Do Caribbean Trained Medical Students Make Better Radiologists?
Before I begin addressing the posed title question of this article, I think it is important to provide you with some of my background. I myself have gone 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 associate program director, I have trained 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 specifically has a connection to St George’s University and a majority of the Caribbean medical graduates that attend our radiology residency come from this institution. So, 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 individual experiences and mix of residents.
In the United States, Caribbean schools are often thought of as a place for college graduates to go when they cannot get into an American medical school. In fact, 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 Caribbean vs. American resident quality to justify this 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, there is one chief resident per residency class. So, when I look back at the past 10 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 quality of residents. If you look at our board passage rate for Caribbean vs. American medical graduates, there is a slightly higher board passage rate for the Caribbean medical graduates.
Third, I think about which former residents I would have liked to work with as colleagues. I tend to harken back to many of the Caribbean residents that I have trained. Granted, there have been some very good American medical graduated residents as well, but there have been a few more Caribbean graduates in this category.
Why Is the Caribbean Graduate So Successful?
Given the justifications for Caribbean graduates to have performed better over the past 10 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 and 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 decided later that they wanted to go to medical school. And, by that time, it may be more challenging to get into an American medical school. So, these residents may have already had real world experiences that make them better understand the politics and realities of a residency program. They know what they need to do in order to perform well.
3. And then finally, another possibility is that we tend to take the best of the Caribbean medical school graduates versus having a selection of American graduates that may not be at the top of their class. This may reflect an inherent bias in the selection process.
What Does This Say About American Medical Schools?
Since we have had such successful Caribbean vs. American graduates, I think there are several conclusions I can make about American medical schools.
American medical schools often do not select medical students on the basis of who are going to be the best physicians, but rather who are 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 that will actually make the best physicians.
In addition, 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 former 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 really 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?
Would love to hear any comments or suggestions