Tag Archives: USMLE

Why Attend a Caribbean Medical School?

Due to the extremely competitive nature of medical school admissions in the United States, many applicants opt to obtain their medical education in the Caribbean. To provide context, the admit rate at St. George’s Medical School in Grenada, West Indies, is 41%. This contrasts markedly with the admit rates at the most selective medical schools in the U.S., such as Harvard, with admit rate of 3.7%, Johns Hopkins of 3.9% and Stanford, at 4.7%.

To help you decide if attending these schools would be the best option for you, let’s evaluate their curriculum, accreditation, admission requirements, residency outcomes, and the overall success of their graduates.

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St. George’s Medical School. Source: The New York Times 

Choose Wisely: Regional vs. Offshore

 Caribbean medical schools fall into one of two categories: regional or offshore.

  • Regional medical schools train students to practice in the country or region where the school is located, and are typically the choice for Caribbean residents who wish to practice in their home country.
  • Offshore medical schools in the Caribbean predominantly train students from the United States and Canada who intend to return home for residency and clinical practice after graduation. Most offshore schools are dual-campus programs, where students spend their first two years of medical school in the Caribbean learning basic sciences and prepare for Step 1 of the USMLE (United States Medical Licensing Examination). Their clinical years are then spent in the United States. Offshore schools find clinical rotations for their students through partnering agreements with U.S. hospitals.

Accreditation

The first factor to consider is that not all Caribbean medical schools are accredited and not all have access to clinical rotations. So before you decide to attend a particular medical school in the Caribbean, make sure that the schools you are considering will allow you to practice and attend clinical rotations in the United States.

Beware of medical schools that use the terms “approved” or “recognized,” which do not connote accreditation. In addition, make sure that the schools have received the official accreditations that truly matter:

  • Caribbean Accreditation Authority for Education in Medicine and Health Professions (CAAM-HP): a peer review process adopted by CARICOM (Caribbean Community) to accredit educational institutions within the medical, dental, veterinary and other health professions. Of the 17 medical schools in the Caribbean that requested assessment over recent years from CAAM-HP, only American University of Antigua, St. George’s, and Ross have been accredited.
  • Other countries’ accreditation. Several Caribbean medical schools are located on islands that are owned or accredited by other countries. American University of the Caribbean School of Medicine (AUC), based in St. Maarten, is accredited by Accreditation Commission on Colleges of Medicine (ACCM), in Ireland, recognized by the the US DOE’s National Committee on Foreign Medical Education and Accreditation (see below). Saba University School of Medicine (located in the Dutch island of Saba), is accredited by NVAO, the accreditation organization of Netherlands and Flanders.
  • S. State Recognitions and Approvals. Only a few states in the US have individual review processes to approve students to receive clinical rotations, residencies, and licensure in that state; accreditation by these states is typically recognized by other states as well:
    • New York State Education Department (NYSED)
    • Medical Board of California (MBC)
    • Florida Department of Education (FL DOE)

Tiers of Accreditation

Caribbean medical schools are ranked in three tiers (top-tier, middle-tier, and bottom-tier) based on approvals and accreditations. In order to have the greatest options of practicing medicine within the U.S., aim for top-tier programs.

Schools such as St. George’s, Ross, Saba, American University of the Caribbean (AUC) and American University of Antigua (AUA) College of Medicine operate in the top tier and offer a medical education equivalent to that of U.S. schools. All four have been approved by the licensing boards of New York, California, and Florida. AUA, St. George’s, and Ross have also been accredited by CAAM-HP.

These medical schools have thousands of alumni in residency or practicing throughout the U.S. and Canada.

Eligibility for US Funding

In addition, the National Committee on Foreign Medical Education and Accreditation (NCFMEA), within the U.S. Department of Education (DOE), plays a central role in determining whether American students at foreign medical schools are eligible for federal student loans. NCFMEA is not an accreditation agency. Instead, it reviews the standards that a foreign country uses to accredit its medical schools, and determines whether those standards are comparable to the US. If so, any accredited medical school within that country can apply to participate in DOE’s federal student loan program.

Admissions Selectivity

U.S. medical schools place strong weight on applicants’ MCAT scores and GPA. Therefore, regardless of your passion for medicine and the strength of your medically related experiences (such as research, shadowing, and community service), if you don’t perform well on these numerical criteria, your chances of acceptance drop dramatically.

While the average MCAT and GPA of applicants to U.S. medical schools has remained fairly constant over recent years, the stats of matriculants has increased, along with the numbers of applicants, showing greater selectivity and therefore competition. While the number of applicants increased 14% from the 2012-13 application year to 2017-18, matriculants only rose 9.3% since medical schools are not significantly adding capacity. Admit rate in just this six-year period dropped from 43% to 41%.

