As you can read on my About page, I went to a Caribbean Medical School by the name of American University of the Caribbean (AUC for short). Usually the initial response I receive when people found out that I went to a Caribbean Medical School falls into one of these three categories:

1. Curiosity: Really? How does that work? Do you do all your rotations on the island too? Is it in English?
2. Jealousy (Fake or Real): Wow, I’m so jealous, I had to do all my stuff in [insert cold place name here], and you just sat on a beach…
3. Contempt: Oh, I guess you must have really messed up in college then, huh?

So let’s start with curiosity.

I think the majority of people who hear I went to a Caribbean Medical School usually are more curious about my experience than anything else. How exactly does it work?

The truth is, I didn’t really know how it worked either. Like I said in my About page I kind of fell into it during my senior year in college. After not getting into medical school, despite what I thought were decent grades and a decent MCAT score, I was distraught. I was going to fall “off the track”, and I began to re-examine my options. Do I go apply to a masters program somewhere? Or do I try to do research? Perhaps I should take some time off and study like a madman to improve my MCAT score? Those were my only options as I saw them. I was fully prepared to accept that as my fate and began to look into all the masters programs around, look into research positions, and thought about whether only improving my MCAT score would make a difference.

Then another option came out of nowhere.

A friend of mine told me about this school in the caribbean that had been around for quite a long time and had been pumping out doctors since it was founded back in 1978. At the time I had spent a good amount of time shadowing a pediatrician and had planned to go into pediatrics. Basically, there are 5 semesters on the island of St. Maarten, and then approximately 2 years of clinical rotations in the United States (or the UK). Five semesters? That isn’t too long. I’ll be back in the states before I knew it. My friend also said that there are three start points, either September, January, or May. He said he was going May 2003 which mean he would be back home in the states December 2004. Now then… did I want to come with him?

I did a little research and applied to AUC, St. George and Ross. I was accepted by all three. However, my friend was going to AUC, so it seemed like if I was going to go to a Caribbean school I should go with someone I knew… right? Now then… after all this rejection, perhaps I wasn’t in my right mind and didn’t think things through completely. However, this was my chance to move forward.  So I did it. I pushed forward.

Now let’s move on to jealousy.

Make no mistake, although St. Maarten is probably the most like the US out of the Caribbean schools (Dominica for Ross and Grenada for St. George), it is nothing like being in the United States. Although we did have some of the basic stuff, such as a McDonald’s, Burger King, movie theater, etc.. they weren’t exactly easy to get to, unless you had a car (which I didn’t). Additionally, I wouldn’t call the island itself inherently safe. The tourist areas were of course “nicer” than the rest of the island, but you must remember it is still an island. During the “down season” the island itself has little money coming in and well, the police are less than helpful.

I remember seeing two policemen passing each other in their patrol cars stop their cars in the middle of the road to have a chat. Mind you, this is a two lane road with each lane going in opposite directions. So these policemen were holding up traffic for a little chitchat… and then they both pulled out their beers for a drink. Not exactly the highest standard of duty there.

However, I would be remiss if I didn’t mention that I had access to some really excellent beaches pretty much the whole time I was on the island. Some other students took advantage of their living conditions, choosing to rent in places with nice views and easy access to the ocean. However, my friend and I decided to stay in the dorms for the whole 5 semesters, a decision I do not regret at all. In my opinion, it’s very difficult to skip class if you literally cross a parking lot to get to it.

Ok, finally, we’re here at contempt. 

Yea. I guess I really messed up in college. There, I said it.

Those B-s in OChem (TWICE! *shudder* It still gives me nightmares to this day) and Biology dropping my GPA down and my MCAT score being only “around the mean” essentially prevented me from going to medical school in the United States. Please let that sink in.

I wasn’t good enough to go to a US Medical School and I accept that. So I went to a Caribbean school. However, that fall “off the track” gave me some grit. I worked harder than I ever could have imagined, surprised myself sometimes even. I did well, not for a “Caribbean student” — but in the only evaluation that ever matters… my own self-evaluation.

However, this is not a Disney movie, and the ending isn’t really a fairy tale ending.

