The Power of a Gap Year: Preparing Future Physicians Through Hands-On Experience

Podcast Transcript

Dr. James K. Stoller:

Hello and welcome to MedEd Thread, a Cleveland Clinic education podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizanno:

Hello, welcome to today's episode of MedEd Thread, an education podcast exploring the growing popularity of taking a gap year before entering medical school or even residency, and how a structured clinical gap year can uniquely prepare learners for a career in medicine. I'm your host, Dr. Tony Tizzano, director of Student and Learner Health here at Cleveland Clinic in Cleveland, Ohio. Today I am very pleased to have Max Regester, a newly minted physician having just completed medical school at the University of Nebraska. Max, welcome to today's podcast.

Max Regester:

Thanks so much for having us. We're really excited to be here.

Dr. Tony Tizanno:

In addition, we have Dr. Anthony Griess, a dermatologist and founder of this novel Gap Year Program, and Max's mentor here as well.

Dr. Anthony Griess:

Yeah, thanks for having us. Really appreciate it. Exactly what Max said.

Dr. Tony Tizanno:

Fabulous. So Max or Anthony, to get us started, please tell us a little bit about yourselves, your educational background. What brought the two of you together in this novel program?

Dr. Anthony Griess:

I'll start probably, 'cause it started before Max a little bit. This gap year program started a little over eight years ago. Actually, the thought came about nine years ago. I was just talking to someone at a mohs meeting and they were working on a gap year program in Boston and they talked about it being kind of a hot item on the East coast where students would take a year before they go into med school. He thought I should probably consider doing it in the Midwest. And I thought, well that sounds like a kind of a neat idea.

So it, it kind of dreamed up on the fly 'cause one of the guys that I talked to who was trying to get into medical school here at the University of Nebraska did not get in and said he needed a clinical year. He happened to be my brother-in-law's nephew. And I said, well, let's just go ahead and go for this gap year and try it. And so we developed a kind of a, a clinical curriculum around him and eventually as that year went on, I started thinking we should probably consider more of a didactic thing too. And so we started doing lectures and stuff. He did one first, I did one. And then it morphed over the next eight years into a full clinical, some research didactic and even basic science gap year program just before going into medical school or PA school.

Dr. Tony Tizanno:

So necessity being the mother of invention, so to speak. And, and it's good to have friends in high places. <laugh> So thank you for that. I'm sure he's very grateful. Max, what do you have to say?

Max Regester:

Yeah, so I went to school at the University of Nebraska Lincoln, largely for my love of the football team. But before even starting undergrad, you know, I knew I wanted to be a doctor, knew I wanted to be a physician and that was my calling. First time I applied, unfortunately I didn't get in and you know, there's a mad dash when that happens to figure out, Hey, what am I doing now?

I knew I still wanted to try and reapply the following year and kind of took that self-assessment of, hey, how do I need to improve myself? And really I felt like, you know, getting more clinical experience was, was what I needed to do. And through the grapevine I heard about this gap year program and with Dr. Griess and this program that he created. And it sounded like something I wanted to be a part of. And really the rest is history.

I say that the gap year program saved my life. That might be a little bit of an exaggeration. I'd probably be still breathing today if I didn't, didn't join the program. But I certainly wouldn't be where I'm now, I'm currently at McNeil Hospital, Loyola University in Chicago. And then next year I'm starting at Mayo Clinic in Rochester for my dermatology residency. And I think I owe a large part of that to this gap year. And so I'm, I'm excited to be able to talk about it.

Dr. Tony Tizanno:

Perfect. So Max, if you could help frame today's topic for our audience with some context around the purpose of actually taking a gap year and why it's gained in popularity for this and other advanced programs in education professional schools.

Max Regester:

Sure. Yeah. And you know, I'm gonna talk, you know, very centric around medical school, but this applies to the vast majority of health professional schools. But you know, I think there's many ways of matriculating into med school and other professional schools. And the one that's kind of viewed as most traditional is, you know, take care of your pre-req courses, your MCATs, all that good stuff during undergrad, apply, and then directly matriculate into med school.

