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DermMatch's Guide to Applying to Dermatology

Discussion in 'Dermatology' started by DermMatch, Jan 1, 2009.

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  1. DermMatch

    DermMatch

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    SDN Members don't see this ad. (About Ads)
    Welcome to SDN's Dermatology Forum. My name is DermMatch, and I joined SDN to help applicants in the dermatology match. I am writing this guide because I was dissatisfied with the Dermguide sold for $8 at the now-defunct DermBoard, historically the place where derm applicants flocked. The for-profit site, which I felt was poorly run and rife with distracting spammer ads, sold me a little essay with no substantive advice for the money I paid. But I bought it because I was stressed and felt like I needed every advantage possible.

    So I assembled a guide to the dermatology match, based on my experience, the experience of my friends in dermatology, and my involvement with the dermatology interview process as a resident. It is not meant to be a definitive guide, but rather a collection of helpful perspectives.

    This guide is permanently posted for all to read here at SDN dermatology forum. I guarantee you that I cover the same ground covered by the Dermboard's application guide, but of course presented from my own viewpoint.

    I welcome your thoughts, but please post your feedback by starting a separate thread in the public forum so everyone can benefit rather than swamping me with PMs.

    To keep this guide as seamless as possible, please do not reply to this thread, as doing so will break up the guide and make reading difficult.

    Also, I welcome private messages with your questions, but because our common contributions help make this SDN forum lively, I will answer these PMs after I post them publicly under my name, with your permission and appropriate redacting for privacy. Posting your question also expands the number of helpful responses you will receive. When you PM, please automatically include your permission to repost publicly so I don't have to send you another PM.

    The content of this thread and its posts written by DermMatch are protected by Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
    This means I keep my copyright but allow people to copy and distribute my work provided they give me credit — no commercial uses of this text are allowed, and this text may not be modified.
    Last edited: Nov 17, 2009
  2. DermMatch

    DermMatch

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    The fundamental question applicants will encounter when applying to dermatology residencies is, "Why did you choose dermatology?" Cynical applicants will keep their honest response under wraps: "It gives you the best pay for the best hours." Certainly, there are undeniable lifestyle benefits to the field, but dermatology is much more than simply a relaxing specialty in medicine. It is diagnostically challenging; encompasses medicine, surgery, and pathology; and involves a range of patient ages.

    Nothing is more boring, however, than to hear an applicant reel off the above generic, rehearsed points, as it doesn't show much independent thinking. Recently, in listening to an applicant recite her canned response, I had to stifle a yawn.

    The key in answering this question well is to state the specific, unique events you experienced that made you realize all of dermatology's special, interesting aspects. Dermatology may involve surgery, and that might pique your interest, but HOW did you learn about dermatology's surgical side? Was it by working with a mentor? Did you do research in Mohs outcomes? Did you work with a patient who had to undergo dermatological surgery? Did you have a personal or family experience with Mohs surgery? And why was whatever unique experience you had so compelling that dermatology was the only career choice for you?

    Answering in specifics will, of course, necessitate more in depth exposure to dermatology than you can get in a typical medical school rotation. Certainly, four weeks will give you a taste of what is involved in dermatology, but being able to answer specifically and compellingly will require more work than just completing a rotation. It will require research, writing case reports, working at the AAD's summer camp for kids, working closely with a mentor, or possibly doing an away rotation. An applicant would need to be a superhero to tackle all of that, but the best applicants do at least some more work than the average.

    [By the way, a little plug for me: I've already given you more compelling tips in this section than the similarly-named section in Dermboard's Dermatology Application Guide. Keep reading!]
    Last edited: Jan 5, 2009
  3. DermMatch

    DermMatch

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    This is fundamentally an unanswerable question. Several elements need to be factored:

    1. Grades, USMLE Step 1

    Honors in most rotations and a high USMLE Step 1 score frequently are the most important hard data that residencies rely on, simply because a significant number use "cut off" values to screen applicants. While not all programs do, and those who do will not admit it publicly, it is a known fact that at least some jigger their end of ERAS to select out applicants. Unfortunately, although it is galling that your heartfelt essay will not be read, the auto-screen is a tool some programs use to whittle down the enormous number of applications they need to examine.

    Classically, common wisdom states that a minimum of 240 on the Step 1 is required to have a good chance at even being interviewed. This is not to say, however, that a lower or higher USMLE score will seal an applicant's fate either way. Again, there are numerous examples of people with very low scores who, although they may not have many interviews, do match in dermatology (I personally know at least one person who fits that criteria). They may get an interview because of another aspect of their application, and their performance in the interview favorably impresses the committee. And there are examples of students who ace the USMLE and are swamped with interviews, but who match way down on their rank list because their dull or irritating personalities reveal themselves during the interview.

