37+ MCAT = Caribbean School = Plastic Surgery Residency

[SouthernSurgeon]

thoracic at Wisconsin - They list this as William S Middleton Veterans Hospital, which does not have a Thoracic surgery residency and never has. Also, the name associated with that listing on their page is actually a Veterinary surgical resident that used to live in Wisconsin, but is now at U of Minnesota.
GS at NY Presbyterian - Currently a PGY1, original match was a prelim spot, had to repeat his intern year, but did get a categorical spot in the end.
IM at Hopkins - Not actually Hopkins, the match is Sinai Hospital of Baltimore which is affiliated with JHU, but is a low tier IM program
Psychiatry at Harvard - Not at Harvard, this is a VA psych program that has a loose affiliation with HMS.
Anesthesiology at NY Presbyterian - Not exactly all that competitive, but this is a good match if you want anesthesia in NYC.
saw 1 ortho and 1 neuro surg. - Both at small community hospitals at the least competitive end of the spectrum. (lot less competitive than many programs in IM/Peds/GS)

This right here should tell you all you need to know about the carib programs. They do some very nice "massaging" of their rank lists to make things look better. Even going back over time and revising a prelim to a categorical.

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[SouthernSurgeon]

What are those guys doing next year? We don't have any of those. Re-applying for surgical sub-specialties or something else?

Most of them end up in general surgery. Our department works with them in the spring to discuss their plans for next year - if they want to reapply in their subspecialty we will set up the schedule so that they get an elective month or two in the fall (to meet attendings in that department and basically have another audition month). But our PD is also realistic with them - reapplying in a subspecialty is a really uphill road. Since I've been here I think really only 2 have managed to end up in their original subspecialty (one by snagging a spot when someone at another program quit/got fired, the other our subspecialty department really liked so they kept him). We've had several land categorical PGY2 spots in general surgery the following year (since a number of these spots do open up across the country over the course of the year). We've also had a few who realized surgery wasn't for them and ended up in things like anesthesia or medicine.

But importantly, I think all of them since I started here are now in a categorical residency in something. Better than some prelims I know at other places.

I like the way our department approaches the prelim year because I definitely think they make an effort to develop them and get them into a categorical residency. At my medical school the prelims definitely felt like cannon fodder.

 

[Law2Doc]

I guess it comes down to if your stats were low enough, and DO was out of the question would you go Caribbean if it was your only means of becoming a doctor?

I would rather re-take the MCAT/post-bacc/SMP, but for older applicants wishing to go primary care this seems like a viable option

For older applicants it's a really bad idea -- you already have an age stigma to overcome, and in most cases the offshore path is a longer one. There are a variety of ways people don't manage to graduate in four years at those offshore places -- you have to get through internal hurdles before you can sit for boards, since you are signing up for rotations at community hospitals you sometimes lose a year waiting for a rotation you need to open up. And then you sometimes end up doing intern year twice, since a lot of these matches are prelims and these people end up in the match again next year. You only should do this path if, after multiple attempts at grade rehabilitation, you come up short, but can't shake the idea of becoming a doctor. As a US citizen there's simply no other valid reason. And you should know its a Hail Mary long shot that only pans out about half the time at best.

 

[kuroichigo]

Those are specialties, not residency programs. There are competitive programs in every one of those specialties (and every derm program is competitive). This is the problem with this argument. You say, "great residency programs" without really knowing what that means. It is a struggle to come out of the Caribbean across the board. The goal of the vast majority of US MD students is to get into their first choice program in their desired specialty. Since US MD students are a diverse group and aren't all gunning for the same spots, ie @DermViser and I would be miserable if you flipped the fields that we are in, people have a decent shot getting into somewhere reasonably high on their list. This is not true for the Caribbean.

But, yes, once you start residency, where you went to school or your scores matter very little. If you are a prelim, it doesn't matter what school you went to. If you end up a categorical resident, you have to do something really stupid to lose your spot.

Ah, gotcha. I agree with all sorry about that misunderstanding.

 

[DermViser]

Many in SDN have no problem about PDs discriminating against students from carib and/or offshore schools, but many of the same people complain about URMs having some kind of an advantage when applying to med school.

If you seriously can't understand the difference between a Caribbean/offshore graduate vs. a URM, then there is absolutely no helping you, Class of 2018.

