“Please inform us of your intended specialty for your 4th year scheduling,” requested our administration in an email sent to students 2.5 years into medical school. Up until that instant, not knowing my future specialty was accepted and actually encouraged. Yet in one moment, that all changed.
Medical education prides itself in giving students the most grueling and holistic experience that covers medicine’s depths from basic molecular sciences to pathological diseases in every specialty. The system is set up to learn a little about everything and figure out which microcosm we want to expand upon when selecting our specialty. There is “free time” intermixed into the medical school years whereby we can put off our pending lectures for the day and take the morning to shadow a specialty of our choosing. With these peripheral, short experiences sprinkled through the first and second year, we are encouraged to gain a glimpse of what we would like to be when we grow up.
Traditionally, the third year is supposed to be the year that medical students figure everything out. We are immersed in weeks-long clinical clerkships with specialties ranging from pediatrics and internal medicine to general surgery and obstetrics and gynecology. In clerkships, we rotate from service to service, trying to take in everything the specialty has to offer. The experiences however, are dependent on multiple factors, including the team, the service, the immersion, and the responsibility. In this imperfect ecosystem, we are required to perform our duties for a satisfactory evaluation and determine if this is the specialty for us. While this method has been the norm for years, with the looming changes to medical education, namely Step 1 becoming pass/fail and curriculums also opting for Ps and Fs, maybe it is time to rewrite how medical students are expected to find their future careers.
Due to the transition to pass/fail designation for Step 1, residency programs are looking to implement more holistic student applications reviews. If there are no number grades, nor Step 1 scores to differentiate between students, what becomes the new metric that program directors use to rank their applicants? Will it be extracurriculars, shadowing, or volunteering? More likely than not, the new metric will be the most feared and time-consuming of them all: research. The problem with picking a specialty in the third year of medical school is that there is very little time to engage in meaningful research and network with attendings to show interest in the field. It is becoming increasingly stressful and grueling to put together a strong application while also performing clinical duties. Hence, more and more applicants opt for research and gap years to fill in any holes in their application. While this is the case for competitive specialties now, if Step 1 is de-emphasized, students applying to less competitive specialties will also need to strengthen their applications if they want to attend top-tier programs.
Ultimately, the adage that the perfect specialty naturally meets every student is not the case. Most students pick specialties based on convenience and where they would be stronger applicants, especially if they are forced to decide late. The longer we wait to decide our futures, the fewer options we have available. This is especially the case for many students who are burdened by increasing student loans.
So, what is the solution? Medical schools and medical education need to come to terms with the idea that helping aspiring physicians find their future specialties is just as important as imparting medical knowledge. Students cannot be left alone to find their own path in an environment that requires so much in such little time. There should be lecture series by attendings from various specialties that highlight the relevant medicine and the scope of practice, life after residency, and prospective earnings. There should be opportunities for mentorship and early exposure to clinical practice or alternative forms of immersion.
COVID-19 is making it harder for 1st and 2nd-year medical students to be in the clinical setting, and so podcasts or various forms of social media could be used to highlight a “day in the life” of various specialties. Many medical schools are also making more drastic curriculum changes that allow students to complete classroom learning by year one and embark on clinical rotations in their second year. This leaves the third year to build a strong resume and hone in on one’s preferred specialty. The earlier students find their passion, the sooner they can form mentorships, meet faculty, and embark on meaningful research projects. Explicitly conveying to students the importance of engaging specialties early and often can really propel them to establish their future careers and spearhead their search for their ultimate profession.
Viraj Shah is a medical student.
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