Incoming M1 with too many specialty interests

[aprilfools]

Hey everyone, as the title suggests I'm an incoming M1 who will be attending my state school in NY this fall. I have a ton of different interests, some of which in very competitive fields, and I want to give myself the best chance of being able to have a say in where I end up for residency (read: I want to be competitive enough to match into a desirable area).

With that in mind, I am looking for some advice on how to set myself to be a competitive residency applicant despite not having one specialty in mind. I want to get involved in research early but I have seen that it is best to do research in your desired field, so I'm not sure what area/areas I should look into once I get to school.

I know that I won't have a good idea of what each specialty is truly like until I'm on the wards in the clinical years, but is there anything I can do/anything some of you previously undecided med students did in your preclinical years to figure out what exactly you wanted to do?


FWIW, more generally I am looking to do something that is on the relatively heavy side with regards to procedures, yet I want to still be doing something very mentally stimulating. I've been a firefighter/EMT and am a bit of an adrenaline junky so emergent situations/high acuity patients definitely appeal to me too, but I do want to have some modicum of a family life/lifestyle balance (though I am willing to figure out how to make it work in whatever specialty I end up in).

More concretely, I am thinking of the following specialties as of right now: Gen Surg (possibly-->trauma), Ortho (possibly-->trauma), EM, Rads/IR, IM (into either Cards or Pulm/CC), and possibly anesthesia. I'm sure there are fields that will appeal to me though that I haven't even thought of or had any exposure to yet, though.

I would love to hear any advice you guys had as to how to explore specialties during my preclinical years and/or how to set myself up to be competitive as an undecided med student.

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[backside_attack]

1. Become a well-adjusted MS1 and do well your first year.

2. See #1.

 

[aprilfools]

1. Become a well-adjusted MS1 and do well your first year.

2. See #1.

I appreciate this advice and realize that adjusting well to med school is the most important thing I need to do, but lets assume I can do this. My question is then what next?

 

[JPSmyth]

I appreciate this advice and realize that adjusting well to med school is the most important thing I need to do, but lets assume I can do this. My question is then what?

I am in the same boat as you. Everyone on SDN seems to say "just do well in school and wait til 3rd year" however if you decide on a competitive specialty early (take ortho for example) it will make your life much easier. You can get involved in department research earlier, make connections, go to conferences, and tailor your med school experience toward your field of choice. The earlier you can decide the better your chances will be in terms of having a strong app

 

[DokterMom]

I appreciate this advice and realize that adjusting well to med school is the most important thing I need to do, but lets assume I can do this. My question is then what?

This is actually good advice -- The most important qualifier for getting into a competitive specialty seems to be a high STEP 1 score. And the most reliable way to get a high STEP 1 score (aside from studying really hard) is mastering your pre-clinical curriculum -- so do that. Keep up, study in depth, review periodically so you don't forget, aim for mastery of the subject matter rather than just passing your classes. And take good care of your mental health and life balance (easier said than done).

Beyond that, seek exposure to multiple specialties. Question one should probably be medical or surgical. If you can't decide between those two, then perhaps the answer is one of the fields that combines elements of both. Then how much patient contact? And of what type? (consultations, procedures, etc.)

Specialty-specific research is nice, but general research is also appreciated, and until you can narrow down your specialty interests, general research is the most logical path.

 

[LyMed]

Agree with all the evidence above. As for research, if you don't know what particular field, find a project that interests you. You can also look up the director and see what their publishing history is like.

However, don't pile on projects and fall behind in class. Again, first things first, get a good STEP score. Like it or not, many competitive specialties have STEP score cut-offs.

 

[mimelim]

I hate to point out the obvious, but shadow. You are going to be busy as a medical student. But, if it is important to you, there is always time to spend time seeing what different doctors do.

 

[OrthoTraumaMD]

I hate to point out the obvious, but shadow. You are going to be busy as a medical student. But, if it is important to you, there is always time to spend time seeing what different doctors do.

Agree with this. Definitely shadow. From reading your post it sounds like ER is your best bet... For "lifestyle balance" gensurg or ortho trauma ain't that accommodating

 

[Affiche]

Lol you just need a few months of medical school to show you how much you hate everything, and whatever is left/remains tolerable wins.

