TANZANIA MEDICAL ELECTIVES PROGRAM

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What is Tanzania Medical Electives?

Tanzania Medical Electives is the process of International and foreign medical students joining Tanzania’s local health system in pursue of gaining practical training and experience of what they have been learning and trained in their respective countries and Universities.

An Assessment of Tanzania Medical Electives Program

Highlights

Introduction to Tanzania Medical Electives

This essay will be looking at the impact of Tanzania medical electives on both the students who go on them, and the Hospitals who host them. The term “Host Hospitals” will be used to describe both host hospitals, and host communities, as medical electives have an impact on both, due to the close link many hospitals have with the communities they are in. Electives are a component of a medical degree during which the student spends their time in a healthcare system they are interested in. Some students choose to stay in the UK for this, but 80-90% ( 1,2) travel Abroad. More than half of these students going abroad choose to go to developing countries and it is these electives that have the most potential for, and evidence of, ethical issues arising as a result of them. Therefore, from here on, it is electives to developing countries like Tanzania which are being discussed unless otherwise specified.

Tanzania Medical Electives Program

• Internal Medicine Tanzania Medical Elective
• Surgery Tanzania Medical Elective
• Pediatrics and Child Health Tanzania Medical Elective
• Orthopedics and Trauma Tanzania Medical Elective
• Community Health Tanzania Medical Elective
• Psychiatry and Mental health Tanzania Medical Elective
• Obstetrics and Gynecology Tanzania Medical Elective
• Emergency Medicine Tanzania Medical Elective
• Clinical Nursing Tanzania Medical Elective
• Oral Surgery Tanzania Medical Elective
• Restorative Dentistry Tanzania Medical Elective

Good for students?

Much of the research surrounding electives focuses on their impact on students, and it overwhelmingly suggests that electives are a positive experience for students who take part in them. Electives can provide students with a multitude of opportunities for students to develop practical skills, knowledge of tropical diseases and cultural competence. Due to a variety of reasons including incorrect beliefs about medical students’ competencies and capabilities and using students to fill staff deficits, medical students are often given more responsibility on electives than they have been during their training in the UK. This increased allows more scope for students to practice skills they have only done a limited number of times, which inevitably leads to a steep learning curve. Therefore, when students return to the UK, either to start their foundation year jobs, or to complete medical school, they are more competent.

Students undertaking electives in Tanzania are usually in climates, environments and cultures very different to those they have trained in. This means they see many conditions and practices, as well as ways of living, to those they are used to in the UK. One of the benefits of this is that student’s knowledge of tropical and rare diseases increases significantly. Diseases such as malaria and cholera are rarely seen in the UK but are common in some parts of the world and can be extremely serious. Having practical experience of such tropical diseases will mean that if a student does see patients with symptoms suggestive of one of these diseases, they will be able to recognize and treat it sooner. The potential benefit for students who end up working in Tanzania further in their career is even more obvious in this regard, because, depending on the country they work in, they may see diseases like malaria quite frequently. As well as clinical knowledge, it has been found that cultural competence improves with students participating in electives Tanzania. The UK is an increasingly multicultural society, meaning that even those students, for whom their elective will be their only experience of working abroad, will need to be good at interacting and effectively treating patients from many different cultures.

Reviewing these benefits, it could be argued that they are advantageous to a student’s future patients more than the student themselves, and this is important to remember when comparing the overall benefit of electives

 Good for host Hospitals?

There is a paucity of literature surrounding how medical students affect host Hospitals, however, much of the literature demonstrates that the effects on host Hospitals are often negative. One of the most significant “areas of concern” identified by White and Cauley, amongst others, is that of the risk to patients. As mentioned in the previous section, one benefit to students is the steep learning curve of practical skills. Sometimes this comes because of a student practicing a skill they are already competent at in order to have more experience. However, the attitude of “practicing on the poor”, whilst not commonplace, is not unheard of either. For most who find themselves in this position, it is because of perceived necessity: students may be one of the only people working at the host hospital with much medical training in areas with significant staff shortages, so they undertake tasks they are not competent to do because they believe that doing so is better than no one doing it. As mentioned earlier, staffs often have misperceptions about the capabilities of students, and this can lead to the staff unintentionally building student’s confidence, which compounds the issue of students doing more than they are capable of. There are also a, fortunately small, number of students who intentionally exploit the freedom they have, one example talks of a student performing a lumbar puncture because he “fancied having a go”. This kind of behavior is obviously unacceptable, and should bring into question the student’s professionalism, however due to lack of accountability for many students on electives; such incidents are less likely to be reported.

It has been discussed that electives provide good opportunities for developing cultural competence, that is, the ability of one to work effectively with people from cultures different to one’s own. However, it must be recognized that there are many situations students display a lack of cultural sensitivity whilst they are on their elective, sometimes not developing in cultural competence, and other times only doing so at the expense of those they have been insensitive to. This extends beyond just offending people, it can have significant negative consequences, as people are put off seeking health advice, are not comfortable sharing details of symptoms that could prove important to diagnosis, and loose trust in their local medical services . Additionally, students may suggest ideas which are irrelevant, inappropriate, or impractical, because their knowledge is centred around diagnosing and treating in the UK, and available treatment and diagnostic tests may be very different in the host Hospital.

The impacts on host Hospitals are not entirely negative. Several articles have explored the impact of an elective on a student’s future career. These have repeatedly shown that students who participate in electives in either developing countries, or underserved populations in a student’s own country increase their likelihood of working with such populations, or doing other sorts of humanitarian work in the future. In this respect, the benefits of electives are manifold: students are more likely to work in developing countries, and they are also more culturally competent and knowledgeable, and therefore more likely to work responsibly in these jobs.

Ideas for Improving Tanzania Medical Electives Program

The title of this essay hints at the dichotomy between the effects on host Hospitals and the effects on students participating in electives which has started to become apparent throughout this essay. The contrast exists in that the positives experienced by students quite often have a negative consequence for host Hospitals, and this is one of the key issues with Tanzania electives which must be addressed.

One way of doing this is by using pre-departure training. Not only has this been shown to increase the benefits seen by medical students, it also plays a significant part in reducing the negative effects experienced by host Hospitals. Many students are unaware of the impact they are having on the host Hospital. By teaching students to be more aware of cultural difference, and having discussions about the ethics of their behaviour when abroad, as well as other factors of Pre-departure training, students are more aware of the impact they are having, and are more conscientious when making decisions. The problem with current Pre-departure training is that there is no consistency between medical schools. Some medical schools offer lots of Pre-departure training, others minimal. Students arranging electives through external companies may also receive Pre-departure training with these companies. To improve the overall effect of electives needs to become more standardized amongst different institutions and organisations.

The creation of partnerships between medical schools in the UK and host Hospitals is another way to reduce the negative impacts on host Hospitals. This has many benefits, it increases accountability, counters issues of staff being unaware of UK students competency, increases awareness of any negative impact the electives might still be having and also allow the potential for reciprocity. There are, inevitably, some problems with these, but overall, they appear to be a very good solution to many of the problems with electives.

Conclusion

It is very difficult to make a conclusion about whether electives are overall good or bad, doing so would involve considering further issues that this essay hasn’t had the space to do, including more considerations on long term effects on future patients of students who have been on electives. It would also be necessary to discuss whether one can ethically justify negative consequences to some if they are outweighed by positive consequences to others. However, what is apparent is that whether electives are good overall, improvements need to be made, and some of these, such as improving pre-departure training and creating partnerships.