7 Caribbean medical schools, part I: Primitive facilities but business is booming MILAN KORCOK
Throughout the Caribbean, in small island nations struggling for their own economic survival, medical schools catering to students from North America are settling in as one of the region's growth industries. In Grenada, Dominica, Montserrat, St. Vincent (in the eastern Caribbean), in the Dominican Republic and Puerto Rico, thousands of students refused entry to US and Canadian medical schools are plunging into their studies determined they will someday return to the mainstream of life in their native countries. With few exceptions these offshore schools are owned and managed by sharp-skilled businessmen who have proven their ability to turn invested dollars into handsome profits. Their approach has been to set up schools in countries where the local economy would benefit by the infusion of extra dollars and where the local governments could act quickly and decisively in approving such ventures. For years, North American students have been finding their way into foreign medical schools with the hope of gaining an MD and getting into practice back home, or gaining credit for completing one part of their studies (usually in basic sciences) and then transferring back into North American schools. They have gone to many countries in their quest: France, Belgium, Ireland, Italy, Rumania, Greece, Spain, the Philippines. Many have gone to schools in Mexico, including the gran'daddy of offshore medical schools, the
Autonomous University of Guadalajara, which claims that 2500 Americans have studied medicine there. In recent years the number of offshore schools has proliferated: in Puerto Rico, the Dominican Republic, and of most interest to Canadians, in the English speaking island nations of Grenada, Dominica and Montserrat. All of these schools claim to offer slight variations on one basic theme: 2 years of the basic sciences, a run at part I of the National Board of Medical Examiners examination (especially for those who intend to transfer back into the third year of a home university), clinical training in a hospital (most promise training in the US, England or other Caribbean nations), followed by a try at the Educational Commission for Foreign Medical Graduates (ECFMG) examination, and licensure at home. To go back home
They offer 4- or 5-year programs, knowing full well that what most students want is to strike a good score on their national boards after the first 2 years and then transfer back into a more recognized school at home. The connection with any of these schools is easy to make, usually through advertisements placed by the schools or their recruiting agencies in The New York Times, or some Canadian metropolitan papers. The schools build up their student body through these advertisements, and build up their cash re-
serves by asking for fees in the $6000 to $7500 range - not out of line with US standards, but then they are hardly established schools offering what US and Canadian schools offer. Take the case of some Puerto Rican ventures. When first visited by Dr. James Schofield, head of accreditation of the Association of American Medical Colleges (AAMC) some of the schools could show very little in the way of faculty or facilities. One of the schools in Puerto Rico was being run out of a dentist's fourthfloor apartment. Another was challenged by the US postal service for misrepresenting itself. In the wake of the publicity some of these Puerto Rican schools closed their doors and disconnected their phones. Other schools, however, continued to prosper. In fact the Universidad Central del Este (UCE) in the Dominican Republic has mushroomed to the point that its owners now claim it has passed Guadalajara in terms of enrollment. It now boasts 3500 students, 90% of them Americans. It is also known there are at least five students from Ontario attending UCE, supported by Canadian student loans. It is not known how many are there without such loans. Because of these early revelations the schools, as a species, have been condemned by not only the AAMC but by its Canadian counterpart, the Association of Canadian Medical Colleges (ACMC). A year ago, Dr. Douglas Waugh, executive director of the ACMC, in a bulletin to Canadian schools
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access to much equipment, hospital the host government attest to the fact that the school exists and is beds or patients. In their promotional literature all licensed. Nonetheless, many of the recruitof the eastern Caribbean schools claim to have American faculty ing advertisements by offshore members, and all promise the stu- schools lay claim to just such WHO dents clinical training in American "recognition". The most remarkable thing about hospitals. However, when CMAJ asked for the AUC is that though it has been information about faculty members operational since early 1978, it has and the hospitals to be used for yet to hold a class in Montserrat clinical training, personnel at St. and is functioning, instead, in