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Studying Medicine in Latin America

Updated on March 16, 2009

Studying Medicine in Latin America

This Hub Page discusses studying medicine in Latin America for those U.S. and Canadian citizens who failed to gain admission to medical schools in the United States and Canada.

Since at least 1946 the competition to gain entrance to a U.S. or Canadian medical college has become increasingly harsh. Many students who enroll in Pre-Medical courses in undergraduate colleges are only 17 or 18 years old and simply do not understand that the academic requirements to become a doctor are much more difficult than they realize. Academic counselors often simply do not inform these students who are - and let's be honest - children about the stern academic challenge that the 4-year pre-medical college will present to them.

First let's examine the fundamental reality of the first academic barrier to becoming a medical doctor. Unless you gain a Grade Point Average (GPA)3.80 or better in your 4 years of undergraduate studies you will NOT be admitted to any U.S. or Canadian medical college. Studying in a pre-medical(Pre-med) curriculum is by far the most difficult of all the college majors a student can choose towards a bachelor's degree. The study required to get good grades in other majors, i.e. English, journalism, sociology, etc. is easier than Pre-med. While other students go out on weekends to parties, to concerts or on dates- the poor pre-med student, if he or she realizes the task before them, will be at home studying until midnight or more even on Friday and Saturday nights. Even then not every student can garner a long string of endless "A"'s for their 4 years of college. Indeed, gaining a near 4.0 GPA in pre-med courses almost literally requires a photographic memory in addition to discipline and sacrifice. Regretfully, not all of us and I daresay even most of us simply do not possess the mental capacity to earn top grades in an academic endeavor where the professors grade on a curve that is considerably above the grading curve for other college majors. What is more young people are often subject to distressing distractions, i.e. family problems, money problems, the need to work at a job while in college, health problems and romantic problems.

However, this Hub discussion is not geared to getting top grades in an American pre-medical academic program but rather what to do when it begins to dawn on you that your Pre-Med grades are simply not high enough to gain acceptance to a U.S. or Canadian medical school. It doesn't matter whether you are 17 or 18 years old just starting college in your freshman year or 21 years and older with your college diploma in hand. What you need is a clear understanding of how the U.S.-Canadian Pre-Med system works to stop you from becoming a medical doctor and the steps required - and these steps will be long and arduous - to attending medical school in Latin America pursuant to one day practicing medicine.

To begin, the U.S.-Canadian Pre-medical college system erects 4 barriers to retard the chances of any pre-med student from gaining admission to a U.S. or Canadian medical school. These barriers are: 1) the steep academic grading curve of pre-med undergraduate courses, 2) the GPA eligibility demarcation, 3) the MCAT examination and 4) the One-In-Seven Rule.

We've already discussed the first barrier. Pre-med courses require the mastery of much more raw data than other college majors. Learning the Krebs Cycle in biochemistry is much more difficult than reciting the motivations of Abraham Lincoln to practice law in Illinois, for example.

The 2nd barrier is an extremely distressing one for Pre-Med college students because they usually only discover it only in their senior year, just before graduation, when they make their first attempts to apply to a U.S. or Canadian medical school. The typical pre-med student usually starts sending out applications to U.S. and Canadian medical schools during the course of his or her senior year at the undergraduate level and may be distressed to find that he or she receives nothing but rejection letters. These rejections prompt the student to investigate the eligibility requirements toward gaining admission to these medical schools. They start visiting academic counselors asking specific questions about their GPA and GPA requirements for eligibility to medical school. They discuss the situation with friends and classmates- sometimes a friendly professor will enlighten them on the situation. They go online to find more information and consult medical journals, newspapers and magazine articles. The result is that a growing horror wells up in their hearts as they realize that a GPA of 3.7, 3.6, 3.5, 3.4, 3.3, 3.2, 3.1, 3.0, 2.9, 2.8, 2.7, 2.6, 2.5, 2.4, 2.3, 2.2, 2.1 and 2.0 is piteously indequate to be declared eligible for admission to a U.S. and Canadian medical school. Indeed these schools divide student applications into 2 groups: A) eligible (GPA's of 3.8, 3.9 and 4.0) and B) ineligible (2.0 to 3.7). It is that simple. Many students as a result are emotionally wrecked when they realize that 4 years of hard work and intense studying- not to mention all their parent's tuition payments - have been wasted on what they now realize is a failed academic effort simply because they are merely "B" or "C" students.

The 3rd barrier is the MCAT, i.e. the Medical College Admissions Test. This examination is a prerequisite for admission into U.S. and Canadian medical schools. Most students take the exam in the summer following graduation from undergraduate college. However, many students who take the MCAT do not realize that the MCAT is only valuable to the so-called eligible students, i.e. those with GPA's of 3.8 and above. Any ineligible student (GPA of 2.0 to 3.7) is simply wasting his or her time paying the $300 application fee to take the MCAT. Even if an ineligible student were to score 100% on the exam- it would do nothing to influence the admissions committees of U.S. and Canadian medical schools to accept that student into the freshman class of medical school. The MCAT is simply another tool to weed out students from the eligible group with regards to admission to medical school. Indeed it is absolutely necessary for a student- with a GPA of 3.8 or higher- to score at least in the 90th percentile (i.e. a better score than 90% of the other students taking the exam) to maintain his or her eligibilty for admission to medical school. Students who score considerably under 90% fall into the vast pool of ineligible students. To be sure the student who scores lower than a 90, say a 75 or 80, on the exam can retake the exam a year later to improve his or her chances but that student will be competing with a whole new population of younger students taking the MCAT examination for the first time. With each passing year the eligible student's chances fade as he or she gets lost in an increasingly larger population of pre-med students competing for medical school admission.

The 4th barrier is considered by many frustrated pre-medical school students to be the worst ordeal of all. Quite simply, here is how it works: For every 7 eligible pre-med students, i.e. GPA of 3.8, 3.9, and 4.0 and who have scored 90% or higher on the MCAT, only 1 of those 7 students will be accepted into the freshman class of a particular U.S. or Canadian medical school. Indeed, 6 out of 7 eligible Pre-Med students will themselves receive the same type of rejection letter from their local medical schools just the same as a student with a 2.2 GPA and a 77 MCAT score would get. To say the least many of these eligible students suffer from considerable emotional anguish when they discover just how nearly impossible it is to become a medical doctor though the North American educational system- most especially if they already invested years of hard study and thousands of dollars of tuition money into their efforts.

However, despair is not something we should let hang over our heads. As in any daunting challenge facing an individual that person must act like a soldier and develop a "battle plan" to deal with the problem, solve it, and eventually overcome it. So let's begin.

1. If you are a freshman or even a sophomore in a pre-medical program at an undergraduate school, the first thing you should do is to select a "minor" to complement your "major" of pre-medical science classes. Pre-medical students have a "major" that includes courses such as Inorganic Chemistry, Organic Chemistry, Biochemistry, Physics, Histology, Botany, Physiology and the like. Many of these courses are similar to those offered in medical schools. The "minor" is, of course, a series of classes that an undergradute student enrolls in as a secondary plateau of continuous learning, i.e. an English major may "minor" in education to prepare himself or herself for a future job as an English teacher. Similarly the pre-med student usually chooses a "minor" - it might be English, history, philosophy or whatever.

