BY NELL SMITH
Posted on Monday, November 12, 2007
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When Blytheville native Dr. Brooke Sudbery decided to go to medical school, she picked a relatively new university on the Caribbean island Grand Cayman.
She wanted to travel abroad, she said, “and see how different cultures practice medicine.”
Now that decision might prevent her from practicing in her home state. The Arkansas State Medical Board is considering a regulation that would bar graduates of some offshore medical schools from receiving an Arkansas medical license.
Sudbery’s school, St. Matthew’s University School of Medicine, is one of nine foreign medical schools whose graduates the Medical Board of California won’t license. That state visited and comprehensively reviewed the school in 2004, something the State Medical Board says it lacks the resources to do.
“They did an on-site review,” Arkansas board attorney Bill Trice said of California, “and they flunked [St. Matthew’s ].”
But Sudbery, 26, says her medical school was just as rigorous as American universities, and she “studied more than I slept most days.” Sudbery is in her second year of her post-medical school training in family medicine at the University of Arkansas for Medical Sciences.
Her residency director in Jonesboro, Dr. Joe Stallings, argues that Sudbery is an excellent doctor, no matter where she went to medical school. He believes the State Medical Board should license doctors based on an individual doctor’s “merits,” rather than the school from which they graduated. Barring graduates from certain foreign medical schools would make it more difficult for some UAMS residency programs to recruit residents, he said.
“This is a very important consideration for our state which struggles to have enough primary care physicians to take care of our people,” he wrote to the board.
The issue comes at a time when two of the state’s family medicine residency programs are on probation with the national accrediting body.
The UAMS Area Health Education Centers in Fayetteville and Pine Bluff were cited for separate problems including being too focused on providing patient services, which generate revenue, at the expense of educating resi- dents and failing to ensure that residents get enough experience delivering babies.
Additionally, state lawmakers recently expressed concern over the quota system UAMS uses to select students into its medical school. The system, mandated by state law, requires the university to accept a minimum of 27 students from each congressional district in the freshman medical school class.
As a result, lesser-qualified applicants in eastern and southern Arkansas can be admitted at the expense of higher qualified applicants from other areas of the state, the UAMS admissions director told legislators.
CONCERN BUILDING The State Medical Board’s concern about certain foreign medical schools has been percolating for several years, with more state medical boards developing lists of unacceptable foreign medical schools. The State Medical Board wants to establish its own criteria by which to judge medical schools — whether that’s adopting another state’s list of unacceptable schools or using some other method — and create the state’s own list of blackballed schools. State law already allows the board to reject foreign medical graduates based on their education, but the licensing agency has had no systematic way of deciding which schools are unacceptable.
The medical board doesn’t track the number of foreign medical graduates it licenses, but 12 international medical graduates, including Sudbery, requested a license at the last quarterly board meeting, according to the board agenda. All applicants with foreign medical degrees are required to appear before the board prior to receiving a license.
Unlike in the United States and Canada, there is no standard accreditation for medical schools in many parts of the world. Most foreign medical schools are sponsored by a country or government, but more for-profit institutions have popped up in the Caribbean and other places.
The struggle to ensure high quality medical education in the United States played out 100 years ago when Abraham Flexner visited all of the American medical schools and published a report calling for higher standards, a document that led to the closing of about half of the country’s medical schools.
More recently, the nation’s medical community has turned its attention to assuring similar standards in foreign medical schools.
California has maintained a list of disapproved foreign medical schools since at least 1983. But the schools currently at issue with the Arkansas board started within the last decade. Sudbery’s school was chartered in 1997, while the other school began in 2000.
The State Medical Board’s concerns about the quality of some foreign medical schools intensified when a doctor in a University of Arkansas for Medical Sciences residency — medical training that follows four years of medical school — said he’d never set foot on his medical school’s campus. He received his education online.
The board granted him a license anyway, because the board didn’t have enough information about the school, said Peggy Cryer, the board’s top staff official. But this summer the State Medical Board began researching some schools and considering setting standards for foreign medical schools, as at least six other states have done.
LICENSE APPLICATIONS The issue came to a head in October when Sudbery and another UAMS resident applied for a license. While Sudbery graduated from a Caribbean medical school, Dr. Daniel Smith graduated from the England branch of St. Christopher Iba Mar Diop College of Medicine, which is based in the African country of Senegal. The doctors do not need a license to remain in their UAMS residencies, but they do need to be licensed to earn extra money working in hospitals. More importantly, they say, if the board decides to bar them based on their medical school they will need to find another state in which to practice once they finish their training.