 

[DermViser]

Surprisingly there were a couple good ones

https://apps.sgu.edu/ERD/2012/ResidPost.nsf/BYPGY?OpenView&RestrictToCategory=PGY1&Count=-1

be it from 2012...

thoracic at Wisconsin
GS at NY Presbyterian
IM at Hopkins
Psychiatry at Harvard
Anesthesiology at NY Presbyterian
saw 1 ortho and 1 neuro surg. before I got tired of reading; I didn't realize how massive the class was

You know that IM program isn't the Osler program at Hopkins and Psych is a VA-Brockton program loosely affiliated with Harvard right? The others I almost guarantee have loose affiliation.

 

[DermViser]

If you care where you are going to practice, what you are going to practice or how good your post medical school training will be, you are in for a world of hurt going to the Caribbean.

I'm always curious about what exactly makes the Carribbean student not as good. Is it the "teach to the test" mentality in the first 2 years? They obviously have a physical diagnosis course. Is it bc their rotations are at community, nonacademic hospitals? Just wondering why the quality leaves much to be desired.

 

[DermViser]

Most of them end up in general surgery. Our department works with them in the spring to discuss their plans for next year - if they want to reapply in their subspecialty we will set up the schedule so that they get an elective month or two in the fall (to meet attendings in that department and basically have another audition month). But our PD is also realistic with them - reapplying in a subspecialty is a really uphill road.

Very nice and kind of your program, who really doesn't have to do **** for them. Kudos to them.

 

[Optimus-Prime]

This right here should tell you all you need to know about the carib programs. They do some very nice "massaging" of their rank lists to make things look better. Even going back over time and revising a prelim to a categorical.

I got massaged

 

[Law2Doc]

I'm always curious about what exactly makes the Carribbean student not as good. Is it the "teach to the test" mentality in the first 2 years? They obviously have a physical diagnosis course. Is it bc their rotations are at community, nonacademic hospitals? Just wondering why the quality leaves much to be desired.

The rotations are very weak facsimiles of what US med students get. There is no LCME governing body setting standards for these so it's really just offshore schools negotiating with individual community hospitals to let med students come and do something that passes for "rotations" there. The community hospitals pocket the cash and basically pawn the med student teaching role off on their residents to help teach, to the extent they have time. At community hospitals a much smaller percentage of residents have an academic leaning to begin with, so the effort they put into teaching is sometimes pretty limited. It can be very similar to shadowing, although they did get to present patients to the attendings on rounds. Because the community programs want the med students to report positive things to keep that cash flow going, the hours are sometimes pretty cushy.

When I was a med student at a US program, our call was the same hours as the intern (sometimes longer since we prerounded) -- it was pretty brutal but it prepared you somewhat for residency. The places I've rotated at as a resident that provide offshore schools rotations are very unlike that. The med students show up mid rounds in the morning and leave at about 5 each day, and do about one weekend shift of "call" per month, nothing at night. They all take long meal breaks each day and disappear to the "library" frequently. The only time they were on the spot was during rounds. At the end the program gives them a nice evaluation and travel mug and tells them to recommend the program to their classmates. So yeah, it's the non accredited rotations that don't give PDs a comfort level of where these folks are on the learning curve. Someone from a low end US med school who did real rotations is simply more of a known commodity.

 

[DermViser]

The rotations are very weak facsimiles of what US med students get. There is no LCME governing body setting standards for these so it's really just offshore schools negotiating with individual community hospitals to let med students come and do something that passes for "rotations" there. The community hospitals pocket the cash and basically pawn the med student teaching role off on their residents to help teach, to the extent they have time. At community hospitals a much smaller percentage of residents have an academic leaning to begin with, so the effort they put into teaching is sometimes pretty limited. It can be very similar to shadowing, although they did get to present patients to the attendings on rounds. Because the community programs want the med students to report positive things to keep that cash flow going, the hours are sometimes pretty cushy.

When I was a med student at a US program, our call was the same hours as the intern (sometimes longer since we prerounded) -- it was pretty brutal but it prepared you somewhat for residency. The places I've rotated at as a resident that provide offshore schools rotations are very unlike that. The med students show up mid rounds in the morning and leave at about 5 each day, and do about one weekend shift of "call" per month, nothing at night. They all take long meal breaks each day and disappear to the "library" frequently. The only time they were on the spot was during rounds. At the end the program gives them a nice evaluation and travel mug and tells them to recommend the program to their classmates. So yeah, it's the non accredited rotations that don't give PDs a comfort level of where these folks are on the learning curve. Someone from a low end US med school who did real rotations is simply more of a known commodity.

