What matters most: Why the COVID-19 pandemic should prompt us to revisit the dermatology resident selection process.

To the Editor: We read with great interest the analysis by Stoj and Grant-Kels regarding the ethical obligation of dermatology trainees to provide essential patient care. Expanding on this concept, we propose that the COVID-19 pandemic should serve as a call to action for our specialty to revisit the dermatology resident selection process, with the goal of emphasizing ideals highlighted as being fundamentally important in this time of global crisis. The upcoming shift of the United States Medical Licensing Examination Step 1 score reporting to pass/fail will leave a vacuum that may be filled by relevant selection criteria to meet the current and future needs of our specialty and medicine.

The COVID-19 pandemic has placed unprecedented demands on the dermatology community, including having to adapt to rapidly changing paradigms of patient care and personal safety. Dermatologists have been presented with difficult ethical and professional dilemmas, including halting most clinical operations to conserve personal protective equipment and support social distancing, and in some cases, practicing medicine well beyond the purview of skin disease. Despite these challenges, members of our field have chosen to prioritize the lives of others over their own personal health or revenue.

Similar demands have trickled down to trainees, who have been presented with unplanned changes to clinical duties, unconventional methods to fulfill educational requirements remotely, and uncertainty for the foreseeable future. The COVID-19 pandemic has underscored the importance of qualities such as self-sacrifice, resilience, teamwork, and adaptability in all clinicians, which should be appropriately mirrored in the dermatology resident selection process in addition to traditional measures of excellence.

The residency applicant screening and selection processes should stress each applicant's personal and professional journey (“distance traveled”). Special attention should be given to applicants who have demonstrated sustained volunteerism, a commitment to address health care disparities, ability to overcome difficult personal circumstances, Gold Humanism Honor Society membership, or prior military service. Several of these attributes have been proposed by prior authors as a means to increase diversity in dermatology, another critical need in the specialty.3, 4, 5 This type of information may be extracted from already available components of the residency application, including the personal statement, letters of recommendation, curriculum vitae, the Medical Student Performance Evaluation, and the interview. Moreover, experience garnered from using virtual communication platforms during COVID-19 may be used to establish virtual interviews of prospective candidates, which may help to reduce financial barriers to applying to dermatology3, 4, 5 for applicants who are otherwise qualified.

Assessment of a broader range of personal and professional accomplishments may identify prospective residents who exhibit selflessness or grit and will enhance the robustness and diversity of our workforce and our potential to contribute to the house of medicine.