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Caribbean medical schools

General Info

Approach Caribbean (and other international) schools with caution. Even if they are WHO listed, otherwise accredited and you receive your MD degree, graduates are sometimes not allowed to enter residency or practice in certain (or all) US states. Not all schools are reputable. So, if you decide on this path, you MUST do your homework very well. You do not want to be stuck with a worthless MD degree, unable to practice medicine in the United States.

Your ultimate goal is to practice medicine in the United States - and for that, you'll have to meet the following requirements if you graduate from a foreign medical school:

1. Complete 4 years of medical school. (A 3-year "accelerated" program leading to an MD is not accepted).
2. Graduate with an MD or equivalent degree.
3. Graduate from a medical school listed in the International Medical Education Directory.
4. Pass the USMLE 1 and USMLE 2 board exams.
5. Become ECFMG certified (not required for Fifth Pathway) - more info below.
6. Complete a US residency program (at minimum 1 year is required for licensure).

Most US residency programs will not consider you if you haven't spent at least a few rotations (ideally one year) of your clinical rotations in the US, in a US hospital or clinical setting, during medical school (and you have some strong recommendation letters from these rotations).

Even then, quite a few US residency programs will not consider international medical school graduates. More than a dozen US states have additional requirements besides ECFMG certification and many US states consider medical schools they will accept (and whose graduates they will allow to obtain a medical license) on a case by case basis.

Caribbean medical schools typically only provide the basic science curriculum (1st and 2nd year) "in the Caribbean" on some island in a medical school setting. The 3rd and 4th year rotations are arranged to take place in affiliated hospitals the United States. Most of these affiliated hospitals are located on the east coast.

Graduates of Caribbean medical schools are usually referred to as IMGs (international medical graduates) or FMGs (foreign medical graduates). They are represented in all specialties in the United States. However, most of the IMGs practice in primary care or other non-surgical fields. There are several reasons for this.

Primary care specialties are, generally speaking, less competitive, have less prestige and are less well compensated. Therefore, they are easier to get into. Also, they are the most understaffed specialties. Hospitals depend on residents to take care of patients and must have enough residents to do so. Therefore, more residency programs in the primary care fields accept IMGs.



At Caribbean medical schools, faculty is usually dedicated to teaching only (has no other commitments to do research), but this makes these schools nearly or completely non-research based. (You may not care anyway). Upon graduation, you earn an MD degree. You are required to take all of the USMLE board exams as your US counterparts do.

Board scores and board pass rates are lower for Caribbean school graduates than those of US-trained MD and DO graduates: USLME1 exam pass rates were 58% for Caribbean schools, 69% for osteopathic (DO) schools and 91% for allopathic (MD) schools according to the NBME Annual Report for 2004.

Applications are submitted directly to the Caribbean medical schools for consideration. You can find each medical school's application online at each schools website. At most Caribbean medical schools, students can enroll and begin their studies at school 3 different times during the year (Spring, Summer, Fall).

Check out the list of Caribbean Medical Schools.

The 3 paths to residency training in the United States

You've already been introduced to ECFMG certification and the Firth Pathway program, both of which are explained in more detail below. These two and one more path are the only ways to obtain a residency training position in the United States. The last path involves transferring from a foreign medical school to a medical school in the United states sometime after the pre-clinical years, usually during 3rd year.

Note that the last path is very, very limited. Most medical schools in the United States only have very few openings (or none at all) for transfer students. Typically a spots may open up if someone in the class drops out, which is rare (97% of medical students in US medical schools graduate). Also, you have to have very good USMLE1 board scores to be considered for a transfer, so the US medical schools are typically very picky in whom they will accept for transfers as well.

So, in summary, here are the 3 paths again:

1. ECFMG Certification (most accessible)
2. Fifth Pathway Program (limited spots)
3. Transfer to US medical school (almost impossible)

Licensing and other issues

Again, it is important to note that not all Caribbean medical schools are equal when it comes to being able to secure U.S. licensure, residencies, etc. Many residency programs will not accept IMGs and many states will not allow IMGs to complete rotations or residencies.

Quoting from "Iserson's Getting Into A Residency", 6th ed, p. 374,
(see the recommended books list - I highly recommend this book):

"There are thousands of IMGs in the United States who have not been able to obtain a license to practice medicine. In many cases, this is because residency programs will not accept them for training, and all jurisdictions in the United States require at least one year of postgraduate training in the US or Canada for licensure... In addition, twenty-six licensing boards (...) maintain lists of state-approved foreign medical schools whose graduates are eligible for a medical license."

Some Caribbean medical schools are not accredited and many states in the US consider each foreign medical school independently (not limited to Caribbean schools) to see if they will allow graduates to practice medicine within the state. For many Caribbean medical schools that means that graduates may only be able to practice in about half of the 50 US states. Some Caribbean medical schools graduate physicians who can practice in all US states. So, be cautious and check things out. Here is a link to the different state medical boards which govern physician licensing in each state.

In some instances, schools have also made misleading statements about hospitals they were supposedly affiliated with in the US - but actually weren't. To be sure, contact the hospitals that the school claims it is affiliated with to verify the claim. If you find inconsistencies, stay away from that school.

Checking residency match lists for Caribbean medical schools you are interested in is also a good way to get a feel for how well students are doing in getting into US residencies. Also, stay away from any foreign medical schools offering MD degrees in less than 4 years, or you will not be able to enter a US residency.

ECFMG

What's the ECFMG?
It's the "Educational Commission for Foreign Medical Graduates"

It was established by the American Medical Association and other similar organizations in the United States to evaluate the qualifications of international medical school graduates who are trying to obtain US residency spots.