But in this instance, the pre-med student who is aware of the near-impossibility of becoming a doctor through the North American collegiate educational system (by North America it is understood to be the U.S. and Canada), needs to urgently start learning Spanish. Indeed, the more courses in Espanol- the better. Ideally, an undergraduate pre-med student should enroll for 4 full years of Spanish taking almost every course offered by the college. That would be Introduction to Spanish, Conversational Spanish, Spanish Literature and Advanced Spanish. Learning another language - especially when you will need to be fluent in not only speaking but also reading and writing that language - is quite difficult and the more classes in Spanish a student takes while in his or her undergraduate college the easier the eventual residence in a Latin American country will be. And don't be afraid! Students in other countries of the world, i.e. Europe, Russia and China routinely learn English (and other languages) as part of a typical curriculum in secondary (i.e. High School) and University (i.e. college). Besides Spanish is now the 2nd most prevalent and important language in the United States. Even for people who do not pursue medicine as a future career, speaking, writing and reading Spanish well is a boon for all one's future endeavors.

2. The 2nd endeavor towards the eventual goal of studying medicine in Latin America is a mighty one that would rattle the heart and mind and soul not only of a grown man of 40 but most assuredly an inexperienced and quite probably immature child of 18 or 19 years old. This endeavor is an emotionally wrenching and intellectually violent physical change that - while hard to endure at the time - will make subsequent years of travel and relocation much easier to tolerate and make gains by. This endeavor is traveling to a Latin American country one summer during one's undergraduate college career and living there for the summer months of June, July and August. This is a geographical relocation that needs to be carefully planned and prepared for at least a year in advance before one's actual journey down Mexico, the Dominican Republic or any one of a dozen or so other Latin American countries. Hence, the probable best summer to make this 3-month Odyssey would probably be the summer after the completion of a student's sophomore year in college. Certainly preparation should begin as a student enrolls in his or her freshman year of university study and ideally while in one's senior year of high school.

Preparation for this 3-month stay requires the consideration of many goals and problems, i.e. 1) What country should I go to? 2) How will my Spanish skills fare once I travel there? 3) What is the political climate of the country? 4) What kind of laws exist there? 5) Should I drive a car there? 6) Do I need any vaccinations or other medical preparations? 7) With whom am I going to live there? 8) Will family or relatives travel along with me there? 8) Can I work there? 9) How is my family going to finance this trip? 10) Should I go to summer school there? These questions are all considerable and require attention to detail and skill in solving the problems that they address. Nevertheless all these details, challenges and problems can be successfully dealt with. Talking to travel agents, the embassy of the selected country, family and friends who may have been born there, and consulting newspapers, magazines and the internet are all very helpful technqiues that can be engaged in to gain the knowledge and expertise to prepare for this journey. Communicating with the State Department in Washington is recommended because they have plenty of literature both on paper and on-line to comprehensively brief the student and his or her family about their travel plans and the chosen country.

Once having arrived in one's chosen country for one's "Summer Vacation in Latin America" and with dwelling arrangements set up- the best course of action for the undergraduate student this particular summer is simply to be a simple tourist there in this strange land. The student should be relaxed and low-key in his or her activities because the goal of this 3 month stay is acclimatization and learning. The young American in his or her strange new world should learn about the people, customs and culture of this new country. And, of course, every day out on the streets, or sitting at a cafe or walking through the market place will be a virtual school-on-the-avenue for learning and improving one's command of the Spanish language. The rules for the young student-tourist are the same as for any student- be relaxed but be alert and stay low-key, i.e. don't make waves like getting drunk in public or driving without a license and so on. Remember although one will be residing in a town or city in a foreign country- it is just a town and city like any other.The basic patterns of conduct and common-sense attitudes of this strange new environment are pretty much the same as the student's hometown and the guidelines with regard to the law, precautions and common sense are identical in both geographical settings. You wouldn't get into a car with a stranger in your home town and you would avoid doing the same during your Latin American visit. You wouldn't get arrested for drunkeness or drugs in your hometown nor would you allow yourself to get similarly busted in your Latin American stay.

With regard to health issues- the reason people get sick in Latin America, i.e. "Moctezmua's Revenge" which is really traveler's diarrhea is not so much that the water is dirty (and it is!) but that there is a change of bacteria and viruses in the entire environment there- water, food, air, surfaces of hand rails, walls, windows, clothing, machines, cars, bathrooms, equipment, utensils- everything. Indeed, getting sick in Latin America has caused many otherwise daring young people to give up the idea of studying medicine there and go back home to train to become an accountant. But if a young person has the courage, gumption and nerves of steel to brave out this adventure - even though at times it may seem to be an ordeal - they can overcome the aggravation of gastro-intestinal illness in Latin America. One should always wash one's hands - with soap- several times a day, drink bottled water, avoid eating raw market-place fruits and vegetables, peel and wash all fruit and vegetables, cook one's food thoroughly. If you do smoke or drink- remember smoking and drinking can sap your energy and leave you more vulnearble to colds and flu as well as diarrhea. Indeed, many tourists catch influenza in Latin America because the physical and emotional stress of travel is a shock to their systems. If you get sick - go see a doctor there. Indeed, they have drugs - not available in the U.S. that can help you recover from the flu.

3. Returning to the States to study for the junior year will be one of immense pride - and relief - for the brave adventurer who dared this 90 days of adventuring in a movie that we cound entitle "Indiana Jones and the Lost Bottle of Tequila." Even at the tender age of 19 or 20 the young student can readily discern that people are pretty much the same the world over. Oh, to be sure culture, customs and language can differ radically- but human nature?'s the same everywhere all over the world. But pride and experience aside, returning to one's junior year of study with a knowledge of the Spanish language that outstrips the foreign language skills of every old high school friend that one ever had is no excuse for not continuing full-blast with more and more Spanish courses during Junior year. There is no such thing as too many Spanish courses when one considers that the language of the medical school curriculum of that Latin American country's medical school is going to be.....Espanol. Although many of the medical school professors in schools South of the Border speak fluent English and they may even talk to the American medical student in that language as a friendly favor- they will never do so in class! But even so one should dive head-first into the icy waters of the difficult mastering of a foreign language because the mastery of Spanish to the point of fluency will be a life-long source of pride and advantageous situations.

4. The Spring Vacation during one's junior year is a time that should be reserved for a strict evaluation of one's undergraduate performance and chances for future study. The student will have finished 75% of his or her studies in college and some hard questions should be asked, i.e. 10 What is my Grade Point Average? Am I an "A" "B" or "C" student? Do I still want to study medicine? How do I feel about my chosen Latin American country a year after having lived there for a while? Will I be scared to live in that country for anywhere from 5 to 10 years after graduating from college? Can I improve my study habits? How is my Spanish? If the answers to these questions and others that are linked to these issues boost the student's confidence then he or she will find the Senior Year and what lies after it to be an adventure generating apprehension - to be sure - but also hope and the pleasure of adventurous excitement.

