Question about Caribbean schools

[IcedCoffeeOnly]

So from reading around SDN the general consensus seems to be that Carib med schools are predatory and often manipulate statistics to deceive people.

But, for those who make it through the 4 years at a Carib school, why do they have a hard time matching to residencies? Let's say some guy named Jorge doesn't get into an MD or DO program after multiple cycles, but truly wants to become a doctor, so he enrolls at SGU. If he makes it through the 4 years with an average step score, shouldn't he be looked at with a good light for his efforts?

Is it an accreditation thing? I guess there's something fundamental about Carib schools I'm missing. Is it a Congress/law thing where a certain % of residents have to be from a US school, and Carib schools don't count as one? I'm not asking why X should/shouldn't go Caribbean, but for those who do and make it (US Citizens/GC holders), why they're at a disadvantage. Thanks!

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[Isoval]

The short answer is:

1) There are few enough US residency spots as it is. Why would you give a US residency spot to someone who didn’t study in the US when you have ten people lined up who did?
2) Caribbean students are generally seen to have black marks all over them. Whether it was a professionalism issue, lack of ability to delay gratification, or whatever the case may be. There are usually reasons why one ends up there.

 

[Stagg737]

Caribbean schools have a reputation for having a poor pre-clinical curriculum that is largely a 2-year+ Step 1 prep course and poor clinical rotations. Some of the things Caribbean students I rotated with hadn't done/didn't know how to do I found concerning (how the eff do you get through med school and not know how to perform a DRE????). Many Carib students also take time off or extra semesters to study for Step 1 or 2 and take more than 4 years to finish med school. Not something that's exactly promising from a PD's perspective when the residents will be expected to be efficient, hard workers.

PDs also will ask the question of why they went to a Caribbean school in the first place. Could be because they weren't academically capable of getting into a US school, but it can also be because they had some red flag (substance use, legal problems, cheating, etc) which forced them to take the Carib route. If it's the latter, many PDs won't want them in their programs (which would be the same for USMDs or DOs if they knew about it). Why risk that when there are plenty of strong candidates in the US?

Additionally, there's a ton of variations in the standards of these schools. USMD schools answer to LCME. DO schools answer to COCA. Carib schools answer to...no one. So PDs often don't know what the standards these students were held to were. This is part of why you'll hear people talk about the "Big 4" which more recently seems to be more focused on St. George, because these are more established schools with better reputations.

Part of it is just straight up optics from residencies and discrimination. It looks less prestigious if you've got a bunch of Carib MDs and DOs in your program, so there's some discrimination there from programs that want to keep up appearances. Is that really fair? No, but it's reality. DOs face similar road blocks, though to a lesser extent.

 

[Lawpy]

Part of it is just straight up optics from residencies and discrimination. It looks less prestigious if you've got a bunch of Carib MDs and DOs in your program, so there's some discrimination there from programs that want to keep up appearances. Is that really fair? No, but it's reality.

This is key. It also works in the other way with some programs heavily selecting for applicants who went to T20 schools to improve their reputation. PDs are still people and are susceptible to biases.

 

[Ms Procrastinator]

This

Caribbean schools have a reputation for having a poor pre-clinical curriculum that is largely a 2-year+ Step 1 prep course and poor clinical rotations.

This

PDs also will ask the question of why they went to a Caribbean school in the first place. Could be because they weren't academically capable of getting into a US school, but it can also be because they had some red flag (substance use, legal problems, cheating, etc) which forced them to take the Carib route. Why risk that when there are plenty of strong candidates in the US?

and this

Additionally, there's a ton of variations in the standards of these schools. USMD schools answer to LCME. DO schools answer to COCA. Carib schools answer to...no one.

Caribbean schools typically raise a lot of eyebrows and are unfortunately seen as sub par by a lot of people.

