Decreasing the Anxiety and Shame of Medical Students Not Placing into a Residency Using an Innovative Fifth-Year Educational Intervention

US medical students, even before the COVID-19 pandemic, exhibited higher rates of mental health challenges than age-matched cohorts. The National Resident Matching Program (NRMP) match process, which places medical students into residency, is the culmination of medical school training and a well-recognized stressor that amplifies anxiety levels and the mental strain that accompanies medical school. Facing an unprecedented year with a decrease in 2021 NRMP placement percentages, Rocky Vista University College of Osteopathic Medicine (RVUCOM) introduced an innovative new program, the predoctoral internship (PDI), to support students who did not match into a residency program. At no extra expense to the student, this program offers a year-long opportunity to customize experiences in both clinical and academic settings, along with leadership training, aimed at bolstering their residency applications. Alternatively, students could participate in a Master's PDI (MPDI), which allowed students to concurrently pursue a master's degree of their choosing with an external program. RVUCOM achieved 100% placement for students completing the PDI or MPDI program, aligning with the institution's historical graduate trends. Perhaps equally important, students in the program reported feeling supported and less ashamed, fostering loyalty to RVUCOM. Transparency in communication and leaning into institutional values reinforced trust within community partners. The intentional balance of rigor and support, coupled with faculty investment, proved crucial for success. The experience held students accountable, allowing personal and professional growth and fostering the development of a deeper professional identity. RVUCOM's innovative approach to unplaced students not only addresses the challenges faced by RVUCOM students not achieving a residency placement, but also transforms an unforeseen circumstance into an opportunity for growth, resilience, and the development of more competitive and accountable medical graduates.