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Exploring Your Possible Interest in Internal Medicine

If you are a third-year student making your way through your clinical clerkships, this is an opportune time to explore all of the different specialties of medicine, and specifically your possible interest in internal medicine.

Although the clinical clerkships are incredibly busy, they are also a way to gain intensive exposure to all of the core disciplines in medicine. Once you have overcome the incredible anxiety associated with starting in the clinics, it’s time to begin thinking about what you may want to do with your career.

Unfortunately, the structure of medical school clinical training seems a bit unfair, since at many schools you may not start your clinical rotations until the third year and then have to make at least some preliminary decisions about what you may want to pursue even before you have had the chance to experience many of the primary medical disciplines. Added to this are the vagaries of scheduling that may determine the order in which you are able to take your clinical rotations, possibly limiting your ability to experience one or more areas of medicine that you might be considering. Rest assured, however, that very few students make it into their fourth year completely at a loss of direction as to where they want to go!

If you are considering the possibility of pursuing internal medicine as a career option, here are some important things to remember and do:

Use your school’s Internal Medicine Interest Group (IMIG) as a resource.
You may already be a member of your IMIG and have participated in a number of their activities over your preclinical years. However, the previous discussions about internal medicine, including exactly what it is, how it is structured, and whether it has the elements that you are looking for in a career, may seem very distant now that you are in your clinical training and actually deciding on a career path is getting closer. Your faculty advisors and more advanced student leaders of your IMIG are the perfect people to help answer your more specific, pragmatic questions about internal medicine, as well directing you to others who will be of help if you ultimately decide to pursue internal medicine as a career.

ACP articles can give you a broader sense of what internal medicine is and what internists do. Although you may be aware of some of this information, it may be more meaningful to look at this now if you are considering pursuing internal medicine.

Your internal medicine core clerkship, if you have already completed it or will soon, is an incredible source of information about internal medicine. Although you won’t see everything there is to see, you will be exposed to a wide variety of general internists and subspecialists practicing in different settings. Beyond hopefully learning a lot that will help you in all of your rotations and whatever career you choose to pursue, your exposure to these individuals will help you get a sense of whether internal medicine might be for you, and some of the relationships you make during the clerkship (such as with fourth-year acting interns, medical interns and residents, and attendings and fellows) may also be incredible sources of information and advice. Some students may hesitate to talk to their medicine clerkship director about a possible interest in internal medicine because they worry that such discussions may be uncomfortable if they aren’t sure that they want to pursue internal medicine. However, clerkship directors are very sensitive to these concerns and are in a great position to direct you to the people who can answer your questions about internal medicine without making you feel as though your level of interest might influence your evaluation in the clerkship or that you might feel as though you are being recruited.

The internal medicine residency is the largest clinical training program in most institutions. You will almost certainly encounter internal medicine interns and residents who can talk to you about what training is like and share their experiences both in medical school and their residency that may be of help to you. And even if you haven’t made up your mind about what to do, the leadership and administration of the residency program are always ready to talk with you about training in internal medicine and/or helping you get in touch with the people who can help answer your questions or give you advice.

Remember that internists and internal medicine is all around you. In addition to your core clinical rotations, many of the faculty who taught you in your preclinical years are internists, as are many of the consultants who you will see on your other clinical rotations. Do not hesitate to watch what they do and talk to them about their career choices and how to find out more about it.

If you are not able to complete your core medicine clerkship in the first half of your third year or remain unsure of your interest in internal medicine after your clerkship (as many students do), do not get overly anxious. Electives and other experiences, including your fourth-year rotations, provide substantial opportunities to experience different aspects of internal medicine and other fields, and for most students, these additional rotations are helpful in determining career choice. Your advisor(s) can be extremely helpful in this case and may help you develop the best strategy for finding your direction.

It is absolutely fine to consider a number of potential career options at the same time, particularly as you are making your way through your third-year clinical rotations. Your faculty and advisors are keenly aware of this, and you shouldn’t hesitate to voice your deliberations among disciplines with them, as they may be able to help answer some of your questions honestly and in an unbiased fashion and offer a helpful perspective. Although internal medicine always seeks the “best and brightest” for the field, it is much more important that you and internal medicine are a good "match" if you decide to pursue it as a career option.

Relax and enjoy your clinical rotations. Although clinical clerkship experiences may not be purely representative of what it would be like to enter a particular field, the intensive exposure to each discipline not only provides factual knowledge but also gives you a sense of what people in that area of medicine do and the type of people who enter that field. This may be invaluable in your thought process about deciding what is best for you.

Don’t disregard your feelings during your clinical rotations. Although clerkship training in medical school is not fully representative of a field of practice and the people in it, your experiences can lend a more subjective sense of whether you might fit in with a discipline and the people who practice that type of medicine. This may be of great help in refining your decision about possible career choice.

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