theworldismine13
God Emperor of SOHH
Second-Chance Med School
http://www.nytimes.com/2014/08/03/education/edlife/second-chance-med-school.html?_r=1
http://www.nytimes.com/2014/08/03/education/edlife/second-chance-med-school.html?_r=1
Sitting around an outdoor table at the Red Crab, a restaurant on the tropical island of Grenada festooned with palm trees and fiery bougainvillea, a dozen aspiring doctors bashfully conceded that they had been, at best, near misses when it came to getting into medical school in the United States.
Many of them had not earned A’s in college physics and organic chemistry. Many had tried other careers first — among them were a talent scout, a ballerina, a pianist and an engineer. And some had come tantalizingly close to the prize. The dancer, Corinne Vidulich, described the agony of being on the waiting list at Albert Einstein College of Medicine in the Bronx for nine months. “They let me know the week before the term started that I didn’t get in,” said Ms. Vidulich, wearing the telltale all-black of a New Yorker. “It was crushing.”
Now they were all students at St. George’s University School of Medicine, one of dozens of medical schools that have sprung up in the Caribbean over the last four decades to catch the overflow of Americans who cannot find a medical school in their home country willing to take them, who for years have contended with the stigma of not being good enough.
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A pathology tutorial at St. George's. Credit Luvnish Karnani for The New York Times
St. George’s is their second chance.
Stephen Franco’s lax study habits had earned him C’s in freshman biology and chemistry at Binghamton University, not good enough for the medical schools he applied to in the United States. St. George’s offered him conditional admission, a four-month preview of courses, money back guaranteed if he didn’t pass. He passed. But in his first semester, he regularly woke his mother late at night to tell her he was terrified and might have to drop out. “If you want to be a science teacher, that’s O.K., too,” she would say to console him. Now 24 and entering his third year as an honors student, he is hoping to take over his father’s internal medicine practice in Brooklyn.
Ms. Vidulich is more than 10 years older than Mr. Franco. Her dancer’s frame is growing soft around the edges — she hasn’t performed for a decade — but she speaks as if projecting to the back row. As a teenager, she studied on scholarship at the Joffrey Ballet School, but a foot injury sidelined her to dancing “The Nutcracker” with provincial companies. Realizing she would never fulfill her dream to join American Ballet Theater, she stopped at age 25.
But she had another interest. An uncle dying of AIDS spent his last days living with her family, “so I had a very early obsession with viruses.” She enrolled at Hunter College, majored in biology and tied with two other students as valedictorian of the class of 2009, with a 3.98 grade-point average. “I thought I was a rock star,” she said. She applied to about 25 medical schools, and “basically I was wait-listed everywhere.” She blames her age, 33 at the time, and her abysmal score on the verbal section of the entrance exam. “The interviewer at Einstein asked me, ‘Are you a native English speaker?’ because my score was so low.”
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From the beginning, her Hunter pre-med adviser had told students to apply to Caribbean safety schools. “I refused because I was too cool,” Ms. Vidulich said. “It was kind of like with American Ballet Theater. I didn’t want to leave New York. I felt like I deserved the best. I was humbled.”
One evening, a customer came into the Brooklyn bar where Ms. Vidulich worked holding a newspaper clipping describing a scholarship program between St. George’s and the New York City Health and Hospitals Corporation, which runs 11 public hospitals. Ms. Vidulich won a full scholarship in return for agreeing to work for four years in a city hospital serving the poor.
St. George’s had another asset. It has tried to ensure the success of its students by paying hospitals to take them for their third- and fourth-year clinical rotations, which lead to those all-important residencies. It has entered into a $100 million, 10-year contract with the corporation for 600 spots. Usually rotations are free, causing other medical schools to grumble that they are being squeezed out. Last academic year, St. George’s placed 2,326 students in rotations in 98 American cities.
Ms. Vidulich is about to return home for her rotations. She no longer scoffs at Caribbean schools.
“Now I am truly proud of it,” she said. “We wanted it more than anything.”
For decades, American medical schools have vilified their Caribbean counterparts for providing a substandard education for students who were weak to begin with. But some schools may be proving the medical establishment wrong.
