An Unconventional Path to MD/PhD

Jake Khoussine
9 min readOct 27, 2022

Every premedical student should take a gap year. The medical school and MD/PhD training paths create a false perception that you might forget all the science prerequisites if you veer off course. However, I learned more valuable information during a gap year away from academia than any prerequisite course taught me, and I believe it made me a better medical student and future physician-scientist.

There’s many reasons you might consider taking a gap year, especially if you’re pursuing MD/PhD: 1) you want more research experience, 2) you don’t get accepted, 3) you need time off, 4) you crave life experience.

Each reason has its own merits and motivations, yet they all offer an opportunity for growth and maturity. What makes you an excellent physician is not your knowledge of basic biochemistry. I majored in biochemistry, and I know this to be true. Your ability to extract knowledge from your environment and apply it to solve problems creatively is more important. Your capacity to relate with diverse people and work collaboratively towards a goal are valuable skills for both physicians and scientists.

An unconventional approach to taking a gap year

I found out about MD/PhD programs in my Junior year of college, and although I had started research as a Sophomore, I still felt unprepared to apply competitively. With urgency, I pursued a summer research program to supplement my experience and worked hard to prepare a strong MD/PhD application. I didn’t want to take time off; I had a schedule to keep. I was in a hurry to get through to the next stage. Everything was a hustle. I remember laying wide-eyed and sleepless at night writing essays and practicing interviews in my head. I progressed through each phase of the MD/PhD application and received invitations to interview. I was on a mission with steadfast focus.

I applied in the 2016–17 admissions cycle, which meant I had to travel in person to all my interviews. I was booking flights to New Haven, Madison, St. Louis, and Denver, while trying to stay afloat in a pesky physics lab that I had been putting off. Practicing for interviews in the mirror of hotel rooms, I was telling myself and about myself. I was eager and prepared to interview. Maybe too eager.

I’ll never forget when a program director commented awkwardly that it was such a surprise to see a student from the University of Oklahoma interviewing for their MD/PhD program — “Oh, wow! We don’t see students from there…”. Already feeling small in the shadow of ivory towers, my confidence was hurt when the director then insinuated in front of other interviewees that I made it there because I’m handsome. To compensate, I tried too hard to make a good impression. I wasn’t acting naturally, and I shorted myself as a result.

I found my program fit, though. An awesome program with kind people who were passionate about science and offered incredible opportunities for personal and professional growth. From my experience, there is a gut-feeling effect that comes into play when deciding on which program to select. I vividly remember the day I received a phone call from the program director at my top choice. It was 3 days before Christmas. I nearly accepted on the spot.

After all my hard work, dedication, and sacrifice, it paid off. I told my father the good news on Christmas day — a Moroccan immigrant who has worked diligently at McDonalds since arriving in the United States. He asked me, with tears in his eyes, “the one that’s paid for???”, before leaving the room to hide his emotion. The memory still makes me cry.

My family never really understood what it meant to do an MD/PhD, but they were proud. I was proud. I spent the remainder of my last semester of college at a different speed. I downshifted and let the physics lab disappear from my concern. It would all work out. To celebrate my acceptance, I asked my father to take a trip with me to Morocco to visit our family. I hadn’t returned in many years — I was too busy. With my priorities in check and feeling stress free, it was a joy to see the homeland with a fresh perspective and in full embrace of the moment.

I went to Morocco in March 2017. I had not yet formally accepted my position in the MD/PhD program, which I intended to do after the second-look weekend in April. However, while staying in Morocco and spending time with my family, I was struck with a deep feeling of imposter syndrome. I couldn’t speak Arabic beyond counting numbers and greeting, so I smiled and nodded my head in family conversations. The homeland was beautiful. The people were warm and welcoming. So many people looked like me. Despite being half Moroccan, I felt distanced from this side of me, and yet, I was about to spend the next 7–8 years being busy once again.

I was sitting in a café by a manicured park sipping espresso when I came up with the plan: I’ll find a research opportunity and make a pitch to the MD/PhD program to allow me to take a year off before starting–a deferral of my acceptance. Do people do that? I wrote to an MD/PhD student and dear friend at my future program for encouragement. “You won’t know, unless you ask”, he advised me.

When I arrived at my second-look weekend, I was nervous. I felt so grateful to have been offered an opportunity to pursue my dream of becoming a physician-scientist at a top-notch institution, and I was asking to delay that acceptance. What nerve! I had already found a potential research mentor in Morocco, and my pitch was compelling. I practiced this one in the mirror, too. While speaking with the program directors, I was flooded with a contentment that is hard to convey; a stark contrast from some of my earlier experiences on the interview trail. They were going to support me on this adventure. My spot would be reserved for the following year on the condition that I provide updates on my research and write about how this experience would forward my career goals as a physician-scientist. I agreed without hesitation. The sun was shining especially bright on that crisp, cold morning in Madison. I still remember exactly where I stood as I told all my people.

