Island Med Student

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

I receive this question so frequently, that I finally decided to address it formally in a blog post.

So, if you go to Ross, will you be able to get a good residency?

The short answer? Yes, absolutely. But that doesn’t necessarily mean you WILL get a good residency. While Ross can help you along the path towards a good residency, it’s ultimately up to YOU to obtain a good spot. Your dedication, how much you study, your USMLE step scores, and your performance during clinical rotations, are amongst the many factors that determine what kind of residency position you will ultimately get.

Now, I have said that it is possible to get a good residency as a Ross graduate, but the reality is that Ross is a Caribbean medical school. And although you might be just as smart and just as good as one of your U.S. counterparts, you will still be looked at as an IMG (International Medical Graduate). This means that it might be a little more difficult for you to get positions at the very top hospitals, but it doesn’t mean you can’t. You will just need to try a little harder, and your Step scores definitely have a lot to do with this.

Some people have also asked about getting into more competitive residencies, such as surgery and radiology. Is this possible as a Ross graduate? Absolutely. But again, you will have to work. Check out this PDF, which lists Ross 2008 graduates’ residency placements. Ross publishes this document every year, and if you’d like to check out previous years’ data, go here.

I have also been asked if Ross graduates can get Canadian residencies. From what I’ve heard, it is more difficult to get Canadian residencies, but it’s possible. You can check out the above list for proof. That’s all I know about that. I’m not Canadian, and have no intentions of moving to Canada, so this is not something that I’ve ever researched.

What about eventually practicing medicine abroad?

I don’t know the laws and regulations in every country. However, if you graduate from Ross, go through a U.S. residency, and obtain state licensure, you can practice in that state. I believe most countries will consider your M.D. degree to be valid. I’m sure there are licensure laws specific to each country, but I can’t cover all of them. If you are looking at practicing in another country, I would research their specific policies and regulations.

For more information about obtaining a residency and links to specific issues specific to Foreign Medical Graduates, check out this article on Medscape.

That’s all I can think of for now. I hope that was helpful for some of you. Please leave a comment or email me if you can think of anything I missed.

Since my recent post about my clinical rotation schedule, I’ve received a lot of emails about what to expect for a Ross schedule, and questions about when is the best semester to start.

Here is the short version. For a little background, most U.S. schools work on a two semester schedule, and usually only accept incoming students once a year in the fall. Hence, they don’t really have to decide when to start. For Ross, I would recommed starting as soon as you’re ready to begin, and not to worry about which semester (Winter, Spring, or Fall) is best. The reason being that there are so many variables involved. You might have to repeat a semester. You might have a reason to take a semester off. You might take months to study for the Steps. You might take only a short time to study. There are really so many variables involved that it’s better to just start right away, and worry about the schedule as it evolves. That’s my personal opinion. Obviously it all does eventually matter, and will affect when you graduate and which Residency Match you apply to. As an example, I will provide my schedule below. I would say that I am not a typical student. Most of the students who started in the same semester as I started are shooting to graduate later, and are applying to the 2011 Match. I’m trying to make the 2010 Match, so my schedule is a bit more packed. Here is what I did/am planning on doing:

Semester 1 Basic Science: Sept 2006 – Dec 2006
Semester 2 Basic Science: Jan 2007 – April 2007
Semester 3 Basic Science: May 2007 – Aug 2007
Semester 4 Basic Science: Sept 2007 – Dec 2007
Study for and Pass Comprehensive Shelf Exam (in order to sit for the USMLE Step 1): Dec 2007
Semester 5 Advanced Introduction to Clinical Medicine (in Miami or Dominica): Jan 2008 – April 2008
Study for and Pass the USMLE Step 1 Exam: April – May 2008
Complete Clinical Rotations and Pass the USMLE Step 2 CK and CS: June 2008 – March 2010
Graduate and Make the 2010 Match: March 2010

As you can now see, when you graduate really depends on so many things, especially including how long you take off to study for exams. If I had started in January or May of 2006, obviously it would have been a bit easier to make the 2010 Match. However, I could also have just taken more time off in between things (as many people do), which would have made me good to make the 2011 Match. Another thing to keep in mind is that you are only eligible to get federal student loan money when you are enrolled in classes, not studying for an exam. To get loans for those “in between” times, you have to go private.

Also, I wanted to answer another question, which is, “what do I want to be when I grow up?” I’m still not 100% sure yet. But I am definitely leaning strongly towards psychiatry right now. I am still entertaining emergency medicine and surgery, but psych is really calling to me right now.

I hope that helps some of you new Rossies out there!

After much blood, sweat and tears, I have most of my schedule for the next year and 5 months planned out. I still have some electives up in the air, but I want to wait and see what I’m leaning towards before I decide which ones I want to take.

