Featured topic and speakers
Finalizing one's specialty choice is a key step before residency application season. Kathleen Kashima, PhD, senior associate dean of students at the University of Illinois College of Medicine offers vital guidance on that crucial decision.
View this AMA/AAMC webinar: “T2R Tools for a Successful Residency Application for 2024 Applicants.”
Speakers
- Kathleen Kashima, PhD, senior associate dean of students; clinical assistant professor for psychiatry and medical education; and clinical psychologist, University of Illinois College of Medicine
- Brendan Murphy, senior news writer, American Medical Association
Host
- Todd Unger, chief experience officer, American Medical Association
Listen on the go to the full episode on Apple Podcasts, Spotify or anywhere podcasts are available.
Transcript
"Talk with people about what might be your gaps, what are some of the things that are missing? Try to figure out how do I get these experiences or what do I need to do and when do I need to do it by when to be able to apply? And are there other paths to doing some of the things that you really enjoy? There are some of those procedures, what are the kinds of similar experiences and other specialties? Is there additional training one can get by going through a different path? Those are all different examples of how one can maybe still get to do some of the things one wants to do but taking different paths."
Unger: That was Dr. Kathleen Kashima, who serves several roles at University of Illinois College of Medicine, including senior associate dean of students, clinical assistant professor for psychiatry and medical education and clinical psychologist. In today’s episode of Making the Rounds, Dr. Kashima will share her advice on how to choose your specialty as you think about the next step in your career: residency. Here’s AMA senior news writer, Brendan Murphy.
Murphy: Hello and welcome to the Meet Your Match series on Making the Rounds, a podcast by the American Medical Association. I'm Brendan Murphy, senior news writer at the AMA. I have with me today, Kathleen Kashima, PhD, who is senior associate dean for students and a clinical assistant professor for psychiatry at the University of Illinois College of Medicine. She's also a practicing psychologist and immediate past chair of the AAMC Group on student affairs. How are you today, Dr. Kashima?
Dr. Kashima: I'm fine, Brendan. Thank you so much for having me.
Murphy: We're very excited to have you. Today Dr. Kashima will provide guidance for a very important step in medical students' career paths, how to choose a specialty. So I think a good place to start is to talk about your background working in residency selection with students. Can you tell us a little about that?
Dr. Kashima: Sure, Brendan, thank you. And hello listeners. Special thanks to the AMA for this podcast and the Road to Residency series. So let's see, I've been in medical student affairs for over 25 years and I've been working as a medical student affairs dean, a career I truly enjoy for that long time at a multi-campus medical school and have been honored to serve in national leadership roles with colleagues. This topic is a high priority for our discussion, so I'm really familiar with the various challenges students face, given its complexity and the variety of influencing factors that individuals have involved in these decisions. I also just want to share, as you said, as clinical psychologist, I'm going to advocate for the importance to the listeners of building a trusted support team, what I call a road to residency team or R to R team during this process.
Now, probably more than ever, with all the changes going on, there's much uncertainty and maybe some anxiety. So I just really want to reassure all of you that there are many people in leadership roles in organizations such as the AMA, the Association of American Medical Colleges, AAMC, specialty societies, and most importantly, people at your medical school who are communicating, collaborating, innovating and investing resources to improve the transition to residency for a community of stakeholders, including you. And want to say also actually some anxiety gives us energy to take action.
Murphy: That is helpful advice and we are at a point where there might be a bit of anxiety associated with both specialty choice and the whole Match process as students are both finalizing that choice and getting ready to submit their applications and their letters of recommendations. Can you talk about where they should be in that specialty decision at this point in their trajectory?
Dr. Kashima: Sure. Medical school is a long journey and what I would say that each person also has their own journey. So really the best thing to do is really, as I mentioned, have your conversations with your medical school advisors, have this, building in this R-to-R team, and talking about your own situation and figure out where you might be in that in terms of the process to deciding, especially in a residency, if you're early on in your medical school career, we want you to be open to options. And if you're further along, we're hoping through your experiences that you're going to gain a better sense of a specialty choice and residency application.
Murphy: You mentioned that R-to-R team, that road to residency team, you are part of it from any students. I'm going to throw a hypothetical at you. If I am a student and I am narrowing my options down to a few specialties a year away from matching or 10 months away from matching, what are the key considerations I should put into that decision?
