Tag: Advice

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How To Match Into Dermatology: an interview with a dermatology resident

Dermatology is one of the most competitive specialties in medicine. Today I sat down with Benny Wu who is a current dermatologyy resident at Broward Health Medical Center. He shared his journey to dermatology and some advice on how to match into derm.

 

Thanks for letting me pick your brain, Benny. Can you tell my readers a little bit about yourself?

It is an honor for me to share my path to Dermatology residency with your readers and followers. I am currently a PGY-2 Dermatology Resident at Broward Health Medical Center in sunny Fort Lauderdale, Florida. Before medical school, I was a figure skater for thirteen years – competed on the national and international level. In 2005, I chose to end my competitive skating career due to recurring injuries and realized it was ‘time’ to move forward with life by pursuing my second passion: medicine and science. Unfortunately, during college, I did not juggle my college coursework and figure skating very well. I had an embarrassingly low G.P.A. from the University of California, Irvine and did terribly on my MCAT. The next pivotal moment that had a direct impact on my medical career came in 2007. A medical school formerly known as the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, now called Rowan University School of Osteopathic Medicine (RowanSOM), offered a Master’s in Biomedical Sciences degree for students who performed poorly during college but remained interested in attending medical school. RowanSOM advised me that my chances of being accepted into their medical school would be greatly increased if I performed exceptionally well in the Master’s program and if I improved my MCAT score. I performed extremely well in the Master’s program and brought my MCAT score way up (I distinctly remembered in 2005, my Physical Science score was 5/15, but in 2008 my Physical Science score went up to 10/15). Luckily, I was accepted into RowanSOM’s D.O. program in 2008. During the Master’s program and pre-clinical years I fell in love with immunology and became invested in how the body worked from the cellular and molecular level. Because of my fascination with immunology and medical research RowanSOM invited me to complete the D.O./Ph.D. combined program in 2011. Outside of medicine, I enjoy staying physically active (running and cycling) and cooking. One of my therapeutic outlets is cooking with fresh ingredients accompanied by a glass (or several glasses) of wine!

 

What motivated you to pursue dermatology?

Answering the following two questions can best explain my motivation for pursuing Dermatology

(1) What interests me in Dermatology – Dermatology requires a STRONG background and fund of knowledge in Internal Medicine and its subspecialties (Infectious Disease, Rheumatology, Nephrology, Pulmonology). Response to treatment is readily appreciated and is not heavily dependent on laboratory findings. One example I share with medical students is this – imagine being able to make a clinical diagnosis and assess response to treatment independent of lab findings – of course, more often than not, a confirmatory diagnosis will require a skin biopsy (side note: there are lots of procedures in Dermatology, too!). On the other hand, as much as we would like to refute this way of thinking, the importance of outward appearance in our society, and how it impacts one’s sense of self-worth, cannot be ignored or disregarded – just ask any severe nodulocystic acne patient how he feels after a full course of Accutane – it really is life-changing!

(2) What problems do I think Dermatology faces – I emphasize the difficulties because issues in any specialty can serve as motivating factors for medical students and young attendings. In Dermatology, the pathophysiology of many skin conditions remain unclear or unknown – there is a lot of opportunities for both basic science and clinical research in Dermatology. However, the more pressing concern is the dwindling interest in complex medical Dermatology – this may be due to decreased reimbursements from insurance carriers – but I see this unique problem as an opportunity for Dermatologists-in-training to start new Dermatology fellowship programs, such as Dermatology Hospitalists. For example, severe pemphigus patients admitted for rituximab infusion – this is classically a Dermatology-driven problem that can be managed by the primary Dermatology service.

 

Something that impressed me about you is that how persistent you were in pursuing your desired specialty. You didn’t match into dermatology…twice. But you persisted and landed a residency position in your dream job. What did the experiences of not matching into dermatology teach you?

Not matching into Dermatology taught me the importance of focusing on my modifiable weaknesses.

After failing to match again during my intern year at Drexel, I had to ask myself two questions: (i) is Dermatology the only specialty for me? (ii) if so, what can I do to maximize my chances the third time around?

Facts are facts. I am a D.O. with average USMLE scores for Dermatology (these are not modifiable). However, my lack of publication and research experience in Dermatology was modifiable. Thus, I made a promise to myself that I would give myself one last chance – reapply to Dermatology – but this time as a Northwestern Dermatology Clinical Research Fellow.

Also, I learned how much ‘grit’ I have. Dr. Angela Duckworth’s book, “Grit: the power of passion and perseverance” discussed the importance of being ‘gritty’ especially when dealing with failures or disappointments. If you have not read this book, I urge every one of your followers to read it, especially before the interview season begins – I believe in the two equations outlined by Dr. Duckworth: talent x effort = skill; skill x effort = achievement; TALENT counts ONCE while EFFORT counts TWICE.

