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How do you have time to explore different specialties if you want something competitive?


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Let's say you were gunning for something hyper-competitive like optho or plastics, wouldn't you have to start networking/research from day 1 of med school? Lots of people say that in med school you should take the time to explore specialty and pick what you like around third year. But, it feels like you have no chance of matching into a competitive specialty if you start that late into the race.

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I would say you're pretty correct overall, but not day 1 of med school. The issue is most hyper competitive programs require showing strong interest and research in that field (i.e. being the head of that interest group, at least 1 but hopefully more research projects/publications). I would say most people would need to have decided by second year or so that they want one of these specialties so that there's enough time to pursue these activities. Third and fourth year are so busy, I would not recommend waiting until then to start research or other activities from scratch. Of course, if you do extremely well in a clerkship rotation/elective in a hyper competitive specialty and become "well known" to people who are well-respected/involved in choosing residents, you may get in somewhere with less research/activities. I would not rely on that happening though since there are many unpredictable aspects to electives, like you may have a more junior preceptor or you may have multiple preceptors so its harder for the program to get to know you. Hope this helps!

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From what I've seen there's a lot of luck and randomness involved - people that match or don't won't look that different on paper, often has more to do with fit, and letters, rather than how much research or interest is shown, but can vary by program for sure.  I don't think gunning would hurt, and could help, but it's not as important as the impression and performance during electives (where prep can also help for sure).  

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2 hours ago, ArchEnemy said:

From what I have seen, most of my classmates gunning for the ultra-competitive specialties already knew what they were interested in by the end of MS1, so that they can conduct research in the summer after first year.

If they started early enough were they able to match, or was it more luck determined?

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On 10/18/2020 at 3:02 AM, MasterDoc said:

Let's say you were gunning for something hyper-competitive like optho or plastics, wouldn't you have to start networking/research from day 1 of med school? Lots of people say that in med school you should take the time to explore specialty and pick what you like around third year. But, it feels like you have no chance of matching into a competitive specialty if you start that late into the race.

the other thing is there are some relatively common themes in some of these more competitive specialities - in other words most people can figure out if they are for them way earlier. One big question is just surgery vs non-surgery - and if you can figure that out at least you can really reduce to the things you have to consider. If you decide surgery is possible then you want to do that networking anyway as you want to get that figured out for sure - you need to learn all you can about the field because it is a big choice to make. Plus at least initially any surgery related research/networking etc probably would help for any surgery field (some competitive programs are also skeptical of people immediately gunning for a subtype of surgery anyway - I mean why do you want plastics over any other type of surgery would be an obvious question.)

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6 hours ago, rmorelan said:

the other thing is there are some relatively common themes in some of these more competitive specialities - in other words most people can figure out if they are for them way earlier. One big question is just surgery vs non-surgery - and if you can figure that out at least you can really reduce to the things you have to consider. If you decide surgery is possible then you want to do that networking anyway as you want to get that figured out for sure - you need to learn all you can about the field because it is a big choice to make. Plus at least initially any surgery related research/networking etc probably would help for any surgery field (some competitive programs are also skeptical of people immediately gunning for a subtype of surgery anyway - I mean why do you want plastics over any other type of surgery would be an obvious question.)

I've seen people get really into (or not) a certain area whether it be neurosurg or anesthsia after rotating through it.  To me that makes sense too - one actually then has experience in the area and can better tell likes or dislikes, whereas before knowledge of the field was based on interest.  Ophtho and ortho are both surgery, but definitely somewhat different for example.  Depends a little on clerkship structure and elective availability too, I think-  too late with lack of any research or networking would make things very difficult too.

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5 hours ago, indefatigable said:

I've seen people get really into (or not) a certain area whether it be neurosurg or anesthsia after rotating through it.  To me that makes sense too - one actually then has experience in the area and can better tell likes or dislikes, whereas before knowledge of the field was based on interest.  Ophtho and ortho are both surgery, but definitely somewhat different for example.  Depends a little on clerkship structure and elective availability too, I think-  too late with lack of any research or networking would make things very difficult too.

yup that happens for sure. Nothing beats experience - and I don't think any system is going to be perfect for getting everyone that exposure ( for instance neuro surg in clerkship is an elective at many places and you simply may not get it even if you want it - which means you could miss out considering that field. Far too many subfields to do them all. You cannot do everything in clerkship). 

Hopefully there is enough early on self-reflection and opportunity to explore at least broad things early on. For instance maybe you don't know neuro surg until clerkship but ideally you would at least know if surgery of some kind is an option - there is overlap in many of the basics of those fields at least. Then you can further explore those routes and know you are considering something competitive and adjust accordingly. 

and even if you don't start "on time" at least all hope is not completely lost - I know people that went for competitive things in the end with little prep - as much as all this research and ECs are valuable the programs are aware good people can come on late. I have friends that decided out of the blue on plastics during clerkship and still go it without a lot of prep (not ideal but there is once again randomness and luck involved here). 

at the very least med students I think have to have the idea in their heads that one of the primary purposes of pre-clerkship is to try and narrow this down. There are no deadlines/tests/assignments or other external pressure to do it in most places so it is all on the student - still ultimately if med school doesn't lead to a suitable residency for you that isn't a great outcome so you have work at it. 

Edited by rmorelan
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