Fatigue and Finance - issues when planning electives. TEN Award ~ Frazer Cowgil - Runner up

by Ruth Price on 22 Sep 2016

The Course and Fatigue

We have reached the end of fourth year. A collective sigh of relief as our shattered group collapses into the summer for a well-earned rest. One thing is on everyone’s minds to sort before the hectic placement schedule recommences, with all its trappings and challenges (for me, ironing): electives.

One of the great attractions of beginning a course in medicine was that in some distant time, when I would know all of the Oxford Handbook, would be that I could ferry myself off to some far-flung region of the world and immerse myself, dedicate myself to working in a hospital where maybe I could make some sort of difference.

But now I have arrived, I find myself thinking about sacking it all off and going for a more relaxed elective, as a break post-finals before I start work as a foundation doctor. At the end of fourth year I was ready to sleep all summer, go into suspended animation for a month. How will I be after finals, the biggest exams of my life?

Is it that the biggest problem faced is nothing to do with the elective itself, but the course and fatigue it brings? A spell in a tropical climate, afternoons on the beach, travelling around the rainforest sounds like paradise after five long years of studying. Why should I take on an arduous placement in the US or Canada when I could head off to the Caribbean?

Added into this is the length of elective. The medical school at Nottingham has been reducing the length of time that students are allowed to be out of their sight. Whereas the cohorts of previous years were afforded 10 weeks, with some of that set aside for travelling, it is now a paltry seven, with the entirety to be committed to the placement. If there is now no allowance for travelling, and experiencing the country you choose to visit, then it is no wonder that some students are looking into finding a more relaxed placement so that they may travel. This is forcing students into a poor trade-off. In the past it was possible to dedicate yourself to an elective placement and then travel. Now it is one or the other.

Home and Away

One of the big questions is whether to have your elective in the UK or venture abroad. The data from the last three years at my university shows an increasing number of students are choosing to shun the glamorous option of leaving the country to remain at home. In 2013, 55 students stayed in the UK, in 2014, there were 74, and in 2015, 85.

It is hard to say exactly why this trend has appeared, but I will propose three reasons. Firstly, the same reason as above - holiday. This may well be the last chance for some people to spend a long stretch of time at home with their families before they begin their jobs in August. Secondly, the global economic crash of 2007-08 has had an effect on the amount of the spending power of the British, with disposable income still below pre-crash levels [1]. Thirdly, the amount of danger posed by travelling abroad.

The risk of death when travelling to developing countries was put at between 1:340 to 1: 430 in a 2006 paper [2], and the publicity surrounding the deaths of two medical students in Malaysia in 2014 may have caused students to think twice about going abroad on safety grounds.

All In All

I can only really speak for those at Nottingham, but I feel the pressures of the course and financial difficulty seem to the two biggest difficulties in planning an elective. Of these, one is intrinsic to Nottingham, and the other is likely to be a national worry. I would be interested to see how the number of awards offered for electives and the levels of those applying for them has changed over the last ten years.

Either way, I am excited to have the opportunity to venture abroad, and I plan to make the most of it – though how I do so will depend on the winner of my internal debate: work or holiday?


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