International Medical Electives Research Articles

HPB SO44 - From Electives to Career-Changing: A Cross-Sectional Survey exploring the impact of International Medical Electives in Hepato-Pancreatic-Biliary Surgery Unit

Abstract Background International medical graduates (IMGs) are crucial in addressing NHS workforce shortages, representing one-third of staff. Reliance on IMGs is likely to continue. Electives offer IMGs a valuable opportunity to overcome work culture and clinical skills challenges, difficult to address through PLAB tests alone. These experiences can aid in passing the exam. Entering a new culture and service can be daunting; electives help build confidence by increasing familiarity with the NHS and UK medical traditions. This survey was designed to gain insight into IME experiences, the educational value perceived by participants, and their influence on personal growth and career direction. Method A cross-sectional survey was sent to 26 IMGs who completed an IME rotation in the HPB department at University Hospitals of Leicester NHS Trust since 2019. The survey included quantitative and qualitative questions to gather demographic details, insights into experiences, educational values gained, and career impact. Medical education and HPB surgery experts evaluated the survey for content validity and alignment with learning outcomes.Conducted via Google Forms®,recruitment emails were sent anonymously with weekly reminders for four weeks to ensure high response rates. Quantitative data were analysed using descriptive statistics, and qualitative data underwent thematic analysis. Results 18 out of 26 participants (62.2%) responded. Ages ranged from 23-30, with 61.11% between 23-25 years. The gender split was 61.11% male and 38.89% female. Most (66.67%) were medical students during their elective, while 33.33% were Foundation Doctors. 72% of respondents are preparing for or have taken GMC registration exams, with 44% are already fully registered. The survey revealed overall positive responses, highlighting the welcoming and educational environment. However, participants suggested improving the induction program and providing a more defined daily schedule for elective students. These insights offer opportunities to enhance an already valuable program. Conclusion The study revealed a successful international medical elective program in the HPB department. Most respondents found the experience met their expectations, achieved learning objectives, and positively influenced their careers. All participants were satisfied and would recommend the elective, with 94% considering NHS careers. The program provided effective teaching, mentorship, and hands-on clinical experience for most participants. Many have begun or completed GMC registration, indicating lasting impact. This initiative is valuable in attracting and preparing IMGs for the NHS and should be replicated across the UK, with a structured program and ensuring necessary exposure and guidance.

Benefits and Drawbacks of International Medical Elective Databases in Abroad Elective Research: A Narrative Review.

International medical electives (IMEs) are considered high-impact practice in global health education. Nevertheless, international medical elective (IME) research remains scarce, with only a few new publications appearing each year. The discrepancy between the many unanswered questions regarding IMEs and the lack of opportunities to perform research in this field has been further aggravated by the COVID-19 pandemic. Elective databases cataloguing structured IME reports/testimonies could offer a viable solution here. This narrative review provides a balanced and objective evaluation of the strengths and weaknesses of elective databases, summarizing their potential usefulness in IME research. The methodology employed was a multidisciplinary narrative review of the published and grey literature on databases cataloguing IME testimonies. Elective databases offer numerous benefits to the IME researcher. Their size allows for large analyses, built on hundreds of equally structured elective testimonies. Pre-defined outcomes, such as the elective destination, elective discipline or duration, are queried in a standardized way, allowing for a broad set of research questions. Elective databases are usually open-access, not confined to a single university, and free to use. Most databases also offer user-friendly filter functions, permitting targeted analyses centered around a particular outcome. A major drawback is that reports are rarely verified. Subject to several forms of bias (eg, recall and reporting bias), elective databases may not be suitable for all types of research questions, and the report quality is often inhomogeneous. Above all, they rarely allow for an informational depth that may result from qualitative face-to-face interviews. Elective databases could be a valuable supplement to interview-based elective research, potentially allowing for larger and broader analyses not confined to single institutions.

Long-term trends in international medical electives fees: a database mining study.

