The ULTIMATE GUIDE for Matching into Competitive Specialties – PART ONE

Overview

• Change Your Mindset (FAITH)
• Make people fall in love with you (NETWORKING)
• Show them how smart you are (ACADEMICS)

Look forward to the following topics in Part 2 and 3:
– Show them how curious you are (RESEARCH)
– Show them how unique you are (HOBBIES/TALENTS)
– Paint a glorious picture (ERAS)
– Make them laugh, or cry (INTERVIEW SKILLS)
– Maintain an elevated mindset (AFTER THE MATCH, FAILURE)
– Q&A (ADVICE FROM RESIDENTS/FELLOWS/PROGRAM DIRECTORS)

Change Your Mindset (FAITH)

The MOST IMPORTANT FACTOR in accomplishing anything you want in life, is believing you can do it. If you don’t believe you CAN accomplish a goal, you won’t put in the right amount of energy into accomplishing it. Doubting yourself, thinking about how hard something is going to be, or having a negative attitude about your chances to succeed all have quantifiable impact on your ability to obtain what you want. Here are some practical tips to change your mindset.

• Have a vision: See yourself matching into the specialty and program of your dreams. Imagine the patients you will help. Think of the life you will live. Take note of the positive emotions you would feel if you were to accomplish your goal. Hold onto those positive emotions when things get rough or shaky.

• Make a decision: DO YOU WANT TO GO INTO DERMATOLOGY??? Then GO FOR IT WITH ALL YOUR MIGHT. Don’t settle for a specialty that doesn’t interest you because of your fear of failure. You miss 100% of the shots you don’t take. Once you decide that this is what you want to do, you can throw away that Plan B in your pocket and start developing Plan A- 1.0, Plan A- 2.0 etc. The method might change, the length of time it takes you to get there might be longer than you hoped, but if you REALLY WANT IT, the goal should stay the same. I’m aware that not everyone agrees with this mentality, but I stand behind this way of thinking because it has helped me succeed in every area of my life.

• Try your best to stay out of the chat rooms and applicant spreadsheets: If you’re anything like me, you’re probably going to look no matter WHAT I say (I spent hours and hours on those chat rooms). Just keep in mind that people are extremely anxious and neurotic in those chats, and that negative energy can very easily get passed on to you. People also LIE THROUGH THEIR TEETH on there, about their step scores, publications, and more. Just be careful, it’s the wild wild west.

• Take what people say with a grain of salt: Not all advisors and mentors are created equally. They tend to look at statistics and obsess over numbers. For example, if you have a step score below a certain number, they may tell you that it is unlikely for you to match into Dermatology, so you should consider another specialty. Let’s consider, just for a moment, the fact that any stat about the likelihood of a person to match with a given score does not take into account how well they networked, how good their interview skills are, or even their research. There is so much more to this than stats.

• Control what you can: There are factors that are IN YOUR CONTROL (ie how hard you study for an exam, how many mentors you reach out to) and factors that are OUT OF YOUR CONTROL (ie lack of a dermatology department at your medical school, a preceptor deciding they don’t like you during a clinical clerkship). Your job is to make sure that everything that is in your control is in TIP TOP SHAPE. Namely: after you read this guide, you have work to do. Whatever you’re doing well now, do more of it. If you have any poor habits that will decrease your likelihood of being successful, STOP THEM. Get accountability partners (study buddies, meditation partners, prayer partners etc). DO WHAT YOU NEED TO DO to continue moving towards your goals. Believe that those factors that are out of your control are NOT LARGE ENOUGH to overcome the factors that ARE in your control. You can. You CAN. YOU CAN.

Make people fall in love with you (NETWORKING)

THIS IS WHERE YOU CAN CHANGE THE GAME FOR YOURSELF. Networking effectively is one of the only factors about your journey to residency that you can truly and completely control. Some of you may think you have been “networking” because you have a mentor that you speak to regularly in your field of choice, or you have gone to a few conferences and collected business cards, or because you have even contacted a program director or two in the past. Here’s the deal… NONE of this is enough. Don’t get me wrong, they are a great start, but ONLY a start.

