Incoming Speciality Interest and Later Interest after Step and Rotations

[workaholic007]

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Hello everyone

I am a M1 at a low-tier medical school, and I have been doing relatively well in my classes. I average low 90s in my classes with class average in low 80s (I assume I am top 25% in the class then?). I am looking into doing research this summer but I have no idea what field I am interested in. It seems like majority of the guys in my class however are set on becoming an orthopedic and neuro surgeon. I am confused on how people are so sure regarding their interest so early in medical school. Also, aren't these fields so competitive that only few people in a class match into them?

My question is how do medical school interests in field evolve overtime. Do people lose their interest in surgical fields due to their lack of board scores or their initial absence of exposure and experience during rotation? As a M1 entering summer, what advice do you have for someone who is doing relatively well in their classes but has no idea what field they want to enter.

 

[Dro133]

Off of the top of my head I can think of at least three folks in my class who wanted to go into neurosurgery from day 1 of preclinicals, who are now pursuing different fields. Another classmate was interesting in ortho from day 1 but is now likely to end up in a different field. For these folks, reasons for evolving interests included re-evaluating one's priorities (i.e. desire for better work-life balance) and not being competitive enough based on Step scores. I'm sure there are also people who discover throughout the course of their 3rd year rotations that their interests are more suited for another field.

Advice: continue doing well in your classes, and if you can fit it into your schedule, absolutely shadow and find mentors in different fields early on. Third year will not expose you to all fields and practice settings, so take advantage of your relatively flexible preclinical schedule. Also, shadowing provides a low-pressure way to observe various clinical settings/attending lifestyles and ask candid questions without worrying how doing/saying x/y/z will impact your evaluations.

Best of luck!

 

[Dominus]

Lots of people change. I know a handful of people who came into medical school with an interest that persisted and they all had a relevant background in that field (EMT wanting to do ED, neuro major w/ research doing neurosurgery, etc.). I know lots of people who changed, some as late as August of 4th year after doing a sub-i and realizing they hated their field. I think research is a great idea but don't worry too much about doing it in a specific field if you do not have a specific interest quite yet. They won't look down on your for doing out of field research when you apply.

 

[bobjonesbob]

Hello everyone

I am a M1 at a low-tier medical school, and I have been doing relatively well in my classes. I average low 90s in my classes with class average in low 80s (I assume I am top 25% in the class then?). I am looking into doing research this summer but I have no idea what field I am interested in. It seems like majority of the guys in my class however are set on becoming an orthopedic and neuro surgeon. I am confused on how people are so sure regarding their interest so early in medical school. Also, aren't these fields so competitive that only few people in a class match into them?

My question is how do medical school interests in field evolve overtime. Do people lose their interest in surgical fields due to their lack of board scores or their initial absence of exposure and experience during rotation? As a M1 entering summer, what advice do you have for someone who is doing relatively well in their classes but has no idea what field they want to enter.

Consider doing some shadowing if you have time. Shadowing doesn't always give the best impression of what it's like as an attending or resident but it's a good way to meet some people in the department and learn about specialties especially if they aren't core third year clerkships.

As Dro said above, a lot of those people won't end up in surgical subspecialties for various reasons.

Another thing to be aware of is that a lot of students never really have an "aha moment." It's usually easy to rule out a few specialties, but it's hard to pick what you want to do for the rest of your life. The most important thing is to keep doing well and keep your options. If you have a good class rank and step 1, it makes it much easier to switch specialties if you decide to late in the game.

 

[Dr G Oogle]

I wanted to do ortho and now I’m a Urogynecologist if that tells you anything. Application and scores competitive for ortho, you just evolve to find different interests. I know of a guy whos an anesthesiologist and was a practicing MFM.

 

[Tenk]

I wanted to do EM on day one of medical school. I wanted to do EM when I matched EM. There was only one other guy in my class who was the same. We watched everyone else be interested in EM then switch to something else or suddenly become interested in EM during MS3/4. Point is, I think it is actually more rare to stick to the same plan since day one of med school than change your mind and explore other options

 

[CyrilFiggis]

I am a M1 at a low-tier medical school, and I have been doing relatively well in my classes. I average low 90s in my classes with class average in low 80s (I assume I am top 25% in the class then?).

Explore your options through your schools interest groups or shadowing a doc. There are some specialties like ortho, derm, ENT where you need research to be competitive, but you don’t need to start now. There are plenty of applicants who take a gap year between 3/4 to work on that. In the end the research is just to show a level of commitment to the specialty.

