Introduction
Medical electives offer a valuable, exciting, and unique opportunity for medical students to explore different healthcare systems and pursue areas of medical interest, at home or abroad (Willott et al., 2019). They provide a chance to develop clinical skills in unfamiliar settings, enhance cultural sensitivity and adaptability, and build meaningful connections with like-minded, enthusiastic professionals across the globe (Hayashi et al., 2020).
Electives can be undertaken in one’s home country or abroad. Both options offer a time of profound learning, personal growth, and meaningful exchange. However, overseas electives often get the spotlight, with approximately 90% of UK medical students choosing to undertake their elective placement overseas, and 40% in a “developing” country (Gillett, 2016; Johnston et al., 2018).
When it comes to international electives, particularly those in resource-limited settings, more critical reflection is needed (Chmura and Nagraj, 2024). In today’s global health landscape, which is increasingly reckoning with its colonial roots and striving to decolonise its structures and practices, we must ask: who truly benefits from these experiences, and what are the potential harms of overseas electives?
Before jetting off to a distant destination, reflecting on the deeper questions of purpose, privilege, power, and potential harm is important. Are we entering communities to genuinely learn and contribute, or are we unintentionally reinforcing systems of exploitation, resource extraction, and inequality under the guise of education?
A question of varying thresholds
Many of us have, at some point, come across the unsettling trope of the “white saviour complex” or the growing trend of “voluntourism”, whether through disconcerting posts on social media or glossy medical elective adverts that promise the chance to float between the hospital ward and the beach. At their core, these concepts promote the troubling narrative that individuals from higher-resource settings are heroes primed to “rescue” those from lower-resource settings. They also create sweeping generalisations about whole continents, failing to see the individuality of settings and, often, lumping together entire continents as if they are one big charity case, overlooking the rich diversity, local knowledge, and resilience within those communities. The actions associated with such ideas are often framed as altruistic, yet they rarely acknowledge the colonial legacies that created the very inequities they aim to address, legacies that have fostered power imbalances, dependency, and systemic injustice.
The framing of volunteering and electives as a purely selfless act in which there is a one-way exchange between a generous giver and a passive beneficiary is a comforting story, but rarely the full one. In reality, there can often be an underlying benefit to the giver, like CV enhancement, personal fulfilment, and public praise (McGloin and Georgeou, 2015). Within this dynamic, we must ask: who truly benefits?
A troubling symptom of this mindset is the posting of images on social media, often of vulnerable individuals, especially children, without their consent or their parents’ from medical electives (Harng and He, 2018). This raises a crucial question: would you share similar images of patients during a clinical placement in your home institution? If the answer is no (which it should be), why does crossing a border suddenly make it acceptable?
This double standard points to a deeper issue of potential disregard for the dignity, privacy, and safety of patients in low-resource settings. The consequences extend beyond photography into clinical practice, with reports of medical students performing procedures or undertaking responsibilities abroad that they would never be permitted to do at home (Chmura and Nagraj, 2024; Elit et al., 2011). This is well articulated by Doctor Will Smith, who states that “they (electives) risk legitimising the idea that it is acceptable for students who haven’t fully completed medical training in the UK to travel to other countries and try out their skills on those who are potentially less fortunate than those at home” (Smith, 2022).
When you zoom out and look at the bigger picture in its historical context, it starts to feel uncomfortably familiar. Not resource extraction this time, but experience extraction — gathering clinical opportunities, sometimes at the expense of the host community. So, we’re left with an uneasy question: is this just another form of neocolonialism, dressed up in scrubs and a stethoscope?
Skills missing from the suitcase?
I do not want to mitigate the unique role of us as medical students. We possess a specialised set of skills, time, and (hopefully) enthusiasm that allows us to learn, interact with patients, and contribute meaningfully to the clinical environment. Our presence on electives can have value. But a harder question must be asked: are we genuinely more helpful than we are costly to the institutions and communities hosting us?
