My Journey Into Residency in the United States; A Story of Persistence and Unrelenting Tenacity.

As an International Medical Graduate(IMG) the journey into residency in the United States is one that is not necessarily laced with roses, rainbows and unicorns. Usually, characterized by "thorns", tears, sweats and pain. It takes valor to leave behind a place you have always known and comfortable in to step into the "unknown" in search of a better life, a better training in order to be able to give back to your society one way or the other. It takes courage to venture into the untold path in search of more.

Every individual on earth has a unique journey. Two individuals may go through life doing exactly the same thing, but I can bet that the outcome will be variable in so many ways because of several factors. The beauty of life however is that even though some people are bound to have smooth adversely uneventful journeys, some might have very exciting and adventure-filled journey. However, everyone will reach the summit, all things being equal, with hard work and dedication as  a constant. Which is why, one of the most dangerous things you can do to yourself is to compare your life with that of another person.

I have had an interestingly unique career pathway. I attended medical school in Nigeria and practiced for a couple of years before I relocated to the United Kingdom. There, I took the board exams and practiced for a number of years. I had intention of starting training in Britain, but I moved to the United States(long story, perhaps for another time) where I studied for the boards and became eligible to practice medicine in the United States. Some would call me "Ajala". Now, Ajala in my mother tongue is the proverbial description for someone who travels a  lot. If perhaps those my intercontinental moves have just been for fun and jolliness, that would have been all exciting. However, my path have been laced with series of examinations. Not only the virtual examinations of life, but the actual ones in which you put pen to paper or finger to keyboard and brain to screen for several hours on end.
I jokingly keep telling my friends that I feel as if I have been writing exams my entire married life. If there is a title like "The most 'Examined' wife" or something like that. Then I should get it. If perhaps you know anyone else in my shoes, please let's form a club. 

Recently published a post on Before Residency Starts. You can read here. There I gave a snippet view into days culminating in the Big Match(The Match is an automated, national process for pairing medical students and International medical graduate with residency programs.)

The purpose of this post is to encourage someone never to give up on their dreams. The path may be long and the road rough, never take your eyes off the prize. It might take longer than you anticipated, but at the end things will work out if you persist. Stop listening to naysayers. Start ignoring the voice of negativity.
If you get obsessed with the weather, you will never plant anything.

Having written and passed all the needed board examinations, in fulfillment of the criteria to be eligible to participate in the match application process, I still had some doubts. At the beginning of the application season for residency program, I wrote down two lists. The first was a list of the number of factors I felt were against me. This is because getting into residency in the USA, especially for an IMG like myself, is very tough and highly competitive. Second, was a list of things I felt were working for me. I realized that there where five major factors I perceived to be working against me. Fortunately, as if to cancel the effect of the "unfavorable" circumstances, I wrote down five factors I believed were in my favor.

Many would wonder why I was so excited about the match. After all, my colleagues I left back in Nigeria are already consultants. Even those I left back in the UK are done with their training.
I rejoice because I am running my own unique race. I am not in competition with anyone else, but myself.
So the purpose of this blog post is to encourage you to never give up on your dreams. The journey may be hard, treacherous and almost dangerous, but remain persistent.

Even when there are factors seemingly pointing to the fact that your dream is doomed by human standards, never throw in the towel because it is never over until it is actually over.

A number of things to consider that I found helpful:

1. Cultivate the habit of writing down your goals.

Write down the big goals, break down the big goals into smaller goals and daily do something about them. Even, though many times your plans would change. You would have to revise it from time to time. You still need to write it down because it gives your goal a tangible visual feel to it, which makes it potentially achievable. Plus you get a sense of satisfaction as you get nearer to your goal.

2.Keep track of your time.

Dedicate a certain number of hours to hustle in the place of studying. Burn the midnight candle if you must. What I did was that at the beginning of my study time each day, I wrote down the "Start" time and "Stop" time anytime I took a break. At the end of each day, I added up all the total number of hours I studied. At the time I studied full time from 9am to 5pm. After that, I couldn't read anything till my children( I have two little ones) went to bed, then I would get about two more hours before going to bed.

3. Try to distinguish between what is an "outlet" for stress and what is a distraction.

There seems to be a thin line between both. Know when you are spending excess time on social media versus when you should be grinding in the place of study versus when you need an actual break to rest your brain.

4. Have a tool to access how close you are to your goal.

It may be a  mock test or a revision tool. For the USMLE, it was the NBME. This is a standardized exam that gives you a prediction of your score on the real exam, as well as break down to you areas of your strength and weaknesses that you can then work on and improve.

5. Never be discouraged if by the assessment tool your progress is minute.

Still keep pushing. For areas of your weaknesses, get fresh materials, use a different study strategy. Find out what works and what doesn't work. Devise a new plan and stick with it.

6.Get a discussion partner if you must.

No man is an Island. There are various exam forums that could be quite helpful with finding someone with similar goals. Going through many of the forums were very helpful a lot of times. A word of caution on these various exam forums though. Be selective and discerning as you take advise from them. If I followed everything I read on those platforms, I would have bidden my dream of practicing medicine in the States good bye a long time ago. Choose helpful tips, shun depressing , demoralizing ones. Be highly selective and discretionary.

