MED 5 exit exam

Filed Under Medical University of the Americas, Rhymes with Rant |

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.

————
*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.

Comments

36 Comments so far

BCWB on November 21, 2008 10:32 am
I am scared as hell and not sure if I am or will actually be ready for this exam when it comes time. I will do my best just like everyone else and when it is all said and done hopefully I will be one of the proud studying at home for Step 1 and not one of the disappointed at home studying to come back here. I like the fact that they want to make sure you pass this before taking the Step 1, but more vital steps should be taken earlier on I feel. The administration has done a good job with the little they had to work with and I am sure it will only improve. Best of luck to everyone in Med 5 and Med 4 currently. I hope we all can make it through here and let the Step exam decide our fate instead of the comp shelf!!
alexia on November 21, 2008 11:15 am
I am not trying to ‘argue’ with you, but I have never heard of a school in the US that allows one to start clinical rotations before the boards are taken.
At my school we get 3 weeks off of class, take the boards, and one week later, we start rotations.
alexia on November 21, 2008 11:18 am
I also want to point out that it is unusual in the US for students to take an exam very similar to the boards, only to prepare them to actually pass the boards and increase the school’s pass rate. It seems like they are messing with the numbers, no?
Beach Bum on November 21, 2008 11:50 am
USMLE world is your friend. The Comp is pretty scary, but it can be done! Have fun!
jhawke on November 21, 2008 12:07 pm
alexia - sorry, it’s Canada that takes the MCCQE I after 4 full years. thanks for the correction. i’m Canadian and arrogant enough to think that the rest of the continent works like us.

i don’t know what you mean by “messing with the numbers”… if a school is hard to get into, it will have a higher caliber of students and higher pass rate. the same is just as true for a school that is hard to get OUT of.

or are you claiming that the NBME comprehensive shelf exam is sort of “cheating” with extra prep? if so, then all of the Step 1 review courses out there (including Kaplan, Falcon, etc) are “messing with the numbers” and i know an awful lot of American med students that attend them. it’s definitely NOT unusual for American med students to take an exam very similar to the boards to prepare them for the real thing.

also (for general info since we like to compare MD and DO programs so much around here), i wanted to include 2007 data on USMLE info for US MD, US DO and foreign med schools:
http://www.usmle.org/Scores_Transcripts/performance/2007.html

i’m curious as to why (if US DO and MD curricula etc are so similar) the scores are so different?
alexia on November 21, 2008 12:32 pm
Hmm, I have never looked into the overall pass rate for osteopathic students because my school has a high pass rate…Why is the overall pass rate lower than MD students? Maybe because some DO schools do accept people who don’t perform as well on the MCAT (and thus standardized tests), but compromise with research/personal/work experience, and very high GPA’s. I haven’t compared the 2 pass rates, honestly.

Also, there are 20-some DO schools in the US, and hundreds of MD schools. Plenty of those MD schools are highly, highly competitive. Could that affect pass rate? Probably.

What I meant by ‘messing with the numbers’ is that yes, we do have the option of taking a prep course, and practice board exams.
Though, US schools don’t require their students to pass the ‘practice board exam’ in order to guarantee a high pass rate on the actual board exam.

If you are wondering, my school’s pass rate is in the 90’s…
jhawke on November 21, 2008 12:47 pm
okay, i’ll agree with you. MUA owners are making a ton of money off 5 semesters of tuition from people that are horrible students and will make terrible doctors.

then, $45,000 later, they are kicking those same students to the curb and saying “oh, too bad. we don’t want you in our family anymore because you’ll make us look bad. thanks for the money. seeya and good luck.”

but in the end, they are preventing those people from actually hurting anyone in America by practicing inadequate or ignorant medicine.

… which should be a good thing overall.

