What Canadians need to know for Caribbean medical school - AMA

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Apr 5, 2018
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Hello. I'm a Canadian who studied in Ireland and matched back to Canada. I wanted to write this post because I currently have a family member studying at a Caribbean medical school. I was shocked by how little the current Caribbean students know before going into the program.
In addition, I have family members and friends that have studied medicine in Ireland, Scotland, UK, and Australia. Thus, I have a fairly good understanding of how Caribbean medical schools compare. This is advice that I would not have known for myself 7 years ago. I got lucky with the medical school I choose.

1.Choose Medical school in UK, Scotland, Ireland, and Australia over Caribbean

a. You are almost guaranteed an intern position in UK, Ireland, Scotland and Australia if you do not match to residency back in Canada/US

Studying abroad is ultimately a huge financial gamble. You could end up with 200 K to 400 K + debt upon graduation with no job or income. Truly that is the worse feeling in the world. As result, there should be no reason for a Canadian to go to a Caribbean medical school when there are far safer options in the UK, Scotland, Ireland, and Australia. All these schools will allow most Canadians to stay in the country to work as an intern. This helps to strengthen their application for the next match while also allowing them to have an income and backup. Eventually 100% of students in my year and the year below secured a residency spot. If you don't match as a Caribbean student you have no options. Sadly, I have met many working regular jobs with 200 k in debt.

b. The quality of medical education UK, Scotland, Ireland, and Australia is superior
You basically undergo the same medical education as local medical students. The problem with Caribbean medical schools is that it is profit driven first. They focus on scoring high on the USMLE board exams so they can attract more cash cows with their statistics. Once you start rotating through hospitals, you will find that quality teaching is hard to come by. Caribbean students are often shocked at how they are thrown into the hospital with little guidance. They often complain about the lack of teaching. The are not aware that the physicians are not paid to teach you and are overworked themselves. One news article quoted that hospitals get $400 per week per students. I make $200/hour so why would anyone have the incentive to teach unless they really like it. You will find yourself doing meaningless tasks such as drawing bloods all day.

c. Caribbean med schools are designed to kick out a certain percentage of students in the first 1-2 years.
These for profit schools intentionally take on more students than they have capacity for. They will then take your money and then kick out a good portion of students based on academic performance. If something goes wrong, do not expect them to have your back. This does not happen in UK, Irish, Scottish or Australian schools. You can fail a course but they will not kick you out for it.

d. Financial nightmare, unethical practices, and disorganization at Caribbean schools
I can only speak to one top tier Caribbean school that my family member is currently at. At her school, they hired sales people to lie and convince prospective students that their school is a great option. The school quoted her a lower tuition by offering a Canadian scholarship. Once she got in, they said it was no longer available and she had to pay the full tuition. Not only that, but other students starting warning her to not pay her semester's tuition until last minute. She was told that if something goes wrong, you will never see your money back so all students don't pay until the last minute. Honestly, the nightmare stories doesn't end there.

e. Misleading match rates and board exams scores
The residency match rates and USMLE scores are also falsely elevated and misleading. The board scores are high because they kick out low performers. At my friends school, they would refuse to allow people to write the real board exams until they score high enough on the mock exam. If you do not score high enough on the mock exam, they will let you keep trying if you pay another semester's worth of tuition until you pass.

e. Poor match rates to Canada
If the recruiter says otherwise they are lying. I know tons more Caribbean students that are jobless than I know of success stories unfortunately.
With that said, Canada is opening up more IMG spots in the next few years.

f. Limited elective options in Canada
You will have a harder time getting electives in Canada or possibly none at all depending on the school. Not all school are allowed to do electives in Canada. You need to check the list on the Canadian elective website. Even if your school is listed, most Canadian programs favour Irish and UK medical students for electives.

g. Bias
Canadian residencies programs are aware of the variability and weaknesses when it comes to Caribbean and foreign medical schools. My program had Irish students in the past so they were already fully aware of what weaknesses I might encounter. Generally, they will prefer someone who graduated from UK or Ireland over Caribbean. They are not as impartial as you think. They do judge you based on where you graduated, because it does predict potential issues in residency.

h. Lots of Canadian Caribbean students have unrealistic expectations, red flags, or are naive
I speak to my family almost daily and cringe on a regular basis at the stories I hear. Some students seem to have not done their research and went into the program after eating all the lies the recruiter fed them. Refuses to hear anything contradictory to what they believe. Some have major personality red flags for medicine that would make you think you would never want them as your doctor.

i. Not all Caribbean schools are created equal.
My friend graduated from SGU and matched back to Canada. He told me it was okay but rotations weren't that great and there was a lack of teaching on rotations. My family member who is at another Caribbean school is going through a much tougher time on rotations. It is impossible for her to get in contact with admin or to get them to do anything on time for applications. If these are the issues at first tier schools, I can't expect the lower tiers to be any better.

