sBMJ | Go for it

Go for it

The studentBMJ, in partnership with the IFMSA, has launched the new International Experiences section on studentbmj.com, where students can post a report of their elective and IFMSA exchange experiences. Helen Gordon and Se Eun Jung explain what an IFMSA professional exchange is all about and what it takes to set up the programme in your medical school

Every year nearly 7000 medical students escape from the medical school they know so well to learn something new, which they cannot experience at home-a different healthcare system and a different life as a medical student. This programme is organised for students by students and has run successfully since 1951 and 6600 people world wide participated last year.

The IFMSA backbone
The exchanges are facilitated and organised through the Standing Committee on Professional Exchanges (SCOPE), which could be considered the backbone of the International Federation of Medical Students' Associations (IFMSA). Its aim is to promote and strengthen international understanding of medical students through international exchanges. These exchanges offer students a unique educational and cultural experience, and are an interesting addition to the traditional medical curriculum. The experience broadens students' knowledge of medical and social conditions in another country.

Each country has a national member organisation (NMO) that is affiliated to the IFMSA. For example, the United Kingdom's NMO is called Medsin-UK. The NMOs are ultimately responsible for the exchanges in their country and they oversee and facilitate the exchange process through the election of at least one national exchange officer, who signs contracts with other countries and looks after every exchange that takes place in their country. They also encourage new faculties to set up exchanges and train the local exchange officers. Each local committee at the respective medical school has local exchange officers, who organise the exchanges at local level. They explain the exchange process to the students who will be going abroad and look after the students who come to the faculty.

WWW.PHOTOS.COM
Remember, this is not a holiday-someone will expect you to work a bit

What's it all about?
Cost
The outgoing students pay a fee for the exchange, which covers their accommodation, food, and social programme for the four weeks, and that is organised for them by the local exchange officer. Each NMO sets the fee for the exchange independently, taking into consideration what they think students in their country can afford. For example, in the UK, the exchange fee is £ 180. In Ghana, the fee is €66 and in Peru $200. It can be a cheap and easy way to travel and is often one of the few ways in which students in developing countries are able to experience another way of living.

Educational experience
M In the UK, the exchanges work bilaterally (that is, as one student goes out a foreign student comes in). It is therefore different from the UK elective period and it is not a holiday. This is an educational experience in a well supervised environment, where students can experience a different healthcare system and be encouraged to appraise their own by comparison, as well as becoming more aware of global health issues.

The student is integrated into the medical school of the host country. The medical faculty may define specific clinical objectives to be achieved. Generally, as most teaching with the designated clinical supervisor is meant to be in English, the standard of medical practice and formal teaching is good. The student's clinical placement may be assessed and a SCOPE certificate is awarded at the end of the clerkship, which is signed by the supervising doctor if the student's attendance, knowledge, attitudes, and skills are up to scratch.

About the IFMSA
This exchange programme was first set up through the IFMSA (International Federation of Medical Students' Associations), an independent, non-political organisation. There are currently 86 member countries with 92 national member organisations. The IFMSA was founded in 1951 as a result of the postwar spirit of friendship among international medical students, and from the outset international exchanges were established as the core activity.

Four weeks abroad as part of your medical degree

Choice of more than 80 countries
Teaching is in English
Students pay board and lodging according to the cost of living in their own countries
General Medical Council and Global Health Council support
Awareness of international health issues
Another healthcare system
Cultural learning experience
Medical skills and knowledge
Looks good on a curriculum vitae

Student experiences
"I learnt more than I ever could have imagined. Not only was I in new and exciting surroundings learning about the housing, economy, food, and customs, but I also learnt a lot about health here. To understand some of the equipment and techniques they used I had to go back to basic physiology. I never realised that each country was so different in their medical ideas and expectations. Talking to Brazilians about their needs, expectations, and the problems they face in their healthcare system has really opened my eyes and broadened my knowledge. In among this extra knowledge I still obtained the medical knowledge and practised the medical skills that I would have learned in four weeks at home, and probably learnt even more because I was more motivated, saw diseases I am unlikely to see at home, and felt like I was representing British medical students. There were some problems, of course. It was frustrating not being able to talk to all of the patients and requiring a translator, but the doctors, nurses, and other students who spoke English were happy to help and I think even this was positive as it improved my communication skills."

Zoya Hameed, St Bartholomews and the London Medical School, on exchange to Brazil

"Being on this clerkship has given me the opportunity to live and study in London, which I think is a great city. Working in the hospital gives me a different view on what it is like compared to home, For example, in the UK doctors work longer hours than in Spain. Other than that, the working conditions are quite similar to home. Although it has been a great experience for me, I think that it was difficult for me not being a native English speaker in an English speaking country with many different accents. It was sometimes difficult to understand the patients. And although it was not my first time in London, it was my first time in a UK hospital and I felt a bit lost and would have appreciated more help at the beginning. Overall, though, I think it was a really good chance for me to learn outside of my country."