And while that's viewed as the most traditional, it's becoming less and less common. According to the double AMC (AAMC) in 2023, 73% of the students of med students reported taking at least one gap year after undergrad, before med school. So a very large portion of students are taking a gap year. And then you ask the question, well why? Why are students taking these gap years? And I think a lot of that stems from just the competitiveness that, that, that there is in getting into med school.

And that same cycle, 2023 to 2024 and the double AMC reported acceptance rates just over 43%. So you've got over half of these students that are wanting to get into the field, are passionate about it, but but didn't get in. So that's where the gap year comes in. The tricky part is that, you know, in our experience in talking with different admissions committee folks and looking at the literature, at times gap years are painted in a bit of a negative light and viewed as maybe an unnecessary delay. And that's where we wanna talk about some of the strengths, certainly with this program, but with gap years in general.

Dr. Tony Tizanno:

Perfect. So Dr. Griess, you have been doing this for eight years and you've developed this comprehensive approach and I'm sure you've been fine tuning it along the way. You know, what do you see as the advantages as you watch these students go through your program?

Dr. Anthony Griess:

For the first 10 years, I was in Omaha. I taught the first and second years dermatology 'cause they didn't have a course. And I thought, well I could teach medical students, I can take these pre-medical students that really wanna get in and teach them the same way. And so I just feel like it's just one, they're getting an experience that's gonna be similar to the first and second year, at least as far as dermatology goes. And two, they're actually going to be able to see the whole team of medicine from the beginning to the end.

So they're gonna start out mainly as a nursing team and actually see what it's like to be a nurse. And so I I, I feel like it's really important to see all aspects of the surgical team and or clinical team before you go to medical school. So you, you kind of know what you're signing up for.

And then I kind of wanted to get a basic science curriculum around them so they would actually see some of the toughness of the basic science. So we threw together some cancer biology lectures, immunology lectures and infectious disease lectures 'cause I kind of, that's the pathology of almost all organ systems. I wanted 'em to get a feel for what medical school would be like. So I just feel like they just kind of know what they're going into before they go.

Plus, with our group, we do a lot of needles and so sharps training is intense and they actually learn to be really good around sharps. And I can tell you when I train medical students, they're just not intense about it and it can definitely creep a person out when the needle's not being used right. And so I think our gap years are really good with sharps and needles when they go to to school.

Dr. Tony Tizanno:

Well that's fabulous. So this is really a reality check in some ways that they have a much clearer picture of just what, as you pointed out, signing up for when you look at your experience here, in what ways did your participation in the program provide an opportunity for personal growth and perhaps even career exploration?

Max Regester:

I'll try and be brief, but you know, I think it starts with my own personal accounting and feedback that I received after not getting into medical school of, Hey you need to increase your clinical experience, 'cause I just didn't get a ton during undergrad. And you know, I got that in loads during my gap year. You know, it's 14 months total of truly being integrated into the team and doing everything the MAs and nurses are doing, whether it's rooming patients, taking histories, performing surgeries, wound care, patient instructions, writing notes in the EMR, you name it, we did it.

So I think my skills when it came to just interacting with patients, talking with them, making them feel comfortable and then applying that with different patient care skills grew immensely. Not only that, you know, I think that you don't realize that there's a lot of things in medicine as a med student that are very critical, like documenting in an EMR and you ask any third year med student, what's one of the hardest things? It's how in the heck do I navigate Epic?

And you know, being able to be a part of that for a year and be a part of the documentation team was massive. I knew how to write a soap note. A lot of my med students thought it was what you clean your body with. I was like, that's true, but it's also a format we use for notes and just different things like that that you wouldn't know unless you've actually done it.

