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The challenges of career planning in medical school

In this Stanford Medicine Unplugged piece, fourth-year medical student Akhilesh Pathipati offers suggestions to improve medical school career counseling.

I will graduate from medical school next month. With the transition to residency approaching, I’ve spent a lot of time thinking about next steps in my career. I even did a self-reflection exercise for a class in which I listed out professional decisions that will come up in the next few years (including choices like fellowship selection, type of practice setting, whether to pursue management roles, and more). I then rated the different options on a set of six criteria that matter to me.

The project threw into sharp relief the strengths and limitations of career counseling in medical school. It prioritizes how to do well in school and get to residency. For example, I received great guidance on specialty selection. I spoke to mentors in several specialties, attended panel discussions, and tried out different fields through clinical electives. After deciding on a specialty, I also received excellent advising on how to position myself for residency. There were resources at hand to support me throughout the application process.

However, medical school advising has a limited scope regarding decisions beyond residency. When I paused to think about my long-term goals, I realized that I know little about the tradeoffs associated with different clinical practice settings (e.g. academics, private practice, hospital-based, etc.), working in different geographies, or taking on management responsibilities.

What’s more, it’s difficult to access such information. For the most part, medical students train in teaching hospitals with mentors who have limited experience outside of academics. At Stanford, we at least gain exposure to different practice environments because we rotate at four different hospitals. Yet even here, there is a pervasive belief that students should not broach subjects like how income and lifestyle vary in those settings.

Many educators justify this belief by arguing that students should not think about such issues while in school — we should dedicate our energy to learning medicine and think about career factors later. There are two flaws with this mindset. First, students need to make career decisions while still in school. Choosing a specialty and ranking residency programs require us to think about our future goals. Second, students still consider these issues. But instead of making smart decisions, we share hearsay with each other and reach uninformed conclusions.

Medical schools should improve long-term career counseling, as students need to be able to have honest conversations about what we want and how to achieve it. I believe two changes could help us approach graduation with even greater optimism about the careers ahead of us.

First, medical school career centers should collect and distribute data on how professional opportunities vary by specialty, practice setting, geography, and other factors. The biggest barrier to career planning in medical school is a lack of reliable information. Schools can show us how to find it.

Second, schools should increase engagement between students and alumni. This could take the form of creating a robust alumni database, formal mentorship programs, or something else. Regardless of the specific form of engagement, alumni can serve as role models who provide advice, support, and real insights into different career paths.

Medical school is a transformational experience and the first step in our professional careers. With a few changes, it can do an even better job preparing us for the many steps to follow.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Akhilesh Pathipati is a fourth-year MD/MBA student at Stanford. He is interested in issues in health care delivery.

Photo by freeGraphicToday

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