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Re: Medical/Educational News

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DR doctor in the US

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Re: Medical/Educational News

A Dominican doctor friend of mine who came to the US recently says he ended up driving a taxi because the English he was taught in the DR is not functional enough to serve him in the field he is in or for Harvard where he began to attend. He is a respected and practicing doctor in the DR, and wanted to come to the US for experience. He was interested in attending Harvard and began there, but couldn't keep up because of his English. He plans on driving taxi for another year to save some money and go back to the DR and establish a clinic. I have heard some of the English that is taught in some places in the DR and it is not sufficient for this purpose. I have seen that happen to other foreign doctors also, that their English was not sufficient for practicing medicine or for the education necessary to make up deficiencies. It would be well to note that, for anyone considering locating in the US, to first learn sufficient English. Even if a DR passes in Spanish, he is told that he must be able to get around hospitals in English.
 
I

Into the fray

Guest
Re: Medical/Educational News

As a professor at a Dominican university that has a medical school, I would like to take a moment and RANT!
1. The two above posts speak (a)about not having enough English to attend Harvard?? Give me a break! Poor poopsy whoopsy! Iddy biddy taxi driver was going to get experience at Harvard?? Yeah, right. Sure, he'll save money and come back here and open a clinic and tell everyone that he "studied at harvard". What a bunch of Bull----!
(b)You are right on about Happy Meal Diplomas! That Utesa you mentioned teaches in English so that the owner gets a bundle of dollars per student....I wouldn't let one of them within a mile of me!!
2. There are excellent Medical Schools in the DR. UNPHU and PUCMM are perhaps the most famous. They are completely different
in their approaches to the degree. UNPHU is very traditional-lots of science and text books and labs. PUCMM's course of study was designed by the WHO and PanAmHO, as well as people from U of Chicago and Harvard Med. It is a completely modulated program with hands-on experience from the third semester on.
They do not recruit foreign students-with the limited exception of the Dominican/Hispanic communities of New York and Miami and Puerto Rico. They teach only in Spanish, Dominican-style.
For those that wish to attend Residency programs in the US, the pass rate has been up in the low 90s for the past 12 years. Not too many students take these exams, but those that do tend to pass.

I have no respect for these wanna-be doctor whiners. Florida will be a major loser if this group is allowed to practice, and the insurance rates for malpractice will skyrocket. Would you want to insure one of them??

Nuff said..
 

Dolores1

DR1
May 3, 2000
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Re: Medical/Educational News

We are planning an update of our Living in Santo Domingo book that includes a chapter on studying medicine in the DR. We would like you to review the chapter. Could you please contact me. My email is dolores@dr1.com
 
E

ECH, M.D.

