Is an elective still a relevant part of a medical degree?

by Eileen Song, 6th Year Medicine, University of Auckland

The final-year elective is a very well-known component of the medical school curriculum. It is a set period of time which encompasses new opportunities and a sense of freedom for students, in choosing what, where and how they learn, as well as having an effect on their career progression. There are many ways in how a student may approach their elective; whether they want to experience the medical system of another culture where the access to resources and technologies differ, or whether they want to develop useful connections for training purposes. Students are able to take the medical elective and use it to maximise their potential by reaching their intended objectives.

In my opinion, the medical elective is a crucial part in the degree for academic, skill-enhancing and character-building purposes. Bullock et al.[1] describes the irreplaceable role of “degree-integrated placements”1 for not only allowing the application of formal learning, but also the development and acquirement of “personal transferable skills”1. My interpretation of these skills refers to the communicational and interpersonal skills that are only truly put to the test in the clinical setting. As with the usual curricular clinical attachments, students need to adapt themselves to the culture of the team they are assigned to. This is magnified on an elective, particularly on an overseas elective, as a different culture also comes into play.

Students complete their elective in a location and speciality which they are interested in and have selected according to their own circumstances. This is important as insight into these particular specialities may not have been as readily accessible within the medical curriculum or the cohort location for which the students are allocated to. Or, they wish to gain certain clinical experiences which are only provided by certain clinicians, or in certain hospitals. Whether students choose these to strengthen their knowledge in a certain area, or to gain exposure in another, these are all rare clinical experiences which are otherwise difficult to obtain. For example, I conducted my six week selective this year in Hong Kong with the Department of Cardiothoracic Surgery. If not for this selective, I would not have had any exposure to this specialty throughout the course of my medical degree.

Furthermore, the student role allows maximal utilisation of this rare opportunity. As the elective does not fall under employment, there are no formal responsibilities towards the hospital or the medical system. Students are therefore not obliged to stick to one particular job or roster, but rather, have the flexibility to move around the department to see and experience as much as possible. Again, I experienced this on my selective this year, where I was allowed to rotate between different operating lists, clinics, and ward rounds for both the thoracic and cardiac team – whereas the local students would usually only be assigned to one of these teams for one week.

I also had the opportunity to meet many other elective students from all around the world whom which I could share knowledge and experiences with. While I was in Hong Kong, I met not only the local students, but also students from Italy, Slovakia, Germany and the United States of America. It was fascinating to discuss all the similarities and differences between the various medical school and hospital systems.

From my experience of engaging with graduates, the elective is often the most enjoyable or memorable part of the degree. Due to its student-led nature, it is the component which is regulated the least by the medical school as stated by Lumb et al.[2]. The paper suggests that this allows students to be exposed to both the greatest potential risks as well as the greatest potential opportunities2. One could argue that this flexibility has the potential to be misused. For example, if there is a lack of planning for not just the hospital allocation, but also the travel and accommodation aspect, the student may experience more issues which could cast a shadow over their entire elective experience. In some circumstances, it may even seem as if the few weeks allocated towards the elective could be better used for further formal learning or clinical training within the home hospital. However, with the right guidelines and pre-departure procedures in place, these less ideal elective outcomes can be kept to a minimum, and more fruitful elective experiences can be promoted2. The University of Auckland works towards this by assigning every elective student with an elective supervisor, for whom all plans can be discussed with. Moreover, there is an elective checklist, as well as a risk assessment form that is to be completed before the elective can be approved.

All in all, electives have played a large part in the senior clinical years of the medical degree for a very long time. Especially with the rapidly developing world of science and technology, I think that it retains its important function of further opening the world of medicine to the eyes of students. Skills, knowledge and insight gained from places around the world, whether it originates from positive or negative learning experiences, can act as valuable learning points which students can use to better themselves in their future practice.

 

[1] Bullock K, Hejmadi M, Lock G. 2012. Work placements for bioscience undergraduates: are they really necessary? J Biol Educ, 46: 4-11.

[2] Lumb, A., Murdoch-Eaton, D. orcid.org/0000-0002-2246-8785. 2014. Electives in undergraduate medical education: AMEE Guide No. 88. Medical Teacher, 36(7): 557-572. ISSN 0142-159X. https://doi.org/10.3109/0142159X.2014.907887