Path At Last! Failure is Not Fatal

If I told myself in 2008 where I would be in 13 years, I would not have believed it.

When we set out on the journey to find our next Path At Last! guest blogger, we had our sights set high with Brian Cox, MD, MAS (@Dr_Brian_Cox). His top-notch tweets led him to receive the 2020 #PathTweetAward for trainees. Dr. Cox has expertise in clinical research and statistics; in 2020, his collaborative efforts helped publish five manuscripts and eleven abstracts. Dr. Cox is currently working on his fellowship in gastrointestinal and liver pathology at Cedars-Sinai, where he served as past chief resident. With all of his experience gained, recognitions achieved, and successes earned, Dr. Cox’s journey through medical school and residency didn’t come without challenges, and it’s these challenges that make Dr. Cox’s story so inspiring, so relatable. Without further ado, we present to you Path At Last! Failure is Not Fatal by Dr. Brian Cox.


I didn't get into American medical school on my first attempt. I was a fresh graduate of Georgetown University with a year of research under my belt. My application lacked any glaring defects, but I didn't get in. It crushed me: "Would I ever be a doctor?" Self-doubt and feelings of hopelessness cornered my consciousness. However, instead of sitting on my hands and reapplying, I gathered myself and applied abroad. I was accepted to Queen’s University Belfast for medical school in 2009.

The opportunity to live and learn in the United Kingdom for five years was undoubtedly a personal paradigm shift. I learned I thrive in an entirely new environment. I traveled widely and met individuals from all over the world. Being 10,000 miles from home encouraged self-sufficiency and necessitated focus, especially while cycling along country roads in the rain. However, the harrowing commute was only a soggy footnote to my UK experience. The British socialized healthcare system stressed clinical acumen and “patient-centered” care above all else. As one of the few Americans in Belfast (affectionately: “Yank”), I found myself the de facto ambassador of American practices, principles, and attitudes. The status often led to lengthy interrogations during surgery or clinic rotation. These conversations quickly evolved into paid research positions that gave me hands-on experience in pathology, oncology, epidemiology, and medical ethics.

After graduation in 2014, I was offered a position at the Glasgow Royal Infirmary in Scotland. Instead of accepting the offer, I set my sights on returning home. Since my hope was to continue to pursue oncology research, either as a clinician or principal investigator, I sought to further my research expertise with a Masters of Advanced Studies (M.A.S.) in Clinical Research at University of California San Diego. During my Masters, I worked as an oncology clinical trials research coordinator and took each of my USMLE Steps: 1, 2C, 2S and 3.


Unfortunately, though, Step 2 took two tries to complete. I must admit, reading FAIL in all caps, Arial Black font is still a heart-sinking, emotional memory. I considered diving into research and forgetting residency altogether. However, after self-reflection, this failure marked a genuine moment of personal growth. Among Sir Winston Churchill’s many quotes about never (never, never) giving up, the quote that resonates most strongly was: “Success is not final, failure is not fatal: it is the courage to continue that counts.” Upon reading that quote, I realized that failing Step 2 was not a fatal blow. I would retake it. My future successes did not have to end with it.


I pushed forward with my application and received only two residency invitations: Loma Linda University (LLU) and the National Institutes of Health (NIH). While I was applying, my Navy physician wife landed her next duty station in Ventura, California, approximately 120 miles from Loma Linda University. We had already spent a year apart while I finished medical school in Belfast, so we were not about to spend the next four years on different coasts. After I spoke candidly about my situation with the program director at the NIH, I graciously told them I would not be ranking their program and approached LLU with my hat in my hands.


Although my first year of residency at Loma Linda was incredible, it was not without its academic and personal challenges. I commuted 3 hours every other day for a year while still maintaining good standing at LLU. The program director and I became close. One evening, he asked if I would like to transfer to a program closer to home. I explored several options in the Los Angeles area and found a fit at Cedars Sinai.


The Cedars residency program allowed me to flex my research expertise almost immediately. Over the next three years, I poured myself into research and managed to involve myself in over 20 abstracts, 6 publications, and a book. I was elected chief resident, garnered a GI/Liver fellowship, and became intimately involved in the ABP, CAP, USCAP, and ASCP. The road has been exceedingly long and winding, but my past failures gave me the tenacity to embrace the challenge.


I embraced the pathology Twitter community in 2019 and found myself addicted to sharing educational pathology content. My visibility on the platform and increasingly large network has been most recently rewarded when I was selected as a finalist in ASCP's "Top 40 under Forty."


If I told myself in 2008 where I would be in 13 years, I would not have believed it.

These diverse experiences have undoubtedly made me a better person, husband, father, and doctor. My journey to residency spans three continents and multiple hurdles, but my motivation and discipline to achieve is unwavering. I am continually looking to broaden my perspective and ultimately capitalize on new opportunities, despite the possibility of failure. My hope is to bring that same enthusiasm to every challenge, to detest complacency. I encourage you to do the same. You never know what your next success will bring or what your next failure will teach you.

What a journey! Our sincerest gratitude goes out to Dr. Brian Cox for sharing his amazing story. We are searching for our next Path At Last! guest bloggers. We’ll be reaching out to pathologists at all career levels via email and DM on Twitter. If you’re interested in sharing your path to pathology, just contact Kristin at kmitchener@instapathbio.com or DM us on Twitter @instapathbio.