A post promoting the Trinity School of Medicine just appeared on the KevinMD blog. It was entitled "Addressing the 'ugly truth' about Caribbean medical schools: Why they’re not all the same." Its purpose seemed to be to persuade the reader in particular that the Trinity School of Medicine, (located conveniently in St Vincent and the Grenadines, "high on a hillside in the Ratho Mill district of Kingstown, the capital of St. Vincent and the Grenadines," conveniently near the Young Island Resort and "Living the Dream" sailboat cruises, per Google) is not the same as, and in fact is superior to other offshore medical schools.
In particular, Stacy Meyer, Vice President for Enrollment, asserted that the school would address the problem of huge attrition rates at offshore schools by embracing "a principle of mutual support," seek out faculty who would actually spend time with students, and would actually have "office hours," and provide tutoring and an "Academic Progress Committee." She promised to provide good housing with "privacy, a full kitchen, air conditioning and high speed internet." She stated that the school would deal with the stress of medical training by providing "on-campus access to professional help and a culture of openness." She concluded with "better support, better quality of life for the students? It will only mean better doctors."
It sounds nice, but her post was remarkable for what it left out. Does that extras "support" translate into an attrition rate lower that other comparable schools? Is there any data that the doctors produced are "better?" What about the school's curriculum, the quality of its faculty, and the accountability of its leadership?
In fact, review of the school's website provides little hard information. While the school aims to attract US and Canadian students, I could not find a single member of its regular faculty who has a medical degree from a US or Canadian school. Its faculty is tiny, 22 regular faculty members plus 3 deans and a chancellor, much smaller than the faculty of a conventional US or Canadian school. Information about its curriculum is fragmentary. The school claims an 85% match rate, but provides no information about attrition, and hence the denominator for that rate.
What Is Trinity School of Medicine? Who Runs It? Who Benefits From It?
Even more curious, I could find very little information, and that which I found was rather contradictory, about who actually is accountable for the operations of Trinith School of Medicine, and who, if anyone, owns it.
The school's website, including its "about" page, say nothing about the nature of its organization, basically whether it is a for-profit company, or not for profit organization. Wikipedia simply says the school is "private." Although the school is located in St Vincent and the Grenadines, its website lists its address as 925 Woodstock Road, Suite 200, Roswell, GA 30075. On the other hand, the Manta database says the school is located in Alpharetta, GA, and is a "single location business" with 10 employees.
The school's website"administration" page has a headline next to a picture of Steven R Wilson stating he is "CEO and President." However, accompanying text states that he is the president and CEO of "Trinity LLC." I can find no further explanation on the website of "Trinity LLC." (Note that the website has no search function.)
There is a Hoover's profile on a Trinity LLC located in Atlanta GA, listed as a private company, but it appears to be a "site preparation contractor."
Mr Wilson apparently is a businessman who
served as President and CEO of several highly regarded institutions over the past 22 years. Prior to Trinity School of Medicine, Mr. Wilson was President of TSYS Loyalty, Inc., a wholly owned subsidiary of TSYS, TSS on the NY stock exchange from 2003 until 2006 when he left to pursue the start-up of Trinity School of Medicine. Prior to TSYS, Mr. Wilson was President and CEO of Enhancement Services Corporation from 1998 to 2003, an institution that provided loyalty transaction processing and fulfillment services to the world's largest financial institutions. Mr. Wilson was also the President and CEO of Business Travel, Inc. from 1986 to 1997.
Although his background seems to have no relevance to biomedical science, medicine, or health care, his official profile states
Mr. Wilson's background and experience are a vital element in Trinity's success as it endeavors to become one of the finest Caribbean medical schools available to students from North America and around the globe.
The Trinity website includes a listing of the members of its "board of trustees." Non-profit institutions generally have boards of trustees whose role is be stewards of the organizations. However, Trinity appears to be a privately held business. Such businesses may have "boards of directors," but the power of such boards in closely held private businesses may be negligible.
