A group of intern doctors who pursued their medical degrees overseas are fuming over what they describe as direct biases regarding the sitting of their licensing examination.

The interns, who studied in Cuba, China, and Russia, told the Jamaica Observer that because their programmes are not accredited they are required to do a one-year internship in Jamaica and then successfully sit the two-part Caribbean Association of Medical Council (CAMC) examination before being fully registered as doctors in Jamaica.

But the bone of contention for the group, referred to as locum interns, results from delays in sitting part two of the CAMC exam, which they claim is limited by space, plus postponement of this year’s test due to the COVID-19 outbreak.

“In Jamaica, much like many other countries, once you have studied abroad you have to complete a licensing exam. The standardised examination used in Jamaica is the Caribbean Association of Medical Council (CAMC), which is set by the Medical Council of Jamaica (MCJ),” one locum intern who studied in China told the Sunday Observer.

“Being promoted from medical intern to senior house officer is dependent on successfully completing this exam. Unfortunately, many international medical graduates are held back due to insufficient space to sit the exam and are forced to extend their internship indefinitely,” the intern added.

“The MCJ’s inability to address this ongoing issue has left many international graduates’ careers in limbo for years. In September 2019, this was the harsh reality that befell many a hopeful locum medical interns, who had passed part one of the CAMC, and who had paid for part two, in the anticipation of advancing to the next level of their careers. These medical interns were denied part two of the exam due to limited slots, and even though the money was refunded, the disappointment and frustration was no easier to bear,” the intern said.

“Even more frustrating was the fact that persons who were unable to sit part one of the examination, due to the coronavirus, will be pushed back at least two sittings, further delaying matriculation into the health care system. Please consider the fact that there are not only Jamaican nationals being assessed in this exam; doctors from India, Africa, and all over the Caribbean take part in this exam, to be able to practice in Jamaica,” the intern explained.

Another locum intern, who studied in Cuba, shared that due to the postponement of the CAMC exam she has had to extend her internship as no alternative or accommodation regarding the licensing exam has been made.

“The situation now for me and others like myself is that I am on my second extension of my internship, even though I have completed one year of my internship already and successfully passed each rotation throughout the year,” she said.

She also stated that this postponement has added to a backlog of individuals waiting for years to sit the CAMC examination.

“I’ve noticed that for the past couple years we have had a backlog of persons, including Jamaican nationals, waiting to sit this exam and paying their money sitting down unemployed. There are others three years back waiting to do the exam,” the intern said.

The exam, she said, is set in March, April, November, and October — once for the month, but no more than 80 candidates can be accommodated.

“We are competing with people who are studying from different countries who weren’t even trained by the same institutions the Jamaican Government sent us for our scholarships. I am talking people from Nigeria, talking from other countries other than Russia, China and Cuba. Each year doctors go to Med Council to find out there is no space,” she said.

“Our exam was scheduled to be in March, but due to the COVID-19 it was postponed and it seems it has been postponed indefinitely. The last time we went there we were told they have to prioritise UWI (The University of the West Indies) students. Fine, but we are products of your own as well. You guys gave us a scholarship and we are here trying to find ways. We are not trying to fight the system, we want to do our exams. But during this COVID time you found a solution to help out The UWI graduates, so why not help us out? Help us out so that we can move on,” the intern argued.

She said a new batch of students from overseas is scheduled to arrive in August and they will go through the same problems. “Plus, we have the ones from last year who have not sat any exams at all. It is a continuous thing. What if the Ministry of Health did not allow us to extend our internship?”

The claim of a backlog was corroborated by Jamaica Medical Doctors Association President Dr Elon Thompson, who said he has communicated with the MCJ on behalf of the interns for clarity on what will obtain under the circumstances that the postponement was due to COVID-19.

“I have written to the MCJ who is responsible for the exams, but as to whether it shed more clarity to the matter, that’s another question. I am nowhere nearer to advising them and they know this. It’s unfortunate, it’s very unfortunate — the backlog and the postponement of this year’s exam,” Dr Thompson told the Sunday Observer.

“I don’t know what their (MCJ) plan is. I want to know what their plan is so I can advise them (locum interns) but I have not gotten anything concrete apart from to say that you will be informed when a decision is made. I know it is a very difficult time for everybody, but this is also a very difficult time for the locum interns, and the MCJ has to understand their position and be a little more sensitive to it and engage them. There has to be some closure to this matter. It can’t be that they are there just waiting, waiting and some people have no jobs or no source of income,” Dr Thompson said.

Another consultant lobbying on behalf of locum interns added: “I know people waiting to do CAMC exams now and they are saying that they are struggling to find space as they keep hearing that the space is full. There is a back up and I know people waiting to get a date for the exam and are just working. I hear hospitals are cutting back in terms of employment so you are going to have a bunch of unemployed doctors soon.”

To further compound their issues, the locum interns said they are paid 10 per cent less than students who graduated from The UWI.

But MCJ Registrar Dr Howard Spencer refuted the claims of bias, explaining that UWI programmes are accredited and the CAMC examination is developed, as in years gone by it was found that foreign students needed more clinical exposure before matriculating.

“We have had students going to Cuba for a long time, many years. The first group of students who came back were fully registered when they began their programmes here. When the consultants they worked with reviewed the work, how they were adapting and managing, it was realised that they needed to do an internship programme,” Dr Spencer said.

“Internship programmes in Cuba are set up in a certain way that it does not satisfy what is done in Jamaica. It’s not biases, but the students who went to Cuba and came home, having been reviewed by the consultants they worked with in those days, it was said that they needed to do an internship. Following upon that, they needed to do an examination, now known as the CAMC examination. To be fully registered you have to do the CAMC examination, which has two parts, and if you’re successful in the CAMC exam you have to do a recognised internship. When we say recognised internship, that is in one of the hospitals that we have accredited as having a satisfied internship programme,” Dr Spencer said.

Addressing the claim of a backlog in relation to the CAMC exam, Dr Spencer said it was a result of COVID-19. He further asserted that locum interns who are at the internship level for prolonged periods have either failed the CAMC exam or asked to be delayed because they are not confident in their ability to pass the exam.

“Students going to China and Russia, there is no way we can accredit those schools. So we review the curriculum of those schools, they come to Jamaica and again they have to do a recognised internship and the CAMC examination and then they are recognised based on that. It is not a bias. It is just how it is structured in relation to ensuring the exposure they have got in Cuba, Russia and China is satisfactory and they can work with our patients in Jamaica without exposing them to any risks,” he said.

“Normally there are two exams per year and those examinations involve the part one and part two examinations. The part two examinations need to have you examining patients and other things you may encounter while working in the hospital setting. The delays this year have been related to COVID and they are working on how to address that, because the examination, especially part two where you you have patients who you are seeing, we can’t have the examinees risking contact with the patients. Those who are here for two years have either failed the exam or ask for it to be delayed because they don’t feel confident in doing the exam,” Dr Spencer said.

Further, he said the MCJ is not the organisation that runs the exam, rather it is administered by the CAMC. However, CAMC occupies a space in the MCJ’s office.

Regarding the 10 per cent less salary that locum interns receive, Dr Spencer said this is so because the Ministry of Health has a budget for a certain number of interns from The UWI, but they created a second budget for locum interns as they recognised they needed to have some amount of financial support after they had finished school.