Quality Concerns Of Caribbean Med Schools

[drusso]

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http://www.ama-assn.org/amednews/

You need to be registered to read the entire article, but in summary: Various groups including the ACGME/LCME/AOA and state licensing boards are concerned about the recent growth in caribbean medical schools. Medical educators interviewed in the article raise the distinction between being able to pass a licensing exam versus being groomed and trained in an educational environment that imparts the necessary skills and attitudes to practice medicine competently.

What I find interesting about these recent arguments is the continuing emphasis on professionalism and attitudes as being centrally important in medical education. Historically, these are attributes that can't be "licensed" but often believed to emerge through various "accreditation" processes. The point being that state medical boards may begin to put more weight on various accreditation procedures and training experiences (ie ACGME accreditation for residency or LCME/AOA accreditation for medical school) instead of measured individual performance (passing a licensing examination). Jordon Cohen of the AAMC alludes to this too in his 2005 presidential address:

"As Lynn Eckhert noted a few moments ago, of the some 24,000 individuals who funnel through the GME pathway toward independent practice each year, more than one third-over 8,500 individuals-have received their undergraduate medical education from somewhere other than an LCME-accredited school. To be specific, about 2,700 are graduates of osteopathic medical schools, some 1,300 are U.S. citizen graduates of foreign medical schools, largely in the Caribbean, and well over 4,500 are non-U.S. citizens who attended a wide variety of schools abroad. As you may know, all the other suppliers of U.S. physicians--the osteopathic schools, the for-profit offshore schools, and many other foreign schools--also see a U.S. doctor shortage on the horizon, and they are rapidly expanding their capacity even as we speak. Five new osteopathic schools have opened in the past 10 years and several more are on the drawing board....

Is this a cause for concern? I certainly think it is. To think otherwise would imply that ACGME training provides graduates of non-LCME schools with all the benefits our students obtain as undergraduates-that by the time residents finish their training, any differences that existed on entry to GME are no longer evident. I just don't believe that.

I think our model of undergraduate medical education offers the public something of special value-that it equips our students with a set of critically important, foundational capabilities and attitudes that the current format of GME does not and cannot provide. Even if you think otherwise, consider the ethical questions raised by our reliance on foreign schools to educate so many of our country's doctors. Can we, in good conscience, continue to recruit so many highly educated professionals from developing countries who clearly need them much more than we do? "

For years I've advised premeds to seriously consider, among all other consequences of an off-shore medical education, the real possibility that caribbean medical schools' lack of a federally recognized, validated, and rigorously peer reviewed educational accreditation process could someday be a serious liability---especially if individual states use accreditation as a proxy for professionalism, quality, or competency. Both US MD and DO schools have validated, systematic review and accreditation processes that guarantee this and keep them accountable to stakeholders in the US health care system (patients, payors, and insurers) while caribbean schools have not developed these mechanisms.

I'm curious what others who have first hand experience with the caribbean educational system think about this. Should caribbean medical schools develop their own competing model of medical education, become LCME-accredited, or what? How do you think that they will find their way out of this situation?

 

[McGillGrad]

Which LCME-approved school did you graduate from?

 

[tkim]

"You need to be registered to read the entire article, but in summary: Various groups including the ACGME/LCME/AOA and state licensing boards are concerned about the recent growth in caribbean medical schools."

I don't have access to the article, either, but Doc Russo mentions it's not just the LCME that expresses concern.

Don't make it or take it personal, please.

 

[McGillGrad]

It is also interesting to note that up until recently, the Canada made is extremely difficult for any non-Canadian physicians (including Americans) to practice in Canada because Canadian standards were not met by non-Canadian physicians.

This means that you would be termed inferior in Canada. Apply that logic to your argument.

 

[McGillGrad]

I don't have access to the article, either, but Doc Russo mentions it's not just the LCME that expresses concern.

Don't make it or take it personal, please.

The argument is being presented by an American graduate who has no knowledge of the education provided by Caribbean or Foreign bodies. That exudes bias and is directly related to my second post.

 

[tkim]

The argument is being presented by an American graduate who has no knowledge of the education provided by Caribbean or Foreign bodies. That exudes bias and is directly related to my second post.

He points out that the Carribean schools lack a similar accrediting body such as the AOA or LCME and raises the question of whether such a body is necessary.

There are many, many points of discussion that spring from this thread. If you respond only to attack the original poster and not the ideas under discussion, you are really not contributing much to the thread.

If you have better - and I think Doc Russo specifically asks people with more info on Carrib schools to contribute - knowledge, please offer it up.

 

[McGillGrad]

He points out that the Carribean schools lack a similar accrediting body such as the AOA or LCME and raises the question of whether such a body is necessary.

There are many, many points of discussion that spring from this thread. If you respond only to attack the original poster and not the ideas under discussion, you are really not contributing much to the thread.

If you have better - and I think Doc Russo specifically asks people with more info on Carrib schools to contribute - knowledge, please offer it up.

I keep forgetting that my years of liberal arts have given me the advantage of critical thinking and thesis location. I will go ahead and give you a quick review. The underlined text is his argument and his thesis. Everything before the underlining was the build-up and evidence. Everything following the underlined thesis is more unfounded proselytizing.

 

[tkim]

I'm going to take a step back and let Doc Russo flesh out his argument. In the meantime, I sincerely hope more meaningful discussion takes place in this thread.

 

[McGillGrad]

H

If you have better - and I think Doc Russo specifically asks people with more info on Carrib schools to contribute - knowledge, please offer it up.

All in all the first two years of the Caribbean covers all topics covered in American medical schools. There are only so many ways you can teach the basic sciences. Then the students have to successfully pass Step 1 in order to continue to clinicals.
Most Caribbean schools have clinicals in the United States alongside American Medical School (AMS) students. The top 4 Caribbean medical schools (that graduate the majority of licensed Caribbean physicians) have mostly ACGME approved rotations.
Then just as all AMS students, they have to take Step 2 and interview for a residency.

I fail to see where this magical element is added. Where exactly do American Medical Graduates get these extra "foundational capabilities and attitudes," that make them superior?

 

[McGillGrad]

Which LCME-approved school did you graduate from?

Nevermind, I found your licensing information. I am surprised by your post because you are attacking your own degree.