Guest
Re: Medical/Educational News

Not wanting to be the first, I now feel I can follow ?Into the Fray? and make some comments. First, the reader must understand there has been a tremendous proliferation of off-shore medical schools that cater to those that have been denied admittance to medical schools in their own countries (USA/Canada). These so called ?Universities? are nothing but basic science schools for students who want to become physicians. They are not universities in the traditional sense of multiple educational disciplines (law, engineering, etc.) They are cash-cows for their proprietary owners and can garner 3 to 6 million dollars a year depending on the number of students.
The United States, in order to protect the public from unscrupulous and ill trained people ?claiming? to be physicians have instituted several safe guards. Patients have a RIGHT to expect THEIR physician to be subject to the same exacting standards the rest of the medical community is. Patients have a RIGHT to expect the HIGHEST standard of care from their physician. There are no Class ?A? and Class ?B? medical schools in the USA anymore. ALL M.D.?s (U.S. and Foreign graduates) must take and PASS the United States Medical Licensing Exam (USMLE), a three part exam that is very comprehensive in testing one?s knowledge and understanding of medicine. They must then take and PASS the Clinical Skills Assessment exam (CSA) given at a Philadelphia center with ?patient models? to demonstrate you know how to approach a patient and their problem and how to plan a course of action. It also demonstrates your communication skills (very important). And finally, all Foreign Medical Graduates (FMG?s) must take and PASS TOEFL exam (Test of English as a Foreign Language). It is interesting that even American and Canadian students must take and pass this exam!
I had to laugh about the Harvard story. I actually know a Dominican ?Physician? who advertises he ?went to Harvard??well, he did, for a week-end seminar! And has a nice wall plaque (in ENGLISH) to prove it.
Before proceeding, let me state that I have no ?bone to pick? with anyone. I am a member of a time honored profession and I resent those that would discredit it in any way. I also want to say at the very outset that I know personally quite a few Dominican physicians who are extremely well trained and educated in the medical sciences and have the utmost confidence in their ability. However, there are others who do not meet this qualification. Some who would not even make good EMT?s
I am always leery of ?would be? physicians like Dr. Lopez, in the New York Times, article, who says he is being discriminated against because he is a foreign physician, complaining the exam is ?stacked against him.? Further stating the American Medical Association and the Florida Medical Association do not want ?competition? from foreign graduates.
Then it goes on to state the Cuban/American doctors? lobby will press the Legislature to ELIMINATE LICENSING EXAMS ENTIRELY for the group and require them to work under supervision for a while in lieu of the exam.
Simply because they CAN NOT pass the required exams. They could not pass the exam even when it was translated into Spanish! I am about to demonstrate why MOST of the ?physicians? in question can not pass these exams.
The state of California requires, in addition to passing the aforementioned examinations, that the school that confers the M.D. degree be ?recognized/approved? after AN ON SITE VISIT by a team from the California Board of Medical Quality Assurance. This onsite visit is a team of approximately 8 to 10 persons dispatched to spend a working week at the University in question. During this inspection they try to define just what kind of education the students receive and is it comparable to accepted educational standards in the USA. Without this recognition by the State, an M.D. can NOT TRAIN OR BE LICENSED IN THE STATE OF CALIFORNIA. The University/School must apply for and request the recognition/approval at their expense.
The report that follows is an evaluation of UTESA (the school of Dr. Lopez) by the California Board approximately four years ago. This report is a matter of public record and may be requested from the California Board of Medical Quality Assurance. The Board was NOT impressed with the degree of education at UTESA.
UNIVERSIDAD TECNOLOGICA DE SANTIAGO (UTESA)

INTRODUCTION

UTESA is a general university, with a main campus in Santiago, and a branch campus in Santo Domingo. Both campuses have medical schools: the Santiago campus' is a Spanish Language school only, while the Santo Domingo campus has both a Spanish Language and an English Language Division. We visited only the English Language division of the Santo Domingo campus of UTESA, reasoning that it was this division which supplied most of the applicants for medical licensure in California. We hoped to find time for a visit to the Santiago campus, as our hosts were very eager for us to visit there, explaining that its facilities were newer than the Santo Domingo facilities. However, as Santiago is remote from Santo Domingo, and as the two schools are entirely distinct, such a trip would have constituted an unscheduled additional whole site visit, necessarily infringing upon the other two schools in Santo Domingo who had invited us to site visit them (at their expense), and we were forced to decline the repeated invitations.

Our hosts were unfailingly gracious and accommodating, provided transportation and translation services, and made every effort to supply us with the information we requested.

I. PHYSICAL FACILITIES A. PRECLINICAL

The facilities are set in a pleasant and well-manicured campus, which is spacious and park-like. The buildings are antiquated, there are 6 or 8 classrooms each containing 30 to 50 folding desks and a blackboard, with no other didactic aids in evidence. There is a single large room which could seat the entire student body at once, but no chairs in it, and there is not an auditorium in the usual sense. The laboratories are antiquated as well, with outmoded clinical laboratory apparatus and an assortment of retorts, condensers, burets and similar old fashioned chemical laboratory equipment prominently displayed. One room contains a large number of microscopes, also all prominently displayed. The anatomy laboratory consists of 6 or 8 dissecting tables, perhaps 3 cadavers in various stages of advanced dissection, and a few plastic buckets containing anatomical specimens preserved in formalin. The histology and pathology study materials consist of a set of slides for each of these courses to be used on the premises, but not borrowed. The vivarium is a small open-sided outbuilding, and contains 4 rabbits, 3 mice, and 2 frogs, plus charts of the male and female reproductive systems. There is an experimental surgery laboratory, of about 8 by 12 feet, which contains an animal operating table and light, an assortment of surgical instruments displayed on a Mayo stand, and a bank of perhaps a dozen lockers, each containing surgical scrubs which have clearly never been used.

