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I just finished my Obstetrics & Gynecology rotation for my family medicine residency. My preceptor – a talented OB/GYN with a specialty in pelvic pain – went to medical school in the Caribbean, and completed his Obstetrics & Gynecology residency at the University of Toronto. He is a success story for a Caribbean medical school and for all international medical schools aiming to appeal to US and Canadian medical student hopefuls. But he is special, and so is his story. For every one doctor like him, there are several more who do not obtain their residency specialty of choice and do not manage to do so at their University of choice. There are horror stories out there of people spending hundreds of thousands of dollars and many years of their life at a foreign medical school with no residency spot, and nothing to show for it. I feel terrible for people who are stuck like this but it is inherently more risk to train outside of Canada or the US. Today, we will help you understand why.
If you take even a cursory look around the internet, there are legions of articles dedicated to helping young people make sense of the uncertainty around medical school in the Caribbean and West Indies. This month, we are launching a series of posts that explore common questions around medical schools in non-traditional locations: Caribbean, Ireland & Europe, Australia, New Zealand and a few more far flung locales. Getting into medical school in North America is difficult, especially Canada. Getting into medical schools in other places is typically less difficult and there are more spots. So why not take the leap towards a medical degree outside of your native land?
Today, we focus on the Caribbean medical schools. The Caribbean is the most common foreign medical school destination for Canadian and US students. Most notable among these include St. George Medical School, AUC Medical School, Saba University School of Medicine and Ross University. There are approximately 40 medical schools in the Caribbean catering to mostly US students, and there is a growing market for Canadians.
For the most part, yes. They are legitimately trying to train and place doctors. Especially with respect to the top four schools listed, they have a decent record of US-focused clinical placements for trainees and successful placement of residents.
Caribbean medical schools, like many US universities, are for-profit institutions and consumers should have a “Buyer Beware” attitude when exploring them. The top schools are typically accredited by US licensing boards and the ruling government. For example, Saba is an island in the Dutch Caribbean and is administered by The Netherlands.
The Caribbean medical schools have large marketing budgets designed to persuade undergraduate and high school students that this is their best option, even if they haven’t faced medical school rejection by a Canadian or US medical school. Therefore, they will tell you everything you want to hear about how great they are. They’re not going to lie to you, per se. But they may overemphasize their ability to find clinical placements in the US or Canada during clerkship and to help you match to the residency program and location of your choice. In fact, in a 2006 pilot survey of Canadians Studying Medicine Abroad by CaRMS, Caribbean-trained Canadian medical students reported that just over 40 percent were not intending to return to Canada for residency. The most common reason for this was that the students didn’t want to do a Return of Service (ROS) but the second most common reason was that students didn’t think they would get a residency of their choice. And remember, a residency choice includes a specialty and a location. For some students, location is the deal breaker and sometimes it’s the specialty.
The general features of each of school are available on their websites, and there are dozens of Caribbean medical schools to choose from. All of them have different affiliations in the US and Canada, and different success rates.
The Caribbean medical schools are, for the most part, looking for smart people with the desire to help communities be healthier. Because getting into medical school in North America is so difficult, there are a lot of people who don’t make the cut but who would be great doctors. The Caribbean medical schools are experts at finding these people because the admission requirements are quite straightforward.
There are no cut-offs. The admissions criteria are intentionally vague so that they can fill up their classes and earn money. This is central to the mission of a for-profit medical school. If you go to a Caribbean medical school, there will be people in your class who did not perform well academically as undergraduates. This doesn’t mean they won’t be good doctors, but there is an increased chance they will not succeed. For this reason, dropout rates at Caribbean medical schools are high. We aren’t sure if the students that aren’t doing well drop out or if it’s another group. Either way, when the admissions criteria are lower and competitiveness is limited, the pool of candidates will be of lower quality.
Even though YOU might be an extraordinary medical student, yours peers may not be. Every time you show up on a new medical floor to report for duty, the reputation of the medical student from your school precedes you. This is true for North American medical schools too, but this effect seems more powerful for Caribbean-trained doctors. If the last medical student from Saba or Ross was weak, your preceptors and the nurses will be skeptical. You will have more to prove.
Check out our video which will help you choose the best Caribbean medical schools:
The per-term costs for medical school in the Caribbean are more expensive than Canadian schools, but generally less than the US schools. Costs change annually, so check out the websites for individual school data.
Most of the best Caribbean schools are eligible for US federal student loans and also for Canadian bank student lines of credit. Most Caribbean medical school applicants will require financing and there are a few scholarships available at the discretion of the school.
To be competitive for US and Canadian residency programs, most of your clerkship placements and electives need to be done in the US or Canada. Schools with good connections make this happen. My OB/GYN preceptor did his in Louisiana. Even these placements do not guarantee your ideal residency. Each school has guidance on clinical placements on their website and even more detail is shared over the first basic science terms.
Each of the Caribbean schools has affiliated US hospitals and clinical centres. As more and more Caribbean-trained medical graduates finish residencies and establish careers in the US and Canada, there are more opportunities for current students and clinical placements.
The graduates of most Caribbean schools are eligible for participation in the U.S. National Resident Matching Program (NRMP) and the Canadian Residency Matching Service (CaRMS). In the CaRMS match, foreign-trained and foreign-born medical school graduates participate in the second round of the match where there are fewer spots in fewer specialties.
In a 2011 interview with the CBC, then CaRMS CEO Sandra Banner stated, "This year I have 628 Canadians studying abroad in this match. The number of positions available for entry-level training is going to be around 400 positions. In addition, we have 1,800 immigrant medical students who want to come to Canada. There definitely will be Canadian students who will not get back into Canada." Similar stories are out there for US residents.
The exact match rates and absolute numbers for Caribbean medical students are not available, but they are less successful in matching residents than non-Caribbean school students.
If you go to medical school in the Caribbean, you are not guaranteed a residency spot in the US or Canada. The chances are better for the US but quite unfavorable for Canada. In addition, Canada has seen a few controversies over second-round residency spots being held for well-connected foreign-trained graduates, such as when the son of the Head of Cardiac Surgery at St. Paul’s Hospital in Vancouver landed a coveted spot in his father’s program (Click here to read more about this story).
If you don’t care to return to Canada or the US for residency and you can afford the Caribbean, then go for it. You will likely land a residency spot elsewhere and there are many nations in which post-graduate medical education is stellar, if under-respected. Go to one of the top schools though, so you can at least spend some time training in the US during medical school.
Would you like us to help you get into medical school?
About the author:
Dr. Ashley Faye White is currently a rural medicine resident at McMaster University and a senior admissions expert at BeMo. She has an M.D. from McMaster medical school and has navigated her way into med school as a non-traditional applicant.
To your success,
Your friends at BeMo