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The ethics of electives

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The ethics of electives

  1. 1. Electives Presentation Jonny Currie Bristol
  2. 2. Why do we do electives?
  3. 3. Overseas electives  Different cultural and organisational setting  See diseases rare in UK  Personal development  Travel  Experience different medico-social context
  4. 4. A tale of two electives… Adams and Sheather, 2001. Elective Ethics. sBMJ 9; p.305-356.
  5. 5. Medical tourism  Self-serving  Raise unmet expectations  Ineffective  Impose burdens on local health facilities  Inappropriate If under colonialism natural resources and human labour were exploited; Are western societies now using under-developed nature of developing countries as training grounds for their own teachers and other professionals? Are medical electives the new neo- colonialism?
  6. 6. Are medical electives the new neo-colonialism?
  7. 7. Practising ethics • Ambassadors abroad • Discomfort about suddenly being expected to “see patients” • Poor supervision • Limited resources • Huge health needs Justifies acting role of doctor?
  8. 8. Practising ethics  Patients have right to know are being cared by students  Ethics of intervening  Legal ground  Moral boundaries
  9. 9. Risk to the poor – benefit to the rich • Medical students profit from international elective experience and practise within USA/Europe benefits in training transferred to patients in developed world • burden of harm is placed on the population in the developing world and most benefit is accrued by patients in developed nations  exploitation might emerge
  10. 10. The Elective Industry  Parallels to Gap Year industry  Diverse organisations  Simplistic definition of development
  11. 11. The Elective Industry SPW is a true development organization. We will not send you on an exotic holiday where you can also indulge in a little teaching, or environmental work. You will know that if you participate in one of our programmes you will be helping to make a real difference - not only for your CV, but for the people you are working with. Original emphasis, Student Partnership Worldwide, 2002 Does the idea of travel to far off destinations appeal to you? How about the adventure of joining an expedition into the world’s greatest mountain ranges? And I expect you’d like to help a disadvantaged community and acquire new skills while working on an aid project . . . . At the same time you’re probably thinking about how your Gap Year will fit into the broader picture, will it be something to impress future employers and how will it look on your CV? Venture Co., 2002, p. 1
  12. 12. Incorrect representation of ‘developing world’ Limited critical engagement allows students to confirm their presumptions, with added authority of ‘experience’ Fatalistic faith in the ‘luck of the draw’ ‘Lotto logic’ Outgoing reflections of students What the gap year industry lacks is a pedagogy for social justice
  13. 13. The route to internationalisation?  Authors question whether electives enable students to meet requirements of globalisation  Comprehensive programme of international health teaching  Preaching to the converted Edwards et al, 2004. Understanding global health issues: are international medical electives the answer?
  14. 14. Curricula for change • WHO qualities of ‘5 star doctor’ • Community oriented • Reconciling individual and community needs • Initiating actions on behalf of community  Tomorrow’s Doctors:  Public health medicine prominent in curriculum  Health promotion;  illness prevention;  Assessment and targeting of population needs  Awareness of environmental and social factors in disease
  15. 15. International Health electives  Karolinska Institute, Sweden  Global Multiculturalism Track, Massachusetts, USA  University College London, UK
  16. 16. Health Systems  Developing countries face severe health workforce shortages  4 million health workers needed to fill gap (World Health Organisation)  NGOs can lure qualified people from Ministry of Health and into private sector
  17. 17. Parallel health systems  NGOs can high more staff at higher salaries  Can acquire specialised equipment  Or create idealised projects serving one limited population in a geographic area  Result is a fragmented and inequitable health system
  18. 18. I. NGOs will engage in hiring practices that ensure long-term health system sustainability. II. NGOs will enact employee compensation practices that strengthen the public sector. III. NGOs pledge to create and maintain human resources training and support systems that are good for the countries where they work. IV. NGOs will minimize the NGO management burden for ministries. V. NGOs will support Ministries of Health as they engage with communities. VI. NGOs will advocate for policies that promote and support the public sector.
  19. 19. Funding  Electives operate in context of inequality  Consider how you spend your money  Ethics of funding?
  20. 20. What can you do?  Before you leave:  think what you hope to gain and what you are capable of doing  question medical school on when to ask for help and what to do when not forthcoming  knowledge and skills of health context  Broad learning on determinants of disease
  21. 21. What can you do?  Once you’re there:  discuss with supervisor what is expected and how you can be most helpful  offer something in return  relevant research  On return:  future student or research exchanges  Reflect on experience  Develop global understanding
  22. 22. Final remarks  We live in a global economy; surely we should practise global medicine?  One-way process  Strive to minimise the risk: benefit ratio
  23. 23. Essential reading UCL Elective Pack Available at: Improving health for the world’s poor: what can health professionals do?
  24. 24. Global Health education
  25. 25. Websites