A Scoping Review of the Ethical Impacts of International Medical Electives on Local Students and Patient Care

Abstract

Background: International electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to lower and middle income countries (LMICs) becomes more common following the global pandemic in 2020, ethical considerations of such practices re-emerge. We conducted a scoping review to assess the extent to which five ethical themes were addressed in existing literature about electives, with the aim of investigating the ethical impacts of medical student electives on local resources, patients and clinicians in LMICs. Methods: We systematically searched PubMed, Global Health and Embase databases using the search terms “(ethics) AND (medical electives)”. Thematic content analysis was undertaken using a combination of deductive and inductive themes. The deductive themes included: exceeding clinical competence, use of limited local resources, respect for patients and local culture, collaboration with local community/colleagues, and one-sided benefits in partnership. In addition, we also allowed for emerging themes within the data, and conducted a narrative synthesis of the results. Results: A total of 37 papers discussed ethical issues relating to medical student international electives to LMICs. Most publications were written from the medical student perspective (n=14), rather than by the host-institution (n=5), with several written from third-party perspectives (n=18). Negative impacts on local host students and impact upon patient care, were identified as additional ethical considerations. Conclusions: Our review demonstrated that there is limited awareness in the existing literature of the potential negative impacts of medical electives to local LMIC students’ access to medical education, and patient care. We recommend that these ethical themes should be further explored in pre-departure elective teaching courses, and post-elective debriefs to increase medical students’ awareness of the impact of their presence on host communities.