Compilation Research in Dermatology

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Via a PM, from an SDNer who's been in the trenches looking for a dermatology fellowship:

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Things to consider when choosing a research fellowship

1. Make sure your mentor is STRONGLY affiliated with a department (ideally, the PD or Department Chair or at least a well-known and well-respected faculty member). Some mentors may have department affiliation but have their own research center or their own separate clinic and you may work only at that location. This may not be a bad thing (if your mentor has enough pull at that program or the derm world in general), but in general, working in close proximity with other attendings in the department, having your workspace/office in the same area they're situated and having frequent contact with others in the department makes a difference.

2. Make sure you will have frequent contact with other department members - just seeing them at Grand Rounds doesn't do much. It's beneficial if part of the fellowship includes working in clinic with other attendings (at least one day a week, hopefully more). This is important when it comes to getting letters, getting people to call programs for you to get you interviews, or to follow-up on your interviews (more chances that someone will know someone at your desired department).

3. It's a definite plus when your fellowship includes attending resident conferences/didactic sessions – you're seen as one of the group already, and whether or not residents have a formal vote, this can be a major plus when rank time comes around, since residents can definitely voice an opinion. But obviously, try to be easygoing and fun to be around all while showing your intelligence/what a great resident you'd make and simultaneously not annoying anyone with your personality/gunnership.

4. Make sure you will have sufficient new material on your CV to reapply your first year, and that your mentor will support you reapplying your first year by writing a strong letter. Some fellowships are a definite 2 years - you're too busy in clinic to write enough to make a difference on your CV, and it's understood that you'll reapply your 2nd year, not your first. If you're okay with this going in, fine, but most people don't want to wait 2 years to reapply.

5. Try to go to a place where you're either the only fellow or junior fellow to a senior fellow (bonus points for you if the senior fellow is already matched). Otherwise, you will not be first in line for new positions that your mentor hears about, and you may not get recommended for immediate openings if there's a senior fellow who hasn't matched. Some programs have large numbers of fellows the same year as you that you will have to compete with, and the same considerations apply.

6. Ask how many interviews previous fellows have gotten, whether they've matched on the first go around or not, and where. Ask if they've actually matched or been placed in positions (placement can be a good thing or a bad thing – sometimes you can be placed in immediate openings for residency, and sometimes you can be placed in a program where you're doing 1-2 years more of fellowship prior to starting derm). And talk to previous fellows, outside of the interview. Ask for their personal phone number or personal email address (they will not want to discuss their true feelings at work or on work email). The current fellows (especially ones who have matched, they'll be more open) will be a great source of info on how you'll be treated, how supportive your mentor may be, and what your mentor will/won't do to help you match.

7. Get started early working in clinics with your mentor as well as other attendings so you can get LORs or at least someone else to call for you, and maybe get involved in the research/case reports of other attending as well, if you have the chance and you're not stepping on your mentor's toes. You'll be working hard, you might as well spread out and work with different people so they know your work ethic and remember you favorably come match time.

8. Make sure your mentor will contact programs for you - ask him/her what exactly he does to help his fellows match. In dermatology, calls and personal contacts can matter more than a lot of other things on your CV and can sometimes make up for deficiencies on your CV.

9. This may be obvious, but try to get into a guaranteed match position, or one that has a strong history of taking its own fellows, even if it's not your dream program - derm is so unpredictable, it's better to get in anywhere than to hold out for a better program and not get in at all. Many fellowships don't take their own fellows! It's generally easy enough to find out about this by looking at where past fellows have matched and talking to current fellows.

10. Another thought to consider – doing fellowship in a big city with multiple derm programs (i.e., NYC, Boston, Chicago) may make you more likely to get interviews at the other programs in the city. The name of the institution you do your fellowship at carries weight as well.

11. There are some programs that will take fellows this year for a start date of July 2010 – meaning that if you're a 4th year med student, you could go ahead and line up a fellowship if you want (even if you match in your intern year, you'll have that extra year to kill, and if you don't match your intern year, you'll have a fellowship already). Most fellowships that will be offered this year after match, though, are for a start date of July 2009. Look though old Internet fellowship posts for a pretty good list, and the AAD maintains a list as well: http://www.aad.org/members/residents/_doc/FellowhshipDirectory.pdf (yes, there's a typo, but the link works)

It seems like a lot of things to consider and do, but you've already worked so hard to get into derm, what's another year of writing like mad and making connections with people in the field? Fellowships are a great way to get in if you weren't lucky enough the first or next times you applied or if you had something lacking in your application. Work your butt off, keep your spirits up, and good things will eventually happen for you. Best of luck!

