the way it goes

for anyone wondering what the hell it is, exactly, that I am doing out here.

A guide to the structure of my med school, for dummies.

Most caribbean med schools, mine included, are structured to mirror many traditional US medical schools. Medical school is roughly divided into two parts, the first two years spent learning theory ("basic science"), and then the next two years spent doing clinical rotations (much like internships) in hospitals. The process is based around the US licensing system, and my degree is recognized by most US states, and Canada.

The US medical licensing system is composed of a series of three tests - USMLE step I, II, and III. The entirety of basic sciences in the Caribbean is to prepare you for the USMLE step I exam, which you take after your first five semesters of basic sciences. Step I is absolutely one of the most important tests you will take in your life - your score on this essentially determines your fate as a resident. Residency positions in the US take into account many factors, and your Step score is one of the most pivotal. If you barely pass the Step I, you're basically not going to get a residency, which means that you've wasted the past three or four years of your life and roughly around $150 000. Especially for foreign medical graduates, who eat the crumbs off the floor of US medical graduates, a decent Step score is required to earn a residency position in any position other than family or internal medicine, and in some cases, respect.

Here, medical school is 10 semesters, roughly, back-to-back. The first five semesters are spent learning "basic sciences", and in this case are spent on the island. Which equates to about 20 months, meaning I should be ready to leave the island sometime around April 2012. Semesters 1-4 here are roughly divided up into five components of equal size, known as "blocks". Roughly every three weeks, up until Block 4, you sit for examinations in most of your more important courses. Some blocks are cumulative, some aren't. Block 5, depending on the course, can either be a regular final exam, or it can be the Shelf. The Shelf is made up of old, retired USMLE Step I questions and is supposed to be a good indicator of how a student will do on the Step I exam. If you ace a Shelf in a course, you should be suitably prepared to answer Step I questions in those areas. Remember, this isn't how all Caribbean schools work, just mine.

Semester 5 is a little different. A Caribbean medical school's credibility and reputation is based on how many of its students are able to pass the Step I exam. So the entirety of Med5 is structured to give you the best review and the best tools possible to get a great score. Because Step I results are so critical, my school implemented an extra step to ENSURE that the Med5s that go on to write the Step I pass: this is known as the Comp. The comp is the last dragon you have to slay before you can save the princess, leave the island, and go on to write the Step I. Typically people write the Comp at the end of Med 5, pass, and then go home, never to return again, to write the Step I.

Once you pass the Step I (and depending on your score, I hear), you go on to spend the next 5 semesters doing clinical rotations in the US. Locations for clinical rotations vary each year depending on the university's contracts with the hospital, and I could be anywhere from New York to Louisiana.

But at least there will be an ATM.

eight minutes

is how long I have before my scheduled study break ends.

my first month here on the island was spent in total uncertainty. i took a step into a cold river and wondered if i wanted to go for a swim. where do i live? where is the school, and where is the grocery store? what am i doing here in this strange place where the streets are narrow and everyone dresses like it's fall?

attrition is a very real thing, i'm sure in canadian medical schools too, but moreso here when everyone who comes here gives up so much. not only the people and places that we love, but banks that open past 2pm and ATMs. soon the uncertainty extended to, who is next. and it's still here, and it's going to be here for 19 more months. i wondered a lot in the first month if I would be swallowed up with uncertainty and be home before the end of term.

truthfully i haven't had much trouble adjusting. the overwhelming feeling i had living at home was a sense of solitude and it's not very different feeling it in a different place. the grocery stores are the same size, it takes the same amount of travel time to reach anywhere and the bugs aren't as bad as in guelph.

i was so so so unsure about how well i was doing, if i liked it, if i would be here, if i could make it through the first half of medical school on the island as so many don't. so unsure until the first set of exams came two weeks ago.

my most real fear was that i couldn't measure up. i can't remember the last time i've actually applied myself in school for whatever reason, and i was so afraid that i wouldn't have the aptitude as a student required to get through. caribbean students are disadvantaged in many ways, and as a result we have to work harder faster and smarter than others to get the same treatment. until the first set of exams.

i got the highest mark in my class for anatomy and 0.4 short of a 90 in histology. here, As are above 90 and below 70 is a fail. i have never in my life pictured myself as a straight a student, and always imagined that i would have to sacrifice so much of who i am to become that person. i guess in a way i have

its so so so silly to base so much of your beliefs on what your grades are, just for one test. but for me that was a sign that i really do have what it takes to make it through to the very end. it won't be easy but i know now i can do it.

i'll see you all in 19 months.

august 30

I wrote this on my laptop after the hurricane hit, before I got around to setting up this blog. It's a little out of date but gives you a good introduction to life here on Nevis.

