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Lost and Found in Medical Training

Many people told me that my third year of medical school would be both the most rewarding and the most difficult. That I would choose my future specialty and discover my specific path in medicine — a task which, as I began the year, seemed both exciting and daunting. Little did I know that during my third year of medical school, I would learn just as much about myself as I would about patient care and the practice of medicine. As I progressed through each clerkship and specialty, I tried on a different hat, wondering … does this one fit? I have reimagined my future a hundred different ways and molded a new understanding of my strengths, weaknesses and aspirations. Along the way, I received advice from preceptors, mentors and peers which I have gathered like small pieces of treasure, hoping they will collectively guide me toward the right specialty.

During my internal medicine rotation, I saw complex patients and participated in the management of chronic illness. When discussing my interests, my preceptor asked, “Do you like your problems solvable or not solvable?” He then explained that surgeons have the satisfaction of seeing a patient with a fixable problem like a bad hip, appendicitis or a breast mass and being able to intervene quickly. The surgeon’s focus in everyday practice, he told me, is more on technique and skill in the operating room rather than diagnostic and therapeutic nuance. Internists and family medicine physicians manage patients with multiple medical conditions like diabetes and COPD, as well as complicated disease courses. They must enjoy working on problems for which there may not be a clear fix. 

My surgery rotation was the most exciting and exhausting two months of the year. I was fascinated by the pathologies I saw in the operating room and was eager to assist. I was consistently amazed by what the surgeons were able to accomplish in a short amount of time with a procedure. On day one, my attending explained that in medicine, “You are either a thinker or a doer.” Recognizing my enthusiasm right away, he watched me practice my suturing skills, retract and strain over the operative field to visualize the anatomy. By the end of my surgery rotation, he announced, “I can tell: you are a doer.”

When I began my emergency medicine rotation, I asked a resident what it was like to work in the emergency department. He said, “You have to figure out if you like to see your patients first in the EMR at your desk with a cup of tea in your hands or if you like to meet them in the moment and think on your feet.” I found this to be true in comparing emergency medicine and inpatient medicine on the wards, but I later found that family medicine in an outpatient clinic also required quick thinking. I loved evaluating and counseling patients in a clinic that, though busy, afforded time to get to know them a bit better than I had in the emergency department, and I found that many of the skills I developed during my emergency medicine rotation translated well to family medicine.

Before my third year, I had never considered a career in neurology, and I approached the rotation with no expectations. By the third week, I was feeling inspired. I loved the patients and their stories and found the neurology exam to be fun. I worked hard to extract relevant information from patients’ histories and was rewarded as I saw their conditions improve over days to weeks. I spent my evenings reading about the basic neuroscience behind their pathologies. It felt like things were finally starting to fall into place. However, one physician warned me that in neurology, with its many degenerative diseases, I would have to accept that many patients would never fully recover and, in fact, would take a downward course despite my best efforts. This gave me pause, prompting me to quiz other neurologists about their experiences. I ultimately concluded that my desire for more diverse patient pathologies and greater variety in treatment modalities made neurology the wrong fit for me.  

In processing the input gathered thus far, I have tried to be an active listener and evaluate new information for myself. I have also learned that I must contextualize the advice I receive. I realize that no one person, no matter how wise, understands me better than myself. Everyone along the way has generously shared their wisdom about the pros and cons of each field. As soon as I think I have found an affinity for one specialty, I hear, “Have you considered OB-GYN?” “You seem like an emergency medicine doc!” and “You should apply to ENT!” It seems there are so many ways to think about the different specialties! Every physician has an understanding of medicine shaped by their unique experiences and has their own two cents to throw in.

My favorite advice has actually come from my mother, a physician herself. She is a psychiatrist and, of course, was optimistic that I would follow in her footsteps and join her one day in her busy private practice. I was excited for my psychiatry rotation and went in with high hopes. However, within a couple of weeks of an inpatient rotation, I knew that psychiatry was not my calling. I found the cases difficult and frustrating because I didn’t feel a strong connection with my patients and could not foresee a meaningful recovery in many cases. I longed for my days spent on the medicine floors of the hospital. This came as a surprise to me and made me question how well I really knew myself. On my last day of the rotation, as I vented to my mother on the phone, she said something that has stuck with me: “Don’t worry too much; your specialty will choose you. You just have to be paying attention when it happens.”

As I finish my third year and begin thinking about residency applications, I am finally able to envision a path forward in internal medicine. I enjoy the emphasis on teamwork and collaboration with consultants to coordinate patient care. I like working with many different organ systems and being able to treat each patient from head to toe. I am also looking forward to the opportunity to subspecialize within internal medicine. I recently expressed my anxiety about making a choice to one of my mentors. She assured me that even decades out of training, she is still shifting and transforming her practice and career. “There is always room for evolution.”

If I could impart any advice to younger students, it would be to take full advantage of each and every clinical learning experience and to be flexible with yourself as your interests and identity develop and evolve. Make time to reflect on what lights you up. Actively seek out different points of view, and be a filter, not a sponge, for the advice received. Much of the guidance I have received along this journey has been invaluable. Even when my seniors were just thinking out loud or providing some casual input on our way to the next case, their input made a big impact. I feel lucky to be joining a community that is so full of generous mentors, whose advice I plan to reshape and pass on to my own mentees.

Anna Thiemann Anna Thiemann (1 Posts)

Contributing Writer

California Northstate College of Medicine

I am a fourth-year medical student at California Northstate University College of Medicine, and I am planning to go into internal medicine for residency. I grew up in Santa Cruz, California and attended college at UC Santa Barbara. I have an interest in gastroenterology, nutrition, and the mind-gut connection. During my free time, I enjoy running and reading historical fiction.