Please explain your reasoning.

 

[Waiting4Ganong]

<usual rubbish deleted>

I can see an argument that Carib for profit schools don't really give students the "other" non-usmle factors that go into making a doctor. So why not increase US medical student numbers to admit say an extra 1.5K students a year from non-traditional backgrounds (postbacs, grad students, Nurses, EMT) providing they meet min requirements (MCAT>30 and passing grade in two medical school classes should do it!). This would leave 18K
graduating from US MD schools each year leaving space still for 4.5K true internationals (that guy from top of his class in Sydney for example!).

A drastic solution would be to make acceptance into a US ACGME residency require graduation from a US MD school or be a true FMG. Carib schools disappear overnight (they serve no other function). This would require that the LCME admissions people find a way to recruit those top 1300 carib students who would be otherwise lost in this system...


Sorry if this post is less coherent than usual (ie: more incoherent than usual 🙄 ) - trying to do three things at once today...

 

[neilc]

All in all the first two years of the Caribbean covers all topics covered in American medical schools. There are only so many ways you can teach the basic sciences. Then the students have to successfully pass Step 1 in order to continue to clinicals.
Most Caribbean schools have clinicals in the United States alongside American Medical School (AMS) students. The top 4 Caribbean medical schools (that graduate the majority of licensed Caribbean physicians) have mostly ACGME approved rotations.
Then just as all AMS students, they have to take Step 2 and interview for a residency.

I fail to see where this magical element is added. Where exactly do American Medical Graduates get these extra "foundational capabilities and attitudes," that make them superior?

let me start by saying that i think the top carib schools do an excellent job of training future physicians...that being said, i do think that there are a bunch of less than stellar schools popping up. i doubt these schools have the resources, faculty and infrastructure to provide a good, solid medical education.

the way i viewed the article was that there should be an accreditation process that validates the education in the carib schools. not too tall in order, IMHO. the better schools have already put together some group with the intent of evaluating and accrediting schools.

i think the OP has one good point...the lack of an independent evaluation or accreditation is a fairly large liability. the carib schools really only have DOE and the state of CA to provide any sort of evaluation. that is one reason i have always encouraged potential students to at least attend a school that has SOME outside, independent evaluation that demonstrates credibility.

but, i don't see the argument being that the US schools have some magic ingredient. nor do i think that there is anything extremely special about the teaching of basic sciences. i think the point is that even this basic level of instruction cannot be assured without a process. and, given the small resources, the non-us trained faculty and the lack of solid infrastructure at many of the newer, smaller carib schools, there is a real risk that the seemingly simple task of providing a basic science education is too much to ask.

IMHO, accreditation is a great thing. the good schools (ie saba, auc, ross, sgu) will have no problems with it. the bad schools will disappear. what could be more simple?

 

[drusso]

Look: I'm not trying to "attack degrees" or bash caribbean schools. Some of you may know that I've been involved with SDN since its inception and believe in the value of good, productive argument of contentious issues as they relate to medical education. These arguments do not have to degenerate into flame wars or personal attacks. I've been through hundreds of utterly unproductive "DO vs MD" threads and have the scars to prove it!

Now, I've already made clear my bias on the issue so you know exactly where I stand---that is, (just to reiterate the point again so it's not misconstrued)---choosing to get your medical education through a non-accredited off-shore medical school invites more "hassles" and career hurdles compared to attending an accredited US medical school (MD or DO). I'm not making any claims about whether certain individuals who attend those schools will make great doctors. But I've been consistent for years in advising pre-meds that if they have a choice, they should choose any US-accredited medical school (MD or DO) over a non-accredited one. (Doctor of Medicine or Doctor of Osteopathic Medicine Which?) Clearly, if they have no choice at all then its any port in a storm.

I think that these new arguments about individual licensure versus accreditation raise interesting issues for both US DO schools and caribbean schools, but I think that the stakes are much higher for the caribbean schools because of their lack of formal organizational bodies that represent to the public and stakeholders exactly what they do. The AOA and its various accreditation bodies (it's Bureaus of professional education, its independent health care facility accreditation body, its independent board examination groups, its specialty colleges, etc) work on many of the same policy issues as do the US MD groups (the AMA, the LCME, the ACGME, etc). As DO's we have a parallel infrastructure (AMA =AOA; ACGME = ECOPT/OPTI; AAMC = AACOM; NBME = NBOME; AMSA = SOMA) to certify, accredit, and represent what we do. All the same MD and DO groups go to Capital Hill together to lobby on various issues, they all employ the same law firms, they split cab fares, they even trade employees! The executive director of the AOA used to be vice president of health policy at the AMA!

John B Croby Biography

And, the major point being, these individuals are the ones who make health care policy that affects medical education and service delivery every day. It is their biases that actually have the force to change the way things are done---not mine! Those of you who know a little history of the osteopathic medical profession know that this parallel structure evolved out of necessity. DO's had to develop these mechanisms and it took almost 100 years to get every thing set in place. Organized allopathic medicine (not individual doctors, but the "rain-makers" and "agents of change" and policy wonks in the allopathic medical profession) more or less consider the whole US osteopathic establishment the "Mac OS" of the US Health Care System---or the "Battlestar Galactica" of US physicians---a small minority alternative. And, to some extent, I suspect that keeping DO's around helps them feel just a little less fascist about the whole situation. Or, as they saying goes among old-timer DO's: "First they (the MD's) tried to bury us, then they tried to absorb us, now they're just killing us with kindness (ie taking our graduates, taking our money, and taking our hospitals).

However, the major strength of the situation for the osteopathic establishment is that no matter what the AMA, AAMC, ACGME, state licensing boards, etc may say about accreditation as a proxy for "quality," or "professionalism," or "attitudes," or "critical thinking" they can't say that osteopathic professional groups don't have it. They do. And they have for several decades...

All of which leads me to my original question to those of you who believe in the "caribbean cause": What should caribbean (or other off-shore medical schools) do if these arguments (ie accreditation trumps individual licensing) continue to be persuasive among those who regulate medical practice?