Abroad medical electives are recognized as high-impact practice and considered a necessity to provide global health training. As of recently, the COVID-19 pandemic and its related travel restrictions prohibited most international elective activities. Another important barrier to abroad electives that received comparably little attention is elective and application fees, which - combined - may be as high as $5000 per month, and may prevent students with limited financial resources from applying for an international elective. Elective fees have never been systematically analyzed and trends in teaching and application fees have rarely been subject to dedicated scientific investigations. Using data from two large elective reports databases, the authors addressed this gap in the literature. The authors analyzed trends in abroad elective fees within the last 15 years in some of the most popular Anglo-American elective destinations among students from Germany, including the United States of America, Australia, New Zealand, the Republic of South Africa, Ireland and the United Kingdom. The authors identified n = 726 overseas elective reports that were uploaded between 2006 and 2020, of which n = 438 testimonies met the inclusion criteria. The United Kingdom and Australia were the most popular elective destinations (n = 123 and n = 113, respectively), followed by the Republic of South Africa (n = 104) and the United States of America (n = 44). Elective fees differed substantially-depending on the elective destinations and time point. Median elective fees were highest in the United States of America (€ 1875 for a 4-week elective between 2018-2020), followed by the Republic of South Africa (€ 400) and Australia (€ 378). The data also suggests an increasing trend for elective fees, particularly in the United States. Rising fees warrant consideration and a discussion about the feasibility of reciprocity and the bidirectional flow of students in bidirectional exchange programs.

A scoping review of the ethical impacts of international medical electives on local students and patient care

BackgroundInternational electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to lower and middle income countries (LMICs) becomes more common, ethical considerations of such practices emerge. We conducted a scoping review to assess the extent to which five ethical themes were addressed in existing literature about electives, with the aim of investigating the ethical impacts of medical student electives on local resources, patients and clinicians in LMICs.MethodsWe systematically searched PubMed, Global Health and Embase databases using the search terms “(ethics) AND (medical electives)”. Thematic content analysis was undertaken using a combination of deductive and inductive themes. The deductive themes included: exceeding clinical competence, use of limited local resources, respect for patients and local culture, collaboration with local community/colleagues, and one-sided benefits in partnership. In addition, we also allowed for emerging themes within the data, and conducted a narrative synthesis of the results.ResultsA total of 37 papers discussed ethical issues relating to medical student international electives to LMICs. More publications were written from the medical student perspective (n = 14), than by the host-institution (n = 5), with nearly half written from third-party perspectives (n = 18). Negative impacts on local host students and impact upon patient care were identified as additional ethical considerations.ConclusionsOur review demonstrated that while there is a degree of awareness in the existing literature of the potential negative impacts of medical electives to local LMIC students’ access to medical education and patient care, continued work is needed to ensure equitable partnerships. We recommend that these ethical themes should be further explored in pre-departure elective teaching courses and post-elective debriefs to increase medical students’ awareness of the impact of their presence on host communities.

International medical electives in Sub-Saharan Africa: experiences from a 19-year NGO-driven initiative

BackgroundMainstream medical education remains largely focused on national health issues. Therefore, in order to expose medical students to international health issues, it is beneficial to facilitate international medical electives.MethodsThis article describes the Junior Project Officer (JPO) program, a medical experience based on clinical electives in Sub-Saharan Africa, supported by a Non-Governmental Organisation (NGO). Residents spend 6 months as part of a multidisciplinary medical team in Africa. A post-elective online survey was administered to all who participated in the program in the period 2002–2020. The questionnaire comprised three domains: (i) general and pre-departure information; (ii) the experience; (iii) the post-experience.ResultsQuestionnaires were received from 157/241 subjects, a response rate of 65%. The most common specialties were pediatrics, public health, and internal medicine. Of all, 87% carried out clinical activities; 45% also worked in the management of health services, and 60% carried out research activities. About 64% reported difficulties linked to a lack of equipment, different ways of working (57%), and exposure to situations for which they did not feel technically prepared (56%). In 25% of cases, residents reported that their school’s attitude to their doing the elective was not positive: upon their return, over 50% felt that their experience was not sufficiently valued by their institution. Respondents considered the experience important for professional and personal growth (93% and 80% respectively ). Forty-two participants (27%) reported that the experience had a significant impact on their future career choices.ConclusionDespite the difficulties encountered, a well-structured experience in international health can have a positive impact on residents, professionally and personally. Key factors behind the positive outcomes are the substantial length (6 months) of the experience, and the long term working relationships between the sending and receiving institutions. The schools in Italy that provide the students for the electives need to see more evidence that international electives are worth the investment.

Preparation, relationship and reflection: Lessons for international medical electives.

International medical electives (IMEs) provide opportunities for global health education within undergraduate medical curricula; however, ethical and practical preparations vary. Single-centre, prospective, mixed-methods study, utilising online questionnaires with students and host supervisors, contemporaneous reflective diaries and focus groups, to explore the preparedness and experiences of final-year UK medical students undertaking IMEs. Students experienced communication challenges and felt underprepared prior to IME. Students undervalued cultural preparation, whereas host supervisors primarily desired humility and cultural sensitivity. Visitors to high-income countries underpredicted cultural differences with reflective practice supporting understanding of global health inequalities. Burden on hosts and ethical dilemmas related to acting beyond competence remained significant concerns. International medical electives provide experiential learning, and with authentic reflection facilitate professional development. Enhanced culturally competent preparation and debriefing is however essential for collaborative and responsible student learning. Acting beyond competency persists, requiring concerted reform during the pandemic-mandated hiatus of IMEs.

