s/o Pre-med thoughts

[Matryoshka]

I've been reading the Pre-med thread with great interest, and had dd read it too.

 

About a year ago, she decided she'd love to be a forensic pathologist (previous career goal: marine archaeologist). She also says she'd like to try to go to college in Germany or German-speaking Switzerland. She is working toward her DSD II exam, which would allow her to attend a German-speaking university without further language testing.

 

She would have to work very, very hard to make this happen, but these goals seem to be motivating her to do just that, so the last thing I want to do is discourage her. She is attending a B&M high school as a freshman, completely homeschooled before that.

 

She will have some challenges to overcome, specifically with math. She is taking non-honors Algebra Part B this year. If she makes a 93 average, she can double-up with Geometry and Alg II next year to get back on track to take Calculus as a senior, but I'm really not sure that's such a good idea - she's lately been coming to the same conclusion. Right now I think her math average is high 80s. I think slow and steady is better for her than cramming it in - I think she could just crash and burn. She would also have to drop orchestra to take another math (I'm a little frustrated that there are only 7 classes/year at the high school. In the neighboring district my brother works at, there are 8).

 

She's now thinking of just doing her best and plugging along in math - if she doesn't double up next year, she will end with Pre-Calc as a senior. Seems for any kind of science major, pre-med, here or abroad, they're going to want AP Calc. Yikes. She is thinking of taking a gap year to cover the AP Calc, either here or in Germany. Is this doable?

 

There's also the science sequence. She's taking Honors Biology and doing well (other than math, all her core courses are Honors). She plans to take Honors Chemistry next year. She'd also like to take Human Anatomy (year), Marine Bio (semester) and Forensic Science (semester). Senior year, I saw the recommendation to take AP Bio, AP Chem, and AP Calc. But doesn't she need to take Physics at some point? We did a 9th-grade level Physics course in 8th, and she did well (she could do the algebra in there better than in her math book - said it 'made more sense' - but it wont' be on her transcript). She can't take high school Physics till her senior year if she doesn't take Trig/PreCalc till then. There just isn't space for AP Bio, AP Chem, and Honors Physics senior year.

 

Could she take AP Chem during a gap year? Does not taking AP Calc and AP Chem in high school mean you can never go to med school?

 

I have no idea how this will play out. She is a very tenacious, hard-working kid. She's only 14 and I know things could well change, but I want to support her where she's at and at least map out a plan that's possible so in case she doesn't change her mind, she doesn't end up just shy of her goals. Working hard, taking lots of science, having a reason to do well in math, and becoming truly fluent in a foreign language all doesn't seem like a waste even she ends up doing something completely different! I sure don't want to tell her - oops, you're only in Algebra in 9th, better give up your dreams now!

 

Advice??

[Matryoshka]

No responses... I'm thinking my question may be lost in the ramble above...

 

So what I really want advice on is... if a kid possibly interested in med school some day is taking Algebra in 9th, how should she best go about choosing her high school courses to maximum advantage?

 

That other pre-med thread rather made it seem that if you're not taking AP Calc/Bio/Chem by 12th, you didn't stand a chance. Surely there is some path open for a late-bloomer in math, even if not the most conventional one? What could that path be?

[Reya]

Whatever her path, she should be making As in math. If she is making Bs, her foundation is too rocky to build on. So if speeding up will make her math grade drop, I'd nix it right away.

 

What matters more than actual classes taken is aptitude and attitude. She clearly has the attitude. She may or may not have the aptitude--Bs in non-honors math classes would be very concerning to me.

 

With science, there really isn't a reason to take physics at all if she doesn't want to for her degree plans--for her own education, I'd argue that there is. :) But that's separate.

 

There are many paths to med school, and being in the position where you're basically retaking the same course is, of course, the easiest one, but that isn't the only way. If her foundation is solid and she is well able to handle the bio, chem, and calc in college, she will be fine, but the courses will probably come as a shock. If she makes less than a VERY high B in any of those three her freshman year, I'd encourage her to change her plans.

[Reya]

Keep in mind that German schools won't take any credit, anyway, and doing a premed major for an American med school in Germany will get complicated.

 

I went to language school in Costa Rica after 4 years of high school-level Spanish in an area where I had many Spanish-speaking classmates but several bad teachers...so it kinda balanced, there. The level of effort that it took to do everything in Spanish all day long was really amazingly exhausting. I'd had no conception of how draining it would be.