I am certain that all of us will arrive at our electives with solid clinical skills and the best of intentions. But good intentions, while important, are not always enough. What many of us often lack are equally critical tools, like cultural humility, an understanding of local health systems, and an awareness of the broader historical and political context in which we’re working. One of the most striking absences in many medical curricula is a comprehensive education in Global Health (Matthews et al., 2020). If my experience is anything to go by, the topic is briefly skimmed over, perhaps a lecture or two, but rarely explored in any meaningful depth. Only upon independent further reading or study do we begin to grapple with the uncomfortable reality of how medical and academic institutions and practices have historically contributed to colonial structures, many of which continue to shape global health today and perpetuate global health inequalities.
Without such preparation, students may arrive at their elective destinations oblivious to the ramifications of their presence. Host institutions may be overstretched and divert valuable resources such as staff time, supervision, accommodation, and translation to support visiting students (Elit et al., 2011). So, whilst our medical education so far has primed us to contribute to our elective environments, are we adequately prepared to contribute without being a burden? Are we entering spaces expecting to learn from them, or are we assuming they exist for our learning?
Moreover, without the appropriate preparation and cultural understanding, our presence may unintentionally reinforce harmful power dynamics. It can be as subtle as using English as the default language, failure to respect local hierarchies or customs, or relying on local staff to show us around without recognising the extra labour involved. These may seem trivial or even harmless, but they reflect a deeper issue of arriving without the full skill set required to navigate a complex cultural and ethical landscape respectfully. If we consider ourselves learners, then we must be honest about the fact that learning comes with a cost, and in this case, it should not be paid for with someone else’s time, dignity, or resources. Just like on placement at home, patient care and staff wellbeing should not suffer for the sake of our education.
So maybe the most important pre-elective checklist question isn’t “Have I packed my universal adapter?” but “What is missing from my suitcase?”. Not just in terms of clothes or stethoscopes, but in terms of mindset, knowledge, and awareness. Am I truly prepared to engage ethically, respectfully, and humbly? Because ultimately, the legacy that we leave behind should be more than a group Polaroid taped to a staff room wall, and the most valuable thing we take with us should not be a tan. It should be the knowledge that we arrived eager to learn, listened more than we spoke, approached our placement with humility, and gave something of real value in return.
So, what is the solution?
This article is by no means a definitive guide to the complexities of medical electives; we have barely touched the surface! Rather, it aims to serve as a conversation starter, an invitation to reflect more deeply on what electives mean in today’s global health landscape. Because when electives are done ethically, bilaterally, and sustainably, they can be brilliant for both students and host institutions. But to get there, we need to shift the narrative and unlearn some of our outdated perceptions. We need to start seeing electives as complex, valuable experiences that come with responsibilities, not just opportunities. What this article hopes to highlight is the urgent need for the elective experience to evolve, encouraging students to be aware not only of the potential benefits but also of the risks and harms that electives can carry if approached uncritically.
Preparation for electives abroad goes beyond vaccinations and visas. This preparation could take many forms, and no doubt will be a process of unlearning and not a singular decision. Medical schools have a fundamental role in providing this comprehensive preparation, including robust pre-departure training that equips students with the tools to navigate ethical dilemmas, cultural complexities, and the often uncomfortable historical legacies of colonialism that continue to shape global health systems. Perhaps what is also needed is a broader, more critical medical curriculum, one that confronts these legacies openly and examines medicine’s global role with nuance.
Additionally, structured, reflective research before electives should be encouraged to empower students to understand the cultural, political, linguistic, and historical context of their destination. Without this, there is the risk of stepping into unfamiliar health systems without appreciating the dynamics at play, including power, privilege, and inequity.
Another question worth asking is whether the current structure of electives is fit for purpose. With many electives lasting only a few weeks, is that enough time for students to gain a meaningful understanding of the culture, health system, strengths, and challenges of their host setting? Or do such short stays risk promoting superficial engagement, reinforcing dangerous perceptions, and reducing rich, complex societies to brief learning moments?
Importantly, this article is not a call to shame or guilt students who are planning electives abroad. Instead, it is a prompt for deeper thought and self-reflection. While there may not be one “right” way to do electives, there is a right time to start rethinking how we approach them, and that time is now. It starts with asking better questions, demanding better preparation, and acknowledging that meaningful change often begins with discomfort.
