The Problem with Caribbean Medical Schools

[azskeptic]

I am not a doctor nor do I portray one on television. I am just an interested bystander who has a son who is thinking of going to medical school who happens to be involved in looking at consumer issues as a hobby.

But the more I read about Caribbean med schools the more evident to me the problems that many of you face for the future. As long as there are so many flimsy schools (online schools, schools that grant advanced credit to non-medical school folks such as chiropractors,podiatrists,lab techs,nurses,dentists), the other schools will have problems. Let me give you an example. If you were a medical board who has waded through many applications from graduates of non-approved schools and through mispelled letters from Deans, documents which purport to show attendance but when checked you find out that the students were still working full time in their chiropractic/dental offices I would imagine you would get rather suspicious of all schools of the Caribbean region. To me this is dangerous for the schools that are trying to be equivalent to US schools (or British etc. schools in 1st world countries). When the reality that many of these 'schools' are actually rented buildings with relatively non-existent local staff or even students comes out,which it is, it hurts the credibility of all. The same thing happened in the 80's when some Russian schools were selling MD degrees to chiropractors and the result was Russian schools are still having large problems getting their graduates accepted and licensed in the US.

If I was a Ross/SGU,etc. I think I would be forming a Caribbean Medical School Association,with a strong code of ethics, and pushing the govts. to help clean up the mess in the area. The investments that real schools make in buildings,staffs, advertising, procurement of equipment/cadavers,etc. is immense. In a business one sometimes has to join together with 'competitors' to be sure that their industry is not suffering in the public eye. The 'bad actors' hurt all, and especially hurt innocent folks i.e. you students who are going above and beyond the call of duty to become doctors. In fact they hurt all offshore schools so the St. Christophers,etc. of the world should be involved.

I admire and respect those who are making big sacrifices. It must not be easy to take on huge debt loads for an uncertain future. It isn't easy to move from the relative comfort of the US/Canada,etc. to developing nations but all good things include some risk. I urge you to speak out to your professors/administration to clean up their industry because they are risking their future and most importantly YOUR future.

[microphage]

Originally Posted by azskeptic

If I was a Ross/St. Christophers/SGU,etc. I think I would be forming a Caribbean Medical School Association,

Nitpicking:St. Chris isn't in the Caribbean.

my 0.0002 cents: As for the other comments, I doubt anything can shut down a med school if the WHO doesn't even do anything about it.

[bts4202]

hey, thats not such a bad idea!! I know that it would cost a ton, but it might be worth it. Imagine it:

1. Organization is formed and meets with all US state medical licensing boards to determine a minimum standard of medical education. Since the US does not accredit any foriegn schools, this organizations strength would rely on its integrity and reputation alone.

2. Org should write out a set of requirements that each school has to meet, such as what was done with the AAIMG, however real investigations should be done and done TRANSPARENTLY. There should be accountable administration within the organization that is open to scrutiny and will be in front of the public eye if neccesary.

3. Schools that wish to be placed on their "approved" list would pay the Org to come and look at their school. The Org would be completely independant of any school so that no bias will exist. A thorough investigation would be done into all aspects of the school and each criteria on the list would be assessed.

4. If the school did well enough, then they would be invited to become members of the Org into which they would pay dues. If a school was a member of that Org, then state govn'ts would know that they were being held to a certain standard.

5. There would be periodic and random checks on the school to see if things had changed within the school and if they had changed for the worse, the membership would be suspended.

6. If a reputation was built on being stringent, honest, and uncoruptable... then it might become a source of confidence in IMG's. It might also increase the ability of students from these schools to get competitive residencies. Since no one in the US regulates foriegn schools and very few people in the US have trust for the regulations set by most caribb islands(or african countries), then this Org might really help.


What does everyone think? What am I forgetting?

[azskeptic]

BTS is right. In the absence of an official agency that one can trust (WHO does literally nothing other than get a letter from the country govt. and that is it, EFCMG does nothing other than allow people from WHO approved schools to take an exam, USMLE does nothing other than allow folks to take exams), the area has to do it themselves.

If there was a group that represented 90% of the schools, it would be listened to by the State Boards. The State Boards obviously don't enjoy having to pick through the info to see if a school is legit or not.

Heck, if you think about it, dogs are more closely registered in most countries than foreign medical schools appear to be. You can do almost anything without fear of it doing anything to the administration. For instance giving MD's to your board of directors and not calling them honorary. One school,from my research, gave a podiatrist/chiropractor an MD degree, then thought better of it and mysteriously he disappeared from their faculty/board lists.

az

[stephew]

you have no idea about the politics that going into this issue. With the success of SGU and Ross initially, many othr schools have sprouted up. Some are quite good; there are a few owned by the same person or group; that are those that are founded by disgruntled members of other schools.

And you know what? the students do just fine. They have the chance to look into each school before applying and there are resources (the forum is just one place) for them to find out what questions they should be asking.

When its in the interests of the caribbean schools, they do band together (there is one unified exam-the USMLE- for us grads and IMGS thanks to ROSs and SGU 15 years ago taking issue with the unfair licensing practices previously).

But be ware: overpolicing of the caribbean schools can have the very neat effect of devaluing them. PDs in the US know the good places and the good schools and I would have to see new good ones stamped out because of other schools over protecting their interests. The "consumer advocate" approach has to be careful- not because students shouldnt be protected, but like everyithing politically, the road to hell is paved with good intentions. Another cliche: watching out for what you wish for; you just may get it. Overpolicing or hostile "advocacy" is a bad idea. So long as we had federal standards to protect the quality of doctors coming into the US, the most important issue is covered.