Dr. Kashima: Yep. So Brendan, that's a great question and I would say to listeners, if you're at that point, it's great progress if you're down to narrowing your options because there are over 160 medical specialties and subspecialties. So that would be great work. First, before I answer your question, I just really want to recommend a webinar that will be helpful to listeners if they haven't already seen it yet before. And it's the AMA, AAMC sponsored, co-hosted webinar “T2R Tools for a Successful Residency Application for 2024 Applicants.” If you don't have AAMC account log in, you'll need to make one to access that. But this webinar was information packed of residency selection, process, programs and tools, as well as the importance of evaluating resources you might use. So that, and included in that discussion was the AMA offering a long list of webinars, podcasts and articles in addition to FREIDA, the comprehensive database of residency and fellowship program. So I really strongly advise listeners check that out.
Now, to answer your question, there's a few considerations in narrowing down options. They are, I'm going to list them first, decision making process, your fit with specialty and your ability to match. So I have some questions for listeners to consider for each of those. So first, decision making process, as I mentioned, what decision making strategies have you used in the past that you've found helpful? And one of the things we talked about was building the R-to-R team, but that's something to really consider is what things you found helpful when you've made major decisions. Second, what's your fit with a specialty? Some questions to consider include what specialties fit your personality, interests, talents and skills, life and career, what are the positive aspects of that specialty? And what are the emotions and feelings you have about that specialty? And what concerns do you have about the specialty?
Try to brainstorm ideas and generate some thoughts about those concerns and maybe do a fit test. I've had students draft bullet points and figure out why this specialty and articulate how this specialty fits with your career goals. And then finally, what's your ability to match? How confident are you in your ability to succeed in this specialty? How competitive are you? Are you being realistic? So those are some questions to consider.
Murphy: That's all valuable insight and there are so many resources at the AMA, including the Meet Your Match podcast, which we're very happy to have you on Dr. Kashima. If you look in the bio of this podcast, you'll see a link to the AAMC, AMA webinar Dr. Kashima mentioned. Talking about this specific specialty decision, it is a journey from M1 to M4. How do you see students' specialty preferences shift during medical school? What are some of the reasons for those shifts?
Dr. Kashima: It's so interesting because I think there are many students who think, “Oh my gosh, when I go to medical school, I've got to know from the get-go what specialty I'm going to go into.” And actually, most students don't know only maybe around a quarter of the students do know from the beginning and the rest of the students changed their mind. So what are some of the different things that why students change their mind? Well first thing you're going to hear, and you probably already heard, those of you who are more advanced in your medical school that your faculty are going to say to you in the beginning, keep your minds open because you haven't experienced a lot of medical school school yet. And as soon when you get into your latter years when you do clinical experience, you're going to be having direct experience yourself in settings with patients and engaging with those who work in those specialties. So that's a great time to figure out what might be some different things that appeal to you about a specialty.
And I think one of the major factors for students too is talking with people in those specialties. So the practitioners and hearing about what they like about, or love about their specialties, and what kind of things they thought they didn't know about. And maybe on second thought maybe you might be interested in other specialties. There's also changes or advances in a specialty with time. Some of the people you speak with may have started in a specialty years ago and there's been some advances, for example, in some of the specialties like internal medicine, family medicine, Peds, there's a new physician called nocturnes for those people who like to work at night. So these are some of the changes that can happen within this specialty.
And AMA also has shared information about hiring practices. Now I know many of our listeners take a look at what are the specialties that are hiring more physicians, what are not and keeping abreast of those things. So those are all different factors that can change specialty. And finally changes that happen for you during medical school. Do you have personal changes? You could have relationships change, family issues, these might impact your geographic interests and finding what might be the optimal balance in your work life career and specialties have different demands on your time. So those are all different factors why students can change their minds.
Murphy: And of course, there are the actual experiences you have during your rotations. Students are in the midst of sub-Is and away rotations. How do those rotations help students finalize specialty choice or potentially rule one out?
Dr. Kashima: Well, it's really, I think so important and I'm thankful that part of the medical education experience is to have those opportunities for sub-Is and away rotations show. Sub-Is really help you to become an integral, have an experience to be an integral member of a treatment team with primary responsibility for patient care. And that's really helpful for a student to figure out is a specialty, really what's for me? Because some experiences or exposures are really just literally watching. And so, these sub-internships really help.
Also, away rotations give students and you an opportunity to have different clinical experiences in different settings as well as community-based or academic-based if you're at an institution that doesn't have those opportunities and you get to work with new colleagues at institutions. Some students find that these away rotations are also a great opportunity to figure out, do I want to not only apply to this specialty, but do I want to apply to this institution?
Murphy: A big part of this process and a big talking point among people in advisory capacities like yourself is this concept of realistic applying. It's a reality that not all specialties are equally competitive. How do you gauge your competitiveness as a student?
