An Insider's Guide to Selecting Your Medical Specialty

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6 min read

Insider Medical Admissions

The following piece was written by Dr. Michelle Finkel. Michelle has been featured in our Admissions Expert series and is a former Harvard Medical School faculty member. She is the founder of Insider Medical Admissions.

Getting into medical school is the first step in a long, satisfying, and challenging medical career. Those readers interested in application tips, including letters of recommendation, personal statements, and interview help, should check out my previous Varsity Tutors blog entries for professional advice. Today, I’m going to look forward to your career in medical school and discuss how to overcome the “medical school paradox.” Please see last month’s entry for an introduction to this topic.

Briefly, readers of prior entries will recall that the “medical school paradox” is the fact that demonstrating commitment to your chosen field is critical, according to the National Resident Matching Program (NRMP®) Program Director Survey, and yet, we’re told early in medical school to explore all specialties. The advice to be broad-minded is philosophically excellent, but the NRMP® Program Director Survey shows that being focused is strategically important: Sixty-three percent of (residency director) respondents said perceived commitment to their field was a factor in selecting which applicants they interviewed. As we covered last month, that’s more than honors in clinical clerkships (62%), evidence of professionalism and ethics (55%), and honors in basic sciences (45%)—all of which one might think would be more important to residency directors.

So we can see that demonstrating commitment to your chosen field is critical, but it’s hard to show early, strong commitment when you’re told to explore all specialties during medical school. For better or worse, demonstrating dedication to your future chosen specialty matters, and the earlier you begin, the more accomplishments and activities you will have under your belt to bolster that commitment.

Of course, if you know early in your medical school career that you want to pursue a field, getting started as soon as possible with research, publications, volunteer work, and a faculty advisor is wise. But what if you are a late-bloomer? How can you show commitment to a field when you may not know what you want to do? More important still, how do you avoid the "gunner" mentality that might undermine your process of self-discovery?

There are several easy, efficient ways to show commitment to contender specialties. At the macro level, join the specialty’s national organization if they allow student members (sometimes available at steeply discounted rates) and attend a national convention if feasible. At the micro level, join your school’s interest group in the field. No group? Establish one, and make yourself known as you develop relationships with faculty mentors. Big interest group already in existence? Volunteer to organize a regional event of your creation for the group that affords you the opportunity to become known to faculty mentors. If you have several possible specialty interests, it takes minimal effort to belong to several national organizations or school interest groups. These are ways to show commitment early without necessarily spending a lot of time, and you’ll be able to say you were a member of the pediatrics interest group for three years, by the time you complete your application the summer before your fourth year. 

Another way to show commitment is to seek “golden egg” activities. Start with one project, and use it as a building block to be developed further into several projects that you can use to demonstrate commitment to multiple specialties. For example, let’s say you give a short talk during your first core rotation—surgery—at the beginning of your third year. You choose “appendicitis” as your topic. Now, when you get to your ob/gyn rotation, you need to give a talk as well. Why not choose appendicitis in pregnancy, as you’ll have already done some of the work? And now that you have some background, you may decide to write an online article on the topic, or you may ask a faculty member who is doing research on current diagnostic modalities for appendicitis if you can get involved in her state-of-the-art review article. The point is that you have used one accomplishment, expanding on it and developing an expertise and a trail of commitment. But commitment to what? Well, that’s the beauty of something like this. In this example, if you decide to apply to surgery, obstetrics and gynecology, family practice, or emergency medicine, you have demonstrated early commitment to your field. Golden egg activities are strategic and afford you expertise. And depending on the activity, they can be especially helpful for someone who is not sure to what field s/he will be applying.

Finally, a simple way to show commitment is to make sure you track your relevant experiences. I’m always surprised by how many students, when they’re ready to apply, have forgotten what accomplishments they’ve had during their first three years of medical school. Ensure that you keep a running tab of everything you’ve done. If it turns out that the activity is not helpful, no problem—you don’t need to include it on your application. But it’s better to have too much on your list than too little.

Along the lines of keeping track of your accomplishments, the more forward-thinking medical student might try keeping track of not just general accomplishments, but categories of accomplishments that could someday demonstrate commitment to a future specialty. Next time you sign in online, create a cloud-based spreadsheet with headings for clinical experience, research experience, leadership positions, awards and honors, and society memberships. As you proceed through your medical school journey, make note of which categories are bursting at the seams and which ones are poorly represented. This is your chance to recognize and address your weaknesses while you still have an opportunity to correct what may be perceived as deficiencies in an otherwise strong application. Weight the categories appropriately, as well: It's great that you were president of the neurosurgery interest group, but if you never set foot in the operating room during a neurosurgical case, you'd have a tough time explaining to a residency director that you know what it means to pursue a career as a brain surgeon.

Not everyone enters medical school knowing what specialty s/he wants to pursue. The savvy applicant need not fret each time she sees the classmate who knew from age seven she wanted to specialize in left nostril surgery. Exploring a variety of options is important and healthy. Choosing a specialty is like committing to a marriage—you want to ensure you make a wise decision that endures for the lifetime of your career. You can overcome the medical school paradox by using simple techniques, so that you pursue intellectual rigor while not shooting yourself in the foot when application time rolls around. 

The views expressed in this article do not necessarily represent the views of Varsity Tutors.