How to Advise Medical Students Interested in Dermatology: A Survey of Academic Dermatology Mentors
Dermatology residency programs are among the most competitive residencies of medical specialties. To navigate this competitive process, students seek advice from dermatology mentors who provide a range of responses depending on their experience or preferences. To consolidate this range of advice, we surveyed members of the Association of Professors of Dermatology (APD) on their responses to common questions from medical students regarding quantity of program applications, research gap year, internship year, letters of intent, away rotations, letters of recommendation (LORs), and the new Electronic Residency Application Service (ERAS) supplemental application. Although recommendations given to students remain individualized, our study describes the range of advice received and details the differences between mentor advice and common student practices throughout the application cycle. We hope these data will help mentors in advising students as well as inform organizations seeking to create standards and official recommendations regarding aspects of the application process.
Practice Points
- Dermatology mentors recommend students apply to 60 or fewer programs, with only a small percentage of faculty routinely recommending students apply to more than 80 programs.
- Dermatology mentors strongly recommend that students should not send a letter of intent to programs, as it rarely is used in the ranking process.
- Dermatology mentors encourage students to ask for letters of recommendation from writers who know them the best, irrespective of the letter writer’s rank or title. The type of letter (standardized vs nonstandardized), chair letter, or letters from an away rotation do not hold as much importance.
Preferences for Intern Year—Prior research suggests that dermatology residency program directors favor PGY-1 preliminary medicine internships because of the rigor of training.9,10 Our data continue to show a preference for internal medicine preliminary years over transitional years. However, given nearly two-thirds of dermatology mentors do not give applicants any recommendations on PGY-1 year, this preference may be fading.
Letters of Intent Not Recommended—Research in 2022 found that 78.8% of dermatology applicants sent a letter of intent communicating a plan to rank that program number 1, with nearly 13% sending such a letter to more than 1 program.11 With nearly half of mentors in our survey actively discouraging this process and more than 75% of mentors not utilizing this letter, the APD issued a brief statement on the 2022-2023 application cycle stating, “Post-interview communication of preference—including ‘letters of intent’ and thank you letters—should not be sent to programs. These types of communication are typically not used by residency programs in decision-making and lead to downstream pressures on applicants.”12
Away Rotations—Prior to the COVID-19 pandemic, data demonstrated that nearly one-third of dermatology applicants (29%) matched at their home institution, and nearly one-fifth (18%) matched where they completed an away rotation.13 In-person away rotations were eliminated in 2020 and restricted to 1 away rotation in 2021. Restrictions regarding away rotations were removed in 2022. Our data indicate that dermatology mentors strongly supported an away rotation, with more than half of them recommending at least 2 away rotations.
Further research is needed to determine the effect numerous away rotations have on minimizing students’ exposure to other specialties outside their chosen field. Additionally, further studies are needed to determine the impact away rotations have on economically disadvantaged students, students without home programs, and students with families. In an effort to standardize the number of away rotations, the APD issued a statement for the 2023-2024 application cycle indicating that dermatology applicants should limit away rotations to 2 in-person electives. Students without a home dermatology program could consider completing up to 3 electives.14
Who Should Write LORs?—Research in 2014 demonstrated that LORs were very important in determining applicants to interview, with a strong preference for LORs from academic dermatologists and colleagues.15 Our data strongly indicated applicants should predominantly ask for letters from writers who know them well. The majority of mentors did not give value to the rank of the letter writer (eg, assistant professor, associate professor, professor), type of letter, chair letters, or letters from an away rotation. These data may help alleviate stress many students feel as they search for letter writers.
How is the Supplemental Application Used?—In 2022, the ERAS supplemental application was introduced, which allowed applicants to detail 5 meaningful experiences, describe impactful life challenges, and indicate preferences for geographic region. Dermatology residency applicants also were able to choose 3 residency programs to signal interest in that program. Our data found that the supplemental application was utilized predominantly to select applicants to interview, which is in line with the Association of American Medical Colleges’ and APD guidelines indicating that this tool is solely meant to assist with application review.16 Further research and data will hopefully inform approaches to best utilize the ERAS supplemental application data.
Limitations—Our data were limited by response rate and sample size, as only academic dermatologists belonging to the APD were queried. Additionally, we did not track personal information of the mentors, so more than 1 mentor may have responded from a single institution, making it possible that our data may not be broadly applicable to all institutions.
Conclusion
Although there is no algorithmic method of advising medical students who are interested in dermatology, our survey data help to describe the range of advice currently given to students, which can improve and guide future recommendations. Additionally, some of our data demonstrate a discrepancy between mentor advice and current medical student practice for the number of applications and use of a letter of intent. We hope our data will assist academic dermatology mentors in the provision of advice to mentees as well as inform organizations seeking to create standards and official recommendations regarding aspects of the application process.
