Should International Medical Electives Continue Despite the Pandemic?

By Scott Baltic

May 26, 2020

NEW YORK (Reuters Health) - A new report supports continuing international medical electives to resource-poor countries in the face of the COVID-19 pandemic.

Writing in the Journal of Travel Medicine, two medical students in the U.K. and a physician in Benin argue that students taking an elective can bring much-needed medical expertise to assist overburdened healthcare systems in poor countries.

According to the World Health Organization, they note, only four countries in West Africa appeared to be adequately prepared for COVID-19. "A rapid expansion of cases in this region is likely to overwhelm health systems, which are already limited by lack of personal protective equipment (PPE), intensive care capacity and healthcare professionals," the authors add.

Nonetheless, many international electives have been cancelled or cut short, said David McMaster, a medical student at the University of Nottingham School of Medicine and one of the authors of the paper.

The barriers to continuing, he told Reuters Health by email, include the national lockdown, difficulty in obtaining medical insurance/indemnity, international travel restrictions, the availability of PPE, and the unwillingness of medical schools to allow students to continue on planned electives.

He and his coauthors note that in the UK alone, about 4,000 medical students each year undertake an elective in a developing country.

"Electives are highly valued and have long been thought of as essential to medical training, with no other part of the medical school experience transforming students so rapidly and profoundly," McMaster said.

The authors acknowledge the risks inherent in international travel, including physical injuries, infectious diseases, and mental health issues, as well as additional risks from COVID-19, but contend that these are manageable.

They suggest encouraging medical students to go in groups, after receiving pre-departure training, including briefings on local health systems, use of PPE, management of COVID-19 patients, and risk assessment. If a host nation requires international students to isolate on arrival (for up to 14 days), this would be an excellent opportunity for training.

"Electives are an essential part of both medical education and global health, and during this uncertainty we strongly believe that medical students should be given the opportunity to volunteer to augment international aid efforts in low-income countries," the authors conclude.

Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University, in Townsville, Australia, told Reuters Health by email, "The authors made a very good case for electives of medical students in situations as described in this paper."

She added, however, that it's crucial that these efforts be organized, managed and monitored in a collaborative way by the appropriate authorities, such as the medical schools and local health authorities, "with painstaking preparation for those students who wish to participate."

"No doubt," she noted, "there will be plenty of cowboy-agencies that will send out medical/health students as soon as travel is possible without any care for the local people."

Dr. Etienne Renaud-Roy of the Centre Hospitalier Affilie Universitaire Mauricie-Centre-du-Quebec, in Quebec, Canada, who has worked in Africa and has published papers on international medical electives, told Reuters Health by email that "this article is entirely based on the assumptions that what would be missing is mainly human resources and that the best option to fill this lack of resources would be Western medical students."

At least in Benin and Burkina Faso, where he has personal experience, he continued, what's generally missing are appropriate PPE, supplies for large-scale diagnosis and equipment to support hypoxemic respiratory failure and acute respiratory distress syndrome.

In cases where human resources are the main bottleneck in providing care, Dr. Renaud-Roy explained, medical students typically are learners and not skilled healthcare providers. In his experience, host supervisors clearly say they would prefer residents or students in their final year.

SOURCE: Journal of Travel Medicine, online May 6, 2020.