An International Student’s Experience at Harvard Medical School

Podcast interview with Azan Virji, Harvard Medical School student and founder of F-1 Doctors

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Azan Virji discusses his path to Harvard Medical School, and challenges faced by international medical students [Show summary]

Med student Azan Virji explores the unique challenges he faced as an international student applying to Harvard Medical School, as well as his mission to mentor students like himself through the organization he founded, F-1 Doctors.

F1-Doctors: A virtual community connecting international medical school applicants with mentors who are current international students [Show notes]

Our guest today is Azan Virji. Azan grew up in Tanzania and came to the U.S. as a student at Yale University, where he studied molecular, cellular, and developmental biology and was a Yale Global Health Scholar. He earned his MPH in 2019, also from Yale, and then went on to begin his medical studies at Harvard in 2019. Knowing all too well the difficulties facing international applicants to U.S. medical schools, which were exacerbated by the corona pandemic and visa policy changes, Azan founded F-1 Doctors in May 2020. Its mission is to provide a network of international medical students, dental students, residents, and attendings to international applicants who are struggling to pursue their med school dreams.

Can you tell us a little bit about your background? [2:21]

I was born in Kenya, which is neighboring Tanzania, but then I grew up in Tanzania because my mom is from Kenya and my dad is from Tanzania. I think of myself as an East African baby, and I went to high school there as well. I spent 18 years of my life there and went to high school in Mwanza, Tanzania. It was a pretty small high school; my graduating class at the end was almost 24 students. In school, I was the person who would always volunteer to do things. I was always really interested in leadership activities and getting leadership experiences. I was what we called the Head Boy at the time. It’s based on the British curriculum, where you’re basically the link between the students and the faculty. And then I was also a really big theater nerd. I used to do plays regularly and used to sing a lot. On top of all of that, I was really hard working. I wanted to focus on academics and really wanted to do good in school.

Then, I applied to colleges, mostly here in the United States. The reason for that was twofold. I think it’s pretty obvious that some of the best institutions of higher learning are here in the United States. Some of the world-class research happens here, and I really wanted to be a part of that environment. But on top of that, I also come from a very low-income background. I’m a first generation, low-income student, and I really needed financial support to attend a place of higher learning. It’s something that I couldn’t afford on my own. And in the United States, particularly, a lot of colleges here do have a lot of generous financial aid packages that they offer to attract international students from the rest of the world. I got a great financial aid package to attend Yale. That’s how I finally found myself, after never having left East Africa, in the US for the very first time, almost six years ago now.

It was definitely quite a cultural shock in the beginning, trying to get used to the different way of learning. I think that was really hard for me, particularly when it comes to writing essays in English. That’s something I really struggled with when I first came here because the way I was taught to write essays was very different. I found myself struggling a lot when it came to English writing classes, when I got here. The way you phrase your arguments and the way you structure your paragraphs just really got to me.

And I also found myself underestimating the level of intensity of classes. When I came in, I’d already done organic chemistry before, so I thought I’d be fully well-equipped for sophomore organic chemistry. So I joined a sophomore level course, even though there was a freshman level course that was available. That was a poor decision that I made. And I struggled all through that course because I didn’t realize that the whole concept of a quiz and a midterm and an exam and being constantly tested is very different than what happens in the UK system, where you have maybe a midterm and then a final exam and that’s it, or just a final, a lot of times. It was hard to switch my mind to thinking that every single week I need to be studying, every single week there’s homework to do, every single week there’s a quiz. That was hard to navigate.

Did any of your fellow students in high school come to the United States or go to England? [7:09]

Two of them did. I think the school that I attended lent itself to that. Many students went all across the world for a higher education. We had students who went to the UK, some went to Australia, some went to Europe, and some came to the US as well.

When did you decide to become a doctor? [7:34]

I’ve actually always wanted to be a physician. I think initially I knew I really was passionate about the biological sciences, and I was drawn to it, and I was really excited to study for the biological sciences over any of my other subjects. That’s how I initially realized. But then I think after being exposed to the patient population in Tanzania, that’s where I fully realized that I wanted to be a physician. I wanted to help out these individuals who don’t have a lot of access to healthcare and who are suffering from infectious diseases that are very easily treatable. That was my first inclination that I wanted to be a physician, and ever since then, I think it’s always been the goal. Now I’m finding myself also transitioning into realizing I may want to do a little more healthcare administrative work as well. That’s been an interesting career trajectory.

Did you volunteer as a high school student when you were in Tanzania? [8:40]

I did a little bit of lab work initially, just working in a lab and helping the lab techs run tests. But then after that, I slowly made my way into the consultation room with the physician. And it was just so baffling to see these diseases that individuals keep getting constantly. And this ties into my interest with public health as well: You will see that a patient will come in with malaria and get treated for it and then, just two or three weeks later, will come back again with malaria. It’s hard when you’re in a country where access to healthcare is pretty low.

