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MarsRover

How did you settle on which specialty to do electives in

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I am only an ms2 so time to figure this all out, but I was looking for advice on how you settled on which specialty to pursue.

My issue is that I like plastics because the reconstructive aspect offers a lot of challenge in picking which procedures to use and changing them based on the needs of the reconstruction which will often be much different. Urology is a great mix of medicine and surgery. Neuro is in my opinion one of the most challenging and cool medical specialties in figuring out and reasoning a diagnosis. 

Our school does longitudinal integrated clerkship, so I won't really have a surgery unit per say. Also I wouldn't really get exposure to those two surgical fields really anyway. Plus given when we have to pick electives, and the competitiveness of uro and plastics especially - do you on some level just sort of have to roll the dice and go with it? I have shadowed, but I don't find that particularly helpful yet anyway. Anyway just looking for advice. 

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I think it's difficult to judge the content of a particular medical specialty without direct experience in it.

What you can do however, is consider the broader factors that may influence your decision.

For example, inpatient vs outpatient, medicine vs surgery, call vs no call, rural vs urban, adult vs pediatric, more or less team oriented, other aspects of the patient population you like/dislike, patient continuity vs none, hours worked per week, having control over your schedule or not, what you find most interesting/fulfilling, more or less procedural, are you ok standing for long periods of time in the same spot, etc.

Really try to flesh out those lifestyle factors that are important to you and consider how well they would line up with various specialties you are currently considering.

Beyond that, yeah you kind of have to pick something and go for it. 

If it works--go on, if you end up not liking it, now you know and have a better idea of what you do want to pursue.

It's ok to not have it 100% figured out and people change their minds all the time.

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Agree with freewheeler, also add to that whether or not you need to have good outcomes or are you okay with average or poor ones, whether or not you like to work with your hands, how intense do you like your day to be etc.. 

Lifestyle is important, for this you should ask residents, distinguish between residency and staff lifestyles as well as practice locations. If you are someone who wants to live in a specific city, you will find that is a lot harder in specialties like plastics or uro. Look up different staff (especially younger) you have worked with online, see what they have done to get to where they are. Realistically, you will have to take a similar path. 

If you have any early clerkship electives use them to determine what you want, you really won't know unless you do an elective. Even then sometimes its not clear, but it helps clarify a lot. If you don't, then it is a bit tougher, you have to rely more on shadowing and then just pick. Uro and plastics do have some overlap, but look into different aspects of each specialty and see what you like, renal transplant is different from fertility urologists and reconstructive surgery is different from burns and cosmetics etc. 

 

 

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On 10/12/2017 at 3:43 PM, MarsRover said:

I am only an ms2 so time to figure this all out, but I was looking for advice on how you settled on which specialty to pursue.

My issue is that I like plastics because the reconstructive aspect offers a lot of challenge in picking which procedures to use and changing them based on the needs of the reconstruction which will often be much different. Urology is a great mix of medicine and surgery. Neuro is in my opinion one of the most challenging and cool medical specialties in figuring out and reasoning a diagnosis. 

Our school does longitudinal integrated clerkship, so I won't really have a surgery unit per say. Also I wouldn't really get exposure to those two surgical fields really anyway. Plus given when we have to pick electives, and the competitiveness of uro and plastics especially - do you on some level just sort of have to roll the dice and go with it? I have shadowed, but I don't find that particularly helpful yet anyway. Anyway just looking for advice. 

Did you shadow in these areas and ask these questions of the staff while you were there? The thing about doing a clerkship elective is that you are still seeing only a subset of a specialty, performed in one unit at one time in one particular location (usually an academic teaching hospital).

Talking to people is necessary to get a broader sense of the field as a whole, as well as the finer points distinguishing one field from another. What is essential for you to be satisfied in your career - e.g. using your hands, being in the OR? What would bother you (e.g. poor outcomes, chronic conditions), but not necessarily bother the people in that field?

Basically, I spent a lot of time researching and reading around different specialties as I entered medical school (there is a wealth of resources both in print and online), and matched those with what was important to me in a career to form a short-list of fields to explore. In preclerkship, I shadowed in order to confirm/disconfirm my initial thoughts about suitability of each field. This helped me plan out my elective strategy in clerkship.

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I think another big question is whether you like the bread and butter of a specialty. It’s easy to get out of bed at 2 am to see some super cool zebra once. It’s another thing entirely to get out of bed at 2 am multiple times per week for whatever that specialty’s bread and butter is. 

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Family medicine was a no brainer for me. I like having generalist knowledge rather than specialist knowledge; knowing across a broad spectrum of medicine is much more important to me. I like the versatility and variety of family medicine; I can do ER work, palliative, obstetrics, addictions medicine, sports medicine, etc. I like being able to work as little or as much as I want. I like having a good balance of lifestyle and income. I like talking to people and talking to other healthcare professionals.

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Agree with all the advice from above.

This book is also useful. It's American so some stuff is out of context, but the gist of each specialty and what the day to day life involves is here.

https://www.tesd.net/cms/lib/PA01001259/Centricity/Domain/344/Careers in Medicine.pdf

I think the thing people forget too is that your experience as a resident or med student is far from staff life. For the most part, internists and pediatricians rarely do CTU and spend most of their time in outpatient clinics and in the community, which we get very little exposure to at most programs. Surgeons only operate 1-2 days a week and spend the rest of the time doing clinic or administrative duty. Understanding the full scope of practice and what the daily life is about is a big component of decision making!

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