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6 Steps to Choosing a Specialty, from First to Fourth Year

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One of the hardest parts of medical school is figuring out what you want to be when you grow up: your ultimate specialty. As a current fourth-year medical student, I’ve watched many of my classmates struggle with choosing a specialty. It’s something I struggled with. Looking back, here are six steps you can take to make the process easier.

Years 1–2

1. Learn what specialties exist.

I had never heard of radiation oncology or PM&R before medical school. First things first, print a list of all the specialties that exist, including their fellowships. As time passes, cross out specialties you’ve eliminated. Seeing the list will remind you of all the possibilities and ensure you’re not surprised by a secret niche field at the end of third year.

2. Do well in class and on USMLE Step 1.

Take note of which subjects you like and which you’re good at. Focus on learning the material well instead of looking for cryptic signs about what specialty is right for you. Mastering classwork prepares you for wards and Step 1. Doing well on Step 1 keeps doors open and lays a foundation for Step 2. But don’t stress over being perfect. Different people excel at different points of medical school, and there are many ways to show your competitiveness, including third-year grades, research, and aways.

Year 3

3. Identify the bread and butter.

Whether you help deliver twins or divert an emergency in the OR, little thrilling experiences in third year will make you rethink the meaning of life. But these don’t necessarily reflect the everyday. Consider the most mundane work of a specialty and ask yourself if you’re happy doing that. Think about the typical acuity and pace. You may love your experiences in the ER, but feel drained by the speed of each day.

4. Talk to others, but beware.

Talk to medical students, residents, and attendings, but remember that people tend to praise their own specialty. Instead, ask them how they chose between their specialty and another one they loved. Also beware of star power. A great teacher or a stellar resident can cast an attractive glow around their specialty. Ask yourself if you love their specialty or if you’re just trying to emulate them. Finally, beware of friends and family who envision a certain field for you. They have invaluable insight into your natural strengths, but they will also tend to recommend specialties they are comfortable with.

Year 4

5. Your desire versus your desirability.

Your competitiveness does not end with Step 1. Talk to your program director honestly about your application. It often comes down to a balance between how badly you want to pursue a specialty (your desire) and how competitive you are (your desirability). If you’re not an ideal applicant, are you willing to move to a remote area for residency? Take a year off for research? Juggle applying to a back-up specialty? These are the questions your program director will help you identify and answer.

6. Experience it twice.

Save time at the beginning of fourth year to experience your chosen specialty again. If you’re stuck between two or three, try to rotate through all of them. In third year, everything is shiny and short-lived. A second rotation will help you confirm what you want. Are you excited to go to work in the morning? Go with your gut and don’t be afraid to consider a research year if you think you’ve made a mistake. Better to realize that now rather than five years into practice.

Barbara Lam is a fourth-year medical student at the Keck School of Medicine of USC. She is currently applying to residencies in Internal Medicine. She is also a 2017–2018 Doximity Fellow.

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