Chapter 54 for more advice).A medical elective usually takes place during the latter years at medical school prior to graduating. It is an opportunity to try something different and pursue an area of study in which you are particularly interested. Many students also use the elective as an opportunity to travel abroad. The duration of the elective varies between medical schools but you will typically have between 6 and 8 weeks. It is possible to achieve many things in this time but the best electives are those that are planned carefully and well in advance.
Think broadly about the sources of information that are available to help guide your decision-making.
Your medical school may be able to provide you with examples of previous students’ elective choices, sometimes including other students’ project reports.
Speak to students from previous years; they may have contact details or suggestions of places where they did their electives.
Talk to hospital staff including consultants and other senior doctors. They may have supervised students on previous electives or have contacts in their field of expertise around the world.
The Internet is a vast resource that may help you to find the contact details of specific institutions or directories of organizations. Remember, however, that smaller, more remote institutions in the developing world may not have websites—to find these, you may need to rely upon word of mouth.
Most medical schools will permit a wide range of different types of elective. The emphasis is on what you can learn and gain from the time rather than where it is spent. Possible types of elective include:
Many students choose to undertake their elective based in a hospital. This may range from a large teaching hospital in the US to a small rural hospital in Africa.
Particularly for those students considering a career in general practice, you may decide that you would like to spend your elective working in a community-based setting. For example, you may choose to be based at a homeless shelter in inner city London, with a community HIV/AIDS programme in Africa, or with a maternal health project in Bangladesh.
A number of non-governmental and missionary organizations take students for elective placements.
Some organizations such as the International Federation of Medical Students’ Associations (IFMSA) exist specifically for medical students and offer a range of elective projects and exchange programmes.
Perhaps you have a passion for climbing, skiing, or diving? You could undertake an elective in expedition medicine, mountain medicine, dive medicine, aviation and space medicine, or with the ‘flying doctors’.
Top tip
Refer to the Oxford Handbook of Expedition and Wilderness Medicine, by Johnson et al. (2nd ed, 2015, Oxford University Press) for more information on this vast field and which opportunities to look out for.
Many students choose to undertake a clinical placement as part of their elective. Think imaginatively about which clinical area you would like to be based in. It is also important to do your research carefully. If you have a specific area in mind, make sure you find an institution where this specialty is available.
Some students choose to carry out an audit or research project during their elective period, often alongside a clinical placement. This can range from a qualitative study to a laboratory-based project, a quantitative study, or an audit of existing guidelines. If you are going to be carrying out a research project, it is particularly important to plan ahead. You will need to put together a research proposal and are likely to need to apply for ethical approval (see Chapter 54 for more advice).
Many organizations provide funding for medical students and it may be possible to pay for the whole enterprise this way. As well as saving money, elective bursaries often take the form of awards and prizes which can be helpful for your CV later on.
Before you make any decisions, take a few moments to think through what you want to get out of your elective. With careful planning, it is often possible to achieve multiple things in the same elective period.
Being a medical student can be exhausting and many see their elective as a ‘break’ from studying. Some electives are more tightly organized than others but it is certainly possible to build in sun, sea, and sand if you wish.
It can be difficult to travel for long periods of time during medical school whether because of finance or course commitments. This can be your opportunity to see the world.
Although it is difficult to gain much from research over such a short period, simpler projects could be completed during the elective period. It is also an opportunity to network with doctors from other specialties and institutions.
No medical school claims to rotate all students through every medical and surgical specialty. This can be a problem if you have a passing interest in ophthalmology or plastic surgery but have never had any formal experience. The elective can be your opportunity to explore potential career options.
If you have an idea which specialty you would like to pursue, the elective is a further opportunity to develop your ‘commitment’. If you are less certain, but want to think strategically, find an elective that is applicable to multiple potential specialties. For example, an elective working in a clinic for pregnant women with HIV could be considered as commitment to genitourinary medicine, obstetrics and gynaecology, infectious diseases, or public health.
Perhaps there is a country you have always wanted to work in? Would you rather stay in the UK or go abroad? Do you want to go to a developed or developing country? Do you want to be in an urban or rural area?
For example, you might have particularly enjoyed your paediatrics placement, you might want to learn more about malaria, or you might want to explore life as a cardiac surgeon.
While there are sources of financial support available, some options are inevitably more expensive than others.
