HughMyron

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So I know that some people go into medical school knowing that they are going to be OB/GYNs, FPs, Peds, surgeons, etc.

I'm not one of them.


I was wondering, when should you start thinking about potential specialty options? The only thing I know so far is that I probably don't want to do anything surgical, mostly because of legal, work, and lifestyle considerations.
 

JFK90787

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My general feeling (probably wrong) is that at the top schools a greater proportion of people go in knowing what they want to do. This is especially true for people who want to be surgeons.

For the rest of us plebeians, 3rd year is when we really try to figure that out.
 

sinombre

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You probably won't "know" for a while, but despite what anyone else says, it can't hurt to start considering specialties early on (as long as you remain open minded and are cognizant of the naivety associated with being an MS0 and the inevitable associated romanticized views that go along with it). At least that's what I tell myself.
 
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A lot of people have some ideas. And you get asked this question A TON by other people. But I would say most don't usually get too excited about anything until they hit the clinic in 3rd year and can start getting a feel for what they like. This also is right after getting your Step 1 score back, which can certainly influence how you feel about a desired specialty.

Don't feel like you really need to know. You really don't need to until 3rd year (when you start planning your 4th year rotations). People change their minds all the time. Getting some relevant research helps, so having a good idea in first or second year and pursuing that interest can be helpful, but it's not really necessary.

And in med school interviews, it's a good idea not to be too sold on any particular specialty. You can have interests, but don't be sold on one.
 

cubssox2000

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So I know that some people go into medical school knowing that they are going to be OB/GYNs, FPs, Peds, surgeons, etc.

I'm not one of them.


I was wondering, when should you start thinking about potential specialty options? The only thing I know so far is that I probably don't want to do anything surgical, mostly because of legal, work, and lifestyle considerations.
While it is not bad to have an idea as to what you like (primary care vs specialized, medicine vs surgery vs peds), you should keep an open mind. Most people will make a preliminary decision during the pre-clinical years and shadow in those fields. Then they will make the big decision during 3rd year and take appropriate courses at the beginning of 4th year to get LORs and stuff.
 

mimelim

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You will often here the following phrases:

"Most people who think they know what they want to do when they enter medical school change their mind by the end"

or

"Don't worry about it until you are on rotation as an MS3"


The reality is, the vast majority (90%+) figure out what they want to do as an MS3. However, there are a few big 'buts'. I know numerous people who were expecting to have this big "Ahaha!" moment when everything would become clear and they would know exactly what they want to do with the rest of their life and have gotten burned. You simply aren't going to figure things out in one rotation and you shouldn't. You should be figuring things out over time and use your clinical years as a test phase for different specialties. A few things:

1) Always keep an open mind. Things will surprise you. Every specialty has its perks and drags. If you aren't open to the possibility of being surprised, you will never be surprised.

2) Start looking early. It is never too early to get clinical exposure. Do NOT go overboard and don't make it a priority over other things. You do not need to know what you are going into until MS3 when you are picking your MS4 rotations.

3) Figure out what is important to you, regardless of specialty. Working with hands? Long term relationships with patients? Short term? No time? etc. It is easier to chose between specialties when some of them are simply off the table.


I will use myself as an example:

I came into medical school wanting action and to work with my hands. I play rock climb, do carpentry/wood working, love building models etc. I figured out that I preferred long term contact with my patients, but at the same time, I need to be running around with my hair on fire to really enjoy myself. I need very very sick patients that need me in high acuity situations. In terms of what I wanted to do, I went EM -> Neurosurgery -> Trauma Surgery -> OB/Gyn (that is a funny story) -> Trauma Surgery -> Cards (interventional) -> Trauma Surgery -> Vascular Surgery -> Matched into Vascular Surgery, all in the span of Junior year in college to MS4 in medical school.
 
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HughMyron

HughMyron

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Thanks.

I had a question: to what extent do you consider stuff like financial, educational, work-life, employment, etc related questions? For example, I thought Pathology was cool until I learned about the substantial issues people were having finding jobs in the field.
 

cubssox2000

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Thanks.

