The experiences medical students have during their core clinical clerkships can be a major factor when it comes time for them to pick a physician specialty.
In fact, it often can be the deciding element. A 2025 study published in The American Journal of Medicine examining the factors that weigh strongest for students who specialize in internal medicine found that the most predictive factor for a medical student to pursue internal medicine is how much they enjoyed that clerkship rotation.
The career-planning importance of the exposure that medical students get on clinical rotations transcends specialty. In annual surveys of medical students, more generalizable factors that most frequently contribute to specialty choice weigh heavily, with personal interests and skills as well as content of a specialty typically at the top of the list. One’s experience during clinical rotations plays a role in examining those factors.
So, core clerkship rotations can shape your career. How should you approach them as a data point for picking a specialty? An academic faculty member offers a list of questions that medical students should ask themselves during rotations to aid specialty choice-related fact finding.
Am I keeping an open mind?
David Savage, MD, PhD, is now an academic faculty member practicing hematology/oncology in New Mexico, but a decade ago, he was a medical student approaching clinical rotations without any firm plans.
“When I started medical school, I honestly had no clear idea what I wanted to do,” said Dr. Savage, an AMA member who serves on the AMA Council on Medical Education. “So, when I started my third-year rotations, I just tried to keep an open mind. Every time I would go to work every day, no matter what I was doing, I tried to give 100% of my attention and focus to whatever my rotation. I tried to look interested and tried to read up on the topics that were important in that specialty.”
Even if you have a pretty firm idea of which specialty you’d like to pursue, the process of physician specialty choice should be fluid. Considering that, it’s worth noting that medical students who begin medical school with a specialty preference change their mind more often than not.
The AMA offers resources to help medical students on the critical step of selecting a specialty The AMA’s Specialty Guide, by FREIDA™, helps you identify specialties that match your career plans and clinical interests. This tool outlines major specialties, training requirements, and connects you to relevant association information.
What am I observing?
At the end of each week on a rotation, Dr. Savage would note some of the nonclinical aspects of his time on the service and what they might mean for a career in that discipline.
"At the end of the week, when I was reflecting on my experience, I would ask myself: ‘Did I like the stuff that I saw this week so much that I want to do this forever?” Dr. Savage said. “Did I like the attendings and like the kind of lifestyle that they have, and would I want a lifestyle just like that?"
"Did I find the stress in the workload of the residents I was working with to be manageable in a way that I wouldn't mind being that kind of resident? I asked myself that question for every clerkship I went through."
Am I letting the decision come to me?
With most clinical rotations lasting at least a month, you might go quite a while before you find your passion.
“I got to internal medicine about halfway through my third year, and I didn't know too much about it,” Dr. Savage said. “When I started learning about it, I found that you get to become a bit of a knowledge expert on a lot of different things. Then a lot of the care you do in internal medicine is not just medication-based, but you're caring for the social situation of the person, and sometimes you're caring for the family who's trying to take care of a person.
“That all-encompassing, whole-person, systems-based care really, really appealed to me.”
What might be some long-term paths in a specialty?
While Dr. Savage was still years away from deciding to subspecialize in hematology-oncology and pursue a postresidency fellowship in that field, the seeds for that career path were planted during his internal medicine rotation.
"On the internal medicine wards, I did see a lot of patients with cancer, and I kind of tangentially saw the work of the fellows who were taking care of them,” he said. “That was part of what really got me interested in oncology, because I saw people who were really sick get a lot better because of the things the oncologists were doing for them. I thought that was noble and worthwhile, and I thought: Wow, I would love to learn how to do that myself."
For a more detailed exploration of life in a field, the AMA “Shadow Me” Specialty Series features real-life perspectives from physicians, providing direct insight into what careers in various specialties are truly like and helping you make an informed, confident choice.
