third year differential

Applying for Residency

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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

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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

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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

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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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All in the Family: A Profile of Family Medicine

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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

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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

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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

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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

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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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Answering The Most Common Question in Medical Education

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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.
Doctors-in-training have heard this question thousands of times, beginning the moment they announced their intentions to pursue a career as a physician: The question, of course, is some variant of “What kind of doctor do you want to be?” Before I interviewed for medical school, I was told to answer noncommittally; it was suggested that, if I already knew what kind of doctor I planned to become, it would imply the clinical years weren’t important to me. I was told to leave it open-ended so as not to rule any specialty out too early. I see the value in that—looking back, how could I have possibly had a good idea, given my limited clinical exposure before medical school? Even for students that do have clinical experience, it’s easy to imagine they could change their minds and, regardless, should be open to learning from the clinical years. Similarly, we were told not to answer too definitively during third year either—the idea being that if we tell an attending what we want to do, and it isn’t the specialty we are currently working with, we will be permanently alienating ourselves from that profession.

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A Portrait of Obstetrics & Gynecology

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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.
Having finished my first rotation, Women’s Health Clerkship, I’d like to offer a short look into the specialty, sharing some of my observations the last few weeks. As I have said often over the past two months, I believe this was the perfect rotation to kick off third year. OB/GYNs have a wide scope of practice, and their field contains elements of many other specialties. During this rotation I was exposed to clinical medicine, by which I mean the art of seeing patients in a clinical setting, spending a few minutes with each, and using history and physical exam skills to offer a diagnosis and treatment plan. I was also exposed to surgery. I hadn’t realized just how surgical of a specialty it is, or at least can be, depending on how a doctor chooses to practice. (More on that later.) I also saw some inpatient medicine, managing patients in a hospital setting and consulting with other specialties as needed. And of course, OB/GYNs have a very unique aspect of medicine that is theirs alone: the labor & delivery floor. This breadth of practice settings was an excellent introduction to many aspects of medicine that I’m only beginning to understand.

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Beginning Clinical Rotations–An Exercise in Humility

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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.
As I write this article, I am thinking about how to compress all that I’ve seen and experienced the last several weeks into a few paragraphs. I’m not sure I’ll be able to do it justice, and if I wrote out all my thoughts it would probably exceed the page limits and the reader’s concentration. So I’m going to focus on a few aspects of this first month of being a third year medical student, and I suspect several themes will reappear and be expanded in future posts.

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Column Intro: The Third Year Differential

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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.

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