Rethinking international medical electives
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q1472 (Published 04 July 2024) Cite this as: BMJ 2024;386:q1472
What’s the point of an international medical elective? When I used to consider the benefits, I often thought about how this kind of elective would allow me to see patients in a different setting, immerse myself in a new culture, and mean that I could practise my clinical skills—“me,” “myself,” and “I.” Learning more about global health has made me rethink.
If international medical electives are for the good of the medical student alone, then the way we currently approach them seems to work. In one survey of medical students in Canada who had participated in a global health elective, 90% of sampled students agreed that their elective provided a valuable opportunity for personal growth.1 Students in this study also reported that their elective had made them more resourceful (90%) and improved their awareness of the social determinants of health (88%).
Despite the potential benefits to the medical student and their future patients, these metrics seem myopic. With around 40% of UK medical students undertaking their elective in a developing country, we must look beyond the benefits that international electives provide to just individual students.2 We must see the fraught dynamics that can unfold when a student from a high income country undertakes an elective in a low income country, and consider how different cultural contexts and variations in practice can lead to ethical opacity. Medical students and their universities must start placing greater store on the value of these electives to the host country, particularly when these are in low resource settings.
The medical principle of “first, do no harm” means that it’s important for all elective placements to establish defined boundaries and supervision so that medical students are supported to work within their scope of practice and uphold patient safety standards. Medical students are, after all, still students.
Ensuring that hosted medical students are properly supervised does, however, rely on the assumption that there will be enough senior staff to support them. Students on international medical electives shouldn’t detract educational attention away from local students who will be caring for their communities in the long term.
A more considerate approach
So, what can we do? Reflection, preparation, and training have formed the framework for my medical education, and these pillars can apply to planning for medical electives too. Reflecting on their motivations for an elective, including the impact it will have on the relevant hospital, will allow students to take a more considerate approach to their elective planning.
Preparing for an elective should be done in conjunction with the elective hospital, enabling students to familiarise themselves with local customs and practice in a way that provides early cultural context. It might be helpful to contact previous students who have been on an elective there to ask what they wish they had known. Students could also speak to local medical staff in advance to gain an insight into their role within the team and how they can contribute. Training should establish the essential skills required for an elective and provide a clear demarcation of the student’s clinical scope and limitations. Such training programmes should be an important part of the medical school curriculum, with educational content that is shaped by the perspectives of previous host institutions and supervisors without putting additional work on them. In the long term, standardised pre-departure training for medical students undertaking international medical electives could greatly improve the value for both parties.
Bilaterally beneficial
Yet this alone is not enough; these measures still centre the visiting student in the equation. We can, and should, go further to ensure medical electives are mutually beneficial to the host institution and the student. Medical schools can follow Dundee Medical School’s lead by providing reciprocity to their hosts.34 Their “Responsible Electives” project encourages an “educational fair trade approach,” with students required to fundraise for their host so that healthcare settings with limited resources benefit from providing elective experiences. Furthermore, the students who participate in this scheme undertake an extended elective of 10 weeks instead of six, a decision informed by the host partners, who say this allows students to integrate into the clinical environment more and “find their feet.”
Financial and material support from visiting students can bolster the benefits of these electives for host institutions. Students Working Overseas Trust (SWOT), a student led charity at Queen’s University Belfast, fundraise so that students can bring equipment and monetary donations to hospitals in resource constrained settings. The form these donations take responds to the specific needs of the host institution; a former president of the society described how on her elective, “We worked with the medical director there to make a plan… They needed beds, so that’s what we bought.”5 We need more projects such as this that encourage students to think about the impact and legacy of their elective, empowering them to make a positive contribution to their host institution. Medical schools should encourage such initiatives, which are informed by host countries and led by students, by providing operational and funding support to get these off the ground.
International medical electives give so much to students; it’s only fair that we give back. Let’s rethink what medical electives mean not only for us but, more importantly, for the patients and communities in the hospitals providing electives.
Footnotes
Competing interests: Inez Murray is a medical student at Queen’s University Belfast.
Provenance: Commissioned; not peer reviewed.