2. Why did you choose to go into academic medicine? How and when does one develop that interest and make the decision to become a researcher/educator and a physician?

‘ I believe that career development is a process that is constantly in evolution. I graduated from medical school with the aim of becoming a physician-scientist with a lab dominated career. When I realized that clinical medicine was my passion, I decided early during residency to not pursue that pathway. My PhD was in immunology, and that gave me a rich background because it was so relevant in many skin pathologies. In the end, it was time well spent because it helped me think about diseases in a different way.
I decided to go into teaching and academics during my third year of residency. There are many forms of teaching, including teaching others in the field, educating the next generation of dermatologists, and being able to think and write things about dermatology that would spark interest in research. It was a gradual process for me, and I think that medical school is too early of a time to make the decision. Residency would be a good time to think about it- medical school should be a time for learning the language and culture of medicine, and the essential skills for becoming a physician.’

3. From your experience as Residency Director, how do you think residency program admissions have changed and evolved? 

There have been tremendous changes in residency selection, and in dermatology as a whole, which reflects who we are and who we think the next generation should be. Conversations in dermatology have largely paralleled trends in medicine. For example, increasing diversity is a priority for residency selection. The challenge has been in operationalizing that: there have been a lot of discussions focused around the best practices for holistic review, finding the best applicants, and even re-defining the best candidates. UCSF is no exception: we have really proposed a genuine holistic review. During my first year as residency program director, we took off all sorting filters from our candidates. We also double read applications from underrepresented minorities. There is also tremendous education on implicit bias being conducted for the faculty and resident community. This includes professional workshops, methods of making an inclusive learning environment, and addressing topics such as racial microaggression. Each year we evolve and refine our system. We are only one program, but having these aims are our priority.

4. Follow up-there has been talk about how STEP 1 will change to Pass/Fail. Do you think this might affect how residency programs select candidates?

In the early 2000’s, there was a study asking dermatology residency program directors to rank the traits they looked for in applicants. One of the highest rated traits was the STEP 1 score. This adjustment could inherently change the way we evaluate applicants. I believe that the USMLE is only one measure of medical knowledge, which is only one of the six competencies of being a physician. It is important to be knowledgeable, but it is not the only important measure in becoming a good physician. Taking the score off is a good aim, as it may allow applicants who are average standardized test takers to have their other excellent traits be seen and shine. We know there is systemic bias in standardized testing, so I think this is an important, evidenced-based consideration by the NBME.
There is one other trend currently occurring that I want to comment on: many programs are getting rid of an honors grading system in favor of a pass/fail system. I do have concerns that without both Honors grading and a Step 1 score, we are going to lose some ability to assess medical students at large. It becomes difficult to compare applicants from different schools. There is a risk of other forms of bias and disadvantage to further enter the system, such as the reliance on social capital and networks to gain residency positions. There will have to be efforts at the school and program director level to evaluate the many ways to assess students for their competencies as physicians and future dermatologists.

5. What should students prioritize when ranking their residency programs?

'It is important to find a program which is a good fit, either for the skillset they want to learn, the patient population they want to treat, or the geographic location. Academic programs are different in terms of subspecializations (including procedural dermatology, dermatopathology, and pediatric dermatology), and each has different strengths and interests to which students should align their own learning goals. Patient population is also very important: the more patients you see (in terms of number and diversity), the better dermatologist you are. Programs with lots of clinical exposure and mentored learning are the best, especially those which prioritize their educational philosophy and deliver in terms of learning opportunities and didactics.'

6. In your opinion, what are some important qualities for a dermatology resident to excel?

'One of the most important things is understanding that getting into residency is not the end goal, but the beginning of one’s career as a dermatologist. Applicants should pace themselves to develop as a physician and select a residency program that allows them to learn dermatology in a way that aligns their competency as a dermatologist with their excellence as a physician. It’s not an easy thing to do, but it should be a critical aim.' 

7.How do you see the field of dermatology and dermatological research changing in the next few years?

