BackgroundMost international electives in which medical students from high-income countries travel abroad are largely unstructured, and can lead to problematic outcomes for students as well as sending and receiving institutions. We analyse the problems of unstructured medical electives and describe the benefits of an elective experience that includes more organisation and oversight from the sending medical school.ResultsA number of structured elective programmes have been developed, including those at the Medical School for International Health, Israel and the University of Dundee, United Kingdom. These programmes provide significant pre-departure training in global health and the ethical dimensions of electives, support and monitoring during the elective, and post-elective debrief. Crucially, the programmes themselves are developed on the basis of long-term engagement between institutions, and have an element of reciprocity.We further identify two major problems in current medical electives: the different ethical contexts in which electives take place, and the problem of ‘voluntourism’, in which the primary beneficiary of the activity is the medical student, rather than the receiving institution or health system. These two issues should be seen in the light of unequal relations between sending and receiving institutions, which largely mirror unequal relations between the Global North and South.ConclusionWe argue that more structured elective programmes could form a useful corrective to some of the problems identified with medical electives. We recommend that medical schools in countries such as the UK strongly consider developing these types of programmes, and if this is not possible, they should seek to further develop their pre-departure training curricula.

Delivering quality primary care to large populations is always challenging, and that is certainly the case in India. While the sheer magnitude of patients can create difficulties, not all challenges are about logistics. Sometimes patient health-seeking behaviour leads to delays in obtaining medical help for reasons that have more to do with culture, social practice and religious belief. When primary care is accessed via busy state-run outpatient departments there is often little time for the physician to investigate causes behind a patient's condition, and these factors can adversely affect patient outcomes. We consider the case of a woman with somatic symptoms seemingly triggered by psychological stresses associated with social norms and familial cultural expectations. These expectations conflict with her personal and professional aspirations, and although she eventually receives psychiatric help and her problems are addressed, initially, psycho-social factors underlying her condition posed a hurdle in terms of accessing appropriate medical care. While for many people culture, belief and social norms exert a stabilising, positive influence, in situations where someone's personal expectations differ significantly from accepted social norms, individual autonomy can be directly challenged, and in which case, something has to give. The result of such challenges can negatively impact on health and well-being, and for patients with immature defence mechanisms for dealing with inner conflict, such an experience can be damaging and ensuing somatic disturbances are often difficult to treat. Patients with culture-bound symptoms are not uncommon within primary care in India or in other Asian countries and communities. We argue that such cases need to be properly understood if satisfactory patient outcomes are to be achieved. While some causes are structural, having to do with how healthcare is accessed and delivered, others are about cultural values, social practices and beliefs. We note how some young adult women are adversely affected and discuss some of the ethical issues that arise.

While medicine is in a fairly constant state of change, the same could be said about the organisation and provision of healthcare, which can lead to conflicting obligations as regard ethics, professionalism and the standards to which clinicians are generally held to account. Additional complexity arises if there is confusion as to what these two domains comprise, and while there is plenty of literature on ethics and professionalism in medicine, much less has been written about the relationship between them. A lay observer could be forgiven for having little sense of where one ends and the other begins. It is also possible that few practicing professionals have pondered specifically on these issues, and not only should it help educators (whose task it is to design, implement and assess programmes and curricula) to have greater clarity on these issues, but it could potentially be of benefit to patients as well.Ethics and professionalism are not the same, even though they are closely connected. If ethics and professionalism are to become part of the DNA of practicing clinicians, it should be clear to everyone of what the domains comprise, and what the terminology means. This could make a difference in how doctors behave towards each other, and more importantly, towards their patients; attitudes define behaviours, which in turn influence the way in which individual episodes of care are given, so this is far more than simply a question of semantics. All Rights Reserved © 2015 Universidad Nacional Autónoma de México, Facultad de Medicina. This is an open access item distributed under the Creative Commons CC License BY-NC-ND 4.0. PALABRAS CLAVEÉtica; Profesionalismo; Medicina; Cultura; Cuidados de la salud Ética y profesionalismo en un mundo cambianteResumen La medicina se encuentra en un estado constante de cambio, y lo mismo podría decirse de la organización y la prestación de servicios de salud, lo que puede dar lugar a obligaciones contradictorias en cuanto a la ética, el profesionalismo y las normas a las que los clínicos generalmente se enfrentan. La complejidad aumenta si hay confusión en cuanto a lo que comprenden estos 2 dominios, y si bien hay mucha literatura sobre la ética y el profesionalismo en la medicina, menos se ha escrito acerca de la relación entre ellos. Un observador lego podría Peer Review under the responsibility of Universidad Nacional Autónoma de México. -NC-ND 4.0. 176 R.P. Worthington ser perdonado por tener poco conocimiento sobre dónde termina uno y empieza el otro; también es posible que pocos profesionales hayan reflexionado específicamente sobre estos temas, y no solo puede ayudar en el caso de los educadores (cuya tarea es diseñar, implementar y evaluar los programas y planes de estudios) para tener mayor claridad sobre estos temas, sino que potencialmente podría también beneficiar a los pacientes.La ética y el profesionalismo no son lo mismo, a pesar de que tienen una conexión íntima, y si la ética y el profesionalismo se convertirán en parte del ADN de la práctica de los médicos, debe...

Turkey currently hosts 3.6 million registered Syrian refugees, most of which reside in urban centres. Urban refugees in Turkey face significant challenges in accessing the healthcare to which they are entitled under international and Turkish law. This literature review seeks to provide a holistic overview of the major barriers refugees face in accessing adequate healthcare. Language forms the single greatest obstacle despite efforts to provide services staffed by Arabic speakers. Poverty exacerbated by lack of employment, unhygienic living conditions, and the COVID-19 pandemic also play significant roles. Above all, hostile Turkish public sentiment towards refugees motivates restrictive government policies and discourages aid. Potential means by which this situation may be addressed include prompt address of the financial hardships brought on by COVID-19, permitting NGOs to evaluate the effectiveness of migrant health centres, and the resumption of refugee registration in key provinces.

Major inconsistencies in hearings and investigations may not be in anyone's best interests: fairness is core to most notions of justice, whether from the perspective of a doctor in training, clinical educator or member of the public. Therefore, schools and programmes need to take this into account when reviewing processes and procedures. Although the career of a doctor in training is important, it is not the only consideration. If systems fail the public has a right to be concerned, and striving to ensure that medical students graduate to become safe, professional doctors is something of concern to all clinical educators.