Abstract
ObjectivesTo understand the impact of the international medical elective (IME) on Nepali patients and physicians alongside visiting European and American medical students. MethodsAt a hospital in Nepal, semi-structured interviews were conducted with 15 patients and 15 physicians about positive and negative experiences with visiting medical students. Likert scale surveys about knowledge of Nepal, clinical competencies, and post-elective feedback were administered to 56 visiting medical students before and after their elective. Interviews were coded using conventional content analysis and surveys were analyzed using descriptive statistics and paired t-tests. ResultsEmergent positive themes from interviews were that visiting students enhanced the reputation of the hospital, afforded financial benefits, improved international collaboration, and increased knowledge, culture and language exchange. However, negative themes were the language barrier and time expended to orient students. Before vs. after the elective, visiting students had increased knowledge of Nepal’s healthcare system (M=1.9, SD=0.6 vs. M=3.2, SD=0.6, t(55)=-10.22, p<.001), ability to communicate with health professionals from different backgrounds (M=3.3, SD=0.7 vs. M=3.6, SD=0.7, t(55)=-3.11, p=0.003) and practice in resource constrained environments (M=2.4, SD=0.9 vs. M=2.8, SD=0.9, t(55)=-2.42, p=0.02). However, students had no change in history (M=4.0, SD=0.7 vs. M=3.9, SD=0.7, t(55)=0.84, p=0.40), physical exam (M=3.9, SD=0.6 vs. M=3.9, SD= 0.7, t(55)=0.22, p=0.82) or diagnostic (M=3.5, SD=0.7 vs. M=3.4, SD=0.8, t(55)=1.52, p=0.14) abilities. ConclusionsThis study demonstrated a variety of benefits and harms of the IME. To improve the IME experience, medical educators should emphasize pre-departure orientation and fostering equitable partnerships between sending and receiving institutions.
Highlights
For medical students at these universities, global health experiences are increasingly popular, with an estimated 27% of the United States and 40% of British medical students participating in international medical electives (IMEs) before graduation.[3,4]
Increased international collaboration: In addition to improved local reputation, many physicians believed the IME improved the international recognition of the hospital
This relationship was seen as mutually beneficial for both host physicians and visiting students, with one physician commenting: “It is good to have the students come here, because we can make relationships with foreign universities and even go there.”. These international partnerships allowed for professional development opportunities for Nepali physicians, with six of the physicians interviewed attending conferences or completing advanced fellowships in the USA or Europe
Summary
Globalization has led to an expanding sphere of influence for high-income country (HIC) academic institutions.[1,2] For medical students at these universities, global health experiences are increasingly popular, with an estimated 27% of the United States and 40% of British medical students participating in international medical electives (IMEs) before graduation.[3,4] In response, medical schools are providing students with a variety of global learning opportunities, most often in the form of IMEs. Students may act as observers or be more involved in the medical care of patients.[7]
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