Menu Icon Search
Close Search

Column Intro: The Third Year Differential

Created July 19, 2016 by Brent Schnipke
Share

Central to the skillset of every physician is the differential diagnosis. This is a list of possible diagnoses that helps guide clinical decision-making. By asking specific questions, performing a focused physical exam, and ordering lab tests, all through the lens of the differential, physicians are able to rule in or rule out each item on the list. The differential is not fixed, however; it is a fluid list that can be rearranged or completely changed at any time given new information. This information often comes in the form of an extra piece of history from the patient, a new finding from an imaging study, or frequently, from several lab tests coming back negative.

In many ways, the first clinical year of medical school (traditionally the third year) is like a differential for each student, except instead of diagnoses, the list in question consists of medical specialties. All the possible fields a student can choose to specialize in – family medicine, surgery, ophthalmology, and the rest – are on a list of options in the mind of each student. Students begin the clinical years with different lists, some more established than others. Some might have strong feelings about a certain specialty, and the third year is a chance to finally confirm it in the clinic. Others are less firmly committed; they might have inclinations towards or away from certain specialties, but are generally unsure of what they want to pursue.

Third year students rotate through just about everything. Although it is important for medical students to learn how to be doctors–much of the nuts-and-bolts training happens during residency–third year is a chance to see and do everything. This ideally creates well-rounded, broadly knowledgeable physicians regardless of specialty. Further, spending each day in the clinic allows the students to determine what really should go at the top of their ‘differential’; in other words, which specialty they will choose.

Just like the typical differential diagnosis, the student’s specialty differential is dynamic. Certain options might be crossed off quickly, as a student rotates through a specialty that does not connect with them at all. For many, previously unexplored options are added after a particularly good experience. Elective rotations early in fourth year help solidify a top choice or decide between two options; and occassionaly, students will apply in more than one specialty, using most of fourth year and the interview process itself to make the decision. And of course, some doctors end up changing their minds and doing a fellowship or completely different residency later in their careers.

The process is different for each aspiring physician, because each student has different predilections, skills, and personality, combined with varying exposure to each option. This column will explore this “Third Year Differential” through the lens of one third-year student. Of course, third year is about much more than choosing a specialty, but confidently deciding involves looking closely at each rotation. Consequently, this column will examine the full experience of learning clinical medicine; articles will feature snapshots of each specialty, interesting and noteworthy experiences, profound moments of learning, and advice for succeeding in different specialties and, more generally, in the clinical years of medical school.

Look for Brent’s regular column, Third Year Differential, the 4th Monday of every month.

About the Author
Brent Schnipke is a third year medical student at Wright State University Boonshoft School of Medicine in Beavercreek, OH. He is a graduate of Mount Vernon Nazarene University with a degree in Biology. His interests include medical education, writing, medical humanities, and bioethics. Brent is also active on social media and can be reached on Twitter @brentschnipke.

// Share //

// Recent Articles //

  • Do You Recognize the Classical Clinical Triad in This Emergency Case?

  • Posted May 26, 2017 by Figure 1
  • A 35-year-old female, G0P0, presents to the emergency department with lower abdominal pain and vaginal spotting. Her last menstrual period was nine weeks ago. She was treated for a chlamydial cervical infection in the past, and has never taken oral contraceptives. On abdominal examination, no mass is detected, however, there is moderate tenderness in the...VIEW >
  • You Can Buy That on Amazon?

  • Posted May 26, 2017 by The Short Coat Podcast
  • All work and no play…is not what we do. Sometimes you’re having so much fun that the time flies by and you forget that you have other important things to do.  That’s what happened on this week’s show, in which Dave brings Aditi Patel, Aline Sandouk, Kylie Miller and Irene Morcuende along for a trip...VIEW >
  • Considering Rejection: Lessons Learned From an ESL Classroom

  • Posted May 25, 2017 by Nicole Hawkins
  • I was seated on a child-sized plastic chair along a wall in the classroom when the teacher summoned me to the front of the room. She handed me a sheet of stickers and, in broken English that was heavily accented, indicated that my task was to watch the approximately twenty children in front of me...VIEW >
  • My Own Little Ice Age

  • Posted May 24, 2017 by Miguel Galán de Juanai
  • Reposted with permission from here. I can finally say I’m in my last year of medical school. It has been a bumpy ride, but only one clerkship, a research project and an OSCE separate me from graduating. I remember receiving my acceptance letter eight years ago. Thinking back to those days, neither vocation nor sentiment...VIEW >
  • What is Cirrhosis?

  • Posted May 23, 2017 by Open Osmosis
  • What is cirrhosis? Cirrhosis is a disease where the liver becomes scarred over time from chronic inflammation and liver cell damage. Cirrhosis can be caused by a variety of diseases, with alcohol abuse and viral hepatitis being some of the most common. This video discusses the cellular mechanism behind fibrotic tissue generation and the pathophysiology...VIEW >
  • Medical, +1 MORE
  • Q&A with Dr. Jennifer Villwock, ENT

  • Posted May 22, 2017 by Rafid Rahman
  • Dr. Jennifer A. Villwock is the current Rhinology and Skull Base Fellow at the University of Kansas Medical Center. After graduating in 2011 from the Michigan State College of Human Medicine, she completed her ENT residency at the State University of New York (SUNY) Upstate Medical University. Dr. Villwock is active in the American Academy...VIEW >
  • Premeds Can Be Science Podcasters, ft. Terel Jackson

  • Posted May 19, 2017 by The Short Coat Podcast
  • An unstated goal of ours is to show medical learners that podcasting is a beneficial experience for both listeners and hosts,  and we’re always banging on about the need for better science communicators. So Erin Pazaski, Levi Endelman, Kylie Miller, and Irene Morcuende were recently excited to get an email from Terel Jackson, an OSU premed who said...VIEW >

// Forums //