What is an international health elective?

An IH elective involves spending elective time, during your undergraduate medical training, working and learning in another country. The elective experience may involve a mix of shadowing/observation, active participation, attending lectures.

Why Should You Consider Doing an International Elective?

There is a variety of reasons why anyone would consider doing an international elective. A few of them are listed here:

• International electives allow students to learn respect for and appreciation of the medical problems challenges and solutions of other countries and regions.
  
  
• University of Alberta medical students who take time (in the form of an IH elective) to learn first-hand how medicine is practiced in areas of the world outside of North America are more confident and competent upon return to their medical training here at the University of Alberta. Although there is often much lacking in lesser-income countries with respect to healthcare facilities and equipment, students will find themselves learning tremendous amounts from their foreign colleagues and supervisors. As was said earlier, necessity and lack of resources foster creativity, ingenuity and resourcefulness. Students will learn to think differently and to use basic principles as the foundation for their diagnosis and treatment decisions on basic principles. It is the type of mindset that is admired in the medical profession, that those involved in medical teaching in Canada try to incorporate into curricula, but that is frustrated by the sense of security (and hence, laziness) that comes from the availability of modern technology that renders "unnecessary" the rigorous examination of clinical problems. Technology increases efficiency but, oftentimes, fosters mental laziness and ignorance. The absence of the most advanced technology that students training in healthcare facilities in Edmonton would normally have access to will challenge students taking part in IH electives such that they will be more capable and more competent upon return.
  
  
• Although the reality in Canada is a largely tertiary-care-centred healthcare system, that form of healthcare delivery is more the exception than it is the rule internationally. This is particularly evident in lower- and lowest-income countries. IH electives allow U of A students to take part in the delivery of health assistance in accordance with a primary care mode of operation. Approximately twenty percent of University of Alberta Medical School Graduates will go on to practice medicine overseas. Exposure to the reality of healthcare delivery will prove invaluable to those students.
  
  
• Some reasons from the IHMEC guidebook, include:
  
  
  • International health often provides experience, perspective and insight which, like any profound experience of learning or growth, are primaril within one's self and not easily measured. Nevertheless, there are several compelling reasons to consider an international health elective.
    
    
  • The range of illnesses and services in North America are fairly atypical of the world as a whole. An international elective can provide broader perspectives on health, illness, andhealth care.
    
    
  • Clinical and community health skills may be sharpened through applying them to unfamiliar problems and settings.
    
    
  • New knowledge may be gained and disseminated through focused research. A student or resident may find upon returning home that familiar things are now also seen from a fresh and more complete perspective.
    
    
  • The host community may benefit from the student's or resident's elective (although this is not always the case).
    
    
  • Familiarization with geographic and travel medicine. Developing familiarity ith medical and social conditions unique to regions has become increasingly important as growing numbers of travelers visit countries that still harbor endemic diseases virtually unknown in the U.S., and require preventive and sometimes curative attention.
    
    
  • Improve the quality of medical education for ethnic populations within the United States. Health care providers are increasingly faced with the challenge of diagnosing and treating global diseases in new immigrants, as well as dealing with acute and chronic illnesses in the context of cultural patterns unfamiliar to the provider. Also, many new immigrants have been traumatized by war, displacement into refugee camps, or even torture, and present unique psychosocial challenges not commonly seen in the domestic population.
    
    
  • Gain an appreciation of the need to promote global equity in health care. Equity in health care distribution demands that, as world citizens, health care providers from more prosperous countries consider responsibility to medically underserved populations, both in their own country and in those of developing nations.
    
    
  • Develop a global network of relationships with other health care providers and students. There is much that can be learned from ongoing exchanges of information, research, and medical practice with other countries.
    
    
  • Develop a population-based perspective of health care. Grouping populations and communities into managed care panels is now forcing North American practitioners to consider health status of defined populations rather than only those of individuals or families. This population-based approach to medical care has been practiced for decades in countries such as Chile, Great Britain, and Cuba. Much can be learned from those experiences.
    
    
  • Promote personal attitudi al changes. Permanent changes in perspective, attitudes, and practice patterns are often noted by those who participate in international health activities, especially in resource constrained environments. As economic issues increasingly distract medical practice in the U.S., attention to the needs of poor and underserved populations of both the U.S. and the rest of the world may engender a greater sense of purpose and humanism in th medical profession.

When is the best time to do an international health elective?

There are a few things to consider in making the decision as to when you would like to have your elective:

• when you have time available in your schedule
• when the elective hosts/supervisors are willing/available to provide supervision for you
• the minimum duration of the elective (often specified by the hosts) and the maximum amount of time (and funding) that you have available for the elective

Further advice from the IHMEC Guidebook:

It is generally agreed that an international experience can be of value at any stage of medical school or residency training. And it is possible to do a community health or research elective in the second or third year. However, medical students should have completed the required clerkships and have basic clinical skills, both for their own benefit and for the benefit of the people at the site, before participating in a clinical elective. Sometime during the fourth year of medical school when there is flexible elective time is the most common time to go. Fourth year students should not plan to be abroad during the announcement of the residency Match which generally occurs on the second week of March in the student's final year.

The major cost of any international health elective is the airplane ticket. If funding is tight but you still wish to do an international health elective, it is recommended that you select a country that is physically located closer to Canada (a country in Central or South America, for example) rather than one that is located further away from Canada (such as the African, European and Asian nations), as tickets to the former will be cheaper than tickets to the latter. Costs in addition to that of airplane tickets include accommodations (although this will most likely be provided free-of-charge), local travel (taxi, bus, ferry, etc.), food and personal expenses (entertainment, etc.). There is no "typical" figure for the total cost of an international health elective, but students have been known to spend between $1,500 and $6,000 CDN.

