Objectives:
I would like to give students an actionable guide and advice to determine if a year off during medical school is right for them. There is no one right answer, and much depends on the individual situation. That being said, this guide will allow students to start thinking about this option earlier on in their medical school career and answer the “tough” questions that will enable them to make this decision.

Helpful Links/ References Used In Making This Guide:

Introduction and Common Questions:
While the standard MD degree is four years, many students may ponder the possibility of taking a “year out” opportunity during medical school. In this guide, I will try to use the phrase “year out”, as I feel that the phrase “year off” implies a negative connotation. Whether it be for personal reasons, career advancement, exposure to new opportunities, or a mix of all of the above, there are a quite a few ways to spend one’s time away from the standard medical school curriculum. I wrote this guide as a student who took a research year between MS-3 and MS-4, and my personal experience will come at the end of the guide as a point of reference. However, the purpose of this guide is to help students answer the tough questions about whether a year out opportunity is right for them, and help start the process for lining up the numerous opportunities available to MD students. I will discuss the various opportunities broadly, and offer a 3-step approach to plan and finalize the year out opportunity. Overall, I recommend applying broadly, starting early, and doing your due diligence with the help of mentors to make the best decision.

Questions You Should Ask Yourself (And Why They Are Important):

I consider a year out to be differentiated from “time off” of school when it changes your graduation date. Oftentimes during medical school, health reasons or interpersonal relationship issues come up and require students to take a temporary leave of absence. Students can often still return to their same academic year and graduate at their intended date. However, leaves of absence can extend long enough where it is impossible to graduate on schedule, and therefore convert into year out opportunities. In this hybrid approach, students fill the “extra” time between their leave of absence and the next academic year with year out opportunities. With a standard year out approach, students commit to an entire academic year in their activities (advanced degree, research, clinical experience, etc.), and return to medical school after they are completed.

Being honest with yourself about what you’re truly aiming to get from a year out experience is the most important way to figure out whether a year out opportunity is right for you. There’s no right or wrong answer here! Are you looking to learn a new set of skills or knowledge? Hoping to pad your research portfolio for a competitive specialty? Gain exposure to a clinical scenario that you would be otherwise unable to? Interested in traveling to a new city or staying in the same one? Is this year primarily for increasing residency competitiveness, or more so to develop yourself? All of these approaches are valid, but require different amounts of prep work. Remember that a year out opportunity oftentimes means graduating with a different class than the one you started with!

Unless dictated by a leave of absence, generally the main branch point is between MS-2 and MS-3 year or MS-3 and MS-4 year. This depends on personal preference and likely the opportunity which you may be seeking out. Keep in mind that STEP 1 is generally taken during between MS-2 and MS-3, while STEP 2 is taken earlier on in the MS-4 year. If interested in a degree-seeking program such as an MBA or MPH, there may be a “cleaner” break between the preclinical and clinical years. However, for research years and clinical opportunities, finishing your required clinical rotations will likely give you better insight into what specialty / clinical experience you may be interested in during your time off.

Some opportunities such as research fellowships or 1-year MPH degrees will require a full-time commitment of a year, while other more informal opportunities such as ad-hoc research or clinical electives can be done in a smaller time frame. Keep in mind that things like onboarding, training, and paperwork can eat up significant amounts of time and productivity early on. It is important to be clear about what you need to get out of this opportunity. For example, if your goal is to have multiple peer-reviewed papers and abstracts from your time off, a 3 month ad-hoc research experience probably won’t be enough to do anything significant. Try to be realistic about your expectations, as the year will go by faster than you think!

Another question for this year out opportunity is whether or not you really need it. Will your career arc be significantly impacted positively or negatively from this change? For example, getting an MS in biostatistics may only help you if you plan on a physician-scientist career AND expect to do statistical work yourself. Conversely, doing a lot of research in GI immunology when your goals are to match into a heavily clinical OB/ GYN residency program may not be the best use of your time.

