Medical School in The Caribbean

Over the course of this series it has become very apparent that medicine is a competitive occupation no matter what country you live in. This holds true to higher degree in some countries more than others. Brenda, a Canadian in the midst of getting her MD from a Caribbean medical school, was nice enough to do a write up for me on what it’s like to get your medical degree from a school in the Caribbean. The Caribbean school route is becoming extremely common amongst American and Canadian students and I felt it was an avenue that definitely needed to be covered in the Medical Education Monday series. I’m really excited to have Brenda’s information to share with y’all today. Please feel free to email me with questions and I will make sure she or I finds the answers for you. As always, comments I’ve added are included in orange font.

Picture I took last summer of St. Matthew’s University residence hall in Grand Cayman.
It literally backs up to crystal clear water & white sand beaches, not fair!
Medical schools have been popping up in the Caribbean for many years now. These institutions offer the opportunity for individuals who have not been able to get into a Canadian or American school a chance to still persue their dream of becoming a doctor. Each school is slightly different, so please do your research when thinking of applying. Also, be wary that some schools are not exactly permanent – they get built and try to get as many students as they can and then shut down. In addition, some schools are not approved by all governing bodies, so please do your research! There are some really good ones that have been around forever and are getting to be as competitive to get in as an American school, but before you apply you need to figure out which ones are appropriate. (Click Here for information on Accredited  Caribbean Medical Schools).

My journey was tough. I went back and forth with several options. When I finally decided to pursue my dream of medicine I didn’t have the time to go through all the required courses in a Canadian university. I did my research and found a school where they offered a pre-med program where, for 8 months, we covered the basics – anatomy, chemistry, medical terminology, etc. With a good GPA I was automatically admitted into the MD program at this school. Attending a Caribbean medical school is slightly more difficult because we are seen as international medical school graduates, but I think in the end it’s all worth it.

Getting In:

How old is one when they begin medical school?
With the Caribbean schools the average age is slightly higher because most individuals have pursued other careers before starting. However, there are also those coming straight from undergrad. For pre-med programs, you need as little as 2 years of undergraduate work to get in.
What exams does one have to take to get in?
Each school in the Caribbean is different. Some require the MCAT and some do not. For the pre-med program, it is not required.
Is there any required pre-requisite coursework?
The required courses to get in are very similar to the US schools.
Is it a competitive occupation?
It is beginning to become a little more competitive to get into these Caribbean schools. Some are becoming as good, and very close to being as competitive, as US schools. The required GPAs are getting higher and higher each year.
What are you called at this stage of training?

Being In:

How long is it?
Four years
How are the years broken down?
Two years of basic sciences on the respective island. Two years of clinical training in the United States. There are some clinical rotations where the Caribbean students are learning right alongside American students.
Describe your typical day.
Semesters 1-3: These are purely basic science. Beginning either 8 or 9am and going all the way to 4:00pm, you sit in a classroom where the professor lectures. Each semester has 4 subjects. After classes, you study. There are “blocks” which are computer-based exams every 3 weeks for each class. At the end of the semester you take a shelf exam that is written. This exam contains old USMLE Step 1-type questions and it is the same exam written by the students in the US. (These are exams written by the National Board of Medical Examiners, or NBME, and they are what my US medical school uses as block finals as well).
Semesters 4-5: Book-type lecturing is decreased at this point and students are doing more hands-on training, like learning to take histories and physicals. We also go to the local hospital.Comprehensive Exam: This is written at the end of Semester 5. It is basically a cumulative shelf exam. It is required in order to go on to take USMLE Step 1.
3rd year rotations: Family Practice, Ob/Gynecology, Internal Medicine, Psychiatry, Pediatrics and Surgery rotations with a shelf exam at the conclusion of each clerkship. Most accredited schools have students do 3rd year rotations at their affiliated US hospital, not in the Caribbean. (Not surprisingly, since many of the Caribbean med students are American, this layout is almost identical to the layout of medical school in the US).
If you choose a specialty, when do you have to decide by?
Most people will decide what specialty they want to go into by the end of their 3rd year rotations.
What are you called at this stage of training?
Medical Student

Getting Out:

What exams do you have to take?
To work in the US we are required to pass the United States Medical Licensing Exam (“USMLE”). We take “USMLE Step 1” after our second year, it is an 8 hour exam covering basic clinical sciences. “USMLE Step 2” has a clinical knowledge part and clinical skills part that has to be passed before graduation at the end of your 4th year. “USMLE Step 3” is taken at the end of your residency training.
Do most people graduate?
Because of the intensity of basic sciences not everyone graduates this portion of the training, each class loses around 1/5th (20%) of their students.
When are you finally considered a “doctor?” 
After your 4th year of med school you graduate and are offically an “MD.”
Do you have additional training or do you start working immediately?
To work in the US you must do a residency in the US. Getting a US residency as a graduate of a medical school in another country is tough, but not at all impossible. Everyone applying to residency in the US must be a medical school graduate (or soon-to-be graduate) and must have passing scores on the USMLE Step 1 and Step 2 (Clinical Knowledge and Clinical Skills portion). However, passing is not usually good enough to get you the residency you want – it’s competitive and the higher your score the better your chances. 
What’s the average debt for attendance?
Each school is different but it can range anywhere from $98,000 to $212,000. Of course, this is only the tuition and you must factor in the price of housing, which can vary substantially. Also, the cost of plane tickets to and from the island when you want to visit your home. 
What are you called at this stage of training?
After graduation you are officially a “doctor.” For your first year of residency you’ll be considered an “intern” and for the rest of your residency training you will be referred to as a “resident physician.”

Being Out:

Most of these students are working towards a career in US medicine and their salaries/schedules/licensing/etc. will not differ from physicians who graduated from a US medical school. For information on physician salaries, job security, specialities, licensing, etc. in the US, see Medical School in the United States.

Past Medical Education Monday Posts: