State Medical Licensing moderator to speak at AACRO

[azskeptic]

My presentation to the AACRO (American Association of Collegiate
Registrars and Admissions Officers) convention in San Diego 4-18-06

http://www.aacrao.org/forms/meeting/SessionFormPublic/search?action=find (http://www.aacrao.org/forms/meeting/SessionFormPublic/search?action=find)


If You Wakeup On a Gurney Be Sure The Person Treating You Didn't Go To
An Internet Medical School

By Dean Hughson, consumer advocate/volunteer
www.internetmedicalschool.homestead.com (http://www.internetmedicalschool.homestead.com/)
tel 602-696-3248
deanhughson@gmail.com (deanhughson@gmail.com)


In 2002 my son, then a freshman in college, asked me if I would
investigate medical education for him. Since I am on a computer 10-12
hours/day, selling egg products, I did what I normally do. I googled
medical education and to my amazement I was immediately bombarded with
advertisements for offshore medical schools. Having grown up in the
1950's in Kansas City Missouri I remembered medical school as being
competitive and difficult to get into but following the ads to
websites in various countries it appeared to me to have changed. So
began a new 'hobby' for me and as my kids say "Dad, it would be easier
if you played golf than got involved in looking at questionable
medical schools" but it has been interesting.

Currently there are several thousand US students who are attending
offshore medical schools that have been specially built to attract US
citizens who have not been able to get into US medical schools for
various reasons. As you may be aware 28% of the physicians in the US
are foreign educated but the majority of them are actually immigrants
from other countries. Our country has a long history of attracting
immigrant physicians and many of our teaching professors are graduates
of some of the best medical schools in the world. But what about the
US students who go to schools in the Caribbean or Mexico: what kind of
educations do they get?

My initial research indicated that unlike the US many of these
countries lack accreditation agencies or agencies to supervise medical
schools. They are happy to have the schools settle in their countries
because they bring jobs and demand for housing,etc. for local
communities but interestingly FEW of the countries actually allow the
students to provide medical care under supervision locally. The
larger problem is that due to lacking adequate medical care facilities
and staff, these schools must hire staff from other countries and my
research found convicted felons, diploma mill graduates, people with
questionable MD degrees, and a wide variance of credentials. Unlike
the US which has the LCME agency to oversee medical schools these
countries do not have staff to look over the performance of the
schools or admission standards. As one state medical board staff
person said "The admission standards are your $20,000 check".

There are some good offshore medical schools that have turned out
excellent physicians and have track records of achievement. If you
look up SGU, AUC, Saba, Ross, Mua-Nevis (the top 5 in my ratings)
you'll find graduates in many programs in the US. But there are
many schools popping up that are doing things that are not done in the
US. Examples include medical schools that allow non—MD education, such
as chiropractic, dentistry, or podiatry graduates to be given advanced
standing and THEN attend medical school via the internet while working
their normal full time jobs. Many state medical licensing laws in the
US were written long ago and never anticipated this happening and thus
some of these graduates are being allowed to sit for exams and
license. One could argue "Well, they passed the exams so they must
know the material" but medicine is more than just exams.

So the logical question is what is needed to protect students and
society? I am advocating that states inspect offshore medical schools,
the way that some progressive states like California, Texas and New York do
where they send in similar teams to evaluate schools and thus approve
them before their graduates can come to their states. This is a
financial burden on states but since the US govt. has no similar
program states are forced to do this. I would suggest that before you
recommend a student apply at an offshore medical school that they do
some research on what schools are approved by major states like Texas,
California, New York, or Florida.

My volunteer project has not been without its challenges. I have had
physical threats from some students and even a medical school
attempted to send a thug to frighten me. I don't frighten easily. I
have spoken worldwide on what I call the '2 old professors, a cadaver,
and 10 students above a pizza parlor school' problem. Some students
didn't listen to my advice and ended up wasting years when their
medical schools were found to not be legally established; currently
700-800 students are enmeshed in a potential license threatening issue
in the UK. But with some luck we'll get the word out to more and more
students. Students are forced to learn about charter issues,
accreditation, and local laws if they wish to venture into untested
waters in some of these schools.

I am always willing to help anyone who calls and I would be pleased to
provide you information that I find on schools you may run across.

Thank you for this opportunity to be of service.

[dt]

Hey Az, how come they let just anybody talk?








(just kidding... in case you didnt notice.)

[###]

..............

[teratos]

The medical profession as a whole is still a "Good Ole Boys Club". The old grey-hairs are very resistant to any change from the traditional "I did it this way so you can, too" method of doing anything. G

[Miklos]

I think we would be better off finding ways to improve the assessments of graduates -- which is what really matters.

Agreed. How would you go about it?

[###]

................

[Scott1981]

it seemed like a good speech. however, texas really doesnt go out and do site visits yet. true, they did ross..... but its not like they are freely doing them for other schools that want it.