This should be your networking goal: Developing lasting and meaningful relationships with mentors and advocates that are faculty members at every program you think you might want to go to. I firmly believe that doing this was the single most important thing that lead to a successful interview season and match for me. The next statement is not to brag, but simply an illustration: In addition to the other interviews I received, out of the top ten ranked Dermatology programs on Doximity the year that I applied, I got interviews at 8/10. The two I did not get interviews at were the ONLY two programs on that list that I didn’t have a personal relationship with a faculty member. Let that sink in.

Furthermore, when I went to my interviews, there were many occasions when faculty members singled me out to say hello or ask how I was doing to the point where other applicants would ask: “Did you attend this program for medical school?” “Did you do an away rotation here?” The answer was usually, “No.” I had never even met most of them in person prior to interviewing.

Effective networking CHANGED EVERYTHING for me. Besides developing lasting relationships with great mentors and getting valuable advice, I also improved my interview skills by talking to so many people, and significantly increased the number of interviews I was offered. I had faculty members at different programs who felt a responsibility to help me, make phone calls on my behalf, speak up for me in meetings, give me interview tips for their specific programs… and the list of benefits goes on and on. I STILL maintain regular relationships with many of them today.

So how did I create this network? And what’s the formula so you can do the same or better?

1. Identify potential mentors/contacts/advocates: Go to the websites of all the programs you may be interested in applying to in the future, all across the country, and identify faculty members that you want to contact. I usually looked for people that had something in common with me (minorities, women, people that were interested in research areas similar to mine). Make a list of these people and find their email addresses or their secretaries’ email addresses. I personally reached out to over 50 academic dermatologists across the country. I probably received responses from 25-30 of them, and used the following steps to build rapport. Pro-Tip: Another way to identify mentors/contacts is by going to conferences in your desired field and talking to speakers/presenters. When you introduce yourself, always make sure to ask for a business card or their email address, and contact them as below.
   
   
2. Reach out: Send a BRIEF email to them introducing yourself, stating your interest in their specialty, and have an ASK (ie brief phone call or meeting in person to learn more about their journey to the specialty, opportunity to help with any research projects they are working on, etc). My go-to line was: “I am writing to you because I wanted to introduce myself, as well as learn more about your journey to the field of dermatology. Please let me know if you have any availability for a brief in-person or phone meeting in the near future.” You can attach your CV if you desire. Make sure this email is SHORT and TO THE POINT with a lot of WHITE SPACE and not a lot of words!!! Faculty members are busy people, the longer your email is, the less likely they are to read and respond. Pro-Tip: put a small professional photo of yourself in the body of the email underneath your signature. Make sure you look friendly and confident in the photo. This allows them to become familiar with your face, which will eventually come in handy when you visit their program for interviews etc (maybe that’s why so many faculty members were able to recognize me on the interview trail).
   
   
3. Meet with them: Schedule BRIEF in person or phone meetings based on the faculty member’s preference (usually somewhere between 15-30 min). BE EARLY. During the meeting try to ask the person questions about their journey more than you talk about yourself. This is how you will truly learn from them and get to know them. From a psychological standpoint, most people enjoy conversations in which they spend a lot of time talking about themselves, so make sure they enjoy the conversation. Of-course, personality types factor in here. Some people won’t have much to say and will want you to carry the conversation. Be prepared for this. Some of them will also ask you questions, which you should try to answer enthusiastically. Some will seem uninterested. Try to maintain your enthusiasm and don’t take anything personally!  Pro-Tip #1: Have a good handshake when you enter and leave the room. Make good eye contact, but don’t stare. Try to mirror the person’s tone and body language, which helps to build rapport. Pro-Tip #2: Keep a running spreadsheet of who you talked to and when, and any major advice they gave you or major personal details they gave about themselves (ie their dog Bingo or their newborn daughter Ashley, etc). This information will help you when you follow up. Pro-Tip #3: You may not get responses from many of the people you reach out to. Feel free to send a follow up email no sooner than 2 weeks later. If they still don’t respond, let it rest for now. DON’T TAKE THIS PERSONALLY.
   
