In 1998, P&S admitted 150 students into the class of 2002, but only 147 diplomas were given at last May’s commencement. It wasn’t that three members of the entering class did not graduate. In fact, 51 of the students who entered in 1998—more than a third—did not graduate in 2002.

So what happened to those 51, and who filled their chairs at the 2002 commencement?

The answers illustrate a growing trend for medical students to take at least a year off from their studies—often after their third year—to pursue an interest outside of medical school. While some explore options outside P&S, others from earlier classes return to complete their education.

“When I came here in 1979, to take a year off was unheard of,” says Dr. Linda Lewis, senior associate dean for student affairs and clinical professor of neurology. “The Class of 2002 was a little unusual—51 is a lot of people—but the recent average has been for 20 percent of a class to take time for other things.”

One of the reasons students suspend their medical school studies is to earn a master’s degree in public health (M.P.H.) at Columbia’s Mailman School of Public Health. Through this program, students learn the methods involved in protecting and improving the health of entire populations. Those armed with an M.P.H. in addition to an M.D. degree prepare themselves for careers in the administration of health care delivery, whether in the public or private sector, in the United States, or abroad.

According to Dr. Victor Grann, clinical professor of medicine and public health at P&S and the Mailman School of Public Health and director of the M.D./M.P.H. dual degree program: “The fields of public health, which focuses on populations, and medicine, which focuses on the individual, are deeply intertwined. Those interested in patient care get a broader perspective by studying populations and evidence-based medicine. By exploring research design and comparing results, physicians can make informed decisions about treating their patients as well as understanding a population’s health needs.”

At one time, Dr. Lewis says, only one or two students would seek an M.P.H. each year. An endowment from the Macy Foundation made the program more enticing. “Before the Macy program, students working on their M.P.H. were required to do so while simultaneously working on their fourth-year requirements at P&S,” she says. “With this new program, students receive tuition to pay for the program and the year off from their medical studies to complete it.”

Macy scholar Jeremy Keenan’03, decided to get his M.P.H. because of his interest in international health; he considered population-based study an important factor not usually covered in the medical school curriculum. “I feel that I now have a completely different way of looking at health than I did before. I can see the big picture, so to speak.”

Rebecca Bauer’03 was not a part of the Macy scholarship program but still saw the value in taking a year off to earn her M.P.H. “I had thought about a dual degree when I was applying to medical school, but I wasn’t interested in trying to do both degrees simultaneously in four years,” she says. “I thought it would be too hard.

“I had been interested in the policy aspects of medicine for quite a while. When my academic adviser introduced me to clinical and outcomes research, I became more interested in learning about study design and biostatistics. I plan to do outcomes research to complement my clinical practice.” Her adviser is David P. Roye Jr.’75, the John H. Livingston Professor of Clinical Orthopedic Surgery at P&S.

During medical school, students often look for opportunities to conduct research. Starting in 2001, the Doris Duke Clinical Research Fellowship presented students with the chance to take a full year to learn and pursue clinical research.

“The best clinical research begins with observing patients,” says Dr. Donald Landry, associate professor of medicine and director of the Doris Duke fellowship program. “What to do with these observations—in terms of study development and improving clinical practice—is not taught in medical school. Through this fellowship, faculty doing state-of-the-art clinical research at Columbia can pass on their skills and provide students with the tools they need to focus on those observations and apply them to patient care.”

Doris Duke fellow Alexander Coon’03, who conducted research in neurological surgery, knew his fellowship year would be key to a successful academic career. “Patient-related research is a specific skill that doesn’t get a lot of focus in medical school. I deliberately sought out this program in order to develop the skills I would need in the future to perform my own clinical studies and trials,” he says.

Brian Su’03, another Doris Duke fellow, spent several months in South Africa participating in a clinical study for a device designed for flexor tendon surgery of the hand. “You need at least one year to conduct any kind of reasonable clinical study.” He hopes to apply what he learned during his fellowship toward product development of new orthopedic devices, a sizable aspect of academic orthopedics.

Carrie Rebecca Muh’03 chose to pursue a research opportunity on her own when her career goals changed. “I had been sure that I wanted to pursue a residency in general surgery and then go on to a cardiac surgery fellowship, so I had spent time working in a cardiac surgery lab,” she says. “But in March of my third year, I did my neurosurgery rotation and fell in love with the field. I wanted to learn more about neurosurgery and to be sure that it was the right career for me, and taking a year off to do research sounded ideal. Since the residencies are very competitive, I hoped it might also improve my chances of obtaining a good residency.” She spent her year in the Gabriele Bartoli Brain Tumor Research Laboratory in the Department of Neurological Surgery.

For students with an interest in management and health care, Columbia offers a dual degree program that combines the M.D. with the M.B.A. degree. Last year, three students took advantage of the program, which requires students to take 15 business courses and earn a total of 45 credits at Columbia’s business school.

“Doctors think they are good business people, but they really aren’t,” says Dr. Lewis. “When Wall Street and managed care took over in the 1980s and 1990s, medicine became a business. This program was developed for those students looking to one day run major medical organizations.”

Amanda Heron’03 decided to go for an M.B.A. “to increase my understanding of the way the world works. With so many of the problems in medicine coming from financial and operational efficiency issues, I thought it was important to understand business dynamics and be able to apply them to medicine.

“My M.B.A. has changed my career plans by broadening the range of things I can do as a physician. I am interested in emergency medicine and will hopefully be able to not only practice as a physician, but also be involved in hospital administration. It would be great to practice in a place where I also had a say in the operational setup.”

In addition to students in structured five-year programs, Dr. Lewis says three P&S students are on their way to becoming lawyers before they finish becoming doctors. One is at Columbia Law School, one is at Oxford, and a third just completed a degree at Stanford.

Then consider M.D./Ph.D. students, who leave medical school for the lab after their second year. These students are admitted to both P&S and Columbia’s Graduate School of Arts and Sciences. “They know then that they’re working on a program seven to eight years in length,” says Dr. Michael Shelanski, the Delafield Professor and Chairman of Pathology and director of the M.D./Ph.D. program. “Those pursuing this program are interested in laboratory research at a level equal to or in excess of their desire to take care of patients. Medicine is a powerful background to have. More and more we need people who understand disease and its complexities and who are versed both in clinical work and in hard science in order to translate laboratory work into patient treatment.”

Some students don’t have another degree or time in a research lab in mind when they request a year off. Eleven students took a year-long leave of absence for personal reasons. These reasons included having a baby or simply needing a break.

“Some students realize they’re not doing as well as they could be, and so they take the year to regroup,” says Dr. Lewis. She emphasizes that the decision is not perceived as a weakness.

“Somebody who can’t decide what to do with his or her life and who has the introspection and insight to recognize that there is more to life than medical school doesn’t leave it just to escape,” she says. “They do it to gain a broader perspective. Most can’t wait to get back, and they are better physicians for having taken the year.”

The trend to extend M.D. studies by a year or more is on the rise but it’s also an unpredictable trend. As medicine evolves, Dr. Lewis says, “there’s no way of knowing what the next phase will be, what program will next find itself as a complement to medicine.”

Students planning to suspend their medical studies first get permission from Dr. Lewis. “I can’t think of an instance where I would deny anybody the year off. Even if someone tells me they want to take the year off to bartend, they’ll get it, because I think that person will be a much better physician after that year off than he or she would have been if depressed or coerced into continuing.

“The bottom line is that if we take good care of the students, they’ll take good care of the patients.”

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