The influence of international medical electives on career preference for primary care and rural practice.

BACKGROUND: Previous studies have demonstrated a correlation between medical students who undertake international medical electives (IMEs) in resource poor settings and their reported career preference for primary care in underserved areas such as rural practice. This study examines whether a similar correlation exists in the Australian medical school context. METHODS: Data was extracted from the Medical Schools Outcomes Database (MSOD) of Australian medical students that completed commencing student and exit questionnaires between 2006 and 2011. Student responses were categorized according to preferred training program and preferred region of practice at commencement. The reported preferences at exit of students completing IMEs in low and middle income countries (LMIC) were compared to those completing electives in high income countries (HIC). RESULTS: The effect of elective experience for students expressing a preference for primary care at commencement was non-significant, with 40.32 % of LMIC and 42.11 % of HIC students maintaining a preference for primary care. Similarly there were no significant changes following LMIC electives for students expressing a preference for specialist training at commencement with 11.81 % of LMIC and 10.23 % of HIC students preferring primary care at exit. The effect of elective experience for students expressing a preference for rural practice at commencement was non-significant, with 41.51 % of LMIC and 49.09 % of HIC students preferring rural practice at exit. Similarly there were no significant changes following LMIC electives for students expressing a preference for urban practice at commencement, with 7.84 % of LMIC and 6.70 % of HIC students preferring rural practice at exit. CONCLUSIONS: This study did not demonstrate an association between elective experience in resource poor settings and a preference for primary care or rural practice. This suggests that the previously observed correlation between LMIC electives and interest in primary care in disadvantaged communities is likely dependent on student and elective program characteristics and supports the need for further research and critical examination of elective programs at Australian medical schools.

International medical electives undertaken by Australian medical students: current trends and future directions.

OBJECTIVES: To estimate the proportion of students in Australian medical schools who undertake international medical electives (IMEs), particularly in developing countries, and to ascertain which medical schools provide predeparture training and postelective debriefing. DESIGN, SETTING AND PARTICIPANTS: Extraction of data on the number of students undertaking electives from the Medical Schools Outcomes Database (MSOD) for the 2013s 2006 to 2010; and interviews with the directors of each medical school in Australia in May to July 2012 to ascertain the availability of predeparture training and postelective debriefing. MAIN OUTCOME MEASURES: The proportion of medical students undertaking IMEs overall and within developing countries and the proportion of medical schools with optional and mandatory predeparture training and postelective debriefing. RESULTS: Fifty-three per cent of graduate-entry (GE) program students and 35% of high-school entry (HSE) program students undertook IMEs. Fifty-nine per cent of electives undertaken by GE program students were in developing countries, compared with 56% for HSE program students. Predeparture training was offered by 12 of the 16 Australian medical schools, but it was mandatory in only six. Only eight schools offer postelective debriefing. CONCLUSIONS: A large proportion of Australian medical students undertake IMEs in developing countries. However, a considerable proportion of students do not undertake formal preparation for, or reflection on, their experiences. Predeparture training and postelective debriefing should be scaled up across Australian medical schools to provide students with the guidance and support to maximise the benefits and minimise risks associated with undertaking IMEs in developing countries.