This guide, which also will appear at www.the-dermatologist.com in its entirety, is divided into categories that are of high importance and are also frequently asked by students regarding matching in dermatology. Part 2 of this 3-part series discusses United States Medical Licensing Examination (USMLE) Step 1 scores, Alpha Omega Alpha (AOA) membership, curriculum vitae (CV) and away rotations.
USMLE Scores
Step 1: Selection committees heavily consider the USMLE Step 1 score. Numerous websites detail arguments about what scores are considered great versus mediocre. In general, if a program is using a cutoff score for screening purposes, the cutoff score will not be >235. I have heard of some programs using 250 as a cutoff score but do not know definitively if these claims are valid. The average board score for applicants accepted in the 2007-2008 academic year was 240. With successive years, there has been a progressive upward trend in the average board score and I can only assume that it will continue to rise (hence the importance of studying from the start of medical school).
Your board score will provide important information to the programs you are applying. First, it will give them an objective idea of your baseline basic science knowledge. Dermatology is a challenging field that incorporates many of the basic sciences. A solid foundation in medical knowledge will make the lives of your attendings easier and it will be appreciated.
Second, it will tell them how well you are likely to perform on the annual in-service exams as well as the boards at the end of your residency training (a required test to become a board-certified dermatologist). Programs use such statistics (in-service/board exam scores) to recruit applicants. The idea is that the higher the pass rate on these exams, the better training the applicant would receive if he/she were to match at their program. This is the type of information programs will provide during interviews. Therefore, programs do not like to take risks on students with low board scores, as this will result in a decrease in pass rate statistics.
How low is considered acceptable? The answer to this question is program dependent but I believe it is generally accepted that >230 is impressive. Note, this is not to say that applicants with board scores <230 do not have a chance at dermatology. There are applicants with a score <230 that match just like there are applicants with a score >250 who do not match. In the end, it is the whole package they are considering, not 1 factor. The USMLE score is only 1 factor. Statistically, your chances of being offered interviews are greater with a higher board score. Finally, unless you scored extremely high (or low) on the USMLE exams, do not expect this topic to be discussed during interviews.
Step 2: When to take Step 2 can be a bit tricky. My program placed a deadline of December 31 as the latest possible date to complete the test. Regardless, it is a personal decision and will partly depend on your Step 1 result. The risk of taking Step 2 early includes a lower score than Step 1, which may affect your chances of matching. Thankfully, Step 2 is not comparable to Step 1 in terms of difficulty and chances of scoring lower are unlikely because you will become accustomed to taking standardized tests during your junior clerkships. For the sake of setting some ranges, the below are provided to give you an approximate idea of when to take the test early and when to wait:
•<230: Consider taking Step 2 early in fourth year (August/September)
•230-240: Personal preference on when to take the test (I would consider waiting)
•>240: Take Step 2 later in fourth year (December/January)
Please note that the above ranges are merely suggestions. There is no algorithm for making the appropriate decision. It is based on what you want to do and what makes you most comfortable. If anything, the above algorithm represents my individual comfort zones and nothing more.
The point of taking Step 2 later is that, theoretically, the time it takes to get your score back will be past the deadline for which the rank lists are due. Once the rank lists are submitted, there is no turning back. Even if you scored low at that time, the programs cannot use it against you as their rank lists have been submitted.
Regardless of when you take your test, you can opt to hold your score from being released to programs (however, this may look suspicious to a program if you have listed your test as taken in August but have not reported a score by December when you are interviewing). If you receive your score and are satisfied with it, you can personally release it to your programs. If you are unhappy with the results, you can choose against releasing your score.
AOA Membership
Becoming a member of AOA is an honor. The bigger question, however, is how important is it when applying for a dermatology position? In the 2007-2008 year, approximately 50% of applicants applying for dermatology had AOA membership. This is the highest in any field. However, it also means that 50% of applicants did not have AOA membership. Therefore, this should be reassuring to you that whether you have AOA membership or not, you can match into dermatology.
The 1 major issue with AOA status is the lack of a standardized approach in the induction of members into the honor society. Clearly, there is an objective parameter that must be met — good grades and a high board score. However, many universities also take into consideration the philanthropist in the student (eg, volunteering, research, leadership positions, teaching opportunities, etc.). This introduces subjectivity to the election process that allows people with lower grades or board scores to become members due to extensive and impressive extracurricular activities (ECAs). Conversely, students with high grades and high board scores can miss the opportunity to become a member due to a lack of ECAs. The lack of a standardized method for electing members is a phenomenon understood by programs and some institutions do not weigh AOA status as heavily as others. Nevertheless, it is 1 piece of information that can set you apart from other applicants and should be regarded as a very high and honorable achievement.