 

I could not imagine trying to take high-level courses that were novel to me using notation and conventions I wasn't used to at the same time. I believe that your daughter would find a freshman year of English, calc, bio, chem, and a fluffy elective extremely demanding in the US given her math background. I was very ambitious in college--I took over 20 credit hours for 3 years running--but I can't imagine the level of stress that such an arrangement would cause.

[Melissa B]

Are you in a state where she can dual enroll her senior year? She could take Pre-Calc and Biology in the fall and Calc and Chemistry in the spring.

There are also forensic science areas that do not require a medical degree. Is it only pathology that she is interested in?

[Matryoshka]

Are you in a state where she can dual enroll her senior year? She could take Pre-Calc and Biology in the fall and Calc and Chemistry in the spring.

There are also forensic science areas that do not require a medical degree. Is it only pathology that she is interested in?

 

She likes the idea of doing autopsies/post-mortems. She's been watching too much Bones - she wants to be Cam. :) Do you mean lab-type forensics? I don't think she's so interested in that. What other areas do you mean?

 

About the dual-enrollment - I thought one of the huge no-nos was to have cc classes for anything that would be a pre-med pre-req?

[Matryoshka]

Keep in mind that German schools won't take any credit, anyway, and doing a premed major for an American med school in Germany will get complicated.

 

 

She's already looked up what she'd need to get into a science major in a German university (they do want AP Calc). I do think it will be very hard. I think she's thinking about doing the med school part over there, too. I'm not sure med schools are set up the same way there? I need to talk to my German cousin about this - she's a surgeon now; she ended up doing her residency and now works in Switzerland, but the French-speaking part, so she also has some experience with the language barrier. Also, thousands upon thousands of foreign students with less than stellar English skills come to the US to study all sorts of scientific and technical degrees with success every year. We just hosted a Basque exchange student who wants to come to the US to study biochemistry. Her first barrier is going to be passing her exams in Spanish, which is not her first language, before she could even be considered to come here to study in English, but it's still a goal she's working toward.

 

Which is to say, while very difficult, and not the path I'd choose, it's not necessarily impossible, and as I said, it's motivating her to work very hard pretty much across the board, so I don't want to say "that's nuts, give it up" at this point yet. Maybe she'll go to Germany but major in something else; maybe she'll go to med school but stay in the US, maybe she'll end up doing neither, or maybe she'll pull the whole thing off - I don't feel like it's my call to make at this point (if she were, say ignoring academics because she was convinced she was going to be a rock star, that would be a different type of possibly unreachable dream that I would discourage - but I don't see the current choices based on this dream as being anything but positive, kwim?)

 

Anyone know if you do med school abroad can you do residency here, or how does that work? There are lots of foreign doctors in the US - surely they all didn't start back as undergrad freshmen and go through the whole thing here? What is the correct "entry point" from outside the system?

[regentrude]

I think she's thinking about doing the med school part over there, too. I'm not sure med schools are set up the same way there?

 

 

No, they are set up completely differently. There is no such thing as "premed" - students who get into a medicine major study for six years in the med program, right from the beginning.

It is extremely competetive, because it is one of the few majors where student numbers are restricted (for most other majors, you just show up and study, as long as you have the Abitur- any university has to take you).

 

Here is a link to more information:

http://www.study-in.de/de/studium/voraussetzungen-fuer-ein-studium--15755

[creekland]

I'm going to agree that her math needs to be solid - very solid - and it's more important to be solid than to get other classes in. She may need a 5th year (gap year) to be as prepared as you and she want to be before heading pre-med IMO.

 

The other option is to go for a lower level college, but I'm not thinking those exist - esp for med school - in Germany. They would here. There are med schools that don't require Calc or Calc based Physics (BUT I'm not sure what's covered on the MCAT). There are lower level colleges where most students didn't do AP ahead of time - and it you're at the top of one of these schools, med schools will still consider your app (esp state med schools).

 

It's very rare for foreign students to do med school in our country as most schools restrict their schools to US or US and Canada. You'd have to check to see if the same is true for Germany. I suspect the link Regentrude gave will be a good place to look.

