About halfway through the internal medicine residency, there comes a time when a resident must decide on what he or she plans to do after three years of training. We may come across a second-year resident saying: What should I do next? Should I become a hospitalist or plan for a fellowship? But in what? Cardiology and gastroenterology are fascinating careers, but is my resume ready for a competitive match? I also like pulmonology and critical care, but what if I don’t get into it? Hematology/oncology is a lucrative specialty, but rheumatology also carries a good work-life balance. Should there be any backup plan?
In every residency year, there’s a group of residents who know exactly what they are planning to do after completing the three years of internal medicine training. Their resume shows a deep interest in the field of choice, their personal statement is ready to impress the interviewers, and they are well-prepared for the successful interview season. On the other hand, there’s a group of residents not able to determine the post-residency plan.
Having gone through the experience of fellowship interviews recently, I now understand the dilemma of a candidate who is not sure about the career path after the residency training. Such a resident often ends up applying in multiple specialties in one match cycle. On the day of the match, while everyone else is waiting to hear whether they matched or not and where they’ll be getting further training, this resident also awaits to know which specialty s/he is entering. I hear people saying that they’re capable of liking any specialty, but can you like, for example, nephrology when you always wanted to do critical care? You interviewed for nephrology just because you did not want to stay unmatched.
For a resident unsure about the choice of specialty, what a senior could suggest is to analyze each block at the end of the month and think if you can practice that specialty at least for the next ten years or so of your life.
Another exercise that can be done is called the “imagining” exercise. For this, sit quietly in your room with your eyes closed and electronics switched off. Imagine yourself waking up on the most comfortable bed, living in a beautiful home, having a supportive family, and stable finances. After having all of this, you still want to get out of the bed and drive to the hospital every morning. If you are planning to join critical care, imagine yourself working with the sickest of patients, running codes and working non-stop in the critical care unit. If you are thinking to wake up as a hematologist/oncologist, imagine yourself driving to the clinic each day to see patients who just received a new diagnosis of cancer or are at the terminal stage of their disease. You are seeing cancer patients, performing bone marrow biopsies, dealing with benign hematology cases and taking part in the inpatient consultations as well. The same imagining technique goes for rheumatology, endocrinology, nephrology, cardiology, gastroenterology and hospital medicine.
The idea behind this exercise is to imagine yourself waking up and practicing in the field where you’re thinking of applying for the fellowship. Whatever your choice, if the thought of this field makes you feel like getting up each morning and practicing it with passion and happiness, it’s conveying the message that this is what you should be choosing. The second question is how much do you want it? Can you wait for another year, do a chief-year and reapply again next year in case if you don’t match? Or are you planning to change your choice of specialty?
Applying in multiple specialties for fellowship simultaneously may not be wrong, but not choosing a specialty just because you think it is too competitive to get into or you are not sure about it should not be the main purpose of your fellowship application.
Junior residents should be encouraged not only to learn and practice clinical skills in each block but also to analyze the specialty closely and imagine themselves practicing it for the next several years. This exercise can make the process of career decision making easier during the residency.
Abeer Arain is an internal medicine resident.
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