You should also know that there are programs that will screen a pool of applicants based on AOA status. Meaning, they will begin serious consideration of applications once the computer has screened out non-AOA members.
In the profile section of your Electronic Residency Application Service (ERAS) application, in addition to filling out your name and address, you will be asked to assign your AOA status. Our school has set up nominations such that in any given class, approximately 30 students will be elected into AOA. Of those 30 students, approximately 7 to 8 students will be inducted as junior members and the remaining as seniors. Junior members will know their status early enough to mark it on their application before the deadline for ERAS submission. Senior members will have to submit their application and update their profile section of ERAS once they are notified of their induction. This does not pose as a problem because programs are notified electronically when there is a change to your profile.
You might be worried about programs reviewing your application before your status is known. Luckily, senior members are elected early enough and programs are usually notified before the review process begins. Additionally, programs understand that many medical schools have a junior/senior election process and that many members will be selected after ERAS is submitted. There is no question on ERAS that asks about a “pending” AOA status.
Curriculum Vitae
You will be embarking on a voyage into the field of dermatology earlier than any formal documentation is provided to dermatology programs. Therefore, during most of your fourth-year externships in dermatology, the attendings will not have a copy of your academic record. This is where the CV comes into play. I recommend you compose a CV before you begin your fourth year and update it frequently. You must work hard to bring out your best attributes in your CV. This is your opportunity to sell yourself. Remember, everyone has flaws. There is no such thing as a perfect applicant. Your job is to make your CV as flawless as possible without crossing the boundaries of illegal or unethical representation.
The format should be no longer than 2 pages and must be appealing to the eye. Make sure to bold any statements or accomplishments you would like to emphasize (eg, your name as authorship on publications, honors, hobbies, etc.). Normally, a CV does not contain numbers but rather a brief history of your education, leadership positions, research, volunteer experiences, honors and awards and hobbies. However, if you are proud of your grade point average or board score, do not hesitate to include it. Consider including your class rank in your CV. Keep descriptions of accomplishments short (1-2 sentences) and full of verbs (eg, conducted, oversaw, participated, carried out, presented, founded, etc.)
If you set up an appointment with an attending to talk about dermatology, place your CV in an envelope and hand it to the attending a day or 2 before your scheduled meeting. This will give the attending a chance to go over your record and will focus the conversation.
Finally, when you are on interviews, make sure to bring a few copies of your CV. Some interviewers will not have thoroughly reviewed your application. Unfortunately, the little time you have with an interviewer might be spent shuffling through your application in the hopes of organizing the information in 10 to 15 minutes. While this is not a good interview technique, it can occur. If you have a nicely written, clear CV to provide the interviewer it can help the interviewer, (which will be appreciated), make you appear organized and help to highlight your most important accomplishments.
Away Rotations
I recommend you do as many dermatology rotations as your program allows. Do not pay attention to websites that say it is looked down upon to “waste” your fourth year doing many of the same rotations. Your preliminary year in medicine will be an opportunity to build on your clinical medicine foundation. The initial months of your fourth year should be focused on building up your CV and making as many dermatology connections as possible. At our institution, a fourth-year student can get clinical credit for up to 4 rotations in dermatology, which adds to a total of 16 weeks (each rotation is 4 weeks long).
I started my rotations immediately after my third year ended and continued with dermatology rotations until October. I began with a research elective followed by 3 clinical rotations. I did my research elective on the East Coast, 2 clinical rotations in Chicago, and 1 clinical rotation on the West Coast. I felt it was important to complete dermatology rotations across the United States so as not to show favor to any 1 region. I wanted to make it clear to programs that I was open to moving anywhere in the country and was not restricted to any particular location. I am not sure with certainty if this strategy paid off because it is not a topic discussed by programs. However, I do think location restriction is a concern for programs when they are deciding whom to interview.
You can do your subinternship anytime after you complete as many dermatology rotations as possible. Of course, this is assuming you honor your Internal Medicine rotation in the third year. If you do not, you may want to consider taking it earlier to reassure the programs of your clinical skills improvement.
Where should you do away rotations? (A table with the number of residency positions offered by dermatology programs in the United States will appear in the final article installment next month and at www.the-dermatologist.com.) This is important when you decide where to rotate because the more positions there are at a program, the higher your chances of matching at that institution. This is a factor I did not consider when choosing my rotations and therefore ended up rotating at a program that, at the time, accepted 2 residents. It is obvious that matching at a program that takes 2 residents per year is much more challenging than a program that supports 8 residents per year.
