International medical electives during and after the COVID-19 pandemic - current state and future scenarios: a narrative review
Tóm tắt
International medical electives are an important and popular component of the academic curriculum in many medical schools and universities worldwide. The purpose of abroad electives is to provide medical students with an opportunity to gain a better understanding of education and healthcare in an international context. The COVID-19 pandemic, however, has substantially changed the international elective landscape. Travel restrictions, closures of international elective programs and the expansion of virtual methods for education caused a widespread disruption to abroad electives. A comprehensive analysis with regard to other consequences for abroad electives, however, has not been done before. Thus, we sought to a) summarize the current transformation of the international medical elective and b) to address potential challenges for post-pandemic international medical electives. The methodology employed is a multidisciplinary narrative review of the published and grey literature on international electives during the last two years of the COVID-19 pandemic. Students worldwide had electives postponed or canceled. Apart from evident immediate pandemic-related consequences (such as the substantial decline in global electives and impaired elective research opportunities for educators), there are other several problems that have received little attention during the last two years. These include challenges in the elective application process, poorly-understood consequences for host institutions, and growing global (ethical) disparities that are likely to increase once elective programs will gradually re-open. There is ample evidence that the post-pandemic elective landscape will be characterized by increasing elective fees, and a more competitive seat-to-applicant ratio. Ethical problems for international electives arising from an unequal global vaccine distribution will pose an additional challenge to students and elective coordinators alike. The COVID-19 pandemic transformed the international medical elective landscape in an unprecedented way, and future generations of medical students will face a series of additional challenges when applying for global medical electives.
Tài liệu tham khảo
Ali S, Devi A, Humera RA, Sohail MT, Saher F, Qureshi JA. Role of clinical electives on academic career: a cross sectional study. J Adv Med and Med Res. 2020;4:21–6.
Bozorgmehr K, Schubert K, Menzel-Severing J, Tinnemann P. Global health education: a cross-sectional study among German medical students to identify needs, deficits and potential benefits (Part 1 of 2: mobility patterns & educational needs and demands). BMC Med Educ. 2010;10(1):66.
Harth SC, Leonard NA, Fitzgerald SM, Thong YH. The educational value of clinical electives. Med Educ. 1990;24(4):344–53.
Weigel R, Wiegand L, Balzereit S, Galatsch M. International medical electives for medical students at a German university: a secondary analysis of longitudinal data. Int Health. 2021;13(5):485–7.
Stys D, Hopman W, Carpenter J. What is the value of global health electives during medical school? Med Teach. 2013;35(3):209–18.
Niemantsverdriet S, Majoor GD, Van Der Vleuten CPM, Scherpbier AJJA. ‘I found myself to be a down to earth Dutch girl’: a qualitative study into learning outcomes from international traineeships. Med Educ. 2004;38(7):749–57.
Imperato PJ. A third world international health elective for U.S. medical students: the 25-year experience of the state university of New York downstate medical center. J Community Health. 2004;29(5):337–73.
Watson DA, Cooling N, Woolley IJ. Healthy, safe and effective international medical student electives: a systematic review and recommendations for program coordinators. Trop Dis Travel Med Vaccines. 2019;5(1):4.
Hayashi M, Son D, Nanishi K, Eto M. Long-term contribution of international electives for medical students to professional identity formation: a qualitative study. BMJ Open. 2020;10(8):e039944.
Grudzen CR, Legome E. Loss of international medical experiences: knowledge, attitudes and skills at risk. BMC Med Educ. 2007;7(1):47.
Slifko SE, Vielot NA, Becker-Dreps S, Pathman DE, Myers JG, Carlough M. Students with global experiences during medical school are more likely to work in settings that focus on the underserved: an observational study from a public U.S. institution. BMC Med Educ. 2021;21(1):552.
Lu PM, Park EE, Rabin TL, Schwartz JI, Shearer LS, Siegler EL, et al. Impact of global health electives on US medical residents: a systematic review. Ann Glob Health. 2018;84(4):692–703.
Nishigori H, Otani T, Plint S, Uchino M, Ban N. I came, I saw, I reflected: a qualitative study into learning outcomes of international electives for Japanese and British medical students. Med Teach. 2009;31(5):e196-201.
Imafuku R, Saiki T, Hayakawa K, Sakashita K, Suzuki Y. Rewarding journeys: exploring medical students’ learning experiences in international electives. Med Educ Online. 2021;26(1):1913784.
Hayashi M, Son D, Onishi H, Eto M. Contribution of short-term global clinical health experience to the leadership competency of health professionals: a qualitative study. BMJ Open. 2019;9(7):e027969.