The Junior year Spring Vacaation evaluation by the undergraduate pre-med student is crucial for future planning and motivation because the summer vacation following the Junior year will be another travel ordeal back to Latin America. Indeed, this is the second tremendous travel challenge, at hand following the Junior year, that must be met with courage, determination, budgeting of one's funds and careful preparation. Once again, another journey back to Latin America and the country of the student's choice is required. Only this time it is not a vacation to learn Spanish and acclimatize one's self to daily life there.

No, this journey will be a BUSINESS TRIP. And the business at hand will be the most challenging effort of the young student's life, i.e. introducing yourself to the school of your choice - actually a list of 3 or 4 schools - and to the medical school officials there. Prior to actually traveling to these Latin American schools the American student should send letters of introduction- in Spanish, of course - to the various school's admitting committee's during the school year- i.e. September, October or November of one's junior year. Undergraduate, graduate and professional schools in Latin America have roughly the same academic calendar as in the USA and Canada. Classes begin in Augusts or September and run until May or June. July and August are months reserved for summer vacation. A few school officials and secretarial staff will be at the school during the summer but formal business - and decisions - are reserved for the regular school year. Nevertheless the American student should request a formal visit - in the summertime - to be received and interviewed by an admissions officer. The school officials are quite familiar with meeting prospective new students during the summer because these Americans are unable to visit Mexico during ther school year - although visiting these officials during Christmas vacation or Spring Break during the Junior year can be approved and arranged. Once the letter is sent a response will be sent from the school back to the student probably 2 to 3 weeks later and the admission officer will select a date for the appearance of the student- in December (Christmas vacation), April (Spring Break) or July-August (Summer vacation). Now, if a student wants to apply to more than 1 medical school in the Latin American country of his or her choice, summer would be the best time for visits because it would allow the student to travel by bus (bus fare in Mexico, for example, is quite reasonable) to 3 or 4 selected cities to "interview" with the admission officer of each school.

Another technique that can be used is the liason. If the student or his or her family knows a professional person who lives and works in Latin America that person can act as an intermediary introducing the American student to the admissions officer or officers of a particular Latin American medical college. Usually the liason will be a professional, i.e. a doctor, lawyer, politician, government official, engineer, architect, scientist or someone in the military of that country. The traditional custom is that the family pays money to the liason to perform as an intermediary. This money is not bribe money- it is simply a payment of gratitude for the services rendered by the liason.

Ironically the Junior year trip to Latin America and the 3 or 4 medical schools on the student's short-list will be much easier than the Sophomore year "vacation."The American pre-med student will have the experience of his or her previous journey to provide him and her not only with savvy - but also moxie. The itinerary should be as follows. If the 3 or 4 selected schools are in the same city (usually larger cities like Mexico City, Caracas, Buenos Aires, Santo Domingo, San Juan, etc. have more than one medical school) then the student can travel by city bus, taxi or local train to each school on successive days. If, however, the student has selected a number of schools that are located in different cities around the country then traveling with a long-distance bus service is the best way to travel. If the student's family has enough money then air travel can be done. Air travel in Latin America is every bit as good as in the U.S. and Canada. A train trip between cities is also an available and safe option.

Interviewing for admission to a Latin American medical school is exactly like interviewing for a job in Canada or the United States. The same rules and tricks apply. Let's divide it up between boys and girls.

For boys: Get a haircut! Now, before you weep over losing those beautiful
Paul McCartney, Jim Morrison and Ozzy Osbourne locks- please remember you can always grow your hair back once you're in school. Although some private medical schools may have a dress code, the public medical colleges usually don't. What both of these types of schools want from American or Canadian male students in their colleges is neatness. Come to class in casual dress- unfaded, non-frayed jeans are okay and your hair can be long, say, over your ears and reaching your collar so long as its neatly brushed and combed - but take a shower with soap and shampoo every morning and wear clean clothes. If it's a hot day- wear a T-shirt (no obscene, bloody or politically radical logos please) and if it's a cooler day an attractive but simple dress shirt is ideal - no tie is necessary. You fellas can even buy these hot-weather embroidered formal shirts that the Latin American politicians wear in lieu of a tie and jacket. Beards and mustaches are okay at the interview and in school so long as they're neatly trimmed. Remember many of the Latin American medical school professors are left-wingers and sport their own Che Guevara locks and facial hair. In addition to the conservative- but temporary - hair style male students at the interview should wear a jacket and a tie. If you don't want to wear a suit- that's fine- but a sports jacket, dress shirt, tie (no bow-ties please!) and shined, leather shoes will do just as well.

For girls- Female students to the interview do not need to cut their hair- but tying it up into a ponytail or bun is recommended. In Latin American cultures - and here in North America - females always have had more freedom in dressing in a more libertine and expressive manner- but this is an interview in Latin American school in a Latin American culture. Therefore American women at the interview should wear a dress. No slacks, please! Remember, "Women's Lib" may be known in Latin American countries - but it is not always accepted. Makeup should be at a minimum- a little lipstick and a touch of make-up but that's it. No eyeliner please! Also please remove all your tongue ornaments, lip ornaments and the like. Conservative ear-rings are all right- but not if you're a guy! Pant-suits may be acceptable if it's professional looking- but if the female student is apprhensive about this- then wear a dress. The dress should not be ostentatious- no bows, no gaudy buttons, no frilly lace. In other words wear a business dress- the type of dress a woman wears in the U.S. or Canada when going to work.

The psychology of the interview for men and women will be the same and the interviewing student should be pleasant, somewhat cheerful, alert and courteous. The student should compliment the school as a fine institution and express a great desire to be enrolled and study there because it would give him or her a sense of pride to be there as a student. When the interviewer asks the student about his or her accomplishments - ditch your modesty and practically gush about your good grades and scholastic and athletic honors.

If the subject of drugs and booze comes up you should immediately declare that you are a non-smoker and practically a teetotaler. The last thing the medical school you are chosing wants is an American student there busted and jailed for drunkeness or pot smoking. Now cigarette smoking doesn't mean you're going to smoke pot in a hotel room there and get raided but in Latin America they tend to associate marijuana smoking with tobacco smoking and if you declare that you are a tobacco-abstainer- it will convince the school officials that you are not going to delve into marijauana smoking.

The interview for Latin American schools almost never discusses politics, religion, sex or the relationship between the United States and the country of your medical school. The interviewer is not interested in that kind of stuff and will give you the benefit of the doubt that you are respectful of him, the school, the city your are going to be residing in and the country of his birth. Friendliness and vigilant diplomacy will go a long way.

Finally the interview is a chance for the admissions official to make sure that you can pay for your tuition. Unlike the U.S. and Canadian medical school where not even a $50,000 "donation to the school" will get a "C" student into the freshman medical school class, the Latin American schools will accept almost anyone who can pay the tuition. Despite popular legend you need to bribe your way in, reality is quite different. Most Latin American school officials consider bribery to be reprehensible. The greased palm bit of Latin America lore is exaggerated. Of course there is graft, bribery and corruption in Latin America but no more than here in the States or the Dominion. Just remember there have been 4 - count' em! - 4 - Illinois governors indicted for fraud in the last 35 years alone! Kerner, Walker, Ryan and Blagoyevich.

When the interview is over give the interviewer a gentle but firm handshake, a big smile and graciously depart from the room. When you get to the hotel or apartment where you're staying for the day, relax, take a shower, go out the plaza, get a drink, get something to eat and then get a good's night sleep.

