Why is the Caribbean a bad decision?

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I think this "all in" stuff is the most confusing part of the whole new NRMP scheme. There are so many ways for programs to circumvent this, and they still do (aProgDirector probably can clarify this and/or knows people who've done exactly what I describe). If you read the fine print carefully, they can still offer pre-match spots up to the cut-off date of registering their spots in the Match (which I think is mid-February). So, if you are offered a pre-match spot before mid-February, you don't have to "list" that spot in the Match and you are still complying with the "all in" requirements.

Likewise, there could be a way that the program could offer a "dual track" for a given specialty, say Family Practice, where some spots are "Match spots" and others are never going to be in the Match. So, the ones declared to be in the NRMP will be considered qualified for complying the "all in" policy.

I don't think this new policy/scheme is as black and white as you guys think its is. And, I don't really think it's 100% enforceable. What're the "teeth" to it? There aren't any as far as I can see.

-Skip
 
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OP, I would read and research the web for the info you're looking for. There are tons of resources to get the answers you want. Also, attend an Open House/Information session from SGU/AUC/Ross/SABA or whichever one you were looking at. They are free and give you lots more info that you can't get from the web, because there are also almuni that will speak with you. Talk to people who have actually been there and done that. Weigh the pros and cons of every aspect as well. I've seen many good replies to this thread.

Also, here is an official report from the NRMP and ECFMG, which give you very detailed statistics of last year's match with regards to IMG's (International Medical Grads). It is very very helpful. Gives you a solid idea on how IMG's (from the Carib and other countries) did in the Match last year. You can see that no matter where you go to medical school, you can match here in the US (given, everyone will not go the same route as US medical students, meaning they might be applying after 4 years of medical school or being already a doctor, it's all in the report as well).

Remember, to make an informed decision, you must be well-informed!
 

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I think this "all in" stuff is the most confusing part of the whole new NRMP scheme. There are so many ways for programs to circumvent this, and they still do (aProgDirector probably can clarify this and/or knows people who've done exactly what I describe). If you read the fine print carefully, they can still offer pre-match spots up to the cut-off date of registering their spots in the Match (which I think is mid-February). So, if you are offered a pre-match spot before mid-February, you don't have to "list" that spot in the Match and you are still complying with the "all in" requirements.

Not exactly.

If a program is "all in", in order to take a PGY-1 off cycle and not match them they need to start training by Feb 1. So, if I wanted to take some IMG's outside the match (i.e. pre-match) and also match candidates, I'd need to pre-match them AND start them by Feb 1. Obviously they would need to already be ECFMG certified and graduated from medical school, and I'd need to interview them early in the season to do this, and need to get visas (if required). Plus, I would then have those housestaff off cycle for their entire three years. Basically, it would be a big mess.

Likewise, there could be a way that the program could offer a "dual track" for a given specialty, say Family Practice, where some spots are "Match spots" and others are never going to be in the Match. So, the ones declared to be in the NRMP will be considered qualified for complying the "all in" policy.

This is forbidden by the All In policy. The policy is per program. Multiple tracks in the same program all need to be in or out -- with the only "exception" being dual accredited ACGME/AOA programs where some slots can be in the AOA match, and then revert to the NRMP match if they do not fill.

I don't think this new policy/scheme is as black and white as you guys think its is. And, I don't really think it's 100% enforceable. What're the "teeth" to it? There aren't any as far as I can see.
-Skip

The "teeth" is the match. If a program is found to be violating the All In rule, they can (theoretically) be removed from the match altogether and will become "All Out". That's not the end of the world for the program since they can still sign people outside the match, but it would be a big negative to any program that gets a significant number of its interns from the NRMP match.

How would the NRMP know? Actually, it's easy. They can compare each program's match numbers to their GME census numbers. The number of interns should match (plus or minus a few -- for example if I don't promote one of my interns, my GME census will have one more intern than what I matched).

Would they really remove a program from the match? I don't know. I expect they would issue a warning first -- the goal is to keep as many programs in the match as possible. But ultimately if a program refused to cooperate or violated the rules for at least 2 matches, they would probably be removed from the match.
 