CinGeorge's University school of med- cinnati, Ohio. Its founder and president, Paul icine were the only ones willing to name names. S. Tien, an electrical engineer born In fact St. George's, whose vice in China and formerly head of a chancellor is Dr. Geoffrey H. technical college in Ohio, says the Bourne, former chairman of ana- school has an enrollment of betomy at Emory Medical School in tween 200 and 300 and will defAtlanta and former chairman of initely start its classes in Montserrat anatomy at the University of Lon- in January 1980. Facilities are redon, offers up a seven-page roster portedly being built on that island. Tien, who got into the medical noting the names and qualifications school business after his own son members faculty of its 25 full-time Inferior product and 100 visiting and former lec- failed entry into American medical Waugh's concern is not only that turers. However, ACMC's Waugh schools, is now in a tough court an inferior product will get back has noted that many of these lec- fight with the Ohio Board of Reinto the mainstream of Canadian tureships look suspiciously like paid gents and the Ohio State Board of medicine, but that students are let- vacations - one lecture in return School and College Registration. ting themselves in for, at best, an for use of a prominent name. They want a temporary injunction uncertain future and are paying a When a Canadian applicant, to keep AUC from holding classes high price for the privilege. whose files were shown to CMAJ, in their state. Tien holds that they Of most interest to Canadians at asked for names of faculty members don't have the right to object since this point are the three schools of at the University of Dominica, the he does not confer degrees in and the eastern Caribbean, the English applicant was told they would be of the state of Ohio. speaking schools. Tuition at AUC is $2500 per divulged at the assessment interAll have been under a good deal view; and the Universidad Central semester, three semesters per year. AUC now has a faculty of six. of suspicion as to their motives and del Este simply noted that all faculWhen CMAJ contacted AUC in their effectiveness in preparing med- ty members were Spanish speaking ical students. and that faculty lists were not kept. Cincinnati and asked for details Visitors to these schools and a The methods some of these about Canadian enrollment, a good many disenchanted students, schools use to promote themselves spokesman said that the school's who left almost at the first sight also raise a lot of suspicion among attorney had advised all staff to answer no questions. of their new "campus", say the fa- observers. cilities ranged from inadequate to The American University of the abominable. They say there were Caribbean (AUC) is one school Awkward questions not enough faculty members, not actively seeking Canadian students. We asked these questions, among enough books and not enough It bills itself as the "closest foreign equipment. medical school to the continental others: But perhaps most important was United States offering an MD proIs the school open to Canadian the fact that not one of the nations gram in English". students? that housed these schools had anyIt is licensed by the government Yes Sir. thing like the hospital facilities or of Montserrat, a small island not Have any applied? pools of patients to allow a reason- far from Antigua. The brochure sent I can't answer that. able clinical training. Even the best to prospective students claims that Have any been accepted? of the hospitals on these islands is the school is "recognized by the that. I can't answer primitive by North American World Health Organization". enrollment? What is your total standards. This claim is rather obscure since that. I can't answer The schools' defenders said they the WHO does not "recognize" Could you give us your name? need time to get a faculty together schools, it simply lists them in a I can't answer that either. and to prove themselves. They also worldwide directory. A listing in At another school actively repoint out that the first 2 years of that directory is no sort of qualitastudy are rooted in the basic tive judgement of the school and cruiting via newspaper advertisesciences, and that doesn't demand can be achieved simply by having ments, the University of Dominica, warned that the "proliferation of entrepreneurial medical schools has proceeded at a frightening pace. "They reproduce in concept the proprietary US schools of the turn of the century that were put out of business as a result of the Flexner report of 1910." Waugh goes on to say that the experience of graduates from offshore schools presenting themselves for the ECFMG examination prior to return to their home country has been "dismal almost beyond belief". He cites that in 1977, of 133 US citizens from the UCE who took the examination only 3 passed. As of 1980, Canadian graduates of foreign medical schools will be required to pass a new examination: the Medical Council of Canada's evaluation examination.
