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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

By the author of one of the leading websites for Caribbean Medical


Schools for the past 12 years CaribbeanMedicine.com!

Asad Raza, M.D.

Caribbean Medical Schools: A Journey and Guide


Copyright 1999-2012 by Asad Raza, M.D.
All Rights Reserved
This book is available for purchase at the following online bookstores:
www.Amazon.com
www.BookSurge.com
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www.Alibris.com
www.BooksinPrint.com
www.GlobalBooksinPrint.com
Printed in the United States of America
International Standard Book Numbers
ISBN-10: 061555251X
ISBN-13: 978-0-615-55251-4
To order multiple copies at discount rates, please contact:
Create Space customer service department: www.createspace.com
Edited by Carla McDonald | theroundpen@yahoo.com
Cover and Interior Design by Leigh Anne Ference-Kaemmer | www.laferencekaemmer.com
Cover Photograph by R. Gino Santa Maria | Dreamstime.com

_____________________
This book is dedicated to the people of Baghdad, Mosul, Basra,
Fallujah, Karbala, Najaf, Kabul and Kandahar.
With my love and admiration.
_____________________

_____________________

Two roads diverged in a yellow wood,


and sorry I could not travel both . . .
and I took the one less traveled by and
that has made all the difference
_____________________

Robert Frost, 1920


The Road Less Traveled

xi

Table of Contents
ACKNOWLEDGEMENTS 
Chapter 1

INTRODUCTION

xix

1

Preface
Basic Path 
Exams
Residency
Some Basic Pros and Cons
Medical Schools in the Caribbean
Admission 
Tuition 
Financial Aid 
Basic Advice 
About 

1
2
2
4
8
10
14
15
17
18
20

Chapter 2

MY FIRST TWO YEARS


OF MEDICAL SCHOOL 








The Journey 
The Basic Science Classes 
Anatomy, Histology, Embryology 
Biochemistry, Physiology, Psychology, Ethics 
Microbiology, Neuroscience, Genetics , Epidemiology
Pathology I, Pharmacology, Physical Diagnosis 
Clinical Medicine, Pathology, USMLE Board Review
Island Life 
USMLE Step 1 

21
21
22
22
24
25
27
28
29
32

xii

Chapter 3

MY THIRD AND FOURTH


YEARS OF MEDICAL SCHOOL

33

Third Year Clinical Rotations 


33
Pediatrics
34
Psychiatry
35
Internal Medicine
35
Obstetrics and Gynecology
36
Surgery37
Fourth Year 
38
Summary of Events 
39
Chapter 4

USMLE 

USMLE Step 2 CK (Clinical Knowledge) 


USMLE Step 2 CS (Clinical Skills) 
Clinical Skills Assessment 
USMLE Step 3 

Chapter 5

My Residency Application

Choosing a Specialty 
Make Your Visa List 
Call the State Licensing Boards
Apply with ERAS!
Attend Interviews
Match Day and Visa Application

41
41
42
42
45

47
47
48
48
49
50
50

xiii

Chapter 6

Work Visas 

J-1 Visa 
J-1 Waiver
H-1B Visa 
My H-1B Visa Story 
Green Card 

51
51
52
53
55
58

Chapter 7

BOOKS USED IN
MEDICAL SCHOOL 

61

Chapter 8

HOW I CHOSE A CARIBBEAN


MEDICAL SCHOOL 67

Evaluating, Researching and Comparing all the Schools 67


Saba Websites 
70
Student Websites 
70
Business Website For Saba Island 
70

Chapter 9

MY PERSONAL STORY 

An Immigrants Journey 

71
71

xiv

Chapter 10

SUMMARIZED TIME LINE 

A Quick Look at All the Key Steps 


Chapter 11

DETAILED TIME LINE 

A Complete Summary of
All the Events During Your Four Years 
Basic Sciences 
Clinical Sciences 

75
75

77
77
77
78

Chapter 12

CARIBBEAN MEDICAL
STUDENT COMMENTS 

What Students from Other Schools


Have to Say About Their Experiences
AUC 
Ross 
Saba 
Spartan 
St. Eustatius
St. George 
Unibe 
Windsor 

81
81
81
85
87
91
91
93
94
95

xv

Chapter 13

FINANCIAL AID 

 How to Pay for Medical School


Financial Aid Sources 
Chapter 14

HELPF UL URLs 

Essential Websites for Your Research


Caribbean Medical Schools 
Medical Organizations of the United States 
Chapter 15

MY RANKINGS 

My Ranking of the Medical


Schools in the Caribbean

97
97
98

99
99
99
100

101
101

Chapter 16

MCAT AND
USMLE ADVICE

Information and Tips on How to Pass These Exams

105

105

xvi

Chapter 17

RESIDENCY PROGRAMS

Descriptions of the Residency Programs


Completed After Medical School 

111
111

Chapter 18

Opportunities for
International Medical
Graduates in Canada

121

Chapter 19

HIGH COST OF AN
INFERIOR EDUCATION125
Chapter 20

FACTS FOR INTERNATIONAL


MEDICAL STUDENTS 
Chapter 21

WORDS OF WISDOM

129
133

xvii

Chapter 22

FREQUENTLY ASKED
QUESTIONS
Admission
Financial Aid
Medical School
Clinical Rotations
USMLE
Immigration and Visas
Residency Training
Licensure
Chapter 23

About the Author

139

139
159
161
164
169
170
176
183

191

Chapter 24

TESTIMONIALS
ABOUt THIS BOOK

193

xix

ACKNOWLEDGEMENTS
To my grandfathers, Hashmath Raza and Jawad Ali Baig, both
of whose biological fathers died when they were young boys, but
with the help of their mothers, studied hard, earned University
degrees and became great men . . . still remembered by many to
this day.
To my father Rashid Raza and my mother Zainab Raza, both
of Hyderabad, India, for raising me with a tremendous emphasis
on education.
To my sister Mariam Mirza in Dubai, UAE and my brother
Ali Raza in Ontario, Canada for being great siblings. We are a
great team. I love you.
To my teachers, professors and coaches at the schools I
graduated from: Brampton Centennial Secondary School, York
University and Saba University School of Medicine.
Finally, to the United States of America for providing me with
all the opportunity I could ever desire in life.

INTRODUCTION

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

Caribbean Medical Schools | A Journey and Guide

the first year class at a U.S. medical school. So, 99% of students
that are accepted and matriculate at a U.S. medical school are U.S.
citizens or permanent residents of the United States (Green Card
holders).
Therefore, instead of giving up on what, for most, is a very deeplyfelt goal of attending medical school, many students have chosen to
enter medical schools in the Caribbean with the goal of obtaining a
residency and eventually practicing in the United States or Canada.
I want to provide much-needed information to students, like
you, who are considering this option, as there must be many uncertainties you are facing.

BASIC PATH
1. Graduate from a Caribbean Medical School
(M.D. degree)
2. Obtain ECFMG certification
3. Obtain a residency in the United States

EXAMS
ECFMG
ECFMG (Educational Commission for Foreign Medical Graduates) is an organization that issues a certificate that you will need to
obtain to become eligible to enter a residency (post-graduate training)
position in the United States. To obtain the certificate you must pass:

INTRODUCTION

 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.

Caribbean Medical Schools | A Journey and Guide

RESIDENCY
This is by far the most important aspect. Remember, the
M.D. degree can be earned anywhere. It is a residency that
will be your ultimate goal.
There were 16,893 U.S. medical graduates in 2011, and there
were 26,158 total residency positions available in the United
States NRMP residency match. This means that the difference
of 9,265 spots were available to the Independent Applicant
pool.
This pool includes U.S. D.O. (Doctor of Osteopathic Medicine) graduates, Canadian medical school graduates, and all
International Medical Graduates (IMGs) from all over the
world, regardless if they are a U.S. citizen, Canadian citizen
or a citizen of any other country.
In 2011 a total of 20,842 Independent Applicants were competing for those remaining 9,265 spots.
Caribbean medical schools place their students in clinical
rotations in affiliated hospitals in the United States during the
third and fourth year of medical school. Therefore, Caribbean
medical students are at a far greater advantage when competing
with other IMGs for U.S. residency (post-graduate training)
positions.
Residency programs tend to feel more comfortable with
students that have been trained in a U.S. hospital and are familiar with basic procedures and technology. This also gives
Caribbean medical students the benefit of establishing contacts
and friendships with the doctors and supervisors during the
clinical years. Those people will not only write your letters
of reference, but can aid you in obtaining a position in a U.S.
residency program.

INTRODUCTION

U.S. Residency Programs


Residencies for recognized specialties are diagrammed below.
The length of each bar represents the years of training required
for certification.
1

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

Caribbean Medical Schools | A Journey and Guide

Comparison of residency positions


available in Canada and the U.S.
FREIDA (www.ama-assn.org/go/freida) lists all ACGME-accredited residency programs. The U.S. column in this table is the NRMP
(www.nrmp.org) list, which only has those programs that participate
in their Match, which is a lower number. In the U.S. a certain number
of residency positions are available outside of the NRMP match (nonNRMP residencies).
The Canadian column is complete (stats taken from www.carms.ca).
Keep in mind that the U.S. Match is much better for Caribbean grads
as it has around a 50% IMG match rate; whereas the Canadian match
rate for IMGs averages around 10%.
Residency
Program
Anatomic Pathology
Anesthesiology
Dermatology
Diagnostic Radiology
Emergency Medicine
Family Medicine
General Surgery
Internal Medicine
Neurology
Neurosurgery
Obstetrics/Gynecology
Ophthalmology
Orthopaedic Surgery
Otolaryngology
Pediatrics
Physical Med and Rehab
Plastic Surgery
Psychiatry
Radiation Oncology
Urology

Spots in Canada
in 2011
24
118
26
88
65
1089
114
402
40
16
100
38
81
29
157
23
28
131
21
32

Spots in the
U.S. in 2011
1081
841
362
1124
1626
2708
1108
5121
594
195
1205
Non-NRMP
670
283
2482
373
108
1097
171
Non-NRMP

INTRODUCTION

Residency
Program
Anesthesiology
Anatomic
Pathology
Dermatology
Diagnostic
Radiology
Emergency
Medicine
Family
Medicine
General
Surgery
Internal
Medicine
Neurology
Neurosurgery
Obstetrics/
Gynecology
Ophthalmology
Orthopaedic
Surgery
Otolaryngology
Pediatrics
Physical Med/
Rehab
Plastic Surgery
Psychiatry
Radiation
Oncology
Urology

% 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

Caribbean Medical Schools | A Journey and Guide

SOME BASIC P ROS AND CONS


These are the PROS:
1) Split camp U.S. program: first two years (sciences) completed in
the Caribbean, last two years (clinicals) completed at affiliated
hospitals in the U.S.
2) U
 .S. curriculum: hence, better preparation for the USMLE
than other foreign schools.
3) Much easier to get accepted than U.S. or Canadian schools.
4) Three entering dates: September, January and May.
But these are the CONS:
1) Having to go from state to state to do your clinicals.

However, if you enjoy traveling and going to different places


and meeting new people, and want to take advantage of
establishing contacts, this could be a PRO! Also, it is possible to get most of your rotations in the same place with
certain schools.
2) The Visa problem for non-U.S. citizens when trying to get
a residency in the U.S.

There are two types of visas available to do residency in the


United States. The first one is the J-1 visa, which you can get
through the ECFMG. You will need to have an offer from
a U.S. residency program and a Statement of Need from
the Ministry of Health in your home country. However,
after completion of your residency in the U.S., you must
return to your home country for two years, unless you get
a J-1 waiver.

INTRODUCTION

The second visa is H-1B. This requires that you take an


additional exam (USMLE Step 3) before applying for the
visa. This may take several months to get before starting
residency, so its good to plan ahead with a timeline. Twelve
states (Arkansas, California, Connecticut, Florida, Louisiana, Maryland, Nebraska, New York, South Dakota, Texas,
Utah, West Virginia) will allow candidates to register for
the Step 3 examination before they have started a residency
program. So getting a visa is very possible, but will require
some additional time.
NOTE: you are not limited to those states for a residency. You
are free to do a residency in other states. Those states listed are
the ones that allow students to register for Step 3 before starting
a residency.
3) May have to do better than the average U.S. grad on USMLE
Step 1 and USMLE Step 2 CK to get a residency, and also
have to pass the USMLE Step 2 CS!

Examinations are given in a format compatible with that


of the USMLE at some schools. But success on the boards
will depend on the students work ethic and determination.
Be prepared to work hard.
4) If you are from Canada, obtaining a residency in Canada
as a foreign medical graduate is very difficult.

10

Caribbean Medical Schools | A Journey and Guide

MEDICAL SCHOOLS IN THE CARIBBEAN


All these schools are listed with the WHO (World Health
Organization) and the IMED here: https://imed.faimer.org
Readers are reminded that WHO has no authority to grant
any form of recognition or accreditation to schools of medicine
or other training institutions. Such a procedure remains the exclusive prerogative of the national government concerned.
WHO limits itself to publishing information on medical
schools that have been provided or confirmed by the governments of its member states.
English Language Caribbean Medical
Schools Recognized by the Medical
Board of California
Source: www.mbc.ca.gov/applicant/schools_recognized.html
M.D. Programs
Dominica
Ross University School of Medicine
www.rossu.edu
Grenada
St. Georges University School of Medicine
www.sgu.edu
Netherlands Antilles
Saba University School of Medicine
www.saba.edu
St Maarten
American University of the Caribbean School of Medicine
www.aucmed.edu

INTRODUCTION

11

M.B.B.S. Programs
Jamaica
University of the West Indies Faculty of Medical Sciences
www.mona.uwi.edu/fms
Barbados
University of the West Indies School of Clinical Medicine
www.cavehill.uwi.edu
Trinidad and Tobago
University of the West Indies Faculty of Medicine St. Augustine
www.sta.uwi.edu/fms
The above listed seven medical schools are the only English
language medical schools located in the Caribbean that are approved by the Medical Board of California.

The Importance of California licensure:


States in the U.S. are becoming increasingly strict with regard
to recognizing foreign medical diplomas, in particular from graduates of new offshore Caribbean medical schools. Most states are
slowly, but surely, approaching the high standards of California,
which is the strictest state.
Therefore, it is best to only consider schools that are licensed
in California, as the other states in the U.S. will soon adopt the
same guidelines as to which foreign medical diplomas they recognize and approve for licensure.

12

Caribbean Medical Schools | A Journey and Guide

F ull List of English Language Medical


Schools in the Caribbean
Anguilla
Saint James School of Medicine Anguilla
anguilla.sjsm.org
Antigua and Barbuda
American University of Antigua College of Medicine
www.auamed.org
University of Health Sciences Antigua School of Medicine
www.uhsa.ag
Aruba
Aureus University School of Medicine
www.aureusuniversity.com/aruba
Xavier University School of Medicine
www.xusom.nl
Barbados
 niversity of the West Indies,
U
Barbados Faculty of Medical Sciences
cavehill.uwi.edu
Bonaire
Saint James School of Medicine Bonaire
bonaire.sjsm.org
Cayman Islands
 t. Matthews University
S
School of Medicine (Grand Cayman)
www.stmatthews.edu

INTRODUCTION

Curacao
Avalon University School of Medicine
www.avalonu.org
Caribbean Medical University School of Medicine
cmumed.org
St. Martinus University Faculty of Medicine
www.martinus.edu
Dominica
All Saints University School of Medicine, Dominica
www.allsaintsuniversity.org
Ross University School of Medicine
www.rossu.edu
Grenada
St. 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

Caribbean Medical Schools | A Journey and Guide

Saba Island
Saba University School of Medicine
www.saba.edu
St. Kitts and Nevis
International University of the Health Sciences (IUHS)
www.iuhs.edu
Medical University of the Americas (Nevis)
www.mua.edu
University of Medicine and Health Sciences, St. Kitts
www.umhs-sk.org
Windsor University School of Medicine
www.windsor.edu
St. Lucia
American International Medical
University School of Medicine
aimu-edu.us
Atlantic University School of Medicine
ausom.org

ADMISSION
The mean GPA (Grade Point Average) and MCAT (Medical College Admission Test) for accepted students at Caribbean
medical schools varies greatly. A competitive applicant usually
has a GPA of around 3.2 and MCAT scores of 7 or 8. Most of
these schools require at least three years of undergrad, but some
will accept students after only two years.
Chances for admission are better if you apply well before the
date you would like to enter, as most of the spots are open then.
But buyer beware! Some of these schools are so desperate for
students that they will accept anyone that applies.

INTRODUCTION

15

Two big problems arise with this:


First, several of these newer schools are really bad, so getting admission into them means nothing. Second, many of the
students that are offered these easy admissions are totally not
academically suitable for medical school and therefore will never
pass the USMLEs. In the process they and their parents will lose
tens of thousands of dollars.
The MCAT is optional at most schools, but it is highly recommended that you write it. It is excellent preparation for medical
school studies.

