Allison R Chang, Shraddha Pandey, Adnan Alseidi, Michel Kabbash, Sarah Lund, Blake T Beneville, Nicole M Santucci, Maria Kaltchenko, Riley Brian
In the context of evolving assessment systems, residency application competitiveness emerged as a primary factor influencing students' decisions to take a gap year. Students described that the transition of Step 1 to pass/fail led to fewer objective application metrics, with an ensuing focus on increased research productivity as a perceived differentiating factor amongst applicants. Personal and professional growth motivations remained present, but often played secondary roles in decision-making. For both gap year and traditional students, concerns regarding research years included variable access to funding, financial and temporal costs, and implications for delayed career and family timelines.
OBJECTIVE: Recent changes have substantially impacted the assessment of medical students, including adjustments in clerkship grading and the transition of Step 1 to a pass/fail grading system in 2022. This study examines factors influencing students' decisions to take a gap year and the potential impact of assessment changes on the landscape of these decisions.
DESIGN: This qualitative study used semi-structured interviews of medical students applying to surgical specialties to gather in-depth perspectives regarding their decision-making processes around taking or not taking a gap year.
SETTING: We conducted virtual interviews with students from 5 U.S. medical schools located in the West, Midwest, Mid-Atlantic, and South.
PARTICIPANTS: Interviewees comprised 25 senior medical students pursuing surgical specialties including general surgery, orthopedic surgery, neurosurgery, plastic surgery, and otolaryngology-head and neck surgery.
RESULTS: We identified 5 main themes related to students' gap year decisions. Local institutional and specialty cultures set background expectations around gap years. Within these contexts, 3 dominant and often interrelated reasons motivated gap year decisions: the anticipated potential of a gap year to affect residency application competitiveness; personal, nonacademic circumstances; and the desire for professional growth. Regardless of students' gap year wishes, logistics ultimately dictated decisions for many students.
CONCLUSIONS: In the context of evolving assessment systems, residency application competitiveness emerged as a primary factor influencing students' decisions to take a gap year. Students described that the transition of Step 1 to pass/fail led to fewer objective application metrics, with an ensuing focus on increased research productivity as a perceived differentiating factor amongst applicants. Personal and professional growth motivations remained present, but often played secondary roles in decision-making. For both gap year and traditional students, concerns regarding research years included variable access to funding, financial and temporal costs, and implications for delayed career and family timelines.