When Dr. Sneha Sheth went online last summer to begin filling out applications for an internship course – the next phase of her training after graduation – she was gripped by disappointment.
Of the 500 study programs she considered, nearly half were rated unfriendly to international medical students like her by the Match a Resident website, which helps medical students overseas navigate the U.S. residency application process. Dr. Sheth submitted her applications in September and spent months getting nervous. Then came the grief of rejections from numerous programs and no replies from others.
“There are 50 percent of the programs you don’t want, which is a scary feeling,” said Dr. Sheth, 28, who recently graduated from medical school in the Caribbean. “It’s like if they don’t want you, who will?”
The frustration of the match process of assigning graduates to programs to begin practicing medicine left Dr. Sheth wondered if she’d been foolish to enroll in a Caribbean medical school. She had spent tens of thousands of dollars but was banned from American residency programs (although she recently got a place in a Canadian).
In the 1970s, a wave of medical schools began to open in the Caribbean, mostly aimed at American students who had not been accepted into American medical schools; today there are around 80 of them. Unlike their US counterparts, the schools are mostly for-profit institutions whose excess income from tuition and fees goes to investors.
Admission standards in Caribbean schools tend to be looser than schools in the United States. Many do not consider the results of the standardized medical college admission test a factor in admission. Acceptance rates in some are ten times higher than in American schools. They also do not guarantee such a clear career path. The match rate for international medical graduates is about 60 percent, compared with over 94 percent for U.S. graduates.
In 2019, Tania Jenkins, a medical sociologist, examined the makeup of U.S. residency programs and found that more than a third of the largest university courses in internal medicine in the country had a predominantly U.S. medical graduate population. Medical students in the Caribbean find a rate 30 percentage points lower than their counterparts in the United States.
“US medical graduates enjoy tailwinds,” said Ms. Jenkins. “Caribbean medical students are facing headwinds. You have to overcome a number of obstacles in order to get a chance at inferior and inferior educational institutions. “
The challenges faced by Caribbean medical students in advancing their careers have raised questions about the quality of their education. But with the number of medical schools growing rapidly around the world – from around 1,700 in 2000 to around 3,500 today – tracking and reporting on the quality of medical schools abroad has proven a difficult task.
In recent years, medical instructors and accreditors have put more effort into assessing the credibility of these institutions with the aim of keeping applicants informed about subpar Caribbean schools that charge tens of thousands of dollars in tuition and fees and sometimes no position relate their students to professional success.
These efforts have been largely led by the Foreign Medical Graduate Education Commission, which reviews foreign medical school graduates and issues credentials, including documentation of their exam results and academic history. In 2010, the commission announced an initiative requiring every doctor who applies for certification to have a degree from an accredited medical school. The group also said it will take a closer look at the standards for organizations that accredit medical schools around the world. The new regulation will apply from 2024.
The commission has already penalized two Caribbean medical schools – the Medical School of the University of Science, Art and Technology in Montserrat and the Medical School of the Atlantic University in Antigua and Barbuda. The group refused to give testimonials to the graduates of these schools, saying they found the schools “outrageous for the treatment of students and the misrepresentation of themselves”. The medical school in Montserrat then sued the commission, but the case was dismissed in a US federal court. The Montserrat University of Science, Art and Technology Faculty of Medicine did not respond to requests for comment.
“I am very concerned that students are being taken advantage of by schools that may not give them the correct information about how they will study and what options they will have when they finish school,” said Dr. William Pinsky, Commissioner.
He said he hoped students would be better protected by 2024 when accreditation organizations intend to complete assessments of all international medical schools through a tougher accreditation process.
One of the primary accreditation bodies for Caribbean medical schools is the Caribbean Accreditation Agency for Education in Medicine and Other Health Professions, known as CAAM-HP. Lorna Parkins, the organization’s executive director, said some of the key factors the group considers when it comes to denying accreditation include high turnover rates and low exam success rates.
