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Studying medicine
They are called “offshore” medical schools because they are in the Caribbean islands, very close to the United States. They have become ever more popular since their inception in the 1970’s, when they were created to offer students an alternative in their quest to obtain a medical education. Following are some answers to several of the most asked questions of those interested in studying medicine in this country. 

Over the past 5 years, more than 20,000 graduates of foreign medical schools have entered residency programs in the United States to obtain graduate medical education. The vast majority of these international medical graduates (IMGs) have gone on to practice in the United States after completing their training. Consequently, the number of IMGs has risen steadily reaching nearly 25% of all allopathic physicians practicing in the United States. These physicians practice in disproportionately high numbers in areas of the country that have been neglected by the US health care system. 
Of these medical graduates, most are enrolled in Caribbean island schools, including those in the Dominican Republic. The reason for such interest in the schools is quite simple. There are about 46,000 applicants for about 16,000 openings for medical students in the United States.

Routinely, pre-med advisers attempt to discourage students from pursuing their medical career dreams in offshore schools. Their reasons not only include the obvious ones such as different languages and cultures but also, the not so obvious ones — the quality of instruction and the resources available (e.g. libraries and laboratories).
It should be noted that only half of the U.S. students who go abroad to study medicine actually become practicing physicians. 

Some of these proprietary schools in the Caribbean capitalize on the desperation of would-be medical doctors. These young people are extremely vulnerable and there is a lot of money to be made from them. For aspiring physicians, however, the cost of attending an offshore school — which can be comparable to some out-of-state tuitions in the United States — is a price that many are more than willing to pay.
But it should also be noted that many students who have matriculated through offshore schools have gone on to enjoy rewarding careers in medicine in the United States. 

The road to a medical degree, via a foreign offshore school, is not an easy path to follow, but it is not impossible if one is willing to persevere and overcome the obstacles a foreign graduate encounters.

It is difficult, if not impossible, to establish any quality control standards for offshore medical schools at the present time. It is therefore incumbent upon the prospective student to investigate thoroughly any school he or she is considering. This investigation should include an on-site visit by the student to meet with the administration and faculty and to see the facilities first hand. “Glossy” photographs may not represent the true picture. An on-site visit will also provide the prospective student with an opportunity to meet and question the current students in order to get a balanced picture of the curriculum offered. The administration is not going to paint the school in a derogatory fashion, no matter how direct the question. In fact, some have been known to actually lie to the students to get them to register at their institutions.

There are several questions the neophyte medical student should ask of a school’s administration and have the answers confirmed, as best as possible, by students in attendance. 

1. What states (we are referring to states within the U.S.) permit graduates of the school to pursue post graduate training (Residency)?
2. What states recognize/accredit the school and will permit graduates to be licensed to practice medicine in their territory?
3. Is the school approved for students to receive Federal Student Loans?
4. What percentage of the students pass Step I of the USMLE? Step 2?
5. How many or what percentage of the faculty are U.S. trained? (How can a student be prepared for the USA medical system if no one on the faculty is familiar with it?)
6. What percentage of the staff are full time faculty members devoting all of their time to the school?
7. What are the admission criteria for acceptance? (Be wary of a school that will accept anyone who has the tuition in hand.)
8. What is the class by class failure rate of students and how many times are they allowed to fail a subject(s) before being discharged by the school as unacceptable to continue the study of medicine?
9. Upon graduation from a particular school, is the student eligible for a license in the country in which it is located? 
10. How much time is spent in actual clinical training? Where is the training conducted and by whom? How much actual clinical time is under direct supervision of a professor and not “house staff?"

The above ten questions are very important, especially in foreign medical schools where the quality of training is, for the most part, unknown. These are questions that the prospective student should ask of the school administration and the student body. 

The next ten questions are the ones most frequently asked by students making inquiries about a foreign medical education. 

