How does a medical student choose a clinical specialty? The ancient Greek aphorism “know thyself” is sage advice that may help future doctors find their calling, but it’s only a starting point, some medical educators say.
To help its students settle on their specialties, Harvard Medical School has developed a career advising program that incorporates the Association of American Medical Colleges' Careers in Medicine program and extends it to provide information sessions, networking opportunities and individual guidance to MD students from their first weeks on campus until they leave for their residencies.
During the School’s self-study for the Liaison Committee on Medical Education (LCME) regularly scheduled site visit and accreditation review in 2019, career advising emerged as a strength of the HMS MD program, said Anthony D’Amico, advisory dean and director of the Oliver Wendell Holmes Society.
“Students were satisfied with the School’s response to their feedback about career advising,” said fourth-year MD student Kirstin Woody Scott, who co-led the LCME review student leadership team.
The results of an independent student analysis survey as part of the LCME review showed that 83 percent of the respondents expressed satisfaction with existing and recently expanded resources and programs regarding student advising at HMS.
Part of the reason for this positive feedback was the addition of needed help.
“The cornerstone of this success has been the assignment of Csilla Kiss to work with me and Dean for Students Fidencio Saldaña in the newly created position of student advising manager,” said D’Amico.
Several years ago, Kiss and D’Amico recognized an opportunity to formalize and unify career advising at HMS. They started with a pilot program in the Oliver Wendell Holmes Society, improving offerings based on the feedback they received from students.
“We responded to the students’ needs, and the schoolwide program we have now is based on the pilot,” said Kiss, who is student advising manager in the Program in Medical Education at HMS.
The HMS career advising program, which spans all four years, could serve as a model for other medical schools, said D’Amico. Kiss was recognized nationally by the AAMC with the 2019 Careers in Medicine Excellence in Medical Student Career Advising Award in November, he added.
Getting to know the specialties
During their second week at HMS, students can choose to attend biweekly specialty-themed lunches. The sessions introduce students to daily life as a physician in 20 medical specialties, with the panels composed of up to six clinicians and a mix of faculty, alumni and residents.
Following the lunches, students may attend drop-in mentoring sessions to begin building their professional networks and exploring research and shadowing opportunities.
Additional programs are also offered during the students’ first and second years. These include career advising dinners for students in the Harvard-MIT Program in Health Sciences and Technology and a peer-to-peer mentoring panel discussion on how residents and faculty chose their specialties. There is also a session on how to balance school and life, where clinicians share pointers for personal and professional success.
Many of the HMS career advising sessions are recorded and can be streamed on a secure server for students who are unable to attend.
During the next phase of their training “students enter the career immersion phase where they serve as clinical clerks and are part of the care team for patients across specialties,” said D’Amico.
During the Principal Clinical Experience comes more time in the clinic with clerkships giving students opportunities to try on different specialties for size and to reflect on how their strengths and interests align with each field. They get a chance to see firsthand which patient populations are served by each specialty, D’Amico added.
As students consider their career paths, the popular Conversations in Medical Life Series and Clinical Scientist Series invite accomplished physician-scientists as guest speakers to share insights and provide inspiration.
One-on-one advising is also available throughout students’ time at HMS, giving them opportunities to meet with society advisors, the dean for students, hospital-based mentors and others, including more than 500 alumni advisers across the country who have offered to share their expertise and experience with students seeking individual mentoring. The alumni advising initiative is overseen by Dea Angiolillo, HMS ’79, who coordinates with the HMS Offices of Student Affairs and Alumni Affairs and Development.
Designed for rising fourth-year students, Creating a Competitive Residency Application group sessions give students the opportunity to learn the ins and outs of residency applications for various specialties.
Scott said it was helpful to hear “honest-to-goodness advice” directly from residency directors.
“Having that kind of access to program directors is pretty remarkable,” she added.
Finally, during their post-PCE experience, students can explore two or three of their top specialties by participating in advanced clinical electives, which require a higher level of patient care responsibility.
Once each student decides on a specialty, they are “assigned a specialty advisor to help them navigate and create a competitive residency application in their chosen field,” said D’Amico.
“For example, in emergency medicine, residency directors like to see that students have done an away rotation to see how they perform in a place that’s new to them,” D’Amico said.
Whereas in dermatology, directors like to see that students have been involved in research and are visually oriented, he added.
The HMS career advising program also offers activities such as practice interview sessions and preparing program ranking lists for the Match application.
Fourth-year HST student Clara Starkweather’s practice interviewer was a surgery attending who helped her prepare to discuss challenging topics, such as healthy, team-based conflict resolution.
“These topics came up in several residency interviews, and I can't emphasize how important it was that the practice interviewer had me think about it beforehand,” she wrote in an email.
The career advising program culminates just before graduation, with a session on transitioning to internship, where residents from area hospitals share what to expect in regard to work schedules and interacting with senior residents, faculty and patients when the new doctors begin their residencies.
Knowing thyself—and finding fulfillment
Third-year student Maria Thomas said that “the best piece of advice that I received from these sessions was to keep reflecting whenever you get a chance.”
Thomas said writing about her feelings and talking with friends and family also helped her bring her interests into focus.
“There were rotations where—even after working a long shift—I came back happy and wanting to discuss more medicine,” Thomas said. “One of those was definitely internal medicine,” adding that she’s close to settling on that as her specialty.
“Our goal is to help students navigate the specialty selection process from the day they enter HMS through Match and to set the stage for when they enter internships and beyond—to allow them to find themselves in successful and fulfilling specialties while striking a balance between personal and professional life goals leading to happiness,” said D’Amico.