St. Vincent's Student Clinic Dermatology Night 2/6/20

Join UTMB Dermatology faculty and residents for the upcoming dermatology night at St. Vincent’s Clinic. Please see the calendar link below to reserve your volunteering spot.

When: Thursday, February 6th at 5:30-8:30PM (volunteers should arrive at 5:15)
Where: St. Vincent's House, 2817 Post Office Street, Galveston, Texas 77550

Volunteer link: http://stvsc.org/index.php/students/sign-up

UTMB “Revitalizes” Electives and Selectives for 2020-2021 Academic Year

UTMB continues its innovative curriculum by changing MS3 and MS4 electives and Selectives to 3 weeks during the upcoming 2020-2021 academic year (they had previously been either 2 or 4 week duration). This change will increase the total number of Periods at UTMB from 13 to 17. It will permit upper level UTMB medical students to take more electives, but it could cause issues with scheduling away rotations because most of them are 2 or 4 weeks in duration. It is also possible that UTMB will require a “pre-PGY1” rotation around the NRMP Match to prepare our students for their first PGY year of residency.

ACGME Continues Accreditation for all 3 UTMB Dermatology Department Residency and Fellowship Programs

Congratulations to the UTMB Department of Dermatology for receiving continued ACGME accreditation for all three of its residency and fellowship programs: Dermatology, Dermatopathology, and Micrographic Surgery and Dermatologic Oncology (Mohs).

Dermatology Scheduling Advice for UTMB Medical Students

UTMB Dermatology encourages our medical students to learn about dermatology throughout medical school, starting in the first year. Here is the outline of the available opportunities currently available and the timeline for those who are seriously thinking about a dermatology career:

First Year

1. Sign up for the UTMB Dermatology Interest Group (DIG) during orientation. Joining this student organization will put you in contact with other dermatology-minded medical students in your own class and upper level students. You will learn more about dermatology research opportunities, dermatology-related community service, and leadership positions in the DIG. Early during the first year the DIG conducts a meeting to discuss dermatology opportunities at UTMB and the Dermatology Program Director is available to answer questions. The DIG also conducts a suture workshop in the second half of the first year, and DIG members have priority (space is limited). The UTMB DIG has a blog that has been continuously published since 2004 and is a treasure trove about UTMB Dermatology activities ( digutmb.blogspot.com )

2. Sign up for the St. Vincent’s dermatology clinic that is held the first Thursday of every month. You will take care of unfunded patients with skin diseases and be supervised by current UTMB dermatology residents and faculty. It is a good way to learn more about the UTMB Dermatology Department.

3.There are unfunded preclinical dermatology preceptorship rotations (DERU-1050) of 4 week duration for first year medical students during the months of May and June.  Four students may participate each month. UTMB holds a meeting in January each year to let first year medical students know about summer clinical and research opportunities, and immediately after the meeting you will be able to sign up for what interests you. All students interested in the preclinical dermatology preceptorship will be randomly selected for preceptorship positions. During this preclinical rotation you work in the UTMB dermatology clinics along with the dermatology residents and faculty, and attend dermatology conferences. You will also receive graduation credit for this elective. This is where most first year medical students have the first opportunity to collaborate with dermatology residents and faculty on poster presentations for the fall meeting of the Texas Dermatological Society and other conferences. This is an early start for your dermatology research experiences.

4. UTMB also offers bench research opportunities for first year medical students through its Medical Student Summer Research Program ( https://researchexperts.utmb.edu/en/publications/the-medical-student-summer-research-program-at-the-university-of- )Stipends are typically provided. Participants present their research at a poster conference on campus where awards are given. Although the UTMB Department of Dermatology does not currently conduct bench research in the department, other labs on campus are investigating dermatology related topics.

5. If you have a dermatology research project in mind and have identified a faculty mentor, you should consider participating in the UTMB Dermatology Honors Research Program. Successful completion of the program (thesis defense) will result in Latin research honors at graduation. You also receive BSHS Selective credit upon successful completion of the program if you register for DERU-4004 during your MS4 year. Most students who participated in this program published their thesis in a peer-reviewed dermatology journal as the first author and they are dermatologists now. For more information see https://escholarship.org/uc/item/6471z2jq The new faculty in charge of this UTMB program is Bret T. Howrey, PhD (Family Medicine).