Typical third-party sources of funding for international health electives include personal finances, the Christian Medical and Dental Society (CMDS), the Alberta Medical Association (AMA) and local churches.



What about safety issues, and what happens if I become sick or am injured while there?

Some of the major concerns of people planning for travel to another country include:

• What happens if I become ill or am injured while there?
• What happens if there is civil unrest while I am there?
• What happens if I get into legal trouble while there?
• What happens if I am robbed/mugged while there?
• Where do I go if I need legal/financial/medical assistance?
• What happens if I lose my passport or visa?

There is no simple answer to this question. International electives can certainly increase the competence of students such that they perform better on subsequent clinical rotations and electives when they return to the University of Alberta. This is important, as rotation preceptors/supervisors are often approached by students for letters of reference to be included in residency application packages. Additionally, taking part in an international health elective indicates that a student is globally conscious, aware of the international scope of healthcare and disease, and empathic to the needs of the global community. The preceeding are advantages to taking part in an international elective; however, how they are and will be viewed by the members of the admissions committee for your desired residency program cannot be predictied. A majore disadvantage of using elective time to complete an international health elective is that the focus of the international health elective may be quite different from that of the field into which you would like to be matched in the CaRMS match. This becomes even more of a problem if you do not use all or most of your elective time to fulfill an international health elective and use less or none of your elective time doing work in the specialty into which you are hoping to be matched. If this is the case then the admissions committee in your desired residency will have to place all weight on your evaluations from your clinical rotation in the corresponding field rather than on elective time and rotation time in the field.



What medical supplies can I/should I take?

This will most often best be answered by the electives contact. Note, however, that not everything that is desired by the electives contacts will be available for students to take with them. Conversely, not everything available to students will be desired by the elective contact(s). It is advised that students discuss the provision of medical supplies with the local (U of A) international health electives supervisor prior in order to determine what is avaialbe. Once this has been done, the student may discuss the possibilities with the overseas elective contact and attempt to reach some sort of agreement on what supplies and what quantity of supplies will be provided. You can have a look at the American Medical Students' Association's Travel Advice page for a fairly extensive list of medical equipment that you might consider taking with you (if permitted to do so).

Where can I find out what international health electives are available/possible?

A good starting place in your search for contacts through whom international electives may be set up is the International Health Electives Database on this site.

When should I contact a potential elective supervisor (ie. How far in advance)?

Some electives are difficult to set up (difficulty in contacting the supervisor, obtaining a visa, securing housing, etc.), while all spots available in other electives are filled very quickly. Although the various electives in the database recommend varying times in advance at which you should contact the elective supervisor(s) it is strongly recommended that, if possible, you attempt to initiate communication with your desired elective supervisor 1-1.5 years in advance.

What do I need to prepare/have in order before setting out for the elective?

The first thing that an international elective student requires is the proper attitude:

• you must be culturally sensitive
  
  
• you must match your expectations with the realities of your destination
  
  
• you must be prepared for the amount of work that is required to prepare for an international elective experience
  
  
• you must be prepared for the burden that you may be faced with over the course of the elective; students need to get away sometimes and take a breather

A good resource that you may find helpful in preparing for your elective is our International Health Elective Checklist. The checklist has helpful ideas regarding preparation for an elective, what to do while you're away (how to approach the elective experience) and what you will need to do when you return.

What should I expect to achieve during the course of the elective?

• rural or non-urban experience is important
  
  
• length of time should be somewhat open (allow for adjustment time (time and culture))
  
  
• a one month minimum of on-the-job elective time is required; a 6-week total is satisfactory
  
  
• take time to see the country as well

Where can I find general information about the various countries/cities in which IH electives are offered?

There are several sites through which you can find general and tourist information regarding the countrie(s) in which international electives are possible. Some useful links are listed below.

• On-Campus Resources
  • The U of A Resources Section (international student groups, etc.)
    • International Healthcare Initiatives for Medical Students Committee (IHIMS)
    • Students' International Health Association (SIHA)
    • U of A International
    • International Student Groups (U of A International Website)
    • Ethnic Student Groups (U of A Students' Union Website Search -- select Ethnic/Cultural/Religious and then press Search)
    • Native Student Services
    • School of Native Studies
  
  
• General Information
  • Yahoo! Countries -- Find links to websites with information about any of 193 countries
  
  
• Demographics and Statistics
  • InfoNation -- View and compare statistics for up to seven countries at once
  • The CIA World Factbook -- Tremendous source of statistics and other information for virtually every country in the world
  • Stats and Indicators -- Indicators/Stats for UN Member States (part of the World Health Report)
  • WHO Statistical Information System (WHOSIS) -- Health information system
  • Cardiovascular Infobase -- Country profiles, health stats, socioeconomic information, health system information, etc. can also be found on the site; great resource
  
  
• Maps
  • Country Maps and General Information -- Courtesy of the United Naitons
  • Atlapedia -- Atlapedia (statistics, general information and maps)
  • MapQuest -- MapQuest World Atlas (maps)
  
  
• Miscellaneous
  • United Nations Development Program -- Good site for information on current events and programs

Where can I find out if there are any warnings about any particular countries, etc.?

• Outbreaks -- Publication of the World Health Organization
• Emergencies and Humanitarian Action -- Publication of the World Health Organization
• Travelers' Health -- Publication of the National Center For Infectious Diseases (Centers For Disease Control)
• Peacekeeping Maps -- UN Peacekeeping Maps (i.e. where you will NOT be permitted to go for your elective)
• Vaccination/Disease Stats, Maps and Charts -- Courtesy of the WHO

What happens if I'm called on to do an advanced procedure for which I have not been trained?