How to Apply to Dermatology Residency: Step-by-Step Guide (2024)

Deciding what specialty is right for you and preparing for residency applications is the most important step of your career in medicine. Whether you are an aspiring premed or deep in the trenches of medical school, it is never too early (or too late) to begin considering what your post-graduate years will encompass and how to set yourself up for application success.

This article will provide a comprehensive step-by-step process to applying to one of the most competitive specialties out there: Dermatology! We will systematically explore how to showcase yourself to admission committees through essays, interviews, and, now featuring, the enigma that is signaling and ranking for the Match.

If you are still unsure if dermatology is right for you, we will also briefly cover the major components of ruling the skin stuff in or out, including how to assess your fit and competitiveness. However, if your discipline decision tree remains rife with branches, it is essential to leverage your mentors, official residency resources, and series such as “So You Want To Be…” (blog version) to begin paring down before taking the full dive into this guide.

Dermatology Application Guide Introduction

Here’s what to expect from this guide:

Step 1: Decide if Dermatology Is Right for You

How Does the Specialty Bread and Butter Align?
What Fellowship Opportunities Are There?
Does the Lifestyle Speak to You?

Step 2: Assess Your Competitiveness

Research Portfolio
Grades and Activities
Hard Scores

Step 3: Make Yourself a Strong Candidate

Clinical Performance
Distinguishing Extracurriculars
Research Endeavors
Step/COMLEX Scores
Shelves
Rave Reviews (Letters of Recommendation)
To Away or Not Away

Step 4: Create a Mentor Network

Clinical Advocates
Research Home Base(s)
Near-Peers

Step 5: Prepare Your Application

Why Dermatology? The Personal Statement (PS)
Don’t Forget About Your Intern Year!
Cornerstone Experiences
So, What Do You Do for Fun? The Hobbies Section
Abstracts, Presentations, Publications, and More
You Must Be PROACTIVE

Step 6: Program Selection

Special Tracks (Research)
Acronym Soup: Prelims and TYs
How Many Programs Are Enough?
Geographic and Setting Preferences
What’s up with Signaling?

Step 7: Rock Your Interviews

Patience Is a Virtue
Perfect Practice Makes Perfect
No Really—It’s a Marathon

Step 8: Create Your Rank Order List

Home Field Advantage
Permutation Preparedness
Prepare for the Worst…

Dermatology Residency Application Resources

FRIEDA
Doximity Residency Navigator
Program Websites
Word of Mouth
The Spreadsheet

Finally, before we begin, this how-to article has been written from the perspective of a medical student who had the privilege and honor of attending the Stanford University School of Medicine.

To that end, Austin recognizes the inherent advantage of applying into dermatology with a strong home program at his back. Combined with taking a research year, excelling in rotations, and earning 95th percentile plus USMLE scores, he matched at his first choice of remaining at Stanford for dermatology residency.

Sharing this information is not meant to be a source of discouragement, as the beauty of medicine is in its diversity of future clinicians. Rather, it is a disclosure that, despite these accomplishments, the author was once a paralyzed, undifferentiated first-generation medical student coming from a small Colorado university and even smaller hometown.

You have every right to consider the full gamut of specialties regardless of your self- or other-perceived competitiveness. With that, let’s demystify the path to becoming an expert on the skin!

Step 1: Decide if Dermatology Is Right for You

Choosing your specialty requires patient, iterative soul-searching through deep analysis of personal and near-peer experiences, engagement with resources such as Careers in Medicine, and an honest review of your overall competitiveness as an applicant. Beyond that, it’s about applying a standardized approach to either spark, further fuel, or determine your passion for a discipline. Below is our abbreviated take on that approach.

Begin with how the specialty resonates with you and your goals. Consider these big categories first, then add more sections as needed to further delineate your fit.

How Does the Specialty Bread and Butter Align?

Rare diseases, cutting-edge procedures, and novel pharmacotherapies are often the headlines that initially draw medical students to a specialty. However, making your career decision solely on the shiniest, most exciting clinical and surgical moments is both necessary and sufficient for trajectorial disaster.

When objectively considering the cohort of physicians you are joining, ask and observe averages. What are most visits or procedures like? What’s the most so-called mundane element of the specialty?

For dermatology, the answer to both is far and above skin exams.

If you like pattern analysis, finding the “ugly duckling,” and comprehensive sun protection counseling interspersed with compassionate reassurance, this specialty may be right for you!

While dermatology was born out of internal medicine, your procedural capabilities will be employed nearly every day through biopsies and excisions, activities that are complemented by astutely detecting and treating external manifestations of internal disease while parsing out primary dermatologic issues, many of which are lifelong.

From climbing the acne therapy ladder to managing side effects of the latest psoriasis biologic, every visit is an exciting visual investigation of the organ that both you and the patient know best.

Of course, if skin exams aren’t your thing, you can still find fulfillment in dermatology through subspecialty and research niches, but know that you will not be able to escape the three years of near-daily nevus analysis during residency.

What Fellowship Opportunities Are There?

Compared to other specialties, dermatology ranks on the lower end of subspecialty avenues, though such fellowships are supremely diverse from one to the other.

Pediatrics, Mohs Micrographic Surgery, Dermatopathology, and Cosmetic Dermatology are the most popular accredited forks a dermatologist can take on the post-residency road, representing the full breadth of microscopic and surgical opportunities across a patient’s lifespan.

Unlike a specialty such as internal medicine, in which you decide your organ system passion after a couple years of generalized training, dermatology fellowships will always center on the skin. For that reason, ensuring you are epidermally inclined is all the more integral to your career success and happiness.

Does the Lifestyle Speak to You?

Ah, The ROAD to Happiness. If you haven’t heard this phrase, it is a historical acronym arguing the four specialties with the best lifestyle are radiology, ophthalmology, anesthesiology, and dermatology.

