Offshore medical school

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An offshore medical school is a medical school that caters "primarily to foreign (American and Canadian citizens) students, wishing to practice medicine in the US and Canada" according to the World Bank, [1] compared to local schools that focus on their home nation. [2] [3] Such schools are chiefly located in the Caribbean basin, [4] but also includes schools in other locations, such as Mexico (Universidad Autónoma de Guadalajara School of Medicine) [5] [2] and Australia (University of Queensland Ochsner program), [6] [7] which run programs that target American students.

Contents

Education

Offshore medical schools often specialize in the Medical Doctor degree, while US and Canadian medical schools are often departments of universities that offer several degrees. The curriculum of offshore medical schools in the Caribbean follows the one in US, as they usually only offer two years of basic science study and use teaching hospitals or clinics in US or Canada, sometimes in UK for clinical training. [8] [4]

The teachings often focus on the United States Medical Licensing Examination (USMLE) and the Educational Commission for Foreign Medical Graduates (ECFMG) certification process, and the measurement of performance is the passing rate of students in the exams. In most schools, passing of the USMLE Step 2 exam is required to graduate and get a M.D. degree. [1]

In most schools, the academic calendar is divided into 3 academic terms per year, with semesters starting in January, May and September. [8] [4] The lack of a summer break offers students a potentially faster route than US medical schools to a degree with a compressed curriculum.

Student body

Caribbean offshore medical schools have less than 5% local students; the rest are mainly from North America. Students are also relatively older than their North America counterparts. As of 2004, the average ages in schools are 27–30 years old, and half of them are nurses, paramedics, physician assistants, etc. on their second career. Whether a school has state board accreditation or is recognized by loan programs appear to have great influence on the number of applicants, and the effect is seen in the size of student body. [1] Between 1993 and 2007, the mean age of first time ECFMG certification exam applicants from Caribbean offshore medical schools was 29.5 years, and 38% of the applicants were female. The passing rate were 57.4% for the USMLE Step 1 but results varies wildly by country. [9]

Accreditation and recognition

There is no central authority for accreditation as rules and regulations in many Caribbean countries differ greatly. CAAM-HP [4] is a local accreditation body, while ACCM, based in Ireland, is invited by some countries to accredit on their behalf. [10] [11]

The Medical Board of California recognizes only four offshore medical schools in the Caribbean as providing medical education that is equivalent to American schools: [3] St. George's University School of Medicine, Ross University School of Medicine, American University of the Caribbean School of Medicine, Saba University School of Medicine. The California list of recognized schools is used by boards of medicine from several U.S. states (e.g. Colorado, Oregon, Indiana and Tennessee). [12]

The New York Department of Education maintains a list of the schools that have been approved to allow students to complete more than 12 weeks of clinical clerkships in New York State. As of 2021, it included: [13]

Admissions

While admission to American medical schools is highly competitive, [14] standards are generally lower for offshore medical schools. Thus, more American graduates with less than stellar resumes are accepted. The challenge for most of these students is graduating and matching into residency programs in the United States. [15]

History

In the 1970s, American entrepreneurs, noticing high demand for medical education not being met by US schools, started the business of training North American students in offshore universities in the Caribbean. [2] Caribbean countries were selected to locate these medical schools due to the less demanding regulatory environment compared to the United States or Canada. In the late 1970s, three schools were started: St. George's University School of Medicine (Grenada, 1976), Ross University School of Medicine (Dominica, 1978, later moved to Barbados), American University of the Caribbean (Montserrat, 1978, later moved to Sint Maarten). [2] Since then, there has been a steep increase in the amount of offshore medical universities (see table below). [16]

The increasing number of schools has both positive and negative effects. On one hand, low initial cost in establishment increased competition, that in turn increases the quality of service. On the other hand, this created a big demand in clinical rotations that even the large states have problem accommodating, [17] let alone their home country, and draw attention from US and Canada auditors who are concerned over public loan use. [18] [19]

New Offshore Caribbean Medical Schools by Decade 1970s-2010s
YearNumber of New Schools (still operational)Countries
1970s3Barbados, Dominica, Montserrat
1980s3Antigua and Barbuda, Dominican Republic, Saint Lucia
1990s9Anguilla (UK), Barbados, Belize, Cuba, Guyana, Saba (NL), Saint Kitts and Nevis, Saint Vincent and the Grenadines
2000s19Antigua and Barbuda, Aruba (NL), Belize, Cayman Islands (UK), Curacao (NL), Dominica, Guyana, Montserrat (UK), Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines
2010s23Antigua and Barbuda, Aruba (NL), Barbados, Curacao (NL), Guyana, Jamaica, Montserrat (UK), Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines

Local impact

Nonetheless, the local economies often benefit from the academic and economic influence from those schools. [1] Instead of getting research grants and local government funds, offshore schools often depend on wealthy students from out of country. The spending by foreign students and faculty, as well as increased local employment is a significant factor in the local economy. [1] When schools grow, they often do construction on campus, which increase demand for material and instruments. The local healthcare industry also receive financial and educational help from offshore schools in exchange of clinical experience of students.

