When do you reasonably know your calling?

[fantasty]

If you are shopping around between several subspecialties, when do you ultimate decide the path that is right for you? I understand the sequence of events of applying to fellowships. But, I'm curious about when IM docs made their decisions about the fields that they went into.

I personally won't have much elective time during M4 year to take medicine electives that would give me some exposure to the fields I'm interested in (for example, ID consults, rheum, geriatrics, allergy/immuno, etc). And, I've looked at some residency programs to see how their rotation schedules. Some programs seem to push some subspecialty time to the 2nd and 3rd years, which seems like it would make getting the appropriate clinical exposure difficult before fellowship applications.

I'm not really needing advice on my specific situation (since I'm sure most students would have some flexibiity to either take an elective while in school or ensure the needed residency rotations early enough). But, I'm curious when people on the forum "knew" what they wanted to do (within medicine). Did you know during M4? Did sub-I or electives point you in the direction? Or was it during R1 (or later)? Did you go through each subspeciality with an open mind and systematically rule out the alternatives?

Anyway - best wishes

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[kungfufishing]

I probably knew on about shift 3 of my first EM rotation, but I think it is sort of a "love it or hate it" specialty. However, seems like many feel their specialty is such. Yet another good reason to take a wide variety of electives is that you never know when you will find something you react really positively towards.

 

[AJM]

I think I knew somewhere late my intern year or early 2nd year. I had it narrowed down by the time I had decided on IM as a med student - I was deciding between cards, gi, and pulmonary, although even then I was strongly leaning towards pulm.

My program was great in that they let us do a couple of subspecialty electives during the intern year-- mine were GI and ID (i didn't get to do pulm until the beginning of 2nd year). Other required subspecialty inpatient months I had that year were heme/onc, CCU, ICU, and hepatology, so I got a decent exposure to many of the fields I was considering. I was able to rule out GI after doing my 3-week elective in it early in the year. Then I did the CCU/inpatient cardiology service -- liked the rotation, but I softly ruled out cards after doing that month, although I kept the option open in case I decided I didn't like pulmonary. I then did ICU and pulmonary consults almost back-to-back (ICU at end of internship and pulm elective in the beginning of 2nd year). Luckily I really liked both of them, and solidified my subspecialty decision by August of 2nd year.

I think it helps to have narrowed down your list of potential subspecialties somewhat before you start residency, however you should still approach the subspecialties with an open mind. I know many people who changed their minds during residency. On the other hand, if you go in wanting to try out all the subspecialties, you won't make your decision until the end of your last year, especially since most of your elective time isn't until 3rd year. There's nothing wrong with deciding late, though -- lots of people do wait to decide, and they will take 1-2 years off before fellowship to work and make money.