Bridging the Gap: A Structured Pre-Professional Medical Education Gap Year Affirms Career Pathway, Promotes Competency Development and Enhances Preparedness for Success

Bridging the Gap: A Structured Pre-Professional Medical Education Gap Year Affirms Career Pathway, Promotes Competency Development and Enhances Preparedness for Success | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bridging the Gap: A Structured Pre-Professional Medical Education Gap Year Affirms Career Pathway, Promotes Competency Development and Enhances Preparedness for Success R. Maxwell Regester, Amy Cannella, Alan R. Erickson, Harlan Sayles, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6719425/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jan, 2026 Read the published version in BMC Medical Education → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Medical school admissions committees often prioritize traditional pathways, but structured clinical gap year (scGY) programs may offer valuable opportunities for career exploration, competency development, and professional preparedness. The impact of scGY programs on these outcomes remains unclear. The objective of this study was to evaluate the impact of a structured clinical gap year program on career exploration, competency-based skill development, preparedness for professional school, and burnout mitigation. Methods: This observational study surveyed 38 participants who completed a 14-month dermatology-focused scGY program at a single private practice. The program included direct patient care, surgical assisting, electronic medical record use, structured mentorship, and weekly didactic sessions. Thirty-seven participants responded to a post-program survey (97% response rate). Data collected included academic outcomes, self-reported confidence in ACGME core competencies (before and after the program), perceived preparedness for professional school, and burnout. Changes in competency confidence were assessed using Wilcoxon signed-rank tests. Results: Participants reported significant improvements in all competency domains, with the greatest increases in patient care/clinical skills (mean improvement: 6.2 points) and interpersonal/communication skills (mean improvement: 5.9 points). Compared to their peers, 64% felt more prepared and 36% felt much more prepared for professional school. Career exploration rankings indicated the scGY program was more valuable than shadowing or volunteering. Additionally, 89% believed that completing a scGY reduced burnout. Conclusions: A structured clinical gap year program enhances competency development, affirms career pathways, and improves professional school preparedness while reducing burnout. These findings suggest that admissions committees should recognize scGY experiences as valuable, rather than viewing them as unnecessary delays in medical training. Gap year career exploration competency development professional preparedness burnout prevention Figures Figure 1 Figure 2 Figure 3 Background Amongst medical school admissions committees, pre-medical advisors and even students, there is uncertainty about the best pathway to medical school. Some believe the traditional path – direct matriculation to professional school after completing an undergraduate degree – is the most effective route to becoming a successful health professional. This view often casts alternative pathways, such as paid healthcare experiences (gap years), as unnecessary delays or even as potentially detrimental interruptions in a student’s progression toward a medical career. 1 However, emerging evidence suggests that these non-traditional routes, including structured clinical gap year (scGY) experiences, may offer unique opportunities for growth, career exploration, and competency development. This discussion is particularly relevant in today's competitive landscape. The American Association of Medical Colleges (AAMC) reports that for the academic year 2023–2024, a staggering 52,577 individuals submitted nearly one million applications to MD-granting medical schools. Despite the average applicant applying to 18 schools, only 43.7% were accepted, showcasing the intense competition in the field. 2 The competition becomes even stiffer when applying to more selective schools, with acceptance rates as low as 1.2%. 3 On the American Medical College Application Service (AMCAS) application, students submit undergraduate coursework, grade point averages (GPA), Medical College Admission Test (MCAT) scores, personal statements, and letters of recommendation. An additional section allows applicants to share work experience, extracurricular activities, awards, honors, and publications, with the opportunity to highlight three that were most meaningful. 4 While all elements of the application are perceived as important, how each is weighted and factored into acceptance or rejection by admission committees is unknown. Three common pathways to medical school exist: 1) immediate matriculation after a four-year degree program (traditional), 2) non-traditional students matriculating after different life experiences, and 3) students who by choice or circumstance take a gap year between college and professional school. Regardless of the path, all applicants try to determine which activities will bolster their application for admission. Admission committees operate confidentially and do not make their internal processes widely available. Considerable variation likely exists between institutions and among members of an individual committee who may weigh elements of the application differently. They must ensure that students possess the cognitive traits and personal characteristics requisite to the practice of medicine. The ideal applicant must also demonstrate adequate career exploration to assure commitment to the grueling pathway to the profession. Studies show that objective measures, such as the MCAT score and to a lesser degree the undergraduate GPA, 5 can reliably predict short term medical student success. This predictive ability has not been seen in more subjective assessments, such as interview scores and holistic review. 6 Objective metrics speak to academic ability, and the subjective letters of recommendation and interview scores may identify desired personality traits. However, less easily discerned are the intangible attributes of career exploration, including a commitment to patient care and requisite professionalism, communication skills, and dedication to self-improvement. Most applicants aim to demonstrate career exploration via their portfolio of extracurricular activities. In a 2023 survey by the AAMC, medical school admissions officers ranked the experiences of medical and non-medical volunteerism, clinical shadowing and leadership of higher importance than paid healthcare employment when making decisions about who to interview and accept. 7 Each admission committee may view the portfolio of experiences differently, making their intended outcomes poorly defined and difficult to measure. Furthermore, applicants participate in diverse individualized experiences, making direct comparisons a challenge. Although important pieces of the application puzzle, limited data, if any, exists about which experiences predict success in medical school and beyond. One recent study of prior healthcare employment (PHE) showed that 49 out of 434 students who participated in a minimum of six months of any type of PHE before medical school outperformed their peers in the clinical training environment. The authors propose that this early contextual learning enhances patient care and documentation skills, strengthens teamwork, feedback, and communication, and reflects personal traits like work ethic, motivation, and resilience. 8 While PHE shows improved outcomes, but ranks lower than other experiences by admission officers, pre-medical advisors are uncertain how to guide their advisees who desire to take a gap year in health care employment. To improve advising practices, pre-medical advisors have called for the study of this group of students with respect to the utility of a gap year on performance and the perception of the experience by students and medical professionals. 