Although many programs extend “courtesy” interviews to rotators, it is important to understand that you are not guaranteed an interview just because you rotate at a certain program. First, you may not have impressed the faculty (or did not make an effort to get to know them) so they were not interested in offering you an interview. Second, there are some programs that are very popular with students. As such, they will have a large number of rotators, which may cause you to be lost in a “sea of students.” It is extremely difficult to stand out when there are many other students amongst you competing for the same interview. Therefore, always get to know the faculty and be sure to express your interest in their program. Let everyone know (including coordinators, nurses and other students) of your interest. Do not assume they understand your intentions merely based on the fact that you are rotating there.
If you happen to have your eyes set on 1 of the popular programs that has many rotators, you may want to do the rotation as early as possible. This might be your only chance to avoid the large number of students that will be sure to visit the program in the upcoming months. Another strategy that might be beneficial, but which counters the above advice, is to save your most desired program for the third or fourth dermatology rotation in your fourth year of school. You will probably be at your peak performance and have the most dermatology knowledge at this time. Because the goal of doing away rotations is to maximally impress faculty members, this strategy can be advantageous. Ultimately, it is your decision how to schedule the sequence of your rotations. I learned about these issues as I completed my own rotations and believe it would have been helpful if I were made aware, beforehand, of such matters.
One last thought to keep in mind. Besides my research elective, I wanted to be a bit strategic in the rotations I chose so I picked all programs that had accepted our students in the past. This was not an idea unique to me as I realized that my classmates, also applying for dermatology, were rotating at the same programs. I believe it is extremely uncommon for a dermatology program to take 2 students from the same institution in the same year. Therefore, it might be wiser to choose programs based on the number of residents taken or at least a combination of the 2 factors. Below are 7 recommendations of what to do during your rotation:
1. Be assertive with the faculty. Get to know ALL of them (they all have a say).
2. Make sure you have a copy of your CV with you at all times and ask to sit down with the chair and program director to discuss dermatology. This sit-down will break the ice with the faculty member and create a comfortable environment for you during the formal interview.
3. Make an effort to familiarize yourself with the residents, nurses and other ancillary staff.
4. Try to get in a case report with a faculty member while doing your rotation. I was involved in 1 case report with the program director at a university and I kept in contact with her for 5 to 6 months finalizing the manuscript. This allows them to get to know you on a more personal level, prevents them from forgetting you and allows you to show them your skills.
5. If you have to do a presentation, work hard on it. Spend a lot of time on it and do your research. You will be asked questions after your presentation and you want to be prepared with answers.
6. Go to consults! I did this at my rotations and not only is it educational, but it is also looked highly upon. The first day you start, ask the residents or the student coordinator about how consults are carried out and jump on board with them.
7. Befriend other rotators. Remember, they are under the same situation as you and are under the same, if not, more stress. A collegial atmosphere will decrease the tension for everyone (yourself, nurses, faculty, residents and other students) and is a very impressive form of behavior acknowledged by the same people who will decide your rank. An overly competitive attitude is easily noticed by the healthcare team and not appreciated. I made great friends with students I rotated with and continue to communicate with them.
Look for the final part in this 3-part series, which will discuss letters of recommendation, personal statement, where to apply, plan B and final words, in the 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.
This guide, which also will appear at www.the-dermatologist.com in its entirety, is divided into categories that are of high importance and are also frequently asked by students regarding matching in dermatology. Part 2 of this 3-part series discusses United States Medical Licensing Examination (USMLE) Step 1 scores, Alpha Omega Alpha (AOA) membership, curriculum vitae (CV) and away rotations.
USMLE Scores
Step 1: Selection committees heavily consider the USMLE Step 1 score. Numerous websites detail arguments about what scores are considered great versus mediocre. In general, if a program is using a cutoff score for screening purposes, the cutoff score will not be >235. I have heard of some programs using 250 as a cutoff score but do not know definitively if these claims are valid. The average board score for applicants accepted in the 2007-2008 academic year was 240. With successive years, there has been a progressive upward trend in the average board score and I can only assume that it will continue to rise (hence the importance of studying from the start of medical school).
Your board score will provide important information to the programs you are applying. First, it will give them an objective idea of your baseline basic science knowledge. Dermatology is a challenging field that incorporates many of the basic sciences. A solid foundation in medical knowledge will make the lives of your attendings easier and it will be appreciated.
Second, it will tell them how well you are likely to perform on the annual in-service exams as well as the boards at the end of your residency training (a required test to become a board-certified dermatologist). Programs use such statistics (in-service/board exam scores) to recruit applicants. The idea is that the higher the pass rate on these exams, the better training the applicant would receive if he/she were to match at their program. This is the type of information programs will provide during interviews. Therefore, programs do not like to take risks on students with low board scores, as this will result in a decrease in pass rate statistics.
