Mexico Medical Student: An American Gets an Education South of the Border

Nicholas Genes, MD, PhD

Disclosures

August 02, 2006

"Enrico" is a US citizen who just started his second year at Universidad Autonoma de Guadalajara (UAG) School of Medicine. He freely describes his life and studies at the Mexican medical school on his Web log, "Mexico Medical Student." His stories provide a frank and decidedly unique perspective on the foreign medical school experience. Recently, Enrico discussed the developments in his life that led him to Mexico and what he found when he got there.

Dr. Genes: How does a Mexican medical school differ from the US model?

MMS: Well, since I have not attended a US school personally, I'm going by what I know through my cousin (who graduated a year ago) and other friends from whom I got a good idea. Mainly, the biggest difference is the student population: The United States weeds out students before they get in the door, and attrition/failure is very low. By contrast, the flimsy requirements of many international schools, such as mine, allow entry of people who either shouldn't be here or who haven't quite "gotten it" yet about what needs to change for them to do well. As such, you have [a student body] that ranges from brilliant, acing everything, to good, hard-working (by far the majority), to those that seem destined to not make it. There aren't any quotas for passing/failing, but the M.O. is that you are thrown into the deep end, and you have to sink or swim primarily of your own merit; there are no retention/tutoring/special programs to help, and most of the faculty teach their own notes with little correlation of what's "on par" with an LCME-accredited school -- you make up that difference yourself.

It's also impossible to separate culture from where you go to school in a foreign country, and unless you are familiar with the Mexican culture (I was raised on the border, and even I had quite a bit of adjustment), it can be daunting. I know people who left here, not because they couldn't hack the academics, but because they refused to assimilate and go with the flow. (You aren't going to change an institution as a whiny foreigner.) There is a strong patriarchal "What I know is right and to hell with what the American journals say" kind of attitude at times, but thankfully, one sees that more in the older physicians who will hopefully retire soon and stop endangering patients.

Also, it's not that hard to be a doctor here -- just keep going to school, pass, and take a not-that-difficult test when you're done. That's it; you're set for as long as you like. Residency here is famously hard to get into, and most doctors just stay with their GP status, even though they'll advertise treating everything under the sun. Personally, I'm always wary of who I see as a physician here, because I know that Dr. So-and-so could have done only the 4 years of school (plus internship and social service), or they could have done a residency/fellowship, etc. Believe me, I run for the hills if I see the former, especially when it's been years since they've opened a book or read a journal. This doesn't describe most general doctors who try to at least stay somewhat current on recent findings, but there is very little oversight to help find out who isn't that way or to what degree.

Enrico at Mexico Medical Student hosts Grand Rounds
August 8, 2006

Dr. Genes: For someone who has bared a lot on his blog (especially in regard to your family, your new child, and feelings about school), you've been quiet about your background and how it is that you got into medicine and UAG, in particular.

MMS: I was born and raised in the Rio Grande Valley in South Texas. I went to the University of Houston, where I stayed many years until moving away, but then I returned as a full-time employee in their IT Web Services department in 2002 until I left for medical school. I'm in my 30s, so I'm definitely a nontraditional student going to a nontraditional school.

My undergrad and graduate studies were in biochemistry and biophysics. I did research in homology/molecular modeling and bioinformatics.

As I stated in my blog bio, I was burned out of school. Quite simply, my undergrad GPA sucked (less than 2.6) and shut me out of US med schools. I never thought I'd go to med school, and I took a typical noncompetitive/grad student approach to my classes, with my own dash of slackerdom thrown in. I took a year of additional undergrad coursework, trying to raise my undergrad GPA, but even admissions directors told me that short of getting a new degree, there's not much I could do in the way of taking individual courses to convince them I was worthy of serious consideration; in their view, it was my lack of "stick-to-it-iveness" that was my biggest downfall.

My MCAT was in the 30s, so that wasn't the problem, even as per the committees. Even looking at my transcript and coursework would show not a marginal student but an inconsistent one, getting As, Cs, and drops in the same semester. They never regarded me as someone who wasn't capable, just someone who, statistically, screamed "high risk." Whatever. I'm done crying over spilt milk, and to be fair, it's not like I have a better solution to the smart-student-but-irreconcilably-blemished-on-paper applicant problem. Admissions people gotta do what they gotta do; I did what I had to do -- go to medical school elsewhere.

Dr. Genes: Do you feel (or do you anticipate) prejudice from med students and doctors in the United States?

MMS: I am not worried about prejudice, honestly. I have heard from enough residents and attendings that by the time one gets into one's residency, one is judged by how well he or she performs, interacts with the team, etc, not by which school is embossed on the degree. I might have a slight advantage being a Latino -- being in Mexico for school wouldn't be such a stretch for a stranger to consider -- but people with obvious Caucasian backgrounds might have it a bit rougher since that tends to more obviously clash and beg the question "Why?"

In the end, "Why Mexico?" is irrelevant once you're in residency, I think, and any resident or higher having gone through medical school and met enough people from other medical schools will realize that it's all just different flavors of the same thing, would take it in stride. The potential to be more hands-on is definitely greater here, and that can be an advantage once we're stateside. If nothing else, being a truly bilingual physician -- reading and writing English and Spanish fluently -- is a tremendous asset in and of itself. I fully expect to leverage this with the Spanish-speaking community when I return.

Dr. Genes: Early on, you wrote about your plans for the blog: "It was never my intent to start a medical school blog, but it would be nearly impossible to not have that be at the forefront since that's what my life will be consumed by. Add that to the fact that I'm in a foreign country and, well, I'd be crazy not to let the content just write itself." Has it been as easy to write about this stuff as you expected?

MMS: No, in fact! Obviously, time is a factor -- more so than I would have thought. The biggest problem (which actually reinforces the time issue) is that it can take me a long time to write a post; I want it to be as close to what I'm thinking as possible. There are so many gifted writers and bloggers out there, and I did feel a sense of inferiority... in an area in which I was newbie first-year medical student who could never hope to match the clinical tales of a resident or beyond... I wrote a post about medical blogs and where I feel I do/don't fit in.

Dr. Genes: Enrico has come a long way, both in his life and with his med student blog. This week, he hosts Grand Rounds, the weekly collection of the best in online medical writing. (The link to Grand Rounds goes "live" on August 8, 2006). Check it out, and be sure to read more about this remarkable man's unique perspective on medicine.

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