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Who Am I? A Perspective from Third Culture Kids

Hey, Mom, I finally made some friends in school. Can I hang out with them this summer?” she said excitedly.

Navigating Your Internship Year

Dr. Ali Hassan Mushtaq is a 9th batch alumnus from Alfaisal University, currently in his intern year. He has been involved in extensive research, 

Diversifying Your Skills - Essential Tools in Preparing for a Successful Future

Though not talked much about within routine medical curricula, diversifying your skills 

Alfaisal Alumnus Wins the Osler Cup

Dr. Omar Ahmad Khdeir is a graduate of the 6th batch of the college of medicine at Alfaisal. 

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Navigating Your Internship Year

Navigating Your Internship Year

By Dr. Ali Hassan Mushtaq

Dr. Ali Hassan Mushtaq is a 9th batch alumnus from Alfaisal University, currently in his intern year. He has been involved in extensive research, teaching, and mentorship during his time at Alfaisal, namely as a tutor in the PAL program and the USMLE prep course 2021. He writes about how to navigate through internship with special tips on clinical electives.

Obtaining Electives

A US hospital-based work experience in a clinical specialty like Surgery/ Medicine allows one to get acquainted with the routine functioning of the US healthcare environment: history taking and physical examination, using EPIC (Electronic Medical Record), and providing assessment and management plans. However, the primary goal of an elective for an IMG is securing LORs (Letters Of Recommendations) and interview spots for the upcoming Match.

Your goal is to secure clinical electives within the 12 months of internship. The best type of clerkship is a sub-internship where you have the added responsibility of on-call participation and treatment similar to a PGY1, but this differs from one institute to another.

The process is tough and lengthy; be prepared for many rejections. Most institutions host only their students or medical students accredited by the Liaison Committee on Medical Education (LCME) or Alpha Omega Alpha Honor Medical Society (AΩA). To optimize your chances, start the process early, preferably right after finishing 5th year. Some institutions require you to apply at least 6 months in advance, but most have a window period of 3 to 6 months before the start of your rotation date.

While most electives appear on VLSO (Visiting Student Learning Opportunities), quite a few require you to apply to individual institutes. Online forms can be found on their websites or simply email en masse to medical education coordinators.

Another way is to employ ‘the wasta card’: contacts, family friends, relatives in the US, whoever it may be, reach out and ask. Aim for a hands on elective. However, a hands-on observership is also quite useful.

Requirements

Try to finish a few prerequisites while searching for electives:

  • Letters of recommendations
  • USMLE Step 1 (required by many institutes)
  • Personal statement: Convey your passion for the specialty, your accomplishments and how they have developed you as a person, your future plans, and how this experience in their institute will help you to accomplish those goals.
  • CV: Structured, to the point, highlighting professional accomplishments.
  • Letter of good standing: Mentions that you are in good standing, have completed core clinical clerkships and all courses have been taught in English (obtained by emailing Ms. Mariam Tabrizi).
  • Make an account on VSAS (Visiting Student Application Service)
  • Complete the AAMC (Association of American Medical Colleges) immunization form
  • Criminal Background Check/Police Clearance: from the local police station (obtain a letter from the university to facilitate the process)
  • HIPAA and OSHA certifications (some institutes)
  • Valid BLS Certificate
  • School final transcript
  • TOEFL (some require a score of 26 or 28 in speaking and listening)
  • B1/B2 Visa (usually after acceptance, since you need them to send it to you)
  • Extras: Malpractice/ professional liability insurance, urine drug screen (some institutes)

Things I wish I knew

  • The experience one individual has in year X will be different in year Y, simply due to changing situations (e.g. COVID) and new collaborations
  • Not all doctors are going to hand out LORs. You will get rejected so take the feedback positively and work on yourself to make improvements.
  • Avoid comparing your experience with another individual in the same institute. It depends on various factors, most of which are out of your control. Do the best you can and enjoy the experience.

