Dermatology Online Journal

The esprit de corps of dermatology residents
Jashin J Wu MD¹, Stephen K Tyring MD PhD²
Dermatology Online Journal 9(3): 21

1. Department of Internal Medicine, Baylor College of Medicine2. Departments of Microbiology and Immunology, Dermatology, and Internal Medicine, University of Texas Medical Branch,Galveston, Texas 77555. jashinwu@hotmail.com

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Some dermatology residency applicants wonder how happy they will be as residents and after they complete their training. What factors correlate with the level of morale among the residents at various dermatology programs? How do major changes at a program affect the residents? How do residents view required research in the curriculum?

One study by the University of Alabama at Birmingham reported the perspective of 248 residents regarding the didactic, clinical, and surgical aspects of United States dermatology residency training.[1] Residents with more didactic-faculty involvement, consultations and research, and especially surgical procedures were more satisfied with their training. This implies that resident satisfaction is strongly correlated with a more challenging and varied training curriculum as well as greater faculty involvement. Seventeen percent of residents believed that they were not adequately trained. A study of an internal medicine residency program showed that resident satisfaction can be accurately measured with surveys and that residents respond positively to program modifications based on resident feedback.[2] The University of Alabama changed its resident curriculum to include broader surgical training and a more diverse conference schedule based on the survey results.

Major changes in residency programs tend to negatively affect the quality of training and morale of residents.[2, 3, 4] However, significant changes can be accomplished without severe adverse effects. Alam described the process of converting a single program at Columbia University into two separate but strong programs.[5] In short, intensive communication among all parties and a proactive stance enabled the formation of two programs with minimal disturbance of resident life.

Occasionally, the residents meet required research in a program's curriculum with hesitancy. Dermatologists at the University of Miami described their requirement to complete a research project as part of their 3-year-clinical training.[6] Each resident averages 4 publications before completing residency. A survey of graduated residents found that although only 45 percent enjoyed the research requirement, 90 percent thought that research is a beneficial part of training, 75 percnet felt research helped them become a critical thinker, and 50 percent believed research helped patient care. The faculty members felt that research experience helps separate dermatologists from others who care for the skin, who may or may not be physicians. For these reasons, they concluded that, although residents may not agree at first, research is a critical part of training in a dermatology residency.

Anecdotally, dermatology residents often say how happy they are compared to their peers in other specialties, especially internal medicine and general surgery. Controllable lifestyle and workload are major factors in general satisfaction in residency training. Further, there are frequent stories of medicine or surgery residents who decide to switch into dermatology, whereas dermatology residents who have already started dermatology training very rarely switch into other fields.

Morale amongst dermatology residents is multi-factorial, but it is highly correlated with effective communication between residents and staff, faculty involvement, and the willingness of programs to change the curriculum based on constructive feedback. Although residents may see required research as a mandatory task, it results in the development of the independent thought process. This ultimately may be more important than reading and memorizing textbooks.

References

1. Webb JM, Rye B, Fox L, Smith SD, Cash J. State of dermatology training: the residents' perspective. J Am Acad Dermatol 1996;34:1067-71.

2. Seelig CB. Changes in residents' attitudes in response to residency program modifications: a prospective study. South Med J 1992;85:972-5.

3. Eaglstein WH. Why train residents and teach students in dermatology. J Am Acad Dermatol 1995;33:138.

4. Cruz PD. A personal perspective on residency education. Arch Dermatol 1995;131:406-10.

5. Alam M. Mergers, separations, and transformations of dermatology residency training programs: a resident's perspective. Arch Dermatol 1998;134:1158.

6. Kirsner RS, Kerdel FA, Falanga V, Trent J, Eaglstein WH. The role of mandated research during dermatology residency training. J Invest Dermatol 1999;112:400-1.

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