And then like Dr. Griess had mentioned, I think that truly integrating yourself into that role as an MA and and understanding the role of a nurse because you lived it, is crucial when you eventually become the leader of a healthcare team, just because you understand their perspective and can maximize their experience as well as a part of that healthcare team, which only leads to better patient outcomes.

So there was a bunch of things there. And then outside of all the patient care, you know, you develop relationships with your mentors. Dr. Griess and I are still very close to this day and he wrote me an incredible letter of rec, I don't even know if I earned it was so good. But <laugh> you know, it, it's the kind of thing where all these different things are helping you not only build your resume but build yourself as a person. And while I think it certainly helped my resume for getting into medical school, it propelled me to success throughout medical school and and into residency. And I think that started in that gap year.

Dr. Tony Tizanno:

Yeah. You know, it's fabulous that you're able to get this at the very outset because you don't see this, as you mentioned, till the third year. So you have a perspective like, I'm gonna need this, I'm gonna need that because I know down the road this is gonna be important. You're getting that upfront and in addition to which you're getting the network and kind of begin to develop a professional identity, I would think.

Max Regester:

Oh, totally. And I forgot to mention the research part too. That's another, you know, in the, the world of pass fail, step one, it's becoming increasingly important at, at least from a med student perspective to pursue research to help your chances of matching into more competitive specialties, if that's what you want to do. And getting to start that process a year before med school and show a longitudinal, you know, write the IRB, conduct the research, collect the data and synthesize it over the course of a longitudinal period of time was massive as well. So I could talk on and on about it. But those are a few highlights.

Dr. Tony Tizanno:

Well thank you very much. So, Dr. Griess, I, I gotta tell you, I have to hand it to you. When I first began to understand the depth and breadth of what you're doing, I thought, wow, if everyone could do that. But I would imagine that anyone who's considering is thinking how on earth do you embrace and manage the commitment necessary to put this all together in a program as comprehensive as it as yours is?

Dr. Anthony Griess:

Well, I'll probably get a little in trouble by saying this, but one, I have a little time in the afternoon. I usually am done between 1 and 1:30 with clinical stuff. So I had some time to put together curriculum. I have great nursing staff. My chief nurse Amy Rau has been instrumental in making sure all of it kinda gets done beside me.

But I just gotta be honest with you, I think you just want the relationships from the get go to the end. I mean, I, I feel like you're training the future doctors and it's never bad to have a future doctor in your corner if you need one. It's just really rewarding to see people go from literally just coming out of college all the way through doctorhood. It's fun to watch. So you just keep that in the back of your mind when you're trying to knock out a immunology lecture or a cancer biology lecture and say, this is worth it.

I mean, they're gonna remember this. They're gonna want their friends to come and do this. And they're like family to us. All the nurses will tell you all the gap years are family to them. So everybody's bought into this, they come back, they occasionally lend a hand when we're low on staff, it's kind of a family atmosphere and we just see them develop and they become doctors and it's really rewarding. So the reward is worth all the effort.

Dr. Tony Tizanno:

Well, you, you're personifying the definition of a mentor. I mean, it's just fabulous. So Max, you know, when you look at the variety of gap years that people take, being able to find something that's organized like this, it strikes me that not all gap years are created equal. You know, how does one even begin to start, look around, pick and choose?

Max Regester:

Yeah, that's absolutely true that not all are created equal. And I think it starts with taking that self-assessment that I spoke about. When you're thinking about a gap year, you have to decide what do I want to get out of it? You know, do I need to work on certain areas of myself and my resume to improve my chances of matriculating or do, hey, I, I don't know if I need to work on much, but my batteries are pretty drained and I just need a recharge before heading off to the rigor that is med school.

And I think a, a great way to start that is obviously self-reflection, but also in my case of what I did was I reached out to my home program and then other medical schools that I applied to that I didn't get into and you know, very professionally and respectfully said, Hey, thanks for the opportunity to apply to your school, but if you're willing, could you let me know maybe areas that I fell short and what I could work on to improve next year.

