Hopefully a "fair and balanced" review of offshore schools:
The bottom line is that Carib schools (especially Med Schools) are a mixed bag. Calling them "a scam" or "a waste" is ridiculous. Saying that they are "equivalent to US schools" is also untrue:
1. They accept people who cannot get into a US medical school. Whether you see this as "giving deserving people who messed up their GPA / can't do well on the MCAT a second chance" or "leeching tuition off of desperate students who can't get into US medical schools" depends on how you view the situation.
2. Top performers in Carib schools will do fine, and be able to get mid-competitive fields /spots. Anesthesia, EM, Rads, University IM, etc. Ortho/NS/Vascular/Derm is very unlikely even for the top performers, and usually requires years of research and/or connections.
3. Middle performers will also do fine, but often end up in FM / Community IM / peds / Psych / Neuro / Path. Nothing wrong with those fields, but those attending Carib schools should understand that their choices may be limited.
4. Those at the bottom of their class, failing a class, or worse failing a step, often have much more problems. Students retake, pass, and then think everything will be OK, and it might not be. These students might still match, but it's much harder.
4b. Everyone thinks they will be in the top 25%. Only 25% can be in the top 25%. No one can tell if that's going to be you.
5. A reasonable percentage of all students starting in carib schools fail out in the first 2 years. Exactly how high that percentage is, is unclear. It clearly varies by school. Some see this as "The school takes more students than it has clinical spots for, and then fails them out to make more money". Others see it as "These schools know that some percentage of students will fail out. Rather than leave clinical spots empty, they take enough pre-clinical students so that their clinical spots are filled -- this offers the maximum number of students an opportunity to be a physician". The crux is whether the pass level is adjusted specifically to fail out people, or whether it's set at some reasonable benchmark and some people happen to fail.
The other part of this discussion usually revolves around "Well, the school takes people with very low MCAT's and then they fail out -- it's a scam and they should have a higher MCAT cutoff". Data from the LCME shows that lower MCAT scores tend to be associated with failing the USMLE. But population statistics don't tell you how any one person will do -- some people with low MCAT's do just fine. So, again, how you interpret this depends upon how you look at it.
6. Not all schools are created equal. The most established schools are SGU and Ross, and from my viewpoint the two are probably equivalent. SGU appears to be more expensive (although prices change, this may not be accurate in the future). Ross appears to take more students and appears to have a higher drop out rate, although no school publishes their drop out rate so it's hard to be certain. Ross has recently had major problems with a hurricaine severely damaging Dominica, and exactly how it is going to recover/deal with this is unclear. AUC and Saba are often included in the "top 4", AUC is on the "best/safest" (but most expensive) island (also damaged by hurricaine), and Saba is often touted as the cheapest. There are many others of varying quality -- expect higher drop out rates and worse match outcomes.
6a. If a medical school you are looking at doesn't require the MCAT, that's a very bad sign.
7. If you fail out of med school, or can't match to a residency, you really have limited options. A partial MD is of no value. An MD without a residency is also of very limited value, especially an international degree. People talk about "consulting", but I've never seen that actually happen. There are several stories of people getting jobs working for insurance companies, or state disability office, etc. These positions don't pay well, but at least they are something and might qualify for PSLF.
8. If you fail out of school, or can't find a residency because of poor performance, your loans are non-dischargable. Paying them off is very difficult. PSLF or "extreme hardship" may be able to discharge them after 10+ years. if you have a cosigner, they are on the hook just as much as you. I would not recommend that anyone go to a carib medical school if a family member / friend needs to cosign loans.
9. US med schools have increased their class size. Residency spots are also increasing slowly. So far, it hasn't been a problem. It may be that as time goes forward, that IMG's will have further trouble getting even IM and FM spots and the change might happen between the time you matriculate and graduate. But, the opposite might be true also -- spots might grow at a higher rate than students.
So: Going to a Carib school is an uphill process. You need to work harder and be better than your US colleagues to do "equally" well. Carib schools often tout their successes, and ignore the students who never make it to graduation, are only able to get a prelim spot, or not match at all. Yet, at the better carib schools, the majority of students probably succeed (again, difficult to say due to lack of transparency), mainly in the primary care fields. Advertising from these schools (on their websites) doesn't do a great job of balancing these risks and benefits. Threads on SDN tend to tout the negatives, which is probably healthy so that prospective students see the dangers involved.
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