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Education Research: Choosing Wisely: A Mixed-Methods Study of Career Choices of Students Completing Advanced
Brian E Emmert1, Amy A Pruitt2
1Department of Neurology, Division of Epilepsy, Vagelos College of Physicians and Surgeons, Columbia University, New York; and.
Background And Objectives:
Specialty choice is a critical decision for medical students who are often torn between multiple specialties; their final choice affects the trajectory of their careers and their long-term well-being. Understanding the process of this decision is invaluable for mentors, particularly those advising students who indicate a substantial interest in a specialty by electing an upper-level rotation.
Methods:
We surveyed 120 students who completed an elective neurology subinternship (Sub-I) between 2013 and 2024 about how they decided among specialties. We asked these graduates to provide narrative descriptions of their decision-making process and advice for current students deciding between specialties. We analyzed quantitative data using chi-square tests and qualitative data by content analysis.
Results:
Fifty-nine of 120 graduates responded (49% response rate). Thirty (51%) are currently practicing neurology and 29 (49%) are practicing another specialty. Sixty-four percent changed their premedical school specialty preference during school (p < 0.001). More than half (54%) made their final decision during the subinternship (p < 0.001), and 63% required a second rotation in multiple specialties. Future neurologists reported greater comfort with uncertainty (p < 0.001) and placed higher importance on mentorship than those who chose other specialties (p = 0.02). Twenty-eight respondents (47%) had an "epiphany moment" that led to their decision, whereas 31 (53%) did not (p > 0.05). The major themes identified in the decision-making process were clinical experience, intellectual curiosity, and the culture/lifestyle of the specialty.
Discussion:
This study demonstrates that high-quality subinternships and strong mentorship play essential roles in guiding undecided medical students. Clinical experience, culture and lifestyle of the specialty, and intellectual curiosity are key factors which shape this decision. These insights can help mentors, especially those advising neurology subinterns, provide targeted guidance, supporting students in choosing a specialty that is both personally fulfilling and intellectually rewarding.