[azskeptic]

Steph, the problem is that all we have now to protect us in the US are the exams....any school (even if a rented building with non-existent staff) can get WHO approval if the country officials send a letter. Perhaps our last bastion of protection is the state boards but they have little consistency on what constitutes an equivalent medical school or education.

Interesting issues though.

In some ways it is like what has happened to chiropractors. There are many good people in that field who genuinely want to help people with back problems,which they can do well with. But the members of their industry who practice 'voodoo' get them all lumped into questionable,even if they aren't, members of their industry. I remember 35 years ago accompaning a friend of mine to see a DC who told him he could hypnotize him and stop him from smoking...he took out a 'book', a fake jewel, and while reading from the book, tried to do it..he hadn't taken any training but had bought a book from one of the chiropractic journals and was trying to expand his business. Looked pretty silly,even to us young folks at the time. Later when I was in graduate school I realized that real hypnotists don't use books to do it. You see many chiropractors leaving their field now due to not being able to make a living at it. They have problems getting 'patients' and after they run out of family members for their education required practice they have problems..the schools can do little to help them get patients into their clinics. Look now at some of the schools that require the 'med students' to set up their own clinicals, mentors,etc.....bound to fail in the long run...

all in all, an interesting issue. Change usually comes from within though and not from outside their system.

[Silenthunder]

Hey all,

just my .02,

I agree with Stephew on just about everything said.

I don't have ANY clue as to the political problems with trying to set up an independant organization to watch over the standard of Caribbean education. I do however have a strong intuitive pull towards believing that doing something like this is fraught with political problems.

I also believe that Stephew brought up a great point about this kind of thing possibly leading towards overprotective measures.

I also believe that the WHO should take more interest in the medical schools in the Caribbean.

While this is a great idea, I wonder who would start something like this? The well established schools (SGU, Ross, AUC, etc.) don't seem to have much to gain from this kind of thing. The less well established ones may be unwilling to fund this kind of venture because they may be: A) afraid that such an organization would find fault with many of their practises;
B) that such a venture would be very costly, and thus cut down on their profit margins. I do realize that there should be another point here: C) that such an organization could grant them credibility.

In absence of this kind of system we are left with the current system ( I almost balk to call it such-), and the idea of : "buyer beware".

I believe it's a good idea.

cheers

[tRmedic21]

Originally Posted by Silenthunder

I also believe that the WHO should take more interest in the medical schools in the Caribbean.

The WHO doesn't take an interest in ANY medical schools. They just list them. If they did take an interest in Carib schools, that would suggest a difference between them and the rest of the world, which there simply isn't, in the eyes of the WHO. I personally find WHO listing to be worthless, but it is a requirement, apparently, to obtain licensure in the US. Why we should require that an organization with no criteria should claim a school is beyond me.... kinda like saying if you can get a friend to come to the dealer with you, you can walk away with a new car.....

Overall, I think the idea of a Foreign Med School Assn. is a great idea. The thing is, who would run it? Who's gonna foot the bill to get it off the ground? You would need a fair number of schools to give it some pull or credibility, I would say 10 to start. It could be quite expensive and time-consuming to inspect all the involved schools, or the ones who are applying for entry. Overall, though, I would certainly find membership in such an organization to be of significant benefit for both state licensing boards, and prospective students.

[MD3s]

azskeptic,

As I am waking up from post call, and check e-mail and forums, etc. I come across this post... and realize that you have no idea what these schools have done for us and have allowed our futures to expand beyond what we thought was possible.

My parents had the same reservations and concerns as you have for your son, and it was through researching the history of the schools, residency matches of the graduates and professional successes, that I realized which medical school suited me and all my concerns. It was my devotion, dedication and determination, as I hope it is your son's, that helped me endure the journey. So pardon me, but eventhough I still have bags under my eyes, my apartment being a mess, having to get caught up with CNN, read NEJM and learn more about my patients, did I also mention that I also have to eat?!....it has all been worth it (PERIOD)

Going outside the US for medical school is a gamble. Going to a non-established school is even more of a gamble. We are all here for one reason, we could not get into the U.S. So we meet in the middle, and choose a school that is semi-established and has a good track record. By that track record, Program Directors of residencies have something to base their decisions, beit favorable or unfavorable. To make a 'Caribbean Medical Association' would only tarnish the better schools there and would not help the challenged/developing schools. The whole essence of establishing these medical schools back in 1978 was to prove that they and their students (who have similar stats, although could not beat the numbers game) are exactly the same if not better than the average U.S. medical student, in which the standards are set directly by the LCME, and indirectly by the AMA. The whole battle is to prove that if these schools were on U.S. soil that they would perform identical to U.S. medical schools and would surpass LCME standards.

There is one organization, the ECFMG, which is actually a brach of the AMA that regulates forgein/incoming doctors. One organization is enough to police/evaluate/judge applicants.. and it helps because it is of the same blood of the AMA. Adding more Foreign medical associations would only add more confusion, and reduce credibility. It is the ECFMG that should lay the burden on the WHO to be more strict with their 'approvals.'

Let the ECFMG standards do its job. Less established schools with less qualified professors, by logic will not perform well. There are enough hoops that we have to go through ie USMLEs, etc. that will put us all on the same playing field with each other (IMGs that is).

Now, I'm going to go back to what I have worked so hard for, and do my duties as a DOCTOR.

And as we all know, changing politics is slower than trying to stir mollases.

[azskeptic]

My message is not about the good schools,many which are as good as most in the US...my message is about the worst schools,which we have nothing to match in the US...

I tip my hat to people like yourself who have worked themselves through the maize...it isn't easy.

But the bad schools will drag down the reputation of the good ones.