 

[AcademicNeurosurgery]

I hate to point out the obvious, but shadow. You are going to be busy as a medical student. But, if it is important to you, there is always time to spend time seeing what different doctors do.

Agree with this. Definitely shadow. From reading your post it sounds like ER is your best bet... For "lifestyle balance" gensurg or ortho trauma ain't that accommodating

Definitely shadow. There is always time for this - post-exam, Winter break, Spring break, etc. I dedicated one day/week the entire summer between M1/M2 to shadowing and treated it like a real rotation. I showed up at 6AM, stayed until 11PM, took call etc. Can't think of a better way to see if a specialty is right for you. I had a friend who shadowed as well during the summer but would go in around his research schedule (e.g. in the afternoon so he could attend morning lab meetings). I don't think this gives you a realistic idea of a day in the life.

 

[masaraksh]

Ortho trauma is just so lifestyle friendly. Complex acetabulum fractures and pilons are repaired strictly at 9a-4:30p on weekdays, and open fractures with neurovascular compromise typically wait until the next business day.

 

[aprilfools]

Ortho trauma is just so lifestyle friendly. Complex acetabulum fractures and pilons are repaired strictly at 9a-4:30p on weekdays, and open fractures with neurovascular compromise typically wait until the next business day.

Oh wow as a firefighter and EMT I didn't know that thank you so much for pointing that out!

I said I'm looking for a balance that I would be willing to figure out, not for a cushy 9-5.

 

[coldcase331]

Hey everyone, as the title suggests I'm an incoming M1 who will be attending my state school in NY this fall. I have a ton of different interests, some of which in very competitive fields, and I want to give myself the best chance of being able to have a say in where I end up for residency (read: I want to be competitive enough to match into a desirable area).

With that in mind, I am looking for some advice on how to set myself to be a competitive residency applicant despite not having one specialty in mind. I want to get involved in research early but I have seen that it is best to do research in your desired field, so I'm not sure what area/areas I should look into once I get to school.

I know that I won't have a good idea of what each specialty is truly like until I'm on the wards in the clinical years, but is there anything I can do/anything some of you previously undecided med students did in your preclinical years to figure out what exactly you wanted to do?


FWIW, more generally I am looking to do something that is on the relatively heavy side with regards to procedures, yet I want to still be doing something very mentally stimulating. I've been a firefighter/EMT and am a bit of an adrenaline junky so emergent situations/high acuity patients definitely appeal to me too, but I do want to have some modicum of a family life/lifestyle balance (though I am willing to figure out how to make it work in whatever specialty I end up in).

More concretely, I am thinking of the following specialties as of right now: Gen Surg (possibly-->trauma), Ortho (possibly-->trauma), EM, Rads/IR, IM (into either Cards or Pulm/CC), and possibly anesthesia. I'm sure there are fields that will appeal to me though that I haven't even thought of or had any exposure to yet, though.

I would love to hear any advice you guys had as to how to explore specialties during my preclinical years and/or how to set myself up to be competitive as an undecided med student.

You'll narrow it down with time. First advice is to attend all the specialty group meetings at the beginning of the year to get your feet wet (and lots of free pizza). As you go through material, you'll learn what you like and what you don't. We are currently going through neuro right now, and I despise it with the white hot passion of 1000 suns. You'll also start to form what you want in terms of a life during your career, and that will help you narrow it down even more.

 

[takeurmeds02]

Lol you just need a few months of medical school to show you how much you hate everything, and whatever is left/remains tolerable wins.

LOL, this.

In all seriousness though, your best bet is to wait until after your first test to gauge if you need to study harder or if you can relax. Then you can go from there with shadowing experiences. I'd say the earliest you should start any research is maybe second semester. If not at that time, then the summer between 1st and 2nd year is the standard. If you still don't know exactly what you want to do by that summer then do very general IM research that interests you. It won't necessarily black-ball you from other competitive specialties and it'll give you something worth-while to talk about on the residency interview trail.

This is a very premature question though lol.

 

[MSTP18]

Shadow and for research even more important thank picking an interesting project would be picking a good mentor. Does your school have any resources for finding faculty who have expressed interest in mentoring students? That's a good place to start.