May Allah make this journey easy for all of us! Keep us in your prayers!

Obtaining Electives

  • You may be unsure about which field you want to pursue right now. A good way to make this decision is by the process of elimination: Do you absolutely hate the OR setting, refuse to stand for hours and hours during internal medicine rounds, or simply dislike dealing with adolescents? Do you want to take the ‘ROAD to an easy life’ (Radiology, Ophthalmology, Anesthesia, Dermatology)? Make sure to decide which route you want to take. You may choose to apply to multiple specialties during the match process (e.g. IM and Family Medicine).
  • Look at the prospects: salary offered, work/life balance (working hours, weeks per year), and the chance of matching. Residency is a grueling process and the institution you train at will dictate your fellowship options and employability in the popular states.
  • If you’re interested in neurosurgery, one of the most competitive options out there, don’t give up simply because it seems difficult. People have matched there, although they had to put in a lot more effort than other specialties (e.g. a few years of research in the US). Above all, be realistic; you reap what you sow.

Getting letters of recommendations (LORs)

Show interest, participate and get along with your colleagues. Ask questions, act interested and participate in discussions. Be careful, don’t overdo it. Everyone wants to leave early so a few questions here and there are acceptable but to question everything will annoy others and effect you negatively. Another vital point is to be interesting, some of my closest friends secured LORs based on discussions about novels and the stock market.

Your performance, at least for IM, will be gauged by your presentation skills of the SOAP criteria. The most important aspect of this includes your assessment of the patient and the tailored management plan. If you do not know, simply say so. Do not give false or inaccurate information. The best way to excel at this is by having an open conversation with residents and asking for their feedback before presenting in morning rounds. Many times, the resident may provide tailored plans for you to present if you build a good relationship. Similarly, if a resident is asked a question and you know the answer, do not interject until it is redirected towards the team. Do not try to undermine the residents in any way. They have a say in your residency application and sometimes the attending gets feedback on your performance through them.

End of the week, first ask for feedback and how to improve yourself. If you receive a positive response, proceed to humbly inquire if they are willing to write you a LOR and specify its importance for IMGs. If they accept, write them an email mentioning what you have learned with them along with your CV and personal statement. Inform them that they will be required to upload the letter on ERAS (Electronic Residency Application Service) once you get your token, after graduation.

Aim to obtain 4+ LORs. People have matched with 1 or 2 but aim to get at least 4 as not everyone who promised a LOR may deliver when match season approaches. The finest LORs are from institutes like Mayo or Cleveland Clinic, from a core faculty member who writes you a personalized LOR. This is the bar that most students don’t get to meet, which is okay. While it may be debatable, a personalized LOR, written by someone you worked with for a long time from a small institute is probably better than a generic one written by someone from a top institute. Alternatively, some program directors would not prefer a LOR from someone who shares your last name or nationality. However, something is better than nothing so don’t feel shy in asking. with your residents and asking their feedback before presenting in morning rounds.

Tips

  • Apply as a medical student (includes interns): Considered the highest level of experience a student can obtain in the US, superior to observership/ externships. Inpatient should be prioritized over the ambulatory setting.
  • Clinical electives may be done between your 4th and 5th year summer but prioritize your STEP examinations instead
  • Complete Step 1 and 2 before going for electives as studying for Step 2 during rotations is difficult (yet not impossible)
  • As per university policy, half of your internship in Riyadh can be done in private institutes so finish them in the first 6 months while you prepare for exams and electives.
  • Some sub-internships, e.g. Mayo Clinic, may require you to have completed at least one month of USCE (US clinical experience)
  • Avail the health insurance discount offered through the IO website.
  • Understand that even when thoroughly planned, things may not go your way. You may not get into the program you wanted or have to rent a car to get to different places but in the end, make sure to not make compromises on what you went there to achieve.
  • Electives have more to do with your personality and social skills rather than your knowledge. Try to present a reliable, amiable personality.
  • Take advice from students who have recently gone through the process as things are rapidly evolving.
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Who Am I? A Perspective from Third Culture Kids

Who Am I? A Perspective from Third Culture Kids

By Raffi Almutawa & Maryam AlTayeb

“Hey mom, I finally made some friends in school. Can I hang out with them this summer?” she said excitedly.