9 This study evaluates a structured clinical gap year program (scGY) launched in 2017 for students aiming to attend medical or other healthcare professional schools. Applicants undergo interviews before joining clinical teams of physicians and physician assistants, where they participate in patient care, surgical assisting, and electronic medical record tasks. The program is complemented by weekly lectures on high-yield topics, mentorship, research opportunities, and personalized recommendation letters. A detailed description of the program is available in the supplemental information. With the uncertainty among pre-medical students, advisors and admissions officers about the utility of a gap year program, these investigators aim to determine if a pre-medical scGY experience can serve as adequate career exploration, show longitudinal improvement in competency-based domains and prepare students for success in professional school. Methods This study was deemed exempt by the University of Nebraska Institutional Review Board. Thirty-eight participants who completed a gap year program at a private dermatology practice in Omaha, NE, were contacted via email to complete a 44-question survey. Metrics were collected on undergraduate school and major, GPA, MCAT scores, USMLE scores, chosen profession, and matriculation into professional school. Twenty-eight competency-based questions were developed and grouped into categories using three Midwest medical schools’ published Program Objectives utilizing domains in alignment with the Accreditation Council for Graduate Medical Education (ACGME) framework. The competency domains (number of questions) included medical knowledge (4), patient care and clinical skills (4), practice-based learning and improvement (2), interpersonal and communication skills (6), professionalism (4), systems of health care (3), interprofessional collaboration (2) and personal and professional development (3). Using a 10-point Likert Scale, where zero represents no knowledge or ability to perform the skill and 10 represents complete mastery of the subject or skill, respondents were queried about their confidence at the beginning and upon completion of the gap year. Participants were also asked about participation in career exploratory experiences, preparedness and burnout compared to peers who did not complete a scGY. Data was collected on research activity. Open-ended questions were included to allow individualized comments. Information was also collected for programmatic improvement. The full survey is available in the supplemental information. Data was summarized using descriptive summary statistics (counts and percentages) for all survey items. Wilcoxon signed-rank tests were used to evaluate changes in ratings from pre- to post-gap year for each competency-based question. Open-ended questions were thematically analyzed. Results Of 38 gap year participants, 37 returned surveys (response rate of 97%). One participant is an investigator (RMR), and only descriptive characteristics were included to minimize bias. Thus, competency questions were analyzed for 36 of 37 surveys (97%), and participant descriptors were analyzed for 37 of 37 surveys (100%). These participant descriptors are summarized in Table 1 . Table 1 summarizes the descriptive characteristics of participants in the scGY program. Number (Percentage or Range) Undergraduate Information Institutions 14 Cities 12 States 8 Majors in Science 34 (92%) Biology 14 (38%) Biochemistry 7 (19%) Mean GPA 3.8 (range 3.3–4.0) Mean MCAT Score 510 (range 495–525) Applied to Professional School Prior to Gap Year Yes 17(46%) No 20 (54%) Accepted or Matriculated into Professional School Yes 30 (81%) No 7 (19%) Professional School Attended after Gap Year MD 16 DO 6 PA 5 Master of Medical Science 1 Master of Public Health 1 Post-Baccalaureate Program 1 USMLE Pass on First Attempt Step 1 9 (100%) Step 2 6 (100%) Step 3 1 (100%) Career Exploration : Of all scGY participants, 13 (36%) were more likely and 18 (50%) were much more likely to pursue a career in healthcare after completing the program. One participant (3%) was much less likely to pursue a career in healthcare. Thematic exploration of open-ended questions regarding the impact of the scGY experience on a participant’s acceptance into professional school revealed 17 (49%) perceived a positive overall impact and 7 (20.0%) perceived an enhanced interview performance. The most common specific impacts on professional development were increased clinical experience (18; 51%) and increased real-life understanding and application of medical/patient care (14; 40%). In addition to the scGY Program, participants had engaged in multiple additional career exploratory experiences including 36 in shadowing (100%), 31 volunteering in health care (86%), and 23 participating in research (64%). Among all activities, the scGY Program was ranked the most important for preparation to succeed in the pre-clinical years of training, with 32/35 (91%) participants listing it as the most important. No other activity received more than one vote for the most important. Shadowing was ranked the second-most important and volunteering in a health care setting was ranked the third-most important (Fig. 1 ). Participants were asked to rank the importance of shadowing for career exploration on a 0–10 scale, and the overall average was 6.3. Thematic analysis of individualized comments about shadowing likes and dislikes revealed both positive and negative remarks (12), only negative remarks (9) and only positive remarks (6). The most common positive themes included exposure to different specialties (10; 35%) and gaining insight into the daily life and responsibilities of a provider (9; 31%). The most common negative themes were not being hands-on/lack of active participation (9; 31%) and that shadowing does not fully/accurately represent the profession (6; 21%). Competency Domains : All 28 questions in eight competency domains showed significant improvement from pre- to post-gap year training, with an average increase in competency across all questions of 3.5 out of 10 points (range 1.3 to 6.4 points). Figure 2 shows question means grouped by domain. The largest overall point improvements were seen in the domains of patient care and clinical skills: obtain patient history (from 2.1 to 8.3) and perform patient care (from 1.3 to 7.6), and interpersonal and communication skills: document in EHR (from 1.9 to 8.3) and present relevant patient information (from 1.8 to 7.8). Preparedness : Participants were sorted into two groups. Group 1 consisted of those in the last month of the program and Group 2 consisted of those who completed the program at least one year prior. Participants rated their preparedness for their next professional step before and after the program on a 10-point Likert scale. (Fig. 3 ) Overall, participants felt more prepared for their next academic or professional step (increase of 3.4) and more prepared to work in a professional setting (increase of 3.0). Of the 22 participants who matriculated into professional school, 14 (64%) felt more and 8 (36%) felt much more prepared to succeed compared to their peers who did not complete a scGY. Of all scGY participants, 18 (51%) felt more and 15 participants (43%) felt much more prepared. Burnout : Thirty-two participants (89%) agreed that students who complete a scGY Program have lower rates of burn out. Thematic analysis of comments revealed the scGY provided motivation to continue schooling/pursuit of a medical career (6 participants, 38%) and it gave time and opportunity to pursue interests outside of school (5 participants, 31%). Research Activity : Seven (18%) scGY students participated in research, including protocol development, IRB submission, data collection and abstract or manuscript preparation that has or will result in presentations or publications. Discussion and Conclusions This study shows that participating in a robust clinical health care employment experience prior to starting professional school should be viewed by both students and admission committees as a valuable pre-medical educational experience, and not a red flag for a lesser applicant. This is the first study to our knowledge that demonstrates that students rate a scGY as superior to other career exploratory activities. Participants noted that the program provided a realistic perspective of the medical profession and the hands-on experience that they crave, helping them solidify their decision to pursue a career in healthcare. Ranked second in our study, shadowing is perceived by many as the gold standard for career exploration. Our analysis revealed significant limitations in shadowing, including limited hands-on experience, poor engagement and lack of access. Though admission committees value volunteering and students validated its importance, it was ranked third in exploratory importance. Our study suggests a disconnect between the importance ratings of experiences in an application portfolio between admissions officers 7 and the applicants. Participation in the scGY program led some to the realization that healthcare was not the right career path, while others changed their trajectory within the