feature article

Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.
Doctors-in-training have heard this question thousands of times, beginning the moment they announced their intentions to pursue a career as a physician: The question, of course, is some variant of “What kind of doctor do you want to be?” Before I interviewed for medical school, I was told to answer noncommittally; it was suggested that, if I already knew what kind of doctor I planned to become, it would imply the clinical years weren’t important to me. I was told to leave it open-ended so as not to rule any specialty out too early. I see the value in that—looking back, how could I have possibly had a good idea, given my limited clinical exposure before medical school? Even for students that do have clinical experience, it’s easy to imagine they could change their minds and, regardless, should be open to learning from the clinical years. Similarly, we were told not to answer too definitively during third year either—the idea being that if we tell an attending what we want to do, and it isn’t the specialty we are currently working with, we will be permanently alienating ourselves from that profession.

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