffeo, “and the only word to describe my experience is ‘unbelievable.’ The University of Pisa set me up at a hotel a few minutes from the train station, and they covered the cost of my stay for nearly four weeks. It was just a 20-minute walk or a 10-minute bus ride to the old hospital.”

Maffeo spent most of her time shadowing Marco Romanelli and other dermatologists at clinics for wounds, psoriasis and melanoma. She also pursued other specialties that interested her — OB-GYN, pediatrics and anesthesiology.

“This gave me an early exposure to some of the material I would study later when I was back in Miami,” said Maffeo. “The students I met were very friendly. We went out to dinner together several times, and they were excited to have the opportunity to practice speaking English.”

Maffeo sat in on several lectures, taught in Italian, and found them to be more informal than in Miami, with the students all wearing jeans. One of the differences she found in dealing with patients was the existence of a national registry of patients diagnosed with psoriasis; being on the registry qualified them to receive the newest drugs at a discounted rate. On the other hand, she noted, long waits in the ER seem to happen everywhere.

“When I came back, I realized it would fall on me to market the experience to the next class,” said Maffeo. “For the program to continue and grow, I knew I had to bring my ‘A’ game. I made a slide show of my photos from the trip, put up flyers and baked Italian cookies. At the end of the meeting, we had a list of 30 names.”

Three more Miller School students have followed Maffeo — Charlotte LaSenna in 2012, Inna Granovsky in 2013 and Victoria Billero in 2014. They have shared many experiences and impressions during their stay.

The exchange students’ time was divided between two hospitals. The “old hospital” that Maffeo referred to — now known as the University Hospital of Pisa (Santa Chiara) — was built in 1257, but inside it offers 21st century care, including dermatology. The new hospital, Cisanello, is a large, modern complex of buildings housing most other medical specialties.

The majority of the students’ activities involved shadowing physicians and observing their interactions with patients.

“It’s like what our third- and fourth-year students do,” said LaSenna, who stayed the month at a small B&B. “They take a very hands-on, practical approach. The strongest connections are in dermatology because that’s what the Romanelli brothers practice, and it had an impact on my whole direction in medical school. I got involved right away in a research project with Dr. Marco Romanelli, and I found that for me dermatology is the right fit. And I have learned that I really like the academic medical setting, with its mix of research and clinical activities.”

All of the students also found time to shadow physicians in internal medicine, endocrinology, pediatrics, hematology, OB/GYN and a variety of other specialties.

Inna Granovsky, a Russian-born third-year student whose family came to the U.S. when she was 9, and who is enrolled in the combined B.S./M.D. Medical Scholars Program, had been to other parts of Italy before, but as a tourist.

“It was an amazing mix of clinical and cultural experiences,” she said. “Overall it felt less computerized and more based on human contact.”

Granovsky and Billero both stayed with the family of a faculty member — a model the program will use moving forward because it gave the students a more home-like feeling during their month away.

“One of the benefits of spending several weeks in one setting was being able to track outcomes in individual patients,” said Billero. “The first day I was in the wound healing clinic, a diabetic patient with a very deep venous ulcer came in for treatment. During my last week in Pisa, he presented with inspiring progress.”

All of the Miami students made friends with the Italian medical students. In many cases, they were younger, because in the Italian system, students wishing to become physicians enter a six-year medical school program directly from high school. Billero was “adopted” by a group of third-year Italian medical students who were doing a dermatology rotation for a month.

“They were very welcoming,” she said. “We went out for coffee most weekdays, and on the weekends they showed me the neighboring Tuscan towns they were from. I am looking forward to returning the favor if they ever visit Miami.”

Granovsky said she expects the experience will have a long-term impact on her career.

“I got to see a whole different system of medicine,” she said, “and I was already from another culture myself. The exchange program gave me a broader perspective, and it will help me become a better doctor.”

“This program has offered a unique opportunity for our students to observe Italy’s healthcare delivery system — an excellent example of high-quality European medicine — firsthand,” said Laurence B. Gardner, M.D., professor of medicine and Executive Dean for Education and Policy. “It’s important that our students become familiar with the legacy of Italy and its role in medical education.”

To date, the program funding has only been sufficient to support one student each June, but that is about to change. Paolo Romanelli recently received a check from a donor who wishes to remain anonymous that should cover the cost of sending three or four students. This will open up the program to students who don’t speak Italian and may not wish to travel alone.

The exchange program has also had its first Italian student — Lorenzo Macchia, who came to Miami in 2013. Ironically, his father, Enrico, is the endocrinologist who was shadowed in Pisa by Granovsky during the same month Macchia was visiting Miami.

With nine successful conferences completed, and momentum building for the student exchange, the two medical schools have signed a formal agreement of cooperation that opens up the possibility of a variety of scholarly joint ventures. Romanelli credits Eduardo de Marchena, M.D., professor of medicine and surgery, and Associate Dean for International Medicine, Emilio Nunez, M.B.A., Executive Director; and Julissa Gutierrez, Senior Manager, all with the Miller School of Medicine’s International Medicine Institute, with providing valuable assistance.

The agreement was signed by Goldschmidt and Petrini, who is now Director of the University of Pisa’s Department of Clinical and Experimental Medicine. It somehow is fitting that an institutional partnership that was the dream of two brothers has been secured by the signatures of two long-time friends.

For more information about the annual conference or the student exchange, please contact Paolo Romanelli at .(JavaScript must be enabled to view this email address) or Marco Romanelli at .(JavaScript must be enabled to view this email address).

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