I see at least few different solutions:

1) All caribbean schools become LCME-accredited (I think that this what most caribbean students would prefer, but I doubt that caribbean schools have the resources to make it a reality in the near future).
2) All caribbean schools become AOA-accredited (this would certainly be the *most* interesting solution!)
3) All caribbean schools embrace some European accreditation standard.
4) All caribbean schools band together and develop their own infrastructure and organized professional societies with the influence and credibility to "be at the table" with the US MD's and DO's.
5) All caribbean schools embrace and promote a more global process/model of medical education and accreditation using already established international mechanisms. (I think that some schools informally do this already. But, maybe carribbean schools should explicitly promote this strategy: a "we train doctors for the world" campaign that sends their students all over the globe learning medicine from all sorts of physicians in different countries and cultures. Every professional group as its tagline and cause: AMA = "Helping doctors help patient." AOA = "Treating your family and ours." Maybe the analagous off-shore caribbean professional group could be "Making doctors for the world." Thus, they could argue that embracing any *ONE* standard--US or otherwise--would jeopardize the model of medical education they are seeking to provide.)

Anyway, I throw these up for discussion. I know that there are many caribbean advocates here and I'd like to hear how they address these concerns and issues with pre-meds who come to them for advice, what they see happening to their alma maters, and what they invision the off-shore caribbean infrastructure looking like in 20 years.

 

[Waiting4Ganong]

Unreserved apologies for a brainstem/knee jerk response to your posting that article. You can never win a fight against a strawman! I've withdrawn my post - in my defence - I did warn it may be incoherent!

P.S: For the record - I think US organised medine would gain a great deal from reaching out to other national accreditation bodies (why only Canada?) and set some common standards. I'm not a huge fan of Carib or offshore schools but if they do meet the standards (which surely must include some home clinical rotations?), why not let a couple of them come "onshore" (?SGU, Ross). Associated with this would have to be a policy to only accept those applicants for ACGME residency programs and state licences whose medical schools are in (inter)nationally accredited schemes. Anyway - I've demonstrated a lack of useful contrib. already today so I'll sign off there...

 

[McGillGrad]

but, i don't see the argument being that the US schools have some magic ingredient. nor do i think that there is anything extremely special about the teaching of basic sciences.

Here is the exact sentence:

I think our model of undergraduate medical education offers the public something of special value-that it equips our students with a set of critically important, foundational capabilities and attitudes that the current format of GME does not and cannot provide

 

[neilc]

Here is the exact sentence:

gotcha...thanks for pointing it out.

i agree that med school is more than just the USMLE and GME, but i certainly do not think that the US has a monopoly on excellent medical education. and, the better offshore schools in the carib have copied the US model so well, that i think anything "special" is built into those schools as well.

it does seem like a poorly disquised "we US grads are so much better" type thread.....

 

[leviathan]

gotcha...thanks for pointing it out.

i agree that med school is more than just the USMLE and GME, but i certainly do not think that the US has a monopoly on excellent medical education. and, the better offshore schools in the carib have copied the US model so well, that i think anything "special" is built into those schools as well.

it does seem like a poorly disquised "we US grads are so much better" type thread.....

Every country thinks they have the best medical education. Canadian friends of mine in medical school or residency think Canada has a superior education to the American system, for example.

 

[fivebass]

I think it is fairly evident that many of the US medical licensing organization are there to protect the profession and those working in that profession. By instating licensing requirements on schools and those who want to join the profession, these organizations are able to manipulate the medical profession. In a way, they may be seen as “quality control”. All of this effort put into regulating a profession ensures the vitality and the continuation of the professionals at a traditional level. Large licensing organizations are seen in just about every profession in the US from law to engineering.

The question of the need of licensing organization for the carib schools shows how the “regulators” of the medical profession in the US feel their profession being threatened. It seems as though the emergences of carib graduates will up-set the balance in the medical profession that has been created by these licensing organizations.

This is just my opinion. I have no reason to doubt the competence of carib grads compared to US grads. I simply see licensing organizations as a way to protect a profession.

 

[drusso]

So, then is the general consensus that applicants to caribbean schools are told to ignore the entire issue and not worry about it? I'm wondering how the leadership at caribbean medical schools share this information with prospective students.

 

[neilc]

first of all, i doubt this ever comes up with applicants. why would it? the better schools have few if any problems getting grads licensed in any state. there is currently no accreditation body to talk about. it is not currently an issue.

the better question is what are they doing to generate legitamacy, and to seperate the good from the bad...so far, they have done all they can. approval in the states that require it, DOE, NCFEMA evals, etc...they are going further by trying to get CARICOM set up as a regional accreditating body.

i think the issue is really with the smaller,newer schools that are popping up. there is no real question that the older, larger schools have been doing it right for a while now. the article (in my interpretation, at least) is pretty clearly worried about the fly by night operations, as opposed to the established ones. so i think the "issue" is not even a significant problem for the vast majority of carib students. the better schools know what is at stake, they know they are good enough to pass muster with pretty much any accrediting body. they just need to find one who will accredit, or develop one.

anybody who pays any attention the the carib schools know who the real players are, and who the pretenders are. there just needs to be an official process to let the boards know, and to give the newer schools a legit standard to meet.

 

[NewCanadian]

[/QUOTE]Should caribbean medical schools develop their own competing model of medical education, become LCME-accredited, or what? How do you think that they will find their way out of this situation?[/QUOTE]

Caribbean Accreditation Authority for Education in Medicine and
Other Health Professons (CAAM), Kingston, Jamaica

A recent letter from the Executive Director of the CAAM explains:

"The Caribbean Accreditation Authority for Education in Medicine and
Other Health Professons (CAAM) was launched in July 2004 following
signature of the Agreement establishing the Authority by CARICOM member
countries. At present there is a Secretariat which is responsible for
the day-to-day activities of the CAAM. The Authority is funded by
CARICOM member countries.

"The UWI is indeed the first medical school whose medical education
programmes are undergoing the accreditation process.

"The medical education programmes of St. George's University in Grenada
and the University of Guyana are on track to follow the UWI.

"Ross University has not yet indicated interest in being accredited by
the CAAM but are fully aware of the Authority's existence.

"With respect to gaining information on the Caribbean Community you may
consult its website at www.caricom.org

"Should you require any further information please do contact the
Secretariat.

