Path2Pathology: An IMG Experience

When I was a medical student in Pakistan, I did not know that pathology was a career option, even though I loved pathology as a subject. I saw pathologists mainly as teachers and not as practitioners. It was only after I graduated and consulted one of my father’s friends who is a neurologist based in Ohio that I saw the light. From then on, I was working towards a pathology residency. I started off in Pakistan but decided to pursue a bigger challenge and more structured training, and that is when I started my journey towards a residency in the United States. I needed a role model and I found one in one of my seniors from medical school, Shahbaz Ali Khan, who had matched at Oklahoma University in 2015 and is now a faculty member in New York City. He was a constant source of advice throughout my journey. Some of my classmates from medical school, who had undergone the match process, also gave me useful advice and I’m thankful to them for their guidance and support. They gave me their opinion on which programs to apply during the match process, which resources to use for USMLE exams and what helped them most along their residency journeys.

I consider myself lucky that I found elective rotations in the United States. My advice to IMGs trying to pursue residency training in the US is to start early and try contacting as many faculty members as possible, asking them for potential observerships or research opportunities. I emailed hundreds of people and got very few replies. I mentioned early that I got lucky because one of the respondents was Dr. Jeffery Medeiros at M.D. Anderson Cancer Center in Houston. In a brief email, he said that his department had a room for an observer next year. I was over the moon when I got that email and it certainly changed the course of my life.

IMGs need to be ready when opportunity strikes and should not stop looking for more opportunities to work with U.S. based institutions. Try to focus on places where you would like to do your residency training, since U.S. based medical students can “audition” at their favored places, but IMGs rarely get those opportunities. Once I had one observership in hand, I went looking for others. I got another opportunity in New York, at Memorial Sloan Kettering, but it was too late in the application cycle for me to pursue. Another thing that worked in my favor was that one of my father’s friends helped me get an observership in southern West Virginia. I was able to see different ends of the healthcare spectrum that way, from a rural community hospital to a major referral center. At the community hospital, I saw the pathologist doing surgical pathology, frozen sections, rapid on-site evaluation, and some microbiology and lab management. At MD Anderson, everyone was hyper-specialized which had its own benefits. While I was doing my observerships, I showed up with passion, commitment and readiness. While I was in Houston, I met a resident who was rotating at M.D. Anderson from the University of Texas Medical Branch in Galveston. He encouraged me to visit the program and get a feel for it.

I followed his advice, visited Galveston (for the first time, using public transport, which was not easy), and liked the place. I ended up moving to Galveston for a potential observership, which was not possible at the time, but I persisted. I was asked to get a different visa if I wanted a research position and I was not in a position to do so, on such short notice. Eventually, I got an interview from the program later that year and matched there for an AP/CP residency. It took me two years from studying for my USMLE Step 1 until the time I got residency interviews and took part in the match process.

A lot of things have changed since 2017 when I was applying for residency. COVID-19 changed the world in many ways and some of the aftereffects are here to stay. Virtual interviews, virtual open houses and prominent social media presence from programs are things that enhance the application-match process and I highly encourage applicants, IMGs or non-IMGs, to use these resources to the best of their ability. I have found attendings in pathology to be some of the kindest and most welcoming doctors I have ever met. I encourage applicants to get in touch with faculty at places that they favor highly. I also urge applicants to try and attend national and state meetings, if able. National organizations, such as the College of American Pathologists (CAP) and American Society of Clinical Pathology (ASCP) have opened up their membership to medical students and being part of these organizations definitely enhance applicants’ knowledge and resources. PathElective

has made life easier for people who can either not get or not afford away rotations. There is a virtual pathology student interest group (@PathSIG on twitter) and many similar resources that cater to students applying for a match. I have prepared a module for PathElective focusing on incoming residents in pathology. I discuss residency interviews, structure of residencies, histological pattern recognition, tips for surgical pathology rotations, and an overview of the fellowship process. I also started a podcast (Follow your Path) interviewing experts in different subspecialties of pathology, asking them what makes their chosen specialty unique and what interested residents can do to enter that field.

Lastly, my advice to IMGs is to give back when they can. Mentor other people who are in similar situations to them when they were medical students. Volunteer for mentoring and collaborating. As IMGs, we may have to work twice as hard to get where we want to go, so don’t lose sight of the goal. Lastly, be humble and generous along your journey.