I had a question: to what extent do you consider stuff like financial, educational, work-life, employment, etc related questions? For example, I thought Pathology was cool until I learned about the substantial issues people were having finding jobs in the field.
Not very much. You shouldn't go into a field just because it makes the big bucks. You should pick something that you will be happy doing every day. If you choose a field just because it makes the most money, but you are miserable, you will burn out very quickly.

That being said, once you start med school you can start thinking about things like private practice vs academia. You can also think about whether you want to do research or not. You can see this from shadowing opportunities as well right now. Just remember that there will be plenty of time to change decisions, so don't close any doors too early.
 

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Thanks.

I had a question: to what extent do you consider stuff like financial, educational, work-life, employment, etc related questions? For example, I thought Pathology was cool until I learned about the substantial issues people were having finding jobs in the field.
markets change over time and residency is long so you really shouldn't focus too heavily on this stuff -- the economic situation can be very different by the time you finish. And all fields pay an adequate salary if you enjoy it. Pick what you like best and the rest will fall into place.
 

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I am just beginning to understand how this all works. I assume having done research in your specialty of choice is a big plus for residency programs. How do you go about looking for research opportunities early in medical school when you don't know what you're interested in yet? Also, consider that conducting substantive research should take a year or more.
 

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How many elective rotations do 3rd/4th years get on average before they need to start applying for residencies? I'm interested in a handful of specialties for which there are (usually) no core rotation so I'm curious about this.
 

MedPR

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I'm happily surprised by all the informative and worthwhile replies. Good one HughMyron

Sent from my SGH-T999 using SDN Mobile
 

MedPR

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How many elective rotations do 3rd/4th years get on average before they need to start applying for residencies? I'm interested in a handful of specialties for which there are (usually) no core rotation so I'm curious about this.
I tjnk the majority of school don't give their M3s time for elective rotations. However, you can rotate within a certain subspecialties during that clerkship (like cards during IM). M4 varies, but from my research you basically have all year for electives except for 2-4 blocks of required rotations.

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How many elective rotations do 3rd/4th years get on average before they need to start applying for residencies? I'm interested in a handful of specialties for which there are (usually) no core rotation so I'm curious about this.
I'm sure it varies on the school. Here you get 9 elective rotations and I believe you can do them in any order (aka do some in 3rd year).
 
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How many elective rotations do 3rd/4th years get on average before they need to start applying for residencies? I'm interested in a handful of specialties for which there are (usually) no core rotation so I'm curious about this.
The problem is that you pretty much have to decide third year because you have to create a 4th year schedule that maximizes your residency app (like away rotations, when to take Step 2, when to do acting internships, etc). You can't really be deciding on your specialty after a 4th year elective.

It does depend on the school. Unfortunately, it can be hard to swing these experiences though. One common complaint I hear is that we don't do EM until 4th year, and by then, you need to have already decided. The best way around this is to contact people in a desired specialty during 1st and 2nd year and try to get some experience. You don't have the luxury of a full rotation, but it can be quite informative. Third year rotations are then good because they can tell you whether you like certain things or dislike certain things (shift work, long term patient exposure, procedures, etc). That can be helpful in eliminating certain specialties and deciding on others, even if you don't have the luxury of a full rotation in that field.
 
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I am just beginning to understand how this all works. I assume having done research in your specialty of choice is a big plus for residency programs. How do you go about looking for research opportunities early in medical school when you don't know what you're interested in yet? Also, consider that conducting substantive research should take a year or more.
Research matters in some fields more than others. So if you are interested in a few fields, and one of them usually requires research, I would aim for research in that field even if you aren't sure. I've heard a few times to aim for research in the field that is most competitive. Any research will help, so don't be too worried about picking the wrong project.
 

mcloaf

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I thought Pathology was cool until I learned about the substantial issues people were having finding jobs in the field.
I'm having this same concern about CT Surg. Though, considering much of pressure is coming from invasive cards that isn't going anywhere I'm not really sure if there's going to be a solution by the time I'll be coming out of residency. :(
 

mimelim

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I am just beginning to understand how this all works. I assume having done research in your specialty of choice is a big plus for residency programs. How do you go about looking for research opportunities early in medical school when you don't know what you're interested in yet? Also, consider that conducting substantive research should take a year or more.
Research in your specialty of choice is a big plus and almost mandatory in some fields. They tend to be the more competitive fields and really want to see your commitment to that field. This is why you need to be looking and figuring things out as you go along and not default to the "I will figure it out as an MS3". If you get excited because of the surgery interest group, start exploring opportunities. It is rather painful to get a ton of research time in while a medical student. (unless you take a year off between M2/M3) For the vast majority of students this does not make a difference at all. Only a small fraction of physicians in practice are active researchers and that is reflected in residencies.

