The crown jewel of medical school

Your elective could be the most exciting part of your time at medical school. Earim Chaudry and Aeisha Aslam explain why and how to organise one

One of the highlights of your medical degree is the opportunity to spend time abroad. Ask almost any doctor about their elective and you're almost certain to induce a kind of nostalgic daydream. “Ah yes my elective,” (glazed eyes and smile). “I had a really amazing time. So where are you going?” (typical blank look from medical student). “I don't know, I haven't given it much thought yet.”

Here is a guide to help you to plan your elective, wherever it is you decide to go. It is important to remember that the elective is your chance to sample whatever type of medicine you would like; you have complete autonomy to travel anywhere and do anything you want (well almost). There are opportunities to work in almost any country in the world, from remote medical outposts deep in tropical jungles through to working at the forefront of medicine and surgery in state of the art hospitals. You are unlikely to have the opportunity to travel abroad for two months when you are working, and your next chance may well be in retirement. As with most things in life, what you put in is what you get out. A bit of time and organisation can make the difference between just completing a compulsory part of your course and enjoying the experience of a lifetime.

Although organising an elective can be a baffling and stressful task, it doesn't need to be. Here are some pointers to give you a helping hand.

Should I stay in my home country or venture abroad?

If you have personal, academic, or financial reasons for wanting to stay at home, there is no reason why you shouldn't still have a memorable elective. Try to at least spend your time in a hospital somewhere different from where you are training—for example, if you are from London, head to Edinburgh or Dublin. If you are training in the United Kingdom, why not try something different, such as an elective with Her Majesty's Prison Service (www.hmprisonservice.gov.uk) or the Helicopter Emergency Medical Service (www.hems-london.org.uk), which is based at the Royal London Hospital.

Poor finances need not prevent you from travelling abroad, because there are plenty of funds to apply for before you give up hope (box 1), and if the worse comes to the worse, take out a loan—remember, you will soon be earning. Wanting to spend extra time revising at home is always a poor excuse because you can always deepen your knowledge and your tan abroad.

Your elective should broaden your horizons, and not only on a clinical level. Going abroad will immerse you in a whole new culture and approach to medical care, and there is definitely something to be learnt from being away from familiarity. Most probably you will see conditions and diseases that you have never seen before and will probably never see again.

Developed or developing world? And where?

There are a multitude of factors that will inevitably help you to answer this question. If you feel that you have a yearning to see cutting edge medicine with all the latest innovations and treatments then America, Canada, Australia, certain parts of South Africa, and Japan (although a firm grasp of Japanese would definitely be helpful) are likely to satisfy your desires. These countries have well established elective programmes that are easily searchable on the world wide web, although be aware that some places are very popular and are likely to be booked up more than a year in advance, so apply as early as possible.

Electives in developing countries certainly carry greater risk and are difficult to organise, but the rewards are potentially greater. Although you may be missing out on your home comforts and the things you take for granted, such as hot water and a Western style toilet, this is compensated for by the opportunity to really get stuck in at the hospital. You will learn, in the absence of investigations, to use only your clinical judgment. There are likely to be ample signs of advanced disease, and practical procedures to perform, and perhaps for once you might actually feel like a valued member of the medical team. Problems

may arise, however, when you turn up to realise that, actually, you are the team. This can be difficult because without you the patient may receive no care whatsoever. Wherever you go and whatever you do, just remember to apply some ethics. You are not qualified yet. Is there a reason why they don't let you do these things back at your medical school? You should be aware of the standards set by the General Medical Council that will apply to you as a future doctor — recognise the limits of your professional competence.

Some medical schools allow students to visit two separate countries, in which case it would be an excellent idea to compare medicine in developed countries with that of developing countries.

Researching and deciding where to go

A wealth of information is available, and a good place to start is Mark Wilson's fantastic book, ¹ which gives details of hospitals in more than 100 countries, with helpful comments about what to expect from an elective, and even advice about accommodation and social life. Don't forget to check out the book's section on adventure medicine, especially if you are interested in an elective at the National Aeronautics and Space Administration (NASA), or with the flying doctors service, or even if you just want to escape the smell of hospital food.

Use the internet—it truly is your window to the world (box 2).

Try to get hold of previous elective reports by students in the years above you as they are likely to be brimming with plenty of practical advice (box 3). Some of your consultants may have contacts abroad who are doing specialist work that you might be particularly interested in—if you don't ask, you will never know. Travel brochures, and the Lonely Planet and Rough Guide books are definite sources of inspiration and may well kindle an interest.

Climate, language, religion, safety, and cuisine are all factors to consider. If you don't speak the national language then history taking is going to be limited by your skill at charades. In countries such as Malaysia, even though only about 30% of the population can speak English, the doctors teach in English.

Travelling alone might give you greater freedom to do what you want, but can also make for an extremely lonely trip. Consider going with a friend—someone to share your experiences and living costs with—and most importantly someone trustworthy to take those silly photos of you that you will treasure for years to come.

Remember that some places are just not safe, so your social life may be severely limited, and although the trauma in South Africa is legendary, you would not want to be on the receiving end of it.

Areas where HIV is prevalent are also worth a special mention. Although the needlestick transmission rate is about 0.3% (surprisingly low),² don't consider these areas if you think that you will be too fearful to even touch a patient. Students who are determined to go to such high risk areas have to appreciate that they need to purchase a post-exposure prophylaxis kit, which is likely to cost around £100.

What you do and where you go will be limited only by your imagination and resourcefulness. The world is well and truly your oyster, and as Mark Wilson says, “Medicine is your passport to the world.”¹

Earim Chaudry , final year medical student
Email: e.chaudry@ucl.ac.uk
Aeisha Aslam, final year medical student, Royal Free and University College London Medical School, University of London



studentBMJ 2006;14:265-308 July ISSN 0966-6494

1. Wilson M. The medic's guide to work and electives around the world. London: Hodder Arnold, 2004.
2. Tokars JI, Marcus R, Culver DH, Schable CA, McKibben PS, Bandea CI, et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. Ann Intern Med 1993;118: 913-9.