MetaCast

Rhanderson Cardoso: Hello, everyone, and welcome to MetaCast, the podcast of the Meta Analysis Academy. I am honored today to receive a very special guest, Giovanna Salema Pascual, who is coming from Italy to Boston and will share her experiences from growing up in Brazil, moving to Italy for medical school, and now coming here to Boston for observerships, research opportunities, and so much more. I'm honored to have you here today, Giovanna. Thank you so much for joining. Before I pass it over to her, I just want to remind you all about the Meta Analysis Academy.

I want to give a brief explanation about the Meta Analysis Academy. This is a program that teaches you how to do systematic reviews and meta-analyses to transform your careers, to learn how to publish research with autonomy, and to open great opportunities in your career. We do not do publications for our students. We teach you how to do this incredible research. Now, Giovanna, thank you so much for joining.

Giovanna Salema Pascual: Could you please introduce yourself to everyone?

Giovanna Salema Pascual: Thank you so much, Dr. Cardoso. It's a pleasure to be here. It’s really an honor. Thank you for the invitation.

I’m Giovanna. I am from Brasília. I grew up in Brasília, and I’m studying medicine in English at the University of Bologna.

Rhanderson Cardoso: Fantastic. So, tell us a little bit about this decision in your career to go from Brazil to Italy for medical school. Can you tell us why you made that decision? Why Italy? What factors did you consider when making this decision?

Giovanna Salema Pascual: Of course. I really never thought about studying abroad before. I grew up in Brazil and always planned on going to the University of Brasília. But, during the pandemic, I think UnB (University of Brasília) was closed for two entrance exams. So I had already been studying for a while and started to think, “Okay, I really want to move on with my studies. What can I do?” At that time, my mom was living in Europe, and she encouraged me to look for opportunities abroad. Back then, I already spoke English, so she said, "I’m sure there will be opportunities in English here. Let’s take a look." There are a lot of opportunities. It’s amazing how many options there are, most of them in private universities.

One of the things that pushed me toward Italy was that they not only have really good traditional institutions, but they’re also public and have a lower cost compared to others that are equally good but more expensive. During the pandemic, with the University of Brasília delaying admissions and results for almost a year, I found myself with no option but to keep studying. But I didn’t know when things would return to normal, and that encouraged me to look for other options.

Rhanderson Cardoso: It's a crazy time in everyone’s life, of course, but it’s interesting that for some people, like yourself, it totally changed your career path, right? I mean, you were planning to go to the University of Brasília, one of the most traditional medical schools in Brazil, but the pandemic created a barrier. So, what was the process like once you explored this option? Your mom said, "Hey, Giovanna, come to Europe for medical school." What was the admissions process like? Is it different for foreign students versus European students?

Giovanna Salema Pascual: Definitely. My process was quite funny because it was really fast. I started looking into it in June, subscribed in July, took the exam in September, and by October, I was already moving countries and moving my life. So, it was really fast.

They have an exam called the IMAT (International Medical Admissions Test), which is for universities that teach in English. The process is different if you want to study in Italian versus English. The IMAT consists of 60 multiple-choice questions that need to be completed in 100 minutes. It covers general knowledge, logical reasoning, biology (which is heavily tested), chemistry, physics, and math. It’s somewhat similar to ENEM in Brazil.

One thing I liked about the IMAT was that they had a correction factor where every two wrong answers would cancel out one correct answer, just like some exams in Brazil. I was already familiar with that kind of strategy from Brazil. The content wasn’t that different either, except that I had to translate my knowledge into English.

European citizens rank all the universities that teach in English by order of preference, so if their first option doesn’t work out, the second one might, and so on. But non-EU citizens, like myself, must choose one university and apply only to that one, so it’s a bit more competitive.

Rhanderson Cardoso: So, you chose Bologna as your first option?

Giovanna Salema Pascual: Yes, I chose Bologna as my first option. I have European citizenship, so I was able to rank all 12 institutions that teach in English. At Bologna, there are 90 spots, 70 reserved for European citizens and 20 for non-EU citizens. Since I have European citizenship, I had to apply as a European and be counted among the 70 spots. Bologna was my first choice.

Rhanderson Cardoso: Very nice. Do you think having European citizenship was helpful? Did it make the process easier?

