Caribbean medical schools are, first and foremost, schools of opportunity. They’re a necessary one, too. Nearly 3,000 U.S. citizens study abroad and match into residencies in the U.S. every year, nearly all of which do so after not gaining admission at home. The Caribbean is a huge part of that. With no shortage of qualified people wanting to be doctors, and a marked shortage of doctors, it’s no wonder the Caribbean persists as an option. Caribbean schools underscore not just an economic demand, but an acute need. That doesn’t mean they shouldn’t strive to improve, though.

When we opened our institution for operation ten years ago, we took the opportunity to look at how things had been done for the past thirty years, and where we could improve. We kept coming back to the same basic idea: Limiting enrollment to match the U.S. average (140-150 per year) addressed the majority of the issues students have historically faced studying in the Caribbean. We prioritized quality for each of our students over raw quantity of students.

It’s a simple idea, but the ripple effect is incredible.

Helpful students, accessible faculty

Not everyone is going to make it through medical school. Attrition because the students aren’t supporting each other or the faculty isn’t accessible shouldn’t be why, though.

Caribbean medical schools need to embrace a principle of mutual support as part of their admissions process and, through that, influence campus culture. The students are the bricks of the social structure of any school. Seeking empathetic, helpful people that can relay difficult concepts to others (whether colleagues struggling with material or patients receiving a complex diagnosis) are an excellent addition to a school and a hospital.

If students are the bricks though, the faculty are the mortar. Schools must seek out faculty that that give their time and energy openly and enthusiastically to their students. This manifests in how they present the material as well as their accessibility for additional guidance.

The tricky part is this: you actually have to stay small for it to really work. It’s why you don’t see massive medical schools in the U.S. or Canada.

While adding faculty to maintain the ratio of students to teachers is an excellent stopgap when admissions balloons, it’s ultimately only a simulation of an intimate learning environment rather than actually providing one. Making matters worse, this approach of just adding faculty often won’t show its cracks until students start to slip through them.

Quality student housing

Schools need to provide access to, or just straight up provide, housing. It has to be at a quality that enhances a student’s success, too. This doesn’t mean over the top resort living, but privacy, a full kitchen, air conditioning, high speed internet? These are not difficult to provide, nor should they be considered anything but the bare minimum of what Caribbean medical students should expect.

This becomes untenable as student populations swell. Staying small side-steps that entirely, though and allows for quality housing for everyone without having to rely on attrition to make room.

Academic support

Attrition rates in the Caribbean of 40 percent to even a jaw-dropping 60 percent are simply not acceptable.

First, school of opportunity or not, students should only be admitted with their admission department’s full confidence. Past that, though, schools must keep a careful eye out for any academic difficulty as a sign to intervene.

This can come in the form of extended faculty office hours, student-tutoring, or even a formal approach like an Academic Progress Committee. Our APC is comprised of faculty who meet regularly to evaluate and guide students that may be facing challenges. Coming up with new approaches to help individual students to develop better study habits or simply gain a firmer grasp of the material must be embraced as part of curriculum development. A smaller school allows for this through both institutional agility and that the professors simply know their students.

Mental health care

Medical school is incredibly demanding. It’s intrinsic to the field of medicine, from the high stakes of decisions made in practice to the sheer volume of practical and theoretical material that students need to absorb. While limiting enrollment helps in the areas outlined above, there’s still additional support schools can, and should, offer.

This includes a culture among the administration, staff, and faculty that they are there for one purpose: to make good on the promise of the institution to turn their students into doctors, and that the belief in them extended through an admissions offer persists through the full four years.

More formally, it means on-campus access to professional help and a culture of openness that recognizes just how stressful medicine is, and that students are already experiencing a version of that stress.

The era of “bury your feelings and pretend you’re fine” is coming to an end. Our faculty is primarily made up of MDs who know firsthand how appropriately processing stress and emotional discord leads to greater outcomes for themselves and, ultimately, their patients. That needs to be at top of mind for any medical school and extended to the students from day one.

It ultimately comes down to this: A school with an annual intake of over 1,000 students that loses 40% of them to attrition is abandoning 400 students a year. That means for the students that survive at a large Caribbean school and declare it all worth it, they, and their school, are ignoring their twelve hundred colleagues who were let down, failed by their institution that prioritized volume over quality.

Caribbean schools will always be about opportunity. And we’ll always try to extend that opportunity to the people who have demonstrated potential.  That will mean taking an informed-chance on students we admit. That said, for the community of schools as a whole, it’s time to leave behind the legacy of “more” and emphasize “better.” Better support, better quality of life for the students? It  will only mean better doctors.

Stacy Meyer is vice-president of enrollment, Trinity School of Medicine.

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