 

Why do you think you didn’t match multiple times?

I failed to match numerous times because of the following reasons:

  1. Did not initially consider D.O. Dermatology programs
  2. Did not apply broadly (limited myself geographically).
  3. My degree, D.O. – Dermatology is a competitive specialty even for U.S. M.D. graduates.
  4. Average to below-average USMLE Step 1 score (238) for matched applicants – as a D.O., a spectacular Step 1 score (>250) would have helped – but not a guarantee by any means.
  5. CV did not differ much between the first and second time applying.

What did you do differently the second time to improve your chances of matching? Why do you think you failed to match a second time?

I did not do anything differently the second time around – as you know, we were co-interns at the time and had limited time to add significant publications or research experiences to my CV. The only addition to my CV in the 2017 cycle was one publication – a review article on drug-induced pyoderma gangrenosum.

 

So you finished your required preliminary year in internal medicine and you are offered the opportunity to stay and complete a categorical three-year residency in internal medicine. Why didn’t you stay?

Do you want a fluffy answer or the real answer? ☺ I did not stay because Dermatology remained one of the few medical specialties that I could see myself doing long-term. However, I loved infectious disease as well. Like I said before, there was one modifiable ‘weakness’ in my application – Dermatology research experience. Near the end of intern year, I was offered a Dermatology Clinical Research Fellow position at Northwestern University, Feinberg School of Medicine. Privately, I told myself that if I did not match the third time around, I would complete Categorical-Medicine residency and possibly pursue Infectious Disease.

 

What did you do professionally after your preliminary year to improve your application while you re-applied for the third time?

Right after the Medicine-Preliminary year, I moved to Chicago and completed a Dermatology Clinical Research Fellowship at Northwestern University. Simultaneously, I entered the 2018 ERAS and NRMP and applied with new recommendation letter writers (2 from Northwestern Dermatology Faculty, 1 from University of Pennsylvania Dermatology Faculty, 1 from Drexel/Hahnemann University Hospital Medicine Residency PD) and 1 new publication (ichthyosis, X-linked) with the Northwestern Dermatology Chair, Dr. Amy Paller (https://www.ncbi.nlm.nih.gov/pubmed/28846233).

 

Thankfully you matched. What do you think you would have done if you didn’t match for a third time?

If I did not match, after three attempts, I would have done the following in sequential order:

  1. Try to secure an unfilled position through the SOAP.
  2. Apply to the few programs that secured extra funding for more spots or received ACGME-approval to increase program size after the NRMP Match quota deadline. Because Dermatology is a relatively small community, one advantage of doing a research fellowship at a major academic institution, such as Northwestern, is that PDs will advertise open positions on a listserv available to only Association of Professors of Dermatology Members (Dermatology PDs). Northwestern forwarded open positions to their research fellows since 2 out of 5 research fellows did not match.
  3. If number 1 and 2 don’t work in my favor, then I would seek out available PGY-2 Medicine Categorical positions, with the hope of specializing in Infectious Disease later down the road.

How many dermatology programs did you apply to each year? How many did you rank?

– In 2016, I applied to ~50 Dermatology Programs and 18 Medicine-Preliminary Programs. Ranked 5 Dermatology Programs (NRMP).

– In 2017, I applied to ~90 Dermatology Programs (including both Advanced ‘A’ and Physician-only ‘R’ positions). Ranked 2 Dermatology Programs (NRMP).

– In 2018, I applied to 95 Dermatology Programs (15 AOA-accredited “D.O.” programs and 80 Dermatology Programs – including both ‘A’ and ‘R’ positions). Ranked 2 AOA-accredited Dermatology Programs (NMS Match). Ranked 6 Dermatology Programs (NRMP)

 

What advice do you have for medical students who want to pursue dermatology?

– Read, read, and read more: highly recommend Lookingbill and Marks Dermatology textbook – this is a basic Dermatology textbook – very user-friendly.

– Approach to reading primary research articles: learn how to interpret and formulate questions as you read research articles – (i) is the study design robust – assess strengths and weaknesses (ii) any bias (iii) does it directly address the hypothesis – keep in mind that negative papers can still be valuable (iv) author financial relationship disclosure – is there a conflict of interest? Learning these skills early on will help you tremendously at audition rotations – this will quickly set you apart from other applicants – always remain inquisitive.

– Align yourself with a Dermatology mentor as soon as possible: if your school does not have a home Dermatology Department then search for a local Dermatology Society (for example, Chicago Dermatological Society [CDS] and PhillyDerm in Philadelphia, PA).

– No need to submit to only Dermatology journals: if you see a compelling case in your non-Dermatology clerkships that is Dermatology-relevant (for example, VZV reactivation in an immunocompromised patient) submit the case as a Continuing Medical Education (CME) quiz to a Family Medicine or Internal Medicine journal.

