Island Med Student

Check out my post on Medscape to read my rant about med students who slack off, and then blame everyone else for not learning anything!

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Okay, so the title of this post is very misleading. I am attending Ross University School of Medicine, and I would like the world to know that I have had a very positive experience with Ross thus far. I have never regretted my decision to attend a Caribbean medical school. But I’ll admit that I am also a “chronic optimist.” I tend to always see the glass as half full, and I very rarely complain about things. However, I receive emails all the time from people who want to know the “dirt” on Caribbean schools. And I received an email a few days ago from a student who asked me to list the “top 10″ things that I don’t like about Ross (in order of importance). This will be a very hard list to create. But here goes:

1) The stigma. As I’ve said many times, there is obviously a stigma associated with attending a Caribbean medical school. However, I must say that I have found this to rarely be a problem (again, my darn optimism!).

2) The large class size. Yes, Ross accepts many students every semester. And for some people, this makes it challenging to “be heard.” But again, I will say that this has never been a negative for me. I’ve almost always found that I’ve gotten the attention I needed…but that leads me to number three.

3) Scheduling clinical rotations can be challenging. Because of our class size, and because of the fact that there are limited clinical spots for us students, it can sometimes be difficult to get individualized attention, and the “best” spots available. But all in all, I must say that I have been “mostly” satisfied with my scheduling, and most of my rotations.

4) The cost. This might be the worst thing that I can complain about. Ross’s tuition and fees is on par with the more expensive U.S. medical schools. And when you add on the additional costs related to traveling, the price really adds up. If I have one regret, it is the astounding amount of student loan debt that I’m facing.

5) Living in Dominica. This one is really difficult for me to count as a negative. For me, this was one of the TOP reasons for choosing Ross. I was truly excited about living in Dominica. But for those people who can’t appreciate the beauty of this wonderful country, I guess they count it as a drawback.

6) There isn’t really a “home base.” Since you spend a portion of your time in Dominica, and then the rest at various sites in the U.S., it can sometimes feel a little discombobulating. For me, this was actually a great advantage. But for others, it can be unpleasant.

7) It’s difficult to place into competitive residencies. Yes, it’s harder for Ross grads (or other non-AMG grads) to place into more competitive residencies. But the reality is that you CAN place, and it does happen. But you may need to work harder and have a better CV than your AMG counterparts.

8 ) Not enough administrative guidance. Since we really don’t have a solid “home base” and because there are so many of us, it can be difficult at times to get good guidance from the school. Although, I’d say in my experience, I have been mostly satisfied with the response I’ve received.

9) Having to repeat semesters. Many people complain about the fact that if you fail one class by even one point, you must repeat the entire semester. While I can understand and appreciate this complaint, I also understand Ross’s policy. If you are struggling with even one class, it means that you really need to get a better hold on your studying routine, and try again.

10) It ain’t Harvard. Nuff said.

Sorry if you were expecting better complaints, but I am just not a good complainer!

Note: I actually had to google “Ross Sucks” and go onto ValueMD to come up with this list!

I say this all the time: I am a chronic optimist. I really do tend to see the glass as half full, at least most of the time. However, this does not mean that I’m not immune to those darn pessimists, and the comments of others. People email me all the time, asking for the “down low” on med school, Ross University, and other related topics. My general response is that I loved almost everything. But that’s really related to my chronic optimism. There aren’t many things that I hate.

I’ve been trying to keep a very positive outlook on the whole residency match process. I want to believe that when a program says they like me, they are telling the truth. I want to believe that I have a good chance of matching at my program of choice. Perhaps I’m just fooling myself, but that’s the way I tend to think.

But lately, I’ve found myself being influenced by all the other med students who are also matching. I hear their stories of people interviewing at and ranking 15+ programs, but then not matching. I hear them say “just because a program says they like you, that doesn’t mean it’s true…they say that to everyone,” and I’ve found myself taking their comments to heart.

But today I found a reason to again believe in myself. I want to believe that I will match. I want to believe that other people have the same confidence in me that I do. And I’m going to try to block out everyone else’s voice, and just listen to my inner “happy” voice.

On another note, I just got back from a wonderful doggy walk, just as the sun was setting on the horizon. All the photos in this post are from my journey through Bushwick tonight. Enjoy.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I had a wonderful weekend, which including going out with Micah and my Son Tom on Saturday night. Today I started my first day of an elective rotation in infectious diseases. I’m hoping to improve my antibiotic selection skills, which could certainly use much improvement.

