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Mar 24

Written by: DIGA Blogger
3/24/2017 10:39 PM  RssIcon

Hi everyone! I am a 4th-year medical student who has successfully matched into dermatology (woo!). I wanted to share my experience with the daunting process of applying to a dermatology residency in hopes that it will help answer your questions and alleviate some stress. I encourage you to speak to as many people who have gone through this process as possible, as the experience and opinions will vary from person to person. I will split this blog post up into five parts:
1) Research year
2) Away Rotations
3) Application
4) Interview Trail
5) Post-interview communication

Research Year

I decided on dermatology in the middle of my third year. I had no research and a pretty average Step 1 score for derm, so I chose to pursue a research year to enhance my competitiveness. Since I had no experience in basic science research, I sought out clinical research opportunities (DIGA lists a bunch of research opportunities on www.derminterest.org). The advantage of clinical research is that it allows you to be quite productive in terms of publications. Much of my research was survey based, conducted in a relatively short period of time, and publishable as a short research “letter.” On your application, no one will know whether your publication was 150 words or 1,500 words, so keep that in mind. I chose to do research at an institution with a residency program, where I knew I would be able to get to know the residents and attendings. This was definitely a strategic move that paid off for me in that I was able to form strong relationships with the residents and faculty. However, it also may be helpful to work with a “big name” in dermatology, especially if that person will write you a strong letter. Weigh the pros and cons of your research opportunities to see what makes the most sense for you.

In terms of research, I often asked myself, “Which is more important – quality or quantity?” My mentor told me that quality is more important, and I think this is true to some extent. However, I was able to publish or submit 15 articles/book chapters (13 from my research year alone), and interviewers were very impressed with my productivity. I did a variety of research – original studies, retrospective database reviews, and case reports. I also jumped on some other studies that attendings or residents needed help finishing. A mix of research is better than just churning out case reports in my opinion. Journal name also makes a difference, so if you can get at least one or two publications in a reputable journal, that is ideal.

Of note, ERAS only allows you to input research that is “submitted” or “in press.” There is no option for “manuscript in preparation,” although you can list articles in the description of your research year. Interviewers may not care about articles in preparation, but it does show that you are actively working on papers. And in at least one interview, I was asked about an article that I had listed as “in preparation” because of an interest that interviewer had. By application time, I had 5 articles “in-press” and 2 book chapters published (from my 3rd year). All other articles were “submitted.”

In summary, I would recommend clinical research as the most efficient way to get a lot of research publications. Of course, basic science research is also extremely valuable and well respected. It is understood that projects take longer to complete. While there is no “magic number” of published articles, I would definitely recommend having more than 3 publications to give yourself the best shot in the match.

Away Rotations

Away rotations are an absolute must when applying to dermatology. Developing personal relationships with residents and attendings is probably one of the most important things you can do to enhance your chances of matching. In fact, statistically speaking, you have a much higher chance at matching into your home program, or a program at which you did an away rotation or research. At the end of the day, you can have a stellar application and board scores, but if the program doesn’t feel that they can work closely with you for three years, they aren’t going to take you.

How many away rotations should you do and for how long? I would recommend at LEAST two, and more if possible. I would also recommend 4-week rotations over 2-week rotations so you can really get to know people. However, two weeks at a program is better than nothing.

A note on geography: some people think it is strategic to do away rotations in different geographical locations to have a better shot at getting interviews in that region. You will see when you apply that this process is very geographically based and you will most likely get the majority of your interviews in the area in which you completed medical school or in your hometown. Programs are not informed of where you completed away rotations, so the only way to “show” them is if you get a letter of recommendation from the Program Director of the program at which you rotated. You can also discuss your desired geographic location in your personal statement if you are hoping to be in a specific area.

When applying to aways, you can apply to multiple programs during one time slot, and to the same program over multiple time slots. In my opinion, it is not a big deal if you have to “turn down” a program that offered you an away. Program coordinators receive tons of away applicants and aren’t going to keep a running list of the names of students who turned them down. They are just doing their best to schedule as many people as they can. My other advice is to reach out to residency coordinators at programs where you know you definitely want to do an away early on, even before VSAS opens. This gives you an opportunity to establish contact, express your interest, and have some potential leverage if you are having trouble scheduling or being accepted into an away. I’ve also heard of mentors calling on behalf of their students to try to get them into an away rotation. Don’t be shy about using your connections if you have any. A lot of people are doing it.  And don’t forget that some programs offer away rotations outside of VSAS (check back on www.derminterest.org for a list of these programs).

My advice for away rotations is the same advice you receive before you start your third year: be yourself, be HELPFUL, don’t be annoying (i.e. ask questions when the resident is clearly very busy), don’t answer questions that are posed to a resident (even if you know the answer), work well with the other medical students on the rotation (i.e. don’t be an obnoxious gunner). In dermatology, people don’t expect you to know very much, which is great. It is obviously helpful to read and study, and the amount expected of you may depend on the program, but overall, your job is to be helpful, ask appropriate questions at the right time, try to learn as much as you can, and get to know the residents and attendings.