    II. Research or publications

    In-depth work in dermatology nets applicants several things: First, a recommendation from a mentor who hopefully will go to bat for you even beyond writing a letter; second, fodder for the interview or essay; third, a published or soon-to-be published work; and fourth, material to present at a dermatology conference. Based on the experience of several applicants, it seems better to do your research at your home dermatology department, as you will get to know your program director and s/he can go to bat for you the most effectively. Being a stranger in a strange land--that is, doing your research away, either at another institution or through programs like the NIH--can also be rewarding but may be more challenging if you don't already know your department very well. There is a definite risk that if you are gone for one year, key department faculty literally will not know who you are when you return. It's happened.

    IIIa. Awards: Dermatology

    Several grants and book awards exist that are open to medical students. Winning one can help show more commitment to dermatology than the average applicant. Also, investigate your local dermatological society, which will often sponsor book awards for presenting cases.

    IIIb. Awards: AOA

    Medical schools differ widely in awarding students AOA. Traditional programs will rank junior and senior AOA based completely on scores and grades, while other schools will award AOA status based on hard statistics as well as recommendations. Some other schools award AOA only at the end of three years, and bestow this gold star based on a student's overall contributions on campus. At those schools, even stellar statistics won't guarantee AOA, and students with average statistics, but whom the nominating faculty likes a lot, can win.

    Residencies understand the wide variety of AOA systems in play, and AOA therefore becomes another marker of whether an applicant has done well in medical school. I would argue that the emphasis they place on AOA varies as widely as the AOA election systems that exist. For instance, I interviewed with an East Coast program, not traditionally high ranking, where *literally* the first question the program director asked me, as he thumbed through my ERAS, was, "Were you AOA?" I was not, and explained to him the system used at my school. While I could be wrong, my sense was that my lack of AOA did not hurt me in light of my overall application, as more than one interviewer at that particular program expressed their support for my application. Indeed, the director specifically asked me to reiterate my interest in his program, although I ended up matching at another program popularly considered more competitive than his.

    Nervous applicants tend to focus on what they believe is the one glaring gap in their ERAS, or the one shining star. While everything like AOA helps, it truly is the holistic application and interview that affects an application. I did not have AOA, and a good number of my friends applying to dermatology did not. Yet collectively, we interviewed at a wide variety of programs, and we all matched. Because of this, one could argue that AOA is only one element of a competitive application (and that at least the programs where we interviewed did not use AOA as a screening cut-off).

    IV. Other activities

    Leadership positions on campus? Work abroad? Volunteering with underserved communities? Involvement with DIGA (Dermatology Interest Group Association)? All good things and worth pursuing, but nothing that would clinch a match. These are, however, interesting fodder for your interviews, and in-depth unique pursuits--serious artistic abilities, previous other careers--will often set you apart from other applicants in an interviewer's mind. In that sense, leadership positions in DIGA-like organizations pale in comparison.

    V. Connections

    Ah, the unspeakable reality. Dermatology is a small field, and getting to know your department very well--including your program director and your chair--can be invaluable. For a fact, chairs and program directors will place calls for individual applicants at the residency of their choice, in order to ensure that their favorites get placed. This may land a person an interview who may have otherwise been overlooked, or even may ensure a high ranking, thus leading to a good match. This is reality, so know how to play the game. Being pushy, ever-present, and obnoxious, however, will not win points. We all know of irritating applicants who desperately tried to network but who failed to match because they annoyed everyone around them.

    If you do not have a home dermatology program, it will be important to reach out to other departments or dermatologists and inquire about working with them, either through research or a rotation. Consider investing a year to do more intense research so that they can truly get to know you and write a strong letter.

    Even personal connections in the form of relatives in high places and, yes, even your parents' friends, can and have been known to help. Applicants won't trumpet these personal relationships--who wants to admit nepotism?--but they are a factor and have been known to open an interview door, if not help boost a ranking. Your delicate task, of course, is not preening about the heavies in your corner because you can quickly turn an asset into a liability. No one likes a spoiled brat.

    Which elements are most important? I'd say I, II, and V.

    [Oh, again, I just wrote more than quintuple what's available in the similar section in Dermboard's Derm Application Guide. All that's there is the equivalent of "Gee, you can get good scores and match! You can get low scores and still match! Just keep trying!" I can't believe I was stupid enough to fork over cash for that "guide." Save your money and read on.]
    Last edited: Nov 17, 2009
  4. DermMatch

    DermMatch

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    The early bird gets the worm in this game. If you are uncertain about dermatology, it is still best in your first year to explore the steps that committed applicants will be taking from the start. But starting late doesn’t rule you out. People match in dermatology only after deciding late in medical school—indeed, people match in dermatology even after completing another residency. However, a successful applicant typically will have planned ahead in shaping at least some aspects of their application.

    While there are many approaches to applying to residency—one of the chief differences being whether you take a research year or whether you graduate in four years—a few principles are useful. Providing a semester-by-semester timeline is artificial (that’s what another well-known AKA Dermboard dermatology application guide does, with little practical benefit); instead, I will outline general pathways applicants can follow and adjust to their own unique situations.