[Miklos]

At the end of the day, you can't design a process to train people unless you know what outcomes you are seeking. And, if you know the outcomes, you should be able to measure them -- otherwise, how would you certify that the process works?

Well, IMO here's the crux of the problem.

[pruritis_ani]

I agree that there needs to be a better way to assess grads as well.

However, given what we have available today, I think that extra scrutiny on the process is well justified. Certainly when it comes to offshore schools.

I don't think these schools are out to push the frontiers of medical education, either. When internet curriculums are developed, they should be developed from medical universities that evolve them, and base them on an already sound curriculum. A stand alone interned based university in the Carib has no business being involved in medical education, at least not yet.

[azskeptic]

it seemed like a good speech. however, texas really doesnt go out and do site visits yet. true, they did ross..... but its not like they are freely doing them for other schools that want it. Texas is beginning this year.

[azskeptic]

Yep....why, they allow a PHD in physics and an eggman talk..ha ha








(

[Scott1981]

Texas is beginning this year.

this is great news.

[JTP73]

Texas is beginning this year.What's the cost to have Texas send their group to your school? Do I hear 65K? 70K? 75K? ;)

Seriously, how is this set-up to occur?

[microphage]

Yep....why, they allow a PHD in physics and an eggman talk..ha ha








(

got any room for me?

[azskeptic]

got any room for me? sure......come on down

[###]

..............

[azskeptic]

I think one of the things that gets lost in all the accreditation talk is whether there is any evidence to show that a particular school is difficient. For example, for all the talk about SC, I never saw anyone provide any evidence to suggest that the school or its graduates were in any way deficient. They may well have been -- but nobody knows.

Similarly, I can see accrediting bodies running around measuring things that may or may not have anything to do with outcomes. I think this is a very bad practice. Indeed, it is analogous to the use of surrogate outcome measures in clinical trials -- which are fraught with hazards (look at the studies on antiarrythmics). Surrogates are tempting because they enable you to focus on something convenient to measure (books in the library, research output, etc.) that you believe is causally related to the output of interest. Although this this kind of reasoning appears logical, it often goes astray.

Finally, it seems absurd to have all the different states apply their own criteria and independently certify schools. First of all, you are liable to end up with a jumble of conflicting standards. Second, the states do this rarely and are not well equipped to do this kind of work well. I would put California review of SMU as exhibit A of a report of questionable quality. I don't know if SMU is any good or not but I was not impressed with the quality of the report. I would expect more of the same if all the states start sending delegations to the islands to evaluate schools. There has to be a better way.

I suspect the current system of using the USMLE to certify medical school level training with the additional requirement of US residency training is probably sufficient. I would like to see studies to test whether the current system is broken before we design a beaurocracy to fix it. In short, is there any evidence too show that students who learn basic sciences above a pizza parlor turn into deficient doctors? Also, is there any evidence to show that students who go through clinical training in a loose assortment of subcontracted hospitals are deficient compared to US students? Once these types of questions are answered, one might have some basis for accrediting schools. Without an agency involved like the LCME there is no one quality controlling the schools and that is the issue in many cases. Think you'll see more talk about this in the near future.

[Miklos]

Without an agency involved like the LCME there is no one quality controlling the schools and that is the issue in many cases. Think you'll see more talk about this in the near future.

I respect your opinion, but I think that DrB brings up a valid point here.

The LCME is principally interested in controlling its dominant market position, period.

[Aviv Imanuel]

However, did anyone occured to ask you "do you have any data on how these students do on their residencies?"

After all, I guess, the idea of having residency programs is to teach medical school grads on how to become real physicians. From paper docs to real docs.

If we cannot address this objectively, are we admitting that, by default the whole residency training requirements accompanied by STIRCT and demanding exams is a sham?

Obviously nobody asked you this, correct?




My presentation to the AACRO (American Association of Collegiate
Registrars and Admissions Officers) convention in San Diego 4-18-06

http://www.aacrao.org/forms/meeting/SessionFormPublic/search?action=find (http://www.aacrao.org/forms/meeting/SessionFormPublic/search?action=find)


If You Wakeup On a Gurney Be Sure The Person Treating You Didn't Go To
An Internet Medical School

By Dean Hughson, consumer advocate/volunteer
www.internetmedicalschool.homestead.com (http://www.internetmedicalschool.homestead.com/)
tel 602-696-3248
deanhughson@gmail.com (deanhughson@gmail.com)


In 2002 my son, then a freshman in college, asked me if I would
investigate medical education for him. Since I am on a computer 10-12
hours/day, selling egg products, I did what I normally do. I googled
medical education and to my amazement I was immediately bombarded with
advertisements for offshore medical schools. Having grown up in the
1950's in Kansas City Missouri I remembered medical school as being
competitive and difficult to get into but following the ads to
websites in various countries it appeared to me to have changed. So
began a new 'hobby' for me and as my kids say "Dad, it would be easier
if you played golf than got involved in looking at questionable
medical schools" but it has been interesting.

