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To determine the variability among Caribbean medical schools in the performance of their students against markers of quality.The Educational Commission for Foreign Medical Graduates (ECFMG) database and the American Medical Association (AMA) Masterfile were linked. Analyses were restricted to ECFMG applicants, from 1980 to 2000, who attended the 12 Caribbean medical schools that produced 200 or more U.S. International Medical School Graduates (USIMGs).The schools produced 17,049 USIMG (48% of all USIMGs) and 5,840 non-USIMG (5% of all non-USIMGs) applicants for ECFMG certification. By school, the ECFMG certification rate ranged from 28% to 86% for USIMGs and from 27% to 82% for non-USIMGs. Specialty Board certification for graduates of these schools also varied widely.Medical schools in the Caribbean play an increasingly important role in supplying the U.S. workforce. There is considerable variability among them, both in the numbers of physicians they produce and the performance of their students against indicators of quality such as ECFMG and specialty Board certification.