Dermatology research is an incredibly diverse field, and I am always humbled and amazed to be able to watch the specialty thrive and evolve from the vantage point of a journal editor. Dermatology is just catching up with the trend of finding evidenced-based, high value, and cost-effective methods to treat patients. We are trying to identify and improve on practice gaps to take care of both our patients and our healthcare system, and to retain our scope of practice. There is also some incredible movement in understanding pathophysiology due to huge advances in gene sequencing and molecular biotechnology. It is helping us identify risk factors that predispose patients to disease, as well as cost effective ways of treating them. Artificial intelligence is also a growing field which we can use to improve our practice in terms of diagnosis and treatment of patients, as well as identifying at risk populations for disease and providing remote access to care.

8. Student Submitted: You’ve had a storied career alongside your clinical practice, having heavily integrated yourself in the UCSF Dermatology Program, The American Academy of Dermatology Leadership Program, AND become the Editor in Chief of the largest Dermatology journal there is. How does someone even begin to get involved in any of those things, and what does it take?

'I am fortunate to have had the chance to train at UCSF and be at the intersection of many different groups, including the AAD and JAMA dermatology. One of the wonderful things about dermatology being a small knit community is that there is a lot of generosity. If you have passion about something and want to contribute, people are very welcoming and will help cultivate your interests. The other piece for me has been mentorship and sponsorship. I have benefitted from the guidance and promotion of so many people. It really takes a village: even students and peers of mine have really helped me grow as a person, as a physician, and as a dermatologist, and helped me see the best in myself and identify ways I can contribute to the specialty.'

9. Do you have any advice for beginning medical students with an interest in dermatology, and how they can inform their interests and become a competitive candidate?

One of the travesties of medical education is that there is so little exposure to specialties in training. No matter what specialty you go into as a physician you should have a wide breadth of exposures. Medical school should be the time to soak up as much clinical exposure and different specialties and try to understand different vantage points and perspectives. Physicians in different specialties think differently and see things from different frameworks. You should involve yourself to clinical experiences to help round out your experience as a medical student and round out your perspective in the field you choose to pursue, and it helps you find your people. Choosing dermatology is not just about the clinical material but finding people who think like you. This requires students to be proactive, to seek out preceptors and mentors to have those experiences, and it is never time wasted. Dermatology is such a broad field, and you should seek multiple experiences and mentors to get a sense of as many clinical areas as you can.
In terms of becoming a competitive applicant: a lot of that is your evolution, including doing well on all your rotations and honing your doctoring skills. There is an emphasis on Step 1, but you should be trying to maximize your medical school experience. Thinking about getting into residency isn’t the most satisfying the way to build your career. I think that really developing yourself as a physician and following your passions are much more important and will shine more brightly on your application than checking off boxes for residency. Reflecting on what makes you tick, and working to develop those passions (aka fostering intrinsic motivation) will set you up to have a long and fulfilling career, far more than working to fulfill extrinsic motivations. To give a concrete example: people think residencies value publishing and doing research, but quite frankly, research is not for everyone. I think spending a lot of time doing research when it isn’t interesting or doesn’t fuel your passion isn’t time well spent, especially if you are interested in contributing in other ways that would better utilize your skills, such as developing a volunteer program or learning about a clinical disease. Of course, don’t blow off research (if you are already doing it) or step 1, but just think about following your passions and being the best you can be at that rather than just fulfilling criteria for residency.

10. Last one- do you have a skincare routine? Any tips on how to maintain good skin health, especially for someone who enjoys surfing/outdoor activities such as yourself?

Everyone should pick a routine that fits your skin type. For example, I have sensitive skin so I find products which are more hypoallergenic to get around that. I believe that simple is better, and I use very few skin products. I am also a huge proponent of mineral sunscreens, and I love trying new products and finding fashionable photoprotective clothing since I do a lot of water sports.
 

Sun Protection Column
Jamie Schlarbaum, University of Minnesota School of Medicine

 

This list is an excerpt from the DIGA Interview Tips Manual.  If you are interested in learning more, you can read the full article on our website!