    I. Introducing yourself to your department

    This is an ongoing effort which often smacks of artificiality, especially if you show up in the first week of your first year in medical school saying, “I know I want to be a dermatologist.” Getting the department to know you, however, is vitally important as a way not only to bolster your own application to your home program, but also to garner supporters who can write letters and place calls for you during application season. It is not only getting to know the program director, faculty members, and maybe even the chair, but also getting to know residents who could very well be faculty once the time comes to submit your ERAS. I would treat this endeavor as an organic effort which should unfold over time, while you do research and finish your dermatology rotation, as during those efforts you will most likely come up with reasons to chat informally with department players. The key is not looking like a pandering ass.

    When you finally do declare your serious intention to apply, you may likely need to schedule a meeting with the program director or your rotation director, both of whom are key in helping you with your application. This is when you can discuss the merits of your application, or any other nuts and bolts of the process. Doing a full-court press by scheduling tons of meetings with the program director is not necessary and won’t yield more per se (in fact, I would wager that it can become annoying). Be judicious in taking up his or her time. Use it to let them know you are sincerely interested in dermatology, and because of your interest, you would love to help them or the department in any way as a means to get to know the field better.

    Formally meeting with other faculty members is nice but not necessarily key, as they are one of many decision-makers and may not have a strong voice in the application committee. Get to know them organically during your second-year dermatology course, Grand Rounds, your dermatology rotation, or if you are truly interested in their field of expertise, during their specialty clinics or by helping them with research.

    Stay on everyone’s good side, including the residents, as again, they talk amongst themselves, to attendings, and to the program director. Kissing ass, however, is pathetic because it is transparent and irritating. I once had a medical student offer to help me carry my lunch. That is not necessary and just makes it clear how absolutely low you are willing to grovel, thus making people lose respect for you. Be helpful in the clinic by assisting with biopsies, but you don't need to be a maid.

    While kissing ass is pointless, you should also not be rude and cold to the residents, even if they are junior. As an illustration, I once offered to show a rotating medical student how to spray liquid nitrogen on an actinic keratosis. No, it's not rocket science, but being able to help with patient care sure beats standing around doing nothing. This medical student took me up on my offer, but didn't say thank you or even introduce himself to me. Not good, and if I see him during interviews, I won't be overcome with good vibes.
    Last edited: Jan 5, 2009
  5. DermMatch

    DermMatch

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    IIa. Planning your curriculum at home

    Fitting in your first and main home dermatology rotation early is key. You need to understand that if you're organized, all letters and supporting documents are ideally submitted by mid-October. While Dean's Letters go out on November 1st, and most programs don't download your ERAS until that is done, a few programs have deadlines earlier in October (notably U-Penn, at least in recent years). If you want to apply to those programs, you may as well complete your entire dossier early. And that includes scheduling your derm rotation in time for your evaluation to be completed by those deadlines.

    Rotating as early as you can also gives you more exposure to the department, and more validity when you claim you just LOVE dermatology because of everything you learned during your early rotation. It also frees you up to rotate early at away programs if you are so inclined. In addition, if you plan to sink a year into research at your home school, your completed dermatology rotation will allow you to learn about faculty interests and cherry pick a research project, seguing nicely from pupil in a rotation to research assistant in the lab or clinic.

    Also, if you're lucky enough to rotate so early that no one else will be with you on your rotation (because no one else has clued into the fact that an early rotation in derm is good), then you can luxuriate in being the only med student on with the residents. (Of course, now that I've spilled the beans, there may be a stampede to the registrar to rotate in derm early; try not to get crushed.)

    If your school's curriculum forecloses any chance of rotating early because of its ridiculous requirements, then you don't have any options except to hurry up and cram in a July rotation in your fourth year. So will all other derm applicants in a similar position at your school, which will make it even more important to impress the residents and attendings. Pressure's on.

    IIb. Planning your curriculum away

    The never-ending debate: Do I stay or do I go? Remember that no visiting student is ever guaranteed an interview at their away rotation. Certainly, programs may have policies where they interview all rotators, but when I say "interview," I mean REAL interview, rather than a pro forma event.

    I myself did not do a single away rotation, because I did not think the hassle of arranging an away rotation at one of my desired institutions was worth the risk of screwing up my image there. So many things can go wrong with an away rotation: You have to learn a new medical record system, a new clinic system, a new hospital system. You have to get into the swing of a different department. You'll be welcomed, but not as warmly as their home students. You could inadvertantly piss off an attending, a resident, the PD, the chair... the list goes on.

    But people argue, you can nab a good letter! That is true... but I've also heard of rotators who asked to meet with the host PD in order to get a letter, only to be blown off repeatedly until the rotation was over. Thus leaving the rotation with no letter.

    Then again, I've heard of applicants whose only interviews were at their home school and their away rotations. Seemingly, then, their away rotation was a lifeline! Yet even in those cases, I still ask the question, "Was that interview offer a REAL offer, because they REALLY liked you, or was it pro forma, because they interview all rotators as a matter of course?" Because if an applicant only has interviews from their home school and their away rotation(s), they are probably in a bit of a pickle.

