Yes, I agree that glaring personality issues in any applicant should be a cause of concern but purely based off the fact that your two examples were students from established US MD programs goes to show that those red flags can be in anyone.
You asserted that with residency interviews it should be based solely on academic merit at that point. I was merely pointing out that, that is just a small piece of the overall picture and character factors are a big component of what is also being assessed for a number of important reasons. Hence why I ended that post with the following:
"Granted the individuals in the two examples above were a graduate and soon be graduate of established US MD programs,
given the factors that commonly lead individuals to pursue the Carib route it’s much more likely to run into potential scenarios like those above with that pool of applicants."
Excluding significant academic issues (which removes the bulk of Carib applicants), when I filter applicants in ERAS by school and look just at Carib applicants there is a much higher prevalence of applicants with IAs, prior dismissals for professionalism, misdemeanors, felonies, etc. compared to US students. Also, given the inherent risk associated with attending Caribbean schools, it puts into question an applicants' judgement. I realize you take issue with why these risks exist in the first place, but nonetheless it's reality and something people have to seriously consider when considering the Carib route. I legitimately cannot think of a sound, reasonable explanation to attend a Caribbean school. All of these are highly associated with problematic character traits, which as I stated above, are indicative of broader and pervasive issues (i.e., ongoing) and not just isolated incidents in a vacuum. Yes, sometimes these are isolated incidents and individuals grow and learn from them. There are US med schools which reward demonstrating someone has changed and learned from their mistakes, and clearly demonstrating this can provide some reassurance for some residency programs when evaluating applicants with red flags. However, given the lax admission standards for Carib schools, this route offers no such reassurance.
Hopefully this analogy helps illustrate the issue:
I'm not big candy/sweets person (which is beside the point) but I do like Runts. My favorite flavor is strawberry, closely followed by lime, and then orange. I don't mind banana every now and then, but I absolutely fuking despise cherry with a passion. There are two bins of Runts in front of me and I'm allowed to pick ten pieces of candy from either bin. Bin one (US applicants) is filled with a mix of all 5 flavors, but slightly more strawberry, lime, and orange. Bin two (Carib applicants) is filled with a bunch of cherries, some bananas, just a smattering of orange and lime, and even fewer strawberries. Which bin am I most likely to pick my ten pieces from?
Last time I checked, they get paid and are expected to interview every qualified student regardless of the school they came from. If they're excluding well qualified students purely based on the school or program they went to then there's something seriously wrong with this field that attempts to value diversity and equity. So they're not going out of their way to interview another 100 Caribbean students that have stellar LORs, great USMLE scores, and a decent personality. It's their job. It's the decisions that come after that which bother me. It should be an objective decision and not based on personal opinion or assumptions of the applicant's character.
Lol, no. Residency selection committees are not compensated for doing so and it is a very time intensive process. It is physically impossible to review and interview every single applicant thus filters (which vary amongst specialties and programs depending on individual priorities) are used to narrow the pool. My program received over 3000 applications for 6 spots. ~40% of those got a somewhat closer look to narrow it down to ~140 applicants we can accommodate interviewing. Even amongst those ~140, applicants start to blur together and we have no issues with diversity within that pool. Of those applicants ~110 will end up on our rank list. Going back to the Runt analogy, we want to filter those 3000+ Runts such that we maximize the potential number of strawberries and limes in our final bin of ~110 Runts; and we have limited time and resources in being able to do so. US schools are a known commodity in terms admissions, academic, and professionalism standards and based on that and past experience we have greater confidence in the number of strawberries and limes we'll get, being okay that we may end up with an orange or even banana, and have low odds of getting a cherry.
I have to bring it back to character unfortunately because that seems to be the main reason as to why people have an aversion to Caribbean students. Judgement of their character then has downstream effects of PDs being more inclined to take people who "played by the rules". That shouldn't have to be the case.
As stated previously by others and myself, character is very important because it can have very significant negative (and positive) effects on coresidents, the program and department as whole, the relationship of the program/department with other departments in the system, and the broader reputation of the program/department. Yeah, we can't predict everything but we use the available information with the available resources to evaluate and minimize potential risk.
When Caribbean students reach the point of applying to residencies, it's safe to say that they're in good academic standing, have passed their exams, have been proficient enough to complete clinical rotations and electives.
No. When I filter applicants by school and look just at Carib applicants the prevalence of prior dismissals, academic issues, taking more than 4 years to complete med school for reasons other than research or additional degrees, Step failures, low Step scores, etc. is MUCH, MUCH higher. Also, as previously stated, the clinical rotations of Carib students are not comparable to those of US students. I personally know people who have gone the Carib route and also know physicians who take payments from Carib school to take students for clinical rotations and then either just have the students shadow for a few days or just take the payment, complete an eval, and/or write a LOR without offering any clinical experience.
-Personality? That's through an interview that is sometimes not even offered strictly because of their standing as a Caribbean student.
Interviews, LORs, PS, overall application, MSPE. And again, it is absolutely impossible to interview every single applicant. It's not a perfect system and there certainly are subjective factors, but it's the best we have. The only reasonable way I can think to improve this aspect is to incorporate IO psychologists on both the program and applicant side of the process, but there is no practical or feasible way of doing this and it wouldn't completely eliminate unknown factors and subjectivity.
-LORs? If the feedback is positive and meaningful then there's no reason why the doctor's legitimacy or standing should come into play. They're not the ones applying to residency. They're a licensed and board certified doctor and that should be enough.
LORs are HIGHLY subjective, largely generic and interchangeable between applicants, and often taken with a large grain of salt. If a LOR author is known to a residency selection committee member and the letter is personal and genuine we're likely to give it more credence. Otherwise, it's like reading tea leaves. We know some people use generic templates and never turn down students when they ask for LORs regardless of the extent or quality of their experience with the student. We know it's not uncommon for attendings to just tell students to write a letter that they then throw in their signature and a statement claiming the student waived their right to read the letter. One the physicians I know who took Carib students collected the money from the school, gave the students the entire rotation to just study for shelf without any clinical exposure, and offered to write a "glowing" eval and LOR. As an aside, this physician had a decades long history of numerous board complaints for professionalism issues with sanctions placed on his licenses and ultimately lost his licenses about 2 years ago.
If the fear is saturating the residency market and overwhelming PDs with applicants, then that shouldn't be any of our concern as students/residents.
Yeah, it should be of concern. It dilutes the profession and puts medicine into a similar predicament as law (which we are progressively nearing).
AAMC has forecasted a physician shortage by 2034.
This is a much more nuanced issue, with maldistribution v. a sheer shortage being a significant and often overlooked factor.
IMG have a big presence there but I am looking forward to the mega thread