UCE — Universidad Central del Este, (in San Pedro de Macoris, 45 miles from the capital); PUCMM — Pontificia Universidad Católica Madre y Maestra, (in Santiago, 85 miles from the capital.) 

As illustrated above, most schools are known by acronyms and the remainder are as follows:
UASD (Autonomous Universidad of Santo Domingo). Started 1600. UASD (Universidad Autónoma de Santo Domingo). Alma Mater. Tel. 533-1596 (Coordinación Académica) or Rectoría, Tel. 533-1104. 

UNPHU (National University Pedro Henriquez Ureña). Started 1966. Tel. (809) 562-6601, Medical School, Tel. 563-2254. Admissions Tel. 563-1282. Email: [email protected] (Eduardo García).
http://www.unphu.edu.do

INTEC (Instituto Tecnológico de Santo Domingo). Started 1973. See http://www.intec.edu.do Email: [email protected], Tel. 567-9271. Medical dean is Raymundo Jiménez who can be reached at [email protected]

UNIBE (Universidad Iberoamericana). Started 1982. Email: [email protected], Tel. 689-4111 See http://www.unibe.edu.do

PUCMM (Pontificia Universidad Catolica Madre y Maestra). Started 1976. Located in Santiago, 85 miles from the capital), Tel. 580-1962 
http://www.pucmmsti.edu.do

UCE (Universidad Central del Este), in San Pedro de Macoris, 45 miles from the capital. Started 1970. Rectoría, Tel. 529-3562

Will I be required to study in Spanish?
No, there are schools that teach in English such as UNIBE. You are given, however, accelerated courses in Spanish to facilitate working in the hospitals where that language is always used. 

Will I be able to receive Federal Student Loans if I study in a foreign country?
You are eligible for Federal Student Loans if you are a U.S. citizen (permanent residents are not eligible to study abroad on Federal Student Loans) and your school is an approved institution. 

How much is the tuition in foreign medical schools?
The tuition for schools in the Dominican Republic is considerably lower than that in the United States. Contact the school you are interested for their tuition cost. 

What about living facilities while in the Dominican Republic?
Affordable housing is available, but you must look for it. You can find small apartments comparable to US standards that are usually within walking distance of most of the schools. It is advisable to arrive a week or two early and stay at an Apart-Hotel (one bedroom type apartments that do not require any lease or deposit) until you have made inquiries from other students as to the best and most convenient places to live. 

What about transportation? Can I drive?
To be quite honest, driving in the Dominican Republic is not for everyone. Being a passenger can also be nerve-wracking. There are rules of the road, but most drivers seem to think that they only apply to everyone else. There are private motorcars known as “públicos” and they operate on specified routes. You get on and off just like a normal city bus and the ride is only RD$5. You can hire a taxi and travel almost anywhere in the city for RD$50. If you prefer to drive your own car, you must obtain a Dominican license (after 90 days) and purchase insurance from a local insurer.

What about mail and communications with home?
There is no problem with the telephone system. It is quite modern and features direct dialing to just about anywhere in the world. Most apartments have telephones or at least facilities for them to be installed. The postal service is another matter. It is unreliable at times and most students and other U.S. expatriates rely on private companies where you both send and receive your mail for a fee. This should be investigated immediately upon your arrival to establish a mailing address. The DR is also served by UPS, FedEx and DHL.

How easy is it to process my “official” documents, letters and transcripts once I have arrived and again, when I wish to leave the island with my degree?
Unfortunately, this part is not easy and requires a great deal of patience by the student. Transcripts and documents are frequently “lost,” misplaced, and misfiled, and the administration may require them to be submitted more than once. The better organized the university, the least chances this will happen. Furthermore, experience shows that many universities will stand by their students and facilitate all documentation these need to pursue accreditation abroad. 
This is important. When it is time to leave the island, the same thing may happen. Also, the documents raised here are all in Spanish, including the Medical Degree (even from English Programs). They must be “validated” by the State Education Office, translated, and then “legalized” by the State. This can, and usually is, a very time consuming, expensive process (over US$2,000.00) and very frustrating for the student. This process, and the expected cost involved, should be fully explained to the student. 