If your next interview is in the same city then merely repeat your travel itinerary the next day as the previous day's interview visit. If you are leaving for another city to interview at the school there - then prepare and conduct yourself much like you would on a bus, train or airplane trip in the U.S. or Canada.

The "short-list" of medical schools to visit and interview at should be no more than, say, 4 schools. Indeed, the odds are good that 1 of the 3 or 4 schools that you visit and interview with will accept you. Latin American medical colleges actually like to have foreign students studying with them there- especially Americans and Canadians. Their presence at their school ads to their prestige and, of, course the Americans and Canadians have money and will pay their tuition for the most part on time.

Once the last interview has been conducted you can relax in your Latin American "paradise" as though you were a real tourist! Go to the plaza (in Mexico they call it the "Zocalo"), stroll the avenues, have a drink at a bouelvard-side cafe, gab with people you meet there, enjoy yourself!

Then it's back home to get ready for your Senior year in college.

In the waning days of summer before the Senior year of pre-med begins the American and Canadian student should obtain a photo-copy or on-line print-out of their academic grade report. By the start of the Senior year, with most students already well-aware of their Grade Point Averages, one might ask what's the point? Well, the point is the student should evaluate his or her GPA- not for entry into U.S. or Canadian medical schools- but for the sake of the Latin American medical colleges. A GPA of 2.0 and 3.7 - while it provides aboslutely no hope in getting accepted to a medical school North of the Rio Grande - will play an important role in getting into a Latin American medical college. What this means is that the more prestigious a Latin American university and its medical college is the more likely an American stuident will gain admission to that school if one sports a higher GPA. This distinction is not to say that an American student with a "C" or lower "B" average cannot be admitted to a prestigious medical school in a big city but it is usually the schools in smaller (and poorer) cities that will be less fussy and finicky about a student's GPA. Again in Latin America most schools will accept "B" and "C" students so long as they keep their noses clean, act decently there and pay their tuition fees. Hang on to the GPA report and try to match it up with the acadmeic requirements of the short-list of Latin American schools that you have selected.

By the way, students, particularly those with "B" GPA's of 3.0 to 3.6, who consider studying medicine in Europe- the odds of gaining admission to a European medical school (and that includes Australia, New Zealand and South Africa) are quite slim. These regions have their own overwhelming numbers of applicants for limited spaces in the freshman medical school class. Indeed any medical schools in the so-called "First World," i.e. United States, Canada, Europe, South Africa, Australia and New Zealand very rarely will enroll an American or Canadian student- and that student will need straight A's i.e. a GPA of 3.8 to 4.0 plus a 90% MCAT score even to be considered. About the only way to get into medical school in Russia, China and Japan is if you are of Russian, Chinese or Japanese descent and if you are, then you will probably have to attend high school in those countries.

Most American and Canadian college students entering their Senior year of undergraduate studies or having actually graduated with their diplomas in hand are usually more mature and more sophisticated than they were during their Freshman year. A 17 or 18 year old child has now grown into a 20 or 21 year old young man or young woman. There is a world of difference by now with regard to experience, maturity, wits, cleverness, habits and self-confidence. And for the pre-med student who has already made two extended trips to Latin Americam, well, this person is a veritable Indiana Jones when it comes to courage and daring-do. This maturity and increased self-confidence will bode well for the Senior year and for the challenges arriving after graduation. Hopefully this added maturity and toughness will enpower the Senior year student to study quite hard in their 4th year in college. Whether his or her GPA is 2.2 or 3.5 hard studying in the Senior year will give this to make the leap over the icy mountains of apprehension and uncertainty an confer onto this brave and determined person the "momentum" - mostly based on pride and boosted expectations - to actually forage into a strange, new but ultimately exciting world of endurance but also adventure.

Moreover, if his or her GPA is 3.6 or 3.7 there may yet be a chance to reach that magic 3.8 goal. However, for those students near the 3.8 threshold one must contemplate the rude reality of the dreadful "One-in-Seven" rule. Whereas a "C" student with a 2.2 GPA has zero chance of getting into a U.S. or Canadian medical school, the student with a 3.6 and 3.7 GPA looking to boost the average to 3.8 in one's Senior year still faces a daunting 7-1 longshot chance of gaining admission to the U.S. or Canadian medical school of his or her choice. By all means the student should apply to U.S. and Canadian medical schools in the Senior year but then should keep going to those last 2 Spanish classes of his or her Senior year no matter what the outcome.

Congratulations! You've just graduated from college! You have attended the commencement ceremony along with hundreds of other students and probably about a 100 pre-med students from your 4-year undergrad program. Of that 100 students 95 of them have been rejected by their 3 or 4 favorite medical schools. Of that 95 maybe 4 or 5 will go on to graduate school to earn a master's degree and maybe even a PhD. Such an effort should be applauded but it almost will surely fail to get that student into a U.S. or Canadian medical school. The admission committees of these schools want a 3.8 GPA or higher combined with a 90% MCAT score or higher. They are not interested in any masters degree or PhD that you might have struggled to obtain. Remember as you get older while in graduate school- there are more and more 21 year old college graduates clogging the admission lanes toward U.S. and Canadian medical schools and some of them will sport 3.8 and plus GPA's and 90% and over MCAT scores that will far outshine any master's degree or PhD that an older student will have earned.

Of the remaining 90 pre-medical students about 80 of them will choose another career.They may go on to graduate school but they will be changing their major from biology to something more suited to another career, i.e. journalism, English, political science, sociology - you name it. They may start working on the job at another career hoping to move up the ladder. Others will go into a related health care industry, i.e. hospital technicians, nursing, bioloogy teachers, dentistry, veterinary medicine. Veterinary medicine is a very noble endeavor but pays poorly and leaves the frustrated physician very sorry that he or she became a "horse doctor." Some will try to get accepted to Medical Colleges of Osteopathy.

Osteopathy is known as "Snake Oil Medicine" in that it claims all disease is caused by crookednness of the spine. Obviously people who graduate from professional schools of Osteopathy quitely abandon the principles of osteopathy - and practice conventional medicine.

And then there are the 10 students left who have the courage - some critics call it the gall - to dare to maintain their dreams of being a medical doctor one day. They are the ones who may have already visited Latin America or who are contemplating traveling there. We mentioned that younger students in their freshman and sophomore years will have the opportunity to make the 2 recommended trips to Latin America and the chance to study undergraduate Spanish for 3 and 4 years. However, the older student, i.e. the new graduate aged 21 or 22 or 23 years old who finishes college and then finds out to his great consternation that the entire 4 year pre-medical curriculum was a complete waste because his or her GPA was only 3.2 or 2.7 or 2.4 - that student can also make the transition from "Gringolandia" to "Latino America" as well as the younger, forewarned college student. It is not a crime of dereliction to get through 4 years of college unawares that one has already failed to gain admission to a U.S. and Canadian medical school without even realizing it. Indeed, college counselors are notorious for failing to warn college students that the road to medical schools runs through an "academic minefield" imn undergraduate college. It is not a crime of unpreparedness that a young man in college tries to study hard but also wants to go out on dates with a girl or attend a concert on Friday and Saturday nights or that a young woman wants to spend some quality time with her boyfriend on weekends or go to a nightclub, or movie, or rock concert on the weekends. No the onus falls on the willful neglect that counselors and pre-med publications exhibit by not completely explaining the academic battlefield of pre-med studies. Indeed some "C" students in their Senior year of undergarduate college still harbor the naïve belief that all they need to get into a U.S. or Canadian medical school is the tuition money! When they learn otherwise they can be they will be horrified and emotionally depressed.