Recognition…about Yasien Eltigani
But Caribbean schools occasionally misrepresent their accreditation status on their websites, Ms. Parkins added. Sometimes she hears of students struggling to move out of substandard schools.
“It is my daily concern,” said Ms. Parkins. “I know that students have very high credit and that their families make great sacrifices to raise them.”
Applying to a medical school in the United States requires a certain level of expertise: how to study for the MCAT; how to apply for loans; and how you can compete for a selected number of places. Applicants with less access to resources and mentoring are disadvantaged and sometimes less aware of the disadvantages of international medical training.
Dr. Yasien Eltigani, 27, a Sudanese and UAE immigrant to the United States, said he had little help tackling the obstacle course of medical school applications. He only applied to nine schools, all in Texas, unaware that most US students were applying on a large scale, and was all turned down. When he saw a Facebook ad for St. George’s University in Grenada two years later, he decided to apply.
Looking back, he says he wished he had applied to American schools again instead of going the Caribbean route. Although he was able to get involved in a residency program that he had recently started, he found the process frightening.
“If you fall behind in a US medical school, your chances of a match are good while you are at risk in a Caribbean medical school,” he said. “As an immigrant, I didn’t have much orientation.”
Caribbean medical school administrators say their intentions are simple: they aim to expand the opportunities for students to study medicine, especially those of racially, socio-economic, and geographic backgrounds to people who may not have traditionally been persecuted have medical careers.
“US medical schools have more applicants than they know what to do,” said Neil Simon, president of the American University of Antigua College of Medicine. “So why are they objecting to medical schools that are licensed and educating a much more diverse student population? Wouldn’t you think that they would receive us with open arms? “
Mr Simon said he was aware of the bias AUA graduates face when applying for residency in the United States and that he saw the stigma as unfounded. He added that international medical graduates are more likely to practice family medicine and work in underserved areas, especially in rural communities.
However, experts say that the diffusion of for-profit medical schools does not always serve the best interests of students. The Liaison Committee on Medical Education, which accredits U.S. schools, did not recognize for-profit schools until 2013 when it changed its stance after an antitrust ruling that the American Bar Association should accredit for-profit law schools. There is still considerable skepticism about the profit-oriented model among medical professionals.
“If medical students are viewed as dollar signs rather than trainees who require a lot of investment, support and guidance, it fundamentally changes these students’ educational experience and the way their education goes,” said Ms. Jenkins.
Some students at medical schools in the Caribbean said the quality of their education had deteriorated in recent years as some universities were exposed to natural disasters.
When Hurricane Maria hit Dominica in 2017, where the campus of the Ross University School of Medicine was located, the school decided to offer accommodation to its students on a ship docked near St. Kitts. It sounded like an adventure to some students. But as soon as they got on the boat, they found that it was not suitable for thorough study.
With few places to study or power outlets available on the ship, Kayla, a freshman, woke up at 2 a.m. each day to find a place to study for the day. (Kayla asked to be identified by only her first name so she could freely share her experience.) Her exams were held in a room with windows overlooking the ocean waves. She and her classmates said that when they looked up from their tests, they immediately felt sick. She couldn’t take Dramamine, she said, because it made her tiredness worse. Some of her fellow students left her before the end of the semester because they could not cope with the study conditions on the ship.
“We understand that extenuating circumstances are challenging for everyone,” a spokesman for Adtalem Global Education, the parent organization of Ross University School of Medicine, said in an email. “We have taken extraordinary measures to give students the opportunity to continue their studies or to take a leave of absence until the campus facilities can be restored.”
But the combined challenges of these schools have given way to a saying, “It’s extremely easy to get into Caribbean schools,” said Abiola Ogunbi, a recent graduate from Trinity Medical Sciences University in Saint Vincent. “But it’s hard to get out.”
As accreditation standards evolve, Ms. Jenkins said one of the most important things you can do to protect students is to ensure schools are transparent. “People should go into training with their eyes open,” she said.