Things to consider before planning your placement

CONSIDERATIONS WHEN PLANNING YOUR ELECTIVE

Planning and embarking on your elective is an exciting time! As well as experiencing a completely different healthcare system, it’s an opportunity to travel somewhere new and experience a culture that is very different from your own. However at the same time many students are apprehensive when embarking on their elective and what they may encounter whilst away. We hope to ease these anxieties by providing the necessary knowledge and advice to help plan an ethical elective.

An important part of planning your elective is being aware of different environments and situations you may be faced with whilst abroad. Various barriers can prevent UK students from engaging in responsible medical placements abroad and students may find themselves unprepared for resource limitations that the area may face. This can lead to students finding themselves in situations where they are faced with ethical dilemmas. Many students feel overwhelmed upon arriving and don’t feel equipped to deal with situations they are faced with. This can lead to them making decisions they would not ordinarily make. When working in a resource poor setting, students may feel more pressure to work beyond their competence. When appropriately supervised and with the patient’s consent this may be appropriate, however this is often not the case and students may feel pressure to act believing that any intervention is better than nothing. Cultural relativism, the notion that ethics abroad are different to back home, encompasses this idea however students should remember that they are held to the same standards abroad as they would be back in the UK and anything they would feel uncomfortable doing in the UK they should feel equally uncomfortable doing abroad.

Medical electives require a lot of organisation and are a high administrative burden. For healthcare systems that are already resource stretched this can be a source of further strain. In addition, students need to consider how much supervision they can realistically expect in resource-poor countries. This can be a barrier to students undertaking responsible medical placements as they may not fully appreciate this whilst planning their elective and only upon arrival do they realise they may not have the supervision they were hoping for. This is when situations that lead to difficult ethical decision making arise, for example be asked to carry out a procedure beyond your skill level without supervision.

Additionally, it is common for medical students to embark on electives where they are unable to speak the local dialect. This communication barrier can lead to students being unable to effectively communicate their level of competence. It may be the case that students end up in ethical dilemmas due to local healthcare professionals misunderstanding their clinical skill level. Medical students should take this into account when organising their electives and decide whether their language skills would be appropriate for that country as improvement in communication therefore would help to alleviate this problem.

In conclusion, several barriers prevent medical students from undertaking responsible medical placements abroad. A major factor is the lack of understanding prior to organising and embarking on placements abroad. Both of the healthcare system they are visiting and of the ethical decisions they may be faced with. Therefore research prior to embarking on an elective is key and will make a huge difference to how enjoyable it is.