References
Chmura, M., Nagraj, S., 2024. A scoping review of the ethical impacts of international medical electives on local students and patient care. BMC Med. Ethics 25, 5. https://doi.org/10.1186/s12910-023-00998-7
Elit, L., Hunt, M., Redwood-Campbell, L., Ranford, J., Adelson, N., Schwartz, L., 2011. Ethical issues encountered by medical students during international health electives. Med. Educ. 45, 704–711. https://doi.org/10.1111/j.1365-2923.2011.03936.x
Gillett, G., 2016. Electives, voluntourism and the ethics of selling poverty. GEORGE GILLETT. URL https://georgegillett.com/2016/01/13/electives-voluntourism-and-the-ethics-of-selling-poverty/ (accessed 4.14.25).
Harng Sin, Shirleen He, 2018. Voluntouring on Facebook and Instagram: Photography and social media in constructing the ‘Third World’ experience – Harng Luh Sin, Shirleen He, 2019.
Hayashi, M., Son, D., Nanishi, K., Eto, M., 2020. Long-term contribution of international electives for medical students to professional identity formation: a qualitative study. BMJ Open 10, e039944. https://doi.org/10.1136/bmjopen-2020-039944
Johnston, N., Sandys, N., Geoghegan, R., O’Donovan, D., Flaherty, G., 2018. Protecting the health of medical students on international electives in low-resource settings. J. Travel Med. 25. https://doi.org/10.1093/jtm/tax092
Matthews, N.R., Davies, B., Ward, H., 2020. Global health education in UK medical schools: a review of undergraduate university curricula. BMJ Glob. Health 5. https://doi.org/10.1136/bmjgh-2020-002801
McGloin, Georgeou, 2015. “Looks good on your CV”: The sociology of voluntourism recruitment in higher education. ResearchGate.
Smith, W., 2022. The colonial overtones of overseas electives should make us rethink this practice. Medium. URL https://wlil-sitmh.medium.com/the-colonial-overtones-of-overseas-electives-should-make-us-rethink-this-practice-1a535c2ae66f (accessed 4.14.25).
Willott, C., Khair, E., Worthington, R., Daniels, K., Clarfield, A.M., 2019. Structured medical electives: a concept whose time has come? Glob. Health 15, 84. https://doi.org/10.1186/s12992-019-0526-2
Medical electives offer a valuable, exciting, and unique opportunity for medical students to explore different healthcare systems and pursue areas of medical interest, at home or abroad (Willott et al., 2019). They provide a chance to develop clinical skills in unfamiliar settings, enhance cultural sensitivity and adaptability, and build meaningful connections with like-minded, enthusiastic professionals across the globe (Hayashi et al., 2020).
Electives can be undertaken in one’s home country or abroad. Both options offer a time of profound learning, personal growth, and meaningful exchange. However, overseas electives often get the spotlight, with approximately 90% of UK medical students choosing to undertake their elective placement overseas, and 40% in a “developing” country (Gillett, 2016; Johnston et al., 2018).
When it comes to international electives, particularly those in resource-limited settings, more critical reflection is needed (Chmura and Nagraj, 2024). In today’s global health landscape, which is increasingly reckoning with its colonial roots and striving to decolonise its structures and practices, we must ask: who truly benefits from these experiences, and what are the potential harms of overseas electives?
Before jetting off to a distant destination, reflecting on the deeper questions of purpose, privilege, power, and potential harm is important. Are we entering communities to genuinely learn and contribute, or are we unintentionally reinforcing systems of exploitation, resource extraction, and inequality under the guise of education?
A question of varying thresholds
Many of us have, at some point, come across the unsettling trope of the “white saviour complex” or the growing trend of “voluntourism”, whether through disconcerting posts on social media or glossy medical elective adverts that promise the chance to float between the hospital ward and the beach. At their core, these concepts promote the troubling narrative that individuals from higher-resource settings are heroes primed to “rescue” those from lower-resource settings. They also create sweeping generalisations about whole continents, failing to see the individuality of settings and, often, lumping together entire continents as if they are one big charity case, overlooking the rich diversity, local knowledge, and resilience within those communities. The actions associated with such ideas are often framed as altruistic, yet they rarely acknowledge the colonial legacies that created the very inequities they aim to address, legacies that have fostered power imbalances, dependency, and systemic injustice.