While you can often achieve your optimal work-life integration regardless of the specialty, much of the competitiveness of dermatology residency stems from the alluring lifestyle. With hit shows like Dr. Pimple Popper, the public and medical students alike both imagine dermatologists driving their Porsche into the office, seeing high-end patients for a few hours a day, and returning to their families without breaking a sweat.

Well, just like Grey’s Anatomy is far from an anatomical view of medicine, such lifestyles are often the exception to the norm.

Of course, when considering work hours, dermatologists are some of the highest compensated specialists out there. They also have minimal inpatient and on-call duties, unless they choose to have more, and there are very few truly life-threatening skin disorders (think diagnoses such as toxic epidermal necrolysis and the like).

To that end, if you prefer high-intensity environments riddled with time-sensitive, life-altering clinical decisions, dermatology may not be the best fit. Everyone is different, but for those who prefer a life independent of medicine with regular hours, dermatology should be on the list. Lifestyle SHOULD NOT serve as the foundation of your career decision, but that said, it is a significant factor that will color every day of your professional life.

Now that you’ve reflected on three major factors that should comprise a litmus test of every specialty you are considering, let’s move on to the less fun part of assessing your dermatology fit: Competitiveness.

Step 2: Assess Your Competitiveness

It is no secret that dermatology is one of the most competitive specialties out there. While this fact should by no means dissuade you from the path, I would be remiss if I didn’t clearly state that strong performing medical students are more of a fit for dermatology as it pertains to a successful ERAS season. What does “strong performing” really mean? Let’s dive into it!

Research Portfolio

Now that Step and COMLEX Level 1 are pass/fail, the balance has naturally shifted away from standardized exams to other measures of performance, including the need for research output. Depending on the resource, successful dermatology applicants rank among the highest in terms of publication numbers. Oftentimes, these numbers are some of the scariest within the competitiveness comparison game.

However, while it is essential to engage in and showcase your scholarly endeavors, you do not need to publish in Nature to match into dermatology. Whether you enjoy basic science, clinical trials, or community engagement projects, the most important element of your research portfolio is how your work aligns with your values and passions. Yes, having publications is a requisite for feeling secure throughout the application process, but, speaking from experience, quality trumps quantity.

The “pure numbers game” of research has recently given way to more holistic reviews of an applicant’s academic output, and, depending on the institution, having a ton of second author case reports as opposed to one or two intensive first author projects can actually hurt you. Given the resources necessary to engage in research, this metric is inherently biased in favor of students attending medical schools with heavy NIH funding.

However, so long as you identify, develop, and follow through with a scholarly passion, big or small, the results will speak for themselves.

Grades and Activities

As more medical schools transition to varying flavors of pass/fail grading systems, covering the spectrum of pre-clinical and clinical performance schemes becomes increasingly difficult.

Suffice to say, clinical rotation performance is regarded as one of the most crucial factors adcoms evaluate while weighing your application. Arguably, “high passing” those domains of professionalism and patient care hold more weight than shelf scores, especially when you include the summative comments.

Some face a pure pass/fail system, which has its pros and cons. In such cases, you must go the extra mile for both your patients and team matters that much more, as adcoms will be solely considering what residents and attendings said about you to assess your candidacy. For that reason, do not sacrifice your clinical evaluations for one or two more research papers.

What about what you do outside of the curriculum? As in medical school applications, your activities comprise the bulk of your ERAS portfolio, meaning you should consider where your extracurricular passions lie and seek out opportunities to improve and lead student organizations and novel initiatives.

While free clinics provide solid volunteering opportunities, this is not the time to create a checkoff list. Moreover, this part of the application is not one to neglect, as it showcases your selflessness and engagement with things that are bigger than test scores and authorships. Consider who you are, what you love, and above all else, don’t copy others just because they seem like they have it all together.

Hard Scores

While the first level of Step and COMLEX is now pass/fail, that does not mean standardized exam scores are not a significant factor in your application.

Dermatology has often led the way when it comes to holistic review and minimization of the weight of biased test scores, going so far as to blind reviewers to items like Step 2 scores when considering interview offers; however, they still stand as a “clean” metric to assess your potential for succeeding in residency.

Do not take this marathon exam lightly, but know that a low score won’t sink the ship. Think of everything else you’ve done or are doing, and you will see why dermatology adcoms really value everything you bring to the table.

Step 3: Make Yourself a Strong Candidate

Now that you’ve walked across the mental tightrope of determining if dermatology is the right fit for your preference and competitiveness, it’s time to set yourself up for success.

Ideally, you would map your path to dermatology residency as far in advance as possible, but so long as you remain competitive in the following areas, matching into the specialty after deciding late (even the middle to end of third year) is possible. All to say, take heed to this advice from year one, and you will be able to pivot towards whatever specialty you find as your professional home.

Clinical Performance

This may seem like déjà vu, but I cannot stress enough how much your clinical grades and summative performance matter to adcoms nowadays, especially in dermatology. Obviously, there are going to be rough rotations and residents and attendings who you don’t jive with, but if you put your best foot forward every day, it pays dividends during ERAS season.

Be early, be proactive, be engaged, and be a good person. It’s as simple as that. Do not try to edge out your peers, answer every pimp question, or sacrifice patient care time for a UWorld or AMBOSS block.

The detailed strategy for success again depends on the grading system your school has in place, but if it is strictly pass/fail, there is no need to go for a 90+% on the shelf. Your medical school performance evaluation (MSPE), AKA the Dean’s Letter, is often composed of direct quotes from resident, fellow, and attending reviews of your performance across the disciplines.

Don’t like the OR? It’s still your job to give it a shot while on the surgery rotation. If anything, rotations are designed to give you a test run of each major specialty such that you can make an informed career decision, so it would behoove you to imagine becoming whatever physician you are working alongside.

