International Health Electives: Four years of experience
Introduction
More than 2 million people each day move across international borders as a consequence of increases in international travel, trade and immigration. One consequence is an increasing global interdependence of health.1 In today's world, the distinction between ‘domestic’ and ‘foreign’ has lost some of its clarity. At home, an increasing number of patients belong to different cultures, so requiring physicians to have a broader perspective on patient care and cross-cultural communication.2
Medical electives are an important and expected part of the medical curriculum in many medical schools, in both industrialised and developing countries. Instituted in the 1970s,3 this part of the course has not been subjected to the rigorous analysis of learning processes and expected outcomes that have been matters of course for other components of the medical curriculum. The lack of preparation before the elective, a lack of analysis of educational objectives, and of benefits for the hosting institution, have led to some people denouncing electives as a period of medical tourism, where usually the most affluent students benefit.4
A sizeable number of medical students from developed countries choose to travel to a less developed country for their elective period. Although, attention has been paid to the health risks5, 6, 7, 8, 9, 10, 11, 12, 13 and ethical challenges14, 15, 16 of such electives, the amount of preparation before the elective and the analysis of educational objectives are less frequently considered.
This paper will explore issues around the elective period in the UK. Firstly, we describe the current status of medical electives in UK medical schools. Secondly, we present the experience of an innovative programme, developed by the International Health and Medical Education Centre at University College London, UK, in which a 4-week module on International Health was linked with the elective period. Finally, we analyse some of the published evidence available regarding international health experiences at the student level and we discuss whether the model reported in this paper might remedy the current gap between medical electives abroad and the lack of preparation at the medical schools for such experience.
Section snippets
The current status of medical electives in UK medical schools
A survey was performed to explore whether medical schools in the UK have an elective period scheduled as part of the students’ medical training, its duration, objectives and responsibilities. Information was also collected about the pattern of destinations of the electives, and the nature of the advice and counselling provided to students prior to their elective.
The survey was distributed by post in June 2002 to all UK clinical medical schools. Contact was made by telephone and email after 6
The International Health Elective Programme—filling the gap
The International Health and Medical Education Centre at University College London (www.ihmec.ucl.ac.uk) has developed Student Selected Modules (SSMs) and International Health electives, in order to combine the experience abroad with appropriate training for this, including education in issues surrounding globalisation, poverty, cultural awareness and ethics of electives, among other topics.
It might be asked as to why teach International Health to medical students? International Health is more
Discussion
The World Health Organization describes some of the qualities of the 21st century “five star doctor” as community oriented, reconciling individual and community health needs, and initiating actions on behalf of the community.27 Medical schools have a unique purpose: selecting and educating competent, caring physicians capable of meeting society's expectations.28
In Tomorrow's Doctors29 it was stated that public health medicine should figure prominently in the curriculum, encompassing health
Conclusions
We have presented evidence that large numbers of medical students travel to different countries and that international experiences have positive effects in several areas such as personal and professional development and increasing cultural sensitivity. The International Health Elective programme reported in this paper describes how it is possible to incorporate into the medical curriculum a preparatory module for students planning to take an overseas elective, with potential positive outcomes.
Acknowledgements
The International Health Electives programme run by IHMEC is funded by the Development Awareness Fund of the Department for International Development (Grant DAF 30, Using medical students and young doctors as educators for development awareness). The Nuffield Fellowships in International Health are kindly funded by the Nuffield Trust. We would like to express our gratitude to all our partner institutions for their support for the programme.
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