Imagine that you are born in a country where English is not the primary language and that an interest in biological sciences, a passion for healing and the lure of a prestigious career catapults you into medical school. What follows is a whirlwind of events. In order to prove that Newton was correct you continue to be in motion, scaling new heights of academic excellence. The search for the next frontier and the desire to be at the leading edge of medical science brings you to the U.S. Writing this article gives me an opportunity to reflect upon what happens next and possibly provide helpful insight to international trainees who are at different stages of this journey.
Let me start by talking about the upside. If you are an international trainee in the U.S., you have already overcome the most difficult step of getting accepted into an accredited medical training program in this country. Now, as long as you have a clear career objective and the motivation to work hard, the U.S. graduate medical education system will help you advance your career. When I started as an internal medicine resident and a new international trainee I was pleasantly surprised at the ease with which I could access medical information electronically both for patient care and educational purposes. This facilitated case-based learning and laid the foundation for an evidence-based practice of medicine. I soon realized that there were other components of care delivery that were as important as medical knowledge. My subsequent years of training taught me the importance of quality, safety, multi-disciplinary teamwork, care transitions and, above all, the ability to assess and prioritize the needs of my patient. If you are a trainee reading this article, I would encourage you to pay close attention to these components of training not only as simple terms but as learning objectives.
“If I were to identify one skill that helps overcome some of these hurdles, I would pick effective communication skills.”
The journey is beautiful and the hardships endured along the way provide the contrast. Several training programs do not consider applications from international medical graduates when selecting a residency class. This can be frustrating and it is during these difficult stages that one learns to persevere and not lose hope. The hours of a trainee are long, the learning curve is steep and financial strain is almost unavoidable. If that sounds difficult, add to it the social challenges of adapting to a new culture, a change in food and eating habits, linguistic barriers at the patient-physician interface, and the fear of isolation among peers. This makes the transition from medical school to a trainee physician extremely challenging for even the most outstanding international trainee. If I were to identify one skill that helps overcome some of these hurdles, I would pick effective communication skills. Some individuals are naturally gifted communicators; most however need to learn and practice. Participating in teaching skills workshops and using validated online resources is helpful. Soliciting feedback from ‘role models’ often identifies areas for improvement and can be quite helpful as well. Identifying mentors, not only among faculty but also among peers, especially those who have traveled this path, is also invaluable.
Transitioning to subspecialty training poses additional unique challenges for the international trainee. You should focus your attention on identifying a career path early during residency, excelling in all aspects of clinical training, seeking out opportunities to engage in scholarly activities, developing a credible relationship with peers and an impeccable reputation among mentors that would eventually translate into strong letters of recommendation. I distinctly remember something that a fellowship program director once told me when I was a resident, “The best residents make the best fellows, and that’s who you want to be, a top-notch resident in the eyes of your patients, peers and faculty members.”
The transition to your first job is another critical and high-stress phase in the life of an international trainee. The conflict between staying in the U.S. and going back to one’s home country is coupled with anticipating needs from a social, academic, professional and immigration standpoint. Planning ahead of time is pivotal to a successful transition.
In summary, I have always felt that as an international trainee, you cannot accurately plan for all the eventualities of life. But you can observe the people around you and imbibe the traits that you find admirable. Learn to listen to your inner voice and let it guide you when you are at crossroads in your career. Failure is disappointing, but it is also universal. Success has different measures and it is important to know what it means to you and your loved ones. May the force be with you!
Dr. Majumder has no conflicts to disclose