Caribean Medical Schools

[JohnGrisham]

Its very clear how some of you posting have no real semblence of understanding of how medical school admissions work in Canada and the US. Its actually quite sad, and gives the continued arrogant CMG perspective that CMGs are all special snowflakes and better than everyone.

 

I'd be very cautious of sharing those views when your in clinicals. Your resident or attending very well may have been an IMG or FMG. They make up a fairly large part of the actice practicing medical system.

[Intrepid86]

Caribbean medical schools were created to cater to American students. The expectation is to enter the US Residency Match upon completion of their studies. Canadians who graduate from the Caribbean typically end up in the United States too. Some will also take the MCC exams (on their own time, in addition to the USMLEs) to be eligible for the Canadian Match, and therefore the chance of matching into a Canadian residency. However, those who match back to Canada are the exception to the rule.

 

Generally speaking, Canadian medical schools are difficult entry/easy exit; Caribbean medical schools are easy entry/difficult exit. There is an enormous amount of standardized testing, and successful Caribbean graduates who match to Canada will have done at least 5 (USMLE Step 1, Step 2 CS, Step 2 CK, MCCEE, and NAC OSCE). Those who come back are more than ready... and while the academic hurdles are significant, this doesn't even include the logistical hurdles of going to school in the Caribbean for basic sciences, rotating in various US states for clerkship, attending interviews etc.

 

Getting into a Canadian Medical school requires a huge amount of dedicated effort. That is obvious. However, going to the Caribbean is not an easy way out, because that effort will be repaid in spades, all without the guarantee of even matching. Most people don't appreciate the process, because they don't actually know what's involved. They've never gone through it. Opinions are largely formed from assumptions and anecdotes repeated so frequently that they're simply accepted as being true.

 

The Caribbean is not for everybody. It is high risk/high reward. You must be comfortable with uncertainty. You must do your due diligence, mentally prepare yourself, and have a backup plan before pursuing this route. It is a great journey and a dream come true for those who are successful, but can be the exact opposite for those who are not.

[ralk]

Lol, such broad and extreme statements. I personally think you're a loser and slacker for making such lazy statements. How does that feel?

 

There are plenty of people in the carribean who were competitive in Canada but just unlucky, just the same as there are many who were unlucky.

 

No need to perpetuate unnecessary hate. The ones that make it through all 4 years and match, generally had to work harder than many(not all or not most) Canadian students in med school where its p=MD.

Its very clear how some of you posting have no real semblence of understanding of how medical school admissions work in Canada and the US. Its actually quite sad, and gives the continued arrogant CMG perspective that CMGs are all special snowflakes and better than everyone.

 

I'd be very cautious of sharing those views when your in clinicals. Your resident or attending very well may have been an IMG or FMG. They make up a fairly large part of the actice practicing medical system.

 

Generally speaking, Caribbean school attendees were not competitive in Canada. Those who are competitive but unlucky are generally best-served by applying again in Canada or going to the US. There are a few who are unwilling to wait another cycle and likely could have gotten in with more time, though impatience isn't exactly a redeeming quality. I think saying there are "plenty" of Caribbean students who were competitive in Canada is an overestimation, both of how many students were competitive and how competitive they were.

 

It's true that Caribbean medical students have to work quite hard to match, while the minimal effort to match here in Canada is much lower. However, CMGs aren't exactly sitting around on our butts either, as most go well above the minimum effort required. In addition, all that effort doesn't necessarily lead to competence. Much of that effort is wasted or inefficient, which is why Canadian schools have done away with some of that academic rigor.

 

It's also true that many current residents and attendings are IMGs, including some very well-respected physicians. That said, few are Caribbean grads. The wave of Canadians considering the Caribbean started only recently, within the last decade or so, and the success record is not great. Most current IMG attendings will be from Europe, South Africa or India. Resident IMGs will be more frequently from the Caribbean, but even then, it seems as though UK/Ireland/Australia grads are boxing them out a bit.

 

I agree that it's wrong to characterize all Caribbean grads as "losers and slackers". However, as a group, the stigma against Caribbean grads does exist with some justification behind it - most Caribbean grads will not have had the same degree of pre-medical school accomplishments that CMGs did. We shouldn't apply such stigmas to individuals carelessly, just as we shouldn't assume people can't change or improve as they go, but I think it's fair to be aware as to why a physician might be a Caribbean grad, so long as that label is not held over their head indefinitely if they do show an adequate level of competence.

