Last summer, when Dr. Sneha Sheth went online to start filling out applications for residency – the next phase of her training after medical school – she was in for a shock.
Of the 500 residency programs she was considering, nearly half were deemed unfriendly by the website to international medical students like her. match a resident, which helps medical students abroad navigate the US residency application process. Dr. Sheth submitted his applications in September and stayed on the sidelines for months. Then came a crisis of rejection from several programs, and no response from others.
“50 percent of the programs are what you don’t want, which is a scary feeling,” said Dr. Sheth, 28, who recently graduated from Caribbean Medical School. “It’s like, if they don’t want you, who will?”
The disappointment of the Match process, which places graduates into programs where they can begin practicing medicine, led Dr. Sheth to question whether she was foolish to enroll in Caribbean Medical School. She had spent tens of thousands of dollars but dropped out of US residency programs (though she recently landed a position in a Canadian one).
In the 1970s, a wave of medical schools began in the Caribbean that primarily catered to American students who were not accepted into US medical schools; Today there are about 80 of them. Unlike their US counterparts, schools are primarily for-profit institutions, with their additional revenue from tuition and fees going to investors.
Caribbean schools tend to have more lax admissions standards than schools in the United States. Many do not consider standardized medical college entrance test scores as a factor in admission. Acceptance rates in some are 10 times higher than in US schools. They also do not guarantee a clear career path. The residency match rate for international medical graduates is around 60 percent, while it is more than 94 percent for US graduates.
In 2019, Tania Jenkins, a medical sociologist, studied the structure of US residency programs and found that in more than a third of the nation’s largest university-affiliated internal medicine programs, the residency population was overwhelmingly American medical graduates. Caribbean medical school students get into residency at a rate 30 percentage points lower than their American counterparts.
“American medical school graduates enjoy tailwinds,” said Ms Jenkins. “Caribbean medical students experience headwinds. There are many barriers they must overcome in order to have a chance at low-prestige and low-quality training institutions.”
The challenges faced by Caribbean medical students in career advancement have raised questions about the quality of their education. But with the rapid increase in the number of medical schools worldwide – from about 1,700 in 2000 to about 3,500 today – tracking and reporting on the quality of medical schools abroad has proved a difficult task.
In recent years, medical educators and accreditors have made a more concerted effort to evaluate the credibility of those institutions, aiming to inform applicants about subpar Caribbean schools that charge thousands of dollars in tuition and fees. and sometimes fail in position. To your students for career success.
That effort is led in large part by the Educational Commission for Foreign Medical Graduates, which reviews graduates of foreign medical schools and provides them with certificates, including exam scores and documentation of their academic history. In 2010, the commission announced an initiative to require every physician applying for certification to graduate from an accredited medical school. The group also said it would more closely examine the standards of organizations that accredit medical schools around the world. The new rule will be effective from 2024.
The commission has already penalized two Caribbean medical schools – the University of Science in Montserrat, the Faculty of Arts and Technology and the Atlantic University School of Medicine in Antigua and Barbuda. The group refused to award certificates to any of those schools’ graduates, saying they found the schools “serious in terms of treating students and misrepresenting themselves”. The medical school in Montserrat later sued the commission, but the case was dismissed in US federal court. The University of Medicine’s Faculty of Science, Arts and Technology in Montserrat did not respond to requests for comment.
Dr William Pinsky said, “I am deeply concerned that students are being taken advantage of by schools who may not give them proper information about how they are going to learn and what their opportunities will be when they finish school.” , head of the commission.
He said he expects students to be better protected by 2024, when accrediting organizations plan to complete the assessment of all international medical schools through a more rigorous accreditation process.
One of the primary accrediting bodies for Caribbean medical schools is the Caribbean Accreditation Authority for Education in Medicine and Other Health Professions, known as CAAM-HP. Some of the key factors the group considers in denial of accreditation include high attrition rates and low exam pass rates, said the organization’s executive director, Lorna Parkins.
