Choosing Your Specialty: Gaining Insights from Clinical Clerkships

How Do Medical Students Choose Their Specialty?

Choosing a medical specialty is a highly personal and introspective decision that involves a combination of self-reflection, exposure to various specialties, and consideration of individual strengths, preferences, and values. In my experience, the first question that I had to answer was “Do I want to pursue a medical specialty that is primarily surgical/procedural?”.

TConsider your interest in bedside or operating room procedures. If you find excitement in these, a surgical/procedural subspecialty like cardiothoracic surgery or interventional radiology may be a good fit for you! If you are indifferent about procedures, then you may want to pursue a specialty like internal medicine, where many medical subspecialties like cardiology and pulmonary and critical care offer a balance between procedural and non-procedural medical practice. Should you strongly dislike wearing gloves and being in a sterile field, steer clear of all surgical/procedural-based specialties! After you make this delineation, then begin considering the following factors which can contribute to your decision-making process:

Personal Interests:

Students often choose a specific specialty driven by an intrinsic passion for a field. A genuine fascination with a particular area of medicine becomes a powerful motivator, influencing decision-making. This can encompass intellectual stimulation, with some students attracted to the complexities of diagnostic puzzles, while others derive fulfillment from the practical and procedural aspects of certain specialties.

Clinical Experiences, Such as Clerkships:

Exposure to different clinical settings during rotations can profoundly influence specialty choice. Direct patient interactions and hands-on experiences provide insights into the day-to-day realities of various specialties, allowing students to assess their compatibility with the demands and challenges of each field.

Mentorship and Guidance:

Guidance from mentors, faculty, and experienced practitioners plays a crucial role in shaping a student’s perspective on medical specialties. Mentors can provide valuable insights, share personal experiences, and offer advice that aids students in making informed decisions.

Work-Life Balance Considerations:

The work-life balance associated with different specialties is a significant consideration for many students. Some may prioritize specialties that offer a more predictable schedule and fewer on-call responsibilities, while others may thrive in high-intensity, fast-paced environments.

Future Career Goals:

Consideration of future career goals, such as pursuing academic medicine, research, business, policy, or clinical practice, can influence specialty choice. Certain specialties may align more closely with specific career trajectories and aspirations.

How Do Clerkship Experiences During Medical School Influence Specialty Decisions?

In a 2021 study by the Medical Science Editor, 70% of students found clerkship experiences significantly influenced their specialty choice. Clinical clerkships represent a transformative phase in medical education, providing students with firsthand exposure to diverse medical specialties. These experiences can significantly shape a student’s perception and preference for specific fields. Specifically, this is your first opportunity with direct patient interaction.

Clinical clerkships offer insight into the daily responsibilities, challenges, and rewards associated with different specialties. In my experience, many students cite meaningful patient interactions as the origin of their career specialty. Comparing and contrasting experiences in surgery, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and other specialties allows you to identify areas that resonate with your interests and skills.

Additionally, clerkships provide hands-on experiences that contribute to the development of concrete clinical skills. Discovering skills in specific procedures, diagnostics, or patient populations may influence your choice of aligned specialties. Additionally, you will be exposed to physicians and specialists who can serve as powerful role models. Observing the dedication, expertise, and fulfillment of experienced practitioners can inspire and influence you toward specific specialties. I often challenge myself and my medical students to think about “who they want to become” and “who you want to surround yourself by” when picking a medical specialty. Lastly, clerkships expose students to the unique challenges posed by different specialties. Some students may be drawn to the fast-paced, high-stakes environment of emergency medicine, while others may find satisfaction in the long-term relationships cultivated in primary care.

Maximizing Clinical Clerkships to Evaluate Suitability for Chosen Specialty

The best advice I could give any medical student is to participate in every clerkship to the fullest. Why? Because if you end up matching into Family Medicine for residency, your surgery clerkship during medical school will likely be the first and last time you will ever work in an operating room. You should fully immerse yourself in your clerkships and approach each one with an open mind and earnestness to learn about this specialty, even if you think this is not the specialty for you. Clinical clerkships serve as a critical transition period, preparing you for the responsibilities and expectations of residency. I encourage you to think about which rotations you enjoyed the most, and which ones you could see yourself doing for many more years – this is often a good sign that this may be the specialty for you!

What Are the Best/Worst Specialties?

This question is inherently subjective, as the answer varies based on personal perspectives. No single specialty is superior or inferior, each being a vital component of our healthcare system. When contemplating the “best” or “worst” specialty, consider aligning it with your personal and professional objectives. Factors influencing this assessment include work-life balance, intellectual engagement, procedural preferences, patient demographics, financial aspects, on-call commitments, research prospects, training duration, geographic flexibility, job market trends, inpatient or outpatient focus, field innovation, and more. Reflect on these elements during your clinical clerkships and seek insights from practitioners about their decision-making processes.

Selecting a medical specialty is a complex process that unfolds during medical school, with clinical clerkships being crucial. The decision is influenced by personal interests, exposure to diverse specialties, mentorship, and various factors. In clerkships, you’ll gain insights into patient care intricacies, specialty demands, and unique challenges. Whether choosing primary care, a surgical specialty, or diagnostic medicine, clerkships form the foundation for informed decisions. Ultimately, the choice is deeply personal, evolving with experiences, values, and aspirations.