When do you choose your specialty in med school?

[monkeyMD]

I know that many people have a specialty in mind when entering medical school. However, I am also aware that many people change what they would like to pursue while in med school. So when do most people make up their minds about which path to pursue? You definitely do have to know prior to applying for residency, but when and what influences people's choice? What opportunities in med school allow you to make up your mind?

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[aSagacious]

From what I've heard, 3rd year rotations usually play the biggest part in influencing students' decisions, sometimes a bit later (though not too much later).

 

[CodeBlu]

From what I've heard, 3rd year rotations usually play the biggest part in influencing students' decisions, sometimes a bit later (though not too much later).

I agree with this sentiment, but I have to add the following...

If you have a good idea about what you want to pursue.. either Medicine or Surgery... that's the first big fork in the road.

Then you can do more observerships/research to make your residency app look nicer.

 

[Law2Doc]

I agree with this sentiment, but I have to add the following...

If you have a good idea about what you want to pursue.. either Medicine or Surgery... that's the first big fork in the road.

Then you can do more observerships/research to make your residency app look nicer.

Yeah, the two early forks should be cerebral vs procedural (I think this makes more sense than medicine vs surgery because there are a lot of hands on fields that aren't really surgery) and then working with adults vs kids. That narrows the choices considerably.your step 1 score after second year will help narrow things even further, whether you like it or not. But generally you can start talking intelligently about specialty choices after you have seen a bunch in third year. You have to pull the trigger on choosing a specialty early in 4th year, and might want to have done away rotations and targeted research before this time, so it pays to be proactive and use some spare time in second year to take a look at certain other specialties during your spare time in the early years if you can. For example, if you might be interested in rad onc, optho, etc you might want to shadow there sometime in 2nd year because most places won't even have an elective in that field. And so on.

 

[ucsfstudents]

It's different for everyone, but most people choose it during the 3rd year of medical school -- i.e. the clinical years where you directly participate in the care of the patients and interact with the physicians in that field. The decision on the field often boils down to lifestyle, enjoyment, capacity, USMLE board scores, personality type, and other factors such as priorities in life, etc. If you don't get along with the people you work with, you are less likely to choose that field, and vice versa. Certain personalities tend to end up in certain specialties. For example, many orthopedic surgeons are ESTJ personality types.

In general, most students rotate through:
- OBGYN
- Neurology
- Psychiatry
- Internal Medicine
- Family Medicine
- Pediatrics
- General surgery
- Anesthesia
- I'm sure I'm missing one....
If the subspecialties are of interest to you, you can then take those electives during your 4th year of medical school.

 

[flatearth22]

After you get a 197 on Step 1 you fall in love with Family Medicine.

 

[HumbleMD]

It's different for everyone, but most people choose it during the 3rd year of medical school -- i.e. the clinical years where you directly participate in the care of the patients and interact with the physicians in that field. The decision on the field often boils down to lifestyle, enjoyment, capacity, USMLE board scores, personality type, and other factors such as priorities in life, etc. If you don't get along with the people you work with, you are less likely to choose that field, and vice versa. Certain personalities tend to end up in certain specialties. For example, many orthopedic surgeons are ESTJ personality types.

In general, most students rotate through:
- OBGYN
- Neurology
- Psychiatry
- Internal Medicine
- Family Medicine
- Pediatrics
- General surgery
- Anesthesia
- I'm sure I'm missing one....
If the subspecialties are of interest to you, you can then take those electives during your 4th year of medical school.

Emergency Medicine. Anesthesia isn't everywhere. Some schools will also fit in Ortho, Ophto, and ENT

You'll have experiences throughout all of your first 3 years that will shape you. For an n of 1 I was leaning towards surgery after the preclinical years. I was down to OBGYN v. Urology v. Surgery by the end of my clerkships. Then I did electives to try them out, and settled on OBGYN.

 

[tima]

Not really. By increasing the step 2 score, year 3 grades, I can see that person applying to other residencies. Still better chance to match in other speciliteis than IMG/FMG.

After you get a 197 on Step 1 you fall in love with Family Medicine.

 

[Aphtalyfe]

After you get a 197 on Step 1 you fall in love with Family Medicine.

LOL. qft

 

[Noah Capurso]

As has been said, 3rd year is the most common time to make decisions and, in general, it is best to have narrowed it down to at most 2 or 3 specialties by the time you start 4th year. A few things to add though:

- It helps to know early if you want to apply in a highly selective specialty such as plastics, derm, neurosurg, rad onc, etc. Knowing earlier will allow you to gain more exposure, get to know the faculty, and build your application.
- There are plenty of opportunities to be exposed to different specialties during the first two yrs of med school.
- If you are unsure at the end of 3rd year, you can always take a year to do research. It will give you extra time to think about it and will really sweeten up your residency application.
- If you are still unsure at residency application time you can apply for a prelim intern year to help you decide. It will buy you more time and will also count as your first year for some specialties. This isn't especially recommended but it is better to go this route than apply to a field you end up disliking.
- And finally, I disagree that there is such a cerebral/procedural dichotomy. Sure, some specialties are more hands on than others but I'd like to think that there is a fair amount of thinking going on for surgeons. Also, pretty much every specialty will have some degree of procedures (even psychiatry with ECT, TMS etc.) There are also specialties that are really balanced in terms of thinking/hands on such as anesthesia, optho, em.

 

[Morsetlis]

After you get a 197 on Step 1 you fall in love with Family Medicine.

 

[Law2Doc]

...
- And finally, I disagree that there is such a cerebral/procedural dichotomy. Sure, some specialties are more hands on than others but I'd like to think that there is a fair amount of thinking going on for surgeons. Also, pretty much every specialty will have some degree of procedures (even psychiatry with ECT, TMS etc.) There are also specialties that are really balanced in terms of thinking/hands on such as anesthesia, optho, em.

I think you missed the point. It isn't "cerebral" vs "non-cerebral". It's cerebral vs procedural. I wasn't suggesting that procedural fields don't think. I was suggesting that medicine vs surgery is not the decision branch, it's procedural vs nonprocedural paths. For instance you can go into IM and sub specialize into a field like hematology which is a lot of rounding and very few procedures, or you can go into IM and do GI and spend the bulk of your day with a scope in your hand. But you have to decide what kind of personality you are and whether you are the kind of person that likes to put the emphasis on making the plan or implementing the plan. FWIW, ECT is not really the kind of thing I was talking about when I said procedural. People who are "hands on" types may gravitate towards fields where you use a scalpel or scope. They aren't going to gravitate towards ECT or cardioversion, etc. Just my two cents.

 

[JimmyChitwood]

You also need to understand whether or not you are a nerd, are social, etc.

At this point, just shadow as much as possible. Later on you'll rotate and have more exposure and understanding in terms of what you want to do, but that's pretty far down the road.

 

[Law2Doc]

You also need to understand whether or not you are a nerd, are social, etc...

I think this is less important than premeds sometimes think. While eg ortho has the reputation as the field for ex-jocks, and something like eg radiology has a rep for attracting tech nerds, and to be sure some people who fit these bills self select and go down these routes, it's not a hard and fast rule. There are some very nerdy ortho surgeons and some very social radiologists out there.

 

[tiedyeddog]

There are some very nerdy ortho surgeons and some very social radiologists out there.

I think it is pretty much a given you are at least an incognito nerd if you are going into ortho.