I highly enjoyed reading this as i think the article manages, in few paragraphs, to paint a whole complex issue. Some students from UK or US might not find this familiar, as the university environment in these countries is more flexible and better adapted to individual needs and profiles of the various students. In many other countries, however, medical education is rigid and set into a centrally planned schedule, centrally chosen courses, basically a structure everyone follows. This comes with a set time frame in which most people graduate; not obeying to this set frame for whatever reason might indeed damage your reputation, not only among colleagues, but also among faculty members, and family and friends might also disagree with it. However, although one can`t change the course choice or schedule, often there is no burocratic rule saying you can not take a year off, but people just never even think of doing it, as the general view in all environments (family, friends, university etc)is not a positive one.

Of course you can not say that taking a year off is always a good thing. But for a certain person, with a certain opportunity or in a certain situation, it might very well be. And still, in some countries (probably more than i know of), even if you are convinced it is better for you to take a year off, the pressure from outside is quite strong. Looking from the outside, it is easy to say it is a matter of seeting priorities (in the end, noone really stops you, right?), but in a country like mine (Romania) and like Portugal, it takes more courage, more motivation, more determination, more strenght to do this, as you need to go against the stream, fight all the prejudices, pressures and obstacles that you are perfectly aware you will get once you are back to your studies.

I really want to thank Tiago for this article.

Editor - The article by Tiago Villanueva represents the voice of the medical students who fail by a few marks in the exams especially in one subject. But there is another side for it. The Universities make the rules of the game clear at the time of admissions or they will tell the students well in advance about the changing rules. So students should be prepared to follow the rules of the university.

Medical curriculum is a demanding curriculum. It needs a lot of focus, determination and dedication from the student. The student must think twice before getting into the medical field because it is not so easy to pass the exams unless he/she is very regular in studies. Since there is a lot of competition to get into medical field, the universities have tightened the admission and exit criterion. The professors like to see all their students doing well in the final exams. The students should be ready to cope up with any changes in the exam pattern.

As for the promotion to the higher class after the exams is concerned, the rules are not same with all the universities. There is a need for globalization of the rules regarding the admission/exit criterions and the promotion criterion.

Coming to the point that the factual knowledge is lost if you are out of the medical school for one year, it is true. Any knowledge will fade off if it is not used; let it be just a factual knowledge or a skill, you need to hone it again if you are doing it again after some time. But then, if the universities are not very strict with the promotion criterion, some of the students take it for granted and they don’t prepare themselves well for the exams.

My advice to the student community is 'to keep the umbrella ready before the rainy season starts'. You have to study regularly and have to keep using your knowledge. Take failure as the stepping stone for success. Learn from your previous mistakes and let it not happen again.