How do international electives fit into medical education?

Last summer, I traveled to Vietnam with a family doctor on faculty in my school's family medicine department. The first thing he taught me when I got there was how to drive a motorcycle. Not exactly what I expected from an international health experience, but undeniably cool!

I then used my newly-founded motorcycle driving abilities (I didn't have a license, but, really, it didn't matter) as we traveled to different health communes in rural Vietnam screening local residents for diabetes and hypertension in the morning and managing more complicated long-term patients of his in the afternoon. I diagnosed and treated my own patients in the morning - dispensing new meds, modulating medication doses and talking to patients about prevention. In the afternoons, I learned about managing complicated rheumatoid arthritis, cleft palate, congenital heart defects and more - all without the help of subspecialists and generally without labs or radiology.

When I returned home later that summer, not only had I developed a solid fund of clinical knowledge but I also had developed a solid relationship with a family doctor who breathes and lives primary care, the commitment to the underserved and compassion for patients.

The AAMC Graduation Survey, which all medical students complete before graduation, found that 38% of students participated in an international experience in 2000. Most of these experiences occurred either in the summer between their 1st and 2nd years of medical school or as an elective during 4th year.

A literature review completed in 2003 of International Health Experiences of Medical Students suggested an association between international experiences and career choices in primary care specialties and in underserved populations. The article and others published suggest that students develop soft skills in empathy, compassion and others while completing an international health elective - skills that are essential for doctors but often not taught in the medical school setting.

Offering more international health electives may draw more medical students to primary care and family medicine - not a silver bullet but one strategy among many in this multifaceted cause-and-effect of student specialty choice.

What can family medicine and primary care departments do? One significant barrier to a student's participation in an international health elective is the financial burden. We need to offer more scholarships and funding for students interested in international experiences - not just our strongest students but students who are on the margin about their interest in primary care and underserved care.

Another barrier is the timing - if students miss out on an international health elective between their first and second year of medical school, they may not have another chance to participate in one until well into their fourth year... beyond when specialty decisions are made. Could medical school curricula be redesigned to allow elective time in 3rd year and the potential of international electives then?

For those interested in an international health elective, the AAFP student website offers resources in finding electives.

I personally will never forget the time I spent in Vietnam and one day I hope to return as a physician to serve there. I hope that other students will have the opportunity to pursue international health electives - not only so that we can serve those abroad but also so that we can develop ourselves into better and more compassionate clinicians.


References:
Thompson MJ et al. "Educational Effects of International Health Electives on U.S. and Canadian Medical Students and Residents: A Literature Review." Academic Medicine 2003;78:342-7.

Godkin M and J Savageau. "The Effect of Medical Students' International Experiences on Attitudes Toward Serving Underserved Multicultural Populations." Fam Med 2003;35:273-8.