Executive Director
Caribbean Accreditation Authority for
Education in Medicine and Other Health
Professions (CAAM)
P.O. Box 5167, Kingston 6, JAMAICA

Other information IS available at:
http://www.mona.uwi.edu/fms/currentnews.htm

***************
CARICOM www.caricom.org

"OBJECTIVES OF THE COMMUNITY
The Community has the following objectives:
(a) improved standards of living and work;
(b) full employment of labour and other factors of production;
(c) accelerated, co-ordinated and sustained economic development and convergence;
(d) expansion of trade and economic relations with third States;
(e) enhanced levels of international competitiveness;
(f) organisation for increased production and productivity;
(g) the achievement of a greater measure of economic leverage and effectiveness of Member States in dealing with third States, groups of States and entities of any description;
(h) enhanced co-ordination of Member States' foreign and [foreign] economic policies; and
(i) enhanced functional co-operation, including -
(i) more efficient operation of common services and activities for the benefit of its peoples;
(ii) accelerated promotion of greater understanding among its peoples and the advancement of their social, cultural and technological development;
(iii) intensified activities in areas such as health, education, transportation, telecommunications.

MEMBERS
1. Antigua and Barbuda
2. The Bahamas
3. Barbados
4. Belize
5. Dominica
6. Grenada
7. Guyana
8. Haiti
9. Jamaica
10. Montserrat
11. Saint Lucia
12. St. Kitts and Nevis
13. St. Vincent and the Grenadines
14. Suriname
15. Trinidad and Tobago
CARICOM ASSOCIATE MEMBERS
1. Anguilla - 4 July 1999
2. Bermuda - 2 July 2003
3. British Virgin Islands - 2 July 1991
4. Cayman Islands - 15 May 2002
5. Turks and Caicos Islands - 2 July 1991

 

[bansheeDO]

The argument is being presented by an American graduate who has no knowledge of the education provided by Caribbean or Foreign bodies. That exudes bias and is directly related to my second post.

I would think a Carribbean graduate would welcome the opportunity to create an accrediting body to maintain a set of standards that held accountable for. It would lend credibility to a system of education that has cast serious doubts. But rather than welcome such a process or even discuss creating one, you immediately got defensive and offerred trite insults. Perhaps your bitter response is due the fact that you are aware that Caribbean schools will likely never create an accrediting body because it would limit them and not allow them to circumvent U.S. standards such as mandating the MCAT which they only recently adopted a few year ago. I would encourage you to adopt a different attitude. There is no need to play the role of school's mascot. Instead, I would encourage you to apply those liberal art endowed critical thinking skills toward a solution instead of bitter acrimony.

 

[bansheeDO]

The argument is being presented by an American graduate who has no knowledge of the education provided by Caribbean or Foreign bodies. That exudes bias and is directly related to my second post.

I would think a Carribbean graduate would welcome the opportunity to create an accrediting body to maintain a set of standards that would allow Caribbean schools to be held accountable for. It would lend credibility to a system of education that has cast serious doubts in the past. But rather than welcome such a process or even discuss creating one, you immediately got defensive and offerred trite insults. Perhaps your bitter response is due to your impression that Caribbean schools will likely never create an accrediting body, because it would limit them and not allow them to circumvent U.S. standards such as forgoing the MCAT requirement which they held up until a few years ago.

I would encourage you to adopt a different attitude. There is no need to play the role of the school mascot. Instead, I would encourage you to apply those liberal art endowed "critical thinking" skills toward a solution instead of bitter acrimony.

 

[CatsandCradles]

I see at least few different solutions:

1) All caribbean schools become LCME-accredited (I think that this what most caribbean students would prefer, but I doubt that caribbean schools have the resources to make it a reality in the near future).

What are some of the resources that the Carribean schools will need to become LCME accredited?

Does this involve setting up extensive legal groups in Washington DC? Or does this mean that there is a "large sum" of money so to speak?

And if this happens, will there be government disputes as to who owns the school?

And is the Liason Comitte for Medical Education only for the US? It includes Canada too...

...so correct me, but this is like a medical school under American regulations...yet it is on the UK's island/soil. Sort of like making Oxford University have American regulations even though it's on UK soil.

Are the Brits going to be happy about us Yanks taking over thier schools?

Now many of these Carribean schools are not on UK soil, SGU is on an island owned by the Netherlands.

2) All caribbean schools become AOA-accredited (this would certainly be the *most* interesting solution!)

Now there's a thought. But similar to my worry previously - I wonder what the Brits would think if their schools fell into the hands of the American Osteopathic Association.

And another thought, the DOs in the UK don't like US DOs. They have a very different scope of practice.

3) All caribbean schools embrace some European accreditation standard.

I think this would be a good idea. Hey a lot of those islands are under control of Europe.

4) All caribbean schools band together and develop their own infrastructure and organized professional societies with the influence and credibility to "be at the table" with the US MD's and DO's.

Another good idea. But I think your number 5 is more interesting

5) All caribbean schools embrace and promote a more global process/model of medical education and accreditation using already established international mechanisms. (I think that some schools informally do this already. But, maybe carribbean schools should explicitly promote this strategy: a "we train doctors for the world" campaign that sends their students all over the globe learning medicine from all sorts of physicians in different countries and cultures. Every professional group as its tagline and cause: AMA = "Helping doctors help patient." AOA = "Treating your family and ours." Maybe the analagous off-shore caribbean professional group could be "Making doctors for the world." Thus, they could argue that embracing any *ONE* standard--US or otherwise--would jeopardize the model of medical education they are seeking to provide.)

 

[ER-ER-Oh]

There is only one reason Caribbean schools exist: US allopathic schools DO NOT ACCEPT enough candidates to meet the needs of US consumers of health care. PERIOD. There is no magic to this. I've said this before, I had good grades and good MCAT scores. There are people who got into US schools who had lower qualifications than I did, PERIOD. 2/3's of my class could have been top students at any US school. It's all about the frat-boy, sorority-girl mentality of medical schools...looks like doc, acts like a doc, let's let them into the club.

 

[PathOne]

I would agree, that the lack of accreditation at Carib schools is a problem. Currently, there's only the WHO listing requirement, which, in my mind, is a complete joke, as there's absolutely no initial or ongoing quality control.

