I'm curious to get a sense of how many of you change your mind in terms of what area of medicine you wanted to practice in from the day you entered medical school to what you actually went into.

This is only for people who considered themselves to be fairly certain of what they wanted to do. Somebody who had a feeling for an area or think they liked a speciality shouldn't respond.
I'm looking only for people who felt they knew what they wanted to do.

I'm dividing the poll into two areas.

Changed/didn't change for people without any extensive experience in the area they came into medical school wanting to do
and
changed/didn't change for people with extensive experience in the area they came into medical school wanting to do


Note: I define experience pretty highly. In my book, somebody who volunteered in the ER or on pediatrics and then came in wanting to do EM or peds doesn't count as having experience and should vote in the without experience options. Same with someone who shadowed physicians. Someone who shadowed an orthopedic surgeon for a few weeks/months before medical school would vote similarly if they felt they wanted to do orthopedics.

When I say experience I'm talking about things such as having an allied health job in a specific area such as being a nurse, respiratory therapist, patient care tech, nursing assistant, OR tech scrubbing in for surgery day in and day out, a paramedic/EMT.

In other words, something where you're actually taking care of patients and analyzing the medical information and treatments related to that specialty.


Reason why I make this distinction is because I'm trying test a hypothesis that if you have heavy experience in an area prior to medical school and come into medical school wanting to go into that area, then there is a greater chance you'll go into that area than someone who wants to go into an area not having this experience.

For example, it seems pretty reasonable for somebody who was a nurse on the CCU for a few years before medical school to know they want to go into cardiology. Same thing for a paramedic knowing they want to do EM. Or an OR tech who scrubbed in and helped with surgery knowing they want to do surgery.

Would a CCU nurse/paramedic/OR tech know exactly what it is like to be a cardiologist/EM doc/surgeon? No, of course not.
But they would have a fairly good idea of each.

My first experience in medicine was volunteering at a peds surg ward after 10th grade. I then did research in peds ortho the summer before freshman and sophomore year of college. As a bioengineering major in college, I became fascinated in CT surg and knew I wanted to go through G Surg first when I entered med school. I'm now 2 months away from being a PGY2 in G Surg.

I'm curious to get a sense of how many of you change your mind in terms of what area of medicine you wanted to practice in from the day you entered medical school to what you actually went into.

This is only for people who considered themselves to be fairly certain of what they wanted to do. Somebody who had a feeling for an area or think they liked a speciality shouldn't respond.
I'm looking only for people who felt they knew what they wanted to do.

I'm dividing the poll into two areas.

Changed/didn't change for people without any extensive experience in the area they came into medical school wanting to do
and
changed/didn't change for people with extensive experience in the area they came into medical school wanting to do


Note: I define experience pretty highly. In my book, somebody who volunteered in the ER or on pediatrics and then came in wanting to do EM or peds doesn't count as having experience and should vote in the without experience options. Same with someone who shadowed physicians. Someone who shadowed an orthopedic surgeon for a few weeks/months before medical school would vote similarly if they felt they wanted to do orthopedics.

When I say experience I'm talking about things such as having an allied health job in a specific area such as being a nurse, respiratory therapist, patient care tech, nursing assistant, OR tech scrubbing in for surgery day in and day out, a paramedic/EMT.

In other words, something where you're actually taking care of patients and analyzing the medical information and treatments related to that specialty.


Reason why I make this distinction is because I'm trying test a hypothesis that if you have heavy experience in an area prior to medical school and come into medical school wanting to go into that area, then there is a greater chance you'll go into that area than someone who wants to go into an area not having this experience.

For example, it seems pretty reasonable for somebody who was a nurse on the CCU for a few years before medical school to know they want to go into cardiology. Same thing for a paramedic knowing they want to do EM. Or an OR tech who scrubbed in and helped with surgery knowing they want to do surgery.

Would a CCU nurse/paramedic/OR tech know exactly what it is like to be a cardiologist/EM doc/surgeon? No, of course not.
But they would have a fairly good idea of each.

