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I've always wondered about this but can never get a clear answer. Considering the fact that you apply for the MATCH at the beginning of your fourth year in medical school, how can you get a feel for specialties other than the required rotations during the third year? I just don't understand how people apply for residencies in other specialties if they haven't done a rotation in it. I understand that some people just "know" what they want to pursue, but what about those who don't know and don't necessarily want to pursue a required rotation specialty?
 

mordounhas

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At my school, you get a 1-month "selective" during 3rd year in which you can experience any field. In addition, you are allowed some latitude to delve into some specialties. For example, during gen surg, you're required to do 1 month in a gen surg ward, but can choose to do ophtho, ortho, ENT, neuro, urology, or whatever during the second month (and are given some freedom to choose). So I'd assume you get some opportunities at many schools to take a peek at some of the more random specialties.

That being said, I'm a second-year, and think it will be somewhat difficult to make 4th-year scheduling decisions based entirely off of the first 7-8 months of 3rd year let alone figure out a career choice.
 

Instatewaiter

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I've always wondered about this but can never get a clear answer. Considering the fact that you apply for the MATCH at the beginning of your fourth year in medical school, how can you get a feel for specialties other than the required rotations during the third year? I just don't understand how people apply for residencies in other specialties if they haven't done a rotation in it. I understand that some people just "know" what they want to pursue, but what about those who don't know and don't necessarily want to pursue a required rotation specialty?
at my school people who are interested in things like ENT, rads, ophtho or any other non-core elective can do it as part of an elective during surgery or do their family med or neurology month during 4th year and do an AI in that specialty during third year.
 

Law2Doc

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I've always wondered about this but can never get a clear answer. Considering the fact that you apply for the MATCH at the beginning of your fourth year in medical school, how can you get a feel for specialties other than the required rotations during the third year? I just don't understand how people apply for residencies in other specialties if they haven't done a rotation in it. I understand that some people just "know" what they want to pursue, but what about those who don't know and don't necessarily want to pursue a required rotation specialty?
That's a great question, and you've pretty much highlighted the biggest flaw in the med school process, as I see it. You are expected to KNOW what you are going into by approximately August of 4th year. If you fall in love with a core rotation (IM, Peds, OB, Surg, Psych) fantastic. If you are more likely interested in one of the other 20 specialties, you are kind of screwed. Most programs don't have the 3rd year "selective", or 3rd year flexibility the prior poster described, although that would make a lot of sense. In surgery you will get some exposure to some surgical subspecialties (maybe ENT, Ortho), maybe anesthesia. In IM you might get some derm exposure. But you are right, you won't come into 4th year with all the exposure you might want. Some people do some shadowing during second year to see a few more specialties. And you will have a couple of months at the beginning of 4th year to work with. You don't generally have a summer off after third year so fourth year will start in June. That gives you June, July and August to take electives, and still get your ERAS application in by the beginning of September. So you have to choose those months wisely. Then for the fall months, you may want to be doing away rotations, so if you have an inkling that you are interested in a field, you might have to line those up as soon as you have that inkling. Worst case scenarios (1) you can defer graduation a year and do targeted research, while at the same time shadowing, if you decide too late what you want to go into. (2) you can try to line up a transitional year to get more exposure to multiple fields. A transitional year is an internship year that was originally designed for indecisive folks; however because it is regarded as cushier than most internships due to many lax electives, these are now largely full of folks heading on to derm or rads who just need to satisfy a prelim year requirement. Thus these can be among the most competitive slots to snag. (3) make an educated guess about what you will like, start in on it, and if it doesn't pan out, you can try to change fields. None of these options are ideal for different reasons, so you really ought to do whatever you can, via shadowing whenever you have down time, and choosing your fourth year initial electives wisely, to hone in on your desired field.
 
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NightSwim

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Oh man, I've always wondered about this too. Based on what Law2Doc said, it seems like electives during June, July and August of M4 are HUGE for students undecided about speciality choice after M3. I would guess most students would want to do a sub-I/AI during these months.
 
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ok thanks for all of the feedback. Yeah it looks like if you don't get an elective period during third year, that summer between third and fourth year is a good time to figure it out.
 

thesauce

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OP: this is a major problem with the curriculum. Officially, you only have one elective in 3rd year to figure it out. You can try and look into specialties during your sparse free time during 1st or 2nd year, but by 4th year, you pretty much have to know, especially if you're going into Ophtho or Uro because they are early match.

There are more than a dozen specialties that I had no exposures to whatsoever, including ortho, ophtho, uro, derm, plastics, anesthesia, ENT, pathology, and almost all surgery subspecialties. Eventually you just have to accept that you could be happy in a number of fields and make a decision.
 