Common Interview Questions: Address your plans for the future, why you chose the programs and what you will bring to the program if selected. Be prepared to answer these types of questions multiple times throughout the interview process.
- Tell me about yourself.
 - Why do you want to become a Dermatologist?
- Who is your role model and why?
- What is your greatest strength?
- What is your greatest weakness?
- Have you done any research? If so, tell me about it.

Personal Interview Questions: Personal interview questions are questions about your personality, your work style and work ethic, how you handle stress, what you expect from an employer, and how you handle certain situations.
 - What are your 5 – 10 year goals?
- What are your interests outside of medicine?
- What are you looking for in a program?
- How would your friends describe you in one word?
 - What qualities do you feel you can add to our program?
- If you could not be a physician, what other career would you choose?
- What do you believe sets you apart from other candidates?
- What are your interests outside of medicine?

Experience-Related Interview Questions: These questions typically encourage applicants to elaborate more on the extent of their clinical foundation and/or experiences. They focus on the applicant’s perceived performance and address any challenges that may stand out.
- Tell me about a particularly memorable patient.
- Tell me about a challenging time you had in medical school.
- Tell me about a patient care mistake you made and what you learned from it.
 - How do you stay current on new findings within your specialty of interest?

Emotional Intelligence Interview Questions: These questions focus on how the applicant manages themselves and their relationships with others.
- How would you handle working with someone you disliked?
 - Describe an incident when communication was difficult (with a peer/colleague) and how you managed that difficulty.
- What causes you stress and how do you deal with it?
- Tell me about a time you failed and what you learned from it.

Wild Card Interview Questions: These questions are designed to throw you off. There is no “right” answer to any one of these questions. Focus on remaining honest and don’t be afraid to take some time to think of an answer if needed.
 - What is the most adventurous thing you have ever done?
- Tell me about your favorite non-medical book or movie.
 - If your house was on fire, list three things you would save.
 - How would you spend 1 million dollars?
- Tell me a good joke.
 - Teach me something non-medical in 30 seconds.

 

The leaves start to fall and change to their beautiful colors of yellows and reds. The weather starts to drop and people are seen wearing more layers of clothing but there is one thing most people, especially people of color, must prepare for: battling against the dry skin or "ashiness" when winter comes! Xerosis, or "dry skin", is common in darkly pigmented individuals, Fitzpatrick Skin Type IV to VI (1). There tend to be a physiological difference among the Fitzpatrick Skin Types 1 to VI (1-2). The barrier function of the stratum corneum (SC) differs between skin types and has been greater in darkly pigmented skin (2-3). The SC of darkly pigmented skin tends to have higher transepidermal water loss (TEWL), lower water content, and lower pH (1, 4-5).
            Ashiness is used to describe another condition characterized by any xerotic process with loss of natural skin shine that prevails in individuals with dark skin complexion that presents as whitish areas (6). Winter can have a big impact on the physiological and structural changes. The cold environment can change the activity of desquamatory enzymes (6-8). This occurs when the humidity of air is reduced with ensuring water depletion in the outer SC (6, 9-10).  Dark skinned individuals should moisturize, use lukewarm water showers instead of hot water showers, use a mild cleanser, limit the amount of exfoliation and ensure the products used have sun protecting factors (SPF) (11). Although it is winter, dark skinned individuals should still protect themselves by using sunscreen with an SPF of at least 30 (12).  
Current research is studying 3D in vitro reconstructed skin model to show the unexpected differences in epidermal morphogenesis and differentiation between keratinocytes of Caucasian and African skin types (Fitzpatrick Skin Types 1 to V1), which can hopefully be used to create cosmetic products to the different skin types (2).
 
References:

 

The DIG chapter at the Loyola University Chicago Stritch School of Medicine has participated in numerous community service activities this year. One of the outreach events took place in March 2019, where chapter members volunteered at Proviso East High School's annual health fair. They shared information on sun safety and common skin conditions to high school students.