YOU again, :rolleyes:
Good poll though :thumbup:

YOU again, :rolleyes:
Good poll though :thumbup:


You know you love me... :D

Are you now in med school?

You know you love me... :D

I sincerely admire your enthusiasm. ;)

Are you now in med school?


Nope, not yet. Starting this year.

Right now I'm working and enjoying my last chance to bug residents and attendings I work with in a consequence free atmosphere :D (since I'm not getting evals from them yet)

(by bug I mean ask as many questions as I want no matter how stupid...and believe me, that's a hell of a lot of questions with a person like me...)

Well OK, I'll be honest, I give them a hardtime occasionally.

A few weeks ago I almost gave a resident a heart attack when I told him that a critical patient had a worse lab value after we intervened to correct the previous value
(can't remember what it was, I think I told him that a patient's K went down from 2.5 to 2.1 after we gave K; either that or some blood gas got worse after tweaked the vent)

I told him I was kidding and that the new lab value that I looked up was fine and corrected...we got and still do get along great, but he looked like he wanted to hang me with his stethoscope...

I'm terrible... :meanie:

Came in as neurosurg, then gen surg, then peds CT surg, then peds cards, briefly considered ER somewhere in there (who doesn't?). So naturally I'm doing general IM. :)

A few weeks ago I almost gave a resident a heart attack when I told him that a critical patient had a worse lab value after we intervened to correct the previous value
(can't remember what it was, I think I told him that a patient's K went down from 2.5 to 2.1 after we gave K; either that or some blood gas got worse after tweaked the vent)

Let me guess...this wasn't a G Surg resident or CT Surg fellow that freaked out, right? We don't tend to freak out about things like that. :)

Came in as neurosurg, then gen surg, then peds CT surg, then peds cards, briefly considered ER somewhere in there (who doesn't?). So naturally I'm doing general IM. :)

Just out of curiosity, did you decide not to pursue Neurosurg, G Surg and Peds CT Surg because of the lifestyle? (As in, they still interest you...)

Came in as neurosurg, then gen surg, then peds CT surg, then peds cards, briefly considered ER somewhere in there (who doesn't?). So naturally I'm doing general IM. :)



....wow

that's all I can say is wow

I'll ask the same as Blade, was it the lifestyle that made you switch? or did you lose interest in the field?

In other words, theoretically speaking if lifestyle was exactly the same in all fields of medicine (i.e. neurosurg was the same as derm), what would you have gone into?


My hypothesis is that it's not all lifestyle considering general IM is not exactly a lifestyle paradise...

Let me guess...this wasn't a G Surg resident or CT Surg fellow that freaked out, right? We don't tend to freak out about things like that. :)



No, wasn't either of those. Like I said, I forget what it exactly was, it may have been something more severe or a bigger difference in values. Didn't really freak out--maybe a little exaggerated--just looked worried...

Told them I was kidding right away though, so at least I didn't let them start looking up stuff in all sorts of references about the patients condition for nothing :D

Nah, no biggie. Low K even after oral supplementation or a K run? Call the lab, check for lab error. ;)

Reason why I make this distinction is because I'm trying test a hypothesis that if you have heavy experience in an area prior to medical school and come into medical school wanting to go into that area, then there is a greater chance you'll go into that area than someone who wants to go into an area not having this experience.

I would say that's true if both applicants are equal.

If the latter applicant is much stronger, then I doubt the more "experienced" applicant will get that residency position.

After all, what kind of significant experience can one acquire before medical school??

I would say that's true if both applicants are equal.

If the latter applicant is much stronger, then I doubt the more "experienced" applicant will get that residency position.


Applying to residency wasn't what I was talking about. (although I do see how you could interpret my post like that)

Everybody always says over and over again that people change their mind of what they are going to do from the time they get into medical school to what they actually go into.