Fortunately for the older student - say the 21 or 22 college graduate - the battle to gain admission to a Latin American medical school may very well result in success. One obvious disadvantage is that the older strudent may not have had extensive study in the Spanish language or, perhaps, none at all. This deficiency can be compensated for by enrolling right quick in any suitable Spanish courses at a junior college, senior college or private language school, i.e. Berlitz. Even the mastering of rudimentary Spanish - which can be accomplished in just 6 months - can provide a strong impetus for the travel down to Latin America.

Another apparent disadvantage is that the older student may never have visited Latin America while the younger student - who made his or her preparations as early as high school to do such traveling - may very well have been to Latin America twice already. But this seeming inexperience can be more than compensated for by the fact that the older student - in his or her 20's - has much more emotional armor, the experience that fosters common sense and the freedom from the stresses and time constraints of active college study. Indeed the older student also has the opportunity to travel to the Latin American country of his or her choice and find a job there while also studying, part-time, Spanish at the local university. Bi-lingual Americans and Canadians may work in Latin America on a work visa. If the older student has enough money then he or she can spend 6 to 12 months in the Latin American country of his or her choice not only studying Spanish in formal class but getting a head start on his or her medical studies by buying and studying medical books in Spanish. After 6 to 12 months of such priming the student can then solicit an interview pursuant to being accepted at a medical school on his or her "short list" without having to travel back and forth between the U.S. (or Canada) and Latin America (save for family visits or vacation time). Young men and young women in their 20's, then, who usually have the experience, "street smarts" and emotional stability that teenagers often lack, are better suited and better prepared to deal with the daily stress and problems of residing in a foreign Spanish-speaking country than youngsters 4 or 5 years their junior. For both groups a formal letter of invitation to be admitted to the medical college will be sent to the soliciting student.

Sometime during the Senior of undergraduate college the American or Canadian student will get a letter of invitation to appear at the Latin American medical school of his or her choice from the short list of 3 or 4 schools during the summer, or perhaps in September immediately prior to the commencement of classes in the Freshman year. This invitation is the request to appear at the school and formally register. Now, some students may not get an invitation and then will have to travel to this school in Latin America to formally interview and petition for admission in the summer or September following graduation from undergraduate college in the U.S. or Canada. Some schools consider the Junior year interview to be merely an "introduction," i.e. the American and Canadian student is "introducing" himself or herself to the school officials with the formal application for acceptance occurring a year later. In any case, this third voyage to Latin America is necessary to ultimately start one's medical school career there.

And now...the battle begins! You have just been admitted to a medical school in Latin America! Theoretically there is no difference between an American or Canadian citizen attending a medical school in Latin America as opposed to those U.S. and Canadian citizens who attend medical school North of the Rio Grande (known as the Rio Bravo in Spanish). The curriculum in Latin American medical schools is the same as in U.S. and Canadian medical colleges. To be sure, the foreign student may be required to study in class and then sit for an exam in the political history of the host foreign country but these courses are only 2 to 4 weeks in length and the exam is a rather easy multiple choice test of 30 to 50 questions. Apart from this type of examination the first year of medical school will consist of the basic science courses of Anatomy, Biochemistry, Histology and Embryology - which is the standard fare of schools in the U.S. and Canada.

Walking onto the campus of a medical college in a Spanish-speaking foreign country can be unnerving or even downright frightening but after a few days that fear can be dispelled. The American or Canadian student needs to display diplomatic skills to not only get along with the professors but also his or her classmates. The diplomatic foreigner needs to think this thought from the get-go: "I am guest in this country and I must behave with sobriety and restraint." The foreign student should try his or her best be friendly but low-key, charming but not arrogant and humorous but not buffoonish. A sense of humor- especially a self-deprecating one - can work wonders to breaking the ice with Latin American class mates. Remember these students are usually 17 or 18 year old kids fresh out of high school (La Secondaria) and cannot relate well to their own older peers in their 20's. The 22 year old American or Canadian student should handle these 17 and 18 year old Latino kids with lots of friendliness, low-key behavior and restraint.

A harder task may be the getting-along with the medical college professors.They are as different as night and day. Some are pro-American while others are "Yankee Go Home" types. Whatever their prejudice for or against you maintaining a working and positive relationship with them requires daily diplomatic skill. If the professor wants to suspend the discussion of the anatomical description of the gall bladder to argue with the foreigner about "Yankee imperialism" then the foreigner should simply reemphasize that he or she has all the respect in the world for the professor's country, their people and customs and culture. Respect, courtesy and a self-deprecating joke can be very effective, i.e. "Yes, Senor professor...I'm a Yankee but I don't even know how to spell Yankee!" Hopefully, everybody in the classroom will laugh and the professor will get back to the gall-bladder. Many professors and students are often wary about the foreign student and his motovations and attitudes but breaking the ice with them in this way let's them know that you are just another student who only wants to be friendly and respectful. Fortunately these types of polarizing incidents are few and far in-between. Indeed many of these professors have visited the U.S. and Canada and may have even lived there for some years of their life.

An important investigation must be done before the first day of class. Check with the school officials to confirm that the school is duly registered and an active member of the World Health Organization (La Organizacion de La Salud Mundial). The WHO is an agency of the United Nationas and their active membership is required for the foreign medical student to make a successful re-entry into the U.S. and Canada to practice medicine.

If the school is not a WHO-member you can ask the office of student affairs to ask the Dean of the school to obtain membership with the WHO. You don't have to talk to the dean himself or herself - just ask the Student Affairs Office to do so. Each and every school in Latin America realizes that WHO-registration is important. Indeed, the only schools in Latin America that are not registered with the WHO are brand new schools who have not yet gotten around to actually registering with the WHO.

The raw mechanics of class lecture and home study are exactly the same as in undergraduate college or medical school in the U.S. and Canada. Evenso the keyword for the foreign student in Freshman class of medical school is...discipline. You fought your way into this school far away from home to study, learn and pass your exams- not to throw the whole thing away by partying and getting drunk in the town plaza. For the freshmen year severely restrict your social life to a Friday and Saturday night stroll and meal in the center-of-town plaza. Your time is going to be highly structured anyway.

Classes begin as early as 8 A.M. and may run to 5 P.M. You then can eat a meal on the road or go shopping for groceries- but then get home, eat dinner and start studying! Study from 7 or 8 right up until bedtime- around 11 or midnight. Oh you can watch TV, listen to the radio or listen to music tapes while you study. You can take a 5 minute break every hour. But apart from that- get studying! Your study is not simply designed to help you learn medical facts. On the contrary evey page that you study in your medical book strengthens your Spanish- more vocabulary and more knowledge about grammar, syntax and slang. Ineed words and grammar you learn in your medical study at night can be put to use on the street the next day. Remember as you study your 5 medical courses for Freshman year you also have an additional academic course that you are taking- and that is Spanish. After 2 or 3 months of this effort you'll be amazed at how skilled your handling of the Spanish language will become.