How many elective rotations do 3rd/4th years get on average before they need to start applying for residencies? I'm interested in a handful of specialties for which there are (usually) no core rotation so I'm curious about this.
You do not really need to do electives prior to decision making unless you are interested in things outside of the core, OB/Gyn, Family Med, Internal Medicine, Surgery, Neuro, Psych, and Peds. All of the Cards, Nephro, Pulm etc are all off shoots of IM. CRS, CVS, Peds, surg onc and others are off of Gen Surg etc. You need to know that you are interested in those others, Derm, EM, surgical subspecialties etc. prior to selection of your 4th year electives (most schools are 100% elective your 4th year, with some sub-I requirements).
 
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In terms of what I wanted to do, I went EM -> Neurosurgery -> Trauma Surgery -> OB/Gyn (that is a funny story) -> Trauma Surgery -> Cards (interventional) -> Trauma Surgery -> Vascular Surgery -> Matched into Vascular Surgery, all in the span of Junior year in college to MS4 in medical school.
Lol, please do tell!

Even as a pre-med (with a lot of exposure to many specialties) I've bounced around in my ideas a lot. But I typically don't know which car I want till I've test-driven a few.
 

Law2Doc

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... But I typically don't know which car I want till I've test-driven a few.
then be pro-active. I've rarely seen an attending say no if a first or second year med student asks if they can come by and see a procedure, shadow for an afternoon, etc. But they aren't going to seek you out. That's probably the best way to see specialties that aren't incorporated into the third year core rotations.
 

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then be pro-active. I've rarely seen an attending say no if a first or second year med student asks if they can come by and see a procedure, shadow for an afternoon, etc. But they aren't going to seek you out. That's probably the best way to see specialties that aren't incorporated into the third year core rotations.
I agree and there are MANY that you (the OP) will never see unless you really take the initiative.
 

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To answer the original question, med students should always be thinking about what specialty they plan to choose. Remember, this choice is what you are likely going to do on a daily basis for the next 35 years. I realized after it was all said and done that my choice to become a doctor was not as important as my choice of what kind of doctor I wanted to be. Although they are all doctors, the "lives" of OB/GYN's vs Psychiatrists vs Ophthalmologists vs Family Medicine docs vs Anesthesiologists are totally totally different.

It is a crucial choice that will likely define your career, so yeah you should be thinking about it.

Now, the problem is, as some have pointed out, you can't have a real good grasp of the specialties until third year when you do rotations. First two years of med school the focus should be grades and Step 1. It is common for med students to go through first 2 years of med school just worried about their grades and maybe having an inclination of what they might do, but are not sure, and know rotations will help them.

When should med students start thinking about specialty? Always. When do they receive the best information to allow them to make the decision? Third year.

Also during third year, you get introduced to...THE SYSTEM. The system of how the hospital runs. Rounds, Consults, Orders, Admissions, Discharges, Clinic, Call, Dictations, Transfers, Units, Codes, etc. You also get introduced to how each specialty has their own way of dealing with all of the above.

You may notice that med students will fall onto one side of the coin in regards to the following areas:

1. Rounds vs No Rounds
2. Clinic vs No Clinic
3. OR vs No OR
4. Procedures vs No Procedures
5. Patients vs No Patients
6. Chronic Care vs Acute Care

There may be more categories you can throw up there I guess. Certain med students will discover the system of how the hospital works and realize, regardless of specialty, that there are aspects of the system they like and dislike. They will also realize that certain specialties will have more of one aspect and less of the other.

Some people may like the chronic nature of taking care of patients, enjoy clinic, and despise the OR. Family medicine or Internal medicine specialties may be good fits there.

