Concerned about the quality of education at three Caribbean medical schools, some of whose graduates seek licenses to practice in California, state medical licensing officials took unprecedented action Thursday to monitor the colleges for five years.
The Board of Medical Quality Assurance, meeting in San Diego, also released detailed critical reports on training programs at the three schools, and imposed numerous conditions on the schools if the state is to continue licensing their graduates.
One of the schools, which cater to Americans unable to win admission to medical colleges in the United States, is St. Georges' University School of Medicine, whose students were evacuated in the 1983 invasion of Grenada by U.S. armed forces.
The medical board began questioning the Caribbean schools after it began finding evidence that graduates were poorly prepared and in some cases may have falsified their academic credits. Several of these graduates are licensed to practice in California and many more were in hospital residency and internship programs. The board started looking at qualifications of the students more carefully and sent a team of its members and staff to inspect the facilities.
The reports noted that one of the schools, Ross University School of Medicine in the West Indies, had virtually no admission standards and was founded as a "business opportunity" with the purpose of making a medical education available to "everyone who wants one."
Another West Indies school, America University of the Caribbean, was faulted for sending its students for practical training to a U.S. Virgin Islands hospital that "does not have adequate faculty or patients to support a core (clinical) program." The medical board said it would no longer recognize credit given to students who were trained at the hospital.
At St. George's, the inspection team discovered that a faculty committee's decision to flunk out a student who had received Fs in three courses was reversed by the school's vice chancellor, who is not a physician. Later, when the student tried to transfer to U.S. schools, the St. George's administration recommended him "without qualification."
All three schools were faulted for giving in to student demands to compress their medical educations into the shortest time possible and for placing too much emphasis on passing the examinations required to become physicians in the United States.
In theory, the California licensing board has no authority over medical institutions outside the United States. But the threat of withdrawing recognition of the graduates was enough to persuade all three to promise to make changes, said the board's executive director, Kenneth J. Wagstaff.
"We have gotten their attention, we have gotten them to change," he said. "We will continue to review (licensing) applicants from the schools on a case-by-case basis."
The board's action marked the first time it has decided to take on the role of monitoring the quality of education programs at medical schools. For schools in the United States, the board relies on an independent, non-governmental review body, which enforces its own strict standards. But there is no similar body for certifying the quality of foreign medical education.
State law requires that foreign medical school graduates demonstrate that they have received an education equivalent to what is offered in the United States.
"There is no cookbook that describes American education in a standard way," Wagstaff said.
The reports on the schools point out that the investigators, with only limited time available for each school, did not explicitly compare the Caribbean schools to their U.S. counterparts.
However, the three schools were faulted for failing to provide more than meager opportunities for research and independent study that have become a standard part of the curriculum in the United States.