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U P DAT ED
F o R
2012 - 2013
CARIBBEAN MEDICAL SCHOOLS
A
Journey
and
Guide
U P DAT ED
F o R
2012 - 2013
CARIBBEAN MEDICAL SCHOOLS
A
Journey
and
Guide
By the author of one of the leading websites for Caribbean Medical Schools for the past 12 years – CaribbeanMedicine.com!
Asad Raza, M.D.
Caribbean Medical Schools: A Journey and Guide Copyright 1999-2012 by Asad Raza, M.D. All Rights Reserved This book is available for purchase at the following online bookstores: www.Amazon.com www.BookSurge.com www.Abebooks.com www.Alibris.com www.BooksinPrint.com www.GlobalBooksinPrint.com Printed in the United States of America International Standard Book Numbers ISBN-10: 061555251X ISBN-13: 978-0-615-55251-4 To order multiple copies at discount rates, please contact: Create Space customer service department: www.createspace.com Edited by Carla McDonald |
[email protected] Cover and Interior Design by Leigh Anne Ference-Kaemmer | www.laferencekaemmer.com Cover Photograph by R. Gino Santa Maria | Dreamstime.com
_____________________ This book is dedicated to the people of Baghdad, Mosul, Basra, Fallujah, Karbala, Najaf, Kabul and Kandahar. With my love and admiration. _____________________
_____________________
“Two roads diverged in a yellow wood, and sorry I could not travel both . . . and I took the one less traveled by and that has made all the difference” _____________________
Robert Frost, 1920 “The Road Less Traveled”
xi
Table of Contents ACKNOWLEDGEMENTS Chapter 1
INTRODUCTION
xix
1
Preface Basic Path Exams Residency Some Basic Pros and Cons Medical Schools in the Caribbean Admission Tuition Financial Aid Basic Advice About
1 2 2 4 8 10 14 15 17 18 20
Chapter 2
MY FIRST TWO YEARS OF MEDICAL SCHOOL
The Journey The Basic Science Classes Anatomy, Histology, Embryology Biochemistry, Physiology, Psychology, Ethics Microbiology, Neuroscience, Genetics , Epidemiology Pathology I, Pharmacology, Physical Diagnosis Clinical Medicine, Pathology, USMLE Board Review Island Life USMLE Step 1
21 21 22 22 24 25 27 28 29 32
xii
Chapter 3
MY THIRD AND FOURTH YEARS OF MEDICAL SCHOOL
33
Third Year Clinical Rotations 33 Pediatrics 34 Psychiatry 35 Internal Medicine 35 Obstetrics and Gynecology 36 Surgery37 Fourth Year 38 Summary of Events 39 Chapter 4
USMLE
USMLE Step 2 CK (Clinical Knowledge) USMLE Step 2 CS (Clinical Skills) Clinical Skills Assessment USMLE Step 3
Chapter 5
My Residency Application
Choosing a Specialty Make Your Visa List Call the State Licensing Boards Apply with ERAS! Attend Interviews Match Day and Visa Application
41 41 42 42 45
47 47 48 48 49 50 50
xiii
Chapter 6
Work Visas
J-1 Visa J-1 Waiver H-1B Visa My H-1B Visa Story Green Card
51 51 52 53 55 58
Chapter 7
BOOKS USED IN MEDICAL SCHOOL
61
Chapter 8
HOW I CHOSE A CARIBBEAN MEDICAL SCHOOL 67
Evaluating, Researching and Comparing all the Schools 67 Saba Websites 70 Student Websites 70 Business Website For Saba Island 70
Chapter 9
MY PERSONAL STORY
An Immigrant’s Journey
71 71
xiv
Chapter 10
SUMMARIZED TIME LINE
A Quick Look at All the Key Steps Chapter 11
DETAILED TIME LINE
A Complete Summary of All the Events During Your Four Years Basic Sciences Clinical Sciences
75 75
77 77 77 78
Chapter 12
CARIBBEAN MEDICAL STUDENT COMMENTS
What Students from Other Schools Have to Say About Their Experiences AUC Ross Saba Spartan St. Eustatius St. George Unibe Windsor
81 81 81 85 87 91 91 93 94 95
xv
Chapter 13
FINANCIAL AID
How to Pay for Medical School Financial Aid Sources Chapter 14
HELPF UL URLs
Essential Websites for Your Research Caribbean Medical Schools Medical Organizations of the United States Chapter 15
MY RANKINGS
My Ranking of the Medical Schools in the Caribbean
97 97 98
99 99 99 100
101 101
Chapter 16
MCAT AND USMLE ADVICE
Information and Tips on How to Pass These Exams
105
105
xvi
Chapter 17
RESIDENCY PROGRAMS
Descriptions of the Residency Programs Completed After Medical School
111 111
Chapter 18
Opportunities for International Medical Graduates in Canada
121
Chapter 19
HIGH COST OF AN INFERIOR EDUCATION125 Chapter 20
FACTS FOR INTERNATIONAL MEDICAL STUDENTS Chapter 21
WORDS OF WISDOM
129 133
xvii
Chapter 22
FREQUENTLY ASKED QUESTIONS Admission Financial Aid Medical School Clinical Rotations USMLE Immigration and Visas Residency Training Licensure Chapter 23
About the Author
139
139 159 161 164 169 170 176 183
191
Chapter 24
TESTIMONIALS ABOUt THIS BOOK
193
xix
ACKNOWLEDGEMENTS To my grandfathers, Hashmath Raza and Jawad Ali Baig, both of whose biological fathers died when they were young boys, but with the help of their mothers, studied hard, earned University degrees and became great men . . . still remembered by many to this day. To my father Rashid Raza and my mother Zainab Raza, both of Hyderabad, India, for raising me with a tremendous emphasis on education. To my sister Mariam Mirza in Dubai, UAE and my brother Ali Raza in Ontario, Canada for being great siblings. We are a great team. I love you. To my teachers, professors and coaches at the schools I graduated from: Brampton Centennial Secondary School, York University and Saba University School of Medicine. Finally, to the United States of America for providing me with all the opportunity I could ever desire in life.
INTRODUCTION
1
Chapter 1 INTRODUCTION P REFACE Caribbean medical schools have become a very popular option for undergraduates wishing to pursue a career in medicine. In Canada, a country of 34 million people, there are 14 English language medical schools (3 French). Nationwide, those 14 medical schools offer only 2,043 spots annually. In Ontario, where I grew up, only one out of every six applicants gets accepted and matriculates (in 2010 there were 5,412 applicants for 954 spots in that province). As a result, many qualified students are being rejected year after year. A typical path for Canadian students has been to apply to medical schools in the United States, but this has proven to be a difficult and extremely expensive route. In the United States there are 125 medical schools offering a total of 18,655 spots; and, one out of every 2.3 applicants gets accepted. In 2010 there were 42,742 applicants for those 18,655 spots. But, if you are a Canadian applying to the U.S., you are considered a foreign applicant. In 2010, only 171 foreign (non-U.S. citizen) students entered
2
Caribbean Medical Schools | A Journey and Guide
the first year class at a U.S. medical school. So, 99% of students that are accepted and matriculate at a U.S. medical school are U.S. citizens or permanent residents of the United States (Green Card holders). Therefore, instead of giving up on what, for most, is a very deeplyfelt goal of attending medical school, many students have chosen to enter medical schools in the Caribbean with the goal of obtaining a residency and eventually practicing in the United States or Canada. I want to provide much-needed information to students, like you, who are considering this option, as there must be many uncertainties you are facing.
BASIC PATH 1. Graduate from a Caribbean Medical School (M.D. degree) 2. Obtain ECFMG certification 3. Obtain a residency in the United States
EXAMS ECFMG ECFMG (Educational Commission for Foreign Medical Graduates) is an organization that issues a certificate that you will need to obtain to become eligible to enter a residency (post-graduate training) position in the United States. To obtain the certificate you must pass:
INTRODUCTION
3
SMLE Step 1 U (taken after the first two years of med school) SMLE Step 2 CK U (taken after the third year of med school) SMLE Step 2 CS U (taken after the third year of med school) USMLE The United States Medical Licensing Exam Steps I, II and III are standardized tests that U.S. medical students have to take and pass as well. 1. USMLE Step I is based on the first two years of medical school - the basic sciences. 2. U SMLE Step II is based on the third year core clinical rotations. 3. USMLE Step III is all clinical, with an emphasis on the management and treatment of a patient. Most take it after their first year of residency. Also, twelve states will allow candidates to register for the Step 3 examination before they have started a residency program. USMLE Step 2 CS The USMLE Step 2 CS (Clinical Skills), which was formerly known as the CSA (Clinical Skills Assessment), is a one-day (pass/fail) exam in which you interview and diagnose patients. You can take it at one of the five ECFMG centers that offer it: Pennsylvania, Georgia, California, Illinois, Texas.
4
Caribbean Medical Schools | A Journey and Guide
RESIDENCY This is by far the most important aspect. Remember, the M.D. degree can be earned anywhere. It is a residency that will be your ultimate goal. There were 16,893 U.S. medical graduates in 2011, and there were 26,158 total residency positions available in the United States NRMP residency match. This means that the difference of 9,265 spots were available to the “Independent Applicant pool.” This pool includes U.S. D.O. (Doctor of Osteopathic Medicine) graduates, Canadian medical school graduates, and all International Medical Graduates (IMGs) from all over the world, regardless if they are a U.S. citizen, Canadian citizen or a citizen of any other country. In 2011 a total of 20,842 Independent Applicants were competing for those remaining 9,265 spots. Caribbean medical schools place their students in clinical rotations in affiliated hospitals in the United States during the third and fourth year of medical school. Therefore, Caribbean medical students are at a far greater advantage when competing with other IMGs for U.S. residency (post-graduate training) positions. Residency programs tend to feel more comfortable with students that have been trained in a U.S. hospital and are familiar with basic procedures and technology. This also gives Caribbean medical students the benefit of establishing contacts and friendships with the doctors and supervisors during the clinical years. Those people will not only write your letters of reference, but can aid you in obtaining a position in a U.S. residency program.
INTRODUCTION
5
U.S. Residency Programs Residencies for recognized specialties are diagrammed below. The length of each bar represents the years of training required for certification. 1
2
FAMILY PRACTICE
3
4
5
EMERGENCY MEDICINE PEDIATRICS
SUBSPECIALTIES
INTERNAL MEDICINE
SUBSPECIALTIES
OBSTETRICS/GYNECOLOGY PATHOLOGY G E N E R A L SUBSPECIALTIES SURGERY NEUROLOGICAL SURGERY ORTHOPAEDIC SURGERY OTOLARYNGOLOGY UROLOGY TRANSITIONAL or PRELIM MEDICINE or PRELIM SURGERY
ANESTHESIOLOGY DERMATOLOGY NEUROLOGY NUCLEAR MEDICINE OPHTHALMOLOGY PHYSICAL MEDICINE PSYCHIATRY RADIOLOGY - DIAGNOSTIC RADIATION ONCOLOGY
6-7
6
Caribbean Medical Schools | A Journey and Guide
Comparison of residency positions available in Canada and the U.S. FREIDA (www.ama-assn.org/go/freida) lists all ACGME-accredited residency programs. The U.S. column in this table is the NRMP (www.nrmp.org) list, which only has those programs that participate in their Match, which is a lower number. In the U.S. a certain number of residency positions are available outside of the NRMP match (nonNRMP residencies). The Canadian column is complete (stats taken from www.carms.ca). Keep in mind that the U.S. Match is much better for Caribbean grads as it has around a 50% IMG match rate; whereas the Canadian match rate for IMGs averages around 10%. Residency Program Anatomic Pathology Anesthesiology Dermatology Diagnostic Radiology Emergency Medicine Family Medicine General Surgery Internal Medicine Neurology Neurosurgery Obstetrics/Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology Pediatrics Physical Med and Rehab Plastic Surgery Psychiatry Radiation Oncology Urology
Spots in Canada in 2011 24 118 26 88 65 1089 114 402 40 16 100 38 81 29 157 23 28 131 21 32
Spots in the U.S. in 2011 1081 841 362 1124 1626 2708 1108 5121 594 195 1205 Non-NRMP 670 283 2482 373 108 1097 171 Non-NRMP
INTRODUCTION
Residency Program Anesthesiology Anatomic Pathology Dermatology Diagnostic Radiology Emergency Medicine Family Medicine General Surgery Internal Medicine Neurology Neurosurgery Obstetrics/ Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology Pediatrics Physical Med/ Rehab Plastic Surgery Psychiatry Radiation Oncology Urology
7
% IMGs Avg hrs/week in the U.S. (PGY-1) in 2011 14.4 61.6
Avg Salary (U.S. $) (PGY-1) in 2011 48,343
37.1
50.9
47,505
3.5
45.2
49,142
10.3
51.7
49,973
8.7
56.3
47,912
41.6
63.3
47,394
20.5
75.5
48,023
53.7
64.2
47,699
40.9 11.8
64.4 76.6
48,786 47,580
20.2
71.1
47,793
6.9
51.6
49,062
2.9
70.5
47,577
2.4 32.1
67.6 65.6
47,556 48,090
19.7
54.6
48,959
10.6 38.7
64.9 56.2
55,151 48,448
3.6
50.0
49,120
4.9
66.4
49,771
8
Caribbean Medical Schools | A Journey and Guide
SOME BASIC P ROS AND CONS These are the PROS: 1) Split camp U.S. program: first two years (sciences) completed in the Caribbean, last two years (clinicals) completed at affiliated hospitals in the U.S. 2) U .S. curriculum: hence, better preparation for the USMLE than other foreign schools. 3) Much easier to get accepted than U.S. or Canadian schools. 4) Three entering dates: September, January and May. But these are the CONS: 1) Having to go from state to state to do your clinicals.
However, if you enjoy traveling and going to different places and meeting new people, and want to take advantage of establishing contacts, this could be a PRO! Also, it is possible to get most of your rotations in the same place with certain schools. 2) The Visa problem for non-U.S. citizens when trying to get a residency in the U.S.
There are two types of visas available to do residency in the United States. The first one is the J-1 visa, which you can get through the ECFMG. You will need to have an offer from a U.S. residency program and a “Statement of Need” from the Ministry of Health in your home country. However, after completion of your residency in the U.S., you must return to your home country for two years, unless you get a J-1 waiver.
INTRODUCTION
9
The second visa is H-1B. This requires that you take an additional exam (USMLE Step 3) before applying for the visa. This may take several months to get before starting residency, so it’s good to plan ahead with a timeline. Twelve states (Arkansas, California, Connecticut, Florida, Louisiana, Maryland, Nebraska, New York, South Dakota, Texas, Utah, West Virginia) will allow candidates to register for the Step 3 examination before they have started a residency program. So getting a visa is very possible, but will require some additional time. NOTE: you are not limited to those states for a residency. You are free to do a residency in other states. Those states listed are the ones that allow students to register for Step 3 before starting a residency. 3) May have to do better than the average U.S. grad on USMLE Step 1 and USMLE Step 2 CK to get a residency, and also have to pass the USMLE Step 2 CS!
Examinations are given in a format compatible with that of the USMLE at some schools. But success on the boards will depend on the student’s work ethic and determination. Be prepared to work hard. 4) If you are from Canada, obtaining a residency in Canada as a foreign medical graduate is very difficult.
10
Caribbean Medical Schools | A Journey and Guide
MEDICAL SCHOOLS IN THE CARIBBEAN All these schools are listed with the WHO (World Health Organization) and the IMED here: https://imed.faimer.org Readers are reminded that WHO has no authority to grant any form of recognition or accreditation to schools of medicine or other training institutions. Such a procedure remains the exclusive prerogative of the national government concerned. WHO limits itself to publishing information on medical schools that have been provided or confirmed by the governments of its member states. English Language Caribbean Medical Schools Recognized by the Medical Board of California Source: www.mbc.ca.gov/applicant/schools_recognized.html M.D. Programs Dominica Ross University School of Medicine www.rossu.edu Grenada St. George’s University School of Medicine www.sgu.edu Netherlands Antilles Saba University School of Medicine www.saba.edu St Maarten American University of the Caribbean School of Medicine www.aucmed.edu
INTRODUCTION
11
M.B.B.S. Programs Jamaica University of the West Indies Faculty of Medical Sciences www.mona.uwi.edu/fms Barbados University of the West Indies School of Clinical Medicine www.cavehill.uwi.edu Trinidad and Tobago University of the West Indies Faculty of Medicine St. Augustine www.sta.uwi.edu/fms The above listed seven medical schools are the only English language medical schools located in the Caribbean that are approved by the Medical Board of California.
The Importance of California licensure: States in the U.S. are becoming increasingly strict with regard to recognizing foreign medical diplomas, in particular from graduates of new offshore Caribbean medical schools. Most states are slowly, but surely, approaching the high standards of California, which is the strictest state. Therefore, it is best to only consider schools that are licensed in California, as the other states in the U.S. will soon adopt the same guidelines as to which foreign medical diplomas they recognize and approve for licensure.
12
Caribbean Medical Schools | A Journey and Guide
F ull List of English Language Medical Schools in the Caribbean Anguilla Saint James School of Medicine Anguilla anguilla.sjsm.org Antigua and Barbuda American University of Antigua College of Medicine www.auamed.org University of Health Sciences Antigua School of Medicine www.uhsa.ag Aruba Aureus University School of Medicine www.aureusuniversity.com/aruba Xavier University School of Medicine www.xusom.nl Barbados niversity of the West Indies, U Barbados Faculty of Medical Sciences cavehill.uwi.edu Bonaire Saint James School of Medicine Bonaire bonaire.sjsm.org Cayman Islands t. Matthew’s University S School of Medicine (Grand Cayman) www.stmatthews.edu
INTRODUCTION
Curacao Avalon University School of Medicine www.avalonu.org Caribbean Medical University School of Medicine cmumed.org St. Martinus University Faculty of Medicine www.martinus.edu Dominica All Saints University School of Medicine, Dominica www.allsaintsuniversity.org Ross University School of Medicine www.rossu.edu Grenada St. George’s University School of Medicine www.sgu.edu Jamaica All American Institute of Medical Sciences aaimsedu.com University of the West Indies Faculty of Medical Sciences www.mona.uwi.edu/fms Montserrat Seoul Central College of Medicine www.seoulmed.org University of Science, Arts & Technology (USAT) Faculty of Medicine www.usat-montserrat.org/medicine.htm
13
14
Caribbean Medical Schools | A Journey and Guide
Saba Island Saba University School of Medicine www.saba.edu St. Kitts and Nevis International University of the Health Sciences (IUHS) www.iuhs.edu Medical University of the Americas (Nevis) www.mua.edu University of Medicine and Health Sciences, St. Kitts www.umhs-sk.org Windsor University School of Medicine www.windsor.edu St. Lucia American International Medical University School of Medicine aimu-edu.us Atlantic University School of Medicine ausom.org
ADMISSION The mean GPA (Grade Point Average) and MCAT (Medical College Admission Test) for accepted students at Caribbean medical schools varies greatly. A competitive applicant usually has a GPA of around 3.2 and MCAT scores of 7 or 8. Most of these schools require at least three years of undergrad, but some will accept students after only two years. Chances for admission are better if you apply well before the date you would like to enter, as most of the spots are open then. But buyer beware! Some of these schools are so desperate for students that they will accept anyone that applies.
INTRODUCTION
15
Two big problems arise with this: First, several of these newer schools are really bad, so getting admission into them means nothing. Second, many of the students that are offered these ‘easy’ admissions are totally not academically suitable for medical school and therefore will never pass the USMLEs. In the process they and their parents will lose tens of thousands of dollars. The MCAT is optional at most schools, but it is highly recommended that you write it. It is excellent preparation for medical school studies.
TUITION Here is a table comparing the tuition (in U.S. $) at the Caribbean medical schools. One semester is four months in duration. These tuition rates were valid as of January 2012. But may have changed since then. Please verify these values with each school. Medical School All American Institute of Medical Sciences All Saints University American International Medical University St. James School of Medicine American University of Antigua University of Health Sciences Atlantic University School of Medicine AUC
Caribbean Island School is Located on
Tuition Tuition for for Basic Clinical Sciences per Rotations semester per semester
Jamaica
$6,000
$7,200
Dominica
$4,995
$6,995
St. Lucia
$9,500
$9,850
Anguilla
$6,500
$7,500
Antigua
$12,282
$13,970
Antigua
$11,500
$11,300
St. Lucia
$3,800
$6,800
St. Maarten
$16,900
$18,900
16
Caribbean Medical Schools | A Journey and Guide
Medical School Aureus University School of Medicine Avalon University CAHSU Caribbean Medical University Destiny University International American University MUA Ross Saba Seoul Central College of Medicine Spartan St. Eustatius St. George
Caribbean Island School is Located on
Tuition Tuition for for Basic Clinical Sciences per Rotations semester per semester
Aruba
$6,495
$7,995
Curacao Belize
$6,500 $8,000
$7,700 $9,500
Curacao
$4,900
$6,900
St. Lucia
$7,000
$8,000
St. Lucia
$6,000
$9,500
Nevis Dominica Netherlands Antilles
$9,500 $16,575
$10,450 $18,200
$10,150
$10,950
Montserrat
$4,999/trimester
$6,000
St. Lucia St. Eustatius
$4,950 $7,800 Terms 1&2: $22,414 3&4: $30,660
$9,750 $8,400
Grenada
St. James School of Bonaire Medicine St. Martinus University Curacao St. Matthews Cayman Islands Trinity School of St. Vincent Medicine University of Medical St. Kitts and Health Sciences University of Science, Montserrat Arts and Technology UWI - Faculty of Jamaica Medical Sciences UWI – School of Barbados Clinical Medicine UWI – Faculty of Trinidad and Medicine St. Augustine Tobago St. Kitts and Windsor Nevis Xavier University Aruba School of Medicine
$22,625
$5,000
$7,500
$7,400 $9,400
$10,500 $10,950
$10,800
$12,500
$7,925
$11,000
$4,100
$4,500
$18,126
Per year
$16,618
Per year
$21,500
$25,000
$4,990
$4,990
$6,500
$9,000
INTRODUCTION
FINANCIAL AID UNITED STATES Federal: www.fafsa.ed.gov Sallie Mae: www.salliemae.com Stafford: www.staffordloan.com CANADA Bank of Montreal: www.bmo.com Canada Trust: www.tdcanadatrust.com/student/pro.jsp CIBC: www.cibc.com OSAP: osap.gov.on.ca Royal Bank: www.royalbank.ca Scotia Bank: www.scotiabank.com INTERNATIONAL IEFA: www.iefa.org Financial Aid Guide: www.princetonreview.com/scholarships-f inancial-aid.aspx
17
18
Caribbean Medical Schools | A Journey and Guide
BASIC ADVICE Keep in mind that a school listed with the World Health Organization (WHO) or the International Medical Education Directory (IMED) still may not qualify for licensure in the United States. What really matters is state approval. Currently only five English language medical schools located in the Caribbean islands are approved by all fifty states in the United States. Those Caribbean medical schools are American University of the Caribbean, Ross University, Saba University, St. George’s University and the University of the West Indies. Be prepared. Know what you are getting yourself into: 1. Please contact several people in your search for info, preferably “the source” (school administration, medical organization, etc.). Research, research, research! 2. Be VERY aware of the RISKS involved with attending a foreign medical school and becoming an international medical graduate (IMG). Contact the AAMC, AMA, NRMP, CaRMS and find out the facts regarding this issue. Only go to an established California-approved medical school. Stay away from schools that just opened up in the last few years and are promising basic sciences on their island with USMLE preparation and guaranteed clinical rotations. 3. The most important thing I can tell you about attending medical school is to make sure you are academically suitable. In other words, be certain that you will be able to handle the intense medical curriculum. I found, for me, the biology section of the MCAT prepared me quite well for my studies in medical school. If you feel your background is weak, and that you may have problems, then before
INTRODUCTION
19
you attend, I strongly recommend taking some college/ university courses, in biology, physiology, biochemistry, etc. Just take a look at the medical school curriculum to get an idea of what types of courses you need to prepare for, and make certain that you do! 4. ...and lastly, follow your heart. Don’t attend medical school because it will make your parents happy, or because you think it will make you prestigious or rich. All this is actually not true about a career in medicine. Attend only if you have a genuine interest in the study of medicine and the subjects involved, and you love to study. This way you will be happy. Otherwise you will be miserable and will drop out. Find out the FACTS. Get them directly from the source - the “horse’s mouth,” as they say - whether that is the medical schools, the ECFMG, FSMB or other governing bodies. It is important to know the truth and the risks involved with Caribbean medical schools, and the realities. That is the only way you can make the most informed decision for yourself. Some basic questions one should ask the Caribbean school are: 1) What is your USMLE Step 1 and Step 2 first-time pass rate? 2) What is your clinical placement rate (at affiliated hospitals in the U.S.)? 3) What percentage of your graduates obtain a residency in the U.S.? Ask away! Don’t be satisfied until you know everything. Then, and only then, can you decide whether or not to attend a Caribbean medical school. Read this great book, post on the forums and share your information. I sincerely wish the best of luck to you all. I know the pain you are going through.