Don’t be afraid to ask near-peers and residents for advice on how to succeed on the rotation. This aspect of your candidacy may seem like the most subjective one, and it can be stressful since you are depending on so many others to volunteer their precious time and energy to write more than a generic review, but if you fully immerse yourself in your clinical years (that means minimizing research, side hustles, etc.), your clerkship relationships will bear the fruits of support and advocacy.

Distinguishing Extracurriculars

There is no magic formula to devising the perfect list of 10 activities for your dermatology ERAS application. However, it is essential to showcase your altruism, collaboration, and leadership in clinical and non-clinical settings.

Research Endeavors

Matching at a top tier dermatology residency does not mean all your research needs to land in dermatology journals.

However, if you are even slightly considering a competitive specialty like dermatology, orthopedics, ophthalmology, or plastic surgery, it is essential to dive into scholarly work in at least one such field during your pre-clinical years. Not only will doing so maximize your chances of having a high-quality publication come ERAS season, but you will also develop longitudinal relationships with mentors who will go to bat for you through superb letters of recommendation (LOR).

That said, don’t let that dissuade you from dabbling in other disciplines, so long as you don’t overcommit and underperform. Leading projects and finishing what you started will result in the highest quality research portfolio and strongest LOR, so do not repeatedly jump on random retrospective chart reviews if you can help it.

Of course, this aspect of your application is heavily influenced by the opportunities at your institution, so if case reports and such are all that’s available, that’s okay! You’ve heard me say it before: Quality over quantity is becoming more the name of the game than ever.

First authorship is an achievement well worth the labor, and you can often reflect on such projects even better in your descriptions of your research activities—which count as one of the 10 ERAS activities mentioned above. Add to that the ability to better speak about your work in interviews, and there is a huge impetus to be the project lead.

Strategically, pushing three first author projects forward while balancing pre-clinical work is likely not sustainable, so it is okay to join those in-progress endeavors requiring multiple medical students to analyze and report data. Middle authorship is not necessarily a bad thing, but holistic adcoms will notice those students who repeatedly lead projects to completion. If you can get to the point of having one project in the data gathering phase, another in analysis, and another in manuscript preparation, especially during your pre-clinical years, the hurry up and wait nature of research will give way to smoother progress.

Notably, while I mentioned avoiding research during your clinical years, that does not mean don’t finish what you started. Rather, once you get past your second year, become very selective about the projects you take on, as it is quite possible even the smallest research question can balloon into something that not only takes time away from the clinic or the hospital, but also doesn’t result in a publication in time.

Another question students often wrestle with is whether they should take a research year. Such a decision should be informed by a close academic advisor or experienced dermatology mentor who knows you and your residency competitiveness the best.

However, it is often not possible to step out for financial reasons (remember, just because your school doesn’t offer support doesn’t mean you can’t find a grant or two), and that is okay! It is completely possible to match into dermatology without a research year. Though, speaking from experience, it is much less stressful to take the longer route.

Even if you can do so, don’t step out without knowing exactly how you will achieve peak productivity over the year, lest you end up with nothing at the end of the day. Such an outcome should not be considered lightly, as adcoms will likely be comparing similar applicants to one another. In other words, they would expect those who take an extra year to apply to have more deliverables.

In the end, even if research is not your forte, you can always find a way to produce academic work regardless of your skill or interest background. If you don’t like the wet lab, see if you can get involved in a translational pilot study or clinical trial. Still too hardcore? Assess the needs of local populations or your free clinic and publish some interesting data or improvements.

Just like your activities, your research endeavors should come from a place of passion, and while achieving results is not always sunshine and rainbows, remaining committed to your work is a strong marker of grit and adaptability.

Step/COMLEX Scores

Now that round 1 has become pass/fail, this section gets a little bit simpler.

While the latest ERAS cycle was filled with conflicting advice and limbo states regarding the importance (or even need for) Step 2/COMLEX LEVEL 2 scores, now that the dust has settled, I can say from experience that these exams should not be taken lightly, pun intended.

Yes, dermatology adcoms are moving away from standardized test scores as competitiveness metrics, but your preliminary (prelim) and transitional year (TY) programs still use those numbers. Applying to intern year programs separately from dermatology is definitely a tough thing to wrap your head around. Up until this point, making such a distinction wasn’t relevant, as what was good for dermatology was good for prelim/TYs.

That’s not to say that dermatology adcoms don’t look at scores; they just weigh them differently, and those weights can change throughout the application season. For example, initial reviewers may be blinded to your scores, but come ranking time, they reemerge as a factor.

In previous years, average matched Step 2 scores have ranged in the 240s-250s, but expect that number to climb as you and your peers place more emphasis on it compared to previous generations, who often could get away with applying with only a Step 1 score if it was good enough.

You do not need a 270+ to match into dermatology. In fact, having another publication or two with an above average Step 2 score is arguably more of a winning proposition than a single publication with a 275. This makes strategizing more nuanced, but overall, try to shift your dedicated study time towards the second round as much as your school allows, and don’t be afraid to take more than a month to prepare.

Shelves

We touched on this in the rotations section, but shelf exam scores are important only to the point of distinguishing your overall clerkship grade, if applicable.

While a high pass is better than a pass, and such a grade often relies on a strong shelf score, the summative comments from your care and professionalism reviews have the double impact of influencing your grade and MSPE.

That said, this all is a moot point if your school is solely pass/fail without internal ranking, which is on the rarer side. In this case, the comments count for nearly everything. If your school is not the case, it’s more important to score higher on the medicine disciplines.

Obviously, there is medicine in each specialty, but dermatology adcoms will likely weigh your performance in more closely related disciplines, meaning that if you have lingering commitments, such as research projects, shift them away from the time you would devote to shelf studying as much as possible.