 

Applicants 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018
Total MCAT 28.3 28.4 28.6 28.3 501.8 504.7
GPA Total 3.54 3.54 3.55 3.55 3.55 3.56
Total Applicants 45,266 48,014 49,480 52,550 53,042 51,680

 

Matriculants 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018
Total MCAT 31.2 31.3 31.4 31.4 508.7 510.4
GPA Total 3.68 3.69 3.69 3.70 3.7 3.71
Total Matriculants 19,517 20,055 20,343 20,631 21,030 21,338

On the other hand, Caribbean medical schools accept students with lower GPAs and MCAT scores and typically do not have minimums. At AUC, the average accepted student’s GPA is 3.27 and the average MCAT is 469. At St. George’s, the average overall GPA for enrolled students entering fall 2016 was 3.3, with the undergraduate science average of 3.2.

Over the past 40 years, St. George’s University has graduated 17,000 alumni and Ross University has graduated 14,000 alumni. At these schools, a 3.4/3.5 gpa is competitive. If you did poorly freshman year, your admission chances at a U.S. medical school decrease, but Caribbean medical schools will consider you.

Academic Performance

Now that we have established the rationale for attending Caribbean medical schools, let’s look at how their graduates actually perform. How prepared are they for the practice of medicine, and how is their education valued? Two leading measures are the pass rate for the USMLE (Untied States Medical Licensing Examination) and residency placement, respectively.

USMLE
The USMLE consists of Step 1, Step 2 Clinical Knowledge, and Step 3. A passing score on all three parts is required to practice medicine in the US. The steps assess the following:

  • Step 1: Basic science knowledge that is foundational to the practice of medicine; understanding principles underlying health, disease, and modes of therapy.
  • Step 2 Clinical Skills (CS) and Clinical Knowledge (CK): Application of medical knowledge, skills, and understanding of clinical science to provide supervised patient care.
  • Step 3: Application of medical knowledge and understanding of biomedical and clinical science to provide unsupervised patient care.

At SGU (St. George’s University School of Medicine) the pass rate in 2017 was an impressive 95% overall, and 95% for US and Canadian students. This compares favorably with the pass rate of 96% at US and Canadian medical schools. The pass rate at SGU has surpassed 95% for five consecutive years. In 2017, the pass rate at other foreign schools was 77%, and the pass rate at US and Canadian DO schools was 95%.

Residency Placement

Residency placement is the all-important next step after medical school, on the path to the practice of medicine.

SGU posts its lists of residency placements online. As an example of the quality of placements, for the Class of 2018 graduates who placed in New York, hospitals included top programs such as Albert Einstein, Mount Sinai, and New York University. Specialties consisted of the full range, including anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pathology, pediatrics, psychiatry, and surgery.

In 2018, 936 St. George’s University grads procured PGY1 positions. There was 93% residency placement in PGY1 the year of graduation. For U.S. students at Ross University there was 94% residency placement.

 

Fast Facts – Caribbean Offshore vs. US Medical Schools Features

 

Selected Top Tier Caribbean Medical Schools

University Total Enrollment Attrition Rate Median MCAT Median GPA Residencies
St. George’s University 6,021 10% 497 3.33 937
American University of the Caribbean (AUC) 400/ year 13% 496 3.27

 

300

 

Ross University  3,500  27%  496 3.22 627

 

Selected U.S. Medical Schools

University Total Enroll Acceptance Rate Median MCAT Median GPA
Harvard University 726 3.5% 518.72 3.92
George Washington U

 

707

 

2.5%

512

 

3.70

Drexel University

 

1,083

 

4.2%

513

 

3.62

New York Medical College

 

818

 

5.7%

513

 

3.58  

Factors to Consider

Various factors are important to consider when gauging the quality of the medical education you will receive at a particular Caribbean medical school. Ask the following questions:

  1. What are the school’s average USLE Step 1 scores?
  2. How is the curriculum structured?
  3. What are the mean overall and BCPM (biology, chemistry, physics and math) GPAs and MCATS of accepted students? Are MCATs required to submit an application?
  4. Where do students complete third and fourth year clerkships?
  5. Does the Caribbean school encourage away electives?
  6. What percentage of 4th year students earn residency placements?
  7. Where and in what specialties did students in the most recent graduating classes match for residency, and what percentage of fourth year students matched into categorical residencies?

Students should always apply to a few of their dream schools, but they should also consult the MSAR (Medical School Admission Requirements), or individual schools’ websites, to determine a list of five to seven additional schools at which they would be competitive grade-wise. Students should also create a list of three or more schools at which their academics are on the very high end, to maximize the chance of securing an acceptance.

Overall, Caribbean medical schools offer less competitive applicants less selective options, a faster application process, and comparable education and residency opportunities as medical schools in the U.S. For many US students, these options provide you with the chance to successfully pursue your passion for a career in medicine. For more information about applying to medical school, in the US and Caribbean, contact us at http://www.colleagiategateway.com. As always, we’re happy to help!

 

Pass/Fail, and Other Trends in Med School Grading

In recent years, there have been vast changes in the way medical students are evaluated and graded. Most notably, many medical schools have replaced their letter or tiered grading system (honors, high pass, etc.) with a much simpler one: pass or fail. According to a recent AAMC initiative, the number of schools using a pass/fail system in the pre-clerkship increased to 87 in 2014 from 71 the previous year. A school’s grading policies have far-reaching implications on its academic culture and community, informing everything from stress levels and competitiveness to the methods by which students are evaluated. As such, it is important that prospective medical students take grading policies into careful consideration as they evaluate different opportunities. 