But Caribbean schools sometimes misrepresent their accreditation status on their websites, Ms Parkinson said. She occasionally hears from students who are struggling to transfer from lower-quality schools.
“It’s my daily concern,” said Ms. Parkinson. “I know students have a lot of debt, and their families sacrifice a lot to educate them.”
Applying to medical school in the United States requires a certain level of information: how to study for the MCAT; How to apply for loan; And how to make yourself competitive for select spots. Applicants with less access to resources and advice are at a disadvantage and sometimes less aware of the shortcomings of international medical education.
Dr. Yassian Altigani, 27, who is Sudanese and immigrated to the United States from the United Arab Emirates, said he found little help navigating the obstacle course of medical school applications. He applied to only nine schools, all in Texas, not realizing that most American students applied more widely, and was rejected from all of them. Two years later, when he saw a Facebook ad for St. George’s University in Granada, he decided to apply.
Looking back, he says he wishes he’d re-apply to American schools instead of going the Caribbean route. Although he was able to match a residency program he had recently started, he found the process anxiety-inducing.
“If you fall behind in American medical school, your odds of matching are good, while in Caribbean medical school you are at risk,” he said. “As an immigrant, I didn’t have much in the way of guidance.”
Caribbean medical school administrators say their intentions are straightforward: they aim to expand opportunities for students to attend medical school, particularly to include those from racial, socioeconomic and geographically diverse backgrounds, Those who traditionally cannot pursue a career in medicine.
“There are far more applicants to American medical schools than there are,” said Neil Simon, president of the American University of Antigua College of Medicine. “So why do they object to medical schools that have gained approval and are educating a student population that is so much more diverse? Don’t you think they will welcome us with open arms?”
Mr Simon said he was aware of the bias that AUA graduates face when applying for residency positions in the United States and saw the stigma as unfounded. He noted that international medical graduates were more likely to pursue family medicine and work in under-served areas, especially rural communities.
But experts say the proliferation of for-profit medical schools doesn’t always serve the best interests of students. The Liaison Committee on Medical Education, which certifies American schools, did not recognize any for-profit schools until 2013, when it changed its stance following an antitrust decision that asked the American Bar Association to recognize for-profit law schools. gives recognition. Among medical educators, there still exists substantial skepticism towards the for-profit model.
“If medical students are seen as dollar signs rather than trainees who require a lot of investment, support and guidance, it would fundamentally change the training experience of these students and the way they are educated. It is,” said Ms Jenkins.
Some students at Caribbean medical schools said the quality of their education had further declined in recent years as some campuses suffered natural disasters.
When Hurricane Maria hit Dominica in 2017, where the campus of Ross University School of Medicine was located, the school decided to offer its students a stay on the ship docked near St. For some students, it seemed like an adventure. But as soon as they got on the boat, they realized that it did not lend itself to rigorous study.
With few study sites or electrical outlets available on the ship, Kayla, a first-year student, woke up at 2 a.m. each day to claim a place where she could study for the day. (Kayla asked to be identified only by her first name so that she could openly share her experience.) Her exams were conducted in a room full of windows that looked out over the waves of the ocean. She and her classmates said that if they saw from their tests, they felt nauseated immediately. She couldn’t take Dramamine, she said, because it made her tired. Some of her classmates left before the end of the semester because they couldn’t handle the study situation on the ship.
“We understand that contingencies pose challenges for all,” a spokesperson for Adtalem Global Education, the parent organization of the Ross University School of Medicine, said in an email. “We took extraordinary measures to provide students with the option of continuing their studies or taking a leave of absence until campus facilities are restored.”
But the combined challenges of these schools have given rise to a saying: “Caribbean schools are extremely easy to get into,” said Dr. Abiola Ogunbiyi, a recent graduate of Trinity Medical Sciences University in St. Vincent. “But it’s hard to get out.”
As accreditation standards evolve, Ms Jenkins said one of the most important ways to protect students is to ensure transparency in schools. “People should go into their training with open eyes,” she said.