Mentors without Borders

In a nutshell

Pursuing medicine as a career is challenging even for those with high levels of commitment, discipline, and resilience. Many rely on guidance from mentors whose experiences serve as the roadmap for new generations. Finding a mentor can be difficult in certain parts of the world or when there is a need to live, study, and stablish a professional practice outside the country of origin. Good mentorship can help students enhance the skills required to succeed during the application process for medical education while also providing support as they navigate training and transition to the workplace. We have created a program called “Mentors without Borders” to offer free mentorship to those interested in medicine as a career in and out of the United States. It primarily focuses on strengthening skills needed for academic writing and publication of scientific articles in medicine. This initiative has already benefited several students and physicians from all over the world and is aiming to become a fully structured program with a larger outreach in the future.

Introduction

No one becomes a physician without the support and guidance of those who proceeded them. Mentoring is an integral part of the field of medicine and may be taken for granted in places such as New York City where there is a plethora of physicians to call upon as mentors. We have created a program called “Mentors without Borders” to fulfill the innate desire to never say no to a physician who wishes to learn.

Pursuing medical education in the United States is a competitive campaign. According to the Association of American Medical Colleges, roughly only half of 55,188 medical school applicants matriculated during the 2022-22023 academic year1. The battle to secure a postgraduate training opportunity is also fierce given the high demand and high academic level of most candidates in the absence of sufficient residencies and fellowships positions.

Some primary and secondary specialties such as plastic surgery, neurosurgery, cardiology, and dermatology are coveted, and the selection criteria may vary depending on what a particular training program and/or institution prioritize (e.g., more clinical versus more research-oriented training). However, US Medical Licensing Examination (USMLE) tests’ scores and scientific publications seem to carry the greatest weight when it comes to the selection of applicants across all programs.

During the Match 2022, the mean number of abstracts, presentations, and publications, submitted by a US Senior who matched in family medicine and plastic surgery were 28.4 and 4.1, respectively2. The mean number of volunteer experiences submitted by matched U.S Senior students was 6 for pathology residency and 11 for dermathology2. Volunteer experiences are another important resource to become a strong applicant since they open opportunities for research collaborations, networking, and letters of recommendation.

Very early, US medical students are encouraged to decide their area of interest to start laying the ground for a strong application and increase their chance of obtaining a position in their preferred residency by the time they graduate. Often, these students find themselves choosing their future primary specialty before having the opportunity to complete important clinical rotations which could be helpful to guide their decision. Proactive mentorship and institutional support seem to be the key to facilitating this process even under pressure.

The 2022 Main Residency Match had a total of 42,549 active applicants. Among this group, 18.5% were non-U.S. citizen students and graduates of international medical schools. A percentage that has been increasing in the last 5 years2. International medical graduates (IMGs) contribute to the diversity of the physician workforce in the US representing a quarter of all training and actively practicing physicians3-4.

Like US medical graduates, most IMGs wish to enter American medical training programs with the aspiration to fulfill their professional goals in an academic environment. Many of them choose to pursue the highly competitive residency or fellowship application process while also dealing with socioeconomic hardship and even compromised personal safety in some of their places of origin. In addition, most IMGs lack the mentorship and support institutions from developing countries offer. Regardless of what motivates physicians from all over the world to come to the US, IMGs are important for the American Health Care System (HCS).

A narrative review by Murillo Zepeda and collaborators, describes the main challenges IMGs confront while taking part in the US Graduate Medical Education (GME) and HCS environments. The authors name the adaptation to the US culture as the main barrier, followed by adaptation to the US GME and HCS settings, deficient communication skills, racial discrimination, emotional distress, and financial constraints5.

These challenges get in the way of building competitive applications for preferred residencies and fellowships, something that could partially explain why most IMGs opt to apply to less competitive fields, usually primary care and family medicine4-5,even when some of these physicians have already specialized in other areas in their countries of origin. Achieving a competitive number of publications can be difficult without proper mentorship and research exposure particularly in geographical areas where medical research is not well supported. In these circumstances and without guidance from a senior investigator, some IMGs may struggle to timely and effectively participate in academic writing and submission of manuscripts that could ultimately increase their number of publications.