6. Medical students also have the chance to help current dermatology residents with their scholarly project, a graduation requirement for the UTMB Dermatology Residency Program (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726645/ ). Completed projects are usually presented at the spring Texas Dermatological Society meeting, and some are published. You be given credit as a author of this work if you contribute to this work.

7. Work hard in all of your courses. Even though UTMB is now pass/fail, your performance will still be considered for Alpha Omega Alpha (AOA) membership in the MS3 and MS4 years. The more you learn during the first year of medical school, the better you will do on Step 1 at the end of your second year.

Second Year

1. Continue participating in DIG meetings and activities (it is never too late to join if you have just become interested in dermatology)

2. Continue to attend St. Vincent’s dermatology clinic on the first Thursday of each month (it is never too late to start going)

3. Continue working with residents and faculty on presentations for the Texas Dermatological Society fall and spring meetings (and other dermatology meetings)

4. During POM2, all second year medical students will be assigned to one dermatology clinic. If your POM2 faculty is a dermatologist, you will have a second chance to go to dermatology clinic as your “wild card” clinical experience.

5. Continue helping current dermatology residents with their scholarly projects.

6. Consider taking a research year at the end of MS2. A dermatology research year should improve your application due to additional research activity that lead to presentations at national meetings and peer-reviewed publications, making your dermatology residency application more competitive. Downsides are that they are not usually paid, not offered at all medical schools, do not guarantee a dermatology residency match, and delay graduation.

7. Take Step 1 preparation seriously and study hard to do the best you can.

Third Year

1. Continue participating in DIG meetings and activities (it is never too late to join if you have just become interested in dermatology)

2. Continue to attend St. Vincent’s dermatology clinic on the first Thursday of each month (it is never too late to start going)

3. Continue working with residents and faculty on presentations for the Texas Dermatological Society fall and spring meetings (and other dermatology meetings)

4. During the 3^rd year, you will have two opportunities to take dermatology electives. UTMB Dermatology offers more dermatology electives than most other programs. In your third year schedule, you will have the opportunity to take a 4 week dermatology elective. In addition, you may also take a 4 week dermatology electives during Period 13 (holiday period). Period 13 dermatology electives fill up fast, so if the student quota is full, ask to be placed on the waiting list. Electives offered are described here: http://ar.utmb.edu/SOM/Electives/blist.asp?dc=der

5. Start planning your away dermatology rotations through VSAS ( https://apps.aamc.org/vsas/public.html#/find-electives ) . An application is required and away rotation spots fill up fast, so you should consider applying to several programs for each Period that you want to be away from Galveston. Away rotations are very important for successful matching in dermatology. Over half of dermatology matches occur at the applicant’s home program or at a program where the applicant has rotated. The best times to rotate are from the end of MS3 until the end of October. Good places to rotate are institutions where students from your school have matched in the recent past. It is also better if the away rotation takes 4 or more residents each year. If you have a legitimate geographic or personal ties to the away rotation site that is a plus (programs think you may be more interested in going there).  Beware of programs that accept lots of rotators but do not interview all of them (you still may want to rotate there for a variety of reasons, but don’t go there if you are counting on an interview with them). It is debatable if a 2 week rotation (some of these are available) is as valuable as a 4 week rotation in terms of chances for a match at that program. If you are accepted to more than one program, be courteous and decline the rotation right away.

6. Consider taking a research year at the end of MS3. This may be a serious consideration if the applicant has just recently become interested in dermatology but has no dermatology research. A dermatology research year should improve your application due to additional research activity that lead to presentations at national meetings and peer-reviewed publications. Downsides are that they are not usually paid, not offered at all medical schools, do not guarantee a dermatology match, and delay graduation.

