Faculdade de Medicina da Universidade de São Paulo Comissão de Relações Internacionais (CRInt) Chamada 006/2015. Harvard Medical School Estados Unidos

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1 Faculdade de Medicina da Universidade de São Paulo Comissão de Relações Internacionais (CRInt) Chamada 006/2015 Harvard Medical School Estados Unidos Em cooperação com a Harvard Medical School, a CRInt-FMUSP anuncia a seleção de dois alunos para realizar um estágio médico, sendo um para cada período de acordo com as opções a seguir. Estágios Período do estágio Inscrição para seleção Verifique a lista de estágios em: tareas.aspx Verifique a lista do período dos estágios e da submissão de documentos: 2E6B CD7-93CED745AFC4/ _Calendar.pdf 1 a 3 meses (Outubro a Dezembro de 2015) 08 a 12 de junho de a 3 meses (Janeiro a Março de 2016) 03 a 07 de agosto de REQUISITOS 1.1. Para participar, o candidato deve atender aos seguintes requisitos a) Ser aluno de graduação FMUSP do 6º ano de Medicina no momento do intercâmbio; b) Ter desempenho acadêmico de excelência; c) Ser fluente em língua inglesa e apresentar TOEFL com nota superior a 100. d) Estar apto a completar a candidatura e a apresentar os documentos exigidos pela Harvard Medical School após a seleção ( ) Por critério de equidade, será dada prioridade a alunos que não tenham participado de intercâmbio acadêmico. 2. INSCRIÇÃO (PRÉ-SELEÇÃO) 2.1. A pré-seleção será feita pela CRInt e Comissão de Graduação mediante a apresentação dos seguintes documentos: a) Ficha de inscrição; b) Histórico Escolar; c) Currículo Lattes; c) TOEFL; 2.2. O aluno poderá cursar de 1 a 3 estágios, mas na ficha de inscrição ele deverá fazer uma lista indicando várias possibilidades em ordem de prioridade As inscrições serão recebidas pessoalmente na CRInt-FM (Av. Dr. Arnaldo, sala 1345 Faculdade de Medicina da Universidade de São Paulo Comissão de Relações Internacionais Av.Dr. Arnaldo, 455 1º andar sala: 1345 CEP: São Paulo - SP Brasil Tel: (+55 11) crint@diretoria.fm.usp.br

2 atendimento das 8h às 15h) no período indicado. Não serão aceitos pedidos incompletos ou entregues fora do prazo A pré-seleção será feita pela CRInt e Comissão de Graduação mediante análise dos documentos e entrevista com a comissão de seleção, a ser agendada após o término das inscrições Após a pré-seleção, os alunos deverão atender os requisitos exigidos pela Harvard Medical School. Somente os alunos pré-selecionados deverão entregar os documentos exigidos pela universidade (conferir o anexo da presente chamada). 3. BENEFÍCIOS 3.1. Os selecionados poderão usufruir da: a) Isenção de taxas acadêmicas; b) Todas as demais despesas (passagem aérea, hospedagem e demais gastos) são de inteira responsabilidade do aluno FMUSP. Mais informações sobre Moradia e Transporte podem ser encontradas no site da Universidade; c) Possibilidade de solicitar um auxílio financeiro pelo fundo para intercâmbio da FMUSP. 4. DISPOSIÇÕES FINAIS 4.1 Após o final do estágio o aluno poderá solicitar o aproveitamento de crédito das disciplinas cursadas, mediante análise da Comissão de Graduação Esta chamada poderá sofrer atualizações ou ser cancelada a qualquer momento. Por favor, consulte a página da CRInt para verificar se houve retificação A CRInt está à disposição para sanar as dúvidas bem como auxiliar os alunos durante o processo de inscrições. Faculdade de Medicina da Universidade de São Paulo Comissão de Relações Internacionais Av.Dr. Arnaldo, 455 1º andar sala: 1345 CEP: São Paulo - SP Brasil Tel: (+55 11) crint@diretoria.fm.usp.br