 

[Lawpy]

also btw for any Caribbean thread, @gyngyn Caribbean DDx (which is regularly quoted by @Goro ) is something important to consider:

"The DDx for a Caribbean grad is pretty off-putting: bad judgement, bad advice, ego, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems,weak research skills, high risk behavior... This is not to say that all of them still have the quality that drew them into this situation. There is just no way to know which ones they are. Some PD's are in a position where they need to, or can afford to take risks too! So, some do get interviews.

Bad grades and scores are the least of the deficits from a PD's standpoint.

A strong academic showing in a Caribbean medical school does not erase this stigma. It fact it increases the perception that the reason for the choice was on the above-mentioned list!"

 

[IcedCoffeeOnly]

also btw for any Caribbean thread, @gyngyn Caribbean DDx (which is regularly quoted by @Goro ) is something important to consider:

"The DDx for a Caribbean grad is pretty off-putting: bad judgement, bad advice, ego, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems,weak research skills, high risk behavior... This is not to say that all of them still have the quality that drew them into this situation. There is just no way to know which ones they are. Some PD's are in a position where they need to, or can afford to take risks too! So, some do get interviews.

Bad grades and scores are the least of the deficits from a PD's standpoint.

A strong academic showing in a Caribbean medical school does not erase this stigma. It fact it increases the perception that the reason for the choice was on the above-mentioned list!"

True, but couldn't it also show some level of redemption? Maybe something like "Well, this guy made some pretty bad mistakes (but redeemable), but he really pulled himself together in med school (since Step 1 is standardized)." I guess the "reinvention" path Goro mentions could be a better way to redeem yourself though.

This is all just my naivety in the medical field being curious.

 

[efle]

True, but couldn't it also show some level of redemption? Maybe something like "Well, this guy made some pretty bad mistakes (but redeemable), but he really pulled himself together in med school (since Step 1 is standardized)." I guess the "reinvention" path Goro mentions could be a better way to redeem yourself though.

This is all just my naivety in the medical field being curious.

Unfortunately a good step1 score means you did a great job of memorizing info from textbooks and applying it to vignettes on a computer screen. It doesn't mean you had solid clinical years with useful training that will make you a good intern/resident. Taking a Caribbean grad is a big roll of the dice that a residency director has no motivation to risk, unless they're struggling to fill their seats. Hence you see Caribbean grads almost universally shut out of competitive specialties and locations, and typically matching to less competitive programs in less competitive specialties (e.g., primary care in the middle of nowhere)

 

[Stagg737]

True, but couldn't it also show some level of redemption? Maybe something like "Well, this guy made some pretty bad mistakes (but redeemable), but he really pulled himself together in med school (since Step 1 is standardized)." I guess the "reinvention" path Goro mentions could be a better way to redeem yourself though.

This is all just my naivety in the medical field being curious.

Sure, but as stated before, how do you differentiate those who redeemed themselves and grew from those who were decent students from the start but had other problems? Why take that gamble when you have a plethora of US grads without those issues to worry about?

 

[907914]

If someone theoretically just wants to live in the Caribbean, do Puerto Rican schools accept applications from stateside students?

 

[el_duderino]

If someone theoretically just wants to live in the Caribbean, do Puerto Rican schools accept applications from stateside students?

Puerto Rico schools are US schools accredited by LCME. They're not FMGs.

 

[ciestar]

If someone theoretically just wants to live in the Caribbean, do Puerto Rican schools accept applications from stateside students?

These arent international schools. They aren’t at any disadvantage as they’re USMDs and are accredited by LCME. That said, non-Puerto Rican residents can absolutely apply there if they have ties there OR speak spanish.

 

[907914]

These arent international schools. They aren’t at any disadvantage as they’re USMDs and are accredited by LCME. That said, non-Puerto Rican residents can absolutely apply there if they have ties there OR speak spanish.

I wasn’t trying to insinuate that they were a foreign institution, that is why I brought Puerto Rico up. Benefits of USMD and the Caribbean-type lifestyle.

 

[Goro]

If someone theoretically just wants to live in the Caribbean, do Puerto Rican schools accept applications from stateside students?

3/4 of them do.