Impact of offshore medical school on the United States of America

As an example of the significance of offshore medical schools, in 2007, two such schools—St. George's University School of Medicine and Ross University— had more graduates (1,644 and 1,591, respectively) in Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs than any American medical school. [4] Five offshore Caribbean medical schools combined for 73% of the total number of international students entering family medicine residencies in the United States of America according to the Society of Teachers of Family Medicine: Ross University School of Medicine, St. George’s University School of Medicine, American University of the Caribbean School of Medicine, American University of Antigua College of Medicine, and Saba University School of Medicine. [20] A study conducted in 2019, indicated that international medical graduates account for 23.8% of the family medicine workforce, of those one third attended medical school in the Caribbean, [21] and more than 25% attended off-shore Caribbean medical schools. [22] Moreover, these medical schools have been credited to produce a significant portion of the primary care specialists who work in medically underserved and low income areas. [23]

See also

Related Research Articles

The Association of American Medical Colleges (AAMC) is a nonprofit organization based in Washington, D.C. that was established in 1876. It represents medical schools, teaching hospitals, and academic and scientific societies, while providing services to its member institutions that include data from medical, education, and health studies, as well as consulting. The AAMC administers the Medical College Admission Test and operates the American Medical College Application Service and the Electronic Residency Application Service. Along with the American Medical Association (AMA), the AAMC co-sponsors the Liaison Committee on Medical Education (LCME), the accrediting body for all U.S. MD-granting medical education programs.

The United States Medical Licensing Examination (USMLE) is a three-step examination program for medical licensure in the United States sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Physicians with a Doctor of Medicine (MD) degree are required to pass the USMLE for medical licensure. However, those with a Doctor of Osteopathic Medicine degree (DO) are required to take the COMLEX-USA (COMLEX) exams but may also sit for the USMLE as well.

According to the US Department of Education, the Educational Commission for Foreign Medical Graduates (ECFMG) is "the authorized credential evaluation and guidance agency for non-U.S. physicians and graduates of non-U.S. medical schools who seek to practice in the United States or apply for a U.S. medical residency program. It provides comprehensive information and resources on licensure, the U.S. Medical Licensure Examination (USMLE), residencies, and recognition."

<span class="mw-page-title-main">Medical education</span> Education related to the practice of being a medical practitioner

Medical education is education related to the practice of being a medical practitioner, including the initial training to become a physician and additional training thereafter.

The United States Medical Licensing Examination (USMLE) Step 1 is a standardized test that assesses a medical student's knowledge of basic science concepts and their application to clinical medicine. The exam is one of three components required for medical licensure in the United States and is typically taken by students after their second year of medical school.

USMLE Step 2 CK is a nine-hour-long exam that represents the second part of the United States Medical Licensure Examination. It assesses clinical knowledge through a traditional, multiple-choice examination divided into eight 60-minute blocks, each containing up to 40 questions, as well as an hour of break time. In contrast to USMLE Step 1, which prioritizes knowledge of basic sciences, the focus of Step 2 is on clinical application of medical knowledge, and requires the examinee to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. The USMLE Step 2 is generally taken during the third or fourth year of medical school by U.S. medical students. Step 2 results are reported numerically on a scale between 1 and 300; this is in contrast to Step 1, which is pass/fail only.

<span class="mw-page-title-main">St. Matthew's University</span> For-profit Cayman Islands university

St. Matthew's University (SMU) is a private for-profit offshore medical school located in Grand Cayman, Cayman Islands in the Caribbean. SMU has a School of Medicine and a School of Veterinary Medicine, which confer M.D. and D.V.M. degrees, respectively. St. Matthew's University is owned by R3 Education, Inc.

The Liaison Committee on Medical Education (LCME) is an accrediting body for educational programs at schools of medicine in the United States and Canada. The LCME is sponsored by the Association of American Medical Colleges and the American Medical Association.

<span class="mw-page-title-main">Medical University of the Americas – Nevis</span>

Medical University of the Americas (MUA) is a private for-profit offshore medical school in Charlestown, Nevis. It is owned by R3 Education, Inc. which also owns St. Matthew's University and Saba University School of Medicine MUA confers upon its graduates the Doctor of Medicine (MD) degree.