 

[Stagg737]

Oh wow as a firefighter and EMT I didn't know that thank you so much for pointing that out!

I said I'm looking for a balance that I would be willing to figure out, not for a cushy 9-5.

In the off chance that your response to @masaraksh is actually serious, both the situations he mentioned are emergent and will require you to get to the hospital ASAP. If you're in ortho trauma get ready for some fun 3 am calls...

 

[masaraksh]

In the off chance that your response to @masaraksh is actually serious, both the situations he mentioned are emergent and will require you to get to the hospital ASAP. If you're in ortho trauma get ready for some fun 3 am calls...

I'm just saying that as a 4th year rotating on Ortho Sub-Is right now I'm hoping to tell M1-2s that they do their due diligence in researching what life is truly like as an orthopod. Its not easy and its best to know about the sacrifices you'd have to make beforehand. I also overheard a conversation where a chief going into a trauma fellowship at a super well known place for ortho trauma just ripped on how hand call is even more brutal.

And all I'm saying is that if you're already as a pre-clinical med student prioritizing lifestyle at least to some degree and family life and have a list of interests as broad as "Gen Surg (possibly-->trauma), Ortho (possibly-->trauma), EM, Rads/IR, IM (into either Cards or Pulm/CC), and possibly anesthesia. " its almost correct to just cut out all surgical fields.

 

[TheFutureFatMan]

study.
make good grades.
study.
make good grades.
do well on boards.
research.
study.
make good grades.


...study...

 

[Stagg737]

I'm just saying that as a 4th year rotating on Ortho Sub-Is right now I'm hoping to tell M1-2s that they do their due diligence in researching what life is truly like as an orthopod. Its not easy and its best to know about the sacrifices you'd have to make beforehand. I also overheard a conversation where a chief going into a trauma fellowship at a super well known place for ortho trauma just ripped on how hand call is even more brutal.

And all I'm saying is that if you're already as a pre-clinical med student prioritizing lifestyle at least to some degree and family life and have a list of interests as broad as "Gen Surg (possibly-->trauma), Ortho (possibly-->trauma), EM, Rads/IR, IM (into either Cards or Pulm/CC), and possibly anesthesia. " its almost correct to just cut out all surgical fields.

Totally agree, just made the first comment because the OP seemed to take your response at face value instead of with the sarcasm that was intended. I mean god help the patient whose doc that thinks an open fracture with neurovascular compromise can wait until tomorrow...

 

[username456789]

Totally agree, just made the first comment because the OP seemed to take your response at face value instead of with the sarcasm that was intended. I mean god help the patient whose doc that thinks an open fracture with neurovascular compromise can wait until tomorrow...

It seemed pretty clear to me that he was responding with an equal amount of sarcasm.

Read it again.

 

[Nucleus Accumbens]

Hey everyone, as the title suggests I'm an incoming M1 who will be attending my state school in NY this fall. I have a ton of different interests, some of which in very competitive fields, and I want to give myself the best chance of being able to have a say in where I end up for residency (read: I want to be competitive enough to match into a desirable area).

With that in mind, I am looking for some advice on how to set myself to be a competitive residency applicant despite not having one specialty in mind. I want to get involved in research early but I have seen that it is best to do research in your desired field, so I'm not sure what area/areas I should look into once I get to school.

I know that I won't have a good idea of what each specialty is truly like until I'm on the wards in the clinical years, but is there anything I can do/anything some of you previously undecided med students did in your preclinical years to figure out what exactly you wanted to do?


FWIW, more generally I am looking to do something that is on the relatively heavy side with regards to procedures, yet I want to still be doing something very mentally stimulating. I've been a firefighter/EMT and am a bit of an adrenaline junky so emergent situations/high acuity patients definitely appeal to me too, but I do want to have some modicum of a family life/lifestyle balance (though I am willing to figure out how to make it work in whatever specialty I end up in).

More concretely, I am thinking of the following specialties as of right now: Gen Surg (possibly-->trauma), Ortho (possibly-->trauma), EM, Rads/IR, IM (into either Cards or Pulm/CC), and possibly anesthesia. I'm sure there are fields that will appeal to me though that I haven't even thought of or had any exposure to yet, though.

