Still on my M3 FM rotation, and I'm getting a lot of pressure to choose family medicine from my preceptors. I like my rotation and I get along super well with everyone, but my heart is with anesthesia, surgery, and OB for my 1, 2, and 3 choices (probably going with anesthesia).

I just tell them I have NO idea and I'm keeping an open mind as I go through my rotations, but it's a lie. I just don't want to be graded adversely for saying, no, I'm not interested in FM.

Should I just keep playing coy? I'm finishing out my 2nd of 6 weeks tomorrow.

It's great that they want to recruit you! I bet they are perfectly capable of reading between the lines and know that family medicine may not be for you. They just don't want to let someone like you go to a different field. I say keep saying what you are saying. I think it is a bit rude to tell people who are so much in love with their field that you are not even keeping an open mind as they teach and mentor you.

My school is geared that way also. Over the break, I did Anesthesia on my vacation, so the surgery residents all saw me doing that. Now they ask if I'm doing Anesthesia. At this point, I just said yes. What am I going to do - lie to their face? I reply like - I want to be the best surgery clerkship student you have, but I do plan to do Anesthesia as a career. Obviously, it is important I do well in surgery then and know it. etc.

On every single rotation, I have classmates that give some stupid party line like - I just have no idea what I want to do with my life - when you know full and well they plan to be an infectious disease doctor or a pediatrician. It is so completely ridiculous, and truly I think it makes them sound like idiots. You have SOME idea, and some of you are lying - what I always think when I hear this. And the residents have told me they know when someone is just giving them a line, and it IS annoying! If you don't want to do a certain specialty - I usually deflect with "I want to be the best surgery student on this clerkship - that's what I want to do." Usually gets a laugh. I think it is so sad we aren't "allowed" to have an area we'd like to go into. However, clee is right. You have to show respect and that you are interested. I have thrown myself into surgery and trying to learn everything I can despite the fact that I know I am not applying in it, and now after xmas - so do the residents.

Anyway - this was long winded, but one last thing. One of the younger interns who is easier to talk to and is less intimidating did tell me that some residents are going to automatically judge anyone not going into their specialty. He said to do what I'm doing and deflect with referring back to the clerkship instead of life goals, but obviously not lying to anyone's face either if they saw me on Anesthesia and realized I wouldn't give up vacation to NOT do it for a living. Anywho - hope this helps.

I think the bottom line is to try to find a way to be respectful to those pushing you while deflecting back to how much you are enjoying this clerkship rather than responding about your career. The intern I talked with said he responded in a similar way and it worked out for him his third year.

PS - it is your life. Choose what specialty works for you. My school also has some similar pushing, but we are the ones with the blood, sweat and tears and studying and money invested. Ultimately, even if we thought we'd be the most amazing family practice doc when we entered - if we changed our minds - it's ok. Remember I used to think...not think BELIEVE with all my might I would be an OB. I'm not going to be, but that's ok. I'm certainly going to work hard in OB clerkship, though! Learn as much as I can!

Hmmm. I always knew it was 90% psych vs 10% neuro, and said that. I don't think it hurt me. Often people would still try to "convert" me. I think the only real 'pressure' I received was just friendly, a way to communicate someone saying they thought I'd be a good doctor in their field. I would often follow up with things I liked about the rotation I was on, things I wanted to take from it for practice in my expected specialty, or something, I guess.

But, every school is different....

I've already had people make fun of me for wanting to do Anesthesia. Not in a nice way either. As if I'm lazy. It's actually infuriating. It must be institution-dependent.

Southern-that is awful! As a faculty mentor, I tell my students that residency is like med school and college-you have to choose what fits you. Even though I am FP and a faculy mentor, I told all of my third years that while I would love it if they went into FP< I realize it isn't for everyone and they have to live their lives and be happy. Ultimately as an advisor I feel that it is my job to support them in making their choices. And yes, as faculty you can tell when someone is lying. It is annoying. I just don't understand those that pressure others beyond friendly joshing around. It is such a personal choice. And, seriously, even though Family Med has the rep of being easy, there are lots of med students who I wouldn't want in a Fam Med residency. It definitely takes a certain personality....