health care field. All participants rated their experience in the program as positive, suggesting these changes were not the result of poor mentorship or a negative program experience, but rather robust career exploration. Learning one’s desired path is a poor fit before enrolling in professional school may be the greatest outcome of the scGY program. Every participant in our study who completed the scGY Program and enrolled in professional school felt more prepared to succeed compared to their peers who did not complete a similar gap year. This finding is in alignment with a previously published study in the United Kingdom that found that 77 of 79 gap year participants and 48 of 105 non-gap year participants who subsequently enrolled in medical school supported taking a pre-medical gap year. 10 As many medical schools are moving clinical training earlier in the curriculum, students are asked to simultaneously adapt to the academic rigor and perform in the high-stakes clinical environment of medical school. This poses a significant challenge to most students, and having a year of clinical professional training and identity formation can mitigate many of the clinical environment stressors. A study looking at the effects of early clinical exposure by certifying as an emergency medical responder before starting coursework in the first year of medical school showed improved subjective reporting of competencies. When investigators looked further, the greatest improvements were seen in students who also had additional PHE. 11 Our competency outcomes endorse this finding, showing significant improvements in every question of each domain. We saw the greatest improvements in patient care and clinical skills and interpersonal and communication skills. Every scGY participant who matriculated into medical school passed their coursework and USMLE steps on the first attempt. It is possible that a scGY Program can “prime the pump,” allowing more rapid acquisition of knowledge, skills and attitudes incorporated into a solid foundation built by prior contextual learning. A key advantage of the scGY Program is the mentorship component. Participants highlighted the value of personalized guidance from practicing physicians, which aided in career decisions and strengthened applications with impactful letters of recommendation. The program also fostered peer support, enhancing both personal and professional development, and one participant stated, "I really enjoyed having other gap years my age who were also going through the application process because it gave me a support system.” Poor family and social support have been shown to be risk factors for medical student suicidal ideation, 12 and building early and lasting mentoring and peer networks may mitigate some of this risk. With the epidemic of physician and medical student burnout, our findings were in alignment with a previously published study that students taking any type and duration of gap year prior to a combined baccalaureate-MD program exhibited significantly lower levels of burnout. 13 Although the scGY participants were not administered burnout surveys, 89% felt that completing the scGY reduced burnout when attending professional school. The reasons are likely multi-factorial, but may be due to increased time for reflection, exploration of activities outside of medicine, preparedness to succeed in school, and building support networks. The opportunity to participate in research is also a positive outcome of the scGY program, with seven students producing work suitable for presentation or publication. Published data on non-clinical research gap year programs are at the pre-medical and post-graduate level. Reported benefits of these programs include increased number of publications, perceived application advantage for competitive programs, and off-loading clinical faculty with research demands for rank advancement. 14–16 The scGY program gives participants the simultaneous benefits of clinical training with opportunities to bolster their research portfolio. In turn, the clinical providers overseeing the students are afforded a talented and engaged workforce and opportunities to teach and mentor outside of a career in academic medicine. One strength of this study is the high survey response rate, enabling the capture of nearly complete data. Unlike most published data on gap year programs with varying experiences and duration, and the standardized content and length of the program is another strength of this study. This study has several important limitations, including a small sample size, self-reported recall survey data, and the lack of a control group. All participants worked in a multi-specialty dermatology clinic, which limited exposure to other areas of medicine. However, only two of the scGY participants have pursued dermatology. Importantly, the clinical experience is essentially unchanged since program inception in 2017, but the full program has improved over time to include a more robust didactic program and facilitated mentoring, making the positive findings more conservative. Future research should concentrate on the long-term impacts of scGY programs on medical school performance, residency placement and overall career satisfaction. Longitudinal studies are needed to confirm whether the observed early benefits lead to sustained professional success and to develop scGY models that optimize educational outcomes. Additional research should also focus on scGY opportunities as an avenue for students under-represented in medicine to gain early access to clinical exposure and mentoring. Given our findings, which suggest that a scGY program may reduce student burnout, additional studies should explore this in greater depth, including whether similar reductions in burnout are experienced by the mentors who oversee a scGY program. In conclusion, a scGY Program can offer significant advantages in both career exploration and preparation for professional healthcare education, challenging the notion that the direct path from college to medical school is superior or preferred. A scGY program significantly develops confidence in core competencies essential for professional school and medical practice. Mentoring, research opportunities, peer support networks and reduced burnout are additional benefits of the program. Far from being a fallback option, a PHE gap year allows students to affirm their career choice, develop key skills, and enter professional school better prepared for success. Admission committees should recognize these programs as a legitimate and valuable pathway to the medical profession, dispelling the bias that such experiences signal a lesser applicant. Declarations Author Acknowledgements The authors would like to thank Carl F. Schanbacher, MD, for sharing his idea and experience in administering a gap year program, the University of Nebraska College of Medicine librarians for their assistance in literature review for this manuscript, and the providers, administrators and nursing staff of Dermatology Specialists of Omaha for instituting and implementing the gap year program (Drs. Jill Nelson, Tricia Hultgren, Judy Wolpert, Ashley Drake, Sara West and Kendra Lesiak). Author Acknowledgements: The authors would like to thank Carl F. Schanbacher, MD, for sharing his idea and experience in administering a gap year program, the University of Nebraska College of Medicine librarians for their assistance in literature review for this manuscript, and the providers, administrators and nursing staff of Dermatology Specialists of Omaha for instituting and implementing the gap year program (Drs. Jill Nelson, Tricia Hultgren, Judy Wolpert, Ashley Drake, Sara West and Kendra Lesiak). Declaration of Interest Statement: The authors report no conflict of interest. No funding provided. Funding sources : None Conflicts of Interest : None declared Human Ethics and Consent to Participate Declaration: This study was reviewed and deemed exempt by the University of Nebraska Medical Center Institutional Review Board. All participants were informed about the nature and purpose of the study and consented to participate voluntarily by completing the survey. Informed consent statement was obtained from all participants. This research was conducted in accordance with the Declaration of Helsinki. Clinical trial number : not applicable References Schwartzstein RM, Marzouk S. Gap Years—Unbridled Good or Unwarranted Cost? JAMA. 2024;332(24):2053–2054. doi:10.1001/jama.2024.19750 AAMC. Table A-1: U.S. MD-Granting Medical School Applications and Matriculants by School, State of Legal Residence, and Gender, 2023-2024, www.aamc.org/media/5976/download?attachment. Accessed 28 Mar. 2024. Wood, Sarah. 