What I meant was if a person comes into med school with the experiences I described, then would they be less likely to change their mind than if somebody comes straight out of college who has never talked to a patient or stepped foot on a hospital unit, thinking they want to do cardiology or neurosurg just by what they saw volunteering for a little bit or on Discovery Health or something like that.

So like I said, has nothing to do with residency. And it wouldn't give anybody a leg up on residency either-definitely agree with you on that.


After all, what kind of significant experience can one acquire before medical school??

Consider the following example...

I met a person who was just about to start their 3rd year.

He was a nontrad with a couple of kids who worked as a paramedic for several years before med school.

He already knew what he wanted to do and at least from what he sounded like, he was pretty sure of it too.

His field of choice? Emergency Medicine

Now would he know exactly what being an EM doc is like? Obviously not since he's not a doc himself.

But it seems to me foolish to say that somebody who worked as a paramedic for several years doesn't have a fairly good and accurate idea of what the practice of Emergency Medicine is like as well as what it's like to be an EM doc

I have similar experience myself working on CT surg ICU, so therefore discussing treatment plans on rounds, taking care of patients, and helping out in codes. Also assisting with CT surgery in the OR. I see the lifestyle too. I've been working many an evening and night with attendings in at 3 AM sometimes.

So that's what I'm trying to test-
If there's a difference in the percentage of people like this guy and me who come into med school knowing what field they want to do having experience like this guy did and wind up going into that field and don't change at all...
as compared to
somebody who knows they want to do EM, who hasn't had real clinical experience like this guy did who still wind up going into that field and don't change at all.

Neurosurg was interesting to think about but I didn't like the prospect of dreadful outcomes (as they say, "a good neurosurgery outcome is a patient who sees lightning, hears thunder, and eats soup."). Kinda the same deal as neurology.

CT surg was enticing but a billion years of training only to have an invasive cardiologist take over your job.

Gen surg was the classical case of a bunch of dickheads driving a motivated med student away from the profession. For my clerkship, I told everyone on my team on day one it was to be the decision maker between GS and IM. In six weeks, I got to suture a total of three times and lance two boils on a hidradinits suppurativa patient. Oh, and I got to take out staples. Twice. Five weeks into the rotation my attending did not know my name in spite of being in the OR with me daily. And I got no teaching. Needless to say, this was in huge contrast with IM and closed the deal.

I love working with my hands and I'm very good at fine motor tasks (have some lifelong hobbies like that), but in the end IM had the people I could look up to, wanted to work with, and knew I would get the support, the encouragement, and the teaching from.

I've been told it's not smart to make a career choice based on one bad rotation but tell you what... You have to want to do the job even on the worst day and gen surg was more sh!t than I was willing to put up with. Having said that, a good friend of mine rotated on a different team the month before me and ended up switching from hardcore ER to GS. So you never know.

But no, it wasn't a lifestyle thing. I like to work hard.

I have similar experience myself working on CT surg ICU, so therefore discussing treatment plans on rounds, taking care of patients, and helping out in codes. Also assisting with CT surgery in the OR. I see the lifestyle too. I've been working many an evening and night with attendings in at 3 AM sometimes.

Whoa! That's awesome!

Questions

1) They let you see patients? And you're not in med school yet?

2) They let you assist with surgery? When I was an undergrad doing shadowing, the best I got was a, "You can now listen to the stethoscope. But if you get it dirty, I'll eat you."

3) You worked until 3AM? You should skip medical school and say you've already demonstrated the commitment and know-how to move on to the residency/career of your choice!

Whoa! That's awesome!

Questions

1) They let you see patients? And you're not in med school yet?

2) They let you assist with surgery? When I was an undergrad doing shadowing, the best I got was a, "You can now listen to the stethoscope. But if you get it dirty, I'll eat you."

3) You worked until 3AM? You should skip medical school and say you've already demonstrated the commitment and know-how to move on to the residency/career of your choice!

I can't tell if you're being sarcastic or not...(my apologies if you're not meaning to be sarcastic, please correct me)

If you are, then there's no need to be a wise guy jackass

As I've said before, anybody who is not a doctor who thinks they know what it's like to be a doctor is a moron.

