In the UK the medical elective is one of the most eagerly anticipated parts of a students time at medical school. Academically it is an opportunity to study an area of interest in more depth, and learn about the healthcare systems in other countries. It is also one of the few chances senior medical students get to travel, relax and escape from the day-to-day monotony of university life.

I was therefore concerned whilst following the story of two elective students who were recently arrested whilst trying to cross the Jordan-West Bank border¹. I could not understand what the students were doing in such a volatile and violent area of world. Especially as their Associate Dean had specifically requested that "all students must be sure their choice of destination is a safe one that avoids the potential for either injury or incarceration on political grounds"². It is well known that Israel and in particular the West Bank are dangerous areas, especially as only 2 weeks previously two British men had carried out a suicide bombing on a Tel Aviv bar. Students were also advised to consult the Foreign Office Website before travelling, and this again underlined the dangerous nature of the area by strongly advising against travel to the West Bank.

Although the students involved claimed that they were merely visiting the region as tourists, it strikes me as unlikely that this was their only motive. A statement released by Birmingham University Palestinian Society hints towards political motives behind their visit - "The Palestinian Society takes pride in the courage of its executive members, Tahseen and Iyaz, and deplores the brutality and rogue behaviour of the Israeli security forces."

The conflict in Israel/Palastine has claimed the lives of many innocents, and it always raises strong feelings in supporters of both sides. But, however strong your feelings, and however brutal the atrocities, this is not an excuse to abuse your position as a medical student, and abuse the trust given to students for their electives.

The arrest of the students has reflected badly both on the medical school involved and medical students in general. They purposefully ignored advice from the medical school and put themselves in unnecessary danger, caused a minor political incident for the country and embarrassed their fellow students. It seems likely after this incident that future elective students will loose some of the much-prized independence that comes with the elective. I hope they are proud of their political statement, and that they feel it is worth the damage to the reputations of hundreds of future elective students.

1. UK medical students arrested in Israel, P223, July 2003 issue, by Clare Hughes
2. University of Birmingham Medical School Office Web Page

My response is to a respondant doctor rather than to the article itself, an informative and eyeopening piece. I was concerned after reading it (and making a mental note to ensure that my own elective was trouble free!) to find that Dr. Halpem seemed to think that the two students detailed in the article, simply by virtue of having muslim names, had sinister "alterior motives" for completing their tour of the middle east by entering israel. I myself and many of my friends have similar plans, not to cause terrifying disruption, but to appreciate a city of such grand history that holds three great monotheistic faiths together. I was appalled to find that Dr. Halpem decided (as apparently the israeli authorities had) on the guilty motives of the medics. As for his condemnation, that they were searching for trouble by going to an unsettled area, I would hope that all medics use their electives to truly go to places where the people are in need of their help rather than going on a glorified vacation to the States as most do. Hopefully it will build on our desire to continue to donate our services (as medcins sans frontiers does for example - without being accused of spoiling medicine for everyone)once we have our house jobs. Facts are important when you intend to comment, and it disturbed me that one of our own should negelct that fact.

A few things got me wondering when reading this article and its responses. No qualms are made at the "fact" that the Jordanian Authority held the students for the same amount of time as the Israeli's. I wonder why this is? "Facts", as Natasha calls them in her response, are also of little compensation to the families devastated by the attack in Tel Aviv "allegedly" by two British Muslims. The blissful ignorance of not living in a country where constant attacks on our everyday life (and family) occur, means it is hard for us "British" to understand the somewhat "over-protective" nature of the Israeli government to defend itself (the only democratically elected country in the middle east). Explore the splendor of Israel by all means. But, as Dr Halpern pointed out, sensitivity to their unfortunate "imposed" situation must be taken. With love

I don't think the idea of reducing the training period of the consultants is going to work.

The current training does not provide a sound clinical and operative experience for juniors.The situation is much worse in teaching hospital.If the government want to train sho to consultant level then they have to assess all DGH and teaching hospital . Only a very few consultants allow their sho to operate.The will result in reduced number of taining posts for trainees.Most of the teaching will be derecognised. The number of nontraining posts will flourish.

uk has a lot of associate specialist and staff grades.They can be absorbed after formal assessment and examination.

A junior consultant will struggle to make decisons and will have to depend on senior staff grades for operating difficult cases.

American medical education very uniform. Almost most of the post gradutes get equal oppurtunity and uniform training. But in uk the training is very variable and worse.

If they reduce the traing hours and the traing period NHS will have to face more medical negligence claims and will collapse

White¹ seems to have somewhat missed the point, and has added to the current disheartening barrage of negativism. Recent letters suggest that the student should be guided by strict rules, but since every situation in medicine is different, it is far more appropriate to be guided by dynamic principles.

To address White's¹ specific point, I have heard from many people who have been made to introduce themselves as 'Doctor', but I have heard of no-one who has gone on to use this title alone without having first graduated. The way people choose to teach is as diverse as the ailments in any A&E. Caley² illustrates how the term 'medical student,' is confused by many patients with physiotherapists, social workers and nurses, and although I am not suggesting we all wear doctor badges tomorrow, it is sometimes necessary to clarify in varying ways who we are, and thus rigid rules here would cause problems. The debate following Henderson's³ letter on white coats being the identifier of the student illustrated that hard and fast rules on this matter again cannot be applied, since the student has to move through many different circumstances in many different hospitals; simply dress accordingly. The StudentBMJ itself recognises that "morals applied to medicine are not fixed but fluid"⁴.