Currently there are several thousand US students who are attending
offshore medical schools that have been specially built to attract US
citizens who have not been able to get into US medical schools for
various reasons. As you may be aware 28% of the physicians in the US
are foreign educated but the majority of them are actually immigrants
from other countries. Our country has a long history of attracting
immigrant physicians and many of our teaching professors are graduates
of some of the best medical schools in the world. But what about the
US students who go to schools in the Caribbean or Mexico: what kind of
educations do they get?

My initial research indicated that unlike the US many of these
countries lack accreditation agencies or agencies to supervise medical
schools. They are happy to have the schools settle in their countries
because they bring jobs and demand for housing,etc. for local
communities but interestingly FEW of the countries actually allow the
students to provide medical care under supervision locally. The
larger problem is that due to lacking adequate medical care facilities
and staff, these schools must hire staff from other countries and my
research found convicted felons, diploma mill graduates, people with
questionable MD degrees, and a wide variance of credentials. Unlike
the US which has the LCME agency to oversee medical schools these
countries do not have staff to look over the performance of the
schools or admission standards. As one state medical board staff
person said "The admission standards are your $20,000 check".

There are some good offshore medical schools that have turned out
excellent physicians and have track records of achievement. If you
look up SGU, AUC, Saba, Ross, Mua-Nevis (the top 5 in my ratings)
you'll find graduates in many programs in the US. But there are
many schools popping up that are doing things that are not done in the
US. Examples include medical schools that allow non—MD education, such
as chiropractic, dentistry, or podiatry graduates to be given advanced
standing and THEN attend medical school via the internet while working
their normal full time jobs. Many state medical licensing laws in the
US were written long ago and never anticipated this happening and thus
some of these graduates are being allowed to sit for exams and
license. One could argue "Well, they passed the exams so they must
know the material" but medicine is more than just exams.

So the logical question is what is needed to protect students and
society? I am advocating that states inspect offshore medical schools,
the way that some progressive states like California, Texas and New York do
where they send in similar teams to evaluate schools and thus approve
them before their graduates can come to their states. This is a
financial burden on states but since the US govt. has no similar
program states are forced to do this. I would suggest that before you
recommend a student apply at an offshore medical school that they do
some research on what schools are approved by major states like Texas,
California, New York, or Florida.

My volunteer project has not been without its challenges. I have had
physical threats from some students and even a medical school
attempted to send a thug to frighten me. I don't frighten easily. I
have spoken worldwide on what I call the '2 old professors, a cadaver,
and 10 students above a pizza parlor school' problem. Some students
didn't listen to my advice and ended up wasting years when their
medical schools were found to not be legally established; currently
700-800 students are enmeshed in a potential license threatening issue
in the UK. But with some luck we'll get the word out to more and more
students. Students are forced to learn about charter issues,
accreditation, and local laws if they wish to venture into untested
waters in some of these schools.

I am always willing to help anyone who calls and I would be pleased to
provide you information that I find on schools you may run across.

Thank you for this opportunity to be of service.

[azskeptic]

It appeared most of the people who came to my talk were PD from residency programs. From their questions if I was in the offshore medical business for profit I would hire a PR firm as one person asked me "Is Ross legit?" Another one came up to me and wanted to know if ANY of the offshore programs had reputable teachers.

There needs to be some research indeed done on how people do and especially from particular schools. That would be valuable info for potential students. Good ideas.

However, did anyone occured to ask you "do you have any data on how these students do on their residencies?"

After all, I guess, the idea of having residency programs is to teach medical school grads on how to become real physicians. From paper docs to real docs.

If we cannot address this objectively, are we admitting that, by default the whole residency training requirements accompanied by STIRCT and demanding exams is a sham?

Obviously nobody asked you this, correct?

[Aviv Imanuel]

There needs to be some research indeed done on how people do and especially from particular schools. That would be valuable info for potential students...absolutely.

Thanks for your feedback


It appeared most of the people who came to my talk were PD from residency programs. From their questions if I was in the offshore medical business for profit I would hire a PR firm as one person asked me "Is Ross legit?" Another one came up to me and wanted to know if ANY of the offshore programs had reputable teachers.

There needs to be some research indeed done on how people do and especially from particular schools. That would be valuable info for potential students. Good ideas.

[nemo2006]

I agree with what genossa has to say. How can a person be allowed to practice medicine in a state and then even GRADUATE from there and after all this be denied license to practice as a doctor?

It would be like saying,
I found you fit for training (offered a residency spot)
Found you fit to graduate (just like American graduates)
You are fit to practice yet we shall not let you practice.
Can there be a bigger hypocricy than this?