Supporting the Transition of International Students into Caribbean Offshore Medical Schools: A Phased, Theory-Informed Model Grounded in Collective Faculty Experience

Abstract

Phenomenon: Caribbean offshore medical schools (OCMS) enroll substantial numbers of international students, predominantly from North America, who experience a physically, academically, socially, and culturally complex transition at entry. Existing medical education literature on student transition focuses largely on domestic students in their home countries. In contrast, evidence concerning transition into OCMS remains extremely limited, and institutional practice across the region appear inconsistent and unevenly developed. Attrition rates at some OCMS range from 40 to 70 per cent, a pattern that should be interpreted not solely because of student selection processes, but also as indicative of shortcomings in institutional support structures. Although most students adapt successfully, a subset encounters preventable difficulties that may be mitigated through more intentionally designed and comprehensive support systems.

Argument: Drawing on established transition models (Bridges; Bean and Eaton; Menzies and Baron), social cognitive theory (Bandura), recent systematic evidence on peer mentoring (Gehreke et al.,2024), and the collective experience of the authoring group, we argue that OCMS should implement a structured and longitudinal transition support model extending from pre-arrival through the first two years of medical training. The authoring group comprises physicians and academics from India, Nepal and the Philippines, who trained and practiced in their own countries as well as China, Africa and the United States, now working in the Caribbean as medical educators, thereby contributing insights grounded in both international student experience and institutional practice. We propose a four-phase model of transition support consisting of pre-arrival preparation, induction, early embedding, and ongoing developmental support. Within each phase, the specific transition competencies should address general and social self-efficacy, self-directed learning, and reflective practice.

Implications: The proposed model is intended as a practical framework any OCMS can modify according to the local resources, rather than as a research-validated intervention. Its most useful function may be diagnostic; it prompts an institution to ask which phases it currently supports well, and which it does not. We describe the gaps we see within our own institutions’ existing provisions, outline measures that have been implemented in response, and consider what a meaningful research agenda for OCMS transition might look like.

Keywords: student transition; Caribbean medical education; offshore medical schools; international medical students; self-efficacy; academic advising; reflective practice; peer mentoring; induction.