    Ultimately, doing an away rotation is a personal decision, and I wager that the vast majority of applicants will do an away rotation if only to get one more letter under their belt. The funny thing is that faculty know the game and see through that; in fact, I've had faculty say that they realize students do extra rotations just to rack up the letters.

    My advice would be to do an away rotation if you can comfortably schedule it without stress and if you like the city you'll be headed to (ie, your family lives there, your significant other lives there). But that's just my advice.
    Last edited: Jan 5, 2009
  6. DermMatch

    DermMatch

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    III. Scheduling a research project

    There are many ways to skin the research cat.

    Starting a research project in dermatology the summer after your first year, to continue come hell or high water through the misery of second year and the pain of third year, will provide the best chance of producing solid publication fodder that will gild your CV come ERAS time.

    Another alternative would be to decide by December of your third year to take a year off for dedicated research, so that you have enough time to apply to national research grants, or school-based funding. That, of course, is only suitable for those who have the stomach to extend their med school lives by one year.

    Or you could be extra-organized during your second and third year by squeezing out time to work on a case report or other easy at-bats.

    Built-in research blocks also give you time to churn out a case report or jump into more substantive ongoing research.

    For those of you with no home dermatology department, snagging a research position will necessarily involve going off campus, either during elective time or for an entire year. The same principles, however, apply in choosing a project and a mentor.

    One note: It is not your death-knell if you do not do dermatology research the summer after your first year. Many residents matched after doing dermatology-oriented research later on, either as med students squeezing in time during their four years, or as those on the five-year plan. My personal bias, actually, is against those who did research in dermatology the summer after their first year, because it is obvious that the student wanted derm from Day 0 and that generally screams GUNNER to me. That, of course, is my personal pet peeve, and you will find others who nod approvingly at that early-bird-on-steroids approach, as they themselves were those early birds.

    No matter how you decide to do research, consider seriously whom you will be working for. Here comes the cynical reality: You may be truly interested in a particular topic, but assess well your research mentor. Is this attending well-connected? Specifically, is this attending a program director or chair? And if this attending is a program director or chair, is she or he sufficiently well-established that she or he will be able to pen a walk-on-water recommendation for you that will truly reel in the interviews? Or is she or he a newbie who is out-ranked in the department by other, more established attendings who actually may have more pull?

    And that is the sad reality. You may be fascinated by Topic X, researched by Attending Podunk. And you may be bored to tears by Topic Y, spearheaded by Attending Glamorous. My advice would be to go with Attending Glamorous.

    But here is another catch: Does Attending Glamorous really care to go to bat for you, or are you another cog in his wheel? If his queue is full of other clamoring medical students, and if he is personally committed to only a few, you may find yourself left out in the cold. This may be particularly true if you are doing research with attendings who are not at your institution, as attendings will logically be more likely to support students at their own institution versus interlopers.

    If that is the case, then Attending Podunk, who is committed to seeing you succeed, may be better than any star attending.

    Ultimately, however, no matter how you try to control for variables mentioned above, quality work that's published or presented at prestige conferences like Society for Investigative Dermatology will be the heavy on your CV. Having one or two publications is typical. Those who have more than three are rarer, those with more than five are rarer still (but frighteningly do exist). From this perspective, MudPhuds crush others, but that's another discussion altogether.
    Last edited: Jan 21, 2009
  7. DermMatch

    DermMatch

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    IV. Application logistics: The easy part of the match process

    When should I apply? Where should I apply? Whom do I ask for recommendations? How do I structure my resume? What clothes do I wear? Do I attend the preinterview dinner? How do I juggle my flights and hotels? These questions are the easy ones to handle after you've sculpted the best possible resume over the last few years. Sadly, The Guide that Costs $8 spends a huge chunk of real estate discussing these points, whereas I believe that once you have invested significant effort into shaping your candidacy, these issues are easily dispensed with.

    When should I apply? Submit your application by the earliest deadline dictated by whatever programs you are applying to. There is no extra benefit to submitting your application earlier than that.

    Where should I apply? Apply to as many programs you can afford, as no matter how much people want to believe they can calculate their chances, no magic number will guarantee a match. It would be unfortunate if geographic restrictions limit where you can apply. True stories abound of people who failed to nail a derm residency because they were tied into, for instance, couples matching, with their partner applying to another field. In fact, I met a candidate during my application cycle from a prestigious medical school with a tippy-top-ranked dermatology department who was couples matching, and who seemed an ideal candidate--confident, charming, and accomplished. Sadly, that person did not match, and last I heard, was quite bitter. While one could say that this candidate simply didn't have a CV that stacked up, I blame this person's first decision to couples-match. It's like starting a race with a ball and chain already attached to your ankle. Many may lynch me for saying this, but I assert it's worth maximizing your chances by eliminating restrictions like couples matching than risk not matching at all - and engendering lifetime resentment if derm is truly your first love. Derm is a temporary three-year residency with easy call and hours that allows weekend travel to see significant others. With this flexibility, many residents successfully maintain even bicoastal relationships. Not matching in derm the first time 'round, however, could very well mean that you are shut out of this profession for life.

