After two years of pathology residency training in the United States, I wonder which part of my journey I should focus on. Like every individual’s journey, mine had its own obstacles and challenges. As an International Medical Graduate (IMG), it was more difficult for me to find out which of the many steps I needed to take next to apply to residency in the US. It’s not easy for IMGs to get opportunities for observership with no contacts in the US. I remember contacting over 50 programs requesting them to give me an opportunity to observe with them. Most of the emails seemed to disappear into the void, but I’m so thankful to the programs that responded, even if some of them were just saying no because of my associated visa situation. Unlike a cohort of match applicants in the US, I was the only person applying for pathology from my program in India. However, even though I started alone, I gathered a bunch of very supportive peers, both American Medical Graduates (AMGs) and IMGs, and mentors during my observerships and interview season. Some of them are still my most trusted mentors and support systems today! While I was looking forward to the moment I matched, it happened while I was admitted in the hospital. Understanding my family’s words was difficult for me; I didn’t really get to experience any match excitement. But let’s not focus on what tried to stop me – let’s focus on what drove me.
It sounds cliché but pathology has always been my first and true love as a medical specialty. Even as a young school student, I loved science and I loved teaching. Despite coming from a family with no medical background, I knew that becoming a doctor would give me an opportunity to combine my passion for science and teaching. Bubbling with excitement, in medical school I was one of the first-row students, taking meticulous notes and not missing any classes or clinics. Thus, it was a little bit of a surprise for my classmates to see me choose pathology as a career choice despite being so clinically oriented, possibly more so because I was an active participant of medical school debates and case presentations at rounds. Why would such a person choose to “remain confined away from patients and peer into a microscope all day”? But that was not how I saw my pathology teachers. I didn’t see them as people who were assisting members of the healthcare team; I saw them as people who were directing the course of actions for the other team members. I also participated in tumor boards during medical school and internship. Being in tumor board meetings and seeing the surgeons, the oncologists and all the other team members look at the pathologist for the final word…the final diagnosis solidified my utmost respect and love for the specialty.
I was introduced to this specialty during my first and second year of medical school where I got to preview slides and get involved in laboratory tests and interpretation. During medical school, I also developed an interest in research. I chose pathology knowing that this would also give me an opportunity for teaching and research more than other specialties. My residency program in India was at a large tertiary care center; our hospital catered to a large number of cancer patients. It was disturbing to see the burden of women’s cancers in advanced stages, especially because of lack of robust screening. I was thus interested in oncologic pathology, especially malignancies of the gynecologic tract. As I wanted to get involved in more advanced translational research, I chose to pursue a career in pathology in the US. I started preparing for STEP exams during my senior residency in India. This was riddled with a bunch of towering personal problems that I could never have overcome without my family’s support and the indescribable sacrifices that my mom and the rest of my family made for me.
When I started my residency at Mount Sinai, my notions about pathology were only reinforced. Being led by a chairperson, Dr. Cordon-Cardo, who is a visionary in the nascent field of systems pathology, I knew that I was in a place where pathologists are leaders of healthcare. I was also fortunate to find dedicated and passionate mentors like our program director, Dr. Barbara Sampson, and Dr. William Westra, who exemplify how pathologists can be pioneers of medicine and revolutionize the way we see pathology and patient care. Perhaps, the most heartwarming aspect of pathology that I realized only after becoming a part of the family was how warm and welcoming it is. There is a sense of belonging and oneness, even among pathologists who don’t know each other. I see it quite evidently in the PathTwitter community. There are pathologists who would love to help you even if they don’t know you. I find comfort in the fact that I am now a part of this enchanting pathology family on and off social media.
When you’re a part of a community where you see people willing and eager to help, you at least try to imbibe their qualities. I have always been inspired by the innumerable efforts by the College of American Pathologists (CAP) in every aspect of pathology: efforts in mentoring medical students and working on pathologist pipeline, advocating for the specialty, representing pathology at other national inter-specialty meetings, bestowing awards to encourage innovation and research, organizing sessions to make leaders out of pathologists, hosting numerous educational sessions for residents, fellows and attendings, etc. I’ve seen CAP as the true champion for pathologists in all aspects imaginable. This made me want to become a part of this amazing organization. I am currently my program’s delegate to the CAP Residents Forum, a junior member of the CAP 15189 Committee, and the delegate to the American Medical Association (CAP Liaison).
The fact that medical students have very limited exposure to see what pathologists actually do is quite disturbing to me. When I was a first-year resident, I volunteered to be involved in teaching medical students in labs. During these sessions, I always made it a point to talk about the true role of pathologists beyond just making diagnoses on slides, tissues and autopsies, often encouraging them to come up to pathology department to learn more (Yes, I said come “up”. Unlike what many people think, we’re on the 15th floor with the nicest views of Central Park). I have also volunteered as a CAP Pathologist Pipeline Champion to get more medical students interested in pathology.
My advice for medical students who are on the verge of choosing a specialty: pathology can give you whatever you want from it. You can become teachers, researchers, hospital team leaders, patient-facing clinicians and more by being a pathologist. Yes, pathologists look into microscopes, but not always (especially not so much now with the widespread practical usage of digital pathology). Pathologists are great communicators—to clearly describe what’s going on with the patient and what to do in a brief and lucid way can only be achieved by a great communicator. Pathologists are also amazing teachers, teaching not only students and residents but also our colleagues in other specialties.
And to medical students across the globe who are facing any kind of struggle, remember: there may be ninety-nine factors pulling you down and just one to support you; focus on the one shining star and not the darkness around.
Meet our blogger
Swati Bhardwaj, MBBS, MD completed her medical school training from Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India. She completed her residency training in Pathology from the same institute. She was awarded a Gold medal for excellence in her residency training. She is currently a PGY-3 AP/CP resident at Icahn School of Medicine at Mount Sinai, New York with interests in surgical pathology with a focus on Gynecologic and Genitourinary Pathology. She will be pursuing a Genitourinary Pathology fellowship at The Johns Hopkins Hospital in the year 2024-25 with plans to apply for a Gynecologic Pathology fellowship for 2025-26. Her research interests include translational oncologic research in these two specialties, in particular endometrial cancers, ovarian cancers, cervical and vulvar cancers in gynecologic pathology and renal and prostate cancers in genitourinary pathology. She has a keen interest in education and actively volunteers for medical student labs and teaching sessions at Mount Sinai. She is passionate about pathology and is also a CAP Pathologists Pipeline Champion to improve medical student recruitment to Pathology. She actively meets with and has discussions with the student interest group at Mount Sinai to promote interest in pathology. She has received multiple awards including First Prize at the CAP Abstract Program 2021, Honorable mention for her abstract on the role of p16 in head and neck cancers at the USCAP 2022, Proof of Concept award (2022) for funding her research at Mount Sinai Hospital, among others. She aspires to be an accomplished academic pathologist with a balanced career involving clinical work, research and education.
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