this is a view of Nevis from the window of an American Airlines plane. in order to be able to relish this view as you head back to North America for the next chapter of your academic medical career, you have to pass one final big exam.
you have to complete a comprehensive (on every subject from MED1-5) Basic Science shelf exam from the National Board of Medical Examiners with a grade that is equivalent to 185 on the USMLE Step 1.
the logic behind this is that 185 is a passing grade for Step 1* and our administration wants to increase our first-time pass-rate to upwards of 90%. this criteria is important for state-side and international accreditation. in order to prove we are a medical school with an education equivalent to our counterparts in North America and graduates worthy to work across the USA and around the world, we have to meet certain standards.
according to Iserson, the first-time pass rate for foreign medical students is 67%. i don’t know MUA’s current status, but i figure it’s pretty close and is definitely well below students in the USA for several reasons that are beyond the scope of this post — including the caliber of students that come to Caribbean med schools, the fact that we write Step 1 before clinical rotations instead of after (like most North American Canadian schools), whether or not English is your first language, and the general quality of curriculum scope and education.
the current first-time pass rate for American medical schools is upwards of 93%.
if we can’t produce numbers similar to the USA, why would MUA expect their students to be treated the same as American medical school grads? alternatively, if our pass rate is similar to North American schools, why shouldn’t we be able to be licensed to work anywhere in the USA or Canada? why shouldn’t our diploma be looked upon as just as valuable if we can prove we learned the same amount of material in a shorter amount of time?
to get an idea of where MUA is currently at, let’s quickly look at the class that completed their Basic Sciences (finished 5 semesters of classes on island) in August 2008…
approximately 40+ students wrote the “exit exam” and only half passed. the penalty for failing is that you have to return to the island in three months and re-take the exam. in the interest of exam hygiene (keeping it clean and honest), MUA does not yet (and may never) offer state-side retakes.
the re-takers recently returned to Nevis and rewrote in the middle of the November. results came in this week: only 3 more students passed. 18 failed for a second time.
in a “three strikes you’re out” kinda way, the re-re-takers have one last chance to pass the final exam. if they fail again, they will be dismissed from MUA and their only option to continue a career in medicine will be to transfer to another school.
is this a good thing or a bad thing?
for the 18 students that have to re-re-take the exam, it’s obviously very stressful financially (flying back and forth) and academically (all that studying with no end in sight) and emotionally (what on earth am i doing with my life??). i feel bad for them and empathize with their frustration. people end up in Caribbean medical schools for a variety of reasons, and i don’t doubt that troubles with traditional academic settings is one of them. plus, if you have any sort of debilitating test anxiety, you’re sort of screwed if you want to become a doctor.
i know academic standards have shifted a bit even in the time i have been at MUA with more stringent pass requirements, less curving, and more shelf exams for each semester. MUA has recently moved to instating NBME shelf exams as the sole final exam worth 25% of your class grade. which essentially means you have to learn the material to the level of the North American Medical Board of Examiners before you are able to move on to the next semester. this probably means that my class (and all of the classes behind us) are better prepared for the comprehensive final and Step 1. it probably means the classes before us weren’t as well-prepared for the exit exam because they didn’t take nearly as many semester shelf exams and are paying for it by having to do even more work now. which sucks.
but from MUA’s point of view, they are improving the caliber of the school by “weeding out”** graduates that may or may not pass Step 1. so far, every August 2008 student that passed the comprehensive shelf has passed Step 1. there are always stories here and there of people who got Cs in every class, did poorly on the exit exam and totally rocked Step 1, but in general this supports the administration’s theory that the comprehensive final is a good gauge of how prepared you are to write Step 1.
and the most efficient way to improve your school’s first-time pass rate is to prevent people you think are going to fail from taking Step 1.
as a future MUA grad that is going to take the name of this school on my diploma and into every hospital and emergency room and doctor’s office that i go to once i leave Nevis, i am thankful for a school administration that is interested in improving the caliber of our graduates. i don’t deny this whole exit exam thing is scary as hell, but working my butt off to get off this island and move forward will be well worth it. i look forward to meeting fellow MUA students again on rounds and being proud of how well we will be able to answer questions from residents and attendings. i am excited to show up our American counterparts and improve the name and negative stigma of Caribbean medical schools within North America. we are smart! we will make amazing doctors someday! just wait and see.
i love Nevis, but once i say goodbye after MED 5, i really hope the only time i return will be on holiday to the Four Seasons.
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*as a quick reminder to non-med non-Caribbean student readers, we need to pass Step 1 before we can start our clinical rotations.
**horrible phrase, i know — apologies to the 18 re-re-takers.