Having the LCME perform such an accreditation has some merits, as it already accredits schools in two countries, and clearly has some experience in this field. Additionally, the Joint Commission not only accredits US Hospitals, but also hospitals in other parts of the world.
However, this issue is also political, as AMA would probably work long and hard to prevent a glut of doctors, due to increased supply of med school slots. Obviously, AMA/LCME is much more restrictive about certifying new schools than their DO counterparts.

Still, I strongly feel that training physicians is a complicated task, and that it's a problem in general, and for the established Carib schools in particular, that it's apparently so easy to set up a medical school in the Carib; get a WHO listing, hiring some third world instructors and conduct medical training under a tin roof in a couple of classrooms.

Ultimately, the most practical solution would probably be a working regional Carib accreditation system. I highly doubt that the current or former European parents of most of these islands would be interested in supplying a solution, as so very few of the Carib graduates end up in Europe. Also, teaming up with the DO's probably wouldn't work either, as some, if not a lot, of those attending Carib schools feel strongly about the whole DO-MD discussion (which, btw, isn't the point of this post).

 

[drusso]

I would agree, that the lack of accreditation at Carib schools is a problem. Currently, there's only the WHO listing requirement, which, in my mind, is a complete joke, as there's absolutely no initial or ongoing quality control.

Having the LCME perform such an accreditation has some merits, as it already accredits schools in two countries, and clearly has some experience in this field. Additionally, the Joint Commission not only accredits US Hospitals, but also hospitals in other parts of the world.
However, this issue is also political, as AMA would probably work long and hard to prevent a glut of doctors, due to increased supply of med school slots. Obviously, AMA/LCME is much more restrictive about certifying new schools than their DO counterparts.

Still, I strongly feel that training physicians is a complicated task, and that it's a problem in general, and for the established Carib schools in particular, that it's apparently so easy to set up a medical school in the Carib; get a WHO listing, hiring some third world instructors and conduct medical training under a tin roof in a couple of classrooms.

Ultimately, the most practical solution would probably be a working regional Carib accreditation system. I highly doubt that the current or former European parents of most of these islands would be interested in supplying a solution, as so very few of the Carib graduates end up in Europe. Also, teaming up with the DO's probably wouldn't work either, as some, if not a lot, of those attending Carib schools feel strongly about the whole DO-MD discussion (which, btw, isn't the point of this post).

FYI---It's interesting to see the Federal and State Medical Board's take on the whole issue:

Special Committee on the Evaluation of Undergraduate Medical Education

 

[Skip Intro]

I'm having trouble with the continued and repeatedly ignorant assumptions that have been made on this thread. Caribbean medical schools do have accreditation bodies and standards.

Read that again.

Caribbean medical schools do have accreditation bodies and standards.

They may not be the LCME. They may not be the AOA. They may not even be very rigorous. But, they do exist. Individual countries are responsible for maintaining these accreditation standards, and they must be maintained for the WHO to list the school in the IMED directory.

"Okay, big deal," you say. "Any country can whip together an accrediting body and some standards, especially a corrupt little third-world Caribbean island nation."

Fair enough. This is a legitimate counter-argument. HOWEVER, matriculants in certain schools have the blessing - in advance - of state licensure boards as well as the federal government. They are already deemed "substantially equivalent" to U.S. schools. Their individual country's accrediting body is also certified by the U.S. They are already eligible for federal loans. Why create an extra accrediting body when they've already received (and are regularly audited) by existing ones? Quite simply, the ones that fail to meet the "substantially equivalent" sign-off will not receive this funding, nor will their graduates be able to be licensed in that state. In other words, caveat emptor.

The fact is, the reason why a unified accrediting body (like the LCME) does not exist in the Caribbean there is no necessity for it. Ross, St. George's, and AUC graduates easily return to the U.S., easily obtain residencies (many of them quite competitive - myself included), and easily obtain licensure. The "extra hoops" alluded to are often nothing more than just-slightly-more-than-bothersome red tape, and certainly don't equate to the entire mandatory year of required osteopathic internship in order to avoid future licensure issues.

Until such a time as it's mandated, this proposed unified accrediting body will not exist. So, continuing this entire discussion is essentially a fool's errand. The people proposing such a body are not informed of the demographics. If you cut-off the extra 1200-1500 U.S.-IMG doctors per year that enter residency in the U.S. each from the Carib schools, you will be losing out on a huge amount of future physicians who are desperately needed to take care of an aging population in the U.S. - including that portion of the population that already has limited access to healthcare. You can't argue against demographics. That's why this tempest in a teacup will never snowball. It's nothing more than an exercise in political masturbation.

So, don't get your panties in a bunch, boys and girls. As long as there is a doctor shortage (and there will be for at least the next 20 years), the snobs can try to stir the **** all they want. And, they won't get very far.

The fact is, most informed students who attend these schools know these things - and they are the majority. To assume that we don't shows your ignorance on the subject matter, not ours. Are there some crappy schools in the Caribbean that still get doctors licensed in the U.S.? Sure. But, that speaks more to the quality (and perhaps permissibility) of individual licensure boards in a particular state that is desperate for doctors. You think they want to limit the influx of bodies needed to fill spots in a desperately short-staffed profession? You'd be wrong.

So, my advice is to focus your energy on things that actually might improve the medical profession - uniformly, equitably, and given deference to the individual practitioner. Otherwise, to blanketly apply standards to an entire group of individuals - ones who've proven that they can survive the challenges and demands and hardships of choosing a difficult path to becoming a doctor - only reeks of elitism and (dare I say) bigotry.

-Skip Intro

 

[Trifling Jester]

http://www.ama-assn.org/amednews/
I think our model of undergraduate medical education offers the public something of special value-that it equips our students with a set of critically important, foundational capabilities and attitudes that the current format of GME does not and cannot provide. Even if you think otherwise, consider the ethical questions raised by our reliance on foreign schools to educate so many of our country's doctors. Can we, in good conscience, continue to recruit so many highly educated professionals from developing countries who clearly need them much more than we do? "

Critically important foundational capabilities and attitudes (or insert some other "intangibles argument" here)...Nothing objective that can be measured, right? Of course not, since it would provide a basis for rebuttal. I'm curious - exactly what attitudes do you think an LCME accredited school will give its students that an overseas one cannot?