(and since you are offering — where is your school’s pass rate published?)
Erin on November 21, 2008 12:55 pm
That does seem a little bit hokey to only let the students who do well on the ‘exit exam’ go on to take the Step 1. This does artificially increase your pass rate. Nothing like that is done in Canadian medical schools-everyone writes the exam (althought the MCCQE is much easier I think, but we do right the shelfs to pass our rotations and we don’t weed people out from writing those). It is very similar situation to high schools who make their graduation rate/provincial exam marks look higher by forcing students half-way through their grade 12 year who aren’t doing so well to register for an upgrade year or to transfer to different schools with remedial programs.
jhawke on November 21, 2008 1:30 pm
good point, Erin.

i guess you could say North American medical schools are hard to get into and MUA is hard to get OUT of. : )
sarah on November 21, 2008 2:50 pm
face it guys, my school is the best. We only accept people who are ALREADY doctors. so ha ha haha to you.
Oh yeah, and then…we have to pass like 100 tests and a final exam that covers every topic in the world in great detail. If we don’t have at least a 99.6% pass rate, the entire class is held back an extra 2 years. If the entire class doesn’t raise the pass rate the second time around, half of us get transferred to a DO school, and have to a Caribbean med school. It’s tough, but worthwile in the end. Oh, and we eat people like Alexia for breakfast.
sarah on November 21, 2008 2:51 pm
oops…i’m going to be one of those annoying people who writes a whole new post just to correct a spelling mistake in their first post..
have = half
sarah on November 21, 2008 2:52 pm
oops…third post to correct another spelling mistake
worthwile = worthwhile
alexia on November 21, 2008 3:39 pm
I don’t understand how by me challenging jennifer, I am seeing as some huge asshole. It’s fine with me, I still stand by my opinion/observations.

I don’t know where my school’s pass rate is listed on the internet- why do you care?
It was given to us in a recent meeting with the dean.
Plus, my school is one of ‘the best’ osteopathic schools in the country. The end.
jhawke on November 21, 2008 4:11 pm
i don’t think anybody thinks you’re “a huge asshole”, alexia, but the my-school-is-better-than-your-school rant gets a little tiring after awhile. we know your American school is obviously superior and mine is crap. you’ve made your point many months ago and many times over. you’re learning more at a better pace and will eventually make a better doctor (with the letters DO behind your name) than me with my Caribbean MD amongst the med school castaways.

your DO school might be one of the best in the country, but um, it’s still a DO school. that’s like me saying “my med school is one of the best in the Caribbean.”

anyone that looks down on the Caribbean would say “um, but you’re still in the Caribbean.”

(and i was only asking about an online reference for your pass rate because i don’t usually argue numbers unless i can back them up.)
sarah on November 21, 2008 4:51 pm
and I wasn’t mocking you Alexia, although I guess I was making a point that all this comparing is really stupid. You are not your school, you’re either good or not good on your own merits. Good schools turn out crappy professionals, and crappy schools turn out wonderful professionals.
alexia on November 21, 2008 9:27 pm
Jennifer,

Please explain your reasoning regarding MD vs. DO schools?
You will be entering the US as an ‘international student’ and I am already in the US, being taught by both DO’s and MD’s, already part of the US hospital system in a city with 5 other medical schools, and I gain hundreds of hours of *extra training* in the musculoskeletal system.
I will have DO after my name, good observation, wtf does that imply? Many of us choose to be osteopaths (remember that part about hundreds of hours in extra training?). I don’t think, if given the choice, you would have ended up in Nevis, would you have?
Joanne on November 22, 2008 12:03 am
Seriously though… WHO CARES where your doctor is educated? For instance, I just had a rather tragic incidence that left me with little use of my left arm and I was in extreme agony. What did I care about? A doctor/surgeon who cared and took care of me and what I didn’t care about was where he was educated. If you have the training, then please help me. Who cares if one certain school takes in a student or 2 that another med school doesn’t take in? SERIOUSLY!!!

