Having just officially entered the residency application cycle at the time this piece is being written I thought I would reflect on my decision-making process during my clinical years of medical school.
I feel I adopted a somewhat backward approach in selecting the field into which I am now applying. Rather than thinking about what specialty most interested me and then considering pathways within that, I worked back from potential fellowships of interest and then contemplated the best pathway to constructing the type of career I ultimately wanted. Coming into third-year my broad interests were hematology/oncology and infectious disease. From this basis, I determined that the two roads I could walk in terms of these topics were internal medicine and pathology. I next determined that making a decision between these two would likely require exposure to Infectious Disease, Hematopathology, Solid Tumor Oncology, Molecular Pathology, and Microbiology ideally by the time application season began. With the unexpected assistance of COVID, an accommodating elective scheduling during 3rd year, and a proactive approach to 4th year, I have largely achieved this goal with the exception of hematopathology, though I got reasonable experience in even this during my general anatomic and clinical pathology elective. Adding to this direct experience in my various fields of interest was a determination of where my approach to issues would be better suited. Ultimately I found this to be pathology as the lessons I gained at the bedside drove my curiosity about underlying mechanisms and future directions. Having these contributions further recognized by ASCP with the medical student award further pointed me in the direction where I felt I would be most suited. Furthermore, working in liminal fields I was able to gain insights from experienced IM doctors about pathology and pathology attending physicians about IM and where they felt I was better suited after working with me. One thing you will note is that excluding IM, my core rotations did not play a huge role in shifting my career trajectory excepting perhaps by giving me the opportunity to more closely engage with pathology in surgery and ob/gyn which perhaps makes my approach, not the most generalizable.
While my precise approach may not work for everyone I think there are a few lessons from it which will. Firstly, if you have a strong idea of what you want don’t be afraid to embrace it. While my early rotations were challenging for a number of reasons, one was certainly a fear to share my interests less it be taken as disinterest in the field I was currently rotating in. When I became more open about my likely entry into pathology I not only found a deeper pool of confidence which positively impacted all my work but also found many of my preceptors giving opportunities to learn how pathology was relevant to the rotation and contribute. The second is asking preceptors for their impression of where I seem well suited. Attending physicians have worked inter-professionally for decades and have a strong sense of the types of skills and personalities various specialties call for. Lastly, use your elective time effectively. Nothing helps determine fit better than actually seeing and hopefully doing the work up close and having those who have been doing it far longer give you feedback.