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Hi, 4th year med student here. I just realized that I like derm but I also like other fields such as IM and FM. We are choosing our 4th year electives soon and the electives are limited due to COVID and I might only be able to do 4 weeks of derm if I really want to do it.

I don't have any research or volunteer activity related to derm and I don't want to go unmatched so I guess I have to definitely back it up with FM. I just need some suggestions on how to proceed? should I completely forget about it considering how competitive it is and there are so many people (in my own class) who have been planning for it since year 1 or should I just take a chance??? any suggestions would be appreciated.

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Derm is extremely competitive even with a full 4 years of research/electives. But what really makes or breaks an application is networking. In small fields like that with one or two spots per program "fit" is going to be the most important selection heuristic so they will choose someone that is a known factor, either from their home program or someone who has done an elective there and knows that will do well in the program/with the other staff/residents. That being said, it's not impossible to do in 6m but you're at a huge disadvantage. Unless you already have connections, you'd pretty much have to dedicate all your time between now and carms, reaching out to staff at your program, hopefully working on some research, hopefully finding mentors, etc.

If you really love it you could consider doing a 1 year masters in it and delaying carms if that's an option at your school.

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On 6/26/2020 at 3:44 PM, MedZZZ said:

Hi, 4th year med student here. I just realized that I like derm but I also like other fields such as IM and FM. We are choosing our 4th year electives soon and the electives are limited due to COVID and I might only be able to do 4 weeks of derm if I really want to do it.

I don't have any research or volunteer activity related to derm and I don't want to go unmatched so I guess I have to definitely back it up with FM. I just need some suggestions on how to proceed? should I completely forget about it considering how competitive it is and there are so many people (in my own class) who have been planning for it since year 1 or should I just take a chance??? any suggestions would be appreciated.

In order to best help, can you explain why did you just realize you like derm? 

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I have seen it happen - but also I should ask what is the downside. The risk about going for derm is you are not going for something else. If you are completely happy with say Family medicine if you don't get derm, and have no extreme concern about where you would do family medicine then what is the cost to trying to go for derm? 

 

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1 hour ago, Edict said:

In order to best help, can you explain why did you just realize you like derm? 

I just finished my derm rotation before COVID and also did pediatric derm and I really enjoyed the experience. It has changed my perspective on dermatology, I realized that they deal with a lot of systemic diseases with dermatological manifestation. I am a result-oriented person and I also liked how you can see the result of your management quickly and how it can affect patient's self confidence and quality of life. I also did one day in MOHS surgery clinic and that was just another amazing experience. I never thought I would like it in first and second year because I thought it would be boring but now I see that there are many niches in derm: MOHS, pediatric derm, systemic illnesses, etc.

But I understand that this is risky given the situation but also could be possible considering that no one is able to do OOP electives now and electives are generally possible and programs are understanding of that ... I don't know

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5 minutes ago, rmorelan said:

I have seen it happen - but also I should ask what is the downside. The risk about going for derm is you are not going for something else. If you are completely happy with say Family medicine if you don't get derm, and have no extreme concern about where you would do family medicine then what is the cost to trying to go for derm? 

 

I was initially going for IM and FM  but I feel like if I do 4 weeks of derm electives let's say, I would decrease my chance for FM and iM since I would not have enough electives. I think if I want to apply for derm, I have to forget about IM and only do FM...

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1 minute ago, MedZZZ said:

I just finished my derm rotation before COVID and also did pediatric derm and I really enjoyed the experience. It has changed my perspective on dermatology, I realized that they deal with a lot of systemic diseases with dermatological manifestation. I am a result-oriented person and I also liked how you can see the result of your management quickly and how it can affect patient's self confidence and quality of life. I also did one day in MOHS surgery clinic and that was just another amazing experience. I never thought I would like it in first and second year because I thought it would be boring but now I see that there are many niches in derm: MOHS, pediatric derm, systemic illnesses, etc.

But I understand that this is risky given the situation but also could be possible considering that no one is able to do OOP electives now and electives are generally possible and programs are understanding of that ... I don't know

does the school you are at have a derm program? Can you discuss this with that program to see what they are looking for, or what steps you can take? 

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1 hour ago, MDinCanada said:

I was a derm gunner since 2nd year and I won't be applying, things change! the pool this year will be different especially bc of covid

Why are you not applying if you don't mind me asking?

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Just now, MedZZZ said:

I was initially going for IM and FM  but I feel like if I do 4 weeks of derm electives let's say, I would decrease my chance for FM and iM since I would not have enough electives. I think if I want to apply for derm, I have to forget about IM and only do FM...

Possibly true - although trying to juggle 3 specialities is always a hard. You probably shouldn't try to attempt more than two. 

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1 hour ago, MedZZZ said:

I just finished my derm rotation before COVID and also did pediatric derm and I really enjoyed the experience. It has changed my perspective on dermatology, I realized that they deal with a lot of systemic diseases with dermatological manifestation. I am a result-oriented person and I also liked how you can see the result of your management quickly and how it can affect patient's self confidence and quality of life. I also did one day in MOHS surgery clinic and that was just another amazing experience. I never thought I would like it in first and second year because I thought it would be boring but now I see that there are many niches in derm: MOHS, pediatric derm, systemic illnesses, etc.