7. Although it is not absolutely necessary to take Step 2 CK and CS at the end of the second year, a growing trend is for institutions to require these tests in order to place you on the NRMP match list. It is better to study hard for these exams and get them out of the way early (Step 2 CK is usually higher than Step 1, so it also helps the applicant)

Fourth Year

1. Continue participating in DIG meetings and activities (it is never too late to join if you have just become interested in dermatology)

2. Continue to attend St. Vincent’s dermatology clinic on the first Thursday of each month (it is never too late to start going)

3. Continue working with residents and faculty on presentations for the Texas Dermatological Society fall and spring meetings (and other dermatology meetings)

4. UTMB requires an Acting Internship (AI) for graduation, and fortunately UTMB Dermatology offers one of the few dermatology AIs in the country (see  https://escholarship.org/uc/item/63d8j499 ) It is best to take this early in the MS4 year so that you already have the skills and knowledge to impress faculty at your away rotations!

5. ERAS opens in September of your senior year. Everything should be ready to go on the first day (including letters of recommendation from dermatology faculty). That is because most dermatology positions are offered as advanced positions (dermatology residency does not begin until the applicant has completed a PGY1 year in an accepted clinical specialty such as pediatrics, internal medicine, family medicine, surgery, obstetrics/gynecology, emergency medicine, or a transitional year. Taking a PGY1 year in any of these programs starts the Medicare Funding Clock.  This often becomes a funding issue if the dermatology applicant does not match into a dermatology advanced position at the time of the PGY1 match. Dermatology requires 4 years of residency (PGY1 + PGY2, 3, and 4 in dermatology), and Medicare starts the residency funding clock running at the time of the initial match. Since Medicare funding is only 3 years for pediatrics, internal medicine, family medicine, and emergency medicine, if an advanced dermatology position match does not occur at the same time, those reapplying to dermatology have one year of residency that is not completely funded by Medicare. Some institutions are unable to fund this additional year, and are not able to consider taking an applicant under these circumstances. However, if the applicant takes a PGY1 year in surgery (5 years of funding) or in obstetrics/gynecology (4 years of funding), complete Medicare funding is available if the surgery resident did not spend more than 2 years in the surgery residency or if the obstetrics/gynecology resident did not spend more than 1 year in the program. If the applicant matches into a transitional PGY1 year and does not match into dermatology right away, there is no Medicare penalty since the transitional year does not start the funding clock. Transitional and preliminary program interviews in all of these residency programs fill fast, so early application is advantageous. Applicants will usually start going to these interviews as early as September. Dermatology residency applications typically occur much later, with some as early as November. However, the vast majority of dermatology interviews occur in January, so it is wise to take vacation that month or take a didactic elective or BSHS Selective where presence on campus is not required. UTMB Dermatology offers 4 didactic electives (DERU-4007, DERU-4008, DERU-4011, DERU-4017; see http://ar.utmb.edu/SOM/Electives/blist.asp?dc=der )  and 3 didactic Selectives (DERU-4012, DERU-4051, and DERU-4402), that include the option of teleconferencing or make-up written assignments for each class meeting if you are away for interviews (see http://ar.utmb.edu/BSHSselectives/brochure.asp?dc=der ) . A BSHS Selective, a writing requirement is required by UTMB for graduation. Try not to be in a situation when you cannot go to interviews because you are on a rotation that only permits two absences! The more interviews you go to , the better your chances for a dermatology match. 

• As mentioned, advanced residency positions are the most common type of dermatology residencies. There are also a few categorical dermatology residency programs where the applicant spends 4 years training at a dermatology residency in the same institution that includes the PGY1 year. In addition there are combined dermatology/internal medicine and combined dermatology/pediatric residency programs that are 5 years long (2.5 years of dermatology and 2.5 years of internal medicine or pediatrics with completing residents eligible for board certification in both specialties) which also includes the PGY1 year.

6. Some applicants who like dermatology and a different specialty make dual applications to both. This can be difficult due to time restraints for several audition rotations in two different specialties. Other issues are obtaining letters of recommendation from two sets of physicians. Some of these applicants do not to apply to both departments in the same institution. If discovered, applying to two different specialties may indicate lack of applicant commitment to both of them. Sadly, some applicants who match into their backup specialty still want to become dermatologists and are later unhappy with this choice.

