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Underrepresented in Medicine Specific FAQsDIGA Mentorship Program is delighted to have compiled an FAQ specific to UIM dermatology residency applicants. UIM Resident (Dr. D) : Dr. Diego Dasilva, Dermatology Resident (PGY3) at the University of PennsylvaniaUIM Program Director (Dr. L): Dr. Janiene Luke, Program Director at Loma Linda DermatologyComments, Questions, or Suggestions? Please email sveerabagu@tulane.eduWhat is a competitive step 1 score to match into dermatology?Dr. D: Traditionally 250+ is the target because based on matching data from NRMP you see over 95% of applicants in this score range matching in Dermatology. However, the average step 1 score of matched URM applicants is lower which I believe shows a shift to a more holistic evaluation taking into account background/obstacles overcome, community involvement, research, teaching roles, etc. instead of just scores. Nonetheless, it is best to get above a 230 because many programs screen applicants out with a score lower than this and do not review the entire application.Dr. L: If an applicant scores 250 or above on Step 1, that is excellent. Most people who get 220-240 are in a range that would be acceptable to most programs. Traditionally, the concern was to select residents whom we felt confident would pass their dermatology boards (and why a lot of programs heavily relied on exam scores to begin with) but most first-time test takers graduating from US dermatology residencies will pass, so it is variable how much weight programs will put on the actual score. For students who score in the 200-220 range on Step 1- they should try to show improvement on step 2. For those below 200 or who have failed, they should definitely demonstrate improvement on Step 2. For those who have failed the test multiple times, there may be a learning or test taking issue and students should investigate whether or not that is the case. If students are concerned about their scores, they should also understand that there are other methods of demonstrating academic excellence as well such as preclinical performance and performance on clinical rotations.Currently, there is a push for more holistic review by programs across the country, however it has not yet been fully adopted. So, for some programs, scores may not be so heavily weighted and are considered part of the student’s overall application. Our program does not screen with cut-off filters, and we look at everyone’s application. Students can look at a program’s website to see if they utilize holistic review. There are a lot of reasons why someone may not have done as well as they would have liked on a board exam. For example, if your mother was diagnosed with breast cancer during this time, it would be better to mention this. Even if you think that the reason is that you did not study well, addressing this really helps. Additionally, discussing how you have improved is important as well. It is better for the applicant to address any issues in their application. If not, programs are left trying to figure out what happened. We are looking for applicants with maturity – for the example of not studying well or enough, we would like to see if you can accept responsibility for your mistakes. Are you willing to improve and take feedback or are you going to blame others? As a resident you are bound to make mistakes, so we want to see how you handle these types of situations. How should we approach applying to programs that have very few (if any) UIM residents as part of their program?Dr. D: I think it is still worth applying if you like the program (mission, location, patient population, etc.) because there is increasing emphasis on diversity in Dermatology and many programs may be seeking to match URM applicants even if they have not done so recently. I think it is perfectly reasonable to ask your interviewers if the program has a diversity committee or task force to get an idea of their dedication to increasing representation. If they do not have one or seem to not care much, then the program may not be a great fit for you. For programs with only one or two URM residents it is always helpful to reach out to them and ask about their experience in residency. Dr. L: If you are interested in the program, it is still worthwhile to apply even if there are not a lot of URMs. Just because a certain program does not have many URM residents does not mean they are not supportive of URMs in their program. There are many reasons why a program may not have many URM residents. Derm is already highly competitive given the relatively small number of openings compared to the number of applicants. The pool of URM applicants tends to be smaller as well, so many programs are often vying for the same applicants. Alternatively, some applicants prefer matching in certain geographic locations and that can affect which program they ultimately rank and match to. My advice is to check the program’s website as some have statements specifically on diversity/inclusion. These are the programs you, as an URM, may want to target. The AAD has the diversity champion initiative, which you may want to look into as well (). Many programs have committed to increase the amount of URM residents that they have more formally through this initiative.The AAD has diversity conferences, as well. Doing a bit of digging will help URM students find programs best suited for their needs. I did my residency in NYC. My Program Director was an older white gentleman, and while he was not a person of color, he supported me, my co-residents, and was a great mentor. Allyship, found in those individuals who may not identify as URMs but still show their support, is important. Allies lobby actively to support diversity in dermatology. The reality is there are not a lot of URMs in academic medicine which further compounds the situation. Looking for allies and getting a sense of what the program values is helpful in these instances.How do you approach being the only person of color in the room? Dr. L: It is often difficult being the only person