Lauden SM, Gladding S, Slusher T, Howard C, Pitt MB. Learning abroad: residents’ narratives of clinical experiences from a global health elective. J Grad Med Educ. 2019;11(4s):91–9.
Bales AM, Oddo AR, Dennis DJ, Siska RC, VanderWal E, VanderWal H, et al. Global health education for medical students: when learning objectives include research. J Surg Educ. 2018;75(4):1022–7.
Holmes D, Zayas LE, Koyfman A. Student objectives and learning experiences in a global health elective. J Community Health. 2012;37(5):927–34.
Peluso MJ, Rodman A, Mata DA, Kellett AT, van Schalkwyk S, Rohrbaugh RM. A comparison of the expectations and experiences of medical students from high-, middle-, and low-income countries participating in global health clinical electives. Teach Learn Med. 2018;30(1):45–56.
Faiman B. The changing landscape of healthcare and continuing education. J Adv Pract Oncol. 2020;11(7):669–70.
Ullah I, Ullah A, Ali S, Poulova P, Akbar A, Shah MH, et al. Public health expenditures and health outcomes in Pakistan: evidence from quantile autoregressive distributed lag model. RMHP. 2021;16(14):3893–909.
National Health Spending in 2020 Increases due to Impact of COVID-19 Pandemic | CMS. [cited 5 Apr 2022]. Available from: https://www.cms.gov/newsroom/press-releases/national-health-spending-2020-increases-due-impact-covid-19-pandemic
Agyei-Nkansah A, Adjei P, Torpey K. COVID-19 and medical education: an opportunity to build back better. Ghana Med J. 2020;54(4 Suppl):113–6.
Gupta A, Gupta B, Ahluwalia P. Paradigm shift in medical education. Indian J Clin Anaesthesia. 2021;8(1):148–9.
Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. Lancet Infect Dis. 2020;20(7):777–8.
Al-Balas M, Al-Balas HI, Jaber HM, Obeidat K, Al-Balas H, Aborajooh EA, et al. Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: current situation, challenges, and perspectives. BMC Med Educ. 2020;20(1):341.
Succar T, Beaver HA, Lee AG. Impact of COVID-19 pandemic on ophthalmology medical student teaching: educational innovations, challenges, and future directions. Survey of ophthalmology. 2022 Feb [cited 5 Apr 2022];67(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33838164/
Walters M, Alonge T, Zeller M. Impact of COVID-19 on medical education: perspectives from students. Acad Med. 2022;97(3S):S40.
Wanigasooriya K, Beedham W, Laloo R, Karri RS, Darr A, Layton GR, et al. The perceived impact of the Covid-19 pandemic on medical student education and training – an international survey. BMC Med Educ. 2021;21(1):566.
Gutman A, Tellios N, Sless RT, Najeeb U. Journey into the unknown: considering the international medical graduate perspective on the road to Canadian residency during the COVID-19 pandemic. Can Med Educ J. 2021;12(1):e89-91.
Ravishankar M, Berkowitz AL. Beyond electives: Rethinking training in global neurology. Jo Neurol Sci. 2021;430:120025.
McMaster D, Veremu M, Jonas KM. Should international medical electives to resource-poor countries continue during COVID-19? J Travel Med. 2020;27(6):taaa071.
Storz MA. The COVID-19 pandemic: an unprecedented tragedy in the battle against childhood obesity. Clin Exp Pediatr. 2020;63(12):477–82.
Smith W. The colonial overtones of overseas electives should make us rethink this practice. BMJ. 2021;375:n2770.
Lucey CR, Johnston SC. The transformational effects of COVID-19 on medical education. JAMA. 2020;324(11):1033–4.
Zaidi Z, Dewan M, Norcini J. International medical graduates: promoting equity and belonging. Acad Med. 2020;95(12S):S82.
Papapanou M, Routsi E, Tsamakis K, Fotis L, Marinos G, Lidoriki I, et al. Medical education challenges and innovations during COVID-19 pandemic. Postgraduate Medical Journal. 2021 Mar 28 [cited 5 Feb 2022]; Available from: https://pmj.bmj.com/content/early/2021/03/28/postgradmedj-2021-140032
Park J, Rhim HC. Consequences of coronavirus disease 2019 on international medical graduates and students applying to residencies in the United States. Korean J Med Educ. 2020;32(2):91–5.
Choi B, Jegatheeswaran L, Minocha A, Alhilani M, Nakhoul M, Mutengesa E. The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: a national survey. BMC Med Educ. 2020;20(1):206.
