When should you consider a Caribbean medical school? [PODCAST]

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“If we want to achieve a physician workforce that mirrors our population, medical schools must collectively understand that we have created an admissions system that selects against Latinx and BIPOC students. We need a new system. But a new admission system will not be enough. More medical students of color, while a start, is not the complete answer: We need more doctors of color.”

Heidi Chumley is dean, Ross University School of Medicine.

She shares her story and discusses her KevinMD article, “Who gets to go to medical school?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Heidi Chumley. She is dean at Ross University School of Medicine, and her KevinMD article, which we’ll talk about today, is titled “Who gets to go to medical school?” Heidi, welcome to the show.

Heidi Chumley: Thank you, Kevin. Happy to be here. Thanks for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, briefly share your story and journey to where you are today.

Heidi Chumley: Yeah, absolutely. So I’m Heidi Chumley. I’m a family physician by training. I went to medical school, did my residency, and also did an academic leadership fellowship out at University of Texas San Antonio Health Science Center many years ago. That was where my first faculty position was. I went from there to University of Kansas School of Medicine and spent eight years out there, four on the senior leadership team. And then about 10 years ago, I was recruited to be dean at American University of the Caribbean, another international school.

And I’ll tell you that I wasn’t planning, when I was interviewing for that job, to actually ever take it. That could be our little secret, Kevin, right? I wasn’t actually planning to take it until I got out there and met the students. My experience from Kansas had been, you know, every year we had 100 students from Kansas who were qualified to go to medical school, who we couldn’t fit into our class, and wondered where they were. But when I went down there and was interviewing for this job and had a chance to sit and talk with a group of students, I just had this epiphany, right? This is like, here’s where they are. Here’s where these students are. And I wanted to change, you know, what I was doing with my career and then move into this area.

So fast forward, it’s been about eight and a half years there, and then about a year ago, I was moved over to Ross University School of Medicine. Same parent company; they’re sister schools. And I have been there for the last year.

Kevin Pho: So whenever we talk about medical schools, international medical schools in the Caribbean, there’s a certain perception about them. So what are some misconceptions that you just want to clear up for my clinician audience?

Heidi Chumley: Oh, wonderful. Thank you for that. I’ve been working on that for 10 years, right? So I think that probably one of the strongest misperceptions is that the students who go to international medical schools, particularly in the Caribbean, are not qualified. There is a misperception that the students there somehow are, you know, not as good as their U.S. counterparts. I think there is also a perception that, you know, the schools will take anybody. And from that, I think, then stem the other things that you hear, just about the overall quality of the educational program in those different places.

Kevin Pho: All right, and we’re going to talk more about that, but let’s lead into that with your KevinMD article, titled “Who gets to go to medical school?” And for those who get a chance to read your article, just walk my audience through it. Share the story of why you decided to write it.

Heidi Chumley: “Who gets to go to medical school?” is really about educational justice. It’s about what are the things that we do as a set of leaders in U.S. medical education that let some students, some people, have an opportunity to become doctors and keep others from having that opportunity. And if we think about it, you know, the only way to be a physician, right, the only way to be a physician is to get to go to medical school. So the opportunity to do that really separates who has that opportunity.

In the article, I go into a few things that have been just really long-standing traditions of medical school admissions. I talk about the MCAT and the MCAT’s role in the selection process, and how there may be, you know, some challenges around that. And then I also talk about a few of the other things that are held in pretty, you know, high regard by admissions committees: ability to shadow, volunteer experiences that aren’t paid work, and how those things also are probably, you know, not equally distributed opportunities across our society.

Kevin Pho: So tell me, in general, some demographic characteristics of those who choose to go to medical school in the Caribbean.

Heidi Chumley: Yeah, so the students that we have out in the Caribbean, first, back to your misperceptions question, about 85 percent do come from the U.S. So that’s something that I think a lot of people don’t know. We do have higher percentages of underrepresented minority students that join us out in the Caribbean than you’ll see in the United States.

Kevin Pho: And tell us about the training, the didactics, the facilities in general.

Heidi Chumley: Yeah, really similar to a U.S.-style education. So our students spend their first year and eight months, we’re on three semesters a year, so a year and eight months, out doing medical sciences, which is learning, you know, the same disciplines that they teach in the U.S., same organ system focus, teaching early clinical skills. Students then take the USMLE Step 1 exam, the same exam that the allopathic students in the U.S. take. And then, after they spend their time out there in the Caribbean, they come back to the U.S. and do their clinical rotations at many different hospital partners in the U.S., take Step 2, go through the same residency match, and end up in the same residencies as many of their peers that went to U.S. medical schools.

Kevin Pho: So one of the comments that I often read is that sometimes there’s a little bit of a contrast between residency matching from medical schools in the Caribbean in contrast to those in the United States. So can you comment on that?

Heidi Chumley: It is a little bit more difficult, right, for students who go to international medical schools to match into a residency program. Not that their success rate is any different; we have a really high success rate. But they do have to jump through a couple of extra hoops. So all the students who attend an international medical school have to go through the ECFMG to go into a U.S. residency program, and there are a couple of extra hurdles to be certified by the ECFMG for the match. The first is an occupational English test that they have to take before they can be certified.

The second part, which is more of a nuanced difference, is that the students coming from international medical schools have to have passing scores on their USMLE Step 1 and USMLE Step 2 exams before they can actually be in the match. Your U.S. students can be going to take the test, not have their scores back yet, and still enter the match. But the international students actually have to have those scores already posted. So it alters their timeline. That makes it a little bit more difficult to hit an aggressive timeline.