Mentorship in Medical School
Megan O'Connor, Eastern Virginia Medical School

You're just starting your first year of medical school. You feel lucky to be in medicine and are well on your way through the first few months of didactics. Yet, with Anatomy looming, even thinking about residency applications can be scary. You've thought about Dermatology as a potential option but are unsure and possibly even intimated about the process. While the residency application process can be challenging, preparation during your early years of medical school can help your application and increase your likelihood of matching. Academics and board scores are important, but they are not the complete application. Research is a component to help further bolster your application. To find research opportunities, you will need a mentor. Here a few tips for the first-year medical student in finding a mentor.

Find Peer Mentors
Who are the students in the classes ahead of you that are pursuing Dermatology? What steps did they take? Who has supported them? Find your support team within your school. These students may have research projects you can help with and even projects that could become your own. Finding peer mentors will also help you determine the amount of support available at your school. If other students have paved the way already, ask for help in your pursuit of research and in preparing your future residency application. These individuals can introduce you to faculty as well as their own research mentors. Dermatology is a small field, try to find an additional advocate to fight in your corner. Through this process, it is crucial to be professional and avoid coming across as too aggressive. Be helpful, say yes, and always remember that you are not “owed” anything.

Find Clinician Mentors
If you do not have a home program, you can still find research. The key is to be proactive. Your local area may have Dermatology mentors, or alternatively, you could find a mentor online through the American Academy of Dermatology website (https://www.aad.org/mentorship/) or through the Skin of Color Society Network (http://skinofcolorsociety.org/about-socs/). Ask your mentor, medical school faculty, and colleagues. Do specific names of researchers keep coming up? Try to volunteer to assist with these clinicians’ research. One of the key aspects is networking and establishing your reputation as a proactive and interested student. Consider attending your program's grand rounds and journal clubs. You may find a mentor amongst the clinicians or even find an area of medicine that interests you to develop your own project. Finding your potential mentor in the fall/winter of your first year can help set you up for the summer after your first year of medical school. Ideally, your research project would be completed during this summer with potential continuation through your M2 year and accepted manuscripts in reputable journals by August/September of your 4th year. Physicians may not have time or want a student for research. This is okay. Don’t be hurt by the rejection and instead thank them for responding to you. Also remember that research need not be strictly dermatologic, especially early on. However, finding Dermatology mentors and projects is invaluable (read necessary) for success in the match.

Find Remote Mentors
What you research and where you complete said research is important. When you are working with a mentor, you build a connection and are fostering a relationship. If you want to pursue a residency in a specific geographic location, think about how you can build connections and get your name (and ultimately your residency application) known in the area. Think about programs/areas there that not only interest you but also have opportunities for you. However, even if you can't go in-person to an area, remote research is an option. Many projects can involve literature reviews or investigating national databases which may be a potential option for remote research.

1. AAD and Girl Scouts of America: 

Hi Fellow DIGA Members! I want to share a unique opportunity for chapters across the country to begin in early 2020.  Last year, my peers and I conducted a series of Good Skin Knowledge sessions with the Girl Scouts centered around derm awareness and education. The American Academy of Dermatology will be rolling out a new initiative to expand this program in a “train the trainer” model so we can reach troops across the country! I will have more information about dates shortly. If you are interested in becoming involved, please fill out the following survey and I will contact you with more details. https://www.surveymonkey.com/r/Z6R6VH2
 
Best, 
Katie O’Connell
OConneK@evms.edu
EVMS DIGA

2. Yale Journal of Biology 
The Yale Journal of Biology and Medicine is a student-led, Pubmed-indexed, peer-reviewed journal focusing on the fields of biology and medicine. Our March 2020 issue on Skin is collating a database of reviewers in the field of dermatology. We ask that those interested be willing to commit to a review time-window of two weeks in late December to let us know by filling out this short Google Form (https://forms.gle/vFZt3JkXXAN52typ9) by Monday, Sept. 30th. Please e-mail Deputy Editors of the issue, Halbert Bai (halbert.bai@yale.edu) and Connor Graham (connor.graham@yale.edu) if you have any questions.

DIGA Opportunities

The next edition of the DIGA newsletter will be in the Spring. For publication in our Spring 2020 newsletter, please submit the following by January 25, 2020 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! :)