Will any of my pre-medical college courses be accepted in transfer?
Most likely they will, but you certainly should check with the school. A problem may arise when a course is required in the medical school and it has been taken by the student in undergraduate studies. For example, Biochemistry may have been taken by an undergraduate Chemistry Major in the U.S. The course will probably transfer but will not be applied to the Biochemistry that is necessary in medical school even though it is the same course. The reason: it was not taken while a student in the medical school. It is also not uncommon for a school to accept several courses and then, when the student is getting ready to graduate, notify them that the courses did not actually transfer. Also, be aware of “hidden” charges for transferring credits. Some schools charge as much as US$10 per credit to transfer previously earned university credits and call it an “administrative fee.” It is best for the student to have all agreements and total charges in writing from the administration, as policies have been known to change during the period of attendance.

What about the cost of living in the Dominican Republic?
Dominicans can live off the local economy very cheaply. North Americans, however, are used to more of the amenities in life. There are large supermarkets with many of the items you would find in your own stores at home. There are also some very pleasant shopping areas with prices that are comparable to those in the U.S. Remember, with the exception of local produce and products, everything else is imported and this adds to their cost. 

What is the process for getting a medical license or training in the U.S. if I graduate from a foreign medical school?
Even if you are an U.S. citizen and a graduate of a foreign medical school, you are considered a “foreign” medical graduate (FMG) and are required to submit to the requirements of the Educational Commission for Foreign Medical Graduates and be certified by ECFMG. The ECFMG certification program was established to provide assurance that a physician educated outside of the United States, Canada or Puerto Rico has met the minimum standards and is eligible to enter an accredited residency training program or fellowship in the United States. Most, if not all, states in the U.S. require ECFMG certification as a prerequisite for licensure.

In order to be certified by the ECFMG, international medical graduates must pass its qualifying examinations and document completion of the educational requirements to practice medicine in the country in which they have received their medical education. 

The examination requirements for ECFMG certification include a medical science examination and an English proficiency test. Currently, there is only one examination available for certification, the United States Medical Licensing Examination (USMLE). 

The USMLE Step 1 and Step 2 each require two days to complete. Step 1 assesses whether a physician understands and can apply key concepts of basic biomedical science. Step 2 assesses medical knowledge and understanding of clinical sciences. 

To be eligible to take the examinations administered by ECFMG, an applicant must be either a student officially enrolled in a medical school listed in the current edition of the World Directory of Medical Schools published by the World Health Organization or must be a graduate of a medical school which was listed in the World Directory at the time of graduation. 

Eligibility to sit for the USMLE examinations or having an ECFMG certificate is no assurance that such will grant acceptance in all states for either post-graduate training or licensure. Each state has its own specific licensing and training requirements and it is suggested that students check with the various states in which they might like to train or eventually be licensed. It should be noted that at this time, domestic graduates are required to spend one year in post-graduate training prior to licensure while for a foreign medical graduate it is three years. Step 3 of the USMLE is taken near the completion of the third year of training and is the prelude to licensure.

You may consider getting a license to practice in the Dominican Republic. This is granted by the Ministry of Public Health after a year of public service in a rural clinic is completed. One year service in government city hospitals has also been admitted under special circumstances.

If you are still interested in a medical education in an offshore school after reading this article, we suggest you arrange for a visit to the institution of your choice and investigate it first hand. A personal visit will pay huge dividends and may prevent an early termination of your studies. It is a small price to pay before you invest major sums of money. Who knows, you may not enjoy the adventure of living and studying in a foreign country away from the security of family and friends. It happens. Not too frequently, but it does occur.

For a foreign medical student’s experience at getting into a residency program in the US, see 
http://www.geocities.com/ResearchTriangle/Lab/8987/matching.html

 

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