Friday, 20 July 2012

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.

48 comments:

  1. Hi! I have a gap of two years in which I was only studying for the Steps. How do I explain this gap in my CV/Cover Letter? Thank you in advance!

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    Replies
    1. Hello Dr. Gonzalez, When was your year of graduation? if it was 2011, then it is relatively recent and should not be that much of an issue. However if your last clinical exposure was more than 2 years ago and your YOG is older then it may matter. you may chose to leave that out in your cover letter and CV. you can explain it in your personal statement indicating what you did in the 2 years and why you did it! good luck.

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  2. Hi Droidor,

    I am an IMG from India. I got admitted to the MBBS course in 2000 and then I took a gap of almost 7 years from second year onwards. I have graduated in Feb 2013. I know this is going to badly or even kill the chances of my residency in the states. I have'nt appeared for step 1 as I am unsure about how this gap is going to affect my chances. I would be really grateful if you could guide me on this. I am aiming for a residency in Obs-Gyn or Pediatrics. Thanks.

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    Replies
    1. Hi Dr. Jaiswal, This will likely hamper your chances but not kill them. If you do well in your USMLE steps, then the question may come up as to why you had a 7 year break in between. You can also your personal statement to address this issue and provide clarifications.

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    2. Hi Dr.Jaiswal.I would like to talk to you personally. Me too USMLE aspirant. My email id is nocodeish@yahoo.in

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  3. Hello,
    I plan on applying to a very competitive field, and even though I am also interested in a less competitive field, I plan to only apply to the very competitive one (surgical specialty). If this doesn't work out, I have a medically related job lined up to buy time so that I can reapply for the less competitive residency (IM). Would this type of gap hurt my chances of getting the second residency I'm interested in? Would the fact that I applied to an entirely different residency a year prior hurt me, as well?

    Thanks

    ReplyDelete
    Replies
    1. as long as you remain productive in medically related profession, you can get by with the gap. however, remember that the further you are away from the YOG (with exception of PhD graduate school), your chances to secure interview drop. it wont affect your chances the scond year if you applied to another specialty the prior year as long as you tailor your application (CV, LOR and personal statement) to the specialty you are applying.

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  4. hi i m an img from india ,did my grduation in2011,and then had agap of2 years,planning to apply for next year i.e.2014,recently join as resident in feb 2013 ,cleared step one ,got 224 score,......how it will effect my residency application...........

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    Replies
    1. depends on what you did with you gap? were you involved in medical training or practice? where are you a resident at? your performance in step 2 will be also very important determinant for interview

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  5. Hi i'm a US med student, taking first rotation off in 3rd year due to medical reasons. As a result I also pushed back my step 1 beyond the allowed date by my school [to July instead of finishing by june]. How will this affect my residency application since my pediatrics rotation will be in 4th year, I'm taking step 1 late compared to everyone in my class, and my 1.5 month gap? [still graduating on time]

    ReplyDelete
    Replies
    1. if you are graduating on time and there is a valid medical reason for the time off, there should be no issues. the fact that you are taking your USMLE a month and half later than you class should also not matter.. check your medical school office to see the implications of appearing for the exam later than stipulated date. it may be more of a logistical issue for the office than a hard deadline.

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  6. how to offset the effects of a large gap on the cv?

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    Replies
    1. This is an excellent question: I am in process of working on an article to address this issue. Briefly, 1. document productivity in the gap or 2. Personal achievements post gap to justify the hiatus. More points to be expanded in the article later. Regards.

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  7. Hi
    i'm an IMG from india,graduated in 2001,got 94 and 93 in step 1 and 2 in 2003 and 2004,cleared step 2 cs on second attempt in 2010.ecfmg certified and step 3 passed in 2013 april.i also have an MPH.I have a gap of 4 years on my cv.rest of the time i worked as a resident doctor.any tips to go about getting a residency?

    ReplyDelete
    Replies
    1. please check and make sure that you are eligible under the 7 year rule. USMLE program recommendations to medical licensing authorities (Most states follow the recommendation) require that the dates of passing the Step 1, Step 2, and Step 3 examinations occur within a seven-year period;

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    2. the 7 year rule is applicable at the time of applying for an initial license which happens after getting a residency spot.there are 18 states which have a 10 year rule for passing all three steps instead of 7 years.what i wanted to know is if I can try for a residency only in those 18 states or elsewhere too.could you please shed some light on this?

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    3. You may want to delve into that a little further. You need a license of some sort to practice medicine even as resident. Some institutions have training licenses while some require limited licenses. In any case, the state governing body reviews petitions for licenses and you may potentially run into issues during that as well. That certainly hold true when you are applying for a full unrestricted practicing professional license. One thing you could do is write to program coordinators (now would be a good time, since there is no pre application craziness and they would not be terribly swamped with correspondence) from programs in those 18 states and ask them to clarify the GME policies regarding eligibility.