Hate rounds, hate clinic, and would prefer little to no patient contact? What about pathology or radiology?

You get it.

For me I did not enjoy rounds or clinic. I loved procedures. I enjoyed acute care much more than chronic care (I wanted to hear a patient's problem and fix it right there and then, and move on to next problem). I enjoy patient interaction, but I did not enjoy being responsible for 15 pts on my "list". I prefer taking care of one patient at a time instead of managing 15 at once. All of this landed me into the specialty of Anesthesiology.

Hope this helps.
 
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To answer the original question, med students should always be thinking about what specialty they plan to choose. Remember, this choice is what you are likely going to do on a daily basis for the next 35 years. I realized after it was all said and done that my choice to become a doctor was not as important as my choice of what kind of doctor I wanted to be. Although they are all doctors, the "lives" of OB/GYN's vs Psychiatrists vs Ophthalmologists vs Family Medicine docs vs Anesthesiologists are totally totally different.

It is a crucial choice that will likely define your career, so yeah you should be thinking about it.

Now, the problem is, as some have pointed out, you can't have a real good grasp of the specialties until third year when you do rotations. First two years of med school the focus should be grades and Step 1. It is common for med students to go through first 2 years of med school just worried about their grades and maybe having an inclination of what they might do, but are not sure, and know rotations will help them.

When should med students start thinking about specialty? Always. When do they receive the best information to allow them to make the decision? Third year.

Also during third year, you get introduced to...THE SYSTEM. The system of how the hospital runs. Rounds, Consults, Orders, Admissions, Discharges, Clinic, Call, Dictations, Transfers, Units, Codes, etc. You also get introduced to how each specialty has their own way of dealing with all of the above.

You may notice that med students will fall onto one side of the coin in regards to the following areas:

1. Rounds vs No Rounds
2. Clinic vs No Clinic
3. OR vs No OR
4. Procedures vs No Procedures
5. Patients vs No Patients
6. Chronic Care vs Acute Care

There may be more categories you can throw up there I guess. Certain med students will discover the system of how the hospital works and realize, regardless of specialty, that there are aspects of the system they like and dislike. They will also realize that certain specialties will have more of one aspect and less of the other.

Some people may like the chronic nature of taking care of patients, enjoy clinic, and despise the OR. Family medicine or Internal medicine specialties may be good fits there.

Hate rounds, hate clinic, and would prefer little to no patient contact? What about pathology or radiology?

You get it.

For me I did not enjoy rounds or clinic. I loved procedures. I enjoyed acute care much more than chronic care (I wanted to hear a patient's problem and fix it right there and then, and move on to next problem). I enjoy patient interaction, but I did not enjoy being responsible for 15 pts on my "list". I prefer taking care of one patient at a time instead of managing 15 at once. All of this landed me into the specialty of Anesthesiology.

Hope this helps.
One of the most helpful posts I've seen on the site. Thank you!
 
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HughMyron

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1. Rounds vs No Rounds
2. Clinic vs No Clinic
3. OR vs No OR
4. Procedures vs No Procedures
5. Patients vs No Patients
6. Chronic Care vs Acute Care
I'm sorry, but could you explain what "Rounds," "Clinic," and "Procedures" mean?

Other than that, I liked your post. Thanks!
 

mimelim

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Great post excaliber.

I'm sorry, but could you explain what "Rounds," "Clinic," and "Procedures" mean?

Other than that, I liked your post. Thanks!
I'll try to explain.

1. Rounds vs No Rounds
Rounds are a daily activity where a physician or team of physicians + allied health professionals walk around and check in on their patients. While rounding, the physician will elicit from the patient, nurses, charts etc new things that have happened since the last time they were rounded on. It is very common in academic centers for these to be a teaching exercise since rounds are where many if not most decisions are made regarding patient care. Any physician that admits patients to the hospital will round.

Rounders: All admitting inpatient services, including but not limited to, surgeons, IM, Peds, Neuro, Psych, and OB/Gyn.
Non-Rounders: Anesthesiology, Pathology, Radiology, EM and physicians that work exclusively or almost exclusively outpatient including, IM, Peds, FM, Derm, etc.