But I understand that this is risky given the situation but also could be possible considering that no one is able to do OOP electives now and electives are generally possible and programs are understanding of that ... I don't know

Do the 4 weeks of electives because if you don't your chances of matching derm is a probable zero.

There are other ways to fulfill your interests bolded above. Try going for derm and IM/peds. I've seen people matching into IM then end up doing rheum and allergy fellowships to get their fill of derm plus systemic conditions. From peds, same thing. There is also a 2-year peds derm fellowship that peds residents can apply to, with a focus on congenital lesions, laser treatments, etc, in Toronto. Good luck.

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2 hours ago, MedZZZ said:

Why are you not applying if you don't mind me asking?

I did pediatric derm and complex adult derm.

The clinical part of derm is really fine, its very efficient and fun because your patients are generally healthy (and even if they're not, you don't deal with the unhealthy part), however the residency is intellectually quite rough, at least from what I saw from attending the resident classes. And from speaking to many residents and even some who have completed residencies in other specialties before entering derm, it's one of the hardest board exams. I'm just not interested in the grind anymore, I want to start prioritizing other aspects of my life, so I'm going for family. The flexibility of family is also really nice, you can kinda change patient population during your practice by "specializing" in certain types of practice.

It's super interesting though.

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People successfully apply and match to derm every year with a "late" interest in the specialty, but "late" is usually relative and refers to discovering their interest sometime during clerkship-- when you still have flexibility in terms of organizing electives and potentially making connections and getting some research onto your CV. 

I really don't want to discourage you, but I think this year may be an even tougher year to have a late interest, since you have no access to away electives. IMO electives are one of, if not the #1, metrics for derm applicants, because 1) it's such a small specialty so facetime is extremely important but also 2) it's incredibly competitive so you want to maximize your chances of matching across the country, and the best way to do that is if programs know you. 4 weeks is low for a derm applicant, considering that most of your competitors will have maxed out their electives to 8 weeks. If you're set on this path, you'll need to lock in those home electives and absolutely knock them out of the park. It'll be an uphill battle since you need to use your personality and clinical acumen to hopefully outshine people with a longtime interest in the specialty, who have spent the past 3-4 years already building connections, working on research, and making a strong impression on your home program. In the past students could more easily achieve this by rocking their electives and getting solid references, but that's another challenge this year. Derm requests a high number of letters (3-5 *mandatory* letters depending on school), preferably from derms, and so it's a scramble even in a normal year to get that all together. With only 4 weeks (1-2 electives), it may be challenging, though of course not impossible, for you to find staff who will write you strong letters. 

I would second other commenters who have suggested that you reflect on the reasons that you want to apply to derm, and which aspects overlap with other specialties! If you particularly enjoyed peds derm, remember that completing a pediatrics residency still leaves the door open to pursue the peds derm fellowship at SickKids in the future. 

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2 hours ago, Quark said:

People successfully apply and match to derm every year with a "late" interest in the specialty, but "late" is usually relative and refers to discovering their interest sometime during clerkship-- when you still have flexibility in terms of organizing electives and potentially making connections and getting some research onto your CV. 

I really don't want to discourage you, but I think this year may be an even tougher year to have a late interest, since you have no access to away electives. IMO electives are one of, if not the #1, metrics for derm applicants, because 1) it's such a small specialty so facetime is extremely important but also 2) it's incredibly competitive so you want to maximize your chances of matching across the country, and the best way to do that is if programs know you. 4 weeks is low for a derm applicant, considering that most of your competitors will have maxed out their electives to 8 weeks. If you're set on this path, you'll need to lock in those home electives and absolutely knock them out of the park. It'll be an uphill battle since you need to use your personality and clinical acumen to hopefully outshine people with a longtime interest in the specialty, who have spent the past 3-4 years already building connections, working on research, and making a strong impression on your home program. In the past students could more easily achieve this by rocking their electives and getting solid references, but that's another challenge this year. Derm requests a high number of letters (3-5 *mandatory* letters depending on school), preferably from derms, and so it's a scramble even in a normal year to get that all together. With only 4 weeks (1-2 electives), it may be challenging, though of course not impossible, for you to find staff who will write you strong letters. 

I would second other commenters who have suggested that you reflect on the reasons that you want to apply to derm, and which aspects overlap with other specialties! If you particularly enjoyed peds derm, remember that peds is the one path that still gives you the option of still becoming a certified dermatologist via the derm fellowship program. 

No, you most certainly will not be a certified dermatologist going this route. The fellowship is non-accredited - the only way to board certification in derm is through a derm residency. 

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7 hours ago, ZBL said:

No, you most certainly will not be a certified dermatologist going this route. The fellowship is non-accredited - the only way to board certification in derm is through a derm residency. 

You’re right, I looked it up to be sure and stand corrected. Edited my original post accordingly.

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Juggling 3 specialties is hard, but it does depend on how competitive you are for the other two and what kind of program you want. If you want a competitive location, it would be challenging, but if lets say your dream location isn't something many others want and you are competitive for im and fm already, i don't see any problem with applying for these 3 specialties. 

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