Giovanna Salema Pascual: Not necessarily. I’m proud to say I did well on the IMAT, so in my case, it wouldn’t have made a difference, but I do think it’s helpful because European students have more options if they don’t get into their first-choice school. Non-EU students only get one shot at their chosen university. However, I do believe that students from Brazil are very well-prepared for exams like the IMAT, so that was an advantage for me.

Rhanderson Cardoso: Brazil has a strong education system. Speaking of non-EU students, how does the immigration process work after you're accepted to a university in Italy?

Giovanna Salema Pascual: Non-EU students have to go through a pre-enrollment process with the embassy before taking the exam. After being accepted, you apply for a student visa, which must be renewed annually.

Rhanderson Cardoso: Got it. So, you’ve been accepted to the University of Bologna. Can you share a bit about what medical school is like in Italy and at Bologna specifically?

Giovanna Salema Pascual: Sure. A fun fact about the University of Bologna is that it’s the oldest university in the Western world—it dates back to 1088. It’s almost 1,000 years old, which is incredible. Bologna is also a very student-focused city. The entire city feels like a university campus, with university buildings, libraries, and lecture halls everywhere. It creates an amazing environment to study and live in.

At Bologna, the academic year is divided into two semesters. Each semester has three months of lectures, followed by two months dedicated to exams. During the exam period, we don’t have classes, so students can choose when to take their exams within that two-month window. It gives students the flexibility to either spread out their exams or complete them as quickly as possible, depending on their study preferences.

Rhanderson Cardoso: That sounds very different from Brazil. Do you have practical training as well?

Giovanna Salema Pascual: Yes, we have lessons until the very end of medical school, but the amount of practical training in the hospital increases as we progress. By the final year, we spend a lot of time in the hospital, and we also focus on our thesis, which is a big part of the graduation process.

Rhanderson Cardoso: Do you have something equivalent to an internship or sub-internship like we do in Brazil or the U.S.?

Giovanna Salema Pascual: Not exactly. It’s more of a supervised experience. We spend time in the hospital and observe, but it’s not as hands-on as the internato in Brazil. We still have a lot of lessons alongside our practical training.

Rhanderson Cardoso: So, we’ve been talking a lot about the University of Bologna, where Giovanna studies, and I want to take this opportunity to emphasize that the Meta Analysis Academy and MetaCast are not affiliated with the institutions where Giovanna studies or where I work. I didn’t introduce myself in the beginning, but many of you already know me. My name is Rhanderson Cardoso, and I’m a cardiologist here in Boston. This program is not affiliated with the institutions where I currently work either.

Giovanna, what year are you right now in Bologna?

Giovanna Salema Pascual: I just finished my fourth year and am about to begin my fifth year.

Rhanderson Cardoso: Almost done—fifth and sixth year ahead. Let’s talk about your international experiences because you haven’t just gone to Italy. I know you’re very much like a citizen of the world at this point! Let’s talk about your time abroad—your first international experience, which I believe was in England, then Greece, and now Boston. What was your first experience internationally?

Giovanna Salema Pascual: I’ve always learned English in school, and I also attended private English lessons. So, I knew vocabulary and grammar, but what really gave me fluency and confidence in the language was a student exchange I did in Bournemouth, England. I thought I heard a British accent, right? [laughs] That experience really changed my life. Back then, I didn’t know how much it would impact me, but now, looking back, I know I wouldn’t be here today without it. It gave me the fluency and confidence to pursue a medical career in English and to be here today.

Rhanderson Cardoso: How long did you spend in England?

Giovanna Salema Pascual: I spent three weeks in an English school in Bournemouth. We attended school every day, and it was really fun. It was a life-changing experience.

Rhanderson Cardoso: A lot of our students internationally, especially from Brazil, always ask me how to learn English, and doing an exchange program like that is a great way. If you’re in the early days of medical school and have the time, consider doing an exchange or even working during the summer to finance a trip abroad. I once went to Alaska in the summer and met a student from Brazil who was working at a restaurant to finance her international experience and improve her English.

I spent a year in the U.S. when I was 10 or 11, and it was transformative for me as well. So, if you’re in the early stages of your medical career, consider doing something like an exchange program or observership abroad. Even one month in a hospital—whether it’s in Australia, the UK, or the U.S.—can really improve your English and open new doors.

