An American Studying Medicine in Cuba takes the US Medical Licensing Exam

Graham Sowa

HAVANA TIMES — Last week I completed Step 1 of the United States Medical Licensing Exam (USMLE).  Studying for this exam the past two months explains my literary absence from this collective blog of open-minded writing from Cuba.

Even though the USMLE is a requirement for all medical students who want to be doctors in the United States of America I felt even more pressure to perform because I am also representing the Cuban medical education system.

The exam covers content from the first two years of medical education.  Even a highly distilled set of notes covers hundreds of pages of dense content.  Excelling at the exam takes a harrowing dedication to sitting in one spot for many hours every day and trying to learn the basics of the last 400 years or so of accumulated medical knowledge.

A good score is necessary to practice medicine in the United States and even more mission critical if one is trying to compete for a coveted medical residency in specialties such as surgery or dermatology.

But I am not trying to enter into a competitive residency, nor am I particularly excited about yet another future-determining multiple guess exam.  For me the drive to excel at the USMLE is to show people that medical education in Cuba is up to snuff.  But even that goal is fraught with the pitfalls of closed mindedness from both sides of the political spectrum.

I know many sets of eyes are on medical students who study in Cuba.  There is already a predisposition for many United States trained doctors to think a little less of their foreign trained companions.

Imagine how this could be complicated by somebody who was ideologically or practically opposed to Revolutionary Cuba.  Any failure on my part could easily be projected onto the Revolution as a whole.  Perhaps this is why even small failures in Cuba are not likely to be officially recognized.  (But then something must be said about maintaining silence for reasons of fear.)

Most people who follow Cuban news and events can almost predict how the supporters and detractors of the Revolution will react.  An easy example involving the Cuban medical system is the cholera outbreak in the country.

Of course the lack of official government information and need to generate headlines led people to start publishing “unverified” reports from numerous sources.  And the opinions that surrounded these reports were, for the most part, of two types:  1) Cholera is an example of Socialist and Cuba medical failure and 2) The quick response to the cholera outbreak by the Cuban government is an example of Socialist and Cuban success.

And that is basically how I feel my performance on my exam will be measured by those who do not know me personally.  If I have failed this exam (I will know the results in 3 weeks) I could easily be used as an example of another failure of the Revolution.

If I pass the exam the apologists of the Cuban Revolution could easily give all the credit of my success to the Cuban education system, even though I invested considerable time apart from my studies in Cuba to prepare for the USMLE.

So that is my preoccupation as I await the results of the exam.  I don’t want to be used as another example to fuel two extreme sides of a debate that are rarely rational or productive in coming up with solutions.

Studying medicine in Cuba means spending the rest of our lives in this situation:  we must constantly be weary of those who will use us as examples of a failure or success that is not wholly our own.

I am not trying to argue here that exams such as the USMLE are not good measures of knowledge or standards to hold our future professionals to.  But these exams are meant for comparing students to national standards.

I would rather judge the school overall by this criterion: prospective doctors enter medical school with drive and ambition, the medical school is doing well if it doesn’t destroy all of that in four years.



Graham Sowa: I've been living in Cuba for three years now. I would like to blame my obvious hair loss seen in this updated photo on the rigors of life here and medical school, but it is probably just genetic. I've made some of the strongest friendships during my time in Cuba from other writers on this website. The strength of those friendships has almost restored my faith that the online world can lead to offline and real life change. On that same note I've adjusted to using internet one or two hours a month. In the meantime I have rediscovered things like flipping through the pages of books, writing stuff down by hand, and having to admit that I don't know something instead of rapidly looking up the answer on Google while the teacher isn't looking.

10 thoughts on “An American Studying Medicine in Cuba takes the US Medical Licensing Exam

  • I am an american student studying medicine in cuba, and i want to write the USMLE exam.

    Can I take step 1 at the end of my 2nd year ? Step 2 at the end of 4th year etc, Or do i have to wait to graduate to begin taking the USMLE exams?

  • Hi graham. I also am a medical graduate of elam. I am about to take the step 1 exams but need certification of the 135 form. Can you advise me how I should go about it? I was told I need to go to a consultation juridical Internacional first. If soo which did u use.?

  • I am happy for you. My daughter will be graduating from University of Alabama, Birmingham in April. I trying to convince her to apply to the program in Cuba. Good luck to you in the future Dr. Sowa. From Dr. Kerry Collins

  • Hello everyone. I got my exam results today and I just want to let everyone know I passed. I did not get a great score, but it was only a little bellow my goal and I’m very happy to be done with this part of the process. Of everyone who took the exam about 45% scored worse than me and 55% scored better than me.

  • Graham – Doing a little e-mail time !!
    Trust all is well in your world.
    My health ( heart problems ) just prior to trip to Cuba, is doing quite well.
    Don’t know if you are up to speed on some of my views of Cuba.
    We had a really good time being tourists.
    Saw and learned a little of the lifestyle. Well worth the time and money.
    Got my boat ride across the harbor. Cheryl also took some prohibited pictures and I could not see anything there to help over throw government. :-))
    Good Luck and please keep in touch

  • It’s shocking to learn, Okasis, that there is a shortage of doctors and medical facilities in Hawaii. I spent a year there at the submarine base at Pearl Harbor, and have always thought that doctors and other medical personnel would flock to your beautiful islands.

    It is my understanding that Hawaii is close to getting single-payer healthcare. Is this not true?

  • I offer you Best Wishes and sincere congratulations. I envy you the opportunities, but at 75, I’m a bit older than the students they need. I know you will make the grade by the way, anyone who leaps as many hurdles as are required of an US Citizen who wants to study in any 6 year bi-lingual program, much less one in Cuba, obviously has the tenacity to pass the test.

    A Graduate from the University of Hawaii at Manoa [Honolulu] is attending the Cuban Medical University. I’d imagine it’s been about 4 yours since she entered. She was originally from Dallas.

    After my first trip to Cuba in 2008, I tried to interest the local politicians in providing information about this program, as we have a large number of low-income students who cannot afford to continue their education. Except for one Professor at the Hilo CC, the silence was deafening.

    We are a rural Island, with many similarities to Cuba, both in climate and diversity of cultures. The shortage of Doctors and Medical Facilities, is chronic and worsening. Yet the assumption that a good education in Cuba is somehow tainted because it does not come with a $200,000 Student Loan is endemic. The additional benefits of a cross cultural education and bi-lingual studies is unique, as is the emphasis on Community Service in rural and poor communities. It’s unfortunate people who could actually do something lack the imagination or interest to pursue the opportunity. Instead, they apply for grants to various NGOs for short-term programs, which seldom bear fruit.

    As an aside, I have met the same resistance from the local Agricultural School Professors, who travel the world studying tropical agriculture diversity, organics, and sustainability. They write articles from Haiti, the Dominican Republic, and Brazil. At the same time I t get no reply when I inquire if they have looked into Cuba’s experiences with Organic, Urban, and non-Industrial Agriculture since the demise of the USSR.

    It’s crazy. How can supposedly educated people be so close-minded about things of which they know nothing? Growing Bananas should not be a Political Action!

  • Good luck Graham. We all know how good is our education…!

  • Being from your area of Texas originally, and also being an ardent supporter of US single-payer healthcare, i follow your posts with great interest. Best wishes.

    Do you pronounce USMLE as U-SMiLE? Probably not! Cheers.


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