TUITION
Here is a table comparing the tuition (in U.S. $) at the
Caribbean medical schools. One semester is four months in
duration. These tuition rates were valid as of January 2012. But
may have changed since then. Please verify these values with
each school.
Medical
School
All American Institute
of Medical Sciences
All Saints University
American International
Medical University
St. James School of
Medicine
American University
of Antigua
University of Health
Sciences
Atlantic University
School of Medicine
AUC

Caribbean
Island
School is
Located on

Tuition
Tuition for
for Basic
Clinical
Sciences per
Rotations
semester
per semester

Jamaica

$6,000

$7,200

Dominica

$4,995

$6,995

St. Lucia

$9,500

$9,850

Anguilla

$6,500

$7,500

Antigua

$12,282

$13,970

Antigua

$11,500

$11,300

St. Lucia

$3,800

$6,800

St. Maarten

$16,900

$18,900

16

Caribbean Medical Schools | A Journey and Guide

Medical
School
Aureus University
School of Medicine
Avalon University
CAHSU
Caribbean Medical
University
Destiny University
International
American University
MUA
Ross
Saba
Seoul Central
College of Medicine
Spartan
St. Eustatius
St. George

Caribbean
Island
School is
Located on

Tuition
Tuition for
for Basic
Clinical
Sciences per
Rotations
semester
per semester

Aruba

$6,495

$7,995

Curacao
Belize

$6,500
$8,000

$7,700
$9,500

Curacao

$4,900

$6,900

St. Lucia

$7,000

$8,000

St. Lucia

$6,000

$9,500

Nevis
Dominica
Netherlands
Antilles

$9,500
$16,575

$10,450
$18,200

$10,150

$10,950

Montserrat

$4,999/trimester

$6,000

St. Lucia
St. Eustatius

$4,950
$7,800
Terms
1&2: $22,414
3&4: $30,660

$9,750
$8,400

Grenada

St. James School of


Bonaire
Medicine
St. Martinus University
Curacao
St. Matthews
Cayman Islands
Trinity School of
St. Vincent
Medicine
University of Medical
St. Kitts
and Health Sciences
University of Science,
Montserrat
Arts and Technology
UWI - Faculty of
Jamaica
Medical Sciences
UWI School of
Barbados
Clinical Medicine
UWI Faculty of
Trinidad and
Medicine St. Augustine
Tobago
St. Kitts and
Windsor
Nevis
Xavier University
Aruba
School of Medicine

$22,625

$5,000

$7,500

$7,400
$9,400

$10,500
$10,950

$10,800

$12,500

$7,925

$11,000

$4,100

$4,500

$18,126

Per year

$16,618

Per year

$21,500

$25,000

$4,990

$4,990

$6,500

$9,000

INTRODUCTION

FINANCIAL AID
UNITED STATES
Federal:
www.fafsa.ed.gov
Sallie Mae:
www.salliemae.com
Stafford:
www.staffordloan.com
CANADA
Bank of Montreal:
www.bmo.com
Canada Trust:
www.tdcanadatrust.com/student/pro.jsp
CIBC:
www.cibc.com
OSAP:
osap.gov.on.ca
Royal Bank:
www.royalbank.ca
Scotia Bank:
www.scotiabank.com
INTERNATIONAL
IEFA:
www.iefa.org
Financial Aid Guide:
www.princetonreview.com/scholarships-f inancial-aid.aspx

17

18

Caribbean Medical Schools | A Journey and Guide

BASIC ADVICE
Keep in mind that a school listed with the World Health
Organization (WHO) or the International Medical Education
Directory (IMED) still may not qualify for licensure in the United
States.
What really matters is state approval. Currently only five English language medical schools located in the Caribbean islands
are approved by all fifty states in the United States.
Those Caribbean medical schools are American University of
the Caribbean, Ross University, Saba University, St. 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

you attend, I strongly recommend taking some college/


university courses, in biology, physiology, biochemistry,
etc. Just take a look at the medical school curriculum to
get an idea of what types of courses you need to prepare
for, and make certain that you do!
4. ...and lastly, follow your heart. Dont attend medical school
because it will make your parents happy, or because you
think it will make you prestigious or rich. All this is actually not true about a career in medicine. Attend only if
you have a genuine interest in the study of medicine and
the subjects involved, and you love to study. This way you
will be happy. Otherwise you will be miserable and will
drop out.
Find out the FACTS. Get them directly from the source - the
horses mouth, as they say - whether that is the medical schools,
the ECFMG, FSMB or other governing bodies. It is important
to know the truth and the risks involved with Caribbean medical
schools, and the realities. That is the only way you can make the
most informed decision for yourself.
Some basic questions one should ask the Caribbean school are:
1) What is your USMLE Step 1 and Step 2 first-time pass rate?
2) What is your clinical placement rate (at affiliated hospitals
in the U.S.)?
3) What percentage of your graduates obtain a residency in
the U.S.?
Ask away! Dont be satisfied until you know everything. Then,
and only then, can you decide whether or not to attend a Caribbean medical school. Read this great book, post on the forums
and share your information. I sincerely wish the best of luck to
you all. I know the pain you are going through.

20

Caribbean Medical Schools | A Journey and Guide

ABOUT
This guide was originally started in 1999 by me for a few friends
who were interested in attending a foreign medical school. It
was soon realized that this information was very much needed
by many others as well.
Since then, in the past 13 years now, my guide, book, website
and forum have been widely read, with tens of thousands of students from all over the world taking advantage of the valuable
information they provide. I honestly never thought the response
would be so profound.
The goal of the guide remains the same: to provide step-by-step
information to anyone who is interested in studying medicine at
a Caribbean medical school and then going to the United States
to obtain a residency and later a license to practice medicine.
I have gone through the entire process: I have attended and
graduated from a Caribbean medical school, completed the two
years on the island, completed the two years of clinical rotations
in the United States. I have passed the MCAT, USMLE Step
1, USMLE Step 2 CK, USMLE Step 2 CS, TOEFL, MCCEE,
MCCQE Part 1 and USMLE Step 3.
I received my ECFMG certificate and the H-1B Visa and I
did my post-graduate (residency) training in the United States.
I obtained my full state medical license and am now practicing
as a physician in the U.S.
If you wish my success to be yours, I can show you how: 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!

MY FIRST TWO YEARS OF MEDICAL SCHOOL

21

Chapter 2
MY FIRST TWO YEARS
OF MEDICAL SCHOOL
THE JOURNEY
After a lack of success in gaining admission at a Canadian or
U.S. medical school, I decided to pursue an M.D. degree in the
Caribbean.
With over 1600 medical schools worldwide, why the Caribbean? Well, as a Canadian, I knew that once I left Canada to go
to a foreign medical school, getting back into Canada would be
very difficult, so my goal was to go to the U.S. and work there.
Now, getting into the U.S. for a residency depends largely on
your USMLE board scores. Since the USMLE is based entirely
on the U.S. medical curriculum, many foreign medical graduates
have a tough time doing well on this exam because they learned
medicine in another country, at a school that has a different curriculum than the U.S. schools.
So, in choosing a foreign school, with the goal of eventually
working in the U.S., I chose a Caribbean school because these
schools have a U.S. curriculum and you can do your third and

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Caribbean Medical Schools | A Journey and Guide

fourth years of medical school (the clinical rotations) in the U.S.


This maximizes your chance of obtaining a residency position in
the U.S..
After looking through all the schools, I chose Saba University
School of Medicine. So let me tell you all about how my years
went on this rock.
Hence begins the story of an International Medical Graduate
(IMG).

THE BASIC SCIENCE CLASSES


I started FIRST SEMESTER (of five on the island) on
September 6, 1999. What a historic day in my life!
Our classes were 1) Anatomy, 2) Histology and 3) Embryology.
1) Anatomy
The professors structured this course in an excellent way. At the
start of each block they gave you a handout, which had everything
you needed to know. During the lectures they supplemented the
handout. Plan on wasting your time reading that big Moore book?
Well, that is a no-no. Just know those handouts cold for the tests.
I recommend the Board Review Series for Anatomy. The
Netter Atlas is a must, always have it open while studying. Now,
for the lab, you need to go after hours to the lab (with other med
students) and quiz each other on all the cadavers: dont just know
your cadaver, you must know all of them. This course will teach
you where all the organs, vessels and nerves are so that later you
can learn about their diseases with a better understanding.
2) Histology
This course was easily the worst experience I had at Saba. The
professor was this incredibly conceited and rude person, who

MY FIRST TWO YEARS OF MEDICAL SCHOOL

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.

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Caribbean Medical Schools | A Journey and Guide

SECOND SEMESTER we had Biochemistry, Physiology,


Psychology and Ethics.
4) Biochemistry
A lot of stuff to learn, but Dr. S. was excellent. He made biochemistry seem easy. Dr. L. taught us the harder blocks, so it was
tough. Pathways, pathways ... and more. Enzymes, rate-limiting
steps and all that short term memory stuff. Make yourself some
nice charts and keep them for when you get to pharmacology,
where you learn about drugs that block these pathways.
Class notes and Lippincott is all you need. Lippincott text
rules. There is a lot of stuff on this course, but that book, with
your time commitment, will help you really get a handle on this
course. Dr. S. based his final exam on the 30 Biochemistry pages
in the famous First Aid for the USMLE Step 1 book: a great idea,
I think.
5) Physiology
This is a very important course because physiology is the study
of the normal functioning of the human body. You need to get
a good handle on it before you get to pathology, which is the
study of the abnormal. So learn as much as you can. I had a good
experience in this course.
I recommend the Saunders Physiology book by Costanza.
Great subject. Saunders Physiology by Costanza is the #1 book
for physiology. There is a lot of controversy about whether to use
Guyton. My opinion? You have got to be kidding me ... waaay too
much info in that book for a one-semester course. That Guyton
book is awful.

MY FIRST TWO YEARS OF MEDICAL SCHOOL

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

Caribbean Medical Schools | A Journey and Guide

organized. Microbiology is very important. Get a good handle on


all the bugs: bacteria, parasites, fungi and viruses. Make charts with
a list of all the bugs and some classic buzzwords about each. It
will help you later on.
9) Neuroscience
Please rescue me! Could things get any worse? The lectures for
this class are the biggest joke. You sit in class for two hours every
day and learn nothing. So I would go home after class and read
that God-awful Snell book. I read the entire book (540 pages) and
recall, I HATE reading big textbooks. But I had no choice. I typed
up chapter summaries for the entire book. Neuro can be very hard,
so dont get bogged down with details, just learn the big picture.
10) Genetics
The prof plagiarized this course straight from the Thompson and
Thompson Genetics books. He put all his copied lectures in one
notebook. During class he explained them as if he wrote them. In
addition, unfortunately he demonstrated terribly unprofessional
behavior: from verbally abusing students to physically abusing
teachers (yes, this is true), to failing students he did not like.
Welcome to the Caribbean, folks.
He desperately needed professional help in controlling his temper. I think he had a very sad and troubled life. I have no idea why
the school kept him on staff. Genetics was easy so dont worry.
11) Epidemiology
Just print out her PowerPoint lectures and read them and the
book. Dont sweat this course the amount of Epidemiology
you need to know for the USMLE Step 1 would probably take
about two weeks to learn. This course is about statistics related to
health care.

MY FIRST TWO YEARS OF MEDICAL SCHOOL

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.

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Caribbean Medical Schools | A Journey and Guide

14) Physical Diagnosis


I did the absolute bare minimum in this course, because it was
so badly taught and disorganized, and I learned next to nothing.
So I cant tell you anything about it, sorry.
FIFTH SEMESTER (almost out of here!), we had Introduction to Clinical Medicine, Pathology II and at the end of the
semester, USMLE Review.
15) Introduction to Clinical Medicine
This was by far the most useless course of the entire five semesters. I mean, they could have made this course very helpful, and
really solidify what we had learned so far. But they didnt. It was
mostly student presentations, which are snooze city, and irrelevant
lectures by useless profs. Geez, what can I say, presentations! So
learn how to use Microsoft PowerPoint and get a head start on
writing History and Physicals if you have time.
16) Pathology II
Arguably the most important course for the boards, but we
had the most horrible profs this side of the Atlantic Ocean.
Sometimes I could not believe how bad they were. They were
mostly heavy-accent losers from foreign countries. I mean, this
course had the worst professors. Man, oh man. The only reason I
would even attend class is because we had this bogus attendance
policy. But people still skipped! Just read Robbins, Golgan or the
Kaplan books and teach yourself.
You have to know your pathology of organs systems. Otherwise
you will never pass the boards. Learn patient presentations, even
for Step 1. Be able to link pathology to pharmacology and microbiology, as these types of questions appear in large numbers.
Get the First Aid book and the Vignettes and a good digestible
pathology book and study, study, study!

MY FIRST TWO YEARS OF MEDICAL SCHOOL

29

17) USMLE Board Review


They put this at the very end. Four weeks of professors coming
in and trying to review two years worth of basic sciences. I just
sat in the back of the class and read my Kaplan books.
Well, on April 18, 2001, a day I never thought would come, I
finally finished my time on that boring island (yeah!).
I started my third year clinical rotations in August of 2001 in
the United States.
Important Note:
My dear friends, please remember that finishing five semesters
of basic sciences at a Caribbean medical school does not mean
much. In fact, it means absolutely zero!
EVERYTHING you have to do in order to get a residency in
the United States happens AFTER you leave the island.

ISLAND LIFE
EXERCISE
I continued to run, but not nearly as often as I used to. I did
some weights at the gym in Windwardside (which is where I
lived). But man, did I miss my track club back home - all the
training and the races I used to run.
Saba Bay to Bay Road Race
When I first came to Saba Island I saw how hilly the place was
and, I must admit, I was pretty disappointed. I knew it would be
very hard for me to continue running on Saba the way I used to
back home in Ontario, Canada.

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Caribbean Medical Schools | A Journey and Guide

I started anyhow, but it was pathetic. I mean, a 25-minute run


was exhausting me on those monster hills and back home I
used to run for an hour everyday!
In July, 2000 the wonderful people of Saba, including Suzanne
Nielsen, held the Bay-to-Bay (Island Wide) run/walk on Saba.
From the airport all the way to the other end of the island Fort
Bay. Approximately 12km (7.5 miles).
I thought it would be impossible to run it. I mean the climb
from the airport to the first three villages is crazy. You go from
zero to 2000 feet above sea level within the first part. I walked
half of it and still won the event in 1 hour and 16 minutes. Later
they told me that the Saba record was 1 hour and 7 minutes.
In December 2000 they held the event again and I ran the
entire way! The first part, from the airport to the church at Upper Hells Gate was entirely uphill! But I ran it in 19 minutes. I
knew I would break the record when I saw this time on my watch.
Anyhow, I had not been training, to be honest, just going for 25
minute runs here and there. But I still put in a very strong effort
and reached the bottom in 39 minutes and made it to the finish
in 43:33. New Saba record!
It was pretty cool. I am sure someone can break this record, but
I dont think someone can lower it below 41 minutes. However,
you never know! Its all really in the mind because when Professor David Aarons and I set the pace that day, we led a total of
six people under the old record.
SOCIAL
Well, for me, life on the island was not as great as it could be.
The island is very small with only around 1400 people.
I chose to live as inexpensively as possible. I had no cable,
phone or vehicle.
In a way its good, because I got a lot of studying done, but
yes, I have to admit, things got very boring and lonely. It was a
sad time in my life.

MY THIRD AND FOURTH YEARS OF MEDICAL SCHOOL

31

Sometimes I would go out to a party at the house of some of


the students; or go to Guidos, Lollipops or Queens Garden for
a dance or whatever.
Other students, however, were living with all the luxuries you
can have on Saba: phone, internet, vehicle, cable, nice houses,
warm water for a shower, air conditioning, etc.
I figured I could do without these things for 20 months, because
I could barely afford to go to this school I had an excellent
ability for sacrifice.
As far as finances go, I just paid tuition/fees and $470/month
for rent (I lived in Windwardside, which is the heart of Saba).
If you lived in some crappy place in St. Johns or Hells Gate you
could probably get a place for $300 or less. I spent money on
food, photocopies and not much else.
BREAKS
During the break after first semester I went to St. Vincent (a
nearby island). I was there for three weeks. It was a really memorable time, and I had a lot of fun.
In second semester, I went to St. Barts for a day trip. It is a nice
little French island with some neat places to shop, dine and beach.
During the break after second semester I went to St. Martin
with a friend of mine. St. Martin is nice, man. That is a really
beautiful place for a vacation and to meet women.
The break after third I HAD to go home, otherwise my mother
would have killed me. It was nice to see my family after a year.
They made fun of how much weight I had gained.
INTERNET
The internet was, as always, my source of info and communication to the outside world. Internet access is difficult as there
is only one free place the library. You can get internet in your
room to your PC, but that requires getting a phone line and

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Caribbean Medical Schools | A Journey and Guide

internet access, which is costly.


But I continued to post on my website forums to help incoming
students or to learn a little myself from what others had posted.
POST ISLAND
USMLE STEP 1
After I completed the first two years of medical school (the
basic sciences) on the island, I went back home to Toronto, Ontario, Canada to study for USMLE Step 1.
I took the Kaplan center access med pass for USMLE Step 1
which consisted of:
1) Preview (Step 1 books)
2) Lesson (videotaped lectures)
3) Review (question banks)
The first 30 days (which included the books) were $600
Canadian dollars.
I studied for 14 weeks for USMLE Step 1. The first seven
weeks I read the Kaplan USMLE Step 1 books and I went to
the Kaplan center and watched the videotaped lectures with a
30-day Kaplan Med Pass.
Info at: www.kaplanmedical.com
Then the second seven weeks I completed questions online with
Kaplan QBank and several other CD roms I had.
I also read the High Yield section of the First Aid for USMLE
Step 1, and a few other books I had. I studied very hard for this
exam. I wrote the test on July 28, 2001. I got my results four
weeks later and I passed.

MY THIRD AND FOURTH YEARS OF MEDICAL SCHOOL

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)

Aug 13, 2001 Sept 21, 2001

Psychiatry (6 wks)

Nov 5, 2001 Dec 14, 2001

Internal Medicine (12 wks)

Dec 17, 2001 March 8, 2002

OBGYN (6 wks)

March 11, 2002 April 19, 2002

Surgery (12 wks)

April 22, 2002 July 12, 2002

I started my third year clinical rotations on August 13, 2001.


I completed my first rotation at Leonard J. Chabert Medical
Center in Houma, Louisiana, USA.

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Caribbean Medical Schools | A Journey and Guide

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/

MY THIRD AND FOURTH YEARS OF MEDICAL SCHOOL

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.

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Caribbean Medical Schools | A Journey and Guide

The most enjoyable part of this rotation, for me, was helping
out at the free clinic. The Chief of Staff at Saint Joseph Hospital
ran this clinic and he would let med students come and just hop
right in, as if we were the docs! Of course, he would have the
final say on any treatment. It was great experience to be given
the responsibility of handling patients. I would go in, do a SOAP
note, talk to the patient and then come out and present it to the
doctor, and he would approve or disapprove of what I wanted to
do. He would then explain what should be the proper management of the patient.
At the end of this rotation I had an oral exam and a written
exam. The doctor that had supervised me the longest completed
my student evaluation that my university required for each rotation.
This hospital had a lecture series given by the Chief of Staff
mixed in with student presentations. We went to lecture three
times a week, time permitting. Even though Provena St. 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.

