SKIN May 2022 Volume 6 Issue 3 (c) 2022 THE AUTHORS. Published by the National Society for Cutaneous Medicine. 260 SHORT COMMUNICATION Step 1 as Pass/Fail: Navigating Dermatology Application Components as Holistic Review Expands Albert G. Wu MS1, Abigail Cline, PhD MD2, Marian Russo, MD2 1 New York Medical College School of Medicine, Valhalla, NY 2 Department of Dermatology, Metropolitan Hospital, New York, NY Historically one of the most competitive specialties, dermatology saw only 82.9% of US MD seniors successfully matching into the specialty in 2022 (national average = 92.9%)1. The 2022-2023 application cycle will be the first where applicants may have their Step 1 scores listed as “Pass/Fail“ rather than numerically. In an attempt to clarify how the step scoring representation change could shift appliation evaluation, we sent a 53-question survey via email to dermatology program directors (PDs) to evaluate the importance of 26 application aspects. Respondents were asked to rate these aspects on a 1-5 Likert scale (1= Not all important to 5= Extremely important), as well as how its importance would be affected, if at all, by Step 1 becoming Pass/Fail. Respondents predicted that longitudinal methods of candidate evaluation such as letters of recommendation, away rotations, and medical school transcripts, would increase in importance after the score change, while criteria most likely to become less important included USMLE Step 1 and USMLE Step 2 scores (Table 1). As the number of applicants to dermatology continues to increase, residency programs have been developing methods of holistic evaluation, including considering a candidate‘s journey to dermatology, professional goals, and volunteerism, in additional to traditional metrics of exam scores, academic record, and publication total. 2 In the most recent appliation cycle, the Association of Professors of Dermatology (APD) approved implementation of a supplemental application and preference signalling in an effort to give applicants more tools to represent themselves3. These additions represent an effort by programs to more clearly understand each applicant, even in the wake of rising application numbers and the logistical constraints of reviewing each one. Therefore, students should take the time to throughly explore their motivations and passions for going into the field, so they can clearly represent themselves. Hopefully, this journey would bring applicants into contact with mentors and professionals who are able to offer guidance and support, while creating meaningful experiences for residency programs to look to to better understand candidates. These may still create barriers for many individuals, including those without a home institution dermatology program, those lacking mentors4, or those unable to find opporunities to explore their interest in the field. SKIN May 2022 Volume 6 Issue 3 (c) 2022 THE AUTHORS. Published by the National Society for Cutaneous Medicine. 261 Table 1. Ranking of Anticipated Importance of Survey Items by Mean Response (n=26) Survey Categories Evaluated Items Importance (out of 5) Predicted Change Applicant Characteristics Letters of Recommendation 4.58 More Important Honors in Rotations 4.23 More Important Medical School Transcript 4.12 More Important Dean's Letter 3.77 More Important Extracurricular Activities 3.69 No Change Rotation at your program 3.69 More Important Personal Statement 3.65 More Important Scholastic Work Other Awards/Honors 3.62 More Important USMLE Step 1 Score 3.38 No Change Number of Publications 3.35 More Important USMLE Step 2 Score 3.27 Less Important Oral Presentations 3.00 No Change Poster Presentations 3.00 No Change Telephone Call on Behalf of Applicant 2.96 More Important Alpha Omega Alpha (AOA) Membership 2.92 No Change Other degrees (MPH, MBA, MS, PhD) 2.85 No Change Previous Application 2.73 No Change Applicant's Medical School 2.73 No Change Research Fellowships 2.62 No Change Applicant Reputation Previous Residency 2.50 No Change Race 2.31 No Change Applicant's Graduate Institution (other than Medical School) 2.15 No Change Applicant's Undergraduate Institution 2.08 No Change Personal Appearance 1.96 No Change Age 1.38 No Change Gender 1.31 No Change Even with these changes, there are still signficantly more applicants than residency spots. An arms race is being waged within the objective measures of the application, most prominently in research publications5, the average for which has increased over 300% since 2007- and while other metrics such as volunteer and work experiences have not increased significantly6, dermatology applicants were above the national average in every matched applicant characteristic published by the 2020 NRMP Charting the Outcomes of the Match report. Qualititative measures, including away rotations, interviews, and letters of recommendation, as well as longitudinal measures of academic and clinical performance, may be the most practical way for programs to evaluate a candidate’s fit for their philosopy, goals, and values. Conflict of Interest Disclosures: None Funding: None Corresponding Author: Albert G. Wu New York Medical College School of Medicine 40 Sunshine Cottage Rd Valhalla, NY 10595 Email: awu4@student.nymc.edu References: mailto:awu4@student.nymc.edu SKIN May 2022 Volume 6 Issue 3 (c) 2022 THE AUTHORS. Published by the National Society for Cutaneous Medicine. 262 1. https://www.nrmp.org/wp- content/uploads/2022/03/2022-Match-by-the- Numbers-FINAL.pdf 2. Luke, J., Cornelius, L., & Lim, H. W. (2021). Dermatology resident selection: Shifting toward holistic review? Journal of the American Academy of Dermatology, 84(4), 1208–1209. doi:10.1016/j.jaad.2020.11.025 3. APD statement for 2020-2021 application cycle. Penn Dermatology Residents. (2020, June 3). Retrieved from https://dermatology.upenn.edu/residents/apd- statement/ 4. Fernandez JM, Behbahani S, Marsch AF. A guide for medical students and trainees to find virtual mentorship in the COVID era and beyond. J Am Acad Dermatol. 2021 May;84(5):e245- e248. doi: 10.1016/j.jaad.2020.12.075. Epub 2021 Jan 10. PMID: 33440219. 5. Ezekor M, Pona A, Cline A, Huang WW, Feldman SR. An increasing trend in the number of publications and research projects among dermatology residency applicants. J Am Acad Dermatol. 2020 Jul;83(1):214-216. doi: 10.1016/j.jaad.2019.09.021. Epub 2019 Sep 19. PMID: 31541752. 6. Atluri S, Seivright JR, Shi VY, Hsiao JL. Volunteer and work experiences among dermatology residency applicants. J Am Acad Dermatol. 2021 Feb;84(2):e97-e98. doi: 10.1016/j.jaad.2020.08.134. Epub 2020 Sep 30. PMID: 33007333.