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.