How to decide on specialty?

[Orchid]

I'll be starting clerkship soon... and I still dont know what specialty I want.

 

How does one go about truly trying to decide on a specialty? Interests are so varied.... anywhere from family to radiology!

 

When picking my clerkship electives, should I just try out different ones? Or do I need to know for sure what I want (so that if its competitive), I can do most of my electives in the area. Any advice would be great.

 

I'm also wondering if someone can explain the concept of CALL... I dont really fully understand it. i.e. dermatology has virtually no call as a career, therefore very well demanded... but surgery has call, therefore poor lifestyle... what is 1 call, 2 call or whatever?

 

Thanks so much!

[ploughboy]

I'm also wondering if someone can explain the concept of CALL... I dont really fully understand it. i.e. dermatology has virtually no call as a career, therefore very well demanded... but surgery has call, therefore poor lifestyle... what is 1 call, 2 call or whatever?

 

Call means you're carrying around a pager. When somebody needs you, they page you and you call back. The most common reasons to be paged are to deal with a patient issue on the wards (if you're working on an inpatient team) or to consult/admit a patient from the emergency room.

 

Since there are very very few true derm emergencies (uh...three conditions, if memory serves. Please don't ask me what they are, 'cuz I forget) it's very unusual to need to get ahold of a dermatologist *right now*.

 

By way of contrast, there are lots of surgical problems that need to be dealt with as soon as they present themselves, rather than being booked into an outpatient clinic six months hence. So surgical residents/consultants get woken up in the middle of the night a lot.

 

1 in 3 call means you're on call every third night. 1 in 4 means every four nights, etc.

[Satsuma]

To further qualify call...there is in-house call and home call. In-house you stay in the hospital all night. Home call...you can stay at home, but usually you still need to be able to get to the hospital within 15 minutes or so if called for this option. Most of your clerkship call will be in-house call.

 

There is also first and second call etc. First means...if the floor has a problem and need to page your service you are the first to be called to go assess the situation (alot of clerkship you will be first call - depending on the school I guess). If you don't know what to do...you call the next up the ladder who is your junior or senior resident covering. If they don't know how to manage it, then they will call the staff. So you can see that, as staff, in a teaching hospital, even though you are on call, you won't be called for everything, since you have students and residents getting called ahead of you.

 

Also, you will have worked all day before doing call. And you can leave the next day at noon (provided all your work is done). The exceptions are obsgyn and anesthesia who are able to leave at 8:00 am. Apparently new PAIRO rules are in the works so that all specialties can leave at 8:00 am. Which is great cause I really find the 8-noon the next day hardest. Hope that actually goes through!

 

Picking a specialty is not easy. Hopefully, you arranged your rotations so you had things you think you are interested in early so you can rule them in or out. You will know more when you actually go through your rotations. I thought I was interested in alot of things until I did them. I ended up picking emerg...and at the beginning of clerkship had no interest in emerg.

[svp2k5]

I'll be starting clerkship soon... and I still dont know what specialty I want.

 

How does one go about truly trying to decide on a specialty? Interests are so varied.... anywhere from family to radiology!

 

When picking my clerkship electives, should I just try out different ones? Or do I need to know for sure what I want (so that if its competitive), I can do most of my electives in the area. Any advice would be great.

 

I'm also wondering if someone can explain the concept of CALL... I dont really fully understand it. i.e. dermatology has virtually no call as a career, therefore very well demanded... but surgery has call, therefore poor lifestyle... what is 1 call, 2 call or whatever?

 

Thanks so much!

 

Well, clerkship is the best opportunity to decide which specialties/fields you like and which ones you dislike. I found that there were many fields I liked, but only a few I could see myself doing for the rest of my life. You are about to have the best resources available to you to make these decisions. Staff docs and Residents can give you an excellent idea of what to expect in the different fields, and I found them to be very helpful in making a decision.

 

The best advice at this point is to keep an open mind, and the rest will take care of itself.

[leviathan]

Sorry, it just had to be posted here.