CMA JOURNAL/OCTOBER 20, 1979/VOL. 121 .-For Rx summary see page 1107
1131
there was also some confusion where classes would be held. That school, founded in 1978 in Dominica, was to classes last fall in temporary ters in Philadelphia.
about early begin quar-
Classes in a hotel But due to a misunderstanding between the school's founders, Robert Ross and Jerome Berenson, and the school's administrators that deal fell through, and so the first classes were held in Dominica, which is what the brochure promised. Classes are now held at what was once the Castaways Hotel. At press time it was announced that, due to havoc created by Hurricane David, classes for this fall semester and possibly the January 1980 semester would not be held in Dominica but a "prestigious US university". A spokesman for the school refused to state which university would serve. CMAJ has since determined that the American University in Washington DC has agreed to teach the displaced students from Dominica. At present Dominica has approximately 100 students, no Canadians among them, said Ross. But he noted that four or five were expected in the January 1980 semester. To Robert Ross the running of a medical school can be nothing more than a sideline. He is widely known as an enterprising businessman and grain dealer who has made millions in trade between the United States and communist countries. His letterhead notes branch offices in Moscow, Warsaw and Bucharest. The signs on his office designate not only the University of Dominica, but the Quality Cement and Building Material Co., Quality Chemical and Fertilizer, Quality Coal, Quality Grain Export and Quality Petroleum Co. Both Ross and Berenson have also been associated with medical student placement services. Under the title of the International Accredited College Admissions Company of New York, Ross once offered the government of Kuwait the opportunity to place 35 medical students and 25 dental students in a US medical school at a price of $20 000 per student. Ap-
On the island of Grenada there are efforts being made to improve the standards of one medical school.
parently the school knew of no such offer. In a second part to that proposal he offered placement of up to 50 students in an offshore facility but declined to mention the name of the facility as "negotiations with that country were still proceeding". After some consultation with the AAMC the Kuwait government turned Ross down. The greatest impact
The English-speaking Caribbean school that has made the most impact to date in terms of attracting attention and Canadian enrollment, and the one going all out in its quest for recognition and respect is St. George's University school of medicine in Grenada. It was founded by a young, wealthy, energetic businessman, Charles Modica, who himself spent a year at a medical school in Spain, didn't like it, returned to the US and earned a law degree. The son of a wealthy New York real estate man, Modica started St. George's with a $1 0-million loan at six percent from his father and 10 other backers, including 6 physicians (3 of whom have sons at the school). To Modica, the business of medical schools was not virgin territory.
He was the man most responsible for turning the Dominican Republic's UCE into the giant it is today, although that fact now troubles him. After his experience at a medical school in Spain, Modica wrote a manual outlining his experiences for other prospective foreign students. This caught the attention of the owner of UCE who asked Modica to serve as a recruiter for him. He was paid $300 for each American he delivered. Enrollment boomed, but according to Modica the school didn't have adequate facilities to handle such large numbers, and after a disagreement with the owner he severed the relationship. He figured he could do better with his own English language school. The result was St. George's. When that school first opened in 1977, its reputation was already tarnished. The fact of its being known as a "proprietary'' school didn't help either. Also, facilities were primitive, Modica admits that. He knew that once students saw their "campus" there would be a dramatic drop off. He was right. For the first class he accepted 200. Of these just about half remain. But something has happened in the interim and business is boom-
CMA JOURNAL/OCTOBER 20, 1979/VOL. 121
1133
