DIGA Newsletter: Summer 2019 Edition

Diversity in Dermatology Chair

Itisha Jefferson

Loyola University Stritch SOM

Melanoma & Sun Protection Chair

Jamie Schlarbaum
University of Minnesota SOM

Professional Societies Liaison

Jennifer Strunk

Albert Wu, New York Medical College

Background: Prior to his tenure as Chair of the Dermatology Department at New York Medical College, Dr. Safai served as the Chief of Dermatology Service and Director of the research program at Memorial Sloan Kettering Cancer Center (MSKCC). His research contributions include providing a viral etiology for Kaposi's Sarcoma and initial identification of the HIV virus. For this column, we chose to focus on questions that incoming medical students might have on informing their interest in dermatology and medical research.

You have quite a geographically diverse medical education background: a medical degree from Tehran University, a fellowship at Memorial Sloan Kettering Cancer Center, and a Doctor of Medical Sciences from the University of Gutenberg. What experiences lead you to pursue dermatology as a career?

I was born in Ardestan, a small city in Iran. I held an early interest in astronomy: during that time, there was a lot of talk about going to the moon, and I was so excited that I wanted to become an astronaut. Education was highly prioritized by my parents, who saw it as an essential path for a stable future, and I spent many hours studying under the guidance of my mother. I ranked fifth in the nation on the national college entrance exam Konkor, and in Iran, highest level of education is in medicine. So, I went to Tehran University Medical School, and became a doctor. Of course, I wanted advanced training, so I came to the United States. I still felt too spread out, and wanted a field to really hone in and focus my skills on. I decided to do dermatology because at the time, it was still a small field with a lot of unknown territory. I trained in dermatology at NYU, and as I finished, the field of immunology was starting to see some activity. The t-cell had just been described, and there was a lot of potential to learn new things in the field, so I decided to take a fellowship at Memorial Sloan Kettering (MSK) Cancer Center, one of the largest and most renown cancer centers in the world. It turned out that many of the aspects of immunology I learned could be applied to dermatology, and I was able to combine the two together. I was offered a position at MSK, and established the Dermatology program. It was challenging to build a program from the ground up while doing research, but my goal was to have a strong program with three important aspects: research labs, research fellows, and a large patient population. I was eventually selected for the Chief of Service by the Center’s research committee. While writing grants and applying for funding, I would meet many intelligent and established individuals, physician scientists who were MD-PHDs. I felt that in order to further progress in my field, I needed to also become a physician scientist. After working with the Gutenberg University in Sweden and splitting time between my research and my thesis, I was able to receive the equivalent of a PhD, a Doctor of Medical Science (DSc), as well as the title of associate professor. As I continued to do research, I increasingly saw the role of the immune system in skin diseases. In the 1980s, I was able to concentrate what I had learned into the book “Immunodermatology”, helping to establish and define the field as well as pass on what I had learned.

What questions/decisions should a medical student ask themselves before deciding to go into dermatology, and what can they do to help themselves make that decision?

I think that dermatology has expanded into a very broad specialty. This is exciting because there are a lot of areas in dermatology which can be advanced through research, and for students wanting to go into academia, the unknown field is a gold mine. The other side of dermatology is aesthetic, or cosmetic. I don’t think this area is as scientifically explored yet- current treatments rely heavily on technical skill, like injecting fillers or botox. Even in that area, there are new frontiers that can be developed, such as factors to rejoin and rebuild aging skin. These are fantastic chances to investigate.

Students should ask themselves why they wish to go into dermatology, and to be honest with themselves about the reasons why. It is a very competitive field, and you have to be willing to put in a lot of hours to become a competitive candidate. I suggest that an interested student do some research, which programs also want to see, and develop an accurate idea of what is like being a dermatologist first.

In your opinion, what are some things for 4^th year medical students to look for in a residency as they submit their choices for match?

That depends on the student’s future plans. If they are looking to become a clinician, you need to look for a hospital or departmental program that allows for hands on patient care. Don’t be an observer, be the person who treats the patient and does the work. Large hospitals in the city or community hospitals are great site for training in not only in dermatology, but in every specialty. You get a much larger patient population, more resources, and exposure to more things. If the student are interested more in cosmetic dermatology or wants to own their own practice, try to go for a program with a lot of private practices in its network
.

In your opinion, what are some important qualities for a dermatology resident to succeed?