of color, and it can be overwhelming because you sometimes feel the weight of being viewed as the representative of whatever race/group you are from. Continue to remember why you want to be a dermatologist. It is better to consider yourself a trailblazer – paving the way so that more people of color will want to come after you. I am the only African American faculty member in my dermatology department, but overall, we are diverse group as I have Latinx, Middle Eastern, Indian, and Asian colleagues. It can feel like a huge burden at times, but releasing yourself from being the representative of your race/group can help. Finding allyship in your co-residents and co-faculty, in the future, will help as well. Your presence in your program is powerful and patients are often very excited to see you. Some patients have specifically sought me out because I am African American. Overall: Be comfortable standing firm and knowing you belong. For URM/UIM's WITHOUT a home dermatology program: How did you navigate this throughout your time in medical school? How did you highlight this difficulty on your residency application?Dr. D: I did not personally deal with this, but I have mentored students coming from medical schools without dermatology departments. The successful ones often work hard to seek opportunities at larger academic centers – trying to do 2-3 away rotations (these days will likely be virtual) and get involved in research projects. Leveraging contacts/colleagues at medical schools with dermatology programs is helpful but even if you don’t personally know someone then reaching out to program directors and explaining your situation and desire to get involved goes along way. I would certainly write about this in the personal statement or at the least emphasize it in your interviews – it is always beneficial to talk about obstacles you’ve overcome, and this definitely qualifies. Dr. L: The Skin of Color Society has a diversity in action worksheet which contains information on what to do each year during medical school (linked below) . Get acquainted with faculty from nearby programs that may allow you to zoom into the program’s didactics/grand rounds or participate in journal club. The AAD also has a Diversity Mentorship Program where you can be paired with a mentor/Skin of Color expert. I recommend M3s and M4s look into that program. For M1s and M2s, doing a summer project after MS1 year is great. Case reports or anything you can contribute while you have more time during your MS1 and MS2 years are also valuable. M3s and M4s should focus on doing well in clinical rotations and working with their mentors. Link to what to do each year of medical school: important is diversity in dermatology residency as an URM who will be applying? Will it be considered as a factor during match?Dr. D: For many programs it is becoming increasingly important! Traditionally it was not, leading to dermatology being the second least diverse field in all of medicine (behind only orthopedic surgery). In the last 5-10 years this has been highlighted in many dermatology publications and then brought back into attention by all the social injustices faced by URM communities. This has led to some residency programs creating diversity positions where the slot is actually reserved for a URM applicant (Duke is one such program). However, even programs that do not have a reserved spot have created task forces on increasing diversity and have become focused on using a more holistic application evaluation to match more URMs instead of putting all the emphasis on scores. I believe that diversity is strongly considered by many programs in offering interviews and ranking applicants and the best way to get a sense of this is to look at their current residents to get an idea of their track record. Dr. L: Recently, there has been a lot of emphasis on trying to improve the lack of diversity in dermatology. Every program is different and each has its own mission/goals. The AAD and Association of Professors of Dermatology (APD) are trying to improve diversity in dermatology and these priorities are being emphasized nationally. Our current goals are to improve the process of applying to dermatology with emphasis on transparency in the application process, holistic review and more coordination amongst programs. How much research do we need to have?Dr. D: This is tough to answer because there are people who match with 0-1 publications and people who don’t match with 20+ publications. It really is just one piece of the complete application. That being said I think it’s ideal to have one higher impact publication (RCT or larger chart review) and a couple of smaller ones (this counts many things – letters, case reports/series, abstracts, presentations etc. and I do not think it matters if you are first author or not although that is always the goal to have). I also want to make it clear that many applicants with numerous publications have taken a research year and so it is only logical they would have more than an applicant who went straight through. As a PD of a prominent institution told me, these applicants would be viewed as apples and oranges and cannot be compared on the basis of research alone. Dr. L: I recommend doing what you are passionate about. Those who are interested in research should continue to pursue it, however, it should not interfere with your clinical and academic performance. Look at the programs that you are interested in. There are some programs that emphasize and conduct more research, and there are some that are more clinically oriented. If research is not your strongest suit, then tailor your application to those that are more clinically focused. It is still very important to understand the research process and know what is involved when submitting a paper. Reviewing the literature, staying organized - these are all critical skills. A completed research project shows the ability to do something from start to finish. More and more people are taking a year off for research. If this is something you are able to and want to do, then pursue it. However, many