Welcome to Part 3 of the series! Please read Part 1 and Part 2 before continuing.

A brief word on mental health: Reading this series (hopefully) helps you feel more organized and better understand expectations. But it may also cause stress and anxiety. Please take care of yourself and those around you. If you are feeling overwhelmed, anxious, or depressed, please reach out to someone who can help you navigate through it. You are never alone.

Note: This advice represents my opinion only - not those of affiliated institutions - and was written in the spring/summer of 2024. Some information may be outdated if you are reading this in the future. This is only reflective of my experience.

Signals were introduced for a reason. Gone are the days of applying to >110 programs, hoping for 8-10 interviews. Because the expected value of each application with a signal is higher, applicants can get the same 8-10 interviews from a smaller list of only 28 programs. In theory, the process should be less costly and time-intensive.

As of summer 2024, you have 28 program-specific signals, 3 gold and 25 silver signals in a tiered system. Applicants can also select a preference for three geographic areas of the country. Away rotations are another ‘signal’ and should overlap with your application signals. This changes how applicants should think about ERAS before submitting. So, you have to narrow your application list to only 28 total programs.

The data show that the likelihood of an interview from a non-signaled program is <1% (read more from the Sherriff of Sodium). Of course, as a nervous applicant, I applied to more than that. However, I only got interviews from places I signaled.

So what does this mean for planning aways and signals?

Being limited to 28 signals/programs on ERAS changes how applicants should choose away rotations and program list.

Aways: Doing an away rotation at a program, then sending a silver signal, or worse, no signal, can send a strange message. So plan around doing aways at places where you would send a gold signal - of course, more easily said than done.

Program Signals: The 28 signals should be the same as your ideal rank list. I would strategically create 28-program lists and apply only to programs you would actually go to. Speak with your advisors and be realistic about your competitiveness. Think about a reasonable mix of programs from different ‘competitive’ tiers (yes, I realize that is crazy given that Dermatology is super competitive), but you know what I mean. You may struggle if you are a weaker applicant who only applies to the country’s top 28 programs. So go with your gut, get advice, and do what makes sense.

Geographic Signals: These used to be very important but carry less weight now. If your 28 programs all fall within 3-ish geographic preferences, then it makes your life easy. Otherwise, I would try to use 3 geographic areas cover as many programs as possible. If 70% of programs fall within three areas, choose those. I’m unsure impactful geographic signaling is overall, as I did get interviews outside my geographic preferences. But now that we send direct program signals, these matter less. Saying ‘no preference’ likely does not hurt you too much, but I would try to put some preferences down as I’m sure programs like to know if you have a compelling reason to come to the area in addition to the program itself.

Great, so how do you think about where you fit in?

Program selection is one of the most challenging parts. Websites look similar, and learning about programs before interview day can be hard, as you need to apply the interview day info sessions. And as we read above, you’re mostly limited to the 28 signals. Some people know current dermatology residents/faculty to learn about programs but most do not.

Learning about Programs: Beyond the website

The best way to learn about a program is to talk to current residents. Not everyone has that option, but this is the time to leverage your network. It’s essential to be clear that you are just trying to learn and don’t expect any favors. Be respectful, reasonable, and courteous. Make a list of questions ahead of time. Some popular topics include program culture, rotations/sites, research opportunities, standard post-residency outcomes/placement, mentorship, teaching, etc. Read the room but don’t be afraid to share what’s important to you and why you want to learn about it. Other ways to learn are to ask your dermatology advisor or faculty, read the blog/follow the program's social media, and Google the core faculty to see what they specialize in/care about. What unique rotations, clinics, research, electives, settings, or other opportunities do they offer? (Note: Try not to listen too much to the Reddit posters. You never know what’s real and what’s hearsay).

Building a Coherent Program List:

Many applicants approach it like college application tiers - top, middle, and lower. But we know dermatology is super competitive, with great programs at every level of ‘prestige.’ The tiered approach is certainly reasonable. Have an honest conversation with yourself and your mentors/advisors about your application’s competitiveness. Strike a balance between aspiration and practicality. Don’t lose sight of the goal - more interviews lead to a better chance of matching.

Believe in Serendipity:

Always leave room for luck. If you’ve always dreamt about Program X, even if it seems out of reach or unrealistic, don’t deny yourself the possibility of going. Of course, you can’t have a list of 28 dream programs, but you never know who will connect with your story, journey, and passion within the field. You may regret not knowing what might’ve happened if you don’t even give yourself a shot.

Dual-Applying:

Dual-applying has been unfairly stigmatized. Dermatology is absurdly competitive. You’ve sacrificed years, income, important events, etc., to apply for residency. I would never fault anyone for dual-applying, and it makes sense if you have a weaker application. It’s probably better to match into a prelim year or another specialty than to go unmatched, but speak to your advisors about the best strategy and plan your contingencies early. Don’t wait until Match Day to make a backup plan if you need one - research year, prelim year, another specialty, etc.

Examples of an Application List: This is for educational purposes only, not specific advice. Unfortunately, I don’t know any particular reader’s application. Please confer with your advisors and mentors.

General:

You made it. You’ve done all this work. Now, it’s time to summarize what you’ve done and share your experiences. For better or worse, most of ERAS is formulaic. There are few areas to editorialize, so we’ll only focus on the two main ones - the personal statement and selected experiences.

Personal Statement:

Giving advice here is tricky. Everyone has a unique story to tell, and there are many ‘right’ answers about what to include. In general, it’s helpful to provide a story. Human beings are storytellers, so turning your journey into a compelling narrative makes it easier to understand. Ideally, you want to highlight important aspects of your identity and prior experiences while showing commitment, growth, reflection, ambition, and humility. Keep it concise - one page at most!

A successful formula I’ve seen is:

Experiences:

This is your second-best opportunity to showcase your individuality. My year, we were able to put 10 experiences down. I mostly focused on professional, volunteer, and research experiences, but left 1 space for Hobbies/Personal interests.

I was a fan of bullet points instead of paragraphs as they are easier to read. For each experience, discuss how long did it, what you accomplished, and what it taught you. Your three most meaningful experiences will likely be the ones asked about most in interviews, so be thoughtful about what you choose and how your application will be remembered. Express your individuality and your journey!

Many applicants leave Prelim and TY year research as an afterthought. Let’s try not to do that! This year is formative, as it gives you a foundation in medicine and is the beginning of your professional identity as a doctor. I’ll leave whether you do a TY or Prelim year up to you and your advisors.

I would recommend applying to at least 25-30 programs. Do your research. Ask around about programs that prior years recommend. These interviews generally happen much earlier than Dermatology interviews. Be sure to look up when the 28 dermatology programs plan to offer interviews so you can avoid those dates when scheduling TY/Prelim interviews. I made myself a spreadsheet with all the programs' potential interview dates to avoid any possible conflicts.

Most people apply to programs near where they currently live or where they will be for PGY-2. I would also recommend trying out something new if you have the flexibility, being near family support if you have children, etc. This is a chance to explore!