Overall, seek out your near-peers, especially those who matched, to contextualize your school-specific strategy for grades and shelf scores.

It is impossible to max out your performance in all domains, but it is essential you direct your precious time and energy to that which provides the most return on investment.

Rave Reviews (Letters of Recommendation)

Hopefully, you will have already identified a couple of letter of recommendation writers through your research projects over the years, preferably from a diverse cohort of younger faculty who often have more time to get to know you, as well as heavy hitting professors whose names hold weight in the dermatology community, but your other letter writers will emerge in your clinical years.

We will get to numbers in the preparing your application section, but suffice to say dermatology LOR writers are necessary but not entirely sufficient for your ERAS application.

Many dermatology programs also want to hear from a medicine colleague through a sub-I and/or medicine committee LOR, and most, if not all, prelim and TYs will require at least one medicine LOR, so ensure you learn from your advisors and peers how to acquire these.

Also, don’t limit yourself to LORs from dermatology research projects. If your school has a dermatology sub-I or continuity clerkship, give such rotations your all to round out your application with a clinical dermatology LOR.

When taken together, the letters should comprehensively and cohesively speak to your clinical and academic strengths in dermatology and medicine, and while names matter, letter content matters more. If you are remaining wholly committed to each of your endeavors, no matter how small, these LOR opportunities should take care of themselves.

Don’t compete against three classmates to get the same LOR, as each letter will likely be more diluted because of such infighting.

Furthermore, it is critical to ask near-peers and trusted advisors who to avoid when it comes to letters of recommendation.

When you ask someone to advocate on your behalf, make sure they can guarantee a high quality LOR by asking them directly whether they feel comfortable strongly supporting you.

Learn more: How to Get Strong Medical School Letters of Recommendation.

To Away or Not Away

Like so many of the items on this list, recommendations to do away rotations vary by person and school.

For those lucky enough to have strong home dermatology programs, it is possible your adcoms will actually recommend against an away rotation. On the flip side, aways are likely a necessity for those who are without a home dermatology residency, though absolute numbers of rotations are often hotly debated.

If you do find yourself doing an away, remember that faculty are always watching. Try to earn positions at the programs you either are most interested in or have no family or regional ties to. As long as you perform at the sub-I level, your presence will put you on their radar.

Scheduling aways can get hairy quickly, so prepare well in advance, and lean on your near-peers and advisors. If your advisors suggest you don’t need to do an away, only do so if you absolutely want to have a slight leg up at a particular program you have no ties to. Since you are there for a month, you have just as much of a chance to mess up and leave a bad impression as you do a good one, so choose wisely.

Step 4: Create a Mentor Network

This section is an extension of the points regarding LOR, rotations, and your extracurricular work.

Regardless of the residency you choose, I firmly believe a strong mentor network is a gamechanger, and having senior, junior, and near-peer advocates matters even more when striving to break into a competitive field like dermatology.

Beyond objective and subjective measures of performance in your pre-clinical and clinical years, adcoms will be weighing the words, written and otherwise, of your mentors heavily. In dermatology, it is safe to say everyone knows everyone, so be careful and deliberate in choosing your network.

Clinical Advocates

Continuity clinics and rotations don’t start day one of medical school, but begin thinking about how you will collate a balanced mentor network, including those who can speak to your clinical aptitude.

Oftentimes, these mentors are the most difficult to develop longitudinal relationships with, owing to the fact that you are constantly switching rotations. This makes the opportunities to be with your mentor weekly or so over the course of a year that much more valuable.

Admittedly, we are often advised to seek out the “heavy hitters,” AKA the most successful/prolific mentors, but I argue that their success takes them away from the clinic, thereby decreasing their ability to effectively convey your potential as a clinician in an LOR.

Moreover, younger faculty are often more bright-eyed and bushy-tailed when it comes to LORs, which makes for a less generic letter regarding how effective and efficient your skin checks are. Thus, do not fret if your clinical mentor is only a few years your senior. It’s more important that they are invested in you as a future colleague.

Research Home Base(s)

Research mentor networks are more formulaic. The common advice is to cultivate and sustain a partnership with a professor and associate or equivalent professor to provide balance in your commitments and LORs.

Such a choice offers the dual benefit of providing a “heavy hitter” complemented by someone who remembers the residency application process better, leading the resultant mentor cross-talk to fill in gaps rather than produce redundant advice and LORs.

It can be tricky to figure out who should be your home base(s) for research, which is where your near-peers come in. Don’t be afraid to ask who has the best track record; after all, this is your future career on the line!

Also, if you dabble in collaborative or team research, expect to feel a bit uncomfortable when asking certain mentors for LORs and not from those whom you have worked with less. Do not ask for six LORs and only use two; that looks far worse. If you picked the right PIs, they will understand.

Near-Peers

It’s rare to procure an LOR from a resident, and it’s singularly bad if you get one from a fellow student. However, both cohorts’ advice is often worth its weight in gold.

While it may be uncomfortable to ask pointed questions about how to maximize your chances of matching, your near-peers shouldn’t fault you for it. Sage advice gets passed down generationally, and even if you are more introverted, you must be vulnerable and ask what’s on your mind.

Who are the best people to work with on campus? What’s the best way to structure my schedule to match derm? These answers won’t be in the student handbook, but rather in your colleagues’ brains. Avoiding the mistakes that previous cohorts made will make you a great candidate even as applications get more competitive year after year.

Step 5: Prepare Your Application

You have put in the hours, gone the extra two miles, and created a network of strong advocates through your conscientious extracurricular and research endeavors. As ERAS season approaches, so too does the precipice of putting yourself out there for all adcoms to see (again).