How low is considered acceptable? The answer to this question is program dependent but I believe it is generally accepted that >230 is impressive. Note, this is not to say that applicants with board scores <230 do not have a chance at dermatology. There are applicants with a score <230 that match just like there are applicants with a score >250 who do not match. In the end, it is the whole package they are considering, not 1 factor. The USMLE score is only 1 factor. Statistically, your chances of being offered interviews are greater with a higher board score. Finally, unless you scored extremely high (or low) on the USMLE exams, do not expect this topic to be discussed during interviews.
Step 2: When to take Step 2 can be a bit tricky. My program placed a deadline of December 31 as the latest possible date to complete the test. Regardless, it is a personal decision and will partly depend on your Step 1 result. The risk of taking Step 2 early includes a lower score than Step 1, which may affect your chances of matching. Thankfully, Step 2 is not comparable to Step 1 in terms of difficulty and chances of scoring lower are unlikely because you will become accustomed to taking standardized tests during your junior clerkships. For the sake of setting some ranges, the below are provided to give you an approximate idea of when to take the test early and when to wait:
•<230: Consider taking Step 2 early in fourth year (August/September)
•230-240: Personal preference on when to take the test (I would consider waiting)
•>240: Take Step 2 later in fourth year (December/January)
Please note that the above ranges are merely suggestions. There is no algorithm for making the appropriate decision. It is based on what you want to do and what makes you most comfortable. If anything, the above algorithm represents my individual comfort zones and nothing more.
The point of taking Step 2 later is that, theoretically, the time it takes to get your score back will be past the deadline for which the rank lists are due. Once the rank lists are submitted, there is no turning back. Even if you scored low at that time, the programs cannot use it against you as their rank lists have been submitted.
Regardless of when you take your test, you can opt to hold your score from being released to programs (however, this may look suspicious to a program if you have listed your test as taken in August but have not reported a score by December when you are interviewing). If you receive your score and are satisfied with it, you can personally release it to your programs. If you are unhappy with the results, you can choose against releasing your score.
AOA Membership
Becoming a member of AOA is an honor. The bigger question, however, is how important is it when applying for a dermatology position? In the 2007-2008 year, approximately 50% of applicants applying for dermatology had AOA membership. This is the highest in any field. However, it also means that 50% of applicants did not have AOA membership. Therefore, this should be reassuring to you that whether you have AOA membership or not, you can match into dermatology.
The 1 major issue with AOA status is the lack of a standardized approach in the induction of members into the honor society. Clearly, there is an objective parameter that must be met — good grades and a high board score. However, many universities also take into consideration the philanthropist in the student (eg, volunteering, research, leadership positions, teaching opportunities, etc.). This introduces subjectivity to the election process that allows people with lower grades or board scores to become members due to extensive and impressive extracurricular activities (ECAs). Conversely, students with high grades and high board scores can miss the opportunity to become a member due to a lack of ECAs. The lack of a standardized method for electing members is a phenomenon understood by programs and some institutions do not weigh AOA status as heavily as others. Nevertheless, it is 1 piece of information that can set you apart from other applicants and should be regarded as a very high and honorable achievement.
You should also know that there are programs that will screen a pool of applicants based on AOA status. Meaning, they will begin serious consideration of applications once the computer has screened out non-AOA members.
In the profile section of your Electronic Residency Application Service (ERAS) application, in addition to filling out your name and address, you will be asked to assign your AOA status. Our school has set up nominations such that in any given class, approximately 30 students will be elected into AOA. Of those 30 students, approximately 7 to 8 students will be inducted as junior members and the remaining as seniors. Junior members will know their status early enough to mark it on their application before the deadline for ERAS submission. Senior members will have to submit their application and update their profile section of ERAS once they are notified of their induction. This does not pose as a problem because programs are notified electronically when there is a change to your profile.
You might be worried about programs reviewing your application before your status is known. Luckily, senior members are elected early enough and programs are usually notified before the review process begins. Additionally, programs understand that many medical schools have a junior/senior election process and that many members will be selected after ERAS is submitted. There is no question on ERAS that asks about a “pending” AOA status.
Curriculum Vitae
You will be embarking on a voyage into the field of dermatology earlier than any formal documentation is provided to dermatology programs. Therefore, during most of your fourth-year externships in dermatology, the attendings will not have a copy of your academic record. This is where the CV comes into play. I recommend you compose a CV before you begin your fourth year and update it frequently. You must work hard to bring out your best attributes in your CV. This is your opportunity to sell yourself. Remember, everyone has flaws. There is no such thing as a perfect applicant. Your job is to make your CV as flawless as possible without crossing the boundaries of illegal or unethical representation.
