There are a lot of problems I find with this quick response that is often given. The first of which is that it lumps all schools together. The second is that I'm a big believer that it's much more about the individual than the institution. Caribbean schools, in general, accept many people who would otherwise not get accepted in the US (MD or DO), meaning that, academically speaking, they're not as competitive as their USMD and DO counterparts. Obviously, as the trends would follow, they'd be less competitive coming out of medical school, as well. The fact that these people were educated off-shore is only one of many variables and I'd believe that US DO students would still do quite a bit better if they had instead attended off-shore schools. One of the disadvantages, however, is that an SGU grad will not have osteopathic residency options, which traditionally (as a generalization) are less competitive. The problem the OP may find may not be whether he/she attends a DO school or a Caribbean school, but more so of dealing with which group, as a whole, they tend to fit in amongst more comparably academically. If the off-shore group, then they'd fare in the match more similar to those who went off-shore, whether they go DO or whether they go to SGU -- my opinion is that the results may roughly be similar (as far as the allopathic match goes).