And for every single individual, there’s an opportunity cost that they have to be thinking about. As a farmer in rural Tanzania, you have the option of taking a sick day and going to the hospital and getting treated or continuing to work so that you can put food on the table for your family. It was really hard to see those two choices that individuals often have to make. That’s where I realized that I definitely want to be more involved with providing care to these individuals who, in some ways, don’t have a choice.

When did you decide to get your MPH, and why did you decide to do it before the MD? [10:26]

Given this large interest in the health of the population, and how to alleviate healthcare access, and break down stigma when it comes to certain disorders, and all these different healthcare interventions that I knew were a big part of public health, when I came to Yale, this is something I started to explore a little more. That’s when I became the Global Health Scholar and did a lot of global health projects as well during my time at Yale. At Yale, they had this really cool program where you start your master’s degree in your senior year of college. That made it perfect in some ways because I knew I was really interested in this, and this was something that I wanted to get. It just made sense if I could save a whole year’s worth of tuition and education costs, and then just go to the school of public health and start my master’s degree my senior year of college. It worked out pretty well. I think, in the grand scheme of things, it made sense to do it before I went to medical school.

I’ve talked to a lot of individuals about this, but in medical school, it’s really easy to get bogged down by all the minutiae of the health of one individual, and I think it’s important to have that mindset and that perspective before you’re in that consultation room about all the other external factors that affect the health of that individual that you’re seeing. Right? For example, it’s very easy for the physician to just prescribe a drug for a particular ailment, but that person may not have the insurance to actually purchase that drug. Or they may not adhere to it because of the side effects, or some cultural component associated with it. All those things, I thought, were really important to learn before I made my way to medical school and learn about all the different diseases.

What was the hardest part of the med school application process for you? [12:47]

Two things were particularly challenging. Taking the MCAT was tough. There’s the whole CARS section. And like I said earlier, English is not my strongest suit. So I struggled with that. There’s a skill set that you need to acquire of reading passages really quickly and not focusing on all the details, but getting the overall picture. It’s something I struggled with, and I didn’t do too well. Even on the day before my MCAT, I was still trying to figure out, how do you do this?

I also had to take it in South Africa. I was on my gap year when I was thinking of applying to medical school and taking my MCAT, so I went home, and that’s where I studied for the MCAT. The only closest location where I could take it was either South Africa or Dubai. So I had to get on a plane, an international flight, just so I could take my MCAT, which is completely ridiculous to think about when you’re here in the US, and if you’re in Boston, for example, there’re just tons of testing locations where you can go and take it on any day. That was particularly challenging as an international student.

The second part related to me being an international student. I felt truly alone in this process. There was no one really that I could turn to for advice and say, hey, you’re also an international student who got into medical school. What is it like, what’s the process like? Are you viewed differently as an international student? I had no one. In some ways, I had to just hope for the best. Nobody wanted to provide the information. I had to rely on the Student Doctor Network. That was particularly challenging.

You obviously did something right because you got into Harvard Medical School. What do you like best about Harvard Medical School? (And I don’t mean the brand.) [15:04]

I think that’s a common perception: that it’s the brand. But at the end of the day, there’s so much more to it than the ivory towers that you see. There’s quite a few things I like about HMS. I think the pass/fail curriculum that HMS currently has truly lends itself to creating a more collaborative space. And it’s really easy to reach out to someone for notes or ask for help, because you don’t feel like you’re ever competing with someone. Your grades are your own. It’s all pass/fail. At the end of the day, it feels like it’s truly a community of students who are all trying to learn medicine and no one is trying to be better than the other.

And the second thing is that out of all the faculty that I’ve had interactions with, every single one of them is truly committed to teaching and truly committed to improving the craft of teaching and making their curriculum better. I can’t tell you the number of times I’ve heard the word “feedback” over the course of my first year because all the faculty are just constantly trying to solicit feedback so that they can be better at teaching and can improve their curriculum and all the content as well.

The third thing is that we get to see patients in our very first year. Every Wednesday, even in your first year of medical school, you’re starting to see patients and you have a whole clinical day. That’s really nice because for a lot of us, the patients are what drew us to medicine and to the profession.

And then lastly, the case-based learning model also is fantastic. You never find yourself wanting to fall asleep in class. Actually, you can’t fall asleep in class. It’s not just a lecture format. You’re constantly engaging with other people and bouncing off ideas. Even if they’re totally wrong, you’re constantly engaging. You’re constantly talking during class. I think it’s a really good model to teach. And of course, when you see patients, they are the case.