16 MED Schools with the Lowest Acceptance Rates | the Short List: ..., www.usnews.com/education/best-graduate-schools/the-short-list-grad-school/articles/medical-schools-with-the-lowest-acceptance-rates. Accessed 28 Mar. 2024. AAMC. 2024 AMCAS Applicant Guide, students-residents.aamc.org/media/11616/download. Accessed 28 Mar. 2024. Murphy, Brendan. “MCAT Scores and Medical School Success: Do They Correlate?” American Medical Association , 8 Mar. 2024, www.ama-assn.org/medical-students/preparing-medical-school/mcat-scores-and-medical-school-success-do-they-correlate. Kreiter C, O’Shea M, Bruen C, Murphy P, Pawlikowska T. A meta-analytic perspective on the valid use of subjective human judgement to make medical school admission decisions. Med Educ Online. 2018;2018(1):1522225. doi: 10.1080/10872981.2018.1522225. AAMC. Using MCAT® Data in 2025 Medical Student Selection. Washington, DC: AAMC; 2024. Accessed 8/3/2024. Strowd, L. C., Gao, H., O'Brien, M. C., Burns, C., Freischlag, J. A., Strowd, R. E., Grier, D., & Peters, T. R. (2020). Prematriculation Healthcare Employment Predicts Success in Clerkship Environment. Medical science educator, 30(1), 211-217. https://doi.org/10.1007/s40670-019-00859-2 Charland, D. M. (2023). A Phenomenological Study of the Lived Experiences of Premedical Advisors Advising Undergraduate Students about Gap Year Options (Order No. 30314619). Available from ProQuest Central; ProQuest Dissertations & Theses Global; ProQuest One Academic; Publicly Available Content Database. (2791147954). Paterson-Brown, L., Paterson-Brown, F., Simon, E., Loudon, J., Henderson-Howat, S., Robertson, J., & Paterson-Brown, S. (2015). The Influence of a 'Gap Year' on Medical Students. Journal of Education and Training Studies, 3(4), 49-56. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=eric&AN=EJ1067252&login.asp%3fcustid%3ds5794986&site=ehost- Tapasak B, McCall M, Cheung E, et al. (July 09, 2022) Developing Medical Student Competencies, Clinical Skills, and Self-Efficacy With an Emergency Medical Responder Certification Course. Cureus 14(7): e26678. DOI 10.7759/cureus.26678 Seo C, Di Carlo C, Dong SX, Fournier K, Haykal K-A (2021) Risk factors for suicidal ideation and suicide attempt among medical students: A meta-analysis. PLoS ONE 16(12): e0261785. https://doi.org/10.1371/journal.pone.0261785 Guang SA, Eltorai AEM, Durand WM, Daniels AH. Medical student burnout: Impact of the gap year in burnout prevention. Work. 2020;66(3):611-616. doi: 10.3233/WOR-203203. PMID: 32623422. Fishman EK, Lugo-Fagundo E, Chu LC, Rizk RC. The gap year for college students interested in medicine: Can they contribute to your mission? Curr Probl Diagn Radiol. 2024 Jul-Aug;53(4):452-454. doi: 10.1067/j.cpradiol.2024.05.011. Epub 2024 May 4. PMID: 38724308. Cotter EJ, Polce EM, Williams KL, Spiker AM, Grogan BF, Lang GJ. Current State of Research Gap-Years in Orthopedic Surgery Residency Applicants: Program Directors' Perspectives. Iowa Orthop J. 2022 Jun;42(1):19-30. PMID: 35821932; PMCID: PMC9210394. Wright-Chisem J, Cohn MR, Yang J, Osei D, Kogan M. Do Medical Students Who Participate in a Research Gap Year Produce More Research During Residency? J Am Acad Orthop Surg Glob Res Rev. 2021 May 13;5(5):e21.00061. doi: 10.5435/JAAOSGlobal-D-21-00061. PMID: 33983156; PMCID: PMC8126556. Additional Declarations No competing interests reported. Supplementary Files BridgingTheGapSurveyFinal.docx StructuredClinicalGapYearProgramDescription.docx Cite Share Download PDF Status: Published Journal Publication published 17 Jan, 2026 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 07 Jul, 2025 Reviews received at journal 06 Jul, 2025 Reviews received at journal 01 Jul, 2025 Reviewers agreed at journal 16 Jun, 2025 Reviewers agreed at journal 15 Jun, 2025 Reviewers invited by journal 15 Jun, 2025 Editor assigned by journal 14 Jun, 2025 Editor invited by journal 13 Jun, 2025 Submission checks completed at journal 11 Jun, 2025 First submitted to journal 11 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6719425","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":472236579,"identity":"f3a8363b-9621-4250-8224-3259b3e9c843","order_by":0,"name":"R. Maxwell Regester","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYNCCChs5EHXgAfFazqQZg7UkEK2Dse1wYgOIQZQW82lnHz78wpaWPj/s8EOgLXZyug0EtMjcTjc2luGxyd14O80AqCXZ2OwAAS0S0mls0hISabkbZyeAtBxI3EaEFvbfEgaH0w1np38gWgsb44eEwwny0jnE28IszXAgzXCDdE7BgQQD4vzC+PHnPxt5+dnpmz98qLCTI6gFBJh5gIQBWKUBEcpBgPEHkJBvIFL1KBgFo2AUjDwAADwkQ1XtQd7HAAAAAElFTkSuQmCC","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":true,"prefix":"","firstName":"R.","middleName":"Maxwell","lastName":"Regester","suffix":""},{"id":472236580,"identity":"48d17608-9241-40f5-a518-1f304984b0f9","order_by":1,"name":"Amy Cannella","email":"","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Amy","middleName":"","lastName":"Cannella","suffix":""},{"id":472236581,"identity":"a49d2170-c8e4-4683-ba1c-09dd7a109920","order_by":2,"name":"Alan R. Erickson","email":"","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Alan","middleName":"R.","lastName":"Erickson","suffix":""},{"id":472236582,"identity":"630145b0-a0b0-4f6a-b92d-36e0ef1dbea9","order_by":3,"name":"Harlan Sayles","email":"","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Harlan","middleName":"","lastName":"Sayles","suffix":""},{"id":472236583,"identity":"e54ff0b9-a268-4c03-8d93-35ea3a06688e","order_by":4,"name":"Amy Rau","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Amy","middleName":"","lastName":"Rau","suffix":""},{"id":472236584,"identity":"29420acd-ff91-4771-913f-5272ad9b3cf6","order_by":5,"name":"Anthony J. Griess","email":"","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"J.","lastName":"Griess","suffix":""}],"badges":[],"createdAt":"2025-05-21 20:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6719425/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6719425/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-08501-z","type":"published","date":"2026-01-17T16:30:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84869315,"identity":"1df58c63-97de-4df2-87b7-9fe9807a660c","added_by":"auto","created_at":"2025-06-18 08:48:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48230,"visible":true,"origin":"","legend":"\u003cp\u003erepresents the scGY participants’ rankings of exploratory experiences preparation to succeed in the pre-clinical years of training. Purple represents the 1\u003csup\u003est\u003c/sup\u003e most, blue the 2\u003csup\u003end\u003c/sup\u003e most and red the 3\u003csup\u003erd\u003c/sup\u003e most important.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6719425/v1/9191e1d1412eea614dce7771.png"},{"id":84869313,"identity":"26bb7fa1-b39e-442a-8221-ebcf6dac7345","added_by":"auto","created_at":"2025-06-18 08:48:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":64641,"visible":true,"origin":"","legend":"\u003cp\u003eshows average points scored across each competency domain at the start (prior, orange bars) and upon completion (post, blue bars) of the structured clinical gap year experience. Zero represents no knowledge or ability to perform the skill and 10 represents complete mastery of the subject or skill.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6719425/v1/3924b1eeb29d533080b13ee5.png"},{"id":84871135,"identity":"6db640a7-fdc7-4dbe-9782-efbf397368b6","added_by":"auto","created_at":"2025-06-18 09:04:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":27362,"visible":true,"origin":"","legend":"\u003cp\u003eshows scGY participants’ ratings of overall preparedness for the next professional step and working in a professional setting compared to their peers who did not take a similar gap year. Zero represents being not at all prepared and 10 represents being completely prepared. Blue represents Group 1, orange Group 2, and grey all participants.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6719425/v1/0f6f7287d42a68e71107aa77.png"},{"id":100614819,"identity":"cda45d7b-f2ca-4836-b702-b932f13ff203","added_by":"auto","created_at":"2026-01-19 17:26:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":633207,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6719425/v1/d0d1b444-25cf-4b85-b69e-0215bee1d496.pdf"},{"id":84869319,"identity":"098e1bf6-01f8-407b-abc2-9dfc1217d105","added_by":"auto","created_at":"2025-06-18 08:48:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30078,"visible":true,"origin":"","legend":"","description":"","filename":"BridgingTheGapSurveyFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-6719425/v1/c7bd90616cba872a64ce7c6c.docx"},{"id":84871133,"identity":"e4de0632-7144-4763-b495-c8ef983bd099","added_by":"auto","created_at":"2025-06-18 09:04:03","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":36455,"visible":true,"origin":"","legend":"","description":"","filename":"StructuredClinicalGapYearProgramDescription.docx","url":"https://assets-eu.researchsquare.com/files/rs-6719425/v1/24faf6f45a564a35b053cd63.