And ethically, we should be recruiting the very best doctors regardless of where they learned medicine. You know, provided the applicants have "critically important foundational capabilities and attitudes" in those faroff exotic lands of India and Grenada.

-The Trifling Jester

 

[sleepy31]

It's all about the frat-boy, sorority-girl mentality of medical schools...looks like doc, acts like a doc, let's let them into the club.

You nailed my anxiety on the head with this statement. I am premed, nontraditional and have a physical disability that is prejudiced mostly by doctors themselves and not the general public (the tend to think its "kinda neat" 😴 ). I have the grades, and it looks like I will probably have the MCAT scores to get into an AMS, but I am not sure that is the route that I WANT to go. I am enticed by the Carribean schools because I am getting the feeling these schools provide an education rather than initiation. I am not concerned with it being "what I put into it" as I am extremely disciplined and motivated (have to be with a physical disability). I am not entirely concerned with residency programs - I may just head straight for a Ph.D program after the M.D. anyway. Mostly, I fear what I am already starting to see, hear and feel. I am sensing (though I could very well be wrong) that AMSs act as if they are doing their students a favor by allowing them to study at an AMS. I don't want that feeling. I want a facility that is fostering and wanting its students to succeed. 👍

One of my three undergraduate degrees was obtained at a school that was among the top 5 in the nation for that field. I hated that school (loved the university though). The professors were mostly less than helpful and it got its reputation soley because of the quality of students that it taught. My other two degrees were obtained from a university with a very small department that is growing like wildfire. The professors were very caring and involved with their students, constantly pushing them to do better and go further. The opportunities were endless as the school was not saturated. That is what I want in a medical education. 😀

And quite frankly, though the weather in CA is beautiful, I like the ground I stand on to be solid. Not practicing there is NOT an issue.

 

[neutropenic]

It's all about the frat-boy, sorority-girl mentality of medical schools...looks like doc, acts like a doc, let's let them into the club.

Oh, so that's why I had to show them my fraternity branding scar on interview day. It was a bit awkward disrobing though. It all makes sense now.

Oh, the days of strolling down Piedmont Avenue carrying bricks and wooden crosses, I miss those days.

I am enticed by the Carribean schools because I am getting the feeling these schools provide an education rather than initiation.

Yes, initiation. We had whips, paddles, and blindfolds at our white coat ceremony. I had to keep on saying, "Yes, pledgmaster, one more please." 😳 No, not really.

My sense is that these institutions are more aimed at profit than anything. They serve a means to an end. Right or wrong, I feel that Carib students end up being second class citizens. I don't condone it, but it seems institutional. It seems like many resprogs would rather take an AMG who has failed steps, failed years in medical school than take an average or above average Carib student. Some resprogs won't even interview foreign grads.

What ever happened to the movement to decrease GME slots closer to the number of US grads? Wasn't that part of some medicare spending bill? What would happen to the Carib schools if that happened? Would they just disappear?

There is no magic to this. I've said this before, I had good grades and good MCAT scores. There are people who got into US schools who had lower qualifications than I did, PERIOD.

I will admit that there is what appears to an outside observer an element of arbitrariness and capriciousness to medical school admissions.

Maybe we should go to the Indian model and just admit based on test scores alone?

But our system is a holistic one that evaluates the whole applicant and there are many constituencies also that must be addressed. There is the son/daughter of a doctor so and so slot. There is the viola player from Crescent City or Bolinas and gosh golly gee we haven't had anyone from theat area in centuries so we gotta take her slot. There is the used to work as an i banker and is gung ho and interesting slot. There is the worked in Dr. Jung's lab for the last 18 summers and she's practically a fixture slot. There is the URM that's a cheerleader and started a clinic serving diabetic children in Guadalajara with her summer break slot. There are many slots that are already set aside, and with different demands for a limited commodity. The doling of the slots seems capricious but it is not. It is a well thought out process. Maybe not along the lines that everyone would like to see, but it is a deliberate process nonetheless.

 

[mehul_25]

I am a PGY-4 PM&R resident about to graduate from residency. I am a US Citizen. I am also a graduate of a foreign medical school.

I ALWAYS tell applicants to exhaust all efforts to get into US allopathic and osteopathic medical schools prior to considering the Caribbean or other foreign destinations.

I find many of the posts on this site and others like it to be misdirected. Many people here immediately rail against posts that they perceive to be anti-Caribbean. They take a hard-line stance in an effort to project Caribbean schools as equivalent to US schools. Unfortunately for anyone in Caribbean schools or planning to go to them this is simply untrue. For most, the Caribbean provides an option where none other exists, not a completely consequence-free loop-hole.

To argue against the comments made by Dr. Russo is absurd. It is arguing against fact. It is a fact that there are concerns regarding the quality of training in Caribbean medical schools. It is a fact that they do not provide the comprehensive curriculum that is prevalent in the majority of US schools. It is a fact that there are no overriding guidelines or governing bodies that oversee the quality of these schools.

It is also a fact that there are many, many high-quality Caribbean graduates. It is a fact that the most-established schools typically have no problem placing residents into quality training programs particularly in primary care specialities.

If we as FMGs want to continue to assert our rights to train and practice in the US, we must also keep in mind the concerns that affect our ability to do so. It would be arrogant to blind ourselves to the issues of training abroad for the sake of ego. Most of my peers; those of us who graduated from medical school together would welcome greater oursight and regulation in Caribbean schools. I would welcome LCME-accreditation, regional accreditation (like that bestowed upon University of the West Indies), however I suspect that this would be unlikely for a variety of factors, chief among them to be reluctance of foreign medical schools to allow outsiders to interfere with their fiefdoms.

 

[drusso]

I think the original post hit the nail on the head: the question is whether to certify individuals or processes (or both). I think it is only necessary to certify processes to the extent that we are unable (or unwilling) to certify individuals.

Exactly right. However, the current climate in health care policy is focusing on addressing quality issues vis-a-vis process and procedural initiatives. Think Leapfrog, Six Sigma, P4P, etc in the business world. These initiatives focus on improving the process and not the product per se. Good processes will result in quality products.

