Electives have been part of the UK curriculum since the 1970s and today remain an exciting prospect as it gives most students their first experience of international health, the challenge of living and working in a culture different to their own, and for some, an opportunity to relax on the beach.  However, a medical elective is still fraught with challenges which are exacerbated by the fact that 35% of medical schools provide no specific pre-elective training, whilst having a lack of explicit guidelines.
One of the highest priority obstacles to overcome for students is how to fund their elective. Given that flights, visas, vaccinations and both personal and professional insurance need to be paid for before considering accommodation and food, the individual cost for a student planning an elective abroad often runs up into the thousands of pounds. There are, fortunately, grants and bursaries provided by medical schools and other organisations however these are not numerous enough to cover everyone’s expenses. With the comparatively longer term times of medical students stretching the bank balance already, many have to resort to asking their parents for help, take out a loan or instead be forced to opt for a home elective to reduce costs.
The most exciting part of planning an elective is deciding where to go. I have frequently heard about the three types of electives; doing something cutting edge in a developed country, experiencing healthcare in a developing country or working minimal hospital hours somewhere hot. There is no right answer for everyone either; as although using an elective as a holiday rather than a university placement may be frowned upon by academics and more ambitious colleagues, medicine is an exhausting degree and using the time to rest to prepare yourself for future years may be best for the individual. Alternatively, it may be more important to the student to be involved in a particular field that is relevant for their future career. Furthermore, having a taste of aid work or the possibility of more hands on experience as well as a cheaper location will make developing countries tempting for some. With so many options available, including the possibility of picking two and splitting the elective, the big challenge is trying to imagine our future path, and then choosing an elective that will serve it best.
However, in the back of our mind should always be safety, and not just that of others. The tragic events that resulted in the deaths of two Newcastle University students on a medical elective in Malaysia is a stark reminder to all about how dangerous travel can be. Additionally, although many of us may have dreams of one day working with organisations like Medecins Sans Frontiers, there is a reason they don’t offer electives, and that is safety. It is with that in mind that we need to check government travel recommendations when planning our elective, and keep up to date with news and local events as the time draws closer.
Each individual placement will have its own individual challenges. Developed English speaking countries such as the USA and Australia, appear comparatively straightforward, however, placements can be difficult to organise and need to be applied for early. Additionally, universities such as Harvard could charge you over $4500 for just four weeks placement which is enough to make anyone question if the prestige is worth it. Furthermore, they have more stringent requirements for visas, assuming you can pick the right one from the 71 options if going Down Under.
However, whilst electives in developing countries may not require organisation so far in advance they have different challenges. The first being a language barrier, as GCSE French may not make the grade when trying to take consultations in a second tongue. Moreover, although you may believe you’ve picked an English speaking country, there may be many local languages, such as in India where there are 22 languages recognised in the constitution. While at least learning “hello”, “please” and “thank you” may help, the culture shock that comes with it is an unknown and will affect each person differently. It may be beneficial to have been travelling before, go with a friend or take greater care over the selection of the hospital.
As students we want a hospital where we will be supported and taught, whilst feeling part of the team. This is surprisingly hard to deliver and equally hard to assess from a website. The best source for this is reviews from students at university and from websites such as The Electives Network, however this is still subjective. Applying is at least slightly easier than choosing, but still involves updating a CV last used for bar work in 2010 and tracking down the right letters from your university before anxiously waiting up to months for a reply.
Finally, we need to think about the big questions. Am I choosing an elective that will allow me to stay within my competencies? Or given that the most frequent expectation of an elective (94%) is acquiring clinical skills, are we expecting to do more than we should? And finally, considering 3000 of 8000 UK students take electives in developing countries each year, how can we best use our electives to help the local community whilst obeying the GMC and working within our limits?  It could be argued that although not fully qualified, medical students can provide some help to a population that otherwise would receive no healthcare, however this contributes to global health inequality and assumes that the rights of the poor are different from the rights of the wealthy. 
Although organisation of medical electives can be improved, most notably by giving all students pre-elective training and clearer guidelines on the clinical skills we should expect to do abroad, it is the challenges of organising our own trip, tailored to what we want as individuals, is what ultimately makes it so rewarding.
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