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bridging the Gap: A Structured Pre-Professional Medical Education Gap Year Affirms Career Pathway, Promotes Competency Development and Enhances Preparedness for Success","fulltext":[{"header":"Background","content":"\u003cp\u003eAmongst medical school admissions committees, pre-medical advisors and even students, there is uncertainty about the best pathway to medical school. Some believe the traditional path \u0026ndash; direct matriculation to professional school after completing an undergraduate degree \u0026ndash; is the most effective route to becoming a successful health professional. This view often casts alternative pathways, such as paid healthcare experiences (gap years), as unnecessary delays or even as potentially detrimental interruptions in a student\u0026rsquo;s progression toward a medical career.\u003csup\u003e1\u003c/sup\u003e However, emerging evidence suggests that these non-traditional routes, including structured clinical gap year (scGY) experiences, may offer unique opportunities for growth, career exploration, and competency development.\u003c/p\u003e \u003cp\u003eThis discussion is particularly relevant in today's competitive landscape. The American Association of Medical Colleges (AAMC) reports that for the academic year 2023\u0026ndash;2024, a staggering 52,577 individuals submitted nearly one million applications to MD-granting medical schools. Despite the average applicant applying to 18 schools, only 43.7% were accepted, showcasing the intense competition in the field.\u003csup\u003e2\u003c/sup\u003e The competition becomes even stiffer when applying to more selective schools, with acceptance rates as low as 1.2%.\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOn the American Medical College Application Service (AMCAS) application, students submit undergraduate coursework, grade point averages (GPA), Medical College Admission Test (MCAT) scores, personal statements, and letters of recommendation. An additional section allows applicants to share work experience, extracurricular activities, awards, honors, and publications, with the opportunity to highlight three that were most meaningful.\u003csup\u003e4\u003c/sup\u003e While all elements of the application are perceived as important, how each is weighted and factored into acceptance or rejection by admission committees is unknown.\u003c/p\u003e \u003cp\u003eThree common pathways to medical school exist: 1) immediate matriculation after a four-year degree program (traditional), 2) non-traditional students matriculating after different life experiences, and 3) students who by choice or circumstance take a gap year between college and professional school. Regardless of the path, all applicants try to determine which activities will bolster their application for admission.\u003c/p\u003e \u003cp\u003eAdmission committees operate confidentially and do not make their internal processes widely available. Considerable variation likely exists between institutions and among members of an individual committee who may weigh elements of the application differently. They must ensure that students possess the cognitive traits and personal characteristics requisite to the practice of medicine. The ideal applicant must also demonstrate adequate career exploration to assure commitment to the grueling pathway to the profession.\u003c/p\u003e \u003cp\u003eStudies show that objective measures, such as the MCAT score and to a lesser degree the undergraduate GPA,\u003csup\u003e5\u003c/sup\u003e can reliably predict short term medical student success. This predictive ability has not been seen in more subjective assessments, such as interview scores and holistic review.\u003csup\u003e6\u003c/sup\u003e Objective metrics speak to academic ability, and the subjective letters of recommendation and interview scores may identify desired personality traits. However, less easily discerned are the intangible attributes of career exploration, including a commitment to patient care and requisite professionalism, communication skills, and dedication to self-improvement.\u003c/p\u003e \u003cp\u003eMost applicants aim to demonstrate career exploration via their portfolio of extracurricular activities. In a 2023 survey by the AAMC, medical school admissions officers ranked the experiences of medical and non-medical volunteerism, clinical shadowing and leadership of higher importance than paid healthcare employment when making decisions about who to interview and accept.\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEach admission committee may view the portfolio of experiences differently, making their intended outcomes poorly defined and difficult to measure. Furthermore, applicants participate in diverse individualized experiences, making direct comparisons a challenge. Although important pieces of the application puzzle, limited data, if any, exists about which experiences predict success in medical school and beyond.\u003c/p\u003e \u003cp\u003eOne recent study of prior healthcare employment (PHE) showed that 49 out of 434 students who participated in a minimum of six months of any type of PHE before medical school outperformed their peers in the clinical training environment. The authors propose that this early contextual learning enhances patient care and documentation skills, strengthens teamwork, feedback, and communication, and reflects personal traits like work ethic, motivation, and resilience.\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhile PHE shows improved outcomes, but ranks lower than other experiences by admission officers, pre-medical advisors are uncertain how to guide their advisees who desire to take a gap year in health care employment. To improve advising practices, pre-medical advisors have called for the study of this group of students with respect to the utility of a gap year on performance and the perception of the experience by students and medical professionals.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study evaluates a structured clinical gap year program (scGY) launched in 2017 for students aiming to attend medical or other healthcare professional schools. Applicants undergo interviews before joining clinical teams of physicians and physician assistants, where they participate in patient care, surgical assisting, and electronic medical record tasks. The program is complemented by weekly lectures on high-yield topics, mentorship, research opportunities, and personalized recommendation letters. \u003cem\u003eA detailed description of the program is available in the supplemental information.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eWith the uncertainty among pre-medical students, advisors and admissions officers about the utility of a gap year program, these investigators aim to determine if a pre-medical scGY experience can serve as adequate career exploration, show longitudinal improvement in competency-based domains and prepare students for success in professional school.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was deemed exempt by the University of Nebraska Institutional Review Board. Thirty-eight participants who completed a gap year program at a private dermatology practice in Omaha, NE, were contacted via email to complete a 44-question survey. Metrics were collected on undergraduate school and major, GPA, MCAT scores, USMLE scores, chosen profession, and matriculation into professional school.\u003c/p\u003e \u003cp\u003eTwenty-eight competency-based questions were developed and grouped into categories using three Midwest medical schools\u0026rsquo; published Program Objectives utilizing domains in alignment with the Accreditation Council for Graduate Medical Education (ACGME) framework. The competency domains (number of questions) included medical knowledge (4), patient care and clinical skills (4), practice-based learning and improvement (2), interpersonal and communication skills (6), professionalism (4), systems of health care (3), interprofessional collaboration (2) and personal and professional development (3). Using a 10-point Likert Scale, where zero represents no knowledge or ability to perform the skill and 10 represents complete mastery of the subject or skill, respondents were queried about their confidence at the beginning and upon completion of the gap year.