As a recent graduate from one of ‘the big four’ caribbean medical schools, I feel obligated to provide an honest review of the typical IMG pathway and my personal experience. To summarize my personal background - I was a graduate of the University of Toronto with a GPA below that which would have been acceptable for entrance into a Canadian or US medical school. I did one round of applications to the Canadian medical school system (did not apply to any US school), was not accepted, and decided to attend a Caribbean school rather than apply to a masters or research position. I completed my basic science years with marks at the top of my class, did most of my clinical rotations in NYC (one in Canada), and scored well on my boards (USMLE Step 1: 245, USMLE Step 2 CK: 266, USMLE Step 2 CS: pass). I applied to both family medicine and internal medicine in the US match and family medicine only in the Canadian match, with my preference being for an inpatient focussed, unopposed, reputable family medicine program. I received 35 total US interviews (roughly split between IM and FM), from which I attended 18, and 2 Canadian interviews which I attended both. I am currently awaiting the March match results.

First of all, I will preface by saying that I have been generally happy with my experience so far and have no regrets about the decision to pursue the IMG pathway. That being said, many of my classmates have had different experiences and suffered many of the pitfalls that come with this road.

For those considering applying to a Caribbean medical school, the first thing you should know is that besides meeting the basic course requirements to get in, all you really have to do to get accepted is fill out the application. I honestly have never heard of ANYONE getting rejected by a Caribbean school, and therefore always found it annoying when people had celebration parties and made excited facebook posts about their acceptance (in case you can’t tell, I’m kind of a judgmental asshole…just a heads up).

While getting accepted is about as easy as signing up for a new credit card, making it through to residency becomes exponentially more difficult. Those who are unsuccessful in making through to the end and matching into residency, typically fall into two groups. The first is made up of those who straight up fail out. Most schools have a policy that if you fail a course, you have one chance to repeat the entire term, and then you are kicked out of school. Many succumb to this fate in their first or second term (upon starting Biochem, Neuroscience, ect), and are arguably the luckier ones. I say this because the second group of people are those who don’t necessarily fail out, but are still unable to secure a residency, and have thus paid four years of tuition, which is then pretty much down the drain. This happens either because they have gotten low marks in their basic sciences (just passing is not sufficient), have a failed course on their record or have poor USMLE scores. Sadly this group is the majority of those that go unmatched. I recall classmates high fiving and going out to celebrate after getting a 75% on their final exam, or after getting 230 on USMLE step 1 - all of whom now have between 0 and 3 interviews. The truth is that the bar for ‘passing’ is put in place so that these medical schools are able to continue pumping students through and collecting their tuition. If the schools actually cared about generating viable residency candidates, the bar for passing really should be set closer to 85-90%.

The IMG path is LITTERED with the remains of unsuccessful medical students who were unrealistic about their abilities and have done little more than pad the pockets of the for-profit medical schools. My recommendation to anyone considering this path would be to look at the courses you have done poorly in during your undergrad, if your low marks are in physics, inorganic chemistry, calculus, and your high marks are in anatomy, physiology, human biology, then you’ll probably do alright in medical school; however if your failing anatomy it may be time to pick another career. Second, ask those who know you best for their honest thoughts on your abilities. I want to meet the parents of some of the people I have seen failing every class and ask them why they didn’t sit their kids down prior to applying and say “listen, we love you, but this isn’t for you”. If you are the parent of a student who falls into this category, you are doing your kid a disservice by not being honest with them. Lots of little kids want to fly, that doesn’t mean you should let them jump out of a plane with an empty parachute.

So lets assume a student is able to do well in their courses, gets decent board scores and moves on to their clinical rotations. Most of the hospitals that the Caribbean schools have affiliations with are not great hospitals. There are certainly exceptions but many of the hospitals in my experience have limited resources and inconsistent faculty (some are great teachers, others are aweful). It should be noted that as a whole, the north american medical school system (in terms of clinical rotations) has gone in the opposite direction from its previous militaristic approach. Students are not overworked, yelled at or expected to perform outside of their abilities. While this may sound like a good thing, the truth is that students are now UNDER worked, allowed to coast by with minimal effort and not expected to push their comfort zones in order to grow as aspiring physicians. While not specific to IMG programs, this undoubtedly has a potential to further prolong the careers of those those that will inevitably be unsuccessful in matching to residency.

To summarize the IMG pathway: Easy to get in. CAN be difficult to stay in. Even if you stay in, it doesn’t mean that you SHOULD. And lastly, despite the undertones of pessimism, there are certainly people for which this is a GREAT option.

I realize this has been a fairly unstructured, nonsensical rant, and I will hopefully have future posts which are of higher quality once I gauge people’s interest in the subject matter. Please feel free to comment with any specific questions regarding my experience with applications, medical school or residency match.