During away rotations, you may hear from residents about who you need to “impress.” Typically, programs give the first year or third year residents some amount of “say” about the candidates. Different programs place different weights on this. Make sure to give yourself enough opportunities to work with the people you need to so that they can get to know you.

Thank you letters at the end of a rotation are not necessary but don’t hurt. I would recommend keeping a log of interesting patient encounters and general impressions about the program. This will come in handy during interviews (some people may ask you about a patient who made an impact on you, for example), for thank you notes, and just to remember how you felt about the program.

Applications

Personal Statement. The application in ERAS really isn’t that bad. You can finish it in a few hours. The personal statement is the part that takes the longest amount of time, so do NOT wait until the last minute for this. It will go through multiple renditions and takes time to evolve. Have your family, friends, mentors, and advisors read it and give you their input. However, it is important to stay true to yourself and tell your story in YOUR voice. You need to feel that your personal statement sounds like you and represents you. You want to be proud of it.

The personal statement is the first opportunity you have to share your “story.” If you don’t have one, create one. You will tell this “story” over and over again on the interview trail. Whether it’s about a patient that made you go into dermatology, a personal experience, a family member or friend, you need to be able to explain why you are passionate about the field.

As for the style, it is typically recommended that you write pretty conservatively. If you are a good writer, you can add a little bit of flair. For example, my first paragraph was a brief colorful description discussing the process of painting and the difficulty of creating skin color with paint. I was told it was a little risky, but it is an important part of my story and so I went for it. After your intro, you want to answer the question “Why am I passionate about dermatology?”

Overall, I wasn’t asked about my personal statement very often unless it resonated with someone. I think that generally speaking, if it’s “strange,” it will be a red flag and if it’s “normal,” that’s what you want. A “spectacular” personal statement is just icing on the cake. It doesn’t need to be spectacular. It just needs to be honest, well organized, and well written.

A note about personalizing personal statements for programs: you can do this if you choose to, but it’s not necessary. It might come in handy if you have strong ties to a particular location and want to be there for residency, etc. For the prelim/TY personal statement, you can keep your personal statement the same and simply add a brief paragraph at the end discussing your desire to build a “strong foundation” in medicine.

A final piece of advice for applications: make sure you can confidently speak about every single thing on your CV. And take the hobby portion seriously! This is important. Hobbies come up ALL the time in interviews. If you write “photography” because you like to take pictures on your Iphone and are asked about it by an attending with a sincere interest in this subject, that interview might not go well… be honest.

Letters of Recommendation. For prelim and transitional years, you will need at least one LOR from a medicine/peds/surgery attending. In addition to your medicine letter, you can also assign dermatology LORs to your prelim/TY application. For dermatology programs, applicants typically assign up to 4 (max) letters from dermatology attendings. I used 2 letters from my research year, and one letter each from the chair and program director at my home institution.

Interview Trail

This is the fun part! It’s a very social and exhausting time, but have fun with it and just try to enjoy the experience. You will meet great people that you will see over and over again for the rest of your career.

Also, if you don’t get an interview at a place that you really want, I would recommend writing a heartfelt letter to the program director about 2 weeks after you know interviews were offered (and copy the residency coordinator). It may not work, but it's not going to hurt. Same goes for prelim programs (this usually works).

Most programs will host a pre-interview dinner or happy hour. They’ll either be at a bar, restaurant, or a resident’s house. This is a great time to get to know the residents, pick their brain about the program, and get some inside scoop about interview day. I would highly recommend going to as many of these as you can, although sometimes travel plans don’t allow for it. Attendings often ask if you were able to make it to the dinner the night before, and it’s always good to be able to say, “Yes! It was really fun. The residents were so helpful and nice, blah blah.”

Here’s how interview day typically works: You arrive early in the morning, listen to a program overview/welcome from the chair and program director, and then start interviews. Sometimes they break applicants up into two groups and half of you start with a tour. You’ll typically interview with most of the faculty, and can have up to ten interviews at some places. Most of the time you’ll meet with two people at a time. Interviews are usually ten minutes long and you have breaks periodically throughout the day. When you’re not interviewing, you hang out with the other applicants and the residents and have time to ask them questions. Most interview days end by 3 or 4pm.

Before my first interview, I literally did research on every single faculty member – their research interests, publications, etc. It’s good to have a sense of who people are and what they do (director of inpatient medicine, dermpath, etc), but don’t go crazy looking up everyone’s research unless you share a background in a particular topic. By the end of interview season, I just glanced at the program website before interview day, but that was it. You’ll find that many program websites tend not to have much information anyway, and that you get most of your information about the program and the faculty during interview day.

Here is a list of questions that I was asked, on repeat:

Tell me about yourself.

For this question, I would outline where you grew up, a bit about your family structure (doctors in the family? One of 6 kids? Do you have a twin?), where you went to college and what you studied, any gap years/research years and what you did, and you could maybe veer off into why you chose to be a doctor and go into dermatology. This question basically gives them ways to connect with you (“Oh, you grew up in Timbuktu?? You went to X college?? Me too!”).