2. There are successes with Caribbean school and it CAN still be a viable option but there is much more risk involved

a. I know a handful of Canadian Caribbean students who have matched back to US and Canada. My only advice is that Caribbean schools can work well for a minority. It still entails much more risk than other more viable options. For example, there have been a few Caribbean medical schools that got destroy by natural disaster. Some schools lose accreditation. Sometimes you can't do the exams you need because the school is under investigation.

b. Dual citizenship can help
Anyone who applies for the US match should be aware that non-US citizens get much fewer interview spots because of VISA requirements. Some programs are more IMG friendly than others. In my year, the average Canadians got 1 to 15 US interviews only after applying broadly. Having US citizenship helps significantly to increase the number of interviews.

c. If you want to match the US
If you want to match to a US residency, then going to a Caribbean school can offer an advantage. You can make your connections during your US rotations to increase your chances of matching to the US. Alternatively, you can study in the UK, Ireland or Australia, but do all your elective rotations in the United States.

d. Individual performance
I have noticed that most Caribbean students who I personally know that have matched to US or Canada, are very bright to begin with. No red flags prior. Scores high in medical school and performs well during residency. Excellent people skills. I do feel that if you are good you are good no matter which medical school you go to and you will find a way to succeed. If you are intelligent and you are not going to a Caribbean school because you are struggling academically or have red flags, then chances are Caribbean medical schools can work for you. Ive noticed the unmatched people generally have red flags, personality issues, or poor academic performance. I'm not surprise they don't match.

The USMLE is arguably the hardest exam I have ever written. If someone is struggling academically already or with MCAT what makes you think the board exams are any easier?

e. Connections matter a lot more than you think
As much as we like to think this doesn't matter, some Caribbean students are able to match based solely on the right connections.

I hope this can help someone. Please feel free to ask me anything. I will check this post from time to time.

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That seems about right to me. I'm Canadian and went the Caribbean route. Dual applied for residency in the US and Canada, got plenty of interviews in the States and got interviews to every IMG stream I applied to in Canada. I decided it would accept whatever I could get my hands on, and that meant that if a program in the States wanted me, I'd go there. These matches are binding and the US match came first. As soon as I matched in the States the Carms system automatically took me out of the Canadian Match as expected (Can't match both places and then choose later).

Some advice to my fellow Canadians who may want to dual apply in Canada and the USA:

-Score high. I got to sneak in my Step 1 score since I wrote before the switch to pass/fail - I'm happy about that and I got a 27X on the MCCQE1 - you cannot screw this up
-never stop writing your exams: write Step 2 as soon as you're eligible then do the MCCQE1, utilize the similarities between the various tests to maximize on your study efforts, then do Step 3 (NAC OSCE is whenever it makes sense). Don't wait to write Step 3. Use the momentum and just get it done
-Be rich. I'm not kidding (or at least have ample funds via a line of credit - this will set you back over $20,000 (the US match is way more expensive but the Canadian exams will set you back), if you're from Ontario get OSAP - a lot of the funds you'll receive are grants (you don't pay those back at the end)
-Know that an FM residency in the States is 3 years and it's 2 in Canada
-The pay is roughly the same but don't forget that the USD almost always outperforms Canadian dollars - that $60,000 will go a lot further when you're paying off your loans if its USD
- it's much easier to get a residency in the States even though you need a visa - if your only goal is to get a spot and you have to choose one or the other, you're better off picking the US in my opinion - also, you had to write the Step exams anyway, so it's not extra work (or $$$)
- get your plan together early - those reference letters you got from your preceptors - yeah, you can't use those for Carms (at least FM), so get ready to ask for new reference letters in the format Carms requires them to be in
-Various provinces have supplemental hoops you need to jump through, so know what those are well in advance
- know the timelines and what you'll be participating in (and not), this year the US match was first - but if you applied in Canada as well you can't participate in the SOAP round in the US. you should know this going in - pleading ignorance will get you nowhere

Good luck
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