 

Going back to math, if she's willing, she can look at Khan Academy for extra help on any topic she doesn't feel solid in. A good foundation is super important for success in higher level classes. If she ends up doing well and wants to try for AP Calc while still in high school, can she do Geometry on the side (online class, summer class)? For our school this can be done as long as it's an accredited class. That way she wouldn't have to drop Orchestra...

[maize]

Matroyshka, is there any chance you daughter could do an exchange year in Germany or Switzerland? Maybe do that for the gap year you are envisioning--or do it for what would be her senior year then have her come home for another year to really focus on the math etc.. I'm thinking that she could get a better feel for what attending university over there would be like, and she would be much better prepared.

[regentrude]

The other option is to go for a lower level college, but I'm not thinking those exist - esp for med school - in Germany. They would here. There are med schools that don't require Calc or Calc based Physics

 

 

No, those schools do not exist in Germany.

All college bound German students have to take calculus in high school; it is part of the mandatory curriculum, irrespective of later major.

[Matryoshka]

No, they are set up completely differently. There is no such thing as "premed" - students who get into a medicine major study for six years in the med program, right from the beginning.

It is extremely competetive, because it is one of the few majors where student numbers are restricted (for most other majors, you just show up and study, as long as you have the Abitur- any university has to take you).

 

Here is a link to more information:

http://www.study-in....-studium--15755

 

Thank you for chiming in, Regentrude! I was hoping you'd show up. :)

 

The link is very helpful. I also found another one that said that after the 6 years, it's another 6 years to specialize in forensic pathology(!) Yeesh, so many years - this is the big reason I never went the doctor path. I wanted to get on with my life and not study so long! It also sounds like there are very few actual positions available, but I think that may be true even here (not sure she's thinking of staying in Germany forever - she also has dreams of living in England and Iceland and travelling and says she might even come back home someday). At least there are more positions than in marine archaeology - I joked with her that for a job opening in that field, she'd have to wait for someone to fall off Bob Ballard's boat!

 

This dd has always had big passions and big dreams. The irony is that of my three girls, she's the only one who struggles in math - the other two are very strong in math - but also don't have big passions.

[Matryoshka]

Matroyshka, is there any chance you daughter could do an exchange year in Germany or Switzerland? Maybe do that for the gap year you are envisioning--or do it for what would be her senior year then have her come home for another year to really focus on the math etc.. I'm thinking that she could get a better feel for what attending university over there would be like, and she would be much better prepared.

 

I'm not sure she could do that and not lose a year of school here, so for me it was making more sense just to do it after her senior year. She's been to school in Germany twice already, once for 4 weeks and once for 2, but of course she was much younger and it was just a taste and didn't "count" for anything.

 

I'm starting to wonder if this goal lasts till the end of high school, if it would make sense for her to take a semester of college (not cc) classes here after graduating, including Calc and Physics, then if she's still gung-ho on this, apply for the next year and head over early for more immersion. Or maybe she'll just need two years.

[Matryoshka]

I'm going to agree that her math needs to be solid - very solid - and it's more important to be solid than to get other classes in. She may need a 5th year (gap year) to be as prepared as you and she want to be before heading pre-med IMO.

 

I'm starting to think this may just be a necessity.

 

It's very rare for foreign students to do med school in our country as most schools restrict their schools to US or US and Canada. You'd have to check to see if the same is true for Germany. I suspect the link Regentrude gave will be a good place to look.

 

Actually, it said there were a certain number of seats set aside for non-EU students, though it was easier for an EU student to get in.

 

I wonder if she went to the 6-year med route over there, could she come back here to do her internship/residency? Where do all the foreign doctors here come into the system? If she does run off to conquer the world, I selfishly hope that she'll come back home someday...

 

Going back to math, if she's willing, she can look at Khan Academy for extra help on any topic she doesn't feel solid in. A good foundation is super important for success in higher level classes. If she ends up doing well and wants to try for AP Calc while still in high school, can she do Geometry on the side (online class, summer class)? For our school this can be done as long as it's an accredited class. That way she wouldn't have to drop Orchestra...

 

She doesn't like Khan Academy that much, but I continue to suggest it.

 

I think I need to talk to her Guidance Counselor about an outside class in Geometry, and what, if anything, they'd accept as credit. She doesn't want to do it this summer, as she's got a bee in her bonnet about visiting Iceland (she's saving her own money). Colliding passions... but it would be good to know options. I do worry a bit about her taking a math class in such a short time span and really getting it, although since Geometry isn't really foundational like the Algebra sequence, maybe it would be okay. But she'd still have to get it well enough to get a good grade...