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Thank you to this committed SDNer, who landed a derm spot after a lot of hard work!

Keep this post a stand-alone. Do not add your replies directly to this thread, as it will make it difficult for others to read. If you would like to post your questions about this topic, please start a new thread in the public dermatology forum.

As I have never looked for a fellowship, please also do not PM me (DermMatch) regarding questions about this topic. I will unfortunately not be able to answer these specific PMs.

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So here are some links to some sites that are offering research fellowships:

Derminterst.org

Dermboard

Here is an old thread from the dermboard any pissed off research fellow out there

Here is another old post from the dermboard about research fellowships that I thought would be helpful in this guide:

http://dermatology.yuku.com/reply/3164/t/Fellowship-Opportunity.html#reply-3164

"Too often it's true...cheap, slave labor. I'm currently a fellow and have huge regrets of having wasted a year with someone who was professed to be a "great mentor" and a "great teacher." Turned out to be neither. Instead I was supervised (not mentored) by a narrow-minded, opinionated, egotistical, selfish but "well respected expert." Perhaps a 'bad match'? No. Previous fellows had a similar experience.

If unmatched:

1) Do not rush when making a decision about what to do
next. This is a very vulnerable period and one taken advantage of by many programs looking for fellows. Believe me, they are as desperate as you are when looking for a fellow. Give yourself the credit that you deserve.

2) Do NOT ask the current fellows for an opinion on how they are liking their fellowships. Guess what my answer will be when they ask me: "it was great working with so, and so...great mentor!" Why? because of the huge power differential that still exists in that relationship, especially so if the fellow did not match. And if they matched, all their ill-harbored feelings about their experience will magically disappear because THEY MATCHED! and will want to leave that position in the best possible terms.

3) Best to contact previous fellows to get a more objective perspective about the fellowship (ask for their names, where are they at? and just call them). LEARN TO 'READ' BETWEEN THE LINES. Listen to, don't just hear what they have to say.

4) Do not be fooled by what is put on paper (i.e. description of the fellowship). Programs, as well as candidates, are very good at making themselves look a lot better than they truly are. This is especially true of fellowship descriptions.

5) Ask how productive the fellow has been that year. Being involved in a lot of trials can mean that you are doing all the work but none of the thinking. Publishing a lot is a relatively good indicator of how involved your mentor was in their time commitment to you and advancing your chances of getting into dermatology.

6) Having a good track record of keeping their fellows for residency is NOT a guarantee they will keep you. Having a bad track record of not doing so, pretty much IS a guarantee they will NOT keep you. Don't go there!

7) Do some serious introspection. If dermatology is truly what you want to be doing 10 years from now, then don't give up. If you have doubts, you're either doing it for the wrong reasons or don't love the specialty enough to make it worth the sacrifice that it may be needed to get in.

I know it's unsolicited advice, but it may be of help to some of you out there. Good luck!"


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Keep this post a stand-alone. Do not add your replies directly to this thread. Unless you are currently a research fellow or a previous fellow who has matched then please add your opinions, so others who are unmatched can learn from your experience and PM you with specific questions. If you would like to post your questions about this topic, please start a new thread in the public dermatology forum.

As I have never looked for a fellowship, please also do not PM (DermMatch or Long Dong) regarding questions about this topic. We will unfortunately not be able to answer these specific PMs.
 
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This is advice for people who are looking for a dermatology research fellowship. I highly recommend reading this: http://forums.studentdoctor.net/threads/sdns-guide-to-landing-your-dream-derm-fellowship.604363/. Really take it to heart.

I was in your shoes at one time and I know what you are going through. I didn't match into derm my first time as an MS-4 and I was devastated. I won't go through the roller coaster of emotions I had because many of you have gone through or will be going through those same emotions this week. After matching into Derm during fellowship, I do think it was worth it to do one, but I also realize it could just as easily have gone the other way in terms of not matching again. Whatever you do, make sure you're set to at least go into internship after med school. One thing which got me through this was looking at support stories from those who had been through this before: http://www.derminterest.org/phpBB3/viewforum.php?f=12. While Derm is a great field for many reasons, not matching is not worth taking your life.