I now have my official schedule in place, except for my very last 4 weeks, so I thought I’d share it with everyone:

Infectious Disease: December 7 – January 1
Nephrology: January 4 – January 29
Pain Management: February 1 – February 12
Pediatrics: February 15 – March 26
Hopefully a sub-internship: April 5 – April 30

And then I will be finished! Yes, I am doing pediatrics very late in the game but that is a whole another long story.

Also, for all ye curious souls out there, here is my schedule for the residency Match and graduation:

Residency Interviews: Now – February 12
Deadline for Ranking the programs: February 24
Find out if I matched or not: March 15
Match RESULTS: March 18
Official Graduation Day: April 30
Graduation Ceremony at Madison Gardens: June 4
First day of residency: July 1

More to come about infectious diseases!

Check out my post on Medscape to read about some common med school myths dispelled!

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Check out my post on Medscape to see a fun comparison of my life now to my life when I first started med school.

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This is a post I have been meaning to write forever. It would probably be better if I had written this a long time ago, when I was still in Dominica (as everything would be fresh in my mind, and the resources there would be the same), but nevertheless, I feel like it might be helpful for me to list some things.

Here is my disclaimer: things might have changed in Dominica since I was there (from 2006-2008). Also, let me say upfront that what you decide to bring really depends on the type of person you are. If you don’t really care so much about brand name items, and you are willing to pay a little more or less, you really don’t need to bring that much. If you are the opposite, you should bring more. I only brought two suitcases, within the weight limit, and was pretty much okay. You will have to decide for yourself what you really need.

Here are my suggestions (in somewhat order of importance):

1) ALL computer/tekmology related items that you need. This includes laptop, cables, camera, iPod, headphones, jumpdrive, etc. Technology items are expensive and very hard to come by in Dominica. Bring everything you might need.

2) Clothes. This is rather obvious. There are clothes available, but not necessarily the ones you would like. Bring plenty of t-shirts/tank tops, shorts, flip flops, underwear, etc. Dominica is HOT. You will need to dress accordingly. But you should also bring a pair of jeans, and a sweat shirt, etc., as the classrooms and library tend to be very cold. Bring some shoes that you can hike in (I highly recommend hiking), and a few work-out outfits for running, going to the gym, etc. Also bring some swimwear and at least one nice outfit, with shoes, for your white coat ceremony. You will need dress clothes for ICM and stuff like that, but not until your 3rd semester on.

3) Toiletries. If you can’t live without a special type of deodorant, make-up, or face lotion, bring it with you. If you don’t mind using whatever is available, you will be able to find other substitutes in Dominica.

4) Medicine. Although there are pharmacies and such, it’s not a bad idea to bring a supply of any medications with you if you can. It just makes things easier.

5) Food. If there are items that you CAN’T live without, bring them with you. Dominica has plenty of food, but maybe not the selection that you’re used to in the States or Canada.

6) Books. This is a complicated issue. It depends on if you decide to buy your books in advance, or buy them once you get on the island. In retrospect, I think I would have bought them in advance on Amazon and had them shipped, but this really just depends on what your needs are.

7) School supplies. You will be able to find almost any type of binder, highlighter, notebooks, etc., at the RossU bookstore. However, they will be much more expensive there. If you want to pay less, you should buy these in advance.

8 ) Heavy duty flashlight and umbrella. It’s not that you can’t find these in Dominica, but it’s probably easier if you just bring them with you, as you will need them every day!

9) Battery operated clock. If you have an iPod, I highly recommend the iHome. You can buy clocks in Dominica, but it’s not a bad idea to have one from the outset.

10) A good pair of scissors and a can opener/swiss army knife. For some reason, these are hard to come by in Dominica.

11) Bug spray. You can find it there, but if you like, you can bring it with.

Okay, now here is where my advice is different from other lists I’ve seen online. I really don’t think you need much more than the above items. Obviously, if there are other items that you CAN’T live without (favorite stuffed animal, photo of your loved one, a pet rock) you should bring those as well. However, I don’t necessarily agree with other lists I’ve read. You don’t “have” to bring everything under the sun with you. You can find plenty of things in Dominica. You don’t need to bring pots and pans with you, unless you are very specific about the kind you need. Again, as I said above, you can find many things in Dominica, just perhaps not to the standard you’re used to. But for me, that was part of the fun! Why go to a new country and live there for two years without experiencing what they have to offer?