Ah, so it's the lack of LCME standardization of their rotations, as you have community hospitals thrown in an educational, academic role. Hence, an "Honors" from these places is essentially useless. Unlike say a teaching hospital with a U.S. med school with med school faculty, who more would grade you realistically based on your actual performance, so it means something to residency institutions.

 

[mimelim]

I agree with @Law2Doc. There is no minimum standard and more importantly, the people just aren't as academically inclined. Add to that an on average weaker starting protoplasm and you just don't get good products.

 

[Law2Doc]

Ah, so it's the lack of LCME standardization of their rotations, as you have community hospitals thrown in an educational, academic role. Hence, an "Honors" from these places is essentially useless. Unlike say a teaching hospital with a U.S. med school with med school faculty, who more would grade you realistically based on your actual performance, so it means something to residency institutions.

I'm not sure it's even much about the honors/pass distinction (or weaker starting protoplasm.) To a very large extent the intense rotations in US allo med school (and presumably osteo as well) give you a decent and known starting point for a US allo residency (even if you only pass). These offshore grads (through no fault of their own, but due to their program) don't have that and the PD has to guess where they might be on the learning curve. And no PD wants to make that guess if he can instead just take a known commodity who jumped through all the LCME mandated hoops.

 

[KnuxNole]

The rotations are very weak facsimiles of what US med students get. There is no LCME governing body setting standards for these so it's really just offshore schools negotiating with individual community hospitals to let med students come and do something that passes for "rotations" there. The community hospitals pocket the cash and basically pawn the med student teaching role off on their residents to help teach, to the extent they have time. At community hospitals a much smaller percentage of residents have an academic leaning to begin with, so the effort they put into teaching is sometimes pretty limited. It can be very similar to shadowing, although they did get to present patients to the attendings on rounds. Because the community programs want the med students to report positive things to keep that cash flow going, the hours are sometimes pretty cushy.

When I was a med student at a US program, our call was the same hours as the intern (sometimes longer since we prerounded) -- it was pretty brutal but it prepared you somewhat for residency. The places I've rotated at as a resident that provide offshore schools rotations are very unlike that. The med students show up mid rounds in the morning and leave at about 5 each day, and do about one weekend shift of "call" per month, nothing at night. They all take long meal breaks each day and disappear to the "library" frequently. The only time they were on the spot was during rounds. At the end the program gives them a nice evaluation and travel mug and tells them to recommend the program to their classmates. So yeah, it's the non accredited rotations that don't give PDs a comfort level of where these folks are on the learning curve. Someone from a low end US med school who did real rotations is simply more of a known commodity.

People at academic programs also like to hide in the library, take "long" lunch breaks and only show up to rounds too.

 

[Law2Doc]

People at academic programs also like to hide in the library, take "long" lunch breaks and only show up to rounds too.

Its not the same thing at all. Not to the same degree, and an extra hour out of sight is bigger when you are only in the building a fraction as long. ANd no, nobody only just showed up to rounds on core rotations where i went to med school. Maybe on a fourth year elective, but you'd never try that for inpatient medicine or surgery. When I was a Med student we spent the bulk of the day in the team room, and if there was something going on, we were there to see it. The big difference was we actually needed the face time to show our team first attitude and get good evaluations -- nobody was going to write us a nice evaluation just to keep our school happy. You got good evals by being there and actively helping out, and nobody ever having to ask "where's the med student?" If a community hospital started giving out harsh evaluations, since there's a choice of venues, these offshore students would quickly stop doing their rotations there and the gravy train would quickly dry up. So they get treated very differently, much like casinos treat their high rollers, IMHO to their ultimate educational detriment.

Again, I am comparing my own experience as a med student with that of the several offshore rotations I've now personally witnessed. because these offshore programs contract for rotations with community hospitals throughout the country, some will undoubtedly be better and worse than I've seen. But none have to be AAMC/LCME compliant, and so most won't. it's precisely this variation that makes PDs run for the hills. A PD wants a known commodity. The guy who shows up with a fluff evaluation who maybe never did a real rotation is simply not at the same starting point in residency as the guy who logged 80 hours a week in the ICU during a month long sub-I actually helping with patient care on a continuing basis.