Dr. Kashima: Yeah, you're correct, Brendan. The reality is that the number of applicants is increasing to residency programs and at the same time, the growth in the number of residency positions isn't necessarily aligning with graduating student interests. So that makes it a real challenge in terms of trying to figure out how competitive I am. And so, I think one of the key things I say to all of you is to really review your qualifications with respect to existing data. And as I mentioned earlier, check out that webinar because that talks about a number of these resources. But also, importantly is to really be realistic and honest with yourself about what those qualifications are. And when you're talking with a key component of this is well-informed specialty guidance.
So that means people who are currently knowledgeable about residency applications and GME programs now and are up to date on all that information to help you to figure out how competitive you are. And also, like I mentioned before, it's also talking with your home school advisor and deans because they know your progress, your experience in medical school and they know school data from students at the institution who have matched in that specialty. And again, as I repeated before, really talk to your R-to-R team about this too. But the main thing is to really be realistic and open and honest with yourself about how competitive you are with different specialties.
Murphy: If I'm a middle of the road average medical student, which is a very brilliant student, and I may have aspirations for something like dermatology, which is consistently one of the top five most competitive specialties, this is a situation where my qualifications may not align with my aspirations. What do you tell students in that situation?
Dr. Kashima: Yeah, so some of the same things I talked about earlier, just a second ago, but also start to look at and talk with people about what might be your gaps, what are some of the things that are missing? Try to figure out how do I get these experiences or what do I need to do and when do I need to do it by when to be able to apply? And are there other paths to doing some of the things that you really enjoy? Like you said, let's say about dermatology, which is really competitive. There are some of those procedures, what are the kinds of similar experiences and other specialties? Is there additional training one can get by going through a different path? Those are all different examples of how one can maybe still get to do some of the things one wants to do but taking different paths.
I think another common interest is sports medicine. And I think some people might think, oh, my only way to working in that field is maybe going into ortho, which is also another very competitive specialty. But there's other ways to get to a sports medicine fellowship. One can be a family medicine physician, one can be an internal medicine. I think there's other ways to get to that goal and that's why talking with people in the field, doing what I call also informational interviews with individuals who are doing something like you think that's what I want to do, can help you to figure out ways to address those gaps and then figure out how much time it's going to take and do I want to spend the time to do that or do I want to think about another specialty.
Murphy: That is really such a valuable point that the path to being the type of physician you aspire to be is so far from linear.
Dr. Kashima: Yeah.
Murphy: One option for students who are torn on two specialties, I suppose even more than two is possible, is dual applying, that is the process of applying for residency positions in multiple specialties. It's not uncommon, but most students don't do it. Can you talk about the pros and cons of dual applying in your view?
Dr. Kashima: Sure, sure. Well, dual applying, just to say first off, I think one thing you all need to realize is that it's applying to two different things. So you've got to get two different sets of everything. And so, I think just being, if one is going to do that, then you've got to be able to recognize, you've got to be able to manage all that. So that could be a pro or a con depending on how one looks at it, but the pros are that it keeps your options open. I think at a time, if you apply your first time to application by doing this, you have the gamut of programs to apply to. You have the time, a little more time to think about what letters do I need to get working with your R-to-R team to figure out the different components of what needs to go into that application? And you have the opportunity to think about geography because you're applying to all the different kinds of positions. But like I said, it does take more time.
The con is that you've got already a tight timeline. Students who apply to just one specialty already feel like there's so much to do. And at the same time when you're still in medical school, you've got to keep up with all your electives, your sub-Is, et cetera. So that's a challenge. Programs may also realize that you are dual applying and they might make the interpretation of that, that you are interested in more than one of these specialties than the other. And if that's the case, that might be a problem. Sometimes you may also have to apply to a third specialty because if one of them is an advanced specialty, you need prelim programs. That would be even more you need to do.
But overall, by applying to two, some of the benefits are that generally people say that it is better to go in your first time and do this in a broad way, but also that if you increase your chances of matching, it is better than having to go through the Supplemental Offer Acceptance Program, SOAP, when you have only what is left in the positions and you don't have as many options. And at that point you might even have to switch to another specialty that you hadn't considered before.
Murphy: Is a con that you might set yourself up for disappointment when you favor one specialty over the other, which is human nature?
Dr. Kashima: Yeah, you're right. Yeah, that is a con because then if you've only applied to the one and then you don't match, you're going to need to figure out what am I going to do differently to go in the Match again next year or am I going to need to think of another specialty and then do dual applying or parallel applying the next year to make sure you get a match. Yeah.
