Getting admitted into an American or Canadian medical school is a tremendous accomplishment. Unfortunately, for many aspiring physicians, the incredibly high competition to get into one of these programs can often delay or end one’s career dreams. Many capable undergraduate students with strong GPAs and countless hours of volunteer service are turned away each year due to the limited number of spaces available. Many students spend additional years attempting to raise their grades, obtaining a master's degree, or volunteering more, to no avail. Eventually, some abandon hope of becoming a physician and pursue other careers. However, for those who are truly unwavering in their quest to become a physician, there is another option: Training overseas as an international medical student; more specifically, training in the Caribbean. Yes, I know, the Caribbean! I’ve heard it all as to why not to go, the most common complaints being the lack of a quality medical education and the inability to secure a good residency program. I, too, had my doubts. Even after witnessing the lack of success of many of my peers who took this path and faced with the choice of seeking out another degree on top of my undergraduate education I decided to give the Caribbean medical program a shot. I also did not want to lose more years before getting to the point of graduating as a physician.
When I first arrived at the Caribbean medical school, I was surprised by the age of many of the students. A significant percentage of the school consisted of students who had decided to begin their medical career straight out of high school. Many were 19 and 20 years old. By choosing this path, many are able to bypass the entire undergraduate and MCAT phase required for entry into most North American medical schools. Although one would assume that they were at a disadvantage due to their lack of an undergraduate degree, the reality is that most of these younger students were able to comprehend the subject matter and compete quite well with their older peers who had completed an undergraduate degree. Many of these students earn their MD degrees and get into residency programs by the age of 23 or 24 compared with age 26 or 27 for most North American graduates. I personally know of several students who are presently completing residency programs in North American hospitals. Bypassing the undergraduate degree has the advantage of saving on 3 to 4 years of tuition plus living expenses while accelerating one’s career path. In reality, a student who successfully completes the MD degree by age 23 can become board certified in some fields, such as internal medicine, by age 26 or 27. This is the same age that many North American medical school graduates are just beginning their residency programs.
Now, let’s discuss the so-called “infamous classroom experience.” Yes, the classrooms were often not as modern or as well-equipped as their U.S. or Canadian counterparts. Some of the equipment was old; the seats were uncomfortable; and the air conditioning systems occasionally malfunctioned, this being the most detrimental given the tropical heat in the Caribbean. Despite the unimpressive conditions, the actual course content was up to par when compared with and measured against standardized tests used in North American schools, such as the United States Medical Licensure Examination (USMLE) Steps 1, 2 (Medical Knowledge and Clinical Skills), and 3, and the Canadian National Assessment Collaboration (NAC) Examination. The teaching faculty was competent in their respective fields and was able to effectively communicate with the students. Many faculty members previously taught at North American institutions and were able to teach heavy course materials in a relatively short amount of time. As with all serious educational programs, a great deal of independent study and discipline were needed along with scheduled lectures in order to succeed. Good time management skills were essential to cover the vast medical school curriculum regardless of where one studied.
While international medical programs have their advantages with regards to acceptance and entry requirements, most of the disadvantages arise when attempting to match for a residency program in the U.S. or Canada. Most hospitals have limited spaces available for international medical graduates. To further exacerbate the situation, many of the mandatory rotations provided by the Caribbean medical schools are done in hospitals that do not offer residency positions to international graduates. Because of this, many international graduates focus on performing well on both Steps 1 and 2 of the USMLE to help them stand out compared to American or Canadian medical school graduates. Additionally, international students should try to participate in enough extracurricular activities to give them a chance to be equally competitive with their fellow international graduates and/or North American graduates.
Attending a Caribbean medical school is usually not the first choice for any prospective American or Canadian medical student. It is often a second (or third) choice. The cost of living in a foreign country with limited loan options and the risk of not securing a residency position following graduation can be major disadvantages. Simply put, it is a risky venture and one not to be taken lightly. However, the fact is that upon completion of the MD program with its required rotations, all graduates can proudly say that they are physicians and are qualified to practice medicine. Once they obtain residency, they are on the same position as their North American graduates. For most students who are truly passionate about becoming a physician, these programs offer an opportunity to fulfill that dream, notwithstanding the disadvantages noted. The reality is that thousands of competent physicians have graduated from these Caribbean medical schools during the past 3 decades. Many have become well-respected physicians, and some are even department heads in prestigious hospitals throughout North America. These programs may not be the most prestigious available, but they are successful in producing many competent physicians every year and still represent a viable alternative to those who fall through the cracks of the traditional medical school system in North America.
Nilesh Maraj Prashad, BSc