ing. For the January 1979 semester there were 1500 applications for 150 spots. Total enrollment is now close to 850. Modica went no holds barred in pulling together a faculty. His primary appointment as vice chancellor was Dr. Bourne. The 69-yearold Bourne, wary of the thought of retirement, says it was he who approached the school for this job, not the other way around. Bourne says he was looking for a real challenge and the thought of starting up a new medical school was exciting. Bourne is the father of Dr. Peter Bourne, former drug abuse adviser to President Carter and now a fervent supporter of St. George's. Another eminent acquisition was Dr. William M. McCord, formerly president of the Medical University of South Carolina. He now serves St. George's as clinical dean. One of McCord's primary tasks has been to sell the idea of St. George's to US hospitals that could be used for the clinical training of students. The price is $1000 per student, paid to the hospital. McCord has reportedly lined up 200 slots in hospitals in the Midwest and eastern United States. Approaches were also made to Canadian hospitals on behalf of Canadian students at St. George's. But a spokesman for St. George's said that no Canadian hospitals are involved in clinical training with St. George's students at this time. Two Canadian students who were in that first class are now rotating through US hospitals. Robert Adler of Montreal is doing clinical training at St. Claire's Hospital in Schenectady, New York. He told CMAJ he hopes to be able to move back to Canada after gaining his full MD at Grenada and then passing the ECFMG examination. Eli Inzlicht, also of Montreal, is at Paramount Hospital in Long Beach, California. Both spoke candidly to CMAJ about their experiences at St. George's. Their comments are quoted extensively in the second part of this article, which will appear in a subsequent issue of CMAJ. St. George's has continued to expand. It has two campuses on the
island of Grenada, and it has added a preclinical fifth-semester program on the nearby island of St. Vincent. The St. Vincent program (chartered as Kingstown Medical College) is headed by Dr. Morris Alpert, former associate professor of surgery and anatomy at Albany Medical College. (The Kingstown campus has now added a college of marine sciences. It, too, is being promoted. in New York newspaper advertisements.) Of all the English-language schools, St. George's has made the most progress. But some medical educators still feel it has a long way to go. Reservations about quality
As recently as September 1978 a two-man team of Caribbean medical educators visited St. George's. They expressed many reservations about the quality. These are some of their comments: "There was no doubt that the facilities for teaching histology and anatomy were adequate . "There was considerable concern over the clinical program Nine months before students would be entering clinical training there were no clear proposals . "It is a kind euphemism to refer to the facility we saw as a university." So far, medical schools and their attendant campuses can be found on four of the English Caribbean islands. But the entrepreneurs who have planted the seeds to date seem determined to get a bigger harvest. Patrick F. Adams, who has served as lawyer to Modica and who actively recruits for UCE in the Dominican Republic has made several overtures to the government of Antigua for a 4-year program that would also serve neighbouring Barbuda. His proposal, put forward by his own Institute of Foreign Medical Education, calls for a program based on the "English System", the structure being "a combination of Oxford university and Harvard course content". An added feature of this program would be a facility for rehabilitative surgery in a privately sponsored spa.
1134 CMA JOURNAL/OCTOBER 20, 1979/VOL. 121
When the editor of the Antigua Leader heard of the proposal he launched a virulent attack on Adams and the institute, and the government that would listen to such a scheme. Said the Leader editorial: "Now that a medical school catering to Americans is to be set up in Antigua, we should not be surprised to hear of the medical universities of Castries, Plymouth, Roseau and Basseterre. "It would appear that we seem bent on making ourselves the laughing stock of the world." Adams' proposal was rejected. In another initiative, a group called the Institute for International Education (a recruiting group that has advertised its placement services in Canadian newspapers) made a proposal to the government of the Bahamas for a program that would start out with 60 to 70 students and increase to 1000. The proposal was rejected. Similar proposals were also rejected for Barbados and Trinidad. Robert Ross, founder of the University of Dominica, had another of his school proposals rebuffed by the government of Jamaica. The fact is that some island governments are wary of providing facilities that will benefit American students without benefiting their own. Dr. L.J. Charles, chief medical officer of health of the Bahamas, says his own government has been approached for medical school schemes at least eight times between 1975 and 1977. None were accepted and none are likely to be unless the schools are established affiliates of a medical faculty of a reputable university. The intent of the owners of these schools is clear, says Dr. Charles. They are meant to service American students for return to the American community, he says. And despite the fact that some of the schools have offered local students free or subsidized spots in their enrollment, this kind of curriculum is not suited to the needs of the West Indian practitioner. "The offshore medical schools have no rational role to play in the immediate or future health needs of the Caribbean commonwealth," says Charles. U