“Flight 2A334D is now boarding at gate 27” the mysterious airport PA announced dreadfully. It’s happening again; friends were finally made, but where was she? Gone again. Broken, hurt, and, now, motion sick. But the truth is motion sickness was the least of her worries – she was tired. She is tired. Life seems to be running at lightning speed without her, and it sucks. Here we go again.

The usual cycle kicks off; she introduces herself, the euphoria of someone new peaks for a week by those around her, and then it’s instant rejection. She isn’t one of them; she’s an ornament they’ve outcasted and silently renounced without even taking their blindfolds off. Always too much, and never enough. She only knows one peace – that she is not wanted. The frustration of it all eats her up inside and leaves room for nothing but tears. “I want to go back. I want to go back. I want to go back. I wa…” the words find no end. “Is this who I am? A sad, lonely loser? I hate this. I hate everything. Why can’t things go back to how they used to be. What is wrong with me – why why why why? Should I… change?” And there it was – her next mission: changing to fit in.

She started by wearing what they wore, and speaking the way they spoke. It felt like self betrayal for a while, but eventually, she got the hang of it. She adapted, and even started acting like they did. Everything around her changed: her style, her personality, and her friend count; she finally had some. This is exactly what she wanted – the warm embrace of feeling welcomed and valid. Along with this came the spike of euphoria. She walked around smiling with her eyes. But who was she? Just another droid in the production line? No, far worse. She was not herself, and when she realized, everything went to hell. Everything sucks again.

She looked at the mirror in confusion: “Who am I?” There is no happiness without a preceding or succeeding sadness, and for her, it was both. That joy dropped. She started trying to change back, but it was too late. The more she goes back, the more validation she loses. But then she realized; that sensation she had falsified in her head. And so, she wrote to herself in an attempt to regain her consciousness:

“Cold and empty space

Radiating everything but warmth

Unfamiliar vacancy

Mirrored by a trail of fallacies

Who are you,

Really?

Who are you?

Reflection I catch glimpses of…

Who are you?

Shadows that follow

Are that of a stranger

Or do you belong to

A soul I no longer call my own”

She decided it was time to strike a balance she could be proud of. It finally worked; real happiness walked up to her front door and gave her her long-needed embrace. “Mom I made some friends at school. Can I hang out with them this weekend?” But, in a split second, the world had come to shift again. A never-ending torment, she thought to herself. As the sky began to settle, the earth rumbled, and, like the nature of the wind, they packed up and left once more. She remembered looking out the airplane window, searching for comfort in the vastness of the clouds. “I never even got to say goodbye,” she said to herself. It was always this way, but she let it pass. Forming permanent connections to temporary places. Feeling a sense of privileged statelessness. Her mind wandered along with the clouds as she thought of the lush greenery she had almost come to call home.

As the turbulence came upon her, she knew it was time to begin again – to adapt, as her father had called it. To adapt to the ever-changing circumstances of her lack of stability. The smell of the airport, the eerily cold air, and the rumble of the intercom in a foreign language – the promise of change was all too familiar. As they drove to their new “home,” her eyes were met with nothing short of the barren desert. Archaic images of an unchanged world that remained frozen in time. She closed her eyes in hopes that it would all reincarnate into what it was, but it never really did. The gritty sands pained her heart; the absence of life plagued her soul. This was not home; she knew it would never be. She felt her eyes shut involuntarily, never to open again, never welcome to this.