Docmomof4 - I like your perspective. Making me wish you were on faculty at my school!

As a former FM faculty-- it does annoy me when people lie about what they want to do. I mean I really don't care what you choose-- not everyone should do FM. We need to have specialists, etc. as well. But it helps when you teach if you know what the student is interested in and wants to get out of the rotation. For example, if you had told me that you were interested in OB/Gyn-- then I would probably let you have a more active role with the paps, colpos, deliveries, etc. And I have never graded a med student adversely because they did not want to be in my field--- I mean for heaven's sake I taught transitional interns who were accepted into ophthalmology residencies when they use to rotate on the peds floor! What does annoy me is when a medical student does not respect my profession or my time. I know FM is considered the light rotation-- no weekends, no call, etc-- but that doesn't mean we can't teach you anything. I start my clinic at 7am, but I tell the med students to come in at 9am because I know it's a light rotation. If that is the case then don't ask me to leave at 3 pm everyday so you can catch your train. Last I checked the train runs every 15 mins. You wouldn't do that on the surgery rotation then don't do it on my service.

Now that I am in private practice-- I still take med students. I don't get paid to do it and it definitely interferes with the flow of my clinic,etc., but I do it because I love to teach and I want to give back. If that is the case then I expect medical students to come in wanting to learn and willing to work. That's it. There is no prerequisite to go into FM, etc.

Megboo, you are probably getting pressured because you told them that you don't know what you want to do. They figure they can influence you if you are undecided. Obviously clee03m is right that they are probably very impressed with you. But I just don't think that if you told them that you were leaning toward anesthesia, etc. that they would grade you down. That just seems ridiculous and quite petty-- I would not do that and neither would any of my colleagues.

Sorry if this is a long post, but sometimes I feel like a lot of the posts are so medical student sided and really when you become an attending you look at it quite differently.

Thanks for the insight you all. I am leaning toward anesthesia, but I have other interests too. Unfortunately, FM is lower on the list. I don't mean to lie just to lie to get a good grade, but more like I don't want to upset anyone and end up with an adverse grade because of that. I've been a little more forthcoming about my OB interests (which is my 2nd or 3rd choice for possible residency choice), so I'm getting my hands more dirty with more OB.

I've always been more of a people pleaser when it comes to my superiors, and I think I just need to develop the proverbial balls here!

True, true, I personally don't grade down medical students because they are not going into anesthesia. But I see them in their 4th year. I would treat them differently, however. If I get a student going into anesthesia, I would teach and let them do more stuff. Not grade up, but make more of an effort with comments and stuff. But then again, I am a bit of a lazy attending. I am in private practice, and I started getting medical students as a result of a hospital policy change. Never liked teaching. Too anal and want to manage all aspects of my patient care.

I guess I never really lied. I mean I thought I really could go into half the field I tried. And the other half was what I thought I wanted before doing the rotation. But I would either say that I doing this rotation has really made me consider the field (truth), or that while I had some rotations I loved, I am keeping an open mind (also truth) but I would tell them what I loved and found interesting about their field. Once I made up my mind, I told them. But that was in my 4th year.

I empathize with you, megboo. It's hard to navigate this fine line. I recently started honestly saying I was planning to do psych, and then I'd often follow that up with something I had learned on the clerkship that I thought would really help me. For example, on medicine or surgery I would point out how much I enjoyed primary care or managing patients with delirium, which are both related consult-liaison psych. I also would gently deflect with saying what I loved about their field. I think for me, it came down to being true to myself. Saying out loud what specialty I plan to do made the decision more "real" for me, and that's why I started to answer honestly. But I tried to answer with tact and respect as well for my superiors.