[JohnGrisham]

I'm not going to bother arguing when opinions have already been set.

 

But the hundreds of Canadian IMGs matching every year is an obvious point that shows they are competent, at least enough to get a residency.

 

As for Canada, again, I vehemently hate how everyone continues to think that the competitive nature of Canadian admissions has ANY CORRELATION with what is necessary to be a doctor.

 

So many people in Canada who miss the cut post interview or dont even get an interview in the first place due to high cut offs or barriers to entry- they are not unqualified.

 

When will people understand that admissions stats and entry reqs are only due to supply and demand. You dont need a 33 mcat or a 4.0 or thousands of hours of volunteering to be a good doctor.

[indefatigable]

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[JohnGrisham]

I think it's also worth noting that competitive in Canada is more of an ideal than reality. A large proportion of CMg seats are offered based on region of residence. People born in Gta not only compete against other Ontarians but also everyone else - there are a lot of examples of Ontarian having to compete for a few Oop spots and hardly having anything in Ontario. Should it be held against someone that they accepted an Ip seat in some province but didn't get accepted to UofT? Gpa not high enough for Ottawa? The people that go to the carribean tend to be from Ontario and the larger provinces, where there seem to be more applicants for fewer spots.

Very true.

 

There are many people in IP programs that would not ever get into OOP programs, or gotten into medical school at all had they been born in a different province. I am one of them. The only reason I got into medical school in Canada was due to IP status.  I would be in the US had I not had the privilege of being born where I was, and the huge amount of luck to win the lottery of getting a CMG spot. 

 

 

[ralk]

I'm not going to bother arguing when opinions have already been set.

 

But the hundreds of Canadian IMGs matching every year is an obvious point that shows they are competent, at least enough to get a residency.

 

As for Canada, again, I vehemently hate how everyone continues to think that the competitive nature of Canadian admissions has ANY CORRELATION with what is necessary to be a doctor.

 

So many people in Canada who miss the cut post interview or dont even get an interview in the first place due to high cut offs or barriers to entry- they are not unqualified.

 

When will people understand that admissions stats and entry reqs are only due to supply and demand. You dont need a 33 mcat or a 4.0 or thousands of hours of volunteering to be a good doctor.

 

You give the bolded statement, yet you think landing a residency shows competency? There's far more evidence underlying our medical school admissions, as horribly flawed as they are, than there is underlying our residency selection process. GPA, MCAT, ECs - these all demonstrate a degree of effort and intelligence, both of which are quite important and do correlate with what is necessary to be a good physician. They are not sufficient metrics on their own, and we over-emphasize them in the admissions process to the exclusion of other meaningful attributes, but all else being equal, having a high MCAT or high GPA is preferable for good reason.

 

I'm in full agreement that the number of potentially-competent future physicians is greater than the number of people admitted to Canadian medical schools and that the selection process does not necessarily select the best candidates. You're preaching to the choir on that point. However, you've also moved the goalpost quite a bit in your argument there, from "competitive" to "qualified", which are quite different things. Many people are qualified who are not competitive. In addition, the population of rejected-but-competent applicants and those who went to the Caribbean are not the same groups, though there is some overlap. Not only do Caribbean students often lack the 33 MCAT, 4.0 GPA, or significant ECs, they can lack those other qualities that make a good physician, since Caribbean schools don't really screen for them either.

 

It's totally fair to point out the flaws in our system - it's far from perfect - but that doesn't make the Caribbean pathway good, or even equal to the CMG system when it comes to producing quality physicians, incluing for the subset that match to Canadian residencies.

[JohnGrisham]

You give the bolded statement, yet you think landing a residency shows competency? There's far more evidence underlying our medical school admissions, as horribly flawed as they are, than there is underlying our residency selection process. GPA, MCAT, ECs - these all demonstrate a degree of effort and intelligence, both of which are quite important and do correlate with what is necessary to be a good physician. They are not sufficient metrics on their own, and we over-emphasize them in the admissions process to the exclusion of other meaningful attributes, but all else being equal, having a high MCAT or high GPA is preferable for good reason.

 

I'm in full agreement that the number of potentially-competent future physicians is greater than the number of people admitted to Canadian medical schools and that the selection process does not necessarily select the best candidates. You're preaching to the choir on that point. However, you've also moved the goalpost quite a bit in your argument there, from "competitive" to "qualified", which are quite different things. Many people are qualified who are not competitive. In addition, the population of rejected-but-competent applicants and those who went to the Caribbean are not the same groups, though there is some overlap. Not only do Caribbean students often lack the 33 MCAT, 4.0 GPA, or significant ECs, they can lack those other qualities that make a good physician, since Caribbean schools don't really screen for them either.