– Ask yourself these question: “is Dermatology the only specialty I see myself doing?” Remember, Dermatology has significant overlap with Rheumatology, Infectious Disease, and Family Medicine/Primary Care. By not limiting your publications to Dermatology journals, should you decide to apply to Family Medicine or Internal Medicine down the road, it will appear less likely that you ‘settled’ for another specialty.

 

What are important aspects of a residency application for dermatology? Is it heavily research oriented?

– Research is critical (except for a few Dermatology programs, most are academically-driven and require residents to publish annually). Many of the applicants I met on the interview trail took a year off to do research. However, a dedicated research year is not critical – instead, focus on getting 2-3 FIRST author PMID (PubMed Indexed) publications by the time ERAS is ‘due’ (typically ~ September 15)

– First authorship holds much more weight – keep in mind papers can come in a variety of flavors: case-reports, case-series, CME quizzes, and review articles.

– By taking command of your publications, this will serve you well during the interview – you may be interviewing with a faculty member who is an ‘expert’ in the topic of your research or publication(s).

 

Any residency interview tips specific to dermatology that you wish someone told you before you hit the interview trail?

(i) Please do not discount the value and importance of PCs! I believe that Kaiser-Los Angeles Dermatology granted me an interview because I was professional and courteous when communicating with the PC.

(ii) Compile a list of programs that you would like to receive an interview – construct a personalized letter of interest to each program – outline the reasons why that program is attractive (besides being Dermatology!) – email the letter to the PC in late September so it can be added to your file for review.

(iii) Pay attention to your speaking volume and level of engagement during the pre-interview dinner and interview day – I lived by this saying ‘loose lips sink ships.’

(iv) If you are placed on the wait-list, email the PC and ask when the interview(s) are held? – Three weeks before the interview date(s), send the PC an email reminding him/her of your interest and provide application updates, if applicable.

(v) Avoid emailing or calling the PC with general questions about the program – study and thoroughly comb through the program websites.

(vi) Only reserve emails when you have SIGNIFICANT application updates – for example, I was asked to give an oral presentation at the 2018 American Academy of Dermatology (AAD) Annual Meeting [https://www.aad.org/scientificsessions/am2018/SessionDetails.aspx?id=11492] after I certified my ERAS – after updating my programs of interest, I received an interview invite from one program several hours later.

(vii) After the interview, prepare handwritten thank you cards for the PD and PC – note: in 2018, several programs explicitly stated NO thank you cards.

(viii) Prepare written templates for the following scenarios: (a) requesting letter of recommendations (b) accepting interview invites (because rarely do Dermatology applicants reject interview invitations) (c) letter of interest – tailored to specific programs (d) post-interview thank you card (e) top choice/you are my number one letter. I have templates (Dermatology-specific) for all these scenarios – please contact me directly if you wish to see my templates.

(ix) Avoid post-interview communication with the PD, PC, and residents – unless it is for SIGNIFICANT application updates – also, no harm in sending your number one a letter of intent several weeks before the rank list is due – note: in 2018, several programs explicitly said no post-interview communications.

 

Here are some facts for you and my followers. In 2016, based on NRMP match rate data, dermatology was the 5th most difficult specialty to match into behind only neurosurgery, orthopedic surgery, plastic surgery, and vascular surgery. Likewise in 2016, dermatology was among the six specialties with the highest average USMLE step 1 score for applicants who matched into their preferred specialty along with neurosurgery, orthopedic surgery, otolaryngology, plastic surgery, and radiation oncology. That average USMLE step 1 score was 250. Although I believe that high board scores shouldn’t be the only important aspect of a medical student’s residency application, it is hard to argue with objective data in that if you want to match into a highly competitive residency like dermatology you need to ace your boards. What advice do you have for medical students who want to pursue dermatology but don’t have those ultra-competitive board scores?

I scored a 238 on my USMLE Step 1 (please keep in mind that I took my Step 1 in 2011 – the passing score changed several years later). Regardless, 238 is not a strong score for Dermatology. If you scored <240 on USMLE Step 1, focus on the modifiable aspects of your application – (i) research – aim for 3 to 4 first author publications (ii) mentorship – seek out mentors as soon as possible so you have time to develop a relationship with them – this will lead to STRONG letters of recommendation (iii) research year – consider a research year (between MS III/IV) – I highly recommend the Northwestern Dermatology Pre-Doctoral Fellowship (iv) I cannot stress this enough – if you want to pursue Dermatology, remain focused on the modifiable aspects of your CV!

 

How did you find and develop a relationship with a mentor in dermatology?