So, after your experience in England, you went back to Brazil, and then you knew how to speak English well. After that came Italy, and then Greece. What was that experience like?

Giovanna Salema Pascual: One great thing about the University of Bologna is that it has so many agreements and strong relationships with universities worldwide. At one point during university, I decided I wanted to explore the world and gain more experience before deciding where I’d want to go for residency.

In Italy, they also have IFMSA (International Federation of Medical Students' Associations), which Brazilian students might know as CISM. You can gather points throughout university, and then you apply and rank among other students to choose a set list of countries where you’d like to go. Usually, you apply for these opportunities in your fourth, fifth, or sixth year. My parents always told me that I had nothing to lose by trying, so I applied in my third year and actually got in. I managed to choose from five countries, and once Greece was an option, I knew that was the one. So, I went to Ioannina, Greece, and spent a month in the neurology department at the university there. I had a wonderful time—I loved neurology, I loved Greece, and the medicine there was very patient-focused. I really enjoyed the experience, and I also got to spend the summer in Greece, which wasn’t bad either! [laughs]

Rhanderson Cardoso: Not a bad side of things at all! So, that was your first experience abroad from Italy. How about your Italian? The medical school is in English, but did you learn Italian? Did you already know Italian before moving to Italy?

Giovanna Salema Pascual: I didn’t know Italian at all before moving to Italy. The only Italian I had been exposed to was when I visited Italy once and from my grandmother, who loves watching Italian TV programs. But I didn’t speak it.

You do need to learn Italian, though. The course is in English from start to finish, but from the second year onwards, you need at least a B1 level in Italian to work in the hospital. Over the years, you gradually improve your language skills, but you need Italian for the hospital experience, and it’s also helpful in daily life.

Rhanderson Cardoso: Do they test your Italian during the admissions process, or is it solely based on the IMAT?

Giovanna Salema Pascual: No, the admissions process is fully based on the IMAT, so you don’t need to know Italian before being accepted. It gives you time to be accepted and then learn the language afterward. The university also offers Italian language courses to help with that.

Rhanderson Cardoso: How did you learn Italian? Was it through those university courses, or did daily life help as well?

Giovanna Salema Pascual: I learned through both. I took Italian language courses offered by the university, but I also learned through daily life—especially when dealing with bureaucratic tasks. Believe it or not, that helps a lot because you have no choice but to learn the language when you need to handle paperwork and communicate with people.

Rhanderson Cardoso: Speaking of international experiences, you’re currently here in Boston, and this is your second time here for observerships or rotations in the United States. Many of our audience members, whether they’re in Brazil, Europe, India, or Pakistan, are interested in coming to the U.S. for observerships or residency. Can you share how you got these opportunities here in Boston, both the first time and now for the second round?

Giovanna Salema Pascual: Of course. The same logic applied as when I went to Greece. I really wanted to experience different parts of the world and gather as much information as possible before making a well-informed decision on where I wanted to do my residency. So, I researched hospitals and doctors, and I know that Boston has world-renowned institutions. I emailed a couple of doctors, introduced myself, and explained my academic and clinical interests, and how their work inspired me. I also explained how the experience would contribute to my career and how I could contribute to their work in some way.

I put all of that into a motivation letter, attached my CV, and got a recommendation letter before reaching out to them. It worked! I know it works for many people, although sometimes it takes longer or less time depending on the situation.

The second time around was easier because my references were now the doctors I had worked with during my first observership. Networking really opens doors, and once you have one experience, it becomes easier because people trust you and are willing to recommend you.

Rhanderson Cardoso: And the first time, you came with a scholarship, right?

Giovanna Salema Pascual: Yes, I came with a scholarship the first time. That’s another great thing about the University of Bologna. They offer a lot of funding for international experiences, whether for internships, observerships, or even to do part of your thesis abroad. I applied for a scholarship that funded most of my costs, including the visa, accommodation, and flight tickets. The only thing I had to cover was food, which I would have already paid for in Italy anyway.

Rhanderson Cardoso: That’s incredible! It sounds like the University of Bologna is a great place for medical school. So, where have you been rotating in neurology, and what has that experience been like?

Giovanna Salema Pascual: Both times, I’ve been in neurology. The first time, in addition to the observership, I was also a research trainee. That was my first real experience with primary research, where I was reviewing patient charts and collecting relevant data. It was a really nice experience.