Throughout the Caribbean, in small island nations struggling for their own economic survival, medical schools catering to students from North America are settling in as one of the region's growth industries. In Grenada, Dominica, Montserrat, St. Vincent (in the eastern Caribbean), in the Dominican Republic and Puerto Rico, thousands of students refused entry to US and Canadian medical schools are plunging into their studies determined they will someday return to the mainstream of life in their native countries. With few exceptions these offshore schools are owned and managed by sharp-skilled businessmen who have proven their ability to turn invested dollars into handsome profits. Their approach has been to set up schools in countries where the local economy would benefit by the infusion of extra dollars and where the local governments could act quickly and decisively in approving such ventures. For years, North American students have been finding their way into foreign medical schools with the hope of gaining an MD and getting into practice back home, or gaining credit for completing one part of their studies (usually in basic sciences) and then transferring back into North American schools. They have gone to many countries in their quest: France, Belgium, Ireland, Italy, Rumania, Greece, Spain, the Philippines. Many have gone to schools in Mexico, including the gran'daddy of offshore medical schools, the
Autonomous University of Guadalajara, which claims that 2500 Americans have studied medicine there. In recent years the number of offshore schools has proliferated: in Puerto Rico, the Dominican Republic, and of most interest to Canadians, in the English speaking island nations of Grenada, Dominica and Montserrat. All of these schools claim to offer slight variations on one basic theme: 2 years of the basic sciences, a run at part I of the National Board of Medical Examiners examination (especially for those who intend to transfer back into the third year of a home university), clinical training in a hospital (most promise training in the US, England or other Caribbean nations), followed by a try at the Educational Commission for Foreign Medical Graduates (ECFMG) examination, and licensure at home. To go back home
They offer 4- or 5-year programs, knowing full well that what most students want is to strike a good score on their national boards after the first 2 years and then transfer back into a more recognized school at home. The connection with any of these schools is easy to make, usually through advertisements placed by the schools or their recruiting agencies in The New York Times, or some Canadian metropolitan papers. The schools build up their student body through these advertisements, and build up their cash re-
serves by asking for fees in the $6000 to $7500 range - not out of line with US standards, but then they are hardly established schools offering what US and Canadian schools offer. Take the case of some Puerto Rican ventures. When first visited by Dr. James Schofield, head of accreditation of the Association of American Medical Colleges (AAMC) some of the schools could show very little in the way of faculty or facilities. One of the schools in Puerto Rico was being run out of a dentist's fourthfloor apartment. Another was challenged by the US postal service for misrepresenting itself. In the wake of the publicity some of these Puerto Rican schools closed their doors and disconnected their phones. Other schools, however, continued to prosper. In fact the Universidad Central del Este (UCE) in the Dominican Republic has mushroomed to the point that its owners now claim it has passed Guadalajara in terms of enrollment. It now boasts 3500 students, 90% of them Americans. It is also known there are at least five students from Ontario attending UCE, supported by Canadian student loans. It is not known how many are there without such loans. Because of these early revelations the schools, as a species, have been condemned by not only the AAMC but by its Canadian counterpart, the Association of Canadian Medical Colleges (ACMC). A year ago, Dr. Douglas Waugh, executive director of the ACMC, in a bulletin to Canadian schools
CMA JOURNAL/OCTOBER 20, 1979/VOL. 121
1129