My Ph.D. was on neutrophil biology in sepsis. Naturally, I asked myself the question “which skin conditions are driven by neutrophil dysfunction?” I found out that several neutrophil-mediated skin diseases fall under the spectrum of diseases commonly known as ‘neutrophilic dermatoses (ND).” As a fourth-year medical student, I reached out to Drs. Misha Rosenbach and Robert Micheletti from the University of Pennsylvania Dermatology (they are both Dermatology Hospitalists and have research interests in ND) – I contacted them and expressed my interest in Dermatology and ‘expertise’ in neutrophil biology. At that time, they happened to be in the process of spearheading a retrospective chart review of patients admitted with Sweet’s syndrome! Long story short, I completed two months of research with them, and they became my mentors through this process. Although I was not a University of Pennsylvania medical student, Dr. Micheletti supported my Dermatology Residency Application all three times – Dr. Micheletti emailed me on Match Monday, one hour after NRMP released the much anticipated “Did I Match?” email, and asked how I am doing and if I matched. Mentors do not have to be from your home institution. The mentor-mentee relationship takes work – take these relationships seriously but also show your ‘humanistic side’ or ‘brand of personality’ when appropriate. Remember, there are MANY ways to find and develop a relationship with a mentor – this is just one example of how I did it.

 

What is the biggest misconception about the field of dermatology?

The biggest misconception about Dermatology is that it is an ‘isolated’ specialty – like I mentioned before, Dermatology overlaps with many, if not all, of the Internal Medicine subspecialties – think: systemic lupus erythematosus (Rheumatology), HIV-associated dermatoses (Infectious Disease), systemic sclerosis (Rheumatology, Nephrology, Gastrointestinal, Pulmonology). There is significant overlap between all of the previously mentioned specialties – we see more multidisciplinary clinics, such as Rheumatology-Dermatology, for connective tissue disease patients with skin manifestations. Again, you do not need to limit your manuscript submissions to Dermatology journals – many internal diseases present on the skin – for instance, a CME quiz or review paper on atypical presentations of sarcoidosis can be submitted to a Pulmonology journal.

 

What are the strangest, most bizarre, or most unique questions you’ve been asked after people find out that you’re going into dermatology?

What people commonly say when they find out I am a Dermatology Resident is “oh, that is why you have such nice skin.” The most common question is “what should I do about X, Y, and Z (insert common COSMETIC complaints here) – because of this, I tell new people I meet that I am a Medicine Resident ☺. Also, my phone will occasionally receive pictures of rashes and bumps from my friends – I usually respond with “not interested” haha, just kidding! All jokes aside, I enjoy the question “why Dermatology?” – this question reminds me of the reasons why I chose to pursue Dermatology – and I take this opportunity to educate the public that Dermatologists are not merely ‘pimple-poppers, cyst-removers, and soft tissue injectors.’

 

Okay, so now the question that I’m sure you must be asked non-stop: what’s your skincare regimen?

Well, I do have pretty fabulous skin… ☺ haha. Disclaimer: ‘healthy’ skin is heavily driven by his/her genetic makeup – but evidence-based medicine suggests that sun protection and intact skin barrier are critical for optimal skin health. And of course you should not use this as medical advice. If you have skin questions or concerns you should always seek out an expert consultation with a dermatologist. This is my skin care routine:

 

Morning

In the shower: limit shower time to <10 min and use lukewarm, NOT HOT, water.

(a) Panoxyl 10% benzoyl peroxide (BPO) face and body wash – apply wash to my face only – prevents acne breakouts – has antibacterial and anti-inflammatory properties (BPO will whiten colored clothing so make sure you thoroughly rinse off the BPO, especially if you use colored towels).

(b) Cetaphil Gentle Cleansing Bar Soap.

 

Post-shower

If you are prone to eczema or dry skin – use towel to damp dry – followed by emollient (cream-based, not lotion) application – emollient will ‘lock-in’ moisture.

– Cetaphil Men’s Daily Facial Moisturizer SPF 15 – quick word about SPF – unless you have a genetic skin disease (i.e. Gorlin’s syndrome) – no need for SPF>30 – SPF and percentage of UV blocked employs a base-10 logarithmic scale – this means that an SPF of 10 blocks out 90% of UV, SPF 15 blocks out 93.3% of UV and so forth – the percentage of UV blockage basically levels off above SPF 30 – save your money and spend it on an excellent emollient, instead – see below.

– Cetaphil or CeraVe Moisturizing Cream (from tub NOT pump or squeeze bottle) – I use this to prevent moisture loss and to maintain an intact skin barrier – this is especially important for long hours in the hospital (definitely experienced this as a Preliminary-Medicine intern) – apply liberally to arms and legs.