What a painful thing it is —to have relationships with so many cultures while not having ownership of any. To live in the moment, however fleeting, but to always be met with anticipation of grief. She thought to herself how ungrateful she must be to live the life she does, and yet feel so much sorrow. She existed in a paradox of culture. She was missing in a fragment of her own imagination. Collecting fragments of the world everywhere she went, trying to piece together a puzzle with dust. A sense of loss loomed over her, and she sat there wondering if she would ever be found.

Despite all her efforts to remain the same, she did not. Acceptance, she had come to learn, was the cornerstone of her happiness. She learned about herself, her new world, and her new peers. She learned about language, art, music, and culture — all the things that gave life meaning past the mundane day-to day occurrences. To learn about another is to learn about yourself. She vividly remembered reading a book about a club she never knew she signed up for, “Third Culture Kids,” and a line painted a vivid image in her memory: “I rise and fall into the shallows of resistance — the remainder of what I once was, accepting of what I will become.” Letting go, not resisting, granted her mind much freedom. And so, she learned to enjoy the process of being ontologically ambiguous, searching for home in new places, new people, and most importantly within herself.

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Diversifying Your Skills - Essential Tools in Preparing for a Successful Future

Diversifying Your Skills – Essential Tools in Preparing for a Successful Future

Ismail Mohammed Shakir

7th Batch Alumnus

Coordinator, Graduate Programs & Research

Ex-Director, International Office

College of Medicine, Alfaisal University

Though not talked much about within routine medical curricula, diversifying your skills is necessary for your personal and professional growth. Through this piece, I wish to introduce you to CARL-I, the acronym that summarizes the essential soft skills that you can consider investing into through your journey in medical school to prepare yourself as a well-rounded physician-to-be.

Curiosity and Creativity

It is crucial that while you are proficient with your medical knowledge and skills, you also have an inquisitive mind that allows you to be inspired by the various simple and complex interactions that you experience daily. When motivation is driven by curiosity, it can lead you to experience newer situations resulting in increased knowledge, improved skill set, and the ability to be creative. 

Developing these skills often requires a mindset that is willing to zoom out and hunt for creative solutions, often “outside the box”. However, 360-degree thinkers understand that not all solutions “outside the box” work well and that they need to simulate the different proposed solutions and predict their outcomes. They take into consideration past and present experiences, challenges, priorities, related situations, consequences, other dependencies, and overall goals. They are able to run the solutions to a challenge/problem through a simulation in their minds to predict which solution may work best. Whenever you find yourself bogged down with work and the daily hustle and bustle, teach yourself to take a pause and seek inspiration. Perhaps, try learning more about 360 degree thinking.

Collaboration and Teamwork

As a physician, working in teams and collaborating with other physicians, nurses, administrative and support staff, is required to provide high quality multi-disciplinary care. As medical students, you must learn to collaborate with your peers by working on group presentations, providing patient care, participating in organizing community awareness events, working on research projects, etc. 

It is known that collaboration and teamwork encourage problem-solving and boosts confidence. Working in a team of individuals with shared interests offers you a unique advantage to learn from each other’s experience and rapidly advance your skills. It also allows you to tackle some of the most complex situations with a sense of shared responsibility for successes and failures. Nevertheless, do remember to value your teammates’ perspectives and appreciate their work at all times. In Ratan Tata’s words – “If you want to walk fast, walk alone. But if you want to walk far, walk together”.

Conflict Resolution

Conflicts are common when working in a team together on a project and can reduce productivity leading to negative feelings and sometimes even reduced motivation to work. Conflict resolution is a skill that is required regardless of your position and in all fields of work. Individuals who possess conflict resolution skills are able to manage difficult personalities and situations. 

Conflict resolution is a critical competency required among working professionals and can be comfortably learnt while in medical school. We must understand, however, that we all have our own styles of dealing with conflicts, but the goal of peace-making must be common to all our strategies. 

When you find yourself amidst a conflict, know that anger does no good. Take a step back and allow yourself to think rationally and say nothing offensive. Conflicts must not eat away our relationships. Most, if not all, of the conflicts and disagreements we get into will mean nothing in the coming months or years. 

