What to say when you're asked what you want to be when you grow up

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May 13, 2003
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OK everyone... here's my dilemma... when in your MSIII and IV clinical rotations, people are inevitably going to ask what area you eventually plan to go into. Assuming you already know what you want to do, do you remain neutral when asked or do you really say? I mean, if your dream is cardiothoracic surgery and your pediatrics preceptor asks you, do you really say so? It's obvious then that pediatrics means little to you and it could possibly skew your preceptor's interactions with you, and we all know it's not good to burn bridges.

My gut says just play it safe and be neutral, as in "I haven't really decided, I have an open mind, blah blah blah". Anyone? Any advice would be greatly appreciated.

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It was pretty routine at my school for people to honor in rotations outside their stated preference. For instance, a lot of the folks who were goin into EM were bright go-getters, and they would honor in surgery, IM, etc. It's critical that you maintain the illusion that you are intensely interested in that subject, however. If you're perceived as being bored or just passing time, you'll get dinked.
I agree with what womansurg said. I would add that trying to play the "I haven't decided." game later in your third year and in your fourth make you look like you aren't passionate about anything. I was up front with everyone about what I wanted to do. I do think that it hurt me on some rotations (my phych dept. reserved honors for those planning to do psych) but one of my best evals was from IM where the prof. said that I was planning to go into EM but had worked really hard in IM. I think that looks really good.
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I'm a MedPeds resident at a university program so most months I'm responsible for supervising and teaching medical students. I have never considered the student's intended specialty when evaluating them. (No you do not automatically pass the month if you claim to want to be a pediatrician!) However, I always ask students about their interests and previous exposures at the beginning of the week. If I know that the student is interested in Ortho, CV Surgery, etc I can make the rotation more meaningful for them by exposing them to the relevant applications in medicine or pediatrics. I actually had a student who was interested in CV surgery so we went over congenital heart defects and the physiology of the various repairs. He's now a rising 4th year who just emailed me with questions because he is trying to decide between pediatric cardiology and pediatric CV surgery.
In my case I would just tell them it was something other than what I was doing now.. in medicine i said peds, in peds I said ER, in surgery i said anesthesia (they loved that), etc...
I can't stand the students that want to do whatever they are rotating in at the time. I think attendings see right through this.

I am honest with them. I have my decision narrowed down to two choices, and only one of them was a clerkship that I rotated through my third year.
I agree with geek medic, I think that most docotrs respect honesty and fortitude more than having their butts kissed. They are used to it and can see right through it.
I thank all you guys for your input... I think it's best to be honest.. I'm a terrible liar anyway...

I am going into pathology -- I know that the pathologist is always the weird one in the basement of the hospital -- and I was worried that by labeling myself as such, it would drive a barrier between my preceptors (seeing patients and enjoying it) and me (not so much). I guess the best strategy is just be honest, be interested, and be helpful. Is that about right?
bump.. I'm interested in this discussion too.. I guess you have to convey that although you're more oriented towards a certain area, it doesn't mean you're unsuitable/uninterested in something else.
I never expect students to lie to me or the rest of the team about what their interests are. Rather, I would prefer that they be honest about their interests so that we can make the current rotation more user-friendly for them and perhaps find a way to incorporate its principles into their future career plans (as someone else pointed out earlier).

I would be disappointed in any resident or faculty member that downgraded a student simply because they weren't interested in pursuing a career in the field in which they area rotating. IF however a student shows such a disdain or complete lack of interest in the rotation, then I have no problem giving them a poor evaluation if their work suffers...which I've had to do. All I ask if that you show up on time, do the work that's asked of you, and try and glean something of value from the rotation.
I think Dr. Cox's views are the the most just and fair, but unfortunately that doesn't happen everywhere.

I had an inkling of interest in ortho when I went into the rotation, which automatically garnered an Honors. (I worked pretty hard, too, but so did others who didn't have any interest in ortho and received a lower score). As soon as you express your interest, people know. Even the nurses and secretaries that don't see you...the walls have ears!!


What I do now, I just tell it like it is. Say you're interested in the field(s) you're interested in. Then work your butt off and learn whatever you can. And then, once it's over, switch gears. That's all. The more reading-between-the-lines and politicking you do, the more complicated it gets. For me, that would have driven me bonkers.

-Todd MS IV
Hi there,
I will generally ask medical students what they want to go into. My reason for doing this is so that I might tailor their experiences with me for more application to their interests. If I find that a student is interested in surgery, I try to get them into the bigger cases and point out good review books and texts. They also like to get practice doing things like chest tubes.

If a student is not interested in surgery, I try to get them into closing wounds and doing minor surgical procedures that will give them more hands-on surgical experience. I try to tailor their learning to practical things that will come in handy for E. Medicine, Anesthesia etc.

I had a student who was interested in Anesthesia so I let him do procedures like infiltrative anesthesia and pull epidural catheters. I also walked him through things like central lines. When I had a student who was interested in EM or FP, I let them remove and suture small skin lesions. I also tried to make sure that they would know when to consult surgery.

When I was a student on medicine service, I totally appreciated my medicine residents teaching me things that would help me become a better surgical resident. I was never penalized for not wanting to go into medicine or pediatrics. I would never penalize a student for not wanting to go into surgery.