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If a program is "all in", in order to take a PGY-1 off cycle and not match them they need to start training by Feb 1.

Therefore, you can have January graduates of Carib schools (for example, like Ross offers) get into and start your program in January, and you would not have to list that spot in the Match - totally outside the Match. If I were the owner and administrator of a Carib school, this would be a potential selling point for my program.

Likewise, I still am not sure how a "dual track" could be found out by the ACGME/NRMP, especially if those are unfunded spots. It is ironic that the NRMP wants to whip this pony in the name of fairness. Most programs that offer pre-match spots historically cannot and have not been able to fill through the Match, none of the U.S. graduates want 'em, and/or the programs do not have the time and resources to afford towards recruiting.

Ripe for a anti-trust lawsuit, in my humble opinion...

-Skip
 
Therefore, you can have January graduates of Carib schools (for example, like Ross offers) get into and start your program in January, and you would not have to list that spot in the Match - totally outside the Match. If I were the owner and administrator of a Carib school, this would be a potential selling point for my program.

Yes. If I wanted half my spots outside the match and half in, I could start all my "outside" interns in January and then match others to start in July. This is a huge PITA of course -- I'd only have 1 month to get everyone licensed and credentialed, and obviously visas wouldn't be possible in that time frame. Whether it could be a selling point totally depends on whether programs do this, of course.

Likewise, I still am not sure how a "dual track" could be found out by the ACGME/NRMP, especially if those are unfunded spots. It is ironic that the NRMP wants to whip this pony in the name of fairness. Most programs that offer pre-match spots historically cannot and have not been able to fill through the Match, none of the U.S. graduates want 'em, and/or the programs do not have the time and resources to afford towards recruiting.

Doesn't matter whether the spots are funded or not. The GME Census counts all residents in training, regardless of funding status. It's organized by our friends in the AAMC. You can read all about it here: https://www.aamc.org/services/gmetrack/ I guess programs could be untruthful if they were trying to scam the system. This is different from how we report our trainees for Medicare funding -- that's done through the Medicare Cost Report.

In any case, I think we agree more than we disagree. Any program that wanted to subvert the system probably can. For example, instead of starting my pre-matches before Feb 1, I'd start them July 15th. As far as I can tell, there's nothing that stops me from doing that -- although I am having difficulty finding an official "all in" policy on the NRMP website (there's an All In page, but it's very vague). The NRMP can threaten action against a program if found to be violating, but it's hard to prove unless the program is doing so on a large scale.
 
Is there any disadvantage for Caribbean grads not applying to the match as a 4th year student? Would it be advantageous to apply the year after graduation, spending time doing research/observerships at programs they are interested in?
 
Is there any disadvantage for Caribbean grads not applying to the match as a 4th year student? Would it be advantageous to apply the year after graduation, spending time doing research/observerships at programs they are interested in?

I'm sure there is a disadvantage, and the disadvantage grows year over year since they assume your medical knowledge and skills aren't fresh in your mind. It probably isn't recommended since there is no disadvantage in you applying to match and if you don't get into the programs you are interested in, thats when you can spend the time to do research/observerships.
 
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http://b83c73bcf0e7ca356c80-e8560f4...s-in-the-Match-IMG_Final_Revised.PDF-File.pdf

Latest match data from the ECFMG is out. Looks like SGU wins again, with 689 of 1050 (65.6%) match participants matching. Their USIMGs performed better overall though, with 534 of 792 (67.4%) matching. Can't really say with Ross, as there are two med schools on Dominica- the numbers for the island as a whole don't look good though. Given that the majority of students that are on Dominica are Ross students, I'd venture to say that the majority of the 1,100 students there belong to Ross, 595 of which matched. AUC in St. Marteen fared quite well, with 180 of 300 matching (60%).

Figure, if anyone decides the Carib is worth it, they might as well take a look at what schools offer them the best shot at matching. SGU and AUC seem to be the way to go, with Ross after that, and most of the world left in the dust. A notable exception is Israel, with a 75.6% match rate for their 119 total grads that applied (probably mostly or all from Sackler). Outside of SGU, Ross, AUC, and Sackler, the only place from which USIMGs cleared a 50% match rate was Mexico. Basically, if you're going abroad, these are the places to go.
 