Rationale for Pass/Fail Grading for Pre-Clerkship Years

This change can be largely attributed to a greater concern for medical student’s overall well-being. One study in Academic Medicine found that the class of University of Virginia (UVA) medical students who were graded pass/fail showed a significant increase in satisfaction as compared to their counterparts who were evaluated using a standard letter grading system. An even broader study surveyed students from seven different medical schools, and found that students evaluated using grading schemes with three or more categories had higher levels of stress and emotional exhaustion, and were more likely to experience burnout than those who were graded pass/fail. Many schools also find that a this system fosters a greater sense of collaboration and cooperation among students, while diminishing competitiveness.

The benefits of this pass/fail grading scheme extend beyond the students themselves, as it may also be helpful to schools as they seek to attract the best and brightest to their institution. In fact, a survey at UVA Medical School found that 81% of the entering class cited the pass/fail grading system as somewhat to very important in their decision to accept the offer of admission.

Examples of Pass/Fail Medical Schools

Schools that employ pass/fail grading during the pre-clerkship years include  Case Western School of Medicine, Albert Einstein College of Medicine and Rochester School of Medicine.

Even within the standard pass/fail grading system, however, there are small differences that distinguish one school from another. Students at Harvard Medical School, for example, are given grades of “satisfactory” or “unsatisfactory” during their pre-clerkship years, but students of exceptional merit can receive a Letter of Excellence that is added to their permanent file.

Many students are wary of pass/fail schools that may still track grades and establish ranking orders behind the scenes. However, schools such as Yale School of Medicine explicitly state that “there are no grades and there is no class ranking.”

Concerns (and Rebuttals)  

As expected, there are some concerns associated with a pass/fail grading scheme. Some worry that a non-tiered grading system may negatively impact students’ residency placement, scores on medical licensing exams (USMLE Step 1 and 2) or overall academic performance. If students are placed into only two categories, is there less incentive and, therefore, less motivation for them to work hard?

These concerns, however, have largely been refuted. The study cited above, involving UVA students, found that a change from a letter grading scale to a pass/fail system did not result in a decline in students’ academic performance or USMLE Step 1/2 scores. Furthermore, there was no negative affect on residency placement, as demonstrated by the quality of residency programs to which students were matched.

Alternatives to Pass/Fail for Pre-Clerkship Years

Despite the hype about pass/fail grading, there are still a significant number of schools (~81 according to AAMC) that evaluate their students using greater than two categories during the pre-clinical years. Pittsburgh School of Medicine, for example, employs a three-tiered grading structure: Honors/Satisfactory/Unsatisfactory for the first two years. The University of Maryland School of Medicine employs a letter grading approach: Honors, A, B, C, D, F.

Different Grading Approaches for Different Years

 Schools often employ different grading schemes depending on course types or year of medical school. The pass/fail system discussed above largely applies to the pre-clerkship years of medical school, when students are learning and reviewing the sciences before entering clinics. The majority of schools recently surveyed by AAMC also use the simple pass/fail system for grading students in electives. However, many schools utilize an entirely different grading scheme when evaluating students in their later years of medical school. In fact, the majority of schools surveyed by AAMC use a four-tiered grading system: honors, high pass, pass, and fail for required clerkships and fourth year electives and sub-internships.

Evaluation Components

In the same way grading frameworks are changing, so are the actual methods used to evaluate students. Schools not only assess their students using standard written exams, but now also use a variety of novel evaluation techniques. Although Yale does not give grades for the first two years, it still employs unique forms of evaluation such as direct questioning during seminars and laboratories to deem acceptable performance or not. Feinberg School of Medicine at Northwestern provides feedback to students using conventional methods such as examinations, as well as skills assessments, and narrative evaluations. Moreover, as of 2012, students at Northwestern build an electronic portfolio that is continuously reviewed with their mentors to ensure they are meeting the school’s required competencies.

Schools such as Perelman School of Medicine at UPenn utilize particularly innovative assessment methods, including simulations and standardized patients. Made possible by recent advances in technology, these assessments involve a patient simulator in a realistic hospital environment. Standardized patients, however, are trained individuals or in some cases, actual patients who help to create real-life medical scenarios.

Academic Honors

Often, these evaluation techniques are used to identify students for academic honors. Boston University School of Medicine awards Latin honors (e.g. summa cum laude) based on a number of factors: performance in courses, scores on medical licensing exams, and other more subjective criteria, such as “extreme initiative and talent.” Other types of academic recognition include membership in the medical honors society Alpha Omega Alpha, as well as distinction in research, and various clerkship and departmental awards.

Every medical school differs slightly in its approach to grading, and it is imperative to thoroughly research schools of interest in order to properly understand these nuances. For more information on medical school grading or any other part of the medical school application process, contact Collegiate Gateway – as always, we’re happy to help.