Medical Programme in Carribean / USA

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Trinity School of Medicine

What is the Procedure to Do MBBS IN USA?
Large numbers of students in India aspire to undertake medical studies in USA. The reason is that US leads the medicine specializations because of the intensive research that the institutions and scholars there undertake. However, getting admission in top medical schools in USA is not easy and the procedure is entirely different as compared to India or other countries in Asia like China or Philippines. Even the admission to medical university in USA is different from the European counterparts. So the students are confused and want to ascertain as what is the passage to find admission in medical schools in USA.

How to do MBBS in USA
To study medicine in USA, it is imperative that the aspirant takes the Pre Medical course that culminates in BS (Bachelor of Science) degree. This is the pre-requisite here and only then the candidate is considered eligible to seek direct admission. The aspirant also has to comply with various norms while USMLE (United States Medical Licensing Examination) framework regulates the medical curriculum in USA.

The standard route to MBBS in USA
Admission to top medical colleges in USA is determined by the scores that the aspirant achieves in MCAT (Medical College Admission Test). MCAT is the only pan USA screening to judge the suitability of the candidate for a seat in medical curriculum in more than 350 medical colleges and universities in USA. The test is conducted by the AAMC or Association of American Medical Colleges which also releases the score for the takers. Every year large numbers of candidates in USA, India and different countries take this exam to gain a seat. However, like in India, the MCAT of USA is highly difficult competitive exam for the takers. The advantage is that if the candidate achieves good score in MCAT then he can pursue MBBS in US medical university with subsidized fee structure as the institutions of medicine are funded/aided by the US government. However, as said above, it is necessary to complete the pre medical course also before becoming eligible to seek admission through MCAT. Hence, the roadmap to do MBBS in USA after 12th is a tough one and also entails heavy expenditure.

Program Description & Roadmap to Complete Medical Licensure in USA.
The National Board Medical Examinations in US is responsible for conducting different exams that make the candidate a registered and licensed medical practitioner in USA. The process has been divided in three steps and all the three steps are controlled and regulated through the framework of USMLE or United States Medical Licensing Exam.

What is USMLE?
USMLE ( United States Medical Licensing Examination ) is the three stage examination process that has been mandated for every student who graduates out successfully from the medical curriculum in any US institution. With the medical student passing all three stages of USMLE, he is entitled to be granted a valid license to practice in USA.
USMLE has been developed as a testing process to assess the candidate’s ability to apply the knowledge of medicine acquired by him during the curriculum at the med institution. The focus of testing is to find out whether the seeker can fruitfully employ the medical knowledge, concepts and skills and principles to deliver patient centered treatment and cures; as these have been considered as the core elements of effective health care services in society.
All the three stages are interwoven in terms of assessing the suitability of the candidate for granting medical practice license and therefore all need to be cleared; and any one stage of USMLE cannot be held as the right to seek license!
The USMLE is owned and conducted by FSMB (Federation of State Medical Boards) and NBME (National Board of Medical Examination).

Who Governs USMLE?
US Medical Licensing Exam is governed by a committee comprising representatives of ECFMG, NBME and FSMB and also the members from public domains. The overall direction and guidance to run the USMLE program is offered by this committee that also looks into the techniques and standards to determine the pass and fail benchmarks and other associated policies and procedures of relevance.

Why One National Examination?
One unified USMLE structure has been developed for medical education in USA to replace the older concept wherein there used to be more than one passages for the allopathic medical graduates to get license to practice in US. Prior to USMLE, there was NBME Parts Examination as also the ]FLEX] or Federal Licensing Examination. Now this system has been done away with to ensure uniformity in standards of med practitioners in USA despite any medical university from which they graduated! Thus the assessment standards are now same pan USA through the system of USMLE.
USMLE is thus accepted by all state medical boards for allopathic physicians while for osteopathic physicians, there is COMLEX-USA.

Eligibility to appear for USMLE:
- A medical student who is officially enrolled or who has graduated from any of the medical universities in USA or Canada for a course leading to MD Degree that has been accredited by the US’s LCME or Liaison Committee on Medical Education.
- A medical student or one who has graduated from a medical educational institution outside US and Canada and who is eligible for examination by ECFMG. Indian students pursuing MBBS can take this exam after completing their second year.
- A medical student who has been officially enrolled in or has graduated from a US medical institution for a course leading to the DO Degree which is duly accredited by the American Osteopathic Association.