However, there are a lot of people here who have the opposite problem. They seem to think that the only people who know anything about medicine are physicians.

In other words, if you make an arbitrary scale in terms of knowledge about medicine, many of you seem to think that physicians would be 100 out of 100 and that everybody else in any other field within healthcare would be 0 out of 100.

This couldn't be further from the truth and is simply stupid.

Physicians do indeed have the greatest knowledge of medicine, but there are many other fields which have a vast knowledge as well.

There are plenty of times I've seen senior nurses with years and years of experience get into disagreements about what to do with a patient with a 1st or 2nd year resident and they jump over the residents head and page the attending...
and who does the attending very frequently side with???
dare I say it, at least in my experience...the nurse :eek:

I've also seen plenty of times where the attending comes up with one vent management technique for a patient, but then switches to the recommendation from an experienced respiratory therapist

Personally, if I got in an accident and was in the SICU, I'd much rather take a nurse with 20-25 years experience running my care than an average 1st or 2nd year resident. (Obviously I'd prefer the SICU attending though for sure...)

Again, obviously physicians know the most of all healthcare occupations when talking about knowledge of medicine
But it's far, extremely far, from a 0 to 100 type of relationship

The sooner some people grow up and get their arrogant heads out of their asses here, the better off they'll be. :thumbup:

I was being serious

I think he wasn't being sarcastic.

And yes, ICU nurses and RTs can be a tremendous help when managing vents, pressors, drips, etc.

Although I've seen some situations where an otherwise experienced person in another field has ended up butting heads with a resident in terms of a management decision, and was simply wrong. Sometimes, as the person whose head is NOT on the chopping block if something goes wrong, you have the luxury of adopting a more conservative or aggressive attitude in a given situation.

We (okay residents, not me) have to do what's best for our patients, but we also have to cover our rear eands and the hospital's rear end, and our attending's rear end... it's a tremendous and humbling responsibility. If we mess up, it's not simply a matter of hiking to the facility across town and applying for a new job... the consequeces for us are generally much much greater.

Just my $0.02, from the perspective of someone who used to 2nd-guess physicians' management at times.

Those are all great points.

I was being serious


haha, oops

my bad, sorry :D

Although I've seen some situations where an otherwise experienced person in another field has ended up butting heads with a resident in terms of a management decision, and was simply wrong. Sometimes, as the person whose head is NOT on the chopping block if something goes wrong, you have the luxury of adopting a more conservative or aggressive attitude in a given situation.

We (okay residents, not me) have to do what's best for our patients, but we also have to cover our rear eands and the hospital's rear end, and our attending's rear end... it's a tremendous and humbling responsibility. If we mess up, it's not simply a matter of hiking to the facility across town and applying for a new job... the consequeces for us are generally much much greater.

Just my $0.02, from the perspective of someone who used to 2nd-guess physicians' management at times.



I'm glad you mentioned this because from my post, I may be come out to look like someone who would think the situations I described would be the majority of cases.

Just wanted to throw in that they are indeed not the majority of cases. The resident (be it physician or resident) is correct the majority of the time and will not do what the nurse or resp tech suggests.

I was just making the point that it's not a physician is right 100% of the time situation.

I definitely see the nervousness over treatment issue and the responsibility issue.
I haven't felt this first hand obviously, but I work or have worked in various ICU settings from adult to child and have seen what sometimes can only be described as sheer terror in some cases, on the part of residents who don't exactly feel comfortable in an ICU environment, to at least worry from residents who do feel comfortable in an ICU environment.

Understandably so, this is the feeling I get from some residents -- :eek:

I would imagine this responsibility would definitely make one hesitant of doing X or Y treatment, even if it may be the right thing to do.

I guess that's why the attending is just a phone call away :thumbup:

First experience in medicine was becoming a scrub tech after I finished high school. Loved surgery, medicine, the whole kit-and-kaboodle.

Just out of curiosity, what made you decide to become a scrub tech?