    Whom do I ask for recommendations? ERAS allows you four recommendations, not counting the Dean's Letter. Basic is a recommendation from your course director, as he or she should comment on your rotation performance and possibly how he or she witnessed you falling in love with dermatology. Another standard recommendation would be filed by your research mentor, as you need commentary about how you were a brilliant investigator.

    For the remaining, ideally you would get an in-depth, sensitive letter from a dermatology attending for whom you did even more research, with whom you rotated, or with whom you wrote a case report. Whatever the situation, I would favor getting an in-depth letter instead of superficial notes even from, say, an away rotation where you barely made a mark. Using that principle, it therefore does not hurt to get a deeply supportive letter from your internal medicine rotation singing hallelujah about your genius, versus a curtly short note from a Dermatology God who plainly does not know you from his plumber. Please be aware that it is not the kiss of death if you do not stuff your CV with missives from Dermatology Gods. In fact, this is where I differ *sharply* from That Other Guide Which Costs $8, which blithely suggests that you swamp the department with EVEN MORE recommendations beyond what ERAS requires. Do not follow that advice. If a program wants more from you, they will ask. Again, the thicker the application, the thicker the applicant: This is a truism that does not change for the dermatology match.

    How do I structure my resume? Follow ERAS guidelines. ERAS prints out quite nicely, and lays out people's CVs in a crystal clear format. If necessary, read off-the-shelf resume books, like the Knock 'Em Dead series, to help you write catchy blurbs for each activity you list. Do not, however, exaggerate, even the slightest, your involvement with those extracurriculars. We are adept at sensing this, and it does not impress. Already during this match cycle, as I'm writing this, I can think of at least a handful of people who have stretched the truth about their activities. Truly, if an extracurricular activity was peripheral, you may want to excise it entirely, rather than stick something flimsy into the resume which you may later feel the temptation to exaggerate. Don't be afraid to have a streamlined, focused CV. Finally, by golly, don't lie. A quick Google search will expose you.

    What clothes do I wear? Conservative, but you can add a little bit of life to your outfit so you don't look like a complete drone. Men can wear business suits that don't only have to be dark grey, but make sure they fit well (a common problem among poor nerdy med students), and choose a sharp tie. If necessary, go to Brooks Brothers and have them dress you, then go to Men's Wearhouse to buy the outfit. During one match season, a gentleman was seen wearing an almost purple-looking corduroy or velour-like blazer. That was an unfortunate direction to go, as he was remembered more for his suit than his accomplishments, or at least equally so.

    Women do not just have to wear black suits. You can mix and match colors between the jackets and bottoms (either pants or skirts are fine), using a conservative but non-black palette. Tasteful jewelry is also acceptable, but please cut back on the heavy makeup; you don't want to look like a tart.

    And boys and girls, keep your hair in check. You're interviewing for a job, not a rock band.

    Do I attend the preinterview dinner? Yes, if you can, but it is not essential, especially if you miss it because you had to interview elsewhere. Do keep in mind that your preinterview dinner presents an opportunity to interact with residents but is also prime time for residents to evaluate you. Despite the camaraderie at dinner, you are, like it or not, being evaluated by them, whether it be overtly or subconsciously. Be friendly but don't be a fool.

    How do I juggle my flights and hotels? Just do it.
    Last edited: Nov 8, 2009
  8. DermMatch

    DermMatch

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    Nothing engenders as much stress as The Interview. You're jetlagged, exhausted, running around in a strange city, and you have to charm a string of strangers while you jostle your way through a crowd of competitors.

    Yet nothing is as important as the interview in pushing your candidacy to the top of the rank list or to the bottom of the pile.

    I. Getting the offer

    As soon as you get an interview offer, every one of your actions should send the message that you are a polished, professional candidate who would be a hardworking resident with no attitude, and who would give back to the field in the future.

    And that starts with your acceptance and yes, even your rejection of an interview offer.

    When you accept your interview offer, you will be interacting with the program administration, whether it be the coordinator or the administrative assistant. These people are vital to the smooth running of the residency program, and therefore are generally well-liked and held in high esteem by the faculty and residents. Do not be rude to them, and do not lie to them. This sounds like a no-brainer, but it is shocking how many candidates are actually rude to residency administrators. The fact is that we all talk: Residents talk to the PD, the PD talks to administrators, and the administrators talk to the residents, in one big circle. Assume that anything you say to one will be repeated ad nauseum--especially if it exposes you as a card.