How do you match into dermatology? Well, just like the aforementioned advice, the methodology is nuanced. Nonetheless, there are key points every residency applicant should consider when preparing their application.

Why Dermatology? The Personal Statement (PS)

Ah, the dreaded question: why the skin? After nearly half a decade or more, you return to where it all began, except this time, your anecdotes and experiences need to show (not tell!) why dermatology is the best fit.

Given you are a senior medical student, adcoms often expect the residency PS to be more professional than your medical school one. You must clearly explain how you have developed into a budding dermatology resident by engaging in clinical and scholarly work that portends potential for moving the field forward.

However, this observation shouldn’t stifle your creative writing skills. Poignant patient encounters and extracurricular activities are still fair game, so long as you paint the picture of confidence in dedicating the rest of your life to the epidermis. To that end, it doesn’t matter whether you portray yourself as inventing the next blockbuster dermatologic therapy or becoming a melanoma expert.

Whatever flavor you make the PS, you need to be clear about the why of what you are saying, and that is accomplished through expounding upon your actions. No more shadowing or observation anecdotes. What about those patients you took an active role in caring for? The PS is often the most difficult component of the ERAS application, but it can also make the most difference if it reflects the unique soon-to-be resident version of you.

When it comes to personalizing your dermatology PS to each program, the jury is out, especially now that signaling is embedded in the application process. For now, a happy medium is to pick your top 5-8 programs (10 max) and tweak the last paragraph to explain why their curriculum and opportunities offer the best fit. For your generalizable version, stick to extolling the virtues of collaboration, diversity, and specialty clinics that make X program attractive.

Learn more: Residency Application Personal Statement Guide.

Don’t Forget About Your Intern Year!

Wait, you need a medicine PS too? Unfortunately, yes. Given that there are only a handful of categorical dermatology residencies, you will be crafting a PS explaining why your TY or prelim year is important in your professional development as well.

The good thing is, you don’t need to completely rewrite your PS. In fact, since dermatology is closely adjacent to medicine, you often only need to tweak a paragraph or two to make it work.

These adcoms are still interested in why you are pursuing dermatology, but they would be irked if you didn’t explain how you would leverage your intern year to become a better skin doctor.

Don’t fret too much over the reasons. As mentioned above, prelim and TY programs heavily value standardized scores. Explaining that a year of medicine is foundational in understanding manifestations of internal disease and the like is easier than meditating on why you chose dermatology over every other specialty out there.

Technically, you can also iterate out your intern PS, but doing so for more than 5 intern or TY programs is arguably overkill. Just like with the personalized derm PS, identify the aspects of your top programs that are unique or highly valued at the institution, and explain how engaging in such an environment would contribute to your development as an excellent physician. Most of all, don’t overthink this aspect!

Cornerstone Experiences

As of last cycle, your ERAS activities and experiences have been pared down to 10 maximum, including research endeavors, volunteering, student leadership, side hustles, and teaching/mentoring, which makes striking a balance all the more important.

Thankfully, you are still able to select your three most meaningful activities, though you will only have 700 characters instead of the usual 1325 on AMCAS to do so. To aid with the pre-ordained brevity of your descriptions, the common advice is to use bullet points rather than prose, which also makes it easier on adcoms to effectively skim without losing out on the details.

Focus on numbers, outcomes, and anecdotes that set even a common activity apart from your peers. What did you specifically do to improve the organization? How did your leadership enhance the student body? What were the methods you honed while a part of X lab? Balance the birds-eye view with detailed descriptions of your contributions, and adcoms will remember you better.

So, What Do You Do for Fun? The Hobbies Section

New for the 2024-2025 ERAS cycle, you will have 300 characters to expound upon your hobbies and interests. This change frees up an activity in your experiences section while providing space to share what keeps you going outside of medicine.

There is no magic answer to this section, but it’s important to go beyond “enjoying the outdoors and watching movies.” You don’t need to be a competitive knitter, but think of specific experiences that go beyond the generic genres.

Is there a type of baking you prefer? How about particular podcasts or blogs? What about your pets? Yes, plants count. Don’t be afraid to use adjectives to spice up your description. Just like with the experiences section, bullet pointing here can make it easier on you and the adcoms.

Abstracts, Presentations, Publications, and More

This section of the ERAS application seems to change every year, as does the advice regarding how to maximize your numbers without being flagged as a double-dipper.

You will have the opportunity to cite every poster, abstract, and paper you have been a part of, and you certainly should, regardless of where you are in the author order. For those cases in which your project produced all three, a rule of thumb is to avoid citing a poster presentation or abstract alongside an oral presentation with the same title, even if they were at different conferences.

In other words, aside from published manuscripts, oral presentation trumps poster, which trumps abstract.

The special case would be one in which your abstract is published as part of a special edition of a peer-reviewed journal, which is not uncommon. Whether you include it separately from your poster or oral presentation is hotly debated, but I’d argue it counts as a separate publication. I also received no negative feedback from doing so in my application.

Overall, use your best judgment, and be sure to ask your successful near-peers and mentors for advice. Unfortunately, the fluidity of ERAS doesn’t make for a clear-cut answer.

You Must be PROACTIVE

While residency applications aren’t technically rolling admissions, it is essential to submit ERAS on day 1, no exceptions! Why? Dermatology program administrators often pick a certain day early in the cycle to download all the residency applications, and, after that, aren’t coming back.

That means if you submit more than a couple days late, your application may not even hit an adcom reviewer’s desk.

Do not let all your hard work go to such waste!. Have everything filled out a couple days before the first day of ERAS submissions in September, including those sometimes hard to track down LORs, such that all you have to do is press the button. If you don’t, none of what you toiled for may matter. DO NOT BE LATE!

Step 6: Program Selection

If you have read anything about applying to dermatology residency, you will have likely noticed that people apply to double or more the number of programs than they did for medical school, and that speaks to the massive competitiveness of the process.

