Abstract
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>As healthcare systems increasingly shift toward prevention and community-based care, the demand for physicians in extramural specialties continues to grow. Yet, a mismatch persists between workforce needs and medical students’ career aspirations. Little is known about how medical students and trainees develop an interest in extramural specialties such as youth health care (YHC). This study explores trainees’ trajectories toward becoming a youth health care physician (YHCP).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We conducted a qualitative study using semi-structured online interviews with fourteen YHCPs in training. We combined an inductive and deductive approach, applying the person-environment (PE) fit framework to explore participants’ evolving experiences of fit and misfit.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Participants described growing misfit with clinical culture of medical school (i.e. the ‘hidden curriculum’), particularly during hospital-based clerkships, combined with limited exposure to YHC. For some, this misfit extended to doubts about becoming a doctor. Over time, participants developed a sense of fit and belonging within YHC, either directly or after exploring other specialties including extramural specialties.</jats:p> </jats:sec> <jats:sec> <jats:title>Discussion</jats:title> <jats:p>These findings reframe specialty choice as a longitudinal search for belonging and alignment, in which trainees iteratively explore, evaluate, and refine their sense of fit across contexts. Clerkships serve as key sites for testing fit, yet also expose learners to the clinical culture, including the hidden curriculum. Broadening exposure and supporting reflective fit processes may encourage more medical students to choose extramural specialties, ultimately fostering a more balanced and sustainable alignment of the medical workforce.</jats:p> </jats:sec>