Just stick to the routine. Go to class, listen to lectures, attend laboratory sessions then get home and study. A good study routine is 3 to 5 hours every evening Monday through Thursday. On Friday nights go to town - you can even have a beer if you want! You can meet and gab with tourists. You can even sip a tequila or a mezcal (oof! that stuff is strong). You can go to a movie - alone or with friends. You can even go with a date (romance is an art we'll talk about later). All these things you can do. But get home and to bed by midnight. Saturday mornings - if there is no class - get up fairly early, say 8:30 or 9, take a bath or shower, go out on the street and shop for some groceries. Get back to your place by 11. Prepare breakfast or lunch, eat it and then....get to studying! Study the entire afternoon from about 1 P.M. to 6 P.M. - even 7 P.M. Then, for your own sanity, get out of the house and enjoy the Saturday night scene of your Latin American city or town. But again by midnight most smaller cities and towns in Latin America start "rolling up the sidewalks" and by 1 A.M. the cafes are ghost towns. Sunday morning engage in the same routine- get up by 9 A.M., do a little shopping if need be, clean up your place, wash your clothes, put your lecture notebooks in order, go visit a friend or 2 to gab for a few minutes. But by 1 P.M. be sitting at your desk or writing table and start studying! By 6 P.M. you can close the books. Now Sunday night is a little different. Your Latin American city has an active social life on Sunday evenings but you have an obligation to get home by 9 P.M. The next day is Monday and that is a school day. You can study an hour, watch a little TV but bedtime should be no later than midnight. You're going to need that 7 or 8 hours of sleep to start another long and tough week of class and study ahead.

With regard to auditing classes, i.e. sitting in on a professor's lecture for a day or two for your edification, may make some professors angry. They may think that you've registered for his class halfway through the semester. Always ask a professor if you could audit his lecture once or twice during the school year and get his or her permission first. Usually they will be quite flattered.

And now a word about insects. There are 4 insects in Latin America that are going to cause you trouble. They are mosquitoes, spiders, scorpions and that horrible little monster - the cockroach. If a Latin America mosquito bites you the odds of you getting malaria or even a form of West Nile virus are very, very low. However, the problem is that there are more mosquitoes in a warmer climate and they are very aggressive. By all means, invest $10 and buy a mosquito net that you can drape over a makeshift wooden frame over your bed. That way you can sleep peacefully at night while the mosquitoes dive bomb themselves into a polyester netting instead of onto your skin. Spiders in warmer climates are bigger than in colder climates and while most are not poisonous they can straddle down on the silk string and bite you! Usually mosquito netting and a quick check of your shoes and slippers will protect you from them. Scorpions are much more dangerous. They crawl into houses all the time and you must be vigilant. Sometimes they perch on walls and can get into your bed covers. Before going to bed at night or for a daytime nap, make a routine visual scan of your bed covers, shoes and slippers. If you encounter a scorpion - don't touch it! Although their bite usually won't kill a person it can make you sick enough to need to visit a doctor. To get rid of it use a whisk broom to brush it up into a plastic container, dump the critter outside and then crush it to Death with a few good whacks with a broom.

Cockroaches actually are the worst of all. While they won't kill you they are disgusting monsters that thrive in the heat. Although cockroaches are found in the U.S. and Canada - usually the so-called German cockroach - they thrive by the millions in warm climates. They are filthy little monsters that live in sewers and waste dumps. Therefore rules of cleaninliness and garbage disposal are crucial to keeping these little monsters to a minimum. First, never leave any food out - even crumbs - on the counters or cabinets or tables in your kitchen. Food should be sealed in plastic containers and glass jars. Indeed, the only time food should be out in the open exposed to the air is when you are eating. Since cockroaches hide behind the walls by day and sneak out by night to scavenge for food that food should be sealed and jarred tightly away. Insecticide sprays can be used to spray corners in the kitchen but they should be used sparingly so they don't make you sick. Besides insecticides can only control cockroach populations in a building- not completely erradicate them. Trying to kill a cockroach is hard - they are speedy little vermin that scuttle away really fast. If you can- whack them with a broom and then sweep their little carcasses outside. Cockroaches transmit disease - so that is another reason to wash your hands frequently.

Another insect that can be terrifying are termites. Termites can infiltrate a house by the thousands if they decide to establish a nest there. If termites invade your apartment ask your landlord to have the place fumigated while you are away at class one day. But the time you get home the apartment will have been aired out and safe to occupy. Make sure all food is sealed, jarred amd safely put away from the insecticide fumes.

Many American and Canadian student have reported that they have very little trouble with their indigenous classmates and acquaintances. But there can be enormous trouble with other American and Canadian classmates! For starters it is unlikely that a typical American or Canadian medical student will be the only foreign student in the medical college. The odds are good that there will anywhere from 5 to 30 other foreign students there. Although most will be Americans there may be 2 ort 3 Canadian, 2 or 3 Haitains (they speak French) and 2 or 3 students from other Latin American countries.

By far the biggest problem that an American and Canadian student can encounter at school are Americans who abuse alcohol and drugs. These Americans may be tourists that the student has befriended or fellow classmates. In any case getting mixed up with heavy drinking and pot-smoking Americans - whether they are tourists or classmates - is a recipe for personal disaster. There are so many things that could go wrong! What if they (these Americans) invite you into a hotel room to smoke a joint? What if you go to a party and the designated driver is roaring drunk? What if some American dunderhead puts marijuana in chocolate brownies and forgets to tell you about it? What if some tourists offers to pay you to be a courier for drugs? Holy Jesus Christ! Use some common sense, will you? - and get the Hell away from such people - even if they are classmates. Remember there is no such thing as a "Community of American Students" in your school. These people are all strangers to you and who will never see you again once you graduate. Don't let them ruin your life like the American student who went with friends to smoke pot in a hotel room only to get arrested, jailed and deported. Don't let them tragically injure you like the American student who at a party ate, unawares, a chocolate brownie containing marijuana and wound up in the hospital later that night suffering from an overdose. Don't let them borrow your books and then never return them. Don't let them borrow money and then never pay you back. Don't let them pretend to be your friends only to stab you in the back worse than your worst enemies. Who the Hell are they? You wouldn't trust them in Dayton, why should you trust them in Oaxaca, Mexico?

The first year of medical school in Latin America may present 2 other problems of a social nature. First is crowds. If you attend a soccer game, a social event, a religious festival or some other type of gathering people in Latin America tend to form a crowd. Sometimes that crowd can get so big they you may become terrified. I mean there can be a thousand people packed together warm body to warm body, arm to arm, hip to hip. If you get caught up in a crowd like that the thought "What if there's a panic?" can really unnerve you. The best answer is to avoid crowds whenever you can. So, instead of attending a soccer game - watch it on TV and instead of attending a concert - listen to it at home on the radio.