[regentrude]

although since Geometry isn't really foundational like the Algebra sequence, maybe it would be okay.

 

If I may comment on that: geometry is actually foundational! The geometry material is a vital prerequisite for trigonometry/precalculus and also parts of calculus. Geometry is also the class when students are introduced to mathematical thought and proofs, a way of thinking that is necessary to succeed in higher math courses which should be presented in a more abstract and theoretical way.

[at the beach]

FWIW, my daughter has spent lots of time around residents and fellows this year. She tells me they come from a variety of backgrounds and from their own statements math isn't necessarily their strong suit. ;) Not suggesting you slack on the math, of course. Anyway, a recent resident she met spent three years working at Home Depot after college before deciding on med school. A good friend of hers had top stats, a 33 MCAT and got no interviews first time applying straight from college. A year later, he got accepted pretty quickly, started this fall and is loving it. The same year my daughter's friend got rejected, a relative got into med school right from college. She didn't have top stats. She wasn't even in her university's honors program when she started college, and her major was Biology.

 

It looks like the new MCAT will have a stats section but from what I can tell there currently is no separate math section at all. ETA: It looks like new MCAT includes stats but it is actually not a separate section. And there will be more humanities. Some med schools don't even require calculus as a prerequisite. For Case Western, a year of college calculus is only required for students applying to the medical scientist training program. Ohio State and University of Michigan--no calculus requirement. None at Vanderbilt. Johns Hopkins website says that it requires one year of calculus and/or statistics and AP credit for Calculus is okay. Regardless of AP credit, JH recommends a minimum of one semester of statistics. Tufts does not have a math course requirement but recommends coursework in statistics, calculus and computer science. Columbia doesn't appear to have a math requirement. And the physics requirement at any website I've looked at is not calculus-based.

 

Here is a link to the what's on the new MCAT: https://www.aamc.org...reviewguide.pdf

[CrystalM]

The one thing missing from these two Med school threads is obtaining a DO license as opposed to an MD license to become a doctor. In the U.S. they are equivalent licenses but the requirements to get into a DO school are a little less strict. Here is a link to the American Association of Colleges of Osteopathic Medicine. http://www.aacom.org/about/osteomed/pages/default.aspx

 

This route to become a doctor could be a better option for your daughter if she enters colleges with less than AP Calc. Check out this link for more info on what will be required to apply to a DO school. http://www.aacom.org/InfoFor/applicants/Pages/default.aspx

 

I hope this helps ease fears that I think are being generated from a slight lack of knowledge of the various paths to fulfilling the medical school dream.

 

Crystal

[Jane in NC]

It looks like the new MCAT will have a stats section but from what I can tell there currently is no separate math section at all. And there will be more humanities. Some med schools don't even require calculus as a prerequisite. For Case Western, a year of college calculus is only required for students applying to the medical scientist training program. Ohio State and University of Michigan--no calculus requirement. None at Vanderbilt. Johns Hopkins website says that it requires one year of calculus and/or statistics and AP credit for Calculus is okay. Regardless of AP credit, JH recommends a minimum of one semester of statistics. Tufts does not have a math course requirement but recommends coursework in statistics, calculus and computer science. Columbia doesn't appear to have a math requirement. And the physics requirement at any website I've looked at is not calculus-based.

 

 

A question--this from someone who knows nothing about med school.

 

Requirements of applicants and expectations are often different. For example, few students will be accepted into UNC-CH as an undergrad with only minimal requirements. So I am wondering if there is a difference between the lack of requirement of certain math classes and the reality of what successful applicants have on their transcripts.

[kiana]

One of my friends got into a UK university by submitting a year of good (4.0) grades from a local college in lieu of A levels/APs. Would that be an alternative? Or maybe high school in Germany would work, if she could exchange for a year and then take a "13th grade" year?

[creekland]

A question--this from someone who knows nothing about med school.

 

Requirements of applicants and expectations are often different. For example, few students will be accepted into UNC-CH as an undergrad with only minimal requirements. So I am wondering if there is a difference between the lack of requirement of certain math classes and the reality of what successful applicants have on their transcripts.