    "Lying?" you think. "Why would I lie in accepting or rejecting an interview offer?" Again, the ordinary person would be shocked at what applicants think they can get away with. You say your flight was delayed and the traffic was horrendous, and that's why you are late, or why you simply couldn't make your interview. Was your flight *really* delayed? Was the traffic *really* that bad? You may lie, but Google never does. And yes, administrators have been known to check out your veracity on weather.com. We residents hear these stories, and all we can do is hit ourselves upside the head.

    If you don't want to interview, turn down the offer with plenty of advance warning. If you accept, and you later are dying to get out of the commitment, contact the administrator and simply say, "I'm sorry, but I won't be able to make the interview." Period. And DO affirmatively contact them. A no-show is remembered, and just provides us more tidbits to gossip about you behind your back at the AAD.

    II. The Interview Day

    Residencies structure their interview days differently, but all have basically the same fundamental format. There is a preinterview social gathering the night before the interview. On The Big Day itself, candidates may be staggered into groups or shepherded through in a rotating herd for their interviews. You'll also get the obligatory tour, which I always thought was pointless, so make sure you're wearing comfortable Allen Edmonds or reasonable heels and appropriate outerwear.

    A. The preinterview social gathering

    Whether it be a cocktail hour merging into a fancy dinner, a stand-alone fancy dinner, or a pizza free-for-all, residencies usually host a social gathering before The Big Day. Sometimes faculty will attend, and sometimes they won't. At times there will be a more formal presentation about the program, covering the basics like the residency's strengths, and details about its three-year layout. Whatever the format, the preinterview social gathering is truly a sincere attempt to welcome applicants, acknowledging that they've slogged their way across country and at least deserve a nice stiff drink on the house.

    While the preinterview event is sincerely meant to be a relaxed affair, you are interacting with the residents and possibly faculty, and therefore you need to be on your best behavior. This first Jungian impression you leave on them will be in many respects indelible, and will factor into whether they think they want to work with you. No matter how unfair you think it is, many an applicant has been judged on their ability to have a friendly, relaxed conversation without looking constipated. The impression you make will carry over into conversations between residents that evening, into the next day, and no matter how objective everyone tries to be, into the rank list.

    So calibrate how you come across. Tend to be loud? Try to modulate your voice. Shy? You may want to try harder to make friendly small talk, no matter how much you want to faint. Don't dominate the conversation. Don't gossip about other programs, don't gossip about other applicants. Be positive. The only things you should complain about are the weather and the airlines.

    (Why the preceding paragraph? Because these little transgressions are all things that applicants have done which left negative impressions on others.)

    You should wear business casual to the preinterview social event. Realize that the residents and faculty will be coming from work, where they have been wearing business casual all day. You want to look like them. So by golly, don't wear a suit.

    It is not the end of the world if you cannot attend the preinterview event, but realize that you do not want to miss an opportunity to have the residents get to know you. If you are a social Quasimodo, that might not be a bad thing, but generally you want to try to go. Travel plans get in your way? You don't need to go so far as to contact the chief resident in advance, but you may want to mention in passing during The Big Day how sorry you were that you couldn't attend because of your crazy travel schedule, and make an extra attempt to show the residents how friendly and nice you'd be as their colleague.

    B. The Interview

    Every residency program organizes The Big Day differently, but almost all will provide a simple breakfast and lunch, have a tour, and drag you through a series of interviews. Do not be shocked that you will meet nearly every important attending through a chain of interviews, each staffed by either one or two of them. A handful of places may also have a panel interview where you stare down a tableful of faculty. Additionally, programs will have you formally interview with residents, and if they do, they will nearly always include the chiefs, as well as possibly residents who volunteer to martyr themselves. The number of interviews may be push double digits, and therefore you will not have too much time at each -- sometimes as little as 10 minutes.

    Because of the limited time, you need to be ready to make a good impression at each interview station in 5 minutes, and convince your judges that you are The One. How to do this? Practice, practice, practice. Be able to describe any high points of your life, including your research, in 1 minute as there is no time to drone on endlessly. Understand that interviewers can meet more than 20 new people in a day, and their eyes are glazing over as the minutes tick by. Come across pithy and focused to spare them more pain.

    Also because most interviewers are bored to death, smiling and (appropriate) joking goes a long way in making a positive lasting impression. If interviewers joke with you, relax and parry back. People want to see an element of your personality, as they will be working as your supervisors and colleagues. Alternatively, they will also remember how unmemorable you were, as no one wants to work with a dud.

    Rehearse your answer to the classic question, "Why dermatology?"; be prepared to weave that seamlessly into remarks about other issues. And when you do answer that question, provide a unique specific reason why you are interested in the field which does not involve bashing other practices like primary care. Certainly, we all fled from the torture of late-night calls begging for OxyContin refills that drive PCPs nuts, but when you scoff at the noncompliant patients in primary care, or when you say, "I just couldn't work up dizziness anymore," you come off as sounding arrogant and, worse yet, naive: Dermatology has its own scourge of noncompliant patients, and acne can get very boring.