When someone asks… hey do you have a great doctor?.. they’re not asking where was he/she was educated?? Any doctor that bases themself on where they went to school has an ego problem and shouldn’t be practicing medicine anyhow.

What I know for sure is that Jennifer will make a great doctor and there isn’t a person around that could argue that.
Pam on November 22, 2008 12:31 am
I agree with you Joanne - when it comes to choosing a doctor most people base there decision on the personality, someone they can relate too and someone that makes them feel comfortable. I know with jen’s personality and ability to find the positive in any situation she’ll be a fantastic doctor. I’m keeping my fingers crossed that she’ll come back and practice on the prairies :))

Maybe Alexia is just jealous she didn’t get to go to med school in the Caribbean, where she not only became a doctor but also met the man of her dreams :)
jane on November 22, 2008 11:08 am
I hear Humility pills are being handed out at US Med Schools this holiday season…Someone might want to take one or a heaping handful!
jhawke on November 23, 2008 7:23 pm
it must be winter in Canada… sarah has a much cooler head than me these days.

alexia - a PhD is different than an MD which is different than a DO. they are all called doctors for different reasons.

so, no matter how much you claim the DO and MD curricula are similar (er, actually i guess you are actually claiming the DO curriculum is *superior*), they are different degrees with different purposes. which is why i believed comparing them in the first place was pointless.

might as well get a vet student in here too.

when i choose a family doctor to take care of my kids’ fevers or deliver my baby or perform quadruple-bypass heart surgery on my grandpa, i will choose an MD over a PhD or a DO. do i care whether that MD trained in India or Antarctica? i care that they can pass the board exams for *my* country and do a good job with me and my family. there are a great many doctors from South Africa in northern British Columbia that i respect a great deal and would let cut me open any day.

so in this discussion about medical schools on this blog written by a medical student, i am obviously biased toward the Medicinæ Doctor degree. you are an osteopath student. the end.

Betsy would probably disagree.
RAEB on November 23, 2008 9:22 pm
Wow.
sarahMT on November 24, 2008 11:21 am
wow! it never fails to drive me crazy that in human medicine, there are so many people who can’t get over themselves long enough to realize that we’re all on the same team and we all bring our own unique set of strengths and expertise to the table. we desperately need caring, competent healthcare professionals and the path taken isn’t nearly as important as that end result.

i was so spoiled by the vet clinic. we were such a good team and we spent much more time giving our cute little patients the best care we could without taking time to consider whose job it was to do what. we all felt “important” but we all realized that the team needed all it’s members to do the best work.

then again, what do i know? i’m just a lowly small blood bank running medical technologist who’d LOVE to go to the carribean vet school (if i won the lottery) even over the ohio state university because i can’t imagine a bigger adventure.
RAEB on November 24, 2008 4:08 pm
Sarah you read my mind. Come by more often!
MartyDev on November 24, 2008 4:40 pm
While not being a med student, doctor or anything remotely connected with healing people or (animals, for all you vets out there), I do recognise the whole “my qualification is better than yours syndrome” that seem to have permeated the comments raised by Jennifer’s blog.

I’m going to bore you all now by telling you about my line of work. I’m an archivist by profession. It isn’t nearly as testing or as gruelling as being a doctor. I can’t imagine what commitment people like Jennifer have to have, to be able to do what she’s doing for the career she’s chosen.

To become archivists in the UK we have to hold a post-grad qualification, typically a diploma in Archives Administration/Records Management. Students at the small amount of universities that offer this course can, upon successful completion of a dissertation, receive a masters degree.

I took a distance learning route, on a course organised and run by the professional body that oversees the archives profession in the UK. The course is intense (relatively speaking), taken while working full time. Aside from the coursework, I had to sit finals and submit a dissertation. The qualification I received as a result was a diploma, not a masters. The reason for this was that even though the body which ran the course accredited the archives courses run by the universities, it couldn’t itself award masters degrees because it wasn’t a university.