20
Caribbean Medical Schools | A Journey and Guide
ABOUT This guide was originally started in 1999 by me for a few friends who were interested in attending a foreign medical school. It was soon realized that this information was very much needed by many others as well. Since then, in the past 13 years now, my guide, book, website and forum have been widely read, with tens of thousands of students from all over the world taking advantage of the valuable information they provide. I honestly never thought the response would be so profound. The goal of the guide remains the same: to provide step-by-step information to anyone who is interested in studying medicine at a Caribbean medical school and then going to the United States to obtain a residency and later a license to practice medicine. I have gone through the entire process: I have attended and graduated from a Caribbean medical school, completed the two years on the island, completed the two years of clinical rotations in the United States. I have passed the MCAT, USMLE Step 1, USMLE Step 2 CK, USMLE Step 2 CS, TOEFL, MCCEE, MCCQE Part 1 and USMLE Step 3. I received my ECFMG certificate and the H-1B Visa and I did my post-graduate (residency) training in the United States. I obtained my full state medical license and am now practicing as a physician in the U.S. If you wish my success to be yours, I can show you how: it’s all outlined and explained in detail in this book. Simply read the book and be on your way. I wish you the very best in achieving your goals!
MY FIRST TWO YEARS OF MEDICAL SCHOOL
21
Chapter 2 MY FIRST TWO YEARS OF MEDICAL SCHOOL THE JOURNEY After a lack of success in gaining admission at a Canadian or U.S. medical school, I decided to pursue an M.D. degree in the Caribbean. With over 1600 medical schools worldwide, why the Caribbean? Well, as a Canadian, I knew that once I left Canada to go to a foreign medical school, getting back into Canada would be very difficult, so my goal was to go to the U.S. and work there. Now, getting into the U.S. for a residency depends largely on your USMLE board scores. Since the USMLE is based entirely on the U.S. medical curriculum, many foreign medical graduates have a tough time doing well on this exam because they learned medicine in another country, at a school that has a different curriculum than the U.S. schools. So, in choosing a foreign school, with the goal of eventually working in the U.S., I chose a Caribbean school because these schools have a U.S. curriculum and you can do your third and
22
Caribbean Medical Schools | A Journey and Guide
fourth years of medical school (the clinical rotations) in the U.S. This maximizes your chance of obtaining a residency position in the U.S.. After looking through all the schools, I chose Saba University School of Medicine. So let me tell you all about how my years went on this “rock.” Hence begins the story of an International Medical Graduate (IMG).
THE BASIC SCIENCE CLASSES I started FIRST SEMESTER (of five on the island) on September 6, 1999. What a historic day in my life! Our classes were 1) Anatomy, 2) Histology and 3) Embryology. 1) Anatomy The professors structured this course in an excellent way. At the start of each block they gave you a handout, which had everything you needed to know. During the lectures they supplemented the handout. Plan on wasting your time reading that big Moore book? Well, that is a no-no. Just know those handouts cold for the tests. I recommend the Board Review Series for Anatomy. The Netter Atlas is a must, always have it open while studying. Now, for the lab, you need to go after hours to the lab (with other med students) and quiz each other on all the cadavers: don’t just know your cadaver, you must know all of them. This course will teach you where all the organs, vessels and nerves are so that later you can learn about their diseases with a better understanding. 2) Histology This course was easily the worst experience I had at Saba. The professor was this incredibly conceited and rude person, who
MY FIRST TWO YEARS OF MEDICAL SCHOOL
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quite honestly did not care about you or what you learned. He just walked into class every day and recited (by memory) the day’s lecture, at a New York taxi cab’s speed and then left. The students who came to Saba with a really good histology background were able to do well, but otherwise you were screwed. On at least three times during this course, the Scranton incorrectly marked questions wrong on our tests. All these times this professor said that he would give us these points at the end of the course. These are points that we had EARNED (not a curve!). Well, at the end of the course he didn’t give them to us. He was a liar on a big power trip. I complained about him to the President of the school, the school did nothing. This is one thing you will notice very early on when you attend a Caribbean medical school: there is no real professionalism among the teaching staff. A great book is the Wheaters w/CD ROM. Now for the lab component, like anatomy, you need to go after hours to the lab and learn the slides. This is largely a course that deals with the way something looks under a microscope, normally and abnormally, and to learn how to differentiate between the two. 3) Embryology Basically, if you just read your textbook, you were fine. Lectures were like a story. I preferred reading the text (even though I hate reading big books). But this book is very readable and interesting. Read the book! There is no shortcut. You may think that there is, but it won’t work. The High Yield book for embryology is terrible, way too point form. A lot of people dismiss this class, but it IS important because many of the diseases you learn in Pathology are embryological. This course will teach you about the ‘nine month’ period that a baby goes through from conception to birth.
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Caribbean Medical Schools | A Journey and Guide
SECOND SEMESTER we had Biochemistry, Physiology, Psychology and Ethics. 4) Biochemistry A lot of stuff to learn, but Dr. S. was excellent. He made biochemistry seem easy. Dr. L. taught us the harder blocks, so it was tough. Pathways, pathways ... and more. Enzymes, rate-limiting steps and all that ‘short term’ memory stuff. Make yourself some nice charts and keep them for when you get to pharmacology, where you learn about drugs that block these pathways. Class notes and Lippincott is all you need. Lippincott text rules. There is a lot of stuff on this course, but that book, with your time commitment, will help you really get a handle on this course. Dr. S. based his final exam on the 30 Biochemistry pages in the famous First Aid for the USMLE Step 1 book: a great idea, I think. 5) Physiology This is a very important course because physiology is the study of the normal functioning of the human body. You need to get a good handle on it before you get to pathology, which is the study of the abnormal. So learn as much as you can. I had a good experience in this course. I recommend the Saunders Physiology book by Costanza. Great subject. Saunders Physiology by Costanza is the #1 book for physiology. There is a lot of controversy about whether to use Guyton. My opinion? You have got to be kidding me ... waaay too much info in that book for a one-semester course. That Guyton book is awful.
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6) Psychology Dr. K (a fellow York University grad!) makes your life a lot easier in this course. Believe me, this course could be really hard, but Dr. K teaches it in a fun way. I recommend the High Yield book. Psych is a good read. You can relax (at least I did) and read the Kaplan and Saddock Pocket Handbook and learn a lot. 7) Ethics The J.D. who taught this brought his 17 years of law practice experience to this course. It is quite interesting. So sit back, relax (everyone got an A) and just listen and talk about medical ethics, and learn some cool things. THIRD SEMESTER we had Microbiology, Neuroscience, Genetics and Epidemiology. 8) Microbiology The first month of this course was - God - such a struggle. I mean, the prof was just awful. Our class notes were basically a bunch of random words with no correlation ... a word salad. So every student was reading a different source to TRY to understand what the hell was going on. Just look at the books people in my class were reading a Immunology required text, Lange’s, High Yield, BRS, USMLE Review Book, Medical Micro Book, etc. With the students who took their course before, their schema once again compensated, but me, the math major, got killed. Just when I thought I had to throw in the towel, Dr. T. came in and taught us. She was like our “MESSIAH” saving us from the falling depths of hell. She was wonderful. In five semesters on the island, my favorite textbook was the Clinical Microbiology Made Ridiculously Simple - get it! For Immunology we all used different sources because it was sooo badly
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Caribbean Medical Schools | A Journey and Guide
organized. Microbiology is very important. Get a good handle on all the bugs: bacteria, parasites, fungi and viruses. Make charts with a list of all the bugs and some classic ‘buzzwords’ about each. It will help you later on. 9) Neuroscience “Please rescue me!” Could things get any worse? The lectures for this class are the biggest joke. You sit in class for two hours every day and learn nothing. So I would go home after class and read that God-awful Snell book. I read the entire book (540 pages) and recall, I HATE reading big textbooks. But I had no choice. I typed up chapter summaries for the entire book. Neuro can be very hard, so don’t get bogged down with details, just learn the big picture. 10) Genetics The prof plagiarized this course straight from the Thompson and Thompson Genetics books. He put all his copied lectures in one notebook. During class he explained them as if he wrote them. In addition, unfortunately he demonstrated terribly unprofessional behavior: from verbally abusing students to physically abusing teachers (yes, this is true), to failing students he did not like. Welcome to the Caribbean, folks. He desperately needed professional help in controlling his temper. I think he had a very sad and troubled life. I have no idea why the school kept him on staff. Genetics was easy so don’t worry. 11) Epidemiology Just print out her PowerPoint® lectures and read them and the book. Don’t sweat this course … the amount of Epidemiology you need to know for the USMLE Step 1 would probably take about two weeks to learn. This course is about statistics related to health care.
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FOURTH SEMESTER (second year begins!). We had Pathology I, Pharmacology and Physical Diagnosis. 12) Pathology I This course was largely a review of stuff you already know (the first half of the Robbins book). The profs were terrible and you basically realize what a waste of time it is after a few weeks. Just read the pocket Robbins and read their PowerPoint® lectures (which were basically pocket Robbins typed word-for-word into PowerPoint®). Pathology is arguably the most important course. It is held over two semesters. Robbins text is used here, it’s a horrible book. Personal opinion? The Golgan book is way better. Can you read and understand all that is Robbins? If yes, then that’s great! If not, get the pocket Robbins. Pathology I is mostly all cellular ‘ga-ga’ - really boring. Learn it all because, unfortunately, they will be on the boards. 13) Pharmacology Dr. N. and Dr. I. did a great job at teaching this course of 700 drugs. The orange Katzung review book is excellent. The green Katzung book is far too detailed for a one-semester course. Also, the board simulator series pharmacology questions are very good to do for preparation. Read their PowerPoint® lectures first, then read the corresponding chapter in that review book and do the MCQs. For the final exam, I did all 570 pharmacology questions from the Board Simulator CD Rom; it helped a lot! You have to know this course well; it is extremely important. For each drug learn the generic names, drug class, mechanism of action, usage, side effects and drug interactions. Study this course hard.
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14) Physical Diagnosis I did the absolute bare minimum in this course, because it was so badly taught and disorganized, and I learned next to nothing. So I can’t tell you anything about it, sorry. FIFTH SEMESTER (almost out of here!), we had Introduction to Clinical Medicine, Pathology II and at the end of the semester, USMLE Review. 15) Introduction to Clinical Medicine This was by far the most useless course of the entire five semesters. I mean, they could have made this course very helpful, and really solidify what we had learned so far. But they didn’t. It was mostly student presentations, which are snooze city, and irrelevant lectures by useless profs. Geez, what can I say, presentations! So learn how to use Microsoft PowerPoint® and get a head start on writing History and Physicals if you have time. 16) Pathology II Arguably the most important course for the boards, but we had the most horrible profs this side of the Atlantic Ocean. Sometimes I could not believe how bad they were. They were mostly heavy-accent losers from foreign countries. I mean, this course had the worst professors. Man, oh man. The only reason I would even attend class is because we had this bogus attendance policy. But people still skipped! Just read Robbins, Golgan or the Kaplan books and teach yourself. You have to know your pathology of organs systems. Otherwise you will never pass the boards. Learn patient presentations, even for Step 1. Be able to link pathology to pharmacology and microbiology, as these types of questions appear in large numbers. Get the First Aid book and the Vignettes and a good ‘digestible’ pathology book and study, study, study!
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17) USMLE Board Review They put this at the very end. Four weeks of professors coming in and trying to review two years worth of basic sciences. I just sat in the back of the class and read my Kaplan books. Well, on April 18, 2001, a day I never thought would come, I finally finished my time on that boring island (yeah!). I started my third year clinical rotations in August of 2001 in the United States. Important Note: My dear friends, please remember that finishing five semesters of basic sciences at a Caribbean medical school does not mean much. In fact, it means absolutely zero! EVERYTHING you have to do in order to get a residency in the United States happens AFTER you leave the island.
ISLAND LIFE EXERCISE I continued to run, but not nearly as often as I used to. I did some weights at the gym in Windwardside (which is where I lived). But man, did I miss my track club back home - all the training and the races I used to run. Saba Bay to Bay Road Race When I first came to Saba Island I saw how hilly the place was and, I must admit, I was pretty disappointed. I knew it would be very hard for me to continue running on Saba the way I used to back home in Ontario, Canada.
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I started anyhow, but it was pathetic. I mean, a 25-minute run was exhausting me on those monster hills … and back home I used to run for an hour everyday! In July, 2000 the wonderful people of Saba, including Suzanne Nielsen, held the Bay-to-Bay (Island Wide) run/walk on Saba. From the airport all the way to the other end of the island – Fort Bay. Approximately 12km (7.5 miles). I thought it would be impossible to run it. I mean the climb from the airport to the first three villages is crazy. You go from zero to 2000 feet above sea level within the first part. I walked half of it and still won the event in 1 hour and 16 minutes. Later they told me that the Saba record was 1 hour and 7 minutes. In December 2000 they held the event again and I ran the entire way! The first part, from the airport to the church at Upper Hell’s Gate was entirely uphill! But I ran it in 19 minutes. I knew I would break the record when I saw this time on my watch. Anyhow, I had not been training, to be honest, just going for 25 minute runs here and there. But I still put in a very strong effort and reached the bottom in 39 minutes and made it to the finish in 43:33. New Saba record! It was pretty cool. I am sure someone can break this record, but I don’t think someone can lower it below 41 minutes. However, you never know! It’s all really in the mind because when Professor David Aarons and I set the pace that day, we led a total of six people under the old record. SOCIAL Well, for me, life on the island was not as great as it could be. The island is very small with only around 1400 people. I chose to live as inexpensively as possible. I had no cable, phone or vehicle. In a way it’s good, because I got a lot of studying done, but yes, I have to admit, things got very boring and lonely. It was a sad time in my life.
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Sometimes I would go out to a party at the house of some of the students; or go to Guido’s, Lollipop’s or Queen’s Garden for a dance or whatever. Other students, however, were living with all the luxuries you can have on Saba: phone, internet, vehicle, cable, nice houses, warm water for a shower, air conditioning, etc. I figured I could do without these things for 20 months, because I could barely afford to go to this school … I had an excellent ability for sacrifice. As far as finances go, I just paid tuition/fees and $470/month for rent (I lived in Windwardside, which is the heart of Saba). If you lived in some crappy place in St. John’s or Hell’s Gate you could probably get a place for $300 or less. I spent money on food, photocopies and not much else. BREAKS During the break after first semester I went to St. Vincent (a nearby island). I was there for three weeks. It was a really memorable time, and I had a lot of fun. In second semester, I went to St. Barts for a day trip. It is a nice little French island with some neat places to shop, dine and beach. During the break after second semester I went to St. Martin with a friend of mine. St. Martin is nice, man. That is a really beautiful place for a vacation and to meet women. The break after third I HAD to go home, otherwise my mother would have killed me. It was nice to see my family after a year. They made fun of how much weight I had gained. INTERNET The internet was, as always, my source of info and communication to the outside world. Internet access is difficult as there is only one free place – the library. You can get internet in your room to your PC, but that requires getting a phone line and
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internet access, which is costly. But I continued to post on my website forums to help incoming students or to learn a little myself from what others had posted. POST ISLAND USMLE STEP 1 After I completed the first two years of medical school (the basic sciences) on the island, I went back home to Toronto, Ontario, Canada to study for USMLE Step 1. I took the Kaplan center access med pass for USMLE Step 1 which consisted of: 1) Preview (Step 1 books) 2) Lesson (videotaped lectures) 3) Review (question banks) The first 30 days (which included the books) were $600 Canadian dollars. I studied for 14 weeks for USMLE Step 1. The first seven weeks I read the Kaplan USMLE Step 1 books and I went to the Kaplan center and watched the videotaped lectures with a 30-day Kaplan Med Pass. Info at: www.kaplanmedical.com Then the second seven weeks I completed questions online with Kaplan QBank and several other CD roms I had. I also read the High Yield section of the First Aid for USMLE Step 1, and a few other books I had. I studied very hard for this exam. I wrote the test on July 28, 2001. I got my results four weeks later and I passed.
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Chapter 3 MY THIRD AND FOURTH YEARS OF MEDICAL SCHOOL THIRD YEAR/CLINICAL ROTATIONS My third year schedule was as follows: Pediatrics (6 wks)
Aug 13, 2001 – Sept 21, 2001
Psychiatry (6 wks)
Nov 5, 2001 – Dec 14, 2001
Internal Medicine (12 wks)
Dec 17, 2001 – March 8, 2002
OBGYN (6 wks)
March 11, 2002 – April 19, 2002
Surgery (12 wks)
April 22, 2002 – July 12, 2002
I started my third year clinical rotations on August 13, 2001. I completed my first rotation at Leonard J. Chabert Medical Center in Houma, Louisiana, USA.
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PEDIATRICS (6 wks) • Aug 13, 2001 - Sept 21, 2001 This is a six-week rotation that I did to start off my third year. There were four physicians that we rounded with, one physician per day in the morning. There were five students in this rotation. It was an 8 a.m. – 4 p.m. type shift, not that stressful. Because it was my very first rotation, there was a lot to be learned, including simple things like common hospital abbreviations that I did not know. In the morning we were in the hospital. When we arrived we had about an hour or so to go see the patients that had been admitted to the hospital (the ‘In-Patients’). When we went to see the patient, we would write a daily report in standard S.O.A.P. (Subject, Objective, Assessment, Plan) format - basically the patients’ complaints, their current vital signs, the current assessment and possible treatments. When the doctor arrived we would then do rounds. At this time we would have to present the patient to the doctor; in other words, tell the doctor about the patient. The doc would then agree or disagree with what we had written and further advise on the plan for the patient and discuss the patient’s condition. In the afternoon we were in the clinic. These were the ‘OutPatients.’ When a patient came in, we (the students) would first go in and perform a physical exam, just the basics, looking at their ears, listening to their heart, lungs, bowel sounds, and then writing down what we found - normal or abnormal. Then the doctor would come in and take a look at what we had written and proceed with the treatment of the patient. Bread and butter of pediatrics is asthma, ADHD and otitis media. We had a test at the end of this rotation. After this rotation, I wrote and passed the TOEFL to get that requirement out of the way. (Note that this test is no longer required for IMGs). I did my next three rotations in Elgin, Illinois, USA at Provena Saint Joseph Hospital. More info see: http://www.provena.org/stjoes/
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PSYCHIATRY (6 wks) • Nov 5, 2001 – Dec 14, 2001 This was a laid-back rotation. Basically, I spent time up on the Psych floor and with a psychiatrist. I saw the doc a couple of times a week and he would go over some patients with me and look over History and Physical reports I had done. There was a psych lecture series given at a nearby mental health clinic that I attended. In the afternoons all the in-patients had group sessions which were quite interesting and amusing at times. There were also out-patient programs on weekends that I went to. Bread and butter of psych is depression, depression, depression, bipolar and some schizophrenia. INTERNAL MEDICINE (12 wks) • Dec 17, 2001 – March 8, 2002 This was an extensive rotation that covered far more than you could grasp in three months. The first four weeks I was with an internist/geriatric specialist in his office. I saw all the patients with him. I drew blood, gave shots, wrote prescriptions, etc. I spent time with him at lunch and did rounds with him at two hospitals and nursing homes. Bread and butter of this practice is hypertension, diabetes, hyperlipidemia, thyroid disorders and urinary incontinence. The next three weeks I spent in the Emergency Room. I learned how to put in IVs, foleys, do EKGs and suture. The ER is not like what most people think; it’s not the excitement that you see on TV. It’s more like a walk-in clinic. The last five weeks I rotated one week at a time through five specialties (Oncology, Nephrology, Gastroenterology, Cardiology, Neurology). Whew! Too much to soak in, but I would just go home at the end of the day and read about the stuff that I saw during the day. I read the Blueprints books mostly. These are great books.
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Caribbean Medical Schools | A Journey and Guide
The most enjoyable part of this rotation, for me, was helping out at the free clinic. The Chief of Staff at Saint Joseph Hospital ran this clinic and he would let med students come and just hop right in, as if we were the docs! Of course, he would have the final say on any treatment. It was great experience to be given the responsibility of handling patients. I would go in, do a SOAP note, talk to the patient and then come out and present it to the doctor, and he would approve or disapprove of what I wanted to do. He would then explain what should be the proper management of the patient. At the end of this rotation I had an oral exam and a written exam. The doctor that had supervised me the longest completed my student evaluation that my university required for each rotation. This hospital had a lecture series given by the Chief of Staff mixed in with student presentations. We went to lecture three times a week, time permitting. Even though Provena St. Joe’s was not an ACGME (Green Book) hospital, it was a great place to do rotations. OBSTETRICS AND GYNECOLOGY (6 wks) • March 11, 2002 - April 19, 2002 This was one of those rotations that pleasantly surprised me. I had heard from other students that an OB/GYN rotation is hard and really a pain; but, for me, it turned out pretty memorable. I was with a very successful physician/business man. He had three practices and a lab business. I was with him in his offices and assisted him with deliveries (vaginal and cesarean). He was a rather interesting character, always cracking jokes. He took me out three times (twice to ladies night in the Chicago area) and we had great discussions on medicine and other world issues. He really motivated me to work hard and made me realize how competitive the private practice setting is.
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He learned Spanish (from scratch) so he could better serve the large Hispanic community in Elgin, Illinois. Also, he mastered doing laparoscopic hysterectomies. See, 85% of the large hysterectomies in the United States are done abdominally, but he has done 95% of his laparoscopically. It takes more time to learn this procedure, but it results in a shorter recovery time for the patient. I assisted him in these lap hysterectomies as well as other procedures like Dilation and Curettage and Loop Electrosurgical Excision procedures and Cesarean and vaginal deliveries. Bread and butter of OB/GYN is routine pregnancy exams, pap smears, uterine fibroids, endometriosis, pelvic pain, cervical dysplasia, hysterectomies, ultrasounds and – unfortunately - cancer. SURGERY (12 wks) • April 22, 2002 – July 12, 2002 I did this rotation at Peninsula Hospital Center in Far Rockaway, New York, USA. I was living in Jamaica, Queens, New York (home of rapper 50 Cent!) Down the street was a KFC with cashiers taking orders behind bullet-proof glass. Twelve weeks in the operating room you get to see and assist in a wide variety of surgeries, for example: cholecystectomies, appendectomies, amputations, pericardial window, bowel resections, arterial grafts, and many other procedures. The operating room can be a grueling place. There was a lecture series at the hospital, with grand rounds, and also tumor board. We also had an opportunity to gain valuable experience at three clinics (vascular, surgical and breast). I took the USMLE Step 2 CS (it was called the ‘CSA’ back then) in December of 2002 and the USMLE Step 2 CK in January of 2003. My third year was 42 weeks of core rotations, my fourth year was 30 weeks of electives that I completed in Toledo, Ohio, USA from July 15, 2002 to February 21, 2003.
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FOURTH YEAR I completed my fourth year in Toledo, Ohio, USA. I set up all my rotation there myself. It went as follows: Family Practice (inpatient) (4 wks)
July 15, 2002 – Aug 9, 2002
Family Practice (outpatient) (4 wks)
Aug 12, 2002 – Sept 6, 2002
Gastroenterology (6 wks)
Oct 21, 2002 – Nov 29, 2002
Nephrology (6 wks)
Jan 13, 2003 – Feb 21, 2003
Internal Medicine (outpatient) Sept 16, 2002 – Oct 11, 2002 (4 wks)
Infectious Disease (6 wks)
Dec 2, 2002 – Jan 10, 2003
Basically, fourth year is a time for you to choose certain areas that you feel will be beneficial to you and your future plans. I think Gastroenterology is very high yield. Also inpatient Internal Medicine is an area where you can learn a lot. Since I wanted to be in primary care I chose my electives in those fields (Family Practice, Internal Medicine, etc.). You don’t really have to set up your rotations. You can stay at the same hospitals where you did your third year and that is the easiest way. I guess I wanted to make my life difficult, so I tried to set up all of my fourth year by myself. I just emailed several Family Practice residency programs, and a few said yes, I could come for an elective or two. Then, once I was there, I just started talking to doctors and asked them if I could “hang out” with them for six weeks or so. That’s pretty much the way it went.
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My advice for clinical rotations is to try to do them at ACGME hospitals that have residency programs. Also, make sure that the rotations offer didactic sessions (lectures or meetings). Some clinical rotations I did were just completely worthless. I learned absolutely nothing in them. The attending was never there and I just sat around. There is also an enormous amount of self-teaching. You basically have to be a self-starter and just get some good books and teach yourself. If you can teach yourself, you will do well. But if you require spoon feeding, you will never survive and will never pass the USMLEs. My friends, do NOT underestimate the amount of time you will need to complete everything (rotations, tests). You need a lot of time and hard work! Do NOT take time off during your clinical rotations. This has been proven to be the kiss of death. Guaranteed. The thing is that once you get into rotations, you are on your own. The school does not care if you take two years or four years to complete your rotations. The problem with this is that if you give a slacker an inch, he will take a mile. So people take time off and never get things done on time, miss the Match, miss two matches, etc.
SUMMARY of EVENTS My dates for all my important events were as follows: 1
September 1999
Started Medical School in Caribbean
3
July 2001
Passed USMLE Step 1
2
4
5
6
April 2001
August 2001
October 2001 July 2002
Finished Second Year on the Island Started Third Year in the U.S. Passed TOEFL
Started Fourth Year
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Caribbean Medical Schools | A Journey and Guide
7
December 2002
Passed USMLE Step 2 CS
9
Feb 21, 2003
Finished Fourth Year
8
10
11
12
13
14
15
January 2003
April 11, 2003
April 17, 2003 May 29, 2003 July 1, 2003
August 15, 2003 Sept 1, 2003
Passed USMLE Step 2 CK Received M.D. Diploma
Received ECFMG Certificate Received Step 3 Permit Took USMLE Step 3 Got Step 3 Result
Sent Out Residency Application
16
Oct, 2003-Jan, 2004 Attended Interviews
18
April 2004
17
19
20
21
March 2004
Residency Program Match
April 2004
H-1B Visa Application
June 2004
July 1, 2004
State Training License Application Obtain Social Security Number Start Residency
It is my firm belief that it is chronologically impossible to complete all this in four years. Guaranteed. Canadians and other non-U.S. citizens who want the H-1B Visa will need an extra year (or two!) to complete all this. I have never heard of any non-U.S. citizen who started in September to successfully be able to start residency on July 1 four years later. Even the lucky ones, who match on time, need several months extension from the residency program to complete Step 3, get a training license, get a social security number, etc.
