For preclinical medical students, specialty exploration can feel both urgent and premature at the same time. Many arrive in medical school with a strong sense of what physician specialty they want to pursue, but the evidence suggests those plans often change as medical students move through medical school.
Still, researchers have found that while they are less influential than milestones that take place later in training such as core clerkship rotations, preclinical experiences do affect physician specialty choice.
Which preclinical experiences tend to offer the most value for preclinical students weighing their future career plans? How should first- and second-year medical students pursue real-world experience to make better decisions later? Research data and expert physician insights shed light on those questions.
Shadowing drives pre-clinical specialty exploration
For a 2023 study published in the journal BMC Medical Education, researchers examined when medical students at an Ohio medical school chose their specialty, whether their original interests held steady, and which curricular and noncurricular experiences shaped their final decisions.
The study found that among preclinical factors, physician shadowing had the highest positive perceived impact on specialty interests and choice.
“When it works out, certainly shadowing is a nice opportunity to understand what the life of someone working in a particular specialty is like,” said John Andrews, MD, the AMA’s vice president for graduate medical education innovations.
He advised that medical students pursue brief, targeted shadowing opportunities.
“I don’t think it’s an activity to which students should devote a tremendous amount of time. It’s not like a shadowing experience has to be longitudinal or on a weekly basis.”
The AMA offers tools to aid you with your medical specialty choice. FREIDA’s Specialty Guide—and corresponding series of videos offering expert insight on specialty choice—provides a clear, approachable overview of medical specialties and subspecialties and can help you choose a career path. It’s designed to simplify medical students’ specialty selection process, highlight major specialties, detail training information and provide access to related association information.
Mentors can shape specialty preference early
Examining factors that ultimately influenced career paths, the study found that 65% of respondents said mentorship affected specialty choice. Among mentors, physicians in the chosen specialty had the strongest perceived positive impact.
When seeking out mentors, Dr. Andrews advised medical students to start with “the people you know.” He also cautioned against putting too much stock in any one person’s experience.
“I worry a little bit about the influence of a small number of people on someone’s professional choice,” he said. For some medical students, “thinking gets heavily influenced by the relationships that they form with faculty and their views of whether someone seems inspired by or really enjoys the work that they do.”
Faculty relationships can have a negative impact as well, Dr. Andrews added.
“If a particular specialty is represented by only one or two people whom you come in contact with and the example that they set isn’t great, it may distract you,” he said. “It may cause you not to consider that specialty where you would otherwise be very happy, just because you’ve seen others have that experience.”
Preclinical specialty exposure beyond shadowing
Among preclinical curricular factors, shadowing with physicians had the strongest perceived impact on specialty interests and choice, followed by classroom subject matter, events or keystone lectures, and involvement in interest groups, all of which were rated positively but lower.
“In the preclinical years, anything that informs your interests is a good thing,” Dr. Andrews said.
Specialty interest groups offer an opportunity outside the formal curricular structure for medical students to do a deeper dive on a field of medicine. Available at most medical schools and across most physician specialties, they offer a chance for medical students to build their specialty-specific knowledge, gain early leadership experience and make connections that may extend beyond their medical school. Involvement in one of these groups can be useful in building an application for a competitive specialty.
Medical student specialty preferences often change
The study found that 60% of respondents chose their specialty during their third year of medical school, and only 50% pursued a specialty that was among their initial interests—backing up additional data showing that the majority of medical students change their preferred specialty.
Considering the fluid nature of physician specialty decisions, Dr. Andrews’ strongest advice for preclinical medical students examining specialty options is to keep an open mind.
“I worry a bit about premature closure on specialty,” he said. “Sometimes people go to medical school saying, ‘I’m going to be a certain kind of physician,’ and they won’t even consider anything else.
“Medicine is a broad field. There are many different specialties. There are many different environments in which to practice. And if you narrow your focus too early, you may miss an opportunity that would have been good for you.”
For medical students exploring their career options, the “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.