7. Even when things do not work out as planned, giving up is not an option.

 Believe there has to be a divine purpose for it. You might feel you have your whole life figured out and then something happens. Still remain persistent, eyes on the goal.

8. You have no excuse whatsoever not to pursue your purpose.

I took one of the exams( Clinical Skills examination of the USMLE, Step 2) while eight months pregnant so you definitely got this. Already, my colleagues who were not pregnant were struggling, but I ignored my baby bump, pushed myself to achieve success.

9. Even if you fail, still it is not over.

Just dust yourself of every 'dirt' and keep moving. Even though you have a lot of explanation to do down the line, but that should not deter you. I failed one of the exams and it was one of the most devastating events of my life because it meant the work of a whole year had gone down the drain. It meant that I had cut my chances of ever matching by more than half. Already as an old IMG, the chances where slim and I made it worse by failing my CK exam. However I realized that according to the words of Winston Churchill, "Success is not final, failure is not fatal: it is the courage to continue that counts".

10. Occasionally, when you are closest to achieving your purpose or realizing your dream, the universe might want to play a trick or two on you.

A day before retaking my Clinical knowledge exam, I got a call from my baby-sitter I had arranged with previously to babysit my children the entire day while I took my nine-hour examination that she would not be able to do so. I was devastated. It was too late to start arranging for another trusted "emergency" babysitter. Plus husband was definitely not around. He was in another continent at the time. Canceling the exam was not an option.
What was I supposed to do? So I prayed to God for wisdom and strength. Went to church that Sunday, came back home, fed my children played with them. I packed my bag in preparation for "the day of battle" the next day. My previous thought was that they would stay home all day with the baby sitter, so I would not bother with pick up and drop off at the daycare, as I could finish the exam late and the daycare would close. Actually she was supposed to arrive at my house the day before my exam so as to help with grooming the kids as well. Alas, things did not go as I planned. I woke my babies up at 5 am( Gosh, those kids have suffered with me sha!). Brushed their teeth, gave them a bath dressed them, fed them. Put them in the car and we were at the daycare by 6 am which did not open till 6:30a.m. We all waited for the daycare to open, then I dropped my babies off and kissed them goodbye. I called an "uber"(the way uber has been helpful to my life, I am forever grateful to the founder) and went to my exam center which was about 40 minutes away. Fortunately, I made it in time. I did the 'grind' for 9 hours, took another uber back to their daycare and picked up my babies just in time. About 5 minutes to closing time. God indeed granted me strength. I couldn't have done it without Him. Eventually, I did not just pass the exam. I aced it to the glory of God.

11. When your victory is closest, sometimes all hell is let loose but stay prayerful and vigilant and be sensitive. 

During the course of the same retake CK exam. While taking the third block of questions on the exam, there was a power outage that lasted 45 minutes. We were presented with the option of re-scheduling. Some people took the option and left. I stayed, I knew if I walked away at that point, I just might never bother ever again. My son was already scheduled for surgery two days from then. So I stayed. The rest is history. Stay committed to your dreams even in the face of adversity. 

12. Networking is Key.

 Connect with people. Be friendly. Seek counsel. Especially from those who have already been through what you are going through. They might have one or two golden advice to give that would make a whole lot of difference. Honestly, considering my very introspective personality, networking was hard. I tried to reach out to people I know since people advise you to network(which for me was the most painful part of the process. I put it on the same pedestal as studying for step 1). Many gave me valuable piece of information. Many gave words of encouragement. A lot of people were willing to help. A lot really wanted to help but had their hands tied and so could not. A lot of subtle insults but "hey girl, eyes on the prize". I remember quipping to myself several times.

13. Emails are important. 

I remember my dilemma at the beginning of the application season whether I should send emails to program directors or not. I asked people, some said it was probably okay to send emails, while some practically said it was a bad idea. I know program directors are very busy at that time and I really feel their pain. They do not have a small responsibility at all. So the idea of some random emails from some desperate, random applicant might not be met with a red carpet, paparazzi-flavored welcome. However, considering all the program directors I met on my interview trail, they are real humans with kind and compassionate hearts. I met the most amazing and friendly ones with real blood flowing through their veins and four heart chambers as all of us. They are not some 'monster' sitting in front of computers chunking out rejection letters. Send personalized emails. Let them know how much you are genuinely interested in their program. That might work or not, but at least try.

14. Pray hard.

I believe in God. God is real and He hears prays. I prayed to him on days when I was mentally stressed and exhausted and He granted me strength. Days when I felt like giving up, He gave succour to my soul and gave me the needed nudge to achieve success.  It will get to some point especially during the nine-hour stretch of exam that you know you need God absolutely. I could not have done it without His grace.

I believe you can achieve whatever you have set your heart to do, as long as you are determined and hardworking.Stay committed to your purpose and indeed your dreams would come true. 

"Stay true to yourself, yet always be open to learn. Work hard, and never give up on your dreams, even when nobody else believes they can come true but you. These are not cliches but real tools you need no matter what you do in life to stay focused on your path". -Phillip Sweet

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