I have always found that there is a tactful way to be yourself. People will judge you no matter what decisions you make. Being who you truly are (without offending others) is the best way (in my opinion) to live an integrated and successful life. In other words, appreciate family medicine (if you can) but don't feel the need to lie about it.

My roommate in medical school made the mistake of telling everyone she was going into opthalmology. She is now a cornea specialist, but the so/so grade she got in internal medicine as her stated career goals annoyed the residents and attendings gave her many sleepness nights, tears, etc. We know what medical training should be, but you should know what it is. I wouldn't tell them.

Anyway, have you rotated in all of these other areas yet? I don't think its dishonest to tell them you don't know. I and many others changed their minds, last minute. I wouldn't burn any bridges, keep an open mind.

Unfortunately for me, for example, I have IM last. My school ends late, so I finish in July. In August, I have an away. In September I rotate with the military. There is no "I don't know" at that point. That would be seriously impossible even just logistically. My applications for my away are due by April 1. DUE. Hopefully, my IM service will be more reasonable. I can't help that it won't be IM, but I can be incredibly interested and respectful (as I am anyway). At that point if I said I didn't know - that would just be a slap in the face to them. I'm going to be honest when I get there, but I'll probably deflect and talk about my advisor who mentors me and I have worked under, who is under the IM umbrella.

I still have to rotate through OB/Gyn, Psych, Peds, and IM. So I'm not being dishonest when I say "I don't know", even though I'm about 90% sure anesthesia is where I'm headed.

OB/Gyn is actually a second choice, Surg a third, but there are some IM specialties that I find interesting as well.

So no, I'm not technically lying, but I kinda feel like I am when I say it when I know how I feel about anesthesia.

I'm not a giggly kind of girl and I don't play coy, I just flat out say, I'm keeping an open mind right now. Having finished 2/3 of my FM rotation, I'm pretty sure I'm not interested in it. I like the peds, but only the babies, and I like the OB, and I like the procedures. I found an ovarian mass on a patient yesterday and that got me excited, but I loathe dealing with chronic health issues. I'm also going to bang my head against a wall if I see one more cold/flu case.

In 2 weeks I start OB/Gyn and it will be much more interesting for me.

I'm a little bummed that I will also be doing my IM rotation last, and late because I was on maternity leave last fall, when I was supposed to do IM. I will finish the 3rd week of Sept and then go take Step 2 that weekend. I'm trying to be able to do a 2-week rotation in between semesters in June for anesthesia (M4) to get a nice LOR. I did one week already with surg, but that was getting my feet wet, so to speak. I'm going to have tons of questions in a couple of months for our anesthesia moms here - look out!

Well, yes, one of the most important things is not to have people think that you are being dishonest or "playing the game." So if you are in a situation where it is known where you are applying at such and such a time then of course, you have to tell them. And there are diplomatic ways to explain why you chose something else.

I myself don't take it personally and as a medicine subspecialist tell my students that are going into surgical fields or radiology that I expect them to do even better on their medicine rotation this is one of their only chances to learn internal medicine and they will need it the rest of their career. As a result, I get asked to write a lot of letters of rec by these students, as its good to have a non-surgical letter of rec as part of your application.

But the bottom line is on rotation esp. early in the year it is a good idea to have an open mind and not to close any doors (esp. because you may think you know for sure, but that can change), and sadly there are a few that do (hopefully unconciously) sway their grade based on their perception of your future big picture that shouldn't have a huge impact on your overall future.

I agree with sah, mostly because you might change your mind. All people are biased toward their own specialty choice, and the simple fact that you are interested in something (completely) different might be cause for (subconscious) insult. I would not want to be in the situation where someone started out assuming I don't value what they do until proven otherwise. The other downside is that your attendings/residents might not invest in you as much.

So anyways, I kept my mouth shut, and every time I did let my interests slip, even after I had established that I was a hard worker and smart and cared about the specialty, I regretted it. Wish I could be more supportive!