The Accreditation Process of Caribbean Medical Schools

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Before considering studying medicine in the Caribbean, it is essential for all prospective students to understand what it means for a school to be “fully accredited,” as many Caribbean medical schools will claim this, but not all are. The standard of education vary widely at different schools in the Caribbean, and which school you choose to go to will impact the states you will be able to legally practice in in the future. I received an email from a friend asking about this topic, and so I feel it will be helpful if I posted my answer here for everyone to read.

“I was reading online and it’d say how not all of the schools are accredited, which scares me. Ideally, going to a Caribbean school for 2 years and doing clinical rotations in the U.S. would be great and I wasn’t sure if all the Caribbean schools would allow that. do you know which of the Caribbean schools are top rated? I guess my fear is whether it could stop me from practicing in the states…” — Jacinta

Disclaimer: In this post, I am only addressing off-shore American medical schools in the Caribbean. Regional medical schools located in the Caribbean and U.S. domestic medical schools in Puerto Rico are not included in this article.

It is true that not all international medical schools are accredited or fully qualified for its graduates to practice without limits in the United States. In fact, most are not. Many schools like to juggle the terms “accredited”, “recognized”, and “approved” when talking about their qualifications, and they often use these terms broadly. The truth is schools can be qualified on many different levels and in many ways, not all of which equals accreditation. A school can be “approved” by a government to confer degrees, “recognized” by its Ministry of Education as a school, and be listed in an authoritative directory of medical schools, but not be accredited by a recognized independent accrediting agency like CAAM-HP, NVAO, or ACCM. Schools like this are technically not accredited. When talking about medical school, the word “accreditation” should not be a term that is juggled around and interpreted broadly. Therefore, try to be critical when you read that a school is “accredited”, “approved”, or “recognized.” The qualification process is complex, but here I’ll take you step by step in the process in which foreign medical schools must go through to become accredited or fully qualified for its graduates to practice without limits in the US:

1. GOVERNMENT CHARTER
First and foremost, the prospective school must obtain a charter from the government of the country in which they plan to establish their med school. A charter is NOT an accreditation, and does not reflect the quality of education at the school. A charter simply means that the government of that country allows the school to function as a school and confer medical degrees in that country.

2. DIRECTORY LISTING
To be internationally recognized as an “official” medical school, it must be in an “official” medical school directory. As of 2019, that directory is the World Directory of Medical Schools (WDOMS), created by merging the former IMED (FAIMER/ECFMG) and AVICENNA (WHO/WFME) directories. According to the U.S. Educational Commission for Foreign Medical Graduates (ECFMG), only students who obtain degrees from schools listed in the WDOMS (or former IMED/AVICENNA) directory are eligible to take the USMLE exams and participate in matching (until 2023, when ECFMG will also require that the school be accredited by a WFME-recognized accreditation agency, which will be discussed below). However, it’s important to note that the WDOMS (or IMED/AVICENNA) is only a directory and NOT an accreditation (the WDOMS, FAIMER/IMED, and WHO/WFME/AVICENNA even state this themselves on their respective websites), and therefore being on the WDOMS (or IMED/AVICENNA) list says nothing about the quality of the medical school. There are many unaccredited medical schools listed in the WDOMS (and IMED/AVICENNA) directory. The only requirement for a school to be on the WDOMS directory is to have a government charter from the country in which the school is located (see #1 above).

3.  ACCREDITING AGENCY
The school must then be accredited by an accrediting agency to determine if the school meets the educational quality and administrative standards of the accrediting agency. For American medical schools, it is the Liaison Committee on Medical Education (LCME), which only accredits schools in the United States and Canada. Foreign medical schools use other accrediting agencies, such as those of their own government or a multinational accrediting agency like the ACCM or CAAM-HP.

Currently, ECFMG does not require medical schools to be accredited by any accrediting agency for their graduates to be certified to enter residency programs and practice medicine in the US. Because of this, many Caribbean medical schools, particularly those in countries that do not have strict accreditation requirements, remain unaccredited. However, this will change in 2023 when ECFMG starts requiring medical schools to be not only accredited, but accredited by an agency that is recognized by the World Federation for Medical Education (WFME) as having acceptable international standards for accrediting medical schools. Of the accrediting agencies that accredit Caribbean medical schools, only the ACCM, CAAM-HP, and NVAO meet this requirement. Only students from schools accredited by these agencies would be able to sit for the USMLE step exams, become ECFMG-certified, and practice medicine in the United States.

4. NCFMEA
Not all international accrediting agencies accredit schools in the same way. For this reason, the US has a National Committee on Foreign Medical Education and Accreditation (NCFMEA) that reviews the accrediting agencies that accredit foreign schools to determine whether or not they have standards comparable to the LCME used in the US and Canada.