The format should be no longer than 2 pages and must be appealing to the eye. Make sure to bold any statements or accomplishments you would like to emphasize (eg, your name as authorship on publications, honors, hobbies, etc.). Normally, a CV does not contain numbers but rather a brief history of your education, leadership positions, research, volunteer experiences, honors and awards and hobbies. However, if you are proud of your grade point average or board score, do not hesitate to include it. Consider including your class rank in your CV. Keep descriptions of accomplishments short (1-2 sentences) and full of verbs (eg, conducted, oversaw, participated, carried out, presented, founded, etc.)
If you set up an appointment with an attending to talk about dermatology, place your CV in an envelope and hand it to the attending a day or 2 before your scheduled meeting. This will give the attending a chance to go over your record and will focus the conversation.
Finally, when you are on interviews, make sure to bring a few copies of your CV. Some interviewers will not have thoroughly reviewed your application. Unfortunately, the little time you have with an interviewer might be spent shuffling through your application in the hopes of organizing the information in 10 to 15 minutes. While this is not a good interview technique, it can occur. If you have a nicely written, clear CV to provide the interviewer it can help the interviewer, (which will be appreciated), make you appear organized and help to highlight your most important accomplishments.
Away Rotations
I recommend you do as many dermatology rotations as your program allows. Do not pay attention to websites that say it is looked down upon to “waste” your fourth year doing many of the same rotations. Your preliminary year in medicine will be an opportunity to build on your clinical medicine foundation. The initial months of your fourth year should be focused on building up your CV and making as many dermatology connections as possible. At our institution, a fourth-year student can get clinical credit for up to 4 rotations in dermatology, which adds to a total of 16 weeks (each rotation is 4 weeks long).
I started my rotations immediately after my third year ended and continued with dermatology rotations until October. I began with a research elective followed by 3 clinical rotations. I did my research elective on the East Coast, 2 clinical rotations in Chicago, and 1 clinical rotation on the West Coast. I felt it was important to complete dermatology rotations across the United States so as not to show favor to any 1 region. I wanted to make it clear to programs that I was open to moving anywhere in the country and was not restricted to any particular location. I am not sure with certainty if this strategy paid off because it is not a topic discussed by programs. However, I do think location restriction is a concern for programs when they are deciding whom to interview.
You can do your subinternship anytime after you complete as many dermatology rotations as possible. Of course, this is assuming you honor your Internal Medicine rotation in the third year. If you do not, you may want to consider taking it earlier to reassure the programs of your clinical skills improvement.
Where should you do away rotations? (A table with the number of residency positions offered by dermatology programs in the United States will appear in the final article installment next month and at www.the-dermatologist.com.) This is important when you decide where to rotate because the more positions there are at a program, the higher your chances of matching at that institution. This is a factor I did not consider when choosing my rotations and therefore ended up rotating at a program that, at the time, accepted 2 residents. It is obvious that matching at a program that takes 2 residents per year is much more challenging than a program that supports 8 residents per year.
Although many programs extend “courtesy” interviews to rotators, it is important to understand that you are not guaranteed an interview just because you rotate at a certain program. First, you may not have impressed the faculty (or did not make an effort to get to know them) so they were not interested in offering you an interview. Second, there are some programs that are very popular with students. As such, they will have a large number of rotators, which may cause you to be lost in a “sea of students.” It is extremely difficult to stand out when there are many other students amongst you competing for the same interview. Therefore, always get to know the faculty and be sure to express your interest in their program. Let everyone know (including coordinators, nurses and other students) of your interest. Do not assume they understand your intentions merely based on the fact that you are rotating there.
If you happen to have your eyes set on 1 of the popular programs that has many rotators, you may want to do the rotation as early as possible. This might be your only chance to avoid the large number of students that will be sure to visit the program in the upcoming months. Another strategy that might be beneficial, but which counters the above advice, is to save your most desired program for the third or fourth dermatology rotation in your fourth year of school. You will probably be at your peak performance and have the most dermatology knowledge at this time. Because the goal of doing away rotations is to maximally impress faculty members, this strategy can be advantageous. Ultimately, it is your decision how to schedule the sequence of your rotations. I learned about these issues as I completed my own rotations and believe it would have been helpful if I were made aware, beforehand, of such matters.
One last thought to keep in mind. Besides my research elective, I wanted to be a bit strategic in the rotations I chose so I picked all programs that had accepted our students in the past. This was not an idea unique to me as I realized that my classmates, also applying for dermatology, were rotating at the same programs. I believe it is extremely uncommon for a dermatology program to take 2 students from the same institution in the same year. Therefore, it might be wiser to choose programs based on the number of residents taken or at least a combination of the 2 factors. Below are 7 recommendations of what to do during your rotation:
1. Be assertive with the faculty. Get to know ALL of them (they all have a say).
2. Make sure you have a copy of your CV with you at all times and ask to sit down with the chair and program director to discuss dermatology. This sit-down will break the ice with the faculty member and create a comfortable environment for you during the formal interview.