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Any program that wanted to subvert the system probably can. For example, instead of starting my pre-matches before Feb 1, I'd start them July 15th. As far as I can tell, there's nothing that stops me from doing that -- although I am having difficulty finding an official "all in" policy on the NRMP website (there's an All In page, but it's very vague). The NRMP can threaten action against a program if found to be violating, but it's hard to prove unless the program is doing so on a large scale.

And, I think this is precisely the "game" they are playing. They know, on some level, that they probably can't compel you to do this. It's not a "law", it's a "rule" that they want you to play by. I looked into this before (about a year ago) and found the same thing, namely that you can't find anywhere on the the NRMP website where they mandate this, that you have to do this "or else". (If you can find it, I'd love to read it.)

That's why I've said that I don't believe this rule has any teeth. It would create the situation for an anti-trust violation. They don't want to have to pay anymore lawyers after the fiasco ten years ago. They just want everyone to play along to make the system more "fair", whatever that means. Point is, I don't think they understand what "fair" is to those little FP programs in less-than-desirable locations that no U.S. graduate wants to do their residency in anyway and who otherwise would have trouble filling their spots every year.

The more I work in healthcare, the more I realize how many bad decisions are made by distant committees sitting in offices that often have nothing to do with what goes on at the actual front lines.

-Skip
 
Sorry to quote myself...

The more I work in healthcare, the more I realize how many bad decisions are made by distant committees sitting in offices that often have nothing to do with what goes on at the actual front lines.

And, most people in healthcare lack the "testicular fortitude" to challenge nonsense when they run into it.

-Skip
 
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Sorry to quote myself...



And, most people in healthcare lack the "testicular fortitude" to challenge nonsense when they run into it.

-Skip

Very true. If we did have testicular fortitude, we'd stand up to all the insurance companies who, despite lacking knowledge about medicine, feel free to dictate to us how to practice medicine. We'd also stand up more to those malpractice attorneys who file frivolous lawsuits.
 
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Considering how much things will change over the next few years, I'd advise against the Caribbean.
 
What's up with all the "drive-bys" lately? (haha)

-Skip

I'm a Caribbean student but do feel things are changing to an extent that attending school off-shore may be too risky in the future.

I have been posting more lately. Step 2 stuff is fun but I need an occasional break. :)
 
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I'm a Caribbean student but do feel things are changing to an extent that attending school off-shore may be too risky in the future.

I have been posting more lately. Step 2 stuff is fun but I need an occasional break. :)

Can you elaborate more on how things are changing?
 
Is there any disadvantage for Caribbean grads not applying to the match as a 4th year student? Would it be advantageous to apply the year after graduation, spending time doing research/observerships at programs they are interested in?

Yes, the odds of matching drastically go down after your graduation year.


And as for Skip's point, I think you are right about the lack of any consequence for working around the all-in policy. I'm not convinced that a lot of programs will have the sand to actually bend the rules though. I think for the most part, pre-matching is a thing of the past.
 
http://b83c73bcf0e7ca356c80-e8560f4...s-in-the-Match-IMG_Final_Revised.PDF-File.pdf

Latest match data from the ECFMG is out. Looks like SGU wins again, with 689 of 1050 (65.6%) match participants matching. Their USIMGs performed better overall though, with 534 of 792 (67.4%) matching. Can't really say with Ross, as there are two med schools on Dominica- the numbers for the island as a whole don't look good though. Given that the majority of students that are on Dominica are Ross students, I'd venture to say that the majority of the 1,100 students there belong to Ross, 595 of which matched. AUC in St. Marteen fared quite well, with 180 of 300 matching (60%).

