Exclusive Series: A Student’s Guide to Matching into Dermatology Part 1

[To read part 2 of this exclusive series Student's Guide to Matching into Dermatology, click here.]

As I neared the end of my junior clerkships, I still had not decided on what field of medicine to pursue. I entered every rotation with an open mind to learn as much possible regarding the different fields and although exciting, none quite fit what I was looking for in my profession.      

With that, I signed up for a dermatology research elective at an away rotation and immediately realized my strong interest with the field. I was aware of the competitive nature of dermatology very early in medical school and its reputation for being nearly impossible to match into. In addition to all the match statistics working against me, I had to quickly build on my application, figure out what rotations to take and if I even had a chance at matching into a residency. 

Through this process, I became very interested in knowing how important the different aspects of a student’s application (eg, grades, research, Alpha Omega Alpha [AOA] membership] are when applying for dermatology. 

I also wanted to hear from previous alumni who had undertaken this endeavor. However, contacting these successful predecessors can be difficult. Additionally, even if you were able to get in touch with them, the information would usually be limited to a single phone conversation or email. The purpose of this guide is to better inform those who are interested in dermatology and answer the most commonly asked questions. By doing this, I hope to alleviate some anxiety about applying for dermatology in addition to providing some strategy in organizing your final application. 

It is not a mystery that the match rate into dermatology is one of the lowest in medicine. Some of the factors that will help you match are under your control, such as grades, United States Medical Licensing Examination (USMLE) Step 1 score, research and extracurricular activities (ECAs). Other factors are out of your control, such as AOA membership, competitiveness of the field, connections and the lack of dermatology department at some schools. Remember that even the most qualified applicants go unmatched every year. Conversely, those that are considered “less qualified” (as compared to the “average” dermatology applicant) will match. Your job as a student is to try to control for as many of the “controllable” factors as you can. 

If you fail to match the first round, you will at least know you were prepared. This should not deter you from pursuing dermatology, however. Instead, reorganize your strategy and begin to focus on the next year’s application cycle.

This guide is divided into categories that are of high importance and are also frequently asked about by students (See Table). 

[To read part 2 of this exclusive series Student's Guide to Matching into Dermatology, click here.]

It is designed to give some order to applying for the dermatology match and to help you make some significant decisions in your upcoming years. This guide is also intended to help increase the number of interviews you are offered. Simply put, the more interviews you get, the higher your chances of matching. It will not focus on the actual interview or post-interview period. However, once you have been offered an interview, what happens during your visit to the institution becomes very important. Be prepared and it will all payoff.

Grades

Medical schools have different ways of evaluating students as they progress through their education. Some universities use the grading system while others are on the pass/high pass/honors system. 

However, grades in different stages of medical school are important for different reasons. One common factor is that regardless of the academic year (M1, M2, M3 or M4) all of your grades are important and the better you do, the more opportunities you will make available for yourself come interview season.

Regarding your basic science years, it is critical to master all of your courses. The reason for this is multifold. First, the scope of dermatology includes a vast array of systemic disorders that manifest on the skin. Additionally, the usage of systemic therapeutics for the treatment of dermatologic pathology is very common. Therefore, to be a successful dermatologist, one must have a strong understanding of the basic sciences including physiology, pathology and pharmacology. 

This should be the motivation for successful completion of the first 2 years of medical school; a desire to master the sciences to be the best possible physician and dermatologist. However, there are additional key driving forces. First, hard work and determination will increase your chances to score high on the USMLE Step 1, a factor considered when reviewing applications. USMLE Step 1 is not by any means a test that is crammed for. Rather, it is a test you begin studying for the first day you start medical school and a test you review for weeks before you take it. 

Second, a solid academic start will surely pave the way for your recognition in academic excellence. There are 2 national honor societies established in most medical schools, AOA and Gold Humanism Honor Society (GHHS). Whereas GHHS recognizes students who foster the values and behaviors that reflect humanism, AOAs main focus is on academic accomplishment. One of many criteria for induction into AOA is performance in the basic science courses. Therefore, getting a head start in medical school can help facilitate your recognition in high academic achievement, acting as one factor that will set you apart from other applicants. More on AOA and how members are inducted into the honor society will be discussed in part 2 of this series.

By now you have invested 2 solid years of your life to medicine and for that, congratulations. Now what? Although basic science grades are very important, it is critical to be successful in your junior clerkships. This is because your junior clerkship evaluations will serve as the initial indication to programs of how you will be as a resident/colleague. Keep in mind that if you are fortunate enough to be offered an interview, it is then your personality that the programs are most interested in. Dermatology is a small field with programs that can be as small as 6 residents. Therefore, it is important for programs to be able to pick residents that they feel they can get along with and tolerate for the duration of their residency training. Scoring big points on your clerkship evaluations will have an immense effect on programs and eventually your rank on their list. This is especially true for your Internal Medicine Clerkship. Therefore, keep an open mind in your third year. Even if you are set on dermatology from the start, approach every rotation with optimism and treat everyone on the healthcare team with respect as they will eventually have a say in your evaluation. Your evaluations will then be made available as part of your Medical Student Performance Evaluation for all programs to read. Selection committees will not favor negative comments by residents and/or attendings. 

