A gap year is defined as ‘a semester or year of experiential learning, typically taken after high school, or prior to career or post-secondary education, in order to deepen one’s practical, professional, and personal awareness’, according to the Gap Year Association. Most people who graduate medical school go on just a few weeks later to begin residency training in their chosen medical specialty. However, some graduates contemplate taking a gap year between medical school and residency to decompress from the intensity of medical school training before jumping back into the stressful and intense years of clinical training. 

Should this be done electively? The prevailing opinion is: probably not.

In general, common wisdom among medical program directors is that extended time off is detrimental to learning, results in a loss of clinical skills, and it will be that much more difficult for the new medical resident to get back into the mindset of clinical training. 

However, since the late 1990s, there has been an increasing trend towards taking an elective gap year. Some recent graduates feel burned out and need a break from the rigorous learning cycle of medical school. This is particularly true for current graduates who served clinical rotations during the height of the Covid-19 pandemic, the fallout of which continues. Trainees may decide to use this extra time towards studying for the USMLE exam, doing scientific research, or volunteering for a worthy cause. Some decide to broaden their horizons with travel experiences. They feel that these activities will ultimately improve their skills and make them better physicians.

Here are some issues that should be considered before electively taking a gap year between medical school and residency:

• If you have federal or private loans, you should speak with a loan officer from that institution about your repayment options, and whether an economic deferral or forbearance is possible. This issue can have a lot of financial repercussions and you should make sure you understand what your obligations are, and obtain this information in writing. 
• Additionally, you should consider that you will likely be asked to explain the reason for taking a gap year when you apply for your residency position. 
• If possible, you might try to speak with an administrator of your program of choice ahead of time, to gauge how a gap year candidate will be perceived. Some program directors feel that taking an elective gap year means that the candidate is unsure of his commitment to medicine, and may be more likely to quit the program during internship. 

One study of the National Residency Match Program (NRMP) statistics revealed that there was a 95% match rate for MD seniors, while only a 40% match rate for those who waited one or more years after medical school before applying. In some cases, it is presumed that the gap year candidate failed to match into a residency program, and had no choice other than to reapply the following year. 

Sometimes, a gap year is taken by necessity rather than by choice. 

One such scenario involves the international medical graduate (IMG). An IMG is considered to be someone who graduated from a non- US medical school. The match rate for IMGs is approximately 55%, while for US trained graduates the match rate is about 92-95% overall. If the IMG fails to match to a residency program, he has to reapply the following year. 

During this gap year, he should spend time building up his resume and medical application. Recommended activities to help his or her application stand out include setting up shadowing rotations in his field of interest. During this time, he can develop a mentoring relationship with a physician who can write a strong letter of recommendation and help advocate and guide the applicant during this process. 

Clinical research also helps add weight to a candidate’s resume and may help to set him apart from other applicants. Extracurricular activities such as teaching and volunteering are other ways to increase the chances of matching with the residency program of choice.

The suggestions listed above are also appropriate for the US graduating medical senior who fails to match into a training program. According to the NRMP, in 2021, 7% of US graduating medical seniors failed to match into a program. This applicant will have to take a gap year by necessity and reapply next year. By using this year to add weight to his resume and pursue volunteer activities, the applicant should return the next year as a much stronger candidate who will match to his choice residency and become a confident physician.