And I think that advice that I got back from those folks was invaluable. And the big takeaway was, hey, you need more patient clinical hours and clinical experience. And that's where I looked for a program like this.

I think this program's pretty unique. So I don't know that everyone's gonna be able to pursue a program like this. I hope there's more that are formed and you know, as time goes on. But I think the, the big thing that I look for is a longitudinal experience just because it allows you to develop those relationships in a way that you can't in a two week, you know, volunteer experience or short term thing. So I think something that's longitudinal is huge and then it's all up to you.

I mean you can do the Xbox Gap year if you want. You can volunteer here or there and then play Xbox with your friends. But I think ultimately you get out of it what you put into it. So if you find the right people that are willing and to invest into you, you should certainly treat it almost as an extension of medical school. And I feel like that's what I did and what Dr. Griess did of, hey, this is a prerequisite to medical school and let's get you started early.

Dr. Tony Tizanno:

Boy, that's certainly a feeling I get. So Dr. Griess, are you familiar with any other programs that are like yours?

Dr. Anthony Griess:

Not really. I think the one that I modeled it after had some lectures and some research. I don't know exactly how they run it there. I think they're pretty gap year heavy, but I've never actually witnessed their gap year program. I just kind of, this one evolved on its own and I'm not really sure how theirs goes.

I can tell you though, Max was pretty instrumental in getting my wife involved who's in academia. That helps a ton because she can do research and stuff like that. So I have a little advantage when it comes to after the gap year for the students that are in med school because she's up there at the med center helping 'em out. So that's a special advantage. I don't know how many people are gonna have in their back pocket.

Dr. Tony Tizanno:

It's a family affair. You can never beat that. So Max, I see the upside. Is there a downside to doing this?

Max Regester:

Yeah, I think there's certainly downsides to talk about and, and when I talk about the delay, the negative light that it can be painted around a gap year sometimes I think it comes from, you know, the opportunity costs. There's an extra year you have to delay pursuing the career that you're passionate about and you know, a year extra that you're foregoing a physician salary in that earning eventually someday.

And then, you know, I think it really comes down to the availability of programs like this. Like I said, I don't know that there's a ton. So while the gap year can certainly be incredibly positive, if you aren't able to find experiences that are gonna grow you as a person, then that can be a limiting factor as well.

The other thing that I think is really important to talk about is gap years in theory might not be paid. And in that situation it certainly lends itself to those that are of a higher socioeconomic class and may not be as amenable to folks that, you know, can't rely on family support to go a year without pay. And that's why I think a program like the one that, that we're talking about with Dr. Griess is, is so crucial and actually levels the playing field because you make a very livable wage.

In fact, I was able to pay down a lot of my, my undergrad loans, which was a nice bonus. But not only does it level the playing ground from a financial standpoint, but you're able to build those relationships with quote unquote people in high places and and physicians in fields that you may be interested in while making a livable wage. So while I think that financial piece can certainly be a limitation, if you're able to find a program and folks that are willing to support you in that area, it it helps mitigate that issue.

Dr. Tony Tizanno:

That's fabulous. And you know, again, kudos to Dr. Griess for putting it together like that. This is not a place for a wallflower. You're boots on the ground and you're working and you're getting to work with a team. You're beginning to see that it's just not the physician at the top of this pedestal and everything flows down. You're counting on the nursing staff, the various technicians and so forth.

I mean, these perspectives don't come until later in medical school. And if they could come earlier, it would color the whole educational experience, I think in a favorable manner. So Dr. Griess, I understand that you're the recipient of the University of Nebraska Medical Center's Excellent Education Service award. Why is service to their learners not only a focus, but an imperative of yours?

Dr. Anthony Griess:

I will give you the quote I got when I got this. The reason why I think it's important is that to pay it forward kind of thing. I had great mentors to get me where I am and you have to kind of pay it forward if, if that, if you've got that, that's what you do and you try to do that same thing for someone else. And if you pass that message along, that's someone else you did it for, will do it again. And it just keeps going. So I I just think you just keep paying it forward because that's how it works.