As of 2019, there are 5 accrediting agencies in 10 countries (or political entities) in the Caribbean that are recognized by the NCFMEA. Notice I mention both accrediting agencies and countries, because a country may have multiple accrediting agencies, only which a few may actually be NCFMEA approved, and vice versa. Here are the accrediting agencies:

  • Accreditation Commission on Colleges of Medicine (ACCM) – Accredits American University of the Caribbean (AUC) in St. Maarten, St. Matthews University (SMU) in Cayman Islands, Medical University of the Americas (MUA) in Nevis, and University of Medicine and Health Sciences (UMHS) in St. Kitts.
  • Dominica Medical Board – Used to accredit Ross University when it was in Dominica, until the university moved to Barbados in 1/2019.
  • National Council of Higher Education, Science, and Technology – Accredits several regional medical schools in the Dominican Republic.
  • Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP) – Accredits St. George’s University (SGU) in Grenada, American University of Antigua (AUA) in Antigua & Barbuda, Ross University in Barbados, Trinity School of Medicine in St. Vincent & the Grenadines, and Jamaica
  • Nederlands-Vlaamse Accreditatieorganisatie (NVAO) – accredits Saba University in the Caribbean Netherlands (aka Bonaire, Saba, St. Eustatius). When the islands of Bonaire, Saba, and St. Eustatius joined the Caribbean Netherlands in 2010, their respective medical schools became required to be NVAO-accredited, just like in the rest of the Netherlands in Europe. Saba University was the only school that successfully did so. As a result of not successfully getting NVAO accreditation, University of Sint Eustatius and St. James School of Medicine were not allowed to continue operating in the Caribbean Netherlands and subsequently moved their campus and government charter to other countries. University of Sint Eustatius was renamed  “American University of Integrative Sciences” and moved from Sint Eustatius to St. Maarten in 2014, then to Barbados in 2017 where it is applying for CAAM-HP accreditation. St. James School of Medicine relocated from Bonaire to Anguilla and St. Vincent and is given initial accreditation by the CAAM-HP.

The NCFMEA does not determine whether or not graduates can practice in certain states. The main purpose of the NCFMEA for reviewing accreditation standards is to determine whether or not American students attending a particular international school can participate in the US federal financial aid program. Being recognized by the NCFMEA is only one of several strict criteria for being approved for the US federal financial aid program, which I will describe towards the end of this article.

5. STATE APPROVALS
In addition, there are many states that also require foreign medical schools to be reviewed by their own state board of medical education. States like California, New York, and Florida require state-approval in order for students to do clinical clerkships in those states during their third or fourth years in medical school. (Notice I emphasize clerkship, rather than internship, residency, or licensure. If you are not familiar with the difference between these terms, please consult this page). New Jersey used to allow international medical schools to conduct clinical clerkships in the state, but have since closed their clerkship sites to international schools. Schools that already had clerkships in New Jersey before the change in policy (like Ross and SGU) were grandfathered in and allowed to keep their sites in these states. Regardless, it doesn’t really matter which states a school can conduct clerkships in. What really matters most is which states graduates of the school can get residency and licensure in. Therefore, the most important state approval is California state approval.

CALIFORNIA
Not only is California approval required for you to do clerkships in the state, but also required for you get a residency as well as licensure to practice in the state. However, what makes California approval really important is that it is not only required in California but also in other states that follow California’s Approved List of International Medical Schools, including Alaska, Colorado, Indiana, and New Mexico. Tennessee also follows California’s list but allows graduates of unapproved schools to provide documents to prove equivalence to be considered for licensure. In addition to these states, some states follow California’s Disapproved List in which graduates of officially California-disapproved schools cannot obtain residencies or licensure in those states (but graduates of schools that are neither disapproved or approved may get licensed). These states include North Dakota and Vermont. It is a possibility that other states may also start following the California list in the future. At the time of this writing (2019), graduates from schools not approved by California must practice 10 years outside of California before they can become eligible to practice in California. 

Only six off-shore Caribbean med schools are on California’s Approved List: American University of the Caribbean (AUC), St. George’s University (SGU), Ross University, Saba University, American University of Antigua (AUA), and Medical University of the Americas (MUA). Graduates can therefore practice in California and the numerous other states that follow California’s list. As of 2019, these six schools are also the only ones where graduates are allowed to practice in all 50 states.

Off-shore Caribbean med schools on California’s Disapproved List include: Spartan Health Sciences University, University of Health Sciences Antigua, and St. Matthew’s University (SMU). Graduates from these schools cannot practice in any of the states that follow California’s Approved List and Disapproved List as stated above.

