VMD: First, please outline what you see as the situation.

MAL: In addition to the Cuban medical schools or the University of the West Indies, there are now more than 50 private schools in the region that were opened after St. George’s University, which was the first of its kind. Most of these imitators can fairly be described as diploma mills, with few faculty members and substandard facilities. But even the few that are more than shell games do not seem to be working with the highest academic goals as their bedrock mission: Several artificially elevate their USMLE “passing rates” by limiting which of their students may actually take the test; this manipulation leads to high attrition rates which may camouflage the possible scarcity of the clinical spots available to the schools’ students. Future students need to explore the whole continuum of a school’s academic program before committing to a school that will take their tuition. We strongly encourage anyone thinking of going to medical school outside of the country to visit all schools under consideration. At St. George’s, we like students to know what they are committing to before they commit.

VMD: How is a student to separate the wheat from the chaff?

MAL: Each student should demand answers to several key questions:

1. What is the REAL residency placement rate for the school’s graduates? According to 12/08 reports to the US Department of Education, for the academic year 2006-2007, St. George’s residency placement rate in ACGME training spots was an immediate 95.4% and 97.5% after one year. The placement for Ross was 80%. Not all of the Caribbean schools reported information like this to secure DOE loans, so residency placement rates for ALL schools are not readily available in a quantifiable form. If you are asking and feel that you are not getting the absolute real information, walk away.
2. What percentage of students graduate? Again, according to the 12/08 US Department of Education reports, the graduation rate for St. George’s students entering in 2002-2003 academic year was 87.41% - At SGU, from 7% - 10% transfer into US medical schools, so the rate of physician graduation is actually over 90%. In its report, Ross University estimated a 66% graduation rate for students entering in 2002-2003. Although empirical data on the other schools is not available, based upon USMLE pass rates and the paucity of clinical affiliations, we conclude that the attrition rate is something a prospective student should thoroughly inspect before committing to attend.
   
   True attrition numbers tell stories beyond quality of academics, however. Attrition and delayed clinical placements, as well as charges for repeated terms if a student fails one course, increase the overall outlay for tuition for an education that lasts longer than planned and certainly undercut the claims of lower tuition at some of the Caribbean schools.
3. What is the school’s pass rate on the USMLE? Students should research the October 2008 report in Academic Medicine, which showed Grenada (with St. George’s as the only medical school in the country) to be the 15-year leader for both Step 1 and Step 2 CK. The pass rates ranged from 19.4% to 84.4% for Step 1, and from 26.3% to 79.7% for Step 2 CK. No one wants to be in a school at the bottom end of those ranges. You will find many claims on websites about short periods of time wherein a school’s pass rate is high. Remember, schools can control who sits the USMLE over short periods of time, and they can then artificially skew their rates during those periods. You want to make sure you have empirical data over the long run. Also make sure that you ask a school to give you the pass rate in the exact same manner as released by the NBME: How many students that took it in one year passed on the first time they took it within that year? This is how St. George’s reports its USMLE pass rates. And this is the question that needs to be answered.
4. Are alumni licensed to practice in all 50 states in the US? Graduates from St. George’s University, Ross University, SABA, and the American University of the Caribbean are licensed to practice in all 50 states.
5. Are American students at the school able to obtain loans through the US Department of Education? The students at St. George’s University, Ross University, and the American University of the Caribbean are eligible to receive DOE loans. No other private schools in the Caribbean have approval by the DOE for their students to receive loans.
6. Is there a real campus, a real community? Is there school-sponsored transportation? St. George’s University has built a $250+ million campus in Grenada, which includes state of the art classrooms, lecture halls and laboratories, a student center, a health services center and climate controlled student housing. For those 35% of students who live off campus, there are school buses running from 6AM to 2AM in the areas where students live. Again, we urge you to visit each campus – see if you would be happy living and learning and socializing there.
7. What is the size of the faculty? The faculty at St. George’s University School of Medicine number over 1,100. Over 270 of these are campus-based, teaching in the basic sciences. We don’t know the exact number of faculty at other schools, but we have counted numbers on the website faculty listings. We urge you to do the same.
8. What are the clinical placements for the students? Medical students at St. George’s do not have to wait for clinical placements – the University has secured enough to ensure continuity between basic sciences study and clinical training. All placements are at affiliated hospitals (with an SGU Director of Medical Education and program directors in each core rotation) that have ACGME-approved residency training programs at the hospital at the time SGU students are there. This is most important; being at a hospital in a core rotation where there is NOT a simultaneous ACGME-approved residency program can cause problems with licensure in key states.

VMD: Beyond these questions, are there other actions for a student to take?

MAL: Yes. We encourage all prospective applicants to visit any school they are considering. Medical school is the beginning of your professional life and the $1,200 – $1,500 it might cost to visit all the schools is much less expensive than making a mistake which will impact the rest of your life.

VMD: Anything else you’d like to add?

MAL: I have been dedicated to medical school admissions for about 30 years and I am always amazed at how impatient students are and concerned about where that youthful impatience can lead them.

• Some students will attend a school that accepts them by return mail! Don’t they want to belong to a school that takes pride in class selection and make up? Students should welcome a long and rigorous admissions process. When doing your due diligence, please ask about the process.
• Some students will attend a school that has intensive year-round courses because, at the ripe old age of about 24, they think they are very old and need to accelerate through medical school. We know from experience that students and faculty need breaks in this very intensive medical program and wonder at 24 year olds thinking they must hurry. Do you want to send your mother to the neurosurgeon who accelerated rapidly through medical school?
• Some students will attend a school that has a McDonalds (or some such establishment) in the area rather than attend a school where the quality is superb, simply because a Big Mac or Starbucks is not available. Students really need to focus on the outcomes and on pride of belonging. Please visit and ask about any support services for students, faculty qualifications, the curriculum, USMLE pass rates, and residency placement rates.

Most of all, I am amazed at the very quixotic human need to believe what you see on a website and hear at a presentation. While I laud this desire to believe as a human being, I caution you over and over again. Please visit each campus. Touch and feel and ask and see. Talk to students; talk to faculty; talk to staff. Ask as many questions as possible. The environment in which you will learn this intense and rigorous discipline is most important.

I wish you all the best of luck in your academic endeavors.

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Legend: VMD = ValueMD; MAL = Margaret A. Lambert