First, decide for yourself if this is truly worth continuing to go for and that you can only see yourself doing Derm and no other specialty. You'll need this genuine motivation to sustain you through. The feeling of being under the microscope during your fellowship, worrying about offending any person in the program, or caring what others in the department think of you, etc. over a long period of time can take a huge toll on you. You're giving up a lot of control by doing a fellowship. If you'd be fine or just as happy doing any other specialty, then please do that. The reality is that Derm attendings know the field is competitive and know there are more than enough people willing to do anything to try to match into it. You're giving up at a minimum 1-2 years (or even longer) of attending salary by doing a research fellowship for the chance of maybe, but not a guarantee, of matching into Derm. Nothing is a guarantee here (more on this in a bit) and when you apply for the match, you'll have to once again put all your eggs in one basket.

Second, decide how long you will do a derm fellowship for before you apply again and how many total times you will apply for Derm. Some fellowships are 1 year in length only, some are 1 year with a chance for a second year (if you were to match when you apply in the first year), some commit you to completing 2 years (so you'd apply during your 2nd year and potentially match). When you apply for Derm, you're almost always applying for a position that is one year off from the time you apply. Make sure your mentor and you are on the same understanding of your timeline. Too often, I've seen fellows make the mistake of not having an understanding or leaving their commitment open-ended and this can be taken advantage of very readily.

There are many derm research fellowships advertised on residency program websites and on forums who don't necessarily have your best interests at heart. I'm not trying to scare or discourage you, but your goal is to match into a Derm program. Many of these research fellowships, first and foremost, want a warm body who will do their research. Your goal of matching is secondary to them, if it's even on their radar, and so when a program starts to get desperate they will take someone who realistically may not match, just so they have someone. And they can always fall back on saying that they never made any promises. They will always dangle the carrot that if you work hard enough there's a high possibility of you geting a derm spot, but it doesn't mean anything until you actually match. I've met fellows who have done years of research and were nice people who interviewed well, but for some reason or another did not match even at their own program, and eventually gave up after expending years worth of getting publications but were led to believe by their mentors that they would match.

Some derm programs, if you're doing an in-house research fellowship, do not look towards their own fellows at all. Some fellowships are only looking for warm bodies even though they don't publish anything and fellows don't match and every year end up being a musical chairs game in terms of getting a new fellow. Realize that a lot of these Derm research fellowships are just as desperate to get good fellows who help in their research, as you are desperate to get into a research fellowship. They'll entice you and know just the right words to say to you, but don't let your time of vulnerability cause you to make hasty decisions. There are derm faculty out there who have no moral qualms about taking advantage of vulnerable applicants. I've seen and met other fellows this has happened to. Don't let it happen to you.

There are several types of derm research fellowships out there if you search:
  • Clinical Research -- this is probably the best, all your work is clinical and you work with derm patients. It can be your traditional clinical trial fellowship where you're a subinvestigator recruiting patients for long term trials, but it doesn't have to be.
  • Basic Science Research -- these tend to be 100% lab based, where you work with a Derm research lab group. Your role is similar to someone who has completed a PhD and is now doing a postdoc research year(s).
  • Translational Research -- which is a combination of basic science and clinical research together; In theory, it's basic science research that is applicable to the patient bedside with hopes of finding future treatments, etc. so you would be in the lab as well as on the patient side.
If you are an American medical school graduate, do not do basic science or translational research, for several reasons:
  • First, you will be paid peanuts compared to a resident salary. Clinical research fellowships, which require a full license with Step 3 completion, usually pay at a PGY-2 resident level.
  • Second, you have a limited time to get pubs out for your application and while those 2 areas of research are impressive, it's only impressive if you actually publish in them, assuming you even have results worth publishing.
Ok, so first go to your academic letter writers/faculty advisor/program director in Derm. Have them look at your entire application and give it to you straight. What kept you from matching? Board scores? Grades? Lack of research? Don't lose your cool or get emotional. It's really tough, but you want to put the best face on and leave with a clean break. I can't emphasize that enough. You want to leave with no residual grudge - bc you'll need their help for fellowship and for matching later. At this point, you can't change grades or board scores - Step 3 no one cares, you just have to pass bc it's necessary to get a full license. The only thing you can change now on your application is research involvement, publications, and networking if you get to present at Derm conferences. A lot of your ability to match will be based on how well you network, no matter how great a med student you were, bc there are Derm programs who don't like to interview reapplicants as a rule. To put it crudely: many programs see reapplicants as "used goods".