\u003c/p\u003e \u003cp\u003eParticipants were also asked about participation in career exploratory experiences, preparedness and burnout compared to peers who did not complete a scGY. Data was collected on research activity. Open-ended questions were included to allow individualized comments. Information was also collected for programmatic improvement. \u003cem\u003eThe full survey is available in the supplemental information.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eData was summarized using descriptive summary statistics (counts and percentages) for all survey items. Wilcoxon signed-rank tests were used to evaluate changes in ratings from pre- to post-gap year for each competency-based question. Open-ended questions were thematically analyzed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf 38 gap year participants, 37 returned surveys (response rate of 97%). One participant is an investigator (RMR), and only descriptive characteristics were included to minimize bias. Thus, competency questions were analyzed for 36 of 37 surveys (97%), and participant descriptors were analyzed for 37 of 37 surveys (100%). These participant descriptors are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003esummarizes the descriptive characteristics of participants in the scGY program.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (Percentage or Range)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndergraduate Information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstitutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajors in Science\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (38%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiochemistry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean GPA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8 (range 3.3\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean MCAT Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e510 (range 495\u0026ndash;525)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApplied to Professional School Prior to Gap Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(46%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (54%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccepted or Matriculated into Professional School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (81%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional School Attended after Gap Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster of Medical Science\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster of Public Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-Baccalaureate Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUSMLE Pass on First Attempt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCareer Exploration\u003c/span\u003e: Of all scGY participants, 13 (36%) were more likely and 18 (50%) were much more likely to pursue a career in healthcare after completing the program. One participant (3%) was much less likely to pursue a career in healthcare.\u003c/p\u003e \u003cp\u003e Thematic exploration of open-ended questions regarding the impact of the scGY experience on a participant\u0026rsquo;s acceptance into professional school revealed 17 (49%) perceived a positive overall impact and 7 (20.0%) perceived an enhanced interview performance. The most common specific impacts on professional development were increased clinical experience (18; 51%) and increased real-life understanding and application of medical/patient care (14; 40%).\u003c/p\u003e \u003cp\u003eIn addition to the scGY Program, participants had engaged in multiple additional career exploratory experiences including 36 in shadowing (100%), 31 volunteering in health care (86%), and 23 participating in research (64%). Among all activities, the scGY Program was ranked the most important for preparation to succeed in the pre-clinical years of training, with 32/35 (91%) participants listing it as the most important. No other activity received more than one vote for the most important. Shadowing was ranked the second-most important and volunteering in a health care setting was ranked the third-most important (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eParticipants were asked to rank the importance of shadowing for career exploration on a 0\u0026ndash;10 scale, and the overall average was 6.3. Thematic analysis of individualized comments about shadowing likes and dislikes revealed both positive and negative remarks (12), only negative remarks (9) and only positive remarks (6). The most common positive themes included exposure to different specialties (10; 35%) and gaining insight into the daily life and responsibilities of a provider (9; 31%). The most common negative themes were not being hands-on/lack of active participation (9; 31%) and that shadowing does not fully/accurately represent the profession (6; 21%).\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCompetency Domains\u003c/span\u003e: All 28 questions in eight competency domains showed significant improvement from pre- to post-gap year training, with an average increase in competency across all questions of 3.5 out of 10 points (range 1.3 to 6.4 points). Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows question means grouped by domain. The largest overall point improvements were seen in the domains of patient care and clinical skills: obtain patient history (from 2.1 to 8.3) and perform patient care (from 1.3 to 7.6), and interpersonal and communication skills: document in EHR (from 1.9 to 8.3) and present relevant patient information (from 1.8 to 7.8).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePreparedness\u003c/span\u003e: Participants were sorted into two groups. Group 1 consisted of those in the last month of the program and Group 2 consisted of those who completed the program at least one year prior. Participants rated their preparedness for their next professional step before and after the program on a 10-point Likert scale. (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) Overall, participants felt more prepared for their next academic or professional step (increase of 3.4) and more prepared to work in a professional setting (increase of 3.0). Of the 22 participants who matriculated into professional school, 14 (64%) felt more and 8 (36%) felt much more prepared to succeed compared to their peers who did not complete a scGY. Of all scGY participants, 18 (51%) felt more and 15 participants (43%) felt much more prepared.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eBurnout\u003c/span\u003e: Thirty-two participants (89%) agreed that students who complete a scGY Program have lower rates of burn out. Thematic analysis of comments revealed the scGY provided motivation to continue schooling/pursuit of a medical career (6 participants, 38%) and it gave time and opportunity to pursue interests outside of school (5 participants, 31%).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eResearch Activity\u003c/span\u003e: Seven (18%) scGY students participated in research, including protocol development, IRB submission, data collection and abstract or manuscript preparation that has or will result in presentations or publications.\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eThis study shows that participating in a robust clinical health care employment experience prior to starting professional school should be viewed by both students and admission committees as a valuable pre-medical educational experience, and not a red flag for a lesser applicant.\u003c/p\u003e \u003cp\u003eThis is the first study to our knowledge that demonstrates that students rate a scGY as superior to other career exploratory activities. Participants noted that the program provided a realistic perspective of the medical profession and the hands-on experience that they crave, helping them solidify their decision to pursue a career in healthcare. Ranked second in our study, shadowing is perceived by many as the gold standard for career exploration. Our analysis revealed significant limitations in shadowing, including limited hands-on experience, poor engagement and lack of access. Though admission committees value volunteering and students validated its importance, it was ranked third in exploratory importance. Our study suggests a disconnect between the importance ratings of experiences in an application portfolio between admissions officers\u003csup\u003e7\u003c/sup\u003e and the applicants.\u003c/p\u003e \u003cp\u003eParticipation in the scGY program led some to the realization that healthcare was not the right career path, while others changed their trajectory within the health care field. All participants rated their experience in the program as positive, suggesting these changes were not the result of poor mentorship or a negative program experience, but rather robust career exploration. Learning one\u0026rsquo;s desired path is a poor fit before enrolling in professional school may be the greatest outcome of the scGY program.