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Many students in the Caribbean did not get into U.S. medical schools. Corinne Vidulich was on the waiting list at Albert Einstein College of Medicine in the Bronx for nine months. "It was crushing," she said. Credit Luvnish Karnani for The New York Times
Thousands of Caribbean graduates — roughly 7,700 from St. George’s alone — are licensed to practice in the United States. They have seeded hospitals and physician practices across the country and are in a position to be mentors to the next generation of Caribbean attendees.
“I have sons and daughters of graduates coming down now,” said Charles R. Modica, St. George’s chancellor.
There are more than 70 medical schools across the Caribbean, about half of them catering to Americans. A handful — including St. George’s, Saba University, Ross University in Dominica and American University of the Caribbean in St. Maarten, all of which are for-profit — have qualified for federal financial aid programs by demonstrating that their standards are comparable to those in the United States. And they report that high numbers of their test-takers — 95 percent or more — pass the United States Medical Licensing Exam Step 1, a basic science test.
But quality is all over the map in the Caribbean. A 2008 study in the journal Academic Medicine looked at 14 schools and found that the first-time pass rate on the exam ranged from 19 percent to 84 percent. Countries whose schools performed lowest were the Cayman Islands, Haiti, Cuba, Aruba, Dominican Republic, Antigua and Barbuda and, the lowest, St. Lucia, which hosted four medical schools at the time. High performers were in Jamaica, Barbados, Dominica and, the highest, Grenada.
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Still, the ultimate test is whether students meet the criteria to be eligible for residencies back home, the ticket to becoming a practicing physician. Between 1980 and 2000 at the 12 biggest Caribbean schools, the percentage of graduates who fulfilled basic requirements ranged from 28 percent to 86 percent, according to another study. This year only 53 percent of United States citizens who attended foreign medical schools (most of them in the Caribbean) were placed through the National Resident Matching Program, compared with 94 percent of students from U.S. schools.
The schools say that the match rate does not tell the full story, that many of their students find residencies outside the process, by going to hospitals directly. John R. Boulet, a co-author of both studies and a researcher at the Foundation for Advancement of International Medical Education and Research, said that more than 90 percent of American graduates of foreign medical schools who have passed the requisite tests find a residency position. “Through persistence they eventually get in,” he said.
Like St. George’s, Ross and American University have leveraged residencies by paying hospitals to accept their students for clinical clerkships in their third and fourth years of medical school. Those students get to know the residency directors, who may then favor them for residency positions.
At St. George’s, which has the largest network of clerkships, only 43 of its 672 American students applying for a residency last year did not receive one within a year. Students from foreign medical schools, however, are less likely to receive the most prestigious residencies, and many end up in rural or poor urban hospitals, and in less lucrative primary care specialties.
For those who do not obtain residencies, the economic consequences can be devastating. Caribbean students are typically saddled with higher debt than medical students in the United States, in part because tuition is generally higher.
Tuition and fees at St. George’s come to $246,400 for four years, compared with $190,500 at Albert Einstein, the highly selective school Ms. Vidulich had hoped to attend. Average federal loan debt in 2012 was $220,000 for St. George’s students, $191,500 for Ross’s and $234,600 for American University’s, according to the Education Department. But their federal loan default rates — 1 percent or less — are about the same as for graduates in the United States, whose debt was closer to $170,000.
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In a class covering chest and lung examinations, Sevwandi De Silva, left, practices on Jahan Manjur, a fellow student at St. George’s. Credit Luvnish Karnani for The New York Times
With no centralized databank of information, or even a single accrediting body, it’s hard for consumers to judge the schools.
“Like anything else, you pays your money and you takes your chances,” Dr. Boulet said. “It would be nice to have, like, a U.S. News & World Report on foreign medical schools. It doesn’t exist.”
The only schools for which statistical comparisons can be easily made are those participating in financial aid programs with the Department of Education, which posts debt burden, exam passage rates and completion rates of American students. The statistics show that about half of Ross’s 2012 graduates failed to graduate on time; at American University it was almost a third, and at St. George’s just under a fifth. But the federal methodology doesn’t follow a cohort, or take into account those who leave a program. If it did, results would look much different. Of students who entered St. George’s program in fall 2009, 10 percent dropped out, 1 percent transferred and 65 percent made it to graduation in four years. Twenty percent more took five years and an additional 4 percent took six or more years.
