Turning a Gap into a Bridge: The Fifth Year Option (Dr. Aamir Hussain)

I am excited to introduce Dr. Aamir Hussain as the first guest writer on the Road to Rank blog! He is completing a preliminary internship at Hofstra, and will be starting his dermatology residency at Georgetown.

For those who don’t know, most medical schools offer students the option to pause their rotation schedule between the third and fourth years to gain additional research or educational experience (either at the same institution or elsewhere). For example, Dr. Hussain extended medical school to obtain a master’s degree in public policy. I have been asked by many students applying into competitive specialties whether they should “take a fifth year” to strengthen their residency application. There’s no one-size-fits-all approach to this question because it depends on many different factors: board scores, prior research experience, personal and financial implications, etc. However, I have seen many cases where extending medical school opened doors for an applicant that may never have happened without the experience gained during that extra year. Whether it leads to more research publications, an additional degree, or even just one key mentor who is willing to pick up the phone on an applicant’s behalf, the fifth year option often leads to more residency interviews and a higher chance of successfully matching into a competitive specialty. However, the decision should not be taken lightly. There are significant costs associated with the fifth year option, and program directors will fully expect an applicant to have something tangible to show for taking the extra time off.

Dr. Hussain does an excellent job in this post detailing a few of the many opportunities available to a medical student interested in taking a fifth year to strengthen their residency application!

The first question to consider is whether you truly want an additional degree during your gap year from medical school. When considering any type of gap year program, it is important to think about the specific things you would like to gain from the “time off”, as well as the opportunity cost of spending an extra year as a student. For example, if taking a research year, you may gain some additional publications and conference presentations that can strengthen your residency application. However, this comes at an opportunity cost of a lost year of income as an attending, and potentially needing to use savings rather than earning a salary during that year.

While taking a research year is a common opportunity for students (especially those applying into highly competitive specialties), there are a few drawbacks:

  1. There is an immense pressure to publish or present. Residency programs will definitely ask what you accomplished during your gap year, and they expect some kind of finished product. If you don’t have any tangible achievements, you may come across as inefficient or lazy. This is probably an unfair statement (after all, research faces many setbacks, and “positivity bias” is still present in today’s papers!); however, many Program Directors are old-fashioned and may get nervous about you being “out of the medicine game” for a year and will want to see that your sacrifice was worth the cost.

  2. Funding is not always guaranteed. While many famous programs and fellowships have stable funding and are consistent each year, many students working under a specific principal investigator (PI) have found that their grant funding can run out, their PI can be let go or transferred to a faraway institution, or there may be additional financial obstacles to completing their research.

  3. Should you focus on quality or quantity of research? This is admittedly a hard question to answer. Case reviews and case reports are often easier to publish, but seem less impressive than basic science or clinical research. It is important to pick a project that you are passionate about, that you will dedicate time to, and that you can talk about in interviews.

If research is not interesting to you, another popular option is to consider a master’s or other additional degree program. One benefit of a degree is that you are guaranteed a tangible product (as long as you pass!), so residency programs will know that you had a meaningful accomplishment during your gap year. The downside is that many degrees are not directly relevant to the practice of medicine, and it is up to you to make that connection. Also, while medical education is largely standardized, master’s education is not; therefore, going to a “big-name” or “highly-ranked” program is much more important. When considering a dual degree, think about your geographic preference for your gap year, whether you would like to stay at the same institution, and your institution’s particular strengths.

The following are some of the common master’s degree options:

  1. Master’s in Public Health (MPH): This is by far the most common, and many medical schools offer it as a 5-year dual degree along with the MD. Otherwise, both 1- and 2-year programs exist depending on the institution. MPH degrees focus on biostatistics, epidemiology, and often have a research component to them. They often have significant overlap with medical school coursework, and connections with the practice of medicine are often easy to make.

  2. Master’s in Business Administration (MBA): This degree is rising in popularity among healthcare professionals. Many medical schools offer it as a 5-year dual degree with the MD. Part-time, online, and full-time 1- and 2-year programs exist depending on the institution. This degree focuses on how to run a business, including coursework on management techniques, leadership, negotiations, accounting, and finances. Students interested in private practice might be interested in this degree. Among all of the master’s options, the “brand name” (i.e. the institution’s reputation) is most important for an MBA.

  3. Master’s in Public Policy (MPP): This degree is still relatively uncommon for healthcare professionals because its relevance to medicine is the most tenuous. These degrees are highly variable depending on the institution. Public policy is a broad term that encompasses government work, nonprofit management, international affairs, social welfare and reform, public speaking, economic analysis, and many other topics. Both 1- and 2-year degree programs are available depending on the institution. When choosing this program, you must do a lot of research about the curriculum, and the post-graduate opportunities for students.

  4. Master’s in Biostatistics: This degree is also rising in popularity, especially for students interested in data-driven research. A strong background in mathematics, statistics, evidence-based medicine, and computer programming is usually expected. These programs are usually 1-year. One benefit of this degree is that students can often pursue independent research and publish as part of their coursework.

This is not meant to be an exhaustive list of degree options! Each institution offers its own unique opportunities, and it is important for students to stay abreast of financial aid, funding, and other fellowship applications.

Students should play to their strengths, and find unique angles for gap years whenever possible. I have met students who pursued global health opportunities that they began in undergrad or earlier, others who have worked on an artistic pursuit such as poetry or painting, and still others who completed service-learning fellowships. Be creative, and let residency programs see the passion in your work!

Dr. Aamir Hussain

Twitter: @AamirNHussain

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