PURPOSE Students' idealism and desire to work with underserved populations decline as they progress from preclinical training through clerkships and residency. With an increasingly diverse population and increasing health disparities, academic health centers need to incorporate changes in their curricula to train socially responsible and idealistic physicians. International electives can provide valuable learning experiences to help achieve these goals.METHODS Sixty-six preclinical medical students at the University of Texas Medical Branch participated in an international elective from 1997 to 2005. After 1 week of didactics, they spent 3 weeks as part of a multidisciplinary medical team in rural Nicaragua. Postelective questionnaires were administered. From students' responses, we identifi ed common learning themes and grouped them under the categories of attitudes, awareness, and skills. Limitations included a self-selection bias, lack of a control group, and limited follow-up. RESULTSAfter the elective, students had an increased interest in volunteerism, humanitarian efforts, and working with underserved populations both in the United States and abroad, as well as more compassion toward the underserved. Students also reported a heightened awareness of social determinants of health and public health, and a broadened global perspective, as well as increased self-awareness.CONCLUSIONS Our fi ndings illustrate that a well-structured, mentored experience in international health can have a positive impact on preclinical students' attitudes, including their compassion, volunteerism, and interest in serving underserved populations, all measures of idealism. INTRODUCTIONI dealism is defi ned as "the cherishing or pursuit of high or noble principles, purposes, or goals." 1 In medicine, these aims traditionally include relief of suffering and improved quality of life for all humankind, and are measured by volunteerism, service to underserved peoples, and concern for the health of society as a whole. Shaywitz and Ausiello 2 assert that these ideals are what defi ne us as physicians and what attract students to medicine.Several studies have documented declining attitudes and idealism in medical students and residents as they progress through their medical training. These changes include decreased interest in serving underserved populations, decreased sense of physician responsibility for the health of all, and declining attitudes toward the medical profession in general. [3][4][5][6] With an increasingly diverse patient population, including many persons who lack access to health care, and the recognition of growing health disparities, society has an even greater need for physicians with idealistic and altruistic values.Both the Institute of Medicine and the Association of American Medical Colleges (AAMC) have recently released reports on the future of academic health centers (AHCs) and their role in training physicians to be responsive to the changing needs of society. These reports emphasize the importance Jani...

Knowledge of the responsibilities of engineers is the foundation for answering ethical questions about the work of engineers. This paper defines the responsibilities of engineers by considering what constitutes the nature of engineering as a particular form of activity. Specifically, this paper focuses on the ethical responsibilities of engineers qua engineers. Such responsibilities refer to the duties acquired in virtue of being a member of a group. We examine the practice of engineering, drawing on the idea of practices developed by philosopher Alasdair MacIntyre, and show how the idea of a practice is important for identifying and justifying the responsibilities of engineers. To demonstrate the contribution that knowledge of the responsibilities of engineers makes to engineering ethics, a case study from structural engineering is discussed. The discussion of the failure of the Sleipner A Platform off the coast of Norway in 1991 demonstrates how the responsibilities of engineers can be derived from knowledge of the nature of engineering and its context.

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