USMLE
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Chapter 4 USMLE
USMLE STEP 2 CK (Clinical Knowledge) I started studying for this test about two months into third year and studied straight into my fourth year. A lot of studying! I initially read the: 1) Blueprints Series (five books – Psyh, Peds, Surgery, Int Med, OBGYN) 2) Blueprints Q&A books (five books) The Blueprints series is a good start. They are easy to read, you can read each book in just a few days (or weeks). The books are concise and have some good questions in the back. The matching Q&A books are good, but they only have approximately one hundred questions per book. Once I read the Blueprints, I was ready to get into more details. So I started with the:
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Caribbean Medical Schools | A Journey and Guide
3) Kaplan USMLE Step 2 CK books These books are very detailed and have a ton of info. I think they are the very best books on the market for USMLE Step 2 CK. They should be read repeatedly. After I finished with them I started practicing questions with: 4) Kaplan Step 2 QBook (850 questions) 5) Kaplan Step 2 QBank (1000 questions) 6) Kaplan CD Rom (400 questions) 7) NMS Step 2 QBook (900 questions) Once I finished I reviewed with this great little book by Adam Brochert called: 8) USMLE Step 2 Secrets Great book! Best review book out there for Step 2 CK! The author also has written a matching question book called Mock Exam. www.usmle.org also has 150 questions that you can get from them for free.
USMLE STEP 2 CS (Clinical Skills) CLINICAL SKILLS ASSESSMENT (formerly known as the CSA - CLINICAL SKILLS ASSESSMENT) This exam consists of 11 patients (not real patients, they are actors). You basically go into each room with a clipboard in your hand. You have 15 minutes to take a history, do a physical exam and discuss tests and possible diagnosis. Then you come out of the room and you have 10 minutes to write a patient note.
USMLE
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There are certain things you must do with every patient (or you will fail). Those things are: 1) Always examine directly on skin. Never through a gown. 2) Always auscultate directly on skin. Never through a gown. 3) Always wash your hands before touching a patient. Basically, before you go into the room, there will be a note on the door. It contains the introduction info about the patient, like the chief complaint and vitals. You then knock and enter. Introduce yourself. “Hi, I’m Asad Raza. I am a medical student, and your name is?” You then start asking questions. 1) Chief complaint 2) HPI (History of Present Illness) – Onset, Duration, Progression, Frequency, Location, Radiation, Quality, Intensity, Alleviating factors, Aggravating factors, Associated symptoms. The mnemonic is ODP FLR QI All Agg Ass 3) PMH (Past Medical History) 4) PSH (Past Surgical History) 5) FH (Family History) 6) SH (Social History) – Alcohol, Tobacco, Drugs, Occupation, Marital status, Diet, Sleep, Sexual activity, Exercise. Mnemonic is ATD OMD SSE 7) Medications 8) Allergies 9) Review of Systems Just go through this standard list. Write down the answers the patient gives you on the paper and clipboard you are provided.
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It’s actually very easy. Some cases have a few other things you need to ask (of course). And, for some cases, you don’t need to ask as much. This part of asking questions should only take about five minutes. Now, at this point, you are ready to do the physical exam. Remember to wash your hands. Palpate, percuss and auscultate directly on skin – not through a gown. The standard things to check on a physical exam are: Heart, Lungs, Abdomen. There is one very important and interesting thing I want to point out. This test is not really a test of your physical diagnosis skills. For example, as long as you put your stethoscope on the patient’s heart, you will earn the point for that part of the exam. Remember the patients are not doctors! They are just normal people who are there to act. If you spend a lot of time with your cardiovascular exam, you will still only earn that one point. So stick the stethoscope on the patient and then move on to the next thing. The physical exam should take about five minutes. Now, for the final five minutes of the 15 minutes you are in the room, you discuss the tests you are going to order and what possible things you think the patient might have. Basically, you tell the patient the work-up plan and the differential diagnosis. Then you thank the patient, shake hands, walk out of the room and sit down and write your patient note. You have ten minutes for this. You are given a standard form to fill out. You write down basically exactly what happened in the room. I took the exam on December 13, 2002 in Atlanta, Georgia. I took the Greyhound Bus from Toledo, Ohio to get there. The only thing I used to prepare for this exam was those 40 cases that are floating around the internet. It’s a PDF file that has 40 cases that are written exactly the way they appear on test day! The file, when printed out, is 190 pages. Each case goes through: OPENING SCENARIO: This is exactly what is hanging on the patient’s room door. PATIENT PROTOCOL: What the patient has memorized.
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CHECKLIST: The exact questions you need to ask for this case to score the points you need to pass. WRITE-UP: Sample answers of what you should write on test day! These cases are exactly what the actual test is like. They are the best. Just memorize them cold and you will be set. Don’t waste your money on that worthless OSCE book. Those 40 cases are all you need. The cases that I used to study for the USMLE Step 2 CS are available here: www.CanadaQBank.com
USMLE STEP 3 After I finished all my fourth year electives on February 21, 2003, I contacted my school to request my M.D. Diploma. They sent it to me on April 11, 2003. I immediately sent a copy to ECFMG and I got my ECFMG certificate on April 17, 2003. I then sent out my application for Step 3 to FSMB with a copy of my M.D. diploma and ECFMG certificate. I got the permit to take the exam on May 29, 2003. I registered for the state of Connecticut. After I got the permit I called my nearest Prometric center (in Michigan) and scheduled a date for July 1 and July 2 (it is a two-day test). I got my results six weeks later in the middle of August. Then I was ready to apply for a residency with ERAS. The ERAS cycle opens up on September 1. Perfect timing. I started studying for USMLE Step 3 as soon as I was done with Step 2. I read: 1) Kaplan USMLE Step 3 books (Internal Med, Neuro, Peds, Psych, OBGYN, Surgery, Epi/Ethics) These are really good. I read them twice and then started on questions with:
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2) Kaplan Step 3 QBook (850 questions) 3) Kaplan Step 3 QBank (1000 questions) 4) Kaplan Step 3 CD Rom (200 questions, 20 CCS cases) 5) NMS Step 3 QBook (900 questions) Step 3 is done in two parts. The first part is 480 multiple-choice questions, similar to ones you get on Step 2. The second part consists of nine CCS cases (CCS means Clinical Case Simulations). It’s basically a patient on the computer that you have to manage, work up, order tests on and come up with a diagnosis and treatment. I had 20 CCS cases that I wrote out and memorized from the Kaplan CD. Five CCS cases on the CD that www.usmle.org makes available. And 50 CCS cases on this CD: Interactive Step 3 CCS Cases It’s a private CD I purchased on www.ebay.com, those cases were excellent. So, in total, I had 75 CCS cases that I memorized in preparation for the Step 3 exam.
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Chapter 5 My Residency Application
Here are my “Six Steps to Applying for Residency in the United States:” 1) Choosing a specialty Well, this is a personal decision. Choose something you like, something that matches your personality. Do you want to work all day and all night for the next five years? Or do you want a more relaxed life? Do you like people? Or would you rather to look at specimens and x-rays? Also, if you are an IMG, the tough specialties are out. Stick to primary care and a few other IMGfriendly areas. All the programs are listed at websites like: www.careermd.com and www.ama-assn.org/go/freida Decide what specialty you want to apply for. Choose an IMGfriendly area like Family Practice, Internal Medicine, Pediatrics, Psychiatry, OBGYN, etc.
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As an IMG you should stick to primary care. If you have high board scores and you are a U.S. citizen, then you can consider other specialties. Otherwise, FP, IM, Peds or Psych. By far, IM is the most realistic to get. PMR, OBGYN, Neurology, Pathology and Anesthesiology are also IMG-friendly. Go to FREIDA online here: www.ama-assn.org/go/freida or you can go to this website: www.careermd.com and e-mail or call all the programs you are interested in. All the Family Practice residency programs are at this site: www.aafp.org/residencies If you are a non-U.S. citizen the biggest and most important (and perhaps the ONLY ) question you should ask is, quite simply: “Does your program sponsor the J-1 Visa and/or H-1B Visa?” 2) Make your Visa List Well, this only applies to non-U.S. citizens who need a work visa. If you are a citizen or Green Card holder, then ignore this step. Just email all the programs you are interested in and ask them, “Do you sponsor J-1 or H-1B?” I emailed all 500+ FP programs in the U.S. and about 50 programs said that they would sponsor H-1B. You will have to contact the programs yourself. If you require a work visa, make sure you email the programs and ask them if they sponsor the J-1 Visa and/or H-1B visa. 3) Call the State Licensing Boards This is a very important step, but it is also a huge pain in the behind. I started calling and, after a few states, I gave up. It just takes so long to get the right department and nobody has an answer to your question. When I called and asked the simple question, “How many of my 72 weeks of clinical rotations have to be at ACGME hospitals for me to be eligible for a training
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license in your state?” the reply was, “uh…we have no idea what you are talking about.” This was very frustrating. So I basically just waited until my interviews and asked all my questions to the Program Director. Good news. I actually did all this research for you already. I have published the full list of rules and requirements on my forum at www.CaribbeanMedicine.com in the ‘Main Forum’ section. Look at the post titled ‘State Training License Requirements.’ Figure out which states you are eligible for a training license in. Contact the State Medical Boards at: www.fsmb.org Once you have made your final list of programs, then you MUST and, I repeat, MUST call the state medical boards that these programs are located in and ask, “As a (fill in your school here) University graduate, am I eligible for a training license in your state?” My dear friends, residency program directors don’t care about where you did your rotations; but, the state licensing boards DO CARE! There is nothing more painful than to match to a program and then find out a few weeks later that you are not eligible for a training license in that state either because you don’t have the required clinical rotations, or because you did rotations at nonACGME hospitals. So, for your sake, CALL the State Medical Boards! The phone numbers are all listed here: www.fsmb.org 4) Apply with ERAS! Narrow down your list of states based on geographic preference related to weather, close proximity/distance to current location and family, etc. I took my list of programs, narrowed it down to forty and applied. The ERAS application is all online. I filled it out and wrote a personal statement. Then I sent ECFMG my Dean’s Letter, four LORs, Transcript
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and a color photo. This application process may seem a bit overwhelming, but it’s really not that bad. Just plan ahead of time or you will find yourself going crazy at the last minute trying to get all the documents and information you need. The ERAS application opens up on September 1. They allow you to start entering your info into the website in mid-July. ERAS website is here: www.aamc.org Go to the ERAS website, and fill out your application online and send ERAS your LORs and Dean’s Letter by mail. Also, register with NRMP here: www.nrmp.org The NRMP are the ones who will match you! 5) Attend Interviews Now sit back and wait for interviews. The residency programs will either email, call or send a letter in the mail. Attend the interviews. Most interviews are held between October and January. Be sure to ask the relevant questions during your interview. After interviews, when you come back home, be sure to write the program director a thank-you letter. Ask the appropriate questions. Write thank-you letters. Then, when it’s all over, rank the places where you interviewed, and enter your rank order list on the NRMP website. 6) Match Day and Visa Application The Match day is in mid-March or so. You can apply for your visa after you match to a residency program. The Match is done by the NRMP here: www.nrmp.org If you match in March, then congrats. Now contact a competent immigration attorney and start your H-1B Visa application process. Once you get the visa, you are finally done. Walk proudly into your residency program on July 1!
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Chapter 6 Work Visas For CANADIANS and other NON-U.S. CITIZENS
J-1 VISA You can get current information about the requirements by emailing:
[email protected] Here is my executive summary: From 1993-2001, trying to get the J-1 visa as a Canadian was really hard, sometimes even impossible. So it was quite discouraging. But things have changed. In 2002 Health Canada changed the policies a tad and made it a little more open to get this visa. But it is still a difficult visa to obtain for many reasons. Here are the steps. Basically, to get this visa you need: 1) An offer from a U.S. residency program saying that they have accepted you 2) Your ECFMG certificate (of course) 3) To write and pass the MCCEE (write this in your fourth year of med school)
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4) A letter from the Royal College of Canada stating that the residency you are going to doing in the U.S. is acceptable to Canadian standards. 5) A “Statement of Need” letter from the Canadian Health Ministry
“Statement of Need” – what is that, you ask? Well, remember what the J-1 visa is – it is an EXCHANGE visa. Which means that after you finish your residency in the U.S. you must return to your home country (e.g., Canada) for a minimum of two years. So, Canada has to tell the U.S. that they actually have a ‘need’ for you once you return. Pretty basic thing. Anyhow, how does one get a “Statement of Need” letter? You need to write and pass a test: MCCEE. Info about this test is at: www.mcc.ca Then apply for the “Statement of Need” letter with Health Canada:
[email protected] You will apply for the J-1 visa with the ECFMG (not the USCIS), read: www.ecfmg.org/evsp/index.html Now, if you do NOT want to return to Canada for that “two year” requirement, then you CAN stay in the U.S. if you agree to go and work as a physician in a rural/under serviced area in the U.S. for 3-5 years. After you finish this two-year ‘return to Canada’ requirement, you are free to go back to the U.S. to work as a doctor. Now, what visa will you need to get to this point, to work in the U.S., you may ask. The answer is surprisingly simple – an H-1B. Makes you wonder why you didn’t get it in the first place, doesn’t it?
J-1 Waiver Okay, now for some good news related to the J-1 visa. Finally! After you finish a residency in the U.S., it IS possible to stay in the U.S. The way is to get a J-1 waiver. Detailed info about the J-1 Waiver can be found by contact-
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ing the J-1 Waiver programs for each state. They are listed here: www.CaribbeanMedicine.com/j1waiver.htm Also read the posts on the Caribbean Medical School forums at: www.CaribbeanMedicine.com Look in the ‘Canadian Forum’ for the J-1 Waiver information. To get your “Statement of Need” letter, contact your home country’s Ministry of Health. A list of Ministries of Health for countries around the world are here: www.fda.gov/InternationalPrograms/Agreements/ucm131179.htm en.wikipedia.org/wiki/Ministry_of_Health
H-1B VISA PROCESS TO GET THE H-1B VISA (THE GOLDEN VISA OF CHOICE!) (a) Pass USMLE Step 1 (b) Pass USMLE Step 2 CK (c) Pass USMLE Step 2 CS, finish all your clinicals. 1) After you finish your final clinical rotation, call your medical school and ask if your evaluation form from your last rotation has arrived. If so, request your M.D. diploma. (It is wise to request your M.D. diploma two months in advance so that the school has adequate time to order it for you.) 2) Get your M.D. diploma in the mail from your school. If you have planned this correctly, you should receive your M.D. diploma within four weeks of completing your final rotation. Then send to ECFMG: two passport sized pictures and two photo photocopies of the diploma. 3) Once ECFMG gets your M.D. diploma photocopy, they
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will then send you the ECFMG certificate. So, from the time you get your M.D. diploma, it will take approximately three weeks to get the ECFMG certificate. 4) As soon as you get your ECFMG certificate, send a copy of it – with the USMLE Step 3 application – to FSMB immediately. You must have your ECFMG certificate to apply for the USMLE Step 3. The application form for USMLE Step 3 is at: www.fsmb.org The test is done over two days. It consists of 480 MCQs and nine CCS cases. Note: Only 12 states in the U.S. allow IMGs to register for Step 3 before starting residency. They are: Arkansas, California, Connecticut, Florida, Louisiana, Maryland, Nebraska, New York, South Dakota, Texas, Utah and West Virginia. The best state to apply for is Connecticut. Remember, you can take the test in any state. Also, you are free to do residency in any state. Contact FSMB for details. 5) Four weeks later you will get your orange USMLE Step 3 scheduling permit. Call the Prometric testing center in the state you wish to write it in and schedule a date. Note: Prometric centers might not have a two-day open slot for you. So you may have to wait around three weeks to get a date to write Step 3. 6) Take the USMLE Step 3. 7) Five weeks later you will get your Step 3 result, if you have passed (no one cares about your score, you just need to pass). At this point you are eligible to apply for the H-1B visa. You must (of course) have an offer from a U.S. residency program that is willing to sponsor you. 8) Before you can apply for the H-1B visa, you need to obtain a State Training License. The time it takes to get this depends on which state you are starting residency in. For
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some states, this will take several months, while other states do not even require a training license! It is up to you to find out the details. 9) The H-1B visa application process takes three months. But if you pay an extra $1000 (one thousand) you can apply with ‘premium processing’ that will expedite your application to only 15 DAYS. It is done by the hospital, immigration attorney and the USCIS. 10) The final step is to apply for a Social Security Number (SSN). This is done after you enter the U.S. This process takes anywhere from 4-8 weeks. It all depends upon your country of origin/citizenship and your ethnic background. 11) Once you get the SSN, then you can finally walk proudly into your U.S. residency program and start your postgraduate training. SUMMARY: From the day you finish your last clinical rotation it will take approximately 19 WEEKS (5 MONTHS) to have a Step 3 result in your hand. The breakdown is: 4 (M.D. Diploma) + 3 (ECFMG Certificate) + 4 (Step 3 Permit) + 3 (Step 3 date) + 5 (Step 3 result) = 19 weeks. See above for details. The best thing about H-1B is that after you get it, you are eligible to apply for a Green Card, which will allow you to live and work in the United States permanently.
MY H-1B VISA STORY After I matched, the residency program that I matched to assigned the immigration attorney they work with to me. I gathered all my documents. I had to send her:
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• Application for H-1B visa
• My USMLE exam reports (Steps 1, 2 and 3) • All medical certificates (ECFMG, etc.) • Copies of my degrees (BSc, M.D.) • Copies of my passport
• Copy of my driver’s license • Birth certificate
• All University transcripts • Resume
• Letters of reference The H-1B visa fees were: Immigration lawyer fee $1495 H-1B application fee
$185
Total:
$2680
Premium Processing fee $1000
My residency program paid for the lawyer and application fees. I only had to pay the premium processing fee (which speeds up an H-1B application to less than 15 days). My residency program was exempt from the annual H-1B cap of 65,000 because they were a non-profit hospital affiliated with a University. This was my very first time applying for an H-1B work visa. I was in my country of citizenship (Canada) at the time I applied. The state that I matched in does not require a training license for residents (someone doing a residency). So I did not have to apply for a training license. I used an immigration attorney that the program assigned to me. It is the same for most programs. The program will assign their immigration attorney to you. The H-1B visa was valid for all years of my residency training.
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My H-1B visa did not begin until July 1 and I was only allowed to enter the U.S. ten days before this start date. Therefore, once my H-1B petition was approved, I was not permitted to enter the United States (was not able to cross the border) any earlier than June 21. So, since my orientation started on June 21, I crossed right after midnight on the morning of June 21 and made it to the orientation on time. So the basic steps in the H-1B process are: 1) Match to a residency program 2) Apply for a state training license (I did not have to do this, because the state that I matched in does not require a training license for first-year residents). Warning! Many states do require a training license and the process to get one can take very long for IMGs, up to several months! So plan ahead! 3) Apply for the H-1B visa with an immigration attorney (with premium processing this should take less than 15 days). 4) Once you get your H-1B Approval Notice (Form I-797B) you can enter the U.S., but no earlier than 10 days before your start date (most residency programs start on July 1). 5) When you are going to the U.S. (from Canada in my case), at the point of entry (U.S. border at Sarnia, Ontario for me) show the border officials your Approval Notice. They will give you an I-94 (it’s a little white card) and they will put an H-1B visa stamp on it (they do this for you on the spot). 6) Once you arrive in your city in the U.S., go to the nearest SSN (Social Security Number) office and apply for your SSN. Show them your Birth Certificate, Passport, I-94 and H-1B Approval Notice. You need an SSN to start your residency. It can take on average of 4-8 weeks to get
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one. Once you apply for your SSN, give the receipt to your residency program. This should allow you to start your job. Some residency programs may assign you a temporary SSN until you get your real one. Whew! What a crazy and complicated process. Made me wish I was a U.S. citizen!
GREEN CARD After residency, I got a job with an employer that agreed to sponsor me for the Green Card. Note that I did my residency on an H-1B visa. When I started the job after residency, I was placed on another H-1B initially. My employer immediately got the application for the Green Card started with my immigration consultant. My Green Card application fees totaled $8,500. The way it works at this stage is that first you get an EAD (Employment Authorization Document). Think of this as a pre-Green Card. This EAD allows you to work in the U.S. without having to be on the H-1B visa anymore. Then you get the Green Card later. It takes anywhere from six months to five years to get the Green Card. How long it takes depends on your country of birth. As of the writing of this book, the wait times are longest for persons born in India and China, about 4-5 years. Everyone else should be able to get a Green Card within one year or so. I applied for my Green Card through a ‘Labor Certification.’ This is a process by which an employer shows that it has tried to hire a U.S. physician for the position without success. The employer must meet a number of requirements including advertising the job in a major national publication or a major specialty publication, then review all the CVs that come in to make sure no qualified U.S. physicians are available.
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I had my Green Card filed under the EB-2 category. Employment-Based Second Preference (EB-2) includes members of professions holding advanced degrees (e.g., M.D.). Once your Green Card application is in process, you get an EAD within a few months. Keep in mind that when you apply for a U.S. Green Card the USCIS will put you on a waiting list based on your country of birth. Currently backlogs exist for people born in two countries: India (like me) and China. If you are born in India or China then you will have to wait a long time (like 4-5 years) for your Green Card. You can, however, keep renewing your H-1B visa every year. Such backlogs and delays will continue to be an issue unless the President and Congress make more Green Cards available for skilled foreign nationals. Write to them: www.whitehouse.gov and ask for change. Yes we can! Just for the sake of completion, once you have a U.S. Green Card, you have to be on that for five years before you can apply for U.S. citizenship.
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Chapter 7 BOOKS USED IN MEDICAL SCHOOL These are the books my classmates and I used during the first two years of medical school (the basic sciences). Don’t waste your money on textbooks that you will never use: ANATOMY: a) Gross Anatomy (Board Review Series) by Chung Kyung Won ISBN: 068301563X AND b) Atlas of Human Anatomy by Frank H. Netter ISBN: 0914168819 HISTOLOGY: Wheater’s Functional Histology: A Text and Colour Atlas ISBN: 0443056129
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EMBRYOLOGY: The Developing Human: Clinically Oriented Embryology by Keith L. Moore, T.V.N. Persaud ISBN: 0721669743 BIOCHEMISTRY: Lippincott’s Illustrated Reviews: Biochemistry by Pamela C. Champe, Richard A. Harvey ISBN: 0397510918 PHYSIOLOGY: a) Board Review Series Physiology by Linda S. Costanzo ISBN: 0683303961 OR b) Physiology W B Saunders Co; by Linda S. Costanzo ISBN: 0721666116 PSYCHOLOGY: High-Yield Behavioral Science by Barbara Fadem ISBN: 0683029401 ETHICS: Nothing MICROBIOLOGY: Clinical Microbiology Made Ridiculously Simple by Mark Gladwin, Bill Trattler ISBN: 0940780321 IMMUNOLOGY: Anything good
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NEUROSCIENCE: Clinical Neuroanatomy for Medical Students by Richard S. Snell ISBN: 0316801038 EPIDEMIOLOGY: Nothing GENETICS: Nothing PHARMACOLOGY: Pharmacology: Examination & Board Review by Anthony J. Trevor, Bertram G. Katzung ISBN: 0838581471 PATHOLOGY: a) Robbins Pathologic Basis of Disease by Ramzi S. Cotran, Vinay Kumar, Tucker Collins, Stanley L. Robbins ISBN: 072167335X OR b) Pocket Companion to Robbins Pathologic Basis of Disease by Stanley L. Robbins (Editor), Ramzi s. Cotran, Vinay Kumar, Tucker Collins ISBN: 0721678599 PHYSICAL DIAGNOSIS: a) Bates’ Guide to Physical Examination and History Taking by Lynn S. Bickley, Robert A. Hoekelman ISBN: 0781716551 OR b) Bates’ Pocket Guide to Physical Examination and History Taking by Lynn S. Bickly (Editor), Robert A. Hoekelman ISBN: 0781718694
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USMLE: a) First Aid for the USMLE Step 1 by V. Bushan AND/OR b) Underground Clinical Vignettes for USMLE Step 1 – Set of 9 Books by Vikas Bhushan, Chirag Amin, Tao Le ISBN: 1890061379 AND/OR c) Kaplan USMLE Step One Study Kit www.kaplanmedical.com B OOKS USED IN CLINICAL ROTATIONS Here is a list of the books that both the students I rotated with and I used during our clinical years: These books can be purchased at www.barnesandnoble.com or www.half.com or www.amazon.com ALL THIRD YEAR ROTATIONS USMLE STEP 2 STUDY: The Blueprints Series (5) in Medicine, Ob/Gyn, Surgery, Pediatrics, and Psychiatry ISBN: 0632045124 USMLE Step 2 study: First Aid for the USMLE Step 2 ISBN: 0071377700 Clinical Rotations: Clinician’s Pocket Reference ISBN: 0838514766 The Washington Manual of Medical Therapeutics ISBN: 0781723590
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Surgical Recall (Recall Series) ISBN: 0683301020 Bates’ Pocket Guide to Physical Examination and History Taking ISBN: 0781718694 History and Physical Examination: 2001-2002 Edition ISBN: 1881528812 Tarascon Pocket Pharmacopoeia: 2002 Deluxe Lab-Coat Pocket Edition ISBN: 1882742222 One great new source I started using in residency and now use exclusively as a physician is my iPhone, with the following medical software: www.epocrates.com. It’s the best!
