A medical student in Cuba is looking for advice

Someone writes: I am trying to help a friends brother who is not a US citizen and currently a medical student in Cuba, and I came across your very informative web site. The brother most likely is going to be able to come to the United States in the fall.

My friend is wondering if he should complete the last year of medical school there in Cuba or come here and continue on. It seems like there is no benefit from completing med school in Cuba, given the difficulty to be licensed in the U.S. And the difficulty in getting a residency position.

Does any of the course work from his studies in Cuba transfer over to U.S? Is it likely that hed have to get a bachelors degree here before ever going to a U.S. Med school? My friend says that he has an outstanding record in the Cuban medical school, speaks excellent English, does well on tests, etc. Any advice you could give?

As far as I know, no medical students from Cuba have transferred to a med school in the United States recently or possibly ever. Regarding your questions, I can only give you my best guesses.

I doubt very much that a course from the Cuban medical school would be accepted here in the US. US med schools that accept a few transfers from Caribbean schools like Ross or St. Georges usually take those students at the beginning of the third year of medical school.

A few schools are doing combined BS/MD degrees in five or six years, but I dont know of a single US school that would take a student directly out of high school into a 4-year program.

A possibly more reliable way to become a physician in the United States would be to graduate from an American university, take the Medical College Admission Test, and apply to med school.

Last month, the ECFMG posted this on its website: "The ECFMG is pleased to announce that it will resume processing of service requests in relation to applicants from and institutions in Cuba. As previously announced, ECFMG was not processing such requests, pending approval of its license application for Cuba by the Office of Foreign Assets Control (OFAC) of the U.S. Department of the Treasury. Today, ECFMG was advised that OFAC has approved the license application."

There are 14 medical schools in Cuba. I do not know if any or all of them will be acceptable to the ECFMG or what position residency program directors will take on applications received from students in those schools. Many current offshore graduates are having problems obtaining residencies in US programs. What will happen with the addition of 14 more schools with an unknown number of graduates is anyone’s guess.The fact that he is a non-US citizen is not helpful.

One of the 14 is the ELAM medical school which has 19,550 students. Wikipedia says it is accredited by the ECFMG and the Medical Board of California.

It is not clear how that many students can be clinically trained in a country with only about 11 million citizens and 13 other med schools. For comparison, the US, which has 30 times the population of Cuba, has 140 allopathic medical schools with about 80,000 total students.

I dont know if Ive clarified things for you or made them more confusing. Your friends brother is going to have to decide for himself what he wants to do, but if he is a truly outstanding student, maybe he should stay in Cuba and finish his education. However, he must understand that there is no guarantee he will be able to obtain a residency in the US, and no residency means no ability to be licensed and no way to practice medicine here.

If any of my readers have other thoughts, I hope they will comment.

Addendum on 8/20/15 at 11:25 a.m. The medical student is not a US citizen.

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OR tech How do I deal with an abusive surgeon

Have you ever come across problems with rage and temperament issues in the OR. I have been an operating room tech for many years and have been in a variety of surgical settings.

A certain surgeon brings in a lot of money to the hospital, but he is terrible. I have been called things no one has ever called me. He throws instruments on my table and mayo stand, screams, and implies that I and my colleagues have no idea what we are doing. I have reported him to my manager and the OR director, but nothing ever comes of it.

Other surgeons have witnessed his behavior and have said something, but nothing was ever done. I understand the OR is a beast of its own, but the culture has to change with these newer guys coming out of residency. The mindset of the surgeon being our customer, which is being rolled out to us now, is not reason for us to put up with abuse. What have you encountered on a peer-to-peer level on how to handle such demeaning behavior? I trained and worked at a level 1 trauma center with emotions that constantly ran high, and still it was less stressful than this particular surgeon. Thank you for your advice. 

A recent paper in the American Journal of Surgery addressed this topic. The authors interviewed 19 OR personnel including nurses, medical students, surgical residents, anesthesiologists, and 2 scrub technicians. Dr. Amalia Cochran, the papers lead author, told me the reason there werent more scrub techs was that they were reluctant to participate.

This figure, modified slightly from the paper, describes the harm that disruptive surgeons can do and suggests some coping strategies.

Italicized items are discussed in the paper

I suggest you read the entire paper. Your hospitals medical librarian should be able to obtain a copy for you without difficulty.

Its a tough situation. When I was a surgical chairman, I had some experience with surgeons behaving badly. I always had trouble getting the nurses and techs to go on the record with their complaints.

If your immediate boss cant help, maybe you could try your hospitals risk management department. A surgeon who bullies the staff is a patient safety risk. Some hospitals have anonymous hotlines where complaints can be lodged.

The only other thing I can suggest is to get several other staff to join in the complaints. Administration can ignore one or two people but not eight or ten.

Can anyone else comment?

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