Now, I’m only doing an observership, also in neurology, at Brigham and Women’s Hospital. I love it! Both experiences have been challenging but in different ways. Now, it definitely helps that I already know people and how the dynamics work, but as I’ve progressed in medical school, I also know more about neurology, and I can take more initiative. I’m more involved in the thought process of diagnosing, and it’s been incredible to be part of that.

Rhanderson Cardoso: That’s fantastic. Why did you choose neurology? What draws you to it?

Giovanna Salema Pascual: Neurology started as a simple interest because I really liked neuroanatomy, but I enjoyed everything in general, so I didn’t know where to start. When I went to Greece, I could apply for four specialties, and one of the departments that accepted me was neurology. I loved the experience and knew after that month that neurology was the right fit for me. It kind of chose me rather than me choosing it.

Rhanderson Cardoso: Great! And have you enjoyed your time here in Boston? Do you like the city?

Giovanna Salema Pascual: I love Boston. I really feel at home here. I love that Boston has everything I like that’s different from Europe, but also has elements I enjoy about Europe. It’s a multicultural city, and it’s beautiful. You get the modern buildings alongside nature—it’s amazing! I feel like there’s never enough time to do everything here.

Rhanderson Cardoso: There really is so much to do in Boston. It's a fantastic city. As we’ve mentioned before on the show, the only downside is the cost of living compared to other cities, but it’s a wonderful place. Lots of parks, public transportation works relatively well, and it’s a great combination of historic and modern elements. The education here is obviously world-class. So, these rotations—were they one-month rotations both times?

Giovanna Salema Pascual: No, last year was six weeks, and this year it’s five weeks. So, a little more than a month each time.

Rhanderson Cardoso: And do you think that’s enough time to leave a good impression, for people to get to know you, and for you to feel comfortable helping out in the rotation?

Giovanna Salema Pascual: I think so. One of the things I like the most about being here is the teaching culture they have in the hospital. The doctors and residents always want to teach you. If you show that you want to learn and you’re paying attention, they’re more than willing to teach. Then, you can go home, study what you’ve seen, and come back the next day even more prepared. So, I think five to six weeks is more than enough time to leave a good impression, especially with how incredible the teaching is here.

Rhanderson Cardoso: What’s your role as an observer? How do you contribute, and what activities do you participate in as part of your observership?

Giovanna Salema Pascual: It varies a lot, and it depends on the attending physician and the residents you’re with that week, as well as how much they know you and trust you. In theory, observers are mostly meant to just observe and shadow the doctors, but as they get to know you and feel more comfortable, they might let you take more initiative and responsibility. You can take part in the patient examination and contribute to the thought process—like gathering the patient’s medical history, performing the physical exam, and thinking about how the findings lead to certain diagnoses.

So, while your official role is an observer, you can gradually get involved in more aspects of patient care depending on how well you prove yourself and build trust with the team.

Rhanderson Cardoso: That’s a great description of what observers should be doing. As an observer, you can be present when a history is taken, present the case during rounds, and help formulate a treatment plan. You can still be part of the team even as an observer, and that can ultimately help you secure letters of recommendation if you decide to apply for residency in the U.S., for example.

Don’t be shy as an observer. Obviously, you have to follow the rules of the observership, but you can engage with the team, ask questions, participate in rounds, present cases, and discuss the plan of action with the residents and attending physicians. The more engaged and involved you are, the better your experience will be.

Giovanna Salema Pascual: Exactly.

Rhanderson Cardoso: So, Giovanna, you’re going back to Italy soon, and you have two more years of medical school. What’s the plan after that, now that you’ve had so many international opportunities—from growing up in Brazil to studying in Italy and gaining experiences around the world? What’s next for you?

Giovanna Salema Pascual: These experiences have really helped me decide that I want to do my residency in the U.S. I absolutely love the teaching culture here, and it’s incredibly inspiring. I would love to be part of that kind of education. So, my plan is to keep building my CV, gaining experience, doing more research, and expanding my network so that I can apply for residency here in the future.

Rhanderson Cardoso: That’s fantastic! By the way, everyone, Giovanna is a teaching assistant in the Meta Analysis Academy. Right before we started recording, she mentioned that she’s currently working on six meta-analyses. So, we’ll soon be seeing a lot of publications from Giovanna Salema Pascual, which will surely help you when it’s time to apply for residency in the U.S.

