Was a gradual journey until I found the exact right spot, then it was fast.
Started out thinking Peds Ortho or Peds ENT, with some sort of peds medical specialty (GI and cardiology were considerations) as a distant third option
Combination of not loving the OR (most of it), culture of surgery, and scoring at the mean for Step 1 put me squarely into peds.
Loved my IM clerkship and so was planning on applying to some Med-Peds programs along with straight Peds, with the thought that if I did Med-Peds I'd actually look to do a dual fellowship in adult and pediatric pulm or adult congenital if I went into cardiology...was thinking med peds enough that I did a medicine sub-I in July of M4
In August of M4 did an away rotation (mostly to hang out with one of my best friends, rather than for any sort of clinical experience), ended up in the PICU...and that was it. Combined everything I wanted and needed from a medical career in one place. Dropped any plans for med-peds, looked at residency programs specifically based on their critical care divisions and how many people went into PICU fellowships. As a resident, only wavered slightly in the 2 months before I started my first PICU month, just to hedge my bets in case I was disappointed and didn't love it as much as I had, but 48 hours in, I knew it was right. Now about to be 3 years out of fellowship and can't imagine doing anything else.