The ethical impacts of international medical electives on local students and patient care

International electives are often considered a valuable learning opportunity for medical students. They can benefit students by allowing them to develop new skills and be exposed to different healthcare settings, as well as increasing their understanding of public health and social determinants of health. Yet, as travelling to lower and middle income countries for electives 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. These ethical themes were: Exceeding clinical competence, One-sided benefits in partnership, Respect for patients and local culture, Use of limited local resources, and Collaboration with local community and colleagues. 

In addition, we grouped the existing papers by the "perspective" on which they were based: we analysed how themes were addressed in publications based on students' reflections after returning from electives, compared to publications written by members of host institutions in LMICs. We found that there may be a mismatch between what the host institutions regard as the key themes and what the visiting students identify and reflect upon. The possible negative impact of elective students' presence on local students’ education and on patient access to care are examples of ethical themes which are not adequately addressed by students on their electives.

Our review demonstrated that while there is a degree of awareness in the existing literature of the potential negative impacts of medical electives, continued work is needed to ensure equitable partnerships. We suggest ways in which future efforts could focus on implementing mutually beneficial changes into elective programmes. This could involve pre-departure training and post-elective debriefs and publications, to increase students’ awareness of the impact of their presence on the host community.

You can read our article in full in BMC Medical Ethics.