 

Evening

Same as morning routine (BPO face wash) with the addition of topical retinoids – retinoids such as adapalene 0.1 or 0.3%. Retinoids are indicated for acne and pre-cancerous skin lesions, but they have also demonstrated repeatedly in several controlled studies to improve fine wrinkling, increase dermal collagen synthesis, and lighten uneven pigmentation – because of these reasons, I use adapalene 0.3% nightly – if your insurance does not cover retinoids (tretinoin, adapalene) it can be purchased over-the-counter under the brand name Differin (adapalene).

 

Things to avoid

Alcohol-based products (dries skin) and anything scented.

 

Benny Wu was born in Taipei, Taiwan and immigrated to the United States (Cupertino, California) when he was 10 years-old. Before medical school, he was a figure skater for thirteen years – competing on the national and international level. He graduated from the University of California at Irvine (Irvine, California) the same year he decided to end his competitive skating career. Before attending Rowan University School of Osteopathic Medicine, Bennybecame interested in medical research while he earned a Master’s of Biomedical Sciences from the University of Medicine and Dentistry of New Jersey. This led him to enroll in the combined D.O./Ph.D. program at Rowan University in 2009. Upon graduation from Rowan University in 2016, Bennycompleted an intense but rewarding Medicine-Preliminary internship year at Drexel/Hahnemann University Hospital in the ‘City of Brotherly Love’ (Philadelphia, PA). After his internship year, Benny fully immersed him in Dermatology clinical research by completing a Dermatology Clinical Research Fellowship at Northwestern University, Feinberg School of Medicine. Besides immunodermatology and translational research, he is passionate about mentoring medical students serious about pursuing Dermatology. Outside of Dermatology, Benny enjoys cycling, completing workouts that incorporate stability, endurance, strength, and athletic power, cooking, baking, and traveling. His next dream vacation spot is South Africa (cage dive with Great Whites). To learn more about Benny including his winding path to a dermatology residency you can follow him on Instagram at dermination_sk8r.

 

Interested in other specialty specific resident interviews? Check out these resident interviews and subscribe so you don’t miss out on the next blog post!

https://mykittykatz.com/what-happens-when-you-dont-match-into-residency-twice/

 

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Spotlight interview: from the Caribbean to a categorical surgery residency

Today I had the good fortune to interview a close friend who matched into one of the toughest specialties in the medical field. Not only did she match into general surgery but she also earned a categorical position. Here’s her advice on how she did it.

 

 

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital?

 

I go by Laura Edwards, or just Laura. I am a native South Floridian but I was raised by a strong mid-western mother. I come from an extremely diverse place, which was paired with values that cherish a nonjudgmental attitude and service for others.

I carry those values with me into practice. I use these with patients and colleagues just the same. I am a team player, whatever that means today or tomorrow. I feel comfortable to take the lead or to coordinate behind the scenes.

Outside of the hospital, I am a laid back lady. I binge-watch amazing TV shows, I meet friends for a brewsky, I read fiction, and I have dog. And yes, I study too.

 

 

What specialties did you apply to? How did you come to choose it/them?

I applied to general surgery positions (categorical and preliminary) only. Not applying for other specialties was a serious decision that was made with much thought and care. Many people encouraged me to have a back-up plan. I had to ask myself all the ‘What if’s?’; “what if I get a preliminary spot the first year, and then AGAIN the second year?’, “How will I significantly improve my application before the next cycle?”, “What will I do if I don’t become a surgeon?”, “How will I cope with that?” etc. I calculated the risks as best I could. Yet, in the end I listened to my gut, which told me that I was going to be a surgeon.

 

  

For those who don’t know, what is the difference between a categorical and a preliminary surgical residency?

In the world of general surgery, a preliminary position is a 1-year contract whereas a categorical position is a 5-year contract (or the amount of years required to finish the program). A preliminary position is for a Post Graduate Year (PGY) -1, -2 or even -3 resident. Going into a preliminary position will require the resident to apply for another position the following year, which means entering ERAS again, i.e. residency starts in July and you start your new application in September, only 2 months later. And as many of us know, the more times one enters ERAS the poorer the outcomes can become with each cycle.

When preliminary positions are offered to general surgery candidates it likely means there is something about your application isn’t absolutely perfect. This can be a variety of things: your medical school, your evaluations, your grades or scores, something said on your interview day, etc. It is my understanding that preliminary positions are usually given as a trial year. The program is confident enough to train you for one year but not enough to commit to 5 years.

Therefore, categorical positions i.e. full-contract positions are the goal. When a categorical position is offered, the program director is saying “We see you as a real potential surgeon. We believe with our training and your foundation you could complete our residency program successfully.”

 

 

How many programs did you end up applying to? 

I applied to approximately 230 categorical positions and 150 preliminary positions. As a international medical graduate, I was very unsure of how my application would fare. Fortunately, my family supported my efforts during this time. We all believed the more applications sent the more opportunities I would find. Every penny is worth it.

