Interview: Dean Coleman, Ross University Medical School

Dean Mary Coleman, Ross University Medical School

SDN recently had the opportunity to interview Dean Mary Coleman of Ross University Medical School.  Ross University Medical School is based on the island of Dominica, in the Caribbean.

When was Ross University founded and what has been its record in producing physicians for the United States?

Ross University School of Medicine (RUSM) was founded in 1978, and 91% of its students are U.S. citizens or permanent residents preparing for medical careers in the United States. The School has graduated more than 7,700 physicians who are eligible to practice medicine in all 50 U.S. states, Canada and Puerto Rico upon successful completion of the requisite licensing examinations. Consistently, more than two-thirds of Ross graduates enter primary care, while the other third go into virtually every specialty of medicine, including transplant nephrology, invasive cardiology, plastic surgery, pulmonary medicine, neonatology, endocrinology, rheumatology, geriatric medicine, infectious diseases, and hematology/oncology.

Students choose Ross because of our faculty, our curriculum, and our technologically advanced campuses and because of our well earned reputation for providing the education that enables them to pass their U.S. licensing exams and obtain excellent residencies. In fact, RUSM places more graduates into residencies in the U.S. than any other medical school in the world.

Describe the Ross medical school curriculum.

Our students spend their first four semesters learning the Foundations of Medicine in Dominica. Since becoming Dean in 2006, I have worked closely with the faculty to integrate basic and clinical science learning in our medical education curriculum. The resulting Organ Systems-based curriculum focuses on early clinical skills introduction and greater acquisition of clinical skills knowledge and training. It includes learning in the basic sciences and an introduction to clinical medicine through a combination of interactions with real patients in Dominica, standardized patients, and virtual simulation.  RUSM’s patient simulation program is quite sophisticated, and is being expanded as a result of the demonstrated quality outcomes for students.  The Organ Systems-based curriculum is similar in composition to curricula at more than 65% of LCME-accredited U.S .medical schools, and is structured on the basis of the major organ-systems of the human body.  Teaching of traditional disciplines is augmented by content from a Department of Integrated Medical Education.

Students’ fifth semester is the Advanced Introduction to Clinical Medicine (AICM), conducted at one of our clinical sites in Miami, FL or Saginaw; MI. Students concentrate heavily on clinical experiences, and further their skills applying basic science to clinical medicine. All students who successfully complete the five semesters of pre-clinical coursework are required to take and pass the USMLE step 1 prior to commencing core and elective clinical rotations.  Student assignments are made strictly through RUSM’s Office of Clinical Sciences (based in Miami, FL) under the direction of the Senior Associate Dean for Clinical Sciences

For RUSM’s Clinical Program, semesters 6 through 10, students complete core and elective clinical clerkship rotations at one of more than 70 teaching hospitals in the U.S. that are affiliated with RUSM.  The standardized curriculum for these students was developed by RUSM faculty through the Curriculum Committee and is used at each affiliated clinical training site to provide a comparable educational experience for each student.

In total, 10 semesters, of which the first four are in Dominica, are required of all students.

Do students prepare for the USMLE, Step 1 during the fifth semester?

In the fifth semester, clinical learning opportunities are designed to further prepare students for their core and elective clinical rotations.  In 2009, Ross students had a 90% first-time USLME Step 1 passing rate (comparable U.S. medical schools 94%).

What do you look for in student applications?

RUSM is committed to giving opportunity to individuals who are passionate about becoming physicians and who have potential for success.  All students admitted have GPA and MCAT scores within a range that has characterized successful RUSM students.  However, GPA/MCAT scores do not guarantee success. We look at the applicant across many factors.  We interview every student and seek to learn about their other interests, their previous professional and life experiences, and their interest and previous experience in the field of medicine and healthcare.  The Faculty Admission Committee makes the final decision on applicants to the school.

For half a century, American medical schools have emphasized selecting students whom they have “predetermined” (through criteria like high MCAT scores) will do well on specific tests and are not likely to drop out of medical school for academic reasons. Although some would regard this as common sense, others have long argued that this approach excludes exactly those students who would be the right match for rural and underserved communities. Do you agree that the admissions policies of most American medical schools exclude many candidates who should be accepted?

