Aim International electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to low- and middle-income countries (LMICs) becomes more common, ethical considerations of such practices emerge. We conducted a literature review to assess the extent to which five ethical themes are addressed in existing literature about electives. Method We searched PubMed database and identified 35 papers which discussed international electives to LMICs, undertaken by medical students, and included discussion of ethics. On reading these, we noted whether or not there was discussion of any of the five chosen themes. A further focus area was explored in more detail: the impact of electives on host students’ access to learning opportunities. Results The most commonly addressed ethical theme was exceeding clinical competence (discussed in 26 papers), second was one-sided benefits in partnerships (in 20 papers). Respect for patients and local culture was addressed in 12 papers, local resource use in 10, and working with local community/colleagues in 10. Interestingly, 6 papers identified a negative impact of visiting students on local students’ learning opportunities. Reasons for this were: visiting students requiring local clinicians’ supervision, interference with teaching programmes, and being prioritised over local students. Conclusions It appears that while there is awareness of some ethical shortcomings of electives, the negative impacts on local students’ access to medical education are addressed infrequently. We recommend that this notion should be further explored in pre-departure elective teaching courses, to increase travelling students’ awareness of the impact of their presence on the host community.

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.