Right now just focus on doing well and not on your class rank. If you have a good board score and a few honors during clinical rotations, you will set yourself up for whatever career you finally decide on.

 

[OnePunchBiopsy]

My question is how do medical school interests in field evolve overtime. Do people lose their interest in surgical fields due to their lack of board scores or their initial absence of exposure and experience during rotation?

There is always a chance that a student's interest will evolve organically: they get exposed to a new field, or their preconceived notion of a field don't favorably match their clinical experiences.

That example aside, if a student is forced to adapt their interests, it is usually board scores and experiences during clinical rotations (third year) that affect career paths.

For board scores of a student interested in a highly competitive specialty, it would be next to impossible to match with bad Step scores. This is a case where the student would have to adapt their interests based on their step score. This happened to quite a few of my colleagues in med school. There are many ways to cope with such a decision, however since everyone is different I'll just say cross the bridge if you come to it.

Furthermore, clinical experiences in third year can make or break you. Some of my classmates claimed they wanted to be surgeons but ended up hating the hours, picking something else. One of my classmates pursuing surgery was expelled for logging procedures they were not even doing. My colleagues striving for very competitive specialties had to form good relationships with the home department to get recommendation letters.

As a M1 entering summer, what advice do you have for someone who is doing relatively well in their classes but has no idea what field they want to enter.

Shoot for the moon. Even if you miss, you'll land among the stars. If you're aiming for something, even if you don't achieve it (or don't know what it is yet), you'll still be somewhere better than where you started. Get involved with research, shadow a specialty you may be interested in, strive to destroy Step 1.

Work hard so that when residency application time comes, you are in a position where you can CHOOSE what you spend the rest of your life doing.

In summary,
Students maximize their odds of matching into a preferred field by networking with physicians in that field, doing research (does not have to be in the specialty, but it helps if it is), performing well on boards/shelf exams, and treating everyone with respect. You should always be professional and courteous to your patients, professors, attendings, nurses, PA's, secretaries, janitors, etc.

In instances where a student does not get to pursue their ideal career, it is usually a lapse in networking, board scores, grades, or professionalism that makes them have to adapt their career goals.

 

[sloop]

People's interests change and they may realize that fields aren't exactly what they thought when they finally get experience in them. Competitiveness can also be a consideration for some. In terms of advice, I would just do as well as you can and keep an open mind.

For what it's worth, I knew I wanted to be a psychiatrist before I applied for med school. My anecdotal experience, for whatever reason, was that the few people in my position seemed much more likely to retain their interest in the field than those who had early aspirations toward other fields. I think this is largely due to the unique nature of psychiatry and the fact that, while they may have general interests in science and medicine, those who go to med school in order to be a psychiatrist probably have motivations that do not overlap as much with other fields.

For most specialties, people were all over the place in terms of where they wound up compared to what they told me at orientation. A few people knew exactly what they liked but many did not. Some people were close—a lot of people who thought they wanted something interventional wound up doing something else interventional. There were a few people who crossed over between like surgical specialties, anesthesia, EM, etc. A few people wound up being pediatricians who thought they wanted to be internists, etc. Then again, some people make last minute switches that most would find unlikely, including a friend of mine who decided to apply to psychiatry instead of anesthesia at the last minute.

 

[BigRedBeta]

1) People change a lot. My med school gave out the list of what our choices had been as incoming students to us on match day and I think less than a 1/3 were actually unchanged.

2) The things that drive a lot of change are varied but in my experience in dealing with a lot of students and residents heading into 3rd year were the following:

• Step 1 scores - more so in terms of weeding people out, a high score doesn't mean someone automatically starts thinking derm when they never considered it before, but that derm hopeful who scores a 225 suddenly has to make sense of their world.
• Course work - there's a lot in med school that many people have never been exposed to before, so sometimes that's very eye opening when a person finds out they love neuroanatomy or cardiac physiology. Similarly, they have done a ton of labwork/bench research in undergrad and find that they are most comfortable in the path lab and decide they'd rather stay in that realm because it's comfortable.
• Patient encounters - either standardized patients or with pre-clinical preceptors. Some people really struggle with that transition and determine early on that the less they see patients the better.

3) I agree with whoever said there are few "aha" moments for most people. It becomes a gradual sort of thing that reveals itself a lot of times.

