Professional Documents
Culture Documents
MCCEE
USMLE Step 1
MCCQE Part 1 Testlet
MCCQE Part 1 CDM
MCCQE Part 2
t
day a
up to k.com
n
g
i
S
qban
da
cana
Each QBank consists of classic, simulated multiple choice questions and/or cases designed to reflect the content of
the MCCEE, MCCQE Part 1 and MCCQE Part 2. Online subscriptions for a 1, 2 or 3 month period can be
purchased to access these questions. Additional 1 month periods can be purchased also.
NEW!
CanadaQBank.com
iPhone and iPad app
for the MCCEE
150 MCCEE
questions
FREE!
U P DAT ED
F o R
2012 - 2013
CARIBBEAN
MEDICAL SCHOOLS
Journey
and
Guide
U P DAT ED
F o R
2012 - 2013
CARIBBEAN
MEDICAL SCHOOLS
Journey
and
Guide
_____________________
This book is dedicated to the people of Baghdad, Mosul, Basra,
Fallujah, Karbala, Najaf, Kabul and Kandahar.
With my love and admiration.
_____________________
_____________________
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
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
33
USMLE
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
Chapter 9
MY PERSONAL STORY
An Immigrants Journey
71
71
xiv
Chapter 10
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
81
81
81
85
87
91
91
93
94
95
xv
Chapter 13
FINANCIAL AID
HELPF UL URLs
MY RANKINGS
97
97
98
99
99
99
100
101
101
Chapter 16
MCAT AND
USMLE ADVICE
105
105
xvi
Chapter 17
RESIDENCY PROGRAMS
111
111
Chapter 18
Opportunities for
International Medical
Graduates in Canada
121
Chapter 19
HIGH COST OF AN
INFERIOR EDUCATION125
Chapter 20
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
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
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
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
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.
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
FAMILY PRACTICE
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
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
% 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
INTRODUCTION
10
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.
12
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. Georges 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
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
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
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
$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
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. Georges
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
20
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: its
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!
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
23
quite honestly did not care about you or what you learned. He
just walked into class every day and recited (by memory) the days
lecture, at a New York taxi cabs 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 didnt 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 wont 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.
24
25
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, Langes,
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
26
27
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, its a horrible book.
Personal opinion? The Golgan book is way better. Can you read
and understand all that is Robbins? If yes, then thats 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.
28
29
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.
30
31
32
33
Chapter 3
MY THIRD AND
FOURTH YEARS OF
MEDICAL SCHOOL
THIRD YEAR/CLINICAL ROTATIONS
My third year schedule was as follows:
Pediatrics (6 wks)
Psychiatry (6 wks)
OBGYN (6 wks)
34
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 patients 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/
35
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; its not the excitement that you see
on TV. Its 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.
36
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. Joes
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.
37
38
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)
Gastroenterology
(6 wks)
Nephrology
(6 wks)
Infectious Disease
(6 wks)
39
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
July 2001
April 2001
August 2001
October 2001
July 2002
40
December 2002
10
11
12
13
14
15
January 2003
16
18
April 2004
17
19
20
21
March 2004
April 2004
June 2004
July 1, 2004
USMLE
41
Chapter 4
USMLE
42
USMLE
43
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, Im 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.
44
Its actually very easy. Some cases have a few other things you
need to ask (of course). And, for some cases, you dont 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
patients 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. Its 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 patients room door.
PATIENT PROTOCOL:
What the patient has memorized.
USMLE
45
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. Dont 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:
46
MY RESIDENCY APPLICATION
47
Chapter 5
My Residency
Application
48
MY RESIDENCY APPLICATION
49
license in your state? the reply was, uhwe 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 dont 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 dont 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 Deans Letter, four LORs, Transcript
50
and a color photo. This application process may seem a bit overwhelming, but its 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 Deans 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 its 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!
WORK VISAS
51
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: j1visa@hc-sc.gc.ca
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)
52
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-
WORK VISAS
53
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
countrys 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
54
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
WORK VISAS
55
56
Letters of reference
The H-1B visa fees were:
Immigration lawyer fee $1495
H-1B application fee
$185
Total:
$2680
WORK VISAS
57
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 (its 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
58
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.
WORK VISAS
59
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.