I am not taking time off (other than a week or 2) to study for the Step 2 CK or CS. People think I’m crazy for that, but I just don’t have the time (see my packed schedule below). I also can’t afford to take time off to work on my residency applications or for residency interviews, so that whole period of my life is going to be somewhat high stress.

Anyway, in case you’re wondering why I haven’t replied to an email or am otherwise out of contact with the world, at least you now know what I am doing. I made this schedule so I could make sense out of things, so my family and friends could keep track of me, and for any interested folks who want to see what a 3rd and 4th year med student’s schedule looks like.

I’ll update the schedule as I fill in the ?’s.

Enjoy.

Psychiatry: June 16 – July 25, 2008
Surgery: Aug 18 – Nov 7, 2008
Internal Medicine: Nov 10 – Jan 30, 2009
Neurology: Feb 2 – Feb 27, 2009
Step 2 CK: March 10, 2009
Family Medicine: March 16 – April 24, 2009
Step 2 CS: April 30, 2009
Gastroenterology: May 4 – May 29, 2009
Radiology: June 1 – June 26, 2009
? Elective Rotation (possibly Emergency Medicine): July 6 – July 31, 2009
? Surgical Subspecialty Elective (possibly Neurosurgery): Aug 3 – Aug 28, 2009
Obstetrics/Gynecology: Aug 31 – Oct 9, 2009
? Pediatrics (waiting for approval): Oct 19 – Nov 27, 2009
? Elective Rotation (possibly Pathology) – Dec 7 – Jan 1, 2010
? Elective Rotation (possibly Psych subspecialty) – Jan 4 – Jan 29, 2010
? Elective Rotation (possibly Psych subspecialty) – Feb 1 – Feb 12, 2010
“Wiggle” room: Feb 12 – March 30
GRADUATION: March 31, 2010

Note: The first pic was taken right before I left the States to go to medical school in Dominica. That was the day before my flight, when I went hiking with my friends (Laura in pic). The second pic was taken just a few days ago on my trip to Coney Island. It’s strange for me to think about the time that has passed in between then and now.

When I was in Dominica, I joined our school’s chapter of Physicians for Human Rights (PHR). I eventually became the webmaster, and then eventually became president. Our PHR chapter managed to perform many small miracles, such as sending sutures to a rape clinic in the Congo, and tutoring troubled youths. One of the most amazing accomplishments was serving a Thanksgiving meal to the residents of the Grange Home for the Aged in Portsmouth. A simple idea that I had about bringing a Thanksgiving meal to Dominicans turned into one of the most memorable days of my life. You can view pics from that event here.

A few days ago, the new batch of PHR folks threw another party/health clinic for the residents of the Grange. Looking through their pictures almost brought me to tears. I remember from the last event how happy and thankful all the residents were. One resident who could barely walk because of his advanced Parkinsonism was out of his chair, dancing with me and the other residents.

One small thing, big change. Plant a seed a watch a tree grow. Plant a tree and watch a forrest grow. It brings me to my knees.

A while back a reader of my blog asked me to comment on the situation with Ross clinical rotations. I’ve been too busy to reply, but now I’m taking a moment to respond.

So, what happened? Well, let me begin by saying that Ross has many hospital affiliations. There are many hospitals that take Ross students, and you can always set up your own rotations at any ACGME approved hospitals. I have never heard of a student not being able to graduate because they couldn’t get all of their rotations scheduled. BUT…and here is the BUT…you might not get your top choice location or hospital. I had wanted to do all of my rotations in Baltimore. I was somewhat misled into believing that this would be possible. However, I didn’t know the reality, which is that you usually don’t get your top choice.

There are a few “top” locations, where you can easily choose from. As far as I know, these are NYC, Michigan, and Miami. These seem to be the “easiest” to get, because they have the most spots available. The number one easiest is probably NYC. Anyway, what it all comes down to is seats. If there is a seat available, you might get it, if not, you won’t. So, you have to go into the whole mess with an open mind. You have to be willing to accept your second or third choice. You have to be flexible. All this is easier said than done.

Since I’ve been at this hospital, I’ve met students from other Caribbean schools that have it much worse. Some of them don’t find out where they’re going until days beforehand. They have little choice, and get sent all over the country. Also, don’t think that Caribbean med schools are the only ones having these problems. Students at U.S. schools go through similar (albeit maybe not as bad) problems with scheduling core rotations.

Now, all that pertains to core rotations. Elective rotations are MUCH easier to get. I’ve seen Ross students do electives at many different hospitals. And it’s much easier to get an elective rotation at a “non-affiliated” hospital.

I put in an email to my advisor today to make some changes to my upcoming schedule. Basically, I’m trying to do all my cores in Brooklyn, since I have a one-year lease on my apartment. We shall see how that goes…

Anyway, good luck everyone! I hope that helps clarify some things!