Abstract
BackgroundMost international electives in which medical students from high-income countries travel abroad are largely unstructured, and can lead to problematic outcomes for students as well as sending and receiving institutions. We analyse the problems of unstructured medical electives and describe the benefits of an elective experience that includes more organisation and oversight from the sending medical school.ResultsA number of structured elective programmes have been developed, including those at the Medical School for International Health, Israel and the University of Dundee, United Kingdom. These programmes provide significant pre-departure training in global health and the ethical dimensions of electives, support and monitoring during the elective, and post-elective debrief. Crucially, the programmes themselves are developed on the basis of long-term engagement between institutions, and have an element of reciprocity.We further identify two major problems in current medical electives: the different ethical contexts in which electives take place, and the problem of ‘voluntourism’, in which the primary beneficiary of the activity is the medical student, rather than the receiving institution or health system. These two issues should be seen in the light of unequal relations between sending and receiving institutions, which largely mirror unequal relations between the Global North and South.ConclusionWe argue that more structured elective programmes could form a useful corrective to some of the problems identified with medical electives. We recommend that medical schools in countries such as the UK strongly consider developing these types of programmes, and if this is not possible, they should seek to further develop their pre-departure training curricula.
Highlights
Most international electives in which medical students from high-income countries travel abroad are largely unstructured, and can lead to problematic outcomes for students as well as sending and receiving institutions
Of the British students undertaking an International medical electives (IME), approximately 40% do so in a low-income country (LIC) (Miranda et al, 2005); in Australia this can be as high as 59% [2]
Proposed future actions We argue that in high-income countries (HIC) such as the UK, medical schools should begin to look seriously at the development of a more structured medical elective, and if this is impossible due to time and resource constraints, many other steps can be taken to improve the quality of pre-departure training and sensitisation
Summary
A number of structured elective programmes have been developed, including those at the Medical School for International Health, Israel and the University of Dundee, United Kingdom. We further identify two major problems in current medical electives: the different ethical contexts in which electives take place, and the problem of ‘voluntourism’, in which the primary beneficiary of the activity is the medical student, rather than the receiving institution or health system. These two issues should be seen in the light of unequal relations between sending and receiving institutions, which largely mirror unequal relations between the Global North and South
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