PM: MD PhD question

[DermMatch]

From an MD-PhD:

I am an MD-PhD student with minimal clinical exposure.... I don't know if I want to do Derm but I don't want to exclude it and lifestyle is an important factor.

That being said, I am presently pursuing a PhD in a [IM specialty] lab and am worried that I am pigeon-holed into [that IM specialty]...i.e. my motives would be questioned. Honestly, I was never interested in [the IM specialty] and found the biochemistry very interesting. I do biochemistry type work and my work can have derm applications but..it's not derm research and won't be presented at derm conferences.

1) How can I find more about about Derm and if I can develop a passion for it?
2) During my PhD (as in now) should I be trying to find a Derm mentor? If I don't know a lick about the Practice of Derm, how can I get my foot in the door? Should I wait until I start third year?
3) How can one be a competitive candidate?
4) How does one get the attention of the Chair for a good LOR? Other places to get good LOR?

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[dermy2010]

I think the key as with any field, just as you probably did research as an undergraduate which got you to decide to do an MD/PhD, you have to shadow a dermatologist and see if you like it. I dont think it's about "developing" a passion, as you put it, but rather when you shadow you should like it naturally. If not, shadow some other fields until you find the right fit. I would def not wait until you are a third year. You are in a good position to use your extended time prior to applying to contribute to the field and show an interest. The more interest in the field you show the better off you will be... Many of us medical students take a year off and do research in order to get into Derm, this is both to do some research in the field but also to make contacts which potentially can help you. But back to the initial suggestion, you wont know if you like it unless you try it...

 

[DermMatch]

Hi -- here is a reply to the anonymous correspondent who emailed me the original post in a PM.

The person who replied mistakenly thought I was the one posing the question (I was just the messenger). His reply is very nuanced so I am taking the liberty of posting it below.

I'm sure the original PMer will appreciate the reply, and I am glad that so many residents are interested in commenting and contributing.

----------------

My story sounded much like yours so perhaps my experience can be helpful in answering some of your questions.

In summary I, too, did my graduate work in a quite non-derm-related field. I initially actually thought I might want to do Cardiology given my research but also wanted to go into the clinical years of med school with an open mind. One feature of my PhD years that helped to "steer" me was that my project required a lot of surgical prep, which I loved. Also, I ended up actually liking to do research and wanted to choose a field that would allow me to spend time with patients and with whatever my research interests ended up to be. I kept Dermatology in the back of my mind throughout grad school because I had really enjoyed the "skin" parts of the preclinical med school lectures and because I already knew that it was a specialty that might allow me to relatively more easily combine clinical and research time. Enough about me, though, let's try to answer your questions:

1) How can I find more about about Derm and if I can develop a passion for it?

My school allowed students to postpone one required rotation in favor of two electives during third year of med school. I did this and took Gen Derm and Peds Derm. I made an effort on both rotations to start working on (small) manuscripts. We're talking case reports here. I also arranged to meet with the chairman of the derm department during my Gen Derm rotation. Hence, I had NO contact with Derm until the second half of my third year of med school, which is also when I realized that Derm is what I wanted to do.

2) During my PhD (as in now) should I be trying to find a Derm mentor? If I don't know a lick about the Practice of Derm, how can I get my foot in the door? Should I wait until I start third year?

See my answer above for the answers to this. In my experience, having done the PhD work kind of cancels out some of the bright-eyed-and-bushy-tailed gunning that "regular" med students have to do to get in the Derm door. There may be relatively more MD/PhDs applying for Derm, but even so they still have an advantage in most Derm programs over "regular" med students.

3) How can one be a competitive candidate?

Board scores. Grades during third/fourth year. Dean's letter. Given that you're an MD/PhD, you should be expected to have a more prolific cv than a "regular" med student. I honestly got the sense on the interview trail that quantity of publications was more impressive than quality. Which is why I had no problem churning out several case reports during third year of med school (NONE of which were published by time interview season hit) rather than focus all my efforts on one project that may or may not be completed.

4) How does one get the attention of the Chair for a good LOR? Other places to get good LOR?

As in #1, I scheduled a meeting with the chairman during my first Derm rotation. Things may have been a bit easier at my program because the chairman also has quite a bit of interaction with students, so he subsequently worked directly with me and could speak about my clinical and my research experience with him. My LOR for derm were: my PhD mentor, the chairman, another dermatologist from my institution that is well published (and well respected in the field), and one of my attendings from my IM rotation during third year. I had absolutely no trouble with these LOR.