Volunteer research positions in competitive fields in the US can also be difficult to obtain. In addition, IMGs must consider the rules and restrictions pertaining to their visa status as well as the personal financial implications of the time spent in such positions. Without volunteer or hands-on rotations, it is difficult to acquire the letters of recommendation needed to apply to residency programs in the US. Some IMGs, while still living in their country of origin, opt for reaching out individually to physicians, investigators, and laboratories with the hope of finding remunerated research opportunities that also offer visa sponsorship even at the expense of delaying the completion of their medical training. Nevertheless, such positions are also not abundant.

The Covid-19 pandemic caused significant delays to those hoping to participate in research or clinical rotations since most hospitals and laboratories worldwide restricted the presence of non-front-line employees, students, and visitors to limit the number of viral exposures and to focus the resources on addressing the health crisis. The pandemic also caused delays in the processing of visas that would allow IMGs to travel to the US to honor clinical and/or research commitments on time.

On the other hand, the pandemic helped expand the use of online communication increasing the outreach of medical education beyond classrooms, conference rooms, and hospital hallways. This compensated at least in part some of the travel restrictions implemented during the pandemic. For national and international medical graduates, the travel restrictions decreased travel expenses since most of the interviews for residency and fellowship applicants were conducted almost exclusively online during the first two years of the pandemic. Online communication opened the door to new resources to learn, network, and collaborate.

Mentors Without Borders

Mentors Without Borders (MWB) is an online non-profit educational initiative that consists in providing free mentorship to those interested in pursuing medical education and training to become physicians in and out of the US. Given its online nature, it can reach every place in the world where there is an internet connection with sufficient speed to allow video calls and screen sharing. It benefits students from all ethnicities and places of origin whether they are living in the US and regardless of their level in the pathway to become full practicing physicians, from pre-med students to IMGs preparing for the USMLE, to postgraduate aspirants.

Students are assigned to a mentor who would hold individual online sessions once a week lasting from 30 minutes to 1.5 hours. The first session focuses on exploring the participant’s career goals, level of education, and scientific interests which help to provide personalized mentorship. The students are as well encouraged to choose a topic of interest to work on a scientific review article during the follow-up sessions. Regardless of any prior academic writing experience or research background, students are coached to write one or more paragraphs a week about their chosen topic. Their work is reviewed during the weekly sessions for constructive feedback emphasizing English grammar and syntaxis, structure and readability of the information, and citation rules and resources, among others. All students receive important insights to help them elaborate on ethical and high-quality manuscripts and to familiarize themselves with the processes of submission and publication of academic articles in national and international medical journals.

The goal is for each student to publish one or more articles before the mentorship ends and to empower them to continue developing the academic writing skills that would help them strengthen their applications to any medical training program in the US and the rest of the world. The program also offers the opportunity to obtain a letter of recommendation and/or establish a network that could benefit them in the future. Some sessions offer guidance regarding the complicated US GME and HCS environments. Many of the students strive to accomplish their career goals while they navigate difficult circumstances in their personal lives, therefore, it is not uncommon for mentors to provide some emotional support within the sessions.

The story behind the beginning of Mentors Without Borders

The events that inspired the birth of MWB are rooted in 2016, when Dr. Mary Salvatore, a thoracic radiologist at Columbia University launched a free lung fibrosis blog where she shared knowledge about this disease with nearly 300 people a day including patients, clinicians, and researchers in the field. Dr. Salvatore had committed to feeding the blog every day with the summary of an important article about lung fibrosis to promote awareness about the disease and to inspire enriching scientific discussions among the participants.

During this time, Dr. Monica Pernia Marin, a physician from Venezuela who was completing the USMLE Certification in New York City, reached out directly to Dr. Salvatore via email to inquire about a possible volunteer research collaboration. After interviewing in person, Dr. Pernia Marin took over the lung fibrosis blog for a year until she left to begin her training in an internal medicine residency program in the city. However, she continued collaborating with Dr. Salvatore in the manuscript and publication of various scientific papers and a textbook.