So, the thinking goes, it is not that any given Caribbean graduate lacks the capacity to practice medicine because of idiosyncratic reasons, but it is because the off-shore educational process has deficiencies in terms of selection, professionalism, and training. The trick to understanding the argument is to separate the individual from the process. The certifying boards and FSMB are beginning to argue LCME and AOA graduates are better "products" because their educational process includes more quality checks. Instead of focusing on single "bad apples" focus on the entire enterprise.

 

[Skip Intro]

It is a fact that they do not provide the comprehensive curriculum that is prevalent in the majority of US schools. It is a fact that there are no overriding guidelines or governing bodies that oversee the quality of these schools.

You are, quite simply, wrong.

http://www.iamra.com/iamra.asp (NB: look at the countries listed)

http://www.ed.gov/about/bdscomm/list/ncfmea.html#decisions (list of schools whose individual accrediting authorities' standards, according to the U.S. Department of Education, have been examined and are deemed comparable to the accreditation standards of the LCME)

http://www.opm.gov/qualifications/SEC-II/s2-e4.asp (Section 4(c) further explains why graduates of these approved schools are eligible, among other things, for employment in the U.S. federal government)

http://content.nejm.org/cgi/content/full/343/15/1120 (read this one in its entirety, it's well worth it)

http://www.medbd.ca.gov/Applicant_Schools_Recognized.htm

http://www.rossmed.edu.dm/Current_N...ates_may_/ross_university_graduates_may_.html

I don't know which undergrad med school you went to, but don't attempt to speak to the facts when you don't know the actual facts. (Frankly, I'd expect a little bit "more" from a supposedly senior resident. Don't you engage in medical practice using an "evidence based approach" in PM&R?)

-Skip Intro

 

[mehul_25]

Skip intro, your hostility is exactly what I would expect. I am curious to what your training might be...

I stand by my statement regarding guidelines and oversight into Caribbean medical schools. Your multiple links are misleading in my opinion. To further clarify my earlier point most accreditation efforts on the part of Caribbean schools particularly with regards to US states (Texas, California) represent a point in time rather than their day-to-day operations. Making everything look great for inspectors for a finite period is certainly easier than actually fixing things.

Critically appraising the process and addressing real deficiencies would benefit current and future Caribbean medical graduates.

 

[oldpro]

This whole thread was started about how Caribbean schools are just as good as US schools, well the truth is.............

In some ways they are and in some ways they are not.

They are different. Different countries, different cultures

You will be a FMG.

You may still be able to get a good residency you want but step score better be high.

Some schools are better than others in the Carib.

There is more than one way to teach and not all the US schools teach the same either.

Some US grads have a problem with not thinking they are GODS and no one who came out of the Caribbean are as good as they.

Not everyone who goes to a Caribbean school could ever get into a US school if they had more spots, keep reading this and it's not true, Some one with a Sci gpa of 3.0 or Uh 2.8 and mcat of 19 will never ever get an interview to a US school. Dream on. There are many out in the Carib with even lower GPA's don't kid yourself.

😎

 

[drusso]

Interesting new recommendations from the AAMC summarized here:

Allopathic Medical School Expansion

 

[Psycho Doctor]

I see at least few different solutions:

1) All caribbean schools become LCME-accredited (I think that this what most caribbean students would prefer, but I doubt that caribbean schools have the resources to make it a reality in the near future).
2) All caribbean schools become AOA-accredited (this would certainly be the *most* interesting solution!)
3) All caribbean schools embrace some European accreditation standard.
4) All caribbean schools band together and develop their own infrastructure and organized professional societies with the influence and credibility to "be at the table" with the US MD's and DO's.
5) All caribbean schools embrace and promote a more global process/model of medical education and accreditation using already established international mechanisms. (I think that some schools informally do this already. But, maybe carribbean schools should explicitly promote this strategy: a "we train doctors for the world" campaign that sends their students all over the globe learning medicine from all sorts of physicians in different countries and cultures. Every professional group as its tagline and cause: AMA = "Helping doctors help patient." AOA = "Treating your family and ours." Maybe the analagous off-shore caribbean professional group could be "Making doctors for the world." Thus, they could argue that embracing any *ONE* standard--US or otherwise--would jeopardize the model of medical education they are seeking to provide.)

Anyway, I throw these up for discussion. I know that there are many caribbean advocates here and I'd like to hear how they address these concerns and issues with pre-meds who come to them for advice, what they see happening to their alma maters, and what they invision the off-shore caribbean infrastructure looking like in 20 years.

are any caribbean schools LCME-accredited? Which ones?

 

[Psycho Doctor]

This whole thread was started about how Caribbean schools are just as good as US schools, well the truth is.............

In some ways they are and in some ways they are not.

They are different. Different countries, different cultures

You will be a FMG.

You may still be able to get a good residency you want but step score better be high.

Some schools are better than others in the Carib.

There is more than one way to teach and not all the US schools teach the same either.

Some US grads have a problem with not thinking they are GODS and no one who came out of the Caribbean are as good as they.

Not everyone who goes to a Caribbean school could ever get into a US school if they had more spots, keep reading this and it's not true, Some one with a Sci gpa of 3.0 or Uh 2.8 and mcat of 19 will never ever get an interview to a US school. Dream on. There are many out in the Carib with even lower GPA's don't kid yourself.

😎

what is a good step score?

 

[Psycho Doctor]

I am a PGY-4 PM&R resident about to graduate from residency. I am a US Citizen. I am also a graduate of a foreign medical school.

I ALWAYS tell applicants to exhaust all efforts to get into US allopathic and osteopathic medical schools prior to considering the Caribbean or other foreign destinations.

I find many of the posts on this site and others like it to be misdirected. Many people here immediately rail against posts that they perceive to be anti-Caribbean. They take a hard-line stance in an effort to project Caribbean schools as equivalent to US schools. Unfortunately for anyone in Caribbean schools or planning to go to them this is simply untrue. For most, the Caribbean provides an option where none other exists, not a completely consequence-free loop-hole.

To argue against the comments made by Dr. Russo is absurd. It is arguing against fact. It is a fact that there are concerns regarding the quality of training in Caribbean medical schools. It is a fact that they do not provide the comprehensive curriculum that is prevalent in the majority of US schools. It is a fact that there are no overriding guidelines or governing bodies that oversee the quality of these schools.

