medical electives

The elective is one of the highlights of the undergraduate course. It gives medical students the opportunity to witness healthcare in a different country and culture. Yet, as exciting as it may seem, it’s easy to feel overwhelmed with everything you need to think about when planning. This article aims to condense this information into helpful tips.

by Dr Gunjan Sharma

Your Aproach

your approach

The first thing to think about is what you want to get out of your elective. What do you hope to achieve from this? Here are some commonly cited reasons for picking a particular elective:

To bulk up your CV
Electives can be a great opportunity to build contacts, get more experience in a certain speciality and develop research skills. You may get opportunities to participate in audits, Quality Improvement Projects and lab research. You may also do poster presentations, attend conferences, or learn more about the speciality you’re interested in; most of which will tick the box for ‘commitment to speciality’ in future applications.

Make sure you highlight from the very beginning what your aims are for your elective. If you want to get an audit or poster presentation out of your elective, make this clear to your supervisor in your first email and ask if there are any projects you can become involved in. Not all clinicians are involved in research, so it’s best to make this clear from the start.
To visit a new place
This is the reason you will hear most people talk about. You may have seen students in the past making full use of this new experience by enjoying time by the beach, skydiving out of aeroplanes, or scuba diving on weekends outside of their scheduled elective time. Some even extend their stay post-elective to unwind after being on placement! The world is your oyster.
To experience healthcare beyond the NHS
The elective gives you the opportunity to experience healthcare outside of the NHS. This encompasses everything from private healthcare systems to no healthcare at all. You may choose a country that will allow you to experience the latest innovations in Medicine, while on the other end of the spectrum, you may learn the struggles of healthcare in a resource-poor country. If you choose the latter, you will see diseases which you’ve only read about in textbooks and hear about experiences you thought only existed in films. Many people who plan their elective with this in mind often describe their elective as a gut-wrenching and heartbreaking experience, but one which they will never forget. Below are a list of countries which offer different types of healthcare.

Many hospitals are government-run, but there are a mixure of private hospitals, particularly in major cities. In rural areas, you will find complementary medicine such as the Ayurvedic and Uani systems.

India

Japan offers a mixture of public and private hospitals. Japan is noted for its high life expetancy and low obesity rates. However, it has recently been highlighted as having a high rate of mental illness thought to be related to its work culture. A number of areas still offer alternative medicine such as herbal remedies and acupuncture.

Japan

Healthcare is left to the local authorities, which can result in lack of access to basic services in certain areas and more of an emphasis on private healthcare as a result.

Philippines

Whilst the country has a mixture of private and public healthcare, the majority of hospitals in Mexico are private, but service a very small number of the population.

Mexico

The Scandinavian countries are well known for their high life expetancy, quality of life and excellent healthcare system. Most have universal healthcare, with some sectors run by the private sector, such as primary care and dentistry.

Scandinavian Countries

Malaysia offers a combination of private and public healthcare, although it is noted that many hospitals in the major cities are privately-run and offer far better diagnostic interventions compared to their public counterparts. Health tourism also forms a big part of Malaysian healthcare.

Malaysia

Singapore has a world-renowned public and private health sector. It has one of the lowest infant mortality rates in the world. Public hospitals have more autonomy over management decisions compared to that in the UK, while Private Hospitals a wider range of more specialised and complex treatments compared to that which is offered in the UK.

Singapore

Peru offers public health care but is noted to have specific healthcare difficulties, including the risks of communicable disease due to its location and the significant difference in mortality rates between middle income and poor citizens.

Peru

4. A bit of everything
Not really sure about what you want to get out of your elective? Want a bit of downtime without going overboard?
Most people will aim for a combination of #2 and #3. They want to see what it’s like to be a doctor in another country while still having a good time. How you divide your time is up to you; some people spend four weeks on placement and four weeks travelling, while others spend more time on holiday and less time at the hospital. Of course, a lot of this will depend upon what your medical school actually expects of you.

Finances

finances

This is a common worry for many medical students planning their electives. Travelling the globe is not cheap, especially if it’s for up to eight weeks.

Some tips to reduce the cost:

Plan with friends.
Going in a group often leads to cheaper travel, accommodation and food costs compared to travelling alone.
Stay in the UK.
This is not as boring as it sounds. Many students stay in the UK for their elective and have a fantastic time. This can help to save money while still makingthe most of the elective opportunities outlined above. Remember, there are valuable opportunities available in the UK including tertiary hospitals, research labs, remote and rural hospitals and GP surgeries, and niche specialities.
Bursaries.
There are many bursaries out there for medical student electives but you have to do your research. The most common bursaries are offered for specific specialities or locations. Many Royal Colleges offer bursaries for electives within their own speciality e.g. a bursary for an elective in mental health offered by the Royal College of Psychiatry. Other bursaries offer financial support for electives in certain countries, such as India or South Africa. Your own medical school might offer support as well, so it might be worth speaking to people in the relevant department.