3. Make an effort to familiarize yourself with the residents, nurses and other ancillary staff.
4. Try to get in a case report with a faculty member while doing your rotation. I was involved in 1 case report with the program director at a university and I kept in contact with her for 5 to 6 months finalizing the manuscript. This allows them to get to know you on a more personal level, prevents them from forgetting you and allows you to show them your skills.
5. If you have to do a presentation, work hard on it. Spend a lot of time on it and do your research. You will be asked questions after your presentation and you want to be prepared with answers.
6. Go to consults! I did this at my rotations and not only is it educational, but it is also looked highly upon. The first day you start, ask the residents or the student coordinator about how consults are carried out and jump on board with them.
7. Befriend other rotators. Remember, they are under the same situation as you and are under the same, if not, more stress. A collegial atmosphere will decrease the tension for everyone (yourself, nurses, faculty, residents and other students) and is a very impressive form of behavior acknowledged by the same people who will decide your rank. An overly competitive attitude is easily noticed by the healthcare team and not appreciated. I made great friends with students I rotated with and continue to communicate with them.
Look for the final part in this 3-part series, which will discuss letters of recommendation, personal statement, where to apply, plan B and final words, in the 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.
This guide, which also will appear at www.the-dermatologist.com in its entirety, is divided into categories that are of high importance and are also frequently asked by students regarding matching in dermatology. Part 2 of this 3-part series discusses United States Medical Licensing Examination (USMLE) Step 1 scores, Alpha Omega Alpha (AOA) membership, curriculum vitae (CV) and away rotations.
USMLE Scores
Step 1: Selection committees heavily consider the USMLE Step 1 score. Numerous websites detail arguments about what scores are considered great versus mediocre. In general, if a program is using a cutoff score for screening purposes, the cutoff score will not be >235. I have heard of some programs using 250 as a cutoff score but do not know definitively if these claims are valid. The average board score for applicants accepted in the 2007-2008 academic year was 240. With successive years, there has been a progressive upward trend in the average board score and I can only assume that it will continue to rise (hence the importance of studying from the start of medical school).
Your board score will provide important information to the programs you are applying. First, it will give them an objective idea of your baseline basic science knowledge. Dermatology is a challenging field that incorporates many of the basic sciences. A solid foundation in medical knowledge will make the lives of your attendings easier and it will be appreciated.
Second, it will tell them how well you are likely to perform on the annual in-service exams as well as the boards at the end of your residency training (a required test to become a board-certified dermatologist). Programs use such statistics (in-service/board exam scores) to recruit applicants. The idea is that the higher the pass rate on these exams, the better training the applicant would receive if he/she were to match at their program. This is the type of information programs will provide during interviews. Therefore, programs do not like to take risks on students with low board scores, as this will result in a decrease in pass rate statistics.
How low is considered acceptable? The answer to this question is program dependent but I believe it is generally accepted that >230 is impressive. Note, this is not to say that applicants with board scores <230 do not have a chance at dermatology. There are applicants with a score <230 that match just like there are applicants with a score >250 who do not match. In the end, it is the whole package they are considering, not 1 factor. The USMLE score is only 1 factor. Statistically, your chances of being offered interviews are greater with a higher board score. Finally, unless you scored extremely high (or low) on the USMLE exams, do not expect this topic to be discussed during interviews.
Step 2: When to take Step 2 can be a bit tricky. My program placed a deadline of December 31 as the latest possible date to complete the test. Regardless, it is a personal decision and will partly depend on your Step 1 result. The risk of taking Step 2 early includes a lower score than Step 1, which may affect your chances of matching. Thankfully, Step 2 is not comparable to Step 1 in terms of difficulty and chances of scoring lower are unlikely because you will become accustomed to taking standardized tests during your junior clerkships. For the sake of setting some ranges, the below are provided to give you an approximate idea of when to take the test early and when to wait:
•<230: Consider taking Step 2 early in fourth year (August/September)
•230-240: Personal preference on when to take the test (I would consider waiting)
•>240: Take Step 2 later in fourth year (December/January)
Please note that the above ranges are merely suggestions. There is no algorithm for making the appropriate decision. It is based on what you want to do and what makes you most comfortable. If anything, the above algorithm represents my individual comfort zones and nothing more.