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Chapter 8 HOW I CHOSE A CARIBBEAN MEDICAL SCHOOL EVALUATING, RESEARCHING AND COMPARING ALL THE SCHOOLS This is how I chose a medical school in the Caribbean. Keep in mind I attended back in 1999. Things have changed since then. The basic science curriculum is virtually the same everywhere, so no school has a real advantage with respect to curriculum. SGU/ Ross/AUC have better facilities, but I don’t think this is very important. SGU/Ross/AUC students have a bit more opportunity for exposure to clinical medicine during the first two years, but the difference is very small. To me, the deciding factors were: 1) Quality of life during school Unlike Ross, students at Saba tend to speak highly of the school. Saba wins on quality of life. In addition, the attrition rate at Ross is pretty high. Even if you are a good student, this creates a bad
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atmosphere. It’s bad to be taking money from students who don’t have an ice cube’s chance in hell of surviving the program. 2) USMLE pass rates. Although Ross/AUC have a slight edge, the USMLE pass rates are comparable. Ross’ high pass rate is achieved by failing a large percentage of each entering class. Only 80 of 230 in a recent class passed through the program in five semesters. It is hard to tell how many of the remaining 150 made it through, but I think the overall attrition rate at Ross is somewhere around 40%. I would much rather go to a school like Saba that does a better job of screening students at admissions. The bottom line is that both schools will provide what you need to pass the USMLE; however, it will be a much more pleasant process at Saba. 3) Quality of clinical rotations. SGU/AUC/Ross have been in the business longer and have a better network. Saba is adequate, but I would give the edge to SGU. On the other hand, Ross students seem to complain about the time delays, etc. Both schools will require you to move frequently. However, there are several students who get most of their rotations in one place. 4) Residencies. SGU/AUC/Ross have more history; however, Saba has done very well at placing students in residencies, and is placing people at some very good hospitals. I think this one is a toss-up. 5) AUC can only put the upper top 20% to 25% students in U.S. core clinical rotations. The rest do those rotations in
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England, Ireland, etc., whereas 100% of the students at Saba do their clinical rotations in the U.S. This becomes handy when competing for U.S. residency spots and also if you are planning to practice medicine in the United States. In addition, doing your clinical rotations outside the U.S. does not prepare you well for USMLE Step 2, because that exam is based entirely on U.S. clinical experience. 6) St. George is the best Caribbean medical school, but it is horrendously expensive (ouch!). Ross and AUC have become quite expensive also. 7) Spartan and other newer medical schools have only a 1020% USMLE pass rate. They cram all their courses together, have no review course and you may have to set up your own clinicals. 8) SABA has a low student/faculty ratio: 6/1. All the students confirmed this and said it added a lot to their education. The faculty are approachable and willing to meet students outside of class for extra help. 9) The island of SABA is a safe and a beautiful place to study medicine for two years. Yes, it is small and boring and there may not be a lot of non-school things to do on a daily basis, but you are there to buckle down and study, are you not? Then on your breaks you can take the one-hour ferry (15 minute plane ride) to St. Maarten and have a good time. Keep in mind that I wrote the above nine points several years ago, when I was first researching these schools. Things may have changed since then, so do some research on your own to find the latest.
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SABA WEB SITES Student Websites Caribbean Medical School – Online Guide (by me!) www.CaribbeanMedicine.com BUSINESS WEBSITES FOR SABA ISLAND: Saba Tourist Office www.turq.com/saba Dive Saba www.divesaba.com Juliana’s www.julianas-hotel.com Sea Saba www.seasaba.com Queens Garden Resort www.queensaba.com
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Chapter 9 MY PERSONAL STORY AN IMMIGRANT’S JOURNEY FROM INDIA TO CANADA TO THE CARIBBEAN TO THE UNITED STATES You may wonder how a Canadian Desi from Brampton, Ontario ended up at a Caribbean medical school. Well, here is the long and short of it: I started undergrad at York University in Toronto in 1993. I wanted to go to medical school, so I applied in Ontario. I applied four times. 1996, 1997, 1998, 1999. No admission. See, Ontario is the most difficult place in all of Canada and the United States combined to gain admission into medical school. I also applied to all the medical schools in the other provinces of Canada. But those med schools are provincially funded schools and therefore only give preference to students from their own province. So, needless to say, I did not get into any of them. I also applied to some medical schools in the United States. But since 99% of students that get accepted to a U.S. medical school are U.S. citizens (and I am not), I did not even get an interview
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at any of those schools. So then came the option of a foreign medical school. Well, I was well aware that as soon I got on that airplane and headed toward a foreign medical school that coming back to Canada would be very difficult. So I knew that if I wanted to stay in North America, my best option was to do a residency in the United States and live and work there. Finally came the issue of which visa I should get in order to be entitled to legally work in the United States. There are three main options, J-1, H-1B and Green Card. Well there you have it: Ontario, Canada, to the Caribbean, to the United States on H-1B. One more thing I would like to say: you might also wonder why Ontario is the most difficult place in North America to gain admission into medical school. The answer is surprising simple: immigrants. Since the early 1970s people have been flocking to Canada from all over the world. The Canadian government gives out immigration like it’s candy on Halloween. So they come from all over: Korea, Japan, China, India, Pakistan, Middle East, etc. Unlike the U.S., where people live everywhere, in Canada 90% of the country is too cold and nobody lives there. So people only cluster in three areas – Toronto, Montreal and Vancouver – Toronto being the most popular, for reasons I will never understand. So, twenty-five years later, these immigrants all want their kids to practice medicine. There are only a few med schools offering a small number of seats in Canada, and you have thousands and thousands (and thousands) of applicants. Combine this with the very strict admissions process and you have a recipe for despair. If I had a chance to do it all over again, I would have gone to a Caribbean med school right after three years of undergrad (back in 1996). I should have never squandered my time applying to all those medical schools in Canada. What a terrible and tragic waste of time and money - worst mistake of my life.
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I honestly never thought that it could get any tougher in Canada, since back in 1998 I had a 3.7 GPA and a 9,12,R,10 on the MCAT and did not get admission. Well, now I look at the websites of the Canadian medical schools and their applicant and admission statistics, and it has gotten even tougher. Time to leave Canada, folks! I was born November 3rd, 1974 in Hyderbad, India. My parents came to Ontario, Canada with me in 1976. I graduated from York University in May of 1997 with an Honours B.Sc. in Applied Mathematics with a 3.76 GPA. I had applied to medical school before with an 8,8,Q,8 MCAT and was unsuccessful. So I decided that, since I had done volunteer activities and I had a genuine interest in medicine, I should try for it again, and not give up on that goal. So I enrolled in Kaplan and studied very hard for the MCAT from November 1997 to April 1998. I wrote the dreaded test again in April 1998. Got 9,12,R,10. I then applied for September 1999 admission to 16 schools, six in the U.S., ten in Canada. To make a very long and expensive story short, again I did not get accepted. I was heartbroken, and completely devastated that even after doing everything I could, I still did not get in. Just when hope seemed completely lost, my friend told me that he was just going to the Caribbean for medical school. Well, I found out as much as I could, and having decided on Saba University, I applied and got accepted. I was, and still am, so happy that I finally obtained an opportunity to achieve my goal of becoming a licensed, practicing physician in the United States.
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Chapter 10 SUMMARIZED TIME LINE
A QUICK LOOK AT ALL THE KEY STEPS To obtain residency in the United States, you will need to do the following: 1) Pass the USMLE Step 1 2) Pass the USMLE Step 2 CK 3) Pass the USMLE Step 2 CS 4) Obtain M.D. degree (or MBBS) 5) Obtain the ECFMG certificate 6)* Write and pass USMLE Step 3 (before starting residency) 7)* Apply for the H1-B visa. Or, you can apply for the J-1 visa with your home country. 8) Start your residency!
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All IMGs have to go through this process. To get the J-1 Visa, you need to get the “Statement of Need” letter from the Ministry of Health in your home country. U.S. Citizens DO NOT need a visa to start a residency program in the U.S. * applies ONLY to non-U.S. citizens, so that they can get the H1-B visa. If you are Canadian, you also have to pass the MCCEE in order to be eligible for the J-1 visa.
DETAILED TIME LINE
Chapter 11 DETAILED TIME LINE A COMPLETE SUMMARY OF ALL THE EVENTS DURING YOUR FOUR YEARS BASIC SCIENCES (5 Semesters) September 2013
Begin medical school
September 2013
Begin studying for USMLE Step 1
April 2015
Finish basic sciences (5 semesters) (At this point you have accomplished nothing)
May – July 2015 Study (with Kaplan) for USMLE Step 1 July 2015
Take USMLE Step 1 at a Sylvan Protometric Center
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CLINICAL SCIENCES (5 Semesters)
August 2015 Summer 2016 Fall 2016 Fall 2016 Fall 2016 Fall 2016 September 2016 Oct 2016 – Jan 2017 January 2017 March, 2017 Spring 2017 Spring 2017 Spring 2017 Spring 2017 July 2017
Begin core (third year) clinical rotations in a U.S. hospital and begin studying for the USMLE Step 2 CK and CS Finish core clinical rotations (third year) Take USMLE Step 2 CK at a Sylvan Protometric center Take the USMLE Step 2 CS Exam at an ECFMG center ERAS post office opens and the Match application cycle officially begins for the year Follow up on all applications and make sure that all required documents are in your file at all hospitals Begin your senior (fourth year) elective clinical rotations Residency interviews If you are Canadian, take the Canadian MCCEE Match Day – NRMP Match Results Announced. Finish up senior elective rotations (fourth year) Graduate from medical school, obtain M.D. diploma Obtain ECFMG certificate (after passing USMLE Step 1, Step 2 CK, Step 2 CS and obtaining M.D. diploma) Apply for J-1 work visa (if necessary) Begin residency
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If you want the H-1B visa, you would also have to pass USMLE Step 3 before starting residency, which may mean waiting a year to start residency. You still do not have a license to practice medicine at this point. In most states, IMGs may only apply for a license to practice medicine after completion of a minimum of three years of ACGME Accredited Residency Training.
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Chapter 12 CARIBBEAN MEDICAL STUDENT COMMENTS
WHAT STUDENTS FROM OTHER SCHOOLS HAVE TO SAY ABOUT THEIR EXPERIENCES Here are some comments from medical students in the Caribbean about their respective schools. It is their opinion and advice, not mine. AUC “First of all, if you have any hope of getting into a U.S. M.D. or DO school, I would go that route. The Caribbean, however, is a viable option. Let me just say being on an island in the Caribbean for 18 months or more is not a vacation in any sense. I attended AUC which is located on St. Maarten and is considered one of the better islands, as far as living conditions are concerned. There are many challenges you will face going to an island. Not everything is like the U.S. Many of the island people despise
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outsiders, the cost of living is extremely expensive and, being an American, you’re a target for crime. I lived in one of the “cheaper” areas of the island for $700/month for a 1-bedroom apartment and experienced everything from hearing gunshots at night to having my car stolen a few weeks before I left the island. I know of at least five people in my school that had their homes burglarized and more people than I could count who lost cars. The police on the island are unreliable and incompetent and the island, as a whole, lacks enforcement of any laws. You will really learn to rely on yourself and your classmates to get through all the problems you will face because nobody at the school or on the island will go out of their way to accommodate you, compounded by the fact you’ll also be dealing with searing heat and more bugs than you could ever imagine. You will always be hounded for money wherever you go and if you want to stay in a better part of the island, expect to pay at least $1,100/month for 1-bedroom. These nice areas aren’t immune to crime either; in fact, they often become targets for thieves. The mentality of the islanders, towards the students is they believe that we are all rich kids paying for school out of our pockets. They don’t understand the concept that most students are using loans. This perception was also confirmed by one of the professors that has lived on the island for many years. Again, I can’t stress enough for you to at least try to get into a DO or M.D. school in the U.S. if you have any chance. My GPA was probably high enough to get into a DO school, but I didn’t want to wait and I was also afraid to take the MCAT, which AUC doesn’t require. In hindsight, I’m happy I’m now a 3rd year student, but I know things could have been so much easier staying in the U.S. Also, more specialty choices are available to one who graduates from a U.S. school. Coming from a Caribbean school, one must score well above the mean on the USMLE to even have a chance at the more competitive residencies. Some residencies are just about impossible to acquire from the Caribbean. Okay, I’ve dwelled on the negatives long enough. The positive
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aspects of going to the Caribbean: It’s a great growing experience, you will mature and become a better person when you leave; there are many opportunities for fun there – diving, beaches, casinos, clubs, restaurants, etc. You, won’t and shouldn’t, be studying all the time. You will also make some of the best friendships you’ve ever had and you’ll be thoroughly impressed by the dedication of yourself and your classmates. I’m fairly pleased with the education I received and I’m very thankful for the opportunity to do what I’ve wanted to do in life. The school campus is well-kept, the labs are adequate and the classrooms are comfortable. The library has all the latest journals and textbooks. The computer lab has roughly 30 computers and laptop connections to the internet. The internet connection is the slowest I’ve ever seen, but at least you can use it for free. The school has a small cafeteria (which I would avoid), but there are a few places to eat near the school. There are many first-class professors at AUC. There are some mediocre professors. I suppose it’s the same at any school, but I soon realized the key to becoming a doctor is surviving med school. In U.S. schools most students are catered to and the attrition rate is very low, but in the Caribbean the attrition rate is very high. My first semester about 30% of the class failed Biochemistry. In Pathology, we only had 17 out of 43 people passing going into the final. I believe only 20% failed the class in the end. Again, another reason to go to a U.S. school where they cater to your needs. I can’t really comment any farther on rotations or residency placements as I won’t be starting rotations until June. I’m currently taking a couple months off studying for Step 1 of the USMLE. I can say everyone I’ve talked to has told me they know of no one who didn’t get a residency spot after completing all the requirements and passing the USMLE. I hope this sheds some light.” • P.E., American University of the Caribbean, St. Maarten
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“I am in my third year of med school and I can only state my experience. I believe if you want to become a doctor, and nothing else can suffice in life, you can do what I did. But remember, you are taking some risks with this road. The risks are living in a foreign country and you will borrow a lot of money. Also there is that passing of USMLE. I believe most people with tunnel mind can finish this without a problem. The school and teachers are just like any other school in the U.S. This education is what you put into it. When you get to third year you will understand that medical education is up to the student. No one will push you. You will need to push yourself to learn. If you do well in school and do well in the USMLE, many things will open up to you so you should not worry about anything. Many hospitals would like to get a native speaker who not only knows how to speak well, but who also knows what they are talking about. So you already have one thing that is going for you.” • A. S., American University of the Caribbean, St. Maarten “The school is not bad. I would, of course, take a U.S. school any day, but that wasn’t an option. It is a self-motivational school. Either you really want it or you don’t do well. I have no regrets. Some professors are better than others, but overall I am fairly satisfied. Again, I do a lot of self-teaching. It really isn’t that difficult, just challenging. Life on the island is good. There are worse places to be with less to do (Dominica and Saba), and there are better places I am sure, but I am overall happy with my choice. I am not sure what the residency or clinical placement status is because I am in my 2nd semester, but it appears that everyone gets pretty much what they want for clinicals if you are in the upper half of your class. Good luck in your decisions and hope I have helped a little.” • G.T., American University of the Caribbean, St. Maarten
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ROSS “A typical day in Dominica varies by semester. Most days you are in class from 8 to 3 or 4. Then you take a break, exercise, go to the beach, eat or whatever. Then you go study. While on the island, I usually studied about 4-5 hours a night and took the weekends off, when possible, to explore Dominica or other Caribbean islands, but it all depends on your background and study habits. I knew about Ross because some other friends of mine from college had taken the plunge to come down here after the premed committee told them they didn’t have what it takes to be medical students or physicians. I was a little leery about applying to Ross, so I decided to go out and make some money while my friends went to Dominica. I was hired as a medical analyst for a law firm in Dallas (where I am from) and liked the job so much that I stayed there for 3.5 years. In the meantime, those guys went to Dominica – one is now in his 4th year of a general surgery residency at the University of Missouri, Columbia Medical Center (he was one of two selected for this highly competitive residency). Another friend finished an Internal Medicine residency at the University of Texas at San Antonio – one of the top internal medicine residencies in the country– and is now practicing with a large group in Arlington, TX. Another friend is in his second year of a surgical residency at MCP-Hanneman University in Philadelphia. So, that should about sum up any questions any of you might have about getting residencies coming out of a Caribbean medical school! I started Ross in August 1997, left the island in May 1999, took the USMLE Step 1 in July 1999 and started my first clinical rotation (Internal Medicine) October 4. I am now in my fourth year and have taken Step 2, the CSA (passed with flying colors), and am applying for OB/GYN residency – highly competitive. I had 14 interviews and ranked 9 programs.
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It should be noted that the vast majority of my interviews were at competitive university-based programs, including Boston University, Mount Sinai School of Medicine, University of Mississippi, Albany Medical College, University of Georgia, Wayne State University, etc. I matched at Albany Medical College, and start residency there July 1, 2001. I will complete my rotations in May and graduate in June – yet another Ross success story. Regarding Dominica, I loved it! The island is beautiful and there are so many nice things to do in the leisure time. It is really cheap to visit the other islands in the Caribbean, and it is a great opportunity to travel. Dominica is a little primitive, but what do you expect from a Caribbean island? If you really crave civilization that much, you can always hop on the ferry to Martinique (an island 30 miles south) and get some French culture, casinos, dancing, Club Med, McDonald’s, etc. Not to mention, you get a 2-week break every four months to go home between semesters. I personally used a couple of the breaks to cruise around the Caribbean and see as much of that part of the world as I could. For $80-$100, you can catch a 20-30 minute plane ride and be in Martinique, Guadeloupe, Antigua or St. Martin. Most people never get to see the Caribbean outside of a honeymoon, and you can do it every other month or so (if you want to) for 2 years. By the way, if you are a Jimmy Buffett fan (as I am), you may have a hard time wanting to leave this place.” • L.B., Ross University, Dominica
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SABA “Hi, I’m currently about to take USMLE Step one. You were asking me how is Saba? If you can afford to make a trip to Saba before you start school there it will be worthwhile. Saba is a small island, it is good for hiking, scuba diving and studying. There are not many distractions there. Lots of my friends who came from the states were terrified by the thought that there is not much to do on Saba. At first I was home sick, but as the semester went by I became used to the island. Locals on Saba are very friendly. Living-wise it is not too expensive, it all depends on how you want to live. Saba does offer dorms – before you start school it would be good idea for you to talk to your future roommate and make sure you can get along with that person. Food-wise you can get pretty much everything on Saba, except the fast food. Saba doesn’t offer lots of fresh vegetables. The best time to shop is on Wednesday. School-wise the curriculum is very good. If you already have some biology background it helps. There are four exams during the semester, which are called Black Mondays. This day is kind of stressful, since you will be taking exams all day. These exams are kind of scary at first, but you will get used to it by second semester. Lots of people asked me how much time you should spend studying and my answer is it all depends on you. I had some friends of mine who studied only a couple of days before Black Monday. You can say these friends of mine were gifted or great memorizers. I used to average about four hours every day studying, since it takes me a while to learn any material. Books-wise, I would suggest talking to students in class ahead of you. I would recommend that you should keep in touch with Second semester students, since they will be able to tell you how the professors are and ask them whether it is a good idea to go with the book or the notes. I hope this helps.” • O.L., Saba University, Saba Island
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“The truth about the Caribbean medical schools is as follows: most of the profs are from the United States, and most of those are Ph.D.s of their respected fields. The pathology and clinical medicine professors were retired pathologists and surgeons. They come down for the sun and they get paid fairly well to teach two hours/day a few months of the year. The schools are getting better about who they take on as students. Like the U.S. schools, the Caribbean schools are getting very competitive. Most of the students are: 1. Non-U.S. students that have very good MCATs but have some quirk that prevented them from getting in; 2. About half the students are professional people making changes: myself and about eight others in school with me are chiropractors; others are podiatrists, nurses, a lot of physical therapists and PAs. The education was, for the most part, pretty good - the big picture stuff and what is needed to pass the board. They have a 90% attendance policy that is strictly enforced – a throwback to when the regulations on foreign medical schools were more strict. So the schedule is very grueling with a lot of late nights – it is not a program for those with a weak soul – a student down south must have some will power. Remember, there are no comforts of home; even paper can be hard to get. There is a lot of studying on your own. I am currently studying for my board in two weeks and am glad to have gone the extra yard on my own. The rotations are scattered all through the country. I am currently going to K.C. to do Psych in the VA; however, I don’t know until I get my board score where I will be after that. The rotations are, I believe, to be slots that are not filled by other medical schools. In my situation, the University of MO has fifty slots at the hospital, and if they are not full, they will let me rotate with them. The other aspect is that all government-owned hospitals are considered teaching, VA and Native American hospital. So naturally, living in OK, I have set up my elective at the local Native American hospital on the reservation. That’s about all I know.” • C. B., Saba University, Saba Island
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“I left the island in 2000, started in 1998. The profs will change. From my experience, Saba is not a money-making scheme. They try to promote their students. However, they will serve to give you the opportunity, you will have to take the ball and run with it. You have to rely on yourself, have to learn to teach yourself the information. There is no spoon feeding with foreign medical schools. Saba is a small island, a volcanic rock jutting out of the sea. There is no water system. You have to drink bottled water or you have to get used to drinking still water that is collected under the house. The people are friendly, and the crime rate is low; but there is no beach, and nothing to do but study. Although you can go scuba diving, there is no other source of entertainment. You will have breaks to go home to visit your family. When I went to Saba at the time, tuition was affordable. Oh, and watch out for the hurricanes. A little about after the two years Saba. You will have to take Step 1, and 2 and CSA. Again, a lot of the work has to be done on your own, and you will have to prepare for that. Rotations have not been a problem with Saba. You might have to travel around the States, but it’s not a problem. Remember, Saba is a difficult place academically and environment-wise as well. If you do decide to go, work hard, keep a cool head, make good friends and you should be fine. It helps if you have a background in science.” • I.P., Saba University, Saba Island
“I am currently in my third year at Saba University. There are plusses and minuses to going to school in the Caribbean. First of all, if you can get into a U.S. school, do whatever you can to avoid the Caribbean. If there is no alternative, and you really, really want that M.D., then it’s a good alternative.
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As for profs…well, it depends on who is at Saba when you take the classes. Saba is unique in the sense that most of the profs who teach are taking classes with you. Let me elaborate. For instance, my biochem prof (Ph.D. in biochem) was a student taking psych and neuro with me. So in other words, the profs get a discount on their tuition because they teach classes while studying to be an M.D. themselves. Make sense? So undoubtedly, it leads to awkward situations outside the classroom. Are they your friends or your profs?? You decide. I’m sure they can be both, but not always. Med school in the Caribbean is what you make of it. I know people who didn’t study at all and were drunk all the time but managed to pass their classes – but then failed their boards. I know others who took it seriously and scored in the 97th percentile on their boards. Like I said, it’s what you make of it. About rotations: Saba has accredited (greenbook) as well as non-accredited rotations. There are states that require accredited rotations and there are other states that don’t, so it depends. I believe for the best education you need accredited rotations with corresponding residency programs in that rotation – these rotations are specifically geared to teach students. Other hospitals that take students but don’t have a formal teaching program, in my opinion, may not be as beneficial. Unfortunately, Saba cannot fit all its students into these accredited rotations since there are a limited number of them. Residencies…from what I hear, Saba students do okay in the Match. I will be applying in August so I’ll have first-hand knowledge about the whole thing then. But be realistic. If you’re going to be a foreign grad (especially Caribbean) don’t think you’re going to get neuro surgery or derm or something like that. There is always the possibility, but again, be realistic about your goals.” • H.K., Saba University, Saba Island
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SPARTAN “Clinical rotations have been keeping me busy. As for Caribbean med schools, there’s a few basic points you need to understand. For starters MOST, but not all, Caribbean schools are simply a ticket to the USMLE. Some will help you to prepare, some will not. I’m rotating now with American students and their attitudes are very different, they’re not “cut-throat,” and, to be honest, they’re not all that hard-working either. Mostly because they don’t need to be as they have everything served to them on silver platters. To make it as a Caribbean grad, and to do well, takes a lot of hard work and dedication. Dealing with the schools themselves is probably the biggest hassle. That’s not to say you can’t do it, but it’s not the easiest or most pleasurable road; and if you’re willing to look beyond that, then maybe a Caribbean school is for you. Spending 16-20 months on a Caribbean island, while it may sound glamorous, is not a cup of tea. They may be beautiful, but most islands are still third world. Living is never easy, but once you are off the island, obviously things are better here in the States. Take care and good luck.” • M.S., Spartan Health Sciences University, St. Lucia
ST. EUSTATIUS “I, of course, have no comparisons to other schools, but I feel the profs on the island are great. They are on these islands because they like to teach. Apparently in regular universities much of their time was occupied hunting for grants and stuff and they missed the contact with students. My personal favorites are Dr. L and Dr. D (Path I & II) and Dr. B, who taught me anatomy. The team that teaches neuroscience and psych is also amazing.
