Choosing a Specialty: The Generalist vs. the Early-Committer

Many students arrive at medical school with a bias that their liberal arts education has instilled, namely, that they should survey everything before deciding on their specialty. Before medical school, students matriculate at colleges that pride themselves on providing a diverse exposure to a variety of subjects: Computer science majors experience the canon of Great Literature before pursuing a life of code, and English majors can take “Physics for Poets.”
For a generalist student sampling from the buffet of medicine, it can be jarring to sit in lecture next to a classmate who declares on the first day of school that she intends to become an orthopedist. These early-committers appear to have whittled down their choices from day one. They magically become apprentices to a faculty member in their chosen specialty by the first quarter, have a publication by their first year, and seem to possess an intuitive roadmap for applying to residency that the generalist cannot read.

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10 Signs You're an Intern

1. 2 Days off in a row = Vacation!
In high school, I looked forward to winter break, spring break, and summer break. In undergraduate, it was the two weeks off over winter break and the week off between quarters. Anything short of a week off felt like barely time to catch your breath – definitely not a vacation. As a medical student, there was still winter break and most bank holidays. Now, as an intern, any time there are two days off in a row, what most of the rest of my non-medicine peers would simply call “the weekend” constitutes the most luxurious vacation.

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5 Reasons Intern Year is Better Than Medical School

students with disabilities

I had a certain level of (I thought well-justified) terror anticipating the start of intern year. No longer able to hide behind the protective “I’m just the medical student” blockade, I was worried about not being able to live up to the burden and the privilege of being someone’s doctor. Third year was rough and I could only imagine the horrors that awaited me as an intern. Yes, it has been a difficult year, filled with long hours and intense days. However, what I found was that contrary to my fears, intern year has been so much better than medical school. If you recently walked across the stage and accept your diploma, congratulations! Here’s what you have to look forward to:

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Tips from the Trenches: 5 Tips for Surviving Intern Year

Dear Incoming Interns,
Congratulations on matching and reaching the end of medical school! I am sure you are very excited to be graduating, and we interns are equally excited for you as it means we are about ready to say “so long” to our intern year. (Right now, I have 62 clinical days left – but who’s counting?) Intern year is one steep learning curve after another. Just about the time you figure out a particular service, you switch to the next. Over time, however, themes emerge, the transitions become easier, and the mass of random lab values, medications, signs and symptoms, slowly gel into cohesive patient narratives. Below is some of my own hard-earned advice from this year, some practical, some personal.

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An Apology from a Resident

Dear Third Year Medical Student,
Congratulations! Your two years of textbook learning are complete and you are ready to launch into your clinical training. It’s an exciting time and you’re likely super-eager to jump in, get involved and save a few lives (or at least stand by helpfully while other people save the lives; let’s not get ahead of ourselves). You have high hopes of becoming a key member of your team, taking care of your patients and learning as much as possible. What you will quickly discover is that your experience will be strongly colored by the residents with whom you will work closely. As a medical student, I had the opportunity to work with some truly great residents. Enthusiastic about their field, they worked to incorporate me into the care process and would take a moment, however brief, to draw attention to valuable teaching points that I might otherwise have overlooked.

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Lessons Learned on the Residency Admissions Trail

This time last year, I embarked on my own medical residency admissions journey. I realized that the decision-making process involved in the ERAS and residency application cycle can be dauntingly ambiguous to many applicants, including myself. Gone are the lists of medical schools or colleges ordered by objective measurements such as research dollars, student-faculty ratios, and admission statistics of entering classes. While there is significant debate on which criteria should be included in ranking schools, the availability of that data at least allowed for individual interpretation based on personal beliefs.

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Navigating Your Future: A Roadmap to Specialty Exploration

Congratulations! You’re in medical school. What you will soon realize is that your answer to “What do you want to be when you grow up?” is going to have to change. Simply saying “doctor” is no longer enough. You need to start to figure out what kind of doctor you want to be. And, although applying to residency may feel very far off, there are steps you can do starting in your first year to help you pick the specialty that best suits you.
Most of us have fairly limited exposure to different specialties as pre-meds; mine consisted primarily of shadowing cardiothoracic surgeons. Yet there is a huge diversity among medical specialties, some of which you may have never heard about. Physiatry, anyone? Others you know of can be quite different than what you had envisioned. A friend of mine recently shadowed an interventional radiologist and was surprised by the surgical nature of the specialty.

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Emergency Medicine: Can a Sizzling Hot Specialty Burn You to a Crisp?

Emergency physicians experience burnout at a rate of more than three times that of the average doctor and more than anyone else inside or outside of the medical field, according to a study published in the Archives of Internal Medicine (1). The study surveyed over 7000 physicians in more than two dozen specialties and compared them with almost 3500 working adults in fields outside of medicine. More than 65% of emergency physicians reported burnout, compared to 55% of internists (the next crispiest specialty), and 27.8% of the general population.

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The Big Question: What Specialty Should I Choose?