International Medical Electives: Another Victim to the COVID Pandemic.

International Medical Electives: Another Victim to the COVID Pandemic.

The student perspective of a staff-student partnership scheme.

The student perspective of a staff-student partnership scheme.

International medical electives for medical students at a German university: a secondary analysis of longitudinal data.

BackgroundInternational medical electives (IMEs) are entry points to global health opportunities. IME uptake at German universities is unclear. We analyse 14 y of IME.MethodsStudent registry data were collected. Univariate linear regression examined relationships between enrolment year and IMEs.ResultsThe median (IQR) number of IMEs of all enrolment years was 54 (32–80) and 51 (38–67)% of all students took an IME. Enrolment year significantly predicted IME frequency and the proportion of students taking IMEs.ConclusionsStudent interest in IMEs is increasing. Universities should invest more broadly in IME opportunities for student, faculty and university enrichment.

Value and feasibility of South-South Medical Elective Exchanges in Africa

BackgroundAn elective is part of the curriculum where students have the flexibility to choose both the study topic and location. International medical electives are a well-established part of curricula at most medical schools in high-income countries. They are highly valued by students and have proven educational benefits, though do come with challenges, such as lack of reciprocity. Low and middle-income countries frequently host students from high-income countries providing learning opportunities, yet also carry the burden of supervision and resource consumption, whilst their students get few elective opportunities. This study explores the value and feasibility of South-South Medical Elective Exchanges (SSMEE), which creates elective opportunities for African medical students in other African countries to create reciprocity within the elective system.MethodA qualitative evaluation of the South-South Medical Elective Exchanges was conducted using a case study approach. Four African medical schools, College of Medicine, Malawi; University of Rwanda, Rwanda; University of Witwatersrand, South Africa and Makerere University, Uganda participated in the pilot study in 2017/18. Each institution selected two students to participate in a four-week elective to another participating institute. Participating students completed a pre-elective questionnaire and a post-elective interview exploring expectations, learning outcomes, challenges and how they are applying this learning. Data was analysed thematically.ResultsData presented is from six of the eight participating students. All students found the elective a valuable experience and learning was demonstrated in four key areas: clinical knowledge and skills; attitudes; personal and professional development and global perspectives. For some, it challenged their assumptions of what an elective is because valuable learning can be achieved whilst remaining in Africa. The main challenge found related to funding the elective.ConclusionsThe SSMEE model is feasible and provides valuable learning for participating students and their peers/colleagues. Financing electives remains the biggest challenge. Since this pilot study, SSMEE has become part of a regional elective exchange network in Africa with an additional four institutions in three other countries. As such SSMEE has resulted in increased opportunities for African medical students and better educational outcomes that are likely to have a positive effect on healthcare systems in Africa.

Embedding international medical student electives within a 30-year partnership: the Ghana-Michigan collaboration

BackgroundGlobal health experiences are an increasingly popular component of medical student curricula. There is little research on the impact of international medical electives embedded within long-standing, sustainable partnerships. Our research explores the University of Michigan medical student elective experience in Ghana within the context of the Ghana-Michigan collaborative.MethodsStudy participants are University of Michigan medical students who completed an international elective in Ghana between March 2006 and June 2017. Post-elective reports were completed by students, including a description of the experience, highlights, disappointments, and the impact of the experience on interest in future international work and future practice of medicine. A retrospective thematic analysis of reports was carried out using NVivo 12 (QSR International, Melbourne, Australia).ResultsA total of 57 reports were analyzed. Benefits of the elective experience included building cross-cultural relationships, exposure to different healthcare environments, hands-on clinical and surgical experience, and exposure to different patient populations. Ninety-five percent of students planned to engage in additional international work in the future. Students felt that the long-standing bidirectional exchange allowed them to build cross-cultural relationships and be incorporated as a trusted part of the local clinical team. The partnership modeled collaboration, and many students found inspiration for the direction of their own careers.ConclusionsEmbedding clinical rotations within a well-established, sustained partnerships provides valuable experiences for trainees by modeling reciprocity, program management by local physicians, and cultural humility—all of which can help prepare learners to ethically engage in balanced, long-term partnerships in the future.

