Monday, January 30, 2017

Caribbean medical schools: A look inside

Did you know that several Caribbean medical schools provide postgraduate premed courses so students can complete their science requirements? At least one school’s nearly year-long premed curriculum includes 8 hours per day of classroom work, rudimentary general chemistry and organic labs, and a physics lab with 40-year-old equipment. The fee is more than $30,000 cash, no loans. That's a lot to pay for courses that are not accredited and credits transferable only to other Caribbean schools.

The goal of these premed programs is to prepare students to take the Medical College Admission Test (MCAT). However, some schools require only that applicants take the MCAT but do not reject anyone on the basis of their scores.

A former student said, “Little did I know that a [Caribbean school] acceptance was the equivalent of a lottery ticket. They actually attempted to weed us out of the small (and unaccredited) pre-med class! It took me a month to figure it out.” One of his professors told him the administration said not to pass everyone in the premed course into the first year of medical school.

He struggled through the premed requirements and wound up at a different school. The dean at that school spoke to the students about USMLE testing and what to expect in the clinical years. Many times during the talk, that dean referred to the school’s “top students” in a way which implied that only the best students were likely to match to a residency position.

Another school administrator told him that some residency programs would not even look at his application if there was an F on his transcript. While most program directors would probably verify that statement, it was not widely known among the students at his medical school. Some had even failed a course but were still planning to become surgeons.

Regarding his struggles in the second year of medical school, the student said the volume of material was overwhelming, everyone in his class was stressed, and approximately one-third had dropped out. He observed that students who were doing well were “type A personalities who had some measure of prior academic success…and could make it through any US or Canadian program with ease.”

He barely made it through the first year with mostly C grades. During his second year he dropped two courses and had to repeat them.

After eventually withdrawing from that school, he applied to another and was turned down.

He warned that those who are thinking about going to school in the Caribbean don’t understand how many don’t make it through.

Dropouts and accurate figures on what percentage of each graduating class passes all USMLE steps and matches to a residency program are unknown.

Meanwhile tuition debt keeps accruing and doesn't go away. The student has over $200,000 to pay off and will be doing so without the benefit of a physician's income. He is now trying to get a job related to his undergraduate major—business.

Regarding the offshore medical school experience, the student had the following observations:

The schools accept many students who they know will not make it through to fill up the class and make a lot of money in the process.

I didn’t find the material in medical school to be all that difficult; it’s the volume of the material and the time constraints that are the problem.

I could not figure out why my studying was only yielding C's when some people were getting the A's and B's. I'm starting to believe people are born smart.

I am not a good test-taker. I make the process harder than it is. The right answer might stare me in the face but I'll always second guess it.

I was informed that residency programs look at more than STEP scores. I was actually under the impression that no matter what red flags I had on my transcript, my STEP scores would decide my future, but I was told by other students that residency programs will look at pre-clinical grades and I even heard from one student that an IM program asked for college transcripts! If that is the case, I would never stand a chance.

I wanted to be a primary care physician. Was all this stress worth it to go into primary care?

I keep reading that the match will continue to get harder and harder.

I have blogged about the decreasing number of residency positions available for international medical graduates.

Despite the recent ban on immigrants from certain countries, I do not expect the situation to change much for US citizen IMGs.

If it comes to a decision about whether to attend an offshore school or not, do your homework. Talk to people who have been there. It's not all palm tress and sunsets.


Anonymous said...

Sounds like Trump University has a medical school division, in the Caribbean...

Then again, truth is stranger than fiction.

Anonymous said...

Interestingly, some Caribbean schools are advertising in Latin America. I've seen ads targeting prospective students in Brazil and Chile.

As you might expect, these ads never mentioned the colossal tuition rates, employment prospects or the fact that instruction is in English. From the story you recounted, I presume these schools would have no qualms taking in students with insufficient English proficiency. Learning medicine in a foreign language can be a tall order.

Caribbean Grad said...

I am a 4th year student at one of the large Caribbean schools. My school definitely seems to treat students as sources of income and the system itself does not cater to individuals, particularly those that want to go into even slightly competitive specialties, but to producing as many graduates as possible. That being said, they do take an interest in matching students, not necessarily to the specialty of their choice, because that is required to maintain the ability to receive federal student aid and there are many individuals within the organization that I felt had a true desire to help the students succeed.

Despite frequently feeling like a number to the school, I do feel like I recieved good basic science instruction and that is reflected in my Step 1 score, as well as excellent clinical instruction, in some cases far superior to many of the experiences that I heard about from my counterparts at US schools. However, clinical rotations are frequently changing and are a "grab-bag" so to speak. It was only through significant research and advice from classmates that I was able to identify worthwhile rotations and schedule those.

While rare, it is possible to succeed as a Caribbean grad. I applied only to categorical general surgery programs in this match and received over 20 interview invitations.

To address some of the concerns in the article, I wholeheartedly agree that acceptance to a Caribbean school is no guarantee of success and there were a number of my classmates who I did not feel had what it takes to become a physician, but there were also a number of my classmates who I tremendously respect and I believe will go on to become excellent physicians. I believe that before making the decision to go to a Caribbean school, one needs to be truly honest with themself about their academic capacity and work ethic and whether or not they feel that they will be able to succeed, which is a very tough thing to do. I would also say that the belief that there is nothing else in this world that you would be happy doing and that there is no way to make it into a US school, even if that means waiting a year while strengthening their application are also prerequisites to choosing to attend a Caribbean medical school.

I would be more than happy to answer any questions that readers might have and hopefully shed some light on my experience as a Caribbean student.

Skeptical Scalpel said...

Trump U med school? I'm surprised he didn't think of that. It would have been a fantastic school. Outstanding. Best in the world, the universe!

Advertising in South America is very interesting. I wonder how many students they have recruited.

Caribbean Grad, I appreciate your thoughtful comments. You have stated the other side of the story very well. I hope you match in surgery. Please let me know.

Anonymous said...

Could a residency outside the US could be an option for Caribbean grads? How about Australia or the UK? The UK often admits residents from other countries.

Continental Europe may be another option if you know the languages. France, Spain and (I think) Italy even have quotas for foreign residents.

Skeptical Scalpel said...

Good question. I do not know whether countries in Europe or Australia would accept people with MD degrees from Caribbean schools. I do know that residency training in countries in other than the United States and Canada is almost never accepted by the American Board of Surgery or state licensing agencies.

Anonymous said...

Anonymous Europe: A few years back they tried to unify European education (the accursed Bologna program), which failed miserably. There were some attempts to unify medschool training too, but that was never even implemented. If you want to work in Europe as a doctor, first you need to have your medical degree accepted by the local chamber of medicine/sometimes medschool where you want to work. This is very rigorous (imagine an A4 paper filled from top to bottom with the required documents). Besides,you have to speak the language of the country fluently. period. People do not like to speak a foreign language if they go to see the doctor, especially in their home country. Language is a big thing at us, being part of the national pride.:)

Skeptical Scalpel said...

Thank you for the useful information as always.

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