Caribbean Medical Education – the Process

The business of educating aspiring U.S. medical professionals internationally, and in the Caribbean in particular, has exploded in the last decade. By and large, the schools that cater to overseas students in the Caribbean are considered a last option for those who have been rejected by accredited medical schools in the United States and Canada.

The Process

Those studying in the Caribbean typically seek a route to a medical career in North America through a certification process overseen by the Education Commission for Foreign Medical Graduates [1] (ECFMG) that involves, among other things, that students pass Step 1 and Step 2 of the U.S. Medical Licensing Examination [2] (USMLE) within a specified period of time, upon meeting eligibility requirements for those exams.

One of those eligibility requirements is attendance at a school listed in the Foundation for Advancement of International Medical Education and Research [3]’s (FAIMER) International Medical Education Directory [4] (IMED), and on a directory of global medical schools maintained by the World Health Organization. Schools are added to the WHO directory upon receipt of a letter stating that they exist and are licensed by the relevant authority in the jurisdiction in which they are located.

FAIMER, established by the ECFMG, describes its IMED thusly: “The International Medical Education Directory (IMED) is a free web-based resource for accurate and up-to-date information about international medical schools that are recognized by the appropriate government agency in the countries in which they are located. The agency responsible for this recognition in most countries is the Ministry of Health. FAIMER is not an accrediting agency. Listing of a medical school in IMED does not denote recognition, accreditation, or endorsement by FAIMER.

The government agencies on the many island nations that dot the Caribbean have different standards when it comes to licensing and overseeing medical schools located in their jurisdictions, but, more often that not, the process involves no more than licensing as a business (which happens to be an institution of education), with little to no oversight beyond that. Therefore, it is very difficult to assess the quality of a particular school or program beyond the kind of anecdotal evidence one might find on a number of discussion forums dedicated to offshore medical education.

View from the U.S.

A few U.S. state medical boards have attempted to evaluate offshore medical schools, most notably the Medical Board of California [5]. According to a list compiled by the California board, just four schools in the Caribbean region catering primarily to overseas students are deemed to offer an education comparable to an accredited U.S. medical school: St. George’s University School of Medicine, in Grenada; Ross University School of Medicine, in Dominica; American University of the Caribbean School of Medicine, in St. Martin; and Saba University School of Medicine, on the island of Saba. Other states have used California’s evaluations to form their own standards with regards to licensing graduates of international medical schools.

A new federal standard that medical schools must meet for their students to remain eligible for federal student loans could be cause for an improvement in standards, according to a Government Accountability Office (GAO) study released in June of this year. Starting this month, medical schools must have at least 75 percent of their students who take a U.S. medical licensing examination pass the test, up from 60 percent under current law, for those students to remain eligible for federal aid.

The GAO report, “Foreign Medical Schools: Education Should Improve Monitoring of Schools That Participate in the Federal Student Loan Program,” [6] estimates that just 11 percent of the foreign medical schools in countries that participate in the federal loan program would achieve that standard, and it recommended that the U.S. Department of Education improve its oversight of the schools’ performance and quality.

The GAO found that while 97 percent of U.S.-educated students passed the Step 1 licensure exam on the first try between 1998 and 2008, only 64 percent of students at foreign schools passed. In 2008-9, about 27 percent of medical residents nationwide were international medical graduates.

Based on its findings, the GAO made four recommendations to the Department of Education:

  1. Collect consumer information on student debt levels and graduation rates from foreign medical schools and make it publicly available.
  2. Require foreign medical schools to submit annual aggregate licensure exam pass rate data.
  3. Verify school-submitted data, possibly by verifying with the USMLE.
  4. Evaluate the potential impact of Congress’s newly enacted 75 percent pass rate requirement for participation in the federal student loan program.

The Schools and Standards

While all institutions in the Caribbean catering to overseas students operate on a for-profit basis (a fact that may be cause enough for some to question their credibility), there do appear to be differing standards among the more than 30 schools that operate in the region, with some seemingly not far removed from diploma mill status, and other more-established institutions having earned a fair degree of credibility and respect.

The vast majority of these schools do not require the Medical College Admission Test [7] (MCAT) for admission, and some use language in their admission literature suggesting that life experience might replace the need for pre-medical classes in chemistry, biology, mathematics and physics. Others have much higher admissions standards, requiring or strongly suggesting that applicants take the MCAT, while also claiming facilities on par with those found in the United States.

At the less rigorous (or less regarded) offshore medical schools, tuition fees seem to average approximately $10,000, whereas at the more respected schools annual tuition fees can top $30,000. A premium, it appears, is paid for the increased likelihood of licensure from state boards

In a 2006 article [8] in the AAMC Reporter, President of the Association of American Medical Colleges (AAMC), Jordan J. Cohen, presented an interesting and balanced discussion of the issues surrounding the offshore medical school industry. The article not only touches on concerns related to the quality of instruction in the Caribbean, but also the role that the offshore medical industry might have in helping to meet labor demands in North American healthcare when one considers current demand for qualified health professionals and current capacity constraints at accredited North American schools.

While the listing of medical schools that follows is by no means encyclopedic, and is no way a reflection of World Education Services’ assessment of those schools or their programs, it does reveal the degree to which the industry has exploded in the last decade, with two-thirds having opened since 2000. The list was compiled entirely from FAIMER’s International Medical Education Directory.

Antigua and Barbuda


Bonaire (Netherlands Antilles)


Curaçao (Netherlands Antilles)


Grand Cayman Island




Saba (Netherlands Antilles)

St. Eustatius (Netherlands Antilles)

St. Martin

St. Kitts and Nevis

St Lucia