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  8. hey,
    I am medical student from INDIA,my internship is due(almost 21 days)which was to be completed by 31st dec 2012,as i took break last year for almost 2 months,i did leave 21 days again this year,now i am statrting to prepare for my residency so i 'll be applying next year.Can you please tell how is this going to effect my chances also there are chancess of me completing 21days next,i do volunteer work at times.
    thanx

    ReplyDelete
    Replies
    1. 21 day gap is not a big deal. Focus on preparing for your residency, do not worry about the gap unless the break was a disciplinary action against you by medical school.

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  9. Hello I am a US citizen who went to caribbean for medical school. I have a 6 year gap (and counting) after I finished basic sciences. So to summarize, I've completed my basic sciences (first two years of medical education), then due to personal reasons/illness I did not continue. I want to get back into medical school and take STEP 1 and do rotations and go from there. What do you think of my chances of getting a residency?

    ReplyDelete
    Replies
    1. Hello Dr. Aman, it will be premature to speculate on your chances in absence of scores and other qualifications. I recommend you finish medical school, score well and have your reason explicitly detailed in your personal statement when you apply for residency.

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  10. hey iam medical graduate from pakistan YOG 2010 i have 1and a half year gap in medical education due to preparation for usmle. how do i explain it ? plus i have a CR-1 visa does that count as permenant resident?

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  11. Hey, I am a US Ivy League 2005 Medical Graduate. I completed my preliminary intern year in internal medicine in 2006. However, I left after that to pursue finance. My USMLE scores are: Step 1 236, Step 2 CK 202, Step 3 ~200. I also passed Step 2 CS after 3 attempts. Now, I want to pursue an anesthesiology residency. My fiancee is currently looking for jobs in the tri-state area, so I am applying to ONLY programs in the tri-state area at the moment. What are my chances of matching this year? What do I need to do to optimize my matches? I currently am working on LORs from the head of my anesthesiology clerkship in my medical school, and three letters from an attending, a fellow, and senior resident (at the time) from my internship. Lastly, I took a subinternship during my 4th year of medical school and worked with the head of the internal medicine department then. I got honors in that subI and should be getting an LOR from him as well. Please help

    ReplyDelete
  12. Hello,

    Thank you so much for this forum, it has been very helpful for me.I have a 2 year gap in my internship but I passed all years of Medical school on time. During that gap I worked in a hospital as a doctor and I have a letter from a doctor saying that I did. What do you think I should do?
    here are some of my details:

    FMG from India, US citizen
    Step 1 235, Step 2 240, CS pass ( all first attempt), Step 3 probably
    2012 graduate, I have USCE 6 months lined up from Dec 2013 to Sept 2014
    1 research presentation at a conference in US

    ReplyDelete
    Replies
    1. This wont be technically considered as a gap in your medical education as you were still involved in clinical practice. have a justification for why you had the 2 year gap in your Personal statement etc.

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  13. This comment has been removed by a blog administrator.

    ReplyDelete
    Replies
    1. i recommend that you heavily focus on your exam preparation and the 3 electives in US. There is no substitute for solid scores and the electives will help you achieve 2 goals - firstly, get US letters of recommendation and secondly, make connections which will help your chances of matching into a program. To what extent you need to have those other things like research or volunteering or job depends on how you score. If you do very well on the steps then you may not even need any of those other things,

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  14. Hello there , thankyou for this great post , I have recently graduated in June 2013 , will give my step 1 in coming february , was speaking to a friend who mentioned about gaps but didnt mention about significance of long gaps as mentioned above , I will be observing/shadowing here in my home country after step 1 , while preparing for ck at the same time while shadowing , have plans of going for 1 year master's in sep 14- sep 15 , my 6 month gap for step 1 wouldnt be a career killer like friend made it seem would it ? considering good scores , excellent letters of rec, master's degree , observership after step 1 to minimise 6 month study gap etc ....

    ReplyDelete
    Replies
    1. 6 months gap wont be a career killer. Do something in parallel - could be anything like volunteering to show that you did not sit at home for 6 months just to study (which would be ideal). What masters are you going for? these days 1 year of MHA or MPH are not worth much per say except allowing you to acclimatize to US and seek connections. AS you rightly said - good nay excellent scores, excellent letters are more important here

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  15. Am an IMG from India, currently preparing for step 1..How much gap is considered acceptable? trying for observership but unable to get. Can volunteer jobs be used to fulfill these gaps??