Ross requires good MCAT scores and undergraduate GPA’s, but we find that MCAT and GPA do not by themselves dictate academic outcomes in medical school.  The average MCAT score for entering students over recent periods is 23-24. Currently, the average undergraduate GPA of enrolled students is 3.2.   There are over 42,000 applicants for 19,000 seats in U.S. medical schools and RUSM offers opportunity to students passionate about becoming physicians that is denied them in the U.S. Our population of graduates is much more diverse than U.S. medical schools and they enjoy successful careers, most in primary medicine and many in rural and underserved communities.

We’re convinced that there are personal characteristics that make great physicians, and we are constantly studying ways to improve our selection process and the academic support we provide our students.

The American schools “no one should fail” admissions policies date back to the time of federal “capitation funds” that penalized medical schools that had high attrition of medical school.

U.S. medical schools have very restricted class size and selection criteria that target students who have the highest academic performance through predictive GPA and MCAT scores.  This does discourage those schools from taking a risk on a candidate who may not meet the school’s predictive criteria for medical school completion.

It is hard on our students and faculty when people drop out RUSM. There is pain associated with that. But there are a large percentage of students who, at the time of their applications, do not have the “scores” that U.S. schools use to predict success. Yet they do succeed in our program and would not have become physicians if we had not provided them with the opportunity. We work hard to quickly assess student outcomes in the first two semesters to ensure (that) students who need support get it, and those who are not able to succeed can quickly change course.

We have recently published articles on the impact of high student debt on professional school graduates, and separately have noted that the U. S. Congress’ General Accounting Office has recommended that the dropout rates of students at Caribbean medical schools with federally financed students loans be studied. How do you respond to this concern?

Medical education is a substantial investment, and students should carefully balance loan debt against career compensation.  Ross manages tuition/fee costs by controlling expenses in areas that don’t directly benefit our students.  More than 80% of our students borrow Title IV (U.S. federal) student loans; the average debt load at graduation (not including undergraduate borrowing) approaches $185,000, but the default rate for RUSM students has consistently been well below 1%.

Are there quantitative scores that you do use to predict success?

We have found that a good GPA in RUSM classes has a good correlation with Step 1 and Step 2 licensing exams success. Student scores on a comprehensive exam after completing the basic science curriculum as well as performance in the fifth semester also correlate with future success. We are continuously working to improve our understanding of those factors on admission that will predict success.

What do you do for those who find that they are having trouble succeeding in medical school?

There are counselors on campus for situational or personal issues. We have an Academic Success Program that addresses study habits and time management. We also have a popular peer-to-peer tutoring program.

Our Student Affairs Department works with individuals to assist in determining which interventions may be best suited to helping a student who is in need of help and makes referrals/recommendations based on assessments.  In our Student Mentor Program, upper class students take new students under their wing.

What is the best way to make a decision as to whether one should apply to the Ross University School of Medicine?

I recommend that any interested person attend one of our Information Seminars, which are frequently held throughout the United States. They can get the list from our website www.rossu.edu, and there is information on the website as well. The information seminars are particularly good. There are faculty and alumni attending to answer questions. At the seminars prospective students meet admissions folks and some of the faculty who will be conducting interviews, and making the admissions decision.

What are some of the problems that students might encounter within your medical school?

When students are challenged it can be from one or more of many factors. There are students who simply cannot handle the rigorous academic curriculum. Some are challenged by living a long way from home in Dominica in a different culture with different resources. Some students have family issues. Anecdotally, there have been students who have withdrawn because a family member has become ill, and they cannot hold both roles of caregiver and medical student.

But I would suspect that the Caribbean also has its attractions.

Students find Dominica much less distracting than many places they might study in the U.S. As education at RUSM is year-round, with three start-dates per year, the rural setting of the campus supports their focus on mastering an accelerated and demanding curriculum. People in Dominica are friendly and there are restaurants, shops and other services close to campus for students. The island itself is a magnificent natural environment. There are over 48 student clubs on campus, and many student groups are active in local community outreach, including health fairs.

