“Congratulations, you have been accepted to the MD Class of 2027!” The email that we had worked so hard for finally arrived. The celebration, however, was short-lived, turning into questions of logistics: Where will I live? How do I get there? What about the people I am leaving behind?
As two students from Ontario heading to Newfoundland and Labrador (NL) for medical school – a destination 3,000 kilometres away with a program that accepts just six out-of-province (OOP) students in a class of 90 – dealing with the doubts took a back seat. We packed up, drove or flew across several provinces, and landed in a place with its own culture, quirks and challenges. Here are a few lessons we’ve learned about adjusting to a new place, and what might help other medical learners in a similar situation.
Feeling like an outsider
Megan: I enjoyed growing up in Russell, Ont., but I don’t see myself living there again. I feel little pull to return home – not out of a lack of love for my community but because my roots are spread across the province. My parents are from different areas of Ontario; I didn’t attend the closest university; and they were excited for me to head to NL for medical school. In contrast, many classmates are planning to return to their hometowns, where parents and even grandparents still live. Our priorities after graduation naturally differ, not because one of us cares more, but because our social obligations are shaped by different cultures.
Here, social ties run deep. Go anywhere with a local and they’ll likely meet someone they know. Even after two years, I still feel new, sensed in the quiet guardedness of those unsure if I’ll stay after graduation. I understand it; NL taxpayers fund my seat, and patients entrust me with their stories. That trust means a lot, but I sometimes wonder if I’m seen only as temporary. I may not settle here long-term, yet I’ve tried to give back through volunteering, advocating and contributing to research. Still, jokes about my accent, lack of local knowledge or even my previous degree consistently remind me that I’m “from away.” While intended to be kind, these comments underscores that I wasn’t raised here, and they can tell.
Clinical training challenges
Josheil: “She’s sick.” For many of us, those words might trigger questions about fever, cough, or recent exposures. But in NL, “sick” can mean something entirely different – such as being pregnant or having recently given birth. This is one of many local expressions; more than 70,000 regional terms have been catalogued in the Dictionary of Newfoundland English, shaped by centuries of migration and socioeconomic status, education and religion.
Learning to navigate these dialects has a direct impact on patient care. When physicians understand patients’ dialects, they encourage more active participation in the interview process, resulting in increased patient cooperation and effective medical care. I’ve found that despite thorough histories, I sometimes miss subtle “extra” details that patients share more freely with classmates who sound like them, a rapport that grows naturally from shared culture or dialect. I can’t fault patients for gravitating toward learners with those connections since, back home, my family sought care from a Punjabi-speaking family doctor who tailored her care to our culture, language and lifestyle. These experiences reinforce the value of culturally attuned care. With dialect “translation” resources and clinical experience, I’ve become more comfortable with the lingo; though I’ll still struggle when a patient says “I’m all in” or “I lost my nature.” Such moments remind me that communication, a CanMEDS core competency, depends on empathy, respect and cultural awareness.
Moments of connection offer hope.
Moments of connection offer hope. Meeting preceptors from other provinces who chose to stay shows integration is possible. We bring valuable perspectives shaped by diverse experiences; differences that enrich, not detract from, medical education in NL.
Racialized experience
Josheil: As a Canadian-born child of immigrants, I never felt like I didn’t belong in Ontario. Throughout middle school, high school and university, there were always classmates who looked like me, spoke the same language at home or shared the experience of immigrant families. I never felt I was “representing” my race or ethnicity; I was simply Canadian. However, moving to NL was a culture shock. In a province with a relatively homogenous population, the difference of being from out of province was further magnified by my skin colour and cultural background.
This hypervisibility initially influenced how I carried myself. I censored myself to avoid being perceived as overly sensitive or confirming certain stereotypes. I even asked peers to call me “Josh,” a nickname rarely used outside my family, because it felt easier than hearing my name described as “too difficult” or “too strange.” What seemed like a small adjustment became a way to navigate frequent microaggressions – comments about my “real” origins, questions about a “Canadian name,” or claims that racism doesn’t exist here because “it’s not like the big cities.” Cultural traditions familiar in more diverse regions, like Sikh History Month or Diwali, often were unknown or misunderstood, deepening my sense of disconnection. Over time, I realized that these challenges weren’t just personal obstacles, but rather a reflection of broader gaps. It was time to embrace my differences rather than hide them. I helped to build Beyond the Surface, an initiative that brings equity, diversity and inclusion to the forefront of medical education. Each month, we publish a newsletter that explores medicine and other health-care topics through the lens of social determinants of health to spotlight underrepresented patient experiences and challenge systemic blind spots in medicine. What began as discomfort and hypervisibility became an opportunity to advocate for cultural safety – for myself, other learners and patients.
Growth, learning and takeaways
Megan: What have I learned from these experiences? I’m grateful to have connected with Josheil, other out-of-province (OOP) students and classmates from NL. Additionally, my circle now extends beyond OOP students. Sharing these challenges with classmates from NL has sparked broader understanding. Conversations about home, community and connection, some of which we’ve shared through Faculty of Medicine podcast episodes with learners from Ontario and Prince Edward Island, have been enlightening, fostering collaboration and empathy beyond what I anticipated.
Since I’ll likely move again for residency as my desired specialty is not offered in NL, these lessons in building community and contributing meaningfully in unfamiliar settings feel invaluable. Being “from away” can be a strength, bringing fresh perspectives and ideas that complement those of locals.
These experiences have deepened my empathy for patients who feel like outsiders. The growing immigrant population in St. John’s faces similar challenges of adjustment, and while I can’t fully understand, I can relate to feeling new and learning local norms. The skills I’ve gained – adaptability, perspective-taking and culturally sensitive communication – will guide me throughout my career.
Conclusion
At some point, we’ve all known what it feels like to be an outsider, whether it was moving to a new province, starting a new job or entering a new relationship. Training away from home is both a challenge and a privilege; it means adapting to new people and cultures while gaining the chance to immerse ourselves in communities that shape us into more empathetic physicians. We share these reflections with optimism – things improve when awareness and dialogue grow.
Medical learners who leave home deserve recognition and structured support, as the value of training lies not only in knowledge but in the perspectives we carry forward.
Acknowledgements
We’re grateful to Dr. David Richard Anthony Elcock for his guidance on this article as an OOP faculty mentor, and to our 2027 OOP family—Kathy, Ali, Savi and Jasmin—as well as the 2028s who joined us along the way. Thank you to the faculty, staff, classmates and especially the patients who welcomed us into this province, shared your stories, and saw us for who we are rather than where we come from. Few truly understand this journey, and your support has meant everything. We’ll carry these lessons forward, and to those learning away from home in the years ahead: You belong here, and you’ll be better for it.
