Undergraduate International Medical Electives: Some Ethical and Pedagogical Considerations

Abstract

The authors argue that attempts to establish more placements to meet the growing demands of undergraduate medical students in North America for international experiences may be outweighing critical reflection on the ethical issues, curricular content, and pedagogical strategies necessary to support equitable engagements with countries of the Global South. On the basis of a critical analysis of literature on international medical electives and experiences (IMEs), the article explores trends in IMEs and exposes several prominent issues, including paradoxes in underlying motivations, missing or ad hoc curricula and pedagogical approaches in IMEs, and ethical challenges that frequently arise. By engaging perspectives from critical educational theory, the authors suggest that IMEs as currently conceived are potentially ripe sites for the reproduction of colonialist ideas of North-South relationships. The authors conclude that IMEs will do little to address historically and politically rooted global health inequities unless critical consciousness is raised through improved global health curricula and appropriate pedagogical strategies.

Using multiple mini interviews as a pre-screening tool for medical student candidates completing international health electives

“…Some behaviors and characteristics, such as flexibility, professionalism, empathy, and ethical understanding are crucial for successful global health fieldwork. These factors are notoriously difficult to instill through pre-departure training [1,8,10,19–24]. This pilot evaluation leads to a better understanding of what is needed for an effective screening process.…”

Epistemological and Ontological Challenges of Transnational Foundation Year Medical Students

“…Findings from a focus group study (Maddison, 2015) indicate that this transnational medical school provides an appropriate environment, or habitus (Bourdieu, 1991), which meets local students' needs for the fostering of self-determination, and which promotes independence, personal and professional development, and belongingness. Further development of students' skills such as critical reflection and self-awareness (Hanson et al, 2011) also leads to a deeper understanding of motivations, power relationships, and ethical issues (Baxter-Magolda, 1992) and impacts in a local context that supports students' personal and academic achievements, and ultimately dovetails into their professional practice. To successfully navigate the path to new ways of learning, knowing and construction of self-determination, timely and suitable support is required, combined with educational sessions which develop skills such as critical reflection and self-awareness -skill sets which have not been previously addressed in the students' Arabic secondary school experience.…”

“…It is important for educators in the transnational education field to acknowledge that letting go of previous mindsets and taken-for-granted assumptions can be uncomfortable for students, but tapping into their previous educational experience and supporting their situated knowledge through the creation of a robust and culturally appropriate framework can enhance their learning (Gay, 2010) and sustain a transformative educational encounter (King, 2004). This points to the importance of facilitating students' skills in critical reflection (Hanson at al., 2011;Marlowe et al, 2014;Stutz et al, 2015) during the transition, so that they gain a deeper insight and understanding of their transformative learning experiences as key stakeholders in the transnational education process (Patel & Lynch, 2013).…”

New trends of short-term humanitarian medical volunteerism: professional and ethical considerations

“…With growing demand for global health experiences, but an insufficient number of academic international opportunities, healthcare students are seeking out these experiences independently, but often without adequate support and preparation 6 13 14 16 19 33 40 63 67–69. For instance, 27.5% of graduating American and Canadian medical students had participated in an international health elective as of 2006,12 but only a small percentage of medical schools provide training in global health topics 70.…”

“…While important for learning global health skills, students often practise clinical skills while on international experiences,14 16 but this can be stressful for trainees and potentially place patients at increased risk without sufficient training or supervision. Teaching and leadership is expected from healthcare faculty, but they themselves may lack the expertise in humanitarian situations or in low-resource medicine to be able to provide adequate support and training 10 16 20 71.…”