The lung fibrosis blog was then taken over by three other IMGs from Venezuela who have heard about the activity and expressed their interest in participating. These three physicians were also able to build the applications that allowed them to find their way into the US GME system. Even after the lung fibrosis blog terminated in late 2018, Dr. Salvatore continued to receive email communications from national and international students located inside and outside the US inquiring about research positions in radiology. Given the lack of enough resources to support these inquiries as well as Covid-related restrictions, Dr. Salvatore started offering free of charge online mentorship to those interested in the modality. Dr. Pernia Marin, now a board-certified physician fully licensed in the US, joined the initiative as a mentor and co-founder.

The initiative in numbers

MWB has benefited more than 30 participants so far. Most of them are IMGs from the Middle East and pre-med students from the US. Two of the physicians who are currently offering mentorship within the program also benefited from it as mentees. So far, fourteen scientific papers have been published in diverse medical journals covering topics related to fibrosis, lung cancer, carcinogenesis, and thoracic radiology6-19 (table 1). Fourteen new manuscripts are currently being prepared for submission and cover a broader range of topics consistent with the various interests of students who have most recently joined the initiative (table 2).

Testimonials

Monica Pernia Marin, MD – from Venezuela
When I received Dr. Salvatore’s reply to my initial email back in 2016, I had no idea of the impact her guidance and collaboration would have on my career and in my life. I still knew how lucky I was because I had not been able to find volunteer opportunities to do research and I did not have any prior publications to demonstrate my skills. Dr. Salvatore immediately understood my struggle and potential. Participating as a writer in the lung fibrosis blog allowed me to develop the ability to analyze medical literature more objectively and summarize it in simple terms. This is an important skill for me to have as a physician because it affects the way I process information and how I communicate what I learn to patients and colleagues. Dr. Salvatore’s support and collaboration helped me become a competitive candidate for the internal medicine residency match and opened the doors for more opportunities. I am delighted to be participating in Mentors Without Borders. This time, I get to teach and guide students from all over the globe who are going through situations that are similar to the one I went through when I decided to continue my medical education in the US. This is also a source of great motivation for me since teaching others is an exercise for continuous learning”.


Reza Soleimani, MD – from Iran
During my six-month mentored experience with Dr. Salvatore, once a week or once every two weeks while working in one of my country’s most underprivileged areas, the most critical barrier to finding the perfect mentor—physical distance—was eliminated. My encouraging and incredibly professional mentor assisted me in improving my scientific thinking, self-esteem, time management, and, most importantly, motivation. She is also supporting me in finding my ideal place for research in my field of interest. I think ‘Mentors Without Borders’ allows individuals from all around the world to achieve their goals, which might not be feasible without a decent guide”.


Sofia M. Tarchi, fourth-year medical student in Milan, Italy – from Italy
“[…] Amidst all the challenges of virtual learning, Dr. Salvatore has been a beacon of kindness, patience, and unwavering support […] Her willingness to invest in my growth as a medical student created an environment where I felt like a valued part of her team, motivating me to push myself further and strive for excellence […] Beyond her role as an exceptional teacher, Dr. Salvatore constantly emphasized the privilege we have as healthcare professionals to positively impact the lives of others […] instilling in me a profound sense of purpose and a deep-rooted desire to utilize my skills to make a difference in the lives of those in need. Moreover, Dr. Salvatore exemplified the delicate art of balancing a clinical and research career. Her ability to seamlessly navigate between patient care and academic pursuits was nothing short of remarkable. Witnessing her success in maintaining this equilibrium has opened my eyes to the vast possibilities that lie ahead in my own professional journey. I’m excited to follow in her footsteps!

Conclusion and future directions

Although impactful, MWB started as a low-scale initiative that is now looking at evolving into a fully structured program. Dr. Salvatore’s vision is to reach a greater number of people in the near future and is currently working on the best strategies to allow more students and mentors to reach out and participate. This model has limitations since it focuses mostly on academic writing and publication principles and does not offer any in-person or clinical hands-on experiences.

On a great scale, MWB could impact many students whose work could contribute greatly to the medical literature in multiple fields. As they receive guidance and support to move forward in their careers, they are also being equipped to mentor younger generations in the future in and out of the programs’ frame.