 

 

Like with undergrads, minimum requirements tend to not be flexible and many do have more than required. However, by establishing their minimums, adcoms are then free to look at those who "only" meet those minimums vs outright rejecting them due to needing the "top." I would think if one only has the minimum requirements, the rest of their app better have something very attractive on it to get an interview. Once one is at the interview stage, I'm not sure apps matter as much.

 

We opted to head for "max" in order to not burn bridges when/if my guy wants to apply to med schools, but that's not an option everyone needs to take.

[regentrude]

. Some med schools don't even require calculus as a prerequisite. For Case Western, a year of college calculus is only required for students applying to the medical scientist training program. Ohio State and University of Michigan--no calculus requirement. None at Vanderbilt. Johns Hopkins website says that it requires one year of calculus and/or statistics and AP credit for Calculus is okay. Regardless of AP credit, JH recommends a minimum of one semester of statistics. Tufts does not have a math course requirement but recommends coursework in statistics, calculus and computer science. Columbia doesn't appear to have a math requirement. And the physics requirement at any website I've looked at is not calculus-based.

 

 

While this may certainly be true about the colleges' requirements, the students will still be competing with students who went above and beyond the minimum requirements and did take calculus and calc based physics.

I teach an algebra based physics course for pre-medical and biology students, but almost all the students in my course have actually taken calculus. Every year, I have some pre-med students who choose to take my harder calculus based physics course(which is not required for their major), because that improves their performance on the MCAT physics section, since the class covers more material in more depth, plus gives them an edge at admissions.

 

I would be careful to just look at requirements; it is important to look at the background of the students who are competing for admission.

[at the beach]

While this may certainly be true about the colleges' requirements, the students will still be competing with students who went above and beyond the minimum requirements and did take calculus and calc based physics.

I teach an algebra based physics course for pre-medical and biology students, but almost all the students in my course have actually taken calculus. Every year, I have some pre-med students who choose to take my harder calculus based physics course(which is not required for their major), because that improves their performance on the MCAT physics section, since the class covers more material in more depth, plus gives them an edge at admissions.

 

I would be careful to just look at requirements; it is important to look at the background of the students who are competing for admission.

 

I wasn't suggesting one only "just" look at requirements nor was I suggesting getting requirements out of the way was the only thing one needed to worry about when it comes to medical school. :) I did mention residents and fellows in my previous post who self-admittedly felt math wasn't their strong suit. I was simply trying to point out to the OP that if her child is in 9th grade doing Algebra 1, perhaps that's okay or even more than okay and that even if her daughter is never super strong in math that might not keep her from medical school anyway. And further, this thread (and the other pre-med thread) implied (at least that's how I took it) that a year of calc was a necessity at most med schools and that one might need to know it for the MCAT. So, out of curiousity, I checked some admissions pages, and to my surprise, I found out otherwise and wanted to put that info out there.

 

Obviously, student background comes into play and the whole picture of who the student is comes into play--how they are showing their passion for medicine is I'm sure a big factor. And those students who take calc-based physics will also be competing with other students who have done other special and above and beyond things. I think once you get that interview, as Miss Marple said in the other thread, your foot is in the door. Absolutely, an MCAT score is important and taking what is necessary to do well on that and to prep for that is important. And now the MCAT is going to include more humanities.

[snowbeltmom]

I teach an algebra based physics course for pre-medical and biology students, but almost all the students in my course have actually taken calculus. Every year, I have some pre-med students who choose to take my harder calculus based physics course(which is not required for their major), because that improves their performance on the MCAT physics section, since the class covers more material in more depth, plus gives them an edge at admissions..

 

 

Regentrude, does the algebra-based physics course at your college cover all of the topics contained in the AP Physics B syllabus? I don't mean for the question to sound disrespectful. I have read comments about the Physics B program that it just skims the surface of many topics but does not go in depth with any of them. Sort of the "mile wide and an inch deep" concept.

 

My son was at CTY a couple of months after completing the AP Physics B course. For some reason, another student at CTY had an MCAT prep book. My son said he took the physics section of the test and got every question correct. I was surprised to hear this since he hadn't had calc, but my son said that he was told that the MCAT physics only tests the concepts included in the AP Physics B course.