MY THIRD AND FOURTH YEARS OF MEDICAL SCHOOL

37

He learned Spanish (from scratch) so he could better serve


the large Hispanic community in Elgin, Illinois. Also, he mastered doing laparoscopic hysterectomies. See, 85% of the large
hysterectomies in the United States are done abdominally, but
he has done 95% of his laparoscopically. It takes more time to
learn this procedure, but it results in a shorter recovery time for
the patient. I assisted him in these lap hysterectomies as well as
other procedures like Dilation and Curettage and Loop Electrosurgical Excision procedures and Cesarean and vaginal deliveries.
Bread and butter of OB/GYN is routine pregnancy exams, pap
smears, uterine fibroids, endometriosis, pelvic pain, cervical dysplasia, hysterectomies, ultrasounds and unfortunately - cancer.
SURGERY (12 wks)
April 22, 2002 July 12, 2002
I did this rotation at Peninsula Hospital Center in Far Rockaway, New York, USA. I was living in Jamaica, Queens, New York
(home of rapper 50 Cent!) Down the street was a KFC with
cashiers taking orders behind bullet-proof glass.
Twelve weeks in the operating room you get to see and assist
in a wide variety of surgeries, for example: cholecystectomies,
appendectomies, amputations, pericardial window, bowel resections, arterial grafts, and many other procedures. The operating
room can be a grueling place.
There was a lecture series at the hospital, with grand rounds,
and also tumor board. We also had an opportunity to gain valuable experience at three clinics (vascular, surgical and breast).
I took the USMLE Step 2 CS (it was called the CSA back
then) in December of 2002 and the USMLE Step 2 CK in January of 2003.
My third year was 42 weeks of core rotations, my fourth year
was 30 weeks of electives that I completed in Toledo, Ohio, USA
from July 15, 2002 to February 21, 2003.

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Caribbean Medical Schools | A Journey and Guide

FOURTH YEAR
I completed my fourth year in Toledo, Ohio, USA. I set up all my
rotation there myself. It went as follows:
Family Practice (inpatient)
(4 wks)

July 15, 2002 Aug 9, 2002

Family Practice (outpatient)


(4 wks)

Aug 12, 2002 Sept 6, 2002

Gastroenterology
(6 wks)

Oct 21, 2002 Nov 29, 2002

Nephrology
(6 wks)

Jan 13, 2003 Feb 21, 2003

Internal Medicine (outpatient) Sept 16, 2002 Oct 11, 2002


(4 wks)

Infectious Disease
(6 wks)

Dec 2, 2002 Jan 10, 2003

Basically, fourth year is a time for you to choose certain areas


that you feel will be beneficial to you and your future plans. I
think Gastroenterology is very high yield. Also inpatient Internal
Medicine is an area where you can learn a lot. Since I wanted to
be in primary care I chose my electives in those fields (Family
Practice, Internal Medicine, etc.).
You dont really have to set up your rotations. You can stay at
the same hospitals where you did your third year and that is the
easiest way. I guess I wanted to make my life difficult, so I tried
to set up all of my fourth year by myself. I just emailed several
Family Practice residency programs, and a few said yes, I could
come for an elective or two. Then, once I was there, I just started
talking to doctors and asked them if I could hang out with them
for six weeks or so. Thats pretty much the way it went.

MY THIRD AND FOURTH YEARS OF MEDICAL SCHOOL

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

Started Medical School in Caribbean

July 2001

Passed USMLE Step 1

April 2001

August 2001

October 2001
July 2002

Finished Second Year on the Island


Started Third Year in the U.S.
Passed TOEFL

Started Fourth Year

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Caribbean Medical Schools | A Journey and Guide

December 2002

Passed USMLE Step 2 CS

Feb 21, 2003

Finished Fourth Year

10

11

12

13

14

15

January 2003

April 11, 2003

April 17, 2003


May 29, 2003
July 1, 2003

August 15, 2003


Sept 1, 2003

Passed USMLE Step 2 CK


Received M.D. Diploma

Received ECFMG Certificate


Received Step 3 Permit
Took USMLE Step 3
Got Step 3 Result

Sent Out Residency Application

16

Oct, 2003-Jan, 2004 Attended Interviews

18

April 2004

17

19

20

21

March 2004

Residency Program Match

April 2004

H-1B Visa Application

June 2004

July 1, 2004

State Training License Application


Obtain Social Security Number
Start Residency

It is my firm belief that it is chronologically impossible to


complete all this in four years. Guaranteed. Canadians and other
non-U.S. citizens who want the H-1B Visa will need an extra
year (or two!) to complete all this.
I have never heard of any non-U.S. citizen who started in September to successfully be able to start residency on July 1 four
years later. Even the lucky ones, who match on time, need several
months extension from the residency program to complete Step
3, get a training license, get a social security number, etc.

USMLE

41

Chapter 4
USMLE

USMLE STEP 2 CK (Clinical Knowledge)


I started studying for this test about two months into third
year and studied straight into my fourth year. A lot of studying!
I initially read the:
1) Blueprints Series

(five books Psyh, Peds, Surgery, Int Med, OBGYN)
2) Blueprints Q&A books (five books)
The Blueprints series is a good start. They are easy to read,
you can read each book in just a few days (or weeks). The
books are concise and have some good questions in the
back. The matching Q&A books are good, but they only
have approximately one hundred questions per book. Once
I read the Blueprints, I was ready to get into more details.
So I started with the:

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Caribbean Medical Schools | A Journey and Guide

3) Kaplan USMLE Step 2 CK books


These books are very detailed and have a ton of info. I think
they are the very best books on the market for USMLE
Step 2 CK. They should be read repeatedly.
After I finished with them I started practicing questions with:
4) Kaplan Step 2 QBook (850 questions)
5) Kaplan Step 2 QBank (1000 questions)
6) Kaplan CD Rom (400 questions)
7) NMS Step 2 QBook (900 questions)
Once I finished I reviewed with this great little book by Adam
Brochert called:
8) USMLE Step 2 Secrets
Great book! Best review book out there for Step 2 CK! The
author also has written a matching question book called Mock
Exam.

www.usmle.org also has 150 questions that you can get from
them for free.

USMLE STEP 2 CS (Clinical Skills)


CLINICAL SKILLS ASSESSMENT
(formerly known as the CSA - CLINICAL SKILLS ASSESSMENT)
This exam consists of 11 patients (not real patients, they are
actors). You basically go into each room with a clipboard in your
hand. You have 15 minutes to take a history, do a physical exam
and discuss tests and possible diagnosis. Then you come out of
the room and you have 10 minutes to write a patient note.

USMLE

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.

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Caribbean Medical Schools | A Journey and Guide

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:

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Caribbean Medical Schools | A Journey and Guide

2) Kaplan Step 3 QBook (850 questions)


3) Kaplan Step 3 QBank (1000 questions)
4) Kaplan Step 3 CD Rom (200 questions, 20 CCS cases)
5) NMS Step 3 QBook (900 questions)
Step 3 is done in two parts. The first part is 480 multiple-choice
questions, similar to ones you get on Step 2. The second part
consists of nine CCS cases (CCS means Clinical Case Simulations). Its basically a patient on the computer that you have to
manage, work up, order tests on and come up with a diagnosis
and treatment.
I had 20 CCS cases that I wrote out and memorized from
the Kaplan CD. Five CCS cases on the CD that www.usmle.org
makes available. And 50 CCS cases on this CD:
Interactive Step 3 CCS Cases
Its a private CD I purchased on www.ebay.com, those cases
were excellent. So, in total, I had 75 CCS cases that I memorized
in preparation for the Step 3 exam.

MY RESIDENCY APPLICATION

47

Chapter 5
My Residency
Application

Here are my Six Steps to Applying for Residency in the United


States:
1) Choosing a specialty
Well, this is a personal decision. Choose something you like,
something that matches your personality. Do you want to work
all day and all night for the next five years? Or do you want a
more relaxed life? Do you like people? Or would you rather to
look at specimens and x-rays? Also, if you are an IMG, the tough
specialties are out. Stick to primary care and a few other IMGfriendly areas.
All the programs are listed at websites like: www.careermd.com
and www.ama-assn.org/go/freida
Decide what specialty you want to apply for. Choose an IMGfriendly area like Family Practice, Internal Medicine, Pediatrics,
Psychiatry, OBGYN, etc.

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Caribbean Medical Schools | A Journey and Guide

As an IMG you should stick to primary care. If you have high


board scores and you are a U.S. citizen, then you can consider
other specialties. Otherwise, FP, IM, Peds or Psych. By far, IM is
the most realistic to get. PMR, OBGYN, Neurology, Pathology
and Anesthesiology are also IMG-friendly.
Go to FREIDA online here: www.ama-assn.org/go/freida or
you can go to this website: www.careermd.com and e-mail or call
all the programs you are interested in.
All the Family Practice residency programs are at this site:
www.aafp.org/residencies
If you are a non-U.S. citizen the biggest and most important
(and perhaps the ONLY ) question you should ask is, quite simply:
Does your program sponsor the J-1 Visa and/or H-1B Visa?
2) Make your Visa List
Well, this only applies to non-U.S. citizens who need a work visa.
If you are a citizen or Green Card holder, then ignore this step.
Just email all the programs you are interested in and ask them,
Do you sponsor J-1 or H-1B? I emailed all 500+ FP programs
in the U.S. and about 50 programs said that they would sponsor
H-1B. You will have to contact the programs yourself.
If you require a work visa, make sure you email the programs
and ask them if they sponsor the J-1 Visa and/or H-1B visa.
3) Call the State Licensing Boards
This is a very important step, but it is also a huge pain in the
behind. I started calling and, after a few states, I gave up. It just
takes so long to get the right department and nobody has an
answer to your question. When I called and asked the simple
question, How many of my 72 weeks of clinical rotations have
to be at ACGME hospitals for me to be eligible for a training

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

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Caribbean Medical Schools | A Journey and Guide

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)

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Caribbean Medical Schools | A Journey and Guide

4) A letter from the Royal College of Canada stating that the


residency you are going to doing in the U.S. is acceptable
to Canadian standards.
5) A Statement of Need letter from the Canadian Health
Ministry

Statement of Need what is that, you ask? Well, remember


what the J-1 visa is it is an EXCHANGE visa. Which means
that after you finish your residency in the U.S. you must return
to your home country (e.g., Canada) for a minimum of two years.
So, Canada has to tell the U.S. that they actually have a need for
you once you return. Pretty basic thing.
Anyhow, how does one get a Statement of Need letter? You
need to write and pass a test: MCCEE. Info about this test is
at: www.mcc.ca
Then apply for the Statement of Need letter with Health
Canada: j1visa@hc-sc.gc.ca
You will apply for the J-1 visa with the ECFMG (not the
USCIS), read: www.ecfmg.org/evsp/index.html
Now, if you do NOT want to return to Canada for that two
year requirement, then you CAN stay in the U.S. if you agree
to go and work as a physician in a rural/under serviced area in
the U.S. for 3-5 years.
After you finish this two-year return to Canada requirement,
you are free to go back to the U.S. to work as a doctor. Now, what
visa will you need to get to this point, to work in the U.S., you
may ask. The answer is surprisingly simple an H-1B. Makes
you wonder why you didnt get it in the first place, doesnt it?

J-1 Waiver
Okay, now for some good news related to the J-1 visa. Finally!
After you finish a residency in the U.S., it IS possible to stay in
the U.S. The way is to get a J-1 waiver.
Detailed info about the J-1 Waiver can be found by contact-

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

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Caribbean Medical Schools | A Journey and Guide

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

some states, this will take several months, while other


states do not even require a training license! It is up to
you to find out the details.
9) The H-1B visa application process takes three months.
But if you pay an extra $1000 (one thousand) you can
apply with premium processing that will expedite your
application to only 15 DAYS. It is done by the hospital,
immigration attorney and the USCIS.
10) The final step is to apply for a Social Security Number
(SSN). This is done after you enter the U.S. This process
takes anywhere from 4-8 weeks. It all depends upon your
country of origin/citizenship and your ethnic background.
11) Once you get the SSN, then you can finally walk proudly
into your U.S. residency program and start your postgraduate training.
SUMMARY: From the day you finish your last clinical rotation
it will take approximately 19 WEEKS (5 MONTHS) to have a
Step 3 result in your hand. The breakdown is: 4 (M.D. Diploma)
+ 3 (ECFMG Certificate) + 4 (Step 3 Permit) + 3 (Step 3 date)
+ 5 (Step 3 result) = 19 weeks. See above for details.
The best thing about H-1B is that after you get it, you are
eligible to apply for a Green Card, which will allow you to live
and work in the United States permanently.

MY H-1B VISA STORY


After I matched, the residency program that I matched to assigned the immigration attorney they work with to me. I gathered
all my documents. I had to send her:

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Caribbean Medical Schools | A Journey and Guide

Application for H-1B visa

My USMLE exam reports (Steps 1, 2 and 3)


All medical certificates (ECFMG, etc.)
Copies of my degrees (BSc, M.D.)
Copies of my passport

Copy of my drivers license


Birth certificate

All University transcripts


Resume

Letters of reference
The H-1B visa fees were:
Immigration lawyer fee $1495
H-1B application fee

$185

Total:

$2680

Premium Processing fee $1000

My residency program paid for the lawyer and application fees.


I only had to pay the premium processing fee (which speeds up
an H-1B application to less than 15 days). My residency program
was exempt from the annual H-1B cap of 65,000 because they
were a non-profit hospital affiliated with a University.
This was my very first time applying for an H-1B work visa. I
was in my country of citizenship (Canada) at the time I applied.
The state that I matched in does not require a training license
for residents (someone doing a residency). So I did not have to
apply for a training license. I used an immigration attorney that
the program assigned to me. It is the same for most programs.
The program will assign their immigration attorney to you. The
H-1B visa was valid for all years of my residency training.

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

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Caribbean Medical Schools | A Journey and Guide

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.

BOOKS USED IN MEDICAL SCHOOL

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

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Caribbean Medical Schools | A Journey and Guide

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

BOOKS USED IN MEDICAL SCHOOL

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

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Caribbean Medical Schools | A Journey and Guide

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

BOOKS USED IN MEDICAL SCHOOL

65

Surgical Recall (Recall Series)


ISBN: 0683301020
Bates Pocket Guide to Physical Examination and History Taking
ISBN: 0781718694
History and Physical Examination: 2001-2002 Edition
ISBN: 1881528812
Tarascon Pocket Pharmacopoeia: 2002 Deluxe Lab-Coat Pocket Edition
ISBN: 1882742222
One great new source I started using in residency and now
use exclusively as a physician is my iPhone, with the following
medical software: www.epocrates.com.
Its the best!

HOW I CHOSE A CARIBBEAN MEDICAL SCHOOL

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

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Caribbean Medical Schools | A Journey and Guide

atmosphere. Its bad to be taking money from students who dont


have an ice cubes chance in hell of surviving the program.
2) USMLE pass rates.
Although Ross/AUC have a slight edge, the USMLE pass rates
are comparable. Ross high pass rate is achieved by failing a large
percentage of each entering class. Only 80 of 230 in a recent class
passed through the program in five semesters. It is hard to tell
how many of the remaining 150 made it through, but I think the
overall attrition rate at Ross is somewhere around 40%. I would
much rather go to a school like Saba that does a better job of
screening students at admissions. The bottom line is that both
schools will provide what you need to pass the USMLE; however,
it will be a much more pleasant process at Saba.
3) Quality of clinical rotations.
SGU/AUC/Ross have been in the business longer and have
a better network. Saba is adequate, but I would give the edge
to SGU. On the other hand, Ross students seem to complain
about the time delays, etc. Both schools will require you to move
frequently. However, there are several students who get most of
their rotations in one place.
4) Residencies.
SGU/AUC/Ross have more history; however, Saba has done
very well at placing students in residencies, and is placing people
at some very good hospitals. I think this one is a toss-up.
5) AUC can only put the upper top 20% to 25% students in
U.S. core clinical rotations. The rest do those rotations in

HOW I CHOSE A CARIBBEAN MEDICAL SCHOOL

69

England, Ireland, etc., whereas 100% of the students at


Saba do their clinical rotations in the U.S. This becomes
handy when competing for U.S. residency spots and also if
you are planning to practice medicine in the United States.
In addition, doing your clinical rotations outside the U.S.
does not prepare you well for USMLE Step 2, because that
exam is based entirely on U.S. clinical experience.
6) St. George is the best Caribbean medical school, but it
is horrendously expensive (ouch!). Ross and AUC have
become quite expensive also.
7) Spartan and other newer medical schools have only a 1020% USMLE pass rate. They cram all their courses together,
have no review course and you may have to set up your
own clinicals.
8) SABA has a low student/faculty ratio: 6/1. All the students
confirmed this and said it added a lot to their education.
The faculty are approachable and willing to meet students
outside of class for extra help.
9) The island of SABA is a safe and a beautiful place to study
medicine for two years. Yes, it is small and boring and there
may not be a lot of non-school things to do on a daily basis,
but you are there to buckle down and study, are you not?
Then on your breaks you can take the one-hour ferry (15
minute plane ride) to St. Maarten and have a good time.
Keep in mind that I wrote the above nine points several years
ago, when I was first researching these schools. Things may have
changed since then, so do some research on your own to find
the latest.

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Caribbean Medical Schools | A Journey and Guide

SABA WEB SITES


Student Websites
Caribbean Medical School Online Guide (by me!)
www.CaribbeanMedicine.com
BUSINESS WEBSITES FOR SABA ISLAND:
Saba Tourist Office
www.turq.com/saba
Dive Saba
www.divesaba.com
Julianas
www.julianas-hotel.com
Sea Saba
www.seasaba.com
Queens Garden Resort
www.queensaba.com

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

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Caribbean Medical Schools | A Journey and Guide

at any of those schools.