STEP – 1.
- The aspirant first has to complete the BS (Bachelor of Science) program that is spread for a period of 16 months with four trimesters of 4 months each. After the BS, the candidate has to successfully complete the 4 years Bachelor level program that leads to MD Degree in medicine. After completing the first two years (which are dedicated to the basic sciences) of this 4 year MD program, the candidate has to sit for the USMLE-1. It is this stage that the quality and aptitude screening first begins for the medical student.
- The next two years of the 4 year MD program are to be spent in hospitals through ‘Clinical Rotation’ which is also called as ‘Externship’ or ‘Clerkship’.
[It should be stated that unlike in India, the MD Degree of USA is not the PG level but equivalent to the Bachelor level which is the MBBS course in India]. Therefore securing an MD Degree alone from any US medical university is not considered sufficient because it does not offer the specialization to the candidate.
- The medical student then appears for the USMLE-2 (CK & CS). All medical students have to appear for this stage irrespective of the standard and repute of the medical university. After completion of the 4 year MD program and the USMLE, the candidate has to take up the PG level Program which is called as Residency in USA.

STEP – 2 (Step 2 CK and Step 2 CS).
On completion of the first 4 years program & USMLE 2, the students have to pursue PG level program (Also called as Residency). The STEP-2 comprises two segments – the STEP-2 CK and STEP-2 CS. The first part (CK) is a computer based assessment and the candidate can take it by sitting anywhere in the world. The second part (CS) is the practical exam and hence the candidate has to appear in it while in USA itself. The STEP-2 of USMLE is of qualifying nature only and not a competitive test. The students from the top medical universities generally pass it without any difficulty.

STEP – 3.
The candidate then has to work in a hospital for an average of 4 years; however the actual time period could range from 3 to 6 years, depending upon the med specialization. For the MS (Master of Surgery) Program, it is more! After this, the medical students have to appear for the USMLE STEP-3 exam which is the Licensure Exam. After passing this step, the medical graduate completes his bachelor and PG level education in USA and is eligible for license to practice in USA.
Thus the total duration of medicine course in USA is around 9 years; subject to the condition that the candidate clears all the requisite exams in first attempt itself. The exams are conducted by the NBME or National Board for Medical Examinations.

EXAM FORMAT:
If you want to study medicine in USA then it is recommended that you take the course at the USMLE and NRMP listed college. The table below offers the clear view of the type of exam and the stages at which these are to be taken.

EXAM. Objective. When to Give. Year.
USMLE - 1 Competitive Exam 2nd Yr of Basic Science 3rd
USMLE - 2 CK / CS Qualifying Exam 2nd Yr of Clinical Rotation 5th
USMLE - 3 Licensure Exam During Residency 8th

Alternative route for Admission to MBBS in USA
For thousands of aspirants that wish to undertake medical education in US medical universities, the passage is very tough because of multiple reasons. The toughness of MCAT and thus inability of most of the seekers to clear it appears to be a hurdle in their dream. The fee structure in top medical universities and especially the private medical colleges in USA is also very high and serves as the restrictive parameter for the candidates looking to pursue the course in USA. However, even in such a context, there is an alternate route to get direct admission in MBBS in USA. The medical colleges in Caribbean Islands like the Trinity Medical College offers the good passage and easily too! The competition barrier is brought down and the fee is also much less! Therefore more aspirants are now taking this route to do MBBS in USA rather than keep trying for years. The medical institutions in the Caribbean offer the medical education for first three years only that lead to the BS Degree and the candidate can take the USMLE-1 Exam. The rest of the six years curriculum is completed in US institutions where the student continues with the Clerkship program and Residency. Trinity School of Medicine also offers scholarship to the seeking students including from India who can find seat easily by applying early!

Selection of University to Study Medicine in USA
In India, the students and parents are hugely misguided on how to pursue medicine curriculum in USA. The lack of desirable and authentic information on their part is the reason of the ignorance and many people also take bad decisions due to which they have to suffer! According to experts there are three vital factors that need to be ascertained by any aspirant before deciding for a successful medical career in USA. These are –

- The medical university should be approved by the MCI or Medical Council of India.
- The medical university should be approved by the CAAM-HP.
- The university should be listed unconditionally on WDOMS or World Directory of Medical Schools.