An international medical graduate (IMG), earlier known as a foreign medical graduate (FMG), is a physician who has graduated from a medical school outside of the country where he or she intends to practice. The term non-local medical graduate may be similarly used in countries with distinct licensing regions within them. Generally, the medical school of graduation is one listed in the World Directory of Medical Schools (WDOM) as accredited by the Foundation for Advancement of International Medical Education and Research or the World Health Organization.

<span class="mw-page-title-main">Saba University School of Medicine</span>

Saba University School of Medicine is a private for-profit offshore medical school located on Saba, a special municipality of the Netherlands in the Caribbean. Saba University confers upon its graduates the Doctor of Medicine (MD) degree. It is owned by R3 Education, Inc. Devens, Massachusetts which also owns St. Matthew's University and the Medical University of the Americas

Medical school in the United States is a graduate program with the purpose of educating physicians in the undifferentiated field of medicine. Such schools provide a major part of the medical education in the United States. Most medical schools in the US confer upon graduates a Doctor of Medicine (MD) degree, while some confer a Doctor of Osteopathic Medicine (DO) degree. Most schools follow a similar pattern of education, with two years of classroom and laboratory based education, followed by two years of clinical rotations in a teaching hospital where students see patients in a variety of specialties. After completion, graduates must complete a residency before becoming licensed to practice medicine.

Most physicians in the United States hold either the Doctor of Medicine degree (MD) or the Doctor of Osteopathic Medicine degree (DO). Institutions awarding the MD are accredited by the Liaison Committee on Medical Education (LCME). Institutions awarding the DO are accredited by the Commission on Osteopathic College Accreditation (COCA). The World Directory of Medical Schools lists both LCME accredited MD programs and COCA accredited DO programs as US medical schools. Foreign-trained osteopaths do not hold DO degrees and are not recognized as physicians in the United States or in other jurisdictions.

<span class="mw-page-title-main">Ross University School of Medicine</span> Caribbean medical school in Barbados

Ross University School of Medicine (RUSM) is a private, for-profit medical school. Its main campus is in Barbados, and its administrative offices are in Miramar, Florida. Until 2019, the university's main campus was in Portsmouth, Dominica. RUSM is owned by Adtalem Global Education Inc.

The American University of Integrative Sciences (AUIS), is a private for-profit offshore medical school with a single campus located in Barbados. Founded in 1999, it was formerly known as the University of Sint Eustatius School of Medicine (USESOM). For a period, the school was based in Sint Maarten, where it was taken over by IEMR LLC, a US-based company. Since October 2017, AUIS has operated in Barbados, and it is currently a candidate for accreditation by the Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP).

Saint James School of Medicine (SJSM) is a private for-profit offshore medical school with two basic science campuses, one in British Overseas Territory of Anguilla, and the other in Saint Vincent and the Grenadines, it is considered one school with two campuses. Saint James confers upon its graduates the Doctor of Medicine (M.D.) degree.

<span class="mw-page-title-main">National Board of Medical Examiners</span> Medical accreditation board

The National Board of Medical Examiners (NBME), founded in 1915, is a United States non-profit which develops and manages assessments student physicians. Known for its role in developing the United States Medical Licensing Examination (USMLE) in partnership with the Federation of State Medical Boards (FSMB), USMLE examinations for medical students and residents are used by medical licensing authorities in the U.S. to help determine qualifications to grant and recognize medical licenses. NBME also creates assessments and materials that are used by medical students, medical educators, practicing physicians, and for state testing of physicians already holding licenses.

The Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP) is an accrediting body for the education programmes and schools of medicine, dentistry, veterinary medicine, nursing and other health professions in the 15 member nations of the Caribbean Community (CARICOM). CAAM-HP was established in 2003 and is headquartered in Kingston, Jamaica.

<span class="mw-page-title-main">Avalon University School of Medicine</span> Medical school in Willemstad, Curacao

Avalon University School of Medicine (AUSOM) is a private medical school located in Willemstad, Curaçao, in the Caribbean. AUSOM confers upon its graduates the Doctor of Medicine (MD) degree. Administrative offices for the university are located in Youngstown, Ohio.

<span class="mw-page-title-main">Mercer University School of Medicine</span> Medical school of Mercer University

Mercer University School of Medicine (MUSM) is the graduate medical school of Mercer University and a component of the Mercer University Health Sciences Center. It was founded in 1982 in Macon, Georgia, United States, and in 2008 opened a second campus in Savannah, Georgia with either site allowing students to complete all four requisite years of medical training. In 2012 MUSM developed a third site in Columbus, Georgia at which students could elect to complete their third and fourth years of training. In 2021, the Columbus transitioned to a full four-year campus.