So then came the option of a foreign medical school. Well, I
was well aware that as soon I got on that airplane and headed
toward a foreign medical school that coming back to Canada
would be very difficult.
So I knew that if I wanted to stay in North America, my best
option was to do a residency in the United States and live and
work there.
Finally came the issue of which visa I should get in order to
be entitled to legally work in the United States. There are three
main options, J-1, H-1B and Green Card.
Well there you have it: Ontario, Canada, to the Caribbean, to
the United States on H-1B.
One more thing I would like to say: you might also wonder
why Ontario is the most difficult place in North America to gain
admission into medical school. The answer is surprising simple:
immigrants.
Since the early 1970s people have been flocking to Canada
from all over the world. The Canadian government gives out
immigration like its candy on Halloween. So they come from
all over: Korea, Japan, China, India, Pakistan, Middle East, etc.
Unlike the U.S., where people live everywhere, in Canada 90%
of the country is too cold and nobody lives there. So people only
cluster in three areas Toronto, Montreal and Vancouver Toronto being the most popular, for reasons I will never understand.
So, twenty-five years later, these immigrants all want their kids
to practice medicine. There are only a few med schools offering
a small number of seats in Canada, and you have thousands and
thousands (and thousands) of applicants. Combine this with the
very strict admissions process and you have a recipe for despair.
If I had a chance to do it all over again, I would have gone to a
Caribbean med school right after three years of undergrad (back
in 1996). I should have never squandered my time applying to
all those medical schools in Canada. What a terrible and tragic
waste of time and money - worst mistake of my life.

MY PERSONAL STORY

73

I honestly never thought that it could get any tougher in


Canada, since back in 1998 I had a 3.7 GPA and a 9,12,R,10 on
the MCAT and did not get admission. Well, now I look at the
websites of the Canadian medical schools and their applicant
and admission statistics, and it has gotten even tougher. Time
to leave Canada, folks!
I was born November 3rd, 1974 in Hyderbad, India. My parents
came to Ontario, Canada with me in 1976.
I graduated from York University in May of 1997 with an
Honours B.Sc. in Applied Mathematics with a 3.76 GPA.
I had applied to medical school before with an 8,8,Q,8 MCAT
and was unsuccessful. So I decided that, since I had done volunteer activities and I had a genuine interest in medicine, I should
try for it again, and not give up on that goal.
So I enrolled in Kaplan and studied very hard for the MCAT
from November 1997 to April 1998. I wrote the dreaded test
again in April 1998. Got 9,12,R,10.
I then applied for September 1999 admission to 16 schools,
six in the U.S., ten in Canada. To make a very long and expensive
story short, again I did not get accepted.
I was heartbroken, and completely devastated that even after
doing everything I could, I still did not get in.
Just when hope seemed completely lost, my friend told me that
he was just going to the Caribbean for medical school. Well, I
found out as much as I could, and having decided on Saba University, I applied and got accepted.
I was, and still am, so happy that I finally obtained an opportunity to achieve my goal of becoming a licensed, practicing
physician in the United States.

SUMMARIZED TIME LINE

75

Chapter 10
SUMMARIZED
TIME LINE

A QUICK LOOK AT ALL THE KEY STEPS


To obtain residency in the United States, you will need to do
the following:
1) Pass the USMLE Step 1
2) Pass the USMLE Step 2 CK
3) Pass the USMLE Step 2 CS
4) Obtain M.D. degree (or MBBS)
5) Obtain the ECFMG certificate
6)* Write and pass USMLE Step 3 (before starting residency)
7)* Apply for the H1-B visa. Or, you can apply for the J-1
visa with your home country.
8) Start your residency!

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Caribbean Medical Schools | A Journey and Guide

All IMGs have to go through this process.


To get the J-1 Visa, you need to get the Statement of Need
letter from the Ministry of Health in your home country.
U.S. Citizens DO NOT need a visa to start a residency program in the U.S.
* applies ONLY to non-U.S. citizens, so that they can get the H1-B visa. If
you are Canadian, you also have to pass the MCCEE in order to be eligible
for the J-1 visa.

DETAILED TIME LINE

Chapter 11
DETAILED TIME LINE
A COMPLETE SUMMARY OF ALL THE
EVENTS DURING YOUR FOUR YEARS
BASIC SCIENCES (5 Semesters)
September 2013

Begin medical school

September 2013

Begin studying for USMLE Step 1

April 2015

Finish basic sciences (5 semesters)


(At this point you have accomplished
nothing)

May July 2015 Study (with Kaplan) for USMLE Step 1


July 2015

Take USMLE Step 1 at a Sylvan


Protometric Center

77

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Caribbean Medical Schools | A Journey and Guide

CLINICAL SCIENCES (5 Semesters)

August 2015
Summer 2016
Fall 2016
Fall 2016
Fall 2016
Fall 2016
September 2016
Oct 2016 Jan 2017
January 2017
March, 2017
Spring 2017
Spring 2017
Spring 2017
Spring 2017
July 2017

Begin core (third year) clinical


rotations in a U.S. hospital and
begin studying for the USMLE
Step 2 CK and CS
Finish core clinical rotations
(third year)
Take USMLE Step 2 CK at a
Sylvan Protometric center
Take the USMLE Step 2 CS Exam
at an ECFMG center
ERAS post office opens and the
Match application cycle officially
begins for the year
Follow up on all applications and
make sure that all required documents are in your file at all hospitals
Begin your senior (fourth year)
elective clinical rotations
Residency interviews
If you are Canadian, take the
Canadian MCCEE
Match Day NRMP Match
Results Announced.
Finish up senior elective rotations
(fourth year)
Graduate from medical school,
obtain M.D. diploma
Obtain ECFMG certificate (after
passing USMLE Step 1, Step 2
CK, Step 2 CS and obtaining M.D.
diploma)
Apply for J-1 work visa
(if necessary)
Begin residency

DETAILED TIME LINE

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.

CARIBBEAN MEDICAL STUDENT COMMENTS

81

Chapter 12
CARIBBEAN MEDICAL
STUDENT COMMENTS

WHAT STUDENTS FROM OTHER SCHOOLS


HAVE TO SAY ABOUT THEIR EXPERIENCES
Here are some comments from medical students in the
Caribbean about their respective schools. It is their opinion and
advice, not mine.
AUC
First of all, if you have any hope of getting into a U.S. M.D.
or DO school, I would go that route. The Caribbean, however,
is a viable option. Let me just say being on an island in the Caribbean for 18 months or more is not a vacation in any sense. I
attended AUC which is located on St. Maarten and is considered
one of the better islands, as far as living conditions are concerned.
There are many challenges you will face going to an island. Not
everything is like the U.S. Many of the island people despise

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Caribbean Medical Schools | A Journey and Guide

outsiders, the cost of living is extremely expensive and, being an


American, youre a target for crime.
I lived in one of the cheaper areas of the island for $700/month
for a 1-bedroom apartment and experienced everything from
hearing gunshots at night to having my car stolen a few weeks
before I left the island. I know of at least five people in my school
that had their homes burglarized and more people than I could
count who lost cars. The police on the island are unreliable and
incompetent and the island, as a whole, lacks enforcement of any
laws. You will really learn to rely on yourself and your classmates
to get through all the problems you will face because nobody at
the school or on the island will go out of their way to accommodate you, compounded by the fact youll also be dealing with
searing heat and more bugs than you could ever imagine. You
will always be hounded for money wherever you go and if you
want to stay in a better part of the island, expect to pay at least
$1,100/month for 1-bedroom. These nice areas arent immune
to crime either; in fact, they often become targets for thieves.
The mentality of the islanders, towards the students is they believe that we are all rich kids paying for school out of our pockets.
They dont understand the concept that most students are using
loans. This perception was also confirmed by one of the professors
that has lived on the island for many years. Again, I cant stress
enough for you to at least try to get into a DO or M.D. school
in the U.S. if you have any chance. My GPA was probably high
enough to get into a DO school, but I didnt want to wait and I
was also afraid to take the MCAT, which AUC doesnt require.
In hindsight, Im happy Im now a 3rd year student, but I know
things could have been so much easier staying in the U.S. Also,
more specialty choices are available to one who graduates from
a U.S. school. Coming from a Caribbean school, one must score
well above the mean on the USMLE to even have a chance at
the more competitive residencies. Some residencies are just about
impossible to acquire from the Caribbean.
Okay, Ive dwelled on the negatives long enough. The positive

CARIBBEAN MEDICAL STUDENT COMMENTS

83

aspects of going to the Caribbean: Its a great growing experience,


you will mature and become a better person when you leave; there
are many opportunities for fun there diving, beaches, casinos,
clubs, restaurants, etc. You, wont and shouldnt, be studying all
the time. You will also make some of the best friendships youve
ever had and youll be thoroughly impressed by the dedication of
yourself and your classmates. Im fairly pleased with the education I received and Im very thankful for the opportunity to do
what Ive wanted to do in life. The school campus is well-kept,
the labs are adequate and the classrooms are comfortable.
The library has all the latest journals and textbooks. The computer lab has roughly 30 computers and laptop connections to
the internet. The internet connection is the slowest Ive ever
seen, but at least you can use it for free. The school has a small
cafeteria (which I would avoid), but there are a few places to eat
near the school. There are many first-class professors at AUC.
There are some mediocre professors. I suppose its the same at
any school, but I soon realized the key to becoming a doctor is
surviving med school. In U.S. schools most students are catered
to and the attrition rate is very low, but in the Caribbean the
attrition rate is very high. My first semester about 30% of the
class failed Biochemistry. In Pathology, we only had 17 out of
43 people passing going into the final. I believe only 20% failed
the class in the end. Again, another reason to go to a U.S. school
where they cater to your needs.
I cant really comment any farther on rotations or residency
placements as I wont be starting rotations until June. Im currently
taking a couple months off studying for Step 1 of the USMLE. I
can say everyone Ive talked to has told me they know of no one
who didnt get a residency spot after completing all the requirements and passing the USMLE. I hope this sheds some light.
P.E., American University of the Caribbean, St. Maarten

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Caribbean Medical Schools | A Journey and Guide

I am in my third year of med school and I can only state my


experience.
I believe if you want to become a doctor, and nothing else can
suffice in life, you can do what I did. But remember, you are taking
some risks with this road. The risks are living in a foreign country
and you will borrow a lot of money. Also there is that passing of
USMLE. I believe most people with tunnel mind can finish this
without a problem.
The school and teachers are just like any other school in the U.S.
This education is what you put into it. When you get to third year
you will understand that medical education is up to the student. No
one will push you. You will need to push yourself to learn.
If you do well in school and do well in the USMLE, many things
will open up to you so you should not worry about anything. Many
hospitals would like to get a native speaker who not only knows how
to speak well, but who also knows what they are talking about. So
you already have one thing that is going for you.
A. S., American University of the Caribbean, St. Maarten
The school is not bad. I would, of course, take a U.S. school any
day, but that wasnt an option. It is a self-motivational school. Either
you really want it or you dont do well. I have no regrets.
Some professors are better than others, but overall I am fairly
satisfied. Again, I do a lot of self-teaching. It really isnt that difficult, just challenging.
Life on the island is good. There are worse places to be with less
to do (Dominica and Saba), and there are better places I am sure,
but I am overall happy with my choice.
I am not sure what the residency or clinical placement status is
because I am in my 2nd semester, but it appears that everyone gets
pretty much what they want for clinicals if you are in the upper half
of your class. Good luck in your decisions and hope I have helped
a little.
G.T., American University of the Caribbean, St. Maarten

CARIBBEAN MEDICAL STUDENT COMMENTS

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.

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Caribbean Medical Schools | A Journey and Guide

It should be noted that the vast majority of my interviews


were at competitive university-based programs, including Boston
University, Mount Sinai School of Medicine, University of Mississippi, Albany Medical College, University of Georgia, Wayne
State University, etc. I matched at Albany Medical College, and
start residency there July 1, 2001. I will complete my rotations
in May and graduate in June yet another Ross success story.
Regarding Dominica, I loved it! The island is beautiful and
there are so many nice things to do in the leisure time. It is really
cheap to visit the other islands in the Caribbean, and it is a great
opportunity to travel. Dominica is a little primitive, but what do
you expect from a Caribbean island? If you really crave civilization that much, you can always hop on the ferry to Martinique
(an island 30 miles south) and get some French culture, casinos,
dancing, Club Med, McDonalds, etc. Not to mention, you get a
2-week break every four months to go home between semesters.
I personally used a couple of the breaks to cruise around the
Caribbean and see as much of that part of the world as I could.
For $80-$100, you can catch a 20-30 minute plane ride and be
in Martinique, Guadeloupe, Antigua or St. Martin. Most people
never get to see the Caribbean outside of a honeymoon, and you
can do it every other month or so (if you want to) for 2 years. By
the way, if you are a Jimmy Buffett fan (as I am), you may have
a hard time wanting to leave this place.
L.B., Ross University, Dominica

CARIBBEAN MEDICAL STUDENT COMMENTS

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

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The truth about the Caribbean medical schools is as follows:


most of the profs are from the United States, and most of those
are Ph.D.s of their respected fields. The pathology and clinical
medicine professors were retired pathologists and surgeons. They
come down for the sun and they get paid fairly well to teach two
hours/day a few months of the year. The schools are getting better
about who they take on as students. Like the U.S. schools, the
Caribbean schools are getting very competitive.
Most of the students are: 1. Non-U.S. students that have very
good MCATs but have some quirk that prevented them from
getting in; 2. About half the students are professional people
making changes: myself and about eight others in school with me
are chiropractors; others are podiatrists, nurses, a lot of physical
therapists and PAs. The education was, for the most part, pretty
good - the big picture stuff and what is needed to pass the board.
They have a 90% attendance policy that is strictly enforced a
throwback to when the regulations on foreign medical schools
were more strict. So the schedule is very grueling with a lot of
late nights it is not a program for those with a weak soul a
student down south must have some will power.
Remember, there are no comforts of home; even paper can
be hard to get. There is a lot of studying on your own. I am currently studying for my board in two weeks and am glad to have
gone the extra yard on my own. The rotations are scattered all
through the country. I am currently going to K.C. to do Psych
in the VA; however, I dont know until I get my board score
where I will be after that. The rotations are, I believe, to be slots
that are not filled by other medical schools. In my situation, the
University of MO has fifty slots at the hospital, and if they are
not full, they will let me rotate with them. The other aspect is
that all government-owned hospitals are considered teaching,
VA and Native American hospital. So naturally, living in OK, I
have set up my elective at the local Native American hospital on
the reservation. Thats about all I know.
C. B., Saba University, Saba Island

CARIBBEAN MEDICAL STUDENT COMMENTS

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

I am currently in my third year at Saba University. There are


plusses and minuses to going to school in the Caribbean. First
of all, if you can get into a U.S. school, do whatever you can to
avoid the Caribbean. If there is no alternative, and you really,
really want that M.D., then its a good alternative.

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As for profswell, it depends on who is at Saba when you


take the classes. Saba is unique in the sense that most of the
profs who teach are taking classes with you. Let me elaborate.
For instance, my biochem prof (Ph.D. in biochem) was a student
taking psych and neuro with me. So in other words, the profs
get a discount on their tuition because they teach classes while
studying to be an M.D. themselves. Make sense? So undoubtedly, it leads to awkward situations outside the classroom. Are
they your friends or your profs?? You decide. Im sure they can
be both, but not always.
Med school in the Caribbean is what you make of it. I know
people who didnt study at all and were drunk all the time but
managed to pass their classes but then failed their boards. I
know others who took it seriously and scored in the 97th percentile on their boards. Like I said, its what you make of it.
About rotations: Saba has accredited (greenbook) as well as
non-accredited rotations. There are states that require accredited
rotations and there are other states that dont, so it depends. I
believe for the best education you need accredited rotations with
corresponding residency programs in that rotation these rotations are specifically geared to teach students. Other hospitals
that take students but dont have a formal teaching program, in
my opinion, may not be as beneficial.
Unfortunately, Saba cannot fit all its students into these accredited rotations since there are a limited number of them. Residenciesfrom what I hear, Saba students do okay in the Match.
I will be applying in August so Ill have first-hand knowledge
about the whole thing then. But be realistic. If youre going to be
a foreign grad (especially Caribbean) dont think youre going to
get neuro surgery or derm or something like that. There is always
the possibility, but again, be realistic about your goals.
H.K., Saba University, Saba Island

CARIBBEAN MEDICAL STUDENT COMMENTS

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.

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I have never seen a bunch of people more committed to teaching the subject they absolutely love as them. If you see them
say hi for me. I also enjoyed the microbiology classes. Some
teachers that we 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

CARIBBEAN MEDICAL STUDENT COMMENTS

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

I can tell you that going to a Caribbean medical school is a


very tough decision and one that you shouldnt take lightly. Ask
yourself a few questions:
First, do you really want to go into medicine? Second, do you
want to focus on primary care (i.e., peds, psych, IM, Family Practice)? Third, are you able to work hard in a foreign environment?
If you answer yes to the above questions, then a Caribbean
school will be for you. Most Caribbean schools are basically the
same. Everybody uses the same textbooks, and in any institution
you will have good profs and bad profs. The key is how much work
are you willing to put in? The more work you put in, the better
you will do. The main difference between Caribbean schools is
during the clerkship years (years 3 and 4). If you go to a school
that does their clerkships in the U.S. (St. Georges, Ross, Saba),
youll see differences.
St. Georges is the best in this respect because all of their
hospitals are ACGME accredited and youll have no problems
getting your license from any of these hospitals. Also, since most
of the schools hospitals are in New York/New Jersey you wont

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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

CARIBBEAN MEDICAL STUDENT COMMENTS

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.