 

 

How many interviews did you go on for each?

I went on 6-7 categorical interviews and 5 preliminary interviews.

 

 

Any crazy stories from the interview trail?

No crazy stories really. But always be friendly with the other applicants; they might become your co-resident or you will see them again at another interview.

 

 

What did you find to be the most frustrating part of the interview process?

 

There were two things that left me frustrated again and again. The first was waiting.

Waiting for interview invitation emails to come in is the most gut-wrenching part. I found myself going through highs of triumph and hope and lows of defeat and fear. It is an extremely unpredictable and emotionally taxing time. I highly suggest taking up some activity that will strongly distract your mind.

Once on the interviews, the second thing I found most frustrating was that many interviewers were unaware of how the Caribbean schools are structured. I found that my interviewers assumed that I completed all my rotations on the island. I found myself explaining the general flow of my medical education. Once I was able to explain that I had done 2 years of clinical rotations at various hospitals in the US, they were much more open to me as a candidate.

I guess, you would think that all interviewers at least glance through your transcript or would see that your letters were from American institutions, but unfortunately this was not always my experience. My advice concerning this is just to assume your interviewer has no idea where you completed the 3rd and 4th years. Use this as an opportunity to talk up your experience.

 

 

Do you feel that coming from a Caribbean medical school hindered your chances to match in one of the most competitive residency specialties?

Yes, without a doubt. The US applicants I interviewed alongside were overall more relaxed with the whole process. They spoke of turning down interviews and gave off the vibe of “It will all be okay; I’ll end up somewhere [as a categorical surgical resident].”

But let’s step back a bit.

I decided to go for surgery very early on in medical school. Therefore, everything I did was geared towards this goal. I joined the surgery interest group, attended knot-tying sessions and studied as hard as I could without going crazy for Step 1. I spent my entire third year lining up sub-internships (aka audition rotations) at hospitals outside of my medical school’s network. I pursued research within the surgical department from the 2nd week of my third year. I nurtured and maintained a MEANINGFUL relationship with my research mentor (and still do to this day). Everyday I woke up; I made sure I did something to become closer to my goal. I thought about it multiple times a day. I made a phone call to a surgery department while walking in between patients, sent a quick email to a coordinator. My efforts were relentless.

I’m sure some US graduates work this hard to attain their goal but I did not get the feeling from fellow applicants that they had the same level of intensity. I truly believe that my edge/aggressive attitude was what got me to where I am today.

In my mind, there is only one chance to gain that cherished categorical surgery spot, so hold nothing back and have no regrets.

 

 

What do you think were your greatest strengths about your application? What set you apart from the other applicants?

 

My step scores got my application through the filters. Then, my letters of recommendation only confirmed what others saw in me. And lastly, probably what set me apart was the friendly and confident-yet-humble manor I held during interviews.

I also have a MA degree in Marriage and Family Therapy. This was the unique twist I had in my application. This gave my application depth and made my reasons for applying to surgery even more sincere and pragmatic. In reality, I use counseling skills in every relationship I have and more importantly at work and with my patients.

For my program in particular, what set me apart in their eyes was my work and patient care they saw during my sub-internship. I went out of my way to make sure the program director knew my name. I always asked my attendings how I could be better. I made sure my chiefs knew I was reading and following up on previous concepts I was unsure of. I was so intent on being impressive that it actually worked and they vouched for me following my interview.

 

 

In contrast, what were your greatest weaknesses about your application?

Of course, the fact that I was an international graduate and had average step scores were things that I had to compensate for, but at the same time, these are things you cannot change.

The one weakness I could have prevented was a particularly bad evaluation from a particularly important person. The clerkship director for my 3rd year surgery rotation knew my interest in surgery and therefore held me to those standards. Instead of striving for excellence, I became overwhelmed and eventually gave up on trying to impress her. That led to poor decisions that only worsened the situation. I knew her evaluation of me would not be stellar but I did not think she would be so damming either.

The lesson to learn from this is to never let anyone get so down on you that you start to believe them. You are your best advocate and champion. Never let that go.

 

 

How did you do on the USMLE’s? 

I studied hard for Step 1 and received a 233.

I took a risk and scheduled my first sub-internship during the month I was also studying for Step 2 CK. I ended up splitting my time 90% rotation and 10% on CK. So inevitably, I got a 233, the same score as Step 1. This was devastating because all institutions look for an increase in score. A stagnant or decrease in score is can be seen as a red flag. Interviewers asked about my CK score on two occasions. Once I explained that I was also doing my first sub-internship rotation they all understood and did not ask any further questions.