Curiosity and a sincere interest in the field are a must. I think if you are sincerely interested in dermatology, and willing to study and develop your interests, you would get very far in the field of dermatology. Of course, you have to show your interest during medical school by doing work which identifies you as an interested student. Residency is a golden opportunity to do research, to explore the unknown, or at least follow along with the trends of the time.

Could you speak a bit about the role academic medicine and medical research plays in the field, and your experiences with it?

I feel very fortunate to have entered into dermatology when it was still a very unexplored field. I was lucky to have the subjects I studied - immunology in particular- to become so applicable to dermatology. Research and academia were at the center of my life. I would not be happy to practice only clinical dermatology, in a private practice. Although I wasn’t making as much money, going into academia satisfied my curiosity and allowed me to be in the translational area and cutting edge of scientific dermatology. Research gives you unique skills and perspectives to approach the problems you try to solve or care for such in a patient. When I realized that Kaposi’s sarcoma was a model of a virally induced human cancer, this was directly contrary to the view at the time. Many saw cancer as purely due to cell mutations. Yet I kept seeing different results in the lab, pointing to a virus, and although it took a bit of time for the technology to catch up to identify the virus, research allowed me that first glimpse into the true nature of the disease. I was looking at the problem through the lens of academia, combine with a clinician’s point of view. Eventual identification of the etiologic virus allowed clinician to help and treat patients more effectively.

What are some aspects of being a dermatologist the beginning medical student might not know? Any myths to watch out for?

I think that there is truth behind the common stereotypes you hear about dermatology. As a dermatologist, you could select a very easy life, work a few hours, make a lot of money. Because of these desirable factors, dermatology has become a very competitive field to get into. But that is a part of dermatology that I am not really that happy about, and that I didn’t practice. It is also an aspect of dermatology not especially helpful to its image. I went into the field because I wanted to learn about different aspects of dermatological diseases, to do research, and explore new frontiers. In reality, you can have either path: It really depends on what the student/resident wants to do. But there is so much new to explore in the academic and scientific aspects of dermatology. Even widespread cosmetic techniques could be improved and scientifically advanced, by bringing them further into the academic realm. We need good students who can lead that change. In my opinion, those would make the best residents to watch out for.

You have done remarkable and extensive research in melanoma, Kaposi’s Sarcoma, lymphoma, and other skin disorders. How can a medical student inform their interest in pursuing research?

Regarding research, I usually tell my residents to ask a simple question: why does something happen? I pursue that, and I don’t usually give up. If I have to study it in the lab then I do that; if the question is not in my field of expertise or if I don’t have the technology to study it, then I go out and collaborate with someone who has the technology. The point is to keep trying to advance the field. I would say that if a medical student is interested in research, then a mentor is the most important person they should find- someone who has knowledge of the field and can guide them.

Do you have any advice for students interested in pursuing dermatology?

In my opinion, dermatology is a gold mine. If I could do it all again, I would choose the same path. Dermatology is a difficult field to get into. It was not easy when I got in 40 years ago, and it is not easy today. Like everything else in life, you have to work hard. So my advice is if you are interested in dermatology and you are sure about it-not because you want an easier life or to make more money- put effort into it, get someone to advise you, find a mentor, and push yourself until you get in. It is possible to get into dermatology, if they are truly interested.

Sun Protection and Melanoma Focus
Jamie Schlarbaum
University of Minnesota School of Medicine

Sun Safety Feature: Product Drives

This past spring, the University of Minnesota Dermatology Interest Group was involved in bringing extra products (hypoallergenic soaps, sunscreens, etc) from local dermatologists to the Minneapolis Crisis Nursery. The Minneapolis Crisis Nursery provides services and supplies to families in times of need in the Twin Cities metropolitan area. There is always a need for grooming products and especially a need for sunscreens! Following the AAD meeting, one dermatologist coordinated with DIG and local dermatology groups to donate over 10 boxes of products. If you are at a program with a dermatology program or have contacts to local dermatologists in the area, consider starting a drive to provide supplies to shelters in your area. Many products are not handed out in clinic, and there are so many extras that many end up being thrown away. This is a simple and easy way to make a difference!

Medical Student Resources: Opportunities to Coordinate Skin Cancer Screenings

There are a variety of ways to get involved with sun protection. One of them is to work with local dermatologists to coordinate your own free skin cancer screening! Many local DIG groups do these events each year. Please find a document on how to plan your own skin cancer screening here

Please consider filling out this database with information about your sun screening or contact information if you are interested in hosting an event! Please contact Jamie at schla255@umn.edu if you have questions or are planning a screening.