While some students will want to travel independently, it may be more important for you to travel with others. Electives can be isolating if you are by yourself but you will be less independent travelling as part of a group.
It is clearly preferable for you to be able to communicate with patients and staff in your chosen location. Speaking the local language is not always a prerequisite but you should think carefully about this communication challenge. ‘Crash courses’ in medical Spanish are popular for students intent on travelling to South America.
Consider the climate of the country you are considering at a given time of year.
There is a wealth of opportunities available to students requiring funding for their medical elective. Planning early is important here so apply in plenty of time to give yourself the highest possible chance of securing a bursary or grant. If you are fortunate to secure a grant, make sure you send a letter of thanks and a copy of your elective report.
There may be sources of funding open only to students from your medical school. There may also be funding available in your local area through charitable trusts or local companies.
These grants are open to all students across the UK and are likely to be competitive, so it is particularly important to plan your application carefully. Do not be put off by perceived competitiveness, though, as they are often underwhelmed by the number of high-quality applications. Make a decision that balances the effort required, potential reward, and likelihood of success. There are useful websites for this including 
www.trustfunding.org.uk.
Some sources of funding are available specifically for certain fields (e.g. paediatrics, obstetrics), and there are specific grants available for women in medicine and for mature students. Look at the royal colleges and specialty associations as most will offer elective awards.
Being enthusiastic and original in your application will help to make your form stand out. This is not something to complete a day before the application deadline—prepare well in advance and ask others to read it critically first.
State your aims and objectives and rationale for doing the project and include a copy of your research proposal. If possible, explain the impact of your project either on your career or the wider community. Funding bodies want to feel that they are supporting projects that will have the greatest possible impact.
Include a breakdown of costs including flights and accommodation. Ask for what you need but economize as far as possible. Funding bodies want maximum reward for their money—projects that are good and economical are most likely to be funded.
Ensure that the arrangements with your host institution are confirmed, and attach a copy of your application form or approval letter. The more organized your project appears to be the harder it is for it to be turned down by funders.
You may be asked to provide a referee for your application, so ask someone who knows you well. Exuberant personalities write enthusiastic references!
Applications may require you to include a CV so make sure you have prepared this ahead of time.
The key message regardless of where you are planning to go on your elective is to start making travel arrangements well in advance. The Foreign Office website has advice about areas of the world that are unsafe and not recommended for travel.
Remember that your passport must be in date for at least 6 months from the date you return from your travels. Check whether the country you are visiting requires a visa. You may need to organize this in advance and make arrangements to travel to the relevant embassy in the UK. Alternatively, you may be able to arrange a visa online.
This should cover health, possessions and flight cancellations. Specific policies are available for medical students travelling on electives. Some insurance companies will provide cancellation cover in case you fail an exam and are unable to go on your elective. Others will cover the need for repatriation following illness abroad or sustaining a needle-stick injury. If your elective is in a country within the European Union, you should complete the Department of Health European Health Insurance Form, EHIC. This form is available online and will provide you with free emergency healthcare should this be required. It is still important to arrange travel insurance to cover ill health and any treatments that become necessary.
This is an important part of the organization for your elective. Contact your defence union to find out whether they will cover you during your elective. If not, they will be able to advise you about which organizations are likely to provide cover. This issue is particularly important for students travelling to the US and Canada; check with your institution whether indemnity cover is provided through them. It is important to remember that the same professional codes of conduct apply to you on your elective as they do as a medical student in the UK. Do not perform procedures or provide care to patients that you would not be confident or competent to perform in the UK.
Some countries require you to undergo a medical assessment (sometimes including a CXR) before you travel. You will need to arrange for this to be done privately well in advance of travel. A travel clinic should be able to arrange this for you as well as any vaccinations that are required for your elective destination.
Remember that some airlines and travel operators offer student discounts on flights. It is advisable to book as early as you can, particularly if you intend to travel during the peak season.
Book yourself in to a travel clinic or with your local student health service at least 3 months in advance—you may require a number of vaccinations over a period of weeks. They will be able to advise you about the specific risks and conditions found in the areas you will be travelling to. The National Travel Health Network and Centre (NaTHNaC) website provides detailed information and advice ( www.nathnac.net).