Finish all derm projects with your home derm program or from other places by the end of your MS-4 year if possible, since internship will be busy. You want a good letter for when you start researching and looking at different derm research fellowships.

Be honest with yourself. Don't go into a fellowship bc you THINK it might land you a spot bc of the person you're working with. Don't get pressured into a spot either. There are faculty members out there are who are very good at playing the game to take advantage and are willing to do so, the same way works in the residency game.

Things to have ready in place:
  • A CV
  • Your most recent ERAS application
  • Transcript
  • Your MSPE
  • USMLE Scores
  • 3-4 Letters of Recommendation, one of them being from your program director of your internship if possible.
  • Finish Step 3 so u can apply for a full license in the state you'll be doing a fellowship in bc clinical research fellowships require this.
Research every single derm research fellowship in the fall and send all of these things with a cover letter early in the fall by email or snail mail, but it's not even too late now in March. Your fellowship mentor should know exactly what he/she is getting in terms of where you stand as of now as this will likely directly influence how much time commitment you will have to make before applying and matching. A lot of places will hold onto your materials in the fall, bc they may have current fellows who are trying to match. They won't know for sure if the person will be staying on after March or not. So from January till June, many fellowships will start interviewing people as potential fellows.

Just like you want to find the best fellowship to get you to match into derm, many derm research fellowships will be trying to find the best person they can find in terms of stats, before interviewing you. A more cynical way to look at it is they'll try to take someone who based on luck didn't match, so they don't have to expend as much effort and energy in getting them over the line to get that person to match when that person applies during their fellowship.
 
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The Interview Day

On the day of the interview, realize there will be a huge power differential between the faculty member and the current fellow. If the fellow matched, the person is likely to trumpet how great the fellowship was - any complaints are more likely to disappear, bc that person matched. If the fellow didn't match and is moving on, you still may not get all the negatives bc that person wants to leave on the best terms and they're actively looking for someone replace them. It's not in their best interests to help you in your decision making process.

Don't feel guilty about asking all the ins and outs of the fellowship - a program that sees this as a bad thing is not a place you want to be. You're using vacation time from internship to find a research fellowship that is right for you. Do your due diligence. What are the expectations of the fellowship and do you have the current skill set to do it? For example, don't sign up for a fellowship in which you're doing lab work, if you've never worked a day in the lab. Now is not the time to start learning something new. Ask a lot of questions. Many times places will hide that you're expected to do a lot of things, but you don't have the available resources to be able to do it all. Or they will gloss over things to make it seem like it's very easy when a lot of the logistics haven't worked out. They will only see you as committing to the fellowship, but your underlying goal is to eventually be in a better position to match to a residency position. Programs have an incentive to portray their research fellowship well bc their #1 goal is to have someone to take over in July.

The fellowship itself:
  • How long has the fellowship existed? The longer it's been there, the more of a track record you will have to go by.
  • Are they willing to give you contact info. to contact those who have completed the fellowship previously? That being said, don't be surprised if you're only given contacts of people who have matched. You may have to do a little bit of digging to contact those who did the fellowship but didn't match.
  • Are there actively ongoing projects and how long have they been going on? Have any abstracts, posters, or publications resulted from them and how long did it take? Was a fellow an author on them?
  • What is the track record of previous fellows matching into Derm, either at that program or at other programs? Your best chance of matching into Derm from a research fellowship is at the program that you're doing the fellowship at. This is because you're a well known entity by then and faculty like to recruit people they know everything about. It is definitely possible to match at other places also, but that will depend on your entire application up to this point. Needless to say, if you don't do well in your fellowship, your chances of matching elsewhere will definitely be less as your letter of recommendation will not be as glowing or worse, mediocre.
  • Are you the only fellow at that derm program or are you competing with 2 or 3 other fellows? Chances are if you're competing with other fellows, seniority will have a lot more to play into who matches there and who doesn't.
  • How many hours per week are you working and what exactly are you doing on a day-to-day basis? Just bc you're working a lot doesn't mean it will get you noticed, that you will get more publications, or that you even have a higher chance of matching there. While there will be work responsibilities, you also have to be doing things that expand your ERAS application. Some fellowships are ridiculous in terms of what you are expected to do. Be wary of this as a lot of this may not be divulged early on.

