Medical students who are interested in pursuing school in the Caribbean are often driven by several factors, including the cost and quality of education, a higher chance of admission, and the ability to explore unique cultures within the backdrop of paradise. Compared to the climbing costs and highly competitive admission process of attending school in the United States, it may seem like enrolling in a Caribbean medical school is the obvious choice. However, paradise may be too good to be true. While Caribbean medical students may wrongly assume that they are immune from taking shelf exams, this is not the case. Many Caribbean medical schools still require students to complete various shelf exams as a tool to measure clinical competency. Due to various issues such as cultural and language differences, limited clinical exposure, curriculum variations, and relocation challenges, Caribbean medical students may face unique challenges throughout the shelf-exam process.
If you are a Caribbean medical student have been accused of violating any examination rules or are facing another challenge with your school's administration, Attorney-Advisor Joseph D. Lento and the Lento Law Firm Education Team can help you understand your rights and navigate your next steps. Contact us today by calling (888) 535-3686 or contact us by using our online contact form.
What Are Shelf Exams And Are They Required?
Shelf exams are standardized assessments administered by the National Board of Medical Examiners (“NBME”) at the end of clinical rotations. Shelf exams typically cover major medical disciplines and are offered in a variety of subjects regardless of whether the subject is a required or an elective course. Some shelf exams subject areas offered by the NBME include:
- Biochemistry
- Emergency Medicine
- Pharmacology
- Family Medicine
- Neurology
- Pediatrics
- Surgery
- Internal Medicine
Although many schools administer shelf exams, they are not required for earning a United States Medical License. Rather, shelf exams are a useful tool for students to understand what knowledge they retained while completing clinical rotations and areas of current weaknesses.
Shelf exams also help the NBME regulate medical schools because they assess medical students' knowledge and clinical reasoning skills in a standardized format across different institutions, regions, and programs. Shelf exams also help students assess whether they are ready to transition from classroom knowledge to clinical practice.
Where And How Are Shelf Exams Administered?
Shelf exams are typically administered by a student's medical school, or as applicable for Caribbean medical students, may be administered by a governing body responsible for the region's medical education. The exact process varies from institution to institution for schools within the United States and especially varies for students attending medical school in the Caribbean. However, most schools will typically administer shelf exams by following the following format.
Registration And Scheduling
At the beginning of each academic year or rotation (rotations can vary from 4 weeks to more than 12 weeks in time,) you will probably receive a scheduling outline of the dates and subjects for upcoming shelf exams. Because cramming last minute for shelf exams is not advisable, this provides you with enough time to craft a study plan that allows you to absorb the examination material while you complete your rotation.
Your medical school will then guide you through the process of registering for the exam(s). Depending on your school or region, you may register for the exam by filling out an online form or by filling out physical forms that are mailed back to the NBME. It's imperative that you pay close attention to registration deadlines to ensure that you complete the required paperwork in time and are eligible to register for the exam. As a Caribbean medical student, it may be more difficult for you to ensure that paperwork arrives via mail in a timely fashion or that you can access and/or retrieve any identifying documents such as a driver's license, etc. that may be lost.
Study Plan
After registering for the exam, your school should help guide you through available resources to ensure that you are successfully prepared for your exam(s). If your school doesn't already have a program to ensure that you have access to study materials such as textbooks, lecture notes, question banks, etc., you should seek out help by speaking with your professors, and upperclassmen, or by contacting the NBME directly to request available study resources. As a Caribbean medical student, you should also ensure that you have assistance from professors and/or students who are well-versed in the various composites of the exam. Cultural differences, language barriers, and medical practices unique to your school's unique region may cause you to either focus on the wrong material or overlook key components of the exam. This is especially important because the exams are graded on a curved national average, meaning that you are graded against students who are completing clinical rotations in the United States.
Aside from studying the subject matter, you should also ensure that you understand what materials you will be required to bring to the exam such as any identification documents, writing instruments, etc. While students in the United States may be able to gain easy access to lost driver's licenses or quickly replace laptops, writing instruments, etc., this may not be as easy for you depending on what part of the Caribbean you are located in.