\u003c/p\u003e \u003cp\u003eEvery participant in our study who completed the scGY Program and enrolled in professional school felt more prepared to succeed compared to their peers who did not complete a similar gap year. This finding is in alignment with a previously published study in the United Kingdom that found that 77 of 79 gap year participants and 48 of 105 non-gap year participants who subsequently enrolled in medical school supported taking a pre-medical gap year. \u003csup\u003e10\u003c/sup\u003e As many medical schools are moving clinical training earlier in the curriculum, students are asked to simultaneously adapt to the academic rigor and perform in the high-stakes clinical environment of medical school. This poses a significant challenge to most students, and having a year of clinical professional training and identity formation can mitigate many of the clinical environment stressors.\u003c/p\u003e \u003cp\u003eA study looking at the effects of early clinical exposure by certifying as an emergency medical responder before starting coursework in the first year of medical school showed improved subjective reporting of competencies. When investigators looked further, the greatest improvements were seen in students who also had additional PHE. \u003csup\u003e11\u003c/sup\u003e Our competency outcomes endorse this finding, showing significant improvements in every question of each domain. We saw the greatest improvements in patient care and clinical skills and interpersonal and communication skills. Every scGY participant who matriculated into medical school passed their coursework and USMLE steps on the first attempt. It is possible that a scGY Program can \u0026ldquo;prime the pump,\u0026rdquo; allowing more rapid acquisition of knowledge, skills and attitudes incorporated into a solid foundation built by prior contextual learning.\u003c/p\u003e \u003cp\u003eA key advantage of the scGY Program is the mentorship component. Participants highlighted the value of personalized guidance from practicing physicians, which aided in career decisions and strengthened applications with impactful letters of recommendation. The program also fostered peer support, enhancing both personal and professional development, and one participant stated, \"I really enjoyed having other gap years my age who were also going through the application process because it gave me a support system.\u0026rdquo; Poor family and social support have been shown to be risk factors for medical student suicidal ideation, \u003csup\u003e12\u003c/sup\u003e and building early and lasting mentoring and peer networks may mitigate some of this risk.\u003c/p\u003e \u003cp\u003eWith the epidemic of physician and medical student burnout, our findings were in alignment with a previously published study that students taking any type and duration of gap year prior to a combined baccalaureate-MD program exhibited significantly lower levels of burnout.\u003csup\u003e13\u003c/sup\u003e Although the scGY participants were not administered burnout surveys, 89% felt that completing the scGY reduced burnout when attending professional school. The reasons are likely multi-factorial, but may be due to increased time for reflection, exploration of activities outside of medicine, preparedness to succeed in school, and building support networks.\u003c/p\u003e \u003cp\u003eThe opportunity to participate in research is also a positive outcome of the scGY program, with seven students producing work suitable for presentation or publication. Published data on non-clinical research gap year programs are at the pre-medical and post-graduate level. Reported benefits of these programs include increased number of publications, perceived application advantage for competitive programs, and off-loading clinical faculty with research demands for rank advancement.\u003csup\u003e14\u0026ndash;16\u003c/sup\u003e The scGY program gives participants the simultaneous benefits of clinical training with opportunities to bolster their research portfolio. In turn, the clinical providers overseeing the students are afforded a talented and engaged workforce and opportunities to teach and mentor outside of a career in academic medicine.\u003c/p\u003e \u003cp\u003eOne strength of this study is the high survey response rate, enabling the capture of nearly complete data. Unlike most published data on gap year programs with varying experiences and duration, and the standardized content and length of the program is another strength of this study.\u003c/p\u003e \u003cp\u003eThis study has several important limitations, including a small sample size, self-reported recall survey data, and the lack of a control group. All participants worked in a multi-specialty dermatology clinic, which limited exposure to other areas of medicine. However, only two of the scGY participants have pursued dermatology. Importantly, the clinical experience is essentially unchanged since program inception in 2017, but the full program has improved over time to include a more robust didactic program and facilitated mentoring, making the positive findings more conservative.\u003c/p\u003e \u003cp\u003eFuture research should concentrate on the long-term impacts of scGY programs on medical school performance, residency placement and overall career satisfaction. Longitudinal studies are needed to confirm whether the observed early benefits lead to sustained professional success and to develop scGY models that optimize educational outcomes. Additional research should also focus on scGY opportunities as an avenue for students under-represented in medicine to gain early access to clinical exposure and mentoring. Given our findings, which suggest that a scGY program may reduce student burnout, additional studies should explore this in greater depth, including whether similar reductions in burnout are experienced by the mentors who oversee a scGY program.\u003c/p\u003e \u003cp\u003eIn conclusion, a scGY Program can offer significant advantages in both career exploration and preparation for professional healthcare education, challenging the notion that the direct path from college to medical school is superior or preferred. A scGY program significantly develops confidence in core competencies essential for professional school and medical practice. Mentoring, research opportunities, peer support networks and reduced burnout are additional benefits of the program. Far from being a fallback option, a PHE gap year allows students to affirm their career choice, develop key skills, and enter professional school better prepared for success. Admission committees should recognize these programs as a legitimate and valuable pathway to the medical profession, dispelling the bias that such experiences signal a lesser applicant.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Carl F. Schanbacher, MD, for sharing his idea and experience in administering a gap year program, the University of Nebraska College of Medicine librarians for their assistance in literature review for this manuscript, and the providers, administrators and nursing staff of Dermatology Specialists of Omaha for instituting and implementing the gap year program (Drs. Jill Nelson, Tricia Hultgren, Judy Wolpert, Ashley Drake, Sara West and Kendra Lesiak).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Acknowledgements:\u003c/strong\u003e The authors would like to thank Carl F. Schanbacher, MD, for sharing his idea and experience in administering a gap year program, the University of Nebraska College of Medicine librarians for their assistance in literature review for this manuscript, and the providers, administrators and nursing staff of Dermatology Specialists of Omaha for instituting and implementing the gap year program (Drs. Jill Nelson, Tricia Hultgren, Judy Wolpert, Ashley Drake, Sara West and Kendra Lesiak).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Interest Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors report no conflict of interest. No funding provided.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding sources\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e: None declared\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate Declaration:\u0026nbsp;\u003c/strong\u003eThis study was reviewed and deemed exempt by the University of Nebraska Medical Center Institutional Review Board. All participants were informed about the nature and purpose of the study and consented to participate voluntarily by completing the survey. Informed consent statement was obtained from all participants. This research was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSchwartzstein RM, Marzouk S. Gap Years\u0026mdash;Unbridled Good or Unwarranted Cost? \u003cem\u003eJAMA.