Mentee Form for Medical Students Interested in Dermatology

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First Name *

Last Name *

Email *

Phone Number

What medical school will/did you graduate from? *

Does your medical school have a home dermatology department? *

Yes

What is your current status? *

Research fellow

Current resident

Other

Are you applying to dermatology residency 2021 - 2022 cycle? *

Yes - current M4

Yes - reapplicant

Yes - other (never applied before)

Other

Definitions/Instructions for Following Questions:

UIM: "Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population." This lens currently includes students who identify as African Americans and/or Black, Hispanic/Latino, Native American (American Indians, Alaska Natives, and Native Hawaiians), Pacific Islander, and mainland Puerto Rican. The definition also refers to students who come from disadvantaged backgrounds." (AAMC)

NIH definitions: https://diversity.nih.gov/about-us/population-underrepresented

For the following questions you will be asked about what is MOST important and what is SECOND MOST important to you. Please answer accordingly.

What do you value MOST in a mentor? What would you like guidance most on from your mentor? Remember mentors are current and recently graduated dermatology residents *

I identify as a UIM in regards to race and I prefer a mentor who identifies similarly.

I identify as a UIM in regards to LGBTQIA and I prefer a mentor who identifies similarly.

I identify as a UIM in regards to socioeconomic/financial status and I prefer a mentor who identifies similarly.

I identify as a UIM in regards to education level (first generation college/medical school) and I prefer a mentor who identifies similarly.

My Step 1 score is lower than the average matched for dermatology (249), and I prefer a mentor who successfully matched with a Step 1 that was lower than this average.

I’m going through the application process this year, and I would like specific help with Interview prep/ERAS/Letters of Recommendation/Personal Statement

I do not have an extensive research background, and prefer a mentor who also did not have this and successfully matched

I did not take a research year, and I prefer a mentor who also did not take one.

I did take a research year, and I prefer a mentor who did take one.

I am a re-applicant, and I prefer a mentor who successfully reapplied.

I have/am about to have a family, and I prefer a mentor who also had a family during the match/residency process

I attend an osteopathic (DO) medical school, and I prefer a DO mentor who matched into dermatology successfully

My medical school does not have a home dermatology program and i would like a mentor who matched without a home dermatology program

What do you value SECOND MOST in a mentor? What would you like guidance on in addition to above from your mentor? Remember mentors are current and recently graduated dermatology residents *

I identify as a UIM in regards to race and I prefer a mentor who identifies similarly.

I identify as a UIM in regards to LGBTQIA and I prefer a mentor who identifies similarly.

I identify as a UIM in regards to socioeconomic/financial status and I prefer a mentor who identifies similarly.

I identify as a UIM in regards to education level (first generation college/medical school) and I prefer a mentor who identifies similarly.

I’m going through the application process this year, and I would like specific help with Interview prep/ ERAS/Letters of Recommendation/Personal Statement

I do not have an extensive research background, and prefer a mentor who also did not have this and successfully matched

I did not take a research year, and I prefer a mentor who also did not take one.

I did take a research year, and I prefer a mentor who did take one.

I am a re-applicant, and I prefer a mentor who successfully reapplied.

I have/am about to have a family, and I prefer a mentor who also had a family during the match/residency process

What is your MOST favorite free time activity? *

Working out

Sports

Music

Outdoors

Cooking/Baking

Movies/TV

Arts/Crafting

Dance

Gardening

Reading

What is your SECOND MOST favorite free time activity? *

Working out

Sports

Music

Outdoors

Cooking/Baking

Movies/TV

Arts/Crafting

Dance

Gardening

Reading

Please answer the following questions

Definitions:

Mentor in dermatology is defined as a mentor who helps their mentee match into dermatology in the near or distant future. This does not include mentors for research projects.

Do you already have a mentor in dermatology (mentor defined above)? This does NOT affect the mentorship match and is for educational purposes only. *

Yes

Should there be more formal initiatives to provide medical students interested in dermatology/applying to dermatology residency with mentors in dermatology? *

Yes

Neutral

Outside of the DIGA Mentorship Program, how difficult is it to find a mentor within dermatology? *

Difficult

Neutral

Easy

Fun fact about you - will be shared in your intro email when you are set up with your mentor:

Is there anything else you would like to share?

Submit

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