What could be improved, even at Harvard Medical School? [17:39]

There’s a lot. But for starters, the big thing that comes to mind is financial aid. You’ve probably heard in the news, as well, that there’s a lot of schools that are transitioning to this idea of medical school going debt-free, particularly for low income students. That’s something that Harvard Medical School is still working on, something that, in my past year at HMS, I have been advocating for and been part of trying to make a reality here at HMS as well. What it means is that every single year, a large number of students who come from diverse backgrounds who are low-income just can’t afford to come to HMS.

The second thing is it would be nice to have more simulations, even though we do see patients, and that’s where we get to apply a lot of our knowledge. But it would be nice to have more simulated patient encounters so that we truly get the full breadth of experience of what we could potentially see. I think that’s something that I would definitely try to advocate for here at HMS as well. The cases are mostly written, but I think just being in that environment where all the monitors are beeping, and your patient is complaining that there’s something, or somebody is on a microphone saying “I’m in pain right now,” you have to be quick on your feet. I think those are experiences that would be nice to be incorporated in our first year as well.

HMS requires a research project. Do you have any idea what you intend to focus on for that project? [19:43]

I’m still not fully set on it. I have to do it in my third or fourth year, but it’s definitely going to be a combination of something involved with global health, along with something related to healthcare management and healthcare administration. That’s what I’m thinking right now. I’m also applying to the MD/MBA program as well here at HMS. I think if I do get accepted into that program, my scholarly project also has to have a business component to it as well. That’s why I’m thinking about something that merges global health with healthcare administration and business.

Why do you want the MBA? [20:36]

I think that’s a more recent career trajectory or a recent passion. After you see how the cookie is made, I feel like you see that so much of health revolves around access. I think that’s the big thing. That’s what I’m most drawn to. The reason I got my MPH is because individuals simply did not have access, living in rural communities. And I think that’s what I want to get my MBA for, to also supplement that knowledge. How do you provide that access in a cost-efficient and sustainable way? Particularly in low-income countries, such as mine in Tanzania, or even rural areas, for example, here in the US, which also experiences great shortages in healthcare as well.

Let’s now turn to F-1 Doctors. What is F-1 Doctors, and how does it assist both international students with a bachelor’s degree from a U.S. college and those who pursued post-secondary education outside the U.S.? [22:08]

F-1 Doctors, as you mentioned, was born earlier this year. There’s a group of us who truly understand what it’s like to go through the entire medical school process as an international student, alone, which is why it’s been so easy to garner support and gain mentors. All of us know how challenging it was when we were doing it. There’s this real true need to give back to those individuals who come after us as well. So it’s basically just a web-based platform or initiative that provides free mentorship to any international student who is considering applying to medical school or to dental school or to residencies here in the U.S., so the whole range of opportunities that are available in the healthcare professional field here in the U.S. We’re also thinking about expanding it to nursing and PA programs, but that’s taking some while, but right now most of our mentors are MD mentors for international students who are on an F-1 visa who are in medical school or in dental school in the U.S.

For the two groups that you mentioned, there’s definitely very different advice or guidance for each group. For the first one, for international students who have gotten their BA here in the U.S., most of us fall into that category. Most of the mentors do. When we have conversations with students, it’s just one-on-one. You schedule a time with a mentor, and it’s basically the mentor, for starters, answering any questions that you have about the process.

I think as mentors, we aren’t knowledgeable about if your GPA’s good enough, or if your MCAT score’s good enough. Those are questions we can’t answer, but it’s more about, “These are the research things that I did. This is the way I tackled volunteering on my application. This is what I feel made me stand out. Not that you have to have the same trajectory, but these are some of the experiences that I had that I can share with you.” For those students, it’s talking to mentors, and on top of that, we also have a list or a resources section on our website. On this resources section, there’s a lot of information for the students about applying to medical school in the U.S., what schools actually accept international students.

At the end of the day, most international students know, or have heard, that the acceptance rate for international students is significantly lower. The reason for that is because only some of the top tier schools in the U.S. will take international students. It’s very easy to conflate those two rates and those two acceptances. Is it because the international students are just not good enough as applicants or need to work significantly harder? Or is it because they’re only allowed to apply to Harvard and Yale and Stanford, which already have really low acceptance rates. So that’s one challenge that’s faced by international students.

The second one is finances. As international students, you don’t have access to federal loans. You have to rely on either scholarship or institutional loans from the institution itself, or private loans, which have really high interest rates and expect you to start paying while you’re in medical school. To alleviate some of those challenges, back to the first group who have done their BA or BS here in the U.S., we have a list on our website of all the medical schools that accept international students and their financial aid policies. That’s one of our top-rated resources because it has all that information in one place. We also have done some webinars in the past that individuals can watch as well, and we also have some really cool partnerships with other organizations to ensure that international students applying and going down this path don’t feel like they’re doing this on their own.