Should international medical electives to resource-poor countries continue during COVID-19?

Medical students on elective offer a workforce that may become essential when local healthcare services in resource-limited countries become overwhelmed. We argue they should not be cancelled, and instead should be offered on a voluntary basis to allow students the opportunity to support struggling health systems during the COVID-19 pandemic.

Ethical globalization? Decolonizing theoretical perspectives for internationalization in Canadian medical education

Internationalization is a process being undertaken at institutions of post-secondary education worldwide in response to globalization. The resulting imperatives for medical education include re-thinking Canadian positionality within uneven, problematic Global North-South relations. Members of the medical education community are in need of training and tools to navigate this complex situation. Using a decolonial theoretical perspective, a literature review was conducted and framed with three ethical questions posed to stimulate collective conversations about internationalization among all members of the health professions education community in Canada. This study identifies analytical gaps in discussions on the role of medical education in the context of colonial, neoliberal, unjust Global North-South relations. The results point to the need for deeper examination of medical curricula for problematic representations and theorization of inequities and racialization. They also suggest that practices for International Medical Electives and the involvement of International Medical Graduates should be evaluated in light of the ethical concerns identified. During this moment of internationalization and globalization in all health professional education, reflexivity and self-awareness are important strategies for engaging with decolonizing theoretical perspectives that are critical of Global North-South relations like neoliberal globalization and colonialism. Increased inclusion of pluralistic ways of approaching both processes are necessary for combatting growing health inequities in Canada and globally.

Production of the Global Health Doctor: Discourses on International Medical Electives

This article attempts to interrupt dominant narratives in the literature about international service-learning (ISL) in the field of medicine by critically deconstructing discourse related to a common model used to teach global health in undergraduate medical education: the international medical elective (IME). Based on a study conducted in 2012, the results have not been previously published. Using a Foucauldian discourse analysis, the study interrogated the underlying assumptions behind the nature of “service” being rendered by conveying the imagery, language, and consequences of the dominant discourses used in journal articles indexed on MEDLINE between 2000 and 2011. The analysis revealed an IMEs literature steeped in problematic discursive (re)productions of colonial constructs and imagined geographies, primarily through two dominant discourses designated as “disease and brokenness” and “romanticizing poverty.” These discourses both justify and reinforce privileged subject positions for students engaged in these ISL experiences, while inadequately considering structures and systems that perpetuate marginalization and health inequities. Such discourses often marginalize or essentialize people of so-called “host” countries, while silencing subaltern perspectives, resistance struggles, knowledges, and epistemologies. Challenging current ISL practices in medicine requires educators to actively work towards decolonialization, in part by recognizing the ability of discourses to produce meaning and subjects.

International medical electives in selected African countries: a phenomenological study on host experience.

ObjectivesTo explore the host experience on international medical electives at a selection of hospitals in low- and middle-income countries in Africa. Outcomes of the study may inform and improve the preparation of global health curriculum, pre-elective training and debriefing for international medical electives. MethodsA descriptive phenomenological study was undertaken, involving semi-structured interviews with ten elective hosts at seven study sites in three African countries. Purposive convenience sampling augmented by snowballing was utilised to recruit study participants. The data were thematically analysed and interpreted with reflexivity to generate an accurate aggregate of the experience of participants in hosting international medical electives. ResultsSix main themes emerged from the thematic analysis of interview data: international medical student contribution to host hospitals, host professional and personal fulfiment, barriers to student learning experience, international medical student preparedness, hope for reciprocity and barriers to cultural immersion and patient care. ConclusionsStudy participants described the experience of hosting international medical elective students as overwhelmingly positive. However, they highlighted issues such as barriers to students’ learning experience and the lack of reciprocity between host and sending institutions as areas which could be addressed to optimize the experience for both hosts and international medical students. An understanding of the host experience provides stakeholders with a clearer idea of what is important in preparation, organisation and evaluation of the elective experience. This study provides the impetus for further research to examine the effectiveness of introducing appropriate pre-departure training and post-elective debriefing to students embarking on international medical electives.