KANSAS
The Kansas State Board of Healing Arts has its own list of approved and disapproved schools. In order to get a license to practice in Kansas, you must be a graduate of an approved school or a school that has not been disapproved. In addition, your school must have been in operation for at least 15 years (from beginning of instruction). AUC and Saba are on Kansas’ approved list. St. Matthew’s University, Spartan Health Sciences University, and University of Health Sciences Antigua are on its disapproved list, and graduates therefore cannot be licensed in Kansas. Ross, SGU, and AUA are not approved, but they are not disapproved either, and they are all over 15 years old, and so graduates are allowed to get licensed in Kansas.

NEW YORK
In addition to being a requirement for students from foreign medical schools to conduct more than 12 weeks of clinical rotations in the state, New York state approval is also required for graduates to obtain residencies in the state, but not required for the graduate to be licensed as a practicing physician afterwards in the state.

TEXAS
For those students interested in practicing in Texas, the Texas Medical Board require state-approval of a school for graduates of the school to obtain licensure without the need to demonstrate substantial proof of equivalency through documents and questionnaires, as would be the case for graduates of international medical schools not approved yet by Texas. Of the off-shore Caribbean med schools, only AUC, SGU, and Ross are on the Texas’ Approved List. Graduates of all other schools not on the list can get licensed to practice in Texas but it will be more difficult.

6. US FEDERAL STUDENT AID
Finally, in order for a foreign medical school to be eligible to receive U.S. Federal Student Aid (Title IV of the Higher Education Act of 1965), they must satisfy an additional number of criteria: First and foremost, the school must be NCFMEA-recognized (as I have described above) and must possess the administrative capability to manage Federal Student Aid. Then here’s the tricky part. The school must meet one of these three criteria:

  1. The school must have had a state-approved clinical training program (like New York or California) since 1/1/1992 and remain approved to this day. or…
  2. The school must have at least a 60% non-US student body, AND have at least a 75% pass rate for all the step exams administered by the ECFMG (i.e. USMLE Step 1, Step 2 CK, Step 2 CS).  or…
  3. The school must have had a state-approved clinical training program since January 1, 2008 and remain approved to this day, AND have at least a 75% pass rate for all the step exams administered by the ECFMG (i.e. USMLE Step 1, Step 2 CK, Step 2 CS).

There are also several other criteria that must be met, like the school must require their applicants to have taken the MCAT, not allow their students to take more than 6 years to finish medical school (or 150% of the official length of the program), and additional requirements as stated in 34 CFR §600.55. Of the off-shore American medical schools, AUC, SGU, Ross, Saba, AUA, and MUA (which are also the 6 schools where graduates can practice in all 50 states) pass the former criteria and are therefore eligible for U.S. Federal student loans (FFELP loans before July 2010 and Direct Loans effective June 2010).

SUMMARY
So to summarize, as of 2019, out of the 30+ offshore medical schools in the Caribbean, there are only six schools where graduates can get licensed to practice in all 50 states: 

These six schools also are eligible to offer US Federal Financial Aid. They are among the oldest off-shore medical schools in the Caribbean, with a history of placing graduates in all types of residencies and teaching hospitals, and a consistent USMLE first-time pass rate comparable to that of the United States. Of the schools in the Caribbean, AUC, Ross, Saba, SGU, AUA, and MUA should be the ones you consider first.

CONCLUSION
In conclusion, of the numerous medical schools in the Caribbean, there are some that do not go beyond getting a government charter and WDOMS (step #2 in the above list) yet call themselves “fully accredited” when in fact, they are not accredited by any accrediting agency. As I clarified above, there is nothing too special about getting a government charter or being listed in the WDOMS. There are others that may be accredited by accreditation agencies that are not recognized by the WFME or NCFMEA and do not have individual state approvals, yet claim to be a “top Caribbean school” in their advertisements, when in fact, their accreditation has not been deemed on par with US accreditation standards. Therefore, be very careful when looking at advertisements or websites of Caribbean medical schools and take what you read with a grain of salt. Thanks to the many steps and the stringent criteria that a school needs to go through to reach step #6, anyone who seeks medical education at any of the top Caribbean medical schools should not worry about the educational quality, financial aid, or the ability to practice in all 50 States.

Now that you’ve read all of this, please check out my Guide to Caribbean Medical Schools where I profile all the Caribbean medical schools based on the 6 steps of accreditation explicated above. Also, check out Caribbean Medical School Rankings based on the steps above. Good luck everyone on the application process!

Benji

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