Furthermore, although it is important to report mistakes in a public forum to ensure that they do not reoccur, we must do this in a responsible manner, as the negative slants as seen recently in the BMJ family cause the medical profession to lose credibility with itself and the public, and we become reluctant to openly admitting our mistakes.

Hinduja's⁵ report on increasing apathy towards teaching has a decidedly negative angle and although an interesting (albeit very limited) study, no suggestions on how to remedy the situation are offered. Of the many responses to Caldicott's⁶ paper regarding consent and medical students, very few offered constructive advice on how to improve the situation. We should exist in a culture where we embrace our mistakes. White's¹ "fears" for my ethical development make me positively depressed, and I thus await the uplifting guidance which is lacking from her original letter.

At the risk of this turning into a negative offering, I recommend that whenever we feel the need to criticise, do so openly, but regular follow-up with positive suggestions is just as important.

1. White D. Deceitful behaviour is not justifiable. StudentBMJ 2003; 11:255
2. Caley M. White coats and stethoscopes - Integration is better than differentiation. StudentBMJ 2003; 11:165
3. Henderson J. We should help patients differentiate between us and doctors. StudentBMJ 2003; 11:124
4. Moscrop A. Is it time to end taking Oaths? StudentBMJ 2003; 11:133
5. Hinduja K, Samuel R. Are attitudes towards teaching changing? StudentBMJ 2003; 11:211
6. Coldicott Y. The ethics of intimate examinations-teaching tomorrow's doctors. BMJ 2003;326:97-101

Dr. Chaudry's article was concise, informative, strong, and heartfelt. I only wish all muslim doctors could express themselves with such clarity and conviction! I hope the article helped broaden the general public misconception of not just islam, but the vibrant women who are a part of it.

it is a matter of our concern that in the name of moderning medical careers-gross changes are abruptly taken into consideration in UK post graduate medical education.

Under our Foreign Medical Students'Programme in our medical college in P.R.China,we train our medical foreign students to compete for post graduate courses in UK i.e. FRCS/MRCP examinations.

Our medical students need early informations about likely changes in UK post graduate medical education and training programmes, to avoid embarrassments and unnecessary expenses leading to frustrations afterwards.

Our teaching faculties need necessary orientations and we need to update our teaching learning curriculum if necessary.

It is surprising to note that 86% of the medical students in UK ,were in dark about the possible changes there.

Secondly,it is difficult to agree with the comment of the author that the concept of a "good doctor" is deeply personal.We must not underestimate the aspirations of our honoured citizens and their valued expectations towards the qualified doctors in the country.We must inculcate the sense of responsibility and doctor like personality among our medical students.

We understand that primary care doctors are "masters of none".But we can not demoralise our students with such hurting comments in our correspondences.

First year students should start their academic career in medical science to be jack of all trades first.

After obtaining MBBS degree ,they should think about specialized trainings and post graduations.They should not get started with preoccupied mind.

It is very true that students' ambition changes with gradual maturation.After getting real life experiences matched with their capabilities,medical graduate's decision making personality develop finally.

On the otherside of the coin -"GMC proposes radical changes to registration"-Rhona MacDonald BMJ 2003;327:123(19th July) is an exciting news for all of us here.Limited registration issued to NOn-EEA doctors till date, is a kind of disrespect shown to the overseas doctors working in UK.

We congratulate GMC president Dr.Graeme Catto for his brave decision to issue single type of registration to all doctors,regardless of where in the world they have qualified.

We,on behalf of all the foreign medical students in this college whole heartedly welcome his decisions framed on the principle of equal treatment for all doctors.

The devastating effect of Severe Acute Respiratory Syndrome (SARS) witnessed in China mainland,is a life time experience for handful of foreign faculties and foreign medical students in Xinxiang city.We all are happy to know that SARS epidemic is coming under control-(WHO).

We also reported recently "SARS almost over-a great relief BMJ(1st June'03)BMJ.com/cgi/eletters/326/7399/1110-0-a in response to Scott Gottlieb's report in BMJ 2003;326:1110-a-0-a.

But there is still pockets of anxiety and worries in different countries till date.The relapse of SARS cases in Toronto in recent time, taught all of us to be careful and not to loosen the seat belts till WHO shows the green signal.

After extensive co-operation to WHO leadership and active involvement of total Governmental machinary in China mailand, remarkable decline in total number of SARS cases has been visualised within limited time period.

Aggresive media involvement for general public awareness all over the country and abroad, helped to control non-essential movements of people within and from outside the country.

A kind of panic situation was developed among common people.Ill-defined knowledge about the mode of spread of this disease, created futher apprehensions and chaos in public life.

Adverse effect of excessive media coverage leading to psychosocial changes in ex-SARS patients, were observed in different cities like Hongkong,Singapore etc.We reported "Post SARS Social Syndrome" BMJ(6th June'03)bmj.com/cgi/eletters/326/7401/1232 in response to the news reported by Jane Parry,BMJ 2003,326(77401)1232.

At present,necessary preventive measures have been put into place and situations are coming under control beyond doubt.

This is the time when our negligence may teach us another bitter lesson like Torono,Canada.We need to be careful.We must wait and watch.

The editorial team of studentBMJ is not politically biased. Ayesha was using this example to illustrate a point,¹ and we do not consider her to have "hijacked the article to her own biased political end."

studentBMJ does ask authors for a declaration of competing interests, in line with BMJ policy. You can read about this policy at www.bmj.com/advice/editorial_policies.shtml