3 Ficha de inscrição Chamada /2015 Universidade Período em que deseja realizar o estágio: Opções de Estágio (indicar em ordem de prioridade indicar ao menos 3): Dados pessoais Nome completo: Telefone: Nº USP: Ano acadêmico em curso: ( ) 3º, ( ) 4º, ( ) 5º, ( ) 6º 2. Informações sobre o Resumo Escolar Média ponderada com reprovações: Número de reprovações: Já realizou intercâmbio acadêmico? ( ) não ( ) se sim, qual o período? O intercâmbio foi realizado com bolsa? ( ) não ( ) se sim, qual? 3. Informações sobre Currículo Lattes Realizou Iniciação Científica? ( ) não ( ) sim, sem bolsa ( ) sim, com bolsa da (agência de fomento) Realizou quantos projetos de IC? 4. Participação em Liga Participou de liga? ( ) não ( ) sim Se sim, quais? Se sim, quantos semestres? 5. Participação em projeto social Participou de algum projeto social? Participou do programa USP ifriends? ( ) não ( ) se sim, qual? ( ) não ( ) se sim, recebeu quais alunos? 6. Publicações ou apresentações na área Possui alguma publicação? Possui apresentações de trabalhos em eventos acadêmicos? ( ) Capítulo de livro ( ) Texto completo em anais de congresso ( ) Artigo em jornais ou revistas de difusão ( ) não ( ) se sim, quantos? Faculdade de Medicina da Universidade de São Paulo Comissão de Relações Internacionais Av.Dr. Arnaldo, 455 1º andar sala: 1345 CEP: São Paulo - SP Brasil Tel: (+55 11) crint@diretoria.fm.usp.br

4 PLEASE PRINT CAREFULLY HMS Exchange Clerk Program Checklist Last Name First Middle Address Birthdate (mm/dd/yy) HMS Exchange Clerk Program Checklist HMS Dean or Registrar Verification Form Official Letter of Support on your school's letterhead Original Official Transcripts HMS Immunization Form HMS form must be filled out in its entirety and signed by a health professional. Home school forms cannot be substituted. In addition, the following documentation must accompany the HMS Immunization Form; Copy of Lab Report posting a positive Measles serology test. Copy of Lab Report posting a positive Mumps serology test. Copy of Lab Report posting a positive Rubella serology test. Copy of Lab Report posting a positive Hepatitis B serology test. Copy of Lab Report posting a positive Varicella serology test or documentation of vaccination. Copy of Lab Report for clear Chest X Ray required for all BCG Vaccinations Personal Health Insurance (may be provided after placement) If proof is indicated in dean's letter, please highlight. Professional Liability/Malpractice (may be provided after placement) If proof is indicated in dean's letter, please highlight. CORI Form only the top portion needs to filed out and signed. Application Fee International Students Only: English Interview Phone interviews are conducted on Tuesday and Thursday from 10am 2pm EST. International Students Only: TOEFL Score Report Initial Initial I understand that all the above materials must be together in ONE packet, otherwise my application will be considered incomplete and can result in my not being scheduled. I acknowledge that I am currently enrolled and my LAST year of Medical School, graduating within 12 months of placement. Signature: Date:

5 DEAN OR REGISTRAR VERIFICATION The Dean or Registrar of your medical school must complete this section. Requested information should be filled in and/or appropriate responses circled below: Student Name: Standard length of time to complete MD program: years Student's year of medical school: Student's expected graduation date: Student is approved to do electives away from home school YES NO Student is in good academic standing YES NO Student has taken and passed Step 1 of the USMLE (U.S. and Canadian YES NO (explain if NO) Students only) Student will be covered by personal health insurance while away YES NO Student will be covered by malpractice insurance while away YES NO Student will be taking the clerkship for credit YES NO INTERNATIONAL SCHOOLS ONLY, PLEASE ANSWER THE FOLLOWING: Is the language of instruction at your medical school in English? YES NO Is student fluent in English? YES NO Please refer tour website under: International Medical Students for more details. Has student taken TOEFL exam? (if Yes, please give score & date taken) YES Date taken: Score: NO Dean or Registrar please complete: Authorized by (signature): Date: Name (print or type): Title: School: Address: Phone number:

6 HARVARD MEDICAL SCHOOL EXCHANGE CLERK CERTIFICATE OF IMMUNIZATION Student Name: Date of Birth: The following information MUST be completed and signed by the applicant s health care facility. Please check the following immunizations that have been completed by the above named student. These immunizations are required for participation in clerkships at Harvard Medical School and its affiliated hospitals. Please refer to the Immunization Instructions on our website or the following form for details. 1. A POSTITIVE SEROLOGICAL TEST FOR IMMUNITY TO MEASLES, RUBELLA AND MUMPS. A HISTORY OF DISEASE IS NOT ACCEPTABLE. A COPY OF THE LABORATORY REPORT MUST BE ATTACHED OPTIONAL : DATES OF IMMUNIZATION WILL NOT SUBSTITUTE FOR THE SEROLOGY. 2. TETANUS DIPHTHERIA PERTUSSIS Tdap 3. HEPATITIS B IMMUNIZATION. A COPY OF THE POSITIVE HEPATITIS B SURFACE ANTIBODY TITER MUST BE ATTACHED. 4. TUBERCULOSIS SCREENING & CHEST X RAY No new test required if: (a) History of childhood BCG vaccination or (b) Prior PPD, QFT or Tspot test consistent with latent TB Type and date: #mm induration: Antibiotic therapy and dates: Date of chest X ray (attach report) REQUIRED 5. PROOF OF CHICKENPOX (VARICELLA) IMMUNITY. either: a. A POSTIVE SEROLOGICAL TEST FOR IMMUNITY (PLEASE ATTACH REPORT) or b. DOCUMENTATION OF VACCINATION Positive MEASLES titer: Positive RUBELLA titer: Positive MUMPS titer: MMR #1 MMR #2 IF NEEDED: MMR #3 Tdap: Series complete #1 #2 #3 Type and date: #mm induration: Result: negative consistent with latent TB If consistent with latent TB, record date of chest X ray and attach report: Record antibiotic therapy, if taken, and dates: Positive Varicella titer: or Vaccination: #1 #2 Signature: M.D., R.N., or School Official Name: (Please Print) Date: Title Name of School: Address: Phone: ( )

7 Harvard Medical School Guidelines for Immunization Compliance Your health and the health of our patients is our primary concern. Please review the following information carefully in order to be eligible for the Exchange Clerk Program. HMS strictly adheres to these immunization guidelines which may exceed CDC recommendations. 1. Measles, Mumps and Rubella a. HMS requires positive IgG results as proof of immunity for each disease. b. A copy of the lab report must be attached for each titer result. c. Boosters or IgM results DO NOT substitute for a positive IgG result. d. Please note that HMS does not accept negative or equivocal titer results, even with a recent booster. e. If you have negative IgG results, to be eligible for the Exchange Clerk Program you will need to be established as a non converter. i. HMS requires that the student must have a negative reading posted 8 weeks from a 3 rd booster vaccination and provide the following documentation: 1. Recorded dates for all 3 MMR vaccinations. 2. Lab report with negative result posted 8 weeks from 3 rd booster. 3. Letter from primary care physician declaring non converter status. f. Do not submit application while waiting for pending results. All immunizations must be complete at time of application. 2. Tetanus, Diphtheria and Pertussis Booster a. Tdap booster must be administered within the last 10 years b. Tdap booster must also cover the entire time of requested period of study. i. For example, if you request April, May and June then your Tdap booster should expire no earlier than July. 3. Hepatitis B a. Visiting medical students will need to complete the 3 part Hepatitis B series before rotating at HMS (incomplete series information is for HMS students ONLY) i. Please submit laboratory report confirming presence of titer for Hepatitis B antibody (HBSAb) ii. HMS does not accept negative or equivocal results. Please see above for more details regarding titers. 4. Tuberculosis Screening and Chest X Rays (ONE of the following is required) a. Documentation of 2 step TB testing; #1 within year of start date, #2 within 3 months of start date. b. For individuals know to be TB skin test positive, documentation of a chest x ray report which rules our active tuberculosis within 2 years of your full rotation dates. c. Documentation of negative QFT or Tspot; if positive QFT or Tspot, then documentation of a chest x ray report which rules our active tuberculosis within 2 years of your full rotation dates. d. A chest x ray within 2 years of your full rotation dates is required for ALL students who have a history of childhood BCG vaccination. Please fill out the pertinent information in the left box of the Certificate of Immunization form. 5. Varicella a. If you have a history of chickenpox infection (varicella), then you will need to submit a laboratory report confirming positive IgG results b. If you have completed the 2 part varicella vaccination series, please recorded vaccination dates. You do not need to submit IgG or IgM if series complete.