2. Clinic vs No Clinic
Anyone who follows up with patients as an outpatient will have clinic. This is somewhat of a continuum since not all clinics are the same. Some people will exclusively see patients in an outpatient clinic, some will never see someone in an outpatient clinic.

Heavy Clinic: Outpatient based IM, Peds, FM, Derm
Variable to light clinic: Surgeons, Neuro, Psych, OB/Gyn
No Clinic: Radiology, pathology, anesthesia, EM

3. OR vs No OR
Self explanatory, surgery vs everyone else.

4. Procedures vs No Procedures
Surgery plus less invasive tests including, but not limited to interventional radiology, heart caths, scopes, dialysis access work, ECT, Bronchs, lumbar punctures. Most non-surgical procedures are simply IM sub-specialties that have their own fellowships. For instance to be able to do heart caths, one must do IM (3y) + Cardiology (3y) + Interventional Cardiology (1y).

Procedures: Surgery, IR, Int Cards, Int Nephro, GI, Pulm/Crit care, Derm, OB/Gyn, EM
No Procedures: Everyone else, although even FM or others will sometimes perform minor procedures depending where you are.

5. Patients vs No Patients
Direct vs. indirect patient care

No Patients: Pathology, Radiology
Patients: Everyone else.

6. Chronic Care vs Acute Care
How long do you see your patients for? One/Two visits or more? There is quite a lot of variability within single specialties. Things like EM or anesthesia are the obvious acute care. The obvious chronic care would be Heme/Onc, IM, Peds, Surg Onc, Vascular Surgery etc.
 

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Exploration is key at the beginning. The AAMC has tools for evaluating what students can expect in each of the specialties: Careers in Medicine.
 

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Great post excaliber.



I'll try to explain.

1. Rounds vs No Rounds
Rounds are a daily activity where a physician or team of physicians + allied health professionals walk around and check in on their patients. While rounding, the physician will elicit from the patient, nurses, charts etc new things that have happened since the last time they were rounded on. It is very common in academic centers for these to be a teaching exercise since rounds are where many if not most decisions are made regarding patient care. Any physician that admits patients to the hospital will round.

Rounders: All admitting inpatient services, including but not limited to, surgeons, IM, Peds, Neuro, Psych, and OB/Gyn.
Non-Rounders: Anesthesiology, Pathology, Radiology, EM and physicians that work exclusively or almost exclusively outpatient including, IM, Peds, FM, Derm, etc.

2. Clinic vs No Clinic
Anyone who follows up with patients as an outpatient will have clinic. This is somewhat of a continuum since not all clinics are the same. Some people will exclusively see patients in an outpatient clinic, some will never see someone in an outpatient clinic.

Heavy Clinic: Outpatient based IM, Peds, FM, Derm
Variable to light clinic: Surgeons, Neuro, Psych, OB/Gyn
No Clinic: Radiology, pathology, anesthesia, EM

3. OR vs No OR
Self explanatory, surgery vs everyone else.

4. Procedures vs No Procedures
Surgery plus less invasive tests including, but not limited to interventional radiology, heart caths, scopes, dialysis access work, ECT, Bronchs, lumbar punctures. Most non-surgical procedures are simply IM sub-specialties that have their own fellowships. For instance to be able to do heart caths, one must do IM (3y) + Cardiology (3y) + Interventional Cardiology (1y).

Procedures: Surgery, IR, Int Cards, Int Nephro, GI, Pulm/Crit care, Derm, OB/Gyn, EM
No Procedures: Everyone else, although even FM or others will sometimes perform minor procedures depending where you are.

5. Patients vs No Patients
Direct vs. indirect patient care

No Patients: Pathology, Radiology
Patients: Everyone else.

6. Chronic Care vs Acute Care
How long do you see your patients for? One/Two visits or more? There is quite a lot of variability within single specialties. Things like EM or anesthesia are the obvious acute care. The obvious chronic care would be Heme/Onc, IM, Peds, Surg Onc, Vascular Surgery etc.
Just to address the rounding concept, all admitting teams generally round, but rounding in eg surgery will be very different than medicine. In surgery the goal is to get through the rounding rapidly before the OR start time. So you may start rounding at 5 am, so you can be scrubbed into a case by 7:30. In eg medicine, rounding may be a much more significant part of your day. I've seen medicine teams round for many, many, many hours. Some like it -- its an intellectual exercise. Others see it as a necessary evil, but somewhat of an impediment to actually getting your work done. Premeds will appreciate this more in third year core rotations.