Kevin Pho: What’s the proportion who go into, say, primary care specialties versus subspecialties?

Heidi Chumley: Yeah, we do see more of our students in primary care residency, certainly a much-needed field in the U.S. In addition to more going into primary care, I think, you know, the question is always, going into a primary care residency program doesn’t mean you’ll actually stay in primary care. And we do have a higher percentage both that go into primary care residencies and that actually are practicing in primary care five years out.

Kevin Pho: So if I’m a premedical student and I’m looking at the various options that are out there, what kind of questions should I be asking myself if I do want to consider an international medical school?

Heidi Chumley: Yeah, great, really important question, because there are a lot of international medical schools, and they vary dramatically in quality. So the first, most important question to ask is: Is the school accredited, and by whom? And then the second most important question, I think, to ask is: How are that school’s students doing with the really important outcomes? What are the chances of getting into a U.S. residency program? How are their students doing on the licensing exams?

Another thing that is a helpful measure of quality is where the students can do rotations in the U.S. Many states in the U.S. have some pretty high bars that schools need to get over in order to have their students come to those states. New York is certainly one of them, and any of those that students see can be markers of quality. And then after that, perhaps what today’s students would do even before that: Talk to your friends, talk to your peers, find somebody enrolled in the school that you’re thinking about, and really get the inside story of what it’s going to be like to go to school there.

Kevin Pho: Now, what kind of premedical students should consider medical school internationally?

Heidi Chumley: So if you are a student who perhaps is not the best test taker, if you’ve been put on a wait list, if you’re not getting interviews, but if medicine is your passion, just take a look at an international medical school. Our school and others are set up to help students who have had different levels of preparation or opportunity coming into medical school, and we find a lot of people actually really thrive in that type of situation.

Kevin Pho: And in terms of the clinical experiences, talk about some of the clinical experiences at Ross.

Heidi Chumley: Well, let me talk about those in two buckets, because we’ve got what we call our early clinical experiences. So those are the experiences you’re going to have when you’re out on the island of Barbados. And that’s actually a pretty exciting thing, if you think about it. You get to be in a different society, in a different type of health care setting, engaged, you know, in meaningful, early, appropriate encounters, really getting to understand how medicine can work in a number of different places, particularly a lower-resource area. Great, great introduction to medicine.

Clinical experiences in the clinical years are in hospitals in the U.S., generally alongside students from allopathic or osteopathic schools, and just quite similar to the experiences that a student’s going to have at a U.S. medical school.

Kevin Pho: Do the majority of students do their rotations in the United States, or what’s the breakup in terms of those who stay at Ross versus going to the United States?

Heidi Chumley: Well, so all students come to the U.S. to do their clinical rotations, 100 percent. The experiences I was talking about earlier are what they do in their, you know, basic science years, to help contextualize what they’re learning in the sciences and keep them motivated.

Kevin Pho: And in terms of the cost, how does that contrast with medical schools, allopathic medical schools, in the United States?

Heidi Chumley: Yeah, so you know what? If you’re going to your own state school, it’s going to be a lot less expensive to go to your state school. If you’re looking at going out of state, or to an osteopathic school, the international schools are going to sit kind of right in the middle of those, cost-wise.

Kevin Pho: We’re talking to Heidi Chumley. She is dean at Ross University School of Medicine, and we’re going to talk about her KevinMD article, “Who gets to go to medical school?” So Heidi, tell me about some of the challenges students may face, or some of the challenges that you face as dean at Ross University.

Heidi Chumley: As we come through and we’re on the other side of the pandemic, a lot of the work that we had really done that was highly successful at really closing that gap, from where students were to where they needed to be successful in medical school, a lot of that gap widened during the pandemic. We noticed that. I think schools everywhere noticed that. And now we know that we’re really probably sitting on at least a couple more years of students who will come to us that have had a really disrupted college education, or even a really disrupted couple of years of life, before coming back to medical school, and really working through, you know, what are the things we need to do differently than what we’ve done in the past that’s been successful, to continue to really be great partners for these students and help them be successful.

Kevin Pho: And when you look at the entire spectrum of medical education, talk about the role that international medical schools like Ross play. What role do you play in the spectrum of medical education?

Heidi Chumley: Yeah, well, a hugely important role. I think, you know, there is a physician shortage in the U.S. It’s been there; it’s ongoing. We think it’s going to continue to be a challenge, and certainly not enough capacity in the U.S., even with the growth of U.S. medical schools, to meet that need. So one of the primary, you know, roles of international medical schools is to really support the U.S. physician workforce, and we do that with numbers, but also through the diversity of the students that we train.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Heidi Chumley: Yeah, well, if I understand your audience, I know that they’re largely clinicians. And I think, you know, certainly everyone who is a clinician these days has the opportunity to talk to young people who are interested in the health professions, be that in medicine, you know, PA, nurse practitioner, whatever. There are people that are interested, and there are many people who are interested who are continuing to get messages from our society that perhaps you’re not qualified, or perhaps you don’t have the academic credentials that you would need to be a physician.

So I would love for all of your audience, if I could have every single one of them, Kevin, to really help with the message of, you know, let’s just broaden our thinking a little bit about that. Perhaps the academic credentials that were necessary, or were thought to be necessary for so many years, perhaps it’s really a bit broader than that. And there are opportunities for people, particularly at the international medical schools, that are good opportunities, that can help students who’ve had a different set of opportunities or a different level of readiness. It can really help them be successful as physicians.

Kevin Pho: Heidi, thank you so much for sharing your time and insight, and thanks again for being on the show.

Heidi Chumley: Thank you for having me.

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