The point of taking Step 2 later is that, theoretically, the time it takes to get your score back will be past the deadline for which the rank lists are due. Once the rank lists are submitted, there is no turning back. Even if you scored low at that time, the programs cannot use it against you as their rank lists have been submitted.
Regardless of when you take your test, you can opt to hold your score from being released to programs (however, this may look suspicious to a program if you have listed your test as taken in August but have not reported a score by December when you are interviewing). If you receive your score and are satisfied with it, you can personally release it to your programs. If you are unhappy with the results, you can choose against releasing your score.
AOA Membership
Becoming a member of AOA is an honor. The bigger question, however, is how important is it when applying for a dermatology position? In the 2007-2008 year, approximately 50% of applicants applying for dermatology had AOA membership. This is the highest in any field. However, it also means that 50% of applicants did not have AOA membership. Therefore, this should be reassuring to you that whether you have AOA membership or not, you can match into dermatology.
The 1 major issue with AOA status is the lack of a standardized approach in the induction of members into the honor society. Clearly, there is an objective parameter that must be met — good grades and a high board score. However, many universities also take into consideration the philanthropist in the student (eg, volunteering, research, leadership positions, teaching opportunities, etc.). This introduces subjectivity to the election process that allows people with lower grades or board scores to become members due to extensive and impressive extracurricular activities (ECAs). Conversely, students with high grades and high board scores can miss the opportunity to become a member due to a lack of ECAs. The lack of a standardized method for electing members is a phenomenon understood by programs and some institutions do not weigh AOA status as heavily as others. Nevertheless, it is 1 piece of information that can set you apart from other applicants and should be regarded as a very high and honorable achievement.
You should also know that there are programs that will screen a pool of applicants based on AOA status. Meaning, they will begin serious consideration of applications once the computer has screened out non-AOA members.
In the profile section of your Electronic Residency Application Service (ERAS) application, in addition to filling out your name and address, you will be asked to assign your AOA status. Our school has set up nominations such that in any given class, approximately 30 students will be elected into AOA. Of those 30 students, approximately 7 to 8 students will be inducted as junior members and the remaining as seniors. Junior members will know their status early enough to mark it on their application before the deadline for ERAS submission. Senior members will have to submit their application and update their profile section of ERAS once they are notified of their induction. This does not pose as a problem because programs are notified electronically when there is a change to your profile.
You might be worried about programs reviewing your application before your status is known. Luckily, senior members are elected early enough and programs are usually notified before the review process begins. Additionally, programs understand that many medical schools have a junior/senior election process and that many members will be selected after ERAS is submitted. There is no question on ERAS that asks about a “pending” AOA status.
Curriculum Vitae
You will be embarking on a voyage into the field of dermatology earlier than any formal documentation is provided to dermatology programs. Therefore, during most of your fourth-year externships in dermatology, the attendings will not have a copy of your academic record. This is where the CV comes into play. I recommend you compose a CV before you begin your fourth year and update it frequently. You must work hard to bring out your best attributes in your CV. This is your opportunity to sell yourself. Remember, everyone has flaws. There is no such thing as a perfect applicant. Your job is to make your CV as flawless as possible without crossing the boundaries of illegal or unethical representation.
The format should be no longer than 2 pages and must be appealing to the eye. Make sure to bold any statements or accomplishments you would like to emphasize (eg, your name as authorship on publications, honors, hobbies, etc.). Normally, a CV does not contain numbers but rather a brief history of your education, leadership positions, research, volunteer experiences, honors and awards and hobbies. However, if you are proud of your grade point average or board score, do not hesitate to include it. Consider including your class rank in your CV. Keep descriptions of accomplishments short (1-2 sentences) and full of verbs (eg, conducted, oversaw, participated, carried out, presented, founded, etc.)
If you set up an appointment with an attending to talk about dermatology, place your CV in an envelope and hand it to the attending a day or 2 before your scheduled meeting. This will give the attending a chance to go over your record and will focus the conversation.
Finally, when you are on interviews, make sure to bring a few copies of your CV. Some interviewers will not have thoroughly reviewed your application. Unfortunately, the little time you have with an interviewer might be spent shuffling through your application in the hopes of organizing the information in 10 to 15 minutes. While this is not a good interview technique, it can occur. If you have a nicely written, clear CV to provide the interviewer it can help the interviewer, (which will be appreciated), make you appear organized and help to highlight your most important accomplishments.
Away Rotations
I recommend you do as many dermatology rotations as your program allows. Do not pay attention to websites that say it is looked down upon to “waste” your fourth year doing many of the same rotations. Your preliminary year in medicine will be an opportunity to build on your clinical medicine foundation. The initial months of your fourth year should be focused on building up your CV and making as many dermatology connections as possible. At our institution, a fourth-year student can get clinical credit for up to 4 rotations in dermatology, which adds to a total of 16 weeks (each rotation is 4 weeks long).
