I keep hearing that clinical rotations for Caribbean students happen in the US but nobody seems to explain exactly where or how competitive it is to get placements. Are we talking major academic medical centers or community hospitals? And do the schools arrange everything or are students left to figure it out themselves?
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Great question and one I wish someone had answered for me before I enrolled. At SGU, the school has affiliated teaching hospitals across the US where they place students for core rotations — internal medicine, surgery, pediatrics, OB/GYN, psychiatry and family medicine. These are mostly community teaching hospitals in states like New York, New Jersey, Florida, Illinois and Georgia. You are unlikely to end up at Mass General or Johns Hopkins for your core rotations. That said, community hospitals are where most of medicine actually happens so the clinical exposure is genuinely solid.
Originally posted by BrandonLane “community hospitals are where most of medicine actually happens”
Exactly this. I think people have a romanticised idea of clinical training happening at big academic centers. Even many US MD students do significant portions of their training at community affiliates. At Ross we have a network of affiliated hospitals and the school coordinates core rotations. The issue isn’t really the quality of the hospitals — it’s the geographic unpredictability. You might be placed in New York one month and rural Georgia the next. If you have family obligations or a partner, this can be genuinely stressful.
How does it work logistically? Do students pay for their own housing during rotations? I’ve heard horror stories about students spending thousands on accommodation while rotating in expensive cities. Is that factored into the total cost of attending?
Originally posted by Victoria88 “Do students pay for their own housing during rotations?”
Yes and this is one of the most undertalked financial realities of Caribbean medical school. During clinical years you are essentially paying tuition PLUS covering your own housing, transportation and food in whatever city you rotate in. New York and California rotations can cost you an extra $2,000–$3,000 per month in living expenses alone on top of tuition. Some hospitals have subsidised housing but it’s not guaranteed. Budget this into your total cost of attendance calculation — it adds up to a significant sum over two clinical years.
Jumping in from the administrative side here. I coordinate clerkship placements at a community teaching hospital in New York that works with multiple Caribbean schools. From our perspective, Caribbean students are generally well prepared academically and we see students from SGU, Ross, AUC and Saba regularly. The placement process is managed between the school and hospital administration, students don’t typically cold-call hospitals to arrange their own core rotations at accredited schools. However elective rotations are a different story. Students often have to arrange those independently and that process is significantly more competitive.
Originally posted by AmeliaReed : “elective rotations are a different story”
This deserves its own thread honestly. Getting elective audition rotations at competitive programs is where Caribbean students face real structural disadvantages. Programs like academic IM, surgery or any competitive specialty at university hospitals often don’t accept visiting students from Caribbean schools or have very limited spots. I emailed over 40 programs for a cardiology elective and heard back from maybe 6. It takes persistence, strong Step scores and good letters from your core rotations to even get a foot in the door.
Originally posted by MiaRoss: “I emailed over 40 programs for a cardiology elective”
40 is actually on the low side from my experience. I sent over 70 emails for general surgery audition rotations and landed 3. But those 3 mattered enormously, one of them led directly to my match. The key insight is that audition rotations for Caribbean students are not optional luxuries, they are essentially mandatory for competitive specialties. Program directors want to see you perform in their hospital before they rank you. Your Step scores open the door but the audition rotation closes the deal.
I want to offer a counterpoint here. I have nothing against Caribbean students personally but the placement system you’re describing community hospitals, geographic unpredictability, having to cold-email dozens of programs for electives is objectively a harder path than what US MD students experience. At my school rotations are integrated, we have home program advantage for residency and research tracks are embedded in the curriculum. I think it’s important for prospective students to understand this structural difference before choosing a Caribbean school over pursuing post-bacc or DO routes.
Originally posted by Charlotte14: “objectively a harder path”
Nobody here is disputing that. The question was where rotations are held and how competitive placements are — not whether Caribbean school is equivalent to US MD. Of course it’s a harder path. But harder doesn’t mean impossible and for many of us the choice wasn’t Caribbean vs University of Michigan. It was Caribbean vs not becoming a doctor at all. Context matters enormously in these conversations.
