Offshore medical school

An offshore medical school is a medical school that caters "primarily to foreign (North American) students, wishing to practice medicine in the US and Canada" according to the World Bank, compared to local public schools that focus on their home nation. Nonetheless, the local economies often benefit from the academic and economic influence from those schools. Such schools are chiefly located in the Caribbean.

Education
Caribbean offshore medical schools often specialize in the Medical Doctor degree, while US and Canadian medical schools are often departments of universities that offer several degrees. The curriculum of offshore medical schools in the Caribbean follows the one in US, as they usually only offer two years of basic science study and use teaching hospitals or clinics in US or Canada, sometimes in UK for clinical training. The teachings often focus on the United States Medical Licensing Examination (USMLE) and the Educational Commission for Foreign Medical Graduates (ECFMG) certification process, and the measurement of performance is the passing rate of students in the exams. In most schools, passing of the USMLE Step 2 exam is required to graduate and get a M.D. degree.

In most schools, the academic calendar is divided into trimesters, with semesters starting in January, May and September. The lack of a summer break offers students a potentially faster route than US medical schools to a degree with a compressed curriculum.

Student body
Caribbean offshore medical schools have less than 5% local students; the rest are mainly from North America. Students are also relatively older than their North America counterparts. As of 2004, the average ages in schools are 27–30 years old, and half of them are nurses, paramedics, physician assistants, etc. on their second career. Whether a school has state board accreditation or is recognized by loan programs appear to have great influence on the number of applicants, and the effect is seen in the size of student body. Between 1993 and 2007, the mean age of first time ECFMG certification exam applicants from Caribbean offshore medical schools was 29.5 years, and 38% of the applicants were female. The passing rate were 57.4% for the USMLE Step 1 but results varies wildly by country.

Faculty
Most educational faculty in Caribbean offshore schools are physicians or medical teachers from US or Canada, with at least a MD degree, some with PhDs. Lacking research faculties, the student-to-teacher ratio ranges between 9 and 13.

Accreditation
Like United States and Canada, there is no central authority for accreditation as rules and regulations in many Caribbean countries differ greatly. CAAM-HP is a local accreditation body, while ACCM is invited by some countries to accredit on their behalf. Although a US state board accreditation is not necessary for students to participate in residency matching, some school seek such accreditation as it is required for attractive residency destinations such as California or New York.

Local impact
Instead of getting research grants and local government funds, offshore schools often depend on wealthy students from out of country. The spending by foreign students and faculty, as well as increased local employment is a significant factor in the local economy. When schools grow, they often do construction on campus, which increase demand for material and instruments. The local healthcare industry also receive financial and educational help from offshore schools in exchange of clinical experience of students.

Growth
According to the World Bank, establishing a medical school in Caribbean is significantly easier than in the U.S. states. Schools are not required to do research and perform clinical training as LCME accreditation demands. Typically it only requires a business license to open a medical school in the Caribbean and get listed in the International Medical Education Directory (IMED), which qualifies their students to undergo the ECFMG certification process. As of 2010, there were 61 IMED-listed medical schools in Caribbean, up from 29 10 years ago, of which 22 began instruction and 5 ceased operation between 2000 and 2010. There were 5 additional schools applied for IMED listing between 2007 and 2010 but did not meet IMED's listing requirement as of 2010.

The increasing number of schools has both positive and negative effects. On one hand, low initial cost in establishment increased competition, that in turn increases the quality of service. On the other hand, this created a big demand in clinical rotations that even the large states have problem accommodating, let alone their home country, and draw attention from US and Canada auditors who are concerned over public loan use.