I would love to hear any advice you guys had as to how to explore specialties during my preclinical years and/or how to set myself up to be competitive as an undecided med student.

Lol, this will change.


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[aprilfools]

Totally agree, just made the first comment because the OP seemed to take your response at face value instead of with the sarcasm that was intended. I mean god help the patient whose doc that thinks an open fracture with neurovascular compromise can wait until tomorrow...

My post was extremely sarcastic, but I do thank you for the advice. Again, I said I would figure out how to make a family life work with whatever speciality I end up in.

I'm not interested in prioritizing a cushy 9-5 lifestyle, I just don't want to end up having a nanny raise my kids

 

[Hakuna Matata]

Just survive your first year. You will realize what topics you find interesting as you go and 3rd year will open your eyes to what certain specialties are really like. If you're interested in competitive specialties then just know starting on day 1 that you have to study and do well and kill your boards. There is no reason to try to figure out your specialty now. I think shadowing is a waste, personally. Unless you're doing it 6 days a week with the same doc doing all the same hours (I.e. rotations), you're not going to get a real feel for it- you'll more likely get to experience the fun parts during good hours and get this distorted view of the specialty.
Just sit back and enjoy your summer of freedom before the real **** starts this fall.


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[ortnakas]

You're an M0-- you don't need to know a specialty yet! That's what specialty and M3 is for.

 

[Nucleus Accumbens]

My post was extremely sarcastic, but I do thank you for the advice. Again, I said I would figure out how to make a family life work with whatever speciality I end up in.

I'm not interested in prioritizing a cushy 9-5 lifestyle, I just don't want to end up having a nanny raise my kids

My fiancé has the same concerns as you. Her and I are getting married soon, and she's worried we won't have time to raise a family.


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[aprilfools]

My fiancé has the same concerns as you. Her and I are getting married soon, and she's worried we won't have time to raise a family.


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Yeah this is really only what I mean when I say I want a lifestyle balance. If I really end up falling in love with gen surg/ortho/trauma or whatever it is I'm totally fine putting in the hours in so long as I actually have time to see my family ya know.

 

[Frogger27]

Yeah this is really only what I mean when I say I want a lifestyle balance. If I really end up falling in love with gen surg/ortho/trauma or whatever it is I'm totally fine putting in the hours in so long as I actually have time to see my family ya know.

ortho trauma is probably one of the worst specialties for this.. You want a specialty that has a somewhat predictable call schedule, which unfortunately is the exact opposite of ortho trauma. If you love surgery you can look more into ENT/urology/optho, which have a much more manageable/predictable call schedule as an attending

 

[aprilfools]

What specialties are these? Do you just mean specialties that do procedures like Cardio, Uro, Gastro, Derm, Ophtho? What other ones? Or do you mean like ENT

Yeah I'm guessing ENT/Urology?

 

[Hakuna Matata]

My fiancé has the same concerns as you. Her and I are getting married soon, and she's worried we won't have time to raise a family.


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Don't let this worry you too much unless you plan to go into a highly demanding specialty. It's all about priorities. If family is a priority, you'll make it work. I got married and had 2 planned pregnancies during med school. Family and medicine don't have to be mutually exclusive. Again, depends on your specialty and your priorities.


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[Nucleus Accumbens]

Don't let this worry you too much unless you plan to go into a highly demanding specialty. It's all about priorities. If family is a priority, you'll make it work. I got married and had 2 planned pregnancies during med school. Family and medicine don't have to be mutually exclusive. Again, depends on your specialty and your priorities.


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We both established we want to practice in a less time demanding field. Potentially a primary care field or anesthesia. We want time to enjoy our youth!


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[geredithmrey]

Don't let this worry you too much unless you plan to go into a highly demanding specialty. It's all about priorities. If family is a priority, you'll make it work. I got married and had 2 planned pregnancies during med school. Family and medicine don't have to be mutually exclusive. Again, depends on your specialty and your priorities.


Sent from my iPhone using SDN mobile

I have similar concerns. May I ask which specialty you ended up going into?
Thanks!

 

[Hakuna Matata]

I have similar concerns. May I ask which specialty you ended up going into?
Thanks!