Dr. Tony Tizanno:

Yeah, very well said. So Max, you're taking this again a step further. You're looking at your experience and you're pursuing scholarly work around it. Can you tell us a little bit about that?

Max Regester:

You know, obviously I'm, I've, I've been a very big fan of the program, but we wanted to, you know, see if other people's experience were the same way and, and see if there was this kind of benefit that I feel like I've had. So we'd decided to develop a survey of all the participants at that time, and this was about a year ago now when we developed the survey, but we sent it out to the 38 alumni that had completed this structured clinical gap year program. It was a 44 question survey with 28 of those questions being competency based questions. And I'll talk more about that in a moment. And then we also spoke about career exploration, professional preparedness and burnout.

So those competency based questions were based around A-C-G-M-E aligned domains and they were adapted from three different Midwest medical schools program objectives. And essentially we asked the participants, Hey, on a 10 point Likert scale, with zero being no ability at all and 10 being complete mastery, how do you feel like you were in these domains or how confident did you feel in these domains before the gap year and then after you completed the gap year?

And the results we got back from that survey were, were pretty profound. So of the 38 people we sent it out to 37 responded, so really high response rate. And of those 37, 30 had matriculated into health professional school. So 81% of them. And when we talk about those competency domains, on average across all 28 questions, there was a 3.5 point jump across the board ranging from anywhere from 1.3 points to 6.4. And and really more interestingly to me was where we saw the biggest jumps were in areas that I think are incredibly important. So when asked about ability to obtain patient history and that jump from 2.1 to 8.3, ability to perform patient care jump from 1.3 to 7.6, ability to document in the EMR jump from 1.9 to 8.3, and then ability to present patient information jump from 1.8 to 7.8.

You tell me, but I think, you know, ability to conduct patient care, obtain patient history and and document, those are incredibly crucial skills that med students usually are lacking in. And having the ability to develop those skills before you start med school just sets you up for, for success in a way that I think is, is really important. And that was my experience. So it was cool to see that come through in the survey.

Additionally, when talking about career exploration, we said, Hey, after completing this gap year, how did your likelihood to pursue a career in healthcare change? 36% said they were more likely and 50% said they were much more likely to pursue a career in healthcare. And then interestingly, there were a couple students that said they were much less likely to pursue a career in healthcare and they didn't cite it as a negative experience with the gap year program, they just said, Hey, I discovered healthcare isn't for me. And for us we feel like that's valuable because, you know, you'd much rather discover that before starting a med school than being two years in and a hundred thousand dollars in debt and saying, boy, this, this isn't actually what I'm passionate about, but I'm stuck. And not only that, I'm taking the spot of somebody who, who would actually enjoy this career.

So we found that feedback really extraordinarily valuable. And then we also asked the participants to list their career exploration activities, the top three being obviously the gap, year number two being shadowing, and then number three being healthcare, volunteering. And we asked them to rank them in a priority of, you know, ability to provide career exploration and set you up for success in the preclinical years of medical school. And the gap year was by far and away ranked number 1.

Thirty two of the participants ranked it as the number one most valuable career exploration with shadowing being number two. And that was pretty interesting to us as well because shadowing's long been known as the gold standard for career exploration. But in the qualitative portion of the survey folks cited themes of just lack of hands-on experience and and longitudinal experience with shadowing that made it not as valuable, potentially.

Dr. Tony Tizanno:

The hands-on part is huge because, you know, I had the good fortune of becoming a phlebotomist for two years before I went and I had no idea what I was getting into and I was so far ahead when it came to engaging with patients. And also the point that you made about learning what you might not want to do is absolutely as important.

But the one thing I would like you to touch upon that you had mentioned to me earlier, and maybe you were about to, so excuse me, if you were, you talked about burnout and you know, to be successful, you have to feel successful and you have to feel good. And burnout is a huge issue for medical students. How did your group feel in that area?

