How I Became a Hematology/Oncology Fellow, Cancer Researcher, and ASCO Volunteer as an International Medical Graduate

Jul 13, 2023

Nazli Dizman, MD, has traveled across the world to pursue her passion for clinical and translational cancer research and further her career as a medical oncologist. Her training has taken her from Turkey to California to Connecticut, and she is now beginning hematology/oncology fellowship at The University of Texas MD Anderson Cancer Center. Follow her on Twitter @NazliDizman.

Please describe your training path thus far.

ND: My path to a career in medical oncology has been an unusual one. I graduated from Ege University School of Medicine in my home country of Turkey in 2012. I completed my internal medicine residency training and chief residency in Turkey in 2016. I had decided to become a medical oncologist while in medical school and developed a passion for cancer research during my residency training in Turkey. In discussion with my local mentor, Dr. Ozcan Yildiz, I began to explore opportunities to gain further experience in clinical and translational cancer research abroad. Through Dr. Yildiz, I was fortunate to be connected with Dr. Sumanta Pal, a world-renowned medical oncologist and researcher at City of Hope Comprehensive Cancer Center in California; in 2017, I began a post-doctoral fellowship under Dr. Pal’s supervision. Witnessing the practice-changing advancements and collaborative work environment in cancer research and patient care, I chose to retrain in the U.S. I subsequently undertook internal medicine residency training at Yale School of Medicine in Connecticut while simultaneously working on research projects remotely with my colleagues at City of Hope. I’m excited to start my hematology/ oncology fellowship at MD Anderson Cancer Center in Texas this year.

Research has always been an important part of my training and career aspirations. Although there were limited opportunities for research in Turkey, I was fortunate to have mentors and sponsors who allowed me to participate in various kinds of research projects. In the U.S., I gained experience in a diverse array of research domains through taking on multiple mentors. Dr. Pal encouraged me to foster several external mentorships outside City of Hope—two individuals, Dr. Toni Choueiri and Dr. Narjust Florez (both at the Dana-Farber Cancer Institute) have since donated countless hours to my career development. Dr. Choueiri is renowned not only for leading multiple pivotal trials in kidney cancer, but also for his advocacy for trainees in the field. In alignment with his vision, we co-lead @IMG_Oncologists on Twitter, a nonprofit initiative aiming to mentor, guide, raise awareness, and help overcome structural barriers for all international medical graduates (IMG) in oncology. Dr. Narjust Florez shares the same fervent passion for elevating the profile of trainees, particularly those from backgrounds where opportunities might be limited. She welcomed me into her illustrious (and international) group of research fellows, where I participate in research projects on disparities in health care, along with workforce diversity and gender equity in medicine and academia.

During my residency at Yale, I felt like a kid in a candy store, surrounded by a multitude of terrific opportunities. I co-chaired the Yale Women’s Housestaff Organization focusing on several activities that include supporting mothers in residency, enhancing mentoring and networking opportunities for residents and fellows, organizing leadership workshops to help those who identify as women excel in their careers, and fundraisers to help support our community. I am fortunate to have had guidance in these grassroots efforts from leaders like Dr. Stephen Huot and Dr. Pamela Kunz. I also co-led the Internal Medicine Residency Program Investigation Distinction pathway, a research-focused curriculum for residents interested in clinical and translational research. I hope the lessons around mentor-mentee relationships I have learned from the likes of Dr. Pal, Dr. Florez, and Dr. Choueiri will benefit my colleagues.

What precipitated your interest in oncology?

ND: My initial interest in oncology was guided by both patient care experiences and a deep fascination with the molecular underpinnings of cancer. It is now more than a decade since I cared for a gentleman with melanoma who first inspired my interest in this field, as I recognized the potential for oncologists to bear witness to patients’ hopes and fears and help them navigate the burden of this challenging disease. The rapid advances in this field have also been truly inspiring. My experience in translational research has enabled me to witness the potential for patient care and the basic sciences to synergistically drive advances in medicine. The ability to contribute to advancements in this field and promote patient care is an honor and continues to drive and inspire me.

How has your involvement with ASCO shaped your career path and your interest in the field?

ND: The first time I attended an ASCO Annual Meeting was in 2016. I’m grateful to have had the opportunity to present my research at these important meetings earlier in my journey, and thus far, I have received four ASCO Merit Awards and have been chosen to be a Featured Voice of ASCO three times. I have performed peer reviews for ASCO Journals and was invited to facilitate a roundtable session to discuss my experience in pursuing advanced fellowships as an international medical graduate at ASCO22.

What I have mentioned so far are my ASCO-related efforts that manifest on paper—what I feel is my greatest gain from ASCO is a bit less tangible. Specifically, the connections I have forged are deeply personal and influential on my career. Through interactions at ASCO with Dr. Nizar Tannir and Dr. Pavlos Msaouel at MD Anderson Cancer Center, I was able to develop a perspective on what fellowship at their institution might entail. This was bolstered by my interactions with Dr. Jennifer Wargo, who offered ample opportunities for me to boost my portfolio of microbiome research. I’ve found tremendous support from key opinion leaders like Dr. Tom Powles, who has generously allowed me to participate in the formulation and design of phase III trials—an opportunity I could never have conceived of as a resident. It has also been deeply inspirational to meet and receive guidance from tremendous women oncologists like Dr. Tian Zhang and Dr. Rana McKay, who are shaping the current landscape of kidney cancer research. I was overwhelmed at the amount of time they were willing to devote to offering me counsel on key career decisions.