Program Format for Indian Students 2017
The Indian students that aspire to take up MBBS in USA cannot appear for the MCAT because they have not completed the BS Degree here in India. This necessitates that they complete their Pre Medical and Basic Sciences Program of 3 years which they can take up at the medical education institutions at St. Vincent in the Caribbean region (that are listed as eligible by the USMLE). After completing their 3 years program from any of these med universities, the students would carry on their next 6 years of education and training including the Clinical Rotation Program in US mainland. They get the chance to undertake Clerkship and PG level Residency programs at the leading hospitals that are affiliated with the university.
The medical universities in the Caribbean Islands prepare their students for the programs and tests that are mandated to seek admission to MBBS in USA. The students are also prepared for the MCQ based USMLE STEP-1 Exam during the three years program and a term exam is also conducted by the university at the end of 3 years. This is the main competitive exam for the students and the Indian students are able to crack it easily due to the educational aptitudes that they develop in the middle schooling in India.

Green Book Rotation at ACGME Teaching Hospitals
The next two years are covered through the Clinical Rotation program that is conducted in US (Baltimore) at a hospital that is covered as per Greenbook Rotation of USMLE Authorities. The student also has the option to undertake first Core rotation of 48 weeks at St. Vincent and can do the Elective 28+4 weeks mandatory rotation in the Neuro Department. The students then appear for the USMLE-2 (CS & CK) before going for Residency (PG level).

Earning Back in PG What you spent at MBBS Level.
During the PG level Residency program, the candidate can earn around USD 4500 to USD 6500 as a stipend at the hospital for 4 years! You can take care of your living expenses through this and also earn back what you spent during the bachelor program! This is the best way to pursue medicine education in USA and the total cost of it for the 9 years duration becomes ZERO! On the other hand, the cost is much higher to undertake MBBS in abroad; especially in countries like China, Ukraine and Russia and the private colleges in India.

How to Get Residency in USA After MD Program?
While this is a difficult task, ECFMG (Educational Commission for Foreign Medical Graduates) of USA offers assistance through ERAS (Electronic Residency Application System) that guides for application filing. It is also mandatory to get registered with NRMP (National Residency Matching Program). During the Residency program, the candidate also clears the USMLE-3 after which license to practice is granted.

National Resident Matching Program® Main Residency Match (NRMP).
Website http://www.nrmp.org/
Email support@nrmp.org
Toll Free (866) 653-NRMP (6767)
In order to apply for Residency Program through ERAS, the eligibility criteria has been duly listed by ECFMG, NBME, USMLE and other authorities. The process begins with online registration with ERAS.

Accreditations:
CAAM-HP accreditation is very important and only six med institutions in Caribbean Islands have it! Further, listing with the FAIMER, USMLE and having collaboration with hospitals for Clinical Rotation are also important! Thus it is important to choose that university which is technically consistent with requirements!

Scholarship For MBBS in USA For Indian Students 2017.
Trinity School of Medicine offers limited scholarship to Indian students passing their 12th and who wish to do MBBS in USA. The students can save up to INR 35 lacs and the eligibility is based on merit and need! The application can be done through our website; but the candidate need to ensure that balance amount is available or there is arrangement for education loan.

Benefits of MBBS Admission in USA for Indian students.
While medicine study in USA for Indian students may appear as the most expensive option, it is actually most cost effective! The student can earn back the entire amount of bachelor level during the PG Residency. The various benefits are -
- MCI permits registration without screening for candidates doing MBBS from USA
- The doctors earn US$ 3,500 to US$ 5,500 during residency in USA (4 Years) making the total cost of the program as ZERO! Due to the Residency being paid, the entire MBBS in America fee structure is earned back at PG level. This way, MBBS in USA for Indian students fees becomes less than Indian costs!
- In USA, there is no capitation fees like in India where it could be as high as 2 crore!
- The average salary of a licensed doctor in USA is more than USD 200000 per annum!
- The duration matches with that of India
GOI has notified wef 23rd April 2016 that NORI (No Obligation to Return to India) will not be issued if one chooses to do MBBS in India and MD in USA. So it is better to do bachelor program also from USA.

Basic Rule to Practice in USA
In order to practice in USA, the PG level Residency is required to be completed. With mere bachelor level, candidate has to sit for MCI screening in India. So it is better to choose the USMLE certified institution only like the Trinity School of Medicine at St. Vincent.
However, no one returns back at Bachelor level since the reason to go to USA is PG/Residency.

Choosing the Right University Program.
While many options are available, proper and authentic choice is must on the basis of accreditation, approvals and hospitals affiliation; because career and heavy money is at stake. The issue of Observership versus Clinical Rotation is also important, say leading overseas education consultants!

Success Ratio:
In 2015, around 65000 students sat for USMLE-1 while the residency seats available are 35000. This signifies the success chance of more than 50%! The passing rate at Trinity School of Medicine is around 86%.

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