 

It's totally fair to point out the flaws in our system - it's far from perfect - but that doesn't make the Caribbean pathway good, or even equal to the CMG system when it comes to producing quality physicians, incluing for the subset that match to Canadian residencies.

Yeah fair, I was making a broader statement encompassing all IMGs not just carribeans.

 

And I definitely am not saying the Carribean pathway is good - just more so saying its unfair for people to keep hating on the ones who do make it through.

 

I mean, getting through 4 years of crap medical school and hurdles after hurdles - that has to mean more than an 4.0 vs a 3.7, or a 33 vs a 28 on the MCAT. 

 

With all the variance in undergrad, i personally do not subscribe to the belief that a 4.0 is any better than a 3.7. Sure, why not have a higher GPA just because you can, but that doesn't mean the person with a 3.3 for example is automatically worse off. 

 

Canadians regularly get into Irish and Aussie programs with "low" stats, and do just fine - many schools of which have been training doctors longer than many Canadian schools. Even then, the prime reason they are there is because they didn't get into Canada. And because they help subsidize domestic graduates there.  

 

UK, 6 year programs - those students didn't even bother with the Canadian route from the get go, they skipped out on undergrad in Canada all together - shouldn't we think less of them too? I mean, at least the ones who went carrib/ireland/aussie tried the Canadian pathway first. 

 

Anyways, to each their own.

[ralk]

I think it's also worth noting that competitive in Canada is more of an ideal than reality. A large proportion of CMg seats are offered based on region of residence. People born in Gta not only compete against other Ontarians but also everyone else - there are a lot of examples of Ontarian having to compete for a few Oop spots and hardly having anything in Ontario. Should it be held against someone that they accepted an Ip seat in some province but didn't get accepted to UofT? Gpa not high enough for Ottawa? The people that go to the carribean tend to be from Ontario and the larger provinces, where there seem to be more applicants for fewer spots.

 

This is true though there's an argument to be made that those regional preferences are in themselves qualifications for applicants. These schools are recruiting the best potential physicians for their service area, not just the best potential physicians period. There is a trade-off in likely quality of the applicants in terms of GPA/MCAT, but a significantly higher likelihood of staying in the service area long-term. For underserviced communities, having qualified physicians who stick around is far more important than having optimally-qualified individuals who don't. It's a statistical argument of course rather than a deterministic one - not everyone from an area will stick around after becoming a physician - but all admissions criteria are inherently statistical arguments anyway. It's a trade-off, but one with clear advantages for patients. The argument against Caribbean students is, as you point out, that they tend to come from over-serviced areas, so the worse pre-medical academic performance (and you can get into Caribbean schools with lower stats than would be permitted anywhere in Canada) comes without a beneficial trade-off for patients in underserviced regions.

[ralk]

Yeah fair, I was making a broader statement encompassing all IMGs not just carribeans.

 

And I definitely am not saying the carribean pathway is good - just more so saying its unfair for people to keep hating on the ones who do make it through.

 

I mean, getting through 4 years of crap medical school and hurdles after hurdles - that has to mean more than an 4.0 vs a 3.7, or a 33 vs a 28 on the MCAT. 

 

I agree, and that's why I really hope that when those of us in Canada have an opportunity to get a closer look at an IMG, we base our opinions on what we see rather than prejudgments. However, I won't assume that just because an IMG landed a residency spot that they're competent, just as I don't assume my fellow medical students are competent just because they're CMGs.

[JohnGrisham]

I agree, and that's why I really hope that when those of us in Canada have an opportunity to get a closer look at an IMG, we base our opinions on what we see rather than prejudgments. However, I won't assume that just because an IMG landed a residency spot that they're competent, just as I don't assume my fellow medical students are competent just because they're CMGs.

Agreed!

 

You keep me on my toes Ralk, sometimes we disagree, but we usually end up on a similar plane of thought ha.

[indefatigable]

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[Artier]

As it stands, Caribbean grads must do the work that Canadian grads largely don't want to do: work in those under-serviced regions that CMGs don't or won't work in.  

Why would Caribbean grads have to do that? Or are you just referring to the few years required for an RoS-binding residency spot?