Clara Marcos Garcia, Spain, on exchange to the UK

Cultural diversity
Students can learn so much from exploring the way others work and learn. Learning about different cultures is important in medical practice and is not well taught in most medical schools. According to a recent study in the BMJ,¹ Further work is needed to embed teaching with cultural diversity within the medical curriculum and to ensure that it is valued by staff and students.The General Medical Council and the Global Health Council recognise the importance of study and work abroad and have both provided letters of support for exchanges.

Assessment
Evaluating this programme helps it to grow and develop every year. At the end of each exchange, the student is encouraged to complete an evaluation questionnaire. This information is used to improve the exchange process and experiences at each hospital. The studentBMJ website now hosts these evaluation forms, and the exchange is not complete until this on - line form is filled in. This information will be used not only to improve the standards of the exchange but also to put together a report on what students learn from exchanges and why they are so important. It will also be a valuable resource for people who are going on exchange to look up information on the faculty they are going to so that they can prepare themselves and have more idea about what to expect.

WWW.PHOTOS.COM
And also remember, you are here to make friends and have a life experience

Things your dean might ask

The role of Medsin-UK
Medsin-UK takes full responsibility for exchanges. This includes signing an official contract between Medsin-UK and the medical student association of the exchanging country

Teaching and assessment
The faculty can set specific guidelines

What about language?
All teaching in all countries takes place in English. Proof of good command of the English language is required

Clinical placement
The outgoing student has a good choice of subjects to study. The faculty should place the incoming student as any local student would be placed. The hospital should treat the foreign student just like any other homeland student

Insurance
The Medical Protection Society provides medicolegal cover for students who are members (both UK and foreign students). Both incoming and outgoing students are required to take out private travel and health insurance while taking part in the exchange programme

Occupational health
Students are required to give proof of hepatitis B, rubella, and tuberculosis immunity. Any other requirements can be added to this

Which countries should I choose?
You should choose countries that agree to our terms, especially concerning dates of the attachment, teaching, and assessment of the UK student. European Union countries often have cheaper flights, a high standard in medical practice, and better facilities, but students may learn more by going further afield. Furthermore, going to developing countries gives their students the opportunity to come to the UK. The choice is thus at the discretion of the medical faculty and the exchange officers. The choice of exchange partners can be based on the experience of previous students

What else do you need to know to start exchanging?
You need to meet your national exchange officers and go through everything, so go to a training session

But what do you do in training?
Training is mainly aimed at the local exchange officers, especially if they have only just taken over from their predecessors, and for anyone interested in setting up the exchange scheme at their university. The aims of the training are to inform people about how the programme is run and the structure of the exchanges and to provide practical information about what is entailed and general tasks and responsibilities. There is also practical training on using the necessary computer databases, as well as peer led training on intercultural communication, team building, strategic planning, conflict resolution, and many more. It is also an opportunity to share and tackle any problems or situations which have arisen or that have to be dealt with

Any other queries?
Please ask. We look forward to hearing from you

Things you must do before you become a participating medical school in the UK

Have the full support of your dean and faculty
Organise the scheme through your national medical student association(that is, Medsin-UK) and your national exchange officers
Know how accommodation, food, social programme, and clinical placement(including library and computer access) will be provided
Know the specific requirements of your faculty (health, year of study,insurance, academic references, and so on)
Come to training so that you can get to know other local and national exchange officers and you know how the programme works
Get people interested both to exchange and to take over from you as localexchange officer

Setting up an exchange
If exchanges aren't currently available at your medical school, there are ways to set them up. It might sound like a lot of work, but there are people available to help you.

Setting up an exchange

Establish a committed working group-about three to four people
Get in touch with the national exchange officers(exchanges@medsin.org) and other people already involved
Join the exchanges yahoo groups (send a blank email to:medsinexchanges-subscribe@yahoogroups.com)
Read the whole proposal and adapt it according to your university
Find a suitable period of time (a four week
clinical special study module (SSM) is ideal).
Get a letter from the clinical sub-dean in
Nottingham, and a support letter from the GMCand the Global Health Council (via national exchange officers)
Talk to people you know from the faculty and get them on your side
Find out about other exchanges and
international programmes that already exist
(eg ERASMUS), approach the organisers, and possibly get their support. Think of ways that the exchange programme could run in parallel to them

Speak to occupational health and other
relevant departments that would be
involved with the exchanges
Come up with ideas for organising board, lodging (hospital accommodation/halls of residence/student houses), and the social programme
Come up with a budget plan how much it
will cost the students/faculty
Send the proposal to the dean / faculty / curriculum committees
Arrange meetings with them in order to present the proposal
Ask for just a couple of exchanges at first
Don't take `no' for an answer, and keep going back until they say `yes'
Liaise with your national exchange officer and other local exchange officers

Se Eon Jung, Helen Gordon national exchange officers 2004-5,
exchanges@medsin.org
studentBMJ 2005;13:353-396 October ISSN 0966-6494

Dogra N, Conning S, Gill P, Spencer], TumerM. Teaching of cultural diversity in medical schools in the United Kingdom and Republic of Ireland. BAJ 2005:330:403-4.
http://bmj.bmjjournals.com/cgi/content/full/330/7488/403