Preparing for Dermatology Residency

Written by Chen (Amy) Chen, M.D.

Dr. Chen (Amy) Chen is a dermatology resident at the UCSF School of Medicine Department of Dermatology and a graduate of Harvard Medical School and Harvard College.

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How to Prepare For Dermatology Residency

This month, thousands of medical students across the country found out their match results and learned about their future specialties and career paths. Match Day is an incredibly exciting time, but also a time that can cause anxiety and stress. For dermatology applicants, it can signal a time of transition and new directions, with an upcoming internship and then a separate dermatology residency a year later. In this article, we hope to provide some insights and strategies into preparing for dermatology residency after match, from the perspective of a current dermatology resident.

Dermatology is an incredible specialty. You have the privilege of seeing patients with a diverse range of skin conditions from all different backgrounds. It is incredibly rewarding, but can also be a very different environment from that of standard medical school rotations and intern year. For example, as an intern, I spent most of the year on medicine wards, carrying a list of 5-10 patients. I would get to know them all well as we rounded on each patient every day for about  15-30 minutes each, and I put together their admission H&P, progress notes, and discharge summaries that included all of their medical problems, history, and details of their admission. Although the days were long and on admitting days I often would not leave the hospital until 7pm, there was often downtime in between to discuss patients with my co-interns, eat lunch, review their medical history and chart thoroughly, and so on. Dermatology residency is very different – most of the year is spent rotating through different outpatient clinics, where we often will see 8-12 patients in a half day, with appointment slots averaging about 15 minutes. The environment is fast-paced, and I often only have time to do a quick 2-3-minute chart review of their last visit before walking in to see the patient in the room. The history and physical is skin-directed, and one of the skills that I have learned over the past 2 years is getting a sense of how deeply to dive into the patient’s other medical issues to obtain a full dermatologically-relevant H&P without running overtime. There is often no time to write notes before seeing the next patient, so I jot down a couple reminders to myself, order the relevant labs and tests, type up their after visit summary and follow-up, and then go see the next patient. I typically write my notes during lunch or at the end of the day, which can be challenging after seeing so many patients. Over the past few years, I have learned several tricks to help myself become more efficient: I try to type the history directly into the note during the patient visit, jot down the key physical exam findings and assessment and plan to remind myself later, and use “smart phrases” for common lesions such as nevi, seborrheic keratoses, and cherry angiomas, and counseling for commonly-prescribed medications. Being familiar with a chart of topical steroids arranged by potency is helpful, and understanding which medications are likely to be covered by your patient’s insurance plan can help reduce the number of prior authorizations, and help your patients get their medications faster. In addition, while topical steroids are commonly prescribed, we will often also prescribe other medications that may require lab monitoring or baseline tests, and being familiar with those medications, counseling, and tests is helpful.

I also downloaded the following apps onto my phone, which I reference frequently:

• Epocrates: has a large drug database of almost all medications that we use, which can be searched for to find the recommended dosing, contraindications, lab monitoring, and counseling
  
• CorticoCalc: a helpful app to determine how much topical steroid should be prescribed in order to cover a certain body surface area for a certain frequency of application and amount of time
  
• UpToDate: a super useful resource to help with diagnosis and management
  

The learning curve for dermatology is steep! Unfortunately, we don’t get much exposure to the field as a medical student or as an intern. Starting dermatology residency can feel like starting medical school all over again in terms of knowledge and the sheer amount of new information, and can feel like jumping into the deep end of the pool. However, know that everybody else is probably feeling the same way too, and the upper-year residents, fellows, and attendings have all been in your shoes before. A lot of the learning is done hands-on while in the clinic, but most programs will also expect you to read a substantial amount. Most programs will provide you with a reading schedule. I don’t recommend reading too much dermatology during intern year, since a lot of the information will stick much better once you are actually in the clinics, and you should enjoy the limited time off that you have as an intern! However, doing some elective rotations in either rheumatology or dermatology (if you can) during intern year can be helpful to start to expose you to some of the common dermatologic conditions. Once you start dermatology residency, I would recommend coming up with a reading schedule for yourself for the year. During first year, it can be hard to find any time to read, but making a schedule can help keep you on track. For my first year, our program recommended that we read all of Bolognia, which worked out to be about 2-3 chapters a week. I made it a point to read 1 chapter each on Saturdays and Sundays (unlike intern year, the vast majority of your weekends during derm residency should be free!), and 1 chapter during the week during my half-day of academic time. In doing so, I was able to finish Bolognia by the end of my first year. I also learn better by answering questions, so I signed-up for some free question banks and made it a goal to do a couple questions each day. Some of the apps I recommend downloading onto your phone for learning are:

• Derm101: a question bank that has a mobile app. Useful to start in second half of first year. It is very easy to do a couple of questions a day during down-time
  
• Dermatology in Review: another free question bank that can be done online
  
• Visual DX: I use this app as an atlas to look at different dermatologic conditions to help train my eye to recognize them based on morphology
  

Other things that you can consider doing in preparation for derm residency is to start to establish mentors or research projects. Research is not essential as a resident, although many programs encourage research and scholarly pursuits. For example, I had a month of research elective time during my intern year, and I reached out to the program director of my dermatology residency to see if there were any research projects that I could work on remotely. We ended up publishing two publications together, and it was a great experience.

Overall, dermatology residency is an incredible experience, and I feel incredibly lucky to be a resident every single day. While some of the days can be busy or stressful, it is such a privilege to be able to take care of patients and to be mentored by such incredible attendings. I wouldn’t change it for anything!