I chose Family Medicine for a whole list of reasons.


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[Chillbo Baggins]

ortho trauma is probably one of the worst specialties for this.. You want a specialty that has a somewhat predictable call schedule, which unfortunately is the exact opposite of ortho trauma. If you love surgery you can look more into ENT/urology/optho, which have a much more manageable/predictable call schedule as an attending

There are a lot fewer truly emergent ortho trauma cases versus gen and trauma surg. Not saying it's negligible, but it's not the worst.

 

[JB50]

Lol you just need a few months of medical school to show you how much you hate everything, and whatever is left/remains tolerable wins.

Please don't say that is reality.

 

[LyMed]

I've enjoyed everything, but then again I got in med because medicine fascinates me. So because of that, I found something to like in every specialty. I had to choose my interest by whittling down what I didn't enjoy.

 

[MSTP18]

Please don't say that is reality.

It's not. Although if I was somehow forced to do OB/Gyn I'd just give up on being a physician entirely.

 

[JB50]

It's not. Although if I was somehow forced to do OB/Gyn I'd just give up on being a physician entirely.

I lol'ed. Couldn't do it.

 

[Danny L]

What's the target USMLE step 1 if you want it to be competitive for any specialty? Like is there room for error or is it like 99th percentile

 

[Affiche]

Please don't say that is reality.

My comment was mostly in jest, but there's some truth to it. Once you feel burned out and exhausted, nothing sounds less appealing than forcing yourself to continue working your ass off for the sole purpose of matching into a specialty that will require you to continue working your ass off.

It varies by school though. Mine front loads the hell out of the first ~6-7 months, slows down a lot at the end of M1, and slows down even more during M2 to alleviate step stress. In contrast, my friends at other schools took it relatively easy this year but expect to get slammed in M2.

If/when you feel burned out, remember that it has nothing to do with your intelligence, your ability to care for patients, your passion for medicine, or whether or not you're "cut out" for this. Ignore comments that suggest otherwise. Remember that, and don't make a career decision at the peak of your burnout lol. Expect both ups and downs, don't let others invalidate your experiences, don't invalidate others' experiences, and you'll get through just fine

 

[JB50]

My comment was mostly in jest, but there's some truth to it. Once you feel burned out and exhausted, nothing sounds less appealing than forcing yourself to continue working your ass off for the sole purpose of matching into a specialty that will require you to continue working your ass off.

It varies by school though. Mine front loads the hell out of the first ~6-7 months, slows down a lot at the end of M1, and slows down even more during M2 to alleviate step stress. In contrast, my friends at other schools took it relatively easy this year but expect to get slammed in M2.

If/when you feel burned out, remember that it has nothing to do with your intelligence, your ability to care for patients, your passion for medicine, or whether or not you're "cut out" for this. Ignore comments that suggest otherwise. Remember that, and don't make a career decision at the peak of your burnout lol. Expect both ups and downs, don't let others invalidate your experiences, don't invalidate others' experiences, and you'll get through just fine

Oh gosh. Does everyone get burned out? I mean like everyone?

 

[Affiche]

Oh gosh. Does everyone get burned out? I mean like everyone?

Just relax lol it's not that bad. Just have realistic expectations.

 

[Stagg737]

It seemed pretty clear to me that he was responding with an equal amount of sarcasm.

Read it again.

My post was extremely sarcastic, but I do thank you for the advice. Again, I said I would figure out how to make a family life work with whatever speciality I end up in.

I'm not interested in prioritizing a cushy 9-5 lifestyle, I just don't want to end up having a nanny raise my kids

Sorry, sarcasm is a lot harder to catch after coming off a hectic 16 hour day when you only got 4 hours of sleep the night before. From talking to attendings, even the worst specialties can eventually have a decent lifestyle. It just depends how many years you're willing to wait and how much of a pay cut you're willing to take to actually have a decent lifestyle.

What's the target USMLE step 1 if you want it to be competitive for any specialty? Like is there room for error or is it like 99th percentile

250+ is strong enough to land you anywhere assuming the rest of your app isn't lacking. 250 is ~84th percentile, so there is some wiggle room, but you've still got to kill it.