7. Match day is held in mid-March. That is when you find out if you matched into a dermatology residency and where you will be going for the PGY1 year. Dermatology has some categorical dermatology programs (where you do the PGY1, 2, 3, and 4 years at the same institution), but they are relatively rare. If you have not matched into dermatology (it is a very competitive match), it is still possible to become a dermatologist, but it is a path best taken by applicants who are very committed to a dermatology career, because success is not a guarantee. There are three main ways this is accomplished:

             

1. At the end of the PGY1 year and successful completion of Step 3, begin a dermatology clinical fellowship. These are not accredited by the ACGME and do not count toward the required 3 years of dermatology residency. Typically the fellow conducts clinical research under the supervision of the clinical investigator, resulting in meeting presentations and publications. Quality of these fellowships and reapplication success vary. It is bests to work with a mentor who has a good track record of helping the fellow successfully match at that institution or other dermatology departments. There are no guarantees of a dermatology residency match. Fellows may stay at the same institution for several years before matching, or may try switching to different clinical dermatology fellowships at different places. Fellows often work with dermatology residents, and learn lots about dermatology while in the fellowship, often becoming expert in clinical research and new drug therapy for skin diseases.

2. Stay at medical school another year (“super senior”) if you have not matched into a PGY1 program and have not yet completed all graduation requirements (Some applicants send in their NRMP match list with the contingency that they don’t want to match into a PGY1 position if they fail to match into dermatology, although matching into a PGY1 transitional year in this circumstance will allow the applicant to apply for a dermatology clinical fellowship since a medical license is needed for most of these. In addition, if the re-applicant is a PGY1 transitional physician, there is always the chance that additional positions will open during the current academic year in the “Physician Only” track that the PGY1 transitional could obtain). Some schools permit you to stay for an additional degree (MS, MBA) and you can use that time to take additional away rotations and conduct dermatology research. This could increase the quality of your application, although it will only be about 5 months before you will need to submit another ERAS application.
3. Another strategy is to become board certified in a different specialty first before reapplying to dermatology. This strategy relies on the future needs of specific dermatology residency programs. Even though Medicare funding has been exhausted, new departments may be in need of physicians who will be able to immediately provided needed clinical skills to care for dermatology patients. High demand physicians are board-certified in pediatrics, internal medicine, surgery, or dermatopathology (initial pathology residency). The pathology trained dermatopathologist will also need to take a PGY1 year in one of the required clinical specialties before starting dermatology residency, because the pathology residency does not meet the clinical requirement for dermatology.

8. UTMB still requires all students take neurology and emergency department electives prior to graduation. The best time to take these is during Periods 8, 9, 10, or 11.

DIG Meeting for Rising 3rd and 4th Year Students (2/10/2020)

UTMB DIG will hold a meeting on Monday, February 10^th to discuss 4^th year schedule planning for UTMB medical students applying to dermatology residencies. The meeting will be held in the 5th floor Dermatology conference room (5.124) at 5 pm. UTMB Dermatology Program Director Dr. Wagner will be present and we will cover logistics of fourth year scheduling, away rotations, and the residency application process. This meeting will also be open to more junior students to discuss scheduling and dermatology electives. 

DIG Suture and Procedure Workshop (2/3/2020)

UTMB DIG will be hosting its annual Suture and Procedure Workshop on February 3^rd at 5pm in the 4th floor Dermatology Conference room (4.130 McCullough Bldg). Seats are limited so please only RSVP if you are certain you can make it. Preference will be given to first and second year medical students. Please use this link to sign up: https://forms.gle/zyckWmZ2eijw4YKe9 Confirmation or wait-list emails will be sent out 1 week in advance. 

Mohs Match Remains Highly Competitive

Data from the December 2019 Mohs Match for Fellowship positions starting in July 2020 indicate that the 70 participating programs offered 82 positions, and filled 81 of them. 141 applicants participated in the match, so the match rate was about 57% (81/141).