    Also be able to communicate some of your life goals in a pithy one or two liner, and link that to how you will be giving back as a dermatologist. And this brings me to a major point: Despite what everyone thinks, you do not have to hammer home how you want to be an academic dermatologist. Over and over, interviewers have stated how they just want some honesty when they ask applicants where they see themselves in 10 years, because everyone knows that most people will go private (and specifically, many people want to go Mohs). Truly, it is *ok* if you are frank and state that you enjoy academics, but that your interest lies outside the ivory tower. But in order to answer this question well--meaning, in order to not come off looking like a money-grubbing swill, or a deluded naif--you need to truly understand what options exist in dermatology. Surprisingly, a career in dermatology can assume many permutations, from straight academics, to part-time academics, to running clinical trials in private practice, to working in public health, the military, or the Indian Health Service. Where you see yourself in ten years reflects the experience and background you bring to dermatology now, which obviously may very well change while you go through residency. Admitting that you may change your mind is alright too.

    Have a question prepared for the end of each interview. We all realize that you have likely run out of questions by the time you reach our program, but you nevertheless leave a positive psychic impression when you are able to look interested and ask a question at the end of your interview. Why? Because interviewers are human, and humans like to talk about themselves and their opinions. So even a simple question is better than no question, because saying, "I don't have any questions," risks making you look bored and disengaged (which you probably are, but why broadcast that?). Good questions include "What do you think are the strengths of this program?", and - if you're feeling edgy - "What do you think the program could improve?" (Although that may come off as confrontational, if you're not socially smooth enough.)

    Read an interview prep book, even though those are aimed at the business world. In the age of easy digital video, tape yourself answering questions posed by your friend, as you cannot underestimate how powerful performance anxiety can be in ruining your interview. Cut out the "umms," "ahhs," "likes," and "you knows," as those are annoying and make you seem insecure and immature.

    Fundamental point: Honesty is key. Do not hedge or fudge because people will compare notes and flush you out. At the same time, you don't have to compulsively show all your warts, which some people tend to do when they are under the gun. Market your strengths.

    C. Everything else about the interview day

    While you are on campus, be unfailingly polite with the staff. If you are the typical med student with blinders on that block everything else non-medical out of your life, you may not have heard of the widely-broadcast devastation one recent job hunter wrought in his life. Besides lying about interviews he didn't receive, this person also treated the administrative staff like dirt at the various firms he was applying to. (See http://dealbreaker.com/2009/10/jeffrey-chiang-will-be-receivi.php for all the gory details.) Of course, unlike this person, we know you wouldn't dare lie about or even exaggerate your achievements on ERAS (as derm is such a small world, you WILL get found out), but what about treating the staff dismissively or worse yet, downright rudely? You're tired and jetlagged, hungry and sick of making nice--it's easy to end up snapping at someone. Remember, however, the admin staff serve in many ways as gatekeepers to your goal, and they talk to faculty, residents, and the PD who will be making a final decision on your chance at their program. So be cloyingly sweet.

    During your time on campus, monitor your interaction with residents, even in the most insignificant encounters, because rest assured that even if the residents don't have a formal vote in ranking applicants, they certainly have influence. Don't discount your chitchat with residents who are not interviewing you. Even those who are just crowded around the lunch spread, and who seem solely focused on nabbing the roast beef sandwich with horseradish dressing, are attuned to how you carry yourself. If you rub them the wrong way, they *will* ensure that decisionmakers know. They're just as invested in who comes to the program as the faculty, because they will be working with you, and they want to recruit the best of the bunch, because who doesn't want to be proud of their residency program?

    General no-no's: Try to control your nervousness, because it just makes everyone around you uncomfortable. That means modulate your voice as well as the speed at which you talk. Don't babble nonstop if you sense that residents whom you're talking to are tuning you out. Don't speak badly about other applicants (yes, this has happened--probably because the poor soul thought that s/he would somehow get a leg up on others). Come across as relaxed and friendly, like someone you'd love to spend the afternoon with. Arrogance is unseemly.

    Whether emailed or hard-copies, thank-you notes are generally pointless, in my opinion, because decisions are made very soon after interviews, sometimes even on the same afternoon. Send them if you are a Miss Manners acolyte but they are dispensable. If you choose to send them, know that I've overheard some attendings criticize emailed notes as being impolite, based on their philosophy that if you're going to do a thank-you note, send a proper one. Then again, emailed thank-you's to the PD get to the recipient instantaneously, possibly soon enough to arrive within the decision-making window.
    Last edited: Nov 8, 2009
  9. DermMatch

    DermMatch

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    Rank ALL the programs you interviewed at, even if you shudder at the thought of spending three years in a godforsaken place, whatever your definition of "godforsaken" is. Don't take the risk that you'll be stuck scrambling and applying a second time around. While finalizing your rank list, don't try to second-guess the programs' intentions, either. The NRMP is set up to favor your choice. Don't ask me about the details--there are plenty of threads on SDN that explain the logical reasoning behind the match system. So just rank your programs the way your heart tells you, and leave it at that.

