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More about offshore med schools and residency prospects

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Back in April, I blogged about the prospects for graduates of Caribbean medical schools matching in categorical surgical positions and estimated that graduates of two of the more prominent Caribbean schools, St. Georges and Ross, had a 2.5 to 3% chance.

What about some of the other Caribbean schools? Hard data are difficult to obtain since most of the schools do not publish match statistics, and in particular, the number of graduates who dont match in any specialty.

Here is what one recent commenter on that April post had to say:

My girlfriend studied at University of Medicine and Health Sciences (UMHS)-St.Kitts in the Caribbean. She is a very hard worker and studied well. All of my savings are gone and extra bank loans add up. No match, no residency, and no more hope. Applied for medical lab tech and waiting. In my opinion, IMG is not an option, try local medical schools and if not try something else.

The UMHS website says 59 of its graduates matched in a specialty in 2014, 2 in preliminary surgery and 2 in general surgery, presumably categorical. The number of graduates of UMHS is not listed although the school apparently has three graduations per year reflecting its three different starting dates for students per year.

Another school, Medical University of the Americas on the island of Nevis, had about 90 matched graduates for 2014, 2 of whom obtained positions in surgery—both preliminary.

An additional commenter on my April post, who turned out to be the owner of a different Caribbean school, said this:

Caribbean medical school is best platform and nice and informative….. Successful communication is key in every successful business…. Understanding your subject and having good knowledge on your blog topic is always essential for a successful blog… Thanks for this post…..

Normally I would have blocked this comment as spam, but before I did so, I googled his school, the American Global University School of Medicine, located in the Central American country of Belize. The International Medical Education Directory lists its total enrollment as 100 students. The schools website does not provide any details about match results for its graduates or much of anything else, such as names of faculty or specific hospitals where students do clinical rotations in the US.

I found some other interesting links—too many to list here—about the school, its officials, and its standing in Belize. You would be wise to google it too, or you can see some links in my comment to the schools owner on my April post.

If you have any interest in attending this or any other school not accredited by the Liaison Committee on Medical Education (LCME), you should do a thorough Internet search before going ahead with an application. Do not send money unless you are certain that the school is legitimate and that most of its graduates are obtaining residency positions.

Keep in mind that the number of residency slots available for international graduates will decline even further over the next few years because several new US medical schools will be producing graduates, and many established schools have expanded their classes.
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Improving the M M conference

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"Surgical pathology works more than 80 hours per week, has no regard for your gender or your life situation, and can be devious and sneaky in its presentation."

The following is a guest post by Dr. Leo Gordon, a surgeon from Los Angeles.

A recent paper in Annals of Surgery found that 24% of graduating surgical residents "were unable to recognize early signs of complications." One possible solution is a redesign of the morbidity and mortality (M&M) conference .

I have spent a significant part of my professional life in an effort—at this point it is a crusade—to change the nature of the M&M conference. For 11 years, I moderated 495 conferences, 1485 presentations, and 30 written examinations based on the error and complication-reducing points raised during the discussions.

If properly implemented, a redesigned M&M conference can satisfy the ACGME core competencies, the suggestions of the Institute of Medicine, and the publics demand for a reduction in medical errors.

What I have dubbed the "M&M Matrix" converts the weekly conference into a vibrant educational effort and creates a constantly updated patient safety curriculum for the resident and attending staff.

If the M&M Matrix is such a valuable idea, why hasn’t it been widely adopted?

Here are the reasons:

1. Implementing the M&M Matrix is a ton of work.

Setting up this program and changing the culture of a traditional conference requires acceptance at all levels of the department. It is a week-long effort, not a one-shot Tuesday morning flirtation with surgical education. To pull this off, someone is going to have to be paid, which is a stumbling block. The residents have to buy into this program. It is more work for them, but think of the benefits of the cautious analysis of a complication. Most departments look at the concept, realize how much work it will take, and revert to the traditional conference.

2. The M&M Matrix requires a moderator with specific talents.

Effective moderation of this conference requires a certain set of skills that not every attending surgeon possesses. The moderator has to select educationally valuable complications to discuss. The moderator has to…well…moderate the conference, focus on worthwhile comments, recognize the difference between a legitimate statement and the sweet reverie of surgical anecdote, and do it in a respectful manner. The moderator has to summarize the conference in a HIPAA compliant manner, distribute the teaching points, and construct an examination based on the conference.

3. The M&M Matrix relies on a structure of classic surgical education, a structure suffering advanced erosion.

I am entering my 36th year of practice. My view of surgical education is inconsistent with work-hour restrictions, life-style considerations, hand-offs, and current methods of patient care. I view the discipline of surgery as an effort to eradicate surgical pathology. Surgical pathology works more than 80 hours per week, has no regard for your gender or your life situation and can be devious and sneaky in its presentation. The method of assessing the effects of surgical pathology should be just as rigorous. I hate to fall back on a military analogy, but the M&M conference should be a boot-camp or basic training for the real war.

4. There is no statistical proof that the M&M Matrix decreases the incidence of complications.

The academics and statisticians have got me here!

How do you get inside the head of a senior resident as he is digging out the left colon in a tough diverticulitis case and show that in that fecund mind, because of this educational format, the resident is thinking:

"Gee, we discussed a lacerated ureter a few months ago. Remember the techniques of assessing the ureter that we discussed at the Matrix Conference? Didnt the outline we got and the test questions suggest that we should identify the ureter above and below and make sure we stay close to the colon?"

How does one quantify that a complication was avoided because of an educational effort?

These four reasons for lack of wider adoption can be overcome by a thoughtful analysis of the benefits of a redesigned conference. Given the current problems confronting surgical education, I believe that the idea will be re-evaluated and will eventually be adopted.

Time will be increasingly valuable in upcoming 60-hour work week. The hour allotted for the analysis of surgical complications has to be leveraged into a durable learning experience.

The incoming president of the American College of Surgeons, Dr. Andrew Warshaw, has chosen Dr. Ernest Codman as the subject of his presidential address. Dr. Codman invented the M&M conference. He conceived and implemented it, and in so doing improved surgical care. I hope that Dr. Warshaw’s remarks will spark a renewed interest in a re-design of the M&M conference.

I have a viable plan. Now I need the support to implement this plan. Perhaps I can complete Dr. Codman’s work!

If you have an opinion about the M&M Matrix, please comment below or contact the author—LeoGordonMD at gmail.com


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