In your fourth year, make sure to do well on your dermatology rotations. Because these externships will be done early, your grades will appear on your transcript. A poor evaluation can be detrimental. Fortunately, dermatology programs you rotate at understand how detrimental a poor evaluation can be to your chances of matching and as long as you work hard, you will most likely honor the rotation. The remainder of your fourth year grades will not likely be included in your application, as these rotations will be completed near or after the Electronic Residency Application Service submission deadline.

Research

The answer to the amount and type of research that needs to be completed by application time can be a whole book in itself. Overall, get involved in any way you can while enjoying your experience. Research should be done to gain an experience and a foundation of knowledge that is otherwise not afforded to you by merely reading textbooks. Involvement in one purposeful research project for many years usually carries more weight than multiple small projects that lack long-term commitment. If you are certain in your decision to pursue dermatology, then a dermatology-associated project can be beneficial. However, what is more important is that a commitment to the advancement of scientific knowledge in any field shows dedication and determination and is viewed favorably by programs.

Many research opportunities exist. In my case, I chose a principal investigator based on his easy approachability. I did not know much about his ongoing projects, but this person seemed  personable and I felt that I would be comfortable working with him. This research (non-dermatologic) opened up many opportunities for me. For instance, I received the opportunity to have a paid trip to Oregon Health & Sciences University to learn a micro-surgical procedure, which I then introduced to our university. The research also won a Summer Research Symposium and a poster was presented at the 38th Annual BioMidwest Research Symposium. In addition, it gave me the opportunity to work towards an “MD with Distinction in Research,” an honor awarded at my university for excellence in research. All of these opportunities were big hits during my dermatology interviews.

You might be asking yourself, but how important is research? It is my understanding that a committed period of time to research is strongly favored by dermatology programs. However, keep in mind that this mode of thinking is not unique to dermatology programs. Almost all fields favor students who show an interest in academia. However, not all fields can be overly selective about who they recruit. In competitive fields where specialties can choose who they desire, they will lean toward students who have shown a true interest in academics, merely because they can.

The research holds more weight if a manuscript was published. This indicates that the project came to a meaningful conclusion and it was decided that publishing it would further the knowledge of physicians who read the paper. Although being an author on any published manuscript is considered important, being first author shows that most of the work and writing came from you. Therefore, first author publications hold more weight. This is, of course, comparing 2 papers of equal weight. For example, first author on a case report does not hold more weight than third author on a major paper published in the New England Journal of Medicine.

Another common issue is when students say they became interested in dermatology very late and feel there is no way of getting any substantial projects completed by application time. This is a concern that I had for myself as well. Although I had 2 years of research at my university, I had not participated in any dermatology-related projects. Initially, I felt like I was at a dead-end road. I had no meaningful dermatology related papers and this would pose as a problem. 

Do not allow yourself to fall into this trap. Research electives are available to fourth year students, and if you are determined you can get effective work done in a short amount of time. Look for research electives at the beginning of your fourth year. If you think 1 research elective is not enough, take 2. Extra research electives will give you ample time to complete meaningful work, which will be favorable to programs. 

If all else fails, taking time off between third and fourth year to do a meaningful year of research can be beneficial. This is a personal choice, however, and one that must be made after weighing the risks versus benefits. Some program directors  I have spoken to do not feel an extra year of research can add much to an applicant’s curriculum vitae, while others feel it is important. I feel that taking a year off to do meaningful research can never hurt, and I have heard of people increasing the number of interviews they were offered by doing a year of research after failing to match their first attempt. 

Extracurricular Activities

The best ECAs are those that provide you the opportunity to take on leadership positions. To my surprise, this topic was not heavily emphasized at my interviews. However, avoid making 2 assumptions from the previous statement: 

1. ECAs are not important and can be avoided 

2. ECAs were not discussed during interviews 

ECAs can help set you apart from other applicants. Just because the interviewer did not praise your ECAs does not mean they were not noticed or appreciated. Also, because interviewers did not mention my ECAs as often as I expected, it does not mean that they were not discussed during conversations. Interviewers will always give you an opportunity to discuss highlights of your time in medical school. This is an opportunity to pick your favorite ECAs to bring out your best features. 

For example, an interviewer may ask you to list your strengths and weaknesses. You can answer this question by listing your strengths and weaknesses and then give an example of an ECA that allowed you to build on a strength or an ECA that helped you notice and correct a weakness.

Again, leadership and teaching positions are always noticed. Find projects early and stay committed.

Part 2 in this series will discuss USMLE scores, AOA membership, curriculum vitae and away rotations, in next issue of The Dermatologist

Dr. Kosari received his Bachelor of Science degree in biology from the University of California, Los Angeles, before earning his medical degree from the Chicago Medical School. He completed his internship at Cedars-Sinai Medical Center and relocated to North Carolina for his dermatology residency at Wake Forest Baptist Health. Currently, Dr. Kosari resides in Charlotte, North Carolina where he practices general dermatology. 

Disclosure: The author reports no relevant financial relationships.