One requirement for foreign medical school graduates (FMGs/IMGs) is ECFMG certification - without it, IMGs cannot participate in the residency match in the United States.

Note that less than 50% of IMGs actually pass all the ECFMG exams and requirements, so this is a stumbling block for quite a few IMGs.

Requirements for ECFMG certification include an ECFMG English test and the Clinical Skills Assessment test (CSA). IMGs must also pass the USMLE step 1 and USMLE step 2 before being able to enter residency programs in the US.

The ECFMG handles all applications for taking the USMLE exams and some of the other requirements for IMGs.

Check the official ECFMG website for more details.

Fifth Pathway Program

This program does not really fit well into this discussion about Caribbean medical schools, but deserves mentioning as part of the discussion about foreign schools, after understanding some of the difficulties involved and ECFMG certification that were discussed in this section previously.

One way for IMGs to qualify for residency in the United States, after graduating from a foreign medical school, is the "Fifth Pathway Program". In this case, no ECFMG certification is required. This program applies to graduates of foreign medical schools which require one additional year of clinical work or social service after completion of the 4-year medical school curriculum. Medical schools in Mexico fall into this category, for example.

There are a few requirements in order to qualify for this program:
1. Students must have completed their 4-year undergraduate degree in the United States.
2. The foreign medical school must be listed in the World Health Organization's World Directory of Medical Schools.
3. All requirements for graduation from the foreign medical school must be met, with exception of the one year of clinical work or social service.

Note that this is different from being an IMG/FMG, because students who go through the Fifth Pathway Program actually never graduate from the foreign medical school, nor do they graduate from any of the medical schools in the United States which sponsor this program. They are given a Certificate of Completion which is accepted by all US states for physician licensing, being able to enter residency training and practicing medicine.

Essentially, IMGs in this program have to complete a 5th year of medical school rotations in the United States after graduating from the foreign medical school. You can find out more about this at the New York Medical College website, which is one of the sponsors of the Fifth Pathway Program.

Note that although this path is available for some foreign graduates, it offers far too few spots - which makes it hard to enter this program.

Residency

Getting into competitive residencies is hardest for international medical school graduates and residencies are often personally arranged by IMGs when they complete their 3rd and 4th year rotations at one of the US hospitals affiliated with their specific Caribbean medical school. Many IMGs from the Caribbean enter primary care related fields (family medicine, pediatrics, internal medicine, OBGYN) as they are much easier to get into than most other specialties.

But some IMGs can be found in all specialties including the very competitive ones. A lot of it depends on the student's board scores. Great board scores eliminate many disadvantages of where someone went to school. Just realize that most residency directors will consider IMGs last (or not at all) and will prefer US medical school graduates to fill the residency spots in their programs. So, your application has to stand out even more (higher board score than most of the US applicants or some other exceptional characteristics) to get into the more competitive residencies as an IMG.

IMGs can participate in the MD residency match as independent applicants and more often than not arrange their own residency during rotations without going through the match at all, as already mentioned.

I would highly recommend the book "Iserson's Getting Into A Residency".
It obviously covers residency information in great depth as the title suggests, but it really covers much more than just residency and is an excellent resource on a wide variety of topics related to the medical education experience. (see the recommended books list - I highly recommend this book)

Financial Aid

Most of the Caribbean medical schools are not eligible for United States Government loan programs. If a particular Caribbean medical school is eligible for US Government loan programs, that's a very good sign that the school is reputable and stable and has had a track record of some sort.

If a school claims that you will be able to qualify for US Federal Government loans if you attend there, ask for the school's "Federal School Code" maintained by the United States Department of Education for every school which qualifies for US federal loans. The medical school has to have this number available for you to qualify for US federal loans. You can use this number the school gives you to inquire at the student loan office of any major bank in the United States to verify that the number is indeed valid and you will qualify for these loans if you attend that particular medical school.

Otherwise, you are completely dependent on private loans. And any medical school pursuit is very expensive, even in the Caribbean. You can easily spend over $100,000, although many schools are a little less expensive than their US counterparts.

Concluding thoughts

For most applicants, Caribbean medical schools present a last resort for going to medical school after they have tried and failed to gain admission to medical schools in the United States. This does not necessarily mean that they will be bad physicians, however. A few people choose this path if they are older and don't want to take the MCAT (as many Caribbean medical school don't require it). Caribbean schools enroll students three times per year instead of once per year. Some of the most "desirable" or reputable Caribbean schools charge more money (as you might expect) than the less reputable ones and can be as expensive as US medical schools.

MCAT and GPA requirements are usually much lower than for MD or DO schools and some schools do not have an MCAT requirement at all. Before choosing a Caribbean school however, be sure to find out if it will meet your needs and check on accreditation and other issues to make sure you can find residencies, etc, as already discussed.

For any international school, it is also important to check what language the courses are taught in. Some are taught in Spanish, for example. Most Caribbean schools use US medical text books and faculty is often from the US or Britain.

Also, be aware that most often, Caribbean medical schools are located in poor countries which may lack conveniences such as continuous availability of electricity, water supply, telephone and air conditioning. Some or all of these many only be available intermittently or be completely absent.

Other Related Info

See the Path to Medicine section for a brief overview of the entire medical training and the Taste of Med School section for more detail about the medical school experience. You can also read Student Perspectives to get an idea of what other applicants did to gain admission to schools. Also, be sure to check out the med school diaries for a more "insider" view into med school life. For a complete list of medical schools, details and statistical information about medical schools, visit the Med Schools Statistics section.


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