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“I have never seen a bunch of people more committed to teaching the subject they absolutely love as them. If you see them say hi for me. I also enjoyed the microbiology classes. Some teachers that we weren’t too happy with have been replaced, but that happened after my time, so not much I can tell you about them. I was one of the first students to enroll in the school, and therefore everything wasn’t quite established yet. I believe that the housing situation has since been solved and the school has established itself quite well in the community. The Island of Saint Eustatius, or Statia, will take some getting used to, coming from the States. Everyone in my class adapted great, even though things are quite different from what you are used to. There are supermarkets, but don’t expect a huge Walgreens-type of affair. Luckily the school itself has excellent internet facilities and it is also quite easy to have a phone hooked up. The security deposit is a bit much, but hey, it’s the Caribbean. Nature on the island is beautiful, especially the volcano above and the reefs below water. If you have been interested in diving, this is your chance to pick it up as well – most of my class took classes after the 1st semester with an outfit called Golden Rock Divers. They cater more to the long-staying tourists on the island (not day-trippers like f.e.Dive Statia) and are therefore more flexible and more geared toward building a long-term relationship. Rotations-wise I have been a special case since I wanted to do rotations in Holland. They have now been set up satisfactorily and I will be commencing in early April doing surgery. There is not much I can tell you about their loan program because I think that has just been put in place recently.” • M.S., St. Eustatius University, St. Eustatius Island
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ST. GEORGE “I’m a second term, alternate program student at SGU. Attending med school in the Caribbean is a different experience altogether – the natives, the professors, the students, everything is different. But it’s all do-able. The profs here are very student oriented, they go the extra mile for students. The first-term professors are excellent. The administration is slow at times, but patience is the key to our career. The curriculum is comparable to that of the States. Rotations are in the States and residency is attainable. Stats show that SGU’s USMLE scores are top-notch. Good luck in the application process.” • G.T., St. George University, Grenada
“I can tell you that going to a Caribbean medical school is a very tough decision and one that you shouldn’t take lightly. Ask yourself a few questions: First, do you really want to go into medicine? Second, do you want to focus on primary care (i.e., peds, psych, IM, Family Practice)? Third, are you able to work hard in a foreign environment? If you answer yes to the above questions, then a Caribbean school will be for you. Most Caribbean schools are basically the same. Everybody uses the same textbooks, and in any institution you will have good profs and bad profs. The key is how much work are you willing to put in? The more work you put in, the better you will do. The main difference between Caribbean schools is during the clerkship years (years 3 and 4). If you go to a school that does their clerkships in the U.S. (St. George’s, Ross, Saba), you’ll see differences. St. George’s is the best in this respect because all of their hospitals are ACGME accredited and you’ll have no problems getting your license from any of these hospitals. Also, since most of the school’s hospitals are in New York/New Jersey you won’t
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be moving around like you would if you went to one of the other Caribbean schools. That’s pretty much the only difference. When it comes to getting a residency, remember: being a foreign graduate means that you’ll always be looked at below a U.S. medical graduate (no matter what your Board scores are). However, since you’ve done rotations in the U.S., you’ll be considered higher than foreign graduates from foreign medical schools.” • F. W., St. George University, Grenada
UNIBE “I would be cautious of the Caribbean because when you go looking for a residency, the program directors hate to admit that their training program is so bad that they have to take Carib. Grads. BUT, if you do decide, I would contact University of the West Indies as it is a real school. You may have no luck, but give it a shot. I went to UNIBE for my Basic Sciences and it wasn’t too bad, although the student body was real sucky, mostly dropouts from the other Carib. schools. Trying to study around them was bad. AUC is a very good school and that would be high on my list. Others are: Ross, Spartan, SABA, St. Matthews – but try to avoid all the other new start-up schools in the Caribbean. Also, stay away from Eastern Europe as there is a lot of scamming going on there. We found an excellent school but it is in Egypt. They cater to American private students and the tuition is reasonable. Look into AUC and UWI. Most of the other schools have been started up by students who have failed out of other schools in the Carib. That is why I recommend only the above schools.” • C.E., UNIBE, Dominican Republic
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WINDSOR “I have done my basic sciences at a Caribbean school: Windsor Univ, located in St. Kitts. Actually, this school is only three years old. What I know is we had education just like all the Caribbean schools. Now, I am doing my clinical sciences in the U.S. In rotations, we were allowed to take physical history, but not allowed to do any surgery. However, you can assist your physician if he lets you do it. Take care!” • R.B., Windsor University, St. Kitts
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Chapter 13 FINANCIAL AID H OW TO PAY FOR MEDICAL SCHOOL There are a few things regarding financial planning I wanted to point out – about TERI vs STAFFORD loans. If you attend a Caribbean medical school and get a TERI loan, then the interest on the loan accumulates from day one. It carries a very high interest rate. Example: if you borrow $15,000, by the time you graduate four years later the principal will grow to much more than that. Please verify, as things may have changed. Now, if you attend a school that is approved for STAFFORD loans and you borrow $15,000, there is no interest until you graduate. So when you finish medical school the principal is still $15,000. Only some schools are approved for STAFFORD…and only some schools are approved for TERI. Please find out which Caribbean medical schools offer which loans. Non-U.S. citizens should also find out if they can get a U.S. co-signer because I believe that is required by both loan organizations.
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Financial Aid Sources: TERI: www.teri.org CanHELP: www.internationalstudentloan.com/canadian_student Educaid: www.educaid.com Stafford: www.staffordloan.com Federal: www.fafsa.ed.gov Princeton Review: www.princetonreview.com/scholarships-f inancial-aid.aspx
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Chapter 14 HELPFUL URLS ESSENTIAL WEBSITES FOR YOUR RESEARCH CARIBBEAN MEDICAL SCHOOLS EDICAL ORGANIZATIONS OF CANADA AFMC M (Association of Faculties of Medicine of Canada): www.afmc.ca CaRMS (Canadian Residency Matching Service): www.carms.ca CPSO (College of Physicians and Surgeons of Ontario): www.cpso.on.ca Ontario Ministry of Health: www.gov.on.ca OMSAS (Ontario Medical School Application Service): www.ouac.on.ca OSAP (Ontario Student Assistance Program): osap.gov.on.ca
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MEDICAL ORGANIZATIONS OF THE UNITED STATES AAMC (American Association of Medical Colleges): www.aamc.org ACGME (Accreditation Council for Graduate Medical Education): www.acgme.org AMA (American Medical Association): www.ama-assn.org FSMB (The Federation of State Medical Boards): www.fsmb.org FREIDA (Fellowship and Residency Electronic Interactive Database): www.ama-assn.org/go/freida LCME (Liaison Committee on Medical Education): www.lcme.org NRMP (National Resident Matching Program): www.nrmp.org List of Canadian and American Medical Schools: www.aamc.org Interview Feedback: www.studentdoctor.net/interview Visa Info: www.murthy.com Mnemonics for med school: www.medicalmnemonics.com Career M.D.: www.careermd.com
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Chapter 15 MY RANKINGS My Ranking of the Medical Schools in the Caribbean NOTE: I do not endorse or disapprove any school. These are just my opinions that I am sharing with you. Please do your own research before choosing a school. Here is a little about each school: 1. ST. GEORGE (Grenada): www.sgu.edu
976 (year school began). No doubt the best in the Ca1 ribbean. You can get all your clinicals in the same city! And they are all ACGME accredited teaching hospitals. The school makes their students write a SGU basic science comprehensive exam. Only the students who pass that are allowed to sit for the USMLE Step 1. Licensure in every state! 150-200 students admitted twice a year in August and January. Basic sciences done on Grenada and St. Vincent. Multi-million dollar campus Numerous clinical training spots in United States and UK. Stafford loans available to students.
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2. SABA (Saba): www.saba.edu
1 993. I kid with my classmates by calling Saba “quality medical education, at a discount price.” It always gets laughs. Seriously though, you have to give the school credit for their record of success. Even if you frown upon the boredom of the small island, the larger picture (clinical, residency) with this school is excellent. New million dollar campus built in 2001. Island is small, clean and very quiet. Population is only 1400. There is no poverty or crime. Almost all students do clinical rotation in the United States. Students eligible for TERI loans and Stafford loans. Opened up a ‘sister’ school on Nevis called MUA in 2000. Saba was approved by California in 2004.
Since its founding in 1993, more than 1,500 physicians have earned their M.D. at Saba University (www.saba.edu). Saba University School of Medicine has been accredited by the Accreditation Commission on Colleges of Medicine (ACCM) and its program has received approvals from licensing boards in New York, California and Florida. The campus is on Saba, which is located very near St. Maarten. Equinox Capital, Inc. (an investment company) acquired Saba, MUA and St. Matthews in 2007. 3. ROSS (Dominica): www.rossmed.edu 1978. Basically, if you can get to clinicals, you’re set. Extensive clinical training sites. Excellent residency placement. Approved by New York, California and New Jersey. However, getting to clinicals without failing is another story. With an attrition rate that is almost hard to believe, and an island with a high crime rate, this school’s basic science program is really a horrifying experience for many. 250 students admitted per semester, with considerable attrition, causing many students
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to transfer to nearby Spartan University. Students approved for Stafford loans and Federal FFEL loans.
Bought by Devry (devry.edu) in 2003.
4. AUC (St. Maarten): www.aucmed.edu
1 978. Very popular and successful medical school. Graduated over 2000 physicians who are now licensed and practicing in the United States and abroad. Yes, they have bounced back from the volcano on Montserrat, and yes they got back their WHO listing. But the school still sends students to England and Ireland for third year clinicals, because they accept way more students than they have U.S. clinical spots for. Class size approaches 200 per class. Island is very westernized with McDonalds, KFC, Burger King, Domino’s, Pizza Hut, Gap, Tommy Hilfiger, Benetton, Calvin Klein, etc. Approved by California.
Bought by Devry in 2011.
5. University of the West Indies: 1960. Good school offering an MBBS degree (equivalent to M.D.). But designed to train people in the Caribbean, so it’s not really an off-shore med school. All four years are done in the Caribbean with no U.S. clinical rotations. They have three campuses (Barbados, Jamaica and Trinidad). Barbados University of the West Indies School of Clinical Medicine www.cavehill.uwi.edu Jamaica University of the West Indies Faculty of Medical Sciences www.mona.uwi.edu/fms
Trinidad and Tobago University of the West Indies Faculty of Medicine St. Augustine www.sta.uwi.edu/fms
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HE preceding SEVEN MEDICAL SCHOOLS ARE T THE ONLY ENGLISH LANGUAGE MEDICAL SCHOOLS IN THE CARIBBEAN THAT ARE APPROVED BY THE STATE LICENSING BOARD OF CALIFORNIA.
Honorable Mention: Medical University of the Americas (Nevis) and St. Matthews University (Grand Cayman) www.mua.edu www.stmatthews.edu In 2007, Equinox Capital (www.equinox-capital.com) bought three Caribbean Medical schools: Saba University, Medical University of the Americans (MUA) and St. Matthews University (SMU). Saba started in 1993, and the founder of Saba University (a great man named Dr. David Fredrick, who I remember well!) started MUA as Saba’s sister school in 2000. Since its founding in 2000, Medical University of the Americas (www.mua.edu) has awarded approximately 500 M.D.s. The MUA program is accredited by the Accreditation Commission on Colleges of Medicine (ACCM) and its program has received approvals from the licensing board in New York. MUA is located on Nevis, near St. Kitts. St. Matthew’s University (www.stmatthews.edu) offers both a medical and a veterinary program. Since 1997, almost 1,500 students have obtained their M.D. and DVM degrees from St. Matthews. The program is accredited by the Accreditation Commission on Colleges of Medicine (ACCM). St. Matthews is located in the Cayman Islands. NOTE: This is by no means an official ranking, it is just my opinion.
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Chapter 16 MCAT AND USMLE ADVICE
INFORMATION AND TIPS ON HOW TO PASS THESE EXAMS MCAT This test consists of four sections: Verbal Reasoning, Physical Sciences, Writing Sample and Biological Sciences. Verbal Reasoning can be the toughest for people. See, with a lot of studying for a few months you can improve considerably on the sciences, but verbal reasoning is hard to improve on. The reason is because the way you read and comprehend is something you develop at a young age. So, to all of a sudden change that in a few months is quite hard. A good way to approach this section is to read some passages every day without fail, like you are on some exercise regimen. Get conditioned to reading passages and then answering questions related to that passage. You can get sample MCAT verbal reasoning passages from the AAMC at: www.aamc.org Physical and Biological sciences can be studied in a variety of
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ways. Everyone is different with respect to their learning styles. So I’ll just tell you what I did. I read the Kaplan chapters for Biology Chemistry, Organic Chemistry and Physics. I learned them well. Then I spent a long time doing passages and questions. I took the Kaplan course in Toronto and I did every single test in their MCAT library. By the end of my time with them, there was nothing left in their center that I had not taken. I needed to do this because I was a math major, so my biology and chemistry skills were very weak. Writing Sample can be the easiest, but it is amazing how many people do not address the three basic tasks that the MCAT requires. Basically, you will get a one-line statement, and you have to write an essay about the statement by addressing three tasks: 1) explain what the statement means, 2) provide a counter example, 3) come to a happy conclusion between 1) and 2). That is what you need to do, so do it! Do not go off on some tangent, because you will get a low score. Also, MCAT graders only spend 90 seconds grading your essay and there is one thing they always look for a if you use an example from the real world, they love historical figures. I always wrote about Mahatma Gandhi – whatever the essay topic, I would write about him. So get to know some famous person from the past and write about his or her life. It’ll look good. The absolute best book to study for the MCAT is the: Kaplan MCAT Comprehensive Review, available at: www.barnesandnoble.com USMLE STEP ONE There are a thousand USMLE books out there. In addition, there are many USMLE CD roms with tons of questions by ‘socalled’ experts claiming they know the secrets of how to beat this
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test. But the simple truth is that the basic standard approach is still the best. That simple approach is: DO VERY, VERY WELL DURING YOUR FIRST TWO YEARS OF MED SCHOOL! First, learn your subjects from your first two years. Know your subjects well … I mean very well. Then, do as many USMLE-style multiple choice questions as you possibly can. Test yourself in 50 question blocks. As mentioned before, there are a ton of CD roms out there: Kaplan, Board Simulator, Appleton and Lange, National Medical Series, Pre Test, Exam Master, etc., etc. You can purchase them at barnesandnoble.com, and www.amazon.com or any medical school bookstore. The actual test has a large number of second and third order questions. These questions require you to think one or two steps further than the standard questions. You need to really have a grasp of your basic science knowledge to be successful on these questions and hence on the test. Otherwise the USMLE Step 1 can be an unbelievable perplexing and torturous experience. Here are some examples: 1) A 40 year old man comes in and presents with symptoms suggestive of mild dementia. Pathology reveals cortical atrophy, neurofibrillary tangles and amyloid plaques. Which of the following conditions does he most likely have? The answer to this question is Alzheimer’s disease. But that won’t be one of the choices. You have to think one step further. See, Down Syndrome (trisomy 21) patients get Alzheimer’s disease by age 40. So, the answer that will be listed is b) a trisomy. 2) A nine year old child is sent to the principal’s office because his teacher feels that the child is not paying attention in class. The teacher reports that the child often,
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when called upon, stares blankly into space for several seconds. What is the ion that the drug of choice for this epileptic disorder works on? This is a classic third order question. You have to start thinking at this level by the end of your second year of medical school. First order is recognizing that the child is suffering from ‘absence seizures.’ Second order is knowing that the drug of choice for this is Ethosuximide. Third order is recalling that this drug works on Calcium. So the answer would be d) Ca. 3) A researcher doing genetic breeding injects a IY-617 dye into a solution of isolated Zeta-Jones cells. The cells turn dark pink. She then adds this solution to a pre-made, dye-free solution of M-Douglas cells. After combining the two, the new solution is preserved and a few hours later the M-Douglas cells are isolated and are found to contain the IY-617 dye. What component of the cell allowed this transfer of dye? This is a perfect example of a very simple question, that is presented in a way so that the reader gets confused or freaked out by the details. The answer to this question is: c) Gap Junctions. Of course you know that, as they allow communications between cells. But the board exams like to do this, where they take concepts that are not difficult, but twist and turn them into questions that sound like they came out of Star Trek. Keep your confidence, don’t get intimidated. In general, there are a ton of USMLE books and CD roms out on the market. Don’t buy 30 different books and think it’s going to help you. Don’t go and buy a new USMLE book every time you see a classmate using one. Do not read large books like
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Guyton or Robbins cover to cover. It will NOT help you. Use one or two good review books and stick to them. I recommend these: USMLE Step 1 Secrets, by David Brown ISBN #: 1560535709 and USMLE Step 2 Secrets, by Adam Brochert ISBN #: 156053608X Have a structured, succinct, lean and lively plan for preparation and stick to it. Concentrate on doing as many questions as possible and read the explanation to them carefully. Stay dedicated and you should be successful. Hey, 93% of U.S. medical students pass USMLE Step 1 on their first attempt. So can you!
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Chapter 17 RESIDENCY PROGRAMS DESCRIPTIONS OF RESIDENCY PROGRAMS DONE AF TER MEDICAL SCHOOL ALLERGY/IMMUNOLOGY An allergist treats those individuals who have abnormal reactions – such as sneezing, itching, skin rashes and respiratory difficulties – to ordinarily harmless substances. An immunologist treats individuals who are susceptible to diseases from which others are usually immune. ANESTHESIOLOGY An anesthesiologist is a physician specialist who, following medical school graduation and at least four years of post-graduate training, has the principal task of providing pain relief and maintenance or restoration of a stable condition during an operation, obstetric or diagnostic procedure.
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CARDIOLOGY A cardiologist focuses on the prevention, diagnosis and treatment of heart disease. DERMATOLOGY A dermatologist diagnoses and treats diseases of the skin, scalp, hair and nails, including skin cancer. EMERGENCY MEDICINE These physicians focus on the immediate decision-making and action necessary to prevent death or disability. These physicians are primarily based in hospital emergency departments. ENDOCRINOLOGY An endocrinologist deals with diseases that affect the thyroid and pituitary glands, and with disorders such as diabetes. They also deal with all diseases involving hormones. FAMILY PRACTICE A family practitioner, having been educated and trained in broad areas of medicine – including internal medicine, pediatrics, surgery and obstetrics and gynecology – provides comprehensive health care to the entire family.
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GASTROENTEROLOGY A gastroenterologist diagnoses and treats disorders of the stomach, intestines, liver, gall bladder and pancreas. This is a subspecialty of internal medicine. GENERAL SURGERY A general surgeon is prepared to manage a broad spectrum of surgical conditions affecting almost any area of the body, having acquired knowledge and skills in problems relating to the head and neck, breast, abdomen, extremities and the gastrointestinal, vascular, and endocrine systems. GYNECOLOGIC ONCOLOGY A gynecologic oncologist is a specialist in obstetrics and gynecology who is trained in the comprehensive management of patients with gynecologic cancer. HEMATOLOGY/ONCOLOGY Hematologists specialize in diseases of the blood, spleen and lymph glands. They treat conditions such as anemia, sick cell disease and leukemia. The medical oncologist specializes in the diagnosis and treatment of all types of benign and malignant tumors (cancer). These specialists also decide on and administer chemotherapy for malignancy, as well as consult with surgeons and radiation oncologists on treatment for cancer. This is a subspecialty of internal medicine.
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INFECTIOUS DISEASES A specialist in infectious diseases focuses on the prevention, diagnosis and treatment of diseases which are caused or complicated by bacteria, viruses and fungi, as well as a number of illnesses of uncertain cause. This is a subspecialty of internal medicine. INTERNAL MEDICINE Internists are involved in the diagnosis and nonsurgical treatment of disease. This is a broad area of medicine emphasizing preventive medicine. Many internists specialize in a subspecialty of medicine, such as gastroenterology, cardiology or medical oncology. NEOHROLOGY Nephrologists treat those with kidney ailments, hypertension, fluid and mineral imbalance and related problems. This is a subspecialty of internal medicine. NEUROLOGY A neurologist deals with the diagnosis and nonsurgical treatment of diseases of the central nervous system (the brain and spinal cord), the peripheral nervous system (the nerves that are tied to the spinal cord) and the muscular system. Common neurological problems include headaches, weakness, seizures, multiple sclerosis and strokes.
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NEUROSURGERY A neurosurgeon diagnoses and treats, often by surgery, diseases or injuries of the central nervous system, the spine and peripheral nervous system. OBSTETRICS & GYNECOLOGY Obstetricians and gynecologists provide comprehensive medical and surgical care of the female reproductive system and associated disorders, including infertility. Those who choose to practice only gynecology do not provide care to pregnant women or deliver babies. OCCUPATIONAL MEDICINE These physicians specialize in the treatment of work-related injuries and provide medical screenings such as executive physicals, pre-placement physicals and consultations with companies regarding return-to-work protocols. OPHTHALMOLOGY Ophthalmologists diagnose and treat diseases of the eye, both medically and surgically, in addition to prescribing glasses and contact lenses.
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ORAL & MAXILLO-FACIAL SURGERY An oral maxillo-facial surgeon is a dentist who has undergone extensive training to surgically treat diseases, defects or injuries of the jaw and related structures. This not only includes removal of teeth in preparation of the jaw for dentures, but also reconstruction of the jaw due to cancer treatment or injury, and treatment of the jaw for joint dysfunction. ORTHOPAEDICS Orthopaedic surgeons are involved in the diagnosis and treatment of illnesses of the extremities, spine and associated structures. OTOLARYNGOLOGY Otolaryngologists provide comprehensive medical and surgical care to those who have disorders affecting the ears, the respiratory and upper alimentary systems, and the head and neck in general. OTORHINOLARYNGOLOGY In addition to providing comprehensive medical and surgical care to those who have disorders affecting the ears, respiratory, upper alimentary system and the head and neck, an otorhinolaryngologist also provides medical and surgical care for disorders affecting the nose.
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PAIN MANAGEMENT These physicians specialize in the treatment of chronic pain conditions utilizing a combination of oral medications, interventional pain management procedures and physical therapy. PATHOLOGY Pathologists deal with the causes and nature of disease. A pathologist contributes to the diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biological, chemical and physical sciences to man or materials obtained from man. PEDIATRICS Pediatricians focus on the development, care and diseases of infants, children and adolescents. PEDIATRIC CARDIOLOGY A pediatric cardiologist specializes in the prevention, diagnosis and treatment of heart disease in infants and young children. PHYSICAL MEDICINE Physical medicine is the medical specialty concerned with the evaluation and functional restoration of patients with disabilities that can be caused by stroke, multiple sclerosis, arthritis and spinal cord injury.
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PLASTIC & RECONSTRUCTIVE SURGERY Plastic surgeons deal with the repair, replacement and reconstruction of defects of the form and function of the outer layers of the body. They not only perform what is commonly known as ‘cosmetic surgery,’ but also treat burns, tumors of the skin and perform reconstructive surgery following accidents and cancer surgery. PSYCHIATRY Psychiatrists are involved with the diagnosis, treatment and prevention of mental, emotional and/or behavioral disorders. Psychiatrists are medical doctors with extensive training in mental health. PULMONARY MEDICINE Pulmonary specialists deal with diseases of the lungs and other chest tissues. They diagnose and treat such diseases as pneumonia, bronchitis, emphysema and related diseases. This is a subspecialty of internal medicine. RADIATION ONCOLOGY A radiation oncologist treats malignant and benign tumors with radiation therapy, and consults with medical oncologists and surgeons regarding the best form of treatment for individuals with various forms of cancer.
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RADIOLOGY Diagnostic radiologists deal with the use of radiant energy in medical diagnoses and therapeutic procedures utilizing radiologic guidance. RHEUMATOLOGY The rheumatologist is concerned with diseases of the joints, muscles, bones and tendons, diagnosing and treating such difficulties as arthritis and muscle strains. Rheumatologists work closely with other specialists, including Orthopaedic surgeons. THORACIC & CARDIOVASCULAR SURGERY These physicians are involved with the surgical and critical care of patients with diseases of the chest, including coronary artery disease, cancer of the lung, esophagus and chest wall, and abnormalities of the heart valves. UROLOGY A urologist medically and surgically manages disorders of the adrenal gland and the genital and urinary systems. VASCULAR SURGERY Vascular surgeons have undergone special training in the surgical repair of blood vessels, excluding those of the heart, lungs or brain.