61
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). Dont 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:
Wheaters Functional Histology: A Text and Colour Atlas
ISBN: 0443056129
62
EMBRYOLOGY:
The Developing Human: Clinically Oriented Embryology
by Keith L. Moore, T.V.N. Persaud
ISBN: 0721669743
BIOCHEMISTRY:
Lippincotts 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
63
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
64
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:
Clinicians Pocket Reference
ISBN: 0838514766
The Washington Manual of Medical Therapeutics
ISBN: 0781723590
65
67
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 dont 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
68
69
70
MY PERSONAL STORY
71
Chapter 9
MY PERSONAL STORY
AN IMMIGRANTS 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
72
MY PERSONAL STORY
73
75
Chapter 10
SUMMARIZED
TIME LINE
76
Chapter 11
DETAILED TIME LINE
A COMPLETE SUMMARY OF ALL THE
EVENTS DURING YOUR FOUR YEARS
BASIC SCIENCES (5 Semesters)
September 2013
September 2013
April 2015
77
78
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
79
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.
81
Chapter 12
CARIBBEAN MEDICAL
STUDENT COMMENTS
82
83
84
85
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 didnt 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.
86
87
SABA
Hi, Im 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 doesnt 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
88
89
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 its 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
90
91
SPARTAN
Clinical rotations have been keeping me busy. As for Caribbean med schools, theres 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.
Im rotating now with American students and their attitudes are
very different, theyre not cut-throat, and, to be honest, theyre
not all that hard-working either. Mostly because they dont 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. Thats not to say you cant do it, but
its not the easiest or most pleasurable road; and if youre 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.
92
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 werent 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 wasnt 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 dont 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, its 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
93
ST. GEORGE
Im 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 its 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 SGUs USMLE scores are top-notch.
Good luck in the application process.
G.T., St. George University, Grenada
94
be moving around like you would if you went to one of the other
Caribbean schools.
Thats pretty much the only difference. When it comes to getting a residency, remember: being a foreign graduate means that
youll always be looked at below a U.S. medical graduate (no
matter what your Board scores are). However, since youve done
rotations in the U.S., youll 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 wasnt 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
95
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
FINANCIAL AID
97
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 STAFFORDand 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.
98
HELPF UL URLS
99
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
100
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
MY RANKINGS
101
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
102
2. SABA (Saba):
www.saba.edu
MY RANKINGS
103
104
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 Sabas 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. Matthews 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.
105
Chapter 16
MCAT AND USMLE ADVICE
106
107
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 Alzheimers disease. But
that wont be one of the choices. You have to think one
step further. See, Down Syndrome (trisomy 21) patients
get Alzheimers 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 principals office because his teacher feels that the child is not paying attention in class. The teacher reports that the child often,
108
109
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!
RESIDENCY PROGRAMS
111
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.
112
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.
RESIDENCY PROGRAMS
113
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.
114
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.
RESIDENCY PROGRAMS
115
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.
116
RESIDENCY PROGRAMS
117
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.
118
RESIDENCY PROGRAMS
119
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.
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
122
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/
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.
124
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.
125
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
126
127
129
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.
130
5.
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.
131
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.
132
WORDS OF WISDOM
133
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
134
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.
WORDS OF WISDOM
135
136
WORDS OF WISDOM
137
138
139
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 dont 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
140
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)
141
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 dont 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.
142
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 Sabas 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.
MUAs curriculum is the same as Sabas, 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 beachesmaybe 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?
143
144
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 dont 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 masters 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
145
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 masters degree does not hide a weak undergraduate
historydont waste your time. Also, doing a masters degree for
the sole reason that it will improve your chances of getting into
medical school is really stupidin 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 isnt 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.
146
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.
147
April 2012
June 1, 2012
September 2012
Interviews begin
April 2013
Interviews end
September 2013
148
INTERNET LINKS
1. American Association of Medical Colleges
www.aamc.org
149
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. applicants average.
But dont 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/
150
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 dont 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 5 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 dont 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 wont
be saving any time, thats 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.
151
If, after all that, you still dont 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.
152
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
153
154
155
156
157
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.
158
-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.
159
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
160
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).
161
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.
162
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 Sabaimpossible to get up those hills, and riding down
themwell, youd 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. Thats 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
163
164
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 its 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.
165
166
167
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 dont 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
168
169
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
170
171
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, lets 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 dont 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.
172
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)
173
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)
174
175
176
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 peoples hopes up. Most recently the CFPC (College of
Family Physicians of Canada) www.cfpc.ca issued a statement
177
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
178
179
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 dont 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.
180
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
181
182
183
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
184
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. Its 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 cant 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.
185
186
187
188
189
190
191
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: admin@caribbeanmedicine.com
193
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,
194
With the help of this site and this book I am in a much better
positionand have definitely decided where I will be attending
medical school this fall.
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
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 residencyI am glad I found this
information.
P.T. Baylor University
195
_____________________
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
PRINT DESIGN
CORPORATE ID
WEB DESIGN
BOOK DESIGN
PACKAGE DESIGN
RETOUCHING