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Clinical research physician Khutaija Noor discusses her article, “Why clinical research is a powerful path for unmatched IMGs.” She addresses the intense pressure and profound disappointment international medical graduates (IMGs) face when they go unmatched for a residency spot in the U.S. Drawing from her own experience, Khutaija reframes this perceived setback as an opportunity, detailing her pivot into the world of clinical research. She challenges the outdated view of research as a non-clinical detour, describing her hands-on role as a clinical trial lead where she serves as an advocate and primary medical contact for vulnerable patients. Khutaija highlights the immense purpose found in contributing to pivotal studies for new treatments, arguing that clinical research is not a consolation prize but a powerful and rewarding field. She offers an empowering message for all IMGs facing uncertainty: Your skills are desperately needed in medical innovation, and your journey is far from over.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Khutaija Noor. She’s a clinical research physician. Today’s KevinMD article is “Why clinical research is a powerful path for unmatched IMGs.” Khutaija, welcome to the show.

Khutaija Noor: Thank you so much, Dr. Kevin, for having me today.

Kevin Pho: All right, so just briefly share your story and then talk about the KevinMD article and the story you decided to share with us today.

Khutaija Noor: Absolutely. So my article is a reflection of my own journey, alongside the journeys of thousands of international medical graduates who apply for residency. I believe the 17th of March is a really tough day for all the applicants after preparing for steps, coming over here for rotations, and putting in so much time into it, and then you don’t match.

And then you feel like that’s the end. If I don’t make it, there is no other way for me to move forward. And that was the same thing that I thought, until I discovered my route to clinical research.

Kevin Pho: Excellent. And we talk about, of course, that day in March. That’s Match Day. That’s when a lot of medical students find out where they’re going to go for residency. And if you’re an international medical graduate, a lot of times you’re sometimes even physicians in your own country beforehand, right? So tell me about the background of a lot of these international medical graduates as they come to the U.S. What have they done before? What are their experiences like?

Khutaija Noor: Absolutely. A few years back, we used to practice in our own home countries as clinicians, as you just said. And then, years later, I decided to pursue residency in the U.S. So that is when you start the journey of steps preparation because, unfortunately, you have to complete your steps to move forward. And then after you’re done with your steps or during your steps, you have been told to get or gain U.S. clinical experience. So you come over here and reach out to your mentors or physicians to see if there is an opportunity for you to rotate with them. So I feel like it’s a very long process, especially if you were not aware of these things.

But with social media, with LinkedIn playing a big part, I see medical students starting the journey very early in their medical school. For example, I have people who have reached out who are just in their second year of medical school and are already preparing for the steps.

Kevin Pho: So in your article, you described the feeling as gut-wrenching whenever international medical graduates don’t match. So tell me more about what happens if they don’t match: the cascade of emotions that they go through. Tell us a little bit more about that.

Khutaija Noor: Sure, absolutely. It’s a very emotional feeling because you have invested years into it. And when I say years, it’s more than three or four years that you have invested, whether it’s for preparation for step one, step two, and then finding rotations, because that’s also a very long process to find the right physician or mentor to work with. And then after finding all those things and making your application ready to submit, you find out that’s it. That’s the end.

The very first time that I applied and did not match, I felt like my world broke down into pieces because I was preparing for this goal throughout all four years, and I was directionless, wondering: where do I go after this? Do I have any other options that I can pursue? So I feel like that’s a very difficult day for anyone, especially on Match Day. But there are options out there now.

Kevin Pho: Do you have any approximate data that gives us an idea of the percentage of international medical students that don’t match?

Khutaija Noor: I think in the past three years, the data show that the statistics are getting lower and lower every year. I cannot quote it correctly, but it was more than 46 percent last year who did not match. And the data state it’s going to keep increasing this year. Again, there are many challenges that international medical graduates have to face, and that is one of the things that plays a very crucial part.

Kevin Pho: So approximately half, almost half of international medical graduates don’t match. What kind of options do they have at that point?

Khutaija Noor: Many states nowadays are starting assistant physician programs. You can also apply for an assistant physician program if you’re done with your steps. The second route is if you want to be clinically active and stay in a surrounding where you want to do some groundbreaking work, research is an option: postdoc or post-graduation research in the field of your interest, whether it’s neurology, psychiatry, or immunology. So there are various options that I believe nowadays people are exploring.

Kevin Pho: So you obviously chose the path of clinical research. Tell us more about that particular path.