Consequently, most of my peers have masters degrees, while I have only a diploma. Does it make me a lesser archivist? To some of my peers, yes.

In the years that have passed since my qualification, however, I’ve more than proved my value and expertise. The years spent working in archives and special libraries while studying gave me a more thorough grounding in what it meant to work in such places than my professional peers who served only one year’s pre-course work experience. I’d also built up a network of professional contacts over those years, upon whom I can call. I was drenched in the experience of working every day in an archive while my peers were in lectures, learning the theory but unable to apply it.

Right, enough with the boring stuff.

As someone who generally only meets doctors when ill, I don’t really care where they qualified, so long as they’re legally and professionally qualified to treat me.
sarah on November 24, 2008 5:45 pm
Hey SarahMT!

I’m in my second year of an MLT program, and am thinking of going into transfusion…I’d love to talk to you about it.
Also, my name is Sarah too (duh) and I also used to work at a vet clinic! Are you my twin?
sarah on November 24, 2008 5:47 pm
MartyDev:

British accent?
single?
Kelly on November 24, 2008 6:07 pm
Jennifer,

Why would you pick an MD over a DO? That makes as much sense as picking an overseas-trained doc over a US-trained doc. Or vice versa. Considering DO’s can take the USMLE, train at the same hospitals, etc (paid the same as MD’s, hold the same high-ranking positions), there isn’t much of a difference post med-school education.
You are starting to sound as ridiculous as the others…

- Kelly
sarah on November 24, 2008 7:06 pm
I need help…I will accept help from a MLT, PhD, MD, DO or a student training in any of the above…

There’s a patient with a fisher race phenotype of D,C,E,c,e

What is the wiener genotype?

To me this doesn’t make sense because how do you know which gene is on which loci? help me
BCWB on November 24, 2008 7:51 pm
This particular post has gotten quite the amount of traffic. The main thing I wanted to do on here all weekend was write back nice and mean things to Alexia. I wanted to go ahead and look up her ‘best’ school and see the truth. I decided to do none of the above because no matter how many people we run into in the US, everyone is going to have an opinion. I just hope and pray that I meet a few of those people with the stigmas about the caribbean doctors because when I diagnose the first ten patients before they even have any idea what is going on, they are going to change their minds. Actions speak far louder than words. I have no need to argue with you Alexia. You are at a DO school, that is great. I thought about DO myself. However, you should not judge others, because in the end you are the one that will be judged and that judge may be as biased as you are being. What goes around comes around. Hope everyone had a great weekend!!
RAEB on November 24, 2008 11:55 pm
MartyDev thanks so much for your insight. Much appreciated.
sarahMT on November 25, 2008 1:10 am
so many sarahs! you are “predicting” the wiener genotype because without genetic studies you don’t know for sure. the most common is R1R2 when all Rh antigens are present (DCe/DcE). get the aabb technical manual if you don’t have it and learn what’s most common. hope that helps. good luck!
jammie dodger on November 25, 2008 4:13 am
So many smart people here, I’m out of my depth. Way, way out. Call the Baywatch team. But I do have a nice British accent.

(Guess I should apologise for adding another comment that doesn’t even add to the debate. Sorry.)
sarah on November 25, 2008 8:06 am
wait a minute…jammie dodger is British??? hmmm
And Sarah, thank you so much!
jammie dodger on November 26, 2008 1:29 pm
Yup, I’m red, white and blue to the core. I’m also handsome, tall, rich, creative, witty and intelligent. OK, only five of those are correct.
MartyDev on November 30, 2008 5:47 pm
Sarah,

British accent? check.
Single? No - married with kids and remaining so! :-)

Jammie Dodger could be just who you’re looking for!
jhawke on December 1, 2008 12:56 pm
Kelly - glad you got my point.

About

Short & Sweet

Recent Posts

Categories

Archives

Blogs I Read

Other Stuff

Quick Dictionary

Search

Nov

21

MED 5 exit exam

Comments