[indefatigable]

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[ralk]

It's a nice argument, but I've never seen overwhelming evidence that this is the case.  Even at NOSM, I recall seeing a large proportion of the class had no intention of staying in the region.  Residency location had a far larger determinant on staying in an area.  For other provinces like BC or even McGill in Quebec, I think it's more of a hollow argument, since there are many people who would actually prefer to be in those areas but do not have IP status and are thus disadvantaged for admissions.  As it stands, Caribbean grads must do the work that Canadian grads largely don't want to do: work in those under-serviced regions that CMGs don't or won't work in.  

 

Absolutely true, residency location is the more important factor, though medical school location strongly influences residency location preferences. Most of NOSM's residents, for example, went to school at NOSM. In addition, NOSM isn't just for northern physicians, but rural as well - a decent number might not want to stay in the north, but still may be working in underserviced areas elsewhere. I hope we move more towards getting residency positions in underserviced locations as well, but I don't think that's an argument against regional preferences - they can work synergistically. 

 

BC and Quebec are a bit unique. It's very easy to get IP status for UBC and their entrance requirements aren't exactly low. They're a lot more like Ontario than the other provinces. Quebec has the French-language issue, which I'd argue keeps more people out of those residency programs than OOP status, especially when you consider that Ontario French-speakers get a break on entrance requirements in Ontario as well.

 

IMGs do have to sign an ROS agreement. The challenge is these agreements don't tend to lead to long-term placements. If an IMG works a 5 year ROS but then moves to an overserviced area for the remaining 25 years of their career, we haven't really solved the distribution problem. Even if only half of students we hope stay in an underserviced area through regional preferences actually do so, it would lead to better long-term distribution of physicians, by a good margin.

[indefatigable]

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[ralk]

I think there's some idealism in your statements here, but whether regionalism is a form of protectionism for residents of a given area or a solid policy to encourage retention is still unclear for me.  Residency may be a different issue as you point out, although it is separate from admissions.  My understanding that McGill in Quebec in particular is considered an English language school, and so not sure whether knowledge of French plays a large role in residency decisions.  

 

I'm not convinced that the outcomes at NOSM would be much different, if people who spent say a year in such a region were considered northern/rural before applying.  I agree with the issues regarding under serviced areas, my point is that simply a high reliance on ROS contracts indicates that current policies may not be working that well.  

 

Finally, with respect to UBC, I would still argue there is still a large difference between IP and OOP.  This is clear on their admission stats and the % scale is much more forgiving than the standard 4.0 scale.  A competitive GPA is probably on the lower end for most Ontario schools.  However, UBC does put much more emphasis on ECs than most Ontario schools do.    

 

There is a difference between IP and OOP at UBC, no doubt, it's just very easy to get IP status and it's not as though the IPs applying to UBC have low stats by Ontario standards. The use of percentages does mean marks have to be less consistent, but with wGPAs in Ontario schools, the difference is probably not that great aside from places like U of T and Ottawa that don't but a high emphasis on the MCAT.

 

I totally agree that a reliance on ROS contracts means the system is not working out well. However, some aspects to regional preferences are rather new. NOSM only opened in 2005. Their grads who went into FM have been in practice no more than 5 years - basically the duration of an ROS contract. Specialists are only 2 years out of residency, max. Long-term effects haven't had time to be realized.

[indefatigable]

There is a difference between IP and OOP at UBC, no doubt, it's just very easy to get IP status and it's not as though the IPs applying to UBC have low stats by Ontario standards. The use of percentages does mean marks have to be less consistent, but with wGPAs in Ontario schools, the difference is probably not that great aside from places like U of T and Ottawa that don't but a high emphasis on the MCAT.

 

I totally agree that a reliance on ROS contracts means the system is not working out well. However, some aspects to regional preferences are rather new. NOSM only opened in 2005. Their grads who went into FM have been in practice no more than 5 years - basically the duration of an ROS contract. Specialists are only 2 years out of residency, max. Long-term effects haven't had time to be realized.

 

I think the broader issues I was originally pointing out is that competitive in Canada is less of a clear concept.  An applicant who is highly suitable for UBC may not be suited for Western or vice versa, not to mention the OOP and SWOMEN statuses, etc..  I will have to beg to differ with regards to comparable competitive stats: %ges makes a very big difference in grade calculations.  UBC really is less grade/MCAT focused than most Ontario schools.

 

Sure, with respect to your earlier point, in some cases there may be a slight bump in retention by restricting OOP applicants.  But, generally I don't think the differences would be that large since after four years of med school in a given locale most people will have some attachments, even if they had none at the beginning.  In the case of Quebec, it basically protectionism: OOP students must sign a conditional ROS contract with the government which is worded as a protectionist document.  

