Ethical issues encountered by medical students during international health electives

• Published in: Medical education 2011-07, Vol.45 (7), p.704-711
• Main Authors: Elit, Laurie, Hunt, Matthew, Redwood-Campbell, Lynda, Ranford, Jennifer, Adelson, Naomi, Schwartz, Lisa
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; Bioethical Issues; Biological and medical sciences; Developing Countries; Education, Medical, Undergraduate - ethics; Education, Medical, Undergraduate - methods; Ethics; Ethics, Medical; Female; Humans; International Educational Exchange; Male; Medical sciences; Medically Underserved Area; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Students, Medical - psychology; Teaching. Deontology. Ethics. Legislation; Uncertainty; Young Adult
• ISSN: 0308-0110; 1365-2923
• DOI: 10.1111/j.1365-2923.2011.03936.x

Medical Education 2011: 45: 704–711 Context  Medical students increasingly wish to participate in international health electives (IHEs). The authors undertook to understand from the students’ perspective the ethical challenges encountered on IHEs in low‐resource settings and how students respond to these issues. Methods  Semi‐structured interviews were conducted with 12 medical students upon their return from an IHE. A purposive sampling strategy was used. Inductive data analysis using a constant comparative technique generated initial codes which were later organised into higher‐order themes. Results  Five themes relating to ethical issues were identified: (i) uncertainty about how best to help; (ii) perceptions of Western medical students as different; (iii) moving beyond one’s scope of practice; (iv) navigating different cultures of medicine, and (v) unilateral capacity building. Conclusions  International health electives are associated with a range of ethical issues for students. Students would benefit from formal pre‐departure training, which should include an evaluation of their expectations of and motivations for participating in an IHE, careful selection of the IHE from amongst the opportunities available, learning about the local context of the IHE prior to departure, and the exploration and discussion of ethical and professionalism issues. Other factors that would benefit students include having an invested onsite colleague or supervisor, maintaining an ongoing connection with the home institution, and formal debriefing on conclusion of the IHE.