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Thursday, April 21, 2011
Blog: International electives for medical students and residents
L. Jane Easdown
An increasing number of medical students and residents are seeking opportunities to work in global health through international electives.(1, 2) In recent surveys, 25% of US medical students and 40% of UK students now have some sort of international experience before residency.(3) In residency selection it is common to look for such activities as a measure of altruism. Service or teaching in developing countries is popular for several reasons. Trainees enjoy working in different healthcare environments and seeing new diseases and treatments. They also experience more autonomy abroad than they would have at home. For those who teach, it is an opportunity to serve as a resource for others. Students often comment on how their teaching activities benefit them as much or more than those they teach. In addition, there is a growing interest in medical education about health disparity both nationally and internationally. Also, who doesn’t enjoy traveling to exotic locales? What pedagogical purpose does an international elective serve? A literature survey of US and Canadian trainees demonstrated an increase in knowledge of tropical disease and, more importantly, a change in attitude towards public health, cross-cultural communication, and serving the disadvantaged. (4) The globalization of our world has led to infectious diseases that may have been confined within discrete borders in the not-so-distant past but now traverse continents. Our own population is also more diverse due to broader immigration facilitated by the increased ease and affordability of travel. This international experience can, therefore, theoretically benefit both those at home as well as abroad.

In a recent letter to The Lancet, the question was raised as to whether the medical student electives in developing countries contribute to global health and training since the impact of these electives has been under-researched and under-assessed.(5) Many doctors have received little or no training in international health prior to these rotations. Further, there may be little coordination of a given community’s particular needs with incoming physicians. There are additional concerns about sending trainees abroad, including security and health risks. Supervision may be inadequate and lead to overextension of talents.(6) Everyone agrees, however, that these electives could potentially be a boon to underserved areas if community needs could be better matched to the specific skill sets of those physicians intending to embark on international electives.

Do you feel that all trainees should have some training in global health? How can we make more efficient use of these trainees by matching their skills with particular local needs? Do you send medical students or residents to areas of the developing world? How are they trained and how are they assessed? What advantages do you see of this approach to medical education now and/or in the future? Your comments are always welcome.

References
1. Drain PK, Holmes KK, Skeff KM, Hall TL, Gardner P: Global health training and international clinical rotations during residency: current status, needs, and opportunities. Acad Med 2009; 84: 320-5.
2. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P: Global health in medical education: a call for more training and opportunities. Acad Med 2007; 82: 226-30.
3. Banerjee A: Medical electives: a chance for international health. J R Soc Med 2010; 103: 6-8.
4. Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ: Educational effects of international health electives on U.S. and Canadian medical students and residents: a literature review. Acad Med 2003; 78: 342-7.
5. Banerjee A, Banatvala N, Handa A: Medical student electives: potential for global health? Lancet 2011; 377: 555.
6. Edwards R, Piachaud J, Rowson M, Miranda J: Understanding global health issues: are international medical electives the answer? Med Educ 2004; 38: 688-90.

Additional resource
Anonymous Educating doctors for world health. Lancet 2001; 358: 1471.
About the Author

J. Lance Lichtor, M.D
J. Lance Lichtor, M.D. is a professor of anesthesiology and pediatrics at The University of Massachusetts Medical School. He is the web editor and an associate editor for Anesthesiology.

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