It is also a fact that there are many, many high-quality Caribbean graduates. It is a fact that the most-established schools typically have no problem placing residents into quality training programs particularly in primary care specialities.

If we as FMGs want to continue to assert our rights to train and practice in the US, we must also keep in mind the concerns that affect our ability to do so. It would be arrogant to blind ourselves to the issues of training abroad for the sake of ego. Most of my peers; those of us who graduated from medical school together would welcome greater oursight and regulation in Caribbean schools. I would welcome LCME-accreditation, regional accreditation (like that bestowed upon University of the West Indies), however I suspect that this would be unlikely for a variety of factors, chief among them to be reluctance of foreign medical schools to allow outsiders to interfere with their fiefdoms.

so would you say it's better to graduate with a DO degree in the US than an MD degree in the Caribbean? Don't Caribbean schools have clinical rotations in the US for years 3 & 4? Doesn't that get your foot in the door in the US? Are any Caribbean schools LCME-accredited? Which ones? Would graduates of thes eprograms have the same problems as those from other caribbean schools?

 

[skypilot]

so would you say it's better to graduate with a DO degree in the US than an MD degree in the Caribbean? Don't Caribbean schools have clinical rotations in the US for years 3 & 4? Doesn't that get your foot in the door in the US? Are any Caribbean schools LCME-accredited? Which ones? Would graduates of thes eprograms have the same problems as those from other caribbean schools?

There are no LCME accredited schools in the Carribean other than U.S. schools in Puerto Rico.

SGU is considered a good school though. Look at their match list:

http://sgu.edu/website/sguwebsite.nsf/Home/2006PostgraduateResidencyAppointments.htm

 

[uknowwhoitis]

Hi all,

what are my chances of getting into SGU or ROSS with a 3.9 from UCI in chemistry but an MCAT of 25O (10/11/4(VR)). Is the 4 going to kill me. Plus I have 1 year research and some clinical???????????

It would be great to know now. I am totally new to schools in the carribean since I was surprised/SHOCKED by my VR section score. Also, to be honest with you guys I am a bit scared about going through the process in that the MCAT has almost scarred me for life about such tests and that no matter what I do my reading comp. wont be too great. With that said then shouln't that mean I will have trouble with USMLE's or are these more knowledge based. Thanks a million.

 

[skypilot]

Hi all,

what are my chances of getting into SGU or ROSS with a 3.9 from UCI in chemistry but an MCAT of 25O (10/11/4(VR)). Is the 4 going to kill me. Plus I have 1 year research and some clinical???????????

It would be great to know now. I am totally new to schools in the carribean since I was surprised/SHOCKED by my VR section score. Also, to be honest with you guys I am a bit scared about going through the process in that the MCAT has almost scarred me for life about such tests and that no matter what I do my reading comp. wont be too great. With that said then shouln't that mean I will have trouble with USMLE's or are these more knowledge based. Thanks a million.

You can definitely get into the Carribean with scores like that but I know people who have gone US allopathic with lower scores. Med school is one multiple choice after another. It will definitely scar you even if the MCAT didn't 🙂 And you scored 10 and 11 in two sections! Good job. If you are only 23 consider taking a few years to reapply and regroup. Maybe do some research. Good luck

 

[oldpro]

I'm having trouble with the continued and repeatedly ignorant assumptions that have been made on this thread. Caribbean medical schools do have accreditation bodies and standards.

Read that again.

Caribbean medical schools do have accreditation bodies and standards.

They may not be the LCME. They may not be the AOA. They may not even be very rigorous. But, they do exist. Individual countries are responsible for maintaining these accreditation standards, and they must be maintained for the WHO to list the school in the IMED directory.

"Okay, big deal," you say. "Any country can whip together an accrediting body and some standards, especially a corrupt little third-world Caribbean island nation."

Fair enough. This is a legitimate counter-argument. HOWEVER, matriculants in certain schools have the blessing - in advance - of state licensure boards as well as the federal government. They are already deemed "substantially equivalent" to U.S. schools. Their individual country's accrediting body is also certified by the U.S. They are already eligible for federal loans. Why create an extra accrediting body when they've already received (and are regularly audited) by existing ones? Quite simply, the ones that fail to meet the "substantially equivalent" sign-off will not receive this funding, nor will their graduates be able to be licensed in that state. In other words, caveat emptor.

The fact is, the reason why a unified accrediting body (like the LCME) does not exist in the Caribbean there is no necessity for it. Ross, St. George's, and AUC graduates easily return to the U.S., easily obtain residencies (many of them quite competitive - myself included), and easily obtain licensure. The "extra hoops" alluded to are often nothing more than just-slightly-more-than-bothersome red tape, and certainly don't equate to the entire mandatory year of required osteopathic internship in order to avoid future licensure issues.

Until such a time as it's mandated, this proposed unified accrediting body will not exist. So, continuing this entire discussion is essentially a fool's errand. The people proposing such a body are not informed of the demographics. If you cut-off the extra 1200-1500 U.S.-IMG doctors per year that enter residency in the U.S. each from the Carib schools, you will be losing out on a huge amount of future physicians who are desperately needed to take care of an aging population in the U.S. - including that portion of the population that already has limited access to healthcare. You can't argue against demographics. That's why this tempest in a teacup will never snowball. It's nothing more than an exercise in political masturbation.

So, don't get your panties in a bunch, boys and girls. As long as there is a doctor shortage (and there will be for at least the next 20 years), the snobs can try to stir the **** all they want. And, they won't get very far.

The fact is, most informed students who attend these schools know these things - and they are the majority. To assume that we don't shows your ignorance on the subject matter, not ours. Are there some crappy schools in the Caribbean that still get doctors licensed in the U.S.? Sure. But, that speaks more to the quality (and perhaps permissibility) of individual licensure boards in a particular state that is desperate for doctors. You think they want to limit the influx of bodies needed to fill spots in a desperately short-staffed profession? You'd be wrong.

So, my advice is to focus your energy on things that actually might improve the medical profession - uniformly, equitably, and given deference to the individual practitioner. Otherwise, to blanketly apply standards to an entire group of individuals - ones who've proven that they can survive the challenges and demands and hardships of choosing a difficult path to becoming a doctor - only reeks of elitism and (dare I say) bigotry.

-Skip Intro

Yep good post 👍