Egiz A, Storz MA. The COVID-19 pandemic: doom to international medical electives? Results from two German elective databases. BMC Res Notes. 2021;14(1):287.
Rose S. Medical student education in the time of COVID-19. JAMA. 2020;323(21):2131–2.
Storz MA, Lederer A-K, Heymann EP. Medical students from German-speaking countries on abroad electives in Africa: destinations, motivations, trends and ethical dilemmas. Hum Resour Health. 2022;20(1):9.
Storz MA, Lederer A-K, Heymann EP. German-speaking medical students on international electives: an analysis of popular elective destinations and disciplines. Global Health. 2021;17(1):90.
Lin CMA. Losing electives and making the best out of a bad situation. BMJ. 2020;370:m2916.
Levene A, Dinneen C. A letter to the editor: reflection on medical student volunteer role during the coronavirus pandemic. Med Educ Online. 2020;25(1):1784373.
Komer L. COVID-19 amongst the pandemic of medical student mental health. Int J Med Students. 2020;8(1):56–7.
Thundercliffe J, Roberts M. International medical electives: another victim to the COVID pandemic. Med Sci Educ. 2022;32(1):269–269.
Wu A, Leask B, Choi E, Unangst L, de Wit H. Internationalization of medical education—a scoping review of the current status in the United States. Med Sci Educ. 2020;30(4):1693–705.
Murray CJL. COVID-19 will continue but the end of the pandemic is near. Lancet. 2022;399(10323):417–9.
Storz M. PJ und Famulatur im Ausland. Berlin, Heidelberg: Springer; 2018 [cited 5 Feb 2022]. p. 1–11. (Springer-Lehrbuch). Available from: https://doi.org/10.1007/978-3-662-57657-1_1
Wellstead G, Koshy K, Whitehurst K, Gundogan B, Fowler AJ. How to organize a medical elective. Int J Surg: Oncol. 2017;2(6):e28.
Anteby R. A foot in the door: foreign international medical students’ obstacles to hands-on clinical electives in the United States. Acad Med. 2020;95(7):973–4.
Bajaj B. The funding of medical electives. Available from: https://www.medschools.ac.uk/media/2550/the-funding-of-medical-electives-bal-bajaj.pdf (cited 5 Apr 2022)
Quaglio G, Maziku D, Bortolozzo M, Parise N, Di Benedetto C, Lupato A, et al. Medical electives in Sub-Saharan Africa: a 15-year student/NGO-driven Initiative. J Community Health. 2022;47(2):273–83.
Sanchez T. Stanford med student lost two jobs during the coronavirus pandemic. So she picked blueberries to make a living. San Francisco Chronicle. 2020 [cited 5 Feb 2022]. Available from: https://www.sfchronicle.com/bayarea/article/Stanford-med-student-lost-two-jobs-during-the-15692326.php
Negash S, Kartschmit N, Mikolajczyk RT, Watzke S, Matos Fialho PM, Pischke CR, et al. Worsened Financial Situation During the COVID-19 Pandemic Was Associated With Depressive Symptomatology Among University Students in Germany: Results of the COVID-19 International Student Well-Being Study. Front Psychiatry. 2021 [cited 5 Apr 2022];12. Available from: https://www.frontiersin.org/article/https://doi.org/10.3389/fpsyt.2021.743158
Dhawan M, Priyanka, Choudhary OP. Omicron SARS-CoV-2 variant: reasons of emergence and lessons learnt. Int J Surg. 2022;97:106198.
Rimmer A. Covid vaccination to be mandatory for NHS staff in England from spring 2022. BMJ. 2021;375:n2733.
Paterlini M. Covid-19: Italy makes vaccination mandatory for healthcare workers. BMJ. 2021;373:n905.
Wise J. Covid-19: France and Greece make vaccination mandatory for healthcare workers. BMJ. 2021;374:n1797.
Unprotected African health workers die as rich countries buy up COVID-19 vaccines. [cited 5 Feb 2022]. Available from: https://www.science.org/content/article/unprotected-african-health-workers-die-rich-countries-buy-covid-19-vaccines
Beaubien J. For the 36 countries with the lowest vaccination rates, supply isn’t the only issue. NPR. 2022 Jan 14 [cited 5 Feb 2022]; Available from: https://www.npr.org/sections/goatsandsoda/2022/01/14/1072188527/for-the-36-countries-with-the-lowest-vaccination-rates-supply-isnt-the-only-issue
Hanson L, Harms S, Plamondon K. Undergraduate international medical electives: some ethical and pedagogical considerations. J Stud Int Educ. 2011;15(2):171–85.
