Trying the find the medical specialty that is right for you is a process that everyone in medical school experiences. It's definitely an important decision that affects your future training and career. The timing of knowing this answer, however, varies. Some seem to already have made up their minds even before starting medical school, while others make up their mind close to the residency application cycle. The bottom line is, that there is no right way (or time) to find out. Starting early is great, but don't worry if you don't find an answer right away. Trust the process and yourself that you'll eventually find something that's right for you.
If you absolutely don't know:
That's ok! Start researching and exploring around. The AAMC website has many resources, such as surveys, career descriptions, and mentorship resources. Talk to those around you- senior med students, faculty members, deans. Asking others about how they reached their decision can be helpful. If you have not entered clinical years yet, don't be afraid to contact physicians to schedule a meeting and share your interest to find out more about their specialty and daily life. This may seem daunting, but most (if not all) of us can remember the time when we also went through this process, and are happy to help.
Another way is to ask yourself "what do I not want to do?", and "why don't I want to do this?". These questions are great to start striking out specialties you don't want to consider and also help you realize what you want to do.
If you have a "broad" idea of what you'd like to do:
Time to explore! Look out for shadowing opportunities, especially in specialties where your medical school may not have core clinical clerkships available. If you are able, plan out your clinical rotations so that you can rotate through these specialties relatively early to confirm/refute your interest. Some people will find that they enjoy the specialty, but many also realize that a specialty is not for them, so it would be helpful to know earlier than later. Just keep in mind that the earlier you do a rotation, the less experience you may have carried forward from previous rotations, so it may also help to not rotate through your top specialty first in clinical years.
It might be helpful to keep a list of specialties that you're interested in and jot down notes of what you like and don't like about them. Some things to consider can include: how much the topic interests you, impressions of the "culture" of the specialty, work-life balance, amount of potential future income, the competitiveness of residency, length of training, and so forth. Over time, you can continue to add/edit and look back to your notes, a great way to reflect on your options.
If you are struggling to decide between a few choices:
Continue to try to gain exposure and experiences to see which specialty is right for you. At the same time, start to broaden your extracurricular activities in these areas of interest, such as joining/leading the student interest group for this specialty and doing research or scholarly projects. Joining national/regional societies and networking with people in the field are also important to building your connections. Overall, remember all of these endeavors are not only to help make you a more competitive applicant but also to help you confirm whether a specialty is right for you.
If at this time you are noticing that you are interested in a competitive specialty, but perhaps you do not have a strong enough CV, or that you would need more time to explore/confirm this decision, consider discussing with your advisor and deans about the potential of a gap year. Many may have mixed feelings about taking a year off, especially since the training to become a physician is such a long process already. If taking a year off is not for you (and there may be other reasons involved, such as finances), then it's worthwhile to consider how important it is to match in the specialty that you are considering. However, if this specialty feels "worth it", and is absolutely something you want to consider, then taking an extra year will help you reach your overall career goal.
It's also ok to dual apply-- talk with your dean or academic office about this option. In addition, there may be residencies that offer combined program tracks, such as meds-peds, and neurology-psychiatry. One other thing to keep in mind is that different residency training may lead you to the same end goal through fellowship. For example, if your interest is in sleep medicine (which is its own fellowship), then training in neurology, psychiatry, or internal medicine with a pulmonology focus could all lead to a similar end goal.
If you have found the "one"
That's great!
Continue to enrich your experiences in this field, as well as continue to build your network. Start to think about what to include in your personal statements, such as relevant patient encounters, past experiences, and traits about your own personality that would make you a good fit for this specialty. You can also think about reaching out to program directors in any residency programs that you are interested in.
(This may not apply to everyone, but if you notice that you are having trouble writing a personal statement that reflects you as a person while including convincing reasons of why a specialty is right for you, then this may be a flag. Try writing a personal statement for another specialty, for example, your 2nd/3rd choice that you had decided against earlier, and notice if it is easier to write. If so, this might indicate that you should think more about whether your current top choice specialty is right for you).
Finally, know that it's ok to change your mind (even if it is late), because after all this decision will affect what you will do for your future career. It is important to consider what will make *you* happy
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