The framing of volunteering and electives as a purely selfless act in which there is a one-way exchange between a generous giver and a passive beneficiary is a comforting story, but rarely the full one. In reality, there can often be an underlying benefit to the giver, like CV enhancement, personal fulfilment, and public praise (McGloin and Georgeou, 2015). Within this dynamic, we must ask: who truly benefits?
A troubling symptom of this mindset is the posting of images on social media, often of vulnerable individuals, especially children, without their consent or their parents’ from medical electives (Harng and He, 2018). This raises a crucial question: would you share similar images of patients during a clinical placement in your home institution? If the answer is no (which it should be), why does crossing a border suddenly make it acceptable?
This double standard points to a deeper issue of potential disregard for the dignity, privacy, and safety of patients in low-resource settings. The consequences extend beyond photography into clinical practice, with reports of medical students performing procedures or undertaking responsibilities abroad that they would never be permitted to do at home (Chmura and Nagraj, 2024; Elit et al., 2011). This is well articulated by Doctor Will Smith, who states that “they (electives) risk legitimising the idea that it is acceptable for students who haven’t fully completed medical training in the UK to travel to other countries and try out their skills on those who are potentially less fortunate than those at home” (Smith, 2022).
When you zoom out and look at the bigger picture in its historical context, it starts to feel uncomfortably familiar. Not resource extraction this time, but experience extraction — gathering clinical opportunities, sometimes at the expense of the host community. So, we’re left with an uneasy question: is this just another form of neocolonialism, dressed up in scrubs and a stethoscope?
Skills missing from the suitcase?
I do not want to mitigate the unique role of us as medical students. We possess a specialised set of skills, time, and (hopefully) enthusiasm that allows us to learn, interact with patients, and contribute meaningfully to the clinical environment. Our presence on electives can have value. But a harder question must be asked: are we genuinely more helpful than we are costly to the institutions and communities hosting us?
I am certain that all of us will arrive at our electives with solid clinical skills and the best of intentions. But good intentions, while important, are not always enough. What many of us often lack are equally critical tools, like cultural humility, an understanding of local health systems, and an awareness of the broader historical and political context in which we’re working. One of the most striking absences in many medical curricula is a comprehensive education in Global Health (Matthews et al., 2020). If my experience is anything to go by, the topic is briefly skimmed over, perhaps a lecture or two, but rarely explored in any meaningful depth. Only upon independent further reading or study do we begin to grapple with the uncomfortable reality of how medical and academic institutions and practices have historically contributed to colonial structures, many of which continue to shape global health today and perpetuate global health inequalities.
Without such preparation, students may arrive at their elective destinations oblivious to the ramifications of their presence. Host institutions may be overstretched and divert valuable resources such as staff time, supervision, accommodation, and translation to support visiting students (Elit et al., 2011). So, whilst our medical education so far has primed us to contribute to our elective environments, are we adequately prepared to contribute without being a burden? Are we entering spaces expecting to learn from them, or are we assuming they exist for our learning?
Moreover, without the appropriate preparation and cultural understanding, our presence may unintentionally reinforce harmful power dynamics. It can be as subtle as using English as the default language, failure to respect local hierarchies or customs, or relying on local staff to show us around without recognising the extra labour involved. These may seem trivial or even harmless, but they reflect a deeper issue of arriving without the full skill set required to navigate a complex cultural and ethical landscape respectfully. If we consider ourselves learners, then we must be honest about the fact that learning comes with a cost, and in this case, it should not be paid for with someone else’s time, dignity, or resources. Just like on placement at home, patient care and staff wellbeing should not suffer for the sake of our education.
So maybe the most important pre-elective checklist question isn’t “Have I packed my universal adapter?” but “What is missing from my suitcase?”. Not just in terms of clothes or stethoscopes, but in terms of mindset, knowledge, and awareness. Am I truly prepared to engage ethically, respectfully, and humbly? Because ultimately, the legacy that we leave behind should be more than a group Polaroid taped to a staff room wall, and the most valuable thing we take with us should not be a tan. It should be the knowledge that we arrived eager to learn, listened more than we spoke, approached our placement with humility, and gave something of real value in return.
So, what is the solution?