Personally, I know of people who have succeeded on both sides of the extremes. Some with higher risk tolerance will only apply to 20 or 30 programs, while those who prioritize maximizing their chances over saving money apply to all 100+.

Based on the annual dermatology program director’s letter last year, there is a concerted effort to incentivize applicants to apply to under 50, but that may not be possible depending on your perceived competitiveness or home program presence. Just like your PS, your program selection is a personal choice, but there are a few key considerations to guide your decision.

Special Tracks (Research)

If you are an MD/PhD candidate or see yourself having a career as a lab PI, you may be looking into programs that offer special research tracks. These often entail less overall clinic time in favor of scholarly work, and they may even come with an extra year in residency.

Every program does it a bit differently, but expect those with large amounts of NIH funding to offer one or two spots to candidates with a future in major basic science, translational, or clinical research.

More rarely, there are special tracks for those interested in an academic physician educator career. These program alterations are more akin to adding a minor rather than a whole research year. If you want the opportunity to educate and mentor the next generation of dermatologists, you may be a shoe-in for this track.

Acronym Soup: Prelims and TYs

If you don’t already know, applying to dermatology is weird. Most programs don’t have an affiliated first-year (intern) program, and because of that, you will be applying separately to these.

Adding another layer of complexity, the intern year can take the form of a prelim experience, which could be akin to what first year medicine residents go through but with a little bit more elective time thrown in, or an oftentimes “cushier” transitional year (TY), which can take many forms, including resembling that of third and fourth year rotations. (Up for another month of ED shifts or OR time?)

One is not necessarily better than the other, though if you want to maximize elective time, TYs in general are the way to go. Because of this, TYs are also more competitive, but given you are applying into dermatology, this shouldn’t deter you.

Expect to take some time getting to know the various curriculums of each program, and keep track of what you find. Otherwise, ranking prelims and TYs will be a blurred guessing game, and you have worked too hard for that to happen.

How Many Programs Are Enough?

As I alluded to in the beginning of this section, recommendations regarding how many dermatology programs you should apply to are in flux. The PDs have jointly recommended applying to no more than you can signal (28), whereas traditional advice is to apply to at least 50, even if you are an above average candidate.

Depending on your risk tolerance and finances, 50-80 programs is a solid number. However, I only received a single interview from a program I didn’t signal, so do with that what you may. With signaling now firmly in place, and assuming your advisors have no concerns about your competitiveness, between 30-50 will likely be safer in this new world of signaling (more on that later).

As for the intern year, don’t push yourself above 30 programs unless it is for a good reason. Many only send an application to 10-20 programs, though I would caution against going under double digits. As a dermatology applicant, you are often one of the best qualified prelim or TY prospects out there, but don’t cut corners this late in your journey. As a rough estimate, keep it to anywhere from a third to no more than a half of the number of dermatology programs you sent an application to.

Geographic and Setting Preferences

Another relatively new addition to ERAS is the selection and 300-character explanation of your preferences for up to three geographic regions and practice settings.

People made a big deal out of these indicators over the last couple of cycles, but less is known about their overall importance when it comes to adcoms offering interviews. If you want to go wherever the wind blows, don’t worry about this application section. On the flip side, if you need to stay close to family or chosen loved ones, indicate where you would like to stay or be.

As for practice setting, your preference should line up with the rest of your application. Planning on staying in academics? Then a purely rural lean would only make sense if you are training at a high power program to then return home to your small town. With only 300 characters to explain why you chose the way you did, don’t sweat this section too much, but don’t let it be disjointed from your narrative or signals.

What’s up with Signaling?

Since adopting signaling, the last two dermatology ERAS cycles have been a mess in terms of signal strategies.

Given last year’s outcomes, expect signals to be a significant factor in your program interview potential. What’s the best way to use 3 gold and 25 silver signals? Beats me. Based on last year’s APD statement, it is important to use one to signal your home program if you wish to stay, but when it comes to others, it seems like the common decision is to use a signal for every top-tier program, which may or may not result in an interview.

Interestingly, that means the “top” programs are receiving many more signals than they have interview spots, which, in turn, dilutes the signal’s power to only serve as a prerequisite for interview consideration.

If you want to maximize your interview opportunities, shift your signals towards those mid-tier programs you are interested in who may not receive as many. Doing so may not give you a shot at every “reach” program, but it will help you stand out from the masses, assuming they don’t catch on to this trend as well.

There are also a few signals to send the prelim and TY programs. Use them to indicate your top choice, but don’t place too much emphasis on making the “right” decision here. Go with your gut, and know that the prelim/TY signal will give you a boost at most programs, especially if you are a good fit.

Step 7: Rock Your Interviews

Okay, you’ve submitted ERAS and are finishing up your last few medical school rotations. Interviews are on the horizon, but how do you approach the coming winter?

Patience Is a Virtue

Depending on your preferences, the dermatology interviewing process is either lamentable or laudable.

In an effort to create equitable opportunities for applicants to maximize their interview schedules, the vast majority of dermatology programs (but not exactly all) work to publish a calendar of three synchronized, or so-called coordinated, interview release dates in November and December alongside anywhere from 1-3 or so interview dates following when invitations are extended.

These dates are usually staggered, and most programs will offer interviews on the second coordinated date, so if you don’t have an interview in early November, don’t fret quite yet. Expect to interview anytime from mid-to-late-October (for those programs who offer interviews earlier) all the way into January.

The dates can seem agonizingly far off from when you submit ERAS, but don’t forget, you survived an even longer process when applying to medical school.

Perfect Practice Makes Perfect

Just like with medical school interviews, you can absolutely prepare for what dermatology programs will throw at you. Practice questions and example responses abound on the internet and within your mentor/near-peer networks, and because of that, teamwork really does make the dream work.