One other thing that I think is important for you to know: I only rarely encountered people who expressed skepticism about how I would translate my grad school work to dermatology. When asked, I simply said that I felt that the most important part of grad school wasn't the project, but learning how to DO research (how to write papers, obtain grants, formulate workable hypotheses, etc), and I felt like I got a very good foundation in that. That seemed to satisfy just about everyone.

I ended up with 17 interviews and matched at my #1 program. The PhD will help you.

 

[dermorrhea]

Hi -- here is a reply to the anonymous correspondent who emailed me the original post in a PM.

The person who replied mistakenly thought I was the one posing the question (I was just the messenger). His reply is very nuanced so I am taking the liberty of posting it below.

I'm sure the original PMer will appreciate the reply, and I am glad that so many residents are interested in commenting and contributing.

----------------

My story sounded much like yours so perhaps my experience can be helpful in answering some of your questions.

In summary I, too, did my graduate work in a quite non-derm-related field. I initially actually thought I might want to do Cardiology given my research but also wanted to go into the clinical years of med school with an open mind. One feature of my PhD years that helped to "steer" me was that my project required a lot of surgical prep, which I loved. Also, I ended up actually liking to do research and wanted to choose a field that would allow me to spend time with patients and with whatever my research interests ended up to be. I kept Dermatology in the back of my mind throughout grad school because I had really enjoyed the "skin" parts of the preclinical med school lectures and because I already knew that it was a specialty that might allow me to relatively more easily combine clinical and research time. Enough about me, though, let's try to answer your questions:

1) How can I find more about about Derm and if I can develop a passion for it?

My school allowed students to postpone one required rotation in favor of two electives during third year of med school. I did this and took Gen Derm and Peds Derm. I made an effort on both rotations to start working on (small) manuscripts. We're talking case reports here. I also arranged to meet with the chairman of the derm department during my Gen Derm rotation. Hence, I had NO contact with Derm until the second half of my third year of med school, which is also when I realized that Derm is what I wanted to do.

2) During my PhD (as in now) should I be trying to find a Derm mentor? If I don't know a lick about the Practice of Derm, how can I get my foot in the door? Should I wait until I start third year?

See my answer above for the answers to this. In my experience, having done the PhD work kind of cancels out some of the bright-eyed-and-bushy-tailed gunning that "regular" med students have to do to get in the Derm door. There may be relatively more MD/PhDs applying for Derm, but even so they still have an advantage in most Derm programs over "regular" med students.

3) How can one be a competitive candidate?

Board scores. Grades during third/fourth year. Dean's letter. Given that you're an MD/PhD, you should be expected to have a more prolific cv than a "regular" med student. I honestly got the sense on the interview trail that quantity of publications was more impressive than quality. Which is why I had no problem churning out several case reports during third year of med school (NONE of which were published by time interview season hit) rather than focus all my efforts on one project that may or may not be completed.

4) How does one get the attention of the Chair for a good LOR? Other places to get good LOR?

As in #1, I scheduled a meeting with the chairman during my first Derm rotation. Things may have been a bit easier at my program because the chairman also has quite a bit of interaction with students, so he subsequently worked directly with me and could speak about my clinical and my research experience with him. My LOR for derm were: my PhD mentor, the chairman, another dermatologist from my institution that is well published (and well respected in the field), and one of my attendings from my IM rotation during third year. I had absolutely no trouble with these LOR.

One other thing that I think is important for you to know: I only rarely encountered people who expressed skepticism about how I would translate my grad school work to dermatology. When asked, I simply said that I felt that the most important part of grad school wasn't the project, but learning how to DO research (how to write papers, obtain grants, formulate workable hypotheses, etc), and I felt like I got a very good foundation in that. That seemed to satisfy just about everyone.

I ended up with 17 interviews and matched at my #1 program. The PhD will help you.

I hope that was helpful to the OP. But, although well-intentioned, I find this anonymous responder's comments to be bothersome and I wanted to get someone else's take. After much contemplation, I decided to fowarded this post to a colleague of mine, who provided his own thoughts on the subject:

"Wow. How profound. I find this person's response to be somewhat arrogant and exemplifies the prototypical malignant personality that is rampant within the field of derm. Plus it sounds like enjoying "skin" was a very minor aspect of his/her decision to go into derm. Fishy.