Keating EM, Haq H, Rees CA, Swamy P, Turner TL, Marton S, et al. Reciprocity? international preceptors’ perceptions of global health elective learners at African sites. Ann Glob Health. 2019;85(1):37.
Bozinoff N, Dorman KP, Kerr D, Roebbelen E, Rogers E, Hunter A, et al. Toward reciprocity: host supervisor perspectives on international medical electives. Med Educ. 2014;48(4):397–404.
Lawrence ER, Moyer C, Ashton C, Ibine BAR, Abedini NC, Spraggins Y, et al. Embedding international medical student electives within a 30-year partnership: the Ghana-Michigan collaboration. BMC Med Educ. 2020;20(1):189.
McMahon D, Shrestha R, Karmacharya B, Shrestha S, Koju R. The international medical elective in Nepal: perspectives from local patients, host physicians and visiting students. Int J Med Educ. 2019;22(10):216–22.
Fotheringham EM, Craig P, Tor E. International medical electives in selected African countries: a phenomenological study on host experience. Int J Med Educ. 2018;23(9):137–44.
Mehta N, Li C, Bernstein S, Pignatiello A, Premji L. Pandemic productivity: competitive pressure on medical students during the COVID-19 pandemic. Can Med Educ J. 2021;12(2):e122–3.
Zeng AGX, Brenna CTA, Ndoja S. Fundamental trends within falling match rates: insights from the past decade of Canadian residency matching data. Can Med Educ J. 2020;11(3):e31-42.
Kachra R, Brown A. The new normal: medical education during and beyond the COVID-19 pandemic. Can Med Educ J. 2020;11(6):e167–9.
Dost S, Hossain A, Shehab M, Abdelwahed A, Al-Nusair L. Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students. BMJ Open. 2020;10(11):e042378.
Sharma D, Bhaskar S. Addressing the Covid-19 Burden on Medical Education and Training: The Role of Telemedicine and Tele-Education During and Beyond the Pandemic. Front Public Health. 2020 [cited 5 Feb 2022];8. Available from: https://www.frontiersin.org/article/https://doi.org/10.3389/fpubh.2020.589669
Bernad J. Thinking strategically: how “ACE” helps IMG trainees. In: Tohid H, Maibach H, editors. International medical graduates in the United States: a complete guide to challenges and solutions. Cham: Springer International Publishing; 2021. 365–70. https://doi.org/10.1007/978-3-030-62249-7_22.
Egiz A, Gillespie CS, Kanmounye US, Bandyopadhyay S. Letter to the editor: “The impact of COVID-19 on international neurosurgical electives.” World Neurosurg. 2022;1(157):249–51.
Soni NJ, Boyd JS, Mints G, Proud KC, Jensen TP, Liu G, et al. Comparison of in-person versus tele-ultrasound point-of-care ultrasound training during the COVID-19 pandemic. Ultrasound J. 2021;13(1):39.
Ottinger ME, Farley LJ, Harding JP, Harry LA, Cardella JA, Shukla AJ. Virtual medical student education and recruitment during the COVID-19 pandemic. Semin Vasc Surg. 2021;34(3):132–8.
Byrnes YM, Civantos AM, Go BC, McWilliams TL, Rajasekaran K. Effect of the COVID-19 pandemic on medical student career perceptions: a national survey study. Med Educ Online. 2020;25(1):1798088.
Desai A, Hegde A, Das D. Change in reporting of USMLE step 1 scores and potential implications for international medical graduates. JAMA. 2020;323(20):2015–6.
Lumb A, Murdoch-Eaton D. Electives in undergraduate medical education: AMEE Guide No. 88. Med Teach. 2014;36(7):557–72.
Law IR, Worley PS, Langham FJ. International medical electives undertaken by Australian medical students: current trends and future directions. Med J Aust. 2013;198(6):324–6.
Willott C, Khair E, Worthington R, Daniels K, Clarfield AM. Structured medical electives: a concept whose time has come? Global Health. 2019;15(1):84.
Jolly B. A missed opportunity. Med Educ. 2009;43(2):104–5.
Ramalho AR, Vieira-Marques PM, Magalhães-Alves C, Severo M, Ferreira MA, Falcão-Pires I. Electives in the medical curriculum - an opportunity to achieve students’ satisfaction? BMC Med Educ. 2020;20(1):449.
Dao TL, Hoang VT, Magmoun A, Ly TDA, Baron SA, Hadjadj L, et al. Acquisition of multidrug-resistant bacteria and colistin resistance genes in French medical students on internships abroad. Travel Med Infect Dis. 2021;39:101940.