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Financial Aid Sources:


TERI:
www.teri.org
CanHELP:
www.internationalstudentloan.com/canadian_student

Educaid:
www.educaid.com

Stafford:
www.staffordloan.com
Federal:
www.fafsa.ed.gov
Princeton Review:
www.princetonreview.com/scholarships-f inancial-aid.aspx

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

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MEDICAL ORGANIZATIONS OF
THE UNITED STATES

AAMC (American Association of Medical Colleges):
www.aamc.org
ACGME (Accreditation Council for Graduate Medical Education):
www.acgme.org
AMA (American Medical Association):
www.ama-assn.org
FSMB (The Federation of State Medical Boards):
www.fsmb.org
FREIDA (Fellowship and Residency Electronic Interactive Database):
www.ama-assn.org/go/freida
LCME (Liaison Committee on Medical Education):
www.lcme.org
NRMP (National Resident Matching Program):
www.nrmp.org
List of Canadian and American Medical Schools:
www.aamc.org
Interview Feedback:
www.studentdoctor.net/interview
Visa Info:
www.murthy.com
Mnemonics for med school:
www.medicalmnemonics.com
Career M.D.:
www.careermd.com

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

 976 (year school began). No doubt the best in the Ca1


ribbean. You can get all your clinicals in the same city!
And they are all ACGME accredited teaching hospitals.
The school makes their students write a SGU basic science comprehensive exam. Only the students who pass
that are allowed to sit for the USMLE Step 1. Licensure
in every state! 150-200 students admitted twice a year
in August and January. Basic sciences done on Grenada
and St. Vincent. Multi-million dollar campus Numerous
clinical training spots in United States and UK. Stafford
loans available to students.

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2. SABA (Saba):

www.saba.edu

1 993. I kid with my classmates by calling Saba quality medical


education, at a discount price. It always gets laughs. Seriously
though, you have to give the school credit for their record of
success. Even if you frown upon the boredom of the small
island, the larger picture (clinical, residency) with this school
is excellent. New million dollar campus built in 2001. Island
is small, clean and very quiet. Population is only 1400. There
is no poverty or crime. Almost all students do clinical rotation in the United States. Students eligible for TERI loans
and Stafford loans. Opened up a sister school on Nevis called
MUA in 2000. Saba was approved by California in 2004.

Since its founding in 1993, more than 1,500 physicians have


earned their M.D. at Saba University (www.saba.edu). Saba
University School of Medicine has been accredited by the
Accreditation Commission on Colleges of Medicine (ACCM)
and its program has received approvals from licensing boards
in New York, California and Florida. The campus is on Saba,
which is located very near St. Maarten.
Equinox Capital, Inc. (an investment company) acquired
Saba, MUA and St. Matthews in 2007.
3. ROSS (Dominica):

www.rossmed.edu
1978. Basically, if you can get to clinicals, youre set. Extensive
clinical training sites. Excellent residency placement. Approved by New York, California and New Jersey. However,
getting to clinicals without failing is another story. With an
attrition rate that is almost hard to believe, and an island with
a high crime rate, this schools basic science program is really
a horrifying experience for many. 250 students admitted per
semester, with considerable attrition, causing many students

MY RANKINGS

103

to transfer to nearby Spartan University. Students approved


for Stafford loans and Federal FFEL loans.

Bought by Devry (devry.edu) in 2003.

4. AUC (St. Maarten):



www.aucmed.edu

1 978. Very popular and successful medical school. Graduated


over 2000 physicians who are now licensed and practicing in
the United States and abroad. Yes, they have bounced back
from the volcano on Montserrat, and yes they got back their
WHO listing. But the school still sends students to England
and Ireland for third year clinicals, because they accept way
more students than they have U.S. clinical spots for. Class size
approaches 200 per class. Island is very westernized with McDonalds, KFC, Burger King, Dominos, Pizza Hut, Gap, Tommy
Hilfiger, Benetton, Calvin Klein, etc. Approved by California.

Bought by Devry in 2011.

5. University of the West Indies:


1960. Good school offering an MBBS degree (equivalent
to M.D.). But designed to train people in the Caribbean,
so its not really an off-shore med school. All four years are
done in the Caribbean with no U.S. clinical rotations. They
have three campuses (Barbados, Jamaica and Trinidad).
Barbados

University of the West Indies School of Clinical Medicine
www.cavehill.uwi.edu
Jamaica

University of the West Indies Faculty of Medical Sciences
www.mona.uwi.edu/fms


Trinidad and Tobago


University of the West Indies Faculty of Medicine St. Augustine
www.sta.uwi.edu/fms

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 HE preceding SEVEN MEDICAL SCHOOLS ARE


T
THE ONLY ENGLISH LANGUAGE MEDICAL SCHOOLS
IN THE CARIBBEAN THAT ARE APPROVED BY THE
STATE LICENSING BOARD OF CALIFORNIA.

Honorable Mention:
Medical University of the Americas (Nevis)
and St. Matthews University (Grand Cayman)
www.mua.edu
www.stmatthews.edu
In 2007, Equinox Capital (www.equinox-capital.com) bought
three Caribbean Medical schools: Saba University, Medical University of the Americans (MUA) and St. Matthews University
(SMU).
Saba started in 1993, and the founder of Saba University (a
great man named Dr. David Fredrick, who I remember well!)
started MUA as 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.

MCAT AND USMLE ADVICE

105

Chapter 16
MCAT AND USMLE ADVICE

INFORMATION AND TIPS ON


HOW TO PASS THESE EXAMS
MCAT
This test consists of four sections: Verbal Reasoning, Physical
Sciences, Writing Sample and Biological Sciences.
Verbal Reasoning can be the toughest for people. See, with a lot
of studying for a few months you can improve considerably on the
sciences, but verbal reasoning is hard to improve on. The reason
is because the way you read and comprehend is something you
develop at a young age. So, to all of a sudden change that in a few
months is quite hard. A good way to approach this section is to read
some passages every day without fail, like you are on some exercise
regimen. Get conditioned to reading passages and then answering
questions related to that passage. You can get sample MCAT verbal
reasoning passages from the AAMC at: www.aamc.org
Physical and Biological sciences can be studied in a variety of

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Caribbean Medical Schools | A Journey and Guide

ways. Everyone is different with respect to their learning styles.


So Ill just tell you what I did. I read the Kaplan chapters for
Biology Chemistry, Organic Chemistry and Physics. I learned
them well. Then I spent a long time doing passages and questions.
I took the Kaplan course in Toronto and I did every single test
in their MCAT library. By the end of my time with them, there
was nothing left in their center that I had not taken. I needed to
do this because I was a math major, so my biology and chemistry
skills were very weak.
Writing Sample can be the easiest, but it is amazing how
many people do not address the three basic tasks that the MCAT
requires. Basically, you will get a one-line statement, and you
have to write an essay about the statement by addressing three
tasks: 1) explain what the statement means, 2) provide a counter
example, 3) come to a happy conclusion between 1) and 2). That
is what you need to do, so do it! Do not go off on some tangent,
because you will get a low score. Also, MCAT graders only spend
90 seconds grading your essay and there is one thing they always look for a if you use an example from the real world, they
love historical figures. I always wrote about Mahatma Gandhi
whatever the essay topic, I would write about him. So get to
know some famous person from the past and write about his or
her life. Itll look good.
The absolute best book to study for the MCAT is the:

Kaplan MCAT Comprehensive Review, available at:
www.barnesandnoble.com
USMLE STEP ONE
There are a thousand USMLE books out there. In addition,
there are many USMLE CD roms with tons of questions by socalled experts claiming they know the secrets of how to beat this

MCAT AND USMLE ADVICE

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,

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Caribbean Medical Schools | A Journey and Guide

when called upon, stares blankly into space for several


seconds. What is the ion that the drug of choice for this
epileptic disorder works on?
This is a classic third order question. You have to start
thinking at this level by the end of your second year of
medical school. First order is recognizing that the child is
suffering from absence seizures. Second order is knowing
that the drug of choice for this is Ethosuximide. Third
order is recalling that this drug works on Calcium. So the
answer would be d) Ca.
3) A researcher doing genetic breeding injects a IY-617
dye into a solution of isolated Zeta-Jones cells. The
cells turn dark pink. She then adds this solution to a
pre-made, dye-free solution of M-Douglas cells. After
combining the two, the new solution is preserved and
a few hours later the M-Douglas cells are isolated and
are found to contain the IY-617 dye. What component
of the cell allowed this transfer of dye?
This is a perfect example of a very simple question, that
is presented in a way so that the reader gets confused or
freaked out by the details. The answer to this question is:
c) Gap Junctions. Of course you know that, as they allow
communications between cells. But the board exams like
to do this, where they take concepts that are not difficult,
but twist and turn them into questions that sound like
they came out of Star Trek. Keep your confidence, dont
get intimidated.
In general, there are a ton of USMLE books and CD roms
out on the market. Dont buy 30 different books and think its
going to help you. Dont go and buy a new USMLE book every
time you see a classmate using one. Do not read large books like

MCAT AND USMLE ADVICE

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.

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CARDIOLOGY
A cardiologist focuses on the prevention, diagnosis and treatment of heart disease.
DERMATOLOGY
A dermatologist diagnoses and treats diseases of the skin, scalp,
hair and nails, including skin cancer.
EMERGENCY MEDICINE
These physicians focus on the immediate decision-making and
action necessary to prevent death or disability. These physicians
are primarily based in hospital emergency departments.
ENDOCRINOLOGY
An endocrinologist deals with diseases that affect the thyroid
and pituitary glands, and with disorders such as diabetes. They
also deal with all diseases involving hormones.
FAMILY PRACTICE
A family practitioner, having been educated and trained in
broad areas of medicine including internal medicine, pediatrics,
surgery and obstetrics and gynecology provides comprehensive
health care to the entire family.

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.

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INFECTIOUS DISEASES
A specialist in infectious diseases focuses on the prevention,
diagnosis and treatment of diseases which are caused or complicated by bacteria, viruses and fungi, as well as a number of illnesses
of uncertain cause. This is a subspecialty of internal medicine.
INTERNAL MEDICINE
Internists are involved in the diagnosis and nonsurgical treatment of disease. This is a broad area of medicine emphasizing
preventive medicine. Many internists specialize in a subspecialty
of medicine, such as gastroenterology, cardiology or medical
oncology.
NEOHROLOGY
Nephrologists treat those with kidney ailments, hypertension,
fluid and mineral imbalance and related problems. This is a subspecialty of internal medicine.
NEUROLOGY
A neurologist deals with the diagnosis and nonsurgical treatment of diseases of the central nervous system (the brain and
spinal cord), the peripheral nervous system (the nerves that are
tied to the spinal cord) and the muscular system. Common neurological problems include headaches, weakness, seizures, multiple
sclerosis and strokes.

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.

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ORAL & MAXILLO-FACIAL SURGERY


An oral maxillo-facial surgeon is a dentist who has undergone
extensive training to surgically treat diseases, defects or injuries of
the jaw and related structures. This not only includes removal of
teeth in preparation of the jaw for dentures, but also reconstruction of the jaw due to cancer treatment or injury, and treatment
of the jaw for joint dysfunction.
ORTHOPAEDICS
Orthopaedic surgeons are involved in the diagnosis and treatment of illnesses of the extremities, spine and associated structures.
OTOLARYNGOLOGY
Otolaryngologists provide comprehensive medical and surgical
care to those who have disorders affecting the ears, the respiratory
and upper alimentary systems, and the head and neck in general.
OTORHINOLARYNGOLOGY
In addition to providing comprehensive medical and surgical
care to those who have disorders affecting the ears, respiratory,
upper alimentary system and the head and neck, an otorhinolaryngologist also provides medical and surgical care for disorders
affecting the nose.

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PAIN MANAGEMENT
These physicians specialize in the treatment of chronic pain
conditions utilizing a combination of oral medications, interventional pain management procedures and physical therapy.
PATHOLOGY
Pathologists deal with the causes and nature of disease. A pathologist contributes to the diagnosis, prognosis and treatment
through knowledge gained by the laboratory application of the
biological, chemical and physical sciences to man or materials
obtained from man.
PEDIATRICS
Pediatricians focus on the development, care and diseases of
infants, children and adolescents.
PEDIATRIC CARDIOLOGY
A pediatric cardiologist specializes in the prevention, diagnosis
and treatment of heart disease in infants and young children.
PHYSICAL MEDICINE
Physical medicine is the medical specialty concerned with the
evaluation and functional restoration of patients with disabilities
that can be caused by stroke, multiple sclerosis, arthritis and
spinal cord injury.

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PLASTIC & RECONSTRUCTIVE SURGERY


Plastic surgeons deal with the repair, replacement and reconstruction of defects of the form and function of the outer layers
of the body. They not only perform what is commonly known as
cosmetic surgery, but also treat burns, tumors of the skin and
perform reconstructive surgery following accidents and cancer
surgery.
PSYCHIATRY
Psychiatrists are involved with the diagnosis, treatment and
prevention of mental, emotional and/or behavioral disorders.
Psychiatrists are medical doctors with extensive training in mental
health.
PULMONARY MEDICINE
Pulmonary specialists deal with diseases of the lungs and other
chest tissues. They diagnose and treat such diseases as pneumonia,
bronchitis, emphysema and related diseases. This is a subspecialty
of internal medicine.
RADIATION ONCOLOGY
A radiation oncologist treats malignant and benign tumors
with radiation therapy, and consults with medical oncologists
and surgeons regarding the best form of treatment for individuals
with various forms of cancer.

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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.

Opportunities for International Medical Graduates in Canada 121

Chapter 18
Opportunities for
International Medical
Graduates in Canada
Newfoundland
Applicants applying for a license for entry to general practice
who are assessed as ineligible may be eligible to enter the Clinical
Skills Assessment and Training Program (CSAT) which has been
developed by the Faculty of Medicine at Memorial University of
Newfoundland. Satisfactory completion of the CSAT will fulfill
the clinical training requirements and enable you to continue the
application process for a provisional license.
For more information:
www.cpsnl.ca

Nova Scotia
The Clinician Assessment for Practice Program is a program
of the College of Physicians and Surgeons of Nova Scotia. It is

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intended for International Medical Graduate (IMG) physicians


who believe they are practice-ready for entry into family practice
without any additional formal residency training in Canada.
For more information:
www.capprogram.ca/

New Brunswick
A restricted license is available, in very limited circumstances,
for certain foreign-trained physicians for direct employment by
a hospital or institution.
For more information:
www.cpsnb.org/english/LicensureinNewBrunswick.htm

Quebec
Under current rules, doctors with a degree from outside Canada
or the United States can practice medicine in the Canadian province of Quebec by obtaining a restrictive permit.
For more information:
www.msss.gouv.qc.ca/sujets/organisation/medecine/rsq/index.php?home

Ontario
In Ontario, IMGs must go through the Match with CaRMS
(www.carms.ca). However, the Centre for the Evaluation of
Health Professionals Educated Abroad (CEHPEA) offers examinations that an IMG applicant can take, that will help boost
their application with CaRMS.
For more information visit:
www.cehpea.ca/

Opportunities for International Medical Graduates in Canada 123

Manitoba
MLPIMG: The Medical Licensure Program for International
Medical Graduates (MLPIMG) is a one-year training program
that will assist foreign trained physicians to obtain medical licensure to practice as primary care physicians in Manitoba.
IMG-ACL: The International Medical Graduate Assessment
for Conditional Licensure (IMGACL) is a three-month assessment process that will assess practice-ready IMG physicians
previous training in order to obtain medical licensure to practice
as primary care physicians in Manitoba.
For more information:
umanitoba.ca/faculties/medicine/education/imgp/index.html

Saskatchewan
The College of Physicians and Surgeons of Saskatchewan is developing a new Saskatchewan-based assessment process designed
to recruit more foreign-trained physicians to the province. The
new program is currently being developed. Details about the new
program will be posted on the website as they become available.
For more information and updates visit:
www.quadrant.net/cpss/index.html
www.quadrant.net/cpss/assessment.html

Alberta
The AIMG Program provides a route to registration for IMGs
who are Canadian citizens residing in Alberta and are not able
to obtain registration through other routes.

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For more information:


www.aimg.ca
Also read about the:
Alberta Health Services Physician Preceptorship
Program for International Medical Graduates
http://www.albertahealthservices.ca/216.asp

British Columbia
The IMG-BC Program expects candidates to have passed
standard Canadian medical entry level examinations such as the
MCCEE and MCCQE Part 1, as well as being able to communicate effectively in English. Further evaluation will include a 16
station OSCE, followed by an optional 1-week orientation and
a 12-week clinical assessment offered to the top 35 candidates.
There are 18 IMG first iteration residency positions; 12 in Family Medicine and 6 in Specialties. The positions will be posted on
the CaRMS website and will be announced on an annual basis.
For more information:
www.imgbc.med.ubc.ca/Home.htm
Other provinces or territories in Canada may have similar
programs or pathways, so you are encouraged to contact the
College of Physicians and Surgeons of the province or territory
you are interested in. All the contact info is here: www.fmrac.ca/
Please keep in mind that CaRMS is the main pathway to
obtain a post-graduate (residency) training position in Canada.
For more information about CaRMS: www.carms.ca/
But, as we have listed above, there are other paths IMGs can
take in order to obtain a license to practice medicine in Canada.

HIGH COST OF AN INFERIOR EDUCATION

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

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Medical Graduates, U.S. citizens who are International Medical


Graduates have lower passing rates and lower scores than foreign
national IMGs. The U.S. citizen with an inferior education who
fails to pass the USMLE exams cannot obtain a residency and
will have little to show but a huge debt. Prospective medical students should consider the following WORDS OF CAUTION:
Store Front medical schools cannot offer the level or depth
of education needed to pass the USMLE exams nor attract the
best faculty.
Substandard schools often exaggerate or distort their poor
USMLE passing rates. As the ECFMG does not release scores
of individual schools, actual passing rates are difficult to verify.
Beware of any unusually high claims of high passing rates that
cannot be verified.
The recruiters are trained in high pressure sales tactics, with
the same techniques that sell automobiles, aluminum siding and
encyclopedias. Their goal is a sale; to make a profit for the school,
often in the guise of flattery and concern for your welfare.
The tuition charged by most substandard schools is very high.
Some of these schools have private loans from the secondary
medical education loan market. It is important to note that some
of these loan companies do not rigorously examine the quality
of foreign medical schools they approve for loans.
Interest rates charged in the secondary loan market are not
deferred; the interest clock starts clicking as soon as the loan is
paid out. Numerous fees may also be charged. Loans may also
be made for living expenses; thus increasing student debt level.
The loan debt from secondary market loans is not dischargeable in bankruptcy; this means payment default will be rigorously
pursued by the loan organization.
The reputable schools often charge a higher tuition rate but
offer a more rigorous education and are likely to have FFEL or
internal loan programs.