My daughter is currently in her third year at Saba and I want to share a parent’s perspective. The rotation placement process was more organised than I expected. Saba placed her in New York for internal medicine and she is currently in Florida for pediatrics. The school has a dedicated clinical placement office and they communicate regularly with both students and parents about upcoming placements. The hardest part for our family has been the constant moving — she has relocated 4 times in 14 months. Emotionally and financially it is taxing but she is getting excellent clinical exposure and her attendings speak highly of her.
As a physician who went through the Caribbean route 15 years ago and now supervises residents, I want to address the quality question directly. The community hospitals where Caribbean students rotate are the same hospitals where many US DO and some MD students train. The attendings supervising you don’t change based on where your medical school is located. What changes is your access to subspecialty exposure and research opportunities which are genuinely more limited. For primary care, internal medicine and psychiatry, Caribbean training is absolutely sufficient preparation. For highly competitive specialties the path is harder but not closed.
Originally posted by Jason00: “For highly competitive specialties the path is harder but not closed”
Step scores really are the great equaliser here. I have a 256 on Step 1 and 262 on Step 2 and I am matching into dermatology this cycle from SGU. Programs look at your scores first before they even see your school name in many cases. Obviously the school name matters at the final ranking stage but a high Step score gets your application to that stage in the first place. If you are serious about a competitive specialty from a Caribbean school — Step scores are not optional, they are your primary currency.
From a school administration perspective I want to clarify how placement actually works at accredited Caribbean schools. We maintain formal affiliation agreements with teaching hospitals across the US. These agreements are reviewed and renewed regularly and are part of our ACCM accreditation requirements. Students are assigned core rotation sites through a structured scheduling system — they are not left to find placements independently for required rotations. Elective and audition rotations are the student’s responsibility to arrange but we provide support, letterhead and liaison contacts to assist. The system is more structured than many prospective students realise.
Originally posted by Rileyyy: “more structured than many prospective students realise”
This is true for the big accredited schools. Where it breaks down is with smaller unaccredited Caribbean schools that don’t have robust hospital affiliation networks. Students from those schools sometimes do end up scrambling for placements independently and rotating at unaccredited sites which can seriously damage residency prospects. If you are choosing a Caribbean school — stick to ACCM accredited institutions with established US hospital networks. The difference in clinical placement infrastructure between a top Caribbean school and a lesser known one is enormous.
This thread has been incredibly informative as someone just starting MS1. A few practical takeaways I’m noting for myself based on everything shared here:
Core rotations are school-arranged at affiliated community hospitals across the US, mainly NY, NJ, FL, IL, AZ and GA
Budget separately for housing and transport during clinical years, easily an extra $1,500–$3,000 per month
Elective audition rotations require proactive outreach, start building your CV and Step prep early
Step scores are non-negotiable if targeting competitive specialties
Stick to ACCM accredited schools with established hospital networks
Thank you all, especially the faculty and practicing physicians in this thread. This is exactly the kind of unfiltered advice that should be in every Caribbean medical school orientation packet.
Wow, this exceeded everything I was hoping for when I posted this question. The combination of student, faculty, coordinator, parent and attending perspectives here gives a genuinely complete picture. My main takeaways are that placement infrastructure at accredited schools is more organised than rumoured, but the financial and logistical demands of clinical years are real and underreported. Going to do a much deeper cost analysis before making my final decision. Grateful for this community.
Something I want to add about the elective rotation process that nobody mentioned. Start building your audition rotation list during your second year of basic sciences, not when you enter clinicals. The programs you want to do audition rotations at often have waitlists months or even a year out. If you show up at the start of third year and try to book competitive audition rotations, you will find the spots already gone. I sent my first batch of emails to rotation coordinators in semester four and still only landed half of what I wanted.
LillianStone wait, you email rotation coordinators directly from the school? Like cold outreach to hospital programs? I had assumed the school handled all of that. This is clarifying something I was totally confused about.
Scarlett for core rotations yes the school arranges those. The school has affiliate agreements and you get assigned. But for audition rotations, which are the electives you do specifically to be seen by a program you want to match at, that is almost entirely on you. You identify programs you want to impress, find the rotation coordinator contact on their website, and send a professional email asking about sub-internship or audition rotation availability. Your school can provide a template and a letter of good standing but the outreach is yours.