Year 3: Choosing a Specialty
Career Exploration and Preliminary Decision Making
Medical students explore many specialties during their clerkships. During each rotation, pay attention to what interests you: "Do you enjoy continuity of care, certain procedures, certain types of illnesses, seeing immediate results, having long term relationships with patients, figuring out diagnostic puzzles, caring for people in the context of their community, addressing issues of mental well-being, prevention, working with the underserved, working with children, etc."
Continue to re-evaluate your interests as you
go through each clerkship and get more data. Don't be afraid to
change your mind. Many students alter their earlier specialty choices during their 3rd year.
Note: At UWSOM, 32.8% of 4th year medical students
who entered in
2005 matched in the top specialty career choice they had chose when they
started
medical school.
Study for USMLE Step 2:
The United States Medical Licensing Exam (USMLE) Step 2 assesses your medical knowledge, skills, and
understanding of clinical sciences. Review the UWSOM students study recommendations for this exam. You can find more information about how to register in this section: "USMLE and Your Medical School Training".
Helpful advice as you consider specialties:
Stay realistic
Assess your strengths, your Step I scores, and your clerkship grades. Match them against successful applicants in your desired specialty. You can find this information in Charting Outcomes of the Match and the NRMP survey of residency directors.
Assess your Competitiveness
Ask our Career Advisor, and the Departmental Counselor in your identified specialty to give you an honest appraisal of your chances. Every year across the country there are students who don't match because of a disconnect between their academic records and their career choice. Don't be one of them.
Before deciding on your fourth year schedule:
- Check the departmental career advising FAQ list to see what each specialty recommends in terms of electives.
- Talk to the departmental career counselor in your area of interest to get additional information on how you can be successful in the match.
- Allow time off for interviews. Most occur between November and January. Plan accordingly because it can be difficult to take time off during required rotations.
- Many students take 4 to 8 weeks off during interview season and/or take an elective to leave time to travel.
Think ahead about letters of recommendation
On clerkships in which you have done well or that you have already identified as your specialty choice, stay in touch with the physicians who knew your work best. Ask them to write you a letter of recommendation while the clerkship experience is still fresh in their mind. Some faculty offer to write you a letter after you complete the clerkship. This is a good time to say yes!
What if I am undecided at the end of my 3rd year?
- Schedule an appointment to meet with our career advisor. It's helpful to discuss this process as it can be stressful. Your college mentors are also available to provide guidance and support.
- Use FRIEDA Online which is a database of over 8700 accredited graduate programs. It includes Physician Workforce information as reported by residents and practicing physicians in every specialty.
- Write a personal statement for each specialty you are considering. See if one flows more easily and you feel more engaged in the process of writing it. This might offer you a clue about where your deeper interest lies.
- Remind yourself that you can apply to programs in two different specialties which will give you until rank day to decide which one is your first choice. Be aware that this path may increase the number of interviews that you will have to do in your 4th year (unless you clarify your decision before interviews begin) and will increase the expense as you apply to more programs.
- Use the tools under Exploring Options, Choosing a Specialty, and Getting into Residency on the AAMC's Careers in Medicine website. Complete their Specialty Indecision Scale if you are struggling with your options.
Sub Internship:
Advantages of Sub Internships:
In general, Sub I's are a good way to show residencies that you can handle more independent medical decision-making. They can be particularly significant for those who have not gotten Honors in their relevant
clerkship. Talk to your departmental advisor about how important they are in your specialty of choice.
These rotations are unofficially called "audition electives"
so choose to do one in a residency where you have a reasonable chance of matching. You aren't maximizing the advantages of a this opportunity if you
choose the most competitive residency in the country and you don't have
the academic record to be considered a residency candidate. In competitive specialties, you
might talk to your UW classmates and consider signing up for different
Sub I's from one another, as that might increase your chances of
matching.
Remember, you can make a negative impression as well as a positive one in a Sub I.
At all Sub I's, work hard, be congenial and friendly, be a great team
member, be positive, treat everyone from physicians to the janitorial
staff with respect, and show initiative. Residents are looking for
future colleagues and practice partners, and they usually have
considerable influence on the rank list. It's essential to demonstrate
that you are a great team player.
Should I do a Sub I at UW?
Competitive specialties will often expect you to do a Sub I at your home institution, no matter what grade you received in your clerkship. Talk to your departmental advisor to see what they advise given your Step 1 scores, your grades and specialty-specific expectations. You can also review the
UWSOM's departmental career advisor FAQ list to find out what is generally recommended in terms of Sub I's for each discipline.
Should I do an away Sub I?
Again, please consult with your departmental advisor as you make this decision. There are pros and cons to all Sub I's, although in highly competitive programs, there is often the expectation that you will do an away Sub I in addition to one at UW. Advantages include meeting faculty and residents in a residency that you are interested in matching at, learning about the program firsthand, and making yourself known to the program. Talk to departmental career counselors for advice on good Sub I's outside the UW system. Remember to request that your most important elective/Sub I is scheduled early, in the summer through the fall. While your grade may not make it into the Dean's letter, you will be able to update your ERAS application with your subsequent grades and you will expand the list of physicians from whom you can request a letter of recommendation.
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