Figure, if anyone decides the Carib is worth it, they might as well take a look at what schools offer them the best shot at matching. SGU and AUC seem to be the way to go, with Ross after that, and most of the world left in the dust. A notable exception is Israel, with a 75.6% match rate for their 119 total grads that applied (probably mostly or all from Sackler). Outside of SGU, Ross, AUC, and Sackler, the only place from which USIMGs cleared a 50% match rate was Mexico. Basically, if you're going abroad, these are the places to go.
These are not doom and gloom numbers, but their are not great either if you ask me. I thought the BIG 4 had a match rate of 80%+... Maybe some of their student pre-match (I don't know why it is so low). The match rate for Mexico (most of these students are probably from UAG) is quiet low for a school that is well established. All in all, if someone plan to go to these schools, you better plan to kill the board (240+) and/or plan to match into a primary care specialty.

Edit: It is not that bad for someone who is planning to do Family Medicine or Psychiatry... The average step 1 is in the low 200 (around 205 for these specialties).
 
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What's up with all the "drive-bys" lately? (haha)

-Skip
Do you think some of the USIMG from the islands pre-match Skip? Why is the match rate that low for the BIG 4?
 
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Do you think some of the USIMG from the islands pre-match Skip? Why the is the match rate is that low for the BIG 4?

This is a better question for aProgDirector.

Having said that, I'm not sure that pre-Match spots will completely go away. There are plenty of loopholes to work around this, as aProgDirector has already elucidated, for those programs willing to do so.

But, I don't think the Match rates are necessarily "low" depending on what specialty you look at. Again, based on the overall numbers and looking at specific specialties, I'd say that SGU and Ross are still your best choices.

-Skip
 
Do you think some of the USIMG from the islands pre-match Skip? Why the is the match rate is that low for the BIG 4?

Guys, again, read the report. This match rate is based on those who matched into the specialty they ranked #1 on their match list. Thus, if you matched into a "back-up" specialty, you are not included as "matching" in this report. That lowers the overall Match rate as reported here. You can argue the nuances of whether this was right or wrong of them to do, but the bottom line is that this lowers the overall match rate for each country.

As to pre-match, yes, some of the USIMGs from the island pre-match. I personally know about 7 students in this Match who have done so this month, and I'm sure there are more (this is just from my school, AUC). The best places to pre-match will of course be if you rotate at a hospital which is all-out, and it's possible to find yourself in this position.

This year was a very competitive year for interviews. From what I am hearing on the trail, a lot of AMGs are applying to more places, which I think is a knee jerk reaction to a match rate around 93% last year for AMGs (which I believe is the same as it was in 2011 or 2010). So, with all those AMGs grabbing interviews, it was tough for IMGs to get interview spots. Personally, I feel that this will help applicants who were good enough to get interview spots. This means that most likely (let's say for IM) programs will fall farther down their rank lists than is usual (maybe 100-200 more AMGs will match into IM this yr than last year......for something like >300 programs), which is a positive for the IMG who got the interview. You now have a pretty good shot if you were competitive enough. Perhaps someone else has a different opinion? But with a university program of about 30, the average is around 6 spots per rank, meaning you would go down your ROL 180 spots to fill your program. I think that may stretch a tad this year.

In the end, it's the same old story. Try to go US MD or DO. If not possible, then go Carib and I would suggest only the well-known schools at this point. I think that the residency issue won't last forever as the AOA position with the ACGME becomes more untenable, and there will be outside pressure to increase spots sometime in the next five years due to an aging baby boomer population. Unfortunately, that means graduating within the next 4-5 years will be difficult for residency matches.
 
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Guys, again, read the report. This match rate is based on those who matched into the specialty they ranked #1 on their match list. Thus, if you matched into a "back-up" specialty, you are not included as "matching" in this report. That lowers the overall Match rate as reported here. You can argue the nuances of whether this was right or wrong of them to do, but the bottom line is that this lowers the overall match rate for each country.

As to pre-match, yes, some of the USIMGs from the island pre-match. I personally know about 7 students in this Match who have done so this month, and I'm sure there are more (this is just from my school, AUC). The best places to pre-match will of course be if you rotate at a hospital which is all-out, and it's possible to find yourself in this position.