Ethical learning on international medical electives: a case-based analysis of medical student learning experiences

BackgroundStudents on international medical electives face complex ethical issues when undertaking clinical work. The variety of elective destinations and the culturally specific nature of clinical ethical issues suggest that pre-elective preparation could be supplemented by in-elective support.MethodsAn online, asynchronous, case-based discussion was piloted to support ethical learning on medical student electives. We developed six scenarios from elective diaries to stimulate peer-facilitated discussions during electives. We evaluated the transcripts to assess whether transformative, experiential learning took place, assessing specifically for indications that 1) critical reflection, 2) reflective action and 3) reflective learning were taking place. We also completed a qualitative thematic content analysis of the discussions.ResultsOf forty-one extended comments, nine responses showed evidence of transformative learning (Mezirow stage three). The thematic analysis identified five themes: adopting a position on ethical issues without overt analysis; presenting issues in terms of their effects on students’ ability to complete tasks; describing local contexts and colleagues as “other”; difficulty navigating between individual and structural issues, and overestimation of the impact of individual action on structures and processes.ConclusionResults suggest a need to: frame ethical learning on elective so that it builds on earlier ethical programmes in the curriculum, and encourages students to adopt structured approaches to complex ethical issues including cross-cultural negotiation and to enhance global health training within the curriculum.

Protecting the health of medical students on international electives in low-resource settings.

Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure. The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material. This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours. This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit items and useful web-based educational resources are provided to help prepare for electives abroad.

Global Health Education for Medical Students: When Learning Objectives Include Research

The Luke Commission, a provider of comprehensive mobile health outreach in rural Swaziland, focuses on human immunodeficiency virus testing and prevention, including the performance of over 100 circumcisions weekly. Educational objectives for medical student global health electives are essential. Learning research methodology while engaging in clinical activities reinforces curriculum goals. Medical care databases can produce clinically significant findings affecting international health policy. Engaging in academic research exponentially increased the educational value of student experiences during an international medical elective. Staff of the Luke Commission, a nongovernmental organization, collected and deidentified information from 1500 Swazi male patients undergoing circumcision from January through June of 2014. Medical students designed studies and analyzed these data to produce research projects on adverse event rates, pain perception, and penile malformations. Institutional review board approval was obtained from the home institution and accompanying senior surgical faculty provided mentorship. First-year medical students enrolled in an international medical elective to explore resource availability, cultural awareness, health care provision, and developing world endemic diseases. While in country, students learned research methodology, collected data, and engaged in research projects. Following the trip, students presented posters at over 10 regional and national meetings. All 4 articles are accepted or under consideration for publication by major journals. During international medical electives the combination of clinical experiences and access to databases from health aid organizations provides the foundation for productive medical student research. All participants benefit from the relationships formed by aid organizations, medical students, and patient populations. Global health research has many complexities, but through careful planning and cultural awareness, medical students can increase their research skills and contribute to the medical literature, bringing attention to and improving health care policies around the world. In sum, the educational experience of medical students is enhanced through the interaction of delivering patient care and completing clinical research studies.

Reliability of a Tool to Measure Culture Shock in Medical Trainees - Project Prime (Psychosocial Response to International Medical Electives) Pilot Study

Reliability of a Tool to Measure Culture Shock in Medical Trainees - Project Prime (Psychosocial Response to International Medical Electives) Pilot Study

The influence of international medical electives on career preference for primary care and rural practice.

BackgroundPrevious studies have demonstrated a correlation between medical students who undertake international medical electives (IMEs) in resource poor settings and their reported career preference for primary care in underserved areas such as rural practice. This study examines whether a similar correlation exists in the Australian medical school context.MethodsData was extracted from the Medical Schools Outcomes Database (MSOD) of Australian medical students that completed commencing student and exit questionnaires between 2006 and 2011. Student responses were categorized according to preferred training program and preferred region of practice at commencement. The reported preferences at exit of students completing IMEs in low and middle income countries (LMIC) were compared to those completing electives in high income countries (HIC).ResultsThe effect of elective experience for students expressing a preference for primary care at commencement was non-significant, with 40.32 % of LMIC and 42.11 % of HIC students maintaining a preference for primary care. Similarly there were no significant changes following LMIC electives for students expressing a preference for specialist training at commencement with 11.81 % of LMIC and 10.23 % of HIC students preferring primary care at exit. The effect of elective experience for students expressing a preference for rural practice at commencement was non-significant, with 41.51 % of LMIC and 49.09 % of HIC students preferring rural practice at exit. Similarly there were no significant changes following LMIC electives for students expressing a preference for urban practice at commencement, with 7.84 % of LMIC and 6.70 % of HIC students preferring rural practice at exit.ConclusionsThis study did not demonstrate an association between elective experience in resource poor settings and a preference for primary care or rural practice. This suggests that the previously observed correlation between LMIC electives and interest in primary care in disadvantaged communities is likely dependent on student and elective program characteristics and supports the need for further research and critical examination of elective programs at Australian medical schools.