Here are some good places to start:

Royal Colleges e.g. Royal College of Radiologists Bursaries
Royal Medical Benevolent Fund - Excellent and up-to-date overview of available bursaries
The Association of Commonwealth Universities - Bursary specifically for electives in low-middle income countries within the Commonwealth

deciding on the location

Location

Having the whole world at your fingertips can feel overwhelming. You will hear your friends talk about their plans to jet off to Australia or sunbathe off the Amalfi Coast. But it can be difficult to decide where you want to go. Here are some things to think about.

1. Rural vs. Urban
Being on placement in a big city is very different to being in a small, rural hospital. Not only is there a vast difference in resources, you may also see very different clinical conditions and the approaches used to manage them. This will also impact the way you apply for your elective.

2. Cost
As mentioned above, finances make up a large part of the elective. Remember that doing an elective in a big city is likely to be more expensive than doing one in a rural location. Certain countries are also cheaper than others, as are flights to those areas.

Just as important is how you intend to spend your time. Spending more time on holiday relaxing may mean having to spend more; especially if you plan to travel or carry out activities like skydiving etc.

3. Safety

Alongside all the usual advice provided to tourists, you need to remember that you will be visiting as a healthcare professional. This means you will be exposed to vulnerable environments and vulnerable people - think blood-borne viruses, infectious diseases and poor hygienic practices. It is important that you research the area you plan to visit beforehand, including any important vaccinations that are needed, any common diseases and appropriate personal protective equipment (PPE) measures. The UK government website is an excellent place to start, as is your GP Surgery, which should offer a Travel Clinic.

using a company - yay or nay?

Companies

Many people have had fantastic experiences using elective organisations. There are many organisations out there which offer a tailor-made elective, all organised and planned for you, including hospital placement, organisation, flights, meals and outdoor activities. This can help to alleviate anxieties around planning as you place the responsibility in someone else’s hands. Some organisations also offer group electives which can give you the opportunity to meet medical students from around the world, make new friends and reduce isolation.

The downside, of course, is the cost. There are both positives and negatives tousing an elective company; what it ultimately boils down to is you as an individual. Are you willing to to pay extra to alleviate the stress of planning and organising everything yourself? Or do you want to have complete independence and decide where you want to go and what you want to do?

If you do decide to use an elective organisation, consider speaking to people who have used the company before. Make sure you do your research, read online reviews and factor in the cost before you go ahead. At the end of this article you can find a list of Company Websites which offer to arrange your elective for you, including travel, accommodation, catering and activities. Remember to read through reviews and have a clear idea of what you are paying for (and what you aren’t) before you decide to pick one.

Elective companies:

Work the World
Review: Offers a variety of destinations with accommodation and travel arranged by the company; offers 24/7 support for peace of mind; can be expensive depending on location.
Projects Abroad
Review: Offer different experiences in one elective, including time spent in both a hospital and rural settings. Accommodation is arranged through company. Note flights may have to be booked by yourself and some destinations require intermediate language skills.
The Mighty Roar
Review: Allow students to pick specific specialities they are interested in. Electives often arranged in groups, so ideal for meeting other medical students from around the world. Cheaper than most other companies; note does not include flights. Not as diverse range of countries.

closing thoughts & additional resources

Resources

It can be easy to feel overwhelmed when planning your elective. You may feel pressured to have ‘the best time of your life’ as you compare your plans with all your peers.

A great place to start is the medical students in the year above you - ask them where they went and if they enjoyed it. Is there anything they would have done differently?

If there is a specific speciality you are interested in, talk to the relevant junior doctors in your local hospital. Ask them about their elective and for any contact details they may be able to give; this can really reduce your planning time.

Finally, use the internet. There are many websites out there which offer advice on medical electives, including personal experiences and advice. A full list of helpful websites can be found below.

Useful Resources:

The Student Room
The Student Room is a UK Student Forum used by British Doctors and Medical Students.
Review: It is a good place to discuss elective plans and ask questions specific to your elective. The article in the link above outlines common things to consider when planning your elective as well as providing some contacts for electives both in the UK and in common non-UK countries.
The Electives Network
Review: This website offers information and reviews of hospitals and placements across the world as well as providing contact details. It is a useful way of gaining a personal perspective on certain hospitals and starting the application process by knowing who to speak to. Bear in mind that some information may be out of date, including contact details, and you should do your own research around contacts as well as using this website.

Student BMJ
Review: The Student BMJ has a specific section on medical electives. This is particularly helpful if you’re not sure where you want to go; articles are written by medical students exploring their elective experiences and offer unique insights into placements and opportunities you may not have considered.

About the Author

Dr Gunjan Sharma is a Foundation Year 2 doctor currently working in Devon. She graduated from Cardiff University and is planning on a career in Forensic Psychiatry. She has an interest in combining Medicine with the Humanities, and enjoys reading and writing in her spare time. Gunjan undertook her elective in a small Psychiatry Hospital in the Himalayan mountains in North India; she later wrote about her experience there in an article published in the British Journal of International Psychiatry.