Enlist your fellow applicants and helpful residents to run mock interviews. If that is not a thing at your school, make it one! By reaching out to your local DIG chapter or specialty advisors, you may well further distinguish yourself as a future physician leader.

Most of all, do not practice just to practice. Hammer those most commonly asked questions (Why dermatology? Where do you see yourself in 5-10 years?) until you are free of nerves but not necessarily operating as a robot. How do you know your answers are good enough? Run them by anyone who will listen, whether it is a family member, significant other, or peer. If your school has an affiliated career center, see if there are people who have experience with preparing students for residency interviews.

In the end, the best way to combat nervous idleness is to take action through as many mock interview opportunities as possible.

No Really—It’s a Marathon

Now, you will likely have plenty of experience by the time you get to dermatology residency interviews, as intern year programs often begin interviewing in early October and finish by the end of November. As such, your first and last interviews could be spread apart by as many as 4 months, which lends the advantage to those who can pace themselves.

While prelim and TY interviews are fantastic practice, they are often much shorter than dermatology interviews. It’s possible to get used to the one to three 15-20 minute 1-on-1 interviews of the former and then, not knowing better, be completely blindsided by hours of questions by dermatologists.

Expect anywhere from 5-11 interviews that last about 10-20 minutes each, and adjust your mindset to handle this potential overload. Given the size of these programs, as well as that of the discipline as a whole, it is no wonder they put you through the ringer.

No matter how intense it gets, don’t forget that you deserve to find the right fit as much as the adcoms do!

Step 8: Create Your Rank Order List

Phew, you made it through! Whether you had one interview or more than ten, you deserve a round of applause for completing one of the most arduous periods of your professional journey. However, there is one last hurdle to overcome, and that is creating a rank order list, or ROL.

Home Field Advantage

It’s a common misconception that the Match is a completely unbiased system. If you have watched any videos on or taken classes that investigate the math behind it, you will realize that, for once in your career, this step of the process is biased toward you.

Basically, what that means is instead of falling prey to ranking programs based on how competitive of an applicant you think you are, you should purely create your ROL based on your preferences—end of story.

The algorithm takes your choices into account more than that of the dermatology or intern year programs, so throw that imposter syndrome to the side one last time and make this part of the residency application cycle completely yours.

Permutation Preparedness

Now, just like with the ERAS application, the ROL situation can get a bit wonky given you are applying separately to dermatology and prelim/TY programs.

For each non-categorical dermatology program you interviewed at, you can create what is called a supplemental ROL that allows you to rank the prelim and TY programs you interviewed at in whatever order makes sense to you.

There is no penalty for having the same supplemental ROL for multiple dermatology programs, just as the only problem with having a unique one for each is the minor headache of recreating the lists, though that’s probably a good problem to have.

Prepare for the Worst…

Finally, given how competitive and seemingly random the dermatology residency application process is, there is still a chance you won’t match, no matter how many interviews you have.

For that reason, you have the option of ranking prelim and/or TY programs on the bottom of your primary ROL such that if you don’t match into dermatology, you can still proceed with the intern year. There are pros and cons to this strategy, and I will spare you from the associated detailed discussion, as it needs to be personalized closely with your advisors.

All to say, it doesn’t cost more to put some contingencies in place so long as your primary ROL doesn’t go over 20 programs (supplemental ROLs are counted separately).

Dermatology Residency Application Resources

Unfortunately, there is no MSAR equivalent for applying to dermatology residency, which is why we created a detailed Guide of Residency Application Resources. Check that out early on in your application process.

Below is an intro to those resources, as well as a couple additional points specific to dermatology. Familiarize yourself with this stuff early on; it’ll help in demystifying the process more than you think.

1 | FREIDA

FREIDA is the official AMA-sponsored list of all accredited residency programs. Depending on your subscription level (yes, more money to spend), you can create program lists within the site, compare program characteristics, and even gain insights into how many interview offers are extended.

Combined with the Doximity Residency Navigator below, make FREIDA your core resource for getting the lay of dermatology land.

2 | Doximity Residency Navigator

Doximity took more of a crowd-sourced approach for their navigator, allowing residents and faculty to freely review programs, though don’t expect to see 100s of ratings for each. It also provides novel information on Step/COMLEX score comparisons and metrics that may not be found on FREIDA.

Best of all, it’s free! You can use either FREIDA or Doximity to procure a program list through their website, but try to use both to their relative strengths. More on that in the link to the guide above.

3 | Program Websites

Individual dermatology and intern year program websites range from labyrinthine to lacking, leading prospective applicants either down rabbit holes or yearning for more.

Nonetheless, they are important to review, as every year around April-June, the program leadership updates their policies and requirements, most importantly about how they treat signaling. This is where you will find a relative gold mine, as you will learn some programs consider signaling only to the point of offering interviews, while others won’t comment on how they use them at all.

I’d suggest diving into these websites after generating a rough school list through FREIDA and Doximity, then paring down from there.

4 | Word of Mouth

Assuming most of what you hear is immune to the telephone game, word of mouth regarding what dermatology programs are the best (or tend to accept your school’s applicants year after year) is worth more than any spreadsheet.

Again, this is where your mentor and near-peer networks come into play, as many will have seen a dozen generations of dermatology applicants come through and identified unique trends that can be leveraged as a competitive advantage.

Of course, take everything with a grain of salt, especially if the opinion has an N-of-1, but don’t avoid such conversations for the sake of not being a “gunner.”

5 | The Spreadsheet

This resource has an ominous name for one reason, and that’s because you should be careful about engaging with it.

Every year, someone fires up a Reddit-linked Google Sheet that has detailed (and often biased) past, present, and future information about dermatology application cycles, ranging from crowd-sourced rankings of individual program tiers to live commentary on how people are taking the waves of hope and despair.