Murphy: And we talked earlier about anxiety associated with this process. Just to alleviate anxiety it is worth pointing out that most allopathic and osteopathic medical students do match on their first run through the process.
Dr. Kashima: Yes.
Murphy: Always like to point that out.
Dr. Kashima: Oh, yes, yes. Yeah, yes, yes, yes. That's a very good point for our listeners.
Murphy: So, what are some instances in which you've seen students dual apply effectively?
Dr. Kashima: Well, it's some of those competitive specialties you were talking about like ortho, some students have applied to anesthesiology, radiology, intervention, different, or that interventional radiology. Those are also competitive too though. So you have to think about what are the dual options that we've seen. Some of the surgical skull subspecialties in general surgery or some students have done prelim surgery, which is a first-year position, with the dermatology it's doing some primary care to look at different ways that you can go into and get more experiences. So those are some of the different ways. And best thing to talk about again, is people currently in the specialty who can best advise you directions. And because there may be changes in new fellowships and different opportunities to get into doing some of the things you really enjoy doing.
Murphy: When students are truly torn on two specialties and they're approaching this fourth-year window where they have to at least narrow their options that we've opened the option of dual applying. One thing that is becoming an option to delay the decision and to get more information and to fill out your resume and become a more well-rounded physician to pursue another advanced degree like an MPH or to take a research year. Would you recommend that path for students?
Dr. Kashima: Yep. So, that's a great question because of that question gets asked quite a bit is, what I first just want to say is just being torn about a specialty decision in itself is not a reason just to say, okay, I'm just going to take another year and do something. Really, I say to students, think about this in a way, it's like, how would you explain this? What would be your rationale to explain this and why it would help your career? Because this is probably something that would be incorporated into your personal statement and it's definitely going to be in your application. So thinking about that, the purpose and your rationale and have it makes sense in terms of pursuing this specialty is really a key way to think about it, because that helps you when you're explaining it to other people too. And it helps you to feel convinced, yes, this is the right thing to do. And it is often some ... Often when one does that, it has a good rationale. It is a great experience because you expand, again, more reasons why this specialty is a good match for you, more reasons why I've gotten more exposure to different skillsets that you can talk about in your application and in your interview.
Murphy: We've gone in pretty good depth on the specialty choice decisions. What aspects of this haven't we covered that you'd like to mention to our student listeners?
Dr. Kashima: Yeah, well just to say the, Brendan, you mentioned earlier about the anxiety, and you and I have talked about also the time it takes and really that this is all happening when you're all still in medical school. So don't forget, this is really an exciting time in your career. Think about it. You've applied and gotten into medical school, so many people who haven't, and remembering you're going to be a physician. Remember the positives about that. And to really believe in yourself at this point, and that in your training and that your medical school is a partner in your education and work with your R-to-R team. And this is a major phase in your career. And so, try to do this with the supportive people and not in isolation.
Remember that you've worked really hard in medical school, you've been preparing for this for years. And really as a clinical psychologist, I say, to perform your best, and this is really getting closer, not to the total end of the finish line because your career it's a long path, but really closing off a phase and you want to be at your best when you're doing this process of making selection for specialty and applying. So, it's important to be resilient, be open and honest with yourself, be flexible and making adjustments because as we've said, your life is changing, you're learning more, you are changing. And most importantly I think is through all this process, is you really benefit from being a valued team member. Why I say that is that you're going to be asked questions. You're going to be asked questions from students who are behind following you. You're going to be asked to participate in surveys and resources.
And this is the kind of information that helps others behind you too, and helps you to affirm the importance of becoming a physician. So those are the things that I think that are really important things not to remember. And as I said earlier too, and this time when so much is going on, it's an exciting time to be in medicine and medical education, and that many people are working to try to make improvements in the field and that we are thankful that you are the future in health care and that we want as many of you as possible to choose your specialty and residency program that's a good fit for you. So I really can't emphasize that more that you are our future and it's so important to us that you have a good fit for your career.
Murphy: Inspiring and informative words, as I think you've offered for this whole podcast. Thank you so much for joining us today, Dr. Kashima.
Dr. Kashima: Yes. And thank you for having me. And again, Brendan, wonderful talking with you and best wishes to all of you in your careers.
Murphy: This has been the Meet Your Match series on Making the Rounds. I'm AMA senior news writer, Brendan Murphy. Thanks for listening.
Unger: Don’t miss an episode of this special series. Subscribe to Making the Rounds on your favorite podcast platform or visit ama-assn.org/podcasts. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
