Sunday, September 30, 2012

Costa Rica rejects high number of medical graduates from Cuba

Costa Rica rejects high number of medical graduates from Cuba
Chrissie Long 30 September 2012 Issue No:241

Graduates of Cuba's Escuela Latinoamericana de Medicina, or ELAM, are
"gravely deficient" in their preparation to practise medicine, the head
of Costa Rica's most celebrated medical school told journalists last month.

Of the 138 graduates who failed the medical licensing exams in Costa
Rica, 59 were graduates of ELAM, said Ricardo Boza Cordero, director of
the medical programme at the University of Costa Rica.

According to Boza, the students were largely behind in fundamental areas
including paediatrics and gynaecology-obstetrics, and failed to achieve
passing scores in the 11 exams administered.

"Taking into account that some who will practise as doctors in Costa
Rica come from foreign universities, we have to make sure they
understand the particulars of our national medicine," he told news sources.

"We made the decision to institute a general exam that evaluates their
knowledge of basic subject matters in the curriculum and clinical

The fact that 43% of those who failed the licensing exam studied in Cuba
comes as a surprise to those familiar with the health system there.
Doctors from Cuba, a country that has long been known as an epicentre of
medicine in Latin America, have been sent all over the world to aid in
health missions in disaster zones.

The country boasts one of the highest life expectancies in the
hemisphere and excellent healthcare coverage rates, according to the
World Health Organization (WHO). Venezuelan President Hugo Chavez sought
medical care on the Caribbean island when he was diagnosed with cancer
in June 2011.

Lack of congruence in curriculum?

But the issue may not be one of quality of education, but the lack of
congruence in curriculum. While Costa Rica may be putting emphasis on
some subject matters, Cuba could be preparing students for other areas
of focus.

The majority of the medical students who failed the test are graduates
of ELAM, a university established in 1999 to provide medical care to the
world's poor.

The university accepts economically disadvantaged students from all over
the world and, through a six-year, free programme run by the Cuban
government, prepares them to practise medicine in their home country.

Boza did admit that the ELAM and Costa Rican curricula were not aligned
in at least 80% of the subject matters. The students were tested on the
20% in which the curriculum diverged under a new examination system
introduced this summer.

Many of the students who took the exam have since protested, claiming
they should have been grandfathered into the old testing methods – that
it, they should not be disadvantaged by the new exam rule, because they
were part of the rule that came before it.

ELAM graduates face hurdles elsewhere

Costa Rica is not the only country in which ELAM graduates are facing
hurdles in licensing exams.

According to a 2010 WHO article: "Their degrees must be validated by
sometimes reluctant medical societies and, even once they receive
validation, there may be no jobs waiting for them in the public sector
where they are most needed."

According to André-Jacques Neusy, executive director of the
Belgium-based non-profit Training for Health Network, who has studied
innovative medical schools throughout the world and is familiar with
ELAM, the Cuban medical school is well aware of the challenges of
integrating graduates into the health systems of other countries.

"ELAM has many graduates in many countries," he said, "and in many parts
of the world, they are not accepted.

"Part of it is Cuba being Cuba," he added, referring to the political
hurdles. "Another issue is that the receiving countries may not have the
capacity to absorb additional doctors. There may not be enough jobs."

In Honduras, graduates from ELAM were excluded from a residency
programme because the government simply did not have enough funds to
extend to them.

By contrast, in Uruguay last month, 90 graduates of ELAM were accepted
into medical practice, news sources there reported.

Referring to the situation in Costa Rica, Neusy said: "I find it hard to
believe that the students were rejected on aptitude alone."

Rachel True, who has been collaborating with ELAM through a US-based
non-profit known as MEDICC, which focuses on enhancing health
cooperation between the two countries, said the issue of accreditation
is very possibly political.

"With anything having to do with Cuba, there are politics involved," she

Prepared to practise in under-served areas

In True's experience, graduates are uniquely prepared to practise
medicine in under-served areas. Because there is such a strong emphasis
on community engagement and social accountability, the students who
graduate from ELAM have a strong desire and a thorough training to
improve health among impoverished populations.

"ELAM does a better job than we do in the United States of preparing
doctors to enter social service," True said.

"Studies have shown that students enter medical school in the United
States with a very high level of altruism. They want to do good. But
that drops off significantly as they approach graduation because they
have to find ways to repay their debt.

"In the ELAM programme, students don't have debt."

True, who tracks the 200 students-graduates of ELAM who have returned to
the US, said the students are very well prepared. "Many of them have
entered residency and have been successful."

Costa Rica saturated with doctors

The students returning to Costa Rica faced the unfortunate situation of
a health system saturated with doctors.

The ELAM graduates are competing with doctors not only from the
country's prestigious public schools, but also from a number of private
universities that have surfaced in recent years.

The country is also trying to position itself as a medical tourism
destination for North Americans and Europeans looking for more
affordable medical care. For that reason, quality control is of high
importance, not only for the Costa Rican government but also for the
country's medical schools.

Boza brings that point home: "The University of Costa Rica needs to
guarantee the preparation and high standards of all the professionals
that come to the country with a degree in medicine and surgery obtained
from a foreign university, with the goal of guaranteeing the welfare and
health of all the inhabitants of the country as well as maintaining the
high standards of quality in the medical sector."

For the ELAM graduates who didn't pass the new examinations? The
university is considering letting them take the exams retroactively.

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