This interview is part of the series, Pathways to Practice: Stories from Underserved in Medicine, which features current residents, fellows, and recent graduates sharing their personal journeys – from formative experiences before medical school to the realities of being in their residency and/or fellowship programs. Each story highlights the moments, mentors, and motivations that led them to choose graduate medical education (GME) programs focused on medically underserved areas. Through these reflections, interviewees explore how their backgrounds and clinical education and training shaped their commitment to providing high-quality health care for all and influenced the paths they plan to pursue in practice.
Dr. Zakaria Alagha completed his internal medicine residency at Marshall University School of Medicine in West Virginia. Having trained in resource-limited environments and underserved communities, he has distinguished himself as a clinician, educator, and researcher committed to advancing health equity. As he continues his education/training and career in pulmonary and critical care medicine, Dr. Alagha aims to expand educational opportunities, mentor future physicians, and improve access to high-quality care for underserved populations in the US and internationally.
ACGME: Tell us about your journey and how it led you to where you are today, including about your medical school and residency or fellowship.
Alagha: My journey began in an environment marked by adversity, studying by candlelight through frequent power outages and driven by an unshakeable conviction that medicine was my calling and that serving others in their darkest moments was my purpose. That foundation carried me across continents and into an internal medicine residency at Marshall University, where I have continued to grow as a clinician, educator, and researcher. Pursuing residency in the US meant simultaneously working, studying, and supporting family members through their own crises, a balance that demanded resilience, perseverance, and unwavering focus.
Background and Early Influences
ACGME: How did your background and early experiences help shape your interest in medicine and your understanding of health care disparities, especially in underserved areas?
Dr. Alagha: Growing up and training in an environment where resources were scarce and access to quality care was never guaranteed taught me that geography, poverty, and conflict can determine whether a patient lives or dies, long before I ever set foot in a US training program. I treated patients in my home country who had no alternatives and no advocates, and I watched family members navigate a fragmented, under-resourced system firsthand, experiences that became the moral foundation of my identity as a physician. Those years instilled in me a lifelong responsibility to pay forward every opportunity I have been given, to the mentors who believed in me, to the underserved communities that shaped me, and to the trainees now walking the same difficult path I once walked.
Choosing a GME Program
ACGME: When it came time to choose a residency or fellowship program, what inspired you to select a program focused on underserved areas, and which aspects of the program aligned with your goals or values?
Alagha: Having trained in resource-limited settings in my home country, I chose an underserved program not despite its constraints, but because of them. I already understood that the skills forged in these environments are among the most transferable a physician can develop and are directly applicable to communities like the ones I came from. Some assume that choosing an underserved program means sacrificing professional growth, but my experience proved the opposite: I secured a grant for simulation-based education in resource-limited programs, and was selected as a judge for both the CHEST (American College of Chest Physicians) and American College of Physicians national competitions. Additionally, I received my institution’s Annual Award for Excellence in Research in recognition of my scholarly contributions. Beyond that, I became the first resident in my program’s history to serve as an editor on the CHEST Journal Editorial Board, a distinction that reflects not the prestige of my zip code, but the investment of a program that refused to place limits on what its residents could achieve. These opportunities did not come despite being in an underserved program; they emerged because of it, and because a community that has been overlooked deserves physicians who are fully invested in its care.
Experiences During Residency/Fellowship
ACGME: Can you share some of the most meaningful challenges and lessons from your residency/fellowship program working in underserved communities, as well as how they have influenced the kind of physician you are becoming?
Alagha: One night during my residency at Marshall remains etched in my memory. A pregnant patient coded and rapidly developed multiorgan failure, and I led an extraordinary coordinated response alongside nurses, residents, fellows, and other subspecialities. Every member of the team worked through the night with one singular purpose: to save two lives. It was the kind of night that tests everything – clinical judgment, calmness under pressure, leadership without ego, and the willingness to push through exhaustion because giving up was never an option. By morning, both mother and baby had survived, and I understood more clearly than ever what underserved medicine at its best looks like: a leader who unites a community of caregivers around their patients and refuses, no matter the odds, to let them down.
At the same time, I navigated profound personal loss and family hardship while simultaneously leading the Research Committee, producing the largest publication output in my program’s history, and earning recognition at both the local and national levels, a testament to what is possible when resilience meets purpose and a community invests in its physicians.
ACGME: What unique skills or insights have you developed through your residency program that you might not have gained elsewhere?
Alagha: Teaching medical students became one of the most transformative dimensions of my training: I mentored medical students; developed resident-led teaching modules; delivered pulmonary board review sessions; and was selected as an educator for the ATS Medical Student Boot Camp. I also served as an editor on the CHEST Journal Editorial Board and as a peer reviewer for other leading journals. These are opportunities often perceived as exclusive to larger academic institutions, yet they demonstrate that a commitment to advancing medical education in underserved and resource-limited settings and the pursuit of academic excellence are not mutually exclusive. Rather, they can complement and strengthen one another.
Looking Ahead
ACGME: What does your future in medicine look like? Can you share the kind of difference you hope to make in underserved communities and any advice you have for physician learners considering similar paths?
Alagha: I aspire to build a career as a pulmonary and critical care physician-scientist and clinician-educator, combining clinical excellence, impactful research, and medical education. I plan to expand the simulation-based education grant initiative I helped develop, continue mentoring residents committed to health equity, and build educational programs that reach physicians working in resource-limited settings both in the US and internationally, including in my home country. Above all, my goal is to give back through meaningful scholarship, teaching, and mentorship, making the same lasting difference in others’ careers that my mentors made in mine.
ACGME: What are important considerations for GME programs to help prepare residents and fellows for practice in underserved communities?
Alagha: GME programs in underserved communities must go beyond clinical preparation and actively cultivate physicians who understand the social, structural, and systemic forces shaping their patients’ lives, embedding health equity, cultural humility, and advocacy into the curriculum from day one. Programs must also invest in building research infrastructure and teaching opportunities that are genuinely accessible to learners from all backgrounds, so that scholarly growth is not a privilege reserved for those at well-resourced institutions. Above all, programs must invest in their residents through mentorship, leadership development, and wellness support, empowering them not only to serve underserved communities but also to remain, lead, and create lasting change.
In Closing
ACGME: Is there anything else you would like to add?
Alagha: None of this would have been possible without the unwavering support of my parents and siblings, my uncle’s steadfast belief in me, and the program directors and mentors at Marshall University who recognized my potential and invested in my growth. Through years of hardship, loss, and sacrifice, my journey has given me something invaluable: a clear sense of purpose. Becoming a father has deepened that purpose and strengthened my commitment to building a future where underserved communities, including the one I come from, have access to exceptional medical care and dedicated physicians. This is more than a personal aspiration; it is a mission I have already begun pursuing and one I intend to carry throughout my career.
If you are in your last year of residency/fellowship or a recent graduate serving in a rural or underserved area, and would like to be featured in a future post in this series, email underserved@acgme.org to share what you’re doing. Visit the Rural and Underserved GME section of the ACGME website to learn more about the ACGME’s work in this area.