This article is by no means a definitive guide to the complexities of medical electives; we have barely touched the surface! Rather, it aims to serve as a conversation starter, an invitation to reflect more deeply on what electives mean in today’s global health landscape. Because when electives are done ethically, bilaterally, and sustainably, they can be brilliant for both students and host institutions. But to get there, we need to shift the narrative and unlearn some of our outdated perceptions. We need to start seeing electives as complex, valuable experiences that come with responsibilities, not just opportunities. What this article hopes to highlight is the urgent need for the elective experience to evolve, encouraging students to be aware not only of the potential benefits but also of the risks and harms that electives can carry if approached uncritically.
Preparation for electives abroad goes beyond vaccinations and visas. This preparation could take many forms, and no doubt will be a process of unlearning and not a singular decision. Medical schools have a fundamental role in providing this comprehensive preparation, including robust pre-departure training that equips students with the tools to navigate ethical dilemmas, cultural complexities, and the often uncomfortable historical legacies of colonialism that continue to shape global health systems. Perhaps what is also needed is a broader, more critical medical curriculum, one that confronts these legacies openly and examines medicine’s global role with nuance.
Additionally, structured, reflective research before electives should be encouraged to empower students to understand the cultural, political, linguistic, and historical context of their destination. Without this, there is the risk of stepping into unfamiliar health systems without appreciating the dynamics at play, including power, privilege, and inequity.
Another question worth asking is whether the current structure of electives is fit for purpose. With many electives lasting only a few weeks, is that enough time for students to gain a meaningful understanding of the culture, health system, strengths, and challenges of their host setting? Or do such short stays risk promoting superficial engagement, reinforcing dangerous perceptions, and reducing rich, complex societies to brief learning moments?
Importantly, this article is not a call to shame or guilt students who are planning electives abroad. Instead, it is a prompt for deeper thought and self-reflection. While there may not be one “right” way to do electives, there is a right time to start rethinking how we approach them, and that time is now. It starts with asking better questions, demanding better preparation, and acknowledging that meaningful change often begins with discomfort.
References
Chmura, M., Nagraj, S., 2024. A scoping review of the ethical impacts of international medical electives on local students and patient care. BMC Med. Ethics 25, 5. https://doi.org/10.1186/s12910-023-00998-7
Elit, L., Hunt, M., Redwood-Campbell, L., Ranford, J., Adelson, N., Schwartz, L., 2011. Ethical issues encountered by medical students during international health electives. Med. Educ. 45, 704–711. https://doi.org/10.1111/j.1365-2923.2011.03936.x
Gillett, G., 2016. Electives, voluntourism and the ethics of selling poverty. GEORGE GILLETT. URL https://georgegillett.com/2016/01/13/electives-voluntourism-and-the-ethics-of-selling-poverty/ (accessed 4.14.25).
Harng Sin, Shirleen He, 2018. Voluntouring on Facebook and Instagram: Photography and social media in constructing the ‘Third World’ experience – Harng Luh Sin, Shirleen He, 2019.
Hayashi, M., Son, D., Nanishi, K., Eto, M., 2020. Long-term contribution of international electives for medical students to professional identity formation: a qualitative study. BMJ Open 10, e039944. https://doi.org/10.1136/bmjopen-2020-039944
Johnston, N., Sandys, N., Geoghegan, R., O’Donovan, D., Flaherty, G., 2018. Protecting the health of medical students on international electives in low-resource settings. J. Travel Med. 25. https://doi.org/10.1093/jtm/tax092
Matthews, N.R., Davies, B., Ward, H., 2020. Global health education in UK medical schools: a review of undergraduate university curricula. BMJ Glob. Health 5. https://doi.org/10.1136/bmjgh-2020-002801
McGloin, Georgeou, 2015. “Looks good on your CV”: The sociology of voluntourism recruitment in higher education. ResearchGate.
Smith, W., 2022. The colonial overtones of overseas electives should make us rethink this practice. Medium. URL https://wlil-sitmh.medium.com/the-colonial-overtones-of-overseas-electives-should-make-us-rethink-this-practice-1a535c2ae66f (accessed 4.14.25).
Willott, C., Khair, E., Worthington, R., Daniels, K., Clarfield, A.M., 2019. Structured medical electives: a concept whose time has come? Glob. Health 15, 84. https://doi.org/10.1186/s12992-019-0526-2
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