My Career Path to Academia as an International Medical Graduate: Aspiration, Perseverance, and Great Mentoring

Jan 14, 2022

After completing his hematology and medical oncology fellowship at the Mayo Clinic in Florida, Muhamad Alhaj Moustafa, MD, joined the institution as a lymphoma specialist and an assistant professor of medicine. He is a member of the ASCO Annual Meeting Education Committee, ASCO Trainee & Early Career Advisory Group, and Publishing Research Group. Follow him on Twitter @AlhajMoustafa.
Describe your training path thus far.
MAM: I am an international medical graduate from Syria. I graduated medical school at University of Aleppo Faculty of Medicine in 2013. During my years in Syria, I grew up in a culture where the word cancer equals death. This was a fact due to lack of advanced therapies. Most patients with cancer would succumb to death within weeks to months after diagnosis. Families tend to hide the diagnosis from their loved ones in an attempt to shield them from the stress of facing this petrifying malady. I wanted to change the course for these patients and their families. Thus, I came to the U.S. as a medical student to rotate in respected institutions to learn more about advances in cancer treatment applications. 
I loved what I saw, and I was mesmerized by the amount of research that physicians are involved in as part of their academic work. During my rotations, I came to know mentors whose unlimited support and advice has shaped my career trajectory in ways I could have not imagined. With the guidance of my first mentor, who was an internal medicine resident at the time, I applied for a research fellow position where I spent a couple of years learning clinical research methodology through enrolling in a diploma program in clinical and translational science. This training was invaluable and led me to decide on a career in academia.
How has your experience as an international medical graduate shaped your training and early-career path?
MAM: As an international graduate, when I arrived in the U.S., I had limited connections and research experience but was charged to reach my potential and ultimate goals. I landed in one of the most prestigious institutions and worked with world-renowned mentors who believed in me and supported me in the most vulnerable phase in my professional career. Now, after 8 years, my mentors and I have become colleagues. 
As much as I would like to think that this path is available to all enthusiastic medical students from all backgrounds, I know that many are not able to advance and reach their potential because of the lack of support. As I was offered a hand to help me stand, I decided to pay that forward whenever I see an opportunity. I have mentored many medical students, residents, and fellows, and I encourage everyone to do so.
What precipitated your interest in oncology?
MAM: The fact that it is one of the less developed subspecialities, especially in low-income countries, and there are tremendous opportunities for field advancement in the future.
How did your fellowship experience differ from residency/internship and medical school?
MAM: In residency, I had a very structured and templated training curriculum with little opportunity to shape the training experience in a way that was unique to my training needs. My fellowship experience was unique due to the fact that our fellowship program was very flexible and accommodating for different career paths.
Knowing that I wanted to pursue an academic career in lymphoma, I was able to utilize my continuity clinics throughout the fellowship to see patients with lymphoma. My clinical mentors used to ask me to see complex lymphoma cases off the regular scheduled clinics to gain the needed expertise. In my second year of training, I was able to initiate a multidisciplinary lymphoma tumor board at our campus to discuss complex cases (which I continue to run as a faculty now). I also utilized my research time in my second and third year of training to enroll in a master’s degree in clinical and translational science to sharpen my clinical research skills.
In my third year, I was engaged more in educational and administrative activities. My role as a chief fellow added a lot to my curriculum building, communication, and leadership skills. I have learned from the leaders in our program how to stand as an approachable servant leader for the total good of our fellowship program, and we were able to make many positive changes.
All of the above-mentioned opportunities would have not been possible to accomplish without the extraordinary support of my mentors and the fellowship program. Establishing great relationships with mentors who are committed to your success and well-being is the most critical step in building your career in whichever path you choose.
Describe a typical day, or week, in your fellowship program.
MAM: Our work schedule as fellows differed based on rotations. In a typical outpatient week, my day would start at 7:30 AM to meet with the faculty that I was assigned to on that day. We would go over the patients on the schedule and I would briefly discuss my plan for each of them. The day typically ran smoothly, with a lot of education constructed on case-based discussions. We have educational conferences on Tuesdays at noon and educational half-days on Wednesday afternoons, where we have multiple and different educational activities including journal clubs, “art of oncology” sessions, fellows’ well-being sessions, and case-based discussion on interesting cases on the inpatient consult service, among other activities. Fellows typically have at least 2 half-days of administrative time where they can do research or follow up on cases they saw during the week.
As a chief fellow, I got to use a little more administrative time to meet with the program leadership to discuss any fellowship-related issues, and to plan the educational activities and send invitations to speakers and faculty members.
If you have to pick one aspect, what aspect of your fellowship experience has been your favorite? What aspect is the most challenging or frustrating?
MAM: The open-door policy and the flexibility our program leadership offer to accommodate different career paths is outstanding. In my opinion, this is what makes a fellowship program exceptional. 
The most challenging aspect of my training is the combined training we are required to do in solid tumors and hematologic malignancies, which is very frustrating if you know your future career is academic and likely to be disease-specific. I believe hematology and medical oncology fellowships should be separated due to increased complexity and specialization, which is becoming a more common theme even in community practice.  
What do you wish you had known before you started fellowship? 
MAM: I wish I knew my current mentors a few years earlier as a medical student. It would have saved me a lot of time and effort identifying my career path.
What advice or pearls of wisdom do you have for the trainees who are starting their fellowship?
MAM: Here are a few of the lessons I’ve learned:
  • Great mentors might not be the ones with the most prestigious titles or the highest numbers of publications—they are the ones who set your interests on the same level as theirs. 
  • If you do not feel comfortable in your relationship with your mentor, then do not prolong that relationship. It will only harm you more in the long run.
  • Well-being, work-life balance, and mental health are key for prosperity and happiness.
  • Stay organized and learn to say “no” when the opportunities you are offered do not align with your interests. 
  • Connections and networking are of utmost importance for career advancement in academia or community practice, so start building them early on during your fellowship.
  • Different fellowship programs have different numbers of and roles for chief fellows. However, regardless of where you go, spending your last year in fellowship as chief fellow is not an easy task and it will consume a lot of your time that could otherwise be used in clinical training or research. But you will gain a lot of administrative and communication skills that will be very helpful if you embark on administrative roles in the future.
  • Be the example that other trainees want to follow and learn from.
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