 

I think for a liberal arts major, who had strengths in areas outside of math and just needed to take the medical school pre-req's, would be fine with an algebra-based physics course as long as it covered all of the topics in the AP Physics B curriculum. The students from your school who took the calc-based physics may have scored higher on the physics section of the MCAT because they were stronger in math to begin with.

[regentrude]

Regentrude, does the algebra-based physics course at your college cover all of the topics contained in the AP Physics B syllabus? I don't mean for the question to sound disrespectful. I have read comments about the Physics B program that it just skims the surface of many topics but does not go in depth with any of them. Sort of the "mile wide and an inch deep" concept.

 

Your question is not disrespectful at all - it is a very good question. The short answer is: no, it does NOT cover everything that is on AP Physics B, for the following reasons:

I, as the instructor of the entire two semester sequence, have discretion which topics to cover because it is the only physics course for these students and not a prerequisite for any follow-up courses. Thus, I have chosen to limit the material that I cover to mechanics, including oscillations and basic fluid dynamics, in the first semester, and electromagnetism, including optics and e-m waves, in the second semester. I prefer to cover basic concepts thoroughly and in depth; if I wanted to get through the entire text, we would have to go faster and the students would not understand in as much depth as I want them to. We only have three class hours per week, and two semesters. (In other colleges, algebra based physics may be a four hour course and/or stretch over three semesters). Also, I am trying to focus on the material needed for biological applications - we discuss things like blood pressure increase due to narrowing of capillaries, electric potentials across cell walls, the microscope, the principle of the MRI, model the nervous system as RC circuits...

 

I completely skip any thermodynamics, because those biology students all have multiple chemistry courses, and thermodynamics is covered in chemistry. Likewise, I do not cover atomic and nuclear physics, because these, too, will be at least touched on in chemistry,

 

I was surprised to hear this since he hadn't had calc, but my son said that he was told that the MCAT physics only tests the concepts included in the AP Physics B course. ...

I think for a liberal arts major, who had strengths in areas outside of math and just needed to take the medical school pre-req's, would be fine with an algebra-based physics course as long as it covered all of the topics in the AP Physics B curriculum. The students from your school who took the calc-based physics may have scored higher on the physics section of the MCAT because they were stronger in math to begin with.

 

 

You are correct that calculus is not needed for the MCAT. However, the calculus based physics course those students I mentioned take is a four hour course for physics majors that covers a lot more material: not only can we go faster because of who the target audience is, we also have 33% more class hours and about 50% more/harder homework. Btw, the calculus based 2 semester course still does not cover modern physics, but it does cover some thermo, and it does a lot more of everything.

[Osmosis Mom]

If your dd wants to study med in Germany, then you should consider that the incoming students there most likely will be 19-20 years old like in Denmark. The medicine program there is also very competitive (but not the most competitive, it depends on number of slots). We do go all the way up to Calculus, but to get into something like Medicine in DK then you don't need the msot advanced math program available. I agree that many doctors (which means med students) are no math whizzes at all. Anyways, I would have her take some math over the summer at a cc college. I don't understand why she can't do that? If she wants to go to Iceland, then she could squeeze that in or choose to potentially wager her option at being able to go study in Germany.

 

We have many international residents here in Boston. They have to take a specific exam when they get here in order to do residency which is hard for many, but probably would be doable for an American student, fresh out of her studies in Germany. I would not be worried about that. would worry a bit about the maturity level and stamina of a young 18 year old starting med studies in Germany, but that is your consideration, of course, as you know her.

[armymomma]

I went to med school as an English major. We had a music major, theology, and history majors in our class. You don't have to super at math to go to med school. DH wanted to be Quincy - old tv forensic pathologist. He decided against it after spending several months of residency at the medical examiners office. TV and real life are very different. She might want to gain some real world exposure - it is a long haul. DH loves pathology and is so glad he chose it. I liked the good hours he had at the MEs office, but the pay tends to be much lower than other pathology subspecialties.

[armymomma]

I went to med school as an English major. We had a music major, theology, and history majors in our class. You don't have to super at math to go to med school. DH wanted to be Quincy - old tv forensic pathologist. He decided against it after spending several months of residency at the medical examiners office. TV and real life are very different. She might want to gain some real world exposure - it is a long haul. DH loves pathology and is so glad he chose it. I liked the good hours he had at the MEs office, but the pay tends to be much lower than other pathology subspecialties.