Conflict analysis can at times be helpful to understand what can be done to avoid regular conflicts and maintain a healthy workplace environment. Oftentimes, when conflicts are chronic you might want to opt to have one of your colleagues or supervisors mediate between the both of you and help eliminate points of friction.

Clock Skills

Being a medical student is not easy. You are expected to cover an enormous amount of material in a short period of time, while you juggle with extracurriculars and other responsibilities you may have. As physicians-to-be, you will be responsible to complete a myriad of tasks – seeing patients, educating residents, conducting research, participating in conferences and community leadership programs, running a department, taking care of family, yourself, and so much more. We waste abundant precious time on a daily basis doing essentially nothing, or something that contributes very little to our end goal. 

As part of managing your time well, you will need to learn how to beat procrastination. It’s simple. Our brains have a narrow time frame between remembering a task and slipping into procrastination mode, which is about 20-40 seconds. Once you go past this narrow time frame, you fall into procrastination mode. But if you are able to get to the task right away, within those 20-40 seconds, you trick your brain into working on the task and it now gets busy with the task at hand and is difficult for it to slip into procrastination mode. Try it the next time you have a task come up.

That being said, time management does not mean cutting down on tasks or activities, such as extracurriculars, completely so that you can have free time and not much to do anyways. It can be learnt only when your plate is full of tasks and projects and when you have to prioritize to stay on top. If successful in managing your time well, you may realize that you have even more time to take up more meaningful tasks or projects.

 

Adaptability

Workplaces are constantly changing making adaptability a skill required more than ever before. In this fast-paced world, if you are not willing to adapt, you will be left behind. You must understand that to be truly innovative, resourceful and ahead of trends, you must seek and embrace change. To be adaptable, however, you will need to be both optimistic and enduring. 

Being adaptable also means that when situations or projects don’t go as planned, you find the silver lining and stay focused and don’t lose yourself to pointless negativity. Beating yourself up does no good. You must see an outcome as either a success or a learning experience (and not as a failure). 

Being adaptable can also help us find creative solutions to the most unexpected challenges in our studies or in our workplaces. Also, those individuals who are adaptable can engage with a variety of people and get the job done efficiently. They can take up newer positions much comfortably which helps them progress faster. As a result, their professional network also expands much quicker offering them even better opportunities.

Responsibility

Taking responsibility means to take ownership of your own personal goals as well as the goals of your team or organization. It also means that you can work independently. Those who fail to take responsibility for their work are often seen as less desirable individuals to work with. They struggle with working in teams and do not progress well in their careers. If you are responsible, your supervisors can trust that you will get the work done on time without constant reminders. Being responsible also means that you hold yourself accountable for the consequences of your actions.

Responsibility, although important, is not a difficult skill to learn. You can begin practicing responsibility by making yourself aware of what is expected of you in your studies, extracurriculars, or at work. You can then establish for yourself a couple principles or a code of conduct – such as a daily schedule – to which you should strictly adhere to no matter how tough it gets. You can follow the “21-Day Fix” to stick to or kick some habits. This could be your first step to up your responsibility game.

Leadership

Whether in medical school or in the workplace, leadership will be among your most valuable assets. Effective leaders are able to communicate well, embrace challenges with creativity, motivate their teams, provide them with valuable feedback, and spread positivity. Leaders are constantly innovating and are rarely ever affected by negativity and setbacks. They are able to carry a team of individuals with diverse capabilities and perspectives and are able to clearly and precisely communicate the vision and goals to their team. They also trust the people they work with and delegate often while they take up newer tasks. 

