Many UK medical schools offer students the opportunity to choose to 'intercalate'; at a few medical schools intercalation (or an equivalent) is mandatory. Intercalation involves taking a year out from the standard medical degree to pursue an additional degree. Usually students intercalate between their third and fourth, or between their fourth and fifth clinical years. Traditionally these were bachelor degrees (e.g. BMedSci), but increasingly medical schools offer master degrees as intercalations.

Before considering the pros and cons of intercalation it's improtant to recognise that whatever your career aspirations, intercalation is not essential. For example, there are lots of paths forging a clinical-academic career and whilst an intercalation can be a great springboard, many people suceed in clinical academia who did not intercalate. When making a decision about whether to intercalate you should consider the pros and cons on their own merits rather than feeling pressured to make a particular decision.

• Specialist knowledge: by intercalating you will gain specialist knowledge and skills in the discipline you choose to focus on (e.g. pharmacology, anatomy, epidemiology, etc). If you have clear career aspirations towards a particular specialty, intercalating in a related discipline can set you up to a flying start.

• Research skills: most if not all intercalations require students to undertake a research poject and to write this up as a dissertation (10,000 words or so). This will turbo charge you generic research and methodology skills, giving you a great platform to grow a research portfolio. Even if after medical school you change your mind about the specialty you'd like to go in to (as many people do!), the generic skills you develop in an intercalation will be useful whatever you decide to do.

• CV enhancement: an interalation is a great asset for your CV. Whereas you will keep refreshing your CV with new projects and activities throughout your career, an intercalation is one of the few ahievements you will always keep on your CV.

• Presentations and publications: hopefully during you intercalation you will benefit from supervision and mentorship by an experienced researcher who will support you to produce a high-quality dissertation. Your should aim to both present your dissertation work at a national conference and to publish it. In addition, throughout your intercalation - away from busy clinical placements - you may have more time to get involved in 'side projects' (perhaps working within the research team you are doing your dissertation with) that can lead to additional presentations or publications.

• Time to reflect: if you are not sure about your future career direction, taking a year away from busy clinical routines might give you the space and time to reflect on your priorities and career goals.

• Cost: the single greatest disadvantage of intercalation is probably cost, including both direct living costs and an additional year of tuition fees (if this is not covered by the NHS bursary). There may be scholarships or bursaries from your medical school, medical societies and royal colleges, and industry that can help cover part (or all) of these additional costs so it is worth exploring all these options and applying if you are eligible.

• Opportunity cost: in addition to the direct costs of an intercalation, there is an opportunity cost with taking an additional year for study. In other words, you are delaying your entry and progression through a clinical career by a year. By the point you are 40 years old, this may mean that you have earned one year less of consultant salary than you would have done had you not intercalated. However, many doctors follow non-linear pathways for a variety of reasons and I don't think it is helpful to plot your career simply on the basis of how to maximise earnings.

• Uncertainty about impact on future job applications: in the past, candidates were awarded additional points in foundation programme applications if they held an intercalated degree. You will be aware that this is no longer the case, as applicants are now given a computer-generated rank. This doesn't mean that there are no benefits to intercalation in terms of future job applications; many specialty applications and clinical-academic jobs will still award additional points for intercalated degrees. Even if your chosen specialty does not directly recognise intercalation with additional points during the selection process, intercalating can give you some interesting and unique insights to talk about in both white space questions on applications and at interview. I think the key is that it is unwise to intercalate purely to chase points, as by the time you get to the point of applying for a role the shortlisting and scoring criteria may well have changed from what it is today.

• Social considerations: if you are at a medical school where most students do not intercalate, there can be some social impact. After completing the intercalation you will go back in to the mainstream medical curriculum a year below most of your cohort. Eventually many of your former peers will be working (and earning) as F1s whilst you are still in your final year of medical school. I'm not sure this is a major factor (particularly if friends also intercalate), but something to bear in mind.

Ultimately, there is no 'right' or 'wrong' decision about whether to intercalate. There are pros and cons, and it is a personal decision whether to intercalate based on personal circumstances and priorities. An intercalation will always add CV value and could open up unique opportunities. However, it is not essential and you will still be able to pursue all the same longterm career goals without intercalating; you might just need to make up elsewhere on your CV for not having an intercalation.

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