I wanted to be a musician, but my parents told me that if I didn't enroll in some sort of post-secondary school, I would be looking for my own place. I was pointed towards scrub tech by a friend who pointed out that I had always been interested in medicine. Good thing I listened. :)

I'm one of the ones who had experience in a field prior to med school and ended up changing. It seems to me that you're assuming people who switch stop liking the field they were set on. In my situation, I just found something I liked more and had had little prior exposure to.

BTW, med school interview question:
Dr: "What field of medicine are you dreading rotating through?"
Me:" Ugh, ophthalmology! The eye turns my stomach."

So much for certainty...

I always thought there was something intensely wrong with those people who claimed to 'have always wanted to be a XXX.' You know, like the ones who say, "oh yeah, since I came out of the womb, I knew I wanted to be an orthopod. Yeah, I just can't do anything else in life."

The way I see it is what kind of one dimensional myopic person is sooooo wedded to one sigular profession that they absolutely cannot envision doing anything else in life? That seems kind of unhealthy, in a mental sort of way. That's like saying you can only ever love one person on this earth, no one else, and ya have to wait around till you can get that one single person, after you sift through 6.5 billion others.

anyway, to make a long post endless, all I wanted to say was that there's SO much hype about 'what field should I go into." BUT, most of the hype comes from people who are very green, i.e., people who aren't in med school, or who haven't started 3rd yr. my advice to you is stop spazzing about this stuff. If you go to med school, the field that most appeals to you will eventually dawn on you. You can;t force yourself into any particular 'mold.' Just let it be.....

I didn't realize having a passion for something made you mentally unstable. Learn something new everyday, I guess...

Passion is ok

Deciding before you've even seen anything is not ok

Either that, or it means you're a money-grubbing sob (i see doc...doc has dough...i want to be that kind of doc)

Yeah, that's true to an extent. I do know docs that went to med school with the intention of doing something, kept an open mind during their rotations, but still went with their original plan. I don't see anything wrong with that.

Neurosurg was interesting to think about but I didn't like the prospect of dreadful outcomes (as they say, "a good neurosurgery outcome is a patient who sees lightning, hears thunder, and eats soup."). Kinda the same deal as neurology.

CT surg was enticing but a billion years of training only to have an invasive cardiologist take over your job.

Gen surg was the classical case of a bunch of dickheads driving a motivated med student away from the profession. For my clerkship, I told everyone on my team on day one it was to be the decision maker between GS and IM. In six weeks, I got to suture a total of three times and lance two boils on a hidradinits suppurativa patient. Oh, and I got to take out staples. Twice. Five weeks into the rotation my attending did not know my name in spite of being in the OR with me daily. And I got no teaching. Needless to say, this was in huge contrast with IM and closed the deal.

I love working with my hands and I'm very good at fine motor tasks (have some lifelong hobbies like that), but in the end IM had the people I could look up to, wanted to work with, and knew I would get the support, the encouragement, and the teaching from.

I've been told it's not smart to make a career choice based on one bad rotation but tell you what... You have to want to do the job even on the worst day and gen surg was more sh!t than I was willing to put up with. Having said that, a good friend of mine rotated on a different team the month before me and ended up switching from hardcore ER to GS. So you never know.

But no, it wasn't a lifestyle thing. I like to work hard.


Interestingly, Gen Surgery attendings have been very nice to me in the past. I don't know why. I just had a great time on my rotations. On the other hand, I have found ortho guys to be some of the biggest d i c k s. It's just luck I guess.

I had pretty much good experiences people wise all around. But even back when I was a scrub tech, I got along with all the attendings really well, even better than some of the nurses/techs.

Medicine->General Surgery->ENT->Ophtho...
Couldn't be happier with the match and how things ended up

It had less to do with me disliking my original specialty of choice, but more with experiencing awesome specialties that I had almost no idea about before medical school started.

Just goes to show... I thought the ortho docs were amazing and some of the best bedside manner and patient counseling I've ever seen.