Resources:

  1. https://www.aamc.org/data-reports/students-residents/data/2022-facts-applicants-and-matriculants-data
  2. Charting Outcomes in the Match: U.S. MD Seniors, 2022. National Resident Matching Program. https://www.nrmp.org/match-data-analytics/residency-data-reports/
  3. Norcini JJ, van Zanten M, Boulet JR. The contribution of international medical graduates to diversity in the U.S. physician workforce: graduate medical education. J Health Care Poor Underserved. 2008 May;19(2):493-9. doi: 10.1353/hpu.0.0015. PMID: 18469420.
  4. Ahmed AA, Hwang WT, Thomas CR Jr, Deville C Jr. International Medical Graduates in the US Physician Workforce and Graduate Medical Education: Current and Historical Trends. J Grad Med Educ. 2018 Apr;10(2):214-218. doi: 10.4300/JGME-D-17-00580.1. PMID: 29686763; PMCID: PMC5901803.
  5. Murillo Zepeda C, Alcalá Aguirre FO, Luna Landa EM, Reyes Güereque EN, Rodríguez García GP, Diaz Montoya LS. Challenges for International Medical Graduates in the US Graduate Medical Education and Health Care System Environment: A Narrative Review. Cureus. 2022 Jul 27;14(7):e27351. doi: 10.7759/cureus.27351. PMID: 35910699; PMCID: PMC9334519.
  6. Pernia Marin M, Salvatore M. Analogies between the periphery of cancer and the leading edge of pulmonary fibrosis. J Transl Med. 2023 Apr 21;21(1):274.
  7. Capaccione KM, Shetty A, Salvatore M. CANNOT B UIP. Clin Imaging. 2023 Jul;99:5-9.
  8. Abu Qubo A, Numan J, Snijder J, Padilla M, Austin JHM, Capaccione KM, Pernia M, Bustamante J, O’Connor T, Salvatore MM. Idiopathic pulmonary fibrosis and lung cancer: future directions and challenges. Breathe (Sheff). 2022 Dec;18(4):220147.
  9. Hosseini M, Salvatore M. Is pulmonary fibrosis a precancerous disease? Eur J Radiol. 2023 Mar;160:110723.
  10. Pernia Marin M, Salvatore M. Fibrosis. J Transl Med. 2023 Jan 30;21(1):59.
  11. Shou AY, Salvatore MM. CT predictors of outcomes in patients with connective tissue disease and progressive lung fibrosis. Clin Imaging. 2023 Feb;94:42-49.
  12. Abu Qubo A, Saqi A, Salvatore MM. The temporal heterogeneity of usual interstitial pneumonia on chest CT. Expert Rev Respir Med. 2022 Sep;16(9):959-961.
  13. Shakil F, Snijder J, Salvatore MM. Why is UIP peripheral? Expert Rev Respir Med. 2022 Aug;16(8):907-915.
  14. Dsouza B, Capaccione KM, Soleiman A, Leb J, Salvatore M. COVID-19 on Chest CT: Translating Known Microscopic Findings to Imaging Observations. Life (Basel). 2022 Jun 8;12(6):855.
  15. Abu Qubo A, Capaccione KM, Bernstein EJ, Padilla M, Salvatore M. The Role of Radiology in Progressive Fibrosing Interstitial Lung Disease. Front Med (Lausanne). 2022 Jan 13;8:679051.
  16. Bertolini A, Capaccione K, Austin JHM, Blum A, Padilla M, DSouza B, Yankelevitz D, Henschke CI, Salvatore MM. Teleradiology: An opportunity to improve outcomes in pulmonary fibrosis. Clin Imaging. 2020 Apr;60(2):263-264.
  17. Snijder J, Peraza J, Padilla M, Capaccione K, Salvatore MM. Pulmonary fibrosis: a disease of alveolar collapse and collagen deposition. Expert Rev Respir Med. 2019 Jul;13(7):615-619.
  18. Salvatore M, Kwon K, Steiner RM. Images in COPD Combined Pulmonary Fibrosis and Emphysema. Chronic Obstr Pulm Dis. 2018 Jan 18;5(2):154-157.
  19. Salvatore M, Margolies L, Bertolini A, Singh A, Yankelevitz D, Henschke C. The need to be all inclusive: Chest CT scans should include imaged breast parenchyma. Clin Imaging. 2018 Jul-Aug;50:243-245.

To participate, contact us at: thefibrosisinstitute@tfi.com