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Sun Safety Tidbits

Psoriasis Awareness

Stephanie Johng
Georgetown University Medical School

Hey DIG! My name is Stephanie Johng and I am this year’s Psoriasis chair for DIGA! I’m so incredibly grateful to share all of our efforts towards increasing awareness and advocating for psoriasis awareness.

The National Psoriasis Foundation (NPF) is a non-profit organization to increase awareness, drive efforts to cure psoriatic disease, and improve the lives of those affected. Since 2007, NPF has raised over 10 million dollars through donations and fundraisers.

Last year, DIGA’s psoriasis Chair Mai-Anh Vu, did an amazing job getting DIG chapters involved in regional NPF events. I’d love to continue this – any chapters involved in regional NPF (or any psoriasis awareness) events – please email me! I’d love to feature your chapter!

For more information/ registration, visit NPF’s website:

If your DIG chapter wants to get more involved but there are no NPF-sponsored events nearby, you can create your own charitable page on their website.

Finding Research in Dermatology

Megan O'Connor
Eastern Virginia Medical School

Late to the research party? Home school doesn’t have a dermatology department? Not sure if you want to pursue a research fellowship?

Wherever you may be or how late you are in medical school, plenty of opportunities for research in dermatology are still available. While the task of finding research may seem daunting, a few tips can help get you started on finding research and more specifically, finding your research mentor.

1) Location, location, location
What you research and where you complete said research are important. When you are working with a mentor, you build a connection and are fostering a relationship. Your home school likely has research opportunities, but if you want to go to different specific geographic location, think about how you can build connections and get your name (and ultimately your residency application) known in the area. Have you always wanted to go to California? Think about programs/areas there that not only interest you but also have opportunities for you.

2) Who does research in that location?
Once you have a location picked, think about who is actually doing research. Take a look at the program’s website and the physicians that are completing research. Many of the physicians have a specific niche within their field. What are their passion and interests? Do they have specific labs? Are they doing basic science focused research? Are their studies more clinically based? You don’t necessarily need to have a love of the exact work but, having an interest can help you determine your focus. Another pearl to add is that you may discover a passion only once you are in the thick of it.

3) Do they publish?
The goal of many students is poster/presentation/publication and finding an attending that also has a strong repertoire of research and published work is key. Utilize the physician names and cross-reference this with PubMed. Was the last publication from their residency days in the early 2000s? They may not have an active interest in publication. Alternatively, they may have a strong interest in research and publication, but their studies are intense, involved, and could take potential years to reach publication.

4) Do they take students?
Now you’ve done the hard work and found the attending you want to work for. He/she has impressive research and a busy schedule. While this can be to your advantage in that he/she will have high expectations you also need to be realistic in going forward. Will this individual be able to “take on” another student? Have students worked for him/her before? Has this attending helped students publish and succeed in matching into a residency? This is a key component and you need to think cautiously. You want to ensure that the research will not only help your path to become a dermatology resident, but will you be able to actually help the attending. While no research can be hurtful to your application, even worse for your application can be if you had a research project that ended poorly. Dermatology is a small field. Many of the physicians know each other well.

5) Is it paid?
Many opportunities are available for paid research such as a year-long fellowship. These are fantastic opportunities to get to know a department, build connections, and get your work published. Unpaid research is common and is fine as well. Another option is to pursue funding outside such as the SA Hambrick Medical Student Grant. You could mention this to your specific mentor and ask if they would help you pursue the funding for a project in their field of interest. This can help demonstrate your serious interest in their work and developing a project together.

A few final caveats:

Showcase Your Work!

Susruthi Rajanala
Boston University School of Medicine

Hi all! As Public Relations and Social Media Chair, I would love to showcase all of the amazing work that the institutional DIG's as well as our board members are doing. Whether you organize an event, publish a paper, present a poster, or are doing other work in the field, I encourage you to send along pictures so I can share them across our social media platforms. You can email me at susruthi@bu.edu or send them as a direct message to our Instagram account @derminterest. Thank you!

The next edition of the DIGA newsletter will be in the Fall. For publication in our Fall 2017 newsletter, please submit the following by September 15, 2019 to diganewsletter@gmail.com:

> Short articles about your DIG's events and activities, accompanied by photos
> Research opportunities
> Creative writing or reflections
> Opportunities to increase medical student involvement within the dermatology community

We look forward to hearing from you! :)