What’s the culture like for Italian medical students after they graduate? Do most of them stay in Italy or Europe, or do they look at options like the U.S.?

Giovanna Salema Pascual: Most of them stay in Europe. The top destinations for Italian graduates are usually Germany, Switzerland, and Austria. Some of my colleagues are also interested in places like Denmark and Finland. Many stay in Italy, but a lot of students move to other European countries. At least at the University of Bologna, going to the U.S. for residency isn’t very common.

Rhanderson Cardoso: Is that right? And how does it work to get into residency in Italy for those who decide to stay? Is there a single admission test like in Brazil, or how does the process work?

Giovanna Salema Pascual: There’s an admission test, and your grades throughout medical school are also very important. If you plan to stay in Italy for residency, you have to keep that in mind from the very beginning of medical school, making sure you’re building up your grades for a strong application. The final test is also a big part of the process.

Rhanderson Cardoso: I’ve heard that exams in Italy are oral exams. Is that true?

Giovanna Salema Pascual: Yes, most exams in Italy are oral exams. The great majority of them are.

Rhanderson Cardoso: One-on-one with the professor?

Giovanna Salema Pascual: Yes, one-on-one with the professor and sometimes with other students watching.

Rhanderson Cardoso: Wow, no pressure! [laughs]

Giovanna Salema Pascual: [laughs] Yeah, it’s definitely challenging, but I’ve developed a good study method that helps me feel more confident and less nervous. In the beginning, it was overwhelming, but now I’m used to it.

Rhanderson Cardoso: That’s great! What are the opportunities like for Italian medical graduates to do their residency in other European countries? Do they have any advantages, or does each country have its own system?

Giovanna Salema Pascual: A great thing about graduating from an Italian medical school is that you get a diploma that is valid throughout Europe. So, yes, you can move to another European country to practice medicine without having to take another licensing exam. However, if the language is different, like German, you do have to go through the language evaluation process.

Rhanderson Cardoso: So if you graduate from medical school in Italy, you don’t need to take an additional test to work in another EU country, but you do need to pass a language exam if it’s required?

Giovanna Salema Pascual: Exactly. Once you pass the language evaluation, you can apply for jobs or residency positions in countries like Germany, Switzerland, and Austria. The process usually involves interviews rather than exams, and residency is considered more like a job that you’re applying for.

Rhanderson Cardoso: Are medical specialties valid between EU countries as well? For example, if you’re a pediatrician in Italy, can you move to Germany and work as a pediatrician without further testing?

Giovanna Salema Pascual: I believe so, but I’m not 100% sure. The language evaluation would still be required, but I think once you’re a specialist in one EU country, your credentials would be recognized in others.

Rhanderson Cardoso: That’s interesting. It’s different in the Americas, where each country has its own system. For example, if you did medical school in Argentina, you’d have to take a test to practice in Brazil, and if you studied in Brazil, you’d have to take a test to practice in the U.S.. In the EU, it sounds like there’s more fluidity between countries.

What are you going to miss most about Europe? You said you like Boston because it has some features you enjoy about Europe. When you’re done in Europe and come to the U.S. for a neurology residency, what will you miss the most?

Giovanna Salema Pascual: I think I’ll miss the lifestyle in Europe. It’s more laid back, and you walk a lot. Everything feels local—there’s a lot of nature, and the food is often locally produced. Everything is within the neighborhood, which I really like. But I’m happy to know that everything in Europe is just a short flight away from Boston. I think that’s another great thing about Boston—it’s positioned so well globally that in just 7 or 8 hours, I can be back in Europe.

Rhanderson Cardoso: That’s true. Boston definitely has a European vibe to it. It’s a big city, but certain neighborhoods, like Cambridge, feel like small cities within a larger metropolis.

Rhanderson Cardoso: What’s the cost of living like in Italy compared to Brazil or the United States, in terms of rent, food, and other expenses?

Giovanna Salema Pascual: Bologna specifically is quite expensive, especially because it’s a small city with more students than available housing. So, rent can be high compared to other parts of Italy and Europe. However, compared to Brasília, where I grew up, I’d say it’s somewhat cheaper, particularly in terms of rent. And it’s definitely a lot cheaper than the U.S.

