to all med students interested in derm
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the following is a LONG post. i put it together for students at my home med school, and it's mostly the stuff i wished i'd had handed down to me. it may be a lot like the application guide that erin puts out (though probably less well organized and less thorough), but i just wanted to put it out there for people. again, these are my opinions, and it was rather quickly put together (probably typos in there)
lastly, PLEASE PLEASE PLEASE PLEASE PLEASE avoid the way too common question of 'what are my chances if i have AOA, research, etc?'
people will get in with low and high board scores, no research or a ton of publications, etc.
no one can quantify your chances for you. it's like patients with bad cancer that want to know how many months they'll live. you can say what probabilities are, but when you break it down for a particular individual, there is ABSOLUTELY NO WAY TO KNOW.
as silly as it sounds, the entire residency application process IS, without question, a game, especially for the more competitive fields. because of that, you want to have the most polished, strongest application you can. aside from connections, your application will be the sole determinant of whether or not you are invited for an interview.
so here it is: my advice. best of luck to you all.
(for whatever it's worth, i matched at my number one program and am incredibly grateful, relieved and excited)
Grades- sounds fickle but try to have as many honors as you can. You WILL be put in some programs? ?no? pile, solely because of sub-stellar grades. It?s the truth. It will not kill you if you have some non-honors grades, but there are people to whom this is important. Some of those people will be the reviewers of your application?
USMLE- rock step I. Some places will have cut-offs. It?s impossible to know who has what as their cut off, so do as well as you can. You do not NEED to have taken step II by the time you apply. If you did great on step I, don?t take step II until after you?ve applied. If you didn?t rock step I, take step II early and do well on that. Of course don?t count yourself out, if you don?t, but everything counts.
Letters of Recommendation- probably best to have as many dermatologist writers as possible. ? would be excellent. Big names are better than not. Someone who really knows you and will write good things is better than someone who doesn?t know you at all. I started collecting letters during 3rd year. Get as many as you want. You do not have to use them all. I always phrased the question like this: ?would you feel comfortable writing me a strong letter of recommendation?? Have your curriculum or research advisor go over your letters and rank them for you, assuming you?ve waived your right to read them.
RESEARCH- Do research in dermatology, if you?re seriously considering applying. Working with people ?known? in the field always helps. Try to have stuff published if you can; it?s always better to have something in press or published than to have a manuscript in progress. Publishing can take months even after the paper is finished. This may mean starting work on stuff during 2nd or 3rd year. Present your research at a national conference if you can. Network, get to know people. Again, don?t be a pushy weirdo, just be yourself and meet people from other places. They?ll remember you: ?oh yeah, you were the student at the meeting...'
Away rotations- Do them if you know of specific institutions you?re interested in. These are a good chance to meet other departments, see what you like, see what they?re staff are like, etc. have a meeting with the program director of that residency program and/or the chair of that department. Be yourself and see if you fit in there. Try to do one early in 4th year. This may mean applying for it at the end of 3rd year. Start looking in feb or march of 3rd year for where you might want to do it and contact those institutions/departments by march or april. They will fill very quickly. Then come back for your home rotation in August or September. This will mean that you?ve already done a month of derm, and you can know more, be more comfortable, etc at your home program. Again, this all sounds absurdly fickle, but it IS a game.
Personal statement: Write a good one. My advice: start as early as you can. Jot stuff down about yourself, defining moments, anecdotes that highlight something about you, etc. flesh these out during the course of a year, revisiting every couple of months. It?s MUCH easier this way than trying to get one done quickly in the month before they?re due, and people recognize something that has been thoughtfully polished rather than hastily reviewed and edited. Every sentence counts, be efficient in writing. Should be less than one page. Should be personal, like you?re almost uncomfortable sharing it, because it?s who you are. Share it with family members, close friends, ask them if it paints a picture of YOU.
Things to look for in a program:
General derm: time spent in clinics. Do you have continuity? Do you see your own patients. Do you have a good mix of clinics and other rotations?
Derm surgery: how much do you do? In my opinion doing surgery rotations for a month at a time is better than doing 28 days over the course of one year. It?s easier to get a better handle of concepts or procedures if you are able to repeat them many times over a concentrated time period. Is the learning hands-on, or more observational? You don?t need to be taking mohs layers as a resident. You can do fellowships if you want to do Mohs. You DO want to feel at least comfortable excising most, if not all, lesions.
Dermpath: how much dedicated time is there for this? How much is taught versus left for you to read independently. How do you learn best.
Specialty clinics: some bigger programs have specialty clinics. Like Dr. Smith is a specialist in CTCL or bullous diseases and has 3 dedicated clinics every week. This is a nice way of seeing lots of more ?difficult? patients and learning from experts in the field.
Variety of skin types: disease presents differently in different skin types. If you know you?re want to practice in miami, you want to have seen stuff on hispanic skin. If you?re going to be in North Dakota, it may be find only to have worked on white skin. But residency is a great chance to really see and learn a lot,
VA available: many institutions have VA hospitals associated with them. This is great opportunity for autonomy. Likely, you?ll be left to run clinics by yourself with an attending staff. There will lots of old white guys with skin cancer. This is a great chance for surgical experience for the residents at all the VA derm departments that I saw.
Cosmetics- some institutions don?t do much at all, but, you must face the reality that patients want more and more of this. There?s a lot of money in it and many private practices are doing lots more of it. You at least want to have had exposure to lasers, resurfacing, peels, vein stripping, etc. You can learn a lot of this, ?on the job,? though, once you?re in practice.
Department vs division of IM- not a huge deal, matters more to staff than it does to residents, though it can have something to do with the money allotted to residents: facilities, expense coverage for national meetings, textbooks, etc.
Big vs small- many programs are 2 or 3 people per year. The biggest ones are 6 or 7. Some are only 1 person per year. This is a personal choice.
Dermatology is an incredibly reading-intensive, minutia-oriented residency and specialty. You will see in everyday practice about 10% of the stuff that you need to ?know? for the derm boards. You want a place where you?re going to be able to learn lots.
Try to figure out how you learn best. From organized didactics, or from reading on your own? From staff going over kodachrome sessions, or from residents going over slides with each other.
Didactics/conferences: who teaches and organized these? Does the program have a set curriculum that is revised or is written up from scratch every year by the chief resident?
Friendly staff that you will want as your teachers: in the end, THIS is why you went to medical school, THIS is why you busted your butt in college to get to med school. You have decided that you want to be a dermatologist, and you WILL be reading/learning new things for the rest of your career but THIS is your shot at getting your formal training.
Beware of ?reputation.? This is a common pitfall, in my opinion. There are many ?big name? places with ?overworked? residents who have very little time for the tons of reading that have to be done during residency. Or who don?t really have meaningful personal interactions with their incredibly famous staff.
Finally, you want to be at the place that?s going to provide you with the best experience and the best teaching. In the end, you want the place where you?re going to learn the most and be happiest (this is an intensely personal thing, and location may be exactly the thing that makes you so happy that you?re in the right state of mind to learn from whoever?s teaching)