   
4. FOLLOW UP: This is where most people go wrong with networking. One meeting is ONLY to initiate a relationship! You have to follow-up in order for it to grow! You can do this in a few ways: First, send a follow-up email the day after your meeting or conversation thanking the person for their time. Second, at 3-6 month intervals, send additional short follow up emails listing any major accomplishments since you last spoke (awards/honors, publications) and thanking them for their advice and ongoing role in your success. Wait another 3-6 months and repeat (or go with the flow, from this point one of them may take a personal interest in you and even initiate conversations more frequently). Pro-Tip #1: If you want to get fancy, tell them how you benefited from SPECIFIC advice they gave you during the last conversation. For example, if someone told you during that initial call “It’s important to learn how to say ‘No’ early-on in life so you don’t over-commit”, tell them about a time since you last spoke that saying “No” to someone allowed you to have time to study or spend time with family etc. This shows that not only did you pay attention to them, but they also had a positive impact on your life! Nothing feels better than knowing you changed someone’s life for the better. This is how you build rapport! Pro-Tip #2: If you want to get REALLY fancy here, throw in a “Hope Bingo is well!” towards the end of the email to show you paid attention to the personal things they told you as well.

Random networking Pro-tips:

• Master the art of being persistent without being annoying when contacting faculty members. Know that they are busy, and responding to you likely isn’t first on their priority list, so sometimes a follow up email/call is appropriate. On the other hand, it’s important to realize the times when someone doesn’t want to mentor you or keep talking to you (ie they respond to your email without giving you information to schedule a meeting even though you asked for it, they are rude and short in meetings, etc). Sometimes it’s ok to let one or two fall off gently.
• If you are an M1 – M3, your contact intervals can be on the wider side (ie every 6 months) so that you stay relevant in their minds but you aren’t harassing them. As an M4, you may want to talk to them more often (ie every 2-3 months) to stay fresh in their minds. There is NO exact formula here, some faculty members will get annoyed no matter WHAT you do, but that’s what worked for me.
• As an M4, avoid sending random emails to initiate relationships with Program Directors and Chairpersons as you get close to submitting your ERAS. They are VERY BUSY at this time. Also, it is OBVIOUS that you are only reaching out to them because you are about to apply. Reach out to other faculty instead. My suggestion is, if you want to develop relationships with PDs/Chairs, have a mentor make a call for you, or start earlier in medical school.
• Don’t take anything personally. Literally. Anything.
• It is also very helpful to meet and talk to residents in the field! They have valuable information on the day-to-day details about the programs, as well as tips for doing well in the Match. They are invaluable resources!!! Unfortunately, it is often hard to find their email addresses online, but you should try.
• These in-person and phone meetings are EXCELLENT interview practice.
• A brief word on away rotations: We’ll talk more about this in Part Two, but on every away rotation you do (if you do any), try to set up a meeting with the program director, the chairperson, and other faculty members while you’re there. During EACH away I went on, I set up around 8 in-person meetings, and was able to sell myself in real time to the people that would soon be making a decision on who to send interviews to. As SOON as you are confirmed for an away rotation, it is OK to send emails trying to schedule in person meetings during your rotation.

Show them how smart you are (ACADEMICS)

FIRST AND SECOND YEAR GRADES:

In my humble opinion, the main thing you should be focusing on during these years is mastering how YOU learn. You should also get your physiology and pathology down so that when you’re studying for Step 1 later, you’re not starting from scratch, even if the memories are fuzzy. M1/M2 grades also help your chances of becoming AOA member (although you’ll have to contact your individual medical school to get a better understanding of what factors are used to decide AOA membership).

USMLE STEP ONE:

If you HAVEN’T taken step yet: Step 1 scores are important. Step 1 scores are important. Step 1 scores are important. There, I said it 3 times, so you MUST believe me by now. STUDY HARD FOR THIS EXAM!!! Try your best to get the highest score possible.

