Vector Volume 11 Issue 1 - 2017

the tensions which exist between service learning and the
respect of patient rights and well-being.[17]
Social justice-oriented approaches to service learning,
coupled with active critical reflection, also serve viable
pedagogical approaches for learning the health advocate
role.[10] This means that students should be able to better
recognise and address relevant ethical and professional
issues, with a greater understanding and appreciation
of altruism, social justice, autonomy, and integrity as a
result.[10] When a student does undertake an elective in a
developing country, such experience leads to higher levels
of community health knowledge on return, a greater sense
of what it means to be vulnerable, a heightened awareness
of the social determinants of health, and an appreciation
of the importance of socially responsible approaches for
community engagement and health advocacy.[10]
Another important consideration is to enable bi-directional
flow of medical students through formal partnerships between
university institutions. This can facilitate more positive
elective experiences through sustainable relationships and
effective involvement in medical care, as well as encouraging
an international medical workforce in the future.[5] Along
with fostering such connections, skills building in crosscultural
effectiveness, long-term sustainability planning, and
local capacity building may help to produce more effective
overseas opportunities with meaningful outcomes.[7]
Discussion
Overall, there is a clear need for individuals who wish to
undertake medical electives in the future to reflect upon
ethical and best practice guidelines prior to departure,[2] and
to subsequently decide whether the experience is right for
them.[12] It would also be of benefit to engage in conversation
with previous cohorts about their elective experiences,
enabling a baseline understanding of any challenges that lie
ahead. Pre-departure, students should aim to gain as much
contextual knowledge as possible in relation to their host
country, including the language, the specific local needs,
the details of the participating institution and the work being
carried out. Students must recognise the possible ethical
consequences of the work being done, and appreciate the
potential impact they might have during such an experience.
[12, 16]
By incorporating a greater emphasis on learning and on
reflection prior to, during, and after an international medical
elective experience, students will be better placed to question
their values, assumptions, and beliefs to help mitigate
the potential harms which their placement may cause.
[15] Students must actively question themselves and their
surroundings, consider the ways in which healthcare is being
delivered, and engage with potential ethical dilemmas and
broader social, political and economic concerns underlying
their medical provision, without necessarily being engaged
in the direct provision of medical care.[11] Indeed, practising
beyond one’s capabilities as a medical student is central
to the potential harm which may result during an overseas
elective in a resource-poor environment, particularly when
this is coupled with a lack of adequate supervision.
Education and planning are essential in minimising harm
to host communities. It is necessary to have well-defined
objectives and structured clinical experiences in place for
students while abroad, which may be promoted by institutions
and educators through mandatory global health education to
ensure medical electives are carried out to the highest ethical
standards.[8, 19] At all stages, electives must be completed
in a way that acknowledges any underlying power balances,
ethical challenges, and resource differentials to provide
community-led efforts which are focused on sustainable
development and community health gains.[7]
There is an undeniable need for more global health
Global Health Programs Abroad
1. University of Saskatchewan, Canada: the ‘Making the Links’ program provides an opportunity for
undergraduate medical students to participate in a local student-led inner-city clinic, a Northern Aboriginal
community health initiative and a long-standing service-learning project in Mozambique over two years. This
includes the provision of a supplementary clinical curriculum, guided and facilitated reflections, as well as a
complementary global health course and language courses.[15]
2. University of British Columbia, Canada: ‘First, Do No Harm: Global Health Initiatives, Ethics and Social
Responsibility’ is a piloted series of interactive workshops.[16] Participants analyse case studies exploring
different ethical dilemmas. Results have indicated that this approach to learning and reflection is necessary
before participating in a global health initiative, and that problem-based learning is effective in teaching
students to engage in the process of identifying and addressing ethical issues.[16]
3. University of Arizona, United States: a four-week immersion program undertaken by students prior to an
overseas placement covers a range of international health topics.
42