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Chapter 18 Opportunities for International Medical Graduates in Canada Newfoundland Applicants applying for a license for entry to general practice who are assessed as ineligible may be eligible to enter the Clinical Skills Assessment and Training Program (CSAT) which has been developed by the Faculty of Medicine at Memorial University of Newfoundland. Satisfactory completion of the CSAT will fulfill the clinical training requirements and enable you to continue the application process for a provisional license. For more information: www.cpsnl.ca
Nova Scotia The Clinician Assessment for Practice Program is a program of the College of Physicians and Surgeons of Nova Scotia. It is
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intended for International Medical Graduate (IMG) physicians who believe they are practice-ready for entry into family practice without any additional formal residency training in Canada. For more information: www.capprogram.ca/
New Brunswick A restricted license is available, in very limited circumstances, for certain foreign-trained physicians for direct employment by a hospital or institution. For more information: www.cpsnb.org/english/LicensureinNewBrunswick.htm
Quebec Under current rules, doctors with a degree from outside Canada or the United States can practice medicine in the Canadian province of Quebec by obtaining a restrictive permit. For more information: www.msss.gouv.qc.ca/sujets/organisation/medecine/rsq/index.php?home
Ontario In Ontario, IMGs must go through the Match with CaRMS (www.carms.ca). However, the Centre for the Evaluation of Health Professionals Educated Abroad (CEHPEA) offers examinations that an IMG applicant can take, that will help boost their application with CaRMS. For more information visit: www.cehpea.ca/
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Manitoba MLPIMG: The Medical Licensure Program for International Medical Graduates (MLPIMG) is a one-year training program that will assist foreign trained physicians to obtain medical licensure to practice as primary care physicians in Manitoba. IMG-ACL: The International Medical Graduate Assessment for Conditional Licensure (IMGACL) is a three-month assessment process that will assess practice-ready IMG physicians’ previous training in order to obtain medical licensure to practice as primary care physicians in Manitoba. For more information: umanitoba.ca/faculties/medicine/education/imgp/index.html
Saskatchewan The College of Physicians and Surgeons of Saskatchewan is developing a new Saskatchewan-based assessment process designed to recruit more foreign-trained physicians to the province. The new program is currently being developed. Details about the new program will be posted on the website as they become available. For more information and updates visit: www.quadrant.net/cpss/index.html www.quadrant.net/cpss/assessment.html
Alberta The AIMG Program provides a route to registration for IMGs who are Canadian citizens residing in Alberta and are not able to obtain registration through other routes.
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For more information: www.aimg.ca Also read about the: Alberta Health Services Physician Preceptorship Program for International Medical Graduates http://www.albertahealthservices.ca/216.asp
British Columbia The IMG-BC Program expects candidates to have passed standard Canadian medical entry level examinations such as the MCCEE and MCCQE Part 1, as well as being able to communicate effectively in English. Further evaluation will include a 16 station OSCE, followed by an optional 1-week orientation and a 12-week clinical assessment offered to the top 35 candidates. There are 18 IMG first iteration residency positions; 12 in Family Medicine and 6 in Specialties. The positions will be posted on the CaRMS website and will be announced on an annual basis. For more information: www.imgbc.med.ubc.ca/Home.htm Other provinces or territories in Canada may have similar programs or pathways, so you are encouraged to contact the College of Physicians and Surgeons of the province or territory you are interested in. All the contact info is here: www.fmrac.ca/ Please keep in mind that “CaRMS” is the main pathway to obtain a post-graduate (residency) training position in Canada. For more information about CaRMS: www.carms.ca/ But, as we have listed above, there are other paths IMGs can take in order to obtain a license to practice medicine in Canada.
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Chapter 19 HIGH COST OF AN INFERIOR EDUCATION It is distressing to see so many new medical schools sprouting up on virtually any independent island or promoters using third world countries to set up “store front” type operations in the United Kingdom. The title of physician is honored and esteemed throughout the world. Numerous television series glamorize the role of physician as living a dynamic, heroic lifestyle. Unfortunately, many promoters in the offshore medical community exploit this image by setting up substandard proprietary schools that prey on the naive and under-qualified applicant. A typical applicant to medical schools in the Caribbean has, unfortunately, an undergraduate GPA below 3.0, no MCATS or total MCAT scores under 20. Most of these young people have been accepted at a substandard school that charges a tuition rate higher than many U.S. medical schools. All we can do is warn them that a poor basic science education and a haphazard clerkship program predict little or no success in passing the exceptionally difficult USMLE Steps I and II. According to an analysis of USMLE passing rates by the Education Commission for Foreign
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Medical Graduates, U.S. citizens who are International Medical Graduates have lower passing rates and lower scores than foreign national IMGs. The U.S. citizen with an inferior education who fails to pass the USMLE exams cannot obtain a residency and will have little to show but a huge debt. Prospective medical students should consider the following WORDS OF CAUTION: “Store Front” medical schools cannot offer the level or depth of education needed to pass the USMLE exams nor attract the best faculty. Substandard schools often exaggerate or distort their poor USMLE passing rates. As the ECFMG does not release scores of individual schools, actual passing rates are difficult to verify. Beware of any unusually high claims of high passing rates that cannot be verified. The recruiters are trained in high pressure sales tactics, with the same techniques that sell automobiles, aluminum siding and encyclopedias. Their goal is a sale; to make a profit for the school, often in the guise of flattery and concern for your welfare. The tuition charged by most substandard schools is very high. Some of these schools have private loans from the secondary medical education loan market. It is important to note that some of these loan companies do not rigorously examine the quality of foreign medical schools they approve for loans. Interest rates charged in the secondary loan market are not deferred; the interest clock starts clicking as soon as the loan is paid out. Numerous fees may also be charged. Loans may also be made for living expenses; thus increasing student debt level. The loan debt from secondary market loans is not dischargeable in bankruptcy; this means payment default will be rigorously pursued by the loan organization. The reputable schools often charge a higher tuition rate but offer a more rigorous education and are likely to have FFEL or internal loan programs.
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STATE LICENSING BOARDS are becoming increasingly aware of substandard schools, especially those offering advanced standing and a medical degree by distance learning. Denial of a license to practice to any physician is reportable on all licensing board applications and to credential verification organizations. Acceptance into a residency program does not guarantee future licensure. In summary, the graduate with an M.D. who cannot pass the USMLE exams has little to show but a huge debt that can be as high as $250,000. The interest clock continues to run; payments cannot be deferred after graduation unless the graduate has passed all exams and is engaged in post-graduate training. Job prospects are limited as is earning power and the Doctor of Medicine is little more than an empty title. The loan repayment will be very high and any graduate in payment default will be vigorously pursued. Years better spent in pursuit of another career will have been lost.
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Chapter 20 FACTS FOR INTERNATIONAL MEDICAL STUDENTS 1. It is significantly more difficult to be accepted into medical school today than 10-15 years ago. MCAT scores and grade-point requirements are higher. Thousands of talented, well-qualified individuals therefore are denied admission each year. 2. Failure to gain admission to a U.S. or Canadian medical school should not be interpreted as a sign of failure. If you have the motivation, there are acceptable programs abroad. 3. You do not have to be gifted in a foreign language to study abroad. Many international schools have English language programs or are located in English-speaking countries. 4. Over 25% of all practicing physicians in the United States are International Medical Graduates (IMGs). U.S. citizens who train abroad are now a significant part of the IMG physician population.
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There are roughly 17,000 U.S. graduates per year and approximately 26,000 post-graduate residency positions available. The number of residency programs has increased every year for the past 30 years. International Medical Graduates are needed to fill these surplus residencies.
6. Th e highest concentrations of IMGs are in the specialties of Internal Medicine, Psychiatry, Anesthesiology and Primary Care. 7. Over the past decade IMGs with high USMLE scores from reputable foreign programs have been able to obtain residencies in more competitive areas such as Surgery, Radiology and Obstetrics and Gynecology. 8. A ll medical students now take one exam called the United States Medical Licensure Exam series (USMLE). 9. Th e passing rate for American and Canadian International Medical Graduates on the USMLE Step 2 Clinical Skills exam exceeds that of other foreign-trained physicians. 10. T oday there is far more scrutiny of U.S. citizens studying medicine abroad by state licensing boards than existed 10 years ago. It is therefore important to study at an established, stable school that will keep permanent records. 11. Residency Training Programs, however, appear to be more receptive to U.S. citizen IMGs than they were 10 years ago. A United States Citizen does not need a special visa. Furthermore, because most American IMGs have done clerkship rotations in U.S. hospitals, they often integrate quickly and with fewer difficulties into training programs.
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12. After passing the USMLE Step 1, USMLE Step 2CK and USMLE Step 2 CS, IMGs are eligible to participate in the National Residency Matching Program.Unlike U.S. medical students, IMGs are free agents and may sign residency training contracts with programs outside of the MATCH. 13. There is no doctor glut in the United States. There is a significant mal-distribution of physicians with high concentrations in urban areas and a severe shortage of qualified physicians in rural locations. 14. Despite recent publicity, a majority of U.S. residency training programs are not decreasing training positions. An increase in Primary Care postgraduate programs balances cut backs in specialty areas. Physicians are retiring or decreasing practice at an earlier age than anticipated. This accounts for the current shortage of Anesthesiologists, for example. 15. For several years there has been discussion in Congress of limiting Medicare funding to residency training programs accepting IMGs. Although it is a remote possibility, such action should not affect foreign-trained U.S. citizens who are permanent residents and tax payers. 16. Patients are more concerned with the quality of care physicians provide than where you attended medical school. A combination of knowledge, skill and genuine concern are what count. 17. Today there are excellent options for study abroad in a variety of countries. World Health Organization (WHO) listing alone does not, however, guarantee a quality education. A medical school, particularly if it was established within the last 10 years, should be thoroughly investigated before a student attends.
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WORDS OF WISDOM
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Chapter 21 WORDS OF WISDOM The following words of wisdom are the best advice you will ever receive. Read each item carefully before you study abroad. 1. The first word of wisdom is that you can receive an excellent education abroad and a competitive residency in the United States. You must first do your homework and study only at a reputable school with rigorous academic standards. More medical schools in the Caribbean, Mexico and Central America have failed than have succeeded. Study only at established schools and be highly skeptical of newly established schools. If this information is not included in the catalog, ask each school for the following: a. The USMLE Step I and Step II passing rates b. A complete list of all training hospitals and their locations c. A list of graduates and their residency placements
d. The names and credentials of all full-time faculty members. e. Proof of listing with the World Health Organization
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2. Follow the same procedure for established European Medical Schools with English language programs. Make sure you have the same access to faculty, library and lab facilities as local students in the regular program. Be prepared to attain language fluency before you begin third and fourth year clerkships. 3. Do not believe what you read in a flashy catalog or on an internet site. Avoid any school where recruiters engage in pressure tactics or make personal concessions for you. Visit the admission office and basic science campus of each school in your final selection pool. Attend lectures and interview several current students. 4. During a personal visit, look for signs of adequate staffing and permanency. Evaluate the faculty credentials and make sure the teaching staff is full-time and in residence. Avoid schools that hire local M.D. practitioners on a part-time basis to teach basic science courses normally taught by Ph.D.-level faculty (physiology, biochemistry, microbiology etc.) 5. Carefully evaluate the integrity of the library, laboratories and classroom facilities. Many of the newer medical schools rent space in local hotels, converted garages or private homes. Look for a permanent, fully-functioning campus and remember that a school that rents a few classrooms has little incentive to remain open during hard times. 6. Be very wary of any school that will allow you to complete part of your basic science studies in the United States or England. To avoid future licensing problems, your entire basic science curriculum should be completed in the country listed by the World Health Organization.
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7. Be equally wary of schools that have substandard basic science campuses and guarantee clerkship rotations in the United States. Many of the newly established schools with poor to non-existent basic science campuses use this tactic to attract new students. This is a tried and true con game that could be very costly in terms of money and wasted time. 8. Go only to schools where the duration of the Doctor of Medicine program is at least 38 months and demands that you have full-time attendance at the campus. Beware of programs that require that you be present only 6-8 weeks or place you on directed study back in the United States. 9. If you are unable to make a personal visit, interview several current students and graduates before you make a choice. Do not go to schools that refuse to give you a list of clinical training hospital sites or do not list the clinical sites in the catalog. 10. Look for medical schools with external loan programs. A school with Stafford, FFEL, TERI, or I HELP loans has a source of oversight and regulation if it is receiving funding from one of these groups. 11. Beware of schools offering their own loan programs or scholarships. Interests rates and terms can change at the whim of the school and you may be held hostage for your transcripts, ECFMG certification or licensing materials until you pay up. 12. Pay only by semester and avoid any school that charges a large deposit, excessive fees or wants a year of tuition in advance. Make sure that tuition charges and refund policies are clearly delineated in the catalog.
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13. The art and practice of medicine cannot be learned on the internet. Furthermore, medical licensing boards do not recognize distance learning for a Doctor of Medicine degree. You may obtain a degree but may never be offered a residency or obtain a license to practice medicine 14. Avoid any school that gives advanced standing to physician assistants, chiropractors, podiatrists, dentists, nurse practitioners or one that has special programs for these occupational groups. Credits earned in these programs are never considered equivocal to medical school courses and will not be counted for credit by licensing boards. 15. Licensing boards frown on medical students who do not maintain full-time residence at the basic science campus and are employed during medical school. There are cases where practicing physicians who earned significant income as physician assistants, nurses or chiropractors while in medical school lost their licenses. Licensing boards target schools with part-time programs and merely have to examine IRS returns during years of medical school attendance. 16. A majority of U.S. licensing boards require 36 or more months in medical school. Many will require documentation of the exact number of hours spent in each basic science course. This means completion of a full Doctor of Medicine program. Because licensing boards do not count the time between semesters, vacations or study breaks, the typical 38-month, (10 semester) M.D. program meets the attendance requirements of the most stringent states. 17. Avoid schools that recruit failures or drop outs from other medical schools. Avoid a school where most of the student body are transfers from other schools. As the school’s
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reputation diminishes, graduates will have a more difficult time obtaining a residency and receiving a state license. 18. If the school opens without a listing by the host country with the World Health Organization, don’t go. Do not believe recruiters who tell you that the listing is pending. This is usually a sign that there is something drastically wrong. You will not be eligible for the USMLE exams or a license to practice. 19. A history of legal problems or sanctions by regulatory agencies is a bad sign. Investigate each school carefully, particularly for fraud in Stafford or FFEL loan programs or falsification of ECFMG or licensing material. The legislative division of the Federation of State Licensing Boards in Euless, Texas, is a source of information on these matters. 20. Be prepared to learn a new language if you study in a non-English speaking country. Although the basic science curriculum may be taught in English, you will need to be able to communicate with your patients and the hospital staff during clerkship rotations. 21. Remember that you are a guest in a foreign country and that conditions will not be like those in the United States. Be flexible, open-minded and consider the opportunity to interact with a new culture part of your medical education. By all means be polite and make an effort to conform to local customs. 22. T HE LAST WORD OF WISDOM: DO NOT BE DISCOURAGED. Chose a reputable California-approved foreign medical school and remember that thousands of American and Canadian citizens
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have studied abroad and successfully practice medicine in the United States. A majority of your patients and colleagues will judge you on the basis of your competency, professionalism and dedication. They will usually not care that you are an international medical graduate if you maintain high professional standards.
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Chapter 22 FREQUENTLY ASKED QUESTIONS ADMISSION QUESTION 1 I have completed all the basic medical sciences (Anatomy, Histo, Embryo, Path, Microbio, etc.) and basic clinical diagnosis courses at the chiropractic college. I was wondering if they offer an advanced standing for people with a background (i.e., possibly fast track)? I don’t know if medical schools in the Caribbean offer advanced standing. Also, I am not sure as to how different state licensing boards in the U.S. would look at this once you complete such a path. You may want to contact the state(s) that you are interested in and ask them about their policies with regard to granting a license to practice medicine for someone who completed a medical degree after having been given advanced standing. The contact info for the state medical licensing boards in the U.S. is at: www.fsmb.org
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QUESTION 2 I have not completed my MCATs. I had a good average over the four years of college. Do you think that this would be a high enough academic grade to consider me without MCATs? Several Caribbean medical schools accept students without the MCAT, so it is an optional requirement for most of these schools. Check the website of each school for details. Information about the MCAT is at: www.aamc.org QUESTION 3 In your opinion, what are the better med schools down in the Caribbean or Central America? You mentioned some are willing to accept people with minimal criteria. Does this make the M.D. degree less respected in the field if you attended these schools? Please see my (unofficial) Caribbean medical school rankings. It is just my opinion, and by no means official. Some schools have been around a long time, like UAG (Mexico) since 1935 or so (I think). Others were established in the mid to late seventies like SGU (Grenada) AUC (St. Maarten), Ross (Dominica). Many newer schools exist, but some of them have no track record whatsoever. You need to look at several things when considering a medical school in the Caribbean, like: 1.) 2) 3) 4)
USMLE pass rate Clinical placement rate in the U.S. Residency matching statistics State licensure record
If the school does not have answers to these questions, or their answers are ambiguous, then chances are it is not a good school to attend.
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QUESTION 4 Are there any other schools within the Caribbean that you considered? I applied to 11 of the 13 English-speaking medical schools and six medical schools in the U.S.. After I did not gain admission I looked into the Caribbean medical schools (all of them) and then decided on Saba. I only applied to one Caribbean medical school. QUESTION 5 Is it tough to get admission into SABA? Admission into Saba is getting tougher, but if you apply early enough I really don’t think it is that hard to get accepted. Even if they reject you, you can always apply for a subsequent entering class or to their sister school MUA – www.mua.edu – which is on the neighboring island of Nevis. I do not know of any specific GPA or MCAT acceptance averages. Perhaps the school might be able to tell you – www.saba.edu. QUESTION 6 What are some characteristics about SABA that attracted you to it, and that may be different from other Caribbean schools? The reasons I chose Saba are outlined above. Other than those reasons: low cost of tuition, good board pass rate, good residency placement rate, everyone gets clinicals, island is safe and quiet and class size was small.
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QUESTION 7 I have recently been accepted to Medical University of the Americas in Nevis and will be going there soon. I was wondering what kind of things you have heard about MUA. A good friend of mine attended MUA. He started there September 2001. I saw him just before he left Toronto to go down to Nevis. He was very excited. It was funny, I had just come back from the Caribbean, and he was just about to go there (I completed the basic sciences in April 2001). MUA is basically Saba’s sister school. Both schools, originally founded by Dr. David Fredrick, are now owned by Equinox Capital. Saba started in 1993, MUA opened their doors in 2000. MUA’s curriculum is the same as Saba’s, and Nevis is a much nicer island to be on than Saba, seven times bigger with seven times the population; Nevis even has a little shopping mall. That island also has beaches…maybe a little too much fun. QUESTION 8 Is there anything I can do right now that may save me time when I am in med school (such as applying for visas, etc.)? Well, you could always study; first semester is anatomy, histology and embryology. You could research issues like the ones you mentioned (visas). Or, work and save money for the big financial crunch that is about to take hold. QUESTION 9 With my experience, grades, etc., are there any U.S. schools that you suggest I apply to?
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You can try to apply to schools in the U.S., although many only accept U.S. citizens. Just take a look at the schools’ websites or email them – www.aamc.org. If you decide to apply to LCME schools in the U.S. or Canada, then you should definitely get this book: Medical School Admission Requirements (or MSAR for short). It is the ‘bible,’ excellent source of info, tells you all you need to know for applying to U.S. and Canadian schools, all the statistics, scores, number of applicants, etc. QUESTION 10 I have heard from an undergrad medical counselor that not all Caribbean medical schools are accredited, or as they subjectively put it, “very good.” I seek some truth in what this counselor said, for I do not plan on basing any opinions by asking simply one person, especially someone who is not involved with the Caribbean medical system! The word “accredited” is not relevant here. Basically for a medical school to be legitimate (not a hoax) it has to be listed with the World Health Organization (WHO). Only students at a WHO listed school are eligible to write the USMLE (U.S. board exams) or the MCCEE, MCCQE (Canadian board exams). But WHO only lists medical schools, they do NOT evaluate or give accreditation. That is done by the state boards. Currently only six English language medical school in the Caribbean Basin are approved by all 50 states in the U.S.. Those schools are: SGU, Saba, AUC, Ross and UWI. There are basically two main categories: LCME medical schools (U.S. and Canadian medical schools), and foreign medical schools (listed with WHO). When your counselor says the schools are “not very good” perhaps he/she is referring to the quality of education, quality of professors, facilities, etc. of each school.
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QUESTION 11 Some schools have three entering classes (i.e., SABA). When do you suggest I have my application so that it is in early enough (in some American medical schools, the earlier your app is in the better your chances of getting in are – for whatever reason) so that I may begin studying medicine by August/September? Apply whenever you want, most schools have rolling admissions so there are no deadlines. Starting in May is the best scenario because it gives you a four-month head start on the entire fouryear process. These four extra months come in handy when you are rushed for time in your third and fourth years with USMLE exams, residency interviews, elective rotations, etc. QUESTION 12 My biggest worry is paying a large sum of money to go to a Caribbean school and then have a limited opportunity to practice in the U.S. (or would have to wait to practice with respect to another physician whose undergrad medical education was done in the mainland). Bottom line is: first, try your hardest to get accepted into a Canadian medical school or a U.S. medical school. Now, at this point, if you don’t get accepted at any LCME medical school (U.S. or Canada) then you have three options: 1) apply again the following year 2) give up on medicine 3) attend a foreign medical school Right? What other options are there? Doing a master’s degree?...research?...it is my firm belief that those things do not help your chances of getting into a medical school in Canada. Some people will argue with me on this, but, hey, I applied to medical
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schools for four years and I applied to 11 of the 13 Englishspeaking medical schools in Canada, so I know what I am talking about. A master’s degree does not hide a weak undergraduate history…don’t waste your time. Also, doing a master’s degree for the sole reason that it will improve your chances of getting into medical school is really stupid…in my opinion. There is more to life than an allopathic medical school In the United States there is osteopathic medicine (DO), which offers residency programs in the same fields as allopathic medicine (M.D.), and they make the same amount of money and are fully licensed, practicing physicians. Check out: www.aacom.org www.osteopathic.org QUESTION 13 Caribbean medical schools are not LCME-certified. I went on their site and all that really means is that there isn’t a “med school quality control” from the mainland with respect to Caribbean schools. Is this cause for concern? (i.e., should this worry potential applicants going to the Caribbean to study medicine?) What are the benefits of getting into an LCMEcertified school over a Caribbean school? LCME is the Liaison Committee on Medical Education. They are the nationally recognized accrediting authority for medical education programs leading to the M.D. degree in U.S. and Canadian medical schools. Visit their website: www.lcme.org. Caribbean medical schools are independently owned and operated. Most have offices in the U.S. and campuses in the Caribbean islands. It is a rather different situation than that of LCME schools.
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QUESTION 14 What about applying to medical schools in the United States, do you have any info about this? Information About APPLYING TO U.S. Medical Schools: Things to consider (In ORDER of importance!): a) The number of applications the school gets. If it is more than 5000, forget about it, because yours will get lost in the shuffle.
b) If you are a non-U.S. citizen, find out if the school accepts non-U.S. citizens! c) The number of “Out of State” applicants they accept. If the number is less than 10, forget it.
d) GPA/MCAT averages, tuition, prerequisites. (You should have a competitive GPA/MCAT for the school you are applying to, the tuition should be not too high (they all are!), and you must have the prerequisites). Pre-Medical advisory committees will often suggest applying to at least 20 schools through AMCAS. Once you get the Medical School Admissions Requirements (MSAR) book from the AAMC, read up on these schools (and others of course) and apply through AMCAS as EARLY AS POSSIBLE! Remember – rolling admissions! Be prepared to spend A LOT of money and put in A LOT of your time. Okay, I’ll try to make this application process as clear and simple as possible. But believe me – it’s not! a) First get the AMCAS application (from www.aamc.org) b) Fill it out very carefully (do your best job) and send it with all the required stuff (transcripts, MCAT scores, etc.) to AMCAS with a fee.
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c) About a month after AMCAS gets your application you will get SECONDARY APPLICATIONS from each school you applied to. This is the REAL application. Fill these out even more carefully (do an even better job) and send them with a fee. d) Then you wait…if you get an interview they will mail you an invitation; otherwise you will get a rejection letter.
NOTE: Be prepared to spend A LOT of money, go through A LOT of frustration and you have to be VERY PATIENT. It is a long application process. TIME LINE FOR U.S. MEDICAL SCHOOLS For September 2013 entering class: March, 2012
AMCAS starts accepting transcripts
April 2012
New MSAR book available from the AAMC
June 1, 2012
First day that AMCAS accepts applications
September 2012
Interviews begin
October 15, 2012
First offers of admission sent out
April 2013
Interviews end
September 2013
Date you enter medical school (Matriculation date)
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INTERNET LINKS 1. American Association of Medical Colleges www.aamc.org
2. AMCAS (American Medical College Application Service) https://www.aamc.org/students/applying/amcas/ 3. The LIST! All the U.S. Medical schools and their URLs https://services.aamc.org/30/msar/ DOCTOR OF OSTEOPATHIC MEDICINE (D.O.) Also look into D.O. schools. “What is D.O.?” you say. It stands for Doctor of Osteopathic Medicine. It is practically the same thing as an M.D. in the United States, and DOs can get the same residencies (family medicine, internal medicine, pediatrics, surgery, anesthesiology, sports medicine, geriatrics and emergency medicine) as M.D.s upon graduation. I have a friend who graduated from Arizona College of Osteopathic Medicine of the Midwestern University and is now in residency in Michigan. It is a very similar program to an M.D. I cannot emphasize this enough. But people don’t know this (or for some stubborn reason don’t believe it) – that is why few people apply to DO schools, and that is why it is easier to get in. Here are the websites for info on Doctor of Osteopathic Medicine: American Association of Colleges of Osteopathic Medicine - www.aacom.org
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QUESTION 15 My GPA and MCAT are not competitive, but I still want to be a Doctor of Medicine (M.D.), what should I do? Well, there are a lot of people in this boat. Assuming your GPA is lower than 3.4, you probably have no chance of getting into a Canadian med school. I may be wrong, but I doubt it! I mean the cut-offs just to get an interview were 3.50, 3.57 and 3.60 for Western, Queens and Ottawa respectively (this was back in 1999; the cut-offs are even higher now). U.S. medical schools do accept people with GPAs as low as 3.0, but as a Canadian applicant you are considered foreign (since you are not a U.S. citizen), so you will need to have a higher GPA than the U.S. applicant’s average. But don’t give up hope! There are other very legitimate options that thousands of students choose each year. Here they are: OPTION ONE: UNITED STATES DO SCHOOLS See Question #14 about DO schools OPTION TWO: CARIBBEAN MEDICAL SCHOOLS V isit www.CaribbeanMedicine.com for info about med schools in the Caribbean that offer the first two years in the Caribbean and then the next two years in the United States OPTION THREE: MEDICAL SCHOOLS WORLDWIDE https://imed.faimer.org/
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QUESTION 16 What about going directly from high school to the Caribbean for medical school? Going to a foreign med school straight out of high school may seem like a way to ‘save time,’ but if you want to come back to the U.S. you will find that you actually don’t save any time; because once you come back to the U.S. you have to pass ALL the U.S. board exams (USMLE Step 1, Step 2, CSA, etc.) and many residency programs require that you do at least 6 to 12 months of clinical rotations in the U.S. before applying to their residency program. One of my friends graduated high school in 1993 and went to India for med school. It was a 5½ year MBBS program. She finished the program in the standard time and returned with her foreign medical degree in 1999. Well, it took her three years to pass USMLE Step 1, USMLE Step 2, CSA and she also had to do clinical rotations in the U.S.! Think about it, that is over 12 years since she finished high school. If she went to undergrad here in North America for four years and then med school for four years, she would have been in residency in 2001, and would have done it with a lot less hassle. I personally don’t recommend going to a ‘straight out of high school’ foreign med school. Sure, a small number will be able to come back, pass all the boards, get clinical rotations and get a residency, but they won’t be saving any time, that’s for sure. It actually takes longer! Most will not be able to pass USMLE Step 1 and will either give up on medicine or go back to the country where they did their medical school. If you are a U.S. citizen, then your best option is to stay in the U.S., attend a good pre-med program at a University, get a good GPA (3.4-3.6), get a good MCAT score (9-10), and then apply to several U.S. med schools. Every year more than 16,000 students get into med school in the U.S., so it is most definitely possible.