If you are undecided, then state that and move on. The idea behind every clinical rotation is that you take something away that will make you a better physician and that you learn the basics so that you can pass the shelf exams. Even better, learn to enjoy every rotation because there is good medicine to be learned.

njbmd (I love my colleagues in pathology! They are the best!)
I definitely agree NJBMD. If I think about my strong students they have planned varied residencies. One of the incoming peds interns was a very strong student and I look forward to working with him when he joins us this summer. The other students that come immediately to mind have chosen fields other than medicine or pediatrics. Perhaps what distinguished them was their approach to the rotation (I may be biased as this was the approach I tried to take as student) was to try to identify the core competencies and knowledge base of the rotation especially as it applied to future interests. As they were honest about their interests and plans I was able to help them make this process more effective in the way I assigned patients and directed their readings. I'm glad your medicine residents helped you to become a better surgeon. I know I learned a lot of medicine from my surgery attendings. One of them even set himself to teaching me all the things he wished his non surgical colleagues knew. I've certainly appreciated that teaching on call from time to time. I hope I've helped my students that way as well.

Cooky- I must challenge the weird pathologist mentality (for reasons other than a good friend from medical school has chosen this path). At our institution our pathologists are very integrated and are welcome participants at our conferences. They've also been very willing to pull and review slides with us. I see the passion they have for their work and their dedication. I think these are very important parts of being a good physician. If pathology is your passion don't be afraid to share that. Make it a point to review slides when your patients have biopsies or bronchoscopies. Correlate the clinical with the pathology (it will help you later because you'll understand the questions to ask submitting physicians when reviewing their specimens). Enjoy your rotations! You have the potential to make this a great year.
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I believe attitude is more important than if you tell your attendings and residents what specialty you want. Honesty wont hurt you the way your attitude will. Be honest- diplomatically. Bottom line- don't be rude or a jerk- that will hurt you. Just come to learn.
I'm a 3rd year and I have now been asked twice from my 2 preceptors thus far what field I was interested in. (I have a feeling this will be a pattern...)

I have a pretty good idea what I want to do, but it's not set in stone. When they ask me this, it's said in a way that's sort of loaded - like "Are you going to become a cardiologist?" I guess that's really loaded, actually.

What do I say? I hate to lie, but I also don't want to come off as interested in going into that field in case I am held to some higher standard; or if I want to get a letter from that attending, I don't want them to think I plan on going into that field, you know?

I know I should probably be honest, I just don't know how to do it and be gracious. Plus, I am not a hundred percent sure I know what I want so far.

There is nothing wrong with simply stating, as you did in your last sentence, "I haven't decided yet."

No need for false flattery, but if you are worried about being "p.c.", you can always say that you're enjoying learning about all the fields and have found specialty x less interesting/specialty y more so, but want to do a few more rotations before making up your mind.

OTOH, if you have already made up your mind, you can always state so, nicely without denigrating the field you're rotating in and stating how all your rotations have been valuable and will continue to be so in your future career.

I don't think anyone would be foolish enough to expect that everyone will find their specialty interesting...just chalk it up to former pre-med paranoia that saying the "wrong thing" will somehow harm you.

Be polite, nice and interested in whatever you do and no one will give a darn if you're interested in pursuing psychiatry while doing a surgical rotation.

I don't think dishonesty is ever a good characteristic for a medical student or physician. I've bumped a recent thread that addressed a similar question well. Enjoy third year!
My attendings have asked me what I want to go into when I am done with school, and I have never lied. I have told them honestly what I want to go into. As I'm sure others have said, they will see right through you if you say "I want to go into psych" when you are in psych, "i want to go into surgery" when you are in surgery, etc. I think that honesty is best. I answered them by saying, "So far I want to go into peds" - including the "so far" to show that I may be open to other things. Your attendings know that you have preferences, and I don't think they care if your preference isn't necessarily the field they are in.

I also agree that attitude is everything. Just because you are not interested in a rotation, DON'T ACT LIKE YOU ARE BORED! Every rotation is an opportunity to learn. I know I have only done 1 1/2 rotations so far, but I'm sure your attending will care more if you have a bad attitude than if you want to go into a different field than theirs.
The honesty-is-the-best-policy has worked the best so far. Actually, since everyone seems to enjoy making fun of pathologists, the docs get to make me the butt of jokes and we all laugh and have a jolly good time.

I'll agree though Kristin, that that lub-dub doc asking you straight up if you wanted to go into cardiology was a bit loaded. I'm sure he wasn't even thinking and didn't mean for it to come out that way.

Agreed though, regarding the paranoia. Pissing people off (while you're still working with them, anyway) usually does not behoove you.... but I'll try to get over it... :)

I worked for a group of Cardiologists for a year (as this is the specialty that I think I want to go into). Though its not exactly the same, whenever we had pre-med students come in to "shadow," I always noticed that the cardiologists would ask if they (the student) wanted to go into cardiology (almost the first thing they would ask). I don't really have an answer as to why they asked it all the time, but I thought I'd let you know that it seems to be a common thing among Cardiologists.
So my cardiologist who asked me on Monday what I wanted to do today referred to me going into family and EM. I want to do ID which I told him Monday. I thought it was kind of funny that he didn't remember. Not criticizing him for this, but it was kind of comical. Obviously what I said was only remembered as "not wanting to be cardiologist."

I appreciate everyone's candor about this. I think the "So far, I'm interested in X" is the best approach.
My reply would be that I want to wake up one day without feeling dead inside because some doctor put pressure on me to do a speciality before I completed all my rotations.