The article likes to focus on how bad the school was, but what I get out of this was the reason this guy didn't know what he was doing was because of his terrible residency training.

I think that is what they should be focusing on in this article.

Beaker, why do you have to respond with a useless post everytime IknowitALL posts? You are cluttering up the forum.

SGUAUCRoss,

If you've been following along from the beginning, you would realize that Beaker is just looking out for our best interest by causing trouble for the trouble-makers. In the example above, Beaker stepped in and likely prevented another pointless confrontation between bts4202 and IKnowitALL, which was probably IKnowitALL's intentions since he or she targets that person quite frequently. Beaker did a similar thing for us in this Spartan forum (and I believe in other forums as well) not long ago and we all appreciated it.

Beaker doesn't post "everytime" IknowitALL posts, only when IKnowitALL writes something antagonizing. But I'll admit that most of IKnowitALL's posts appear to be meant to cause conflicts . If you want the nonsense of useless posts to stop, you should address your concerns to IKnowitALL rather than Beaker. As far as I'm concerned, I support Beaker and the others and I hope they continue to keep this site clean. I'm sure many other silent observers would agree.

I don't know about IKnowitALL's methods, but he/she has helped me get much more information about St. Chris than I ever could.

I'd have to agree with you. And we all have our own way of expressing things.

But going back to the article, I think alot of it does stem from basic sciences. If you dont' know the fundamentals properly, you're going to get all confused in residency. And I'm sure their not going to watch you as stringently in residency either. He could have barely passed his Step 1 by the skin of his teeth, and you don't know how many times he may have taken it either. I think you are allowed up to 3 tries in most states, right? He could have bombed it twice and finally passed the third time because he may have gotten the same exam or same questions repeated. Who knows. But I would say that really understanding Basic Sciences, not just to pass an exam, but to be able to really know the material in terms of its relation to the clinicals probably determines how good of a doctor you become. Just my 2 cents.

SamaraMD,

With all due respect, it's very evident that you have not been through the process yet. You've made many unlikely assumptions as a result.

First of all, 3 passing attempt for any of the steps is not a requirement for most states. But that statement is irrelavant in comparison to the assumption that this individual could have obtained a relatively difficult residency, such as anesthesiology, having barely passed step 1 on his third attempt. Coming from a foreign medical school usually means that an FMG would need to be relatively competitive in comparison to their U.S. Medical Graduate counterparts which are all competing for these selective open spots. In addition, an anesthesiology residency typically begins in the 2nd year after a preliminary intern year (usually in surgery) has already been completed. Besides, passing step 1 DOES mean that you know your basic sciences, but does NOT give an indication as to how good of a physician one becomes, so I very strongly disagree with your assessment about this. And it is extremely unlikely that this FMG "bombed it twice" and then "barely passed step 1 by the skin of his teeth", but was able to obtain a relatively competitive residency. If that were the case, this person would be lucky to land any residency, let alone one like anesthes.

But more importantly, having performed hundreds or even thousands of intubations during his specialty training (anesth preform this procedure much more frequently than any other specialty) would negate the relevance of his assumed knowledge of knowing the basic sciences concept of the relations between the esophagus and the trachea. To make that assumption is simply ignorant. Nobody should be questioning his ability to perform this procedure (having completed an anesthesiology residency ensures this). In fact, many physicians accidently hit the esophagus instead of the trachea during their intubation attempts, but it's usually detected and quickly corrected by following the protocol learned in residency. The problem in this case was his failure to follow that protocol by confirming whether or not the trachea was intubated (which it apparently was not). It has nothing to do with his knowledge and everything to do with his negligence.

Its like a physician with 20 years of experience accidently giving a penicillin injection to a patient who has a known allergy to this drug and it's clearly stated in his chart, but the physician overlooked it. That would also be a negligent error, but would you say that this experienced physician made the error because he didn't know the immunological and pharmacological processes of penicillin sensitivity?? In both cases, the negligence has absolutely nothing to do with the basic sciences knowledge.

Or a non-medical example could be to say that Al Capone evaded his taxes because he didn't have a strong enough background in elementary mathematics to properly calculate the amount of taxes that should be paid. He made tens of millions (equivalent to billions today) without paying one dime in taxes. As we all know, his decision to avoid paying taxes has absolutely nothing to do with his math grades from elementary school?? At least I hope you wouldn't think so .

Was this physician negligent? Absolutely by the evidence provided thus far. Was it due to a deficiency in his basic science training? Absolutely not. Legally, if this physician didn't have the knowledge to perform the procedure, it cannot be legally termed "negligence" on the part of this physician and one would then need to find out why this individual was performing the procedure without being qualified to do so, but this was not the case. Negligence implies that the individual had the knowledge, but caused damage because he didn't use that knowledge properly, as in this case. If he didn't have the knowledge and was permitted to perform this procedure, the negligence would be shifted over to the residency program for certifying him without the ability to perform this procedure properly, the state for licensing him without proper proof of abilites (determined by ECFMG cert, residency completion and board certification), or the hospital for giving him access without proper paperwork. But in this case the physician himself was found negligent which implies that he proved he was qualified to perform this procedure, but neglected to follow the proper protocol.

