The Accreditation Process of Caribbean Medical Schools

Before considering studying medicine in the Caribbean, it is essential for all prospective students to understand what it means for a school to be “fully accredited,” as many Caribbean medical schools will claim this, but not all are. The standard of education vary widely at different schools in the Caribbean, and which school you choose to go to will impact the states you will be able to legally practice in in the future. I received an email from a friend asking about this topic, and so I feel it will be helpful if I posted my answer here for everyone to read..

It is true that not all international medical schools are accredited or fully qualified for its graduates to practice without limits in the United States. In fact, most are not. Many schools like to juggle the terms “accredited”, “recognized”, and “approved” when talking about their qualifications, and they often use these terms broadly. The truth is schools can be qualified on many different levels and in many ways, not all of which equals accreditation. A school can be “approved” by a government to confer degrees, “recognized” by its Ministry of Education as a school, and be listed in an authoritative directory of medical schools, but not be accredited by a recognized independent accrediting agency like CAAM-HP, NVAO, or ACCM. Schools like this are technically not accredited. When talking about medical school, the word “accreditation” should not be a term that is juggled around and interpreted broadly. Therefore, try to be critical when you read that a school is “accredited”, “approved”, or “recognized.” The qualification process is complex, but here I’ll take you step by step in the process in which foreign medical schools must go through to become accredited or fully qualified for its graduates to practice without limits in the US:

1. GOVERNMENT CHARTER
First and foremost, the prospective school must obtain a charter from the government of the country in which they plan to establish their med school. A charter is NOT an accreditation, and does not reflect the quality of education at the school. A charter simply means that the government of that country allows the school to function as a school and confer medical degrees in that country.

2. DIRECTORY LISTING
To be internationally recognized as an “official” medical school, it must be in an “official” medical school directory. As of 2014, that directory is the World Directory of Medical Schools (WDOMS), created by merging the former IMED (FAIMER/ECFMG) and AVICENNA (WHO) directories. According to the U.S. Educational Commission for Foreign Medical Graduates (ECFMG), only students who obtain degrees from schools listed in the WDOMS (or former IMED/AVICENNA) directory are eligible to take the USMLE exams and participate in matching. However, it’s important to note that the WDOMS (or IMED/AVICENNA) is only a directory and NOT an accreditation (the WDOMS, FAIMER/IMED, and WHO/AVICENNA even state this themselves on their respective websites), and therefore being on the WDOMS (or IMED/AVICENNA) list says nothing about the quality of the medical school. There are many unaccredited medical schools listed in the WDOMS (and IMED/AVICENNA) directory. The only requirement for a school to be on the WDOMS directory is to have a government charter from the country in which the school is located (see #1 above).

3. ACCREDITING BODY
The school must then be accredited by an accrediting body to determine if the school meets the educational quality and administrative standards of the accrediting body. For American medical schools, it is the Liaison Committee on Medical Education (LCME), which only accredits schools in the United States and Canada. Foreign medical schools use other accrediting bodies, such as those of their own government or a multinational accrediting agency like the ACCM or CAAM-HP.

Currently, ECFMG does not require medical schools to be accredited by any accrediting body for their graduates to be certified to enter residency programs and practice medicine in the US. Because of this, many Caribbean medical schools, particularly those in countries that do not have strict accreditation requirements, remain unaccredited. However, this will change in 2023 when ECFMG starts requiring medical schools to be accredited (by approved accrediting bodies with standards on par with LCME) in order for their graduates to enter residency programs and practice medicine in the US.

4. NCFMEA
Not all international accrediting bodies accredit schools in the same way. For this reason, the US has a National Committee on Foreign Medical Education and Accreditation (NCFMEA) that reviews the accrediting bodies that accredit foreign schools to determine whether or not they have standards comparable to the LCME used in the US and Canada.

As of 2014, there are 6 accrediting bodies in 8 countries (or political entities) in the Caribbean that are recognized by the NCFMEA. Notice I mention both accrediting bodies and countries, because a country may have multiple accrediting bodies, only which a few may actually be NCFMEA approved, and vice versa. Here are the accrediting bodies:

Accreditation Commission on Colleges of Medicine (ACCM) – Accredits AUC in St. Maarten, St. Matthews University in Cayman Islands, Medical University of the Americas in Nevis, and Saba University in the Caribbean Netherlands (Saba).
Dominica Medical Board – Accredits Ross University in Dominica.
Grenada Ministry of Health, Social Security, The Environment, and Ecclesiastical Relations – Accredits St. George’s University in Grenada.
National Council of Higher Education, Science, and Technology – Accredits several regional medical schools in the Dominican Republic.
Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP) – Accredits American University of Antigua in Antigua.
Nederlands-Vlaamse Accreditatieorganisatie (NVAO) – accredits Saba University in the Caribbean Netherlands (aka Bonaire, Saba, St. Eustatius). When the islands of Bonaire, Saba, and St. Eustatius joined the Caribbean Netherlands in 2010, their respective medical schools became required to be NVAO-accredited, just like in the rest of the Netherlands in Europe. Saba University was the only school that successfully did so. As a result of not successfully getting NVAO accreditation, University of Sint Eustatius and St. James School of Medicine were not allowed to continue operating in the Caribbean Netherlands and subsequently moved their campus and government charter to other countries. University of Sint Eustatius is now in St. Maarten and will be applying for ACCM accreditation in the near future, and St. James School of Medicine is now in Anguilla and is given initial accreditation by the CAAM-HP.

The NCFMEA does not determine whether or not graduates can practice in certain states. The main purpose of the NCFMEA for reviewing accreditation standards is to determine whether or not American students attending a particular international school can participate in the US federal financial aid program. Being recognized by the NCFMEA is only one of several strict criteria for being approved for the US federal financial aid program, which I will describe towards the end of this article.

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