 

[juicyprunes]

Hi Orchid,

 

Here are some things you can consider when trying to decide what specialty would be a good fit...They're just what has worked for me personally

 

1. Procedural or non-procedural?

2. Patient care/contact or not?

3. Lots of clinics or not?

4. Acute or chronic? or both?

5. Variety or more repetitive?

6. Continuity of care or not?

7. Research focused or not?

8. Flexibility important or not?

9. Additional training (e.g. Fellowships) necessary?

10. In hospital or community (i.e. primary care or tertiary)?

11. "Generalist" versus "Specialist" ways of knowledge

 

As someone mentioned previously, make sure you carefully observe your staff and see what their days look like and whether or not you can imagine yourself doing what they do. Don't allow yourself to be overly swayed by the actual subject (although, genuine interest in important), as interest can change over time. Also, ask every resident you speak to why they chose their specialty.

[A-Stark]

Out of curiousity, where did you end up?

 

For me:

1. Procedural with some medicine

2. Patient care/contact!

3. Some clinics are a-okay

4. Acute! Some chronic is okay too.

5. Variety, but I don't mind some repetition. Interesting cases are most welcome.

6. Some continuity is good. Short-term is okay too.

7. Research is good, especially if what you're doing might get a bit repetitive.

8. Flexibility is somewhat important.

9. More training is not really a problem.

10. I think I like hospitals. More "action-oriented".

11. Moderately specialized. I'm comfortable with sticking to an esoteric specialty for the most part... I think.

 

So, what should I be?

[ploughboy]

Out of curiousity, where did you end up?

 

For me:

1. Procedural with some medicine

2. Patient care/contact!

3. Some clinics are a-okay

4. Acute! Some chronic is okay too.

5. Variety, but I don't mind some repetition. Interesting cases are most welcome.

6. Some continuity is good. Short-term is okay too.

7. Research is good, especially if what you're doing might get a bit repetitive.

8. Flexibility is somewhat important.

9. More training is not really a problem.

10. I think I like hospitals. More "action-oriented".

11. Moderately specialized. I'm comfortable with sticking to an esoteric specialty for the most part... I think.

 

So, what should I be?

 

ENT or maternal-fetal medicine.

[a41]

Ok do me!

 

1. Mostly non-procedural

2. Patient care/contact

3. Probably Lots of clinics

4. Acute or chronic? or both

5. Variety

6. Continuity of care

7. Probably not research focused

8. Flexibility important

9. Additional training (e.g. Fellowships) necessary? Maybe

10. In hospital or community - I think either would be great

11. "Generalist"

[A-Stark]

Sounds like General Internal Medicine is for you!

[a41]

I'm definitely leaning that way or maybe FM. Obviously I'll have to see what things are like once I'm on the wards. I might just be influenced by the fact that I've had a lot of fantastic primary care experience/shadowing so far.

[A-Stark]

I have thought about ENT (not sure about Obs/Gyn), along with Gen (or possibly cardiac!) Sx. Though the latter seems to be mostly CABGs, valve replacements, and pacemakers/ICDs, along with the rare transplant and congenital stuff in kids and babies.

 

Does ENT require being impassioned by the head and neck? (except for the brain and eyes, of course... well, and the jaw, teeth, etc.) Or am I thinking about the "interest" factor too much?

 

I suppose, in the end, it's all interesting. Surgery with an interesting mix of cases, in-patients, and clinic is pretty attractive.

[leviathan]

I have thought about ENT (not sure about Obs/Gyn), along with Gen (or possibly cardiac!) Sx. Though the latter seems to be mostly CABGs, valve replacements, and pacemakers/ICDs, along with the rare transplant and congenital stuff in kids and babies.

 

Does ENT require being impassioned by the head and neck? (except for the brain and eyes, of course... well, and the jaw, teeth, etc.) Or am I thinking about the "interest" factor too much?

 

I suppose, in the end, it's all interesting. Surgery with an interesting mix of cases, in-patients, and clinic is pretty attractive.

 

I had the same kind of response as you (acute medicine for sure, but some chronic ok....i love doing procedures....i like variety....i like being more of a specialist than generalist, but i dont wanna be a subsubspecialist in anything). But to be honest, I don't even really know what ENT does? Can someone give examples of cases they would encounter and how they would treat? All I know is that head+neck anatomy was BRUTAL to learn.