Earning a PhD is a very respectable endeavor and there's nothing wrong with being passionate about scientific discovery and the advancement of medicine. Derm is an extraordinarily academic field. However, I take issue with this responder for a couple of reasons. For one, I think dermatology programs differ across the board in terms of what they value in a candidate. Some appeal to candidates with the potential to make great academic contributions, while others have quite different objectives. It is really dependent on the program. For instance, there are needs as equally great for those willing to make contributions in caring for the underserved, or finding solutions that will improve access to dermatological care.

While obtaining a PhD is certainly an accomplishment, it does not in it's own right, give you an automatic advantage over a "regular" medical student. There are plenty of "regular" MDs contributing to research in highly respectable ways and plenty of "regular" med students who have demonstrated their commitment in this area. There are also just as many PhDs who leave academics to pursue private practice. The bottom line is, it's this type of attitude that undermines the significance of even earning a PhD and perpetuates misguided reasons for doing so.

It makes sense that academic institutions wanting to stay "cutting-edge" would seek those they can groom into their next generation of research work-horses. While they cannot force anyone to make career-altering decisions along those lines, I think it is reasonable they would hope these candidates would choose a career in academics, even if it entails less than appealing compensation in the long run. So yes, maybe your chances are better. But be honest with yourself and others about why you would choose this path. Make sure it's not just to ensure that your application gets put in the "keeper" pile.

Just be careful that you don't view that extra title after your name as a mark of superiority over some "regular" med student, apparently viewed by the responder as some brown-nosing gunner, desperate to claw their way into derm. That med student may have put in years of genuine effort getting to know what derm is like. Don't expect to roll up on scene fashionably late and snatch away that highly coveted derm spot just because you can whip out the PhD card from your back pocket. The bottom line is, if you've spent years researching a non-derm related field and did little to demonstrate your true devotion to derm, it's gonna be hard to convince people otherwise. And for the aforementioned reasons, unless you have honed your skills in the art of deception, don't be surprised if others cringe at your canned response of enjoying the "process" of research. People aren't stupid and you will have to do better than that. If you think getting the PhD is your big ticket in, my guess is, you're next step after matching will be getting all your ducks in a row to open your own lucrative cosmetic derm private practice.

Don't do a PhD and/or enter derm for the wrong reasons. Do it because you actually like it. And if you truly love derm, you'll probably end up pouring all your sweat and blood into a derm project anyway."

Ok...So I just wanted to offer another perspective from someone whose opinion I value highly. I am in no way endorsing his thoughts on the matter, but I thought I'd at least share what he had to say!

 

[dermathalon]

Ok, so fair or unfair, a PhD does help your overall chances to match. I totally agree that there are so many more facets to a derm application and a derm applicant than just the degree and it surely is annoying to have some join the party late and still get an advantage in matching. On the other hand, some people really do decide late and part of this is because there is so little derm exposure in the general medical school. Sure, individual programs will look for certain other things, but in the overall scheme, a PhD tends to get more interviews and the PhD can trump a bad step 1 score. Do you need to have a PhD to understand how to do research? Absolutely not...and I have met PhDs that rode the coattails of their advisors and are not talented at independently asking good, testable questions. However, programs are also not so smart to know the difference as I've seen them simply count publications time and time again.

During this interview season, I tried to see how the PhD interviewees had thought ahead . It's fascinating because many don't talk about how they would pursue funding down the line or how they would choose their mentor (both are highly important for serious academicians). There was only one person who mentioned K awards, R awards, industry funding, etc....just a digression but I wanted to point it out.

To the OP: The first respondant was a little arrogant to write down that PhD work cancels out the "bright eyed bushy tailed" gunning efforts of a "regular" medical student...we "regular" med students do alright too when committed to our passions. For perspective, with a few exceptions, almost everyone that I know that has gotten up into the 25 to 30+ interview category happened to be a "regular" (non-PhD) med student, myself included, that showed years of commitment. In some institutions, commitment is not such a big deal and you will have the advantage at these places. In fact, some of the "regular" medical students had better publications, asked better questions, and conveyed a thought out plan for research much better...so don't think that a PhD give you an absolute edge in research...it does not. If you are using your PhD to get into derm, so be it and the PhD will be an advantage but not across the board. Finally, don't wait until third year to make the connections if you already are thinking about derm. The sooner you make them, the better off you will be.