In this connection, it is interesting to note that there are no students at hand, no faculty members present, and no classes in session, although the trimester resumed more than a week ago and the preclinical courses are offered continuously.

B. LIBRARY

The medical library consists of a few thousand very dusty volumes shelved at random, with many volumes shelved upside down, and a card catalogue which consists of a box of index cards about 3 inches deep. A spectacular find was a bound volume of the Quarterly Journal of Medicine from about 1875. A small personal computer is set up on a small table in the hallway outside this room, but the library has not been actually catalogued, and when questioned about Medline, it was not possible to find the disc.

A similar but somewhat larger medical library exists at the downtown general campus of this University, which also has several thousand volumes (many of which again are shelved upside down), equally dusty. There are bound volumes of Pediatrics from the 1940's, shelved randomly and distributed haphazardly between the two library sites. Neither library has a meaningful collection of modem texts, reference works, journals, or an indexing system, and it is clear that these are not working biomedical libraries in the ordinary sense of the phrase. In fact, it is not clear that the libraries are actually used at all.

C. CLINICAL FACILITIES

The hospitals will be described under the Clinical Curriculum section.

H. ADMINISTRATION

UTESA is a private, for-profit university and is described at first to be organized conventionally, with a governing board which selects a president, mechanisms for selecting chancellors and deans of the various schools and divisions and a degree of separation between policy making and ordinary administrative operations. Closer pursuit of this issue, however, reveals that the governing board is not sufficiently separated from the administration, as at least some chancellors and deans are members. There is very little state support or endowment funding: virtually all of the operating budget comes from student tuition.

Although UTESA comprises a number of graduate divisions, there is a degree of utilitarianism to its components as befits a university in a developing nation. There are, however, few or no conventional academic disciplines besides chemistry, economics, mathematics and medicine.

The Registrar?s office at the downtown campus maintains the academic records for all students. It is heaped with files both loose and boxed, with files falling out of shelves and everything in complete disarray. It is not easy to obtain consistent enrollment and graduation figures, as the data are evidently not in spreadsheet form in spite of a few personal computers in evidence. Approximate figures are: 30,000 students total; of which 7000 are in Santo Domingo; and 1300 in the two schools of medicine (Spanish and English language sections combined). It is noteworthy that nobody could give accurate enrollment figures. Neither the Registrar, the Deans, nor even faculty could quote enrollments, class pass/fail rates, student attrition figures, or graduation rate; and the estimates made by the various people varied widely.

HI. FACULTY

There are no full-time faculty in the School of Medicine, in the usual sense of the phrase. Even the Chancellor and the Dean maintain a private medical practice, and are perfectly frank about the fact that the salaries the school can provide are only a "pittance." Although this economic fact of life is pervasive in medical schools in developing nations, it has immediate and devastating consequences:

1. The basic sciences are taught by clinicians, not by fully prepared basic scientists.
2. There is no significant research in the basic sciences.
3. There is a constant struggle with the faculty's distribution of time and energy between their private practice and their teaching commitments.
4. Many faculty hold teaching appointments in two or more schools of medicine.
5. In the clinical arena teaching responsibilities are re-delegated to physicians who are not faculty members, as a matter of course.
6. No hospital provides a full-time director of medical education.

