Being a medical student today requires a lot of tick-box work. Yes, we are examined regularly (oh so regularly), but we cannot pass our rotations without being signed off for the time spent on the wards. Often, this can involve finding a sympathetic doctor who knows that three days before an exam you’re better off in the library than following her around, and I’m sure most students and teachers wouldn’t disagree. However when on elective we are faced with a dilemma – up to ten weeks abroad, in a new environment away from the ward-rounds and multiple choice questions. You can excuse some students for seeing it as more of a holiday than an important learning experience. And so a major tension I’ve found colleagues negotiating is whether to plan their elective based on the cities they want to visit and trips they want to make, or based on the hospitals they want to work in and specialities they want to do. Some students simply plan without the hospital in mind at all. Often there’s a correlation between the conscientiousness of the student and the decision they make. But even so, I certainly know of at least one student who spent 2 weeks on the wards and the rest travelling, making up for time spent in libraries during his degree. The question is though, can you blame him?
Electing to take some time off
An important aspect of being a doctor is understanding people, and people don’t just live in hospitals. The type of patients we see in a GPs office and an ophthalmology theatre are incredibly different. Part of each rotation is about learning how to deal with the different mind-sets, pathologies and expectations of these patients. The types of patients my friend sees in inner-city Tottenham are miles apart from the ones I see in leafy Oxfordshire. Hopefully, through rotations in various parts of the UK as a junior doctor, we will have the opportunity to experience and learn from these sorts of differences. In our NHS we are increasingly seeing patients from all walks of life, and from countries across the world. This is where the elective comes in as it’s important to know how disease is managed and treated in other countries. But isn’t it also important to know what life is like in other countries?
It can be argued that the elective gives medical students a unique chance to do this. Most of us went straight from school to university with no gap years or chances to explore the world. Beyond family holidays, our knowledge of living with other cultures is narrow. Many of us haven’t even truly experienced the working world like our peers who already left university. And even while at university many medical student found it impossible to juggle a part time job with the demands of the degree. There’s also the issue of the students themselves – 80% of medical students come from homes with a professional or someone in a higher management role and more than a quarter were privately educated compared to 7% nationally (http://www.theguardian.com/society/2016/jan/22/medical-school-students-wealthy-backgrounds). This means that over the course of our degrees we are around very similar people to ourselves – often higher socioeconomic status. Thus maybe it is valuable for people to see the elective as a chance to break out of this bubble and meet new people from different backgrounds, outside of a hospital context.
What makes this different from previous generations of elective planners? Well I believe this craving isn’t helped by a desire for originality, especially in the age of social media. Every medical student has seen uploads from their peers’ electives – photos in beaches and on jungles and up mountains. And the stories are fittingly whacky and wonderful. While planning it seems to be a constant competition as each student wants to out-do the other: “Oh, you’re doing trauma in Australia? I’m doing helicopter medicine”, “Oh, you’re doing psychiatry in Cuba? I’m doing ocular surgery on a rural Canadian Aboriginal reservation”. There’s so much choice, but also so much pressure to make the best, or rather, coolest choice (though thanks to TEN there are lots of amazing and unique opportunities to choose from). Furthermore, as young people are constantly anxious about our career progression, and of making it onto the property ladder and working in an NHS which is facing very difficult times, we may be less likely to take time out of our careers to work abroad in the future, unlike our forbearers who have taken sabbaticals to work in Australasia, Africa, Asia and beyond. Therefore we want to use this opportunity to explore while we still can.
Electing to do some medicine
Of course, this argument is not without its drawbacks. First of all, the medical elective is fundamentally that – an opportunity to observe and practice medicine in another part of the world. Taking 8 weeks off to jaunt around your chosen country or countries is denying us the chance to gain really valuable experience of medicine. For example our speciality rotations in my university each last 8 weeks – i.e. I learn all the paediatrics I’m expected to know as a junior doctor in that time. Thus taking that chunk time out on elective when it could be used for medicine seems like a waste of potentially great medical experience.
Furthermore, by staying in a hospital context we can learn more about the standard of care people expect in their home countries and the general culture of health – there may be some disease manifestations or behaviours which only make sense to us once we see them in context. This isn’t just for the obvious examples such as infectious diseases. For example mental health issues often present differently in people from different cultures and seeing this in a health care facility abroad may better prepare us to notice it in the UK. Furthermore, doctors will be expected to take on more management roles in the future, and a big part of that is setting up and running health systems. Seeing how it’s done in other countries, we can learn both useful tips and things to avoid which we wouldn’t be able to do had we spent our elective on the beach.
Finally, but importantly, there’s the element of trust. No university sends their students off expecting them to ditch their placement at the first opportunity. We are required to get signed off, or at some schools, we are simply expected to have the integrity to stay where we said we would. This is incredibly important – the elective is one of our first opportunities to assume the role of a junior doctor. Trust and integrity are pillars of the medical profession and it would seem bold, foolhardy and unprofessional to abuse the trust given to us by our medical schools. Being trustworthy is something which must be cultivated and earned. It doesn’t just come with the title “Dr”. And I would propose that the student who “sacks off” her elective to travel in Chile will struggle – at least initially – to develop that trustworthiness as she progresses through her career. This is of course something which is hard to measure, and who knows if it has an impact on patient care. But if we are to take our role as doctors seriously I think it demands a certain respect to the institutions we belong to – the universities or our future employers. And so I believe staying true to our brief is an important part of that.
While no-one would argue that some travelling is an important part of the elective, I feel that in order to truly make the most of it, we ought to keep it as medical as possible (including research and other related fields). Whilst exploring a city’s bars is a once in a lifetime opportunity, so is working in its hospitals as a student with little responsibility other than just learning as much as you can. And so while I won’t promise to spend every day of my 10 weeks on the wards, I’m looking forward to experiencing medicine abroad as fully as I can.