are unpaid, so I recommend speaking to your advisors and mentors to see if taking a year off is a feasible option . If they tell you about weaknesses in your application and need more time to strengthen it prior to applying, then perhaps you should take more time. When I rotated/applied, I tried to go to places I thought I would be a good fit. You have to be realistic about your application as well. Is a research year recommended?Dr. D: Yes, and no. I think a research year increases your chances of matching at a top tier residency program. It allows you to secure many publications and often make connections with attendings who are renowned in the field. However, the emphasis on this often negatively impacts URMs the most as many positions are unpaid or even if they are paid require you to live in another city, pay rent, sacrifice a year of future salary, etc. Many of us URMs do not come from a financial background which makes this easy to do. I think programs are understanding that more and more as they dedicate time and resources towards increasing diversity and understanding why URMs have not matched well in dermatology historically. The PD I mentioned above went on to say that anyone with a year of dedicated research will have many publications and that in and of itself does not imply that the candidate is highly qualified or ultra-talented but only that they had a whole year dedicated to that purpose. This all being said, my advice is taking a research year if you are genuinely interested in the research matter or if you are completely set on matching at a top-tier institution. [Answered above]What makes a candidate competitive for dermatology residency? Dr. D: A complete package makes for the most competitive candidate. First grades/scores – try to get honors in a majority of your clinical rotations and above a 230 on step 1. Step 2 matters less but I think a 230 is also a good target. Then research, as mentioned above shoot for 1 larger project and a few smaller projects. The goal is just to show that you have an interest in academics which is important to most if not all dermatology programs. Next is recommendation letters – it is ideal to get two to three in dermatology and one in internal medicine (usually sub-internship). It is always great to have these be people who are very prominent in the field but I think it is more important for the writer to know you well or have worked with you closely than a well-known dermatologist who barely remembers who you are. Next personal statement – people often say that this cannot help you match better but it can keep you from matching. Those who say that usually recommend writing a “vanilla” personal statement that is crafted in a way that could not be off-putting to any reader. I think this is different for most URMs. We often have a very difficult past and many obstacles we’ve had to overcome to get to dermatology residency and I think that highlighting what makes you so different from the routine applicant can only help set you apart. This is more controversial, and you may want to ask mentors who know you well. I was almost convinced to use my vanilla statement, but I decided to go with the raw, honest one and frankly got great feedback from interviewers over the season. Lastly, community service/engagement - being part of student groups, volunteering at free clinics, teaching other medical students, etc. is important to the complete package because it shows a well-rounded side of the applicant.[Answered throughout]Does it matter if you are a DO? or MD?Dr. D: This is a tough question because historically it was much easier for MDs to match in dermatology (and most competitive specialties) than DOs. I think the distinction between the two is diminishing but if I were a DO I would apply broadly and make sure put together a “complete” application with all of the components mentioned above and to be sure to write about obstacles faced that perhaps would not pertain to MDs so as to set myself apart. Dr. L: It does not matter as much. Before, DOs were completely separate from MDs in the match process. That was difficult to navigate when the tracks were so different. Now that there will be a unified match, it will not be as difficult as it was in the past. It is still not as common, and we do not have a lot of DO applicants for dermatology compared to MDs. TARGETING PROGRAMS - Dr. L: Many applicants feel like they should apply everywhere and they want to apply everywhere to increase their chances. Not only is this expensive, but it may not be in your best interest. You want to look at your strengths and what you want to offer to residencies and then see what the strengths of those residency programs are and if your strengths and goals align. After doing this you may realize that you may not have to apply to 100+ programs. Programs want people who are very interested in and are a good fit for their program, and it makes it difficult if people are applying everywhere. I applied to places I knew I would be happy at. Mention your interests. Even places I interviewed at that did not have strong skin of color curriculums, were happy to have someone who was interested in it. So, do not discard a program if they do not have your particular interest, because they may be willing to foster a supportive environment for you and they may want you to be the pioneer. Seek out programs that help stimulate your development. Not every program will be perfect when you apply, but at least have a good understanding of what the program values. All you need is someone who is supportive and can help you through your training.What is the general consensus on hair for African American women as applicants during derm interview season?Dr. L: Be yourself. Do what you are most comfortable with. Once you are accepted, if you’re a totally different person, your program may ask, ‘what happened?’ Whatever makes you feel most comfortable - just do that. Sometimes people will feel the intense pressure to conform, but natural hair is becoming more widespread/mainstream and accepted. I know I’m a bit biased since I wear my hair natural, but being your most authentic self is in your best interest, and is what programs are looking for. How do I stand out as a dermatology residency applicant?Dr. D: There are a few ways, but I think the best one is through a unique personal statement. You can also stand out through your extracurriculars including groups, volunteering, teaching, etc. If you have particular passions/experiences that are unique they will allow you to stand out and you can elaborate on them in your ERAS application without having to use the personal statement. Hobbies are also a great way to stand out and even talents/activities you might think are silly may be very interesting to the reviewers and at the very least will make your application more memorable. Back to the personal statement – as I said above, I recommend being honest and raw with your experiences and obstacles overcome in applying to dermatology. You definitely need to write something unique that no other person could ever write. It may be easy to talk about how much you love dermatology and all the cool or inspiring cases you saw on rotations but that won’t help you stand out because any applicant could write about that. How did you demonstrate interest to the program you are at now?Dr. D: I went to medical school where I am now in residency so it was easy for me to demonstrate interest to my mentors here but in general if you love a particular program or city it is worthwhile to do an away rotation there and/or try to get involved in research projects there. After the interview you can also reach out to the PD and let them know that you are planning on ranking the program number one on your list (but beware the large majority of programs will not rank you more favorably just because you tell them this) as there is no downside to doing so. Dr. L: I rotated at the places I was highly interested in. In the COVID-era, things are more difficult. It goes back to what I mentioned previously – honesty. I would not recommend reaching out to every program to express interest as many of us are in communication with each other. I recommend being as honest as possible. We get emails frequently throughout the application cycle, so if you need to reach out to a program, it may be better to do so on the faculty level (have your mentor reach out). Many programs have detailed information on their websites and ways for you to connect. We offered additional virtual opportunities this application cycle. What are residency programs looking for?Dr. D: See number seven above for an overview of what makes an applicant competitive. Beyond that I think there’s also the human connection aspect of being the “right fit” for the program that has nothing to do with your qualifications. Be a kind, respectful and genuine person and be yourself and naturally certain programs will love your personality and others may not and that’s ok. Ultimately you want to end up at a program where you fit in and find that the faculty/other residents share some common ground with you. Dr. L: Your personal statement is crucial. Normally it would be your away rotations and how you interact with the program overall including the staff, faculty and residents. Some programs are allowing virtual electives, but that is not standard across the board. A lot of programs are doing virtual meet and greets which are good opportunities to get learn more about the programs, and can help you evaluate if a program is a good fit. Don’t feel stressed to go to every single meet and greet. But, if there is a program you are particularly interested in, then it is a good opportunity to interact and ask your questions. I can’t emphasize the personal statement enough. Everyone is doing the same thing; opening up with a quote/patient experience, and we want to know who you are and how you got to where you are in your professional journey, and how dermatology fits in with that. The personal statement is a great way to convey this and show us who you are. [Look at section above on Targeting]How do I highlight overcoming obstacles? Should that be in my personal statement?Dr. D: Yes, I think the personal statement is the very best place to highlight obstacles overcome along your path to dermatology. That’s exactly what I did for mine and I believe it paid off and I got great feedback from my interviewers mentioning that they enjoyed reading it and felt they learned a lot about me as a person that they wouldn’t have anywhere else on my application. Dr. L: Like I mentioned before – address any red flags or glaring issues, as honestly as possible. If there is something you need to own up to, own up to it. You can also ask letter writers to discuss these issues on your behalf. It is important to get letters from people who know you really well. For example, if I am reviewing an application from someone with a lower step score and their letter of recommendation says - “Their step 1 score is not reflective of what I have seen of their performance over time. They have been excellent, professional, smart, and able to get their work done.” That says a lot because it talks about other aspects of your character. However, on the other hand, a letter that says “This person is great because they have high scores.” This doesn’t tell me what I want to know – what are this person’s attributes/characteristics? Are they easily adaptable? Did they have to overcome challenges? We universally read all personal statements and letters of recommendation. I would recommend being ready to talk about anything in your application during your interview, and don’t be surprised if someone asks you to discuss or explain anything referenced in your application. Be as honest as you can. For many programs, being honest shows a level of maturity. We’re not all perfect. What we need to know is: can we trust you? If something happens during residency, are you going to make an excuse? learn from it? grow and be a better person? We like to see people who are trying, and those who progress and improve. ................
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