Droopy Snoopy

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Back in the day:

-Most people had 4 years of school to choose either medicine or surgery... -Then you had most of your intern year to figure things out futher...
-or just hang up a shingle as a GP...
-But you could always change your mind, 'cause spots >>> applicants.

Plus:
-You had about 30 drugs to memorize,
-nurses said 'yes doctor' not 'I'm about to go on break', and
-multimillion dollar malpractice suits weren't waiting behind every un-ordered lab

Conclusion:
I've got a sports almanac, anybody got a flux capacitor? Oh well, do the best you can and hope you don't pick something you hate. Your Medicare funding depends on it.
 

Law2Doc

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ok thanks for all of the feedback. Yeah it looks like if you don't get an elective period during third year, that summer between third and fourth year is a good time to figure it out.
Just to clarify, it isn't the summer between 3rd and 4th year, it IS 4th year. You don't get this summer off at most places, you transition right from 3rd to 4th year, give or take a week or so.
 

Law2Doc

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Meh. There's no shortage of interest in the specialties you all have listed.
It's not a question of shortage, it's a question of informed decision making. Meaning one shouldn't realize they don't want to be a urologist AFTER they start working as a urologist simply because they didn't get adequate exposure to the field before applications were due.
 

dragonfly99

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Agree w/tic and
law2doc.

IMHO it would behoove those of you who are still 1st/2nd years to try to do some career shadowing because there will be specialties that you won't be exposed to during 3rd year. Pathology, nuclear medicine, physical medicine/rehab all come to mind. I think the system we have often forces people to choose a specialty too quickly, and thus often to choose poorly. Nobody seems to be inclined to change this, however.
 

lowbudget

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It's not a question of shortage, it's a question of informed decision making. Meaning one shouldn't realize they don't want to be a urologist AFTER they start working as a urologist simply because they didn't get adequate exposure to the field before applications were due.
I get the point of the thread. Most students have a running idea of what they want to do with their lives throughout medical school. Certain experiences shape & validate those decisions along the way, but for those who have a strong draw towards all the specialties listed above will chase those interests regardless of how 3rd & 4th year are structured. Money, lifestyle, & aversion towards generalism further serve as impetus (... uh, impetuses... impeti... gaggle of impetus). What's the probability of an urology residents dropping out of urology to pursue general surgery because they were misinformed about the demands & rewards of urology?

If anything, med students hate specialties that are "shoved down their throats" (at least so say the vocal ones)... ambulatory med & OB/Gyn come to mind.

I think curricular designers should focus 3rd year & 4th year on the medicine that anyone with a medical degree should know. I seriously doubt that everyone with an MD or DO needs to spend 1 month learning the finer points of radiation oncology. That being said, skin, eyes, male GU, and MSK are under-taught in general required clerkships across the board, but there is no reason why ophtho can't be learned during neuro, why anesthesia can't be integrated into surgery or medicine clerkships, why neuro-PMR-ortho-rheum aren't taught as 1 topic area, and why radiology isn't taught across all rotations?

I think 3rd & 4th year curriculum should focus on actually learning the medicine rather than using it as some sort of career fair or some underhanded recruitment ploy or some lame "audition" or sorority rush like it is right now for most medical schools. It detracts from learning medicine *before* the rotation begins.
 
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Law2Doc

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...I think 3rd & 4th year curriculum should focus on actually learning the medicine rather than using it as some sort of career fair or some underhanded recruitment ploy or some lame "audition" or sorority rush like it is right now for most medical schools. It detracts from learning medicine *before* the rotation begins.
Well, the problem with this is brief time involved. You aren't going to learn a whole lot of the medicine involved in any specialty in one to three months. All you can do is get a mild flavor of it. There's a reason residencies are 3-7 years, it's because that's about how long it takes to be trained in these fields, working up to 80 hours/week in them. So no med student is going to come out of a surgery rotation knowing a substantial amount of surgery (a 5 year residency), nobody is going to learn IM (a 3 year residency), and nobody trying their hand at learning radiology (a 4 year residency, after prelim year) is going to learn how to read films to any significant degree, etc. And if as you suggest we even tuck in other residencies (optho, ortho, PM&R, anesthesiology etc) into the cores, then you really aren't going to actually learn the medicine. All of these things take 3+ years to learn, and the med student will get a couple of weeks exposure to them. There just isn't time. When people are spending 3-7 YEARS trying to "actually learn the medicine" in that field, it's laughable for some med students to expect to "actually learn the medicine" in a matter of weeks. So no, I don't think it's about a sorority rush so much as it's a "you are here for three weeks and we cannot possibly teach you this subject in that time period, so help out the residents and see if you like it, because realistically that's all that we can do in this timeframe." I also disagree with your notion that med students already have an inkling of what they are going into independent of the things forced on them. Most med students change their mind at least once during med school, and I know many many people who were impressed enough by a core to switch their interest to that field.
 