The other social problem the Freshman foreign student will encounter in his or her first year of school are political rallies. Latin American students are much more political and radical than American and Canadian students. While the days of the Vietnam Era student radicals in the States and Canada are long gone, the radicalization of young people in Latin American universities is a long standing and permanent phenomenon - even a tradition. Whether they are protesting Yankee Imperialism, a corrupt university chancellor, the State Governor, the sagging economy or tourists who litter the streets - your best and only course of action is to....stay away from it! Again you are a guest in that country and their internal affairs are none of your business. If native students want you to join a political group - politely refuse. Tell them you have their moral support but you feel an equally moral obligation to not interfere in their country's internal affairs. Usually the radicals at any university will leave the foreign students alone so long as that foreign student does not actively oppose their political demonstrations.

When the first year of medical school in Latin America ends the foreign student should do the reverse of his or her undergraduate college days. Instead of going to Latin America for the summer the foreign student should return home to the U.S. or Canada for the summer vacation of 3 months.

Living in Latin America can be emotionally distressing at times and one needs a break to get back to "normalcy," i.e. going back to live with one's parents or renting an apartment back in the U.S. or Canada and getting a summer job to pay the rent for it. That first summer back you can keep up with your Spanish by purchasing a cheap Spanish-language learning CD and by deliberately looking for people who speak Spanish and conversing with them. And like students in U.S. and Canadian medical schools the student can always study a little bit of the sophomore courses that will be presented in Latin American schools. The 2nd year courses in Latin American medical schools are just the same ones offered in U.S. and Canadian medical schools. So you can get a head-start by reading books and learning CD's on Psychiatry, Pathology, Immunology, Gastro-intestinal medicine, Obstetrics & Gynecology and so on. It is at this time that some English-speaking students may have become so confident with their Spanish that they start buying their medical books in English because they know they can easily translate the data in their heads into Spanish during classroom recitations or on written examinations.

You can certainly take those English-language medical books into the country with you to your apartment or home in Latin America to study in the privacy of your place at night but try to refrain from taking such books into class with you. Some professors are insulted that a studenty brings books in English into class when the obvious official language of the university is Spanish.

As for luggage on your trips to and from Latin America- you can save a lot of weight by simply buying your school and leisure clothes in your Latin American city. Latin American cities are not "jungles"- they are cities with all the stores and brand names that one can find in the U.S. and Canada. You can buy anything- jeans, slacks, shoes, shirts, T-shirts, sweaters, coats and caps. And often-times these clothes are cheaper than those sold in your home town. You can then travel up and down during vacations with just a shoulder strap bag. Believe the ticket vendors at airports and bus depots and train stations will compliment you on being so smart!

Your sophomore year at medical school in Latin America will find you more poised and confident tha ever before. You may even begin to "feel at home" in your chosen Latin American city- but the American and Canadian medical school student must maintain his or her vigilance and strictly adhere to those rules of hard discipline that we've discussed. Again you are living and studying in Latin America to get ahead and reach the goals that this long and difficult path is leading you to. Don't screw it up! If you see Americans - whether tourist or classmate - using drugs or getting too drunk - get away from them! If there is any political turmoil - get away from it.

By the 2nd year of medical school the American and Canadian student may have established cordial friendships with numerous Latin American students. This is a wonderful thing but always maintain a respectful and low-key attitude with them. If the Latin American students want to go out and get roaring drunk at a cafe or at a party in someone's house- steer away from it the same way you would as with Americans. If a Latin American student invites you to a party at his or her parents home - go ahead and enjoy yourself - but always comport yourself as a respectful and good-behaved guest in their house just as you do in their country in general. During one's first year in this Latin American setting most American and Canadian medical students tend to stay in the city or town of their residence out of fear of the unknown. By the 2nd year foreign students may want to go out into countryside and visit a little rural village. However, this desire is potentially dangerous because many rural villages in Latin America do not like strangers there- especially Gringos. Indeed numerous villagers carry guns - as though it were the Old West - and they may be drunk and armed at the same time. There are certain designated tourists areas - controlled and regulated by the government - where tourists can go to visit. If you want to spend a weekend going to a famous rural setting you can do it that way. Otherwise- stay in the city!

Some universities which have medical colleges may try to recruit Americans and Canadians to their sports teams. This invitation is very flattering but collegiate sports in Latin America are just as stressful and time-consuming as in the U.S. and Canada. You are there to be a full-time student so it's best to restrict your athletics to an occasional game of pick-up basketball, touch football, softball or soccer with your classmates or other acquaintances.

With the establishment of friendships with Latin students there always exists on the horizon the possibility of romance. Quite a few American and Canadian male students return to the U.S. or Canada with Latin American girlfriends - and even wives. But some American and Canadians - both men and women - have bad experiences with members of the opposite sex. Indeed, the risks and rewards of romance in Latin America are exactly the same as in the States or the Dominion. Don't be afraid of a budding romance but be just as cautious and prudent about it as you would back home. One thing for sure, though, if you're a guy please do not engage in any careless or promiscous sexual behavior with either the native women or tourists. It almost always leads to trouble- you might get the clap or you might be running from a shotgun wedding! If you're a girl use common sense to avoid getting VD or suffering through an unwanted pregnancy. Abstinence, in this setting, is smart and just about the only sensible thing to do. One night stands are extremely dangerous and should be avoided. And you can get AIDS just as easily in Latin America as in your home town!

By the Junior year of medical school in "your" Latin American country you may feel that you just "own" the whole country by now. Indeed, the routine should be "old hat" for you. But the same necessary routine and discipline apply and the 2 cardinal rules, therefore are the same- 1) You are in Latin America to study, and 2) It is your desperate need to avoid trouble. Now you may get a traffic ticket driving a car downtown in Latin America but as long as you don't get arrested for drugs (which means certain deportation) or get locked up for public drunkeness you'll be alright. Don't get into fist-fights or shoplift or engage in public disorderly conduct, shouting-matches and other misdemeanors (even if your Latin girlfriend is walking around with a new boyfriend right in front of you... just get another one and cry on her shoulder about the one that got away). If you're stupid enough to commit a felony, i.e. carjacking, breaking & entering, selling drugs or burglary - then you shouldn't have been in Latin America in the first place.

Traffic in big Latin American cities (i.e. Mexico City, Caracas, Buenos Aires) can be mortally dangerous. Drivers in Latin America drive too fast, run red lights all the time and yield to practically nothing and no one. You must be super vigilant when walking the streets, crossing the streets and walking near traffic. As a pedestrian always yield to a motorist even when you have the right of way. Wait until the street is clear before crossing it. A green light is simply permission for you the pedestrian to attempt to cross the street. Watch oncoming vehicles like a hawk- are they going to stop or aren't they? Be alert for cars turning the corner as you step in the street- many of them don't stop and will run you over rather than stop. In smaller cities and towns the traffic may saner but extreme vigilance is required at all times. If you drive a motor vehicle you will have to contend with "crazy drivers" most of the time. You need to "drive defenseively" and have an eye in the back-of-your-head at all times.

