Sam Marns

Too much choice? Don't take the easy route - TEN Award ~ Christopher Lewis

by Sam Marns on 17 Oct 2016

“What challenges are faced by UK medical students planning their electives today?”

For the focussed, contented or indifferent passenger, the medical career treadmill is an efficient and predictable path to consultant specialism. The elective is frequently described as a once-in-a-lifetime chance to temporarily escape this system without penalty, where permission is granted to step away from the directed learning outcomes of the university curriculum and into the unknown.

As a cohort of high-achieving obsessives, the idea of being granted one single opportunity to experience florid exotic diseases and rediscover that child-like enthusiasm for our vocation poses a source of both excitement and huge anxiety. Sifting through the limitless possibilities of location and specialty, designing an award-winning project, liaising with supervisors at home and abroad, recruiting (or politely declining) travel partners, and managing to keep within tight budgetary constraints... How does one even begin to arrange that ‘perfect’ placement?

It is safe to say that the logistics of planning an elective have evolved enormously since the turn of the century. The dawn of the internet age and the subsequent explosion of online resources has revolutionised communications. This unprecedented connectivity yields obvious benefits to the elective-planner, whose forebears can readily share their experiences, suggestions, and warn others of pitfalls to avoid. The collective bank of knowledge continues to grow exponentially. Ideas and inspiration for placements abound; enquiries and logistics can be arranged with a few keystrokes and the click of a button. What could be easier?

Unfortunately, for the adventurous medical student the blessing of organisational simplicity is also an extraordinary curse. Suffocated by choice, students from across the world default to Tripadvisor mentality and flock towards hospitals with the best online reviews and the most responsive administrative staff. While a straightforward booking process offers a source of comforting reassurance and alleviates pre-travel stress, on arrival the impersonal status of being ‘just another elective student’ may detract from learning experiences and hamper opportunities for cultural integration. Those highly-coveted stories of rare pathology and life-saving interventions at the bedside lack pizzazz when six other students were also clamouring to observe; meanwhile, that fascinating case report may well have already been hijacked by another more astute colleague.

There is a certain irony that organising a placement abroad may never have been simpler, yet breaking trail and enjoying novel undertakings may be more challenging than ever. The elective paradox. Google has placed the world at our fingertips, yet robbed us of the tools to explore beyond the screen. A hospital with no email contact, let alone a formal elective programme, is a terrifying prospect. The hassle of obtaining an international calling card, calculating office hours in a country halfway across the globe, trying to explain the concept of an elective to an administrator speaking their third language over an awful, crackly line in the middle of the night, or even – heaven forbid – trying to access a prehistoric facsimile machine... With so many hundreds of other highly rated opportunities so readily available, the inconvenience of contacting an unproven backwater is a steely deterrent.

Our medical education squeezes the imagination out of all but the most resilient of us – drowned in rigid learning objectives and beaten down by fatigue, we are conditioned to follow the path of least resistance, play by the rules, and select the best choice from options A to E. Perhaps the greatest challenge of organising an elective today is in escaping the consumerist mindset, resisting convention and creating rather than simply choosing an experience. For those who manage to achieve this, the fruition of such a personal endeavour is possibly the elective’s greatest reward.

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