Tips to Excel on a Dermatology Sub-I
Written by Ana Preda-Naumescu
Congratulations! You successfully secured a dermatology away rotation—now what? Receiving an acceptance for a dermatology away rotation often produces mixed feelings: excitement at the opportunity, quickly followed by feelings of insecurity and unpreparedness. Most medical schools do not have a robust preclinical dermatology curriculum, nor do they have ample opportunities for inpatient/outpatient clinical exposure. Often, students are left feeling ill-prepared to shine on their away rotation simply from lack of exposure. You are not alone! Don’t be discouraged—this article will provide you with all the tips and resources needed to put your best foot forward!
Now, before we dive into the nitty-gritty, I would like to offer you a sage piece of advice. Before my away rotation, my mentors told me time and time again that as a medical student I will not be expected to know much in the way of pathology, diagnosis, treatment, etc. This is true—dermatology residents and faculty recognize that exposure to the field is significantly limited as a medical student. While this is reassuring, knowing some stuff will help you stand out. So, what is this stuff that you should know and where can you learn it?
Morphology— Dermatology is often said to ‘have its own language.’ This ‘language’ is the descriptive terminology that dermatologists use to paint a picture of the patient’s skin findings and narrow down the differential diagnosis. Being familiar with this terminology and being able to use it in the physical exam portion of your patient presentation is key to making a good impression.
· Practice describing skin lesions and became familiar with the morphology of common skin conditions! I learned the basics of morphology using the American Academy of Dermatology (AAD) Medical Student Curriculum (linked below). From there, I used other text resources (found throughout this article) to hone my skills. These texts are photograph heavy—each photo of skin findings is usually often accompanied by an expert description. Cover up the description, try to describe it on my own, and then compare your answer to the one provided.
· Basic Dermatology Curriculum by AAD – This collection of online learning modules is free and provides medical students with an overview of common dermatology conditions. In addition, they have dedicated videos to morphology, the basic science of the skin, the skin exam, and important therapeutics. They offer a condensed 2-week module, and a more spread out but comprehensive 4-week module. You can get through all the videos in less than a week if you commit.
Common Dermatological Conditions—
As a medical student, you are not expected to know complex medical dermatology. However, being familiar with commonly encountered skin conditions and their management will help you shine on your away rotation. This may sound daunting—how do I know which conditions are the common ones?
I would suggest becoming familiar with the conditions discussed in the aforementioned Basic Dermatology Curriculum
Lookingbill and Marks’ Principles of Dermatology – This is a great resource for medical students. It is a short, introductory textbook that nicely covers the spectrum of skin conditions you are likely to encounter. I read this book in the week and a half before my away rotation and took it with me in case I needed a surface-level skim to jog my memory while on the job.
Other Resources & How to Use Them—
The following resources are great references to use while on your rotation. They are much more comprehensive than the aforementioned resources in terms of conditions covered; they each give short, condensed descriptions concerning the pathology and treatment options. They have a lot of high-quality photographs, which is always important in dermatology. See something interesting one day in the clinic, or while on inpatient consults? Quickly familiarize yourself using these texts. I do not recommend trying to read this front-to-back before your rotation. If anything, scan through the pictures. Finally, you do not need both of these texts. Choose one and save yourself some money!
Dermatology Essentials aka “Baby Bolognia”—is definitely less daunting than the two-volume set you will grow to love during residency.
Final Tips for Success—
Be Helpful
This sounds like a no-brainer but sometimes on dermatology rotations, it can be difficult to know how to help. Unlike some of your M3 or M4 rotations where you present and work-up your patients, there is often a lot of shadowing on your dermatology away. In that situation, it can be hard to figure out how to make a good impression. A good rule of thumb: try to anticipate what your resident or attending might need, and get it done!
Set up the Biopsy Tray-
Familiarize yourself with shave versus punch biopsies, and what is needed to perform each one. When you hear that the attending or resident is going to perform one of these, take the initiative and set up the tray. I promise this is helpful, and it does not go unnoticed.
Grab the liquid NO2 for freezing actinic keratoses, verruca vulgaris, etc.
Clinic Schedules and/or Patient Lists
If you have access to the EMR and know which clinic you will be in for the following day, look up the clinic schedule. Try to familiarize yourself with each patient's diagnosis and treatment plan—read up on the current literature. Having this sort of familiarity before you arrive each day can change the dynamic of the conversations you are having. Now, you can craft questions that show off your knowledge base and allow you to better engage with your residents/attendings.
If you are spending time on inpatient consults, familiarize yourself with the list!
Be Kind—
Seriously, treat everyone with respect. Dermatology is a competitive specialty, but that is no excuse to try and outcompete your fellow rotators. Trust me—it will be obvious to your faculty and residents if you are unkind to other students or the support staff. If anything, befriend your fellow rotators! These are the individuals that can lend you support during the tough application season, not to mention these people will be your colleagues in the future.
Finally, remember to be yourself and have fun. You are taking steps to realize your dream of being a dermatologist! Celebrate the little things! Do not lose sight of your ‘why’ and please don’t forget that you are on this away rotation to see if they will be a good fit for you, just as they are trying to assess if you are a good fit for them.
