Taking a leave of absence can harm medical students' match prospects, finds study

Students who take a leave of absence during medical school are less likely to match into a residency or fellowship program, a new Yale study finds, a consequence that disproportionately affects Black students. Because nonplacement can negatively affect an individual's career trajectory, and the diversity of the medical workforce generally, programs should reevaluate their admission criteria, the researchers say.

The findings were reported April 15 in JAMA.

Medical students may take a leave of absence for any number of reasons that could stem from medical, mental health, financial, or academic needs, said Mytien Nguyen, an M.D.-Ph.D. student at Yale School of Medicine and lead author of the study.

To see if taking leave affected match rates, Nguyen and her colleagues assessed the residency and fellowship matches of students who matriculated to U.S. medical schools in 2014 and 2015.

They found that of the nearly 37,500 students included in the data, 5.68% took a leave of absence during medical school, with American Indian, Alaska Native, Native Hawaiian, and Pacific Islander (12.03%), Black (9.81%), and Hispanic (10.43%) students taking leaves at higher rates than Asian (6.35%) or white students (3.83%).

Among students who did not take a leave of absence, 3.7% did not match into residency or fellowship programs. That rate jumped to 20.3% among students who did take leave, the researchers found.

"And when we looked at the interaction between taking leave and race and ethnicity, we found that the negative impact taking a leave of absence had on placement was significantly greater for Black students than white students," said Nguyen.

During the matching process, students apply to and interview with specific programs and then rank those programs in order of preference. Medical programs compile a similar ranking of applicants. The National Resident Matching Program then uses an algorithm to determine matches based on the two sets of rankings.

A student who doesn't successfully match can attempt to join a program that has an open spot after the match process, which may not be in their preferred specialty, or reapply during the next match round. Either option can negatively affect a student's career trajectory while the latter may lead to financial strain, said Nguyen.

"Every time you apply is a huge time commitment and requires additional financial resources," she said.

Underrepresented students accounted for more of the documented leaves of absence than other groups; while the researchers did not have data on students' reasons for taking leave, previous research has found that experiences of mistreatment and discrimination are associated with student burnout and attrition from medical school.

Those experiences may contribute to leave rates as well, the researchers offer. Considering the effect taking leave has on match rates, this could have downstream impacts on the diversity of the medical workforce, they added.

To ensure that taking leave does not cause undue impacts on match prospects, residency and fellowship programs and medical schools should assess their policies, said the researchers.

"Programs should evaluate whether any bias against non-linear medical school trajectories exists within their applicant assessment policies," said senior author Dowin Boatright, who is now vice chair of research in the Department of Emergency Medicine at New York University Grossman School of Medicine and began this line of research while at Yale School of Medicine.

"And in general, programs should consider more holistic review processes to minimize the extent to which any societal factors influence their evaluations."

Medical schools should also consider policies that support students while they're on leave and once they return, said Nguyen.

"For example, medical schools could allow students to retain access to resources like health care and libraries while on leave and develop robust reintegration processes for their return," said Nguyen. "This would reduce the negative impacts taking leave might have on students and set them up for success once they reenter."