    No matter what the chair or PD says before match day, don't hang your hat on polite and friendly emails, unless you get a phone call expressing the program's undying love for you. Despite the apocryphal feel of these phonecall stories, they DO happen, usually for applicants who have stellar support from their department and PDs who have lobbied for them at particular places. And no, these applicants aren't always the ones with the best scores, but they are definitely the applicants who have found their way, deservedly or not, into the hearts of well-connected faculty members. (Of course, there will always be stellar applicants who receive these phonecalls who don't have those hotly sought after connections, but I contend those are few and far between.)
    Last edited: Nov 8, 2009
  10. DermMatch

    DermMatch

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    What do you do if you don't match? In recent years past, about forty percent of derm applicants have found themselves in this situation, and if you are still committed to derm, there are numerous ways to handle the aftermath.

    First, however, I hope you matched into an IM prelim internship, ideally a name-brand one. Not only do you learn more medicine in an IM year, but also you want to avoid looking lazy during your second appearance on the dog-and-pony show. In my view, nothing is worse than reapplicants who have to reveal that they are in a transitional internship, and during past match cycles, that point was specifically brought up as a mark against at least one reapplicant in casual conversation amongst residents, who were coming up with their own rank lists. No matter how unfair you think that is, there are those in the derm world who still sniff at transitional years, and you'd rather avoid being on anyone's pet peeve list as soon as they look at your ERAS.

    Certainly, some will argue that a transitional year will give you the downtime to pursue more derm research or to rotate through a derm department, and I can't disagree that this may be true. So, ultimately, you'll need to weigh what you need to do to buff up your resume for that second go-around, but keep in mind that you're being interviewed by people who see themselves as having jumped high hurdles to get to residency, one of which being a prelim internship.

    There is no need, however, to put yourself through the wards scut of a surgical prelim, even if you want to do Mohs. You won't see the light of the OR lamp as a non-surgical intern heading towards derm. And you learn everything you need to know about Mohs surgical techniques during your Mohs fellowship; when you're applying to that, they only care about what you learned during your derm residency.

    Second, you may want to consider a research fellowship in dermatology, many of which attract non-matched applicants (versus people who haven't yet entered the derm match, or derm residency graduates). Do your research wisely, because the last thing you want is a difficult mentor more interested in glory for himself and working you to the bone, instead of grooming you to successfully enter the derm match again. Although sometimes difficult to obtain, get the names of people who completed (or more tellingly, didn't complete) the fellowship you're inquiring about. People may try to stay mum because they don't want to offend, but you may be able to get the inside scoop on the fellowship, enough to make or break the deal. Research fellowships are posted here at SDN, and since there are fewer spots than applicants, move fast.

    A research fellowship doesn't even have to be one of the "official" ones. You can create a spot out of whole cloth, if you approach a particular investigator and come with your own money, either funding you've won or savings from your part-time job pumping gas in college (which of course you wisely invested and made a killing from before the stock market crashed).

    Third, with the possible exception of pediatrics, I would hesitate doing another residency, because that creates all sorts of residency funding issues for derm programs. The feds only give any trainee X number of years of funding for residency and if you use up most of it doing another residency, a derm program is not going to be able to fund you. Lots of info is available about that conundrum here on SDN; please don't ask me because I am still not clear on the details.

    Fourth, I would not break up your medical training to obtain another degree in hopes that it will help you match into derm. The time for doing that would have been before or during medical school. After medical school, if you want to be a practicing physician, you need to work on your clinical skills, which will only rot if you delay applying again to derm residency.
    Last edited: Nov 8, 2009
  11. DermMatch

    DermMatch

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    Initially, I thought I'd write about special situations, like those facing IMG/FMGs from either Caribbean, European, Israeli, or Asian schools. Or people who landed a spot outside the match, or people applying from other fields, or people who are debating whether to put off matching so they can do an MPH, MPP, MA, or other degree.

    Then I realized I was not G-d.

    So I invite people who have confronted these situations and who have matched successfully to PM me with their posts, and I can stick them onto this thread. In particular, I realize that my reapplicant section above may not be thorough enough, so I specifically welcome missives from those who successfully got into derm the second (or third, or fourth...) time around.

    Or start your own thread!
    Last edited: Nov 8, 2009
  12. DermMatch

    DermMatch

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    Since writing this guide, I haven't really received any dissenting opinions or other feedback, besides one or two thank-you's for assembling my thoughts. I do welcome other viewpoints, and would be more than happy to post your objections to anything I've written in the body of this thread so people can have a balanced overview of the dermatology match process.
    Last edited: Nov 6, 2009
  13. DermMatch

    DermMatch

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    Last edited: Nov 8, 2009
  14. N-Surge

    N-Surge Emeritus Moderator Emeritus

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    This is probably a pretty good place to start for those interested in matching into Derm.
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