Max Regester:

We addressed that in the survey as well and, and essentially said, Hey, how do you feel like this, this gap year impacted your burnout levels? And 89% said they believe that the, the gap year lowered their burnout levels. And the the themes that they cited was one, just being able to pursue some things outside of school. You know, when you go through undergrad and straight into med school, there's not a lot of time to pause, take a breath and maybe go take that trip with your friend or, or pursue things outside of school.

And then the other thing people cited frequently was developing a network of people that are going through the same thing as you. And not only the mentors that you develop like Dr. Griess, but other applicants that maybe didn't get in the first time or, or going through this stressful process of trying to matriculate in a medical school. Having that tight knit group going through it together seemed to really be helpful.

So I'd love to be able to do more research on, on the potential effect of a gap here on burnout, but, but the preliminary data that we got from this survey was certainly promising.

Dr. Tony Tizanno:

And I hope we'll get to come back and do this again, maybe around that. So for both of you, what lies on the horizon for students in pursuing a gap year that is well designed and likely to enhance their chances for matriculation into medical school? What's on the wishlist?

Dr. Anthony Griess:

Oh, always bigger, sometimes always better. But I mean, it would have to be Zoom. I don't know how I'd reach so many people with the lectures or, I mean, I'd love to say bigger, but I, I don't know how to make it bigger easy. You have to have someone that really cares to do it and care that the people turn out well and get to med school. And so I guess if I could make it bigger regionally, nationally, that would be great. But I honestly at this point, I'm not sure how'd do it yet, but I'm thinking about it.

Dr. Tony Tizanno:

Yeah, maybe I wonder if you can develop a, uh, a program that you can help be a facilitator for persons who are interested to not have to reinvent the wheel that you've so beautifully accomplished.

Dr. Anthony Griess:

There is effort. I mean that people really have to get aboard. They really want to put the effort into it, but I think there are people out there that wanna do the effort. So we do have it all written down and that would be a goal. I kind of hope the pay it forward starts to come around and the gap years that become doctors have a way of making it bigger too. So...

Dr. Tony Tizanno:

And, and hopefully Max comes back, maybe joins you in practice. Max, did you have something that you wanted to add to this?

Max Regester:

No, I, I totally agree with Dr. Griess and I think that bigger, it may be tough, but just more. You know, I think that the true value on top of all the lectures and all the experience that the, at its core, the value is getting to provide patient care and get hands-on with patients in a way that you just simply cannot get through a shadowing or through different experiences during undergrad. So I think if there are more opportunities for students that are passionate about becoming a healthcare professional to get their hands on patients and truly get involved in patient care, that would be incredible.

Dr. Tony Tizanno:

Perfect. Well, Max, your, your enthusiasm is absolutely contagious. And I, I could let you talk and talk, but you know, Dr. Griess, I really have to hand it to you. There are 38 individuals who owe you a great debt of gratitude. This has been a fascinating and timely topic. Are there any other questions or things that I didn't ask that you think are important for our listeners to know?

Max Regester:

Yeah, you know, I think just to kind of put a bow on it and we, we really appreciate the opportunity to, to chat with you all about this is that, you know, in my conversations with a lot of folks that have taken gap years or was in the admission circles, I just hope that this conversation removes some of the stigma around taking a gap year. And it doesn't make you any lesser or any lesser of an applicant. And just that if you do decide to take one or, or take one outta necessity, know that, like we said, they're not all created equal and, and you have to put in the effort into it to make it worth it.

Dr. Tony Tizanno:

Well said. Well, thank you so much Max and Dr. Griess. This has been an interesting and wonderfully insightful podcast To our listeners, if you would like to suggest a medical education topic to us or comment on an episode, please email us at education@ccf.org.

Thank you very much for joining and we look forward to seeing you on our next podcast. Have a wonderful day.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic education podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread and please join us again soon.