4) Clinical rotations are important for sure, because while everyone has experience being a patient in the outpatient settings, inpatient hospital based medicine is a very different beast. And even fewer have had much experience in the OR.

5) I think the worst thing that a students can do (yet happens all the time) is to base their specialty choice on a great experience based on the people they were around in that field. So many students have a great attending or love their team while on a rotation and think that means it's their best choice to spend the rest of their career without realizing they really don't like the actual medicine they'll have to practice. The thing is though, the medicine doesn't change but the people do. You can find degrading peds residencies and neurosurgery programs that reaffirm your soul, but if you don't like the actual pathology walking through the door, you're going to be unhappy.

So what's a person to do?
For your specific research question, do something that sounds interesting. If its in your desired field, awesome, if not, who cares, better to have it than nothing.

After that, I think the algorithm for most people should be as follows:
1) Do I like the OR or not? If yes, then youre down to surgery specialties and anesthesia. If no, you can rule those fields out.

2) Kids or no kids and by that I mean, will not seeing a particular patient population leave a hole in your professional soul? Most people have one they prefer immensely and the other is at best a "nice to have, not a deal breaker if I never took care of those patients again".

2B) is do I want to only take care of women, if yes, then go directly to OB/GYN as all other questions are largely irrelevant

3) Do I really want to interact with patients that much? If no, then you need to start considering the Path/Rads options

4) Is there a specific organ system I love more than the others? Or would I rather be a generalist? For the surgical fields, this pushes you into your various subspecialties, keeping in mind you could still decide to do pediatric fellowships out of any of them, re: question #2. If you prefer to be a generalist that pushes you towards Gen Surg and to a lesser degree Plastics, and then you can further subspecialize later. For the non-surgical person, this question gets you into the subspecialties, but also includes things like PM&R, EM, Family Practice. Within Peds, the organ specific vs not pushes you towards Peds Critical Care, Neonatology, Adolescent Med and PEM pathways in addition to General Peds. There's less "generalist" fields in Medicine (although geriatrics definitely is) but still is an important question to answer.

5) If you're a non-surgical person and you're still undecided, then you can start to consider things like OP vs IP time. Very few fields are entirely one or the other so you'll mainly be comparing relative amounts of time.

6) Lastly, if you're still stuck between several options, go with what pays the most...

 

[Type2Fiber]

Edit: The link doesn't seem to be working but google '2019 aamc report on residents' and look at table A.1


This link is your answer. You mentioned ortho, per the link almost 50% of ortho residents intended to pursue it upon matriculation to school, which is a function of lot of factors. Mostly that orthopedics is the best specialty

Instead of shadowing, I would actually start with reading/podcasts. You don't have enough time to shadow every specialty. The undifferentiated medical student is a fantastic podcast and there are several similar ones. Then shadow based on what sounds interesting to you

 

[sloop]

Edit: The link doesn't seem to be working but google '2019 aamc report on residents' and look at table A.1


This link is your answer. You mentioned ortho, per the link almost 50% of ortho residents intended to pursue it upon matriculation to school, which is a function of lot of factors. Mostly that orthopedics is the best specialty

Instead of shadowing, I would actually start with reading/podcasts. You don't have enough time to shadow every specialty. The undifferentiated medical student is a fantastic podcast and there are several similar ones. Then shadow based on what sounds interesting to you

Looking at the results of that table, I've mostly come to the conclusion that med students generally have no idea what they want they want to do with their lives. I base this on the fact that one general trend seems to be that there is more retention in fields where there is less upfront specialization and more opportunity for later subspecialization. A second trend appears to be that people motivated by money will continue to be motivated by money.

 

[odyssey2]

Started med school wanting to do rads. Went through clinical rotations and then REALLY wanted to do rads. Now applying rads.

 

[Newyawk]

I really wasnt sure about what to pursue and changed my mind several times. I went through clerkship year with an open mind and knew that if i did well overall and crushed the boards id be OK for most fields. I finally found a field i really liked late in 3rd year and, sure enough, was able to match at a great program despite it being a very competitive field. Doing well overall and keeping an open mind would be my general advice however, there is an important caveat: I go to a top 10 med school. This definitely, without a doubt, helped me jump into that field late, find mentors to start projects with, get letters, etc. and still match well. Coming from a low-tier school will make that option much more difficult. As such, you should figure it out sooner by shadowing. Do try to keep an open mind, as you never know what field you really will enjoy (could be peds, neuro, IR, anything).