Mind the Gap (Year): Being Mindful of Dedicating a Year to Research During Medical School

In a recently published article, Costello and colleagues addressed the role of a research year taken by medical students to enhance their application to dermatology residency programs.¹ These “gap” years are often unpaid, one-year research fellowships undertaken by medical students to make themselves more competitive for dermatology residency programs.² Gap years are commonly taken between the third and fourth years of medical school and should not be confused with unaccredited dermatology clinical or research fellowship programs that are typically completed after the first year of residency. Interestingly, the authors found that of 288 dermatology applicants, those that completed a gap year were not significantly more likely to match into residency.¹ These findings are of considerable value to medical students interested in dermatology residency, given that a gap year is sometimes recommended to enhance competitiveness, especially if the student has a low Step 1 score. If a gap year does not appear to significantly improve chances of matching into dermatology residency, under what circumstances should it be considered?

Our view is that unpaid gap years should only be pursued by students interested in a career in academic dermatology with a significant focus on research rather than as a means to increase competitiveness. For students interested in pursuing a career as an academic dermatologist, clinician-scientist, or career researcher, a dedicated research year may help to develop critical skills such as grant writing, conducting basic science research, and learning important techniques (e.g., tissue and disease modeling). Fortunately, the study also found that applicants who completed a gap year were significantly more likely to match into 20 dermatology residency programs that collectively were awarded the most funding by the National Institutes of Health and had faculty members publishing a large amount of research.¹

These dermatology applicants tended to be highly competitive in terms of Step scores and predominantly completed research fellowships at one of the top 20 programs, though not necessarily the same institution that they ultimately matched into for residency.¹ In fact, there is evidence that attending a top-25 federally funded medical school, total number of publications, and high-impact publications may be associated with matching into dermatology residency programs that place a high value on scholarly endeavors.³

The prioritization of research by dermatology programs is reflected in the applications of successfully matched applicants: the average number of research items per matched dermatology applicant in 2020 was 19, compared to 5.7 in 2007.⁴ As many as 26% of matched applicants matriculated to residency programs at their research mentors’ institutions, suggesting that those students that participate extensively in research at their institution are more likely to match into the dermatology residency program at their institution.⁵

Of course, many applicants undertake unpaid research fellowships during medical school to enhance their applications. There is value in conducting research even for students with career aspirations that do not involve scholarly endeavors. Research engagement in medical school has the potential to increase knowledge about how treatments are developed and the application of evidence-based medicine. But, the decision to undertake a one-year research fellowship is not without its concerns.

Gap years are often unpaid and may have additional costs related to relocation, housing, and other living expenses. Because students must request a leave of absence from their home institution to undertake a gap year, they may no longer be able to access student health insurance, scholarships, student loans, and other benefits associated with student status.⁶ Students may also be at risk of exploitation as free labor, asked to take on additional responsibilities in order to avoid displeasing their mentors, and still have no guarantee that they will match into dermatology residency after completing the research year.² On the larger scale, utilizing a gap year to bolster an application creates pressure for other students to take a gap year to remain competitive, putting pressure on all applicants.

The recent replacement of Step 1 scores by a pass-fail indicator may affect competitiveness of applicants. According to dermatology residency program directors, it is highly likely that the Step 2 clinical knowledge score will become a more important metric in deciding an applicant’s competitiveness.⁷ As a result, students may wish to take the Step 2 exam, typically taken in the fourth year of medical school, and view the results before applying to gauge their competitiveness. Other factors that have recently been reported to have taken on a greater role during the applicant screening and selection process include the reputation of the applicant’s medical school, diversity in an applicant’s background, and the applicant’s demonstration of relevant character traits.^7,8

Pursuit of a gap year is a highly individualized decision that should align with the professional goals of the applicant. Ultimately, the goal of a gap year dedicated to dermatological research should be to lay the foundation for a career in academic dermatology. Therefore, medical students interested in dermatology residency and a future career that is highly focused on research may consider conducting research for a dedicated year outside of medical school, particularly at the institution that they wish to attend for dermatology residency.

1. Costello CM, Harvey JA, Besch-Stokes JG, et al. The role research gap years play in a successful dermatology match. International Journal of Dermatology 2022;61(2):226-230. doi: 10.1111/ijd.15964.

2. Jung J, Stoff BK, Orenstein LAV. Unpaid research fellowships among dermatology residency applicants. J Am Acad Dermatol 2021. In press. doi: 10.1016/j.jaad.2021.12.027.

3. Eversman A, Narang J, Zheng DX, et al. Factors associated with matching into research-focused dermatology residency programs. Arch Dermatol Res 2021. In press. doi: 10.1007/s00403-021-02271-6.

4. Narang J, Eversman A, Kalra M, et al. Retrospective analysis of dermatology residency applicant’s research output from 2007-2018. J Am Acad Dermatol 2021;85(3S):AB186. doi: 10.1016/j.jaad.2021.06.759.

5. Yeh C, Desai AD, Wassef C, Lipner SR. Scaling the gates: mentor relationships and scholarly work facilitate dermatology residency placement. J Am Acad Dermatol 2022. In press. doi: 10.1016/j.jaad.2021.12.053.

6. Akhiyat S, Cardwell L, Sokumbi O. Why dermatology is the second least diverse specialty in medicine: how did we get here? Clin Dermatol 2020;38(3):310-315. doi: 10.1016/j.clindermatol.2020.02.005.

7. Patrinely Jr JR, Zakria D, Drolet BC. USMLE Step 1 changes: dermatology program director perspectives and implications. Cutis 2021;107(6):293-294. doi: 10.12788/cutis.0277.

8. Kearns KG, Chat VS, Uppal S, Wu JJ. Applying to dermatology residency during the COVID-19 pandemic. J Am Acad Dermatol 2020;83(4):P1214-P1215. doi: 10.1016/j.jaad.2020.07.011.