You should also ensure that you are familiar with the format of the exam before taking the exam. Exam formats can vary depending on the discipline and may include different types of questions, time limits, and scoring methodologies.
Receiving Examination Results
After shelf exams are completed, they are graded according to your institution's grading system. For example, while some schools may use the exam as a final exam score, this is not always the case. Other schools may allow professors to apply the scores as an extra credit option, as a pass/fail option, or even to determine whether you graduate with honors. Typically, exams are graded by faculty members or designated examiners.
If you do not understand how your shelf exams are graded, you should consult your school's guidelines and policies before taking the exam to ensure that you are the most prepared you can be on examination day.
Challenges Caribbean Medical Students May Face While Taking Their Shelf Exams
Cultural and Language Differences
Because Caribbean medical schools attract a diverse student body from various cultures and linguistic backgrounds, English may not be the first language for some students. Although Students from the United States likely speak English as their only or first language, their professors, mentors, clinical managers, etc., may struggle at times to communicate complex medical concepts and terminology in an easily translatable way.
Limited Clinical Exposure
Although Caribbean medical students can still complete clinical rotations in the United States, the process can be very challenging and will require extensive research and planning. Many Caribbean schools do not offer residencies or clinical rotations in the United States. Some hospitals allow students from foreign schools to complete clinical rotations, but these opportunities are limited and competitive.
Due to these challenges, many students may be left with the option of completing their rotations in the Caribbean - exposing them to possible limitations in terms of clinical resources and patient populations. This limited exposure can result in scarce learning opportunities, making it much more challenging for Caribbean medical students to apply theoretical knowledge on their shelf exams.
Relocation And Adaptations
Pursuing a medical degree in a foreign country requires a student to make significant adjustments. While the rigors and pressure of medical school are already hard enough, foreign medical students must also adjust to a new environment, culture, and educational system, often far away not only from family and loved ones but also from comfortable conveniences in the United States. While studying for shelf exams, Caribbean medical students may face additional stress and emotional challenges while overseas, affecting their performance during clinical rotations and during shelf exams.
Curriculum Variations
Differences in the curriculum between Caribbean medical schools and schools in the United States may impact the extent and depth of the knowledge covered. Although many quality Caribbean medical schools have challenging curricula on par with schools in the United States, some schools may prey on students by taking enrollment fees in exchange for a poorly developed education.
Caribbean Medical Schools and Their Shelf Exam Policies
While several reputable medical schools in the Caribbean continue to grow in popularity, four schools, collectively known as the “Big Four” seem to attract American Medical Students the most. These schools include:
- Saint George Medical School in the Caribbean is a private medical school in St. Vincent and the Grenadines. The school offers an accelerated program that takes only three years to complete, with students starting their clinical rotations after only one year of coursework. Currently, the school boasts a 94% residency match rate for United States students. According to the school's academic policies, all students must complete and pass shelf exams at the end of their clinical rotations. If a student fails any shelf exams, they are required to retake and pass the failed exam.
- Ross University Medical School, located in Barbados, has a strong reputation for preparing graduates for a career in medicine. The university was founded in 1978 and has grown to offer multiple degree programs, including an MD program, an executive MBA program, a master's in biomedical sciences degree program, and more. The school currently has a 97% residency match rate for United States students. The school also accepts students on a rolling application basis, allowing students to begin coursework at multiple points throughout the year. The school's publications emphasize the importance that shelf-exam scores play in residency applications in the United States and provide extensive assistance for students studying for the shelf exams through tutoring, extra classes, and study materials.
- American University of the Caribbean School of Medicine (AUC) is a private, non-profit medical school with campuses in St. Maarten, St. Lucia, and Barbados. The school offers MD degrees in medicine and osteopathic medicine as well as a nursing degree program. The school has also expanded its offerings to include medical degrees in internal medicine and family medicine. The school currently has a 97% residency match rate for United States citizens. The curriculum at AUC is based on that of other United States-based medical schools but includes components unique to the Caribbean region, such as tropical medicine courses. The school's policies allow students the opportunity to retake a failed shelf exam once but reserve the right to academically dismiss students who continuously fail a shelf exam or fail to sit for their shelf exam.