The best part, however, was yet to come.

A gap year should be a time for personal growth beyond the academic routine

If you stay in academia long enough, lecture-based learning begins to have diminishing returns. As a student, you find your own methods of learning. For me, in-person lectures with professors who read from slides and lacked enthusiasm was the last place I wanted to be. I was ready to learn through experience, experimentation, and failure — lessons from the research laboratory.

In Fall 2017, I arrived in Casablanca and traveled to the nearby city of Mohammedia, where I would live for the next year with a suitcase filled with more books than clothes. I carried a pocket guide to Moroccan Arabic everywhere I went. The most basic encounters with family and strangers alike were challenging to navigate. I’m thankful that I knew how to speak numbers and perform arithmetic, otherwise I’m sure I would have been scammed at the markets. Still, I had to build the courage to look like a trying fool most of the time and be dependent on my cousin to get accustomed. “Aren’t you Moroccan?”, I would be asked incredulously when trying to give directions to my taxi driver. For the first 4 months, I struggled to navigate the streets on my own, and it started to take a toll on my mind.

In months 5–6, I experienced my first panic attacks. As a premedical student, you’d think I’d be able to recognize the physical symptoms of anxiety: palpitations, racing thoughts, restlessness, trembling, fatigue, and a feeling of impending doom. When it’s happening to oneself for the first time, it’s elusive to recognize. I thought I was seriously sick. I tried to rationalize my symptoms through the most unlikely explanations. For example, given the humid climate, I believed that there was black mold growing in my apartment and that I had been inhaling toxins. Why else would my heart be beating so hard and fast? From insomniac nights to waking in cold sweats, I now understand what it means to feel impending doom–as hyperbolic as that may seem. I went to a local doctor with my hypotheses, and I was prescribed propranolol, a beta-blocker used to slow heart rate commonly for performance anxiety.

After accepting that I was indeed suffering from anxiety due to my inability to express myself, I started to turn the corner. There was something about being affirmed that helped me push through the cognitive block. Instead of doom scrolling prevalence of black mold intoxications, I spent my time investing in self-education about anxiety and strategies to overcome it. It took time, but by month 7, I was ready for the next phase.

To accomplish the requirement that I conduct research during my gap year, I moved to the city of Tangier and rented an AirBnB apartment for a month. A new city, a fresh start. Sometimes changing your environment can accelerate the start of a new chapter. My Arabic was improving, and I could travel alone without much issue. Communicating in science was a whole different game, but fortunately, the scientists spoke English…and French, and Spanish. They taught me the basic computer programming required for bioinformatic analysis of human genomic data — yet another language. I was fascinated endlessly. I learned to conduct sequencing pipelines for analyzing RNA seq data from tissue samples. I also took advantage of the close proximity of Tangier and Spain to ride the ferry across the Strait of Gibraltar to the Spanish port city of Algeciras. Thankfully, I speak Spanish, providing me with intermediate relief of my self-expression problems.

A mural in Algeciras that resonated with me: Mama, QUIERO SER ARTISTA

You learn so much about communication when you cannot rely on verbal fluency. The body language, gestures, and facial expressions tell so much of the story. As a medical student caring for patients in the clinic and hospital, I frequently rely on the skills I gained during this time to improve my interactions with patients. You might not always have the answer to a question or concern when a patient presents a problem, but your ability to find the answer and convey competence and humility goes a long way in establishing rapport.

The MD/PhD path is a long journey; the rush is an illusion.

Conceiving this illusion is easier said than done. As an undergraduate, I was relentless in my pursuit of a medical career. Strategizing for imaginary possibilities exhausted me. “Learning from the streets”, as my cousin put it, gave me a new framework to approach the next stage of my training. After living in Morocco for a year, I was more passionate than ever about becoming a physician-scientist. My past concerns for the uncertain future seemed silly. I learned to take myself less seriously — granted this is a work in progress — and I felt more connected to the world. I popped my academic bubble and lived among people who had never stepped foot in a high school, let alone a college campus. They were brilliant nonetheless.

Whether you choose to spend your gap year living in a foreign country or move to a different city, I believe the potential for growth is the same. It’s the uprooting and repotting that creates room for growth. In another post, I will discuss the advantages of taking a gap year for boosting research experience, as I believe pursuing post-bacc research for 1–2 years is an excellent way to determine whether research is a good fit, gain significant research experience, and explore new perspectives. Here, I wanted to open up about my personal experiences to share my story, rather than only giving you platitudes and advice. I hope you find this approach valuable. You have to find your own path and taking your time to enjoy the ride is a crucial piece of the puzzle. Asking good questions, seeking coaches and mentors, and increasing the surface area for serendipity in your life are major keys for defining that path.

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Jake Khoussine

I’m a first generation student in my 5th year of MD/PhD training. This is everything I wish I knew earlier. I hope you find it helpful, feel free to reach out.