‘The hard part is getting out’: How Caribbean medical schools fail their students

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(Science Times)

Last summer, when Sneha Sheth went online to start applying for her residency – the next phase of her training after medical school – she was deeply disappointed.

Of the 500 residency programs she was considering, nearly half were rated “unfriendly” to international medical students, like her, by Match a Resident, which helps overseas medical students navigate the residency application process in the United States. Sheth submitted her applications in September and was nervous for months. Then came the pain of rejection from many programs and the lack of response from others.

“50 percent of the programs you don’t like, and that’s scary,” said Sheth, 28, who recently graduated from Caribbean Medical School. And you think, ‘If they don’t love you, who will? “

Frustrations with the selection process, which assigns graduates to programs where they can begin to practice medicine, made Sheth wonder that she was naive when she enrolled in a Caribbean medical school. She invested tens of thousands of dollars into her studies, but was eventually unable to get into US residency programs (although she was recently accepted into a Canadian residency programme).

In the 1970s, there was a wave of medical schools beginning to open across the Caribbean, mostly targeting Americans who were not accepted into medical schools in their country; Today, there are approximately 80 of those. Unlike their counterparts in the United States, universities are mostly for-profit institutions and their surplus income from tuition and fees goes to investors.

Admission requirements for Caribbean schools tend to be more lax than those in the United States. Many do not consider Standardized Medical School Admissions Test (MCAT) scores to accept applicants. Acceptance rates in some are 10 times higher than US schools. Nor does it guarantee such a clear career path: The residency program match rate for international medical graduates is about 60 percent, compared to more than 94 percent for US graduates.

In 2019, medical sociologist Tanya Jenkins studied the composition of US residency programs and found that in more than a third of the nation’s largest internal medicine programs that were affiliated with a university, the vast majority of residents are US medical graduates. Medical students in the Caribbean enter residencies an average of 30 percentage points lower than their counterparts in the United States.

“Alumni of American medical schools have a favorable wind,” Jenkins said. “Caribbean medical students are facing headwinds. They have to overcome a series of obstacles to get a chance at training institutions of lower status and quality.”

The challenges that medical students in the Caribbean have faced in advancing their careers raise doubts about the quality of their training. But due to the rapid growth in the number of medical schools around the world – from about 1,700 in the year 2000 to about 3,500 today – monitor and publish reports on the quality of medical schools in the world. Aliens proved to be a difficult task.

In recent years, medical and accredited educators have made more concerted efforts to assess the credibility of those institutions, aiming to keep applicants informed about low-quality Caribbean schools, which charge tens of thousands of dollars in tuition and fees and sometimes fail to position their students for professional success.

This effort has been spearheaded in large part by the Foreign Graduate Medical Education Committee, which reviews and presents the credentials of foreign medical school graduates, including documenting test scores and academic records. In 2010, the commission announced an initiative that would require all physicians applying for certification to have graduated from an accredited medical school. He also said he would take a closer look at the standards of organizations that accredit medical schools around the world. The new rule will go into effect in 2024.

Applying to medical school in the US requires a certain level of experience: how to study for the MCAT, how to apply for loans, and how to be competitive when there are a set number of places. Applicants with less access to resources and advice are at a disadvantage and sometimes less aware of the obstacles to studying medicine abroad.

Yassin al-Tijani, 27, a Sudanese who immigrated from the United Arab Emirates to the United States, said he had little help getting past the hurdles in medical school applications. He applied to only nine colleges, all in Texas, and was rejected by all. Two years later, when I saw an ad on Facebook from St. George’s University in Grenada, I decided to apply.

In hindsight, he says, it would have been better to reapply to American schools than to make the Caribbean option. Although she was able to get into the residency program, which she had recently started, the process seemed to be stressful to her.

“If you delay in the medical profession in the United States, your chances of choosing accommodation are good, while if you go to a school in the Caribbean you are at risk,” he said. “As an immigrant, I didn’t have much counseling.”

Caribbean medical school administrators say their intentions are clear: They seek to expand opportunities for students to study medicine, especially those from diverse ethnic, social, economic, and geographic backgrounds, and to include people who may not have traditionally been able to dedicate themselves to medicine.

“American medical schools have so many applicants that they don’t even know what to do with them,” said Neil Simon, president of the American University of Antigua (AUA) School of Medicine. “Why would they oppose medical schools that have been approved and educate more diverse students?”

Simon said he was aware of the bias faced by AUA graduates when applying for jobs in the United States, and that he considers the stigma unfounded. He added that international medical graduates are more inclined to pursue family medicine and work in underserved areas.

But experts say the proliferation of for-profit medical schools does not always serve the interests of students. The Liaison Committee for Medical Education, which accredits American schools, did not recognize any for-profit schools prior to 2013, when it changed its position in the wake of an antitrust ruling that required the American Bar Association to accredit for-profit law schools. Among medical educators, there is still considerable skepticism toward the for-profit model.

“If medical students are seen in dollar signs rather than interns who need a lot of investment, support and guidance, this fundamentally changes the experience of training these students and the way their education evolves,” Jenkins said.

Some students from medical schools in the Caribbean said the quality of their education has deteriorated further in recent years, with some universities facing natural disasters.

In 2017, when Hurricane Maria hit Dominica, where the Ross University School of Medicine campus is located, the school decided to provide housing for its students on a ship docked near San Cristobal. For some students, this seemed like an adventure. But as soon as they get to the ship, they realize that the situation does not lend itself to rigorous study.

With few study places or outlets available on the ship, Kayla, a student, got up every day at 2 am to find a place where she could study during the day. (Kyla asked to be known by her first name only so she could freely share her experience.) His tests were conducted in a room with windows overlooking the sea waves. She and her classmates said that if they looked from the exams, they would immediately feel sick. Some of his classmates left before the end of the semester because they could not afford the study conditions on the ship.

“We understand that extenuating circumstances posed challenges for everyone,” a spokesperson for Adtalem Global Education, the parent organization of Ross University School of Medicine, said in an email. “We have taken extraordinary steps to offer students options to continue their studies or take time off so that campus facilities can be restored.”

But the common challenges of these schools have given way to a saying: “It’s very easy to get into Caribbean schools,” said Abiola Ogunbe, a recent graduate of St Vincent’s University of Medical Sciences. “The hard thing is getting out.”