The view from my front porch

total travel time: 17h

and that is on the conservative end - many students ended up spending nights in random cities, so i have  nothing to complain about

thurs morning shell and i departed mississauga around 3 am and i successfully navigated my way on to the plane, but not before obtaining my last starbucks for approx. 2 years. the first leg of the trip was from toronto to charlotte and was uneventful. next i had a quick layover in charlotte and was en route to st maarten. unfortunately, it would not be the last i saw of charlotte - about an hour into the four hour flight, the flight crew informed us that there was a "woman making weird noises" so to be safe, we were flying back and deplaning. however it was a terrible and unconvincing lie, and we learned when we left the plane that in actuality, a window at the back of the plane was loose. total delay in charlotte ended up putting me in st. maarten at approximately the time my flight to nevis was to have left. luckily I arrived in st. maarten with a spacious 9 minutes to make it through customs and onto the paper plane that was to take us to nevis. as predicted, my luggage was not so speedy and i arrived in nevis sans baggage at approx 8 pm (the population of students that arrived without their luggage seems close to 50%, luckily mine arrived the next day).

a representative from the university met us at the airport, and took me to the apartment that had been set up for me, as i had no idea where it was (i was soon to discover that addresses are an abstract concept in nevis). i met my landlord at the apartment, and spent my first night there alone. there are a total of ten thousand locks on the premises, and i made careful use of every one before heading to bed (and a supply of kitchen knives in the drawer). pictures and a tour of the apartment are forthcoming - at the time of writing this, hurricane earl makes my tropical paradise look considerably less so.

the next morning as i was in the shower i caught a glimpse of the same van that picked me up at the airport outside my apartment, honking. i took a leap of faith and guessed that this was a bus that was picking me up to take me where i needed to go. vital information seems to travel by word of mouth here and being off-campus I am often the last to know. i waited outside on the porch, and sure enough an hour later a bus arrived to take us into town to set up bank accounts and internet. "island time" definitely exists here and i spent the next two hours at the bank tangling with foreign currency and trying to set up an account. afterward, one of the university bus drivers showed up and took me to the largest supermarket on the island. it's no metro - the largest supermarket is rams, and it's about the size of your average country grocery store. i had converted some money into a couple hundred EC (that's Eastern Caribbean currency - $1 US is roughly equal to $2.5 EC) and blew $200 EC on a couple of essentials. with the conversion, you can expect that items on the island will cost you in US roughly double what you're used to paying, some items more or less expensive. cereal, for example, is between $20-30 EC. the bus driver dropped me off at home (they seem to know where we all live - which is good, because none of us do), and not long after, my roommate arrived from the airport. as comfy as lululemon pants are, i was missing a change of clothes, and we planned to walk to the airport to check on the status of my luggage. the idea of walking is largely regarded as ludicrous, and locals are friendly and will often offer rides. we were driven to the airport by our landlord's friend-of-a-friend, which turned out to be only a 20 min walk away. i picked up my luggage (and a free cellphone courtesy of the internet), and went home to happily unpack.

the next day we bummed around and went to the supermarket again. i met more of my fellow students on the bus, and picked up some things i had missed. we came home to meet up with some of our downstairs roommates, who informed us that some students from the dorms were planning on meeting at the bar down the main road (Rumours). so in the evening i met up with the guys and we walked down to the bar, were i learned that short shorts are generally not acceptable on the island and will net you some much unwanted attention. there was a party on the corner with a bouncy castle, not sure why. met some more students at the bar but unfortunately i can't remember anyone's name. there was a special of 2 for 1 drinks up until 10 or 11, and i managed to get 2 vodka orange for $15 EC (i'll let you handle the conversion). i again wished I drank beer as I would have gotten 2 for $5 EC. 2 for 1 not only means a drink in each hand but that your drinks are mostly vodka, a little orange, so the rest of the night is hazy. i do remember threatening to fight at least three people if they didn't take their hands off me IMMEDIATELY. gotta establish boundaries

the next day hurricane earl edged closer to the islands, and i opted to spend most of the day inside. we shut all the windows and were not sure what to expect. locals seemed unconcerned, and even our landlord dropped by after the anticipated start time of the hurricane and stated that typically, hurricanes are "a lot of rain and a little bit of wind". that amount of rain and wind would prove to be a noisy bedfellow, and we were awake most of the night. power cut out around 0300, and we were unsure if objects were being hurled around outside or not. in the end, the hurricane turned out to be just that, in addition to a lot of rain...in our apartment. the sloped nature of the porch by the back door meant that water was collecting and leaking in. it was no big deal, but i was basically mopping between 630-1130 to keep it that way. others were not so lucky and are still mopping water out of their apartments. orientation was delayed the day of the hurricane and we are anxious to get started tomorrow. no power, no internet, and the fact that most of us didn't bring any books means we are hurting for some means of occupying ourselves. i chose to mop.

pictures and video are forthcoming. would you believe i haven't taken a single one? it's been hurricaning the past 2 days, and wouldn't show how truly gorgeous my apartment and the corresponding views are.

 school starts tomorrow!