Another reason why you should strongly consider whether a year out is right for you is because many opportunities are unpaid. Many degree-seeking programs offer scholarships, but they may be few and far between. The year long research fellowships (Sarnoff, NIH Scholars, etc.) are competitive and dwindling in size as research institutions find many students taking advantage of the funding, but not remaining in academic or physician-scientist careers long terms. Some principal investigators have grants which they can place you on their payroll for, but these discussions need to happen EARLY in order for your name to be put on the grant or for the PI / department to pay you. Therefore, you should consider your financial situation and decide if you are willing to still undergo the year out opportunity if you are unpaid (or paying) for the opportunity. Additionally, there is an opportunity cost of losing one entire year of attending-level income, in that you will start practicing one year later than you otherwise would have if you did not take a year off. This may or may not be important to you, but it is an important consideration especially if you have a significant loan burden.


Broad Umbrellas of Opportunities:

Many students elect to take a year to pursue an advanced degree in addition to their MD degree. For example, students interested in healthcare administration or the economics of medicine can pursue an MBA in order to learn these skills. Once residency begins, it may be hard to obtain this knowledge “on-the-fly”, although certain institutions may be supportive of helping pay for the degree during your residency experience. The negative of this degree is that oftentimes it will cost a significant amount of money (often over 50k), which is hard to swallow as a medical student. However, some students are successful in receiving financial assistance or scholarships in order to pay for the degree.

Students applying to competitive specialties or looking to bolster their applications often complete research years both at or away from their medical school. The benefits of a research year include potential publications/ presentations/ abstracts as well as formal and informal networking at conferences and within the department. Students should be objective about their applications with the help of a mentor, and determine if the research opportunity provided will genuinely improve your chances of matching into that specialty and benefit your career long-term. Research years can be highly variable between bench and clinical work in terms of hours, weekends, and responsibilities. Retrospective/ chart review work can be done virtually, while most prospective clinical trials and bench research requires active time on the job. Be sure to try to find research that genuinely interests you, as it will be a significant portion of your life during your time off.

There are several community service, global health, advocacy, and clinical opportunities which you may be able to take advantage of during your time off. These are incredibly variable and specialty-dependent, so it helps to know if you have a specific interest in a field before choosing these opportunities. In my opinion, I feel that clinical opportunities must be fairly extraordinary to take time off from medical school. This is because you will have the opportunity for clinical electives during fourth year and a number of residency programs provide access to global health opportunities which are paid for / bundled into residency without any loss of time. However, some opportunities such as advocacy, community service or addiction medicine training can be worth taking some time off in order to develop a skill set you do not anticipate being able to receive otherwise.

Step 1: Prepare Your Own Application
The first broad piece of advice I will give is to start earlier than you think. I would say roughly speaking, it can take anywhere from 6 months to 1 year before the start of your year out opportunity to get everything finalized. Before looking at year out opportunities, you should make sure that you are in good academic standing with the medical school and that they would be supportive of you taking time off. Overall, successfully completing the MD degree is far more important than any other optional experience, so I would focus on that if you had to choose. Finally, I would take some time to get your resume and curriculum vitae (CV) up to date. I would recommend having a 1-page resume and a more lengthy (somewhere between 2-3 pages) CV. By having this information in hand, you can assess what your individual areas of weakness are in your residency application and be prepare to start your search. There is also the added benefit of helping yourself when you eventually submit your ERAS application for residency.

