Choosing a medical specialty

It is an unfortunate truth of experiential reality that choices are not clear-cut, and the event window for choice may vanish before the information enabling the choice is present.

Eluki bes Shahar

For those lucky enough to have the need to contemplate this...

Ref: http://aggiepie.files.wordpress.com/2008/05/12medicalspecialtystereotypesfull.jpg

Ref: http://www.huffingtonpost.com/dr-peter-rost/want-to-become-a-doctor_b_20148.html (via BMJ?)

All jokes aside, researching which specialties you prefer early on in your medical school years has its advantages. These include the pre-clinical years as much as the later, more exciting time spent in the hospital rotations.

For pre-clinicals, you will want to get a mentor who practices in the specialty you are interested in. This will allow you to be in the hospital early on, with no pressure to perform. You'd be surprised how much you will notice when you are not concerned with evaluations/patient responsibility. You also, more importantly, get to see the "collective body" of the specialists. There are definite stereotypical traits attributable to some specialties more than to others. The common example would be a more commanding or dominating personality for surgery. Does that mean you cannot be a calm, mellow surgeon? Absolutely not! But the law of life is that you will find it much harder to be the exception.

For the clinical years, there is a lot more to do. For example, if you decide to aim for dermatology, you might want to make sure you get an invitation to Stockholm for their annual ceremony, or at least put in the extra effort to beef up your application. Another example would be doing extra electives at rural sites to get experience in self-reliance for a great career in family medicine. If you like a particular program, it is usually good to get an elective there. According to CaRMS, some universities openly state they have preferential treatment for people with whom their faculty is familiar from such electives.

For a competitive specialty, you would probably want to get involved in research in a related field. The reasons are twofold. Firstly, what better way to put your foot where your mouth is when it is time to back up your claim of interest in the specialty. Some elite residency programs in the States require you to have done research, published, or even to have a Msc degree. Secondly, don't neglect the opportunity to get to know the program director of your Oh-So-Desired-Specialty if you get a summer grant in their lab/hospital clinic. Although I will elaborate on it in later post, I would caution you from molecular biology research unless you absolutely love it and know exactly what you want to do. Most likely you are going to be a practicing clinician, so stick to the clinical.

Some residencies, it turns out, are more competitive and select from an extensive pool of medical graduates for a minute number of spots. You'll immediately recognize that this early preparation for one critical point in your life vaguely reminds you something...However, your competition just received a serious upgrade from the last time you had to prove you are better than the average Joe to the medical school admissions committee.

And finally, some serious tools:

• Careers in Medicine via AAMC (usually your career advising office will email you a password)
• Medical Specialty Aptitude Test
  
• The Ultimate Guide to Choosing a Medical Specialty via Amazon
  (The best book I found on the subject, although by no means perfect. In fact, much of it is focused on US specifics, which are somewhat irrelevant for hardcore Canadians like us. Don't feel insulted if you are from outside of Canada, I did mention in the prelude to this blog that I write for and about Canadian medical school applicants/students)
  
• Your colleagues in upper years. Corner one and question them about their rotations in a given specialty. If you are extroverted enough, you could probably get away with leeching on to them for a day in the hospital. From my experience, there is much more amicability and much less cut-throat attitudes in medical school than there are in premed.