Tuesday, March 4, 2008

Picking a Life 1

The Lone Coyote recently focused a couple posts on the thought process she underwent towards deciding on a residency. The interesting aspect of the entire post, beyond the rather frightening nature of entering 4th year unsure of where you want to go, dwells around the central, if not clandestine, topic of exposure.

Stated simply, there is just not enough exposure to the many different fields of medicine in the 3rd year of medical school for students to be able to make clear and complete decisions regarding a job. As it is currently, most schools require students to rotate through some form of Peds, OB/GYN, Gen Surg, Family and/or Internal Medicine, and Psych/ Neuro. You may get exposed to a few “subspecialties” – like a Peds ER or anesthesia during surgery in order to increase your experience, but these are often quite limited. The fallacious idea that I've picked up on is that the students get enough exposure to be able to come to a well determined and thoroughly researched conclusion regarding residency choices.

Absolutely incorrect. These "electives" are often only a week to two at a time, frequently limited by the number of students, clerkship schedules, and regularly are not great experiences.

As an example, during Gen Surg I wanted to take the 2 week anesthesia elective offered. Other students wanted to as well - because they thought it was a cake walk and they'd get to slack for a couple weeks. Because their schedules were more accomodating than mine I received one week. One lousy week with a new batch of SRNAs who wouldn't let you do much because they needed all the exposure and I often sat watching them do everything, confused as hell (we don't have a residency which might have made it better). I could have easily walked away with a bad taste and went straight into surgery.

With similar experiences a number of students will make up their minds during or late in the 3rd year. It's an extraordinarily bad idea, but is often a go-to for many as a means of determining where they fit. Of course, it's not hard to understand that a rotation and the joy received vary greatly based on location, personnel, and other factors that the student may not recognize at the time. However the student applies, schedules rotations in this area, and may feel trapped when they realize that it wasn't quite what they wanted and undergo matching anyway.

I will discuss this more in the next post, but I feel this is a topic that's not addressed nearly enough. There are many stories of people changing fields many times, reentering residency after a few years, or forgoing entering the match because they haven't found "the one". It is, I feel, another way that medical education fails those it's meant to help, to educate.


Bostonian in NY said...

"It is, I feel, another way that medical education fails those it's meant to help, to educate."

Dead on. We waste hundreds of thousands of dollars to sit around and watch, to stoke some egos, to read books in our free time to make sure that we kind of know what's going on before we are made examples of in front of our team, to perform superfluous tasks at God-awful hours of the morning, and ultimately to figure out everything on our own anyway.

I'm looking into EM and my venerable institution of learning doesn't even have a useful EM adviser in our entire 6+ hospital education system. Fortunately, I found this out early on enough in the game so as not to be trapped as a fourth year searching for LOR's in EM and unable to find any.

M said...

I recently attended a lecture regarding this very same topic. Lack of exposure, leading to poorly informed decisions, culminating in a lot of "wasted time" and expletives on the student's part.

Funnily enough, the advice was rather mundane. "Do your own research," and "Read these books when the time is right," was the take home topic Statistics were something at the 20% mark for residents switching specialities and 16% for practicing physicians.

Limited exposure underpins the entire problem but in many aspects, it's unavoidable. Time is always the enemy.

Old MD Girl said...

And to think my PhD program expects me to decide my field as well as a research topic by the end of my rotations. Silly silly!

Liz said...

Hey msg... i have an unrelated question for you. I will email you. Thanks for the great posts lately!

The Lone Coyote said...

Thanks for the links. I agree completely. So much of what we go through is more of a hazing ritual than meaningful learning about what a given specialty is really like. If your school does not have good mentors, or you do not know how to seek them out, you can miss out on a great specialty completely.

I know my school has been working to improve this and I hope they do. There will never be enough time to fully explore everything, but even having access to shadowing in specialties that are not part of the core 3rd year could help. The people who I saw struggle the most with the decision, myself included, were those who did not fall in love with one of the 3rd year core rotations.

T. said...

Anesthesia was my LAST required rotation in med school. The LAST one. I was in my fourth year ranking peds programs. When I went to my dean and said I had fallen in love with a specialty I previously knew nothing about, she wanted to pull some hair out - mine, hers, both probably.

I guess the cheerful piece of unsolicited advice I have to offer is, hokey as this sounds, if you get a strong gut feeling you belong somewhere, listen to it and don't let little details like a huge life-upheaval or a tough residency stand in your way! :)

MSG said...


Wow! I've heard of people who took a rotation after already interviewed and ranked programs and I've always been in awe of the commitment involved to go through that process.