Medical education in the Caribbean: a longitudinal study of United States Medical Licensing Examination performance, 2000-2009.

Purpose: Caribbean-educated physicians play an important role in the United States. The purpose of this study was to investigate medical school development in the Caribbean, concentrating on performance trends of Caribbean-educated physicians over the past decade.
Method: The study included 26,495 Caribbean-educated students/graduates who took one or more exams leading to Educational Commission for Foreign Medical Graduates (ECFMG) certification between January 1, 2000, and December 31, 2009. The authors describe medical school development in the region, discuss recent student demographic trends, and summarize first-attempt success rates, by year and country of medical school, on the United States Medical Licensing Examination (USMLE) Step 1 (Basic Science), Step 2 (Clinical Knowledge [CK]) and Step 2 (Clinical Skills), or the previously required ECFMG Clinical Skills Assessment.
Results: Sixty-one medical schools operated in the Caribbean from 2000 to 2009, of which 56 are currently open, and approximately 10 new schools are in development. The number of Caribbean-educated ECFMG registrants has grown every year, from 1,510 in 2000 to 4,000 in 2009. USMLE Step 1 and Step 2 CK first-attempt pass rates generally increased over the study period. Performance trends by country varied widely.
Conclusions: Medical education programs in the Caribbean and the number of Caribbean-educated ECFMG registrants continue to expand, with students/graduates showing performance improvement in some areas. Performance findings should be interpreted with caution, because of limitations the authors explain.