Medical students from German-speaking countries on abroad electives in Africa: destinations, motivations, trends and ethical dilemmas

Abstract

Background International medical electives are one the highlights of medical training. Literature about international electives is scarce, and understanding what made a student choose one destination over another is unclear. Many medical students based in Europe travel to Africa each year for their elective, however, students’ expectations and motivations are yet largely unexplored. Methods To gain insights into the factors driving students to travel to Africa, we analyzed two large international elective databases based in Germany. We reviewed elective testimonies and extrapolated geographical data as well as the choice of discipline for electives completed in Africa. Based on pre-defined categories, we also investigated students’ motivations and expectations. Results We identified approximately 300 elective reports from medical students from German-speaking countries who chose to travel to Africa for their elective. Students commonly reported destinations in Southern and East Africa, with the Republic of South Africa and Tanzania being the most frequently selected destinations. Surgical disciplines were the most commonly reported choice. Diverse motivations were identified, including the desire to improve knowledge and clinical examination skills. A large proportion of students reported a link between destination choice and the potential to partake in surgical procedures not feasible at home; whether these surgeries were not or no longer practiced at home, or whether students could not partake due to level of training, was not ascertainable from the data. A trend-analysis revealed a growing interest in travelling to Africa for electives within the last 15 years. We observed a sharp decline in reports in 2020, a phenomenon most likely related to SARS-CoV-2-related travel restrictions. Conclusions This study suggests that medical electives in Africa are commonly reported by medical students from German-speaking countries, with diverse motivations for the choice of destination. A non-neglectable proportion of students identified the possibility to engage in surgical procedures as one of the main reasons for choosing Africa. This poses a series of ethical dilemmas, and well-structured pre-departure trainings may be a solution to this. The recent dip in overseas electives should be seen as a unique opportunity for medical schools and universities to restructure their international elective programs.

Clinical electives in China: trends, experiences, barriers

“…Such electives have been repeatedly criticized as potentially harmful and detrimental for trainees, sending institutions, and – above all - the host community [ 26 , 27 ]. Such electives potentially contribute to the exploitation of vulnerable healthcare systems, and may result in ethical dilemmas [ 15 ].…”

“…The reservation must be made, that from a quantitative perspective the number of identified elective reports was only modest ( n = 40). Notably, writing elective testimonies is not mandatory, and students usually receive no credit for this work [ 15 ]. Thus, it is likely that the actual number of students going to China for an abroad elective was much higher.…”

“…As reported earlier, student testimonies are often subject to recall bias and may not replace face-to-face interviews [ 15 ]. In light of the COVID-19 pandemic and the COVID-related decline in elective activities, however, they serve a valuable purpose, are easily accessible and allow for additional insights into abroad elective trends.…”

“…IMEs have been associated with various educational benefits, potentially increasing students’ medical, cultural and linguistic competences [ 14 ]. Abroad electives are traditionally popular in Germany, and there are several anonymous open-access databases cataloguing elective testimonies written by students that went abroad for an elective [ 15 ].…”

Developing a Global Medicine Student Pre- and Post-Travel Curriculum

“…With all four search terms, 29 papers were identi ed; leaving out "students" from the search there were 45 hits; leaving out training there were 30 papers; and leaving out "global health" we obtained 49 hits. Of these 66 papers, only twelve address one or more topics speci cally relevant to pre-departure training for global medicine students (3,4,(7)(8)(9)(11)(12)(13)(14)(15)(16)(17). Two of these papers were reviews; the other papers addressed either speci c topics or an overall curriculum (3,7).…”