Khutaija Noor: Absolutely. I had no experience when I was going into clinical research, and I did some research about it: what is it about? The best feeling about this is you get to see patients real-time and you can see the impact of the new medication or new drug real-time.

I started in administration, just making copies. My mentor said, “Let’s start you with just making copies.” It was a very stepwise, gradual learning process for me rather than a one-time learning process. So after spending two years in clinical research, I decided to get further experience in clinical research from a broader perspective. I also chose the path of getting my graduation certificate from Harvard called Foundation of Clinical Research.

Kevin Pho: So that’s quite a journey. Just to put that in perspective, you completed medical school, four years of medical school and the steps, and they had you start by making copies. Is that right?

Khutaija Noor: That is correct, yes. My mentor is amazing. If not for him, I feel like I would not have clearly understood how clinical research works. He started with making me copies and then he said, “Let’s now move you to prescreening.” This involves taking the whole perspective of the patient and seeing if the patient will benefit from the medication. It was a long journey, but I’m happy it was the journey I had.

Kevin Pho: Tell me about some of the research that you’ve done.

Khutaija Noor: Sure, absolutely. I was very fortunate to be in both psychiatry and internal medicine as a clinical researcher. In psychiatry, I experienced firsthand the groundbreaking drug called Xanomeline from KarXT. I was also a rater using psychiatric assessment scales, so I would rate the patient coming in every time, seeing how their positive and negative symptoms were. I was also fortunate to be a part of a device study for bipolar and major depressive disorder.

That being said, those were the past studies that I conducted along with various sleep studies. I’m currently working on an obesity study, along with some medication that would benefit peripheral neuropathy and cardiovascular diseases. So yes, it’s amazing.

Kevin Pho: And tell me about some of the patient interactions that you have in that clinical research context.

Khutaija Noor: Sure. Any patient who comes in, we give them a thorough understanding of what they are getting into. For example: what is the duration of the study? What is the medication called? How does the medication actually work, or what are the possible side effects? How many times do they have to come in for in-person visits or phone visits? The first visit is very elaborate. That’s what I tell all my patients: “Be prepared for four to five hours, not less than that,” because we talk about when the blood draws will be, ECGs, EKGs. These are all small things that help you build a relationship with the patient.

Because these are all long studies, I’m going to see them for two or three years. I’m going to know if their son is going to get married, their daughter is going to get married, or if, God forbid, they have lost a loved one. You have to build a patient and clinical researcher relationship for them to rely on you and say, “Hey, if this will benefit me, I am good to go with this.”

Kevin Pho: And do you generally stay with one mentor or do you go from mentor to mentor, lab to lab?

Khutaija Noor: I first started with one mentor because I really wanted to get a grasp of clinical research. But now I feel I’m confident enough to work with multiple mentors. So at this stage, I am primarily working with the PI, along with my personal scientific research writing project that goes for publications.

Kevin Pho: And how long have you been doing clinical research for, and how many years do you think it took you before you really became versed and comfortable in that world?

Khutaija Noor: Sure. I think it took me more than a year to be comfortable with it. Like I said, it was a stepwise journey for me, but I have more than four years of experience in clinical research now. That being said, I still want to continue in this field. It’s a groundbreaking field. I always tell people, if you are someone who wants to be a part of groundbreaking research, this is the place to be.

Kevin Pho: And how do you go about finding these mentors? Let’s say for those international medical graduates who may have gone unmatched and are listening to you now, how did you, or how do they, go about finding these principal investigators to do research under?

Khutaija Noor: That’s very interesting for me because I actually went with my CV and handed it to many PIs, so I went in person. I stayed outside for a long time and I said, “Sir, this is my CV. Please look into it. If you need me to do anything, I will be happy to.” So one of them said, “Why don’t you start making Xerox copies for me?” So I started with that.

But I know many people who are hesitant to do that. They think that after getting all this education, they are a little hesitant. But I say, before someone becomes your mentor, you have to prove yourself to them. It takes a lot of hard work, but once you are there, they are going to be doing some amazing work for you and with you.

Kevin Pho: So in terms of your career trajectory, you’ve been doing clinical research for four years. What will be the pinnacle of this path? Would you eventually be a principal investigator yourself?

Khutaija Noor: To be a principal investigator, I would definitely have to go through residency. That being said, I still pursue residency, but I know I have red flags. I’m now an older international medical graduate. I know my chances are few, but that doesn’t mean I don’t have any chance. I just have to present myself at the right place at the right time to the university that would say yes to me.