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If, after all that, you still don’t get into a U.S. med school, then you always have the option of going to a good Caribbean med school, doing two years in the Caribbean and then coming back to the U.S. to do your third and fourth year. This will prepare you better for USMLE and will make it easier to get a residency in the U.S. Currently the USMLE pass rates for students from foreign medical schools is much lower than the students at U.S. med schools. The stats are listed at www.usmle.org. As you will see, 92% of U.S. med students pass USMLE Step 1 on their first try. In contrast, only 64% of foreign med students pass USMLE Step 1 on their first try! When it comes to obtaining a residency, the stats are posted here: www.nrmp.org . As you can see, 93% of U.S. med students match to a residency, whereas around 50% of foreign med graduates match to a residency. QUESTION 17 What about medical schools in the UK or in Europe? Here is my answer to the Europe (UK, Ireland) vs. Caribbean question: A ‘good’ CARIBBEAN medical school is a BETTER CHOICE than a medical school in Europe (UK, Ireland) for Canadians a here are some reasons: a) First as CANADIANS you must face reality and understand that as soon as you leave Canada to go abroad to study medicine your chances of returning are going to be difficult.
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b) Then, you must decide where you want to end up. For most the answer is the United States! c) United States is a LOT more similar to Canada than Europe is, and there are a LOT more opportunities there for U.S. FACT. So, for most Canadians, moving permanently to Europe is not an option, but moving permanently to the U.S. is an excellent option. d) With this established, you have to choose a school that maximizes your chances of getting into the U.S. and getting a U.S. residency. e) CARIBBEAN medical schools offer clinical rotations (Cores and Electives) in the United States. This gives you the HUGE advantage of being in the U.S. system for TWO years prior to applying for a U.S. residency. f ) During those two years, you are preparing yourself better for USMLE Step 2 (as that exam is based entirely on U.S. clinical experience). g) Also, during those years you will be making contacts with program directors that can aid you in obtaining a U.S. residency. h) CARIBBEAN schools offer a U.S. curriculum during the first two-year basic science program. This is proven to prepare students better for the USMLE Step 1 than other foreign schools. i) European schools (in UK or Ireland) offer none of this. You will be in Europe for the four (4) years or more. Then, when you decide to come to the U.S., you will be inadequately prepared for the boards, and you will have ZERO U.S. contacts. You will be in the same boat as someone from Africa, India, Mongolia, Peru or the North Pole for that matter. Actually, as
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CANADIAN you will be worse off, because at least those IMGs can get the “Statement of Need” from their Ministries of Health easily. In contrast, as a Canadian you have to meet many requirements to get the “Statement of Need.” QUESTION 18 My GPA is #.##, my MCAT is #### - what are my chances of getting accepted into a med school in the Caribbean? Here is the answer to this very common question: I have always told students to try their very best to obtain admission into a U.S. or Canadian medical school. If you have tried your best and still have not been accepted to an LCME (U.S. or Canada) school, then and only then should you consider the Caribbean. Admission to a medical school in the Caribbean varies depending on the school. The newer medical schools that have opened up in the past five or six years tend to accept anyone that applies. This may be hard to believe, but it is true. The schools are desperate for students and are willing to give anyone a chance. This can be a dangerous thing, because some of these schools are terrible. No real teaching, no real facilities, no cadavers, no USMLE pass rate, no established clinical rotation program, no graduates, no history of residency placement and, of course, no history of state licensure. A student from U.S. or Canada who has had much difficulty in obtaining admission into a medical school in their country may ‘jump’ at the opportunity to attend an offshore school, especially if admission is so easy. But the consequences of attending such newer schools can be disastrous. This also applies to some of the ‘older’ Caribbean med schools that have made very few improvements over the course of their 20 years of existence in the Caribbean.
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There are only about four or five established medical schools in the Caribbean with a proven record of residency placement and state licensure. It only takes about a couple of hours of research on the internet to figure out which ones those are. Now, as far as admission is concerned, in my firm opinion there are only two schools in the Caribbean that will actually reject an applicant (St. George and Saba) – St. George because they are a ‘real’ University and Saba because enrollment is limited due to the very small size of the island. There may be some disagreement from others with regard to my statement above, but I have rotated with dozens of students from several other Caribbean med schools and those students have all verified this. If you want some specific numbers, I would say that a GPA of 2.5 or more is enough for admission to most of these med schools. A far cry from the 3.7 GPA you need in Canada. MCAT is optional. It is a rather opposite concept with Caribbean med schools as compared to U.S./Canada med schools. In the U.S. and Canada, admission is the most difficult thing. But once you are in, it is smooth sailing. In contrast, with Caribbean med schools, admission is a joke. But once you are in, you are pretty much in a very difficult process, one that involves an enormous amount of self-teaching, self-planning and self-discipline. You are on your own! At many of the Caribbean med schools, during the first two years on the island you have to teach yourself the basic sciences. Then there are some very difficult board exams you must pass – USMLE Step 1, USME Step 2, USMLE Step 2 CS and USMLE Step 3. During the third and fourth years, depending on what school you go to, you have to set up some or all of your clinical rotations and go from state to state to complete them. Then there is the entire process of applying for a residency and competing with thousands of other IMGs from all over the world.
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In addition, if you are a non-U.S. citizen you have to deal with the problems of trying to get a work visa (either J-1 or H-1B). So, as you can see, admission is the least of your worries. Some of the better Caribbean med schools will help their students through the four-year journey somewhat. But most do not. The only schools in the Caribbean that I recommend are: SGU, Saba, AUC, Ross, UAG and UWI. QUESTION 19 Can you explain this WHO listing? I have heard that I should only go to a school that is listed in the WHO directory. WHO (World Health Organization) simply publishes a directory of medical schools worldwide. That is what IMED is: https://imed.faimer.org/ That’s it. The WHO directory is not much more than that. For a school to get listed in that WHO directory, all they have to do is send a letter (by fax or mail) to WHO in Geneva, Switzerland. In that letter all they have to say is that there is a school and that they have a physical address, telephone number, etc. Oh yes, the letter needs to be signed by the medical/health official of the country. WHO does NOT evaluate, assess or give accreditation to any school. That is done by the individual countries, and many small countries have minimal standards, if any at all. For example, in the United States that organization is LCME. www.lcme.org. But LCME only approves med schools in the U.S. and Canada. For foreign medical schools you have to contact FSMB. www. fsmb.org. Contact the state where you are interested in working as a doctor and ask if that state has approved the foreign medical school you intend to attend.
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There are about 30 offshore med schools down there in the Caribbean/offshore region, but only five are approved by all 50 states! Which five, you ask? SGU, AUC, Ross, Saba and UWI. QUESTION 20 Students, who are attending a Caribbean med school that operates any part of their basic science curriculum in the U.S. or Canada, can never obtain a license to practice medicine in the United States or Canada . . . Is this true? Any Caribbean medical school that is operating, or has operated any part of their basic sciences curriculum in the United States or Canada is doing so illegally. Ross tried to do this a few years ago in Wyoming. St Matthews tried to do this a few years ago in Maine. This is not allowed by the state licensing authorities in the U.S.! Contact them and you will see: www.fsmb.org/ QUESTION 21 Students who have gone from high school to a Caribbean M.D. program (without doing any university) can never obtain a license to practice medicine in the United States or Canada . . . Is this true? Certain Caribbean med schools are accepting high school students into their M.D. program! These students have no undergraduate education whatsoever. For example, a list of requirements you need to meet in order to get a license to practice medicine in the state of New York, states:
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A. Pre-professional Education: Satisfactory completion of 60 semester hours of college study from a New York State registered program or the equivalent as determined by the New York State Education Department. This is saying that you need to have completed at least two years of University before entering medical school, in order to be eligible for a license to practice medicine in New York (one year of University is equivalent to 30 semester hours). Other states have similar rules. You can view all the rules by contacting the state medical boards here: www.fsmb.org So, as you can see, if you go from high school to a Caribbean med school, with no University education, you can never work as a doctor in the U.S. Therefore, forget about any Caribbean med school that is either: a) Operating any part of their Basic Science curriculum in the U.S. or Canada b) A ccepting students straight out of high school who have completed no university education Otherwise you will spend tens of thousands of dollars and lots of time and end up with nothing to show for it. The fact remains that medical schools that are located in the Caribbean are considered foreign. - all foreign medical schools in the Caribbean are NOT accredited by LCME. Visit LCME website for details: www.lcme.org. - f or all foreign medical schools in the Caribbean: ALL five SEMESTERS of Basic Sciences MUST be held on the island in the Caribbean for which the charter was issued. - if a Caribbean medical school holds ANY part of the Basic Science curriculum (the first two years of med school) in the U.S. or Canada, the students are NOT eligible for licensure in the U.S. or Canada.
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-A ll 125 medical schools in the U.S. and all 13 English medical schools in Canada require that students who apply must have completed at least three years of undergraduate studies at a recognized University. Most med schools (almost all) also require that the students pass the MCAT. - these are BARE MINIMUM requirements - s tudents who have ‘skipped’ University and jumped directly from high school to a Caribbean med school are walking into the path of grim death -n o state will grant such students any form of licensure upon graduation - YES, foreign medical schools in other countries accept high school students, but those countries offer 5.5 - 7 year medical programs (e.g., MBBS degrees). So the total credit hours meet U.S. requirements. -C aribbean med schools operate 10 semester programs, which are only three years and four months long Please contact the Federation of State Medical Boards for further information: www.fsmb.org/. STUDENTS WHO HAVE GONE FROM HIGH SCHOOL TO A CARIBBEAN M.D. PROGRAM (WITHOUT DOING ANY UNIVERSITY ) CAN NEVER OBTAIN A LICENSE TO PRACTICE MEDICINE IN THE UNITED STATES OR CANADA. Do not, under any circumstances go to Caribbean med school, straight after high school. You MUST attend University first. Otherwise you will NOT be eligible for licensure in United States or Canada ever.
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Financial Aid QUESTION 22 How much financial assistance can I realistically expect from Canada Student Loans? Canada Student Loans (in Ontario it is OSAP – www.osap. gov.on.ca) gives a max of 8580 CAN/year, other provinces have different plans. There are other places from which you get financial aid, for example any one of the banks (CIBC, Bank of Montreal, Scotia Bank) give student lines of credit. Also look into these sources: Bank of Montreal www.bmo.com/ Canada Student Loans Program http://www.rhdcc-hrsdc.gc.ca eduPASS www.edupass.org/f inaid/canadian.phtml OSAP http://www.osap.gov.on.ca TERI www.teri.org
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QUESTION 23 Can you please give me some financial aid sources? Visit this very informative page on how to pay for med school: www.princetonreview.com/scholarships-f inancial-aid.aspx In addition, the websites for the loan organizations for Americans are: Educaid www.educaid.com Federal www.fafsa.ed.gov Sallie Mae www.salliemae.com Stafford www.staffordloan.com Teri www.teri.org Other options include working and saving money before going to med school or applying for bursaries or scholarships (although these are very limited for foreign med schools).
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Medical School QUESTION 24 To you, what is the best thing SABA has to offer (educationally speaking)? The best thing Saba has to offer me is basically an opportunity to become a physician. Otherwise I would have had to give up on that goal. Educationally, you have your good profs and your bad profs (more of the latter, unfortunately), but in the end most of the students make it through the program and get residencies in the U.S., so their system works. QUESTION 25 Where are the professors/faculty from? The professors/faculty are mostly from the U.S.. Some are from Canada, England and abroad (India). QUESTION 26 Does the curriculum conform to that of the U.S.? The curriculum on Saba was designed to be like that at U.S. medical schools. We take the exact same courses and use the same textbooks as U.S. medical students. See the booklist I have written, it is a list of books that most students and I used during our first two years.
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QUESTION 27 How many students were in your class? When I first entered Saba in September of 1999 there were 40 students in my class. Some students left after a few weeks but the class would always bounce back up to 40 because of transfer to Saba from other schools like AUC, Ross. So when we finished basic sciences in April of 2001 we had 41 students in my class, only 28 of which were from the original September 1999 class – the other 13 were transfer students that came to Saba. Now, because of the new campus building, the class size is bigger; at times I have heard as many as 75 students. But this may be a rumor. It may be more like 50-60 per entering class, but please contact the school for exact numbers. QUESTION 28 What are the living conditions like there? Living conditions on Saba. Well, it is a very small rock that is sticking out of the ocean. There is no beach, because it is not an island. It is a huge rock. There is very little flat land, everything is on an incline or decline. A bike is not a means of transportation on Saba…impossible to get up those hills, and riding down them…well, you’d kill yourself. There are only 1400 local people that live there. People live nice on Saba. Everyone lives in a house. I guess it does not cost the Netherlands government much to keep 1400 people happy. The island has some grocery stores, restaurants and not much else. There are several water activities you can do if you are interested. The whole of Saba is only five square miles. That’s it. There is a small baseball diamond and an outdoor basketball court. There is a carnival every year in the summer months. We had two hurricanes when I was down there. Waters runs out, this
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is a guarantee, so you have to conserve, that means no flushing the toilet until you pass out from the stench. There was a small library for medical students with internet access. On Saba, you can get a place ranging from, oh…$300$500 per month, cheaper if you share a place. You can get a car if you want, although I never had one, just hitched everywhere. It was easy. You can have cable television, phone (expensive) and air conditioning or whatever else money can buy. After all, with money you can get just about anything…even on Saba. QUESTION 29 Does the school have sufficient equipment and equipment that’s up to date? Are they technologically sufficient? The first two years are the only time you are on the island. In that time all you really need are your textbooks, a desk, pencil/ pen/highlighter and time to study. What else? You’re not in the nitty gritty yet. Saba has an anatomy lab for first semester, histology lab…all that basic stuff like any medical school. During fifth semester you get the ‘privilege’ of working with the island doctor at Saba’s hospital and have her yell at you for things that you have not been taught yet. Man, I dreaded that…actually, I downright hated it. Technology. Well, like I said, you’ve got your books, so that’s all you need. Bring a laptop … you’ll be in over your head with studying, so you won’t need much else.
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Clinical Rotations QUESTION 30 Do you foresee there being any problems with the clinical program? Can you choose where you would like to go? The school (Saba) sets up with our 42 weeks of third-year core clinicals. Fourth-year electives, which are only 30 weeks, we have to set up ourselves. It is easy to set up fourth year electives. Many medical schools in the U.S. accept foreign students in their visiting elective programs. Yes, you can choose where you would like to go. It is what most students do. Geographical mobility is expected for all students, but with the class size being small, most students end up going back to their home state or near their home state. Some students have to travel some, but usually not more than three times. However, I have heard some students have to move as many as seven times in two years. But then there are others who get all two years in one hospital. So it’s all been done. QUESTION 31 When you mean rotations, you obviously mean your clinical rotations after your two years of basic science studies, correct? Furthermore, in order to bypass the worries of getting state licensure, I assume that all the clinical rotations are in teaching hospitals (ACGME), therefore can one not simply make connections with this hospital for a residency position so that the worries of not being able to get enough residency experience (i.e., 72 weeks) are nullified? Your best bet for state licensure questions is to visit: www.fsmb.org and call, fax or email the state(s) you are interested in.
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I recently talked with Maryland Board of Medicine and I asked them this standard question: “If I want to eventually come to your state and get licensed, when your State Medical Board looks at where I did my clinical rotations how many of the 72 weeks that I did have to have been done at ACGME accredited teaching hospitals to be eligible for licensure?” Well, Maryland board told me that they DO NOT look at your rotations during medical school when it comes time for licensure. They look at your residency training. That’s good news, right? So if you go to a non-ACGME accredited hospital and do your rotations, then it won’t pose a problem with Maryland licensure. The good news is that I already did all this research. The full list of answers to that question is listed in my forum at: www.CaribbeanMedicine.com, look in the ‘Main Forum.’ The thing is, this question never gets answered when I email a state medical board or even write them a letter. I have to CALL them on the phone, and this takes a lot of my time. I contacted the California Board and was told that 54 of the 72 weeks have to be done at ACGME accredited teaching hospitals for licensure in California. So the states differ quite a lot with regard to their rules for licensure. QUESTION 32 Can you please explain to me about teaching hospitals vs. nonteaching hospitals for your clinical rotations? What problems can arise from doing rotations at nonteaching hospitals? Basically there are two types of hospitals one can do their rotations at: 1) ACGME accredited teaching hospitals
This means that that hospital has a residency program.
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There will be recent medical graduates there doing their residency. In addition these hospitals offer rotations for medical students. 2) non-ACGME accredited teaching hospitals
These are hospitals where there is no residency program. However, they do have rotations for medical students and doctors that supervise the students and teach them. The problem can arise when applying for state licensure. The 50 states in the U.S. vary with regard to licensure rules. For example, California requires that at least 54 of the 72 weeks of clinical rotations be done at an ACGME accredited hospital, while Maryland does not require any weeks at an ACGME hospital. Do you see how states can differ? So, doing rotations at a non-ACGME hospital would not pose a problem, unless the state one wants to eventually get licensed in and practice medicine has rules that state otherwise. To find out each state’s rules and requirements, one can contact them at their address/telephone number, which are at this website: www.fsmb.org. The basic requirements to get licensed and practice medicine in the U.S. are the following: 1) Graduate from a medical school listed with the World Health Organization (WHO). 2) Obtain the ECFMG certificate (to do this one has to pass USMLE Step1, USMLE Step 2 CK, USMLE Step 2 CS). 3) Complete a residency training program at an ACGME hospital.
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QUESTION 33 I would like to know about ‘Green Book’ hospitals. I am very confused about this, could you please explain this and how it works. Thank you. In my opinion, to maximize your chances of getting a residency in the U.S., you should do your third and fourth year clinical rotations in the U.S., preferably at ACGME teaching hospitals that are listed in the Green Book and have residency programs. Clinical rotations done at hospitals that have residency programs are considered ACGME teaching rotations, also known as ‘Green Book’ rotations. The ‘Green Book’ (The Graduate Medical Education Directory, which is traditionally printed with a green cover) is available here: www.barnesandnoble.com You don’t have to buy it, as it is also free online here: www.ama-assn.org/go/freida There are two main reasons this is important: a) Doing rotations at hospitals that have residency programs maximizes your exposure and ability to establish connections with residency programs so that when it comes time to apply to one, you will already know people there and they will know you! b) Many states require a certain number of weeks that must be done at ACGME hospitals in order to get licensure in that state. For example, California requires 54 weeks, but Pennsylvania requires all 72 weeks! For more info about this, contact: www.fsmb.org. You can check if a hospital is an ACGME teaching hospital (Green Book) by searching this website: www.ama-assn.org/go/ freida (FREIDA). For example, in my fourth year, I did some
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rotations at St. Vincent Mercy Medical Center in Toledo, Ohio. Now, if I want to find out if that hospital is considered an ACGME teaching hospital, I would go to FREIDA, click on Ohio, then click on ‘Continue’ and you will see that the hospital is listed in the selection of Green Book hospitals: St. Vincent Mercy Medical Center. QUESTION 34 Can you please give me some info on how to set up observerships? Thanks for the question. First, let me clarify that I did clinical rotations. Observerships are when you just observe and have no responsibilities. I am assuming that you are interested in finding out about how to get clinical rotation, as these tend to be more beneficial. Basically for my third year, my school set them up for me. In my fourth year I had the option of staying at the same hospitals to do my fourth year electives, but I decided to set them up myself. The first thing I did was email several residency programs (all the emails of the program directors can be found on www.careermd.com). I wrote them a short email explaining who I was and what I was looking for. Most of them told me that they don’t take foreign medical students. However, a few sent me an application. I filled them out and sent them in. Two programs (one in Michigan and one in Ohio) said that I could come there to do some electives. After I arrived there, I did three electives. Then, after that, just by word of mouth, I was able to set up three more. All you really have to do is just approach a doctor and say “I am a medical student, and I heard that you take med students for clerkships. I was wondering if I could do one with you.” Some hospitals will have an official clinical rotation coordinator. He or she will usually be part of the residency program there.
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There are a lot of hospitals offering clinical rotations to foreign med students, you just have to do some research. To document the experience, simply request a letter of recommendation from the physician you did the rotation with. That should be good enough for the purpose of applying for a residency later on.
USMLE QUESTION 35 With respect to the USMLE Step 2 CS test I would have to write (being a graduate from a Caribbean med school who wants to work in the U.S.): what exactly is it? USMLE Step 2 CS is a test that was introduced in 1998. It is a one-day pass/fail test that all IMGs now have to take at an ECFMG center. It is basically a physical diagnosis-type test, with about 10-11 actors pretending to be patients, each with a certain illness, disease. You need to pass it to get the ECFMG certificate. For more info, read:
www.kaplanmedical.com
www.ecfmg.org
www.usmle.org
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Immigration and Visas QUESTION 36 What kind of VISA would I need (given my above background documentation) in order to be able to do my clinical rounds, residency and be able to practice in the U.S. without having to wait for years before I can actually work as a fullfledged physician? Visas!! For clinical rotations you will need a B-1 visa. There is no problem in getting this, all it takes is a letter from your medical school stating that you are entering the U.S. to undergo unpaid training as a medical student, then at the border the official will stamp your passport with B-1 visa status. Simple as that. Now, once you apply for residency as a non-U.S. citizen, and non-permanent resident, you have TWO options for a visa to enter a paid position at a U.S. hospital: J-1 visa or H1-b visa. The “United States Citizenship and Immigration Services” (USCIS) issues the visas, you can read info at their website: uscis.gov. First, let’s talk about the H1-B: Basically when you go to residency interviews in your last year of medical school, if you are a strong enough candidate, then the hospital will decide whether or not they want to sponsor you for the H1-B visa. Unfortunately, not that many hospitals sponsor the H1-B visa, and those that do only do it for very strong applicants, hence the term “luxury” visa. To be eligible you will need to: 1) get your ECFMG certificate 2) then write USMLE Step 3
See, USMLE Step 3 is an exam that doctors write while they are in their first year of residency or so, but to be eligible for the H1-B, you need to have passed USMLE Step 3 BEFORE
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starting the residency and before applying for the H1-B visa. So this may require some extra time. Also, you will need to get a knowledgeable immigration attorney to help you with the paperwork for this visa. Now, let’s discuss the J-1 visa: From 1993-2001, trying to get the J-1 visa as a Canadian was really hard, sometimes even impossible, so it was quite discouraging. Later, Health Canada changed the policies and it is now much more open to get the visa. Here are the steps. Basically, to get this visa, you need: 1) An offer from a U.S. residency program stating they have accepted you 2) Your ECFMG certificate (of course) 3) Write and pass the MCCEE 4) A “Statement of Need” from the Canadian Health Ministry Anyhow, how does one get a “Statement of Need?” You need to write and pass a test, MCCEE, info about this test is at: www.mcc.ca and then apply for the “Statement of Need” letter with Health Canada. You will apply for the J-1 visa with the ECFMG, read: www.ecfmg.org Now, if you don’t want to return to Canada for that “two year” requirement, then you can get a J-1 waiver and stay in the U.S. if you agree to go and work as a physician in a rural/under serviced area in the U.S. for three years. All these visa issues can be resolved if you marry a U.S. citizen. As of the day of your marriage to a U.S. citizen you are eligible to apply for permanent resident status. This can be done through an immigration attorney and you will get a Social Security number, which entitles you to legally live and work in the U.S. forever. But there is (from what I hear) a lengthy interview process to weed out “phony” paper marriages.