As a person with experience teaching medical students in American medical schools, do you see advantages to teaching in the Caribbean as opposed to a regular medical school on the mainland?

At most U.S. medical schools, faculty are pulled in so many directions that there is little time that they can devote to education as a priority.

Research and patient care (because of the revenues they produce) has a greater value than education, which, though central to the medical school mission, receives comparatively minimal funding.  At RUSM, education and teaching are the priority.

Our faculty maximizes their availability to our students and provides them with the support needed to meet the extremely demanding requirements of the curriculum. Our faculty is focused not only on their knowledge of the science of education, but also on learning new methods of teaching and new ways to reach our students.

Also, most U.S .medical schools have had not been successful in producing students with the diversity and interest in primary care to meet U.S. physician workforce needs. Ross has a diverse student body and roughly 65 percent of our graduates enter primary care fields (i.e., family medicine, internal medicine or pediatrics), exactly what the U.S. needs.

One advantage of a market-based educational institution is that resources are available for continuous faculty development, one of the first areas cut when state monies are reduced.

Describe the typical Ross graduate’s practice, and their range of experiences.

Over 7,700 Ross grads practice in almost every specialty, but 65 percent enter the primary care residencies – family medicine, internal medicine and pediatrics. The percentage going into family medicine residency programs is 35 percent.  Our graduates are passionate about their chosen career.  Many volunteer in community programs, as well as in national and international crises, such as we recently experienced in Haiti and Pakistan.

Does Ross University grant the same kinds of accommodation to disabled and students with disorders such as dyslexia as American universities?

Yes, we give the same consideration to students and provide accommodation for them.

How does the Ross University curriculum compare to other medical schools?

RUSM’s curriculum of medical education is similar to LCME-accredited US medical schools in which the early curriculum in the first four semesters focus on basic science concepts with an emphasis on clinical learning in later semesters. Ross allows students to complete the basic science component in 16 months, which most U.S. students complete in two years. The first four semesters include a learning program that offers a variety of learning modalities, including large classroom lectures, as well as weekly small group learning that includes problem-based sessions, anatomy dissection, interviewing and examination skills, simulation and clinical task training. Most small groups are no larger than eight students. There is a strong component of team-based learning.

We use the most recent technology. Interactive learning takes place in large classrooms, using video-conferencing, including video conferencing in clinical cases, such as interviews with hospitalized patients and audience response systems. We utilize technology to remotely videotape students doing histories and exams, and provide online interviewing software. We also use high fidelity simulation for clinical case management and task trainers for practice of focused clinical procedures.

At RUSM we invest significant resources in faculty development. In addition to content meetings, our faculty regularly attends and presents their work at medical education meetings in the U.S. and Europe.

Are students involved in providing for the health needs of the surrounding community?

Students provide health fairs for the local community, providing blood pressure and glucose and cholesterol screening.  One specific project in which many of our semester 1-4 students participate is the Salybia Mission project which provides regular clinical care for the local Carib Indians in Dominica.  Additionally, many of the student clubs on campus have community outreach and assist in community health care.  Our AICM and clinical students also serve in community outreach healthcare programs.

What provision is made for the health maintenance of your students?

We have created a wellness program for students which helps students determine their own level of fitness and specific exercise programs to improve and track their level of fitness. Our facilities include a fully equipped gym and a Student Union with activities including foosball and ping pong, a jogging track with exercise stations, tennis and basketball courts, a swimming pool and an athletic field for intramural sports such as soccer and flag football.

What about social organizations?

Student organizations are plentiful and address all types of student interests. There is a local chapter of AMSA (the American Medical Student Association).  Religious groups sponsor appropriate films or speakers, ethnic groups raise money for the community via suppers; service groups provide care to the homeless or elderly; environmental groups take on projects such as recycling efforts; athletic groups promote opportunities such as diving, hiking or tennis.