Before I begin addressing the title question of this article, I think it is essential to provide you with my background. I went to an American medical school (Albert Einstein College of Medicine) and have trained at all American institutions throughout my residency and fellowship. During my time as an Associate Program Director, I have taught mostly American and Caribbean trained medical students. Additionally, we have had a smattering of a few other scattered foreign-trained medical students in our program. Our institution has a connection to St George’s University. Also, a majority of the Caribbean medical graduates that attend our radiology residency come from this institution. So, I would like to add a disclaimer that my training and the mix of students in our program may reflect my biases. Other program directors may have different opinions based upon their own experiences and combination of residents.
In the United States, we think of Caribbean schools as a place for college graduates to go when they cannot get into an American medical school. When I first started working at Saint Barnabas Medical Center back in 2006, if you would have told me the best trainees come from Caribbean medical schools, I would have looked at you funny and said, “Really?” However, as time went on, my biases have significantly changed. So, what are some measures of the Caribbean versus American resident quality that justify my change in opinion?
Justification of Caribbean Medical School Quality
First, I think it is reasonable to say that many of our best residents have become our chief residents. Typically, our program has one chief resident per residency class. So, when I look back at the past ten years, a majority of our chief residents are not from American medical schools, as one might think, but rather from Saint George’s University.
Second, you can look at the board passage rate to determine the quality of residents. If you look at our board passage rate for the Caribbean versus American medical graduates, you will find a slightly higher board passage rate for the Caribbean medical graduates.
Third, when I think about the former residents that I would have liked to work with as colleagues, I tend to harken back to many of the Caribbean residents who I have trained. Granted, we have had excellent American medical graduated residents as well. But we have had a few more Caribbean graduates in this category.
Why Is the Caribbean Graduate So Successful in Our Program?
Given the evidence that Caribbean graduates have performed better over the past ten years, the next logical question is: why might that be?
1. A good number of these graduates were unable to get into American medical schools. So, they are always in a position where they need to work harder and smarter to show that they can perform. Perhaps it is the “battle” mentality of the underdog. When I talk to these residents, they will often agree with this assessment.
2. Many of these graduates are “second chancers.” What do I mean by that? Well, often these residents started a different career at first. And then, they decided later that they wanted to go to medical school. By that time, it may be more challenging to get into an American medical school. So, these residents may have experienced more of the “real world” to make them understand the realities of residency. They know what they need to do to perform well.
3. And then finally, another possibility is that we tend to take the best of the Caribbean medical school graduates. Our choice of these graduates compares to having a selection of American graduates that may not be at the top of their class. This selection profile may reflect an inherent bias in the selection process.
What Does This Say About American Medical Schools?
Since we have had such successful Caribbean graduates, there are several conclusions I can make about American medical schools.
American medical schools often do not select medical students by who will be the best physicians. Instead, they decide upon who is going to fit the profile of their class expectations. For many medical schools, it may be more valuable to have a track star Olympian or a racially diversified class than to select medical students who will make the best physicians.
Also, many American medical schools do not merit the reputation they think they deserve. If the quality of the Caribbean student is at least just as good in a residency program, the perceived quality of the American medical school may reflect the bias of the graduates and folks running the American medical system and not the truth regarding the quality of education.
So What Does All of This Mean?
We need to rethink the residency selection process. Perhaps, programs should refrain from their conscious or unconscious bias against the Caribbean medical schools. Based on our experiences, we will continue to use the Caribbean schools as a resource for getting the hardest working, best, and brightest residents. Maybe you should, too?
Barry Julius, MD, is a board-certified radiologist at St. Barnabas Medical Center. He is a 2018–19 Doximity Author. He is the developer of the educational website called radsresident.com.
