a high attrition rate is a bad thing for the school to have because it gives it a bad rap. this means the school is careless in it's admission process and that the school is possibly malignant forcing people to fail out. This all means that the school gives people false hope in order to just take their money, which for the students is a bad thing, when applying to any school not just med school you want to make sure that you have a great chance of graduating after being accepted. what's the point of being accepted and wasting your time and money if you're only going to fail out. Med schools should have a strict admission process in the first place so that those that aren't smart enough don't get in, and they shouldn't accept everyone and then weed them out by making a certain percent of the class fail each exam by having a bell shaped curve.
Very true in theory, but very difficult in practice for Caribbean schools. First of all, you're already dealing with generally underqualified applicant pool in terms of GPA and/or MCATs. The challenges these schools face is looking at this applicant pool, seeing the negatives and knowing where to say "yes, but..." So what options do Caribbean admissions committees really have:
1) They can set basic cutoffs, similar to US admissions policy, looking for the typical "smart" applicants. Of course they would be lower, but not drastically lower. So you say nobody with under a 3.4 and a 26. This would certainly lead to a more selective class, but are you really getting the right US school rejects.
2) You have more fluid admissions standards. You look at the student with a 2.8 GPA but with a 34 on the MCATs. You look at the student with a 3.9 but with a 24. And you continue to look at the 3.4 and 26's. That's casting a much wider net and pretty much ensures that if there's good students out there, good future doctors, slipping through the US school cracks, you'll catch them. Of course, you also catch a lot of duds, hence attrition.
3) You have more fluid admissions standards, still acknowledging that the 2.8/34's are qualified, but just have a more rigorous and thorough application process to really narrow down what's really a vast number of such marginal applicants into only the absolutely qualified. Essentially a fluid yet exclusive admissions policy.
Which approach is really best? Well, anyone with experience in the Caribbean knows that some of the best students would not have made the cut in admissions policy 1 while some of the worst would. So some of the best students only make it because of a very forgiving admissions policy like option 2. Option 1 is probably the worst in my opinion, because let's face it, the narrow group of people above a Caribbean cutoff in both areas but below the US cutoff, well there's not much exceptional in that group. And additionally it's completely antithetical to the founding policies of these schools, that the numbers don't tell the story of a candidate. And Option 3 is just asking way too much of an admissions committee from a practical standpoint. So you're left with Option 2 and the logic that continues to drive expansion at the expense of attrition.
Personally, I'm all for casting a wide net in Caribbean schools, but culling the herd mercilessly. If the quality of entrants isn't impressive, at least the quality of graduates will be...