The current fellow:
  • Do they look happy in their fellowship? Hard to tell sometimes on interview day, but sometimes you can see subtle signs.
  • Ask what they've done: what abstracts, posters, publications they've completed.
  • Did the current fellow match? If so, where? If not, why not? Just because a previous fellow matched doesn't mean that you will. You don't know if that person already had the stats and needed a slight boost from the fellowship or didn't have good stats and needed a huge boost from the fellowship. Some people have completed a prior residency or left another competitive residency and would have qualified for Derm anyways, if they had applied in their 4th year. That being said, if a fellowship doesn't have a good track record or a consistent track record of matching, esp. at their home program, then it's a huge gamble on your part, so stay away.
The Derm faculty member you're working with:
  • Look in PubMed at his/her latest publications. How often does he/she publish? How many of them have the fellow listed as an author? This will tell you whether the fellow is really involved in publishing in their fellowship.
  • Are you actually working personally with that faculty member? There are fellows in which while the Derm faculty member is the head of that fellowship on paper, in reality, you are working under someone else. I would avoid this scenario. It's bad enough that one person has a lot of power to see if you match, but if it is someone who is even lower on the totem pole, that would be miserable. You want your impressions to be direct, not by someone else's word of mouth.
  • Is this person a Chairman or Program Director? Remember that at many programs he/she may be just one vote out of many so they may not have as much power or veto power to choose you. Knowing how much pull they have is important.
  • Is this someone who gets along well and actively mentors his/her fellow(s)? Are they someone who seem reasonable in terms of expectations of their fellow(s)? This may be harder to tease out but really go with your gut - many times the fellow will give you clues or may not say it directly. Nothing is worse than being stuck in a research fellowship with a brilliant mind but who is always grumpy, annoyed, ticked off, in which you're working to impress them.
  • Is this someone who is very well-known in the field? Sometimes this will help you, sometimes it won't. Just bc they are famous in derm doesn't mean that their backing will rub off on you when it comes to other derm programs. Also just bc they are well-known doesn't mean they will be a positive mentor for you or will fully advocate for you at your home program or at other places.
  • Is this person willing to make phone calls to other programs on your behalf, if needed as a last resort, to get interviews?
  • Does this person make you aware of new open positions in Derm programs that will start immediately that coming July? Or do you have to find out from someone else? Or they don't want to tell u bc they don't want to go to the trouble of trying to find another fellow even though they haven't guaranteed you a position at their program?
  • Does he/she allow you to take part into other faculty's clinics occasionally or are you only theirs alone?
  • Does this person introduce you to other Derm faculty at your program and other places and at specialty meetings like SID and AAD?
Read in between the lines:
  • What is the culture of the Dermatology department like? Positive, negative, or toxic?
  • How do other faculty feel about taking their own research fellows as future derm residents? Some derm faculty feel those who prove themselves should be given a chance to be residents, others feel that someone who doesn't have the stats or didn't match the 1st time shouldn't be given a chance no matter how hard they work during fellowship. If it's the latter, and that applies to you, then stay away.
  • Does the derm faculty member you're working under see you as research only or as someone for everyone in the program to get to know?
  • How is the fellow treated by the derm residents and by derm faculty members? Realize initially there maybe some level of uncomfortability bc everyone knows you want to get a derm spot. At least initially, some faculty might be hesitant to communicate with you, since they know you are there as a fellow wanting to match there, this apprehension eventually disappears when they get to know you. Derm residents can have a big voice whether you get blackballed or not, so no matter how badly you might be treated, make sure you stay nice and keep your reputation intact. Rumors fly quickly.
  • Does the fellow get to integrate themselves well with the derm residents -- going to residency teaching conferences or are they very much kept separate? Or are they so busy that they don't get to integrate themselves well in the department? Sometimes the last issue doesn't matter, sometimes it very much does bc other faculty don't get to know you, so rather than take a chance, you're not selected.
So this is all the advice I have. I got into Derm residency after doing a derm research fellowship so it's definitely possible, but there are a lot of inner workings that many applicants don't know about, so hopefully this clears things up a bit as to what your next step should be and how to filter through the many derm research fellowships that are offered.
 
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