Despite working hard, doing well on Step 1, and getting letters of recommendation… I wanted to do radiology, of all things. At the time, this was a very difficult specialty to get. I believe my match year was 2007, where only 20 US-IMGs matched into radiology for PGY2 year, out of a total of 902 spots. With the knowledge that it was unlikely that I would be able to get radiology as a residency, I had essentially relegated myself to doing my second choice, which was Neurology. I had my Letters of Recommendations written and everything was all set…

Until my future wife, a person much stronger, more courageous and more independent than me simply told me, “What are you doing? If you want to do Radiology, just try. You’ll get it. ” I think if this statement came from anyone else I could have argued up and down that I couldn’t get it and rationalize a decision to not apply. However, if this person, if she believed in me, then I really couldn’t argue.

I rewrote my personal statement, from the ground up and re-asked for my letters of recommendation to specify radiology. I even remember that my personal statement was about reversible posterior leukoencephalopathy (now better known as PRES). Every radiology program that existed got an application from me.

My chances were low and I was fully aware of it.

So I had to go all-in. I got a grand total of 7 interviews for radiology. Trust me when I say I had to work hard to get every single one of them. I followed up with the program coordinators at the programs which had taken Caribbean students before. I knew that those programs would be the highest yield.

At Albany Medical Center (where I matched), the program director had not even heard of my medical school before. I only received that interview invite because another student had canceled their interview. Even during the interview, the program director flat out told me, “Actually we’ve never interviewed anyone from your school before.” Those words cut through me like a knife through butter. My chances here were slim. With only 7 interviews, most of which were low yield, chances of matching was low. I was fully prepared to not match and need to re-apply during my intern year. Through some miracle, I matched there. I would like to believe that maybe the program director wanted to give me a chance. If that is so, thanks Dr. Silk.

Having gone to a Caribbean medical school is something that continues to come up at every “life checkpoint”. A US medical student receives the benefit of the doubt, whereas a Caribbean student must start earning that privilege from day 1. In internship I had to prove every day that I was good intern. Every day of residency I had to prove I was just as good as everyone else. Finally, I passed my boards and became a diplomate of the American Board of Radiology. And so I thought all the doubts would go away…\

They didn’t.

My first job was a private practice in Rhode Island. The group president was a very pleasant guy, but still had his concerns about my having gone to Caribbean medical school. He once told me something to the effect of “I feel bad having to say this, but honestly, if you didn’t have a recommendation from someone we knew, we wouldn’t have even considered you.”

Labels and stigmas eventually fade though. All of my current colleagues know that I went to a Caribbean medical school, but none of that matters if I have expertise in a particular question they have. Now then… I didn’t go to a US medical school. I didn’t deserve it, mostly because of my hatred for OChem. Should that have completely barred me from going to medical school? I dunno, I think I’m doing ok right now as a radiology attending and I would hope my colleagues would agree with that.

The pre-med track and its requirements as well as the reliance on MCAT scores needs to be looked into more I think. We are probably missing out on an awful lot of potentially excellent doctors whether it be Ochem, MCAT scores, or some other random classes. Don’t get me wrong, I do understand that pre-med requirements are a litmus test to see if students have the ability to learn complex science, moving on to complex pathophysiology, etc. However:

Everybody is a Genius. But If You Judge a Fish by Its Ability to Climb a Tree, It Will Live Its Whole Life Believing that It is Stupid – Anonymous (not Albert Einstein)

I would modify this slightly to be relevant for medical school admissions. Don’t judge a fish ONLY on its ability to climb a tree.

TL;DR

Curiosity, Jealousy, Contempt are the usual suspects when people find out I went to a Caribbean medical school.

Benefit of the doubt is a luxury that US students get, that Caribbean students do not.

The road after Caribbean medical school is as difficult if not more than difficult than being there.

Don’t judge a fish ONLY on its ability to climb a tree.

—

I know I know I know. The real question is: Should people still consider going to a Caribbean medical school?

Unfortunately, that is an article for another day. The short answer (like always) is: It depends.

Another article for another day will be dedicated to “Falling off the track”, meaning falling off the pre-med track into the abyss of uncertainty called “now what?”

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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