Influence Of A Gap In Medical Education - Cv On Residency Application

Introduction:

Very often, there is a question of how much does a gap in your medical education affect your residency chances?  Though there are no predetermined definitions or rules to describe what constitutes a gap in medical education, common understanding dictates that any period of your life where you are not involved in medical training or carrying out your duties as a physician are called ‘gaps’

Gaps can be small from few days to weeks time, moderate (few months at a stretch) or long gaps (years). Some common examples of small gaps in CV are taking time out to prepare for exam after graduation for medical school or even few weeks spent for personal reasons. The most common cause of moderate sized gap in your CV is actually related to the effort of applying for USMLE itself! Many applicants are done with medical school and are then preparing for steps 1 or 2 CS/CK and take a few months off to make sure everything that needs to be done is done. These moderate gaps have some influence on match chances but the most damaging of all are long gaps where the applicant has been out of medicine for years at a time. On common theme in this scenario is an applicant who has failed multiple times and takes years to get ECFMG certified or an applicant who decides to focus on other career or personal life (kids, spouse etc).

It is important to distinguish an old graduate (applicant with old year of graduation) from someone who has a gap in CV. Not all old grads will be considered as having gaps especially if they have been productive in other medically related fields (residency applicants doing PhD, masters etc). Thus old year of graduation in itself is not a bad thing but having breaks in education or profession is. 

Motivation: 

For an international medical graduate, minimizing the amount of gaps in CV is ideal. However, there are extenuating circumstances where there will be gaps nonetheless. In view of this inevitability, I have analyzed data from NRMP to see which specialties are lenient when it comes to gaps in your CV and which ones are more strict.

Methods: 

The line graph demonstrates two parameters, importance of gap in CV for obtaining interview (INTERVIEW) and importance of gap in CV as regards ranking the applicant (RANK). The individual specialties are depicted on the X-axis with increasing order of importance that the programs place on gap in CV. Since interview precedes the process of ranking, the subjects were ranked according to influence on interview invitations and then the influence on ranking was overlaid.  The ‘interview’ and ‘rank’ factors were different metrics and were normalized using min-max algorithm to allow for appropriate comparison.

Fig 1: Importance of gap in medical education (CV) per program specialty, source NRMP

Result: 

As can be seen in the figure, the subjects of pediatrics, surgery and Ob-gyn placed the least importance on having a gap in your CV when it came to offering an interview. On the other end of the spectrum, emergency medicine, pathology and psychiatry placed the most importance.  Radiology, internal medicine and neurology were in the middle. Most subjects except for emergency medicine had narrow range of fluctuation regarding the importance of gap in CV when it came to ranking applicants for match.

Implications: 

1. Applicants with multiple or long gaps in CV may be better off applying to pediatrics, surgery, Ob-gyn or anesthesia residencies. However, since only pediatrics is IMG friendly, it would be a better choice amongst others.
2. Those interested in pathology and psychiatry have to make sure that there are no big or multiple gaps in their education to increase the chances of matching to their favorite specialty
3. Family medicine was surprising result where in it seemed that programs in FM placed a fair amount of weight on your continued medical education/profession. 
4. When it came to ranking applicants, there was not much inter-subject variation on the importance of gap in CV except for emergency medicine.

Conclusion: 

Having a break in your medical training or profession as a physician can have an important effect on your chances of interview and matching to a residency program. There are significant inter-subject differences, which warrant careful selection of subjects if an applicant has gaps in CV. However, there may be other things in your resume which could make a positive impact in your application and compensate for the negative influence of having a gap in your CV. If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter.