Regardless of a medical student's eventual career path, there are enormous benefits from a successful elective:
However, the benefits of an elective can go far beyond improving a student's medical knowledge and interpersonal skill-set.
The elective is a key training tool for strengthening students' understanding of other cultures and a broadening of their world view – a vital preparation for working within an increasingly multicultural population in the UK.
As doctors are increasingly being called to lead within the NHS, there is an urgent need for students to gain understanding into the complex interactions, barriers and opportunities within different health systems around the world.
Most importantly is that beyond the impact at the individual level, electives present an underappreciated opportunity for the sharing of insight, for mutual learning and for advocacy for global health – both in the UK and in the recipient countries.
In recent years, increasing attention has been drawn to the ethically challenging aspects of taking a medical elective. The GMC requires that all medical students and doctors must "recognise and work within the limits of [their] competence", be "honest and trustworthy" and "act with integrity". Whilst clear protocols for students usually facilitate strict adherence to these requirements in UK healthcare settings, an elective abroad can often present circumstances in which students may become unsure of how to act appropriately.
Too often, students are unaware that the rules of practice to which they are bound at home, are entirely applicable when working in other countries.
The most common ethical challenges are encountered in resource-poor countries, where limited staff and clinical equipment combined with an immense burden of disease mean that students feel an expectation to undertake medical procedures they are neither trained for nor qualified to perform. It is an unethical and dangerous idea that the elective period can be used to gain experience in such practices and is likely to have traumatising consequences. The lack of qualified local staff can be particularly problematic; with inadequate student supervision or the students themselves taking up the already restricted time the doctors have with their patients. Other challenges arise from misunderstanding of local culture, for example of differences in social structure, methods of healthcare provision and the role of gender, family and religion. Students may also find themselves in situations where the line between cultural differences and breeches of human rights is unclear, as is how to react to thses situations.
However, there are several sources of guidance that allow students to make the most of an elective whilst protecting themselves and others from breaches of professionalism and the potentially disastrous consequences.
By taking simple steps to ensure that there is adequate supervision, appropriate expectations and effective follow up and reflection, an elective can exhilarate, motivate and stretch a students' understanding of global health resulting in a refreshed outlook on their own future as a doctor.
Electives have long been part of medical students' final stage of training and are invaluable opportunities to gain insight into healthcare in different social, cultural, economic and political environments.
Whether on clinical placement, volunteering or doing research, students' experiences around the world give them the opportunity to see some of the most important challenges in global health and to consider how the international community should work together in tackling them.