Arguably, the most valuable information comes from updates to the interview release tab(s), which use crowdsourcing to figure out what programs release interviews when (and sometimes to which cohorts).

Overall, it can be helpful to stay up-to-date in the winter months, but beyond that, tread carefully, as last cycle showed how quickly a simple spreadsheet can become a toxic wasteland. (For those who weren’t aware like me, the 2023-2024 sheet had to be deleted due to the animosity that developed between users in the wake of the dermatology diversity initiative defunding letter proposal).

Application Mistakes to Avoid

Given you’ve been essentially working your entire life to get to this point, a list of every dermatology application mistake and how to avoid it would be endless. For that reason, we’ve limited it to the top five most important considerations when navigating around the potholes of the residency journey.

Is There Such a Thing as Deciding Dermatology Too Late?

Yes and no. It is always better to know sooner, as starting early makes for a more cohesive application, but if you were leaning towards another specialty and suddenly change halfway or later through third year, there is still hope!

The most important thing, regardless of the initial path you choose, is to act like you are applying to the most competitive specialty possible. This way, all the doors stay open, even up to the very last second.

If you do find yourself in the late decision cohort, light a fire and enlist help from trusted advisors and near-peers. Oftentimes, they can provide the missing pieces that allow you to present yourself as a future dermatologist regardless of your background.

Balance Applying Too Broadly and Not Broadly Enough

When it comes to the numbers, there remains no hard and fast rule for choosing between applying to 30 dermatology programs and 80+.

Recent trends have made it more evident that there is significant depreciating returns when applying to over 50 programs in light of the latest APD statement (next one to come May-June 2024) and having only 28 signals to go around, but it always feels more safe to ride the wave once you know how tall it actually is.

To that end, for the average to above-average dermatology applicant (let’s say a 250+ Step 2 with strong clinical grades and ~5 publications, give or take), a safe number would probably range between 30-60 programs, depending on your risk tolerance.

If your list is on the lower numbers range, it would behoove you to assess your competitiveness and balance out top-tier programs with those who may value your signals more.

Don’t Play the Comparison Game

As if medical school gunners weren’t enough to require a social detox from time to time, tensions can rise quickly and to extremely toxic levels during the ERAS season.

Hopefully, such negative energy doesn’t emanate from your local applicant cohort, but if it does, be careful about keeping your guard up and not letting their thoughts or interview numbers get to you.

The same goes for The Spreadsheet. Get the information you need and get out. It does you no good to hear that some people supposedly have 12+ dermatology interviews after the first coordinated interview release date, and it would be a mistake to devote a single neuron to ruminating on your ranking among anonymous others.

Applying to one of the most competitive residencies is stressful enough. Do yourself a favor and keep those emotional drawbridges up.

Confident Humility Over All

As an extension to #3, do not feign arrogance and assume that brazen confidence will be attractive to dermatology adcoms.

If you don’t already know, dermatologists are some of the most laid back, down to earth, compassionate physicians out there, and they can often detect a bad apple from miles away. That’s not to say you won’t see pretentious individuals along the interview trail, but it would be a huge mistake to get caught up in ruffling your own feathers.

On the other hand, don’t sell yourself short, especially if self-deprecating humility is your default state. If that’s the case, consciously work to exude more confidence.

However, if you must choose between one extreme or the other, be humble. Use “we” where it was a team effort, but don’t be afraid of saying “I” when you accomplished something. Your aura on paper and in interviews will serve as significant factors in adcoms’ ultimate decisions. Be your accomplished, unpuffed-up self, and good things will come.

Trust Your Viscera

Even more than medical school applications, you will be relying on your intuition and feel for each program to properly rank them according to your unique preferences. The mistake arises when you ignore these visceral feelings in favor of following the herd, blindly pursuing the most prestigious option, or succumbing to contradicting viewpoints.

At this point in your life, if you have been paying attention to your physical and mental wellbeing, you will know what program is the best fit, both inside and outside of the clinic. Don’t let numbers, tiers, or the like override the feel you get from the residents and faculty.

Similarly, if you were super excited about a program based on their website videos but are faced with a completely different feeling at the end of your interview day, it might be time to reconsider where they will go on your ROL.

If you are having trouble uncovering these visceral experiences, talk to those who are closest to you. When were you the most and least excited before and/or after the interview day? Accounting for any bias, these conversations should light the path to the best match.

The Match Favors the Bold

Remember how you have an advantage in the ROL system? Well, these programs want the best candidates, and believe it or not, you are likely one of them.

In the same way, you should remain confidently humble about your prospects, and your application should be bolder than you typically act, both in terms of how you speak about yourself in the ERAS sections and the so-called long shots you may be considering taking on your school list.

Failing to match is significantly worse than not receiving a medical school acceptance for many reasons, so I don’t mean throw caution to the wind, but if you have a non-zero probability of becoming a dermatologist at the program you’ve always dreamed of, there is no better time to take a leap of faith.

In this way, do not undercut yourself by minimizing what you earned, whether that be a lucrative grant or single handedly creating a record-breaking seminar series. There is no place for lying or exaggerating in the process, especially in dermatology, but there is every reason for showcasing yourself as the amazing future skin expert you are.

Success in Dermatology and Beyond

Dermatology is one of the most competitive specialties out there, but by following the advice outlined in this guide, the odds of matching are certainly in your favor.

Approaching your dermatology residency application—or any residency application—thoughtfully and tactfully is vital to your success. Our team of doctors has years of experience helping medical students get matched with their ideal program.

Med School Insiders can help you prepare a stand out residency application. We offer a number of Residency Admissions Consulting Services tailored to your needs, including personal statement editing, USMLE tutoring, interview prep and mock interviews, and overall application editing.