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.