- Saba University Medical School is located in Saba, a small island nation in the Caribbean. The school also has its own hospital, which is highly renowned and considered one of the best hospitals in the area. The admissions process is competitive and the school accepts approximately 90 students per year. Saba has partnered with some of the top medical institutions around the world, including Johns Hopkins University. Like the other “Big Four,” Saba also has a 97% residency match rate for United States students. The school's policies require students to pass their shelf exams. If students fail to pass exams on their first attempt, the school requires them to enroll in a review course.
Legal Issues For Caribbean Medical Students Taking Shelf Exams
Because Caribbean medical students may be overwhelmed by their already existing coursework, they may feel stressed out and anxious at the thought of having to take more tests! Students may be tempted to cheat on the exam, exposing them to severe disciplinary measures by the NBME and the United States Medical Licensing Examination Board (“USMLE.”) Both institutions craft and oversee shelf exams and make a significant effort to notice any “irregular behavior” from test takers. Some types of irregular behavior that may trigger investigation include any actions that:
- Registering for an exam when unauthorized to do so.
- Seeking or obtaining unauthorized access to testing materials such as past questions.
- Reproduction of exam materials, including memorization of exam questions.
- Communication about the contents of the exam, whether online or in-person.
- Taking the exam for someone else or asking someone else to do the exam for you.
- Harassment towards the test center staff.
- Possession of unauthorized materials at the exam site, including recording equipment or cell phones.
- And any other behavior that violates USMLE policy, procedures, or rules.
Caribbean medical students who do not strictly adhere to the legal and ethical requirements of sitting for their shelf exams can face serious consequences including dismissal from their school as well as challenges when applying to residency programs back in the state. If you are a Caribbean medical student currently being investigated for any shelf exam violation, do not wait! Contact attorney-advisor Joseph D. Lento and the Lento Law Firm Education Law Team today for assistance with navigating your options.
Academic Misconduct
Accusations of academic misconduct, such as cheating on the shelf exams, can have severe consequences for Caribbean medical students, including suspension or expulsion from your program. Academic misconduct can also affect your ability to gain admission to another institution, qualify for post-graduate programs, or even gain employment. Academic misconduct may include some of the following types of behavior:
- Cheating.
- Falsification of records and/or data.
- Bribery or blackmail.
- Unauthorized collaboration.
- Sabotaging another student's work.
If you are a Caribbean medical student and feel as though you have been unfairly accused of academic misconduct, do not fall into the trap of feeling as though you cannot fight these allegations because you are a foreign student. Sometimes, false accusations may also be the result of unfair treatment, grading discrepancies, or bias based on factors such as nationality, ethnicity, or language proficiency. Contact the Lento Law Firm Education Team today for assistance in navigating academic misconduct allegations at your school.
Inadequate Accommodations
Disability laws in the United States are well-developed and protect students with documented disabilities, entitling them to reasonable accommodations during exams. Because the laws and policies protecting your rights at your Caribbean medical school may not be as developed, you may find that you need to advocate more for disability-based accommodations and modifications to help you succeed on your shelf exams.
You may feel uncomfortable sharing these obstacles with your school or have been unsuccessful in your attempts to work with your administration. If you believe that legal intervention may be necessary to level the playing field at your Caribbean medical school, the Lento Law Firm Education Team can help!
Breach Of Contract
Caribbean medical students may encounter an unfortunate reality if their medical school fails to meet contractual obligations, such as providing adequate resources, proper clinical training, and faculty support necessary to properly prepare for their shelf exams. If you feel as though your Caribbean medical school has misappropriated your funds and failed to provide proper education, they may have breached certain contractual requirements.
I Am Facing a Legal Issue At My Caribbean Medical School. What Options Do I Have?