However, the risk I took was worth it because that first sub-internship is where I matched that following March. Hennepin County Medical Center saw me as a person, as a blooming surgeon and not as a number. I hope you all find this too when searching for your residency spot.

 

 

What advice would you give to other international medical graduates who want to pursue a categorical residency position?

 

First of all, thank you Marc for interviewing me. The process of getting this all down on paper has been a good exercise. It has helped me to realize new foundational truths that will help others and me along the way. My main pieces of advice for those pursuing a categorical surgical position are as follows:

  • Be your own champion, always
  • Be relentless in your efforts to stand out
  • Do away rotations at non-affiliated hospitals
  • If you don’t have the scores (~230 or above), be realistic about your chances

 

 

Thank you Laura for taking the time to let me interview you. Your tenacity is inspiring.

Be sure to subscribe below and like me on Facebook so you don’t miss you next week’s interview!

 

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Medical Student Sunday Interview with Daily Medicine

The following interview was originally published on Daily Medicine, a blog full of quotes, ideas, lists, and general knowledge. Check it out for your daily dose of medicine!

In the first “Medical Student Sunday” of 2016, Daily Medicine Blog welcomes fourth year medical school student Marc Katz! Many of you have asked me for a look into a Caribbean medical school and now the chance has come to meet a great student from Ross University. Soon he will be matching into a residency spot and I can not wait to congratulate him. Until then, peek into his life through this candid interview:

 

Who are you to the world?

I’m a first generation American born to South African immigrants, a fourth year medical student currently finishing up my last few interviews for residency in internal medicine with plans to pursue a fellowship in cardiology. I also run a blog, MyKatz, where I advice pre-med and medical students about the hidden curriculum of medical school and try and teach others through my mistakes and experiences. My hope is that I can one day I can use my blog as a medium to educate my patients and expand their understanding of disease, health, and wellness. When I’m not in the hospital or library you can find me playing basketball at the gym, playing Call of Duty, finding a new show to watch, or reading a new book in the park. Right now I’m finishing up Scar Tissue by Anthony Kiedis and the next book on my list is The Man in the High Castle. My cousins told me that the show the book is based on is really good so I want to try and read it before I watch it. It’s the same way that I got into Game of Thrones. Except for GoT I binge watched the first two seasons and then didn’t want to wait for the next season to come out next year so I just read the books instead.

 

What has been your journey to medical school? (Were you a traditional or non-traditional student? Did you always want to be a doctor? Etc)

I went straight from undergrad at SUNY- Binghamton to Ross University School of Medicine. I didn’t realize I truly wanted to pursue medicine until my junior year of college so unfortunately my GPA was ever so slightly below average when I was applying. Ross accepted me for the fall semester so I jumped at the opportunity to start my medical career.

Although my grandfather was a well-respected pediatric surgeon in South Africa I was never really pressured into pursuing medicine. It just kind of happened. I blame the years of watching ER growing up. Fun fact, Christiaan Barnard, the man who performed the first successful human-to-human heart transplant in the world, was my grandfather’s resident!

 

What is it like attending a Caribbean medical school? (A lot of students ask me this and I would love a more detailed answer to this particular question)

I loved attending Ross University! It was an amazing experience to study abroad in such a beautiful country. Sure, we had some annoyances. Dominica’s water filtration system was gravity. So when it rained heavily it would trudge up mud and our water would be turned off. I remember walking home from the gym and it started to pour. Lo and behold when I got home I had no running water. Luckily I prepared for this situation and I had a nice shower with bottled water the day before my exam. But it’s not all bad. My strongest memories are those spent with the friends I made on the island. Attending medical school in Dominica is like going to war because only those who experience it can truly understand what it’s like. I spent almost every waking moment with the friends I made on that island for four semesters straight. I seriously wouldn’t have gotten through medical school without my island family and I’ll love them forever for it. Just please don’t tell them I said that. It would be sooo embarrassing if they knew.

 

To you, what is the hardest part of medical school?

Hell, where should I begin? I almost appreciated being on a literal and figurative island during my first two years of med school. We had no distractions and nothing to do besides study…and maybe drink. So focusing on my studies wasn’t difficult but figuring out how to study was. It took me a few weeks to realize how I study best and it was my first major hurdle in medical school. It’s also been the basis of a few blog posts I’ve authored, like How To Study In Medical School, because of how important it is during any graduate education. The next part, actually studying, is even worse.

You have an average of five to six hours of lecture material every day followed by five to six hours of studying every day. It sucks and there is no shortcut. Thankfully I’m a huge nerd and I enjoyed learning about most of the material, but let’s be real…nobody actually enjoys memorizing the enzymatic steps of the Kreb’s cycle.

 

What is a normal day like for a 4th year medical school student?

