When I decided to take an additional year in medical school to pursue a major writing project, I felt like I was breaking the rules. Like many students, I entered med school assuming that the path toward graduation was fixed. Sure, I would get to choose some elective rotations, but the overall timeline would stay the same, right?
At my school, Dartmouth College's Geisel School of Medicine, about 35% of students are deciding to take a fifth year. At Yale University's med school, the majority of students were taking five years by 2013.
But why, when the path to becoming a doctor is already so long, would spending more time in med school be growing in popularity? These commonly cited reasons for taking a fifth year in medical school help to answer that question:
-- To participate in an academic or research project.
-- To compile a more competitive residency application.
-- To pursue an additional degree.
-- To complete additional rotations.
-- To address personal issues that could hinder performance in residency.
To participate in an academic or research project. This is perhaps one of the most common reasons students opt to spend an additional year in medical school.
Med students often undertake projects or research with the intention of strengthening their residency applications, but this is not the only reason they pursue these opportunities.
Sometimes students were involved in a project prior to med school, and they take the chance to see it to its completion before they graduate. Other students may see their projects or research as final chances to dive into topics that they may not be able to revisit during residency.
Regardless of the reason students choose to spend a year doing research or another project, nearly all of them come away with additional skills and knowledge that may be applied as they further their careers.
To compile a more competitive residency application. For some competitive specialties, going the extra mile to demonstrate your commitment to the field is a must.
In competitive fields like dermatology, neurosurgery and ophthalmology, it is the new normal to have completed additional rotations, participated in and published research and acquired advanced clinical skills prior to applying for residency.
Because the traditional four-year med school curriculum may not leave enough room for such extensive investment in one's intended field, taking a fifth year to better show your readiness for the next step of medical training can be prudent.
To pursue an additional degree. Taking a year away from medical school to complete an MBA, M.P.H. or other master's degree is increasingly common, especially for students who envision themselves working in population health or health care administration.
In addition to boosting a residency application, completing these degrees during med school -- instead of during residency or as an attending physician -- gives graduates a chance to apply the skills learned during their master's work earlier in their careers as clinicians. It may therefore be of greater benefit in the long run.
To complete additional rotations. Many students choose a career path during their required core rotations, but a substantial number of students exit the third year unsure about the next step in their training. For these students, the opportunity to complete additional elective rotations is crucial, especially if they may be interested in specialties that do not have core rotations, like pathology or urology.
The ability to explore specialty fields in greater depth, as well as the potential for connecting with mentors who may write letters of recommendation for residency, makes a fifth year a convenient option for students still searching for the right field.
To address personal issues that could hinder performance in residency. In an ideal world, students would devote all their attention to their medical education without worrying about unforeseen challenges. But medical illnesses and injuries, deterioration in mental health and family issues may all necessitate time away from school.
As one doctor told me, "Arriving to residency without gas in the tank is a recipe for disaster." Taking time to ensure one's own wellness is gaining acceptance in the medical field, and stepping away when needed is becoming more common.
It does not benefit anyone when a newly minted doctor arrives to residency unable to cope with the demands of the job.
What does all this mean for premed students?
While extending one's stay in medical school is now more common, most premed students do not think about a fifth year as they gather their application materials. The truth is, many med students do not know that they are going to take a fifth year until they have completed a good amount of their M.D. coursework.
As a premed student, you do not have to decide whether extending an M.D. program is right for you as you get ready to apply. After all, you do not know what kinds of academic opportunities, life changes or new interests lie in front of you.
However, as you research medical schools, find out what percentage of their students take a fifth year and what kinds of things they explore in that extra time. If you would like to keep open the possibility of extending your time in med school, applying to schools that have a strong precedent of supporting this decision will help you keep your options open down the road.
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