 

[jm192]

I would look at things with the mentality of being prepared to be a doctor.

Study hard so that you know as much as you can to take care of patients.
Grades/Steps will follow suit.
Join interest groups and clubs and when you get an idea, dabble in some research.

 

[MSTP18]

Sorry, sarcasm is a lot harder to catch after coming off a hectic 16 hour day when you only got 4 hours of sleep the night before. From talking to attendings, even the worst specialties can eventually have a decent lifestyle. It just depends how many years you're willing to wait and how much of a pay cut you're willing to take to actually have a decent lifestyle.



250+ is strong enough to land you anywhere assuming the rest of your app isn't lacking. 250 is ~84th percentile, so there is some wiggle room, but you've still got to kill it.

ugh, really? That's some strong creepage. I was under 250 and close to 90th percentile back in 2012.

 

[Stagg737]

ugh, really? That's some strong creepage. I was under 250 and close to 90th percentile back in 2012.

Yep, although oddly enough the average hasn't really changed all that much...

http://www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf

 

[ortnakas]

Oh gosh. Does everyone get burned out? I mean like everyone?

It comes in waves. Sometimes you're burned out from studying and/or time in the hospital and all you want to do is sit on your couch and watch Netflix and be sad about your student loan debt. Other days you learn a ton and have fun and feel like you're going to be a doctor soon and it's great and totally worth it.

 

[masaraksh]

There are a lot fewer truly emergent ortho trauma cases versus gen and trauma surg. Not saying it's negligible, but it's not the worst.

From what I overheard from an attending (and @OrthoTraumaMD can correct me): Yes, it is true that there are fewer cases that need to go to the OR EMERGENTLY, and it seems true that there are less surgeries going in the middle of the night (an attending mentioned there is a whole lot less of immediate fixing of pilons or tabs, etc). However, one thing he brought up is that when these cases come in - you have to go see the patient - unless you're at an academic center where residents/chiefs/fellows on call can assess/triage/stabilize these issues until the morning. Also, he does note that most orthopods will not be practicing in academics, and most graduates will be takings at least some amount of trauma call. He also noted that traumapods will often take more call than their other partners - since the ER is the traumapods clinic and you really think that partners want to be stabilizin/pre-OP-ing patients for you all the time to operate?

Also overhearing traumapods say that hand call is one of the most brutal calls puts another chill down my spine. Then, joints, sports, and foot and ankle are definitely lighter call - just with joints you take the hit with basically always having inpatients that need rounding on & some of the worst complications in orthopaedics when things go wrong. Onc - people die. Spine - clinic is hell, dural leaks and paralysis sound uplifting, however you get to afford boats and planes. Peds - , ponesti casting, clubfeet, and all the ketamine.

 

[Señor S]

After good grades (if you intend to match ortho in a "desirable" area these need to be the type of grades that will get you into AOA), try to find a critical care type research project as this can be spun into almost everything you listed.

 

[OrthoTraumaMD]

From what I overheard from an attending (and @OrthoTraumaMD can correct me): Yes, it is true that there are fewer cases that need to go to the OR EMERGENTLY, and it seems true that there are less surgeries going in the middle of the night (an attending mentioned there is a whole lot less of immediate fixing of pilons or tabs, etc). However, one thing he brought up is that when these cases come in - you have to go see the patient - unless you're at an academic center where residents/chiefs/fellows on call can assess/triage/stabilize these issues until the morning. Also, he does note that most orthopods will not be practicing in academics, and most graduates will be takings at least some amount of trauma call. He also noted that traumapods will often take more call than their other partners - since the ER is the traumapods clinic and you really think that partners want to be stabilizin/pre-OP-ing patients for you all the time to operate?

Also overhearing traumapods say that hand call is one of the most brutal calls puts another chill down my spine. Then, joints, sports, and foot and ankle are definitely lighter call - just with joints you take the hit with basically always having inpatients that need rounding on & some of the worst complications in orthopaedics when things go wrong. Onc - people die. Spine - clinic is hell, dural leaks and paralysis sound uplifting, however you get to afford boats and planes. Peds - , ponesti casting, clubfeet, and all the ketamine.

All true.