The website does not explain the actual relationship of the "board of trustees" to the school. The board has only four members, one of whom is a physician, and three of whom are business people. There qualifications to be stewards of a medical school, if that in fact is their role, are not evident.
So what exactly is the Trinity School of Medicine? Who is accountable for how it operates? Who, if anyone,exterts stewardship over it? Who benefits from its operation? Given its opacities, is it a shell company? These are all mysteries.
We need Sherlock Holmes.
Why Should We Care?
As we have said a few times before, most recently here, this is not just about the leadership, governance and ownership of the Trinity School of Medicine. It is about off-shore medical schools, and ultimately about the leadership and governance of health care in the US.
As we most recently noted here,
Admission to US medical schools is increasingly difficult. So many who seek medical careers may be tempted to apply to schools outside the US. In the last 30 years, American entrepreneurs have opened offshore medical schools, mostly in the Caribbean, that cater to US students. They teach in English, and do not require immersion in an unfamiliar culture, so may be more attractive than medical schools in other countries whose mission is to educate physicians to practice in those countries. In 2010, Eckhert documented that the number of offshore medical schools, "for-profit institutions whose purpose is to train U.S. and Canadian students who intend to return home to practice," but not to train physicians to practice in the countries in which these schools are located, was rapidly growing.(1) By 2010, there were 33 such schools, 20 of which were new since 2000.
Such offshore medical schools exist in a grey area. The small countries or colonies in which they are located usually do not seek to regulate them, since the physicians they produce are going to practice elsewhere. There is no requirement that these offshore medical schools be accredited in the US. Such accreditation is currently not required for individual graduates of such schools to be admitted to US house-staff programs or for US licensure. So perhaps it is not surprising that little is known about these schools.
How they choose students, the qualifications or even names of their faculty, their curriculum, how they supervise clinical training (which is mostly done by affiliated North American hospitals), and what happens to their graduates are obscure. Eckhert attempted to describe what is known, but noted "variability exists in the availability of information on faculty; where data exists, it is noted that most of the permanent on-site basic science faculty are internationally trained, many have no documented medical education experience in the United States, and it is not uncommon for them to be OMS [offshore medical school] alumni."
As we also noted, most recently here,
Even less is known about who leads these schools, who if anyone is responsible for their stewardship, and even who owns them.
For comparison, most US schools provide extensive information about their leadership. Just as an example, see the introductory page on the Dean of the University Washington medical school.
Many US medical schools have their own boards of trustees who are supposed to provide stewardship. For example, the UW board is here. Their membership is generally known. Furthermore, most US medical schools report to university leadership, again whose identity is known, and are subject to governance by a university board of trustees. We have certainly criticized the leadership and governance of US academic medicine. At least, however, it is possible to find out the names of the people responsible.
While Eckhert wrote in 2010 that the increasing presence of offshore medical graduates in the US "obligates U.S. medicine to take a closer look at these educational programs," no such scrutiny has occurred since then. While offshore medical schools account for the training of an increasing proportion of US (and presumably Canadian) physicians, we know next to nothing about their leadership and governance. This seems to be just another part of the decreasing accountability of the leadership of US health care, and the increasing opacity of the governance and stewardship of US health care organizations. True US health care reform would make leadership transparent and accountable.
This case also illustrates why we must reexamine our fascination for "market based" approaches to health care, when almost nothing about any part of health care resembles, or could resemble a free market (see this post). We need to make health care more transparent, and shine more sunshine on the nooks and crannies, like off-shore but US corporate owned medical schools.
Finally, as an aside, in this day and age, the possibility that Trinity School of Medicine is actually owned by an anonymous LLC is particularly alarming. Such anonymous shell companies have been implicated in global corruption. Transparency International says this about shell companies
A shell company or corporation is a limited liability entity having no physical presence in their jurisdiction, no employees and no commercial activity. It is usually formed in a tax haven or secrecy jurisdiction and its main or sole purpose is to insulate the real beneficial owner from taxes, disclosure or both.
We really need Sherlock Holmes.