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QUESTION 37 Hi, can you tell me what are the options available for nonU.S. citizen to be able to work in a residency program? There are three (3) main options: J-1 Visa, H1-B Visa and the Green Card (GC). Here is some info about each: 1) J-1 Visas (Non-Immigrant)
The J-1 “Exchange Visitor” Visa allows foreign citizens to receive graduate medical education and training in the United States. The purpose of the J1 Visa is to promote the exchange of medical knowledge and skills. REQUIREMENTS FOR A J-1 VISA a. You must provide a “Statement of Need” from your home country’s ministry of health to demonstrate that your country is in need of the skills and knowledge that you plan to acquire in the U.S.. b. You must become certified by the ECFMG. c. You must obtain a written statement from the accredited U.S. residency program that agrees to sponsor your visa. Once you have fulfilled these requirements, the ECFMG will send you an IAP-66 Form. You can use this form to obtain your J-1 visa at the nearest American embassy or consulate in your country. J-1 VISA TERMS The J-1 visa requires you to return home for at least two years after you complete your residency training. This ensures that your home country will benefit from the medical knowledge you will
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have gained in the United States. You must secure a J-1 Visa Waiver to avoid these terms. J-1 VISA WAIVERS You must meet at least one of three criteria before you will receive a waiver. a. You must prove that you will suffer from persecution if you return to your home country. b. You must prove that your spouse and/or your children are U.S. citizens or permanent residents, and that they will suffer exceptional hardship if you return home. c. You must find an “Interested Government Agency” (IGA) to sponsor your continued employment in the United States. The first two conditions are very hard to prove. Most IMGs who receive waivers find IGAs to sponsor them. Generally, the U.S. government only grants waivers to foreign physicians who can help to offset physician shortage in the U.S. 2) H-1B Visas (Non-Immigrant)
Also known as the “Work Permit Visa,” the H-1B visa authorizes foreign professionals to accept temporary employment in the U.S. for up to six years. The H-1 visa might severely restrict your medical residency options because many teaching hospitals in the U.S. will not sponsor foreign doctors on H-1 visas. REQUIREMENTS FOR THE H-1B VISA a. You must be fully licensed in the U.S. state where you intend to enter a medical residency.
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b. You must have a medical degree from a foreign or U.S. medical school, or you must have a full and unrestricted license to practice medicine in a foreign country. c. You must pass Steps 1, 2, and 3 of the USMLE and demonstrate proficiency in written and oral English. d. After remaining in the U.S. for a maximum period of six years, you must live abroad for one year before you can return to the U.S. on a new visa. 3) Permanent Resident Status (The Green Card)
To take up permanent residence in the United States, you must obtain an immigrant visa or “Green Card.” If you have secured a state medical license and a J-1 waiver, you might qualify for permanent resident status. Be advised that applying for a Green Card can be a very complicated legal process; please consult the USCIS or a qualified immigration lawyer for more detailed information. Whether or not you’re a physician, you can get a Green Card if: a. You are an immediate relative of a U.S. citizen or permanent resident. b. You receive a Green Card through the national Green Card Lottery. c.
An employer sponsors your application.
1. IMMEDIATE RELATIVES OF CITIZENS OR PERMANENT RESIDENTS
You might be eligible for a Green Card if you are the spouse, child, sibling or parent of a U.S. citizen or you are the spouse or unmarried child of a permanent resident in the U.S.
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Before you can receive a Green Card, the relative whose citizenship or permanent resident status qualifies you for the Green Card must file a “Petition for Alien Relative” on your behalf. In the petition, this relative must provide documentation of (1) his or her citizenship or permanent resident status and (2) his or her relationship to you. After the petition has established your relationship to a citizen or permanent resident, you must complete more forms to demonstrate that you meet other requirements for permanent resident status. You must prove, for example, that you do not suffer from a mental defect or contagious disease, that you are not a member of the Communist party, a criminal, a terrorist or that you do not smuggle or sell illegal drugs. Because the conditions determining which “alien relatives” can receive a Green Card are very complex, you should consult the INS and perhaps even an immigration lawyer before beginning the application process. 2. GREEN CARD LOTTERY
If you come from a country that normally doesn’t send many immigrants to the U.S., you might qualify for one of 55,000 Green Cards issued each year through the “Green Card Lottery.” To learn more about the lottery, see the information supplied by the USCIS. Also, be wary of companies or individuals who claim they can increase your chances of success in the lottery; the Federal Trade Commission has determined that most of these claims are fraudulent. 3. EMPLOYMENT
Most IMGs seeking a Green Card have to rely on a spon-
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soring employer. The USCIS grants permanent resident status to IMGs whose long-term employment will benefit the United States. In other words, you’ll have a better chance of obtaining a Green Card if you’re a primary care physician who agrees to work in a medically underserved area. If you don’t meet these criteria, then your employer will have to certify that no fully qualified United States citizen has applied for your job. This certification process can be very complicated and time-consuming. Finally, if you can show that you possess extraordinary professional qualification, you might qualify for a Green Card without committing to a primary care position in an underserved area
Residency Training QUESTION 38 With the doctor shortage here in Ontario, will it really be that difficult to return to this province to practice (even if I went up to an under serviced region of the province)? The question about the doctor shortage in Ontario is rather interesting. Rural areas are the place. These websites have some recent info on this topic: Rural Ontario Medical Program www.romponline.com The whole ‘coming back to Canada’ is always an issue of debate. Several Canadians at my school were set on getting back into Canada, but ended up moving to the U.S.. They always put these ‘doctor shortage’ stories in the paper and get people’s hopes up. Most recently the CFPC (College of Family Physicians of Canada) – www.cfpc.ca – issued a statement
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saying that they are in need of 5000 family doctors across Canada. Well that may be true, but how on earth will they fill that when CaRMS does not have residency programs to train foreign-educated medical graduates (IMGs). Go look at the CaRMS website – www.carms.ca – and you will see how few opportunities there are for IMGs to enter into post-graduate training in Canada. Getting a residency training position in Canada is difficult, but not impossible. QUESTION 39 Also, do you foresee any problem gaining a residency in the U.S.? Well, getting a residency depends on things like these: 1) USMLE scores
2) U.S. clinical experience 3) U.S. citizen or not
4) Letter of reference from U.S. doctors Although there are several other things they look at. As for me, I am not a U.S. citizen, so that presented the biggest problem for me. I applied for Family Medicine so that is a good choice, since there are many spots and it is not as competitive as some of the other residency programs. QUESTION 40 What if a Canadian does NOT wish to practice medicine in the U.S. or Canada? Rather, that person wishes to practice in the Caribbean. Do you know (which might save me some research) how the Caribbean nations view their own medical training? With and without U.S. residency?
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Practicing in the Caribbean. Well, each Caribbean island is an independent country. So they have their own rules and regulations. Some islands, like Saba, St. Maarten, St. Eustatius, Curacao, Bonaire and Aruba belong to the Netherlands (those six islands comprise the ‘Netherlands Antilles’). So practicing medicine there would be under the jurisdiction of the Netherlands Antilles. If you contact them, I am sure they can tell you what the steps are. Most Caribbean medical schools educate students to go back to the U.S. so very few students (if any) stay in the Caribbean afterwards. One exception I can think of is The University of the West Indies. This medical school is designed to educate Caribbean students, so this school’s graduates are the ones that eventually live and practice in the Caribbean. Perhaps contacting this school can give you some info on this topic. QUESTION 41 What is the ECFMG and how does it fit in the whole scheme of tests in becoming a fully-fledged physician? Basically it’s very straightforward. To get a residency in the U.S. you have this path: a) Write and pass the USMLE Step 1 b) Write and pass the USMLE Step 2 CK c) Write and pass the USMLE Step 2 CS (Clinical test) d) Graduate from your medical school, obtain your diploma (M.D. degree) e) Get ECFMG certificate (they will send it to you once you have completed the above four things) At this point you can start a residency in the U.S.
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The biggest confusion people have, and I hope you can clarify this to others, is people wonder how someone can get the ECFMG before the residency selection (match day). See, the match day is in March. But most people graduate in May or June! So how can you get the ECFMG certificate before match day? Well, the answer is: you don’t have to get the actual certificate in your hand. As long as you have passed those three tests by February, the ECFMG will allow you to enter the match. Then, after you graduate (say in May or June), they will send you the actual certificate in the mail. This is perhaps a big confusion point for people. QUESTION 42 When you apply for a residency, what do the hospitals look for in you? (Is it just USMLE scores, or your transcripts as well? What else?) U.S. residency programs look for (in order of importance) the following in applicants: 1) Your citizenship status (U.S. citizens and permanent residents preferred) 2) A USMLE transcript with NO ‘Fs’ on it and a first-time passing score of 200/80 or better on both steps. 3) U.S. clinical experience for a period of no less than 4-6 months over your clinical years during medical school, preferably at ACGME hospitals. The above three things are the MOST important. Other things that will be considered are: 4) Three or more letters of recommendation from U.S. attending physicians that have supervised you during your clinical clerkships during medical school.
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5) Research experience and scientific journal publications during your medical school years. 6) Interesting hobbies and extracurricular activities. 7) Your application personal statement. 8) Any advanced degrees that you may have like PhD, MBA, MPH, etc.
QUESTION 43 What is the difference between ERAS (Electronic Residency Application Service) and the NRMP (National Residency Matching Program)? Both ERAS (The Electronic Residency Application Service) and the NRMP (The National Resident Matching Program) are programs run by the AAMC (The Association of American Medical Colleges). The AAMC has its home page located at: www.aamc.org. I highly suggest reading through its contents. ERAS (The Electronic Residency Application Service) is simply the common application to apply to the residency programs that are using it. It is simply an electronic application, and nothing more. It is just like the AMCAS-E used to apply to medical schools or just like a common application that many undergraduate universities and colleges will accept from high school students. The ERAS application software has included in it places to write your personal statement (why I want to be a ____ (you insert your choice of specialty here). It also has: a place to enter your past education, including any undergrad, grad school, or other medical schools attended; a place for all the contents of a typical Curriculum vitae (resume); it asks for all of your USMLE board scores; it has a place to have a photograph scanned in; your transcripts from college through medical will be scanned in; and
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many other application-related things. It also has an area where you check off the boxes to programs that you want to apply to. I suggest that you look through the ERAS website yourself to find out more information, it’s located at: www.aamc.org/eras. Not all specialties and programs participate in ERAS, some still accept paper-typed applications. The specifics can be found in the ERAS website. All in all, ERAS is the common application that hundreds of residency programs accept. Now I will explain the function of the NRMP (The National Residency Matching Program). Once you have applied to the residency programs through ERAS, some will contact you for an interview and the rest will just reject you. Once you have interviewed at the residency programs, you do the following: The applicant ranks all of the programs from 1 to, let’s say, 15 that he or she interviewed at. The residency program ranks the applicants that it wants, let’s say, 1 to 20. The applicant submits his or her rank order list to the NRMP and the residency program submits its rank order list to the NRMP. Each year, the lists are due by mid-February and if you fail to submit a list, then you are withdrawn (thrown out!) from the Match. A computer at NRMP headquarters in Washington DC runs both sets of lists and with a special algorithm, goes down both party’s lists and matches up the programs with their most desirable candidates that also ranked them highly (the algorithm is actually very complex). In mid-March, the results of the Match are announced and the residency programs find out who they got, and the applicants find out where they will be spending the next few years. Now, the contract that you signed when you filled out your NRMP Match Independent Applicant Agreement stated (and you signed) that the Match result will be binding and you will go wherever you were Matched to. The moral of the story is that one can only get matched to a place that he or she has ranked and people do not have to rank all places that they applied to. 98% of residency programs in the U.S. use the NRMP Match to select candidates for their programs.
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On to the pre-match/out-of-match offers that IMGs can get: Now the IMG loophole in the system. All U.S. medical graduates are bound by their schools to stay within the NRMP Match and obtain their spot this way. Well luckily, as IMGs, we are not bound by this same rule. This means, at any time, an IMG may sign a contract during or after one of his residency interviews and then drop out of the Match. Also, if an IMG makes good contacts during his or her rotation in teaching hospitals in the U.S., he or she is free to just sign a contract with that program and doesn’t even have to apply through the regular application process. For specific information on any particular residency program, including number of applicants, etc., please check out AMA-FREIDA (The American Medical Associations’ Fellowship and Residency Interactive Database Access) located at: www.ama-assn.org/go/freida. When in the site, just click on GME Programs and Main Institution Search, then pick out programs, by specialty and location. So, everyone must apply through ERAS and register with the NRMP simultaneously! You can call the NRMP at (202)828-0566 and request an Independent Applicant Handbook which is free and has all of the important statistics on this past Match as well as all of the import rules and regulations on participating in the Match. In my class, of the people that are starting residency now, I would say that 85% of the students got their position through Match, while 15% or so got their position either pre-match or out-ofmatch. Some, but very few, obtained their positions through the NRMP Match Scramble. Plan on going through the Match, and if you end up signing a contract outside of it, then that’s a nice surprise, but don’t count on that method.
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QUESTION 44 What are my chances of getting a residency position in the United States after I graduate from a Caribbean medical school? Start here: www.nrmp.org. It contains all the stats you are looking for. Look in particular at the data tables. You will see the section where it says U.S. foreign graduates and non-U.S. foreign graduates. U.S. foreign graduate is a U.S. citizen who goes to a foreign (e.g., Caribbean) med school. Non-U.S. is a non-U.S. citizen with a foreign medical degree.
Licensure QUESTION 45 If a student graduates from a Caribbean medical school and completes a residency abroad (Asia, Europe, Africa, etc.) then comes to the United States, what procedures/exams would they have to undergo to start a practice? In order to practice in the U.S., a foreign medical school graduate (regardless of the country of citizenship and school attended) needs to do the following things: take and pass the following exams – USMLE Step 1, USMLE Step 2 CK, Step 2 CS, Examination, provide proof of their M.D. degree to ECFMG (i.e., diploma), and obtain an ECFMG certificate. Next, he or she must enter into an ACGME (Accreditation Council on Graduate Medical Education) accredited residency. Next, he or she needs to take the USMLE Step 3, complete at least three years of residency training and then apply for a state license to practice medicine. Next, take the board certification in
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the specialty that he or she did a residency in, pass it and then the graduate is free to go and join a practice as a Board Certified Physician. It’s really very straight forward. The medical licensing bodies of the U.S. do NOT recognize any residency training (any post-graduate residency/fellowship work) that is done outside the U.S. or Canada. Everyone that wants to practice medicine in the U.S. MUST go through at least three years of U.S. ACGME-approved residency training. There are absolutely NO exceptions. There are many people that have done residency training or even practiced in some field of medicine in another country for many years. These people still have to take all of the above mentioned exams (USMLE Step 1, Step 2 CK, Step 2 CS, Step 3, Board Certification, etc.), apply for and get accepted into a U.S. residency program, complete a residency, etc. If a medical graduate from a Caribbean or any other nonU.S. medical school were to do ANY residency training that is outside the U.S., or that is not ACGME approved, it would not count towards getting a license to practice in the U.S. There is only one path to medical licensure in the U.S. All foreign grads, regardless of how well-known and well-published they are in another country, will still have to start over, as an intern at some U.S. hospital. If you can’t get a residency in the U.S., then you can never practice in the U.S. This policy has come about because many, many countries do not recognize U.S. licensure if a U.S. doctor wanted to practice there. One exception is Canada. It used to be that U.S. residency programs would give one year of credit for every three years of foreign residency training towards completion of residency training, if the person had already proven himself in another country. This practice has since been abandoned and, as of right now, no credit is given for foreign residencies. On the bright side, if you do a residency in another country, you are free to work there and live out the rest of your life there. But the U.S. medical establishment will never recognize you.
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The mother of a friend of mine was an OBGYN in India, had been board certified, well-published, and had practiced OBGYN there (in India) for about 20 years. When she moved to the U.S., she was told that she had to start over and she would get absolutely no credit for all of the time that she invested, but she was welcome to take the exams, get ECFMG certified and apply for a Psychiatry residency in the U.S. After attempting the USMLE exams several times, she was unable to pass them and she finally gave up the dream. She is currently working at a retail clothing store in the Los Angeles area. For many people that do pass all of the exams, most are rejected from residency programs for any combination of the following reasons: no meaningful U.S. clinical experience, being too old (most residency programs would like people in their late 20s and early 30s), and having an ‘F’ somewhere on their USMLE exam transcript (if you can’t pass on the first attempt, most places won’t even look at you!). This story is a very common one among foreign grads. QUESTION 46 Can you please give me the contacts of organizations pertaining to this whole International Medical Graduate issue? Sure! Here are the contact information and web links: United States Medical Licensing Exam Secretariat 3750 Market Street Philadelphia, PA 19104-3190 Phone number: 215/590.9600 www.usmle.org The USMLE Secretariat provides general information about all three Steps of the USMLE, including extensive information about the new computer-based USMLE. However, do NOT
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contact the USMLE with questions about registration for any Step of the USMLE. Instead, contact the agency from which you will request, or have requested, your eligibility permit (listed below) if you have questions or concerns. National Board of Medical Examiners Department of Licensing Examination Services 3750 Market Street Philadelphia, PA 19104-3190 Phone number: 215/590.9700 www.nbme.org The NBME prepares all three Steps of the USMLE in cooperation with the Federation of State Medical Boards of the U.S., Inc. It also handles the provision of eligibility permits that are required in order to schedule and sit for the computer-based USMLE at Sylvan Technology Centers to students and graduates of U.S. and Canadian medical schools. NBME’s website also offers extensive information about all three Steps of the USMLE, including news on changes in passing scores and historical pass rates. The NBME does not provide assistance to international medical graduates who wish to take, or have already taken, one or more Steps of the USMLE. See ECFMG. Federation of State Medical Boards of the U.S., Inc. Department of Examination Services 400 Fuller Wiser Road, Suite 300 Euless, TX 76039-3855 Phone number: 817/571.2949 www.fsmb.org The FSMB is the collective body of individual state medical boards and co-sponsor of the USMLE program, along with the NBME. If you plan to practice medicine in any state, you must
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contact that state’s medical board to complete the process of getting a license. Additionally, all physicians must apply for eligibility permits to take Step 3 with the individual state medical board where you wish to practice, no matter where or when you went to medical school. The FSMB’s contact information is provided here so that you can contact it if you are unable to locate and contact the state medical board where you need to register for Step 3. National Resident Matching Program 2501 M Street, NW, Suite 1 Washington, DC 20037-1307 Phone number: U.S. seniors, hospitals and residency programs may call 202/828.0676 Independent applicants may call 202/828.0566 www.nrmp.org The NRMP administers the “Match,” a computer program that places participating graduating seniors and independent graduates with residencies. Match participants must still apply directly to the residency programs in which they are interested. Accreditation Council for Graduate Medical Education 515 North State Street, Suite 2000 Chicago, IL 60610-4322 Phone number: 312/464.4920 www.acgme.org The ACGME publishes the CD-ROM version of the Graduate Medical Education Directory, a complete catalog of residency programs in the U.S. that, when completed, meet the pertinent requirements for licensure in each state. You may order it directly from their website, using a credit card.
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American Medical Association Ordering Department P.O. Box 7046 Dover, DE 19903-7046 Phone number: 800/621.8335 www.ama-assn.org The AMA, among other things, publishes the printed version of the Graduate Medical Education Directory, or “Green Book,” as it is more commonly known. You may call the AMA publication’s order department at the above number or order the Green Book online at the above internet address. ECFMG 3624 Market Street Philadelphia, PA 19104-2685 Phone number: 215/386.5900 www.ecfmg.org If you graduated from a medical school outside the U.S. and Canada, you must apply for your eligibility permits to take Steps 1 and 2 with the ECFMG, even if you are a U.S. national. The ECFMG does not dispense information about, nor assist with, eligibility permits to take Step 3. See FSMB. QUESTION 47 It sounds like even after one obtains a residency, there is a chance that the person will not get licensed. How so? Well, throughout my residency application and interview process, I applied to 53 residency programs. Not a single one checked whether any of the hospitals that I listed where I did my rotations was an ACGME accredited teaching institution. This may sound like a good thing, but it is actually not. Most programs do not
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care whether or not you did rotations in teaching hospitals, but whether or not these hospitals were U.S. hospitals. This is a pretty bad thing. Why? Because as a foreign grad, you are not eligible to apply for a state license to practice unrestricted medicine until after you have finished at least three years of residency training. The states that issue these licenses do care where you did your medical school rotations. Now, each state has its own rules and regulations with regard to what its definition of a “teaching hospital” is, as well as how many weeks of each specialty, and how many weeks total have to be done in teaching hospitals! I highly suggest that you seriously think about which states you might want to eventually practice in, and contact the state medical board in that state, and have them send you a copy of their physician licensure application as well as their rules for IMGs that apply for medical license. You can find out the phone numbers and addresses of these state boards on the following website: www.fsmb.org. Yes, it is possible to do a residency in one state and have a license to practice in that state because of where you did your medical school rotation. This would mean that you either have to hire a lawyer to help you fight the system, or just move to a state with easier licensure regulations. It does happen, people do get burned. Make sure that you are fully aware of state medical licensure regulations before you begin your rotations! QUESTION 48 What are the procedures to obtain a license, and in what aspect to people (or the school) fail? As stated above, not knowing the rules and regulations can stop a medical career dead in its tracks. The license application involves a review of every month of your time since graduation from high school. They review your undergrad record, MCAT scores, med school record, hospital rotation record, residency
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record, all of your jobs and extracurricular activities, and most importantly, your USMLE score record. Each state also sets a limit on the number of USMLE attempts that they will accept before denying a license application. For example, most states say that you have to pass USMLE Step 1, Step 2 and Step 3 all within 7 years of passing the first step to be eligible for a license. Also, many states say that if you have more than three failures on your USMLE transcript, you are not eligible for a license. I highly suggest that you go to your medical school’s library and get a copy of the AMA’s Green Book, turn to the appendix section and read the table on USMLE performance for foreign medical grads and licensure regulations. NOTE: If after reading this entire compilation there is still something that has not been answered for you, then please post your questions in the forums at www.CaribbeanMedicine.com in the ‘Ask Admin’ section, and I will gladly try to answer those questions for you.
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Chapter 23 About the Author I was born November 3rd, 1974 in Hyderabad, India. My parents immigrated to Canada with me in 1976. I grew up in Brampton, Ontario, Canada and graduated from Brampton Centennial Secondary School. I did my undergraduate Honors Bachelor of Science degree in Applied Mathematics at York University in Toronto, Ontario, Canada. I then completed my Doctor of Medicine degree at Saba University in the Netherland Antilles, Caribbean. I did my residency training in Family Medicine in Wisconsin, USA. I am now a licensed, practicing physician in Michigan, USA. My hobbies are long distance running, the internet, movies, music, international travel and investing. Asad Raza, BSc, M.D. Email:
[email protected]
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Chapter 24 TESTIMONIALS ABOUt THIS BOOK “Dear Dr. Raza,
I purchased this book for my daughter who is starting this agonizing journey. I just skimmed through some pages and stopped to congratulate you on this amazing and successful journey of yours. Your summary of your experience will be priceless for the great numbers of children of immigrants (like your parents and my family) who will try to follow your footsteps. Congratulations,”
• R.N. – parent, Caledon, Ontario
“Dear Asad Raza,
I just finished reading the book. No regrets about buying it. My money is beyond worth it. Greatly informative and educational! I could not have gathered up so much information in such a short time. Many thanks!!!!! Best Regards,” • K.A. – Florida, USA
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“I went from knowing nothing to knowing everything about Caribbean medical schools after reading this.”
• B.K. – University of Toronto
“With the help of this site and this book I am in a much better position…and have definitely decided where I will be attending medical school this fall.”
• K.S. – Univ. California at San Francisco
“I did not even know that there were med schools in the Caribbean, and now I have gained admission and will be attending one.” • F.G. – Univ. of British Columbia
“The key about this information is that it is an actual story of someone who attended a medical school in the Caribbean…not just some info copied from the websites of the school.” • M.H. - Australia
“Even with a good GPA and MCAT, I could not gain admission into any of the New York state medical schools, so I got your book … thanks so much!” • A.S. – Columbia University
“I applied to med school here in Texas for three years, and I did not get in. So I wanted to attend a foreign med school and be able to come back here for residency…I am glad I found this information.” • P.T. – Baylor University
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“Several of my classmates also planned on studying medicine, but didn’t get accepted into an Ontario med school…the book has helped us out in more ways than we can express. Thank you for showing us this path!” • J.M. – Univ. of Western Ontario
“There is so much important and crucial info in your book…I will keep it and refer to it throughout my four years in med school… it has been a valuable source.” • A.D. – Univ. of Illinois at Chicago
“I purchased two other books about foreign medical schools… they were a waste and very outdated…this file is up-to-date and very easy to follow.” • B.T. – McMaster University
“I’ll be graduating from Saba University this year and have matched into emergency medicine. Your website and information were a huge help to me…the information and open letter to Canadian students is exceptional.”
• J.V.L. – Michigan State University
“After four horrible years at U of T, I had given up on all my goals … this info showed me much better options…thank you sincerely.” • L.R. – University of Toronto
_____________________
“When I come this country, I have no luggage, today what I got? … own bloody business see” _____________________ Om Puri “East is East,” 1999
DISCLAIMER: All information in this compilation is offered to the public in good faith. However, it is still up to the public to verify the information. I assume no responsibilities toward whatever acts (direct or indirect) that may ensue as a result of reading this compilation. I strongly recommend contacting many, many people before making a final decision. Copyright © 1999-2012 Asad Raza. All rights reserved
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