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A national survey to determine an optimal fourth year curriculum for dermatology candidates

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A national survey to determine an optimal fourth year curriculum for dermatology candidates
Ali Alikhan MD, Lynda Ledo, April W Armstrong MD
Dermatology Online Journal 15 (10): 2

University of California Davis School of Medicine, Department of Dermatology, Sacramento, California.


Application to dermatology residency programs are bcoming increasingly competitive [1] and faculty advisors face the challenge of how to best advise medical students on preparing residency applications and obtaining clinical training important for dermatology. Students interested in dermatology frequently inquire how to structure their fourth year curriculum. A study in family medicine found agreement among program directors (PDs) regarding clinical rotations that would provide essential skills to family medicine applicants [2]. We surveyed PDs and chairpersons of U.S. dermatology programs as a primary step in determining an appropriate fourth-year framework for students interested in dermatology and also assessed their opinions about the importance and optimal number of dermatology rotations away from their home institutions.


We emailed surveys to PDs and/or chairpersons from 106 U.S. dermatology programs, excluding military and overseas programs. The survey asked the participants: 1) whether they considered away dermatology electives essential for application to dermatology residencies; 2) if so, how many such electives the students should complete; and 3) what non-dermatology electives were important to complete prior to starting dermatology residency. There were no incentives for completing surveys. This study was granted exemption from the University of California Davis Institutional Review Board.


Figure 1Figure 2
Figure 1. Number of away electives in dermatology suggested by 26 dermatology program directors and chairpersons. Additionally, 2 responded that applicants should take as many as they could.

Figure 2. Ten non-dermatology electives considered most important by dermatology PDs and chairs

Of the 106 dermatology programs surveyed, 20 chairpersons/chiefs and 48 PDs (from 67 programs) responded (63% of total programs). Twenty-eight respondents (41%) considered away dermatology electives to be essential whereas 40 (59%) did not. However, eleven respondents who did not consider away dermatology electives "essential," wrote that they were still "important" in helping students match, especially if they had a "particular location or program in mind." Those who believed away dermatology electives essential for a successful match reported a mean of 2.0 electives per student (Fig. 1). Infectious disease, internal medicine and rheumatology were considered among the most important non-dermatology electives to take prior to starting dermatology residency (Fig. 2).


For students able to rotate at "home" dermatology electives, 59 percent of PDs and chairpersons/chiefs did not consider away dermatology electives essential, but thought that an away rotation could be "important" if a student had an interest in a particular program. Second, 71 percent of respondents who supported an away dermatology elective deemed 1 or 2 electives sufficient. Finally, the PDs and chairpersons/chiefs considered experiences in infectious disease, internal medicine, rheumatology, pediatrics, and allergy important preparation for a dermatology residency. These non-dermatology electives complement a student's understanding of dermatology and may be important in fostering a well-rounded applicant in other areas of medicine.

A concerning phenomenon in the dermatology application process is the "pre-residency syndrome." This is characterized by some applicants rotating in dermatology at numerous institutions (so called "serial auditions"), while sacrificing opportunities during their senior year to learn other important areas of medicine or surgery [3, 4]. When advising dermatology candidates, it may be more important to emphasize a diverse and well-balanced curriculum. Away dermatology electives are most important if a student's home institution lacks a dermatology program. In addition to this situation, faculty advisors may suggest one or two away dermatology electives; these program recommendations should take into account the student's interests, strengths, or location requirements.


1. Wu JJ, Tyring SK. The academic strength of current dermatology residency applicants. Dermatol Online J. 2003 Aug;9(3):22. [PubMed]

2. Hueston WJ, Koopman RJ, Chessman AW. A suggested fourth-year curriculum for medical students planning on entering family medicine. Fam Med. 2004 Feb;36(2):118-22. [PubMed]

3. Swanson AG. The 'preresidency syndrome': an incipient epidemic of educational disruption. J Med Educ. 1985 Mar;60(3):201-2. [PubMed]

4. Smith SR. Effects of the 'preresidency syndrome' on students' selection of fourth-year courses. J Med Educ. 1988 Apr;63(4):276-82. [PubMed]

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