But yes, my long-term career goal is to be a PI and have an academic career where I’m actively doing research for universities. I do have some projects that I want to work on.

Kevin Pho: Now, do you also do teaching on the side as part of labs, and talk to me about some of the other members of the labs that you interact with?

Khutaija Noor: Yes, absolutely. I feel like teaching is definitely a part of it. Regarding mentorship, I started a website to provide mentorship and an educational platform for someone who’s interested in being in clinical research because, as a researcher, you have to get at least three or four certifications, bare minimum, to even get started. So we want to educate people about what to get first and what to do next. If there is any overlap, we want to address those things and be a guide to them.

Kevin Pho: So if an international medical graduate didn’t match and they’re thinking about the potential research path, talk to me about that actual decision whether to apply for the match again the following year versus pursuing a career in clinical research. Tell me about some of the questions they need to ask themselves to decide whether that’s the right path for them.

Khutaija Noor: Absolutely. Thank you so much for that question. For a year, you have to show you’re doing something clinical. What is that one thing that you want to do? You can either just be an observer, rotating with someone and not doing anything clinically, or be part of research where you have communication with patients, where you do clinical work, and where you see things firsthand.

The very first question I would ask myself is, “Which is more impactful?” And that is why I took the route of research because here, I’m having active communication with patients rather than passive communication or just being an observer.

That being said, after that question, my second step would be to reach out to people on LinkedIn. That is a powerful tool at this point. I have many people reaching out to me asking what the best route is or if they should go for a certain certification. On my website, I have clearly stated what all the certifications are that are basic requirements for them to start. And since this is a good opportunity for me to share it with people, it’s a Good Clinical Practice certification that they have to do. That will be the very first step to start.

Kevin Pho: And what exactly would that entail to get that certification?

Khutaija Noor: Yes, so it can be through the CITI Program, or there are other websites that you can get the certification from. That certification tells you and teaches you the ethics of research because ethics is huge in research. It teaches you about data. To show something was statistically proven, you have to have proper data entry. It talks to you about every single detail, like how to report an adverse event, what informed consent is, and how to obtain informed consent. So it is a stepwise certification program for you to understand the overall concept of research.

Kevin Pho: And from an economic perspective, how much does this clinical research position pay in contrast to a residency?

Khutaija Noor: I would say almost the same as when you are in your residency, but it depends on which PI you are working for and which company you are working for. That being said, as a clinical researcher, your career growth is also there. You can be a clinical researcher, then a senior clinical researcher, then the clinical research lead, and then you can also get into pharmaceutical companies as a medical science liaison and take it from there.

Kevin Pho: And do you have people do perhaps a year of clinical research and then reenter the match?

Khutaija Noor: Absolutely, yes. I have known people who have reentered the match. I was lucky and fortunate enough to see my friend do it, but now that he has experienced research just like me, his goal is to come back to the academic part of research down the line.

Kevin Pho: And what would you say are the biggest misconceptions about the clinical research pathway that you want to clear up?

Khutaija Noor: I feel like as an international medical graduate, the first misconception is that not everyone is exposed to it. For instance, in my story, I had zero experience and I always thought it was very difficult to get into, that I couldn’t do it. I didn’t know what it would take or how much of my time it would consume.

So that is the biggest misconception: when you don’t have experience or you don’t know, you often create your own walls around you. You start focusing on why not to do it, rather than why you should approach it. So that is the biggest difference I feel. But once you are exposed to it, if you feel like this is what you want to pursue, then this is a great field to pursue.

Kevin Pho: We are talking to Khutaija Noor. She’s a clinical research physician. Today’s KevinMD article is “Why clinical research is a powerful path for unmatched IMGs.” Now, I’m going to end by asking for some take-home messages you want to leave with the KevinMD audience.

Khutaija Noor: Yes. Thank you so much again, Dr. Kevin, for giving me this opportunity. To all my fellow IMGs, I just want you to know that with each effort you put into the application for residency, whether it’s the start or the end of the process, we are all in this together. Our goal is to serve the community. And clinical research is also a pathway that you can discover where you are actively serving the community by making a real-time impact.

So that being said, best of luck to everyone who’s applying this season, and congratulations to everyone who matched last season.

Kevin Pho: Well, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Khutaija Noor: Thank you so much again, Dr. Kevin.