Please notice that most current physicians agree to these simple points about the qualifications for performing intubations are typically obtained during resiency rather than the basic sciences. That's not a coincidence, but an indication that this concept is gained through experience. Once you reach that level, you too will probably realize that the author of this article is making ignorant assumptions in order to imply that Caribbean Medical Graduates are incompetent. While I admit that the author obviously did a great job in expressing that view to the average person, most medical personnel should know better. But please continue to share your views as it gives us an opportunity to see how people digest the author's message.

Questions,

I have to say you are right in saying that I don't know enough to really come to a conclusion about that individual. I was merely putting out my own assessment from reading the article. I was always under the assumption that mastering the basic sciences determines your level of competency in the clinical years and on. But I'm glad that you provided such an in depth reply. It was quite enlightening and educational. But the next question is if it wasn't negligence but rather not properly performing the procedure, how would he have been able to get through residency? If this is a common procedure that is done thousands of time, how could the residency program miss that? It could very well have been negligence as you stated, but if it was lack of knowing the proper procedure, I guess my concern than is that are certain residency programs not going to prepare us properly? Do they have certain standards that they must follow? Is there a specific curriculum most residency programs follow? What's your feedback on this? Thanks.

Samara

dt,

There is also another article if you go to www.ctnow.com and do a search for the article entitled "Get An MD the Easy Way". One is dated 12/14, the other 12/15. Both are by the same author: a "Dolan". In the other article, he quotes current Spartan students who are on the island and also talks to officials in St. Lucia about why they ban Spartan students from licensure on the island of St. Lucia. I am not surprised to find that AMA lists only 219 grads in 22 years; as I said in one of my earlier posts, it was my impression while I was at Spartan that most of the students should not have been there, and probably did not pass the Step 1. I also mentioned that I believe that students may be able to obtain an MD degree from Spartan because Spartan allows one to do all clinical rotations without having passed Step 1. So what happens is that many Spartan students must take both the Step 1 (having already failed it or having not taken it at all) and the Step 2 right before trying to obtain residency. Hence, "doctors" (i.e., those who have completed the SCHOOL'S qualifications for a DEGREE which are clinical rotations and Basic Sciences) are produced at Spartan who cannot obtain US licensure (and therefore cannot legally PRACTICE).

I find these articles interesting, and wonder how the administration will put a spin on it.

Samara,

That's a very good question. While I won't pretend that I know everything there is to know about this subject, I can give my best understandings and direct you to the place where more information can be found.

Most states require that a physician must have completed a minimum of 3 years post MD-graduate training (Residency) in the U.S. at an ACGME approved program. The ACGME is the organization which regulates Residency programs in North America and can be found at http://www.acgme.org/ . From that site, one can see that the ACGME has specific criteria which a program (and the residents of that program) must meet in order to certify completion of any person from an approved Residency program.

It's inconceivable for this individual to have successfully completed an anesthesiology residency (4 years post-MD) without knowing how to conduct a procedure as basic to this field as an intubation. Intubations to an anesthesiologist are about as common as listening to heart sounds with a stethescope for a cardiologist. But even more importantly is that he had to have been able to prove that he was competant enough to consistently be capable of following the protocol to prevent what occurred.

Even though medical errors still occur after residency training (93,000 per yr recently quoted), most are not due to any deficiency in the Residency training itself, but due to negligence (carelessness) on the part of an individual (many can also argue that it's also due to our health care system, but that's a different argument). If it were due to the Residency training, we would see the Residency programs getting sued, which is rarely the case.

The main point and answer to your question is that an individual who has successfully completed Residency training at an ACGME residency program and passed all exams should be qualified, without a doubt, to perform procedures relevant to their training. I'm sure he proved this and I'm also very confident that he was fully competant and capable of doing this. That is the reason why I, and the lawyers and peer-physicians in this case, concluded that it was probably his neglegence (failure to follow the well-known and accepted practices resulting in damages) that resulted in this horrific tragedy (at least until other evidence is provided to prove otherwise). However, the author of this article would like you to believe that it was somehow related to his basic science training (probably because the implication that FMG are underqualified sells better), but that argument simply has no legal (or medical) bearing.

I hope this gives you more insight to the medical and legal points surronding this case. Please look at the ACGME website for more information. Good luck.

Thanks mindprobe. It seems the good thing about Spartan is that they will give anyone a chance to become a doctor. They have been around for over 20 years and have survived many black marks. Hopefully after this round of negative news the Spartan executives can learn from their past and move forward positively.


(They can pay me as a consultant and I tell them how. lol)