access to much equipment, hospital the host government attest to the fact that the school exists and is beds or patients. In their promotional literature all licensed. Nonetheless, many of the recruitof the eastern Caribbean schools claim to have American faculty ing advertisements by offshore members, and all promise the stu- schools lay claim to just such WHO dents clinical training in American "recognition". The most remarkable thing about hospitals. However, when CMAJ asked for the AUC is that though it has been information about faculty members operational since early 1978, it has and the hospitals to be used for yet to hold a class in Montserrat clinical training, personnel at St. and is functioning, instead, in CinGeorge's University school of med- cinnati, Ohio. Its founder and president, Paul icine were the only ones willing to name names. S. Tien, an electrical engineer born In fact St. George's, whose vice in China and formerly head of a chancellor is Dr. Geoffrey H. technical college in Ohio, says the Bourne, former chairman of ana- school has an enrollment of betomy at Emory Medical School in tween 200 and 300 and will defAtlanta and former chairman of initely start its classes in Montserrat anatomy at the University of Lon- in January 1980. Facilities are redon, offers up a seven-page roster portedly being built on that island. Tien, who got into the medical noting the names and qualifications school business after his own son members faculty of its 25 full-time Inferior product and 100 visiting and former lec- failed entry into American medical Waugh's concern is not only that turers. However, ACMC's Waugh schools, is now in a tough court an inferior product will get back has noted that many of these lec- fight with the Ohio Board of Reinto the mainstream of Canadian tureships look suspiciously like paid gents and the Ohio State Board of medicine, but that students are let- vacations - one lecture in return School and College Registration. ting themselves in for, at best, an for use of a prominent name. They want a temporary injunction uncertain future and are paying a When a Canadian applicant, to keep AUC from holding classes high price for the privilege. whose files were shown to CMAJ, in their state. Tien holds that they Of most interest to Canadians at asked for names of faculty members don't have the right to object since this point are the three schools of at the University of Dominica, the he does not confer degrees in and the eastern Caribbean, the English applicant was told they would be of the state of Ohio. speaking schools. Tuition at AUC is $2500 per divulged at the assessment interAll have been under a good deal view; and the Universidad Central semester, three semesters per year. AUC now has a faculty of six. of suspicion as to their motives and del Este simply noted that all faculWhen CMAJ contacted AUC in their effectiveness in preparing med- ty members were Spanish speaking ical students. and that faculty lists were not kept. Cincinnati and asked for details Visitors to these schools and a The methods some of these about Canadian enrollment, a good many disenchanted students, schools use to promote themselves spokesman said that the school's who left almost at the first sight also raise a lot of suspicion among attorney had advised all staff to answer no questions. of their new "campus", say the fa- observers. cilities ranged from inadequate to The American University of the abominable. They say there were Caribbean (AUC) is one school Awkward questions not enough faculty members, not actively seeking Canadian students. We asked these questions, among enough books and not enough It bills itself as the "closest foreign equipment. medical school to the continental others: But perhaps most important was United States offering an MD proIs the school open to Canadian the fact that not one of the nations gram in English". students? that housed these schools had anyIt is licensed by the government Yes Sir. thing like the hospital facilities or of Montserrat, a small island not Have any applied? pools of patients to allow a reason- far from Antigua. The brochure sent I can't answer that. able clinical training. Even the best to prospective students claims that Have any been accepted? of the hospitals on these islands is the school is "recognized by the that. I can't answer primitive by North American World Health Organization". enrollment? What is your total standards. This claim is rather obscure since that. I can't answer The schools' defenders said they the WHO does not "recognize" Could you give us your name? need time to get a faculty together schools, it simply lists them in a I can't answer that either. and to prove themselves. They also worldwide directory. A listing in At another school actively repoint out that the first 2 years of that directory is no sort of qualitastudy are rooted in the basic tive judgement of the school and cruiting via newspaper advertisesciences, and that doesn't demand can be achieved simply by having ments, the University of Dominica, warned that the "proliferation of entrepreneurial medical schools has proceeded at a frightening pace. "They reproduce in concept the proprietary US schools of the turn of the century that were put out of business as a result of the Flexner report of 1910." Waugh goes on to say that the experience of graduates from offshore schools presenting themselves for the ECFMG examination prior to return to their home country has been "dismal almost beyond belief". He cites that in 1977, of 133 US citizens from the UCE who took the examination only 3 passed. As of 1980, Canadian graduates of foreign medical schools will be required to pass a new examination: the Medical Council of Canada's evaluation examination.
