Changing Your Mind—And Your Specialty

I’ve written about choosing a medical specialty throughout the third and even fourth years of medical school, but further discussion is warranted regarding the students who don’t choose a specialty in this “typical” timeframe. It is worth mentioning first of all: many people change their minds for many different reasons. I continue to be impressed by the students, residents, and attendings I meet who took circuitous and sometimes truly fascinating routes to become physicians. The same is true for finding one’s niche as a certain type of physician. Many students feel like everyone else has things figured out, but the truth is the path is not always clear cut. Even when the majority achieve a certain stage (e.g. practicing physician) by the standard route, there are always exceptions, and students may be surprised and encouraged at the myriad ways they can reach their career goals.

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Getting In: The Undergraduate’s Guide to Research Experience

getting in

Undergraduate students do not need told, again, how important it is to be involved in numerous activities: academics, extracurriculars, employment, research, job shadowing, internships, and social life. Students who are pursuing a career in a science or healthcare field (particularly those with aspirations for graduate school) may find even more intense pressure than their peers. This pressure – to check a box in each “category” above and to succeed at all of them – can be quite overwhelming, especially for students who don’t have any experience in one area or another. One of the most common areas with which students struggle is research. Many prehealth students understand that research should be part of their application, but do not know how to get started, or even what “research experience” means. If this sounds like you, check out Getting In: The Undergraduate’s Guide to Research Experience by David Oppenheimer and Paris Grey.

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Applying for Residency

Last month I wrote about the early part of 4th year as a kind of second-look for medical students – an occasion for confirming specialty choice, or perhaps changing one’s mind altogether. For me, it has been an enjoyable and enlightening process to revisit the specialties I was most interested in and examine them more thoroughly, paying attention to finer details as I considered what a career in that specialty would entail beyond the years of residency. The specialty decision is often made on just a few weeks of exposure and may be highly influenced by observing residents, but it is important to remember that residency is relatively brief in the context of a career, and thus it is imperative to get opinions on the field of choice from practicing attending physicians. I have been grateful for opportunities to do just this; rotating through a field a second or third time has enabled me to make this aspect more of a priority.

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Choosing a Specialty: Taking a Second Look

fourth year

By Brent Schnipke

As I have spoken with physicians, residents, and other medical students about the process of choosing a medical specialty, the near-universal reply has something to do with the fact that third-year rotations barely offer enough exposure to each specialty to make an informed decision. Third-year medical students move quickly between specialties, and are often granted only a few weeks to examine a given career choice and decide whether they like it or not. Because of this, major decisions about how a medical student will practice as a doctor are largely based on brief experiences that can be easily biased by particular patients, residents, attendings, hospital systems, and even external life factors. To control for these variables, most students will finish their third year and use the first part of their fourth year to take a “second look” at the specialty they are planning to apply for and to help those students who remain undecided.

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Internal Medicine: The "Classic" Physician

By Brent Schnipke

If the average reader is asked to imagine a typical medical student, he or she might picture the following scene: a group of frazzled young people in short white coats, scurrying around the wards of a large academic medical center. They travel in hordes, flocking to the nearest attending, who calmly asks them asinine questions and then chides them for their lack of knowledge. This scene is stereotypical of an often-stereotyped field, and might be something one would see in a caricature of the hospital – on a show such as Grey’s Anatomy or Scrubs. Although this is only one example of what medical education can look like, it is helpful for giving a simplified look at the life of a third-year medical student in the throes of clinical rotations.

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The Year of Privilege, Part 2

In my last article, I wrote about my perspective on the third year of medical school and how it has evolved over the course of this year. Medical education is unfortunately sparse with free time, which makes it difficult to reflect; writing these posts has been one way for me to slow down and process all the things I’ve seen, the knowledge I’ve gained, and the relationships I’ve built with patients. It was the process of doing this that led to last month’s article, highlighting some of the amazing things I’ve gotten to do this year and some general themes about the clinical side of medical school.

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The Year of Privilege: A New Perspective on Third Year

During my pediatrics clerkship, one of our core faculty gave a lecture during orientation. This orientation lecture was particularly good, as the professor giving it was one of our most-loved faculty members who is deeply in tune with medical students at all stages. This was back in the summer when we were just getting started with our clinical experiences, but what he said stuck with me all year. He noted with a bit of humor that third-year medical students are the lowest of the low—barely even acknowledged by many team members, ignored by some patients who refuse to talk to anyone but a “real doctor,” disregarded by residents unless it is to point out something you are doing wrong. We chuckled, already able to relate with this view, but he turned the conventional description on its head by encouraging us to think of the third year of medical school as “the year of privilege.”

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All in the Family: A Profile of Family Medicine

Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third-year student.
My first day on Family Medicine might be the best depiction of the specialty: my clinical preceptor and I moved between our three clinic rooms, barely able to keep up with the 20+ patients that had appointments. We saw a patient following up on depression with new-onset low back pain; a middle-aged woman with a classic urinary tract infection; a husband and wife geriatric wellness visit; an adult woman with diabetes; a 9-year-old with strep throat; and a few cases of sinus infection to round out the day. By the end, I was exhausted and wondered how I would ever learn everything that my preceptor knew about such a wide variety of disease processes and patients. By the end of the rotation, I was still nowhere near his level or my other professors’ – years of residency and clinical experience still separate us – but had at least developed a sense of how to manage many of the common illnesses, and feel that I have a good understand of the breadth and variety of family medicine.

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Mental Health and More: A Look at Psychiatry

Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.

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Choosing a Specialty: Narrowing Down Your Options

This column has focused on the process faced by every medical student, especially third-years: learning the basics of clinical medicine while trying to choose which specialty is for them. This is not an easy task, and although for many it begins before the third year, it usually is not solidified until clinical experiences confirm a student’s passion and proclivity for a certain discipline. The articles in this column have sought to offer particular stories and experiences that may be typical of a specialty, highlighting as many of the “core” specialties as possible. I am only one person, and these experiences are from my perspective as I try to sort through this process myself. This article will explore the process of narrowing down your specialty choice, including some things you may want to consider besides the obvious question, “which specialty do I like the most?”

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How To Choose A Medical Specialty: A Book Review

By Brent Schnipke

Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.

Note to reader: This month’s post is going to be a little different than previous articles, as I will be offering my book review of How to Choose a Medical Specialty. I’m currently on my Surgery clerkship, and will be writing about this clerkship in December’s post, so stay tuned!

In addition to providing snapshots of my clerkship experiences and a summary of each specialty rotation, this column is also about the process of choosing a medical specialty. After all, this is a major component of the third year of medical school for many students. Although learning the fundamentals of each specialty is essential, the exploration of different paths with the intention to eventually choose one is centrally important for third-year students. The first two years of medical school are generally pre-clinical (mostly classroom work), and applications for residency spots are submitted early in fourth year; therefore, third year is the main opportunity for students to explore fields that might be interesting to them, and to get exposure to many fields. This is the idea behind the title of this column, and one of my purposes in writing it has been to explore this dynamic and to share with other students some of my observations about each specialty, which may help some to make their own choice.

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Pediatrics In Review: A Look at Clerkship #2

Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.
In my first rotation, Women’s Health, I wrote about the humbling experience of helping with the birth of a child. This miracle of life is what attracts many people to the field of obstetrics, but working directly with the baby during the newborn period and throughout his/her childhood is, of course, the role of the pediatrician. As I’ve heard many times on this clerkship, “children are not simply small adults,” and understanding human development, the unique diseases of childhood, and the specific needs of young humans is often complex. For this reason, pediatrics is one of the oldest medical specialties, and remains the third largest by volume in the United States.[1]

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