Step 2: Start Exploring Your Options
If your mentors can help you connect with specific opportunities at this stage, it’s worth doing your due diligence and seeing if they’re a good fit for you. In terms of advanced degrees, now is the time to research application deadlines and requirements so that you’re ready for the next application cycle. Be proactive and reach out to admissions offices early with concerns about balancing coursework and medical school if there is any overlap or question about meeting all of the requirements. For research years, a good way to start might be to reach out to your home department in your specialty of interest to see if there are any good opportunities. See if there are any major players (e.g., professors with funded NIH grants) that might be able to take you on. Be realistic: if you are with this lab for 10 months, can you reasonably expect multiple publications from this principal investigator? Honesty between your mentor and whether you want a paid/ unpaid opportunity and how productive you need to be can go a long way. For clinical/ advocacy/ community service opportunities, it may be helpful to check out the links above or inquire directly with organizations to see if they have supported medical students in these endeavors before. I recommend creating a rough “template letter” via email which you can discuss your general interest in a year out opportunity, the dates you would be available from, and some specifics about the opportunity you are applying for before attaching your CV/ resume. It’s always better to over-apply to opportunities and decline them later than to be stuck deciding between options that you are not excited about. Personally, I feel that there is genuine value in doing a year out opportunity at a location or institution which you could genuinely see yourself for residency. In doing so, you can network informally with the institution for a full year and establish roots that you can come back to. Additionally, you may be able to develop relationships with mentors who can write letters of recommendation or make calls for you when you eventually apply. It will generally be harder to set up an opportunity away from your own medical school, but I think it is worth it to at least explore those options!

Step 3: Commit to Your Choice
Once you have started to narrow down your options, it’s time to speak with your mentors and other important people in your life to finalize the decision. Then, it’s time to tackle any associated paperwork and logistics with enrolling in the opportunity and (potentially) moving to a new place if necessary. Be aggressive about any HIPAA training, CITI research certification, or HR paperwork that might come up—oftentimes, this can lead to delays in your start date if not addressed proactively. On the medical school side, confirm with your school that your paperwork is in line and that you are set up to start your non-clinical time. I personally recommend completing your board examinations before the year out opportunity if possible (STEP 1 and preferably STEP 2), as you will definitely be a bit “rusty” when you come back to clinical rotations and likely will not have as high a knowledge base as when you’re just finishing your required MS-3 rotations. Lastly, make sure to enjoy the year! It is important to be productive, but year out opportunities are also a way to take some time off of the regular medical student grind and enjoy a work/ life balance.

My Own Experience
I started thinking about my year out opportunity early on, as my partner went to a different medical school in another state and was one year behind me. Therefore, I wanted to come up with a year out opportunity that was beneficial for my own career, but also enabled me to line up our graduation years for couples match. My line of thinking was that I wanted to make at least some money during the year instead of paying for an advanced degree or clinical opportunity, and I wasn’t sure how either of those would line up with my future career. I had significant research experience and wanted to leverage that in my CV in order to land a high quality research year. I wanted to go into Anesthesia and knew I had some interests in cardiac anesthesia/ postoperative neurocognitive dysfunction (delirium), and applied to the Sarnoff National Cardiovascular Research Fellowship. I reached the final round for the award, but was not ultimately selected. However, doing a literature search helped me find a bunch of different labs/ PI’s who I felt like would give me a strong foundation for a 1-year experience. Since I was only able to commit to around 10-11 months, I wanted to work with a PI who had a strong track record of publications and work at a place that would serve as a connection for my residency applications the following year. In addition to emailing PIs and setting up informational discussions (if they responded…), I leveraged my existing networks / connections and asked them if they could put in a good word for me. I think medical students in general don’t realize how many people they might know at other institutions through mutual friends! Ultimately, I was able to land a paid position at Harvard Medical School (BIDMC/ MGH), where I was given a lot of autonomy and learned a LOT about clinical research. It took over a year from start to finish to my first initial communication with the PI to being 100% confirmed by HR. This might not be uncommon, since PI’s are generally incredibly busy and you often have to be persistent in following up in them. However, this year out opportunity has helped my career develop in so many ways. Besides providing me with a lot of posters/ presentations/ submitted publications, it also gave me really strong LORs and connections as I applied to residency the following year. In many ways, your research year (especially if clinical) can serve as a year-long “away” rotation at an institution. That has both benefits and risks, but in my case it has panned out well for me. I am always happy to help support anyone who is considering a year out opportunity, or even has questions in general about time off during medical school. Feel free to contact me via Twitter or at akshay.shanker@hey.com!