CMA JOURNAL/OCTOBER 20, 1979/VOL. 121 .-For Rx summary see page 1107
1131
there was also some confusion where classes would be held. That school, founded in 1978 in Dominica, was to classes last fall in temporary ters in Philadelphia.
about early begin quar-
Classes in a hotel But due to a misunderstanding between the school's founders, Robert Ross and Jerome Berenson, and the school's administrators that deal fell through, and so the first classes were held in Dominica, which is what the brochure promised. Classes are now held at what was once the Castaways Hotel. At press time it was announced that, due to havoc created by Hurricane David, classes for this fall semester and possibly the January 1980 semester would not be held in Dominica but a "prestigious US university". A spokesman for the school refused to state which university would serve. CMAJ has since determined that the American University in Washington DC has agreed to teach the displaced students from Dominica. At present Dominica has approximately 100 students, no Canadians among them, said Ross. But he noted that four or five were expected in the January 1980 semester. To Robert Ross the running of a medical school can be nothing more than a sideline. He is widely known as an enterprising businessman and grain dealer who has made millions in trade between the United States and communist countries. His letterhead notes branch offices in Moscow, Warsaw and Bucharest. The signs on his office designate not only the University of Dominica, but the Quality Cement and Building Material Co., Quality Chemical and Fertilizer, Quality Coal, Quality Grain Export and Quality Petroleum Co. Both Ross and Berenson have also been associated with medical student placement services. Under the title of the International Accredited College Admissions Company of New York, Ross once offered the government of Kuwait the opportunity to place 35 medical students and 25 dental students in a US medical school at a price of $20 000 per student. Ap-
On the island of Grenada there are efforts being made to improve the standards of one medical school.
parently the school knew of no such offer. In a second part to that proposal he offered placement of up to 50 students in an offshore facility but declined to mention the name of the facility as "negotiations with that country were still proceeding". After some consultation with the AAMC the Kuwait government turned Ross down. The greatest impact
The English-speaking Caribbean school that has made the most impact to date in terms of attracting attention and Canadian enrollment, and the one going all out in its quest for recognition and respect is St. George's University school of medicine in Grenada. It was founded by a young, wealthy, energetic businessman, Charles Modica, who himself spent a year at a medical school in Spain, didn't like it, returned to the US and earned a law degree. The son of a wealthy New York real estate man, Modica started St. George's with a $1 0-million loan at six percent from his father and 10 other backers, including 6 physicians (3 of whom have sons at the school). To Modica, the business of medical schools was not virgin territory.
He was the man most responsible for turning the Dominican Republic's UCE into the giant it is today, although that fact now troubles him. After his experience at a medical school in Spain, Modica wrote a manual outlining his experiences for other prospective foreign students. This caught the attention of the owner of UCE who asked Modica to serve as a recruiter for him. He was paid $300 for each American he delivered. Enrollment boomed, but according to Modica the school didn't have adequate facilities to handle such large numbers, and after a disagreement with the owner he severed the relationship. He figured he could do better with his own English language school. The result was St. George's. When that school first opened in 1977, its reputation was already tarnished. The fact of its being known as a "proprietary'' school didn't help either. Also, facilities were primitive, Modica admits that. He knew that once students saw their "campus" there would be a dramatic drop off. He was right. For the first class he accepted 200. Of these just about half remain. But something has happened in the interim and business is boom-
CMA JOURNAL/OCTOBER 20, 1979/VOL. 121
1133