If you are facing possible punishment or dismissal from your medical program in the Caribbean, you should be prepared to challenge the school's decision through informal negotiation strategies or a legal process known as an appeal. While every school has unique appeal policies and procedures, appeals typically consist of a formal, in-depth review of a student's academic records and performance. Students may also seek reconsideration of a grade on an assignment or exam. Common issues for academic appeals include:
Throughout the appeals process, it may be necessary for you to gather evidence to prove that your dismissal should be reviewed by an appeals committee or similar review body. Each school's appeals process can vary and is often outlined in its student manual or code of conduct. Although pursuing an appeal can feel like a very difficult situation for students who are already struggling academically or who are facing other personal challenges, Attorney-Advisor Joseph D. Lento and the Lento Law Firm Education Law Team can help. We can walk you through what documents you may need to gather, review your case to point out strengths or weak spots, propose a plan that allows you to stay at your institution while still allowing time for remedial coursework, or depending on your school's policies even attend the appeals hearing on your behalf.
Remediation
Many medical schools, including highly rated schools in the Caribbean, will offer some remediation programs for students who are facing potential dismissal. Remediation programs offer students an opportunity to improve their grades or behavior without the guilt and shame that result from mere punishment.
Some remediation programs may consist of targeted support such as additional tutoring, special courses, summer programs, etc. If personal or behavioral issues are at play, some programs may also include supportive measures such as counseling, anger management, substance abuse programs, etc. If your school does not offer remediation programs and is trying to immediately pursue dismissal, Attorney-Advisor Joseph D. Lento and the Lento Law Firm Education Law Team can help by communicating your need for additional support and resource to your school's administration.
Next Steps After Being Accused of Misconduct On the Shelf Exam
After receiving a letter from the examination board indicating that they believe you may have engaged in misconduct, you will have the opportunity to defend yourself at a formal hearing. During the hearing, you can submit evidence and even call witnesses to testify. Fortunately, you are not required to navigate this complex legal environment alone and can be assisted by the Lento Law Firm Education Law Team, who will carefully review your case, help you gather your evidence, and plead your case.
If your school is also pursuing disciplinary action, you will likely also have a hearing before your school's administration to determine what disciplinary consequences should be enforced. Possible punishments may range from repeating a single course or an entire school year to expulsion. While the Lento Law Firm Education Law Team may or may not be able to attend your school's hearing with you depending on your school's policies, we can still help you craft careful responses to your school's administration and gather evidence. Don't worry, we have experience navigating the nuances of Caribbean Medical Schools. If your school does not find it in your favor, we can help you navigate your school's appeals process.
Consequences Caribbean Medical Students May Face For Not Passing Their Shelf Exams
Failing shelf exams can have devastating consequences for Caribbean medical students, especially when they feel as though they have already made so many sacrifices to pursue a medical degree in a foreign country. For starters, if your school determines your final grade on your shelf exam scores, failing the exam may result in your need to retake the exam or complete your entire clinical rotation. This can also delay your ability to graduate on time and match with residency programs, which may already be an uphill climb for Caribbean medical students who wish to return to the United States and match with a residency program. While some residency program directors may not consider shelf exam scores, others may. Failing multiple exams may trigger concerns that you are unable to succeed in a clinical setting in the United States, risking your entire professional endeavors.
Failing shelf exams can also have a devastating effect on your self-esteem and mental health, leading to feelings of disappointment, frustration, and self-doubt. If you have failed shelf exams and feel as though you have been unfairly discriminated against by your Caribbean medical school or need help navigating the various policies and procedures related to your grade, contact the Lento Law Firm Education Team for help.
If You Are Facing Challenges With Your Shelf Exams At Your Caribbean Medical School, We Can Help
Medical students are hard-working, dedicated, and responsible. If you are currently attending medical school in the Caribbean, you have likely made countless sacrifices over the years on your path to success. Don't attempt to navigate the complexities of education law on your own. If you need legal assistance navigating any issues with your shelf exams at your Caribbean medical school, you can receive the supportive guidance and advocacy of Attorney-Advisor Joseph D. Lento and the Lento Law Firm Education Law Team.
The Lento Law Firm understands the nuances of how Caribbean medical schools operate and has experience defending and advocating on behalf of United States students. You've worked too hard to give up so early. Whether you are facing dismissal, are dealing with issues with the USMLE, or are dealing with a more serious, personal problem at your Caribbean Medical School that requires our attention, we understand these challenges and are here to help. Contact us immediately by calling 888-535-3686 or using our online contact form.
