USMLE MATCH

Credentials: Step 1 - 230, CK - 230, CS pass in one attempt, Home country residency in Pathology, one and a half year experience as a Junior Pathologist in a US-based stand-alone laboratory in India, 6 months of experience as an Assistant professor in Pathology, 5 PubMed indexed publications, 7 posters in US conferences, 4 months US clinical experience at Cleveland Clinic, Medical College of Wisconsin, and University Hospitals, Augusta, postdoctoral research fellowship in molecular pathology at the Mayo Clinic for an year, applied to 121 Pathology programs, interview invites from 41 programs, attended 17 interviews, Matched to Cleveland Clinic Pathology!

Impressive? Maybe! Inspirational? Fuck no! This is the final picture. This is what is apparent on the outside. Inspiration is never derived from these success stories. They are derived from stories of failure. Let me share a few of my vulnerable moments so that if anyone finds themselves in such situations, they could be assured that there is always a light at the end of the tunnel.

Step 1: 230

I studied for step 1 for an entire year. There were two reasons. First I was never good at solving multiple choice questions (which literally translates to being dumb on many scales). I did bad, consistently in all post graduation entrance exams in India for 2 years. At one point, I had a rank of 21,000 all over India. After improving on that I could only afford 9000 rank and Pathology was the only good option, not a choice! I did good in my Pathology residency in India and thought that was the end of multiple choice questions but with USMLE, my old foe returned. I wanted to take enough time to face it again.

Second, I was working a job that required 8-10 hours of mostly standing and grossing. I could not leave that job as that would mean compromising on a letter of recommendation from a US-trained senior pathologist in the laboratory.

I got all the pathology, immunology, and histology questions in the examination correct (duh!). Despite that my anatomy, pharmacology, and behavioral screw-ups could still pull me down to 230.

CK: 230

Took a year in total (including CS and USCE) for CK as well. First 2 months were wasted in waiting for Step 1 results. Additional pressures in this step included personal problems, getting in bad-terms with my only USMLE mentor, leaving my job, and attempting to find USCE. These plus the fact that my knowledge in clinical specialties was not as good as my pathology knowledge might have contributed to me scoring 198 twice in two NBMEs a week before CK in December 2016. Now, I am a very optimistic person usually but these scores were low even for my own optimism. I postponed CK to May 2017 thinking CS and USCE in between would give me a break. After my CS, I came in touch with one of my seniors who was preparing for USMLE and is a Clinical Hemato-oncologist from the best institution in my country. He became my study partner (well, more of a tutor). We did UW together and that is the only reason I scored 230. Always partner with someone who is better than you :P He did not follow this advice and suffered a decrease in score from his step 1 :D (Don't worry, he matched)

CS

Words fail me to express how much I hate this bloody examination. Read my review in the USMLE CS forum to witness my real-time frustration after passing. Being a pathologist, I had not seen a patient for 5 years. I did the Gold USMLE review course to revise physical examinations and was mortified by this exam until I got my result, pass. High performances in spoken English and interpersonal skills and almost borderline on ICE (narrow escape) :D

Home country residency in Pathology

It is no secret now that I sucked both as a medical student (friends, girls, homesickness) and as an MCQ solver which landed me in Pathology and at an average place. My medical school friends said it was a sad day for Pathology when they heard I was going to be a Pathologist. I was the worst student in Pathology. No matter how hard I tried, I could not see anything on the slide. I passed my pathology examination by remembering the slide from its outward shape and by getting my blood smear stained by the laboratory technician.

I started studying seriously for the first time in my life in my Pathology residency. Frankly, I had nothing else to do. Friends were far, got married so no more girls, just one girl (or that is what my wife would like to believe ;) ). Slowly and steadily, I started getting good at Pathology and started to love it.

One and a half year experience as a Junior Pathologist in a US-based stand-alone laboratory in India, 6 months of experience as an Assistant professor in Pathology:

Got employed to a laboratory with many US trained pathologists(J1 home country bond) and people trained from best places in India. I had a lot of inferiority complex for being the least qualified pathologist in the team and the only one without a "brand name". However, as time passed, I found out that I am getting good at it. The objective point of validation was dealing with the same number of similar cases with similar precision as a US-trained pathologist would. If you want to make too many enemies, however, get too successful, too soon. Very soon all my "future LOR authors" started showing me my place and making things difficult for me with subtle threats of destroying my career even in India let alone writing a letter. Had months and months of brain-fuck in an attempt to get that letter (which now I know does not even qualify for a US letter as he was not practicing in the US). But I did not know any better and he made me believe that it is impossible to get a USCE and a US letter. I can tolerate a lot and have a very thick skin but when I just could not take it anymore, I told that person to shove his letter up his ass and left the place.

Joined as an assistant professor of Pathology near my hometown. Worked for 6 months, got paid for only 2. It was a government institution that can get away with any bullshit like these.