Anyway, that’s my list. Much shorter than most, I know. Please feel free to add, subtract, or comment!

I received a nice email from an interested student, and I thought my reply might be nice for others to read, so I’m posting it here.

So, are there enough residency spots (in the U.S.) for IMGs (international medical graduates)? Well, before reading this post, you might want to first read my post about whether or not Ross University graduates can get a good residency spot. You can read that here.

Now, on to the more specific question.

Here is the actual email I received:

How do you feel about future Ross graduates’ ability to competitively
match? As you may know, US schools are increasing enrollment yearly (as are
carib schools) and I’m afraid that will affect our chances of matching 4 yrs
later. (I would be starting Jan 2010 after MERP btw). Based on the NMRP
2009 Data, 93.1% of US MD grads matched, vs a mere 47.8% of US FMG. The %
from 2005 -2009 for FMG matching is generally decreasing, considering
amount of increased enrollment on both sides.

I assume that most of the FMG who matched came from the big carib schools.
Would you happen to know what % matched this year from Ross? And do you
feel that the odds will be problematic for those entering now? (i.e., more
pressure to score higher for lesser or more competitive residency seats,
etc.)

Thanks for your time and energy posting helpful info on your site!

Okay, to address the first concern/question. Yes, I am very aware that both U.S. and Caribbean schools have been increasing their enrollment. Actually, the AAMC realized a few years ago that the nation is facing a shortage of physicians. To address this problem, they asked that U.S. schools increase their enrollment, and encouraged the creation of additional medical schools. This is great, but there is an obvious problem. It’s fine and dandy if more students start graduating from medical schools. However, if there are not enough residency spots to handle these graduates, we are in trouble. Acknowledging this problem, the AAMC has been actively trying to expand the number of residency positions available. You can read about one of the bills they have backed to increase residency spots here.

So, yes there is an issue with expanding the number of medical school graduates without also expanding the number of residency positions. I think the AAMC is making some progress towards rectifying this issue. However, how successful they will be, and how this will affect the competitiveness of residency positions (and in particular Caribbean graduates) remains to be seen. I prefer to remain optimistic, but the reality is that no one is actually sure what will happen over the next few years.

To address the second question of the emailer, about IMGs matching less in recent years, I will ask you to see this data (page 4 in particular) published by the NRMP. In 2009, 93.1% of U.S. allopathic med school seniors successfully matched. In contrast, only 47.8% of IMGs (from the U.S.) successfully matched. This number has decreased from 54.7% in 2005. I don’t really have a good answer for why this has occurred. However, I will hazard a guess and say that it could be to the number of Caribbean med schools popping up in recent years. There are more schools, and many of them might be pumping out unqualified students, who end up not matching, and bring down the percentages. I have no data to back this up, so feel free to not believe me.

However, when looking at the matching rate for IMGs (47.8%), I will ask you to look at another number as well. In 2009, 17.2% of U.S. IMGs actually withdrew from the Match, versus only 1.9% of U.S. allopathic seniors. Again, I will guess as to why this happened. There is a chance that some of these IMGs ended up getting a pre-match (only IMGs have this option), and hence withdrew from the Match. This could be correct, or I could be way off. But it’s my guess. And this obviously is skewing the data.

As for the percentage of Ross graduates who matched in 2009, I’m sorry but I don’t have that number. I know that all my friends matched, but that is obviously not a good sample size!

Anyway, I hope this helped answer your questions. Please feel free to correct me or ask any more questions!

Note: No, you’re not going crazy. The photos above have nothing to do with this post. I am tired and desperate and just picked some random iPhone photos. “My bad.”

I get this question a lot, so let me just address it in a separate post.

Will you be stigmatized for attending a Caribbean medical school? Yes, you will, to some degree. But does it mean that you shouldn’t attend one? Well, that depends on why you want to become a doctor. To read about my thoughts on this, please see this post. The gist is that if prestige is your primary goal, maybe you should reconsider your path. If you want to be an amazing doctor, though, there is absolutely no reason why you can’t attend a Caribbean med school.

