What is an Elective?

Blogpost written by Amelia Wild, Advocacy Lead for InciSioN UK

Medical electives are an exciting opportunity for medical students to explore medicine outside of their usual University placements. Generally undertaken towards the end of the course, they are a keenly awaited component of medical school. They can be done at another home institution, but the majority of students decide to travel overseas.(1) This provides the possibility of exploring a new country and learning about its healthcare system, with an aim of creating more globally aware, competent doctors. However, it also generates ethical considerations, particularly as the majority of overseas placements are in lower resource settings.

Key benefits of an elective:

• Global health education: often limited in core curriculums, electives can highlight methods of alternative healthcare provision, and encourage learning on global health.

• Non-clinical skills: build on an improve students skills, such as leadership, communication and cultural competence.(2,3)

• Increases clinical exposure: to scenarios and conditions that are not commonplace or present in a student’s home country.

• Benefits for the host provider: provide a source of funding, research and extra personnel.

Challenges and considerations of an elective:

• Students travelling from higher to lower resource environments, can become a burden to the provider, indirectly impacting patient care. This is particularly the case if additional safety requirements, supervision or language deficiencies are present.

• Are potentially non-reciprocal relationships, where the host placement provides student education, but the student does not offer contributions in return. Using lower resource countries for training opportunities to benefit the doctors of higher income countries raises pertinent ethical concerns.(3,4)

• Students need to ensure they remain within their clinical competence at all times. This can lead to uncomfortable situations in which they have to decline helping, despite staff shortages. See the BMA for guidance: https://www.bma.org.uk/advice-and-support/ethics/medical-students/ethics-toolkit-for-medical-students/medical-electives-in-resource-poor-settings (5)

• Electives can be costly, particularly those taken abroad. This may include costs for elective provider companies or host facilities, but it can be unclear where these funds are going, and whether they are benefitting those providing the eduction on the ground.

To prevent the potentially self-serving nature of electives, there is a call for more structured programmes in which symbiotic relationships are established between home and host institutions.(6) This could include pre-departure training for students, so they can maximise their learning and impact while away, or even virtual experiences that could decrease the burden.(7,8) However, such programmes are not currently available at all institutions, so if you are organising your own, here are some tips to maintain ethical awareness:

• Be aware of organisations that help organise electives. While they can be useful, they often cost money or require fundraising. Make sure you gain transparency of this money trail, and how it is directed to support patient care. You can read more about this in a previous blog post: https://www.incisionuk.com/post/international-medical-electives

• Contact your medical school to see if they have any established partnerships or contacts.

• Try to establish a key contact with the host organisation. Discuss with them what the elective will entail, which will help you to:

  • identify your goals and ensure they are feasible

  • understand what your role will be, making your competencies clear, so both parties are informed beforehand

  • identify current gaps in service provision, so you can be aware of these before you start clinically. This may help you to recognise an opportunity to contribute.

• Maintain cultural awareness. Electives provide a privilege to learn about language, cultural practices and norms. First and foremost, you must respect these, being aware they may be very different from your own country’s.

• Language. Consider if a language barrier will be present, and how this will affect your experience, your input and any burden to other clinical staff. If it is not an issue, learning some key phrases in the language of the country you are visiting is always a good idea!

• Consider what you can contribute in return for the experience, such as research. Make sure this is based on what your host organisation needs, rather than your personal choice - and don’t forget ethical approval!

• Remember the experience doesn’t have to end when the placement does - think about continuing your contributions through advocacy, research and fundraising!

We hope this was helpful! Well-organised and reciprocal elective placements are a great opportunity to explore Global Health and global Surgery!

Do you have any other ideas? Leave them in the comments!

REFERENCES:

1. Miranda, J.J., Yudkin, J.S. and Willott, C. International Health Electives: Four years of experience. Travel Medicine and Infectious Disease. 2005 Nov 11; 3(3):133–141. doi:10.1016/j.tmaid.2004.09.003.

2. Hayashi M, Son D, Onishi H, Eto M. Contribution of short-term global clinical health experience to the leadership competency of health professionals: a qualitative study. BMJ Open. 2019 Jul 3;9(7):e027969. doi: 10.1136/bmjopen-2018-027969.

3. Overseas Medical Electives: Good for students? Good for host centres? Jennifer Rossiter. Royal College of Physicians Edinburgh.

4. Dowell, J. and Merrylees, N. Electives: isn’t it time for a change?. Medical Education, 2009; 43: 121-126. https://doi.org/10.1111/j.1365-2923.2008.03253.x

5. British Medical Association. Ethical toolkit for students: Medical students and electives in resource-poor settings. [online]. Published 28 June 2024. Accessed 5th October 2025. Accessible at: https://www.bma.org.uk/advice-and-support/ethics/medical-students/ethics-toolkit-for-medical-students/medical-electives-in-resource-poor-settings