As an example of how far-reaching the problem of lack of full-time faculty can be, it was disclosed to us, in a meeting with a group of faculty, that a single faculty member has responsibility for the courses in neuroanatomy, microbiology, and parasitology. Similarly, the concepts of an academic senate, or faculty control of the curriculum, are largely absent: faculty are paid by the hour; there is no tenure, or faculty responsibility for the budget for courses, and little for course content. The school does not have a body of faculty identified or in place as is standard in medical schools in the United States. This is due in large part to the part-time appointment status and hourly wage arrangements for the faculty. One faculty member responded to the question, "What improvements in the curriculum would you like to bring about?" by stating that he would like to have a single cadaver reserved for the neuroanatomy course. The faculty member responsible for the core course in pediatrics did not know how many UTESA students were taking his course, and could not remember the last UTESA student he failed in the course. This group of faculty, meeting with us in the absence of the Dean, agreed at once that only the Dean could modify the curriculum content, and could not state when they last met to coordinate the basic science and clinical curricula.

Iv. CURRICULUM

It should be noted at the outset that the curriculum which leads to the MD degree does not extend over a period of 4 calendar years, but rather, 2 and 2/3 calendar years (or 32 months). In addition, although the instructional periods ("trimesters") are nominally of 16 weeks' duration, it became clear, in the course of our site visit, that there is considerable laxity permitted in the academic calendar, and the likeliest reason we saw so few UTESA students actually involved in either the basic science or clinical curricula was that classes hadn't yet started, more than a week into the trimester. Still further, with respect to the clinical curriculum, an instructional "day" bears little resemblance in either length or content to that found in conventional schools: it ends shortly after noon, and includes an average of 3 hours of lecture in the morning.

It proved impossible to obtain definitive schedules or timetables from any source, students included, but the conclusion that the curriculum is unacceptably both lax and abbreviated is unavoidable.

A. BASIC SCIENCES

Although we did not evaluate the content of the basic science curriculum in formal terms, by examining course outlines or final examinations, for instance, it was difficult to avoid the suspicion that it is rudimentary, by conventional standards. The classrooms we visited were vacant, but the blackboards were filled with elementary instructional materials. The students told us that the curriculum was not intellectually challenging, and clearly articulated that their view of the curriculum was that it provided both time and a framework for them to study independently for the USMLE. The students did not recognize the word oncogene, and did not know what course it should have been taught in. Courses requiring laboratory exercises, such as physiology and pharmacology, generally lack them, and there are no laboratory exercises involving experimental animals. They confirmed that there is no basic science research done by the faculty, and that they are not exposed to the concepts and processes by which new knowledge is created and evaluated.

B. CLINICAL SCIENCES

As already described, the nature of instruction in the core clerkships departs considerably from acceptable standards. There is, for example, no core course in general internal medicine: students are, instead, distributed between many subspecialties in internal medicine, simultaneously, and in a spectator role. They do not recognize the educational process which involves submitting to a faculty member for critique and discussion a comprehensive medical history and physical examination of a patient, together with an analysis of the laboratory examinations, a differential diagnosis list, a treatment plan, and an essay based on the current literature. It follows, therefore (although tragically), that when confronted with the lack of modern library facilities, the students shrugged off the issue) stating that they "study at home": they are not introduced to the concept of using a modern biomedical library to assist in patient care.

Furthermore, because of their irregular daily and trimester schedules, the students only infrequently assume actual responsibility for patient care, and with the exception of emergency room, delivery room, and some minor surgical experiences, students are in an observational role in the clinical curriculum. There is no core course in psychiatry in the clinical curriculum: that course is a didactic course in the preclinical curriculum, with occasional patient presentations by the faculty. Students gain no exposure to the management of psychotropic drugs or the nature of the psychotherapeutic relationship. There is no meaningful electives curriculum.