[A-Stark]

I remember learning head+neck really well... in October. Cranial nerves are cool though. ENT/Otolaryngology is the surgical specialty for most issues apart from the brain, eyes, and the type of things that oral surgeons do. It's also the medical specialty for those regions (e.g. ears, sinuses). Surgical procedures involve skull base surgery, head and neck oncology, some reconstructive and cosmetic facial stuff, otology, laryngeal stuff, etc.

 

If I have any misgivings, it's that I remember being somewhat... disturbed by the pictures presented at one of our case reviews in the fall. However, that might have just been an initial thing, as pictures seem somehow worse than seeing things in person. If I can watch a sternotomy without blinking, I'm not too worried.

[Satsuma]

Bread and butter for ENT includes myringotomy and ear tubes, tonsillectomies, adenoidectomy, lots of ear wax removal, lots of allergies, sinus issues. There are some interesting things you can do if you subspecialize...like say cochlear implants, but how many of them would you do in a year and how interesting would they be after awhile? (I dunno...depends on the person I guess).

 

ENT is a neat specialty as far as surgical specialties go. And has the advantage that there is no medical counterpart, so you can do both the medical and surgical. Decent lifestyle as well. While the surgeries are theoretically interesting, the ones I sat in on were often tedious...you are constantly checking nerves to make sure you haven't damaged them etc, often requiring a microscope during surgery. So you have to be able to tolerate that. OR politics is something you will have to deal with. So maybe harder to get OR time starting out depending on where you are. And also, it seemed that ENT is near the bottom of the pecking order when it comes to OR time and they often seemed to get the surgeries cancelled by ortho and other specialties that have more emergencies.

 

ENT can have a tremendous impact on a person's life...since they deal with speech, hearing and swallowing issues - pretty significant things to your day to day life.

[Diabetes dude]

I had the same kind of response as you (acute medicine for sure, but some chronic ok....i love doing procedures....i like variety....i like being more of a specialist than generalist, but i dont wanna be a subsubspecialist in anything). But to be honest, I don't even really know what ENT does? Can someone give examples of cases they would encounter and how they would treat? All I know is that head+neck anatomy was BRUTAL to learn.

 

There are tons of conditions which ENTs treat but some are considered more 'bread and butter' cases (chronic sinusitis, hearing loss of different causes, thyroid problems). Some of the examples ENT procedures or conditions I can think of are:

 

Nose/sinuses: chronic sinusitis and rhinitis (most common), allergies, nasal polyps/obstruction, septal hemangioma, epistaxis

 

Otology/neurotology: hearing loss, tinnitis, vertigo, otitis media/externa, cochlear implants, acoustic schwannoma, cholesteatoma, skull-base tumors, perforated tympanic membrane

 

Oropharyngolaryngeal: tonsilitis, vocal cord problems/voice changes, pharyngitis, epiglottitis, oral abscess, cysts/tumors

 

H&N oncology and surgery: thyroid cancer, goiter, parathyroid adenoma, salivary gland tumors, oral cancer, laryngeal cancer, lymphoma (referral only), a bunch of benign neck masses (hemangioma, lymphangioma, lipoma, various cysts)

 

Facial plastics/reconstruction: cleft lip/palate, cosmetic facial surgeries & procedures

 

Others: tracheotomy, cricothyroidotomy

[Franky83]

To the OP,

I wouldn't fret the fact that you don't know what specialties you're interested in. That's what Clerkship is for!

 

As others have said, keep an open mind during your rotations and ask yourself those eleven questions every once in a while (your answers may change as clerkship goes on!)

 

Also, try to get as much exposure to the various aspects of each specialty. Eg: clinics, ORs, being on call, managing the ward, CTU/Team medicine etc. This will help you with the question "Could I see myself doing that every single day" The greater your understanding of what the specialty encompasses, the more informed your decision will be.

 

Come spring of your 3rd year, you will hopefully have an idea of 1 or 2 specialties that you're interested in and can get your electives set-up accordingly!