It is also important to know in advance… While Step 1 scores ARE important, they are NOT, by any means, the end-all, be-all. Some programs have cut offs (the programs that publish these cutoffs document that on “Frieda” (https://www.ama-assn.org/residents-students/match/freida), while others don’t. Some have cut-offs and don’t publish that information. It’s all truly a big mystery. Average step 1 score for matched dermatology applicants is somewhere in the high 240s and continuing to trend upwards.

If you HAVE taken step and you got 240 or greater: For the most part, programs don’t have cut-offs higher than 240 for reviewing applications. Your step score hasn’t closed any doors for you. You did wonderfully on step, move on to the next section.

If you HAVE taken step and your score was 220 to 239: You did OK on the exam, and dermatology is not closed off to you. There are a few programs that will not review your application because your score is below their cut off, but you are still WELL in the running for the rest of the programs. You now need to start thinking about getting a higher score on step 2 CK, networking with faculty at programs you are interested in applying to, bolstering your application with excellent research and other things that make you stand out, and applying to a lot of programs.

If you HAVE taken step and your score was below a 220: Is it impossible to match? NO (I can hear all the gasps now). I repeat, NO. I can say that definitively because I know multiple people who matched into dermatology with step scores below 220. I also ASKED MULTIPLE PROGRAM DIRECTORS this exact question… not a SINGLE one of them was willing to quote a certain score under which it was “impossible” to match. Now… is it going to be HARDER for you to match? Maybe even MUCH HARDER depending on how low the score is? Absolutely. Harder does not mean impossible. As above, you need to make sure every other aspect of your application is FIRE. You need to consider doing a year or so of dedicated dermatology research at an institution you are interested in matching to (after having a deliberate conversation with faculty about your chances of getting an interview after that year). You should also be prepared to apply to a whole lot of programs (basically ALL OF THEM), and you should be networking like crazy.

NOTE: There are applicants with scores >240 that DO NOT MATCH. There are applicants with scores <220 that DO MATCH. DO NOT COUNT YOURSELF OUT because of a single score. DO NOT GET COMFORTABLE because of a single score. Each program considers your WHOLE PACKAGE. You are NOT your score (*ques India Irie track*) BUT a higher score increases your chances. That’s just it.

THIRD YEAR GRADES:

More important than M1/M2, are your M3 grades from clinical clerkships. I may drop another guide about tips and tricks to do well in all of those cause that’s a whole topic on its own, but some general tips are:

• Keep an open mind during third year!!! you might THINK you want to do dermatology, but maybe OBGYN will steal your heart. Allow for that opportunity.
• Don’t go into rotations telling everyone what you want to do (unless you want to go into the specialty that you are currently rotating on). When a resident or attending asks you “So… what are you thinking of going in to?” You should respond, “I’m not sure yet! So many different things are interesting and I haven’t made a decision. I really like _______ about _____ (insert rotation you’re on here).” If people think theres a chance of you going into their specialty, they teach you differently, they approach you differently, and I really think they are more likely to like you. You aren’t obligated to tell ANYONE what’s in your head as a third year because the truth is, that’s likely to change anyway.
• When you start working with a new attending or resident, ALWAYS ask what their expectations are of you!!! Then at certain intervals (ie weekly) ask for feedback about whether or not you are reaching their expectations. Make changes right away based on their feedback.
• The general stuff: Get there early. Stay late. Don’t EVER ask to leave early. Be helpful without being in the way.

USMLE STEP TWO:

The average person does about 10 points better on step 2 than step 1. The biggest question here is WHEN to take it. Generally people agree that if you got a lower score on step one, you should take Step 2 earlier in 4th year and aim for a higher score so you can show the programs you improved. If you got a score you’re happy with, it doesn’t matter as much when you take it. Also if you’re taking a year off for research after 3rd year,  I would HIGHLY suggest taking it before you start your research or in the beginning of the year when the information is fresh. Take it from me, it’s significantly harder to remember the information/ study when your brain has completely let go of 3rd year knowledge and only knows one small thing like… Tuberous Sclerosis Complex (that’s what I studied during my research year, and I didn’t get a single step 2 question on it).

PHEW! That wraps up Part ONE, Stay tuned for Part TWO coming soon. Please share this blog post with anyone you know who would benefit from this information.