Most days of my Pathology work experience in India have felt like two with humiliation and examination going hand in hand.

5 PubMed indexed publications, 7 posters in US conferences:

People ask me how to publish and how to do research. All 5 of my published articles remind me of a time when I was badly humiliated either in a meeting or in mass emails with the entire laboratory CCed. Anyway, what does not kill you, makes you stronger. In addition to the knowledge I gained while working, my articles and posters were the best things that I got in the bargain. None of these were however for my benefit, they were just meant to keep the India-returned J1 doctors well published so that they could find a job on H1b. My needs were only coincidental but it turned out to be good nonetheless.

4 months US clinical experience at Cleveland Clinic, Medical College of Wisconsin, and University Hospitals, Augusta:

As mentioned, I felt devastated after losing my only US-contact. I tried a lot but it was impossible. So, I started to reserve a time of an hour between my CK preparations to email people. Written speech seems to be one of my strengths. I got a lot of replies from Pathologists, all of them praising my CV but mentioning that they do not have provisions for an observership. My Facebook friends (multiple US-based pathologists) could not help too. Do not rely a lot on your Facebook contacts. There is only a certain limit of help that they can provide irrespective of your good relations and their likes of each of your posts.

I had an idea, I decided to go for the poster presentations in College of American Pathologists meeting in 2016 which I had earlier decided against due to my relations with my ex-mentor. I used all my experience of walking up to girls out of the blue and talking to them on Pathology professors there. I did hit gold when it worked on two pathologists from the Cleveland Clinic and another pathologist from Augusta. They were kind enough to invite me for an observership. Once I landed these places, I started emailing people with a renewed enthusiasm and was fortunate to get another opportunity at the MCW.

Luck and confidence had a big role to play in the turning point of my USMLE journey. From no US-contacts in December 2016, I moved up to having 4 US-letters in April 2017.

Postdoctoral research fellowship in molecular pathology at the Mayo Clinic for a year:

This paid position (from day 1) seems the most impossible thing in my profile but this is the only thing that came easily to me. After my residency in pathology, practice experience, USCE, publications, posters, and interview skills along with the single biggest factor in finding such positions, CONTACT WITH THE PREVIOUS FELLOW, this was a piece of cake for me. It was a boon as it helped me move to the US and get united to my wife who was doing college in the US and paid for applications, interview travels etc. My experience of working in the US was very different from my Indian experience. My research mentor used to give me leaves for my interviews with a sweet best wishes email each time. This position gave me a lot of substance to talk about during my interviews, including the fact that I operate the Laser Capture Microdissection microscope which was not available at many places I interviewed.

To summarize, I was a careless medical student (71 out of 100 students in final year of medical school) from a state which is 70% tribal area, my medical school was probably last ranked in India, my residency was from a mediocre place, I sucked at MCQs (and still do; postponing Step 3 since 5 months now), developed varicose veins due to standing while working, and faced demons at workplace. But in the end, I had 41 interviews and matched to Cleveland Clinic. This is the only time I have got what I want. This is the only time I really worked hard for something and even kept my ego on the line.

I have heard a lot of success stories and I hate how they are told. Very few people reveal their frustrations, weaknesses, depression, anxiety, and vulnerabilities. I love those stories of the match despite significant red flags. That's where I will get my inspiration, not from a guy who had 40 interviews and matched (and posts dramatic and senseless polls :D )

The truth is that most people work hard. Some of those are validated with success and some are not. Luck has a big part to play in my success as is evident from each and every part of my story. The only thing that kept me going however and reach to Mayo Clinic and Cleveland Clinic is that I never doubted myself after failing. During all these situations mentioned above, I knew I am not made for this. I am made for something better. My wife, parents, and brother seemed to be the only people who would resonate the same feelings. Eventually, you will find some good people too, hold on to them.

Sometimes it is good to be that narcissistic asshole who is deluded into thinking that he is great despite all evidence to the contrary. It worked for me! I have always blamed the system of "scores" and the complete dependence on them to assess a candidate. USMLE in that sense, especially for Pathology till now is a lot better than how it is done in other countries as all facets of my personality were given due regard during my assessment.

The world is cruel. You have to keep patting your own back if you want to succeed in life. And regardless of what is happening in your life, you are not excused, because there is always someone who is dealing with bigger problems than yours like loss of family, taking care of kids, getting divorced etc and still going on...

Factors that lead to my match:

1) Luck! Not a big believer in God so let's call it luck ;)

2) Being confident ( emails, interviews, all communications, during CS)

3) Not getting settled in my present position as a Pathologist

4) Knowing my weakness (exams, clinical knowledge, humility :D ) and knowing my strengths ( humor, pathology knowledge, and skills, written speech, interpersonal skills)

5) Calculated and well-planned approach.

Not everyone has similar weaknesses and strengths, just find out yours and work on them. Make your own story! All the best! :)