    ReplyDelete
    Replies
    1. Hi! Thanks for writing. I have answered your question (Q6) with few other questions here http://www.mleresidencytips.com/2014/05/question-and-answer-session-1.html

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  16. Hi Droidor,
    How do I mention volunteer work in the CV? Do I have to submit some certificate/proof? I have been active with some university groups in the US who does voluntary works. Will those count? I don't know if they'll give me any certificates or something..
    Thanks in advance.

    ReplyDelete
    Replies
    1. Hi! Thanks for writing. I have answered your question (Q5) with few other questions here http://www.mleresidencytips.com/2014/05/question-and-answer-session-1.html

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  17. Hello , i am an IMG from syria and i took a year gap but its within my undergraduate years .. i mean i needed another year summed up to my med school , does that hurt and how to explain it in interviews

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  18. hi,i graduated in 2010 ,i did one year housejob in a superspeciality branch and then i have been doing working as a physician under government service.i am preparing for step as well but the thought of gaps is somewhere boggling my mind a lot. a lot of frnds have been trying to convey me to start preparing for indian exams as its practically impossible for me to get residency. your thoughts pls??

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  19. Hello,

    First I must say that all your posts have been extremely useful to read. I'm an IMG from India. I graduated in April 2013. I spent a few months preparing for GRE as I had initially aimed on joining the MPH course and then applying for residency after. Even though I got 316/340 in GRE (July 2013), unfortunately my student loan got rejected and I was unable to carry on with MPH. So, in Dec, I had been to US and did a shadowing program while I was there for a month. I got back and started preparing for step 1 and hope to give it by this dec. I will try my best to do one or two externships after step 1 while preparing for step 2. But I'm worried about the gaps I've had and by the time of the MATCH it will 2016 March which will be three years since my graduation. What can I do to help my chances?

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  20. Hello, I am a US IMG, I took one year gap after my basic sciences, then took Step I, then started clinicals. I had to take 1 year off to take care of a very close family member overseas, but I did observeship (every other week) while I was there and also worked for a few months. This was for about 7 months. Then I came back to USA and studied for 4 months and took Step I and then started clinicals. Does it hurt me?

    ReplyDelete
  21. Hello,
    I am MBBS graduate from India. YOG is 2009. I spent a year in rural medicine after that 2010. Then I came for Master's in research related field in Biology in the states. I graduated in 2013. I want to go back to clinical work. I have already started with my step 1 preparation. Will it hamper my chances of being away from clinical field for 4-5 years? Will good step scores and US LORS can offset this gap?

    ReplyDelete
  22. Hi
    Im an graduate from Nepal. YOG is 2013, completed internship in 2014 and ive did junior residency till april, 2015. I've taken a gap to study now and will appear for step 1 in January 2016. My subject of choice is internal medicine.
    Is this gap significant? Will it hamper my chances in the interview

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  25. Hello! I am an IMG from Pakistan. I graduated in 2014, took a gap year for steps 1 and 2 and scored 248/242. I am applying in internal medicine. How do I explain my gap. I am really worried :/ thank you!

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  26. Thanks very much for sharing your experience. May I ask you a question?
    I graduated from medical school in China this year and I'm now involve in a phd program for hematology, which is also in China. It will last for at lears 5 years. I plan to try to match after I get the PhD degree. Will this big gap be a big problem? Or it won't since it's still related to medicine? Thank you very much!

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  27. Hello Im from ecuador, third year medical student and took a gap year to travel to the us and learn english will these things affect when I apply for residency ?

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  28. I am a Canadian IMG and attended university in the Caribbean. I took a full year off to study for Step 1 and write a research paper prior to starting rotations. I had a relative pass away during this time and it made it difficult to concentrate on studying. I plan to apply to a residency in family medicine. Just wondering what my chances are of even getting an interview with taking 5 years to finish school?

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  29. Hello.Thanks for the previous informations.I am currently 4th yr med student,IMG.I will graduate this yr and I have to take 1 yr internship and 4 yrs of obligatory service in hospital.I want to apply for general surgery residency .Does this large gap influence a lot?

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  30. I have finished my 2 years of basic sciences in the Caribbean.I have 2 years leave of absence. I want to take the Step 1 in October. I was told by a friend that I have zero chance of getting into residency because of the gap, and its best to start MD 1 all over again. He said the ECFMG new rule is that they will flag any student who has had more than 6 months gap in their medical education. Is this true and if its not true what is my chance of getting into residency?

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  31. Hi,I am IMG and graduated in 2012 and applying for the 2018 match. I recently learned that gap of more than 5 years will seriously affect the number of interview calls we get. Is this true? During these 5 years I was working as a house officer. I have a 251 in step 1 and planning to give CK in December. If I pass Cs in first attempt and apply for Internal medicine, what chances do I have? I am very worried at this point.

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