Leadership can be effectively learned by immersing yourself in extracurricular activities within and outside medical school. Community service programs are excellent ways of learning leadership while directly contributing to the community. To learn leadership properly, you will also need to allow yourself to progress in a stepwise fashion. Jumping to exciting leadership positions without having adequate understanding of the position can only fire back. As a leader, you will also have to learn to not point fingers and blame others. You will need to be able to accept mistakes and failures and strive for improvement. Regardless of the career you choose, the ability to lead well will always be required for success.

Introspection

Introspection is the unbiased self-examination and reflection where you look at your personality and actions, as well as your emotions and motivations and learn from them to act better next time. Introspection should be seen as a master of the CARL soft skills and the most important among them.

Effective self-introspection and reflection can remind you of the consequences of your decision or actions before they negatively impact you and others, especially when you said or did something you didn’t think through well. The advice is that self-introspection must be practiced regularly, at least once a day. If done rightly and consistently, self-introspection can be your most powerful skill that will help you grow every single day – both personally and professionally. Søren Kierkegaard put it very well, “Life can only be understood backwards; but it must be lived forwards”.

The CARL-I skills bring diversity to your skill set and can be easily learnt while in medical school through the various curricular and extracurricular activities. I hope the readers can add their thoughts to mine and synthesize something that fits best for their personalities and work.

Keep exploring. Keep learning.

Wake up every day with a desire to grow.

You are destined for greatness.

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Alfaisal Alumnus Wins the Osler Cup

Alfaisal Alumnus Wins the Osler Cup

Dr. Omar Ahmad Khdeir is a graduate of the 6th batch of the college of medicine at Alfaisal. He is currently a 2nd year Internal Medicine resident at East Carolina University in North Carolina, United States.

During his time as a teaching assistant at Alfaisal, Dr. Khdeir has been an extraordinary educator to his students and an even more supportive mentor. He has a gift of simplifying any complex topic into a digestible format and goes above and beyond to devise new teaching methods to get the message across. In his PRO classes, he used to pull up UWorld questions as soon as he finishes teaching the physical examination skill for that particular topic and this teaching method easily hit a home run amongst many of his ardent listeners.

In recent times, Dr. Khdeir has added a feather to his cap by winning the distinguished American College of Physicians Doctor’s Dilemma competition.

This is the biggest Internal Medicine knowledge-based competition in the world. It brings together some of the brightest residents from across the globe in a friendly but highly competitive environment.

Each training institution nominates three of its residents to form a team to compete at the state/regional level. Winning teams then advance and represent their state in the international championship. The competition layout is similar to the famous TV show Jeopardy, where each game consists of a set of questions that teams can answer by buzzing in first; depending on their answer they either gain or lose the points assigned to that question. Finally, each team must wage from their collected points before they see the final dilemma question. Team members write their answer on a piece of paper and if they get the answer right, they gain the waged points or otherwise they lose them.

Their journey started by winning the local chapter competition after which Dr. Khdeir became the captain of the North Carolina team, and with two of his colleagues, Dr. Swethaa Manickam and Dr. Alex Bradu, they competed against all the training institutions in the United States, Canada, Central America, and the Caribbean in a three-day competition.

What ensued after that comes as no surprise, they won first place and were awarded the Osler Cup, securing their names in the history of the American College of Physicians.

When asked about what he loved about the event, Dr. Khdeir said, “before the final round I told Alex and Swethaa that I have already won two cups today- their company. They are an amazing couple, and I am glad to have met them.

We waged all our collected points in the final dilemma and got the question right. After we won, we took turns calling our parents on speakerphone. Seeing our parents and siblings proud and happy was the biggest award we got.”

Even several years after leaving Alfaisal he continues to be an unforgettable TA to the batches he taught. When we asked Dr. Khdeir to share with us a special message from thousands of miles away, he fervently conveyed, “Do not sell yourself short, you can reach what you aspire for one day; help others and purify your intention. Recognition and awards will follow without you asking for them.”

With his undying passion for medicine Dr. Khdeir, without a shadow of doubt, will continue to make us proud, and we pray that the Almighty will light up his path with everlasting wins. 

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