In terms of food, I don’t find a huge difference between Italy and Brazil. Eating out at restaurants and grocery shopping feels pretty similar in price. But rent in Boston is on another level—it’s very expensive here.

Rhanderson Cardoso: Yes, rent in Boston is definitely out of control. A one-bedroom apartment near the major hospitals like Brigham or Massachusetts General can cost between $2,500 and $3,000 a month. How does rent compare in Bologna?

Giovanna Salema Pascual: In Bologna, for a one-bedroom apartment, you can find something in the city center for around €1,000 per month, which is much more affordable than Boston.

Rhanderson Cardoso: That’s amazing compared to what we pay here. And you said Bologna is small, so even if you live in the center, you’re still close to everything, right?

Giovanna Salema Pascual: Yes, Bologna is very small. I live in the center, and it’s only a 15-minute walk to the hospital. Everything is close by, so it’s really convenient.

Rhanderson Cardoso: That’s incredible! It must be amazing to be able to live in such a historic city with a world-class institution like the University of Bologna. Are you going to miss Bologna when you move?

Giovanna Salema Pascual: I will. It’s amazing to be in a place where, if I’m bored at home, I can just go for a walk and see medieval buildings and so much history. There’s always something to do and so much to learn from the city itself. I’ll definitely miss that.

Rhanderson Cardoso: On a personal note, how do you balance all of your responsibilities? You’re studying for school, doing research, working as a teaching assistant in the Meta Analysis Academy, and managing personal obligations. How do you juggle all of these things?

Giovanna Salema Pascual: It’s hard, not going to lie! It takes a lot of discipline, but I like to wake up early, which helps me make the most of my day. I’m also very organized. I make lists and schedules to keep track of everything I need to do, so I don’t forget anything. There’s always a lot to do, and everything feels important—school, research, tutoring, personal life—so I have to stay on top of it all.

I also make sure to take care of myself. I go to the gym regularly, and I cook my own meals so I can eat healthily. I cook Brazilian food everywhere I go! I also make time to talk to my family and spend time with my friends and boyfriend. Having that balance helps me stay motivated. I’m very disciplined, and that’s what keeps me going.

Rhanderson Cardoso: You mentioned that you like to cook, and I even got a cake that you made as a gift! Thank you for that—very nice! [laughs]

Giovanna Salema Pascual: [laughs] Yes, I love to cook!

Rhanderson Cardoso: Do you get to visit your family in Brazil and Switzerland often?

Giovanna Salema Pascual: I’m very lucky and privileged to have my mom close to me. She lives in Switzerland, so I see her every couple of months, sometimes even every month. But my dad and other family members in Brazil, I only get to see them once a year, maybe every 10 months or so. It’s hard being away from them, but keeping busy helps. Bologna has so much going on with my studies and work, so that keeps my mind occupied.

One great thing about Bologna is that it’s such a central location in Europe. There are lots of trains, buses, and flights to other parts of Europe, so I try to travel and explore whenever I can. That also helps with feeling homesick.

Rhanderson Cardoso: That’s awesome. After hearing all of this, I’m sure listeners are going to want to move to Bologna! By the way, for those who are interested, the registrations for the IMAT open on September 2nd, and the exam will likely be mid to late September. So, for anyone interested in studying in Italy, keep that in mind!

Giovanna Salema Pascual: Yes, that’s right!

Rhanderson Cardoso: Let’s all go to Bologna—it sounds incredible!

Giovanna Salema Pascual: [laughs] You definitely should come and visit!

Rhanderson Cardoso: I’d love to! Actually, I’m going to Europe for the first time tomorrow, right after we finish recording this podcast. I’ll be attending the European Society of Cardiology conference, so I’m really excited about that.

You mentioned earlier that you want to come to the U.S. because of the teaching culture here, where teaching is integrated into everything on rounds. And I know you’ve also taken on an important role in the Meta Analysis Academy, helping us build our community and teach students. Do you see education as a significant part of your career going forward? Do you want to stay in academic medicine and become an educator?

Giovanna Salema Pascual: Absolutely. I’ve realized that I only truly learn something when I teach it to someone else. That’s when the information really sticks. And I’ve been so inspired and grateful for all the people who have taught me along the way, both here in Boston and in Bologna. I would love to pay that forward and be involved in education as I continue my career. It’s something I really enjoy.

