Phase 3

Choosing a specialty within clinical medicine is one of those fundamental questions tied to your identity as a medical student. Your parents want to know, your residents and attendings will want to know, and you want to know for yourself what you’ll spend the next 20-30 years doing day in and day out!

First, let’s remind ourselves that life is long and flexible. Even once you commit to a specialty field, you will have flexibility to take on additional fellowships or different jobs to practice aspects you love and avoid parts you find tedious. With that said, here is a relatively simple algorithm to follow: Do you like surgery or medicine? Now, you can go forth and explore the various subspecialties within general surgery and surgical subspecialties (neurosurgery, orthopedics, plastics, urology, otolaryngology, ophthalmology, etc.) or in medicine and pediatrics (allergy, rheumatology, cardiology, gastroenterology, hematology/oncology, etc). For example, if the OR is your favorite place in the hospital (but not in the world), choose anesthesiology. If you like cerebral medicine but don’t like patient contact, consider radiology or pathology. If you like a bit of everything, consider internal or family medicine. Women’s health plus surgery? Obstetrics and gynecology. And once you’ve narrowed down your choices to similar subfields, you should consider lifestyle and financial aspects of a typical practitioner within those fields to differentiate.

I came into medical school knowing I was most interested in surgical care, started research in a niche-surgical specialty subfield to give myself options in the future, did rotations in almost all the subspecialties, and came down to two similar choices. Ultimately, I chose a field whose people I most enjoyed spending time with and that gave me the most flexibility in future types of fellowships, practices, and lifestyles that I could accommodate alongside my non-medical interests. At the end of the day, being around people you enjoy, patients who appreciate your care as much as you appreciate them, and clinical experiences that make time fly by, will keep you uplifted.

-Kwasi E., M4

I started medical school thinking that I would go into psychiatry or orthopedic surgery. I started shadowing both to get a better feel for the specialties and knew that I would get even more exposure during clerkships. Now that I'm in my fourth year, I'm applying into emergency medicine. Picking a specialty can be a challenging process, and it's important to not rush through it. My advice would be to think about the day-to-day in a given field, not just about the most exciting parts. For me, there was a lot to love about both psychiatry and orthopedic surgery, but the day-to-day of emergency medicine had me waking up even more excited to go into the hospital. I've found that the actual experience of rotating with a certain specialty can feel vastly different than what you might imagine, so make sure to rotate through as many services as you can. There are always rotations that you will enjoy far more than expected and rotations you enjoy far less than you imagined. Lastly, I find it helpful to write about my experience on each rotation both during it and immediately afterwards. It'll be helpful to reflect on months later when you're looking to make your final decision.

-Justin Y., M4

I'm doing a dual MD/MPH degree at WashU. This means that I finished three years at WashU Med, hopped over to the Brown School at Washington University in St. Louis this year for an accelerated one-year MPH, and then will complete my last year of medical school next year. I've really enjoyed diving deeply into public health and using a different side of my brain this year. There are so many different options for taking an extra year at or outside of WashU Med in all interests, from research to entrepreneurship to health equity. WashU Med also gives you plenty of flexibility and support along the way. My advice would be to keep an open mind and to talk to older students and faculty mentors if you are interested in taking an extra year!

Phase Three begins after you complete your clinical clerkships. During this time, you're expected to write two of your board exams (Step 1 and Step 2), complete two mandatory Keystone integrated science courses (KISCs) and two advanced clinical rotations (ACRs — one in your selected specialty and one in medicine), prepare your residency applications and interview for residency spots, and complete a Capstone course aimed at preparing you to be a rockstar during your intern year. It can feel overwhelming at the start, but there are resources available at WashU Med to ease your experience.

Your coach, specialty advisor, mentors from your chosen field, Dean Kathy Diemer and Angie MacBryde from Career Counseling, and Phase Three/Year Four medical students applying to your chosen specialty will be your trusted guides to ensure your Phase Three experience goes smoothly. Therefore, my first tip for maximizing Phase Three involves engaging and staying connected with all the aforementioned individuals from the end of Phase Two until Match Day. They can advise you on how best to schedule your rotations (including away rotations) and board exams to ensure that you obtain everything you need to prepare for residency applications, which open in early September. They can read your personal statement, which you should start writing as early as possible in Phase Three, and help proofread your residency application.

Making the most of your sub-internships and elective rotations is also equally essential for refining your clinical skills and clarifying your career goals. These rotations aren't just about showcasing your medical knowledge. It is also about improving clinical skills and demonstrating teamwork, communication, and adaptability, providing you with meaningful experiences to discuss in your personal statement and during your interviews. It is also the best time to gather stellar and outstanding recommendation letters from faculty. After submitting a great application with all the necessary materials, utilize available resources — mentorship, mock interviews, and workshops — to fine-tune your interview skills. Approach each interview as an opportunity to showcase your capabilities and assess the program's fit with your aspirations. Additionally, as interview season can be stressful, it may be best to schedule vacation blocks or non-hectic rotations to ensure that you have time outside of interviews and rotations to relax and take care of yourself. Finally, celebrate all the little successes (every interview matters) and hope in the fact that all your hard work, dedication, and perseverance will eventually pay off when you match and become the amazing physician you have been working so hard toward becoming.