Why dermatology?

This is where you start to tell your story that will hopefully echo your personal statement. I talked about my art background and how I am a visual learner who loves to use my hands (fine motor skills for procedures, etc), and about my personal history of hair loss. The more personal you can get, the better.

What do you like to do in your free time? Or, “You have some interesting hobbies! Tell me more about ____.”

Be honest. Talk about what you like to do. I gauged my audience here and would emphasize things I thought the person would relate to. For young attendings, I would say, “When I have a free weekend, for example, I love to make time for my friends and family, try new restaurants or go to an exhibit, see a movie, etc.” This usually leads to “What exhibit/movie/book have you read lately?” which makes for a more fun, casual conversation. With older attendings, I would stick to the classics: art, theater. For jockey Mohs surgeons, I would talk about running and yoga. Read your audience and try to connect.

If you had to do something that wasn’t dermatology, what would it be?

It’s an annoying question. I usually answered “internal medicine,” but you could really say anything as long as you can explain why. “Pathology because it's also a visual diagnosis, etc.” “Teacher” is another good answer or “health care policy” if you have an interest in that sort of thing.

What would you do if you don’t match?

Just be honest. I said I would do more research because I loved it and dermatology is really the only thing I can picture myself being happy doing for the rest of my life.

Where do you see yourself in 5, 10 years?

Academic medicine is always the right answer and cosmetics is always the wrong answer. You can say private practice if that’s what you really want. I covered all my bases – I would say that I want to have a foot in academic medicine (teaching residents, etc), but also picture myself doing clinical research as well as obviously seeing patients. I have an interest in hair loss so I emphasized that.

What do you want us to know about you that is not on your application? What do you want us to remember about you?

These are hard questions but similar to “what are your strengths?” Try to focus on things that you bring to the table. It’s helpful to put yourself in the program director’s shoes- what are they looking for in a resident? They are looking for someone who works hard, is a team player, takes initiative, will go above and beyond what is required of them to do the right thing for a patient, has leadership attributes, loves to teach, wants to contribute to the growth and strengths of a program…

Behavioral questions: What would you do if a co-resident was doing less work than you? Tell me about a time you had a conflict and what you did to resolve it? Tell me about a time when telling the truth hurt you? Tell me about a time you had to overcome an obstacle? Tell me about a time you worked well with a team? Strengths? Weaknesses?

These questions can also be difficult as you need to come up with examples on the spot. Do your best. It’s not a big deal if you stumble on some of these. Prepare for strengths and weaknesses.

Research-based questions: know your research and be able to explain it in a couple of sentences.

Do you have any questions?

You will get this question with every single interview, without fail, so it’s always good to have a list. Try to tailor questions to your audience:

Program director: What changes are you hoping to make in the next few years? What do you think are the strengths/weaknesses of the program? Mentorship opportunities? Medical student teaching/etc?

Dermpath: Can you tell me more about the dermpath curriculum? Is there an internal dermpath lab? Is there an opportunity to read slides from biopsies you’ve done?

Surgery: How early on do residents get hands on training/autonomy/etc?

Peds: What are the peds clinics/rotations like?

Anyone: What research opportunities exist for residents? What do you like about working here? What do you like about living in ____? What’s your favorite part of your job?

Residents: Who runs didactics? What is call like? What is a typical day/week like? Strengths/weaknesses of the program?

Other: it’s always good to have a simple clean joke ready and a book that you’ve read lately.

Post-Interview Communication

Thank you notes. Try to send thank you notes within a week (two max) of your interview. I started out handwriting my notes, but quickly transitioned to emails. The benefit of emailing is that sometimes you may get some feedback: “We really enjoyed meeting you! Etc”. If an interviewer brings up a research paper of yours that they liked, always offer to send it to them.

It’s a good idea to jot down things you talked about with each faculty member to make your thank you notes a bit more personal. I kept an excel document where I would write down program impressions/information and keep notes about my various conversations.

Some programs don’t want you to send thank you notes, so it’s always a good idea to ask the residency coordinator whether they accept thank you notes and in what form (physical letters or emails). I didn’t send residents thank you notes even if they interviewed me, but you certainly can.

Letter of intent. As you get closer to the rank list due date, it’s a good idea to send a letter of intent to your top few programs. Only tell ONE program that they are your number one. For the others, you can say “I wanted to inform you that I’ve ranked you at the top of my list.” Be sure to use meaningful examples about what you liked about the program. This could also be the time to provide updates on papers that have been published since your interview, or presentations that you’ve given. Sometimes you get a response, sometimes you don’t. But at least at this point, you know you’ve done everything you can.

Hopefully this very long post has been useful. I wish you the best of luck in this process. Remember to have fun with it, and be yourself above all else! Also head to www.derminterest.org for more information about various opportunities and how to get involved. Leadership is always good!

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