Trinity School of Medicine: Setting New Standards for Caribbean Medical Schools

At Trinity School of Medicine, our guiding vision is clear, "To improve access to scientifically-based quality health care and enhance the health status of the residents of the communities served by our graduates." That perspective shapes every decision we make, from the largest pedagogical philosophy to the smallest detail of student life. It guides us from within and creates new goals with each achievement.

Because that guidance comes from within, we don't look outward that often, at the other schools in our region. However, this letter brought the circumstances students at another institution find themselves. It makes it adamantly clear that while Caribbean medical schools exist because there is a need in the US and Canada going unfulfilled, not all of them are created equally.

First, it's worth noting that there are a number of approaches to an academic environment, and some people are suited for a high population, high attrition setting. We're not disputing that it never works, there are students who either put their heads down and succeed or thrive in that setting, finding themselves fueled by the competition. We've simply found that it is sub-optimal for the type of opportunity for success we want to provide our students.

The anonymous author has organized their thoughts in such a way that, rather than essentially re-write their work, we're going to address each point in her list and, humbly but proudly, use this as an example of how Trinity School of Medicine isn't just an option for students that take the Caribbean route to medicine, it is the best option.

‍1. Attrition rate.

‍The author points out what, to us, is a nightmare scenario: having 1000 students at the white coat ceremony, with a variety of automatic expulsion measures in place that results in a staggering 40% attrition rate by the end of basic sciences.

This is not something you will find at the Trinity School of Medicine. Our September term, our largest class, has 85 students (January has 25, and May is similar) and our attrition rate is 12%. While we do not use "weed out" tactics that find students removed from consideration before they have a chance to interview, we do select our applicants carefully, seeking out those with potential that have, for whatever reason, found themselves shut out. And when there are signs of academic difficulty, we have mechanisms in place to help them succeed. A great example of this is our Academic Progress Committee. The APC meets regularly to evaluate each student, determine the cause of any struggle, and suggest to them a course of action to correct it, whether that's tutoring, new study habits, better stress coping mechanisms, or addressing a health concern. A benefit of keeping our school so small is we have the mental bandwidth and institutional agility to address the issues of individuals and course correct as needed for that student.

‍2. Available clinical rotation slots.

‍Despite admitting 1,000 students in a single year, the author's school only has 600 rotation slots available. Trinity's clinical rotations in Baltimore, MD are designed from the ground up to have spots available not just for every student that enrolls with us, but for anyone that transfers in along the way. We also provide the entire core rotation schedule to students at the start of their clinicals. This sounds so intuitive to us, but it is a depressingly uncommon practice among some schools.

‍3. Housing.

‍The author outlines the nightmarish reality of trying to navigate the already challenging life of a medical student while living in annexed hotel rooms miles from campus with no kitchen or laundry facilities. Trinity's housing is 1-4 bedroom apartments able to accommodate our entire student body, with shuttle services, full kitchens, etc. Medical students have one priority during their time in school (outside of survival): to learn. We want to facilitate that as best we can. To that end, while we are growing, we simply do not accept more students than we have room to comfortably house for the entirety of their time with us on St. Vincent.

‍4. Transparency.

‍Schools need to be honest with applicants and students alike. Year after year, the NMRP publishes data gathered from the most recent match, and the most constant result is the importance of USMLE Step-1 scores as the top criteria a director considers and which scores lead to which specialties. We publish our step-1 scores every year on our blog (along with our unvarnished match rate), as a measure of transparency and act of accountability. In the interest of disclosure, it's worth noting that the author mentions "needing a step score about 10 points higher than the US average to get looked at." Respectfully, we have not found this to be the case with our graduates, but we can understand that anxiety and points in the past where it was definitely more of an uphill battle for IMGs.

‍5. Self-guided learning.

‍Obviously the ability to self-teach is crucial for anyone heading into healthcare. This, by no means, reduces the burden of quality on the faculty or school. The Academic Progress Committee is just one example of how our faculty engages with our students to make sure that they are not just hearing the material, but properly processing it, and learning to apply it. Moreover, whereas the author's colleagues were essentially thrown to the wolves when it came time for the USMLE exams, our entire fifth term is a rigorously guided preparation program, the culmination of an integrated board exam prep that has permeated each course as they've moved through their basic sciences.

‍6. Emotional distress.

‍Quality of life is a tremendous component of success. There is no doubt in our minds that humans are resilient and can succeed under all sorts of horrible conditions, but a question that anyone discussing the topic needs to ask is: must they? While we have active aid in place for acute and chronic mental health difficulties, it's more valuable to focus on Trinity's main differentiator here: the campus culture of support.

This is, by no means, an argument for coddling students in luxury (while our accommodations are lovely, no student is likely to confuse their campus apartment for a resort). Instead, it's a call for understanding. The ability to endure and survive duress is certainly an admirable trait, and a necessary one in a field as demanding as medicine. However, if twice as many students succeed and go on to save lives as physicians because we've created a supportive environment that offers them effective means to cope with stress, isn't that the smarter move?

We think so. It's why we our campus life is built around students feeling "in it together" rather than competing for a top spot. The race they're running is a marathon, and sustainable growth as a student, intellectually and emotionally, not only helps them succeed for that long haul, we think it will ultimately make them better doctors.  To extend that metaphor, the race isn't against each other, it's against themselves to do as we always try to do with the school itself: take every achievement as the new standard and strive further towards a new level of success.