1. Electives
Presentation
Jonny Currie
Bristol

4. Why do we do electives?

5. Overseas electives
 Different cultural and
organisational setting
 See diseases rare in UK
 Personal development
 Travel
 Experience different
medico-social context

6. A tale of two electives…
Adams and Sheather, 2001. Elective
Ethics. sBMJ 9; p.305-356.

8. Medical tourism
 Self-serving
 Raise unmet expectations
 Ineffective
 Impose burdens on local
health facilities
 Inappropriate
If under colonialism natural resources and human labour
were exploited;
Are western societies now using under-developed
nature of developing countries as training grounds for
their own teachers and other professionals?
Are medical electives the new neo-
colonialism?

9. Are medical electives the new
neo-colonialism?

10. Practising ethics
• Ambassadors abroad
• Discomfort about suddenly being expected to
“see patients”
• Poor supervision
• Limited resources
• Huge health needs
Justifies acting
role of doctor?

11. Practising ethics
 Patients have right to know are being cared by
students
 Ethics of intervening
 Legal ground
 Moral boundaries

12. Risk to the poor – benefit to the
rich
• Medical students profit from
international elective experience and
practise within USA/Europe
benefits in training transferred to
patients in developed world
• burden of harm is placed on the
population in the developing world
and most benefit is accrued by
patients in developed nations
 exploitation might emerge

13. The Elective Industry
 Parallels to Gap Year industry
 Diverse organisations
 Simplistic definition of development

14. The Elective Industry
SPW is a true development
organization. We will not send you on
an exotic holiday where you can also
indulge in a little teaching, or
environmental work. You will
know that if you participate in one of
our programmes you will be helping
to make a real difference - not only
for your CV, but for the people you are
working with.
Original emphasis, Student Partnership
Worldwide, 2002
Does the idea of travel to far off
destinations appeal to you? How about
the adventure of joining an expedition into
the world’s greatest mountain ranges? And
I expect you’d like to help a
disadvantaged community and acquire
new skills while working on an aid
project . . . . At the same time you’re
probably thinking about how your Gap
Year will fit into the broader picture, will it
be something to impress future employers
and how will it look on your CV?
Venture Co., 2002, p. 1

15. Incorrect representation of
‘developing world’
Limited critical engagement
allows students to confirm their
presumptions, with added
authority of ‘experience’
Fatalistic faith in the ‘luck of
the draw’
‘Lotto logic’
Outgoing reflections of students
What the gap year industry lacks is a pedagogy for social
justice

17. The route to internationalisation?
 Authors question whether
electives enable students
to meet requirements of
globalisation
 Comprehensive
programme of international
health teaching
 Preaching to the converted
Edwards et al, 2004. Understanding global health issues: are
international medical electives the answer?

18. Curricula for change
• WHO qualities of ‘5 star
doctor’
• Community oriented
• Reconciling individual and
community needs
• Initiating actions on behalf of
community
 Tomorrow’s Doctors:
 Public health medicine
prominent in curriculum
 Health promotion;
 illness prevention;
 Assessment and targeting of
population needs
 Awareness of environmental
and social factors in disease

19. International Health electives
 Karolinska Institute,
Sweden
 Global Multiculturalism
Track, Massachusetts,
USA
 University College
London, UK

20. Health Systems
 Developing countries face
severe health workforce
shortages
 4 million health workers
needed to fill gap (World
Health Organisation)
 NGOs can lure qualified
people from Ministry of
Health and into private
sector

21. Parallel health systems
 NGOs can high more staff
at higher salaries
 Can acquire specialised
equipment
 Or create idealised projects
serving one limited
population in a geographic
area
 Result is a fragmented
and inequitable health
system

22. I. NGOs will engage in hiring practices
that ensure long-term health system
sustainability.
II. NGOs will enact employee
compensation practices that
strengthen the public sector.
III. NGOs pledge to create and maintain
human resources training and support
systems that are good for the
countries where they work.
IV. NGOs will minimize the NGO
management burden for ministries.
V. NGOs will support Ministries of Health
as they engage with communities.
VI. NGOs will advocate for policies that
promote and support the public sector.

23. Funding
 Electives operate in
context of inequality
 Consider how you
spend your money
 Ethics of funding?

24. What can you do?
 Before you leave:
 think what you hope to
gain and what you are
capable of doing
 question medical school on
when to ask for help and
what to do when not
forthcoming
 knowledge and skills of
health context
 Broad learning on
determinants of disease

25. What can you do?
 Once you’re there:
 discuss with supervisor
what is expected and
how you can be most
helpful
 offer something in return
 relevant research
 On return:
 future student or research
exchanges
 Reflect on experience
 Develop global
understanding

26. Final remarks
 We live in a global
economy; surely we
should practise global
medicine?
 One-way process
 Strive to minimise the
risk: benefit ratio

27. Essential reading
UCL Elective Pack
Available at:
http://student.bmj.com/international/elective_pack.php
Improving health for the world’s poor: what
can health professionals do?
http://www.bma.org.uk/ap.nsf/content/Improvinghealth

28. Global Health education
http://www.medsin.org
http://globalhealthedu.org/Pages/default.aspx

29. Websites
http://student.bmj.com/international/electivenpack.php
http://www.bma.org.uk/ap.nsf/content/Improvinghealth
http://www.medsin.org
http://globalhealthedu.org/Pages/default.aspx