And then for the second group that you mentioned, for individuals who have done their college education elsewhere outside of the United States, for them, it’s definitely particularly challenging because we don’t have a lot of mentors who fall into that category. But what we do have is, on our website, we have an Excel document of postbac programs that accept international students. That is the recommendation that we currently give, because based on all the websites that we’ve seen of medical schools, each one of them says, “We need some sort of U.S. college education.” Some of them will get away with Canadian colleges, but anywhere else, you have to get some transcript or education here in the U.S., and that’s why we have our postbac programs that accept international students.

How many mentors are there in F-1 Doctors, and how many students are mentees? How many students have been assisted by F-1 Doctors? [27:43]

We have over 19 mentors right now. We’ve had quite an exponential growth over the last few months, and all of them are internationals on F-1 status. Maybe some of our attendings might have a green card, but that’s because they came and applied to medical school as an F-1, and they have now transitioned into permanent residency. But so far we had over 200 submissions to connect with a mentor and meet with a mentor. That’s where we’re currently at. Every single day we’re getting a new request.

In the MBA world, there’s been a tremendous push to get business schools STEM-certified, which allows a person on an F-1 visa to stay in the United States and do Optional Professional Training for up to three years. Are medical schools considered a STEM school? [28:45]

I’m not too sure about that entirely. I do know that after your medical degree, you do get the same one-year OPT. I assume that it would fall under the STEM criteria as well. You’d get that extension for two years.

How do you manage the time demands of med school and running F-1 Doctors? [29:42]

It’s definitely challenging to say the least. I think it just comes down to managing time and managing expectations. I think those are the two big things. I like to be quite busy, but at the end of the day, I think it’s important for me to say, okay, I’ve spent three hours working on this website for F-1 Doctors. I really need to stop and take a break from it and actually focus on school and studying and being a doctor.

The second is managing expectations. It’s hard because our entire leadership are all mentors and medical students. It’s important not to expect that everyone will be able to give three hours of their time to this organization because that can be quite a lot for some people, so just being very clear about what you can do on a weekly basis. “Let’s set some goals for this next month and let’s try to achieve these goals, however small they may be.” Even if it’s, let’s just recruit one more mentor, that’s fine, as long as we have a set goal and we meet it.

You mentioned that you want to get an MBA in addition to the MD and the MPH that you already have. How do you see your career evolving post-medical school? [31:17]

I’m still very interested in infectious diseases. That’s at the heart of it all, and for that definitely I have to do internal medicine as residency and fellowship for ID after. That’s always been the goal. With that degree in infectious diseases, the goal is to try to travel home to Tanzania regularly, work there as a physician, and also train other doctors. The MBA comes in when I’m thinking more about hospital-related infections and trying to reduce morbidity and mortality associated with that, and the health administrative tasks that are associated with that. I think that’s where the MBA knowledge comes in, as well as, when I go home, thinking about healthcare administration and access to healthcare in a cost-effective and sustainable manner in rural Tanzania, which is significantly harder to do. It’s a very different application of the MBA. Two very distinct ways that I want to use my MBA is what I’m thinking right now.

What would have liked me to ask you? [32:28]

If it’s okay that I give last-minute advice to students: I think it’s really important to not get carried away in college trying to chase someone else’s path to medical school. That’s something that I truly found myself doing right as an international student. I came in and I knew I wanted to go to medical school, but I didn’t know what that looks like. I was reading that you have to take all these premed requirements and you have to have all these extracurriculars and everything. There were students in my class who had a ton of organizations that they were in, and they were leaders in all these organizations. I thought, that’s how I get into medical school.

But after a while I realized that, at the end of it, it’s all just fluff, right? It has to be stuff that you are truly passionate about or you are truly committed to, that’s a part of who you are. I was doing all these organizations that didn’t really mean much and, at the end of the day, wouldn’t mean much on my application, either. It would just be filling up space. That’s why in my junior year of college, I dropped all my extracurriculars and I said, who is Azan? What is Azan truly passionate about? And at the core of it, he’s just a guy from Tanzania who likes infectious diseases. That’s it. And that’s as simple as it has to be.

But then going off from there and saying, okay, if that’s who I truly am at my core, and that’s what I’m interested in, I should make my application centered around that. Right? So that’s when I joined a research lab doing research, and that’s when I did more global health experiences as well. It all came down to saying, what am I truly passionate about? What do I really care about? And what do I really want to do? It’s important to create the path to medical school for yourself and not get carried away by what others are doing.

Where can listeners learn more about F-1 Doctors? [36:34]

You can go to our website: www.f1doctor.com. The reason it’s called F-1 Doctors is because all of us are international students, and that’s the visa that all of us are on to be here in the United States.

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