Also saying certain specialties have "no patients" is a bit confusing. When you eg go to a radiology practice to get imaging or a mammogram or biopsy or hip injection you are very much a patient and the radiologist is your doctor for that encounter. I think you really meant not an admitting service.
 
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Great post excaliber.



I'll try to explain.

1. Rounds vs No Rounds
Rounds are a daily activity where a physician or team of physicians + allied health professionals walk around and check in on their patients. While rounding, the physician will elicit from the patient, nurses, charts etc new things that have happened since the last time they were rounded on. It is very common in academic centers for these to be a teaching exercise since rounds are where many if not most decisions are made regarding patient care. Any physician that admits patients to the hospital will round.

Rounders: All admitting inpatient services, including but not limited to, surgeons, IM, Peds, Neuro, Psych, and OB/Gyn.
Non-Rounders: Anesthesiology, Pathology, Radiology, EM and physicians that work exclusively or almost exclusively outpatient including, IM, Peds, FM, Derm, etc.

2. Clinic vs No Clinic
Anyone who follows up with patients as an outpatient will have clinic. This is somewhat of a continuum since not all clinics are the same. Some people will exclusively see patients in an outpatient clinic, some will never see someone in an outpatient clinic.

Heavy Clinic: Outpatient based IM, Peds, FM, Derm
Variable to light clinic: Surgeons, Neuro, Psych, OB/Gyn
No Clinic: Radiology, pathology, anesthesia, EM

3. OR vs No OR
Self explanatory, surgery vs everyone else.

4. Procedures vs No Procedures
Surgery plus less invasive tests including, but not limited to interventional radiology, heart caths, scopes, dialysis access work, ECT, Bronchs, lumbar punctures. Most non-surgical procedures are simply IM sub-specialties that have their own fellowships. For instance to be able to do heart caths, one must do IM (3y) + Cardiology (3y) + Interventional Cardiology (1y).

Procedures: Surgery, IR, Int Cards, Int Nephro, GI, Pulm/Crit care, Derm, OB/Gyn, EM
No Procedures: Everyone else, although even FM or others will sometimes perform minor procedures depending where you are.

5. Patients vs No Patients
Direct vs. indirect patient care

No Patients: Pathology, Radiology
Patients: Everyone else.

6. Chronic Care vs Acute Care
How long do you see your patients for? One/Two visits or more? There is quite a lot of variability within single specialties. Things like EM or anesthesia are the obvious acute care. The obvious chronic care would be Heme/Onc, IM, Peds, Surg Onc, Vascular Surgery etc.
:thumbup: thank you! Very helpful!
 

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To address the issue of no electives prior to 4th year, I am choosing a medical school that has a 1.5 year pre-clinical period, so 'MS3' and 'MS4' start a half year earlier than schools w/ 2 years of pre-clinical. This is meant to allow more exploration before applying to residencies.
 

Law2Doc

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To address the issue of no electives prior to 4th year, I am choosing a medical school that has a 1.5 year pre-clinical period, so 'MS3' and 'MS4' start a half year earlier than schools w/ 2 years of pre-clinical. This is meant to allow more exploration before applying to residencies.
That's probably a better model, but as I suggested above, there really isn't any impediment to observing a few specialties on your own time during the first two years of any med school if you are so inclined.
 
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How crucial/helpful is it that the specialty of research during the summer between MS1 and 2 matches the specialty of one's residency application?

Do most schools' curriculum allow fourth years to do research before they apply to residencies? That would ensure they have research experiences in that particular specialty, which seems to be necessary for radiation oncology.

Aside from shadowing, what would be the best ways to identify early what one's favorite specialty is from a list of 2-3 choices?
 

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Never too early to start thinking about it.

Well, maybe Kindergarten would be too early just because you don't want to exclude other career paths at that point :)