Approaching the dermatology residency application process during a pandemic.

To the Editor: The COVID-19 pandemic presents an unprecedented crisis that has caused significant disruptions to medical education. Continued uncertainty around travel restrictions, clerkship scheduling, and resumption of clinical activities has heightened medical student anxiety about the upcoming residency application process.

Dermatology is consistently one of the most competitive specialties, with a 28% unmatched rate in 2018. Given this environment and the emphasis placed on personal knowledge of applicants, many applicants complete away rotations to gain exposure to outside programs, secure letters of recommendation, and collaborate on research projects. On average, applicants to dermatology have among the highest number of publications and research and volunteer experiences across all specialties. Many of these opportunities are in jeopardy this cycle given rotation cancellations, altered or limited volunteer opportunities, and interrupted or halted research.

To address students' concerns about the upcoming cycle, we (ISR and CRS) released a dermatology program director consensus statement to be shared with medical students and medical school faculty and deans. Statements from obstetrics and gynecology, otolaryngology, emergency medicine, neurosurgery, and pediatrics have also been published. These statements are in line with recommendations released by the Coalition for Physician Accountability, composed of representatives from several national medical organizations.

Given the ongoing crisis, we suggest changes to the application and recruitment process for academic dermatology programs around the country to consider.

Away rotations: We recommend that dermatology programs reserve away rotation opportunities for students without home institution dermatology options and encourage such students to seek rotations with the closest dermatology practice or program. Additionally, we encourage the creation of virtual experiences to allow for recruitment of students from other institutions. These may be noncredit bearing, be shorter in length than typical rotations, and include a variety of activities, including but not limited to participation in virtual educational conferences, remote panels or meetings with selected faculty and residents, teledermatology clinical care, and virtual tours of facilities.

Interview process: We strongly recommend that programs develop plans for remote interviews via currently available videoconferencing platforms. The capacity to conduct remote interviews will be critical moving forward, even beyond the current pandemic situation, by reducing student costs (which may aid in recruiting applicants from broader socioeconomic backgrounds), allowing for greater scheduling flexibility, and aligning with environmentally sound practices in light of the climate crisis.

As program directors, we understand the difficulty in enacting novel and possibly temporary policies. We also sympathize with the inclination for a wait-and-see approach as parts of the country modify physical distancing and shelter-in-place orders. However, application season is upon us, and with the likelihood of the pandemic continuing in some capacity for the next several months, it is imperative that we take a proactive approach. Expecting students to travel during an overlapping COVID-19 and influenza season risks their health and risks exposure and transmission of infection to faculty and residents. We propose that these suggestions be adopted broadly to alleviate medical student concerns, address potential inequities in applicant opportunities, and implement socially responsible measures that will position us well for future challenges.