The site visit team spent much time inspecting the many hospitals used by UTESA and concluded that the hospitals were very similar in design, construction, patient population and instruction. We observed armed guards and iron gates which were used to keep the vast population under control, and we noted as well the impact of the frequent and sometimes protracted citywide power outages. Along these lines, the students confirmed that having two patients in labor in the same bed is commonplace, and were quite surprised at our alarm at discovering a Caesarian section rate of about 30% at the obstetrical hospital. What did annoy them was that they had to supply their own rubber gloves. No hospital used by UTESA has a blood-gas machine (used for measuring the tension and content of gases in the blood). The absence of this type of equipment and supplies illustrates the pervasiveness of the deficiencies in the overall medical education provided to the students.

V. STUDENTS

There is no process of student selection, in the usual sense, in the Dominican Republic. Any student with a B or better average from high school can enroll. Although some of the secondary schools are stronger academically than others, there is no distinction drawn in the appointment process between the schools In keeping with the fact that tuition is the main source of income for the school, UTESA accepts as many students as apply, and the administration was quite open about expressing the wish that they could accept still more.

Many of the students in the English language division are graduates of US or Canadian colleges and universities, and therefore are of the expected age. Most of the students in the Spanish language division, however, are surprisingly young. Although their curriculum includes a year of premedical (as opposed to basic science) requirements, the faculty we interviewed were quite consistent in their complaints that the students were both immature and underprepared for the comparative rigor of the medical school curriculum. It should be remembered that this is the same curriculum which the English division students found "not very challenging"

The attrition rate is very high: on the order of two-thirds or three-fourths of students who enter fail to graduate. This is explained as being due to both economic constraints, which lead to a considerable degree of intermittency in enrollment, and to academic failure, which leads to much transferring of students between schools. The end result of these two issues is a haphazardness of curriculum content and continuity which no conventional school would tolerate

VI. SUMMARY AND RECOMMENDATIONS

The deficiencies at UTESA are broad in scope and deep in extent, and include many aspects of the school's organization and administration, physical facilities, faculty, curriculum, and student body; so that only a complete reorganization could adequately prepare its graduates to enter the mainstream of the continuum of medical education, and then medical practice, in the United States. The content of the curriculum, taken as a whole, is inadequate, and for this reason, the site visitors saw little purpose in pursuing the difficult problem of determining the actual duration of the various courses and clerkships. We recommend that the Division of Licensing disapprove this school.
And for those that would cry ?foul? and the system has it ?in? for the Dominican Republic?let me just add the summary of the evaluation done at the same time for INTEC. A glowing report.

VI. SUMMARY AND RECOMMENDATIONS

INTEC is a sophisticated and highly innovative university, and its school of medicine equally so. The administration is equivalent to that in any of the smaller US universities, and the physical facilities are completely satisfactory. The library is excellent, and the University Librarian merits special commendation. The faculty are impressive professional educators, and their commitment to the pursuit of excellence is admirable. The curriculum is enviable: innovative, sophisticated, manifestly successful, and demanding. We recommend that this school and its curriculum be recognized as providing education equivalent to that required by Business and Professions Code Sections 2089 and 2089.5.
I leave it up to the reader to decide about unfair practices and discrimination, or just plain unqualified.
 
M

Milo

Guest
Re: Medical/Educational News

I am curious as to what you would think of a graduate of UTESA school of medicine who has passed all the required exams and finished a residency in the US and is now board certified and licensed in several states(not California) and is working as a physician.
 
E

ECH, M.D.

Guest
Re: Medical/Educational News

I would offer them my sincere congratulations for a job well done. And AFTER reading the report of the California Board of Medical Quality Assurance regarding the educational standards at UTESA I would have to conclude that the individual persevered under very adverse conditions and probably with tremendous amount of extra effort and personal study on their part and were able to overcome the reported significant deficiencies in the system to realize their dream of becoming a physician. The U.S. medical system demands excellence and the individual you mention has demonstrated they have it. Now for my question. Is this common (to pass all the exams, train and practice in the USA)for UTESA graduates of the English Language Medical Program (we can only presume those in the Spanish Program plan to stay in the Republic)? What percentage of the graduates are now licensed, practicing physicians in the USA?