HIGH COST OF AN INFERIOR EDUCATION

127

STATE LICENSING BOARDS are becoming increasingly


aware of substandard schools, especially those offering advanced
standing and a medical degree by distance learning. Denial of a
license to practice to any physician is reportable on all licensing
board applications and to credential verification organizations.
Acceptance into a residency program does not guarantee future
licensure.
In summary, the graduate with an M.D. who cannot pass the
USMLE exams has little to show but a huge debt that can be
as high as $250,000. The interest clock continues to run; payments cannot be deferred after graduation unless the graduate
has passed all exams and is engaged in post-graduate training.
Job prospects are limited as is earning power and the Doctor of
Medicine is little more than an empty title. The loan repayment
will be very high and any graduate in payment default will be
vigorously pursued. Years better spent in pursuit of another career
will have been lost.

FACTS FOR INTERNATIONAL MEDICAL STUDENTS

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.

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There are roughly 17,000 U.S. graduates per year and approximately 26,000 post-graduate residency positions available. The number of residency programs has increased every
year for the past 30 years. International Medical Graduates
are needed to fill these surplus residencies.

6. Th
 e highest concentrations of IMGs are in the specialties of Internal Medicine, Psychiatry, Anesthesiology and
Primary Care.
7. Over the past decade IMGs with high USMLE scores
from reputable foreign programs have been able to obtain
residencies in more competitive areas such as Surgery,
Radiology and Obstetrics and Gynecology.
8. A
 ll medical students now take one exam called the United
States Medical Licensure Exam series (USMLE).
9. Th
 e passing rate for American and Canadian International
Medical Graduates on the USMLE Step 2 Clinical Skills
exam exceeds that of other foreign-trained physicians.
10. T
 oday there is far more scrutiny of U.S. citizens studying
medicine abroad by state licensing boards than existed 10
years ago. It is therefore important to study at an established, stable school that will keep permanent records.
11. Residency Training Programs, however, appear to be more
receptive to U.S. citizen IMGs than they were 10 years
ago. A United States Citizen does not need a special visa.
Furthermore, because most American IMGs have done
clerkship rotations in U.S. hospitals, they often integrate
quickly and with fewer difficulties into training programs.

FACTS FOR INTERNATIONAL MEDICAL STUDENTS

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.

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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

d. The names and credentials of all full-time faculty members.


e. Proof of listing with the World Health Organization

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2. Follow the same procedure for established European Medical Schools with English language programs. Make sure
you have the same access to faculty, library and lab facilities
as local students in the regular program. Be prepared to
attain language fluency before you begin third and fourth
year clerkships.
3. Do not believe what you read in a flashy catalog or on an
internet site. Avoid any school where recruiters engage
in pressure tactics or make personal concessions for you.
Visit the admission office and basic science campus of
each school in your final selection pool. Attend lectures
and interview several current students.
4. During a personal visit, look for signs of adequate staffing
and permanency. Evaluate the faculty credentials and make
sure the teaching staff is full-time and in residence. Avoid
schools that hire local M.D. practitioners on a part-time
basis to teach basic science courses normally taught by
Ph.D.-level faculty (physiology, biochemistry, microbiology etc.)
5. Carefully evaluate the integrity of the library, laboratories and classroom facilities. Many of the newer medical
schools rent space in local hotels, converted garages or
private homes. Look for a permanent, fully-functioning
campus and remember that a school that rents a few classrooms has little incentive to remain open during hard
times.
6. Be very wary of any school that will allow you to complete
part of your basic science studies in the United States or
England. To avoid future licensing problems, your entire
basic science curriculum should be completed in the country listed by the World Health Organization.

WORDS OF WISDOM

135

7. Be equally wary of schools that have substandard basic


science campuses and guarantee clerkship rotations in the
United States. Many of the newly established schools with
poor to non-existent basic science campuses use this tactic
to attract new students. This is a tried and true con game
that could be very costly in terms of money and wasted
time.
8. Go only to schools where the duration of the Doctor of
Medicine program is at least 38 months and demands that
you have full-time attendance at the campus. Beware of
programs that require that you be present only 6-8 weeks
or place you on directed study back in the United States.
9. If you are unable to make a personal visit, interview several
current students and graduates before you make a choice.
Do not go to schools that refuse to give you a list of clinical training hospital sites or do not list the clinical sites
in the catalog.
10. Look for medical schools with external loan programs.
A school with Stafford, FFEL, TERI, or I HELP loans
has a source of oversight and regulation if it is receiving
funding from one of these groups.
11. Beware of schools offering their own loan programs or
scholarships. Interests rates and terms can change at the
whim of the school and you may be held hostage for your
transcripts, ECFMG certification or licensing materials
until you pay up.
12. Pay only by semester and avoid any school that charges a
large deposit, excessive fees or wants a year of tuition in
advance. Make sure that tuition charges and refund policies are clearly delineated in the catalog.

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13. The art and practice of medicine cannot be learned on


the internet. Furthermore, medical licensing boards do
not recognize distance learning for a Doctor of Medicine
degree. You may obtain a degree but may never be offered
a residency or obtain a license to practice medicine
14. Avoid any school that gives advanced standing to physician assistants, chiropractors, podiatrists, dentists, nurse
practitioners or one that has special programs for these
occupational groups. Credits earned in these programs are
never considered equivocal to medical school courses and
will not be counted for credit by licensing boards.
15. Licensing boards frown on medical students who do not
maintain full-time residence at the basic science campus
and are employed during medical school. There are cases
where practicing physicians who earned significant income as physician assistants, nurses or chiropractors while
in medical school lost their licenses. Licensing boards
target schools with part-time programs and merely have
to examine IRS returns during years of medical school
attendance.
16. A majority of U.S. licensing boards require 36 or more
months in medical school. Many will require documentation of the exact number of hours spent in each basic
science course. This means completion of a full Doctor of
Medicine program. Because licensing boards do not count
the time between semesters, vacations or study breaks, the
typical 38-month, (10 semester) M.D. program meets the
attendance requirements of the most stringent states.
17. Avoid schools that recruit failures or drop outs from other
medical schools. Avoid a school where most of the student
body are transfers from other schools. As the schools

WORDS OF WISDOM

137

reputation diminishes, graduates will have a more difficult


time obtaining a residency and receiving a state license.
18. If the school opens without a listing by the host country
with the World Health Organization, dont go. Do not
believe recruiters who tell you that the listing is pending.
This is usually a sign that there is something drastically
wrong. You will not be eligible for the USMLE exams or
a license to practice.
19. A history of legal problems or sanctions by regulatory
agencies is a bad sign. Investigate each school carefully,
particularly for fraud in Stafford or FFEL loan programs or
falsification of ECFMG or licensing material. The legislative division of the Federation of State Licensing Boards in
Euless, Texas, is a source of information on these matters.
20. Be prepared to learn a new language if you study in a
non-English speaking country. Although the basic science
curriculum may be taught in English, you will need to be
able to communicate with your patients and the hospital
staff during clerkship rotations.
21. Remember that you are a guest in a foreign country and
that conditions will not be like those in the United States.
Be flexible, open-minded and consider the opportunity to
interact with a new culture part of your medical education.
By all means be polite and make an effort to conform to
local customs.
22. 
T HE LAST WORD OF WISDOM: DO NOT BE
DISCOURAGED.
Chose a reputable California-approved foreign medical school
and remember that thousands of American and Canadian citizens

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have studied abroad and successfully practice medicine in the


United States. A majority of your patients and colleagues will
judge you on the basis of your competency, professionalism and
dedication. They will usually not care that you are an international
medical graduate if you maintain high professional standards.

FREQUENTLY ASKED QUESTIONS

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

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QUESTION 2
I have not completed my MCATs. I had a good average over
the four years of college. Do you think that this would be a
high enough academic grade to consider me without MCATs?
Several Caribbean medical schools accept students without the
MCAT, so it is an optional requirement for most of these schools.
Check the website of each school for details. Information about
the MCAT is at: www.aamc.org
QUESTION 3
In your opinion, what are the better med schools down in
the Caribbean or Central America? You mentioned some are
willing to accept people with minimal criteria. Does this make
the M.D. degree less respected in the field if you attended these
schools?
Please see my (unofficial) Caribbean medical school rankings.
It is just my opinion, and by no means official. Some schools
have been around a long time, like UAG (Mexico) since 1935 or
so (I think). Others were established in the mid to late seventies like SGU (Grenada) AUC (St. Maarten), Ross (Dominica).
Many newer schools exist, but some of them have no track record
whatsoever. You need to look at several things when considering
a medical school in the Caribbean, like:
1.)
2)
3)
4)

USMLE pass rate


Clinical placement rate in the U.S.
Residency matching statistics
State licensure record

If the school does not have answers to these questions, or their


answers are ambiguous, then chances are it is not a good school
to attend.

FREQUENTLY ASKED QUESTIONS

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.

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QUESTION 7
I have recently been accepted to Medical University of the
Americas in Nevis and will be going there soon. I was wondering what kind of things you have heard about MUA.
A good friend of mine attended MUA. He started there September 2001. I saw him just before he left Toronto to go down
to Nevis. He was very excited. It was funny, I had just come
back from the Caribbean, and he was just about to go there (I
completed the basic sciences in April 2001).
MUA is basically 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?

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You can try to apply to schools in the U.S., although many


only accept U.S. citizens. Just take a look at the schools websites
or email them www.aamc.org.
If you decide to apply to LCME schools in the U.S. or Canada,
then you should definitely get this book: Medical School Admission Requirements (or MSAR for short). It is the bible, excellent source of info, tells you all you need to know for applying
to U.S. and Canadian schools, all the statistics, scores, number
of applicants, etc.
QUESTION 10
I have heard from an undergrad medical counselor that not
all Caribbean medical schools are accredited, or as they subjectively put it, very good. I seek some truth in what this
counselor said, for I do not plan on basing any opinions by asking simply one person, especially someone who is not involved
with the Caribbean medical system!
The word accredited is not relevant here. Basically for a medical school to be legitimate (not a hoax) it has to be listed with
the World Health Organization (WHO). Only students at a
WHO listed school are eligible to write the USMLE (U.S. board
exams) or the MCCEE, MCCQE (Canadian board exams). But
WHO only lists medical schools, they do NOT evaluate or give
accreditation. That is done by the state boards.
Currently only six English language medical school in the
Caribbean Basin are approved by all 50 states in the U.S.. Those
schools are: SGU, Saba, AUC, Ross and UWI.
There are basically two main categories: LCME medical schools
(U.S. and Canadian medical schools), and foreign medical schools
(listed with WHO). When your counselor says the schools are
not very good perhaps he/she is referring to the quality of education, quality of professors, facilities, etc. of each school.

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QUESTION 11
Some schools have three entering classes (i.e., SABA). When
do you suggest I have my application so that it is in early enough
(in some American medical schools, the earlier your app is in
the better your chances of getting in are for whatever reason)
so that I may begin studying medicine by August/September?
Apply whenever you want, most schools have rolling admissions
so there are no deadlines. Starting in May is the best scenario
because it gives you a four-month head start on the entire fouryear process. These four extra months come in handy when you
are rushed for time in your third and fourth years with USMLE
exams, residency interviews, elective rotations, etc.
QUESTION 12
My biggest worry is paying a large sum of money to go to a
Caribbean school and then have a limited opportunity to practice in the U.S. (or would have to wait to practice with respect
to another physician whose undergrad medical education was
done in the mainland).
Bottom line is: first, try your hardest to get accepted into a
Canadian medical school or a U.S. medical school. Now, at this
point, if you 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

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schools for four years and I applied to 11 of the 13 Englishspeaking medical schools in Canada, so I know what I am talking
about. A 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.

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QUESTION 14
What about applying to medical schools in the United States,
do you have any info about this?
Information About APPLYING TO U.S. Medical Schools:
Things to consider (In ORDER of importance!):
a) The number of applications the school gets. If it is more
than 5000, forget about it, because yours will get lost in
the shuffle.

b) If you are a non-U.S. citizen, find out if the school accepts
non-U.S. citizens!
c) The number of Out of State applicants they accept. If
the number is less than 10, forget it.

d) GPA/MCAT averages, tuition, prerequisites. (You should


have a competitive GPA/MCAT for the school you are
applying to, the tuition should be not too high (they all
are!), and you must have the prerequisites).
Pre-Medical advisory committees will often suggest applying
to at least 20 schools through AMCAS.
Once you get the Medical School Admissions Requirements
(MSAR) book from the AAMC, read up on these schools (and
others of course) and apply through AMCAS as EARLY AS
POSSIBLE! Remember rolling admissions! Be prepared to
spend A LOT of money and put in A LOT of your time.
Okay, Ill try to make this application process as clear and
simple as possible. But believe me its not!
a) First get the AMCAS application (from www.aamc.org)
b) Fill it out very carefully (do your best job) and send it with
all the required stuff (transcripts, MCAT scores, etc.) to
AMCAS with a fee.

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c) About a month after AMCAS gets your application you


will get SECONDARY APPLICATIONS from each
school you applied to. This is the REAL application. Fill
these out even more carefully (do an even better job) and
send them with a fee.
d) Then you waitif you get an interview they will mail you
an invitation; otherwise you will get a rejection letter.

NOTE: Be prepared to spend A LOT of money, go through A


LOT of frustration and you have to be VERY PATIENT. It is
a long application process.
TIME LINE FOR U.S. MEDICAL SCHOOLS
For September 2013 entering class:

March, 2012

AMCAS starts accepting transcripts

April 2012

New MSAR book available


from the AAMC

June 1, 2012

First day that AMCAS accepts


applications

September 2012

Interviews begin

October 15, 2012

First offers of admission sent out

April 2013

Interviews end

September 2013

Date you enter medical school


(Matriculation date)

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INTERNET LINKS
1. American Association of Medical Colleges

www.aamc.org

2. AMCAS (American Medical College Application Service)



https://www.aamc.org/students/applying/amcas/
3. The LIST! All the U.S. Medical schools and their URLs

https://services.aamc.org/30/msar/
DOCTOR OF OSTEOPATHIC MEDICINE (D.O.)
Also look into D.O. schools. What is D.O.? you say. It stands
for Doctor of Osteopathic Medicine. It is practically the same
thing as an M.D. in the United States, and DOs can get the
same residencies (family medicine, internal medicine, pediatrics,
surgery, anesthesiology, sports medicine, geriatrics and emergency medicine) as M.D.s upon graduation. I have a friend who
graduated from Arizona College of Osteopathic Medicine of
the Midwestern University and is now in residency in Michigan.
It is a very similar program to an M.D. I cannot emphasize
this enough. But people dont know this (or for some stubborn
reason dont believe it) that is why few people apply to DO
schools, and that is why it is easier to get in.
Here are the websites for info on Doctor of Osteopathic Medicine: American Association of Colleges of Osteopathic Medicine
- www.aacom.org

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QUESTION 15
My GPA and MCAT are not competitive, but I still want to
be a Doctor of Medicine (M.D.), what should I do?
Well, there are a lot of people in this boat. Assuming your GPA
is lower than 3.4, you probably have no chance of getting into
a Canadian med school. I may be wrong, but I doubt it! I mean
the cut-offs just to get an interview were 3.50, 3.57 and 3.60 for
Western, Queens and Ottawa respectively (this was back in 1999;
the cut-offs are even higher now). U.S. medical schools do accept
people with GPAs as low as 3.0, but as a Canadian applicant you
are considered foreign (since you are not a U.S. citizen), so you
will need to have a higher GPA than the U.S. 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/

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QUESTION 16
What about going directly from high school to the Caribbean
for medical school?
Going to a foreign med school straight out of high school
may seem like a way to save time, but if you want to come back
to the U.S. you will find that you actually 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.

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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.

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b) Then, you must decide where you want to end up. For most
the answer is the United States!
c) United States is a LOT more similar to Canada than Europe is, and there are a LOT more opportunities there for
U.S. FACT. So, for most Canadians, moving permanently
to Europe is not an option, but moving permanently to
the U.S. is an excellent option.
d) With this established, you have to choose a school that
maximizes your chances of getting into the U.S. and getting a U.S. residency.
e) CARIBBEAN medical schools offer clinical rotations
(Cores and Electives) in the United States. This gives you
the HUGE advantage of being in the U.S. system for
TWO years prior to applying for a U.S. residency.
f ) During those two years, you are preparing yourself better
for USMLE Step 2 (as that exam is based entirely on U.S.
clinical experience).
g) Also, during those years you will be making contacts with
program directors that can aid you in obtaining a U.S.
residency.
h) CARIBBEAN schools offer a U.S. curriculum during
the first two-year basic science program. This is proven
to prepare students better for the USMLE Step 1 than
other foreign schools.
i) European schools (in UK or Ireland) offer none of this.
You will be in Europe for the four (4) years or more.
Then, when you decide to come to the U.S., you will be
inadequately prepared for the boards, and you will have
ZERO U.S. contacts.
You will be in the same boat as someone from Africa, India,
Mongolia, Peru or the North Pole for that matter. Actually, as

FREQUENTLY ASKED QUESTIONS

153

CANADIAN you will be worse off, because at least those IMGs


can get the Statement of Need from their Ministries of Health
easily. In contrast, as a Canadian you have to meet many requirements to get the Statement of Need.
QUESTION 18
My GPA is #.##, my MCAT is #### - what are my chances of
getting accepted into a med school in the Caribbean?
Here is the answer to this very common question:
I have always told students to try their very best to obtain
admission into a U.S. or Canadian medical school. If you have
tried your best and still have not been accepted to an LCME
(U.S. or Canada) school, then and only then should you consider
the Caribbean.
Admission to a medical school in the Caribbean varies depending on the school.
The newer medical schools that have opened up in the past five
or six years tend to accept anyone that applies. This may be hard
to believe, but it is true. The schools are desperate for students
and are willing to give anyone a chance.
This can be a dangerous thing, because some of these schools
are terrible. No real teaching, no real facilities, no cadavers, no
USMLE pass rate, no established clinical rotation program, no
graduates, no history of residency placement and, of course, no
history of state licensure.
A student from U.S. or Canada who has had much difficulty
in obtaining admission into a medical school in their country
may jump at the opportunity to attend an offshore school, especially if admission is so easy. But the consequences of attending
such newer schools can be disastrous. This also applies to some
of the older Caribbean med schools that have made very few
improvements over the course of their 20 years of existence in
the Caribbean.

