Over the past 30+ years, the medical college scene in the Caribbean has grown exponentially. Doctor hopefuls around the world are now packing up and traveling to tropical climates to search for medical education.

New Education Possibilities in the Caribbean

In the mid-1970s, Charles R. Modica founded the first private medical school in the Caribbean – St. George’s University – on the island of Grenada in the West Indies. Shortly after, several other private universities sprang up on other Caribbean islands. Universities such as Ross University, SABA, American University of the Caribbean, St. Matthew’s, and almost 50 others can be found today throughout the region.

Originally, the General Medical Council of the United Kingdom carried out accreditation of medical education programs established in the current and former British colonies, including the University of West Indies.

However, in 2001, the GMC discontinued this practice of accrediting overseas institutions in accordance with European Union regulations. Regional educators realized the importance of accreditation within the Caribbean community and, in 2003, the Caribbean Accreditation Authority for Education in Medicine and other Health Professions was formed. The Authority was empowered to determine and prescribe standards and to accredit programs of medical, dental, veterinary, and other health professions education.

To date, only a handful of universities have been accredited by the Authority (University of West Indies, University of Guyana, St. James School of Medicine, St. George’s University, Ross University, University of West Indies School of Veterinary Medicine).

In the years since the first private school, St. George’s, opened, tens of thousands of students have graduated from Caribbean medical schools and gone on to practice medicine around the world.

But How to Choose?

The quality of education in Caribbean medical schools varies greatly and students are encouraged to conduct their research carefully when choosing the school they will attend. Visiting websites such as ValueMD.com and StudentDoctor.net allows prospective students to get advice and first-hand experiences from alumni or students currently in the programs.

For a more unbiased look at each university, students have access to the journal of Academic Medicine, an academic peer-reviewed medical publication of the Association of American Medical Colleges that provides accurate data on the quality and performance of each school.

In the last few years, several reports in Academic Medicine quantified test scores and graduate certification rates for students from Caribbean medical schools.

In October 2008, the journal reported that Grenada was ranked #1 in USMLE Step One and Step Two/CK in the Caribbean for the highest first-time pass rate among all countries with medical schools in the Caribbean over the past 15 years. Grenada – with St. George’s University School of Medicine as the only medical school in Grenada – had an 84.4% pass rate in Step One, outperforming the other countries that had an average pass rate of 49.9% (44% with Grenada removed) during the same 15-year time period.

The Course of Study

Basic Sciences

Students studying in the Caribbean medical schools complete their Basic Sciences years in the region (usually two years, although many advertise accelerated programs) and then must take Step I of the United States Medical Licensing Examination (USMLE) before they are allowed to go on to their clinical training in affiliated US hospitals. St. George’s University students need to pass the SGU Basic Sciences Comprehension Examination in order to proceed into the clinical training program. To be placed in a US-affiliated hospital for more than 12 weeks, a passing score on the USMLE I is required.

Clinical Sciences

Most Caribbean schools limit clinical training to placements in the United States. St. George’s University offers clinical training at approved hospitals in both the United States and the United Kingdom, supporting its international curriculum, and cross training for best practices in its students.

Postgraduate Training

In the United States, postgraduate training positions are called “residencies.” Residency training is typically viewed as more critical than the medical school a student attends. Therefore, it is important to obtain the best residency possible.

It is best to review the postgraduate residency positions obtained by the graduates of any medical school one is considering attending. If a school does not post the annual and cumulative residency training positions gained by its graduates, you should be very wary of that medical school.

Graduates of all US medical schools must enter the National Residency Match Program to obtain a PGY-1 position (postgraduate year one). Non-US students may enter the Match or may “sign outside the Match” with any hospital that wants to give them a PGY-1 position. Non-US grads must first obtain a certificate from the Educational Commission for Foreign Medical Graduates by successfully passing the appropriate STEPs of the USMLE within a specified time frame.

The requirements for practicing medicine vary from country to country and future students are wise to research what those specifications are before committing to a school that has never met them.

Investigate Before Investing

A student will spend tens of thousands of dollars each year for his or her medical education program. The time and effort spent to evaluate each program to determine a quality education are invaluable. Not only are students encouraged to spend time asking questions and researching, but also investing in a trip to the campus to experience first-hand the commitment that will be made with the acceptance letter.

Speaking with Margaret A. Lambert, Dean of Enrolment Planning at St. George’s University – the longest-serving admissions officer of any of the Caribbean institutions – we were able to gain more insight into investigating the Caribbean medical school experience. She specified a set of questions a student must ask each prospective medical school before committing to spend the next four years of his or her life there:

• What is the true attrition rate? Averaging over the last ten years, how many students are accepted into a class and how many students out of that specific class graduate?
• Is there a modern campus? How many buildings? What acreage? Does it have wireless capabilities? Is there university-provided transportation to and from campus? Is it an authentic educational community? Is there adequate on-campus housing?
• What about the safety and security of the surrounding area?
• What is the student-faculty ratio? What is the average tenure of a full-time professor? How many full-time faculty members?
• What is the number of clinical training spots available for students? Is there a faculty member at each hospital or center to direct training? Are the clinical spots at approved teaching hospitals? (Students at some schools are forced to wait for rotations, delaying their ultimate graduation date. Additionally, some are forced to cobble together rotations across a number of locations to complete their own training.)
• Are there comprehensive, formal academic and personal support services available to further student performance?
• In which countries and US states are graduates licensed to practice medicine?
• Are there research opportunities available?
• How many graduates does the school have?
• What undergraduate schools do the students come from?
• What accreditation does the school have?
• Are scholarships available?