A new problem - in Mexico at least - are the Drug Gangs. The problem is endemic in Mexico and the foreign medical student should probably have enough savvy to know where and where not to go in a Mexican city depending on the time of day and what the local news reports have to say about personal safety in these matters. In all Latin American countries there are drug dealers, criminals and mafia-types as well as potentially hostile student radicals. Your job is to stay safe and keep out of the limelight. Don't flash any money around (after your parents have sent you your monthly allowance) and only go to areas known safe to you, i.e. the market place, the cafes downtown, the library, etc. Just employ the same common-sense safety rules in your Latin American city that you would use at home. As for traveling in Mexico a foreign student might want to do it for a week or 2 in the summer time but during the school year it is best to stick to your routine in the city of your school- attending class, studying at home or at school, shopping, laundry and modest entertainment. You will have plenty of time for traveling after you finish school.

Your Junior year will include such courses as Respiratory Systems, Muscle-Skeleton Systems, Cell Physiology, Metabolic Physiology and the like but the routine is the same. Study, study, study and keep your nose clean. The foreign student may find some subtle changes in his or her Latin American classmates- they're getting older reaching 19, 20 and 21 years of age. As such, these students are getting more mature and may have stopped acting like the little Spanish-speaking twerps that reminded you of the English-speaking 17 and 18 year old twerps that you knew back home in high school. Indeed it might even be possible to enjoin with them in serious political, social and economic discussions - if that's your interest. Nevertheless always behave in a low-key, mellow style showing them nothing but courtesy, respect and amity. You can even play cards, i.e. poker, hearts, blacjkack with your classmates- but try to avoid gambling for money unless the stakes are only a few centavos, i.e. nickles and dimes. If you win more than $5 use the money to buy them snacks and then quit the game.

Most Latin American medical schools are 5-year program s which means your 4th year of medical college does not lead to graduation. Your 5th year at the school is your "Senior" year. For the last 2 years of school consider yourself to be a soldier in a war that is finally going to end soon. Lose yourself in the details of your safe and sensible daily routine. Study, study, and study some more. Take your mid-terms and finals. Maintain your diplomacy with any all indigenous people you cross paths with. On the bus be courteous to people as you board or deboard- remember Latin American buses can get super-crowded and you may want to blow your top. If you do some Latin American fellow will angrily wiggle his finger at you - it's bad etiquette to lose your temper on the bus just because it's overcrowded. You can talk to tourists- many of them are very nice people - but an equal number of them are crazy and dangerous. By this time you should also know which of your American classmates are safe to socialize with and those whom you should avoid like the plague. Remember, these Americans are only classmates- they may not be your friends. At graduation they will leave and be gone. Don't let them hurt you in any way!

The fifth year of school in your Latin American city is your "Senior Year." For students in any country - whether it is high school or undergraduate college or professional school - the Senior Year is a time of joy and great expectations. Your school may hold a Senior Prom - go to it! There may parties given by your friends and their parents and family members - go to them! Your friends may host picnics and barbecues- go to them! Your academic studies should, of course, be your first priority - so study, study and study some more but in your free time enjoy the social amenities that the Senior Year stimulates in the student body. Courses in the 5th year include-Hepatobiliary Systems, Urinary Systems, Epidemiology, Public Medicine, etc. By this time many English-speaking students will find that they can translate the professor's lecture in their heads from Spanish directly into English as they're taking notes. Doing so will fill you with a sense of pride as you will then know you are the master of 2 languages. Spanish-speaking people on the street and on the telephone will compliment you on your Spanish skills - again another event that will give your great pride. After 5 years together most of your Latin American classmates will consider you to be just one of the gang- a regular guy or a regular gal. It is a very nice feeling and will give you pleasant memories for years to come. At graduation time you can simply pick up your diploma from the student office- the secretary there may even give you a hearty handshake. But if you like you can and even should attend the graduation ceremonies wearing graduation cap and gown - yes in Latin America graduating students wear the traditional cap and gown. Nor will this be a permanent goodbye to many of the people you've met and now hold friendships with. Some of your Latin American classmates have relatives in the U.S. and Canada, some may have even lived in the States of the Dominion, some may even speak fluent English having grown up in cities North of the Rio Grande. Some of them will even encounter you in the United States and Canada because they may want to practice medicine up North.

After graduation most if not all American and Canadian medical school graduates make a beeline back home to the U.S. and Canada. There are many reasons why they do this- returning to care for elderly parents, getting a job back home, bringing their spouse and children to the U.S. and Canada to apply for citizenship. But the principal reason to return North is to prepare for the last and biggest ordeal of this Latin American adventure- the so-called re-entry process, i.e. the process of licensing to practice medicine in the U.S. and Canada. The re-entry process involves 4 steps and it is, again, a long and arduous ordeal which, unfortunately, many medical school graduates fail to ultimately accomplish. Here are the 4 steps: 1) the USMLE Basic Science examination, 2) the USMLE Clinical Science examination, 3) residency training, and 4) the FLEX Licensing examination. The USMLE examinations are sponsored by the Educational Council for Foreign Medical Graduates (ECFMG) and are taken by "foreign" medical students - including Americans and Canadians. The word used is "foreign" because it refers to a non-U.S. and non-Canadian medical school as a "foreign" college and does not refer to the citizenship of the students who take the exam. The USMLE Basic Science test involves 300 questions on the so-called "basic sciences" like Anatomy, Biochemistry, Physiology and Embryology. The USMLE Clinical Science test involves the so more - clinical sciences like Cardio-Vascular, Gastro-Intestinal and Obstetrical-Gynecological systems. It too has 300 questions.

These exams are very hard and require hard study. For that reason students should enroll in a medical exam prep-school, i.e. Stanley Kaplan or Harvard Prep Exams (this prep school has nothing to do with Harvard University). These prep programs, while costly, i.e. hundreds of dollars per program, help the student to figure what is going to be on the exam and provide low-cost study books that are geared to the exam. Such prep-school study books are much more focused on the examination questions than one's medical school text books. Re-reading one's medical school text books is too time-consuming and requires the absorption of too much data for this type of exam. If the student wishes to supplement his prep school study books then he or she can get ahold of the Merck Manual and the Professional Guide of Diseases (published by Donna Carpenter and a really good study book!).

After passing the medical boards - and many students fail several times before passing with a minimum passing grade of 75 (so don't get discouraged!) - the student will then become a resident at a hospital before sitting for the so-called FLEX test, i.e. the Federal Licensing Exam. While outside the scope of this Hub Page it is, again, important to note that these exams are difficult and require much study. At least the student no longer has to spend the whole day - day after day and week after week and month after month - in class and laboratory. However, many foreign medical school graduates are near 30 years of age - some are considerably older - and most are now married with children. They have economic problems to contend with, i.e. the need to get a day job (which is getting harder and harder to do as the world economy continues to struggle), they have to spend quality time with spouse and children, they must take care of aging and maybe even ailing parents. It's a tough road even though the student is back in his home country but people like them- and you- who are tough enough, daring enough and resourceful enough -can overcome any problem, challenge, barrier and crisis. Life may very well be like an Indiana Jones adventure and each and every one of you should just pull out your whip, grin and go for it! I think I'm right in that regard, don't you? As Indiana Jones said, in the smoky bar in Nepal, grinning to Marian.... "Trust me!"


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    • pacificnurse profile image

      pacificnurse 6 years ago

      I felt like I was reading a book instead of a hub. A lot of great info.

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      francis5k 4 years ago from New York, New York

      interesting article... yeah good information!

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      CYBERLITO 3 years ago



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