\u003c/em\u003e 2024;332(24):2053\u0026ndash;2054. doi:10.1001/jama.2024.19750\u003c/li\u003e\n\u003cli\u003eAAMC. Table A-1: U.S. MD-Granting Medical School Applications and Matriculants by School, State of Legal Residence, and Gender, 2023-2024, www.aamc.org/media/5976/download?attachment. Accessed 28 Mar. 2024. \u003c/li\u003e\n\u003cli\u003eWood, Sarah. 16 MED Schools with the Lowest Acceptance Rates | the Short List: ..., www.usnews.com/education/best-graduate-schools/the-short-list-grad-school/articles/medical-schools-with-the-lowest-acceptance-rates. Accessed 28 Mar. 2024. \u003c/li\u003e\n\u003cli\u003eAAMC. 2024 AMCAS Applicant Guide, students-residents.aamc.org/media/11616/download. Accessed 28 Mar. 2024. \u003c/li\u003e\n\u003cli\u003eMurphy, Brendan. \u0026ldquo;MCAT Scores and Medical School Success: Do They Correlate?\u0026rdquo; \u003cem\u003eAmerican Medical Association\u003c/em\u003e, 8 Mar. 2024, www.ama-assn.org/medical-students/preparing-medical-school/mcat-scores-and-medical-school-success-do-they-correlate. \u003c/li\u003e\n\u003cli\u003eKreiter C, O\u0026rsquo;Shea M, Bruen C, Murphy P, Pawlikowska T. A meta-analytic perspective on the valid use of subjective human judgement to make medical school admission decisions. Med Educ Online. 2018;2018(1):1522225. doi: 10.1080/10872981.2018.1522225. \u003c/li\u003e\n\u003cli\u003eAAMC. Using MCAT\u0026reg; Data in 2025 Medical Student Selection. Washington, DC: AAMC; 2024. Accessed 8/3/2024.\u003c/li\u003e\n\u003cli\u003eStrowd, L. C., Gao, H., O\u0026apos;Brien, M. C., Burns, C., Freischlag, J. A., Strowd, R. E., Grier, D., \u0026amp; Peters, T. R. (2020). Prematriculation Healthcare Employment Predicts Success in Clerkship Environment. Medical science educator, 30(1), 211-217. https://doi.org/10.1007/s40670-019-00859-2\u003c/li\u003e\n\u003cli\u003eCharland, D. M. (2023). A Phenomenological Study of the Lived Experiences of Premedical Advisors Advising Undergraduate Students about Gap Year Options (Order No. 30314619). Available from ProQuest Central; ProQuest Dissertations \u0026amp; Theses Global; ProQuest One Academic; Publicly Available Content Database. (2791147954). \u003c/li\u003e\n\u003cli\u003ePaterson-Brown, L., Paterson-Brown, F., Simon, E., Loudon, J., Henderson-Howat, S., Robertson, J., \u0026amp; Paterson-Brown, S. (2015). The Influence of a \u0026apos;Gap Year\u0026apos; on Medical Students. Journal of Education and Training Studies, 3(4), 49-56. https://search.ebscohost.com/login.aspx?direct=true\u0026amp;AuthType=shib\u0026amp;db=eric\u0026amp;AN=EJ1067252\u0026amp;login.asp%3fcustid%3ds5794986\u0026amp;site=ehost-\u003c/li\u003e\n\u003cli\u003eTapasak B, McCall M, Cheung E, et al. (July 09, 2022) Developing Medical Student Competencies, Clinical Skills, and Self-Efficacy With an Emergency Medical Responder Certification Course. Cureus 14(7): e26678. DOI 10.7759/cureus.26678\u003c/li\u003e\n\u003cli\u003eSeo C, Di Carlo C, Dong SX, Fournier K, Haykal K-A (2021) Risk factors for suicidal ideation and suicide attempt among medical students: A meta-analysis. PLoS ONE 16(12): e0261785. https://doi.org/10.1371/journal.pone.0261785\u003c/li\u003e\n\u003cli\u003eGuang SA, Eltorai AEM, Durand WM, Daniels AH. Medical student burnout: Impact of the gap year in burnout prevention. Work. 2020;66(3):611-616. doi: 10.3233/WOR-203203. PMID: 32623422.\u003c/li\u003e\n\u003cli\u003eFishman EK, Lugo-Fagundo E, Chu LC, Rizk RC. The gap year for college students interested in medicine: Can they contribute to your mission? Curr Probl Diagn Radiol. 2024 Jul-Aug;53(4):452-454. doi: 10.1067/j.cpradiol.2024.05.011. Epub 2024 May 4. PMID: 38724308.\u003c/li\u003e\n\u003cli\u003eCotter EJ, Polce EM, Williams KL, Spiker AM, Grogan BF, Lang GJ. Current State of Research Gap-Years in Orthopedic Surgery Residency Applicants: Program Directors\u0026apos; Perspectives. Iowa Orthop J. 2022 Jun;42(1):19-30. PMID: 35821932; PMCID: PMC9210394.\u003c/li\u003e\n\u003cli\u003eWright-Chisem J, Cohn MR, Yang J, Osei D, Kogan M. Do Medical Students Who Participate in a Research Gap Year Produce More Research During Residency? J Am Acad Orthop Surg Glob Res Rev. 2021 May 13;5(5):e21.00061. doi: 10.5435/JAAOSGlobal-D-21-00061. PMID: 33983156; PMCID: PMC8126556.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gap year, career exploration, competency development, professional preparedness, burnout prevention","lastPublishedDoi":"10.21203/rs.3.rs-6719425/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6719425/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical school admissions committees often prioritize traditional pathways, but structured clinical gap year (scGY) programs may offer valuable opportunities for career exploration, competency development, and professional preparedness. The impact of scGY programs on these outcomes remains unclear. The objective of this study was to evaluate the impact of a structured clinical gap year program on career exploration, competency-based skill development, preparedness for professional school, and burnout mitigation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis observational study surveyed 38 participants who completed a 14-month dermatology-focused scGY program at a single private practice. The program included direct patient care, surgical assisting, electronic medical record use, structured mentorship, and weekly didactic sessions. Thirty-seven participants responded to a post-program survey (97% response rate). Data collected included academic outcomes, self-reported confidence in ACGME core competencies (before and after the program), perceived preparedness for professional school, and burnout. Changes in competency confidence were assessed using Wilcoxon signed-rank tests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants reported significant improvements in all competency domains, with the greatest increases in patient care/clinical skills (mean improvement: 6.2 points) and interpersonal/communication skills (mean improvement: 5.9 points). Compared to their peers, 64% felt more prepared and 36% felt much more prepared for professional school. Career exploration rankings indicated the scGY program was more valuable than shadowing or volunteering. Additionally, 89% believed that completing a scGY reduced burnout.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured clinical gap year program enhances competency development, affirms career pathways, and improves professional school preparedness while reducing burnout. These findings suggest that admissions committees should recognize scGY experiences as valuable, rather than viewing them as unnecessary delays in medical training.\u003c/p\u003e","manuscriptTitle":"Bridging the Gap: A Structured Pre-Professional Medical Education Gap Year Affirms Career Pathway, Promotes Competency Development and Enhances Preparedness for Success","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 08:47:59","doi":"10.21203/rs.3.rs-6719425/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-07T17:44:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-06T14:23:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-01T16:21:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42233808826643915472768249211032752100","date":"2025-06-16T14:12:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247516463221617351194208543159523760363","date":"2025-06-15T20:40:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-15T19:58:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-14T21:47:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-13T11:24:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-11T15:28:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-06-11T15:25:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1737e2f4-b760-4ff7-a309-4857f97db05d","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T16:50:17+00:00","versionOfRecord":{"articleIdentity":"rs-6719425","link":"https://doi.org/10.1186/s12909-025-08501-z","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2026-01-17 16:30:59","publishedOnDateReadable":"January 17th, 2026"},"versionCreatedAt":"2025-06-18 08:47:59","video":"","vorDoi":"10.1186/s12909-025-08501-z","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08501-z","workflowStages":[]},"version":"v1","identity":"rs-6719425","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6719425","identity":"rs-6719425","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}