I actually wrote a blog post about the day to day life of a third year which you can check out here, The Day To Day Schedule of a Third Year, but I’ve never been asked about fourth year before because there really is no ‘normal day’ of a fourth year medical student. The day-to-day life of a fourth year really depends on the rotation and the individual. I’m willing to bet someone who is going into a surgical residency might have a completely different clinical schedule than I do. I wanted to tour everything internal medicine has to offer so my fourth year schedule has been cardiology, nephrology, hematology & oncology, a medicine sub-internship, gastroenterology, pulmonology, and I’ll be finishing up medical school with an HIV/AIDS elective. Some rotations work you hard and keep you long hours while others let you enjoy your last year of freedom before residency starts. So in that regard fourth year is kind of like third year…you’re just slightly less of an idiot.

Fourth year also includes interview season and it leaves you tired and drained during November and December. That being said, my fourth year has been my favorite year of medical school so far. I’m not constantly anxious about having to go study for step one or step two and there aren’t any more tests, just patients. So I finally get to be self-driven about studying and pursue learning about what interests me. I’m just really excited for residency to start. And for my trip to South East Asia with my friends before residency starts.

 

What is the best advice you ever received?

Never yell at the food staff before you get your food and always pay for your date’s meal. Though I have a feeling you meant it with regards to medicine. If that’s the case then I must admit that the best advice I’ve been given isn’t all that original. I distinctly remember two different people telling me the same advice for two different reasons.

As a third year I was growing frustrated in my attempts to impress my attending whom I wanted a strong letter of recommendation from. And as a fourth year on my medicine sub-internship I was growing frustrated by my patient’s family’s indifferent attitude about the medical care of their loved one. In both instances my roommate and senior resident, respectively, gave me the same advice that was applicable to both situations. They told me to provide and coordinate the best possible care for my patient.

Instead of trying to read my attending’s mind I simply focused on taking care of my patient. I did what I could to make someone feel better everyday. I learned that I can sleep at night knowing that at the end of the day I did everything in my power to take the best care of my patient to the best of my abilities.

 

What qualities in a shadowing pre-medical student impresses you? 

The most impressive pre-med students are those that are awake. Seriously, if you’ve got a heartbeat, a smile on your face, and a skip in your step then you’re already better than half the kids I’ve seen. I remember my favorite pre-med student that was shadowing a surgeon I was working with for the month. During surgery she would diligently write down notes about things she wanted to look up later. She would come back with information that she looked up and asked us follow up questions. When we were waiting for rooms to be cleaned she asked to go watch other surgeries. She showed us that she wanted to be there by being engaged. She was visibly excited to be there and it made my day more fun when she was around. They are the same values and characteristics that make for a good medical student. You can read more about what qualities in a shadowing pre-medical student impress me the most in my blog post, Premeds: How To Shadow Like a Boss.

 

What do you like to do for fun?

Does brunch count as a hobby? Well besides drinking coffee, Bloody Mary’s, and mimosas, I also like to visit my brother at Barclay’s Center where he works and try to go to as many Brooklyn Nets and Islander’s games as I can. I’m also currently trying to knock out my New York City bucket list just in case I don’t match here. By the way, turns out the MOMA closes at 5:30pm during the week in case you wanted to go. Made that silly mistake last week. Still trying to find time and someone to go to the top of One World Trade Center with.

 

Do you have a few tips for medical school students & premeds?

I have too many tips for medical students and premeds! I could preach for days about mistakes I’ve made en route to medical school and how to avoid them as well as how to succeed in medical school. But I do have one real piece of advice for premeds and medical students alike and its not going to be very popular with your friends or family. It is to be selfish. Nobody else is going to make your medical education as their number one priority. That is your job. You are going to miss birthdays, anniversaries, weddings, holidays, parties, and average day to day moments that your friends and family will spend together. You on the other hand should be in the library or hospital studying. As I’ve stated before in a post about The Match, you need a strong step score in order to get past residency program filters and the only thing standing in your way is you. So be selfish and go study.

That being said, if anyone reading this has a more specific questions you can always comment on my blog and ask me a question here or tweet at me at @MarcKittyKatz and I’ll do my best to get back to you as soon as I can!

 

If you are in a relationship, how do you handle balancing school and a committed relationship? 

I am probably the worst person to ask about this…because science is my lady. Just kidding! My life isn’t that sad. I am currently single but I can comment that having a relationship during medical school is totally doable. Tons of classmates of mine met their significant others on the island and during rotations. In my humble opinion, you just have to be honest with yourself and your partner about your med school obligations and make your relationship a priority. It’s just like when people say ‘they don’t have time to exercise’. Nobody in medical school has an extra hour or two in their day but you can make time to exercise and you can make time to date and have a relationship. You just have to make it a priority. I mean, it’s not like it’s going to get any easier in residency. And when in doubt, swipe right.