ELi5: How/when do medical students/professionals decide what field of medicine to specialize in?

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Obviously there’s a number of factors that dictate this. I guess I’m more intrigued specifically by the fields that some might consider “less glamorous” than others.
Does one simply have a revelation- “hey I’m pretty good with guts, guess I’ll be a gastroenterologist”?
Or “I come from a long line of Podiatrists, so naturally I followed in my father’s footsteps.” (Pun intended)

In: Biology

At the end of med school the students apply to residencies in the specialty that interests them. During school and interning they are exposed to many specialties so they have some grounds for pursuing something.

They must be accepted by a residency, however, so grades, recommendations, & interviews all determine if the new doctor can pursue their interest or not.

You may want to be an orthopedic surgeon but if none of those residency programs accept you, well, you do something else.

You can always apply to a different residency later, however, should you wish to change your specialty.

Im not a doctor, but I am a scientist. I figure its more or less the same way i did it: I went with the thing that interests me the most.

Microbiology started interesting me as a child, when I played the game Parasite Eve. Started me looking into it. Of course I soon realized that the stuff in the game is closer to magic instead of science, but the interest remained. And when nothing else interested me anywhere near as much, I decided to make a career out of it.

I don’t recall exactly how I ended up focusing on bacteriophage viruses specifically… I probably just thought the idea of viruses that infect bacteria was really cool. XD And it IS

During Med School, they do rotations in different specialties. Then they choose the one they want to specialize in and apply to residencies in that specialty and spend a number of year in that residency getting the specialize training.

The career pathway is different depending what country you’re in.

In the UK, medicine students will do placements in different hospitals and in general practice (aka family medicine) during their degree to get experience of different things. After they graduate, they become a ‘junior doctor’ in a hospital and will work in lots of different departments, getting further experience in different areas. They might be more interested in a particular area, or they might find that they are better at a particular area, and choose to specialise in it. They undertake further training in this area, while working, to become specialised in it. For some students, one field will stand out to them as their preferred area. For others, the decision may be difficult. It depends on their personality.