ing. For the January 1979 semester there were 1500 applications for 150 spots. Total enrollment is now close to 850. Modica went no holds barred in pulling together a faculty. His primary appointment as vice chancellor was Dr. Bourne. The 69-yearold Bourne, wary of the thought of retirement, says it was he who approached the school for this job, not the other way around. Bourne says he was looking for a real challenge and the thought of starting up a new medical school was exciting. Bourne is the father of Dr. Peter Bourne, former drug abuse adviser to President Carter and now a fervent supporter of St. George's. Another eminent acquisition was Dr. William M. McCord, formerly president of the Medical University of South Carolina. He now serves St. George's as clinical dean. One of McCord's primary tasks has been to sell the idea of St. George's to US hospitals that could be used for the clinical training of students. The price is $1000 per student, paid to the hospital. McCord has reportedly lined up 200 slots in hospitals in the Midwest and eastern United States. Approaches were also made to Canadian hospitals on behalf of Canadian students at St. George's. But a spokesman for St. George's said that no Canadian hospitals are involved in clinical training with St. George's students at this time. Two Canadian students who were in that first class are now rotating through US hospitals. Robert Adler of Montreal is doing clinical training at St. Claire's Hospital in Schenectady, New York. He told CMAJ he hopes to be able to move back to Canada after gaining his full MD at Grenada and then passing the ECFMG examination. Eli Inzlicht, also of Montreal, is at Paramount Hospital in Long Beach, California. Both spoke candidly to CMAJ about their experiences at St. George's. Their comments are quoted extensively in the second part of this article, which will appear in a subsequent issue of CMAJ. St. George's has continued to expand. It has two campuses on the
island of Grenada, and it has added a preclinical fifth-semester program on the nearby island of St. Vincent. The St. Vincent program (chartered as Kingstown Medical College) is headed by Dr. Morris Alpert, former associate professor of surgery and anatomy at Albany Medical College. (The Kingstown campus has now added a college of marine sciences. It, too, is being promoted. in New York newspaper advertisements.) Of all the English-language schools, St. George's has made the most progress. But some medical educators still feel it has a long way to go. Reservations about quality
As recently as September 1978 a two-man team of Caribbean medical educators visited St. George's. They expressed many reservations about the quality. These are some of their comments: "There was no doubt that the facilities for teaching histology and anatomy were adequate . "There was considerable concern over the clinical program Nine months before students would be entering clinical training there were no clear proposals . "It is a kind euphemism to refer to the facility we saw as a university." So far, medical schools and their attendant campuses can be found on four of the English Caribbean islands. But the entrepreneurs who have planted the seeds to date seem determined to get a bigger harvest. Patrick F. Adams, who has served as lawyer to Modica and who actively recruits for UCE in the Dominican Republic has made several overtures to the government of Antigua for a 4-year program that would also serve neighbouring Barbuda. His proposal, put forward by his own Institute of Foreign Medical Education, calls for a program based on the "English System", the structure being "a combination of Oxford university and Harvard course content". An added feature of this program would be a facility for rehabilitative surgery in a privately sponsored spa.
1134 CMA JOURNAL/OCTOBER 20, 1979/VOL. 121
When the editor of the Antigua Leader heard of the proposal he launched a virulent attack on Adams and the institute, and the government that would listen to such a scheme. Said the Leader editorial: "Now that a medical school catering to Americans is to be set up in Antigua, we should not be surprised to hear of the medical universities of Castries, Plymouth, Roseau and Basseterre. "It would appear that we seem bent on making ourselves the laughing stock of the world." Adams' proposal was rejected. In another initiative, a group called the Institute for International Education (a recruiting group that has advertised its placement services in Canadian newspapers) made a proposal to the government of the Bahamas for a program that would start out with 60 to 70 students and increase to 1000. The proposal was rejected. Similar proposals were also rejected for Barbados and Trinidad. Robert Ross, founder of the University of Dominica, had another of his school proposals rebuffed by the government of Jamaica. The fact is that some island governments are wary of providing facilities that will benefit American students without benefiting their own. Dr. L.J. Charles, chief medical officer of health of the Bahamas, says his own government has been approached for medical school schemes at least eight times between 1975 and 1977. None were accepted and none are likely to be unless the schools are established affiliates of a medical faculty of a reputable university. The intent of the owners of these schools is clear, says Dr. Charles. They are meant to service American students for return to the American community, he says. And despite the fact that some of the schools have offered local students free or subsidized spots in their enrollment, this kind of curriculum is not suited to the needs of the West Indian practitioner. "The offshore medical schools have no rational role to play in the immediate or future health needs of the Caribbean commonwealth," says Charles. U