8 HARVARD MEDICAL SCHOOL HUMSR $ OFFICE OF THE REGISTRAR 25 Shattuck Street Boston, MA Telephone Fax CORI REQUEST FORM Harvard University Medical School has been certified by the Criminal History systems Board for access to convictions and pending criminal case data. As an applicant for the HMS Exchange Clerk Program, I understand that a criminal record check will be conducted for conviction, non-conviction, and pending criminal case information only and that it will not necessarily disqualify me. The information below is current to the best of my knowledge. APPLICANT INFORMATION (Please Print) Last Name First Name Middle Name Applicant s Maiden Name (NA, if not applicable) Place of Birth Date of Birth (DD/MM/YYYY) Social Security Number (NA, if not applicable) ID Theft Index PIN (NA, if not applicable) Mother s Maiden Name Current Address: Former Address: Sex: M or F Height: ft. in. Weight: Eye Color: Driver s License Number: State of Issue: APPLICANT SIGNATURE: (Unless otherwise preempted by law) OFFICIAL USE ONLY ***THE ABOVE INFORMATION WAS VERIFIED BY REVIEWING THE FOLLOWING FORM OF GOVERNMENT ISSUED PHOTO IDENTIFICATION: REQUESTED BY: Signature of authorized CORI employee *The CHSB Identity Theft PIN Number is to be completed by those applicants that have been issued an Identity Theft PIN Number by the CHSB. Certified agencies are required to provide all applicants the opportunity to include this information to ensure the accuracy of the CORI request process. All CORI requests that include this field are required to be submitted to the CHSB via mail or by fax to

9 ROTATION MONTH Harvard Medical School Clinical Rotation Dates & Application Deadlines ROTATION DATES TUITION per month DEADLINE to submit online application JUNE June 1 June 28 $4,500 February 28th April 1st JULY June 29 July 26 $4,500 March 31th May 1st RECESS July 27 August 2 AUGUST August 3 August 30 $4,500 April 30th June 1st SEPTEMBER August 31 September 27 $4,625 May 31st July 1st OCTOBER September 28 October 25 $4,625 June 30st August 1st DEADLINE to submit materials NOVEMBER October 26 November 22 $4,625 July 31st September 1st DECEMBER November 23 December 20 $4,625 August 31st October 1st RECESS December 21 January 3 JANUARY January 4 January 31 $4,625 September 30th November 1st FEBRUARY February 1 February 28 $4,625 October 31st December 1st MARCH February 29 March 27 $4,625 November 30th January 1st RECESS March 28 April 3 APRIL April 4 May 1 $4,625 December 31st February 1st MAY May 2 May 29 $4,625 January 31st March 1st IMPORTANT NOTES: Tuition for the clerkship program is subject to change annually. Students at US/Canadian medical schools pay tuition at your own institution. FINAL date to apply for this month. Applications received AFTER this deadline will NOT be processed. Participating in rotations during a RECESS break is not possible. Harvard Medical School cannot certify any work completed over a recess break.