I started my rotations immediately after my third year ended and continued with dermatology rotations until October. I began with a research elective followed by 3 clinical rotations. I did my research elective on the East Coast, 2 clinical rotations in Chicago, and 1 clinical rotation on the West Coast. I felt it was important to complete dermatology rotations across the United States so as not to show favor to any 1 region. I wanted to make it clear to programs that I was open to moving anywhere in the country and was not restricted to any particular location. I am not sure with certainty if this strategy paid off because it is not a topic discussed by programs. However, I do think location restriction is a concern for programs when they are deciding whom to interview.
You can do your subinternship anytime after you complete as many dermatology rotations as possible. Of course, this is assuming you honor your Internal Medicine rotation in the third year. If you do not, you may want to consider taking it earlier to reassure the programs of your clinical skills improvement.
Where should you do away rotations? (A table with the number of residency positions offered by dermatology programs in the United States will appear in the final article installment next month and at www.the-dermatologist.com.) This is important when you decide where to rotate because the more positions there are at a program, the higher your chances of matching at that institution. This is a factor I did not consider when choosing my rotations and therefore ended up rotating at a program that, at the time, accepted 2 residents. It is obvious that matching at a program that takes 2 residents per year is much more challenging than a program that supports 8 residents per year.
Although many programs extend “courtesy” interviews to rotators, it is important to understand that you are not guaranteed an interview just because you rotate at a certain program. First, you may not have impressed the faculty (or did not make an effort to get to know them) so they were not interested in offering you an interview. Second, there are some programs that are very popular with students. As such, they will have a large number of rotators, which may cause you to be lost in a “sea of students.” It is extremely difficult to stand out when there are many other students amongst you competing for the same interview. Therefore, always get to know the faculty and be sure to express your interest in their program. Let everyone know (including coordinators, nurses and other students) of your interest. Do not assume they understand your intentions merely based on the fact that you are rotating there.
If you happen to have your eyes set on 1 of the popular programs that has many rotators, you may want to do the rotation as early as possible. This might be your only chance to avoid the large number of students that will be sure to visit the program in the upcoming months. Another strategy that might be beneficial, but which counters the above advice, is to save your most desired program for the third or fourth dermatology rotation in your fourth year of school. You will probably be at your peak performance and have the most dermatology knowledge at this time. Because the goal of doing away rotations is to maximally impress faculty members, this strategy can be advantageous. Ultimately, it is your decision how to schedule the sequence of your rotations. I learned about these issues as I completed my own rotations and believe it would have been helpful if I were made aware, beforehand, of such matters.
One last thought to keep in mind. Besides my research elective, I wanted to be a bit strategic in the rotations I chose so I picked all programs that had accepted our students in the past. This was not an idea unique to me as I realized that my classmates, also applying for dermatology, were rotating at the same programs. I believe it is extremely uncommon for a dermatology program to take 2 students from the same institution in the same year. Therefore, it might be wiser to choose programs based on the number of residents taken or at least a combination of the 2 factors. Below are 7 recommendations of what to do during your rotation:
1. Be assertive with the faculty. Get to know ALL of them (they all have a say).
2. Make sure you have a copy of your CV with you at all times and ask to sit down with the chair and program director to discuss dermatology. This sit-down will break the ice with the faculty member and create a comfortable environment for you during the formal interview.
3. Make an effort to familiarize yourself with the residents, nurses and other ancillary staff.
4. Try to get in a case report with a faculty member while doing your rotation. I was involved in 1 case report with the program director at a university and I kept in contact with her for 5 to 6 months finalizing the manuscript. This allows them to get to know you on a more personal level, prevents them from forgetting you and allows you to show them your skills.
5. If you have to do a presentation, work hard on it. Spend a lot of time on it and do your research. You will be asked questions after your presentation and you want to be prepared with answers.
6. Go to consults! I did this at my rotations and not only is it educational, but it is also looked highly upon. The first day you start, ask the residents or the student coordinator about how consults are carried out and jump on board with them.
7. Befriend other rotators. Remember, they are under the same situation as you and are under the same, if not, more stress. A collegial atmosphere will decrease the tension for everyone (yourself, nurses, faculty, residents and other students) and is a very impressive form of behavior acknowledged by the same people who will decide your rank. An overly competitive attitude is easily noticed by the healthcare team and not appreciated. I made great friends with students I rotated with and continue to communicate with them.
Look for the final part in this 3-part series, which will discuss letters of recommendation, personal statement, where to apply, plan B and final words, in the 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.