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There are only about four or five established medical schools in


the Caribbean with a proven record of residency placement and
state licensure. It only takes about a couple of hours of research
on the internet to figure out which ones those are.
Now, as far as admission is concerned, in my firm opinion there
are only two schools in the Caribbean that will actually reject an
applicant (St. George and Saba) St. George because they are
a real University and Saba because enrollment is limited due to
the very small size of the island.
There may be some disagreement from others with regard to
my statement above, but I have rotated with dozens of students
from several other Caribbean med schools and those students
have all verified this.
If you want some specific numbers, I would say that a GPA
of 2.5 or more is enough for admission to most of these med
schools. A far cry from the 3.7 GPA you need in Canada. MCAT
is optional.
It is a rather opposite concept with Caribbean med schools as
compared to U.S./Canada med schools.
In the U.S. and Canada, admission is the most difficult thing.
But once you are in, it is smooth sailing.
In contrast, with Caribbean med schools, admission is a joke.
But once you are in, you are pretty much in a very difficult process, one that involves an enormous amount of self-teaching,
self-planning and self-discipline. You are on your own!
At many of the Caribbean med schools, during the first two
years on the island you have to teach yourself the basic sciences. Then there are some very difficult board exams you must
pass USMLE Step 1, USME Step 2, USMLE Step 2 CS and
USMLE Step 3.
During the third and fourth years, depending on what school
you go to, you have to set up some or all of your clinical rotations
and go from state to state to complete them.
Then there is the entire process of applying for a residency and
competing with thousands of other IMGs from all over the world.

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In addition, if you are a non-U.S. citizen you have to deal with


the problems of trying to get a work visa (either J-1 or H-1B).
So, as you can see, admission is the least of your worries.
Some of the better Caribbean med schools will help their students through the four-year journey somewhat. But most do not.
The only schools in the Caribbean that I recommend are: SGU,
Saba, AUC, Ross, UAG and UWI.
QUESTION 19
Can you explain this WHO listing? I have heard that I should
only go to a school that is listed in the WHO directory.
WHO (World Health Organization) simply publishes a directory of medical schools worldwide. That is what IMED is:
https://imed.faimer.org/ Thats it. The WHO directory is not much
more than that.
For a school to get listed in that WHO directory, all they
have to do is send a letter (by fax or mail) to WHO in Geneva,
Switzerland.
In that letter all they have to say is that there is a school and
that they have a physical address, telephone number, etc. Oh
yes, the letter needs to be signed by the medical/health official
of the country.
WHO does NOT evaluate, assess or give accreditation to any
school. That is done by the individual countries, and many small
countries have minimal standards, if any at all.
For example, in the United States that organization is LCME.
www.lcme.org.
But LCME only approves med schools in the U.S. and Canada.
For foreign medical schools you have to contact FSMB. www.
fsmb.org.
Contact the state where you are interested in working as a
doctor and ask if that state has approved the foreign medical
school you intend to attend.

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There are about 30 offshore med schools down there in the


Caribbean/offshore region, but only five are approved by all 50
states! Which five, you ask? SGU, AUC, Ross, Saba and UWI.
QUESTION 20
Students, who are attending a Caribbean med school that
operates any part of their basic science curriculum in the U.S.
or Canada, can never obtain a license to practice medicine in
the United States or Canada . . . Is this true?
Any Caribbean medical school that is operating, or has operated any part of their basic sciences curriculum in the United
States or Canada is doing so illegally.
Ross tried to do this a few years ago in Wyoming.
St Matthews tried to do this a few years ago in Maine.
This is not allowed by the state licensing authorities in the U.S.!
Contact them and you will see: www.fsmb.org/
QUESTION 21
Students who have gone from high school to a Caribbean
M.D. program (without doing any university) can never obtain
a license to practice medicine in the United States or Canada
. . . Is this true?
Certain Caribbean med schools are accepting high school
students into their M.D. program!
These students have no undergraduate education whatsoever.
For example, a list of requirements you need to meet in order to
get a license to practice medicine in the state of New York, states:

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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.

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-A
 ll 125 medical schools in the U.S. and all 13 English medical schools in Canada require that students who apply must
have completed at least three years of undergraduate studies
at a recognized University. Most med schools (almost all)
also require that the students pass the MCAT.
- these are BARE MINIMUM requirements
- s tudents who have skipped University and jumped directly
from high school to a Caribbean med school are walking
into the path of grim death
-n
 o state will grant such students any form of licensure upon
graduation
- YES, foreign medical schools in other countries accept high
school students, but those countries offer 5.5 - 7 year medical programs (e.g., MBBS degrees). So the total credit hours
meet U.S. requirements.
-C
 aribbean med schools operate 10 semester programs, which
are only three years and four months long
Please contact the Federation of State Medical Boards for
further information: www.fsmb.org/.
STUDENTS WHO HAVE GONE FROM HIGH SCHOOL
TO A CARIBBEAN M.D. PROGRAM (WITHOUT DOING
ANY UNIVERSITY ) CAN NEVER OBTAIN A LICENSE
TO PRACTICE MEDICINE IN THE UNITED STATES
OR CANADA.
Do not, under any circumstances go to Caribbean med school,
straight after high school. You MUST attend University first.
Otherwise you will NOT be eligible for licensure in United
States or Canada ever.

FREQUENTLY ASKED QUESTIONS

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

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QUESTION 23
Can you please give me some financial aid sources?
Visit this very informative page on how to pay for med school:
www.princetonreview.com/scholarships-f inancial-aid.aspx
In addition, the websites for the loan organizations for
Americans are:
Educaid
www.educaid.com
Federal
www.fafsa.ed.gov
Sallie Mae
www.salliemae.com
Stafford
www.staffordloan.com
Teri
www.teri.org
Other options include working and saving money before going
to med school or applying for bursaries or scholarships (although
these are very limited for foreign med schools).

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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.

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QUESTION 27
How many students were in your class?
When I first entered Saba in September of 1999 there were
40 students in my class. Some students left after a few weeks but
the class would always bounce back up to 40 because of transfer
to Saba from other schools like AUC, Ross. So when we finished
basic sciences in April of 2001 we had 41 students in my class,
only 28 of which were from the original September 1999 class
the other 13 were transfer students that came to Saba. Now,
because of the new campus building, the class size is bigger; at
times I have heard as many as 75 students. But this may be a
rumor. It may be more like 50-60 per entering class, but please
contact the school for exact numbers.
QUESTION 28
What are the living conditions like there?
Living conditions on Saba. Well, it is a very small rock that is
sticking out of the ocean. There is no beach, because it is not an
island. It is a huge rock. There is very little flat land, everything
is on an incline or decline. A bike is not a means of transportation on 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

FREQUENTLY ASKED QUESTIONS

163

is a guarantee, so you have to conserve, that means no flushing


the toilet until you pass out from the stench.
There was a small library for medical students with internet
access. On Saba, you can get a place ranging from, oh$300$500 per month, cheaper if you share a place. You can get a car
if you want, although I never had one, just hitched everywhere.
It was easy.
You can have cable television, phone (expensive) and air conditioning or whatever else money can buy. After all, with money
you can get just about anythingeven on Saba.
QUESTION 29
Does the school have sufficient equipment and equipment
thats up to date? Are they technologically sufficient?
The first two years are the only time you are on the island. In
that time all you really need are your textbooks, a desk, pencil/
pen/highlighter and time to study. What else? Youre not in the
nitty gritty yet. Saba has an anatomy lab for first semester, histology laball that basic stuff like any medical school. During
fifth semester you get the privilege of working with the island
doctor at Sabas hospital and have her yell at you for things that
you have not been taught yet. Man, I dreaded thatactually, I
downright hated it.
Technology. Well, like I said, youve got your books, so thats
all you need. Bring a laptop youll be in over your head with
studying, so you wont need much else.

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Clinical Rotations
QUESTION 30
Do you foresee there being any problems with the clinical
program? Can you choose where you would like to go?
The school (Saba) sets up with our 42 weeks of third-year core
clinicals. Fourth-year electives, which are only 30 weeks, we have
to set up ourselves. It is easy to set up fourth year electives. Many
medical schools in the U.S. accept foreign students in their visiting elective programs.
Yes, you can choose where you would like to go. It is what most
students do. Geographical mobility is expected for all students, but
with the class size being small, most students end up going back
to their home state or near their home state. Some students have
to travel some, but usually not more than three times. However,
I have heard some students have to move as many as seven times
in two years. But then there are others who get all two years in
one hospital. So 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.

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I recently talked with Maryland Board of Medicine and I asked


them this standard question:
If I want to eventually come to your state and get licensed,
when your State Medical Board looks at where I did my clinical
rotations how many of the 72 weeks that I did have to have been
done at ACGME accredited teaching hospitals to be eligible for
licensure?
Well, Maryland board told me that they DO NOT look at
your rotations during medical school when it comes time for
licensure. They look at your residency training.
Thats good news, right? So if you go to a non-ACGME accredited hospital and do your rotations, then it wont pose a
problem with Maryland licensure. The good news is that I already
did all this research. The full list of answers to that question is
listed in my forum at: www.CaribbeanMedicine.com, look in the
Main Forum.
The thing is, this question never gets answered when I email a
state medical board or even write them a letter. I have to CALL
them on the phone, and this takes a lot of my time. I contacted
the California Board and was told that 54 of the 72 weeks have
to be done at ACGME accredited teaching hospitals for licensure
in California. So the states differ quite a lot with regard to their
rules for licensure.
QUESTION 32
Can you please explain to me about teaching hospitals vs.
nonteaching hospitals for your clinical rotations? What problems can arise from doing rotations at nonteaching hospitals?
Basically there are two types of hospitals one can do their
rotations at:
1) ACGME accredited teaching hospitals

This means that that hospital has a residency program.

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There will be recent medical graduates there doing their


residency. In addition these hospitals offer rotations for
medical students.
2) non-ACGME accredited teaching hospitals

These are hospitals where there is no residency program.


However, they do have rotations for medical students and
doctors that supervise the students and teach them.
The problem can arise when applying for state licensure.
The 50 states in the U.S. vary with regard to licensure rules.
For example, California requires that at least 54 of the 72 weeks
of clinical rotations be done at an ACGME accredited hospital, while Maryland does not require any weeks at an ACGME
hospital. Do you see how states can differ?
So, doing rotations at a non-ACGME hospital would not pose
a problem, unless the state one wants to eventually get licensed
in and practice medicine has rules that state otherwise.
To find out each states rules and requirements, one can contact them at their address/telephone number, which are at this
website: www.fsmb.org.
The basic requirements to get licensed and practice medicine
in the U.S. are the following:
1) Graduate from a medical school listed with the World
Health Organization (WHO).
2) Obtain the ECFMG certificate (to do this one has to pass
USMLE Step1, USMLE Step 2 CK, USMLE Step 2 CS).
3) Complete a residency training program at an ACGME
hospital.

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QUESTION 33
I would like to know about Green Book hospitals. I am very
confused about this, could you please explain this and how it
works. Thank you.
In my opinion, to maximize your chances of getting a residency
in the U.S., you should do your third and fourth year clinical
rotations in the U.S., preferably at ACGME teaching hospitals
that are listed in the Green Book and have residency programs.
Clinical rotations done at hospitals that have residency programs are considered ACGME teaching rotations, also known
as Green Book rotations.
The Green Book (The Graduate Medical Education Directory,
which is traditionally printed with a green cover) is available here:
www.barnesandnoble.com
You 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

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rotations at St. Vincent Mercy Medical Center in Toledo, Ohio.


Now, if I want to find out if that hospital is considered an
ACGME teaching hospital, I would go to FREIDA, click on
Ohio, then click on Continue and you will see that the hospital
is listed in the selection of Green Book hospitals: St. Vincent
Mercy Medical Center.
QUESTION 34
Can you please give me some info on how to set up observerships?
Thanks for the question. First, let me clarify that I did clinical
rotations. Observerships are when you just observe and have no
responsibilities. I am assuming that you are interested in finding
out about how to get clinical rotation, as these tend to be more
beneficial.
Basically for my third year, my school set them up for me. In
my fourth year I had the option of staying at the same hospitals to
do my fourth year electives, but I decided to set them up myself.
The first thing I did was email several residency programs
(all the emails of the program directors can be found on
www.careermd.com).
I wrote them a short email explaining who I was and what I
was looking for. Most of them told me that they dont take foreign
medical students. However, a few sent me an application. I filled
them out and sent them in. Two programs (one in Michigan and
one in Ohio) said that I could come there to do some electives.
After I arrived there, I did three electives. Then, after that, just
by word of mouth, I was able to set up three more. All you really have to do is just approach a doctor and say I am a medical
student, and I heard that you take med students for clerkships.
I was wondering if I could do one with you.
Some hospitals will have an official clinical rotation coordinator. He or she will usually be part of the residency program there.

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169

There are a lot of hospitals offering clinical rotations to foreign


med students, you just have to do some research.
To document the experience, simply request a letter of recommendation from the physician you did the rotation with. That
should be good enough for the purpose of applying for a residency later on.

USMLE
QUESTION 35
With respect to the USMLE Step 2 CS test I would have
to write (being a graduate from a Caribbean med school who
wants to work in the U.S.): what exactly is it?
USMLE Step 2 CS is a test that was introduced in 1998. It
is a one-day pass/fail test that all IMGs now have to take at an
ECFMG center. It is basically a physical diagnosis-type test, with
about 10-11 actors pretending to be patients, each with a certain
illness, disease. You need to pass it to get the ECFMG certificate.
For more info, read:

www.kaplanmedical.com

www.ecfmg.org

www.usmle.org

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Immigration and Visas


QUESTION 36
What kind of VISA would I need (given my above background documentation) in order to be able to do my clinical
rounds, residency and be able to practice in the U.S. without
having to wait for years before I can actually work as a fullfledged physician?
Visas!! For clinical rotations you will need a B-1 visa. There is
no problem in getting this, all it takes is a letter from your medical
school stating that you are entering the U.S. to undergo unpaid
training as a medical student, then at the border the official will
stamp your passport with B-1 visa status. Simple as that.
Now, once you apply for residency as a non-U.S. citizen, and
non-permanent resident, you have TWO options for a visa to
enter a paid position at a U.S. hospital: J-1 visa or H1-b visa.
The United States Citizenship and Immigration Services (USCIS) issues the visas, you can read info at their website: uscis.gov.
First, lets talk about the H1-B:
Basically when you go to residency interviews in your last year
of medical school, if you are a strong enough candidate, then the
hospital will decide whether or not they want to sponsor you for
the H1-B visa. Unfortunately, not that many hospitals sponsor
the H1-B visa, and those that do only do it for very strong applicants, hence the term luxury visa.
To be eligible you will need to:
1) get your ECFMG certificate
2) then write USMLE Step 3

See, USMLE Step 3 is an exam that doctors write while they


are in their first year of residency or so, but to be eligible for
the H1-B, you need to have passed USMLE Step 3 BEFORE

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starting the residency and before applying for the H1-B visa.
So this may require some extra time. Also, you will need to get
a knowledgeable immigration attorney to help you with the paperwork for this visa.
Now, 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.

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QUESTION 37
Hi, can you tell me what are the options available for nonU.S. citizen to be able to work in a residency program?
There are three (3) main options: J-1 Visa, H1-B Visa and the
Green Card (GC). Here is some info about each:
1) J-1 Visas (Non-Immigrant)

The J-1 Exchange Visitor Visa allows foreign citizens


to receive graduate medical education and training in the
United States. The purpose of the J1 Visa is to promote
the exchange of medical knowledge and skills.
REQUIREMENTS FOR A J-1 VISA
a. You must provide a Statement of Need from your home
countrys ministry of health to demonstrate that your country is in need of the skills and knowledge that you plan to
acquire in the U.S..
b. You must become certified by the ECFMG.
c. You must obtain a written statement from the accredited
U.S. residency program that agrees to sponsor your visa.
Once you have fulfilled these requirements, the ECFMG will
send you an IAP-66 Form. You can use this form to obtain your
J-1 visa at the nearest American embassy or consulate in your
country.
J-1 VISA TERMS
The J-1 visa requires you to return home for at least two years
after you complete your residency training. This ensures that your
home country will benefit from the medical knowledge you will

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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)

Also known as the Work Permit Visa, the H-1B visa


authorizes foreign professionals to accept temporary employment in the U.S. for up to six years. The H-1 visa might
severely restrict your medical residency options because
many teaching hospitals in the U.S. will not sponsor foreign doctors on H-1 visas.
REQUIREMENTS FOR THE H-1B VISA
a. You must be fully licensed in the U.S. state where you
intend to enter a medical residency.

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b. You must have a medical degree from a foreign or U.S.


medical school, or you must have a full and unrestricted
license to practice medicine in a foreign country.
c. You must pass Steps 1, 2, and 3 of the USMLE and demonstrate proficiency in written and oral English.
d. After remaining in the U.S. for a maximum period of six
years, you must live abroad for one year before you can
return to the U.S. on a new visa.
3) Permanent Resident Status (The Green Card)

To take up permanent residence in the United States, you


must obtain an immigrant visa or Green Card. If you
have secured a state medical license and a J-1 waiver, you
might qualify for permanent resident status. Be advised
that applying for a Green Card can be a very complicated
legal process; please consult the USCIS or a qualified immigration lawyer for more detailed information.
Whether or not youre a physician, you can get a Green Card if:
a. You are an immediate relative of a U.S. citizen or permanent resident.
b. You receive a Green Card through the national Green
Card Lottery.
c.

An employer sponsors your application.

1. IMMEDIATE RELATIVES OF CITIZENS OR


PERMANENT RESIDENTS

You might be eligible for a Green Card if you are the


spouse, child, sibling or parent of a U.S. citizen or you are
the spouse or unmarried child of a permanent resident in
the U.S.