References

  1. 1 2 3 4 5 "Offshore Education in the OECS, By Swedish Development Advisers AB, The World Bank" (PDF). September 2004.
  2. 1 2 3 4 Sheldon Mclean (January 2018). "A global value chain analysis of offshore medical universities in the Caribbean". Studies and Perspectives. United Nations. ISSN   1728-5445 . Retrieved 15 May 2021.
  3. 1 2 Parolini, Antonella; Platek, Cindy (June 2010). "Offshore Medical Schools in the Caribbean". Credential Evaluators, World Education Services. 23 (5).
  4. 1 2 3 4 5 N. Lynn Eckhert (April 2010). "Perspective: Private Schools of the Caribbean: Outsourcing Medical Education". Academic Medicine. 85 (4): 622–630. doi: 10.1097/ACM.0b013e3181d2aee1 . PMID   20354377.
  5. ↑ Eckhert, N. Lynn (2010). "Perspective: Private Schools of the Caribbean: Outsourcing Medical Education". Academic Medicine. 85 (4): 622–630. doi: 10.1097/ACM.0b013e3181d2aee1 . PMID   20354377.
  6. ↑ "Clinical Schools" . Retrieved 15 May 2021. The offshore clinical school of Ochsner...
  7. ↑ "Offshore Medical Schools Presentation and Panel Discussion — Hunter College".
  8. 1 2 "Overview – Caribbean Accreditation Authority for Education in Medicine and Other Health Professions".
  9. ↑ van Zanten Marta; Boulet John R (2008). "Medical Education in the Caribbean: Variability in Medical School Programs and Performance of Students". Academic Medicine. 83 (10): S33–S36. doi: 10.1097/ACM.0b013e318183e649 . PMID   18820496.
  10. ↑ "Agencies with Recognition Status - World Federation for Medical Education". 9 February 2017.
  11. ↑ "Accreditation Commission on Colleges of Medicine".
  12. ↑ Stephen M. Boreman (16 January 2017). "Accreditation of Foreign Medical Schools in California" . Retrieved 7 May 2021.
  13. ↑ "NYS Medicine:Application Forms". www.op.nysed.gov. Retrieved 9 May 2021.
  14. ↑ "Find the Best Medical Schools".
  15. ↑ "'It's Tough to Get Out': How Caribbean Medical Schools Fail Their Students". The New York Times. 29 June 2021.
  16. ↑ van Zanten Marta; Boulet John R (2011). "Medical Education in the Caribbean: A Longitudinal Study of United States Medical Licensing Examination Performance, 2000–2009". Academic Medicine. 86 (2): 231–238. doi: 10.1097/ACM.0b013e3182045efe . PMID   21169783.
  17. ↑ Students From Caribbean Med Schools Head for New York, Angering Some Local Programs, By Katherine Mangan, The Chronicle of Higher Education, December 12, 2010, http://chronicle.com/article/Students-From-Caribbean-Med/125681/
  18. ↑ U.S. Government Accountability Office. Foreign Medical Schools: Education Should Improve Monitoring of Schools That Participate in the Federal Student Loan Program. http://www.gao.gov/new.items/d10412.pdf. Accessed March 11, 2013.
  19. ↑ Korcok M (1997). "After rejection in Canada, more Canadians pursuing career dreams at offshore medical schools". CMAJ. 156 (6): 865–7, 870. PMC   1227058 . PMID   9084396.
  20. ↑ Stanley M. Kozakowski; Alexandra Travis; Ashley Bentley; Gerald Fetter Jr. "Entry of US Medical School Graduates Into Family Medicine Residencies: 2015–2016". stfm.org. Society of Teachers of Family Medicine. Retrieved 11 April 2021.
  21. ↑ Duvivier, Robbert J.; Wiley, Elizabeth; Boulet, John R. (2019). "Supply, distribution and characteristics of international medical graduates in family medicine in the United States: a cross-sectional study". BMC Family Practice. 20 (1): 47. doi: 10.1186/s12875-019-0933-8 . PMC   6441164 . PMID   30927914.
  22. ↑ Duvivier, R. J.; Wiley, E.; Boulet, J. R. (2019). "Table 4 Medical School Attended for Practicing IMGs in Family Medicine (top 15)". BMC Family Practice. 20 (1): 47. doi: 10.1186/s12875-019-0933-8 . PMC   6441164 . PMID   30927914.
  23. ↑ Amy Keller (7 April 2022). "Filling the doctor gap will require a range of responses". floridatrend.com. Retrieved 18 April 2022.
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