With the support of the innovative and inclusive leaders of ASCO, we recently established the ASCO IMG Community of Practice group that will serve IMG oncologists within ASCO. Notably, this group accounts for more than one-third of oncologists in the U.S. Most importantly, however, is that the many exemplary investigators I have met through ASCO since 2016 have become my friends, mentors, and sponsors over the years. With their guidance, I have had opportunities I could have never imagined as an internal medicine resident in Turkey almost a decade ago. The support from ASCO leadership and ASCO members has fostered my interest in a career as an oncologist, one that I hope will enable me to contribute to advancements in this field, promote equality in care delivery, and provide mentoring and sponsoring to those in earlier stages of their career.

How have your various training experiences (medical school, post-doctoral fellowship, and now residency) differed, and how were they similar?

ND: I have immensely enjoyed every part of my training, both in my home country of Turkey and in the U.S. Although the structure of the health care systems differs between the two countries, the dedication of our health care teams to patient care, and the resilience of trainees and instructors, remain a consistent and inspiring factor in both. While I immersed myself in cancer research during my years at City of Hope, patient care has always remained my priority. During my residency at Yale, my primary goal was to improve my clinical skills and explore evidence supporting our daily practices in medicine. However, it was the privilege of caring for patients that will continue to inspire my clinical and translational research, and ultimately, my career.

Describe a typical day in your residency program.

ND: My typical day starts with a black coffee while walking my dog. I then head to work around 7 AM as a senior resident. After reviewing the charts of my patients and a quick discussion with my intern about overnight events, we attend our residency-wide morning teaching and then start rounds. The morning is spent connecting with patients, helping many through complex clinical and psychosocial challenges, a few urgencies and sometimes emergencies, consultations with other departments (and frequent consultations with UpToDate and PubMed), and formal and bedside teaching. I typically sign out to the night team around 6:30 PM. As a matter of fact, time flies on both the internal medicine service and in our outpatient clinics, making one feel both tired and inspired. All members of the Yale Internal Medicine team live by the invaluable motto of our program, once suggested by Dr. Fred Kantor and kept alive by our program director, Dr. Mark Siegel: “We’re as good as any, nicer than most.”

I start my evenings playing with my dog and training him; Chapkin and I are training to become a volunteer therapy animal team (ultimately to make Chapkin’s dreams of being petted 24/7 come true). Later, after Chapkin gets tired, I often sit in front of my dual screens and work on research projects, plan extracurricular activities, or study for boards.

Dr. Nazli Dizman with her dog Chapkin in a park

Above: Dr. Dizman and Chapkin are training to become a volunteer therapy animal team.

What aspect of your training path has been your favorite? What aspect is the most challenging or frustrating?

ND: My favorite part of my training has been connecting with others, whether it be patients and being part of their lives for a period of time, or co-workers, co-residents, and co-fellows as we support each other through both good and bad times together. I admit, there have been many challenging times throughout my journey, including the years spent seeking a path to visit and train in the U.S. To be able to come to the U.S for a two-month observership, I would have to moonlight seven to eight nights a month for a year, in addition to my regular residency work hours. While engaged in research, I had to prepare for the USMLE exams, many years after finishing medical school and internal medicine residency in Turkey. I couldn’t return home because of visa issues, and the residency match process is very stressful and competitive for IMGs. Having a likeminded and supportive community that understood these specific challenges and supported me on my transition from a former internal medicine resident in Turkey to researcher, and finally a resident in the U.S., were critical to me in overcoming these challenges.

What is something you wish you had known during your journey?

ND: I have been thoroughly impressed at how down-to-earth and relatable the thought leaders in oncology are. Coming from another country, I had significant trepidation around my first encounter with Dr. Pal. This was eased a bit by his reputation among friends and colleagues of being an incredibly humble and thoughtful individual, which I certainly found him to be. I have to admit that I had again a certain fear factor around trying to establish mentorships at the prestigious Dana-Farber Cancer Institute. However, from my very first interactions with Dr. Florez and Dr. Choueiri, I was treated almost as a member of their family. I have been fortunate to go to all three frequently when I approach crossroads in my career, and I will confess that I have even leaned on them for advice during difficulties in my personal life. Coming to the U.S. without family can be lonesome at times, but I have never felt that I am without support thanks to these individuals.

What advice do you have for those interested in pursuing oncology?

ND: My first recommendation is to connect with as many people as you can. In both our personal and professional life, we need to build highly effective and supportive networks. Building a network of friends, mentors, and sponsors from different career stages is key to managing the ups and downs that are part of the early years of training. Being in other peoples’ circles is equally important as a way to help educate and empower others, as well as pay it forward as a mentor. Secondly, don’t be afraid to ask for help. So many people have been through similar struggles to those that we face, and their wisdom and guidance can make our own challenges seem much more manageable.

Can you share a unique personal experience that shaped your professional journey and led you to where you are today?

ND: After publishing my manuscript, which summarized a randomized trial evaluating a microbiome modulator in kidney cancer, Dr. Wargo and I connected to establish collaborations with her group at the MD Anderson Cancer Center. Although I am early in my mentoring relationship with her, she has provided me with immense opportunities. She invited me to deliver a lecture at her institution to her research group, and furthermore made me a member of her research team in anticipation of my fellowship at MD Anderson. She has put me on a national podium, including at a meeting for the Society for Immunotherapy of Cancer. While I have been deeply inspired by my mentors at every point my career, I have never looked to a segment of my training with such anticipation. While a significant component of this is the terrific training environment at MD Anderson with leaders in kidney cancer like Dr. Tannir and Dr. Msaouel, a large part is also the opportunity to train with somebody as kind and fostering as Dr. Wargo.

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