This year was a very competitive year for interviews. From what I am hearing on the trail, a lot of AMGs are applying to more places, which I think is a knee jerk reaction to a match rate around 93% last year for AMGs (which I believe is the same as it was in 2011 or 2010). So, with all those AMGs grabbing interviews, it was tough for IMGs to get interview spots. Personally, I feel that this will help applicants who were good enough to get interview spots. This means that most likely (let's say for IM) programs will fall farther down their rank lists than is usual (maybe 100-200 more AMGs will match into IM this yr than last year......for something like >300 programs), which is a positive for the IMG who got the interview. You now have a pretty good shot if you were competitive enough. Perhaps someone else has a different opinion? But with a university program of about 30, the average is around 6 spots per rank, meaning you would go down your ROL 180 spots to fill your program. I think that may stretch a tad this year.

In the end, it's the same old story. Try to go US MD or DO. If not possible, then go Carib and I would suggest only the well-known schools at this point. I think that the residency issue won't last forever as the AOA position with the ACGME becomes more untenable, and there will be outside pressure to increase spots sometime in the next five years due to an aging baby boomer population. Unfortunately, that means graduating within the next 4-5 years will be difficult for residency matches.
Got it! I did not know the report was for applicants who matched into specialty they ranked #1... If we account for back up and prematch, I think the big 4 might have 80%+ overall match rate, which I think is pretty good...
 
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I think the Caribbean can be an alternative after one has tried admission to US MD/DO schools.
 
Depends on personal things too. Personally I would try podiatry before Caribbean. At this point the chances of getting a residency are similar, at least it's cheaper tho.
I somewhat agree with you. I would try pharmacy or PA before going to a Carib school, but some people can only see themselves as physicians MD/DO... However, I think people should try US MD/DO at least three times before going Carib if they are <30 years old... I have friend who called me yesterday and asked me what he should do because he did not match again after going thru the match three times and I really did not know what to tell him... The only thing I thought about was the 3-year ARNP program at FIU for IMG, but I was afraid to tell him that because he might not receive kindly such advice... I REALLY felt bad!
 
I somewhat agree with you. I would try pharmacy or PA before going to a Carib school, but some people can only see themselves as physicians MD/DO... However, I think people should try US MD/DO at least three times before going Carib if they are <30 years old... I have friend who called me yesterday and asked me what he should do because he did not match again after going thru the match three times and I really did not know what to tell him... The only thing I thought about was the 3-year ARNP program at FIU for IMG, but I was afraid to tell him that because he might not receive kindly such advice... I REALLY felt bad!
Agreed.

Is your friend shooting for anything competitive? Is his step good?
 
Agreed.

Is your friend shooting for anything competitive? Is his step good?
NO... He is (or has been) shooting for FM... He told me he barely passed Step1 (second attempt). He did well in Step2/3 (first attempt). I think he should give up because I heard after three years of not matching, your chances to match are almost impossible..
 
NO... He is (or has been) shooting for FM... He told me he barely passed Step1 (second attempt). He did well in Step2/3 (first attempt). I think he should give up because I heard after three years of not matching, your chances to match are almost impossible..
Yea failing Step 1 is not good. Idk what he should do. Is he American?
 
Depends on personal things too. Personally I would try podiatry before Caribbean. At this point the chances of getting a residency are similar, at least it's cheaper tho.

Yeah, if you want to stare at feet for the rest of your life.

Personally, I would try to exhaust all options at getting into a U.S. school, including several of the newly (or soon-to-be) opened allopathic programs, as well as taking advantage of the increased number of spots at the existing schools.

-Skip
 
Yeah, if you want to stare at feet for the rest of your life.

Personally, I would try to exhaust all options at getting into a U.S. school, including several of the newly (or soon-to-be) opened allopathic programs, as well as taking advantage of the increased number of spots at the existing schools.

-Skip
I think PA might be the best next option, but PA schools are expanding rapidly these days. I wonder what the job prospect for PA will be in the next 10 years...
 
They'll say you won't get a residency and will die alone after a long career at Family Video and $500,000 of debt you can't pay off

But the ones saying this barely qualify to be called premed, so don't put too much weight on it
 
I never put much credence into what "they" say.