 
 
It is Match Week and Jennie, a third year medical student, is starting to panic. She has talked to many of the fourth years as they chose where to apply for residency, went on interviews and decided how to rank the programs. They all seemed to be so sure of their specialties.
Jennie, however, is not at all sure. Pediatrics, psychiatry, and family medicine all seem intriguing. But, how to make a decision? She is worried that she won’t select the specialty that will be satisfying for her.

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The Successful Match: Getting into Pediatrics

 
We recently discussed the pediatric residency selection process with Dr. Su-Ting Li, program director of the University of California Davis pediatrics residency program and Vice Chair of Education in the Department of Pediatrics. After graduating from the UCLA School of Medicine, she completed her pediatrics residency at the University of Washington. Following this, she remained at UW as a National Service Research Award Fellow in General Academic Pediatrics and pursued a MPH in epidemiology. She then joined the Department of Pediatrics at the University of California Davis where she has also held the title of Clerkship Director.
Dr. Li has been heavily involved in medical student and resident education on local, regional, and national levels. She has also been recognized for her research contributions. In 2008, her paper “Primary Operative Management for Pediatric Empyema” was recognized as one of the “Top 10 Articles in Pediatric Hospital Medicine.” She has been highly sought after as a journal reviewer, and is currently a reviewer for 12 prestigious publications, including Academic Medicine and Pediatrics.

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Getting into Residency: Most Important Factors

How do residency program directors decide whom to interview? And what factors influence how they rank those applicants they do interview? The National Residency Matching Program (NRMP) surveyed residency program directors in 2008 and 2010 about what they consider most important when deciding which applicants to interview and what criteria are most valuable when ranking residency applicants. This survey, an underutilized resource, provides valuable insight and information that can help medical students determine how competitive they are for a given specialty. The data can also empower applicants if they use the information to improve their candidacies.
Here is what the survey showed about 1) what factors influence program directors to offer a residency applicant an interview, presented as the percentage of program directors who considered each factor important, and 2) what specific criteria influence their decision to rank a residency applicant after the interview, using a scale from 1 (not at all important) to 5 (very important).

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The Successful Match: Getting into Radiology

the match

Of the 4,455 total residents training in 188 ACGME-accredited radiology residency programs, 88.3% are graduates of U.S. allopathic medical schools, 7.6% are international medical graduates, and 3.9% are osteopathic graduates.1 Dr. Vicki Marx is the director of the radiology program at the University of Southern California Keck School of Medicine, and we asked for her insights into the radiology residency selection process.

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The Successful Match: Getting Into Emergency Medicine

 
There are 4,479 total residents training in approximately 150 ACGME-accredited emergency medicine residency training programs. Of these, 85.1% are graduates of U.S. allopathic medical schools, 9.0% are osteopathic graduates, and 5.7% are international medical graduates.1 Osteopathic students may also enter an AOA-approved emergency medicine residency program. In recent years, there have been over 40 such programs.2 Based on recent match statistics, emergency medicine can be considered to be a moderately competitive specialty.
We recently discussed the emergency medicine residency selection process with Dr. Jamie Collings, the Executive Director of Innovative Education and an associate professor in the Department of Emergency Medicine at the Feinberg School of Medicine at Northwestern University. For many years, she served as the program director of the emergency medicine residency program at Northwestern. Over the past fifteen years, she has been heavily involved in advising students interested in pursuing a career in emergency medicine. Dr. Collings earned her medical degree at the Oregon Health & Science University, and then completed her residency at the University of Chicago.

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The Successful Match: Getting into Obstetrics and Gynecology

There are 4,815 total residents training in nearly 250 ACGME-accredited obstetrics and gynecology training programs.1 Of these, 71.8% are graduates of U.S. allopathic medical schools, 19.9% are international medical graduates, and 8.1% are osteopathic graduates.  In recent years, over 1,100 categorical positions have been available in the Match.

We recently discussed the obstetrics and gynecology residency selection process with Dr. Eugene Toy, the Vice Chair of Academic Affairs and residency program director in the Department of Obstetrics and Gynecology at The Methodist Hospital in Houston, TX.  Dr. Toy is widely known as the creator, series editor, and primary author of McGraw-Hill’s popular Case Files Series.

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Acing Your Residency Interview

 
Most residency applicants have not found themselves in the interviewee seat since they applied to medical school. Well, the residency interview is somewhat different from the medical school interview. Because you have now nearly graduated from medical school (for the traditional applicant), no one is trying to assess your commitment to medicine; rather, they are specifically evaluating your commitment to the specialty to which you are applying. They also are evaluating your ability to perform well as a resident and if you will be a good fit for their program. This article will provide some tips to help you succeed, whether you are applying to residency this interview season or in the future.

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The Successful Match: How to Succeed in your Residency Interview

three tips mmi

For most residency applicants, the arrival of November marks the beginning of the interview season. This often brings back memories of the medical school admission interview, with the ubiquitous “Why do you want to be a doctor?” question.

Four years later, you find yourself in a similar situation – this time, hoping to land a position in the specialty and residency program of your choice. “Why do you want to be a doctor?” is now replaced with “Why do you want to go into [this specialty]?” and “Why are you interested in our residency program?” While the questions will differ to some extent, you may be experiencing the same gamut of emotions – uncertainty, nervousness, and perhaps even fear.

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