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175

Before you can receive a Green Card, the relative whose


citizenship or permanent resident status qualifies you for
the Green Card must file a Petition for Alien Relative
on your behalf. In the petition, this relative must provide
documentation of (1) his or her citizenship or permanent
resident status and (2) his or her relationship to you.
After the petition has established your relationship to a
citizen or permanent resident, you must complete more
forms to demonstrate that you meet other requirements for
permanent resident status. You must prove, for example,
that you do not suffer from a mental defect or contagious
disease, that you are not a member of the Communist
party, a criminal, a terrorist or that you do not smuggle
or sell illegal drugs.
Because the conditions determining which alien relatives
can receive a Green Card are very complex, you should
consult the INS and perhaps even an immigration lawyer
before beginning the application process.
2. GREEN CARD LOTTERY

If you come from a country that normally doesnt send


many immigrants to the U.S., you might qualify for one of
55,000 Green Cards issued each year through the Green
Card Lottery. To learn more about the lottery, see the
information supplied by the USCIS.
Also, be wary of companies or individuals who claim they
can increase your chances of success in the lottery; the
Federal Trade Commission has determined that most of
these claims are fraudulent.
3. EMPLOYMENT

Most IMGs seeking a Green Card have to rely on a spon-

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soring employer. The USCIS grants permanent resident


status to IMGs whose long-term employment will benefit
the United States. In other words, youll have a better
chance of obtaining a Green Card if youre a primary care
physician who agrees to work in a medically underserved
area.
If you dont meet these criteria, then your employer will have
to certify that no fully qualified United States citizen has applied
for your job. This certification process can be very complicated
and time-consuming.
Finally, if you can show that you possess extraordinary professional qualification, you might qualify for a Green Card without
committing to a primary care position in an underserved area

Residency Training
QUESTION 38
With the doctor shortage here in Ontario, will it really be
that difficult to return to this province to practice (even if I
went up to an under serviced region of the province)?
The question about the doctor shortage in Ontario is rather
interesting. Rural areas are the place. These websites have some
recent info on this topic:
Rural Ontario Medical Program www.romponline.com
The whole coming back to Canada is always an issue of debate.
Several Canadians at my school were set on getting back into
Canada, but ended up moving to the U.S..
They always put these doctor shortage stories in the paper
and get peoples hopes up. Most recently the CFPC (College of
Family Physicians of Canada) www.cfpc.ca issued a statement

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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

2) U.S. clinical experience


3) U.S. citizen or not

4) Letter of reference from U.S. doctors


Although there are several other things they look at. As for
me, I am not a U.S. citizen, so that presented the biggest problem
for me. I applied for Family Medicine so that is a good choice,
since there are many spots and it is not as competitive as some
of the other residency programs.
QUESTION 40
What if a Canadian does NOT wish to practice medicine
in the U.S. or Canada? Rather, that person wishes to practice
in the Caribbean. Do you know (which might save me some
research) how the Caribbean nations view their own medical
training? With and without U.S. residency?

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Practicing in the Caribbean. Well, each Caribbean island is an


independent country. So they have their own rules and regulations. Some islands, like Saba, St. Maarten, St. Eustatius, Curacao,
Bonaire and Aruba belong to the Netherlands (those six islands
comprise the Netherlands Antilles). So practicing medicine
there would be under the jurisdiction of the Netherlands Antilles.
If you contact them, I am sure they can tell you what the steps
are. Most Caribbean medical schools educate students to go back
to the U.S. so very few students (if any) stay in the Caribbean
afterwards.
One exception I can think of is The University of the West
Indies. This medical school is designed to educate Caribbean
students, so this schools graduates are the ones that eventually
live and practice in the Caribbean. Perhaps contacting this school
can give you some info on this topic.
QUESTION 41
What is the ECFMG and how does it fit in the whole scheme
of tests in becoming a fully-fledged physician?
Basically its very straightforward. To get a residency in the
U.S. you have this path:
a) Write and pass the USMLE Step 1
b) Write and pass the USMLE Step 2 CK
c) Write and pass the USMLE Step 2 CS (Clinical test)
d) Graduate from your medical school, obtain your diploma
(M.D. degree)
e) Get ECFMG certificate (they will send it to you once you
have completed the above four things)
At this point you can start a residency in the U.S.

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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.

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5) Research experience and scientific journal publications


during your medical school years.
6) Interesting hobbies and extracurricular activities.
7) Your application personal statement.
8) Any advanced degrees that you may have like PhD, MBA,
MPH, etc.

QUESTION 43
What is the difference between ERAS (Electronic Residency
Application Service) and the NRMP (National Residency
Matching Program)?
Both ERAS (The Electronic Residency Application Service)
and the NRMP (The National Resident Matching Program)
are programs run by the AAMC (The Association of American
Medical Colleges). The AAMC has its home page located at:
www.aamc.org. I highly suggest reading through its contents.
ERAS (The Electronic Residency Application Service) is simply the common application to apply to the residency programs
that are using it. It is simply an electronic application, and nothing more. It is just like the AMCAS-E used to apply to medical
schools or just like a common application that many undergraduate universities and colleges will accept from high school students.
The ERAS application software has included in it places to write
your personal statement (why I want to be a ____ (you insert
your choice of specialty here). It also has: a place to enter your
past education, including any undergrad, grad school, or other
medical schools attended; a place for all the contents of a typical Curriculum vitae (resume); it asks for all of your USMLE
board scores; it has a place to have a photograph scanned in; your
transcripts from college through medical will be scanned in; and

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181

many other application-related things.


It also has an area where you check off the boxes to programs
that you want to apply to. I suggest that you look through the
ERAS website yourself to find out more information, its located
at: www.aamc.org/eras. Not all specialties and programs participate
in ERAS, some still accept paper-typed applications. The specifics can be found in the ERAS website. All in all, ERAS is the
common application that hundreds of residency programs accept.
Now I will explain the function of the NRMP (The National
Residency Matching Program). Once you have applied to the
residency programs through ERAS, some will contact you for
an interview and the rest will just reject you. Once you have interviewed at the residency programs, you do the following: The
applicant ranks all of the programs from 1 to, lets say, 15 that
he or she interviewed at. The residency program ranks the applicants that it wants, lets say, 1 to 20. The applicant submits his
or her rank order list to the NRMP and the residency program
submits its rank order list to the NRMP. Each year, the lists are
due by mid-February and if you fail to submit a list, then you are
withdrawn (thrown out!) from the Match. A computer at NRMP
headquarters in Washington DC runs both sets of lists and with
a special algorithm, goes down both partys lists and matches
up the programs with their most desirable candidates that also
ranked them highly (the algorithm is actually very complex).
In mid-March, the results of the Match are announced and
the residency programs find out who they got, and the applicants
find out where they will be spending the next few years. Now, the
contract that you signed when you filled out your NRMP Match
Independent Applicant Agreement stated (and you signed) that
the Match result will be binding and you will go wherever you
were Matched to. The moral of the story is that one can only get
matched to a place that he or she has ranked and people do not
have to rank all places that they applied to.
98% of residency programs in the U.S. use the NRMP Match
to select candidates for their programs.

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On to the pre-match/out-of-match offers that IMGs can get:


Now the IMG loophole in the system. All U.S. medical graduates are bound by their schools to stay within the NRMP Match
and obtain their spot this way. Well luckily, as IMGs, we are not
bound by this same rule. This means, at any time, an IMG may
sign a contract during or after one of his residency interviews
and then drop out of the Match. Also, if an IMG makes good
contacts during his or her rotation in teaching hospitals in the
U.S., he or she is free to just sign a contract with that program
and doesnt even have to apply through the regular application
process.
For specific information on any particular residency program, including number of applicants, etc., please check out
AMA-FREIDA (The American Medical Associations Fellowship and Residency Interactive Database Access) located
at: www.ama-assn.org/go/freida. When in the site, just click
on GME Programs and Main Institution Search, then pick out
programs, by specialty and location.
So, everyone must apply through ERAS and register with the
NRMP simultaneously!
You can call the NRMP at (202)828-0566 and request an
Independent Applicant Handbook which is free and has all of
the important statistics on this past Match as well as all of the
import rules and regulations on participating in the Match. In
my class, of the people that are starting residency now, I would
say that 85% of the students got their position through Match,
while 15% or so got their position either pre-match or out-ofmatch. Some, but very few, obtained their positions through the
NRMP Match Scramble.
Plan on going through the Match, and if you end up signing a
contract outside of it, then thats a nice surprise, but dont count
on that method.

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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

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the specialty that he or she did a residency in, pass it and then
the graduate is free to go and join a practice as a Board Certified
Physician. 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.

FREQUENTLY ASKED QUESTIONS

185

The mother of a friend of mine was an OBGYN in India, had


been board certified, well-published, and had practiced OBGYN
there (in India) for about 20 years. When she moved to the U.S.,
she was told that she had to start over and she would get absolutely no credit for all of the time that she invested, but she was
welcome to take the exams, get ECFMG certified and apply for
a Psychiatry residency in the U.S. After attempting the USMLE
exams several times, she was unable to pass them and she finally
gave up the dream. She is currently working at a retail clothing
store in the Los Angeles area.
For many people that do pass all of the exams, most are rejected
from residency programs for any combination of the following
reasons: no meaningful U.S. clinical experience, being too old
(most residency programs would like people in their late 20s
and early 30s), and having an F somewhere on their USMLE
exam transcript (if you cant pass on the first attempt, most places
wont even look at you!). This story is a very common one among
foreign grads.
QUESTION 46
Can you please give me the contacts of organizations pertaining to this whole International Medical Graduate issue?
Sure! Here are the contact information and web links:
United States Medical Licensing Exam Secretariat
3750 Market Street
Philadelphia, PA 19104-3190
Phone number: 215/590.9600
www.usmle.org
The USMLE Secretariat provides general information about
all three Steps of the USMLE, including extensive information
about the new computer-based USMLE. However, do NOT

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Caribbean Medical Schools | A Journey and Guide

contact the USMLE with questions about registration for any


Step of the USMLE. Instead, contact the agency from which
you will request, or have requested, your eligibility permit (listed
below) if you have questions or concerns.
National Board of Medical Examiners
Department of Licensing Examination Services
3750 Market Street
Philadelphia, PA 19104-3190
Phone number: 215/590.9700
www.nbme.org
The NBME prepares all three Steps of the USMLE in cooperation with the Federation of State Medical Boards of the
U.S., Inc. It also handles the provision of eligibility permits that
are required in order to schedule and sit for the computer-based
USMLE at Sylvan Technology Centers to students and graduates
of U.S. and Canadian medical schools.
NBMEs website also offers extensive information about all
three Steps of the USMLE, including news on changes in passing scores and historical pass rates. The NBME does not provide
assistance to international medical graduates who wish to take,
or have already taken, one or more Steps of the USMLE. See
ECFMG.
Federation of State Medical Boards of the U.S., Inc.
Department of Examination Services
400 Fuller Wiser Road, Suite 300
Euless, TX 76039-3855
Phone number: 817/571.2949
www.fsmb.org
The FSMB is the collective body of individual state medical
boards and co-sponsor of the USMLE program, along with the
NBME. If you plan to practice medicine in any state, you must

FREQUENTLY ASKED QUESTIONS

187

contact that states medical board to complete the process of


getting a license.
Additionally, all physicians must apply for eligibility permits
to take Step 3 with the individual state medical board where you
wish to practice, no matter where or when you went to medical
school.
The FSMBs contact information is provided here so that you
can contact it if you are unable to locate and contact the state
medical board where you need to register for Step 3.
National Resident Matching Program
2501 M Street, NW, Suite 1
Washington, DC 20037-1307
Phone number: U.S. seniors, hospitals and residency programs
may call 202/828.0676
Independent applicants may call 202/828.0566
www.nrmp.org
The NRMP administers the Match, a computer program
that places participating graduating seniors and independent
graduates with residencies.
Match participants must still apply directly to the residency
programs in which they are interested.
Accreditation Council for Graduate Medical Education
515 North State Street, Suite 2000
Chicago, IL 60610-4322
Phone number: 312/464.4920
www.acgme.org
The ACGME publishes the CD-ROM version of the Graduate
Medical Education Directory, a complete catalog of residency
programs in the U.S. that, when completed, meet the pertinent
requirements for licensure in each state. You may order it directly
from their website, using a credit card.

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American Medical Association


Ordering Department
P.O. Box 7046
Dover, DE 19903-7046
Phone number: 800/621.8335
www.ama-assn.org
The AMA, among other things, publishes the printed version
of the Graduate Medical Education Directory, or Green Book,
as it is more commonly known. You may call the AMA publications order department at the above number or order the Green
Book online at the above internet address.
ECFMG
3624 Market Street
Philadelphia, PA 19104-2685
Phone number: 215/386.5900
www.ecfmg.org
If you graduated from a medical school outside the U.S. and
Canada, you must apply for your eligibility permits to take Steps
1 and 2 with the ECFMG, even if you are a U.S. national. The
ECFMG does not dispense information about, nor assist with,
eligibility permits to take Step 3. See FSMB.
QUESTION 47
It sounds like even after one obtains a residency, there is a
chance that the person will not get licensed. How so?
Well, throughout my residency application and interview process, I applied to 53 residency programs. Not a single one checked
whether any of the hospitals that I listed where I did my rotations
was an ACGME accredited teaching institution. This may sound
like a good thing, but it is actually not. Most programs do not

FREQUENTLY ASKED QUESTIONS

189

care whether or not you did rotations in teaching hospitals, but


whether or not these hospitals were U.S. hospitals. This is a pretty
bad thing. Why? Because as a foreign grad, you are not eligible
to apply for a state license to practice unrestricted medicine until
after you have finished at least three years of residency training.
The states that issue these licenses do care where you did your
medical school rotations. Now, each state has its own rules and
regulations with regard to what its definition of a teaching hospital is, as well as how many weeks of each specialty, and how
many weeks total have to be done in teaching hospitals!
I highly suggest that you seriously think about which states
you might want to eventually practice in, and contact the state
medical board in that state, and have them send you a copy of
their physician licensure application as well as their rules for
IMGs that apply for medical license. You can find out the phone
numbers and addresses of these state boards on the following
website: www.fsmb.org.
Yes, it is possible to do a residency in one state and have a
license to practice in that state because of where you did your
medical school rotation. This would mean that you either have
to hire a lawyer to help you fight the system, or just move to a
state with easier licensure regulations. It does happen, people do
get burned. Make sure that you are fully aware of state medical
licensure regulations before you begin your rotations!
QUESTION 48
What are the procedures to obtain a license, and in what
aspect to people (or the school) fail?
As stated above, not knowing the rules and regulations can
stop a medical career dead in its tracks. The license application
involves a review of every month of your time since graduation
from high school. They review your undergrad record, MCAT
scores, med school record, hospital rotation record, residency

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Caribbean Medical Schools | A Journey and Guide

record, all of your jobs and extracurricular activities, and most


importantly, your USMLE score record. Each state also sets a
limit on the number of USMLE attempts that they will accept
before denying a license application. For example, most states
say that you have to pass USMLE Step 1, Step 2 and Step 3 all
within 7 years of passing the first step to be eligible for a license.
Also, many states say that if you have more than three failures
on your USMLE transcript, you are not eligible for a license.
I highly suggest that you go to your medical schools library
and get a copy of the AMAs Green Book, turn to the appendix
section and read the table on USMLE performance for foreign
medical grads and licensure regulations.
NOTE: If after reading this entire compilation there is still
something that has not been answered for you, then please post
your questions in the forums at www.CaribbeanMedicine.com in
the Ask Admin section, and I will gladly try to answer those
questions for you.

ABOU T THE AU THOR

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

TESTIMONIALS ABOU T THIS BOOK

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,

R.N. parent, Caledon, Ontario

Dear Asad Raza,

I just finished reading the book. No regrets about buying it. My


money is beyond worth it. Greatly informative and educational! I
could not have gathered up so much information in such a short
time. Many thanks!!!!!
Best Regards,
K.A. Florida, USA

194

Caribbean Medical Schools | A Journey and Guide

I went from knowing nothing to knowing everything about


Caribbean medical schools after reading this.

B.K. University of Toronto

With the help of this site and this book I am in a much better
positionand have definitely decided where I will be attending
medical school this fall.

K.S. Univ. California at San Francisco

I did not even know that there were med schools in the Caribbean, and now I have gained admission and will be attending one.
F.G. Univ. of British Columbia

The key about this information is that it is an actual story of


someone who attended a medical school in the Caribbeannot
just some info copied from the websites of the school.
M.H. - Australia

Even with a good GPA and MCAT, I could not gain admission
into any of the New York state medical schools, so I got your
book thanks so much!
A.S. Columbia University

I applied to med school here in Texas for three years, and I did
not get in. So I wanted to attend a foreign med school and be
able to come back here for residencyI am glad I found this
information.
P.T. Baylor University

TESTIMONIALS ABOU T THIS BOOK

195

Several of my classmates also planned on studying medicine,


but didnt get accepted into an Ontario med schoolthe book
has helped us out in more ways than we can express. Thank you
for showing us this path!
J.M. Univ. of Western Ontario

There is so much important and crucial info in your bookI will


keep it and refer to it throughout my four years in med school
it has been a valuable source.
A.D. Univ. of Illinois at Chicago

I purchased two other books about foreign medical schools


they were a waste and very outdatedthis file is up-to-date and
very easy to follow.
B.T. McMaster University

Ill be graduating from Saba University this year and have


matched into emergency medicine. Your website and information were a huge help to methe information and open letter
to Canadian students is exceptional.

J.V.L. Michigan State University

After four horrible years at U of T, I had given up on all my


goals this info showed me much better optionsthank you
sincerely.
L.R. University of Toronto

_____________________

When I come this country, I have no luggage,


today what I got? own bloody business see
_____________________
Om Puri
East is East, 1999

DISCLAIMER: All information in this compilation is offered to the public in good faith. However, it is still up to the public to verify the information. I assume no responsibilities toward whatever
acts (direct or indirect) that may ensue as a result of reading this compilation. I strongly recommend
contacting many, many people before making a final decision.
Copyright 1999-2012 Asad Raza. All rights reserved

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