Well, what about residency? Will I still be able to get a good spot? Yes, you will. Does it matter that you went to a Caribbean school? Yes, it does. But that is not the end all be all. See this post I wrote for a longer explanation.

What I’m trying to say is that yes, there is a stigma for Caribbean and other foreign medical graduates. Yes, some people might give you crap for it. But in my experience, it matters way more what type of student you are. I have received amazing commendations from my attendings and residents, and they never seemed to care which school I went to. My patients never even ask which school I attended. And when I do a great job of treating them, show them compassion, and really listen to them, they don’t seem to care at all which school I went to, or even what color hair I have.

If you want an easy path in life, don’t go to med school. If you want to be a doctor, but don’t want to ever have to deal with the possibility of being stigmatized by being a foreign medical graduate, go to a U.S. school. But if you want to be an awesome doctor, and you are willing to work hard for it, ignore what anyone tells you, and live your dreams, then go for it. And don’t let anyone ever tell you that you can’t!

That’s my 8 cents!

I’ve received quite a few emails asking about whether or not Ross, and Dominica in general, is gay friendly. So, I thought it might be helpful to post an entry about it. Keep in mind that I can only provide you with information based on my, and my friends’ personal experiences. I’m sure different people have had their own different experiences. This is simply what I know.

First I will address Dominica.

I would not call Dominica a “gay friendly” country. However, I wouldn’t necessarily call it a “gay unfriendly” country, either. For the most part, Dominicans are very laid back and friendly people. They are generally very accepting and non-judgmental. However, Dominica has a fairly large religious population. I don’t think homosexuality is welcomed by “most” people. There are no gay bars or restaurants, that I am aware of. I personally knew a few gay Dominicans, but the majority of them were not very public about this. I also worked with the AIDS population while in Dominica, and I know that most of the men who came in were very sensitive about not revealing their HIV+ status, because of the stigma associated with AIDS and homosexuality (whether or not they were actually gay).

So, my general recommendation would be to not worry so much about living in, or visiting Dominica if you are gay. However, I would keep in mind that it’s not completely accepted. You have to “feel” out the specific area that you are in. Something as simple as holding hands might be viewed negatively in some areas, and by some people. If in doubt, try to be discrete and avoid “public displays of affection.” If you are a couple and are trying to get a hotel room, you might want to ask for two beds, to be on the safe side. (Of course, you can then do what you want with the beds!)

I’ve never heard of any actual hate crimes against gay people in Dominica. But my guess is there have probably been a few in its history (as you would find in most countries!) My understanding is that Jamaica is probably the worst Caribbean country for gay people (I’ve heard bad horror stories). I’ve heard that St. Barts is the most gay friendly Caribbean island. I would guess that Dominica is somewhere in between.

What about Ross being gay friendly?

From my experience, Ross is a very gay friendly school and campus. I’ve never seen or heard of any bad stories related to gay folks at Ross. Personally, I’ve seen quite a lot of acceptance from the vast majority of the students. There might be the occasional religious fanatic student who is homophobic, but I’ve never met them. We have a powder puff football game every semester where the girls play against each other (actually, I’m not a fan of this, for other reasons), and some of the guys usually dress up as cheerleaders. No one seems to care. (Some of them are gay, and some of them are straight. My point is just that people accept this. I know that there are people out there who think that a man wearing a dress is gay. Of course, I don’t. But I’m just using it as an example.)

I’ve known quite a few gay folks at Ross, and as far as I have known, they’ve never experienced any very bad experiences or discrimination. When I was president of Ross Physicans for Human Rights (PHR), we showed a documentary about a transgendgered couple, and I recieved a lot of support from students. There was also talk of starting a PHR LGBT branch, and I know another guy who was going to start a separate LGBT club. I’m not sure if it ever became an official club, but the fact that there were so many people who wanted to support it, proves that the demand is definitely there.

So, what’s my advice in general? I would absolutely recommend Ross and Dominica for any LGBT (or other!) person. However, I would also recommend being “smart” about being openly gay in some venues. You have to “test the waters,” (pun intended) and just be safe about things, as you would in a small town that you’re unfamiliar with in the States.

That’s all I can think of for now. As always, please comment or email me if you have anything to add, or if you have more questions!

Note: Photos are from D.C. pride celebrations in 2005 and 2006. Photo credit: Micah Walter