Vaccinations you may require in addition to the UK national schedule include:
You should already have been vaccinated against hepatitis B before starting at medical school, but the current Department of Health guidance suggests that a single booster should be given 5 years after the primary vaccination course.
Particular areas of endemicity include South and Central America and Africa.
These infections are most prevalent in low-income areas of the world with poor sanitation and lack of access to clean water. Typhoid is particularly common in Asia, as well as parts of South America and Africa. Rare outbreaks have been reported in Europe.
No longer part of the national schedule so if you have not received a BCG vaccination against TB you should consider this if travelling to an area of 
risk (Asia, Africa, Central and South America).
Meningitis C vaccination is currently part of the UK National Vaccination Schedule. However, travellers visiting at-risk areas for meningococcal disease are advised to receive the quadrivalent ACW125Y vaccine.
Students at greatest risk of hepatitis A infection will be those visiting areas with poor sanitation. Vaccine and immunoglobulin are available.
This is endemic in parts of Asia and the South Pacific so consider vaccination if travelling to these areas.
You should consider rabies vaccination if you are travelling to an area in which rabies is present and you will not be able to access immediate post-exposure treatment (particularly in rural, undeveloped areas).
If you are travelling to a country with high rates of HIV infection and you will be working in a clinical capacity, it may be advisable to take HIV PEP with you. You can buy a 3- or 7-day pack that could be used in case of an emergency while you seek medical help at a specialist unit. The antiretroviral drugs used will vary. The key is to use appropriate precautions, particularly in areas of high HIV endemicity. When performing procedures or observing in theatre, always wear gloves, goggles, mask, and gown. If you are at risk, start taking your prescribed HIV PEP medications, and get yourself to a hospital with an HIV centre as soon as possible. The Department of Health has a useful website with information about HIV postexposure prophylaxis.
The first step in preventing malaria is avoiding bites. Wear trousers and long sleeves after dark, and use an insect repellent containing DEET. Take an insecticide-treated bed net with you (you may not be provided with one in your accommodation, and those provided often have holes in them!). Ensure that you tuck your bed net in all around underneath the mattress. If required for the area you are travelling to, ensure you arrange to take a supply of antimalarial prophylaxis with you. A range of options are available depending on where you are travelling to (and therefore local resistance patterns).
If you have any pre-existing medical conditions, make sure you make an appointment with your GP to ensure that you have all the necessary advice and medications you need before you travel. Check whether there are any restrictions on whether you can take any of the medications you require out of the UK. If you have diabetes and require insulin, remember to get a letter from your GP explaining the reason for taking needles and syringes abroad.
This is a common problem faced by travellers but there are a few tips to help reduce the risk. Remember to drink only boiled or bottled water, avoid ice in drinks, avoid salad and fruit (unless you peel it yourself), and ensure that food you eat is cooked.
The biggest threat to your safety abroad is trauma resulting from a road traffic accident. You would always wear a bike helmet and seatbelt at home, so do not forget to do so when on your elective.
There are a vast number of useful resources available to help you plan your elective.
• The BMA medical electives website has useful information regarding planning your elective: https://www.bma.org.uk/advice/career/going-abroad/medical-electives.
• The Medics Travel website provides a range of information and resources for planning your elective: www.medicstravel.com.
• The International Federation of Medical Students’ Associations (IFMSA) organizes an electives programme with a range of projects and exchanges: www.ifmsa.org.
• The WHO Medical School Directory provides a comprehensive list of medical schools you can apply to: www.who.int/hrh/wdms/en/.
• If you are looking to work with a non-governmental organization, check out the World Association of Non-Governmental Organizations (WANGO) directory: www.wango.org.
• The Department of Health’s ‘Fit for travel’ website offers a range of advice on travelling abroad: www.fitfortravel.nhs.uk/home.aspx.
• The Foreign Office offers an ‘A to Z’ by country with detailed travel advice for each destination: www.gov.uk/foreign-travel-advice.
• The National Travel Health Network and Centre (NaTHNaC) website provides detailed, up-to-date information on recent clinical updates and the vaccinations required for travel to each country in the world: https://travelhealthpro.org.uk/.
Mark Wilson, The Medic’s Guide to Work and Electives Around the World (3rd ed, 2009, CRC Press), contains an extensive directory of contact details for institutions around the world, and is available at most medical school libraries.