Substance

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Med school is bullshiit.

The training is based on the severely outdated Flexner report. That was relevant about 100 years ago when it first came out. There's been a few changes in medicine since then...

The "core" rotation system was all fine and good when doctors could just do the rotating internship and then become a GP if they wanted, but now with the requirement of residency, as well as the ONE SHOT TICKET that is the match, there's no way that medical students can make truly informed decisions about career choice outside of money, prestige, lifestyle, and luck.
 

lowbudget

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Well, the problem with this is brief time involved. You aren't going to learn a whole lot of the medicine involved in any specialty in one to three months. All you can do is get a mild flavor of it. There's a reason residencies are 3-7 years, it's because that's about how long it takes to be trained in these fields, working up to 80 hours/week in them. So no med student is going to come out of a surgery rotation knowing a substantial amount of surgery (a 5 year residency), nobody is going to learn IM (a 3 year residency), and nobody trying their hand at learning radiology (a 4 year residency, after prelim year) is going to learn how to read films to any significant degree, etc. And if as you suggest we even tuck in other residencies (optho, ortho, PM&R, anesthesiology etc) into the cores, then you really aren't going to actually learn the medicine. All of these things take 3+ years to learn, and the med student will get a couple of weeks exposure to them. There just isn't time. When people are spending 3-7 YEARS trying to "actually learn the medicine" in that field, it's laughable for some med students to expect to "actually learn the medicine" in a matter of weeks. So no, I don't think it's about a sorority rush so much as it's a "you are here for three weeks and we cannot possibly teach you this subject in that time period, so help out the residents and see if you like it, because realistically that's all that we can do in this timeframe." I also disagree with your notion that med students already have an inkling of what they are going into independent of the things forced on them. Most med students change their mind at least once during med school, and I know many many people who were impressed enough by a core to switch their interest to that field.
Well, no crap you're not going to learn 7 years of residency material in 7 days. That's not what I'm talking about. What I'm talking about is "kicking the can down the road" where med students show up to a rotation and watch the residents and attending do their job as if it's Take-Your-Kid-to-Work Day. It has nothing to do with an "outdated model" or whatever. It has to do with the attitude that a trainee will learn medicine in residency and not in medical school.

Med students can't master all topics in a subject area, but they can master, say, 4 or 5 topics during their 1 month rotation. It's doable to learn how to examine a shoulder properly, for example, on a neuro-ortho-PMR-rheum rotation that benefits those interested in those specialty as well as any primary care specialty. I think all those with a medical degree should learn how to do this and yet many people don't know how to do it. I think it can be of great benefit to many doctors, especially when you're faced with an elderly patient with left sided chest and shoulder pain with left arm radiation.

That's just one example. Med schools simply need to sit down and spell out what's considered essential for medical students to learn. Getting academicians to sit down and agree on this list and not get in some ego pissing contest is what's actually hard.
 

Law2Doc

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Well, no crap you're not going to learn 7 years of residency material in 7 days. That's not what I'm talking about. What I'm talking about is "kicking the can down the road" where med students show up to a rotation and watch the residents and attending do their job as if it's Take-Your-Kid-to-Work Day. It has nothing to do with an "outdated model" or whatever. It has to do with the attitude that a trainee will learn medicine in residency and not in medical school.

Med students can't master all topics in a subject area, but they can master, say, 4 or 5 topics during their 1 month rotation. It's doable to learn how to examine a shoulder properly, for example, on a neuro-ortho-PMR-rheum rotation that benefits those interested in those specialty as well as any primary care specialty. I think all those with a medical degree should learn how to do this and yet many people don't know how to do it. I think it can be of great benefit to many doctors, especially when you're faced with an elderly patient with left sided chest and shoulder pain with left arm radiation.

That's just one example. Med schools simply need to sit down and spell out what's considered essential for medical students to learn. Getting academicians to sit down and agree on this list and not get in some ego pissing contest is what's actually hard.
I think some places do a better job of this than others. I've been at a place where the med students were an integral part of the team and another where they were basically shadowing and asking if it was time to leave yet. But in both cases the one value added was some exposure to the field and seeing what the residents actually do.