 

I hope NOSM does prove successful in training more doctors for those under-serviced regions.  I feel IMG ROS contracts are a piece of dirty laundry that people don't really like to talk about.   

[ralk]

I think the broader issues I was originally pointing out is that competitive in Canada is less of a clear concept.  An applicant who is highly suitable for UBC may not be suited for Western or vice versa, not to mention the OOP and SWOMEN statuses, etc..  I will have to beg to differ with regards to comparable competitive stats: %ges makes a very big difference in grade calculations.  UBC really is less grade/MCAT focused than most Ontario schools.

 

Sure, with respect to your earlier point, in some cases there may be a slight bump in retention by restricting OOP applicants.  But, generally I don't think the differences would be that large since after four years of med school in a given locale most people will have some attachments, even if they had none at the beginning.  In the case of Quebec, it basically protectionism: OOP students must sign a conditional ROS contract with the government which is worded as a protectionist document.  

 

I hope NOSM does prove successful in training more doctors for those under-serviced regions.  I feel IMG ROS contracts are a piece of dirty laundry that people don't really like to talk about.   

 

I think percentages are a better metric than GPA because they forgive the odd bad mark, but I'm not convinced UBC's standards on that front are that much lower overall. Western and Queen's don't have high GPA requirements at all, while Mac remains a possibility for those with a less-than-stellar GPA (it's rare, but ~3.5 GPA can land an acceptance). The flip side is that to make these schools viable, you need a good MCAT score. At U of T and Ottawa, a mediocre MCAT can be overcome with a stellar GPA. Overall, that's not much different than UBC, where you can get in with mediocre marks or a mediocre MCAT, but generally not both. By not relying on hard cutoffs to the same extent, UBC does allow more flexibility in admissions, which is commendable. However, most of the class still has 85%+ averages and a substantial portion have 90%+ averages.

 

In terms of people sticking around medical school, let me put it this way - half of Western classes tend to be from the GTA. For those who put a focus on location, guess where most of them are trying to match? It's not to London. And that's fair, they want to move to where their families, friends, and oftentimes, partners live. However, that doesn't exactly keep people around - those 4 years in medical school don't mean much compared to the 22+ years beforehand. Western's SWOMEN program is based off of research that shows as much - physicians tend to end up where they're from.

[indefatigable]

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[Wasteman]

Lol, such broad and extreme statements. I personally think you're a loser and slacker for making such lazy statements. How does that feel?

 

There are plenty of people in the carribean who were competitive in Canada but just unlucky, just the same as there are many who were unlucky.

 

No need to perpetuate unnecessary hate. The ones that make it through all 4 years and match, generally had to work harder than many(not all or not most) Canadian students in med school where its p=MD.

 

 

Haha, sorry about that. I didn't mean for my post to be incendiary.  Admittedly it was late and I was posting as a way to stay awake at work. I was careless, and by extension, so were my statements. Given the pejorative history of the world, and the historical tendency of westerners being overly-critical of non-western institutions, despite the obvious differences in prevalent  socio-geopolitical issues, I should have been clearer and sensitive to these facts.

 

Tacitly, from my experience, it is believed that foreign educational systems and qualifications just aren't seen as equal to their Canadian/US counterparts. And again, it has been my experience that those applying to CMS's just weren't up to snuff, and used these institutions in a sort of 'ends justifies the means' sort or way.

 

Nevertheless, my original warning about not attending CMS's stands. Do not attend!

 

I'm sorry if my post comes off as elitist, these are the facts of things.

 

#getatmeson

[NLengr]

It's a nice argument, but I've never seen overwhelming evidence that this is the case. Even at NOSM, I recall seeing a large proportion of the class had no intention of staying in the region. Residency location had a far larger determinant on staying in an area. For other provinces like BC or even McGill in Quebec, I think it's more of a hollow argument, since there are many people who would actually prefer to be in those areas but do not have IP status and are thus disadvantaged for admissions. As it stands, Caribbean grads must do the work that Canadian grads largely don't want to do: work in those under-serviced regions that CMGs don't or won't work in.

You should look at the data from MUN and NL. The majority of physicians in the province come from MUN and MUN grads are very likely to practice in NL.

 

As for the IMGs practicing in the province, most of them are immigrant physicians, not CSAs.

 

But I expect NL is not reflective of the rest of the country. We are far far more attached to our province and our culture than any other province, including Quebec.