Welcome to the next installment of The Roadmap Series: Key Learnings by Residency Year. Confidence and Consolidation: Navigating the Second Year of Dermatology Residency is a concise, practical guide to help PGY-3 residents turn early exposure into dependable clinical skill. Inside you’ll find focused advice on building autonomy and efficiency in clinic, strategic Core Exam preparation, using teaching to deepen learning, and beginning meaningful career exploration. Think of this as a short, reliable playbook to help you cement your knowledge, sharpen judgment, and step confidently toward independent practice.
The second year of dermatology residency marks one of the most exciting phases of training—a time when the groundwork of prior years begins to pay off and residents step into greater confidence. After mastering the steep learning curve of intern year and the whirlwind of the first dermatology-specific year (PGY-2), the PGY-3 year introduces a new stage of growth. This is when residents begin to refine clinical judgment, streamline workflow, and build a sense of independence.
Building Confidence and Independence
By the start of second year, most residents have established a foundation in clinic flow, staff dynamics, inpatient consult logistics, and basic dermatologic lexicon and diagnoses. The focus now shifts toward deepening understanding—moving from recognition to mastery of disease mechanisms, management nuances, and treatment decision-making.
A common theme among programs is encouraging residents to practice autonomy. Many residents find it helpful to form their own assessment and plan before presenting to attendings. Over time, this practice builds diagnostic confidence and clinical efficiency. As residents manage a growing volume of bread-and-butter dermatology more independently, the transition from trainee to near-colleague becomes palpable.
Preparing for the Core Exams
A defining feature of second year is preparation for the American Board of Dermatology (ABD) Core Exams, which cover medical dermatology, pediatric dermatology, surgical dermatology, and dermatopathology. These exams, typically completed between February of PGY-3 and February of PGY-4, represent a key milestone in residency. A major decision during this time is determining which core exam(s) to take first. The medical and pediatric cores have overlapping content and encompass the greatest amount of material, so many residents choose not to take them first. The surgical core is often considered the most straightforward and can be a good starting point, either alone or paired with dermatopathology. Because residents have four total exam opportunities, those who take one exam per sitting must pass each on the first attempt, while others opt to take two exams at one time to build momentum and reduce ongoing stress. As previously mentioned, because the pediatric and medical core have a lot of overlapping content, many residents choose to take those two exams together. The approach to the cores is highly individual—some residents prefer to start with one exam to build confidence, while others take two to finish sooner.
Many find that the anxiety surrounding the first core diminishes afterward, as the process becomes more familiar and manageable. Some resident cohorts coordinate which exams they take to study together, and many programs support this period with structured review sessions, board prep groups, or mock exams. The overarching goal remains to reinforce foundational knowledge while integrating it into daily patient care. Studying for the cores is a time when you start layering in a huge amount of detailed knowledge, and it’s normal to feel like you “know this, but can’t think of it right now.” That’s part of the process. You’re building the foundation. Do your best to stay organized, but give yourself grace when things are still floating around a bit.
Efficiency in Clinical Practice
As diagnostic acumen grows, so does efficiency. Residents become more adept at recognizing disease patterns, narrowing differentials, and presenting concise assessments. Increased confidence also improves patient interactions—clear, assured communication fosters trust and smoother encounters. At this stage, residents can begin to practice self-assessment and adopt a growth mindset, identifying strengths and areas for improvement not only in medical knowledge but also in procedural skills and clinic performance. Feedback from attendings and co-residents can be instrumental in this process. For example, if you find yourself struggling to keep up with clinic pace or spending excessive time on notes, seek tips from colleagues known for their efficiency. Conversely, if you tend to move quickly but overlook details, it may help to slow down and refine your thoroughness. This period is an ideal time to fine-tune your skills, develop balance, and cultivate the habits that will sustain success throughout residency and beyond.
Teaching as a Tool for Growth
Teaching becomes an integral part of the PGY-3 experience. As residents transition from the primarily learner-focused role of PGY-2 to that of teacher and mentor, many are struck by how much they have learned during their first year of dermatology training—not only in medical knowledge but also in the practical aspects of daily practice, such as clinic workflow, order entry, and navigating the EMR. Having just completed the PGY-2 year, residents are uniquely positioned to guide new trainees through these early challenges. They take on greater responsibility for orienting first-year residents and supporting medical students in clinics and procedures. Explaining biopsy techniques, reviewing morphology, and discussing management decisions reinforce the PGY-3 residents’ own understanding while cultivating leadership skills. Programs often note that this peer teaching accelerates both confidence and competence in clinical reasoning.
Looking Ahead: Early Career Exploration
The second year is also an ideal time to begin exploring long-term career goals. Toward the end of PGY-3, many residents start conversations with mentors about career paths, fellowships, and practice settings. This is particularly relevant for those considering dermatopathology, as dermpath fellowships typically match during PGY-3. While it is still possible to apply during PGY-4, doing so may result in a gap year between residency and fellowship. Some programs offer elective time that allows residents to experience community, private, or subspecialty dermatology firsthand. Early exploration—through mentorship, networking, informal shadowing, or conferences—lays valuable groundwork for the final year and helps residents make informed decisions about their future direction.
Key Takeaways for PGY-3 Residents
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- Study strategically: Focus on the Core Exams and establish a consistent review routine.
- Develop autonomy: Approach each case as though managing independently.
- Teach intentionally: Use teaching moments to reinforce clinical reasoning, communication, and solidify your own learning
- Plan ahead: Begin early conversations about post-residency goals and practice types.
Closing Thoughts
The second year of dermatology residency is defined by confidence and consolidation—a bridge between learning and independence. By strengthening knowledge, practicing autonomy, and embracing teaching and exploration, residents prepare not only for the Core Exams but for the transition into their final year and beyond. PGY-3 is when many residents begin to see themselves not just as trainees, but as emerging dermatologists.
Stay tuned for our next installment, PGY‑4 Roadmap: Preparing for Life After Residency. We’ll cover running a clinic and practice‑management basics, leadership and teaching, finishing the CORE exams, and job/fellowship planning—plus practical checklists to help you transition to independent practice.
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