howelljolly is absolutely correct about the board certification exam. Every specialty recognized by the American Board of Medical Specialties has one. Some (like pediatrics) have a higher failure rate, while others like fm and IM are easier (IM pass rate is >90% on the 1st try).
I think med students in general (not just Caribbean med students) usually ignore pathology as a potential specialty, probably because it's not a required rotation at any med school I know of (so, little exposure to the field prior to 4th year). Also, a lot of people go to med school b/c they want to do direct patient care (at least, they start out that way), so many are not attracted to pathology. However, for what it's worth, I think pathology is an underrated specialty. They have good hours and do some interesting stuff, plus you can subspecialize if you want (i.e. become the blood bank pathologist, etc.). I don't have personal knowledge, but would think that pathology would not be super hard to get from one of the better Caribbean med schools, particularly if you have shown genuine interest in the field. However, if you can go to a US school it will make your life easier in general...easier to get a residency, easier to get a medical license, perhaps cheaper to get your degree (i.e. US state med school vs. St George U tuition).