The California Medical Board evaluated Sudbery’s school in 2004 and placed it on its list of disapproved medical schools in 2005. While the school prefers applicants with a 3. 0 grade point or higher, “significant numbers of students whose records fall below — and even much below — that level have been accepted,” according to the California evaluation report.
Many students “tried and failed” to get into American medical schools. Others, fearing they wouldn’t get in, didn’t even try. St. Matthew’s does not require applicants to take the Medical College Admission Test — or MCAT.
The report also cites an “essentially complete absence of research activities” and an “inconsistent and seemingly sketchy review and evaluation of core clinical sites,” where students spend their third and fourth years doing specialty rotations with practicing physicians.
And that education is not inexpensive. Four years of tuition at St. Matthew’s costs $ 73, 400, according to the school’s Web site. That’s compared with about $ 61, 000 for in-state residents at UAMS and $ 124, 256 for those out-of-state.
“I just think that there are some schools out there that are sucking these kids in and taking their money,” said State Medical Board member Anne Britton of Fayetteville. “And they’re being deceived as far as I’m concerned.”
Still, Sudbery notes that the U. S. Department of Education found the accrediting criteria that the Cayman Islands used to evaluate her school is similar to the criteria used to accredit medical schools in the United States.
The school Smith attended is on at least two states’ disapproved schools lists, and, said board attorney Trice, it wouldn’t allow California inspectors on site.
Neither Smith nor Sudbery applied to American medical schools, they say. Smith took the MCAT in April 1999 and didn’t want to wait more than a year to be admitted to an American school. He thought medical school in another country would be an adventure, and St. Christopher welcomed him on campus the following September.
Smith, like Sudbery, said his school was as tough as any in the United States.
“I worked my behind off,” said Smith, a 36-year-old Wyoming native. “... and I’ve got shelves and shelves full of marked up books and notes.”
“It’s really a slap to say that I didn’t train as hard as these other people.”
As proof of their education, Smith and Sudbery say, they both passed all three parts of the U. S. Medical Licensing Examination, a requirement for licensure in all states.
And they’ve excelled in their UAMS residencies. Sudbery, a second-year resident, is considered to be at the top of her residency class. And Smith, a thirdyear resident, said he’s had job offers in Jonesboro from people who have worked with him for three years.
“My residency director... who has the most intimate knowledge of how I practice medicine stood there in front of the board and verified my ability to practice medicine,” he said. “And [board members ], instead of listening to that and looking at the fact that I’ve passed all my exams, said “‘ Uh, I think we’ll go with what California says. ’”
“It has sent a clear message to me that I am not welcome in Arkansas,” Smith said.
He’s now considering job offers in other states.
UAMS CONCERNS The State Medical Board tabled Smith and Sudbery’s licensure applications in October but both doctors have considered requesting a license again in December. But the quality of some forprofit foreign medical schools make even UAMS’ top official uneasy. “The problem with these Caribbean medical schools is that there’s no guarantee that [students are ] given a good first or second year of education,” said UAMS Chancellor Dr. I. Dodd Wilson, “and... very often they’re left on their own to find their education in the third and fourth years.” Sudbery completed her thirdyear clinical rotations in Atlanta with medical schools that contract with St. Matthew’s, and made her own arrangements to do fourth-year clinical rotations with private physicians in Jonesboro who teach UAMS students.
“I was amazed to see that she took most of her 4 th year clerkships in Jonesboro,” Wilson wrote to the board. “I cannot speak about her other courses that she took, but certainly the ones that she took in Jonesboro would not fulfill the overall clerkship requirements for UAMS.”
The six family medicine residency programs in UAMS’ Area Health Education Centers are run separately from the medical school’s other residencies, Wilson said. And because fewer medical graduates are going into family medicine, the health education centers’ selection criteria has changed. He said the centers’ residency directors are struggling to balance acceptable academic standards with the need to train doctors for their communities.
“They’re making choices they probably wouldn’t have made maybe 10 years ago,” Wilson said.
Jonesboro residency director Stallings believes the State Medical Board shouldn’t base its opinion of certain foreign medical schools on what California or New York think of them. Still, he can’t attest to the quality of education at St. Matthew’s or St. Christopher either.
“I haven’t been to those schools, so I have no real knowledge of what they look like or what [students are ] taught,” Stallings said. “All I can say is [Sudbery and Smith have ] passed every test that we’ve had. I see them every day. They practice good medicine.”

SO people are getting sick of calif taking charge in the rest of the worlds education using their flawed system of evaluation.....

So this is another state we cant practice in huh?? When does this crap end...I know that if we transfer to a cali approved school we still cannot practice in cali, but does that apply to other states which follow the cali list or for them is it about graduating from a cali dissapproved school?