The outcasts from the caribbean - off shore medical school graduates

THE OUTCASTS FROM THE CARIBBEAN They may be able and willing to practice where U.S.-educated doctors

The scenic approach to St. George's University School of Medicinetakes a visitor on a pleasant barefoot walk along the white sands of Grand Anse Beach, a route that affords a glorious view across the sparkling blue water of the horseshoe-shaped inner harbor of Grenada's capital city, St. George's. Grand Anse continues past vacation cottages to the ''schoolyard,'' an expanse of beach where more than 300 prospective doctors, most of them U.S. citizens who failed to qualify for admission to medical school in the States or didn't applybecause they knew they'd be turned down, cram for tests. They often wear bathing suits and lie on blankets as they review their texts, or sit at the neat stacks of surfboards that double as desks, or perch on stools at the thatch-roofed circular bar, a reminder that the school's main building was once a motel.

The other approach to St. George's -- by road -- is less idyllicbut gives a truer sense of the place. You dodge mangy goats and scrawny cows as you turn into the school's driveway, and then pass what looks like a car wash (the Department of Anatomy building), a swimming pool (don't use soap), a pile of snorkeling gear, a row of motorbikes, a dust-covered Jeep, a shack (a bio-med lecture is going on inside), a white flying-saucer-shaped structure made of fiber glass (it's a clinic, named for Simon Bolivar, a gift to the school from the Venezuelan government), and dorms that in 1983 were raked with machine-gun fire from U.S. helicopter gunships during what's always referred to by the locals as ''the intervention'' (the bullet holes still show despite fresh plaster), ending up on a patio, where notices like these are pinned to a bulletin board: ''Five neuroanatomy exams for sale, only 10 E.C. ((East Caribbean)) dollars''; ''Old pharmacology tests, 30 E.C.''; ''Honda 600-watt generator, electri city guaranteed every day and every night: remember 1985?'' (''The first semester that year we studied by oil lamps,'' one student says. ''I felt like Abe Lincoln.'')

Incredible as it may seem to doctors who've earned their M.D.s in more traditional settings, this is a medical school in fact as well as name, a facility that, since its controversial founding in 1977, has graduated 1,121 students, most of whom are practicing in the U.S.

It hasn't been easy for them. Apart from the Third World environment in which they've had to study, there has been the hostility of establishment medical educa tors, who've kept pounding out the theme that schools like this have inferior curricula and worse physical plants, and that their backers are just fast-buck hustlers.

But signs of a truce, at least with St. George's, are emerging, although the thaw has nothing to do with so human a response as good feeling. It's a matter of the establishment's being forced to recognize that, for all its faults and inadequacies, the school has finally come up with a departmental structure comparable to that of a U.S. medical school, and that many of its students are doing the place proud.

This winter, after months of agonizing over its future, enduringwhite-glove inspections, making improvements and commitments, and lobbying intensively, St. George's won approval from the New York State department of education to conduct its clinical program in three New York City teaching hospitals. Under this arrangement, known as a clerkship, third- and fourth-year students can fulfill their clinical training requirements. (Unlike interns, who are in their fifth year, students doing clerkships don't have medical degrees, but are allowed to practice medicine under close supervision.) The approval makes St. George's the only foreign medical school with in- struction in English that has state-sanctioned clinical campuses in New York and New Jersey, where students from St. George's have been clerking since 1985. Says Thomas Mon ahan, associate executive secretary of New York's state board for medicine, ''We saw that they seem to have a system to control clinical rotations, and that they're providing an integrated program in the basic and clinical sciences.''

That doesn't mean that St. George's is the ideal place to study medicine, or that the education its students receive is on a par with that of the best U.S. medical schools. But it's far better than some of the prefab flea traps that have sprung up in the Caribbean to serve the thousands of M.D.-hungry Americans attracted by courses taught in English and undeterred by tuitions of as much as $16,000 a year, plus living expenses.

The offshore schools -- their numbers fluctuate between ten and 20, and have included such places as the American University of the Caribbean, Ross University, and Spartan Health Sciences University -- began appearing in the 1970s, with the Dominican Republic the preferred site. Although in some instances the entrepreneurial spirit has run roughshod over dedication to the ideals of medicine, the schools can reasonably argue that they should be in business, because they fill both social and personal needs.