Rhanderson Cardoso: That’s great to hear. Education is so important, especially in academic medicine, where teaching is such a big part of the culture. It’s something that can really set you apart when applying for residency or fellowship in the U.S. Having teaching experience on your CV, like being a tutor in medical school or participating in programs like the Meta Analysis Academy, can make a big difference. Make sure your letters of recommendation highlight that too!

So, have you started preparing for the USMLEs yet?

Giovanna Salema Pascual: Yes, I’m currently studying for Step 1. It’s definitely challenging to balance studying for Step 1 with all my other responsibilities—university, research, and the observership—but I find that studying for Step 1 is actually helping me with other aspects of my medical education. The content is very relevant to what we see in clinical practice, so it’s been a useful experience overall.

Rhanderson Cardoso: It’s true that everyone thinks it’s harder for them because of their individual situation—whether it’s balancing an internship, residency, or something else—but it’s really busy for all of us! I work full-time as a cardiologist, and I still manage to run the Meta Analysis Academy in my free time. You’re studying for Step 1, doing an observership, taking exams in school, working on research, and you’re a teaching assistant too! Life is just busy. I don’t know how you still find time to prepare your own meals, but it sounds like discipline is key.

Giovanna Salema Pascual: [laughs] Yes, it’s all about discipline. That’s what keeps me going. I don’t think I’d be able to get through my day if I didn’t eat my rice and beans!

Rhanderson Cardoso: [laughs] Very good! Well, Giovanna, it’s been an absolute pleasure to have you here on the podcast. I want to thank you again for all the amazing work you’ve done as a teaching assistant in the Meta Analysis Academy, and I’m excited to see what’s next for you in your career.

Before we wrap up, do you have any final words of advice for listeners who are inspired by your story? Maybe they’re thinking about going to medical school in Italy, pursuing international observerships, or coming to Boston like you did. What would you say to them?

Giovanna Salema Pascual: I would say that the world is full of opportunities, and sometimes we focus too much on the place where we grew up. But the world is out there for us to explore. You just need to try. The more you try, the more doors will open. My experiences so far have enriched not only my professional life but also my personal life. I’ve met so many people, learned from different cultures, and expanded my horizons. So, my advice is to go for it—explore as many opportunities as possible, and don’t be afraid to step out of your comfort zone.

Rhanderson Cardoso: That’s great advice, and it’s so true. You don’t need to be restricted by your local opportunities or environment. Today, with the way the world is connected, your environment can be global. You can interact with incredible people like Giovanna, join international communities, or participate in programs like the Meta Analysis Academy.

I spoke to a student from a small town in northern Brazil recently, and she’s now publishing papers with colleagues from São Paulo and other major cities. These opportunities might not have been visible to her before, but now they’re opening up because of the global connections we can make.

Giovanna Salema Pascual: Exactly! One of the things I love about the Meta Analysis Academy is how diverse it is. Last year, we had about 50 students from all over the world, and they were at different stages of their medical careers. It was such a rich exchange of perspectives—not just geographically, but also in terms of career stages. It was an amazing learning experience.

Rhanderson Cardoso: Absolutely. I did a live stream earlier today with a student from Pakistan who wants to do ophthalmology in the U.S. She’s working with ophthalmologists from Iowa and São Paulo, which shows how international connections can really expand your opportunities.

So, to wrap up, I want to thank Giovanna once again for joining us today. I also want to invite all of you listening to check out other episodes of MetaCast. If you speak Portuguese, we have episodes in Portuguese, and of course, we have multiple episodes in English as well. Here on MetaCast, we share the stories of individuals who have excelled in their training and careers, like Giovanna, who came from Brazil, went to medical school in Italy, and gained incredible international experiences in observerships and electives.

Make sure to subscribe to our YouTube channel and follow us on Instagram. And if you want to learn how to publish high-quality research and advance your career, join the next edition of the Meta Analysis Academy. We have a waitlist, or registrations may be open depending on when you’re listening to this episode, so stay tuned for the next edition.

Giovanna, thank you so much for joining us today. It was a pleasure!

Giovanna Salema Pascual: Thank you so much, Dr. Cardoso. It was amazing to be here. Thank you for the opportunity!

Rhanderson Cardoso: Thank you! See you all later. Bye-bye!