MS3 - Research year or go for it?

[OurDeadGrass]

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[asmallchild]

Hi guys, MS3 considering derm right now. ~Top 20 school, step 1 260, H in medicine and surgery so far. Have a couple midauthor basic science pubs from undergrad and did ophtho research in med school with no pubs yet. Don't have any derm dept connections really. Ideally I am interested in academic medicine, would like to have research as part of my career, but am not necessarily dying to go a top derm program (as I understand even if I took a research year that matching, esp at a academic program is not a guarantee)

Would you recommend taking a year off for research? How difficult and what would it look like if I applied without a gap year? I can't defer anything for the rest of MS3 for a home rotation, so I assume my MS4 would be a home rotation in July, and then two aways in Aug and Sept?

Also just a couple of general derm questions:
1. how many patients is typical for an 'average' half day or day? just trying to get an idea of its pace compared to ophtho where i'd say 20-25/ half day is good, and a retina clinic might hit 30-35/half day. The derm person I shadowed ran ~15 pts in a half day, and am not sure if this is chiller than usual.
2. I understand the derm boards are extremely rigorous, how much it is useful in practice?
3. Along those lines, is it common to mull over a ddx, like x vs y vs z, but in the end not matter because the tx is the same? ie excise it either way, or its a viral exanthem resolves on its own or something.

I don't think you need to take a research year but it never hurts. There are no guarantees in derm though so if you have an inkling that you might enjoy a research year, it's always a nice feather in your cap come application time. The ideal time to do this would be to finish your MS3 year, pursue the gap year, and then flow right back into MS4. The typical setup for the start of your MS4 year is a home rotation in July with aways in August and September.

1. It depends, when I used to see gen derm patients I would average around 20-30 patients/day. I was definitely on the lighter side of my colleagues (I saw more excisions and cosmetic cases to compensate)

2. They are tough. There are always complaints it doesn't really mirror what you see in actual practice. It doesn't make a difference, you'll still have to study and pass them.

3. Yes but I've always felt that's part of the art of dermatology and what separates a good dermatologist from the increasing number of midlevels. Can you come up with a good differential diagnosis so you have a Plan B in case your primary plan doesn't work? Can you do it quickly? Can you do it in your head and not have to create a verbal soup that will only confuse the patient? Can you present your primary treatment plan clearly? In what cases is it worthwhile to mention a Plan B to a patient in the event you are wrong? I'm obviously biased but "dry it if it's wet, wet it if it's dry, and if in doubt cut it out" is droll but not an accurate description of what I do for a living.

 

[TMP-SMX]

Hard with no home program hope you can get hooked into an outside program for research, grand rounds/presentations. A research year or two may help if you get hooked into a good program but many research fellow type programs also require you to have your MD already and often are after internship.

1. I work with residents so it's a bit skewed but with 3 residents I probably average about 30 per half day 2 about 20. If I'm solo with one surgery it's about 10 per half day (no scribes).

2. Derm boards are tough but will be changing to the "exam of the future" at some point assuming the ABD doesn't get sued and change their mind.

3. In academics we do mull over ddx especially for grand rounds and when teaching residents/students. Private practice solo can be mundane if that's missing. There's ways to connect with other colleagues with interesting cases though and just need to keep that mindset.

 

[TMP-SMX]

Ok. Earlier the better. That way you can get to know the current residents and get involved with meetings and volunteering.