-Skip
 
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They'll say you won't get a residency and will die alone after a long career at Family Video and $500,000 of debt you can't pay off

But the ones saying this barely qualify to be called premed, so don't put too much weight on it

Pretty sure it's a hell of a lot more than just pre-meds saything that going Caribbean is a bad idea.
 
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Because if you can't get into a US MD or DO program, then it's probably for a pretty good reason that you should fix.
 
Because if you can't get into a US MD or DO program, then it's probably for a pretty good reason that you should fix.

There's a difference between "can't" and "didn't" that is subtle, complex, random, and often missed by not only adcoms but by the general public.

-Skip
 
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There are basically five categories of medical school applicants, as I see it (and I think it probably fairly evenly distributes along the Bell curve):
  1. Definite acceptance: These are students who have killer recommendations, high MCAT scores, high GPAs, and high-achieving. They are probably good looking too. They will usually have their pick of programs and get multiple acceptances.
  2. Probable acceptance: We're talking MCAT in the 30 range, GPA 3.4 or higher, good recommendations, okay-to-above average undergrad pre-med program with good recommendations. If they apply broadly, they will usually get in somewhere.
  3. On-the-cusp: There may be a minor blemish on their transcript somewhere. They might have a very strong GPA, but were only able to get a 28-29 on the MCAT, with at least one 10 in one of the categories (preferably biological sciences). Their pre-med sciences GPA is above a 3.4-3.5, but their overall GPA may be lower in the 3.0 range. They will have very strong recommendation letters nonetheless. A lot of these students will end-up not getting into a U.S. M.D. program and will go the osteopathy route.
  4. Not likely: These are the students who have broad deficiencies in their applications. Their MCAT score is 27 or less. Their science GPA is is below a 3.2. Their overall GPA is maybe at or below 3.0. If they have good recommendations, they're lucky.
  5. Should rethink their dream: These are students who are entirely below the first 4 categories, but nonetheless hold onto the dream of becoming a doctor. Sometimes even despite a decent application it's an intangible thing to the individual, like a glaring personality disorder, that has sabotaged them, but no one has the heart or honesty to tell them.
Needless to say, the first two categories don't have much to worry about. The Caribbean essentially caters to the 3rd through 5th category.

Many of the students who choose the Caribbean, other than being older and "late bloomers" in life, fall into the 3rd category. Probably if they had persisted and worked on their application (and had been willing to wait), they would've gotten into a U.S. program somewhere.

Most of the Caribbean students, I surmise, are in the 4th and 5th category. With good effort and determination, the 4th category can go and do well. But, for some (or more than some) of them, they will find the challenges of being in the Caribbean too difficult to surmount and will drop out or otherwise not succeed. This is because the problems that they had in undergrad could not be put past them.

The fifth category - the one that gets the Caribbean all the bad press - are the ones that will undoubtedly fail. In my opinion, this is the category that the schools have to do a better job of identifying and not taking their money in the first place. It would go a long way to cleaning up the image of what Caribbean medical school, especially at the big well-established schools, means. The other totally unscrupulous schools who will take anyone with a heartbeat and a checkbook... well, no one should attend them. That's just my opinion.

-Skip
 
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Good analogy, SGU has put more doctors into US residency in the last 3 yrs then any other school in the world

Because they accept basically anyone with a pulse. If your incoming class is three times larger than any US school and you're not putting more students into US residencies there is a massive problem
 
Because they accept basically anyone with a pulse. If your incoming class is three times larger than any US school and you're not putting more students into US residencies there is a massive problem


Wrong, they do not admit everyone who applies. If their mcat is lower than they want or GPA is low they will admit students to their post bac program or have them do the 3rd year of their premed program. Post bac is 1 semester and has a GPA requirement.

In 2008 the average mcat was 28 and GPA was 3.34 and science GPA 3.26.
(http://etalk.sgu.edu/faqs/medfaq.pdf)

Here is another link with slightly different stats: http://www.princetonreview.com/schools/medical/MedBasics.aspx?iid=1037718#/

There are many other Carib schools that you are correct about. They will admit anyone.
 
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